Etiology and pattern of presentation of gastritis in children, our experience at a tertiary care hospital

Objective: This study aimed to look in to the frequency of different causes and pattern of presentation of gastritis in children less than 16 years of age. Study Design: Prospective cross sectional study. Place and Duration of Study: This study was performed in the Children Hospital and the Institute of Child health, Lahore, from Jan 2016 to Jan 2017

Material and Methods: This study was performed in the department of Pediatric Gastroenterology, Hepatology and Nutrition at Children Hospital and the Institute of Child health, Lahore, from Jan 2016 to Jan 2017. One hundred and sixty children fulfilling the inclusion criteria were enrolled in this study. All patients went through endoscopy. Macroscopic findings were noted and gastritis was confirmed by histological analysis of gastric mucosa. Biopsies were taken from gastric antrum, the body and pylorus

Results: The mean age of children was 8.73 +/- 3.70 years [range 2-16years], and majority were in the age range of 6-10 years. Males were affected slightly more than females with a ratio of 1.3:1. Drug induced gastritis was the major contributor in 58 [36.2%] patients followed by food related gastritis in 55 [34.3%]. H.Pylori positive gastritis was seen in 38 [23.7%] patients. No cause of gastritis was found in 5.6% of patients

Conclusion: Our study concluded that drug induced gastritis and food related gastritis was more common than H. Pylori positive gastritis in children in our setting

Ileocolonic basidiobolomycosis in a child: an unusual fungal infection

Systemic basidiobolomycosis is a rare fungal infection caused by Basidiobolus rararum [B. rararum]. The clinical presentation is non-specific and is similar to many gastrointestinal conditions such as Crohn's disease [CD]. The most consistent findings of basidiobolomycosis are recurrent abdominal pain, weight loss, fever and peripheral eosinophilia. Most of the patients are diagnosed on surgical resection of the involved region along with compatible histopathological findings like transmural inflammation, granulomas with eosinophilic infiltration [Splendore-Hoeppli phenomenon] and more specifically detection of fungal hyphae on fungal stains. Effective and curative treatment for systemic basidiobolomycosis is available, if diagnosed and managed properly in time. We report here a Saudi boy who had ileo-caecal basidiobolomycosis, but diagnosed after a prolonged course of illness

Nasogastric tube placement in newborns before discharge

The aim of this study was to assess the knowledge of medical staff [physicians] at different levels about insertion or placement of nasogastric tube [NGT] in a normal newborn before discharge. It was a survey-based, observational study conducted at King Khalid University Hospital. A total of 103 doctors were sent text message; among those 81 [78.6%] responded. Among the respondents, 27, 16, 11 and 27 were neonatologists, general physicians, obstetricians/ ENT/pediatric surgeons, and senior registrars neonatology [SRN], respectively. Majority of physicians, 57 [70.3%] rejected the idea of insertion of NGT in a normal newborn but in 24 [29.6%]; answer was to insert NGT in all the newborns before discharge to check the patency of nasal cavities. Regarding the position, region of doctors and their response, majority from Center said 'No' [not in favour of insertion] but from South, 17/18 [94.4%] said 'Yes' [in favour of insertion]. Regarding other specialties, majority of them showed rejection of this idea. In conclusion, most of the healthcare professionals, directly involved with neonatal care, rejected the idea of routine insertion of NGT in normal newborn examination before discharge; rather, some non-invasive technique could be opted

Fungal esophagitis in a child with insulin dependent diabetes mellitus

Esophagitis in children is not uncommon, mostly due to gastro-esophageal reflux. Other conditions like eosinophilic and infective esophagitis need to be elucidated in differential diagnoses. Fungal or Candida esophagitis usually occurs in high risk children who are immune-compromised, malnourished, on steroid therapy or have uncontrolled diabetes mellitus. An eleven-year girl presented with uncontrolled type I diabetes mellitus and recurrent epigastric pain with vomiting. Her oral intake was satisfactory. There was no dysphagia and odynophagia. Physical examination was normal with good oral hygiene. Failure in responding to conventional medications led to endoscopic evaluation, which revealed white patches and esophageal inflammation and diagnosed as fungal esophagitis on histopathology. Although infective esophagitis is encountered sporadically in pediatric age group, but it should always be considered in high risk individuals and when conventional medication fails to resolve the symptoms

To determine the frequency of Factor V Leiden in cases of Deep Vein Thrombosis and Healthy controls

To determine the frequency of Factor V Leiden in cases of Deep Vein Thrombosis and Healthy controls. This case control study was performed in Armed Forces Institute of Pathology Rawalpindi, From 21[st] March to 25[th] September 2013.One hundred patients with diagnostic evidence of Deep vein thrombosis on Doppler ultrasound/Magnetic resonance imaging [MRI] scan were included in the study through non probability convenient sampling and compared with 100 matched healthy controls. DMA was extracted from the blood sample by kit method. In order to identify Factor V Leiden mutation, the polymerase chain reaction [PCR] method was utilized combined with the Amplification refractory mutation system. Data was analyzed using statistical package for social sciences [SPSS] version 17. In 100 patients of Deep Vein Thrombosis [DVT], frequency of Factor V Leiden [FVL] was 13% and it is was 2% in healthy control group. A significant association was found between FVL and DVT with odds ratio of 7.32 and with P value [P = 0.003]. FVL was found to be highly prevalent among patients of DVT, Signifying strong association between the two

Clinical presentation and biochemical findings in children with glycogen storage disease type 1A

To determine the clinical pattern of presentation and biochemical characteristics of glycogen storage disease [GSD] type 1a in children at a tertiary referral centre. Descriptive/ cross sectional study. Department of Pediatric, division of Gastroenterology and Hepatology of the Children's hospital, Lahore over a period of 11 years. Confirmed cases of glycogen storage disease [clinical plus biochemical findings consistent with GSD 1a and proven on liver biopsy] were enrolled in this study from neonatal age till 18 years. Data was retrieved from files and electronic record for these cases. Diagnosis was made on the basis of history, clinical findings including hepatomegaly, hypertriglyceridemia, hypercholesterolemia, hypoglycemia and hyperuricemia [if present]. Diagnosis was confirmed on liver biopsy. Patients with other storage disorders and benign and malignant tumours were excluded from the study. Total patients included in the study were 360 with male to female ratio of 1.25:1. Median age at the time of diagnosis was 25.6 months [age range from one month to 18 years]. Most common presentation was abdominal distension [83%] followed by failure to thrive [69%] and recurrent wheezing and diarrhoea [44%] each. Seizures were present in only 1/3rd of children. Other presentations included vomiting, respiratory distress, altered sensorium, nephrocalcinosis, epistaxis and hypothyroidism. Few patients around 11% presented with acute hepatitis and later were diagnosed as GSD. Significant hepatomegaly was evident in almost all patients but nephromegaly was present in only 5.5% patients. All children had marked hypertriglyceridemia but cholesterol levels were raised in 1/3rd of children. A large majority of children had deranged ALT more than 2 times of normal and around 38% children had marked anemia. Significant hypoglycemia and metabolic acidosis was documented in around 1/3rd of children. Hyperuricemia was not a constant feature [16%]. This study showed abdominal distension and failure to thrive with hepatomegaly a common presentation with hypertriglyceridemia a constant feature. Huge number of patients in this study showed common metabolic disorder in children with diverse clinical presentation

Incidence and diagnostic features of eosinophilic esophagitis in a group of children with dysphagia and gastroesophageal reflux disease

To investigate the incidence and diagnostic features of eosinophilic esophagitis [EoE] in a group of children with dysphagia and gastroesophageal reflux disease. This study was designed as a retrospective case analysis of 229 patients who underwent upper gastrointestinal endoscopy between January 2009 and January 2012 at a private tertiary care hospital in Riyadh, Saudi Arabia to ascertain the proportion of patients with eosinophilic esophagitis. Out of 229 children, 14 children were diagnosed as EoE [esophageal eosinophil count more than 15/high power field on esophageal biopsies], but 3 children were excluded because of other associated conditions. There were 8 males and 3 females with a mean age of 8.4 years [<18 years]. The major presentation was dysphagia followed by vomiting and epigastric pain. History of allergy and bronchial asthma was present in 40-50% of children. Peripheral eosinophilia was present in 36.3% [range 7-28%]. Barium contrast was abnormal in 3 children. Typical ringed [circular] appearance of esophagus was found in 3, linear furrowing in 2, and moderate to severe esophagitis in 8 children. All the patients were managed with swallowed inhaled steroids, except 2 patients who were initially given systemic steroids. Eosinophilic esophagitis is not an uncommon manifestation in children with dysphagia, and should be considered as one of the top differential diagnoses in patients with reflux esophagitis

Hookworm infestation in children presenting with melena-case series

Hookworm infection is common in children and can present with symptoms of upper gastrointestinal bleeding and severe anemia. Ten children below 5 years presenting with melena and severe pallor were seen from December 2006 to May 2007 in the gastroenterology and hepatology department of children's hospital, Lahore. All patients had history of transfusion. Complete blood picture, eosinophil count with peripheral smear, stool complete examination for ova and cysts were performed in all cases, while upper and lower gastrointestinal endoscopies were performed in three patients to locate the source of bleeding. Stool routine examination in all these cases confirmed hook worm ova. These patients were managed with antihelmenthic and stool complete examination was done three days after the medicine. There was no mortality. Though upper gastrointestinal bleeding with hookworm infestation is very rare but in the developing countries it should be considered when other causes of upper gastrointestinal bleeding are ruled out

Frequency, risk factors and outcome in admitted Neonates presenting with hypothermia

Neonatal hypothermia is a significant cause of morbidity and mortality, particularly in preterm and low birth weight babies especially in developing countries. This study was performed to describe the frequency, associated risk factors and outcome of neonatal hypothermia in admitted cases. This was an observational study carried out in prospective manner. Study population consisted of 500 neonates admitted to neonatal unit of the Children's Hospital, Lahore during the months of January and February 2006. Various variables were recorded in a predesigned proforma and outcome was analyzed. The overall frequency of hypothermia was 34.8%. It was significantly associated with low birth weight [p<0.05], prematurity [p<0.0.5], shifting from outside Lahore [p<0.05], and history of birth asphyxia [p<0.05]. Mortality in hypothermic neonates was significantly higher than the non hypothermic ones [p<0.05]. The risk of mortality was recognized to be higher in hypothermic than the non hypothermic admitted neonates