Post-operative bronchoscopy findings of esophageal atresia patients, initial phase of single-institute experience

Background

Esophageal atresia (EA) is not a rare congenital anomaly. It is usually accompanied by tracheoesophageal fistula (TEF). Respiratory morbidities are experienced in most of the survivors. Although it was believed that these symptoms tend to improve by age, permanent lung damage may continue to adulthood in some patients. We aimed to assess the respiratory tract in the follow-up period as an attempt to correlate possible findings with symptoms experienced which allowed us to pay more attention to the respiratory tract during the upcoming surgical interventions. Prospective observational study was conducted on patients presented to our institute, throughout 2018, with various degrees of refractory respiratory tract involvement, after having had their EA repaired inside or outside our institute. After exclusion of esophageal causes of these manifestations, bronchoscopy was performed to correlate the findings with the symptoms experienced by these patients. The study does not include patients repaired after 2018 as surgical modifications were performed and are still under study.

Results

Fifteen patients presented with various respiratory symptoms. Although recurrent chest infection is the commonest presentation, acute life-threatening events were reported in 5 patients. Blind-ended tracheal diverticulum was the most common finding observed in 80% of patients. About 76% of these patients were found to have tracheomalacia. Moreover, bronchoscopy was able to detect recurrent tracheoesophageal fistula in 4 patients. Vocal cords were affected in 13% of these patients.

Conclusions

Frequent respiratory symptoms in operated patients warrant careful long-term monitoring and appropriate management. Although bronchoscopy is considered a mandatory pre-repair procedure, it is a crucial tool in evaluating the survivors. It is pivotal to pay more attention to the respiratory tract to modify the surgical techniques to overcome these pitfalls.

Nutritional rehabilitation for children with cystic fibrosis: Single center study

BACKGROUND

Cystic fibrosis (CF) is an inherited disorder that causes severe damage to multiple organs in the body. Nutritional management has a dramatic effect on growth and survival in CF patients. This study aimed to assess the nutritional status of Egyptian pediatric patients with CF before and after proper nutritional counseling and supplementation.

METHODS

This is an interventional observational study conducted on fifty children with CF recruited from CF clinic, Children's Hospital, Cairo University. The patients were subjected to history taking, clinical examination, full nutritional assessment, including signs of vitamins deficiencies, Subjective global assessment (SGA), anthropometric measurements, laboratory assessment (complete blood count, kidney, liver function tests and Prealbumin as a nutritional marker). After the initial assessment all the patients were subjected to a proper nutritional plan plus vitamin and mineral supplementations then reassessed them after 3 months.

RESULTS

SGA showed that 60% of the patients had severe malnutrition, 62%, 78%, and 48% of the patients were below -2 Z score for height, weight, and BMI respectively which decreased to 45%, 40%, and 32% after nutritional supplementation. 43% of the patients were anemic, 29% were hypoalbuminemic, and 80% had low serum Prealbumin levels. After 3 months of follow up, only 17% had anemia, 11% had hypoalbuminemia, and 41% had low serum Prealbumin. Compliance was detected in 76% of caregivers during the follow up.

CONCLUSION

CF patients had considerable impairment in their nutritional status. Proper caloric intake and vitamin supplementation had a valuable impact on their growth and prognosis.

Plasma microRNA-21, microRNA-146a and IL-13 expression in asthmatic children

Childhood asthma represents a worldwide problem, involving genetic, immune defense and environmental components. MicroRNAs (miRs) are non-coding, single-stranded RNAs involved in immune regulation. The aim was to evaluate clinical potential of plasma miR-21 and miR-146a involved in T helper differentiation in childhood asthma and non-asthmatic controls. Group 1 consisted of 27 asthmatic children receiving inhaled corticosteroids (ICSs), which was compared to group 2 with 21 healthy control children. All patients were assessed by pulmonary function tests. miR-21 and miR-146a expression levels were determined by real-time quantitative PCR, and IL-13 was measured using ELISA. Group 1 showed significant up-regulation of plasma miR-21 and miR-146a levels with mean values 42.6-fold and 4.7-fold higher than average expression, respectively, in group 2. miR-21 levels positively correlated with IL-13 levels and eosinophil percentage, while miR-146a only correlated to eosinophil percentage. There was a linear association between each of miR-21 and miR-146a expression and FEV1 (forced expiratory volume in the first second), miR-21 and miR-146a are up-regulated in asthmatic children. miR-21 served as a better asthma biomarker. Association between both markers and FEV1 points to their role in determining asthma outcome following ICS treatment. miR-21 and miR-146a play a role in eosinophilic endotypic classification of asthma.