Hepatitis C in children with chronic kidney disease: A single-center, Egypt.

Prevalence of hepatitis C varies largely according to geographical distribution, and Egypt so far has the highest prevalence worldwide. The aim of this study was to evaluate hepatitis C infection in chronic kidney disease (CKD) children in our center with regard to its incidence and other morbidities. This is a cross-sectional study involving 50 children with CKD, not on dialysis. All patients underwent a thorough history taking including disease duration and mean duration of admission, clinical examination including blood pressure measurements, and routine laboratory examination such as hemoglobin level, serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine. The detection of anti-hepatitis C virus (HCV) antibodies was done in all patients based on the use of third-generation enzyme immunoassay (EIA) that detects antibodies directed against various HCV epitopes. Nine (18%) children were found to be hepatitis C positive and 41 were negative to hepatitis C. Infected cases were of older age group and had a longer duration of CKD, lower estimated glomerular filtration rate (eGFR), lower hemoglobin, higher ALT, higher serum urea, and creatinine. We conclude that 18% of children with CKDs have hepatitis C infection, and those with longer the duration of renal disease is more likely to be positive for HCV. Furthermore, HCV infection may predispose to higher deterioration of eGFR, lower hemoglobin level, and more days of admission. We recommend routine testing of HCV in all children with CKD.

Mandibular mass in a child on hemodialysis.

We here with report a 13-year-old female patient on regular hemodialysis for the past five years who presented with a large mandibular mass. This was detected to be a brown tumor due to severe renal osteodystrophy as a complication of secondary hyperparathyroidism. The tumor did not regress even with intensive treatment with intravenous active vitamin D and needed surgical removal.

Prospective study of nephrolithiasis occurrence in children receiving cefotriaxone.

AIM: Ceftriaxone is a commonly used antibiotic among the paediatric population. Various reports have associated high doses of Ceftriaxone with the development of nephrolithiasis; our aim was to test this association with a 5 day course of treatment. METHODS: Our study group consisted of 120 patients divided into two groups. The first group included 60 patients who underwent treatment with Ceftriaxone therapy that was started empirically and continued for 5 days at the dose of 80 mg/kg per day. The second group (60 patients) who received treatment with other antibiotics (other than Ceftriaxone), as recommended by hospital protocols. Patients with urinary tract infections (UTI) were excluded as UTI may be a predisposing cause for nephrolithiasis. Baseline and follow up after 5 days were done with; abdominal ultrasound, serum urea, creatinine, serum calcium, 24 h urinary calcium and urinary calcium/ creatinine ratio. Extended metabolic tests were done for cases that developed nephrolithiasis. RESULTS: Five cases out of the 60 patients treated with Ceftriaxone developed calculi; that were small and were eliminated spontaneously in four cases at mean duration of 3 weeks. In these cases renal ultrasonography examinations were normal prior to treatment; and none of them had metabolic disturbances or risk factors leading to stone formation. By multiple regression analysis, only age was related to nephrolithiasis formation being higher in the group that has developed stones. CONCLUSION: Only patients who underwent Ceftriaxone therapy have developed renal stones, even with a short course of therapy (5 days), and in the absence of a known predisposing cause for nephrolithiasis. We have thus concluded that Ceftriaxone by itself maybe a predisposing factor for nephrolithiasis.

Giant cell arteritis in a 12-year-old girl presenting with nephrotic syndrome.

Giant cell arteritis (GCA) is rare in children. The kidneys are generally spared. We present a case of GCA in a 12-year-old girl with severe headache and tender scalp especially over the right temporal area. The right superficial temporal artery was cord like and nodular and the pulsations were barely felt. Several small tender nodular swellings were felt in the occipital area. She had been previously diagnosed as a case of nephrotic syndrome due to underlying membranoproliferative glomerulonephritis. This report is aimed at drawing attention to this rare form of vasculitis in children aiming at decreasing its morbidities.

Dermatophagoides in childhood asthma. Allergy to dermatophagoides associates more severe childhood asthma with a potential role for acaricides.

OBJECTIVE: To evaluate hypersensitivity to Dermatophagoides pteronyssinus (D. pteronyssinus) and Dermatophagoides farinae (D. farinae) in pediatric patients with asthma, and the use of acaricides. METHODS: This is a randomized controlled trial in 82 asthmatic children. They were recruited and evaluated for severity and chronicity according to the Global Initiative for Asthma Guidelines. The study was carried out in the Pediatric Allergy Clinic, Al Noor Hospital, Khalifa Branch, Abu Dhabi, United Arab Emirates between September 2008 and June 2010. Skin prick test (SPT) was performed including D. pteronyssinus and D. farinae, and for those who were sensitive to one, or the other. The therapeutic value of acaricides was evaluated by assessing the severity of asthma before and after their use. RESULTS: Approximately 81.7% of asthmatics were sensitive to house dust mites (HDM). Hypersensitivity was associated with the more severe and persistent asthma (p=0.029). The manifested severity of asthma was not HDM species-specific. There was a linear association between response of children to acaricides and increasing severity of asthma. CONCLUSION: Hypersensitivity to HDM is an important factor for persistent and severe forms of asthma. Acaricides can help control childhood asthma, and we recommend SPT as part of the routine work-up of patients with asthma to determine HDM sensitive patients that can benefit from acaricides use.

House dust mites in pediatric atopic dermatitis.

OBJECTIVE: To evaluate hypersensitivity to Dermatophagoides pteronyssinus (D. pteronyssinus) and D. farinae in pediatric patients with atopic dermatitis (AD), and to assess the therapeutic value of using acaricides with other environmental anti house dust mites (HDM) measures. METHODS: Ninety-eight children with AD were chosen randomly from the Pediatric Allergy Clinic in Al-Noor Hospital, Khalifa branch, Abu Dhabi, United Arab Emirates during the period between January 2008 to January 2009 and were evaluated for severity and chronicity. They were subjected to skin prick test (SPT) including D. pteronyssinus and D. farinae antigens and were also assessed for the therapeutic value of acaricides and environmental anti HDM measures. RESULTS: We found that 74.5% of patients were sensitive to one or both strains of HDM. A highly significant association was found between the severity of the symptoms of AD and its persistence with hypersensitivity to HDM (p=0.001). Acaricides and environmental anti HDM measures can improve patients with mild AD. CONCLUSION: Hypersensitivity to HDM is an important factor for the more acute, more chronic, and more severe AD. Anti HDM measures including the use of acaricides can help control mild AD. We recommend SPT as a part of the work up of patients with AD. The HDM sensitive patients can benefit from anti HDM measures.

Treatment of allergic rhinitis with desloratadine: results of a multinational observational study in the middle East gulf region.

BACKGROUND: : Allergic rhinitis (AR) affects up to 36% of the population in the Middle East Gulf States. The second-generation nonsedating antihistamine desloratadine has demonstrated safety and efficacy in the treatment of AR; however, few studies have evaluated this agent in Arab and Asian populations in the Middle East. METHODS: : This open-label study enrolled subjects ≥12 years with moderate-to-severe AR; they received desloratadine 5 mg QD for 2 weeks. Endpoints included change in mean individual nasal and ocular symptom scores, total symptom score (TSS), and peak nasal inspiratory flow (PNIF) and percentage improvement in global response to therapy. RESULTS: : There were 602 subjects from 5 Middle East countries enrolled. After 2 weeks, desloratadine significantly (P < 0.0001) reduced mean scores for individual nasal and total ocular symptom scores and TSS. PNIF measures of nasal congestion were significantly (P < 0.0001) improved after treatment. Most subjects obtained complete (38.1%) or marked (47.2%) relief of AR symptoms. Treatment failure was reported in 2.2% of subjects. No adverse events were reported, and no subjects discontinued treatment. CONCLUSION: : Most subjects reported significant symptom relief with desloratadine 5 mg/d for 2 weeks. Desloratadine is effective in the treatment of AR in Arab and Asian subjects in the Middle East Gulf region.