Effect of hydroxyurea on physical fitness indices in children with sickle cell anemia

The current studies aimed at determining physical fitness indices and anthropometrics profiles of children with sickle cell anemia (SCA) after the use of hydroxyurea (HU). Ninety-three male schoolchildren--who participated previously in a similar study before the introduction of HU--comprising 2 groups participated in the studies. Group 1 was 41 children who were suffering from sickle cell disease (SCD) and were on HU for a minimum of 2 years, whereas group 2 was 50 normal healthy controls. Anthropometrics measurement and parameters of physical fitness were assessed in all subjects. All children were also subjected to a minimum of 6-minute running exercise test on a flat motorized treadmill at speed corresponding to 5 km/h. Throughout the test heart rate was monitored and recorded during exercise and for 10 minutes during recovery. Blood hemoglobin (Hb) and HbF% were measured after the use of HU. The mean values of weight, height, and lean body mass were still lower in the SCD children (P < .05) compared with the healthy subjects. However, they had significant decrease in the mean heart rate values and they spent longer time on the treadmill before they got tired compared to their previous performance and were just below the normal controls. Hydroxyurea treatment improved the aerobic exercise tolerance and most of the physical fitness parameters in children with SCD.     

Transcatheter Closure of Acquired Left Ventricle-to-Right Atrium Shunt: First Case Report in an Infant and Review of the Literature

Gerbode defect, a left ventricle to right atrium (LV-RA) communication, is usually congenital. Acquired LV-RA communications are rare and only few case reports of successful trans-catheter closure have been published though none of them were on infants. We hereby report a rare case of LV to RA shunt acquired following surgical repair of Tetralogy of Fallot (TOF). The defect was successfully closed percutaneously with an Amplatzer duct occluder. This is the first reported case of device closure of an acquired Gerbode defect in an infant.     

Sexual maturity of children on regular hemodialysis: Role of testosterone and estradiol,a tertiary multicenter experience

A big problem is the delayed growth and sexual maturity in children with chronic kidney disease (CKD) with the consequent reduction in adults’ height. Testosterone and estradiol have significant physiologic changes in children suffering from CKD, resulting in delayed puberty. We aim to assess blood levels of these hormones in patients with CKD-5 on regular hemodialysis.One hundred-six participants were enrolled in the current study, 56 of whom had CKD on hemodialysis 3 times a week 4 hours per session, and 60 healthy age- and gender-matched children acted as controls. Full history was taken, and a clinical review was performed on both patients and controls. The pubertal assessment was performed according to Tanner''s classification and laboratory investigations of total and free serum (s.) testosterone in boys and s.estradiol in girls.Patients’ weight and height were considerably lower than controls. The free and total s.testosterone of patients were significantly reduced. The same applies to s.estradiol levels which were substantially reduced in comparison to controls. In both patients and controls, Tanner staging & male total s.testosterone levels and female s.estradiol levels had significant positive associations. There was a negative association between the sex hormones levels and the disease''s and dialysis duration in the patients’ group.S.testosterone and s.estradiol levels were significantly low in CKD patients on dialysis and were positively correlated with delayed pubertal growth observed in those patients.     

Antibiotic prophylaxis for prevention of postpartum perineal wound complications: a randomized controlled trial

OBJECTIVE: To estimate whether prophylactic antibiotics at the time of repair of third- or fourth-degree perineal tears after vaginal delivery prevent wound infection and breakdown. METHODS: This was a prospective, randomized, placebo-controlled study. Patients who sustained third- or fourth-degree perineal tears after a vaginal delivery were recruited for the study. Each patient was given a single intravenous dose of a second-generation cephalosporin (cefotetan or cefoxitin) or placebo before repair of third- or fourth-degree perineal tears. Obstetricians and patients were blinded to study drug. The perineum was inspected for evidence of infection or breakdown at discharge from the hospital and at 2 weeks postpartum. Primary end points were gross disruption or purulent discharge at site of perineal repair by 2 weeks postpartum. RESULTS: One hundred forty-seven patients were recruited for the study. Of these, 83 patients received placebo and 64 patients received antibiotics. Forty patients (27.2%) did not return for their 2-week appointment. Of the patients seen at 2 weeks postpartum, 4 of 49 (8.2%) patients who received antibiotics and 14 of 58 (24.1%) patients who received placebo developed a perineal wound complication (P=.037). There were no differences between groups in parity, incidence of diabetes, operative delivery, or third-degree compared with fourth-degree lacerations. CONCLUSION: By 2 weeks postpartum, patients who received prophylactic antibiotics at the time of third- or fourth-degree laceration repair had a lower rate of perineal wound complications than patients who received placebo. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clincaltrials.gov, NCT00186082. LEVEL OF EVIDENCE: I.     

Concomitant aortic valve replacement and coronary bypass: the effect of valve type on the blood flow in bypass grafts.

OBJECTIVE: In cases of aortic valve replacement, the downstream flow profile and turbulence in the ascending aorta differ according to the prosthetic aortic valve implanted. The objective of this work is to study the influence of prosthetic valve type on the flow in the bypass grafts implanted to the ascending aorta in cases of concomitant aortic valve replacement and coronary artery bypass. METHODS: The study is conducted on 456 patients receiving concomitant aortic valve replacement and coronary bypass vein grafts anastomosed to the ascending aorta. The patients included in the study received a total number of 725 vein grafts, 249 biological aortic valves and 207 mechanical aortic valves. Intraoperative transit time flow measurement was done for all bypass grafts and a multiple regression model was calculated for the factors influencing the flow in the bypass grafts. RESULTS: The mean flow in vein grafts in patients receiving biological valves was 49.79+/-26.88 ml/min, while in patients receiving mechanical valves it was 46.54+/-26.68 ml/min. The multiple regression model revealed that receiving a mechanical valve is an independent risk factor for lower flow in the vein grafts. CONCLUSIONS: The type of the aortic valve implanted and consequently the downstream flow profile in the ascending aorta do affect the flow in the vein grafts in cases of concomitant aortic valve replacement and coronary bypass. Receiving a mechanical aortic valve is an independent risk factor for lower flow in the vein grafts.