Interactions between Helicobacter pylori and gastroesophageal reflux disease.

Interactions between Helicobacter Pylori (HP) and gastroesophageal reflux disease (GERD) are a complex issue. Several pathophysiological factors influence the development and the course of GERD, HP infection might be only one of these. Many studies emphasize the co-existence of these diseases. HP infection could contribute to GERD through both a protective and an aggressive role. Gastric acid secretion is a key factor in the pathophysiology of reflux esophagitis. Depending on the type of gastritis related to HP, acid secretion may either increase or decrease. Gastritis in corpus leads to hypoacidity, while antrum gastritis leads to hyperacidity. In cases of antral gastritis and duodenal ulcers which have hyperacidity, the expectation is an improvement in pre-existing reflux esophagitis after eradication of HP. In adults, HP infection is often associated with atrophic gastritis in the corpus. Atrophic gastritis may protect against GERD. Pangastritis which leads to gastric atrophy is commonly associated with CagA strains of HP and it causes more severe gastric inflammation. In case of HP-positive corpus gastritis in the stomach, pangastritis, and atrophic gastritis, reflux esophagitis occurs frequently after eradication of HP. Nonetheless, as a predisposing disease of gastric cancer, HP should be treated. In conclusion, as the determinative factors affecting GERD involving in HP, detailed data on the location of gastric inflammation and CagA positivity should be obtained by the studies at future.

Prevention of Helicobacter pylori infection in childhood.

Helicobacter pylori (H. pylori) infection is one of the most common infections worldwide. Although infection rates are falling in the developed and developing countries, H. pylori is still widespread in the world. This article has reviewed the important publications on H. pylori in childhood with a focus on its evolving transmission route and the source of infection and preventive strategies in childhood, PubMed was searched up to identify eligible studies. Relevant publications were searched using the following.

Abdominal aorta intima media thickness in obese children.

The aim of this study is to investigate whether abdominal aorta intima media thickness (aIMT), increases in obese children and to determine risk factors. Ninety-six children aged 5-16 (51 obese and 45 non-obese) were enrolled in this prospective and cross-sectional study. Age, gender, and relative body mass index (BMI) were recorded. Their serum lipids, thyrotropin, fasting glucose and insulin levels were analyzed. The homeostasis model assessment (HOMA-IR) score was calculated for insulin resistance. Anthropometric and biochemical data were assessed along with aIMT. Findings in obese children were compared with those of non-obese control subjects. The aIMT was significantly greater in obese children. Similar trends were observed in both prepubertal children and adolescents. In obese children, the mean aIMT (mm) was 0.021 (years of age) +0.519. In non-obese children, the mean aIMT (mm) was 0.017 (years of age) +0.381. Our data suggests a relationship between glucose metabolism and aIMT in obese children. BMI was an independent risk factor for increasing aIMT. In conclusion, when compared with non-obese controls, obese children demonstrated significantly increased aIMT. Higher BMI, insulin, HOMA-IR and increased systolic blood pressure seem to be the main factors contributing to increased aIMT and risk for developing vascular disease. Childhood obesity contributes to the development of an increased aIMT.

In which regions is breast-feeding safer from the impact of toxic elements from the environment?

Owing to its unique nutritional and immunological characteristics, breast milk is the most important food source for infants. But, children are at greater risk for exposure to environmental toxicants from breast milk. The aim of this study was to evaluate the influence of environmental pollution on essential and toxic element contents of breast milk and determine the risky locations in our population. This study was conducted on women who were breastfeeding (n=90). Milk samples were collected at three locations in Marmara region, Turkey: highly industrialized region highly affected by pollution, urbanized region moderately and rural area that is affected little. Breast milk samples (5 mL) were collected at approximately one month postpartum (mature milk). The concentrations of cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), iron (Fe), manganese (Mn), nickel (Ni), lead (Pb) and zinc (Zn) in milk samples were compared to the milk samples coming from different locations.Lead, cadmium, nickel, chromium, iron and manganese levels in the breast milk are highest and engrossing especially in rural areas compared to the other regions but cobalt, copper, zinc levels are highest in highly industrial areas. The levels of essential and toxic elements in breast milk can vary in different regions. The levels presented in our study are above some countries' data albeit not at toxic levels. Because of global effects, environmental pollution is not the problem for industrializing regions only. Rural area also may not be safe for breastfeed babies.

Diagnosis of a trend towards obesity in preschool children: a longitudinal study.

The study was planned to determine identifiable starting points of a trend towards obesity and the influence of variables in preschool children aged 0 to 6 years. In this longitudinal follow-up study, 102 children were enrolled. Anthropometric measurements such as weight-height centiles (specific for gender and age group), weight-height growth velocities, and body mass indices were taken annually and compared within each group from birth to 6 years. Family history and lifestyle variables were also recorded and compared. Our study has shown that gender does not affect the trend towards obesity. In obese children, the earliest sign of a trend was the rapid increase of weight and weight gain velocity after 6 months. There were upward trends in the BMI values indicating obesity at 1 year of age in boys and at 6 months of age in girls. The height was higher in obese children than in non-obese ones after 4 years of age. Paternal obesity and having an obese sibling were significant risk factors for obesity. In conclusion, 6 months are considered to be the most critical periods for evaluating the development of obesity in childhood. The efforts for preventing obesity should be initiated at 6 months of age.

P-wave dispersion and P-wave duration in children with stable asthma bronchiale.

OBJECTIVE: P-wave dispersion is associated with inhomogeneous and discontinuous propagation of sinus impulses. The aim of this present study was to investigate the impact of P-wave dispersion in children with stable asthma. METHODS: In this cross-sectional study, the study group consisted of 20 children (12 boys, 8 girls) with stable asthma and mean age of 7.7 +/- 2.0 years. During the study, these patients were treated with low dose inhaled corticosteroids for at least six months. Control group consisted of 20 healthy children matched by same sex and age population. Age, weight, height, echocardiographic values, P-wave maximum duration and P-wave dispersion were compared between asthmatic and healthy children. P-wave duration was calculated in 12-leads of the surface electrocardiography. The difference between P maximum and P minimum durations was defined as P-wave dispersion. The obtained results were compared by independent samples t test and Mann-Whitney U test. Correlations for P-wave dispersion were calculated using Pearson test. RESULTS: P-wave maximum duration is slightly increased in patients with stable asthma (0.092 +/- 0.017 ms) as compared with healthy controls (0.083 +/- 0.011 ms) (p=0.07). We found significant correlation between P-wave dispersion and age (r=0.40, p=0.01), weight (r=0.41, p=0.008) and height (r=0.41, p=0.008). CONCLUSION: P-wave maximum duration is slightly increased and P-wave dispersion is correlated with age, weight and height in children with stable asthma.

The factors associated with asymptomatic carriage of Helicobacter pylori in children and their mothers living in three socio-economic settings.

The number of children infected by Helicobacter pylori is increasing worldwide. The aim of this study is to identify demographic and maternal risk factors affecting H. pylori positivity in asymptomatic children. One hundred sixty-five asymptomatic children, 75 (45%) females, and 90 (55%) males, between 2 and 12 years of age (mean 6.8 -/+ 3.0 years) were tested for the presence of H. pylori stool antigen. The ages, genders, weights, heights, and breastfeeding histories of the children were reported. Information concerning the age and education levels of the mothers, number of siblings, and family incomes was also taken. H. pylori stool antigen positivity was 30.9% (n=51) of the children and 30.4% (n=48) of their mothers. H. pylori positivity was detected in 70.6% (36) of children whose mothers were positive (P<0.001, r=0.64). Lower education level of mothers, lower family income, poor living conditions, and higher numbers of siblings were correlated with higher H. pylori positivity in children. The children living in the worst conditions and having less well educated mothers were at higher risk for H. pylori infection. The best way to decrease the prevalence of H. pylori infection in children is to educate women about how to protect themselves and their offspring from H. pylori infection.

Hemoglobin a1c levels in children with asthma using low dose inhaled corticosteroids.

OBJECTIVES: Steroids may raise the blood glucose levels as a systemic effect. Due to this, the potential effect of prophylactic use of inhaled steroids (ICS) on HbA1c levels in children with asthma was investigated. STUDY DESIGN: Case control study. ? SETTING: Outpatient department. PARTICIPANTS: 141 children with asthma but without diabetes (study group) and 52 children without diabetes or asthma (control group). MAIN OUTCOME MEASURE: HbA1c levels. RESULTS: The mean age of the study group (n=141) was 6.6?3.0 years and comprised 70 females (50% of the group) and 71 males. The mean age of the control group (n=52) was 7.1?3.0 years, and comprised 24 females (46%) and 28 males (54%). Age and sex differences between the groups were not significant. The mean HbA1c value was 5.44?0.75% among the children with asthma and 5.14?0.41% in the control group. HbA1c levels in children with asthma was significantly higher than the control group (P=0.006). No significant correlation was found between cumulative dose of ICS and HbA1c levels. Similarly, levels of HbA1c did not change with increased time of usage of ICS (P=0.96). CONCLUSION: Asthmatic children who are taking low doses of ICS have higher HbA1c values than healthy children.

The prevalence of Helicobacter pylori and related factors among university students in Turkey.

The frequency and risk factors for contamination of Helicobacter pylori infection was investigated among Sakarya University students. Two-hundred students randomly chosen from among those who volunteered for the study and met its criteria were included. Data were obtained by a questionnaire. H. pylori positivity was checked with the monoclonal H. pylori stool antigen test. Statistical analysis was done with chi-square test. The average age of the subjects was 21.14 +/- 2.06, and 76% of them were female. Monthly family income was below 575 Euros in 69.5% of them, and 56% were living in state dormitories. H. pylori positivity was found to be as high as 63% in our group. According to the qustionnaire (age, gender, blood groups, family income, crowded family living conditions, smoking, alcohol and caffeine consumption, the presence of gastric symptoms, family history, and hygienic behaviors), no statistical differences were found between the H. pylori positive and negative students. These data support the finding that personal and environmental conditions in adults did not affect H. pylori infectivity, and that H. pylori might be acquired in childhood.

Role of early EEG and neuroimaging in determination of prognosis in children with complex febrile seizure.

BACKGROUND: The present study investigates the role of early use of EEG in children with no known neuropathology prior to the first CFS, and the contribution made by computed tomography (CT) and magnetic resonance imaging (MRI) to treatment and prognosis. METHODS: Over a period of 7 years, the authors evaluated 159 children (age range: 2 months-5 years) who were being treated for CFS at Haydarpasa Numune Training and Research Hospital, Pediatrics Clinic, Istanbul, Turkey, and who had no previously known neurological disorder. Patients who presented with febrile seizure were determined to have CFS if they fulfilled the following criteria: <3 months of age when seizure occurred, duration of seizure >/=15 min, more than one seizure occurred during a single episode of illness, or focal seizures and postictal neurological deficit was found. EEG was performed on all patients. CT was performed on the patients who had postictal neurologic deficit or focal seizures. Cranial MRI was performed on patients who had focal findings in their EEGs. RESULTS: Electroencephalogram abnormality was found in 71 cases; 51 of these were diagnosed with epilepsy during follow up. Six of the 16 cases whose EEGs were abnormal between days 2 and 6 were diagnosed with epilepsy. Twenty of the 30 cases whose EEGs were abnormal between days 7 and 10 were diagnosed with epilepsy. All 25 cases who had abnormal EEGs after day 11 were diagnosed with epilepsy. CT was performed for 36 patients, of which five were found to have pathological changes. Pathological changes were detected in two of the nine patients who had cranial MRI. Patients who received CT or MRI were all diagnosed with epilepsy during follow up. CONCLUSION: The results suggest that if neurological examination of CFS patients are normal after their clinical status has stabilised, EEG should be performed after 7 days at the earliest, however for the most accurate diagnosis EEG should be performed 10 days after CFS. The most important predictor for neuroimaging was found to be detection of postictal neurologic deficit. MRI had no advantages over CT in first treating CFS in the emergency unit.