BACKGROUND Children with acute liver failure(ALF)who meet the criteria are eligible for super-urgent transplantation,whereas children with end-stage chronic liver disease(ESCLD)are usually transplanted electively.Pedi...BACKGROUND Children with acute liver failure(ALF)who meet the criteria are eligible for super-urgent transplantation,whereas children with end-stage chronic liver disease(ESCLD)are usually transplanted electively.Pediatric liver transplantation(PLT)in ALF and ESCLD settings has been well described in the literature,but there are no studies comparing the outcomes in these two groups.AIM To determine if there is a difference in post-operative complications and survival outcomes between ALF and ESCLD in PLT.METHODS This was a retrospective observational study of all primary PLTs performed at a single center between 2000 and 2019.ALF and ESCLD groups were compared for pretransplant recipient,donor and operative parameters,and post-operative outcomes including graft and patient survival.RESULTS Over a 20-year study period,232 primary PLTs were performed at our center;195 were transplanted for ESCLD and 37 were transplanted for ALF.The ALF recipients were significantly older(median 8 years vs 5.4 years;P=0.031)and heavier(31 kg vs 21 kg;P=0.011).Living donor grafts were used more in the ESCLD group(34 vs 0;P=0.006).There was no difference between the two groups concerning vascular complications and rejection,but there were more bile leaks in the ESCLD group.Post-transplant patient survival was significantly higher in the ESCLD group:1-,5-,and 10-year survival rates were 97.9%,93.9%,and 89.4%,respectively,compared to 78.3%,78.3%,and 78.3%in the ALF group(P=0.007).However,there was no difference in 1-,5-,and 10-year graft survival between the ESCLD and ALF groups(90.7%,82.9%,77.3%vs 75.6%,72.4%,and 66.9%;P=0.119).CONCLUSION Patient survival is inferior in ALF compared to ESCLD recipients;the main reason is death in the 1st year post-PLT in ALF group.Once the ALF children overcome the 1st year after transplant,their survival stabilizes,and they have good long-term outcomes.展开更多
AIM: To evaluate transient elastography(TE) as a noninvasive tool in staging liver fibrosis compared with liver biopsy and morphometry in children with different chronic liver diseases.METHODS: A total of 90 children ...AIM: To evaluate transient elastography(TE) as a noninvasive tool in staging liver fibrosis compared with liver biopsy and morphometry in children with different chronic liver diseases.METHODS: A total of 90 children [50 with chronic hepatitis C virus(HCV), 20 with autoimmune hepatitis(AIH) and 20 with Wilson disease] were included in the study and underwent liver stiffness measurement(LSM) using TE. Liver biopsies were evaluated for fibrosis, qualitatively, by Ishak score and quantitatively by fibrosis area fraction(FAF) using digital image analysis(morphometry). LSM was correlated with fibrosis and other studied variables using spearman correlation. A stepwise multiple regression analysis was alsoperformed to examine independent factors associated with LSM. Different cut-off values of LSM were calculated for predicting individual fibrosis stages using receiveroperating characteristic curve. Cut-off values with optimal clinical performance(optimal sensitivity and specificity simultaneously) were selected.RESULTS: The majority of HCV group had minimal activity(80%) and no/mild fibrosis(72%). On the other hand, the majority of AIH group had mild to moderate activity(70%) and moderate to severe fibrosis(95%) and all Wilson disease group had mild to moderate activity(100%) and moderate to severe fibrosis(100%). LSM correlated significantly with both FAF and Ishak scores and the correlation appeared better with the latter(r = 0.839 vs 0.879, P < 0.0001 for both). LSM discriminated individual stages of fibrosis with high performance. Sensitivity ranged from 81.4% to 100% and specificity ranged from 75.0% to 97.2%. When we compared LSM values for the same stage of fibrosis, they varied according to the different etiologies. Higher values were in AIH(16.15 ± 7.23 k Pa) compared to Wilson disease(8.30 ± 0.84 k Pa) and HCV groups(7.43 ± 1.73 k Pa). Multiple regression analysis revealed that Ishak fibrosis stage was the only independent variable associated with higher LSM(P < 0.0001).CONCLUSION: TE appears reliable in distinguishing different stages of liver fibrosis in children. However, its values vary according to the disease type. For that, a disease-specific estimation of cut-off values for fibrosis staging is worthy.展开更多
BACKGROUND With advancements in the treatment of chronic liver disease(CLD),including liver transplantation(LT),quality of life and satisfaction after LT have become an important issue for pediatric patients and their...BACKGROUND With advancements in the treatment of chronic liver disease(CLD),including liver transplantation(LT),quality of life and satisfaction after LT have become an important issue for pediatric patients and their parents.More evidence-based information is needed to describe and assess the impact of pediatric CLD on parents and the satisfaction of parents with treatment to better understand their needs.AIM To assess the satisfaction of parents of pediatric LT patients and that of parents of pediatric CLD patients METHODS During this survey,data were collected from parents of pediatric patients who underwent LT between January 2010 and April 2017(LT group;n=91)and parents of pediatric patients with chronic liver disease(CLD group;n=94).Group comparisons were made based on the pediatric health-related quality of life(PedsQL)health care parent satisfaction scale,impact on family scale(IFS)and demographic characteristics.The PedsQL was administered to parents during a phone interview and the results were used to assess the health carerelated satisfaction of parents.The IFS was used to assess the impact of the child’s CLD status on the family.Demographic variables such as education level(elementary vs middle vs high vs university),monthly income(low vs middle vs high),and place of residence(village vs town vs city)were compared between CLD and LT parent groups.Finally,PedsQL and IFS results were also analyzed according to demographic variables.RESULTS A total of 185 parents aged 19 to 65 years were included.There were statistically significant differences between the LT and CLD groups in terms of career(P<0.001),monthly income(P=0.016),and education level(P=0.041).According to the PedsQL results,family inclusion,communication,technical skills,emotional needs,and overall satisfaction were significantly different between the groups;the LT group had consistently higher scores(P<0.001).Additionally,scores for the IFS parameters of financial impact,familial-social impact,personal strain,and total impact were consistently higher for the LT group(P<0.001).There were statistically significant relationships between education level,monthly income,and place of residence according to the IFS results but not the PedsQL results.There were inverse relationships between the difficulties that parents experience because of their child’s health and education levels,monthly income,and place of residence.However,no relationship was found between education level,monthly income,or place of residence and satisfaction with health care services provided in the hospital according to the PedsQL results.CONCLUSION Parents of children who underwent LT were very satisfied with the health care services provided to their children.However,they had more difficulties than parents of children with CLD.展开更多
AIM:To investigate the ultrastructure of oval cells in children with chronic hepatitis B,with special emphasis on their location in areas of collagen fibroplasia. METHODS:Morphological investigations were conducted on...AIM:To investigate the ultrastructure of oval cells in children with chronic hepatitis B,with special emphasis on their location in areas of collagen fibroplasia. METHODS:Morphological investigations were conducted on biopsy material obtained from 40 children,aged 3-16 years with chronic hepatitis B. The stage of fibrosis was assessed histologically using the arbitrary semiquantitative numerical scoring system proposed by Ishak et al. The material for ultrastructural investigation was fixed in glutaraldehyde and paraformaldehyde and processed for transmission-electron microscopic analysis. RESULTS:Ultrastructural examination of biopsy specimens obtained from children with chronic hepatitis B showed the presence of two types of oval cells,the hepatic progenitor cells and intermediate hepatic-like cells. These cells were present in the parenchyma and were seen most commonly in areas of intense periportal fibrosis (at least stage 2 according to Ishak et al) and in the vicinity of the limiting plate of the lobule. The activated nonparenchymal hepatic cells,i.e. transformed hepatic stellate cells and Kupffer cells were seen in close proximity to the intermediate hepatic-like cells. CONCLUSION:We found a distinct relationship between the prevalence of oval cells (hepatic progenitor cells and intermediate hepatocyte-like cells) and fibrosis stage in pediatric patients with chronic hepatitis B.展开更多
Background: Allergic rhinitis is an inflammatory disorder of the upper airways. Although several oxidants and antioxidants are likely to be involved, alterations in only limited parameters have been studied. Objective...Background: Allergic rhinitis is an inflammatory disorder of the upper airways. Although several oxidants and antioxidants are likely to be involved, alterations in only limited parameters have been studied. Objective: In this study an attempt has been made to study the oxidant-antioxidant imbalance by investigating changes in a wide range of oxidants and antioxidants in the blood. Methods: Blood samples were obtained from 39 chronic allergic rhinitis patients (males 24, females 15), aged 20-70 (mean age 36.33 ± 2.03) years and 53 individuals (36 males, 17 females);aged 24 to 64 (mean age 45.42 ± 1.36) years. Duration of allergic rhinitis was 1.77 ± 0.237 years. In the study group, nasal symptoms were scored and the results were recorded. The patients were classified as having perennial Allergic rhinitis (PAR) if they had had at least 2 rhinitis symptoms (sneezing, rhinorrhea, nasal obstruction, itching) for at least 6 months a year in the previous 2 years and if they had a positive skin prick test response to at least 1 clinically significant perennial allergen (e.g., house dust mites, molds, cockroach, cockroach excrement grass and tree pollen, cat and dog epithelia and molds, or animal dander). They had no other allergic diseases except persistent allergic rhinitis diagnosed by the physical and history examination. Erythrocyte lipid peroxidation, erythrocyte antioxidants viz., glutathione, glutathione reductase, superoxide dismutase, catalase and plasma antioxidants viz., ceruloplasmin, glutathione-S-transferase, vitamin C, total antioxidant activity were estimated in the above two groups. Results: Erythrocyte lipid peroxidation (0 hour, p < 0.01) and superoxide dismutase (p < 0.01) were significantly higher, whereas plasma vitamin C (p < 0.001), ceruloplasmin (p < 0.05) and total antioxidant activity (p < 0.001) were significantly lower in chronic allergic rhinitis patients when compared to controls. Plasma Glutathione S transferase and erythrocyte catalase, glutathione, and glutathione reductase remained unchanged from normal subjects. Conclusion: The changes in different parameters indicate an imbalance in the oxidant and antioxidant status in chronic allergic rhinitis patients. Further studies are required to investigate the potential for antioxidant supplements to be used as routine therapy in chronic allergic rhinitis patients. Capsule summery: The study shows that the body is trying to cope for the oxidative stress by altering the enzyme levels. But external supplement may also be required as the total antioxidant levels are very much depleted.展开更多
Chronic rhinosinusitis and allergic rhinitis are chronic inflammatory diseases that affect the mucous membrane of the nose and paranasal sinuses. These diseases are characterized by recruitment of inflammatory cells t...Chronic rhinosinusitis and allergic rhinitis are chronic inflammatory diseases that affect the mucous membrane of the nose and paranasal sinuses. These diseases are characterized by recruitment of inflammatory cells to the upper airway. For this to take place a complex interaction between inflammatory cells and the cytokines/chemokines(ligand) liberated at the site of inflammation is involved in a process termed chemotaxis or directed cell migration against concentration gradient of the ligand. This entails signal transduction through the cell surface receptor resulting in cellular functional response and directed migration. In this editorial the novel role of CX3CR1 receptor in the immunopathology of chronic inflammation of the nose and paranasal sinuses will be explored with its potential role as therapeutic target in chronic nasal inflammation.展开更多
An enhanced cascade of care should include a younger population,helping to achieve the goal of the World Health Organization with a focus on elimination in the pediatric population.Furthermore,enhanced screening and a...An enhanced cascade of care should include a younger population,helping to achieve the goal of the World Health Organization with a focus on elimination in the pediatric population.Furthermore,enhanced screening and awareness efforts and continued education of health care providers will improve the outcomes of chronic hepatitis C virus(HCV)infection in the pediatric population.The present work discusses and comments on the topic"cascade of care in HCV chronic pediatric patients".展开更多
Chronic myeloid leukemia(CML)in minors is a rare disease which can be effectively treated by tyrosine kinase inhibitors(TKIs)since the year 2000.A majority of pediatricians will encounter one or two CML patients in th...Chronic myeloid leukemia(CML)in minors is a rare disease which can be effectively treated by tyrosine kinase inhibitors(TKIs)since the year 2000.A majority of pediatricians will encounter one or two CML patients in the course of their careers and will typically have to rely on written information along with their own intuition to provide care.Knowledge of response to TKIs and of agespecific side effects has an impact on the design of pediatric CML trials in many ways aiming to contribute toward greater predictability of clinical improvements.Information from a registry on a rare disease like CML offers the enormous benefit of enabling treating physicians to interact and share their collective experience.The International Registry on Pediatric CML(IR-PCML)was founded at Poitiers/France almost 10 years ago.Since then,the number of collaboration centers and in parallel of registered patients continuously increased(>550 patients as of December 2019).Ideally,from a given treatment center in a country data are transferred to a national coordinator who interacts with the IR-PCML.In the sense of quality assurance,the registry can offer dissemination of knowledge on state-of-the-art diagnostics(including reference appraisal),optimal treatment approaches,and follow-up procedures within a network that is exerting its strength via participation.With continuous growth during the recent years,very rare subgroups of patients could be identified(e.g.,CML diagnosed at age<3 years,children presenting with specific problems at diagnosis or during course of treatment)which had not been described before.Publications coming from the IR-PCML disseminated this useful information derived from patients who robustly participate and share information about their disease,among themselves and with their caregivers and clinicians.Patient input driving the collection of data on this rare leukemia is the basis for the considerable success of bringing new therapeutics into clinical use.展开更多
Scientific research has brought about enormous national advancements in cancer management. Currently, Morocco provides several therapeutic tools for cancer, among them chemotherapy, surgery and radiotherapy. In Morocc...Scientific research has brought about enormous national advancements in cancer management. Currently, Morocco provides several therapeutic tools for cancer, among them chemotherapy, surgery and radiotherapy. In Morocco, there is not enough published data on the use of alternative medicine in pediatric oncology. Owing to the increased interest and lack of data on this practice, we conducted this study. It aims to evaluate the uptake, the types of therapies used, the factors influencing, the reasons for this choice and the cost of AM used by patients. An investigation through a questionnaire was carried out on thirty-four children following for cancer within the pediatric hematology and oncology department (PHO) of Marrakech. The survey was conducted over a period of one month and a half between July 25 and September 5, 2022. Data were collected through a questionnaire. From the medical files, we collected data regarding type of cancer, date of admission to PHO department and the treatment received. We asked about the type of AM used: herbs, honey, spiritual AM, zamzam water (water from a “sacred” source in Mecca). Using alternative therapies is a common practice in pediatric oncology with various reasons, among them, the declining socioeconomic level, the diversity, the cultural background, the psychological and the functional status of patients and sometimes the dissatisfaction with conventional medicine.展开更多
BACKGROUND This study evaluated the safety and effectiveness of endoscopic retrograde cholangiopancreatography(ERCP)in pediatric patients with biliary and pancreatic diseases.A retrospective analysis was conducted on ...BACKGROUND This study evaluated the safety and effectiveness of endoscopic retrograde cholangiopancreatography(ERCP)in pediatric patients with biliary and pancreatic diseases.A retrospective analysis was conducted on 57 ERCP procedures performed in 41 children,primarily for treating pancreatic diseases.The overall success rate was 91.2%,with no major complications observed.Post-ERCP pancreatitis(PEP)occurred in 8.8%of cases.Follow-up examinations over one year showed no recurrence of biliary or pancreatic diseases.Notably,endoscopic treatment led to a significant increase in body mass index(BMI).These findings demonstrate the valuable role of ERCP in managing such conditions.AIM To evaluate the safety and efficacy of ERCP for the management of biliary and pancreatic diseases in pediatric patients.METHODS We conducted a retrospective analysis of data from children aged 1-18 years who underwent ERCP for biliary and pancreatic diseases at Beijing Children’s Hospital between January 2021 and December 2022.The collected data included procedure time,endoscopic treatment,success rate,and postoperative complications.RESULTS Forty-one children underwent 57 ERCP procedures,including 14 with biliary duct disease and 27 with pancreatic disease.The mean age of the patients was 7.48±3.48 years.Biliary duct-related treatments were performed 18 times,and pancreatic disease treatments were performed 39 times.ERCP was primarily used to treat pediatric pancreatic diseases[68.4%(39/57)of the procedures].The overall success rate was 91.2%(52/57 patients).PEP was noted in five patients(8.8%,5/57),and no instances of bleeding,perforation,or cholangitis were observed.The patients were followed up for over one year,and no recurrence of biliary or pancreatic diseases was detected.Importantly,BMI significantly increased after endoscopic treatment compared to that before treatment(P=0.001).CONCLUSION The high success rate and lack of major complications support the valuable role of ERCP in the management of pediatric biliary and pancreatic diseases in the pediatric population.展开更多
Background: The COVID-19 pandemic emerged unexpectedly, impacting millions worldwide and, though waning in many regions, remains a significant concern. This study focused on understanding COVID-19’s clinical presenta...Background: The COVID-19 pandemic emerged unexpectedly, impacting millions worldwide and, though waning in many regions, remains a significant concern. This study focused on understanding COVID-19’s clinical presentation, disease progression, and outcomes among hospitalized pediatric patients. Additionally, it sought to investigate the impact of concurrent chronic medical conditions on disease severity. Methods: Conducted retrospectively between September 2020 and December 2021, this study observed pediatric patients (below 18 years) hospitalized with confirmed COVID-19 at an Irbid, Jordan tertiary healthcare center. Patients meeting inclusion criteria, including a positive nasal swab PCR test and hospitalization need, were analyzed. Epidemiological and clinical data were collected and segregated into two groups (A and B) based on the presence of chronic conditions. Comparative analysis encompassed presentation, disease trajectory, and outcomes between these groups. Results: Among 451 tested positive patients, 112 were included in the study. Significant differences emerged between the two pediatric groups hospitalized for COVID-19. Those with concurrent chronic illnesses exhibited heightened symptom severity—fever, dyspnea, fatigue—and a higher incidence of abnormal chest radiographs, often requiring intensive care and experiencing elevated mortality rates. Conclusion: This study underscores the criticality of prioritizing COVID-19 management strategies for pediatric patients with pre-existing chronic medical conditions. The findings highlight the increased vulnerability and poorer outcomes experienced by this subgroup, emphasizing the necessity for tailored interventions and focused care approaches.展开更多
文摘BACKGROUND Children with acute liver failure(ALF)who meet the criteria are eligible for super-urgent transplantation,whereas children with end-stage chronic liver disease(ESCLD)are usually transplanted electively.Pediatric liver transplantation(PLT)in ALF and ESCLD settings has been well described in the literature,but there are no studies comparing the outcomes in these two groups.AIM To determine if there is a difference in post-operative complications and survival outcomes between ALF and ESCLD in PLT.METHODS This was a retrospective observational study of all primary PLTs performed at a single center between 2000 and 2019.ALF and ESCLD groups were compared for pretransplant recipient,donor and operative parameters,and post-operative outcomes including graft and patient survival.RESULTS Over a 20-year study period,232 primary PLTs were performed at our center;195 were transplanted for ESCLD and 37 were transplanted for ALF.The ALF recipients were significantly older(median 8 years vs 5.4 years;P=0.031)and heavier(31 kg vs 21 kg;P=0.011).Living donor grafts were used more in the ESCLD group(34 vs 0;P=0.006).There was no difference between the two groups concerning vascular complications and rejection,but there were more bile leaks in the ESCLD group.Post-transplant patient survival was significantly higher in the ESCLD group:1-,5-,and 10-year survival rates were 97.9%,93.9%,and 89.4%,respectively,compared to 78.3%,78.3%,and 78.3%in the ALF group(P=0.007).However,there was no difference in 1-,5-,and 10-year graft survival between the ESCLD and ALF groups(90.7%,82.9%,77.3%vs 75.6%,72.4%,and 66.9%;P=0.119).CONCLUSION Patient survival is inferior in ALF compared to ESCLD recipients;the main reason is death in the 1st year post-PLT in ALF group.Once the ALF children overcome the 1st year after transplant,their survival stabilizes,and they have good long-term outcomes.
基金Supported by the National Liver Institute,Menofiya University,Egypt,No.2011.MDT013
文摘AIM: To evaluate transient elastography(TE) as a noninvasive tool in staging liver fibrosis compared with liver biopsy and morphometry in children with different chronic liver diseases.METHODS: A total of 90 children [50 with chronic hepatitis C virus(HCV), 20 with autoimmune hepatitis(AIH) and 20 with Wilson disease] were included in the study and underwent liver stiffness measurement(LSM) using TE. Liver biopsies were evaluated for fibrosis, qualitatively, by Ishak score and quantitatively by fibrosis area fraction(FAF) using digital image analysis(morphometry). LSM was correlated with fibrosis and other studied variables using spearman correlation. A stepwise multiple regression analysis was alsoperformed to examine independent factors associated with LSM. Different cut-off values of LSM were calculated for predicting individual fibrosis stages using receiveroperating characteristic curve. Cut-off values with optimal clinical performance(optimal sensitivity and specificity simultaneously) were selected.RESULTS: The majority of HCV group had minimal activity(80%) and no/mild fibrosis(72%). On the other hand, the majority of AIH group had mild to moderate activity(70%) and moderate to severe fibrosis(95%) and all Wilson disease group had mild to moderate activity(100%) and moderate to severe fibrosis(100%). LSM correlated significantly with both FAF and Ishak scores and the correlation appeared better with the latter(r = 0.839 vs 0.879, P < 0.0001 for both). LSM discriminated individual stages of fibrosis with high performance. Sensitivity ranged from 81.4% to 100% and specificity ranged from 75.0% to 97.2%. When we compared LSM values for the same stage of fibrosis, they varied according to the different etiologies. Higher values were in AIH(16.15 ± 7.23 k Pa) compared to Wilson disease(8.30 ± 0.84 k Pa) and HCV groups(7.43 ± 1.73 k Pa). Multiple regression analysis revealed that Ishak fibrosis stage was the only independent variable associated with higher LSM(P < 0.0001).CONCLUSION: TE appears reliable in distinguishing different stages of liver fibrosis in children. However, its values vary according to the disease type. For that, a disease-specific estimation of cut-off values for fibrosis staging is worthy.
文摘BACKGROUND With advancements in the treatment of chronic liver disease(CLD),including liver transplantation(LT),quality of life and satisfaction after LT have become an important issue for pediatric patients and their parents.More evidence-based information is needed to describe and assess the impact of pediatric CLD on parents and the satisfaction of parents with treatment to better understand their needs.AIM To assess the satisfaction of parents of pediatric LT patients and that of parents of pediatric CLD patients METHODS During this survey,data were collected from parents of pediatric patients who underwent LT between January 2010 and April 2017(LT group;n=91)and parents of pediatric patients with chronic liver disease(CLD group;n=94).Group comparisons were made based on the pediatric health-related quality of life(PedsQL)health care parent satisfaction scale,impact on family scale(IFS)and demographic characteristics.The PedsQL was administered to parents during a phone interview and the results were used to assess the health carerelated satisfaction of parents.The IFS was used to assess the impact of the child’s CLD status on the family.Demographic variables such as education level(elementary vs middle vs high vs university),monthly income(low vs middle vs high),and place of residence(village vs town vs city)were compared between CLD and LT parent groups.Finally,PedsQL and IFS results were also analyzed according to demographic variables.RESULTS A total of 185 parents aged 19 to 65 years were included.There were statistically significant differences between the LT and CLD groups in terms of career(P<0.001),monthly income(P=0.016),and education level(P=0.041).According to the PedsQL results,family inclusion,communication,technical skills,emotional needs,and overall satisfaction were significantly different between the groups;the LT group had consistently higher scores(P<0.001).Additionally,scores for the IFS parameters of financial impact,familial-social impact,personal strain,and total impact were consistently higher for the LT group(P<0.001).There were statistically significant relationships between education level,monthly income,and place of residence according to the IFS results but not the PedsQL results.There were inverse relationships between the difficulties that parents experience because of their child’s health and education levels,monthly income,and place of residence.However,no relationship was found between education level,monthly income,or place of residence and satisfaction with health care services provided in the hospital according to the PedsQL results.CONCLUSION Parents of children who underwent LT were very satisfied with the health care services provided to their children.However,they had more difficulties than parents of children with CLD.
文摘AIM:To investigate the ultrastructure of oval cells in children with chronic hepatitis B,with special emphasis on their location in areas of collagen fibroplasia. METHODS:Morphological investigations were conducted on biopsy material obtained from 40 children,aged 3-16 years with chronic hepatitis B. The stage of fibrosis was assessed histologically using the arbitrary semiquantitative numerical scoring system proposed by Ishak et al. The material for ultrastructural investigation was fixed in glutaraldehyde and paraformaldehyde and processed for transmission-electron microscopic analysis. RESULTS:Ultrastructural examination of biopsy specimens obtained from children with chronic hepatitis B showed the presence of two types of oval cells,the hepatic progenitor cells and intermediate hepatic-like cells. These cells were present in the parenchyma and were seen most commonly in areas of intense periportal fibrosis (at least stage 2 according to Ishak et al) and in the vicinity of the limiting plate of the lobule. The activated nonparenchymal hepatic cells,i.e. transformed hepatic stellate cells and Kupffer cells were seen in close proximity to the intermediate hepatic-like cells. CONCLUSION:We found a distinct relationship between the prevalence of oval cells (hepatic progenitor cells and intermediate hepatocyte-like cells) and fibrosis stage in pediatric patients with chronic hepatitis B.
文摘Background: Allergic rhinitis is an inflammatory disorder of the upper airways. Although several oxidants and antioxidants are likely to be involved, alterations in only limited parameters have been studied. Objective: In this study an attempt has been made to study the oxidant-antioxidant imbalance by investigating changes in a wide range of oxidants and antioxidants in the blood. Methods: Blood samples were obtained from 39 chronic allergic rhinitis patients (males 24, females 15), aged 20-70 (mean age 36.33 ± 2.03) years and 53 individuals (36 males, 17 females);aged 24 to 64 (mean age 45.42 ± 1.36) years. Duration of allergic rhinitis was 1.77 ± 0.237 years. In the study group, nasal symptoms were scored and the results were recorded. The patients were classified as having perennial Allergic rhinitis (PAR) if they had had at least 2 rhinitis symptoms (sneezing, rhinorrhea, nasal obstruction, itching) for at least 6 months a year in the previous 2 years and if they had a positive skin prick test response to at least 1 clinically significant perennial allergen (e.g., house dust mites, molds, cockroach, cockroach excrement grass and tree pollen, cat and dog epithelia and molds, or animal dander). They had no other allergic diseases except persistent allergic rhinitis diagnosed by the physical and history examination. Erythrocyte lipid peroxidation, erythrocyte antioxidants viz., glutathione, glutathione reductase, superoxide dismutase, catalase and plasma antioxidants viz., ceruloplasmin, glutathione-S-transferase, vitamin C, total antioxidant activity were estimated in the above two groups. Results: Erythrocyte lipid peroxidation (0 hour, p < 0.01) and superoxide dismutase (p < 0.01) were significantly higher, whereas plasma vitamin C (p < 0.001), ceruloplasmin (p < 0.05) and total antioxidant activity (p < 0.001) were significantly lower in chronic allergic rhinitis patients when compared to controls. Plasma Glutathione S transferase and erythrocyte catalase, glutathione, and glutathione reductase remained unchanged from normal subjects. Conclusion: The changes in different parameters indicate an imbalance in the oxidant and antioxidant status in chronic allergic rhinitis patients. Further studies are required to investigate the potential for antioxidant supplements to be used as routine therapy in chronic allergic rhinitis patients. Capsule summery: The study shows that the body is trying to cope for the oxidative stress by altering the enzyme levels. But external supplement may also be required as the total antioxidant levels are very much depleted.
文摘Chronic rhinosinusitis and allergic rhinitis are chronic inflammatory diseases that affect the mucous membrane of the nose and paranasal sinuses. These diseases are characterized by recruitment of inflammatory cells to the upper airway. For this to take place a complex interaction between inflammatory cells and the cytokines/chemokines(ligand) liberated at the site of inflammation is involved in a process termed chemotaxis or directed cell migration against concentration gradient of the ligand. This entails signal transduction through the cell surface receptor resulting in cellular functional response and directed migration. In this editorial the novel role of CX3CR1 receptor in the immunopathology of chronic inflammation of the nose and paranasal sinuses will be explored with its potential role as therapeutic target in chronic nasal inflammation.
文摘An enhanced cascade of care should include a younger population,helping to achieve the goal of the World Health Organization with a focus on elimination in the pediatric population.Furthermore,enhanced screening and awareness efforts and continued education of health care providers will improve the outcomes of chronic hepatitis C virus(HCV)infection in the pediatric population.The present work discusses and comments on the topic"cascade of care in HCV chronic pediatric patients".
文摘Chronic myeloid leukemia(CML)in minors is a rare disease which can be effectively treated by tyrosine kinase inhibitors(TKIs)since the year 2000.A majority of pediatricians will encounter one or two CML patients in the course of their careers and will typically have to rely on written information along with their own intuition to provide care.Knowledge of response to TKIs and of agespecific side effects has an impact on the design of pediatric CML trials in many ways aiming to contribute toward greater predictability of clinical improvements.Information from a registry on a rare disease like CML offers the enormous benefit of enabling treating physicians to interact and share their collective experience.The International Registry on Pediatric CML(IR-PCML)was founded at Poitiers/France almost 10 years ago.Since then,the number of collaboration centers and in parallel of registered patients continuously increased(>550 patients as of December 2019).Ideally,from a given treatment center in a country data are transferred to a national coordinator who interacts with the IR-PCML.In the sense of quality assurance,the registry can offer dissemination of knowledge on state-of-the-art diagnostics(including reference appraisal),optimal treatment approaches,and follow-up procedures within a network that is exerting its strength via participation.With continuous growth during the recent years,very rare subgroups of patients could be identified(e.g.,CML diagnosed at age<3 years,children presenting with specific problems at diagnosis or during course of treatment)which had not been described before.Publications coming from the IR-PCML disseminated this useful information derived from patients who robustly participate and share information about their disease,among themselves and with their caregivers and clinicians.Patient input driving the collection of data on this rare leukemia is the basis for the considerable success of bringing new therapeutics into clinical use.
文摘Scientific research has brought about enormous national advancements in cancer management. Currently, Morocco provides several therapeutic tools for cancer, among them chemotherapy, surgery and radiotherapy. In Morocco, there is not enough published data on the use of alternative medicine in pediatric oncology. Owing to the increased interest and lack of data on this practice, we conducted this study. It aims to evaluate the uptake, the types of therapies used, the factors influencing, the reasons for this choice and the cost of AM used by patients. An investigation through a questionnaire was carried out on thirty-four children following for cancer within the pediatric hematology and oncology department (PHO) of Marrakech. The survey was conducted over a period of one month and a half between July 25 and September 5, 2022. Data were collected through a questionnaire. From the medical files, we collected data regarding type of cancer, date of admission to PHO department and the treatment received. We asked about the type of AM used: herbs, honey, spiritual AM, zamzam water (water from a “sacred” source in Mecca). Using alternative therapies is a common practice in pediatric oncology with various reasons, among them, the declining socioeconomic level, the diversity, the cultural background, the psychological and the functional status of patients and sometimes the dissatisfaction with conventional medicine.
文摘BACKGROUND This study evaluated the safety and effectiveness of endoscopic retrograde cholangiopancreatography(ERCP)in pediatric patients with biliary and pancreatic diseases.A retrospective analysis was conducted on 57 ERCP procedures performed in 41 children,primarily for treating pancreatic diseases.The overall success rate was 91.2%,with no major complications observed.Post-ERCP pancreatitis(PEP)occurred in 8.8%of cases.Follow-up examinations over one year showed no recurrence of biliary or pancreatic diseases.Notably,endoscopic treatment led to a significant increase in body mass index(BMI).These findings demonstrate the valuable role of ERCP in managing such conditions.AIM To evaluate the safety and efficacy of ERCP for the management of biliary and pancreatic diseases in pediatric patients.METHODS We conducted a retrospective analysis of data from children aged 1-18 years who underwent ERCP for biliary and pancreatic diseases at Beijing Children’s Hospital between January 2021 and December 2022.The collected data included procedure time,endoscopic treatment,success rate,and postoperative complications.RESULTS Forty-one children underwent 57 ERCP procedures,including 14 with biliary duct disease and 27 with pancreatic disease.The mean age of the patients was 7.48±3.48 years.Biliary duct-related treatments were performed 18 times,and pancreatic disease treatments were performed 39 times.ERCP was primarily used to treat pediatric pancreatic diseases[68.4%(39/57)of the procedures].The overall success rate was 91.2%(52/57 patients).PEP was noted in five patients(8.8%,5/57),and no instances of bleeding,perforation,or cholangitis were observed.The patients were followed up for over one year,and no recurrence of biliary or pancreatic diseases was detected.Importantly,BMI significantly increased after endoscopic treatment compared to that before treatment(P=0.001).CONCLUSION The high success rate and lack of major complications support the valuable role of ERCP in the management of pediatric biliary and pancreatic diseases in the pediatric population.
文摘Background: The COVID-19 pandemic emerged unexpectedly, impacting millions worldwide and, though waning in many regions, remains a significant concern. This study focused on understanding COVID-19’s clinical presentation, disease progression, and outcomes among hospitalized pediatric patients. Additionally, it sought to investigate the impact of concurrent chronic medical conditions on disease severity. Methods: Conducted retrospectively between September 2020 and December 2021, this study observed pediatric patients (below 18 years) hospitalized with confirmed COVID-19 at an Irbid, Jordan tertiary healthcare center. Patients meeting inclusion criteria, including a positive nasal swab PCR test and hospitalization need, were analyzed. Epidemiological and clinical data were collected and segregated into two groups (A and B) based on the presence of chronic conditions. Comparative analysis encompassed presentation, disease trajectory, and outcomes between these groups. Results: Among 451 tested positive patients, 112 were included in the study. Significant differences emerged between the two pediatric groups hospitalized for COVID-19. Those with concurrent chronic illnesses exhibited heightened symptom severity—fever, dyspnea, fatigue—and a higher incidence of abnormal chest radiographs, often requiring intensive care and experiencing elevated mortality rates. Conclusion: This study underscores the criticality of prioritizing COVID-19 management strategies for pediatric patients with pre-existing chronic medical conditions. The findings highlight the increased vulnerability and poorer outcomes experienced by this subgroup, emphasizing the necessity for tailored interventions and focused care approaches.
