Efficacy of zinc as adjuvant therapy for pneumonia in children less than five years

Pneumonia is the leading cause of morbidity and mortality in children < 5 years old. Zinc administration lowers the risk of acute lower respiratory infections in children. This study evaluated the efficacy of zinc supplementation in the treatment of pneumonia in Egyptian children aged < 5 years who were diagnosed and treated according to WHO guidelines. In a double-blind, placebo-controlled clinical trial, children with pneumonia or severe pneumonia were randomly assigned to receive zinc [n= 56] or placebo [n =56] daily till recovery and discharge from hospital as an adjuvant to antibiotics. The outcome variables were the duration of fast breathing, chest indrawing if present and fever. The following investigations were performed: complete blood picture, serum zinc. Pneumonia was diagnosed in 16 and 15 cases in zinc and placebo group respectively while severe pneumonia was present in 40 cases in zinc group and 41 in placebo group. At enrollment both groups had deficient serum zinc level. Zinc group had shorter duration of rapid breathing [45.7 +/- 1.1 vs 66.9 +/- 1.3 h], chest indrawing [26.9 +/- 1.2 vs 44.3 +/- L4 h] and fever [23.0 +/- 1.2 vs 32.8 +/- 1.1 h] and the differences between zinc and placebo groups were statistically significant [P=0.000 for each of them]. At discharge both groups had higher serum zinc concentrations than at baseline: 88.8 +/- 1.9 microg/dl for zinc and 75.3 +/- 1.1 microg/dl for placebo group. The difference between the zinc and placebo groups' discharge zinc concentrations was significant [P=0-000]. It is concluded that the use of zinc as adjuvant therapy for pneumonia or severe pneumonia in children < 5 years reduces the duration of rapid breathing, chest indrawing and fever. This study needs to be replicated in other populations, including those with and without a high prevalence of zinc deficiency

Zinc and childhood diseases

Zinc is an essential component of various enzyme molecules, other proteins and bio-membranes. Zinc deficiency is shown to be one of the leading causes of illness and disease in low-income countries. Zinc is necessary for the normal function of the immune system. Zinc supplementation decreases the duration and severity of acute diarrhea and hastens the recovery of persistent diarrhea. It prevents diarrhea, pneumonia and malaria. Zinc supplement improves growth especially height and weight. It decreases child mortality mainly form diarrhea and pneumonia

Case report: chediak-higashi syndrome

Chediak-Higashi Syndrome is a rare inherited autosomal recessive disorder of immune system. Susceptibility to infection due to phagocyte dysfunction ranges from recurrent skin infection to over whelming fatal systemic infection. A three year old boy presented by dark skin all over the body except tiny areas of hypopigmentation. He suffered from repeated attacks of fever, cough, bloody diarrhea. On examination there was severe pallor, grey silver hair, generalized lymphadenopathy and hepatosplenomegaly. His investigations showed pancytopenia and giant lysosomal granules in the cytoplasm of neutrophils and lymphocytes. He received antibiotics for several times but in last episode he looked terminally ill and his parents refused medical advice for admission and took him to home

Impact of probiotics in the management of severe protein energy malnutrition

This is a randomized double-blind controlled clinical trial aimed to assess the impact of using probiotics as adjuvant therapy to WHO guidelines for management of severe protein energy malnutrition associated with diarrhea. Fifty severely malnourished infants and children having diarrhea<14 days were-assigned either to probiotic group [n=25] which received yogurt containing combination of Lactobacillus acidophilus and Bifidobacterium bifidum plus starter or placebo group[n=25] which received yogurt containing only starter. During the study, the enrolled infants and children were assessed and treated according to WHO guidelines. At enrollment and discharge the following investigations were performed: hemoglobin, hematocrit, serum iron, blood glucose, total serum proteins and albumin. On the seventh day of admission, no failure cases were recorded in the probiotic .group while in the placebo group 2 cases [8%] suffered diarrhea, 2 cases [8%] had edema and 6 cases [24%] gained less than 5% of their admitted weight. At discharge the mean duration of admission or diarrhea was shorter in the probiotic group than placebo group [p=0.00 for each of them]. Furthermore the mean percentage of weight gain was higher in the probiotic group than placebo group [p=0.00]. It was concluded that the combination of Lactobacillus acidophilus and Bifidobacterium bifidum when used as adjunctive to WHO guidelines for management of severe protein energy malnutrition associated with diarrhea hastened the recovery from the disease and increased weight gain. Confirmation of this result with a large number of malnourished children is clearly warranted

Assessment of growth in bronchial asthma

The aim of this study was to assess the effect of uncontrolled long standing asthma without corticosteroid therapy on the growth of pre-pubertal Egyptian children. This was an analytical study conducted at Damietta university hospital Two groups of patients suffering from uncontrolled moderate [n=30] or severe [n=18] asthma were compared for their physical and skeletal growth with a control group [n=30]. All enrolled children were followed up for 1 year. At enrollment the following investigations were performed: CBC, serum IgE, tuberculin test, chest x-ray and x-ray of lift hand and wrist [also at end of the study]. At start and end of the study, no statistically significant differences were detected between the 3 study groups regarding growth indicators [weight for height [W/H] and height for age [H/A] percent of median reference]. The percent of change in growth parameters [weight, height, BMI, upper segment lower segment ratio] were comparable from beginning to end of the study and the differences between groups were not statistically significant. At start and end of the study, bone age was delayed among asthmatic children than controls [p=0.00 each of them]. Both severe and moderate asthma groups were associated with lower standard deviation scores of bone age than controls group and the differences between groups were statistically significant [p=0.00 at start and end of the study]. Comparing growth indicators before and after controlling asthma clarified that no statistical significant differences were detected between asthmatic children and controls [W/H p=0.2, H/A p=0.2]. It was concluded that asthma did not influence the growth, however bone age was delayed

Role of zinc in management of shigellosis

This study aimed to asses the impact of zinc supplementation on the clinical severity and recovery from shigellosis among affected infants and children. A randomized, double-blind controlled clinical trial was conducted in shigellosis infected infants children aged<5 years. Sixty patients were randomly allocated to receive either zinc [n=30] or placebo [n=30]. Participants<6 and>=6 months were given 3.5 ml and 7 ml of zinc sulphate or placebo solution, respectively, once a day for 14 days. Standard rehydration and antimicrobial therapy were given to all patients according to WHO guidelines. At enrollment the following investigations were performed: serum zinc, serum electrolytes [Na, K], hemoglobin, hematocrit, and total and differential leukocyte count. A second blood sample was obtained at a follow-up visit after the completion of 14 days of treatment for estimation of serum zinc level. At discharge, duration of diarrhea [39.2[6.5] vs 57.7[7.2] h, p=0,00], and duration of presence of blood in stool [38.1[5,4] vs 561[6.11 h], p=0.00] were significantly shorter in zinc group in comparison to placebo group. The children in zinc group consumed significantly lesser amount of ORS than placebo group [138.3[9.1] vs182 [11.5] ml/kg, p=0.00]. Zinc supplemented children experienced significantly fewer stool motions than those in placebo [11.2[0.6] vs 18.4 [0.4], p=0.00]. After 14 days of intervention serum zinc was higher among zinc group than placebo group [78.4 [16.2]vs 65. [15.8] micro g/dl] and the difference between two groups was statistically significant [p=0.002]. It was concluded that zinc supplementation for infants and children suffering acute shigellosis hasten the recovery from the illness

Zinc supplementation in acute diarrhea, does it affect copper status?

Intervention trials have shown that zinc is efficacious in treating acute diarrhea in children. In randomized double blind controlled clinical trial we evaluated the adverse effect of zinc supplementation on serum copper when used for treatment of mate infants and children [age 3-36 months] suffering from acute diarrhea. The study was carried out at Diarrheal Disease Research and Dehydration Center [DDRRC] at Bab El-Sha'reya University Hospital for one year. One hundred cases with some dehydration according to WHO classification were admitted to hospital and randomized to received either zinc or placebo for 14 days. The following investigations were performed at admission: serum Na, K, zinc, copper and hemogram. All cases were asked to come for follow up visit at the end of therapy [14 days from admission data]. At follow up visit serum for zinc and copper was investigated. At admission serum zinc and copper were within normal range in both zinc and placebo groups and without statistically significant difference. The mean duration of diarrhea for zinc treated group was shorter than that in placebo group [46.2 +/- 22.2 versus 48.9 +/- 23.9 hours] but the difference between the two groups was not statistically significant. Only 80 cases were followed up. On follow up visit serum copper was lower in zinc group than that in placebo group but the difference was not statistically significant. It is concluded that zinc supplementation for 14 days in management of acute diarrhea has no effect on serum copper

Bacterial aetiology of pneumonia and its abstract relation to nutritional status among infants and children

Pneumonia is one of the leading cause of death among children under 5 years. No data are available in Egypt about organisms causing pneumonia among severe protein energy malnutrition [PEM]. The aim of this study was to assess the difference between well nourished and severely malnourished children regarding the bacterial aetiology of pneumonia. The study was an analytical one which carried out for one year among the attendants of Bab El-Sha'reya University Hospital. All study patients had an age 3 months up to 5 years with duration of illness less than 3 days. They were divided into two groups: pneumonia with severe PEM [n=70] and pneumonia with normal nutritional status [n=70]. Pneumonia was diagnosed if there was rapid breathing, chest indrawing or positive X-ray for pneumonia. Severe PEM was considered if any of the following was present: weight for length < 80% of the reference median or pitting oedema. Exclusion criteria were history of wheezing, chronic illness or use of antibiotic for the present illness for more than 2 doses. Severity of pneumonia was classified according to WHO. All enrolled patients were subjected to the following investigations: chest X-ray, complete blood picture, plasma proteins, BCG test and blood culture. Positive blood culture was higher among malnourished than well nourished patients [30% versus 17.1% respectively] but the difference was not statistically significant. Streptococcus pneumoniae was the most common organism in positive culture followed by Haemophilus influenzae in both severe PEM and well nourished patients and there was no statistically significant difference between them regarding the type of bacteria detected. Positive blood culture was higher among patients with severe pneumonia than those with pneumonia in both severe PEM and well nourished patients. Comparison between those with positive culture and those with negative blood culture among malnourished patients did not show any statistically significant difference. We concluded that the yield of positive blood culture with pneumonia was expected low. However relative more positive cases were found among those with severe PEM and or severe pneumonia

Risk factors for severity of childhood bronchial asthma

Bronchial asthma is the most common chronic illness of childhood and despite advances in therapy, asthma prevalence, morbidity and mortality are all increasing in many places. The objective of present study was to assess potential risk factors for severity of bronchial asthma among children 2-10 years of age. The study was a case-control age matched carried out at Bab El-Sha' reya University Hospital for one year. The inclusion criteria included any child 2- 10 years of age with episodes of wheezing in the last 3 months that responded to bronchodilators. The severity of asthma was classified according to National Asthma Education and Prevention Program [NAEPP]. Patients with mild intermittent bronchial asthma were considered as controls [n=100] while patients with moderate or severe asthma were considered as cases [n=100]. Exclusion criteria were congenital heart diseases, chronic chest conditions and history of admission to neonatal intensive care unit. All enrolled patients were interviewed by special questionnaire which included all potential risk factors and were subjected to the following investigations: chest X-ray PA, CBC, total and differential leucocytic count, hemoglobin level and serum immunoglobulin IgE. Residence in urban area, male gender, crowding index >= 4 persons room, low birth weight and passive smoking >10 cigarette/day were risk factors for severity of asthma [Odds ratio 3.3, 2.1, 1.6, 1.5, 1.3 respectively]. After controlling for different confounders, they were still risk factors for severity of asthma. Serum IgE, absolute eosinophil count, percentage of cases with higher serum IgE than normal level and hyper-inflated lung in X-ray were higher among cases than controls but the difference was not statistically significant. We recommended a large scale cohort studies of children to evaluate the relative risk of potential risk factors for severity of bronchial asthma

Risk factors for severe acute respiratory infection[ARI] in the first 5 years of life

The present work is a case control study comparing pneumonia and severe pneumonia cases, according to the WHO classification, with non-severe cases of ARI, i.e. acute upper respiratory infection and bronchitis as a control. The study was performed in the out-patient clinic and inpatient department of Bab El-Sha'reya University Hospital. In the outpatient clinic, a systematic random sample was collected from infants and children aged 0-5 years, suffering from ARl according to their presentation i.e. cough or difficult breathing these include 10 cases and 205 control. Cases of pneumonia and severe pneumonia 143 cases were collected from inpatient department. The results showed that the young age [< 6 months], wasting [ 2], visiting a private physician, and combined risk factors, were all risk factors for severe ARI. The highest sensitivity was house hold cigarette smoking [68%], while wasting and young mothers [< 20y], were associated with high specificity [99%]. Attention must be paid to any patient with ARI, having any of the risk factors

Health workers behaviour in management of severe acute respiratory infection[ARI] in the first 5 years of life

Health workers assessment study, was a descriptive study of the knowledge, skills, and practices of health workers in management of ARI. The study was done at Tema district in Sohag govemorate. During the study, 27 physician were interviewed 119 [70.4%] general part-owners, 5 [18. 5%] paediatrician, and 3 [11:1%] other specialties] together with 36 nurses, and 20 pharmacist. Physician knowledge were lacking WHO classification and management of ARI. Their practices lack history taking, not examine throat, depend on auscultation of the chest, and not appreciate the role of mothers. Their skills were poor in giving advice to mothers. Nurses were confused about their roles with poor knowledge, attitude and practices. Pharmacist managed 30% of cases, so they must he included in any training programme