young boy with budd chiari syndrome secondary heterozygous to factor V leiden - a case report

Budd Chiari syndrome [BCS] is a rare condition with exact incidence not known. It results from obstruction to the venous outflow of liver anywhere from the hepatic veins till the terminal inferior vena cava. Most cases are idiopathic; commonest cause being hypercoagulable state. Other causes include hepatic or metastatic malignancies, infections, inflammatory bowel disease, Behcet

syndrome, aspergillosis and rarely, Inferior vena cava webs. Clinical presentation of BCS is variable. Most of the patients present insidiously with abdominal pain, hepatomegaly and ascites. On rare occasions, onset can be in the form of lethal upper gastrointestinal bleeding due to ruptured esophageal varices

We report a case of BCS secondary to heterozygous factor V Leiden mutation in a young boy. Presentation in our patient was insidious, progressive ascites with abdominal pain

Age, pattern of presentation and risk factor for enteric fever in 2-15 years old children

Objective: To find out age related common pattern of presentation of enteric fever in children

Study design: A cross sectional study

Place and duration: Pediatric Department Al-Nafees Medical College and Hospital Islamabad over a period of 6 months from 1[st] July 2013- 31[st] Dec 2013

Methodology: Patients irrespective of gender between 2-15 years, with fever of more than 4 days without focus were included in the study. Complete blood count and typhi dot test performed on all patients for diagnosis. Performa containing bio data, symptoms and clinical signs was filled of patients with positive serology

Results: A total of 60 patients studied and among them 92 %[ n= 55] and 90% [n=54] patient presented with poor appetite and fever respectively. Among them 90% [n=54] had white coated tongue and 66% [n=40] had low grade fever [100[degree]F -102[degree]F] while 33% [n=20] were having high grade fever [?102[degree]F]. Hepatomegaly was found in 73% [n=44] patients while Hepatosplenomegaly in 20% [n=12] patients. Leukocytosis was more common in children than leucopenia

Conclusion: Common symptom of enteric fever is poor appetite and low grade fever, and white coated tongue with hepatomegaly is common findings on clinical examination. Thrombocytopenia is consistent laboratory finding