Síndrome urémico hemolítico: reporte de dos casos pediátricos con nexo epidemiológico / Hemolytic uremic syndrome: report of two pediatric clinical cases with epidemiologic link / Síndrome urémico hemolítico: reporte de casos pediátricos con nexo epidemiológico

Introducción: el síndrome hemolítico urémico (SHU) es en muchos países, de las causas más frecuentes de insuficiencia renal aguda. La mayoría de los casos ocurre luego de un episodio de gastroenteritis aguda (GEA) por Escherichia coli productora de toxina Shiga (STEC). En Uruguay a pesar de ser una enfermedad de notificación obligatoria, existe subregistro. Objetivo: describir dos casos clínicos de SHU asociados a GEA con nexo epidemiológico. Casos clínicos: se trata de dos varones de 4 y 5 años, sanos. En los días previos, ingesta de carne en el mismo local comercial. Consultaron por dolor abdominal, deposiciones líquidas y vómitos reiterados. El niño de 4 años presentaba fiebre y deposiciones líquidas con sangre. El niño de 5 años dolor abdominal. El estado de hidratación y las constantes vitales eran normales en ambos. Fueron admitidos a cuidados moderados. A las 48 horas y a los 5 días, respectivamente, agregan palidez cutáneo-mucosa intensa, edemas y oliguria. Estudios complementarios: anemia, plaquetopenia e insuficiencia renal. Ingresaron a cuidados intensivos y se realizó diálisis peritoneal. La investigación de STEC fue negativa y la evolución favorable. Conclusiones: en menores de 5 años el SHU asociado a GEA es la forma de enfermedad más frecuente. En Uruguay predominan las cepas STEC no-O157. En estos casos no se pudo identificar el agente. La existencia de un nexo epidemiológico alerta sobre la necesidad de extremar los cuidados en la preparación y cocción de la carne. Debido a la asociación con una enfermedad prevalente, es necesario tener presente esta complicación para poder sospecharla e iniciar el tratamiento en forma precoz y oportuna.

Introduction: hemolytic uremic syndrome (HUS) is one of the most frequent causes of acute renal failure in many countries. Most cases occur after an episode of acute gastroenteritis (GEA) due to the Shiga toxin producing Escherichia Soli (STEC). In Uruguay, despite being a disease that requires mandatory notification, it is under reported. Objective: to describe two clinical cases of HUS associated with GEA with an epidemiological link. Clinical cases: these are two healthy boys aged 4 and 5 years. In the previous days, they reported meat intake in the same commercial premises. They consulted for abdominal pain, liquid stools and repeated vomiting. The 4 year old boy had a fever and bloody stools. The 5 year old boy had abdominal pain. They both showed normal hydration levels and vital signs. They were admitted to moderate care. At 48 hours and 5 days, respectively, they showed intense skin and mucosal paleness, edema and oliguria. Complementary studies: anemia, thrombocytopenia and renal failure. They were admitted to intensive care and peritoneal dialysis was performed. The STEC's investigation was negative and the evolution favorable. Conclusions: in children under 5 years of age, HUS associated with GEA is the most frequent form of the disease. In Uruguay, non-O157 STEC strains predominate. In these cases, the agent could not be identified. The existence of an epidemiological link warns us about the need for extreme care in the preparation and cooking of meat. Due to the association with a prevalent disease, it is necessary to keep this complication in mind in order to suspect it and initiate early and timely treatment.

Introdução: a síndrome hemolítico urêmica (SHU) é uma das causas mais frequentes de insuficiência renal aguda em muitos países. A maioria dos casos ocorre após um episódio de gastroenterite aguda (GEA) devido à Escherichia Coli, a toxina produtora de Shiga (STEC). No Uruguai, apesar de ser uma doença de notificação compulsória, há subnotificação. Objetivo: descrever dois casos clínicos de SHU associada à AGE com vínculo epidemiológico. Casos clínicos: dois meninos saudáveis com idades entre 4 e 5 anos. Nos dias anteriores, eles reportaram consumo de carne nos mesmos estabe- lecimentos comerciais. Eles consultaram para dor abdominal, fezes líquidas e vômitos repetidos. O menino de 4 anos teve febre e fezes com sangue. O menino de 5 anos teve dores abdominais. O estado de hidratação e os sinais vitais foram normais em ambos meninos. Foram internados em cuidados moderados. Às 48 horas e 5 dias, respectivamente, apresentaram aliás palidez intensa da pele e mucosas, edema e oligúria. Realizaramse estudos complementares: anemia, trombocitopenia e insuficiência renal. Eles foram internados em terapia intensiva e realizouse diálise peritoneal. A investigação do STEC foi negativa e a evolução favorável. Conclusões: em crianças menores de 5 anos, a SHU associada à GEA é a forma mais frequente da doença. No Uruguai, predominam cepas STEC não-O157. Nesses casos, o agente não pôde ser identificado. A existência de um nexo epidemiológico alerta para a necessidade de extremo cuidado no preparo e cozimento da carne. Devido à associação com doença prevalente, é necessário considerar essa complicação para suspeitar e iniciar o tratamento precoce e oportunamente.

Molecular detection and prevalence of Rotavirus with acute gastroenteritis among the children of rural and urban areas / Detecção molecular e prevalência de rotavírus com gastroenterite aguda entre as crianças de áreas rurais e urbanas

Rotavirus is the main infective agent of acute gastroenteritis (AGE) in children under the age of five years and causing significant morbidity as well as mortality throughout the world. The study was carried out to detect the prevalence rate, genotypes strain and risk factors of Rotavirus among the children of rural and urban areas of district Bannu Khyber Pakhtunkhwa Pakistan. A total of 180 stool samples were collected from children under the age of 5 years from two major hospitals of Bannu from January to December (2015). The samples were analyzed by Reverse-transcriptase Polymerase Chain Reaction (RT-PCR) for the detection of Rotavirus, positive samples were further processed for genotyping (G and P type) through specific PCR. Of the total, 41 (23%) samples were positive for Rotavirus. The most prevalent G genotypes found were: G3, G8, G9 (each 29%), followed by G10 (15%), and G11 (10%). Whereas the prevalent P genotypes were: P-8 (25%), P-4 and P-10 (each 20%), P-9 (15%), followed by P-6 and P-11 (each 10%). Moreover, Rotavirus infection was more prevalent in summer (23.73%) and winter (22.7%) than spring (20%) and autumn (21.4%). Rotavirus infection exhibited high frequency in June (14%), October (8%) and November (6%). It is concluded that Rotavirus is more prevalent in children and various genotypes (G and P) of Rotavirus are present in the study area. Lack of studies, awareness and rarer testing of Rotavirus are the principal reasons of virus prevalence in district Bannu, Pakistan.

O rotavírus é o principal agente infeccioso da gastroenterite aguda (AGE) em crianças menores de 5 anos e causa de morbidade e mortalidade significativas em todo o mundo. O estudo foi realizado para detectar a taxa de prevalência, cepa de genótipos e fatores de risco de rotavírus entre as crianças de áreas rurais e urbanas do distrito de Bannu Khyber Pakhtunkhwa, Paquistão. Um total de 180 amostras de fezes foi coletada de crianças menores de 5 anos de dois grandes hospitais de Bannu de janeiro a dezembro (2015). As amostras foram analisadas por reação em cadeia da polimerase transcriptase reversa (RT-PCR) para detecção de rotavírus; as amostras positivas foram posteriormente processadas para genotipagem (tipo G e P) através de PCR específica. Do total, 41 (23%) amostras foram positivas para rotavírus. Os genótipos G mais prevalentes encontrados foram: G3, G8, G9 (cada 29%), seguidos de G10 (15%) e G11 (10%). Considerando que os genótipos P prevalentes foram: P-8 (25%), P-4 e P-10 (cada 20%), P-9 (15%), seguido por P-6 e P-11 (cada 10%). Além disso, a infecção por rotavírus foi mais prevalente no verão (23,73%) e inverno (22,7%) do que na primavera (20%) e no outono (21,4%). A infecção por rotavírus apresentou alta frequência em junho (14%), outubro (8%) e novembro (6%). Conclui-se que o rotavírus é mais prevalente em crianças e vários genótipos (G e P) do rotavírus estão presentes na área de estudo. A falta de estudos, conhecimento e testes mais raros de rotavírus são as principais razões da prevalência do vírus no distrito de Bannu, Paquistão.

Epidemiological characteristics of norovirus acute gastroenteritis outbreaks and influencing factors in China, 2007-2021 / 中华流行病学杂志

Objective: To analyze the epidemiological characteristics of norovirus-caused acute gastroenteritis outbreaks in China, identify the factors influencing the scale of outbreaks, and provide scientific evidences for early control of norovirus infection outbreaks. Methods: The descriptive epidemiological analysis approach was applied to analyze the incidence of national norovirus infection outbreaks by using the data from the Public Health Emergency Event Surveillance System in China from January 1, 2007 to December 31, 2021. The unconditional logistic regression model was applied to analyze the risk factors that affected the outbreaks' scale. Results: A total of 1 725 norovirus infection outbreaks were recorded in China from 2007 to 2021, with an upward trend in the number of the reported outbreaks. The southern provinces had their annual outbreak peaks from October to March; the northern provinces had two outbreak peaks from October to December and from March to June annually. The outbreaks occurred mainly in southeastern coastal provinces with a trend of gradual spread to central, northeastern and western provinces. The outbreaks mainly occurred in schools and childcare setting (1 539 cases, 89.22%), followed by enterprises and institutions (67 cases, 3.88%) and community households (55 cases, 3.19%). Human to human transmission was the main infection route (73.16%), and norovirus GⅡ genotype was the predominate pathogen causing the outbreaks (899 cases, 81.58%). The time interval between the onset of the primary case and the outbreak reporting M (Q1, Q3) was 3 (2, 6) days and the case number of the outbreak M (Q1, Q3) was 38 (28, 62). The timeliness of outbreak reporting was improved in recent years and the scale of the outbreaks showed a decreasing trend over the years, the differences in reporting timeliness and outbreak scale among different settings were significant (P<0.001). The factors that affected outbreaks' scale included the outbreak setting, transmission route, outbreak reporting timeliness and type of living areas (P<0.05). Conclusions: From 2007 to 2021, the number of the norovirus-caused acute gastroenteritis outbreaks increased in China and the more areas were affected. However, the outbreak scale showed a decreasing trend and the outbreak reporting timeliness was improved. It is important to further improve the surveillance sensitivity and reporting timeliness for the effective control of the outbreak scale.

Fecal rotavirus and adenovirus antigen detection and clinical analysis of children with acute gastroenteritis in a hospital of Beijing City from 2019 to 2022 / 中华预防医学杂志

As a single-center retrospective study, we analyzed the results of rotavirus and human adenovirus antigens in stool samples with colloidal gold immunochromatography method in children with acute gastroenteritis under the age of five who were treated in our hospital from 2019 to 2022. After excluding nonconforming cases and duplicate cases, 2 896 cases were included, of which 559 cases were detected with at least one viral antigen. According to the test results, they were divided into RV positive group, HAdV positive group and RV & HAdV double positive group. The gender, age, seasonal distribution, clinical symptoms and related laboratory tests were compared and analyzed with χ2 test, analysis of variance and nonparametric test. Among the single samples from 2 896 children, the positive rate of RV antigen was 6.21% (180/2 896), the positive rate of HAdV antigen was 10.91% (316/2 896), and the double positive rate of RV & HAdV was 2.18% (63/2 896). The positive rate of HAdV antigen in 2021 was 16.11%, a significant increase compared with 6.20% in 2020. RV infection has obvious seasonality, and spring and winter are the seasons with high incidence of infection (χ2=74.018, P<0.001), while HAdV infection has no obvious seasonality (χ2=2.110, P=0.550), showing sporadic infection throughout the year. The proportions of fever and vomiting symptoms in children with RV infection were significantly higher than those in the HAdV infection group (χ2=40.401, P<0.001; χ2=32.593, P<0.001), but the positive rate of white blood cells in the stool was significantly lower than that in the HAdV infection group (χ2=13.741,P<0.01). In summary, paying attention to the epidemiological changes of RV and HAdV is of great significance for clinical diagnosis and treatment and disease prevention and control.

Epidemiological Characteristics and Spatiotemporal Distribution Patterns of Human Norovirus Outbreaks in China, 2012-2018 / 生物医学与环境科学（英文）

OBJECTIVE@#To clarify the epidemiological characteristics and spatial distribution patterns of human norovirus outbreaks in China, identify high-risk areas, and provide guidance for epidemic prevention and control.@*METHODS@#This study analyzed 964 human norovirus outbreaks involving 50,548 cases in 26 provinces reported from 2012 to 2018. Epidemiological analysis and spatiotemporal scanning analysis were conducted to analyze the distribution of norovirus outbreaks in China.@*RESULTS@#The outbreaks showed typical seasonality, with more outbreaks in winter and fewer in summer, and the total number of infected cases increased over time. Schools, especially middle schools and primary schools, are the most common settings of norovirus outbreaks, with the major transmission route being life contact. More outbreaks occurred in southeast coastal areas in China and showed significant spatial aggregation. The highly clustered areas of norovirus outbreaks have expanded northeast over time.@*CONCLUSION@#By identifying the epidemiological characteristics and high-risk areas of norovirus outbreaks, this study provides important scientific support for the development of preventive and control measures for norovirus outbreaks, which is conducive to the administrative management of high-risk settings and reduction of disease burden in susceptible areas.

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.

Gastos de bolsillo por gastroenteritis a causa de rotavirus en el Hospital Pediátrico de Cienfuegos, 2019 - 2020 / Out-Of-Pocket Expenses for Gastroenteritis Due to Rotavirus at Cienfuegos Pediatric Hospital, 2019 - 2020

Introducción: La hospitalización por enfermedades diarreicas agudas en menores de cinco años de edad puede generar gastos importantes para la familia. Objetivo: Estimar el gasto de bolsillo y el costo indirecto por la atención a pacientes menores de cinco años de edad hospitalizados por gastroenteritis a causa de rotavirus. Métodos: Estudio de descripción de costos. Se empleó el microcosteo para estimar el costo directo médico (servicio y medicamentos) y no médico (transporte, alimentación, aseo), así como las pérdidas de productividad para el paciente y su familia y las fuentes de financiamiento. Se trabajó con 132 pacientes hospitalizados en el Hospital Pediátrico de Cienfuegos entre septiembre de 2019 y febrero de 2020 con gastroenteritis y test rápido de rotavirus positivo. El gasto se analizó según la situación económica referida y la edad del paciente. Resultados: La media del gasto de bolsillo total fue de CUP 809,66 (IC 95 por ciento 757,57 - 861,75); el 50,8 por ciento por alimentación, el 31,4 por ciento por aseo y un 17,8 por ciento por transportación. Los hogares con mejor situación económica gastaron más (< 0,001). El 87,2 por ciento de las familias utilizó alguna fuente de recursos adicional a sus ingresos habituales. Se afectaron 2,39 personas (IC 95 por ciento 2,27 - 2,52) y se reportó una pérdida de 5,51 días laborales (IC 95 por ciento 5,21 - 5,8). El costo indirecto promedio fue de CUP 418,8 (IC 95 por ciento 382,36 - 455,24). Conclusiones: La hospitalización de un menor de cinco años por gastroenteritis aguda a causa de rotavirus en Cienfuegos significa una carga económica considerable para los hogares, en especial para los de mejor situación económica(AU)

Introduction: Hospitalization for acute diarrheal diseases in children under five years of age can generate significant expenses for the family. Objective: To assess the out-of-pocket expense and the indirect cost for the care of patients under five years of age hospitalized for gastroenteritis due to rotavirus. Methods: This is cost description study. Microcosting was used to estimate the direct medical cost (service and medication) and non-medical cost (transportation, food, cleaning), as well as the productivity losses for patients and their family and the sources of financing. We worked with 132 patients hospitalized at Cienfuegos Pediatric Hospital from September 2019 to February 2020 with gastroenteritis and a positive rotavirus rapid test. Expenditure was analyzed according to the economic situation referred to and the age of the patient. Results: The mean total out-of-pocket expense was CUP 809.66 (95percent CI 757.57 - 861.75); 50.8percent for food, 31.4percent for cleaning and 17.8percent for transportation. Households with better economic situation spent more (<0.001). 87.2percent of the families used some source of resources in addition to their usual income. 2.39 people were affected (95percent CI 2.27 - 2.52) and a loss of 5.51 working days was reported (95percent CI 5.21 - 5.8). The average indirect cost was CUP 418.8 (95percent CI 382.36 - 455.24). Conclusions: The hospitalization of a child under five years of age for acute gastroenteritis due to rotavirus in Cienfuegos represents a considerable economic burden for families, especially for those with better economic situation(AU)

Molecular epidemiological characteristics of the virus in 96 children with acute diarrhea in Changdu of Tibet, China / 中国当代儿科杂志

OBJECTIVES@#To study the molecular epidemiological characteristics of the virus in children with acute viral diarrhea in Changdu of Tibet, China.@*METHODS@#Fecal specimens were collected from 96 children with acute diarrhea who visited the People's Hospital of Changdu, Tibet, from November 2018 to November 2020 and were tested for adenovirus, norovirus, astrovirus, sapovirus, and rotavirus. Gene sequencing was performed for the genotypes of these viruses.@*RESULTS@#The overall positive rate of the five viruses was 39% (37/96), among which astrovirus had the highest positive rate of 17%, followed by norovirus (9%), rotavirus (8%), adenovirus (7%), and sapovirus (5%). There was no significant difference in the positive rate of the five viruses among different age groups (P>0.05). Only the positive rate of astrovirus was significantly different among the four seasons (P<0.05). For adenovirus, 6 children had F41 type and 1 had C2 type; for norovirus, 6 had GⅠ.3 type, 1 had GⅠ.7 type, 1 had GⅡ.3 type, and 2 had GⅡ.4 Sydney_2012 type; HAstrV-1 type was observed in all children with astrovirus infection; for sapovirus, 1 child each had sporadic GⅠ.2, GⅠ.6, and GⅡ.1 sapovirus and 2 children had unknown type; 6 children had rotavirus G9[P8].@*CONCLUSIONS@#Astrovirus and norovirus are important pathogens in children with acute diarrhea in Changdu, Tibet. The positive rate of adenovirus, norovirus, astrovirus, sapovirus, and rotavirus is not associated with age, and only the positive rate of astrovirus has obvious seasonality. F41 type is the dominant genotype of adenovirus; GⅠ.3 is the dominant genotype of norovirus; HAstrV-1 is the dominant genotype of astrovirus; sporadic GⅠ.2, GⅠ.6, and GⅡ.1 are the dominant genotypes of sapovirus; G9[P8] is the dominant genotype of rotavirus.

Food handlers: an important reservoir of protozoans and helminth parasites of public health importance / Manipuladores de alimentos: um importante reservatório de protozoários e helmintos parasitas de importância para a saúde pública

Food handlers plays a primary role in the transmission of pathogenically important protozoans and helminth parasites. This study was aimed to evaluate the prevalence of intestinal pathogenic protozoans and helminth parasites among food handlers in and around University of Malakand, Lower Dir, Pakistan. Stool samples were collected from 642 food handlers (all of male) in a cross-sectional study from January to November, 2017. Wet Mount Techniques and concentration methods by using salt and formol–ether solutions. Three hundred and eighty four cases (59.8%) were found infected with one more parasites. Most of the individuals were found infected with helminth (47.6%) as compared to intestinal protozoans (0.93%). Seventy two cases (11.2%) of the cases presented mixed infection with both intestinal protozoan and helminth parasites. The order of prevalence for intestinal helminth was Ancylostoma duodenale (n = 258, 40.1%), followed by Taeniasa ginata (n=96, 14.9%) Ascaris lumbricoides (n = 54, 8.40%) and Trichuris trichura (n=30, 4.60%). For intestinal protozoa, Entamoeba histolytica/dispar (n = 36, 5.64%) was the only protozoan detected. Mono-parasitism was higher than poly-parasitism. Family size income and education level were the factors significantly (P<0.05) associated in the parasites prevalence. Current research showed that IPIs are primarily the foodborne pathogens still an important public health problem in Pakistan. Effective control programs on parasitic diseases transfer and their associated factors are recommended.

Os manipuladores de alimentos desempenham um papel fundamental na transmissão de protozoários e helmintos parasitas patogenicamente importantes. Este estudo teve como objetivo avaliar a prevalência de protozoários patogênicos intestinais e helmintos parasitas entre manipuladores de alimentos na Universidade de Malakand, Lower Dir, Paquistão. Amostras de fezes foram coletadas de 642 manipuladores de alimentos (todos do sexo masculino) em um estudo transversal de janeiro a novembro de 2017. Técnicas de montagem úmida e métodos de concentração usando soluções de sal e formol-éter. Trezentos e oitenta e quatro casos (59,8%) foram encontrados infectados com mais um parasita. A maioria dos indivíduos foi encontrada infectada por helmintos (47,6%) em comparação com protozoários intestinais (0,93%). Setenta e dois casos (11,2%) dos casos apresentavam infecção mista com protozoários intestinais e helmintos parasitas. A ordem de prevalência de helmintos intestinais foi Ancylostoma duodenale (n = 258, 40,1%), seguido por Taeniasa ginata (n = 96, 14,9%) Ascaris lumbricoides (n = 54, 8,40%) e Trichuris trichura (n = 30, 4,60 %). Para protozoários intestinais, Entamoeba histolytica / dispar (n = 36, 5,64%) foi o único protozoário detectado. Monoparasitismo foi maior do que poliparasitismo. A renda familiar e o nível de escolaridade foram os fatores significativamente (P <0,05) associados na prevalência de parasitos. A pesquisa atual mostrou que os IPIs são principalmente os patógenos de origem alimentar, ainda um importante problema de saúde pública no Paquistão. Programas eficazes de controle da transferência de doenças parasitárias e seus fatores associados são recomendados.

Additive effect of the probiotics Lactobacillus exopolysaccharides and the Satureja calamintha extracts on enteropathogenic Escherichia coli adhesion

Abstract This study assessed the inhibitory potential of the probiotics Lactobacillus (LB) exopolysaccharides (EPS) with or without extracts of Satureja calamintha on enteropathogenic Escherichia coli (EPEc) responsible for gastroenteritis. Methanolic and hydromethanolic extracts were prepared by cold maceration and subjected to phytochemical screening. The compounds of the extracts were determined with the colorimetric assays and identified using high-performance liquid chromatography coupled with diode array detector (HPLC-DAD). Antioxidant activities of the extracts were also evaluated by using 2,2-diphenyl-1-picrylhydrazil (DPPH) radical scavenging. Antibacterial effect on EPEc was evaluated by using both agar disc diffusion and microdilution methods. The in vitro test of auto-aggregation was investigated. Microbiological analysis showed that 63% of the isolated LB were producing EPS, with the amount ranging from 8.21 to 43.13 mg/L. Chemical analysis of the extracts revealed the presence of polyphenols and flavonoids, more abundant in the hydromethanolic extract, which presented the highest content with 2.11 mg EGA/g of polyphenol and 1.64 mg EC/g of flavonoids and 1.71 mg EGA/g of polyphenol and 1.15 mg EC/g of flavonoids in the methanolic extract. Hydromethanolic extracts and EPS exhibited a more important activity than did the methanolic extract against EPEc. The combined action of EPS and extracts reduced the aggregation ability of EPEc and decreased the rate of their adhesion.

Influencia de Salmonella pullorum y S. gallinarum en la producción avícola y la salud pública / Influence of Salmonella pullorum and S. gallinarum on poultry production and public health

La calidad de los alimentos que consumimos se ha convertido en uno de los principales problemas de salud pública a nivel mundial, ya que son la puerta de entrada de patógenos y vectores para la trasmisión de diversas enfermedades. Se estimó que el 17,9% de las enfermedades trasmitidas por el consumo de alimentos, está relacionada con aves de corral, y el 19% de estas enfermedades, están asociadas a la contaminación por Salmonella entérica. La Salmonelosis es una enfermedad invasiva que afecta en gran medida a las poblaciones altamente vulnerables (niños, ancianos e inmunocomprometidos), causando la necesidad de hospitalización y en ocasiones la muerte. A nivel mundial se estima que anualmente hay más de 94 millones de personas afectadas por gastroenteritis causada por el consumo de aves contaminadas con Salmonella, así como más de 155.000 fallecidos. Sin embargo, los orígenes de esta cepa: Salmonella entérica y otras de mayor alcance patógeno están influenciadas muy de cerca por el control de dos cepas con poca acción en la población humana: la S. polloroum y la S. gallinarum. La casi desaparición de estos dos serovares impulsó la colonización de cepas más resistente a los antibióticos y más perjudiciales para los seres humanos(AU)

The quality of the food we consume has become one of the main public health problems worldwide, since it is the gateway for pathogens and vectors for the transmission of various diseases. It was estimated that 17.9% of diseases transmitted by food consumption are related to poultry, and 19% of these diseases are associated with contamination by Salmonella enterica. Salmonellosis is an invasive disease that greatly affects highly vulnerable populations (children, the elderly and immunocompromised), causing the need for hospitalization and sometimes death. Worldwide, it is estimated that annually there are more than 94 million people affected by gastroenteritis caused by the intake of poultry contaminated with Salmonella, as well as more than 155,000 deaths. However, the origins of this strain: Salmonella enterica and others with a greater pathogenic scope are closely influenced by the control of two strains with little action in the human population: S. polloroum and S. gallinarum. The near disappearance of these two serovars prompted the colonization of strains more resistant to antibiotics and more harmful to humans(AU)

Epidemiología de los casos pediátricos en la sala de emergencias de un hospital general / Epidemiology of pediatric cases in the emergency room of a general hospital

Objetivos El objetivo de este estudio es determinar a qué tipo de patologías nos enfrentamos. Utilizamos la Clasificación Internacional de Atención Primaria para asegurar una nomenclatura objetiva y comparable. Métodos Se realizó un estudio descriptivo, observacional y retrospectivo de una muestra de 108102 consultas de atención primaria de pacientes que acudieron a Urgencias de nuestro hospital para evaluar la epidemiología de la atención pediátrica brindada entre 2011 y 2019. Utilizamos el sistema de clasificación diagnóstica ICPC-2. Resultados El número de asistencias fue mayor en enero, febrero y marzo, así como los fines de semana. Tras ser atendidos, el 6,7% de los pacientes ingresaron en nuestro hospital. Las patologías más frecuentes fueron las infecciones del tracto respiratorio superior, gastroenteritis, fiebre y traumatismos / lesiones. Las patologías que con mayor frecuencia dieron lugar a ingresos hospitalarios fueron fiebre, bronquitis, gastroenteritis y vómitos (p> 0,001). En los ingresos hospitalarios de menores de 1 año, la bronquitis fue la patología más frecuente, mientras que entre los de 1 a 6 años fue la gastroenteritis y entre los de 7 a 14 años fue la apendicitis aguda (p <0,001). Conclusiones Las patologías pediátricas suponen un porcentaje importante de las visitas a urgencias, destacando las infecciones del tracto respiratorio superior, las infecciones intestinales y la fiebre. Sería aconsejable incrementar los recursos de personal en los fines de semana. Es necesario enfatizar en la educación sanitaria de la población para ajustar la demanda de asistencia en los servicios públicos. Se requiere más investigación para adaptar mejor la terminología ICPC-2.

Objectives The aim of this study is to determine what type of pathologies we are facing. We use the International Classification of Primary Care to ensure an objective and comparable nomenclature. Methods We carried out a descriptive, observational, and retrospective study of a sample comprising 108102 primary care encounters of patients presenting at our hospital's Emergency Room to assess the epidemiology of the pediatric care provided between 2011 and 2019. We used the ICPC-2 diagnosis classification system. Results The number of attendances was higher in January, February, and March, as well as at weekends. After being seen, 6.7% of patients were admitted to our hospital. The most frequent pathologies were upper respiratory tract infections, gastroenteritis, fever and trauma/injury. Pathologies most frequently resulting in hospital admissions were fever, bronchitis, gastroenteritis and vomiting (p>0.001). In hospital admissions involving patients under 1 year of age, bronchitis was the most frequent pathology, while among those aged between 1 and 6 years, it was gastroenteritis and among those aged between 7 and 14 years it was acute appendicitis (p<0.001). Conclusions Pediatric pathologies account for a significant percentage of visits to the emergency room, highlighting infections of the upper respiratory tract, intestinal infections, and fever. It would be necessary to increase staff resources on the weekends. It is highly recommended to emphasize the health education of the population to adjust the demand for assistance in public services. More research is required to better adapt the ICPC-2 terminology.

Caracterización clínico epidemiológica de la gastroenteritis por rotavirus. Estudio piloto. Hospital Pediátrico de Centro Habana. Noviembre 2017- abril 2018 / Clinical epidemiological characterization of rotavirus gastroenteritis. Pilot study. Paediatric Hospital of Centro Habana

La gastroenteritis causada por rotavirus constituye un importante problema de salud mundial, por lo que se recomienda incluir la vacunación contra el rotavirus en los programas de inmunización. Para evaluar el impacto de una futura introducción en Cuba de una vacuna contra este patógeno, resulta necesario crear una línea de base pre-vacunación de la carga de la gastroenteritis causada por este virus. Entre noviembre 2017 a abril 2018 se implementó en el Hospital Pediátrico de Centro Habana un sistema de vigilancia para la gastroenteritis causada por rotavirus. Se establecieron las definiciones para las categorías de caso sospechoso, probable y confirmado. Por cada niño captado se recogió una muestra de heces que se analizó con tiras rápidas y se confirmó la presencia de rotavirus por ELISA. Para determinar la severidad de la enfermedad se utilizó la escala de Vesikari. Los resultados fueron expresados en cifras absolutas y relativas, el análisis se realizó a través de la prueba de chi-cuadrado. Del total de ingresos por enfermedad diarreica aguda, el 26 por ciento cumplió los criterios de inclusión y el 46 por ciento resultó confirmado como rotavirus. El hacinamiento en el hogar y asistir al círculo infantil se comportaron como factores de riesgo. El servicio de gastroenterología absorbió la mayor carga de ingresos hospitalarios por esta causa. Los resultados mostrados validan la funcionalidad del sistema de vigilancia implementado y brindan nuevas evidencias sobre la carga de la enfermedad y la utilización de los servicios de un hospital pediátrico cubano, debido a la gastroenteritis provocada por rotavirus, lo que justifica la introducción de la vacuna(AU)

Gastroenteritis caused by rotavirus is a major global health problem, therefore it is recommended that vaccination against rotavirus be included in immunization programs. To evaluate the impact of a future introduction in Cuba of a vaccine against this pathogen, it is necessary to have a pre-vaccination baseline of the burden of gastroenteritis caused by rotavirus. Between November 2017 and April 2018, a surveillance system for gastroenteritis caused by rotavirus was implemented in the Paediatric Hospital of Centro Habana. Definitions were established for the categories of suspected, probable and confirmed cases. For each captured child, stool samples were collected, analyzed with rapid strips and confirmated by ELISA. To determine the severity of the disease, the Vesikari score was used. The results were expressed in absolute and relative figures; the analysis was performed through chi-square. Of the total admissions for acute diarrheal disease, 26 percent met the inclusion criteria and 46 percent were confirmed for rotavirus. Overcrowding at home and attending a day care center were risk factors. The gastroenterology service absorbed the greatest burden of hospital admissions for this cause. The results shown validate the role of the implemented surveillance system and provide new evidence on the burden of disease and use of services for rotavirus gastroenteritis in a cuban pediatric hospital(AU)

Presença de Salmonella spp. na produção animal e o uso de fermentados bacterianos para mitigação dos riscos ­ revisão de literatura / Presence of Salmonella spp. in animal production and the use of bacterial fermentations to mitigate risks ­ a literature review / Presencia de Salmonella spp. en la producción animal y uso de fermentaciones bacterianas para mitigar riesgos - revisión de la literatura

As bactérias do gênero Salmonella são um dos principais problemas na produção animal e, consequentemente, na produção de alimentos. Elas são causadoras principalmente de gastroenterites, com alguns serovares podendo resultar na morte do animal ou indivíduo afetado. Órgãos governamentais em todo o mundo determinam condições mínimas de segurança alimentar, exigindo a ausência de Salmonella nos alimentos, sendo exigida análise de no mínimo 25 gramas de amostragem a cada lote. Dessa forma, seu controle na produção animal também é necessário, devido à grande prevalência existente. Dentre as várias estratégias de controle apresentadas, destaca-se o uso de sobrenadantes livres de células (SLC) produzidos por bactérias lácticas, com grande número de pesquisas in vitro. Nesse contexto, o objetivo deste artigo é revisar os avanços recentes no uso de SLC contra Salmonella. Ao final do trabalho, pode-se observar que os SLC têm grande potencial para utilização na produção animal, embora ainda seja necessária uma completa caracterização da sua ação in vivo.(AU)

Bacteria of the Salmonella genus are one of the main problems in animal production and, consequently, in food production. They mainly cause gastroenteritis, with some serovars that can result in the death of the affected animal or individual. Government agencies around the world determine minimum conditions for food safety, requiring the absence of Salmonella in foods, requiring analysis of at least 25 grams of sampling for each batch. Thus, its control in animal production is also necessary, due to the high prevalence that exists. Among the various control strategies presented, the use of cell-free supernatants (CFS) produced by lactic acid bacteria stands out, with a large number of in vitro research. In this context, the purpose of this article is to review recent advances in the use of CFS against Salmonella. At the end of the research, it can be seen that CFS have great potential for use in animal production, although a complete characterization of their in vivo action is still needed.(AU)

Las bacterias del género Salmonella son uno de los principales problemas en la producción animal y, en consecuencia, en la producción de alimentos. Son principalmente la causa de gastroenteritis, con algunos serovares que pueden resultar en la muerte del animal o individuo afectado. Las agencias gubernamentales de todo el mundo determinan las condiciones mínimas para la seguridad alimentaria, lo que requiere la ausencia de Salmonella en los alimentos, lo que requiere el análisis de al menos 25 gramos de muestreo para cada lote. Por tanto, su control en la producción animal también es necesario, debido a la alta prevalencia que existe. Entre las diversas estrategias de control presentadas, destaca el uso de sobrenadantes libres de células (SLC) producidos por bacterias del ácido láctico, con un gran número de investigaciones in vitro. En este contexto, el propósito de este artículo es revisar los avances recientes en el uso de SLC contra Salmonella. Al final del trabajo, se puede ver que los SLC tienen un gran potencial para su uso en la producción animal, aunque aún se necesita una caracterización completa de su acción in vivo.(AU)

Influence of human rotavirus vaccine in hospitalizations for gastroenteritis in children in Brazil / Influencia de la vacuna contra el rotavirus humano en las hospitalizaciones por gastroenteritis en niños en Brasil / Influência da vacina contra o rotavírus humano em hospitalizações por gastroenterite em crianças no Brasil

ABSTRACT Objectives: to describe and analyze the influence of human rotavirus vaccine on hospitalizations for gastroenteritis in children under 5 years of age, in Brazil, 2001 to 2018 (pre- and post-vaccination period). Method: this is a retrospective, descriptive ecological study, combining the description of a time series from 2001 to 2018 and collected in the months August 2019 to Janaury 2020. The data were obtained from a secondary source. To analyze the effect of different variables, multiple models of mathematical evaluations were used (accumulated growth rate, geometric growth rate; standard deviation, mean, variance and simple linear regression). The level of significance was set at 5% (p <0.05). Results: there was a reduction in hospitalizations related to gastroenteritis in children under 5 years old, when comparing the pre- and post-vaccination periods. This reduction occurred in all Brazilian regions. Conclusion: after the implementation of human rotavirus vaccine, there was a significant reduction in hospitalizations of children under 5 years.

RESUMEN Objetivos: describir y analizar la influencia de la vacuna contra el rotavirus humano en las hospitalizaciones por gastroenteritis en niños menores de 5 años, en Brasil, 2001 a 2018 (período pre y posvacunación). Método: se trata de un estudio ecológico descriptivo, retrospectivo, que combina la descripción de la serie temporal de 2001 a 2018 y recogidos en los meses de 2019 a enero de 2020. Los datos se obtuvieron de una fuente secundaria. Para analizar el efecto de diferentes variables se utilizaron múltiples modelos de evaluaciones matemáticas (tasa de crecimiento acumulada, tasa de crecimiento geométrico; desviación estándar, media, varianza y regresión lineal simple). Se consideró el nivel de significancia del 5% (p<0,05). Resultados: hubo una reducción de las hospitalizaciones por gastroenteritis en menores de 5 años, al comparar los periodos pre y posvacunación. Esta reducción ocurrió en todas las regiones brasileñas. Conclusión: luego de la implementación de la vacuna contra el rotavirus humano, hubo una reducción significativa en las hospitalizaciones de niños menores de 5 años.

RESUMO Objetivos: descrever e analisar a influência da vacina contra o rotavírus humano nas hospitalizações por gastroenterite em crianças menores de 5 anos, no Brasil, 2001 a 2018 (período pré e pós-vacinal). Método: trata-se de um estudo ecológico retrospectivo, descritivo, combinando a descrição das séries temporais do período de 2001 a 2018. Os dados foram obtidos de fonte secundária e coletados nos meses de agosto de 2019 a janeiro de 2020. Para análise do efeito de diferentes variáveis, utilizaram-se múltiplos modelos de avaliações matemáticas (taxa de crescimento acumulado, taxa de crescimento geométrico; desvio padrão, média, variância e regressão linear simples). Considerou-se o nível de significância de 5% (p<0,05). Resultados: houve redução das hospitalizações relacionadas à gastroenterites em crianças menores de 5 anos, quando comparados os períodos pré e pós-vacinal. Essa redução ocorreu em todas as regiões brasileiras. Conclusão: após a implementação da vacina contra o rotavírus humano, houve expressiva redução das hospitalizações de crianças menores de 5 anos.

Digestive diseases of cattle diagnosed at the "Clínica de Bovinos de Garanhuns"-UFRPE: retrospective study and influence of seasonality / Enfermidades do sistema digestório de bovinos diagnosticadas na Clínica de Bovinos de Garanhuns-UFRPE: estudo retrospectivo e influência da sazonalidade

Diseases of the bovine digestive system make up an important group of diseases, often being responsible for significant economic losses in the livestock sector. The current work aimed to carry out a retrospective study of the diseases of the digestive system in cattle diagnosed at the "Clínica de Bovinos de Garanhuns", "Universidade Federal Rural de Pernambuco", from January 1999 to December 2018. In this period, a total of 9,343 cattle were admitted to the CBG-UFRPE, of which 2,238 (24.0%) were diagnosed with diseases of the digestive system. In two decades, the total number of cattle admitted annually by the institution almost doubled as well as the number of cases of digestive diseases. The diseases categorized as mechanical/motor were the most prevalent (33.6%), followed by fermentative (28.4%), gastroenteritis (16.0%), esophageal diseases (9.7%), and diseases of the oral cavity (4.5%). Lesions of the rectum and anus, congenital alterations, and other digestive diseases showed relative frequencies below 4%. Traumatic reticulitis and its sequelae (14.5%) are the most prevalent disorders, followed by simple indigestion (10.1%), esophageal and intestinal obstructive disorders (9.0%), non-specific gastroenteritis (8.6%), displaced abomasum (RDA and LDA) (5.5%), and frothy bloat, ruminal lactic acidosis, and impaction of the forestomach and abomasum, which represented approximately 5% each. In general, these diseases presented a lethality rate of 46.0%, with emphasis on mechanical/motor diseases with a lethality rate of 73.8%. In general, diseases were more prevalent in females, crossbreeds, aged over 24 months, and raised in a semi-intensive system. Diseases of the digestive system increased over the years studied, representing a considerable portion of the diseases that affect cattle raised in this region, which makes up the main milk basin in the State of Pernambuco, confirming its economic and social impact in the region.(AU)

As enfermidades do sistema digestório dos bovinos compõem importante grupo de doenças frequentemente responsáveis por perdas econômicas significativas no setor pecuário. Este trabalho teve por objetivo realizar um estudo retrospectivo das enfermidades do sistema digestório dos bovinos diagnosticadas na Clínica de Bovinos de Garanhuns, Universidade Federal Rural de Pernambuco, no período de janeiro de 1999 a dezembro de 2018. Neste período foi atendido um total de 9.343 bovinos dos quais 2.238 (24,0%) foram diagnosticados com enfermidades do sistema digestório. Em duas décadas, o número total de bovinos atendidos anualmente pela instituição quase dobrou, assim como o número de casos de doenças digestivas. As enfermidades categorizadas como de natureza mecânica/motora foram as mais prevalentes (33,6%), seguidas das fermentativas (28,4%), das gastroenterites (16,0%), das enfermidades esofágicas (9,7%) e das enfermidades da cavidade oral (4,5%). As lesões do reto e ânus, as alterações congênitas e outras enfermidades digestórias apresentaram frequências relativas inferiores a 4%. As reticulites traumáticas e suas sequelas (14,5%) destacaram-se como as doenças mais prevalentes, seguidas das indigestões simples (10,1%), dos transtornos obstrutivos esofágicos e intestinais (9,0%), das gastroenterites inespecíficas (8,6%), dos deslocamentos de abomaso (DAD e DAE) (5,5%) e do timpanismo espumoso, acidose láctica ruminal e compactações dos pré-estômagos e abomaso, que representaram aproximadamente 5% cada. No geral estas enfermidades apresentaram taxa de letalidade de 46,0%, com destaque para as enfermidades de natureza mecânica/motora cuja letalidade foi de 73,8%. De maneira geral as enfermidades foram mais prevalentes em fêmeas mestiças, com idade superior a 24 meses, criadas em sistema semi-intensivo. As enfermidades do sistema digestório, crescentes ao longo dos anos estudados, representaram parcela considerável das doenças que acometem os bovinos criados na região que compõe a principal bacia leiteira do Estado de Pernambuco, ratificando seu impacto econômico e social para a região.(AU)

Expert consensus on immunoprophylaxis of childhood rotavirus gastroenteritis (2020 version) / 中华流行病学杂志

Group A rotavirus (RV) is one of the major pathogens that cause severe acute gastroenteritis and death in children under 5 years old in China. RV vaccination is the most effective measure for prevention and control of rotavirus gastroenteritis (RVGE). This consensus is developed by reviewing RV related literatures, RV disease data in China, World Health Organization(WHO) position paper on RV vaccines and expert discussion. This consensus aims to provide professional staff with scientific information on rotavirus vaccine use, and evidence for developing the immunization strategy of childhood RVGE in China.

Expert consensus on immunoprophylaxis of childhood rotavirus gastroenteritis(2020) / 中华预防医学杂志

Group A rotavirus (RV) is one of the major pathogens that cause severe acute gastroenteritis and death in children under 5 years old in China. RV vaccination is the most effective measure for prevention and control of rotavirus gastroenteritis (RVGE). This consensus is developed by reviewing RV related literatures, RV disease data in China, World Health Organization(WHO) position paper on RV vaccines and expert discussion. This consensus aims to provide professional staff with scientific information on rotavirus vaccine use, and evidences for developing the immunization strategy of childhood RVGE in China.

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.