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Acute diarrhea is a condition of increased water stool content, stool volume, and number of bowel movements that lasts less than 14 days. Mild diarrhea is usually self-limiting; however, undertreated moderate to severe diarrhea may cause severe dehydration and lead to hypovolemic shock. In order to prevent severe dehydration and treat patients appropriately, it is crucial for health care providers to determine the right diagnosis of patients with acute diarrhea. This article focuses on pathophysiology, general patient presentation, diagnostic tests and differential diagnosis lists of acute diarrhea to discuss which diagnosis should be made based on patient presentation and objective data.

This article considers the current approaches to the treatment of acute diarrhea, taking into account the ESPGHAN guidelines (2014), which involves the use of oral rehydration therapy, zinc at a dose of 10 mg/day in children under 6 months, in children older than 6 months — 20 mg/day for 10–14 days, probiotics, antisecretory and antiemetic drugs, adsorbents and antibiotics.

Riham M Hamadouk,1 Ahmed H Arbab,2 Bashir A Yousef3 1Department of Clinical Pharmacy, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan; 2Department of Pharmacognosy, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan; 3Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, SudanCorrespondence: Bashir A YousefDepartment of Pharmacology, Faculty of Pharmacy, University of Khartoum, Al-Qasr Ave, Khartoum, 11111, SudanTel +249 155662037Fax +249 183780696Email bashiralsiddiq@gmail.comBackground: Acute diarrhea is one of the most common health problems globally as a minor ailment, it is widely managed by community pharmacists (CPs). Professional patient counseling provided in community pharmacies is essential to decide about acute diarrhea and avoid treatment failure properly.Objective: To assess CPs’ history-taking practice, medication dispensing, and patient counseling in response to acute diarrhea in adults.Methods: A cross-sectional, covert simulated patient (SP) study was conducted in 235 community pharmacies in the Khartoum locality. Two scenarios were used, one scenario assesses afterwards compliance to treatment guidelines and patient counseling, and second scenario determines afterwards if pharmacists referred patients to medical consultation. Six final-year pharmacy students were involved as SPs. All encounters were audio-recorded by SP. Then the investigator filled the checklist that was intended to evaluate the overall practice of pharmacists.Results: As planned, 235 pharmacies were visited twice, resulting in a total of 470 visits (visit completion rate: 100%). In history taking, the most asked questions were the patient’s age (89.8% for scenario 1 and 88.5% for scenario 2). Followed by the presence of blood in the stool (25.5% for scenario 1 and 28.1% for scenario 2). In scenario 1, loperamide was the most dispensed medication (81.3%), while oral rehydration solution (ORS) was dispensed in 0.9% of the visits. In counseling, verbal and written instructions were provided in 47.7% of the visits. Duration of medications was mentioned in 3.8%, advice about fluid intake was offered in 7.2% of the visits. In scenario 2, 17% of the pharmacists managed patient history well to refer patients to medical consultation, while 42.6% recommended referral after sufficient information was provided by the SP.Conclusion: CPs’ practice in counseling toward acute diarrhea was poor; referral to medical consultation was below expectation. The current CPs dispensing practices need improvement; thus, professional education should be encouraged.Keywords: acute diarrhea, community pharmacists, simulated patient, medical consultation

BACKGROUND: Acute diarrhea (AD) is the most frequent gastroenterological disorder, and the main cause of dehydration in childhood, and it is one of the most important causes of morbidity and mortality in children. AIM: Assessment of lactose-free formula effect in nutritional treatment in formula-fed children with acute diarrhea. PATIENTS AND METHODS: A cross-section interventional study carried out on 60 formula-fed children, under two years, referring with acute diarrhea, 30 children obtain lactose-free formulation and 30 children with no lactose-containing formula. According to the period of diarrheal stop and weight, changes compering two groups. RESULTS: Thirty-two males and 28 females children (7.25 ± 5.1 months) included. Children with lactose-free formula had a significantly slighter dated to diarrhea relief compared with control group children (p < 0.01). No variance between two groups in weight change (6.9 ± 3.03 vs. 7.05 ± 3.07 kg, p = 0.2). (46.6%) of patients on Lactose free formula were discharged on the third post admission day, lactose-free formula has more effective recovery to those on cow milk formula (4.1 ± 1.2 vs. 6 ± 1.3 days, p < 0.01 significant). CONCLUSION: Quick giving of lactose-free formulation to children on formula feeding show rapid relief of acute diarrhea.

Introduction: Cryptosporidium is a coccidian parasite that causes diarrhea in animals and humans, especially children. Although several studies have been done on Cryptosporidium infection in some parts of Iran, this parasite is not examined in routine parasitological tests. Therefore, the aim of this study was to determine the frequency of Cryptosporidium infection in children with diarrhea in Tabriz, Iran. Materials and Methods: In this study, 100 fecal samples of children under 13 years of age with acute diarrhea who referred to medical diagnostic laboratories in Tabriz during 2018 were examined for Cryptosporidium infection. The samples were first concentrated by formalin-ether method and after staining with modified acid fast method, they were examined by light microscope. Results: In this study, 3 children (3%), 2 boys, 3 years old and 5 years old, and a 3-year-old girl had cryptosporidiosis. Conclusion: The results of the present study show the presence of Cryptosporidium infection in children in Tabriz. The very low percentage of infection with this parasite indicates that this parasite is not yet considered as a health problem in this area.

Many diseases in infants and young children are accompanied by the development of diarrheal syndrome. As a result, there are organic lesions and functional disorders in the intestine. It is well known fact that 1.4 billion children under 5 years in the world suffer from acute diarrhea, and 123 million of them are forced to seek medical help urgently, 9 million require inpatient care, and 1.8 million children die from dehydration. In this connection, the choice of therapeutic regimen remains urgent. Medications that slow intestinal motility (loperamide) are contraindicated in acute diarrhea in children, since the risk of side effects including ileus, drowsiness, nausea (mortality to 1 %) is high. Probiotics are living microbial drugs commonly used to prevent acute diarrhea. A large number of researches have been conducted, and results of meta-analyzes have been published that have revealed the effect of Escherichia coli strain Nissle 1917 (Mutaflor) in reducing the duration of diarrhea in children with acute gastroenteritis. Escherichia coli strain Nissle 1917 is one of the three bacteria in the world, which is better characterized at the molecular-biological level, the most investigated non-pathogenic and genetically stable strain in the world with 100-year history, having a genetic map, the genome of which is completely sequenced, genetic loci are deterministic. The product is included into the German Collection of Microorganisms and Cell Cultures (DSMZ). The purpose of our study was to improve the therapeutic approaches to the correction of diarrheal syndrome using Escherichia coli strain Nissle 1917 (Mutaflor) in the main treatment regimens. Seventy four children were examined and divided into two groups: the first group — children with diarrheal syndrome, who additionally received Mutaflor from the first day, the second group — children with diarrheal syndrome, who received traditional therapy. As a result of the study, the data were obtained proving the effectiveness of Escherichia coli strain Nissle 1917 (Mutaflor) in the treatment of diarrhea in young children, its beneficial effect not only on intestinal microflora and normalization of intestinal kinetics, but also on faster improvement of clinical symptoms, which allows recommending it to children from the first months of life.

BACKGROUND: Diarrhea is the particular disease that still affects children in Indonesia, with rotavirus being the most common etiology among children under 5 years old. Rotavirus and non-rotavirus diarrhea can spread to the extraintestinal and localized to the liver which causes liver cell damage, thus, the level of the glutamic oxaloacetic and glutamic pyruvic transaminase enzymes increases. AIM: The objective of the study was to prove that there are differences in serum levels of glutamic oxaloacetic and glutamic pyruvic transaminase in children with acute diarrhea due to rotavirus and non-rotavirus infection. METHODS: This study used a cross-sectional design, the research subjects were children aged 6 months old until 60 months old with acute diarrhea in Denpasar Public Health Center, Sanglah, and Wangaya General Hospital within the period of March 2018 until March 2021. Statistical analysis used the Mann–Whitney. RESULTS: A total of 70 subjects were analyzed in this study. There were 24.28% of subjects with rotavirus. Each group had nearly the same degree of severity of 29.4% for rotavirus and 30.2% for non-rotavirus, with a median of serum levels of glutamic oxaloacetic transaminase (SGOT) 47 (19–261) and glutamic pyruvic transaminase (SGPT) 25 (7–217). The results of this study showed that the median difference in aspartate aminotransferase and alanine aminotransferase levels was not significant in rotavirus and non-rotavirus diarrhea (SGOT 45 [16–168], 32 [11–261], p = 0.077; (SGPT 22 [14–91], 18 [5–217], p = 0.12). CONCLUSION: This study concluded that there is a higher median level of SGOT and SGPT in children with acute diarrhea due to rotavirus infection compared to non-rotavirus infection, although it is not statistically significant.

Background/Aim: This study aimed to evaluate the association between the change in peripheral eosinophil count during postoperative pelvic radiotherapy and gastrointestinal (GI) toxicities in patients with cervical cancer. Patients and Methods: The medical records of 163 patients with cervical cancer who underwent postoperative concurrent chemoradiotherapy between 2000 and 2016 were analyzed. Results: Among the peripheral blood cell counts, transient elevation of the eosinophil count was observed during radiotherapy. Of the 163 patients, 117 developed grade ≥2 diarrhea during radiotherapy, and 25 patients developed grade ≥2 late GI toxicities. In multivariate analysis, the maximum eosinophil count and age emerged as independent predictors of grade ≥2 acute diarrhea during radiotherapy, while bowel bag V40 Gy and age were predictive of grade ≥2 late GI toxicities. Conclusion: Early detection of transient elevation of eosinophil may facilitate early treatment of acute diarrhea during radiotherapy.

Background Episodes of acute diarrhea lead to dehydration, and existing care algorithms base treatment around categorical estimates for fluid resuscitation. This study aims to develop models for the percentage dehydration (fluid deficit) in individuals with acute diarrhea, to better target treatment and avoid the potential sequelae of over or under resuscitation. Methods This study utilizes data from two prospective cohort studies of patients with acute diarrhea in Dhaka, Bangladesh. Data were collected on patient arrival, including weight, clinical signs and symptoms, and demographic information. Consecutive weights were obtained to determine the true volume deficit of each patient. Data were entered into two distinct forward stepwise regression logistic models (DHAKA for under 5 years and NIRUDAK for 5 years and over). Results A total of 782 patients were included in the final analysis of the DHAKA data set, and 2139 were included in the final analysis of the NIRUDAK data set. The best model for the DHAKA data achieved an R2 of 0.27 and a root mean square error (RMSE) of 3.7 (compared to R2 of 0.06 and RMSE of 5.5 with the World Health Organization child care algorithm) and selected 6 predictors. The best performance model for the NIRUDAK data achieved an R2 of 0.28 and a RMSE of 2.6 (compared to R2 of 0.08 and RMSE of 4.3 with the World Health Organization adolescent/adult care algorithm) and selected 7 predictors with 2 interactions. Conclusions These are the first mathematical models for patients with acute diarrhea that allow for the calculation of a patient’s percentage dehydration (fluid deficit) and subsequent targeted treatment with fluid resuscitation. These findings are an improvement on existing World Health Organization care algorithms.

Campylobacter species is the main etiology of gastroenteritis due to bacteria. To determine prevalence of Campylobacter species in stool of children less than five years of age with acute diarrhoea, this observational study was conducted in the Department of Microbiology, Sylhet M A G Osmani Medical College, Sylhet from January to December, 2017. Stool samples were collected from 162 under-five children with acute diarrhoea admitted in the Department of Paediatrics. Isolation of Campylobacter species were done by stool culture. About two third of the children were male (65.4%) and more than one fourth of the affected children (26.65%) were in age group 6-12 months. Campylobacter species was isolated in 24 (15%) sample and among them, Campylobacter jejuni were 22 (91.7%) and Campylobacter coli were 2 (8.3%). Isolation rate of Campylobacter species did not differ significantly between age group of 6-12 months and above 12 months (p=0.211) of age; male and female children (p=0.288); among socioeconomic status (p=0.673) and between residential status (p=0.108). Isolation rate of Campylobacter species are frequent among under five children with acute diarrhea and most of the children came from low socioeconomic background and were male. However, a large multicenter study needs to be conducted to generate more evidence regarding the issue. Bangladesh Med J. 2020 Sept; 49(3) : 11-16

Background Acute diarrhea is the second leading cause of preventable mortality and morbidity in children worldwide. This study aimed to identify the main pathogens associated with acute diarrhea and to describe changes in gut microbiota in Mexican children. Methods This single-center observational study included 30 children (6 months to 5 years old) with acute diarrhea who were referred to the Instituto Nacional de Pediatria of Mexico City and 15 healthy volunteers (control group). Stool samples at day 0 (D0) and day 15 (D15) were collected for identification of microorganisms (reverse transcriptase-polymerase chain reaction analyses with xTAG gastrointestinal pathogen panel multiplex assay) and microbiota analysis (16S gene amplification sequencing). Prescription decisions were made by the treating clinician. Results The main pathogens identified were norovirus and Campylobacter jejuni (20% each). The majority of patients (n = 24) were prescribed Saccharomyces boulardii CNCM I-745 for treatment of acute diarrhea. Diarrheic episodes resolved within 1 week of treatment. Compared with D15 and control samples, D0 samples showed significantly lower alpha diversity and a clear shift in overall composition (beta diversity). Alpha diversity was significantly increased in S. boulardii-treated group between D0 and D15 to a level similar to that of control group. Conclusions In these children, acute diarrhea was accompanied by significant alterations in gut microbiota. S. boulardii CNCM I-745 treatment may facilitate gut microbiota restoration in children with acute diarrhea, mostly through improvements in alpha diversity.

A systematic review was conducted in Mexico to consolidate and evaluate evidence after 15 years of rotavirus vaccination, according to the National Immunization Program. Five databases were screened to identify published articles (January 2000–February 2020) with evidence on all clinical and epidemiological endpoints (e.g. immunogenicity, safety, efficacy, impact/effectiveness) of rotavirus vaccination in Mexico. Twenty-two articles were identified (observational studies including health-economic models: 17; randomized controlled trials: 5). Fourteen studies evaluated a human attenuated vaccine (HRV), four studies evaluated both vaccines, and only two evaluated a bovine-human reassortant vaccine, with local efficacy data only for HRV. Local evidence shows vaccines are safe, immunogenic, efficacious, and provide an acceptable risk-benefit profile. The benefits of both vaccines in alleviating the burden of all-cause diarrhea mortality and morbidity are documented in several local post-licensure studies. Findings signify overall benefits of rotavirus vaccination and support the continued use of rotavirus vaccine in Mexico.

Aim. The practical guidelines are intended for primary care physicians, general practitioners, paediatricians, gastroenterologists and general internists to advance the treatment and prevention of gastroenterological diseases in adults and children in therapies with probiotics, prebiotics, synbiotics and their enriched functional foods.Key points. Probiotics are live microorganisms that sustain health of the host when supplied in adequate amounts. Prebiotics include human-indigestible but accessible to gut microbiota substances expediting specific changes in the composition and/or activity of gastrointestinal microbiota that favour the host health. The mechanism of probiotic action comprises the quorum resistance maintenance, nutrient substrate metabolism and end metabolite recycling, macroorganism-sustaining substrate production, as well as the mediation of local and adaptive immune responses.The Russian Federation regulates market differently for biologically active food additives (BAFA), medicinal products (drugs) and functional food products (FFP). We overview the probiotic strains regulated in Russia as BAFAs, drugs and FFPs and provide recommendations on the use of these strains in treatment and prevention of gastroenterological diseases in children and adults.Conclusion. The clinical efficacy of probiotics, prebiotics, synbiotics and fortified functional foods depends on the prebiotic and strain properties and is verified in appropriate comparative clinical trials. Not all probiotics registered in Russia as BAFAs, drugs and FFPs have a strain identity, which provides no warranty of the clinical effect expected. The FFP legislation demands improved regulation mechanisms and control for therapeutic efficacy.

Background Diarrhea among children under five is one of the significant public health concerns in developing countries, such as Ethiopia that is mainly attributed to inadequate water, sanitation and hygiene (WASH) services. Lack of data on the prevalence and factors associated with acute diarrhea in Woldia Town impedes the effectiveness of WASH programs in the area. Therefore, the aim of this study was to investigate the prevalence and WASH-associated factors of acute diarrhea among under-five children in this area. This study will help guide local diarrhea prevention and control programs. Methods A community-based cross-sectional study was conducted among 485 children under age five from March to June 2018. The study participants were allocated proportionally and then households with children of this age group were selected from each kebele (the smallest administrative unit in Ethiopia) using a systematic random sampling technique. Data were collected from mothers/caregivers of the under-five children using a structured questionnaire and on-the-spot observation checklist. A binary logistic regression model with 95 % CI (confidence interval) was used to measure the association between dependent and independent variables. From the multivariable analysis, variables with a p-value Results The prevalence of acute diarrhea among the children was 17.6 % (95 % CI: 14.2–21.0 %). Almost two-thirds 307 (63.4 %) of study participants' main source of drinking water was a private tap; 320 (66.1 %) of households used less than 20 l per capita per day. About one-fifth 99 (20.5 %) of households used an improved sanitation facility. Only one-fifth (21.1 %) of the latrines had nearby handwashing facilities. Less than half 225 (46.5 %) of mothers/caregivers had good handwashing practice at critical times. Water consumption of less than 20 l per capita per day (adjusted odds ratio [AOR] = 2.45; 95 % CI: 1.36–5.84), unimproved sanitation facility (AOR = 3.57; 95 %CI: 1.64–6.51), practicing unsafe child feces disposal (AOR = 2.51; 95 % CI: 1.69–4.64), poor handwashing practice at critical times (AOR = 1.85; 95 % CI: 1.34–3.56) and having no information about diarrhea being prevented by handwashing with water and soap (AOR = 3.12; 95 % CI: 1.64–6.27) were significantly associated with acute diarrhea. Conclusions More than one in six children under age five had acute diarrhea, a proportion that could be considered relatively high. We recommend that government organizations and concerned stakeholders strengthen urban WASH programs to focus on increasing the availability of sufficient water for adequate daily consumption, and promote safe disposal of child feces and good handwashing practices at critical times. Further effort is needed to sensitize mothers/caregivers about diarrhea prevention through effective WASH activity to reduce the burden of this problem among children under five.

Background: Diarrhea is a leading cause of illness and death among children in developing countries. Racecadotril (acetorphan), an enkephalinase inhibitor with antisecretory and anti-diarrheal actions, is an effective and safe treatment for acute diarrhea in adults and children. Objectives: The objective of this study is to evaluate the efficacy and tolerability of racecadotril as a treatment of acute diarrhea in children. Methods: This double-blind, randomized controlled clinical trial was conducted in Dr. MR Khan Children Hospital & Institute of Child Health over 1 year (June 2017- May 2018). The study was approved by the ethical committee of the institute. The efficacy and tolerability of racecadotril (1.5 mg/kg) administered orally 3 times daily) as adjuvant therapy to oral rehydration or intravenous fluid were compared with those of placebo in 40 children aged 3 months to 60 months of children who had acute diarrhea. Results: During the first 72 hours of treatment, patients receiving racecadotril had a significantly lower stool output (grams per hour) than those receiving placebo. The mean (±SE) 72-hours stool output was 54.75± 12.92 g per kilogram in the racecadotril group and 152.50±37.64 g per kilogram in the placebo group (p

İshaller, beş yaş altı çocuklarda dünya genelinde görülen hastalıklar arasında, ikinci en önemli ölüm nedenidir. Görülme sıklığı, beş yaş altı çocuklarda en fazla olmakla birlikte, daha çok iki yaş altı bebeklerde ölüme neden olabilen, önlenebilir ve tedavi edilebilir bir hastalıktır. Büyük çoğunluğu az gelişmiş ve gelişmekte olan ülkelerde olmak üzere, her yıl ishal nedeniyle beş yaş altında yaklaşık 525 bin çocuğun hayatını kaybettiği belirtilmektedir. Bu ölümlerin, en önemli sebebi dehidratasyondur. Ayrıca ishal atakları, kilo kaybına ve büyüme geriliğine yol açmaktadır. Çocukların ishalden korunması temel olduğu gibi, hasta çocukların izlemi de önemlidir. Olgu sunumu şeklinde derlenen bu makale, çocuklarda akut ishal hastalığının önüne geçilmesi ve tedavisi konusunda sağlık çalışanlarını ve toplumu bilgilendirmeyi amaçlamaktadır.

Kawasaki Disease is a spectrum of idiopathic, self-limited fever disease affecting childrenunder 5 years old. This disorder can be challenging to be diagnosed by a pediatrician since thereis no specific diagnostic laboratory test. One atypical Kawasaki Disease case presented withgastrointestinal symptoms, a two-year-old girl was hospitalized with fever, accompanied by non-hemorrhagic diarrhea three days before admission. Physical examination revealed unilateralcervical lymph enlargement and mild-moderate dehydration. Initial laboratory examinationresult showed thrombocytosis, leukocytosis (shift to the left), and normal routine fecal analysis.The patient was initially diagnosed with acute diarrhea with mild-moderate dehydration. She wastreated with a rehydration regimen and antibiotic, but her fever persisted. On the third day ofhospitalization, she fulfilled 3 of the classic Kawasaki Disease criteria (conjunctivitis, crackedlips with strawberry tongue, and lymphadenopathy). Further blood work resulted in increased C-reactive protein 43.35 mg/L and ESR 72 mm/hour, while chest X-ray and electrocardiographwere within normal limit. This patient was proceed to Hasan Sadikin General Hospital for furtherexamination and therapy. Atypical Kawasaki Disease can be a puzzling diagnosis due to itsuncommon presentations. Clinicians should importantly keep it in mind as a differential diagnosisin patients with prolonged fever. Keywords: atypical Kawasaki disease; diarrhea; prolonged fever

Introduction: Rotavirus (RV) belongs to the Reoviridae virus family and the virion comprises of three concentric protein layers. Worldwide, rotavirus (RV) is the most common cause of severe gastroenteritis (G.E.) among infants and young children especially in those countries which has not launched a RV vaccination program and approximately 40% of hospitalized patients suffering from gastroenteritis were infected with RV. Objective: To determine the prevalence of rotavirus infections, genotypes and degree of severity of its acute diarrhea in infants and children attending the children hospital, at Zagazig University Hospitals. Patients and methods: this study was done on 140 patients admitted to Children Hospital, Zagazig University suffering of gastroenteritis, Vesikari clinical severity score was done and stool sample was taken from patients, which was tested for RV by dipstick method and positive patients underwent genotyping by immunochromatography using PCR technique. Results: Among the studied group 128 patients (91.4%) showed positive results for rotavirus detection by dipstick analysis of stool, while only 12 patients (8.6%) were negative. The Vesikari score of severity ranged from 9 to 15 with median of 12 and its mean ± SD was 11.9±1.3. G3 and P8 were the most types in the examined patients. Conclusion: rotavirus is still the main cause of severe gastroenteritis that requires hospital admission. G3 and P8 are the most detectable genotypes.

Objective: To determine the frequency of sodium and potassium abnormalities (hyponatremia and hypokalemia) in children presented with acute diarrhea. Study Design: Prospective Study Place and Duration: Study was conducted at Pediatric department of North West General Hospital, Peshawar during the period from July 2020 to June 2021 (for one Year). Methodology: One hundred and thirty patients of both genders having age upto 5 years presented with acute diarrhea were enrolled in this study. Clinical examination was done after taking written informed consent from patients parents/guardians. Blood sample was taken and sent to laboratory to examine sodium and potassium levels. Data was analyzed by SPSS 24.0. Results: There were 72 (55.38%) males while 58 (44.62%) patients were females with mean age 2.38±1.52 years. Mean disease duration was 3.54±1.33 days. Hyponatremia was found in 40 (30.77%) patients and hypokalemia was observed in 52 (40%) patients. Conclusion: Sodium and potassium abnormalities are very common in children with acute diarrhea and can lead to high rate of morbidity and mortality. We concluded that frequency of hyponatremia and hypokalemia were very high in children with acute diarrhea. Keywords: Acute Diarrhea, Hyponatremia, Hypokalemia, Children

Aim: To determine outcome of probiotics in treatment of acute diarrhea in children aged 6 months to 5 years as compared to control Setting: Department of Pediatrics, Khyber Teaching Hospital, Peshawar Duration: From 23 May, 2019 to 23 Nov, 2019 Study design: Randomized Control Trial Methodology: 200 children were divided in two equal groups. Group A were given Probiotics (Saccharomyces boulardii) in a dose of 250-500 mg daily in two divided doses for 5 days, in addition to oral rehydration solution 50-100ml and 100-200ml after each loose stool in child aged 5 years respectively. Group B were given only oral rehydration solution in same amount as prescribed to Group A. All the children were followed up at day 4. Outcome was assessed in terms of duration of diarrhea and improvement in number of stools per day at the 5th day of presentation. Results: In Group A, 92(92%) patients showed improvement while in Group B, 71(71%) patients showed improvement. Conclusion: Probiotics are found to be significantly more effective in reducing the stool frequency in ac. diarrhea. Keywords: Acute diarrhea, Probiotic, Saccharomyces boulardii (SB)

Diarrhea is the second leading cause of death in children in the world, as well as in Indonesia. To reduce mortality due to diarrhea, it needs fast and appropriate management. Probiotics have been widely used in cases of acute diarrhea in children but have not been recommended at the Klungkung Regional General Hospital. This study aims to determine the effectiveness of prebiotic administration on the duration of diarrhea in pre-school children.This type of quantitative observational research uses a comparative study design. This study involved 40 respondents who were selected based on inclusion and exclusion criteria with purposive sampling technique.The results showed that the duration of diarrhea in pre-school children given prebiotics averaged 23.74 or 24 hours 14 minutes, while the duration of diarrhea in pre-school children given standard therapy was on average 47 hours 49 minutes. The results of the Independent T Test obtained p value = 0.001

Background: Acute diarrhea endemic in India has a prevalence of 7% which is commonly seen inchildren and also is a major problem in adults. Acute diarrhea with dehydration culminates in theloss of electrolytes. Not only Na+ K+ but also Ca2+and Mg2+ are also substantially lost and lead tosymptoms and adds to morbidity and prolong hospitalization. Methods: In this observational study,a total of 100 cases of acute gastroenteritis admitted to the department of general medicine andinfectious disease ward of VIMSAR, Burla, between November 2018 to December 2019 wereinvestigated clinically and biochemically and data were interpreted statistically. Results: Males(56%) were more in number than females (44%), were mostly in the age group of 26-35 years(24%). Hypocalcemia, hypokalemia, hypomagnesemia, and hyponatremia were found in 97%, 59%,49%, 48% of cases respectively. Correlation of Serum Ca2+with (r-value) total episodes of vomiting(-0.536), total episode of stools (-0.880), S. Na+ level (-0.374), S. K+ level (-0.729), with theduration of hospital stay (-0.770) respectively. Correlation of S. Mg2+ levels with (r-value) totalepisodes of vomiting (-0.475), total episode of stools (-0.498), S. Na+ level (-0.301), S. K+ level(-0.801), duration of hospital stay (-0.699) respectively. The correlations were found to bestatistically highly significant (with a p-value is

Oral rehydration is the main treatment of acute diarrhea in children. This study was undertaken to evaluate the efficacy and safety of xyloglucan and gelose (agar-agar) plus oral rehydration solution (ORS) compared with placebo and ORS for reduction of acute diarrhea symptoms in children. In a randomized, double-blind, placebo-controlled trial, children with acute gastroenteritis received xyloglucan/gelose plus ORS (n = 50) or placebo plus ORS (n = 50) for 5 days. Demographic, clinical, anthropometric and laboratory parameters were recorded and analyzed. Xyloglucan/gelose plus ORS reduced the total number of type 7 and 6 stools on the Bristol Stool Form scale (p = 0.040 and p = 0.015, respectively, compared to placebo plus ORS), and had a rapid onset of action, evident 6 hours post-treatment. Xyloglucan/gelose plus ORS also improved associated clinical symptoms (apathy, vomiting, flatulence, and blood in stool). compared with placebo plus ORS. Except for a generalized rash of unknown causality in a patient receiving placebo plus ORS, all other adverse events (dehydration, n = 7, cough, n = 1, exacerbation of vomiting, n = 1) were deemed unrelated to study medication. Xyloglucan/gelose plus ORS was effective and safe in treating acute diarrhea in children.

Background: Acute diarrhea is defined as the passage of stools with abnormal consistency and frequency in a day (e.g. more than three times) which lasts for less than two weeks. Diarrheal diseases are reported as the leading cause of mortality among children aged five years and below. Stool or blood culture tests are very important to determine proper management for diarrheal illness. Objective: to investigate the difference between the role of stool and blood cultures in the diagnosis of acute diarrheal disease and to determine the predictors of positive cultures in patients with diarrheal illness. Subjects and Methods: This prospective cohort study included 77 children. Forty-one of them were males and 36 were females with acute diarrhea with ages between 6months to 5 years who attending Al-Azhar Assiut University Hospital starting from May 2018 until May 2019. Results: The results of the present study demonstrated that Stool culture was positive in 41 cases and blood culture was positive in 8 cases. All cases with positive blood culture were also had a positive stool culture. Twenty-one cases were positive for campylobacter in stool culture and 2 cases of them were pseudomonas positive in blood culture. Twelve cases were salmonella positive in stool culture and 2 cases of them were pseudomonas positive in blood culture. Seven cases were E-coli positive in stool culture and 2 cases of them were E-coli positive and 1cases was positive for pseudomonas in blood culture. Conclusion: The results of this study revealed that stool or blood culture tests are very important to determine proper management for diarrheal illness, Stool culture is more sensitive than blood culture and in severely ill patients, blood culture was required.

The World Health Organization recommends 20 mg of zinc per day for 10 to 14 days for children with acute diarrhea; in previous trials, this dosage decreased diarrhea but increased vomiting.We randomly assigned 4500 children in India and Tanzania who were 6 to 59 months of age and had acute diarrhea to receive 5 mg, 10 mg, or 20 mg of zinc sulfate for 14 days. The three primary outcomes were a diarrhea duration of more than 5 days and the number of stools (assessed in a noninferiority analysis) and the occurrence of vomiting (assessed in a superiority analysis) within 30 minutes after zinc administration.The percentage of children with diarrhea for more than 5 days was 6.5% in the 20-mg group, 7.7% in the 10-mg group, and 7.2% in the 5-mg group. The difference between the 20-mg and 10-mg groups was 1.2 percentage points (upper boundary of the 98.75% confidence interval [CI], 3.3), and that between the 20-mg and 5-mg groups was 0.7 percentage points (upper boundary of the 98.75% CI, 2.8), both of which were below the noninferiority margin of 4 percentage points. The mean number of diarrheal stools was 10.7 in the 20-mg group, 10.9 in the 10-mg group, and 10.8 in 5-mg group. The difference between the 20-mg and 10-mg groups was 0.3 stools (upper boundary of the 98.75% CI, 1.0), and that between the 20-mg and 5-mg groups was 0.1 stools (upper boundary of the 98.75% CI, 0.8), both of which were below the noninferiority margin (2 stools). Vomiting within 30 minutes after administration occurred in 19.3%, 15.6%, and 13.7% of the patients in the 20-mg, 10-mg, and 5-mg groups, respectively; the risk was significantly lower in the 10-mg group than in the 20-mg group (relative risk, 0.81; 97.5% CI, 0.67 to 0.96) and in the 5-mg group than in the 20-mg group (relative risk, 0.71; 97.5% CI, 0.59 to 0.86). Lower doses were also associated with less vomiting beyond 30 minutes after administration.Lower doses of zinc had noninferior efficacy for the treatment of diarrhea in children and were associated with less vomiting than the standard 20-mg dose. (Funded by the Bill and Melinda Gates Foundation; ZTDT ClinicalTrials.gov number, NCT03078842.).

Diarrhea is among the most frequently reported symptoms in clinical practice. Acute diarrhea is usually caused by infectious agents with a self-limited disease course. In contrast, differential diagnosis of chronic diarrhea may be challenging. The aim of this review is to provide the reader with an overview on the causes, pathomechanisms, differential diagnosis and clinical management of acute and chronic diarrhea in adults.

Aim This study was designed to assess the efficacy and safety of Saccharomyces cerevisiae variant boulardii CNCM I-3799 (S. boulardii CNCM I-3799) in the management of acute diarrhea in children. Methods A total of 100 infants and children 3-36 months of age with acute diarrhea received medical care according to the World Health Organization guidelines on the management of acute diarrhea in children and were randomly allocated to the probiotic group (S. boulardii CNCM I-3799 at a daily dose of 5 billion CFU twice daily) or to the placebo group. Infants and children were treated for 5 days and an extended follow-up was planned 1 and 2 months after the end of the treatment period. Primary endpoint was the time of recovery from diarrhea defined as the duration of diarrhea. Other parameters, such as frequency and consistency of stools, associated with the severity of diarrhea episodes were defined as secondary endpoints. Results The administration of S. boulardii CNCM I-3799 was associated with beneficial effects on duration and severity of diarrhea. The time of recovery from diarrhea was significantly shorter in the probiotic group compared with the placebo group (65.8 ± 12 hours vs. 95.3 ± 17.6 hours, P = 0.0001). Faster remission in the probiotic group was also demonstrated by a shorter time before the first episode of semisolid stool [-23.5 hours, diff (95% CI): -7.99 (-31.49 to -15.51), P = 0.0001] and the faster normalization of stool consistency. S. boulardii CNCM I-3799 was well tolerated. Conclusion S. boulardii CNCM I-3799 supplementation in children with acute diarrhea was shown effective in reducing the duration and severity of diarrhea in infants and children.

Objectives: To evaluate the efficacy of oral zinc as adjuvant therapy in acute diarrhea comparing frequency and volume of stool and duration of diarrhea in children. Study Design: Case Control study. Setting: Department of Paediatrics, Shaheed Muhtrama Benazir Bhutto Medical College Layari General Hospital, Karachi. Period: September 2017 to August 2018. Material & Methods: A sample of 200 children, age 5- 15 years, suffering from acute diarrhea was divided into control and cases (study group). Oral zinc therapy (20 mg once daily) was given 14 days and its efficacy was observed in terms of stool frequency, stool volume and duration of diarrhea. Variables were noted at 24 hours and 48 hours and on 7th day of hospitalization. Data was analyzed on SPSS statistical software (version 22.0) at 95% confidence interval (P≤ 0.05). Results: Mean ± SD age in control and study group was noted as 9.1± 5.43 years and 9.5±6.02 years respectively (P=0.053). 89% of children of study group were discharged on 3rd day of hospitalization compared to only 45% from control group. Zinc treated study group shows significant decrease in frequency of loose stools, stool volume and lesser duration of hospital stay. Conclusion: Oral zinc therapy was effective in decreasing the frequency of loose stools and volume and lesser duration of hospital stay in children.

Amaç Akut ishal tüm dünyada en önemli morbidite ve mortalite nedenleri arasında yer almaktadır. İshal nedeni ile başvuran tüm hastalarda, dehidratasyonun temel tedavisi oral rehidratasyon sıvısıdır. Probiyotikler, akut ishal destek tedavi seçenekleri arasında yer almaktadır. Bu çalışmanın amacı akut ishali olan çocuklarda Lactobacillus rhamnosus GG (LGG) ve Bifidobacterium animalis subspecies lactis BB-12 (BB-12) kombinasyonun ishal süresi ve hastanede yatış süresi üzerine etkisinin değerlendirilmesidir.Yöntem Bu çok merkezli, randomize (240 çocuk, probiyotik ile kontrol 2:1 randomizasyon), tek kör çalışma, akut ishal yakınmalarının başlamasından 24-72 saat içerisinde hastaneye başvuran, yaşları 6 ay ile 60 ay arasında değişen çocuklarda yapıldı. Çalışmaya hafif ve orta derecede dehidratasyonu olan çocuklar dahil edildi. Çalışmaya dahil edilen çocuklarda, kontrol grubu standart tedavi alırken, probiyotik grubu 5 gün süre ile LGG ve BB-12 (her bir probiyotik 1×109 koloni) kombinasyonu aldı. Çalışmanın primer sonlanım noktası olarak ishal süresinin Bristol gayta skoru ile takip edilmesi planlandı. Sekonder sonlanım noktası ise hastanede yatış süresi (gün) ve 72. saatin sonunda ishal tablosu gerileyen çocuk yüzdesi olarak belirlendi.Bulgular Çalışmaya katılan 240 çocuğun 218’nin (probiyotik grubunda 150 çocuk, kontrol grubunda 68 çocuk) verileri değerlendirildi. LGG ve BB-12 grubunda ishal süresinin kontrol grubuna göre anlamlı derecede düşük olduğu saptandı (sırası ile 74.5 ± 40.8 saat, 98.4 ± 22.9 saat, P0.05).Sonuç LGG ve BB-12 kombinasyonun akut ishal olgularında ilk kez değerlendirildiği bu çalışmada,ishal süresi üzerine olumlu etkilerinin olduğu gösterildi. Hastaneye yatan çocuklarda ishal süresinin yaklaşık 24 saat kısaldığı saptandı. Hastaneye yatan çocuklara ek olarak, akut ishal nedeni ile poliklinik başvurusu yapan çocuklarda yapılacak randomize klinik çalışmalar ile bu kombinasyonun etkisi daha detaylı değerlendirilmelidir., Background Acute diarrhea continues to be a leading cause of morbidity and mortality worldwide. The main therapy for all individuals with dehydration caused by diarrhea is oral rehydration. Probiotics have been proposed as a complementary therapy in the treatment of acute diarrhea. We aim to evaluate the effect of a combination of Lactobacillus rhamnosus GG (LGG) with Bifidobacterium animalis subspecies lactis BB-12 (BB-12) on the duration of diarrhea and length of hospital stay in children with acute diarrhea.Methods A multicenter, randomized (240 children, 2:1 randomized for probiotic vs. control), single blind, hospital based clinical trial was performed in children (6 to 60 months) with acute watery diarrhea lasting more than 24 but less than 72 hours, requiring hospitalization. We enrolled children with clinical signs of mild to moderate dehydration. The children received conventional therapy with or without the combination of LGG and BB-12 (1 × 109 colony forming units for each) for 5 days. The primary endpoint was the duration of diarrhea (in hours), defined as the first normal stool according to the Bristol stool score (score < 5). Secondary outcome measures were duration of hospitalization (days) and percentage of children without diarrhea at 72 hours of intervention.Results In total, data from 218 of 240 children could be evaluated (150 in the probiotic group and 68 in the control group). The duration of diarrhea was significantly reduced in the LGG and BB-12 group compared to the control group (74.5 ± 40.8 hours vs. 98.4 ± 22.9 hours, P0.05).Conclusion This is the first clinical trial to test the combination of LGG and BB-12, and show its effects on diarrhea duration in children with acute infectious diarrhea. The duration of diarrhea was reduced by approximately 24 hours in the hospitalized children. Further randomized controlled clinical trials including outpatient cases with acute infectious diarrhea in addition to hospitalized cases should be conducted to assess the potential effects of the combination in more detail.

The aim of this study was to perform an epidemiological analysis of the viral strains isolated from outpatients with acute gastroenteritis in Dalian, Liaoning province, China to determine the epidemiology of Norovirus (NoV). Fecal samples were collected from 789 outpatients with acute gastroenteritis in the Xigang district of Dalian, Liaoning province, China from July 2015 to December 2016. Norovirus was detected by real-time reverse transcriptase-polymerase chain reaction (RT-PCR). A selection of the positive samples identified was subsequently sequenced, and these data were analyzed by using the Norovirus Typing tool. Results showed that 38.02% (300/789) of the fecal samples were positive for NoV, of which 95.67% (287/300) were identified as genotype GII with 1.33% (4/300) identified as GI. A further 3.00% (9/300) were combined infections with both GI and GII Norovirus. When analyzing the age distribution, the infections primarily occurred in adults especially the elderly whose NoV positive rate was much higher than the average. Winter was the season when most cases were recorded during 2015 and 2016; however, another infection peak was observed in July 2016. Thirty Norovirus positive samples were successfully sequenced, and results showed that GII.4 was the most commonly identified genotype, along with GII.3 and GII.17. Norovirus is the most common pathogen for acute gastroenteritis in Dalian, Liaoning province of China. The current NoV genotype prevalence in Dalian was found to be similar to that in other regions of China. Genotype GII.4 was the most common genotype in our study, GII.3 and GII.17 were also identified.

The acute diarrhea is a wide-spread disease. The prescription of enterosorbents is appropriate as a primary measure for the treatment of the acute diarrhea for effective prevention of the fluid and electrolyte loss, as well as method for symptom relief of the attack of the disease. Aim of the study - the antidiarrheal efficacy and safety study of high-dispersion silicon dioxide enterosorbent in tablet dosage form in patients with acute diarrhea. This was randomized, double-blind, placebo-controlled, 4-center study. Acute diarrhea was defined as three and more episodes of watery stool per day either during 48 hours or less before study entry in the patients having normal stool recently. It has been postulated that symptoms and signs of acute diarrhea have to be caused by direct infection of the gastrointestinal tract and did not associated with moderate-to-severe systemic states. 144 patients with established acute diarrhea were randomized into treatment group (enterosorbent “Carbowhite”, n = 120) or placebo group. Date collection including severity diarrhea, systemic symptoms was performed at baseline and daily during 7 days. Stool examination and serological assay were performed at baseline. The primary end points were declared as time to complete recovery from acute diarrhea. It has been found that the use of the siliceous enterosorbent (“Carbowhite”) allowed to reduce (p

Child hood diarrhea has continued as a leading cause of morbidity and mortality in Ethiopia. In conjunction with implementing control programs, an up to-date comprehensive information on the magnitude and contributing factors among child hood diarrhea is needed to develop and design effective interventions at the district level. A community based cross sectional study was carried out among 717 mothers/care givers of under five children in four districts of West Guji Zone from July 21, 2018 up to August 21, 2018. The study participants were selected using systematic random sampling techniques. The collected data were entered into Epi-data version 3.5.4 and exported to SPSS version 20 for analysis. Descriptive statistics such as frequencies with percentages were computed. AOR with 95% C.I was employed to test significant association. A total of 717 children participated in this study; of which 262(36.5%) suffered acute diarrhea within two-week prevalence. Factors significantly associated with childhood diarrhea were maternal educational status [AOR=3.75, 95% CI:(1.07,13.22)], age of index child [AOR=2.72; 95% CI(1.18, 6.27)], number of under five children [AOR= 1.527; 95% CI: (1.04, 2.24)], exclusive breast feeding practice [AOR = 2.45; 95% CI:(1.61,3.73)], time supplementary feeding initiated [AOR=2.16; 95% CI(1.22,.3.83)], waste disposal method [AOR = 1.92; 95% CI:(1.26,2.94)] and pneumococcal vaccination [AOR= 6.72; 95% CI(1.20,.37.65)], Vitamin A supplementation [AOR= 1.66 ;95 % CI(1.04,.2.68)]. More than one-third, 262 (36.5%, 95 CI: 33.13%, 39.87%) of the children reported childhood diarrhea which refers it is a major public health problem in the district. This finding point application of integrative intervention strategies such as building toilet, safe water access, effective health education related to appropriate child feeding practices. Key words: Child health, diarrhea, pre-school children.

Background: Depending on the duration, acute diarrhea is defined as the passage of three or more loose or liquid stools per day lasting for 0.05). Conclusion: Both probiotic preparations were almost equally effective in achieving normal stool consistency and frequency in patients with acute diarrhea.

Background: Electrolyte abnormalities constitute the leading causes of morbidity and mortality in younger children with acute gastroenteritis. The aim of the study was to determine the clinical profile and pattern of electrolyte abnormalities in under-five children hospitalized for acute gastroenteritis from November 1, 2014, to January 31, 2015. Methodology: This was a cross-sectional descriptive study among hospitalized under-five children with acute diarrhea who were consecutively recruited from November 1, 2014, to January 31, 2015. Relevant clinical data were obtained, while the physical examination was done on all subjects. Serum electrolytes values were determined using the ion-selective electrode system and compared with standard reference ranges. The data were analyzed using SPSS version 21.0 with the level of statistical significance set at P < 0.05. Results: A total of 108 under-five children were studied. The majority (101; 93.5%) were

Background: This study aimed to evaluate the effect of yeast probiotic Saccharomyces boulardii on the frequency and duration of acute diarrhea in children. Methods: Sixty children were randomized to receive yeast probiotic S. boulardii in a daily dose of 250 mg (trial group-30 patients) or placebo (control group-30 patients) for five days. The clinical and demographic characteristics of two groups were recorded before the intervention. After intervention, the two groups were compared in terms of frequency of diarrhea, duration of diarrhea, and hospital stay. Results: The median (interquartile range) of frequency of diarrhea in the trial group was significantly lower than placebo group (4 [2] vs. 5 [2.5]) (P = 0.04). Also, the median (interquartile range) of duration of diarrhea in the trial group was significantly lower than placebo group (3 [2] vs. 4 [2.5]) (P = 0.03). There was no significant difference between groups for hospital stay (P = 0.8). Conclusions: The present study reveals that the use of yeast probiotic S. boulardii can reduce the frequency and duration of acute diarrhea. Therefore, we recommended S. boulardii administration to acute diarrhea in children.

Acute diarrhea is a major cause of morbidity and mortality in children under five. Probiotics are beneficial for treating acute diarrhea in children, but unclear which specific probiotic is the most effective. We performed a Bayesian network meta-analysis to examine the comparative effectiveness of probiotics. By searching EMBASE, PubMed, and the Cochrane Library up to 31 March 2021, randomized clinical trials (RCTs) on probiotics for treating acute diarrhea in children were included. Primary outcomes included the duration of diarrhea and diarrhea lasting ≥2 days, and secondary outcomes included the mean stool frequency on day 2 and duration of hospitalization, fever, and vomiting. We assessed the certainty of the evidence of outcomes according to Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guideline. Eighty-four studies with twenty-one different interventions in 13,443 children were included. For the primary outcomes, moderate evidence indicated that, Lactobacillus reuteri [mean difference (MD) = −0.84 day; 95% confidence interval (CI), −1.39, −0.29], Bifidobacterium lactis (MD = −0.98 day; 95%CI, −1.82, −0.14), Saccharomyces boulardii (MD = −1.25 day; 95%CI, −1.59, −0.91), Lactobacillus species (spp.) plus Bifidobacterium spp. plus Saccharomyces spp. (MD = −1.19 day; 95%CI, −1.81, −0.58), and Bacillus spp. plus Enterococcus spp. plus Clostridium spp. (MD = −1.1 day; 95%CI, −1.84, −0.35) significantly reduced the duration of diarrhea when compared with placebo. Saccharomyces boulardii [Odds ratio (OR) = 0.22; 95%CI, 0.11, 0.41] and Lactobacillus reuteri (OR = 0.23; 95%CI, 0.090, 0.60) significantly reduced the risk of diarrhea lasting ≥2 days when compared with placebo or no treatment, with moderate evidence. Among all probiotics, Saccharomyces boulardii may be the most effective in reducing both duration of diarrhea (compared with placebo) and risk of diarrhea lasting ≥2 days (compared with placebo or no treatment), with moderate evidence. To be conclusive, Saccharomyces boulardii may be the most effective probiotic for treating acute diarrhea in children, followed by several other single-strain and multi-strain probiotics.

Whether antidiarrheal medications have benefits or demerits when administered to adult patients with diarrhea remains controversial. We aimed to evaluate the association between antidiarrheal drug prescription and clinical outcomes in adult patients with acute diarrhea. This retrospective cohort study was conducted by collecting secondary data of patients' health records at St. Luke's International Hospital from April 1, 2004, to March 31, 2016. We included all participants aged 20-59 years who visited the division of general internal medicine or the emergency room in the hospital due to acute diarrheal symptoms. We excluded those who had chronic diarrhea or were immunocompromised (e.g., those with cancer or immunosuppressant usage). Our primary outcome was return visits within two weeks; the secondary outcome was admission to the hospital due to acute diarrhea within two weeks from the first visit. We compared the outcomes between patients with and without antidiarrheal drug prescriptions. During the study period, a total of 10,246 patients were included, of which 204 (2.0%) were prescribed antidiarrheal drugs. The mean age of the patients was 35.0 (standard deviation: 10.7) years, and 4,130 (40.3%) were men. Patients who were prescribed antidiarrheal drugs were more likely to be prescribed antibiotics (p

Background: Diarrhea is a major contributor to childhood mortality and morbidity in the developing world. Objective: The study was aimed to determine the prevalence of Entamoeba histolytica among children diagnosed with acute diarrhea in Kura General Hospital Kano, from February to August 2017. Methodology: A total of 236 stools samples were collected from children within the age group of 0 – 5 years diagnosed with acute diarrhea attending the Hospital. The stool samples were examined for Entamoeba Histolytica cysts and trophozoites using direct wet preparation and Formol Ether concentration techniques. Results: The result showed that 23 samples which accounted for 9.75% of the samples were found to be positive for the parasite. Highest incidence of the parasite was found among children within the age category of 4 - 5 years. The results also indicated that males (56.5%) were more infected than females (43.5%). However, there is no statistical difference in the rate of infection among the sex and age group of the patients at p< 0.05. Conclusion: In conclusion, maintenance of personal hygiene and improved sanitation of the environment will indeed prevent contamination of food and water sources.

Background: Malnutrition is a major global health problem, with the major burden being in South Asia and Sub-Saharan Afric. The study was undertaken to determine the frequency of hyponatremia an hypokalemia in malnourished children with acute diarrhea. Methods: Hospital based prospective study was conducted on 100 children between the age group of 6months to 5years presenting with acute diarrhea was include in the study. Results: Hyponatremia was observed in total 15 (15.00%) cases of diarrhea. Regarding the grade of malnutrition, hyponatremia was observed in only 4.44% in grade 1, 8.69% in grade, 41.67% in grade 3 and 60.00% in grade 4 malnutrition respectively. Hypokalemia was noticed in 10.00% cases (10 out of 100) with acute diarrhea. The frequency of hypokalemia was 4.44% in grade 1, 8.69% in grade 2, 25.00% in grade 3 and 40.00% in grade 4 malnutrition respectively. Conclusion: Electrolyte disturbances are often subclinical in malnourished children, but become obvious during the episode of acute diarrhoeal disease. Hence serum electrolytes of every malnourished child with acute diarrhoea should be estimated in order to do immediate correction and avoid serious life-threatening outcome. Keywords: IAP, Malnutrition, Diarrhoea

Human parechoviruses (HPeVs) are important causes of infection in children. However, without a comprehensive and persistent surveillance, the epidemiology and clinical features of HPeV infection remain ambiguous. We performed a hospital-based surveillance study among three groups of pediatric patients with acute respiratory infection (Group 1), acute diarrhea (Group 2), and hand, foot and mouth disease (Group 3) in Chongqing, China, from 2009 to 2015. Among 10,212 tested patients, 707 (6.92%) were positive for HPeV, with the positive rates differing significantly among three groups (Group 1, 3.43%; Group 2, 14.94%; Group 3, 3.55%; P < 0.001). The co-infection with other pathogens was detected in 75.2% (531/707) of HPeV-positive patients. Significant negative interaction between HPeV and Parainfluenza virus (PIV) (P = 0.046, OR = 0.59, 95% CI = 0.34–0.98) and positive interactions between HPeV and Enterovirus (EV) (P = 0.015, OR = 2.28, 95% CI = 1.23–4.73) were identified. Among 707 HPeV-positive patients, 592 (83.73%) were successfully sequenced, and 10 genotypes were identified, with HPeV1 (n = 396), HPeV4 (n = 86), and HPeV3 (n = 46) as the most frequently seen. The proportion of genotypes differed among three groups (P < 0.001), with HPeV1 and HPeV4 overrepresented in Group 2 and HPeV6 overrepresented in Group 3. The spatial patterns of HPeV genotypes disclosed more close clustering of the currently sequenced strains than those from other countries/regions, although they were indeed mixed. Three main genotypes (HPeV1, HPeV3, and HPeV4) had shown distinct seasonal peaks, highlighting a bi-annual cycle of all HpeV and two genotypes (HPeV 1 and HPeV 4) with peaks in odd-numbered years and with peaks in even-numbered years HPeV3. Significantly higher HPeV1 viral loads were associated with severe diarrhea in Group 2 (P = 0.044), while associated with HPeV single infection than HPeV-EV coinfection among HFMD patients (P = 0.001). It’s concluded that HPeV infection was correlated with wide clinical spectrum in pediatric patients with a high variety of genotypes determined. Still no clinical significance can be confirmed, which warranted more molecular surveillance in the future.

Background Human adenovirus (HAdV) had been recognized as one of the most common enteric viruses associated with acute diarrhea in children. The present study was carried out to demonstrate the molecular and epidemiological characterization of HAdV Infections among children in Shandong province in China between July 2017 and June 2018. Methods Fecal specimens were collected from children under 5 years old with acute diarrhea. DNA was extracted from the stool specimens and adenovirus DNA was detected by PCR amplification with specific primers. The amplification products were subjected to electrophoresis and visualized on a UV transilluminator. All positive RT-PCR amplification products were sequenced and the obtained sequences analyzed by MEGA (version 7.0). Demographic information and clinical manifestation data were also analyzed. Results In total, 656 fecal specimens were collected and the overall positive rate of HAdV was 7.47%. HAdV infections were detected in all age groups, in which children aged 13–24 months presented the highest positive rate. Seasonal pattern could be observed with a peak in December, January and February. Diarrhea, vomiting, dehydration and fever were the main clinical manifestations, in which vomiting was the most common accompanied symptom. By phylogenetic analysis, four species (A, B, C, and F) were detected and seven different serotypes were identified. HAdV-41 (48.98%, 24/49) was the most common serotype followed by HAdV-3 (18.37%, 9/49), HAdV-31 (14.29%, 7/49), HAdV-7 (8.16%, 4/49), HAdV-40 (4.08%, 2/49), HAdV-1 (4.08%, 2/49) and HAdV-2 (2.04%, 1/49). Conclusion This study indicated that HAdV infection was an important cause of acute diarrhea among children under 5 years old in Shandong province. The results will contribute to (a) increase understanding of the role of HAdV in diarrheal children and enhance identification of the predominant diarrhea pathogen for diagnosis; (b) avoid abuse of antibiotics; (c) monitor the change of prevalent HAdV serotypes and promote vaccine development and vaccination.

Objective To compare the mean number of stools per day in children treated with combination of probiotic (lactobacillus rhamnosus) with ORS and ORS only in acute diarrhea. Study design Randomised control trial. Place and duration of study Department of Pediatric Medicine, PNS Shifa Hospital, from February to July, 2017. Methodology A total of 80 children with acute watery diarrhea were randomly divided into two groups. Forty patients in first group were given probiotic with ORS and 40 patients in second group (control) were given ORS only. All children were monitored from 0 day (inclusion day) to next 5 days. Demographic data was collected regarding age, gender, weight and frequency of loose stools. Dehydration status was also assessed at the time of admission by the attending physician. Data was collected through a structured proforma. Results The average age of the children was 24.3 ±18.65 months. There were 47 (58.8%) males and 33 (41.3%) females. Mean number of stools was significantly low in those patients who were treated with combination of probiotic (lactobacillus rhamnosus) with ORS than those who were treated with ORS only in acute diarrhea (3.25 ±1.13 vs. 4.13 ±0.79; p Conclusion Probiotics are found to be significantly more effective in reducing the stool frequency in acute diarrhea.

Background Persistent diarrhoea is a commonly observed phenomenon both in Bangladesh and all over the developing countries. It is the single most important cause of diarrhoea related deaths in the community, accounting for over half of them. If associated factors are properly identified & treated, it is possible to prevent most cases of persistent diarrhoea. Objective This study was undertaken to find out the possible risk factors associated with persistent diarrhoea in children below 5 years of age. Methods This was a prospective analytical case control study carried out in a tertiary care hospital, Dhaka. A total of 30 consecutive cases of persistent diarrhoea and 60 consecutive acute diarrhoea controls (matched for age and sex) under 5 comprised the study subjects in this study. Children beyond the age and whose parents didn’t give written consent were excluded from the study. Data were collected using a structured questionnaire and a standered case definition of acute & persistent diarrhoeawere adopted. Data were later processed and analyzed using SPSS (Statistical Package for Social Science version 12) in the year 2012. Results were considered statistically significant when p value was