Burden of Early Life Obesity and Its Relationship with Protein Intake in Infancy: The Middle East Expert Consensus / 대한소아소화기영양학회지

Adequate nutrition in early life is proposed to shape a child’s future health by launching the growth trajectory in the proper direction, which helps to avoid negative metabolic programming effects. Protein intake during infancy and early childhood is of great importance, as it plays a key role in infant metabolic programming and the future risk of obesity. Breastfeeding provides the best nutrition in early life, with many benefits tailored for the baby, including the appropriate quantity and quality of proteins. Considering the high prevalence of childhood, and subsequent adult, obesity in the region, a virtual Middle East expert consensus meeting was held to discuss an effective approach for managing childhood obesity. Leading pediatric experts from Bahrain, Egypt, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates participated in the meeting. The experts discussed, debated, and agreed on certain directions, including the importance of educating parents, endorsing breastfeeding, and ensuring optimum quantity and quality intake of proteins in early life.This expert consensus may serve as the starting point for healthcare professionals in the region who are interested in shaping a healthy future for the generations to come.

Management of the Most Common Functional Gastrointestinal Disorders in Infancy: The Middle East Expert Consensus / 대한소아소화기영양학회지

The occurrence of functional gastrointestinal disorders (FGIDs) is a formidable challenge for infants, parents, and healthcare professionals. Although data from the Middle East are scarce, experts consider FGIDs a prevalent condition in everyday clinical practice. The new Rome IV criteria revisited the definitions from a clinical perspective to provide a practical and consistent diagnostic protocol for FGIDs. However, the treatment practices for functional disorders vary considerably among Middle Eastern countries, often resulting in mismanagement with unnecessary investigations and treatments. In addition, the role of various treatment modalities, including probiotics such as Lactobacillus reuteri DSM 17938, in FGIDs requires further discussion and evaluation. During a consensus meeting, a locally relevant approach for treating common FGIDs such as infant regurgitation, infant colic, and functional constipation was discussed and approved by regional experts. The participants suggested a simplified treatment plan and protocol for general pediatricians and other primary care physicians managing FGIDs.This easy-to-follow standardized protocol will help streamline the initial management of this complex disorder in the Middle East region and even globally.

Management of the Most Common Functional Gastrointestinal Disorders in Infancy: The Middle East Expert Consensus / 대한소아소화기영양학회지

The occurrence of functional gastrointestinal disorders (FGIDs) is a formidable challenge for infants, parents, and healthcare professionals. Although data from the Middle East are scarce, experts consider FGIDs a prevalent condition in everyday clinical practice. The new Rome IV criteria revisited the definitions from a clinical perspective to provide a practical and consistent diagnostic protocol for FGIDs. However, the treatment practices for functional disorders vary considerably among Middle Eastern countries, often resulting in mismanagement with unnecessary investigations and treatments. In addition, the role of various treatment modalities, including probiotics such as Lactobacillus reuteri DSM 17938, in FGIDs requires further discussion and evaluation. During a consensus meeting, a locally relevant approach for treating common FGIDs such as infant regurgitation, infant colic, and functional constipation was discussed and approved by regional experts. The participants suggested a simplified treatment plan and protocol for general pediatricians and other primary care physicians managing FGIDs.This easy-to-follow standardized protocol will help streamline the initial management of this complex disorder in the Middle East region and even globally.

Childhood acute poisoning in a tertiary medical college hospital of Bangladesh.

A total of 193(4.7%) cases of acute childhood poisoning admitted to paediatric Unit of Khulna Medical College Hospital, Bangladesh over a period of two years were studied to see the age and sex distribution, ingredients used, seasonal variation etc. Out of them 107(55.4%) cases were male and rest 86(44.6%) were female. 01-03 years was the most vulnerable age group to be affected. Kerosene was the commonest form of ingredient to be used. Overall mortality rate was 4.66%. Childhood poisoning was a common Medical emergency with considerable morbidity and mortality. Parents should be educated to keep the kerosene out of reach of the children. So, that mortality and morbidity can be reduced to a great extent.

study of some biochemical parameters of pulmonary hypertension in children with congenital and rheumatic heart disease

The study included 36 cases with congenital heart disease [CHD] all of them had left to right shunt [17 cases of them had pulmonary hypertension [PHT], 30 cases with valvular rheumatic heart disease [RHD] [15 of whom had PHT]. Ten healthy normal age-matched children were taken as control for each group. Full history and physical examination, pulse oximetry, standard 13-lead ECG and detailed echocardiographic examination were done for every patient and control case. Chest radiograph posterantrior view in erect position was done for all patients. Erythrocytic sedimentation rate, C-reactive rotein and antistreptolysin-O titer were done for patients with RHD. All cases and controls had the following done: plasma level of endothelin-1 [ET-1], angiotesin-II [ANG-II], nitric oxide [NO] and serum level of angiotesin-converting enzyme [ACE] activity. The mean peak pulmonary pressure [PP] in patients having CHD and PHT was 54.35 +/- 9.69 mm Hg, while it was 61.73 +/- 11.55 mm Hg in those with RHD and RHT. The mean peak PP in the group of patients having CHD without PHT was 22.64 +/- 4.11 mm Hg. It was significantly higher than in those with RHD without PHT [9.41 +/- 1.98 mm Hg, P<0.05] and than controls [4.12 +/- 1.25, P<0.01]. It was observed that the mean levels of ET-1, NO, ANG-II and ACE were significantly higher in all cases with CHD [3.42 +/- 0.77, 77.21 +/- 29.14, 81.27 +/- 37.3, 107.2 +/- 47.65, P<0.001], cases with PHT [3.76 +/- 0.81, 94.1 +/- 21.1, 101.4 +/- 33.8, 136.2 +/- 37.9, P<0.001] OR without PHT [2.92 +/- 0.6,61.36 +/- 27.5, 63.28 +/- 16.5, 85.36 +/- 22.6, P<0.5 and 0.01] than in their controls [1.86 +/- 0.6, 34.07 +/- 10.7, 19.15 +/- 10.9, 54.1 +/- 32.1]. It was observed that the mean level of ET-1, NO, ANG-II and ACE were significantly higher in cases with CHD with PHT than in those without PHT [p<0.05 for each]. In the group of patients with RHD, it was observed that the mean levels of ET-1, NO, ANG-II and ACE were significantly higher in all cases [3.89 +/- 1.4, 78.46 +/- 59, 70.35 +/- 37.4, P<0.01 and 0.001] and cases with PHT [4.9 +/- 1.0, 100.5 +/- 32, 95.7 +/- 36.8, 121 +/- 40.9, P <0.001] than in controls [1.55 +/- 0.5, 33.47 +/- 13.0, 22.68 +/- 11.1, 53.27 +/- 32.4]. It was also observed that the mean levels of ET-1, NO, ANG-II and ACE were significantly higher in cases with than in those without PHT [2.6 +/- 0.8, 56.5 +/- 18.0, 44.96 +/- 12.7, 63.3 +/- 37] [P<0.01]. It was observed that the mean levels of ET-1, ANG-II and ACE were significantly higher in cases with CHD having heart failure [3.8 +/- 0.73, 106.8 +/- 50.37, 155.3 +/- 65.66] than those without heart failure [3.26 +/- 0.7, 69.88 +/- 25.1, 91.85 +/- 32.8], P<0.05 and 0.001. There was statistically significant positive correlation between PP in all the studied patients and serum level of ET-1, NO, ANG-II and ACE [P<0.001]. A significant positive corrlation was found between serum level of ET-1 and NO in all the studied cases [P<0.05]. A significant positive correlation was also found between serum level of ANG-II and ACE in all the studied cases [P<0.03]. ET-1 and NO production is increased in cases with PHT secondary to CHD with left to right shunt and to RHD and its production correlates with the level of PP. It could be also concluded that the level of ANG-II and ACE activity is increased in cases with PHT secondary to CHD with left to right shunt and to RHD and its production correlates with the level of PP. The use of NO, NO donors, prostacyclin and ET-1 antagonists should be considered in the management of pulmonary hypertension secondary to hyperkinetic arterial PHT due to CHD with left to right shunt and in the management of venous pulmonary hypertension secondary to RHD. The long-term effect of such drugs on the pathological process in such cases should be studied. Still early intervention in cases with hyperkinetic arterial PHT due to CHD with left to right shunt before the end of the first year of life is highly recommended. It may be also suggested that the use of ACE inhibitors could be useful to prevent the effects of ANG-II on the pulmonary vascular pathology

Visual laser ablation of the prostate [VLAP] with bare fiber in conjunction with laser bladder neck incision in the treatment of patients with benign prostatic hyperplasia [BPH]

The objective of this paper was to assess the effectiveness of visual laser ablation of the prostate [VLAP] using a bare fiber with simultaneous laser incision of the bladder neck for patients with symptomatic benign prostatic hyperplasia. Sixty-seven patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia were entered into a prospective trial where VLAP was done with neodymium: YAG laser, while the bladder neck incision was done with KTP laser was delivered using a bare fiber. There was marked improvement demonstrated at three months post-lasing in symptom score and flow rate. No significant changes were noticed in the subsequent follow-up. However, the bladder neck incision increased the rate of retrograde ejaculation without appreciable improvement in symptom score or flow rate when compared to other published data. None of the patients developed bladder neck contracture. VLAP, using a bare fiber, in conjunction with laser bladder neck incision, produces durable improvement in urine flow rate and symptom score in patients with symptomatic benign prostatic hyperplasia without the development of bladder neck contracturer. This method will reduce the costs of laser prostatectomy

Evaluation of a symptom score index for measurement of lower urinary symptoms in arabic form

To evaluate an Arabic translation of a score index for measuring the severity of symptoms produced by benign prostatic hypertrophy [BPH]. A prospective study on 84 subjects. We first translated the symptom score index from its original English-American language; this questionnaire was then given to patients to be self-administered, as intended by the American Urological Association [AUA]. Assistance by a relative or guidance from the managing physician was allowed when required. The Arabic symptom score index was evaluated by [1] the ability of patients to understand the questions; [2] the ability of patients to complete the answers; [3] test/retesting the same patients' symptoms after a short period of time [1 week]; and [4] any change in the score following treatment Our results indicate the usefulness of the symptom score index in Arabic for assessing patients with symptoms produced by BPH. An objective method of measuring these symptoms is now available for Arabic-speaking patients. Conclusion: The assessment of symptoms by a score index system has become standard medical policy and the Arabic translation should be used in the management of BPH in all Arabic-speaking patients

Chronic diarrhoeal diseases in adults (a preliminary report).

The relationship of chronic diarrhoeal diseases in adults on socio-economic condition, parasitic infestation and degree of anaemia have been investigated. The disease was more prevalent in poor socio-economic group of people. Most of the patients had mixed parasitic infestations. Anaemia was present in all the cases. Difference in the degree of anaemia was not significant amongst the patients having either Ascaris or hookworm infestation.