Recurrent Pneumonia in Children Admitted to Assiut University Children Hospital. Magnitude of the Problem and Possible Risk Factors

Background: Incidence data indicate that recurrent pneumonia occurs in 7.7–9% of all children withcommunity acquired pneumonia. We aim by this study to assess the prevalence of recurrent pneumoniaamong the admissions with diagnosis of pneumonia in Assiut university children hospital for one year andto try to define the possible related risk factors. Patients and methods: This is a prospective hospital basedstudy in Assiut University Children’s Hospital. Children younger than 16 years admitted with a hospitaldiagnosis of pneumonia to Assiut University Children’s Hospital for one year from 1 February 2017 to 31January 2018 were included.Results: Approximately 1 in 12 children with pneumonia in our locality have recurrent pneumonia with percentageof 12.61%. Cardiac diseases especially congenital heart diseases was the cause among 25.45%of the cases, immunodeficiency diseases represented 20.9% of the cases ,while bronchial asthma wasthe cause of recurrent pneumonia among 16.36% of the cases. As regard to risk factors in studied group,prematurity was detected among 7.27 % of the cases while more than 50% were formula fed and more than60% exposed to pollution. Father smoking was detected among 36.36% of cases. Patients aged > 6 yearsshowed significantly higher frequency in risk factors as obesity, indoor and outdoor pollution and use ofsteroids in comparison to other age groups. However, patients aged 0-3 years exhibited significantly higher% frequency of having heart disease, oro-motor in coordination /swallowing dysfunction, gastro esophagealreflux and under nutrition as risk factors for recurrent pneumonia in comparison to other age groups.Conclusions: The most frequent underlying cause for recurrent pneumonia in Assiut University Children’sHospital which presents the largest referral pediatric hospital in Upper Egypt for one year according to ourstudy was cardiac diseases; the second most frequent cause was immunodeficiency diseases, followedby bronchial asthma. Risk factors for recurrent pneumonia include socio-economic status of studiedcases, prematurity, exposure to passive smoking and in or outdoor pollution, obesity, under nutrition, lackof breast feeding, gastro esophageal reflux and steroids usage

Hormonal and inflammatory modulatory effects of hesperidin in hyperthyroidism-modeled rats

The goal of the current study was to investigate the hormonal modulatory efficiency of hesperidin, through its regulatory potential of immunological, inflammatory, and/or antioxidant changes in on hyperthyroidism modeled adult female albino rats. Both normal and hyperthyroidism modeled rats (140-160g) were randomly divided into four groups (10 animals each) as follows: 1) healthy animals were daily ingested with saline for six weeks, and served as control group, 2) healthy animals were intraperitoneally injected with hesperidin (50 mg/kg/day) for a similar period, 3) hyperthyroidism-modeled animals without any treatment acted as positive control, and 4) hyperthyroidism-modeled animals were treated intraperitoneally with hesperidin for a similar period. The findings showed that hesperidin significantly modulated hyperthyroidism deteriorations, this was evidenced by a remarkable decline in serum T4, FT4, T3, FT3, TNF-α, IL1β-, IL4-, IL-6, and IL-10 levels, with a minor increase in TSH and significant raise in CD4+ level. Similarly, valuable improvement was observed in the oxidative status; serum SOD, GPx, CAT, and GSH levels were dramatically enhanced, associated with remarkable drop in MDA and NO levels. Also, hesperidin demonstrated nephro-hepatoprotective and anti-atherogenic potential, this was achieved from the notable reduction in ALAT and ASAT activities as well as urea, creatinine, cholesterol, and triglyceride close to the corresponding values of healthy group. These findings were supported by histological and immunohistochemical ones that showed a notable decrease in the expression of the calcitonin antibody. In conclusion, hesperidin possesses anti-hyperthyroidism, immunoinflammatory regulatory, and antioxidant activities that evidenced from the improvement of physio-architecture of the thyroid gland, reduction of inflammation and restoration of the impaired oxidative stress. This effect might be mechanized through immunological, inflammatory, apoptotic, and/or antioxidant modulatory pathways

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Prothrombotic risk factors and antithrombotic therapy in children with ischemic stroke

Objective: Congenital and acquired prothrombotic disorders have been highlighted in a recent series of cerebrovascular stroke (CVS), with a controversial role in pathogenesis. The aim is to study some prothrombotic risk factors [activated protein C (APC) resistance, von Willebrand factor (vWF), anticardiolpin (ACL) antibodies and plasma homocysteine] in children with ischemic stroke, and to evaluate the role of aspirin and low molecular weight heparin (LMWH) in its management in relation to outcome. Methods: A total of 37 cases aged from 1 month to 15 years ( mean ± standard deviation 26.2 ± 35.7 months), diagnosed as ischemic stroke (>24 hours) were recruited. Complete blood count, prothrombin time and concentration, partial thromboplastin time, serum electrolytes, random blood sugar, C-reactive protein, electrocardiogram and echocardiography were done. Levels of APC resistance, vWF, ACL antibodies [immunoglobulin G (IgG) and immunoglobulin M (IgM)] and plasma homocysteine were estimated. A total of 25 cases received aspirin 3–5 mg /kg/d and 12 patients received LMWH as initial dose at 75 international units (IU)/kg subcutaneously (SC) then 10–25 IU/kg/day for 15 days in a nonrandomized fashion. Results: The levels of APC resistance, vWF, ACL antibodies (IgG and IgM) and plasma homocysteine were significantly higher in stroke cases than in controls. There was no significant difference between cases treated with aspirin and those with LMWH in all prothrombotic factors. Significant positive correlations were found between vWF and ACL antibodies (IgG and IgM) levels before treatment. Significant decrease in cognitive function was detected between cases treated with LMWH and those treated with aspirin. Conclusion: Ischemic CVS in children is multifactorial. Thrombophilia testing should be performed in any child with CVS. Early use of aspirin improves the prognosis and has less effect on cognitive function

Inhibition of Staphylococcus aureus LC 554891 by Moringa oleifera Seed Extract either Singly or in Combination with Antibiotics

Bacterial outbreaks caused by Staphylococcus aureus (S. aureus) are interesting due to the existence of multidrug resistant (MDR) isolates. Therefore, there is a need to develop novel ways to control such MDR S. aureus. In this study, some natural agents such as honey bee (HB), extracts of either Moringa oleifera seeds (MSE), or leaves (MLE) and essential oils of garlic, clove, and moringa were studied for their inhibitory activity against this S. aureus pathogen. About 100 food samples including beef luncheon (n = 25), potato chips (n = 50), and corn flakes (n = 25) were investigated for possible pollution with the S. aureus bacteria. The isolated bacteria suspected to belong S. aureus that grew well onto Baird–Parker agar (Oxoid) and shiny halo zones and positive coagulase reaction were selected and identified by API-Kits; all of them that were approved belong to S. aureus (18 strains). The sensitivity of the obtained 18 S. aureus bacterial strains to 12 antibiotics were evaluated; all of them were resistant to ofloxacin; however, other antibiotics tested showed variable results. Interestingly, the S. aureus No. B3 isolated from beef luncheon was resistant to 10 antibiotics out of 12 ones tested. Multiple antibiotic resistance index (MAR) of this S. aureus strain was about 83.3%. Therefore, its identification was confirmed by sequencing of a 16S rRNA gene which approved a successful biochemical identification carried out by API Kits and such strain was designated S. aureus LC 554891. The genome of such strain appeared to contain mecA gene encoding methicillin resistance; it was found to contain hla, hlb, tsst-1, and finbA that encode α-blood hemolysis, β-blood hemolysis, toxic shock syndrome gene, and fibrinogen-binding protein gene, respectively. In addition, the virulence factors viz. sea; seb; sec encoding enterotoxins were detected in the DNA extracted from S. aureus B3 strain. Aqueous extract of Moringa oleifera seeds (MSE) showed inhibitory activity against S. aureus LC 554891 better than that obtained by tetracycline, essential oils or HB. Minimum inhibitory concentration (MIC) of MSE was 20µg/mL. Instrumental analysis of MSE showed 14 bioactive chemical compounds. Combinations of both MSE and tetracycline showed distinctive inhibitory activity against S. aureus LC 554891 than that obtained by either tetracycline or MSE singly

Data publication: Modification of Porous Ultralow‑k Film by Vacuum Ultraviolet Emission

Modification of spin-on-deposited porous PMO (periodic mesoporous organosilica) ultralow-k (ULK) SiCOH films (k = 2.33) containing both methyl terminal and methylene bridging groups by vacuum ultraviolet (VUV) emission from Xe plasma is studied. The temporal evolution of chemical composition, internal defects, and morphological properties (pore structure transformation) is studied by using Fourier transform infrared spectroscopy, in situ laser ellipsometry, spectroscopic ellipsometry, ellipsometric porosimetry (EP), positron-annihilation lifetime spectroscopy (PALS), and Doppler broadening positron-annihilation spectroscopy. Application of the different advanced diagnostics allows making conclusions on the dynamics of the chemical composition and pore structure. The time frame of the VUV exposure in the current investigation can be divided into two phases. During the first short phase, film loses almost all of its surface methyl and matrix bridging groups. An increase of material porosity due to removal of methyl groups with simultaneous matrix shrinkage is found by in situ ellipsometry. The removal of bridging bonds leads to an increase of matrix intrinsic porosity. Nevertheless, when the treated material is exposed to the ambient air, the sizes of micro- and mesopores and pores interconnectivity decrease with the VUV exposure time according to PAS and EP data. The last is the result of the additional film shrinkage caused by atmosphere exposure. During the second phase the increase of mesopore size is detected by both EP and PAS. The increase of mesopore size goes all the time as it is expected from in situ ellipsometry, but it is masked by the air exposure