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1.
Nutrients ; 13(2)2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33567596

RESUMO

Caffeic acid is one of the most abundant hydroxycinnamic acids in fruits, vegetables, and beverages. This phenolic compound reaches relevant concentrations in the colon (up to 126 µM) where it could come into contact with the intestinal cells and exert its anti-inflammatory effects. The aim of this investigation was to study the capacity of caffeic acid, at plausible concentrations from an in vivo point of view, to modulate mechanisms related to intestinal inflammation. Consequently, we tested the effects of caffeic acid (50-10 µM) on cyclooxygenase (COX)-2 expression and prostaglandin (PG)E2, cytokines, and chemokines (IL-8, monocyte chemoattractant protein-1 -MCP-1-, and IL-6) biosynthesis in IL-1ß-treated human myofibroblasts of the colon, CCD-18Co. Furthermore, the capacity of caffeic acid to inhibit the angiotensin-converting enzyme (ACE) activity, to hinder advanced glycation end product (AGE) formation, as well as its antioxidant, reducing, and chelating activity were also investigated. Our results showed that (i) caffeic acid targets COX-2 and its product PGE2 as well as the biosynthesis of IL-8 in the IL-1ß-treated cells and (ii) inhibits AGE formation, which could be related to (iii) the high chelating activity exerted. Low anti-ACE, antioxidant, and reducing capacity of caffeic acid was also observed. These effects of caffeic acid expands our knowledge on anti-inflammatory mechanisms against intestinal inflammation.


Assuntos
Anti-Inflamatórios/farmacologia , Ácidos Cafeicos/farmacologia , Gastroenterite/tratamento farmacológico , Intestinos/efeitos dos fármacos , Miofibroblastos/efeitos dos fármacos , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Antioxidantes/farmacologia , Quelantes/farmacologia , Quimiocinas/efeitos dos fármacos , Colo/citologia , Colo/efeitos dos fármacos , Ciclo-Oxigenase 2/efeitos dos fármacos , Citocinas/efeitos dos fármacos , Dinoprostona/antagonistas & inibidores , Produtos Finais de Glicação Avançada/antagonistas & inibidores , Humanos , Inflamação , Interleucina-1beta/biossíntese , Intestinos/citologia
2.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541980

RESUMO

Eosinophilic gastroenteritis is a rare inflammatory disorder of the gastrointestinal tract. Although commonly associated with allergic diseases, it is also rarely associated with autoimmune disorders. This case report describes a 17-year-old Filipino male with eosinophilic gastroenteritis, manifesting as abdominal pain, vomiting and diarrhoea. He had no allergic diseases, but he was previously diagnosed with chronic bullous disease. His symptoms improved with the initiation of corticosteroids. To date, this is the first case report of a patient with eosinophilic gastroenteritis and chronic bullous disease.


Assuntos
Enterite/diagnóstico , Eosinofilia/diagnóstico , Gastrite/diagnóstico , Gastroenterite/diagnóstico , Dor Abdominal/etiologia , Adolescente , Anti-Infecciosos/uso terapêutico , Apendicite/diagnóstico , Apendicite/tratamento farmacológico , Apendicite/cirurgia , Diarreia/etiologia , Enterite/tratamento farmacológico , Enterite/patologia , Eosinofilia/tratamento farmacológico , Eosinofilia/patologia , Gastrite/tratamento farmacológico , Gastrite/patologia , Gastroenterite/tratamento farmacológico , Humanos , Masculino , Metronidazol/uso terapêutico , Omento/patologia , Filipinas , Prednisona/uso terapêutico , Vômito/etiologia
3.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370946

RESUMO

Acute gastroenteritis with persistent vomiting, high degree fever and blood streaking stools often suggests bacterial aetiology in children. Authors report a 13-year-old boy presenting with acute watery diarrhoea with persistent vomiting, fever of 103°F, abdominal cramps and blood streaking stools who failed to show any response to parenteral third-generation cephalosporin for 72 hours. The stool examination revealed numerous cystic and amoeboid forms of Blastocystis hominis Metronidazole was started and the boy promptly responded within 24 hours. There was no recurrence of symptoms then onwards. The case highlights the crucial stool examination in case of acute diarrhoeal disease for rare aetiology.


Assuntos
Antiprotozoários/uso terapêutico , Infecções por Blastocystis/diagnóstico , Blastocystis hominis/isolamento & purificação , Gastroenterite/diagnóstico , Doença Aguda/terapia , Adolescente , Infecções por Blastocystis/tratamento farmacológico , Infecções por Blastocystis/parasitologia , Fezes/parasitologia , Gastroenterite/tratamento farmacológico , Gastroenterite/parasitologia , Humanos , Masculino , Metronidazol/uso terapêutico , Resultado do Tratamento
4.
Am J Trop Med Hyg ; 103(2): 887-893, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32588795

RESUMO

Increasing access to rapid diagnostic tests for malaria (mRDTs) has raised awareness of the challenges healthcare workers face in managing non-malarial febrile illnesses (NMFIs). We examined NMFI prevalence, clinical diagnoses, and prescribing practices in outpatient clinics across different malaria transmission settings in Malawi. Standardized facility-based malaria surveillance was conducted at three facilities one of every 4 weeks over 2 years. Information on demographics, presenting symptoms, temperature, clinical diagnosis, and treatment were collected from outpatients presenting with malaria-like symptoms. Of the 25,486 patients with fever, 69% had NMFI. Non-malarial febrile illness prevalence was lower in 5- to 15-year-old patients (55%) than in children < 5 years (72%) and adults > 15 years of age (77%). The most common clinical diagnoses among febrile patients with negative mRDTs in all age-groups and settings were respiratory infections (46%), sepsis (29%), gastroenteritis (13%), musculoskeletal pain (9%), and malaria (5%). Antibiotic prescribing was high in all age-groups and settings. Trimethoprim-sulfamethoxazole (40%) and amoxicillin (29%) were the most commonly prescribed antibiotics and were used for nearly all clinical diagnoses. In these settings with minimal access to diagnostic tools, patients with fever and a negative mRDT received a limited number of clinical diagnoses. Many were likely to be inaccurate and were associated with the inappropriate use of the limited range of available antibiotics. Prescription and diagnostic practices for NMFIs in the facilities require research and policy input. Resource-limited malaria-endemic countries urgently need more point-of-care diagnostic tools and evidence-based diagnosis and treatment algorithms to provide effective and cost-efficient care.


Assuntos
Antibacterianos/uso terapêutico , Febre/epidemiologia , Gastroenterite/epidemiologia , Malária/epidemiologia , Dor Musculoesquelética/epidemiologia , Infecções Respiratórias/epidemiologia , Sepse/epidemiologia , Adolescente , Assistência Ambulatorial , Amoxicilina/uso terapêutico , Criança , Pré-Escolar , Gerenciamento Clínico , Doenças Endêmicas , Feminino , Febre/etiologia , Gastroenterite/complicações , Gastroenterite/tratamento farmacológico , Humanos , Malária/complicações , Malária/diagnóstico , Malaui/epidemiologia , Masculino , Dor Musculoesquelética/complicações , Dor Musculoesquelética/tratamento farmacológico , Prevalência , Infecções Respiratórias/complicações , Infecções Respiratórias/tratamento farmacológico , Sepse/complicações , Sepse/tratamento farmacológico , Infecções dos Tecidos Moles/complicações , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/epidemiologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adulto Jovem
5.
Artigo em Inglês | MEDLINE | ID: mdl-32560168

RESUMO

The French national public health agency (Santé publique France) has used data from the national health insurance reimbursement system (SNDS) to identify medicalised acute gastroenteritis (mAGE) for more than 10 years. This paper presents the method developed to evaluate this system: performance and characteristics of the discriminatory algorithm, portability in mainland and overseas French departments, and verification of the mAGE database updating process. Pharmacy surveys with certified mAGE from 2012 to 2015 were used to characterise mAGE and to estimate the sensitivity and predictive positive value (PPV) of the algorithm. Prescription characteristics from these pharmacy surveys and from 2014 SNDS prescriptions in six mainland and overseas departments were compared. The sensitivity (0.90) and PPV (0.82) did not vary according to the age of the population or year. Prescription characteristics were similar within all studied departments. This confirms that the algorithm can be used in all French departments, for both paediatric and adult populations, with stability and durability over time. The algorithm can identify mAGE cases at a municipal level. The validated system has been implemented in a national waterborne disease outbreaks surveillance system since 2019 with the aim of improving the prevention of infectious disease risk attributable to localised tap water systems.


Assuntos
Gastroenterite , Seguro Saúde , Vigilância de Evento Sentinela , Adolescente , Adulto , Algoritmos , Criança , Pré-Escolar , Prescrições de Medicamentos/estatística & dados numéricos , França/epidemiologia , Gastroenterite/tratamento farmacológico , Gastroenterite/epidemiologia , Humanos , Vigilância da População
6.
Anaerobe ; 64: 102233, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32593567

RESUMO

COVID-19 dramatically affects the elderly. Due to the large usage of antibiotics during the current pandemic and the gastrointestinal manifestations of COVID-19, the elderly population, hospitalized patients, residents in LTCFs and persons that survived the COVID-19 might be more prone to Clostridioides difficile infections (CDI). A renewed attention to CDI is necessary during the ongoing COVID-19 pandemic.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Clostridium/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Gastroenterite/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/efeitos dos fármacos , Infecções por Clostridium/patologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/patologia , Gastroenterite/microbiologia , Gastroenterite/patologia , Trato Gastrointestinal/microbiologia , Trato Gastrointestinal/patologia , Humanos , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/patologia
7.
Sci Rep ; 10(1): 5823, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-32242070

RESUMO

Gastroenteritis is common among children. Campylobacter jejuni is one of the main causative bacterial pathogens, together with Shigella, Salmonella and invasive Escherichia coli. Campylobacteriosis is a zoonotic, usually self-limited disease that does not always require antibiotic treatment. In cases of protracted diarrhoea in healthy children or immunocompromised patients, antibiotic treatment is recommended, and the drug of choice is still macrolides, with very low resistance rates in Campylobacter species. However, it is crucial to isolate the causative organism, because some cases, such as Shigella encephalitis, call for initiation of empiric antibiotic treatment. In this study, we compared the incidence, epidemiology, clinical findings and laboratory results of gastroenteritis with dysentery caused by these organisms in children in our area. C. jejuni was found to be the leading pathogen in children hospitalized with bacterial gastroenteritis, followed by Shigella and Salmonella. Macrolides were the drug of choice for Campylobacter, and ceftriaxone and ciprofloxacin were the best empiric treatments for Shigella and Salmonella, respectively.


Assuntos
Infecções por Campylobacter/epidemiologia , Gastroenterite/epidemiologia , Gastroenterite/microbiologia , Antibacterianos/uso terapêutico , Infecções por Campylobacter/tratamento farmacológico , Infecções por Campylobacter/microbiologia , Campylobacter jejuni/efeitos dos fármacos , Criança , Pré-Escolar , Feminino , Gastroenterite/tratamento farmacológico , Humanos , Lactente , Israel/epidemiologia , Masculino
8.
Curr Pharm Biotechnol ; 21(11): 1042-1051, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32297578

RESUMO

BACKGROUND: Probiotics can be used for the treatment of viral gastroenteritis. OBJECTIVE: This systematic review is to evaluate the evidence regarding the effect of probiotics on human cases of viral gastroenteritis. METHODS: The objective of this review is to evaluate the effectiveness of probiotics against placebo or standard treatment for viral gastroenteritis. A comprehensive search of Cochrane Library, EMBASE, MEDLINE via PubMed and Ovid databases, and unpublished studies (till 27 January 2018) was conducted followed by a process of study selection and critical appraisal by two independent reviewers. Randomized controlled trials assessing probiotic administration in human subjects infected with any species of gastroenteritis viruses were considered for inclusion. Only studies with a confirmed viral cause of infection were included. This study was developed using the JBI methodology for systematic reviews, which is in accordance with the PRISMA guideline. Meta-analysis was conducted where feasible. Data were pooled using the inverse variance method with random effects models and expressed as Mean Differences (MDs) with 95% Confidence Intervals (CIs). Heterogeneity was assessed by Cochran Q statistic and quantified by the I2 statistic. We included 17 RCTs, containing 3,082 patients. RESULTS: Probiotics can improve symptoms of viral gastroenteritis, including the duration of diarrhea (mean difference 0.7 days, 95% CI 0.31 to 1.09 days, n = 740, ten trials) and duration of hospitalization (mean difference 0.76 days, 95% CI 0.61 to 0.92 days, n = 329, four trials). CONCLUSION: The results of this review show that the administration of probiotics in patients with viral gastroenteritis should be considered.


Assuntos
Diarreia/tratamento farmacológico , Gastroenterite/tratamento farmacológico , Probióticos/uso terapêutico , Suplementos Nutricionais , Gastroenterite/virologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Infecções por Rotavirus/tratamento farmacológico , Infecções por Rotavirus/virologia , Resultado do Tratamento
9.
Euro Surveill ; 25(9)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32156328

RESUMO

An outbreak of gastroenteritis with 83 cases occurred at a conference venue in November 2017 in Halland County, Sweden. Stool samples from two venue visitors and a symptomatic secondary case attributed to household transmission were PCR-positive for the ipaH gene, a target found in both Shigella spp. and enteroinvasive Escherichia coli (EIEC). EIEC was isolated from stool samples and whole genome sequencing analysis confirmed EIEC O96:H19 to be the aetiological agent. A cohort study was conducted among venue attendees and employees and the findings implicated contaminated leafy greens as the vehicle of infection, however, no microbiological evidence could support the study results. Here, we report the investigation into the first recorded EIEC outbreak in Sweden and illustrate the challenges associated with the differential laboratory diagnostics of Shigella/EIEC in an outbreak setting.


Assuntos
Escherichia coli/isolamento & purificação , Fezes/microbiologia , Gastroenterite/microbiologia , Shigella/isolamento & purificação , Antibacterianos/uso terapêutico , Estudos de Coortes , DNA Bacteriano/análise , Surtos de Doenças , Escherichia coli/genética , Infecções por Escherichia coli , Gastroenterite/tratamento farmacológico , Gastroenterite/epidemiologia , Humanos , Reação em Cadeia da Polimerase , Suécia/epidemiologia , Sequenciamento Completo do Genoma
10.
Zhonghua Nei Ke Za Zhi ; 59(1): 82-85, 2020 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-31887844

RESUMO

A 43-year-old male presented with elevated serum creatinine for 4 years and developed abdominal pain for 3 days. He started peritoneal dialysis 2 months ago. Dialysis-related peritonitis was ruled out and acute gastroenteritis was diagnosed. The patient was administrated with ertapenem 500 mg/d. An acute mental abnormality developed 3 days later. After excluded organic encephalopathy, ertapenem was discontinued for the suspicion of antibiotic-related encephalopathy. The frequency of peritoneal dialysis was increased to accelerate the clearance of antibiotics. However, the metal abnormality became even more severe. Then a diagnosis of Wernick-Korsakoff syndrome was considered. After the administration of high dose vitamin B(1), the mental disorder dramatically relieved. Vitamin B(1) 30 mg/d is maintained during peritoneal dialysis and the mental disorder does not relapse.


Assuntos
Dor Abdominal/etiologia , Síndrome de Korsakoff/tratamento farmacológico , Diálise Peritoneal , Insuficiência Renal/terapia , Tiamina/administração & dosagem , Encefalopatia de Wernicke/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Ertapenem/uso terapêutico , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Humanos , Síndrome de Korsakoff/diagnóstico , Masculino , Transtornos Mentais , Peritonite , Insuficiência Renal/complicações , Resultado do Tratamento , Encefalopatia de Wernicke/diagnóstico
12.
Arch Dis Child ; 105(2): 141-146, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31272969

RESUMO

OBJECTIVE: To determine the effectiveness and safety of gelatin tannate (GT) for reducing the duration of the acute diarrhoea and gastroenteritis (ADG) in children. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, LILACS and grey literature, published from inception to October 2018. No language restrictions. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials in children with ADG, comparing GT with placebo. RESULTS: Of 797 titles identified, we included three studies (276 children). We performed a random effects model meta-analysis for the main outcome (diarrhoea duration). We did not find significant differences between GT and placebo for diarrhoea duration (mean difference (MD)=-15.85 hours; 95% CI -42.24 to 14.82, I2=92%; three studies), stool frequency at day 2 (MD=0.11 stools/day; 95% CI -0.39 to 0.62: I2=26%; two studies), diarrhoea at day 3 (risk ratio [RR]=0.46; 95% CI 0.06 to 3.47: I2=73%; two studies), vomiting (RR=1.31; 95% CI 0.95 to 1.80: I2=0%; two studies) or adverse events (RR=0.86; 95% CI 0.27 to 2.66: I2=0%; two studies). Most common adverse events included abdominal pain and nausea. CONCLUSION: The effect of GT was no different to placebo for mean diarrhoea duration (low certainty on the evidence) and stool frequency at day 2 (high certainty) and for the presence of diarrhoea at day 3 (very low certainty) of vomiting (moderate certainty) and of adverse events (low certainty). PROSPERO REGISTRATION NUMBER: CRD42018087902.


Assuntos
Diarreia/tratamento farmacológico , Gastroenterite/tratamento farmacológico , Gelatina/uso terapêutico , Taninos/uso terapêutico , Doença Aguda , Criança , Gelatina/efeitos adversos , Humanos , Taninos/efeitos adversos , Resultado do Tratamento
13.
Pediatr Emerg Care ; 36(3): e120-e124, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29135900

RESUMO

OBJECTIVES: Ondansetron has been shown to decrease admission rate and the need for intravenous fluids among pediatric emergency department (ED) patients with acute gastroenteritis, but there is limited evidence regarding its use after ED discharge. This study describes prescribing patterns for ondansetron and assesses the effects of ondansetron home prescription on rate of return. METHODS: Data were gathered from the electronic health record on 2 separate but overlapping groups of patients seen in a pediatric ED from 2012 to 2014. The Gastroenteritis Group included all patients with a discharge diagnosis of gastroenteritis by International Classification of Diseases, Ninth Revision, code. The All Ondansetron Group included any child prescribed ondansetron at discharge. Patterns of ondansetron use and 3- and 7-day ED return rate were assessed for both groups. Discharge diagnosis was evaluated for the All Ondansetron Group. RESULTS: A total of 996 patients with acute gastroenteritis were identified during the study period. Of these, 76% received ondansetron in the ED, and 71% were discharged with prescriptions for ondansetron. Seven-day ED return rates were similar between groups (6% with prescription, 5% without, P = 0.66). A total of 2287 patients received home prescriptions for ondansetron. Fifty-four percent of these patients' discharge diagnoses were classed as gastrointestinal complaints, 14% other infectious conditions, 9% respiratory, and 4% injuries. Their return rate was 6%. There was wide variation in the number of doses prescribed. CONCLUSIONS: Home-use ondansetron is widely prescribed in this urban academic pediatric ED for a variety of indications, without effect on 3- or 7-day ED return. Further prospective studies are necessary to determine the efficacy of this practice.


Assuntos
Antieméticos/uso terapêutico , Serviço Hospitalar de Emergência , Gastroenterite/tratamento farmacológico , Ondansetron/uso terapêutico , Alta do Paciente , Vômito/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Registros Eletrônicos de Saúde , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
14.
Evid. actual. práct. ambul ; 23(4): e002076, 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1141348

RESUMO

Sobre la base de una viñeta clínica de un niño con gastroenteritis aguda sin deshidratación, el autor de este artículo realiza una búsqueda bibliográfica para revisar la evidencia que avala el uso de ondansetrón para tratar sus vómitos, práctica bastante común en instituciones con acceso a este fármaco en sus centrales de emergencia. Luego de dicha búsqueda, el autor concluye que en niños con gastroenteritis aguda sin deshidratación, la administración de ondansetrón no reduce la necesidad de hidratación intravenosa ni la frecuencia ni la severidad de los vómitos. (AU)


Based on a clinical vignette of a child with acute gastroenteritis without dehydration, the author of this article performs a literature search to review the evidence supporting the use of ondansetron to treat his vomiting, a fairly common practice in institutions with access to this drug in their emergency rooms. After this search, the author concludes that in children with acute gastroenteritis without dehydration, the administration of ondansetron does not reduce the need for intravenous hydration or the frequency or severity of vomiting. (AU)


Assuntos
Humanos , Masculino , Pré-Escolar , Ondansetron/uso terapêutico , Gastroenterite/tratamento farmacológico , Vômito/prevenção & controle , Vômito/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Ondansetron/administração & dosagem , Desidratação/prevenção & controle , Desidratação/terapia , Diarreia , Hidratação/métodos , Gastroenterite/diagnóstico , Gastroenterite/dietoterapia
15.
BMC Infect Dis ; 19(1): 1018, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791267

RESUMO

BACKGROUND: Although, India has made steady progress in reducing deaths in children younger than 5 years, the proportional mortality accounted by diarrhoeal diseases still remains high. The present hospital based cross sectional study was carried out to understand the prevalence of various bacterial pathogens associated with the diarrhoea cases in under 5 years age group. METHODS: During, 1st September, 2015 to 30th November 2017, all the childhood diarrhoea cases (≤5 yrs) of SCB Medical College in Odisha, India were included in the study. Stool samples were collected and processed for the isolation of causative bacterial pathogen and the isolated bacterial pathogens were subjected to antibiotic sensitivity testing, molecular analysis of drug resistance. Clinical and demographic data were collected and analyzed. RESULTS: Three hundred twenty patients were enrolled in the study during the study period from whom 82 bacterial isolates were obtained indicating a proportional causality of 25.6% for bacterial diarrhoea among children in this region. Entero toxigenic E.coli (ETEC) accounted for majority of the cases and and more than 50% of the strains were found to be multi-drug resistant (resistant to more than 3 class of antibiotics). More than 50% of the strains were resistant to current choice of treatment like ciprofloxacin, ofloxacin and ceftriaxone and 2.4% being resistant to Imipenem. ESBL production was also observed in some of the strains and one isolate harboured the NDM-1 gene. Fluoroquinolone resistance was found to be linked with multiple mutations in the QRDR region followed by PMQR determinants. CONCLUSION: The current study, to the best of our knowledge is first of its kind which demonstrated the etiology of bacterial diarrhoea in children less than 5 years old and identified diarrheogenic E. coli as the predominant enteropathogen in Odisha. Majority of the isolates being multi-drug resistance calls for a continuous surveillance system in the region which will be helpfulin identifying emerging resistance pattern and for developing suitable intervention stategies.


Assuntos
Infecções Bacterianas/diagnóstico , Infecções Bacterianas/microbiologia , Diarreia/diagnóstico , Diarreia/etiologia , Resistência Microbiana a Medicamentos/genética , Tipagem Molecular/métodos , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Pré-Escolar , Ciprofloxacino/uso terapêutico , Estudos Transversais , Diarreia/epidemiologia , Diarreia/microbiologia , Resistência Microbiana a Medicamentos/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Feminino , Fluoroquinolonas/uso terapêutico , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Gastroenterite/epidemiologia , Gastroenterite/microbiologia , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Técnicas de Diagnóstico Molecular/métodos , Prevalência , Centros de Atenção Terciária
16.
Nutrients ; 11(11)2019 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-31739457

RESUMO

The effectiveness of Lactobacillus reuteri DSM 17938 (L. reuteri) for the management of acute gastroenteritis (AGE) has been recently questioned. We performed a systematic review to update evidence on L. reuteri for treating AGE in children. We searched MEDLINE, EMBASE, the Cochrane Library databases, and additional data sources from January 2016 (end of search for our 2016 systematic review) to August 2019. The primary outcomes were stool volume and duration of diarrhea. Four RCTs were included. None of them evaluated stool volume. Compared with placebo or no treatment, L. reuteri reduced diarrhea duration (four RCTs, n = 347, mean difference, MD -0.87 days, 95% CI [-1.43, -0.31]). L. reuteri use was also associated with a reduced duration of hospitalization (three RCTs, n = 284, MD -0.54 days, 95% CI [-1.09, 0.0]). The small effect sizes of limited clinical relevance and methodological limitations of the included trials should be noted when interpreting these findings.


Assuntos
Diarreia/prevenção & controle , Gastroenterite/tratamento farmacológico , Lactobacillus reuteri , Probióticos/uso terapêutico , Pré-Escolar , Defecação , Diarreia/etiologia , Fezes , Gastroenterite/complicações , Hospitalização , Humanos , Lactente , Lactobacillus reuteri/classificação , Especificidade da Espécie
17.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31694979

RESUMO

BACKGROUND: Ondansetron is an effective antiemetic employed to prevent vomiting in children with gastroenteritis in high-income countries; data from low- and middle-income countries are sparse. METHODS: We conducted a randomized, double-blind, placebo-controlled superiority trial in 2 pediatric emergency departments in Pakistan. Dehydrated children aged 6 to 60 months with ≥1 diarrheal (ie, loose or liquid) stool and ≥1 vomiting episode within the preceding 4 hours were eligible to participate. Participants received a single weight-based dose of oral ondansetron (8-15 kg: 2 mg; >15 kg: 4 mg) or identical placebo. The primary outcome was intravenous administration of ≥20 mL/kg over 4 hours of an isotonic fluid within 72 hours of random assignment. RESULTS: All 918 (100%) randomly assigned children completed follow-up. Intravenous rehydration was administered to 14.7% (68 of 462) and 19.5% (89 of 456) of those administered ondansetron and placebo, respectively (difference: -4.8%; 95% confidence interval [CI], -9.7% to 0.0%). In multivariable logistic regression analysis adjusted for other antiemetic agents, antibiotics, zinc, and the number of vomiting episodes in the preceding 24 hours, children administered ondansetron had lower odds of the primary outcome (odds ratio: 0.70; 95% CI, 0.49 to 1.00). Fewer children in the ondansetron, relative to the placebo group vomited during the observation period (difference: -12.9%; 95% CI, -18.0% to -7.8%). The median number of vomiting episodes (P < .001) was lower in the ondansetron group. CONCLUSIONS: Among children with gastroenteritis-associated vomiting and dehydration, oral ondansetron administration reduced vomiting and intravenous rehydration use. Ondansetron use may be considered to promote oral rehydration therapy success among dehydrated children in low- and middle-income countries.


Assuntos
Antieméticos/administração & dosagem , Desidratação/tratamento farmacológico , Desidratação/epidemiologia , Serviço Hospitalar de Emergência , Ondansetron/administração & dosagem , Administração Oral , Pré-Escolar , Desidratação/diagnóstico , Método Duplo-Cego , Feminino , Hidratação/métodos , Gastroenterite/diagnóstico , Gastroenterite/tratamento farmacológico , Gastroenterite/epidemiologia , Humanos , Lactente , Masculino , Paquistão/epidemiologia
18.
J Med Case Rep ; 13(1): 341, 2019 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-31757225

RESUMO

BACKGROUND: Until today, classic human astroviruses have not been associated with central nervous system infections in immunocompetent patients. CASE PRESENTATION: A 16-month-old Caucasian girl presented with repetitive generalized seizures with a 4-day history of watery diarrhea, which had already gradually improved. Initially, the prolonged seizures ceased after systemic midazolam treatment and were thought to be fever associated. However, her mental status remained altered, and after seizure recurrence, she was transferred to our pediatric intensive care unit. Seizure control was achieved by a combination of high-dose levetiracetam and phenobarbital, but she remained unconscious. An electroencephalogram at this time revealed generalized high voltage theta activity. All laboratory analyses, including extended blood and cerebrospinal fluid analyses, and a brain magnetic resonance imaging were normal. On day 4, the child gradually became conscious, but was very agitated and not able to walk. Since an electroencephalogram at this time still revealed generalized high voltage theta activity, although she had not received sedative medications for 72 hours, she was diagnosed as having encephalopathy. At that time, results of diagnostic testing of the stool sample were positive for classic astrovirus infection, and we decided to analyze the initially obtained cerebrospinal fluid for astrovirus as well. Cerebrospinal fluid was also found positive for human astrovirus. Sequencing analysis revealed a classic astrovirus genotype 1 with exactly the same nucleotide sequence as in the feces. Clinically, the child gradually improved and was discharged on day 9. CONCLUSIONS: Whereas the new human astrovirus subtypes have been recently associated with central nervous system infection, this is the first case of encephalitis in an immunocompetent child due to classic human astrovirus. Considering that classic human astroviruses are the third most common etiological agents of viral gastroenteritis in children, we believe that human astroviruses as causative agents for central nervous system infections should be considered more often, especially in children and infants with preceding gastroenteritis.


Assuntos
Infecções por Astroviridae/diagnóstico , Encefalite/virologia , Gastroenterite/virologia , Mamastrovirus/patogenicidade , Convulsões/virologia , Anticonvulsivantes/uso terapêutico , Infecções por Astroviridae/complicações , Infecções por Astroviridae/fisiopatologia , Diarreia/virologia , Encefalite/tratamento farmacológico , Encefalite/fisiopatologia , Fezes , Feminino , Gastroenterite/tratamento farmacológico , Gastroenterite/fisiopatologia , Humanos , Hipnóticos e Sedativos/uso terapêutico , Lactente , Levetiracetam/uso terapêutico , Fenobarbital/uso terapêutico , Convulsões/etiologia , Convulsões/fisiopatologia , Resultado do Tratamento
19.
FEMS Microbiol Lett ; 366(19)2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31758686

RESUMO

Human norovirus is one of the major causes of foodborne gastroenteritis, and it can be easily transmitted from infected person, virus-contaminated foods and environmental surfaces. Effective disinfection method is needed to stop the transmission of human norovirus. CAC-717 is a new disinfectant consisting of calcium hydrogen carbonate mesoscopic crystals. We aimed to evaluate the efficacy of CAC-717 against human norovirus. This study used human norovirus derived from fecal specimens and cultured murine norovirus, which is one of the surrogate viruses for human norovirus. The disinfection effect against murine norovirus was estimated by infectivity assay and transmission electron microscopy. The inactivation effect against human norovirus was assessed by reverse transcription polymerase chain reaction. Disinfection effect of CAC-717 against the infectivity of murine norovirus was shown within 100 s after the CAC-717 treatment, presenting the destruction of viral capsids. The treatment of CAC-717 significantly reduced human norovirus genomic RNA (3.25-log reduction) by the presence of the mesoscopic structure of calcium hydrogen carbonate. CAC-717 stably inactivated human norovirus in stool suspensions. The inactivation effect of CAC-717 against human norovirus was less susceptible to organic substances than sodium hypochlorite. CAC-717 would be a useful alternative for disinfecting human norovirus in contaminated environmental surfaces.


Assuntos
Carbonatos/farmacologia , Desinfetantes/farmacologia , Norovirus/efeitos dos fármacos , Animais , Carbonatos/química , Desinfetantes/química , Desinfetantes/uso terapêutico , Gastroenterite/tratamento farmacológico , Gastroenterite/virologia , Genoma Viral/genética , Humanos , Camundongos , Microscopia Eletrônica de Transmissão , Norovirus/genética , Norovirus/patogenicidade , Reação em Cadeia da Polimerase Via Transcriptase Reversa
20.
JAMA Netw Open ; 2(11): e1914988, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31702802

RESUMO

Importance: Vomiting resulting from acute gastroenteritis is commonly treated with intravenous antiemetics in acute care settings. If oral treatment were beneficial, patients might not need intravenous administered hydration or medication. Furthermore, a long-acting treatment could provide sustained relief from nausea and vomiting. Objective: To determine whether an experimental long-acting bimodal release ondansetron tablet decreases gastroenteritis-related vomiting and eliminates the need for intravenous therapy for 24 hours after administration. Design, Setting, and Participants: This placebo-controlled, double-blind, randomized clinical trial included patients from 19 emergency departments and 2 urgent care centers in the United States from December 8, 2014, to February 17, 2017. Patients 12 years and older with at least 2 vomiting episodes from presumed gastroenteritis in the previous 4 hours and symptoms with less than 36 hours' duration were randomized using a 3:2 active to placebo ratio. Analyses were performed on an intent-to-treat basis and conducted from June 1, 2017, to November 1, 2017. Intervention: Bimodal release ondansetron tablet containing 6 mg of immediate release ondansetron and 18 mg of a 24-hour release matrix for a total of 24 mg of ondansetron. Main Outcomes and Measures: Treatment success was defined as no further vomiting, no need for rescue medication, and no intravenous hydration for 24 hours after bimodal release ondansetron administration. Results: Analysis included 321 patients (mean [SD] age, 29.0 [11.1] years; 195 [60.7%] women), with 192 patients in the bimodal release ondansetron group and 129 patients in the placebo group. Treatment successes were observed in 126 patients in the bimodal release ondansetron group (65.6%) compared with 70 patients in the placebo group (54.3%), with an 11.4% (95% CI, 0.3%-22.4%) absolute probability difference. The proportion of treatment success was 21% higher among patients who received bimodal release ondansetron compared with those who received a placebo (relative risk, 1.21; 95% CI, 1.00-1.46; P = .04). In an analysis including only patients with a discharge diagnosis of acute gastroenteritis and no major protocol violations, there were 123 treatment successes (69.5%) in the bimodal release ondansetron group compared with 67 treatment successes (54.9%) in the placebo group (relative risk, 1.27; 95% CI, 1.05-1.53; P = .01). Adverse effects were infrequent and similar to the known safety profile of ondansetron. Conclusions and Relevance: This randomized clinical trial found that a long-acting bimodal release oral ondansetron tablet was an effective antiemetic among adolescents and adults with moderate to severe vomiting from acute gastroenteritis. The drug benefits extended to 24 hours after administration. Bimodal release ondansetron may decrease the need for intravenous access and emergency department care to manage acute gastroenteritis. Trial Registration: ClinicalTrials.gov identifier: NCT02246439.


Assuntos
Gastroenterite/tratamento farmacológico , Ondansetron/normas , Administração Oral , Adolescente , Adulto , Antieméticos/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Ondansetron/uso terapêutico , Resultado do Tratamento , Vômito/tratamento farmacológico
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