Oral Zinc Sulfate as Adjuvant Treatment in Children With Nephrolithiasis: a Randomized,Double-Blind,Placebo-Controlled Clinical Trial

Background:

Nephrolithiasis in children is associated with a high rate of complications and recurrence.

Objectives:

Since some evidences reported that zinc has an important place amongst inhibitors of crystallization and crystal growth, we decided to assess the effectiveness of oral zinc sulfate as adjuvant treatment in children with nephrolithiasis.

Patients and Methods:

This was a randomized, double-blind, placebo-controlled clinical trial. 102 children in the age range 1 month to 11 years with first nephrolithiasis were recruited. Patients were randomly divided into two equal groups (intervention and control groups). Intervention group received conservative measures for stones and 1 mg/kg/day (maximum 20 mg/day) oral zinc sulfate syrup for 3 months. Control group received placebo in addition to conservative measures, also for 3 months. Patients were followed up by ultrasonography for 9 months, in 5 steps (at the end of 1st, 2nd, 3rd, 6th and 9th month after treatment) assessing size and number of stones in the kidneys.

Results:

Only at the end of the first month, the average number (intervention: 1.15 ± 3.78, control: 1.3 ± 2.84) (P = 0.001) and size (cm) (intervention: 0.51 ± 1.76, control: 0.62 ± 1.39) (P = 0.001) of stones was significantly lower in the intervention group, and in other points there was no significant therapeutic efficacy in oral zinc adjuvant treatment compared to conservative treatment alone. Also, during the 9-month follow-up, the number and size of stones in both groups decreased significantly (both: P < 0.0001) in a way that the decrease in the intervention group showed no difference with the control group.

Conclusions:

Adjuvant treatment with zinc is not more effective than consecutive treatment in children with nephrolithiasis. However, further studies are recommended due to the lack of clinical evidence in this field.     

Comparison of Epinephrine to Salbutamol in Acute Bronchiolitis

Objective

An appropriate treatment of acute viral bronchiolitis can reduce the symptoms, hospitalization duration and exorbitant costs which is imposed on the families and insurance organizations. This study was conducted to determine the efficacy of epinephrine in comparison with salbutamol in the treatment of the disease.

Methods

Forty infants aged one month to 2 years with acute bronchiolitis in Amin and Al-Zahra hospitals, during 2008, were enrolled in this study. The participants were randomized in two treatment groups to receive epinephrine 0.1 ml/kg or salbutamol 0.15 mg/kg. Three doses of each medication were prescribed at intervals of 20 minutes and continued every 10 minutes after the third dose. The patients in both groups were monitored and rated by RDAI, number of the hospitalized days in the hospital, level of oxygen saturation and vital signs.

Findings

Mean hospitalization duration was 3.3±1.1 and 3±0.9 in the patients receiving salbutamol and epinephrine, respectively (P=0.03). There was a significant difference in assessing RDAI index between the two groups (P=0.03). There were no differences in SPO2, PR, or RR variables in the studied intervals in both groups (P>0.05).

Conclusion

Regarding the effect of epinephrine on reduction of hospitalization duration and the RDAI index in patients with acute bronchiolitis, it seems that using epinephrine instead of salbutamol could be more effective in the management of the disease.     

A Randomized Controlled Trial of Oral Zinc in Acute Pneumonia in Children Aged between 2 Months to 5 Years

Objective  

To evaluate the effectiveness and safety of zinc supplementation as adjuvant in treatment of pneumonia.     

Acute osteomyelitis and septic arthritis in children: a spectrum of disease

A spectrum of acute osteomyelitis and septic arthritis seen in children was studied, identifying four major groups, each with a different clinical presentation and different expected prognosis: (1) the usual group of osteomyelitis with a 10% incidence of poor results; (2) neonatal osteomyelitis (10% of osteomyelitis) with 25% poor results; (3) a group of severely ill patients with disseminated staphylococcal disease (10% of osteomyelitis) with 13% mortality and 38% poor results; and (4) the usual group of septic arthritis, with 5% poor results. Almost all cases of osteomyelitis were due to Staphylococcus aureus except in the neonatal group, where 28% were due to -haemolytic streptococci. Surgical drainage was performed in 91% of the usual osteomyelitis cases, in all with disseminated staphylococcal disease, and in 88% of babies with neonatal osteomyelitis, i.e. all the cases involving a joint. Cloxacillin was the drug of choice in osteomyelitis. In septic arthritis Staph. aureus was cultured in 29%, Haemophilus influenzae in 18%, streptococcus in 12%, pneumococcus in 6%, and no growth in 33%. Open arthrotomy was performed in all cases. Cloxacillin was used for cases infected with Staph. aureus, ampicillin for H. influenzae, and penicillin for streptococcal and pneumococcal infections. Offprint requests to: EB Hoffman     

细支气管炎患儿血清嗜酸性细胞趋化因子测定及肺功能检查的临床意义

目的探讨细支气管炎(简称毛支)患儿嗜酸性细胞趋化因子(eotaxin)水平及肺功能改变的临床意义。方法采用双抗体夹心酶联免疫吸附试验方法,对30例毛支急性期、20例恢复期患儿的外周血标本进行血清eotaxin水平测定,同时采用美国森迪公司2600婴儿肺功能仪进行肺功能检查,并与20例健康对照组儿童相比较。结果毛支恢复期组患儿血清eotaxin水平比急性期组明显下降(P<0.01),但两组均明显高于健康对照组儿童(P均<0.01);毛支恢复期组患儿呼出75%潮气量时的呼气流速/潮气呼气峰流速(25/PF)及潮气呼气中期流速/潮气吸气中期流速(ME/MI)比急性期组明显升高(P<0.01),但25/PF仍低于对照组(P<0.01),而ME/MI与对照组相比无显著性差异(P<0.05);毛支患儿急性期组血清eotaxin水平与25/PF呈负相关(r=-0.42,P<0.05),与ME/MI无相关性(r=0.05,P>0.05)。结论毛支患儿急性期肺功能主要表现为阻塞性通气功能障碍,eotaxin参与了毛支的发病过程。     

Bronchiolitis due to respiratory syncytial virus in hospitalized children: a study of seasonal rhythm

AIM: The objective of this study was to describe the rhythm of respiratory syncytial virus (RSV) bronchiolitis seasonal outbreaks in hospitalized children. METHODS: Data was collected from 1324 patients, who were admitted to our hospital with bronchiolitis, over an 11-year period, from 1994 to 2004. The epidemic onset was established according to the epidemic index. Virological diagnosis was made with immunofluorescent assay from nasopharyngeal washings. Rhythm study was carried-out by spectral analysis with the fast-Fourier transformed and cosinor method. RESULTS: Epidemics begin in September (45%) and October (55%); the highest peak was observed in January, the minimum in August and the end in February (73%), March (18%) and April (9%). When the epidemic outbreak begins sooner, the end is sooner as well. Epidemic onset varies but not its length and the onset was less variable than its conclusion. Spectral analysis showed a 12-months cyclic period along the study years and cosinor analysis demonstrated significant circannual rhythm. When data was segregated by long and short hospital stay, no significant differences were found between the rhythms. Comorbid association among bronchiolitis, otitis and gastroenteritis was very common. CONCLUSION: Bronchiolitis epidemics onset and conclusion varies along time years in hospitalized infants and showed circannual rhythmicity with a 12-months period.     

Concentrations of Zinc, Copper, Manganese and Selenium in Blood and Urine of Patients with Prolactinoma

This study was designed to evaluate trace element metabolism in patients with prolactinoma. The mean concentrations of zinc in plasma, erythrocytes and urine, copper in plasma and erythrocytes and selenium in plasma were within normal limits before and after surgery. Urinary copper excretion was significantly lower than in controls, before surgery (<0.05) and rose towards normal after treatment. Erythrocyte manganese content was significantly lower than in controls, in patients with prolactinoma before surgery P<0.05) and rose towards normal after treatment.     

Plasma Valine and Urinary C-Peptide in Breast-fed and Artificially Fed Infants up to 6 Months of Age

ABSTRACT. Plasma branched-chain amino acids and urinary C-peptide-creatinine excretion was determined at 3, 41/2 and 6 months of age in a group of 50 infants who were either breast-fed or artificially fed and selected at random. The average concentrations of valine in plasma and C-peptide in urine as well as the ratio between C-peptide and creatinine in urine were 2–3 times higher ( p < 0.01) in artificially fed as compared to breast-fed infants at all the ages studied. Plasma valine values correlated significantly with the urinary C-peptide/creatinine ratio ( r = 0.76, p < 0.01), which suggests that the enhanced insulin response induced by the artificial formula is related to its protein content.     

Effects of Vitamin E and Zinc Supplementation on Antioxidants in Beta thalassemia major Patients

Objective

In beta thalassemic patients, tissue damage occurs due to oxidative stress and it happens because of the accumulation of iron in the body. This study was conducted to determine the effect of zinc and vitamin E supplementation on antioxidant status in beta-thalassemic major patients.

Methods

This double blind randomized clinical trial was carried out on 120 beta thalassemic patients older than 18 years. Patients were randomly categorized in four groups. Zinc (50mg/day) and vitamin E (400mg/day) supplements were administered for former and latter group, respectively. In the third group both supplements were administered in similar doses. The fourth (control) group received no supplement. The effect of supplementations on serum zinc and vitamin E, superoxide dismutase (SOD), glutathione peroxidase (GPX), total antioxidant capacity (TAC) and body mass index (BMI) were measured at the beginning and the end of the study.

Findings

Serum zinc levels in group 1 and 3 were significantly increased (P<0.007 and P<0.005, respectively). Serum vitamin E levels in group 2 and 3 were also increased significantly (P<0.001). Mean GPX activity in group1, 2 and 3 decreased significantly (P<0.015, P<0.032 and P<0.029, respectively). Mean SOD activity and TAC did not show significant change after supplementation. BMI had significant increase in all treated groups (P<0.001).

Conclusion

Our results suggest that beta thalassemic patients have enhanced oxidative stress and administration of selective antioxidants may preclude oxidative damage.     

二乙基己基邻苯二甲酸致小鼠附睾生殖毒性及锌保护作用实验研究

目的 探讨二乙基己基邻苯二甲酸(DEHP)埘附睾生殖功能的损害和可能机制,探寻DEHP毒件作用的拮抗剂.方法 出生后20d(PND20)和50d(PND50)雄件KM小鼠分别随机分为正常对照组、玉米油组、DEHP组和DEHP+葡萄糖酸锌组,连续灌胃10d,观察各期各组小鼠附睾组织学改变,检测雄激素受体(AR)、雌激素受体(ER)表达水平;体外培养PND20和PND50小鼠附睾上皮细胞.MTT法测定附睾上皮细胞活性.测定唾液酸(SA)含量、α-1,4-糖苷酶活性及乳酸脱氢酶(LDH)活力.结果 体内实验表明DEHP可导致附睾萎缩等组织病理学改变.并可导致附睾组织AR水平上调和ER水平下调(P0.01);体外实验表明DEHP可导致附睾上皮细胞活性降低.而DEHP+葡萄糖酸锌组附睾的形态、结构及功能均未见明显改变.结论DEHP可使附睾的结构和功能受损.锌对DEHP所致附睾牛殖毒性具有拮抗作用.     

STUDIES ON ERYTHRO-KINETICS IN INFANCY XI. The Change in Circulating Red Cell Volume During the First Five Months of Life

Sixty measurements of circulating red cell volume using a ⁵¹Cr method were performed in 22 full-term and 16 premature infants during the age interval 0–138 days. In 15 of these infants 2 or 3 measurements were made. During the first 6 weeks of life the average decrease of red cell volume was 0.9% per day. In this respect no difference was found between full-term and premature infants. By comparing the change in red cell volume found in this study with data from the literature on the disappearance rate of foetal red blood cells from the circulation, the red blood cell production of full-term infants during the first 2 months of life was found to be quite small and in accordance with previously published estimates. The initial level of red cell volume was regained by the full-term infants at the age of 5–6 months. The data collected also contribute to information on normal values for red cell volume, plasma volume and total blood volume during early infancy.     

彩色多普勒超声诊断小儿急性阑尾炎的临床应用研究

目的探讨彩色多普勒超声诊断小儿急性阑尾炎的临床应用。方法对临床拟诊的78例急性阑尾炎的患儿全部行彩色多普勒超声检查以明确诊断及鉴别诊断。结果78例临床拟诊的急性阑尾炎病人，经彩色多普勒超声检查诊断为急性阑尾炎的51例，全部行手术治疗，经手术及术后病理检查50例证实为急性阑尾炎。本组出现假阳性1例，假阴性1例，准确率为97．7％。结论采用无创伤性、简单安全的彩色多普勒超声诊断小儿急性阑尾炎可靠、准确，值得推广应用。     

儿童急性阑尾炎诊断评分法的制定和初步应用

目的 建立一种诊断性评分法在术前应用，以提高儿童急性阑尾炎诊断的准确性。方法 回顾性分析研究1998年1月～2000年6月于我科行阑尾切除术的860例患者(年龄2～14岁，平均8．2岁)的临床资料，以确认有助于区分急性阑尾炎和假性阑尾炎的指标，并对这些临床资料进行统计学分析。结果 确认7项有诊断意义的指标，以贝叶斯概率对之进行评分，并利用ROC曲线找到诊断临界分值，从而建立诊断性评分系统。应用该评分法对我科2000年9月～2001年2月的107例患者术前评分，证实该法具有较高的灵敏度和特异度。结论 本研究建立的评分法对于提高儿童急性阑尾炎的诊断准确性及降低不必要的手术治疗有一定的帮助。     

Role of Acute Illness Observation Scale (AIOS) in managing severe childhood pneumonia

Objective In the perspective of integrated management of childhood illness (IMCI) strategy and recent evidence favoring use of oral antibiotics in severe pneumonia, a generic illness severity index — Acute Illness Observation Scale (AIOS)-was prospectively validated in children with severe pneumonia in a civil hospital in remote hilly region. Methods AIOS was used in quantifying overall severity of illness for eighty-nine consecutive children (age, 2–59 months) hospitalized with community-acquired severe pneumonia. A detailed clinimetric evaluation of scale was carried out and logistic regression analyses predicted the following outcomes: 1) mode of initial antimicrobial therapy (oral vs. parenteral); and 2) need for intravenous fluids at admission. Results Majority of children (80.9%) with severe pneumonia scored abnormally (AIOS score >10) at initial evaluation. Children with abnormal AIOS scores (>10) had significantly greater severity of respiratory distress and higher incidence of radiological pneumonia. Outcome measures i.e. time to defervescence and length of hospital stay were also positively and significantly correlated with the scores. The six-item scale had good internal consistency (Cronbach’s alpha 0.81); and its factor analysis yielded a single latent factor explaining 54% of variance in illness severity at admission. Furthermore, logistic regression analyses revealed an independent predictive ability of AIOS in aiding clinician to decide the mode of initial antimicrobial therapy (oral or parenteral), as well as need for intravenous fluids. Conclusion Authors study indicates the clinimetric validity of AIOS in managing, Severe childhood pneumonia and suggests its role in further enriching IMCI strategy.     

Pseudo-Chediak-Higashi Anomaly in Acute Myeloid Leukemia (M2) of Childhood

The frequency and clinical significance of the pseudo-Chediak-Higashi (PCH) anomaly were studied in 20 children with acute myeloid leukemia (AML) M2 in the FAB nomenclature. PCH granules were recognized as giant eosinophilic granules, measuring up to 5μ, in the cytoplasm of leukemic cells on smears. At the electron microscope level, most PCH granules were round to oval and outlined by a limiting membrane, and contained homogeneous, granular, crystalloid, rod-like or myelin-like materials. The PCH anomaly was demonstrable in five (25.0%) of the 20 patients, which indicates that the anomaly is not rare in childhood AML M2. There were no differences between PCH anomaly-positive and PCH anomaly negative groups with regard to hepatosplenomegaly, hemoglobin levels, white blood cell counts, bone marrow cellularity, t(8q-, 21q+) chromosome abnormalities or prognoses. Circulating leukemic cells were observed less frequently in the PCH anomaly-positive group than in the PCH anomaly-negative group (p <0.05); the leukemic cells were not demonstrable in three of the five patients in the former group, although they were detected in all 15 patients in the latter group. The existence of PCH granules and/or a defect of the cytoskeleton responsible for the PCH anomaly in leukemic cells may impede their movement from the bone marrow to the peripheral blood.     

Lacteal Zinc and Copper in Relation to Volume, Total Ash and Energy during the First Three Months of Lactation of Brazilian Women

ABSTRACT. The concentrations of zinc and copper were longitudinally studied during the first three months of self-determined lactation periods of nine Brazilian women. Both elements were studied in relation to volume, energy and total ash of milk. During the six bi-weekly intervals, zinc showed a significant difference between the high initial value (as mass/volume), mass/g of ash and mass/kcal) and later values toward the end of the third month, but no significant difference was observed for copper. With respect to all three of those parameters, regression analysis of zinc against length of lactation (six bi-weekly intervals) showed a significant and inverse correlation. Only when expressed as mass/g of ash was copper significantly and directly correlated with length of lactation. The data indicate that zinc secretion into human milk occurs independently of copper and mineral mass and also follows a previously identified physiological pattern.     

The Role of the Small Intestine in Cystic Fibrosis Patients

ABSTRACT. A survey is given of the morphological and biochemical lesions of the small intestine that can he found in cystic fibrosis patients. The available data on the structure and function of the small intestine in CF patients favour the hypothesis that the small intestine itself might contribute to the malabsorption of nutrients in this disease. The most pronounced lesions, i.e. meconium ileus and absent active transport of bile salts are found in the ileum. It might be remembered that the ileum is also the site of intensive exchange of chloride and bicarbonate, a function that is heavily disturbed in the pancreas of CF patients. For this reason, further studies on the ileal function in cystic fibrosis are warranted.