Stool Volume Research Articles

Role of Oral Zinc Supplementation in treatment of Acute Dehydrating Diarrhea in age 6 months to 5 years

Background: Oral Rehydration Salt (ORS) is the standard recommended treatment for acute dehydrating diarrhea but it has very little role in decreasing stool frequency and volume. Current studies recommend oral supplementation of zinc as an adjunct to ORS in treating acute dehydrating diarrhea of children especially those who are at risk of zinc deficiency and malnutrition. Aim: To determine the effect of oral zinc supplementation on duration of acute diarrhea and intake of ORS in children between 6 months and 5 years of age. Settings: Tehsil Head Quarters Hospital, Besham District Shangla, Khyber Pakhtunkhwa from October 2019 to September 2020. Methodology: The study was double blinded Randomized Control Clinical Trial in children aged between 6 months to 5 years of age. A total of 90 children were included in the study. In addition to rehydration, 45 children were given oral zinc (20mg daily) while 45 children were given placebo. Results: All 45(100%) patients in zinc group and 39(86.6%) patients in placebo group recovered after 5 days of treatment. Zinc group had significantly reduced duration of diarrhea (68.3±9.4 vs. 99.8±15.2 hours) and consumed less ORS solution (2.3±0.8 vs. 3.4±1.1 liters) as compared to placebo group. Conclusion: It is concluded from this study that oral zinc supplementation in addition to ORS in treating acute dehydrating diarrhea of children has better effect on the clinical course of disease. Key words: Diarrhea, ORS, Zinc, Dehydration.

Differential Diagnosis of Acute Diarrhea

Acute diarrhea is a condition of increased water stool content, stool volume, and number of bowel movements that lasts less than 14 days. Mild diarrhea is usually self-limiting; however, undertreated moderate to severe diarrhea may cause severe dehydration and lead to hypovolemic shock. In order to prevent severe dehydration and treat patients appropriately, it is crucial for health care providers to determine the right diagnosis of patients with acute diarrhea. This article focuses on pathophysiology, general patient presentation, diagnostic tests and differential diagnosis lists of acute diarrhea to discuss which diagnosis should be made based on patient presentation and objective data.

Daijokito Administration in Critically Ill Patients Increasing the Stool Volume: A Retrospective Observational Study.

Introduction: Daijokito, a traditional Japanese herbal medicine (Kampo), has been used to treat abdominal distention of the middle yang stage pattern. The use of Daijokito has not been thoroughly investigated in critical care. To investigate a new Kampo approach to defecation control in critically ill patients, our study aimed to assess the effects of Daijokito on fecal management.Methods: We analyzed 30 consecutive patients treated with Daijokito in the intensive care unit (ICU) between March 2017 and February 2021. The eligibility criteria were patients who were newly prescribed Daijokito in the ICU during the study period. Exclusion criteria were patients who were started on other laxatives within one day of beginning Daijokito. The study's primary outcome was defecation volume three days before and three days after starting Daijokito. We recorded the most dominant stool quality within three days after the start of Daijokito.Results: Twenty-one patients were included in the analysis. The median age was 69.0 years, and the median sequential organ failure assessment score on admission to the ICU was 6.0. Major diseases included trauma, pancreatitis, and burns. Administration of Daijokito resulted in defecation in 17 of twenty-one patients (81.0%). Comparison of defecation volume between 3 days before Daijokito administration and three days, including the day of Daijokito administration, showed that defecation volume increased significantly after Daijokito administration, with a median of 0 to 360 g (p < 0.001). At the three-day follow-up, six of 17 (35.3%) patients defecated on the day of Daijokito administration, and nine (52.9%) defecated on the day after administration. One patient was judged to have excessive defecation, and Daijokito administration was discontinued. Stool quality was normal in one (5.9%) of the 17 patients, soft-formed in two (11.8%), loose-unformed in 11 (64.7%), and liquid in three (17.6%).Discussion: Daijokito administration in critically ill patients caused defecation in 81% of the patients and significantly increased stool volume. The novelty of this study is that it sheds light on the Kampo treatment of defecation control in critically ill patients. In addition to the present report, further studies are warranted to quantify the therapeutic efficacy and safety of Daijokito.

Systemic adverse events after screening of retinopathy of prematurity with mydriatic.

PurposeTo evaluate systemic adverse events after screening for retinopathy of prematurity (ROP) performed with mydriatic.MethodsThis was a retrospective case series study. Medical records of consecutive patients who underwent screening for ROP with 0.5% phenylephrine and 0.5% tropicamide eyedrops were retrospectively reviewed. The score of abdominal distention (0–5), volume of milk sucked and volume of stool, along with systemic details (pulse and respiration rates, blood pressure and number of periods of apnea) were collected at 1 week and 1 day before ROP examination, and at 1 day after examination. Results were compared between the days before and after examination. Correlation between body weight at the time of examination and the score of abdominal distention was examined. The numbers of infants with abdominal and/or systemic adverse events were compared between pre- and post-examination periods.ResultsEighty-six infants met the inclusion criteria. The score of abdominal distention increased from 2.0 at 1 day before examination to 2.3 at 1 day after examination (p = 0.005), and the number of infants who had worsened abdominal distension increased after examination (p = 0.01). Infants with lower body weight had a higher score of abdominal distention (p < 0.0001, r = −0.57). The number of infants with reduced milk consumption increased after examination (p = 0.0001), as did the number of infants with decreased pulse rate (p = 0.0008).ConclusionsScreening for ROP with mydriatic may have adverse effects on systemic conditions. Infants should be carefully monitored after ROP screening with mydriatic.

Study of Infectious Diarrheas, in Transylvania – Romania

“Diarrhea” is an alteration in a normal bowel movement characterized by an increase in the water content, volume, or frequency of stools. Acute diarrhea of infec¬tious etiology, often referred to as gastroenteri¬tis and is typically associated with clinical signs and symptoms including: nausea, vomiting, abdomi¬nal pain and cramps, bloating, flatulence, fever, passage of bloody stools, tenesmus, and fecal ur¬gency. Infectious diarrheal diseases are the second leading cause of morbidity and mortality worldwide. It is the diarrhea we have also found out during a large 3 yeas study 2017-2020 in Transylvania – Romania. 3577 number of cases were transmitted during this time by the 12 territory sanitary polices, to the Epidemiology Department from the Public Health Center Cluj. These were mostly diagnosed by the territorial family doctors in the region and more then 20%, have need hospitalization, for several days, because of the mentioned disease disorders 3 children died during this time, because of severe complications. The detected infectious microbial etiology, were determined in authorized laboratories, in which it was identified: Shigella spp, Salmonella spp Campylobacter spp, and Yersinia spp. or Rotavirus Giardia, and Fungi species. Most number of cases appeared in children, followed by elderly or adult people, as quantified number of determination.

Stool pattern is associated with not only the prevalence of tumorigenic bacteria isolated from fecal matter but also plasma and fecal fatty acids in healthy Japanese adults

BackgroundColibactin-producing Escherichia coli containing polyketide synthase (pks+E. coli) has been shown to be involved in colorectal cancer (CRC) development through gut microbiota analysis in animal models. Stool status has been associated with potentially adverse gut microbiome profiles from fecal analysis in adults. We examined the association between stool patterns and the prevalence of pks+E. coli isolated from microbiota in fecal samples of 224 healthy Japanese individuals.ResultsStool patterns were determined through factorial analysis using a previously validated questionnaire that included stool frequency, volume, color, shape, and odor. Factor scores were classified into tertiles. The prevalence of pks+E. coli was determined by using specific primers for pks+E. coli in fecal samples. Plasma and fecal fatty acids were measured via gas chromatography-mass spectrometry. The prevalence of pks+E. coli was 26.8%. Three stool patterns identified by factorial analysis accounted for 70.1% of all patterns seen (factor 1: lower frequency, darker color, and harder shape; factor 2: higher volume and softer shape; and factor 3: darker color and stronger odor). Multivariable-adjusted odds ratios (95% confidence intervals) of the prevalence of pks+E. coli for the highest versus the lowest third of the factor 1 score was 3.16 (1.38 to 7.24; P for trend = 0.006). This stool pattern exhibited a significant positive correlation with fecal isobutyrate, isovalerate, valerate, and hexanoate but showed a significant negative correlation with plasma eicosenoic acid and α-linoleic acid, as well as fecal propionate and succinate. No other stool patterns were significant.ConclusionsThese results suggest that stool patterns may be useful in the evaluation of the presence of tumorigenic bacteria and fecal fatty acids through self-monitoring of stool status without the requirement for specialist technology or skill. Furthermore, it may provide valuable insight about effective strategies for the early discovery of CRC.

Biomarkers for Clinical Response of Extracorporeal Photopheresis

Biomarkers for Clinical Response of Extracorporeal Photopheresis

Fecal microbiota transfer for refractory intestinal graft-versus-host disease - Experience from two German tertiary centers.

Steroid refractory graft-vs-host disease (sr-GvHD) represents a challenging complication after allogeneic hematopoietic cell transplantation (allo-HCT). Intestinal microbiota (IM) diversity and dysbiosis were identified as influencing factors for the development of acute GvHD. Fecal microbiota transfer (FMT) is hypothesized to restore IM dysbiosis, but there is limited knowledge about the significance of FMT in the treatment of sr-GvHD. We studied the effects of FMT on sr-GvHD in allo-HCT patients from two German tertiary clinical centers (n=11 patients; period: March 2017 until July 2019). To assess safety and clinical efficacy, we analyzed clinical data pre- and post-FMT (day -14 to +30 relative to FMT). Moreover, IM were analyzed in donor samples and in a subset of patients pre- and post-FMT by 16S rRNA sequencing. Post-FMT, we observed no intervention-associated, systemic inflammatory responses and only minor side effects (5/11 patients: abdominal pain and transformation of peristalsis-each 3/11 and vomiting-1/11). Stool frequencies and volumes were significantly reduced [pre- vs post-FMT (d14): P<.05, respectively] as well as clear attenuation regarding both grading and staging of sr-GvHD was present upon FMT. Moreover, IM analyses revealed an increase of alpha diversity as well as a compositional shifts toward the donor post-FMT. In our study, we observed positive effects on sr-GVHD after FMT without the occurrence of major adverse events. Although these findings are in line with published data on beneficial effects of FMT in sr-GvHD, further randomized clinical studies are urgently needed to better define the clinical validity including mode of action.

Life-Threatening VIPoma Crisis in an Immunocompromised Patient

Background: Vasoactive intestinal peptide-secreting tumors (VIPoma) are rare neuroendocrine tumors (NETs) that present with a triad of profuse watery diarrhea, hypokalemia, and achlorhydria. The resulting renal impairment, electrolytes and acid-base imbalances pose a high risk of morbidity and mortality. We describe a case of life-threatening VIPoma crisis in an immunocompromised patient. Clinical Case: A 64-year-old man was intubated after he was brought in unconscious with tachypnea. Upon review, he had experienced persistent watery diarrhea for the past 6 months, with a weight loss of 18 kg. He had severe hypokalemia (potassium 1.9 mmol/L, n= 3.5-5.0), metabolic acidosis (blood gases pH 6.927, bicarbonate 4.8 mmol/L, base excess -25.9 mmol/L), and acute kidney injury (urea 47.9 mmol/L, creatinine 980umol/L). He continued to have electrolyte imbalances and acidosis due to persistent diarrhea, despite hydration and dialysis support. His biohazard screening results were positive for human immunodeficiency virus (HIV), with a CD4 count of 101 cells/µl. He was given courses of antibiotics for treating pathogenic infections; however, his septic workups were negative for infection, including HIV-related opportunistic infections. Later, pancreatic CT revealed a well-defined heterogeneously enhancing pancreatic head mass, size 6.8x5.2x7.5 cm. Further laboratory investigations confirmed the diagnosis of VIPoma, with elevated VIP levels (1600 pg/ml, n < 75). Eventually, subcutaneous octreotide was started, with resolution of the diarrhea and normalization of his electrolytes and renal function. After a 6-week hospital stay, he was discharged well with monthly octreotide and initiated on antiretroviral therapy (ART). After 3 months of ART, his CD4 count improved, and he remained diarrhea-free with octreotide. He is scheduled for tumor debulking surgery. Conclusion:This case highlights the importance of having a clinical suspicion of NETs, especially in immunocompromised patients. Further investigations and imaging studies to rule out noninfectious pathologies should be considered in patients who respond poorly to standard therapy. In VIPoma, somatostatin analog is an antisecretory treatment and it is highly effective for controlling diarrhea. High-dose octreotide up to 1500 µg/day has previously been studied for treatment of refractory diarrhoea in the setting of HIV infection² and it has been found to be helpful in reducing stool volume and frequency. Lastly, delays in the diagnosis and treatment of VIPoma in immunocompromised patients can be fatal. References1/ Hoffland J., Kaltsas G., de Herder W. Advances in the Diagnosis and Management of Well-Differentiated Neuroendocrine Neoplasms. Endocrine Reviews, Volume 41, Issue 2, April 2020, Pages 371-403.2/ Farthing MJ. Octreotide in the treatment of refractory diarrhoea and intestinal fistulae. Gut 1994;35:S5-10.

Study of infectious diarrheas, in Transylvania-Romania

“Diarrhea” is an alteration in a normal bowel movement characterized by an increase in the water content, volume, or frequency of stools. Acute diarrhea of infec­tious etiology, often referred to as gastroenteri­tis and is typically associated with clinical signs and symptoms including: nausea, vomiting, abdomi­nal pain and cramps, bloating, flatulence, fever, passage of bloody stools, tenesmus, and fecal ur­gency. Infectious diarrheal diseases are the second leading cause of morbidity and mortality worldwide. It is the diarrhea we have also found out, during a large 3 yeas study 2017-2020 in Transylvania – Romania. 3577 number of cases were transmitted during this time by the 12 territory sanitary polices, to the Epidemiology Department from the Public Health Center Cluj. These were mostly diagnosed by the territorial family doctors in the region and more then 20%, have need hospitalization, for several days, because of the mentioned disease disorders 3 children died during this time, because of severe complications. The detected infectious microbial etiology, were determined in authorized laboratories, in which it was identified: Shigella spp, Salmonella spp Campylobacter spp, and Yersinia spp or Rotavirus Giardia, and Fungi species. Most number of cases appeared in children, followed by elderly or adult people, as quantified number of determination. In light of these data, acute diarrheal illness had to be considered a major public health issue against which control efforts are needed. Public health surveillance and response in the field of infectious acute diarrhea include obligatory strategies of infection control.

Infectious Diarrhea, As Public Health Problem, In Romania

Diarrhea had to be understood from medical point of view, as an alteration in a normal bowel movement characterized by an increase in the water content, volume, or frequency of stools. Acute diarrhea of infec¬tious etiology, referred to gastroenteri¬tis and is associated with clinical signs and symptoms including: nausea, vomiting, abdomi¬nal pain and cramps, bloating, flatulence, fever, passage of bloody stools, tenesmus, and fecal ur-gency disorders. In fact, Infectious diarrheal diseases, are the second leading cause of morbidity and mortality worldwide and can cause real public health problems. Such diarrhea was studied as a medical disorder, in a 3 year period, 2017-2020, in Transylvania region from Romania. We have found out 3577 number of cases, data which were transmitted by 12 district Sanitary Polices, to the Public Health Center. This all were mostly diagnosed by the territorial family doctors and more than 50%, have need hospitalization, for several days, because of several disease disorders. The detected infectious etiology, were determined in authorized laboratories, by identified: Shigella spp, Salmonella spp, Campylobacter spp, Yersinia spp, Rotavirus, Giardia. Most number of cases appeared in children, followed by elderly or adult people, as quantified number of determined infectious diarrheas. Acute diarrheal illness had to be considered a major public health issue, against which control efforts are needed. Public health surveillance of infectious acute diarrhea, include obligatory strategies of infection control.

Infectious diarrhea, as public health problem, in Romania

From medical point of view, “Diarrhea” is an alteration in a normal bowel movement characterized by an increase in the water content, volume, or frequency of stools. Acute diarrhea of infec­tious etiology, often referred to as gastroenteri­tis and is typically associated with clinical signs and symptoms including: nausea, vomiting, abdomi­nal pain and cramps, bloating, flatulence, fever, passage of bloody stools, tenesmus, and fecal ur­gency. Infectious diarrheal diseases are the second leading cause of morbidity and mortality worldwide. It is the diarrhea we have also found out, during a large 3 yeas study 2017-2020 in Transylvania – Romania. 3577 number of cases were transmitted during this time, to our Public Health Center, by 12 district Sanitary Polices. These were mostly diagnosed by the territorial family doctors and more than 50%, have need hospitalization, for several days because of the mentioned disease disorders. The detected infectious etiology, were determined in authorized laboratories in which it was identified: Shigella, Salmonella, Campylobacter, and Yersinia, Rotavirus, Giardia. Most number of cases appeared in children, followed by elderly or adult people, as quantified number of determination. In light of these data, acute diarrheal illness had to be considered a major public health issue against which control efforts are needed. Public health surveillance and response in the field of infectious acute diarrhea include obligatory strategies of infection control.

Infectious Diarrhea, as Public Health Problem, in Romania

From medical point of view, “Diarrhea” is an alteration in a normal bowel movement characterized by an increase in the water content, volume, or frequency of stools. Acute diarrhea of infec¬tious etiology, often referred to as gastroenteri¬tis and is typically associated with clinical signs and symptoms including: nausea, vomiting, abdomi¬nal pain and cramps, bloating, flatulence, fever, passage of bloody stools, tenesmus, and fecal ur¬gency. Infectious diarrheal diseases are the second leading cause of morbidity and mortality worldwide. It is the diarrhea we have also found out, during a large 3 yeas study 2017-2020 in Transylvania – Romania. 3577 number of cases were transmitted during this time, to our Public Health Center, by 12 district Sanitary Polices. These were mostly diagnosed by the territorial family doctors and more then 50%, have need hospitalization, for several days because of the mentioned disease disorders. The detected infectious etiology, were determined in authorized laboratories in which it was identified: Shigella, Salmonella, Campylobacter, and Yersinia, Rotavirus, Giardia. Most number of cases appeared in children, followed by elderly or adult people, as quantified number of determination. In light of these data, acute diarrheal illness had to be considered a major public health issue against which control efforts are needed. Public health surveillance and response in the field of infectious acute diarrhea include obligatory strategies of infection control.

Are oral rehydration solutions optimized for treating diarrhea?

A historical turning point occurred in the treatment of diarrhea when it was discovered that glucose could enhance intestinal sodium and water absorption. Adding glucose to salt water (oral rehydration solution, ORS) more efficiently replaced intestinal water and salt losses. Provide a novel hypothesis to explain why mainstream use of ORS has been strongly recommended, but weakly adopted. Traditional (absorptive) and novel (secretory) physiological functions of glucose in an ORS were reviewed. Small amounts of glucose can stimulate both intestinal absorption and secretion. Glucose can exacerbate a net secretory state and may aggravate pathogen-induced diarrhea, particularly for pathogens that affect glucose transport. A hypothesis is made to explain why glucose-based ORS does not appreciably reduce diarrheal stool volume and why modern food science initiatives should focus on ORS formulations that replace water and electrolytes while also reducing stool volume and duration of diarrhea.

Study of Infectious Diarrheas, In Transylvania – Romania

“Diarrhea” is an alteration in a normal bowel movement characterized by an increase in the water content, volume, or frequency of stools. Acute diarrhea of infec¬tious etiology, often referred to as gastroenteri¬tis and is typically associated with clinical signs and symptoms including: nausea, vomiting, abdomi¬nal pain and cramps, bloating, flatulence, fever, passage of bloody stools, tenesmus, and fecal ur¬gency. Infectious diarrheal diseases are the second leading cause of morbidity and mortality worldwide. It is the diarrhea we have also found out, during a large 3 yeas study 2017-2020 in Transylvania – Romania. 3577 number of cases were transmitted during this time by the 12 territory sanitary polices, to the Epidemiology Department from the Public Health Center Cluj. These were mostly diagnosed by the territorial family doctors in the region and more than 20%, have need hospitalization, for several days, because of the mentioned disease disorders 3 children died during this time, because of severe complications. The detected infectious microbial etiology, were determined in authorized laboratories, in which it was identified: Shigella spp, Salmonella spp Campylobacter spp, and Yersinia spp. or Rotavirus Giardia, and Fungi species. Most number of cases appeared in children, followed by elderly or adult people, as quantified number of determination. In light of these data, acute diarrheal illness had to be considered a major public health issue against which control efforts are needed. Public health surveillance and response in the field of infectious acute diarrhea include obligatory strategies of infection control.

Study of Infectious Diarrheas in Transylvania-Romania

“Diarrhea” is an alteration in a normal bowel movement characterized by an increase in the water content, volume or frequency of stools. Acute diarrhea of infectious etiology often referred to as gastroenteritis and is typically associated with clinical signs and symptoms including nausea, vomiting, abdominal pain and cramps, bloating, flatulence, fever, the passage of bloody stools, tenesmus, and fecal urgency. Infectious diarrheal diseases are the second leading cause of morbidity and mortality worldwide. It is diarrhea we have also found out during a large 3 years study 2017-2020 in TransylvaniaRomania. 3577 number of cases were transmitted during this time by the 12 territory sanitary policies to the Epidemiology Department from the Public Health Center Cluj. Those were mostly diagnosed by the territorial family doctors in the region and more than 20%, needed hospitalization for several days because of the mentioned disease disorders 3 children died during this time because of severe complications. The detected infectious microbial etiology were determined in authorized laboratories in which it was identified as Shigella spp., Salmonella spp., Campylobacter spp. and Yersinia spp. or Rotavirus Giardia and Fungi species. Most numbers of cases appeared in children, followed by elderly or adult people, as quantified number of determination. In light of these data, acute diarrheal illness had to be considered a major public health issue against which control efforts are needed. Public health surveillance and response in the field of infectious acute diarrhea include obligatory strategies of infection control.

The alga Euglena gracilis stimulates Faecalibacterium in the gut and contributes to increased defecation

The alga Euglena gracilis (E. gracilis) has recently gained attention as a health food, but its effects on human gut microbiota remain unknown. This study aimed to determine the effect of E. gracilis on gut microbiota and defecation due to modulation of microbiota composition in vitro and in vivo. The in vitro model simulating human colonic microbiota revealed that E. gracilis addition stimulated the growth of commensal Faecalibacterium. Further, E. gracilis addition enhanced butyrate production by Faecalibacterium prausnitzii. Paramylon, an insoluble dietary fibre that accumulates in E. gracilis and is the main component of E. gracilis, did not stimulate Faecalibacterium growth in vitro. Daily ingestion of 2 g of E. gracilis for 30 days increased bowel movement frequency as well as stool volume in 28 human participants. Collectively, these findings indicate that E. gracilis components other than paramylon, stimulate the growth of Faecalibacterium to improve digestive health as well as promote defecation by increasing butyrate production.

Evaluation of Various Solvent Extracts of Tetrastigma leucostaphylum (Dennst.) Alston Leaves, a Bangladeshi Traditional Medicine Used for the Treatment of Diarrhea.

Tetrastigma leucostaphylum (TL) is an important ethnic medicine of Bangladesh used to treat diarrhea and dysentery. Hence, current study has been designed to characterize the antidiarrheal (in vivo) and cytotoxic (in vitro) effects of T. leucostaphylum. A crude extract was prepared with methanol (MTL) and further partitioned into n-hexane (NTL), dichloromethane (DTL), and n-butanol (BTL) fractions. Antidiarrheal activity was investigated using castor oil induced diarrhea, enteropooling, and gastrointestinal transit models, while cytotoxicity was evaluated using the brine shrimp lethality bioassay. In antidiarrheal experiments, all doses (100, 200, and 400 mg/kg) of the DTL extract significantly reduced diarrheal stool frequency, volume and weight of intestinal contents, and gastrointestinal motility in mice. Similarly, in the cytotoxicity assay, all extracts exhibited activity, with the DTL extract the most potent (LC50 67.23 μg/mL). GC-MS analysis of the DTL extract identified 10 compounds, which showed good binding affinity toward M3 muscarinic acetylcholine, 5-HT3, Gut inhibitory phosphodiesterase, DNA polymerase III subunit alpha, and UDP-N-acetylglucosamine-1 carboxyvinyltransferase enzyme targets upon molecular docking analysis. Although ADME/T analyses predicted the drug-likeness and likely safety upon consumption of these bioactive compounds, significant toxicity concerns are evident due to the presence of the known phytotoxin, 2,4-di-tert-butylphenol. In summary, T. leucostaphylum showed promising activity, helping to rationalize the ethnomedicinal use and importance of this plant, its safety profile following both acute and chronic exposure warrants further investigation.

Evaluating efficacy of oral zinc as adjuvant therapy in acute diarrhea in children.

Objectives: To evaluate the efficacy of oral zinc as adjuvant therapy in acute diarrhea comparing frequency and volume of stool and duration of diarrhea in children. Study Design: Case Control study. Setting: Department of Paediatrics, Shaheed Muhtrama Benazir Bhutto Medical College Layari General Hospital, Karachi. Period: September 2017 to August 2018. Material &amp; Methods: A sample of 200 children, age 5- 15 years, suffering from acute diarrhea was divided into control and cases (study group). Oral zinc therapy (20 mg once daily) was given 14 days and its efficacy was observed in terms of stool frequency, stool volume and duration of diarrhea. Variables were noted at 24 hours and 48 hours and on 7th day of hospitalization. Data was analyzed on SPSS statistical software (version 22.0) at 95% confidence interval (P≤ 0.05). Results: Mean ± SD age in control and study group was noted as 9.1± 5.43 years and 9.5±6.02 years respectively (P=0.053). 89% of children of study group were discharged on 3rd day of hospitalization compared to only 45% from control group. Zinc treated study group shows significant decrease in frequency of loose stools, stool volume and lesser duration of hospital stay. Conclusion: Oral zinc therapy was effective in decreasing the frequency of loose stools and volume and lesser duration of hospital stay in children.

Cholera and Pancreatic Cholera: Is VIP the Common Pathophysiologic Factor?

Background: Cholera remains a major global health problem, causing high output diarrhea leading to severe dehydration and shock in developing countries. We aimed to determine whether vasoactive intestinal polypeptide (VIP), the mediator of pancreatic cholera syndrome, has a role in the pathophysiology of human cholera. Methods: We conducted a prospective observational study of cholera cases hospitalized with severe dehydration. Plasma and stool water levels of VIP were measured just after admission, after complete rehydration (3–4 h), at 24 h post-rehydration and at discharge after diarrhea ceased. Results: In total, 23 cholera patients were examined between January and August 2018. The geometric mean of stool VIP (sVIP) and plasma VIP (pVIP) on admission were 207.67 and 8.34 pmol/L, respectively. pVIP values were all within the normal range (</= 30 pcmol/L); however, sVIP levels were very high at all timepoints, though less so just after rehydration. In multivariable GEE models, after adjustment for covariates, sVIP levels were significantly associated with duration of hospitalization (p = 0.026), total stool volume (p = 0.023) as well as stool output in the first 24 h (p = 0.013). Conclusions: The data suggest that VIP, which is released by intestinal nerves, may play an important role in human choleragenesis, and inhibitors of intestinal VIP merit testing for potential therapeutic benefits.