Background and Clinical Significance: Celiac disease (CD) is a gluten-triggered immune enteropathy that may rarely present as Celiac crisis (CC), a life-threatening condition marked by severe diarrhea, dehydration, metabolic derangements, and acute malnutrition. Pediatric diagnostic criteria are lacking, and despite its reduced incidence in high-income countries, CC remains a critical complication, potentially associated with refeeding syndrome. Case Presentation: We report the case of a 23-month-old girl presenting with chronic diarrhea, weight loss, iron-deficiency anemia, hypoalbuminemia, and coagulation abnormalities. Serology confirmed CD, and a gluten-free diet (GFD) was initiated. However, the patient experienced clinical deterioration consistent with CC. Her course was further complicated by refeeding syndrome, ileo-ileal intussusception, and deep vein thrombosis, requiring corticosteroids, anticoagulation, and multidisciplinary nutritional support. Full clinical recovery was achieved within two months. Conclusions: This case highlights the life-threatening potential of CC and the necessity for early recognition. Timely GFD initiation, correction of metabolic abnormalities, and monitoring for refeeding syndrome are essential. We propose pediatric-adapted diagnostic criteria to facilitate earlier recognition and standardize the management of CC. The proposed framework includes major and minor criteria based on the rapid onset of gastrointestinal symptoms with serological evidence of CD autoimmunity, accompanied by clinical instability requiring hospitalization or intensive support and multiple indicators of systemic compromise.

Leaf minimum conductance (gmin) is important in determining plant responses to drought. However, we do not understand how gmin is related to drought tolerance, and how important it is in determining the time to reach physiological breakpoints during dehydration. In 18 coexisting tropical species we quantified gmin to test relationships with mild, moderate and severe dehydration thresholds associated with tolerance to turgor loss, structural integrity breakdown, and disruption of Photosystem-II function. We tested the relative importance of gmin and thresholds in determining time to reach physiological breakpoints, quantified other hydraulic and functional traits, and used principal component analyses to identify the major axes of trait variation. The significant variation observed in gmin across species was unrelated to thresholds for mild and severe dehydration, and consistently explained variation in time to reach critical levels of dehydration. gmin was negatively related to maximum stomatal conductance, but unrelated to most other functional and hydraulic traits. These results highlight the importance of avoiding dehydration via minimizing gmin, and suggest that avoidance and tolerance to dehydration represent independent strategies for leaves to cope with drought. Thus, integrating gmin with contemporary threshold-based metrics is essential for a more comprehensive understanding of species vulnerability to drought.

The paper describes the case of a 2-month-old infant with severe dehydration, hyponatremia and hyperkalemia due to sepsis. He required intensive resuscitation and electrolyte correction and was finally diagnosed with transient secondary pseudoaldosteronism related to infection, with spontaneous resolution and favourable prognosis.

Porcine epidemic diarrhea virus (PEDV) is a major pathogen responsible for severe diarrhea, dehydration, and high mortality in neonatal piglets, continually threatening global swine production. Rapid differentiation of its major genotypes (classical G1, variant G2, and recombinant S-INDEL) is vital for molecular epidemiology and effective disease control, yet existing approaches rely mainly on time-consuming sequencing and phylogenetic analysis of the S gene. To overcome this limitation, we developed a novel triplex TaqMan-based real-time PCR assay for rapid detection and differentiation of the three PEDV genotypes. The assay demonstrated high sensitivity, with the lowest detection limit of 102 copies/μL, and strong specificity, showing no cross-reactivity with six other common swine pathogens (TGEV, PDCoV, PoRV, PRRSV, CSFV, and PRV). It also exhibited excellent reproducibility, with both intra- and inter-assay coefficients of variation maintained below 1.5%. In clinical validation, the assay showed 100% concordance with results obtained from S gene sequencing and phylogenetic analysis. Furthermore, testing of 160 clinical samples revealed cases of co-infection involving G2 and S-INDEL strains. In conclusion, this rapid, specific, and reproducible assay provides a reliable tool for routine molecular diagnosis, facilitating large-scale epidemiological surveillance and enabling genotype-informed control strategies against PEDV.

Introduction: Dyspepsia is a common gastrointestinal complaint in early pregnancy, generally associated with hormonal and functional changes. This condition may reduce quality of life, affect maternal nutritional status, and present a diagnostic challenge in differentiating it from other conditions such as hyperemesis gravidarum or gastrointestinal infection. Case Report: A 27-year-old woman, G1P0A0, at 10 weeks of gestation, presented with nausea and vomiting more than two times per day, accompanied by epigastric discomfort and bloating after meals. Physical examination revealed epigastric tenderness without signs of severe dehydration. Laboratory tests showed normal hemoglobin, mildly elevated leukocytes, slightly decreased potassium, and the presence of bacteria and leukocytes in urine. Result: A working diagnosis of dyspepsia in early pregnancy was established after ruling out hyperemesis gravidarum and gastroenteritis. The patient was treated with Ringer’s lactate infusion, intravenous ondansetron, antacids, and vitamin B complex supplementation, which led to improvement of symptoms. Conclusion: Dyspepsia during pregnancy is a common complaint with both hormonal and functional etiologies. Diagnosis requires thorough history-taking and exclusion of important differential diagnoses. Management should prioritize lifestyle modification and supportive therapy, with safe pharmacotherapy during pregnancy when necessary

Severe Hypernatremic Dehydration in an Exclusively Breastfed Neonate

Cell entry mechanisms of porcine enteric coronaviruses.

A deep learning-based tool for rapid and automated detection of Cryptosporidium oocysts: A new approach for veterinary diagnostics and epizootiological surveys.

ZNF16 inhibits PEDV replication through autophagy-mediated degradation of S1 protein.

Diarrhea is the third leading cause of death in children under five, causing nutritional deficits that hinder growth, cognitive, and academic performance. Each episode before the age of 2 years increases the risk of stunting by 5%. Systematic data, such as sociodemographic, clinical characteristics, and laboratory characteristics, are important for prevention. This descriptive observational study used a retrospective design based on medical records of children with acute diarrhea treated at Dr. Soetomo General Hospital, Surabaya, from 2021 to 2023. A total of 461 subjects met the criteria; 429 underwent electrolyte imbalance testing, 198 were assessed for urea and creatinine levels, and 68 had their acid-base balance evaluated. A total of 288 subjects (62.5%) were male children; 262 patients (75%) were 0-12 months old; 253 (61%) had good nutritional status; 339 (73.5%) underwent therapy for less than 1 week; and 402 patients (65%) recovered. A total of 40% experienced mild-moderate and severe dehydration with neurologic (16.4%) and respiration comorbidities (16.2%). Electrolyte disturbances included hyponatremia (33.1%), hypokalemia (12.1%), hyperchloremia (50.2%), increased urea (28.3%), abnormal creatinine (35.4%), hypobicarbonate (75%), and acidosis (63.2%). Therefore, early detection and appropriate management are essential to mitigate further complications and improve recovery outcomes.

Abstract A 15‐year‐old, spayed, female domestic shorthair cat was presented for evaluation of severe vomiting, progressive weight loss and lethargy. The cat had been maintained on a raw food diet for 12 years. Physical examination revealed severe dehydration and weakness. Haematology demonstrated anaemia, leukocytosis with left shift and thrombocytosis. Serum biochemistry showed hyperglobulinaemia and elevated amylase. Thoracic radiography and contrast oesophagography revealed severe megaoesophagus with complete obstruction at the gastro‐oesophageal junction and no gastric filling. Despite fluid therapy and supportive care, the cat remained anorexic and lethargic. Following extensive discussion with the owner regarding poor prognosis, euthanasia was elected. Necropsy confirmed a 3‐cm fibrotic stricture at the thoraco‐abdominal junction with near‐complete luminal obstruction. This case demonstrates the diagnostic value of contrast radiography in identifying oesophageal obstruction in cats and emphasises the role of necropsy examination in confirming pathology when advanced diagnostics are declined.

Introduction: Tuberculosis (TB) remains a major global health problem affecting both adults and children, particularly in TB-endemic countries. Children are vulnerable to TB infection, especially those with malnutrition, which significantly impairs immune function and increases disease severity, mortality, and diagnostic challenges. Malnutrition may obscure typical clinical manifestations and reduce the sensitivity of standard diagnostic tests, leading to delayed diagnosis and treatment. Case description: a four-year-old girl with severe wasting, multiple cervical lymphadenopathy, hypoalbuminemia, and severe dehydration. The patient had a history of incomplete immunization and close contact with a TB case. Initial investigations revealed a negative tuberculin skin test and chest radiography suggestive of bilateral bronchopneumonia. Despite intravenous ceftriaxone and supportive therapy, no clinical improvement was observed. Further evaluation using a rapid molecular test from a gastric aspirate confirmed TB. Discussion: Severe malnutrition likely contributed to immune anergy, resulting in false-negative initial diagnostic findings and delayed TB diagnosis. This case highlights the limitations of conventional diagnostic methods in malnourished children and underscores the importance of molecular testing in high-risk pediatric patients. Conclusion: TB and malnutrition have a bidirectional relationship that worsens clinical outcomes. Early TB screening in malnourished children and routine nutritional assessment in TB patients are essential to improve diagnosis, treatment outcomes, and survival.

Cholera remains a persistent public health threat in fragile and conflict affected settings where inadequate water, sanitation, and hygiene infrastructure, population displacement, and climate shocks contribute to recurrent outbreaks. Somalia has experienced cyclical cholera epidemics for decades, yet recent national level analyses of mortality predictors remain limited. A retrospective analysis of national cholera surveillance data was conducted using line lists from cholera treatment centers across Somalia for the period January to December 2024. Suspected and confirmed cases were defined according to national guidelines. Demographic, clinical, nutritional, environmental, and laboratory variables were analyzed. Multivariable logistic regression was used to identify factors associated with mortality. A total of 21,945 suspected cholera cases and 138 deaths were reported, corresponding to a case fatality rate of 0.6%. Children under five years accounted for 42% of cases. In the adjusted analysis, use of river water compared with piped water had an adjusted odds ratio of 2.34 (95% CI: 1.12-4.87). Severe dehydration had an adjusted odds ratio of 5.67 (95% CI: 3.21-10.01), and malnutrition had an adjusted odds ratio of 2.12 (95% CI: 1.17-3.83). Residence in Jubaland compared with Banadir had an adjusted odds ratio of 1.91 (95% CI: 1.05-3.47). Children aged 5-14 years and individuals aged 15-44 years had lower adjusted odds of death compared with children under five years. Laboratory confirmation was limited. The 2024 cholera outbreak in Somalia was characterized by substantial pediatric burden and marked differences in mortality by water source, nutritional status, dehydration severity, and region. Strengthening water safety, expanding access to timely case management, integrating nutrition services, improving surveillance capacity, and implementing targeted oral cholera vaccination in high-risk areas are critical to reducing cholera mortality and advancing long term control efforts in Somalia.

BackgroundAcute gastroenteritis (AGE) is a major cause of morbidity and mortality in children under five, especially in low- and middle-income countries. Despite advances in healthcare, the burden of AGE remains significant in Nepal. This study aimed to evaluate the clinico-demographic profile and management outcomes of under-five children with AGE admitted to Patan Hospital.MethodsA descriptive cross-sectional study was conducted at Patan Hospital, including 236 under-five children admitted with AGE between January 2021 and December 2023. Data were collected retrospectively from medical records and analyzed using SPSS version 16.ResultsThe prevalence of AGE was 14.32% among hospitalized under-five children. The mean age of children was 1.55 years. Most children (77.6%) presented with some dehydration, while severe dehydration was noted in 3.8% of cases. Antibiotics were used in 30.93% of cases, with ceftriaxone being the most commonly prescribed (29%). Zinc supplementation was administered in 38.14% of cases. Intravenous fluids were the primary mode of rehydration in 91.95%.ConclusionThis study highlighted significant gaps in adherence to clinical guidelines, particularly regarding the underuse of zinc and ORS. The high rate of empirical antibiotic use highlights the need for better diagnostics to guide targeted therapy and reduce antimicrobial resistance.DisclosuresAll Authors: No reported disclosures

Pathologic mineralization refers to the abnormal deposition of calcium salts in tissues. In dogs, metastatic calcification is an uncommon but serious complication of chronic kidney disease (CKD), resulting from disturbances in calcium/phosphorus metabolism or renal damage by infectious agents. A 5-year-old female Boerboel was presented because of one week of anorexia. Clinical assessment revealed severe emaciation, dehydration, azotemia, hyperphosphatemia, and concurrent ehrlichiosis. Despite oxytetracycline and doxycycline therapy for two days, the dog died. Necropsy and histopathological examination were performed. Grossly, there was extensive mineralization of the diaphragm, intercostal muscles, pleura, pharynx, and great vessels. Histopathology showed tubular epithelial degeneration, protein casts, tubular ectasia, and interstitial fibrosis, consistent with advanced CKD. Laboratory findings of azotemia, hyperphosphatemia, hypoalbuminemia, and hypercalcemia supported renal failure as the underlying process driving the soft tissue mineralization. Extra-renal lesions included hepatocellular atrophy with vacuolar change, Kupffer cell hyperplasia, bronchointerstitial pneumonia with pulmonary edema, and hemorrhagic follicular cystitis with mononuclear infiltration. The combined gross and histopathological findings demonstrate how renal failure-induced mineral imbalance can drive widespread soft tissue mineralization. Veterinary clinicians must monitor calcium/phosphorus status to anticipate life-threatening sequelae.

Dehydration from diarrheal diseases remains a common cause of morbidity and mortality in developing countries. Nasogastric tube is an easy, efficient, and cost-effective method of management that could be a key to minimizing deaths from diarrheal disease. As such, this study assessed the current practices and barriers toward using nasogastric tube for managing moderate to severe dehydration in under-five children. To assess the practices and barriers toward the management of moderate to severe dehydration using nasogastric tube in under-five children among health centers in Gamo Zone, South Ethiopia. A qualitative study design was conducted among healthcare professionals at selected health centers in Gamo Zone. Data about the practice pattern of managing moderate to severe dehydration and barriers toward nasogastric tube utilization were obtained via in-depth interview. Data were reviewed using constant comparative analysis to identify emerging themes, and axial coding was performed to make connections between categories to organize themes into causal relationships. Hypotheses and concepts were developed inductively from the data. In our study, of thirty participants, 21 (70.0%) correctly diagnosed severe dehydration, while 9 (30.0%) diagnosed moderate dehydration. Among those who diagnosed severe dehydration, 5 (23.8%) recommended intravenous resuscitation, and 16 (76.2%) chose oral rehydration. After being informed of failed attempts, four chose to refer, and one clinician remained fixed on intravenous resuscitation, while the remaining 16 clinicians opted for nasogastric tube. Major challenges mentioned by the participants in managing dehydration were late presentation of the patients and equipment shortage. Participants in our study were aware of the significance of nasogastric tube for the treatment of moderate to severe dehydration. However, a gap in clinical skills, a lack of continuous training, high clinician turnover, and institutional policies limiting nasogastric tube utilization for the management of dehydration were major challenges. Therefore, improving clinicians' skills through continuous training and improving management protocol is essential in ensuring safe and effective rehydration and better patient outcomes.

Miliaria crystallina after severe neonatal hypernatremic dehydration.

ABSTRACTPhytobezoars are the most common and well known type of bezoars yet one of the uncommon causes of mechanical obstruction of the small intestine. The reported prevalence rate of phytobezoars is estimated to be 0.4% despite being the 5th most common cause of acute small bowel obstruction. A previously healthy five‐year‐old girl presented to the Emergency Medicine Department with a 5‐day history of nonprojectile, nonbile stained vomiting, abdominal pain, and decreased urine output. Physical examinations revealed severe dehydration symptoms, and laboratory tests indicated abnormal electrolyte levels and metabolic alkalosis. The patient experienced a seizure, received medical interventions, and was diagnosed with mechanical intestinal obstruction due to a phytobezoar. After stabilization, she underwent surgical removal of the phytobezoar without complications and followed postoperative advice successfully. In cases without significant complications, surgical or aggressive medical treatment for bezoars may be unnecessary. Coca‐Cola, alone or combined with endoscopic methods, is effective in dissolving gastric phytobezoars, with success rates exceeding 90%. Conservative management involves proteolytic enzymes, cellulase, carbonated beverages, and endoscopic fragmentation. Clinicians should stay vigilant, as small bowel obstruction can occur up to 6 weeks later. Prokinetic agents and dietary guidelines help minimize bezoar formation. Surgical intervention, unlikely to address the root cause and potentially worsening motility issues, requires careful consideration. Phytobezoars are a significant consideration in pediatric small bowel obstruction cases. Conducting a thorough dietary history, focusing on fiber‐rich foods, is crucial. Radiographic and endoscopic studies aid in locating the phytobezoar. Timely surgical intervention is essential to prevent complications associated with small bowel obstruction.

ABSTRACTDonepezil hydrochloride, used to treat Alzheimer's disease, is typically initiated at a low dose and titrated to minimize gastrointestinal side effects. Despite its favorable safety profile, the patient developed severe anorexia, dehydration, and electrocardiographic abnormalities. This case highlights the need for individualized dosing and careful monitoring of caregivers during pharmacotherapy.

Diabetic ketoacidosis (DKA) commonly occurs in type 1 diabetes due to absolute insulin deficiency, whereas HHS typically develops in type 2 diabetes with relative insulin deficiency. These distinct mechanisms result in different clinical and laboratory profiles. This review aims to compare the pathogenesis, clinical features, and current management of DKA and HHS. This study employed a narrative literature review design. Articles were retrieved from PubMed, Scopus, and Google Scholar using the keywords “diabetic ketoacidosis,” “hyperosmolar hyperglycemic state,” “diabetes mellitus,” and “complications,” covering publications from 2015 to 2025. A descriptive analysis was performed to highlight epidemiology, pathogenesis, clinical manifestations, and emergency management principles. The review indicates that DKA is more frequent and associated with lower mortality when promptly recognized and treated. In contrast, HHS is less common but carries a higher mortality rate, mainly due to severe dehydration, insidious onset, and delayed diagnosis. Management principles for both conditions are similar, including fluid resuscitation, insulin therapy, electrolyte correction, and treatment of precipitating factors. A comprehensive understanding of the differences between DKA and HHS is essential to support early diagnosis, guide appropriate treatment, and reduce mortality.