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).

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.

Effectiveness of traditional Chinese medicine in treating AIDS related diarrhoea:a meta-analysis

Background:To evaluate the efficacy of traditional Chinese medicine(TCM)in treating Acquired Immune Deficiency Syndrome(AIDS)related diarrhoea.Methods:Chinese and English databases(CBM,CNKI,Wanfang Database,PubMed,Web of Science,Cochrane Library)were searched up to November 2021.Studies that compared TCM with western medicine were included.RevMan 5.4,Stata 17,and Grading of Recommendations Assessment Development and Evaluation system were used for data analyses.The inclusion and exclusion criteria,quality assessment process,and potential biases were specified.Result:24 randomized controlled trial with a total of 1,766 participants of TCM compared with western medicine were included,12 of which reported random assignment methods.Meta-analyses showed that,TCM was more effective than western medicine in treating AIDS-related diarrhoea[RR=1.32,95%CI(1.26,1.39),P<0.01],internal treatment of TCM[RR=1.37,95%CI(1.28,1.46),P<0.01],external treatment of TCM[RR=1.27,95%CI(1.17,1.39)],internal and external treatment of TCM[RR=1.21,95%CI(1.07,1.37),P<0.01],Shenlingbaizhu Powder/Pill[RR=1.25,95%CI(1.13,1.39),P<0.01],Xielikang Capsules[RR=1.57,95%CI(1.33,1.84),P<0.01],Jianpizhixie Recipe[RR=1.31,95%CI(1.05,1.65),P<0.01],Moxibustion[RR=1.19,95%CI(1.07,1.32),P<0.01],Ginger Moxibustion[RR=1.24,95%CI(1.04,1.47),P<0.01],when compared to using western medicine alone and with significant differences.Conclusion:Shenlingbaizhu Powder/Pill,Xielikang Capsules,Jianpizhixie Recipe,Moxibustion and Ginger Moxibustion had certain advantages in improving the effective rate of AIDS-related diarrhoea,they needed to be further validated by high quality clinical trials.

牛诺如病毒感染相关腹泻犊牛粪便菌群的特征分析

[目的]比较哺乳期健康犊牛和感染牛诺如病毒(Bovine norovirus,BNoV)的腹泻犊牛粪便菌群多样性和物种组成,初步揭示BNoV感染的腹泻犊牛粪便菌群特征。[方法]首先应用PCR和RT-PCR法对健康和腹泻犊牛粪便中的腹泻相关病原进行检测,然后采用16S rRNA扩增子测序技术对病原检测阴性的健康犊牛粪便(H组)和仅BNoV检测阳性的腹泻犊牛粪便(BNoV组)的微生物多样性、菌群组成和功能进行比较分析。[结果]与H组相比,BNoV组粪便菌群操作分类单元(OTUs)数量和Chao1指数显著升高(P<0.05),Shannon和Simpson指数极显著降低(P<0.01)。与H组相比,BNoV组粪便变形菌门、埃希-志贺属、丁酸球菌属丰度极显著升高(P<0.01),放线菌门、柯林斯菌属、巨球型菌属、厄氏菌属、双歧杆菌属、粪杆菌属等丰度极显著或显著降低(P<0.01;P<0.05)。双歧杆菌属、柯林斯菌属、巨球型菌属、厄氏菌属、粪杆菌属等在H组显著富集,而丁酸球菌属、埃希-志贺属、脆弱拟杆菌、梭菌属等在BNoV组显著富集。与H组相比,BNoV组粪便菌群胞内过程和信号传导、脂质代谢、新陈代谢、异生物质生物降解与代谢、萜类和聚酮类化合物代谢等显著或极显著上调(P<0.05;P<0.01),而膜转运、复制与修复、翻译、核苷酸代谢、遗传信息处理等显著或极显著下调(P<0.05;P<0.01)。[结论]感染BNoV的腹泻犊牛粪便菌群丰富度、多样性、物种组成和功能与健康犊牛显著不同,提示BNoV感染犊牛处于肠道菌群紊乱状态。

茵黄益肠合剂对脾胃虚弱型糖尿病性腹泻患者血糖、血脂及炎性标志物的影响

目的 观察茵黄益肠合剂对脾胃虚弱型糖尿病性腹泻患者血糖、血脂及炎性标志物的影响。方法 选取2022年8月—2023年7月昆明市中医医院收治的脾胃虚弱型糖尿病性腹泻患者60例,按入院时间先后顺序随机分为观察组和对照组各30例。对照组采用西医常规治疗,观察组在对照组的基础上加用茵黄益肠合剂治疗,2组疗程均为14 d。比较2组治疗前后血糖指标[空腹血糖(FPG)、果糖胺(FA)]、血脂指标[总胆固醇(TC)、三酰甘油(TG)]、炎性标志物[C反应蛋白(CRP)、白介素-6(IL-6)、降钙素原(PCT)、血清淀粉样蛋白(SAA)]及不良反应。结果 治疗14 d后,2组血清FPG、FA、TC、TG、CRP、IL-6、PCT及SAA水平较治疗前降低,且观察组血清FPG、TC、TG、CRP、IL-6、PCT水平低于对照组(P<0.05或P<0.01),而2组FA、SAA水平比较差异无统计学意义(P>0.05)。2组整个服药过程中均未发现明显不良反应。结论 茵黄益肠合剂治疗脾胃虚弱型糖尿病性腹泻的效果优于单纯西医治疗,能显著改善血糖、血脂及炎性标志物水平,且未发现明显不良反应,安全性较高。

中药组方对大肠杆菌致小鼠腹泻治疗效果研究

【目的】研究中药组方对犊牛源大肠杆菌致小鼠腹泻的治疗效果,为中药治疗大肠杆菌致犊牛腹泻提供参考依据。【方法】将162只小鼠随机分为9组,空白组、模型组、中药治疗组(2个组方各3个浓度(1.5、1.0、0.5 g/mL))和西药治疗组,每组3个重复,每个重复6只。除空白组外,其余各组小鼠腹腔注射0.5 mL 1×10~8 CFU/mL的大肠杆菌悬液,小鼠出现腹泻后,中药组小鼠分别灌喂0.2 mL不同浓度中药组方提取液(白头翁汤加减和乌梅散加减),西药组小鼠灌喂0.2 mL恩诺沙星,模型组小鼠灌喂0.2 mL蒸馏水,持续7 d。每天记录小鼠体重、采食量,治疗第3天时统计腹泻指数;治疗第7天剖检小鼠,检测小肠病理变化,利用ELISA法检测回肠黏膜分泌型免疫球蛋白(sIgA)、多聚免疫球蛋白受体(pIgR)含量,利用实时荧光定量PCR检测十二指肠Claudin-1、Occludin和ZO-1基因mRNA相对表达量。【结果】与模型组相比,经2个中药组方治疗后腹泻小鼠体重、采食量均可显著增加(P<0.05),腹泻指数显著降低(P<0.05),改善了小肠病理组织学病变,促进了肠绒毛损伤的修复。与模型组相比,2个组方均可显著提高小鼠肠黏膜sIgA、pIgR含量(P<0.05)及十二指肠Claudin-1、Occludin和ZO-1基因mRNA相对表达量(P<0.05)。1.0 g/mL乌梅散加减在2个中药组方中治疗效果最佳,与西药组相比,在小鼠肠组织形态、肠黏膜免疫球蛋白含量及紧密连接蛋白mRNA的相对表达量上不存在显著差异。【结论】乌梅散加减和白头翁汤加减均可降低小鼠腹泻指数,改善肠道病理损伤,其中乌梅散加减的治疗效果更显著,本研究可为中药治疗大肠杆菌致犊牛腹泻提供参考。

猪流行性腹泻病毒YL株分离鉴定及仔猪感染试验

从腹泻仔猪肠道组织中分离获得猪流行性腹泻病毒(PEDV)地方分离株,并对其致病性进行初步分析。对陕西某养殖场采集有腹泻症状3~5日龄仔猪的十二指肠,经RT-PCR检测为PEDV核酸阳性。将阳性样品处理后接种Vero细胞进行病毒分离,并对分离毒株进行病毒含量测定、致病性试验。结果显示,分离到1株PEDV毒株(命名为YL株)。将分离的PEDV病毒液以不同滴度口服接种健康仔猪,2.0 mL/头,发现10^(5.5)TCID_(50)/mL剂量组接种1日后,100%(3/3)试验猪出现腹泻症状。

犊牛腹泻的病因及中草药治疗研究进展

犊牛腹泻是影响犊牛生长发育的主要疾病之一。造成犊牛腹泻的因素有细菌、病毒、寄生虫性腹泻及非感染因素。细菌性腹泻是犊牛临床常见的腹泻原因之一,其发生机制主要是细菌进入肠道后大量增殖,破坏肠道菌群的平衡,进而对犊牛的肠黏膜屏障造成严重破坏。中草药具有调节机体肠道菌群、增强免疫功能、降低犊牛腹泻率等作用。文章对犊牛腹泻的病因及其中草药治疗研究进展进行综述,为中草药临床治疗犊牛腹泻的应用提供参考。

《重订古今名医临证金鉴·腹泻便秘卷》论治泄泻用药规律分析

目的:通过探讨古今名医治疗泄泻的用药规律,为临床用药提供借鉴。方法:收集整理《重订古今名医临证金鉴·腹泻便秘卷》中古今名医治疗泄泻的有效处方,共纳入49位医家治疗泄泻的处方204首,将处方所涉及的单味中药录入Excel 2022软件建立用药数据库,应用SPSS Modeler 18.0统计学软件提供的Apriori算法进行单味药物频次分析、关联分析,应用SPSS Statistics 27.0统计学软件进行聚类分析,通过多角度挖掘治疗泄泻的用药规律与特征。结果:共纳入49位名医治疗泄泻的处方204首,涉及药物230味,用药频次1731次,用药频次高达30次以上的中药有甘草、白术、茯苓、白芍、陈皮、木香等12味。关联规则按支持度≥10%、置信度≥80%,获得“茯苓+甘草→白术”“陈皮+茯苓→白术”“白芍+茯苓→白术”等11个核心药对;聚类分析得到5个组合。结论:通过药物频次分析、关联分析等方法研究古今名医治疗泄泻的用药规律与特征,为临床治疗泄泻用药提供了参考与借鉴。

酵母肽和枯草肽对断奶仔猪生长性能、腹泻率和肠道健康的影响

【目的】旨在研究酵母肽和枯草肽对断奶仔猪生长性能、腹泻率和肠道健康的影响,为抗菌肽在仔猪养殖中的合理利用提供参考依据。【方法】生长试验选取21日龄“杜×长×大”三元杂健康断奶仔猪200头,随机分为5组,每组5个重复,每个重复8头。分别饲喂基础日粮、基础日粮+300 mg/kg酵母肽、基础日粮+500 mg/kg酵母肽、基础日粮+300 mg/kg枯草肽和基础日粮+300 mg/kg酵母肽+300 mg/kg枯草肽,预饲期7 d,正式试验28 d。诱导腹泻试验选取28日龄“杜×长×大”三元杂健康断奶仔猪30头,随机分成3组,每组10头。分别饲喂基础日粮、基础日粮+300 mg/kg酵母肽和基础日粮+500 mg/kg酵母肽,预饲期7 d,正式试验8 d,前3 d用未经氯化消毒井水拌料饲喂诱导腹泻,后5 d用氯化消毒井水拌料饲喂。【结果】(1)生长试验中日粮添加不同剂量酵母肽和枯草肽对断奶仔猪的生长性能无显著影响(P>0.05),但诱导腹泻试验中,酵母肽成剂量依赖性降低仔猪腹泻率;(2)添加500 mg/kg酵母肽显著提高仔猪血液中谷胱甘肽过氧化物酶(GSH-PX)的活力;(3)添加枯草肽300 mg/kg显著提高空肠绒毛高度和绒/隐比(P<0.05)和空肠紧密连接蛋白Claudin-1的mRNA表达量(P<0.05)。(4)添加300 mg/kg酵母肽+300 mg/kg枯草肽能显著降低血液中白介素-1β(IL-1β)的含量(P<0.05),提高空肠绒毛高度和隐窝深度(P<0.05),同时显著升高Coverage指数(P<0.05),Simpson指数有升高的趋势(0.05<P<0.1)。【结论】饲料中添加500 mg/kg的酵母肽能够有效预防仔猪腹泻的发生,提高免疫球蛋白水平,抗氧化能力。单独添加300 mg/kg枯草肽或混合添加300 mg/kg酵母肽和300 mg/kg枯草肽可以增加肠道吸收和屏障功能,降低肠道炎症,改善肠道微生物的多样性。

河北省部分地区腹泻犊牛源大肠埃希氏菌毒力基因检测与耐药性分析

为明确河北省部分地区大肠埃希氏菌携带的毒力因子情况及对药物的敏感度,更好地控制由致病性大肠埃希氏菌导致的犊牛腹泻,从河北省部分地区(廊坊、定州、石家庄、保定、衡水、邢台)的牛场采集了128份腹泻犊牛粪样,从中分离大肠埃希氏菌,利用PCR对分离的大肠埃希氏菌进行毒力因子和耐药基因的检测,并采用K-B纸片法对分离菌株进行12种抗菌药物的药物敏感性试验。结果显示,从128份腹泻犊牛粪便中分离到菌株125株,其中104株为大肠埃希氏菌。104株分离菌中61株携带毒力基因,毒力基因携带率为58.70%(61/104),毒力基因F17、Stx1、irp2、FyuA、STa、Stx2阳性率分别为17.31%、0.08%、24.04%、35.58%、10.58%、0.04%,未检测出K99、F41、LT和eaeA基因,部分大肠埃希氏菌携带多重毒力因子。16种耐药基因的检测显示aph(3'')-Ib、tetC、sul3、qnrA、qnrC、tetB、aac(6′)-Ⅰb、tetA、bla TEM、bla CTX-M、sul1、sul2、oqxA、oqxB、qnrS、qnrB阳性率分别为59.62%、26.0%、28.85%、0.05%、32.69%、29.81%、46.15%、48.08%、82.69%、78.85%、55.77%、74.04%、25.00%、30.77%、43.27%、0.07%。药物敏感性试验结果显示,104株分离菌耐2种以上抗菌药物的菌株达86.62%,对卡那霉素、恩诺沙星和环丙沙星敏感率较高,研究结果可为河北省部分地区大肠埃希氏菌性犊牛腹泻的防治提供理论依据。

ICU老年有创机械通气患者早期肠内营养喂养不耐受现状及影响因素分析

目的:调查ICU老年有创机械通气患者喂养不耐受的现状并探究其影响因素,为识别喂养不耐受高危人群提供理论依据。方法:本研究选取实施肠内营养支持治疗的老年有创机械通气患者202例作为研究对象。采用一般情况资料调查表、肠内营养不耐受状况调查表进行持续5 d的数据收集,采用二元Logistic回归方程进行多因素分析。结果:二元Logistic回归结果显示,鼻饲速度>40 mL·h^(-1)(OR=5.826)、使用血管活性药物(OR=2.581)、呼吸末正压增高(OR=0.821)、低血清白蛋白(OR=1.050)是老年有创机械通气患者喂养不耐受的危险因素,床头抬高≥30°(OR=0.339)、使用可溶性膳食纤维(0R=0.325)是老年有创机械通气患者喂养不耐受的保护因素,差异具有统计学意义(P<0.05)。结论:鼻饲速度、血管活性药物、呼吸末正压、血清白蛋白、床头抬高≥30°、使用可溶性膳食纤维是老年有创机械通气患者喂养不耐受的影响因素,临床工作中应关注以上因素以预测患者喂养不耐受的发生,保证患者营养供给,改善患者预后。

基于“脾主困”思想论治小儿泄泻

小儿泄泻与诸滞困脾关系密切。滞分虚实,虚滞为中土脏虚所生,实滞为寒食湿热及无形中气壅滞,多有虚实夹杂。小儿脾常不足,滞邪困脾,脾失运化,气机枢转反作,清阳不升,携未化谷液合污而下,发为泄泻。临证中,当以“解湿运脾,行滞调气”为治疗原则,善用醒脾运脾,辛温辛平轻清味药以复脾之生理,审证求因,行诸滞,使运化有节,升降有度。

牛肺表面活性剂治疗对肺透明膜病患儿呼吸力学及预后转归的影响

目的探究牛肺表面活性剂对肺透明膜病患儿呼吸力学及预后转归的应用效果。方法选取2021年2月-2022年2月在本院收治的NRDS患儿108例作为研究对象,按照治疗方法的不同分为44例对照组(常规治疗)和64例观察组(牛肺表面活性剂治疗)。对比两组治疗前后呼吸力学的变化情况、治疗后临床疗效以及治疗后并发症发生率。结果观察组患儿的静态肺顺应性、吸气峰流量均高于对照组(P<0.05)。两组相比,观察组患儿总有效率更高,并发症总发生率更低(P<0.05)。结论肺透明膜病患儿使用牛肺表面活性剂可以改善气体交换,能有效提升治疗效果,安全性尚可。

复方谷氨酰胺肠溶胶囊联合双歧杆菌四联活菌片治疗肠道菌群失调相关性腹泻的疗效

目的观察复方谷氨酰胺肠溶胶囊联合双歧杆菌四联活菌片治疗肠道菌群失调相关性腹泻的疗效。方法选取2022年中国人民解放军陆军第七十三集团军医院收治的肠道菌群失调相关性腹泻患者100例,按双色球法分为双歧杆菌组(n=50)与联合治疗组(n=50)。双歧杆菌组给予双歧杆菌四联活菌片治疗,联合治疗组在双歧杆菌组基础上联合复方谷氨酰胺肠溶胶囊治疗,2组均治疗30 d。比较2组临床疗效,治疗前与治疗30 d后真菌感染、细菌计数减少、杆球比例倒置情况及世界卫生组织生存质量测定量表简表(WHOQOL-BREF)(生理、心理、社会关系、环境)评分、症状(腹胀、排便急迫感、腹痛、腹泻)积分,不良反应。结果联合治疗组总有效率高于双歧杆菌组(96.00%vs.82.00%,χ^(2)=5.005,P=0.025)。治疗30 d后,2组真菌感染、细菌计数减少、杆球比例倒置者占比低于治疗前,且联合治疗组低于双歧杆菌组(P<0.01);2组生理、心理、社会关系、环境评分高于治疗前,且联合治疗组高于双歧杆菌组(P<0.01);2组腹胀、排便急迫感、腹痛、腹泻积分低于治疗前,且联合治疗组低于双歧杆菌组(P<0.01)。双歧杆菌组不良反应总发生率为6.00%,与联合治疗组的2.00%比较,差异无统计学意义(χ^(2)=0.260,P=0.610)。结论复方谷氨酰胺肠溶胶囊联合双歧杆菌四联活菌片治疗肠道菌群失调相关性腹泻可提高临床疗效,改善患者肠道微生物环境,减轻临床症状,提高患者的生活质量,且安全性较高。

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.

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.

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.

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.