Pengaruh Suplementasi Seng Dan Probiotik Pasca Perawatan Diare Akut Cair Anak Terhadap Kejadian Diare Berulang

Background. Diarrhea remains a major health problem among children under five years old in developing countries due to its high morbidity. Prevention of diarrhea is needed to reduce the high incidence. Zinc has a function to shorten duration of diarrhea and the use of probiotics preventing and treat acute diarrhea. Objective. To prove effect of zinc and probiotic suplementation on the incidence of recurrent acute watery diarrhea in children aged 6-24 months post-hospitalization. Method. Seventy five subjects aged 6-24 months with acute diarrhea in Dr. Kariadi Hospital, the subject of study I, was observed. The subjects were randomly divided into four groups and received treatment in the form of zinc supplementation, supplementation with probiotics, or a combination of zinc and probiotics and one group as control. Each group received the standard form of rehydration therapy and dietetic. Survival analysis was used to analyze the incidence of recurrent diarrhea and Kruskal wallis was used to analyze the difference of frequency and duration of recurrent diarrhea between four groups. Result. The group who received zinc in conjunction with probiotics had mean recurrent of diarrhea longer than the other three groups (10.94 weeks 95% CI 9.24 - 12.65). There was no statistically significant difference in the mean survival of diarrhea in the four groups (p = 0.892). No significant differences in frequency and duration of recurrent diarrhea in four groups at first, second and third month postsupplementation. Conclussion. There were no significant differences between groups of zinc, probiotics and a combination of zinc and probiotics on the average recurrent diarrhea, duration and frequency of diarrhea. Keyword : acute watery diarrhea, recurrent diarrhea, zinc, probiotic

Cryptosporidium, Enterocytozoon, and Cyclospora Infections in Pediatric and Adult Patients with Diarrhea in Tanzania.

Cryptosporidiosis, microsporidiosis, and cyclosporiasis were studied in four groups of Tanzanian inpatients: adults with AIDS-associated diarrhea, children with chronic diarrhea (of whom 23 of 59 were positive [+] for human immunodeficiency virus [HIV]), children with acute diarrhea (of whom 15 of 55 were HIV+), and HIV control children without diarrhea. Cryptosporidium was identified in specimens from 6/86 adults, 5/59 children with chronic diarrhea (3/5, HIV+), 7/55 children with acute diarrhea (0/7, HIV+), and 0/20 control children. Among children with acute diarrhea, 7/7 with cryptosporidiosis were malnourished, compared with 10/48 without cryptosporidiosis (P < .01). Enterocytozoon was identified in specimens from 3/86 adults, 2/59 children with chronic diarrhea (1 HIV+), 0/55 children with acute diarrhea, and 4/20 control children. All four controls were underweight (P < .01). Cyclospora was identified in specimens from one adult and one child with acute diarrhea (HIV-). Thus, Cryptosporidium was the most frequent and Cyclospora the least frequent pathogen identified. Cryptosporidium and Enterocytozoon were associated with malnutrition. Asymptomatic fecal shedding of Enterocytozoon in otherwise healthy, HIV children has not been described previously

Employment, Knowledge and Latrine Ownership as Risk Factors and Prediction Model of Diarrhea Incidence

Diarrhea is a leading cause of death ranked 3rd after Tuberculosis and Pneumonia in Indonesia. Diarrhea cases in NTT province and also in Kupang City is still high, with Pasir Panjang PHC in 2012 and 2013 ranked the top three, while Oepoi PHC always the lowest rank. This research was conducted to analyze the risk factors for the incidence of diarrhea and create a model equation to predict the diarrhea incidence. This observational analytic research using case control design. Samples with diarrhea cases were recorded in January - June 2015 in the register book Pasir Panjang PHC and Oepoi PHC taken by random sampling to obtain samples for cases 62 children of Diarrhea patient. The control samples are 62 children who are not registered as suffering from diarrhea in the month of June 2015, close to the patient\u27s house, and her mother or people who responsible to take care that children want as respondent. Data were obtained by interviews with the mothers of cases and controls using questionnaires and direct observation using a checklist. Data were analyzed using univariate, bivariate and multivariate logistic regression. There are three variables that significantly affect to the diarrhea incidence, namely employment, knowledge and latrine ownership and the most dominant variable influence that is knowledge (OR 4.353). The model equation Y = - 2.048 +1.153 employment + 1.483 knowledge + 1.480 latrine ownership with a percentage accuracy of the model in classifying observations is 68.5%

The characterization, management, and future considerations for ErbB-family TKI-associated diarrhea.

PurposeDiarrhea is recognized as a common adverse event associated with tyrosine kinase inhibitors (TKIs), with those targeting the ErbB family of receptors being associated with the highest rate of diarrhea.MethodsThis paper reviews data on the incidence, timing, and duration of diarrhea associated with US Food and Drug Administration-approved ErbB family-targeted TKIs from the published literature, and sets forth recommendations for management.ResultsIn the absence of anti-diarrheal prophylaxis the incidence of any-grade diarrhea varies and typically occurs early during the course of treatment. Although it is difficult to determine if the incidence and severity of diarrhea is related to inhibition of a particular kinase target because of the multi-targeted and overlapping activity of many agents, evidence suggests that second-generation TKIs with broader target profiles (i.e., afatinib, lapatinib, neratinib) result in a higher incidence of diarrhea compared with highly specific first- (erlotinib, gefitinib) or third- (osimertinib) generation agents. The mechanisms responsible for TKI-associated diarrhea are not fully understood and are likely multi-factorial, involving dysregulated ion transport, inflammation, and mucosal injury. Management strategies have been developed-and continue to be refined-to prevent and reduce the severity and duration of TKI-associated diarrhea. For agents associated with more significant symptoms, anti-diarrheal prophylaxis reduces the incidence and severity of diarrhea, and ongoing studies are evaluating specific strategies to further reduce incidence and duration of TKI-associated diarrhea.ConclusionsContinued investigations into risk factors and pharmacogenomic markers for diarrhea may further improve management of this common toxicity

A Randomized Controlled Trial of Glucose versus Amylase Resistant Starch Hypo-Osmolar Oral Rehydration Solution for Adult Acute Dehydrating Diarrhea

Background: Reduction of gross diarrhea rate in excess of that seen over time with intravenous therapy and appropriate antibiotics is not usually achieved by oral glucose-electrolyte rehydration therapy for cholera and cholera-like diarrheas. Methodology and Principal Findings: This prospective randomized clinical trial at a tertiary referral hospital in southern India was undertaken to determine whether amylase resistant starch, substituting for glucose in hypo-osmolar oral rehydration solution, would reduce diarrhea duration and weight in adults with acute severe dehydrating diarrhea. 50 adult males with severe watery diarrhea of less than three days' duration and moderate to severe dehydration were randomized to receive hypo-osmolar ORS (HO-ORS) or HO-ORS in which amylase resistant high amylose maize starch 50g/L substituted for glucose (HAMS-ORS). All remaining therapy followed standard protocol. Duration of diarrhea (ORS commencement to first formed stool) in hours was significantly shorter with HAMS-ORS (median 19, IQR 10-28) compared to HO-ORS (median 42, IQR 24-50) (Bonferroni adjusted P, P-adj &lt; 0.001). Survival analysis (Kaplan-Meier) showed faster recovery from diarrhea in the HAMS-ORS group (P &lt; 0.001, log rank test). Total diarrhea fecal weight in grams (median, IQR) was not significantly lower in the HAMS-ORS group (2190, 1160-5635) compared to HO-ORS (5210, 2095-12190) (P-adj = 0.08). However, stool weight at 13-24 hours (280, 0-965 vs. 1360, 405-2985) and 25-48 hours (0, 0-360 vs. 1080, 55-3485) were significantly lower in HAMS-ORS compared to HO-ORS group (Padj = 0.048 and P = 0.012, respectively). ORS intake after first 24 hours was lower in the HAMS-ORS group. Subgroup analysis of patients with culture isolates of Vibrio cholerae indicated similar significant differences between the treatment groups. Conclusions: Compared to HO-ORS, HAMS-ORS reduced diarrhea duration by 55% and significantly reduced fecal weight after the first 12 hours of ORS therapy in adults with cholera-like diarrhea

Role of Exclusive Breastfeeding and S-iga Antibodies Antirotavirus Breast Milk Towards Risk of Acute Rotavirus Diarrhea in Infants Age of 1-6 Months: Do They Corelate to Breastfeeding "Daily Dose" and Antibody Titers?

Exclusive breastfeeding reduces the incidence of diarrhea, especially in children who live in densely populated neighborhood. This study aims to determine the relationship between exclusive breastfeeding and breast milk contains antirotavirus s-IgA antibodies towards risk of acute rotavirus diarrhea in infants aged of 1-6 months. Case-control study design is applied to determine the relationship between exclusive breastfeeding and breast milk contains s-IgA antibodies antirotavirus with risk of acute rotavirus diarrhea. Cases in this study were patients with acute rotavirus diarrhea and controls were patients without acute rotavirus diarrhea. Cases and controls were matched based on age. There were 23 cases and 69 controls. The proportion who received exclusive breastfeeding was 34.8% in cases and 34.4% in controls, with OR of 1.21 (95% CI: 0.45 to 3.28) and p = 0.28. Breast milk contains sIgA antibodies antirotavirus for case was 17.39% and controls was 23.2%, OR was 1.12 (95% CI: 0.29 to 4.29), p = 0.203. In conclusion, exclusive breastfeeding and breast milk contains sIgA antibodies antirotavirus were not associated with risk of acute rotavirus diarrhea in infants 1-6 months. This may be caused by differences in population and demographic studies as well as low of milk sIgA antibody antirotavirus titters. Further research of breastfeeding regardless of antirotavirus containing high antibody titters sIgA is needed

Complete genome sequence of a porcine epidemic diarrhea virus from a novel outbreak in Belgium, January 2015

Porcine epidemic diarrhea virus (PEDV) is a member of the family Coronaviridae and can cause severe outbreaks of diarrhea in piglets from different age groups. Here, we report the complete genome sequence (28,028 nt) of a PEDV strain isolated during a novel outbreak in Belgium

Idiopathic AIDS enteropathy and treatment of gastrointestinal opportunistic pathogens.

Diarrhea in patients with acquired immune deficiency syndrome (AIDS) has proven to be both a diagnostic and treatment challenge since the discovery of the human immunodeficiency virus (HIV) virus more than 30 years ago. Among the main etiologies of diarrhea in this group of patients are infectious agents that span the array of viruses, bacteria, protozoa, parasites, and fungal organisms. In many instances, highly active antiretroviral therapy remains the cornerstone of therapy for both AIDS and AIDS-related diarrhea, but other targeted therapies have been developed as new pathogens are identified; however, some infections remain treatment challenges. Once identifiable infections as well as other causes of diarrhea are investigated and excluded, a unique entity known as AIDS enteropathy can be diagnosed. Known as an idiopathic, pathogen-negative diarrhea, this disease has been investigated extensively. Atypical viral pathogens, including HIV itself, as well as inflammatory and immunologic responses are potential leading causes of it. Although AIDS enteropathy can pose a diagnostic challenge so too does the treatment of it. Highly active antiretroviral therapy, nutritional supplementation, electrolyte replacements, targeted therapy for infection if indicated, and medications for symptom control all are key elements in the treatment regimen. Importantly, a multidisciplinary approach among the gastroenterologist, infectious disease physician, HIV specialists, oncology, and surgery is necessary for many patients

Effectiveness of zinc supplementation on diarrhea and average daily gain in pre-weaned dairy calves: A double-blind, block-randomized, placebo-controlled clinical trial.

The objective of this clinical trial was to evaluate the effectiveness of zinc supplementation on diarrhea and average daily weight gain (ADG) in pre-weaned dairy calves. A total of 1,482 healthy Holstein heifer and bull calves from a large California dairy were enrolled at 24 to 48 hours of age until hutch exit at approximately 90 days of age. Calves were block-randomized by time to one of three treatments: 1) placebo, 2) zinc methionine (ZM), or 3) zinc sulfate (ZS) administered in milk once daily for 14 days. Serum total protein at enrollment and body weight at birth, treatment end, and hutch exit were measured. Fecal consistency was assessed daily for 28 days post-enrollment. For a random sample of 127 calves, serum zinc concentrations before and after treatment and a fecal antigen ELISA at diarrhea start and resolution for Escherichia coli K99, rotavirus, coronavirus, and Cryptosporidium parvum were performed. Linear regression showed that ZM-treated bull calves had 22 g increased ADG compared to placebo-treated bulls (P = 0.042). ZM-treated heifers had 9 g decreased ADG compared to placebo-treated heifers (P = 0.037), after adjusting for average birth weight. Sex-stratified models showed that high birth weight heifers treated with ZM gained more than placebo-treated heifers of the same birth weight, which suggests a dose-response effect rather than a true sex-specific effect of ZM on ADG. Cox regression showed that ZM and ZS-treated calves had a 14.7% (P = 0.015) and 13.9% (P = 0.022) reduced hazard of diarrhea, respectively, compared to placebo-treated calves. Calves supplemented for at least the first five days of diarrhea with ZM and ZS had a 21.4% (P = 0.027) and 13.0% (P = 0.040) increased hazard of cure from diarrhea, respectively, compared to placebo-treated calves. Logistic regression showed that the odds of microbiological cure at diarrhea resolution for rotavirus, C. parvum, or any single fecal pathogen was not different between treatment groups. Zinc supplementation delayed diarrhea and expedited diarrhea recovery in pre-weaned calves. Additionally, zinc improved weight gain differentially in bulls compared to heifers, indicating a research need for sex-specific dosing

Spatial analysis of risk factors for childhood morbidity in Nigeria

Recent Demographic and Health Surveys (DHS) from Sub-Saharan Africa (SSA) indicate a decline in childhood vaccination coverage but a high prevalence of childhood diarrhea, cough, and fever. We used Nigerian DHS data to investigate the impact of geographical factors and other important risk factors on diarrhea, cough, and fever using geoadditive Bayesian semiparametric models. A higher prevalence of childhood diarrhea, cough, and fever is observed in the northern and eastern states, while lower disease prevalence is observed in the western and southern states. In addition, children from mothers with higher levels of education and those from poor households had a significantly lower association with diarrhea; children delivered in hospitals, living in urban areas, or from mothers having received prenatal visits had a significantly lower association with fever. Our maps are a novel and relevant tool to help local governments to improve health-care interventions and achieve Millennium Development Goals (MDG4)