Treatment Of Diarrheal Diseases Research Articles

Functionalized Palygorskite as a Delivery Platforms for Bioactive Asymmetric Beta-Diketone Dyes

Natural clay minerals are among the most versatile materials used in the biomedical field. Palygorskite has found various applications in this field, from the treatment of diarrheal diseases in the past to materials with antibacterial properties and platforms carrying bioactive compounds used in the treatment of diseases, cosmetic and healthcare products in the present. In this study, a possible delivery method of some bioactive asymmetric β-diketonic compounds is presented. Palygorskite modified with amphionic groups (P) and copper ions (PCu) was used as a platform to load bioactive curcumin derivatives (1 and 2). By varying the copper ions, the amounts of charged active compounds were monitored. Studies have shown that the hybrid materials resulting from the loading of 1 and 2 compounds on palygorskite with 30% copper ions (PCu30) can be used as delivery methods for these asymmetric curcumin derivatives, while palygorskite with 50% copper ions(PCu50) loaded with the same type of bioactive compounds has antibacterial properties.

Stereochemistry and dose of bile acids (BA) influence probiotic growth and barrier function in human colon T84 cells

BA-associated diarrhea (BAD) occurs in ~1% of the population, where high [BA] alter the gut microbiota and epithelial barrier function. Probiotics are used to help restore the microbiome and alleviate diarrheal symptoms in these patients. Using T84 cells, we showed that the primary BA, chenodeoxycholic acid (CDCA; 500μM) increased apoptosis, oxidative stress (ROS) and proinflammatory cytokine IL-8 to disrupt tight junctions while its secondary BA, lithocholic acid (LCA), did not. We also showed that probiotics reversed the effects of CDCA in T84 cells (Physiol. 2023, 38, S1). In this study, we examined the dose-dependent effects of di-hydroxy (OH) BAs, CDCA, its 7-OH epimer ursodeoxycholic acid (UDCA) and its mono-OH BA, LCA, on microbial and epithelial cell function. We hypothesize that the differences in the -OH position (3, 7, or 12) and stereochemistry (α or β) will result in varied dose-dependent effects of these BAs. Probiotic strains in Up & Up supplement (30 billion CFUs of 10 strains) were grown in T84 cell culture media ± BA (50 - 500μM) in anaerobic conditions (37°C, 48h). The effect of BAs (50-500μM, 0–18h) on barrier function was studied in confluent T84 cells (TransEpithelial Resistance, TER >1000 Ω.cm2) as follows: i) apoptosis (Annexin-V, flow cytometry); ii. mitochondrial and nuclear ROS production (CellRox, flow cytometry) and iii) paracellular permeability (TER and FITC-10kD dextran fluxes (F10D)). The predominant bacterial species (Control media, CFU x 108: 7.5 ± 1) was Lactobacillus fermentum (L f) (16S rRNA sequencing). CDCA caused a dose-dependent (μM) reduction in growth rate (50: 0.6±0.2; 250: 0.06±0.04; 500: 0.05±0.01; p<0.01, n=3) and changed the predominant species to L. plantarum (L p). UDCA and LCA (50-500μM) alone had no effect but reversed the actions of CDCA on bacterial growth (only 50 LCA/UDCA ± 500 CDCA are shown; CFU x 108: LCA: 7±1; CDCA+LCA: 6.7±0.8; UDCA: 6.2±0.5; UDCA + CDCA: 6.5±1, n=3) and changed the predominant species to L f. In T84 cells, apical exposure of CDCA caused a dose-dependent increase in apoptosis while UDCA or LCA at any dose had no effect (% Annexin V+ cells, 18 H: DMSO: 10±1; CDCA 50: 14±2; CDCA 250: 20±2; CDCA 500: 25±2; UDCA 500: 13±4; LCA 500: 9±2; n=3). CDCA increased ROS starting at 50μM (% CellRox+ cells: DMSO: 12±0.5; CDCA 50: 25±0.1; CDCA 250: 30±0.1; CDCA 500: 36±2). UDCA and LCA (50-500μM) had no effect. Time- and dose-dependent studies show that CDCA decreased TER (% decrease: CDCA 50: 50±5, CDCA 250: 63±7; CDCA 500: 71±8) and increased F10D fluxes (apparent permeability (x 10−9) cm/sec: Control: 8±1; CDCA 50: 35±5; CDCA 250: 78±10; CDCA 500: 90±20). In contrast, UDCA and LCA alone (50-500μM) had no effect on paracellular permeability but restored CDCA-induced barrier dysfunction (apparent permeability (x 10−9) cm/sec: Control: 8±1; CDCA 50: 35±5; CDCA 250: 78±10; CDCA 500: 90±20; UDCA 500: 13±2; CDCA 500+UDCA: 41±12; LCA 500: 15±2; CDCA 500+LCA: 38±2, n>3). Comparing the effects of hydrophobic CDCA with that of its hydrophilic 7-b isomer, UDCA, highlighted the importance of stereochemistry of -OH groups in BA action. CDCA’s deleterious effects on microbiota and epithelia started as low as 50μM, while UDCA, like LCA, restores the microbiota and barrier function. Understanding and targeting the interplay of BA, microbiota and epithelia may open up new therapeutic avenues for the treatment of diarrheal diseases. Supported by Funds from UGSRF, APS to ZF, NSSRP Funds, BenU to ER, AL, MN, MP and JS, UIC Funds to MR. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Ocimum Gratissimum essential oil: A review of extraction methods, phytochemical constituents, pharmacological uses and formulation approaches

Ocimum gratissimum is a plant native to Africa. Its leaves have been used in local dishes over the years, with documented evidence of varying pharmacological uses of its essential oil. This review focuses on the extraction methods, phytochemical constituents, pharmacological uses and formulation approaches of Ocimum gratissimum essential oil. The traditional extraction methods that have been widely used include the solvent, cold press and hydrodistillation methods. However, newer methods such as steam distillation, ultrasound and microwave assisted hydrodistillation, supercritical fluid extraction, pressurized liquid extraction and pressurized hot water extraction methods have not been fully reported. These methods provide more yield of the essential oil compared with the traditional methods and their processes are less laborious. Furthermore, they are often limited to analytical applications as they cannot handle large quantities of samples. The phytochemical constituents of Ocimum gratissimum essential oil vary, based on location of the plant and the time of the season the plant parts were harvested for extraction. The African species have more thymol than eugenol. Other notable constituents are saponins, terpenes and flavonoids in both African species and others. The essential oil of Ocimum gratissimum bears the scent of the plant and other important properties such as protection of the plant from pests and to attract insects for cross-pollination. The essential oil of this plant has been noted to possess various pharmacological properties which explains its use in inflammatory conditions and the treatment of diarrhoeal disease, wound healing and cerebrovascular disorder, amongst others. The essential oil of Ocimum gratissimum has been embedded in gels, cream, silver nanoparticles and nanoemulsion to improve its pharmacological activity and bioavailability. This review article highlights the potentials of the essential oil of this ubiquitous plant as a therapeutic source for the treatment of different tropical diseases.

Medicinal plants for treatment of diarrhoeal diseases among under-five children: experience from traditional healers in North-eastern Tanzania

BackgroundRight through history, humans have relied heavily on plants for sustenance and the healing of different ailments. One of the long-standing traditions that communities have inherited from earlier generations is the use of herbal medicines for the treatment of paediatric ailments, including diarrhoea. This study showcased medicinal plants used by traditional healers for the treatment of diarrhoeal diseases among under-five children in North-eastern Tanzania.Methods and designA qualitative research approach and a narrative research design were employed. The research was carried out in the districts of Korogwe and Handeni in North-eastern Tanzania, with 52 in-depth interviews performed with participants (traditional healers). Purposive sampling method was used to select participants, and a thematic analysis framework was used to analyze the data.ResultsStudy results indicate that traditional healers had enormous insights and were well informed about medicinal plants that were perceived to be efficacious in treating diarrhoeal diseases among under-five children. A total of 54 medicinal plants were reported by the participants to be effective in healing diarrhoeal diseases among under-five children. However, out of 54 medicinal plants, 15 were predominantly disclosed by the majority of participants. Those medicinal plants include Psidium guajava, Rhus natalensis, Ozoroa insignis, Tamarindus indica, Ocimum suave, Combretum molle, Zanha africana, Solanum incanum, and Ximenia americana. Other medicinal plants mentioned by most participants include, Ochna holstii, Elaeodendron schlechterianum, Albizia anthelmintica, Commiphora pteleifolia, Salacia stuhlmanniana, and Zenkerella grotei.ConclusionAll traditional healers seemed to have a clear understanding regarding the medicinal plants that were used to treat diarrhoeal diseases among under-five children. The participants acknowledged to treating under-five children with diarrhoeal diseases using herbal medications on multiple occasions. The findings of this study should inspire more in-depth botanical research to determine whether the medicinal plants reported in this study have anti-diarrhoeal properties.

Occurrence of Diarrheagenic Pathogens and Their Coinfection Profiles in Diarrheic Under Five Children and Tracked Human Contacts in Urban and Rural Settings of Eastern Ethiopia.

Diarrheagenic Escherichia coli, Campylobacter, Nontyphoidal Salmonella, and Shigella are common cause of childhood diarrhea in countries like Ethiopia, but data on their sources and coinfection profiles is limited. A cross sectional study was conducted from November 2021 to January 2023 to determine the prevalence, coinfection, and monthly occurrence rates of major diarrheagenic bacteria in diarrheic under five children and asymptomatic contacts at urban and rural settings in Ethiopia. A total of 345 stool samples were collected from; 262 diarrheic children visiting Hiwot Fana Hospital, Kersa, and Adelle Health Centers; and 83 caretakers and siblings through case based contact tracing. Samples were analyzed using standard laboratory procedures and the overall prevalence of enteric pathogens was 26.96%, with the highest isolation rate during the winter and peaks of 73.91% in February. The occurrence of the pathogens in children and tracked contacts was 27.86 and 24.09%, respectively. In our study, 8.53% coinfection and 23.66% single pathogen infection was recorded in diarrheic children. The study also showed 4.51 and 3.88% of diarrhea in children from urban and rural had attributed to bacterial coinfection, respectively. The most prevalent pathogen in diarrheic children was Diarrheagenic E. coli (10.31%), and followed by Campylobacter. On the other hand, Diarrheagenic E. coli was the second dominant bacteria following Shigella in the traced contacts, with prevalence of 8.43% and 9.64%, respectively. Based on the study site, the prevalence of Diarrheagenic E. coli and Nontyphoidal Salmonella was higher in children from urban than those from rural. However, the occurrence of each pathogen had no significant differences (P > .05) between settings. The high pathogens occurrence rate in the current study indicates the need for strong control strategies and better child carrying and treatment of diarrheal diseases at both urban and rural settings. Further studies on possible sources and factors attributing to the occurrence of enteric pathogens in children are also recommended.

Ethnopharmacological Study and Antibacterial Activities of Some Plants Used in Traditional Medicine for the Treatment of Diarrheal Diseases in Gabon

The purpose of this work was to develop ethnopharmacological and biological studies of plants used in traditional medicine for the treatment of diarrheal diseases. This study results in scientific data that validates the uses of these plants in traditional medicine. Firstly, ethnopharmacological surveys were conducted with a few traditional healers from the provinces of Estuaire, Haut Ogooué and Woleu-Ntem in Gabon. Next, ethnobotanical data such as percentage of families, species, routes of administration, methods of preparation, parts used and number of plant names were analyzed and summarized. Finally, the antibacterial activities of some plants have been evaluated by diffusion and microdilution methods. Thirty-four (34) traditional healers were interviewed. A total of 90 plant species were identified during this study. They belong to 44 families, the most represented were Leguminoseae (13.33%), Apocynaceae (7.78%), Annonaceae (5.55%), Euphorbiaceae (4.44%) and Anacardiaceae (4.44%). Trees were used more (44.44%) than shrubs (32.22%), herbaceous plants (16.67%) and lianas (6.67%). The drug administration was mainly oral (84.62%) and by the anal route. Decoction and maceration were the two most used methods of preparation. Among identified plants, twenty-seven (27) plant extracts were subjected to microbiological analyzes. Plant extracts tested were active on Gram-negative and Gram-positive bacteria. Cola nitida extracts gave the best antibacterial activity against Enterococcus faecalis 103907 CIP. This study identified 90 antidiarrheal plant species and clearly shows the antimicrobial potential of several medicinal species.

Fetotoxicity and Subacute Toxicity of Some Plants Involved in the Treatment of Infectious Diarrhea in Benin

This study aimed to provide data on the subacute toxicity and fetotoxicity of aqueous and hydroethanolic extracts of Daniellia oliveri (Rolfe) Hutch. & Dalziel, Anacardium occidentale L., Diospyros mespiliformis Hochst. ex A. DC., Khaya senegalensis (Desv.) A. Juss., Ocimum gratissimum L., Vernonia amygdalina Delile, Pterocarpus erinaceus Poir., and Manihot esculenta Crantz used in the treatment of diarrheal diseases in Benin. For subacute toxicity, each male and female Wistar rat received by esophageal gavage a maximum of 1000 mg/kg over 28 days following the Organization for Economic Co-operation and Development (OECD) Guideline No. 407. Bodyweight changes, biochemical and hematological parameters were assessed. The fetotoxicity of the extracts was evaluated on Dutch Blue hen eggs at 100 mg/kg and 300 mg/kg. The hatching rate, biochemical and hematological constants were subsequently determined. The subacute toxicity data did not indicate any mortality or signs of toxicity. Also, no significant difference in the bodyweight of the rats and the hematological parameters was noted. Concerning fetotoxicity, a low hatching rate (varying from 20% to 50%) was observed in the batches treated with the extracts at 300mg/kg compared to the rate obtained in the negative control batch (80%). The batches that received the hydroethanolic extracts of Vernonia amygdalina and Manihot esculenta at the tested doses had a hatching rate of 0%. When looking at hematological parameters, no significant difference was noted for all batches. However, an increase in the Aspartate Amino-Transferase (ASAT) values was noted in the batches that received the hydroethanolic extract of Khaya senegalensis and the aqueous extract of Diospyros mespiliformis at 100 and 300 mg/kg. These results explicitly show that the hydroethanolic extracts of Manihot esculenta and Vernonia amygdalina are fetotoxic at the tested doses.

Ethanol leaf extract of Dialium guineense produces anti-diarrhoeal and gastrointestinal motility slowing activities in Wistar rats

Dialium guineense leaves have been traditionally used for the treatment of diarrhoeal diseases in Nigeria. The study was conducted to evaluate the anti-diarrhoeal and gastrointestinal motility slowing effects of the ethanol leaf extract of D. guineense in Wistar rats. The anti-diarrhoeal and gastrointestinal motility slowing effects of the ethanol leaf extract of D. guineense were evaluated using castor oil-induced diarrhoeal model, charcoal meal, and anti-enteropooling tests in Wistar rats. The test groups received various doses (100, 200, and 400 mg/kg) of the extract whereas positive controls received Loperamide (4 mg/kg) or Atropine (5 mg/kg) and negative controls received Normal Saline (10 ml/kg). The phytochemical screening as well as the acute toxicity test of the extract was also performed. The extract produced a dose-dependent significant reduction in the watery nature and frequency of fecal droppings in the castor oil-induced diarrhea. On gastrointestinal transit time and enteropooling, the extract also dose-dependently reduced the small intestinal transit of charcoal meal and intestinal fluid volume in a manner comparable to 5 mg/kg of atropine sulphate and 4 mg/kg of loperamide. The acute toxicity study on the extract revealed an oral LD50 value greater than 5000 mg/kg in mice. The phytochemical constituents detected in the extract were tannins, phenols, resin, alkaloids, saponins, terpenoids, and glycosides. The findings from this study showed that the ethanol leaf extract of D. guineense possesses anti-diarrhoeal properties and thus supports the traditional application of the leaf extract in the treatment of diarrhea in Nigeria.

Study of Ethnomedicinal Plants Used by the Mishing People for Diarrhea Disease

The main aim of the present study is to collect information and identify the specimens of ethnobotanical plants used for the treatment of diarrhoeal disease by the Mishing people of Dhemaji and Lakhimpur districts, Assam. From the Dhemaji district, we have selected Jonai, Silapathar, Sissikalghar, Dhakuakhana, and Boginodi, which are selected under the Lakhimpur district purposefully. Information was collected from randomly selected households, both male and female respondents, and different age groups between 45-85 years of age. An investigation of a total of 66 plant species and 39 families was enumerated, and Rutaceae, Apiaceae, Zingiberaceae, Clusiaceae, Moraceae, and Combretaceae were the dominant families.

Studi Pemanfaatan Tumbuhan Obat Antidiare oleh Masyarakat di Etnis Sumatera Utara

Diarrhea is one of the digestive disorders characterized by loose, liquid and watery bowel movements (defecation) with a frequency of three times a day accompanied by cramps in the stomach. This disorder is caused by a bacterial infection and an imbalance between the mechanisms of absorption and secretion of water and electrolytes in the intestinal tract and is accompanied by hypermobility. In Indonesia, diarrheal disease is the second cause of death for children under the age of 5 years. Indonesia is a country that has the 2nd highest biodiversity with a diversity of medicinal plants, especially in the treatment of diarrheal diseases. The research method is carried out using a literature review with online media based on the Web, Scopus, PubMed, Science Direct, ResearchGate, Google Scholar used for publication. The results show that there are medicinal plants used as diarrhea medicine (antidiarrhea) consisting of 14 orders, 16 families, and 19 species, namely Acorus americanus (Far.) Raf., Ageratum conyzoides L., Blumea balsamifera (L).DC., Bischofia javanica Bl., Dioscorea alata L., Allium cepa L., Psidium guajava L., Cymbopogon citratus (DC.) Stapf., Kalanchoe pinnata (Lam.) Pers., Uncaria gambir (Hunter) Roxb., Lansium domesticum Correa., Nephelium lappaceum L., Strobilanthes crispus Blume., Solanum nigrum L., Solanum torvum Sw., Artocarpus heterophyllus Lam., Carica papaya L., Curcuma longa L., and Curcuma xanthorrhiza Roxb.

Toxicological Characterization of Ten Medicinal Plants of the Beninese Flora Used in the Traditional Treatment of Diarrheal Diseases.

The use of medicinal plants in traditional medicine is a common practice in developing countries. However, this unregulated or poorly rational use may present a dose-dependent risk of toxicity to humans. This study aimed to explore the phytochemical and toxicological characteristics of ten (10) plant species used in the traditional treatment of infectious diarrhea in Benin. The acute toxicity of aqueous and hydroethanolic extracts of Khaya senegalensis, Daniellia oliveri, Rauvolfia vomitoria, Vernonia amygdalina, Manihot esculenta, Ocimum gratissimum, Senna italica, Diospyros mespiliformis, Pterocarpus erinaceus, and Anacardium occidentale was evaluated following the OECD 423 protocol at a single dose of 2000 mg/kg. This safety test was complemented by a larval cytotoxicity test. Hematological and biochemical examinations, as well as a histological study of the liver and kidneys, were performed. Larval cytotoxicity was assessed by the sensitivity of Artemia salina larvae to different concentrations of the plant extracts studied. Testing for chemical compounds was performed on the basis of differential staining and precipitation reactions. The mean lethal concentration (LC50) was determined by the probit method. The qualitative phytochemical screening of the plants studied revealed the presence of catechic tannins, gallic tannins, flavonoids, anthocyanins and sterol-terpenes, alkaloids, saponosides, and reducing compounds. This composition varied according to the plants studied. Acute toxicity data indicated that there was no mortality and no structural and functional alterations of the liver and kidneys of treated animals. Larval cytotoxicity data suggest that the plants studied are not cytotoxic (LC50 ≥ 0.1 mg/mL). These observations reflect the safety of these plants and justify their use in traditional medicine in the treatment of many diseases including diarrheal diseases.

Anti-diarrheal therapeutic potential of diminazene aceturate stimulation of the ACE II/Ang-(1–7)/Mas receptor axis in mice: A trial study

The angiotensin (Ang) II converting enzyme (ACE II) pathway has recently been shown to be associated with several beneficial effects on the body, especially on the cardiac system and gastrointestinal tract. ACE II is responsible for converting Ang II into the active peptide Ang-(1–7), which in turn binds to a metabotropic receptor, the Mas receptor (MasR). Recent studies have demonstrated that Diminazene Aceturate (DIZE), a trypanosomicide used in animals, activates the ACE II pathway. In this study, we aimed to evaluate the antidiarrheal effects promoted by the administration of DIZE to activate the ACE II/Ang-(1–7)/MasR axis in induced diarrhea mice models. The results show that activation of the ACE II pathway exerts antidiarrheal effects that reduce total diarrheal stools and enteropooling. In addition, it increases Na+/K+-ATPase activity and reduces gastrointestinal transit and thus inhibits contractions of intestinal smooth muscle; decreases transepithelial electrical resistance, epithelial permeability, PGE2-induced diarrhea, and proinflammatory cytokines; and increases anti-inflammatory cytokines. Enzyme-linked immunosorbent assay (ELISA) demonstrated that DIZE, when activating the ACE II/Ang-(1–7)/MasR axis, can still interact with GM1 receptors, which reduces cholera toxin-induced diarrhea. Therefore, activation of the ACE II/Ang-(1–7)/MasR axis can be an important pharmacological target for the treatment of diarrheal diseases.

Multiple drug resistance of Campylobacter jejuni and Shigella isolated from diarrhoeic children at Kapsabet County referral hospital, Kenya

BackgroundDiarrhoea is a common cause of mortality and morbidity in children under five years old. In Kenya, it has a 21% case fatality with Enteropathogenic E. coli, Campylobacter jejuni, Shigella spp. and Salmonella spp. accounting for 50–60% of the cases. Sulphonamides, tetracycline, ampicillin and trimethoprim/sulfamethoxazole are typically used in the treatment of diarrhoeal diseases but have become ineffective in the face of emerging antimicrobial resistance. The objective of this study was to evaluate the prevalence and antimicrobial susceptibility of Campylobacter jejuni and Shigella species in children under five years of age presenting with diarrhoea at Kapsabet County Referral Hospital in Kenya.MethodsFaecal samples were collected from 139 children admitted with diarrhoea. Each sample was examined macroscopically for colour, texture, and presence of extraneous material. The samples were then cultured for bacterial growth. Observed bacterial growth was isolated and identified by a series of biochemical tests. Resistance patterns were also evaluated using the Kirby – Bauer Disk diffusion method. The chi – square test and Pearson Correlation Coefficient were used to establish statistical significance.ResultsApproximately 33.1% of the total faecal samples tested were positive for enteric pathogens. Shigella spp. demonstrated resistance to erythromycin (91.7%), doxycyclin (83.3%), ampicillin (82.1%), cotrimoxazole (73.1%), minocycline (66.7%) and cefuroxime (54.2%). Campylobacter jejuni also exhibited resistance to erythromycin (87.5%), doxycyclin (75%), ampicillin (73.7%), cotrimoxazole (73.3%) and minocycline (68.8%).ConclusionsThe resistance patterns of Shigella spp. and Campylobacter jejuni reported in this study necessitates the need for a comprehensive multiregional investigation to evaluate the geographical prevalence and antimicrobial resistance distributions of these microorganisms. These findings also support the need for the discovery and development of effective therapeutic alternatives.Trial registrationRetrospectively registered. Certificate No. 00762

Genetic diversity of bacterial pathogens in children with acute gastroenteritis in Bangladesh during 2014-2019

Background: Acute gastroenteritis is still the health burden in developed and developing countries. From different etiological agents, bacteria and viruses are considered to be significant enteropathogens of acute gastroenteritis in children worldwide including Bangladesh. Among these diarrheal bacteria, Escherichia coli, Non Typhoidal Salmonella, Shigella spp. and Vibrio cholerae are some of the major enetropathogens. Antibiotics are mostly used for the treatment of bacterial pathogens. Antibiotic resistance property of the above mentioned bacterial pathogens is a true hindrance in treatment of diarrheal diseases. Methods and materials: The study was carried on 387 fecal specimens, collected from all children of acute gastroenteritis in four clinics encompassing three localities (Savar, Cattogram and Sirajganj) in Bangladesh from January 2014 to January 2019. For diarrheagenic bacterial pathogens, conventional bacterial identification and molecular characterization methods were used. Prevalence of antibiotic resistance bacterial pathogens were also determined. Sequence data were analyzed by Chromas 2.32, BioEdit and other software. Results: A total of 387 fecal specimens were tested for bacterial and viral pathogens. 39.27% (152 of 387) of the samples were positive for bacterial pathogens and 42% (164 of 387) for viral pathogens. Among diarrheagenic bacterial pathogens, E.coli was the most prevalent (17.3%, 67 of 387) followed by V. cholerae (13.5%, 52 of 387), Salmonella spp. (4.9%, 19 of 387) and Shigella spp. (3.6%, 14 of 387), respectively. We found 50% to 80% isolates of V. cholerae were resistance against the tested antibiotics. While 20% to 60% of E. coli isolates were resistance against those antibiotics. Molecular analysis of antibiotic resistance genes confirmed the presence of qnrA and sul4 resistance elements in diarrheal pathogenic bacteria. To far our knowledge, the report of sul4 in this study is first in Bangladesh. Conclusion: This study will help to better understand the overall bacterial pathogens involved in infants and children diarrheal diseases in Bangladesh. This research work also confirmed the presence of antibiotic resistance bacterial pathogens with unique resistance gene in diarrheal pediatric population in Bangladesh. This study will also provide information for the betterment of detection methods, prevention and treatment strategies for diarrheal diseases in Bangladesh.

Strategies for cystic fibrosis transmembrane conductance regulator inhibition: from molecular mechanisms to treatment for secretory diarrhoeas.

Cystic fibrosis transmembrane conductance regulator (CFTR) is an unusual ABC transporter. It acts as an anion‐selective channel that drives osmotic fluid transport across many epithelia. In the gut, CFTR is crucial for maintaining fluid and acid‐base homeostasis, and its activity is tightly controlled by multiple neuro‐endocrine factors. However, microbial toxins can disrupt this intricate control mechanism and trigger protracted activation of CFTR. This results in the massive faecal water loss, metabolic acidosis and dehydration that characterize secretory diarrhoeas, a major cause of malnutrition and death of children under 5 years of age. Compounds that inhibit CFTR could improve emergency treatment of diarrhoeal disease. Drawing on recent structural and functional insight, we discuss how existing CFTR inhibitors function at the molecular and cellular level. We compare their mechanisms of action to those of inhibitors of related ABC transporters, revealing some unexpected features of drug action on CFTR. Although challenges remain, especially relating to the practical effectiveness of currently available CFTR inhibitors, we discuss how recent technological advances might help develop therapies to better address this important global health need.

Treatment outcome of Diarrhea with or without Probiotics among Children aged 12-60 months

Background: High mortality rate around the globe has been reported due to diarrheal disease among all fewer than five years of age. Many studies show their utilization in the treatment of diarrheal disease especially among children of under-five. Objective: To assess the treatment outcome of diarrhea with and without probiotics among children aged 12-60 months. Methodology: This comparative cross-sectional study was undertaken from July to December 2017. A pre-designed questionnaire was used to collect the information in terms of antibiotics, rehydrating agents, antipyretic agents, and probiotics. A total of 109 patients were selected randomly and then divided into two groups as having 55 children and Non-Probiotic, having 54 children. Guardians of patients were contacted telephonically after 48 hours and 72 hours to ask about the time frame of relief from symptoms, diarrheal episodes, and cure from disease. Data were analyzed by using SPSS 20. Results: Out of 109 patients, 54 patients were in the non-probiotic group and 55 in the probiotic group. The overall age of patients remained 31±12 months. Saccharomyces boulardii (56.4%) and Lactobacillus GG (43.6%) were probiotics prescribed by pediatric physicians. A significant difference (p=0.000) was observed in terms of treatment outcome showing early relief (12 hrs) 43 (78%) vs 22 (41%) in probiotic vs non-probiotic group and early cure (<48 hrs) from diarrhea in probiotic group 48 (87%) vs 35 (65%) as compared to the non-probiotic group. (p=0.00) Conclusion: The use of probiotics during the treatment of acute diarrhea among children below five years shortens the duration of symptoms and helps the cure as early as one day before the patients' not using probiotics.

ANTI-DIARRHEAL ACTIVITY OF AQUEOUS EXTRACT OF NAGASARI FLOWERS (Mesua ferrea L.) IN BALB/c MICE INDUCED BY Escherichia coli

Nagasari (Mesua ferrea L.) is empirically used for curing diarrhea in Nusa Tenggara Barat Province. However, the safety and efficacy of nagasari have not been scientifically validated in animal model. This study evaluates the activity of nagasari flowers aqueous extract in BALB/c mice induced by Escherichia coli to determine the most effective dosage for anti-diarrheal effect. The aqueous extract of nagasari flowers ((0.4% (w/v), 0.8% (w/v), and 1.6% (w/v)) was given to 3 groups of mice whereas negative and positive control groups received aquadestilate and ciprofloxacin 130 mg/kgBW respectively orally once per day for 3 days. The frequency and consistency of feces were observed then the total colony of E. coli in feces was calculated using colony counter. Aqueous extract of nagasari flowers at concentration of 1.6% showed significant inhibitory activity against Escherichia coli compared to positive controls (diarrhea index of 0.425; p>0.05 and total colony of E. coli in feces of 100.2; p>0.05). This study provides scientific support for the traditional use of aqueous extract of nagasari flowers for the treatment of diarrheal diseases.

A Unique Clinical Presentation of an Emerging Invasive Fungal Infection in a Hospitalized Patient: the Lessons Learned

Invasive Saccharomyces cerevisiae infection is a rare and emerging fungal infection. The emergence of this invasive infection is due to the increased use of Saccharomyces boulardii probiotics. Saccharomyces boulardii probiotics are biotherapeutic agents used for the prevention and treatment of various diarrheal diseases. The benefits of these probiotics are well established; however, its associated infectious complications seem underestimated, especially in at-risk patients. Like other rare invasive yeast infections, invasive Saccharomyces infection has a high mortality rate. A 67-year-old man with multiple medical comorbidities and a complicated hospital course received Saccharomyces boulardii probiotics via percutaneous endoscopic gastrostomy tube for 22 days for Clostridium difficile prophylaxis treatment. We diagnosed him with invasive Saccharomyces cerevisiae fungemia resulting from Saccharomyces cerevisiae peritonitis. He developed multiple organ failure and shock, which led to his death 27 days after his first dose of Saccharomyces boulardii probiotics. To the best of our knowledge, we report the first case of invasive Saccharomyces cerevisiae fungemia due to Saccharomyces cerevisiae peritonitis caused by the combination of percutaneous endoscopic gastrostomy (PEG) tube placement and PEG tube administration of Saccharomyces boulardii probiotics in an at-risk hospitalized patient. Our goals for reporting this case are to heighten the index of clinical suspicion of invasive Saccharomyces fungemia, discuss the lessons we learned, and revisit the literature on the management of invasive Saccharomyces infection in at-risk hospitalized patients.

Biopolymer Extracted from Anadenanthera colubrina (Red Angico Gum) Exerts Therapeutic Potential in Mice: Antidiarrheal Activity and Safety Assessment.

Anadenanthera colubrina var. cebil (Griseb.) Altschul (Fabaceae family), commonly known as the red angico tree, is a medicinal plant found throughout Brazil’s semi-arid area. In this study, a chemical analysis was performed to investigate the antidiarrheal activity and safety profile of red angico gum (RAG), a biopolymer extracted from the trunk exudate of A. colubrina. Upon FT-IR spectroscopy, RAG showed bands in the regions of 1608 cm−1, 1368 cm−1, and 1029 cm−1, which relate to the vibration of O–H water molecules, deformation vibration of C-O bands, and vibration of the polysaccharide C-O band, respectively, all of which are relevant to glycosidic bonds. The peak molar mass of RAG was 1.89 × 105 g/mol, with the zeta potential indicating electronegativity. RAG demonstrated high yield and solubility with a low degree of impurity. Pre-treatment with RAG reduced the total diarrheal stool and enteropooling. RAG also enhanced Na+/K+-ATPase activity and reduced gastrointestinal transit, and thereby inhibited intestinal smooth muscle contractions. Enzyme-Linked Immunosorbent Assay (ELISA) demonstrated that RAG can interact with GM1 receptors and can also reduce E. coli-induced diarrhea in vivo. Moreover, RAG did not induce any signs of toxicity in mice. These results suggest that RAG is a possible candidate for the treatment of diarrheal diseases.

Knowledge, utilization, and accessibility of child welfare card among caregivers in a tertiary center in South West Nigeria.

The Child Welfare Card (CWC) contains the records of a child's immunization and information on the other aspects of the child's health, including growth curves and home treatment of diarrheal disease to mention a few. How easily retrievable these records are and what influence the cards have on parents/caregivers regarding the child's nurture are uncertain in our environment. The present study was aimed at assessing the parents/caregivers' knowledge and utilization of CWCs as well as the health-providers' accessibility of the card in the hospital. This study was a cross-sectional descriptive one that involved the parents/caregivers of children aged 60 months and below, attending the children's clinics and wards in a tertiary center. We collected the relevant information, including the sociodemographic data of the parents/caregivers, their knowledge, and assessed the utilization of CWC. The analysis of the categorical data was performed with the IBM Statistical Package for Social Sciences (S.P.S.S) version 23.0 for windows. P values < 0.05 were considered significant. Of the 377 parents/caregivers enrolled in the study, good knowledge of the contents of the CWC was demonstrated by 82 (21.8%) while 78 (20.7%) made the cards available to the health care providers. Eighty (21.2%) made adequate use of the cards at home. A greater number of parents/caregivers from the higher social class had good knowledge of the intervention contents of the CWC (P = 0.005). The accessibility of the cards to the health care-providers was significantly higher among the older parents/caregivers (P = 0.010), those with a good knowledge of CWC (P = 0.020) and parents/caregivers from higher social class (P = 0.001). Subjects with good knowledge were 2.4 times (OR = 2.4, 95% CI = 1.4-4.2) more likely to utilize the intervention contents in the CWC. The overall knowledge, utilization, and accessibility of the CWC were poor. Parents/caregivers with good knowledge were more likely to utilize the information on the CWC compared with participants with poor knowledge.