The Comparative Study of the Effectiveness of Cimetidine, Ranitidine, Famotidine, and Omeprazole in Treatment of Children with Dyspepsia

Background. Functional dyspepsia is a common chronic disorder with non specific upper abdominal pain or discomfort. Different approaches with anti-secretory, spasmolytic, prokinetic and anti-inflammatory effects and most preferably reduction of visceral hypersensitivity seem logical. In this study, we compared the effectiveness of the four most drugs used for treatment of dyspepsia in children. Methods. 169 patients between 2 to 16 years old that 47.3% was male and 52.7% was female were enrolled in this clinical trial study by the diagnosis of functional dyspepsia. Then for each patient one of the drugs; Omeprazole, Famotidine, Ranitidine or Cimetidine was administered, for a period of 4 weeks. Patients were followed after 2 and 6 weeks from the beginning of the treatment. Results. The distribution of drugs between these patients were including; 21.9% with Cimetidine, 21.3% with Famotidine, 30.8% with Omeperazole and 26% with Ranitidine that the proportion of patients with all symptoms relief were: 21.6% for Cimetidine, 44.4% for Famotidine, 53.8% for Omeprazole and 43.2% for Cimetidine (P = .024). In followups within 2 and 6 weeks after beginning medical therapy, no side effects due to drugs were seen. Conclusion. If a cure is defined as all symptoms relief after a period of 4 weeks treatment, our findings showed that Omeperazole are superior to Ranitidine, Famotidine, and Cimetidine for management of functional dyspepsia

The clinical presentation of Post-Transplant Lymphoproliferative Disorder (PTLD) following pediatric liver transplantation

Post-transplant lymphoproliferative disorder is a life-threatening complication of solid organ transplantation. In pediatric recipients, PTLD has been reported in 6.4-19.5 of lung, heart and heart-lung transplants, 4-15 of liver transplants and 1.2-10.1 of kidney transplants. Although most lymphomas typically occur in lymph nodes, extranodal involvement is also common. The aim of our study was to determine the site and symptoms of PTLD in children who underwent liver transplantation during 2009-2012 in Liver Transplantation Center of Nemazee Hospital. Material and methods: This study is a cohort study on existing data of children who received liver transplant between Juanury 2009 and December 2012 at Liver Transplant Center of Nemazee Hospital in Shiraz. During the study period, the PTLD occurrence was assessed in follow up visits, if the diagnosis of PTLD was confirmed the affected patient was entered the study and additional information was obtained. The diagnosis of PTLD was considered in patients with fever of undetermined origin, lymphadenopathy, allograft dysfunction, and pulmonary infiltrates. The data was analyzed using SPSS software ver.18. Statistical descriptive methods, Chi square test, and independent t-test, were used for analyzing the data. P value smaller than 0.05 were considered significant. Results: Totally, 203 children undergoing liver transplant surgery were evaluated. The age range of patients was 8 months to 18 years with mean of 8.8±5.6 years old. In our study 17 (8.4) patients developed PTLD. The mean interval between transplantation and PTLD diagnosis was 8.4 ±5.61 months ranging from 4 to 24 months. A total of five patients (2.5) died during the follow-up period and all of them were PTLD affected children (29.4 of PTLD patients). Lymph nodes were the most predominant site involved (64.7), while liver and GI involved in 35.2. Conclusion: The results of this study emphasize the relatively high incidence of PTLD after liver transplantation in children. Because of its impact on patient's outcome and reducing recipient's survival, it is important to minimize this problem by early diagnosis and providing effective treatment

Investigation of the effect of geometric and operating parameters on thermal behavior of vertical shell-and-tube latent heat energy storage systems

In this study, the effect of the geometrical and operational parameters on vertical cylindrical shell-and-tube LHTES systems is investigated. Four different ratios of the shell-to-tube radius are considered with the phase change material (PCM) on the shell side and the heat transfer fluid (HTF) flowing through the tube. The PCM temperature distributions are measured and compared experimentally among the studied storage units. A weighting method is utilized to calculate the average PCM temperature, liquid fraction, and stored energy fraction to evaluate the performance of the storage units. The results show that a shell to tube radius ratio of 5.4 offers better system performance in terms of the charging time and stored energy in the studied LHTES systems. Furthermore, the effects of HTF flow rate and temperature on the storage performance are studied. The HTF flow rate does not show a significant effect on the storage performance; however, the HTF temperature shows large impacts on the charging time. As the HTF temperature increases from 70 to 80 °C, the charging time reduces by up to 68% depending on the radius ratio

Large Volume Paracentesis in Patients with Liver Cirrhosis Temporarily Diminishes Blood Cell Count

Background: Large-volume paracentesis is the preferred treatment for patients with severe and refractory ascites. Several complications were reported during therapeutical paracentesis. However, there are very few published studies on the change in blood cell count after paracentesis. This study aimed to evaluate any changes in blood cell counts after ascites fluid drainage. Methods: This study was conducted on patients with severe ascites and chronic liver disease who underwent large-volume paracentesis at Namazi Hospital, in Shiraz, Iran, between March 2021 and February 2022. A data gathering form containing the patient’s medical history, cause of cirrhosis, ascites fluid volume, as well as routine tests including primarily sodium, potassium, and basal creatinine, was filled out. Before and after the surgery, the total blood cell count was measured. Before the procedure, adjustment was made in the case of coagulopathy and albumin deficiency. The effect of factors such as the volume of drained fluid, splenomegaly, antibiotics, and steroid use was assessed on the changes in the number of blood cells. Using the JAMOVI 2.3.9 software, a paired t test and multiple regression were applied for statistical analysis (P0.001).Conclusion: The findings of the present study showed that children with tense ascites who had large-volume paracentesis might experience a sharp drop in blood cell count after the procedure, which was a transient physiological condition

An evaluation of ascitic calprotectin for diagnosis of ascitic fluid infection in children with cirrhosis

The most common infection in children with the hepatic disease with or without cirrhotic ascites is spontaneous bacterial peritonitis (SBP), which occurs in the absence of an evident intra-abdominal source of infection. The present study aims to assess the value of calprotectin in ascitic fluid in the diagnosis of ascitic fluid infection in children with liver cirrhosis. Materials and methods In this cross-section study, 80 children with underlying liver disease who attended the Hepatology and Emergency Department in Shiraz University Hospitals were studied. All the patients were evaluated by a thorough history, clinical examination, laboratory investigations, diagnostic paracentesis with PMNLs count, and Calprotectin, which was measured in 1 mL ascitic fluid by ELISA. Results Thirty-five patients (43.75%) were diagnosed with ascitic fluid infection. Of these children 6 cases had positive ascitic fluid culture (SBP). Calprotectin was high in AFI patients with a statistically significant difference in AFI patients compared to non-AFI patients. The cut-off levels were 91.55 mg /L and the area under the curve was 0.971. So it can serve as a sensitive and specific diagnostic test for detection of AFI in children with underlying liver disease. Conclusion Elevated ascitic calprotectin levels in cirrhotic patients are a diagnostic and reliable marker for the detection of AFI and are considered a surrogate marker for PMN

Paucity of Intrahepatic Bile Ducts in Neonates: the First Case Series from Iran

Objective: Paucity of interlobular bile ducts (PIBD), defined as absence or marked decrease in the number of interlobular bile ducts, is one of the causes of neonatal cholestasis. Treatment includes treating the intractable pruritus caused by persistent cholestasis. PIBD can be part of a familial syndrome of cholestasis named Alagille syndrome (AGS). We report clinical status of a case series of Iranian patients with PIBD. Methods: In this retrospective study, patients with cholestasis admitted to the pediatric gastroenterology ward in a referral hospital in Shiraz from January 2006 to January 2010 and underwent liver biopsy were evaluated. Clinical and paraclinical status of children with the pathologic diagnosis of PIBD was assessed. Findings: Disease was presented in all jaundiced patients with aged in average 3 days at presentation. Seven patients had the criteria of AGS. Despite medical treatment, cholestasis was not controlled in 6 (28.6%) patients. Liver transplantation led to the survival of 5 patients while the other patient who did not undergo liver transplantation died at 2 months of age. One patient underwent peritoneal dialysis due to renal insufficiency and died at 9 months of age. After 1-5 years of follow-up, the mortality rate was 9.5%. Conclusion: In patients with intractable cholestasis, only patients that underwent liver transplantation survived. Thus, the most important criterion for liver transplantation in neonatal PIBD is intractable cholestasis. This is the first report that shows AGS can result in neonatal-onset renal insufficiency

Data on fluoride concentration in drinking water resources in Iran: A case study of Fars province; Larestan region

Fluoride is a natural element among minerals, geochemical sediments and natural water systems which is entered to body chain by drinking water. Groundwater is the main and the best source of drinking water in southern areas of Iran especially in the cities of Lar and Gerash (Fars province). So due to the health significance fluoride including dental and skeletal fluorosis, fertility, abortion and thyroid diseases, etc., measuring has high importance in the water resources of this region of Iran. Fluoride concentration was 0.35–3.46 mg/L and 78.26% drinking water sources contains fluoride concentration above the WHO guideline. Keywords: Fluoride, Drinking water, Fars province, Larestan, Ira