Eskander, A. E., H. K. Sawires, and B. A. Ebeid, "Foreign body ingestion in Egyptian children: a 10-year experience of endoscopic intervention in a tertiary hospital.", Minerva pediatrica, vol. 71, issue 5, pp. 443-448, 2019. Abstract

BACKGROUND: There is paucity of data regarding foreign body (FB) ingestion among Middle-Eastern children. We conducted a retrospective analysis of FB ingestion among Egyptian children and determined the predictors that affect the occurrence of complications.

METHODS: This retrospective study was carried out on 1546 patients aged 13 years or younger presenting with FB ingestion and in need of endoscopic FB removal.

RESULTS: There were 711 males (46%) and 835 females (54%) (mean age 4.56±2.26 years). Symptoms were present in 1414 patients (91.5%) while complications were present in 137 patients (8.9%). There was a significant difference between complicated and non-complicated cases with regard to higher age group, duration of impaction, site of impaction and type of FB (P=0.001, P=0.001, P=0.001, and P<0.001, respectively).

CONCLUSIONS: The highest rate of complications was observed in FB impacted in duodenum and those without symptoms while symptomatic cases and impaction in upper esophagus were associated with higher success rate of removal.

Eskander, A. E., N. E. R. Baroudy, and A. E. S. Refay, "Ketamine Sedation in Gastrointestinal Endoscopy in Children.", Open access Macedonian journal of medical sciences, vol. 4, issue 3, pp. 392-396, 2016. Abstract

BACKGROUND: Moderate sedation for gastrointestinal endoscopy has traditionally been provided by the endoscopist. Controversy has ensued over safe and efficient sedation practice as endoscopy has increased in numbers and complexity.

AIM: To evaluate the safety of ketamine sedation given by non-anesthesiologist during gastrointestinal endoscopy in children.

METHODS: A prospective study of 100 paediatric patients with gastrointestinal symptoms who were a candidate for upper or lower gastrointestinal endoscopy in paediatric endoscopy unit at Abo El-Reesh Paediatric Hospital, Cairo University. All children were > 2 years old and weighed > 6 kg. The analysis was performed in terms of sedation-related complications.

RESULTS: A total 100 paediatric patients including 53 males and 47 females with mean age of 5.04 years were involved in the study. All children were medicated with ketamine with a mean dose of 3.77mg/kg. No complications occurred in 87% of cases. Desaturation occurred in 13% of the cases and was reversible by supplemental nasal oxygen. Desaturation was more frequent during Upper GI Endoscopy and with the intramuscular route (p value=0.049). No apnea, bradycardia, arrest or emergence reactions were recorded.

CONCLUSION: Ketamine sedation found to be safe for paediatric gastrointestinal endoscopy in Egyptian children without co-morbidities. Transient Hypoxia (13%) may occur but easily reversed by nasal oxygen therapy.

Eskander, A. E., L. S. Sherif, M. Nabih, N. E. R. Baroudy, G. C. Marcos, E. A. Badawy, and A. E. S. Refay, "Serum Zinc Level and Its Correlation with Vesikari System Scoring in Acute Pediatric Diarrhea.", Open access Macedonian journal of medical sciences, vol. 5, issue 5, pp. 677-680, 2017. Abstract

BACKGROUND: Diarrhea remains the most common infectious disease worldwide. Zinc has been studied extensively recently for its potential effect on prevention, control and treatment of acute diarrhoea.

AIM: This study was designed to correlate the level of zinc with the severity of pediatric diarrhoea estimated by Vesikari Scoring System.

PATIENTS AND METHODS: The present study included 80 children aged two months to 30 months from those suffering from the acute diarrheal episode and admitted to Pediatric Hospital "Abo El Rish" Cairo University. Serum Zinc level was assessed by a colorimetric method with a spectrophotometer.

RESULTS: Zinc deficiency was detected in 45 (56.2%) patient of the studied group Significant negative correlations were found between serum zinc level and severity of dehydration and duration of hospitalization (p < 0.05).

CONCLUSION: Zinc level has an essential role in acute pediatric diarrhoea. Zinc therapy should be considered beside Oral rehydration salts (ORS) to achieve maximum impact on diarrheal diseases; clinical trials are recommended to support the zinc supplementation in developing countries.

Ghobrial, C. M., and A. E. Eskander, "Prospective study of the effect of topical application of Mitomycin C in refractory pediatric caustic esophageal strictures.", Surgical endoscopy, vol. 32, issue 12, pp. 4932-4938, 2018. Abstract

BACKGROUND: Esophageal strictures resulting from caustic ingestion in children are usually difficult to be managed, and surgical replacement is usually required for cases refractory to frequent dilatation sessions. Topical Mitomycin C (MMC) has been recently used in the management of resistant strictures. We evaluated the efficacy of MMC application in treatment of long refractory caustic esophageal strictures.

METHODS: This prospective study included 120 patients of both sexes with refractory caustic long esophageal strictures (> 3 cm in length). All patients were randomly divided into two equal groups using the research randomizer program (1:1 randomization), group I underwent endoscopic dilatation therapy only and group II underwent dilatation with topical application of MMC. Follow-up was done regularly by assessing the dysphagia score and patients were evaluated after 6 months of management. The procedure was repeated four times with 2-week intervals. Complete relieve of symptoms (dysphagia score = 0) was assessed after the follow-up period.

RESULTS: The complete cure was detected in 81.6% of patients in the MMC group compared to only 40% in the first group, p-value < 0.0001. During the follow-up, the average sessions of dilatation needed in group II were 3.25 ± 2.78 compared to 6.25 ± 1.74 sessions in group I (p < 0.001). The mean cost of sessions in patients who showed symptomatic and endoscopic improvement was significantly lower in group II (272.2 ± 51 US$) when compared to group I (404 ± SD 55.7 US$).

CONCLUSIONS: Cure rate was double in the MMC group. MMC application significantly improved symptoms and reduced both the number and frequency of dilatations to alleviate dysphagia in patients with refractory caustic esophageal strictures and hence reduced the cost of treatment.

Tomerak, R. H., A. A. El Badawy, A. E. Eskander, and A. H. Mahmoud, "Does bloody aspirate reflect the state of upper gastrointestinal mucosa in a critically ill newborn?", Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology, vol. 13, issue 3, pp. 130-5, 2012 Sep. Abstract

BACKGROUND AND STUDY AIMS: Critically ill newborns have many risk factors to develop stress related mucosal lesions (SRML). We used upper endoscopy to evaluate the presence of SRML in these neonates, to know the specificity and sensitivity of the bloody gastric aspirate to detect SRML and to identify the risk factors associated with the presence of SRML and bloody gastric aspirate.

PATIENTS AND METHODS: This is a cross-sectional study done on 100 critically ill newborn after becoming clinically stable. SRML were diagnosed if there is hyperaemia, erosions or ulcers in the oesophagus, stomach, and/or the duodenum.

RESULTS: SRML were found in 77% of neonates in the NICU though frank bloody aspirate was detected in only 22% of neonates. The presence of bloody aspirate showed low sensitivity (24.68%) and high specificity (86.96%) for the presence of SRML. The presence of bloody gastric aspirate showed a double fold risk for the presence SRML (OR=2.184, CI=0.584-8.171). Factors associated with SRML included respiratory distress (p=0.000, risk=4.006), the use of nasogastric tube (p=0.017, OR=3.281) and the use of triple antibiotics (p=0.001, risk=1.432). Factors associated with the presence of bloody gastric aspirate included the use of nasogastric tube (OR=1.629, p=0.000) and the presence of haemostatic disorders (OR=3.143, p=0.039). It was also associated with lower haemoglobin levels (p=0.000).

CONCLUSION: SRML represents an under-diagnosed problem in NICUs. Absence of bloody gastric aspirate does not exclude the presence of SRML.

Fadel, F. I., S. H. Makar, A. E. Eskander, and A. H. Aon, "Decreasing intra-dialytic morbid events and assessment of dry weight in children on chronic hemodialysis using non-invasive changes in hematocrit.", Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, vol. 25, issue 5, pp. 1030-7, 2014 Sep. Abstract

Achieving dry weight after hemodialysis (HD) is critical as chronic fluid over-load can result in left ventricular hypertrophy, while small fluid shifts may result in intra-dialytic morbid events (IME). In the pediatric population, estimating dry weight can be difficult due to growth while on dialysis. Continuous non-invasive monitoring of the hematocrit (NIVM) has been proposed as a more accurate method of estimating dry weight. Fifteen pediatric patients on chronic HD (6 males and 9 females; mean age 11.4 ± 2.28 years) were included in an uncontrolled prospective study involving three phases. In phase 1, patients were observed for one month for their dry weight and frequency of IME. Phase 2 consisted of using NIVM-guided ultrafiltration algorithm for rate of blood volume (BV) reduction and post-dialysis refill, recommending an intra-dialytic reduction in BV of 8% in the first hour and <4% per hour thereafter and without significant post-dialytic vascular refill. Phase 3 comprised a one month period for comparing the results. IME decreased from 33 episodes per 180 sessions in phase 1 to 4 per 180 sessions during phase 3 (P = 0.04), without a significant difference in pre-systolic or post-systolic or mean BP before and after the intervention (all P >0.1). In phase 1, 40% of patients experienced no IME, 33% experienced one or two IME while 27% experienced more than two IME; during phase 3, 80% experienced no IME, 20% experienced one or two IME while no one experienced more than two IME. NIVM can serve as an objective method for determining dry weight as well as predicting and preventing IME in the pediatric population on maintenance HD.

Fahmy, M. E., M. A. Osman, R. A. Mahmoud, L. K. Mohamed, K. I. Seif-elnasr, and A. E. Eskander, "Measuring of gastric emptying in Egyptian pediatric patients with portal hypertension by using real-time ultrasound.", Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association, vol. 18, issue 1, pp. 40-3, 2012 Jan-Feb. Abstract

BACKGROUND/AIM: Among the various methods for evaluating gastric emptying, the real-time ultrasound is safe, does not require intubation, or rely on either radiologic or radionuclide technique. The aim of our work was to measure the gastric emptying in pediatric patients with portal hypertension by using the real-time ultrasound.

PATIENTS AND METHODS: Forty patients with portal hypertension with mean age 7 ± 2.8 years and 20 healthy children as a control group underwent gastric emptying study by using real-time ultrasound. The cross-sectional area of the gastric antrum was measured in the fasting state and then each subject was allowed to drink tap water then calculated by using formula area (π longitudinal Χ anteroposterior diameter/4). The intragastric volume was assumed to be directly proportional to the cross-sectional area of the antrum.

RESULTS: The mean gastric emptying half-time volume was significantly delayed in portal hypertension patients (40 ± 6.8 min) compared with the control subjects (27.1 ± 3.6) min (P<0.05). Patients with extrahepatic portal vein obstruction had significant delayed gastric emptying in comparison to patients with portal hypertension due to other etiologies (36.14 ± 4.9 vs 44.41 ± 6.04 min; P<0.01).

CONCLUSION: Ultrasound is a noninvasive and a reliable method for measuring gastric emptying in pediatric patients. Gastric emptying was significantly delayed in patients with portal hypertension. Etiology of portal hypertension may influence gastric emptying time in patients with chronic liver disease.

Eskander, A. E., B. I. Mounir, C. M. Ghobrial, and H. M. El-Karaksy, "Study of helicobacter pylori infection in children with portal hypertensive gastropathy.", Minerva pediatrica, 2015 Nov 25. Abstract

BACKGROUND: Data about the association of Helicobacter pylori (H. pylori) and portal hypertensive gastropathy (PHG) are scarce in children.

AIM: The present study aimed to fill the knowledge gap in this area.

METHODS: To achieve this goal we studied the prevalence of H. pylori infection in a group of infants and children with PHG using rapid urease test and histological demonstration of H. pylori in gastric mucosal biopsy obtained by upper gastrointestinal endoscopy. The results were compared to a control group who underwent endoscopy for other indications maily hematemesis and/or dyspepsia.

RESULTS: H. pylori was equally prevalent in both groups (~60%). Children with PHG were significantly stunted in height, had significantly lower hemoglobin, platelets and serum iron. Severe PHG was associated with higher grade of esophageal varices. Within the group with PHG, H. pylori infection was associated with lower hemoglobin, serum iron and serm ferritin. Moderate to severe PHG was more associated with H. pylori infection.

CONCLUSION: H. pylori infection was not more commonly associated with PHG, however, it might contribute to the severity of PHG. The synergistic effect of PHG and H. pylori infection might contribute to the retarded growth and iron deficiency status noted in this group.

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