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1.
Pediatr Clin North Am ; 69(1): 99-113, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34794679

RESUMO

Traveler's diarrhea is the most common travel disease in both children and adults. Adult guidelines for traveler's diarrhea have been established, but significant gaps persist in guidance for the evaluation and management of pediatric traveler's diarrhea. Adult guidelines are not necessarily applicable in children, and it is essential for clinicians to account for the differences in pediatric pathophysiology, clinical presentations, and treatment recommendations when evaluating and managing pediatric traveler's diarrhea.


Assuntos
Diarreia/diagnóstico , Diarreia/terapia , Viagem , Adolescente , Anti-Infecciosos/uso terapêutico , Infecções Bacterianas/epidemiologia , Criança , Pré-Escolar , Desidratação/epidemiologia , Diarreia/epidemiologia , Hidratação/métodos , Humanos , Doenças Parasitárias/epidemiologia , Fatores de Risco , Viroses/epidemiologia , Adulto Jovem
2.
Sci Rep ; 11(1): 21725, 2021 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-34741071

RESUMO

SARS-CoV-2 enters the intestine by the spike protein binding to angiotensin-converting enzyme 2 (ACE2) receptors in enterocyte apical membranes, leading to diarrhea in some patients. Early treatment of COVID-19-associated diarrhea could relieve symptoms and limit viral spread within the gastrointestinal (GI) tract. Diosmectite, an aluminomagnesium silicate adsorbent clay with antidiarrheal effects, is recommended in some COVID-19 management protocols. In rotavirus models, diosmectite prevents pathogenic effects by binding the virus and its enterotoxin. We tested the trapping and anti-inflammatory properties of diosmectite in a SARS-CoV-2 model. Trapping effects were tested in Caco-2 cells using spike protein receptor-binding domain (RBD) and heat-inactivated SARS-CoV-2 preparations. Trapping was assessed by immunofluorescence, alone or in the presence of cells. The effect of diosmectite on nuclear factor kappa B (NF-kappaB) activation and CXCL10 secretion induced by the spike protein RBD and heat-inactivated SARS-CoV-2 were analyzed by Western blot and ELISA, respectively. Diosmectite bound the spike protein RBD and SARS-CoV-2 preparation, and inhibited interaction of the spike protein RBD with ACE2 receptors on the Caco-2 cell surface. Diosmectite exposure also inhibited NF-kappaB activation and CXCL10 secretion. These data provide direct evidence that diosmectite can bind SARS-CoV-2 components and inhibit downstream inflammation, supporting a mechanistic rationale for consideration of diosmectite as a management option for COVID-19-associated diarrhea.


Assuntos
COVID-19/tratamento farmacológico , Quimiocina CXCL10/metabolismo , Subunidade p50 de NF-kappa B/metabolismo , SARS-CoV-2 , Silicatos/química , Adsorção , Compostos de Alumínio/química , Enzima de Conversão de Angiotensina 2/metabolismo , Anti-Inflamatórios , Sítios de Ligação , Células CACO-2 , Cromatografia Líquida , Argila , Diarreia/etiologia , Diarreia/terapia , Enterócitos/metabolismo , Gastroenterologia , Humanos , Compostos de Magnésio/química , Espectrometria de Massas , Simulação de Acoplamento Molecular , Simulação de Dinâmica Molecular , Ligação Proteica/efeitos dos fármacos , Domínios Proteicos , Rotavirus , Silicatos/metabolismo
3.
Can Vet J ; 62(10): 1123-1130, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34602643

RESUMO

The purpose of this study was to characterize the fecal microbiota of horses with acute and chronic diarrhea before and after fecal microbiota transplantation (FMT). Six client-owned horses with acute and chronic diarrhea received FMT from 2 healthy donor horses. Microbiota analysis using next-generation sequencing was performed on fecal samples collected before and 2 and 7 d after FMT. Signs of diarrhea improved in 4 horses, whereas the remaining 2 horses did not survive. There was a significant difference in the number of bacterial species between donors and recipients (P < 0.05). The Order Lactobacillales and the genera Lactobacillus, Intestinimonas, and Streptococcus were increased in the microbiota of diarrheic horses, and Saccharofermentans genus increased in healthy donors. The results suggest that FMT from the healthy donors was not effective over a 7-day period as it did not change the fecal microbiota of the diarrheic horses. Further research to improve the efficacy of FMT in horses is needed.


Assuntos
Transplante de Microbiota Fecal , Microbiota , Animais , Bactérias , Diarreia/terapia , Diarreia/veterinária , Transplante de Microbiota Fecal/veterinária , Fezes , Cavalos , Resultado do Tratamento
4.
PLoS One ; 16(10): e0257851, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34669729

RESUMO

BACKGROUND: Low-level private health facilities (LLPHFs) handle a considerable magnitude of sick children in low-resource countries. We assessed capacity of LLPHFs to manage malaria, pneumonia, diarrhea, and, possible severe bacterial infections (PSBIs) in under-five-year-olds. METHODS: We conducted a cross-sectional survey in 110 LLPHFs and 129 health workers in Mbarara District, Uganda between May and December 2019. Structured questionnaires and observation forms were used to collect data on availability of treatment guidelines, vital medicines, diagnostics, and equipment; health worker qualifications; and knowledge of management of common childhood infections. RESULTS: Amoxicillin was available in 97%, parental ampicillin and gentamicin in 77%, zinc tablets and oral rehydration salts in >90% while artemether-lumefantrine was available in 96% of LLPHF. About 66% of facilities stocked loperamide, a drug contraindicated in the management of diarrhoea in children. Malaria rapid diagnostic tests and microscopes were available in 86% of the facilities, timers/clocks in 57% but only 19% of the facilities had weighing scales and 6% stocked oxygen. Only 4% of the LLPHF had integrated management of childhood illness (IMCI) booklets and algorithm charts for management of common childhood illnesses. Of the 129 health workers, 52% were certificate nurses/midwives and (26% diploma nurses/clinical officers; 57% scored averagely for knowledge on management of common childhood illnesses. More than a quarter (38%) of nursing assistants had low knowledge scores. No notable significant differences existed between rural and urban LLPHFs in most parameters assessed. CONCLUSION: Vital first-line medicines for treatment of common childhood illnesses were available in most of the LLPHFs but majority lacked clinical guidelines and very few had oxygen. Majority of health workers had low to average knowledge on management of the common childhood illnesses. There is need for innovative knowledge raising interventions in LLPHFs including refresher trainings, peer support supervision and provision of job aides.


Assuntos
Infecções Bacterianas/diagnóstico , Diarreia/diagnóstico , Malária/diagnóstico , Pneumonia/diagnóstico , Ampicilina/uso terapêutico , Antimaláricos/uso terapêutico , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/terapia , Pré-Escolar , Estudos Transversais , Diarreia/epidemiologia , Diarreia/microbiologia , Diarreia/terapia , Feminino , Hidratação/normas , Gentamicinas/uso terapêutico , Humanos , Lactente , Recém-Nascido , Malária/epidemiologia , Malária/parasitologia , Malária/terapia , Masculino , Pneumonia/epidemiologia , Pneumonia/microbiologia , Pneumonia/terapia , Instalações Privadas/tendências , Uganda/epidemiologia , Zinco/uso terapêutico
5.
Asia Pac J Clin Nutr ; 30(3): 358-364, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34587695

RESUMO

BACKGROUND AND OBJECTIVES: Primary Intestinal Lymphangiectasia (PIL) is a rare congenital and digestive disease, which could present through a broad spectrum of clinical manifestations, diagnostic and treatment management. The aim of this study was to introduce the diagnosis and nutrition treatment of children with PIL through the twelve years of experience. METHODS AND STUDY DESIGN: The patients diagnosed with PIL admitted to the Department of Gastroenterology and Nutrition in Xinhua Hospital from June 2006 to September 2017 were included in the study. RESULTS: Ten patients were found to have PIL, and 5 of them were male. The mean age was 66 months at the time of diagnosis and 11 months at onset. The main clinical manifestations were diarrhea, edemas and abdominal distention. Marked dilatation of the intestinal lymphatic vessels was the characteristic of the endoscopic. All the patients presented with hypoproteinemia and hypoimmunoglobulinia. Six of them were treated with parenteral nutrition, and 9 of them were treated with a low-long-chain triglycerides (LCT), high-protein diet supplemented with medium-chain triglycerides (MCT). The clinical symptoms of the patients have improved after the MCT diet therapy. CONCLUSIONS: PIL should be considered first when there are clinical manifestations of chronic diarrhea, edema and abdominal distention, and biochemical results indicated the hypoproteinemia and hypoimmunoglobulinia, and the general treatment is invalid. Gastroscopy and E-colonoscopy with biopsies are the preferred method of diagnosis. Diet intervention (MCT diet) is the cornerstone and longtime medical treatment, which can improve the nutritional status and promote the survival quality of patients with PIL.


Assuntos
Linfangiectasia Intestinal , Criança , Pré-Escolar , Diarreia/diagnóstico , Diarreia/terapia , Dieta , Humanos , Linfangiectasia Intestinal/diagnóstico , Linfangiectasia Intestinal/terapia , Masculino , Estado Nutricional , Triglicerídeos
6.
Nutrients ; 13(9)2021 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-34579049

RESUMO

Helicobacter pylori (Hp) eradication therapy alters gut microbiota, provoking gastrointestinal (GI) symptoms that could be improved by probiotics. The study aim was to assess the effect in Hp patients of a Test fermented milk containing yogurt and Lacticaseibacillus (L. paracasei CNCM I-1518 and I-3689, L. rhamnosus CNCM I-3690) strains on antibiotic associated diarrhea (AAD) (primary aim), GI-symptoms, gut microbiota, and metabolites. A randomised, double-blind, controlled trial was performed on 136 adults under 14-day Hp treatment, receiving the Test or Control product for 28 days. AAD and GI-symptoms were reported and feces analysed for relative and quantitative gut microbiome composition, short chain fatty acids (SCFA), and calprotectin concentrations, and viability of ingested strains. No effect of Test product was observed on AAD or GI-symptoms. Hp treatment induced a significant alteration in bacterial and fungal composition, a decrease of bacterial count and alpha-diversity, an increase of Candida and calprotectin, and a decrease of SCFA concentrations. Following Hp treatment, in the Test as compared to Control group, intra-subject beta-diversity distance from baseline was lower (padj = 0.02), some Enterobacteriaceae, including Escherichia-Shigella (padj = 0.0082) and Klebsiella (padj = 0.013), were less abundant, and concentrations of major SCFA (p = 0.035) and valerate (p = 0.045) were higher. Viable Lacticaseibacillus strains were detected during product consumption in feces. Results suggest that, in patients under Hp treatment, the consumption of a multi-strain fermented milk can induce a modest but significant faster recovery of the microbiota composition (beta-diversity) and of SCFA production and limit the increase of potentially pathogenic bacteria.


Assuntos
Produtos Fermentados do Leite , Diarreia/terapia , Microbioma Gastrointestinal , Infecções por Helicobacter/microbiologia , Probióticos/administração & dosagem , Adulto , Idoso , Antibacterianos/efeitos adversos , Diarreia/induzido quimicamente , Diarreia/microbiologia , Método Duplo-Cego , Fezes/microbiologia , Feminino , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Iogurte
7.
Zhongguo Zhen Jiu ; 41(9): 984-90, 2021 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-34491647

RESUMO

OBJECTIVE: To compare the clinical therapeutic effect on diarrhea-predominant irritable bowel syndrome (IBS-D) of spleen deficiency and damp excess among fire needling therapy with filiform needle combined with acupoint application therapy, simple acupoint application therapy and pinaverium bromide tablets, and explore the mechanism on the improvements in IBS-D. METHODS: A total of 150 patients with IBS-D of spleen deficiency and damp excess were randomized into a combined treatment group (50 cases, 14 cases dropped off), an acupoint application group (50 cases, 16 cases dropped off ) and a western medication group (50 cases, 13 cases dropped off ). In the western medication group, pinaverium bromide tablets were prescribed for oral administration, 50 mg per time, three times a day. In the acupoint application group, the herbal plaster of shenling baizhu powder mixed with fresh ginger juice was placed on Shenque (CV 8), once every two days. In the combined treatment group, on the base of the treatment as the acupoint application group, the fire needling therapy with filiform needle was exerted at Tianshu (ST 25), Shangjuxu (ST 37), Yinlingquan (SP 9) and Dachangshu (BL 25), once every two days. The duration of treatment in each group was 4 weeks. Separately, before treatment and after 7 and 28 days of treatment, the score of clinical symptoms and the score of quality of life scale for IBS (IBS-QOL) were observed in each group. Before treatment and after 28 days of treatment, the levels of , and T lymphocytes, and the ratio of / in peripheral blood of patients were detected successively; as well as the expressions of 5-HT3R mRNA and 5-HT4R mRNA in colon mucosal tissues in each group separately. RESULTS: Except the score for abdominal pain in the acupoint application group and the scores for abdominal pain and abdominal distention in the western medication group after 7 days of treatment, the scores for abdominal pain, abdominal distention, defecation frequency, stool form and incomplete bowel movement after 7 and 28 days of treatment were all reduced as compared with those before treatment in each group separately (P<0.05). After 7 days of treatment, the scores for abdominal distention, defecation frequency and stool form in the combined treatment group were all lower than those in the western medication group (P<0.05). After 28 days of treatment, the score of each clinical symptom in the combined treatment group was lower than either of the rest two groups respectively (P<0.05); and the scores for abdominal pain, abdominal distention and incomplete bowel movement in the acupoint application group were lower than those in the western medication group separately (P<0.05). After 7 and 28 days of treatment, the score of each item in IBS-QOL was increased as compared with that before treatment in each group (P<0.05). After 7 days of treatment, except the scores for heterosexual relationship and human relations, scores of the other items, other scores of IBS-QOL in the combined treatment group were higher than those in the western medication group separately (P<0.05); while the scores of anxiety and behavior disorder in the acupoint application group were higher than those in the western medication group (P<0.05). After 28 days of treatment, the each score of IBS-QOL in the combined treatment group was higher than the other two groups respectively (P<0.05), while the scores of anxiety, behavior disorder, dietary control, social reaction and human relations in the acupoint application group were all higher than the western medication group (P<0.05). After treatment, the levels of and T lymphocytes and the ratio of /in peripheral blood, as well as the expressions of 5-HT4R mRNA in colon tissue were all increased in each group (P<0.05), but the levels of T lymphocyte and 5-HT3R mRNA expressions in colon tissue were reduced in each group (P<0.05). After treatment, regarding the levels of and T lymphocytes and the ratio of /in peripheral blood, as well as the expressions of 5-HT4R mRNA in colon tissue, the values in the combined treatment group were all higher than either of the rest two groups respectively (P<0.05), while the values in the acupoint application group were higher than the western medication group (P<0.05). Concerning to the level of T lymphocytes and 5-HT3R mRNA expression, the values in the combined treatment group were lower than the rest two groups respectively (P<0.05), and the values in the acupoint application group were lower than the western medication group (P<0.05). CONCLUSION: The combined treatment with the fire needling therapy with filiform needle and the acupoint application therapy effectively relieves the clinical symptoms, improves the quality of life and strengthens the immunity in the patients with IBS-D. The therapeutic effect of this combined regimen is better than either simple acupoint application therapy or the oral medication of pinaverium bromide. The mechanism may be related to the regulation of the levels of T lymphocyte subsets and the modulation of the expressions of 5-HT3R and 5-HT4R mRNA in colon tissue.


Assuntos
Terapia por Acupuntura , Síndrome do Intestino Irritável , Pontos de Acupuntura , Diarreia/etiologia , Diarreia/terapia , Humanos , Síndrome do Intestino Irritável/terapia , Qualidade de Vida , Baço , Resultado do Tratamento
8.
Clin Nutr ; 40(10): 5399-5406, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34571239

RESUMO

BACKGROUND & AIMS: Although nutritional care is a cornerstone in the management of pediatric intestinal failure (IF), little is known about feeding difficulty (FD) prevalence. The aim of this study was to determine the frequency of FD and associated factors and to characterize eating behaviours in two pediatric IF rehabilitation centres (Hôpital-Necker Enfants Malades (NEM), France and Alberta Children's Hospital (ACH), Canada). METHODS: Parents of children (aged 1-18 years) on home parenteral nutrition (PN) for >3 months followed at NEM and ACH completed two validated tools: Montreal Children's Feeding scale for severity of FD, Child Eating Behaviour Questionnaire and a pediatric IF-specific questionnaire for FD associated risk factors. RESULTS: In the entire cohort (n = 59, median 5.2 years), 15% had mild, 19% had moderate and 25% had severe FD. No FD was seen in 53% vs 11% and severe FD was seen in 20% vs. 39% of the NEM and ACH cohorts respectively (p = 0.003). Current ETF was less common at NEM vs. ACH (3% vs. 50%, p < 0.001). The FD score was associated with current enteral tube feed (ETF) use (p = 0.04). Compared to healthy reference children, the NEM cohort did not differ for the enjoyment of food, whereas the ACH cohort's enjoyment was lower (p < 0.0001). The ACH cohort scored higher for food avoidance behaviours: food fussiness (p < 0.02), satiety responsiveness (p < 0.0001), and slowness in eating (p < 0.0001) while the NEM cohort was not different from healthy reference children. In the entire cohort, according to parental recall, 60% were reported to be NPO for >12 weeks in the first 6 months of life, and late introduction of purees (>9 months) and lumpy textures (>1 year) were found in 40% and 58%, respectively. Parent-recalled ETF differed between NEM and ACH in the first 6 months of life (45% vs 76%, p = 0.03). CONCLUSIONS: Feeding difficulty and associated risk factors, including early ETF, prolonged NPO and delays in achieving feeding milestones were frequently reported in pediatric IF. Feeding medicalization with the use of ETF may inadvertently contribute to FD and eating disorder behavioural characteristics. This study highlights the need for FD prevention and an increased focus on establishing healthy eating. Future prospective study of FD, associated risk factors and clinical outcomes are merited.


Assuntos
Comportamento Alimentar , Apoio Nutricional , Síndrome do Intestino Curto/terapia , Canadá/epidemiologia , Criança , Pré-Escolar , Diarreia/terapia , França/epidemiologia , Hospitais Pediátricos , Humanos , Lactente , Pseudo-Obstrução Intestinal/terapia , Pais/psicologia , Inquéritos e Questionários
9.
Zhen Ci Yan Jiu ; 46(7): 549-54, 2021 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-34369673

RESUMO

OBJECTIVE: To observe the effect of electroacupuncture(EA) at "Zusanli"(ST36), "Yinlingquan" (SP9) or "Yingu"(KI10) on the expression of 5-hydroxytryptamine type 7 receptor (5-HT7R) in the gastric antrum and colon tissues in functional diarrhea (FD) model rats, so as to explore its mechanisms underlying improving FD. METHODS: Forty male SD rats were randomly divided into control, model, ST36, SP9 and KI10 groups,with 8 rats in each group. The FD model was established by combined administration of restriction (four-limbs' banding) + abdominal cold stimulation + feeding every other day, for 14 days. EA (2 Hz, 0.5 mA) was applied to bilateral ST36 or bilateral SP9 or bilateral KI10 in the 3 corresponding groups for 30 min, once a day for 7 days after successful modeling. Rats of the control group received restriction only. The fecal water content was calculated and the stool form score was given according to the Bristol's methods. The gastric residual rate (GRR) and small intestine propulsion rate (SIPR) were determined to assess the motility of the gastrointestinal tract. Immunohistochemical and real-time fluorescent quantitative PCR were used to detect the expression of 5-HT7R protein and mRNA of the gastric antrum and colon tissues, respectively. RESULTS: Compared with the control group, the fecal water content, the stool form score, the SIPR and the expression levels of 5-HT7R protein and 5-HT7R mRNA were significantly increased (P<0.01,P<0.05) and the GRR was considerably decreased in the model group (P<0.01). The fecal water content, stool form score and SIPR, and expression level of 5-HT7R protein and mRNA in the gastric antrum and colon were significantly lower in both the ST36 and SP9 groups (not in the KI10 group) than in the model group (P<0.01, P<0.05), but the GRR was significantly higher in the ST36 and SP9 groups (not in the KI10 group) than in the model group (P<0.01). The effects of both ST36 and SP9 were significantly superior to those of KI10 in improving all the indexes mentioned above (except SIPR and the mRNA level of 5-HT7R in the colon in SP9 group)(P<0.01, P<0.05). No significant differences were found between the ST36 and SP9 groups in lowering the levels of fecal water content, stool form score, SIPR, and the expression of 5-HT7R protein and mRNA, as well as in up-regulating GRR (P>0.05). CONCLUSION: EA of ST36 and SP9 can improve the motility of gastrointestinal tract in FD rats, which may be related to its functions in down-regulating the expression of 5-HT7R protein and mRNA in gastric antrum and colon tissues. The effects of ST36 and SP9 were obviously better than those of KI10 in ameliorating the gastric and intestinal motility (except GRR) and in lowering the expression of 5-HT7R protein and mRNA.


Assuntos
Eletroacupuntura , Pontos de Acupuntura , Animais , Colo , Diarreia/genética , Diarreia/terapia , Masculino , Antro Pilórico , Ratos , Ratos Sprague-Dawley
10.
Public Health ; 198: 89-95, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34388636

RESUMO

OBJECTIVE: This study aimed to examine the impact of maternal decision-making autonomy and self-reliance in accessing health care on childhood diarrhea and acute respiratory tract infection (ARI) in Nepal. STUDY DESIGN: This was a cross-sectional study. METHODS: This study used data from the Nepal Demographic and Health Survey 2016. Mothers aged 15-49 years provided information about the health of 5308 children included in this analysis. Composite measures of maternal decision-making autonomy and self-reliance in accessing health care were used as exposure variables. Childhood diarrhea and ARI in the 2 weeks preceding the survey were primary outcome variables. Descriptive statistics and multivariable survey-weighted logistic regression methods were used in the analyses. RESULTS: Maternal decision-making autonomy was high for approximately one-fourth (24.7%) of the children's mothers, and 81.7% of children's mothers reported self-reliance in accessing health care as a big problem. Diarrhea among children in the prior 2 weeks was reported among 8% (95% confidence interval [CI]: 6.9-8.4), whereas ARI was reported among 22% (95% CI: 21.1-23.5). The children of women who viewed a lack of self-reliance as a big problem had a 88% (adjusted odds ratio [aOR] = 1.88, 95% CI: 1.26-2.82, P < 0.01) higher odds of diarrhea and 59% (aOR = 1.59, 95% CI: 1.29-1.95, P < 0.001) higher odds of ARI compared with children of women who did not view self-reliance as a big problem. CONCLUSIONS: The study found a significant effect of maternal self-reliance in accessing health care on childhood diarrhea and ARI, independent of other sociodemographic factors. Improvement in maternal self-reliance in accessing health care of women is essential, particularly their autonomy with regard to healthcare seeking behavior and financial empowerment.


Assuntos
Acesso aos Serviços de Saúde , Infecções Respiratórias , Criança , Estudos Transversais , Diarreia/epidemiologia , Diarreia/terapia , Feminino , Humanos , Lactente , Nepal , Aceitação pelo Paciente de Cuidados de Saúde , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/terapia
11.
Hum Resour Health ; 19(1): 99, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404445

RESUMO

BACKGROUND: Lack of programmatic support and supervision is one of the underlying reasons of the poor performance of Pakistan's Lady Health Worker Program (LHWP). This study describes the findings and potential for scale-up of a supportive supervision intervention in two districts of Pakistan for improving LHWs skills for integrated community case management (iCCM) of childhood diarrhea and pneumonia. METHODS: The intervention comprised an enhanced supervision training to lady health supervisors (LHSs) and written feedback to LHWs by LHSs, implemented in Districts Badin and Mirpur Khas (MPK). Clinical skills of LHWs and LHSs and supervision skills of LHSs were assessed before, during, and after the intervention using structured tools. RESULTS: LHSs' practice of providing written feedback improved between pre- and mid-intervention assessments in both trials (0% to 88% in Badin and 25% to 75% in MPK) in the study arm. Similarly, supervisory performance of study arm LHSs was better than that in the comparison arm in reviewing the treatment suggested by workers' (94% vs 13% in MPK and 94% vs 69% in Badin) during endline skills assessment in both trials. There were improvements in LHWs' skills for iCCM of childhood diarrhea and pneumonia in both districts. In intervention arm, LHWs' performance for correctly assessing for dehydration (28% to 92% in Badin and 74% to 96% in MPK), and measuring the respiratory rate correctly (12% to 44% in Badin and 46% to 79% in MPK) improved between baseline and endline assessments in both trials. Furthermore, study arm LHWs performed better than those in comparison arm in classifying diarrhea correctly during post-intervention skills assessment (68% vs 40% in Badin and 96% vs 83% in MPK). CONCLUSION: Supportive supervision including written feedback and frequent supervisor contact could improve the performance of community-based workers in managing diarrhea and pneumonia among children. Positive lessons for provincial scale-up can be drawn. Trial registration Both trials are registered with the 'Australian New Zealand Clinical Trials Registry'. Registration numbers: Nigraan Trial: ACTRN1261300126170; Nigraan Plus: ACTRN12617000309381.


Assuntos
Agentes Comunitários de Saúde , Pneumonia , Austrália , Criança , Diarreia/terapia , Humanos , Paquistão , Pneumonia/terapia
13.
Medicina (Kaunas) ; 57(7)2021 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-34201542

RESUMO

Background and Objectives: Lactobacillus reuteri DSM 17938 (L. reuteri) is a probiotic that can colonize different human body sites, including primarily the gastrointestinal tract, but also the urinary tract, the skin, and breast milk. Literature data showed that the administration of L. reuteri can be beneficial to human health. The aim of this review was to summarize current knowledge on the role of L. reuteri in the management of gastrointestinal symptoms, abdominal pain, diarrhea and constipation, both in adults and children, which are frequent reasons for admission to the emergency department (ED), in order to promote the best selection of probiotic type in the treatment of these uncomfortable and common symptoms. Materials and Methods: We searched articles on PubMed® from January 2011 to January 2021. Results: Numerous clinical studies suggested that L. reuteri may be helpful in modulating gut microbiota, eliminating infections, and attenuating the gastrointestinal symptoms of enteric colitis, antibiotic-associated diarrhea (also related to the treatment of Helicobacter pylori (HP) infection), irritable bowel syndrome, inflammatory bowel disease, and chronic constipation. In both children and in adults, L. reuteri shortens the duration of acute infectious diarrhea and improves abdominal pain in patients with colitis or inflammatory bowel disease. It can ameliorate dyspepsia and symptoms of gastritis in patients with HP infection. Moreover, it improves gut motility and chronic constipation. Conclusion: Currently, probiotics are widely used to prevent and treat numerous gastrointestinal disorders. In our opinion, L. reuteri meets all the requirements to be considered a safe, well-tolerated, and efficacious probiotic that is able to contribute to the beneficial effects on gut-human health, preventing and treating many gastrointestinal symptoms, and speeding up the recovery and discharge of patients accessing the emergency department.


Assuntos
Síndrome do Intestino Irritável , Lactobacillus reuteri , Probióticos , Adulto , Criança , Constipação Intestinal/terapia , Diarreia/terapia , Feminino , Humanos , Probióticos/uso terapêutico
14.
BMC Health Serv Res ; 21(1): 670, 2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34238320

RESUMO

BACKGROUND: Childhood morbidities such as diarrhea and pneumonia are the leading causes of death in Ethiopia. Appropriate healthcare-seeking behavior of mothers for common childhood illnesses could prevent a significant number of these early deaths; however, little nation-wide research has been conducted in Ethiopia to assess mothers' healthcare-seeking behavior for their under five children. METHODS: The study used the Ethiopian Demographic and Health Surveys (EDHS) data. The EDHS is a cross sectional survey conducted in 2016 on a nationally representative sample of 10,641 respondents. The main determinants of care-seeking during diarrhea and acute respiratory infection (ARI) episodes were assessed using multiple logistic regression analyses while adjusting for complex survey design. RESULTS: Only 43% and 35% of households sought medical attention for their children in episodes of diarrhea and ARI, respectively, during a reference period of 2 weeks before the survey. The odds of seeking care for diarrhea are lower for non-working mothers versus working mothers. The likelihood of seeking care for diarrhea or ARI is higher for literate fathers compared to those with no education. The place of delivery for the child, receiving postnatal checkup and getting at least one immunization in the past determined the likelihood of seeking care for ARI, but not for diarrhea. The odds of seeking care are higher for both diarrhea and ARI among households that are headed by females and where mothers experienced Intimate Partner Violence (IPV) violence. Religion and types of family structure are also significant factors of seeking care for diarrhea episodes, but not for ARI. CONCLUSIONS: The findings call for more coordinated efforts to ensure equitable access to health care services focusing on mothers living in deprived household environment. Strengthening partnerships with public facilities, private health care practitioners, and community-based organizations in rural areas would help further improve access to the services.


Assuntos
Mães , Aceitação pelo Paciente de Cuidados de Saúde , Criança , Estudos Transversais , Diarreia/epidemiologia , Diarreia/terapia , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Masculino , Morbidade
15.
Cochrane Database Syst Rev ; 7: CD012997, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34219224

RESUMO

BACKGROUND: Haemolytic uraemic syndrome (HUS) is a common cause of acquired kidney failure in children and rarely in adults. The most important risk factor for development of HUS is a gastrointestinal infection by Shiga toxin-producing Escherichia coli (STEC). This review addressed the interventions aimed at secondary prevention of HUS in patients with diarrhoea who were infected with a bacteria that increase the risk of HUS. OBJECTIVES: Our objective was to evaluate evidence regarding secondary preventative strategies for HUS associated with STEC infections. In doing so, we sought to assess the effectiveness and safety of interventions as well as their potential to impact the morbidity and death associated with this condition. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 12 November 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: Studies were considered based on the methods, participants, and research goals. Only randomised controlled trials were considered eligible for inclusion. The participants of the studies were paediatric and adult patients with diarrhoeal illnesses due to STEC. The primary outcome of interest was incidence of HUS. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as recommended by Cochrane. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS: We identified four studies (536 participants) for inclusion that investigated four different interventions including antibiotics (trimethoprim-sulfamethoxazole), anti-Shiga toxin antibody-containing bovine colostrum, Shiga toxin binding agent (Synsorb Pk: a silicon dioxide-based agent), and a monoclonal antibody against Shiga toxin (urtoxazumab). The overall risk of bias was unclear for selection, performance and detection bias and low for attrition, reporting and other sources of bias. It was uncertain if trimethoprim-sulfamethoxazole reduced the incidence of HUS compared to no treatment (47 participants: RR 0.57, 95% CI 0.11-2.81, very low certainty evidence). Adverse events relative to this review, need for acute dialysis, neurological complication and death were not reported. There were no incidences of HUS in either the bovine colostrum group or the placebo group. It was uncertain if bovine colostrum caused more adverse events (27 participants: RR 0.92, 95% CI 0.42 to 2.03; very low certainty evidence). The need for acute dialysis, neurological complications or death were not reported. It is uncertain whether Synsorb Pk reduces the incidence of HUS compared to placebo (353 participants: RR 0.93, 95% CI 0.39 to 2.22; very low certainty evidence). Adverse events relevant to this review, need for acute dialysis, neurological complications or death were not reported. One study compared two doses of urtoxazumab (3.0 mg/kg and 1.0 mg/kg) to placebo. It is uncertain if either 3.0 mg/kg urtoxazumab (71 participants: RR 0.34, 95% CI 0.01 to 8.14) or 1.0 mg/kg urtoxazumab (74 participants: RR 0.95, 95% CI 0.79 to 1.13) reduced the incidence of HUS compared to placebo (very low certainty evidence). Low certainty evidence showed there may be little or no difference in the number of treatment-emergent adverse events with either 3.0 mg/kg urtoxazumab (71 participants: RR 1.00, 95% CI 0.84 to 1.18) or 1.0 mg/kg urtoxazumab (74 participants: RR 0.95, 95% CI 0.79 to 1.13) compared to placebo. There were 25 serious adverse events reported in 18 patients: 10 in the placebo group, and 9 and 6 serious adverse events in the 1.0 mg/kg and 3.0 mg/kg urtoxazumab groups, respectively. It is unclear how many patients experienced these adverse events in each group, and how many patients experienced more than one event. It is uncertain if either dose of urtoxazumab increased the risk of neurological complications or death (very low certainty evidence). Need for acute dialysis was not reported. AUTHORS' CONCLUSIONS: The included studies assessed antibiotics, bovine milk, and Shiga toxin inhibitor (Synsorb Pk) and monoclonal antibodies (Urtoxazumab) against Shiga toxin for secondary prevention of HUS in patients with diarrhoea due to STEC. However, no firm conclusions about the efficacy of these interventions can be drawn given the small number of included studies and the small sample sizes of those included studies. Additional studies, including larger multicentre studies, are needed to assess the efficacy of interventions to prevent development of HUS in patients with diarrhoea due to STEC infection.


Assuntos
Diarreia/complicações , Infecções por Escherichia coli/terapia , Síndrome Hemolítico-Urêmica/prevenção & controle , Prevenção Secundária/métodos , Escherichia coli Shiga Toxigênica , Adulto , Animais , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/uso terapêutico , Viés , Bovinos , Criança , Colostro/imunologia , Diarreia/microbiologia , Diarreia/terapia , Síndrome Hemolítico-Urêmica/epidemiologia , Humanos , Incidência , Compostos de Organossilício/efeitos adversos , Compostos de Organossilício/uso terapêutico , Placebos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Trissacarídeos/efeitos adversos , Trissacarídeos/uso terapêutico
16.
Am J Gastroenterol ; 116(7): 1523-1532, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34183579

RESUMO

INTRODUCTION: It is unclear whether the alleged efficacy of probiotics in childhood acute gastroenteritis depends on the duration and severity of symptoms before treatment. METHODS: Preplanned secondary analysis of 2 randomized placebo-controlled trials in children 3-48 months of age was conducted in 16 emergency departments in North America evaluating the efficacy of 2 probiotic products (Lactobacillus rhamnosus GG and a combination probiotic: L. rhamnosus and L. helveticus). Participants were categorized in severity groups according to the duration (<24, 24-<72, and ≥72 hours) and the frequency of diarrhea episodes in the 24 hours (≤3, 4-5, and ≥6) before presentation. We used regression models to assess the interaction between pretreatment diarrhea severity groups and treatment arm (probiotic or placebo) in the presence of moderate-to-severe gastroenteritis (Modified Vesikari Scale score ≥9). Secondary outcomes included diarrhea frequency and duration, unscheduled healthcare provider visits, and hospitalization. RESULTS: A total of 1,770 children were included, and 882 (50%) received a probiotic. The development of moderate-to-severe gastroenteritis symptoms after the initiation of treatment did not differ between groups (probiotic-18.4% [162/882] vs placebo-18.3% [162/888]; risk ratio 1.00; 95% confidence interval 0.87, 1.16; P = 0.95). There was no evidence of interaction between baseline severity and treatment (P = 0.61) for the primary or any of the secondary outcomes: diarrhea duration (P = 0.88), maximum diarrheal episodes in a 24-hour period (P = 0.87), unscheduled healthcare visits (P = 0.21), and hospitalization (P = 0.87). DISCUSSION: In children 3-48 months with acute gastroenteritis, the lack of effect of probiotics is not explained by the duration of symptoms or frequency of diarrheal episodes before presentation.


Assuntos
Diarreia/terapia , Gastroenterite/terapia , Probióticos/uso terapêutico , Pré-Escolar , Feminino , Humanos , Lactente , Lactobacillus helveticus , Lactobacillus rhamnosus , Masculino , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
17.
BMJ Open ; 11(6): e042079, 2021 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-34145005

RESUMO

OBJECTIVES: To examine the prevalence of dehydration without diarrhoea among admitted children aged 1-59 months and to describe fluid management practices in such cases. DESIGN: A multisite observational study that used routine in-patient data collected prospectively between October 2013 and December 2018. SETTINGS: Study conducted in 13 county referral hospitals in Kenya. PARTICIPANTS: Children aged 1-59 months with admission or discharge diagnosis of dehydration but had no diarrhoea as a symptom or diagnosis. Children aged <28 days and those with severe acute malnutrition were excluded. RESULTS: The prevalence of dehydration in children without diarrhoea was 3.0% (2019/68 204) and comprised 15.9% (2019/12 702) of all dehydration cases. Only 55.8% (1127/2019) of affected children received either oral or intravenous fluid therapy. Where fluid treatment was given, the volumes, type of fluid, duration of fluid therapy and route of administration were similar to those used in the treatment of dehydration secondary to diarrhoea. Pneumonia (1021/2019, 50.6%) and malaria (715/2019, 35.4%) were the two most common comorbid diagnoses. Overall case fatality in the study population was 12.9% (260/2019). CONCLUSION: Sixteen per cent of children hospitalised with dehydration do not have diarrhoea but other common illnesses. Two-fifths do not receive fluid therapy; a regimen similar to that used in diarrhoeal cases is used in cases where fluid is administered. Efforts to promote compliance with guidance in routine clinical settings should recognise special circumstances where guidelines do not apply, and further studies on appropriate management for dehydration in the absence of diarrhoea are required.


Assuntos
Desidratação , Diarreia , Criança , Desidratação/epidemiologia , Desidratação/terapia , Diarreia/epidemiologia , Diarreia/terapia , Hidratação , Hospitais , Humanos , Lactente , Quênia/epidemiologia , Prevalência
18.
Am J Clin Oncol ; 44(8): 402-408, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34107499

RESUMO

BACKGROUND AND OBJECTIVE: Immune-mediated diarrhea and colitis (IMDC) is a common adverse event in cancer patients receiving immune checkpoint inhibitors (ICIs). Gastrointestinal (GI) infections can co-occur with IMDC, and its impact on the course and outcome of IMDC remains unclear. PATIENTS AND METHODS: We retrospectively reviewed cancer patients who received ICIs and developed IMDC between January 2015 and September 2019. GI multiplex panel is used to assess GI infection. The study group included patients with positive infection except those who are only positive for Clostridioides difficile or cytomegalovirus. The control group is IMDC patients with negative infection using frequency matching. Patients' disease course and outcome were compared between groups. RESULTS: A total of 72 patients with IMDC were included: 22 in the study group and 50 as control. Escherichia coli of different pathotypes was observed in 17 patients. Five patients had viral infections, for example, adenovirus, norovirus, and sapovirus. Patients with GI infections more frequently had grade 3 or 4 colitis (43% vs. 18%, P=0.041). Overall, GI infections were not associated with different risks of IMDC recurrence or overall survival. Antibiotics treatment did not affect the requirement for infliximab or vedolizumab but relate to a higher risk of IMDC recurrence (50.0% vs. 0.0%, P=0.015). CONCLUSIONS: In our study, concomitant GI infections are associated with more severe symptoms in IMDC patients. Antimicrobial treatment did not circumvent the need for immunosuppressive therapy for IMDC or improve the clinical outcome. Concomitant GI infection was not associated with a higher risk of IMDC recurrence or poor overall survival.


Assuntos
Colite/induzido quimicamente , Diarreia/induzido quimicamente , Gastroenteropatias/microbiologia , Gastroenteropatias/virologia , Inibidores de Checkpoint Imunológico/efeitos adversos , Idoso , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Infecções por Clostridium/induzido quimicamente , Colite/mortalidade , Colite/terapia , Diarreia/mortalidade , Diarreia/terapia , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/etiologia , Feminino , Gastroenteropatias/tratamento farmacológico , Humanos , Inibidores de Checkpoint Imunológico/uso terapêutico , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/microbiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Viroses/etiologia , Viroses/virologia
20.
Int Arch Allergy Immunol ; 182(10): 989-996, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34167114

RESUMO

INTRODUCTION: There are a limited number of studies about the clinical findings of coronavirus infection in pediatric patients with asthma. We aimed to evaluate the clinical and laboratory characteristics of pediatric patients with asthma and healthy children without chronic disease who infected with SARS-CoV-2. METHODS: This is a retrospective, case-control study comparing the asthma diagnosed and healthy children who were diagnosed as COVID-19 in our hospital between March 11 and November 10, 2020. RESULTS: During the study period, 6,205 children were diagnosed with CO-VID-19 in our hospital. Only 54 (0.87%) patients had a diagnosis of asthma. The mean of the age was 10.5 years and 53.7% (n:29) of the patients with asthma were male. Cough, shortness of breath, emesis, and diarrhea were found to be significantly higher in asthma group than in the control group (respectively p = 0.002, 0.000, 0.002, 0.019, 0.015). Patients who were given SABA was significantly higher in asthma diagnosed patients (p = 0.000). Hospitalization was significantly higher in asthma group (p = 0.025), and the duration of hospitalization was significantly higher in control group (p = 0.034). There was no significant difference between the 2 groups in terms of requiring oxygen treatment and in laboratory findings between groups. CONCLUSION: This study revealed that pediatric patients diagnosed with asthma were in a mild clinic. According to these findings, asthma may not affect the course of the COVID-19 in children.


Assuntos
Asma/epidemiologia , COVID-19/epidemiologia , SARS-CoV-2 , Adolescente , Agonistas Adrenérgicos beta/uso terapêutico , Antiasmáticos/uso terapêutico , Asma/diagnóstico , Asma/terapia , COVID-19/diagnóstico , COVID-19/terapia , Criança , Tosse/diagnóstico , Tosse/epidemiologia , Tosse/terapia , Diarreia/diagnóstico , Diarreia/epidemiologia , Diarreia/terapia , Dispneia/diagnóstico , Dispneia/epidemiologia , Dispneia/terapia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Oxigenoterapia , Estudos Retrospectivos , Vômito/diagnóstico , Vômito/epidemiologia , Vômito/terapia
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