ABSTRACT
UNLABELLED: There are few data on prevalence of hepatopulmonary syndrome (HPS) in children with chronic liver disease (CLD). This prospective study evaluated the prevalence and diagnostic procedures of HPS in Egyptian children with CLD. One hundred twenty (120) children with CLD were subjected to room-air pulse oximetry in supine and upright position, contrast enhanced echocardiography (CEE) and technetium-99m-labeled macroaggregated albumin (99mTc-MAA) perfusion lung scan. Arterial blood gas (ABG) analysis in upright position was performed for all children with identified intrapulmonary vascular dilatation (IPVD). Clinical, laboratory, imaging and endoscopic data were recorded and analyzed. RESULTS: Hypoxemia was found in 14 cases (11.7%) of the total cohort all of them had IPVD, whereas 6 cases (5%) of the patients had IPVD without hypoxemia. Therefore, HPS and subclinical HPS were diagnosed in 11.7% and 5% of CLD patients, respectively. Only 10 HPS patients had a pathological arterial oxygen saturation (SaO2) in the supine position (< or = 97%) but all showed a pathological SaO2 decrease (> or = 4%) after changing from supine to upright position. 99mTc-MAA perfusion lung scan revealed IPVD in 16.7% whereas CEE detected IPVD in 10% only of enrolled patients. There were strong correlations between shunt index estimated by lung scintiscan and oxygenation parameters in HPS patients. The characteristics of HPS patients were similar to that of non-HPS patients except for clubbing, dyspnea, cyanosis, orthodoexia and bleeding varices that were more associated with HPS patients as well as well as the Child-Pugh grades, which tended toward higher scores in HPS patients.
Subject(s)
End Stage Liver Disease/diagnosis , Hepatopulmonary Syndrome/diagnosis , Adolescent , Child , Child, Preschool , Cohort Studies , Egypt/epidemiology , End Stage Liver Disease/complications , End Stage Liver Disease/epidemiology , Female , Hepatopulmonary Syndrome/epidemiology , Hepatopulmonary Syndrome/etiology , Humans , Lung/diagnostic imaging , Lung/pathology , Male , Prevalence , RadiographyABSTRACT
Although persistent transmission of hepatitis C virus (HCV) from infected mothers to their infants is reported in 4-8%, transient HCV perinatal infection also occurs. This prospective cohort study determined perinatal HCV infection- and early and late clearance-rates in 1,863 mother-infant pairs in rural Egyptian villages. This study found 15.7% and 10.9% of pregnant women had HCV antibodies (anti-HCV) and HCV-RNA, respectively. Among 329 infants born of these mothers, 33 (10.0%) tested positive for both anti-HCV and HCV-RNA 2 months following birth-29 (12.5%) having HCV-RNA positive mothers and 4 (with transient infections) having mothers with only anti-HCV. Fifteen remained HCV-RNA positive at one and/or 2 years (persistent infections), while 18 cleared both virus and antibody by 1 year (transient infections). Among the 15 persistent cases, 7 cleared their infections by 2 or 3 years. At 2- to 6- and at 10- to 12-month maternally acquired anti-HCV was observed in 80% and 5% of infants, respectively. Four perinatally infected and one transiently infected infant were confirmed to be infected by their mothers by the sequence similarity of their viruses. Viremia was 155-fold greater in mothers of infants with persistent than mothers of infants with transient infections. Maternal-infant transmission of HCV is more frequent than generally reported. However, both early and late clearance of infection frequently occurs and only 15 (4.6%) and 8 (2.4%) infants born of HCV-RNA positive mothers had detectable HCV-RNA at one and 2-3 years of age. Investigating how infants clear infection may provide important information about protective immunity to HCV.
