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1.
Medicine (Baltimore) ; 100(1): e24120, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429783

RESUMO

BACKGROUND: Evaluating the effectiveness and safety of external treatment of traditional Chinese medicine therapy for COVID-19 with diarrhea is the primary purpose of this systematic evaluation program. METHODS: We will search the randomized controlled trials from inception to November 2020. The following database is our focus area: Cochrane Central Register of Controlled Trials, Embase, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Database (CBM), VIP database for Chinese technical Periodicals, and Wanfang Database. We will choose articles published both in Chinese and English. Two reviewers will conduct the study selection, data extraction, and assessment independently. The assessment of risk of bias and data synthesis will be carried out using Review Manager Software V.5.3. RESULTS: The results will provide high-quality synthesis of current evidence for researchers in this subject area. CONCLUSION: This studys decision will provide evidence of whether external treatment of traditional Chinese medicine is an effective and safe intervention for coronavirus disease 2019 with diarrhea. REGISTRATION NUMBER: INPLASY2020110095 (DOI number: 10.37766/inplasy2020.11.0095).


Assuntos
/terapia , Diarreia/terapia , Diarreia/virologia , Medicina Tradicional Chinesa , Projetos de Pesquisa , Humanos
3.
Lancet Digit Health ; 2(5): e250-e258, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-33328057

RESUMO

BACKGROUND: Acute diarrhoeal disease management often requires rehydration alone without antibiotics. However, non-indicated antibiotics are frequently ordered and this is an important driver of antimicrobial resistance. The mHealth Diarrhoea Management (mHDM) trial aimed to establish whether electronic decision support improves rehydration and antibiotic guideline adherence in resource-limited settings. METHODS: A cluster randomised controlled trial was done at ten district hospitals in Bangladesh. Inclusion criteria were patients aged 2 months or older with uncomplicated acute diarrhoea. Admission orders were observed without intervention in the pre-intervention period, followed by randomisation to electronic (rehydration calculator) or paper formatted WHO guidelines for the intervention period. The primary outcome was rate of intravenous fluid ordered as a binary variable. Generalised linear mixed-effect models, accounting for hospital clustering, served as the analytical framework; the analysis was intention to treat. The trial is registered with ClinicalTrials.gov (NCT03154229) and is completed. FINDINGS: From March 11 to Sept 10, 2018, 4975 patients (75·6%) of 6577 screened patients were enrolled. The intervention effect for the primary outcome showed no significant differences in rates of intravenous fluids ordered as a function of decision-support type. Intravenous fluid orders decreased by 0·9 percentage points for paper electronic decision support and 4·2 percentage points for electronic decision support, with a 4·2-point difference between decision-support types in the intervention period (paper 98·7% [95% CI 91·8-99·8] vs electronic 94·5% [72·2-99·1]; pinteraction=0·31). Adverse events such as complications and mortality events were uncommon and could not be statistically estimated. INTERPRETATION: Although intravenous fluid orders did not change, electronic decision support was associated with increases in the volume of intravenous fluid ordered and decreases in antibiotics ordered, which are consistent with WHO guidelines. FUNDING: US National Institutes of Health.


Assuntos
Tomada de Decisões Assistida por Computador , Sistemas de Apoio a Decisões Clínicas , Assistência à Saúde , Diarreia/terapia , Hidratação/métodos , Fidelidade a Diretrizes , Administração Intravenosa , Adolescente , Adulto , Antibacterianos , Bangladesh , Criança , Pré-Escolar , Assistência à Saúde/normas , Eletrônica , Feminino , Hospitais , Humanos , Lactente , Masculino , Papel , Prescrições , Atenção Primária à Saúde , Organização Mundial da Saúde , Adulto Jovem
5.
Acta Gastroenterol Belg ; 83(3): 461-474, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33094595

RESUMO

Chronic diarrhoea is a common clinical problem with a plethora of possible causes and underlying pathophysiological mechanisms. The value of diagnostic assessment by laboratory testing, stool analysis, evaluation of bile acid malabsorption, endoscopy, breath testing and radiological imaging techniques is discussed. The decision to focus investigations on excluding certain pathologies remains a matter of clinical judgement. Functional diarrhoea and irritable bowel syndrome (IBS) being the most frequent causes of chronic diarrhoea, recent insights in the role of dietary management, management of dysbiosis by pre-, pro- and antibiotics and faecal microbiota transplantation, as well as targeted treatment by spasmolytics, 5-HT3 receptor antagonists and eluxadoline will be reviewed.


Assuntos
Diarreia , Síndrome do Intestino Irritável , Ácidos e Sais Biliares , Diarreia/diagnóstico , Diarreia/etiologia , Diarreia/terapia , Transplante de Microbiota Fecal , Humanos , Síndrome do Intestino Irritável/diagnóstico , Síndrome do Intestino Irritável/terapia , Parassimpatolíticos
6.
Rev Med Suisse ; 16(710): 1916-1919, 2020 Oct 14.
Artigo em Francês | MEDLINE | ID: mdl-33058577

RESUMO

Probiotics are a big food and pharmaceutical industry today. The most widely used probiotics are Lactobacillus spp, Bifidobacterium spp, strains of Enterococcus spp, Streptococcus spp and yeasts such as Saccharomyces pp. Among the best-known indications are Clostridioides difficile colitis and diarrhea due to antibiotics, but probiotics are also proposed as adjuvants for atopic syndromes, autoimmune diseases, prevention and treatment of obesity, diabetes and cystic fibrosis, where dysbiosis play an important role. However, their use remains debated due to a lack of powerful data proving their effectiveness and their often-overlooked side effects.


Assuntos
Probióticos/efeitos adversos , Probióticos/uso terapêutico , Antibacterianos/efeitos adversos , Diarreia/microbiologia , Diarreia/terapia , Disbiose/microbiologia , Disbiose/terapia , Humanos
7.
Mil Med Res ; 7(1): 45, 2020 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-32962760

RESUMO

BACKGROUND: Gastrointestinal symptoms are not rare among coronavirus disease 2019 (COVID-19) patients, but there have been no reports regarding convalescent plasma therapy for the recovery of gastrointestinal problems in COVID-19 patients. CASE PRESENTATION: We present two cases of patients with COVID-19-associated recurrent diarrhea and positive fecal occult blood who successfully recovered after a one-time convalescent plasma administration. CONCLUSION: When COVID-19 patients develop recurrent or refractory gastrointestinal symptoms and fail to respond to the available treatment, alternative therapy with convalescent plasma administration may be considered.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Diarreia/terapia , Hemorragia Gastrointestinal/terapia , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Idoso , Infecções por Coronavirus/diagnóstico , Diarreia/etiologia , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Humanos , Imunização Passiva/métodos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Recidiva , Amostragem , Índice de Gravidade de Doença , Taiwan , Resultado do Tratamento
8.
Medicine (Baltimore) ; 99(38): e22227, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957362

RESUMO

BACKGROUND: Diarrheal disease currently claims the lives of approximately 500,000 children each year. Rotaviruses are the pathogens primarily responsible for more severe cases and more than one-third of diarrhea-associated deaths in children under 5 years old globally. At present, commonly used drug therapies for rotavirus diarrhea in Western medicine, such as oral rehydration salts, montmorillonite, probiotics, and nitazoxanide, often cannot achieve satisfactory curative effects. Moreover, infants' and children's compliance with drugs and injections is often lower than their compliance with acupoint application therapy. A large number of studies have shown that acupoint application can increase the clinical cure rate and shorten the duration of diarrhea. However, there is a lack of systematic reviews on the safety and efficacy of acupoint application in the treatment of rotavirus diarrhea. Therefore, we will conduct a study to evaluate the safety and efficacy of acupoint application for rotavirus diarrhea in infants and children. METHODS: We will search the relevant medical literature using PubMed, EMBASE, Web of Science, Cochrane CENTRAL, China National Knowledge Infrastructure, the Wanfang Database, the Chinese Biomedical Literature Database, and the Chinese Scientific Journal Database from inception to August 2020. Both MeSH and free text terms will be utilized to obtain the maximum numbers of papers. No language restrictions will be applied, and the publication type will be limited to randomized controlled trials. Two teams will independently review and assess the studies for inclusion in the review. RevMan V 5.0 software will be applied for data extraction. The methodological quality of the included studies will be evaluated according to the Cochrane Handbook. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: The conclusion of this systematic review will provide evidence regarding whether acupoint application is an effective intervention for infants and children with rotavirus diarrhea. INPLASY REGISTRATION NUMBER: INPLASY202070123.


Assuntos
Pontos de Acupuntura , Diarreia/terapia , Medicina Tradicional Chinesa/métodos , Infecções por Rotavirus/terapia , Criança , Diarreia/virologia , Humanos , Lactente , Metanálise como Assunto , Infecções por Rotavirus/complicações , Revisões Sistemáticas como Assunto
9.
Medicine (Baltimore) ; 99(38): e21617, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957305

RESUMO

BACKGROUND: The study aims to evaluate the efficacy and safety of probiotic therapy for coronavirus disease 2019 with diarrhea. METHODS: The following electronic bibliographic databases will be searched to identify relevant studies from December 2019 to December 2020: MEDLINE, PubMed, Embase, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Chinese Technical Periodicals, Wan-fang data, Chinese Biological Medicine Database, and other databases. The search results will not be restricted by language, all included articles were randomized controlled trial. Two independent researchers will conduct article retrieval, de-duplication, filtering, quality assessment, and data analysis through the Review Manager (V.5.3). Meta-analysis, subgroup analysis and/or descriptive analysis were performed on the included data. RESULTS: High-quality synthesis and/or descriptive analysis of current evidence will be provided from outcomes. CONCLUSION: This study will provide the evidence of whether probiotics is an effective and safe intervention for coronavirus disease 2019 with diarrhea.PROSPERO registration number: CRD42020192657.


Assuntos
Betacoronavirus , Infecções por Coronavirus/microbiologia , Diarreia/terapia , Pneumonia Viral/microbiologia , Probióticos/uso terapêutico , Infecções por Coronavirus/complicações , Diarreia/microbiologia , Humanos , Metanálise como Assunto , Pandemias , Pneumonia Viral/complicações , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
10.
Benef Microbes ; 11(5): 477-488, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32877228

RESUMO

Neonatal calf diarrhoea is one of the challenges faced by intensive farming, and probiotics are considered a promising approach to improve calves' health. The objective of this study was to evaluate the effect of potential probiotic lactobacilli on new-born dairy calves' growth, diarrhoea incidence, faecal score, cytokine expression in blood cells, immunoglobulin A (IgA) levels in plasma and faeces, and pathogen abundance in faeces. Two in vivo assays were conducted at the same farm in two annual calving seasons. Treated calves received one daily dose of the selected lactobacilli (Lactobacillus reuteri TP1.3B or Lactobacillus johnsonii TP1.6) for 10 consecutive days. A faecal score was recorded daily, average daily gain (ADG) was calculated, and blood and faeces samples were collected. Pathogen abundance was analysed by absolute qPCR in faeces using primers directed at Salmonella enterica, rotavirus, coronavirus, Cryptosporidium parvum and three Escherichia coli virulence genes (eae, clpG and Stx1). The faecal score was positively affected by the administration of both lactobacilli strains, and diarrhoea incidence was significantly lower in treated calves. No differences were found regarding ADG, cytokine expression, IgA levels and pathogen abundance. Our findings showed that oral administration of these strains could improve gastrointestinal health, but results could vary depending on the calving season, which may be related to pathogen seasonality and other environmental effects.


Assuntos
Doenças dos Bovinos/terapia , Diarreia , Lactobacillus johnsonii/metabolismo , Lactobacillus reuteri/metabolismo , Probióticos/uso terapêutico , Animais , Animais Recém-Nascidos , Bovinos , Doenças dos Bovinos/microbiologia , Doenças dos Bovinos/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/veterinária , Criptosporidiose/prevenção & controle , Citocinas/sangue , Indústria de Laticínios , Diarreia/prevenção & controle , Diarreia/terapia , Diarreia/veterinária , Infecções por Escherichia coli/prevenção & controle , Infecções por Escherichia coli/veterinária , Fezes/virologia , Trato Gastrointestinal/microbiologia , Imunoglobulina A/sangue , Infecções por Rotavirus/prevenção & controle , Infecções por Rotavirus/veterinária , Salmonelose Animal/prevenção & controle
11.
Medicine (Baltimore) ; 99(35): e21920, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871927

RESUMO

INTRODUCTION: Collagen colitis (CC) is a microscopic colitis diagnosed by mucosal biopsy and is extremely rare in children. PATIENT CONCERNS: We reported a child with severe persistent diarrhea that could not be relieved with traditional diarrheal treatment. No abnormalities were found after multiple colonoscopies. DIAGNOSES: A significant increase in total IgE levels was found in the patient's blood. He had a history of mild chronic allergic rhinitis and slightly intermittent wheezing. However, we found that the child had a hyperallergic reaction to multiple respiratory antigens and had mild pulmonary dysfunction. Finally, colonoscopy with biopsy identified the diagnosis of CC. INTERVENTION: Considering that a respiratory allergic reaction was one of the causes of diarrhea, anti-allergic treatment was given to the child, and his severe diarrhea was soon relieved. Corticosteroid treatment was suggested to the patient, but his parents firmly refused steroid therapy. According to the patient's specific allergic reaction to mites, desensitization treatment was finally chosen for him. OUTCOMES: After 1 year of desensitization for dust mites, the patient's respiratory symptoms improved, total IgE levels decreased, autoantibodies declined, and diarrhea did not reoccur. Colonoscopy with biopsy showed a significant improvement in pathology. CONCLUSION: CC in children is rare, and childhood CC induced by a respiratory allergic reaction has not been previously reported. Therefore, this is a special case of CC in a patient who was cured with anti-allergy treatments and desensitization instead of steroid therapy.


Assuntos
Colite Colagenosa/diagnóstico , Colite Colagenosa/etiologia , Diarreia/etiologia , Hipersensibilidade Respiratória/complicações , Antialérgicos/uso terapêutico , Biópsia , Criança , Doença Crônica , Colite Colagenosa/terapia , Colonoscopia , Dessensibilização Imunológica , Diarreia/terapia , Humanos , Masculino , Hipersensibilidade Respiratória/terapia
12.
Nat Commun ; 11(1): 4333, 2020 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-32859933

RESUMO

Diarrhoea is one of the most burdensome and common adverse events of chemotherapeutics, and has no standardised therapy to date. Increasing evidence suggests that the gut microbiome can influence the development of chemotherapy-induced diarrhoea. Here we report findings from a randomised clinical trial of faecal microbiota transplantation (FMT) to treat diarrhoea induced by tyrosine kinase inhibitors (TKI) in patients with metastatic renal cell carcinoma (ClinicalTrials.gov number: NCT04040712). The primary outcome is the resolution of diarrhoea four weeks after the end of treatments. Twenty patients are randomised to receive FMT from healthy donors or placebo FMT (vehicle only). Donor FMT is more effective than placebo FMT in treating TKI-induced diarrhoea, and a successful engraftment is observed in subjects receiving donor faeces. No serious adverse events are observed in both treatment arms. The trial meets pre-specified endpoints. Our findings suggest that the therapeutic manipulation of gut microbiota may become a promising treatment option to manage TKI-dependent diarrhoea.


Assuntos
Carcinoma de Células Renais/complicações , Diarreia/terapia , Inibidores Enzimáticos/metabolismo , Transplante de Microbiota Fecal/métodos , Neoplasias Renais/complicações , Tirosina/metabolismo , Idoso , Método Duplo-Cego , Tratamento Farmacológico , Disbiose , Fezes , Feminino , Microbioma Gastrointestinal , Humanos , Masculino , Pessoa de Meia-Idade , Doadores de Tecidos
13.
Medicine (Baltimore) ; 99(34): e21817, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846822

RESUMO

BACKGROUND: Diarrhea-predominant irritable bowel syndrome (IBS-D) is a common functional intestinal disease characterized by abdominal pain and diarrhea. Herb-partitioned moxibustion (HPM), a characteristic external therapy, is effective in treating IBS-D. However, no systematic review has been carried out to assess the efficacy and safety of HPM for IBS-D. The aim of this study will systematically evaluate the efficacy and safety of HPM for the treatment of patients with IBS-D. METHODS: We will perform the comprehensive literature search in both English and Chinese electronic database including PubMed, Embase, Cochrane Library, Web of Science database, Medline, Chinese BioMedical Literature Database, China National Knowledge Infrastructure, Wanfang database, Chongqing VIP information, and SinoMed from their inception to July 2020. All randomized controlled trials of HPM for the treatment of IBS-D will be included. RevManV5. 3 will be applied to analyze the data. RESULTS: This study will provide high-quality synthesis of current evidence of effectiveness and safety on HPM for patients with IBS-D. CONCLUSION: The conclusion of our systematic review will provide evidence to judge whether HPM is an effective intervention for IBS-D. TRIAL REGISTRATION NUMBER: 10.17605/OSF.IO/3JXCZ.


Assuntos
Diarreia/terapia , Medicamentos de Ervas Chinesas/uso terapêutico , Síndrome do Intestino Irritável/terapia , Moxibustão/métodos , Terapia Combinada , Diarreia/etiologia , Medicamentos de Ervas Chinesas/efeitos adversos , Humanos , Síndrome do Intestino Irritável/complicações , Metanálise como Assunto , Moxibustão/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
15.
Arab J Gastroenterol ; 21(3): 146-150, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32680695

RESUMO

The new COVID-19 pandemic has been initially linked to respiratory manisfestations. However, there is increasing evidence that other systems are affected by SARS-CoV2; one of which is the gastrointestinal system with several organ-related symptoms and possible implications on prognosis and spread. Diarrhoea is one of the main symptoms of gastrointestinal involvement. In this review the mechanisms, characteristics, prognostic significance and managment of of COVID-19 related diarrhoea are discussed. The possibility of faecal transmission of disease is reviewed.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Diarreia/virologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Infecções por Coronavirus/transmissão , Diarreia/diagnóstico , Diarreia/terapia , Humanos , Pandemias , Pneumonia Viral/transmissão
16.
BMC Vet Res ; 16(1): 264, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32727468

RESUMO

BACKGROUND: Neonatal diarrhea remains one of the main causes of morbi-mortality in dairy calves under artificial rearing. It is often caused by infectious agents of viral, bacterial, or parasitic origin. Cows vaccination and colostrum intake by calves during the first 6 h of life are critical strategies to prevent severe diarrhea but these are still insufficient. Here we report the field evaluation of a product based on IgY antibodies against group A rotavirus (RVA), coronavirus (CoV), enterotoxigenic Escherichia coli, and Salmonella sp. This product, named IgY DNT, has been designed as a complementary passive immunization strategy to prevent neonatal calf diarrhea. The quality of the product depends on the titers of specific IgY antibodies to each antigen evaluated by ELISA. In the case of the viral antigens, ELISA antibody (Ab) titers are correlated with protection against infection in calves experimentally challenged with RVA and CoV (Bok M, et al., Passive immunity to control bovine coronavirus diarrhea in a dairy herd in Argentina, 2017), (Vega C, et al., Vet Immunol Immunopathol, 142:156-69, 2011), (Vega C, et al., Res Vet Sci, 103:1-10, 2015). To evaluate the efficiency in dairy farms, thirty newborn Holstein calves were randomly assigned to IgY DNT or control groups and treatment initiated after colostrum intake and gut closure. Calves in the IgY DNT group received 20 g of the oral passive treatment in 2 L of milk twice a day during the first 2 weeks of life. Animals were followed until 3 weeks of age and diarrhea due to natural exposure to infectious agents was recorded during all the experimental time. RESULTS: Results demonstrate that the oral administration of IgY DNT during the first 2 weeks of life to newborn calves caused a delay in diarrhea onset and significantly reduced its severity and duration compared with untreated calves. Animals treated with IgY DNT showed a trend towards a delay in RVA infection with significantly shorter duration and virus shedding compared to control calves. CONCLUSIONS: This indicates that IgY DNT is an effective product to complement current preventive strategies against neonatal calf diarrhea in dairy farms. Furthermore, to our knowledge, this is the only biological product available for the prevention of virus-associated neonatal calf diarrhea.


Assuntos
Anticorpos Antibacterianos/uso terapêutico , Anticorpos Antivirais/uso terapêutico , Doenças dos Bovinos/terapia , Diarreia/veterinária , Imunoglobulinas/uso terapêutico , Imunoterapia , Animais , Animais Recém-Nascidos , Anticorpos Antiprotozoários , Bovinos , Doenças dos Bovinos/microbiologia , Doenças dos Bovinos/virologia , Criptosporidiose/prevenção & controle , Indústria de Laticínios , Diarreia/microbiologia , Diarreia/terapia , Diarreia/virologia , Imunização Passiva/métodos , Imunização Passiva/veterinária
17.
Medicine (Baltimore) ; 99(28): e21293, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664185

RESUMO

BACKGROUND: In the beginning of December 2019, the novel coronavirus pneumonia was first detected in Wuhan, China. Its widespread infectivity and strong pathogenicity has posed a great threat to public health, seriously affecting social production and life. Accumulating evidence suggests that gastrointestinal symptoms, such as diarrhea, are common among patients with COVID-19. Tuina (massage) therapy is 1 of the widely employed complementary and alternative medicine interventions in the world. It can act on the subcutaneous muscular layer, enhance the local blood circulation and tissue metabolism of the skin, thus exert its effects on digestive systems and alleviate aversive diarrhea symptoms. This systematic review and meta-analysis will summarize the current evidence of tuina (massage) used as an intervention for diarrhea symptoms in COVID-19. METHODS: We will search the following electronic databases for randomized controlled trials to evaluate the effectiveness and safety of massage therapy in treating exercise-induced fatigue: China National Knowledge Infrastructure, Wanfang and Pubmed Database, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature, Excerpta Medica database and MEDLINE. Each database will be searched from inception to June 2020. The entire process will include study selection, data extraction, risk of bias assessment and meta-analyses. RESULTS: This proposed study will evaluate the effectiveness and safety of massage therapy for diarrhea symptoms in COVID-19 patients. The outcomes will include the improvement of diarrhea symptoms and adverse effect. CONCLUSIONS: This proposed systematic review will evaluate the existing evidence on the effectiveness and safety of massage therapy for diarrhea symptoms in COVID-19 patients.Dissemination and ethics: The results of this review will be disseminated through peer-reviewed publication. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process.


Assuntos
Infecções por Coronavirus , Diarreia , Fadiga , Massagem/métodos , Pandemias , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Diarreia/etiologia , Diarreia/fisiopatologia , Diarreia/terapia , Fadiga/etiologia , Fadiga/prevenção & controle , Humanos , Metanálise como Assunto , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
18.
Lancet Glob Health ; 8(8): e1038-e1060, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32710861

RESUMO

BACKGROUND: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. METHODS: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000-17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. FINDINGS: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000-7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910-68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. INTERPRETATION: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. FUNDING: Bill & Melinda Gates Foundation.


Assuntos
Países em Desenvolvimento , Diarreia/terapia , Hidratação/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Teorema de Bayes , Pré-Escolar , Geografia , Pesquisas sobre Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Modelos Estatísticos
19.
Zhongguo Zhen Jiu ; 40(7): 702-6, 2020 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-32648391

RESUMO

OBJECTIVE: To observe the clinical therapeutic effect of herb-separated moxibustion at Jinsuo (GV 8)- eight-diagram points on diarrhea-type irritable bowel syndrome (IBS-D) of liver stagnation and spleen deficiency as compared with oral administration of pinaverium bromide tablets and Chinese herbal decoction, tongxieyaofang. METHODS: A total of 126 patients with IBS-D of liver stagnation and spleen deficiency were randomized into a herb-separated moxibustion group (moxibustion group), a western medication group and a Chinese herbal medication group, 42 cases in each one. In the moxibustion group, the herb-separated moxibustion was applied to Jinsuo (GV 8)-eight-diagram points. The herbs in tongxieyaofang (fried rhizoma atractylodis macrocephalae, fried radix paeoniae alba, pericarpium citri reticulatae and radix saposhnikoviae) were ground into herbal paste and the paste was put on Jinsuo (GV 8)-eight-diagram points. The suspending moxibustion was exerted over the points for 40 min, once daily. In the western medication group, pinaverium bromide tablets were taken orally, 50 mg each time, three times a day. In the Chinese herbal medication group, the decoction of tongxieyaofang was taken orally, one dose a day, taking separately in two times. The duration of treatment was 8 weeks in each group. Before and after treatment, the symptom score of traditional Chinese medicine (TCM), gastrointestinal (GI) symptom score, the score of IBS symptom severity scale (IBS-SSS) and the score of IBS quality of life (IBS-QOL) scale were observed in patients of each group separately. The clinical therapeutic effect was evaluated. RESULTS: After treatment, the scores of TCM symptoms, GI symptom scores and IBS-SSS scores were all obviously reduced in each group (P<0.05). Each of the scores in the moxibustion group was lower than the western medication group and the Chinese herbal medication group respectively (P<0.05). After treatment, the scores of each of eight subscale structures of IBS-QOL scale, named dysphoria, interference with activity, body image, health worry, food avoidance, social reaction, sexual intercourse and relationship, were all increased obviously in each group (P<0.05). The scores of each of eight subscale structures in the moxibustion group were higher than the western medication group and the Chinese herbal medication group respectively (P<0.05). The total effective rate was 92.9% (39/42) in the moxibustion group, higher than 71.4% (30/42) in the western medication group and 73.8% (31/42) in the Chinese herbal medication group respectively (P<0.05). CONCLUSION: Herb-separated moxibustion at Jinsuo (GV 8)-eight-diagram points remarkably relieves gastrointestinal symptoms and improves the quality of life in patients of diarrhea-type irritable bowel syndrome of liver stagnation and spleen deficiency, and its clinical therapeutic effect is superior to oral administration of either pinaverium bromide tablets or tongxieyaofang.


Assuntos
Diarreia/terapia , Síndrome do Intestino Irritável/terapia , Moxibustão , Medicamentos de Ervas Chinesas , Humanos , Fígado , Medicina Tradicional Chinesa , Qualidade de Vida , Baço , Resultado do Tratamento
20.
Am J Gastroenterol ; 115(10): 1596-1603, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32558690

RESUMO

Bile acids (BAs) are the central signals in enterohepatic communication, and they also integrate microbiota-derived signals into enterohepatic signaling. The tissue distribution and signaling pathways activated by BAs through natural receptors, farsenoid X receptor and G protein-coupled BA receptor 1 (GPBAR1, also known as Takeda G-coupled receptor 5), have led to a greater understanding of the mechanisms and potential therapeutic agents. BA diarrhea is most commonly encountered in ileal resection or disease, in idiopathic disorders (with presentation similar to functional diarrhea or irritable bowel syndrome with diarrhea), and in association with malabsorption such as chronic pancreatitis or celiac disease. Diagnosis of BA diarrhea is based on Se-homocholic acid taurine retention, 48-hour fecal BA excretion, or serum 7αC4; the latter being a marker of hepatic BA synthesis. BA diarrhea tends to be associated with higher body mass index, increased stool weight and stool fat, and acceleration of colonic transit. Biochemical markers of increased BA synthesis or excretion are available through reference laboratories. Current treatment of BA diarrhea is based on BA sequestrants, and, in the future, it is anticipated that farsenoid X receptor agonists may also be effective. The optimal conditions for an empiric trial with BA sequestrants as a diagnostic test are still unclear. However, such therapeutic trials are widely used in clinical practice. Some national guidelines recommend definitive diagnosis of BA diarrhea over empirical trial.


Assuntos
Ácidos e Sais Biliares/metabolismo , Diarreia/metabolismo , Diarreia/terapia , Dieta com Restrição de Gorduras , Sequestrantes/uso terapêutico , Benzotiazóis/uso terapêutico , Ácido Quenodesoxicólico/análogos & derivados , Ácido Quenodesoxicólico/uso terapêutico , Colestenonas/sangue , Resina de Colestiramina/uso terapêutico , Doença Crônica , Cloridrato de Colesevelam/uso terapêutico , Colestipol/uso terapêutico , Fezes/química , Humanos , Mucosa Intestinal/metabolismo , Síndrome do Intestino Irritável/metabolismo , Isoxazóis/uso terapêutico , Fígado/metabolismo , Síndromes de Malabsorção/diagnóstico , Síndromes de Malabsorção/tratamento farmacológico , Síndromes de Malabsorção/metabolismo , Receptores Citoplasmáticos e Nucleares/agonistas , Ácido Taurocólico/análogos & derivados
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