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PubMed1995

[Attitudes of Bolivian pharmacy distributors in a case of diarrhea].

In order to learn the recommendations given for a case of diarrhea by persons who sell medications at pharmacies, interviewers visited pharmacies in three Bolivian cities and said they had a child suffering from diarrhea. Less than 2% of the vendors recommended using oral rehydration salts, increasing fluid intake, or consulting a doctor. Most of them recommended antibiotics, antidiarrheals, or both. Oral rehydration salts were not available in nearly two-thirds of the establishments visited, and those that had the salts rarely offered them. This study revealed the lack of integration of these professionals into the Health Secretariat's training program, and as a result activities were initiated to solve this problem.

Adult↗
PubMedDate not supplied

[In vitro effect against Giardia of 14 plant extracts].

OBJECTIVE: To investigate antigiardiasic activity in plants used in Mexico as antidiarrheics and/or antiparasitics. MATERIALS AND METHODS: Fourteen species were evaluated. The antigiardiasic activity was measured in vitro in a blinded fashion using trophozoites of Giardia duodenalis incubated with plant extracts. The viability of trophozoites was ascertained using MTT (3-[4,5-dimethylthiazol-2-il]-2, 5-diphenyl tetrazolium bromide) which is reduced to MTT-formazan by the activity of live trophozoites. The reduced MTT was extracted with an acidified alcohol (2-propanol with HCI 0.04 M) and measured in a spectrophotometer at 570 nm. Negative (trophozoites without extract) and positive controls (incubated with tinadazol) were included. RESULTS: The scientific and trivial names of the plants are given (trivials in Spanish marked by an asterisk). They had the following trophozoite mortality (mean +/- SD in percent): Justicia spicigera (muicle*) = 91 +/- 0.5; Lipia beriandieri (oregano) = 90 +/- 0.6; Psidium guajava (guava) = 87 +/- 1.0; positive control of tinidazol = 79 +/- 1.9; Punica granutus (granado*) = 78 +/- 1.3; Magnifera indica (mango) = 77 +/- 1.0; Plantago major (lante*) = 76 +/- 1.2; Cupressus semperbirens (cipres) = 73 +/- 1.2; Castella tormentosa (chaparro amargoso*) = 70 +/- 0.7; Hematoxilon campechanum (palo de Campeche*) = 67 +/- 1.2. Without or with a low mean activity were Prosopis juliflora (mesquite*) and Rizophora mangle (mangle*) with 0%, Oriza sativa (rice) with 5%, Capsicum annum (pimiento*) with 21% and Persea americana (avocado) with 23%. There were no associations of the antigiardiasic effect with concentration or osmolality of the extracts. CONCLUSIONS: A clear in vitro antigiardiasic effects was seen in nine species. Three of them were superior to tinidazol which is a drug of common use in the treatment of giardiasis.

Animals↗
PubMed1994

[Stimulating effects of a calcium antagonist foridon on absorption detected by segmental perfusion of the small intestine].

A continuous perfusion of the jejunal segment has been performed in 18 patients with chronic intestinal diseases. The addition of 40 mg foridon, a calcium antagonist from dihydropyridine series increased the absorption rate of glucose, Na+ and water by 28.0%, 44.3% and 41.1%, respectively. The stimulating effect was independent of basal absorption and did not impair the absorption. It is planned to test foridon and other calcium antagonists as antidiarrheal medication.

Adult↗
PubMed1994

A continuing assessment of risk factors for the development of Escherichia coli O157:H7-associated hemolytic uremic syndrome.

Univariate and multivariate analyses were applied to determine risk factors for the progression of Escherichia coli O157:H7 enteritis to hemolytic uremic syndrome (HUS). Both clinical and laboratory variables were assessed for 118 pediatric patients (28 HUS; 90 enteritis only). Verotoxins 1 and 2 were produced by 89% of E. coli strains whereas verotoxin 2 only was produced by 11%. Although a greater frequency of strains producing verotoxin 2 only occurred in HUS isolates (p = 0.11), toxin phenotype was not significantly associated with risk after multivariate analyses. HUS patients with or without neurological manifestations had similar frequencies of the two toxin phenotypes among their isolates. Significant associations for young age (RR = 0.984; 95% CI = 0.971-0.998) and prolonged use of antidiarrheal agents (RR = 44.11; 95% CI = 8.48-229.4) with HUS were apparent. A lesser chance of progression was observed for patients whose strains possessed a 4 kb plasmid (RR = 0.27; 95% CI = 0.08-0.94). Our results are consistent with the hypothesis that progression to HUS is dependent upon both bacterial virulence factors and the clinical characteristics of the individual patient.

Bacterial Toxins↗
PubMed1994

Calcium-antagonist effect of quercetin and its relation with the spasmolytic properties of Psidium guajava L.

The antidiarrheal properties of water and methanolic extracts of Psidium guajava leaves have been demonstrated with anteriority and their spasmolytic effect was attributed to quercetin, a flavonoid contained in this plant. The present paper reports the intestinal smooth muscle relaxation produced by quercetin on isolated guinea pig ileum previously contracted by a depolarizing KCl solution. Quercetin also inhibited intestinal contraction induced by different concentrations of calcium, shifting the contraction curve to the right showing a clear calcium-antagonistic effect. Quercetin effect on ileal and aortic smooth muscles are compared, the ileum being more sensitive to this flavonoid. The calcium-antagonist property of quercetin is discussed and also its contribution to explain the spasmolytic effect of this popular herbal remedy.

Animals↗
PubMed1993

Awareness of diarrheal disease control in rural and urban areas of Bihar.

Awareness regarding different aspects of prevention and treatment of diarrheal diseases among parents in rural and urban areas of Patna district were studied. Survey was done in 245 households from 30 villages of Bihta block and about 275 households from 30 different mohallas of Patna town. All aspects were poorly known to the rural community, particularly the illiterates and a large segment of literates of Bihta block. Rural people were significantly less aware than their urban counterparts regarding value of prolonged breast feeding, spoon feeding rather than bottle feeding, using hand pump and tap water for drinking and using latrine for nightsoil disposal in preventing diarrhea. Utility of measles immunization in prevention of diarrhea was unknown to the community. Generally parents thought antidiarrheal drugs a must for treatment. Knowledge regarding ORS and its use in diarrhea and vomiting was very poor and significant difference (p < 0.001) in awareness was observed between educated and illiterates. Majority parents did not know the correct method of preparation and uses of ORS and SSS. Due to high literacy rate and health consciousness, the educated and majority of literate parents of Patna town were better aware, more factual and had rational view regarding causes, method of prevention, fundamentals of use of ORS and home management of diarrhea in children, although certain aspects are yet to be cleared to them.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude to Health↗
PubMed1994

Loperamide blocks high-voltage-activated calcium channels and N-methyl-D-aspartate-evoked responses in rat and mouse cultured hippocampal pyramidal neurons.

The effects of the antidiarrheal agent loperamide on high-voltage-activated (HVA) calcium channel activity and excitatory amino acid-evoked responses in two preparations of cultured hippocampal pyramidal neurons were examined. In rat hippocampal neurons loaded with the calcium-sensitive dye fura-2, rises in intracellular free calcium concentration ([Ca2+]i) evoked by transient exposure to 50 mM K(+)-containing medium [high extracellular potassium concentration ([K+]o)] were mediated by Ca2+ flux largely through nifedipine-sensitive Ca2+ channels, with smaller contributions from omega-conotoxin GVIA (omega-CgTx)-sensitive Ca2+ channels and channels insensitive to both nifedipine and omega-CgTx. Loperamide reversibly blocked rises in [Ca2+]i evoked by high [K+]o in a concentration-dependent manner, with an IC50 of 0.9 +/- 0.2 microM. At the highest concentration tested (50 microM), loperamide eliminated rises in [Ca2+]i evoked by high [K+]o, a result otherwise achieved only in Ca(2+)-free medium or by the combined application of nifedipine, omega-CgTx, and funnel web spider venom to Ca(2+)-containing medium. The action of loperamide was neither naloxone sensitive nor mimicked by morphine and was seen at concentrations substantially less than those required to block influx of Ca2+ through the N-methyl-D-aspartate (NMDA) receptor-operated ionophore. Similar results were obtained in cultured mouse hippocampal pyramidal neurons under whole-cell voltage clamp. Voltage-activated Ca2+ channel currents carried by barium ions (IBa) could be discriminated pharmacologically into nifedipine-sensitive (L-type) and nifedipine-resistant, omega-CgTx-sensitive (N-type) components. Loperamide (0.1-50 microM) produced a concentration-dependent reduction of the peak IBa with an IC50 value of 2.5 +/- 0.4 microM and, at the highest concentration tested, could fully block IBa in the absence of any other pharmacological agent. The loperamide-induced block was rapid in onset and offset, was fully reversible, and did not appear to be related to the known calmodulin antagonist actions of loperamide. The current-voltage characteristics of the whole-cell IBa were unaffected by loperamide and the block was not voltage dependent. Loperamide also attenuated NMDA-evoked currents recorded at a membrane potential of -60 mV, with an IC50 of 73 +/- 7 microM. The block of NMDA-evoked currents was not competitive in nature, was not reversed by elevation of the extracellular glycine or spermine concentration, and was not affected by changes in the membrane holding potential. Steady state currents evoked by kainate and DL-alpha-amino-3-hydroxy-5-methylisoxazolepropionic acid were, in contrast, relatively unaffected by 100 microM loperamide.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMedDate not supplied

Cytomegalovirus colitis after 5-fluorouracil and interferon-alpha therapy.

Cytomegalovirus (CMV) infection is an opportunistic viral infection primarily affecting immunocompromised patients. Patients with inflammatory bowel disease have an increased risk for developing CMV infections of the gastrointestinal tract. While receiving continuous infusion of 5-fluorouracil and interferon-alpha, a 72-year-old woman with stage IV pancreatic carcinoma developed severe colitis with diarrhea that was refractory to conventional antidiarrheals. A biopsy specimen from the colon revealed CMV inclusions, which were confirmed by immunofluorescence. The patient was given ganciclovir 210 mg (5 mg/kg) every 12 hours for 14 days, and the diarrhea resolved after approximately 8 days of therapy. This is the first reported case of CMV colitis associated with combination 5-fluorouracil and interferon-alpha therapy.

Aged↗
PubMed1993

[The use of actapulgite for the treatment of acute diarrhea in infants and children. Review of pediatric studies].

Epidemiological data on diarrhea due to Rotavirus are similar enough across different regions of the world to allow the pooling of clinical studies of Actapulgite for the treatment of acute diarrhea in infants and children in France and Africa. A total of 7,616 infants and children were entered into these open or placebo-controlled trials. Most patients were under two years of age, results of the analysis confirmed the antidiarrheal efficacy and safety of Actapulgite.

Acute Disease↗
PubMed1996

[Treatment of persistent diarrhea with S. boulardii in returning travelers. Results of a prospective study].

AIM: The efficacy and tolerability of Saccharomyces boulardii (S.b.) were investigated in patients with diarrhea contracted while travelling abroad. METHOD: The efficacy of S.b. was determined on the basis of the frequency and consistency of stools (fewer than 3 unformed stools a day), and symptom changes. A total of 95 patients (49 females, 46 males) aged between 19 and 69 (mean age 32) years were treated with S.b. at a daily dose of between 150 and 450 mg (mean 428 mg) (3 x 1-3 capsules). RESULTS: Prior to admission to the study, diarrhea had persisted for an average of 11 days; under treatment with S.b. it cleared up after a mean of 5 days. A tendency towards greater efficacy in patients returning from The Middle East and South America was noted. Tolerability was assessed to be very good or good by almost all participants, with side effects occurring in only 2 cases. CONCLUSION: The study demonstrates that S.b. is both effective and well tolerated when used for the treatment of persistent diarrhea (mean duration 11 days) that had often failed (67% of the cases) to respond to previous antidiarrheal or antibiotic drugs.

Administration, Oral↗
PubMed1996

Suppression of enterotoxin-induced intestinal fluid secretion by wood creosote.

Wood creosote suppresses intestinal fluid secretion induced by heat-labile enterotoxin (LT) of enterotoxigenic Escherichia coli (ETEC). When rabbit jejunum is ligated into a 5-cm segment and LT is administered locally, it actively induces intestinal fluid secretion in a dose-dependent manner. Local administration of wood creosote together with a fixed dose of LT suppressed the LT-induced fluid secretion in a dose-dependent manner. At a 50-ng/segment dose of LT, 7.4 +/- 1.1 ml (n = 5) of fluid is secreted into an intestinal segment; coadministration of wood creosote (150 micrograms/segment) significantly (p < 0.01) suppressed the fluid secretion to 2.4 +/- 2.3 ml. Based on these results, we conclude that the antidiarrheal activity of wood creosote is attributable to its antisecretory or proabsorptive effect (or both) on the intestine.

Animals↗
PubMed1996

Functional anorectal disorders.

The functional anorectal disorders-functional fecal incontinence, pelvic floor dyssynergia-type constipation, levator ani syndrome, and proctalgia fugax-are common but poorly understood gastrointestinal complaints. Fecal incontinence may occur in constipated patients when a fecal impaction of the rectum reflexly inhibits the internal anal sphincter and allows leakage of soft stool, or it may occur in diarrhea. Constipation-related incontinence can be treated with habit training (use of a routine time to defecate backed up by laxatives) or biofeedback to teach relaxation of the pelvic floor, but diarrhea-related fecal incontinence usually requires antidiarrheal medications. Pelvic floor dyssynergia occurs when the pelvic floor muscles paradoxically contract instead of relaxing when the patient strains to defecate. Biofeedback to teach relaxation of these muscles is effective in two thirds of patients. Levator ani syndrome involves chronic, and proctalgia fugax involves fleeting rectal pain. The cause of these painful conditions is unknown, and no treatment of proven efficacy is available.

Anal Canal↗
PubMed1997

Comparison of stably expressed rat UGT1.1 and UGT2B1 in the glucuronidation of opioid compounds.

Opioids are important drugs used as analgesics, antitussives, antidiarrheals, and in the therapy of myocardial infarctions, and as antagonists of opioid intoxication. The glucuronidation of these compounds, catalyzed by UDP-glucuronosyltransferases (UGTs), is well known to be a primary step in their metabolism to hydrophilic products and in their ultimate excretion. The present study was designed to compare the reactivity and relative glucuronidation efficiencies of opioid agonists, antagonists, and partial agonists with two rat UGT isoforms; UGT1.1, which is generally considered the "bilirubin UGT," and UGT2B1, which has previously been shown to catalyze the glucuronidation of testosterone, chloramphenicol, and (-)-morphine. Rat UGT2B1, stably expressed in HK293 cells, exhibited high glucuronidation rates and catalytic efficiencies for many opioids, although values for (-)-morphine and nalorphine were the highest. In contrast, these compounds were very poor substrates for expressed rat UGT1.1. Comparably high glucuronidation rates and efficiencies were found for buprenorphine and diprenorphine with both UGT isoforms. These results suggest that opioids with morphinan-based chemical structures similar to (-)-morphine interact with UGTs differently than those with oripavine-based chemical structures similar to buprenorphine. To investigate the contribution of rat UGT1.1 and UGT2B1 in the overall rate of glucuronidation of buprenorphine in the rat liver, hepatic microsomes from Gunn rats (where UGT1.1 activity is absent) and Wistar rats (where UGT1.1 activity is present) were studied. Buprenorphine glucuronidation activity in Gunn rat liver microsomes exhibit approximately 25% of rates observed in Wistar rat liver microsomes, whereas (-)-morphine, naloxone, and naltrexone glucuronidation rates were not significantly different in microsomal preparations from Gunn and Wistar rats. These data suggest that UGT2B1 is the major hepatic enzyme involved in the glucuronidation of (-)-morphine and naloxone in livers from untreated rats, whereas buprenorphine glucuronidation is preferentially catalyzed by rat UGT1.1.

Analgesics, Opioid↗
PubMed1996

[Clinical assessment of a new oral bacterial treatment for children with acute diarrhea].

This study was carried out to evaluate the efficacy of a new oral bacteriotherapeutic drug in 63 children under 4 years old affected by infective diarrhoea or by extraintestinal infective pathology caused by oral antibiotic therapy. The patients were divided into three groups: the first and the second included subjects affected by acute diarrhoea enrolled in a comparative and controlled study; the third included subjects in chemotherapeutic treatment because suffering from infective extraintestinal pathologies, these patients were enrolled in a not controlled study. The first group underwent the rehydratant treatment for the acute enteritis together with the therapy with inactivated Lactobacillus acidophilus LB to value its antidiarrheic activity. To the second group (control group) was administered a no bacteriotherapeutic drug, while to the third group was administered the antibiotic therapy for extra-intestinal pathologies together with inactivated Lactobacillus acidophilus to avoid possible phenomena due to intestinal dysmicrobism. For all the patients included in the study, were reported; the number, the characteristics, the consistency of the motions and the description of the symptomatology during the treatment and daily. The greater part of the patients affected by the intestinal infective pathology subdued bacteriologic tests by coproculture. The obtained results showed a statistically significant clinical improvement of the first group patients compared with those of the second group, while those of the third group showed that the drug activity prevents the intestinal dysmicrobism affections due to the antibiotic therapy.

Acute Disease↗
PubMedDate not supplied

[Proctocolectomy with ileoanal anastomosis: morbidity and functional results in patients with and without colorectal cancer].

BACKGROUND: The elective prophylaxis for colorectal cancer in patients with familial adenomatous polyposis (FAP) or with ulcerative colitis (UC) is the RPIPAA. AIMS: To evaluate the functional results and the morbidity rate in patients who underwent restorative proctocolectomy with ileal-pouch anal anastomosis (RPIPAA). METHODS: All patient underwent a proctocolectomy with a J reservoir, ileal pouch-anal anastomosis. RESULTS: There were 8 males and 3 females with a mean age of 31 years; the diagnoses were: FAP (n = 4); FAP + colorectal cancer (n = 3); metachronous colorectal cancer (n = 3) and UC + right colon cancer (n = 1). The average surgical time and the intraoperative bleeding were 5.6 h and 600 ml respectively. There were no operative deaths. The surgical complications were: section of left urether (n = 1); hemoperitoneum of 1,200 ml (n = 1); minor pelvic sepsis (n = 1); ileoanal stenosis (n = 1) and pouchitis (n = 1). Tumor staging was: Dukes A (n = 2), B1 (n = 1), B2 (n = 4). The mean follow-up was 22 months. Average of stools at the 3rd, 6th and 12th month was: 7.4, 5.6 and 3.8 respectively. Sexual function was: normal (n = 8), retrograde ejaculation (n = 2) and impotence (n = 1). The use of antidiarrheal agents in 24 hours at the third, sixth and twelfth month was 3, 2 and .8 respectively. CONCLUSIONS: The RPIPAA is associated with a low rate of morbidity and good functional results, similar to previously published results. However, these results should be taken with caution due to the small, selected and retrospective nature of the study.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

[Intoxication by diphenoxylate (author's transl)].

Two cases of intoxication by diphenoxylate, inespecific antidiarrheal, depressor of the intestinal motility, are presented. Diphenoxylate is chemically related with meperidine. One case was caused by hipersensitivity and the other one by overdose. Both had a favourable outcome. Existent bibliography was reviewed and clinical signs of this intoxication pointed-out. It is suggested that diphenoxylate should not be prescribed to children under thirty months.

Child, Preschool↗
PubMed1997

[Irritable colon].

Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder, defined as a variable combination of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities. It is attributable to the intestine with symptoms of abdominal pain, altered bowel habits and bloating. The diagnosis is primarily based on typical symptoms and prudent use of investigations to exclude organic disorders. The initial positive diagnosis is accurate and on a longterm follow-up its revision rarely required. A change in its clinical manifestation may imply the superimposition of another disorder. Treatment primarily rely on the confidence in the diagnosis and a strong physician-patient relationship. High fiber diets and bulking agents may be effective in alleviating symptoms. Though antispasmodic, antidiarrheal and psychotropic drugs are repeatedly used in patients with moderate to severe symptoms their effects remain uncertain. Psychotherapy, hypnosis and biofeedback may relief symptoms and may be considered for motivated patients with moderate to severe symptoms.

Colonic Diseases, Functional↗
PubMed1998

Octreotide in the management of diarrhea induced by graft versus host disease.

PURPOSE/OBJECTIVES: To evaluate the potential benefit of the somatostatin analogue, octreotide, for the management of diarrhea induced by graft versus host disease (GVHD). DATA SOURCE: Pilot clinical trial involving 21 patients undergoing allogeneic transplant with positive histologic or radiographic evidence of GVHD of the gastrointestinal tract who failed antidiarrheal therapy with loperamide. DATA SYNTHESIS: A complete response, defined as resolution of diarrhea, was seen in 71% of trial participants (15 of 21 patients). At the dose and scheduling used (500 mcg i.v. three times daily for a median of seven consecutive days), octreotide was extremely well tolerated in all patients. CONCLUSIONS: In this pilot study, octreotide treatment was effective in reducing the amount of diarrhea in patients with acute GVHD. The data suggest that patients receiving octreotide early in the course of the diarrhea experienced more benefit than patients with persistent diarrhea prior to receiving octreotide. The demonstrated safety and efficacy of octreotide in this patient population support further investigation of this therapeutic strategy for GVHD-induced diarrhea. A randomized, controlled, clinical trial of octreotide versus loperamide for the initial treatment of GVHD-induced diarrhea is warranted. IMPLICATIONS FOR NURSING PRACTICE: Octreotide should be administered early in the course of GVHD as soon as onset of diarrhea is noted and should be discontinued as soon as diarrhea resolves to avoid constipation and the potential development of an ileus. Because response to the drug usually occurs quickly, maintaining treatment for additional days or weeks is unnecessary. If a benefit is not seen in four to seven days, continuing octreotide therapy is neither cost-effective nor prudent.

Adult↗