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The enhancement the cake of cashew kernels downgraded (Anacardium occidentale) (TA), the detoxified cake of kernels rubber (Hevea brasiliensis) (TH) and jatropha (Jatropha curcas) (TJ) in pig feed, was study on 21 pregnant gilts (73.4±8.1 kg). These females randomly distributed by group of three, received control diet (RT) and six other diets containing 7.5% or 15% of TA (RTA7.5 and RTA15), 7.5% or 15% of TH (RTH7.5 and RTH15) or 7.5% or 15% of TJ (RTJ7.5 and RTJ15). During the trial of 152 days, gilts under RTJ15 regime and two gilts under RTJ7.5 regime were withdrawn after respectively 14 and 21 days’ supply due to a persistent diarrhea. The latest gilt under RTJ7.5 had aborted at 90 days of gestation. No significant difference was observed on the average litter size (9.2 piglets). The average weight of piglets at birth ranged from 1.3±0.2 kg (RTA15) and 1.1±0.2 kg (RTH7.5), while the average daily gain (ADG) of

Since 1977, a disease of racing pigeons characterized by nervous signs and a persistent diarrhea, but with no respiratory signs, has spread across Europe in the early 1980s and subsequently to much of the northern hemisphere. This syndrome is regarded as the third great panzootic of Newcastle disease (ND) and is known as PMV-1 infection of pigeons, or "pigeon PMV-1". Racing pigeons had been largely ignored by disease control authorities as a source of Newcastle disease virus (NDV) infection for domestic poultry, and in 1984 the pigeon virus caused 20 outbreaks of Newcastle disease in chickens; transmission occurred by feed contaminated by infected pigeons.

The ileocecal region (ICR) is used extensively in reconstructive urological surgery. To evaluate whether resection of the ICR may cause protracted diarrhea, 50 patients undergoing ileocecal resection were studied. Fifty patients undergoing left colectomy for cancer were used as controls. No significant change in bowel habits was noted in the control group. Among patients undergoing ICR resection 42% had transient loosening of stools 2 weeks after surgery which improved within 3 months. Twelve months after surgery only 6 patients with solid stools preoperatively had loose stools, and none suffered diarrhea. In conclusion, in the patients studied after resection of the ICR diarrhea gradually resolved. More work is necessary to study other potential metabolic consequences of such resection.

Diarrhea continues to stand among the most important causes of global morbidity and mortality in children under 5 years of age. Although the introduction of oral rehydration and other case-management strategies have reduced acute diarrhea fatalities, many of the survivors develop persistent diarrhea and/or deficiencies of growth and cognition. Thus understanding the true global burden of diarrhea requires attention to acute diarrhea as well is its sequelae. To understand the etiology of moderate to severe diarrhea among children in high mortality areas of sub-Saharan Africa and south Asia we performed a comprehensive case-control study of children under 5 years of age at seven sites. Each site employed an identical case-control study design and each utilized a uniform comprehensive set of microbiological assays to identify the likely bacterial, viral and protozoal etiologies. Results of the studies will inform diarrhea prevention and management efforts worldwide.

Cryptosporidium is an entero-pathogen which causes gastrointestinal disturbs. Primarily this organism infects the microvillous border of the intestinal epithelium, and to lesser extent extra intestinal epithelia, causing acute gastrointestinal disturbs (Fayer, 2004). The duration of infection and the ultimate outcome of intestinal cryptosporidiosis greatly depend on the immune status of the patient. In fact, immunologically healthy patients usually recover spontaneously in a week. The clinical signs can range from asymptomatic to acute, severe and persistent diarrhea and their potential for Cryptosporidium transmission can persist for weeks after symptoms cease (Deng et al., 2004; Fayer, 2004; Hunter and Thompson, 2005).

A 41-year-old female presented with persistent diarrhea, and was diagnosed with Zollinger-Ellison syndrome when her gastrin level was greater than 3000 ng/L. All modalities for preoperative localization of her gastrinoma were unsuccessful, including transabdominal and endoscopic ultrasound, computed tomography, pancreatic angiogram, selective transhepatic portal venous sampling and magnetic resonance imaging. The gastrin-secreting tumour was visualized using the somatostatin analogue pentatreotide labelled with111Indium, combined with gamma camera imaging. A successful resection of the tumour resulted in the normalization of serum gastrin levels 3.5 years after presentation. A discussion of the merits and sensitivities of these tests for preoperative localization of gastrin-secreting tumours will be presented.

OBJETIVO: Avaliar interações de amostras de Escherichia coli enteroagregativa com tecido intestinal humano, a fim de documentar potenciais alterações em diferentes regiões do trato digestivo. MÉTODOS: Amostras de Escherichia coli enteroagregativa isoladas das fezes de crianças com diarreia persistente e a amostra protótipo 042, isolada de uma criança com diarreia em Lima, no Peru (controle positivo), foram analisadas por microscopia óptica de luz após semeadura em cultura de orgão in vitro de fragmentos de mucosa ileal e colônica. Foram analisadas as interações entre as diferentes cepas de Escherichia coli enteroagregativa e as mucosas ileal e colônica. RESULTADOS: A análise por microscopia óptica de luz indicou associação destes micro-organismos com o epitélio, provocando alterações. As cepas estudadas aderiram a ambas as regiões avaliadas (intestino delgado distal e grosso) e causaram alterações, especialmente naquelas áreas onde interagiram diretamente com o epitélio. No íleo, algumas regiões mostraram internalização secundária. CONCLUSÕES: Esses agentes podem causar diarreia persistente por meio de alterações no intestino delgado, no qual ocorrem as funções digestivo-absortivas. As lesões inflamatórias descritas na mucosa colônica poderiam explicar a colite mostrada em algumas crianças infectadas por Escherichia coli enteroagregativa. OBJECTIVE: To examine the interactions of Enteroaggregative Escherichia coli strains with small and large intestinal mucosa, in order to detect potential alterations in both regions of the digestive tract. METHODS: Enteroaggregative Escherichia coli strains, isolated from stools of infants with persistent diarrhea and the prototype strain 042 (O44:H18), isolated from a child with diarrhea in Lima, Peru (positive control), were analised by light microscopy after in vitro organ culture assay of ileal and colonic mucosa. The interactions between the different enteroaggregative Escherichia coli strains and the ileal and colonic mucosa were analysed. RESULTS: Light microscopy analysis suggested an association of enteroaggregative Escherichia coli strains with the epithelium, inducing alterations. These bacteria adhered to both small and large bowel mucosa. The enteroaggregative Escherichia coli strains induced alterations in those areas where they were directly interacting with the epithelium. In the ileum, some areas showed a secondary internalization. CONCLUSIONS: The enteroaggregative Escherichia coli strains could cause persistent diarrhea inducing alterations in the small intestinal structures, where the digestive-absorptive functions take place. Inflammatory lesions observed in colons could justify the colitis described in some children infected by enteroaggregative Escherichia coli. OBJETIVO: Evaluar interacciones de muestras de Escherichia coli enteroagregativa (EAEC) con tejido intestinal humano, a fin de documentar potenciales alteraciones en distintas regiones del tracto digestivo (intestino delgado distal e intestino grueso) y definir, con eso, su rol en la persistencia del proceso diarreico. MÉTODOS: Muestras de EAEC aislada de las heces de niños con diarrea persistente y la muestra prototipo 042, aislada de un niño con diarrea en Lima, Perú (control positivo) fueron analizadas por microscopía óptica de luz (ML) después de siembra en cultura de órgano in vitro de fragmentos de mucosa ileal y del colon. Fueron analizadas las interacciones entra las distintas cepas de EAEC y las mucosas ileal y del colon. RESULTADOS: El análisis por ML indicó asociación de estos microorganismos con el epitelio, provocando alteraciones. Las cepas estudiadas adhirieron a ambas regiones evaluadas: intestino delgado distal y grueso y causaron alteraciones, especialmente en aquellas áreas donde interactuaron directamente con el epitelio. En el íleo, algunas regiones mostraron internalización secundaria. CONCLUSIÓN: Estos agentes pueden causar diarrea persistente mediante alteraciones en el intestino delgado, donde ocurren las funciones digestivo-absortibas. Las lesiones inflamatorias descritas en la mucosa del colon podrían explicar la colitis descrita en algunos niños infectados por EAEC.

OBJETIVO: Avaliar interações de amostras de Escherichia coli enteroagregativa com tecido intestinal humano, a fim de documentar potenciais alterações em diferentes regiões do trato digestivo. MÉTODOS: Amostras de Escherichia coli enteroagregativa isoladas das fezes de crianças com diarreia persistente e a amostra protótipo 042, isolada de uma criança com diarreia em Lima, no Peru (controle positivo), foram analisadas por microscopia óptica de luz após semeadura em cultura de orgão in vitro de fragmentos de mucosa ileal e colônica. Foram analisadas as interações entre as diferentes cepas de Escherichia coli enteroagregativa e as mucosas ileal e colônica. RESULTADOS: A análise por microscopia óptica de luz indicou associação destes micro-organismos com o epitélio, provocando alterações. As cepas estudadas aderiram a ambas as regiões avaliadas (intestino delgado distal e grosso) e causaram alterações, especialmente naquelas áreas onde interagiram diretamente com o epitélio. No íleo, algumas regiões mostraram internalização secundária. CONCLUSÕES: Esses agentes podem causar diarreia persistente por meio de alterações no intestino delgado, no qual ocorrem as funções digestivo-absortivas. As lesões inflamatórias descritas na mucosa colônica poderiam explicar a colite mostrada em algumas crianças infectadas por Escherichia coli enteroagregativa.

To highlight recent advances in our understanding of prolonged episodes of acute diarrhea and persistent diarrhea in children. The focus is on the contribution of these illnesses to the global burden of diarrhea, their impact on childhood growth and development, novel epidemiologic links between prolonged and persistent diarrheal episodes, and strategies for their prevention and management.Although less common than acute diarrhea, prolonged and persistent episodes of diarrhea in childhood constitute a significant portion of the global burden of diarrhea. These episodes also play a key role in the vicious cycle of childhood diarrhea and malnutrition in which undernutrition is both a risk factor and an outcome of diarrhea. Increased efforts to provide WHO-recommended zinc therapy for all children with diarrhea in developing countries will significantly reduce morbidity and mortality. In children who develop persistent diarrhea, yogurt-based or amino acid-based diets may accelerate their recovery.In addition to increased implementation of strategies already known to effectively prevent and manage acute diarrhea, further research is needed to address the recognition, prevention, and treatment of prolonged episodes of acute diarrhea and persistent diarrhea in resource-limited settings.

According to popular report, the folk illness, Doença de criança (The Child's Disease) is the leading cause of infant and childhood death in Northeast Brazil; most health professionals, however, are unaware it exists. Doença de criança is described based on ethnographic interviews with 50 traditional healers and 50 bereaved mothers whose children have died from the condition. Doença de criança is a sociocultural label developed by the popular medical system and applied to the end stages of severe childhood infectious diseases and malnutrition against a background of grinding poverty. Doença de criança is discussed as an analog to persistent diarrhea. Practical treatment and management implications of this relationship are presented. Doença de criança, most importantly, offers a new, holistic paradigm for the future study of persistent diarrhea.

There has been a great deal of research in recent years on household behaviors related to diarrhea management. Most of the available data on household diarrhea management, however, pertains to acute diarrheal episodes. There is a dearth of knowledge concerning household and caretaker behaviors when the diarrhea is of longer duration. This paper briefly reviews some of what has been learned about household behaviors in the management of acute diarrhea and discusses its relevance for persistent diarrhea. Based upon what has been learned from anthropological studies of acute diarrhea and the little that is known about caretaker behavior during persistent diarrhea, a hypothetical model of the interactions among household behavior and characteristics of diarrheal episodes is presented. The model argues that maternal (or caretaker) concern increases with diarrheal duration, and that changes in behavior, both adaptive and maladaptive, are more likely to occur during an episode of persistent diarrhea, compared to acute. In some cases, these actions may directly influence the outcome of the episode. There is a need to better understand household case management behaviors through the continuum of diarrheal duration and the effect of these behavioral factors on episode outcome. This information is necessary in order to communicate effective messages to caretakers about what they should know and what they should do when persistent diarrhea occurs.

In a population-based study, all infant deaths occurring in a one-year period in the metropolitan areas of Porto Alegre and Pelotas, in southern Brazil, were studied. There were 227 infants who presented diarrhoea during the fatal illness, and in 75% of these diarrhoea was considered to be the underlying cause of death. Acute diarrhoea (14 days' duration) accounted for 28% of the deaths, persistent diarrhoea for 62% and dysentery for a further 10%. Approximately one-half of the children with persistent diarrhoea were admitted to a hospital in the first two weeks of the episode. Hospital-acquired infections were likely to have contributed to one- to two-thirds of deaths due to dysentery and persistent diarrhoea. A comparison with neighbourhood controls showed that breast milk provided substantial protection against deaths due to either acute or persistent diarrhoea.

Dietary intake during diarrhea in children less than three years of age was estimated from information recorded on illustrated dietary forms used by children's caretakers during the first week of illness in a prospective community-based study of diarrheal diseases in Lima, Peru. The frequency of consumption and the amount consumed of food groups and selected commonly consumed foods were analyzed by the final duration of the diarrheal episode. Cereals were less frequently consumed during the acute phase of diarrheal episodes that ultimately became persistent (> 14 days' duration), apparently shortening the duration of the episode by one day (median duration of four days in children not consuming vs three days in children consuming cereals during diarrhea, p < 0.02 Kaplan-Meier log-rank test). Only roots and tubers (mainly potatoes) were consumed in greater quantity during episodes that became persistent. There was no evidence that consumption of breast milk or non-maternal milk was associated with an alteration in diarrheal duration. This study provides further evidence of the beneficial effects of continuing feeding during diarrhea using foods available at the home level, especially cereals, which are commonly used in the diet of young children.

p. 1-112 Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-10T18:15:14Z No. of bitstreams: 1 Tese _ Maria Efigenia.pdf: 1177812 bytes, checksum: e7ab5f7bbee1bf8001e5519270ae0b07 (MD5) Approved for entry into archive by Rodrigo Meirelles(rodrigomei@ufba.br) on 2013-04-13T20:13:39Z (GMT) No. of bitstreams: 1 Tese _ Maria Efigenia.pdf: 1177812 bytes, checksum: e7ab5f7bbee1bf8001e5519270ae0b07 (MD5) Made available in DSpace on 2013-04-13T20:13:39Z (GMT). No. of bitstreams: 1 Tese _ Maria Efigenia.pdf: 1177812 bytes, checksum: e7ab5f7bbee1bf8001e5519270ae0b07 (MD5) Previous issue date: 2009 Objetivo: avaliar o efeito da suplementação dietética com o antioxidante N-acetilcisteína (NAC), oferecido a crianças com diarréia persistente. Método: trata-se de um ensaio clínico, duplo-cego, randomizado, controlado com placebo no qual foram estudadas 55 crianças, de ambos os sexos, com idades entre 02 e 36 meses, atendidas em um hospital pediátrico com diagnóstico de diarréia persistente ( 14 dias de duração). Os pacientes foram distribuídos, randomicamente, em dois grupos que receberam como dieta padrão o iogurte natural integral e a suplementação dietética com 3g de N-ACC(28 crianças) ou placebo(27 crianças) duas vezes ao dia. Estas crianças foram mantidas em uma unidade metabólica, onde o peso, a ingestão dietética de soro de reidratação oral e água, assim como as perdas fecais, urinárias e por vômitos, foram mensuradas durante todo o estudo e analisadas a cada 24 horas. Foram realizadas avaliações antropométricas e bioquímicas no momento do internamento e da alta do estudo. Resultados: Ao final do período de observação, os dados mostraram que a mediana de duração da diarréia (h) e de perda fecal (ml/kg/dia) foram menores em favor do grupo teste, embora sem significância estatística. Conclusão: Este estudo demonstra que a utilização de NAC como suplemento na dieta de crianças com diarréia persistente pode proporcionar vantagem terapêutica em comparação com a alimentação convencional. Salvador

p. 1-112 Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-10T18:15:14Z No. of bitstreams: 1 Tese _ Maria Efigenia.pdf: 1177812 bytes, checksum: e7ab5f7bbee1bf8001e5519270ae0b07 (MD5) Approved for entry into archive by Rodrigo Meirelles(rodrigomei@ufba.br) on 2013-04-13T20:13:39Z (GMT) No. of bitstreams: 1 Tese _ Maria Efigenia.pdf: 1177812 bytes, checksum: e7ab5f7bbee1bf8001e5519270ae0b07 (MD5) Made available in DSpace on 2013-04-13T20:13:39Z (GMT). No. of bitstreams: 1 Tese _ Maria Efigenia.pdf: 1177812 bytes, checksum: e7ab5f7bbee1bf8001e5519270ae0b07 (MD5) Previous issue date: 2009 Objetivo: avaliar o efeito da suplementação dietética com o antioxidante N-acetilcisteína (NAC), oferecido a crianças com diarréia persistente. Método: trata-se de um ensaio clínico, duplo-cego, randomizado, controlado com placebo no qual foram estudadas 55 crianças, de ambos os sexos, com idades entre 02 e 36 meses, atendidas em um hospital pediátrico com diagnóstico de diarréia persistente ( 14 dias de duração). Os pacientes foram distribuídos, randomicamente, em dois grupos que receberam como dieta padrão o iogurte natural integral e a suplementação dietética com 3g de N-ACC(28 crianças) ou placebo(27 crianças) duas vezes ao dia. Estas crianças foram mantidas em uma unidade metabólica, onde o peso, a ingestão dietética de soro de reidratação oral e água, assim como as perdas fecais, urinárias e por vômitos, foram mensuradas durante todo o estudo e analisadas a cada 24 horas. Foram realizadas avaliações antropométricas e bioquímicas no momento do internamento e da alta do estudo. Resultados: Ao final do período de observação, os dados mostraram que a mediana de duração da diarréia (h) e de perda fecal (ml/kg/dia) foram menores em favor do grupo teste, embora sem significância estatística. Conclusão: Este estudo demonstra que a utilização de NAC como suplemento na dieta de crianças com diarréia persistente pode proporcionar vantagem terapêutica em comparação com a alimentação convencional. Salvador

The study was undertaken to better understand the role of total gut transit time (TGTT) on the absorption of nutrients in patients with persistent diarrhea. Twenty-six boys aged 3-18 months with persistent diarrhea and 25 age-matched healthy controls were studied. Their TGTT was measured with charcoal markers during their treatment with a diet made up with rice powder soya oil, glucose, and egg white. Coefficients of absorption of nutrients were estimated in a 72-h balance study. The median TGTTs in patients and controls were 5 and 11.6 h, respectively. Among the patients, the TGT correlated significantly with absorption of total energy (p less than 0.01), absorption of fat (p less than 0.01), stool frequency (p less than 0.01), and stool weight during the 1st 24 h (p less than 0.01). Coefficients of absorption of energy, fat, and carbohydrate were significantly different among the patients above or below the median transit time (5 h). None of these relationships was present among the healthy controls. The TGTT was negatively associated with the duration of clinical recovery. The results of this study suggested that intestinal transit time is an important factor for absorption of nutrients that may influence clinical recovery in patients with persistent diarrhea.

To explore the relationship between vitamin A deficiency and persistent diarrhea among young children, we studied the vitamin A status of 23 children greater than 5 years of age with persistent diarrhea by performing conjunctival impression cytology (CIC) and the relative dose-response test (RDR) as a measure of liver reserve of vitamin A. The control group consisted of 23 age- and sex-matched children who were otherwise healthy in whom CIC was performed and fasting plasma retinol values were determined. The criteria for vitamin A deficiency in CIC were paucity of goblet cells and scanty, abnormal epithelial cells. None of these children had ocular manifestations of vitamin A deficiency. Among the children with persistent diarrhea, CIC characteristic of vitamin A deficiency was found in 17 (group 1) and CIC results were normal in six (group 2). In group 1, the serum retinol levels were 1 +/- 1 microgram/dl, and RDR was 88 +/- 14. In group 2, the serum retinol levels were 8 +/- 4 micrograms/dl (p less than 0.001) and the RDR was 16 +/- 12 (p less than 0.001). In the control group, the CIC results were normal in all the children and the plasma retinol levels in these children were 19 +/- 8 micrograms/dl. In conclusion, 17 of 23 children with persistent diarrhea had abnormal CIC results, significantly low serum retinol levels, and significantly high RDR results, although they had not yet manifested xerophthalmia.(ABSTRACT TRUNCATED AT 250 WORDS)

Fecal samples from diarrheal patients and non-diarrheal controls were examined for Cryptosporidium oocysts in a year-long prospective study at a diarrhea treatment center in Dhaka, Bangladesh. Cryptosporidium oocysts were detected in 42 (3%) of 1,382 diarrheal patients but in none of 235 non-diarrheal controls. In 32 (76%) of 42 patients, no other enteropathogens were detected. Children less than 5 years of age were more commonly infected than older children (4.8% vs. 1.6%, P greater than 0.05) and adults (4.8% vs. 0.2%, P less than 0.01). A higher number of cases were detected during hot and humid months (April--July). Nineteen children less than 5 years of age (index cases) and their 71 family members were followed for 3 weeks after the release of the index cases from the hospital. Diarrhea continued for greater than 14 days (persistent diarrhea) in 8 (32%) index children. Cryptosporidium oocysts were detected in 1 (12.5%) of 8 family members who developed diarrhea during the follow-up period. Index cases excreted oocysts for 3-28 days (12.37 +/- 8.35 days). Almost all the patients recovered with oral rehydration. Cryptosporidium ssp. cause self-limited diarrhea episodes in children less than 5 years of age in Bangladesh, with a low frequency of intrafamilial transmission.

To evaluate the role of Lactobacillus rhamnosus GG (LGG) as probiotic in persistent diarrhea (PD) in children of North Bengal, India.Hospital-based study.Randomized, double-blind controlled trial.All patients of PD admitted over a period of 2 years were included in the study as per predefined inclusion criteria. They were randomized to receive oral rehydration solution (ORS) alone, or ORS plus LGG powder containing 60 million cells, twice daily for a minimum period of 7 days or till diarrhea has stopped along with correction of dehydration with ORS and/or intravenous fluids as per WHO protocol and antibiotics in culture positive patients. The duration and frequency of purge and vomiting were studied. Data were analyzed by SPSS-10 software. Statistical significance was calculated by Student t test and chi2 test.The study comprised of 235 patients randomized into 2 groups, cases (117) and controls (118). Both the groups were similar with respect to age, number of breastfed infants, presentation with dehydration, degree of protein energy malnutrition, and distribution of infections. Stool culture was positive in 90 (38.3%) patients, Escherichia coli being the commonest organism followed by Shigella spp. and Clostridium difficile. The mean duration of diarrhea was significantly lower in the cases than in controls (5.3 vs. 9.2 d). The average duration of hospital stay was also significantly lesser in cases. No complication was observed from the dose of LGG used.LGG (dose of 60 million cells) could decrease the frequency and duration of diarrhea and vomiting and reduced hospital stay in patients of PD.

En los países en vía de desarrollo, el ciclo desnutrición-mala absorción-diarrea persistente, es una de las principales causas de la mortalidad infantil. Con frecuencia se deben a infecciones entéricas. La evaluación del niño con diarrea persistente, comienza con ciertos estudios paraclínicos. El pronóstico de la diarrea persistente, ha mejorado con el uso de dietas enterales y de la nutrición parenteral. In the world’s developing countries, the cycle of malnutrition, malabsorption, and persistent diarrhea is one of the leading causes of death in children. It is most often caused by an enteric infection. Evaluation of the patient with persistent diarrhea should start with certain screening studies. The prognosis for persistent diarrhea has been markedly improved through the use of enteral diets and parenteral nutrition.

Diarrheal disease is a major cause of childhood morbidity and mortality worldwide. Chronic enteropathy with subsequent persistent diarrhea and associated vicious cycles of malnutrition, increased gu

The objective of the study was to define the characteristics and microbiology of persistent diarrhea (PD) in US children.Six-month prospective cohort study of a convenience sample of 604 healthy 6- to 36-month-old children recruited by the Slone Center Office-based Research Network.Of 611 diarrhea episodes, 50 (8.2%) lastedor = 14 days. The incidence of PD was 0.18 episodes per person-year, and the median duration of episodes was 22.0 days (range, 14-64 days). PD episodes were more likely than acute episodes to result in a medical visit (28.0% vs 8.2%; P = 0.0001). The most commonly used treatments were oral rehydration solution (12.0% of episodes) and antibiotics (6.0%). No bacterial or parasitic pathogens were associated with PD; but norovirus, rotavirus and sapovirus were each significantly more prevalent in PD stools compared with baseline stools, with relative risks of 12.4, 6.9 and 6.2, respectively. Fifty-nine per cent of the PD specimens tested were negative for all studied pathogens.PD occurs with a frequency of approximately 1 case per 5 person-years in US infants and young children. It seems to be a generally benign illness, with only 28% of cases presenting to medical care. Although viral pathogens seem to cause a minority of PD episodes in this population, most are not due to currently known infectious agents.

To evaluate the effects of green banana and pectin (nondigestible, dietary sources of colonic shortchain fatty acids [SCFA]) on intestinal permeability, 57 boys (5-12 months) with persistent diarrhea (or = 14 days) were given a week's treatment with a rice-based diet containing either cooked green banana (n = 19), pectin (n = 17), or rice diet alone (n = 21). Intestinal permeability was assessed before and after treatment by giving a lactulose-mannitol (LM) drink and measuring urinary recovery after 5 hr. Treatment with banana significantly (P0.05) reduced lactulose recovery, increased mannitol recovery, and decreased the LM ratio, indicating improvement of permeability. Pectin produced similar results. Permeability changes were associated with a 50% reduction in stool weights which correlated strongly (green banana, r2 = 0.84, pectin, r2 = 0.86) with the LM ratio. Green banana-derived and SCFA-mediated stimulation of colonic as well as small bowel absorption is responsible for their antidiarrheal effects. The antidiarrheal effects of green banana and pectin are mediated by improvement of small intestinal permeability in addition to their known colonotrophic effects.

Although some evidence exists to support the practice of using calcium carbonate to treat nelfinavir-induced diarrhea, there is a lack of data supporting the role of calcium in diarrhea induced by other protease inhibitors (PIs).The objective of this prospective open-label study is to evaluate the efficacy of calcium carbonate in the treatment of PI-induced persistent diarrhea in HIV-infected patients.Along with dietary advice, patients were asked to take oral calcium carbonate 500 mg twice daily for 2 weeks. Visual Analog Scale (VAS) and the National Cancer Institute of Canada (NCIC) scale were used to assess the severity of diarrhea. Data were analyzed using paired t tests to test for differences in VAS and NCIC scores between baseline and 14 days. Pearson correlation was used to explore the relationships between change in diarrhea and patient baseline factors.At day 0, the mean VAS +/- standard deviation was 6.6 +/- 2.1 and decreased to 5.3 +/- 1.9 (p=.01) after 14 days. At day 0, the mean NCIC score was 1.9 +/- 0.8 and decreased to 1.2 +/- 0.9 (p=.005) after 14 days. No baseline patient factors predicted change in NCIC or VAS grade.Calcium carbonate is associated with a reduction of diarrhea in individuals with diarrhea induced by PI.

Objetivos: testar a hipótese de que a mucosa do intestino delgado proximal de crianças com diarréia persistente apresenta alterações morfométricas e estereológicas proporcionais ao estado nutricional, utilizando captura de imagens através de microscópio acoplado ao computador. Métodos: estudo transversal incluindo 65 pacientes pediátricos, com idade entre quatro meses e cinco anos, com diarréia de mais de 14 dias de duração, avaliados pelos escores z, divididos em eutróficos = z > 2 DP e desnutridos = z < -2DP; eutróficos = z > 2 DP, risco nutricional = z < -1DP e desnutridos = z < -2DP; e de maneira contínua em ordem decrescente, utilizando-se as tabelas do NCHS. Após a captura das imagens através do programa Scion Image, foram medidas a altura dos vilos, a profundidade das criptas, a espessura da mucosa, a espessura total da mucosa e a relação vilo/cripta (100 aumentos) e a altura do enterócito, altura do núcleo e do bordo em escova (500 aumentos). A análise estereológica foi feita através de arcos ciclóides. Resultados: para os escores z P/I, P/E e E/I, divididos em duas categorias de estado nutricional, não houve diferença estatisticamente significante quanto às medidas da altura dos vilos, profundidade das criptas, espessura da mucosa, espessura total da mucosa e relação vilo/cripta. A altura do enterócito foi a característica que apresentou maior diferença entre os grupos eutróficos e desnutridos, para os índices P/I e P/E, em 500 aumentos, sem atingir significância estatística. No entanto, para três categorias de estado nutricional, a análise morfométrica digitalizada mostrou diferença estatisticamente significante para a relação vilo/cripta entre eutróficos e desnutridos leves e entre eutróficos e desnutridos moderados e graves (p=0,048). A relação vilo/cripta foi maior nos eutróficos. Através do coeficiente de correlação linear de Spearman, a altura do enterócito, a altura do núcleo do enterócito e a do bordo em escova mostraram clara associação com os índices P/I (r=0,25;p=0,038) e P/E (r=0,029; p=0,019). A altura do núcleo do enterócito e a do bordo em escova mostraram, ainda, associação com o índice P/E. Conclusões: as correlações encontradas entre o estado nutricional e a morfometria das variáveis da mucosa do intestino delgado relacionaram- se ao peso dos pacientes. Embora estas associações tenham sido de magnitude fraca a moderada, há uma tendência à diminuição do tamanho do enterócito, do seu núcleo e do bordo em escova, à medida que aumenta o grau de desnutrição. Objectives: to test the hypothesis that the proximal small intestines of children with persistent diarrhea present morphometric and stereologic changes proportional to their nutritional status, using microscope images stored in a computer. Methods: cross-sectional study with 65 pediatric patients, whose ages ranged from 4 months to 5 years, with persistent diarrhea for over 14 days. The nutritional assessment was performed according to the z-scores for weight/age (W/A), weight/height (W/H) and height/age (H/A) ratios, divided into: well-nourished = z >2SD and malnourished = z 2SD, nutritional risk = z

Dr. Smith’s first patient of the day is a 63-year-old woman, Mrs. Meyer, who has persistent diarrhea and a weight loss of 10 pounds (from 92 pounds to 82 pounds) over 2 months. She is widowed and has three daughters who live in town. When Dr. Smith asked about her past medical history, she indicated that she smokes about two packs per day, consumes about two drinks per day, and has been hospitalized once for an appendectomy and for the births of her three children.

G. Kirungi1,∗, Y. Karamagi2, I. Kasirye3, M. Odiit4, E. Kawuma4, J. Naluwooza5, B.N.M. Mukasa6 1 Mildmay Uganda HIV and AIDS care, training and research, Kampala, Uganda 2 Mildmay Uganda HIV and AIDS care, Training and Research, Kampala, Uganda 3 Mildmay Uganda HIV and AIDS care,training and Research Centre, Kampala, Uganda 4 Mildmay Uganda, Kampala, Uganda 5 Mildmay Uganda HIV and AIDS care, training and Research Centre, Kampala, Uganda 6 Mildmay Uganda HIV and AIDs care, training and Research centre, Kampala, Uganda

Objective: We evaluated and compared the efficacy of the World Health Organization (WHO) oral rehydration solution (ORS) and 2 different formulations of reduced osmolarity ORSs in infants with persistent diarrhea. Study design: Infants with persistent diarrhea (n = 95) were randomized to 1 of the 3 ORSs: WHO-ORS (control, n = 32), a glucose-based reduced osmolarity ORS (RORS-G, n = 30), or a rice-based reduced osmolarity ORS (RORS-R, n = 31) for replacement of ongoing stool losses for up to 7 days. Major outcome measures were stool volume and frequency, ORS intake, and resolution of diarrhea. Results: Although there were variations from one study day to another, the stool volume was approximately 40% less in the reduced osmolarity ORS groups; consequently, these children required less ORS (22% for RORS-G and 27% for RORS-R groups). A higher proportion of children in the RORS-R groups also had resolution of diarrhea during the study period. No children in any of the treatment groups had hyponatremia. Conclusion: Reduced osmolarity ORS is clinically more effective than WHO-ORS and may thus be advantageous for use in the treatment of children with persistent diarrhea. (J Pediatr 2001;138:532-8)

We describe the ultrastructural abnormalities of the small bowel surface in 16 infants with persistent diarrhea. The age range of the patients was 2 to 10 months, mean 4.8 months. All patients had diarrhea lasting 14 or more days. Bacterial overgrowth of the colonic microflora in the jejunal secretion, at concentrations above 10(4) colonies/ml, was present in 11 (68.7%) patients. The stool culture was positive for an enteropathogenic agent in 8 (50.0%) patients: for EPEC O111 in 2, EPEC O119 in 1, EAEC in 1, and Shigella flexneri in 1; mixed infections due to EPEC O111 and EAEC in 1 patient, EPEC O119 and EAEC in 1 and EPEC O55, EPEC O111, EAEC and Shigella sonnei in 1. Morphological abnormalities in the small bowel mucosa were observed in all 16 patients, varying in intensity from moderate 9 (56.3%) to severe 7 (43.7%). The scanning electron microscopic study of small bowel biopsies from these subjects showed several surface abnormalities. At low magnification (100X) most of the villi showed mild to moderate stunting, but on several occasions there was subtotal villus atrophy. At higher magnification (7,500X) photomicrographs showed derangement of the enterocytes; on several occasions the cell borders were not clearly defined and very often microvilli were decreased in number and height; in some areas there was a total disappearance of the microvilli. In half of the patients a mucus-fibrinoid pseudomembrane was seen partially coating the enterocytes, a finding that provides additional information on the pathophysiology of persistent diarrhea.

Objective.To evaluate the potential benefit of dietary supplementation of a rice-lentil (Khitchri) and yogurt diet with 3 mg/kg/d of elemental zinc (as zinc sulfate) in hospitalized malnourished children (age 6–36 months) with persistent diarrhea for 14 days.Methodology.Randomized, double-blind placebo-controlled trial.Setting.Nutrition Research Ward at the National Institute of Child Health, Karachi, Pakistan, where children were admitted for 14 days of inpatient supervised rehabilitation.Main Outcome Measures.Primary outcome: overall weight gain by day 14. Secondary outcomes: overall energy intake, stool output, time to diarrheal recovery and weight gain (≥3 days), plasma zinc, copper, prealbumin, and insulin-like growth factor-1.Results.Of 87 children randomized for supplementation with either zinc or placebo, the two groups were comparable at admission in terms of severity and duration of diarrhea, as well as nutritional and anthropometric parameters. The overall weight gain, stool volume, stool frequency, as well as the time taken for diarrheal recovery or steady weight gain, were comparable for both supplemented children and controls. Supplemented children had a significant improvement in plasma zinc levels and serum alkaline phosphatase by day 14 of therapy in comparison with controls. Plasma copper levels were low in both groups at admission and although an increase was seen in control children, levels decreased further after zinc supplementation. There was no significant difference between the two groups for hemoglobin, serum albumin, prealbumin, and plasma insulin-like growth factor-1 increments during the course of therapy. Evaluation of primary and secondary outcome criteria among the subset of children with plasma zinc levels Conclusions.Although there was satisfactory recovery in malnourished children with persistent diarrhea receiving the Khitchri-yogurt diet, there was no evidence of improved weight gain or acceleration of recovery from diarrhea with zinc supplementation. In contrast, the reduction in plasma copper levels in zinc-supplemented malnourished children suggests that caution should be exercised in supplementing severely malnourished children with zinc alone.

Cryptosporidium parvum, a leading cause of persistent diarrhea in developing countries, is a major threat to the U.S. water supply. Able to infect with as few as 30 microscopic oocysts, Cryptosporidium is found in untreated surface water, as well as in swimming and wade pools, day-care centers, and hospitals. The organism can cause illnesses lasting longer than 1 to 2 weeks in previously healthy persons or indefinitely in immunocompromised patients; furthermore, in young children in developing countries, cryptosporidiosis predisposes to substantially increased diarrheal illnesses. Recent increased awareness of the threat of cryptosporidiosis should improve detection in patients with diarrhea. New methods such as those using polymerase chain reaction may help with detection of Cryptosporidium in water supplies or in asymptomatic carriers. Although treatment is very limited, new approaches that may reduce secretion or enhance repair of the damaged intestinal mucosa are under study.

The mean +/- SEM duration of diarrheal episodes decreased from 7.1 +/- 2.2 days to 4.3 +/- 0.9 days (P < 0.05) while the incidence of diarrheal episodes remained steady (2.2 +/- 0.3 versus 2.4 +/- 0.5 episodes; P = not significant) between two three-month periods before and after the oral administration of a single large age-adjusted dose of vitamin A among children at historical risk for persistent diarrhea in an impoverished Brazilian community.

A 32-year-old woman presented with Castleman's disease associated with intestinal amyloidosis. The association of amyloidosis and Castleman's disease is very rare, with only 15 cases reported in the literature. To our knowledge, this is the second case in which persistent diarrhea and malnutrition led to the patient's death.

Diarrheal disorders in childhood are the second most common cause of child deaths worldwide. Nutritional rehabilitation is the most important factor among treatments when diarrheal disorders develop and has a general beneficial effect on the patient’s condition, intestinal function, and immune response. Breast milk is the most nutritious food for treating acute and chronic diarrhea in infants. Until now, many infant formulas have been developed, and particularly, special formulas for treating acute or chronic diarrhea are commonly used. Lactosefree formulas, soy based formulas, and hydrolyzed and amino acid-based formula are typical formulas. In general, replacement with specialized lactose-free formulations is unnecessary in children with persistent diarrhea, and it has been reported that infants that are not severely compromised have food allergy and intestinal failure. However, a general knowledge does not always applied to all populations because the genetic, economic or environmental factors are different. Physicians should know about the components and characteristics of special formulas in order to coach parents to use these formulas properly.

In an empiric approach to develop the definition of persistent diarrhea, we evaluated the relationship between diarrheal duration and risk of ensuing clinically significant decline in nutritional status, in a cohort of 395 children24 mo. Weights were obtained at the onset of diarrhea (wt I) and after three months interval (wt II). The occurrence of an adverse outcome (AO) was defined as a decline of -- 5% in NCHS weight for age (% WFA) between weights I and II or death in this interval. The risk of AO was similar for episodes of / or7 days while it was substantially higher in episodes with14 days duration (45%) than for shorter duration episodes, relative risk (RR) = 2.5 (p0.001). Relative risk remained similar for duration thresholds of 21 (2.3) and 28 days (2.6). As episode durations greater than 14 days are associated with substantial elevation of the risk of clinically cogent sequelae, such episodes may be termed 'persistent' at least in terms of poor prognostic expectations.