Chronic abdominal pain in children

Recurrent abdominal pain in childhood, is classically defined as three or more episodes of pain severe enough to interfere with daily activities over the span of more than three months. It is a common presenting complaint to both general practice and pediatricians with a prevalence of 10-15 % of school age children. However an organic underlying disorder is rare; most studies suggest in the order of 5-10%. The clinical characteristics that facilities the recognition of children who are more likely to harbor organic disease are therefore important to the practicing primary care provider and pediatricians in order to avoid unnecessary, costly and invasive investigations.peer-reviewe

Update on celiac disease

Celiac disease is a chronic autoimmune process that is modulated by an environmental trigger, namely glladin; a part of gluten which is present in wheat, barley and rye, Celiac disease is clearly increasing in prevalence worldwide and with easier access to screening tools the notion that it is a disease of Western society is in increasingly being challenged, We have also seen a broader gamut of symptoms and disease conditions that are associated with celiac disease to the extent that the nomenclature of classic and non-classic manifestations seems redundant. The increased recognition in prevalence is poorly understood but seems to also reflect a true increase in incidence, These observations supported by constantly improving diagnostic techniques; including serologic, genetic testing and endoscopic moralities has frustratingly not been paralleled in any measure by any breakthrough in managementpeer-reviewe

Constipation and encopresis in children

Chronic constipation is defined as a decrease in frequency or the painful passage of bowel movements present for several weeks. Retentive encopresis is the term reserved for the involuntary and uncontrollable soiling that occurs in children with chronic constipation. Constipation is a relatively common pediatric complaint accounting for up to 3% of general paediatirc outpatient visits and 25% of visits to a pediatric gastroenterologist. Encopresis is also common, occurring in at least 1.5% of all childrenpeer-reviewe

Child with neurodisability

Neurodisability is increasingly being recognized as an important niche within pediatrics, more so since being recognized as a distinct subspeciality within the UK-STA in 2003. The spectrum of disorders encompassed in neurodisability includes learning disability, epilepsy, cerebral palsy, auHstlc spectrum disorders, head injury rehabilitation and neuromatabolic disorders. The child with neurodisability (ND) can be a challenge on several levels of care and it is incumbent upon the primary care physician, or pediatrician, to recognize the ramifications of the neurodisability to other systems including nutritional and gastrointestinal disorders. This article will address the nutritional complications of ND in childhood, feeding strategies, and the impact and management of disordered motility resulting in gastroesophageal disease and constipation in these patients. The second installment of this series will address dietary modifIcation in ND syndromes including autism.peer-reviewe

New gastrointestinal diagnostic modalities : capsule endoscopy

With an approximate length of 15 feet, the small intestine presents a daunting challenge to the clinician faced with symptoms referable to this relatively inaccessible area. In the last decade, capsule endoscopy (CE) has established an increasingly broad niche in the diagnostic armamentarium of both paediatric and adult clinicians; it is now the established standard of care in the work up of obscure gastrointestinal hemorrhage, suspected Crohn's Disease, polyposis syndromes and arguably, chronic abdominal pain.peer-reviewe

A possible hazard of splenectomy

The first case of splenectomy in St. Luke`s Hospital of a four months old infant is described. The infant died from a fulminating septicemia just over six weeks after splenectomy. Similar case studies indicated that fulminating infection occurs after splenectomy, particularly in infancy which could result fatal. In this regard, this study recommends that splenectomy should not be performed in the preschool child. Furthermore a careful follow-up of all splenectomised patients is advisable, by also treating any infection no matter how minor it may appear to be.peer-reviewe

An electrochemical investigation of oxygen adsorption on Pt single crystal electrodes in a non-aqueous Li+ electrolyte

Cyclic voltammetry has been used to probe the initial stages of oxygen reduction and oxidation in lithium-containing dimethyl sulfoxide at well-defined Pt single crystal electrodes in order to elucidate any catalytic effects ascribable to surface structure. In contrast to previous work involving sodium-oxygen, lithium-oxygen studies did not yield any significant differences for reaction on the three basal planes of platinum. Rather, all three planes generated a similar voltammetric response. However, by judicious use of various potential sweep limits, the formation of superoxide together with both a “conformal” or surface adlayer of lithium peroxide (Li2O2) together with a “microcrystallite” surface Li2O2 phase was resolved. Voltammetric peak intensity versus sweep rate measurements confirmed that superoxide electrooxidation was diffusion limited whereas electrooxidation of the two Li2O2 phases displayed behaviour typical of a surface-confined process. Under steady-state conditions for the formation of superoxide, it was found that for both the conformal and microcrystallite Li2O2 phases, electrooxidation followed zero-order kinetics, pointing to the importance of free surface sites in facilitating these reactions. A marked change in the rate of Li2O2 formation was found to coincide with a coverage of 0.25 monolayers, as measured by the charge density of the conformal Li2O2 electrooxidation peak. We postulate that electron tunnelling through both the conformal Li2O2 layer and microcrystallites deposited on this surface layer coincides with this coverage and accounts for such behaviour. This phenomenon of electron tunnelling through single conformal and mixed conformal/microcrystallite structures should prove vitally important in governing the overall electrooxidation rate

Supercritical CO2 extraction of waxes as part of a holistic biorefinery

The scope of this project was to utilise supercritical carbon dioxide (scCO2) extraction technology as a pre-treatment step in a holistic C4 biorefinery in order to extract added value metabolites from C4 agro-residues. The lipid profile of three different types of C4 biomass agro-residues namely miscanthus, maize and sugarcane was studied. Wax extractions with organic solvents and scCO2 were conducted on different parts of the plant. A diverse range of hydrophobic molecules were identified including long-chain fatty acids, n-policosanols, fatty aldehydes, n-alkanes, wax esters, sterols, steroid ketones and triterpenoids. The extracts exhibited significant differences in melting temperatures, highlighting the possibility for utilisation in different applications. The advantages of scCO2 extraction over conventional organic extraction are clearly demonstrated in this work. Herein, the first reported fractionation of maize stover wax gave rise to three waxy fractions. Fraction A consisted of high molecular weight compounds while Fraction B was predominantly phytosterols. Fraction C had the lowest melting profile and the wax was tested as a renewable antifoaming agent. Fraction C successfully reduced foam and had no negative effects on the detergent performance. The extraction of wax from C4 biomass only utilises around 1% of the total biomass. In order to have a systemic view of a C4 biomass processing scenario where scCO2 extraction is integrated into a biorefinery, the effects of scCO2 extraction on the downstream processing of maize stover and miscanthus were studied. In fermentation of maize stover for surfactant production, results show that there was a higher glucose consumption (19%) and greater growth (18%) for the scCO2-extracted maize stover when compared to non-treated maize stover. In fermentation experiments for ethanol production a 40% increase in overall ethanol production for the scCO2-extracted maize stover was obtained. Saccharification results on miscanthus leaves showed a 22% increase in sugar release for scCO2 extracts. Finally, this work cannot be developed further unless an economic evaluation of the manufacturing process is done. This is the first time an economic assessment for the scCO2 extraction of waxes from biomass has been carried out. The cost for miscanthus and maize stover wax extraction was found to be €148/kg of wax and €88.19/kg of wax respectively. If the biomass was pelletised, leaves were solely taken into consideration (4 times the wax yield) and the biomass was combusted following the extraction, then the cost of the wax could be reduced to as much as €8.60/kg of wax for miscanthus and €1.97/kg of wax for maize

Clinical outcome of pediatric collagenous gastritis : case series and review of literature

Collagenous gastritis (CG) is characterized by patchy subepithelial collagen bands. Effective treatment and the clinical and histological outcome of CG in children are poorly defined. The aim of this study is to summarize the published literature on the clinical outcome and response to therapy of pediatric CG including two new cases. We performed a search in Pubmed, OVID for related terms; articles including management and clinical and/or endo-histologic follow up information were included and abstracted. Reported findings were pooled in a dedicated database including the corresponding data extracted from chart review in our patients with CG. Twenty-four patients were included (17 females) with a mean age of 11.7 years. The clinical presentation included iron deficiency anemia and dyspepsia. The reported duration of follow up (in 18 patients) ranged between 0.2-14 years. Despite most subjects presenting with anemia including one requiring blood transfusion, oral iron therapy was only documented in 12 patients. Other treatment modalities were antisecretory measures in 13 patients; proton pump inhibitors (12), or histamine-2 blockers (3), sucralfate (5), prednisolone (6), oral budesonide in 3 patients where one received it in fish oil and triple therapy (3). Three (13%) patients showed no clinical improvement despite therapy; conversely 19 out of 22 were reported with improved symptoms including 8 with complete symptom resolution. Spontaneous clinical resolution without antisecretory, anti-inflammatory or gastroprotective agents was noted in 5 patients (4 received only supplemental iron). Follow up endo-histopathologic data (17 patients) included persistent collagen band and stable Mononuclear cell infiltrate in 12 patients with histopathologic improvement in 5 patients. Neither collagen band thickness nor mono-nuclear cell infiltrate correlated with clinical course. Intestinal metaplasia and endocrine cell hyperplasia were reported (1) raising the concern of long term malignant transformation. In summary, CG in children is a chronic disease, typically with a variable clinical response and an indolent course that is distinct from the adult phenotype. Long term therapy usually inclused iron supplementation but cannot be standardized, given the chronicity of the disease, variability of response and potential for adverse events.peer-reviewe

Synthesis of cholesterol-reducing sterol esters by enzymatic catalysis in bio-based solvents or solvent-free

Enzymatic synthesis of a β-sitosterol ester in bio-based solvents was compared with conventional solvents. Limonene and p-cymene gave higher initial reaction rates than n-hexane, and comparable conversions after 24 hours (∼75%). Importantly, a solvent-free system yielded the highest conversion (88%)