Combination therapy versus monotherapy for gastroesophageal reflux in children with difficult-to-treat bronchial asthma

Gastroesophageal reflux [GER] is a common disorder in children with bronchial asthma. Difficult-to-treat asthma; It has been identified as a potential trigger, complication and even differential diagnosis for asthma. GERD; Our aim was to find out the efficacy of the combined use of both the proton pump inhibitor esomep-Proton pump inhibitors; razole and the antidopaminergic prokinetic domperidone versus the sole use of esomeprazole in Prokinetics improving asthma severity in children with difficult to treat asthma. Among 178 children with difficult-to-treat asthma, GER was assessed using upper GIT endoscopy. Those who had GER were randomly divided into 2 equal subgroups the first was treated with esomeprazole for 12 weeks while the other was treated with esomeprazole and domperidone for the same period [beside the usual treatment for asthma in both groups]. Childhood-asthma control test [C-ACT], forced expiratory volume in 1st second [FEVj] [% of predicted], peak expiratory flow [PEE] variability, induced sputum substance P [SP] and endoscopic reflux score [ERS] were recorded before and after the treatment. Gastro-esophageal reflux [GER] was observed in about 45% of children with difficult-to-treat asthma. The C-ACT, induced sputum SP, ERS and FEVj showed significant improvement while PEE variability showed no significant changes when comparing combination therapy subgroup [esomeprazole and domperidone] with esomeprazole only subgroup combination of domperidone and esomeprazole was more effective in improving the endoscopic reflux score, childhood-asthma control test [C-ACT] and FEVj [% of predicted] and significantly reduced the sputum SP than the use of esomeprazole only in children with difficult-to-treat asthma

Antimicrobial-resistant bacteria in a general intensive care unit in Saudi Arabia

To assess the prevalence of multi-drug resistant [MDR] bacteria causing infections in patients at the intensive care units [ICUs] of Riyadh Military Hospital [RMH], as well as their antimicrobial resistance patterns for one year. A retrospective, cohort investigation was performed. Laboratory records from January to December 2009 were studied for the prevalence of MDR Gram-negative and Gram-positive bacteria and their antimicrobial resistance in ICU patients from RMH, Riyadh, Kingdom of Saudi Arabia. A total of 1210 isolates were collected from various specimens such as: respiratory [469], blood [400], wound/tissue [235], urinary [56], nasal swabs [35], and cerebro-spinal fluid [15]. Regardless of the specimen, there was a high rate of nosocomial MDR organisms isolated from patients enrolled in the General ICU [GICU] in Riyadh. Acinetobacter baumannii [A. baumannii] comprised 40.9%, Klebsiella pneumonia [K.pneumonia] - 19.4%, while Pseudomonas aeruginosa [P. aeruginosa] formed 16.3% of these isolates. The P. aeruginosa, A. baumannii, K. pneumoniae, Escherichia coli, Staphylococcus aureus [methycillin sensitive and methycillin resistant], and Staphylococcus coagulase negative are the most common isolates recovered from clinical specimens in the GICU of RMH. Respiratory tract specimens represented nearly 39% of all the specimens collected in the ICU. The most common MDR organisms isolated in this unit were A. baumannii, and K. pneumoniae