1.
Comparison of Oropharyngeal Microbiota from Children with Asthma and Cystic Fibrosis.
Boutin, S, Depner, M, Stahl, M, Graeber, SY, Dittrich, SA, Legatzki, A, von Mutius, E, Mall, M, Dalpke, AH
Mediators of inflammation. 2017;2017:5047403
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The lungs are under constant exposure to microorganisms contained in inhaled air and the upper respiratory tract. In healthy subjects, the lower airways are colonized by bacteria. Changes in the microbiome are found in several lung diseases associated with chronic airway inflammation including chronic obstructive pulmonary disease, asthma and cystic fibrosis. The aim of the study was to find out whether the throat microbiota of children with asthma and cystic fibrosis differ from healthy children. Another aim was to find out whether the throat microbiota of children with asthma differ from those with cystic fibrosis. The study compared the throat microbiota of healthy school-aged children with that of age-matched children with asthma and cystic fibrosis. Results indicate that the microbiota of cystic fibrosis, asthmatic, and healthy children show high levels of similarities with a strong core microbiota. The cystic fibrosis group show a decrease in both diversity and total bacterial load in the throat in comparison to asthmatic and control children. The cystic fibrosis group also showed a significant increase in typical pathogens in the throat. Based on the results, the authors conclude that the three patient groups had a core microbiome and a host regulation that favours the growth of commensals.
Abstract
A genuine microbiota resides in the lungs which emanates from the colonization by the oropharyngeal microbiota. Changes in the oropharyngeal microbiota might be the source of dysbiosis observed in the lower airways in patients suffering from asthma or cystic fibrosis (CF). To examine this hypothesis, we compared the throat microbiota from healthy children (n = 62) and that from children with asthma (n = 27) and CF (n = 57) aged 6 to 12 years using 16S rRNA amplicon sequencing. Our results show high levels of similarities between healthy controls and children with asthma and CF revealing the existence of a core microbiome represented by Prevotella, Streptococcus, Neisseria, Veillonella, and Haemophilus. However, in CF, the global diversity, the bacterial load, and abundances of 53 OTUs were significantly reduced, whereas abundances of 6 OTUs representing opportunistic pathogens such as Pseudomonas, Staphylococcus, and Streptococcus were increased compared to those in healthy controls controls and asthmatics. Our data reveal a core microbiome in the throat of healthy children that persists in asthma and CF indicating shared host regulation favoring growth of commensals. Furthermore, we provide evidence for dysbiosis with a decrease in diversity and biomass associated with the presence of known pathogens consistent with impaired host defense in children with CF.
2.
Effects of fasting and preoperative feeding in children.
Yurtcu, M, Gunel, E, Sahin, TK, Sivrikaya, A
World journal of gastroenterology. 2009;15(39):4919-22
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Preoperative fasting is usually carried out to prevent the risk of vomiting during anaesthesia. The study investigated whether children should have a long period of fasting before surgery. Eight groups of 10 children (aged 1-10 years) with disorders of groin and scrotum were orally fed normal liquid food (NLF) or a high calorie diet (HCD) in 2 divided doses at 6 hour intervals, then fasted for 2, 3, 4 or 5 hours prior to surgery. Four groups had NLF and 4 groups had HCD. All children had their glucose, prealbumin and cortisol levels measured twice, just after the oral feeding and just before surgery. Once anaesthesia was sufficient and stable, gastric liquid was collected and measured. Patients with disease that could delay gastric emptying, had high acid production or were on medication were excluded from the trial. The researchers found that there was no significant difference in blood prealbumin levels in all groups. There was significant increase in blood cortisol in 4 groups when fasted (NLF-2h fasted, HCD-2h fasted, NLF-3h fasted and HCD-5h fasted). Stomach aid residue liquids were at tolerable levels of 1-2ml in all children. Anaesthesia was uneventful, with no coughing, laryngospasm or vomiting reported, and outcomes of surgery and wound healing were not affected. The authors noted that drinking clear liquids up to 2 hours before surgery was unlikely to substantially affect the volume of gastric fluids, and did not appear to increase the risk of vomiting in normal, healthy children. Glucose and insulin infusions appeared to minimise endocrine stress response and normalised post-op insulin sensitivity. Additionally, there may be a psychological benefit for children as irritability appeared to decrease prior to surgery. The study concluded that there was no need for fasting longer than 2 hours prior to inguinoscrotal region surgery.
Abstract
AIM: To investigate whether children should undergo surgery without a long period of fasting after feeding. METHODS Eighty children with inguinoscrotal disorders (aged 1-10 years) were studied prospectively. They were divided into eight groups that each contained 10 children who were fed normal liquid food (NLF) and a high-calorie diet (HCD) 2, 3, 4 and 5 h before surgery, in two doses at 6-h intervals. NLF was given to four groups and HCD to the other four. In all groups, glucose, prealbumin and cortisol levels in the blood were measured twice: just after oral feeding and just before the operation. After the establishment of adequate anesthesia, gastric residue liquid was measured with a syringe. RESULTS Blood glucose levels in all patients fed NLF and HCD were high, except in patients in the HCD-4 group. There was no significant difference in the blood prealbumin levels. There was a significant increase in the blood cortisol levels in the NLF-2 (14.4 +/- 5.7), HCD-2 (13.2 +/- 6.0), NLF-3 (10.9 +/- 6.4), and HCD-5 (6.8 +/- 5.7) groups (P < 0.05). CONCLUSION The stress of surgery may be tolerated by children when they are fed up to 2 h before elective surgery.
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A randomized controlled study comparing elemental diet and steroid treatment in Crohn's disease.
Zoli, G, Carè, M, Parazza, M, Spanò, C, Biagi, PL, Bernardi, M, Gasbarrini, G
Alimentary pharmacology & therapeutics. 1997;11(4):735-40
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An elemental diet is considered an effective primary treatment for active Crohn's disease, usually given by a feeding tube. This RCT evaluated the affect of elemental diet administered orally on disease activity, intestinal permeability and nutritional status when compared to high-dose corticosteroids. 22 Crohn’s disease patients were enrolled of which 2 withdrew and 20 were randomised to oral elemental diet group (n-10) or corticosteroid plus normal diet group (n=10) for 2 weeks. After 2 weeks clinical disease activity improved significantly in both groups. Crohn’s disease activity and erythrocyte sedimentation rate improved in the diet group. Crohn's disease activity improved in the corticosteroid group. Disease remission rate was higher in the diet group (n=8) compared to the corticosteroid group (n=5). 12 months after the study there was no difference in disease relapse rate between groups. Intestinal permeability was significantly improved in the diet group only. However, at the start of the study, permeability levels were randomly lower in the corticosteroid group than the diet group so it is not possible to say that elemental diet was more effective than corticosteroids in promoting gut mucosal healing. Nutritional status improved in both groups but was more evident in the diet group. The authors conclude that an oral elemental diet is effective in promoting and maintaining remission of Crohn’s disease activity, in restoring intestinal permeability and improving nutritional status, and is generally well tolerated with a high degree of compliance.
Abstract
BACKGROUND Elemental diet is considered an effective primary treatment for active Crohn's disease, but it is usually given by a feeding tube. METHODS Twenty-two patients (12 males, median age 30 years, range 18-60) with moderately active Crohn's disease were enrolled in a randomized study in which the efficacy of an elemental diet administered orally was compared to high-dose corticosteroids in achieving clinical and laboratory remission. Ten patients were treated by oral elemental diet (Peptamen, Clintec, USA) and 10 received corticosteroids. Both treatment regimens lasted 2 weeks. The two groups did not differ with respect to age, sex, body weight, location of disease, treatment or disease activity prior to the study. In all patients studied, simple Crohn's disease activity index, nutritional status (expressed as body mass index), percentage of ideal body weight, fat mass, fat free mass, erythrocyte sedimentation rate, interleukin-6, intestinal permeability (expressed as permeability index), prealbumin, retinol binding protein and multiskin test were evaluated before and after treatment. RESULTS After 2 weeks of treatment, there were significant improvements in simple Crohn's disease activity index, erythrocyte sedimentation rate, permeability index, body mass index, prealbumin, retinol binding protein and multiskin test in the elemental diet group. There were significant improvements in simple Crohn's disease activity index and fat free mass in the corticosteroid group. CONCLUSIONS These data suggest that, in the short term, an oral elemental diet is at least as effective as steroids in inducing remission of mild-moderately active Crohn's disease, but it may be more effective in improving the nutritional status of these patients, probably through a more rapid restoration of normal intestinal permeability.