Upper gastrointestinal bleeding in children in southern Iran.

Objective. To find out whether the causes of upper GI bleeding in our center in a developing country differed from developed countries. Methods. Children presenting to our center with upper GI bleeding from March 2002 to March 2007, were retrospectively evaluated. Informations were retrieved from patient’s history and physical examination and results of upper GI endoscopy regarding etiology of bleeding, managements, use of medications which might predispose patient to bleeding, and the mortality rate. Results. From 118 children (67 boys; with age of 7.7±4.7 yrs) who underwent upper GI endoscopies, 50% presented with hematemesis, 14% had melena and 36% had both. The most common causes of upper GI bleeding among all patients were gastric erosions (28%), esophageal varices (16%), duodenal erosions (10%), gastric ulcer (8.5%), Mallory Weiss syndrome tear (7.8%), duodenal ulcer (6.8%), esophagitis (1.7%) and duodenal ulcer with gastric ulcer (0.8%). The causes of bleeding could not be ascertained in 20.5% of cases. No significant pre-medication or procedure related complications were observed. Endoscopic therapy was performed in 13.5% of patients. In 14.4% of patients, there was a history of consumption of medications predisposing them to upper GI bleeding. Two deaths occurred (1.7%) too. Conclusion. The findings in the present study showed that half of upper GI bleedings in pediatric patients from south of Iran, were due to gastric and duodenal erosions and ulcers. This study concludes that the causes of upper GI bleeding in children in our center of a developing country, are not different from those in developed ones.

Clinical profile of dengue hemorrhagic fever cases in Mexico

OBJETIVO: El dengue hemorrágico en México es una enfermedad emergente desde 1994. La circulación de los cuatro serotipos incrementa el riesgo de epidemias de dengue hemorrágico. MATERIAL Y MÉTODOS: Se reportan los datos clínicos y epidemiológicos de los casos de dengue hemorrágico confirmados y notificados por el IMSS de 1995 a 2003. Se analizaron las características clínicas y epidemiológicas entre grupos. Para el control y la evaluación final de las variables se utilizó un modelo multivariado. RESULTADOS: Los casos fueron asignados en dos grupos: 438 con dengue clásico, que incluye 109 casos con manifestaciones hemorrágicas sin trombocitopenia, y 977 casos de dengue hemorrágico con 79 defunciones. Los factores de riesgo asociados a las defunciones fueron: hematemesis (RR 2.6; IC 95 por ciento 1.4-4.6) y melena (RR 2.2; IC 95 por ciento 1.2-3.7). CONCLUSIONES: El cuadro clínico descrito para la población del Instituto Mexicano del Seguro Social permite identificar factores pronósticos que ayuden al clínico a prevenir y manejar adecuadamente los casos severos de dengue hemorrágico.

Yield of endoscopy in children with hematemesis.

Upper gastrointestinal (UGI) endoscopy is an important tool in the evaluation of patients presenting with haematemesis. The objective of this study was to report the yield of this procedure in a Saudi Arabian population. We analysed the result UGI endoscopy in children and adolescents of 0-18 years of age who presented with haematemesis over a period of 10 years. From 1993 to 2003, endoscopy was performed on 60 consecutive children presenting with haematemesis. This group represented 12% of the indications during the same period. The majority (98%) were Saudi nationals, with an age range from 4 days to 18 years, and a male to female ratio of 1:1.5. The overall yield of endoscopy was 75%; however, the yield was higher (91%) in children below 12 years of age. Gastritis was the commonest cause of haematemesis (44%), followed by oesophagitis (36%). However, age-related analysis shows that oesophagitis was a more common cause of haematemesis in the younger age group (45%) than gastritis in adolescents (30%). In contrast, gastritis was more common in older children (56%) than oesophagitis (28%). Peptic ulcer disease and oesophageal varices were seen in only 3 (7%) and 2 children (4.3%), respectively. The overall yield of endoscopy in our patients is similar to that in most reports. However, oesophagitis and gastritis were the commonest causes of haematemesis, whereas oesophageal varices and peptic ulcer disease were much less common.

Etiology of haemetemesis: a study of 350 cases

To find out the etiology of Haemetemesis. Design: A prospective study of consecutive patients admitted with haemetemesis during one year from 1.1.98 to 31.12.98. Setting: Medical Intensive Care Unit, Jinnah Postgraduate Medical Centre, Karachi. Subject 350 patients with haemetemesis admitted to Medical 1.C.U. in 1998. Main outcome measures: Oesophageal varices as a cause of haemetemesis is on rise. Leading causes of haemetemesis are oesophageal varices 39%, peptic ulcer 24% and superficial mucosal lesions 17%. Among cirrhotics, oesophageal varices were present alone in 61.3%, with portal hypertensive gastropathy in 21.9% with peptic ulcer in 7.3%, while among non cirrhotics, peptic ulcer was present alone in 77.3 8% with oesophogeal varices in 11.90%. Oesophageal varices contribute to most cases of haemetemesis and need measures for control and prevention

An epidemic of dengue hemorrhagic fever and dengue shock syndrome in children in Delhi.

OBJECTIVE: To study clinical profiles and outcome of children of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) during 1996 Delhi epidemic. DESIGN: Retrospective study. SETTING: Hospital based study. METHODS: Children hospitalized from September to November 1996 were studied. All patients were diagnosed, managed and monitored according to a standard protocol. RESULTS: One hundred and thirty four children (80 (60%) males and 54 (40%) females) were studied. Sixty (45%) children were less than 6 years of age of which 12 presented during infancy. There were 92 (67%) cases of DHF and 42 (33%) cases of DSS. Common symptoms were fever (93%), abdominal pain (49%) and vomiting (68%). The commonest hemorrhagic manifestation was hematemesis (39%) followed by epistaxis (36%) and skin bleeds (33%). Hepatomegaly was observed in 97 (72%) cases and splenomegaly in 25 (19%). Serology was positive (IgM hemaglutination antibody titres > 1: 160) for dengue type 2 in 31 (80%) of 39 patients in whom sera was tested during the acute phase of illness. Mortality was 6%. Hematocrit > 40% was observed in only 25 (18%) patients and hence the management protocol was based on clinical signs and symptoms and not on hematocrit. CONCLUSIONS: A management protocol of DHF/DSS in which fluid therapy is not based on haematocrit values needs to be formulated.