Appropriateness of drug usage in acute pediatric diarrhea – A prospective observational study

Background: Pediatric diarrhea is the 3rd foremost cause of childhood mortality all over the world. Although these are self-limiting, irrational antibiotic use and polypharmacy are prevalent in their treatment. Antimicrobial therapy is recommended in bacterial diarrhea and severely malnourished children only. Inappropriate use of drugs for the treatment of acute diarrhea can be minimized by adhering to standard guidelines. Aims and Objectives: The objectives of this study were as follows: (1) To evaluate the appropriateness of drug treatment in Acute Pediatric Diarrhea and (2) to assess the appropriateness of antibiotic treatment in diarrhea based on modified Kunin’s criteria. Materials and Methods: A prospective observational study was conducted for 12 months at the pediatric inpatient unit of Bidar Institute of Medical Sciences, Bidar. Prescriptions of 400 cases of acute diarrhea were evaluated for the appropriateness of drug usage using Indian Academy of Pediatrics (IAP) guidelines and modified Kunin’s criteria. Results: Among the 400 acute diarrhea cases, majority were male (54.75%) and below 5 years (58.25%). Oral rehydration solution (ORS) was given to 337 patients and IV fluids to 324 cases. About 55.5% patients were prescribed antibiotics. In 75.67% prescriptions, the antibiotic use was not necessary (modified Kunin’s criteria category V). Only 12.5% prescriptions adhered to IAP guidelines (2006), which included ORS and Zinc. About 54.5% patients were prescribed probiotics and 80% were prescribed antiemetics (ondansetron), which is not appropriate as per guidelines. Conclusion: Majority of patients were prescribed ORS, but only few were given zinc as an adjunctive therapy. Thus, we found that adherence to IAP 2006 guidelines was very low in our setup. Based on our observations, we suggest that prescribers should make use of standard treatment guidelines and choose appropriate drugs and their formulations so that irrational use of drugs can be minimized.

Epidemiological characteristics and genotypes of parechovirus A from children with acute diarrhea in Beijing in 2021 / 公共卫生与预防医学

Objective To investigate the epidemiological chatacteristics and genotypes of parechovirus A (PeV-A) from children with acute diarrhea in Beijing in 2021. Methods Fecal samples were randomly collected from outpatient children under 60 months with acute diarrhea in a sentinel hospital in Beijing from January to December of 2021. RNA was extracted and detected for PeV-A by real-time RT-PCR. Nested RT-PCR was performed to amplify the VP3/VP1 conjunction region. PeV-A genotypes were determined based on sequencing and NCBI BLAST. Group A rotavirus, norovirus, enteric adenovirus, astrovirus and sapovirus were also detected for co-infection analysis. Phylogenetic and statistical analyses were performed using bioinformatics and statistical software. Results Of the 198 stool samples, 11 were positive for PeV-A, with a detection rate of 5.56% (11/198). Among them, 2 cases were co-infected with enteric adenovirus. 81.82% (9/11) of PeV-A infected cases were under 24 months. The highest detection rate was observed in fall, which was 12.50% (7/56). 90.91%（10/11）of PeV-A infection occurred in summer and fall. Among the 11 PeV-A isolates, 9 were sequenced successfully, of which 7 belonged to PeV-A1B genotype and 2 belonged to PeV-A3 genotype. Conclusion PeV-A1B and PeV-A3 are identified in children with acute gastroenteritis in Beijing in 2021. Infants and young children under 2 years old are the high-risk population for PeV-A infection. Most infections occur in summer and fall.

Assessment of role of zinc in the management of acute diarrhea in children at a teaching hospital

Background: Pediatric diarrhea is one of the major causes of childhood mortality around the world. Oral rehydrationtherapy (ORT) along with zinc supplementation can reduce the irrational antimicrobial use and stay in hospital. Aims and Objectives: This study aims to evaluate the role of zinc in reduction of stool frequency and duration of diarrheal episode. Materials and Methods: A prospective observational study was performed for 12 months at pediatric in-patient unit of BRIMS teaching hospital, Bidar. We evaluated 400 prescriptions of acute diarrhea cases for the role of zinc based on reduction of stool frequency and decrease in the duration of diarrheal episode. Results: A study revealed a very statistically significant reduction (P < 0.001) in both stool frequencies during the 3rd–5th day and there was reduction in mean duration of diarrheal episode in the group treated with ORT/parenteral rehydration+ zinc. Conclusion: We observed significant decrease in both stool frequency and mean duration of diarrheal episodes in the group treated with ORT/parenteral rehydration+ zinc as compared to ORT/parenteral rehydration alone. Thus, we recommend practitioners to use ORS and zinc which reduces the stay in hospital and helps in faster recovery. And also, it would definitely reduce the practice of polypharmacy and inappropriate antibiotic prescribing practices.

Study report of deseas history pacients administrated in “Gurvan gal” hospital with diagnosis of rotaviruses / Эрүүл мэндийн лаборатори

Introduction@#Diarrhea is defined as a person excretes more than three times in 24 hours with pathological impurities of more than 10 mg/kg per day. According to the fact sheets of the World Health Organization in 2019, diarrhea is the second leading cause of death among children under 5 years of age. Researchers suggest that about 50 percent of infantile diarrhea occurs in temperate countries and it reaches almost 80 percent in winter which is mainly caused by rotavirus. While immunization is the most effective way to prevent rotavirus infection, there were two types of rotavirus vaccines that have been licensed and available on the global market since 2006. Rotavirus immunization in young children is a safe and effective public health method for controlling rotavirus infection which therefore can reduce childhood morbidity and mortality.@*Study aim@#To study the incidence, clinical manifestations, and complications of rotavirus among children hospitalized with acute diarrhea.@*Methodology@#The study will be conducted using the observational method including descriptive analysis. Statistical data for 2018-2020 will be obtained and analyzed from the pediatric wards of the “Gurvan Gal” hospital. Children diagnosed with rotavirus diarrhea who meet the criteria to be included in the study will be selectively sampled with further analysis of the incidence, clinical features, toxicity, and dehydration of acute diarrhea according to the medical history.@*Results@#Universal immunization is important to significantly reduce rotavirus-associated diarrhea, thereby reducing infection and the risk of disease in infants and young children.

Efectividad de la educación sanitaria para la prevención de enfermedades diarreicas agudas / Effectiveness of health education for the prevention of acute diarrheal diseases

En investigaciones similares se ha reportado un grado de desconocimiento respecto a las enfermedades diarreicas agudas en los padres de grupos de riesgo. Varias investigaciones han abordado el tema de la educación sanitaria como factor determinante en la prevención de enfermedades. Las políticas de salud, están obligadas a mantener vigentes las estrategias de prevención efectivas y proponer una búsqueda continua y exhaustiva de nuevas políticas que ayuden a desterrar la EDA de las principales causas de morbilidad en grupos vulnerables. El desafío actual es atenuar los determinantes sociales y atender a la población con factores de riesgo. En esta revisión se evaluó y sistematizó publicaciones en busca de pruebas de la efectividad de la educación sanitaria en la prevención de la enfermedad diarreica aguda(AU)

Similar investigations have reported a degree of ignorance regarding acute diarrheal diseases in parents of risk groups. Several investigations have addressed the issue of health education as a determining factor in disease prevention. Health policies are obliged to keep effective prevention strategies in force and propose a continuous and exhaustive search for new policies that help banish ADD from the main causes of morbidity in vulnerable groups. The current challenge is to mitigate the social determinants and care for the population with risk factors. In this review, we evaluated and systematized publications looking for evidence of the effectiveness of health education in the prevention of acute diarrheal disease(AU)

Pathogenic study and drug resistance analysis of acute diarrhea induced by Escherichia Coli in Chengde Area in 2016-2018 / 公共卫生与预防医学

Objective To study the etiology and drug resistance of escherichia coli isolated from clinic in chengde from 2016 to 2018, and to provide an objective basis for the epidemiological study and clinical rational use of antimicrobial agents. Methods The feces of 702 diarrhea patients in an outpatient clinic in chengde district from 2016 to 2018 were collected, isolated and prepared by conventional pathogen testing procedures, and the specimens suspected of escherichia coli were identified by multiple PCR and single PCR experiments. DEC was sensitized to 15 antibiotic drugs in vitro by automatic microbiological identification and drug sensitivity analyzer Vitke-2 compact. Results A total of 189 DEC strains was isolated from the feces of 702 diarrhea patients, and the detection rate was 26.92%. Among 189 DEC strains, EAEC had the highest detection rate (57.67%), followed by ETEC (32.80%), then EPEC (6.35%) and mixed (3.17%). EIEC and EHEC were not detected. The virulence genes were mainly ast A 、est Ib and esc V. All types of DEC were detected throughout the year, with the highest detection rate (29.19%) between June and August. The patients were mainly aged between 20 and 45 years old, and the detection rate was 25.86% and 27.97% for men and women. The detection of EPEC was not affected by season, sex or age, except by season and age. DEC had the highest resistance to ampicillin at 62.96%, 51.32%, 49.74% and 30.16% to cotrimoxazole, ciprofloxacin and gentamicin, and less than 20% to the other 11 drugs, all of which were sensitive to meropenem but not resistant. Among 189 DEC strains, esbl-producing strains accounted for 1.59%. Multiple resistant strains accounted for 32.80%. Conclusion DEC for chengde area of the most common bacterial pathogens in gastrointestinal tract infection, clinical laboratory should strengthen the monitoring of the region DEC, especially to carry on a variety of virulence genes, ESBL producing and multiple drug resistance strains, timely grasp the dynamics of bacterial drug resistance, and to guide clinical rational drug use, delay and reduce the generation of bacterial drug resistance.

Epidemiology of classic human astrovirus among infants and young children with acute diarrhea in a hospital outpatient in Shanghai, 2012-2016 / 中华传染病杂志

Objective:To investigate the epidemiological characteristics of classic human astrovirus (HAstV) among children under five years old with acute diarrhea, and to understand the role of HAstV in children acute diarrhea.Methods:A total of 1 010 fecal specimens were collected in 1 010 outpatients under five years old with acute diarrhea admitted to Children′s Hospital of Fudan University, Shanghai from January 2012 to December 2016. Reverse transcription polymerase chain reaction (PCR) or PCR was used for screening classic HAstV, group A rotavirus, norovirus and adenovirus. Genotypes of classic HAstV were determined by nucleotide sequencing and phylogenetic tree analysis.Results:The overall positive rate of classic HAstV was 2.7%(27/1 010). The detection rates of classic HAstV from 2012 to 2016 were 6.9%(10/144), 3.5%(5/144), 2.1%(3/144), 1.5%(4/265) and 1.6%(5/313), respectively. Almost 96.3%(26/27) of children infected with HAstV were 0 to 36 months of age. The prevalence of classic HAstV infections displayed a typical autumn/winter seasonality except in 2016. All the positive classic HAstV strains were genotyped as HAstV-1 with two lineages of HAstV-1a and HAstV-1b. Among them, the lineage of HAstV-1a was the predominant subtype (63.0%, 17/27). There were 77.8%(21/27) of the children with acute diarrhea only infected with classic HAstV, whereas for the remaining cases a variety of other enteric viruses were detected (three cases co-infected with HAstV and group A rotavirus, two cases co-infected with HAstV and adenovirus, and one case co-infected with HAstV, group A rotavirus and adenovirus).Conclusions:Children infected with HAstV are mainly less than 36 months of age. Although the genotype of classic HAstV detected in this study is single, but the lineages are in a state of dynamic change. Long-time and continuous monitor for the epidemiology of classic HAstV is needed to avoid outbreak of diarrhea in children.

Clinical and demographic profile of paediatric patients presenting with acute diarrhea

Background: Diarrhea is a public health problem globally, being the 2nd leading cause of death in children under 5 years. Dehydration as well as malnutrition are also serious consequences of diarrhea. This study was carried out with an aim to focus on the clinical and demographic profile of diarrheal patients of pediatric age.Methods: Infants and children aged 6 months to 5 years were analysed for age and gender distribution, chief complaints, feeding practices, nutritional status and assessment of dehydration; from January 2018 to June 2019 in the Department of Pediatrics of a Tertiary Care Teaching Hospital.Results: Total 150 patients were analysed. Almost 50.67% group A and 41.34% group B patients belonged to toddlerhood. Male preponderance was also noted. Along with diarrhea, vomiting was noted in 22 group A and 21 group B and fever in 19 group A and 29 group B patients. Approximately 41-45% patients had no malnutrition and 55-60% had no dehydration in both the study groups.Conclusions: There is lack of awareness regarding dog bite and its management among the rural people fever and vomiting were most frequently associated with diarrhea. A little less than half of the study participants had some-dehydration. Nearly half of the patients belonged to toddler age group. Majority of the patients were exclusively breast-fed for six months.

Acute diarrhea with blood: diagnosis and drug treatment / Diarreia aguda com sangue: diagnóstico e tratamento medicamentoso

Abstract Objective To restate the epidemiological importance of Shigella in acute diarrhea with blood, providing an overview of the treatment and stressing the need for the correct indication of antibiotic therapy. Sources of Data A search was carried out in the Medline and Scopus databases, in addition to the World Health Organization scientific documents and guidelines, identifying review articles and original articles considered relevant to substantiate the narrative review. Synthesis of Data Different pathogens have been associated with acute diarrhea with blood; Shigella was the most frequently identified. The manifestations of shigellosis in healthy individuals are usually of moderate intensity and disappear within a few days. There may be progression to overt dysentery with blood and mucus, lower abdominal pain, and tenesmus. Conventional bacterial stool culture is the gold standard for the etiological diagnosis; however, new molecular tests have been developed to allow the physician to initiate targeted antibacterial treatment, addressing a major current concern caused by the increasing resistance of Shigella. Prevention strategies include breastfeeding, hygiene measures, health education, water treatment, and the potential use of vaccines. Conclusions Acute diarrhea is an important cause of mortality in children under 5 years and shigellosis is the leading cause of acute diarrhea with blood worldwide. The current concern is the increase in microbial resistance to the recommended antibiotics, which brings an additional difficulty to therapeutic management. Although no vaccine is yet available against Shigella, several candidates are undergoing clinical trials, and this may be the most cost-effective preventative measure in future.

Resumo Objetivo Reiterar a importância epidemiológica da Shigella na diarreia aguda com sangue, fornecer uma visão geral do tratamento e ressaltar a necessidade da correta indicação da antibioticoterapia. Fontes dos dados Realizada pesquisa nos bancos de dados Medline e Scopus, além de documentos científicos e diretrizes da Organização Mundial da Saúde, com a identificação de artigos de revisão e artigos originais considerados relevantes para fundamentar a revisão do tipo narrativa. Síntese dos dados Diferentes patógenos têm sido associados à diarreia aguda com sangue, a Shigella é o mais frequente. As manifestações da shigelose em indivíduos saudáveis são geralmente de intensidade moderada e desaparecem em poucos dias. Pode haver progressão para disenteria franca com sangue e muco, dor em abdome inferior e tenesmo. A coprocultura bacteriana convencional é o padrão-ouro para o diagnóstico etiológico, porém novos testes moleculares foram desenvolvidos, os quais permitem ao médico iniciar tratamento antibacteriano direcionado, sanar uma grande preocupação atual, devido à crescente resistência da Shigella. Estratégias de prevenção incluem aleitamento, medidas de higiene, educação em saúde, tratamento da água e o potencial uso de vacinas. Conclusões A diarreia aguda é uma importante causa de mortalidade em crianças com menos de cinco anos e a shigelose é a principal causa de diarreia aguda com sangue em todo o mundo. A preocupação atual é o aumento da resistência microbiana aos antibióticos preconizados, o que traz uma dificuldade adicional ao manejo terapêutico. Embora ainda não exista vacina disponível para Shigella, várias candidatas estão em fase de testes clínicos, podem futuramente ser a medida preventiva mais custo-efetiva.

Bat-related coronavirus / 第二军医大学学报

The outbreak of coronavirus disease 2019 (COVID-19) in Dec. 2019 sounded another alarm for humanbeing, with the first being the outbreak of severe acute respiratory syndrome (SARS) in 2003. Researchers found that the natural host of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen of COVID-19, may be the Rhinolophus sinicus. There have been four outbreaks of coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV], Middle East respiratory syndrome coronavirus [MERS-CoV], swine acute diarrhea syndrome coronavirus [SADS-CoV] and SARS-CoV-2) worldwide since the beginning of 21st century, and they have caused huge threats and losses to human health, public health, economic development, and social stability. A large amount of evidence suggests that the natural host of all these four coronaviruses may be bats. This article reviews the species and global geographic distribution of bat-related coronaviruses, and the above-metioned four coronaviruses causing severe outbreaks.

Estudo sobre a qualidade da água para consumo humano e as doenças diarreicas no Brasil / Study on drinking-water quality and diarrheal diseases / Estudio sobre la calidad del agua potable y las enfermedades diarreicas en Brasil

A doença diarreica aguda (DDA) está entre as mais comuns no mundo, acometendo pessoas de todas as idades, mas causando óbitos principalmente em crianças. É a segunda causa de morte em crianças nos países subdesenvolvidos devido à dificuldade de acesso à água potável e à ausência de saneamento básico. A quantidade e qualidade da água disponível relacionam-se à qualidade de vida dos seres humanos. Nas últimas décadas, verifica-se um declínio no número de mortes por diarreia no mundo e no Brasil. Objetivou-se com esse trabalho analisar a relação da qualidade da água de consumo e as doenças diarreicas agudas no país. Foram avaliados estudos sobre o tema e exposição dos direcionamentos de ações futuras que podem impactar positivamente na redução da doença. O método utilizado foi a revisão de literatura a partir das bases de dados MEDLINE, SciELO e LILACS, focada em estudos observacionais correlacionando qualidade da água e saneamento básico com prevalência dos casos de diarreia aguda. A maioria dos artigos demonstrou que investimentos em saneamento básico apresentam bons resultados, e que fatores socioeconômicos influenciam no risco de adoecimento. Sendo assim, maiores investimentos e ampliação das ações de vigilância relacionada à água para consumo, com o padrão de potabilidade estabelecido na legislação, contribuem para a redução da ocorrência de doenças diarreicas.

Acute diarrheal disease is one of the most common illnesses worldwide, affecting people of all ages and causing deaths mainly in children. This disease is the second leading cause of death in children from underdeveloped countries due to challenges in accessing drinking water and basic sanitation, indicating a close association between water quantity and quality and the quality of life of human beings. Over recent decades, the number of deaths from diarrhea decreased in Brazil and the world. This work sought to analyze the association between the quality of drinking water and acute diarrheal diseases. For that, a literature review was conducted in the MEDLINE, SciELO, and LILACS databases for observational studies correlating water quality and basic sanitation with the prevalence of cases of acute diarrhea, as well as for those approaching directions for future actions that help reducing the disease incidence. Most articles show that socioeconomic factor influence the risk of illness, and that investments in basic sanitation show good results for coping with it. Therefore, reducing the incidence of diarrheal diseases requires greater investments and expansion of surveillance actions related to drinking water, according to the standards established in legislation.

La enfermedad diarreica aguda es una de las afecciones más comunes en el mundo, afecta a personas de todas las edades y causa muertes principalmente en niños. Es la segunda causa de muerte infantil en los países subdesarrollados debido a la dificultad para acceder al agua potable y la falta de saneamiento básico. La cantidad y calidad del agua están relacionadas con la calidad de vida de los seres humanos. En las últimas décadas ha habido una disminución en el número de muertes por diarrea en el mundo y en Brasil. El objetivo de este trabajo fue analizar la relación entre la calidad del agua potable y las enfermedades diarreicas agudas. Se evaluaron estudios sobre el tema y exposición de los rumbos para acciones futuras que impacten positivamente en la reducción de la enfermedad. El método utilizado fue la revisión de la literatura en las bases de datos MEDLINE, SciELO y LILACS, enfocada en estudios observacionales que correlacionan la calidad del agua y el saneamiento básico con la prevalencia de casos de diarrea aguda. La mayoría de los artículos han demostrado que las inversiones en saneamiento básico tienen buenos resultados y que los factores socioeconómicos influyen en el riesgo de la enfermedad. Así mayores inversiones y ampliación de las acciones de vigilancia relacionadas con el agua potable, con el estándar de consumo establecido en la legislación, contribuyen a la reducción de las enfermedades diarreicas.

Knowledge, attitude and practice of acute diarrheal disease and use of oral rehydration therapy among mothers of under five children

Background: Acute diarrhea in children is among the commonest causes of outpatient and inpatient attendance in medical setup. Though enough has been done in imparting knowledge about diarrhea and its management, there is a gap between knowledge and practice in the population. Aim of the study is to assess the mother's knowledge, attitude and practice about diarrhea in children.Methods: Cross-sectional survey, conducted in the pediatric department of a peripheral hospital in Pune, Maharashtra.Results: Of the 305 mothers surveyed, their knowledge about diarrhea was good with 77.1% knowing correct definition, and most mothers knowing correctly about its mode of transmission, the positive role of good hygiene & sanitation, breast feeding and oral rehydration therapy (ORT) in prevention and management of acute diarrhea. However, their attitude and practice were found lacking, with higher rate of bottle feeding (59.3%) and lesser use of standard (46.3%) as well as home based (69.9%) ORT measures.Conclusions: There is discrepancy between the knowledge and practice. Hence, there is the need of sustained efforts in imparting both knowledge and practice among the population.

Safety and Tolerability of Nonspecific Antidiarrheals in Children with Acute Diarrhea

Introduction: In clinical practice, nonspecific antidiarrhealsare most commonly used by clinicians along with routinetreatment to hasten the recovery. This study was conductedto to study the safety and tolerability of these nonspecificantidiarrheals in children with acute diarrhea.Material and Methods: This was a prospective, observationalstudy done in clinical settings for a period of 3 years at twopediatric clinics and at a tertiary care hospital. Children weredivided into 5 treatment groups (viz, control, racecadotril,Mebarid, Diarex and loperamide) at the discretion of thepediatrician. One questionnaire was provided to parents torecord the details about the course of diarrhea and parentswere sensitized to report any adverse event.Results: Overall occurrence of adverse events wassignificantly higher in racecadotril group (34.86%) comparedto other groups (C:23.16%, M:21.14%, D:17.95%, L:17.65%).Conclusion: These agents may be safe, effective andinexpensive addition to the routine treatment of acute diarrhea.

Diarrea aguda en el lactante y preescolar / Acute diarrhea in toddlers and infants

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.

Serum Calcium, Magnesium And Potassium In Acute Diarrhoea Patients Coming To Pravara Rural Hospital

Introduction:Diarrhoea is a leading cause of morbidity and mortality across all age groups and regions of the world. Electrolyte imbalances are very common with the severity of acute diarrhoea. The aim of present study was to study the Serum Calcium, Magnesium and Potassium levels in patients of acute diarrhea.Materials and methods:This was a descriptive longitudinal study carried out in Department of Medicine, of PRH, Loni. Patients of diagnosed of acute diarrhea of age 18 and above of either gender willing to participate by giving written informed consent were includ-ed in the study. Patients with history of electrolyte abnormalities, history of chronic gastroenteritis, irritable bowel disease, congestive cardiac failure, liver cirrhosis, renal diseases, history of any disease deranging serum electrolyte levels and those on diuretics or any drugs which causes electrolyte imbalance were excluded from the study. Patients included in the study were subjected to demographic profile and serum electrolytes before and after treatment. Re-sults:100 patients were included in the study. Male patients were more in number (56) as compared to female pa-tients. Signs of dehydration were present in 70 patients. The patients suffering from hypokalemia, hyponatremia, hypocalcaemia and hypomagnesaemia were 23, 35, 78 and 84 respectively. Thus electrolyte imbalances are quite common in patients suffering from acute diarrhea. On comparing the serum Calcium, Magnesium and Sodium levels before and after treatment, statistically significant difference was seen. It was not significant for serum Potassium levels. Conclusion:Electrolyte imbalances are quite common in patients suffering from acute diarrhea. The serum electrolytes of patients suffering from acute diarrhea should be routinely examined to rule out electrolyte abnormali-ties and prompt treatment.

Qualidade físico-química e microbiológica da água consumida em Guaíba (RS) e sua implicação na saúde / Physicochemical and microbiological quality of water consumed in Guaíba (RS) and its implications for health

Essa pesquisa aborda a relação existente entre a qualidade da água, utilizada para ingestão, manipulação de alimentos e higiene pessoal, e suas implicações na saúde de uma população, no caso a de Guaíba (RS). Para tanto, ela vale-se do clássico conceito que estabelece o consumo de uma água segura e de boa qualidade como fundamental para o desenvolvimento e manutenção saudáveis de qualquer ser e base da saúde coletiva. Neste sentido, foi desenvolvido pelo Governo Federal, por meio do Ministério da Saúde, o Programa de Monitoramento da Qualidade da Água (VIGIAGUA), responsável por avaliar parâmetros microbiológicos, físicos e químicos da água. O objetivo foi analisar dados do programa VIGIAGUA e registros das doenças diarreicas agudas, no período de julho de 2016 a junho de 2017 no município de Guaíba/RS. Para desenvolvimento do trabalho foi realizada uma pesquisa quantitativa, do tipo descritiva exploratória, avaliando a qualidade da água para consumo humano no município de Guaíba, Rio Grande do Sul (RS), e os possíveis efeitos do consumo dessa água na saúde população. A amostra utilizada foi composta por todos laudos de análise da qualidade de água, disponíveis no Sistema de Informação do Programa de Monitoramento da Qualidade da Água (SIGIAGUA), realizadas pela Vigilância Ambiental em Saúde e dados epidemiológicos de diarréias, obtidas no banco do Sistema de Informação de Vigilância Epidemiológica ­ Doenças Diarréicas (SIVEP-DDA). Esta pesquisa envolveu 239 amostras de água, relacionados a 68 imóveis, no período de julho de 2016 a junho de 2017. Destas amostras, 42% (n=101) dizem respeito a águas Sistema de Abastecimento de Água (SAA), tratadas pela CORSAN e 58% (n=138), oriundas de fontes de Solução Alternativa (SA). Vinte por cento das amostras de SAA foram classificadas "IMPRÓPRIAS", enquanto que para o SA esse índice aumentou para 56%. Entre as amostras classificadas como "IMPRÓPRIAS" (SAA + SA), observa-se que a presença de Escherichia coli representa 75,2% dos parâmetros que tornam a água inadequada ao consumo humano, o fluoreto 27,8%, os coliformes totais 20,60% e a turbidez 14,4%. Não houve diferença significativa na comparação de DDAs com a frequência de amostras classificadas como "IMPRÓPRIAS". No entanto, o comportamento evolução mensal desses mesmos 5 dados, sugerem que possa existir uma relação entre a qualidade da água consumida e o quantitativo das diarreias no município de Guaíba. São necessárias pesquisas mais aprofundadas que trabalhem com um número maior de coletas, avaliando os locais oriundos de DDAs e amostra de água para análise, no mesmo intervalo de tempo.

This research addresses the relationship between water quality, used for ingestion, food handling and personal hygiene, and its implications on the health of a population, in the case of Guaíba (RS). To do so, it draws on the classic concept that establishes the consumption of safe and good quality water as fundamental for the healthy development and maintenance of any being and basis of collective health. In this sense, the Federal Government, through the Ministry of Health, developed the Water Quality Monitoring Program (VIGIAGUA), which is responsible for evaluating microbiological, physical and chemical parameters of water. The objective was to analyze data from the VIGIAGUA program and records of acute diarrheal diseases, from July 2016 to June 2017 in the city of Guaíba / RS. Methodology: a quantitative research, exploratory descriptive, evaluating the quality of water for human consumption in the city of Guaíba, Rio Grande do Sul (RS), was carried out, and the possible effects of the consumption of this water in the health population. The sample used was composed of all reports of water quality analysis, available in the Information System of the Water Quality Monitoring Program (SIGIAGUA), carried out by the Environmental Health Surveillance and epidemiological data of diarrheas, obtained in the system bank. Epidemiological Surveillance Information - Diarrheal Diseases (SIVEP-DDA). Results: The present study involved 239 water samples, related to 68 buildings, from July 2016 to June 2017. Of these samples, 42% (n = 101) refer to Water Water Supply System (SAA) treated by CORSAN and 58% (n = 138), from sources of Alternative Solution (SA). Twenty percent of the SAA samples were classified as "IMPROPER", while for the SA this index increased to 56%. Among the samples classified as "IMPRÓPRIAS" (SAA + SA), it is observed that the presence of Escherichia coli represents 75.2% of the parameters that make water unsuitable for human consumption, fluoride 27.8%, total coliforms 20 , 60% and turbidity 14.4%. There was no statistically significant difference in the comparison of DDAs with the frequency of samples classified as "IMPROPER". However, the monthly behavior of these same data, suggest that there may be a relationship between the quality of water consumed and the quantity of diarrhea in the 7 municipality of Guaíba. Further research is needed to work with a larger number of collections, assessing sites from DDAs and sample water for analysis, in the same time interval.

Diarrea aguda infecciosa: ¿qué debe saber un gastroenterólogo?, ¿cómo mejoramos el diagnóstico etiológico? / Acute infectious diarrhea: what should a gastroenterologist know? how do we improve the etiological diagnosis?

Acute infectious diarrhea is still a major public health problem, both in developing and developed countries, causing morbidity, mortality and high costs. Acute diarrhea particularly affects people in extrema age ranges, travelers and immunosuppressed individuals. Traditional microbiological study, based on cultures, direct microscope analysis, and antigen tests show poor performance, due to low sensitivity and specificity, slowness and the diversity of bacteria, viruses and parasites that complicate getting the results. New molecular techniques based on multiple polymerase chain reaction (PCR) kits allow for the identification, in few hours and simultaneously, of many agents, such as bacteria, viruses and parasites, with high sensitivity and specificity; which will probably transform etiological diagnosis of acute diarrhea

La diarrea aguda infecciosa continúa siendo un problema de salud pública tanto en países en vías de desarrollo como en países desarrollados, causando morbi-mortalidad y grandes gastos económicos. Las diarreas agudas son especialmente importantes en personas con edades extremas, viajeros e inmunodeprimidos. El estudio microbiológico tradicional basado en cultivos, análisis microscópico directo y pruebas de antígenos tiene un rendimiento pobre, dado por su baja sensibilidad y especificidad, lentitud y la gran diversidad de bacterias, virus y parásitos que dificultan la obtención de resultados. Las nuevas técnicas de diagnóstico molecular basadas en kits de reacción de polimerasa en cadena (PCR) múltiple permiten identificar en pocas horas y en forma simultánea una gran cantidad de agentes, tanto bacterias, virus, como parásitos, con alta sensibilidad y especificidad, lo que probablemente transformará el diagnóstico etiológico de las diarreas agudas.

Diarrea aguda, prolongada y persistente en niños y su diferencia de la diarrea crónica / Acute, prolonged and persistent diarrhea in children and its difference with chronic diarrhea

Sobre la base de 55 años de experiencia en el tratamiento de niños con diarrea aguda y la actualización de los conocimientos adquiridos en las últimas décadas en el Programa de Control de la Enfermedad Diarreica de la Organización Mundial de la Salud, se decidió revisar las definiciones de los diferentes tipos clínicos de esta entidad y su diferenciación con la diarrea crónica. Así, se aportan algunos aspectos importantes como los factores que prolongan la diarrea aguda común, el uso de antibióticos, la vacunación contra el rotavirus, el círculo vicioso diarrea-desnutrición, el uso de agentes probióticos y bioterapéuticos, el sobrecrecimiento bacteriano intestinal y la diarrea del viajero. Se concluyó que es necesario identificar precozmente la diarrea prolongada e indicar un tratamiento oportuno para evitar su progresión hacia diarrea persistente, así como el efecto negativo de esta sobre el crecimiento y desarrollo de los niños pequeños, que en ocasiones puede provocarles la muerte.

On the base of 55 years experience in the treatment of children with acute diarrhea and the updating of the knowledge acquired in the last decades in the Control Program for the Diarrheal disease of World Health Organization, it was decided to review the definitions of the different clinical types of this disorder and its differentiation with chronic diarrhea. Thus, some important aspects are offered such as the factors which prolong the common acute diarrhea, the use of antibiotics, vaccination against rotavirus, the vicious circle diarrhea-malnutrition, the use of probiotic and biotherapeutic agents, the intestinal bacterial overgrowth and the traveler's diarrhea. It was concluded that it is necessary to identify early the prolonged diarrhea and to indicate an opportune treatment to avoid its course toward persistent diarrhea, as well as its the negative effect on the growth of small children, which occasionally can cause them death

Aceptabilidad de un atole fortificado con 21 micronutrientes e impacto en la salud y nutrición de niños menores de 6 años de edad en la ciudad de guatemala / Acceptability of a 21 micronutrient-fortified atole and its impact on health and nutrition in children under 6 years of age from guatemala city

Con el objetivo de reducir la desnutrición crónica de niños que asisten 6 jardines infantiles en la Ciudad de Guatemala, se utilizó una bebida a base de soya y maíz como vehículo para el aporte de 21 micronutrientes con niveles elevados de hierro (12mg) y zinc (9mg) y se ofreció a 747 niños entre los 6 meses y 6 años. Se realizó seguimiento antropométrico cada 3m, Hb cada 6m y se registró el número de episodios de enfermedad diarreica aguda e infección respiratoria aguda a lo largo de la intervención. Un ANOVA longitudinal de medidas repetidas demostró que la media de la Hb mejoró de manera significativa a los 6 y 12m de recibir la bebida fortificada (11,26, 11,64, y 11,89g/dL, respectivamente), p<0,01; la prevalencia de anemia disminuyó 44,2% después de 12m, p<0,01; la media del puntaje z de talla para la edad también mejoró, -1,25 (0m) y -1,07 (12m), p<0.01; la prevalencia de retardo del crecimiento disminuyó 25% a los 12m. Se observó una disminución significativa en la prevalencia de infección respiratoria aguda y no se observaron cambios en la prevalencia de diarrea. Un estudio de aceptabilidad demostró que los niños consumen más del 98% del producto. Los resultados sugieren que la intervención con el atole fortificado mejora el estado nutricional y de salud de los niños. El producto es aceptado por los niños y el personal de los jardines infantiles(AU)

With the aim to reduce chronic undernutrition in children that attended 6 Guatemala City daycare centers, a corn and soy-based beverage was used as a vehicle to provide 21 micronutrients and high concentrations of iron (12mg) and zinc (9 mg) and was provided to747 children aged 6 to 72 months. Children were followed for anthropometry every 3m, hemoglobin every 6m, and episodes of acute diarrhea and respiratory tract infections were registered throughout the intervention. A longitudinal Repeated Measures ANOVA demonstrated that mean hemoglobin significantly improved at 6 and 12m of receiving the beverage (11.26, 11.64, and 11.89g/dL, respectively), p<0.01; the prevalence of anemia decreased by 44.2% after 12m, p<0.01; mean height-for-age z score improved from -1.25 (0m) to -1.07 (12m), p<0.01; the prevalence of stunting decreased by 25% after 12m. A significant decrease in the prevalence of acute respiratory infection was observed. No changes were observed in the prevalence of diarrhea. Moreover, an acceptability study showed that children consumed more than 98% of the atole. These results suggest that this nutrition intervention with the fortified atole improves the health and nutritional status of children. The product is widely accepted by the children and staff at the nurseries(AU)

Clinical efficacy and safety of Levofloxacin combined triple viable bacteria tablets of Lactobacillus in the treatment of acute diarrhea / 中国生化药物杂志

Objective To evaluate the efficacy and safety of Levofloxacin combined triple viable bacteria tablets of Lactobacillus in the treatment of acute diarrhea.Methods65 cases of acute diarrhea patients were randomly divided into control group with 32 cases and experiment group of 33 cases.Patients were given antiemetic, fever and nutritional supplements and other symptomatic treatment,the control group was treated with ofloxacin injection 10mL+5% glucose solution 250mL for an intravenous injection, 3 days as a course of treatment;The experiment group was treated on the basis of triple viable bacteria tablets of Lactobacillus 4 tablets, 3 times a day, 3 days for a course of treatment.Clinical curative effect, adverse reaction rate, serum TNF-α, IL-6, CD4+, CD8+ and CD8+ CD4+/ level were compared.ResultsThe total effective rate in the experimental group was significantly higher than that in control group(P<0.05), there was no significant difference in the incidence of adverse reactions between the two groups.The levels of IL-6 and TNF-α were decreased in 2 groups (P<0.05), the levels of CD4+ in the two groups were decreased (P<0.05), and the CD4+ level was lower in the experiment group (P<0.05);the CD4+/CD8+ level was increased (P<0.05), and the CD4+/CD8+ level was higher in the experiment group (P<0.05).ConclusionThe clinical efficacy of levofloxacin combined with triple viable bacteria tablets of Lactobacillus in the treatment of acute diarrhea is significant, and the safety is high.