Identification of a New Serovar of Salmonella enterica in Mediterranean Buffalo Calves (Bubalus bubalis)

This case report describes for the first-time cases of severe gastroenteritis in water buffalo calves due to a new serovar of Salmonella enterica. The study was carried out on fecal matrix collected from live water buffalo calves that showed profuse diarrhea, severe dehydration and fever, exhibiting a systemic course. Culture and molecular investigations identified the pathogens isolated from intestinal contents as two Salmonella serovars, Salmonella enterica enterica O:35 and a new serovar of Salmonella enterica. The isolates showed multi-drug resistance. Timely diagnosis associated with a targeted antimicrobial treatment were found to be sufficient for the survival and recovery of the infected animals. Herd vaccines prepared from isolated pathogens were used to prevent further deaths of the calves.

Predictors of severe forms of rotaviral infection in children

Rotavirus infection (RVI) is one of the most common childhood diseases. The study of predictors of severe forms of this disease is of undoubted interest.Aim. Based on the study of the characteristics of the premorbid background, life history and clinical and laboratory parameters, determine predictors of severe forms of RVI.Patients and methods. In the departments of intestinal infections and resuscitation and intensive care of Pediatric Research and Clinical Center for Infectious Diseases in the period 2018 – 202. a retrospective study of 962 children aged 2 months to 2 years with rotavirus infection was carried out. he severity of the condition was assessed using the Clarke scale. To identify the most significant predictors of the development of severe forms of RVI, two groups of patients were compared: severe (> 16 points) and moderate (≤16 points) forms of RVI. Comparison of the frequency of occurrence of signs in the groups was performed using the Pearson χ2 test and Fisher’s exact method. The forecasting model was developed using discriminant analysis of the statistical package Statistica for Windows.Results. Severe forms of RVI were detected in 65 children. Among the patients with severe forms of RVI, there were no patients with completed preventive vaccination. Patients with severe forms of RVI were admitted to the hospital in the late stages of the disease and had a higher score on the CDS scale. Based on the research carried out, a model for predicting severe forms of RVI was developed. The features included in the model were: the day of illness at admission, the patient’s age, prehospital prescription of antibacterial drugs, the absence of completed vaccination against RVI, and the severity of dehydration. Assessment of the quality of the created model showed that the classification ability was 97.7%.Conclusion. Predictors of severe forms of RVI include admission to a hospital in the late stages of the disease with severe dehydration, early age, prehospital antibiotics and forced transfer to artificial feeding, and absence of completed prophylactic vaccination.

Holocord spontaneous pneumorrhachis in the setting of refractory emesis

Background: Pneumorrhachis (PNR) is the presence of air within the spinal canal and may be either intramedullary or extramedullary in location. The etiology is most commonly iatrogenic or traumatic in nature. Treatment is dependent on underlying cause and physical exam. Case Description: Herein, we describe the second case in the literature of spontaneous holocord PNR in a young patient without risk factors. A 22-year-old male with no past medical history presented to the hospital for 2 days of vomiting and cramping in his hands and feet secondary to severe dehydration. He recently started a new job as a manual laborer and had to leave work early 2 days prior due to overexertion working outside in heat ranging from 100 to 120 degrees Fahrenheit. CT abdomen and pelvis demonstrated spontaneous pneumomediastinum and extramedullary PNR extending upward from L3 throughout the thoracic spine to the upper limit of the scan. Subsequent CT cervical and thoracic spine showed the full length of the extradural air from C2-T12 and again at L3. Conclusion: Spontaneous PNR is an uncommon, typically self-limited condition in which air is introduced into the spinal axis. Anatomic predisposition makes the extradural, dorsal cord in the cervicothoracic region the most common location. Patients are rarely symptomatic, and treatment is supportive in nature once secondary causes with high rates of morbidity and mortality are ruled out.

A Neonate with Autosomal Dominant Pseudohypoaldosteronism Type 1 Due to a Novel Microdeletion of the NR3C2 Gene at 4q31.23

Dehydration with hyponatremia can occur from a variety of causes and can be potentially fatal to infants. Pseudohypoaldosteronism type 1 (PHA1) is a rare disease that can cause severe dehydration along with hyponatremia and hyperkalemia because of renal tubular unresponsiveness to mineralocorticoids. Autosomal dominant PHA1 (ADPHA1, OMIM #177735) is caused by inactivating mutations in the NR3C2 gene, which encodes the mineralocorticoid receptor, and it can lead to renal salt-wasting, dehydration, and failure to thrive during infancy. Here, we report a case of a 20-day-old female neonate who presented as severe dehydration with hyponatremia and polyuria. We suspected that her diagnosis might be PHA1 based on markedly elevated plasma renin activity and serum aldosterone levels. For the genetic diagnosis of PHA1, we performed targeted exome sequencing of all causative genes of PHA1, but the result was negative. We confirmed by chromosomal microarray that a novel heterozygous microdeletion was found in the 4q31.23 region spanning exons 7–9 of the NR3C2 gene, and the patient was diagnosed with ADPHA1. In conclusion, our patient is a case of ADPHA1 that developed into a salt-wasting crisis in the neonatal period due to a microdeletion of the 4q31.23 region inherited from her father.

Hematocrit Value in Diarrhea Patients

Diarrhea is the discharge of stool that is not normal or the form of watery stools with more frequency than usual. Diarrhea can be caused by various things, namely infectious and non-infectious. In acute diarrhea, complications can occur, including dehydration. On hematological.examination. of. diarrhea. patients,.there can be an increase in several blood tests such as an increase in hematocrit and hemoglobin in a state of severe dehydration. The. purpose. of. this. study. was. to. determine. the. hematocrit value in inpatient diarrhea patients at the Tonjong Public Health Center, Brebes Regency. This is a descriptive study using a non-probability sampling technique that relies on medical record data for 30 respondents at the Tonjong Public Health Center, Brebes Regency. The results showed that there were 3 men who had decreased hematocrit levels and 8 people who had normal hematocrit levels. Whereas in women, the hematocrit levels decreased as many as 17 people and those who had normal hematocrit levels were 2 people. Based on the age category, the most are the late elderly as many as 8 people and the final adults as much as 2 people. Meanwhile, based on the status of dehydration, all diarrhea patients who came for treatment at the Tonjong Health Center, Brebes Regency, 100% did not experience diarrhea with dehydration. The hematocrit levels in diarrhea patients at the Tonjong Public Health Center, Brebes Regency were 30 samples, on average they had low hematocrit levels.

Knowledge and Practices of Mothers about Diarrhea in Children Under Three Years Old in Heevi Pediatric Teaching Hospital in Duhok City

Background and Objectives: Diarrheal disease is the second important reason of death in children under 5 years old and is responsible for killing around 760,000 children every year. Diarrhea can last for several days and it can leave the body without the water and salts that are necessary for survival. Most people who die from diarrhea actually die from severe dehydration and fluid loss. The aim of this study is to assess the relationship between mother’s knowledge and their practice about diarrhea in children <3 years old. Research Methodology: A cross-sectional study was conducted on 50 children with diarrheal episodes attending inpatient word. A set of questionnaires from previous studies was adopted and modified to assess the relationship between mother’s knowledge and their practice about diarrhea in children less than 3 years old in Heevi Pediatric Teaching Hospital in Duhok City. Results: More than half of participants (68%) had poor knowledge, though; the 32% had good knowledge. In terms of mother’s practice, most of the participants (64%) had poor mother practice; whereas, only 36% were good mother practice. However, there was a negative correlation between mother knowledge and mother practice (P ≤ 0.001). Conclusions: The findings of the study indicate that due to lack of knowledge and poor practice about management of diarrhea the children were suffering from many complications. Relevance to clinical practice: Nurse educators have a significant role in providing health education to mothers about diarrhea in children.

Derivation and Internal Validation of a Score to Predict Dehydration Severity in Patients over 5 Years with Acute Diarrhea

Diarrheal disease accounts for more than one million deaths annually in patients over 5 years of age. Although most patients can be managed with oral rehydration solution, patients with severe dehydration require resuscitation with intravenous fluids. Scoring systems to assess dehydration have been empirically derived and validated in children under 5 years, but none have been validated for patients over 5 years. In this study, a prospective cohort of 2,172 patients over 5 years presenting with acute diarrhea to International Centre for Diarrhoeal Disease Research, Dhaka Hospital, Bangladesh, were assessed for clinical signs of dehydration. The percent difference between presentation and posthydration stable weight determined severe (≥ 9%), some (3–9%), or no (< 3%) dehydration. An ordinal regression model was derived using clinical signs and demographics and was then converted to a 13-point score to predict none (score of 0–3), some (4–6), or severe (7–13) dehydration. The Novel, Innovative Research for Understanding Dehydration in Adults and Kids (NIRUDAK) Score developed by our team included age, sex, sunken eyes, radial pulse, respiration depth, skin turgor, and vomiting episodes in 24 hours. Accuracy of the NIRUDAK Score for predicting severe dehydration, as measured by the area under the receiver operating characteristic curve, was 0.76 (95% confidence interval = 0.73–0.78), with a sensitivity of 0.78 and a specificity of 0.61. Reliability was also robust, with an Inter-Class Correlation Coefficient of 0.88 (95% confidence interval = 0.84–0.91). This study represents the first empirically derived and internally validated scoring system for assessing dehydration in children ≥ 5 years and adults with acute diarrhea in a resource-limited setting.

Antidiarrhoeal Potential of various Solvent Extracts of Achyranthes aspera against three diverse diarrhoeal animal models

Diarrhoea is a condition characterized by a variation in the bowel movement. It is one of the major health issues in developing countries. Its severity is more in children’s. Diarrhoea causes severe dehydration and some time it may lead to death. Globally, over 5 million children’s are dying each year because of diarrhoea. In the present scenario, herbal medicines are used by the people in a wider range because of its safety as compared to synthetic drugs. So it is very crucial to identify and investigate available natural drugs for treating diarrhoea. Hence, the present study endeavor the evaluation of antidiarrhoeal activity of Achyranthus aspera. The anti-diarrhoeal activity was performed by using different animal models like castor oil-induced diarrhoea, prostaglandin-E2 induced enteropooling and gastrointestinal motility test. All the extracts of Achyranthus aspera showed considerable antidiarrhoeal activity in all the three animal models by reducing diarrhoeal episodes. The findings of the present investigation revealed the significant antidiarrhoeal property of Achyranthes aspera. Hence this plant can be used in the suitable form as an alternative to available synthetic antidiarrhoeal medicines which are not completely safe. Thus the adverse effects of synthetic drugs can be minimized by reducing its use.

Oxygen systems and quality of care for children with pneumonia, malaria and diarrhoea: Analysis of a stepped-wedge trial in Nigeria

Objectives To evaluate the effect of improved hospital oxygen systems on quality of care (QOC) for children with severe pneumonia, severe malaria, and diarrhoea with severe dehydration. Design Stepped-wedge cluster randomised trial (unblinded), randomised at hospital-level. Setting 12 hospitals in south-west Nigeria. Participants 7,141 children (aged 28 days to 14 years) admitted with severe pneumonia, severe malaria or diarrhoea with severe dehydration between January 2014 and October 2017. Interventions Phase 1 (pulse oximetry) introduced pulse oximetry for all admitted children. Phase 2 (full oxygen system) (i) standardised oxygen equipment package, (ii) clinical education and support, (iii) technical training and support, and (iv) infrastructure and systems support. Outcome measures We used quantitative QOC scores evaluating assessment, diagnosis, treatment, and monitoring practices against World Health Organization and Nigerian standards. We evaluated mean differences in QOC scores between study periods (baseline, oximetry, full oxygen system), using mixed-effects linear regression. Results 7,141 eligible participants; 6,893 (96.5%) had adequate data for analysis. Mean paediatric QOC score (maximum 6) increased from 1.64 to 3.00 (adjusted mean difference 1.39; 95% CI 1.08–1.69, p<0.001) for severe pneumonia and 2.81 to 4.04 (aMD 1.53; 95% CI 1.23–1.83, p<0.001) for severe malaria, comparing the full intervention to baseline, but did not change for diarrhoea with severe dehydration (aMD -0.12; 95% CI -0.46–0.23, p = 0.501). After excluding practices directly related to pulse oximetry and oxygen, we found aMD 0.23 for severe pneumonia (95% CI -0.02–0.48, p = 0.072) and 0.65 for severe malaria (95% CI 0.41–0.89, p<0.001) comparing full intervention to baseline. Sub-analysis showed some improvements (and no deterioration) in care processes not directly related to oxygen or pulse oximetry. Conclusion Improvements in hospital oxygen systems were associated with higher QOC scores, attributable to better use of pulse oximetry and oxygen as well as broader improvements in clinical care, with no negative distortions in care practices. Trial registration ACTRN12617000341325

Acid-base and Electrolyte Disturbances in Children Presenting with Acute Watery Diarrhoea in Emergency Observation and Referral Unit of Dhaka Shishu (Children) Hospital

Background: Acute watery diarrhoea (AWD) is a leading cause of illness and death amongst children in developing countries. Electrolyte and acid-base disturbances play an important role in the associated morbidity and mortality. Objectives: To observe the acid-base and electrolyte changes in moderate and severe dehydration in AWD in children. Methods: This cross sectional study was carried out in the Observation and Referral Unit of Dhaka Shishu (Children) Hospital from July 2018 to December 2018. Children below five years of age who came with acute diarrhoea with moderate to severe dehydration were included in the study. After admission 2ml of whole blood was collected with all aseptic measures at the time of insertion of intravenous cannula before giving intravenous fluids to measure serum levels of Na and K while arterial blood was also taken for analysis. The data was analyzed by using SPSS version 20. Results: Total 125 AWD cases were admitted among them 98(78.4%) had moderate dehydration whereas 27(21.6%) had severe dehydration. Hyponatremic dehydration was present in 41(32.8%) cases. Among them 30(30.6%) had moderate dedydration and 11(40.4%) had severe dehydration, hypernatremic dehydration was present in 11.11% cases, hypokalemia was present in 54(43.2%) cases. Among them 42(42.86%) had moderate dedydration and 12(44.44%) had severe dehydration. Metabolic acidosis was present in 38(30.4%) cases [28(28.57%) in moderate dedydration and 10(37.04%) in severe dehydration]. The comparison of mean serum sodium and potassium value of the children with moderate and severe degrees of dehydration did not attain statistical significance, but there was a significant difference in bicarbonate concentration among moderate and severe dehydration cases (p=0.02). Conclusion: Hyponatremia and hypokalamia was the commonest electrolyte abnormality among moderate to severe dehydration with AWD. Mean serum sodium and potassium of the children with moderate and severe degrees of dehydration did not attain statistical significance, but bicarbonate concentration was significantly low among severe dehydration cases. DS (Child) H J 2020; 36(2): 120-124