Percutaneous Endoscopic Gastrostomy Feeding in Children with Cerebral Palsy.

AIM: The prevalence of congenital cerebral palsy (CP) worldwide ranges from 0.15 to 0.4%. CP causes several gastrointestinal complications that inhibit normal eating behavior. This single-center observational study aimed to determine the tolerability and benefits of percutaneous endoscopic gastrostomy (PEG) in pediatric CP patients with malnutrition. MATERIALS AND METHODS: The study included 41 pediatric CP patients with malnutrition. All patient data were retrospectively obtained from Bakirköy Dr. Sadi Konuk Research and Training Hospital, Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Istanbul, Turkey. In addition to baseline measurements of weight, height, triceps skinfold thickness, 1,25-hydroxyvitamin D3, folate, iron, zinc, vitamin B12, hemoglobin, and mean corpuscular volume, data analyzed included follow-up measurements recorded at 3 and 6 months of PEG (standard polymeric enteral supplementation as 1.0 kcal mL-1). RESULTS: There was significant improvement in both height, weight, and triceps skinfold thickness in all patients at 3 and 6 months of PEG (p < 0.05). In terms of blood parameters, there was not significant improvement, except that the number of patients with a low hemoglobin count significantly decreased at 3 and 6 months of (p = 0.022). Moreover, the number of patients with vomiting after PEG also significantly decreased at 3 and 6 months of (p = 0.004). CONCLUSION: PEG significantly improves malnutrition in pediatric CP patients and does not cause any major complications. Based on these findings, we think PEG is a beneficial and cost-effective intervention with a high rate of tolerability in pediatric CP patients with malnutrition.

Comparison of Isocaloric and Hypercaloric Diet in Undernourished Patients.

OBJECTIVE: To determine efficacies of fiber-containing isocaloric and hypercaloric enteral supplements generally used to treat undernutrition. STUDY DESIGN: Retrospective cohort study. PLACE AND DURATION OF STUDY: Department of Pediatrics, Sanliurfa Halfeti State Hospital, Turkey from September 2019 to June 2020. METHODOLOGY: Pediatric patients aged 1-19 years were diagnosed solely with primary undernutrition, were given fiber containing isocaloric or hypercaloric enteral supplements for six months based on their energy requirements. A comparative analysis of anthropometrical data was made with each formula. The analysis included baseline weight, height, BMI of patients, and important micro-nutrient levels at three and six months after intervention. RESULTS: BMI, weight and height z-scores (p <0.001) were improved over six months. There were no differences in BMI and weight scores except for a significant improvement in height between baseline and third month, which was observed in patients who received hypercaloric formula unlike isocolaric formula. There was a two-tailed improvement in blood biochemistry values of both groups. CONCLUSION: Both isocaloric and hypercaloric supplementation had positive effects on anthropometry and blood biochemistry. These results show that both formulae are highly beneficial for children with primary undernutrition. Key Words: Pediatrics, Body mass index, Therapeutics, Gastroenterology, Undernutrition.

Analysis of nutrition clinical studies involving children in the Middle East and globally.

AIM: To assess pediatric clinical nutrition research by analyzing clinical studies in the Middle East (ME) and globally. METHODS: Using ClinicalTrials.gov, the numbers of clinical studies in the ME and globally were analyzed. RESULTS: The majority of clinical nutrition trials are in North America and Europe. The ME accounts for 4% of all nutrition trials. The majority of pediatric nutrition studies in the ME are in the later phases or are observational and/or epidemiological studies with a focus on poor nutrition or nutrition disorders. Industry funding in the ME is mostly by regional or local companies; few major global companies are involved. CONCLUSION: The ME is not well represented in clinical nutrition studies involving children. Effort should be expended to rectify this.

The role of inflammation and COX-derived prostanoids in the effects of bradykinin on isolated rat aorta and urinary bladder.

Bradykinin, a vasoactive peptide, increases during inflammation and induces the formation of prostaglandins through specific receptor activation. Two types of receptors mediate the biological effects of bradykinin, B(1) and B(2) receptors. Although B(2) receptors are present in most tissues, B(1) receptors are expressed after inflammatory stimuli or tissue injury. Bradykinin has a high affinity for B(2) and a low affinity for B(1) receptors, whereas the opposite occurs for des-Arg(9)-bradykinin. Recently, it has been reported that nonsteroidal anti-inflammatory drugs have different inhibitory activities on cyclooxygenase isozymes, COX-1, COX-2, and COX-3. In the present study, we have investigated the contributions of different COX isozyme inhibitions and inflammation on bradykinin-induced effects of isolated rat aorta and urinary bladder smooth muscle contractions. Male Sprague-Dawley rats weighing 200-250 g were used in the study. The vasodilatory responses to bradykinin (1 nM-1 µM) were studied on isolated rat aorta rings contracted with norepinephrine (0.1 µM) following incubation with dipyrone (100, 700, and 2,000 µM). The relaxant responses of dipyrone (100, 700, and 2,000 µM) were also compared on the isolated rat urinary bladder contracted with bradykinin (n = 8). A bacterial lipopolysaccharide was used for the induction of inflammation (n = 8). The levels of PGE(2), PGF(1α), TXB(2), nitric oxide synthase (NOS), IL-10, and TNF-α were all determined in both the plasma and the perfusate of the aorta preparations (n = 5). The vasodilatory activities of bradykinin and des-Arg9-bradykinin were significantly increased upon the inhibition of COX-3 (dipyrone at 100 µM). These effects disappeared in the inflamed group. PGE(2), PGF1α, and TXB(2) were significantly high, but NOS activity was low in the aorta perfusate after the inhibition of COX-3. Dipyrone showed the relaxant activity of the urinary bladder contracted with bradykinin. The vasodilatory activity of des-Arg(9)-bradykinin was in the inflamed group but not in the non-inflamed group. Bradykinin did not contract urinary bladder in inflamed group. The results suggest that COX-induced products may play an important role in the bradykinin-induced rat aortic smooth muscle relaxations.

Synthesis and biological activities of some thiazolidin-4-ones.

In this study, fifteen 2,3-disubstituted-4-thiazolidinone derivatives were synthesized by the reaction of Schiff bases and alpha-mercaptoacetic acid. The structures of the compounds were elucidated by IR, 1H-NMR, 13C-NMR, mass spectral data and elementary analysis. The antihistaminic and anticholinergic activities of the compounds were determined by tests performed on isolated guinea pig trachea in comparison with aminophylline (CAS 317-34-0). Compound 15 (3-[3-(2-methyl-piperidine-1-yl)propyl]-2-(4-methyl-phenyl)thiazolidin-4-one hydrochloride) showed the highest inhibition (53 %).