Hepatitis A and fulminant, hepatitis A viral infection: risk factors among children of Menoufiya Governorate

Hepatitis A viral infection is a common disease among Egyptian infants and children, although it has a benign course in the great majority of cases, severe fulmination which may be fatal can occur. In this study we try to highlight the risk factors associated with both acute hepatitis [A] and that of fulminat cases in attempt to propose preventive measures for both conditions. The study was carried out on 80 children [50 with hepatitis A and 30 fulminat cases along with 50 control cases of matched age and sex. All children were subjected to questionnaire assessing the hygienic measures, housing, food habits, type of feeding, past history of diseases, contaminated needle injection operations blood transfusion and history of drug administration. Anthropometric measures were recorded for all children who subjected to investigation included CBC, blood sugar, liver and renal function test serological marker of HAV, HBV, HCV and abdominal ultrasound. The study revealed that the major risk factors of fulminant hepatitis A include, medical history of infantile diabetes and bilharziasis, drug history of diuretics and anticonvulsant intake, elevation of serum bilirubin [total bilirubin] > 9.56 mg/dL, direct bilirubin > 5.11 mg/ dl, elevation of AST > 635.78 micro /L and ALT > 365.78 micro /L, GGT > 982.62 micro /L and ALP > 756.91 micro /L, prolonged prothrombin time [more than 25.87sec] and prothrombin concentration < 40.67%, reduced Hb level [< 7.4gdL], malnourishment [weight / age% < 1.97, weight / height%< 0.15, MAMC < 11.65cm and TSF < 0.84mm] and lastly reduced hepatic artery resistive index < 0.63, low socioeconomic standards, artificial feeding, bad personal hygiene and medical history of neonatal jaundice and anemia

Duodenal tube test in the diagnosis of biliary atresia

Biliary atresia [BA] is a main cause of severe liver damage in infants. Successful surgical treatment is related directly to the early and rapid diagnosis. The aim of this study was to determine specificity, sensitivity and predictive value of duodenal tube test [DTT] in diagnosis of biliary atresia in a series of 20 infants with cholestatic jaundice. The inclusion criteria include a clay coloured stool and a direct bilirubin level > 2mg/dL. The study protocol include thorough history and clinical examination liver function tests complete blood count, abdominal ultrasound. TORCH screen, HIDA scan and percutaneous liver biopsy. A nasoduodenal tube was placed at the distal duodenum and the fluid was collected by gravity every 2 hours for 24 hours. DTT was considered bile positive when yellow biliary fluid was observed. The patients with bile +ve DTT were not explored surgically and cholestatic workup was completed. Laparotomy and ultra-operative cholangiography was indicated for bile -ve DTT patients and porto-enterostomy was done when biliary atresia was identified. The result of the study show that 13 cases were Bile -ve DTT and 7 cases were Bile +ve DTT. Sensitivity, specificity, positive and negative predictive values of DTT vsHIDA scan were 85%, 71%, 80% and 85% respectively. Sensitivity, specificity, positive and negative predictive values of DTT vs percutaneous liver biopsy were 87%, 100%, 100% and 71% respectively. Lastly all of these 4 parameters were 100% on comparing DTT with intra-operative cholangiography

Plasma level of tissue factor pathway inhibitor in children with chronic liver disease

Tissue factor pathway inhibitor [TFPI] is one of physiological coagulation inhibitors, which when decreased may facilitate coagulation especially in advanced liver disease. The aim of this study is to measure the Plasma level of [TFPI] in patients with chronic liver disease [CLD] of various etiologies and correlate this with other parameters routinely used to assess these patients. We measured Plasma level of [TFPI] in 50patients with [CLD] using a specific ELIZA test along with 10 matched healthy controls. The children were classified into 6 groups, group [I] control group:n=10, group [II] those with chronic HBV and HCV viral infection ; n=17, group [III] a metabolic one ; n=9, group [IV] those with autoimmune hepatitis ; n=10, group [V] patients with biliary disorders ; n = 9 and group [VI] hepatovascular group ; n = 5. All children were also subjected to clinical exam,. Liver function tests, PT and conc, PTT, Plasma level of protein C and factor V, serum fibrinogen, HBSAg, anti HBc total and IgM, anti HCV, HCV-RNA for anti HCV +/- ve patients, ultrasound and liver biopsy was done for 36 patients. The result showed that TFPI was decreased in different types of CLD irrespective to the etiology compared to control group group [I]: 83.2 +/- 18.50ng/mL, group[II]30.9 +/- 20.2 ng/mL, group[III]: 57.5 +/- 21.5 ng/mL, group [IV]: 58 +/- 24.5 ng/mL, group [V]: 35.9 +/- 16.9 ng/mL and group[VI]: 71.2 +/- 47.1 ng/mL. The results gave a statistically sig. value in all groups except group [VI]. There was no sig. difference between cirrhotics and non cirrhotics regarding TFPI Plasma level, [non cirrhotics: 41.2 +/- 23.1 ng/mL ; n=18, cirrohtics: 54.5 +/- 33.2 ng/mL; n =32 The study also showed a sig. decrease of TFPI with disease progression child A cirrohtics: 73.8 +/- 36.46 ng/mL ; n = 7, child B: 52.7 +/- 14.6 ng/mL; n = 4, child C: 36.2 +/- 29.33 ng/mL; n = 7. There was no sig, correlation between TFPI plasma level and AST, ALT . ALP, GGT, protein C and factor V but a sig. one was found with serum fibrinogen and PTT