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

Cardiac troponin T as a diagnostic marker of hypoxic myocardial injury in sick full-term and preterm neonates

Perinatal asphyxia is associated with cardiac dysfunction; this may be secondary to myocardial ischemia. Also, in preterm infants with respiratory distress syndrome, cardiac function is negatively influenced by the severity of lung disease. Cardiac troponin T [cTnT] is the ideal marker used in the detection of myocardial injury. The aim of the present work was to provide evidence of the usefulness of cTnT in the diagnosis of myocardial injury in neonates after intrauterine hypoxia or with respiratory distress syndrome. Forty five neonates were enrolled in the study and were divided into three groups: group I, fifteen full-term neonates with perinatal asphyxia; group II, fifteen preterm neonates with respiratory distress syndrome; and control group, fifteen healthy full term neonates. Arterial blood gases were measured for sick neonates; serum cTnT was assayed and echocardiography was performed for all neonates. Serum cTnT levels were significantly higher in sick neonates [groups I and II] than the control group [P<0.001]. There was significant correlation between cTnT levels and arterial blood gases [pH, PO[2], PCO[2], HCO[3]] and also with echocardiographic parameters of ventricular function [FS% and EF%] [P<0.01]. cTnT is a useful diagnostic marker used for assessment of post hypoxic myocardial injury in fullterm neonates with perinatal asphyxia or preterm neonates with respiratory distress syndrome

Plasma adrenolutin as a marker of increased oxidative stress in children with severe chronic heart failure

The objective of this study was to measure the plasma levels of a marker of oxidative stress [adrenolutin, the oxidative product of catecholamines] and oxidative defenses [antioxidants; vitamin E and C] in children with chronic congestive heart failure [CHF], and to determine the prognostic value of adrenolutin in these patients, A total of 45 children with chronic CHF [>/= 6 months], with a mean age of 6.0 +/- 2.4 years, were enrolled in the study. They included: Ross class II [13 patients], class III [15 patients], and class IV [17 patients]. Twenty healthy children served as a control group. Clinical and echocardiographic assessment was performed for every patient. Plasma adrenolutin, norepinephrine, and epinephrine levels were measured using high-performance liquid chromatography [HPLC], and plasma vitamin E and C levels were assayed. The relation of plasma adrenolutin levels to prognosis was evaluated at follow up period of 6 months. The results showed significantly higher plasma adrenolutin and catecholamine levels in children with chronic CHF as compared to controls, and increased with the severity of the disease with the highest levels in Ross class III and IV patients [P<0.05]. Plasma adrenolutin levels were significantly higher in children with poor prognosis or death during follow-up [P<0.01]. Plasma antioxidant levels [Vitamin C and E] significantly decreased with the severity of chronic CHF and When compared to controls [P<0.05]. There was a significant negative correlation between plasma adrenolutin and vitamin C levels [P<0.05]. Plasma adrenolutin is significantly increased in children with severe chronic CHF, as a marker of increased oxidative stress, and it is associated with a poor prognosis or death; whereas plasma antioxidants [Vitamin C and E] significantly decrease with increasing severity of chronic heart failure. Antioxidant supplements maybe of therapeutic benefit in patients with chronic CHF

Montelukast versus sodium cromoglycate in children with mild persistent asthma: effect on allergic inflammation and bronchial hyperresponsiveness

The effect of montelukast and cromolyn on allergic inflammation and bronchial hyperresponsiveness was compared in 40 children with mild persistent asthma. Twenty children received oral montelukast [Singulair] while twenty children received inhaled cromolyn [Intal-5 MDI] during the study period of 6 weeks. Asthmatic children were evaluated clinically and with pulmonary function tests [forced expiratory volume in one second [FEV[1]] and peak expiratory flow [PEFR], challenge tests [histamine and exercise] and measurement of inflammatory markers [blood eosinophil count, serum immunoglobulin E [IgE], eosinophil cationic protein [ECP], interleukin 4[IL4] and nitric-oxide products in sputum] both. before and after six weeks therapy with either montelukast or cromolyn. Twenty age and sex matched non atopic children served as controls. Asthmatic children, on admission, had significant decrease in mean FEV[1] and PEFR and increase in mean eosinophil count, serum levels of total serum IgE, ECP, IL4 and sputum nitric-oxide products as compared to controls. Both drugs produced significant and equal improvement in pulmonary functions [FEV[1] and PEFR], decrease in the degree of bronchial hyperresponsiveness to histamine and exercise and a significant decrease in blood eosinophil count, serum IgE, ECP and IL4 and sputum nitric-oxide products. However all these parameters were still significantly different as compared to mean control levels. Better asthma symptoms control was observed with montelukast than with cromolyn sodium and there was a greater significant adherence with montelukast than with cromolyn- sodium with both patients and parents preference for montelukast

Serum terminal complement complex as a prognostic predictor in children with congestive heart failure

The activation of the complement system in pediatric patients with congestive heart failure [CHF] still remains unclear. The objective of this study was to measure the serum levels of terminal complement complex [C5b-9] to determine its predictive value for the prognosis in children with CHF, and to correlate these levels with clinical and echocardiographic assessment of heart failure. Forty cardiac patients with CHF, with a mean age of 5.2 years, were enrolled in the study. According to Ross classification of CHF, they were classified as: Ross class II [12 patients], class III [13 patients], and class IV [15 patients]. Twenty healthy children served as a control group. Serum C5b-9 was assessed with Enzyme lmmunoassay and serum tumor necrosis factor- alpha [TNF- alpha] was measured using ELISA kits. Echocardiographic assessment of left ventricular systolic and diastolic functions was performed. Clinical outcomes were determined at follow-up period of 6months [death or major adverse cardiac events]. The results showed that serum C5b-9 [and also serum TNF- alpha] were significantly higher in patients with CHF as compared to controls [P<0.001] and increased with the severity of the disease, with the highest levels in Ross class IV children and in patients with adverse clinical outcomes by 6 months [P<0.001]. there were significant positive correlations between Ross class of CHF and serum c5b-9 levels, and significant negative correlations between echocardiographic parameters of ventricular function and C5b-9 levels [P<0.001]. Serum C5b-9 [the terminal complement complex] is significantly elevated in children with CHF, increasing with the severity of the disease, and it is a prognostic predictor of adverse clinical outcome. Complement may be a novel target for therapeutic intervention with specific complement inhibitors in patients with CHF