Congenital heart diseases in children with oral clefts

Oral clefts are common birth defects often known to be associated with other congenital malformations, Congenital heart diseases [CHDs] are found to be the most common, islolated, associated malformations. The purpose of this study is to detect the prevalence of CHDs in patients with oral clefts. We studied 105 patients presented to CUCH [Cairo University Children Hospital] over one year. A full history and physical examination in addition to full echocardiographic examination were done to all patients. The mean age was 18.9 +/- 18.2 month. 58.1% of patients were males. 55.2% patients had both cleft lip and palate [group 1], while 30.5% had cleft palate [group2], and 14.3% had only cleft lip [group 3]. CHDs were found in 21 patients [20%] compared to 0.1% in general Egyptian population. Type of cleft did not correlate with the frequency of CHDs with a P value = 0.336. ASD was the most common detected defect followed by PDA. Other congenital malformations and dysmorphic features were detected in [9.5%] patients. Cleft patients with CHDs had a statistically significant higher percentage of associated other congenital malformations and dysmorphic features compared to cleft patients with normal heart [a p value = 0.026, <0.001 respectively]. The high prevalence of congenital heart disease in cleft patients may justify a routine echocardiographic screening for all patients with oral clefts

Myocardial performance in hydroxyurea versus transfusion treated sickle cell disease pediatric cases

Sickle cell disease [SCD] is associated with many cardiac abnormalities including increase cardiac output, pulmonary hypertension [PH] and myocardial perfusion abnormalities. Hydroxyurea [HU] is considered to be the most successful drug therapy for severe sickle cell disease. The objective is to study the echocardiographic cardiac abnormalities in patients with SCD on HU therapy comparing them with those on isolated blood transfusion regimen. Descriptive cross sectional case study was conducted on 29 cases of SCD on transfusion regimen [16 cases] and on HU therapy [13 cases]. Doppler echocardiographic assessment of left ventricular systolic and diastolic function, calculation of myocardial performance index [MPI] and left ventricular mass were done to all patients. Right ventricular MPI was higher in HU treated group with difference approaching significance [p = 0.06]. No significant correlation between HU dose and duration and left ventricular systolic or diastolic function, right ventricular diastolic function, or pulmonary artery pressure [PAP]. PH was present in 55% of SCD. No significant difference in PAP between HU and transfusion treated groups. Negative significant correlation between left ventricular deceleration time and estimated systolic pulmonary artery pressure [r=-0.37 p =0.04]. No deleterious echocardiographically detected cardiac effects were observed in HU treated SCD patients. HU had no effect on PH

1[st] line antimicrobial therapy for febrile neutropenic cancer patients

Empiric antibiotic regimens used in febrile neutropenic patients often include an extended spectrum cephalosporin, but the response of therapy in Gram positive coccal bacteremia has been unsatisfactory, thus new antibiotic with better activity against Gram positive bacteria should be tested. Antipseudomonal penicillins including piperacillin are effective against many Gram positive and Gram negative organisms. The aim of this work is to compare combination therapy with piperacillin-tazobactam plus amikacin versus ceftazidime plus amikacin as first line in treatment of febrile neutropenic cancer patients. This study is a single center, prospective and randomized trial performed in pediatric branch wards, of the National Cancer Institute, Cairo University. All patients were subjected to full clinical and laboratory evaluation including microbiological study. Doses were given according to the International Antimicrobial Therapy Cooperative Group [IATCG] of the European Organization for the Research and Treatment of Cancer [EORTC]. 164 febrile neutropenic episodes were enrolled on this study. 82 patients with 105 [64%] high risk febrile granulocytopenic episodes were considered eligible. 53 were treated with piperacillin-tazobactam plus amikacin [group A], and 52 were treated with ceftazidime plus amikacin [group B]. The overall success in group A was higher than group B, yet, the difference was statistically insignificant with a p value=0.2. Time of defervecence was significantly shorter in piperacillin-tazobactam group [p=0.001]. There was no infection related mortality in this study. Side effects were encountered in 3 [5.6%] cases receiving piperacillin-tazobactam in the form of mild skin reaction. 55.7% of positive cultures yielded Gram positive organisms. Staphylococcus species were the most common organism in both groups. Both Gram positive and negative organisms showed higher sensitivity to pipercillin-tazobactam compared to ceftazidime with a significant p value=0.05. Piperacillin-tazobactam is safe and more effective than ceftazidime in febrile neutropenia in pediatric cancer patients

Assessment of nutritional status of some primary school children and their awareness in slum areas

Worldwide, malnutrition is one of the leading causes of morbidity and mortality in childhood. It is still a major health problem in Egyptian community especially in primary school children. Slum populations living in adverse conditions represent nutritionally vulnerable groups that need immediate attention. This is a cross sectional survey study including 1000, [501urban, 499 rural] primary school children, all were subjected to anthropometric measurements, clinical examination, hemoglobin% and stool analysis as well as assessment of feeding practice and nutritional awareness. Also, a questionnaire was conducted on a sample group of persons surrounding the children to evaluate their nutritional awareness. The results showed that 76.9% of urban and 69.3% of rural children are underweight; 9.8% urban and 12.8% rural are stunted; more urban children are anemic than rural group [33% vs 20%, p=<0.05]. About 50% of examined stools were positive. The majority of children have had feeding practices. Only 33.9% of urban children and 29.3% of rural ones have complete balanced diet. Almost all children have a weak level as regard their nutritional awareness; also more tan half of parents [56%] have weak level of nutritional awareness. Children living in slum areas, both urban and rural, suffer from malnutrition diseases which are attributed, not only to the lack of nutritional awareness of the children and their contacts, but also to the adverse socioeconomic conditions. Attention to education, poverty alleviation, appropriate feeding practices, prevention and treatment of infections are required to assist in combating malnutrition in this district

Sonographic abnormalities of the gallbladder in children receiving ceftriaxone

Ceftriaxone, a third-generation cephalosporin is a popular antibiotic in treating pediatric infections because it has a wide spectrum of antimicrobial activity and a long plasma half-life, which allows once a day administration. Sonographic abnormalities of the gallbladder have been reported in patients who received ceftriaxone; some of these patients also had symptoms of gallbladder disease. Although most patients with these abnormal sonographic gallbladder findings are asymptomatic, biliary symptoms can occur and may be severe enough to require discontinuation of ceftriaxone therapy. The purpose of this study was to investigate the incidence and outcome of biliary complications in children receiving ceftriaxone. The study included 69 children admitted to Abou-Elrish hospital during the period from September 2002 to May 2003 and required ceftriaxone therapy for 7 days for various infections. The drug was given in a dose of 100 mg/kg once daily by intravenous route. Abdominal Ultrasonography for gallbladder abnormality was performed within the 1st 2 days of starting treatment; another examination was performed on the 7th day, once more during the course of treatment, its time was variable among our patients; and finally just after the end of treatment. Patients with abnormal sonographic findings were followed every one to two weeks till resolution of the abnormal findings with a follow up period extended to 21-90 days after stoppage of treatment. According to the results, patients were divided into 2 groups according to sonographic findings; group I included 54 patients [78%] with negative sonographic findings of gall-bladder disease, group II included 15 patients [22%]. Twelve of group I1 patients [80%] demonstrated abnormal sonographic findings as semilunar well defined structures showing posterior acousting shadowing, while three patients of them [20%] demonstrated the abnormal sonographic findings as an echogenic material without acousting shadowing i.e. sludge. These abnormal sonographic findings were detected 7-35 days after starting treatment with mean of 18 +/- 11 days, and were completely resolved in 12 patients 14-30 days after stoppage of treatment [17.7 +/- 5.1 days]. However, 3 patients showed incomplete resolution, during a follow up period of 21-90 days with a mean of 57 +/- 34.6 days from the stoppage of treatment. The duration of treatment was significantly longer in-group II than group I [P-value= 0.07]. No statistically significant differences were found between the 2 groups regarding the age, weight and laboratory findings

Conclusion: ceftriaxone-induced biliary pseudolithiasis is asymptomatic, transient and generally resolves spontaneously following discontinuation of the drug in most cases

Sonographic screening of uropathy in patients with malformative heart disease

According to a large number of studies, there is a frequent association of congenital heart disease [CHD] and urinary tract anomalies [UTA]. The purpose of this study is to evaluate the advisability of sonographic screening of uropathy in patients with malformative heart disease. The study comprised 180 children. All of these children were investigated for CUD but none were symptomatic in terms of the urinary tract diseases. The patients were divided into 2 groups, group I included 107 patients [59.4%] with a cyanotic CHD and group II included 73 patients [40.5%] with cyanotic CHD. All patients in the study were subjected to echocardiography and sonographic screening for associated uropathy. Out of 180 children, the incidence of UTA detected by sonography was 24/180 [73.3%]. There was no significant difference in the incidence of UTA between those with a cyanotic CHD 14/107 [13.1%] and those with cyanotic CHD 10/73 [13.7%], p=0.15. However, no association between a specific CUD and a particular UTA could be found

Conclusion: sonography should be routinely performed to screen for previously undetected or silent but potentially serious UTA in children with CHD