Endoscopic findings in children on non-steroidal anti-inflammatory drugs [NSAIDs]

Non-steroidal anti-inflammatory drugs [NSAIDs] remain as the initial approach to the pharmacologic management in juvenile rheumatoid arthritis [JRA]. Gastrointestinal [GI] damage associated with NSAIDs is common in adults, but there are few studies available in children. This study was performed to determine the GI complications due to the use of NSAIDs in a cohort of JRA patients by endoscopy. Twenty-one patients with JRA who were using NSAIDs for at least 3 months were assessed clinically and by endoscopy at Pediatric Immunology Clinic of Nemazee Hospital affiliated to Shiraz University of Medical Sciences in Shiraz, southern Iran from June 1999 to June 2003. The mean age of the patients was 9.8 years [11 females], and the mean duration under NSAIDs management was 16 months. The most common NSAIDs used was diclofenac. GI symptoms were found in 42.9% of patients including 33.4% abdominal pain and 9.5% vomiting. There was no significant difference between the patients and symptoms free subjects in regard to mean duration of treatment. Macroscopic endoscopic lesions were found in 85.7% and infection of Helicobacter pylori [Hp] in 14.3% of cases. There was no significant relationship between endoscopic findings and duration of treatment or clinical symptoms. Our data showed that patients using NSAIDs had frequent GI damage without any relationship to the duration of treatment. There were also a high number of children with GI damage and without any clinical complaint. Furthermore, we found no significant relationship between the duration of drug use and the GI complaints, and no relation between duration and GI complaints to upper GI tract endoscopic lesions. The possibility of GI derangements with NSAIDs in pediatric age group is high. Close monitoring of symptoms and prevention measures are suggested

[Cow's milk allergy in infantile colic]

Introduction and Objective: cow's milk allergy has been considered as a cause of infantile colic. Many physicians change the diet of these infants to a cow's milk free diet. In this study, we evaluated the role of cow's milk allergy in infantile colic in breast fed infants

Materials and Methods: this single blind clinical trial was done in infants between three weeks and three months old with infantile colic who were referred to a subspecialty clinic in Shiraz-Iran from September 2003 to February 2004. Only exclusively breast fed infants were selected. For other infants who were formula fed, only a questionnaire was filled out, stool exam was performed and they were then excluded from the study. Skin prick tests with cow's milk and stool exams [for occult blood] were performed for these infants, and the correct technique of breast feeding was taught to their mothers. Then, the infants were divided to case and control groups randomly. In the case group, the mothers were advised not to consume cow's milk and other dairy products for two weeks. But in the control group, no change in the diet of the mothers was recommended. Furthermore, 50 healthy infants without symptoms of colic were included in the study as the second control group. Their mothers were asked about the type of feeding and stool exams were done for them. Finally, the data were analyzed using chi-square test

Results: from all 270 examined infants, colic was confirmed in 169 cases. Among them, 153 infants were breast fed exclusively. 114 cases in this group allowed the skin prick test to be done. The test was positive in only 3 infants [2.6%]. From these 114 infants, only 77 infants completed the study. 35 infants were in the case group and 42 infants were in the control group. Infants with colic whose mothers did not take dairy products, did not improve significantly in comparison with the control group. Prevalence of formula feeding was significantly higher in colicky infants in comparison with non-colicky infants [24% and 2% respectively]. Prevalence of occult blood in the stools of colicky infants was significantly higher in colicky infants than non-colicky infants [24% and zero respectively]

Conclusion: due to the unresponsiveness of infants to the elimination of cow's milk, it can be concluded that cow's milk allergy is not a common cause of infantile colic. Therefore, it is not advised to eliminate the dairy products from the diet of nursing mothers. Also, it is not necessary to perform skin prick tests as a routine test in these infants. The high prevalence of occult blood in the stools of infants suffering from colic is a new finding. Evaluation of its cause will be helpful in determining the etiology of infantile colic

Role of IgE low-affinity receptor [CD23] in pathogenesis of nasal polyp

Nasal polyps, a common clinical problem, are characterized by eosinophilic and mast cell inflammation. The role of allergy and IgE in pathogenesis of nasal polyps is still unclear. IgE receptors are important components of the immunological pathway in allergic and inflammatory diseases. To determine if the low affinity IgE receptor [CD23] is presented on nasal polyp tissues as a marker of local allergy or inflammation. Twenty patients who had undergone polypectomy enrolled into the study. Polyp tissues were stained by hematoxylineosin and acid-fast methods for histopathologic study. Immunohistochemical staining was performed with monoclonal antibody to leukocyte surface CD23. Polyp tissue fluid was extracted by slicing and centrifuging. Total serum IgE and tissue fluid was measured by ELISA. Thirteen of 20 polyp tissues were positive for CD23. Moderate to large number of eosinophils were observed in 5 patients. Serum IgE level was elevated [>70 IU /ml] in 13 patients and polyp IgE level was elevated in 8 patients. No significant correlation was found between CD23, serum and polyp tissue IgE, and eosinophil infiltration. CD23 may act as non-IgE dependent inflammatory marker in the pathogenesis of nasal polyps

[ study of the effect of drugs used in the treatment of rheumatoid arthritis on nitric oxide production of peritoneal macrophages in Balb/C mice]

Background: Rheumatoid arthritis [RA] is a chronic progressive inflammatory disorder characterized by polyarthritis in association with various systemic symptoms. Nitric oxide [NO] production is increased in serum and synovial fluid of rheumatoid arthritis patients and may be involved in the inflammatory process. The aim of the present study was to assess the effect of various drugs used in the treatment of RA on NO production and if this effect varies with respect to the drugs that were tested

Materials and Methods: Different doses [1-1000 microM] of methotrexate, sulfasalazine, chloroquine and azathioprine were administered to measure IFN-gamma and reaction

Results: Azathioprine, chloroquine and sulfasalazine inhibited NO production in a dose-dependent manner. Azathioprine. reduced NO production at all drug concentrations [p<0.05]. Chloroquine and sulfasalazine reduced NO production when given at 10-1000 microM Correspondence: LPS-induced NO production in peritoneal macrophages of Balb/C mice. NO production was measured by Griess concentrations [p<0.05], but methotrexate reduced NO production [p<0.05] only when given at a high [1000 microM] concentration

Conclusion: The results suggest that, NO inhibition by these drugs can be regarded as a mechanism of action of these medications in the treatment of RA

Hypercalciuria, hyperphosphaturia and growth retardation in children with diabetes mellitus

Previous studies have demonstrated that patients with insulin-dependent diabetes mellitus [IDDM] have a high prevalence of osteopenia. Hypercalciuria has also been well documented in human diabetes and many children with insulin- dependent diabetes mellitus have short stature. To investigate the relationship of hypercalciuria and hyperphosphaturia with growth retardation in patients with IDDM. Forty patients with IDDM aged between 6 and 12 years whose mean heights were less than their 32 non-diabetic siblings of similar age group were enrolled in this study. Urinary and plasma calcium, phosphorus and creatinine levels were measured in both groups. Meanwhile, the height and body weight were determined. Both, the mean height and weight percentiles of subjects with IDDM were significantly less than those of nondiabetic siblings [p<0.001]. The height percentile of children with IDDM had negative correlation [r=-0.75, p<0.001] with the disease duration. The mean urinary calcium to creatinine [Ca/Cr] and phosphorus to creatinine [P/Cr] ratios were significantly higher in IDDM patients compared to their normal siblings [p<0.001]. The growth in the group of diabetic children correlated inversely and significantly [p<0.001] with hypercalciuria and hyperphosphaturia, duration of diabetes and HbA1C level. It is concluded that hypercalciuria and hyperphosphaturia may play a role in growth retardation of diabetic children