RESUMEN
Los postbióticos fueron definidos en 2021 por la Asociación Científica Internacional de Probióticos y Prebióticos (ISAPP) como "una preparación de microorganismos inanimados y/o sus componentes celulares capaces de conferir un efecto benéfico al hospedador". El campo de los postbióticos es un área nueva dentro de la familia de los bióticos; se han desarrollado ya numerosos productos con aplicaciones clínicas, como la estimulación inmunológica, el manejo de diarreas en niños y adultos, el abordaje del intestino irritable, además de tres fórmulas infantiles. En particular, las fórmulas infantiles con postbióticos obtenidos a partir de la fermentación de la leche con Bifidobacterium breve C50 y Streptococcus thermophilus O65, y sus metabolitos, incluido el oligosacárido 3'-GL, han demostrado seguridad y contribución al desarrollo de la microbiota intestinal y el sistema inmune asociado al intestino. Estas modificaciones contribuyen a la prevención y el manejo de los trastornos funcionales digestivos del lactante.
Postbiotics were defined in 2021 by the International Scientific Association for Probiotics and Prebiotics (ISAPP) as a "preparation of inanimate microorganisms and/or their cellular components that confers a health benefit to the host." The field of postbiotics is a new area within the biotics family; numerous products have already been developed for clinical applications, such as immune stimulation, the management of diarrhea in children and adults, the management of irritable bowel syndrome, and 3 infant formulas. In particular, infant formulas with postbiotics obtained from milk fermented with Bifidobacterium breve C50 and Streptococcus thermophilus O65 and their metabolites, including the oligosaccharide 3'-GL, have demonstrated to be safe and to contribute to the development of the gut microbiota and the gutassociated immune system. These modifications help to prevent and manage functional gastrointestinal disorders in infants.
Asunto(s)
Humanos , Lactante , Probióticos , Síndrome del Colon Irritable/microbiología , Síndrome del Colon Irritable/terapia , Fórmulas Infantiles , Streptococcus thermophilus , Diarrea/microbiología , Diarrea/terapia , Prebióticos/administración & dosificación , Microbioma Gastrointestinal , Bifidobacterium breve , Enfermedades Gastrointestinales/microbiología , Enfermedades Gastrointestinales/terapiaRESUMEN
Green banana Musa paradisiaca (GB) has been traditionally used to aid in the treatment of diarrhea. This systematic review and meta-analysis aimed to evaluate current evidence of the effect of GB consumption as a complement to standard treatment in the population with acute or persistent diarrhea. We searched PubMed, Scopus, Web of Science, and LILACS from inception to January 2024; there was no language restriction. Only randomized controlled trials using GB as an intervention were included, and studies using antidiarrheal medication were excluded. A meta-analysis was performed to compare the effect of GB on the resolution of acute and persistent diarrhea. To measure the certainty of evidence, the GRADE assessment was used. Nine randomized controlled trials (seven open and two blinded) were included. Studies were conducted in the pediatric population comprising a total of 3996 patients aged 8 to 34 months, eight studies were written in English and one in Spanish. GB-based food consumption significantly increased the hazard of resolution of diarrhea compared to standard treatment (HR 1.96, 95% CI [1.62; 2.37], p < 0.01; I2 = 52%). The subgroup analysis showed a higher hazard of resolution of diarrhea for children with persistent diarrhea (HR 2.34, 95% CI [1.78; 3.08] compared to acute diarrhea (HR 1.74, 95% CI [1.45; 2.09]).Conclusions: The use of green banana-based foods as a complement to standard treatment in children is probably associated with a faster resolution in acute diarrhea and may aid in the treatment of persistent diarrhea. More clinical trials are necessary to assess if a synergistic effect between GB and other foods exists and proves to be better than GB alone. These findings need to be confirmed in diverse socioeconomic contexts, within the adult population, and under varying health conditionsTrial registration: CRD42024499992.
Asunto(s)
Diarrea , Musa , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Diarrea/tratamiento farmacológico , Diarrea/terapia , Enfermedad Aguda , Preescolar , Lactante , NiñoRESUMEN
Acute diarrhea is the second leading cause of morbidity and mortality attributed to infections in children under five years of age worldwide, with 1.7 million annual estimated cases and more than 500,000 deaths. Although hydroelectrolytic replacement is the gold standard in treating diarrhea, it does not interfere with the restoration of the intestinal microbiota. Several studies have searched for an adequate alternative in restructuring intestinal homeostasis, finding that treatments based on probiotics, prebiotics, and synbiotics are effective, which made such treatments increasingly present in clinical practice by reducing illness duration with minimal side effects. However, there are still controversies regarding some unwanted reactions in patients. The diversity of strains and the peculiarities of the pathogens that cause diarrhea require further studies to develop effective protocols for prevention and treatment. Here, we provide a descriptive review of childhood diarrhea, emphasizing treatment with probiotics, prebiotics, and synbiotics.
Asunto(s)
Diarrea , Prebióticos , Probióticos , Simbióticos , Humanos , Probióticos/uso terapéutico , Simbióticos/administración & dosificación , Prebióticos/administración & dosificación , Diarrea/microbiología , Diarrea/terapia , Diarrea/prevención & control , Niño , Microbioma Gastrointestinal/fisiología , PreescolarRESUMEN
Gastrointestinal symptoms and problems (GI- SP) frequently cause discomfort and suffering in pediatric patients with life-threatening and/or life-limiting illnesses (LTI/LLI). Pediatric palliative care (PPC) professionals should be aware of them and perform a comprehensive approach. OBJECTIVE: To determine the prevalence of GI- SP in patients treated in PPC units and to describe the pharmacological and non-pharmacological measures prescribed. PATIENTS AND METHOD: Observational, prospective, multicenter, prospective study in patients with LTI/LLI, seen by PPC teams in Uruguay. The variables analyzed included age, sex, origin, type of LTI/LLI, presence of mucositis, vomiting, swallowing disorders, abdominal pain, constipation, diarrhea, digestive bleeding, problems with digestive prosthesis, and prescribed pharmacological and non-pharmacological treatment. RESULTS: 10 out of 16 PPC teams participated. 96 out of 436 patients seen presented GI- SP (22%). Median age was 4.2 years (1 month-18 years). LTI/LLI: 65% neurological and 7% oncological. The 96 patients had 114 consultations; 50% had 2 or more GI- SP per consultation. GI- SP observed: swallowing disorders (57%), constipation (53%), nausea and/or vomiting (24%), gastrostomy problems (17%), abdominal pain (10%), digestive bleeding (3%), and diarrhea (2%). There were variable prescriptions of pharmacological and non-pharmacological measures; only 50% of those with swallowing disorder received speech and hearing therapy. CONCLUSIONS: GI- SP motivated consultations in all PPC settings, frequently due to 2 or more GI- SP. Swallowing disorders and gastrostomy complications are frequent but not very visible problems in PPC. According to the comprehensive approach, pharmacological and non-pharmacological measures were implemented.
Asunto(s)
Trastornos de Deglución , Enfermedades Gastrointestinales , Niño , Preescolar , Humanos , Dolor Abdominal/epidemiología , Dolor Abdominal/etiología , Dolor Abdominal/terapia , Estreñimiento , Trastornos de Deglución/epidemiología , Trastornos de Deglución/etiología , Trastornos de Deglución/terapia , Diarrea/epidemiología , Diarrea/terapia , Enfermedades Gastrointestinales/epidemiología , Enfermedades Gastrointestinales/terapia , Cuidados Paliativos , Estudios Prospectivos , Vómitos/epidemiología , Vómitos/etiología , Vómitos/terapia , Masculino , Femenino , Lactante , AdolescenteRESUMEN
BACKGROUND: Probiotics are effective for treating acute infectious diarrhoea caused by bacteria, but there are inconsistent results for the effectiveness of probiotics for diarrhoea caused by viruses. In this article we want to determine whether Sb supplementation has an effect on acute inflammatory viral diarrhoea diagnosed with the multiplex panel PCR test. The aim of this study was to evaluate the efficacy of Saccharomyces boulardii (Sb) as a treatment in patients diagnosed with viral acute diarrhoea. METHODS: From February 2021 to December 2021, 46 patients with a confirmed diagnosis of viral acute diarrhoea diagnosed with the polymerase chain reaction multiplex assay were enrolled in a double-blind, randomized placebo-controlled trial. Patients received paracetamol 500 mg as a standard analgesic and 200 mg of Trimebutine as an antispasmodic treatment plus 600 mg of Sb (n = 23, 1 × 109/100 mL Colony forming unit) or a placebo (n = 23) orally once daily for eight days. The improvement in and severity of symptoms were measured using a symptom diary, the Patient Global Impression and the Patient Global Impression of Change scales (days 4 and 8), both answered and recorded by the patient. RESULTS: Of the 46 patients who completed treatment, 24 (52%) were men and 22 (48%) were women. The average age was 35.6 ± 12.28 years (range 18 to 61 years). The average duration of the evolution of illness at the time of diagnosis was 0.85 ± 0.73 days (maximum 2 days). On day 4 after the diagnosis, 20% reported pain and 2% reported fever, but on day 8, no patient reported pain or fever. On day 4, 70% of patients in the Sb group and 26% in the placebo group reported improvement (P = 0.03), based on the Patients' Global Impression of Change scale, which assesses patient's rating of overall improvement. These findings suggest that 3 to 4 days of treatment with Sb helped to improve symptoms of diarrhoea caused by a virus. CONCLUSION: Treatment with Sb on acute inflammatory diarrhoea of viral aetiology shows no changes regarding the severity of the symptoms; nevertheless, it seems to impact improvement positively. TRIAL REGISTRATION: 22CEI00320171130 dated on 16/12/2020, NCT05226052 dated on 07/02/2022.
Asunto(s)
Enteritis , Probióticos , Saccharomyces boulardii , Saccharomyces , Masculino , Humanos , Adulto , Femenino , Adolescente , Adulto Joven , Persona de Mediana Edad , Resultado del Tratamiento , Saccharomyces cerevisiae , Diarrea/terapia , Diarrea/microbiología , Probióticos/uso terapéutico , Método Doble CiegoRESUMEN
BACKGROUND: Although acute diarrhoea is a self-limiting disease, dehydration may occur in some children. Dehydration is the consequence of an increased loss of water and electrolytes (sodium, chloride, potassium, and bicarbonate) in liquid stools. When these losses are high and not replaced adequately, severe dehydration appears. Severe dehydration is corrected with intravenous solutions. The most frequently used solution for this purpose is 0.9% saline. Balanced solutions (e.g. Ringer's lactate) are alternatives to 0.9% saline and have been associated with fewer days of hospitalization and better biochemical outcomes. Available guidelines provide conflicting recommendations. It is unclear whether 0.9% saline or balanced intravenous fluids are most effective for rehydrating children with severe dehydration due to diarrhoea. OBJECTIVES: To evaluate the benefits and harms of balanced solutions for the rapid rehydration of children with severe dehydration due to acute diarrhoea, in terms of time in hospital and mortality compared to 0.9% saline. SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search date was 4 May 2022. SELECTION CRITERIA: We included randomized controlled trials in children with severe dehydration due to acute diarrhoea comparing balanced solutions, such as Ringer's lactate or Plasma-Lyte with 0.9% saline solution, for rapid rehydration. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. time in hospital and 2. MORTALITY: Our secondary outcomes were 3. need for additional fluids, 4. total amount of fluids received, 5. time to resolution of metabolic acidosis, 6. change in and the final values of biochemical measures (pH, bicarbonate, sodium, chloride, potassium, and creatinine), 7. incidence of acute kidney injury, and 8. ADVERSE EVENTS: We used GRADE to assess the certainty of the evidence. MAIN RESULTS: Characteristics of the included studies We included five studies with 465 children. Data for meta-analysis were available from 441 children. Four studies were conducted in low- and middle-income countries and one study in two high-income countries. Four studies evaluated Ringer's lactate, and one study evaluated Plasma-Lyte. Two studies reported the time in hospital, and only one study reported mortality as an outcome. Four studies reported final pH and five studies reported bicarbonate levels. Adverse events reported were hyponatremia and hypokalaemia in two studies each. Risk of bias All studies had at least one domain at high or unclear risk of bias. The risk of bias assessment informed the GRADE assessments. Primary outcomes Compared to 0.9% saline, the balanced solutions likely result in a slight reduction of the time in hospital (mean difference (MD) -0.35 days, 95% confidence interval (CI) -0.60 to -0.10; 2 studies; moderate-certainty evidence). However, the evidence is very uncertain about the effect of the balanced solutions on mortality during hospitalization in severely dehydrated children (risk ratio (RR) 0.33, 95% CI 0.02 to 7.39; 1 study, 22 children; very low-certainty evidence). Secondary outcomes Balanced solutions probably produce a higher increase in blood pH (MD 0.06, 95% CI 0.03 to 0.09; 4 studies, 366 children; low-certainty evidence) and bicarbonate levels (MD 2.44 mEq/L, 95% CI 0.92 to 3.97; 443 children, four studies; low-certainty evidence). Furthermore, balanced solutions likely reduces the risk of hypokalaemia after the intravenous correction (RR 0.54, 95% CI 0.31 to 0.96; 2 studies, 147 children; moderate-certainty evidence). Nonetheless, the evidence suggests that balanced solutions may result in no difference in the need for additional intravenous fluids after the initial correction; in the amount of fluids administered; or in the mean change of sodium, chloride, potassium, and creatinine levels. AUTHORS' CONCLUSIONS: The evidence is very uncertain about the effect of balanced solutions on mortality during hospitalization in severely dehydrated children. However, balanced solutions likely result in a slight reduction of the time in the hospital compared to 0.9% saline. Also, balanced solutions likely reduce the risk of hypokalaemia after intravenous correction. Furthermore, the evidence suggests that balanced solutions compared to 0.9% saline probably produce no changes in the need for additional intravenous fluids or in other biochemical measures such as sodium, chloride, potassium, and creatinine levels. Last, there may be no difference between balanced solutions and 0.9% saline in the incidence of hyponatraemia.
Asunto(s)
Deshidratación , Hipopotasemia , Niño , Humanos , Bicarbonatos/uso terapéutico , Creatinina , Deshidratación/etiología , Deshidratación/terapia , Diarrea/terapia , Potasio , Cloruro de Potasio/uso terapéutico , Lactato de Ringer , Solución Salina , SodioRESUMEN
BACKGROUND: Small intestinal bacterial overgrowth (SIBO) is associated with diarrhea-predominant irritable bowel syndrome (IBS-D). Probiotics like Saccharomyces boulardii CNCM I-745 (Sb) may be efficacious in balancing the microbiota. This randomized open label study assessed the effect of Sb in patients with bacterial overgrowth associated with IBS-D and its impact on the intestinal microbiota. METHODS: Patients were randomized to receive Sb + dietary advice (Sb + DA) or dietary advice (DA) only for 15 days. SIBO was assessed by the lactulose hydrogen breath test (LHBT). Symptoms were assessed with the IBS Symptom Severity Scale (IBS-SSS) and stool consistency with the Bristol Stool Form Scale. Microbiota and mycobiota were analyzed by 16S rDNA and ITS2. RESULTS: 54 patients were included, among whom 48 (27 Sb + DA, 21 DA) were evaluated. Decrease of hydrogen excretion was slightly higher in Sb + DA group, 41% versus 29% in DA group, and IBS-SSS total score were reduced by -134 and -93, respectively. The proportion of patients with diarrhea was lower in the Sb + DA group than in the DA group (25.9% compared to 47.6%). Bacterial and fungal microbiota showed that Sb treatment was associated with several modifications. Interestingly, F. prausnitzii was more abundant in Sb-treated patients with marked clinical improvement. The safety of S. boulardii CNCM I-745 was excellent. CONCLUSIONS: In patients with SIBO, S. boulardii CNCM I-745 associated with dietary advice reduced bacterial overgrowth and improved digestive symptoms while restoring the intestinal microbiota. The increased abundance of F. prausnitzii coupled with symptom improvement merits further research.
Asunto(s)
Microbioma Gastrointestinal , Síndrome del Colon Irritable , Saccharomyces boulardii , Humanos , Síndrome del Colon Irritable/tratamiento farmacológico , Proyectos Piloto , Intestino Delgado , Diarrea/terapia , Hidrógeno/farmacología , Hidrógeno/uso terapéuticoRESUMEN
In a randomized controlled trial, we evaluated the effects of five oral electrolyte solutions (OESS) with different compositions of water, electrolyte, and acid-base balances of diarrheal neonatal calves. Osmotic diarrhea and dehydration were induced with sucrose in milk, spironolactone, and hydrochlorothiazide for 48 h in thirty 10-day old Holstein healthy calves with 43.5 ± 3.80 kg BW who were fed with natural milk. They were allocated to five treatment groups (n=6) based on the administered OES (commercial: OES A, B, C, D; and non-commercial: OES UEL). On the day of treatment, the calves received 6L of OES in two doses apart from milk intakes. Venous blood samples were collected at -48h (start of induction), -24h, Oh (start of the treatment day), 8h, 16h, 24h, 48h, and 72h. TPP, glucose, D-lactate, L-lactate, pH, pCO2, HCO3, BE, Na, K, CI, SID3, SIG, AG, Atot and percentage change in plasma volume (%PV) were measured or calculated and analyzed by two-way repeated measures ANOVA. All the calves developed osmotic diarrhea, mild to moderate dehydration, hyponatremia, relative hyperchloremia, and moderate to severe metabolic acidosis. The tested OESS were well accepted by the calves and effective in reversing dehydration, electrolyte imbalances, and metabolic acidosis. OES D did not completely correct hyponatremia, and SEO B caused transient hyperglycemia. It has been concluded that all the tested OESS are safe and effective for the treatment of diarrhea in calves with moderate degrees of dehydration and metabolic acidosis, which indicates that they have proper compositions for this purpose.
Em um ensaio clínico controlado e aleatório, foram comparados os efeitos de cinco soluções eletrolíticas orais (SEOs) sobre os equilíbrios hídrico, eletrolítico e ácido-base de bezerros neonatos diarreicos. Diarreia osmótica e desidratação foram induzidas com sacarose no leite, espironolactona e hidroclorotiazida, por 48h, em 30 bezerros Holandeses com 10 dias de idade, 43,5 ± 3,8kg de peso, e alimentados com leite natural. Eles foram distribuídos em cinco grupos de tratamento (n=6) de acordo com a SEO administrada (comercial: SEO A, B, C, D; e não comercial: SEO UEL). No dia do tratamento, os bezerros receberam 6L de SEO em duas doses além da ingestão de leite. Amostras de sangue venoso foram coletadas em -48h (início da indução), - 24h, Oh (início do dia de tratamento), 8h, 16h, 24h, 48h e 72h. PPT, glicose, lactatos Le D, pH, pCO2, HCO3, BE, Na, K, CI, SID3, SIG, AG, Atot e variação percentual no volume plasmático (%VP) foram mensurados ou calculados, e analisados por meio de ANOVA de duas vias de medidas repetidas. Todos os bezerros desenvolveram diarreia osmótica, desidratação leve a moderada, hiponatremia, hipercloremia relativa e acidose metabólica moderada a grave. As SEOs testadas foram bem aceitas pelos bezerros e eficazes para a reversão da desidratação, dos desequilíbrios eletrolíticos e da acidose metabólica. A SEO D não corrigiu completamente a hiponatremia, e a SEO B causou hiperglicemia transitória. Conclui-se que todas as SEOs são eficazes para o tratamento da diarreia em bezerros com graus moderados de desidratação e de acidose metabólica, o que indica que possuem composições adequadas para esse fim.
Asunto(s)
Animales , Bovinos , Acidosis/veterinaria , Diarrea/terapia , Diarrea/veterinaria , Fluidoterapia/veterinaria , Hiponatremia/veterinaria , Animales Recién NacidosRESUMEN
BACKGROUND: The choice of an appropriate probiotic for pediatric acute gastroenteritis (PAGE) can be confusing. Our aim was to compare the efficacy and safety of 2 probiotics (Saccharomyces boulardii CNCM I-745 vs a 4-strain mixture of Bacillus clausii O/C, SIN, N/R, T) for the treatment of PAGE. METHODS: A 2-arm parallel, randomized trial recruited children (6 months to 5 years old) with mild-moderate acute diarrhea, from 8 centers in Argentina. A total of 317 children were enrolled and blindly randomized to 5 days of either S boulardii CNCM I-745 (n = 159) or a 4-strain mixture of B clausii (n = 158), then followed for 7 days post-probiotic treatment. A stool sample was collected at inclusion for pathogen identification. The primary outcome was duration of diarrhea defined as the time from enrollment to the last loose stool followed by the first 24-hour period with stool consistency improvement. Secondary outcomes included frequency of loose stools/day, severity of diarrhea, number reporting no diarrhea at Day 6, time-to-first formed stool, recurrence of diarrhea by study end (Day 12) and safety outcomes. RESULTS: Three hundred twelve (98%) children completed the study. S boulardii CNCM I-745 showed a significant reduction (P = .04) in the mean duration of diarrhea (64.6 hours, 95% confidence interval [CI] 56.5-72.8) compared to those given B clausii (78.0 hours, 95% CI 69.9-86.1). Both probiotics showed improvement in secondary outcomes and were well-tolerated. CONCLUSION: In this study, S boulardii CNCM I-745 demonstrated better efficacy than B clausii mix for reducing the duration of pediatric acute diarrhea.
Asunto(s)
Bacillus clausii , Gastroenteritis , Probióticos , Saccharomyces boulardii , Niño , Diarrea/terapia , Gastroenteritis/terapia , Humanos , Probióticos/uso terapéuticoRESUMEN
Introducción. El tratamiento de la diarrea aguda se basa en prevenir la deshidratación, reducir la duración y gravedad de la enfermedad. El objetivo fue conocer los patrones de tratamiento ambulatorio de la diarrea aguda en <5 años. Métodos. Estudio observacional, analítico, mediante encuestas autoadministradas a pediatras de un hospital de niños de la Ciudad Autónoma de Buenos Aires. Se indagó: edad, sexo, lugar de trabajo, fuentes bibliográficas, indicación de tratamientos farmacológicos, no farmacológicos y medidas de prevención e higiene. Se evaluó la asociación entre prescripciones farmacológicas y características de los encuestados. Resultados. Respondieron 182/216 pediatras; la edad media fue 42,4 ± 10,24 años (el 78,6 %, mujeres); el 59,2 %, del sector público; el 22,4 %, de servicios de guardia. El 91,2 % consultaba guías/consensos. El 92,9 % prescribió fórmulas de rehidratación oral; el 46,2 %, antieméticos; el 43,4 %, antiácidos y/o protectores gástricos; el 35,7 %, probióticos, y el 30,7 %, cinc. El 91,7 % indicó realimentación precoz; el 96,7 %, lactancia materna y el 96-100 %, medidas de prevención e higiene. En el análisis multivariado, tener >40 años se asoció con prescribir antiácidos/protectores gástricos (odds ratio [OR] 2,6; 1,22-5,61), probióticos (OR 3,03; 1,34-6,83) y cinc (OR 0,39; 0,17-0,87); trabajar en el sector privado con prescribir probióticos (OR 3,05; 1,56-5,94) y en servicios de guardia, con prescribir antiácidos/ protectores gástricos (OR 2,60; 1,22-5,54). Conclusiones. El tratamiento se basó principalmente en hidratación, alimentación precoz y lactancia. La edad y el lugar de desempeño de los pediatras modifican el patrón de prescripción.
Introduction. The management of acute diarrhea is based on preventing dehydration and reducing disease duration and severity. The study objective was to establish the patterns for the outpatient management of acute diarrhea in children younger than 5 years. Methods. Observational, analytical study using a self-administered survey among pediatricians from a children's hospital in the Autonomous City of Buenos Aires. Age, sex, place of work, bibliographic sources, indication of drug and non-drug therapies, and preventive and hygiene measures were recorded. The association between drug prescription and the characteristics of surveyed pediatricians was assessed. Results. In total, 182/216 pediatricians completed the survey. Their mean age was 42.4 ± 10.24 years; 78.6% were females; 59.2% worked in the public sector; 22.4% worked in the emergency department; and 91.2% consulted guidelines and/or consensuses. Also, 92.9% prescribed oral rehydration solutions; 46.2%, antiemetics; 43.4%, antacids and/or gastric protectors; 35.7%, probiotics; and 30.7%, zinc. Early food reintroduction was indicated by 91.7%; breastfeeding, by 96.7%; and preventive and hygiene measures, by 96-100%. The multivariate analysis showed an association between age > 40 years and prescribing antacids/ gastric protectors (odds ratio [OR]: 2.6; 1.22-5.61), probiotics (OR: 3.03; 1.34-6.83), and zinc (OR: 0.39; 0.17-0.87); between working in the private sector and prescribing probiotics (OR: 3.05; 1.565.94); and between working in the emergency department and prescribing antacids/gastric protectors (OR: 2.60; 1.22-5.54). Conclusions. Treatment was mainly based on hydration, early food reintroduction, and breastfeeding. Age and work sector affected the prescription pattern.
Asunto(s)
Humanos , Lactante , Preescolar , Adulto , Persona de Mediana Edad , Pacientes Ambulatorios , Pautas de la Práctica en Medicina , Pediatras/psicología , Diarrea/prevención & control , Diarrea/terapia , Hospitales PediátricosRESUMEN
INTRODUCTION: The management of acute diarrhea is based on preventing dehydration and reducing disease duration and severity. , Ángela Gentilea INTRODUCTION The study objective was to establish the patterns for the outpatient management of acute diarrhea in children younger than 5 years. METHODS: Observational, analytical study using a self-administered survey among pediatricians from a children's hospital in the Autonomous City of Buenos Aires.Age, sex, place of work, bibliographic sources, indication of drug and non-drug therapies, and preventive and hygiene measures were recorded. The association between drug prescription and the characteristics of surveyed pediatricians was assessed. RESULTS: In total, 182/216 pediatricians completed the survey. Their mean age was 42.4 ± 10.24 years; 78.6% were females; 59.2% worked in the public sector; 22.4% worked in the emergency department; and 91.2% consulted guidelines and/or consensuses. Also, 92.9% prescribed oral rehydration solutions; 46.2%, antiemetics; 43.4%, antacids and/or gastric protectors; 35.7%, probiotics; and 30.7%, zinc. Early food reintroduction was indicated by 91.7%; breastfeeding, by 96.7%; and preventive and hygiene measures, by 96-100%. The multivariate analysis showed an association between age > 40 years and prescribing antacids/ gastric protectors (odds ratio [OR]: 2.6; 1.22-5.61), probiotics (OR: 3.03; 1.34-6.83), and zinc (OR: 0.39; 0.17-0.87); between working in the private sector and prescribing probiotics (OR: 3.05; 1.565.94); and between working in the emergency department and prescribing antacids/gastric protectors (OR: 2.60; 1.22-5.54). CONCLUSIONS: Treatment was mainly based on hydration, early food reintroduction, and breastfeeding. Age and work sector affected the prescription pattern.
Introducción. El tratamiento de la diarrea aguda se basa en prevenir la deshidratación, reducir la duración y gravedad de la enfermedad. El objetivo fue conocer los patrones de tratamiento ambulatorio de la diarrea aguda en<5 años. , Anabella C. Pacchiottia,b , Cómo citar: Castelllano VE, Giglio ND, Pacchiotti AC, Gentile Á. Manejo ambulatorio de la diarrea aguda infantil: encuesta a pediatras de un hospital pediátrico de la Ciudad de Buenos Aires. Arch Argent Pediatr 2022;120(1):46-53. a. División Promoción y Protección de la Salud, Área Epidemiología. b. Departamento de Urgencia. Hospital de Niños Dr. Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina. Correspondencia: Vanesa E. Castellano: vane0108@hotmail.com Financiamiento: Este estudio recibió colaboración irrestricta del laboratorio Sanofi Aventis, utilizada para el material de las encuestas, equipamiento informático y una beca educacional para la Dra. Anabella Pacchiotti. Conflicto de intereses: V. Castellano, N. Giglio y Á. Gentile han participado como disertantes de conferencias auspiciadas por el laboratorio Sanofi Aventis en congresos y jornadas. Recibido: 11-5-2021 Aceptado: 15-9-2021 Métodos. Estudio observacional, analítico, mediante encuestas autoadministradas a pediatras de un hospital de niños de la Ciudad Autónoma de Buenos Aires. Se indagó: edad, sexo, lugar de trabajo, fuentes bibliográficas, indicación de tratamientos farmacológicos, no farmacológicos y medidas de prevención e higiene. Se evaluó la asociación entre prescripciones farmacológicas y características de los encuestados. Resultados. Respondieron 182/216 pediatras; la edad media fue 42,4 ± 10,24 años (el 78,6 %, mujeres); el 59,2 %, del sector público; el 22,4 %, de servicios de guardia. El 91,2 % consultaba guías/consensos. El 92,9 % prescribió fórmulas de rehidratación oral; el 46,2 %, antieméticos; el 43,4 %, antiácidos y/o protectores gástricos; el 35,7 %, probióticos, y el 30,7 %, cinc. El 91,7 % indicó realimentación precoz; el 96,7 %, lactancia materna y el 96-100 %, medidas de prevención e higiene. En el análisis multivariado, tener >40 años se asoció con prescribir antiácidos/protectores gástricos (odds ratio [OR] 2,6; 1,22-5,61), probióticos (OR 3,03; 1,34-6,83) y cinc (OR 0,39; 0,17-0,87); trabajar en el sector privado con prescribir probióticos (OR 3,05; 1,56-5,94) y en servicios de guardia, con prescribir antiácidos/ protectores gástricos (OR 2,60; 1,22-5,54). Conclusiones. El tratamiento se basó principalmente en hidratación, alimentación precoz y lactancia. La edad y el lugar de desempeño de los pediatras modifican el patrón de prescripción.
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Diarrea/terapia , Pacientes Ambulatorios , Pediatras/psicología , Pautas de la Práctica en Medicina , Adulto , Preescolar , Diarrea/prevención & control , Femenino , Hospitales Pediátricos , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana EdadRESUMEN
Diarrhea following bariatric surgery may be secondary to multiple causes. The aim of the present study is to report a significant reduction in episodes of diarrhea with the stimulation of the lymphatic system in a patient with post-bariatric diarrhea usingthe Godoy method for the treatment for lymphedema. Case Report: A 40-year-old female patient with obesity was submitted to bariatric surgery, type Gastric bypass (roo-en-wy), 13 years ago. Beginning immediately after surgery, the patient began to have around 12 episodes of diarrhea per day for approximately 11 years. The patient also had lower limb lymphedema and was sent to the Clínica Godoy-Brazil for treatment. The patient underwent the Godoy Method® of intensive treatment for lymphedema. However, the most important finding was the immediate reduction in the number of episodes of diarrhea per day, which went from 12-13 to 2-3 after only one day of treatment. This result regarding diarrhea has been maintained for two years, with the maximum number of seven episodes on some days, which subsequently returned to two to three episodes. The Godoy intensive lymphedema treatment method was effective at reducing the number of episodes of post-bariatric diarrhea, offering a novel treatment option for these patients
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Humanos , Femenino , Adulto , Diarrea/terapia , Cirugía Bariátrica/efectos adversos , Linfedema/terapia , Sistema LinfáticoRESUMEN
Background: The treatment of Clostridioides difficile is based on an antibiotics cycle, but for individuals who have more than two recurrences, fecal microbiota transplantation can be considered as a therapeutic option. Objective: To describe the technique and results of fecal microbiota transplantation performed for recurrent infection by Clostridioides difficile. Methods: Retrospective, cross-sectional study based on a review of medical records of patients undergoing transplantation of fecal microbiota. Data were obtained on the criteria used to select the donor, the preparation of stools in the laboratory and the method of delivery of the material offered, as well as information regarding the characteristics of the recipient, such as: gender, age, comorbidities, hospitalizations, use of antibiotics prior to infection, clinical presentation, diagnosis and treatments performed for Clostridioides difficile. After transplantation, data on efficacy, outcome, follow-up time and procedure complications were considered. Results: Between 2012 and 2019, 11 patients underwent fecal microbiota transplantation. The use of antibiotics prior to infection occurred in 9 patients, no patient was hospitalized in the previous 6 months due to another etiology. All had at least 2 cycles of vancomycin for recurrent disease. Of the total of 11 patients, 2 required 2 infusions and 1 patient required 3, totaling 15 fecal microbiota transplants. The success rate was 81.8% with only one infusion and 90.9% resolution considering patients who needed more than one infusion. Conclusion: Fecal microbiota transplantation is a feasible therapy with resolution in 90.9% of cases as a treatment for recurrent Clostridioides difficile infection.
Contexto: O tratamento do Clostridioides difficile é baseado em ciclo antimicrobiano, mas para os indivíduos que apresentam mais de duas recorrências, pode-se considerar o transplante de microbiota fecal como opção terapêutica. Objetivo: Descrever a técnica e os resultados do transplante de microbiota fecal realizados para infecção recorrente por Clostridioides difficile. Métodos: Estudo retrospectivo, transversal, baseado em revisão de prontuários de pacientes submetidos ao transplante de microbiota fecal. Foram obtidos dados sobre os critérios empregados para seleção do doador, o preparo das fezes e o método de entrega do material, além de informações referentes às características do receptor, como: sexo, idade, comorbidades, internamentos, uso de antimicrobiano prévio à infecção, apresentação clínica, diagnóstico e tratamentos realizados para o Clostridioides difficile. Após o transplante, dados sobre eficácia, desfecho, tempo de seguimento e complicações do procedimento foram considerados. Resultados: Entre 2012 e 2019, 11 pacientes foram submetidos ao transplante de microbiota fecal. O uso de antimicrobiano prévio à infecção ocorreu em 9 pacientes, nenhum paciente internou nos 6 meses anteriores por outra etiologia. Todos fizeram pelo menos 2 ciclos de vancomicina para doença recorrente. Do total de 11 pacientes, 2 necessitaram de 2 infusões e 1 paciente necessitou de 3, totalizando 15 transplantes de microbiota fecal. O sucesso foi de 81,8% com apenas uma infusão e resolução de 90,9% considerando pacientes que necessitaram de mais de uma infusão. Conclusão: O transplante de microbiota fecal é uma terapia factível e com resolução em 90,9% dos casos como tratamento de infecção recorrente por Clostridioides difficile.
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Humanos , Clostridioides difficile , Infecciones por Clostridium , Diarrea/terapia , Trasplante de Microbiota Fecal , Disbiosis , Estudio Observacional , Antibacterianos/uso terapéuticoRESUMEN
Bacillus clausii is a gram-positive rod used as a probiotic to treat diarrhea and the side effects of antibiotics such as pseudomembranous colitis. We report a case of B. clausii bacteremia in a non-immunocompromised patient with active peptic ulcer disease and acute diarrhea. The probiotic was administered during the patient´s hospitalization due to diarrhea of infectious origin. B. clausii was identified in the bloodstream of the patient through Matrix-Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) days after her discharge. Given the wide use of probiotics, we alert clinicians to consider this microorganism as a causative agent when signs of systemic infection, metabolic compromise, and hemodynamic instability establish after its administration and no pathogens have been identified that could explain the clinical course.
Bacillus clausii es un bacilo grampositivo que se utiliza como probiótico para tratar la diarrea y los efectos secundarios de los antibióticos como la colitis pseudomembranosa. Presentamos un caso de bacteriemia por B. clausii en un paciente no inmunodeprimido con enfermedad ulcerosa péptica activa y diarrea aguda. El probiótico se administró durante la hospitalización del paciente por diarrea de origen infeccioso. B. clausii se identificó en el torrente sanguíneo de la paciente a través del tiempo de vuelo por ionización por desorción láser asistida por matriz (MALDI-TOF) días después de su alta. Dado el amplio uso de probióticos, alertamos a los médicos para que consideren este microorganismo como agente causal cuando se establezcan signos de infección sistémica, compromiso metabólico e inestabilidad hemodinámica después de su administración y no se hayan identificado patógenos que puedan explicar el curso clínico.
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Bacillus clausii , Bacteriemia , Probióticos , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Diarrea/inducido químicamente , Diarrea/terapia , Femenino , Humanos , Espectrometría de Masa por Láser de Matriz Asistida de Ionización DesorciónAsunto(s)
Diarrea/historia , Diarrea/microbiología , Escherichia coli Enteropatógena , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/historia , Diarrea/epidemiología , Diarrea/terapia , Escherichia coli Enteropatógena/clasificación , Escherichia coli Enteropatógena/aislamiento & purificación , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/terapia , Salud Global , Historia del Siglo XX , Historia del Siglo XXI , HumanosRESUMEN
BACKGROUND: Fifty percent of patients with typical diarrhea-associated hemolytic uremic syndrome (D+HUS) require kidney replacement therapy (KRT). In these patients, dehydration worsens disease prognosis. We evaluated dialysis requirement, presence of seizures, and mortality rate among patients diagnosed with D+HUS treated with volume expansion (VE) versus fluid restriction (FR). METHODS: Thirty-five patients with D+HUS were enrolled; 16 received VE and 19 were historical patients who received conventional FR. RESULTS: Upon admission or during treatment, neither group presented evidence of fluid overload. The VE group received higher volumes of saline (VE 27 ml/kg [10-30] over a 3-h period vs. FR 0 ml), had higher urine output after 12 h (VE vs. FR: OR 6.2 [1.2-41.6], P = 0.03), and required less dialysis (VE 2 [12.5%, CI 95% 0-29] vs. FR 9 [47.4%, CI 95% 24-70], P = 0.035). The VE group had an absolute risk reduction of 0.34 (CI 95% 0.07-0.63); hence, three patients treated with VE were required to avoid one KRT. VE also corrected initial hyponatremia and maintained serum sodium within normal ranges. No statistical differences were observed regarding number of patients with seizures (P = 0.08) or mortality (P = 1.0). CONCLUSIONS: VE markedly reduces the number of patients requiring KRT and keeps serum sodium within a normal range. We propose to initially hydrate every patient with D+HUS and without signs of fluid overload, with 10 ml/kg/h 0.9% saline solution IV, over a 3-h period. Afterwards, if urine output is ≥ 0.5 ml/kg/h, it is recommended to not dialyze and continue IV hydration schedule with isotonic (D5) saline solution, according to their needs.
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Diarrea , Niño , Diarrea/etiología , Diarrea/terapia , Síndrome Hemolítico-Urémico/complicaciones , Síndrome Hemolítico-Urémico/diagnóstico , Síndrome Hemolítico-Urémico/terapia , Humanos , Diálisis Renal/efectos adversos , Estudios Retrospectivos , Solución Salina , Convulsiones , SodioRESUMEN
Neonatal calf diarrhoea is one of the challenges faced by intensive farming, and probiotics are considered a promising approach to improve calves' health. The objective of this study was to evaluate the effect of potential probiotic lactobacilli on new-born dairy calves' growth, diarrhoea incidence, faecal score, cytokine expression in blood cells, immunoglobulin A (IgA) levels in plasma and faeces, and pathogen abundance in faeces. Two in vivo assays were conducted at the same farm in two annual calving seasons. Treated calves received one daily dose of the selected lactobacilli (Lactobacillus reuteri TP1.3B or Lactobacillus johnsonii TP1.6) for 10 consecutive days. A faecal score was recorded daily, average daily gain (ADG) was calculated, and blood and faeces samples were collected. Pathogen abundance was analysed by absolute qPCR in faeces using primers directed at Salmonella enterica, rotavirus, coronavirus, Cryptosporidium parvum and three Escherichia coli virulence genes (eae, clpG and Stx1). The faecal score was positively affected by the administration of both lactobacilli strains, and diarrhoea incidence was significantly lower in treated calves. No differences were found regarding ADG, cytokine expression, IgA levels and pathogen abundance. Our findings showed that oral administration of these strains could improve gastrointestinal health, but results could vary depending on the calving season, which may be related to pathogen seasonality and other environmental effects.
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Enfermedades de los Bovinos/terapia , Diarrea , Lactobacillus johnsonii/metabolismo , Limosilactobacillus reuteri/metabolismo , Probióticos/uso terapéutico , Animales , Animales Recién Nacidos , Bovinos , Enfermedades de los Bovinos/microbiología , Enfermedades de los Bovinos/prevención & control , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/veterinaria , Criptosporidiosis/prevención & control , Citocinas/sangre , Industria Lechera , Diarrea/prevención & control , Diarrea/terapia , Diarrea/veterinaria , Infecciones por Escherichia coli/prevención & control , Infecciones por Escherichia coli/veterinaria , Heces/virología , Tracto Gastrointestinal/microbiología , Inmunoglobulina A/sangre , Infecciones por Rotavirus/prevención & control , Infecciones por Rotavirus/veterinaria , Salmonelosis Animal/prevención & controlRESUMEN
BACKGROUND: Neonatal diarrhea remains one of the main causes of morbi-mortality in dairy calves under artificial rearing. It is often caused by infectious agents of viral, bacterial, or parasitic origin. Cows vaccination and colostrum intake by calves during the first 6 h of life are critical strategies to prevent severe diarrhea but these are still insufficient. Here we report the field evaluation of a product based on IgY antibodies against group A rotavirus (RVA), coronavirus (CoV), enterotoxigenic Escherichia coli, and Salmonella sp. This product, named IgY DNT, has been designed as a complementary passive immunization strategy to prevent neonatal calf diarrhea. The quality of the product depends on the titers of specific IgY antibodies to each antigen evaluated by ELISA. In the case of the viral antigens, ELISA antibody (Ab) titers are correlated with protection against infection in calves experimentally challenged with RVA and CoV (Bok M, et al., Passive immunity to control bovine coronavirus diarrhea in a dairy herd in Argentina, 2017), (Vega C, et al., Vet Immunol Immunopathol, 142:156-69, 2011), (Vega C, et al., Res Vet Sci, 103:1-10, 2015). To evaluate the efficiency in dairy farms, thirty newborn Holstein calves were randomly assigned to IgY DNT or control groups and treatment initiated after colostrum intake and gut closure. Calves in the IgY DNT group received 20 g of the oral passive treatment in 2 L of milk twice a day during the first 2 weeks of life. Animals were followed until 3 weeks of age and diarrhea due to natural exposure to infectious agents was recorded during all the experimental time. RESULTS: Results demonstrate that the oral administration of IgY DNT during the first 2 weeks of life to newborn calves caused a delay in diarrhea onset and significantly reduced its severity and duration compared with untreated calves. Animals treated with IgY DNT showed a trend towards a delay in RVA infection with significantly shorter duration and virus shedding compared to control calves. CONCLUSIONS: This indicates that IgY DNT is an effective product to complement current preventive strategies against neonatal calf diarrhea in dairy farms. Furthermore, to our knowledge, this is the only biological product available for the prevention of virus-associated neonatal calf diarrhea.
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Anticuerpos Antibacterianos/uso terapéutico , Anticuerpos Antivirales/uso terapéutico , Enfermedades de los Bovinos/terapia , Diarrea/veterinaria , Inmunoglobulinas/uso terapéutico , Inmunoterapia , Animales , Animales Recién Nacidos , Anticuerpos Antiprotozoarios , Bovinos , Enfermedades de los Bovinos/microbiología , Enfermedades de los Bovinos/virología , Criptosporidiosis/prevención & control , Industria Lechera , Diarrea/microbiología , Diarrea/terapia , Diarrea/virología , Inmunización Pasiva/métodos , Inmunización Pasiva/veterinariaRESUMEN
OBJECTIVE: To evaluate the association among characteristics of primary health care center (PHCC) with hospitalizations for primary care sensitive conditions (PCSC) in Brazil. METHOD: In this study, a cross-sectional ecological study was performed. This study analyzed the 27 capitals of Brazil's federative units. Data were aggregated from the following open access databases: National Program for Access and Quality Improvement in Primary Care, the Hospital Information System of Brazilian Unified Health System and Annual Population Census conducted by the Brazilian Institute of Geography and Statistics. Associations were estimated among characteristics of primary care with the number of three PCSC as the leading causes of hospitalization in children under-5 population in Brazil: asthma, diarrhea, and pneumonia. RESULTS: In general, PHCC showed limited structural adequacy (37.3%) for pediatric care in Brazil. The capitals in South and Southeast regions had the best structure whereas the North and Northeast had the worst. Fewer PCSC hospitalizations were significantly associated with PHCC which presented appropriate equipment (RR: 0.98; 95%CI: 0.97-0.99), structural conditions (RR: 0.98; 95%CI: 0.97-0.99), and signage/identification of professionals and facilities (RR: 0.98; 95%CI: 0.97-0.99). Higher PCSC hospitalizations were significantly associated with PHCC with more physicians (RR: 1.23, 95%CI: 1.02-1.48), it forms (RR: 1.01, 95%CI: 1.01-1.02), and more medications (RR: 1.02, 95%CI: 1.01-1.03). CONCLUSION: Infrastructural adequacy of PHCC was associated with less PCSC hospitalizations, while availability medical professional and medications were associated with higher PCSC hospitalizations.
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Hospitalización/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Asma/epidemiología , Asma/terapia , Brasil/epidemiología , Preescolar , Estudios Transversales , Atención a la Salud/estadística & datos numéricos , Diarrea/epidemiología , Diarrea/terapia , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Neumonía/epidemiología , Neumonía/terapia , Factores SocioeconómicosRESUMEN
Postbiotics have recently been tentatively defined as bioactive compounds produced during a fermentation process (including microbial cells, cell constituents and metabolites) that supports health and/or wellbeing. Postbiotics are currently available in some infant formulas and fermented foods. We systematically reviewed evidence on postbiotics for preventing and treating common infectious diseases among children younger than 5 years. The PubMed, Embase, SpringerLink, and ScienceDirect databases were searched up to March 2019 for randomized controlled trials (RCTs) comparing postbiotics with placebo or no intervention. Seven RCTs involving 1740 children met the inclusion criteria. For therapeutic trials, supplementation with heat-killed Lactobacillus acidophilus LB reduced the duration of diarrhea (4 RCTs, n = 224, mean difference, MD, -20.31 h, 95% CI -27.06 to -13.57). For preventive trials, the pooled results from two RCTs (n = 537) showed that heat-inactivated L. paracasei CBA L74 versus placebo reduced the risk of diarrhea (relative risk, RR, 0.51, 95% CI 0.37-0.71), pharyngitis (RR 0.31, 95% CI 0.12-0.83) and laryngitis (RR 0.44, 95% CI 0.29-0.67). There is limited evidence to recommend the use of specific postbiotics for treating pediatric diarrhea and preventing common infectious diseases among children. Further studies are necessary to determine the effects of different postbiotics.