Factores de riesgo de enfermedad diarreica aguda en niños menores de un año

Introducción: las enfermedades diarreicas agudas son una causa importante de morbilidad y mortalidad de la población infantil a nivel mundial y en países en vías de desarrollo. Objetivo: identificar los factores de riesgo asociados a la diarrea aguda en niños menores de un año del municipio Bayamo. Métodos: se realizó un estudio observacional analítico de casos y controles, en niños menores de 1 años pertenecientes al municipio Bayamo, que ingresaron con enfermedad diarreica aguda en el Hospital Provincial Pediátrico Docente "General Milanés" en el año 2022. La muestra constituida por 246 pacientes, 82 casos y 164 controles. Se realizó el análisis univariado y multivariado: la razón de productos cruzados y el Chi cuadrado, con una confiabilidad del 95% y una probabilidad menor de 0.05. Resultados: en el análisis univariado la no lactancia materna exclusiva hasta los 6 meses fue el factor de mayor significación estadística (OR 20,695, IC 7,360-58,188 P=0,000), seguido de la desnutrición (OR 10,503 IC 3,322-33,213 P=0,000), uso previo de antimicrobiano (OR 7,798 IC 2,803-21,684 P=0,000. En el análisis multivariado el factor que mostró mayor independencia fue la no lactancia materna exclusiva hasta los 6 meses. Conclusiones: la no lactancia materna hasta los 6 meses de edad resultó ser el factor de mayor riesgo para desarrollar una enfermedad diarreica aguda, seguido de la desnutrición y uso previo de antimicrobiano.

SUMMARY Introduction: acute diarrheal diseases (ADD) are an important cause of morbidity and mortality in children worldwide and in developing countries. Objective: to identify the risk factors associated with acute diarrhea in children under one year of age in the Bayamo municipality. Methods: an analytical observational study of cases and controls was carried out in children under 1 year of age belonging to the Bayamo municipality, who were admitted with acute diarrheal disease to the "General Milanés" Provincial Pediatric Teaching Hospital in 2022. The sample was made up of 246 patients, 82 cases and 164 controls. The univariate and multivariate analysis was performed: the cross-product ratio (Odd Ratio) and the Chi square, with a reliability of 95% and a probability of less than 0.05. Results: in the univariate analysis, non-exclusive breastfeeding up to 6 months was the factor with the greatest statistical significance (OR 20.695, CI 7.360-58.188 P=0.000), followed by malnutrition (OR 10.503 CI 3.322-33.213 P=0.000). previous use of antimicrobial (OR 7.798 CI 2.803-21.684 P=0.000. In the multivariate analysis, the factor that showed greater independence was not exclusive breastfeeding up to 6 months. Conclusions: Non-breastfeeding until 6 months of age turned out to be the highest risk factor for developing an acute diarrheal disease, followed by malnutrition and previous use of antimicrobials.

Introdução: as doenças diarreicas agudas são uma importante causa de morbidade e mortalidade em crianças em todo o mundo e em países em desenvolvimento. Objetivo: identificar os fatores de risco associados à diarreia aguda em crianças menores de um ano de idade no município de Bayamo. Métodos: foi realizado um estudo observacional, analítico, caso-controle em crianças menores de 1 ano de idade pertencentes ao município de Bayamo, que foram admitidas com doença diarreica aguda no Hospital Universitário Pediátrico Provincial "General Milanés" em 2022. A amostra foi composta por 246 pacientes, 82 casos e 164 controles. Foram realizadas análises univariada e multivariada: a razão de produtos cruzados e o Qui-quadrado, com confiabilidade de 95% e probabilidade menor que 0,05. Resultados: na análise univariada, o aleitamento materno não exclusivo até os 6 meses de idade foi o fator estatisticamente mais significativo (OR 20,695, IC 7,360-58,188, P=0,000), seguido de desnutrição (OR 10,503, IC 3,322-33,213, P=0,000), uso prévio de antimicrobianos (OR, 7,798, IC 2,803-21,684, P=0,000. Na análise multivariada, o fator que apresentou maior independência foi o aleitamento materno não exclusivo até os 6 meses. Conclusões: não amamentar até os 6 meses de idade foi o maior fator de risco para o desenvolvimento de doença diarreica aguda, seguido de desnutrição e uso prévio de antimicrobianos.

Implications of Safe Street Foods in Dhaka City: An Opinion

Street foods play an important role in large group of economic people in the Dhaka city. And it is also the major source of income for floating vendors. Huge numbers of vendors sell dishes, snacks, fruits, and beverages in the megacity of Dhaka. The objective of this article is to promote and maintain the hygienic environment of selling street foods among vendors in Dhaka city. Contaminated foods cause various kinds of diarrheal diseases. To prevent this contagious disease food safety needs much more awareness. To ascertain safe street foods, the government and non-government organizations should implement rules and regulations strictly and appropriate programmes should be conducted. The various facets of street foods available in Dhaka city have been briefly described in the present article.

Campylobacter diarrhea in children in South Asia: A systematic review

Background: Campylobacter spp. are one of the commonest causes of diarrhea in children under five and in resource poor settings also lead to malabsorption and stunting. The purpose of this systematic review was to understand the burden of Campylobacter spp. associated diarrhea among children in the South Asian countries. Methods: This systematic review followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines. Databases were searched with defined keywords for publications from the years 1998–2018. Data on proportion of positive samples was extracted to compare the rates of Campylobacter infection among children (under the age of 19) from different study populations. Results: Of the 359 publications screened, 27 eligible articles were included in this systematic review and categorized based on study design. In 8 case-control studies, Campylobacter spp. was detected more frequently among diarrheal cases (range, 3.2–17.4%) than non-diarrheal cases (0–13%). Although there were variations in the study population, overall, children under the age of two years experienced Campylobacter diarrhea more often than older children. Most studies reported stool culture as the method used to detect Campylobacter spp. however retesting using PCR-based methods significantly increased detection rates. Limited data were available on Campylobacter species. In 4 studies that provided species data, C. jejuni (3.2–11.2%) was shown to be the most common species, followed by C. coli. Conclusion: In South Asia, Campylobacter spp. are one of the most common bacterial diarrheal pathogens affecting children but there is a paucity of data on species, risk factors and attributable sources. Although a few studies were available, the epidemiology of campylobacteriosis remains uncertain. To understand the true burden and sources of infection, more detailed studies are needed collecting data from human, animal and environmental sources and using both culture and genomic tools.

Principales agentes etiológicos de las enfermedades diarreicas agudas infantiles en Chimborazo, Ecuador / Main etiological agents of childhood acute diarrheal diseases in Chimborazo, Ecuador

Las enfermedades diarreicas constituyen la principal causa de morbimortalidad en niños menores de cinco años, con alrededor de 1.700 millones de casos y 1,5 millones de muertes por año a nivel mundial. Para el año 2010, en la Sierra de Ecuador se registró un alto porcentaje de infantes fallecidos a causa de enfermedades diarreicas agudas (EDA), incluyendo la provincia de Chimborazo; mientras que, para el año 2016, se registraron en Ecuador 590.523 casos de EDA, siendo más afectados los niños de sectores de mayor pobreza. Se realizó un estudio descriptivo en pacientes pediátricos con episodios diarreicos que acudieron a centros de salud de los cantones rurales de la provincia Chimborazo. Se realizó análisis coprológico y coproparasitológico en 258 muestras; se identificaron bacterias enteropatógenas mediante pruebas bioquímicas y de susceptibilidad antimicrobiana, se realizó diagnóstico parasitológico mediante análisis macroscópico y microscópico y para detección de virus se emplearon pruebas inmunológicas. Se observó un mayor número de casos de EDA en los cantones Alausí (50%) y Chunchi (19%). De los pacientes con EDA, los rotavirus son el principal agente etiológico aislado (24,8%), seguido por Shigella (17,8%); mientras que Giardia intestinalis (8,5%) y Salmonella (10,1%) son los microorganismos que se aislaron con menor frecuencia en las muestras. Los resultados del presente estudio, permiten tener un panorama etiológico de las EDA en la provincia de Chimborazo y contribuir en la vigilancia epidemiológica, ejecución de programas sanitarios y de vacunación, para disminuir la vulnerabilidad de la población infantil ante dichas infecciones(AU)

Diarrheal diseases are the main cause of morbidity and mortality in children under five years of age, with around 1.7 billion cases and 1.5 million deaths per year worldwide. For the year 2010, in the Sierra de Ecuador a high percentage of infants died due to acute diarrheal diseases (ADD), including the province of Chimborazo; while, for the year 2016, 590,523 cases of ADD were registered in Ecuador, with children from the poorest sectors being more affected. A descriptive study was carried out in pediatric patients with diarrheal episodes who attended health centers in the rural cantons of Chimborazo province. Coprological and coproparasitological analysis was performed on 258 samples; Enteropathogenic bacteria were identified by biochemical and antimicrobial susceptibility tests, a parasitological diagnosis was made by macroscopic and microscopic analysis, and immunological tests were used to detect viruses. A greater number of ADD cases was observed in the Alausí (50%) and Chunchi (19%) cantons. Of patients with ADD, rotaviruses are the main etiological agent isolated (24.8%), followed by Shigella (17.8%); while Giardia intestinalis (8.5%) and Salmonella (10.1%) are the microorganisms that were isolated less frequently in the samples. The results of this study allow us to have an etiological panorama of EDA in the province of Chimborazo and contribute to epidemiological surveillance, execution of health and vaccination programs, to reduce the vulnerability of the child population to these infections(AU)

Statistical control charts to assess the incidence of presumably infectious diarrhea reported between 2009 and 2019 in children under 4 years of age in the macro regions of Araçatuba, Marília and Presidente Prudente, São Paulo, Brazil / Gráficos de control estadístico para evaluar la incidencia de diarrea presumiblemente infecciosa notificada entre 2009 y 2019 en niños menores de 4 años en las macro regiones de Araçatuba, Marília y Presidente Prudente, São Paulo, Brasil

Abstract Objective. To evaluate the monthly rates of hospitalizations for childhood diarrhea in macro-regions of Araçatuba, Marília and Presidente Prudente, SP, between 2019 -June Between June 2009. Methods. The average rates and their standard deviations for admission of diarrhea in the target population were obtained from DATASUS and standardized for cases x 100,000 inhabitants. Confidence limits were established, occurrences above confidence limits were considered epidemic events. The normality of the data and serial autocorrelation were tested using the Shapiro-Wilk and Durbin-Watson method. Results. All methods detected epidemic occurrences in the three regions. Araçatuba and Marília, the peaks were concentrated in the first half of the decade and Presidente Prudente, close to the middle. The CUSUM method was more sensitive to detect epidemic periods, however the normality data and assumptions have been violated by serial autocorrelation in a few months. The EWMA method was considered the most appropriate. Conclusions. Statistical process control charts can be used to monitor and compare disease incidence between different regions.

Resumen Objetivo. Evaluar las tasas mensuales de hospitalizaciones por diarrea infantil en las macrorregiones de Araçatuba, Marília y Presidente Prudente, SP, entre entre Junio 2009 -Junio 2019. Métodos. Las tasas medias y sus desviaciones estándar de ingreso de diarrea en la población diana se obtuvieron de DATASUS y se estandarizaron para casos x 100.000 habitantes. Se establecieron límites de confianza, las ocurrencias por encima de los límites de confianza se consideraron eventos epidémicos. La normalidad de los datos y la autocorrelación en serie se probaron utilizando el método de Shapiro-Wilk y Durbin-Watson. Resultados. Todos los métodos detectaron ocurrencias epidémicas en las tres regiones. Araçatuba y Marília, los picos se concentraron en la primera mitad de la década y Presidente Prudente, cerca de la mitad. El método CUSUM fue más sensible para detectar períodos epidémicos, sin embargo, los datos de normalidad y los supuestos han sido violados por la autocorrelación en serie en unos pocos meses. El método EWMA se consideró el más apropiado. Conclusiones. Los gráficos de control de procesos estadísticos se pueden utilizar para monitorear y comparar la incidencia de enfermedades entre diferentes regiones.

Evaluation of Awareness and Usages of Simple and Processed Water Users Concerning Water Borne Diseases

The study was conducted in Shadman and Shahjamal, Lahore. Theresearch focuses on the awareness and uses of water consumers in the area and its connection with the water-borne diarrheal diseases.In the study, water taken from WASA supply or Private Bore Pumps and Boiled water was taken to be as “Plain”. While “filtered” water was standardized as water either from filterplants or from house-hold filters. “Water-borne diarrheal diseases” are taken as the infectious diseases caused by fecal (animal or human) or chemical contamination of water.This descriptive cross-sectional study utilized systematic random sampling, with a sample size of 100. Each participant was required to fill out a pretested questionnaire. The data collected was examinedby using SPSS(Statistical Package for the Social Sciences)version 16.0.Filtered water consumers included a lower percentage of individuals who had suffered from water-borne infections and were seen to have more knowledge regarding water treatment practices and spread of water-borne illnesses. Contrarily, plain water consumers included a higher percentage of individuals who had suffered from water-borne diarrheal diseases and a lower percentage were aware of water treatment practices and water-borne illnesses.Analytical results display a reduced occurrence of water-borne diarrheal diseases associated with filtrationtreatment of drinking water as compared to consumption of plain, untreated water

Probióticos y prebióticos: rol en la terapéutica de la enfermedad diarreica aguda infantil / Probiotics and prebiotics: its role in childhood acute diarrheal disease therapy

RESUMEN: La enfermedad diarreica aguda infantil (EDAI), constituye un problema de salud pública, representando la 2ª causa de morbimortalidad infantil en menores de 5 años, en el Ecuador. La hidratación oral y parenteral en los niños hospitalizados bajo normas de administración de conformidad con el grado de deshidratación y pérdida de peso, así como medidas preventivas como la vacunación obligatoria contra el rotavirus, han contribuido a disminuir, pero no a solucionar este problema de salud infantil. Múltiples factores contribuyen para que no se resuelva: socioeconómicos, educacionales, el destete temprano y malas prácticas alimenticias, entre otros. Últimos estudios han propuesto la utilización de probióticos que contribuyan a disminuir el problema sugieriendo el usode Saccharomyces boulardii (SB), asociado a un prebiótico; lo que permitiría acortar el tiempo de tratamiento de una EDAI; por lo que la simbiosis entre SB y un prebiótico denominado fructooligosacárido (FOS), podría ser una alternativa para reducir costos y complicaciones. Una alternativa para medir el curso clínico de una EDAI en infantes es la escala BITTS, de reciente creación y fácil aplicación por clínicos. El objetivo de este manuscrito fue resumir la evidencia existente respecto del rol de losprobióticos y prebióticos en la terapéutica de de la EDAI.

SUMMARY: In Ecuador childhood acute diarrheal disease (CADD) constitutes a serious public health problem, representing the 2nd cause of infant morbidity and mortality in children under 5 years of age. Oral and parenteral hydration in hospitalized children, with standard treatments according to their degree of dehydration and weight loss, as well as preventive measures such as mandatory vaccination against rotavirus, have contributed to a decrease. Nevertheless, this childhood disease has still not been resolved. There are multiple contributing factors involved that prevent complete eradication of the disease Among these are socio-economic problems, education, early weaning and poor feeding practices, all of which continue to affect infants. Recent studies have proposed the use of probiotics that help reduce the problem and it has been suggested that Saccharomyces boulardii (SB), associated with a prebiotic, would reduce the treatment time of an CADD. Therefore, the symbiosis between the SB probiotic and a prebiotic called fructo- oligosaccharide (FOS) could be an alternative to reduce complications and reduce costs. An alternative to measure the clinical course of an CADD in infants is the BITTS scale, which was recently created and can easily be applied by clinicians. The aim of this manuscript was to summarize the existing evidence regarding the role of PROBIOTICS and prebiotics in the treatment of CADD.

Effect of Valeriana jatamansi extract on fecal UPLC-MS/MS metabolomics in rats with diarrheal irritable bowel syndrome / 中国中药杂志

The purpose of this study was to understand the pharmacodynamic effect of Valeriana jatamansi extract in diarrhea predominant irritable bowel syndrome(IBS-D) rat model induced by maternal separation combined with three kinds of stress, and observe the changes of endogenous metabolites in feces after intervention to find potential biomarkers and related metabolic pathways. The animal model of IBS-D was established by maternal separation combined with restraint, ice swimming and tail clamping. The therapeutic effect of each dose group of V. jatamansi extract was evaluated in terms of abdominal withdrawal reflex pressure threshold, fecal water content and immobility time of forced swimming test. In addition, rat feces were collected for detection of metabolic profiles of small molecular metabolites with UPLC-LTQ-Orbitrap MS platform, so as to find the biomarkers of differential metabolism with multivariate statistical analysis methods such as principal component analysis(PCA) and orthogon partial least squares discrimination analysis(OPLS-DA). The results showed that as compared with the normal group, the threshold of abdominal withdrawal reflex pressure was decreased, the fecal water content was increased, and the immobility time of forced swimming test was prolonged in the model group. The results of fecal metabonomics showed that the levels of 39 metabolites were down-regulated and those of 37 metabolites were up-re-gulated. Further analysis showed that these metabolites were related to bile acid metabolism, unsaturated fatty acid metabolism, amino acid metabolism, ceramide metabolism and other metabolic pathways. This study proved that the extract of V. jatamansi had definite pharmacodynamic effect on IBS-D model rats, and the mechanism was discussed from the perspective of fecal metabonomics.

Características sociodemográficas y clínico-epidemiológicas de los pacientes adultos ingresados por diarrea del viajero en la Clínica Internacional Trinidad, 2015-2017 / Sociodemographic and clinical-epidemiological characteristics of patients admitted for traveler's diarrhea to Trinidad International Clinic, 2015-2017

Introducción: La diarrea del viajero es causa frecuente de hospitalización en turistas internacionales. Objetivo: Describir las características sociodemográficas y clínico-epidemiológicas de los pacientes adultos ingresados por diarrea del viajero en la Clínica Internacional de Trinidad durante los años 2015 al 2017. Métodos: Estudio descriptivo de los 699 pacientes adultos con diarrea del viajero que requirieron de ingreso en el periodo de estudio. Se revisaron sus historias clínicas para analizar la frecuencia en que estuvieron presentes algunas variables sociodemográficas y clínico-epidemiológicas. Para analizar los datos se utilizó la estadística descriptiva con distribución de frecuencias y porcentajes. Resultados: El grupo etario entre 19 y 40 años tuvo un 60,52 por ciento de pacientes afectados; el 58,23 por ciento en el sexo femenino, con una incidencia mayor en los meses de julio (12,88 por ciento) y febrero (12,44 por ciento). Los viajeros procedentes de países europeos representaron el 76,97 por ciento ; el 74,96 por ciento se hospedó en casas particulares. El 1,85 por ciento de los afectados presentaba antecedentes de enfermedad gastrointestinal; el 76,11 por ciento requirió de 1 a 6 h de observación, con deshidratación leve (59,66 por ciento) y moderada (21,75 por ciento). El vómito y las náuseas se presentaron en el 58,37 por ciento de los pacientes y en el 60,73 por ciento la causa no fue precisada. Conclusiones: Las variables sociodemográficas y clínico-epidemiológicas seleccionadas permitieron describir características de los pacientes adultos ingresados por diarrea del viajero. Se recomienda profundizar en el estudio para contribuir a su prevención y optimizar la atención(AU)

Introduction: Traveler's diarrhea is a frequent cause of hospitalization of international tourists. Objective: Describe the sociodemographic and clinical-epidemiological characteristics of adult patients admitted for traveler's diarrhea to Trinidad International Clinic in the period 2015-2017. Methods: A descriptive study was conducted of the 699 adult patients with traveler's diarrhea who required hospitalization in the study period. The patients' medical records were reviewed to analyze the frequency of some sociodemographic and clinical-epidemiological variables. Data analysis was based on descriptive statistics with frequency and percentage distribution. Results: 60.52 percent of the patients affected were in the 19-40 years age group, 58.23 percent were female, and the highest incidence was observed in the months of July (12.88 percent) and February (12.4 4 percent ). Travelers from European countries represented 76.97 percent, and 74.96 percent were staying in private dwellings. Of the patients affected, 1.85 percent had a history of gastrointestinal disease; 76.11percent required 1-6 hours of observation; dehydration was mild in 59.66 percent and moderate in 21.75 percent. Vomiting and nausea were present in 58.37 percent of the patients; in 60.73 percent the cause was not determined. Conclusions: The sociodemographic and clinical-epidemiological variables selected made it possible to characterize the adult patients admitted for traveler's diarrhea. Further research is recommended to contribute to the prevention this disease. Further research is recommended to contribute to the prevention this disease and optimize care(AU)

Compliance with 14 day zinc therapy for acute diarrhoea: a prospective observational study

Background: Acute diarrheal diseases remain a leading cause of global morbidity and mortality in young children. The effective implementation of provision of zinc in addition to low osmolarity ORS remains very poor.Methods: A prospective observational study was done to determine compliance with zinc therapy on 103 children aged between two months to five years with acute gastroenteritis. They were started on WHO ORS and zinc in the form of syrup (20 mg/day in those >6 months of age and 10mg/day in those <6 months of age) and advised to continue for 14 days. Further episodes of diarrhea was considered as the primary outcome variable. Number of days zinc taken was considered as the primary explanatory variable. p-value <0.05 was considered statistically significant.Results: The mean age was 19.49'14.41 months. The compliance to complete 14-day zinc therapy was 62.14%.' The mean number of days zinc was taken was 11.28'3.81 days. In 11.65% of participants, there was further episodes of diarrhea. The main reasons for discontinuation were diarrhea stopped (45%), Ignorance (37.5%), URI (12.5%).Conclusions: Findings indicate that the syrup formulation is acceptable, but further efforts are required to enhance adherence. These findings also highlight the importance of guiding in ensuring adherence to zinc duration while also addressing the tendency of caregivers to terminate treatment once a child appears to have recovered from an acute diarrheal episode.

Prevalencia de patógenos causantes de enfermedad diarreica aguda en el área Metropolitana de Asunción y Central

Introducción: Las enfermedades diarreicas agudas (EDA) constituyen un problema de salud pública y son una de las causas más importantes de mortalidad y morbilidad en niños a nivel mundial. Objetivo: Determinar la prevalencia de enteropatógenos causantes de EDA en el área metropolitana de Asunción y Central. Materiales y métodos: Se realizó un estudio observacional, descriptivo de corte transverso. Se analizaron 743 muestras de heces diarreicas, en las cuales se investigó la presencia de Salmonella spp., Shigella spp., Campylobacter spp., Escherichia coli diarreigénicas y Rotavirus, utilizando técnicas de referencia. Resultados: En el 31,2% (232/743) de las muestras fue posible identificar al menos uno de los patógenos entéricos investigados, siendo las E. coli diarreigénicas fueron las bacterias identificadas con mayor frecuencia, seguido por Rotavirus, Campylobacter spp., Shigella spp. y en último lugar, Salmonella spp. Conclusión: La población más afectada corresponde a niños menores de 5 años. El principal patógeno identificado como agente causal de diarreas fueron las E. coli diarreigénicas en primer lugar, seguido por Rotavirus, Campylobacter spp., Shigella spp. y Salmonella spp. En algunas muestras se detectaron más de un patógeno entérico, encontrando incluso casos de coinfección con hasta cuatro patógenos diferentes.

Introduction: Acute diarrheal diseases (ADD) constitute a public health problem and are one of the most important causes of mortality and morbidity in children worldwide. Objective: To determine the prevalence of enteropathogens causing ADD in the metropolitan area of ​​Asunción and Central. Materials and methods: An observational, descriptive cross-sectional study was conducted. 743 samples of diarrheic feces were analyzed, in which the presence of Salmonella spp., Shigella spp., Campylobacter spp., Escherichia coli diarreigenic and Rotavirus was investigated, using reference techniques. Results: In 31.2% (232/743) of the samples it was possible to identify at least one of the enteric pathogens investigated, being the diarrhenetic E. coli were the most frequently identified bacteria, followed by Rotavirus, Campylobacter spp., Shigella spp. and lastly, Salmonella spp. Conclusion: The most affected population corresponds to children under 5 years of age. The main pathogen identified as the causative agent of diarrhea was diarrigenic E. coli, followed by Rotavirus, Campylobacter spp., Shigella spp. and Salmonella spp. In some samples more than one enteric pathogen was detected, even finding cases of coinfection with up to four different pathogens.

Electrolyte disturbance in rotaviral diarrhea and other acute diarrheal diseases in children under 5 years

Background: Acute diarrheal disease is one of the most common cause of mortality and morbidity in under 5 children. Rotavirus is one of the important cause of diarrhea in under 5. This study was done to know the electrolyte disturbance in under 5 children with diarrhea.Methods: A prospective observational study was conducted in Masonic Medical Centre for Children, Coimbatore on children aged less than 5 years with acute diarrhea with moderate and severe dehydration.Results: Total 220 children are included in study, among them 66(58.9%) had rotavirus infection. Among 220 cases of diarrhea 14.09% (31/220) had hypernatremia, 2.72% (6/220) had hyponatremia, 4.54% (10/220) had hyperkalemia and 9.09% (20/220) had hypokalemia. Among 66 cases of rotavirus diarrhea, 27.27% (18/66) had hypernatremia, 4.5% (3/66) had hyponatremia and 25.75% (17/66) had hypokalemia.Conclusions: Hypernatremia is the most common electrolyte disturbance in acute diarrheal diseases and most frequently seen in rotavirus diarrhea. In most of the situation, there is unavailability of laboratory or time lag in obtaining reports. Hence prediction of electrolyte disturbance and management is more important in diarrheal disease.

Insights into multiple use water enterobacteria from the Brazilian semi-arid: the first approach by pyrosequencing

Thousands of people living in semi-arid regions face problems of drought and loss of water quality. In addition, high incidence of acute diarrheal diseases related to water consumption has been responsible for a high number of deaths and high economic costs for human health. Many of the diseases can be caused by the presence of enterobacteria in reservoirs that serve for multiple purposes. This study aimed to confirm the presence of potentially harmful bacteria, which was highlighted in other articles, and to reveal non-identified genera by culture-dependent methods and pyrosequencing. Twenty-three genera of the Enterobacteriaceae family were detected, with emphasis on Escherichia genus and confirmation of the presence of species such as Salmonella enterica and Enterobacter cloacae. The abundance of heterotrophic prokaryotes and the physical and chemical data show an expected average for this type of environment due to the numbers historically presented in previous articles. The unprecedented detection of the presence of some potentially pathogenic species can alert and raise awareness of the populations that use stored water in the semi-arid regions. Consequently, as a result of the peculiar characteristics of reservoirs under this climate influence, there is a cosmopolitanism of enterobacteria that may be related to the alarming numbers of infections from Waterborne Diseases.

Phytochemical Screening and Anti-diarrheal Activity of the Pulp and Seed Extracts of Ziziphus mauritiana in Rats

In the present study, attempt was made to evaluate the phytochemical composition and anti-diarrheal activity of the seed and pulp extract of Ziziphus mauritania. The anti-diarrheal activity of the crude seed and pulp were evaluated using castor oil induced diarrheal model, charcoal meal test and anti-fluid accumulation test in rats. The result of phytochemical test indicated that tannins, flavonoids, saponin, cyanogenic glycosides, and terpenoids were present in both seed and pulp. In the castor oil induced model both the seed and pulp extract significantly prolonged diarrheal onset was observed in treated rats compared to the negative control. Similarly, in the fluid accumulation test, the extract of the seed and pulp produced a significant decline in volume of intestinal contents. Results from the charcoal meal test revealed that all the extract produced a significant anti-motility effect. Based on the findings of this work, the pulp extract of this plant possess anti-diarrheal properties and validates its use in traditional medicine for the treatment of diarrhea

Genetic and Antibiotic Resistance Characteristics of Campylobacter jejuni Isolated from Diarrheal Patients, Poultry and Cattle in Shenzhen / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate genetic and antibiotic resistance characteristics of Campylobacter jejuni (C. jejuni) isolated from Shenzhen.</p><p><b>METHODS</b>Multilocs sequence typing and agar dilution methods were used to define the genotype and antibiotic resistance of C. jejuni, respectively.</p><p><b>RESULTS</b>In total, 126 C. jejuni strains were isolated. The prevalence of C. jejuni was 5.3% in diarrheal patients. The prevalence in poultry meat (36.5%) was higher than that in cattle meat (1.1%). However, the prevalence in poultry cloacal swabs (27.0%) was lower than that in cattle stool (57.3%). Sixty-two sequence types were obtained, among which 27 of the STs and 10 alleles were previously unreported. The most frequently observed clonal complexes were ST 21 (11.9%), ST-22 (10.3%), and ST-403 (7.1%). ST-21, ST-45, ST-354, ST-403, and ST-443 complexes overlapped between isolates from patients and cattle, whereas ST-45 and ST-574 complexes overlapped between isolates from patients and poultry. All C. jejuni were resistant to at least one antibiotic. The highest resistance rate was toward ciprofloxacin (89.7%), followed by tetracycline (74.6%), and nalidixic acid (69.0%).</p><p><b>CONCLUSION</b>This is the first report of the genotypes and antibiotic resistance of C. jejuni in Shenzhen. Overlapping clonal complexes were found between isolates from patients and cattle, and between patients and poultry.</p>

Caracterização da intoxicação alimentar causada pelo Bacillus cereus: uma revisão / Characterization of food poisoning caused by Bacillus cereus: a review

Neste trabalho foi realizada uma revisão com o objetivo de demonstrar a importância do Bacillus cereus, o perfil toxigênico desse grupo de bactérias formadoras de esporos, que tem sido coligada a surtos de intoxicação alimentar, as metodologias utilizadas para sua determinação, identificar os fatores de virulência das toxinas emética e diarréica, bem como formas para evitar a intoxicação e os tratamentos para prevenção. A presença de B. cereus tem sido detectada em equipamentos e utensílios, mostrando que são fontes potenciais de transmissão do micro-organismo para os alimentos e também a importância da higienização correta dos equipamentos.

Detección molecular de Escherichia coli diarreogénica en pacientes pediátricos con síndrome diarreico agudo en Paraguay / Molecular detection of diarrheogenic Escherichia coli in pediatric patients with acute diarrheal syndrome in Paraguay

La Escherichia coli diarreogénica (ECD) se ha clasificado con base en criterios clínicos, epidemiológicos y moleculares en cinco grupos, cada uno con factores de virulencia específicos. El objetivo fue determinar la prevalencia de ECD en pacientes pediátricos con enfermedad diarreica aguda del Laboratorio Central de Salud Publica en el periodo 2012- 2015. Se procesaron muestras de heces con síndrome diarreico agudo, provenientes de pacientes pediátricos, en los cuales se buscó algún gen de virulencia ECD utilizando métodos convencionales de siembra y screening molecular, mediante PCR múltiple con cebadores diseñados específicamente para amplificar los genes de virulencia elt, est, eae, stx, ipaH y aggR. Del total de muestras analizadas, 13% (180/1379) de las muestras presentó algún factor de virulencia compatible con algún patotipo ECD con mayor predominio en niños de 1 a 3 años. La frecuencia de los distintos patotipos fue la siguiente: 61 (34%) ETEC, 40 (22%) EAEC, 41 (23%) EPEC, 27 (15%) EIEC, 7 (4%) STEC y 3 (2%) ETEC/EAEC, 1 (0.5%) ETEC/EAEC/EIEC. El porcentaje de E. coli diarreogénicas detectado tiene similitud con lo reportado en otros países de la región, lo que nos indica que estos patógenos son parte importante de la etiología de la enfermedad diarreica aguda infecciosa en la población infantil en nuestro país. Se debe destacar que para el diagnóstico de las diferentes categorías ECD, es necesario disponer de un procedimiento diagnóstico específico dirigido a la detección de los factores de virulencia utilizando métodos moleculares o métodos inmunológicos.

Diarrheagenic Escherichia coli (DEC) has been classified based on clinical, epidemiological and molecular criteria in five groups, each with specific virulence factors. The objective was to determine the prevalence of DEC in pediatric patients with acute diarrheal disease of the Central Laboratory of Public Health in the 2012-2015 period. A total of 1447 fecal samples of acute diarrheal syndrome from pediatric patients were processed in which a DEC virulence gene was searched using conventional screening and molecular screening methods with multiple PCR primers specifically designed to amplify virulence genes, st, lt, eae, stx, ipaH and aggR. From the total of analyzed samples, 13% (180/1379) of the samples presented some virulence factor compatible with a DEC pathogen type with greater predominance in children from 1 to 3 years. The frequency of the different pathogen types was as follows: 61 (34%) ETEC, 40 (22%) EAEC, 41 (23%) EPEC, 27 (15%) EIEC, 7 (4%) STEC and 3 (2% ETEC/EAEC, 1 (0.5%) ETEC/EAEC/EIEC. The percentage of DEC detected is similar to that reported in other countries of the region, which indicates that these pathogens are an important part of the etiology of acute infectious diarrheal disease in children in our country. It should be noted that for the diagnosis of different DEC categories, it is necessary to have a specific diagnostic procedure aimed at the detection of virulence factors using molecular methods or immunodiagnostic methods.

Correlation between 0-5 year old children’s diarrheal infections and soil bacterial contamination in Ulaanbaatar city / Монголын Анагаах Ухаан

Background@#The 2030 Agenda for Sustainable Development offers an historic opportunity to set a new course for the next era for significant changes for children and their families, with water, sanitation and hygiene (WASH) is at the centre of this ambitious new agenda, with a distinct water sector goal (SDG 6) that aims for universal, sustainable, affordable and equitable access to safe drinking water and adequate sanitation and hygiene, as well as the elimination of open defecation by 2030. According to the data of the National Statistics Office of Mongolia, the total population of the country is 3,036,988 of which 1.3 million inhabit in Ulaanbaatar with over 60 percent of them living in the ger districts. Sanitation facilities which fail to meet the hygiene requirements are used by 97.3 percent of the ger-district households.@*Materials and Methods@#The research was implemented using laboratory test methods following the cross-sectional model. In the ger communities of the 9 districts of Ulaanbaatar, 111 sites were selected for soil sampling in July, August and September of 2016 with 3 repetitions. The samples were tested in the reference laboratory of the Public Health Institute, titres of E.Coli and quantities of Protei were defined and assessed in comparison against the normative levels provided in the Standard MNS 3297:91 “Environmental protection. Soil. The indicators of norm sanitation condition for soil communities.@*Results@#The findings of the study show that the most or 79.2 percent (225) of the sites where E.Coli was detected had low level of contamination, 18.3 percent (52) had moderate contamination and 2.1 percent (7) had high level of contamination. By locations of soil sampling for E.Coli detection, 588.74 titres were counted in the samples from near the ger-district service centres which was the highest among other locations and 5.88 times exceeded the mean contamination category of MNS3291:91 Standard as much as 5.88 times. The E.Coli contamination in the samples taken from near the main roads and gas stations were higher than the Submitted abstract International expert consultation on sanitation in cold climate 148 mean standard category (100-1000) by 16 points, but still lower than at the other locations (p=0.22). The mean value of the Proteus titres from July, August and September in the soil samples from the proximities of the car and tyre repair shops and car wash centres was higher than at other locations and would fall within the high contamination category according to the Standard. The 1.0 percent of the causes of diarrhea in small children in ger areas in UB is E.Coli in the topsoil. But the total number of bacteria in soil accounts for the 2.1 percent of the causes of diarrhea in small children.@*Conclusions@#</br> 1. Thesurficial soil of the ger-districts in city Ulaanbaatar are getting contaminated due to human and animal excreta and pit latrines which do not meet the hygiene requirements.</br> 2. Pollution of soil pathogenic microorganisms affects the diarrheal infection in children from ger areas in Ulaanbaatar.

Enfermedad diarreica aguda por rotavirus en pacientes ingresados en un servicio de gastroenterología pediátrica / Acute diarrheal disease caused by rotavirus in patients admitted in a pediatric gastroenterology service

Se realizó un estudio descriptivo, prospectivo y transversal de 72 pacientes menores de 18 meses de edad con enfermedad diarreica aguda por rotavirus de tipo A, quienes fueron ingresados en el Servicio de Gastroenterología del Hospital Infantil Docente Sur "Dr. Antonio María Béguez César" de Santiago de Cuba, durante el período comprendido de marzo del 2012 a diciembre del 2013, con vistas a caracterizarles según algunas variables clínicas, epidemiológicas y terapéuticas. En el análisis estadístico se aplicaron el cálculo porcentual y la prueba de la Χ² (con un nivel de significación igual a 0,05), que revelaron un predominio del grupo etario de 12-18 meses, de los estilos de vida regular y malo, así como de la procedencia rural y la lactancia artificial. Asimismo fueron más frecuentes el cuadro sintomático de diarrea, vómito y fiebre, y la complicación deficiencia transitoria de la enzima lactasa.

A descriptive, prospective and cross-sectional study of 72 patients younger than 18 months of age with acute diarrheal disease caused by type A rotavirus who were admitted in the Gastroenterology Service of "Dr. Antonio María Béguez Caesar" Southern Teaching Pediatric Hospital in Santiago de Cuba was carried out, during the period of March, 2012 to December, 2013, with the aim characterizing them according to some clinical, epidemic and therapeutic variables. In the statistical analysis the percentage calculation and the Chi square test were applied (with a significance level similar to 0,05), that revealed a prevalence of the age group 12-18 months, of the lifestyles middle and poor, as well as of the rural origin and artificial nursing. Also the symptomatic pattern of diarrhea, vomit and fever, and the complication of transitory deficiency of the enzyme lactase were most frequent.

The role of human adenoviruses type 41 in acute diarrheal disease in Minas Gerais after rotavirus vaccination

Abstract Human adenovirus species F (HAdV-F) type 40 and 41 are commonly associated with acute diarrheal disease (ADD) across the world. Despite being the largest state in southeastern Brazil and having the second largest number of inhabitants, there is no information in the State of Minas Gerais regarding the role of HAdV-F in the etiology of ADD. This study was performed to determine the prevalence, to verify the epidemiological aspects of infection, and to characterize the strains of human adenoviruses (HAdV) detected. A total of 377 diarrheal fecal samples were obtained between January 2007 and August 2011 from inpatient and outpatient children of age ranging from 0 to 12 years. All samples were previously tested for rotavirus, norovirus, and astrovirus, and 314 of 377 were negative. The viral DNA was extracted, amplified using the polymerase chain reaction and the HAdV-positive samples were sequenced and phylogenetically analyzed. Statistical analyses were performed using the Chi-square test (p < 0.05), considering two conditions: the total of samples tested (377) and the total of negative samples for the remaining viruses tested (314). The overall prevalence of HAdV was 12.47% (47/377); and in 76.60% (36/47) of the positive samples, this virus was the only infectious agent detected. The phylogenetic analysis of partial sequences of 32 positive samples revealed that they all clustered with the HAdV-F type 41. The statistical analysis showed that there was no correlation between the onset of the HAdV infection and the origin of the samples (inpatients or outpatients) in the two conditions tested: the total of samples tested (p = 0.598) and the total of negative samples for the remaining viruses tested (p = 0.614). There was a significant association in the occurrence of infection in children aged 0–12 months for the condition 1 (p = 0.030) as well as condition 2 (p = 0.019). The occurrence of infections due to HAdV did not coincide with a pattern of seasonal distribution. These data indicate the significant involvement of HAdV-F type 41 in the etiology of ADD in Minas Gerais, which demonstrates the importance of other viral agents in the development of the disease after the introduction of rotavirus vaccine immunization.