Evaluation of cytomegalovirus infection after six months of liver transplantation in children in Shiraz, Southern Iran

Liver transplantation [LT] is a life-saving treatment for end-stage liver diseases [ESLD]. Cytomegalovirus [CMV] infection is one of the important causes of morbidity after LT. To evaluate the incidence of late-onset [after 6 months of LT] CMV infection in pediatric recipients. A retrospective analysis was conducted to evaluate 50 pediatric patients who underwent LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We retrospectively investigated episodes of CMV infection after 6 months of LT proven by CMV antigenemia test. Three recipients [6%] developed late-onset CMV infection. These patients finally responded to ganciclovir. CMV infection is one of the most common post-LT viral infections that usually occurs in the first six months of LT. Our study shows that the incidence of late-onset CMV infection is relatively low, but it still remains a significant problem. Therefore, monitoring and management is crucial for improving the survival of children

Liver transplantation and aortic valve replacement

Surgical procedures involving heart and liver are rare and have been limited to either combined heart and liver transplantation or coronary artery bypass graft surgery [CABG] or aortic valve surgery and orthotopic liver transplantation [OLT]. Aortic valve replacement [AVR] and pulmonary valve vegetectomy for bacterial endocarditis after OLT have also been reported. There are only five cases with aortic stenosis and cirrhosis reported to have combined AVR and liver transplantation. In the presence of cirrhosis, AVR has a significant risk for mortality because of bleeding from coagulopathy, renal failure, infection, and poor post-operative wound healing. Herein, we report on a case and management analysis of combined sequential AVR, and OLT in a 40-year-old cirrhotic man with Child and MELD score of C and 29, respectively. Echocardiography detected severe aortic insufficiency [AI] with enlarged left ventricle. Due to severe AI, the cardiologist recommended AVR prior to transplantation. The patient underwent metallic AVR. 4 months later, he received OLT. Both operations were successful and uneventful. Prioritizing AVR before OLT was successful in this patient. However, each patient must be evaluated individually and multiple factors should be assessed in pre-operation evaluation

Prevalence of zinc deficiency in 3-18 years old children in Shiraz-Iran

Zinc is an essential trace element with a prominent role in human nutrition. Zinc deficiency has been linked to growth retardation, hypogonadism in males, and lack of sexual development in females. It ranges from 50% in sub-Saharan Africa to 5% in high income countries. The aim of this study is to evaluate the prevalence of zinc deficiency in healthy children in Shiraz, Southern Iran. In this study, 902 children aged 3-18 years old were randomly sampled for serum zinc level. Age, sex, weight, height, BMI, stunting and wasting indices were also recorded. With atomic absorption spectrophotometry method, the serum level of zinc less than 70 micro g/dL was considered as deficient. Mean serum level of zinc was 122.3 +/- 55 micro g/dL. The prevalence of zinc deficiency was 7.9%. There was no relationship among serum zinc level and age, sex, height, weight or BMI, but mild wasting [weight for age] and mild stunting [height for age] were significantly more prevalent among zinc deficient children compared to children with normal or high level of zinc. Zinc deficiency in Shiraz is not as prevalent as other areas of Iran. It was significantly more frequent among stunted and wasted [malnourished] children. Difference in soil zinc level, recent wide prescription of zinc supplements by pediatricians and especial pattern of nutrition, considered as possible factors responsible for lower prevalence of zinc deficiency in Shiraz, deserve more investigations

Evaluation of candida infection after six months of transplantation in pediatric liver recipients in Iran

Liver transplantation [LT] is the standard treatment of end-stage liver diseases [ESLD]. Invasive fungal infection is one of the important causes of morbidity and mortality after transplantation. To determine the incidence of late-onset [after 6 months of LT] Candida infection in recipients. A retrospective study was conducted to evaluate 50 pediatric patients after LT for 8 years at the LT Unit of Nemazee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. We followed the patients until 6 months post-LT for episodes of Candida infection proven by culture. One recipient [2%] developed late-onset esophageal candidiasis with improvement after intravenous amphotricin therapy but finally expired with a diagnosis of post-transplant lymphoproliferative disorder [PTLD]. The incidence of late-onset Candida infection is not significant in pediatric liver recipient, but it still remains a significant problem. Control of Candida colonization would reduce the risk of invasive fungal infections and possibly more fatal complications

Congenital hepatic fibrosis and need for liver transplantation

Herein, we describe two patients who underwent liver transplantation with the clinical diagnosis of hepatic failure and cryptogenic cirrhosis; histopathology of the explanted hepatectomy specimen revealed congeni- tal hepatic fibrosis. To the best of our knowledge, coexistence of hepatic failure and cirrhosis in congenital hepatic fibrosis, have not yet been reported in the English literature

Migraine headache and acid peptic diseases in children

Although there are some studies on correlation between migraine headache and GI symptoms, they did not significantly support the correlation between migraine headache and acid peptic diseases. This case control study aimed to find such a correlation. There were 70 patients [5-15 years old] who had endoscopic documented acid peptic diseases. The frequency of migraine headache in this group and also in a group consisting of a sample of normal population [300 individuals] without any GI problem in the past year was determined by a questionnaire. The frequency of migraine headache was determined in each kind of acid peptic disease in the patients, being 92.9%, 68.6%, 24.3%, 4.3%, and 4.3% among patients with gastritis, esophagitis, doudenitis, gastric ulcer, and duodenal ulcer, respectively. The frequencies of migraine headache among the normal population and acid peptic disease group were 11.3% and 22.9%, respectively. The difference was found to be statistically significant. Our findings showed a significant correlation between migraine headache and acid peptic diseases, especially esophagitis and gastritis. This result accords with that in some of the previous studies

Peri-operative high-dose V post-operative low dose steroid therapy in the management of biliary atresia: a preliminary report

The use of high-dose steroid therapy peri portoenterostomy may have a positive impact on the frequency of cholangitis and survival rate. A prospective study was conducted on two groups of patients [less than three months of age] suffering from biliary atresia from 1999 to 2005. The patients in group I [G I] were managed peri-operatively by high-dose methylprednisolone while the other group [G II] received low dose methylprednisolone only post-operatively [2mg/k/day for 1 month]. Infants in GI [n = 30] received methylprednisolone for 3 successive days before operation [10-8-6mg/kg/day], and 10 mg/k at the day of operation respectively. Thereafter the dose was tapered in the next successive 6 days by 8, 6, 5, 4, 3, and 2 mg/kg/day and continued for one month. Seventy two infants with biliary atresia were operated [39 girls and 33 boys]. Twenty-six of the 30 patients [86%] in G I became jaundice-free within 90 days after portoenterostomy while only seven [15%] of the 42 patients in G II had normal bilirubin [P < 0.0001]. Episodes of postoperative cholangitis in G I were 20% [6 of 30], and 53% [24 of 42] in G II [P < 0.005]. The difference in 3-year survival rate between the two groups is also remarkable: Eighty seven percent [26 of 30] in GI versus 29% [13 of 45] in G II [P < 0.005]. Death related to biliary atresia occurred in 1 [3.3%] patient in GI compared with 12 [29%] patients in G II [p < 0.005]. These results provide strong evidence that peri-operative high dose steroid therapy is not only safe in this patients population, but because of its anti-inflammatory and cholerrhetic effects has a positive impact on preventing recurrent cholangitis, and ultimately survival

Bowel movement patterns in children with acute appendicitis

Acute appendicitis is currently one of the most important causes of acute abdominal peritonitis and emergency laparatomy. Despite its low mortality, it remains a cause of concern for surgeons due to the postoperative complications of wound infection, sepsis, intrabdominal abscess and even bowel obstruction resulting from adhesions. High incidence of acute appendicitis provides a strong impetus for further studies. This study was conducted to determine the bowel movement patterns and dietary fiber consumption in pediatric patients with appendicitis in Shiraz, southern Iran. The study included 202 pediatric patients under the age of 18 years at Nemazee Hospital affiliated to Shiraz University of Medical Sciences, who had undergone appendectomy with the preoperative diagnosis of acute appendicitis from March 2003 to March 2004. Using a written semi-standard questionnaire, the variables recorded were age, gender, stool consistency, number of bowel movements, type of bread consumed, habit of fruit and vegetable consumption, clinical presentation [signs and symptoms] and the time taken from the onset of symptoms to arrival in hospital, the date of patients admission to the emergency room to the time of surgery, and the duration of postoperative hospitalization. The pathology of appendicitis was clarified and recorded. The patients aged from 3-18 years [mean: 11.2 +/- 3.6 years], with a male to female ratio of 2:4. Anorexia was the most common symptom, affecting 78.7% of patients. Of 31 patients with constipation, 58% did not report daily regular intake of fruits while the others had regular fruit intake. Only 3 patients [9.7%] had regular daily consumption of vegetables, and 27 patients [87.1%] had pathology reports of fecalith, while in the nonconstipated patients, only 1.2% had such reports. The abdominal pain was periumbilical in many patients [42.6%], which shifted to McBurny point in most [96%] patients. 134 patients [66.3%] visited a health center within 24 hours after the first symptoms. Surgeries were performed on 132 patients [65.3%] within 6 hours, on 67 patients [33%] within 6-12 hours, and on 3 patients [2%] in more than 12 hours. Our findings suggest a high rate of constipation in patients with lower fiber intake, which is consistent with the hypothesis indicating the role of dietary fibers in lowering the incidence of appendicitis

Endoscopic findings in children on non-steroidal anti-inflammatory drugs [NSAIDs]

Non-steroidal anti-inflammatory drugs [NSAIDs] remain as the initial approach to the pharmacologic management in juvenile rheumatoid arthritis [JRA]. Gastrointestinal [GI] damage associated with NSAIDs is common in adults, but there are few studies available in children. This study was performed to determine the GI complications due to the use of NSAIDs in a cohort of JRA patients by endoscopy. Twenty-one patients with JRA who were using NSAIDs for at least 3 months were assessed clinically and by endoscopy at Pediatric Immunology Clinic of Nemazee Hospital affiliated to Shiraz University of Medical Sciences in Shiraz, southern Iran from June 1999 to June 2003. The mean age of the patients was 9.8 years [11 females], and the mean duration under NSAIDs management was 16 months. The most common NSAIDs used was diclofenac. GI symptoms were found in 42.9% of patients including 33.4% abdominal pain and 9.5% vomiting. There was no significant difference between the patients and symptoms free subjects in regard to mean duration of treatment. Macroscopic endoscopic lesions were found in 85.7% and infection of Helicobacter pylori [Hp] in 14.3% of cases. There was no significant relationship between endoscopic findings and duration of treatment or clinical symptoms. Our data showed that patients using NSAIDs had frequent GI damage without any relationship to the duration of treatment. There were also a high number of children with GI damage and without any clinical complaint. Furthermore, we found no significant relationship between the duration of drug use and the GI complaints, and no relation between duration and GI complaints to upper GI tract endoscopic lesions. The possibility of GI derangements with NSAIDs in pediatric age group is high. Close monitoring of symptoms and prevention measures are suggested