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Discusses issues which concern children born to families in developing countries. Focuses on: (1) population impact on children; (2) family planning; (3) infant feeding; (4) oral rehydration therapy and immunizations; and (5) education. (RJC)

A total of 267 Nigerian mothers with children under the age of five years were investigated regarding the degree of their awareness and acceptance of oral rehydration therapy in the treatment of childhood diarrhea. Results indicate that only 39 percent of the mothers had heard of ORT in treating diarrhea. (RJC)

Background and aims: Diarrhoea is one of the deadliest diseases and causing death among children in India, but no systematic attempt is made to understand it especially its control using oral rehydration salts (ORS). It is well known that use of ORS and Zinc have been effective in containing diarrhoea among children. An attempt is made using large scale national data set in India to understand use of ORS and Zinc to control diarrhoea and their associated factors among diarrhoeal children under five in India. Methods: Publicly available most recent cross-sectional National Family Health Survey data in India was used for the study. The multi-stage cluster sampling design was used with 2011 Census of India as a sampling frame. Households were selected using a Systematic Random Sampling design from selected primary sampling units in rural and urban clusters. From the selected households, the eligible children were those who suffered from diarrhoea in the two weeks preceding the survey and were less than 5 years old. Using this criterion, out of 232,920 children in the survey of less than five years, 16,213 sample diarrheal children found to be available for the study. Both descriptive and inferential statistical techniques were used to analyse the data. Results: Across India, 61% and 31% of the children were given ORS and Zinc respectively. However, combined ORS + Zinc treatment was only around 24%. The treatment of ORS, Zinc, and combined ORS + Zinc supplementations were significantly higher among younger children, children of 24–35 age group mothers, children from rich wealth index groups, belong to Hindu religion and general caste compared to their counterparts. The logistic regression results showed that consumption of ORS among diarrhoeal children under five years of age depends upon size of a child at birth. For instance, diarrheal children who were very small size at birth compared to very large at birth, had 39% lower odds of consuming ORS (AOR = 0.61; CI 0.48, 0.78; p<0.001). Another important variable is place of first treatment sought for diarrheal children. That is children who first sought treatment in private hospital compared to government hospital had 52% lower odds of ORS consumption. The logistic regression adjusted AORs are similar with Zinc and ORS + Zinc supplementations. Conclusions: To improve the coverage and management of childhood diarrhoea in India, planning activities should focus not only on distribution, and increasing knowledge of ORS preparation especially for urban slum residents and rural disadvantaged groups through demonstration. There should be also proper focus on providing ongoing pathways to ensure proper supply chains. [ABSTRACT FROM AUTHOR]

Background: Sierra Leone has improved child health outcomes in recent decades. However, diarrhoeal diseases remain a public health concern, particularly among children under five. This study investigates the trends and inequalities in oral rehydration therapy and continued feeding for children under five with diarrhoea in Sierra Leone in 2008, 2013 and 2019. Methods: The analysis utilised data from the Sierra Leone Demographic Health Survey rounds conducted in 2008, 2013, and 2019. The software utilised for the calculation of various measures of inequality, including simple difference, ratio, population-attributable risk, and population-attributable fraction, was the World Health Organization Health Equity Assessment Toolkit. An inequality assessment was conducted for six stratifiers: maternal age, maternal economic status, maternal level of education, place of residence, sex of the child, and sub-national region. Results: Our findings reveal that children under five with diarrhoea receiving oral rehydration therapy and continued feeding increased from 56.5% in 2008 to 59.7% in 2019 in Sierra Leone. Children of mothers aged 20–49 had more coverage over time than those with mothers aged 15–19. Children of mothers who are wealthy, more educated, and living in urban areas show a decrease in coverage with time compared to the poor, the lowly educated, and those residing in rural areas. Male children had higher coverage than female children. Regional inequality decreased slightly from 21.5 percentage points in 2008 to 21.2 percentage points in 2019. Conclusion: The findings revealed a mixed picture of progress in oral rehydration therapy and continued feeding for children under five in Sierra Leone. While national coverage has increased, inequalities persist. Children of older mothers and those from disadvantaged backgrounds have experienced improvements, while children of younger, wealthier, and more educated mothers in urban areas have seen a decline in coverage. The gender and regional inequalities remain. Expanding community-based health programs, providing subsidised or free supplies, and strengthening health systems in underserved areas are key strategies to ensure equitable and effective healthcare for all children in Sierra Leone. [ABSTRACT FROM AUTHOR]

Background: Diarrhoeal disease remains a leading cause of morbidity and mortality in childhood. The advent of oral rehydration therapy (ORT) including home treatment of diarrhoea has affected the incidence of dehydration Objective: To assess the impact of oral rehydration therapy on childhood diarrhoeal disease. Design: Cross sectional study. Methods: The duration of the diarrhoeal illness, the degree of dehydration, treatment given at home and the outcome were studied in children seen at the Diarrhoea Training Unit (DTU) of the University of Borin Teaching Hospital during the periods July 1993 to June 1994 and July 1997 to June 1998. Results: Eight hundred and ninety one patients presented in the DTU over the one-year period in 1993/94 compared to 109 patients over the same period in 1997/98. There was a significantly higher mean duration of diarrhoea before presentation in the 1993/94 group (58.3 13 hours) compared to the 1997/98 group (25.7 £6.1 hours) (t = 2.12, p < 0.025). Severe dehydration was seen in 11 percent of the cases in the 1993/94 group compared to five percent in the 1997/98 group (&? = 9.42, P < 0.01). Seventy-six percent of the patients in the 1993/94 group and sixty six percent in the 1997/98 group received various antidiarrhoeal drugs before presentation. Conclusion: The application of oral rehydration therapy resulted in the reduction of cases of severe dehydration seen in children with diarrhoea in Ilorin. The parents presented earlier in the 1997/98 than in the 1993/944 group but the use of antidiarrhoeal drugs was still common. There is therefore, a need for further training of health workers and mothers on the home management of diarrhoea. The use of drugs that are not indicated in the management of diarrhoea should be discouraged, while ORT use showd be strengthened.

Background: Evidence on ivermectin as a treatment for Covid-19 is controversial. A Cochrane review concluded that the efficacy and safety of ivermectin is uncertain (evidence up to April 2022) and WHO recommended its use only in the setting of clinical trials. This study aimed to assess the efficacy and safety of oral ivermectin in hospitalized patients with mild to moderate Covid-19. Trial design and methods: A double-blind, randomized placebo-controlled clinical trial was conducted among RT-PCR-confirmed, adults, hospitalised within the first four days of symptoms. Patients received oral ivermectin 24 mg or placebo daily for five days. RT-PCR was repeated on days five and ten. Clinical progression was monitored using the World Health Organization Clinical Progression Scale. Serum ivermectin levels were measured on days three, five, and seven. The primary outcome was the difference in the viral load between day zero and ten in the two groups. Results: Out of 1699 patients screened, 249 underwent randomization and 127 received ivermectin, and 122 placebo. D10 median viral load for E gene (IQR) was 2,000 copies/mL (100 − 20,500) with ivermectin (n = 80) and 4,100 copies/mL (1,000–65,600) with placebo (n = 81, p = 0.028), per protocol analysis. The difference in Log viral load between day zero and ten between ivermectin and placebo was 3.72 and 2.97 respectively (p = 0.022). There was no significant difference in the WHO clinical progression scale or the adverse effects. Ivermectin blood levels taken before or with meals were not significantly different. Only 7 and 17 patients achieved blood levels above 160ng/ML and 100ng/ML respectively and they did not achieve a significantly lower viral load. Conclusion: Although ivermectin resulted in statistically significant lower viral load in patients with mild to moderate Covid-19, it had no significant effect on clinical symptoms. Trial registration number: SLCTR/2021/020, Sri Lanka Clinical Trials Registry. 19/07/2021. [ABSTRACT FROM AUTHOR]

Background: Owing to the highly contagious nature of SARS-CoV-2, the use of personal protective equipment (PPE) among the healthcare workers (HCWs) is mandatory. However, PPE associated adverse effects are also there. Objective: To study the adverse effects associated with PPE and their preventive measures amongst the HCWs. Material and Methods: A descriptive study was conducted among 200 HCWs working in a Covid center of a tertiary care center. The participants were sent the questionnaires online. Some of them not having smart phones were interviewed telephonically. Their information profile, the various adverse effects associated with PPE, and the preventive measures being practiced by them were noted. Data was analyzed using descriptive and inferential statistics. Results: Total 97% HCWs reported adverse effects with hazmat suit; 96% with N 95 mask; 92% with goggle and 78% with gloves. The adverse effects associated with the prolonged use of the mask were erythema; erosions and scar at the nasal bridge; ear pain; difficulty in breathing; and headache. Sixty-seven percent of the participants had sweating with the use of gloves, which led to cutaneous exfoliation such as dry hands (55%) and skin itching (43%). Moisturizers and natural oils were used to prevent the dryness of hands. For the pressure related injury over the nasal bridge due to N95 mask, participants used to apply Band-Aid (adhesive bandage) and cotton dressing. Conclusion: Adverse skin reactions related to PPE are common among HCWs. Comprehensive assessment of the skin condition and awareness on adverse skin reactions should be advocated. [ABSTRACT FROM AUTHOR]

Objective: To evaluate oral rehydration therapy (ORT) compared with intravenous rehydration therapy (IVT) in the early inpatient management of hyperemesis gravidarum (HG). Methods: A total of 124 women hospitalized for HG from February 10, 2021 till January 6, 2023 were randomized to ORT (n = 61) or IVT (n = 63) for an initial 12 h. Inclusion criteria includes women older than 18 years, with a viable intrauterine pregnancy less than 14 weeks at their first hospitalization for HG with ketonuria of at least 2+. Primary outcomes were (1) satisfaction score with allocated intervention, (2) weight change, and (3) ketonuria change at 12 h. Secondary outcomes included vomiting frequency, nausea score, serial vital signs, hematocrit and electrolyte levels at 12 h, deviation from treatment protocol (cross‐over therapy), participant recommendation of allocated treatment to a friend, and length of hospital stay. Results: Primary outcomes of (1) participant satisfaction score (on a 0–10 visual numerical rating scale) was 7 (interquartile range [IQR] 5–8) versus 9 (IQR 8–10), P < 0.001; (2) weight gain was 293 ± 780 g versus 948 ± 758 g, P < 0.001; and (3) ketonuria improvement was 50/61 (82.0%) versus 49/63 (77.8%) (relative risk [RR] 1.05, 95% confidence interval [CI] 0.88–1.26, P = 0.561) for ORT versus IVT, respectively. For secondary outcomes, vomiting frequency was 2.6 ± 2.7 versus 1.1 ± 1.4 episodes (P < 0.001), participant cross‐over rate to opposing treatment 20/61 (32.8%) versus 0/63 (0%) (P < 0.001) (in the 12‐h study period) and participant recommendation of allocated treatment to a friend rate 24/61 (39.3%) versus 61/63 (96.8%) (RR 0.41, 95% CI 0.30–0.56, P < 0.001) for ORT versus IVT, respectively. By hospital discharge, 31/61 (50.8%) of women allocated to ORT had required IVT. Other secondary outcomes of serial assessments of nausea score and vital signs, hematocrit and electrolyte levels, and length of hospital stay were not different. Conclusions: ORT was inferior to IVT in two primary outcomes and three secondary outcomes. Cross‐over rate to intravenous therapy from oral therapy was 50.8% by hospital discharge. Intravenous rehydration therapy should remain as first‐line rehydration therapy in the early inpatient treatment of HG. Clinical Trial Registration: The present study was registered in ISRCTN registry on December 6, 2020 with trial identification number: ISRCTN 40152556 (https://doi.org/10.1186/ISRCTN40152556). The first participant was recruited on February 10, 2021. Synopsis: Oral rehydration therapy is inferior to intravenous rehydration therapy in the early inpatient management of hyperemesis gravidarum. [ABSTRACT FROM AUTHOR]

BACKGROUND: Diarrhoea is defined as the passage of loose, liquid or watery stools more than three times a day. Though simple and effective treatment measures are available which can markedly reduce diarrhea associated morbidity and mortality, yet in developing countries due to poor diarrhea and Oral rehydration therapy (ORT) related knowledge, diarrhoea still continues to be a major public health problem. The study aimed to estimate the knowledge, attitude and practice of mothers in the management of diarrhoea among under-five children in a rural area of India. METHODS: A Cross-sectional study was conducted among mothers having children below five years of age in rural area of India. Proportionate sampling technique was used to recruit mothers. A pretested, pre designed structured questionnaire was used to obtained the data. RESULTS: A total of 382 mothers were participated in the study. The mean age of study participants was 25.72 ± 3.98 years. Overall knowledge score showed that (74.6%) three-fourth of the study participants had average knowledge regarding diarrhoeal management. Majority of the mothers (62.6%) showed positive attitude in diarrhoea management. The practice scores showed that nearly half of the study participants (50.3%) had good practice regarding diarrhoea management. CONCLUSION: The knowledge of mothers regarding management of diarrhoea among under-five children was average and most mothers had positive attitude. However, only half of the mothers had good practice. [ABSTRACT FROM AUTHOR]

Purpose: Rapid gastric emptying and intestinal absorption of beverages is essential for rapid rehydration, and certain amino acids (AA) may augment fluid delivery. Three sugar-free beverages, containing differing AA concentrations (AA + PZ), were assessed for fluid absorption kinetics against commercial sugar-free (PZ, GZ) and carbohydrate-containing (GTQ) beverages. Methods: Healthy individuals (n = 15–17 per study) completed three randomised trials. Three beverages (550–600 mL) were ingested in each study (Study 1: AA + PZ [17.51 g/L AA], PZ, GZ; Study 2: AA + PZ [6.96 g/L AA], PZ, GZ; Study 3: AA + PZ [3.48 g/L AA], PZ, GTQ), containing 3.000 g deuterium oxide (D2O). Blood samples were collected pre-, 2-min, 5-min, and every 5-min until 60-min post-ingestion to quantify maximal D2O enrichment (Cmax), time Cmax occurred (Tmax) and area under the curve (AUC). Results: Study 1: AUC (AA + PZ: 15,184 ± 3532 δ‰ vs. VSMOW; PZ: 17,328 ± 3153 δ‰ vs. VSMOW; GZ: 17,749 ± 4204 δ‰ vs. VSMOW; P ≤ 0.006) and Tmax (P ≤ 0.005) were lower for AA + PZ vs. PZ/GZ. Study 2: D2O enrichment characteristics were not different amongst beverages (P ≥ 0.338). Study 3: Cmax (AA + PZ: 440 ± 94 δ‰ vs. VSMOW; PZ: 429 ± 83 δ‰ vs. VSMOW; GTQ: 398 ± 81 δ‰ vs. VSMOW) was greater (P = 0.046) for AA + PZ than GTQ, with no other differences (P ≥ 0.106). Conclusion: The addition of small amounts of AA (3.48 g/L) to a sugar-free beverage increased fluid delivery to the circulation compared to a carbohydrate-based beverage, but greater amounts (17.51 g/L) delayed delivery. [ABSTRACT FROM AUTHOR]

Treatment with immune checkpoint inhibitors is effective in various cancers, but may be associated with immune-mediated side effects in other organs. Among the more common ones is gastrointestinal tract involvement, especially colitis. In most patients, colitis is mild or responds to corticosteroid treatment. A smaller proportion of patients, more often those treated with cytotoxic T lymphocyte antigen-4 inhibitors, may have a more severe course of colitis, even life-threatening complications. In these patients, prompt action, timely diagnosis with endoscopic evaluation and early treatment with high-dose corticosteroids and, if ineffective, rescue therapy with biologic agents such as infliximab and vedolizumab are needed. We present three cases from our clinical practice, data on incidence and clinical presentation, current recommendations regarding diagnostic approach and treatment of immune checkpoint inhibitors induced colitis. [ABSTRACT FROM AUTHOR]

Background: Multiple clinical studies have described the benefits of probiotic Saccharomyces boulardii (S. boulardii) CNCM I-745 against diarrhoea, but the real-world evidence supporting its use is lacking. Objective: To evaluate effectiveness of the S. boulardii CNCM I-745 group in a real-world setting. Methods: This was an electronic medical record (EMR)-based, retrospective, multicentre, comparative study in Indian adult patients presenting with diarrhoea managed between January 2020 and January 2022. Data of patients at the baseline visit, with a follow-up visit within 15 days, and who were administered S. boulardii CNCM I-745 (for the test group) or any other treatment modality excluding probiotics (for the control group) were considered. Effectiveness was evaluated on the basis of number of patients who did not complain of diarrhoea at follow-up. Results: Of 30,385 adult patients with diarrhoea, 270 patients prescribed S. boulardii CNCM I-745 were included, while the control group comprised 1457 patients. The baseline median age of the test group was 47 years (range 19–86 years), while it was 44 years (range 19–100 years) for the control group. The majority of patients in both study groups were females (56.7% in the test and 51.5% in the control group). Median duration between visits was 5 days (range 1–15 days) in both study groups. In all, 77.8% patients (95% CI 72.34–82.59) in the test group did not complain of diarrhoea at follow-up, while the proportion was 15.8% (95% CI 13.95–17.76) in the control group (p < 0.05). Odds ratio (OR) for absence of diarrhoea in the S. boulardii CNCM I-745 group versus the control group was 18.7 (95% CI 13.6–25.7, p < 0.05). For subgroups on concomitant antibiotics, a significant advantage was noted again for the test versus the control group (76.8% versus 18.4%; p < 0.05; OR: 14.7 with 95% CI 8.8–24.4; p < 0.05). Conclusion: The effect of S. boulardii CNCM I-745 probiotic in controlling diarrhoea was better than anti-diarrhoeal and/or oral rehydration therapy in real-world clinical practice. The effect was similar even with concomitant antibiotic usage. [ABSTRACT FROM AUTHOR]

We assess progress towards improved case management of childhood diarrhea in Nigeria over a period of targeted health systems reform from 2013 to 2018. Individual and community data from three Demographic and Health Survey rounds are leveraged in a geospatial model designed for stratified estimation by venue of treatment seeking and State. Our analysis reveals a highly regionalised health system undergoing rapid change. Nationally, there have been substantial increases in the proportion of children under 5 years old with diarrhea receiving the recommended oral rehydration therapy after seeking treatment at either a health clinic (0.57 [0.44–0.69; 95% CI] in 2008; 0.70 [0.54–0.83] in 2018) or chemist/pharmacy (0.28 [0.17–0.42] in 2008; 0.48 [0.31–0.64] in 2018). Yet State-level variations in venue attendance and performance by venue have conspired to hold the overall proportion receiving this potentially life-saving therapy (0.45 [0.35–0.55] in 2018) to well-below ideal coverage levels. High performing states that have demonstrated significant improvements include Kano, Jigawa and Borno, while under-performing states that have suffered declines in coverage include Kaduna and Taraba. The use of antibiotics is not recommended for mild cases of childhood diarrhea yet remains concerningly high nationally (0.27 [0.19–0.36] in 2018) with negligible variation between venues. Antibiotic use rates are particularly high in Enugu, Kaduna, Taraba, Kano, Niger and Kebbi, yet welcome reductions were identified in Jigawa, Adamawa and Osun. These results support the conclusions of previous studies and build the strength of evidence that urgent action is needed throughout the multi-tiered health system to improve the quality and equity of care for common childhood illnesses in Nigeria. [ABSTRACT FROM AUTHOR]

Background: To investigate the short-term and long-term outcomes of preserving the celiac branch of the vagus nerve during laparoscopic distal gastrectomy. Methods: A total of 149 patients with prospective diagnosis of gastric cancer who underwent laparoscopic-assisted distal gastrectomy (LADG) combined with Billroth-II anastomosis and D2 lymph node dissection between 2017 and 2018 were retrospectively analyzed. The patients were divided into the preserved LADG group (P-LADG, n = 56) and the resected LADG group (R-LADG, n = 93) according to whether the vagus nerve celiac branch was preserved. We selected 56 patients (P-LADG, n = 56) with preservation of the celiac branch of the vagus nerve and 56 patients (R-LADG, n = 56) with removal of the celiac branch of the vagus nerve by propensity-matched score method. Postoperative nutritional status, weight change, short-term and long-term postoperative complications, and gallstone formation were evaluated in both groups at 5 years of postoperative follow-up. The status of residual gastritis and bile reflux was assessed endoscopically at 12 months postoperatively. Results: The incidence of diarrhea at 5 years postoperatively was lower in the P-LADG group than in the R-LADG group (p < 0.05). In the multivariate logistic analysis, the removal of vagus nerve celiac branch was an independent risk factor for the occurrence of postoperative diarrhea (odds ratio = 3.389, 95% confidential interval = 1.143-10.049, p = 0.028). In the multivariate logistic analysis, the removal of vagus nerve celiac branch was an independent risk factor for the occurrence of postoperative diarrhea (odds ratio = 4.371, 95% confidential interval = 1.418-13.479, p = 0.010). Conclusions: Preservation of the celiac branch of the vagus nerve in LADG reduced the incidence of postoperative diarrhea postoperatively in gastric cancer. Trial registration: This study was registered with the Ethics Committee of the First Affiliated Hospital of Dalian Medical University in 2014 under the registration number: LCKY2014-04(X). [ABSTRACT FROM AUTHOR]

Introduction: Acute promyelocytic leukemia (APL) is the most malignant form of acute myeloid leukemia (AML) with short survival without treatment. All trans retinoic acid (ATRA) is a vitamin A metabolite and plays an important role in the treatment of APL. Hypercalcemia is a rare side effect of ATRA. Case Report: A 67-year-old female patient was investigated due to widespread bruising and pancytopenia. The patient was diagnosed with APL and remission was achieved by administering idarubicin together with ATRA in the induction treatment. The patient has hypocalcemia due to acquired hypoparathyroidism, and it was observed that the calcium level increased with the initiation of fluconazole 200 mg/day for antifungal prophylaxis together with ATRA in the consolidation treatment. It was observed that the calcium value reached 13 mg/dL by increasing the fluconazole to 400 mg/day treatment dose due to oral mucositis. Management and Outcome: The development of hypercalcemia has been reported in previous case reports when ATRA is used together with voriconazole, fosfluconazole, itraconazole, and posaconazole, which inhibit cytochrome P450 enzymes. In this case, it is the first in the literature that a patient with hypocalcemia due to acquired hypoparathyroidism developed hypercalcemia after fluconazole and ATRA were used together. Discussion: Since hypercalcemia may develop while azole drugs are administered during ATRA treatment, it is important to monitor calcium levels to prevent complications of hypercalcemia. [ABSTRACT FROM AUTHOR]

Objective: Postoperative fasting following thoracoscopic surgery can cause intense thirst and oral discomfort. However, there is currently no research on ultraearly oral hydration (UEOH) in middle-aged or elderly patients after thoracoscopic surgery. The aim of this study was to investigate the effectiveness and safety of UEOH for improving oral discomfort after thoracoscopic surgery. Methods: This single-center prospective double-blind randomized controlled trial was conducted from April 2022 to November 2023. A total of 64 middle-aged and elderly patients who underwent the first thoracoscopic surgery on the day were enrolled at our institution. Postoperatively, in the Postanesthesia Care Unit (PACU), patients were randomly assigned at a 1:1 ratio to either the UEOH group or the standard care (SC) group. The primary outcome was the patient's thirst score at 6 h after surgery. Secondary outcomes included the incidence of postoperative oral discomfort; pain scores; the occurrence of adverse reactions such as nausea, vomiting, regurgitation and aspiration; anxiety scores on the first postoperative day; the time to first flatus; and recovery satisfaction scores. Results: The demographic and surgical characteristics were similar between the two groups. Patients in the UEOH group had lower thirst scores 6 h after surgery than did those in the SC group(16.1 ± 6.70 vs. 78.4 ± 8.42, P < 0.01). The incidence of postoperative oral discomfort (P < 0.01), anxiety scores on the first postoperative day (P<0.05), and time to first flatus (P<0.05) were better in the UEOH group. Additionally, the incidences of adverse reactions, such as postoperative nausea, vomiting, regurgitation and aspiration, were similar between the two groups (P>0.05). Conclusion: For middle-aged and elderly patients undergoing thoracoscopic surgery, the use of a modified UEOH protocol postoperatively can improve thirst and promote gastrointestinal recovery without increasing complications. Trial registration: This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 07/12/2023 with the registration number ChiCTR2300078425. [ABSTRACT FROM AUTHOR]

Studies carried out in several species have demonstrated that detection of low-calorie sweeteners in the lumen of the intestine, by the sweet receptor, T1R2- T1R3, initiates a signaling pathway leading to enhanced expression and activity of intestinal Na+/glucose cotransporter 1, SGLT1. This results in an increased gut capacity to absorb glucose, sodium chloride and water, the basis for oral rehydration therapy. Horses express T1R2, T1R3 and downstream signaling elements in the intestinal tissue. As such, the potential of sweetener-stimulation of T1R2-T1R3 leading to upregulation of SGLT1 allows the provision of more glucose (energy) and hydration for horses. This is especially important when the need for glucose increases during strenuous exercise, pregnancy, and lactation. There are significant differences among species in the ability to detect sweeteners. Amino acid substitutions and pseudogenization of taste receptor genes underlie these variations. Nothing is known about the sweetener specificity of horse T1R2-T1R3. Using heterologous expression methodology, we demonstrate that sweeteners sucralose, stevia and neohesperidin dihydrochalcone (NHDC) activate horse T1R2-T1R3, but cyclamate does not. Determination of sweetener specificity of equine sweet receptor is crucial for developing suitable dietary additives to optimize glucose absorption, hydration and avoiding the intestinal disease brought about by microbial fermentation of unabsorbed carbohydrate reaching the large intestine. [ABSTRACT FROM AUTHOR]

Background and aim: Chinese herbal injection (CHI) is a widely used preparation for advanced non-small cell lung cancer (NSCLC) treatment to alleviate the adverse drug reactions and enhance the clinical efficacy of chemotherapy. However, its efficacy and safety in combination with platinum-based chemotherapy (PBC) remain poorly understood owing to the lack of high-level evidence in the face of a wide variety of CHIs. Therefore, in this study, we aimed to explore the efficacy and safety of CHIs in combination with PBC regimens in the treatment of mid- and advanced NSCLC. Methods: Systematic evaluation and meta-analysis were conducted as per the Preferred Reporting Project for Systematic Evaluation and Meta-Analysis Protocols (PRISMA-P). Seven databases were comprehensively searched for relevant randomized controlled trials (RCTs) through August 1, 2022. The quality of each study was evaluated based on the Cochrane Handbook for Systematic Reviews of Interventions. Statistical analysis was performed using Revman 5.3, with dichotomies expressed as risk ratio (RR) and 95% confidence interval (CI). Objective response rate (ORR) and disease control rate (DCR) were selected as the primary outcomes, with quality of life (QoL) and toxic side effects as secondary outcomes. Results: A total of 140 RCTs were included in this study. The results of the metaanalysis suggested that, compared with PBC alone, PBC combined with CHIs significantly improved the ORR (RR=1.35, 95% CI: 1.30-1.41, P<0.001), DCR (RR=1.15, 95% CI: 1.13-1.18, P<0.001) and QoL (RR=1.29, 95% CI: 1.24-1.33, P<0.001). Moreover, the combination treatment reduced chemotherapyinduced leukopenia (RR=0.69, 95% CI: 0.64-0.75, P<0.001), anemia (RR=0.70, 95% CI: 0.62-0.79, P<0.001), thrombocytopenia (RR=0.68, 95% CI: 0.62-0.75, P<0.001), nausea and vomiting (RR=0.69, 95% CI: 0.63-0.76, P<0.001), diarrhea (RR=0.59, 95% CI: 0.48-0.73, P<0.001), and constipation (RR=0.68, 95% CI: 0.54-0.86, P=0.001). Conclusion: According to the available evidence, CHIs in combination with PBC can improve clinical efficacy and reduce the toxic side effects in the treatment of advanced NSCLC. However, considering the study's limitations, more rigorous and high-quality studies are needed to further confirm the results. [ABSTRACT FROM AUTHOR]

Volume depletion is a common condition and a frequent cause of hospitalization in children. Proper assessment of the patient includes a detailed history and a thorough physical examination. Biochemical tests may be useful in selected cases. Understanding the pathophysiology of fluid balance is necessary for appropriate management. A clinical dehydration scale assessing more physical findings may help to determine dehydration severity. Most dehydrated children can be treated orally; however, intravenous therapy may be indicated in patients with severe volume depletion, in those who have failed oral therapy, or in children with altered consciousness or significant metabolic abnormalities. Proper management consists of restoring circulatory volume and electrolyte balance. In this paper, we review clinical aspects, diagnosis, and management of children with volume depletion. [ABSTRACT FROM AUTHOR]

Background: Tenapanor is a novel selective inhibitor of intestinal sodium/hydrogen exchanger 3 transporter. This is the first trial to assess the efficacy and safety of tenapanor in Japanese patients with hyperphosphatemia who are undergoing peritoneal dialysis. Methods: This phase 3, open-label, multicenter, single-arm clinical trial targeted patients whose serum phosphorus was within 3.5–7.0 mg/dL with phosphate binders at screening. After phosphate binder washout, tenapanor was orally administered twice-daily, stepwise from 5 to 30 mg/dose for 16 weeks. The primary endpoint, mean change in serum phosphorus level, was evaluated at week 8. The 16-week treatment period was completed with tenapanor alone, and only one phosphate binder type was allowed for combined use after the primary endpoint. Results: Of the 54 patients enrolled, 34 completed the study. At week 8, the primary endpoint, mean change in serum phosphorus level (last observation carried forward), was − 1.18 mg/dL (95% confidence interval: − 1.54, − 0.81 mg/dL) with tenapanor. From a baseline value of 7.65 mg/dL, serum phosphorus decreased to 6.14 and 5.44 mg/dL at weeks 8 and 16, respectively, and 46.3% and 76.5% of patients achieved serum phosphorus within 3.5–6.0 mg/dL at week 8 and week 16, respectively. The most common adverse event, diarrhea, occurred in 74.1% of patients; the severity of diarrhea was mild or moderate. Thus, the discontinuation percentage due to diarrhea was low at 5.6%. Conclusions: Administration of tenapanor resulted in a sufficient reduction in serum phosphorus level at week 8 and was considered safe and tolerable. Trial registration: NCT04766385. [ABSTRACT FROM AUTHOR]

Oral rehydration therapy (ORT) is the cornerstone treatment for managing dehydration. However, ORT cannot “halt” the underlying intestinal fluid loss, a significant mechanism of infectious organisms responsible for causing diarrhea. Reports have demonstrated the role of calcium in treating contagious diarrhea through the calcium-sensing receptor (CaSR), which is absent in oral rehydration solution (ORS). CaSR is a novel target that has demonstrated its effectiveness in treating diarrhea. CaSR is activated by a simple calcium agonist, an easily accessible, inexpensive, and safe-to-use option in the pediatric population. Adding nutrients would be simple and may increase the efficacy of the current ORS treatment. Maltodextrin (MDs) over glucose in ORS has shown benefits in these patients as the osmolality of MDs is significantly lower than that of disaccharide sugars. Thus, adding multivitamins, nutrients, and energy boosters to WHO- ORS may improve the efficacy of ORS in treating diarrhea, reducing malnutrition, and providing energy to curb fatigue.

Introduction: Treatment of mild to moderate hypokalemia is a high potassium-containing diet and oral pharmaceutical potassium products. However, several medical centers in Iran use injectable dosage forms orally, which is not a confirmed method by reliable guidelines. Objectives: This study investigated the advantages and side effects of oral tablets versus injection vials of potassium chloride orally. Patients and Methods: This descriptive-analytical cross-sectional study was performed from March 2022 to June 2022. Thirty patients received tablets (“potassium chloride tablet” group), and thirty patients received injection vials (“potassium chloride vials orally” group) of potassium chloride orally. The variables, including age, gender, clinical side effects, and serum level of potassium, were regularly recorded. Results: The mean duration of serum potassium normalization was 42.00 hours for the “potassium chloride tablet” group and 84.57 hours for the “potassium chloride vials orally” group. The mean total potassium intake was 127.20 mEq/L in the “potassium chloride tablet” group and 280.03 mEq/L for the “potassium chloride vials orally” group. No significant difference was observed in gastrointestinal complications, including esophagitis, bloating, stomach ache, and nausea. None of the patients have required endoscopy due to esophagitis. Conclusion: Our result suggested that prescribing oral potassium chloride tablets has superior benefits over injection vials. However, more detailed research is needed to reveal the other aspects of this problem. Study Registration: This study was retrospectively registered in Research Registry UIN (UIN: reviewregistry1668). [ABSTRACT FROM AUTHOR]

Background: Antibiotic-associated diarrhea (AAD) represents a significant burden in pediatric healthcare, with probiotics posited as a potential mitigative strategy. This study aimed to evaluate the efficacy and safety of probiotic supplementation in reducing the incidence, severity, and duration of AAD among pediatric patients. Methods: In a double-blind, randomized, placebo-controlled trial, 214 pediatric patients receiving antibiotics were allocated to receive either probiotic supplementation or a placebo. The primary outcome was the incidence of AAD. Secondary outcomes included the severity and duration of diarrhea episodes, analyzed using appropriate statistical tests. Results: The probiotic group exhibited a significantly lower incidence of AAD (14% vs. 30%, p<0.01). Additionally, the severity (median severity score: 2 [IQR 1-3] vs. 3 [IQR 2-4], p=0.02) and duration (median duration: 2 days [IQR 1-3] vs. 4 days [IQR 3-5], p<0.01) of diarrhea were significantly reduced in the probiotic group compared to the placebo. Subgroup analysis indicated a pronounced benefit in children aged 1-5 years and those treated with penicillin. No significant difference in adverse events was observed between the groups. Conclusion: Probiotic supplementation is effective and safe in reducing the incidence, severity, and duration of AAD in pediatric patients, particularly among younger children and those on penicillin therapy. These findings support the adjunctive use of probiotics in pediatric antibiotic regimens. [ABSTRACT FROM AUTHOR]

Swine flu, caused by the H1N1 influenza virus, is a subtype of influenza A that affects both the upper and lower respiratory tracts. It is primarily found in pigs and can be transmitted to humans through genetic variations in the virus. The 1918 Spanish flu pandemic resulted in the deaths of 50 to 100 million individuals. In 2009, the pandemic affected 178 countries, resulting in an estimated 43 to 89 million cases and 1799 deaths. The pathophysiology of H1N1 involves inflammation of the respiratory tract, with an incubation period of 1 to 4 days and a contagious period lasting 5 to 7 days. The signs and symptoms of swine flu include cough, sore throat, fever, myalgia, congestion, headache, rhinorrhoea, dizziness, sneezing, loss of appetite, fatigue, abdominal pain, shortness of breath, and in rare cases, vomiting and diarrhoea. The most common cause of death is respiratory failure, and neurological symptoms can occur due to high fever. To diagnose swine flu, various tests such as haematological, biochemical, and microbiological tests are conducted, including the collection of nasal or oral swabs for reverse transcriptase polymerase chain reaction (RT-PCR). Prevention and control measures include managing swine flu in pigs through herd management, hygiene practices, and vaccination. Treatment options vary based on the severity of the case. Mild to moderate cases can be managed with rest, antipyretics, NSAIDs, antihistamines, and oral rehydration therapy. Severe cases may require intravenous hydration, antibiotics for bacterial infections, antiviral therapy, and respiratory support. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy and safety of the 5-fluorouracil (5-FU), cisplatin, and vincristine (FPV) chemotherapy regimen in patients with gestational trophoblastic neoplasia (GTN). Methods: We performed a retrospective study of 96 GTN patients with International Federation of Gynecology and Obstetrics (FIGO) scores of 5 or greater in the Second Affiliated Hospital of Zhengzhou University from October 2013 to October 2019, including 54 patients who received FPV chemotherapy and 42 who received 5-FU/actinomycin D/vincristine (FAV) chemotherapy. A pulsed intravenous device was used to administer 5-FU. The clinical characteristics, adverse events, and response rates were compared between the groups. Results: The patients in the FPV and FAV groups received a total of 228 and 190 courses of chemotherapy, respectively. Complete response (CR) was found in 88.89% (48/54) and 90.48% (38/42) of patients in the FPV group and FAV group, respectively (p = 0.801). Both chemotherapy regimens yielded CR in all low-risk patients (100% vs. 100%), whereas 86.67% and 88.24% of high-risk patients achieved CR (FPV vs. FAV, p = 0.836), respectively. The most common adverse events (AEs) were myelosuppression and gastrointestinal reactions including neutropenia (83.97%), anemia (60.05%), and nausea (46.41%). In comparison to those in the FAV group, patients in the FPV group reported higher rates of grade 1/2 nausea (53.51% vs. 37.89%, p = 0.001), hepatotoxicity (28.95% vs. 17.89%, p = 0.008), oral mucositis (23.25% vs. 10.53%, p = 0.001), and grade 3/4 neutropenia (47.37% vs. 27.37%, p < 0.001), while grade 1/2 diarrhea (7.46% vs. 13.68%, p = 0.037) and grade 3/4 oral mucositis (0 vs. 6.32%, p < 0.001) were much more common in the FAV group. The rate of overall survival at 5 years was 96.8% in the FPV group and 97.3% in the FAV group (p = 0.760), whereas the 5-year disease-free survival rates were 95.9% and 93.9% (p = 0.754), respectively. Conclusion: The FPV and FAV regimens with pulsed intravenous 5-FU yielded comparable CR rates and tolerability in patients with GTN with FIGO scores of >5. Further randomized controlled trials are warranted to validate their efficacy. [ABSTRACT FROM AUTHOR]

Key Points: Question: What is the effect on glycemic control of adding once-weekly tirzepatide vs thrice-daily prandial insulin lispro to insulin glargine treatment in inadequately controlled basal insulin–treated type 2 diabetes? Findings: In this randomized clinical trial (N = 1428), mean change in hemoglobin A1c (HbA1c) at week 52 was −2.1% with tirzepatide vs −1.1% with insulin lispro; treatment differences were statistically significant with less hypoglycemia and more body weight reduction with tirzepatide. Meaning: Adding once-weekly tirzepatide vs prandial insulin lispro to insulin glargine in basal insulin-treated patients with type 2 diabetes and inadequate glycemic control resulted in greater reductions in HbA1c along with more weight loss and less hypoglycemia. Importance: Tirzepatide is a glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist used for the treatment of type 2 diabetes. Efficacy and safety of adding tirzepatide vs prandial insulin to treatment in patients with inadequate glycemic control with basal insulin have not been described. Objective: To assess the efficacy and safety of tirzepatide vs insulin lispro as an adjunctive therapy to insulin glargine. Design, Setting, and Participants: This open-label, phase 3b clinical trial was conducted at 135 sites in 15 countries (participants enrolled from October 19, 2020, to November 1, 2022) in 1428 adults with type 2 diabetes taking basal insulin. Interventions: Participants were randomized (in a 1:1:1:3 ratio) to receive once-weekly subcutaneous injections of tirzepatide (5 mg [n = 243], 10 mg [n = 238], or 15 mg [n = 236]) or prandial thrice-daily insulin lispro (n = 708). Main Outcomes and Measures: Outcomes included noninferiority of tirzepatide (pooled cohort) vs insulin lispro, both in addition to insulin glargine, in HbA1c change from baseline at week 52 (noninferiority margin, 0.3%). Key secondary end points included change in body weight and percentage of participants achieving hemoglobin A1c (HbA1c) target of less than 7.0%. Results: Among 1428 randomized participants (824 [57.7%] women; mean [SD] age, 58.8 [9.7] years; mean [SD] HbA1c, 8.8% [1.0%]), 1304 (91.3%) completed the trial. At week 52, estimated mean change from baseline in HbA1c with tirzepatide (pooled cohort) was −2.1% vs −1.1% with insulin lispro, resulting in mean HbA1c levels of 6.7% vs 7.7% (estimated treatment difference, −0.98% [95% CI, −1.17% to −0.79%]; P <.001); results met noninferiority criteria and statistical superiority was achieved. Estimated mean change from baseline in body weight was −9.0 kg with tirzepatide and 3.2 kg with insulin lispro (estimated treatment difference, −12.2 kg [95% CI, −13.4 to −10.9]). The percentage of participants reaching HbA1c less than 7.0% was 68% (483 of 716) with tirzepatide and 36% (256 of 708) with insulin lispro (odds ratio, 4.2 [95% CI, 3.2-5.5]). The most common adverse events with tirzepatide were mild to moderate gastrointestinal symptoms (nausea: 14%-26%; diarrhea: 11%-15%; vomiting: 5%-13%). Hypoglycemia event rates (blood glucose level <54 mg/dL or severe hypoglycemia) were 0.4 events per patient-year with tirzepatide (pooled) and 4.4 events per patient-year with insulin lispro. Conclusions and Relevance: In people with inadequately controlled type 2 diabetes treated with basal insulin, weekly tirzepatide compared with prandial insulin as an additional treatment with insulin glargine demonstrated reductions in HbA1c and body weight with less hypoglycemia. Trial Registration: ClinicalTrials.gov Identifier: NCT04537923 This study examines the efficacy and safety of tirzepatide vs insulin lispro adjunctive therapy to insulin glargine among those receiving basal insulin with inadequately controlled type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background and objectives: To evaluate mothers of children under the age of five regarding knowledge, attitudes, and practices of acute diarrhoea, ORT, and zinc. To inform mothers about the usage of zinc, ORS, and other rehydration fluids. To encourage mothers to adopt new behaviours and attitudes towards the use of zinc and oral rehydration therapy in order to reduce morbidity and death associated with diarrhoea. Method: Children aged 6 months to 60 months of both sexes with acute diarrheal disease were the subjects of a prospective study undertaken by the Department of Paediatrics, Mallareddy Medical College for Women, Hyderabad, Telangana, India between November 2021 and January 2023. Result: Oral rehydration salts (ORS), which replenish fluid and electrolytes, was unclear to 70.2% of mothers. Only 18 out of 111 parents were able to prepare ORS, 30 were able to recognise dehydration symptoms, and 78 could suggest a substitute for ORS. After diarrhoea, 72.9% of mothers administered their children ORS. ORS was given by 51.3% of mothers the same day, 18.9% the following day, and 4.7% didn't. 72 percent of mothers thought ORS could be administered for a single day, 2.7% for two days, 2.7% indefinitely, and 24.3% weren't sure. 72.9 percent of lavatory users were clean. Conclusion: Breastfeeding, sufficient nutrition, and particular attention during diarrhoea help children recover. Long-term, consistent message through the correct channels to promote excellent hygiene practices works best. Eliminating barriers to mothers providing their children ORS, other rehydration fluids and zinc can help children develop and flourish. Clinicians' activities affect mothers' learning and performance. This is one reason they trust antibiotic diarrhoea treatment. Thus, general practitioners, allied specialists, medical students, paediatric, internal, and infectious residents should be retrained. [ABSTRACT FROM AUTHOR]

Pediatric growth faltering (GF), previously known as failure to thrive and now also called pediatric malnutrition and weight faltering, is a common clinical finding in primary care. Most pediatric GF cases are caused by inadequate caloric intake, not organic disease states. Evaluation requires clinicians to obtain detailed nutritional, medical, psychosocial, and family histories; take accurate anthropometric measurements; and perform a careful physical examination. Evaluation findings should be analyzed to determine whether targeted diagnostic workup, specialty referral, or a trial of nutritional counseling is indicated. Management includes caregiver education about childhood nutrition and frequent monitoring of growth parameters. A multidisciplinary approach that includes nutritionist, developmental therapist, and other specialty team member involvement is desirable. [ABSTRACT FROM AUTHOR]

Abstract Background Cesarean section often requires an urgent transfusion load due to decreased blood pressure after spinal anesthesia. This prospective randomized study aimed to investigate whether a preoperative oral rehydration solution (ORS) stabilized perioperative circulatory dynamics. Methods Sixty-three parturients scheduled for cesarean section under combined spinal epidural anesthesia (CSEA) were randomly allocated to one of three groups: Group O received 500 mL ORS before bedtime and 500 mL 2 h before CSEA; Group M received mineral water instead of ORS; and Group C had no fluid intake (controls). After entering the operating room, stomach size was measured using ultrasound. Blood samples were obtained, and CSEA was induced. Vasopressors were administered when systolic blood pressure was 20%. As a vasopressor, phenylephrine (0.1 mg) was administered at ≥ 60 beats/min heart rate or ephedrine (5 mg) at

Background: Type I Diabetes Mellitus is the most common endocrine-metabolic disorder of childhood and adolescent. Diabetic ketoacidosis is a potentially life-threatening complication among children, characterized by triad of hyperglycemia, ketosis and academia, accounting for majority of hospital admissions and deaths related to Diabetes in children. Early diagnosis and prompt management substantially reduces the mortality. Objectives: This study was done to evaluate clinical profile, severity, complications and immediate outcome of patients admitted in PICU with Diabetic Ketoacidosis. Results: Out of 30 children included in our study, 70% were females(n21) and 30% were males(n9). Newly diagnosed diabetics accounted for 17 (56.5%) of the patients. The common presenting complaints of DKA in our study was altered sensorium (100%), rapid breathing (93%), vomiting (80%) and abdominal pain (73%) followed by polyuria (63%), polydipsia (60%), weight loss (50%) and fever (40%). Amongst all 30 cases, 20 patients (66%)had moderate dehydration meanwhile 10(33.3%) had severe dehydration. Complications like Hypokalaemia (20%), other electrolyte imbalance (16%) like hypocalcaemia, hyponatremia, superadded infection (26%) like upper and lower respiratory tract infection, acute febrile illnesses were commonly encountered in our study and 11(36%) cases of DKA were not associated with any complications. Out of 30, 5 (16%) children had mild DKA, 13(43%) children had moderate DKA and 12 (40%) children have severe DKA. In our study, all patients recovered and were shifted to ward with mortality of 0%. Conclusion: DKA was most prevalent in newly diagnosed IDDM cases. Infections was the most common precipitating factor. No lethal complications were recorded in our study. [ABSTRACT FROM AUTHOR]

Hyperemesis gravidarum occurs in up to 2 % of pregnancies. It is customary to regard the condition as purely an obstetric issue. However, there are reasonable grounds for reframing it as a neuropsychiatric state dependent upon genetic factors and involving peptides active within the central nervous system. Neurological abnormalities can also arise due to Wernicke's encephalopathy and the electrolyte abnormalities of refeeding syndrome. Aside from rehydration and antiemetic drugs, the condition can respond well to certain psychotropic medications and to psychological interventions, it may therefore be reasonable to regard hyperemesis of pregnancy as requiring both psychiatric and medical expertise for comprehensive management. [ABSTRACT FROM AUTHOR]

Background No licensed human vaccines are available against enterotoxigenic Escherichia coli (ETEC), a major diarrhoeal pathogen affecting children in low- and middle-income countries and foreign travellers alike. ETVAX®, a multivalent oral whole-cell vaccine containing four inactivated ETEC strains and the heat-labile enterotoxin B subunit (LTB), has proved promising in Phase 1 and Phase 1/ 2 studies. Methods We conducted a Phase 2b double-blinded, randomized, placebo-controlled trial amongst Finnish travellers to Benin, West Africa. This report presents study design and safety and immunogenicity data. Volunteers aged 18–65 years were randomized 1:1 to receive ETVAX® or placebo. They visited Benin for 12 days, provided stool and blood samples and completed adverse event (AE) forms. IgA and IgG antibodies to LTB and O78 lipopolysaccharide (LPS) were measured by electrochemiluminescence. Results The AEs did not differ significantly between vaccine (n  = 374) and placebo (n  = 375) recipients. Of the solicited AEs, loose stools/diarrhoea (26.7/25.9%) and stomach ache (23.0/20.0%) were reported most commonly. Of all possibly/probably vaccine-related AEs, the most frequent were gastrointestinal symptoms (54.0/48.8%) and nervous system disorders (20.3/25.1%). Serious AEs were recorded for 4.3/5.6%, all unlikely to be vaccine related. Amongst the ETVAX® recipients, LTB-specific IgA antibodies increased 22-fold. For the 370/372 vaccine/placebo recipients, the frequency of ≥2-fold increases against LTB was 81/2.4%, and against O78 LPS 69/2.7%. The majority of ETVAX® recipients (93%) responded to either LTB or O78. Conclusions This Phase 2b trial is the largest on ETVAX® undertaken amongst travellers to date. ETVAX® showed an excellent safety profile and proved strongly immunogenic, which encourages the further development of this vaccine. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To conduct an in‐depth exploration of oral hydration care provided to people living with dementia in acute hospital wards, using a person‐centred care framework. Background: Oral hydration care is an important, yet rarely explored aspect of fundamental care for people with dementia admitted to acute hospitals. Using person‐centred care as a conceptual framework we investigated how oral hydration care is delivered for people living with dementia in acute hospital wards. Design: A qualitative, multiple‐case study. The cases were three acute wards in one hospital. Methods: Direct observation of care for 13 people with dementia (132 h), semistructured interviews with ward staff (n = 28), ward leaders (n = 4), organisational leaders (n = 5), people with dementia (n = 6), their relatives (n = 5), documentary analysis of clinical inpatient records (n = 26) and relevant hospital policies. Data were analysed using framework analysis. Results: Four themes were identified: (1) The acute hospital: oral hydration is obscured and not prioritised (2) Overshadowing of oral hydration at ward level (3) Siloed nature of hydration roles (4) Strategies for, and barriers to, delivering person‐centred oral hydration care. Conclusions: This study combines the concept of person‐centred care and oral hydration care for people living with dementia admitted to acute hospital wards, demonstrating that person‐centred hydration care was complex and not prioritised. Relevance to Clinical Practice: Nurses should consider means of improving prioritisation and cohesive delivery of person‐centred hydration care in acute hospital wards. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the beneficial effect of racecadotril in children with acute diarrheal illness. Methods: This randomized case-control study was conducted at Watim General Hospital over four months from April to July 2023. A total of 120 children aged 3 months to 12 years with acute diarrhoea were included and randomly allocated to two groups. Group A (n=60) received standard treatment with oral rehydration therapy, while Group B (n=60) received oral rehydration therapy, zinc, probiotics, and racecadotril. The primary outcome measured was the mean duration of illness, and the secondary outcome was the number of stools 48 hours after the start of treatment. Data were collected using a pre-designed proforma and analyzed using SPSS version 24. Results: The study population had an average age of 50.35±41.52 months, with equal gender distribution. The mean duration of illness in Group A was 2.72±1.34 days, while in Group B, it was 2.70±1.29 days. There was no statistically significant difference in the mean duration of illness between the two groups (p=0.945). Conclusion: This study did not demonstrate a significant reduction in the mean duration of illness for children with acute gastroenteritis using standard treatment with or without racecadotril. Further investigations and large-scale studies may be needed to establish the efficacy of racecadotril in the management of acute diarrhoea in children. [ABSTRACT FROM AUTHOR]

Objective: Preoperative oral rehydration solution (ORS) supplementation offers wide postoperative benefits, but its role in reducing post-spinal myocardial ischaemia is uncertain. We evaluated this aspect in elective lower limb orthopaedic surgeries and compared it to conventional preoperative fasting. Methods: Prospectively, we randomised 126 patients aged >60 years into two groups: (A) received reconstituted ORS (1000 mL) during the overnight preoperative fasting, continued up to 2 hrs prior to spinal anaesthesia (SA) induction; (B) kept on conventional overnight preoperative fasting. This study evaluated electrocardiographic ischaemic changes at 2, 5, 10, 15, and 30 minutes after SA induction. Results: In total, 27 patients (group A: 7; group B: 20) developed transient electrocardiographic ischaemic changes. On intergroup comparison, group B had a significantly higher incidence at all time points, with highest statistical levels at 5- and 10-minutes (P < 0.001). The receiver operating characteristic curve at a threshold fasting duration (fluids) of >3 hours, had an area-under-curve of 0.74 to predict such changes within 30 minutes of SA induction (sensitivity 96.30%, specificity 55.56%, accuracy 64.29%, odds ratio 32.50, relative risk 20.80, P < 0.001). Post-spinal hemodynamic changes were higher in group B than in A; hypotension and tachycardia were statistically significant (P=0.020). The pleth variability index was significantly higher (P < 0.001), while perfusion index was significantly lower (P < 0.001) in group B at all time points. Conclusion: Preoperative ORS supplementation significantly reduced post-spinal transient ischaemic electrocardiographic changes in elderly patients than conventional overnight fasting. [ABSTRACT FROM AUTHOR]

Rotavirus is one of the main pathogens that causes severe diarrhea in children under the age of 5, primarily infecting the enterocytes of the small intestine. Currently, there are no specific drugs available for oral rehydration and antiviral therapy targeting rotavirus. However, metformin hydrochloride, a drug known for its antiviral properties, shows promise as it accumulates in the small intestine and modulates the intestinal microbiota. Therefore, we formulated a hypothesis that metformin hydrochloride could inhibit rotavirus replication in the intestine. To validate the anti-rotavirus effect of metformin hydrochloride, we conducted infection experiments using different models, ranging from in vitro cells and organoids to small intestines in vivo. The findings indicate that a concentration of 0.5 mM metformin hydrochloride significantly inhibits the expression of rotavirus mRNA and protein in Caco-2 cells, small intestinal organoids, and suckling mice models. Rotavirus infections lead to noticeable pathological changes, but treatment with metformin has been observed to mitigate the lesions caused by rotavirus infection in the treated group. Our study establishes that metformin hydrochloride can inhibit rotavirus replication, while also affirming the reliability of organoids as a virus model for in vitro research. [ABSTRACT FROM AUTHOR]

Background: Cesarean section often requires an urgent transfusion load due to decreased blood pressure after spinal anesthesia. This prospective randomized study aimed to investigate whether a preoperative oral rehydration solution (ORS) stabilized perioperative circulatory dynamics. Methods: Sixty-three parturients scheduled for cesarean section under combined spinal epidural anesthesia (CSEA) were randomly allocated to one of three groups: Group O received 500 mL ORS before bedtime and 500 mL 2 h before CSEA; Group M received mineral water instead of ORS; and Group C had no fluid intake (controls). After entering the operating room, stomach size was measured using ultrasound. Blood samples were obtained, and CSEA was induced. Vasopressors were administered when systolic blood pressure was < 90 mmHg or decreased by > 20%. As a vasopressor, phenylephrine (0.1 mg) was administered at ≥ 60 beats/min heart rate or ephedrine (5 mg) at < 60 beats/min heart rate. The primary outcome was the total number of vasopressor boluses administered. Secondary outcomes were the cross-sectional area of the stomach antrum, maternal plasma glucose levels, serum sodium levels, total intravenous fluid, bleeding volume, urine volume, operative time, and cord blood gas values after delivery. Results: The total number of vasopressor boluses was lower in Group O than in Group C (P < 0.05). Group O had lower total dose of phenylephrine than Group C (P < 0.05). There were no significant differences between Group M and other groups. No differences were detected regarding secondary outcomes. Conclusions: In women scheduled for cesarean section, preoperative ORS stabilized perioperative circulatory dynamics. Neither ORS nor mineral water consumption increased the stomach content volume. Trial Registration: This trial is registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000019825: Date of registration 17/11/2015). [ABSTRACT FROM AUTHOR]

Background: Twenty percent of colorectal cancer liver metastases (CLMs) are initially resectable with a 5-year survival rate of 25%-40%. Perioperative folinic acid, 5-fluorouracil, oxaliplatin (FOLFOX) increases progression-free survival (PFS). In advanced disease, the addition of targeting therapies results in an overall survival (OS) advantage. The aim of this study was to evaluate panitumumab and FOLFIRI as perioperative therapy in resectable CLM. Methods: Patients with previously untreated, wild-type Rat sarcoma virus (RAS), and resectable CLM were included. Preoperative four and postoperative eight cycles of panitumumab and folinic acid, 5-fluorouracil, irinotecan (FOLFIRI) were administered. Primary objectives were efficacy and safety. Secondary endpoints included PFS and OS. Results: We enrolled 36 patients in seven centers in Austria (intention-to-treat analyses, 35 patients). There were 28 men and seven women, and the median age was 66 years. About 91.4% completed preoperative therapy and 82.9% underwent liver resection. The R0 resection rate was 82.7%. Twenty patients started and 12 patients completed postoperative chemotherapy. The objective radiological response rate after preoperative therapy was 65.7%. About 20% and 5.7% of patients had stable disease and progressive disease, respectively. The most common grade 3 adverse events were diarrhea, rash, and leukopenia during preoperative therapy. One patient died because of sepsis, and one had a pulmonary embolism grade 4. After surgery, two patients died because of hepatic failure. Most common grade 3 adverse events during postoperative therapy were skin toxicities/rash and leukopenia/neutropenia, and the two grade 4 adverse events were stroke and intestinal obstruction. Median PFS was 13.2 months. The OS rate at 12 and 24monthswere 85.6% and 73.3%, respectively. Conclusions: Panitumumab and FOLFIRI as perioperative therapy for resectable CLM result in a radiological objective response rate in 65.7% of patients with a manageable grade 3 diarrhea rate of 14.3%. Median PFS was 13.2 months, and the 24-month OS rate was 73.3%. These data are insufficient to widen the indication of panitumumab from the unresectable setting to the setting of resectable CLM. [ABSTRACT FROM AUTHOR]

Background: The incidence of irinotecan-induced diarrhea varies between 60-90%, by which the incidence of severe diarrhea is 20-40%. The objective of this phase III trial was to determine the effectiveness of the probiotic mixture containing Bifidobacterium, BB-12® and Lactobacillus rhamnosus, LGG® in the prophylaxis of irinotecan-induced diarrhea in metastatic colorectal cancer patients due to a reduction in the activity of intestinal beta-D-glucuronidase. Methods: From March 2016 to May 2022, a total of 242 patients with colorectal cancer starting a new line of irinotecan-based therapy were registered to the study in 11 cancer centers in Slovakia. Patients were randomized in a ratio 1:1 to probiotic formula vs. placebo that was administered for 6 weeks. Each capsule of Probio-Tec® BG-Vcap-6.5 contained 2.7x109 colony-forming units (CFU) of 2 lyophilized probiotic strains Bifidobacterium, BB-12® (50%) and Lactobacillus rhamnosus GG, LGG® (50%). Results: Administration of probiotics compared to placebo was not associated with a significant reduction of grade 3/4 diarrhea (placebo arm 11.8% vs. probiotic arm 7.9%, p=0.38). Neither the overall incidence of diarrhea (46.2% vs. 41.2%, p=0.51) nor the incidence of enterocolitis (3.4% vs. 0.9%, p=0.37) was different in the placebo vs. probiotic arm. Subgroup analysis revealed that patients with colostomy had higher incidence of any diarrhea and grade 3/4 diarrhea in the placebo arm compared to the probiotic arm (48.5% vs. 22.2%, p=0.06 and 15.2% vs. 0%, p=0.06, respectively). Moreover, patients on probiotic arm had significantly better diarrhea-free survival (HR = 0.41, 95%CI 0.18 - 0.95, p=0.05) and needed less loperamide (p=0.01) compared to patients on placebo arm. We did not observe any infection caused by probiotic strains used in this study. Conclusion: This study failed to achieve its primary endpoint, and results suggest a lack of benefit of administered probiotic formula for the prevention of irinotecan-induced diarrhea. However, subgroup analysis suggests a possible benefit in patients with colostomy. [ABSTRACT FROM AUTHOR]

A well-accepted strategy to prevent kidney stones is to increase urine volume by increasing oral intake of fluids, especially water, to lower supersaturation of the relevant, relatively insoluble salts, and thereby lower the risk of precipitation. Randomized controlled trials have shown that this strategy works. It is inexpensive, safe, and intuitively attractive to patients. However, although any beverage can increase urine volume, and citrus juices can increase urine citrate content and pH, no beverage other than water has been clearly shown by randomized controlled trial to prevent kidney stones. We designed an innovative, palatable, low-calorie, high alkali citrate beverage to prevent kidney stones, called Moonstone. One packet of Moonstone powder, mixed in 500 ml of water, contains 24.5 meq of alkali citrate. We administered one packet twice a day to ten calcium stone formers. Moonstone resulted in an increase in mean 24-h urine citrate and urine pH, and a decrease in supersaturation of calcium oxalate in calcium stone formers compared to an equal volume of water. These changes, comparable to those seen in a prior study of a similar amount of (potassium–magnesium) citrate, will likely be associated with a clinically meaningful reduction in kidney stone burden in patients with calcium stones. The effect to increase urine pH would also be expected to benefit patients with uric acid and cystine stones, groups that we hope to study in a subsequent study. The study preparation was well tolerated and was selected as a preferred preventative strategy by about half the participants. Moonstone is an alternative, over-the-counter therapy for kidney stone prevention. [ABSTRACT FROM AUTHOR]

Background: Infectious diarrhea is endemic in many parts of the world. It is generally mixed in etiology involving viruses, bacteria, and parasites. Antibiotics belonging to fluoroquinolones class are most commonly used but are beneficial only in certain types of acute diarrhea with side effects like tendinopathy, arthropathy, neuropathy, arrhythmia, hypoglycemia, and hyperglycemia. Rifaximin with its unique mechanism, along with established metronidazole is proposed as a treatment option for acute diarrhea caused due to mixed gastrointestinal infections. This study aims to evaluate the efficacy and tolerability of a fixed-dose combination of rifaximin and metronidazole in the empirical management of acute diarrhea. Method: An open-label, non-comparative, non-randomized, multicenter trial was conducted on 238 patients presenting with acute diarrheal episodes involving various etiologies. Since this is an observational study and was conducted post-approval of the drug by the state FDA; informed consent and ethics approval was not mandatory. Patients were given fixed dose combination tablet containing rifaximin 200 mg and metronidazole 400 mg twice a day for 5 days. Primary outcomes were a change from baseline in the number of soft or watery stools, fever, nausea, vomiting, abdominal pain, and gas/flatus at day 5. Results: In the final analysis, 150 patients were included, as 88 patients were lost to follow-up. After 5 days of therapy, the mean number of watery stools per day was reduced from 7.133 ± 2.055 to 0.733 ± 0.833 (p < 0.0001). Side effects complaints such as gastritis (5.33%), nausea (10.66%), and metallic taste (3.33%) were reported. Conclusion: A combination of rifaximin and metronidazole significantly reduces the number of watery stools and associated symptoms and is a clinically effective and safe option in the empirical management of acute diarrhea of various etiologies. [ABSTRACT FROM AUTHOR]