Racecadotril for acute diarrhoea in children: systematic review and meta-analyses

OBJECTIVE Racecadotril is an antisecretory agent that can prevent fluid/electrolyte depletion from the bowel as a result of acute diarrhoea, without affecting intestinal motility. An up-to-date systematic review is indicated to summarise the evidence on Racecadotril for the treatment of acute diarrhoea in children. DESIGN A Cochrane format systematic review of Randomised controlled trials (RCTs). Data extraction and assessment of methodological quality were performed independently by two reviewers. Methodological quality was assessed using the Cochrane risk of bias tool. PATIENTS Children with acute diarrhoea, as defined by the primary studies. INTERVENTIONS RCTs comparing racecadotril to placebo or other interventions. MAIN OUTCOME MEASURS Duration of illness, stool output/volume and adverse events. RESULTS Seven RCTs were included. Five comparing racecadotril with placebo or no intervention, one with pectin / caolin and one with loperamide. Moderate to high risk of bias was present in all studies. There was no significant difference in efficacy or adverse events between racecadotril to loperamide. Meta-analysis of 3 studies with 642 participants showed significantly shorter duration of symptoms with racecadotril compared to placebo (Mean Difference (MD) -53.48 hours, 95% CI -65.64 to -41.33,). Meta-analysis of 5 studies with 949 participants showed no significant difference in adverse events between racecadotril and placebo (Risk Ratio (RR) 0.99, 95% CI 0.73 to 1.34). CONCLUSIONS There is some evidence that racecadotril is more effective than placebo or no intervention in reducing the duration of illness and stool output in children with acute diarrhoea. However, the overall quality of the evidence is limited due to sparse data, heterogeneity and risk of bias. Racecadotril appears safe and well tolerate

Rotation Curve Fitting Model

One key piece of evidence for dark matter is the flat rotation curve problem: the disagreement between measured galactic rotation curves and their luminous mass. A novel solution to this problem is presented here. A model of relativistic frame effects on Doppler shifts due to the slightly curved frames of an emitting galaxy and the Milky Way is derived. This model predicts observed Doppler shifted spectra (in excess of the luminous mass) based only on the observed luminous matter profile and one free model parameter. Fits to the 175 galaxies reported in the SPARC database of galactic rotation profiles and accurate photometry measurements are compared between this novel model and dark matter and MOND (RAR) models. We find on the SPARC sample of 175 galaxies; that MOND-RAR has an average reduced chisquare of $\chi^2_r = 4.22$ for 175 galaxies fitted, the isothermal dark matter model has $\chi^2_r = 1.90$ for 165 galaxies fitted, and the new model we present has $\chi^2_r = 2.39$ for 172 galaxies fitted. Implications of this model are discussed.Comment: 27 pages, 9 figure

Delivery mode-associated gut microbiota in the first 3 months of life in a country with high obesity rates A descriptive study

Delivery methods during childbirth and their related gut microbiota profiles have important impacts on health later in life, they can contribute to the development of diseases such as obesity, whose highest prevalence rate is found among the Mexican child population. Coincidentally, Mexico has one of the highest global average annual rate increase in cesarean births (C-section). Since Mexico leads the world in childhood obesity, studying the relationship between childbirth delivery methods and gut microbiota profiles in this vulnerable population may be used to identify early risk factors for obesity in other developed and developing countries. The objective of this study is to determine the association between child delivery method and gut microbiota profiles in healthy Mexican newborns. Fecal samples of 57 term infants who participated in a randomized clinical trial in 2013 to study the safety ofAgavefructans in newborns, were used in this study. DNA samples were extracted and used to characterize the microbiota composition using high-throughput 16S rRNA gene sequencing. The samples were further divided based on childbirth delivery method, as well as early diet. Gut microbiota profiles were determined and analyzed using cluster analysis followed by multiple correspondence analysis. An unusual high abundance of Proteobacteria was found in the gut microbiota of all Mexican infants studied, regardless of delivery method. Feces from infants born by C-section had low levels of Bacteroidetes, high levels of Firmicutes, especiallyClostridiumandEnterococcus, and a strikingly high ratio of Firmicutes/Bacteroidetes (F:B). Profiles enriched in Bacteroidetes and low F:B ratios, were strongly associated with vaginal delivery. The profile of gut microbiota associated with feces from Mexican infants born by C-section, may be added to the list of boosting factors for the worrying obesity epidemic in Mexico

Cultural antecedents of sustainability and regional economic development - a study of SME ‘Mittelstand’ firms in Baden-Württemberg (Germany)

This paper examines behavioural and regional/geographic cultural antecedents of sustainability in SME contexts. The study identifies prevailing macro-representations of sustainability in the literature and highlights an over-focus on large firms constituting the predominant unit of analysis. Moreover, there is a propensity in the literature to view sustainability primarily in terms of ‘environmental’ – closely linked to a corporate strategic imperative narrative of economic competitiveness and profitability. Overall, this perspective tends to generate accounts which are acultural, apolitical and ahistorical in terms of innovative actions and sustainability practices. In response, using a conceptual framework of moral identity, the paper develops a more micro-foundational insight to sustainability (developing notions of ‘tangible’ and ‘intangible’) and examines regional economic development attitudes at individual owner-manager/managing director level in small-to-medium-sized firms. Methodologically, an inductively framed interview schedule was employed with owner-managers and managing directors (n = 30) of manufacturing SMEs in the Baden-Württemberg region (Germany). The study identified a range of micro-foundational behavioural antecedents operating in the sample companies. In particular, it underlined that many of the SME owner-managers/managing directors expressed views informed by a particular moral identity connected with a perspective rooted in regionally bound, longstanding and ‘expected’ behaviours of trust, fairness, honesty and community responsibility

Health Effects of Infant Formula Supplemented with Probiotics or Synbiotics in Infants and Toddlers: Systematic Review with Network Meta-Analysis

Supplementation of infant and follow-up formula with probiotics or synbiotics has become a common practice. In 2011 and 2017, the evidence regarding the impact of these interventions was analysed systematically. Recently new evidence was published. To evaluate through a systematic review with network meta-analysis the evidence on the impact of infant formula supplemented with probiotics or synbiotics for healthy infants and 36-month-old toddlers. RCTs published between 1999–2019 for infant formulas supplemented with probiotics alone or synbiotics in healthy infants and toddlers were identified. Data analysis included clinical (gastrointestinal symptoms, risk reduction of infectious diseases, use of antibiotics, weight/height gain and frequency of adverse events) and non-clinical outcomes (changes in faecal microbiota and immune parameters). A random effect model was used. Hedges’ standard mean difference (SMD) and risk ratio (RR) were calculated. Rank analysis was performed to evaluate the superiority of each intervention. Twenty-six randomised controlled trials with 35 direct comparisons involving 1957 children receiving probiotic-supplemented formula and 1898 receiving control formula were reviewed. The mean duration of intervention was 5.6 ± 2.84 months. Certain strains demonstrated a reduction in episodes of colic, number of days with fever and use of antibiotics; however, there was considerable heterogeneity which reduced the level of certainty of effect. No significant effects were observed on weight, height or changes in faecal proportions of Bifidobacteria, Lactobacillus, Bacteroides or Clostridia. Although there is some evidence that may support a potential benefit of probiotic or synbiotic supplementation of infant formulas, variation in the quality of existing trials and the heterogeneity of the data preclude the establishment of robust recommendations

Practical algorithms for managing common gastrointestinal symptoms in infants

10.1016/j.nut.2012.08.008Nutrition291184-194NUTR