Quantitative MRI Assessment of Pancreatic Steatosis Using Proton Density Fat Fraction in Pediatric Obesity

Objective@#To assess the feasibility of quantitatively assessing pancreatic steatosis using magnetic resonance imaging (MRI) and its correlation with obesity and metabolic risk factors in pediatric patients. @*Materials and Methods@#Pediatric patients (≤ 18 years) who underwent liver fat quantification MRI between January 2016 and June 2019 were retrospectively included and divided into the obesity and control groups. Pancreatic proton density fat fraction (P-PDFF) was measured as the average value for three circular regions of interest (ROIs) drawn in the pancreatic head, body, and tail. Age, weight, laboratory results, and mean liver MRI values including liver PDFF (L-PDFF), stiffness on MR elastography, and T2* values were assessed for their correlation with P-PDFF using linear regression analysis. The associations between P-PDFF and metabolic risk factors, including obesity, hypertension, diabetes mellitus (DM), and dyslipidemia, were assessed using logistic regression analysis. @*Results@#A total of 172 patients (male:female = 125:47; mean ± standard deviation [SD], 13.2 ± 3.1 years) were included. The mean P-PDFF was significantly higher in the obesity group than in the control group (mean ± SD, 4.2 ± 2.5% vs. 3.4 ± 2.4%; p = 0.037). L-PDFF and liver stiffness values showed no significant correlation with P-PDFF (p = 0.235 and p = 0.567, respectively). P-PDFF was significantly associated with obesity (odds ratio 1.146, 95% confidence interval 1.006–1.307, p = 0.041), but there was no significant association with hypertension, DM, and dyslipidemia. @*Conclusion@#MRI can be used to quantitatively measure pancreatic steatosis in children. P-PDFF is significantly associated with obesity in pediatric patients.

Determining the optimal timing of screening spinal cord ultrasonography to detect filum terminale lipoma in infants

Purpose@#The purpose of this study was to identify the optimal timing for screening spinal cord ultrasonography (US) to detect filum terminale lipoma in infants. @*Methods@#We retrospectively reviewed infants (<12 months old) who underwent repeated spinal cord US between April 2011 and January 2019. We excluded infants if they only had one US examination, or if they had lesions other than filum terminale lipoma. Infants with filum terminale lipoma on magnetic resonance imaging were included in the lipoma group and the others in the control group. A linear mixed model was used to assess differences in the growth pattern of filum terminale thickness by age and group. The cutoff thickness on US and its diagnostic performance were assessed according to age. @*Results@#Among 442 infants with 901 US examinations, 46 were included in the lipoma group and 58 in the control group. Sixty-seven infants had unmeasurable filum terminale thickness on initial US, including 55 neonates (82.1%) before 1 month of age. The lipoma group had significantly greater filum terminale thickness than the control group (P<0.001). Thickness increased with age in the lipoma group (P=0.027). The sensitivity of US was 87.5% and the area under the receiver operating characteristic curve was 0.949 (95% confidence interval, 0.849 to 0.991) with a cutoff value of 1.1 mm in 4- to 6-month-old infants. @*Conclusion@#Screening spinal cord US could effectively diagnose filum terminale lipoma in 4- to 6-month-old infants with a cutoff thickness of 1.1 mm. Spinal cord US can be used to screen young infants with intraspinal abnormalities.

Establishing molecular microbiology facilities in developing countries

Microbiology laboratories play an important role in epidemiology and infection control programs. Within microbiology laboratories, molecular microbiology techniques have revolutionized the identification and surveillance of infectious diseases. The combination of excellent sensitivity, specificity, low contamination levels and speed has made molecular techniques appealing methods for the diagnosis of many infectious diseases. In a well-equipped microbiology laboratory, the facility designated for molecular techniques remains indiscrete. However, in most developing countries, poor infrastructure and laboratory mismanagement have precipitated hazardous consequences. The establishment of a molecular microbiology facility within a microbiology laboratory remains fragmented. A high-quality laboratory should include both conventional microbiology methods and molecular microbiology techniques for exceptional performance. Furthermore, it should include appropriate laboratory administration, a well-designed facility, laboratory procedure standardization, a waste management system, a code of practice, equipment installation and laboratory personnel training. This manuscript lays out fundamental issues that need to be addressed when establishing a molecular microbiology facility in developing countries

Association of Attention Deficit Hyperactivity Disorder with Heroin Addiction.

Objectives: To study the association of attention-deficit hyperactivity disorder (ADHD) with heroin addiction. Study design: A cross-sectional, hospital based study. Place and duration of study: The study was carried out at Lady Reading Hospital and Khyber Teaching Hospital, Peshawar, Pakistan from 4th April 2012 to 13th September 2012. Subjects and Methods: A sample of 137 adult heroin addicts were analyzed that whether they were ADHD and that childhood problem continues to manifest symptoms in adults. For retrospective assessment of childhood ADHD, the Wender Utah Rating Scale (WURS) as well as the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) symptom checklist for ADHD was used. The Conners’ Adult ADHD Rating Scales (CAARS) was used to assess the persisting symptoms of ADHD in adults. Inclusion criteria: Patient diagnosed with heroin addiction according to ICD-9 and DSM-IV. Exclusion criteria: Patient has co-morbid with any other mental illnesses. Results: The difference between the mean score of WURS and CAARS of ADHD patients were significantly greater than the normal patients. Heroin addicts showed 41.6% (WURS) and 38.6% (DSM-IV diagnostic criteria) that indicated evidence of retrospective ADHD affliction in childhood. 22.6% were IV users. CAARS was presented in 37.9% heroin addicts who exhibited a substantiation of ADHD persistent in adulthood. The difference between the mean score of WURS and CAARS of ADHD patients were significantly greater (P = 0.003), than the normal patients. Conclusions: These results revealed that addiction is associated with co-morbidity with ADHD, expressed in the form of heroin addiction.

Managing HCV infection in pediatric age group: suggested recommendations

Hepatitis C virus [HCV] infection in children is different from the adult infection in many ways, like natural course of the disease; duration, therapeutic response and side effects profile of the drug therapy; and prognosis. Special considerations include consideration on what could be the appropriate time to investigate a suspected child, when to institute drug therapy and how to prevent vertical transmission. Although over the past one decade many land mark studies have greatly increased our insight on this subject, yet we are far from developing a consensus statement. In this article, a concise yet comprehensive review of HCV infection in children - diagnosis and treatment - is given, followed by suggested recommendations at the end. It is hoped that these recommendations will help develop local guidelines on this subject

Antiviral therapy in HCV-infected decompensated cirrhotics

Decompensated cirrhosis has traditionally been considered a contraindication to interferon and ribavirin therapy. Whereas, the same may be true for advanced cirrhosis, which is only successfully amenable to liver transplantation [LT], there are reports in the literature in which antiviral therapy was given successfully in selected cases of early hepatic decompensation with an aim to attain sustained viral clearance, halt disease progression, and expect potential [though, often, partial] recovery of hepatic metabolic activity. Antiviral therapy may also be instituted to prevent hepatitis C recurrence after LT [it has even caused removal of some patients from the waiting list for LT]. Thus, decompensation per se is no more an absolute contraindication to antiviral therapy. Nonetheless, considering that a large proportion of such patients have pre-existing hematological cytopenias, modifications in antiviral dose regimens and close monitoring is required in order to prevent worsening of the same. Although the final sustained virological response rates attained in these patients are relatively low, successful antiviral therapy is potentially lifesaving which explains the need to go for it. In this article, the pros and cons of antiviral therapy in decompensated liver cirrhosis are reviewed with special emphasis on how to avoid antiviral dose reductions/withdrawals secondary to the development of hematologic side effects by using hematopoietic growth factors

Considerations in the management of hepatitis c virus-related thrombocytopenia with eltrombopag

Thrombocytopenia is a common clinical problem in HCV-infected cases. Multiple studies have consistently shown a rise in platelet count following a successful HCV treatment thus proving a cause-effect relationship between the two. Although, many therapeutic strategies have been tried in the past to treat HCV-related thrombocytopenia [e.g. interferon dose reductions, oral steroids, intravenous immunoglobulins, splenectomy etc], the success rates have been variable and not always reproducible. After the cessation of clinical trials of PEG-rHuMGDF due to immunogenecity issues, the introduction of non-immunogenic second-generation thrombopoietin-mimetics [eltrombopag and Romiplostim] has opened up a novel way to treat HCV-related thrombocytopenia. Although the data is still sparse, eltrombopag therapy has shown to successfully achieve the primary endpoint platelet counts of >/= 50, 000/micro L in phase II and III, randomized, double-blind, placebo-controlled trials. Likewise, though it is premature to claim safety of this drug especially in high-risk patient groups, reported side effects in the published literature were of insufficient severity to require discontinuation of the drug. Based on the current and emerging evidence, a review of the pharmacologic basis, pharmacokinetics, therapeutic efficacy, safety profile and future considerations of eltrombopag in the context of HCV-related thrombocytopenia is given in this articfie. A MEDLINE search was conducted [1990 to August 2009] using the search terms eltrombopag, HCV, thrombocytopenia

Role of granulocyte colony-stimulating factor [G-CSF]/Filgrastim as an adjunct in chronic hepatitis C management

Drug-induced hematotoxicity is the commonest reason for reducing the dose or withdrawing interferon [IFN] therapy in a case of chronic hepatitis C thus depriving the patient of a possible cure. Traditionally, severe neutropenia has been considered an absolute contraindication to start antiviral therapy. Since the advent of adjunct therapy with Granulocyte-colony stimulating factor, the same is not true any more. Some recent landmark studies have used this adjunct therapy to help avoid antiviral dose reductions. although, addition of this adjunct therapy has been shown to significantly increase the overall cost of the treatment, if the infection is cured at the end of the day, this extra cost is worth bearing. Although, more studies are needed to refine the true indications of this adjunct therapy, determine the best dose regimen, quantify the average extra cost and validate that whether or not the addition of this therapy increases the sustained virologic response rates achieved, the initial reports are encouraging. Therefore, although not recommended on routine basis, some selected patients may be given the benefits of these factors. In this article, a review of the current literature on this subject is given followed by few suggested recommendations at the end to help develop local guidelines

Chronic hepatitis C with associated renal disease: Suggested recommendations for the development of local guidelines

HCV infection is estimated to be the commonest liver disease in renal dialysis patients with a prevalence rate of 5% to as high as 50% in some centres. Although no local Pakistani data exists, any estimation of <50% would probably be an underestimation. Since, end-stage-kidney disease is generally an immunocompromised state, antibodies to hepatitis C virus [HCV] may not develop despite of the presence of active hepatitis C infection. The diagnosis of HCV infection thus requires reverse-transcriptase polymerase chain reaction [RT-PCR]. As far as treatment is concerned, ribavirin has traditionally been considered contraindicated in advanced kidney disease patients because it causes hemolytic anemia in a significant number of patients. Also, pegylated interferon, which is the current standard in the management of chronic hepatitis C cases, is generally not advised in renal disease patients owing to its prolonged half life and thus increased probability of side effects. It is thus clear that chronic hepatitis C infection in association with renal disease poses a special diagnostic and managerial problem. In the recent past, many landmark studies have greatly increased our insights in the diagnosis and management of hepatitis C cases and many conditions previously considered to be contraindications for antiviral therapy are no more considered contraindicated. The current evidence is enough to warrant a thorough revision on this subject. In this article, the current state-of-the-art standards on this subject are given followed by a few suggested recommendations at the end

Disseminated non-tuberculous mycobacterial infection in an immuno-competent host with no pre-existing lung disease: a case report

A Turkish male aged 36 years presented with pyrexia cough, weight loss and night sweats, had prosthetic aortic valve with no evidence of infective endocarditis or HIV infection. There was no radiographic evidence of lung involvement. A bone marrow trephine revealed numerous non-caseating granulomas. Mycobacterium avium intracellulare was isolated from sputum and Early Morning Urine samples

Siting MSW landfills with a weighted linear combination methodology in GIS environment

Landfill has been taken to the bottom of the hierarchy of options for waste disposal but has been the most used method for urban solid waste disposal. However, landfill has become more difficult to implement because of its increasing cost, community opposition, and more restrictive regulations regarding the siting and operation of landfills. Land is a finite and scarce resource that needs to be used wisely. Appropriate allocation of landfills involves the selection of areas that are suitable for waste disposal. The present work describes a type of multi-criteria evaluation [MCE] method called weighted linear combination [WLC] in a GIS environment to evaluate the suitability of the study region for landfill. The WLC procedure is characterized by full tradeoff among all factors, average risk and offers much flexibility than the Boolean approaches in the decision making process. The relative importance weights of factors are estimated using the analytical hierarchy process [AHP]. In the final aggregated suitability image, zones smaller than 20 hectares are eliminated from the allocation process. Afterwards, the land suitability of a zone is determined by calculating the average of the suitability of the cells belonging to that zone, a process called zonal land suitability. The application of the presented method to the Gorgan city [Iran] indicated that there are 18 zones for landfill with their zonal land suitability varying from 155.426117 to 64.149024. The zones were ranked in descending order by the value of their zonal land suitability. The results showed the use of GIS as a decision support system [DSS] available to policy makers and decision makers in municipal solid waste [MSW] management issues

Mouth and genital ulcerations in the community

To estimate the prevalence of mouth and genital ulceration in the community and its relationship to rheumatic diseases. A house to house survey was carried out over a period of 18 months extending from September 1993 to February 1995, on 5,894 individuals utilizing detailed questionnaires on symptoms of musculoskeletal diseases and associated symptoms including history of mouth, genital ulcers, eye symptoms, and skin changes. After the initial phase, a 2nd phase was completed by trained nurses and paramedical staff, the purpose of which was to explore in detail, the history of those responding positively to any of the questions in phase one. The 3rd stage was conducted by general practitioners and rheumatologist to interview and examine those identified in phase 2 at King Fahad Hospital, Buraidah, Kingdom of Saudi Arabia. We identified 7 [0.1%] cases of genital ulceration, 43 [0.7%] cases of mouth ulceration, 263 [4.5%] cases of reddish eye or blurred vision, and 124 [2.1%] cases of skin rashes. Only 2 cases had both mouth and genital ulceration in addition to eye disease, skin rash and musculoskeletal pain. There was significant correlation between mouth ulcers and skin rash, eye symptoms, genital ulcerations, male sex, single status, weight loss and backpain. The vast majority of mouth and genital ulcers are not associated with a known rheumatic disease

How Common is back pain in Al-Qassim region

The aim of this study was to estimate the prevalence of back pain in the adult population of Al-Qaseem Central Province, Kingdom of Saudi Arabia and to find associated features and factors. A house-to-house survey covering 1,000 household in the towns and villages of Al-Qaseem province was carried out over a period of 18 months extending from September 1993 until the end of February 1995. A total of 5,894 adults, aged 16 years and above, were questioned by trained staff regarding back pain, and the demographic data in addition to general, medical and social history. A response was obtained in 5,743 [97.4%]. Their mean age was 34.14 ' 15.16 [range 16-99]. Back pain was reported by 1,081 [18.8%], wherein 499 [8.8%] were men, and 574 [10%] were women. Back pain was more prevalent in married [23.3%] individuals than unmarried [6.4%]. Adjusted odds ratio [OR] for back pain in married individuals was 1.88 [95% confidence intervals [CI] 1.49-2.37]. Back pain was strongly correlated with age [correlation coefficient = 0.378 P < 0.01]. It also showed significant correlation with weight and height, depression, family history of back pain, change in work ability, frequency of attendance at local doctor, use of medication and lower education level. The association with body mass index became evident only after comparing the heaviest 20th percentile to the lightest [OR 1.335 [95% CI, 1.279-1.402]]. Certain occupational status [unemployed, farmers, professional workers and housewives] were associated with back pain. Back pain was relatively common in this largely unindustrialized community although its prevalence is lower than reported from some western countries

Mosculoskeletal pain in the community

To estimate the prevalence of musculoskeletal [MSK] pain in Al-Qaseem province in central Saudi Arabia. Over a period of 18 months extending from September 1993 through to the end of February 1995, a house-to-house survey was conducted in Al-Qaseem province and included 5,894 adults asking regarding musculoskeletal pain. We obtained a response from 5,823 [98.8%], 2,667 [45.8%] men, and 3,156 [54.2%] women. The mean age was 34.14 +/= 15.16 years. Musculoskeletal pain was reported by 1,477 [25.4%], 762 [13.1%] men and 715 [12.3%] women. Musculoskeletal pain was significantly correlated with age [r =0.454], married status [r=0.238], unemployment [r=0.122], lower educational attainment [r=0.347], frequent attendance at local doctor [r=0.703], consumption of medications for pain [r =0.551], and change in ability to work [r=0.492]. We found no association with sex or body mass index. Musculoskeletal pain, although common in the community, is less prevalent than reported from Western countries, but has similar socio-medical consequences