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Acute diarrhea is a condition of increased water stool content, stool volume, and number of bowel movements that lasts less than 14 days. Mild diarrhea is usually self-limiting; however, undertreated moderate to severe diarrhea may cause severe dehydration and lead to hypovolemic shock. In order to prevent severe dehydration and treat patients appropriately, it is crucial for health care providers to determine the right diagnosis of patients with acute diarrhea. This article focuses on pathophysiology, general patient presentation, diagnostic tests and differential diagnosis lists of acute diarrhea to discuss which diagnosis should be made based on patient presentation and objective data.

Heat Stroke is a kind of medical emergency that can cause severe dehydration and neurological changes as a result multi-organ injuries or failure could be possible. Heat strokes occur when the body temperature exceeds 40 0C due to external heat and humidity. The liver is widely affected by heatstroke that’s why taking care of patients suffering from heatstroke is very important. Various studies have been reported in the literature regarding acute liver failure but none of the studies discussed acute liver failure during the hospital stay. Patients during their hospital stay will have a higher risk of mortality due to heatstroke. In this paper, an analytical study has been done on admitted patients to a government hospital in India. These patients are suffered from heatstroke from April 2007 to September 2011 and a second time period from July 2018 to September 2019. The sample includes 60 patients with 58 (97%) males having a totaled number of 12 fatalities. The observed International Normalized ratio (INR) parameter is greater than 1.6 and no increased mortality has been noticed, aspartate aminotransferase (AST), as well as alanine aminotransferase (ALT) levels, were not associated with an increased mortality rate.

Gastroenteritis is one the most common diseases worldwide, and it’s more dangerous in children, although in most time it’s self-limited, it can be fatal in case of children, the most dangerous side of GE is diarrhea and the dehydration that follows it. Since dehydration is the most dangerous symptom of the Gastroenteritis Oral rehydration solutions and even intravenous solution intake (in case of severe dehydration) is the main treatment, followed by symptomatic treatment such anti-emetics or antidiarrheal drugs, although caution should be considered for drugs used in children. The need to make cost-effective diagnostic and treatment decisions, avoid unnecessary investigation and referral, provide long-term effective control of symptoms, and minimize the risk of complications constitute the main challenges that PCPs face. During the last few years, the role of primary care physicians in the diagnosis and management of gastroenteritis has been recognized as very important, and it has been suggested that they have all the available resources in order to ensure high standard of care for their patients. In particular, clearly articulated clinical practice guidelines, effective medications, accurate noninvasive investigations, and evidence-based primary care management plans are available to support PCPs who want to raise their threshold for referring patients with GI symptoms.

Background Patients affected by cystic fibrosis can present with metabolic alkalosis such as Bartter's syndrome. In this case report we want to underline this differential diagnosis and we aimed focusing on the suspect of cystic fibrosis, also in case of a negative newborn screening. Case summary In a hot August -with a mean environmental temperature of 36 °C- an 8-mo-old female patient presented with severe dehydration complicated by hypokalemic metabolic alkalosis, in absence of fever, diarrhea and vomiting. Differential diagnosis between cystic fibrosis and tubulopathies causing metabolic alkalosis (Bartter's Syndrome) was considered. We started intravenous rehydration with subsequent improvement of clinical conditions and serum electrolytes normalization. We diagnosed a mild form of cystic fibrosis (heterozygous mutations: G126D and F508del in the cystic fibrosis transmembrane conductance regulator gene). The trigger factor of this condition had been heat exposure. Conclusion When facing a patient with hypokalemic metabolic alkalosis, cystic fibrosis presenting with Pseudo-Bartter's syndrome should be considered in the differential diagnosis, even if the newborn screening was negative.

Cholera still affects about three million people a year and kills approximately 100,000. Cholera can be effectively managed in the majority of cases with oral rehydration solution alone. Up to one third of patients present with severe dehydration, which can be diagnosed clinically, and will require rapid intravenous rehydration with Ringers Lactate or other appropriate fluid before being managed with oral rehydration solution. Antibiotics reduce the duration of illness and should be used in patients with severe dehydration. Resistance is common and local sensitivities should guide the choice of antibiotic. All children between six months and five years should receive zinc supplements. Effective case management with strict attention to detail including infection control and the use of protocolized approaches can reduce the mortality to around 1% even in resource poor settings.

This case was recorded at the Faculty of Veterinary Medicine, University of Wijaya Kusuma Surabaya. Oreo cats were found with a state of weakness, severe dehydration, and a lump in the lower abdomen. The results of the physical examination of Oreo cats were diagnosed as having a mammary carcinoma, with a differential diagnosis of inguinal hernia, and mastitis. To confirm the diagnosis, blood tests and X-ray supporting examinations are carried out. From the results of the examination, the results of the blood check showed normal results, but on the X-Ray examination, there was an intermediate opacity on the part of the bulge and no ring was found that led to the hernia diagnosis. The consistency of the bulge at the time of the xray was slightly changed when compared to when the cat was found, where the consistency of the bulge became slightly flaccid accompanied by a yellowish-white discharge from the oreo cat's nipples. Based on the x-ray results that show the presence of intermediate colored opacity and the discharge of cloudy yellow milk, it can be concluded that the Oreo cat has chronic mastitis. Surgery and removal of the mammary glands (mastectomy) are still the best treatment options. In a mastectomy, the incision is performed in an ellipse, prepared from the surrounding tissue, then the nipple is removed.).

Ultra-marathons are typically held over harsh terrains such as mountains, deserts, or other wilderness, and place severe demands on the physical and psychological capabilities of participants. Adventure-race competitors commonly report hallucinations. The goal of this study was to gain insight into visual hallucinations (VHs) during a mountain ultra-marathon. Thirty-one Taiwanese runners who participated in the 2018 Run Across Taiwan Ultra-Marathon, which spans 246 km with an altitude difference of 3266 m and an overall cut-off time of 44 h, volunteered for this study. Self-reported questionnaires on sleep duration, hallucinatory experiences, clinical symptoms of cold- and heat-related illnesses, and the 2018 Lake Louise Acute Mountain Sickness (AMS) Score were recorded prerace, during the summit, immediately postrace, and 3-days postrace. Hematological samples were collected 1 week before, immediately after, and 3 days after the race. Eight ultra-marathoners (six males and two females; seven finishers and one withdrawer) were recruited. Three out of eight (37.5%) subjects (two males and one female) reported experiencing VHs during the last 60 km. Three out of five (60%) lower-ranked subjects experienced VHs. All eight runners slept for

Background: Children hospitalised with severe acute malnutrition (SAM) are frequently complicated (>50%) by diarrhoea (≥3 watery stools/day) which is accompanied by poor outcomes. Rehydration guidelines for SAM are exceptionally conservative and controversial, based upon expert opinion. The guidelines only permit use of intravenous fluids for cases with advanced shock and exclusive use of low sodium intravenous and oral rehydration solutions (ORS) for fear of fluid and/or sodium overload. Children managed in accordance to these guidelines have a very high mortality. The proposed GASTROSAM trial is the first step in reappraising current recommendations. We hypothesize that liberal rehydration strategies for both intravenous and oral rehydration in SAM children with diarrhoea may reduce adverse outcomes. Methods An open Phase II trial, with a partial factorial design, enrolling Ugandan and Kenyan children aged 6 months to 12 years with SAM hospitalised with gastroenteritis (>3 loose stools/day) and signs of moderate and severe dehydration. In Stratum A (severe dehydration) children will be randomised (1:1:2) to WHO plan C (100mls/kg Ringers Lactate (RL) with intravenous rehydration given over 3-6 hours according to age including boluses for shock), slow rehydration (100 mls/kg RL over 8 hours (no boluses)) or WHO SAM rehydration regime (ORS only (boluses for shock (standard of care)). Stratum B incorporates all children with moderate dehydration and severe dehydration post-intravenous rehydration and compares (1:1 ratio) standard WHO ORS given for non-SAM (experimental) versus WHO SAM-recommended low-sodium ReSoMal. The primary outcome for intravenous rehydration is urine output (mls/kg/hour at 8 hours post-randomisation), and for oral rehydration a change in sodium levels at 24 hours post-randomisation. This trial will also generate feasibility, safety and preliminary data on survival to 28 days. Discussion. If current rehydration strategies for non-malnourished children are safe in SAM this could prompt future evaluation in Phase III trials.

Background: Diarrhea causes, annually, approximately 1.7 billion cases and 760,000 deaths worldwide among children under 5 years of age, although these are preventable and treatable. This study aim to assess the cost-effectiveness for the treatment of diarrhea in emergency services in the management of children of acute gastroenteritis with non-severe dehydration. Methods: A stochastic decision tree model considering the perspective of the Brazilian public health system was used to calculate the cost-effectiveness of the 5 interventions: oral rehydration therapy (ORT) at home, and if it fails supervised ORT; they would receive; ORT at home, and if it fails intravenous rehydration therapy (IVT). ORT at home and if it fails, the half of them will receive supervised ORT, and the other half would receive IVT; Patient receives supervised oral treatment; Patient receives IVT. Quality-adjusted life year (QALY) was used to measure the clinical outcomes. Results: The strategy of initiating oral rehydration in children younger than 5 is the most efficient practice with a cost of $14.28 and effectiveness of 0.89 QALYs. Conclusion: ORT is an underutilized resource for the management of children with non-severe dehydration in emergency services. The overprescribed IVT increases cost without a corresponding significant increase in effectiveness. Keywords: Cost-benefit analysis, Gastroenteritis, Fluid therapy, Infusions, Intravenous

RESUMEN Objetivos Analizar la relación que existe entre la contaminación de agua por ooquistes de Cryptosporidium spp. y los efectos en la salud de las poblaciones humanas y animales en Colombia. Métodos Es un ensayo de tipo analítico que se centró en la aplicación documentada y analizada, de la metodología de las "Fuerzas Motrices" y el modelo OMS de Determinantes Sociales de la Salud tomando como ejemplo la Criptosporidiosis. Resultados Las "fuerzas motrices" involucradas en la relación entre contaminación de agua por Cryptosporidium spp. y la salud de humanos y animales fueron el aumento en la demanda de productos pecuarios y la producción pecuaria de baja calidad; la "presión" consistió en la mala implementación de prácticas de producción, la invasión de zonas protegidas y de reservas ecológicas, y la disminución de fronteras entre lo rural y lo urbano; el "estado" se basó en la contaminación del suelo y las fuentes de agua, y en la deficiencia en el manejo de las excretas; la "exposición" radicó en la entrada de ooquistes vía fecal-oral, por la contaminación del suelo y el agua, y el "efecto" consistió en una diarrea autolimitante, una deshidratación severa, el síndrome de mala absorción y la muerte. Conclusiones Los ecosistemas pueden mantener poblaciones saludables, pero cuando son mal administrados o rápidamente alterados debido a la presión humana, también pueden estar asociados con la aparición de enfermedades, como la Criptosporidiosis. ABSTRACT Objectives To analyze the relationship between water contaminated with Cryptosporidium spp. oocysts and its effects on the health of human and animal populations in Colombia. Materials and Methods Analytical essay focused on the documented and analytical application of the Driving Forces Methodology and the WHO model of Social Determinants of Health using cryptosporidiosis as an example. Results The driving forces involved in the relationship between water contaminated with Cryptosporidium spp. oocysts and human and animal health were increased demand for livestock products and low-quality livestock production. Regarding pressure, it was related to the poor implementation of production practices, the invasion of protected areas and ecological reserves, and the reduction of rural-urban borders. On the other hand, status was associated with contamination of soil and water sources, as well as the deficient management of excreta. Finally, exposure was determined by the entry of oocysts via the fecal-oral route through contaminated soil and water, and effect consisted of self-limiting diarrhea, severe dehydration, malabsorption syndrome, and death. Conclusions Ecosystems can maintain healthy populations, but when they are mismanaged or rapidly altered by human pressure, they can also be associated with the emergence of diseases such as Cryptosporidiosis.

WHO recommended severe dehydration without shock in acute diarrhea to be rehydrated by nasogastric drips (NGD) of oral rehydration solution (oralit). In this respect the criteria of a still palpable and countable pulse, the absence of meteorism and absence of complication, the reverse warranting iv fluid therapy, can be used as practical guidelines to identify the patient "without shock". A clinical trial comparing the result of NGD oralit rehydration therapy to that of intravenous Ringer-lactate on small children with diarrhea and severe dehydration was conducted. Seventy jive patients admitted to the Department of Child Health Palembang General Hospital from January up to July 1986, aged 1 to 59 months, suffering from acute diarrhea with severe dehydration fulfilled to above mentioned criteria. Randomly 36 were assigned to NGD rehydration therapy using WHO standard ORS (in Indonesia is named as oralit) and 39 were rehydrated with iv Ringer lactate solution, given in four hours consisting of 40ml/kg BW, 30ml/kg BW, 20 ml/kg BW and 20ml/kg BW in the first, second, third and fourth hours respectively. Based on the failure rate of rehydration in the first four hours, the recurrence of dehydration after rehydration and the side effects of fluid therapy, it was concluded that acute diarrhea cases with severe dehydration who fulfilled the above mentioned criteria can be rehydrated by NGD oralit as effective and safe as by iv Ringer lactate.

A prospective, multicentre study was conducted in four sentinel surveillance hospitals to assess the trend and epidemiology of acute diarrhea caused by Rotavirus in Vietnam. During the period 2012–2015, a total 8,889 children under 5 years of age were enrolled in the surveillance, and 8689 stool samples were collected. Of these cases, Rotavirus was most common pathogen 46.7% (4054 cases); in which 26.6% (1117) rotavirus-positive stool samples were evaluated to identify genotypes. The proportion of rotavirus positive specimens decreased annually from 54.7% in 2012 to 36.6% in 2015. Rotavirus was detected year-round, but most rotavirus gastroenteritis cases (77.1%) occurred between December and May, corresponding to the rotavirus seasonality. It is found that the peaks varied by regions. Rotavirus positivities varied between the youngest and oldest age, but children 6–11 months old (38.8%) and 12–23 months old (38.4%) counted for most cases. A significant higher number of diarrhea within 24 hours (8.3 times, 95%CI: 8.1–8.4 times) and higher proportion of severe dehydration (12.9%) in Rotavirus positive group than that in Rotavirus negative group (7.7 times, 95%CI: 7.6–7.9 times; and 9.7%, respectively). A downtrend of prevalence of G1P[8] was observed from 82% in 2013 to 15% in 2015. However, G2P[4] was found in 5% of samples in 2012, 9% in 2013, 36% in 2014, and 28% in 2015. Rotavirus infection is the most important cause of acute diarrhea among hospitalized children in Vietnam, and a rotavirus vaccination program for children may significantly reduce this disease.

Introduction Diabetic ketoacidosis (DKA) is a life-threatening illness which classically presents with polyuria, polydipsia, and polyphagia that can rapidly progress to severe dehydration and altered mental status from cerebral edema. Younger patients may present with subtle or atypical symptoms that are critical to recognize and emergently act upon. Such patients are often cared for by teams in the emergency department (ED) requiring multidisciplinary collaboration. Methods This simulation case was designed for pediatric emergency medicine fellows and residents. The case was a 14-month-old male who presented to the ED with respiratory distress and dehydration. The team was required to perform an assessment, manage airway, breathing and circulation, and recognize and initiate treatment for DKA including judicious fluid administration and an insulin infusion. The patient developed altered mental status with signs of cerebral edema requiring the initiation of cerebral protection strategies. We created a debriefing guide and a participant evaluation form. Results Forty-two participants completed this simulation across seven institutions including attendings, residents, fellows, and nurses. The scenario was rated by participants on a 5-point Likert scale and was generally well received (M = 5.0). Participants rated the simulation case as effective in teaching how to recognize (M = 4.8) and manage (M = 4.5) DKA with cerebral edema in a pediatric patient. Discussion This simulation represents a resource for learners in the pediatric ED in the recognition and management of a toddler with DKA and can be adapted to learners at all levels and tailored to various learning environments.

Background: Rotavirus is the most common cause of acute gastroenteritis in children below five years. Objectives: The aim of this study to evaluate the prevalence of rotavirus among children with diarrhea, the efficacy of Rotavirus Rapid Test Device (RTD)and ELISA and evaluate the relationship between the demographic agent and clinical presentation associated with rotavirus. Material and Methods: A cross-sectional study was conducted at AL-Batool Teaching Hospital in Baqubah, from the first of April 2019 to 31 of March 2020, on (300) children with diarrhea below five years of age. The patients included (n=161, 53.6%) males and (n=139, 46.3%) females. The patient’s age, gender, living area, season, mode of feeding, source of water supply and sterilization, were collected through a questionnaire prepared for this study. The Rapid Test and ELISA are used for the detection of rotavirus in fecal specimens. Results: The rotavirus antigen was detected in (47.33%) stool specimens by the ELISA test and (59%) by Rotavirus Rapid Test Device (RTD) from (300) children with diarrhea and high infection in the age group between 13-24 months at the rate (49.40%). The highest infection rate in spring was (56.00%) and lower in summer (33.33%). The infection males more than females (42.24% vs. 39.57%). High significant infection among children living in rural areas (55.68%) compared to those living in urban areas (35.48%). According to the clinical features, the results showed the rate of rotavirus infection in children with fever was (54.90%), vomiting (42.03%), those suffering from severe dehydration (48.85) some dehydration 78 (46.15%), however, rotavirus infection was significant with fever only.

To report rotavirus-associated AGE (AGE) profile of admitted children among vaccine-introduced areas in Bhubaneswar, Odisha. This study was conducted between 2016 and 2019 at the Capital Hospital, Jagannath hospital and Hi-Tech Medical College and Hospital. All AGE patients below five years old, hospitalized in the study facilities were enrolled. A stool sample was collected and transported to the central laboratory (Christian Medical College, Vellore) for rotavirus antigen detection and genotyping. Clinical and demographic information was collected using a predesigned case report format (CRF). Out of the 1213 stool samples, 447 (36.9%) were identified to have rotavirus with 350 (78.3%) of them belonging to 6 mo to 2 y age group. Rotavirus gastroenteritis exhibited a single peak from November to February. A total of 414 (92.6%) of rotavirus gastroenteritis children had severe or very severe dehydration with odds of rotavirus diarrhea leading to severe dehydration being 1.5 (95% CI, 1–2.4) compared to moderate dehydration. The common genotype combination was G3P[8] (46%) followed by G1P[8] (19%), G2P[4] (5%), and G9P[4] (3%). Rotavirus gastroenteritis peaked between December to February while the most common genotype combination among the rotavirus GE was G3P[8] and G1P[8]. The present study provides the clinical profile of admitted children in the hospitals with diarrhea and the circulating strains of rotavirus which will help in documenting the epidemiology and the performance of vaccine against the disease in the state.

Athletes use different combinations of weight loss methods during competition preparation. The aim of this study was to identify and characterize pre-competition weight loss models, which describe these combinations. The second aim was to determine if any existing model pose a higher risk of severe dehydration and whether any of the models could be continued as a lower-risk option. The third aim was to explore whether athletes who used different weight management strategies could be differentiated based on age, sex, training experience or anthropometric parameters. Study participants were randomly selected from Olympic taekwondo competitors and 192 athletes were enrolled. Active (47% weight-reducing athletes), passive (31%) and extreme (22%) models have been described. In the extreme model, athletes combined the highest number of different weight loss methods (3.9 &plusmn, 0.9 methods vs. 2.4 &plusmn, 0.9 in active and 1.5 &plusmn, 0.6 in passive), reduced significantly more body mass than others (6.7 &plusmn, 3.5% body mass vs. 4.3 &plusmn, 1.9% and 4.5 &plusmn, 2.4%, p &lt, 0.01) and all of them used methods with the highest risk of severe dehydration. The active and passive models could be continued as a lower-risk option, if athletes do not combine dehydrating methods and do not prolong the low energy availability phase. The extreme model carried the highest risk of severe dehydration. Every fifth weight-reducing taekwondo athlete may have been exposed to the adverse effects of acute weight loss. Taekwondo athletes, regardless of age, sex, training experience and anthropometric parameters, lose weight before the competition and those characteristics do not differentiate them between models.

Introduction: After the worldwide pandemic of coronavirus 19 disease (COVID-19), pediatric involvement has been seen as case reports with various initial symptoms. Case Presentation: Here, we report a 2-months old boy with severe dehydration, fever, and electrolyte imbalance with lung involvement compatible with COVID-19 in the Northeast of Iran (North Khorasan). Conclusions: Pediatric case reports in COVID-19 are limited, and it seems that the disease has a milder course compared to the adult patients, but the range of the clinical features is wide.

Background: Cholera remains a major global health problem, causing high output diarrhea leading to severe dehydration and shock in developing countries. We aimed to determine whether vasoactive intestinal polypeptide (VIP), the mediator of pancreatic cholera syndrome, has a role in the pathophysiology of human cholera. Methods: We conducted a prospective observational study of cholera cases hospitalized with severe dehydration. Plasma and stool water levels of VIP were measured just after admission, after complete rehydration (3–4 h), at 24 h post-rehydration and at discharge after diarrhea ceased. Results: In total, 23 cholera patients were examined between January and August 2018. The geometric mean of stool VIP (sVIP) and plasma VIP (pVIP) on admission were 207.67 and 8.34 pmol/L, respectively. pVIP values were all within the normal range (p = 0.026), total stool volume (p = 0.023) as well as stool output in the first 24 h (p = 0.013). Conclusions: The data suggest that VIP, which is released by intestinal nerves, may play an important role in human choleragenesis, and inhibitors of intestinal VIP merit testing for potential therapeutic benefits.

COVID-19 pandemic has killed over 310,000 individuals as of 17 May 2020. Healthcare providers are profoundly vulnerable to be contaminated instead of taking every single careful step. Although the respiratory tract and the lungs are the target organs some complications may develop even at the introductory phase of this sickness course. Hemoconcentration with raised serum ferritin levels is one of the dangerous conditions that may occur from chronic hypoxia and severe dehydration because of increased insensible loss due to continuous excessive perspirations. Recent posthumous pulmonary tissue studies revealed that the viral infective mechanism, as well as the miniaturized erythrocyte aggregates, are additionally a significant contributing phenomenon to create acute respiratory distress syndrome (ARDS). Hematological issues require to deal proactively alongside other vital organ protection protocols for better outcomes. This article will depict the disease sequence of an intensivist working in a corona unit after being infected by COVID-19.

Introduction: Mixed martial arts (MMA) athletes typically undergo energy restriction and severe dehydration to compete in a specific weight category: a process known as making weight. This can pose a health risk to athletes and has led to fatalities. Some risks can be mitigated with structured sports nutrition. Methods: This case study provides an overview of a 10-week sports nutrition intervention devised to support an elite male MMA athlete for a world lightweight title bout. Results: Over a 9-week period, body mass was reduced from 81.6 kg (baseline) to 75.4 kg (1-week pre-competition): total loss 6.2 kg (8.2%) equivalent to 0.68 kg.wk-1. In the final 5 days, body mass was reduced by a further 5.2 kg (7.4%), before regaining 5.8 kg (8.3%) and entering competition at 76 kg. There was no incidence of injury or illness throughout the training camp and the athlete reported positive feedback regarding health, wellbeing, and physical performance. Conclusions: The intervention demonstrates a pragmatic approach tomaking weight by allowing moderate rapid weight loss(RWL)and rapid weight gainunder controlled conditions. In the absence of rule changes to prevent RWL, coaches and athletes can utilise sports nutrition strategies to minimise the risks associated with a traditional approach to making weight.

Diarrhoea contributes significantly to the under-five childhood morbidity and mortality worldwide. This cross-sectional study was carried out in a tertiary care hospital in Ujjain, India from July 2015 to June 2016. Consecutive children aged 1 month to 12 years having &ldquo, some dehydration&rdquo, and &ldquo, dehydration&rdquo, according to World Health Organization classification were eligible to be included in the study. Other signs and symptoms used to assess severe dehydration were capillary refill time, urine output, and abnormal respiratory pattern. A questionnaire was administered to identify risk factors for severe dehydration, which was the primary outcome. Multivariate logistic regression modeling was used to detect independent risk factors for severe dehydration. The study included 332 children, with mean &plusmn, standard deviation age of 25.62 &plusmn, 31.85 months, out of which, 70% (95% confidence interval [CI] 65 to 75) were diagnosed to have severe dehydration. The independent risk factors for severe dehydration were: child not exclusive breastfed in the first six months of life (AOR 5.67, 95%CI 2.51 to 12.78, p &lt, 0.001), history of not receiving oral rehydration solution before hospitalization (AOR 1.34, 95%CI 1.01 to 1.78, p = 0.038), history of not receiving oral zinc before hospitalization (AOR 2.66, 95%CI 1.68 to 4.21, 0.001) and living in overcrowded conditions (AOR 5.52, 95%CI 2.19 to 13.93, 0.001). The study identified many risk factors associated with severe childhood dehydration, many of them are modifiable though known and effective public health interventions.

Background There are many cases that present to the emergency room as brought in dead (BID) and in such cases, previous medical history of the deceased is unknown. Many of the medical problems are either preventable or treatable if managed on time. This study is aimed to determine the age, gender and causes of BID. Results This is a 6 year retrospective autopsy study of all BID patients in Lagos State University Teaching Hospital, Ikeja between 1st January 2010 and 31st December 2015. The data were retrieved from the autopsy reports and were analysed using Statistical Package for Social Sciences version 18. Test for statistical significance was set as p

Background Acute diarrhoea (AD) remains a leading cause of childhood death. We evaluated whether delayed healthcare seeking was associated with severe dehydration in rural South Africa. Methods In a prospective cohort study of children with AD admitted to a secondary-level hospital, data were collected through structured caregiver interviews and hospital record review. The primary outcome was severe dehydration/death, and the primary determinant was delay >12 h between AD symptom onset and healthcare facility presentation. Results Total 68% (71 of 104) of children experienced a delay, and 51% (54 of 104) had severe dehydration with no in-hospital deaths. There was no difference in children with (35 of 71) or without (19 of 33) delay for severe dehydration. Mothers of children with severe dehydration tended to be younger [median (interquartile range) 24 (21-28) vs. 27 (23-30) years, p = 0.07] and used less oral rehydration solution (63 vs. 80%, p = 0.08). Conclusion Delay of >12 h in seeking healthcare for AD was not associated with severe dehydration.

Travellers' diarrhoea is a common illness, particularly among travellers visiting low-income countries, and is generally self-limiting and uncomplicated. However, it has a disproportionate impact on well-being, occurring as it does during holidays or business trips, and can result in severe dehydration. Most causes of acute travellers' diarrhoea are bacterial or viral, and the pathogen is often not identified, either because the illness resolves too quickly, or because medical attention is sought only after a delay. Parasites are a more important cause of chronic diarrhoea after travel; however, the most common reason for continuing symptoms is post-infectious irritable bowel syndrome. Here we review the epidemiology and causative organisms, and provide a rationale for the investigation and treatment of both acute and chronic travel-associated diarrhoea.

Background Inadequate hydration in the elderly is associated with increased morbidity and mortality. However, few studies have addressed the knowledge of elderly individuals regarding hydration in health and disease. Gaps in health literacy have been identified as a critical component in health maintenance, and promoting health literacy should improve outcomes related to hydration associated illnesses in the elderly. Methods We administered an anonymous survey to community-dwelling elderly (n = 170) to gauge their hydration knowledge. Results About 56% of respondents reported consuming >6 glasses of fluid/day, whereas 9% reported drinking ≤3 glasses. About 60% of respondents overestimated the amount of fluid loss at which moderately severe dehydration symptoms occur, and 60% did not know fever can cause dehydration. Roughly 1/3 were not aware that fluid overload occurs in heart failure (35%) or kidney failure (32%). A majority of respondents were not aware that improper hydration or changes in hydration status can result in confusion, seizures, or death. Conclusions Overall, our study demonstrated that there were significant deficiencies in hydration health literacy among elderly. Appropriate education and attention to hydration may improve quality of life, reduce hospitalizations and the economic burden related to hydration-associated morbidity and mortality.

Introduction: Diarrhea is a common illness among travelers to developing countries. Located in a tropical region, Bali has a potentially high prevalence of travelers diarrhea. This hospital-based cross-sectional study was carried out to assess the clinical and microbiological profiles of diarrhea among travelers admitted to Kasih Ibu hospital, Denpasar-Bali. Methods: This study enrolled a total of 71 patients at Kasih Ibu hospital between April 2015 and August 2016. All patients completed an epidemiologic questionnaire; their clinical histories were taken, and physical examinations were performed. Stool samples were collected for bacterial and parasitologic studies and susceptibility testing. Results: Most patients were female (70.4%), and the nationality of most patients was Dutch (15.5%). Secretory diarrhea was the most frequently found diarrheal type (88.7%), with only 5.6% of cases having severe dehydration which developed into acute kidney injury. A high percentage of Entamoeba spp. was also seen in this study (54.9%). Of the 37 stool samples available for microbiological testing, 62.2% showed growth; Escherichia coli was the most commonly isolated bacteria (54.1%). Patients not infected by Entamoeba spp. were found more likely to experience nausea and vomiting (P Conclusion: Secretory diarrhea was the most prevalent type of diarrhea among travelers admitted to Kasih Ibu hospital, Bali. The most frequently found pathogens were Entamoeba spp. and E. coli. Although most patients had only mild dehydration as a complication, acute kidney injury did occur in some cases.

ObjectiveTo establish the relationship between serum point-of-care (POC) ketones at triage and moderate-to-severe dehydration based on the validated Gorelick Scales.Design, setting and patientsProspective unblinded study from April 2016 to February 2017 in a paediatric emergency department. Patients aged 1 month to 5 years, with vomiting and/or diarrhoea and/or decreased intake with signs of moderate or severe dehydration or clinical concern for hypoglycaemia were eligible.Main outcome measuresThe primary outcome was to describe the relationship between triage POC ketones to the two Gorelick Scales. Secondary outcomes were to examine the response of ketone levels to fluid/glucose administration and patient disposition.ResultsOne-hundred and ninety-eight patients were included; median age 1.8 years. The median triage ketones were 4.6 (IQR 2.8–5.6) mmol/L. A weak correlation was identified between triage ketones and the 10-point Gorelick Scale (Spearman’s ρ=0.217, p=0.002), however no correlation between triage ketones and the 4-point Gorelick Scale was identified. Those admitted had median triage ketones of 5.2 (IQR 4–6) mmol/L and repeat ketones of 4.6 (IQR 3.3–5.7) mmol/L compared with 4.2 (IQR 2.4–5.3) mmol/L and 2.9 (IQR 1.6–4.2) mmol/L in those discharged home.ConclusionNo correlation between triage POC ketones and the 4-point Gorelick Scale was established. POC ketones at triage have poor accuracy for predicting hospital admission. The elevated profile of POC ketones in non-diabetic children with acute illness suggests a potential target of tailored treatments for further research.

Background Gastroenteritis(GE) is common in children. Aim of the audit 1.To identify if rehydration treatment given was appropriate for the degree of dehydration? 2.To look how many children with gastroenteritis received saline boluses in emergency department or in ward when it was not indicated clinically. 3.To find out if we are using modes of rehydration other an intravenous in children with mild to moderate dehydration. 4.Whether ORS solution was used by parents before coming to hospital? Methodology All children Results 1.Total 24 patients were collected from ED 20(83%) and Gabriels ward4(17%). 2. Out of them 11 (45.8%)were female and 13(54.2%)were male patients 3. Age ranges from 5 weeks to 11 years.13(54%)patients were below 2 years of age. 4. All 24(100%) patients had vomiting and 17(70.3%)patients had diarrhoea and vomiting at presentation.8(33.3%) patients had temperature also. 5. 4(16.6%) patients had been given ORS before coming to hospital. 6. 18(75%) patients had no dehydration and 6(25%) with clinical dehydration.No patients presented in shock. 7. Regarding mode of rehydration 20(83.3%) patients were given trial of oral rehydration and 4 (16.7%) were given IV rehydration after failed oral challenge 8. IV bolus of Normal saline were given to 2(8.3%) patients. 9. Ondenstron was given to 18(75%) patients. 4(16.7%) patients failed oral challenge. 10. Nasogastric rehydration was not given to any of the patients. Conclusions The use of ORS before coming to hospital was negligible. If used appropriately at home can reduce the hospital attendances. The NG mode of rehydration was not tried in any of our patients. By adapting NG mode of Rehydration we can avoid IV rehydration. The saline boluses were not indicated in patients who received them as they were not in severe dehydration or shock. Recommendations and action plan 1. Education of GPS and parents about the importance of use of ORS once started with the symptoms of GE to avoid hospital admissions. 2. Awareness among NCHDs and paediatric nurses to use alternate routes of rehydration other than IV. 3. Patients presenting to ED department with no signs of dehydration should be encouraged for use of ORS at home. 4. Current practice of giving saline bolus in pateints who are not shocked should be discouraged.

Introduction: Pneumonia and diarrhoea are amongst the most common causes for hospital admission for children in low- and middle-income countries such as Bangladesh. Undernourished children often have more severe infections and a higher morbidity and mortality. Objective: The objective of this study was to determine the clinical features and outcomes of pneumonia in severely malnourished children with and without diarrhoea. Methodology: A retrospective chart analysis was carried out on children under 5 years of age who were admitted in intensive care unit of the Dhaka hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). A total of 245 severe acute malnourished children with pneumonia and diarrhoea (PD group) were compared with 89 children with pneumonia only (PO group). Results: A significantly higher number of children from the PD group had some/severe dehydration (16.3% vs. 1.1%; p < 0.005) when compared with children from the PO group. The PD group showed less cough (83.3% vs. 100%; p < 0.001), lower chest wall indrawing (40.4% vs. 60.7%; p = 0.001), and crackles (62.4% vs. 87.6%; p < 0.001) compared to the PO group at the time of admission. Conclusion: Early diagnosis and treatment of some/severe dehydration in addition to WHO recommended other routine treatment of diarrhoea, pneumonia and severe acute malnutrition in children may help to reduce childhood morbidity and mortality especially in low- and middle-income countries.

Management of acute gastroenteritis (AGE) includes treatment of underlying infections as well, since AGE may be an atypical presentation of urinary tract infection (UTI). The present study was planned to study the prevalence of UTI in children presenting with AGE. Two hundred consecutive patients presenting with AGE at 2 months to 4 years of age to one center's emergency department over 1 year were evaluated for UTI. Of 200 patients, 103 were male and 97 were female. One patient had infectious diarrhea. One hundred and forty-one (70.5%) patients were febrile, 63 (31.5%) patients had mild dehydration, 107 (53.5%) patients had moderate dehydration and 30 (15%) patients had severe dehydration. Twenty-five (12.5%) patients had pyuria. Fifteen (7.5%) patients had positive urine cultures. One of these (6.7%) patients had a history of UTI in the mother and 5 (33.3%) patients reported a history of UTI in their siblings. Of 15 patients with UTI, 13 (86.6%) were girls; 5 (38.4%) had labial adhesions. Escherichia coli and Klebsiella were isolated in 4 and one cases in urine culture, respectively. UTI underlies 7.5% of children presenting with AGE.

SUMMARYSapoviruses (SaVs) are responsible for sporadic cases and outbreaks of acute gastroenteritis. Despite this, few studies in India have focused on the epidemiological investigation of SaV in cases of acute gastroenteritis. The aim of this study was to understand the molecular epidemiology, genetic diversity and clinical impact of SaV in diarrhoeic children from Pune, Western India. Between 2007 and 2011, a total of 985 faecal samples from diarrhoeic cases and non-diarrhoeic controls were collected and examined for the presence of SaV by nested RT–PCR. SaV was detected in 2·7% (21/778) of the cases and 1·9% (4/207) of the controls. We observed that the majority of SaV mono-infections caused severe gastroenteritis (67%) with clinical manifestations of diarrhoea (100%), vomiting (73%) and dehydration (80%). All known human SaV genogroups were detected in the study. At least eight genotypes were identified from cases and controls. Genogroups GIV and GV, along with genotypes GI.5, GII.4 and GII.6, were discovered for the first time in India. Two GII.4 study strains were found to be 98·5–99% identical, having a novel intra-genogroup recombinant (GII.1/GII.4) recently reported from the Philippines, suggesting probable evidence of recombination. The circulation pattern of SaV genotypes varied during the study period, with GII.1 being predominant in 2007 and 2009, GIV.1 in 2008, and GV.1 in 2011.

BACKGROUND Viral diarrhoea is still a major cause of childhood morbidity and mortality worldwide, with high morbidity in children younger than 5 years of age particularly in developing countries. The objective of this study was to determine the frequency of viral diarrhoea in children less than 5 years of age at Kathmandu University Hospital/Dhulikhel Hospital (DH), Nepal and Medical University of Innsbruck (MUI), Austria and to compare the clinical presentation and the common cause of acute childhood diarrhoea in the two institutions. METHODS This was a hospital based, comparative study done in two different hospitals DH and MUI. A total of 200 cases of under 5 years old children, among which 100 cases attending DH from 1 st December 2011 to 29 th February 2012 and 100 cases attending MUI from 1 st March 2012 to 31 st May 2012, presented with acute onset of diarrhoea were enrolled in the study. The fresh stool specimens were analysed in the laboratory of individual hospital in order to examine the common pathogens. RESULTS Majority of children were classified as no dehydration (DH: 75% and MUI: 74%); in DH 5% were classified as severe dehydration, whereas in MUI it was null. In MUI, 96% of children were brought within 3 days of illness, whereas only 32% were brought in DH which was statistically significant (p=

Background: In Libya, routine access to rotavirus testing is not available and clinicians treat presumptively, leading to inappropriate treatments. This study describes the management of rotavirus infection among Libyan children in public hospitals. Methods: A prospective cross-sectional study was conducted to describe the management of rotavirus among children in three public hospitals in Libya from August 2012 to April 2013. We reviewed internal documents to determine if protocols were in place to guide management of diarrheal illness. Children under five presenting with diarrhea had stool samples collected and tested for rotavirus. Comparisons of treatments were made by rotavirus status and level of dehydration; mild, moderate and severe. Results: A total of 545 diarrhea patients below 5 years of age were enrolled in the study. Of those, 311 (57%) cases were infected by rotavirus. Treatment was administered without investigating the cause of diarrhea. Intravenous fluids (IVF) treatment was the most common treatment for rotavirus cases and was administered to 306 (98%) of cases. Antibiotics were administered to about 137 (44%) of rotavirus cases. Antibiotics were more likely to be administered with more severe dehydration. Conclusions: Presumptive treatment with antibiotics was very common in Libyan. Protocols for management of diarrheal illness and rotavirus cases in children need to be established for effective treatment.

Background: Diarrhoea is the major cause of morbidity and mortality among children less than 5 year of age. Adequate rehydration therapy is most important aspect of management. Home based Oral Rehydration Therapy (ORT) prevents morbidity and mortality. In this study our objective was to assess the awareness, knowledge and practice of mothers of under-five children regarding ORT and home management of diarrhoea. Methods: A cross-sectional study was carried out at tertiary care centre of south Rajasthan. A questionnaire was provided to all the mothers of under-five children. Results: A total of 235 mothers were enrolled. 65% mothers have awareness regarding diarrhoea prevention. 80% of mothers were aware of Oral Rehydration Solution (ORS) and 72.7% knew how to prepare and administer ORS. Also, majority of mothers 78% were aware about home available fluids for rehydration. Knowledge of danger sign of severe dehydration was poor. Mothers educated only till class eight were almost twice less likely to know about ORS preparation as compared to better educated mothers (70%vs 30%). No association was found between lack of knowledge regarding home available fluids with younger age. Conclusions: Majority of mothers were aware regarding ORS and home available fluids. Knowledge of danger signs related to severe dehydration was low. Lack of education predisposed to ignorance regarding ORS preparation. Health education will be required to prevent diarrhoea morbidity and mortility.

Group A rotavirus (RVA) acute gastroenteritis (AGE) is a common cause of severe childhood diarrhea. The dominant circulating RVA genotypes in a given region may vary between and within the geographic regions and from year to year. Our cross-sectional study was designed to determine the burden of RVA genotypes among children with AGE admitted to referral Children Hospital at Egypt prior to implementation of the vaccine. Stool samples with clinico-epidemiological data were collected from 92 children ≤ 3 years-old with AGE. RVA G and P typing were performed with type-specific primers. RVA was detected in 48.9% of patients. Higher rates of RVA infections, 73.3% were detected in infants < 1 year-old. Breast-fed infants were significantly fewer in RVA positive group (P = 0.0006). Non-breastfeeding was a major risk factor for RVA AGE (OR 0.3, P = 0.02). RVA diarrhea occurred mostly in autumn and winter months (55.4% and 26.6%) with a significant difference in autumn (P = 0.0005) and was associated with vomiting and dehydration (OR; 1.66, P = 0.021 & 1.4, P = 0.03). RVA genotypes G1P[8] (26.7%), G9P[8] (20%) and G3P[8] (15.6%) were accounting for 62.3% of RVA AGE. G9 was significantly associated with mucus diarrhea, than G1 or G3 which were associated with watery diarrhea (P = 0.025). Also, G9 was significantly associated with loose stool for > 5 days (P = 0.006) and 54.4% of G9 patients had severe dehydration. The diversity of RVA strains detected in Nile Delta Egypt and emergence of G9 RVA highlight the need to apply vaccines against this genotype in Egypt.

Dysphania ambrosioides or anserine, known in Morocco as M'Khinza, is a plant belonging to family Chenopodiaceae. In Morocco, it is used for its therapeutic properties including, in particular, antipyretic properties. However, it can be toxic if it is incorrectly calibrated. We report two cases of poisoning whose data were collected in the Pediatric Emergency Department in Rabat. The study involved a 5-month old infant and a 10 year old girl with, respectively, toxic encephalopathy and severe dehydration associated with acute gastroenteritis after the ingestion of undetermined doses of infusion of this plant used as antipyretic. They both died in less than 12 hours. This study highlights the importance of considering M'Khinza-induced neurotoxicity and enterotoxicity in order to reach a correct diagnosis, the role of information and the need to fight against harmful consumption. Research on traditional pharmacopoeia should be encouraged in order to identify the therapeutic properties and to formalize, streamline and codify prescriptions.

Dehydration is common and frequently under-diagnosed in chronic malnourished children, leading to life-threatening conditions. In this pilot study we applied bioimpedance vector analysis (BIVA) to determine hydration status in 52 neurologically impaired (NI) paediatric patients (14.08 ± 5.32). Clinical and biochemical data were used to define malnutrition and dehydration. Body composition analysis and hydration were also assessed by BIVA and we considered 143 normal-weight healthy subjects (15.0 ± 1.7), as controls for hydration status assessment. BIVA revealed a pathological hydration status in NI children, showing higher resistance (p

Objective: To delineate various presentation of infantile tremor syndrome (ITS) as nutritional emergency. Material and Methods: All children presenting to emergency who had typical features of ITS admitted in PICU at tertiary care hospital, Bagalkot were analysed. A detailed history and physical examination was carried out. Relevant laboratory investigations were done. Results: A total of 9 cases were seen during this period. All children presented in PICU with life threatening emergencies like severe pneumonia, CCF, convulsions and severe dehydration. Mean age group of 12 months and all of them belong to lower socioeconomic group. Strikingly none of our babies received proper complimentary feeding.All children were on breast milk, 6 babies on exclusive breast feeding, 3 children received improper andinadequate complimentary feeding. Notably all cases were Severe Acute Malnutrition (SAM) as per WHO classification.All children received injection Vitamin B12 and folic acid, intravenous antibiotics and other micronutrients. All children improved,there was no mortality noted and mean duration of hospital stay was 17.8 days. Conclusion: ITS can present as life threating emergency in PICU.All children with ITS has severe acute malnutrition. ITS has good prognosis with proper nutritional rehabilitation and supportive management.

Store-operated calcium entry (SOCE) is the mechanism by which extracellular signals elicit prolonged intracellular calcium elevation to drive changes in fundamental cellular processes. Here, we investigated the role of SOCE in the regulation of renal water reabsorption, using the inbred rat strain SHR-A3 as an animal model with disrupted SOCE. We found that SHR-A3, but not SHR-B2, have a novel truncating mutation in the gene encoding stromal interaction molecule 1 (STIM1), the endoplasmic reticulum calcium (Ca(2+)) sensor that triggers SOCE. Balance studies revealed increased urine volume, hypertonic plasma, polydipsia, and impaired urinary concentrating ability accompanied by elevated circulating arginine vasopressin (AVP) levels in SHR-A3 compared with SHR-B2. Isolated, split-open collecting ducts (CD) from SHR-A3 displayed decreased basal intracellular Ca(2+) levels and a major defect in SOCE. Consequently, AVP failed to induce the sustained intracellular Ca(2+) mobilization that requires SOCE in CD cells from SHR-A3. This effect decreased the abundance of aquaporin 2 and enhanced its intracellular retention, suggesting impaired sensitivity of the CD to AVP in SHR-A3. Stim1 knockdown in cultured mpkCCDc14 cells reduced SOCE and basal intracellular Ca(2+) levels and prevented AVP-induced translocation of aquaporin 2, further suggesting the effects in SHR-A3 result from the expression of truncated STIM1. Overall, these results identify a novel mechanism of nephrogenic diabetes insipidus and uncover a role of SOCE in renal water handling.

BACKGROUND Dehydration, mainly due to diarrheal illnesses, is a leading cause of childhood mortality worldwide. Intravenous (IV) therapy is the standard of care for patients who were unable to tolerate oral rehydration; however, placing IVs in fragile, dehydrated veins can be challenging. Studies in resource-rich settings comparing hyaluronidase-assisted subcutaneous rehydration with standard IV rehydration in children have demonstrated several benefits of subcutaneous rehydration, including time and success of line placement, ease of use, satisfaction, and cost-effectiveness. METHODS A single-arm trial assessing the feasibility of hyaluronidase-assisted subcutaneous resuscitation for the treatment of moderately to severely dehydrated individuals in western Kenya was conducted. Children aged 2 months or older who presented with moderately to severely dehydration clinically warranting parenteral rehydration and had at least 2 failed IV attempts were eligible. Study staff received training on standard dehydration management and hyaluronidase infusion processes. Children received all other standards of care. They were monitored from presentation and through discharge, with a 1-week phone follow-up. Predischarge surveys were completed by caregivers, and semistructured interviews with providers were performed. RESULTS A total of 51 children were enrolled (median age, 13.0 months; interquartile range of 18 months). Fifty-one patients (100%) had severe dehydration. The median length of subcutaneous infusion was 3.0 hours (interquartile range [IQR], 2.95). The median total subcutaneous infusion was 700.0 mL (IQR, 420 mL). Median time to resolution of moderate to severe dehydration symptoms was 3.0 hours (IQR, 2.95 hours). There were no significant complications. CONCLUSIONS Hyaluronidase-assisted subcutaneous resuscitation is a feasible alternative to IV hydration in moderately to severely dehydrated children with difficult to obtain IV access in resource-limited areas.

The presented case is one of severe dehydration and acute kidney injury with significant resultant complications that required considerable fluid and electrolyte replacement. Approaches to fluid resuscitation in the context of hypernatraemia and the hyperosmolar state were considered and then judiciously combined to manage a complex case with a successful outcome. Conflicting guidance in this domain is discussed with recommendations for a future management strategy that is tailored to individual patients.

Aim. To systematically update diagnostic accuracy of the Clinical Dehydration Scale (CDS) in clinical recognition of dehydration in children with acute gastroenteritis. Methods. Six databases were searched for diagnostic accuracy studies in which population were children aged 1 to 36 months with acute gastroenteritis; index test was the CDS; and reference test was post-illness weight gain. Results. Three studies involving 360 children were included. Limited evidence showed that in high-income countries the CDS provides strong diagnostic accuracy for ruling in moderate and severe (>6%) dehydration (positive likelihood ratio 5.2-6.6), but has limited value for ruling it out (negative likelihood ratio 0.4-0.55). In low-income countries, the CDS has limited value either for ruling moderate or severe dehydration in or out. In both settings, the CDS had limited value for ruling in or out dehydration

International audience; Knowledge of rotavirus epidemiology is necessary to make informed decisions about vaccine introduction and to evaluate vaccine impact. During April 2010-March 2012, rotavirus surveillance was conducted among 9,745 children 80% of isolates during the second year. Hospitalization and death rates and severe dehydration among rotavirus case-patients did not differ during the 2 years. The emergence of G12P[8] warrants close attention to the characteristics of associated epidemics and possible prevention measures.

Ramadan is a month in the Islamic calendar when Muslims fast during daylight hours. We used data from the surveillance system of the International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka Hospital in Dhaka, Bangladesh, a predominantly Muslim country, to compare the etiology and clinical presentation of patients who presented with diarrhea during Ramadan to that of control periods, defined as the 30 days immediately before Ramadan. The proportion of infecting pathogens was largely the same, although Shigella spp. were less likely to be identified during Ramadan. Clinical presentations during Ramadan among adult Muslim diarrheal patients were also comparable to those admitted during control periods. A subgroup of cholera patients who presented after sunset during Ramadan had a shorter duration of diarrhea and higher prevalence of severe thirst, drowsiness, and severe dehydration. Our findings suggest that Ramadan has few effects on the profile of enteric pathogens and clinical features of adults seeking medical care for diarrhea.

Acute gastroenteritis with viral infection in infants causes severe diarrhea and often results in acute renal failure due to severe dehydration. However, a viral infection, particularly rotavirus, rarely induces postrenal failure due to bilateral stones in infants. Herein, we report three cases of postrenal failure in infants due to bilateral ureteral stones induced by acute gastroenteritis with rotavirus. Following immediately nephrostomy, chemical dissolution therapy succeeded to treat postrenal failure. Immediate nephrostomy for the release of upper urinary tract obstruction combined with urinary alkalization as a chemical dissolution therapy should be considered in such cases.

Peritoneal encapsulation is a rare congenital cause of bowel obstruction in children. We present the case of a 12-year-old male with severe dehydration and recurrent episodes of vomiting. This pathology should be considered in cases of bowel obstruction with a virgin abdomen.

On January 6, 2015, a man aged 40 years was admitted to Kenyatta National Hospital in Nairobi, Kenya, with acute watery diarrhea. The patient was found to be infected with toxigenic Vibrio cholerae serogroup O1, serotype Inaba. A subsequent review of surveillance reports identified four patients in Nairobi County during the preceding month who met either of the Kenya Ministry of Health suspected cholera case definitions: 1) severe dehydration or death from acute watery diarrhea (more than four episodes in 12 hours) in a patient aged ≥5 years, or 2) acute watery diarrhea in a patient aged ≥2 years in an area where there was an outbreak of cholera. An outbreak investigation was immediately initiated. A confirmed cholera case was defined as isolation of V. cholerae O1 or O139 from the stool of a patient with suspected cholera or a suspected cholera case that was epidemiologically linked to a confirmed case. By January 15, 2016, a total of 11,033 suspected or confirmed cases had been reported from 22 of Kenya's 47 counties (Table). The outbreak is ongoing.