Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections

Antibiotic-associated diarrhea(AAD) and Clostridum difficile infections(CDI) have been well studied for adult cases, but not as well in the pediatric population. Whether the disease process or response to treatments differs between pediatric and adult patients is an important clinical concern when following global guidelines based largely on adult patients. A systematic review of the literature using databases Pub Med(June 3, 1978-2015) was conducted to compare AAD and CDI in pediatric and adult populations and determine significant differences and similarities that might impact clinical decisions. In general, pediatric AAD and CDI have a more rapid onset of symptoms, a shorter duration of disease and fewer CDI complications(required surgeries and extended hospitalizations) than in adults. Children experience more community-associated CDI and are associated with smaller outbreaks than adult cases of CDI. The ribotype NAP1/027/BI is more common in adults than children. Children and adults share some similar risk factors, but adults have more complex risk factor profiles associated with more co-morbidities, types of disruptive factors and a wider range of exposures to C. difficile in the healthcare environment. The treatment of pediatric and adult AAD is similar(discontinuing or switching the inciting antibiotic), but other treatment strategies for AAD have not been established. Pediatric CDI responds better to metronidazole, while adult CDI responds better to vancomycin. Recurrent CDI is not commonly reported for children. Prevention for both pediatric and adult AAD and CDI relies upon integrated infection control programs, antibiotic stewardship and may include the use of adjunctive probiotics. Clinical presentation of pediatric AAD and CDI are different than adult AAD and CDI symptoms. These differences should be taken into account when rating severity of disease and prescribing antibiotics.

Post Cholecystectomy Diarrhoea—A Systematic Review

Introduction: Post-cholecystectomy diarrhoea (PCD) is probably the most distressing postoperative non-pain symptom. Its nature is not fully understood. The aim of this systematic review was to assess the prevalence, aetiology, predisposing factors and management of PCD from the past study reports. Methods: We conducted a wide ranged review of published literature on PubMed, Web of Knowledge, and the Cochrane library without any time limitation. Results: Twenty five studies were included. The prevalence of PCD was 9.1% (302/3306) with no significant difference between genders. The prevalence of bile acid malabsorption (BAM), the most important suggested aetiological factor, was seen in 65.5% (36/55) patients with PCD. There were no obvious predisposing factors. We found 92% (23/25) of patients with PCD responded to cholestyramine therapy. The cure rate for cholecystectomy on preoperative cholegenic diarrhoea was 54.5% (121/222). The prevalence of post-cholecystectomy new onset constipation was 7.9% (78/987). Conclusion: The aetiology of PCD is unknown and appears to be multifactorial. The BAM prevalence was only 65.5%, however 92% of PCD patients responded to cholestyramine therapy suggesting that cholestyramine therapy could also have curative effect on other unknown aetiological factors related to bile metabolism. The complexity of the aetiology of PCD is more projected by considering the curative effect of cholecystectomy on preoperative cholegenic diarrhoea, and the occurrence of post-cholecystectomy new onset constipation. However, the relationship between cholecystectomy and PCD is an undeniable fact.

Serum metabolic profiling of traditional Chinese medicine syndromes in patients with diarrhea-predominant irritable bowel syndrome

Objective:The clinical symptoms of diarrhea-predominant irritable bowel syndrome(IBS-D)can be effectively improved by traditional Chinese medicine(TCM)treatment,based on the usage of specific therapies for different TCM syndromes.However,in the stage of diagnosis,the standard criteria for the classification of TCM syndrome were still deficient.Through serum metabolic profiling,this study aimed to explore potential biomarkers in IBS-D patients with different TCM syndromes,which can assist in diagnosis of the disease.Methods:Serum samples were collected from healthy controls(30 cases),IBS-D patients with LiverStagnation and Spleen-Deficiency syndrome(LSSD,30 cases),Yang Deficiency of Spleen and Kidney syndrome(YDSK,11 cases)and Damp Abundance due to Spleen-Deficiency syndrome(DASD,22 cases).Serum metabolic profiling was conducted by ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry.The potential biomarkers were screened by orthogonal partial least square-discriminate analysis,while metabolic pathways undergoing alterations were identified by pathway enrichment analysis in Metabo Analyst 4.0.Results:Overall,34 potential biomarkers were identified in LSSD group,36 in YDSK group and 31 in DASD group.And the 13 metabolites shared by three groups were determined as the potential biomarkers of IBS-D.Glycerophospholipid metabolism was disturbed significantly in IBS-D patients,which may play a role in IBS-D through inflammation.What’s more,three TCM syndromes have the specific potential biomarkers in glycerophospholipid metabolism.Conclusion:The serum metabolomics revealed that different TCM syndrome types in IBS-D may have different metabolic patterns during disease progression and glycerophospholipid metabolism was one of the pathways,whose metabolism was disturbed differently among three TCM syndromes in IBS-D.Therefore,the specific potential biomarkers in glycerophospholipid metabolism of three TCM syndromes in IBS-D can serve as the objective indicators,which can facilitate the TCM-syndrome objective classification of IBS-D.

582例小儿腹泻病因调查分析

目的分析小儿腹泻病因,为临床治疗和预防提供理论指导。方法回顾性分析2018年1月至2020年12月于海口市妇幼保健院住院的582例小儿腹泻患儿的临床资料。结果582例患儿中男354例,女228例;发病年龄:2个月~1岁293例,>1~2岁170例,>2~3岁85例,>3~4岁34例;发病时间:1~3月份205例,4~6月份97例,7~9月份96例,10~12月份184例;患儿来源地区:市区228例,农村354例。582例患儿中,感染性腹泻469例,其中病毒性肠炎289例,抗生素相关性腹泻98例,细菌性肠炎75例;非感染性腹泻113例,其中食饵性腹泻45例,症状性腹泻34例。感染性腹泻患儿男性、农村儿童占比高于非感染性腹泻患儿,差异有统计学意义(P<0.05);感染性和非感染性腹泻患儿年龄、月份分布比较差异无统计学意义。结论小儿腹泻病患儿以男性农村患儿居多,以感染性腹泻多见,主要为病毒性肠炎,发病年龄以2岁以下小儿为主,发病时期在10~12月和1~3月2个时间段。临床应以预防为主,做好2岁以下农村儿童的卫生保健工作。

某院2016-2020年轮状病毒感染腹泻患儿流行病学特征分析

目的分析轮状病毒感染腹泻患儿的流行病学特征。方法将2016年1月-2020年12月期间在信丰县人民医院接受治疗的175例轮状病毒感染腹泻患儿作为研究对象,收集其病历资料进行分析。结果2016-2020年间轮状病毒感染腹泻患儿,主要发病于春冬两季,分别有66例(37.71%)、73例(41.71%),主要为0~3岁儿童,有100例(57.14%);所有患儿均出现水样、稀便症状,102例(58.29%)伴恶心呕吐;男性患儿119例(68.00%),女性患儿56例(32.00%)。结论小儿更容易在春冬季节患轮状病毒感染腹泻,且男性和0~3岁低幼儿童更易发病,患儿临床表现以水样、稀便为主,还可能出现恶心呕吐、发热、脱水等症状。

脐血干细胞移植成功治疗早发IPEX综合征1例报告并文献复习

X连锁多内分泌腺病肠病伴免疫失调综合征(IPEX)是一种由FOXP3基因变异引起的原发性免疫缺陷病,典型表现包括严重肠病、1型糖尿病和湿疹三联征。患儿,男,以糖尿病、顽固性腹泻、湿疹、反复感染起病,经遗传学检测确诊为FOXP3基因变异引起的IPEX综合征,最终经脐血干细胞移植治疗,患儿自身免疫症状得到改善。对早发糖尿病、顽固性腹泻及湿疹婴幼儿,应考虑IPEX综合征可能并进行遗传学检测,早期造血干细胞移植可阻止大多数患儿的疾病进展和并发症的发生,提高患儿生存率。

微生态疗法“促菌生”治疗婴幼儿秋季腹泻的临床研究

目的 :观察促菌生治疗婴幼儿秋季腹泻的疗效。方法 :根据设定标准 ,选择了 2 0 0例患者 ,其中10 0例作为治疗组 ,另 10 0例作为对照组 ,对治疗组口服蜡样芽胞杆菌活菌片 ,而对照组常规给予抗病毒药物 ,补液对症治疗。结果 :在治疗组中 97%的患者治愈 ,其显效时间最短 2 d,最长 8d;在对照组中 72 %的患者治愈 ,其显效时间最短为 3d,最长 12 d。两组的平均显效时间、治愈率及总有效率差异具有显著性 ,P≤0 .0 1。结论 :口服蜡样芽胞杆菌活菌片 ,可以提高肠道环境的质量及维持正常的肠蠕动 。

致泻性大肠杆菌疫苗研究进展

大肠杆菌引起的腹泻多发生在儿童及发展中国家,发展致泻性大肠杆菌疫苗具有特殊的意义。除了灭活疫苗、减毒疫苗、结合多糖疫苗和亚单位疫苗外,新近出现的DNA疫苗、转基因植物疫苗和ghost疫苗技术为疫苗的研制提供了新的思路。本文综述了目前致泻性大肠杆菌疫苗研究的新进展。

Treatment-related gastrointestinal toxicities and advanced colorectal or pancreatic cancer:A critical update

Gastrointestinal toxicities(GIT), including oral mucositis,nausea and vomiting, and diarrhea, are common side effects of chemotherapy and targeted agents in patients with advanced colorectal cancer and pancreatic cancer. Being often underreported, it is still difficult to precisely establish their burden in terms of both patient's quality of life and cancer care costs. Moreover, with the use of more intensive upfront combination regimens, the frequency of these toxicities is rapidly growing with a potential negative effect also on patient's outcome, as a result of dose reductions, delays or even discontinuation of active treatments. Thus, identifying patients at higher risk of developing GIT as well as an optimal management are paramount in order to improve patient's compliance and outcome. After the description of the main treatment-induced GIT, we discuss the current knowledge on the pathophysiology of these side effects and comment the scales commonly used to assess and grade them. We then provide a critical update on GIT incidence based on the results of key randomized trials conducted in patients with metastatic colorectal cancer and advanced pancreatic cancer.

Gastrointestinal dysbiosis and the use of fecal microbial transplantation in Clostridium difficile infection

The impact of antibiotics on the human gut microbiota is a significant concern. Antibiotic-associated diarrhea has been on the rise for the past few decades with the increasing usage of antibiotics. Clostridium difficile infections(CDI) have become one of the most prominent types of infectious diarrheal disease, with dramatically increased incidence in both the hospital and community setting worldwide. Studies show that variability in the innate host response may in part impact upon CDI severity in patients. That being said, CDI is a disease that shows the most prominent links to alterations to the gut microbiota, in both cause and treatment. With recurrence rates still relatively high, it is important to explore alternative therapies to CDI. Fecal microbiota transplantation(FMT) and other types of bacteriotherapy have become exciting avenues of treatment for CDI. Recent clinical trials have generated excitement for the use of FMT as a therapeutic option for CDI; however, the exact components of the human gut microbiota needed for protection against CDI have remained elusive. Additional investigations on the effects of antibiotics on the human gut microbiota and subsequent CDI will help reduce the socioeconomic burden of CDI and potentially lead to new therapeutic modalities.

柴胡桂枝干姜汤配合脐疗治疗腹泻型肠易激综合征效果观察

目的 探讨分析柴胡桂枝干姜汤配合脐疗治疗腹泻型肠易激综合征的效果。方法 选取2015年1月—2018年5月本院消化内科收治的108例腹泻型肠易激综合征患者随机分为观察组和对照组,观察组给予柴胡桂枝干姜汤配合脐疗治疗,对照组给予西药常规治疗,比较2组患者临床疗效、临床症状缓解时间、治疗前后IBS-SSS、IBS-QOL评分。结果 观察组患者总有效率较对照组显著提高(P<0.05);治疗前2组患者BS-SSS、IBS-QOL评分差异无统计学意义(P>0.05),治疗后观察组患者IBS-SSS评分下降更显著,IBS-QOL评分上升更显著,差异均具有统计学意义(P<0.05)。结论 柴胡桂枝干姜汤配合脐疗治疗腹泻型肠易激综合征可显著提高临床疗效,改善患者临床症状,提高患者的生活质量。

配方奶粉饲喂哺乳仔猪的促生长效果

[目的]探讨配方奶粉对哺乳仔猪的促生长作用。[方法]选取长大母猪初产20窝、经产28窝哺乳期仔猪分别设置对照组、试验组,对照组不饲喂配方奶粉,试验组饲喂配方奶粉,进行饲养对比试验。[结果]加饲奶粉液的初产、经产试验组哺乳仔猪断奶体重分别比对照组增加0.59、0.97 kg;平均日增重分别高20.84、51.00 g/d;试验组增重效果显著高于对照组;平均边际成本分别为11.76、10.67元/头。[结论]奶粉可以提升哺乳仔猪生长速度,但对奶粉喜好具有一定窝间和个体间差异,未观察到仔猪因采食奶粉表现肠道不适或引起腹泻的现象,哺乳期适宜的配方奶粉可以部分替代母乳。

葛根芩连汤氯仿部位含量测定及对羧酸酯酶的抑制作用研究

目的:建立葛根芩连汤氯仿部位的多成分含量测定方法,并考察其抑制羧酸酯酶(CES2)的作用。方法:采用溶剂萃取法提取葛根芩连汤氯仿部位,以葛根素、小檗碱、黄芩苷、甘草苷4种指标性成分,采用超高效液相色谱(UPLC)对其进行含量测定;采用荧光素二乙酸酯(FD)为CES2的特异性荧光探针底物,在人肝微粒体(HLM)孵育体系中考察葛根芩连汤氯仿部位对CES2的抑制作用。结果:葛根芩连汤氯仿部位中指标性成分含量测定结果为:葛根素347 mg·g^-1、小檗碱1.65 mg·g^-1、黄芩苷14.9 mg·g^-1、甘草苷1.04 mg·g^-1,该部位抑制CES2活性的IC50为0.5 mg.mL-1。结论:葛根芩连氯仿部位及其单体均对CES2具有较强的抑制作用,揭示葛根芩连汤有效部位可通过抑制羧酸酯酶以缓解伊立替康所致迟发型腹泻,为中药缓解其毒副作用的机制提供科学依据。

2种保留灌肠法治疗婴幼儿腹泻的疗效比较

目的探讨加深插入保留灌肠法对婴幼儿腹泻治疗的效果。方法将300例婴幼儿腹泻患儿随机分为观察组和对照组,各150例,观察组采用加深插入保留灌肠法,对照组采用传统保留灌肠法,观察2组患儿灌肠后首次大便排出时间及临床疗效。结果观察组与对照组在大便排出时间及临床疗效2方面比较均有显著性差异(p<0.01)。结论加深插入保留灌肠法对治疗婴幼儿腹泻疗效明显。

中频脉冲穴位导入中药三香双术散治疗湿热内蕴证小儿腹泻的临床疗效观察

目的:旨在探讨中频脉冲导入中药三香双术散治疗小儿腹泻病的疗效,为中医外治法治疗泄泻的提供新思路及临床基础数据。方法:从2016年9月至2017年8月期间深圳市宝安中医院(集团)儿科住院部及门诊收集符合本研究纳入标准的病例数共90例,采用随机对照的研究方法分为治疗组A、对照组B1、对照组B2三组,每组各30人。三组患儿均予西医常规内治法治疗(轻度脱水予口服补液盐及微生态制剂、中度脱水予静脉补液,有感染表现时予抗生素治疗,有发热、呕吐等予对症处理);治疗组A:在西医常规内治法治疗基础上,加用中频脉冲药物导入治疗仪治疗;对照组B1:予西医常规内治法治疗;对照组B2:在西医常规内治法治疗基础上,加用单纯的中药三香双术散穴位贴敷治疗。实验结束后,对三组患儿临床疗效进行比较分析。结果:治疗后,治疗组患儿临床总有效率为93.3%,明显高于对照组B1的56.7%及对照组B2的76.7%(P<0.05),治疗组在大便次数及大便性状改善方面优于对照组B1及对照组B2,三组比较差异显著(P<0.05),且治疗组中医症候总积分方面下降亦明显低于对照两组,三组比较差异具有统计学意义(P<0.05)。结论:中频脉冲导入中药三香双术散治疗小儿腹泻病疗效显著,值得临床推广应用。

酪酸梭菌活菌散联合醒脾养儿颗粒治疗小儿消化不良性腹泻的效果

目的分析酪酸梭菌活菌散联合醒脾养儿颗粒治疗小儿消化不良性腹泻的效果。方法选取2017年4月至2018年4月我院收治的76例消化不良性腹泻患儿为观察对象,并将其按随机数表分为对照组和观察组,各38例。对照组患儿单纯以酪酸梭菌活菌散治疗,观察组患儿则给予酪酸梭菌联合醒脾养儿颗粒进行治疗,对比两组患儿的治疗效果。结果治疗后,观察组患儿的大便次数少于对照组,大便性状恢复时间短于对照组,差异具有统计学意义(P<0.05);观察组患儿不良反应总发生率低于对照组,差异具有统计学意义(P<0.05);观察组患儿的治疗总有效率为97.4%,显著高于对照组的78.9%,差异具有统计学意义(P<0.05)。结论使用酪酸梭菌活菌散联合醒脾养儿颗粒治疗小儿消化不良性腹泻,可尽早帮助患儿康复,降低不良反应发生率,疗效显著,值得临床推广。

健脾安肠方治疗腹泻型肠易激综合征效果观察

目的观察健脾安肠方治疗腹泻型肠易激综合征的效果。方法选择本院2017年4月至2019年4月收治的腹泻型肠易激综合征患者100例,随机分为对照组和观察组各50例。对照组给予谷参肠安联合益君康治疗,观察组给予健脾安肠方治疗,比较两组总有效率和两组患者治疗前后的肠易激综合征严重程度积分(IBS-SSS)、T淋巴细胞亚群及5-羟色胺(5-HT)水平。结果观察组总有效率高于对照组,差异有统计学意义(P<0.05)。两组治疗前IBS-SSS、T淋巴细胞亚群、5-HT组间比较,差异无统计学意义(P>0.05)。观察组治疗2周、4周后IBS-SSS积分低于对照组(P<0.05)。观察组治疗4周后5-HT水平低于对照组,T淋巴细胞亚群优于对照组(P<0.05)。结论健脾安肠方可改善腹泻型肠易激综合征患者T淋巴细胞亚群,调节5-HT的表达,提高治疗效果。

儿童腹泻病伴惊厥62例临床特点及病因分析

目的:探讨儿童腹泻病伴惊厥的临床特点及病因分析。方法:对儿童腹泻病伴惊厥的62例住院患儿的临床资料进行回顾性分析。结果:高热惊厥25例,低钙血9例,低镁血症2例,低钠血症4例,高钠血症1例,低血糖1例,轻度胃肠炎伴婴幼儿良性惊厥(BICE)14例,病毒性脑炎4例,中毒性脑病2例。结论:儿童腹泻病伴惊厥病因较多,与高热、电解质紊乱、轻度胃肠炎伴良性婴幼儿惊厥、病毒性脑炎等有关。

兰州地区婴幼儿腹泻轮状病毒的分型特点

目的 调查研究兰州地区婴幼儿腹泻轮状病毒的分子流行病学特点。方法 分别用酶联免疫吸附试验 (ELISA)、聚丙烯酰胺凝胶电泳 (PAGE)、逆转录 聚合酶链反应 (RT PCR)三种方法对2 0 0 0年 1～ 2月、10～ 12月 ,2 0 0 1年 1～ 3月在兰州医学院第一附属医院儿科门诊及住院部收集的 114份婴幼儿腹泻粪便标本进行轮状病毒病原检测 ,并用核酸杂交方法对轮状病毒阳性标本进行分型。结果 三种方法检测轮状病毒感染的阳性率分别为 6 1% (ELISA)、5 8% (PAGE)、5 8 8% (RT PCR) ,轮状病毒核酸的电泳型有长、短两种类别 ,以长型为主 (81 8% ) ,偶有长、短型混合感染。流行的G型主要为G3(6 1% ) ,其次为G2 (2 5 4 % )、G1(13 6 % ) ,未见G4型 ,8例未能分型。P型主要为P1A(77 4 % ) ,其次为P1B(2 2 6 % ) ,无P2型。结论 婴幼儿轮状病毒腹泻在兰州地区的流行病学特点与世界各国报道的情况相仿 ,但 2 0 0 0年 1～ 2月、10～ 12月 ,2 0 0 1年 3月期间 ,其流行的主要基因型为G3型。本次研究结果从分子水平初步揭示了兰州地区轮状病毒的流行情况 。

附子理中丸联合当归生姜羊肉汤治疗脾肾阳虚证腹泻型肠易激综合征临床观察

[目的]观察附子理中丸联合当归生姜羊肉汤治疗脾肾阳虚证腹泻型肠易激综合征(IBS-D)临床疗效。[方法]将120例患者按随机数字表法分为治疗组(50例)和对照组(70例),治疗组予附子理中丸联合当归生姜羊肉汤治疗,对照组予附子理中丸,2组均治疗4周,观察治疗前后中医症状积分变化、复发率及评价临床疗效。[结果]与本组治疗前比较,2组中医证候积分差异有统计学意义(P<0.05);2组治疗中医证候积分差、临床疗效比较,差异有统计学意义(P<0.05);与对照组比较,治疗组在治疗后3、4、5个月复发率显著优于对照组(P<0.05);而2组治疗6个月后复发率比较差异无统计学意义(P>0.05)。[结论]附子理中丸联合当归生姜羊肉汤治疗脾肾阳虚证IBS-D疗效确切,值得推广应用。