Bone Mineral Density in Patients with Pediatric Inflammatory Bowel Disease Using Dual Energy X-Ray Absorptiometry

Background@#Inflammatory bowel disease (IBD) is a chronic inflammatory immune-mediated condition that affects the gastrointestinal system and alters bone growth and bone mineral density (BMD). Here we aimed to study the prevalence and predictors of a low BMD in pediatric patients with IBD. @*Methods@#This retrospective cross-sectional analytical study included pediatric patients with IBD in whom BMD was evaluated using dual energy X-ray absorptiometry of the total body and lumbar spine. Osteoporosis was defined as a BMD Z-score ≤-2, osteopenia as -2 to -1, and normal as >-1. Clinical and laboratory findings were compared between patients with and without osteoporosis. @*Results@#Of the 48 patients, 30 (62.5%) were males, 35 (72.9%) had Crohn’s disease, and 13 (27.1%) had ulcerative colitis. The mean age at diagnosis was 9.9±2.8 years. The median age at the time of the BMD scans was 11.9 (interquartile range, 9.9–14.3) years. Total body BMD scans identified 13 (27.1%) and 16 (33.3%) patients with osteoporosis and osteopenia, respectively. Spinal BMD scans revealed that 17 (39.5%) and 14 (32.6%) patients had osteoporosis and osteopenia, respectively. A low body mass index (BMI) Z-score (p=0.038), ileocolonic disease location (p=0.008), and a low calcium level (p=0.008) were significant predictors of osteoporosis on the total body BMD scans. A low BMI Z-score (p=0.039), decreased hemoglobin level (p=0.018), low calcium level (p=0.033), and infliximab use (p=0.019) were significant predictors of osteoporosis on the spinal BMD scans. @*Conclusions@#This study showed a high prevalence of low BMD among pediatric patients with IBD. A low BMI, ileocolonic disease location, low hemoglobin and calcium levels, and infliximab use were significantly associated with osteoporosis.

Hexon and fiber gene changes in an attenuated fowl adenovirus isolate from Malaysia in embryonated chicken eggs and its infectivity in chickens

Fowl adenovirus (FAdV) is distributed worldwide and causes economic losses in the poultry industry. The objectives of this study were to determine the hexon and fiber gene changes in an attenuated FAdV isolate from Malaysia in specific pathogen-free chicken embryonated eggs (SPF CEE) and its infectivity in commercial broiler chickens. SPF CEE were inoculated with 0.1 mL FAdV inoculum via the chorioallantoic membrane (CAM) for 20 consecutive passages. The isolate at passage 20 (E20), with a virus titer of 10(8.7)TCID₅₀/mL (TCID₅₀, 50% tissue culture infective dose), was inoculated (0.5 mL) into one-day-old commercial broiler chicks either via oral or intraperitoneal routes. The study demonstrated that 100% embryonic mortality was recorded from E2 to E20 with a delayed pattern at E17 onwards. The lesions were confined to the liver and CAM. Substitutions of amino acids in the L1 loop of hexon at positions 49 and 66, and in the knob of fiber at positions 318 and 322 were recorded in the E20 isolate. The isolate belongs to serotype 8b and is non-pathogenic to broiler chickens, but it is able to induce a FAdV antibody titer. It appears that molecular changes in the L1 loop of hexon and the knob of fiber are markers for FAdV infectivity.

Neonatal indirect hyperbilirubinemia and glucose-6-phosphate dehydrogenase deficiency / 소아과

PURPOSE: This study aimed to determine the prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency among infants with neonatal indirect hyperbilirubinemia (NIH); compare G6PD-deficient and G6PD-normal patients regarding hyperbilirubinemia and need for exchange transfusions (ET); and assess risk factors for ET and kernicterus. METHODS: This is a case-control retrospective study. Medical records of NIH patients admitted to the Pediatric Department, Salmaniya Medical Complex, Bahrain, between January 2007 and June 2010 were reviewed. Data on sex, age at presentation, hospitalization duration, need for ET, hemoglobin (Hb) level, reticulocyte count, direct Coombs test, serum total and indirect bilirubin levels, thyroid function, blood and urine cultures, G6PD status, and blood groups were collected and compared between the G6PD-deficent and G6PD-normal patients. RESULTS: Of 1,159 NIH patients admitted, 1,129 were included, of whom 646 (57%) were male. Among 1,046 patients tested, 442 (42%) were G6PD deficient, 49 (4%) needed ET, and 11 (1%) had suspected Kernicterus. The G6PD-deficient patients were mainly male (P<0.0001), and had lower Hb levels (P<0.0001) and higher maximum bilirubin levels (P=0.001). More G6PD-deficient patients needed ET (P<0.0001). G6PD deficiency (P=0.006), lower Hb level (P=0.002), lower hematocrit count (P=0.02), higher bilirubin level (P<0.0001), higher maximal bilirubin level (P<0.0001), and positive blood culture result (P<0.0001) were significant risk factors for ET. Maximal bilirubin level was a significant risk factor for kernicterus (P=0.021) and independently related to ET (P=0.03). CONCLUSION: G6PD deficiency is an important risk factor for severe NIH. In G6PD-deficent neonates, management of NIH should be hastened to avoid irreversible neurological complications.

Acute pancreatitis due to ascaris lumbricoides worm

We present a case of obstructive acute pancreatitis due to infestation with ascaris worm in a very young child. The child had an acute abdominal presentation. The investigations showed high serum amylase; the CT scan showed a hypoechoic tubular shadow in the jejunum with evidence for severe pancreatic necrosis. The child was managed conservatively, and received anthelmintic medication. She passed the worm in the stool and recovered completely

Optimum reckoning of contra lateral breast dose using physical wedge and enhanced dynamic wedge in radiotherapy treatment planning system

It was intended to investigate the effect of physical wedge [PW] and enhanced dynamic wedges [EDW] on contralateral breast dose during primary breast irradiation in radiotherapy treatment, using high energy photon beams. The Varian's Clinac dual mode linear accelerator model 2100 C/D and Siemen's Primus accelerators were used for radiation doses with 6 MV and 15 MV. Doses were delivered using Tangential field techniques and asymmetric collimator jaws. Eclipse three-dimensional Treatment Planning System [3DTPS] was used to measure contralateral breast dose for all fiend settings. Sixty five patients [with cancerous breast as well as chest wall] were taken and their contralateral breast doses were measured at a point 5 cm across, at 2 cm depth from the end of the medial field. The contralateral breast dose mean difference was 0.25 cGy and 0.24 cGy during the comparison of PW and EDW on Varian's Clinac and 0.19 cGy and 0.18 cGy were found for medial EDW and without medial EDW for the same machine in breast cases and chest wall cases respectively as per total prescribed dose. The mean difference for PW [Clinac] and PW [Primus] was found 0.08 cGy and 0.31 cGy and during the comparison of medial PW and without medial PW on primus machine this mean difference was 0.25 cGy and 0.51 cGy in breast cases and chest wall cases respectively as per total prescribed dose. The investigation demonstrates the significance that the EDW produces less scattered dose, which can cause second breast malignancy, compared to PW. Furthermore, the medial wedge, too, can cause second breast malignancy and should be avoided in planning

Age, body mass index, and number of previous trials: are they prognosticators of intra-uterine-insemination for infertility treatment?

To examine whether pregnancy rate [PR] of intrauterine insemination [IUI] is related to certain demographic factors, such as age and body mass index [BMI], along with number of IUI cycles performed, a set of infertile Saudi women. During this prospective study [a 24-month period], 301 Saudi women with infertility underwent IUI in our infertility clinic. We investigated whether PR is correlated with patient age and BMI, and the number of IUI trials, in order to determine if they could be used as prognosticators of pregnancy success. The highest PR was 14.89% for ages 19-25 and the lowest PR was 4.16% for ages 41-45, indicating no statistically significant difference among PR in all age groups [p value of 0.225]. Also, in terms of BMI, the highest PR was 13.04% for BMI >/= 35 and the lowest was 7.84% for BMI of <25 to 18.5, indicating no significant difference among different BMI groups [p value of 0.788]. One-cycle treatment, as expected, was more successful [PR=12.84%] than 2-cycle treatment [PR=5.75%], however, 3-5-cycles treatment still showed encouraging results [PR=17.24%]; but the difference did not reach statistical significance [p value=0.167]. PR after IUI treatment remained approximately 10% from 19 to 40 years of age and declined after 40. Although no significant difference was observed among different age groups, earlier treatment is still recommended. There was a positive but not statistically significant correlation between PR and patient's BMI indicating that BMI is not a determining factor. There was also no correlation between PR and number of IUI trials. Patients can thus try as many times as they want before moving on to in vitro fertilization [IVF] treatment

Ovarian stimulation medications and patients' responses as prognostic factors in IUI-treated infertile Saudi patients

Intrauterine Insemination [IUI] remains the first thought of infertility treatment. To compare the stimulation effects and Pregnancy rate [PR] outcomes of two ovulation induction [OI] medications, human-derived menopausal gonadotrophins [hMGH], Merional [MER], and recombinant follicular stimulating hormone [rFSH], Puregon [PUR], in a cohort of Saudi infertile patients, for better predictability of treatment results. During a 24-month period, 296 women underwent IUI single treatments. PR's were correlated with the type of stimulation medication that were prospectively and randomly assigned to each patient, and with the number and size of maturing follicles detected on the hCG injection day. MER and PUR needed comparable number of days [9.26 +/- 4.74 and 9.73 +/- 6.27 respectively] before follicles were ready for IUI, although the average amount used from MER, 1199.90 IU, was about double that was used from PUR, 621.08 IU. The overall PR in case of PUR however was nearly double that of MER, 13.28% and 7.14% respectively. The best PR, 16.22%, occurred when the follicles matured within 12-13 days. Three follicles of at least 15-mm diameter on the hCG day had better PR's than one or two, however when the follicles' diameters were at least 18-mm, PR was significantly higher, [p=0.013]. MER and PUR had comparable stimulation effects; however PUR had noticeably higher PR. The best PR occurred when the follicles matured within 12-13 days. PR in case of three maturing follicles on the hCG day was better than only one or two, and significantly better when their diameters were at least 18 mm

Neonatal hemochromatosis. case series from Bahrain

To review clinical presentations, diagnosis, response to treatment, and outcome of infants with neonatal hemochromatosis [NH]. This is a retrospective review of all cases admitted to the Pediatric Department at Salmaniya Medical Center, Manama, Bahrain between March 2008 and May 2011. The diagnosis was based on serum iron and ferritin, alpha-fetoprotein levels [AFP], liver and buccal biopsies, and abdominal MRI scan. Ten patients [8 males and 2 females] were diagnosed with NH. Two patients were intrauterine growth restriction [IUGR] and 6 were preterm. The median birth weight was 1.700 grams. The median age at presentation was 16 days, and at diagnosis was 23 days. Two patients had positive consanguinity. Clinical presentations of the infants were hepatosplenomegaly [n=5], ascites [n=3], and hypoglycemia [n=6]. All patients had raised ferritin levels, prolonged prothrombin time, and 9 patients had high serum iron and serum AFP. Abdominal MRI showed iron overload in the liver [n=8]. Liver biopsies showed evidence of hemochromatosis [n=3]. Buccal biopsies stained positive for iron [n=1]. Eight patients received antioxidant therapy and survived. Two patients passed away. Neonatal hemochromatosis is a rare liver disease of newborns with a spectrum of clinical severity. Elevated serum ferritin and AFP support the diagnosis after excluding other causes of neonatal liver failure. The use of antioxidant therapy helps to improve the outcome