Conservative Treatment of Hemorrhoidal Disease

Background: Hemorrhoids are vascular cushions underlying the distal rectal mucosa and contributing for approximately 15–20% of the resting anal pressure with a complete closure of the anal canal. They can become pathological (hemorrhoidal disease, HD) being the most common cause of painless rectal bleeding during defecation with or without prolapsing anal tissue. The treatment of HD must be tailored to both the severity of disease and patient’s expectation. Methods: A narrative review of all the most relevant papers present on Pubmed was conducted. Results: Conservative treatment is effective in managing the majority of patients complaining of early stages of the disease. Dietary and lifestyle modifications to achieve regular defecation and soft stool are the first therapeutic step. Oral phlebotonic drugs can help to control symptoms. The use of topical medications, particularly during the acute phase or in the post-hemorrhoidectomy period can also be beneficial for all patients complaining of HD. Conclusion: Despite a large number of available products on the market and the high incidence of HD, very few randomized controlled trials have been carried out and most of the studies are uncontrolled case series. Larger and better designed trials are necessary to establish the real benefit of all types of drugs in the treatment of early stages of HD.

PENGARUH KESEIMBANGAN FOREMILK DAN HINDMILK DENGAN POLA DEFEKASI BAYI YANG MENDAPATKAN ASI EKSKLUSIF DI DESA SUKARENDE

Mothers who exclusively breastfed their babies from 2011-2015 tended to increase. However, in breastfeeding there are still many maternal understandings that are lacking about foremilk and hindmilk. Foremilk and hindmilk are related to the duration of the baby breastfeeding, if the baby has not been obtained in a balanced manner can cause problems in the pattern of defecation of infants especially those aged 1-6 months. The purpose of study was to determine the effect of foremilk and hindmilk balance with defecation patterns of infants who received exclusive. The study design was cross sectional, with total sample 30 mothers who had infants aged 1-6 months and exclusively. The results showed the majority (96.7%) frequency of defecation of infants 1-8 times, consistency of soft stool (96.7%) and yellow stool (93.3%). Out of 30 respondents 53.33% of mothers had a balance of foremilk and hindmilk while breastfeeding and 86.66% of infants had normal defecation patterns. Chi-square test results did not influence the balance of foremilk and hindmilk with the pattern of defecation with 30 respondents surveyed. This shows that the balance of foremilk and hindmilk has not affected the pattern of infant defecation including frequency, consistency and color of feces.

Bowel habits of exclusively breastfed 0-4 month-old babies

Background Exclusively breastfed newborns have frequent bowelmovements and sometimes watery stool, which parents or doctorsmight think as diarrhea.Objective The aim of this study was to observe the bowel habitsof exclusively breastfed infants.Methods A longitudinal study was done on 100 babies born be-tween November and December 2002 in Cinta Kasih MaternityHospital. The inclusion criteria were fullterm baby, exclusivelybreastfed for 4 months, and informed consent from parents. Ba-bies with problems in organ or nerve that influenced the gastrointes-tinal tract were excluded. Stool frequency, consistency, and colorwere observed.Results The mean stool frequency per day were 3 times in the 1 stweek (95%CI 2.6;3.4), 2 times in the 2 nd week (95%CI 1.7;2.3),1.8 times in the 3 rd week (95%CI 1.5;2.1), and 1.5 times in the 4 thweek (95%CI 1.3;1.7). In the second and third month, it was 1.4times a day and the fourth month, 1.2 times a day. The consis-tency of meconium was soft in the first four days. After that, 18% ofbabies had watery stool, which increased to 30% on day 15-113.In the last week of the fourth month, all babies had soft stool. Meco-nium was black and lasted for 1-3 days. On the fourth day, thestool became yellow. On day 5-14, 6% of babies had green stool,which increased to 12% on day 15-120.Conclusion The first week of the first month was the week whenthe stool frequency was highest compared to the weeks or monthsafter. The consistency of meconium was soft. After it disappeared,most babies had soft stool. Eighteen up to 30% percent of babieshad watery stool. Regarding the color, meconium was black andstayed for 1-3 days. After that, most babies had yellow stool and 6-12% had green stool

Eradication of Blastocystis hominis prevents the development of symptomatic Hashimoto’s thyroiditis: a case report

In this case report we describe a 49 year-old man who presented with chronic urticaria, angioedema and soft stool consistency. During diagnostic examinations Hashimoto’s thyroiditis was found even though the patient never had clear symptoms of this disease. Blastocystis hominis was isolated through a stool microbiologic examination, implicating that this parasite can cause the development of Hashimoto’s thyroiditis and chronic urticaria. After two-weeks treatment with metronidazole the Blastocystis hominis was eradicated, then urticaria and angioedema disappeared. During the four years of follow-up, the patient presented without any symptoms, whereas thyroid hormones were normalized and anti-thyroid antibodies declined. For the first time in the literature we show that eradication of Blastocystis hominis can prevent the development of both symptomatic Hashimoto’s thyroiditis and chronic urticaria.

Dramatic Improvement in down Syndrome—Associated Cognitive Impairment with Donepezil

OBJECTIVE: To report 2 cases of patients with Down syndrome and severe cognitive impairment who gained dramatic improvements in quality of life (QOL) upon donepezil treatment. CASE SUMMARIES: Case 1. A 38-year-old woman with Down syndrome, diagnosed with secondary progressive dementia when her mental state had deteriorated rapidly after graduation from junior high school, started donepezil treatment. The loading dose was 3 mg/day and was increased to 5 mg/day for maintenance. One month after the dose was increased, adverse effects such as soft stool and urinary incontinence appeared. These adverse effects disappeared when the dose was decreased again to 3 mg/day. Her QOL improved dramatically with this minimal dose. She recovered verbal and written communication skills that she had lost for the past 21 years. Case 2. A 22-year-old man with Down syndrome, who had been diagnosed as having severe mental retardation, was put on donepezil therapy. Both loading and maintenance doses were 3 mg/day. His QOL had also dramatically improved, with some recovery in verbal communication. Transient agitation/violence and transient muscle weakness appeared during the first few months of treatment. DISCUSSION: Patients with Down syndrome may be more sensitive to donepezil therapy than others and may benefit from this medicine, although they may also have adverse effects more frequently. CONCLUSIONS: Donepezil may be a useful medicine for some patients with Down syndrome with severe cognitive impairment or mental retardation if the adverse effects are manageable.

Protective Efficacy of a Sulfated Sialyl Lipid (NMSO3) against Human Rotavirus-Induced Diarrhea in a Mouse Model

ABSTRACT Antiviral activity of sulfated sialyl lipid (NMSO3) against human rotavirus (RV) was examined in vitro and in vivo. NMSO3 inhibited the replication of four major serotypes (G1 to G4) of human rotavirus with a low 50% effective concentration of 1 to 5 μg/ml and 50% cytotoxic concentration of 153 μg/ml when determined by plaque assays with MA104 cells. Exposure of NMSO3 to HCl (pH 2.0) for 30 min exhibited no loss of anti-RV activity. Time-of-addition experiments revealed that NMSO3 inhibited the adsorption of four serotypes of RV to MA104 cells. Furthermore, an assay of virus binding with radiolabeled RVs revealed that NMSO3 inhibited the binding of virus to MA104 cells, suggesting that NMSO3 may bind to VP4 and/or VP7. Prophylactic oral administration of NMSO3 (10 μg three times per day, 4 days) to five suckling mice starting 30 min before inoculation of MO strain (3 × 106 PFU/mouse) prevented the development of diarrhea. Four of five mice showed no stool or brown formed stool, and only one mouse showed brown soft stool, while water treatment caused watery diarrhea in all five mice. The mean titer of antibody to RV in mice which received NMSO3 at 10 μg three times per day for 4 days was significantly lower than that of untreated, infected mice. NMSO3 is a promising candidate for the prophylactic treatment of human RVs.

Histiocytic ulcerative colitis in three non-boxer dogs

Histiocytic ulcerative colitis (HUC) is described in three non-boxer dogs. Clinical signs were typical of large-bowel diarrhea and included soft stool, hematochezia, tenesmus, and an increased frequency of defecation. Diagnosis in each case was made by light microscopic evaluation of endoscopically obtained colonic biopsy specimens. Treatment regimes varied, but included immunosuppressive agents, anti-inflammatory drugs, antimicrobials, and dietary modification. Clinical response was substantial in two patients, while the third patient was euthanized due to treatment failure. The authors' observations indicate that HUC may be encountered in non-boxer dogs.

Magnesium in the Prophylaxis of Migraine—a Double-Blind, Placebo-Controlled Study

The migraine prophylactic effect of 10 mmol magnesium twice-daily has been evaluated in a multicentre, prospective, randomized, double-blind, placebo-controlled study. Patients with two to six migraine attacks per month without aura, and history of migraine of at least 2 years, were included. A 4-week baseline period without medication was followed by 12 weeks of treatment with magnesium or placebo. The primary efficacy end-point was a reduction of at least 50% in intensity or duration of migraine attacks in hours at the end of the 12 weeks of treatment compared to baseline. With a calculated total sample size of 150 patients, an interim analysis was planned after completing treatment of at least 60 patients, which in fact was performed with 69 patients (64F, 5M), aged 18–64 years. Of these, 35 had received magnesium and 34 placebo. The number of responders was 1 in each group (28.6% under magnesium and 29.4% under placebo). As determined in the study protocol, this was a major reason to discontinue the trial. With regard to the number of migraine days or migraine attacks there was no benefit with magnesium compared to placebo. There were no centre-specific differences, and the final assessments of treatment efficacy by the doctor and patient were largely equivocal. With respect to tolerability and safety, 45.7% of patients in the magnesium group reported primarily mild adverse events like soft stool and diarrhoea in contrast to 23.5% in the placebo group.