Orientador: Paulo Eduardo de Oliveira Carvalho / Coorientador: Antonio José Maria Cataneo / Banca: Olavo Ribeiro Rodrigues / Banca: Celso Vieira de Souza Leite / Resumo: A Revisão Sistemática avaliou a eficácia e segurança de diferentes intervenções farmacêuticas no tratamento da diarreia induzida por quimioterapia em pacientes com câncer colorretal. A Revisão incluiu ensaios clínicos randomizados e controlados com diferentes intervenções farmacológicas para o tratamento de diarreia induzida por quimioterapia em pacientes com cancer colorretal. Os participantes foram pacientes com cancer colorretal e diarreia induzida por quimioterapia, randomizados para as diferentes intervenções no tratamento da diarreia. O controle se realizou pelo uso de algumas drogas, placebo ou nenhuma intervenção. Os desfechos primários medidos foram redução ou cessação da diarreia, mudanças no protocolo de quimioterapia e morte durante a quimioterapia. Os desfechos secundários foram custo do tratamento, efeitos adversos atribuídos à intervenção e à hospitalização durante a quimioterapia. Os métodos de busca para identificação dos estudos foram CLib, Medline e Embase. Avaliaram-se os estudos presentes na busca e identificaram-se vinte e um estudos que preenchiam os critérios de inclusão. Foram avaliados esses estudos com textos completos, utilizando-se a folha de extração de dados. Apenas seis estudos restaram para a inclusão. A Revisão Sistemática demostrou a necessidade da realização de um ensaio clínico randomizado prospectivo e controlado, especificando a melhor intervenção farmacológica no controle da diarreia induzida pela quimioterapia em pacientes com câncer colorretal / Abstract: A Systematic Review was conducted to evaluate the effectiveness and safety of different pharmacological interventions to treat chemotherapy induced diarrhoea in patients with colorectal cancer. This Systematic Review included randomized controlled trials comparing different pharmacological interventions to treat chemotherapy induced diarrhoea in patients with colorectal cancer. Participants were patients with CRC and chemotherapy induced diarrhoea, randomized to different interventions for the treatment of diarrhoea. Intervention was with drug used alone or associated to other drug for the treatment CID. The control was the use of other drug, placebo or no intervention. Primary outcome measured was the reduction or the cessation of diarrhoea, Changes in the chemotherapy protocol, death during chemotherapy and the secondary outcome costs of treatment, any adverse effect attributed to the intervention, hospitalization during chemotherapy. The search methods for identification of studies were CLib, Medline and Embase. The authors evaluated the studies present in the search and identified thirteen studies met the inclusion criteria. The authors evaluated these studies with complete texts using the form extraction, but did not identify any study. A Systematic Review demonstrated that the necessity of conducting a randomized prospective controlled by specifying the best pharmacological intervention in the control of chemotherapy-induced diarrhea in patients with colorectal cancer. Keywords: Cancer diarrhea treatment, chemotherapy, colorectal cancer / Mestre

Introdução: Esse estudo foi realizado em área periurbana carente do Município de Guarulhos, SP, que passa por intensa ocupação e necessita de serviços urbanos como saneamento. A localidade é atendida pela Unidade Básica de Saúde Recreio São Jorge que conta com o Programa Saúde da Família. Objetivos: Associar as condições de acesso da população aos serviços de saneamento e a ocorrência de doenças diarréicas em crianças. Método: Trata-se de estudo transversal e ecológico, cujas informações provêm das fichas de acompanhamento das 817 crianças da localidade (Ficha C) e fichas de cadastro (Ficha A) das respectivas famílias (728). A ocorrência de diarréia em crianças de 0 a 2 anos foi associada às variáveis ambientais: existência de tratamento domiciliar de água, tipo de acesso à água, tipo de esgotamento sanitário. As variáveis de condições de saneamento foram correlacionadas à ocorrência de diarréia por micro-área. Resultados: A cobertura de abastecimento de água das famílias é 93,18%, embora a intermitência do serviço seja freqüente. O uso de água de poços simultaneamente à da rede pública é comum na localidade. Das famílias, 63,88% tratam água no domicílio, por meio de cloração, fervura ou filtragem e apenas 42,72% possuem sistema de coleta pública dos esgotos. A variável de interação tipo de moradia construída em outros materiais que não tijolos e destino impróprio de esgoto sanitário apresentou associação no modelo de regressão com a ocorrência de doenças diarréicas (p<0,001). O coeficiente de correlação entre a ocorrência de diarréias e o tratamento de água no domicílio foi - 0,395, confirmando a importância do tratamento de água domiciliar. Foi encontrada relação inversa entre a ocorrência de diarréia e a cobertura de coleta dos esgotos sanitários (-0,337). Os locais não servidos pela rede coletora de esgotos apresentaram maior número de fossas ou de lançamento de esgotos a céu aberto, aumentando a probabilidade de disseminação de agentes patogênicos devido às precárias condições de vida da população. O abastecimento de água não apresentou correlação significativa, pois a maioria das famílias tem sua moradia ligada à rede de abastecimento público de água. Conclusão: Embora seja área periurbana carente, a população tem boa cobertura de abastecimento de água, porém a utilização de água de poço e a intermitência do serviço estão presentes. Sendo assim, o tratamento domiciliar da água se mostrou importante como medida preventiva. Em relação aos esgotos sanitários, recomendam-se medidas como provimento da rede coletora dos esgotos quando possível, ou campanhas para promover o uso correto de fossas sépticas. / Introduction: This study was realized in needed periurban area of the City of Guarulhos, SP, which has intense occupation and lacks of urban services as sanitation. The locality is served by the Unidade Básica de Saúde Recreio de São Jorge who is inserted on the Family Health Program. Objectives: To associate conditions of access of population to the services of sanitation and the children’s health conditions. Materials and methods: That’s a transversal and ecological study, whose information come from the files of accompaniment of the 817 children of the locality (Fiche C) and files of register in cadastre (File A) of the respective families (728). The occurrence of diarrhoea disease in children of 0-2 years was associated with these environmental variables: existence of domiciliary water treatment, type of access to the water and type of sanitation. The variables of sanitation conditions had been correlated to the occurrence of diarrhoea disease for micro-area. Results: The covering of water supply of the families is 93.18%; even so the intermittent of this service is frequent. It is common the use of water of wells simultaneously to the public supplying. The families, 63.88% deal with water in the domicile, by means of chlorine, boil or filtering and only 42.72% possesses system of sewers public collection. The interaction variable type of housing constructed in other materials that bricks and improper destination of sanitary sewer are associated in the model of regression with the occurrence of diarrhoea in young children (p<0.001). The correlation coefficient among the occurrence of diarrhoea disease and the water treatment in the domicile was -0.395, confirming the importance of the domiciliary water treatment. It was found inverse relation between occurrence of diarrhoea disease in young children and the covering of collection of the sanitary sewers (-0.337). The places not served by public sewers collecting, have shown a bigger number of pits or throwing in open air increasing the probability of dissemination of pathogenic agents due the precarious life conditions of the population. The water supply did not present significant correlation; therefore the majority of the families are served by public water supplying. Conclusion: Although been a needed periurban area, the population has good covering of water supply; however the well water used and the intermittent of service are present. The domiciliary treatment of water is showed important as prevention. In relation to sanitary sewers, are recommended measured as provisions of the collecting net of sewers when possible, or campaigns to promote the correct use of septic pits.

Resandet mellan länder ökar allt mer och många resor går från rikare till fattigare länder i tropiska och subtropiska områden. De resande möter ett annat panorama av sjukdomar än i hemlandet och det vanligaste hälsoproblemet bland resenärer är turistdiarré. Inför resan söker många råd på en vaccinationsmottagning. Råd ges bland annat kring kost och vaccin för att förhindra turistdiarré. Syftet med studien var att undersöka det vetenskapliga underlaget för att sjuksköterskor skall kunna ge evidensbaserade råd kring kosthållning och vaccination för att undvika turistdiarré. Sökningar i framför allt PubMed och Cinahl utmynnade i 15 kvantitativa artiklar som kom att utgöra material till litteraturstudiens resultat. Litteraturen gav motstridiga svar på frågan om kostrådens betydelse för att förhindra turistdiarré. Resultaten antydde att risken för att insjukna varierade med ålder, resans duration och destination. Resultatet visade vidare att det finns ett vaccin med viss effekt mot turistdiarré. Färre vaccinerade insjuknade och de som insjuknade var sjuka kortare tid. Vaccinet skyddade framför allt mot svårare diarrésjukdom. De studier som fanns gjorda på området var få och i många fall relativt gamla. Fler studier behövs för att säkrare slutsatser skall kunna dras som underlag för individuellt anpassade evidensbaserade råd. / Travel between countries continues to increase and many trips go from richer to poorer countries in tropical and subtropical areas. Travellers meet a different spectrum of diseases than in their home countries and the most common health problem among travellers is travellers´diarrhoea. It is common among travellers to seek advice at a travel clinic prior                                         to the trip. Advice is given on, among other things,                                                          diet and vaccine to prevent travellers´ diarrhoea. The aim of this literature study was to investigate the evidence base to enable nurses to provide evidence based advice on diet and vaccine to prevent travellers´ diarrhoea. The search for articles in mainly PubMed and Cinahl lead to 15 quantitative articles, which constituted material for the result of the literature study. The literature gave contradictory answers to the question of the significance of dietary advice. The results indicated that the risk for travellers´ diarrhoea varied with age, duration of the trip and destination. The results further showed that there is a vaccine with some effect against travellers´ diarrhoea. There was a lower incidence rate among the vaccinated and the ones who did contract travellers´ diarrhoea were ill during a shorter period of time. The vaccine protected mainly against more severe diarrhoea. The studies carried out on the area were few and in many cases relatively old. More studies are needed to enable assertive conclusions as material for individually suited evidence based advice.

Vitamin A has well recognised benefits for the reduction in severity of diarrhoeal episodes but the impact of therapeutic doses given during diarrhoea on the biochemical and clinical outcomes is less clear. In this study these potential therapeutic benefits were investigated to establish the optimum time for vitamin A supplementation to improve vitamin A status. Establishing the optimum time for vitamin A supplementation during an infectious stage would improve cost effectiveness and clinical benefit. Young children (174) between the ages of 3 and 60 months with severe diarrhoea were randomised in a double - blinded placebo controlled trial into one of 2 groups. The 1 st group received 60 mg of retinol as retinyl palmitate on admission during the acute diarrhoeal stage. The 2nd group received the same dose of vitamin A once symptoms had resolved, usually between 3 - 7 days. At each of these two time points, children not receiving vitamin A were given an identical placebo dose. Baseline (day 0) and day 3 serum samples were collected for vitamin A, retinol binding protein (RBP) and other biochemical markers. At four and eight weeks after discharge both morbidity and weight gain were recorded. The modified dose response test (MRDR) was conducted at the eight - week follow - up to estimate vitamin A liver stores. Initially, most of the children presented with watery diarrhoea and dehydration and were clinically very ill. At day 3 plasma retinol concentrations improved in both groups viz. from 0.57umol/L to 0.97umol/L in the 1st group and from 0.49umol/L to 0.90umol/L in the 2nd group. Similar improvements were found in retinol binding protein viz. 21.28 mg/L to 31.06 mg/L in the 1st group and 17.05 mg/L to 24.80 mg/L in the 2nd group. At 8 weeks there was also no significant difference between the two groups either for serum retinol (0.69umol/L and 0.73umol/L respectively) nor for MRDR ratios (0.036 and 0.049 respectively). The MRDR results at 8 weeks indicated that these children did not have depleted vitamin A liver stores and that the low serum retinol levels seen at baseline were probably due to the acute phase response during an infectious episode. The results of these analyses showed no significant difference between the two treatment groups thus indicating that there was no benefit to giving vitamin A on recovery from an infectious episode instead of on admission, as is currently practised. / Thesis (M.Med.Sc.)-University of Natal, Durban, 2001.

No description available.

Diss. (sammanfattning). Uppsala : Sveriges lantbruksuniv., 2003. / Härtill 6 uppsatser.

Made available in DSpace on 2014-06-11T19:24:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-04-23Bitstream added on 2014-06-13T19:52:04Z : No. of bitstreams: 1 silveira_rfm_me_botfm.pdf: 324486 bytes, checksum: 5c0e4e4b28eb7e439fe79416d1408a5b (MD5) / A Revisão Sistemática avaliou a eficácia e segurança de diferentes intervenções farmacêuticas no tratamento da diarreia induzida por quimioterapia em pacientes com câncer colorretal. A Revisão incluiu ensaios clínicos randomizados e controlados com diferentes intervenções farmacológicas para o tratamento de diarreia induzida por quimioterapia em pacientes com cancer colorretal. Os participantes foram pacientes com cancer colorretal e diarreia induzida por quimioterapia, randomizados para as diferentes intervenções no tratamento da diarreia. O controle se realizou pelo uso de algumas drogas, placebo ou nenhuma intervenção. Os desfechos primários medidos foram redução ou cessação da diarreia, mudanças no protocolo de quimioterapia e morte durante a quimioterapia. Os desfechos secundários foram custo do tratamento, efeitos adversos atribuídos à intervenção e à hospitalização durante a quimioterapia. Os métodos de busca para identificação dos estudos foram CLib, Medline e Embase. Avaliaram-se os estudos presentes na busca e identificaram-se vinte e um estudos que preenchiam os critérios de inclusão. Foram avaliados esses estudos com textos completos, utilizando-se a folha de extração de dados. Apenas seis estudos restaram para a inclusão. A Revisão Sistemática demostrou a necessidade da realização de um ensaio clínico randomizado prospectivo e controlado, especificando a melhor intervenção farmacológica no controle da diarreia induzida pela quimioterapia em pacientes com câncer colorretal / A Systematic Review was conducted to evaluate the effectiveness and safety of different pharmacological interventions to treat chemotherapy induced diarrhoea in patients with colorectal cancer. This Systematic Review included randomized controlled trials comparing different pharmacological interventions to treat chemotherapy induced diarrhoea in patients with colorectal cancer. Participants were patients with CRC and chemotherapy induced diarrhoea, randomized to different interventions for the treatment of diarrhoea. Intervention was with drug used alone or associated to other drug for the treatment CID. The control was the use of other drug, placebo or no intervention. Primary outcome measured was the reduction or the cessation of diarrhoea, Changes in the chemotherapy protocol, death during chemotherapy and the secondary outcome costs of treatment, any adverse effect attributed to the intervention, hospitalization during chemotherapy. The search methods for identification of studies were CLib, Medline and Embase. The authors evaluated the studies present in the search and identified thirteen studies met the inclusion criteria. The authors evaluated these studies with complete texts using the form extraction, but did not identify any study. A Systematic Review demonstrated that the necessity of conducting a randomized prospective controlled by specifying the best pharmacological intervention in the control of chemotherapy-induced diarrhea in patients with colorectal cancer. Keywords: Cancer diarrhea treatment, chemotherapy, colorectal cancer

Magister Public Health - MPH / The program that was studied is part of the Child Health Program devised and supported by CARE International and implemented in Kanyama, a high density and low cost community found on the outskirts of Lusaka, Zambia. Diarrhoea was identified as one of the three most common diseases affecting the children under the age of five years. Through community participation, the program was implemented by the Kanyama residents to reduce the cases of diarrhoea, malaria and pneumonia among children aged five years and under. The main aim of this study was to explore the perceptions of the impact of community participation by the community leaders and community members in the diarrhoea prevention program and to establish constraints affecting participation. / South Africa

No / Enteroaggregative Escherichia coli (EAEC), increasingly recognized as an important cause of infant and travelers' diarrhoea, exhibits an aggregative, stacked-brick pattern of adherence to epithelial cells. Adherence is mediated by aggregative adherence fimbriae (AAFs), which are encoded on the pAA virulence plasmid. We recently described a highly prevalent pAA plasmid-borne gene, aap, which encodes a protein (nicknamed dispersin) that is secreted to the bacterial cell surface. Dispersin-null mutants display a unique hyper-aggregating phenotype, accompanied by collapse of AAF pili onto the bacterial cell surface. To study the mechanism of this effect, we solved the structure of dispersin from EAEC strain 042 using solution NMR, revealing a stable beta-sandwich with a conserved net positive surface charge of +3 to +4 among 23 dispersin alleles. Experimental data suggest that dispersin binds non-covalently to lipopolysaccharide on the surface of the bacterium. We also show that the AAF organelles contribute positive charge to the bacterial surface, suggesting that dispersin's role in fimbrial function is to overcome electrostatic attraction between AAF and the bacterial surface

Yes / Children are at a higher risk of succumbing to diarrhoea. Zimbabwe remains one of the countries topping in terms of morbidity and mortality due to diarrhoea diseases among under-fives. This study aims to determine factors affecting diarrhoea among under-five children in Zimbabwe. Methodology: A systematic review was executed based on searches from six databases. All types of studies published between 2018 and 2022 in English about diarrhoea disease and among children under the age of five in Zimbabwe were included. Seventeen articles met the requirements of this study. All the data was inputted onto a data extraction sheet and thematic analysis was carried out on the study outcomes to identify themes. Results: Diarrhoea risk factors can be categorized into two main themes; modifiable and non-modifiable diarrhoea risk factors. Under the modifiable risk factors are four subthemes: environmental, socio-economic, behavioural, and modifiable biological diarrhoea risk factors. Under the non-modifiable risk factors are two sub-themes: age and gender. For any Water, Hygiene and Sanitation (WASH) intervention to succeed, these risk factors should be present at optimum. If any of the factors is not optimally present, WASH interventions must concurrently address the risk factor or else the intervention is predestined to fail. Conclusion: WASH remains an important issue in Zimbabwe as a tool to improve the lives of children under five years old. There is a necessity to investigate why certain interventions work well in other low-income countries and not Zimbabwe. All WASH interventions must make a thorough baseline assessment of conditions present on the ground to ensure the success of interventions.