Helicobacter pylori infection and gut microbiota in adolescents: Is there a relation?

Helicobacter pylori infection is a prevalent global infection associated with several complications such as peptic ulcer, upper gastrointestinal bleeding, and stomach cancer. An imbalance in the gut microbiota composition or the relationship between the microbiota and the host may be implicated in the infection. To investigate this, we studied the intestinal microbiota of 50 newly infected adolescents with H. pylori compared with 50 age-matched and sex-matched healthy controls. The gut microbiota composition was assessed using real-time polymerase chain reaction (RT-PCR), and the fecal bacterial diversity and composition were compared between groups. Our findings revealed that Clostridium difficile and Salmonella spp. were significantly higher in the patient group compared to the control group. Additionally, lower counts of eubacteria, Bacteroides fragilis, Lactobacillus spp., Escherichia coli, and Methanobrevibacter smithii, were observed in the gut of adolescents with H. pylori. Conversely, adolescents with H. pylori infection had non-significantly higher counts of Bifidobacterium spp., C. difficile, and Salmonella spp. Multiple logistic regression analysis revealed that a greater abundance of Bifidobacterium spp. and Salmonella spp., a higher prevalence of C. difficile, and a lower abundance of Lactobacillus spp. were predictive of H. pylori infection. Overall, our results suggest that H. pylori infection is associated with changes in fecal microbiome composition.

Vitamin D in Children With Inflammatory Bowel Disease: A Randomized Controlled Clinical Trial.

BACKGROUND: Vitamin D has anti-inflammatory and immune regulatory functions. GOALS: The authors investigated the effect of vitamin D supplementation in children with inflammatory bowel disease (IBD) and hypovitaminosis D on disease activity, quality of life (QOL), inflammatory markers, and cytokines. STUDY: This randomized double-blinded controlled clinical trial included 120 children with IBD and hypovitaminosis D; 22 of them were excluded later. Patients were randomized to receive either oral vitamin D3 in a dose of 2000 IU/day or placebo for 6 months. The primary outcome was to evaluate the effect of vitamin D supplementation on the IBD activity score. The secondary outcomes were to assess the QOL, inflammatory markers, cytokines, the safety of vitamin D, and to correlate serum vitamin D level with various clinical and laboratory variables. RESULTS: Vitamin D supplementation significantly decreased the IBD activity score in the vitamin D group compared with the placebo group. Moreover, QOL significantly improved after vitamin D supplementation. Inflammatory markers, for example, erythrocyte sedimentation rate, C-reactive protein, and fecal calprotectin and interleukin-2 IL-12, IL-17, IL-23, and tumor necrosis factor-alpha significantly decreased in the vitamin D group. However, IL-10 significantly increased after vitamin D supplementation. Vitamin D was significantly inversely correlated with the activity score, QOL score, levels of all inflammatory markers, the frequency of hospitalization, and emergency department visits. CONCLUSION: Vitamin D supplementation may have a beneficial effect in children with IBD.

Does Metal Hypersensitivity Have Relevance in Patients Undergoing TMJ Prosthetic Replacement?

PURPOSE: Although concerns regarding implant-related metal hypersensitivity exist, no guidelines have been accepted for screening or treatment of patients with metal sensitivity before temporomandibular joint replacement (TMJR). The present study aimed to determine the trends in TMJR metal sensitivity screening and the effect of positive test results on patient treatment. MATERIALS AND METHODS: A questionnaire was distributed to members of the American Society of Temporomandibular Joint Surgeons and the European Society of Temporomandibular Joint Surgeons using a web-based data collection and analysis tool. The questions aimed to establish the screening methods used to establish a diagnosis of metal hypersensitivity and any changes in management when metal hypersensitivity had been documented. RESULTS: A total of 72 responses (32.43%) were collected through the survey, with respondents primarily practicing in the United States (47.22%). Of the participants, 75% believed that metal hypersensitivity occurs with TMJR and only 2.77% did not. Most agreed that patients should be questioned about any metal sensitivities before consideration for TMJR (91.66%), and 80.55% routinely asked their patients if they had a previous sensitivity to any metals. Nickel was the most commonly encountered metal allergen (64.28%). If a metal allergy were reported, 44.28% of surgeons would refer the patient to determine the specific metal allergen. The diagnosis for metal allergy was based primarily on patient signs and symptoms (52.85%) and an allergist or dermatologist consultation (44.28%). The lymphocyte transformation test was the test most used by respondents to confirm the diagnosis. Of the surgeons, 41.42% would choose to observe/monitor as their first choice for patients testing positive for metal hypersensitivity. In the case of a "mild" reaction to metal hypersensitivity testing, 54.28% would alter their implant choice to a nonreactive metal component. For "severe" reactions to preoperative metal hypersensitivity testing, 62.85% would alter their implant choice to a nonreactive metal component, and 22.85% would choose not to perform TMJR. CONCLUSIONS: The results from the present study have demonstrated that respondent TMJ surgeons agree that metal hypersensitivity occurs with TMJR. However, their approaches to screening and managing metal hypersensitivity vary. Further research of this topic is required to eventually develop specific management pre- and postoperative guidelines for the treatment of patients with metal sensitivities.

Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery.

BACKGROUND: Postoperative junctional ectopic tachycardia is one of the most serious arrhythmias that occur after pediatric cardiac surgery, difficult to treat and better to be prevented. Our aim was to assess the efficacy of prophylactic dexmedetomidine in preventing junctional ectopic tachycardia after pediatric cardiac surgery. METHODS AND RESULTS: A prospective controlled study was carried out on 90 children who underwent elective cardiac surgery for congenital heart diseases. Patients were randomized into 2 groups. Group I (dexmedetomidine group): 60 patients received dexmedetomidine; Group II (Placebo group): 30 patients received the same amount of normal saline intravenously. The primary outcome was the incidence of postoperative junctional ectopic tachycardia. Secondary outcomes included bradycardia, hypotension, vasoactive inotropic score, ventilation time, pediatric cardiac care unit stay, length of hospital stay, and perioperative mortality. The incidence of junctional ectopic tachycardia was significantly reduced in the dexmedetomidine group (3.3%) compared with the placebo group (16.7%) with P<0.005. Heart rate while coming off cardiopulmonary bypass was significantly lower in the dexmedetomidine group (130.6±9) than the placebo group (144±7.1) with P<0.001. Mean ventilation time, and mean duration of intensive care unit and hospital stay (days) were significantly shorter in the dexmedetomidine group than the placebo group (P<0.001). However, there was no significant difference between the 2 groups as regards mortality, bradycardia, or hypotension (P>0.005). CONCLUSION: Prophylactic use of dexmedetomidine is associated with significantly decreased incidence of postoperative junctional ectopic tachycardia in children after congenital heart surgery without significant side effects.

Prognostic Impact of WT-1 Gene Expression in Egyptian Children with Acute Lymphoblastic Leukemia.

BACKGROUND: Acute lymphoblastic leukemia (ALL) is the most common childhood cancer representing 23% of pediatric cancers. Wilms' tumor -1 gene is a novel prognostic factor, minimal residual disease marker and therapeutic target in acute leukemia. AIM OF THE WORK: The aim of this work was to study the impact of WT-1 gene expression in the prognosis of ALL. PATIENTS AND METHODS: This study was conducted on 40 Egyptian children with newly diagnosed ALL who were subjected to full history taking, thorough clinical examination and laboratory investigations including; complete blood count, LDH, BM aspiration, cytochemistry, immunophenotyping, FISH technique for detection of t(12;21) and t(9;22) and assessment of WT-1 Gene by real-time PCR in BM samples at time of diagnosis. RESULTS: Positive WT-1 gene expression was found in 22 cases (55%) and negative expression in 18 cases (45%). Positive WT-1 gene expression group (n=22) includes 14 males and 8 females with mean age at presentation of 5.261 ± 0.811 while negative WT-1 gene expression group (n=18) includes 12 males and 6 females with mean age at diagnosis of 9.669 ± 3.731 with significantly older age in negative WT-1 gene expression group but no significant differences between positive and negative WT-1 gene expression groups regarding sex and clinical presentations. There were no significant differences in platelets and WBCs counts, hemoglobin and LDH levels and the number of peripheral blood and BM blast cells at diagnosis between positive and negative WT-1 gene expression groups but after induction therapy there were significantly lower BM blast cells in positive WT-1 gene expression group. There were no statistically significant differences between positive and negative WT-1 gene expression groups regarding immunophenotyping and chromosomal translocations including t(12;21) and t(9;22). There were a significantly higher relapse and death rate and a lower rate of CR, DFS, and OAS in negative WT-1 gene expression group. MRD at end of induction therapy was found in 14 cases out of 40 patients. There were significantly higher number of patients with MRD+ in negative WT-1 gene expression group (After the therapy 20 out of 22 (89%) patients with positive WT-1 gene expression attained a negative MRD, while only 6 out of 18 (33%) with negative WT-1 attained a negative MRD) (p-value = 0.006). CONCLUSIONS AND RECOMMENDATION: WT-1 gene expression is an important prognostic factor in patients with ALL, being able to prognosticate a negative MRD. Therefore, we can recommend its incorporation into novel risk-adapted therapeutic strategies in patients with ALL.

Study of Common Bacterial and Fungal Pathogens in Children with Hematological Malignancies during Febrile Neutropenia: Single Center Egyptian Study.

BACKGROUND: Infection 'is a common complication in children with hematological malignancies' during febrile neutropenia. ' OBJECTIVE: The aim of this study was to' evaluate common bacterial and fungal pathogens in children with hematological malignancies during febrile neutropenia in single center Egyptian study. ' PATIENTS AND METHODS: This study was carried out on 90' children with hematological malignancies during febrile neutropenia including 54 with ALL, 27 with AML and 9 with NHL with their ages ranging from 2.5- 13 years and mean age value of 5.5 ± 3.5. Complete blood count, BM aspiration, and blood and throat cultures were done for all patients. RESULTS: Positive bacterial growth was found in 54 cultures (30%) including 42 blood cultures and 12 throat cultures with significantly higher Gram negative bacterial growth. Staphylococcus aurous and Pseudomonas aeruginosa were the most common Gram positive and negative organisms respectively. Cefepime was the most effective antibiotic against isolated bacterial growth where 80% of Gram negative bacterial growth was sensitive to it, 20% showed intermediate response and no Gram negative Cefepime resistance was recorded. On the other hand, 62.5% of Gram positive organisms was sensitive to it, 25% showed intermediate response and Gram positive Cefepime resistance was found in 12.5%. Ampicillin sulbactam 'was the most effective antibiotic against Gram positive' organisms with 100% sensitivity. Positive fungal growth was found in 36 cultures (20%) including 30 throat cultures and 6 blood cultures and all fungal isolates were candida. Amphotericin was active against 100% of fungal isolates, while resistance to Fluconazole and Voriconazole was found in 25% and 33.33% respectively. CONCLUSIONS: 'Gram negative is still more common than gram positive' infections and fungal infection is also a common cause of fever in patients with hematological malignancies during neutropenia and must be taken in consideration in every case of febrile neutropenia.

Therapeutic value of black seed oil in methotrexate hepatotoxicity in Egyptian children with acute lymphoblastic leukemia.

BACKGROUND: 'Acute lymphoblastic leukemia is the most common childhood malignancy'. Adding methotrexate to treatment protocols increased survival rate in children with leukemia. Methotrexate efficacy is limited by its hepatotoxicity. AIM OF THE STUDY: To assess the therapeutic value of Black seed oil in 'methotrexate induced hepatotoxicity in Egyptian children with acute lymphoblastic leukemia'. SUBJECTS AND METHODS: This study was conducted on 40 children with acute lymphoblastic leukemia' including 20 patients under methotrexate therapy and Black seeds 80 mg/kg/day for one week after each methotrexate dose [Group II] and 20 patients under methotrexate therapy and placebo [Group III]. This study included also '20 healthy children of matched age and sex as a control group' [Group I]. All patients were subjected to complete blood picture, bone marrow aspiration and liver functions. RESULTS: No significant differences in liver functions between group II and III before therapy were observed. There were nonsignificant increase in total, direct and indirect serum bilirubin, serum ALT, AST, and alkaline phosphatase levels and prothrombin time in group II after methotrexate and Black seed oil therapy but there was significant increase in group III after treatment with methotrexate and placebo with 'significant differences between group II and III ' after therapy. There were significant differences in prognosis regarding remission, relapse, death and 'disease free survival but no significant difference in overall survival between group II and III'. CONCLUSION: Black cumin seeds decreased MTX hepatotoxicity and improved survival in children with ALL and can be recommended as adjuvant drug in patients with ALL under methotrexate therapy.

Parvovirus B19 infection in children with a variety of hematological disorders.

This study was carried out to detect Parvovirus B19 (PB19) DNA together with its antibodies in the sera of children with a range of hematological disorders to clarify the contribution of this infection to changes observed in hematological picture in those populations. This study included 85 pediatric patients with different hematological disorders. Twenty healthy subjects with matched age and sex were included as controls. Patients were classified into four groups; group I included 25 patients with hemolytic anemia in aplastic crisis, group II included 20 patients with hemolytic anemia without aplastic crisis, group III included 20 acute leukemia patients under chemotherapy, group IV included 20 patients with recently diagnosed acute leukemia. Virological study for PB19 included determination of specific IgG & IgM together with viral DNA by polymerase chain reaction (PCR). In all groups of patients with positive markers for PB19, there were statistically significant differences in the mean Hb concentration and RBC count (P < 0.001 for each), presence of neutropenia (P = 0.003) and lymphocytosis (P < 0.001) compared to controls. There was statistically significant difference in the prevalence of PB19 IgM, IgG and PCR among studied groups compared to control group. In group I and group II IgG had the highest positive rate (56 and 35%, respectively). In group III IgG also had a high positive rate (45%). However, in group IV IgM had the highest positive rate (50%) followed by PCR (45%) then IgG (40%). In conclusion, PB19 infection is detected in high rates among children with hematological disorders. PB19 must be suspected and screened for when there is anemia in those patients associated with neutropenia and lymphocytosis. In patients with acute leukaemia under chemotherapy who have unexpected anemia, neutropenia and lymphocytosis Parvovirus infection should be considered before a change of chemotherapy protocol. Screening of blood for PB19 may be helpful in understanding the epidemiology of infection with this virus. The direct detection of DNA by PCR in sera needs to be coupled with serology for a more reliable diagnosis of PB19 infections in these children.