Caracterización de pacientes con enfermedades asociadas a inmunosupresión con infecciones por Cryptosporidium spp. atendidos en un hospital pediátrico referencial de Argentina, 2018-2023 / Description of the characteristics of patients with diseases associated with immunosuppression and Cryptosporidium spp. infection seen at a referral children's hospital in Argentina, 2018­2023

Cryptosporidium spp. es un protozoario productor de diarrea. Los pacientes inmunocomprometidos pueden desarrollar formas clínicas graves y persistentes. Se describen las características de pacientes con enfermedad de base asociada a inmunosupresión (EAI) con infección por Cryptosporidium spp. (IC) atendidos en un hospital pediátrico referencial de Argentina entre los años 2018 y 2023. Se analizaron datos demográficos, EAI, características de la diarrea y coinfecciones. Se incluyeron 30 pacientes con EAI e IC. La mayoría registró trasplante de órgano sólido, neoplasia hematológica e inmunodeficiencia primaria. Dieciocho presentaron diarrea persistente al momento del diagnóstico. Seis pacientes registraron coinfecciones. Se debe considerar la criptosporidiosis en el diagnóstico diferencial de enfermedad diarreica aguda o persistente en niños con distintos tipos de EAI, como el trasplante de órgano sólido, neoplasias hematológicas e inmunodeficiencias primarias.

Cryptosporidium spp. is a diarrhea-causing protozoan. Immunocompromised patients may develop severe and persistent clinical forms. Here we describe the characteristics of patients with an underlying disease associated with immunosuppression (DAI) and Cryptosporidium spp. infection seen at a referral children's hospital in Argentina between 2018 and 2023. Demographic data, DAI, diarrhea characteristics, and co-infections were analyzed. A total of 30 patients with DAI and cryptosporidiosis were included. Most of them had undergone a solid organ transplant, had a hematologic neoplasm, or primary immunodeficiency. Persistent diarrhea was observed in 18 patients at the time of diagnosis. Co-infections were recorded in 6 patients. Cryptosporidiosis should be considered in the differential diagnosis of acute or persistent diarrhea in children with different types of DAI, such as solid organ transplant, hematologic neoplasms, and primary immunodeficiencies.

Gastrointestinal adverse events of metformin treatment in patients with type 2 diabetes mellitus: a systematic review and meta-analysis with meta-regression of observational studies.

INTRODUCTION: Metformin is the most prescribed medication for type 2 diabetes mellitus (T2DM); there is a well-established link with the elevated incidence of gastrointestinal (GI) adverse events (AE) limiting its administration or intensification. OBJECTIVES: The objective of this systematic review and meta-analysis of observational studies was to evaluate the pooled incidence of GI AE related to metformin use in patients with T2DM. MATERIALS AND METHODS: PUB MED/CINAHL/Web of Science/Scopus were searched from database inception until 29.07.2024 for observational studies in English describing the frequency of GI AE in patients with T2DM treated with metformin. Random-effects meta-analyses were used to derive effect sizes: event rates. RESULTS: From 7019 publications, we identified 211 potentially eligible full-text articles. Ultimately, 21 observational studies were included in the meta-analysis. The prevalence of GI AE was as follows: diarrhea 6.9% (95% CI: 0.038-0.123), bloating 6,2% (95% CI: 0.020-0.177), abdominal pain 5,3% (95% CI: 0.003-0.529), vomiting 2.4% (95%: CI 0.007-0.075), constipation 1.1% (95%: CI 0.001-0.100). The incidence of bloating (coefficient -4.46; p < 0.001), diarrhea (coefficient -1.17; p = 0.0951) abdominal pain (coefficient -2.80; p = 0.001), constipation (coefficient -5.78; p = 0.0014) and vomiting (coefficient -2.47; p < 0.001) were lower for extended release (XR) metformin than metformin immediate release (IR) formulation. CONCLUSIONS: This study highlights the prevalence of GI AE in patients receiving metformin, with a diarrhea predominance, followed by bloating, diarrhea, abdominal pain, constipation, and vomiting. The incidence is lower in patients administered with XR metformin. TRIAL REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021289975 , identifier CRD42021289975.

Frequency and genotyping of group A rotavirus among Egyptian children with acute gastroenteritis: a hospital-based cross-sectional study.

BACKGROUND: This hospital-based cross-sectional study aims to investigate the epidemiologic and clinical characteristics of rotavirus group A (RVA) infection among children with acute gastroenteritis and to detect the most common G and P genotypes in Egypt. METHODS: A total of 92 stool samples were collected from children under five who were diagnosed with acute gastroenteritis. RVA in stool samples was identified using ELISA and nested RT-PCR. Common G and P genotypes were identified utilizing multiplex nested RT-PCR assays. RESULTS: RVA was detected at a rate of 24% (22 /92) using ELISA and 26.1% (24 /92) using VP6 nested RT-PCR. The ELISA test demonstrated diagnostic sensitivity, specificity, and accuracy of 91.7%, 100%, and 97.8%, respectively. G3 was the most prevalent G type (37.5%), followed by G1 (12.5%), whereas the most commonly detected P type were P[8] (41.7%) and P[6] (8.2%). RVA-positive samples were significantly associated with younger aged children (p = 0.026), and bottle-fed (p = 0.033) children. In addition, RVA-positive samples were more common during cooler seasons (p = 0.0001). Children with rotaviral gastroenteritis had significantly more frequent episodes of diarrhea (10.87 ± 3.63 times/day) and vomiting (8.79 ± 3.57 times/day) per day (p = 0.013 and p = 0.011, respectively). Moreover, they had a more severe Vesikari clinical score (p = 0.049). CONCLUSION: RVA is a prevalent cause of acute gastroenteritis among Egyptian children in our locality. The discovery of various RVA genotypes in the local population, as well as the identification of common G and P untypeable strains, highlights the significance of implementing the rotavirus vaccine in Egyptian national immunization programs accompanied by continuous monitoring of strains.

Epidemiological survey of calf diarrhea related viruses in several areas of Guangdong Province.

Introduction: Bovine torovirus (BToV), Bovine enterovirus (BEV), Bovine norovirus (BNoV), Bovine coronavirus (BCoV), Bovine rotavirus (BRV), and Bovine viral diarrhea virus (BVDV) are significant pathogens causing diarrhea in calves, characterized by their high prevalence and challenging prevention and control measures. Methods: We analyzed 295 calf diarrhea samples, amplifying the M gene from BToV-positive samples, the 5'UTR gene from BEV-positive samples, the RdRp gene from BNoV-positive samples, the VP7 gene from BRV-positive samples, the S gene from BCoV-positive samples, and the 5'UTR gene from BVDV-positive samples. Subsequent homology analysis and phylogenetic tree construction were performed. Results: The overall viral positive rate in Guangdong Province was 21.36%. Specific detection rates were as follows: Foshan City at 50.00% (18/36), Guangzhou City at 43.90% (36/82), Huizhou City at 21.21% (7/33), Yangjiang City at 2.08% (1/48), Meizhou City at 1.39% (1/72), and Heyuan City at 0.00% (0/24). The detection rates for BToV, BEV, BNoV, BCoV, BRV, and BVDV were 0.34% (1/295), 6.10% (18/295), 0.68% (2/295), 1.36% (4/295), 10.85% (32/295), and 2.03% (6/295), respectively. Notably, the highest overall virus detection rate was observed in the Guangzhou-Foshan region, with BRV and BEV showing the highest detection rates among the six viruses. This study marks the first report of BToV and BNoV in Guangdong Province. Phylogenetic analysis revealed that the BToV strain belonged to type II, sharing genetic similarities with epidemic strains from various provinces in China. The BEV strains were categorized into E and F types, with the F type being the predominant strain in Guangdong Province and exhibiting the closest genetic relationship to strains from Heilongjiang and Guangxi. The BNoV strains, along with Hebei strains, were identified as GIII.2 subgenotype. BCoV strains showed the highest genetic similarity to strains from Sichuan. All BRV strains were classified under the G6 subtype and had the closest genetic relationship with human rotavirus strains. BVDV strains were identified as subtype 1b, closely related to the Beijing strain. In conclusion, this study investigated the prevalence and evolutionary characteristics of diarrhea-associated viruses in calves in specific areas of Guangdong Province, providing a valuable reference for establishing effective prevention and control measures in cattle farms.

Development and characterization of segment-specific enteroids from the pig small intestine in Matrigel and transwell inserts: insights into susceptibility to porcine epidemic diarrhea Virus.

Introduction: The critical early stages of infection and innate immune responses to porcine epidemic diarrhea virus (PEDV) at the intestinal epithelium remain underexplored due to the limitations of traditional cell culture and animal models. This study aims to establish a porcine enteroid culture model to investigate potential differences in susceptibility to infection across segments of the porcine small intestine (duodenum, jejunum, and ileum). Methods: Intestinal crypt cells from nursery pigs were cultured in Matrigel to differentiate into porcine enteroid monolayer cultures (PEMCs). Following characterization, PEMCs were enzymatically dissociated and subcultured on transwell inserts (PETCs) for apical surface exposure and infection studies. Characterization of region-specific PEMCs and PETCs included assessment of morphology, proliferation, viability, and cellular phenotyping via immunohistochemistry/immunocytochemistry and gene expression analysis. Subsequently, PETCs were inoculated with 105 TCID50 (50% tissue culture infectious dose)/mL of a high pathogenic PEDV non-S INDEL strain and incubated for 24 h. Infection outcomes were assessed by cytopathic effect, PEDV N protein expression (immunofluorescence assay, IFA), and PEDV N-gene detection (quantitative reverse transcription polymerase chain reaction, RT-qPCR). Results: No significant morphological and phenotypical differences were observed among PEMCs and PETCs across intestinal regions, resembling the porcine intestinal epithelium. Although PETCs established from different segments of the small intestine were susceptible to PEDV infection, jejunum-derived PETCs exhibited higher PEDV replication, confirmed by IFA and RT-qPCR. Discussion: This segment-specific enteroid culture model provides a reliable platform for virological studies, offering a controlled environment that overcomes the limitations of in vivo and traditional cell culture methods. Standardizing culture conditions and characterizing the model are essential for advancing enteroid-based infection models.

Association between bowel movement disorders and depressive symptoms: a cross-sectional study.

Objectives: This study aimed to explore the association between bowel movement disorders and depression in adults. Method: A cross-sectional study was conducted using data from the National Health and Nutritional Examination Survey (NHANES), 2005-2010. Depression, constipation, diarrhea, and fecal incontinence were self-reported via questionnaires. Weighted logistic regression and subgroup analyses were performed to explore the association between bowel movement disorders and the risk of depression. Restricted cubic spline (RCS) was also conducted to investigate the association between bowel movements disorder and depression. Results: A total of 13,820 participants were collected. Compared to the participants with normal bowel movements, the full-adjusted depression model ORs for constipation and diarrhea were 2.28 (95%CI,1.78-2.92), 1.75 (95%CI,1.31-2.31), respectively. Any kind of bowel leakage were associated with depression. The RCS showed the possible nonlinear association between bowel movement frequency/stool shape and depression. Conclusions: Constipation, diarrhea, and bowel leakage are associated with an increased risk of depression.

A 37-kb Deletion in Region 16p13.3 in an Infant with Osteopetrosis and Congenital Diarrhea Including the CLCN7 and PERCC1 Genes.

Introduction: Congenital diarrhea presents a diagnostic challenge in cases where standard assessments are inconclusive. Case Presentation: We report a female infant with thrombocytopenia, increased bone density, and pale optic disc symptoms, suggestive of osteopetrosis. However, she also exhibited noninfectious, blood- and mucus-free diarrhea, not accounted for by osteopetrosis. Genetic testing, including clinical exome sequencing and chromosomal microarray analysis, revealed a homozygous 39-kb deletion on chromosome 16p13.3. This deletion spanned the CLCN7 gene associated with osteopetrosis and the PERCC1 gene implicated in congenital diarrhea. Conclusion: This case illustrates the importance of considering 16p13.3 deletions when confronted with the dual presentation of congenital diarrhea and osteopetrosis, expanding the diagnostic considerations for similar clinical presentations.

Discovery of the FXR/CES2 dual modulator LE-77 for the treatment of irinotecan-induced delayed diarrhea.

Irinotecan (CPT-11) is a widely utilized topoisomerase I inhibitor in the treatment of colorectal cancer and other malignant tumors. However, severe and even life-threatening dose-limiting toxicity-delayed diarrhea affects the clinical application of CPT-11. The standard treatment for CPT-11-induced delayed diarrhea is prompt use of loperamide (LPA), however LPA can also cause constipation, diarrhea and even intestinal obstruction and has a high failure rate. Carboxylesterase 2 (CES2) is the main enzyme in the intestinal transformation of CPT-11, which can convert CPT-11 into toxic metabolite SN-38 and produce intestinal toxicity. Inhibiting CES2 activity can block the hydrolysis process of CPT-11 in the intestine and reduce SN-38 accumulation. Additionally, Farnesoid X receptor (FXR) agonists have anti-inflammatory, anti-secretory, and protective functions on intestinal barrier integrity that could potentially alleviate diarrhea. In this study, we investigated for the first time the anti-delayed diarrhea effect of FXR agonists, and the first time identified LE-77 as a potent dual modulator that activates FXR and inhibits CES2 through high-throughput screening. In the CPT-11-induced delayed diarrhea model, LE-77 demonstrated a dual modulator mechanism by activating FXR and inhibiting CES2, thereby reducing the accumulation of SN-38 in the intestine, alleviating intestinal inflammation, preserving intestinal mucosal integrity, and ultimately alleviating delayed diarrhea.

Combination of Lactiplantibacillus Plantarum ELF051 and Astragalus Polysaccharides Improves Intestinal Barrier Function and Gut Microbiota Profiles in Mice with Antibiotic-Associated Diarrhea.

The purpose of this study was to investigate the improvement of the intestinal barrier and gut microbiota in mice with antibiotic-associated diarrhea (AAD) using Lactiplantibacillus plantarum ELF051 combined with Astragalus polysaccharides. The amoxicillin, clindamycin, and streptomycin triple-mixed antibiotic-induced AAD models were administered with L. plantarum ELF051 or Astragalus polysaccharides or L. plantarum ELF051 + Astragalus polysaccharides for 14 days. Our findings revealed that the combination of L. plantarum ELF051 and Astragalus polysaccharides elevated the number of goblet cells and enhanced the proportion of mucous within the colon tissue. Furthermore, the expression of sIgA and IgG were upregulated, while the levels of IL-17A, IL-4, DAO, D-LA, LPS, and TGF-ß1 were downregulated. L. plantarum ELF051 combined with Astragalus polysaccharides elevated the expression of tight junction (TJ) proteins, facilitating intestinal mucosal repair via Smad signaling nodes. Furthermore, their combination effectively increased the relative abundance of lactic acid bacteria (LAB) and Allobaculum, and decreased the relative abundance of Bacteroides and Blautia. Spearman rank correlation analysis demonstrated that LAB were closely related to permeability factors, immune factors, and indicators of intestinal barrier function. In summary, the effect of combining L. plantarum ELF051 and Astragalus polysaccharides on AAD mice was achieved by enhancing intestinal barrier function and regulating the composition of the gut microbiota.

Development of an indirect ELISA for the serologic detection of bovine viral diarrhea virus based on E2 antigen sub-genotypes 1b, 1e, and 1d.

Bovine viral diarrhea virus (BVDV) causes ongoing economic losses to cattle industries, directly through reduced herd performance or indirectly through control program costs. ELISA assays, one of the most widely used techniques due to their ease of implementation, have been a valuable tool for mass surveillance and detection of BVDV. In this study, we developed a new indirect ELISA (rE2-ELISA) for serologic detection of BVDV. The assay considers three recombinant E2 protein subtypes as antigens, allowing serologic diagnosis of BVDV-1b (high prevalence worldwide), BVDV-1d and 1e (high prevalence in southern Chile) sub-genotypes. Recombinant E2 (rE2) proteins were successfully expressed in stably transfected CHO cells. Conditions for rE2 ELISAs were established after determining appropriate concentrations of antigen, blocking agent, secondary antibody, and serum dilutions to achieve maximum discrimination between positive and negative serum samples. The developed rE2-ELISA showed a sensitivity of 92.86% and a specificity of 98.33%. Clinical testing of 180 serum samples from herds in southern Chile showed high accuracy (kappa > 0.8) compared to the commercial BVDV Total Ab kit (IDEXX), with 95.37% positive and 87.5% negative predictive value. In addition, the rE2 ELISA has shown the capability to detect anti-BVDV antibodies from naturally infected animals with sub-genotypes 1b, 1e, or undetermined. These results indicate that the developed indirect ELISA could serve as a valid, and efficient alternative for identifying BVDV-infected animals, thus contributing to the success of disease control and eradication programs.

A parasite that should not be neglected in geriatric individuals: Entamoeba histolytica.

OBJECTIVES: To highlight the importance of neglected Entamoeba histolytica (E. histolytica) infections in the geriatric age group, which is an increasing proportion of the world's population. METHODS: This study was carried out between January 2022 and December 2023 at Van Yüzüncü Yil University, Faculty of Medicine, Parasitology Laboratory, Van, Turkey. The study included 96 geriatric patients with diarrhea (geriatric group). Two different control groups (CGs) were also included in the study, comprising 92 patients aged 18-64 years with diarrhea as CG1 and 50 geriatric individuals without diarrhea and other gastrointestinal complaints as CG2. Samples were analysed macroscopically and then evaluated by microscopic, enzyme-linked immunoassay, and polymerase chain reaction. RESULTS: This study detected E. histolytica in 31.3% of the geriatric group and 14.1% of the patients in CG1 (p=0.004). Entamoeba histolytica positivity was not detected in CG2. According to the multiple correspondence analysis, there was a close association between E. histolytica positivity and bloody diarrhea and mucous diarrhea in the geriatric patients. It was also determined that E. histolytica can cause abdominal pain, abdominal distension, and epigastric tenderness in geriatric patients. CONCLUSION: Both the risk of E. histolytica infection and the pathogenicity of the infection increase in geriatric individuals. Therefore, it was concluded that amoebiasis is a serious health problem in the geriatric population and should not be neglected.

Foodborne Bacterial Pathogens in Animal, Food, and Environmental Samples Collected From the Physical Exposure of Children With Diarrhea in Ethiopia: A One Health Approach.

Foodborne pathogens (FBPs) are transmitted principally through the consumption of contaminated food or drinking water and pose a remarkable public health risk, particularly in low-income countries. A cross-sectional study was conducted between November 2021 and January 2023 to estimate the prevalence, co-occurrence, and monthly patterns of FBPs in the physical exposures of children with diarrhea in Harar town and Kersa district, Ethiopia. Animal, food, and environmental samples were collected from direct or indirect contact sites of children with diarrhea. The isolation and identification of FBPs, including nontyphoidal Salmonella (NTS), diarrheagenic E. coli (DEC), and Shigella, was performed using selective and deferential culture media and a series of biochemical tests. Among the 438 analyzed samples, the overall prevalence of these pathogens was 18.3%, with 3.9% co-occurrence and 14.4% single pathogen occurrence rates. The highest prevalence was observed in wastewater (40.9%; AOR = 3.3; 95% CI: 1.1-10.1). The pathogen detection rate in food was 17.9% (AOR = 1.2; 95% CI: 0.4-3.6), with no significant difference between animal-sourced and other food categories. The occurrence rates of NTS, DEC, and Shigella in the meat samples were 13.9%, 5.4%, and 6.5%, respectively. Interestingly, DEC and Shigella were detected in cooked food. Moreover, Shigella was detected in drinking water (5%) and other water sources (10%). A significantly higher prevalence of FBPs was detected in poultry than in cattle and camel feces. This study revealed fluctuations in the monthly occurrence patterns of FBPs, with a peak of 37.1% during the dry season. In conclusion, the study revealed a high prevalence of FBPs, with no significant differences between rural and urban areas or food and water sources, highlighting the need for food safety measures in both settings. Further studies with larger sample sizes and advanced diagnostics are recommended to determine the relative contribution of each source.

Caretaker's Knowledge, Attitudes, and Practices Regarding the Causes, Treatments, and Risks of Diarrhea Among Under-Five Children in North-Eastern Tanzania: A Cross-Sectional Study.

Background. Pediatric diarrhea remains a public health concern. This study explored caretaker's knowledge, attitudes, and practices regarding the causes, treatments, and risks of diarrhea among under-fives in Korogwe and Handeni districts, north-eastern Tanzania. Methods. We conducted a qualitative, cross-sectional study. Participants were selected through purposive sampling. Data were gathered through in-depth interviews and focus group discussions, and they were analyzed using thematic analysis. Results. Most participants had good knowledge about the risks of diarrhea among under-fives. However, most participants had poor knowledge of the causes and treatments of diarrhea. A significant proportion of participants had negative attitudes and poor practices about the treatment of diarrhea. A small percentage of participants possessed positive attitudes and appropriate practices for managing diarrhea. Conclusion. To bridge the knowledge gaps among caretakers and promote positive attitudes and behaviors about the management of diarrheal diseases, health authorities are urged to strengthen health education in the study communities.

Case Report: Cronkhite-Canada syndrome: presentation of a pediatric case and review of the literature.

Background: Cronkhite-Canada syndrome (CCS) is extremely rare in children, presenting with complex clinical manifestations often leading to misdiagnosis. Case presentation: We reported a description of a 13-year-old boy with CSS presenting with persistent diarrhea, vomiting, abdominal pain, along with symptoms of weight loss, alopecia, and skin hyperpigmentation. The patient had ectodermal manifestations such as alopecia and skin hyperpigmentation. Laboratory tests revealed hypoalbuminemia, normal inflammatory indicators, positive anti-dsDNA antibodies, anti-centromere antibodies, and anti-nuclear antibodies. Gastrointestinal endoscopy identified polypoid changes in the stomach, duodenum, and colon, with pathology indicating glandular dilation, cryptitis, and crypt abscesses. Treatment with prednisone led to significant improvement in symptoms, including normalization of stool consistency, hair regrowth, and disappearance of skin hyperpigmentation. Conclusion: This study emphasizes the importance of comprehensive assessment, endoscopic examination, histological biopsy, and the effectiveness of steroid therapy in the diagnosis and management of CCS in children. In children presenting with diarrhea, abdominal pain, weight loss, polyposis, and ectodermal manifestations, CCS should be considered.

Stress triggers irritable bowel syndrome with diarrhea through a spermidine-mediated decline in type I interferon.

Irritable bowel syndrome with diarrhea (IBS-D) is a common and chronic gastrointestinal disorder that is characterized by abdominal discomfort and occasional diarrhea. The pathogenesis of IBS-D is thought to be related to a combination of factors, including psychological stress, abnormal muscle contractions, and inflammation and disorder of the gut microbiome. However, there is still a lack of comprehensive analysis of the logical regulatory correlation among these factors. In this study, we found that stress induced hyperproduction of xanthine and altered the abundance and metabolic characteristics of Lactobacillus murinus in the gut. Lactobacillus murinus-derived spermidine suppressed the basal expression of type I interferon (IFN)-α in plasmacytoid dendritic cells by inhibiting the K63-linked polyubiquitination of TRAF3. The reduction in IFN-α unrestricted the contractile function of colonic smooth muscle cells, resulting in an increase in bowel movement. Our findings provided a theoretical basis for the pathological mechanism of, and new drug targets for, stress-exposed IBS-D.

Safety and Tolerability of CP101, a full spectrum, oral microbiome therapeutic for the prevention of recurrent C. difficile infection: A Phase 2 Randomized Controlled Trial.

BACKGROUND AND AIMS: Recurrent Clostridioides difficile infections (CDI) remain common. While novel microbiome therapeutics gain approval, the efficacy of a full spectrum, oral microbiome therapeutics is unknown. This study aimed to determine the safety and efficacy of CP101, an orally administered microbiome therapeutic, to restore a diverse microbiome and prevent recurrent CDI in a broad population. METHODS: We conducted a multi-center, phase 2, double-blind, randomized, placebo-controlled trial in adults with recurrent CDI. Participants with one or more CDI recurrences and diagnosis by PCR or toxin EIA for the qualifying episode were included. Participants were randomized 1:1 to receive a single oral dose of either CP101 (∼ 6 x 1011 CFU of lyophilized microbial cells) or placebo after standard-of-care (SOC) antibiotics. The primary efficacy endpoint was the proportion of participants without CDI recurrence through Week 8. Safety, efficacy and microbiome endpoints were evaluated through Week 8 and 24. RESULTS: 198 participants were analyzed; CP101 (n=102) and placebo (n=96). Overall, 27.5% with a first recurrence and 62.7% diagnosed by PCR-based testing. The proportion without CDI recurrence through Week 8 was significantly higher in the CP101 group compared to placebo (74.5% [76/102] vs 61.5% [59/96], p=0.0488) with durable efficacy observed through Week 24 (73.5% [75/102] vs 59.4% [57/96], p=0.0347). Similar efficacy was observed regardless of diagnostic modality or number of CDI recurrences. Rapid and durable increase in microbiome diversity was observed in the CP101 group compared to placebo. The incidence of adverse events was similar between the two groups. CONCLUSIONS: CP101 was superior to placebo in reducing recurrent CDI with a safety profile similar to placebo. https://clinicaltrials.gov/study/NCT03110133.

Investigation of the diagnostic and prognostic importance of Tumor Necrosis Factor-alfa (TNF-α), Procalcitonin (PCT), Interleukin-6 (IL-6) and Haptoglobin (HP) in calves with neonatal diarrhea.

This study aims to investigate the effects of Procalcitonin, Tumor Necrosis Factor-alpha, Interleukin-6, and Haptoglobin levels on the prognosis of calves classified according to the severity of diarrhea. The animal material comprised 48 diarrheic calves of different breeds and sexes, aged 1-30 days, and 16 healthy calves aged 1-30 days. The 48 diarrheic calves used were divided into 3 groups, each consisting of 16 calves. Group 1 was designed as Viral (Rota + Corona n = 16), Group 2 as Bacterial (E. coli n = 16), and Group 3 as Parasitic (Cryptosporidiosis n = 16). Each of these groups was further divided into 2 subgroups (moderate and severe subgroups). Blood samples were taken from the diarrheic calves before treatment (0 h) and at 24 and 72 h after treatment. Complete blood count, biochemical, blood gas analyses, and ELISA tests were performed. It was determined that 18.75 % (9/48) of the 48 diarrheic calves included in the study died, while 81.25 % (39/48) survived. The highest mortality rate among the patient groups was observed in the severe rota + corona group (37.5 %). The average PCT concentration in the diarrheic calves in the Rota-corona and E. coli groups at 0 and 24 hours was found to be higher than both the healthy calves and the diarrheic calves in the Cryptosporidium spp. group (P<0.001). This increase was also observed in the Cryptosporidium spp. group at 72 h (P<0.001). A positive and moderate correlation was observed between Procalcitonin and TNF-α (r = 0.603, P<0.001). As a result, it was concluded that the Procalcitonin value, along with other tests, could be used as a biomarker to determine the prognosis of the disease in diarrheic calves, regardless of the etiological agent. This study was evaluated as an original study in which cytokines and acute phase proteins were investigated before and after treatment, with diarrhea divided into subgroups.

Clinical Transplant Kidney Function Loss Due to Small Intestinal Bacterial Overgrowth.

Small intestinal bacterial overgrowth (SIBO) is a clinical syndrome involving gastrointestinal symptoms caused by the presence of excessive bacteria in the small intestine. SIBO often leads to diarrhea and poses diagnostic and treatment challenges. Here, we report about a renal transplant recipient who experienced diarrhea-induced hypovolemic shock due to SIBO, necessitating the reintroduction of dialysis, and aim to provide insights to aid health-care providers in diagnosing and managing severe diarrhea in this specific patient group. A 14-year-old boy, who had undergone renal transplantation at the age of 2 years, experienced severe, recurring diarrhea leading to hypovolemic shock. The patient underwent volume loading and continuous hemodiafiltration. Upper gastrointestinal endoscopy findings suggested Whipple's disease. Antibiotics were initiated; however, the diarrhea did not improve. Examinations for infectious enteritis and food allergies yielded negative results. The diarrhea improved with rifaximin (RFX), but recurred repeatedly after its discontinuation. Antibiotic rotation, wherein RFX, amoxicillin hydrate and potassium clavulanate, ciprofloxacin, and RFX were administered in this order for 4 weeks each, improved the diarrhea. A lactulose breath test performed immediately before the second RFX course yielded negative results. The patient's condition was diagnosed as SIBO based on the clinical course, although the diagnostic criteria were not met. SIBO should be considered in cases of gastrointestinal symptoms in patients with transplanted kidneys. Antibiotic rotation should be considered for SIBO treatment in immunosuppressed patients.

A case report of IPEX syndrome in Palestine: detailed family identification and breadth of disorders with the same defect.

Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is a monogenic disorder characterized by multi-systemic autoimmunity secondary to loss-of-function mutations in the gene coding the forkhead box P3 (FOXP3) transcription factor which is important for the development, maturation, and maintenance of CD4 + regulatory T (T-reg) cells. Fewer than 300 affected individuals have been identified worldwide. The occurrence of IPEX is below 1:1,000,000. Herein we present a case of a 15-day-old male who was admitted to NICU 15 days after delivery due to respiratory distress. He was found to have metabolic acidosis due to DKA. During his stay in the NICU, he experienced seizures and was intubated for a month. He was diagnosed with neonatal diabetes. He also experienced recurrent respiratory infections and multiple episodes of diarrhea rash, and meningitis. At the age of 7 months, genetic testing confirmed IPEX with FOXP3 mutation, specifically the p.(Pro75Leu) variant of the FOXP3 gene. Subsequently, multiple family members were diagnosed. The unique variability observed in organ involvement and presentation timing among individuals within the same family, despite carrying an identical mutation, is a distinctive aspect, particularly considering the monoallelic expression of the FOXP3 gene in males. This phenomenon strongly suggests the presence of modifying genes that play a significant role in the pathogenesis of IPEX syndrome. The case presentation underscores the importance of clinical suspicion of IPEX in cases of neonatal DM. It also highlights the challenges associated with managing rare genetic disorders in pediatric patients. It also emphasizes that the IPEX genotype has a wide phenotype. This case is considered the first documented case of IPEX in Palestine.

Effects of opium tincture on gastrointestinal function and motility in healthy volunteers: A magnetic resonance imaging study.

BACKGROUND: Opioids inhibit motility and secretion of the gut and have been used for antidiarrheal treatment for centuries. However, the underlying mechanisms of opium tincture are not evident. AIM: To investigate the effects of opium tincture on gastrointestinal motility, intestinal volumes, and water content of different gut segments assessed by magnetic resonance imaging (MRI). METHODS: Twenty healthy volunteers were included in a randomized, placebo-controlled, crossover study of 9 days of treatment with 30 drops of opium tincture per day. MRI was performed on day 1 (before treatment) and day 9 (during treatment). Measurements included assessments of gastric volume, gastric emptying, gastric motility, small bowel volume, small bowel water content, small bowel motility, colon volume, colon water content, and whole gut transit. KEY RESULTS: Opium tincture delayed gastric emptying by a mean difference of 5.6 min [95% CI: 1.8-9.4], p = 0.004, and increased postprandial gastric meal volume (17-21%, p = 0.02). Small bowel endpoints did not change. Opium tincture delayed whole gut transit time (p = 0.027) and increased ascending colon volume by 59 mL [95% CI: 15-103], p = 0.004, and transverse colon volume by 48 mL [95% CI: 4-92], p = 0.027. T1-relaxation time of the descending colon chyme was decreased during opium treatment, indicating dryer feces (difference: -173 ms [95% CI: -336 -11], p = 0.03). CONCLUSION AND INFERENCES: Opium tincture induced changes in the stomach and colon in healthy volunteers. An improved understanding of how opioids affect gut functions may lead to a better understanding and optimized management of diarrhea.