Effect of household water treatment with chlorine on diarrhea among children under the age of five years in rural areas of Dire Dawa, eastern Ethiopia: a cluster randomized controlled trial.

BACKGROUND: Diarrheal disease is a leading cause of child mortality and morbidity worldwide. Household water treatment with chlorine significantly reduces morbidity due to waterborne diseases. However, the effect of point-of-use (POU) water treatment in improving the quality of water in areas where POU is not provided free of charge and the effectiveness of home visits in inspiring household members to use POU regularly have not been studied. The objective of this study was to evaluate the effectiveness of drinking water disinfection by chlorination on diarrheal disease reduction among children under the age of 5 years in rural eastern Ethiopia. METHODS: A cluster randomized controlled trial was carried out in rural Dire Dawa from October 2018 through January 2019. The 405 households were randomized to intervention and control arms and intervention materials were distributed after conducting a baseline survey. This trial evaluated the effectiveness of household drinking water disinfection by chlorination in reducing incidence of diarrhea among children under the age of 5 years. Intervention households received 1.2% sodium hypochlorite with demonstration of its proper use. Participants in the control households continued with their usual habits of water collection and water storage. Generalized estimation equation (GEE) with log link Poisson distribution family and exchangeable correlation matrix was used to compute crude incidence rate ratio (IRR), adjusted IRR and the corresponding 95% confidence intervals. RESULTS: In the intervention households, in total, 281 cases of diarrhea were documented (8.7 cases per 100 person-weeks observation); in the control households, in total 446 cases of diarrhea were documented (13.8 cases per 100 person-weeks observation). A 36.0% (adjusted IRR = 0.64, 95% CI: 0.57-0.73) reduction in incidence of diarrhea was observed in the intervention arm when compared with the control arm. The highest and the lowest reductions were obtained in children of age ranges 1 to 2 years and 3 to 4 years, 42.7 and 30.4%, respectively. Adherence to the intervention was 81.3% as measured by free residual chlorine test. CONCLUSIONS: In rural areas where diarrhea is the second leading cause of morbidity, water chlorination at the household level using liquid bleach considerably reduced episodes of diarrhea among children under the age of 5 years. Therefore, chlorinating drinking water at the household level may be a valuable interim solution for reducing the incidence of diarrheal diseases until potable water is made accessible to the majority of the population in Dire Dawa Administration and other Ethiopian communities. TRIAL REGISTRATION: PACTR, PACTR201807815961394. Registered 16 July 2018, www.pactr.org.

[The multifunctional therapy of various forms of irritable bowel syndrome]. / Mnogofunktsional'naya terapiya pri razlichnykh formakh sindroma razdrazhennogo kishechnika.

Irritable bowel syndrome (IBS) is a pathological condition characterized by heterogeneous etiology, pathogenesis, and clinical symptoms. These characteristics dictate the necessity of prescribing multiple medications for the treatment of IBS. Such compulsory polypharmacy inadvertently enhances the risk of adverse reactions to the treatment, increases its cost, and impairs compliance on the part of the patients. The objective of the present study was to evaluate the effectiveness of the administration of the clorine-bromine brine with the use of sinusoidal modulated current electrophoresis (SMC-phoresis) for the treatment of different forms of IBS. THE PATIENTS AND METHODS: We examined and treated 80 patients with different forms of IBS. The patients were divided into two equal groups comprised of 40 patients each. The patients of the study group were treated with the use of SMС-phoresis of the bromine-chlorine brine based at the «Varzi-yatchi¼ spa and health resort (the Udmurt Republic) making use of the sparing or stimulating techniques depending on the type of IBS. Each therapeutic course consisted of 10-12 sessions. The patients in the group of comparison received the standard pharmaceutical treatment for IBS (myotropic anti-spasmodics and lactulose). The emphasis was laid on the evaluation of dynamics of the intestinal motor function in different variants of IBS with the use of the EGS-4M apparatus based on the GSRS questionnaire (Gastrointestinal Symptom Rating Scale). Special attention was given to the interpretation of the main gastrointestinal syndromes and the evaluation of the quality of life of the patients in the course of the treatment and after its completion. RESULTS: Тhe main symptoms of IBS after a course of SMC-phoresis with the natural brine were significantly less pronounced compared to those in the patients managed by means of standard pharmacotherapy. Positive dynamics in the clinical picture of the disease had beneficial influence on the quality of life of the patients which approached that of the healthy subjects in the group of comparison. The results of colonography suggested the presence of various types of disturbances of motor function of the intestines. SMC-phoresis of the natural chlorine-bromine brine had a positive influence on dyskinesia associated with diarrhea and constipation associated with IBS, while the effect of the standard pharmaceutical treatment was unidirectional and significantly inferior to it in terms of efficiency. CONCLUSION: The use of complementary therapy can provide a better clinical outcome of IBS and to a greater extent improve the quality of life of the patients presenting with various forms of this pathology.

Use of household bleach for emergency disinfection of drinking water.

Household bleach is typically used as a disinfectant for water in times of emergencies and by those engaging in recreational activities such as camping or rafting. The Centers for Disease Control and Prevention recommend a concentration of free chlorine of 1 mg/L for 30 minutes, or about 0.75 mL (1/8 teaspoon) of household bleach per gallon of water. The goal of the study described in this article was to assess two household bleach products to kill waterborne bacteria and viruses using the test procedures in the U.S. Environmental Protection Agency's Guide Standard and Protocol for Testing Microbiological Purifiers. Bleach was found to meet these requirements in waters of low turbidity and organic matter. While the test bacterium was reduced by six logs in high turbid and organic-laden waters, the test viruses were reduced only by one-half to one log. In such waters greater chlorine doses or contact times are needed to achieve greater reduction of viruses.

Prevalence of dental erosion in adolescent competitive swimmers exposed to gas-chlorinated swimming pool water.

OBJECTIVES: The purpose of this study was to analyze the prevalence of dental erosion among competitive swimmers of the local swimming club in Szczecin, Poland, who train in closely monitored gas-chlorinated swimming pool water. MATERIALS AND METHODS: The population for this survey consisted of a group of junior competitive swimmers who had been training for an average of 7 years, a group of senior competitive swimmers who had been training for an average of 10 years, and a group of recreational swimmers. All subjects underwent a clinical dental examination and responded to a questionnaire regarding aspects of dental erosion. In pool water samples, the concentration of calcium, magnesium, phosphate, sodium, and potassium ions and pH were determined. The degree of hydroxyapatite saturation was also calculated. RESULTS: Dental erosion was found in more than 26 % of the competitive swimmers and 10 % of the recreational swimmers. The lesions in competitive swimmers were on both the labial and palatal surfaces of the anterior teeth, whereas erosions in recreational swimmers developed exclusively on the palatal surfaces. Although the pH of the pool water was neutral, it was undersaturated with respect to hydroxyapatite. CONCLUSION: The factors that increase the risk of dental erosion include the duration of swimming and the amount of training. An increased risk of erosion may be related to undersaturation of pool water with hydroxyapatite components. CLINICAL RELEVANCE: To decrease the risk of erosion in competitive swimmers, the degree of dental hydroxyapatite saturation should be a controlled parameter in pool water.

Analysis of the effectiveness of different hygiene procedures used in dental prostheses.

PURPOSE: To compare the effectiveness of bacterial plaque removal of six denture hygiene procedures used by patients to clean their dentures. MATERIALS AND METHODS: Fifteen students randomly divided into groups G1, G2, G3, G4, G5 and G6 used maxillary intraoral appliances for 24 h without cleaning them. Afterwards, the appliances were submitted to the following procedures: P1: washing under running water for 20 s; P2 and P3: cleaning with alkaline peroxide (Corega Tabs®) for 5 and 30 min, respectively; P4: brushing with water and liquid soap for 40 s; P5: alkaline hypochlorite for 10 minutes; P6: home use chlorine solution (Q'boa® at 0.45% for 10 min), throughout a period of 6 consecutive weeks. The procedures followed a circulating scheme, so that all the appliances were submitted to all the hygiene methods studied. After the hygiene procedures, the appliances were stained, photographed and submitted to the weighing method. RESULTS: After ANOVA and Tukey's test, differences were observed: P5 = 0.73 ± 0.3 (b), P6 = 1.27 ± 0.4(b,c), P4 = 1.92 ± 0.5 (b,c), P3 = 2.24 ± 1.0 (b,c), P2 = 7.53 ± 2.5 (c) and P1 = 26.86 ± 15. 3 (a). CONCLUSION: From the results of the study, it could be concluded that the use of alkaline hypochlorite is the best way to remove bacterial plaque, followed by the home-use chlorine solution and brushing with water and liquid soap. Corega Tabs® must be used for 30 min of immersion to have a cleaning effectiveness similar to that of alkaline hypochlorite.

Possible antioxidant role of SPA therapy with chlorine-sulphur-bicarbonate mineral water.

The aim of our research was to analyze the antioxidant role and efficacy of thermal or salus per aquam (spa) therapy with chlorine-sulphur-bicarbonate mineral water. The study has been performed on 30 rats. The animals were randomized in three groups, each of them composed by ten animals, denominated A, B and C. The A group was the control group and was not subjected to any specific treatment (placebo); the B group has been treated with a standard cycle of hydropinics treatment with mineral water of Therme of Stabia in Castellammare (Naples, Italy) denominated STABIA; the C group was treated with a standard cycle of hydropinic treatment with mineral water of Therme of Stabia in Castellammare (Naples, Italy) denominated SULFUREA. After two weeks of treatment all the rats were sacrificed and blood was collected for the plasmatic determination of reactive oxygen species (ROS). The results demonstrated a significant (P < 0.05) reduction of ROS in B (374 Carr. U. +/-73) and C group (399 carr. U. +/-62) treated with mineral waters if compared with control group (571 + 69 Carr. U.). In conclusion this study suggests a possible antioxidant effect of chlorine-sulphur-bicarbonate spa hydropinic treatment with a consequent suitable intestinal physiology, with reduction of the functional and organic modifications that can lead to pathological disorders of the gastroenteric diseases in whose pathogenesis the oxidative stress can develop an important role.

Valores de trihalometanos en agua de consumo de la provincia de Granada, España / Trihalomethane levels in drinking water in the province of Granada [Spain]

Objetivos: La cloración del agua da lugar a la formación desubproductos potencialmente dañinos para la salud, entre elloslos trihalometanos, que se han hallado elevados en algunaszonas de España. En este estudio se investigan los valoresde trihalometanos en el agua de consumo suministrada porvarios sistemas de abastecimiento de la provincia de Granada,en el área de actuación de la cohorte madres-hijos de laRed INMA (Infancia y Medio Ambiente).Métodos: Se analizaron 82 muestras de agua de consumoen dos campañas de muestreo en invierno y verano de 2006.Se determinó la concentración de cloroformo, bromodiclorometano,dibromoclorometano y bromoformo, siguiendo un procedimientooptimizado basado en cromatografía de gases yespectrometría de masas.Resultados: El rango de concentración de trihalometanos totalesse situó entre 0,14 y 18,75 g/l en la campaña de inviernoy entre 0,01 y 31,87 g/l en la de verano. El compuestomayoritario fue cloroformo. La concentración media de trihalometanosen agua de origen superficial y subterráneo fue de10,13 y 1,41 g/l, respectivamente.Conclusiones: Los valores de trihalometanos encontradosson muy inferiores a la concentración máxima admisible (100g/l) establecida por la Unión Europea para estos compuestos.Estos valores varían significativamente según el origendel agua, con mayores concentraciones en áreas urbana ysemiurbana, donde el agua es mayoritariamente de origen superficial.La presencia de trihalometanos en la zona es menora la descrita en otras regiones españolas(AU)

Objectives: Drinking water chlorination generates potentiallyharmful by-products, such as trihalomethanes. Trihalomethanelevels are high in some parts of Spain. The aim of the presentstudy was to investigate trihalomethane concentrationsin drinking water from distinct water supplies in the provinceof Granada, within the framework of the Childhood and Environment(INMA) study.Methods: Eighty-two tap water samples were collected in twocampaigns during the winter and summer of 2006. An optimizedprocedure based on gas chromatography and massspectrometry was used to determine concentrations of chloroform,bromodichloromethane, dibromochloromethane, andbromoform in the samples.Results: Total trihalomethane concentrations ranged from 0.14to 18.75 g/l in winter samples and from 0.01 to 31.87 g/lin summer samples. The most abundant compound waschloroform. Mean trihalomethane concentrations were 10.13in surface waters and 1.41 g/l in ground waters.Conclusions: The trihalomethane levels found were considerablybelow the maximum permitted level of 100 g/l in the European Union. The values obtained varied widely accordingto the type of water source: the highest concentrations werefound in urban and sub-urban areas, where the water is largelyof surface origin. The presence of trihalomethanes waslower than that reported in other Spanish regions(AU)

[Effect of chlorine-sodium hydrocarbonate mineral water on the gastric secretory function in subjects with various daily motor activity patterns].

Effect of Shadrinskaya ID mineral water on the gastric secretory function was evaluated in wrestlers and subjects unengaged in sports activities. Characteristics of the observed functional response of the digestive system provided a deeper insight into the mechanisms by which mineral water along with the controlled muscular load acts on the secretory performance of the stomach. Specific changes of the gastric secretory function at rest and in the veloergometer test were documented in subjects with different patterns of daily motor activity. The knowledge of mechanisms of muscular tension and optimal ways to use mineral water may help to prevent negative manifestations of emotional and physical stress in athletes.

A multifactorial investigation of the ability of oral health care products (OHCPs) to alleviate oral malodour.

UNLABELLED: AIM, BACKGROUND: Oral malodour (halitosis) is generally ascribable to oral microbial putrefaction generating malodorous volatile sulphur compounds which predominantly comprise dihydrogen sulphide and methyl mercaptan. This study assesses the relative effectiveness of 6 oral health care products in reducing oral cavity volatile sulphur compound concentrations. METHOD: A mixed model 3-factor factorial experimental design involving 6 volunteers, 7 treatment regimens (products I-VI* and water placebo) and 5 time-points (0.00-5.29 h) was undertaken. Electron-donating volatile sulphur compound levels were determined in triplicate using a sulphide monitor (Interscan model 1170) both prior to (0.00 h) and following oral rinsing (20 ml of 5 of the products) or chewing (2 capsules of the remaining product) episodes with each product examined (0.29, 1.29, 2.29 and 5.29 h post-administration). RESULTS: Results were recorded as peak and steady-state volatile sulphur compound equivalents (ppb). With the exception of one of the products, each oral health care product tested was found to reproducibly reduce volatile sulphur compound concentrations within 20 min of treatment; the mean % decreases in peak (and corresponding steady-state) levels ranging from 3.6 (0.0) to 16.8 (16.4)%. Subsequently, volatile sulphur compound concentrations returned to their zero-control (baseline) values within 5 h, the rate of this regression being in the reverse of the order observed for the magnitude of the primary 20 min reduction for both peak and steady-state measurements. As expected, the water placebo exerted no influence on oral cavity volatile sulphur compound levels. The most effective oral health care products contained admixtures of chlorite anion and chlorine dioxide (both of these agents have the ability to directly oxidise volatile sulphur compounds to non-malodorous products and the latter is also powerfully cidal towards odourigenic micro-organisms). CONCLUSIONS: We therefore conclude that oral health care products containing such oxohalogen oxidants may provide a useful therapeutic strategy for the treatment of oral malodour.

Cleaning effectiveness of root canal irrigation with electrochemically activated anolyte and catholyte solutions: a pilot study.

AIM: The aim of this study was to evaluate the potential of electrochemically activated (ECA) anolyte and catholyte solutions to clean root canals during conventional root canal preparation. METHODOLOGY: Twenty extracted single-rooted human mature permanent teeth were allocated randomly into four groups of five teeth. The pulp chambers were accessed and the canals prepared by hand with conventional stainless steel endodontic instruments using a double-flared technique. One or other of the following irrigants was used during preparation: distilled water, 3% NaOCl, anolyte neutral cathodic (ANC) (300 mg L-1 of active chlorine), and a combination of anolyte neutral cathodic (ANC) (300 mg L-1 of active chlorine) and catholyte. The teeth were split longitudinally and the canal walls examined for debris and smear layer by scanning electron microscopy. SEM photomicrographs were taken separately in the coronal, middle and apical parts of canal at magnification of x800 to evaluate the debridement of extracellular matrix and at a magnification of x2500 to evaluate the presence of smear layer. RESULTS: Irrigation with distilled water did not remove debris in the apical part of canals and left a continuous and firm smear layer overlying compressed low-mineralized predentine. All chemically active irrigants demonstrated improved cleaning potential compared to distilled water. The quality of loose debris elimination was similar for NaOCl and the anolyte ANC solution. The combination of anolyte ANC and catholyte resulted in improved cleaning, particularly in the apical third of canals. The evaluation of smear layer demonstrated that none of the irrigants were effective in its total removal; however, chemically active irrigants affected its surface and thickness. Compared to NaOCl, the ECA solutions left a thinner smear layer with a smoother and more even surface. NaOCl enhanced the opening of tubules predominantly in the coronal and middle thirds of canals, whereas combination of ANC and catholyte resulted in more numerous open dentine tubules throughout the whole length of canals. CONCLUSIONS: Irrigation with electrochemically activated solutions cleaned root canal walls and may be an alternative to NaOCl in conventional root canal treatment. Further investigation of ECA solutions for root canal irrigation is warranted.

Mouthrinses as adjuncts in periodontal therapy.

Periodontal diseases are a group of related inflammatory disorders, initiated by dental plaque and causing destruction of the supporting structures of the teeth. Although the inflammatory response is a fundamental defence mechanism against bacterial infection, its persistence over a long period of time may extensively damage the periodontal tissues: cementum, alveolar bone, periodontal ligament and dentogingival tissues. These disorders, despite recent improvements in oral health are still a major cause of tooth loss in patients over 35 years of age.