Introduction Of Secretory Diarrhea

Secretory diarrhea means that there is an increase in the active secretion, or there is an inhibition of absorption. The most common cause of this type of diarrhea is a cholera toxin and E.coli those stimulate the secretion of anions, especially chloride ions .Bacterial and viral infections usually included in the etiology of diarrhea  and these pathogens are present in wide diversity which complicates the process of  accurate surveillance and diagnosis, especially in developing countries with little or no access to modern laboratory procedures. The specific disease burden attributable to a particular infectious agent is particularly complex, given the multiplicity of these agents and their serotypes, and its accurate documentation depends largely on laboratory facilities. While, in the long term, access to clean water, better hygiene, adequate nutrition, and improvement of sanitary measures would certainly have the greatest impact on diarrhea diseases, Some other varieties of bacterial pathogens such as Staphylococcus aureus, Clostridium perfringens, Clostridium difficile or Klebsiella spp, as well as by various protozoa including Giardia, Cyclospora and Cryptosporidium spp (e.g. Giardia lambia, Cryptosporidium parvum) and Entamoeba histolytica are also included in etiology of diarrhea diseases. The leading cause of diarrhea disease in young children throughout the world is rotavirus.

Significance of the results

A significant difference was identified, concluding that frequency of diarrhea and associated symptoms were significantly reduced when treated with Dirasif. The data offered support to the experimental hypothesis and therefore null hypothesis was rejected.

Epidemiology

Diarrhea diseases are one of the leading causes of childhood morbidity and mortality in developing countries. An estimated 1,000 million episodes occur each year in children under 5 years of age. Diarrhea causes an estimated 5 million deaths in children fewer than 5 years of age per year. About 80% of these deaths occur in children in the first 2 years of life. Approximately one third of deaths among children fewer than five are caused by diarrhea . In the year 2000, diarrhea diseases claimed an estimated 1.4 to 2.5 million lives; they are among the leading causes of death in children in developing countries. Both the incidence and the risk of mortality from diarrhea diseases are greatest among children younger than 1 year of age, and thereafter rates decline incrementally. Other direct consequences of diarrhea in children include malnutrition, diminished growth, and impaired cognitive development in resource-limited countries.

Treatment assignment and Follow-up

One hundred patients consented to participate in the study. Pretreatment clinical and laboratory parameters (stool D/R) for the treatment groups were noted. The two treatment groups were comparable in efficacy results and side effects of the medicine administered. All subjects were clinically studied and completed the assigned therapy during the period 2007 to 2009.

Loose motion

The loose motion before treatment there was no difference between test and control group at base line and after treatment in test and control group showed, test group (Dirasif) has 90% improvement as compared to control (Furoxone) 74% improvement. After applying the test of significance there was significant difference between these two drugs with Chi-Square Test was applied and p-value was calculated as 0.03 .

Abdominal pain

Dirasif was prescribed to 7 patients with complaint of abdominal pain. After the treatment with herbal drug

Dirasif. All patients showed complete improvement.

Furoxone was prescribed to 5 patients with complaint of abdominal pain. After the treatment with allopathic medicine Furoxone 1 out of 5 showed complete improvement and 4 patients showed no improvement.

The abdominal pain before treatment there was little difference between test and control group as shown in table. and after treatment in test and control group showed, test group (Dirasif) has 100% improvement and control (Furoxone)  showed 20% improvement. After applying the test of significance there was significant difference between these two drugs with Chi-Square Test was applied and p-value was calculated as 0.0036

Evidence Based Medicine

The books on traditional medicine are replete with the usage of medical treatment and
comprehensive literatures on the medical benefits. There are descriptive naration in its
very length and approach to treat ailments. However the documentations. in, the old
treatments of medical etiology are without any valid evidence based on clinical
assessment as evidence based medicine. This shortage of clinical based dosage form
design of traditional medicine has created a negative impact. Although it is a possibility
that traditional medicine used in ancient time till to date may have repeatedly been used
to cure different ailments. Though it may have pronounced type of pharmacological
effect and may be involved to bring about the mode of treatment. But in the absence of
any valid scientific documents the traditional medicine will not be accepted and should
riot be accepted as the genuine materia medica with specific medical effects. It is in the
best of traditional medicine to carryout extreme investigation and provides sufficient
evidence of the traditional medicine to be evidence-based medicine. All this is not
required as an image building process but definite grounds of the medical rules, are to be
followed that will provide traditional medicine a permanent status about its efficacy to be
prescribed in diseases.                                      ..•      '
 

Diagnosis

Diagnosis is one of the most advance area in the medical circle and investigation bring
about exactly to pin point in a patient that he is suffering from the diseases. In the olden
days, the physician use to bring about a clinical investigation based on the sign and
symptom of the diseases. That's why shotgun therapy was the dominant factor and
physician use to rely more on their clinical judgment. But with the advent of
technological explosion the diagnosis seems to be progressively under coming for
chemical and physical analysis and the method of diagnoses is going to expand in leaps
and bounds in the distant not so far.

Conclusion

The scientific and technological advancement of modem medicine has ruled over the last

Compare with Allopathic Medicine:

In the events of clinical trial protocol for the targeted diseases, usually a comparison is to be made with either placebo so as to prove its effectiveness to combat the disease. There could be another viable option available in the form of allopathic drug already tested and found authentic in its clinical effects and onset on the body system. Therefore, a comparison of Unani medicine with the allopathic could give reliable clinical evaluation. Actually comparison in fact is based on either crude drug or its extract or the fraction of extract in Unani medicine, which is compared to pure compounds. In this event there are two different types of availability operative usually function. In case of Unani medicine crude drug releases its active compound at a slow pace thus minimal effective level is achieved in an extended duration. Whereas the unitary chemical compound is available quickly, therefore, the biological responses are faster and attained in the short time. But again quick response brings about many side effects, which in certain cases give rise to side effects or more intensely the adverse effect. However in case of Unani medicine the chemical constituents released are many .in number and their quantity is quite small, therefore, release, absorption and metabolism in the body require longer period of time for effective- level achievement to bring about physiological, biochemical and pharmacological manifestation. However, all these factors are taken into consideration even then Unani medicine can bring about a clinical impact in the health care design. Suffice is to say that in all fairness the traditional medicine should be.

METHODOLOGY

Physical Examination
Selection Criteria of patients
It included patients with secretory diarrhea.

The Test Group
The case group was presented herbal formulation Dirasif which comprises of different herbal medicinal plants components.

The Control Group
The control groups are subjected to allopathic dosage form design Furoxon.

Diagnostic Technique
The diagnosis of secretory diarrhea was determined on the basis of Stool D/R.



Methods/Design
This is randomized controlled trial in primary care with an open intervention. Adult patients judged by the general practitioner (GP) to need either herbal or allopathic medicine for secretory diarrhea are randomized in treatment therapy.

Eligibility
Ages eligible for study: 10 – 40 years, genders eligible for study: Both male and female
inclusion and exclusion criteria.
Informed consent from the patients was taken.

Inclusion Criteria:
The cases suffering from secretory diarrhea were selected on the following lines
The patients suffering from secretory diarrhea
Patients living in Karachi or its outskirt or suburban areas.
Patients having no obvious pathological finding on routine examination
All socioeconomic classes including lower middle and higher.
Male and female patients between 10 to 40 years of age.

Exclusion Criteria

The major exclusion criteria for this trial were:
Patients belonging to the distant area outside Karachi were excluded because of inherent difficulty in follow up.
Patients with acute secretory diarrhea.
Patient with concurrent physical illness, for example uncontrolled hypertension, diabetes mellitus
Patients having congenital secretory diarrhea.
Patient having history of adverse reaction to any of the study drugs as or contraindicated for their use. 

Independent variable

Independent variable
It includes the present and past history, personal history, family history and socioeconomic history, medical and surgical history.

Dependent variable
It includes watery diarrhea, abdominal pain, tenesmus, dehydration,anorexia, nausea, vomiting, general weakness,irritability

Confound variable
Age, sex, nutrition, pulse, blood pressure, temperature, respiration

Sample Size

Sample size estimated in clinical assessment on secretory diarrhea has been carried out based on general physical examination, general appearance of the patients, age, sex, and local examination of the abdomen in a pilot study at Shifa ul Mulk Memorial Hospital. Trial was conducted on 100 patients. One hundred patients of secretory diarrhea from both groups (50 patient from control and 50 from experimental group) between ages of 12-40 years irrespective of socioeconomic status.

Sample selection

The sample was selected from the out patient department registered & enrolled in Shifa ul Mulk Memorial Hospital and on the basis of stool D/R and inclusion and exclusion criteria the patient fulfilling the secretory diarrhea criteria as candidates were selected. The study period include was from 2007 to 2009. Among this population all the patient suffering from secretory diarrhea were interviewed immediately and upon their consent to participate they were grouped as test and control groups.

Data collection/Statistical Analysis

Data collection

Data collected for this research work included filling of clinical trial proforma through personal interview, personal observation, use of case record, file and documents. The clinical trial proforma attached here which clearly specifies the clinical feature and information.

Statistical Analysis

Statistical analysis were performed using SPSS and excel software, the Chi Square Test was determined. All differences were considered statistically significant by generating a ‘p-value’ from test statistics. The significant result with ‘p-value’ less than 0.05 was considered as statistically significant.

Adverse Effects

Headache and malaise occur occasionally with oral furazolidone therapy and can be minimized or eliminated by reducing dosage or discontinuing the drug. Following oral furazolidone administration, hypoglycemia, agranulocytosis, and, in one patient, partial deafness and dizziness have also been reported. Rarely, some patients receiving oral furazolidone experience a disulfiram-like reaction to alcohol. Polyneuritis and hemolytic anemia (in patients with glucose-6-phosphate dehydrogenase deficiency and in neonates) also have been reported rarely.

Manufacturing procedure

All the medicinal plant drugs that were designed for Dirasif were purchased from the Jodia market in Karachi. The details are as follows: Myrtus communis seeds, Aegle marmelos fruit, Punica granatum husk, Phyllanthus emblica fruit, Berberis vulgaris extract of fruit.
All these plant drugs were cleaned thoroughly and soaked in water eight times weight of drugs for a night. Then at morning, it is boiled to make decoction until half of the water remains left. This decoction was passed through filtration processes and a clean and transparent decoction was obtained. Sugar was added in the decoction two times weight by volume of the decoction to prepare sugar syrup. Citric acid added as a decrystallizing agent in the mid of preparation of the syrup. At the end preparation sodium benzoat was also added as a preservative agent.Again it was passed through the process of filtration. Syrup Dirasif 5ml was given two times a day.

Dirasif formulation and selection criteria

Selection process involves the determination of action needed to address the multiplicity of symptoms presented as well as a basic understanding of the processes involved with secretory diarrhea having researched this following the initial visit. It was determined that the following caution would be beneficial of herbal drug formulation.

Myrtus communis

Antidiarrheal, Antidysenteric, Antibiotic Antispasmodic, Astringent, Anti-inflammatory, Antiseptic Antioxidant, Carminative Homeostasis.

Aegle marmelos

Antidiarrheal, Antidysenteric Anti-inflammatory, Astringent, Antiviral, Antibiotic, Antigiardial


Antioxidant, Anti rheumatic, Anti-pyretic, Anti-Spasmodic, Antiviral, Blood purifier
 

THESIS ON MATERIA MEDICA

Myrtus communis Linn.

Botanical Name: Myrtus communis

English: Myrttle Berry

Arabic: Hub-ul-Aas

Urdu : Aas



Description

Myrtus communis, also known as true myrtle, or simply myrtle, is an evergreen shrub which has been grown in the Mediterranean regions for centuries. It can reach up to 15 ft (4.5 m) tall, but is smaller when regularly pruned. All its parts are scented. It has small deep-green leaves, white flowers and small dark fruits.
The true myrtle is a showy evergreen shrub that is relatively frost hardy, and that can give a Mediterranean aspect to USDA zones 8b gardens and warmer.

Active constituents

Myrtenol, myrtenol acetate, limonene (23%), linalool (20%), pinene (14%), cineol (11%), furthermore, p-cymene, geraniol, nerol, phenylpropanoid, methyleugenol. myrtucommulone-A, myrtucommulone-B, semimyrtucommulone, galloylated alkylphloroglucinol glucosides, i.e. gallomyrtucommulone-A, gallomyrtucommulone-B, gallomyrtucommulone-C and gallomyrtucommulone-D, oligomeric acylphloroglucinol, myrtucommulone-A, semimyrtucommulone, the galloylated alkylphloroglucinol, glucosides, gallomyrtucommulones-A, B, C and D, α-pinene (18%), limonene (20%), 1.8 cineole (5%), linalool (16%), linalyl acetate (8.16%), myrtenyl acetate (9%), geranyl acetate (3%), α-humulene (2%), α-terpineol (1.5%), trans-caryophyllene (1%), methyl eugenol (1%), trans-β-ocimene (0.9%), α-terpinolene (0.9%), along with minor quantities of eugenol (0.4%), neryl acetate (0.4%), α-terpinyl acetate (0.5%), p-cymene (0.8%), γ-terpinene (0.6%), terpinen-4-ol (0.3%), methyl chavicol (0.7%) and methyl iso-eugenol (0.2%)[28].

Pharmacological activity

In traditional Indian medicine dried and fresh fruits of the plant are used. All parts of the plant are used in various Ayurvedic/Unani Medicine, herbal preparations, including the fruit, seed, leaves, root, bark and flowers . According to Ayurveda, amla fruit is sour (amla) and astringent (kashaya) in taste (rasa), with sweet (madhura), bitter (tikta) and pungent (katu) secondary tastes (anurasas). Its qualities (gunas) are light (laghu) and dry (ruksha), the post-digestive effect (vipaka) is sweet (madhura), and its energy (virya) is cooling (shita) . The herb Phyllanthus emblica has gained interest as a potential treatment for human bone disorders as well as diabetes patients. Gaining attention for its potential effects against hepatitis B,research on Phyllanthus niruri has revealed possible antiviral activity also against human immunodeficiency virus (HIV)

Aegle marmelos Linn.

Botanical Name: Aegle marmelos

English : Bael tree, Holy fruit tree

Hindi : Bel, sirphal

Urdu : Bail giri

Description

A medium sized armed deciduous tree up to 8.0 m high with straight, sharp, axillary thorns and yellowish brown shallowly furrowed corky bark; leaves trifoliate, aromatic, alternate, leaflets ovate or ovate-lanceolate, crenate, pellucid-punctate, the laterals subsessile and the terminal long-petioled; flowers greenish white, sweet scented, in axillary panicles; fruits globose, woody berry with yellowish rind; seeds numerous oblong, compressed, embedded in orange brown sweet gummy pulp. -Fruit 2 1/2 to 3 1/4 inches in diameter, globular or ovoid in shape, color grayish brown, outside surface hard and nearly smooth. Rind about 1/8 inch thick and adherent to a light red pulp, in which are ten to fifteen cells, each containing several woolly seeds. It has a faint aromatic odor and mucilaginous taste . 

Active Constituents

Limonene (51.7%) and (Z)-β-ocimene (39.8%), 1,8-cineole (40.5%), α-phellandrene (34.5, (Z)-β-ocimene (5.1%), eight monoterpene hydrocarbons (92.8%), oxygenated monoterpenes (2.5%), sesquiterpene hydrocarbons (2.2%), oxygenated sesquiterpene (0.2%), phenolic compound, mucilage and pectin, coumarins, steroids, skimianinc, sterol, aegelin.,marmorosin, imperatorin. Altoimperatorin, B sitosterol, psoralin, xanthotoxin, scopoletin and tembamide.

Medicinal actions

Fresh half-ripe Bael fruit is mildly astringent and is used in India for dysentery and diarrhea; the pulp may be eaten or the decoction administered. The dried fruit does not contain the constituent’s requisite for the preparation of the decoction. It is said to cure without creating any tendency to constipation.

Pharmacological activity

Aegle marmelos Correa has been widely used in indigenous systems of Indian medicine due to its various medicinal properties. The decoction was assessed for its antibacterial, antigiardial and antirotaviral activities. The effect of the decoction on adherence of enteropathogenic Escherichia coli and invasion of enteroinvasive E. coli and Shigella flexneri to HEp-2 cells were assessed as a measure of its effect on colonization. The effect of the decoction on production of E. coli heat labile toxin (LT) and cholera toxin (CT) and their binding to ganglioside monosialic acid receptor (GM1) were assessed by GM1-enzyme linked immuno sorbent assay whereas its effect on production and action of E. coli heat stable toxin (ST) was assessed by suckling mouse assay. The decoction showed cidal activity against Giardia and rotavirus whereas viability of none of the six bacterial strains tested was affected. It significantly reduced bacterial adherence to and invasion of HEp-2 cells. The extract also affected production of CT and binding of both LT and CT to GM1. The decoction of the unripe fruit pulp of A. marmelos, despite having limited antimicrobial activity, affected the bacterial colonization to gut epithelium and production and action of certain enterotoxins. These observations suggest the varied possible modes of action of A. marmelos in infectious forms of diarrhea thereby validating its mention in the ancient Indian texts and continued use by local communities for the treatment of diarrhea diseases .

PUNICA GRANATUM LINN.

Botanical Name: Punica granatum

English: Pomegranate

Urdu: Anar


Description

A pomegranate is a fruit-bearing deciduous shrub or small tree growing to between five and eight meters tall. The pomegranate is native to Iran and has been cultivated in the Caucasus since ancient times. It is widely cultivated throughout Armenia, Azerbaijan, Iran, Afghanistan, Pakistan, Turkey, North India, the drier parts of southeast Asia, Peninsular Malaysia, the East Indies, the Mediterranean and Southern Europe and tropical Africa.Introduced into Latin America and California by Spanish settlers in 1769, pomegranate is now cultivated in parts of California and Arizona for juice production.In the Northern Hemisphere, the fruit is typically in season from September to February. In the Southern Hemisphere, it
is in season from March to May .

Description

A pomegranate is a fruit-bearing deciduous shrub or small tree growing to between five and eight meters tall. The pomegranate is native to Iran and has been cultivated in the Caucasus since ancient times. It is widely cultivated throughout Armenia, Azerbaijan, Iran, Afghanistan, Pakistan, Turkey, North India, the drier parts of southeast Asia, Peninsular Malaysia, the East Indies, the Mediterranean and Southern Europe and tropical Africa. Introduced into Latin America and California by Spanish settlers in 1769, pomegranate is now cultivated in parts of California and Arizona for juice production.
In the Northern Hemisphere, the fruit is typically in season from September to February. In the Southern Hemisphere, it is in season from March to May .

Chemical constituents

Vitamin C, vitamin B5 (pantothenic acid), potassium,antioxidantpolyphenols,hydrolyzable tannins, punicalagins catechins, gallocatechins, anthocyanins, prodelphinidins, delphinidin, cyanidin, and pelargonidin .

Description

A pomegranate is a fruit-bearing deciduous shrub or small tree growing to between five and eight meters tall. The pomegranate is native to Iran and has been cultivated in the Caucasus since ancient times. It is widely cultivated throughout Armenia, Azerbaijan, Iran, Afghanistan, Pakistan, Turkey, North India, the drier parts of southeast Asia, Peninsular Malaysia, the East Indies, the Mediterranean and Southern Europe and tropical Africa. Introduced into Latin America and California by Spanish settlers in 1769, pomegranate is now cultivated in parts of California and Arizona for juice production.
In the Northern Hemisphere, the fruit is typically in season from September to February. In the Southern Hemisphere, it is in season from March to May .

Pharmacological activity

The rind of the fruit and the bark of the pomegranate tree are used as a traditional remedy against diarrhea, dysentery and intestinal parasites . The seeds and juice are considered a tonic for the heart and throat, and classified as a bitter-astringent (pitta or fire) component under the Ayurvedic system, and considered a healthful counterbalance to a diet high in sweet-fatty (kapha or earth) components . The astringent qualities of the flower juice, rind and tree bark are considered valuable for a variety of purposes such as stopping nose bleeds and gum bleeds, toning skin, (after blending with mustard oil) firming-up sagging breasts and treating hemorrhoids . Pomegranate juice is also used as eye drops as it is believed to slow the development of cataracts .

BERBERIS VULGARIS LINN.

Berberis vulgaris Linn.

Botanical Name: Berberis vulgaris

Local Name: Ishkeen

Urdu Name: Rasont

Description

Berberis vulgaris is a deciduous spiny shrub. Stem branched, 2 to 3 meters long. Leaves obovate, sessile arranged spirally on stem. Leaves margin ciliated. From each node 3 to 4 leaves born in cluster. Inflorescence a racemes, flower stalk long, arising from the axil of leaves. Flower yellow.Berries is red.

Active constituents

Alkaloids of the isoquinoline type, mainly berberine, berbamine and derivatives, berberrubine, bervulcine, columbamine, isotetrandrine, jatrorrhizine, magnoflorine, oxycanthine and vulvracine, Oxyacanthine (C19H21NO3), berbine , vinetine; and berbamine (C18H19NO3) , sugar essential oil, while malic acid .

Pharmacological activity

Antibacterial; Antipruritic; Antirheumatic; Antiseptic; Appetizer; Astringent; Cancer; Cholagogue; Diaphoretic; Diuretic; Expectorant; Hepatic; Laxative; Ophthalmic; Purgative; Refrigerant; Stomachic; Tonic.

The bark and root bark are antiseptic, astringent, cholagogue, hepatic, purgative, refrigerant, stomachic and tonic [59, 60, 61, 62 63, 64, 65]. The bark is harvested in the summer and can be dried for storing. It is especially useful in cases of jaundice, general debility and biliousness, but should be used with caution [64]. The roots are astringent and antiseptic . The root bark has also been used as a purgative and treatment for diarrhea and is diaphoretic. A tincture of the root bark has been used in the treatment of rheumatism, sciatica etc [65, 66, 67]. The root bark is a rich source of the alkaloid berberine (about 6%) [68]. Berberine, universally present in rhizomes of Berberis species, has marked antibacterial effects. Since it is not appreciably absorbed by the body, it is used orally in the treatment of various enteric infections, especially bacterial dysentery. It should not be used with Glycyrrhiza species (Liquorice) because this nullifies the effects of the berberine.Berberine has also shown antitumour activity and is also effective in the treatment of hypersensitive eyes, inflamed lids and conjunctivitis. It is also used as a febrifuge. The fruit, or freshly pressed juice, is used in the treatment of liver and gall bladder problems, kidney stones, menstrual pains etc. The leaves are astringent and antiscorbutic. A tea made from the leaves is used in the treatment of coughs .

INTRODUCTION OF SECRETORY DIARRHEA

Diarrhea represents a major health problem in developing world. It has been estimated that diarrhea claims about two million deaths per year, ranking third among all causes of infectious disease deaths worldwide. Most of these deaths occur in children under five years of age . average morbidity attack rate of diarrhea in children is 3.2 episodes per year , but in some regions of developing world, 12 episodes per year per child have been reported. The long-term consequences of such heavy disease resulting a serious damage on physical and mental development of children that may eventually result into loss of human health and proper functioning in adolescence and as well as in future life .Some other diarrhea related diseases like cholera, shigellosis and typhoid fever most often occur in developing countries, adding to the burden of disease among the most vulnerable such as refugees, internally displaced populations and groups living in shanty towns.

Diarrhea is derived from the Greek, "diarrhea" meaning "a flowing through", also spelled diarrhea , is the condition of having frequent loose or liquid bowel movements. Diarrhea also means an increased frequency or decreased consistency of bowel movements. In many developed countries, the average number of bowel movements is three per day. However, researchers have found that diarrhea best correlates with an increase in stool weight; stool weights above 300 grams per day generally indicates diarrhea. This is mainly due to excess water, which normally makes up 60-85% of fecal matter. In this way, true diarrhea is distinguished from diseases that cause only an increase in the number of bowel movements (hyperdefecation) or incontinence (involuntary loss of bowel contents).

Etiology of secretory diarrhea

Among the major bacterial agents of diarrhea diseases are Vibrio cholerae causing cholera, Salmonella spp, including S typhi causing typhoid fever, and of Shigella spp, the agents of shigellosis which usually cause bacterial dysentery, Campylobacter spp especially C jejuni and a variety of enteropathogenic Escherichia coli strains, including the enterotoxigenic ETEC strains that are the main cause of travelers’ diarrhea.

Some other varieties of bacterial pathogens such as Staphylococcus aureus, Clostridium perfringens, Clostridium difficile or Klebsiella spp, as well as by various protozoa including Giardia, Cyclospora and Cryptosporidium spp (e.g. Giardia lambia, Cryptosporidium parvum) and Entamoeba histolytica are also included in etiology of diarrhea diseases. The leading cause of diarrhea disease in young children throughout the world is rotavirus. Every year, before the advent of rotavirus vaccines, an estimated 527 000 young children died from severe diarrhea caused by rotavirus infection, most of them occurring in developing countries in South Asia and sub-Saharan Africa. Other viruses causing diarrheas include enteric adenoviruses, astroviruses and caliciviruses, the latter (noroviruses) being responsible for most gastrointestinal infections leading to diarrhea diseases . All these pathogens are transmitted by the faecal-oral route.

Increased intesti­nal secretion may be mediated by hormones Vas­oactive intestinal polypeptide – VIP and drugs. These sub­stances, as well as bile acids, fatty acids, and pros­tagladins, act by stimulation of adenylcyclase resulting in elevated levels of cyclic AMP in the intestinal mucosa, causing increased secretion of crypt cells and secretory diarrhea.

Epidemiology:

Diarrhea diseases are one of the leading causes of childhood morbidity and mortality in developing countries. An estimated 1,000 million episodes occur each year in children under 5 years of age. Diarrhea causes an estimated 5 million deaths in children fewer than 5 years of age per year. About 80% of these deaths occur in children in the first 2 years of life. Approximately one third of deaths among children fewer than five are caused by diarrhea . In the year 2000, diarrhea diseases claimed an estimated 1.4 to 2.5 million lives; they are among the leading causes of death in children in developing countries. Both the incidence and the risk of mortality from diarrhea diseases are greatest among children younger than 1 year of age, and thereafter rates decline incrementally. Other direct consequences of diarrhea in children include malnutrition, diminished growth, and impaired cognitive development in resource-limited countries.

According to some reports released in October 2009 suggests diarrhea is now estimated to cause 3 times more deaths than previously thought, at 1.1 million annually for people aged 5 and over, up from 300,000 assumed in a 2002 study. According to a UNICEF, diarrhea kills some 1.5 million children under the age of 5 annually.

Sign and symptoms of secretory diarrhea

Diarrhea in developed countries is almost invariably a benign, self-limited condition, subsiding within a few days. The clinical presentation and course of illness depend on the etiology of the diarrhea and on the host. For example, rotavirus is more commonly associated with vomiting, fever, and a greater number of work days lost than non-rotavirus gastroenteritis.
Diarrhea implies an increase in stool volume and diminished stool consistency. In children younger than 2 years, diarrhea is as daily stools with a volume greater than 10 mL/kg.
In children older than 2 years, diarrhea is defined as daily stools with a weight greater than 200 g. In practice, this typically means loose-to-watery stools passed 4 or more times per day.
Individual stool patterns widely vary; for example, breastfed children may normally have 5-6 stools per day.
Flatulence associated with foul-smelling stools that float suggests fat mal-absorption, which can be observed with infection with Giardia lamblia. Knowledge of the characteristics of consistency, color, volume, and frequency can be helpful in determining whether the source is from the small or large bowel.

Diagnosis

Despite clinical clues, determining the causative agent of diarrhea in an individual patient on the basis of clinical grounds alone is usually difficult. Stool cultures are usually unnecessary for immuno-competent patients who present within 24 hours after the onset of acute, watery diarrhea. Microbiologic investigation is indicated in patients who are dehydrated or febrile or have blood or pus in their stool. Epidemiologic clues to infectious can be found by evaluating the incubation period, history of recent travel, unusual food or eating circumstances, professional risks, and recent use of antimicrobials, institutionalization, and HIV infection risks.
A stool sample may help define the type of diarrhea. The presence of fat, occult blood, and white blood cells will help determine if a watery, inflammatory, or fatty diarrhea is present. A bacterial culture and ova/parasite studies of a stool specimen will also help determine if an infectious etiology is present. Other investigations include: a blood count to look for anemia and infections, an electrolyte and kidney function panel to assess for electrolyte abnormalities and renal insufficiency, and albumin to assess nutritional status.

Treatment

Treatment of diarrhea depends on the cause. Diagnosis of medical problems such as IBD (Crohn's disease or Ulcerative Colitis) or Celiac disease requires assessment and treatment by medical specialists, especially if there is poor weight gain, chronic or severe symptoms, or bloody diarrhea. Avoidance of specific causes or risk factors may be of benefit in other situations, such as eliminating dairy products in lactose-intolerant individuals, or drinking only from safe water sources in places with poor sanitation. Careful hand washing after using the toilet and especially before handling food is very important for prevention of infectious diseases. "Toddler's diarrhea" is a transient and benign cause of diarrhea in young children that does not affect appetite, growth or behavior, does not cause pain, and does not require treatment.
Complementary and alternative medicine (CAM) is a group of diverse health care systems. There are many CAM therapies used to treat diarrhea. Many treatments have not been well studied in children, especially regarding effectiveness and safety. There are very few high-quality studies, and this can make it difficult to give good evidence-based advice. The information presented here is based on published research, a lot of which is based in developing countries where diarrhea is a serious and common problem and CAM are being used commonly

INTRODUCTION DIARRHEA

Diarrhea causes an estimated 5 million deaths in children under 5 years of age per year. About 80% of these deaths occur in children in the first 2 years of life. Approximately one third of deaths among children under five are caused by diarrhea. In the year 2000, diarrhea diseases claimed an estimated 1.4 to 2.5 million lives; they are among the leading causes of death in children in developing countries. Secretory diarrhea means that there is an increase in the active secretion, or there is an inhibition of absorption. The most common cause of this type of diarrhea is a cholera toxin and E.coli those stimulate the secretion of anions, especially chloride ions.. Bacterial and viral infections usually included in the etiology of diarrhoea .

Object

To investigate the safety and efficacy of Dirasif (Herbal Medicine, test group) in comparison with Furoxone (control group) for the treatment of secretory diarrhea.

Eligibility/Design

Eligibility

Ages eligible for study: 10-40 years, genders eligible for study: Both inclusion and exclusion criteria. Informed consent from the patients.

Design


Case control direct, unicentre, prospective, randomized authentic allopathic controlled, two arm parallel group clinical trial.

Subjects

Patients of both genders with clinical diagnosis of secretory diarrhea. Sample sizes for this study included from Dirasif a total of 50 and Furoxone a total of 50 subjects were registered and treated.

Interventions

Patients (n=100) were randomly assigned to receive Dirasif for 4 month and followed 1 month for evaluation of stool D/R of patient. Furoxon was given in the similar manner to the patients for the assessment of stool D/R. Study period was of 4 month with a window for the follow up visit of one month accounting for variable duration of secretory diarrhea treatment.

Outcome measure

Primary efficacy parameter to prevent secretory diarrhea and clinical response. Secondary efficacy parameter secretary diarrhea response to the treatment.

Result

Comparison of data recorded by participants relating to these variables showed significant differences between test and control groups ( 0.05) despite of the fact that no side effects were at all recorded in test group. Overall clinical success was observed different in both treatment groups however the efficacy of the test treated medication (Dirasif) was superior as p=0.03. In conclusion on the basis of statistical analysis done by chi square test null hypothesis is rejected.

Conclusion

Dirasif is more effective than the Furoxon in the treatment of secretory diarrhea. Dirasif has proved effective against secretory diarrhea. There was no untoward manifestation associated with the use of this medication and this is found a good acceptability by all treated patients. It has added benefit of safety.

About Thesis and Dedications

!! STUDY ON THE EFFICACY OF COMPOUND HERBAL MEDICINES & DRUG IN SECRETORY       DIARRHEA!!


                                                                           Dedicated
                                                                               

                                                                    to
                                                            

                                           !!  My Teacher  & My Parents !!

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