ABSTRACT
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
ABSTRACT
Objective: To differentiate between clinical and demographic spectrum, and outcome in hepatovenocaval syndrome [HVCS] and Budd-Chiari syndrome [BCS]. Study Design: Descriptive study. Place and Duration of Study: Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Children Hospital, Lahore, from January 2014 to January 2017
Methodology: All children less than 18 years of age, presenting with ascites and visible veins over abdomen, flanks and back were enrolled in the study. Real time Doppler Ultrasonogram was performed in all children for documentation of intrahepatic part of IVC obstruction along with or without hepatic venous obstruction. Children meeting inclusion criteria underwent liver profile, coagulation profile, diagnostic paracentesis for SAAG gradient, and Gadolinium enhanced multiphasic MR scan. Liver biopsy and venography was performed in selected patients
Results: A total of 92 children presented with ascites, among them 58 children met our inclusion criteria. Intrahepatic IVC obliteration, i.e. HVCS, found in 67% [n=39] and hepatic venous outflow obstruction, i.e. BCS was found in 33% [n=19] children. Children with BCS were older than HVCS with mean age of 9.5 +/-2.58 versus 4.12 +/-0.977 years. HVCS group had 14 boys and 24 girls with a ratio of 1:1.8, while BCS had a ratio of 1:0.9 with 10 boys and 9 girls. No etiological factor was found for HVCS, while most of patients with BCS had a procoagulant disorder. Caudate lobe hypertrophy was a consistent feature in BCS, while IVC obstruction was found in HVCS persistently. Orthotopic liver transplant was needed in three cases [7.6%] of HVCS and four [20.96%] of BCS cases. Antibiotic therapy has a good role in HVCS, while anticoagulation and diuretics had good result in BCS
Conclusion: Hepatovenocaval syndrome [HVCS] mostly affected younger children, especially girls. BCS usually affected older age groups with pro-coagulant disorders who responded to anticoagulation and diuretic. Further studies are needed to compare both conditions
ABSTRACT
Berardinelli-Seip congenital lipodystrophy [BSCL] syndrome is a rare genetic disorder caused by dysregulation of glycemic and lipid metabolism. We report five BSCL cases with typical clinical pictures and complications. These, to the best of our knowledge, represent the first case series from Pakistan. BSCL is characterized by marked atrophy of adipose tissue, acromegaly, acanthosis nigricans and tall stature. We could not perform genetics studies in any patient owing to non-availability of genetic laboratory in Pakistan. All the cases presented hypertriglyceridemia. One case developed hyperinsulinism controlled with metformin. There is no curative treatment and the current approach is low-fat diet and management of insulin resistance and diabetes. Recently published studies showed that leptin-replacement therapy is promising in the metabolic correction of complications of BSCL. This highlights the importance of further research in BSCL treatment
ABSTRACT
Objective: To determine the effectiveness and safety of Sofosbuvir and Ribavirin combination in treatment-n?ive children with HCV infection
Study Design: An experimental study
Place and Duration of Study: Gastroentrology, Hepatology Department, The Children's Hospital and The Institute of Child Health, Lahore, from January to December 2016
Methodology: HCV PCR positive treatment-n?ive patients, 5 to 18 years of age, were enrolled by consecutive nonprobability sampling. Clinical features and investigations including complete blood count, bilirubin, ALT, PT and HCV genotyping were done. All patients were started on Sofosbuvir 400 mg once daily and Ribavirin 10-15 mg/kg/day. Patients were followed on 4-weekly basis. PCR was done after 4 weeks; if positive then again at 12 weeks. End of treatment and 12 weeks post treatment PCR was done in all patients. Total duration of therapy was 24 weeks. Computer program SPSS version 20 was used for data analysis
Results: A total of 35 patients with mean age of 10.24 +/-2.80 years, including 22 boys [62.86%], and 13 girls [37.14%] were included. The most common HCV genotype was genotype 3 encountered in 27 [77.15%], followed by genotype 1 in 6 [17.14%], while 2 [5.71%] patients were untypable. Thirty [85.71%] patients achieved rapid virological response while the rest 5 [14.28%] had early virological response. End-of-treatment PCR was negative in all patients. SVR was achieved by 34 [97.14%] patients. The treatment was well tolerated. Headache was observed in 8 [22.86%] patients, which improved spontaneously
Conclusion: Sofosbuvir and Ribavirin combination is highly effective in HCV genotypes 1 and 3 with no major undesirable short-term side effects