Traveler's diarrhea in children: New insights and existing gaps

Network Pharmacology and Intestinal Microbiota Analysis Revealing the Mechanism of Punicalagin Improving Bacterial Enteritis

BACKGROUND

The Chinese medicine punicalagin (Pun), the most important active ingredient in pomegranate peel, has significant bacteriostatic and anti-inflammatory properties. The potential mechanisms of Pun for bacterial enteritis, however, are unknown.

OBJECTIVE

The goal of our research is to investigate the mechanism of Pun in the treatment of bacterial enteritis using computer-aided drug technology, as well as to investigate the intervention effect of Pun on mice with bacterial enteritis using intestinal flora sequencing.

METHODS

The targets of Pun and Bacterial enteritis were obtained by using the specific database, and cross-targets were screened among these targets, followed by PPI and enrichment analysis of the targets. Furthermore, the degree of binding between Pun and key targets was predicted through molecular docking. After successfully establishing the bacterial enteritis model in vivo, mice were randomly assigned to groups. They were treated for 7 days, the symptoms were observed daily, and the daily DAI and body weight change rate were calculated. Following administration, the intestinal tissue was removed, and the contents were separated. The tight junction protein expression was detected in the small intestine by the immunohistochemical method; ELISA and Western Blot (WB) were performed to detect the expressions of tumor necrosis factor-α (TNF-α) and interleukin- 6 (IL-6) in the serum and intestinal wall of mice. The 16S rRNA sequence was used to determine the composition and diversity of the intestinal flora of mice.

RESULTS

In total, 130 intersection targets of Pun and disease were screened by network pharmacology. The enrichment analysis showed cross genes were closely related and enriched in the cancer regulation and the TNF signal pathway. The active components of Pun could specifically bind to the core targets TNF, IL-6, etc., determined from molecular docking results. In vivo experiment results showed that the symptoms in the PUN group mice were alleviated, and the expression levels of TNF-α and IL-6 were significantly reduced. A Pun can cause substantial changes in the intestinal flora of mice in terms of structure and function.

CONCLUSION

Pun plays a multi-target role in alleviating bacterial enteritis by regulating intestinal flora.

[International travels with children]

International travels with children need special planning and preparation. Besides considering general aspects, such as the age of the child, physical fitness, pre-existing illnesses, type and extent of the journey, climatic conditions at the destination and previous travel experiences, it is important to discuss relevant travel-associated risks in the context of travel consulting. This includes extensive advice concerning mosquito protection and malaria prophylaxis and counselling and implementation of travel vaccinations. Depending on the situation of the family, an individualized travel concept can be prepared, creating the foundation for a possible problem-free international travel.

Estimating the seasonally varying effect of meteorological factors on the district-level incidence of acute watery diarrhea among under-five children of Iran, 2014-2018: a Bayesian hierarchical spatiotemporal model

Under-five years old acute watery diarrhea (U5AWD) accounts for most diarrheal diseases' burden, but little is known about the adjusted effect of meteorological and socioeconomic determinants. A dataset containing the seasonal numbers of U5AWD cases at the district level of Iran is collected through MOHME. Accordingly, the district-level standardized incidence ratio and Moran's I values are calculated to detect the significant clusters of U5AWD over sixteen seasons from 2014 to 2018. Additionally, the author tested twelve Bayesian hierarchical models in order to determine which one was the most accurate at forecasting seasonal number of incidents. Iran features a number of U5AWD hotspots, particularly in the southeast. An extended spatiotemporal model with seasonally varying coefficients and space-time interaction outperformed other models, and so became the paper's proposal in modeling U5AWD. Temperature demonstrated a global positive connection with seasonal U5AWD in districts (IRR: 1.0497; 95% CrI: 1.0254-1.0748), owing to its varying effects during the winter ((IRR: 1.0877; 95% CrI: 1.0408-1.1375) and fall (IRR: 1.0866; 95% CrI: 1.0405-1.1357) seasons. Also, elevation (IRR: 0.9997; 95% CrI: 0.9996-0.9998), piped drinking water (IRR: 0.9948; 95% CrI: 0.9933-0.9964), public sewerage network (IRR: 0.9965; 95% CrI: 0.9938-0.9992), years of schooling (IRR: 0.9649; 95% CrI: 0.944-0.9862), infrastructure-to-household size ratio (IRR: 0.9903; 95% CrI: 0.986-0.9946), wealth index (IRR: 0.9502; 95% CrI: 0.9231-0.9781), and urbanization (IRR: 0.9919; 95% CrI: 0.9893-0.9944) of districts were negatively associated with seasonal U5AWD incidence. Strategically, developing geoinformation alarm systems based on meteorological data might help predict U5AWD high-risk areas. The study also anticipates increased rates of U5AWD in districts with poor sanitation and socioeconomic level. Therefore, governments should take appropriate preventative actions in these sectors.

Evaluation and Management of Traveler's Diarrhea in Children

Traveler's diarrhea is the most common travel disease in both children and adults. Adult guidelines for traveler's diarrhea have been established, but significant gaps persist in guidance for the evaluation and management of pediatric traveler's diarrhea. Adult guidelines are not necessarily applicable in children, and it is essential for clinicians to account for the differences in pediatric pathophysiology, clinical presentations, and treatment recommendations when evaluating and managing pediatric traveler's diarrhea.

Fever in the Returned Pediatric Traveler

Global mobility has been steadily increasing in recent years. The assessment of the febrile child returning from international travel is a diagnostic challenge. The COVID-19 pandemic has profoundly affected international travel and made evaluation and management of the sick returned traveler more challenging. Children visiting friends and relatives abroad remain at higher risk of infection compared to tourists. This review presents a guidance on the initial assessment of a traveling febrile child including interpretation of medical history, physical examination, and laboratory findings. Important clues to etiology include exposure to different infectious agents, incubation periods of pathogens, and prophylaxis regimens and vaccines received. Early identification of potentially life-threatening and highly contagious infections is essential. In this article, we discuss the epidemiology, evaluation, and management of specific travel related infections such as malaria, typhoid fever, dengue fever, viral hemorrhagic fever, rickettsiosis, leptospirosis, schistosomiasis, gastrointestinal, and respiratory infections.