Validation of Serum Aminotransferases Levels to Define Severe Dengue Fever in Children / 대한소아소화기영양학회지

PURPOSE: We aimed to study the pattern of liver-injury in children with dengue fever (DF) and validate serum aminotransferase ≥1,000 IU/L as a marker of severe DF. METHODS: Children admitted with DF were included. DF was defined by presence of clinical criteria and positive serological or antigen tests in absence of other etiology. DF severity was graded as dengue without or with warning signs and severe dengue. Liver-injury was defined as alanine aminotransferase (ALT) more than twice the upper limit of normal (boys, 30 IU/L; girls, 21 IU/L). RESULTS: Of 372 children with DF, 144 (38.7%) had liver-injury. Risk of liver-injury and aminotransferase levels increased with DF severity (p < 0.001). Recommended ALT and aspartate aminotransferase (AST) cut-off at ≥1,000 IU/L had sensitivity 4.8% (5/105), specificity 99.3% (265/267) for detection of severe DF. In children with ALT and AST < 1,000 IU/L (n=365), the area under receiver operating curves for prediction for severe DF, were 0.651 (95% confidence interval [CI], 0.588–0.714; p < 0.001) for ALT and 0.647 (95% CI, 0.582–0.712; p < 0.001) for AST. Serum ALT at 376 IU/L and AST at 635 IU/L had sensitivity and specificity comparable to ≥1,000 IU/L for defining severe DF. CONCLUSION: Liver-injury is common in DF. The ALT and AST levels increase with DF severity. ALT and AST levels of ≥1,000 IU/L could be lowered to 376 IU/L and 635 IU/L respectively for defining severe DF.

An outbreak of hand–foot–mouth disease: A report from the hills of northern India.

Background. Hand–foot–mouth disease (HFMD) is known to cause outbreaks around the world as well as in India. We report the clinical characteristics of an outbreak in Dehradun, Uttarakhand. Methods. The study was done in the Department of Paediatrics of a tertiary care referral teaching hospital in northern India. Children (<18 years of age) presenting with vesicular skin lesions distributed over the hand, foot and mouth were prospectively enrolled between August 2013 and October 2013. The diagnosis of HFMD was made clinically, and laboratory investigations were done for clinical care. Children were managed with supportive measures and followed for 6 weeks after discharge. No virological investigations were done to identify the offending agent. Results. Thirty-three children (18 boys, 54.5%; median [range] age 4 [1–17 years]) were enrolled. The majority of children were <5 years of age (75.8%), who presented with prodromal symptoms (93.9%), mostly milder (80.6%) in severity. The most common prodromal symptoms were fever (93.9%), cough (72.7%) and malaise (54.5%). All children had rash on their hands and feet whereas the majority (85%) had oral lesions as well. All children recovered completely and had no complications during 6 weeks of follow-up. Conclusion. HFMD was milder and all children (mostly <5 years of age) recovered completely without complications. Natl Med J India 2015;28:126–8

Serum Liver Enzyme Pattern in Birth Asphyxia Associated Liver Injury / 대한소아소화기영양학회지

PURPOSE: To study temporal pattern of serum liver enzymes levels in newborns with hepatic injury associated with birth asphyxia (BA). METHODS: Singleton term newborns with BA and +2 SD) above the mean of control subjects at any of the three time points. RESULTS: Sixty controls and 62 cases were enrolled. Thirty-five cases (56%) developed BA-associated liver injury (ALT>81 IU/L). They had higher serum levels of ALT, aspartate aminotransferase, lactate dehydrogenase than the control infants, with peak at 24-72 hours. In controls, serum liver enzyme levels were significantly higher in appropriate-for-date (AFD) babies than small-for-date (SFD) babies. Serum enzyme pattern and extent of elevation were comparable between SFD and AFD babies. Degree of serum liver enzyme elevation had no relationship with severity of hypoxic encephalopathy. CONCLUSION: Serum liver enzyme elevation is common in BA; it peaks at 24-72 hours followed by a sharp decline by 6-12 days of age. Pattern and extent of enzyme elevation are comparable between SFD and AFD babies.