TaqMan Array card testing of participant-collected stool smears to determine the pathogen-specific epidemiology of travelers’ diarrhea

Background: We assessed the compliance with self-collection of stool smears on Whatman® FTA® Elute Card (FTA Card) and detection of travelers’ diarrhea (TD) associated pathogens using a quantitative PCR assay (customized TaqMan® array card [TAC]), in a prospective, observational cohort of travelers. Methods: Enrolled travelers documented symptoms on a travel diary and collected an FTA Card during a diarrheal episode, or at the end of travel if they remained asymptomatic. TAC testing was performed on FTA Cards from TD cases and 1:1 matched asymptomatic controls and 1:1 matched loose stool cases that did not meet TD criteria. Odds ratios (OR) were used to determine the association between detected pathogens and TD. Results: 484 of 2456 (19.7%) travelers completed an illness diary and met TD criteria, and 257 (53.1%) collected an FTA Card during the TD episode. FTA Cards were stored for a median of 2 years at room temperature (IQR: 1-4 years) before extraction and testing. The overall TAC detection rate in TD cases was 58.8% (95%CI: 52.5-64.8). Enterotoxigenic E. coli was the most common pathogen in TD cases (26.8%) and 3.5% of samples were positive for norovirus. The odds of detecting TD-associated pathogens in 231 matched cases and asymptomatic controls was 5.4 (95% CI: 3.6-8.1) and 2.0 (95% CI:1.1-3.7) in 121 matched TD and loose stool cases (p < 0.05). Enteroaggregative E coli was the most common pathogen detected in asymptomatic controls and loose stool cases. Detection of diarrheagenic E coli, Shigella/enteroinvasive E coli (EIEC), and Campylobacter spp. was significantly associated with TD. Conclusions: FTA Cards are a useful adjunct to traditional stool collection methods for evaluating the pathogen-specific epidemiology of TD in austere environments. Qualitative detection of pathogens was associated with TD. Measures to improve compliance and quality of FTA Card collection with decreased storage duration may further optimize detection.

Hypertensive Crisis in Pregnancy with COVID19: Confirmed with rt-PCR for Nasopharyngeal Swab

The novel coronavirus has already spread across the geographical borders to 213 countries and self-governing territories. However, the effect of SARS-CoV-2 infection on pregnant mothers is still poorly understood and sparsely documented. Here, we present a case of a primi mother, who presented with diarrheal episode and proceeded to a hypertensive crisis and placental abruption with rt-PCR (nasopharyngeal swab) confirmed for COVID19. SARS-CoV-2 enters and downregulates host cell-bounded enzyme ACE2 (angiotensin-converting enzyme). This activates the renin angiotensin aldosterone mechanism (RAAM). The activation of RAAM plays a pivotal role in the pathophysiology of hypertensive emergencies. Hence, there is a theoretical possibility of hypertensive crisis associated with ACE2/RAAM dysfunction in pregnant mothers who have COVID19. Therefore, close monitoring of blood pressure and early intervention are of paramount importance in anticipating and preventing serious complications related to hypertension in pregnancy in mothers who have tested positive for SARS-CoV-2, especially in this pandemic situation. Emergency hospital admission and urgent care must be afforded to mothers presenting with high blood pressure with the features suggestive of COVID19 as they are at a risk of rapid deterioration.

The influence of human genetic variation on early transcriptional responses and protective immunity following immunization with Rotarix vaccine in infants in Ho Chi Minh City in Vietnam: A study protocol for an open single-arm interventional trial

Background: Rotavirus (RoV) remains the leading cause of acute gastroenteritis in infants and children aged under five years in both high- and low-middle-income countries (LMICs). In LMICs, RoV infections are associated with substantial mortality. Two RoV vaccines (Rotarix and Rotateq) are widely available for use in infants, both of which have been shown to be highly efficacious in Europe and North America. However, for unknown reasons, these RoV vaccines have markedly lower efficacy in LMICs. We hypothesize that poor RoV vaccine efficacy across in certain regions may be associated with genetic heritability or gene expression in the human host. Methods/design: We designed an open-label single-arm interventional trial with the Rotarix RoV vaccine to identify genetic and transcriptomic markers associated with generating a protective immune response against RoV. Overall, 1,000 infants will be recruited prior to Expanded Program on Immunization (EPI) vaccinations at two months of age and vaccinated with oral Rotarix vaccine at two and three months, after which the infants will be followed-up for diarrheal disease until 18 months of age. Blood sampling for genetics, transcriptomics, and immunological analysis will be conducted before each Rotarix vaccination, 2-3 days post-vaccination, and at each follow-up visit (i.e. 6, 12 and 18 months of age). Stool samples will be collected during each diarrheal episode to identify RoV infection. The primary outcome will be Rotarix vaccine failure events (i.e. symptomatic RoV infection despite vaccination), secondary outcomes will be antibody responses and genotypic characterization of the infection virus in Rotarix failure events. Discussion: This study will be the largest and best powered study of its kind to be conducted to date in infants, and will be critical for our understanding of RoV immunity, human genetics in the Vietnam population, and mechanisms determining RoV vaccine-mediated protection. Registration: ClinicalTrials.gov, ID: NCT03587389. Registered on 16 July 2018.

Bioactivities of Aeschynomene aspera (Fabaceae) Leaf Extract

Aeschynomene aspera (Family- Fabaceae), a traditionally used medicinal plant, is aquatic, perennial, erect subshrub up to 200 cm tall with compound leaves and locally it is called Shola (Bangladesh), Laugaun (India). The study started with phytochemical screening of ethanolic leaf extract of A. aspera followed by bioactivity study such as in-vitro antioxidant activity by free radical (DPPH) scavenging assay, estimation of total phenolic as well as total flavonoid contents and the analgesic, antidiarrheal and anthelmintic activities. Analgesic, antidiarrheal and anthelmintic activities were evaluated by acetic acid induced writhing inhibition in mice, castor oil induced diarrheal episode in mice and using living parasites Haemonchus contortus, respectively. The presence of carbohydrate, reducing sugar, glycosides, tannins, alkaloids, steroids, gums and flavonoids was estimated with the help of phytochemical screening. In DPPH scavenging assay the extract showed IC50 value of 86.14μg/mL where ascorbic acid showed 12.02μg/mL. It also exhibited total phenolic and flavonoid contents as 461.09 GAE/100g and 297.20mg Quercetin/100g of dried plant extract. About 36% and 61% writhing inhibitions were observed in mice at 250 and 500mg/kg doses of A. aspera leaf extract, respectively. Anthelmintic activity showed by the extract was dose dependent. The extract also showed 46.01 and 71.68% inhibition of defecation in mice at doses 250 and 500 mg/kg, respectively. All these suggest that the A. aspera extract possesses antioxidant, analgesic, anthelmintic and antidiarrheal activities. Bangladesh Pharmaceutical Journal 23(2): 109-116, 2020

Compliance with 14 day zinc therapy for acute diarrhoea: a prospective observational study

Background: Acute diarrheal diseases remain a leading cause of global morbidity and mortality in young children. The effective implementation of provision of zinc in addition to low osmolarity ORS remains very poor.Methods: A prospective observational study was done to determine compliance with zinc therapy on 103 children aged between two months to five years with acute gastroenteritis. They were started on WHO ORS and zinc in the form of syrup (20 mg/day in those >6 months of age and 10mg/day in those <6 months of age) and advised to continue for 14 days. Further episodes of diarrhea was considered as the primary outcome variable. Number of days zinc taken was considered as the primary explanatory variable. p-value <0.05 was considered statistically significant.Results: The mean age was 19.49±14.41 months. The compliance to complete 14-day zinc therapy was 62.14%. The mean number of days zinc was taken was 11.28±3.81 days. In 11.65% of participants, there was further episodes of diarrhea. The main reasons for discontinuation were diarrhea stopped (45%), Ignorance (37.5%), URI (12.5%).Conclusions: Findings indicate that the syrup formulation is acceptable, but further efforts are required to enhance adherence. These findings also highlight the importance of guiding in ensuring adherence to zinc duration while also addressing the tendency of caregivers to terminate treatment once a child appears to have recovered from an acute diarrheal episode.

EVALUATION OF ANTI-DIARRHOEAL EFFECT OF CURCUMIN

Turmeric has been used in traditional medicine as household remedy for various diseases including biliary diseases, cough, hepatic diseases, wound healing and diarrhea etc. Curcumin is the active salt present in turmeric. This study was carried out to provide scientic basis for the use of curcumin in diarrhea and to compare it with standard medicine i.e. Loperamide. The albino rats were divided into ve groups of six animals in each group. Group I (control) received vehicular uid. Group II (positive control) received standard drug for diarrhea i.e. loperamide at the dose of 2mg/kg body weight. Group III, IVand Vwere administered curcumin intragastrically by the naso-gastric tube, in the dose of 500mg/kg, 750mg/kg and 1 gm/kg body weight respectively, suspended in normal saline. After one hour of above treatment, 1 ml of castor oil was given intragastrically to all the overnight-fasted animals to induce diarrhea. Each animal was housed separately and observed for time of onset and number of diarrheal episode for 4 hours. The data was analyzed by using SPSS 11. Remarkable anti-diarrheal effect of curcumin against castor oil induced diarrhea was observed in dose dependent manner. From the present study, we can draw a conclusion that, Curcumin have signicant anti-diarrheal effect. It may be used as an adjuvant for the treatment of diarrhea, and irritable bowel syndrome.

Nutritional Management in Child Diarrhea: An Evaluation of Awareness in General Population from Dobrogea Region

Diet has a major role in the treatment of acute diarrhea in children, along with a minimal drug therapy, but not necessarily using antimicrobials. Children can successfully pas a diarrheal episode with diet and symptomatic treatment. It is important to know how to properly choose foods to introduce in ill children diet. There is a lack of statistical data in our region regarding dietary treatment in child diarrhea. This study was realized by completing a questionnaire regrading nutritional management in children with diarrhea. 110 persons from Dobrogea region completed this questionnaire. We analyzes demographic and clinical issues, people preferences in choosing different foods appropriate to this pathology and minimal knowledge about medication. Our results evidenced that general population knowledges regarding nutritional management of acute diarrheal disease in children and infants are appreciable. Foods like rice, toast, applesauce/baked apple, mint/figs/bilberry leaves teas, vegetables soup, bananas were found among people preferences, proving appropriate information. Antimicrobial drugs misusage is not reported, 83 out of 110 people avoiding them.