Systematic review and Meta-analysis of efficacy and safety of Fengliao Changweikang prescription in treatment of acute gastroenteritis / 中国中药杂志

This study systematically evaluated the clinical efficacy and safety of Fengliao Changweikang prescription for treating acute gastroenteritis(AGE). The databases of CNKI, Wanfang, VIP, SinoMed, Medline, Cochrane Library and two clinical trial registration platforms were retrieved from inception to August 30, 2022, to collect randomized controlled trial(RCT) on Fengliao Changweikang prescription treating AGE. Two researchers independently conducted literature screening, data extraction, and risk of bias assessment according to pre-established inclusion and exclusion criteria. RevMan 5.4.1 was used for data analysis. Finally, 18 RCTs were included, involving 3 489 patients. Meta-analysis showed that compared with conventional western medicine, Fengliao Changweikang prescription improved the relief rate of abdominal pain(RR=1.27, 95%CI[1.17, 1.38],P<0.000 01); Fengliao Changweikang prescription + conventional western medicine increased the cure rate(RR=1.43, 95%CI[1.12, 1.82], P=0.004), shortened the duration of diarrhoea(RR=-1.65, 95%CI[-2.44,-0.86], P<0.000 1), abdominal pain(RR=-1.46, 95%CI[-2.00,-0.92], P<0.000 01), vomiting(RR=-2.16, 95%CI[-2.51,-1.81], P<0.000 01) and fever(RR=-2.61, 95%CI[-4.00,-1.23], P=0.000 2), down-regulated the level of interleukin-8(IL-8)(RR=-1.07, 95%CI[-1.26,-0.88], P<0.000 01), IL-6(RR=-8.24, 95%CI[-8.99,-7.49], P<0.000 01) and hypersensitive C-reactive protein(hs-CRP)(RR=-3.04, 95%CI[-3.40,-2.69], P<0.000 01) and recurrence of AGE(RR=0.20, 95%CI[0.05, 0.90], P<0.04). In conclusion, Fengliao Changweikang prescription was safe in clinical application. It was beneficial to alleviate the clinical symptoms of diarrhea, abdominal pain, vomiting, and fever, and down-regulate the levels of some serum inflammatory factors in AGE patients. However, considering that few high-quality studies have evaluated the efficacy and safety of Fengliao Changweikang prescription in treatment of AGE, further evidence is needed in the future.

Application effect of magnetic service concept in clinical nursing for patients with acute gastroenteritis / 中国实用护理杂志

Objective:To explore the application effect of magnetic service concept in clinical nursing for patients with acute gastroenteritis.Methods:A total of 101 patients with acute gastroenteritis undergoing magnetic service concept intervention in gastroenterology department of Lishui Central Hospital were selected as study group from January 2019 to January 2020, other 97 patients with acute gastroenteritis undergoing routine nursing intervention were enrolled as control group from January to December 2018. The scores of Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), self-care ability and quality of life before and after intervention were observed and compared between the two groups. The scores of nursing satisfaction were recorded and compared between the two groups.Results:After nursing, HAMA and HAMD scores in study group were (13.39 ± 4.56) and (17.89 ± 6.63) points, which were significantly lower than those in control group (18.60 ± 6.79) and (21.51 ± 6.03) ( t values were 6.36 and 4.11, P<0.05). After nursing, scores of self-concept, self-responsibility, self-care skills and health awareness in study group were (79.12 ± 4.98), (79.85 ± 5.47), (80.22 ± 3.89) and (76.25 ± 5.98) points, which were higher than those in control group (52.08 ± 3.63), (58.88 ± 7.25), (57.65 ± 3.62), (54.12 ± 5.06) points (t values were 23.06-43.41, P<0.05). After nursing, scores of physiology, mentality, emotion and social contact in study group were (69.14 ± 4.21), (82.13 ± 6.12), (71.25 ± 5.28) and (82.95 ± 7.22) points, which were higher than those in control group (60.41 ± 3.26), (69.57 ± 4.26), (57.13 ± 3.21), (68.07 ± 5.14) points (t values were 16.27-33.63, P<0.05). The scores of satisfaction with life care, regular wards inspections, bell calling, service attitudes and health education in study group were (90.40 ± 6.80), (91.38 ± 6.82), (90.22 ± 4.96), (90.88 ± 5.56) and (92.46 ± 6.38) points, which were higher than those in control group (81.22 ± 5.83), (80.44 ± 4.25), (82.12 ± 4.65), (83.24 ± 4.56), (82.06 ± 3.55) points (t values were 10.18-14.09, P<0.05). Conclusions:The magnetic service concept can improve psychological status and quality of life in patients with acute gastroenteritis, enhance self-care ability and nursing satisfaction.

Epidemiological characterization of sapovirus gastroenteritis aggregation in a kindergarten in Jinshan District， Shanghai / 上海预防医学

Objective:To analyze the epidemiological characteristics of an aggregational gastroenteritis and determine the genotypes of sapovirus， and to provide scientific basis for formulating effective control strategies. Methods:Unified case definition， active case search and descriptive epidemiology were used to analyze the epidemic. Feces or anal swabs of untreated students， teachers， canteen staff as well as canteen environment samples were collected. Norovirus and sapovirus nucleic acid tests were conducted by real-time fluorescent RT-PCR， and sapovirus nucleic acid was amplified by conventional RT-PCR. The gene region of capsid protein was analyzed by MEGA7.0 software and phylogenetic tree was constructed. Results:A total of 12 cases were reported in the epidemic， and the incidence rate was 44.44%. All reported cases， with vomiting symptoms， were found in the same class. The epidemic showed a point-based outbreak. The first case became the source of infection in class， and the epidemic lasted for 8 days. Real-time fluorescent RT-PCR assay confirmed that five children's feces were positive for sapovirus nucleic acid， and the first-episode children's feces were positive for sapovirus and GII norovirus nucleic acid. Sequence alignment result showed that the sapovirus strains belonged to GI.1 type with homologous genes. Conclusion:Based on the clinical manifestations， field epidemiological investigation and laboratory test results， we confirm that the first case of the epidemic in class is caused by GI.1 sapovirus infection. The epidemic is effectively controlled by comprehensive measures such as case isolation and disinfection.

A molecular epidemiological study of pediatric norovirus gastroenteritis, 2017-2019 / 中国当代儿科杂志

OBJECTIVES@#To study the molecular epidemiological characteristics of norovirus in children with acute gastroenteritis from 2017 to 2019.@*METHODS@#A retrospective analysis was performed on the medical data of children with acute gastroenteritis who were admitted to Children's Hospital of Chongqing Medical University from January 2017 to December 2019. A total of 1 458 stool samples were collected from the children, and viral RNA was extracted. Reverse transcription polymerase chain reaction was used for gene amplification, sequencing, and genotype identification of the VP1 region of capsid protein in norovirus.@*RESULTS@#Among the 1 458 stool samples, 158 (10.8%) were positive for norovirus. There was no significant difference in the positive detection rate of norovirus between different years (@*CONCLUSIONS@#Norovirus GII.4 Sydney 2012 was the major epidemic strain in the children with norovirus gastroenteritis from 2017 to 2019. Although norovirus infection can exist throughout the year, August to October is the peak period. During this period, norovirus surveillance and key population protection are strengthened to help prevent and control norovirus diarrhea.

First report of human astrovirus MLB2 in Brazil detected in feces of children with acute gastroenteritis living in the state of Roraima, Northern Brazil

ABSTRACT Human astrovirus (HAstV) 1-8 and highly divergent HAstVMLB1−3 genotypes have been detected in children both with and without acute gastroenteritis (AGE). One hundred and seventy fecal samples from children (≤5 years old) living in the Amazon region were evaluated for the presence of HAstV1-8, HAstV MLB1−3 and HAstVVA1−3, using an usual RT-PCR protocol and a new protocol with specific primers designed to detect HAstVMLB1−3. HAstVMLB1 and HAstV MLB2, as well as the HAstV3 and 5 genotypes were detected. HAstVMLB1−2 genotype was detected for the first time in Brazil at a frequency of 3.5% (6/170).

Study of electrolyte disturbances and renal parameters in acute gastroenteritis under 5 years of age in a tertiary care hospital of Bengaluru, India

Background: Diarrhoea still continues to be a major cause of hospitalization and death in under fives. Electrolyte disturbances play an important role in the associated morbidity and mortality.  Acute renal failure is one of the important complications of acute gastroenteritis (AGE) in children. Early intervention and proper fluid replacement may lessen this risk. This study was designed to find out the incidence of acute gastroenteritis and the status of associated electrolyte derangements and renal involvement.Methods: This was a cross sectional study conducted at KIMS, Bengaluru in which 117 children from the age of 1 month to 5 years with acute diarrhea were included based on a predefined inclusion and exclusion criteria. Demographic profile of the patients, details of diarrhea, clinical examination and accompanying degree of dehydration (defined as per WHO criteria) were recorded. Serum electrolytes along with renal parameters were investigated.Results: Total 117 children with acute gastroenteritis were enrolled in the study as per the inclusion criteria which constituted 5% of total paediatric admissions. Children aged 1-12 months had the highest incidence of diarrhea (50%). Male to female ratio is 1.3:1. 65% had some dehydration, 19% no dehydration and 16% had severe dehydration. Isonatremia was seen in 58% followed by hyponatremia in 35% and hypernatremia in only 7%. 83% had isokalemia, hypokalemia in 12%, hyperkalemia in 5%. Levels of serum sodium and potassium decreased with the severity of dehydration. Serum urea and creatinine were significantly high in severe dehydration (p value 0.001). Out of 28 children who were given diluted ORS before admission, majority had hyponatremia (39%) and all of them who received concentrated ORS had hypernatremia.Conclusions: Hyponatremic dehydration is the second most common type of dehydration next to isonatremic dehydration, but it is more common in children who took diluted ORS. Increased awareness regarding ORS preparation may help in preventing electrolyte imbalance in AGE. The levels of serum sodium and potassium decreased and urea and creatinine increased with severity of dehydration. Measurements of serum electrolytes and renal parameters early can help to predict the complications due to AGE and may help in the prevention of diarrhea related complications in children.

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.

Investigation on the acute gastroenteritis outbreak caused by sapovirus infection in Yangzhou City / 公共卫生与预防医学

Objective To investigate the characteristics of outbreaks of acute gastroenteritis caused by sapovirus infection among primary school students in Yangzhou. Methods An on-site epidemiological investigation was carried out to analyze the clinical symptoms and risk factors of epidemic transmission. Samples of patients were collected for nucleic acid detection of sapovirus. Follow-up observations were carried out on cases with positive detection to explore the duration of intestinal detoxification of sapovirus infection. Samples of close contacts without clinical symptoms were collected to analyze recessive infection status. Results A total of 30 cases were reported from two outbreaks of sapovirus infection. As a main symptom, the incidence rate of vomiting was 93.33%. The duration of intestinal detoxification of the cases was 3 to 19 days, with an average of 11.12 days. The rate of recessive infection was 26.32%. The risk factor for sapovirus infection was exposure to vomit or feces within 1 meter (OR=12.94, 95%CI 1.19-140.37), and the protective factor was washing hands before eating (OR=0.064, 95%CI 0.007-0.56). Conclusion The main symptom of sapovirus infection was vomiting, with a high rate of recessive infection and a long detoxification period. It is easy to cause an outbreak in primary schools. Exposure to vomit or feces within 1 meter could increase the risk of sapovirus infection. Washing hands before eating could reduce the risk of sapovirus infection.

Study on the influencing factors of serum small and dense low-density lipoprotein cholesterol levels in patients with chronic diseases in Zhoujiadu Community / 公共卫生与预防医学

Objective To investigate influencing factors of serum small and dense low-density lipoprotein cholesterol (sd LDL-C) levels in patients with chronic diseases in Zhoujiadu community, and to provide a scientific basis for the treatment of sd LDL-C related chronic diseases. Methods A total of 200 patients with common chronic diseases who were admitted to our hospital from November 2017-November 2019 were selected. Basic data including height, weight, past medical history and family history of the patients were collected. Biochemical indicators were measured to understand dietary structure. The influencing factors of serum sd LDL-C were analyzed by multiple stepwise regression. Results The levels of serum sd LDL-C in patients with advanced age, increased BMI, thickened IMT, fatty liver and coronary heart disease were significantly increased (P<0.05). Pearson linear correlation analysis showed that serum sd LDL-C level of patients with chronic diseases was positively correlated with TC, TG, LDL, ALT and AST, and negatively correlated with HDL (P<0.05). Multiple linear regression showed that TG, BMI, IMT, fatty liver, oil heating (frying and frying) and the use of mixed oil were independent risk factors of sd LDL-C level in patients with common chronic diseases, while HDL-C was a protective factor (P<0.05). Conclusion The levels of serum sd LDL-C in patients with common chronic diseases in Zhoujiadu community were correlated with dyslipidemia, BMI, thickening of IMT, fatty liver, oil heating (frying and frying), and use of mixed oil.

New progress in anti-norovirus drugs and vaccines / 药学学报

Norovirus (NoV) is the main pathogen causing the global acute gastroenteritis in humans and NoV infection has become an important public health problem that threatens human health. Because of the lack of appropriate animal models and in vitro cell culture models, the development of NoV biology and antiviral research has been restricted, and there is currently no effective antiviral drug or vaccine against NoV. In the past few years, considerable progress has been made toward the development of norovirus antivirals. This review selects the most representative research examples and provides an overview of recent advances in anti-norovirus drugs and vaccines.

Observational study to assess demographic, clinical profile and outcome of acute kidney injury due to acute gastroenteritis during monsoon season

Background: Worldwide incidence and causes of acute kidney injury (AKI) are variable and even more in developed and developing countries. At least 80% of AKI in tropics is community acquired. Acute gastroenteritis (AGE) is a common problem in developing countries. Present study concentrates on AGE as cause of AKI during monsoon period. It presents in epidemic proportion during monsoon and is preventable with timely intervention.Methods: The study was carried out prospectively in tertiary care hospital in Mumbai during monsoon season of 2012 and 2013. AKI was staged as per AKIN criteria. Patients were treated for primary disease and AKI, initially conservatively and dialysis if indicated. Patients were followed during the hospital stay.Results: Two hundred and thirty patients had AKI due to infectious disease during monsoon. Incidence of AKI due to diarrhea was 23%, and affecting males predominantly in 4th decade. Diarrhea and vomiting were the most common presenting complaints. 32% patients required dialysis. Mortality rate was 3.8%.Conclusions: AKI secondary to AGE is common in tropics. Treatment of primary disease and hemodynamic optimization at the earliest helps to prevent AKI. Presents with less severe AKI and has better outcome. Multiorgan involvement and need for supportive lifesaving therapies were risk factors for AKI.

Seasonal variations among admitted paediatric patients at tertiary care hospital, Gadap Town, Karachi, Pakistan

Background: In pediatrics, the season is one of the elements contributing to the etiological factors of community based diseases. Awareness of this variation can help the physicians for prevention and counseling of the patients. A cross-sectional observational study was designed with non-probability convenient sampling technique to determine the frequency of patients admitted to the paediatric ward of the hospital in a whole calendar year and to ascertain which disease presentation is most common. Methods: Study conducted at paediatric ward of Al-Tibri Medical College and Hospital Karachi, Pakistan having patients admitted during May 2018 to April 2019. After ethical approval and informed consent from their parents/ guardian, a total of 734 paediatric patients that were admitted from paediatric OPD/ emergency were selected for the study. Paediatric patients that were referred, in emergency/ ICU and surgical paediatric patients were excluded from the study. Chi-square test was applied to evaluate the statistical variation among the patients.Results: From the 734 patients, 357 (48.6%) patients were of acute gastroenteritis, 104 (14.2%) of respiratory illness, 86 (11.7%) of viral fever, 67 (9.1%) of urinary tract infection, 36 (4.9%) of neurological illness, 29 (4.0%) of protein calorie malnutrition, 25 (3.4%) of enteric fever, 20 (2.7%) of haematological illness and 10 (1.4%) patients were admitted due to sepsis.Conclusion: Our study concluded that majority of the patients admitted were of acute gastroenteritis / admitted due to gastric issues, therefore further studies in the vicinity would help to better understand the issues and help plan a strategy to combat the diseases.

Gastroenteritis aguda por norovirus en pacientes con atención hospitalaria: estudio transversal / Acute gastroenteritis due to norovirus in patients with hospital care: a cross-sectional study

Resumen Introducción: Debido a la disponibilidad de técnicas moleculares en la atención clínica, las gastroenteritis agudas (GEA) por norovirus han retomado importancia como un agente causante de hospitalización. El objetivo de este estudio fue describir las características clínicas y evolutivas de pacientes menores de 16 años hospitalizados por GEA por norovirus. Métodos: Estudio retrospectivo. Se recabó información clínica de los pacientes atendidos en hospitalización del 1 de noviembre del 2016 al 28 de febrero del 2018 por GEA con detección de norovirus (genotipo I y II) en heces por medio de reacción en cadena de la polimerasa con transcriptasa inversa. Resultados: Estudiamos 103 pacientes; 96 (93.2%; intervalo de confianza del 95% [IC 95%]: 86.6-96.7%) con deteccion de genotipo II y 7 (6.8%; IC 95%: 5.3-8.7%) de genotipo I; 76 (73.8%) ≤5 anos. El 48.5% fueron atendidos durante el invierno. La evolucion fue a la autolimitacion en menos de 7 días en todos con manejo hidroelectrolitico. No hubo diferencias en la gravedad y sintomas segun el grupo viral: en ambos predominaron los vómitos (82%). Solo un paciente cursó con perforación intestinal por coinfección con Shigella sp.; tres pacientes (3.1%) manifestaron crisis convulsivas (dos febriles y una epiléptica). Conclusiones: La GEA por norovirus, a pesar de causar una enfermedad meritoria de hospitalización, tiene un pronóstico favorable con autolimitación rápida. Su detección por pruebas rápidas en heces podría evitar la prescripción injustificada de antibióticos.

Abstract Background: Because of the availability of molecular techniques in clinical care, acute gastroenteritis (AGE) due to norovirus has returned to importance as a causative agent of hospitalization. The aim of this study was to describe the clinical features and evolution of patients less than 16 years hospitalized for AGE associated with norovirus. Methods: Retrospective study. Clinical information of the patients attended from November 1, 2016 to February 28, 2018 by AGE with detection of norovirus (genotype I and II) in faeces by means of polymerase chain reaction with reverse transcriptase was collected. Results: We studied 103 patients; 96 (93.2%; 95% confidence interval [95% CI]: 86.6-96.7%) with genotype II detection and seven (6.8%; 95% CI: 5.3-8.7%) genotype I; 76 (73.8%) ≤5 years. 48.5% attended during the winter. The evolution was to self-limitation in less than 7 days in all with hydro electrolytic management. There were no differences in the severity and symptoms according to the viral group; in both cases the vomiting predominated (82%). Only one patient had intestinal perforation due to co-infection with Shigella sp.; three patients (3.1%) manifested seizures (two febrile and one epileptic convulsions). Conclusions: Despite causing a meritorious disease of hospitalization, GEA by norovirus has a favorable prognosis with rapid self-limitation. Its timely detection by rapid tests in feces could avoid the unjustified prescription of antibiotics.

Utilización de probióticos, antisecretores y zinc en la gastroenteritis aguda en pediatría en Uruguay / Use of probiotic, antisecretory drugs and zinc for acute gastroenteritis in Uruguayan pediatric patients / Uso de probióticos, drogas anti-secretoras e zinco em gastroenterite aguda em pediatria no Uruguai

Resumen: Introducción: luego de la difusión de las sales de rehidratación oral, que resultó en una radical disminución en la morbimortalidad por gastroenteritis aguda (GEA), existe interés creciente en tratamientos destinados a reducir su duración. Objetivo: conocer la utilización de los tratamientos para disminuir la duración de la GEA (probióticos, antisecretores, zinc) por los pediatras uruguayos. Método: encuesta online difundida a través de la Sociedad Uruguaya de Pediatría. Resultados: n=245 encuestas de pediatras procedentes de 17/19 departamentos del país (59% Montevideo). El 39,4% no indica probióticos en tratamiento de GEA; 5,8% lo indica siempre, y 49% en algunas situaciones (15,2% ingreso hospitalario; 21,2% inmunodeprimidos). La elección se basa en 13% en evidencia científica y 47,9% por disponibilidad en el lugar de cobertura. El 32,2% conoce adecuadamente el impacto en la duración de la diarrea. El 61,4% nunca utiliza antisecretores y 24,9% lo utiliza (96,6% racecadotrilo; 3,4% loperamida) en algunas situaciones (56,7% <5 años; 41,6% >5 años; 21,6% en pacientes que requieren internación). El 22% conoce adecuadamente el impacto de su utilización en la duración de la diarrea. En relación con el uso de zinc, 76,3% lo utiliza en algunas situaciones (64% pacientes desnutridos; 46% pacientes internados; 31% >6 meses y 26% <6 meses), y 6,9% lo utiliza siempre). Conclusiones: existe una amplia utilización de probióticos y zinc y un escaso uso de antisecretores en nuestro medio. Los pediatras uruguayos reconocen el posible rol de estos fármacos en la GEA. Un alto porcentaje de los pediatras no conoce la evidencia que fundamenta su uso. Es necesaria la implementación de programas de educación médica continua para guiar su uso.

Summary: Introduction: there is an increasing interest regarding treatments that shorten the duration of acute gastroenteritis (AG) in children, although little is known about it in Uruguay. Aim: that Uruguayan pediatricians get acquainted with probiotics, antisecretory drugs and zinc treatments. Methods: online survey sent to pediatricians members of the Uruguayan Pediatrics Association. Results: n=245 surveys carried out by pediatricians at 17/19 departments in Uruguay (59% from Montevideo). 39.4% stated they had not used probiotics to treat AG, 5.8% had always used it and 49% used it depending on the situation (15.2% used it with inpatients and 21.2% with immune depressed children). The choice of probiotics was based: 13% on scientific evidence and 47.9% on availability. 32.2% of pediatricians knew the real impact of probiotics on the duration of AG. 61.4% did not use antisecretory drugs and 24.9% used them depending on the situation (56.7% <5 years old, 41.6% >5 years, 21.6% inpatients). 96.6% of them chose Racecadotril and 3.4% Loperamide. 22% were aware of the real impact of the duration of AG. 76.3% of pediatricians used zinc to treat GEA in some situations (64% malnourished children, 46% inpatients, 31% >6 months, 26% <6 months) and 6.9% always used it. Conclusion: while probiotics and zinc are widely used, antisecretory drugs are slightly used as AG treatments in Uruguay. Uruguayan pediatricians identify the potential useful role of these treatments for AG, although many of them are not aware of its real use, so it is necessary to offer permanent medical training programs in this respect.

Resumo: Introdução: há um interesse crescente em tratamentos para reduzir a duração da gastroenterite aguda (GA) em pediatria, embora ainda há pouco conhecimento do tratamento no Uruguai. Objetivo: que os pediatras uruguaios se familiarizem com os tratamentos com probióticos, medicamentos anti-secretores e zinco. Métodos: pesquisa online enviada aos pediatras da Sociedade Uruguaia de Pediatria. Resultados: n = 245 pesquisas realizadas por pediatras em 17/19 departamentos do Uruguai (59% de Montevidéu). 39,4% afirmaram não ter usado probióticos para tratar a GEA, 5,8% sempre usaram e 49% usaram dependendo da situação (15,2% usaram com pacientes internados e 21,2% com imunossuprimidos). A escolha dos probióticos foi baseada: 13% na evidência científica e 47,9% na disponibilidade. 32,2% dos pediatras conheciam o real impacto dos probióticos na duração da GA. 61,4% não faziam uso de drogas antisecretoras e 24,9% usaram dependendo da situação (56,7% <5 anos, 41,6% ± 5 anos, 21,6% internados). 96,6% deles escolheram Racecadotril e 3,4% Loperamida. 2% conheciam o impacto real na duração da GA. 76,3% dos pediatras usaram zinco para tratar a GA em algumas situações (64% das crianças desnutridas, 46% dos pacientes internados, 31% >6 meses, 26% <6 meses) e 6,9% sempre usaram. Conclusão: os probióticos e o zinco são amplamente utilizados, enquanto os antisecretores são pouco usados no Uruguai. Pediatras uruguaios tem identificado o potencial papel útil desses tratamentos para a GA, embora muitos deles ainda não conheçam seu uso real, por isso é necessário oferecer programas permanentes de capacitação médica nesse assunto.

Systematic review on the characteristics of acute gastroenteritis outbreaks caused by sapovirus / 中华流行病学杂志

Objective To understand the epidemiological and etiological characteristics of outbreaks on acute gastroenteritis caused by sapovirus (SaⅤ) worldwide.Methods Literature about the outbreaks on acute gastroenteritis caused by SaⅤ were retrieved from the databases including WanFang,CNKI,PubMed and Web of Science after evaluation.Time,geography,setting and population distributions of outbreaks,transmission mode,SaⅤ genotype and clinical characteristics of the patients were analyzed.Results A total of 34 papers about SaⅤ were included,involving 146 outbreaks occurred between October 1976 and April 2016.In these papers,138 outbreaks were reported on the related months.All these outbreaks occurred in northern hemisphere.SaⅤ outbreaks occurred all year around,but mainly in cold season,the incidence was highest in December (25 outbreaks) and lowest in in August (2 outbreaks).Most outbreaks were reported by Japan,followed by Canada,the United States of America and the Netherlands.There were 141 outbreaks for which the occurring settings were reported,child-care settings were most commonly reported setting (48/141,34.04％),followed by long-term care facility (41/141,29.08％) and hospital (16/141,11.35％).Clinical symptoms of 1 704 cases in 31 outbreaks were reported,with the most common symptom was diarrhea (1 331/1 704,78.12％),followed by nausea (829/1 198,69.20％),abdominal pain (840/1 328,63.25％),vomiting (824/1 704,48.36％) and fever (529/1 531,34.53％).Genotypes of SaⅤ were determined for 119 outbreaks.GⅠ (51/119,42.86％) and GⅣ (45/119,37.82％) were predominant.The outbreaks of G Ⅳ SaⅤ increased suddenly in 2007,and the outbreaks of G Ⅰ SaⅤ mainly occurred in 2008 and during 2011-2013.Conclusions SaⅤ outbreaks were reported mainly by developed countries,with most outbreaks occurred in cold season,in child-care settings and long term care facility.G Ⅰ and GⅣ were the most common genotypes of SaⅤ.Prevention and control of SaⅤ outbreak in China seemed relatively weak,and it is necessary to conduct related training and to strengthen the SaⅤ outbreak surveillance in areas where service is in need.

Pathogenic characteristics of viral gastroenteritis among pediatric inpatients under five years old during 2014-2017 / 中华流行病学杂志

Objective@#To conduct a viral pathogen surveillance program on pediatric inpatients less than five years old with acute gastroenteritis in Shanghai and to better understand the pathogenic spectrum and molecular features in the target population, for setting up programs on control, prevention, medication and vaccine applications of the diseases.@*Methods@#Fecal samples were collected from inpatients less than 5 years old who were admitted to a pediatric hospital for having acute gastroenteritis. Information related to demographic, clinical and epidemiological features of the patients was also collected. Laboratory assays including ELISA, real-time PCR and nested PCR, were performed to detect the presence of pathogens as rotavirus, calicivirus, astrovirus and adenovirus.@*Results@#A total of 1 018 samples were collected (male 671 and 347 female), with the positive detection rate as 40.57% which peaked from autumn till winter, annually. Calicivirus and rotavirus A presented with the highest detection rates (24.75% and 13.95% respectively). The lowest detection rate was found in the 0-6 month-olds (32.20%). 65% of the patients with positive virus had received antibiotic treatment prior to the hospitalization. However, no statistically significant difference was seen, regarding the rates of antibiotic medication in the virus positive or negative populations (P>0.05). Data from the Rotavirus genotype analysis revealed that G9P[8] genotype was the predominant strain, and causing majority of rotavirus infections in all the age groups.@*Conclusions@#Among the inpatients under 5 years of age in Shanghai, the positive detection rate for Calicivirus was higher than that for rotavirus group A, suggesting the necessity to carefully monitor the changes regarding the pathogenic spectrum and subtypes of the virus. Antibiotics should also be attentively administered, together with the development of suitable vaccine.

Genotypes and molecular characterization of group A rotavirus in domestic sewage in Yantai, 2014-2016 / 中华实验和临床病毒学杂志

Objective@#To understand the genotype distribution and molecular epidemiological characteristics of the group A rotavirus (RVA) in domestic sewage, and further explore the importance of environmental surveillance in investigating RVA regional circulation.@*Methods@#Sewage samples were collected monthly in the city of Yantai from January 2014 to December 2016. After concentration, total RNA was extracted, and RVA VP7 and VP4 coding regions were amplified via RT-PCR. PCR products were purified, cloned and Sanger sequenced. Genotyping and phylogenetic analysis was conducted based on the sequences.@*Results@#Thirty-six sewage samples were collected and 86.1% was positive with VP7 and VP4 sequences. A total of 205 VP7 and 239 VP4 nucleotide sequences were obtained, belonging to 4 G genotypes and 6 P genotypes. Among these, G9 (95.6%, 196/205), P[8] (58.6%, 140/239) and P[4] (28.0%, 67/239) were the most common genotypes. Phylogenetic analysis for G9, P[8] and P[4] sequences revealed co-circulation of multiple transmission chains in local population.@*Conclusions@#This study describes the genotype distribution and sequence characteristics of local RVA in Shandong province, and the result demonstrate that surveillance on environmental sewage is an effective way in investigating RVA molecular epidemiology.

Analysis on influencing factors for acute gastroenteritis outbreaks caused by norovirus in Beijing, 2014-2018 / 中华流行病学杂志

Objective@#To analyze the influencing factors of acute gastroenteritis outbreaks caused by norovirus in Beijing from 2014 to 2018.@*Methods@#Data of acute gastroenteritis events caused by norovirus in Beijing from April 2014 to March 2018 were collected. Unconditional logistic regression model was conducted to identify the risk factors of the outbreaks.@*Results@#A total of 765 acute gastroenteritis epidemics caused by norovirus were reported in Beijing, in which 85.88% (657/765) were cluster events and 14.12% (108/765) were outbreaks. Among the outbreaks, 70.37% (76/108) were reported in 2017; 84.26% (91/108) were reported in winter and spring; 88.89% (96/108) were reported in kindergartens, primary or secondary schools; 81.48% (88/108) were through person-to-person transmission; 93.52% (101/108) were caused by norovirus GⅡ infection. The risk of outbreaks in suburban and out suburb area were 1.84 times (95%CI: 1.13-3.02) and 3.78 times (95%CI: 1.62-8.82) as high as that in urban area, respectively. The risks of outbreaks in primary, secondary schools and other institutions were 6.26 times (95%CI: 3.53-11.10), 14.98 times (95%CI: 6.23-36.01) and 8.71 times (95%CI: 3.07-24.71) as high as that in kindergartens, respectively. The risk of outbreak in which patients having lower hospital visiting rate than the median rate of all events was 2.29 times than that in the context of having higher hospital visiting rate (95%CI:1.42-3.68). The risk of foodborne outbreak was 14.55 times as high as that transmitted through person-to-person (95%CI: 3.15-67.07).@*Conclusion@#Measures such as strengthening the prevention and control of norovirus outbreaks in suburbs, primary schools, secondary schools and other institutions, promoting patients to visit the hospital actively, improving the management of foodborne events and kitchen workers should be taken to reduce the incidence of acute gastroenteritis outbreaks caused by norovirus.

Systematic review on the characteristics of acute gastroenteritis outbreaks caused by sapovirus / 中华流行病学杂志

Objective To understand the epidemiological and etiological characteristics of outbreaks on acute gastroenteritis caused by sapovirus (SaⅤ) worldwide.Methods Literature about the outbreaks on acute gastroenteritis caused by SaⅤ were retrieved from the databases including WanFang,CNKI,PubMed and Web of Science after evaluation.Time,geography,setting and population distributions of outbreaks,transmission mode,SaⅤ genotype and clinical characteristics of the patients were analyzed.Results A total of 34 papers about SaⅤ were included,involving 146 outbreaks occurred between October 1976 and April 2016.In these papers,138 outbreaks were reported on the related months.All these outbreaks occurred in northern hemisphere.SaⅤ outbreaks occurred all year around,but mainly in cold season,the incidence was highest in December (25 outbreaks) and lowest in in August (2 outbreaks).Most outbreaks were reported by Japan,followed by Canada,the United States of America and the Netherlands.There were 141 outbreaks for which the occurring settings were reported,child-care settings were most commonly reported setting (48/141,34.04％),followed by long-term care facility (41/141,29.08％) and hospital (16/141,11.35％).Clinical symptoms of 1 704 cases in 31 outbreaks were reported,with the most common symptom was diarrhea (1 331/1 704,78.12％),followed by nausea (829/1 198,69.20％),abdominal pain (840/1 328,63.25％),vomiting (824/1 704,48.36％) and fever (529/1 531,34.53％).Genotypes of SaⅤ were determined for 119 outbreaks.GⅠ (51/119,42.86％) and GⅣ (45/119,37.82％) were predominant.The outbreaks of G Ⅳ SaⅤ increased suddenly in 2007,and the outbreaks of G Ⅰ SaⅤ mainly occurred in 2008 and during 2011-2013.Conclusions SaⅤ outbreaks were reported mainly by developed countries,with most outbreaks occurred in cold season,in child-care settings and long term care facility.G Ⅰ and GⅣ were the most common genotypes of SaⅤ.Prevention and control of SaⅤ outbreak in China seemed relatively weak,and it is necessary to conduct related training and to strengthen the SaⅤ outbreak surveillance in areas where service is in need.

Deshidratación. Revisión de terapia de rehidratación / Dehydration. Review on oral rehydration therapy

La deshidratación es el cuadro clínico caracterizado por el balance negativo de agua y electrolitos. La deshidratación por gastroenteritis aguda es una de las causas más importantes de morbimortalidad en pediatría. La edad más frecuente es en menores de 18 meses. El diagnóstico de deshidratación es clínico. No existe ningún examen de laboratorio con suficiente sensibilidad y especificidad para estimar el grado de deshidratación. La terapia de rehidratación oral es el tratamiento de primera línea, efectiva en más del 90 % de los casos. Actualmente, se recomiendan las soluciones de rehidratación oral con bajo contenido de sodio (≤75 mEq/l). La rehidratación intravenosa está indicada en los pocos casos en los que la rehidratación oral ha fracasado, está contraindicada o las pérdidas son graves y persistentes

Dehydration is characterized by a negative balance of water and electrolytes. The dehydration from acute gastroenteritis is one of the most important causes of morbidity and mortality in pediatrics. It is most common in those under 18 months of age. The diagnosis of dehydration is clinical. There is no laboratory test that is either sensitive or specific to estimate the degree of dehydration. Oral rehydration therapy is the first-line treatment, effective in more than 90% of the cases. Currently, low sodium rehydration solutions (≤75 mEq/l) are recommended. Intravenous fluid rehydration is indicated in the few cases when oral rehydration therapy has failed, is contraindicated or the losses are serious and persistent