Endoscopic postdilatation application of Mitomycin C in children with resistant esophageal strictures / 소아과

BACKGROUND: The esophagus is the most common part of gastrointestinal (GI) tract at the risk of stricture. Benign disorders are the leading causes of narrowing. Caustic ingestion is the most common cause of esophageal stricture in children, especially in developing countries. Clinical responses to the topical application of Mitomycin C in various medical procedures have been reported. PURPOSE: The study aimed to evaluate the methodology, efficacy, and side effects of Mitomycin C in the treatment of esophageal strictures. METHODS: This study included 30 children with resistant esophageal strictures. Upper GI endoscopy was performed up to the area of stricture, esophageal dilatation was done, endoscopy was repeated, and Mitomycin C was applied topically under direct endoscopic vision. The effect of the procedure was followed over a period of 3–5 years. RESULTS: The response to Mitomycin C was excellent (clinically and endoscopically) in 28 patients (93.3%) and good (endoscopically only) in 2 patients (6.7%). No side effects of topical Mitomycin C in children with esophageal strictures were reported in this study. CONCLUSION: Esophageal dilatation followed by local Mitomycin C application may be a useful strategy for treating resistant esophageal strictures.

Helicobacter pylori should be treated in children with growth failure

Helicobacter pylori [H. pylori] infect at least 50% of the world's human population. In most children, the presence of H. pylori infection does not lead to clinically apparent disease, even when it causes chronic active gastritis. According to the last Egyptian Demographic and Health Survey [2007], 79% of children were stunted, 6% were severely stunted, and more than 3% were wasted. The aim of this study was to estimate the prevalence of H. Pylori infection in children suffering from growth failure [GF] or failure to thrive [FTT]. Also to evaluate the differences in stature and weight between infected and non-infected children and to estimate the effect of eradication of H. pylori on the rate of the children growth and their nutritional status. Fifty children [5-8 yrs. of age] suffering from GF were included in the study. Their weight or rate of weight gain was significantly below that of other children of similar age and sex. Another 20 healthy matched children with no signs of growth failure were used as control group. Complete health history, dietary history, anthropometric measurements and thorough clinical examination were undertaken for those children. Complete blood picture, hormonal assessment [if needed], and stool analysis were performed. H. pylori analysis including ELlSA test for antibodies, stool test for H. pylori antigens and/or upper endoscopy with rapid urease testing of biopsy tissues were done. Children suffering from H. pylori were treated with clarithromycin, metronidazole and omeprazole for 2 weeks. The above examinations and investigations were repeated for all the children after 6 months. Out of the 50 children, 34 were suffering from acute H. pylori infection. All of them suffered from GF in the form of wasting and/or stunting. Their dietary history showed that they all received low energy intake, low iron and zinc intake compared to the adequate dietary intake of the control group. There were signs of anemia in the form of pallor and low hemoglobin levels [42 gm %] in 52% of the children. After receiving the treatment for 2 weeks and follow-up for 6 months, H. pylori were eradicated in 91% of the infected children. The dietary intake became adequate in 73% of the children. The energy, iron and zinc intakes became within the normal limits in these children. Those children showed improvement of their Z-score for weight, height and BMI

Conclusion: H. pylori infection is common in Egyptian children suffering from GF, with a prevalence rate of 68%. Early acquisition of H. pylori infection seems to be related to growth failure. Mechanisms by which H. pylori infection might influence growth are unknown, although a direct effect cannot be excluded through anorexia and decreased food intake. It is recommended that GF children especially those with iron deficiency anemia, should be evaluated for H pylori infection. They should be managed by eradication of H. pylori to avoid growth failure and resistance to treatment of the iron deficiency anemia

When to give a booster dose for hepatitis B vaccinated children in Egypt

Viral hepatitis is a major cause of morbidity and mortality. Hepatitis B and C account for more than 75 percent of all chronic liver diseases. Hepatitis B vaccination has been implemented in the Egyptian Extended Program for Immunization since 1993. The aim of our study was to assess the status of the immunologic memory after a booster dose of HB vaccine in a group of healthy 5-year-old children. Those children had been initially immunized with the vaccine starting at birth and had good response at 9 months of age but had no detectable antibody at 5 years. Eighty seven children, who have negative anti- HBs antibodies after 5 years of HB EPI vaccinations, were given a booster dose of 10 [micro g HB vaccine. After 45 days from this booster dose, estimation of anti-s was repeated. The results revealed that, after the booster dose, 44 children [50.6%] out of the 87 children were converted to positive anti-s and the other 43 remained anti-s negative or non-immunized. The ages of all children ranged between 5.2 and 6.2 years with a mean of 5.5 years. There was no sex differences between both groups as male to female ratio was 1.1:1. There was no significant difference between positive and negative anti-HBs children according to weight, height, mid-arm circumference and head circumference. Serum iron was the only iron status parameter that showed significant difference between the positive arid negative anti-HBs children. Anti-HBs .positive patients had significantly lower serum iron although both groups were anemic with Hb concentrations below 11.5 gm %. All children who were negative and responded to the booster dose had anti-HBs anamnestic response above 100 IU. Those who were originally positive at 5 years had lower anti-HBs levels [only 3% >I00 IU/L]

Conclusion: it seems that the response for the HB EPI schedule after 5 years is equivocal in Egypt. About 50% of the children who underwent the HB EPI schedule retain the anamnestic response after 5 years and are not in need of booster doses. The other 50% lost their immune response after 5 years and seem to be in need of further booster doses to protect them against HBV infection and its serious complications. A single dose could not boost their immunity for HB virus to adequate levels