BACKGROUND Fever is a common cause of medical consultation and hospital admission,particularly among children.Recently,the United Kingdom’s National Institute for Health and Care Excellence(NICE)updated its guideline...BACKGROUND Fever is a common cause of medical consultation and hospital admission,particularly among children.Recently,the United Kingdom’s National Institute for Health and Care Excellence(NICE)updated its guidelines for assessing fever in children under five years of age.The efficient assessment and management of children with fever are crucial for improving patient outcomes.AIM To evaluate fever assessment in hospitalized children and to assess its adherence with the NICE Fever in under 5s guideline.METHODS We conducted a retrospective cohort review of the electronic medical records of children under five years of age at the Department of Pediatrics,Salmaniya Medical Complex,Bahrain,between June and July 2023.Demographic data,vital signs during the first 48 h of admission,route of temperature measurement,and indications for admission were gathered.Fever was defined according to the NICE guideline.The children were divided into five groups according to their age(0-3 months,>3-6 months,>6-12 months,>12-36 months,and>36-60 months).Patients with and without fever were compared in terms of demography,indication for admission,route of temperature measurement,and other vital signs.Compliance with the NICE Fever in the under 5s guideline was assessed.Full compliance was defined as>95%,partial compliance as 70%-95%,and minimal compliance as≤69%.Pearson’sχ^(2),Student’s t test,the Mann-Whitney U test,and Spearman’s correlation coefficient(rs)were used for comparison.RESULTS Of the 136 patients reviewed,80(58.8%)were boys.The median age at admission was 14.2[interquartile range(IQR):1.7-44.4]months,with the most common age group being 36-60 months.Thirty-six(26.4%)patients had fever,and 100(73.6%)were afebrile.The commonest age group for febrile patients(>12-36 months)was older than the commonest age group for afebrile patients(0-3 months)(P=0.027).The median weight was 8.3(IQR:4.0-13.3)kg.Patients with fever had higher weight than those without fever[10.2(IQR:7.3-13.0)vs 7.1(IQR:3.8-13.3)kg,respectively](P=0.034).Gastrointestinal disease was the leading indication for hospital admission(n=47,34.6%).Patients with central nervous system diseases and fever of unknown etiology were more likely to be febrile(P=0.030 and P=0.011,respectively).The mean heart rate was higher in the febrile group than the afebrile group(140±24 vs 126±20 beats per minute,respectively)[P=0.001(confidence interval:5.8-21.9)]with a positive correlation between body temperature and heart rate,r=0.242,n=136,P=0.004.A higher proportion of febrile patients received paracetamol(n=35,81.3%)compared to the afebrile patients(n=8,18.6%)(P<0.001).The axillary route was the most commonly used for temperature measurements(n=40/42,95.2%),followed by the rectal route(n=2/42,4.8%).The department demonstrated full compliance with the NICE guideline for five criteria:the type of thermometer used,route and frequency of temperature measurement,frequency of heart rate measurement,and use of antipyretics as needed.Partial compliance was noted for two criteria,the threshold of fever at 38°C or more,and the respiratory rate assessment in febrile patients.Minimal compliance or no record was observed for the remaining three criteria;routine assessment of capillary refill,temperature reassessment 1-2 h after each antipyretic intake,and refraining from the use of tepid sponging.CONCLUSION This study showed that fever assessment in hospitalized children under five years of age was appropriate,but certain areas of adherence to the NICE guideline still need to be improved.展开更多
BACKGROUND Children like to discover their environment by putting substances in their mouths.This behavior puts them at risk of accidentally ingesting foreign bodies(FBs)or harmful materials,which can cause serious mo...BACKGROUND Children like to discover their environment by putting substances in their mouths.This behavior puts them at risk of accidentally ingesting foreign bodies(FBs)or harmful materials,which can cause serious morbidities.AIM To study the clinical characteristics,diagnosis,complications,management,and outcomes of accidental ingestion of FBs,caustics,and medications in children.METHODS We conducted a retrospective cohort study of all children admitted for accidental ingestion to the Department of Pediatrics,Salmaniya Medical Complex,Bahrain,between 2011 and 2021.Demographic data,type of FB/harmful material ingested,and investigations used for diagnosis and management were recorded.The patients were divided into three groups based on the type of ingested material(FBs,caustics,and medications).The three groups were compared based on patient demographics,socioeconomic status(SES),symptoms,ingestion scenario,endoscopic and surgical complications,management,and outcomes.The FB anatomical location was categorized as the esophagus,stomach,and bowel and compared with respect to symptoms.The Fisher’s exact,Pearson’s χ^(2),Mann-Whitney U,and Kruskal-Wallis tests were used for comparison.RESULTS A total of 161 accidental ingestion episodes were documented in 153 children.Most children were boys(n=85,55.6%),with a median age of 2.8(interquartile range:1.8-4.4)years.Most participants ingested FBs(n=108,70.6%),31(20.3%)ingested caustics,and the remaining 14(9.2%)ingested medications.Patients with caustic ingestion were younger at the time of presentation(P<0.001)and were more symptomatic(n=26/31,89.7%)than those who ingested medications(n=8/14,57.1%)or FBs(n=52/108,48.6%)(P<0.001).The caustic group had more vomiting(P<0.001)and coughing(P=0.029)than the other groups.Most FB ingestions were asymptomatic(n=55/108,51.4%).In terms of FB location,most esophageal FBs were symptomatic(n=14/16,87.5%),whereas most gastric(n=34/56,60.7%)and intestinal FBs(n=19/32,59.4%)were asymptomatic(P=0.002).Battery ingestion was the most common(n=49,32%).Unsafe toys were the main source of batteries(n=22/43,51.2%).Most episodes occurred while playing(n=49/131,37.4%)or when they were unwitnessed(n=78,57.4%).FBs were ingested more while playing(P<0.001),caustic ingestion was mainly due to unsafe storage(P<0.001),and medication ingestion was mostly due to a missing object(P<0.001).Girls ingested more jewelry items than boys(P=0.006).The stomach was the common location of FB lodgment,both radiologically(n=54/123,43.9%)and endoscopically(n=31/91,34%).Of 107/108(99.1%)patients with FB ingestion,spontaneous passage was noted in 54(35.5%),endoscopic removal in 46(30.3%),laparotomy in 5(3.3%)after magnet ingestion,and direct laryngoscopy in 2(1.3%).Pharmacological therapy was required for 105(70.9%)patients;79/105(75.2%)in the FB group,22/29(75.9%)in the caustic group,and 4/14(28.8%)in the medication group(P=0.001).Omeprazole was the commonly used(n=58;37.9%)and was used more in the caustic group(n=19/28,67.9%)than in the other groups(P=0.001).Endoscopic and surgical complications were detected in 39/148(26.4%)patients.The caustic group had more complications than the other groups(P=0.036).Gastrointestinal perforation developed in the FB group only(n=5,3.4%)and was more with magnet ingestion(n=4)than with other FBs(P<0.001).In patients with FB ingestion,patients aged<1 year(P=0.042),those with middle or low SES(P=0.028),and those with more symptoms at presentation(P=0.027)had more complications.Patients with complications had longer hospital stays(P<0.001)than those without.CONCLUSION Accidental ingestion in children is a serious condition.Symptomatic infants from middle or low SES families have the highest morbidity.Prevention through parental education and government legislation is crucial.展开更多
BACKGROUND Liver transplantation(LT)is a life-saving procedure for patients with end-stage liver disease and has become the standard and most effective treatment method for these patients.There are many indications fo...BACKGROUND Liver transplantation(LT)is a life-saving procedure for patients with end-stage liver disease and has become the standard and most effective treatment method for these patients.There are many indications for LT that vary between countries and settings.The outcome of LT depends on the available facilities and surgical expertise,as well as the types of liver graft donors available.AIM To assess the clinical characteristics of patients from Bahrain who underwent LT overseas,and analyze factors affecting their survival.METHODS In this retrospective cohort study,we reviewed the medical records and overseas committee registry information of all pediatric and adult patients who were sent overseas to undergo LT by the Pediatric and Medical Departments of Salmaniya Medical Complex and Bahrain Defence Force Hospital via the Overseas Treatment Office,Ministry of Health,Kingdom of Bahrain,between 1997 and 2023.Demographic data,LT indication,donor-recipient relationship,overseas LT center,graft type,post-LT medications,and LT complications,were collected.Outcomes measured included the overall and 5-year LT survival rate.Fisher’s exact,Pearsonχ2,and Mann-Whitney U tests were used to compare the pediatric and the adults’group in terms of clinical characteristics,donor-recipient relationship,medication,complications,and outcome.Survival analysis was estimated via the Kaplan-Meier’s method.Univariate and multivariate analyses were used to detect predictors of survival.RESULTS Of the 208 eligible patients,170(81.7%)were sent overseas to undergo LT while 38(18.3%)remained on the waiting list.Of the 170 patients,167(80.3%)underwent LT and were included in the study.The majority of the patients were Bahraini(91.0%),and most were males(57.5%).One-hundred-and-twenty(71.8%)were adults and 47(28.3%)were children.The median age at transplant was 50.0[interquartile range(IQR):14.9–58.4]years.The main indication for pediatric LT was biliary atresia(31.9%),while that of adult LT was hepatitis C-related cirrhosis(35.0%).Six(3.6%)patients required re-transplantation.Most patients received a living-related liver graft(82%).Pediatric patients received more living and related grafts than adults(P=0.038 and P=0.041,respectively),while adult patients received more cadaveric and unrelated grafts.Most patients required long-term immunosuppressive therapy after LT(94.7%),of which tacrolimus was the most prescribed(84.0%),followed by prednisolone(50.7%),which was prescribed more frequently for pediatric patients(P=0.001).Most patients developed complications(62.4%)with infectious episodes being the most common(38.9%),followed by biliary stricture(19.5%).Tonsilitis and sepsis(n=12,8.1%for each)were the most frequent infections.Pediatric patients experienced higher rates of infection,rejection,and early poor graft function than adult patients(P<0.001,P=0.003,and P=0.025,respectively).The median follow-up time was 6.5(IQR:2.6–10.6)years.The overall survival rate was 84.4%,the 5-year survival rate,86.2%,and the mortality rate,15.6%.Younger patients had significantly better odds of survival(P=0.019)and patients who survived had significantly longer follow-up periods(P<0.001).CONCLUSION Patients with end-stage liver disease in Bahrain shared characteristics with those from other countries.Since LT facilities are not available,an overseas LT has offered them great hope.展开更多
BACKGROUND Respiratory syncytial virus(RSV)is a prevalent cause of lower respiratory tract infections.It may be associated with hepatocellular involvement,as indicated by increased liver enzymes aspartate aminotransfe...BACKGROUND Respiratory syncytial virus(RSV)is a prevalent cause of lower respiratory tract infections.It may be associated with hepatocellular involvement,as indicated by increased liver enzymes aspartate aminotransferase and alanine transaminase(ALT).AIM To evaluate the rate of increased liver enzyme levels in children with acute bronchiolitis and correlate them with clinical,laboratory,and radiological variables.METHODS The study was a retrospective review of the medical records of children who presented with acute bronchiolitis when admitted to the Pediatric Department,Salmaniya Medical Complex,the Kingdom of Bahrain,between 2019 and 2020.We collected the demographic data,the clinical presentation,the laboratory and radiological findings,and the clinical outcomes.We compared the patients with elevated liver enzymes to those with normal levels at the time of presentation and at follow-up.RESULTS We included 166(57.8%)of 287 patients with acute bronchiolitis who fulfilled the inclusion criteria.Ninety-three(56%)patients were males.The median age at presentation was 3.4(interquartile range 1.1 to 12.4)mo.Fifty-four(28%)patients tested positive for RSV,which was confirmed in 15 of them(28%)by PCR.Laboratory findings of 161 patients tested at presentation showed high ALT levels in 14(8.7%)patients and normal ALT in 147(91.3%).Coagulation profiles were measured in 46(27.7%)of 166 patients.High prothrombin time was present in 15(32.6%),a high international normalized ratio was present in 13(28.3%),and high activated partial thromboplastin time was present in three(6.5%).Thrombin time was elevated in nine(27.3%)of 33 patients.Five(21.7%)of 23 patients with available radiological data had hepatomegaly;one of them had findings suggestive of fatty infiltration.High ALT had a significant association with lengthy hospital stays(P<0.05)and positive urine culture(P<0.05).Seventy(42.2%)patients had documented follow-up with liver function tests over a median follow-up period of 10.2(IQR,2.4-23.3)mo.Total serum protein and serum globulin levels were normalized at the follow-up time,with a significant P value of<0.05.CONCLUSION This study showed a low prevalence of liver function involvement in patients with acute bronchiolitis with a benign course.However,there was a rising trend in ALT during follow-up.Prolonged hospital stay and positive urine cultures were associated with elevated liver enzymes.展开更多
BACKGROUND Gastrointestinal bleeding(GIB)is a serious health problem worldwide,particularly during childhood.This can be an alarming sign of an underlying disease.Gastrointestinal endoscopy(GIE)is a safe method for th...BACKGROUND Gastrointestinal bleeding(GIB)is a serious health problem worldwide,particularly during childhood.This can be an alarming sign of an underlying disease.Gastrointestinal endoscopy(GIE)is a safe method for the diagnosis and treatment of GIB in most cases.AIM To determine the incidence,clinical presentation,and outcomes of GIB in children in Bahrain over the last two decades.METHODS This was a retrospective cohort review of the medical records of children with GIB who underwent endoscopic procedures in the Pediatric Department at Salmaniya Medical Complex,Bahrain,between 1995 and 2022.Demographic data,clinical presentation,endoscopic findings,and clinical outcomes were recorded.GIB was classified into upper(UGIB)and lower(LGIB)GIB according to the site of bleeding.These were compared with respect to patients’sex,age,and nationality using the Fisher’s exact,Pearson’sχ2,or the Mann-Whitney U tests.RESULTS A total of 250 patients were included in this study.The median incidence was 2.6/100000 per year(interquartile range,1.4-3.7)with a significantly increasing trend over the last two decades (P < 0.0001). Most patients were males (n = 144, 57.6%). Themedian age at diagnosis was 9 years (5-11). Ninety-eight (39.2%) patients required upper GIEalone, 41 (16.4%) required colonoscopy alone, and 111 (44.4%) required both. LGIB was morefrequent (n = 151, 60.4%) than UGIB (n = 119, 47.6%). There were no significant differences in sex (P = 0.710), age (P = 0.185), or nationality (P = 0.525) between the two groups. Abnormalendoscopic findings were detected in 226 (90.4%) patients. The common cause of LGIB was inflammatorybowel disease (IBD) (n = 77, 30.8%). The common cause of UGIB was gastritis (n = 70, 28%).IBD and undetermined cause for bleeding were higher in the 10-18 years group (P = 0.026 and P =0.017, respectively). Intestinal nodular lymphoid hyperplasia, foreign body ingestion, andesophageal varices were more common in the 0-4 years group (P = 0.034, P < 0.0001, and P = 0.029,respectively). Ten (4%) patients underwent one or more therapeutic interventions. The medianfollow-up period was two years (0.5-3). No mortality was reported in this study.CONCLUSIONGIB in children is an alarming condition, whose significance is increasing. LGIB, commonly due toIBD, was more common than UGIB, commonly due to gastritis.展开更多
文摘BACKGROUND Fever is a common cause of medical consultation and hospital admission,particularly among children.Recently,the United Kingdom’s National Institute for Health and Care Excellence(NICE)updated its guidelines for assessing fever in children under five years of age.The efficient assessment and management of children with fever are crucial for improving patient outcomes.AIM To evaluate fever assessment in hospitalized children and to assess its adherence with the NICE Fever in under 5s guideline.METHODS We conducted a retrospective cohort review of the electronic medical records of children under five years of age at the Department of Pediatrics,Salmaniya Medical Complex,Bahrain,between June and July 2023.Demographic data,vital signs during the first 48 h of admission,route of temperature measurement,and indications for admission were gathered.Fever was defined according to the NICE guideline.The children were divided into five groups according to their age(0-3 months,>3-6 months,>6-12 months,>12-36 months,and>36-60 months).Patients with and without fever were compared in terms of demography,indication for admission,route of temperature measurement,and other vital signs.Compliance with the NICE Fever in the under 5s guideline was assessed.Full compliance was defined as>95%,partial compliance as 70%-95%,and minimal compliance as≤69%.Pearson’sχ^(2),Student’s t test,the Mann-Whitney U test,and Spearman’s correlation coefficient(rs)were used for comparison.RESULTS Of the 136 patients reviewed,80(58.8%)were boys.The median age at admission was 14.2[interquartile range(IQR):1.7-44.4]months,with the most common age group being 36-60 months.Thirty-six(26.4%)patients had fever,and 100(73.6%)were afebrile.The commonest age group for febrile patients(>12-36 months)was older than the commonest age group for afebrile patients(0-3 months)(P=0.027).The median weight was 8.3(IQR:4.0-13.3)kg.Patients with fever had higher weight than those without fever[10.2(IQR:7.3-13.0)vs 7.1(IQR:3.8-13.3)kg,respectively](P=0.034).Gastrointestinal disease was the leading indication for hospital admission(n=47,34.6%).Patients with central nervous system diseases and fever of unknown etiology were more likely to be febrile(P=0.030 and P=0.011,respectively).The mean heart rate was higher in the febrile group than the afebrile group(140±24 vs 126±20 beats per minute,respectively)[P=0.001(confidence interval:5.8-21.9)]with a positive correlation between body temperature and heart rate,r=0.242,n=136,P=0.004.A higher proportion of febrile patients received paracetamol(n=35,81.3%)compared to the afebrile patients(n=8,18.6%)(P<0.001).The axillary route was the most commonly used for temperature measurements(n=40/42,95.2%),followed by the rectal route(n=2/42,4.8%).The department demonstrated full compliance with the NICE guideline for five criteria:the type of thermometer used,route and frequency of temperature measurement,frequency of heart rate measurement,and use of antipyretics as needed.Partial compliance was noted for two criteria,the threshold of fever at 38°C or more,and the respiratory rate assessment in febrile patients.Minimal compliance or no record was observed for the remaining three criteria;routine assessment of capillary refill,temperature reassessment 1-2 h after each antipyretic intake,and refraining from the use of tepid sponging.CONCLUSION This study showed that fever assessment in hospitalized children under five years of age was appropriate,but certain areas of adherence to the NICE guideline still need to be improved.
文摘BACKGROUND Children like to discover their environment by putting substances in their mouths.This behavior puts them at risk of accidentally ingesting foreign bodies(FBs)or harmful materials,which can cause serious morbidities.AIM To study the clinical characteristics,diagnosis,complications,management,and outcomes of accidental ingestion of FBs,caustics,and medications in children.METHODS We conducted a retrospective cohort study of all children admitted for accidental ingestion to the Department of Pediatrics,Salmaniya Medical Complex,Bahrain,between 2011 and 2021.Demographic data,type of FB/harmful material ingested,and investigations used for diagnosis and management were recorded.The patients were divided into three groups based on the type of ingested material(FBs,caustics,and medications).The three groups were compared based on patient demographics,socioeconomic status(SES),symptoms,ingestion scenario,endoscopic and surgical complications,management,and outcomes.The FB anatomical location was categorized as the esophagus,stomach,and bowel and compared with respect to symptoms.The Fisher’s exact,Pearson’s χ^(2),Mann-Whitney U,and Kruskal-Wallis tests were used for comparison.RESULTS A total of 161 accidental ingestion episodes were documented in 153 children.Most children were boys(n=85,55.6%),with a median age of 2.8(interquartile range:1.8-4.4)years.Most participants ingested FBs(n=108,70.6%),31(20.3%)ingested caustics,and the remaining 14(9.2%)ingested medications.Patients with caustic ingestion were younger at the time of presentation(P<0.001)and were more symptomatic(n=26/31,89.7%)than those who ingested medications(n=8/14,57.1%)or FBs(n=52/108,48.6%)(P<0.001).The caustic group had more vomiting(P<0.001)and coughing(P=0.029)than the other groups.Most FB ingestions were asymptomatic(n=55/108,51.4%).In terms of FB location,most esophageal FBs were symptomatic(n=14/16,87.5%),whereas most gastric(n=34/56,60.7%)and intestinal FBs(n=19/32,59.4%)were asymptomatic(P=0.002).Battery ingestion was the most common(n=49,32%).Unsafe toys were the main source of batteries(n=22/43,51.2%).Most episodes occurred while playing(n=49/131,37.4%)or when they were unwitnessed(n=78,57.4%).FBs were ingested more while playing(P<0.001),caustic ingestion was mainly due to unsafe storage(P<0.001),and medication ingestion was mostly due to a missing object(P<0.001).Girls ingested more jewelry items than boys(P=0.006).The stomach was the common location of FB lodgment,both radiologically(n=54/123,43.9%)and endoscopically(n=31/91,34%).Of 107/108(99.1%)patients with FB ingestion,spontaneous passage was noted in 54(35.5%),endoscopic removal in 46(30.3%),laparotomy in 5(3.3%)after magnet ingestion,and direct laryngoscopy in 2(1.3%).Pharmacological therapy was required for 105(70.9%)patients;79/105(75.2%)in the FB group,22/29(75.9%)in the caustic group,and 4/14(28.8%)in the medication group(P=0.001).Omeprazole was the commonly used(n=58;37.9%)and was used more in the caustic group(n=19/28,67.9%)than in the other groups(P=0.001).Endoscopic and surgical complications were detected in 39/148(26.4%)patients.The caustic group had more complications than the other groups(P=0.036).Gastrointestinal perforation developed in the FB group only(n=5,3.4%)and was more with magnet ingestion(n=4)than with other FBs(P<0.001).In patients with FB ingestion,patients aged<1 year(P=0.042),those with middle or low SES(P=0.028),and those with more symptoms at presentation(P=0.027)had more complications.Patients with complications had longer hospital stays(P<0.001)than those without.CONCLUSION Accidental ingestion in children is a serious condition.Symptomatic infants from middle or low SES families have the highest morbidity.Prevention through parental education and government legislation is crucial.
文摘BACKGROUND Liver transplantation(LT)is a life-saving procedure for patients with end-stage liver disease and has become the standard and most effective treatment method for these patients.There are many indications for LT that vary between countries and settings.The outcome of LT depends on the available facilities and surgical expertise,as well as the types of liver graft donors available.AIM To assess the clinical characteristics of patients from Bahrain who underwent LT overseas,and analyze factors affecting their survival.METHODS In this retrospective cohort study,we reviewed the medical records and overseas committee registry information of all pediatric and adult patients who were sent overseas to undergo LT by the Pediatric and Medical Departments of Salmaniya Medical Complex and Bahrain Defence Force Hospital via the Overseas Treatment Office,Ministry of Health,Kingdom of Bahrain,between 1997 and 2023.Demographic data,LT indication,donor-recipient relationship,overseas LT center,graft type,post-LT medications,and LT complications,were collected.Outcomes measured included the overall and 5-year LT survival rate.Fisher’s exact,Pearsonχ2,and Mann-Whitney U tests were used to compare the pediatric and the adults’group in terms of clinical characteristics,donor-recipient relationship,medication,complications,and outcome.Survival analysis was estimated via the Kaplan-Meier’s method.Univariate and multivariate analyses were used to detect predictors of survival.RESULTS Of the 208 eligible patients,170(81.7%)were sent overseas to undergo LT while 38(18.3%)remained on the waiting list.Of the 170 patients,167(80.3%)underwent LT and were included in the study.The majority of the patients were Bahraini(91.0%),and most were males(57.5%).One-hundred-and-twenty(71.8%)were adults and 47(28.3%)were children.The median age at transplant was 50.0[interquartile range(IQR):14.9–58.4]years.The main indication for pediatric LT was biliary atresia(31.9%),while that of adult LT was hepatitis C-related cirrhosis(35.0%).Six(3.6%)patients required re-transplantation.Most patients received a living-related liver graft(82%).Pediatric patients received more living and related grafts than adults(P=0.038 and P=0.041,respectively),while adult patients received more cadaveric and unrelated grafts.Most patients required long-term immunosuppressive therapy after LT(94.7%),of which tacrolimus was the most prescribed(84.0%),followed by prednisolone(50.7%),which was prescribed more frequently for pediatric patients(P=0.001).Most patients developed complications(62.4%)with infectious episodes being the most common(38.9%),followed by biliary stricture(19.5%).Tonsilitis and sepsis(n=12,8.1%for each)were the most frequent infections.Pediatric patients experienced higher rates of infection,rejection,and early poor graft function than adult patients(P<0.001,P=0.003,and P=0.025,respectively).The median follow-up time was 6.5(IQR:2.6–10.6)years.The overall survival rate was 84.4%,the 5-year survival rate,86.2%,and the mortality rate,15.6%.Younger patients had significantly better odds of survival(P=0.019)and patients who survived had significantly longer follow-up periods(P<0.001).CONCLUSION Patients with end-stage liver disease in Bahrain shared characteristics with those from other countries.Since LT facilities are not available,an overseas LT has offered them great hope.
文摘BACKGROUND Respiratory syncytial virus(RSV)is a prevalent cause of lower respiratory tract infections.It may be associated with hepatocellular involvement,as indicated by increased liver enzymes aspartate aminotransferase and alanine transaminase(ALT).AIM To evaluate the rate of increased liver enzyme levels in children with acute bronchiolitis and correlate them with clinical,laboratory,and radiological variables.METHODS The study was a retrospective review of the medical records of children who presented with acute bronchiolitis when admitted to the Pediatric Department,Salmaniya Medical Complex,the Kingdom of Bahrain,between 2019 and 2020.We collected the demographic data,the clinical presentation,the laboratory and radiological findings,and the clinical outcomes.We compared the patients with elevated liver enzymes to those with normal levels at the time of presentation and at follow-up.RESULTS We included 166(57.8%)of 287 patients with acute bronchiolitis who fulfilled the inclusion criteria.Ninety-three(56%)patients were males.The median age at presentation was 3.4(interquartile range 1.1 to 12.4)mo.Fifty-four(28%)patients tested positive for RSV,which was confirmed in 15 of them(28%)by PCR.Laboratory findings of 161 patients tested at presentation showed high ALT levels in 14(8.7%)patients and normal ALT in 147(91.3%).Coagulation profiles were measured in 46(27.7%)of 166 patients.High prothrombin time was present in 15(32.6%),a high international normalized ratio was present in 13(28.3%),and high activated partial thromboplastin time was present in three(6.5%).Thrombin time was elevated in nine(27.3%)of 33 patients.Five(21.7%)of 23 patients with available radiological data had hepatomegaly;one of them had findings suggestive of fatty infiltration.High ALT had a significant association with lengthy hospital stays(P<0.05)and positive urine culture(P<0.05).Seventy(42.2%)patients had documented follow-up with liver function tests over a median follow-up period of 10.2(IQR,2.4-23.3)mo.Total serum protein and serum globulin levels were normalized at the follow-up time,with a significant P value of<0.05.CONCLUSION This study showed a low prevalence of liver function involvement in patients with acute bronchiolitis with a benign course.However,there was a rising trend in ALT during follow-up.Prolonged hospital stay and positive urine cultures were associated with elevated liver enzymes.
文摘BACKGROUND Gastrointestinal bleeding(GIB)is a serious health problem worldwide,particularly during childhood.This can be an alarming sign of an underlying disease.Gastrointestinal endoscopy(GIE)is a safe method for the diagnosis and treatment of GIB in most cases.AIM To determine the incidence,clinical presentation,and outcomes of GIB in children in Bahrain over the last two decades.METHODS This was a retrospective cohort review of the medical records of children with GIB who underwent endoscopic procedures in the Pediatric Department at Salmaniya Medical Complex,Bahrain,between 1995 and 2022.Demographic data,clinical presentation,endoscopic findings,and clinical outcomes were recorded.GIB was classified into upper(UGIB)and lower(LGIB)GIB according to the site of bleeding.These were compared with respect to patients’sex,age,and nationality using the Fisher’s exact,Pearson’sχ2,or the Mann-Whitney U tests.RESULTS A total of 250 patients were included in this study.The median incidence was 2.6/100000 per year(interquartile range,1.4-3.7)with a significantly increasing trend over the last two decades (P < 0.0001). Most patients were males (n = 144, 57.6%). Themedian age at diagnosis was 9 years (5-11). Ninety-eight (39.2%) patients required upper GIEalone, 41 (16.4%) required colonoscopy alone, and 111 (44.4%) required both. LGIB was morefrequent (n = 151, 60.4%) than UGIB (n = 119, 47.6%). There were no significant differences in sex (P = 0.710), age (P = 0.185), or nationality (P = 0.525) between the two groups. Abnormalendoscopic findings were detected in 226 (90.4%) patients. The common cause of LGIB was inflammatorybowel disease (IBD) (n = 77, 30.8%). The common cause of UGIB was gastritis (n = 70, 28%).IBD and undetermined cause for bleeding were higher in the 10-18 years group (P = 0.026 and P =0.017, respectively). Intestinal nodular lymphoid hyperplasia, foreign body ingestion, andesophageal varices were more common in the 0-4 years group (P = 0.034, P < 0.0001, and P = 0.029,respectively). Ten (4%) patients underwent one or more therapeutic interventions. The medianfollow-up period was two years (0.5-3). No mortality was reported in this study.CONCLUSIONGIB in children is an alarming condition, whose significance is increasing. LGIB, commonly due toIBD, was more common than UGIB, commonly due to gastritis.
