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Diarrhea is one of the most common diseases affecting children around the world. Diarrhea is the loss of fluids and electrolytes by defecating in the form of watery or watery stools more than 3 times a day with or without blood or mucus (Sudarti, 2015). Diarrhea is included in the top 10 disease category in Lingga Regency. The number of diarrhea at all ages in 2018 was 1665 people, data was obtained from 10 health centers in Lingga Regency. From the data of the Pancur Puskesmas, the incidence of diarrhea in children 1-5 years old has increased to 15% from 112 toddlers to 124 toddlers in 2020. Thus, the researchers wanted to examine the factors associated with the incidence of diarrhea in children under five in the working area of the Pancur Community Health Center in 2020. The sample of the study was mothers of children aged 7-59 months who met the exclusion and inclusion criteria which amounted to a large sample taken by looking at The number of population exceeds 100 then the number of samples taken is 30% of the total population (30/100 x 124 = 37 people). The sampling method in this study was purposive sampling (Ari Saryano, 2014). There is a significant relationship between maternal knowledge about diarrhea and the incidence of diarrhea in children under five years of work at the Pancur Puskesmas Health Center which is marked by a value of p = 0.011

Background Diosmectite, a natural colloidal clay, has been used worldwide for a number of approved indications, including the treatment of chronic functional diarrhea. Here, we used high-resolution whole metagenome shotgun sequencing to assess the impact of a 5 weeks administration of diosmectite (3 g/sachet, 3 sachets/day) on the fecal microbiota of 35 adults with functional chronic diarrhea. Results Gut microbiota was not impacted by diosmectite administration. In particular, richness remained stable and no microbial species displayed a significant evolution. Segregating patients either by diosmectite response (non responder, early responder, late responder) or by nationality (Great-Britain or Netherlands) yielded the same results. Conclusion We concluded that no microbiota-related physiological alterations are expected upon long-term treatment with diosmectite. Trial registration Clinicaltrials.gov NCT03045926

Aims: While bowel preparation for colonoscopy is the key to successful examination, taking laxatives and showing stools to others causes both physical and mental distress to the patient. Thus, an alternative method to evaluation bowel preparation is necessary. In the current study, we studied the colonic fecal retention by ultrasonography (US) and examined the US finding which reflected completion of BP. Material and methods: The subjects were outpatients who underwent colonoscopy. This report summarizes the ultrasonographic images of patients who underwent multiple US examinations for all five sites of the colon just before, during, and immediately after bowel preparation. According to the standard protocol, the patients took 2 L of polyethylene glycol-ascorbic acid as a laxative, which was discontinued when the nurse visually judged the stool to be clear. Results: S even patients in their 50s–80s, none of whom were unable to complete a colonoscopy due to residual feces were included in study. Following bowel preparation, the US images showed anechoic areas with haustration in four or all five areas of the colon. Three of the seven patients received low-dose laxatives (1.1–1.2 L); all three had watery stools in three or more colon areas and none of them were constipated at the time of taking 1 L of laxatives. Conclusions: Completion of bowel preparation can be assessed by the observation of anechoic areas with haustration in multiple colonic sites by ultrasonography.

Diarrhea is a very common side effect of antibiotic use. Unfortunately, this fact is often both overlooked and misunderstood by prescribers, both in terms of definitions and causes. A conventional definition of diarrhea is a change in the usual stool frequency with at least three watery stools per day. From a laboratory perspective, a diarrheal stool should conform to the shape of the container, and since Clostriodioides difficile (formerly Clostridium difficile) colonization without disease is common, formed stools should not be tested for the presence of C. difficile. Antibiotic-associated diarrhea (AAD) may occur during the course or after completion of antibiotics. The prevalence of AAD is reported as between 3.2% and 29% in various studies. The diagnosis of AAD is complicated by the fact that many things cause loose stools, including a variety of bowel-related diseases, parasites, viruses, and bacteria, as well as laxatives and drugs aside from antibiotics, dietary factors, and common underlying conditions seen in healthy people, including lactose intolerance.

Clostridium difficile (C. difficile) infection (CDI) is an increasing common healthcare-associated infection and disproportionally affects our elderly patients and patients in long-term care facilities (LTCFs) (Asempa and Nicolau, Clin Interv Aging. 12:1799, 2017). As described in other chapters of this book, patients with CDI can have multiple loose or watery stools in 1 day causing extreme dehydration, electrolyte disarray, sepsis, toxic megacolon, and even death. With the increasing prevalence and severity of CDI over the past decade, clinicians are understandably concerned when suspecting CDI in one of their patients and keen to test to see if C. difficile is present in the stool. However, the presence of C. difficile in the stool is not sufficient to diagnose CDI, and the current diagnostic tests commercially available are complex. CDI is a toxin-mediated infection and therefore, diagnostic assays often focus on the presence of toxin as a necessary component to develop infection, as opposed to colonization with non-toxigenic C. difficile strain. Nucleic acid amplification test (NAAT), enzyme immunoassay (EIA), and cytotoxigenic culture (CC) and cell cytotoxicity assay (CCTA) are available options. A multistep algorithmic approach has been recommended to utilize the above-mentioned testing. Diagnostics are challenged by decreased immune response in the elderly and delays in an LTCF setting. In this chapter, we will describe the different C. difficile diagnostic tests and their appropriate use in clinical practice in long-term care patients.

Background Lipid droplets in human milk have a mode diameter of ∼4 μm and are surrounded by a native phospholipid-rich membrane. Current infant milk formulas (IMFs) contain small lipid droplets (mode diameter ∼0.5 μm) primarily coated by proteins. A concept IMF was developed mimicking more closely the structure and composition of human milk lipid droplets. Objectives This randomized, controlled, double-blind equivalence trial evaluates the safety and tolerance of a concept IMF with large, milk phospholipid–coated lipid droplets (mode diameter 3–5 μm) containing vegetable and dairy lipids in healthy, term infants. Methods Fully formula-fed infants were enrolled up to 35 d of age and randomly assigned to 1 of 2 formulas until 17 wk of age: 1) Control IMF with small lipid droplets containing vegetable oils (n = 108); or 2) Concept IMF with large, milk phospholipid–coated lipid droplets comprised of 48% dairy lipids (n = 115). A group of 88 breastfed infants served as reference. Primary outcome was daily weight gain during intervention. Additionally, number and type of adverse events, growth, and tolerance parameters were monitored. Results Equivalence of daily weight gain was demonstrated (Concept compared with Control IMF: −1.37 g/d; 90% CI: −2.71, −0.02; equivalence margin ± 3 g/d). No relevant group differences were observed in growth, tolerance and number, severity, or relatedness of adverse events. We did observe a higher prevalence of watery stools in the Concept than in the Control IMF group between 5 and 12 wk of age (P

Background. Hypoglycaemia is a common presenting feature of illness among children admitted with various conditions into the paediatric emergency room. Objective. To determine the prevalence of hypoglycaemia among children admitted into a Nigerian teaching hospital, identify some of its associated factors and assess its relationship to patient outcome. Methods. In this cross-sectional study, 388 children were consecutively recruited. Their sociodemographic characteristics, clinical features and management outcome were obtained. Plasma glucose was measured using the glucose oxidase method and classified as hypoglycaemia (

Kotwasser bei Pferden stellt eine immerwahrende Herausforderung an praktische Tierarzte und Ernahrungsspezialisten dar. Oft gehen Therapieansatze mit eher masigem oder kurzzeitigem Behandlungserfolg einher. Das frustriert Tierarzt und Besitzer in gleichem Mase. Dabei ist vor allem die Diagnostik ausschlaggebend fur den Erfolg der Behandlung. Denn Kotwasser ist keine Krankheit, sondern nur ein Symptom fur einen fur das Pferd untragbaren Zustand. Die Frage nach dem „Warum“ also dem oder den Auslosern, muss immer vor allen Behandlungen stehen. Das sollte sich eigentlich von selbst verstehen, jedoch sieht man allzu oft als Diagnose den Begriff „Kotwasser“ und als Behandlung ein Zusatzfuttermittel, alternative Therapeutika, Hefen, Krauter oder Lebendbakterien. Dabei muss die Diagnostik bei Kotwasser ganzheitlich und tiefgreifender sein. Das bedeutet eine Kombination aus Labordiagnostik, Pravalenz- sowie Folgekettendiagnostik. Und auch die Palpation darf nicht fehlen.

Background: Diarrhoea is one of the leading causes of morbidity and mortality among under-five children. Timely management of the children with oral rehydration solution (ORS) has substantially declined the mortality and morbidity from acute infectious diarrhea. The use of ORS largely depends on the level of knowledge and attitude of mothers. Mothers’ knowledge about diarrhoea can be improved through educational interventions. The objective of the study was to assess knowledge of mothers of urban slums of Ahmedabad city of Gujarat regarding ORS and Zinc for management of diarrhoea before and after training. Methods: This Interventional study was conducted among purposively selected 100 mothers of under five children of urban slums of Ahmedabad city of Gujarat, India during June to August 2011. After taking verbal consent, baseline knowledge of mothers regarding ORS and Zinc for management of diarrhoea was assessed by pre-designed, pre-tested and semi structured questionnaire. Single educational interventional training for 45 minutes was given to selected mothers Pre and post training assessment was done by scoring method and also mean, standard deviation, Wilcoxon sign rank test were applied. Results: Almost 83% of the mothers could define diarrhoea as the passage of watery stools three or more times a day, this knowledge was significantly increased to 100% after the training. Baseline knowledge of the mothers regarding causes of diarrhoea in children, signs and symptoms of dehydration in children, Correct method of preparation of ORS and importance of zinc therapy along with ORS was 4%, 22%, 39% and 26% respectively which was significantly increased to 73%, 90%, 89% and 76% respectively after the intervention. Conclusions: Knowledge of the mothers of under-five children regarding causes of diarrhoea, signs and symptoms of diarrhoea, correct method of preparation of ORS and importance of zinc therapy along with ORS has been significantly increased after intervention.

Introduction : diarrhea is the third leading cause of hospital morbidity in children under five years in the War Memorial Hospital (WMH). With the current changes in climate, little is known about the seasonal and spatial distribution of diarrhoeal diseases in the WMH. We determined trends of diarrhoeal diseases in children under five years in the WMH. Methods : we reviewed secondary data of children under five years who attended the WMH and were diagnosed of diarrhoea. Diarrhoea was defined as a clinician’s diagnosis of the passage of three or more watery stools a day in a child under five years in the WMH. Descriptive data analysis was done and expressed as frequencies and relative frequencies. Monthly proportions of diarrhoea and rainfall figures were presented to show seasonal distributions of cases. Geographical distribution of cases was determined using Epi Info and Arc GIS. Results : a total of 865 diarrhoeal cases in children under five years reported to the hospital. Out of this, 425 (49.13%) were female children with 346 (40%) aged 0-11 months. The highest peak occurred in the rainy season from May to August. However, there was a weak negative relationship between diarrhoeal diseases and rainfall for the whole study period. Cases were clustered in the northeastern part of the Kassena Nankana Municipality (KNM). Conclusion : the most affected age group was in 0-11 months. Majority of cases were from the North Eastern part of the Municipality. There was seasonal variation of diarrhoeal diseases. Diarrhoeal diseases have the highest occurrence in the rainy season but an increase in rainfall does not necessarily lead to an increase in diarrhoeal cases. Intervention to reduce diarrhoea should be intensified before the rainy season and in the northeastern parts of the municipality.

To study feeding tolerance in infants fed formula with increased sn-2 palmitate and oligofructose ( sn-2+OF) in a real-world setting, healthy Chinese infants were enrolled in this 48-day observational study on their current feeding regimens: exclusively breastfed (BF; n = 147), exclusively sn-2+OF formula-fed (FF; n = 150), or mixed-fed with breast milk and sn-2+OF formula (MF; n = 163). Throughout the study, incidence (90% confidence interval) of hard stools was ≤2.1% (0.0-5.3) in FF and 0.8% (0.0-3.5) in MF, with no hard stools in BF. Incidence of watery stools was ≤5.0% (1.0-9.2) in FF and ≥5.1% (2.4-9.3) in MF and BF. Gastrointestinal tolerance scores, although low in all groups (lower scores indicating better tolerance), were slightly higher ( P ≥ .03) in FF (17.5 ± 4.8) and MF (18.2 ± 5.0) versus BF (16.3 ± 3.2) at mid-study; this difference disappeared at study end. Overall, low incidences of hard and watery stools and good feeding tolerance were observed in infants fed sn-2+OF formula.

Introduction The Bristol Stool Form Scale (BSS) which consists of 7 photographs of different stool forms allows assessment of stool consistency (scale 1 for hard lumps to scale 7 for watery stools), in an objective manner in adults. The BSS is also sometimes used to characterise the stools of infants and young children. Despite its use, there is general agreement among paediatric gastroenterologists that the BSS is not adequate to be used in infants and young children who wear diapers; thus, a new scale specifically designed for this population is needed. Our aim is to develop a paediatric stool scale, the Brussels Infant and Toddler Stool Scale (‘BITSS’), and to evaluate the interobserver agreement of stool assessment with the BITSS between the patient9s parent and healthcare providers (physicians and nurses). Methods and analysis This study has two phases. In the first phase, 11 key-opinion leaders in the field of paediatric gastroenterology representing different areas of the world selected seven coloured photographs of infants and/or young children wearing diapers to match the original descriptors of the BSS. The selected photographs were used to create a new scale in which the drawings of stools of the BSS were replaced by infant/toddlers stool photographs. In phase II, we aim at demonstrating that parents, nurses and primary healthcare physicians interpret the stool-pictures of the BITSS with a high degree of consensus and that the agreement is independent of whether it is a parent or a healthcare provider. Interobserver variability of stool assessment with the BITSS between the patient9s parent and healthcare providers will be assessed. Ethics and dissemination The study will be approved by the Ethics Committee of the participating centres. The findings of this study will be submitted to a peer-reviewed journal. Abstracts will be submitted to national and international conferences. Trial registration number NCT02913950.

Norovirus infection typically presents with vomiting and diarrhea in both children and adults. Since the introduction of rotavirus vaccination, it has become one of the most common causes of gastroenteritis. The spectrum of presentation includes asymptomatic infection; mild illness with or without fever and watery stools; more severe illness with fever, vomiting, headache, and constitutional symptoms; and potentially mortality, particularly in the immunocompromised. Increasingly recognized is the association of norovirus infection with benign afebrile and febrile convulsions in children, which could incur significant health care costs.

OBJECTIVE The aim of the study was to compare infants' gastrointestinal tolerance of formulas supplemented with 2 different levels of galacto-oligosaccharides (GOS) versus a control formula (CF) or human milk. METHODS Healthy, full-term infants (n = 180) were enrolled in this 3-group controlled, double-blind, multicenter study, and a concurrently enrolled, nonrandomized human milk-fed group (HM) by 8 days of age. Infants were randomized to be fed formula supplemented with either 4 g (EF4) or 8 g (EF8) GOS/L or a CF until day of life (DOL) 119. Infants were to be seen at DOL 14, 35, 56, 84, and 119. Parents were to record detailed 24-hour information about intake, tolerance to feedings, and stool patterns and consistency each day from enrollment to DOL 35, and for 3 days before DOL 56, 84, and 119. Stool consistency was scored on a 5-point scale as watery (1), loose/mushy, soft, formed, or hard (5). RESULTS The mean stool consistency score was higher in the CF group throughout the study (CF > EF8 and CF > HM for all study periods and CF > EF4 from DOL 15 to 35, P < 0.05). There was a significantly higher percentage of watery stools in the EF8 versus the CF group from study day 1 (SD 1) to DOL 14 (P < 0.05), but no differences between the groups in number of stools per day. The percentage of feedings with spit up and/or vomiting within 1 hour after feeding was significantly lower for HM versus EF8 and CF from SD 1 to DOL 14 (P < 0.05). CONCLUSIONS In this clinical study, milk-based term infant formula (Similac Advance) with 4 g GOS/L was well-tolerated in terms of stool consistency and additional measures of gastrointestinal tolerance by newborn infants through the first 4 months of life.

The objectives of this study were to determine whether the symptoms of diarrhea (defined as loose or watery stools), constipation (hard or lumpy stools), abdominal pain, and bloating occur in episodes rather than sporadically in patients with irritable bowel syndrome (IBS); to identify rules for defining the onset and termination of symptom episodes; and to assess the overlap of these episodes.IBS patients kept a symptom log in which they rated the consistency of each bowel movement (BM) on the Bristol Stool Scale for 3 months. Each night they transferred these data to an internet website and also rated abdominal pain and bloating for that day. Data were analyzed for 124 patients who completed at least 21 consecutive diary days (mean of 73 days) without taking laxative, antidiarrheal, or IBS-specific medications. For each symptom in each patient, we computed the correlation between consecutive observations (autocorrelations) in the diary to determine whether the symptom tended to occur in clusters of several instances, as would happen in episodes vs. happening randomly. Next, we compared different patterns by which diarrhea and nondiarrhea stools alternate to identify episode definitions that captured at least 75% of loose/watery stools. A similar pattern analysis was performed for constipation. Pain and bloating episodes were defined as days with an intensity rating3 on a 0-10 scale. These patterns were converted into rules for defining the onset and termination of symptom episodes. Last, we used these episode definitions to examine the overlap of pain with episodes of diarrhea, constipation, and pain.Significant (P0.05) autocorrelations were found in the Bristol Stool Scale ratings of 69.4% of patients and in the daily abdominal pain and bloating ratings of 52.4% and 68.5% of patients, respectively. Defining a diarrhea episode as two or more loose/watery stools never separated by1 nonloose/watery stool or by a day without a BM captured 76% of all loose/water stools. Defining constipation episodes as two or more hard/lumpy stools never separated by1 nonhard/lumpy stool captured 80% of hard/lumpy stools. Sequences of 3 or more days without a BM were also defined as constipation episodes because they were strongly associated with hard stools. Average episode durations were 2.1 days for diarrhea, 4.5 days for constipation, 3.1 days for pain, and 3.5 days for bloating. Overlap analysis showed that only 41.6% of constipation episode days and 67.0% of diarrhea episode days were pain episode days. Bloating and pain coexisted on 59.1% of days on which either type occurred.Loose/watery stools and hard/lumpy stools occur in well-defined episodes. Pain and bloating also occur in episodes, but contrary to the Rome criteria more than half of the pain episodes occur outside episodes of abnormal stool consistency.

espanolEl colera es una enfermedad infectocontagiosa intestinal y aguda causada por los serotipos O1 y O139 de la bacteria Vibrio cholerae que se caracteriza por cursar con una diarrea secretoria caracterizada por deposiciones semejantes al "agua de arroz" por su elevada cantidad de sodio, bicarbonato y potasio y la escasa cantidad de proteinas. En su forma grave, se caracteriza por una diarrea acuosa de gran volumen que lleva rapidamente a la deshidratacion y al fallecimiento del paciente. Entre el resto de las infecciones causadas por Vibrio spp. distintas del colera destacan las septicemias e infecciones de la piel y partes blandas ocasionadas por la ingesta de pescado o marisco contaminado por Vibrio vulnificus, incluso en ocasiones por la ingesta de agua salada de mar contaminada, cuadro de extrema gravedad en pacientes inmunodeprimidos y cirroticos que puede tener un curso fatal. EnglishCholera is a contagious and acute intestinal infectious disease caused by Vibrio cholerae, serotypes O1 and O139, which characterizes by a secretory diarrhea with "rice watery stools" because of their high amount of sodium, bicarbonate and potassium and the low amount of proteins. In its severe form, it is distinguished by the large volume of watery diarrhea that quickly leads to dehydration and patient's death. Among other infections caused by non- cholera Vibrio spp. it is important to mention a clinical picture of septicemia and skin and soft-tissue infection caused by eating fish or shellfish (or even by drinking salty seawater) contaminated with Vibrio vulnificus. The bacteria cause a very severe infection which might have a fatal prognosis in immunocompromised and cirrhotic patients.

The clinical course of IBS is chronic, although symptoms vary and oscillate not only between subtypes, but also within the same patient over time. Overall, women are twice as likely as men to suffer from constipation-associated symptoms such as bloating, straining, abdominal distension and feelings of incomplete evacuation. Men in turn, tend towards diarrhea-associated symptoms, including watery stools, enhanced stool frequency, abdominal pain and bloating. Irrespective of the subtype, patients suffering from IBS tend to exhibit psychiatric and psychosocial disturbances, they are more vulnerable to stress and generally exhibit a high degree of abnormal illness behaviour. The current chapter summarizes major clinical features that are linked to the particular subtype of IBS. We also put interest on factors such as gender differences or lifestyle that may predispose to the occurrence of IBS symptoms.

Objective: To determine the incidence of urinary tract infections (UTIs) in infants and children (4 months to 6 years of age) with febrile diarrhea, as outpatients. Methods: This was a prospective institutional review board–approved study. patients (between 4 months and 6 years of age) were enrolled in the study who presented to the pediatric emergency room with a complaint of fever (rectal temperature 101°F or more) and diarrhea (watery stools >3 in number). The patients were evaluated for state of hydration, and also urine samples were collected. For those children not toilet trained, urine specimens were collected by bladder catheterization, and for those children toilet trained, urine specimens were obtained by midstream collection method. The urine samples obtained were sent for analysis and culture. Results: Eighty patients were enrolled in the study. The number of specimens obtained by clean catch midstream was 20, and by bladder catheterization was 60. None of the urine specimens obtained by both methods of collection grew any organism. There was no increased incidence of infections in male children whether circumcised (10/60) or uncircumcised (50/60). The mean temperature was 102.8°F (range = 101°F to 105°F). Statistics: Using in silico online 2 × 2 χ2 test by comparing both the positive and negative urine culture results, 2-tailed P value is

A young man in his 20s with a 1 -year history of Crohn's disease, presented with severe abdominal pain, constipation, vomiting, 20 pound weight loss and 5–6 persistent watery stools per day. Three months prior to his presentation, the patient had received treatment with Humira, however, due to the loss of his job and lack of finances, he had not received subsequent treatment. Laboratory values were significant for an elevated C-reactive protein of 25 mg/L (0–4.9 mg/L), and an erythrocyte sedimentation rate of 16 mm/h. An abdominal/pelvic contrast-enhanced MRI enterography revealed multiple enteroenteric fistulas and distention of …

Resistant glucan mixture (RGM), a water-soluble dietary fiber produced by the random polymerization of glucose with activated carbon as a catalyst at a high temperature, has been recently developed by our group. There has been little physiological and safety research into RGM and therefore we now present our research into its safety. A reverse mutation assay indicated that RGM is not mutagenic either with or without metabolic activation. We conducted a 90-day subchronic oral toxicity study in rats. Male and female rats fed either a 3% or 5% w/w RGM diet had no muddy or watery stools, and there was no RGM-related death in any group. Although some parameters in the 3% and 5% w/w groups were significantly different from those in the control group, these changes were not due to any toxicity from RGM. The results indicated that the No Observed Adverse Effect Level (NOAEL) of RGM was 3.3 and 3.9 g/kg body weight (BW) per day in male and female rats, respectively. We then studied the gastrointestinal effects of RGM in healthy adult humans. Gastrointestinal symptoms, such as gurgling sounds, flatus and tenesmus, were mild and transient. In men and women, the maximum no-effect dose for diarrhea was more than 0.9 g RGM /kg BW. The results of our current safety assessment studies suggest that RGM is safe for human consumption.

A partially-breastfed male baby aged 11 months and 22 days was admitted as he had been passing loose stools since birth and had experienced occasional vomiting and failure to thrive. He passed watery stools 8-10 times per day, but there was no blood or mucous. The parents were healthy and their marriage was nonconsanguineous. The antenatal and birth history included polyhydramnios and premature delivery at 35 weeks of gestation. The baby's birthweight was 2.3kg (P23). He was hospitalised several times for persistent diarrhoea before coming to our hospital, but had no episodes of intestinal pseudo-obstruction. He always had to take medication, such as oral rehydration salts and Smectite. This article is protected by copyright. All rights reserved.

Four hundred stool samples (76 watery and 324 soft-formed) obtained from children attending three hospitals in Funtua Local Government Area of Katsina State were examined for Cryptosporidium oocysts. A structured questionnaire was administered to determine the factors that enhance the prevalence of infection. Stool samples were examined for Cryptosporidium oocysts using formol-ether concentration technique and the modified Ziehl Neelson staining technique. The overall prevalence of infection obtained was 4%. The results showed that 10.5% watery stools and 2.5% soft-formed stools contained Cryptosporidium oocysts (p 0.05). More male children were infected (4.9%) than females (3.2%), but the difference was not statistically significant (p>0.05). Infection was more prevalent in children who defaecated in open fields than those who used pit latrines and water closets (p>0.05). This study showed that source of drinking water, eating of food served in the same plate, washing of hands prior to eating, washing of fruits and vegetables before eating, washing of hands after use of toilet, contact with animals as well as other children did not influence Cryptosporidium infection.Keywords: Cryptosporidium; immunocompetent; immunocompromised; microvilli.

A 40-year-old woman presented with diarrhea, reporting to her physician that she had been having loose stools for 2 years, with 4 to 5 bowel movements per day, progressing over the previous 6 months to 15 large-volume, watery stools daily, including nocturnal stools.

We studied 1,179 North American travelers who visited Mexico from 2005 to 2007. Travelers' diarrhea (TD) was reported by 521 (44%) participants. Among subjects with TD, 218 cases were examined for cryptosporidiosis by polymerase chain reaction (PCR) and enzyme-linked immunoassays (ELISA). There were 14 (6%) cases of cryptosporidiosis and 141 cases (64%) of bacterial diarrhea. Compared with bacterial diarrhea, a longer stay in Mexico was a risk factor for cryptosporidiosis. Additionally, Cryptosporidium cases passed greater number of watery stools (P0.05), suffered more episodes of diarrhea (Por = 0.05), and were more likely to experience tenesmus (Por = 0.05) compared with bacterial causes of TD. ELISA detected seven (3%) cases of Cryptosporidium, whereas PCR identified an additional seven cases (6%). Speciation by 18SrRNA sequencing showed that 13 cases were caused by C. parvum and only 1 case was caused by C. hominis. ELISA showed a sensitivity of 50% and specificity of 100% compared with PCR.

All cases of diarrhea involve increased fecal excretion of water. Understanding the mechanisms of infectious diarrhea requires review of the physiology of water and electrolyte absorption. Every day, 8 to 9 liters of fluid flow into the intestine, most of it reabsorbed in the small bowel. There are 2 main types of infectious diarrhea: secretory noninvasive diarrhea, such as cholera, due to impairment of water absorption mechanisms in the small bowel and inducing watery stools and dehydration; and enteroinvasive diarrhea, due to alteration of the colonic mucosa, inducing dysentery. Most cases of infectious diarrhea are acute. Some pathogens, mainly parasites, can induce chronic diarrhea. A HIV serology is then warranted. Some patients develop chronic irritable bowel syndrome after acute gastroenteritis.

Background: On 31st August, 2014, eighty cases of the gastroenteritis were reported in Ghallour sub-centre area. We investigated the outbreak to identify the source, propose control and preventive measures. Materials and methods: We defined a case as occurrence of three or more watery stools with or without vomiting, w.e.f 27 January, till 2nd Feb2014 in residents of Ghallour sub-centre area of Jawalamukhi Block. We hypothesized it as a water borne outbreak. We determined age and sex specific attack rate. We collected information about personal history on age, sex, residence, and date of onset of symptom from case patient and established line list. We collected 9 stool samples/rectal swabs from the cases; 3 pre and 4 post chlorination water samples and sent them for microbiological testing. We mapped water supply pipelines of the area and reviewed water chlorination record. Results: We identified 390 cases. The overall attack rate was 8% with range of 1.3% to 36%. The cases patients were reported from all age groups and both the genders with the youngest student; 1 year old to the oldest one as 88 years. Two thirds of the cases reported vomiting with some complaining of pain abdomen. Villages like Jathman, Khattni, Rajol Patta, Kohara has 100% case patients of loose motions while villages like Dhroli, (100%), Sasan (63%) and Ghallour (50%) etc have combined symptoms of loose motions and vomiting. No fatality was reported. Escherichia coli was detected in the samples from water samples. Records of chlorination were not properly maintained. Conclusion/recommendation: The outbreak was caused due to contamination of water at the source in Jolly Khad. Regular treatment of the water needs to be done right at the source before being lifted.

Diarrhoea may be defined as frequent passage of loose stools or, more accurately, passage of an increased volume of stool water. A stool volume of more than 200 ml/m2/day indicates diarrhoea, as does a stool weight of more than 150-200 g watery stool/m2/day. Such precise measurements are difficult to achieve in children, and infants would have to be admitted to a metabolic unit. Therefore, more practical definitions are required. • Diarrhoea in infancy and early childhood may be defined as an increase in stool frequency associated with a change to loose or watery stools. • It must be remembered that normal breast-fed infants may pass frequent loose stools. Diarrhoea in a breast-fed infant is defined as a departure from the normal stool pattern with increased volume and frequency. • Acute diarrhoea may be defined as diarrhoea of less than 2 weeks' duration. • Chronic diarrhoea is that of more than 2 weeks' duration. Diarrhoea in infancy and childhood has many causes, which vary geographically. Repeated bacterial infection is important in chronic diarrhoea in the developing world, but an uncommon cause in developed countries in the absence of underlying immunodeficiency. Rare intractable diarrhoea syndromes may require long-term parenteral nutrition, or even small intestinal transplantation.

Cholera, a known diarrheal disease is associated with various risk factors like hypovolemic shock, rice watery stools, and death in developing countries. The overuse of antibiotics to treat cholera imposed a selective pressure for the emergence and spread of multi-drug resistant Vibrio cholerae strains. The failure of conventional antimicrobial therapy urged the researchers to find an alternative therapy that could meddle the cholera murmurs (Quorum Sensing). It seems to effectively overcome the conventional cholera therapies in parallel to decrease the morbidity and mortality rate in the developing countries. The paramount objective of this review essentially focuses on the different Quorum Sensing (QS) regulatory switches governing virulence and pathogenicity of Vibrio cholerae. This review also provides an insight into the plausible QS targets that could be exploited to bring about a breakthrough to the prevailing cholera therapy.

A 27-year-old Caucasian male presented with a one-month history of diarrhoea, severe abdominal cramping, heartburn and weight loss. The symptoms began right after breakfast in the morning and continued with 3–4 watery stools throughout the day, but none during the night. Spicy foods, alcoholic beverages and excessive water intake seemed to exacerbate the pain, but soda seemed to alleviate it. The patient denied use of antibiotics, antispasmodics, or antihypertensive drugs, and drank minimal milk. The patient denied any recent international travel or contact with diapers or ill persons but confirmed that the symptoms started about a week after a river trip. There was no known family history of GI disease. …

Chronic Third and Fourth Degree Perineal Tear Following Obstetric Trauma- A Case Series This is a study conducted on 6 cases of chronic perineal tear repaired at vydehi institute of medical sciences and research centre. The cases were analyzed with respect to risk factors, method of surgery and outcome after surgery. Results: Out of 6 cases studied 2 had incontinence for both watery stools and solid stools. Out of 6 cases studied 4 were incontinent only for watery stools and all were incontinent for flatus. Immediately following surgery all were continent for solid stools and 2 were incontinent for watery stools and flatus. At the end of 6 months all the patients were continent for solid and watery stools and only one patient was incontinent for flatus.

I believe there are four essential elements in the management of patients with irritable bowel syndrome (IBS): to establish a good physician-patient relationship; to educate patients about their condition; to emphasize the excellent prognosis and benign nature of the illness; and to employ therapeutic interventions centering on dietary modifications, pharmacotherapy, and behavioral strategies tailored to the individual. Initially, I establish the diagnosis, exclude organic causes, educate patients about the disease, establish realistic expectations and consistent limits, and involve patients in disease management. I find it critical to determine why the patient is seeking assistance (eg, cancer phobia, disability, interpersonal distress, or exacerbation of symptoms). Most patients can be treated by their primary care physician. However, specialty consultations may be needed to reinforce management strategies, perform additional diagnostic tests, or institute specialized treatment. Psychological co-morbidities do not cause symptoms but do affect how patients respond to them and influence health care-seeking behavior. I find that these issues are best explored over a series of visits when the physician-patient relationship has been established. It can be helpful to have patients fill out a self-administered test to identify psychological co-morbidities. I often use these tests as a basis for extended inquiries into this area, resulting in the initiation of appropriate therapies. I encourage patients to keep a 2-week diary of food intake and gastrointestinal symptoms. In this way, patients become actively involved in management of their disease, and I may be able to obtain information from the diary that will be valuable in making treatment decisions. I do not believe that diagnostic studies for food intolerances are cost-effective or particularly helpful; however, exclusion diets may be beneficial. I introduce fiber supplements gradually and monitor them for tolerance and palatability. Synthetic fiber is often better-tolerated than natural fiber, but must be individualized. In my experience, excessive fiber supplementation often is counterproductive, as abdominal cramps and bloating may worsen. Antidiarrheal agents are very effective when used correctly, preferably in divided doses. I use them in patients in anticipation of diarrhea and especially in those who fear symptoms when engaged in activities outside the home. I encourage patients to make decisions as to when and how much to use. However, almost always, a morning dose before breakfast is used (loperamide, 2 to 6 mg) and, perhaps again later in the day when symptoms of diarrhea are prominent. I prefer antispasmodics to be used intermittently in response to periods of increased abdominal pain, cramps, and urgency. For patients with daily symptoms, especially after meals, agents such as dicyclomine before meals are useful. For patients with infrequent but severe episodes of unpredictable pain, sublingual hyoscyamine often produces rapid relief and instills confidence. In general, I recommend that oral antispasmodics be used for a limited period of time rather than indefinitely, and generally for periods of time when symptoms are prominent. For chronic visceral pain syndromes, I recommend small doses of tricyclic antidepressants. These agents are especially effective in diarrhea-predominant patients with disturbed sleep patterns but may be unacceptable to patients with constipation. I educate patients that side effects occur early and benefits may not be apparent for 3 to 4 weeks. I consider using SSRIs in low doses in patients with constipation-predominant IBS; cisapride, 10 to 20 mg three times per day, also may be beneficial. When taken with drugs that inhibit cytochrome P450, cisapride has been associated with serious cardiac arrhythmias caused by QT prolongation, including ventricular arrhythmias and torsades de pointes. These drugs include the azole fungicides; erythromycin, clarithromycin, and troleandomycin; some antidepressants; HIV protease inhibitors; and others. In patients with IBS with mild to moderate co-morbid depression, I have found that the use of SSRIs such as paroxetine, fluoxetine, or sertraline may be beneficial. It is important to tell patients that anxiety and disturbed sleep may occur during the first 10 days and benefits may not occur for 3 to 4 weeks. I prescribe a small amount of a short-acting benzodiazepine such as alprazolam, 0.5 mg two times per day, to control these symptoms. For generalized anxiety without depression, buspirone or clonazepam may be useful. I have found that patients who also have associated panic disorder may benefit from a benzodiazepine, tricyclic antidepressant, or an SSRI. However, these patients are best managed in conjunction with a psychiatrist or psychologist. I consider the use of alternative therapies in patients who fail to respond to conventional measures and who are receptive to alternative strategies. These include general relaxation techniques such as biofeedback and hypnosis therapies.

SummaryWhat is known and objective Correction of acute hypophosphatemia leaves no long-term complications, but failure to recognize and treat an acute situation can be fatal. Case summary A 65-year-old female presented to the Emergency department with complaints of abdominal pain, multiple episodes of watery stools and vomiting for 3 days. On the 3rd day, she developed abdominal distension and breathlessness and was referred to this hospital for further management and finally diagnosed with hypophosphatemia. What is new and conclusion As hypophosphatemia is often underestimated, this case report emphasizes the importance of correcting hypophosphatemia in all critically ill patients.

In a survey of five villages in the Eastern Highlands of Papua New Guinea, Serpulina pilosicoli was isolated from rectal swabs from 113 of 496 individuals (22·8%). Colonization rates ranged from 22·6–30·1% in four of the villages but was only 8·6% in the other village. In comparison colonization was demonstrated in only 5 of 54 indigenous people (9·3%) and none of 76 non-indigenous people living in an urban environment in the same region. Colonization did not relate to reported occurrence of diarrhoea, age, sex, or length of time resident in a village. A second set of 94 faecal specimens was collected from 1 village 6 weeks after the first set. S. pilosicoli was isolated from 27 of 29 individuals (93·1%) who were positive on the first sampling and from 7 of 65 individuals (10·8%) who previously were negative. In this case, isolates were significantly more common in watery stools than in normal stools. The annual incidence of infection in the village was calculated as 93·6%, with an average duration of infection of 117 days. S. pilosicoli could not be isolated from any village pig (n=126) despite its confirmed presence in 17 of 50 commercial pigs (34·0%) sampled at a local piggery. Four of 76 village dogs (5·3%) and 1 of 2 village ducks were colonized with S. pilosicoli, suggesting the possibility of cross transmission between humans and animals.

The antigenecity and nutritional adequacy of N-253 formula, a partly hydrolyzed formula, were evaluated in high risk infants with a family history of atopy, on immunological and hematological parameters, weight gain, clinical conditions and stool characteristics; during the first four months of life. Its effects were compared with those observed in infants taking a conventional infant formula and breast-fed infants, There were no changes in serum IgE, cow's milk specific IgG, cow's milk-specific IgG4 concentrations and the number of eosinophils in the N-253 formula-fed infants during the study period. Whereas, those parameters were increased in infants fed with the conventional infant formula and in breast-fed infants. Positive RAST against cow's milk was not detected in the N-253 formula-fed infants (0/33), while it was detected in conventional infant formula-fed infants (2/13). Green and watery stools were observed more frequently in the N-253 formula-fed infants than in the conventional infant formula-fed infants. Weight gain and hematological values were within normal ranges in all three groups during the study period. These results suggest that the antigenecity of cow's milk is reduced in N-253 formula and that N-253 formula has nutritional efficacy for infants.

BACKGROUND: Watery stools are equated with rapid and hard stools with slow intestinal transit; however, the relation between stool form and transit through specific regions of the gut is not clear cut. In addition, more information is needed on interindividual variability of these measurements. AIM: To examine the relations between stool form and gastric emptying, small bowel and colonic transit. METHODS: Regional gut transit was assessed scintigraphically and segmental colonic transit was also quantified by radio-opaque markers. On two occasions, 32 healthy volunteers (12 men, 20 women) were studied, women during the follicular and luteal phases of menstruation, men twice within a similar four week period. Diets were standardised and stool form was recorded on a seven point scale. RESULTS: Women had significant harder stools; hard stools were correlated significantly with slow transit and loose stools with fast transit through the colon. CONCLUSIONS: Stool form could not be related to gastric emptying or small bowel transit.

1.1 Diarrhoea is a global problem Diarrhoea is one of the most common causes of morbidity and mortality in children worldwide. The word diarrhoea is derived from the Greek "diarrhoia", meaning to flow through. In clinical terms, diarrhoea refers to either an increased stool frequency or a decreased stool consistency, typically a watery quality. The World Health Organization (WHO) defines a case as the passage of three or more loose or watery stools per day. Nevertheless, absolute limits of normalcy are difficult to define; any deviation from the child's usual pattern should arouse some concern (particularly when the passage of blood or mucus, or dehydration occurs) regardless of the actual number of stools or their water content. Diarrhoeal illness is the second leading cause of child mortality; among children younger than 5 years, it causes 1.5 to 2 million deaths annually. In 1982, on the basis of a review of active surveillance data from studies conducted in the 1950s, 1960s and 1970s, it was estimated that 4.6 million children died annually from diarrhoea. In 1992, a review of studies conducted in the 1980s suggested that diarrhoeal mortality had declined to approximately 3.3 million annually. It was noted that children in the developing world experienced a median of between two and three episodes of diarrhoea every year. Where episodes are frequent, young children may spend more than 15% of their days with diarrhoea. About 80% of deaths due o diarrhoea occur in the first two years of life. The main cause of morbidity from acute diarrhoea is dehydration, which results from loss of fluid and electrolytes in the diarrhoeal stools. In severe cases this could lead to vascular collapse, shock and eventually death. Other causes of death include malnutrition from loss of nutrients from the stool, effects of infection on metabolism and the withholding or modification of food during diarrhoea which is a common practice. Diarrhoeal illnesses may have a significant impact on psychomotor and cognitive development in young children. Early and repeated episodes of childhood diarrhoea during periods of critical development, especially when associated with malnutrition, co-infections, and anemia may have long-term effects on linear growth, as well as on physical and cognitive functions. Worldwide childhood death secondary to diarrhoea declined from an estimated five million per year in 1980 to less than two million in 1999. The decline is generally attributed to global

A survey of laboratory diagnosis of Clostridium difficile infection (CDI) was conducted in 103 Spanish hospitals. A mean of 23.2 stool specimens/1000 admissions were processed to detect CDI. Overall, 35.9% of the laboratories specifically selected stool specimens for diagnostic C. difficile toxin testing. The most commonly used criteria were loose or watery stools, previous antibiotic therapy and nosocomial diarrhoea. Most laboratories (95.1%) processed the stool specimens in house, mainly five to seven days/week. All laboratories except one detected toxins directly in stool specimens, and 94.9% used enzyme immunoassays (EIAs). Only 16.3% of the laboratories used toxigenic culture as a diagnostic tool, and most of them used EIAs to detect toxins in isolates. The most common diagnostic strategy was toxin detection in stool specimens using EIA alone (79.6%), and the second most common strategy was the combination of toxin detection in stool specimens and isolates (10.2%). The estimated annual incidence of CDI was 1.71 cases/1000 admissions, and this was significantly higher in large hospitals. CDI is underdiagnosed in Spain because most laboratories use EIAs performed directly on stool specimens as the only diagnostic procedure. A national laboratory survey of diagnostic methods and testing protocols for the diagnosis of CDI is simple and inexpensive, and could act as the first step towards implementing national standardized criteria for optimal diagnosis of CDI.

Samuel, a 24-year-old British, man attends a Gay Man’s Sexual Health clinic for investigation of troublesome diarrhea. For the preceding 10 days he has been passing loose watery stools about five times per day. The stools are offensive, float on the surface of the water in the toilet, and are difficult to flush away. He has not, however, noticed blood, pus, or mucus in the stools. His appetite has been poor, and he has had some upper abdominal discomfort with increased flatulence. He is otherwise symptomless, in particular he has not felt feverish. He has not traveled outwith the United Kingdom within the past 2 years. There is no past history of gastrointestinal disorders. He has been fully immunized against hepatitis A and B.

The intestinal colonization rate of Aeromonas spp. was determined for 52 cesarean-born Peruvian neonates. Rectal swabs were obtained daily from newborns during their postdelivery hospitalization (mean = 5.5 days), and the gross appearances of their feces (blind determinations) were recorded. Aeromonas spp. were recovered from rectal swabs of 12 of 52 (23.1%) infants during their first week of life; the isolates were obtained from 5 of 9 (55.6%) infants with at least one stool with a watery consistency and from 7 of 43 (16.3%) neonates with no watery stools (P = 0.022). None of the infected infants became clinically ill. No other commonly recognized enteropathogens were detected in watery stools. An environmental survey indicated that hospital water was the probable source of infection. These and other data indicated that Aeromonas colonization occurs transiently at a very early age in Peruvian neonates and that in some instances, initial infection may be followed several days later by one or more watery stools of normal volume.

Congenital chloride diarrhoea (CCD) usually presents with abdominal distension, visible peristalsis and watery stools from birth that show chloride loss of more than 90 mmol/l. It may mimic low intestinal obstruction on antenatal ultrasound scanning after 30 weeks' gestation. This condition has been reported mainly from Finland. We report a case of CCD in a Saudi boy which was suspected antenatally, confirmed post-natally and managed successfully.

Background: On August 31, 2014, eighty cases of the gastroenteritis were reported in Ghallour sub-center area. We investigated the outbreak to identify the source, propose control, and preventive measures. Materials and Methods: We defined a case as occurrence of three or more watery stools with or without vomiting, w.e.f January 27, till February 2, 2014 in residents of Ghallour sub-center area of Jawalamukhi block. We hypothesized it as a water borne outbreak. We determined age and sex specific attack rate. We collected information about personal history on age, sex, residence, and date of onset of symptom from case patient and established line list. We collected nine stool samples/rectal swabs from the cases; three pre and four post chlorination water samples and sent them for microbiological testing. We mapped water supply pipelines of the area and reviewed the water chlorination record. Results: We identified 390 cases in 16 villages under the sub center. The overall attack rate was 8% with a range of 1.3% to 36%. The cases patients were reported from all age groups and both the genders with the youngest student; 1-year old to the oldest one as 88 years. Two-third of the cases reported vomiting with some complaining of pain abdomen. Villages like Jathman, Khattni, Rajol Patta, Kohara has 100% case patients of loose motions while villages like Dhroli, (100%), Sasan (63%) and Ghallour (50%), etc., have combined symptoms of loose motions and vomiting. No fatality was reported. Escherichia coli was detected in the samples from water samples. Records of chlorination were not properly maintained. Conclusion / Recommendation: The outbreak was associated due to contamination of water at the source in Jolly Khad. Regular treatment of the water needs to be done right at the source before being lifted.

Background and aims Formula containing increased sn- 2 palmitate with oligofructose ( sn- 2+OF) may improve stool consistency. We hypothesised that hard and watery stool incidence among infants fed α-lactalbumin-enriched formula with sn -2+OF would be ≤2.5% (upper limit of 80% CI Methods Healthy term infants ( n = 4 40) aged ~42 days were enrolled in this 48-day study on their current feeding regimens: formula-fed ( n = 1 42), HM-fed ( n = 1 43), or mixed-fed ( n = 1 55). Stool consistency was assessed at 4 visits using a 3-day diary with validated 5-point scale (1 = watery, 5 = hard). Gastrointestinal (GI) tolerance was assessed using a validated questionnaire (score range = 13–65; lower values indicate better tolerance). Results Incidence of hard stools across visits ranged from 0.7% [80% CI: 0.1–2.7] to 2.1% [0.8–4.6] for formula-fed infants, with incidence rates ≤0.8% in mixed-fed, and no hard stools reported in HM-fed groups. Incidence of watery stools ranged from 2.8% [1.2–5.4] to 5.0% [2.8–8.3] for formula-fed infants, which was lower than the incidence rates for mixed-fed (≤8.2%) and HM-fed (≤16.3%) groups. Stool consistency score (2 = runny, 3 = mushy soft) of formula-fed infants (2.9) was higher than HM-fed infants (2.4–2.5; p Conclusions Formula with sn -2+OF fed to Chinese infants results in soft stools and low incidence of hard and watery stools. Low GI tolerance scores indicate the formula is well tolerated.

Soy fiber has been shown to reduce the duration of watery stools during acute diarrhea caused by bacterial and viral pathogens in underdeveloped countries. A randomized blinded clinical trial was conducted with middle-class American children to assess the efficacy of soy fibersupplemented infant formula. Stool characteristics, intake, and weight were recorded. Infants >6 months of age (n = 44) fed soy fiber-supplemented formula (Isomil DF) had a significantly shorter estimated median duration of diarrhea (9.7 hours vs. 23.1 hours) than those fed soy formula (Isomil). The use of fiber-supplemented soy formula may reduce the duration of diarrheal symptoms in U. S. infants more than 6 months of age with acute diarrhea.

Minimization of side effects of immunosuppressive therapy after pediatric heart transplantation is an important objective of aftercare. Not only various medications and foods but also gastrointestinal problems can cause increased peak levels of immunosuppressants. Especially, tacrolimus is well known for elevated levels during diarrhea (1Y3). In the follow-up care of pediatric heart transplanted patients, the new immunosuppressant everolimus is increasingly used. However, the influence of diarrhea on everolimus blood levels has not been evaluated yet. We report about two patients with elevated everolimus levels during severe diarrhea with at least two watery stools per day.

Serotyping of Vibrio cholerae is based on the somatic '0' antigen. Cholera is caused by the 01 serotype ev. cholerae 01), and there were pre­ viously a total of 138 serotypes identified. A new serotype of V. cholerae has recently been identified as the pathogen responsible for explosive outbreaks of severe dehydrating diarrhoea in India and Bangladesh. This has been designated V. cholerae 0139. [1] Since it produces an illness that is clinically indistinguishable from cholera, it is considered to be another serotype of V. cholerae that can cause cholera.[2] The synonym 'Bengal' has been proposed because the serotype was first isolated along the Bay of Bengal. Replacement of fluid and electrolyte losses is the most important part of tbe management of patients with cholera caused by V. cholerae 01 or V. cholerae 0139. Treatment of cholera due to V. cholerae 01 with effective antimicrobials has been useful in shortening the duration of diarrhoea and faecal excretion of the pathogen, and in reduc­ ing the volume of watery stools, with subsequent decreased requirement for rehydration fluids. This randomised clinical trial was conducted at the Diarrhoea Treatment Centre of the Interna­