Résumé
Background: Upper gastrointestinal bleeding [UGIB] is a common pediatric emergency. Esophago-gastro-duodenoscopy [EGD] is the first line diagnostic procedure to identify the source of bleeding. However etiology of UGIB remains unknown in 20% of cases. Furthermore, emergency endoscopy is unavailable in many hospitals in our country
Aims: Identify clinical predictors of positive upper endoscopy outcomes and develop a clinical prediction rule from these parameters
Methods:Retrospective study of EGDs performed in children with first episode of UGIB, in the endoscopic unit of Children's Hospital of Tunis, during a period of six years. Statistical analysis used SPSS20. Univariate analysis was performed and multivariate logistic regression was then modelled to derive a clinical prediction rule
Results: We collected 655 endoscopies [23.2% normal, 76.8% pathological]. We found that time to EGD within 24 hours from the onset of bleeding [p=0.027; Adj OR: 3.30 [1.14 - 9.53]], rebleeding [p=0.009; Adj OR: 6.01 [1.57 - 23.02]], positive gastric lavage outcome [p=0.001; Adj OR: 4.79 [1.95 - 11.79]] and non steroidal anti-inflammatory drugs intake [p=0.035; Adj OR: 5.66 [1.13 - 28.31]] were predictors of positive upper endoscopy outcomes. By assigning each factor, the adjusted odds ratio [Adj OR], we developed a score with four items, ranging from 4 to 20. Using the receiver operating characteristic [ROC] curve the best cut off >/= 9 was defined [sensitivity 88.2%, specificity 60.6%, positive predictive value 92.7% and negative predictive value 47.6%]. The score discriminated well with a ROC curve area of 0.837 [95% confidence interval [0.769 - 0.905]]
Conclusions: This clinical prediction rule is a simple measure that may identify children who needed emergency endoscopy. A prospective study is required to validate our results and evaluate other clinical features that were insufficient for this analysis
Résumé
To report a new case of hypoparathyroidism in a child with beta thalassemia major. We report a case of a 17-year-old Tunisian girl with transfusion-dependent thalassemia major presented with paresthesia and pubertal delay. Laboratory investigations showed hypocalcaemia and hyperphosphatemia. Parathyroid hormone level was low [2 ng/1, normal range: 12-72 ng/1] than expected for the degree of hypocalcaemia. Serum ferritin concentration was 1770ng/ml. The patient was started on oral daily calcium supplementation, Alfa calciferol and intensive iron chelation therapy. Follow-up after 6 and 12 months revealed normal Calcium and ECG showed QT intervalwithin normal range. Investigating calcium homeostasis at regular intervals and early management of any abnormality can preclude the occurrence of complications