Effect of micronutrients supplementation, vitamin A, zinc, folic acid and selenium in management of infants with persistent diarrhea

Persistent diarrhea is still one of the most important pediatric health problems all over the world. Aim of this work was to study the effect of micronutrient supplementation [Zinc, vitamin A, folio acid and selenium] in management of infants with persistent diarrhea. The present study included seventy-five infants suffering from persistent diarrhea. Cases were distributed randomly into five groups. Studied groups were given zinc [first group], vitamin A [Second group], folio acid [Third group], selenium [fourth group] and the fifth group was supplied with mixture of all above micronutrients Fifteen healthy infants of matched age and sex were served as normal controls. History taking, clinical examination and the following laboratory investigations were done; stool examination, stool bacterial culture, D-xylose test, serum albumin, transferrin, prealbumin, sodium and potassium and complete blood count. Cases with persistent diarrhea were followed up for 3 weeks where the laboratory investigations were done at the end of this period. Only 22.67%of studied cases were exclusively breast-fed. Recovery time was significantly shorter and weight gain was significantly higher in zinc, vit. A and micronutrients mixture groups than folic acid and selenium groups [P<0. 05]. Significant increase in hemoglobin, RBCs and serum albumin in zinc, vit A and micronutrients mixture group as compared to before treatment [P<0, 05]. Significant increase in blood D-xylose, serum prealbumin and serum transferrin in all studied groups as compared to before treatment [P<0. 05]. From the present study it could be concluded that zinc and/or vitamin A with dietetic intervention are effective in management of persistent diarrhea. While folic acid and selenium has no apparent beneficial effect in management of persistent diarrhea

Physical and psychological study of different presentations of rheumatic fever and pediatric autoimmune neuropsychiatric disorders after streptococcal infection

A recent line of research has suggested that autoimmune-mediated central nervous system manifestations of Group A-beta hemolytic streptococcal [GABHS] infection may not be restricted to Sydenham chorea [SC] but may include a range of neurobehavioral disturbances that has been termed pediatric autoimmune neuropsychiatric disorder after streptococcal infection [PANDAS]. To clarify the clinical link between rheumatic fever and its variant rheumatic chorea and PANDAS. This study was done on 86 children. Their ages ranged from 5 to 15 years. They were among the patients admitted to the Pediatric Department, Tanta University Hospital. They were classified into 5 groups: [A] Six patients with PANDAS, [B] Twenty rheumatic chorea patients, [C] Twenty children with non-choreic rheumatic fever, [D] Twenty patients with recent GABHS infection, and [E] Twenty healthy children as controls. They were subjected to history taking, clinical examination and psychiatric and psychometric assessment. Serum samples were taken for the following laboratory investigations: CBC, ESR, ASOT and CRP. The children were also subjected to ECG and X-ray chest and heart in addition to colored echo-Doppler examination. A significant increase in psychiatric manifestations was found in rheumatic chorea. Great similarities between PANDAS and rheumatic chorea patients were found as regard physical, psychiatric and laboratory findings. Both PANDAS and SC had no significant differences as regards prevalence or the type of psychiatric manifestations. Psychiatric manifestations should be looked for in rheumatic patients. Assessment of psychiatric patients for possible early presentation of rheumatic fever should be done. PANDAS should be studied in further researches to detect epidemiology and relation to rheumatic fever and SC

Urinary leukotriene E[4] in asthmatic children with and without nocturnal exacerbations

Nocturnal exacerbations of bronchial asthma are very common and disturbing signs with serious consequences on patient's quality of life. The exact mechanism of these exacerbations is not known but inflammatory mediators may play an important role. To study the role of leukotriene E[4] [LTE[4]] in the pathogenesis of nocturnal exacerbations of bronchial asthma. The study was conducted on 50 asthmatic children who used to attend the outpatient clinics of the Pediatric and Chest Departments of Tanta University Hospital. Their ages ranged 8-14 years. The study was carried out over 10 months from October 1, 2000 to July 31, 2001. They were classified into two groups. Group A included 25 asthmatic children without nocturnal symptoms, and group B comprised 25 children who used to have nocturnal asthma exacerbations. Twenty non-asthmatic children of comparable ages were included in the study as controls. All of the children were subjected to full history taking, clinical examination, pulmonary function tests [PFTs], methacholine bronchial challenge test, and measurement of LTE[4] in urine. Values of morning drop of peak expiratory flow [PEFR] in children with nocturnal symptoms [Group B] was significantly higher than those in the asthmatic children without nocturnal exacerbations [Group A] [P<0.05]. The PC[20] FEV[1] was significantly lower in group B than in group A [P<0.05]. Urinary LTE4 levels were found to be significantly higher in group B than in group A [P<0.05]. In asthmatic children with nocturnal exacerbations [group B], urinary LTE[4] levels were found significantly higher at night more than at day hours [P<0.05]. Also, in this same group B, there were significant positive correlations between urinary LTE[4] levels and morning drop in PEFR values and significant negative correlation between urinary LTE[4] levels and PC[20] FEV[1] [P<0.05]. There was no significant difference in urinary LTE[4] levels between atopic and non-atopic asthmatic children. Measurement of urinary LTE[4] levels may represent a non-invasive method for assessment of airway inflammation and for predicting the outcome of nocturnal exacerbations that disturb the life of asthmatic children

Tracheobronchial aspirate proinflammatory cytokines: early predictors of chronic lung disease in neonates with respiratory distress syndrome

The objectives of the present study were to investigate if early measurements of proinflammatory cytokines in tracheobronchial aspirate fluid from neonates with respiratory distress syndrome [RDS] could be used to early predict chronic lung disease [CLD]. This is in comparison with other risk factors including gestational age, birth weight, prenatal steroid, mode of delivery, duration of exposure to FiO[2] >0.21, peak inspiratory pressure [PIP] and duration of ventilatory support, air leaks, patent ductus arteriosus [PDA], and intraventricular hemorrhage [IVH]. Thirty-six preterm infants less than 34 weeks of gestation with RDS were mechanically ventilated and days 2 and 7 - measurements of concentrations of tumor necrosis factor-alpha [TNF-alpha] and the interleukins IL-1beta, IL-6, and IL-8 were made, using enzyme immunoassay techniques. Echo-Doppler and head ultrasonography studies were done for each patient. Each patient was followed-up for 28 days. Ten patients developed CLD, six patients died before the elapse of 28 days, and 20 patients experienced uncomplicated course of RDS. Infants who developed CLD had significantly increased concentrations of TNF-alpha, IL-1beta, IL-8, and IL-6 on days 2 that persist by day 7. TNF-alpha, IL-6, IL-8, and IL-1beta concentrations correlated significantly with lower gestational age, birth weight, time spent on a ventilator, duration of supplemental oxygen, maximal PIP, symptomatic PDA, and appearance of air leak. IL-6 cut-off point level of 650 pg/ml at day 2 predicts CLD with accuracy of 100%, and IL-1beta cut-off point level of 165 pg/ml at day 2 predicts CLD with accuracy of 100%. In conclusion, increased concentrations of tracheobronchial aspirate fluid proinflammatory cytokines could be the most valuable early predictor of CLD and will assist in selecting infants for early interventions including corticosteroid treatment or more selective blockage of components of inflammation

Lead exposure and neurobehavioral development in school children

The vulnerability of young children to lead toxicity has been increasingly recognized in recent years. Central nervous system is one of the most sensitive systems to lead. This study aimed to determine some risk factors associated with lead exposure and to detect the effect of lead exposure on children neurobehavioral development. One hundred school children were studied. They were interviewed and were subjected to estimation of blood and hair lead levels, assessment of intelligence and scholastic achievement, assessment of adjustment and neurological screening. Urban residence, dwelling in old houses and passive smoking were recognized as significant risk factors for lead exposure [p<0.05]. No significant difference between subjects age and their blood and hair lead levels [p>0.05]. A significant negative correlation was recorded between subjects intelligence and scholastic achievement and their blood and hair lead levels [p<0.05]. No significant difference between children with blood or hair levels above or below cutoff points as regards neurological screening [p>0.05]. Maladjusted children were significantly higher among children with elevated blood lead above cutoff point, but no significant difference as regards elevated hair lead [p>0.05]. Urban residence, dwelling in old houses and passive smoking were recorded as significant risk factors for lead exposure. Lead exposure was associated with neurobehavioral deterioration. Lead exposure can be assessed by measuring lead in blood and hair but blood screening method is more sensitive than hair one