The Effect of Electroacupuncture Treatment with Different Intensities for Functional Diarrhea: A Randomized Controlled Trial

Background. Electroacupuncture (EA) may have a role in the treatment of diarrhea symptoms. However, the efficacy and safety of EA with different current intensities in improving gastrointestinal function, psychology, and quality of life (QOL) of functional diarrhea (FD) remain unknown. Objective. To investigate the efficacy and safety of EA with different current intensities in improving gastrointestinal function, psychology, and QOL for FD patients. Methods. 73 FD patients were randomly divided into three groups: low current intensity group (LI) of EA, high current intensity group (HI) of EA, and loperamide control group (LC). Four weeks of treatment were provided in the three groups. The primary outcome was the proportion of normal defecation. Additional outcomes included the change from baseline for the weekly spontaneous bowel movements (SBMs) and the change from baseline for the mean Bristol Stool Form Scale (BSFS). QOL was assessed by the 36-item short-form health survey (SF-36). Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to assess the psychology state. Results. Low current intensity of EA significantly improved the proportion of normal defecation during treatment and follow-up period ( P < 0.01 ). EA significantly improves the mean BSFS scores and weekly SBMs, and this efficacy is equivalent to loperamide ( P < 0.05 ). The SF-36 scores of general health in LI and HI groups and vitality and mental health in LI group were significantly increased compared to baseline ( P < 0.05 ). Low current intensity of EA can significantly improve SAS and SDS scores ( P < 0.05 ). Conclusions. EA significantly improved stool consistency and weekly SBMs in FD patients. Compared with loperamide, low current intensity of EA may have a better sustainable effect in restoring normal defecation in patients with FD, and it can also effectively improve QOL, anxiety, and depression. However, larger sample sizes are needed to determine safety and efficacy. Trial registration number: NCT01274793.

Association of early-onset constipation and diarrhea with patient outcomes in critically ill ventilated patients: a retrospective observational cohort study

Constipation and diarrhea are both associated with poor outcomes in critically ill patients. Although constipation and diarrhea are closely related, few studies have examined them simultaneously. The purpose of this study was to describe patient defecation status after intensive care unit (ICU) admission and determine the association of early-onset constipation and diarrhea after ICU admission with outcomes for critically ill ventilated patients. Critically ill patients were retrospectively investigated and their defecation status was assessed during the first week after admission. The patients were divided into three groups: normal defecation, constipation, and diarrhea, and multiple comparison tests were performed. Additionally, multivariable analysis was performed for mortality and length of stay. Of the 85 critically ill ventilated patients, 47 (55%) experienced constipation, and 12 (14%) experienced diarrhea during the first week of ICU admission. Patients with normal defecation and diarrhea increased from the fourth and fifth day of ICU admission. Diarrhea was significantly associated with the length of ICU stay (B=7.534, 95% confidence interval: 0.116-14.951). Early-onset constipation and diarrhea were common in critically ill ventilated patients, and early-onset diarrhea was associated with the length of ICU stay. Prevention of constipation and diarrhea before the fifth day of ICU admission is essential.

An integrated approach to the pathogenetic therapy of constipation

The data on the causes of defecation disorders, mechanisms of normal defecation, and pathogenetic aspects of constipation are presented. Functional gastrointestinal disorders are considered as a common pathology of the gastrointestinal tract, which is based on combined morphological and physiological abnormalities associated with visceral hypersensitivity, disorders of gastrointestinal motility, protective mucous barrier, immune function and the composition of the intestinal microbiota. The article discusses the possibility of using the drinking medicinal mineral water Zajecicka Horka (Zayechitskaya bitter) for intestinal pathology and other functional gastrointestinal disorders.

A New Approach for Pelvic Tumors Invading the Rectum

Objective: Sometimes pelvic tumors invade the rectal wall, needing removal Design: An alternative technique of radical/conservative surgery (trying to preserve as much as possible the muscular complex) is presented, inspired by De La Torre treatment of Hirschprung’s disease. The lower rectum is only partially resected on the non-involved side, where only mucosa is removed, followed by a lower end to end rectal anastomosis Results: Normal defecation Conclusion: A good surgical alternative

Mitochondrial Encephalomyopathy Masked By “Cerebral Infarction”

The patient, male, 49 years old, was admitted to our hospital due to “blurred vision for 3 days worse than before”.3 days prior to the hospital patients with no obvious incentives in his eyes to the left side is not clear from the previous increase, with the right side of the headache, obscures vision is characterized by absence of vision to the left of both eyes, walk tilt, easy to hit objects, the right side of the headache is acerbity keenly feel, at that time did not attach importance to it, not treatment, no obvious improvement in symptoms, then to the hospital emergency line head CT no bleeding, “Cerebrovascular disease” was included in the Department of Neurology. During the course of onset, there was no dizziness, nausea and vomiting, palpitation or feeling of stepping on cotton. Since the onset of the disease, Poor spirit, poor sleep, good diet, normal defecation.

Review of Intersphincteric Resections for Rectal Cancer Treatment

Colorectal cancer is the third most common cancer, second most common cancer in women, and the fourth leading cause of death in the world. Radical surgical treatment with Total Mesorectal Excision (TME) is considered the best treatment for cancer found in the lower third of the rectum and has benefits of complete tumor removal to reduce risk of recurrence and to improve survival. Advances in preoperative chemoradiation therapy have increased chances of achieving a 1 cm distal margin and allowed successful sphincter-preserving surgery by intersphincteric resection (ISR) and Coloanal Anastomosis (CAA) that allows normal defecation. MRI is particularly useful in evaluating localization of the tumor, involvement of anal sphincter (internal and external sphincters), levator ani muscles, and adjacent structures to the anus, with an accuracy of 85%, sensitivity of 87%, and specificity of 75%. Performing ISR with TME oncologic principles achieves similar results to Low Anterior Resection (LAR), but depends on the presence of sufficient Distal Rectal Margin (DRM); if a sufficient DRM cannot be achieved, then patients are offered an Abdominoperineal Resection (APR) with permanent colostomy and poor quality-of-life results.

Evaluation of Diarrhea in Patients with COVID-19

Background/Aims:The COVID-19 disease, which was declared epidemic by the World Health Organization (WHO), is a global emergency public health problem. Patients with extrapulmonary symptoms are the group of patients who should be considered for person-to-person transmission in the community. In our study, it was aimed to investigate the characteristics of patients with COVID-19-related diarrhea symptoms. Materials and Methods:The study was conducted retrospectively in COVID-19 rtRT-PCR-positive patients in five medical centers. 3 or more loose/liquid stools per day or increased number of defecations compared to normal defecation were defined as diarrhea. The patients were analyzed in two groups as those with and without diarrhea. Results:1086 patients were included in the study. 78 (7.2%) of the patients had diarrhea. Diarrhea was watery in 54 (69.2%) patients while with blood and mucus in 18 (23.1%) patients. Diarrhea continued for an average of 5.2±1.6 (2-11) days. The clinical and laboratory findings of patients with diarrhea were more serious than those without diarrhea. Diarrhea is more common in the elderly and people with comorbid disease, and patients with diarrhea had higher CMI score and CRP and higher complaints of fever, cough, shortness of breath, myalgia and fatigue. Conclusions:The presence of diarrhea should indicate a suspected COVID-19 infection and suggest testing for early diagnosis of the disease. It should be kept in mind that the course of the disease may be more severe in these patients and precautions should also be taken in terms of fecal transmission during discharge.

Hábitos defecatorios en niños y adolescentes con mielomeningocele. Resultados de una gran serie incorporados en forma prospectiva

Introduction. Myelomeningocele (MMC) is an embryologic neural tube defect. Aim. To determine defecatory habits in MMC patients older and younger than 4 years old according to medullary level and factors affecting catharsis. Patient and methods. Descriptive study of prospective cohort by multidisciplinary team at Posadas Hospital, from March 2003 to March 2017. Inclusion criteria: MMC catered. Exclusion criteria: colostomizated. Results. n = 301. Female: 54%. Age: 1 month to 17 years. Median age: 3 years. GI: 178 patients ≤ 4 years. GII: 123 patients > 4 years. In GI: 82% normal defecation vs. 15% in GII; GI 18% constipation; GII 11% constipation, 79% incontinence. According medullary level: high (thoracic and high lumbar), low (middle lumbar, low lumbar and sacral). Constipation in GI: High 24% and in Low 14% (p = 0.13). GII incontinence in 86% High and in 73% Low (p = 0.06). 37% of walkers without aid, 23% of the children using valves and only 12% of wheelchair bound patients were continent (p = 0.01). Normal school: 30% continent; and 6% who continent attended special school (p = 0.001). Conclusions. 1) More frequent evacuation abnormalities after age of sphincteric control. 2) In ≤ 4 years old, constipation wasn´t related to medullary level; ≥ 4 years old patients defecatory trouble was directly. proportional to medullary level. 3) Special school pupils and wheelchair bound patients > 4 years experienced incontinence degree significantly higher. 4) No difference in defecatory trouble with or without urinary Catheterization. 5) More incontinence in > 4 with ventriculoperitoneal shunt. 6) Functional encopresis must be considered in association with organic factors in this patients.