A double-blind gastroscopic study of a bismuth-peptide complex in gastric ulceration

Forty courses of treatment with bicitropeptide (BCP) were administered to 30 patients with gastric ulcers, in a double-blind crossover trial. Healing was judged gastroscopically after 4 weeks, at which time 79% of ulcers had healed on BCP and 35% on placebo (P<0,01). There were no side-effects. Bicitropeptide is a bismuth-protein complex, active at a pH of less than 4. A protective 'protein-bismuth complex' layer is said to be formed over the ulcer.S. Afr. Med. J., 48, 1610 (1974

Nutrizym as a pancreatic enzyme replacement

Twenty courses of Nutrizym or placebo were administered to patients with steatorrhoea due to pancreatic insufficiency. Stool fat excretion fell significantly in all patients while on Nutrizym (P<0.001). On placebo, a mean (±SD) of 27,6 ± 18,3 g/24 h of fat was excreted in the stools. On Nutrizym a mean of 12,4 ± 9,9 g/24 h of fat was excreted. All patients felt subjectively better and weight loss was arrested.S. Afr. Med. J., 48, 1489 (1974)

A double-blind gastroscopic study of a Bismuth-peptide complex in gastric ulceration

Forty courses of treatment with bicitropeptide (BCP) were administered to 30 patients with gastric ulcers, in a double-blind crossover trial. Healing was judged gastroscopically after 4 weeks, at which time 79% of ulcers had healed on BCP and 35% on placebo (P<O,Ol). There were no side-effects. Bicitropeptide is a bismuth-protein complex, active at a pH of less than 4. A protective 'protein-bismuth complex' layer is said to be formed over the ulcer.S. Afr. Med. J., 48, 1610 (1974)

Single frequency whole-body impedance studies in children with diarrhoeal disease and development of a variable frequency system

Diarrhoeal disease is a major cause of infant mortality in this and other developing countries. The assessment of the degree of dehydration in these children is often based on subjective findings alone. These have been shown to be inaccurate as an assessment of the degree of dehydration. Whole-body impedance (WBI) is a method of measuring total body water which is used to assess body composition. This WBI technology, which operates at a single frequency, has been applied to the assessment of dehydration in children with diarrhoeal disease. The normal range of WBI was determined on a group of normally hydrated children and was found to have a mean of 746 Ω, a standard deviation of 85 Ω and 95 % confidence interval for the mean from 720 Ω to 772 Ω. WBI did not depend on age, mass, height or sex. The WBI of a group of children dehydrated from infantile gastroenteritis was measured both before and after rehydration. The dehydrated group had a mean WBI on admission of 1089 Ω and a standard deviation of 149 Ω with a 95 % confidence interval for the mean from 950 Ω to 1109 Ω. This value was significantly greater than that of the normal group. The WBI of the dehydrated group after rehydration was not significantly different from the normal group. In addition a variable frequency bioimpedance analyser was designed and tested. It was found to have an error of less than 1 % over the frequency range 1 to 100 kHz. The device was evaluated on 11 normal and dehydrated children. Four dehydrated children were tested before and after rehydration and this data was compared to a standard electrical model for WBI. It was found that the model could represent the measured data over this frequency range. The extracellular resistive element of the model was mainly responsible for the changes seen during rehydration, suggesting that dehydration in gastroenteritis is mainly due to fluid loss from the ECF compartment

Relative Value of Tests for Intestinal Malabsorption

In the investigation of 79 patients to establish the presence or absence of intestinal malabsorption, the most accurate pointers to malabsorption were established. A good test should be abnormal in most patients with malabsorption, and be normal in normal patients. The investigations adhering nearest to these criteria were found to be jejunal biopsy, barium meal and follow-through, and Schilling and xylose tests. Stool fat estimat:on, glucose tolerance and vitamin A tolerance were less useful tests of malabsorption. There was no correlation between stool fat excretion and vitamin A tolerance.S. Afr. Med. J., 48, 1338 (1974)

The pancreatic-function test - method and normal values

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The relationship between duodenal ulcer depth and gastric acid output

In the course of 750 routine duodenoscopies. 119 patients with duodenal ulcers who also had gastric acid tests, were assessed. A relationship was found between the depth of duodenal ulcers and the height of the gastric acid output. In both Black and Indian patients, maximal acid output was significantly higher in patients with deep duodenal ulcers compared with flat duodenal ulcers. There were more Blacks with deep ulcers, and more Indians with flat ulcers.S. Afr. Med. J., 48, 1405 (1974)

Cardiac outcomes in severe acute respiratory syndrome coronavirus-2-associated multisystem inflammatory syndrome at a tertiary paediatric hospital

INTRODUCTION: We describe a cohort of children referred with multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2 and compare this cohort with a 2019 cohort of children with Kawasaki disease. METHODS: We conducted a retrospective cohort study of 2019 and 2020 referrals to the inflammatory cardiology service at Great Ormond Street Hospital for Children. We compared cardiac and inflammatory parameters of a sub-section of the 2020 cohort who presented with reduced left ventricular ejection fraction with the remainder of the cohort. RESULTS: Referrals significantly increased between February and June 2020 compared to 2019 (19.8/30 days versus 3.9/30 days). Frequency of coronary artery aneurysms (11/79 (13.9%) versus 7/47 (14.9%)) or severe coronary artery aneurysms (6/79 (7.6%) versus 3/47 (6.4%)) was similar between 2020 and 2019, respectively. The 2020 cohort was older (median age 9.07 years versus 2.38 years), more likely to be of Black, Asian, or other minority ethnic group (60/76 (78.9%) versus 25/42 (59.5%)), and more likely to require inotropic support (22 (27.5%) versus 0 (0%)). Even children with significantly reduced left ventricular ejection fraction demonstrated complete recovery of cardiac function within 10 days (mean 5.25 days ± 2.7). DISCUSSION: We observed complete recovery of myocardial dysfunction and an overall low rate of permanent coronary sequelae, indicating that the majority of children with multisystem inflammatory syndrome in children are unlikely to encounter long-term cardiac morbidity. Although the frequency of myocardial dysfunction and inotropic support requirement is not consistent with a diagnosis of Kawasaki disease, the frequency of coronary artery abnormalities and severe coronary artery abnormalities suggests a degree of phenotypic overlap

COVID-19 Pandemic Preparedness in a UK Tertiary and Quaternary Children's Hospital: Tales of the Unexpected

We describe the adaptive coping strategies required in the management of a heterogeneous group of SARS-CoV-2 paediatric patients. The diverse range of presentations, presenting in distinct phenotypic waves, exemplified the importance of preparedness for the unknown. Lessons learned will be essential in planning for a likely second wave of SARS-CoV-2

6-month multidisciplinary follow-up and outcomes of patients with paediatric inflammatory multisystem syndrome (PIMS-TS) at a UK tertiary paediatric hospital: a retrospective cohort study.

BACKGROUND: Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a new, rare, post-infectious complication of SARS-CoV-2 infection in children. We aimed to describe the 6-month outcomes of PIMS-TS. METHODS: This retrospective cohort study comprised children (aged <18 years) who fulfilled the UK Royal College of Paediatrics and Child Health (RCPCH) diagnostic criteria for PIMS-TS and were admitted to Great Ormond Street Hospital (London, UK) between April 4 and Sept 1, 2020. Patients were followed up by a multidisciplinary team of specialists at 6 weeks and 6 months after admission. Biochemical and functional outcomes were analysed. FINDINGS: 46 children were included in this study. The median age at presentation was 10·2 years (IQR 8·8-13·3), 30 (65%) patients were male and 16 (35%) were female, 37 (80%) were from minority ethnic groups, and eight (17%) had pre-existing comorbidities. All patients had elevated markers of systemic inflammation at baseline. None of the patients died. By 6 months, systemic inflammation was resolved in all but one patient. 38 (90%) of 42 patients who had positive SARS-CoV-2 IgG antibodies within 6 weeks of admission remained seropositive at 6 months. Echocardiograms were normal in 44 (96%) of 46 patients by 6 months, and gastrointestinal symptoms that were reported in 45 (98%) of 46 patients at onset were present in six (13%) of 46 patients at 6 months. Renal, haematological, and otolaryngological findings largely resolved by 6 months. Although minor abnormalities were identified on neurological examination in 24 (52%) of 46 patients at 6 weeks and in 18 (39%) of 46 at 6 months, we found minimal functional impairment at 6 months (median Expanded Disability Status Scale score 0 [IQR 0-1]). Median manual muscle test-8 scores improved from 53 (IQR 43-64) during hospital admission to 80 (IQR 68-80) at 6 months, but 18 (45%) of 40 patients showed 6-min walk test results below the third centile for their age or sex at 6 months. PedsQL responses revealed severe emotional difficulties at 6 months (seven [18%] of 38 by parental report and eight [22%] of 38 by self report). 45 (98%) of 46 patients were back in full-time education (virtually or face to face) by 6 months. INTERPRETATION: Despite initial severe illness, few organ-specific sequelae were observed at 6 months. Ongoing concerns requiring physical re-conditioning and mental health support remained, and physiotherapy assessments revealed persisting poor exercise tolerance. Longer-term follow-up will help define the extended natural history of PIMS-TS. FUNDING: None