Watery diarrhea,hypokalemia and achlorhydria syndrome due to an adrenal pheochromocytoma

Watery diarrhea, hypokalemia and achlorhydria (WDHA) syndrome caused by vasoactive intestinal polypeptide (VIP) -producing tumor only rarely occurs in patients with nonpancreatic disease. A 49-year-old woman was referred for evaluation of a right adrenal tumor incidentally diagnosed by abdominal ultrasound during the investigation of chronic watery diarrhea. Laboratory findings showed hypokalemia and excessive production of VIP and catecholamines. After surgical resection of the tumor, diarrhea subsided and both electrolytes and affected hormone levels normalized. Immunohistochemical examination confirmed a diagnosis of pheochromocytoma, which contained VIP-positive ganglion-like cells. We herein present the clinical and histogenetic implications of this rare clinical entity, with literature review.

Microscopic colitis

Microscopic colitis may be defined as a clinical syndrome, of unknown etiology, consisting of chronic watery diarrhea, with no alterations in the large bowel at the endoscopic and radiologic evaluation. Therefore, a definitive diagnosis is only possible by histological analysis. The epidemiological impact of this disease has become increasingly clear in the last years, with most data coming from Western countries. Microscopic colitis includes two histological subtypes [collagenous colitis (CC) and lymphocytic colitis (LC)] with no differences in clinical presentation and management. Collagenous colitis is characterized by a thickening of the subepithelial collagen layer that is absent in LC. The main feature of LC is an increase of the density of intra-epithelial lymphocytes in the surface epithelium. A number of pathogenetic theories have been proposed over the years, involving the role of luminal agents, autoimmunity, eosinophils, genetics (human leukocyte antigen), biliary acids, infections, alterations of pericryptal fibroblasts, and drug intake; drugs like ticlopidine, carbamazepine or ranitidine are especially associated with the development of LC, while CC is more frequently linked to cimetidine, non-steroidal antiinflammatory drugs and lansoprazole. Microscopic colitis typically presents as chronic or intermittent watery diarrhea, that may be accompanied by symptoms such as abdominal pain, weight loss and incontinence. Recent evidence has added new pharmacological options for the treatment of microscopic colitis:the role of steroidal therapy, especially oral budesonide, has gained relevance, as well as immunosuppressive agents such as azathioprine and 6-mercaptopurine. The use of anti-tumor necrosis factoragents, infliximab and adalimumab, constitutes a new, interesting tool for the treatment of microscopic colitis, but larger, adequately designed studies are needed to confirm existing data.

Current status and challenges in drug discovery against the globally important zoonotic cryptosporidiosis

The zoonotic cryptosporidiosis is globally distributed,one of the major diarrheal diseases in humans and animals.Cryptosporidium oocysts are also one of the major environmental concerns,making it a pathogen that fits well into the One Health concept.Despite its importance,fully effective drugs are not yet available.Anti-cryptosporidial drug discovery has historically faced many unusual challenges attributed to unique parasite biology and technical burdens.While significant progresses have been made recently,anti-cryptosporidial drug discovery still faces a major obstacle:identification of systemic drugs that can be absorbed by patients experiencing watery diarrhea and effectively pass through electron-dense(ED)band at the parasite-host cell interface to act on the epicellular parasite.There may be a need to develop an in vitro assay to effectively screen hits/leads for their capability to cross ED band.In the meantime,non-systemic drugs with strong mucoadhesive properties for extended gastrointestinal exposure may represent another direction in developing anti-cryptosporidial therapeutics.For developing both systemic and non-systemic drugs,a non-ruminant animal model exhibiting diarrheal symptoms suitable for routine evaluation of drug absorption and anti-cryptosporidial efficacy may be very helpful.

Inevitability of an Enhanced Monitoring Strategy to Reduce Water Borne Illness Combining Indicators of Sanitary Protection and Measuring Water Quality

Background: Diarrhoea is the second leading cause of childhood mortality in children under five years old. Water is a major contributing risk factor for this disease that is a common illness and a global killer. Material and Methods: Water samples from different areas of Karachi were collected and were processed by MPN technique to evaluate the presence of microbiological substances. Results: Out of the processed samples, 64% were positive for the presence of mix enteric pathogen from different areas of Karachi;from Bhens colony, 74% were positive for the presence of fecal coli forms, among which 4% were positive for EHEC isolated from storage tank and water tank. Conclusion: The abovementioned results reflect the presence of organisms of public health importance in different sources of drinking water. According to WHO guidelines, there should be zero tolerance of these organisms in water.