Seroepidemiological study on helicobacter pylori infection in children and adults in Assiut Governorate, Upper Egypt

Helicobacter pylori is considered as one of the most common chronic bacterial zoonotic infections worldwide. H. pylori infection constitutes a public health hazard problem with a fatal sequele. This study was designed to estimate the prevalence of H. pylori among children and adults in Assiut Governorate in Upper Egypt and to evaluate the risk factors affecting the increase of infection. A total of 200 peripheral blood samples constituting 50 samples from children and 150 samples from adults were collected from hospital patients. A full detailed anamnestic and clinical assessment in the form of questionnaire was designed for each patient to determine the risk factors with specific emphasis to age, sex and residence. Seroprevalence of H. pylori IgG antibodies was evaluated by using enzyme linked immunosorbent assay. We estimated a seroprevalence rate of 75.5%. H. pylori exposure was higher in adults [79.33%] than in children [64%] and it was statistically significant. The seroprevalence of infection was higher in rural areas [87.3%] than in urban areas [40%]. H.pylori infection was prevalent among humans in the areas studied. Public health hazard of H. pylori infection and preventive measures to control the infection were discussed

Coagulation defects and platelets function in splenectomized and non-splenectomized beta-thalassemic children

The aim of this work is to evaluate the coagulation defects and platelet function in beta-thalassemic children before and after splenectomy. Also to evaluate the effect of L-carnitine therapy on the coagulation events and platelet function in these patients. The study included 56 beta-thalassemic children who were admitted at the Hematology Unit in the Pediatric University Hospital - Assiut with 20 sex and age matched children as controls. They were subjected to clinical examination and laboratory investigations in the form of: screening tests for coagulation: PT, APTT TT, PC and fibrinogen, natural anticoagulants studies like protein S, protein C and antithrombin III activity and platelet response to adinosindiphosphate [ADP], ristocetin [Rist], collagen and arachidonic acid [AA]. Nineteen children did splenectomy and these studies were done after 2 months of this manover. L-Carnitine therapy in a dose of 3 gm orally daily for 2 months was given to 20 non-splenectomized beta-thalassernic children and the previous follow up laboratorial studies were done. It was found that platelet response to ADP, Rist, collagen and AA was significantly decreased in non-splenoctomized patients and significantly increased in the splenectomized ones in comparison to controls. The coagulation screen tests showed significant defect in the form of prolonged PT, APTT, TT and low PC with decrease fibrinogen levels in both splenectomized and nonsplenecloinized beta-thalassemic children in comparison to controls with no significant difference between before and after splenectomy. Natural anticoagulants except protein S were significantly lower in both non-splenectomized and splenectomized beta-thalassemic children than those of the controls with no difference between before and after splenectomy. L-Carnitine therapy improved the platelet aggregation in the non splenectomized beta-thalasseinic children with no affection on the coagulation tests and natural anticoagulants. In conclusion, thalassemia major can be complicated by defective platelet aggregation and bleeding tendency. Splenectomy causes increased platelet aggregation which with the decreased levels of natural anticoagulants lead to the liability to thromboembolic complications. L-Carnitine might affect and improve platelet aggregation in non-splenectomized children but it could aggravate the thromboembolic complications in the non-splenectomized ones. Iron overload prevention with iron celation and antioxidants is recommended to prevent platelet aggregation and coagulation defects. Salicylates therapy to cases with thromboembolic complications might decrease thrombus formation and dangerous events

Gene polymorphism of factor V and variceal bleeding in infants and children

The aim of this work is to evaluate the presence of factor V Leiden mutation and the activity of the natural anticoagulants in variceal bleeding in infants and children. This study included 50 infants and children with variceal bleeding who were admitted at the Gastroenterologoy, Hepatology and Malnutrition Unit, Pediatric University Hospital, Assiut University. The search was done in the period from January 2004 till July 2006. The age was between 5 months up to 14 years with mean age of 8.7 +/- 3.9 years. Twenty children of matchable age and sex were enrolled as controls. After the consent of the parents of patients and controls complete clinical examination with the following investigations for the cases and controls were done: 1. Liver function tests [total bilirubin, direct bilirubin, Alanine transaminase [ALT], Aspartate transaminase [AST], Alkaline phosphatase [ALP]] and hepatitis markers. 2. Prothrombin time [PT]. 3. Activated partial thromboplastine time [APTT]. 4. Thrombin time [TT]. 5. Prothrombin concentration [PC]. 6. Fibrinogen. 7. Natural anticoagulants; Protein S, Protein C, Antithrombin III [A TIII]. For cases the following investigations were done: 1. Evaluation of factor V Leiden mutation. 2. Abdominal ultrasound and Doppler. 3. Ultrasound guided needle biopsy to the liver and pathological examination. 4. Upper endoscopy with sclerotherapy or band ligation if needed. Follow up endoscopy after 2 months was done for each case. Out of the 50 patients 14 patients [28%] were diagnosed to have extrahepatic portal hypertension [EHPH] due to portal vein thrombosis [PVT]. 5 of them gave a history of admission in the neonatal intensive care unit and 7 suffered liver cirrhosis. The rest of cases 36[72%] were diagnosed as having intrahepatic portal hypertension [IHPH] 8/50 [16%] cryptogenic cirrhosis, 5/50 [10%] congenital hepatic fibrosis, 10/50 [20%] chronic HBV infection, 5/50 [10%] chronic HCV infection, 3/50 [6%] autoimmune hepatitis, 2/50 [4%] Wilson disease, 1/50 [2%] biliary cirrhosis and 2/50 [4%] neonatal hepatitis. Oesophageal varices was detected in 40 [80%], both oesophageal and gastric varices in 6 [12%] and isolated gastric in 4 [8%] of the cases. In cases with IHPH serum bilirubin and indirect bilirubin as well as liver transaminases and ALP were significantly higher than those of the EHPH and controls. No significant difference was found between EHPH and the controls. Natural anticoagulants were significantly decreased in cases with IHPH in comparison to EHPH and controls. Cases with EHPH show low levels of the natural anticoagulants in 4 while normal values were found in the remaining 10 patients. Leiden mutation was positive in 6 cases of portal vein thrombosis [42%] 4 of them suffered liver cirrhosis and in 3 cases with chronic HCV and in 2 cases with chronic HBV. One of the causes of portal hypertension in infants and children is portal vein thrombosis. PVT may be due to local precipitating factors as umbilical catheterization, umbilical sepsis or neonatal sepsis or due to an inherited factor like inherited thrombophilic mutation as FVL mutation that causes activated protein C resistance. Other inherited factors like inherited deficiency of Protein S, Protein C and ATIII may be the cause of PVT. Band ligation of the oesophageal varices may be beneficial in the treatment especially in cases due to PVT. Sclerotherapy may represent a trigger factor for PVT in cirrhotic patients with genetic thrombophilia. Screening for FVL mutation could be helpful in cases of hepatic cirrhosis to prevent PVT and also is diagnostic for most of the unexplained cases. The use of anticoagulant therapy maybe useful in the recently discovered cases of PVT and so decrease the risk to develop varices and their complications

Delayed gastric emptying in children with type I diabetes mellitus

Diabetes mellitus is considered a cause of gastroparesis in 30-50% of children and it Is presented with various gastrointestinal symptoms. Erythromycin has a variable effect in treating gastroparesis and the increase in blood sugar can affect its effect. The aim of the work is to assess gastroparesis in diabetic children and to evaluate its relation to gastrointestinal symptoms and also to study the role of erythromycin in the treatment of gastroparesis. The study included 67 children suffered type I diabetes mellitus of moro than 5 years duration. Their ages ranged from 7-11 years. Ten children of matchable age and sex were taken as controls. Clinical history and examination were done with the measurement of glycosylated hemoglobin% and gastric emptying time by scintigraphy. Glycosylated hemoglobin% [HbA1c%] was significantly high in the diabetic patients in comparison to that of the controls [8.02 +/- 1.77 and 4.92 +/- 1.64 respectively]. Out of the 67 patients 31[46.26%] showed delayed gastric emptying time and 18 of them were with gastrointestinal symptoms. HbA1c% was significantly high in those patients with delayed gastric emptying time in comparison to those with normal gastric emptying time [8.48 +/- 1.92 and 7.06 +/- 0.81 respectively]. Also it is higher in those with symptoms than those without symptoms [9.64 +/- 1.75 and 6.89 +/- 0.39 respectively]. As regards the other possible complications that are found in diabetes, patients with neurological type showed significant higher HbA1c%and more delayed gastric emptying time than those without neurological complications [8.31 +/- 2.13 and 6.92 +/- 1.39 and 236.21 +/- 79.12 and 102.1 +/- 43.21 respectively]. By giving erythromycin to the symptomatized patients in a dose of 250, mg 3 times daily for 3 months, 8 out of 18 showed improvement. A positive correlation was found between HbA1c% and GET. In conclusion, gastroparesis could be found in diabetic patients even without symptoms. The presence of other complications especially the neurological type and the uncontrolled blood sugar augment gastroparesis. Therefore, the variable response to erythromycin in gastroparesis is multifactorial

A study of some viral pathogens in infants and children with lowe respiratory tract infection and attending the intensive care unit

Acute lower respiratory tract infections are the most common illness in pediatrics. A great variety of viruses especially RSV can cause bronchopneumonia and bronchiolitis in infants and children. This work aimed to evaluate some viral pathogens in pneumonia and bronchiolitis in infants and children admitted to the ICU. This study included 142 patients, 70 suffered bronchopneumonia and 72 suffered bronchiolitis admitted to the ICU in Assiut Pediatric University Hospital, Egypt. The study was done from November 2002 to February 2003 and from the period of November 2003 to February 2004. Clinical evaluation, chest x-ray, complete blood count and arterial blood gases as well as endotracheal suction for collection of the samples for viral study and bacterial cultures were done. Regarding viral tissue culture 66 patients were positive to the studied viruses [26 with bronchopneumonia and 40 with bronchiolitis] with male predominance [43 males with 65.1%]. Out of the 66, 48 were below age of 12 months, 12 were below age of 24 months and 6 were below 36 months. Respiratory Synsytial virus [RSV] was found in 32 cases [484%], influenza A was in 12 [18.1%], Parainfluenza 3 in 18[27.2%], Parainfluenza I in 4 [6%] and adenovirus in 4 [6%]. It was noticed that there were positive bacterial cultures in 27 cases and also mixed viral types. Malnutrition especially the severe type was concomitant with viral infection specially RSV, As regards the blood gases and respiratory rate it was found that cases with bronchiolitis showed significant differences than those of bronchopneumonia where bronchiolitis was more severe than bronchopneumonia. There were 76 cases negative to the studied viruses 44 were bronchopneumonia and 32 were bronchiolitis. Bacterial cultures were positive in 25 patients. Analysis of the blood count showed leucocytosis in the cases as a whole with significant higher levels in the cases with positive bacterial cultures than those with viral infection only. Lymphocytes were significantly higher in the cases with positive viral cultures than those negative to these cultures and eosinophils were significantly higher in the cases negative to the studied viruses and also showed negative bacterial cultures that the cause could be due to allergic conditions. As regards the outcome of the cases that were positive to the studied viruses 29 died [43.9%], 20 of them were due to RSV infection. It is concluded that RSV is the commonest cause of viral lower respiratory tract infection in infants and children. Mixed viral and bacterial infection is not uncommon which is strongly concomitant with the immunocompromised patients' especially malnourished cases. So the use of immunostimulants in addition to antimicrobial and antiviral drugs may be beneficial in such cases

Influence of zinc supplementation on thyroid function and intelligence in children with down syndrome

This study was conducted to evaluate some factors that may affect the cognitive abilities of children with Down syndrome [DS] including hypothyroidism; zinc and selenium deficiency; and the oxidative five stress and additionally, to study the effect of zinc supplementation on the mental state of such cases. Sixty Down syndrome patients were enrolled together with 20 apparently healthy controls with matched age and sex. Estimation of the IQ scores, evaluation of the thyroid function tests, measurement of the serum levels of zinc and selenium, as well as plasma levels of superoxide dismutase activity [SOD] and hydrogen peroxide [H[2][O]2] were done to all cases and controls, Cases with severe mental retardation [IQ 25-39] were received oral zinc sulfate supplementation. A follow up study was done to reevaluate all the above-mentioned studied parameters after 3, and 6 months. Results showed that, in comparison with the controls, DS patients had significantly lower serum levels of both zinc and selenium and significantly higher serum level of TSH, as well as plasma levels of both SOD and H[2]O[2]. There were significant positive correlations between the IQ scores and each of T3, T[4], zinc and selenium serum levels, while significant negative correlations were found between the IQ scores and serum level of TSH, as well as plasma levels of both SOD and H[2]O[2]. The follow up study showed significant rise of serum zinc level after 3 months of zinc supplementation. Progressive improvement of the IQ scores and thyroid function tests were noticed. This improvement was significant after 6 months of zinc supplementation. In conclusion, cognitive abilities in DS patients may be affected by multiple factors as hypothyroidism, oxidative stress as well as zinc and selenium deficiency. Zinc supplementation for 6 mo may help these abilities to be improved