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1.
Article in Chinese | WPRIM | ID: wpr-877561

ABSTRACT

OBJECTIVE@#To compare the therapeutic effect between long-snake moxibustion combined with western medication and simple medication on diarrhea type irritable bowel syndrome (IBS-D) of spleen and kidney @*METHODS@#A total of 60 patients with IBS-D of spleen and kidney @*RESULTS@#Compared before treatment, the symptom scores of abdominal pain, defecation frequency, mucous stool and appetite reduction were decreased (@*CONCLUSION@#Long-snake moxibustion combined with western medication can effectively treat the IBS-D of spleen and kidney


Subject(s)
Acupuncture Points , Animals , Diarrhea/drug therapy , Humans , Irritable Bowel Syndrome/drug therapy , Kidney , Moxibustion , Quality of Life , Snakes , Spleen , Yang Deficiency/drug therapy
2.
Gastroenterol. latinoam ; 30(supl.1): S26-S30, 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-1116309

ABSTRACT

Acute diarrhea (AD) is the increase in frequency and volume of bowel movements with decrease in their consistency that lasts less than 14 days. AD is a major public health problem and is still nowadays a cause of significant morbidity and mortality during childhood, especially in children with nutritional deficits. At a younger age, there is a greater susceptibility to diarrhea, which is more intense and more likely cause dehydration. The prevention and management of dehydration is the mainstay of treatment. The use of medications must be used with caution, analyzing individual cases and based on the best available evidence. We will analyze the subject with special emphasis on treatment according to scientific evidence.


La diarrea aguda (DA) se define como el aumento en la frecuencia y volumen de las deposiciones con disminución de la consistencia y que dura menos de 14 días. La DA es un gran problema de salud pública y es aún hoy en día una causa de importante morbimortalidad durante la infancia en especial en niños con déficits nutricionales. A menor edad hay mayor susceptibilidad de presentar diarrea, siendo ésta de mayor intensidad y con mayores posibilidades de producir deshidratación. La prevención y el manejo de la deshidratación es el pilar fundamental del tratamiento. El uso de medicamentos debe ser criterioso, analizando cada caso individual y basado en la mejor evidencia disponible. Analizaremos el tema con especial énfasis en el tratamiento según evidencia científica.


Subject(s)
Humans , Infant , Child, Preschool , Diarrhea/diagnosis , Diarrhea/drug therapy , Rehydration Solutions/therapeutic use , Acute Disease , Ondansetron/therapeutic use , Probiotics/therapeutic use , Dehydration/etiology , Diarrhea/etiology , Diarrhea/prevention & control , Anti-Bacterial Agents/therapeutic use
3.
Gastroenterol. latinoam ; 29(supl.1): S63-S67, 2018. tab
Article in Spanish | LILACS | ID: biblio-1117866

ABSTRACT

The management of Clostridium difficile (CD) infection has changed in recent years. The latest clinical guidelines and systematic reviews suggest the use of vancomycin orally as the first line of treatment regardless the severity of the crisis (main difference compared to previous recommendations), this is due to changes in its epidemiology, the decrease in effectiveness and the increase of recurrences with the use of metronidazole, particularly in severe crisis. In addition, the use of new agents such as fidaxomicin has been approved. Fulminant crisis require an aggressive management combining oral treatment, enemas and intravenous therapy in addition to a collaborative management with the surgery team. With respect to recurrences, the use of vancomycin in pulses and with extended therapy schemes is suggested; fecal microbiota transplantation (FMT) is also an attractive therapy for patients with multiple recurrences. The following is a summary of the latest recommendations and available evidence regarding the management of CD infection in the most frequent situations, both in first crisis and in its recurrences.


El manejo de la infección por Clostridium difficile (CD) ha tenido modificaciones los últimos años. Las últimas guías clínicas y revisiones sistemáticas sugieren el uso de vancomicina vía oral como primera línea de tratamiento independiente de la severidad de la crisis (diferencia principal con recomendaciones previas), esto debido a cambios en su epidemiología, la disminución de la efectividad y al aumento de las recurrencias con el uso de metronidazol, particularmente en crisis severas. Además, han sido aprobados el uso de nuevos agentes como la fidaxomicina. Las crisis de carácter fulminante requieren un manejo agresivo combinando terapia oral, vía enemas e intravenosa, además de un manejo en conjunto con el equipo de cirugía. Respecto a las recurrencias se sugiere el uso de vancomicina en pulsos y con esquemas de terapia extendida siendo además, el trasplante de microbiota fecal (FMT) una terapia atractiva para pacientes con múltiples recurrencias. A continuación se resumen las últimas recomendaciones y evidencia disponible respecto del manejo de la infección por CD en las situaciones más frecuentes, tanto en la primera crisis como en sus recurrencias.


Subject(s)
Humans , Vancomycin/therapeutic use , Clostridium Infections/drug therapy , Diarrhea/drug therapy , Fidaxomicin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Recurrence , Vancomycin/administration & dosage , Clostridioides difficile/drug effects , Clostridium Infections/complications , Diarrhea/microbiology , Fecal Microbiota Transplantation , Fidaxomicin/administration & dosage , Rifaximin/therapeutic use , Metronidazole/therapeutic use , Anti-Bacterial Agents/administration & dosage
4.
Lima; s.n; dic. 2016. ilus.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-847791

ABSTRACT

INTRODUCCIÓN: Antecedentes: El presente dictamen presenta la evaluación de la eficacia y seguridad del uso de colestiramina en el tratamiento de diarrea crónica asociada a malabsorción de ácidos biliares en niños. Aspectos Generales: La diarrea crónica es el signo principal de la malabsorción de ácidos biliares (MAB), la cual se produce por un desbalance en la homeostasis de estos ácidos en la circulación enterohepática. Los ácidos biliares recirculan entre el hígado y el intestino delgado a través del sistema de circulación enterohepática. Este sistema permite la absorción de grasas en el intestino delgado y la reabsorción de los ácidos biliares en el íleon terminal. Tecnología Sanitaria de Interés: La colestiramina es un secuestrador de ácidos liliares. Esta consta de resinas no digeribles cargadas positivamente que se unen a los ácidos biliares en el intestino, y permiten su excreción en las heces en forma de complejos insolubles. Así, evita que los ácidos biliares se acumulen en el colon y provoquen desbalance hídrico y diarrea. METODOLOGIA: Estrategia de Búsqueda: Se llevó a cabo una busqueda de la literatura con respecto a la eficacia y seguridad de colestiramina en el tratamiento de diarrea crónica en la bases de datos de PubMed, Tripdatase y www.clinicaltrials.gov. RESULTADOS: Sinopsis de la Evidencia: Se llevó a cabo una búsqueda de evidencia científica relacionada al uso de colestiramina en el tratamiento de pacientes con diarrea crónica asociada a malabsorción de ácidos biliares. En la presente sinopsis se describe la evidencia disponible según el tipo de publicación, siguiendo lo indicado en los criterios de elegibilidad (Guias de Práctica Clínica, Evaluación de Tecnologías en Salud, Revisiones Sistemáticas, Resúmenes de Artículos, MA, ECA fase III). CONCLUSIONES: A la fecha (octubre 2016) no se han llevado a cabo ensayos clínicos aleatorizados que evalúen la eficacia y seguridad del uso de colestiramina en pacientes pediátricos o adultos con diarrea crónica ocasionada por la malabsorción de ácidos biliares. Los resultados reportados en el presente dictamen preliminar corresponden a cuatro GPC, una revisión sistemática basada en estudios observacionales y el resumen de un estudio retrospectivo que evalúa la respuesta al tratamiento con colestiramina en pacientes adultos con diarrea crónica acuosa. El Instituto de Evaluación de Tecnologias en Salud e Investigación (IETSI) aprueba el uso de colestiramina como alternativa de tratamiento en pacientes con diarrea crónica por ácidos biliares. En el periodo de vigencia de este dictamen es de un año y la continuación de dicha aprobación estará sujeta a los resultados obtenidos de los pacientes que se beneficien con dicho tratamiento y a nueva evidencia que pueda surgir en el tiempo.


Subject(s)
Humans , Diarrhea/complications , Diarrhea/drug therapy , Short Bowel Syndrome/drug therapy , Bile Acids and Salts , Cholestyramine Resin/administration & dosage , Malabsorption Syndromes , Technology Assessment, Biomedical , Treatment Outcome
5.
Arch. endocrinol. metab. (Online) ; 59(3): 231-235, 06/2015. tab, graf
Article in English | LILACS | ID: lil-751314

ABSTRACT

Objective Haemoglobin A1c (Hb A1c) is routinely used for monitoring glycemic control in patients with diabetes. Hb A1c seasonal fluctuations can be directly related to different biological, geographical and cultural influences. Our purpose was to evaluate seasonal variation of Hb A1c in a hospital-based adult population over a period of 5 years.Materials and methods We analyzed retrospectively monthly Hb A1c mean values (DCCT, %) based on all the assays performed to adult patients at a tertiary care university Portuguese hospital between 2008-2012.Results We obtained 62,384 Hb A1c valid measurements, with a peak level found in January-February (7.1%), a trough in August-October (6.8%) and an average peak-to-trough amplitude value of 0.3%. This trend was observed in both genders and age subgroups evaluated.Conclusions There is a Hb A1c circannual seasonal pattern with peak levels occurring in winter months in this Portuguese population. This finding should be recognized in daily clinical practice to warrant better clinical and epidemiological interpretation of Hb A1c values. Arch Endocrinol Metab. 2015;59(3):231-5.


Subject(s)
Adult , Female , Humans , Middle Aged , Immunoconjugates/therapeutic use , Immunosuppressive Agents/therapeutic use , Polyendocrinopathies, Autoimmune/drug therapy , Diarrhea/drug therapy , Diarrhea/etiology , Enterocytes/pathology , Lymphocyte Activation/drug effects , Polyendocrinopathies, Autoimmune/physiopathology , Treatment Outcome
6.
Article in English | IMSEAR | ID: sea-158378

ABSTRACT

Background & objectives: Shiga toxin producing Escherichia coli (STEC) is an important zoonotic foodborne pathogen, capable of causing haemorrhagic colitis (HC) and haemolytic uremic syndrome (HUS). As data from India on human infections caused by STEC are limited, this study was carried out for hospital based surveillance for STEC as a causative agent of diarrhoea, bloody diarrhoea and HUS at a tertiary care centre and to study the virulence gene profile and strain relatedness by multi locus variable tandem repeat analysis (MLVA). Methods: A total of 600 stool samples were studied. Stool samples of every fifth patient presenting with non-bloody diarrhoea, all cases of bloody diarrhoea and diarrhoea associated HUS (D+HUS) were collected from October 2009 to September 2011. Stool samples were cultured for STEC and characterization of STEC was done by serogrouping, virulence genes analysis, and MLVA typing. Results: STEC were isolated as a sole pathogen from 11 stool samples [5 of 290 (1.7%) non-blood diarrhoea and 5 of 300 (1.6%) blood diarrhoea cases]. STEC was also isolated from one fatal case of HUS who was an eight month old child. Only six of 11 isolates were positive for stx2 gene, whereas stx1 was present in all 11 isolates. Only one isolate was positive for eae. Other adhesion genes present were iha in five isolates, followed by toxB and efa1 in two each and saa gene in one, isolate. Among the plasmid encoded genes, espP, hly and etpD were each present in one isolate each. In the MLVA typing, diverse profiles were obtained except two untypeable isolates from different patients shared the same MLVA profile. Both these isolates were not epidemiologically linked. Interpretation & conclusions: This study demonstrated that STEC could be a causative agent of diarrhoea, bloody diarrhoea and sporadic HUS. However, further work needs to be done to study and explore the prevalence of these organisms in the food chain in this region.


Subject(s)
Adult , Child , Child, Preschool , Diarrhea/drug therapy , Diarrhea/genetics , Diarrhea/microbiology , Escherichia coli Infections/drug therapy , Escherichia coli Infections/genetics , Escherichia coli Infections/microbiology , Feces/microbiology , Female , Hemolytic-Uremic Syndrome/drug therapy , Hemolytic-Uremic Syndrome/genetics , Hemolytic-Uremic Syndrome/microbiology , Humans , India , Infant , Male , Middle Aged , O Antigens/genetics , O Antigens/isolation & purification , Serogroup , Shiga-Toxigenic Escherichia coli/genetics , Shiga-Toxigenic Escherichia coli/isolation & purification , Shiga-Toxigenic Escherichia coli/pathogenicity
7.
Article in English | IMSEAR | ID: sea-157648

ABSTRACT

Bacteriological analysis of 1661 stool samples from children (<5 years) with diarrhoea who have been admitted to 3 different hospitals of Southern Orissa from Jan 2007 to Dec 2010 was carried out using standard procedures. Among all the samples, enteropathogens were isolated in 1199 culture positive samples wherein Escherichia coli was isolated in 927 cases( including 136 pathogenic Escherichia coli),Vibrio cholerae O1 in 174 samples; Shigella spp in 50 samples; Salmonella spps.in 18 samples, Klebsiella pneumoniae in 5 samples. The isolation of bacterial enteropathogens was highest during July 2008 followed by August 2006 and Cholera cases were isolated more during rainy season. Vibrio cholerae O1 isolates were resistant to co- trimoxazole, furazolidone and nalidixic acid. Many of the Pathogenic Escherichia coli strains showed varying resistance to ampicillin, furazolidone, cotrimoxazole, ciprofloxacin and nalidixic acid. Shigella spp. and Salmonella spp also showed varying resistance patterns. More studies are necessary to evaluate the contribution of enteropathogens in causing diarrhoeal diseases and to define the changing antibiogram patterns in this region.


Subject(s)
Child, Preschool , Diarrhea/drug therapy , Diarrhea/epidemiology , Diarrhea/etiology , Escherichia coli , Hospitalization , Humans , Incidence , India/epidemiology , Infant , Infant, Newborn , Microbial Sensitivity Tests , Salmonella , Shigella , Vibrio cholerae
8.
Article in English | IMSEAR | ID: sea-156443

ABSTRACT

Background. Patients with HIV/AIDS are at a high risk of being infected with toxin-producing strains of Clostridium difficile (C. difficile) because of frequent hospitalization, exposure to antibiotics and antibiotic prophylaxis for opportunistic infections. There are little data from India on the prevalence of C. difficile infection in such patients. Methods. We assessed the occurrence of C. difficile infections in HIV-positive patients with diarrhoea by looking for the presence of its toxin as well as by culturing. Enzyme immunoassay (EIA, Premier toxins A and B; Meridian Diagnostic Inc.) was used to detect toxin from 237 fresh stool samples collected from HIV-positive patients with diarrhoea. Culture was done on cycloserine–cefoxitin–fructose agar and brain– heart infusion agar. Results. C. difficile was found in 12 of 237 (5.1%, 95% CI 2.64%–8.68%) HIV-positive patients with diarrhoea (9 patients were positive by EIA and 3 by culture). The presence of C. difficile in patients who had received antiretroviral therapy (7/66 [10.6%]) was significantly higher (p<0.016) compared with those who had not (5/171 [3%]). Of the 12 patients positive for C. difficile, 7 were on antiretroviral therapy for a mean (SD) of 34.4 months with mean CD4+ count of 186 (98.81) cells/cmm and 5 patients were anti-retroviral-naïve with mean CD4+ count of 181 (68.7) cells/cmm. All the 12 patients were on antibiotics for previous 2 months and 4 of 12 had been hospitalized in the previous 30 days. Conclusion. C. difficile infections occurred more frequently in patients who had received antiretroviral therapy. Our study population had a lower frequency of C. difficile infections compared to previous studies.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Anti-Retroviral Agents/therapeutic use , Clostridioides difficile/drug effects , Clostridioides difficile/isolation & purification , Coinfection/epidemiology , Coinfection/prevention & control , Cross-Sectional Studies , Diarrhea/drug therapy , Diarrhea/epidemiology , Diarrhea/microbiology , Enterocolitis, Pseudomembranous/drug therapy , Enterocolitis, Pseudomembranous/epidemiology , Enterocolitis, Pseudomembranous/prevention & control , Female , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Male , Middle Aged , Prevalence , Risk Factors , Young Adult
9.
Indian J Exp Biol ; 2014 Feb; 52(2): 139-146
Article in English | IMSEAR | ID: sea-150342

ABSTRACT

The antidiarrhoeal activity of Cryptocoryne spiralis rhizomes extract (250, 500, 750 mg/kg, po) was evaluated using faecal excretion, castor oil-induced diarrhoea, small intestinal transit, intestinal fluid accumulation, gastric emptying and PGE2 induced enteropooling models in rats. In addition, various biochemical estimations, histopathological studies and antibacterial evaluations on strains responsible for diarrhoea were also performed. The results illustrated a significant reduction in normal faecal output rate after 5th and 7th h of treatment, while castor oil-induced diarrhoea model depicted a protection of 55.44% at same dose level from diarrhoea. The other models except, gastric emptying test demonstrated more pronounced effect at same dose level. A significant inhibition in nitric oxide, increase in carbohydrates, protein, DNA, Na+ and K+ level with minimum degeneration of colonic fibrous tissues and potent antibacterial activity were also observed. The antidiarrhoeal potential of C. spiralis may be as a result of antimotility and antisecretory type effect mediated through nitric oxide pathway.


Subject(s)
Animals , Antidiarrheals/administration & dosage , Antidiarrheals/chemistry , Araceae/chemistry , Castor Oil/toxicity , Diarrhea/chemically induced , Diarrhea/drug therapy , Diarrhea/pathology , Humans , Metabolic Networks and Pathways/drug effects , Nitric Oxide/metabolism , Plant Extracts/administration & dosage , Plant Extracts/chemistry , Rats , Rhizome/chemistry
10.
Journal of the Egyptian Society of Parasitology. 2014; 44 (2): 455-466
in English | IMEMR | ID: emr-166027

ABSTRACT

Cryptosporidiosis represents a major public health problem which transmitted by contamination of food or water by sporulated Cryptosporidial oocyst. Causing self- limited diarrhea in immuno-competent person and chronic and life threatening diarrhea among immunocompromised individuals. It can be diagnosed by concentration and detection of its Oocyst in different environmental samples and water by microscopic and immunological examination such as enzyme immunoas-say [ELISA] for parasite antigens and nucleic acid amplification assay as well as use of molecular techniques such as Polymerase Chain Reaction [PCR].Treatment is face challenges, Macrolides, Paramomycin, Nitazoxanide and Mirazid. All these drugs have partial efficacy in reducing disease severity in immunocompetent individuals. Nitazoxanide has partial efficacy in immunocompromised individuals. Resolution of Cryptosporidiosis can be maintained with effective Highly Active Antiretroviral Therapy [HAART]


Subject(s)
Humans , Cryptococcosis/drug therapy , Diarrhea/diagnosis , Diarrhea/drug therapy , Polymerase Chain Reaction , Treatment Outcome
11.
Arq. gastroenterol ; 50(4): 304-309, Oct-Dec/2013. tab, graf
Article in English | LILACS | ID: lil-697580

ABSTRACT

Context Irritable bowel syndrome (IBS) is a functional bowel disease characterized by abdominal pain and altered intestinal habits. The pathophysiology of IBS remains unclear. Recent studies have demonstrated that some IBS patients, especially in diarrhea-predominant IBS (IBS-D), display persistent signs of minor mucosal inflammation and a modified intestinal microflora. The mesalazine has known intestinal anti-inflammatory properties. Saccharomyces boulardii is a probiotic used for a long time in treatment of diarrhea, including infectious diarrhea. Objective Evaluate the effects of mesalazine alone, combined therapy of mesalazine with liophylised Saccharomyces boulardii or alone on symptoms of IBS-D patients. Methods Based on Rome III criteria, 53 IBS-D patients (18 year or more) were included. To exclude organic diseases all patients underwent colonoscopy, stool culture, serum anti-endomisium antibody, lactose tolerance test and ova and parasite exam. Patients were divided in three groups: mesalazine group (MG) - 20 patients received mesalazine 800 mg t.i.d. for 30 days; mesalazine and Saccharomyces boulardii group (MSbG) - 21 patients received mesalazine 800 mg t.i.d. and Saccharomyces boulardii 200 mg t.i.d. for 30 days and; Saccharomyces boulardii group (SbG) – 12 patients received Sb 200 mg t.i.d. for 30 days. Drugs that might have any effect on intestinal motility or secretion were not allowed. Symptom evaluations at baseline and after treatment were performed by means of a 4-point likert scale including: stool frequency, stool form and consistency (Bristol scale), abdominal pain and distension. Paired t test and Kruskal-Wallis test were used for statistical analyses. Results Compared to baseline, there were statistically significant reduction of symptom score after 30 th day therapy in all three groups: MG (P<0.0001); MSbG (P<0.0001) and in SbG (P = 0.003). There were statistically significant differences in ...


Contexto A síndrome do intestino irritável (SII) é uma doença funcional do intestino, caracterizada por dor abdominal e alterações do hábito intestinal, cuja fisiopatologia permanece desconhecida. Estudos recentes sustentam a hipótese de que algumas formas de SII, especialmente a síndrome do intestino irritável tipo diarreia (SII-D), apresentam sinais de uma inflamação de baixo grau persistente da mucosa intestinal e alterações da microflora intestinal. A mesalazina é conhecida por suas propriedades anti-inflamatórias intestinais. O Saccharomyces boulardii é um probiótico largamente utilizado para o tratamento da diarreia relacionada à causa infecciosa. Objetivo Avaliar os efeitos da mesalazina, da terapia com mesalazina combinada ao Saccharomyces boulardii e do Saccharomyces boulardii, em pacientes com SII-D. Método Com base nos critérios de Roma III, 53 pacientes com SII-D (maiores de 18 anos) foram incluídos. Para excluir as doenças orgânicas, todos os pacientes realizaram colonoscopia, coprocultura, anticorpo anti-endomísio, teste de tolerância à lactose e exame parasitológico de fezes. Os pacientes foram divididos em três grupos: grupo mesalazina (GM) – 20 pacientes foram medicados com mesalazina via oral 800 mg t.i.d. por 30 dias; grupo mesalazina e Saccharomyces boulardii (GMSb) – 21 pacientes foram medicados com mesalazina 800mg t.i.d. e Saccharomyces boulardii 200 mg via oral t.i.d. por 30 dias; grupo Saccharomyces boulardii (GSb) – 12 pacientes foram medicados com Saccharomyces boulardii 200 mg t.i.d. por 30 dias. Não foram permitidas drogas concomitantes com algum efeito sobre secreção ou motilidade intestinal. Os sintomas foram avaliados no basal e após tratamento por meio da escala de Likert de 4 pontos que incluía: frequência ...


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Irritable Bowel Syndrome/drug therapy , Mesalamine/administration & dosage , Probiotics/administration & dosage , Saccharomyces , Drug Therapy, Combination , Diarrhea/drug therapy , Treatment Outcome
14.
Mem. Inst. Oswaldo Cruz ; 108(6): 741-754, set. 2013. graf
Article in English | LILACS | ID: lil-685487

ABSTRACT

Live attenuated vaccines have recently been introduced for preventing rotavirus disease in children. However, alternative strategies for prevention and treatment of rotavirus infection are needed mainly in developing countries where low vaccine coverage occurs. In the present work, N-acetylcysteine (NAC), ascorbic acid (AA), some nonsteroidal anti-inflammatory drugs (NSAIDs) and peroxisome proliferator-activated receptor gamma (PPARγ) agonists were tested for their ability to interfere with rotavirus ECwt infectivity as detected by the percentage of viral antigen-positive cells of small intestinal villi isolated from ECwt-infected ICR mice. Administration of 6 mg NAC/kg every 8 h for three days following the first diarrhoeal episode reduced viral infectivity by about 90%. Administration of AA, ibuprofen, diclofenac, pioglitazone or rosiglitazone decreased viral infectivity by about 55%, 90%, 35%, 32% and 25%, respectively. ECwt infection of mice increased expression of cyclooxygenase-2, ERp57, Hsc70, NF-κB, Hsp70, protein disulphide isomerase (PDI) and PPARγ in intestinal villus cells. NAC treatment of ECwt-infected mice reduced Hsc70 and PDI expression to levels similar to those observed in villi from uninfected control mice. The present results suggest that the drugs tested in the present work could be assayed in preventing or treating rotaviral diarrhoea in children and young animals.


Subject(s)
Animals , Mice , Acetylcysteine/pharmacology , /pharmacology , Diarrhea/drug therapy , PPAR gamma/agonists , Rotavirus , Rotavirus Infections/drug therapy , Antioxidants/therapeutic use , Cyclooxygenase Inhibitors/therapeutic use , Diarrhea/virology , /metabolism , /metabolism , Intestines/virology , Mice, Inbred ICR , NF-kappa B/metabolism , Protein Disulfide-Isomerases/metabolism
15.
Rev. panam. salud pública ; 33(5): 370-377, may. 2013. ilus, graf, tab
Article in English | LILACS | ID: lil-676418

ABSTRACT

OBJECTIVE: To update the available evidence about zinc use for treating diarrhea in children and to assess its effect on the malnourished population, a subgroup that has not been fully explored in previous analyses. METHODS: A systematic review was performed of randomized clinical trials that assessed children up to 5 years old with acute diarrhea who received zinc supplementation. Controls received a placebo or oral rehydration therapy. After searching the main databases, without language restrictions, two independent reviewers selected eligible studies, extracted the data, and assessed the risk of bias of included studies. Meta-analyses were calculated using Mantel-Haenszel or inverse variance random effects. RESULTS: Eighteen of 1 041 studies retrieved were included in the review (n = 7 314 children). Zinc was beneficial for reducing the duration of diarrhea in hours (mean difference [MD] = -20.12, 95% confidence interval [CI] = -29.15 to -11.09, I² = 91%). The effect was greater in malnourished children (MD = -33.17, 95% CI = -33.55 to -27.79, I² = 0%). Diarrhea prevalence on days 3, 5, and 7 was lower in the zinc group. The incidence of vomiting was significantly greater in the group that received zinc than in the control group. Included randomized controlled trials were of low risk of bias in most domains assessed. CONCLUSIONS: Oral zinc supplementation significantly decreases diarrhea duration and has a greater effect on malnourished children. Zinc supplementation seems to be an appropriate public health strategy, mainly in areas of endemic deficiencies.


OBJETIVO: Actualizar los datos probatorios disponibles acerca del uso del zinc en el tratamiento de la diarrea infantil y evaluar su efecto en la población malnutrida, un subgrupo no plenamente estudiado en análisis anteriores. MÉTODOS: Se llevó a cabo una revisión sistemática de ensayos clínicos aleatorizados que evaluaban a niños de hasta 5 años de edad con diarrea aguda y a los que se les había administrado suplementos de zinc. A los controles se les había administrado un placebo o terapia de rehidratación oral. Después de efectuar búsquedas en las principales bases de datos, sin restricciones en cuanto a idiomas, dos revisores independientes seleccionaron los estudios idóneos, extrajeron los datos y evaluaron el riesgo de sesgo de los estudios incluidos. El metanálisis se efectuó mediante el modelo de efectos aleatorios de Mantel-Haenszel o de la varizanza inversa. RESULTADOS: En la revisión se incluyeron 18 estudios de los 1 041 recuperados (n = 7 314 niños). El zinc tuvo un efecto beneficioso en la reducción de la duración de la diarrea en horas (diferencia media [DM] = -20,12, intervalo de confianza del 95% [IC] de -29,15 a -11,09, I² = 91%). Este efecto fue más intenso en niños malnutridos (DM = -33,17, IC del 95% = de -33,55 a -27,79, I² = 0%). La prevalencia de diarrea en los días 3, 5 y 7 fue inferior en el grupo tratado con zinc. La incidencia de vómitos fue significativamente mayor en el grupo tratado con zinc que en el grupo de referencia. Los ensayos aleatorizados controlados que fueron incluidos mostraron un bajo riesgo de sesgo en la mayoría de los dominios evaluados. CONCLUSIONES: La administración oral de suplementos de zinc reduce significativamente la duración de la diarrea y tiene un efecto aún mayor en niños malnutridos. La administración de suplementos de zinc parece ser una estrategia de salud pública apropiada, principalmente en las zonas afectadas por carencias endémicas.


Subject(s)
Child, Preschool , Humans , Infant , Dietary Supplements , Diarrhea/drug therapy , Zinc/therapeutic use , Diarrhea, Infantile/drug therapy , Incidence , Randomized Controlled Trials as Topic
16.
Clinics ; 68(3): 351-358, 2013. ilus, tab
Article in English | LILACS | ID: lil-671426

ABSTRACT

OBJECTIVE: To identify the impact of supplemental zinc, vitamin A, and glutamine, alone or in combination, on long-term cognitive outcomes among Brazilian shantytown children with low median height-for-age z-scores. METHODS: A randomized, double-blind, placebo-controlled trial was conducted in children aged three months to nine years old from the urban shanty compound community of Fortaleza, Brazil. Demographic and anthropometric information was assessed. The random treatment groups available for cognitive testing (total of 167 children) were: (1) placebo, n = 25; (2) glutamine, n = 23; (3) zinc, n = 18; (4) vitamin A, n = 19; (5) glutamine+zinc, n = 20; (6) glutamine+vitamin A, n = 21; (7) zinc+vitamin A, n = 23; and (8) glutamine+zinc+vitamin A, n = 18. Neuropsychological tests were administered for the cognitive domains of non-verbal intelligence and abstraction, psychomotor speed, verbal memory and recall ability, and semantic and phonetic verbal fluency. Statistical analyses were performed using SPSS, version 16.0. ClinicalTrials.gov: NCT00133406. RESULTS: Girls receiving a combination of glutamine, zinc, and vitamin A had higher mean age-adjusted verbal learning scores than girls receiving only placebo (9.5 versus 6.4, p = 0.007) and girls receiving zinc+vitamin A (9.5 versus 6.5, p = 0.006). Similar group differences were not found between male study children. CONCLUSIONS: The findings suggest that combination therapy offers a sex-specific advantage on tests of verbal learning, similar to that seen among female patients following traumatic brain injury.


Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Dietary Supplements , Diarrhea/drug therapy , Glutamine/administration & dosage , Verbal Learning/drug effects , Vitamin A/administration & dosage , Vitamins/administration & dosage , Zinc/administration & dosage , Brazil , Cognition/drug effects , Double-Blind Method , Neuropsychological Tests , Poverty Areas , Risk Factors , Sex Factors , Socioeconomic Factors , Treatment Outcome
18.
Article in English | WPRIM | ID: wpr-103952

ABSTRACT

Chronic diarrhea with a 35 kg weight loss (75 kg to 40 kg) occurred during 2 years in an alcoholic patient was diagnosed with Isospora belli infection in the Republic of Korea. The patient, a 70-year old Korean male, had been a heavy drinker for more than 30 years. He was admitted to the Seoul National University Hospital because of long-standing diarrhea and severe weight loss. He had an increased white blood cell (WBC) count with high peripheral blood eosinophilia (36.8-39.9%) and lowered protein and albumin levels but without any evidence of immunosuppression. A parasitic infection was suspected and fecal examination was repeated 3 times with negative results. Peroral endoscopy with mural biopsy was performed in the upper jejunum. The biopsy specimens revealed villous atrophy with loss of villi together with various life cycle stages of I. belli, including trophozoites, schizonts, merozoites, macrogamonts, and microgamonts. The patient was treated successfully with oral doses of trimethoprim 160-320 mg and sulfamethoxazole 800-1,600 mg daily for 4 weeks. A follow-up evaluation at 2.5 years later revealed marked improvement of body weight (68 kg), increased protein and albumin levels, and normal WBC count with low eosinophils (3.1%). This is the first clinical case of isoporiasis with demonstration of various parasitic stages in the Republic of Korea.


Subject(s)
Aged , Alcoholism/complications , Antiparasitic Agents/administration & dosage , Diarrhea/drug therapy , Humans , Isospora/isolation & purification , Isosporiasis/diagnosis , Male , Republic of Korea , Sulfamethoxazole/administration & dosage , Treatment Outcome , Trimethoprim/administration & dosage
19.
J. pediatr. (Rio J.) ; 88(2): 125-128, mar.-abr. 2012. tab
Article in Portuguese | LILACS | ID: lil-623457

ABSTRACT

OBJETIVO: Avaliar a distribuição e suscetibilidade a antimicrobianos de Shigella isolada de crianças com diarreia aguda e sem diarreia em Teresina (PI). MÉTODOS: Quatrocentas crianças com idade até 60 meses foram estudadas. Fezes foram coletadas de todos os pacientes entre janeiro de 2004 e agosto de 2007. Shigella foi identificada por métodos convencionais e antibiograma e pesquisa de β-lactamase de espectro ampliado (ESBL) foram realizados por difusão em ágar. RESULTADOS: Shigelose foi detectada apenas em crianças com diarreia aguda (26/250; 10,4%), especialmente naquelas entre 6 e 24 meses de idade e nos meses chuvosos. Shigella foi suscetível a ceftriaxona, ciprofloxacina e ácido nalidíxico. Mais da metade das amostras foram resistentes a sulfametoxazol-trimetoprim e ampicilina. ESBL não foi detectada. CONCLUSÕES: S. flexneri é comum em Teresina. A resistência a ampicilina e sulfametoxazol-trimetoprim é preocupante, pois estas drogas são amplamente utilizadas na prática e sulfametoxazol-trimetoprim ainda é recomendada para tratamento de crianças com suspeita de shigelose.


OBJECTIVE: To evaluate the distribution and susceptibility to antimicrobials of Shigella isolated from children with acute diarrhea and without diarrhea in Teresina, state of Piauí, Brazil. METHODS: Four hundred children aged up to 60 months were studied. Stools were collected from all the patients between January 2004 and August 2007. Shigella was identified by conventional methods and antibiogram and extended-spectrum β-lactamase (ESBL) were performed by agar diffusion. RESULTS: Shigellosis was only detected in children with acute diarrhea (26/250; 10.4%), especially in those aged from 6 to 24 months and in the rainy months. Shigella was susceptible to ceftriaxone, ciprofloxacin and nalidixic acid. More than half of the strains were resistant to sulphametoxazole-trimethoprim and ampicillin. ESBL was not detected. CONCLUSIONS: S. flexneri is common in Teresina. The resistance to ampicillin and sulphametoxazole-trimethoprim gives cause for concern, as these drugs are widely used in practice and sulphametoxazole-trimethoprim is also recommended for treating children suspected of having shigellosis.


Subject(s)
Child, Preschool , Female , Humans , Infant , Male , Anti-Bacterial Agents/pharmacology , Drug Resistance, Microbial , Diarrhea/microbiology , Feces/microbiology , Shigella flexneri/drug effects , Shigella sonnei/drug effects , Acute Disease , Ampicillin/pharmacology , Brazil , Diarrhea/drug therapy , Epidemiologic Methods , Trimethoprim, Sulfamethoxazole Drug Combination/pharmacology , beta-Lactamases/biosynthesis
20.
Clinics ; 67(1): 11-18, 2012. ilus, tab
Article in English | LILACS | ID: lil-610618

ABSTRACT

OBJECTIVE: Apolipoprotein E4 may benefit children during early periods of life when the body is challenged by infection and nutritional decline. We examined whether apolipoprotein E4 affects intestinal barrier function, improving short-term growth and long-term cognitive outcomes in Brazilian shantytown children. METHODS: A total of 213 Brazilian shantytown children with below-median height-for-age z-scores (HAZ) received 200,000 IU of retinol (every four months), zinc (40 mg twice weekly), or both for one year, with half of each group receiving glutamine supplementation for 10 days. Height-for-age z-scores, weight-for-age z-scores, weight-forheight z-scores, and lactulose:mannitol ratios were assessed during the initial four months of treatment. An average of four years (range 1.4-6.6) later, the children underwent cognitive testing to evaluate non-verbal intelligence, coding, verbal fluency, verbal learning, and delayed verbal learning. Apolipoprotein E4 carriage was determined by PCR analysis for 144 children. RESULTS: Thirty-seven children were apolipoprotein E4(+), with an allele frequency of 13.9 percent. Significant associations were found for vitamin A and glutamine with intestinal barrier function. Apolipoprotein E4(+) children receiving glutamine presented significant positive Pearson correlations between the change in height-for-age z-scores over four months and delayed verbal learning, along with correlated changes over the same period in weight-for-age z-scores and weight-for-height z-scores associated with non-verbal intelligence quotients. There was a significant correlation between vitamin A supplementation of apolipoprotein E4(+) children and improved delta lactulose/mannitol. Apolipoprotein E4(-) children, regardless of intervention, exhibited negative Pearson correlations between the change in lactulose-to-mannitol ratio over four months and verbal learning and non-verbal intelligence. CONCLUSIONS: During development, apolipoprotein E4 may function concomitantly with gut-tropic nutrients to benefit immediate nutritional status, which can translate into better long-term cognitive outcomes.


Subject(s)
Child, Preschool , Female , Humans , Male , /genetics , Cognition/drug effects , Diarrhea/drug therapy , Growth Disorders/genetics , Malnutrition/drug therapy , Micronutrients/administration & dosage , /drug effects , Brazil , Diarrhea/metabolism , Diarrhea/psychology , Gene Frequency/drug effects , Gene Frequency/genetics , Glutamine/administration & dosage , Growth Disorders/metabolism , Intestinal Absorption/drug effects , Intestinal Absorption/genetics , Lactulose , Malnutrition/metabolism , Malnutrition/psychology , Mannitol , Poverty Areas , Prospective Studies , Permeability/drug effects , Vitamin A/administration & dosage , Zinc/administration & dosage
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