Effect of honey supplementation on clostridium difficile infection in childhood cancer

Background: the treatment of cancer is associated with nausea and vomiting, oral mucositis, constipation, xerostomia and diarrhea and weight loss, additionally; chemotherapeutic agents promote inflammatory changes in the gut, intestinal necrosis, and anaerobic conditions, allowing proliferation of Clostridium Difficile. Honey, as a natural honeybee product, has antioxidant, antimicrobial, immunomodulatory and anticancer effects. Honey can fight microbial infection by its immuno-activating, anti-inflammatory and prebiotic activity

Objectives: the aim of this study was to evaluate the effect of honey supplementation on frequency of Clostridium Difficile infection [CDI] and gastrointestinal complications in pediatric patients undergoing chemotherapy

Design: a cross sectional study conducted on 40 patients with malignancy recruited from Children's Hospital, Ain Shams University, Oncology Unit and Clinic, Cairo, Egypt in the period from December 2015 to December 2016. Patients were divided into two groups; group I [25 patients] received honey in the dose of 2gm/kg 3 times dailyfor 1month] while group II [15 patients] did not receive honey. All the studied patients were subjected to medical history and clinical examination, with special emphasis on gastrointestinal complication including oral mucositis, vomiting, diarrhea, constipation, and abdominal pain. Follow up was done for weight, height z score, gastrointestinal complications and any adverse events. Stool analysis, culture, C difficle toxin A, B by ELISA was done to all patients at baseline and repeated to patients receiving honey at week 4 of supplementation. Main outcome measure frequency of CDI, gastrointestinal complication, febrile neutropenia

Results: the frequency of C difficle was 8% [2], the first case was 9 years old patient with ALL [50%] and the other 11 years old patient with Burkitts lymphoma both were diagnosed by positive stool culture and positive stool ELISA for toxin A, B. gastrointestinal complications were significantly less and improved in the supplemented group and mean of hemoglobin significant increase in group 1

Conclusion: the frequency of CDI in children with cancer 8% diagnosed by stool culture and toxin A, B study in stool. Honey improved the oral mucositis and different GIT complications associated with chemotherapy

Role of CT in the Diagnosis and Follow up of Pediatric Oncology Patients with Fungal Infection

Background: invasive fungal infections are rare in pediatric population, but have a high morbidity and mortality rates despite the development of antifungal treatment. It ranges from superficial, mucosal to invasive infection

Aim of the Work: to assess the value of CT in the diagnosis of invasive fungal infection and differentiating it from other causes of infection or metastatic deposits in patients with childhood cancer and persistent fever in spite of antibacterial treatment and to assess the radiological response after treatment with antifungal drugs

Patients and Methods: our study was done over one year period from October 2017 to October 2018, included 22 immunocompromised pediatric patients from El -Demerdash tertiary hospital, included [8 male, and 14 female] with age range [14m- 16 yrs.]. We identified immunocompromised patient of having underlying malignancy or auto-immune deficiency. We included all patients with fever, neutropenia and high CRP, in whom we suspected chest or paranasal sinus infection

Results: in our case group; the most common underlying disease was ALL-B cell [n=6, 40%], followed by ALL-T cell [n=2, 13.3%], AML [n=2, 13.3%], aplastic [n=3, 20%], hepatobalstoma [n=1, 6.7%] and auto-immunodeficiency [n=1, 6.7%]. Analysis of the radiological data showed that macronodules was the most significant finding to suggest fungal rather than bacterial infection [53.3% vs. 0% respectively, p=0.015], followed by consolidation [40% vs. 57.1%, p=0.45] and ground glassing [26.7% vs. 14.3%. Cavitary lesions, pleural effusion and lung abscess were associated only with fungal disease, yet it is not considered significant enough in our study as a reliable sign to suggest fungal infection

Conclusion: increase number of hospitalized pediatric patients with fungal infection is a rising problem, with no specific criteria for early diagnosis among this population causing delay of the proper treatment. In our study hematological malignancy was the most common underlying disease with macronodules being the most specific finding to suggest fungal infection in pediatrics

Noninvasive assessment of elevated pulmonary vascular resistance in children with pulmonary hypertension secondary to congenital heart disease: a comparative study between five different doppler indices

Pulmonary vascular resistance [PVR] is an important hemodynamic parameter in patients with congenital heart disease [CHD]. Noninvasive estimation of PVR represents an attractive alternative to invasive measurements. The study included 175 patients with pulmonary hypertension [PH] secondary to CHD. All patients underwent full echocardiographic study and invasive hemodynamic measurements. The study population was then subdivided into four subgroups. Each of the following Doppler indices was measured in one of these four subgroups: peak tricuspid regurgitant velocity [TRV], the ratio of the TRV to the velocity time integral of the right ventricular outflow tract [TRV/TVIRVOT], peak velocity of tricuspid annular systolic motion [TSm], heart rate corrected acceleration time and infliction time of the proximal left pulmonary artery [ATc, InTc]. The data obtained was correlated with invasive PVR measurement. An ROC curve analysis was done to generate cutoff points with the highest balanced sensitivity and specificity to predict PVR > 6WU/m2. The receiver operating characteristics [ROC] curves were compared with each other to determine the most reliable cutoff point in predicting elevated PVR > 6WU/m2. There was a significant correlation between both the TRV and TSm and invasive measurement of PVR [r = -0.511, 0.387 and P value = 0.0002, 0.006 respectively]. The TSm and TRV cutoff values were the most reliable to predict elevated PVR > 6 WU/m2. A TSm cutoff value of 616.16 cm/s provided the best balanced sensitivity [85.7%] and specificity [66.7%] to determine PVRCATH > 6 WU/m2. A cutoff value less than 7.62 cm/s had 100% specificity to predict PVRCATH > 6 WU/m2. A TRV cutoff value of >3.96 m/s provided the best balanced sensitivity [66.7%] and specificity [100%] to determine PVRCATH > 6 WU/m2. Both TRV and TSm had the highest area under the ROC curve among the 5 DOPPLER indices studied. Prediction of elevated PVR in children with PH secondary to CHD could be achieved noninvasively using a number of Doppler indices. Among the five Doppler indices examined in the current study, the peak TRV and the TSm of the lateral tricuspid annulus had the highest balanced sensitivity and specificity to predict PVRI > 6 WU/m2.