Focus on acute diarrhoeal disease

Diarrhoea is an alteration of normal bowel movement characterized by an increase in the water content, volume, or frequency of stools. Diarrhoea needs to be classified according to the trends over time （acute or chronic） and to the characteristics of the stools （watery, fatty, inflammatory）. Secretory diarrhoeas, mostly acute and of viral aetiology in more than 70% of cases, are by far the most important subtype of diarrhoeas in terms of frequency, incidence and mortality （over 2.5 million deaths/year in developing countries）. Natural and synthetic opiates such as morphine, codeine, and Ioperamide which react with endogenous opiates （enkephalins, beta-endorphins, dynorphins） mainly act on intestinal motility and slow down transit. An antidiarrhoeal drug developed in recent years, racecadotril, acts as an enkephalinase inhibitor. Clinical studies have shown that it is just as effective as ioperamide in resolving acute diarrhoea but with greater reduction in pain and abdominal distension. Some studies have explored the prevalence of diarrhoea in old age. An epidemiological study carried out in Italy by 133 General Practitioners on 5515 elderly outpatients reported a prevalence of diarrhoea, defined according to the Rome criteria, of 9.1%. Infectious diseases （19%） and drug use （16%） were the most common causes of diarrhoea in old age. Regardless of the cause, the treatment of elderly patients with diarrhoea must include rehydration and nutritional support. Every year, more than 50 million tourists travel from industrialized countries to places where hygiene levels are pool. At least 75% of those travelling for short periods mention health problems, and in particular traveller＇s diarrhoea.

Role of a probiotic (Saccharomyces boulardii) in management and prevention of diarrhoea

AIM： To assess the efficacy and safety of Saccharomyces boulardii （S. boulardii） in acute watery diarrhoea and its role in reducing the frequency of episodes of diarrhoea in subsequent two months. METHODS： Children from 2 mo to 12 years of age, with acute diarrhoea were selected according to inclusion criteria and randomised in S. boulardii group （treated with ORS, nutritional support and S. boulardii, 250 mg bid） and in control group （treated with ORS and nutritional support only）. Active treatment phase was 5 d and each child was followed for two months afterwards. Frequency and consistency of stools as well as safety of drug was assessed on every visit. A comparison of two groups was done in terms of number of diarrhoeal episode in subsequent two months. RESULTS： There were fifty patients in each group. Baseline characteristics such as mean age and the average frequency of stools were comparable in S. boulardii and control group at the time of inclusion in the trial. By d 3 it reduced to 2.7 and 4.2 stools per d respectively and by d 6 it reduced to 1.6 （5. boulardii Group） and 3.3 （control group）. The duration of diarrhoea was 3.6 d in S. boulardii group whereas it was 4.8 d in control group （P = 0.001）. In the following two months, S. boulardii group had a significantly lower frequency of 0.54 episodes as compared to 1.08 episodes in control group. The drug was well accepted and tolerated. There were no reports of the side effects during treatment period CONCLUSION： S. boulardii significantly reduces the frequency and duration of acute diarrhoea. The consistency of stool also improves. The drug is well-tolerated.

Antidiarrhoeal efficacy of Mangifera indica seed kernel on Swiss albino mice

Objective:To examine the antidiarrhoeal activity of alcoholic and aqueous seed kernel extract of Mangifera indica(M.indica) on castor oil-induced diarrhoeul activity in Swiss albino mice.Methods:Mango seed kernels were processed and extracted using alcohol and water. Antidiarrhoeal activity of the extracts were assessed using intestinal motility and faecal score methods.Results:Aqueous and alcoholic extracts of M.indica significantly reduced intestinal motility and faecal score in Swiss albino mice.Conclusions:The present study shows the traditional claim on the use of M.indica seed kernel for treating diarrhoea in Southern parts of India.

Potential antibacterial activity of berberine against multi drug resistant enterovirulent Escherichia coli isolated from yaks(Poephagus grunniens) with haemorrhagic diarrhoea

Objective:To evaluate the antimicrobial efficacy of berberine,a plant alkaloid.Methods:Five multi-drug resistant（MDR） STEC/EPEC and five MDR ETEC isolates from yaks with haemorrhagic diarrhoea were selected for the study.Antibacterial activity of berberine was evaluated by broth dilution and disc diffusion methods.The binding kinetics of berberine to DNA and protein was also enumerated.Results:For both categories of enterovirulent Escherichia coli（E.roli） isolates, berberine displayed the antibaclerial effect in a dose dependent manner.The MIC50 of berberine chloride for STEC/EPEC isolates varied from 2.07μM to 3.6μM with a mean of（2.95±0.33）μM where as for ETEC strains it varied from 1.75 to 1.96μM with a mean of（1.87±0.03）μM. Berberine bind more tightly with double helix DNA with Bmax and Kd of（24.68±2.62） and（357.8±57.8）,respectively.Berberine reacted with protein in comparatively loose manner with Bmax and Kd of（18.9±3.83） and 【286.2±113.6),respectively.Conclusions:The results indicate clearly that berberine may serve as a good antibacterial against multi drug resistant E.coli.

Potential of Zimbabwean commercial probiotic products and strains of Lactobacillus plantarum as prophylaxis and therapy against diarrhoea caused by Escherichia coli in children

Objective: To evaluate the potential of commercial fermented products sold in the country,and strains of Lactobacillus plantarum(L,plantarum)as prophylaxis and therapy against diarrhoea in children,Methods: The antimicrobial potential of cultures of lactobacilli enriched from 4 Zimbabwean commercial food/beverage products: Dairibord Lacto sour milk(DLSM),Probrand sour milk(PSM),Kefalos Vuka cheese(KVC) and Chibuku opaque beer(COB); and four strains of L,plantarum obtained from Balkan traditional cheeses against clinical strains of Escherichia coli(E,coli) was assayed using the well diffusion method,Three commercial paediatric antidiarrhoeal drug products: Biogaia(BG),Prolife(PL) and Probio Junior(PJ) and a mutant strain of E,coli [strain 11105(ATCC)- a vitamin B-12 auxotroph and penicillin G acylase-producing strain] were used as controls,An agar diffusion assay and a competitive exclusion assay were carried out on Mueller Hinton agar,Results: Crude cultures of putative lactobacillus strains obtained from Zimbabwean dairy products(Probrand sour milk,Kefalos Vuka vuka cheese and Chibuku opaque beer) had significantly higher antimicrobial activities against clinical strains of E,coli than strains of L,plantarum isolated from Balkan cheeses(CLP1,CLP2 or CLP3) and crude microbial cultures from commercial paediatric probiotic products(BG,PJ and PL) of a culture of Lactobacillus rhamnosus LGG(P<0.05),Conclusions: The putative Lactobacilli from four commercial Zimbabwean dairy products(Probrand sour milk,Kefalos Vuka vuka cheese and Chibuku opaque beer),and three strains of L,plantarum from Balkan cheeses(CLP1,CLP2 or CLP3) exhibited high antibacterial activities that can be harnessed to control paediatric diarrhoea that is caused by pathogenic strains of E,coli,Studies to characterise the probiotic potential of the live cultures in the products and the new strains of L,plantarum are underway.

Global research on Clostridium difficile-associated diarrhoea:A visualized study

BACKGROUND Clostridioides(Clostridium)difficile(C.difficile)is still the most common cause of healthcare-associated diarrhoea and is increasing in prevalence as a communityacquired infection.In addition,the emergence of antibiotic resistance in C.difficile can increase the likelihood of the disease developing and/or spreading.AIM To provide an up-to-date picture of the trends in publications related to C.difficile infection,together with specific insights into hot-button issues in this field.METHODS Publications on C.difficile infections in the field of microbiology between 2001 and 2020 were identified from the Scopus database and Reference Citation Analysis.Bibliometric indicators were determined,including the number and type of publications,countries,affiliations,funding agencies,journals and citation patterns.VOSviewer was used to determine research areas and hot-button issues by identifying recurring terms with a high relative occurrence in the title and abstract.RESULTS A total of 8127 documents on‘C.difficile-associated diarrhoea’published between 2001 and 2020 were retrieved from the Scopus database.In the last decade,there has been a significant almost fourfold increase in the number of published papers on this topic.The United States was among the countries(44.11%)with the most publications,and the most involved institution was the University of Leeds in the United Kingdom(2.50%).Three clusters of research were identified and included‘illness spectrum and severity,as well as the signs,symptoms and clinical pathogenesis of C.difficile’;‘laboratory diagnosis and characterization of C.difficile’and‘risk factors for C.difficile infection’.CONCLUSION This study contains the most up-to-date and comprehensive data ever compiled in this field.More international research and cross-institutional collaborations are needed to address more global C.difficile concerns and to benefit from greater sharing of expertise,which will result in higher quality or more effective studies in the future.Promising research avenues in the near future may draw the attention of relevant scientists and funding organizations and open up novel C.difficile infection–based diagnosis and treatment approaches.

Anti-Colorectal Cancer Chemotherapy-Induced Diarrhoea: Current Treatments and Side-Effects

Chemotherapy-induced diarrhoea (CID) is a common side-effect experienced by patients being treated with a variety of antineoplastic agents. Approximately 80% of patients undergoing chemotherapeutic treatment for colorectal and other gastrointestinal cancers present with CID;moreover, about 5% of early deaths associated with combination anti-cancer chemotherapy are due to CID. Chronic post-treatment diarrhoea amongst cancer survivors can persist for more than 10 years greatly effecting long-term quality of life. Gastrointestinal toxicities such as diarrhoea and vomiting are amongst the primary contributors to dose reductions and delays throughout anti-cancer treatment, presenting a significant hurdle in clinical management of anti-cancer regimes and often result in sub-optimum treatment. However, little is known about pathophysiological mechanisms underlying CID. This work provides a review of chemotherapy-induced diarrhoea, current management guidelines, and shortcomings of current treatments as well as emerging and already existing anti-diarrhoeal treatments potentially suitable for CID.

Prevalence of Diarrhoea and Associated Factors among Under-Five Children in Jigjiga District, Somali Region, Eastern Ethiopia

Background: Diarrheal disease is a major cause of morbidity and mortality among children in many developing countries, including Ethiopia and is a leading cause of morbidity in Pastoralist Ethiopian-Somali region. Diarrheal disease is not purely medical, but huge part of this should be traced back to the social, economic, environmental and behavioural aspects of the family. Determining these interactions is relevant to prevent and control diarrhoea. Objective: The objective of this study was to measure the prevalence of diarrhoea and describe associated factors relating to diarrheal disease among under-five children in Jigjiga district. Methods: A cross-sectional study was conducted in Jigjiga district from June 12 to 26 in 2014 using a structured and pretested questionnaire. A total of 1807 primary care takers were interviewed. Proportionate to size allocation was done and simple random selection was used to select sample units. Diarrheal morbidity occurred in the under-five children in the past 14 days were registered to determine prevalence. Data were entered using Epi Info version 3.5.3 and analysed in SPSS version 20. Odds ratio with 95% CI in a multivariate logistic regression was employed to control confounding factors. Results: The findings of this study showed that the overall two-week period prevalence of diarrhoea in under-five children was 27.3%: 95% CI (26.9%, 27.4%). Education of the primary caretaker, occupation of the father, birth order of the child, maternal diarrhoea, and hand washing during critical times, water source, type of water storage container, latrine availability, frequency of household solid waste water disposal, availability of liquid waste water drainage system and the type of the kitchen floor material showed as independent predictors of under-five child hood diarrhoea. Conclusion: This study revealed that diarrhoea morbidity was relatively high among children under-five years of age residing in Somali region. Efforts to reduce childhood diarrhoea should focus mainly on water, sanitation and hygiene interventions including health education.

Unremitting diarrhoea in a girl diagnosed anti-N-methyl-D-aspartatereceptor encephalitis:A case report

BACKGROUND Asymptomatic cytomegalovirus(CMV)infection is common in children;in contrast,in children with a weakened immune system,invasive CMV can occur.This is the first case report of a severe manifestation of CMV esophagoenterocolitis in a girl diagnosed with anti-N-methyl-D-aspartate-receptor(antiNMDAR)encephalitis who received only a moderate dose of corticosteroid therapy.CASE SUMMARY A 12-year-old-Thai girl presented with acute behavioural change and headache for 6 d.Electroencephalogram and positivity for NMDAR autoantibodies were compatible with anti-NMDAR encephalitis.Hence,she received pulse methylprednisolone 10 mg/kg per day for 4 d and continued with prednisolone 1.2 mg/kg per day.On day 42 of corticosteroid therapy,she developed unremitting vomiting and diarrhoea.Endoscopy showed multiple ulcers and erythaematous mucosa along the gastrointestinal tract.Tissue CMV viral load and viral-infected cells confirmed CMV esophago-enterocolitis.Therefore,the patient received ganciclovir 5 mg/kg per dose every 12 h for 3 wk and then 5 mg/kg per dose once daily for 3 wk.Unremitting diarrhoea slowly improved from stool output 1-4 L per day to 1-2 L per day after 3 wk of treatment.Pulse methylprednisolone 20 mg/kg for 5 d was initiated and continued with prednisolone 1 mg/kg per day.After this repeated pulse methylprednisolone treatment,surprisingly,diarrhoea subsided.Immunologic work-up was performed to rule out underlying immune deficiency with unremarkable results.CONCLUSION Unremitting diarrhoea from CMV esophago-enterocolitis subsided with antiviral and methylprednisolone therapy,implying the immune and NMDAR dysregulation in anti-NMDAR encephalitis.

Univariate and multivariate analysis of risk factors for severe clostridium difficile-associated diarrhoea: Importance of co-morbidity and serum C-reactive protein

AIM: To investigate risk factors for severe clostridium difficile associated diarrhoea (CDAD) in hospitalised patients. METHODS: We analysed risk factors for severe CDAD (associated with systemic signs of hypovolemia) in 124 hospitalised patients by retrospective chart review. RESULTS: Severe CDAD was present in 27 patients (22%). Statistical analysis showed a significant association with a higher 30-d mortality (33% vs 4%, P < 0.001) and a higher proportion of longer hospital stay exceeding 14 d (74% vs 52%, P = 0.048). Charlson co-morbidity score (OR 1.29 for 1 point increment, P < 0.05) and serum C-reactive protein at diagnosis (OR 1.15 for 10 mg/L increment, P < 0.001) were independent predictors of severe CDAD. CONCLUSION: Patients with a severe level of co- morbidity and high serum C-reactive protein levels at the time of diagnosis should receive particular attention.

Knowledge and practice of care-givers who have under-five diarrhoeal children:a quantitative cross-sectional study in Mataniko settlements in Honiara, Solomon Islands, 2016

Introduction:Diarrhoea remains the second most serious health problem among children below five years old in Solomon Islands and is one of the leading causes of infant mortality,which caused about one in every ten children dying before the age of five years.Globally,around 6 million children (＜5 years) suffer from diarrhoea each year.Because of lack of previous studies,this study aims to assess the predictors of knowledge and practice of caregivers towards diarrhoea among under-five children in Mataniko informal settlements in Honiara,Solomon Islands,2016.Methods:This quantitative study was conducted at three randomly selected settlements in Honiara,Solomon Islands from June to July 2016.This study was conducted among both male and female caregivers who had children under five years of age,were aged 18 and over,live in Solomon Islands and were willing to participate in the study.A validated structured questionnaire was used to collect the data based on a 2-week recall of diarrhoea episodes.To avoid double-counting,each surveyed household was geo-referenced using global positioning system (GPS).The collected data were entered and analysed using SPSS (version 23.0) and descriptive and analytical statistics.P＜0.05 was considered as statistically significant.This study was approved by relevant ethical committees.Results:A total of 205 caregivers with at least one child under-five years participated in the study.The mean ages of caregivers and the under-five children were (30.7+8.2) years and (2.6+1.5) years,respectively.Among 205 caregivers,94 of them had reported that their children (＜5 years) had suffered with at least one episode of diarrhoea within the last 2 weeks prior to the survey.This gave a prevalence rate of 45.9％.The caregiver's knowledge about the causes (99.0％) and prevention (98.0％) of under-five diarrhoea was extremely high.Nevertheless,less than half had regularly practiced essential hygiene habits.The factors which appeared to be significantly associated with under-five diarrhoea were irregular hand washing (odds ratio [OR] 2.07,95％ confidence interval [CI]:1.12-3.81,P=0.020),inappropriate methods of disposing of children's fecal waste (OR 1.88,95％ CIL 1.06-3.33,P=0.030),and using the river for bathing (OR 1.83,95％ CI:1.04-3.23,P=0.036),and laundry (OR 2.17,95％ CI:1.23-3.84,P=0.008).Conclusion:Diarrhoea is a major public health problem among children below five years in Mataniko informal settlements.To address these exposures,relevant programs and projects should be designed,especially in areas like family planning,household economic allocation and political commitment.Awareness and advocacy programs on birth spacing,food hygiene and potential health risks about the river should be ongoing at the community level.

Assessment of Counselling for Acute Diarrhoea in North-Eastern German Pharmacies—A Follow-Up Study Using the Simulated Patient Methodology

Aim: As the primary aim of this study, we analysed whether the quality of advice provided by pharmacies in the period between 2014 (baseline study) and 2017 (follow-up study) could actually be increased using a single written performance feedback given to each pharmacy in 2014. The secondary aim of the follow-up examination was to analyse whether the quality of advice differed depending on the professional group providing the advice. Methodology: To ensure the least possible distortion in the comparison between the baseline and the follow-up studies, the study design used for the follow-up examination in 2017 was not changed compared to the baseline examination in 2014. The data for the follow-up examination were therefore collected using the simulated patient method in all 21 pharmacies in a city in the north-east of Germany. Three female and two male test buyers used four different scenarios for self-medication of acute diarrhoea in all of the pharmacies (a total of 84 test purchases). Results: There were significant differences between the overall results from the baseline study (2014) and the follow-up study (2017) (Wilcoxon signed rank test;z = &ndash;2.065, p = 0.039, r = 0.225). In the overall average, the pharmacies in 2017 achieved only 2.7 (30%) of 9 possible points whereas in 2014 they achieved 3.3 (37%). The quality of advice between the professional groups did not show any significant differences (Kruskal-Wallis test: χ2(2) = 1.946;p = 0.378, r = 0.027). Conclusions: The quality of advice for acute diarrhoea in adults declined over time. A written performance feedback intended to improve the quality proved ineffective. Interventions with a far greater impact are required to achieve an improvement in the quality of advice provided.

Experimental Induction of <i>Escherichia coli</i>Diarrhoea in Weaned Piglets

Escherichia coli diarrhoea is a multifactorial condition which usually occurs during the post-weaning and is responsible for economic losses in pig production. One approach, to evaluate if substitute of antibiotic in vivo is effective in controlling postweaning diarrhea in the gastrointestinal tract ecosystem, is to use an appropriate disease model. However, there are still many criticisms related to the incidence and the severity of the diarrhoea in the experimental conditions. The aim of the study was to set up an Escherichia coli challenge model in order to induce a significant percentage of diarrhoea in weaned piglets for the evaluation of innovative compounds in vivo. A total of 35 piglets, weaned at 33±2 days were randomized into 3 groups: control (CG), infected 1 (IG1) and infected 2 (IG2). One day after arrival piglets of IG1 and IG2 were orally inoculated with 3.7 × 108 CFU of Escherichia coli O149. All piglets were fed a high protein ration for 3 days. Daily health status and faeces were recorded by a point scale individually. Challenge strains in faecal samples were evaluated by polymerase chain reaction, serotyping and biochemical identification. Diarrhoea was observed in 96.67% (58.6% severe;41.4% mild) of all infected piglets and occurred on average 1.3 days after the challenge. The CG group presented one piglet with a transient mild diarrhoea. The E. coli challenge significantly affected the consistency and color of faeces (P E. coli O149, mainly hemolytic (88%), was isolated in 56% of faecal samples and the 70% of piglets with severe diarrhoea shed E. coli O149 in the faeces. Zootechnical parameters did not show significant differences. The experimental conditions described in this study allowed to effectively induce diarrhoea in weaned piglets. In conclusion a multifactorial approach (infectious, nutritional and management) is necessary to reproduce in vivo diarrhea in piglets.

Prevalence of diarrhoea and its associated factors in children under five years of age in Baghdad, Iraq

Introduction: Diarrhoeal disease is one of the principal causes of morbidity and mortality among children in developing countries. Poor nutrition leads to ill health and it contributes to further deterioration in nutritional status. Methodology: A cross-sectional study was conducted in Baghdad, Iraq. The study was conducted in three paediatric hospitals and from paediatric departments in other three general hospitals in Baghdad, Iraq. Sample was drawn conveniently, three paediatric hospitals from Baghdad hospital list. 150 respondents were chosen from these paediatric hospitals and 50 respondents were chosen from the paediatric departments in three general hospitals. Results: males had twice the risk of diarrhoea (OR 1.9, 95% CI 1.1;3.5). The risk of diarrhoea was 3 times higher among children with mothers who had lower level of education (OR 3.5 95% CI 1.3;10.1), 5 times higher with unemployed mothers (OR 4.7 95% CI 2.1;10.4) and 2 times higher with mothers who had poor nutritional knowledge (OR 2.5 95% CI 1.4;4.9). The risk of diarrhoea was three times higher among children with fathers who had lower level of education (OR 3.3 95% CI 1.7;6.6). The binomial logistics regression, Mothers’ level of education and employment status, fathers’ level of education, mothers’ nutritional knowledge were used as possible independent associated factors. Conclusion: Children in Baghdad remain at risk of frequent diarrhoea episodes and other complications which might affect their development status. It is becoming increasingly important to focus on improving the underlying factors by increasing the mother nutritional knowledge through special antenatal classes, and improving family economic status.

Adenovirus and Rotavirus Associated Diarrhoea in under 5 Children from Enugu Rural Communities, South East Nigeria

Globally, diarrhoea is the second commonest infectious cause of death in children less than 5 years old. It is estimated that more than one billion diarrhoea episodes occur every year causing up to 700,000 deaths among children younger than 5 years of age. Seventy-two percent of these deaths occur in children below two years and enteric viruses have been recognized as a major cause of childhood diarrhoea. This study was undertaken to determine the prevalence of enteric Adenoviruses and Rotaviruses in children with diarrhoea in rural Enugu communities of Enugu State South East Nigeria. Methods: Stool samples were collected from children less than 5 years with diarrhoea seen in any of the participating hospitals in Enugu State. Samples were collected between June 2015 and May 2017. Detection of rotavirus and enteric adenovirus antigens were performed using commercially available ELISA kit (Oxoid-ProspecT&#174;). Demographic data of the children were also collected. Results: Of the 290 stool samples that had sufficient materials for adenovirus and rotavirus ELISA, 14 (4.8%) and 89 (30.7%) were positive for enteric adenovirus and rotavirus respectively. 3 (1%) were co-infected with adenovirus and rotavirus. Rotavirus positive cases were more among hospitalized patients while enteric adenovirus was more among outpatients. Marked peaks of rotavirus positivity were seen in January of each year but no peak was seen among adenovirus positive cases. Higher vomiting frequencies and severe dehydration were more among rotavirus positive cases compared to adenovirus positive cases (p = 0.030 and 0.001 respectively). Conclusion: Many diarrhoea cases among children aged <5 in the population studied were associated with enteric adenoviruses and rotavirus. This finding suggests that enteric viral agents (adenovirus and rotavirus) are important aetiologies for childhood diarrhoea in Enugu state Nigeria. Appropriate preventive, diagnostic and treatment interventions should be instituted so as to reduce the mortality and morbidity associated with these viruses.

Use of Probiotic Yogurt in the Management of Acute Diarrhoea in Children. Randomized, Double-Blind, Controlled Study

Background: In Bolivia there are few probiotic preparations available in the market, practically without alternatives to the use of freeze-dried products. An alternative used as a good alternative in other parts of the world is yogurt with a probiotic strain added. In this study we report the use of a locally prepared yogurt with a lyophilized probiotic added. Methods: This is randomized, double-blind and controlled clinical trial in children hospitalized with acute diarrhoea carried out at the Paediatric Centre Albina Pati?o in Cochabamba, Bolivia with children 10 to 35 months participating. Children were randomly assigned to receive an oral rehydration solution and Saccharomyces boulardii (positive control) or the same solution plus yogurt preparation containing Lactobacillus rhamnosus (yogurt group). The primary outcome was the duration of diarrhoea. Secondary outcomes were the duration of fever, vomiting and hospitalization. Results: Of the 74 children incorporated 42 completed the protocol;baseline characteristics were similar in both groups. The median duration of diarrhoea was similar in children who received yogurt (71 hours) and controls (79 hours) (p = 0.3). The mean duration of fever was also similar in both groups: S. boulardii (24 hours) or yogurt (11 hours) (p = 1.02), as was the duration of vomiting: 17 hours vs. 32 hours in the control group (p = 0.37). A significant difference in the numbers of daily bowel movements was observed in the third day, the probiotic group was lower (p = 0.01). There was no effect on the duration of hospitalization (p = 0.26). Conclusions: The use of a yogurt containing L. rhamnosus has an effect comparable to S. boulardii. Introduction of yoghurt with a probiotic in the diet of patients hospitalized with acute diarrhoea may help reduce its duration, regardless of its aetiology.

Utilizing Healthcare Developments, Demographic Data with Statistical Techniques to Estimate the Diarrhoea Prevalence in India

Diarrhoea is one of the leading causes of morbidity and mortality in developing countries in Africa and South Asia such as India. Prevalence of diarrheal diseases in those countries is higher than developed western world and largely has been associated with socio-economic and sanitary conditions. However, present available data has not been sufficiently evaluated to study the role of other factors like healthcare development, population density, sex and regional influence on diarrheal prevalence pattern. Study was performed to understand the relationship of diarrheal prevalence with specific measures namely;healthcare services development, demographics, population density, socio-economic conditions, sex, and regional prevalence patterns in India. Data from Annual national health reports and other epidemiological studies were included and statistically analyzed. Our results demonstrate significant correlation of the disease prevalence pattern with certain measures like healthcare centers, population growth rate, sex and region-specific morbidity. Available information on sanitation like water supply and toilet availability and socioeconomic conditions like poverty and literacy measures could only be associated as trends of significance. This study can be valuable for improvisation of appropriate strategies focused on important measures like healthcare resources, population growth and regional significances to evaluate prevalence patterns and management of the diarrhoea locally and globally.

Treatment of Diarrhoea in Humans Using Lactobacillus salivarius PROBIOTIC Isolated from Human Saliva

In this study, Lactobacillus salivarius was isolated from human saliva by culture technique using MRS medium, identified through relevant biochemical protocols, and compared to a known control of Lactobacillus acidophilus sourced from Puritan Pride Inc., Qadelade, New York, USA. Primary isolation of microorganisms of interest was carried out at Cheznik Diagnostic and Research laboratories while animal preparation and treatment were carried out at Animal Farm, Mgbakwu Awka. Twenty wistar rats were used as the test animals and another twenty for positive control. The animals in the test group were induced to diarrhea using 1 ml of castor oil following 12-hour fasting while the control group was fed with daily feed and distilled water. The test animals upon production of diarrhoeic stool were fed with 1 × 109 cfu/ml (410 mg/dl w/v) of the Lactobacillus sp isolate in distilled water. The diarrhoea was resolved within 24 hours of treatment. The average weights of the animals taken just after preparation and early treatment (Tx) showed appreciable loss in weight among the test animals possibly due to stress compared to initial weight at T0. However, upon continued treatment with the isolate, obvious weight gain (Tf) compared to Tx was observed. The results of the haematological data at the final analysis showed proximal values and consistency to that of the control group following administration of the Lactobacillus sp isolate. The routine general health data of the test animals showed marked improvement upon treatment with the isolate. A test of significance at 0.05 showed a positive agreement (p Lactobacillus sp showed marked sensitivity to erythromycin, ceftazidine, and chloromphenicol antimicrobial drugs just like other known probiotic strains. No known health hazard or death was recorded. From the study, it was observed that saliva can also proffer a good site in addition to the gut and ileum for the isolation of probiotic microorganisms. It has also shown that the presumptive Lactobacillus salivarius, though strain-specific, possesses probiotic properties effective in resolving most gut issues but especially in diarrhoeic cases.

Diagnosis and treatment of post-cholecystectomy diarrhoea

The incidence of cholecystitis is relatively high in developed countries and may usually be attributed to gallstones,the treatment for which involves complete surgical removal of the gallbladder(cholecystectomy).Bile acids produced following cholecystectomy continue to flow into the duodenum but are poorly absorbed by the colon.Excessive bile acids in the colon stimulate mucosal secretion of water and electrolytes leading,in severe cases,to diarrhoea.Bile acid diarrhoea(BAD)is difficult to diagnose,requiring a comprehensive medical history and physical examination in combination with laboratory evaluation.The current work reviews the diagnosis and treatment of BAD following chole-cystectomy.

Household Survey on Access to Medicines Used for the Treatment of Diarrhoea in Musoma Municipal Council, Tanzania

Background: Access to medicines is part of the human right to health. According to WHO, access to medicine is measured by how easily households obtain medicines for acute and chronic conditions including diarrhoea through household surveys. Diarrhoea is among the top ten leading causes of death. Anti-diarrhoea medicines save lives but, should be available and obtainable to do so. The objectives of this study were to determine anti-diarrhoea medicines used by households, their sources and factors affecting their accessibility in Musoma Municipal. Methods: A cross-section survey was conducted in Musoma Municipal Council, Mara, Tanzania. The lottery method of simple random sampling was used to select three wards and pick three streets from each ward. The study population was 255 household heads from households selected by systematic random sampling from each street. A structured questionnaire was used to obtain information from household heads. Results and Discussion: Males (51.8%) had more diarrhoea illnesses than females (48.2%). Distinctive household heads (52.6%) had primary education. The majority, (79.1%) of all diarrhoea patients were recommended/prescribed anti-diarrhoea medicines. Of those whom anti-diarrhoea medicines were prescribed/recommended, 63.5% adhered to the prescriber’s/dispenser’s instructions and obtained and used anti-diarrhoea medicines. The most frequent source of anti-diarrhoea medicines was ADDO (38%). Widely used anti-diarrhoea medicines were antimicrobials (77.5%) followed by ORS (17.5%). Reasons not to seek or obtain anti-diarrhoea medicines were;Patient started feeling better (56.3%), Alternative treatment (26%), Financial reasons (10%), Decided medicines weren’t needed (3.5%), Distance from source (2.2%), Reactions to medicine (1%). Utilization of primary health care services was only 21.5%. Under-fives were mostly prescribed with antimicrobials (62.5%) than ORS (31.2%) and Zinc (6.3%) in mild to moderate dehydration contrary to Standard treatment guidelines (STG) in Tanzania. Conclusion: Anti-diarrhoea medicines are moderately easily obtainable in Musoma Municipal (50% of all diarrhoea patients obtained medicines). Alternative treatment (26%) and financial reasons (10%) were vivid factors hindering access. Treatment of diarrhoea in under-five years old is not adhered to in Musoma Municipal (use of 62.5% of antimicrobials and only 31.2% of ORS in mild diarrhoea cases).