Ranitidine versus omeprazole as a prophylaxis of upper gastro intestinal tract bleeding in ventilated and in critically III non-ventilated children

Stress-related mucosal disease [SRMD] refers to superficial erosions or ulceration of the proximal gastrointestinal mucosa in acuto illness. The contributory rolo of stross induced high gastric activity was documontod and sovoral medications were triod to provont SHMD in high risk pationls in PICU The aim of this work was to compare the efficacy of ranitidine versus omeprazole for prophylaxis of UGITB in mechanicaily ventilated and in critically ill non-ventilated pediatric patients admitted to PICU. Design: 9-months prospective controlled study. Setting: Pediatric ICU, Pediatric Department, Tanta University Hospital Patients and Methods: 60 critically ill children were included [30 males and 30 females]. Every patient was subjected to SOFA scoring. Gastric juice aspirate samples were examined for occult blood by chromatographic immunoassay and aspirate pH by pH meter. In 40 patients either IV ranitidine or omeprazole was started by 3[rd] day of admission and continued for 4 days. No UGITB prophylactic therapy was given to 20 patients [controls]. In patients receiving IV ranitidine, IV omeprazole and controls the prevalence of UGITB by day 6 in unventilated cases was 40%, 10% and 70% and In in ventilated cases was 50%, 20%, and 70% respectively. In patients receiving IV ranitidine successful control of average gastric pH to >/= 4 occurred in 70% of cases by day 3, and in 40%, 30% and 20% by days 4, 5 and 6 respectively. In patients receiving IV omeprazole the relative values were 90% by day 3 and 100% later on. Conclusions: IV omeprazole and IV ranitidine prophylactic therapy decreased the incidence of SRMD and increased the gastric pH to >/= 4.0 which was more obvious and sustained in those receiving omeprazole. IV omeprazole is preferred for SUP in PICU patients

Sucralfate versus omeprazole as a prophylaxis of upper gastro intestinal tract bleeding in ventilated and in critically III non-ventilated children

Upper gastrointestinal bleeding [UGITB] complications in the form of mucosal congestion, ulceration and bleeding related to stress-related mucosal disease [SRMD] will lengthen hospitalization and increase mortality intensive care unit [ICU]. Several medications were tried to prevent SRMD. to compare the efficacy of oral Sucralfate [OS] versus IV omeprazole [IVO] for prophylaxis of UGITB in mechanically ventilated and in critically ill non-ventilated patients. 10-months observational controlled study. Setting: Pediatric ICU, Pediatric Department, Tanta University Hospital Patients and Methods: 60 pediatric patients were included 30 males and 30 females. In every patient; SOFA scoring, Gastric juice aspirate samples were examined for occult blood and aspirate pH bypH meter. In 40 patients either OS or IVO was started by 3 day of admission and continued for 4 days. No UGITB prophylactic therapy was given to 20 patients [controls]. In patients receiving OS: There was insignificant decrease in gastric bleeding [GB] and increase in gastric pH in comparison to controls; and in patients after OS than before. In patients receiving IVO the unventilated patients showed significant decrease in GB cases and increase in gastric pH in comparison to controls; and in patients after IVO than before. The ventilated patients showed insignificant decrease in GB cases in comparison to controls; and in patients after IVO than before. Also, there was significant increase in pH in unventilated and ventilated IVO group in comparison to controls, and in after IVO than before. Conclusions: OS may not be the appropriate choice for SUP due to its limited effects on UGITB and gastric pH. Meanwhile, IVO reduce UGITB in a higher proportion of patients and increase gastric pH to higher levels. So, it may be the SUP drug of choice in high-risk patients

Risk of epilepsy after electrographically proven neonatal seizures

Neonatal seizures often are manifestations of significant neurological disease and major predictors of adverse neurological outcome in the newborn. The present work aimed at estimation of outcomes of neonatal seizures especially the development of epilepsy. The present study was conducted on 30 patients [15 males and 15 females] with neonatal seizures, their ages ranged from one to 30 days. All patients were subjected to full history taking and through clinical examination. Laboratory investigations included: complete blood picture, metabolic screening tests [blood glucose, serum Ca, Mg and Na, blood urea, serum creatinine, serum bilirubin and ferric chloride test], sepsis screen [blood, CSF and urine culture, and TORCH titers], brain C. T. scan and EEG [interictal and follow up]. The etiologic diagnosis of neonatal seizures was based on positive clinical data, laboratory data and/or imaging data. Follow up for at least 6 months was performed with serial neurological evaluation and EEG. From this study, it was found that the seizures etiologies were diverse, hypoxic ischemic encephalopathy [HIE] was the most common cause 46.7%, meningitis 16.7%, cerebral dysgenesis 10%. Metabolic causes 13.3% and intracranial hemorrhage 13.3%. Etiology of seizures was significantly correlated with total outcome, subsequent development of epilepsy and developmental delay. There was significant correlation between findings of neurological examination and total outcome, epilepsy and developmental delay. Neonates with mildly abnormal neurological findings had favorable outcome in 100% of cases. Patients with severely abnormal neurological findings were associated with unfavorable outcome [mortality, epilepsy or developmental delay] in 81.8% of cases. Type of seizures was significantly correlated with the total outcome and mortality. Generalized tonic seizures had the worst prognosis. There was significant correlation between brain CT findings and total outcome, subsequent development of epilepsy and developmental delay. EEG findings were significantly correlated with the outcomes findings of neurological examination and frequency of seizures but insignificantly correlated with type of seizures, onset of seizures and brain CT findings. The 3-months follow up EEG was significantly correlated with the development of epilepsy. Seizure etiology, neurological evaluation of the newborn at birth [mildly, moderately and severely abnormal], clinical characteristics of seizures [onset, frequency and types], brain CT. and EEG findings [interdicted EEG background activity], 3-months follow-up EEG and meticulous follow-up clinical examination were the most important determinants for prediction of the neurological outcome of neonatal seizures. Epilepsy and developmental delay after neonatal seizures were more frequent in presence of one or more of the following: severely abnormal neurological examination at birth, cerebral dyesgenesis as an etiology of seizures, generalized tonic seizures, seizure frequency >/= 2 seizures/h, abnormal brain CT scan findings and abnormal inter-ictal EEG background. EEG is recommended to be performed for all cases with neonatal convulsions as a diagnostic and prognostic tool. Meticulous follow up [clinical examination, EEG] of cases with neonatal seizures is essential to predict the subsequent development of epilepsy and developmental delay

Airway major mucins in asthmatic children

Mucus is a protective coating secreted in the healthy airway. Structurally, mucins are complex glycoconjugates: their protein backbones are products of mucin [MUC] genes. Twenty mucin genes have been reported. MUC5AC and MUC5B are major gel-forming mucins in normal or pathologic airway secretions. Sputum production is a common symptom in asthma, especially during asthma exacerbations contributing to: airway hyperresponsiveness, airways obstruction, decreasing FEV[1] and fatal attacks of asthma. The aim of this study was to evaluate the expression and distribution of MUC5AC and MUC5B in the sputum and bronchial biopsies of mild and moderate asthmatic children. 2 9/12 years prospective study. Chest unit, Pediatric Department, ENT Department, Tanta University Hospital. 25 asthmatic children during and after acute attack, admitted and treated in chest unit;16 males and 9 females, aged 6-13 years [mean 9.4 +/- 3.6 yr.] On admission, the severity of the asthmatic paroxysm was mild persistent asthma [MiPA] in 14 patients and moderate Persistent asthma [MoPA] in 11. All were treated in chest ward. The study involved [1] sputum induction with RNAs extraction and direct Quantification of MUC5AC and MUC5B mucins of the sputum. [2] Bronchoscopy with mucosal biopsies from each subject for RNA extraction and immunohistochemical analysis. Semiquantitative reverse-transcription polymerase chain reaction [RT-PCR] was performed for MUC5AC and MUC5B to investigate their expression. On RT-PCR examination of the sputum sample, MUC5AC was significantly detected in 80%, 92% and MUC5B in 52%, 68% in MiPA and MoPA respectively compared with controls. MUC5AC and MUC5B mRNAs were amplified weekly in endobronchial mucosa of the controls, whereas they showed two- and threefold mRNA upregulation, in MiPA and MoPA respectively. In sputum samples there were significantly more mucins in MiPA and MoPA than in controls. In addition, there were significantly more mucins in MoPA than in MiPA. Also there was significantly more MUC5AC than MUC5B in each group. MUC5AC immunoreactivity in asthmatics was abundant in goblet cells with no staining of submucosal glandular cells. While immunoreactivity for MUC5B in asthmatics showed abundant signaling in submucosal glandular cells and moderately positive staining in epithelial goblet cells. Goblet cell number was significantly increased in MiPA and MoPA in comparison with controls with no difference between MiPA and MoPA. This study was designed to characterize mucin gene expression in tracheobronchial mucosa and sputum in asthmatic children. The present results suggest that upregulation of MUC5AC and MUC5B with the associated goblet cell hyperplasia [GCH] may play important role in the pathophysiology of asthma. We found that even mild asthma was associated with GCH and increased stored mucin in the airway epithelium. Moderate asthma has even more increased levels. Further elucidation of the regulation of specific airway mucin genes by relevant mediators and identification of the mechanisms that result in GCH is needed

Chromosomal aberrations in childhood acute lymphoblastic leukemia: diagnostic and prognostic implications

Cytogenetic analysis in ALL is often hampered by poor chromosome morphology, few malignant metaphases, undetectable chromosomal rearrangements due to regions of a similar size and banding pattern and sometimes only normal metaphases derived from normal cells are found after cell culture. Structural as well as numerical aberrations may therefore remain undetected using conventional G-banding. The application of modem molecular cytogenetic techniques including a broad set of fluorescence in situ hybridization [FISH] has greatly improved the detection rate of genetic changes in ALL. The present study was designed to estimate the incidences of different genetic subgroups in childhood ALL with abnormalities involving BCR/ABL, MLL, TEL/AML1 rearrangements, and p16 deletions using FISH technique and conventional cytogenetic analysis. We tried to demonstrate the usefulness of FISH technique. This study was conducted on BM and/or BP from 48 patients with childhood ALL. Their age range from 2-13 years mean age was 6.7 years. Patients were followed-up for 18 months [range 14-28 months]. Morphological, cytochemical, immunophenotyping, cytogenetic and FISH analysis were performed for every patient. FISH was performed with probes for BCR/ABL, MLL, TEL/AML1 rearrangements, and p16 deletions for each case of childhood ALL. Numerical and/or structural aberrations were identified in 52.1% of all cases by conventional G-banding alone. Numerical and/or structural aberrations were identified in 75% of all cases by the combination of conventional G-banding and interphase FISH. Gene rearrangements were disclosed by FISH in 11 [47.8%] of 23 patients who showed a normal banded karyotype or no mitotic cell in G-banding. The most common gene rearrangement was p16 deletion [21.27%] and the incidences of others were 15.9% for TEL/AML1, 12.1% for MLL, and 5% for BCR/ABL rearrangement. p16 homozygous deletions were observed in six cases [12.7%] and hemizygous deletions in four cases [8.5%]. One case had both in two different cell populations. p16 deletions were significantly more common among T-lineage ALL [T-ALL] patients than among precursor-B ALL patients. TEL/AML1 translocations were found in seven [7/44] [15.9%]. Three out of the seven cases show culture failure and none of the remaining cases showed t[12;21] in G-banding analysis. All those seven patients were pre-B cell lineage according to standard immunophenotyping. One patient showed the loss of one AML1 signal in addition to the TEL/AML1 fusion. MLL rearrangements [11q23 abnormalities] was detected in 5/41 [12.1%] by combined conventional cytogenetic analysis and by FISH. Two different types of MLL gene rearrangements were observed in FISH analysis; translation and deletion. One had split signal of the MLL gene caused by a translation between chromosome 6 and 11 t[6;11], detected by conventional cytogenetics. Amplification of MLL gene was observed in one case [2.27%]. Four of five cases with MLL translocations showed no chromosome abnormality involving 11q23 in G-banding analysis. All cases with MLL gene rearrangement were pre-B cell lineage according to standard immunophenotyping. BCR/ABL rearrangement: t[9;22][q34;q11] was detected by conventional cytogenetic and by FISH in one case. Another one displayed BCR/ABL1 fusion signal by FISH only. FISH can overcome some limitations of conventional cytogenetic and molecular-genetic analyses and due to high sensitivity specific chromosomal aberrations in mitoses and/or interphase nuclei can be detected. FISH analysis using DNA probes specific for p16 deletion, TEL/AML1, MLL, and BCR/ABL gene rearrangements is a powerful tool for leukemia diagnosis and risk stratification and it should be used as a routine procedure for all patients with newly diagnosed ALL as well as for monitoring of treatment effect in children with ALL

role of helicobacter pylori in recurrent aphthous stomatitis in children

Helicobacter pylori [HP] organisms are spiral, microaerophilic, gram-negative bacteria affecting 70-90% of the population in developing countries. Infection is acquired before the age of 10 years. HP causes the majority of gastric and duodenal ulcers. Transmission may be by; ingestion, fecal-oral and oral-oral routes. In recurrent aphthous stomatitis [RAS], various microorganisms have been suspected but, the histological similarities between RAS and peptic ulcers, and the response of RAS to the broad-spectrum antibiotics suggested that HP may has a probable role in RAS development. To determine the presence of Helicobacter pylori and, if detected, its potential prevalence in causing recurrent aphthous ulcers confined to mucosa-associated lymphoid tissues [MALT] of the pharynx. 17-months prospective, controlled study. Pediatric Department, Tanta University Hospitals, Tanta, Egypt. A total of 80 patients with recurrent multiple aphthous ulcers of the oral cavity and pharynx were assigned to group 1 [n=32] [6-12 years; mean age, 8 +/- 2 years; 14 male and 18 female], in whom the ulcers were strictly limited to the mucosa-associated lymphoid tissues, or group 2 [n=48] [7-13 years; mean age, 9 +/- 3 years; 22 male and 26 female], in whom the ulcers were randomly distributed in the oral cavity and pharynx. 20 sex- and age-matched children served as normal control. Helicobacter pylori DNA was extracted from 3mm diameter tissue samples and polymerase chain reaction [PCR] amplifications were performed for the16S ribosomal RNA gene. HP DNA was detected in 24 patients [75%] in group [I]; in group [II], 6 patients [12.5%] were shown to be PCR positive. HP DNA was not detected in any of the control samples. There is a possible causative role for HP in recurrent aphthous ulcerations with a characteristic distribution and affinity to MALT of the pharynx. Hence; RAS and the risk of HP-associated gastrointestinal complications can be decreased with therapies for eradicating HP. It is recommended that tonsillectomy and adenoidectomy for MALT affected by RAS, improving oral hygiene may protect the host against HP infection and re-infection