Objective: Evaluate the effect of probiotics association in reducing the total bilirubin level in the serum of neonates with jaundice. Methods: 69 neonates with indirect hyperbilirubinemia were divided randomly into two groups: control and treatment. The control group was treated using phototherapy and the treatment group was treated using phototherapy plus L.Reuteri probiotic. Inclusion criteria: all term newborns admitted for phototherapy for unconjugated hyperbilirubinemia. Exclusion criteria: septic or ill newborn, phenobarbital therapy, transfusion and parents ‘refusal to enter the study. Baseline bilirubin level was obtained prior to initiating phototherapy and then daily for an average of 3 days. Results: Before treatment, the level of bilirubin was similar in the two groups (p>0.05). We noted a more significant difference in bilirubin at day 1 (p=0.000), day 2 (=0.000) and day 3 (p=0.000) during treatment in the probiotic group when compared to the control group. We also noticed a more significant decrease in bilirubin between day 1 and day 2 (p=0.000) and between day 2 and day 3 (p=0.000) in the probiotic group when compared to the control group. Conclusion: The decrease of bilirubin in neonates with jaundice is more rapid and more significant in the group receiving probiotics as an adjuvant to phototherapy in case of presence of incompatibility or not.

Background: Patients with sickle cell disease are at higher risk of infections with encapsulated bacteria due to immature immune responses and functional asplenia. We aimed to study our patient population for the emergence of gram-negative organisms other than Salmonella as the cause of osteomyelitis and document a vast decrease in Streptococcus pneumoniae bacteremia rates. Methods: We conducted a retrospective chart review of 158 patients with sickle cell disease registered at our hospital. Over a period of 13 years, every patient presenting to the emergency department (ED) with fever had their medical record reviewed for blood cultures, wound cultures, and magnetic resonance imaging results for osteomyelitis. Results: The number of patients presenting to the ED with fever was 105, with 581 febrile episodes and 893 blood cultures. Among those, no culture grew Streptococcus pneumoniae, 14 grew coagulase-negative staphylococci (1.5%), one grew Salmonella enterica Paratyphi B, and three grew Salmonella enterica group C (in the same patient). The total number of osteomyelitis episodes in patients with sickle cell disease presenting with fever and documented by imaging was nine (1.5%). In patients with osteomyelitis, organisms were isolated in four patients (44%), including Enterobacter cloacae, Bacteroides, Pseudomonas aeruginosa, and Salmonella enterica group C. Conclusions: Immunization against Streptococcus pneumoniae and the use of prophylactic penicillin has virtually eliminated pneumococcal bacteremia among our patients. We observed the emergence of gram-negative organisms other than Salmonella as the cause of osteomyelitis in patients with sickle cell disease.

BackgroundThe war in Syria triggered the influx of a large number of refugees into neighboring countries, particularly Lebanon. In 2019, the Syrian population made up 13.33% of the total population in Lebanon. This shift in demographics influenced many sectors in the country, including the healthcare system. The purpose of this study is to analyze the impact of Syrian refugees on the Lebanese healthcare system across five public health centers (PHCs) and the prevalence of type II diabetes (T2D) in these patients. MethodsPatient data was collected across five PHCs from different regions in Lebanon. Comparisons between Lebanese and Syrian patients were analyzed for demographics, relative number of patients, and prevalence of T2D.

Purpose: Isolated hypoaldosteronism is a rare cause of salt wasting in infancy caused by the loss of activity of aldosterone synthase (AS), which is encoded by the CYP11B2 gene. This condition may be life-threatening, especially in newborns. Methods: We are reporting the case of a newborn male born to consanguineous parents, who presented at the age of 1 month with severe dehydration, vomiting, and hypotonia. Results: Lab studies showed severe hyponatremia, hyperkalemia, and metabolic acidosis. Hormonal assessment confirmed a normal corticotrope axis with severe deficiency in aldosterone. Genetic analysis revealed a novel mutation in the CYP11B2 gene in the highly conserved donor splice site of exon 3 and confirmed the isolated aldosterone deficiency. The patient was subsequently treated with fludrocortisone and sodium only, without hydrocortisone. Conclusion: AS deficiency is a rare inherited disease. There should be a high index of suspicion of cases with life-threatening salt-wasting in infancy as dramatic clinical improvements and good long-term prognosis can be achieved with timely replacement treatment.

Background: Acute diarrhea is a major cause of morbidity and mortality in children, particularly in developing countries (the second cause of death). Probiotics and symbiotics are recent treatments for this disease, especially in the acute phase. Our objective is to compare probiotic or symbiotic treatment against placebo in acute diarrhea by following the evolution of diarrhea in terms of hours, number of bowel movements, volume of stools and their consistency. On a larger scale, we want to find a cost-effective intervention that reduces the morbidity and mortality of diarrhea. Methods: Eighty-three children aged 6 months to 5 years, from three different regions of Mount Lebanon, were randomized to receive a probiotic, a symbiotic or a placebo once daily for 5 days. Patients were excluded from the study if they had any history of a chronic disease. The statistical analysis was carried out on SPSS v22.00 Results: Out of 120 surveys distributed to parents, 84 were completed: 43 patients received probiotics (nine received Lactobacillus, 21 received spores, and 13 patients received yeast), 24 received symbiotics and 17 were controls. Stool consistency normalized on day 4 in the probiotics and symbiotics groups (P = 0.009). Less number of days with fever (P = 0.018) were observed in the probiotic and symbiotic groups (1 day) compared to placebo (4 days). No difference in the symptoms associated with diarrhea was observed in the different groups. Conclusions: Probiotics and symbiotics normalized stool consistency in pediatric diarrhea by day 4 and decreased the number of days with fever compared to control. Our study did not show a statistically significant difference between the different probiotics and symbiotics for the treatment of diarrhea.