Norovirus Infection and Histo-blood Group Antigens in Children Hospitalized with Diarrhea in Lulong and Chenzhou in China

Norovirus （NOV） is a pathogen that commonly causes viral diarrhea in children. Studies indicate that NoV recognizes human histo-blood group antigens （HBGAs） as cell attachment factors. In order to explore the correlation between of NoV infection and HBGAs, a cross-sectional study was conducted in children less than five years old who were hospitalized with diarrhea in two areas of China between November 2014 and February 2015. Of the paired stool and saliva samples taken from 424 children,

Nosocomial diarrhea in children:is astrovirus the leading pathogen?

Objective:To screen for the presence of mixed infection with rotavirus.Methods:The present study included 140 children aged less than 2 years with acute diarrhea.Fecal samples of all these patients were analyzed for the presence of astroviral antigen by enzyme immunoassay.Also 40 rotavirus positive fecal samples were screened for the presence of astrovirus.Results:In case of acute diarrhea in children the prevalence of astrovirus was around 34% (48/140).It was seen that even in rotavirus positive cases astrovirus co infection was 25% .Conclusions:Astrovirus is a growing problem which is often underrecognised.With the rotavirus vaccine licensure being imminent astrovirus will emerge out as the single most important cause of viral

The Treatment of Children's Diarrhea with Massage and Acupunture in 58 cases

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History of Vitamin A Supplementation Reduces Severity of Diarrhea in Young Children Admitted to Hospital with Diarrhea and Pneumonia

Background: Although the role of vitamin A in childhood pneumonia in association with diarrhea is not fully proven, we did not find any published data demonstrating the impact of lack of vitamin A supplementation in under-five children who present with the co-morbidities of pneumonia and diarrhea. This study examined whether previous vitamin A supplementation was associated with reduced severity and duration of diarrhea and pneumonia for children presenting with both illnesses. Methods: All admitted children (n = 189) aged 0 - 59 months to the Special Care Ward of the Dhaka Hospital of icddr,b with diarrhea and radiological pneumonia from September-December 2007 were enrolled. We compared clinical features of the children who received (n = 96) and did not receive (n = 93) high potency capsule vitamin A supplementation during previous immunization according to EPI schedule. Results: In logistic regression analysis, after adjusting for potential confounders such as respiratory rate, lower chest wall in-drawing, severe wasting and systolic blood pressure, vitamin A non-supplemented children with pneumonia and diarrhea more often presented in their early infancy (95% CI 1.01 - 1.09), had duration of diarrhea for >4 days (95% CI 1.79 - 11.88), had clinical dehydration (95% CI 1.2 - 5.63), and more often required hospitalization for >7 days (95% CI 1.03 - 8.87). But, there was no significant difference in the clinical features of pneumonia, such as history of cough, respiratory rate, lower chest wall in-drawing, nasal flaring, head nodding, grunting respiration, cyanosis, and inability to drink between the groups. Conclusion: Lack of vitamin A supplementation in under-five children with radiological pneumonia and diarrhea is independently associated with young infancy, duration of diarrhea for >4 days, dehydration and hospitalization for >7 days which underscores the importance of routine supplementation of vitamin A in young infancy. However, lack of vitamin A supplementation did not influence any clinical signs of pneumonia.

Etiology of Diarrhea among Severely Malnourished Infants and Young Children: Observation of Urban-Rural Differences over One Decade in Bangladesh

There is inadequate information on the etiology of diarrhea in severely malnourished (SM) young children. Thus, the study aimed to determine the etiology of diarrhea among severely malnourished (z score ?3.00 SD) children in rural and urban Bangladesh. From the database (2000-2011) of Diarrheal Disease Surveillance Systems (DDSS) at rural Matlab and urban Dhaka hospitals of icddr,b, 2234 and 3109 under-5 children were found severely malnourished (underweight, stunted or wasted) respectively. Two comparison groups [moderately malnourished (MM) and well-nourished (WN)] were randomly selected in a ratio of 1:1:1. Children with all categories of SM were more likely to be infected with Vibrio cholerae (rural—11%;urban—15%), Shigella (16%;9%), Salmonella (1%;2%) and Campylobacter (3%;4%);and less likely to have rotavirus (25%;20%) compared to only one SM category. Isolation rate of Vibrio cholerae was significantly higher among SM both in rural and urban children (7%;13%) than those of MM (5%;10%) and WN (2%;8%) and lower for rotavirus (30%;31%), (34%;43%), (35%;47%) respectively (p 0.01). However, for Shigella it was only higher among rural SM children (11%) [MM (9%), and WN (8%) (p 0.01)]. The isolation rate of Salmonella in SM (2%) was similar to that in MM (2%;p = 0.72) but significantly higher than that in WN (1%;p 0.01) among urban children. Isolation rates of bacterial enteric pathogens were higher but rotavirus was lower in SM children in both rural and urban area with geographical heterogeneity.

Prevalence of diarrhea and associated risk factors among children under-five years of age in Eastern Ethiopia: A cross-sectional study

Diarrhea remains a major cause of mortality in children under 5 years of age in Sub-Saharan countries in Africa. Risk factors for diarrhea vary by context and have important implications for developing appropriate strategies to reduce the burden of the disease. The objective of this study was to assess the prevalence of diarrhea and associated risk factors among children un-der 5 years of age in Kersa district, located in Eastern Ethiopia. A community-based cross-sectional study was conducted among 1456 randomly selected households with at least one child under 5 years of age. A questionnaire and an observational check list were used for col-lecting information on socio-economic charac-teristics, environmental hygiene and behavioral practices, and occurrence of diarrhea among children under 5 years of age. Logistic regres-sion was used to calculate the adjusted odds ratio of 95% confidence interval. The two-week prevalence of diarrhea among children under 5 years of age was 22.5% (95% CI: 20.3-24.6). Improper refuse disposal practices (OR = 2.22, 95% CI: 1.20-4.03), lack of hand washing facilities (OR = 1.92, 95%CI: 1.29-2.86), living in rural area (OR = 1.81, 95% CI: 1.12-3.31), the presence of two or more siblings in a household (OR = 1.74, 95% CI: 1.33-2.28), and age of the child (OR= 2.25, 95% CI;1.5-3.36) were the major risk factors for diarrhea. This study demonstrated that diarrhea morbidity was relatively high among children under 5 years of age residing in Eastern Ethiopia. Efforts to reduce childhood diarrhea should focus on improving household sanitation, personal hygiene, and child birth spacing.

Predictors of Meningitis in Under-Fifteen Children Attending an Intensive Care Unit of an Urban Large Diarrheal Disease Hospital in Bangladesh

Background: Data are lack on predicting features of meningitis in diarrheal children although the great clinical importance. Objective: To evaluate clinical and laboratory features in predicting meningitis in under-fifteen children having diarrheal illnesses. Methods: Children aged 1 month to 15 years, admitted in the ICU of the Dhaka Hospital of icddr, b between March 2011 and February 2012 with fever and seizure or altered consciousness and having LP done were enrolled into this analysis. Those children who had abnormal CSF findings [pleocytosis (normal range of leukocyte, 0 - 10/mm3) and/or elevated protein (normal range, 0.10 - 0.45 mg/dl) and low glucose (normal value, 60% of corresponding blood glucose)] were defined as meningitis. Comparison was made between children with (cases = 17) and without meningitis (controls = 66) from our study children. Data were retrospectively collected from SHEBA, an online database system of the Dhaka Hospital of icddr, b. Results: Death was significantly higher among the cases compared to the controls (29% vs. 3%, p = 0.003). In logistic regression analysis, after adjusting for potential confounders, cases frequently had hypoxemia (95% CI 1.55 - 21.93), absent peripheral pulse (95% CI 1.95 - 27.13) and neutrophilia (95% CI 1.13 - 17.00). Conclusion: Our data suggest that children with meningitis had higher case fatality rate. Simple independent predictors of meningitis such as hypoxemia, absent peripheral pulse, and neutrophilia may help clinicians to initiate early and prompt management in order to curve lifelong sequel due to meningitis and death in such patient population especially those in resource poor settings.

Frequency of E.coli pathotypes in acute diarrhea of children and its related factorsat Beassat hospital,Sanandaj

Objective:Diarrhea is a leading cause of morbidity and mortality among children in developing countries.The bacterial pathogen most commonly associated with childhood diarrhea is Escherichia coli.A one-year prospective study was carried out in Sanandaj to determine the prevalence and roles of the different E.coli pathotypes in children less than five years of age with acute diarrhea.Methods:Rectal swab were collected prospectively from children with acute diarrhea and transported to the Department of Microbiology,School of Medicine, KUMS,Sanandaj during 2008.The study was approved by the institutional ethics committee.Results:During this study period,rectal swabs were investigated from a total of 466 children 1 to 144 months of age(mean, 29.97 months±S.D) with diarrhea.Among the children,191(41%,191/466) were girls,and 275 (59%,275/466) were boys.The age-specific incidence rates of acute diarrhea among children 13-24 and 1 - 12 months of age were 37.37%(37/99) and 26.26%(26/99),respectively,during the study period.A total of 99 strains of E.coli were detected.EPEC 59(59.59%) and EIEC 22(22.22%),were the most commonly found Escherichia coli strains detected in stools from children.Disk diffusion testing showed E.coli strains resistance to tetracycline(89.89%),chloramphenicol(88.88%),Ampicillin(79.79%),Amoxicillin (75.75%) and Ceficime(75.75%).Among risk factors like age,sex,haemoglubin,fathers and mothers education,food and weight of children only mother's education was significant(P =0.018).Conclusion: In most of the clinical laboratories in Iran,E.coli does not considered as an etiologic agent responsible for diarrhea. Results in this study revealed that E.coli should be considered as an etiologic agent causing acute diarrhea among children.We therefore,recommend the routine isolation and identification of E.coli strains in all the clinical laboratories in Sanandaj.Guidelines for appropriate use of antibiotics in Sanandaj need updating.

Diarrhea Disease among Children under 5 Years of Age: A Global Systematic Review

Diarrhea diseases remain the second leading cause of death among children under five years globally. Nearly one in every five child deaths, about 1.6 million each year, are due to diarrhea. Further, diarrhea kills more young children than malaria, measles and Acquired Immunodeficiency Syndrome (AIDS) combined. As a result, better understanding of childhood diarrhea occurrence can perhaps help reduce associated morbidity and mortality rates. Therefore, this study conducted a global systematic review on occurrence of childhood diarrhea. The broad objective of this study was to review present and past researches on childhood diarrhea and most importantly for children under 5 years of age. The review focused on understanding the burden of diarrhea, causes of childhood diarrhea and solutions to the disease. A systematic literature review was conducted using the databases of PubMed, CINAHL, Web of Science and Google Scholar. Search key terms used were childhood diarrhea, risk factors and intervention practices. Journal articles and related reports were filtered and limited from 2005 to 2020. Sixty-one reports and articles that met inclusion criteria were used in this review. Review found that, childhood diarrhea imposes economic costs on the health system and families. Also, repeated bouts of diarrhea can lead to malnutrition, stunting and delayed brain growth later in life and can lead to stress and tension to the affected households. The dependence on open water sources which are often contaminated with fecal materials was found as the major cause of the rising prevalence of childhood diarrhea. Other important factors were poor hygienic practices and lack of sanitation facilities contribute to the spread of diarrhea diseases. Improvements in the quality of drinking water, sanitation facilities and hygiene practices especially in low and middle income countries have been suggested by many studies as an intervention to reduce childhood diarrhea.

Health and Nutritional Status of Young Foster Children Attending a Diarrhea Treatment Hospital in Bangladesh

There is scarcity of evidence-based information about socio-demographic as well as ailment factors associated with foster children in Bangladesh. Thus the aim of the present study was to determine the socio-economic, health and nutritional status of young foster children in urban Dhaka. A total of 208 (1%;n = 208/28,948) under-5 foster children were enrolled in the Diarrheal Disease Surveillance System of icddr,b between 1993-2012. Randomly selected under-5 children (n = 624) with a ratio of 1:3 were extracted and constituted as comparison group. Forty-three percent (n = 90) foster children were male. Lack of formal schooling of mother was higher among foster children compared to non-foster children (52% vs. 35%;p < 0.001). Higher proportion of foster children suffered from some or severe dehy-dration (60% vs. 47%;p = 0.001) and often received intravenous saline (12% vs. 5%;p = 0.002) in comparison to non-foster children. Significantly lower proportion of foster children had rotavirus diarrhea (26% vs. 43%;p < 0.001). In multivariate analysis, foster children were 2 times (95% CI: 1.31-4.32) more likely to be stunted and 194 times (95% CI: 82.25-457.76) more likely to be non-breastfed. Infants aged 6-11 months were 8 times (95% CI: 3.70-15.50) more likely to be foster compared to older children and probability of fostering was 7 times (95% CI: 3.96-13.33) higher among mothers with a median age of 25 years. The findings of our study clearly demonstrate the existing health and nutritional problems of foster children. Therefore, appropriate health and nutrition interventions are critical for foster children in Bangladesh.

Morbidity, Mortality and the Impact of Climate on the Evolution of Acute Rotavirus Diarrhea in Children under 5 Years Old in Bangui

Background: Rotavirus is the most common pathogen of severe acute diarrhea in children under five years of age worldwide. Objective: The objective of this study was to determine the morbidity and mortality of rotavirus diarrhea while describing the seasonal kinetics of the infection according to climatic parameters in Bangui. Methodology: This was a descriptive and analytical cross-sectional study conducted from January 1, 2011 to December 31, 2020 in the Central African Republic (CHUPB). The health data were recorded and processed with the Access 2019 software, then analyzed with the STATA version 14 software. The climatic trends in the study area and its seasonal variations were highlighted by the monthly rainfall coefficient of Alfred Angot: Cm = 12 Pm/P. Results: Morbidity was 45.99% of cases. The 1 to 12 months old represented 93.81% of cases. The mean age of the children was 6.8 months, the sex ratio was 1.20. The symptomatic triad was diarrhea (100%), vomiting (90.20%) and fever (87.5%). Moderate dehydration was reported in 81.05% of cases. The main genotype combinations found were P[8]G1 in 34.02% (n = 115/338), P[6]G1 in 21.59% (n = 73/338) and P[6]G2 in 16.86% (n = 57/338). Case fatality was 11.45%. The risk of death was influenced by rural origin, severe dehydration, hypovolemic cloc and duration of hospitalization > 5 days. Low rainfall correlated with the highest rates of rotavirus diarrhea. Likewise, high temperature correlated with the highest number of cases of rotavirus diarrhea. Conclusion: Acute rotavirus diarrhea is an important morbidity and mortality issue in children under 5 years old in Bangui.

Serum Zinc Levels and Immune Status of Children with Persistent Diarrhea Following Oral Zinc Supplementation

Background: Persistent diarrhea (PD) is a common disease in childhood worldwide. Clinical studies suggested that zinc supplementation is useful in most PD children. However, the relationship between the zinc and immune status of the PD children has not been reported. Objective: To examine serum zinc levels and immune status in 6 to 24 months old children with PD before and after 120 days of oral zinc supplementation and to evaluate the effects of zinc supplementation on serum zinc levels and immune status in PD children. Methods: A case control study was carried. Fifty-eight children aged 6 to 24 months with PD were enrolled. 58 patients were divided into two groups, zinc group (28 cases) and control group (30 cases). Laboratory investigation of serum zinc levels, Lymphocyte subsets (CD3+%, CD4+%, CD8+% and CD4+/CD8+ ratio) and immunoglobulins (IgG, IgA and IgM) levels was carried out in all these patients once at enrollment and again after 120 days of treatment. Results: Before treatment, the serum zinc concentration was 4.37 ± 1.23 μmol/L in zinc group and 4.42 ± 1.45 μmol/L in control group (P > 0.05). However, after treatment, the serum zinc concentrations in the zinc group were significantly higher (8.81 ± 2.56 μmol/L), as compared to the control group (4.12 ± 1.02 μmol/L) (P < 0.05). Regarding immune status, Lymphocyte subsets CD3+%, CD4+%, CD8+% and CD4+/CD8+ ratio and IgG, IgA and IgM levels of all the children with PD were measured once at enrollment and again after 120 days of treatment. There were no significant differences between the zinc and the control groups in CD3+%, CD4+%, CD8+% and CD4+/CD8+ ratios (P > 0.05) before giving treatment. However, after 120 days of treatment, in the zinc group there was a significant rise in CD4+% (53.60 ± 5.78). The CD4 was significantly higher in the zinc group as compared to the control group (44.73 ± 4.39) (P < 0.05). Besides CD4+%, the CD4+/CD8+ ratio was also found to be higher among zinc group (1.49 ± 0.29) as compared to the control group (1.26 ± 0.18) after treatment (P < 0.05). But there were no statistically significant differences in CD3+% and CD8+% between zinc and control group after treatment (P > 0.05). Regarding immunoglobulins, there were no significant differences between zinc and control group in IgG, IgA and IgM levels (P > 0.05) at the time of enrollment (before treatment). However, after treatment, the mean IgG levels in zinc group and control group were 6.36 ± 0.95 g/l and 5.67 ± 0.74 g/l, respectively, P < 0.05. Similarly, after treatment, IgM levels in the zinc group were found significantly higher (1.58 ± 0.13 g/l), as compared to the control group (1.43 ± 0.20 g/l) (P < 0.05) but no significant differences in IgA levels were evident between the two groups after treatment. Conclusion: Administration of oral zinc supplement improved both serum zinc levels and immune status in children with PD. Zinc supplementation should be administered as adjunctive therapy for PD children.

Molecular Prevalence and Epidemiological Characteristics of Diarrheagenic <i>E. coli</i>in Children under 5 Years Old in the City of Koula-Moutou, East-Central Gabon

Background and Purpose: Diarrhoeagenic E. coli (DEC) is one of the germs responsible for childhood diarrhea in developing countries. This study aims at determining the prevalence of the five main pathotypes of DEC isolated from faeces of children under five years old with diarrhea or not, living in the city of Koula-Moutou. Methodology: Isolates of E. coli were phenotypically screened on chromIDTM agar and molecularly by multiplex PCR to detect the presence of enteroaggregative E. coli (EAEC), enteropathogenic E. coli (EPEC), enterotoxigenic E. coli (ETEC), enterohemorragic E. coli (EHEC) and enteroinvasive E. coli (EIEC). The evaluation of their sensitivity to 12 β-lactam antibiotic molecules was carried out by Kirby Bauer method. This method has also made it possible to characterize phenotypically the different β-lactamases produced. Results and Conclusion: Overall, at least one DEC pathovar was detected in the 63 E. coli strains with phenotypic and molecular frequencies of 63.5% and 68.5% respectively. Thus, ETEC (28.3%) and EHEC (28.3%) were the most frequent DEC in diarrheal isolates. ETEC/EHEC hybrid was recorded in both groups with rates of 7.5% in diarrheal cases and 10.0% for controls. The results showed produced carbapenemase type β-lactamases (31.7%), followed by ESBL (24.4%) and few produced high level penicillinases (4.9%). The DEC, in particular ETEC and EHEC are most likely the epidemiological agents responsible for childhood diarrhea in this study.

Assessment of Diarrheal Disease Management Practice in Under-Five-Year Children According to WHO Guideline in Health Facilities of Hawassa City, SNNPR, Ethiopia

Objective: To explore the practice of management of diarrhea in under-5-year children at health facilities found in Hawassa town, and associated factors with malpractice in comparison. Methodology: Cross Sectional study was conducted in 2 hospitals, 2 health centers and 2 private clinics that are found in Hawassa city which is found in Southern Nations, Nationalities and peoples (SNNP), 275 KM to south from Addis Ababa, capital city of Ethiopia from august 2017-October 2017. Structured checklist was used to retrieve the required information from the patients on arrival and stay in pediatrics OPDs and wards. The data analysis carried out using SPSS version 20.0. Logistic regression was carried out to analyze the association between the independent and dependent variables. Statistically significant associations were declared at p-values of less than or equal to 0.05. Results: Out of 420, about 397 (94.5%) children with diarrheal disease between the ages of 3 - 59 months were studied. The study subjects were from governmental hospitals (35.5%), health centers (34.5%) and private clinics (30%) that are found in Hawassa City. Sign of dehydration was 66 (17%) of which majority 59 (83%) of them were rehydrated. As to Zink supplementation, only 180 (45%) received it;antibiotics were the commonly (59.1%) prescribed drugs. Only 43.3% of children were appropriately managed. Hospitals had higher odds of inappropriate management of diarrhea with AOR = 1.61 (95% CI: 1.04 - 2.5) and children one year or younger were more inappropriately managed for diarrhea at the health facilities with AOR of 2.3 (95% CI: 1.57 - 4.41). Conclusions: In the current study the management of diarrhea at the health facilities is unsatisfactory as only less than half of children with diarrhea were properly managed. Treatment of diarrhea at hospital level and the patient’s age being less than 1 year were found to significantly affect the level of mismanagement of the diarrheal disease. Therefore, orientation and trainings for health care providers especially GPs and Residents should be given to adhere to recommended zinc therapy, Oral Rehydration Salts (ORS) replacement therapy and rational antibiotics prescription.

慢性迁延性腹泻儿童食物过敏的特征分析

目的:分析慢性迁延性腹泻儿童食物过敏的特征。方法:选取2017年2月—2023年2月北京丰台医院收治的75例慢性迁延性腹泻患儿作为研究对象,所有患儿进行14种食物过敏原特异性免疫球蛋白(IgE)抗体检测,进行常规饮食指导,随访并逐年记录过敏情况。结果:<1岁的患儿中,14种食物过敏原特异性IgE抗体均存在阳性情况,阳性率前3位依次为牛奶(81.8%)、蛋类(60.0%)及大米(30.9%);≥1岁的患儿中,存在除猪肉之外的13种食物过敏原特异性IgE抗体阳性情况,阳性率前3位依次为牛奶(75.0%)、蛋类(60.0%)、大米与大豆(30.0%,并列第3)。≥1岁的患儿西红柿、大豆、蘑菇、玉米、虾、蟹、鳕鱼食物过敏原特异性IgE抗体阳性率高于<1岁的患儿,差异有统计学意义(P<0.05)。75例患儿经1~2年的随访,均对过敏食物耐受。结论:慢性迁延性腹泻儿童与多种食物过敏有关,食物过敏原特异性IgE抗体是诊断的重要指标之一,临床应给予患儿高度关注及饮食指导。

基于护理程序的整体护理联合细节护理在秋季腹泻患儿中的应用效果

目的探究基于护理程序的整体护理联合细节护理在秋季腹泻患儿中的应用效果。方法选择2017年8月至2019年2月在郑州市妇幼保健院治疗的秋季腹泻患儿102例,应用随机数表法将其分为对照组(常规护理)及观察组(基于护理程序的整体护理联合细节护理)各51例,对比两组临床指标、胃肠道功能、护理有效率、患儿依从性率、家长满意度率。结果观察组止吐时间、止泻时间、退热时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。护理后,两组胃泌素(GAS)、胃动素(MTL)均有所降低,双歧杆菌、乳酸杆菌均有所提高,且对照组GAS、MTL高于观察组,双歧杆菌、乳酸杆菌低于观察组,差异有统计学意义(P<0.05)。观察组护理有效率(94.12%)高于对照组(78.43%),差异有统计学意义(P<0.05)。对照组患儿依从性率(78.43%)低于观察组(96.08%),差异有统计学意义(P<0.05)。观察组患儿家长的护理满意率(96.08%)高于对照组(80.39%),差异有统计学意义(P<0.05)。结论对秋季腹泻患儿采用基于护理程序的整体护理联合细节护理,护理效果显著,可快速改善患儿临床症状、胃肠功能,提高患儿依从性、家长护理满意率。

整体护理干预在小儿轮状病毒感染性腹泻中的应用效果

目的分析整体护理干预在小儿轮状病毒感染性腹泻中的应用效果。方法选取2023年1月至10月滨州医学院附属医院收治的68例轮状病毒感染性腹泻患儿作为研究对象,根据就诊时间分为参比组(n=34,常规护理)与分析组(n=34,整体护理干预)。比较两组临床症状改善时间及住院时间、护理满意度及并发症发生情况。结果分析组止泻、退热、呕吐症状消失时间及住院时间均短于参比组,差异有统计学意义(P<0.05)。分析组沟通支持、尊重支持、情感支持、优质护理支持评分均高于参比组,差异有统计学意义(P<0.05)。分析组并发症总发生率低于参比组,差异有统计学意义(P<0.05)。结论小儿轮状病毒感染性腹泻中应用整体护理干预,可缩短临床症状改善时间,降低并发症发生率,提高护理满意度。

白细胞介素10受体A基因突变导致的极早发型炎症性肠病临床特点及基因分析

目的总结白细胞介素10受体A(interleukin 10 receptor A,IL-10RA)基因突变导致的极早发型炎症性肠病(very early onset inflammatory bowel disease,VEO-IBD)患儿临床特点和遗传学特征。方法回顾性分析2007年3月到2019年5月在首都医科大学附属北京儿童医院院消化科住院的慢性腹泻的患儿中,确诊为VEO-IBD的患儿,其中病因为IL-10RA基因突变的患儿15例,对照组为15例非IL-10RA突变所致VEO-IBD患儿,统计分析其临床特点及基因报告。结果IL-10RA基因突变所致的VEO-IBD患儿,克罗恩病(Crohn s disease,CD)11例,溃疡性结肠炎(ulcerative colitis,UC)4例,临床症状以慢性腹泻(15/15例,100.0%)、便血(15/15例,100.0%)为主,肠外表现依次为口腔黏膜溃疡(6/15例,40.0%)、皮肤红斑(5/15例,33.3%);肛周表现依次为直肠会阴瘘5例(5/15,33.3%),肛瘘4例(4/15,26.7%),肛裂3例(3/15,20.0%),直肠会阴瘘、皮赘并存1例(1/15,6.7%);全身表现为IL-10RA基因突变组营养不良13例(13/15例,86.7%),肛周病变13例(13/15例,86.7%);对照组营养不良6例(6/15例,40.0%),肛周病变5例(5/15例,33.3%),此两项指标与IL-10RA基因突变组相比,差异有统计学意义(P<0.05)。15例IL-10RA突变患儿中,共检测到9个突变位点,其中c.301c>T(p.R101W)和c.537G>A(p.T179T)为最常见的突变位点。IL-10RA突变导致炎症因子增高,引起肠道炎症反应。凝血酶原时间和部分凝血活酶时间均明显延长。结论IL-10RA基因突变导致的VEO-IBD患儿发病年龄早,除消化道症状外,肠外表现和肛周病变较为常见,结肠镜下病变特点以结肠多发溃疡最常见,其次为炎性息肉。c.301c>T(p.R101W)和c.537G>A(p.T179T)为最常见的基因突变位点。IL-10RA突变导致炎症因子增高,引起肠道炎症反应。

双歧杆菌四联活菌片联合蒙脱石散对腹泻患儿肠黏膜屏障及血清炎性因子水平的影响

目的:研究双歧杆菌四联活菌片+蒙脱石散对腹泻患儿肠黏膜屏障及血清炎性因子水平的影响。方法:随机数字表法将该院(2022年3月至2023年3月)确诊的204例腹泻患儿分为研究组、参照组,各102例。参照组行蒙脱石散治疗,研究组在其基础上行双歧杆菌四联活菌片治疗。比较两组临床疗效、肠黏膜屏障功能指标、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、血管活性肠肽(Vasoactive intestinal polypeptide,VIP)、C反应蛋白(C-reactive protein,CRP)、胃动素(Motilin,MTL)、白细胞介素-10(Interleukin-10,IL-10)、生长抑素(Somatostatin,SS)、γ干扰素(Interferon-γ,IFN-γ)、不良反应发生率。结果:研究组总有效率高于参照组(P<0.05);治疗后研究组D-乳酸、二胺氧化酶、内毒素水平低于参照组(P<0.05);治疗后研究组IL-10、IFN-γ高于参照组,MTL、VIP、SS、TNF-α、CRP低于参照组(P<0.05);治疗后研究组不良反应总发生率与参照组相比,差异无统计学意义(P>0.05)。结论:联合治疗方案疗效显著,可有效改善患儿肠道黏膜,减少炎症反应,且不良反应少,安全性高。

精细护理模式在小儿腹泻中的应用

目的 探讨精细护理模式在小儿腹泻中的应用。方法 选取2022年5月至2023年5月西安市阎良区人民医院收治的80例腹泻患儿,按照不同干预方案分为对照组(40例)与研究组(40例)。对照组采用常规护理,研究组采用精细护理模式。比较两组大便及腹痛情况、生活质量、家属满意度。结果 干预后,两组大便性状评分、大便频次及腹痛情况评分均低于干预前,且研究组低于对照组(P <0.05)。干预后,两组儿童生存质量测定量表系列4.0各维度评分及总分均高于干预前,且研究组高于对照组(P <0.05)。研究组家属总满意率高于对照组(P <0.05)。结论 精细护理模式在小儿腹泻中应用可改善患儿大便及腹痛情况,提高患儿生活质量及家属满意度,值得临床推广。