Comparative randomized controlled blind study of the anti-shivering effect of hydrocortisone, granisetron and meperidine in post-spinal anesthesia in patients undergoing cesarean section

Background: it was observed that a considerable proportion of patients undergoing surgery experience intraoperative and postoperative hypothermia and it was found that misregulation of body temperature due to anesthesia as well as the cold temperature of the operation room were the main cause

Purpose: to compare the anti-shivering effect of meperidine, hydrocortisone and granisetron after spinal anesthesia during elective cesarean section

Patients and Methods: this study presents a placebo-controlled prospective randomized blind study. Included patients were randomly [using computer generated randomization table] allocated into four equal groups each group consists of 28 patients

Results: in our study, age, sex, and ASA grade distribution of patients were nearly identical in the four groups. Furthermore, the duration of surgery and amount of irrigation fluid used in the four different groups were also similar. We did not observe a change in temperature gradient between the four groups. A study with a more prolonged duration of postoperative temperature monitoring is needed to note if core-periphery temperature changes occur with passage of time

Conclusion: the results indicate that IV granisetron 40 micro g/kg was effective as IV meperidine 0.4 mg/kg and both are slightly effective than IV hydrocortisone 2 mg/kg in reducing the incidence and intensity of shivering during spinal anesthesia compared to control group

Chanarin-Dorfman syndrome: a case report and review of the literature

Chanarin-Dorfman syndrome, a "neutral lipid storage disease with ichthyosis," is a multisystem inherited metabolic disorder associated with congenital ichthyosis and accumulation of lipid droplets in various types of cells. Case report: A 3-year-old male presented to the Pediatric Hepatology Unit, Cairo University Children's Hospital, Cairo, Egypt, with accidentally discovered hepatomegaly. He had generalised ichthyosis with dark skin pigmentation and bilateral ectropion. Abdominal examination revealed generalised abdominal distention with firm nontender hepatomegaly. His liver functions were deranged. Blood film showed many vacuolated neutrophils. Serum triglyceride and creatine kinase levels were elevated. Abdominal ultrasound showed a moderately enlarged liver with a bright echo pattern. Liver biopsy revealed marked diffuse macrovesicular fatty changes. The diagnosis of Chanarin-Dorfman Syndrome was made based on the dermatological, haematological, and liver biopsy findings

Glycogen storage disease type III in Egyptian children: a single centre clinico-laboratory study

Glycogen storage disease type III [GSD III] is an autosomal recessive disorder caused by deficiency of glycogen debrancher enzyme and is characterised by clinical variability. We herein describe the clinical and laboratory findings in 31 Egyptian patients with GSD III presenting to the Paediatric Hepatology Unit, Cairo University, Egypt. Eighteen patients [58%] were males. Their ages ranged between 6 months to 12 years. The main presenting complaint was progressive abdominal distention in 55%. Twelve patients [38.7%] had a history of recurrent attacks of convulsions; four had an erroneous diagnosis of hypocalcaemia and epilepsy. Dolllike facies was noted in 90%. Abdominal examination of all cases revealed abdominal distention and soft hepatomegaly which had bright echogenicity by ultrasound. Hypertriglyceridaemia was present in 93.6%, hyperlactacidaemia in 51.6% and hyperuricaemia in 19.4%. Liver biopsy showed markedly distended hepatocytes with well distinct cytoplasmic boundaries and 32% had macrovesicular fatty changes. Serum creatine kinase was elevated in 64.6% of patients and correlated positively and significantly with age [r = 0.7 and P = <0.001], while serum triglycerides correlated negatively with age [r = -0.4 and P = 0.05]. Blood glucose assessment and search for hepatomegaly in an infant with recurrent seizures may prevent delay in the diagnosis. A huge soft liver reaching the left midclavicular line that appears echogenic on ultrasonography is characteristic of GSD III. A distended hepatocyte with rarified cytoplasm is pathognomonic but not diagnostic. Hypertriglyceridaemia correlates negatively with age, in contrary to CK level

association of HLA class II DR B1 alleles with HCV infection in Egyptian children

Human leucocyte antigens [HLA] class II appear to play an important role in the individual's immune response to viral infection. The aim of this study is to assess the relationship between HLA class II antigens with the clinical, laboratory and histopathological state of the liver in Egyptian children and adolescents with chronic hepatitis C virus [HCV] infection. The study included 46 chronically infected HCV children and adolescents without - hepatitis B virus [HBV] nor human immunodeficiency virus - [HIV]. Their mean age was 10.4 +/- 4.23 years [3-17]. HLA-DRB typing was done by polymerase chain reaction [PCR] for the patients and 20 control subjects. Biochemical and haematological parameters were assessed as well as a liver biopsy was taken from the included patients. The most frequent alleles demonstrated among patients were DRB1*03, DRB1*04 and DRB1*13 [45.6%, 39.1% and 26.1%], respectively. Analysis of DRB1 frequencies between patients and control revealed that DRB1*15 is significantly reduced among patients when compared with the control group [p<0.01]. Patients possessing the allele DRB1*03 had significantly reduced platelet count [p=0.03], and this allele was presented to a greater extent in patients with minimal grade of inflammation. Patients with DRB1*04 had significantly low serum albumin [p=0.04] and patients with DRB1*13 had significantly high serum aspartate aminotransferase [AST] levels [p=0.05]. In Egyptian HCV-infected children, special HLA patterns were found; HLA DRB1*03 was present in nearly half of the patients, while the frequency of HLA DRB1*15 was significantly reduced among the cases in comparison to the control subjects

Predictors of non-alcoholic fatty liver disease in obese and overweight Egyptian children: single center study

Pediatric non-alcoholic fatty liver disease [NAFLD] is a global problem which has been increasingly recognized with the dramatic rise in pediatric obesity. The aim of the present study was to identify the clinical, sonographic, and biochemical predictors for NAFLD in obese children. Seventy-six children [2-15 years] were included after an informed consent. All were subjected to full anthropometric assessment [including height, weight, body mass index, subscapular skin fold thickness, waist and hip circumference and calculation of waist: hip ratio], biochemical assessment of liver function tests, lipid profile and insulin: Sixteen patients [21%] had elevated ALT and 6 [7.9%] had elevated AST. Significant dyslipidemia [low HDL-c, high total cholesterol, high LDL-c and triglycerides] and higher insulin resistance were found in obese patients [P<0.01]. The main sonographic findings were hepatomegaly in 20 patients [26.3%] and echogenic liver in 41 patients [53.9%]. Liver biopsy showed simple steatosis in eight cases [24.2%] and non-alcoholic steatohepatitis [NASH] in seven cases [21.2%]. Anthropometric measurements, increased hepatic echogenicty by ultrasound, insulin resistance and lipid profile were good predictors of NAFLD in obese children if assessed together. However, LDL-c was the only sensitive predictor [independent variable] for NAFLD in both uni- and multivariate logistic regression analyses. Dyslipidemia per se is a strong predictor of NAFLD among obese Egyptian children

Spectrum of chronic liver diseases in Egyptian children in Benha

We studied Retrospectively 70 patients with chronic liver disease in Benha University Hospital from 2000 to 2004. Our aim was to define the spectrum of chronic liver diseases presented to our pediatric hepatology clinic. The study included 50 males and 20 females with age ranging from 21 days to 13 years. All patients underwent liver biopsy, sonographic and biochemical analysis. Our results revealed that sixteen patients [22.85%] had chronic hepatitis, 12 [17.14%] had cholestasis, 12 [17.14%] had metabolic liver diseases, 7 [10%] had active micro nodular cirrhosis, 5 [7.14%] had hepatoportal fibrosis, one case [1.42%] had congenital hepatic fibrosis and 3 [4.28%] had fatty infiltration. Three patients [4.28%] had vascular hepatic disorders, 1 [1.42%] with parasitic hepatic infestation, 1 [1.42%] had osteopetrosis and 9 [12.85%] had non specific changes. We have tried to use an independent predictor of liver fibrosis [AST/ALT ratio] and our results show that its sensitivity and specificity were [68.1%] and [60.4%] respectively. We concluded that liver biopsy should be performed as early as feasible in the course of liver disease and should be repeated. It will not only facilitate diagnosis and treatment but also help to increase our understanding of the various disease processes

Tropical liver diseases in Egyptian children

Each tropical region has its own spectrum of liver disease. In Egyptian children, this has yet to be defined. In an effort for such definition, we enrolled 516 biopsy-proven patients with chronic liver disease in a follow up study spanning over 3 years to diagnose tropical liver diseases in them and encountered 37 [7.2%] patients with hepatosplenic schistosomiasis, 32 [6.2%] with hepatic venoocclusive disease, 6 [1.2%] with hepatic fascioliasis, 2 [0.4%] with amoebic liver abscess and 2 [0.4%] with visceral leishnianiasis. Their clinicopathologic criteria were identified in an effort to clarify the natural history of tropical liver disease in our region