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In what way a diarrhea could be infectious?

Exposure to a wide range of pathogens might cause illness. It is a common observation that not everyone exposed to a virulent enteric pathogen will become ill. Most of the enteric pathogens are commonly isolated from stool without symptoms, which characteristically represents asymptomatic infection, rather than colonization. Host factors and organism inoculation size are likely important in determining who is at higher risk of becoming ill. The symptom of illness caused by infection in the gastrointestinal tract is diarrhea. Diarrhea is defined as output of more than 200g of unformed feces per day or by decreased stool consistency and increased stool frequency.

What could be the result of infectious diarrhea

On a global level, diarrhea is the second most important cause of overall death, the main cause of pediatric mortality, and generally a major cause of severe morbidity. The mean annual attack rate for children younger than five years is typically 1 to 2 for persons of all ages in the USA, versus 8 to 12 for children in the most developing regions.

What information Dexact-f actually provides?

The etiology of diarrhea is diverse: Some of the causes of diarrhea include infections (viral, bacterial, and protozoal), however diarrhea is the primary symptom of several other diseases such as inflammatory bowel diseases (Crohn’s diseases, ulcerative colitis, diverticulitis), syndromes of malabsorption (pancreatic insufficiency , nontropical sprue, tropical sprue and bacterial overgrowth syndrome, Whipple’s diseases, short bowel syndrome, post gastrectomy), irritable bowel syndrome, change in food and fluid status, and alcohol consumption, but can also be due to less common causes including endocrine abnormalities, neoplasms, bowel ischemia, or radiation induced. As diverse as the etiology is the treatment that goes with it. A proper diagnosis is important to select an effective treatment. Dexact-f differentiates infectious diarrhea from other causes of diarrhea. Dexact-f results is negative in cases of asymptomatic infections (positive feces cultures that do not indicate an infection).

How Dexact-f helps in immediate identification of acute bowel inflammation / infectious gastroenteritis ?

During acute injuries a protein is released by the injured epithelial cells named (INJURIN). Injurin induces production of healing growth factors such as hepatocyte growth factor (HGF) from mesenchymal cells. HGF has high affinity to the proteins (HSPG, c-Met)  on the cell membrane of intact adult epithelial cells that induces growth and motility of neighboring epithelial cells to cover the injured area. Dexact-f recognizes immediately presence of HGF with high affinity to HSPG and therefore distinguishes an acute injury (inflammation/infection) in the bowel.

Interpretation of various HGF / ph meter readings: 
What does it mean if result is positive or highly positive? What does it mean if result is negative or highly negative?

· If the test is low positive/positive and faeces pH is 6-8,  a local enteritis is suspected. This alternative is a common result of infectious gastroenteritis and might be caused by toxins or viral etiologies and is self-limited. No antibiotic is recommended.

· During severe septicemia the low pH in blood is compensated by high pH in feces. Therefore patients with severe sepsis have very high feces pH.  If the test is highly positive and feces pH is > 9-10, a  case of invasive amoebiasis or bacteria  with high risk of perforation and systemic infection is suspected. Wide-range antibiotic is recommended.

· If the test is negative and feces pH is 5-6, other, non-infectious causes of diarrhea are suspected. Further investigations should be considered.

· If the test is negative and feces pH is <5, a long-lasting infection or malabsorption is suspected. Further investigations should be considered.

What are the total spectrum of suspicion(s) one could get after using Dexact-f? 
(List of suspected diseases (responsible for infectious gastroenteritis / acute bowel inflammation).

The most common causes are:
Bacterial: Vibrio cholera, enterotoxigenic Esccherichia coli, Shigella strains, Salmonella, Campylobacter, E coli O157:H7, Clostridium difficile.

Viral: Rotavirus, Norwalk virus, Calicivirus, Enterovirus

Protozoa: Giardia, Entamobea histolytica, cryptosporidium

Intoxications: Stafylococcus aureus, Bacillus caereus.

Is it an antigen test or an antibody test?

The test detects presence of hepatocyte growth factor (HGF) a cytokine in stool samples by interaction of HGF with its receptor.

After how many days on the onset of symptoms can it detect?

It becomes positive as soon as the inflammation occurse; the same day or may be few hours before.

How many strips are packed in one bottle and what is their expiry from the date of shipment?

There are 20 strips in one bottle and there is up to one year expiry from the date of shipment depending on temperature, humidity and handling.

What is the storing temperature required?

The storing temperature is 20-32 centigrade.

Up to how many hours /day of the stool sample can your test detect ? In other words, if the stool sample is collected say before 8 hours than can you strip detect the bacteria/infection or only freshly collected stool sample be used? 

Feces samples can be tested 30 minutes until 36 hours after defecation in room temperature and up to 4 days after defecation in refrigerator.

There are different types of bacteria / infection in stool samples. What is the type of bacteria and/or infection can your strip detect ? Please name the bacteria / infection.

All of the bacteria that cause acute inflammation in the bowel can turn the Dexact-f to positive. The test differentiates acute from chronic inflammation. The bacterial infections known to be responsible for infectious gastroenteritis are Salmonella, Shigella, Campylobacter, EHEC, Cholera that cause acute inflammation. Toxin of bacteria in old foods that cause acute inflammation in bowel such as Staphylococcus aureus, Chlostridium deficile that causes antibiotic diarrhea, give all positive results.

During septicaemia and organ dysfunction, an acute inflammation in the bowel might cause diarrhea with a very high feces pH and highly positive Dexact-f test.

Patients suffering from Diarrhea has loose motions. Their stools are watery (liquid). Can such samples be used on your strip?

Yes, the watery stool is the best sample to use Dexact-f in.

Is your product meant just for stomach related problems? and can it detect only diarrhea or other problems?

The test is developed and monitored for stool samples. Due to consistence and other environmental differences such as pH and containing enzymes and proteins the test appropriate for stool samples differs from other body fluids. This test is covering entire bowel area. Or in other words, this test could detect acute inflammation (damage in the bowel area / entire intestinal area).

Can you provide comparison data by your method and others (Enzyme immune assays or Rapid card tests).

Yes. The comparison between HGF and calprotectin is mentioned in the book; Reference Handbook for Diagnosis and Management of Acute Diarrhoea and the published article: Differences in the expression of hepatocyte growth factor in acute and chronic bowel inflammation—Implications for diagnosis?

DOI:10.4236/abb.2013.48A2006

What are the advantages or merits of the DEXACT F test over Fecal calprotectin by ELISA or other rapid tests?

These two different school of thoughts, two different tests having different indications and values.

Calprotectin:
1-is a protein produced by neutrophiles during inflammation.
2-The amounts of Calprotectin is increased during inflammation in the bowel.
3-The amounts of calprotectin is increased during all sort of inflammation; acute or chronic.
4-The value of the test is in chronic diarrhoea.
5-Calprotectin has a high negative predictive value; it means if the test is negative we do not need to be worried about IBD.
6-In the case of colon cancer the test is not as valuable.
7-It has low positive predictive value; It means the positive test result does not give a clear answer what to do.

Dexact-f:
1-The amount of biologically active HGF (hepatocyte growth factor) is increased  during acute inflammation.
2-The test is negative during chronic inflammation.
3-The value of test is in acute diarrhoea; positive result indicates infection.
4-The test has a very high positive predictive value (97%); positive result means local acute inflammation in the bowel.
5-dExact-f has a pH meter included that informs the level of inflammation in the bowel.
6-The value of dExact-f is to give information within a minute if patient has damage in the bowel area or not. After knowing the information the concerning doctor could decide what to do next without wasting time in waiting for routine examination’s result.  In India it is very common to give antibiotics from the beginning irrespective of need and necessity. After getting information from Dexact-f, a doctor could decide if patient really need antibiotic or not during the acute visit.

You have stated that the Sensitivity of the product is 93%. Please let me know the specificity also.

The specificity of test ranged between 92-96% in different patient groups. The average sensitivity and specificity based on the groups is more than 90%.

Does it has any Journal references?

There are publications in international journals regarding the value of determination of HGF in bowel and pH in bowel. Please see the Scientific Articles.

Do you also provide free evaluation kits?

Yes. Only to serious channel partner(s) and are available at postal and packaging handling price.