Evaluation and assessment of risk factors clinical presentation & management of Acute GE in summer in Preschoolers

PG Part 1, Department of Paediatrics, A.M.Shaikh Homeopathic Medical College and PG Research Center, Belgaum

PROFESSOR, HOD AND PG GUIDE,Department of Peadiatrics,
A.M.Shaikh Homeopathic Medical College and PG Research Center, Belgaum

During the summer months, the mortality from diarrhea among infants and young children is very high. Summer diarrhoea  also known as acute gastroenteritis are due chiefly of two causes, unclean food and hot weather. During summer there is high risk of getting infections by water or other food due to increased growth of bacteria. Children are very prone for summer diarrhea. Hence the prospective study is done to study the clinical presentation and for the assessment of risk factors of acute gastroenteritis in children of preschool age that is 0 to 6 years  .A prospective  clinical study is done with 26 cases taken between 01/04/2022 and 31/07/2022 in the OPD of A.M Shaikh Homoeopathic Medical college Belgaum. After a thorough study it is evident that there are increased cases of acute gastroenteritis and it has been treated with homoeopathic medicines based on totality.

Diarrhea is defined as a change in consistency and frequency of stools, i.e. liquid or watery stools, that occur 3 times a day. If there is associated blood in stools, it is termed dysentery. In the vast majority of cases, these acute episodes subside within 7 days. Acute diarrhea may persist for 2 weeks in 5-15% cases, which is labeled as persistent diarrhea1

Acute diarrhea constitutes a leading cause of morbidity and mortality among children below 5 years of age in developing countries. On an average, 3.3 episodes of diarrhea are experienced per child per year, but in some areas the average exceeds 9 episodes per year. More than 2 million deaths are estimated to result each year as a consequence of diarrheal disease in under-fives. Eighty percent of these deaths occur in the first 2 years of life, main causes being dehydration, complications associated with dysentery, malnutrition and serious infection such as pneumonia. Most of the diarrheal episodes occur during the first 2 years of life (highest incidence 6–11 months), low socioeconomic status, in non-breastfed infants, and in association with measles, severe malnutrition and immunodeficiency.2,3

Intestinal infections are the most common cause of acute diarrhea. However, certain drugs, food allergy, systemic infections (e.g. urinary tract infection and otitis media) and surgical conditions (e.g. appendicitis or Hirschsprung disease) can also present as acute onset diarrhea1.In developing countries, the organisms most frequently associated with AWD include enterotoxigenic Escherichia coli (ETEC), enteropathogenic Escherichia coli (EPEC), Shigelladysenteriae and Campylobacter jejuni. Rotavirus is a common cause of severe diarrhea, vomiting and fever leading to rapid dehydration. Vibrio choleraeis an important organism in endemic areas and during epidemics. Nontyphoidal Salmonella is a common organism in areas where commercially processed foods are widely used and in hospital outbreaks. Most of these organisms produce watery diarrhea. The main cause of acute dysentery is S. dysenteriae, C. jejuni and infrequently enteroinvasive Escherichia coli (EIEC) or Salmonella. Epidemics of dysentery are usually caused by S. dysenteriae type 1. Entamoebahistolytica can cause dysentery in adults but is a less common cause in young children. Diarrhea may also be caused by a number of antibacterial agents like ampicillin, cotrimoxazole, chloramphenicol, amoxicillin, clindamycin, etc. Pseudomembranous colitis is the most severe form of antibiotic associated diarrhea.2

Risk Factors
Factors determining susceptibility to diarrhea include poor sanitation and personal hygiene, nonavailability of safe drinking water, unsafe food preparation practices and low rates of breastfeeding and immunization. Young children(<2Years) and those with malnutrition are more susceptible to acute diarrhea and have more severe and prolonged episodes. Risk factors for prolonged and recurrent episodes of diarrhea include presence of hypo- or achlorhydria( due to Helicobacter pylori infection or therapy with proton pump inhibitors), selective IgA deficiency, infection with human immunodeficiency virus (HIV) and other chronic conditions. Alteration of normal intestinal microflora by antibiotics can predispose to C. difficile infection1

Clinical Features
Most enteropathogens can cause diarrhea by more than one mechanism. Hence the clinical presentation depends upon the underlying pathophysiological changes taking place in the gastrointestinal tract. Three clinical types of diarrhea have been defined, each reflecting a different pathogenesis and requiring different approach to treatment.

CONCLUSION: This study on acute GE in summer season concludes that acute GE is more prevalent in children between the age group of 5 to 6 years and the most commonly used medicines are Calc carb, Ars alb, Nat mur, Podo &Ipecac which helped them to get cured completely

1) Behrman RE, Kliegman R, Schor NF, W. SGJ, Stanton B, Nelson WE. In: Nelson Textbook of Pediatrics. 21st ed. Philadelphia: Elsevier Inc.; 2020. p. 287–.
2) PARTHASARATHY A. IAP Textbook of Pediatrics. 7th ed. Vol. 1.newdelhi: JAYPEE Brothers MEDICAL P; 2019. p.512-
3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8112734/   accessed on 26/07/2022
4) Lakshmanaswamy A. Clinical pediatrics: History taking and case discussion. 5th ed. New Delhi: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011. p.241

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