ABSTRACT
Purpose@#Pediatric patients in low-income countries are at a high risk of malnutrition.Numerous screening tools have been developed to detect the risk of malnutrition, including the Subjective Global Nutritional Assessment (SGNA), Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and Screening Tool for Risk of Nutritional Status and Growth (STRONGkids). However, anthropometry remains the main tool for assessing malnutrition. We aimed to identify the value of four nutritional screening tools versus anthropometry for evaluating the nutritional status of children. @*Methods@#We conducted a cross-sectional study of 1,000 children aged 1–12 years who visited the outpatient clinic of Cairo University Pediatric Hospital. Each participant was evaluated using anthropometric measurements (weight, length/height, and weight for length/height) as well as the PYMS, STAMP, STRONGkids, and SGNA screening tools. The sensitivities and specificities of these four tools were assessed using anthropometry as the gold standard. @*Results@#Of the patients, 1.7% were underweight, 10.2% were wasted, and 35% were stunted.STRONGkids demonstrated the highest sensitivity (79.4%) and a high specificity (80.2%) for detecting malnutrition compared with weight for height, followed by STAMP, which demonstrated lower sensitivity (73.5%) but higher specificity (81.4%). PYMS demonstrated the lowest sensitivity (66.7%) and the highest specificity (93.5%), whereas SAGA demonstrated higher sensitivity (77.5%) and lower specificity (85.4%) than PYMS. @*Conclusion@#The use of nutritional screening tools to evaluate the nutritional status of children is valuable and recommended as a simple and rapid method for identifying the risk of malnutrition in pediatric patients.
ABSTRACT
Most paediatric patients with Wilson's disease [WD] present with hepatic manifestations, but some may have neurologic or psychiatric features. Our aim was to define the clinical, biochemical features and the outcome of therapy of a group of Egyptian children diagnosed with WD. The study was carried out at the Paediatric Hepatology Unit at Cairo University Children's Hospital, Egypt; 54 patients were diagnosed with WD from 1996 to 2009. The diagnosis was based on low serum ceruloplasmin levels, increased urinary copper concentrations before or after D-penicillamine challenge and/or the presence of Kayser-Fleischer [K-F] rings. The clinical presentation was as follows: hepatic presentation in 33 patients [61%], hepato-neurologic 3 [5.5%], neurologic 5 [9.3%] and presymptomatic 13 [24%]. Twelve couples had more than one affected sib. Increased urinary copper concentrations before or after D-penicillamine challenge was found in all patients, low serum ceruloplasmin in 97% and K-F rings in 31.5%. All patients were treated with penicillamine and zinc sulphate except one presymptomatic case who was treated with zinc sulphate only. Three patients underwent liver transplantation and eight patients died after a median duration of treatment of 6 months [1-36]. The hepatic symptoms improved with treatment but the neurological symptoms remained stationary. Clinical and biochemical assays remain the standard for diagnosis of WD. Penicillamine and zinc therapy can effectively treat WD with hepatic symptoms. Liver transplantation remains life saving for those with fulminant and end stage WD. Screening for presymptomatic sibs is of utmost importance
ABSTRACT
Objective: The present study aimed at verifying the safety and efficacy of rifampicin in ameliorating pruritus in pediatric patients suffering from persistent cholestasis
Methods: Twenty-three patients attending the Pediatric Hepatology Unit at Cairo University Children's Hospital, Egypt, were included in the present study. They were suffering from intractable pruritus secondary to persistent cholestasis from various etiologies. They were 14 males [60.87%] and 9 females [39.13%]. The mean duration of itch was 19 +/- 27.5 months. Rifampicin was started at a dose of 10 mg/kg/day in two divided doses. Liver function tests were followed up weekly to detect any deterioration that may be attributed to the drug
Results: Seventeen patients [74%] showed improvement of pruritus with rifampicin. Fourteen out of the seventeen [61%] improved at a dose of 10 mg/kg/day in 2 divided doses. The remaining 3 patients [13%] needed gradual dose increase by increments of 2 mg/kg/day every 2 weeks [maximum dose 20 mg/kg/day] until clinical improvement was observed. None of the patients showed any deterioration in liver functions, even though, a significant improvement in total serum bilirubin, ALT and AST was noticed following therapy
Conclusions: Rifampicin in a dose of 10-20 mg/kg/day is safe and effective in ameliorating uncontrollable pruritus in pediatric patients suffering from persistent cholestasis. No hepatoxicity was noted on close follow up in the studied children
ABSTRACT
Viral hepatitis is a major health problem allover the world. Perihepatic lymph nodes [LN] enlargement detected by ultrasonography [US] has been observed in acute and chronic hepatitis; a correlation has been found between hepatic inflammatory activity and total LN volume. Ultrasonography can detect many other changes in patients with acute viral hepatitis. This study included 35 patients with viral hepatitis; 20 with acute viral A hepatitis [11 males and 9 females, their age ranged from 2.5-7 years [yr]], and 15 with chronic viral hepatitis [10 HCV and 5 HBV] [9 males 8. 6 females, their age ranged from 3-16 yr]. Patients were taken from the hepatology clinic, Cairo University Children's Hospital. Another 15 children were taken as controls. History taking, thorough clinical examination, investigations [CBC, liver function tests, and serologic liver markers], and liver biopsy [for some chronic cases] with histopathologic examination were done for patients. Abdominal US was done for patients and controls. Results revealed that in chronic hepatitis patients, the most frequent risk factors for acquisition of hepatitis include dental extraction [60%], blood transfusion [40%], and surgical operation [33%]. Also, there was a low HB vaccination coverage among chronic hepatitis patients [33%]. Anorexia, malaise, jaundice, and dark-colored urine were the main symptoms present in all patients with acute viral A hepatitis. On examination, jaundice and tender hepatomegaly were detected in 65% of cases. In patients with chronic viral hepatitis, malaise was present in all cases while anorexia and abdominal pain were present in 65% of cases. On examination, firm hepatomegaly was detected in 50% of cases whilejaundice and splenomegaly were detected in 33% of cases. No evidence of fulminant hepatitis or liver cell failure was found in all patients. Concerning laboratory parameters, serum transaminases were significantly elevated in patients with acute viral A hepatitis compared to those with chronic viral hepatitis. Also, chronic hepatitis patients were significantly anemic [mean HB concentration = 10.6g/dl] and thrombocytopenic [mean platelets count = 202 x 10 3/mm3] compared to patients with acute viral hepatitis [anemia was detected in 33% and thrombocytopenia was detected in 25% of chronic cases]. Abdominal US revealed that LN at the hepatoduodenal ligament [HDL] were found in 90% of patients with acute viral A hepatitis compared to 53% of patients with chronic viral hepatitis [B, C], and this difference was significant. Of importance, a direct positive relationship was found between total LN volume and liver function tests in patients with acute and chronic hepatitis, but this relationship was significant only for serum bilirubin [total, direct] of acute hepatitis patients
Conclusion: Abdominal US being an easy to perform, safe, and non-invasive diagnostic tool is recommended to be used for the evaluation and lollow-up of patients with acute and chronic viral hepatitis