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Diarrhea and Malnutrition
Published in Fima Lifshitz, Childhood Nutrition, 2020
Andrea Maggioni, Fima Lifshitz
In the child with diarrhea, the maintenance of fluid and electrolytes and the proper dietary treatment remain the essential factors in the successful treatment of this disorder.164 Oral hydration solutions should be employed to prevent dehydration and therefore must be begun at the first sign of illness and maintained throughout. Dietary elimination of the many ingredients that are not tolerated by the patient with diarrhea is also necessary to achieve a prompt and a smooth improvement of the illness. It is extremely important to prevent the development of prolonged diarrhea, malnutrition, and other complications rather than to remedy them. An aggressive dietary treatment at the onset of the disease is the best prophylaxis and treatment of diarrhea and its complications.
The Pituitary Gland, Psychoneuroimmunology and Infection
Published in Herman Friedman, Thomas W. Klein, Andrea L. Friedman, Psychoneuroimmunology, Stress, and Infection, 2020
Istvan Berczi, Andor Szentivanyi
Infectious agents have the capacity to activate the immune system, both in a nonspecific and specific manner, and cause inflammation and specific immune reactions. The inflammatory response may be regarded as a first line of defense against infection. Injured cells release a number of chemotactic-proinflammatory cytokines which will attract leukocytes to the site of infection that play a major role in the inflammatory process. The complement system is also activated frequently and the split products C3a and C5a function as chemotactic factors and activators for mast cells and basophils, monocytes and macrophages, and granulocytes, and thus inflammation is induced. Once specific immunity has been developed in the host, reinfection with the same microorganism may lead to immediate hypersensitivity, delayed type hypersensitivity, or Arthus type reactions, which are inflammatory reactions mediated by IgE antibodies and mast cells, by T lymphocytes and by complement fixing antibodies, respectively. Sensory nerves also have the capacity to induce inflammation by causing mast cell discharge. In turn, mast cell products act on the nervous system. This is especially important in infections of the gastrointestinal tract where diarrhea can rapidly be initiated by this mechanism which is helpful for the elimination of the infectious agent.
Fluid balance and continence care
Published in Barbara Smith, Linda Field, Nursing Care, 2019
The final part of this chapter focused on the problems patients can experience with elimination of faeces, with particular reference to constipation and diarrhoea. Throughout this chapter, the need to preserve the patient’s privacy and dignity has been emphasised. The nurse must be aware of and be able to recognise the sensitive issues that can arise regarding elimination. These issues should be remembered at all times when caring for patients with urinary and faecal problems.
Profiles of polypharmacy in older adults and medication associations with signs of aspiration
Published in Expert Review of Clinical Pharmacology, 2021
Dai Pu, Michael C.H. Wong, Edwin M.L. Yiu, Karen M.K. Chan
In univariate analysis, laxatives, proton pump inhibitors, and supplements also showed associations with signs of aspiration. Although they did not emerge as significant in multivariate analysis, they will be briefly discussed here. Use of laxatives may be associated with swallowing difficulties that are causing reduced oral intake of foods that are high in fiber to aid in stool elimination. However, the prevalence of constipation that requires laxatives also increases with age [47], so its association with signs of aspiration in univariate analysis may simply be reflective of this. Proton pump inhibitors are typically used to reduce stomach acid and manage gastro-esophageal reflux disorder (GERD). GERD can cause dysphagia [48], and those who suffer from GERD often report symptoms of dysphagia [49], which includes signs of aspiration. Finally, supplements were used by more than 30% of the older adults in this study, which may reflect frailty in this group. Frailty is associated with presbyphagia (age-related changes in swallowing function). A more detailed examination of the types of supplements that were used and whether they were medically recommended may yield more information.
Evaluation of the changes in exposure to thiol compounds in chronic kidney disease patients using the PBPK model
Published in Xenobiotica, 2021
Hiroaki Takubo, Toshio Taniguchi, Kazunori Iwanaga, Yukihiro Nomura
The structure of the PBPK model and the physiological parameters are shown in Figure 2 and Table 2, respectively. Gastrointestinal absorption is often described by the multiple gastrointestinal compartment model using solubility, intestinal transit time and the in vitro data-derived absorption rate of compounds. In this study, a gastrointestinal compartment with Fa, ka and lag time was combined with the typical PBPK model that Sayama et al. had reported (Sayama et al. 2013). The model was constructed using Phoenix WinNonlin, version 6.3 (Certara, Princeton, NJ). The systemic part of this model is composed of 11 tissue compartments (lungs, adipose tissue, bones, brain, heart, muscles, kidneys, spleen, liver, skin and small intestine), which are linked by venous and arterial blood pools. Perfusion rate-limited kinetics were assumed, and each tissue was represented by a single well-stirred compartment. The liver and kidney were considered as the elimination sites. Although, thiol compounds are generally known to covalently bind to endogenous thiols, this PBPK model does not include the binding mechanism in tissue compartments, assuming the reversibility of the disulfide bonds. Dalcetrapib and prasugrel are also not detected in plasma after oral administration to humans. The metabolic processes involved in the formation of the active metabolites were also not included assuming an extremely rapid rate of metabolism to the active metabolites in the body.
Phenotypic screening techniques for Cryptosporidium drug discovery
Published in Expert Opinion on Drug Discovery, 2021
Melissa S. Love, Case W. McNamara
Although this review has not focused on the advancements in in vivo models of cryptosporidiosis, the demonstration of compound efficacy in an animal model of disease is a crucial step in the drug development process. The clinical relevance of many of the models commonly used is still unproven, and there are many instances in which those data between models does not agree (e.g., clofazimine is potent in the IFNγ KO mouse model, but shows no effect in the NSG mouse model even at high doses) [67,97]. Though not fully understood, the host immune system plays a large role in controlling Cryptosporidium infection, and the difference in immunocompetency between the two models may explain the discrepancy in activity. It is unknown which model will most closely translate into clinical efficacy in the target populations (e.g., young children, or HIV-positive patients) [131,132]. Animal models with diarrhea (calf and piglet) may be the most relevant with regards to dosing and pharmacokinetics, but these models are generally reserved for later stage compounds and should not be used to prioritize early leads. Disease models with diarrhea are also important for examining the relationship between elimination of clinical symptoms (i.e., diarrhea) and elimination of oocyst shedding. Elimination of diarrhea provides symptom relief and can allow for rehydration treatment of the patient while elimination of parasite shedding may prevent transmission of disease; as such, both endpoints are important for developing a therapeutic for cryptosporidiosis.