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1.
BMC Gastroenterol ; 22(1): 406, 2022 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-36058908

RESUMO

BACKGROUND: Common variable immunodeficiency (CVID) is a rare disease that affects children and adults and is often difficult to diagnose. Despite being one of the most frequent causes of immunodeficiency, involving gastrointestinal (GI), respiratory, and hematological systems, the disease onset can have heterogeneous and intermittent symptoms, frequently leading to diagnostic delay. GI symptoms are common and can include diarrhea, but the asymptomatic periods lead to overlooking the recurrent pattern. The same can occur with respiratory infections, thus delaying CVID suspicion. The starting point for CVID diagnosis is the decreased gamma globulin levels in serum protein electrophoresis (SPE), also observed through direct immunoglobulin's dosage. CASE PRESENTATION: The patient is a 38 years-old man who had intermittent diarrhea and recurrent airway infections for 19 years, but the CVID diagnosis was achieved only after SPE was carried out. At that time, he was already malnourished, and developed other complications related to CVID in a short period. CONCLUSIONS: SPE is readily available and inexpensive, but is not part of the laboratory approach in diarrhea. According to the case presented herein, it can be useful for patients with recurrent infections or other clues of the disease.


Assuntos
Imunodeficiência de Variável Comum , Diagnóstico Tardio , Adulto , Proteínas Sanguíneas , Imunodeficiência de Variável Comum/complicações , Imunodeficiência de Variável Comum/diagnóstico , Diagnóstico Tardio/efeitos adversos , Diarreia/etiologia , Eletroforese , Humanos , Masculino
3.
Rev Med Suisse ; 18(793): 1578-1583, 2022 Aug 31.
Artigo em Francês | MEDLINE | ID: mdl-36047547

RESUMO

Chronic diarrhea is defined by a decrease in stool consistency and a bowel frequency of more than 3 times per day, lasting for at least 4 weeks. Multiple underlying causes may be responsible for chronic diarrhea. There are four main pathomechanisms for chronic diarrhea: osmotic diarrhea, secretory diarrhea, infectious diarrhea and bowel dysmotility. Overlaps between these mechanisms may exist. A stool collection over a 72-hour period frequently allows to classify diarrhea into one of these four entities. Such classification finally helps for the identification of underlying cause(s), thereby allowing rational diagnostic measures. It also limits the costs of diagnostic workup. This article aims to present the main causes of chronic diarrhea, the diagnostic steps to perform and to provide a guideline for clinicians in daily practice.


La diarrhée chronique est définie par une diminution de la consistance des selles (défaites à liquides) et par une émission de selles supérieure à 3 ×/jour pendant plus de 4 semaines. Les raisons peuvent être multiples. Quatre pathomécanismes peuvent être à l'origine de la diarrhée chronique : osmotique, sécrétoire, inflammatoire et motrice. Des chevauchements entre ces mécanismes peuvent exister. La récolte de selles pendant 72 heures permet, dans la majorité des cas, de clarifier la physiopathologie des diarrhées et donc d'identifier la cause sous-­jacente permettant d'effectuer des mesures diagnostiques rationnelles et de limiter les coûts. Cet article a pour objectif de présenter les principales causes de diarrhée chronique, d'énumérer les étapes diagnostiques à réaliser et de donner une ligne directrice aux cliniciens dans la pratique quotidienne.


Assuntos
Diarreia , Gastroenteropatias , Doença Crônica , Diagnóstico Diferencial , Diarreia/diagnóstico , Diarreia/etiologia , Gastroenteropatias/diagnóstico , Humanos
5.
Eur J Gastroenterol Hepatol ; 34(9): 925-932, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35913778

RESUMO

INTRODUCTION: Post-coronavirus disease (post-COVID) symptoms arise mostly from impaired function of respiratory tract although in many patients, the dysfunction of gastrointestinal tract and liver among other organ systems may persist. METHODS: Primary data collection was based on a short gastrointestinal symptom questionnaire at the initial screening. A brief telephone survey within the patient and control group was performed 5-8 months after the initial screening. R ver. 4.0.5 and imbalanced RandomForest (RF) machine-learning algorithm were used for data explorations and analyses. RESULTS: A total of 590 patients were included in the study. The general presence of gastrointestinal symptoms 208.2 days (153-230 days) after the initial acute severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection was 19% in patients with moderate-to-serious course of the disease and 7.3% in patients with mild course compared with 3.0% in SARS-CoV-2 negative controls (P < 0.001). Diarrhea and abdominal pain are the most prevalent post-COVID gastrointestinal symptoms. RF machine-learning algorithm identified acute diarrhea and antibiotics administration as the strongest predictors for gastrointestinal sequelae with area under curve of 0.68. Variable importance for acute diarrhea is 0.066 and 0.058 for antibiotics administration. CONCLUSION: The presence of gastrointestinal sequelae 7 months after the initial SARS-CoV-2 infection is significantly higher in patients with moderate-to-severe course of the acute COVID-19 compared with asymptomatic patients or those with mild course of the disease. The most prevalent post-COVID gastrointestinal symptoms are diarrhea and abdominal pain. The strongest predictors for persistence of these symptoms are antibiotics administration and acute diarrhea during the initial infection.


Assuntos
COVID-19 , Gastroenteropatias , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Antibacterianos/uso terapêutico , COVID-19/complicações , COVID-19/diagnóstico , Diarreia/diagnóstico , Diarreia/etiologia , Gastroenteropatias/diagnóstico , Gastroenteropatias/etiologia , Humanos , Estudos Prospectivos , SARS-CoV-2
7.
BMJ Case Rep ; 15(8)2022 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-35948360

RESUMO

Recurrent episodes of vomiting and diarrhoea in a child can present as a diagnostic dilemma and be easily misdiagnosed as recurrent viral gastroenteritis episodes. Primary adrenal insufficiency can present with recurrent episodes of vomiting and diarrhoea with the presence of metabolic acidosis and can be life-threatening if left undiagnosed and untreated. A high index of suspicion should be kept for diagnosing primary adrenal insufficiency in a child presenting with recurrent episodes of vomiting and diarrhoea with laboratory evidence of metabolic acidosis and hypoglycaemia. Primary adrenal insufficiency, in a male child specifically, should raise alarm for X-linked adrenoleukodystrophy (X-ALD). Very-long-chain fatty acids and confirmatory genetic testing for an ABCD1 gene mutation can help confirm the diagnosis. Addison's disease often presents prior to the onset of the cerebral form of X-ALD. Early diagnosis of X-ALD allows for MRI screening for the development of cerebral disease in its early stages when treatment with stem cell transplant can halt the disease and be lifesaving.


Assuntos
Doença de Addison , Adrenoleucodistrofia , Adrenoleucodistrofia/complicações , Adrenoleucodistrofia/diagnóstico , Criança , Diarreia/etiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Vômito/etiologia
10.
Lancet Oncol ; 23(9): 1189-1200, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35952709

RESUMO

BACKGROUND: TGF-ß is an immunosuppressive cytokine that is upregulated in colorectal cancer. TGF-ß blockade improved response to chemoradiotherapy in preclinical models of colorectal adenocarcinoma. We aimed to test the hypothesis that adding the TGF-ß type I receptor kinase inhibitor galunisertib to neoadjuvant chemoradiotherapy would improve pathological complete response rates in patients with locally advanced rectal cancer. METHODS: This was an investigator-initiated, single-arm, phase 2 study done in two medical centres in Portland (OR, USA). Eligible patients had previously untreated, locally advanced, rectal adenocarcinoma, stage IIA-IIIC or IV as per the American Joint Committee on Cancer; Eastern Cooperative Oncology Group status 0-2; and were aged 18 years or older. Participants completed two 14-day courses of oral galunisertib 150 mg twice daily, before and during fluorouracil-based chemoradiotherapy (intravenous fluorouracil 225 mg/m2 over 24 h daily 7 days per week during radiotherapy or oral capecitabine 825 mg/m2 twice per day 5 days per week during radiotherapy; radiotherapy consisted of 50·4-54·0 Gy in 28-30 fractions). 5-9 weeks later, patients underwent response assessment. Patients with a complete response could opt for non-operative management and proceed to modified FOLFOX6 (intravenous leucovorin 400 mg/m2 on day 1, intravenous fluorouracil 400 mg/m2 on day 1 then 2400 mg/m2 over 46 h, and intravenous oxaliplatin 85 mg/m2 on day 1 delivered every 2 weeks for eight cycles) or CAPEOX (intravenous oxaliplatin 130 mg/m2 on day 1 and oral capecitabine 1000 mg/m2 twice daily for 14 days every 3 weeks for four cycles). Patients with less than complete response underwent surgical resection. The primary endpoint was complete response rate, which was a composite of pathological complete response in patients who proceeded to surgery, or clinical complete response maintained at 1 year after last therapy in patients with non-operative management. Safety was a coprimary endpoint. Both endpoints were assessed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT02688712, and is active but not recruiting. FINDINGS: Between Oct 19, 2016, and Aug 31, 2020, 38 participants were enrolled. 25 (71%) of the 35 patients who completed chemoradiotherapy proceeded to total mesorectal excision surgery, five (20%) of whom had pathological complete responses. Ten (29%) patients had non-operative management, three (30%) of whom ultimately chose to have total mesorectal excision. Two (67%) of those three patients had pathological complete responses. Of the remaining seven patients in the non-operative management group, five (71%) had clinical complete responses at 1 year after their last modified FOLFOX6 infusion. In total, 12 (32% [one-sided 95% CI ≥19%]) of 38 patients had a complete response. Common grade 3 adverse events during treatment included diarrhoea in six (16%) of 38 patients, and haematological toxicity in seven (18%) patients. Two (5%) patients had grade 4 adverse events, one related to chemoradiotherapy-induced diarrhoea and dehydration, and the other an intraoperative ischaemic event. No treatment-related deaths occurred. INTERPRETATION: The addition of galunisertib to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer improved the complete response rate to 32%, was well tolerated, and warrants further assessment in randomised trials. FUNDING: Eli Lilly via ExIST program, The Providence Foundation.


Assuntos
Adenocarcinoma , Segunda Neoplasia Primária , Neoplasias Retais , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Capecitabina , Quimiorradioterapia/efeitos adversos , Diarreia/etiologia , Fluoruracila , Humanos , Terapia Neoadjuvante/efeitos adversos , Estadiamento de Neoplasias , Segunda Neoplasia Primária/patologia , Oxaliplatina , Pirazóis , Quinolinas , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/patologia , Fator de Crescimento Transformador beta
11.
J Clin Gastroenterol ; 56(9): 740-747, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-35960533

RESUMO

Health care providers are likely to encounter patients with recurrent unexplained abdominal pain. Because hereditary angioedema (HAE) is a rare disease, it may not be part of the differential diagnosis, especially for patients who do not have concurrent skin swelling in addition to abdominal symptoms. Abdominal pain is very common in patients with HAE, occurring in up to 93% of patients, with recurrent abdominal pain reported in up to 80% of patients. In 49% of HAE attacks with abdominal symptoms, isolated abdominal pain was the only symptom. Other abdominal symptoms that commonly present in patients with HAE include distension, cramping, nausea, vomiting, and diarrhea. The average time from onset of symptoms to diagnosis is 6 to 23 years. Under-recognition of HAE in patients presenting with predominant gastrointestinal symptoms is a key factor contributing to the delay in diagnosis, increasing the likelihood of unnecessary or exploratory surgeries or procedures and the potential risk of related complications. HAE should be considered in the differential diagnosis for patients with unexplained abdominal pain, nausea, vomiting, and/or diarrhea who have complete resolution of symptoms between episodes. As highly effective targeted therapies for HAE exist, recognition and diagnosis of HAE in patients presenting with isolated abdominal pain may significantly improve morbidity and mortality for these individuals.


Assuntos
Angioedemas Hereditários , Dor Abdominal/complicações , Dor Abdominal/etiologia , Angioedemas Hereditários/complicações , Angioedemas Hereditários/diagnóstico , Diagnóstico Diferencial , Diarreia/etiologia , Humanos , Náusea/etiologia , Recidiva , Vômito/etiologia
12.
Curr Opin Infect Dis ; 35(5): 417-423, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-35980005

RESUMO

PURPOSE OF REVIEW: Giardia is a common intestinal parasite worldwide, and infection can be associated with clear, and sometimes persistent symptomatology. However, in children in high-prevalence settings, it is most often not associated with or is perhaps even protective against acute diarrhea. Nonetheless, recent longitudinal studies in high-prevalence settings increasingly identify an association with long-term outcomes that has been difficult to discern. RECENT FINDINGS: Recent studies have made progress in disentangling this apparent paradox. First, prospective, well characterized cohort studies have repeatedly identified associations between Giardia infection, gut function, and child growth. Second, experimental animal and in-vitro models have further characterized the biological plausibility that Giardia could impair intestinal function and subsequently child development through different pathways, depending upon biological and environmental factors. Finally, new work has shed light on the potential for Giardia conspiring with specific other gut microbes, which may explain discrepant findings in the literature, help guide future higher resolution analyses of this pathogen, and inform new opportunities for intervention. SUMMARY: Recent prospective studies have confirmed a high, if not universal, prevalence of persistent Giardia infections in low-and-middle income countries associated with child-growth shortfalls and altered gut permeability. However, the predominance of subclinical infections limits understanding of the true clinical impact of endemic pediatric giardiasis, and global disease burdens remain uncalculated. Integrating the role of Giardia in multipathogen enteropathies and how nutritional, microbial, metabolic, and pathogen-strain variables influence Giardia infection outcomes could sharpen delineations between pathogenic and potentially beneficial attributes of this enigmatic parasite.


Assuntos
Giardíase , Animais , Diarreia/epidemiologia , Diarreia/etiologia , Giardia , Giardíase/complicações , Giardíase/epidemiologia , Giardíase/parasitologia , Humanos , Incidência , Prevalência , Estudos Prospectivos
13.
Adv Ther ; 39(9): 4003-4020, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35869354

RESUMO

Irritable bowel syndrome with diarrhea (IBS-D) is a chronic disorder of gut-brain interaction, characterized by recurrent abdominal pain in association with more frequent, loose stools. The pathophysiology of irritable bowel syndrome (IBS) includes disordered gut motility, alterations in gut microbiota, neural-hormonal system abnormalities, immune reactivity, and visceral hypersensitivity. Timely diagnosis of IBS-D can be achieved easily using clinical criteria. Formal IBS diagnosis is important for optimizing treatment and patient outcomes and facilitating patient access to appropriate educational resources. Yet, given the symptom overlap with other gastrointestinal conditions, diagnosis of IBS-D often is perceived to be challenging. Treatment of IBS includes both nonpharmacologic and pharmacologic options. Rifaximin, alosetron, and eluxadoline are effective treatments indicated for IBS-D, but have limited availability internationally. Dietary approaches may also be indicated for certain patients with IBS-D. Psychological interventions may be effective in treating abdominal pain alone and global symptoms in IBS. We describe use of these diverse therapies and provide an overview to facilitate the primary care provider's approach to distinguishing IBS-D from other conditions with symptom overlap.


Assuntos
Síndrome do Intestino Irritável , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/terapia , Diarreia/diagnóstico , Diarreia/tratamento farmacológico , Diarreia/etiologia , Fármacos Gastrointestinais/uso terapêutico , Humanos , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/terapia , Atenção Primária à Saúde
14.
Am J Trop Med Hyg ; 106(6): 1757-1764, 2022 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-35895434

RESUMO

Diarrhea remains a leading cause of death in children in developing countries, including Nicaragua, but little is known about patterns of diarrhea occurrence in Central America over long periods of time. The purpose of this study was to determine the incidence, risk factors, long-term trends, and seasonality of diarrhea in children age 2 to 14 years in Managua, Nicaragua. From 2011 to 2019, we examined episodes of diarrhea among 6,485 children who participated in a prospective cohort study and presented for care in a primary care facility. We performed a longitudinal analysis considering time-varying variables and the intra-subject correlation of outcomes. In addition, we analyzed the weekly incidence of diarrhea, applying seasonal trend decomposition to extract secular and seasonal patterns. The overall incidence rate of diarrhea was 133.4 episodes per 1,000 person-years (95% CI, 128.3-138.7). We observed a slight increase in the incidence of diarrhea from 2011 to 2019. Younger age was the strongest predictor of the risk of diarrhea, and incidence increased with every additional hour without running water in the household per day. Diarrhea incidence in Managua was seasonal, with high peaks each year between May and July. Despite reductions in childhood mortality since 1990 in Nicaragua, diarrheal morbidity remains a major problem in Managua.


Assuntos
Diarreia Infantil , Diarreia , Adolescente , Criança , Pré-Escolar , Diarreia/epidemiologia , Diarreia/etiologia , Diarreia Infantil/etiologia , Características da Família , Humanos , Incidência , Lactente , Nicarágua/epidemiologia , Estudos Prospectivos
15.
Curr Opin Clin Nutr Metab Care ; 25(5): 334-340, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35838278

RESUMO

PURPOSE OF REVIEW: To provide an up-to-date review on the clinical assessment of two important gastrointestinal problems with overlapping symptomatology but diverse cause and testing methods. Small intestinal bacterial overgrowth (SIBO) is characterized by the presence of excess bacteria in the small intestine associated with bloating, distention, gas, and diarrhea. Lactose intolerance is caused by lactase enzyme deficiency in the small bowel mucosa leading to lactose malabsorption and symptoms of bloating, gas, and diarrhea. RECENT FINDINGS: SIBO is assessed by hydrogen/methane breath test using glucose as a substrate and/or small bowel aspirate and culture but these tests have shortcomings. Consequently, several new diagnostic techniques, including novel capsule technologies and other approaches are being evaluated. Lactose intolerance can be assessed by hydrogen/methane breath test using lactose as a substrate, or small bowel mucosal lactase assay, genetic testing and lactose tolerance test, although the efficacy and practicality of these diagnostic modalities are not equal. SUMMARY: In clinical practice, gas, bloating, distention, pain, and diarrhea are common gastrointestinal symptoms that often remain unexplained when routine gastrointestinal endoscopy, imaging, and stool tests are negative. These patients should be evaluated for SIBO and/or food intolerances including lactose intolerance.


Assuntos
Intolerância à Lactose , Testes Respiratórios/métodos , Diarreia/diagnóstico , Diarreia/etiologia , Humanos , Hidrogênio , Lactase , Intolerância à Lactose/diagnóstico , Intolerância à Lactose/microbiologia , Metano
16.
Rev Gastroenterol Peru ; 42(1): 45-47, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-35896073

RESUMO

Celiac disease is an immune-mediated systemic disease with a wide spectrum of clinical presentations. The term celiac crisis describes the acute and potentially fatal form. Clinically it is characterized by severe diarrhea, dehydration, and metabolic disturbances. The case of a 7-year-old male patient attending the ward with tetany, lower limb edema, steatorrhea and weight loss of 8 months of evolution is reported, with analytical findings of hypocalcemia, hypomagnesemia, hypokalemia and coagulopathy. The diagnosis of celiac crisis was made on the basis of serological and clinical findings compatible with celiac disease in the context of severe metabolic abnormalities and acute malnutrition, later confirmed by pathological anatomy. The importance of this report lies in reviewing the characteristics of this serious entity, which requires a high index of suspicion for its diagnosis.


Assuntos
Doença Celíaca , Hipopotassemia , Pediatria , Tetania , Doença Celíaca/complicações , Doença Celíaca/diagnóstico , Criança , Diarreia/etiologia , Humanos , Hipopotassemia/complicações , Hipopotassemia/diagnóstico , Masculino , Tetania/complicações , Tetania/etiologia
17.
J Environ Public Health ; 2022: 4671719, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35874895

RESUMO

Background: Cholera is a major public health problem in Ethiopia. This study aimed to generate evidence to better understand the epidemiology of cholera as well as chronicle the city administration's emergency management efforts during the Addis Ababa cholera outbreak in 2016. Method: A descriptive analysis was performed using the cholera outbreak data collected from June 8 to October 31, 2016. A case was defined as a patient aged 5 years or older who develops acute watery diarrhea with or without vomiting. Administrative and laboratory finding reports were also used, as well as documented situational updates. Result: A total of 8,083 cases (AR of 0.24 percent) with 15 deaths (CFR of 0.18 percent) were reported. Males in unskilled manual occupations and housewives accounted for 2,198 (27.2%) and 1,195 (14.8%), respectively, of the total. A total of 6,908 cases (85.46 percent) sought medical attention within two days of the onset of the condition. The presence of the Kolfie river as well as the relatively confined living conditions of the residents aided in the emergence and rapid spread of the disease. The increased in-and-out movement of people, combined with the city administration's deficient development infrastructure of water, hygiene, and sanitation, contributes to higher morbidity and a longer duration of the outbreak. Multiple command posts established in various locations as well as a lack of collaboration among relevant stakeholders resulted in inefficient information and resource management. Furthermore, there is a lack of risk factor surveillance for the early detection of cholera-causing agents. Conclusion and Recommendations. This outbreak caused significant morbidity and mortality. Prioritizing early risk detection, implementing preventive measures, and developing positive working relationships with relevant parties are all critical. A well-established community-based surveillance system and incident management system (IMS) will be required for future emergency management. It is recommended that the city administration make critical adjustments to its developmental infrastructures related to water, sanitation, and hygiene and implement risk factor surveillance from sewerage lines for the early detection of agents that cause cholera.


Assuntos
Cólera , Cólera/epidemiologia , Diarreia/epidemiologia , Diarreia/etiologia , Surtos de Doenças , Etiópia/epidemiologia , Humanos , Masculino , Saneamento , Água
18.
BMC Gastroenterol ; 22(1): 325, 2022 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-35778677

RESUMO

BACKGROUND: Bile acid diarrhoea (BAD) can be severely debilitating and negatively affect patients' quality of life (QoL). We carried out a multi-centre prospective study exploring QoL outcomes in patients with BAD after treatment with colesevelam. METHODS: Patients with or without a positive 23-seleno-25-homotaurocholic acid (SeHCAT) scan were recruited and categorised into four groups: SeHCAT negative control group (CG), idiopathic BAD, post-cholecystectomy (PC) and post-terminal ileal resection for Crohn's disease (CD). Patients with a positive SeHCAT were treated with colesevelam and dosing was titrated to symptomatic response. Patients were reviewed at 4- and 8-weekly intervals and QoL was evaluated by EQ-5D-3L, SF-36, IBDQ-32 at each visit (where relevant). Patients with a negative SeHCAT (CG cohort) completed one set of questionnaires before being discharged from the study. RESULTS: 47 patients (BAD = 24, PC = 12, CD = 11) completed paired QoL questionnaires before and after treatment and 30 CG patients completed a baseline questionnaire. There was a significant improvement in IBDQ-32 mean scores before and after treatment in CD patients [134.6 (95%CI 112.5-156.6) and 158.4 (136.1-180.6), respectively (p = 0.007). Following treatment, BAD patients had significantly improved mean SF-36 scores in the "Role limitation due to physical health" dimension (p = 0.02) and in the overall mental component summary (p = 0.03). Prior to starting treatment, BAD patients had the lowest scores in the 'activity' dimension of the EQ-5D-3L (p = 0.04), which improved significantly after treatment (p = 0.002). Overall, the BAD and CD cohort showed improved mean scores with treatment in all components of the SF-36 and EQ-5D-3L, while the PC cohort showed a general decline in mean scores after treatment. 55% of patients clinically responded to treatment of which 41.7%, 58.3% and 81.8% responded from the BAD, PC and CD groups respectively. Correlations between those deemed as responders with improvements on the SF-36 and EQ-5D dimensions were not statistically significant. CONCLUSION: Our results demonstrate improved QoL in the BAD and CD cohort with treatment. Further larger studies are recommended specifically investigating the PC cohort and whether patients may improve with newer treatments such as FXR agonists. Trial registration Ethical approval REC Ref: 16/LO/1325.


Assuntos
Doença de Crohn , Qualidade de Vida , Ácidos e Sais Biliares/uso terapêutico , Cloridrato de Colesevelam , Doença de Crohn/complicações , Doença de Crohn/tratamento farmacológico , Diarreia/tratamento farmacológico , Diarreia/etiologia , Humanos , Estudos Prospectivos , Psicometria/métodos
19.
BMC Pediatr ; 22(1): 394, 2022 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-35799163

RESUMO

BACKGROUND: Despite global interventions to prevent and control diarrhea, it still remains a public health problem leading to childhood morbidity and mortality majorly in developing countries. In Uganda, diarrhea is amongst the five leading causes of under-five mortality, contributing to more than 140,000 deaths every year and this accounts for 7.1% of all under-five mortalities in Uganda. Efforts to prevent and lower diarrheal diseases need to be informed by data on determinants of diarrhea. The study assessed factors associated with diarrheal diseases among children below five years in selected slum settlements in Entebbe municipality, Wakiso District, Uganda. METHODS: The study employed a cross-sectional study design covering 384 randomly selected households having children < 5 years old in the study area using quantitative research methods. Data was collected using close-ended questionnaires and diarrhea disease history was captured for the last month before the survey. Bivariate and multivariate logistic regression analyses were used to identify the risk factors associated with childhood diarrhea considering a 95% confidence level. RESULTS: The prevalence of Diarrhea disease in children among the selected slum settlements in Entebbe municipality was found to be at 62.4%. Access to water from a protected water source (deep well and borehole), presence of a vent in toilets, age, and child birth weight were found to be significantly associated with diarrheal diseases among children below five years in the selected slum settlements in Entebbe municipality. CONCLUSION: The prevalence of childhood diarrhea among children < 5 years of age in selected slums of Entebbe municipality was found high. Use of water from a protected source, presence of a vent in toilets, age, child birth and weight were identified as predictors of diarrhea occurrence. These findings imply that community health education is urgently needed for fighting childhood diarrhea in the study area to eliminate the predisposing factors to diarrhea.


Assuntos
Diarreia , Áreas de Pobreza , Pré-Escolar , Estudos Transversais , Diarreia/epidemiologia , Diarreia/etiologia , Humanos , Lactente , Prevalência , Uganda/epidemiologia , Água
20.
Pan Afr Med J ; 42: 13, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35812262

RESUMO

Introduction: Salmonella and Shigella infections are waterborne associated infections globally known to cause serious illnesses in all age groups, but can be more devastating in children below five years. Antimicrobial resistance has been known to worsen the existing challenge in the management of Salmonella and Shigella infections. The aim is to isolate and identify Salmonella and Shigella among children less than five years with diarrhea and to determine resistance to commonly prescribed drugs at the Lodwar County and Referral Hospital in Northern Kenya. Methods: using a cross-sectional study design, a descriptive experimental study was conducted on 196 children with diarrhea using rectal swabs. A structured questionnaire was used to collect sociodemographic information. Samples were then received in the microbiology laboratory, and macroscopic and microscopic examinations were done before culture on specific selective media. Thereafter, biochemical confirmation of the growths done then confirmed results tabulated before analysis. Results: from the total samples collected (196) Shigella dysenteriae cases were 4 (5%), while Shigella Flexneri were 7 (9%), Shigella sonnei were 3 (4%), Shigella boydii were 4 (5%) and Salmonella typhimurium were 2 (2.4%). From these, about 70% of the isolated Salmonella and Shigella demonstrated high antibiotic resistance to Amoxilliclav and Ampicillin, both with high minimum inhibitory concentrations (MICs) values of about 8ug/ml. While over 80% drug susceptibility was noted in Amikacin (1ug/ml), Ciprofloxacin (2ug/ml), Ceftriaxone (4ug/ml) and Ceftazidime (4ug/ml). Conclusion: Salmonella and Shigella are among the common contributors of diarrhea among children less than five years. Drug resistance among the commonly used antibiotics is a serious indicator that possible misuse of antibiotics especially the beta lactam penicillin's.


Assuntos
Disenteria Bacilar , Shigella , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Estudos Transversais , Diarreia/epidemiologia , Diarreia/etiologia , Farmacorresistência Bacteriana , Disenteria Bacilar/tratamento farmacológico , Disenteria Bacilar/epidemiologia , Fezes/microbiologia , Humanos , Quênia/epidemiologia , Testes de Sensibilidade Microbiana , Prevalência , Salmonella
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