Mongolian gerbil model has been extensively used for the study of neuroprotective drugs since transient bilateral common carotid artery occlusion induces neuronal cell death to selectively vulnerable regions, including the CA1 sector of the hippocampus. Previously we have shown that NutriSim©, a nutritive supplement used empirically in the treatment of several degenerative disorders protects against brain damage induced by ischemia-reperfusion in Mongolian gerbils. These effects are partly attributed to its antioxidant action. The purpose of this study was to further investigate the potential neuroprotective effects of NutriSim© with histological measures of global ischemia in gerbils. We found that a single dose of NutriSim© was able to prevent significantly the ischemia-induced pyramidal cell loss as well as the number of hyperchromatic cells and glial cells after a week of treatment. In consonance with these data, increased TUNEL positive cells after ischemia is reduced in NutriSim© treated animal after a week.

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The increased recognition of the difference between the adult and the pediatric populations in terms of the manifestation and the management of gastroesophageal reflux disease (GERD), owes much to the number and nature of high quality clinical research and drug trials conducted in the past decade. The plethora of choices available to treat GERD is unprecedented. A primary care physician clearly understands the investigative and therapeutic options available, and some of the risks associated with them. What makes the physician wary is the absence of a) a clear objective definition of gastroesophageal reflux disease (GERD) in a pediatric population and b) sufficient data to support the use of the armamentarium available. The variety of definitions and terms used in the literature to define GERD adds to the confusion and results in a variety of approaches to manage it. In light of the new developments, the objective of the review is threefold, 1) to simplify as much as possible the current evidence based pediatric literature in defining GERD and its common presentations in the three distinct sub-populations of children as newborns and infants (0-12 months), toddlers and children (1-10 years), and adolescents (11-18 years). These cut-off periods are arbitrary and some overlap is inevitable, 2) to review the diagnostic and therapeutic tools available today, and 3) to effectively apply these tools and formulate pathways in some case scenarios, for the esophageal and extra esophageal GERD manifestation in the three distinct age groups specified above.

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Once the diagnosis of hypertension has been established in a child or an adolescent, the investigations to be requested need to include a search for the primary cause when secondary hypertension is suspected, the identification of associated and co-morbid conditions and the evaluation of target-organ damage. Instituting therapy should be based on clear indications, the choice of lifestyle and/or pharmacological treatment should be guided by the pathophysiology of the underlying mechanism and based on evidence-based guidelines.

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The renewed interest in hypertension in children and adolescents has resulted from the recognition that its presence in adults often has its roots at a younger age. Accurate measurement of blood pressure in children is essential to establish a diagnosis and it should be based on an appropriate technique and comparison to well established population-based standards. The causes are multiple in young children and a thorough evaluation of possible primary causes is imperative.

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