Hemoptysis in children: single center experience

To review the causes of hemoptysis in children presenting to the respiratory department at King Hussein Medical Center. A retrospective chart review of all children who presented with hemoptysis was conducted from 1[st] April 2002 to 1[st] April 2012. Diagnosis of pulmonary hemorrhage was based on radiological and bronchoscopic findings. Demographic data, age at presentation, number of attacks, and presence of another diagnosis were recorded. Radiological and laboratory data were included as well. A total of 60 children with 68 episodes of hemoptysis were reviewed. Diffuse pulmonary hemorrhage was seen in five patients, three of them had idiopathic pulmonary hemorrhage, one had celiac disease and another had Wagener disease. Of the 55 patients with localized pulmonary hemorrhage the most common cause was cystic fibrosis [30%] and congenital heart disease [27%], followed by pulmonary arteriovenous malformation [8%], ruptured hydatid cysts [7.3%] and retained foreign body [5.4%]. Fifty one out of the 55 [92.7%] with localized hemorrhage had localized patch on the chest x-ray; 40% had previous x-ray within the previous two years showing the same radiological patch at the time of hemoptysis episodes. Massive hemoptysis was found in three patients. Diagnostic flexible bronchoscopy was done in all patients within one week of the episode of hemoptysis. High resolution chest CT-scan was done for all patients with the diffuse type. Dynamic chest CT-scan was done in 50% of patients with localized hemorrhage. Embolization was done in five patients with AV malformation and two patients with cystic fibrosis. Surgical lobectomy was done in those with sequestration, hydatic cyst and one patient with foreign body and another one with localised bronchiectasis. Hemoptysis is not uncommon in children. As an entity it should always be thoroughly investigated. Etiology differs according to age. Idiopathic pulmonary hemorrhage still constitutes a major group

Shwachman-diamond syndrome: first case report at the royal medical services

We report a case of Shwachman -Diamond syndrome who initially presented with severe anemia at the age of two months then later developed intermittent neutropenia and persistent thrombocytopenia and short stature. Skeletal abnormalities fully manifested at the age of four years. This is the 1[st] case to be reported in children in the Royal Medical Services hospitals

comparison of efficiency and safety of a single dose of intramuscular dexamethasone acetate with oral prednisolone in the management of asthma exacerbations in children

To determine wether a single intramuscular dexamethasone acetate injection is as effective as five days of oral prednisolone in improving symptoms and preventing relapse in children with acute asthma. This is a prospective quasi, randomized, and non-blinded trial. We enrolled 30 children, aged 9 months to 14 years with known history of asthma who presented to the emergency department with moderate exacerbation. The primary outcome was to measure the rate of relapse, persistance, worsening, recurrence of symptoms and hospitalization in 5 and 21 days after discharge from emergency department. All patients completed the study. More patients in the prednisolone group continued to use bronchodilator than patients in the dexamethasone group [three patients in the former compared to one patient in the second group]. No patient in both groups had severe replase or needed hospitalization. Patients in the prednisolone group experienced difficulty in administration of the tablets and 3 of them missed 50-75% of the total dose. There were no significant local or systemic adverse effects in both groups. All patients in dexamethasone group were satisfied with the treatment while most parents in the prednisolone group preferred an alternative form of treatment. We found that IM dexamethasone acetate is more clinically effective than a 5-day course of oral prednisolone tables in treatment of moderate asthma exacerbations. It was well tolerated, and preferred by most parents. we recommend it as an alternative option especially in those who are not compliant to oral prednisolone

Prevalence and risk factors for myopia

This study aimed to estimate the prevalence of refractive errors especially myopia in school children and to study risk factors for myopia. During the period between February 2003 and February 2004, 1320 school children aged 8- 17 years attending pediatric and internal medicine clinic in Royal Medical Services for non ophthalmologic complaints were evaluated. A questionnaire was given to each child or his parents including information about parent's education and occupation, if there is a sibling wearing spectacles, ethnic group and the duration spent for near work. Visual acuity was assessed using Snellen's E-chart and any patient with visual acuity of less than 6/12 or with eye abnormality was referred to ophthalmology clinic for detailed eye examination. Eye examination included Snellen's visual acuity testing, anterior segment examination via slit lamp, posterior segment examination after mydriasis via indirect ophthalmoscope and cycloplegic refraction. The results revealed that 77 children [5.8%] had significant refractive errors. Myopia was the leading refractive error [4.8%]. Young age, female sex, educated parents, family history for sibling wearing spectacles and prolonged near work were all risk factors for developing myopia. The study concluded that the prevalence of refractive errors especially myopia is considered to be high in school children in Jordan; therefore an eye screening program is indicated in this region