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This study aims to determine the effectiveness of clinical pathway implementation in pediatric patients with acute diarrhea with mild-moderate dehydration on clinical outcomes, length of stay, use of quality and quantity of antibiotics at North Jakarta Teaching Hospital. This study is a quantitative study using a retrospective cohort case study method. The samples in this study were pediatric patients with a diagnosis of acute diarrhea with mild-moderate dehydration who were hospitalized at the North Jakarta Teaching Hospital for the period January-December 2020 and January-December 2021 before and after the implementation of the clinical pathway, totaling 274 patients. The data used is secondary data in the form of medical records of pediatric patients with acute diarrhea with mild-moderate dehydration who were hospitalized at the North Jakarta Teaching Hospital. The data that has been collected is then processed and analyzed using the chi-square test. The results showed Qualitative use of antibiotics with the Gyssens method after the application of clinical pathway is better than before the application of clinical pathway. Quantitative antibiotic administration with the DDD method in pediatric patients with acute diarrhea with dehydration before and after the application of clinical pathway the highest was ceftriaxone antibiotics after the application of clinical pathway with DDD/100 patient-days value increased compared to before clinical pathway. [ABSTRACT FROM AUTHOR]

Travelers’ diarrhea has a high incidence rate among deployed US military personnel and can hinder operational readiness. The Global Travelers’ Diarrhea study is a US Department of Defense­–funded multisite surveillance effort to investigate the etiology and epidemiology of travelers’ diarrhea. During 2018–2023, we enrolled 512 participants at partner institutions in 6 countries: Djibouti, Georgia, Egypt, Honduras, Nepal, and Peru. Harmonized laboratory methods conducted at each partner institution identified >1 pathogens, including Escherichia coli (67%–82%), norovirus (4%–29%), and Campylobacter jejuni (2%–20%), in 403 (79%) cases. Among cases, 79.7% were single infections, 19.6% were double infections, and 0.7% were triple infections. The most common enterotoxigenic E. coli colonization factors identified were CS3 (25%) and CS21 (25%), followed by CS2 (18%) and CS6 (15%). These data can inform best treatment practices for travelers’ diarrhea and support US military health readiness.

Background: Diarrhea is the first cause of death for children under five years of age worldwide. In Indonesia, diarrhea cases due to rotavirus infection tend to be detected throughout the year. Purpose: The study was to determine the epidemiology of diarrhea cases due to rotavirus infection of pediatric patients in Dr. Soetomo Hospital, Surabaya based on the variables of person, place, and time. Methods: This type of research uses both descriptive and quantitative methods. The samples used were cases of rotavirus infection in toddlers in Dr. Soetomo Hospital, Surabaya in 2015–2019. Results: From 2015 to 2019, there were about 110 cases (31.98%) of acute diarrhea caused by rotavirus infection at Dr. Soetomo Hospital, Surabaya. The findings revealed that the majority of rotavirus infections (42.73%) occurred in children aged 6-11 months followed 12-23 months (35.45%) and were male (56.36%). The highest cumulative incidence was observed in August 2018 and February 2029, with a value of 1,0. Rotavirus infection was most common among children living in Gubeng sub-District, with 19 cases (17.27%). Conclusion: Epidemiological studies of rotavirus infection by person, place, and time reveal the distribution of disease cases and enable targeted interventions to respond to the disease.

Diarrhea continues to be a global health problem as acute diarrhea carries the risk of dehydration, while both acute and chronic diarrhea can significantly affect patients’ quality of life and reduce productivity. The innovative medical device Actitan, which consists of a complex of natural molecules, could be an effective option for the treatment of diarrhea from various causes. The aim of this post-market cross-sectional study was to evaluate the perceived efficacy, safety and usage pattern of the two formulations for adults (Actitan-P) and children (Actitan-F) among patients/child caregivers, physicians and pharmacists. Participants completed online questionnaires with closed multiple-choice questions that were rated on a verbal 5-point Likert scale. These surveys were conducted via the online platform Real World Data, which provides digital questionnaires for patients, doctors and pharmacists. Two separate surveys were conducted for the two formulations, with a total of 2630 participants (1488 participants for Actitan-P and 1142 participants for Actitan-F). Overall, the results indicate a high level of efficacy and safety of the product. In the case of Actitan-F, more than 96% of caregivers rated safety as good or excellent, and over 92% rated efficacy as good or excellent. Actitan-P also received positive feedback: nearly 86% of patients reported good/excellent efficacy, and more than 93% rated safety as good or excellent. These positive evaluations were confirmed by physicians and pharmacists, who also did not report adverse effects. In summary, this study confirms the role of Actitan as a safe and effective option for the treatment of diarrhea of different causes and in different patient groups, including young children.

Saeed Alfadly,1,2 Mohammed Anaam,1,3 Sulaiman Ibrahim Alzunaydi,1 Abdulsalam Sulaiman Almutlaq,1 Abdulaziz Mohammed Swidan,1 Saud Alsahali,1 Yasser Almogbel,1 Mohammed Alshammari,4 Mohammed Almunef,1 Khalid Siddeeg1 1Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Saudi Arabia; 2Pharmacy Department, College of Medicine and Health Sciences, Hadramout University, Hadramout, Yemen; 3Al-Rowaad Medical College, Sana’a, Yemen; 4Department of Pharmacy practice، College of Pharmacy, University of Hafr Albatin, Hafr Albatin, Saudi ArabiaCorrespondence: Saud Alsahali, Email s.alsahali@qu.edu.saObjective: The study aimed to evaluate the knowledge and counseling skills of community pharmacy professionals regarding managing acute diarrhea in children in the Qassim region of Saudi Arabia.Methods: A cross-sectional study consisting of a questionnaire and simulated client scenario was conducted to collect data from pharmacy professionals working in community pharmacies over a period of 3 months in the Qassim region of Saudi Arabia. Pharmacy professionals were assessed for evaluating cases using 5 indicators (the age of the child, the frequency of diarrhea, fever and the presence of mucus or blood) and also for their recommendations and counseling.Results: The data were collected from 60 pharmacy professionals after site visits. In the questionnaire, 60% of the pharmacy professionals used all 5 indicators, while in the simulation, 13.3% used at least 3 indicators and 80% used 2 or fewer indicators (p = 0.35). An oral rehydration solution was recommended alone by 35% of the pharmacy professionals and with other drugs by 13.3% in the questionnaire, while in the simulation, an oral rehydration solution alone was recommended by 15% and other drugs by 48.3%. Approximately 86.7% of the pharmacy professionals did not give any dietary advice, and 50% did not counsel the simulated client on the recommended drug.Conclusion: The community pharmacy professionals in the study did not ask enough questions to evaluate a child suffering from acute diarrhea appropriately in the simulation. More questions were asked in the questionnaire; however, the difference is not significant. Additionally, they did not provide proper dietary advice, and their recommendation of an oral rehydration solution was insufficient.Keywords: acute diarrhea, fever: community pharmacy, actual practice, questionnaire: simulated client, knowledge

Background: Diarrhea is the first cause of death for children under five years of age worldwide. In Indonesia, diarrhea cases due to rotavirus infection tend to be detected throughout the year. Purpose: The study was to determine the epidemiology of diarrhea cases due to rotavirus infection of pediatric patients in Dr. Soetomo Hospital, Surabaya based on the variables of person, place, and time. Methods: This type of research uses both descriptive and quantitative methods. The samples used were cases of rotavirus infection in toddlers in Dr. Soetomo Hospital, Surabaya in 2015-2019. Results: From 2015 to 2019, there were about 110 cases (31.98%) of acute diarrhea caused by rotavirus infection at Dr. Soetomo Hospital, Surabaya. The findings revealed that the majority of rotavirus infections (42.73%) occurred in children aged 6-11 months followed 12-23 months (35.45%) and were male (56.36%). The highest cumulative incidence was observed in August 2018 and February 2029, with a value of 1,0. Rotavirus infection was most common among children living in Gubeng sub-District, with 19 cases (17.27%). Conclusion: Epidemiological studies of rotavirus infection by person, place, and time reveal the distribution of disease cases and enable targeted interventions to respond to the disease. [ABSTRACT FROM AUTHOR]

Acute diarrhea represents a major public health issue, and the management of adult patients admitted to the emergency department (ED) for this problem is still challenging. In a retrospective analysis on more than 20,000 patients visiting a tertiary ED for acute diarrhea and then being discharged home, we found that age > 65 years, onset of symptoms > 24 h since ED admission, refusal of hospitalization, and a history of chronic renal and liver diseases were independently associated with ED readmission for abdominal symptoms within 7 days. In the younger group, the presence of comorbidities significantly impacted on ED readmission, while fever and alteration of serum creatinine were the main determinants in the older group. Antibiotics were prescribed in about 25% of patients, although diarrhea etiology (viral or bacterial) was usually not available. According to international guidelines, fluoroquinolones were the most prescribed class, showing an inverse correlation to ED readmission. However, β-lactams and probiotics were also commonly prescribed; the latter were independently correlated to ED readmission in the elderly group. A comprehensive, guideline-based approach, including a detailed clinical history and laboratory and comorbidity assessment, should be encouraged to support physicians in the management of different age subgroups of adults admitted to the ED for acute diarrhea. [ABSTRACT FROM AUTHOR]

Diarrhea continues to be a global health problem as acute diarrhea carries the risk of dehydration, while both acute and chronic diarrhea can significantly affect patients' quality of life and reduce productivity. The innovative medical device Actitan, which consists of a complex of natural molecules, could be an effective option for the treatment of diarrhea from various causes. The aim of this post-market cross-sectional study was to evaluate the perceived efficacy, safety and usage pattern of the two formulations for adults (Actitan-P) and children (Actitan-F) among patients/child caregivers, physicians and pharmacists. Participants completed online questionnaires with closed multiple-choice questions that were rated on a verbal 5-point Likert scale. These surveys were conducted via the online platform Real World Data, which provides digital questionnaires for patients, doctors and pharmacists. Two separate surveys were conducted for the two formulations, with a total of 2630 participants (1488 participants for Actitan-P and 1142 participants for Actitan-F). Overall, the results indicate a high level of efficacy and safety of the product. In the case of Actitan-F, more than 96% of caregivers rated safety as good or excellent, and over 92% rated efficacy as good or excellent. Actitan-P also received positive feedback: nearly 86% of patients reported good/excellent efficacy, and more than 93% rated safety as good or excellent. These positive evaluations were confirmed by physicians and pharmacists, who also did not report adverse effects. In summary, this study confirms the role of Actitan as a safe and effective option for the treatment of diarrhea of different causes and in different patient groups, including young children. [ABSTRACT FROM AUTHOR]

This study aims to identify and understand the pathophysiology of amoebiasis, and evaluate the effectiveness of treatment of amoebiasis in children using metronidazole. The research method involved analysis of physical examination and laboratory results, as well as treatment with antibiotics and zinc tablets. The results showed that the administration of metronidazole as therapy for amoebiasis in a 13-month-old child who had white liquid diarrhea with mucus without blood, was effective in killing Entamoeba histolytica parasites. This conclusion suggests that metronidazole is an efficient and low-cost treatment for amoebiasis in children. The implication of this study is the importance of using metronidazole as standard therapy to treat amoebiasis in children, as well as the expansion of further research to better understand the pathophysiology and treatment of amoebiasis. [ABSTRACT FROM AUTHOR]

Introduction: Colostrum is uniquely rich in immunoglobulins, growth factors, antibacterial peptides, probiotics, prebiotics, and essential vitamins and minerals. Available as a supplement, BC is used to prevent gastrointestinal infections, boost immune support, and aid in managing chronic inflammation, autoimmune diseases, and even athletic recovery. Aim: The aim of this article is to assess the potential benefits of colostrum across various health areas, including gastrointestinal health, immune system support, respiratory diseases, dermatology, autoimmune conditions and the development of preterm infants. The article will also present a critical analysis of current scientific data and examine future research directions and therapeutic advancements. Review methods: This article is based on a comprehensive, non-systematic review of the scientific literature. A thorough search of the PubMed database was conducted, and 45 sources published up to 2024 were analyzed to ensure that the information presented is current and relevant. Abbreviated description of the state of knowledge: Analysis of the literature suggests that colostrum may provide passive protection, reduce inflammation and support gut integrity in preterm infants. Inflammatory bowel disease may benefit from colostrum, though results for IBS are mixed. It aids wound healing, has anti-aging effects, and shows potential in autoimmune disease management. It also boosts respiratory immunity and aids athletes' recovery and performance. Conclusions: Colostrum contains bioactive components like immunoglobulins, lactoferrin, and growth factors. While current studies highlight its benefits in enhancing immunity, supporting gut health, and managing inflammatory conditions, more comprehensive clinical trials are required to confirm its efficacy and safety across various populations and health conditions.

Background: Fournier’s gangrene (FG) is a rare necrotizing infection of the genital and perineal structures. It can be very fatal, especially when appropriate treatment is delayed. Clinical Description: A 17-month-old girl presented with acute diarrhea, fever, and perineal ulceration. The perineal ulcer started as reddish rashes on the 3rd day of diarrhea, which rapidly progressed to form a large ulcer the next day. She was critically ill and in heart failure at presentation. Management and Outcome: After stabilization, investigations and cultures were taken. She had hyponatremia, hypokalemia, and neutropenia. The wound swab and blood culture yielded Pseudomonas aeruginosa and coagulase-negative Staphylococcus aureus (methicillin resistant). She was treated with antibiotics, wound debridement and other supportive care. She recovered fully from her acute illness with complete healing of the ulcer. Conclusion: This case report brings to the fore the possibility that acute diarrhea in the presence of other predisposing factors may cause FG. Early recognition and prompt management by multidisciplinary team can result in successful outcomes.

Background Acute diarrhea is the most common gastrointestinal disease in children under five years of age with high morbidity and mortality risk. The use of lactose-free formula in the management of children with acute diarrhea was said to accelerate the diarrheal resolution time. Objective To determine the efficacy of lactose-free formula in managing acute diarrhea in pediatric patients by systematic review and meta-analysis. Methods A comprehensive literature search was conducted on PubMed, Proquest, Web of Science, and CINAHL Plus Database from November 1971 to July 11th, 2021. The study selection process was carried out under PRISMA 2020 guidelines based on several eligibility criteria. The quality of the included studies were further assessed using Modified Jadad Scores. Results Fifteen randomized controlled trials (RCTs) were included, involving a total of 1,390 children with acute diarrhea. Shorter recovery time (MD -0.21; 95%CI -0.50 to 0.08; P=0.16) was observed in patients receiving lactose-free formula than the control group. However, this finding was not statistically significant. The subgroup analysis showed that lactose-free formula significantly shortened the recovery time compared to oral rehydration solution (ORS) group (MD -0.70; 95%CI -0.98 to -0.41; P=0.00001). Furthermore, lactose-free formula also significantly reduced the amount of stool output (MD -0.61; 95%CI -0.86 to -0.36; P=0.00001) and the incidence of persistent diarrhea more than seven days (OR 0.22; 95%CI 0.10 to 0.51; P=0.0004) compared to the control group. Conclusion Lactose-free formula as dietary management for acute diarrhea in children can reduce stool output and the incidence of persistent diarrhea for more than seven days. It also may shorten the recovery time compared to the administration of ORS alone.

To analyze the epidemiological characteristics of group A rotavirus (RVA) diarrhea in Beijing between 2019 and 2022 and evaluate the effectiveness of the RV5 vaccine. Stool specimens were collected from patients with acute diarrhea, and RVA was detected and genotyped. The whole genome of RVA was sequenced by fragment amplification and Sanger sequencing. Phylogenetic trees were constructed using Bayesian and maximum likelihood methods. Descriptive epidemiological methods were used to analyze the characteristics of RVA diarrhea. Test‐negative design was used to evaluate the vaccine effectiveness (VE) of the RV5. Compared with 2011–2018, RVA‐positive rates in patients with acute diarrhea under 5 years of age and adults decreased significantly between 2019 and 2022, to 9.45% (249/634) and 3.66% (220/6016), respectively. The predominant genotype of RVA had changed from G9‐VIP[8]‐III between 2019 and 2021 to G8‐VP[8]‐III in 2022, and P[8] sequences from G8‐VP[8]‐III strains formed a new branch called P[8]‐IIIb. The complete genotype of G8‐VP[8]‐III was G8‐P[8]‐I2‐R2‐C2‐M2‐A2‐N2‐T2‐E2‐H2. The VE of 3 doses of RV5 was 90.4% (95% CI: 28.8%–98.7%) against RVA diarrhea. The prevalence of RVA decreased in Beijing between 2019 and 2022, and the predominant genotype changed to G8P[8], which may be related to RV5 vaccination. Continuous surveillance is necessary to evaluate vaccine effectiveness and improve vaccine design. [ABSTRACT FROM AUTHOR]

Background Acute diarrhea is the most common gastrointestinal disease in children under five years of age with high morbidity and mortality risk. The use of lactose-free formula in the management of children with acute diarrhea was said to accelerate the diarrheal resolution time. Objective To determine the efficacy of lactose-free formula in managing acute diarrhea in pediatric patients by systematic review and meta-analysis. Methods A comprehensive literature search was conducted on PubMed, Proquest, Web of Science, and CINAHL Plus Database from November 1971 to July 11, 2021. The study selection process was carried out under PRISMA 2020 Guidelines based on several eligibility criteria. The quality of the included studies were further assessed using Modified Jadad Scores. Results Fifteen randomized controlled trials (RCTs) were included, involving a total of 1,390 children with acute diarrhea. Shorter recovery time (mean difference/MD -0.21; 95%CI -0.50 to 0.08; P=0.16) was observed in patients receiving lactose-free formula than the control group. However, this finding was not statistically significant. The subgroup analysis showed that lactosefree formula significantly shortened the recovery time compared to oral rehydration solution (ORS) group (MD -0.70; 95%CI -0.98 to -0.41; P=0.00001). Furthermore, lactose-free formula also significantly reduced the amount of stool output (MD -0.61; 95%CI -0.86 to -0.36; P=0.00001) and the incidence of persistent diarrhea more than seven days (OR 0.22; 95%CI 0.10 to 0.51; P=0.0004) compared to the control group. Conclusion Lactose-free formula as dietary management for acute diarrhea in children can reduce stool output and the incidence of persistent diarrhea for more than seven days. It also may shorten the recovery time compared to the administration of ORS alone. [ABSTRACT FROM AUTHOR]

Diarrheal diseases are of great concern worldwide and are responsible for considerable morbidity and mortality. This study investigated the epidemiology and the antibiotic susceptibility of bacterial enteropathogens among diarrheal patients of all ages in Crete, Greece during 2011-2022. Stool specimens were tested by conventional cultural methods for Salmonella, Shigella, Campylobacter, diarrheagenic Escherichia coli (EPEC, STEC), Yersinia enterocolitica, Aeromonas species and Clostridioides difficile. Antimicrobial susceptibility was determined by the disk diffusion method for Enterobacterales, Campylobacter and Aeromonas, and by the gradient diffusion method for C. difficile. Of the 26,060 stool samples from patients of any age, 1,022 (3.9%) were positive for bacterial enteropathogens. Campylobacter spp. were the most commonly isolated bacteria (56.4%), followed by Salmonella enterica (32.3%), and E. coli (EPEC, STEC) (6.5%). Toxigenic C. difficile was isolated from 341 out of 8,848 diarrheal specimens examined (3.9%). Resistance to ampicillin was observed in 12.4% of Salmonella, 66.7% of Shigella and 34.8% of E. coli (EPEC, STEC) isolates. Resistance to trimethoprim/sulfamethoxazole was observed in 5.8% of Salmonella, 33.3% of Shigella, and 15.1% of E. coli (EPEC, STEC) isolates. High rates of ciprofloxacin resistance (77.3%) were detected among Campylobacter isolates, while resistance to erythromycin was observed in 2.4% of them. All C. difficile isolates were susceptible to vancomycin and metronidazole. Our findings suggest declining trends in prevalence of bacterial enteropathogens, except for Campylobacter spp. and changes in the susceptibility rates to antimicrobials. Continuous surveillance of prevalence and antimicrobial susceptibility of bacterial enteropathogens is mandatory for implementing targeted and effective prevention and infection control measures. [ABSTRACT FROM AUTHOR]

The aims of this study were to determine the distribution and prevalence of gastroenteritis caused by human adenovirus (HAdV) in children in Yunnan province, China, in 2015–2021 and to identify preventive measures that can be taken to reduce morbidity and mortality in children.HAdV is a significant agent of diarrhea in children, but limited data are available regarding the epidemiology and genetic diversity of HAdV in children with diarrhea in Yunnan province, China. A total of 1754 fecal samples were subjected to real-time RT-PCR to detect and quantify HAdV. Positive samples were further analyzed using next-generation sequencing (NGS), and epidemiological data were analyzed as well.1754 patients with diarrhea were enrolled, of which 1041 were male and 713 were female (M:F ratio: 1.46). Seventy-two stool samples out of 1754 (4.10%) were positive for HAdV. The detection rates of all age groups varied from 2.50–4.78%. The highest incidence of HAdV was observed in children under 2 years of age, especially in children 12–24 months-old. From 2015–2021, the annual detection rate ranged from 1.62–12.26%. HAdV was detected throughout the year, but with marked seasonality. Children were most likely to be positive for HAdV in June and November. We detected HAdV in 15.53% (16/103) of samples collected in June and in 8.19% (14/171) of those collected in November. The entire viral genome was successfully sequenced for 13 of the 72 HAdV-positive samples, and 76.92% (10/13) of these were classified as genotype F41 and 23.08% (3/13) were classified as genotype C2.ConclusionsIn Yunnan province, children of all ages are susceptible to HAdV infection, but there has been marked variation in the yearly prevalence. The highest rate of HAdV detection was in June, followed by November. Priority should be given to disease prevention over the development of targeted antiviral therapies, and effective vaccines for preventing HAdV diarrhea are needed. It is also important to establish a surveillance system to collect relevant clinical and epidemiological data quickly in order to assess the potential risk of HAdV infection in children and to identify epidemic strains for the development of effective vaccines. [ABSTRACT FROM AUTHOR]

Background: Acute gastroenteritis continues to be a prevalent global health issue among children. The release of interleukin-6 (IL-6) and interleukin-8 (IL-8) from the gastrointestinal tract's epithelial cells is essential for protection against mucosal infections because it triggers the body's inflammatory reactions to infectious pathogens both locally and systemically. Objectives: To investigate serum levels of IL-6 and IL-8 in malnourished children with acute diarrhea. Patients and Methods: A case-control study that included three groups of 30 children each: children with severe acute malnutrition (SAM) and acute diarrhea (SAM-AD), well-nourished children with acute diarrhea (AD), and healthy controls (HC). Participants underwent clinical evaluation and routine laboratory investigations. Serum levels of IL-6 and IL-8 were measured within 72 hours of diarrheal onset using Luminex? Human Premixed Multi-Analyte kit. Results: Serum level of IL-6 in the SAM-AD group (median 1.0 [IQR 1-4.3] pg/ml) was comparable to the HC group (2.2 [1-4.6] pg/ml) but significantly lower than the AD group (12 [3.9-175.6] pg/ml). The SAM-AD group had significantly lower IL-8 levels (16.2 [11-39] pg/ml) than the AD (612 [84.8-800] pg/ml) and HC (157.5 [23.8-298.7] pg/ml) group. IL-6, IL-8, and CRP showed significantly strong correlation with one another (r > 0.67; p <0.001). The presence of fever was significantly associated with higher levels of IL-6, IL-8, and CRP. Conclusion Our study found significantly lower serum levels of IL-6, IL-8, and CRP in malnourished children with acute diarrhea compared to well-nourished children with acute diarrhea, which indicates that malnutrition may impede the acute phase inflammatory response during acute diarrhea. [ABSTRACT FROM AUTHOR]

Introduction: Diarrheal diseases are significant causes of under-five children mortality and morbidity in developing countries. This is particularly alarming among the community living in conflict zones where less attention is given for basic services including water, food, and health. However, there are no detailed investigations on acute diarrhea among under-five children in conflict-affected areas, which impedes intervention approaches. Therefore, this study was designed to assess the prevalence of acute diarrhea and associated factors among under-five children in conflict-affected setting of Raya Kobo, Northeast Ethiopia. Methods: A community-based cross-sectional study was employed among 463 under-five children in Raya Kobo district, from February to March 2021. The study participants were selected from ten rural kebeles. Pre-tested questionnaire and observational checklist were used to collect the data. Bivariate and multivariable logistic regression analyses were computed to identify factors associated with the prevalence of acute diarrhea. Results: The prevalence of acute diarrhea among under-five children was 21% (95% confidence interval (CI): 18.50–23.91%). Unimproved drinking water source (Adjusted odds ratio (AOR) = 2.89; 95%CI: 1.38–6.06), disposal of garbage in open field (AOR = 3.33; 95%CI:1.66–6.67), having low monthly income (AOR = 5.73; 95%CI: 3.07–10.59), absence of latrine facility (AOR = 3.18; 95%CI: 1.09–8.78), poor hand washing practice at critical times (AOR = 2.52; 95%CI:1.28–4.05), not regularly cleaning food utensil before child feeding (AOR = 2.54; 95%CI:1.31–4.94), and not received Rota vaccine (AOR = 4.28; 95%CI: 1.82–10.11) were the determinant factors. Conclusions: To reduce the burden of acute diarrheal diseases, post-war intervention approaches should emphasize on advocating for Rota virus vaccination, regularly cleaning food utensils before feeding, improving hand washing practice at critical times, provision of improved drinking water source, and use of proper solid and domestic sewage discharge/disposal methods.

Abstract Background Two types of rotavirus vaccines (RVs), Rotarix (RV1) and RotaTeq (RV5), were licensed as optional vaccines in 2012 and became part of the National Immunization Program (NIP) in the fiscal year 2020 in Thailand. The main objective was to evaluate the impact of rotavirus vaccines on the burden of acute diarrheal severity ranging from outpatient visits, diarrheal-related admission or deaths in the pre-NIP period (fiscal year 2015–2019) and in the fiscal year 2020. The minor objectives were assessed on the monthly admission rate, rotavirus vaccine coverage rate and rotavirus vaccine completed dose (RotaC). Methods Data regarding OPD, admission, and death cases under the Thailand National Health Coverage (NHC) from fiscal year 2015–2020, which were recorded as International Classification of Diseases and Related Health Problem 10th (ICD-10), were analyzed. Results The burden of diarrheal-related disease diminished after the rotavirus vaccine was introduced in the fiscal year 2020 when compared to the previous 5 fiscal years. The OPD visit rate decreased from 10.1 to 8.3 visits per 100 person-years (P

Acute diarrhea represents a major public health issue, and the management of adult patients admitted to the emergency department (ED) for this problem is still challenging. In a retrospective analysis on more than 20,000 patients visiting a tertiary ED for acute diarrhea and then being discharged home, we found that age > 65 years, onset of symptoms > 24 h since ED admission, refusal of hospitalization, and a history of chronic renal and liver diseases were independently associated with ED readmission for abdominal symptoms within 7 days. In the younger group, the presence of comorbidities significantly impacted on ED readmission, while fever and alteration of serum creatinine were the main determinants in the older group. Antibiotics were prescribed in about 25% of patients, although diarrhea etiology (viral or bacterial) was usually not available. According to international guidelines, fluoroquinolones were the most prescribed class, showing an inverse correlation to ED readmission. However, β-lactams and probiotics were also commonly prescribed; the latter were independently correlated to ED readmission in the elderly group. A comprehensive, guideline-based approach, including a detailed clinical history and laboratory and comorbidity assessment, should be encouraged to support physicians in the management of different age subgroups of adults admitted to the ED for acute diarrhea.

Qiulin Xiao,1,2 Bo Chen,1 Zhenya Zhu,1 Ting Yang,1 Enfu Tao,1 Chenmin Hu,1 Wei Zheng,3 Weihong Tang,2 Xiaoli Shu,1 Mizu Jiang1,3 1Gastrointestinal Laboratory, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, 310052, People’s Republic of China; 2Department of Gastroenterology, Hangzhou Children’s Hospital, Hangzhou, Zhejiang, 310014, People’s Republic of China; 3Department of Gastroenterology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, Zhejiang, 310052, People’s Republic of ChinaCorrespondence: Mizu Jiang, Department of Gastroenterology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, 3333 Bin Sheng Road, Hangzhou, Zhejiang, 310052, People’s Republic of China, Tel +86-571-87061007, Fax +86-571-86658672, Email mizu@zju.edu.cnObjective: To examine the association between the fecal microbiota of acute diarrhea in children and provide gut microbiota information related the acute diarrhea with rotavirus.Patients and Methods: Children with acute diarrhea aged 3– 60 months were selected for the study. Routine stool examination was performed, and stool samples were collected and stored at − 80 °C until further analysis. Fecal microbial DNA was extracted, and DNA concentration and quality were detected. PCR amplification and 16S rDNA high-throughput sequencing analysis using the Illumina MiSeq platform were performed, and intestinal flora was statistically analyzed.Results: Children with acute diarrhea exhibited gut microbial dysbiosis. Lower microbial diversity and richness were observed in the viral enteritis and bacterial enteritis groups than in the control group. Composition of the microbiota in acute diarrhea differed from that in the control group. The Bacteroidetes/Firmicutes dramatically decreased in the viral enteritis and bacterial enteritis groups. However, the relative abundance of Proteobacteria and Fusobacteria increased, especially in the bacterial enteritis group. In addition, the relative abundance of Actinobacteria had dramatically increased in the viral enteritis group. According to the Kyoto Encyclopedia of Genes and Genomes map analysis, the membrane transport dysfunction was caused by rotavirus infection, while the membrane transport dysfunction was more evident in bacterial infection.Conclusion: Acute diarrhea infections cause fecal microbiota dysbiosis in children. Changes in fecal microflora in children suggest that the regulation of intestinal flora in children with acute diarrhea should be strengthened.Keywords: acute diarrhea, microbiome, Fusobacteria, Firmicutes, Bacteroidetes, 16S rDNA sequencing, rotavirus

Abstract Background Acute diarrhea with fever can potentially represent a more severe form of the disease compared to non-febrile diarrhea. This study was to investigate the epidemiological characteristics and enteric pathogen composition of febrile-diarrheal patients, and to explore factors including pathogens associated with fever by age group. Methods A nationwide surveillance study of acute diarrheal patients of all ages was conducted in 217 sentinel hospitals from 31 provinces (autonomous regions or municipalities) in China between 2011 and 2020. Seventeen diarrhea-related pathogens, including seven viruses and ten bacteria, were investigated and their association with occurrence of fever symptoms was assessed using multivariate logistic analysis. Results A total of 146,296 patients with acute diarrhea (18.6% with fever) were tested. Th diarrheal children below 5 years had the highest frequency of fever (24.2%), and related to significantly higher prevalence of viral enteropathogens (40.2%) as compared with other age groups (P

ObjectivesAcute diarrhea in children is generally managed by replacing the lost fluid with oral rehydration solution (ORS). Probiotic supplementation has been reported to reduce the severity of diarrhea. In the present study, we investigated the effect of Weizmannia coagulans (Bacillus coagulans) MTCC 5856, along with ORS on acute diarrhea of all causes in non-hospitalized children.MethodsA total of 110 children of ages between 1 and 10 were enrolled in a double-blind placebo-controlled study and were randomly allocated to receive W. coagulans MTCC 5856 (4 × 108 spores, N = 54) + ORS and zinc (Zn) or a placebo (N = 56) + ORS and (Zn) for 5 days. The consistency of the stool, mean duration of diarrhea in hours, mean diarrhea frequency per day, and the dehydration status were collected as efficacy endpoints. Safety was evaluated by the occurrence of adverse events.ResultsThe mean age of the children was 5.55 ± 2.57 years (61 boys and 49 girls). The mean duration of diarrhea was 51.31 ± 20.99 h in the W. coagulans MTCC 5856 group and 62.74 ± 24.51 h in the placebo (p = 0.011) group. The frequency of diarrhea was lower in children supplemented with the probiotic, but the difference was not statistically significant. The perceived efficacy score and dehydration status improved significantly in the W. coagulans MTCC 5856 group compared with the placebo group. No adverse events were recorded.ConclusionThe results of the study suggest that W. coagulans MTCC 5856 could be supplemented along with ORS and zinc to reduce the duration of diarrhea in non-hospitalized children.Clinical Trial RegistrationClinicalTrials.gov, identifier CTRI/2022/06/043239.

Diarrhea remains a significant health concern worldwide, particularly in developing countries, contributing to 10% of deaths in children under 5 years. Bacterial infections, notably Shigella and Enteropathogenic Escherichia coli (EPEC), are prevalent causes. This study explores the association between vitamin D3 levels and acute diarrhea in children through a systematic literature review and meta-analysis. Ten studies, including case-control, cross-sectional, and cohort designs, were analyzed. The meta-analysis revealed a significant relationship between vitamin D3 deficiency and acute diarrhea, indicating a higher risk in children with lower vitamin D3 levels. While conflicting findings exist, this study provides valuable insights into the potential role of vitamin D3 in mitigating the risk of acute diarrhea in children. [ABSTRACT FROM AUTHOR]

Background: Two types of rotavirus vaccines (RVs), Rotarix (RV1) and RotaTeq (RV5), were licensed as optional vaccines in 2012 and became part of the National Immunization Program (NIP) in the fiscal year 2020 in Thailand. The main objective was to evaluate the impact of rotavirus vaccines on the burden of acute diarrheal severity ranging from outpatient visits, diarrheal-related admission or deaths in the pre-NIP period (fiscal year 2015–2019) and in the fiscal year 2020. The minor objectives were assessed on the monthly admission rate, rotavirus vaccine coverage rate and rotavirus vaccine completed dose (RotaC). Methods: Data regarding OPD, admission, and death cases under the Thailand National Health Coverage (NHC) from fiscal year 2015–2020, which were recorded as International Classification of Diseases and Related Health Problem 10th (ICD-10), were analyzed. Results: The burden of diarrheal-related disease diminished after the rotavirus vaccine was introduced in the fiscal year 2020 when compared to the previous 5 fiscal years. The OPD visit rate decreased from 10.1 to 8.3 visits per 100 person-years (P < 0.001), or a 17.8% reduction (incidence rate ratio (IRR) = 0.82; 95% confidence interval (CI): 0.81 to 0.82). The admission rate significantly declined from 31.4 to 30.5 cases per 1,000 person-years, (P < 0.001), or a 2.9% reduction (IRR = 0.97; 95% CI: 0.96 to 0.98). The diarrheal-related mortality rate also subsided from 10.2 to 8.1 cases per 100,000 person-years (P 0.3), or a 20.0% reduction (IRR = 0.88; 95% CI: 0.50 to 1.22). The major population in both admissions and deaths was infants under 1 year of age (P < 0.001). Seasonality was seen as a constant bimodal pattern, with a significant decrease in monthly admissions after 6 months of rotavirus vaccine introduction to NIP (P < 0.001). RotaC was 37.4% in the first year of NIP. Conclusions: The rotavirus vaccine had a potential benefit for reducing the diarrheal disease burden, especially in infants under one year of age. Seasonality outbreaks of acute diarrhea subsided after the rotavirus vaccine was introduced. The RotaC was fairly low in the first year of the NIP. The quality of the rotavirus vaccine should be warranted. Trial registration: Number TCTR20220120003, date of registration: 20/01/2022, site: Thai Clinical Trials Registry. [ABSTRACT FROM AUTHOR]

Acute gastroenteritis is one of the main causes of electrolyte imbalance in infants. We aimed to determine the frequency of and factors associated with dysnatremia at presentation and establish the ideal intravenous treatment scheme. The records of hospitalized infants aged 1–12 months with community-acquired acute gastroenteritis between January 2017 and March 2021 were retrospectively reviewed. Factors associated with dysnatremia at presentation were analyzed by multivariable logistic regression analysis. Subsequent sodium levels 4–24 h after intravenous fluid treatments, which were categorized into 2 groups, were determined in the subgroup of infants with normal sodium levels at presentation. A total of 347 infants with a median age of 8.0 (5.0–10.0) months were included. The frequency of dysnatremia at presentation was 14% (hyponatremia 12% and hypernatremia 2.0%). Severe dehydration was associated with dysnatremia at presentation (p = 0.048). Among 68 infants with normal sodium levels at presentation, the median sodium change was highest in the 5% dextrose in saline group, with changes of + 3 (0.5–5) and + 1 (− 2 to 2) mmol/L in infants who received 5% dextrose in saline and 5% dextrose in 1/3–1/2 saline, respectively (p = 0.001). Four out of 47 infants (8.5%) developed hyponatremia while receiving 5% dextrose in 1/3–1/2 saline. None of those who received 5% dextrose in saline developed subsequent dysnatremia. Conclusion: The frequency of dysnatremia at presentation among infants with acute gastroenteritis was 14%. Severe dehydration was associated with dysnatremia at presentation, so electrolyte levels need to be assessed in these patients. The use of isotonic solution did not promote acquired dysnatremia. This study supports once more that current guidelines recommending isotonic solution for children, and, especially, infant rehydration, are important also for infants in Thailand. What is Known: • There were a wide variation in the incidence of dysnatremia at presentation in children with acute gastroenteritis in previous pediatric series. • The AAP guidelines recommend using isotonic solution in children with acute illness from 28 days to 18 years of age to prevent acquired hyponatremia. What is New: • The incidence of dysnatremia at presentation in infants with acute gastroenteritis was 14% (hyponatremia 12% and hypernatremia 2.0%). • The use of isotonic solution did not promote acquired dysnatremia in infants with acute gastroenteritis. [ABSTRACT FROM AUTHOR]

Transplant renal vein thrombosis is a rare complication after kidney transplantation, which can seriously threaten graft survival. Though the measures like thrombolytic therapy or operative intervention could be taken to deal with this complication, allograft loss is the most common outcome. Thus, early finding as well as decisive intervention is crucial to saving the graft. Here we present a 46-year-old male patient who underwent kidney transplantation from a cadaveric donor who developed a transplant renal venous thrombosis induced by acute diarrhea more than 1 year after renal transplantation with an initial symptom of sudden anuria and pain in the graft area. Subsequently, serum creatinine levels increased to 810.0 μmol/L. Pelvic CT showed increased vascular density of the transplanted kidney, and contrast-enhanced ultrasound confirmed venous thrombosis. The patient was treated with heparin sodium alone and diuresis gradually resumed. After more than 1 year of follow-up, serum creatinine returned to the baseline level prior to thrombosis. Our case indicates that quick ancillary examination and treatment without hesitation would be indispensable in rescuing allografts with renal vein thrombus. Unfractionated heparin can be recommended as an effective treatment for mid-long-term renal transplantation patients with renal vein thrombosis.

Various pathogenic microorganisms have been implicated as the cause of infectious diarrhea in children as a result of water and food contamination. The study's goal is to determine the reliability of complete blood count (CBC) in peripheral blood of children with acute diarrhea which infected by certain enteric bacteria, with an emphasis on leukocytes (WBCs). A study conducted to examine the pattern of bacterial distribution in children with acute diarrhea's stool, as well as the relationship between the presence of pathogenic bacteria in stool samples and the number of total WBCs and differential leukocyte count in peripheral blood. Samples size includes (76) of health none diarrhea and (174) diarrheal patients, statistical analysis revealed that co-infection by E. coli and Klebsiella sp. was significantly higher (P<0.001) among children which suffered by diarrhea in compare to health individuals. In addition, the logistic regression shows co-infections and infections by Klebsiella sp. (OR: 29.44, 16.288 respectively) more likelihood leads to acute diarrhea compare to E. coli infection alone (P<0.001). Neutrophils/Lymphocyte ratio (NRL) was (2.412) times higher and neutrophils (1.069) times more in diarrheal group (P<0.001), also the AUC for NRL was 0.833(sensitivity: 81.61 and specificity: 68.42), while for percent of neutrophils was less 0.671 (sensitivity: 46.24 and specificity: 85.71). Concluded that peripheral leukocyte count, particularly the NRL index, is helpful in children with acute diarrhea and additionally that the prevalence of diarrhea is altered by different bacterial infections. [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]

The objective of this randomized controlled study was to determine whether integrating GV-1 aqua-acupuncture (aqua-AP) and conventional therapy can accelerate the resolution of acute diarrhea in dogs. A total of 39 client-owned dogs experiencing acute diarrhea of less than 5 days duration were enrolled and randomly assigned to Group A, conventionally treated control (no aqua-AP); Group B, conventionally treated control plus sham aqua-AP (subcutaneous injection of vitamin B12 at a non-acupuncture point); or Group C, conventionally treated plus aqua-AP at GV-1 (vitamin B12 injected at GV-1 acupuncture point). Conventional treatment, uniformly applied to all patients, consisted of a bland diet, metronidazole and probiotics. Each owner, blinded to the group assignment of their dog, reported the time duration from the start of the treatment to the first observed normal stool (denoted as Tns). Study results revealed a significant difference among the Tns values of the 3 study groups. The mean±SD Tns in Group A was 68.0±59.5 hours and 59.5±41.6 hours in Group B. Group C was 22.6±28.6 hours, which was more than 50% shorter than each of the other 2 groups. Furthermore, the proportion of subjects in Group C, whose first stool after treatment initiation was normal, was significantly greater than the other groups (A: 7.7%; B: 7.7%, and C 46.2%; p = 0.029). These findings suggest that aqua-AP at GV-1 can be an effective integrated treatment with conventional therapy for resolving acute diarrhea in dogs. Further studies with a larger sample size, and comparisons with other conventional treatments are warranted. [ABSTRACT FROM AUTHOR]

Background: Acute diarrhea with fever can potentially represent a more severe form of the disease compared to non-febrile diarrhea. This study was to investigate the epidemiological characteristics and enteric pathogen composition of febrile-diarrheal patients, and to explore factors including pathogens associated with fever by age group. Methods: A nationwide surveillance study of acute diarrheal patients of all ages was conducted in 217 sentinel hospitals from 31 provinces (autonomous regions or municipalities) in China between 2011 and 2020. Seventeen diarrhea-related pathogens, including seven viruses and ten bacteria, were investigated and their association with occurrence of fever symptoms was assessed using multivariate logistic analysis. Results: A total of 146,296 patients with acute diarrhea (18.6% with fever) were tested. Th diarrheal children below 5 years had the highest frequency of fever (24.2%), and related to significantly higher prevalence of viral enteropathogens (40.2%) as compared with other age groups (P < 0.001). Within each age group, the febrile-diarrheal patients were associated with a significantly higher prevalence of bacterial pathogens than afebrile-diarrheal patients (all P < 0.01). There was discrepancy when each pathogen was compared, i.e., nontyphoidal Salmonella (NTS) was overrepresented in febrile vs non-febrile patients of all age groups, while the febrile vs non-febrile difference for diarrheagenic Escherichia coli (DEC) was only significant for adult groups. The multivariate analysis revealed significant association between fever and infection with rotavirus A among children [odds ratio (OR) = 1.60], for DEC in adult groups (OR = 1.64), for NTS in both children (OR = 2.95) and adults (OR = 3.59). Conclusions: There are significant discrepancy of the infected enteric pathogens in patients with acute diarrhea with fever between age groups, and it is valuable for priority detection of NTS and rotavirus A in patients with children < 5 years old and NTS and DEC in adult patients. The results may be useful in identifying dominant pathogen candidates for the application of diagnostic assays and prevention control. [ABSTRACT FROM AUTHOR]

Background. After acute diarrhea in young children, intestinal disturbances and even chronic functional intestinal di­seases may occur. To date, no pathogenetically based criteria have been found that would indicate the probability of chronic intestinal disorders, just as the mechanisms of their occurrence after acute diarrhea have not been fully elucidated. The objective: to evaluate the frequency and nature of bowel disorders in children of the younger age group within 6 months after a stay in hospital for acute diarrhea and to establish their relationship with coprological indicators — fecal calprotectin (FCР), the content of carbohydrates (reducing substances, RS), lactic acid (LA) and short-chain fatty acids (SCFA) — acetic, propionic and fatty (butyric). Materials and methods. The study involved 47 children aged 6–24 months who were hospitalized for acute diarrhea. Acute enterocolitis (group I) was diagnosed in 18 patients and was caused by Campylobacter jejuni in 12 cases, Escherichia coli O-18 and Escherichia coli O-44 in 3, Salmonella enteritidis in 2 and Yersinia enterocolitica in one case. Rotaviral gastroenteritis (group II) was diagnosed in 11 patients. Another 11 children had acute symptomatic (parenteral) diarrhea (group III) against the background of intestinal infection — acute otitis, pneumonia, pyelonephritis. In 7 children, diarrhea was classified as functional digestive disorder (group IV). Routine clinical tests were supplemented with an examination of feces for the presence of intestinal parasites, Clostridium difficile A/B toxins, adenoviruses, human hemoglobin, RS, FCP, SCFA and LA. Results. Six-month follow-up established that 14 of 18 children in group I had permanent or temporary loose stools. These complaints in 13 cases were combined with episodes of abdominal pain similar to intestinal colic. The same complaints were much less frequent in children of group II (6 and 3 of 11, respectively), group III (4 and 2 of 11) and group IV (only in 2 of 7 children). The rank correlation analysis did not reveal any significant relationships between the intensity and duration of complaints and FCP, RS, LA, and SCFA in patients of groups I and II. On the contrary, in group III, there were multiple correlations of complaints with FCP, RS, LA, and SCFA. In group IV, the association of loose stools with an increase in LA and acetic acid has been found. Conclusions. According to the 6-month follow-up, 57 % of young children with acute diarrhea complained of loose stools and/or recurrent abdominal pain after discharge from the hospital. Most often, intestinal disorders were detected in children who had acute bacterial enterocolitis. There were no correlations between the intensity of post-infectious (bacterial or viral) disorders with FCP, RS, LA and SCFA during hospitalization. In contrast, such associations were numerous in children with symptomatic (pa­renteral) and functional diarrhea. It was suggested that the studied coprological parameters can be used to predict the state of the intestine after acute diarrhea.

ABSTRACT Changes in diet and environment can lead to acute diarrhea in companion animals, but the composition and interactions of the gut microbiome during acute diarrhea remain unclear. In this multicenter case-control study, we investigated the relationship between intestinal flora and acute diarrhea in two breeds of cats. Acutely diarrheic American Shorthair (MD, n = 12) and British Shorthair (BD, n = 12) and healthy American Shorthair (MH, n = 12) and British Shorthair (BH, n = 12) cats were recruited. Gut microbial 16S rRNA sequencing, metagenomic sequencing, and untargeted metabolomic analysis were performed. We observed significant differences in beta-diversity (Adonis, P

Acute diarrheal illness is a serious public health issue in developing and developed economies, with high morbidity and mortality rates. Children below five years are the most vulnerable, with one in every six dying from diarrhea. Diarrhea may be caused by various viruses, protozoa, and bacteria. Rotavirus, in particular, is often associated with diarrhea in children. Early detection of rotavirus infection reduces the need for medication and the spread of the virus and helps determine the optimal treatment strategies. In this study, we compared the efficacy of the rapid immunochromatography technique (ICT) with that of enzyme-linked immunosorbent assay (ELISA) to detect rotavirus antigens in stool samples. Overall, 361 stool samples were obtained from hospitalized children under five-years-old, with acute watery diarrhea symptoms and were tested by both rapid ICT and ELISA. Among these samples, 104 (28.81%) tested positive by ICT and 109 (30.19%) by ELISA. Furthermore, the specificity and sensitivity of ICT were assessed using ELISA, the gold standard test. ICT had a 95.41% sensitivity and a 100% specificity. Thus, during emergency testing, ICT may be utilized as an alternative test for quick diagnosis with high specificity and sensitivity in patients with rotavirus diarrhea.

For different breeds of dogs with acute diarrhea, the gut microbiota and metabolome profiles are unclear. This prospective observational study analyzed the gut microbiomes of poodles with acute diarrhea and Labrador retrievers with acute diarrhea based on 16S amplicon sequencing, with respective healthy dogs as controls. Fecal non-target metabolomics and metagenomics were performed on poodles with acute diarrhea. This study found that the diversity and structure of the microbial community differed significantly between the two breeds in cohorts of healthy dogs. Two breeds of dogs with acute diarrhea demonstrated different changes in microbial communities and metabolic functions. The metabolism of starch and sucrose was significantly decreased in dogs with acute diarrhea, which may be attributed to the reduced activity of dextran dextrinase. Non-targeted metabolomics identified 21 abnormal metabolic pathways exhibited by dogs with acute diarrhea, including starch, amino acid, bile acid metabolism, etc., and were closely related to specific intestinal flora. This study provided new insights into breed specificity and the development of dietary treatment strategy in canine gastrointestinal disease. [ABSTRACT FROM AUTHOR]

Simple Summary: Little is known about what happens in the canine gastrointestinal tract during episodes of acute diarrhea in dogs. In the present study, a proteomic approach was used to investigate at the time of inclusion, and at two subsequent time points (2 and 14 days after the onset of the clinical condition), changes in the digestive environment in a subset of dogs suffering from acute uncomplicated diarrhea. Four (groups of) proteins showed significant differences at two or more of the three time points investigated, mainly evidencing a reaction of the organism to the disease. Further studies are needed to confirm the present findings. Acute diarrhea is a very frequent condition affecting dogs; nevertheless, little is known about what happens in the GI tract during such conditions. Proteomics allows the study of proteins present in a specific biologic substrate, and fecal proteomic investigations have been recently implemented to study GI diseases in dogs. In the present study, the fecal protein profiles of eight dogs suffering from acute uncomplicated diarrhea at the time of inclusion was investigated for the first time, and then the same patients were followed, replicating two further evaluations at two subsequent time points (after 2 and 14 days from the first presentation), with the aim of gaining possible new insights regarding the pathologic changes in the gastrointestinal environment during such conditions. Two-dimensional gel electrophoresis (2-DE) was performed, followed by mass spectrometry. Nine spots, corresponding to four (groups of) proteins (i.e., albumin, alkaline phosphatase, chymotrypsin-C-like, and some immunoglobulins), showed significant differences at two or more of the three time points investigated, almost all behaving similarly and decreasing at T1 (2 days after the onset of the condition) and significantly increasing at T2 (14 days after the onset), mainly evidencing a reaction of the organism. Further studies including a greater number of patients and possibly different techniques are needed to confirm the present findings. [ABSTRACT FROM AUTHOR]

Background Acute diarrhea is an important contributor to under-5 mortality. Green banana is traditionally used as a home-based remedy for diarrhea. Objectives To identify the effect of green banana on duration, recovery and prevention of severe dehydration in under-5 children with acute watery diarrhea with no/some dehydration. Methods This study was conducted in the rural field practice area of a tertiary care center between January 2020 and December 2021 in under-5 children presenting with acute diarrhea with no/some dehydration. One hundred fifty-three children were divided into group A (received cooked green banana supplementation along with standard management) and group B (received only standard management). Duration of diarrhea, proportion of children recovered, requirement of hospitalization, development of persistent diarrhea and number of diarrheal episodes in 1 year follow-up period were compared between two groups. Results Green banana supplementation was significantly associated with reduction in duration [median (interquartile range)—4 (1.5) day versus 5.5 (1) day, P  < 0.001] of diarrhea, less hospitalization (9.2% versus 22.1%, P  = 0.03) and early recovery, both at day 3 (17.1% versus 3.9%, P  = 0.007) and day 7 (90.8% versus 77.9%, P  = 0.03). Green banana also protected children from the development of persistent diarrhea (7.9% versus 19.5%, P  = 0.04). It also reduced future episodes of diarrhea by 40.5%. Conclusion Green banana supplementation could be a promising adjunct therapy in acute diarrhea and thereby it might reduce under-5 mortality. [ABSTRACT FROM AUTHOR]

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Abstract Background The incidence of acute diarrhea in Thai children under five years of age has increased over the last three decades. Even though mortality has significantly declined, the burden and cost of medical treatment are still high. Our objectives are to describe the burden and pattern of acute diarrhea cases that required admissions by Thai children under five years of age from 2015 to 2019. Methods Data regarding the admission of acute diarrhea cases of Thai children with Thailand National Health Coverage (NHC) under five years of age from 2015 to 2019, recorded as International Statistical Classification of Diseases and Related Health Problems, tenth Revision, Thai Modification (ICD-10-TM), were analyzed. Results The incidence trend of yearly acute diarrhea in children 0–5 years of age slightly increased from 33.36 cases per 1,000 population in 2010 to an average of 33.79 cases per 1,000 population/ year from 2015 to 2019 or approximately 0.43 cases per 1,000 population over the last decade while diarrhea-related mortality had a low, constant rate of 0.71 to 1.16 per 100,000 population per year. Two thirds of the mortality rate was observed in children under 1 year of age or 4.1 cases per 100,000 person-years in 5-year period (P

Abstract Background Early and accurate identification of infection viruses among children can benefit the personalized medical treatment and management, and reduce the future occurrence of serious symptoms. Thus, it is critical to develop a high-throughput multiplex real-time RT-PCR method to improve the accuracy and efficiency in routine clinical lab tests. Methods We developed a real time RT-PCR combined with melting curve analysis (RRCMC) method for simultaneous detection of rotavirus A, B, C, norovirus GI and GII, adenovirus, astrovirus and sapovirus. Results Stool samples were collected from 160 children with acute diarrhea and tested by RRCMC assay. A total of 71 patients were tested positive with norovirus, adenovirus or rotavirus. The RRCMC assay has high specificity. There is no internal cross-reaction among the 8 diarrhea viruses and no cross-reaction of other commonly intestinal pathogens and human genome. The limit detection was ranged from 1 × 102 to 1 × 105 nucleic acid copies/ml for each diarrhea virus. Conclusion The RRCMC method is a suitable rapid clinical test for infectious viruses, with the advantages of high-throughput, low cost, high sensitivity and specificity.

Abstract Background Childhood diarrhea remains a major disease burden, particularly in developing countries, and is a leading cause of death in children aged

Abstract Background Since Ethiopia has been implemented the Community-Led Total Sanitation and Hygiene (CLTSH) approach to control incidence of diarrhea, few studies have compared the prevalence of diarrhea and associated factors in rural areas that have implemented this approach with those that have not implemented it, and none have examined it in the district of Menz Gera Midir in the Amhara Region of Ethiopia. This study addressed this gap. Method A community-based comparative cross-sectional study was conducted among 224 children under five in three randomly selected rural kebeles (the smallest administrative units in Ethiopia) where CLTSH had been implemented and 448 similar children in three other randomly selected rural kebeles where CLTSH had not been implemented during February and March, 2020. Data were collected using a structured questionnaire and an on-the-spot observational checklist. Data were analyzed using three different binary logistic regression models with 95% confidence interval (CI): the first model (Model I) was used for CLTSH-implementing kebeles, the second model (Model II) for non-CLTSH-implementing kebeles, and the third model (Model III) for pooled analysis of CLTSH-implementing and non-implementing kebeles. To control confounders, each multivariable logistic regression model was built by retained variables with p

Context: Irrational use of medications for acute diarrhea in children is rampant. We conducted this survey to analyze prescription practices among pediatricians for acute diarrhea and their deviation from standard treatment guidelines. Subjects and Methods: A self-administered online questionnaire regarding prescription practices was circulated among pediatricians in Maharashtra, India, through various academic groups on WhatsApp, during the World Oral Rehydration Salt (ORS) Week, 2021. The questionnaire was anonymous and consisted of 15 compulsory close-ended multiple-choice questions. Results: Two hundred and eighty-seven pediatricians participated. Among which, 88.9% of the participants said that they prescribed ORS in acute diarrhea, 26.8% preferred zinc supplementation only in the case of watery diarrhea, 62% used probiotics or probiotics plus zinc combinations, and 60% said that they prescribe antisecretory drugs such as racecadotril. Forty percentage of the participants admitted that they occasionally use antibiotics for the management of acute diarrhea, while 5% said that they frequently do so. Most pediatricians advise appropriate ORS substitutes. Large number of pediatricians perceived probiotics (51.2%), dietary restriction (15.7%), racecadotril (10.5%), and antibiotics (6.3%) to be an important part in managing acute diarrhea. Only 25.4% of the pediatricians answered correctly and said parental counseling along with zinc and ORS work best as treatment. Conclusions: This study demonstrates low adherence by pediatricians to standard treatment guidelines for the management of acute diarrhea. Misuse of antibiotics and unscientific use of drugs were evidenced from this study. Awareness regarding the advantages of ORS among pediatricians is high. At present, there is a need to focus on appropriate feeding practices, emphasizing on the role of zinc and discouraging use of antibiotics, probiotics, antisecretory drugs, and irrational combinations.

Background: Despite significant loss of bicarbonate during acute diarrhea, pediatric data are scarce with acute diarrhea/severe dehydration (ADSD) and severe non-anion-gap metabolic acidemia (sNAGMA). We planned to study their clinical profile, critical care needs, and outcome. Patients: Children (1 month-12 years) with ADSD and sNAGMA (pH <7.2 and/or bicarbonate <15 mEq/L, and normal/mixed anion gap) admitted in Pediatric Emergency Department from January 2016 to December 2018 were enrolled. Children with pure high-anion-gap metabolic acidemia were excluded. Methods: Medical records were reviewed retrospectively. The primary outcome was time taken to resolve acidemia. Secondary outcomes were acute care area free days in 5 days (ACAFD5), and adverse outcome as composite of Pediatric Intensive Care Unit (PICU) admission and/or death. Results: Out of 929 diarrhea patients admitted for intravenous therapy, 121 (13%; median age, 4 months) had ADSD and sNAGMA. Median (IQR) pH was 7.11 (7.01-7.22); 21% patients had pH <7.00. Hyperchloremia (96%) and hypernatremia (45%) were common. About 12% patients each required inotropes and ventilation, while 58% had acute kidney injury (AKI). Median (IQR) time for resolution of acidemia among survivors was 24 (12, 24) hours. Thirty-two patients had adverse outcome. Higher grades of sNAGMA were associated with shock, AKI, coma, hypernatremia, hyperkalemia, adverse outcome, and lesser ACAFD5. Shock, ventilation, renal replacement therapy (RRT), and higher grades of sNAGMA were predictors of adverse outcome, with former two being independent predictors. Conclusions: Severe non-anion-gap metabolic acidemia in children with ADSD is associated with organ dysfunctions, dyselectrolytemias, and lesser ACAFDs. Resolution of acidemia took unacceptably longer time. Higher grades of sNAGMA were a predictor of adverse outcomes. Trials are suggested to assess the role of additional bicarbonate therapy. [ABSTRACT FROM AUTHOR]

Purpose of Review: To selectively review the evidence that there are or are not unique features of diarrhea in older individuals that should alter the differential diagnosis or evaluation of diarrhea in older adults. Recent Findings: A recent population-based study indicates a prevalence rate of diarrhea of 6.6% in the entire adult population and 9.6% in the oldest subjects. Several specific diarrheal disorders may have a prevalence pattern skewing to older individuals or to their circumstances, and these should be ranked higher in the differential diagnosis of older people with acute and chronic diarrhea. Summary: Acute, infectious diarrhea may occur in outbreaks in institutional settings. Because of diarrhea complicating use of drugs, previous surgeries, or other illnesses, the differential diagnosis of chronic diarrhea in older patients always should include iatrogenic causes. Diarrhea complicating chronic diseases, such as diabetes, also should be considered. Causes of chronic diarrhea that occur more often in older patients, such as microscopic colitis, small intestinal bacterial overgrowth, and enteropathy, should be investigated. [ABSTRACT FROM AUTHOR]

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Background: Secondary lactose intolerance occurs commonly from intestinal inflammation following infection recommending avoidance of milk contains lactose. Objective: To identify the role of lactose-free milk (LFM) in the treatment of acute diarrhea in children ≤ 2 years in Al-Ramadi Maternity and Childhood Teaching Hospital in Ramadi city, Iraq. Material and methods: A single-blind randomized controlled trial study was done on babies ≤ two years old who presented with acute diarrhea. Two hundred cases were chosen randomly, 100 of them were received LFM added to the regime of management of diarrhea (group A), and the other 100 cases were received ordinary formula milk (OFM) (group B). Babies who were breastfeeding, those with chronic or bloody diarrhea, and those who received antibiotics were excluded from this study. Data about age, gender, the response ( stopping diarrhea), and its duration within 3 days were recorded. Results: The response of stopping diarrhea after 3 days among group A was 89%, while group B was 67%. There was a highly statistically significant difference between the 2 groups (P-value = 0.001). Out of 44 babies in the age group 0-6 months in group A, there were 42 (95.4%) who respond to therapy, and it was the highest age group affected. There was a high statistically significant difference (P-value = 0.003) between the rate of response and the age group in group A. However, there was no significant difference (P-value > 0.05) between the gender and the response rate. Moreover, there was no significant difference (P-value > 0.05) between the rate of response and the age and gender of the babies in group B. There was a statistically significant difference (P-value