Efficacy of rifaximin among non-constipated irritable bowel syndrome patients with or without small intestinal bacterial overgrowth: a randomized, double-blind, placebo-controlled trial

Background: IBS is a functional gastrointestinal disorder marked by abdominal pain and changes in stool frequency or form. Recent studies indicate a link between IBS, especially the diarrhea-predominant subtype, and small intestinal bacterial overgrowth. This study aimed to evaluate symptom resolution among IBS patients with or without SIBO on rifaximin treatment as compared with placebo. Methods: A double-blind, placebo-controlled, randomized clinical trial took place at the Department of Gastroenterology, Dhaka Medical College and Hospital, from January to December 2019. In the study 104 non-constipated IBS patients were assessed for SIBO using gut aspirate culture. Those with SIBO (?105 CFU/ml) and those without were randomly assigned (computer-generated) to receive either 1500 mg/day of rifaximin for 14 days or a placebo. Results: Among 104 non-constipated IBS patients, 39% had SIBO, with IBS-D patients more associated (83% vs. 60%). Rifaximin significantly improved symptoms in the SIBO group at 4 and 16 weeks (90% vs. 20%, p<0.001; 66% vs. 15%, p<0.001). In the non-SIBO group, significant improvement was observed at 4 weeks (38.7% vs. 18.8%, p<0.001) but not at 16 weeks (25.8% vs. 18.8%, p=0.501). Rifaximin significantly improved abdominal pain, stool form, and frequency in the SIBO group compared to placebo. However, there was no significant improvement in the non-SIBO group. Conclusions: Rifaximin is superior to placebo in relieving symptoms of non-constipated IBS patients with SIBO.

Hygiene behaviors and nutritional status of children living in orphanages in Bangladesh

Background: Malnutrition is considered a complicated public health issue and depends on multiple factors. Hygienic behavior is related to orphan children抯 growth, nutritional outcomes, and sound health. The study抯 aim was to assess the hygiene behaviors and nutritional status of orphan students in Bangladesh. Methods: A descriptive cross-sectional quantitative study was conducted in three orphanage centers. A total of 120 respondents were interviewed. A descriptive analysis of the collected data was performed. Results: The monthly mean and median expenditure of orphans was 2000�5 BDT (20$). The number of toilets and waiting time for the orphan to use them are closely associated (?2= 33.38; Cramer抯 V=0.44, df=13; Sig; p<0.001). On average, an orphan waits 32.20 minutes to use the toilet facility when they need it. Orphan family income and disposal of waste in the toilet of the orphan center are strongly associated (?2=99.19; Cramer抯 V=0.49, df=39; Sig; p<0.001). There was a significant association between attending toilet-related hygiene and types of diseases. Hair fall, muscle wasting, fever, and xerosis of the skin were common diseases among orphans. Types of diseases orphans and schedule for the dietary chart are strongly associated (?2=23.35; Cramer抯 V=0.37, df=24; Sig; p<0.001). Conclusions: Integrated approach is required to counter the extent of malnutrition among orphans. Teachers of orphanages should receive proper training so that they are able to take care of the physical and mental health of the orphan children.

Presence of neutral fat in stool and its association with aetiology and presenting features of diarrhoea in children.

Enteric infections, impaired digestion, loss of villous cells, and poor absorption of fat may lead to presence of neutral fat in stool, particularly in children with diarrhoea. We aimed to examine the association between presence of neutral fat in stool and aetiology of diarrhoea and nutritional status of the patients at different age groups. A total of 13,171 patients aged 5 days-106 years enrolled in the Diarrhoeal Disease Surveillance System of the Dhaka Hospital of ICDDR,B during 1996-2001 were studied. Presence of neutral fat in faecal specimens, aetiology of diarrhoea, and nutritional status in children below 5 years of age were determined and analysed. Of the total study individuals, 7,671 (58%) had neutral fat in their faecal specimens. Neutral fat was more frequently present in faeces of individuals infected with rotavirus in all age groups or in enterotoxigenic E. coli (ETEC) infection in children 0-23 months old while compared with those who did not have these infections (p=0.005, p=0.014, respectively). Neutral fat was less frequently (p<0.001) present in malnourished 0-23 months old children. Presence of neutral fat in the stool in diarrhoea due to rotavirus and in young childhood ETEC diarrhoea signifies compromised gastrointestinal function due to these infections. The mechanism of persistence of neutral fat in the stool of such patients, and its nutritional and clinical implications require further studies.

Topography and morphometry of the common bile duct and major duodenal papilla of man and principal domesticated animals.

A comparative topography and morphometry of the common bile duct and major duodenal papilla was studied on the extrahepatic biliary apparatus of human and major domesticated animals such as horse, ox, Black Bengal (BB) goat, sheep, dog and cat of local breed. In Black Bengal goat, sheep, dog and cat, the extrahepatic biliary system seemed to be the continuation of the cystic duct, which was found to continue as the common hepatic/common bile duct into which all the hepatic/lobar ducts open. In man, the mean length and the mean diameter of the common bile duct were 7.67+/-0.58 cm. and 7.27+/-0.77 mm. respectively. In the ox, these values were 1.57+/-0.72 cm. and 11.82+/-0.79 mm. respectively; in the Black Bengal goat, 7.23+/-0.74 cm. and 4.45+/-0.72 mm. respectively; in the sheep, 5.27+/-0.66 cm. and 3.75+/-0.79 mm. respectively; in the dog, 4.72+/-0.67 cm. and 6.43+/-0.55 mm. respectively and in the cat, 3.26+/-0.87 cm. and 5.63+/-0.43 mm. respectively. In man, the mean length and the mean diameter at the base of the MDP were 4.37+/-0.56 mm. and 3.97+/-0.72 mm. respectively. In horse, these were 52.36+/-0.67 mm. and 12.47+/-0.63 mm. respectively; in ox, 12.53+/-0.73 mm. and 8.83+/-0.68 mm. respectively; in Black Bengal goat, 14.36+/-0.55 mm. and 5.23+/-0.57 mm. respectively; in sheep, 11.27+/-0.69 mm. and 4.51+/-0.74 mm. respectively; in dog, 17.43+/-0.82 mm. and 6.72+/-0.64 mm. respectively and in cat, these values were 12.36+/-0.47 mm. and 7.12+/-0.87 mm. The distance of the Major Duodenal Papilla (MDP) form the pyloric end of the stomach was proportionately shorter in the meat-eaters, i.e., the omnivorous man (9.76+/-0.88 cm), and the carnivores, dog (6.37+/-0.73 cm) and cat (2.75+/-0.87 cm.) when compared to that of the herbivores, i.e., ox (55.37+/-0.68 cm.), BB goat (23.27+/-0.89 cm.) and sheep (25.62+/-0.77 cm.). In the horse, the major duodenal papilla was perpendicular to the duodenal mucosal surface with the largest mean length and the mean diameter. In all other animals, it was obliquely placed on the duodenal surface with its opening directed aborally.

Mucoepidermoid carcinoma of the lung--a case report.

Mucoepidermoid carcinoma is an uncommon primary lung tumor. Mucoepidermoid carcinomas have been reported in all age group and equally in both sexes. A case of mucoepidermoid carcinoma histologically confirmed by biopsy is reported here. The patient is a 15 years old male presented with cough and dyspnoea for 5 days. Chest roentgenography showed segmental consolidation of right lower lobe. Chest computed tomography revealed a soft tissue mass with calcification within the lumen of lower trachea in precarinal location. The patient underwent thoracotomy for endotracheal mass and resection was done. Following operation, the patient is symptom free and follow-up CT scan shows normal tracheal outline.