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Esophageal diverticulum and high-grade esophageal stricture responsive to serial balloon dilation and nutritional therapy
Kimberly Law, Joseph Spuches, Alexander Wilsey, Michael J Wilsey
April-June 2016, 1(2):64-66
Aims: 16 year old boy withrecessive dystrophic epidermolysisbullosa and previous history of esophageal strictures presents with progressive dysphagia and hematemesis. Patient was admitted to hospital to determine cause of hematemesis. Methods: Patient underwent endoscopy using Olympus GIF-XP 160 endoscope. Results: Endoscopy revealed active esophagitis and multiple blood clots. A high-grade esophageal stricture was noted at level 35cm from incisors, in which the endoscope (5.9 mm diameter insertion tube) could not pass. Endoscopy two days later revealed an esophageal diverticulum and bifurcation located 35cm from the incisors. Instilling a small amount of water revealed a blind ended sac on the left side and a lumen leading to the stomach on the right side (see image). The true esophageal lumen was dilated using a 6-7-8mm CRE™ Wire guided Balloon Dilator (Boston Scientific). He was treated with nutritional therapy (TPN, then enteral feedings following gastrostomy placement by interventional radiology), sucalafate, ranitidine, and zinc. Three subsequent endoscopic dilationsincreased the true lumen diameter to 15 mm. Follow-up esophagram revealed a notably smaller esophageal diverticulum and a small amount of mediastinal air, suggesting microscopic esophageal perforation treated conservatively with IV antibiotics. Conclusion: EGD three months later showed no residual esophageal stricture and complete resolution of the esophageal diverticulum. Balloon dilation along with management of nutrition have been shown to be effective and safe methods of treating esophageal strictures in children, and in this case has been effective in managing an esophageal diverticulum.
[ABSTRACT]   Full text not available  [PDF]
  44 2 -
Low-dose Cyclophosphamide-induced hepatotoxicity in a multiple sclerosis patient: A case report and literature review
A Chakkor, M Salihoune, K Znati, N Mahassini, N Kabbaj
July-September 2017, 2(3):14-16
Cyclophosphamide (CTX) is an alkylating agent commonly used to treat malignancies and immune-mediated inflammatory nonmalignant processes. It is used off-label for multiple sclerosis (MS) treatment as a disease-modifying therapy (DMT). Acute adverse effects include bone marrow suppression, hemorrhagic cystitis, nausea, vomiting, and hair loss. Hepatotoxicity with high dose CTX is well recognized but low dose CTX induced hepatitis has rarely been described. We report a case of a 28-year-old woman with MS who developed acute icteric hepatitis within 8 weeks of receiving low dose intravenous CTX and methylprednisolone (MP). Liver biopsy showed liver cell necrosis. CTX and steroid treatment were discontinued, and her symptoms and laboratory tests improved. Steroids were reintroduced without relapse; the evolution was favorable with liver enzymes normalization. To the best of our knowledge, this is the first report of acute cholestatic hepatitis developing after administration of low-dose CTX in MS patient. We may suggest that baseline liver function tests and periodic assessment should be monitored during CTX treatment.
[ABSTRACT]   Full text not available  [PDF]
  40 4 -
Review of food-related symptoms in children with Crohn's disease following treatment with liquid enteral feeds
Babu Vadamalayan, Mamoun Elawad
October-December 2017, 2(4):20-24
Aims: Whilst it is well established that liquid enteral feeds can effectively bring Crohn's disease into remission, it is still not clear as to the role that foods play in inducing symptoms. We aimed to review food related symptoms in children once disease was in remission following treatment with liquid enteral feed (the first line treatment for children presenting to our unit with Crohn's) with or without immunosuppressive treatment. Methods: Children with Crohn's disease, presented between 2000-2005 and treated with liquid enteral feeds were reviewed. Paediatric Crohn's disease activity index (PCDAI), site of disease, and indicators of an allergic predisposition (atopy, non-food allergies) and results of blood tests for IgE and specific IgE to foods were recorded. Children were treated with liquid enteral feeds (E028 extra or Modulen) for 6-8 weeks then foods were individually introduced at 3-day intervals and foods that induced symptoms were avoided and reintroduced at later date. Results: 16 of the 49 children had food related symptoms. Abdominal pain was the most common problem (12 cases). 10 of the 49 were atopic and all 10 had food related symptoms. 13/49 had raised total IgE and 3 of 21 positive specific IgE. Foods most commonly causing symptoms were milk products, wheat, egg, Soya, potatoes. PCDAI ranged from 0-18 (mean 5.8). 24 male (49%), 25 female (51%), aged 5-16 years (mean 15) were included in this study. Conclusion: Food-associated symptoms occur in Crohn's children when re-starting a normal diet after a period of treatment with liquid enteral feeds. Atopic children are highly likely to develop food related symptoms and affected all atopic children in this study. Foods most commonly causing symptoms were milk, wheat, egg, Soya and potatoes. Individual reintroduction of food with dietician support is helpful if food-associated symptoms are to be detected.
[ABSTRACT]   Full text not available  [PDF]
  36 6 -
Association of vitamin D levels with physical and sociocultural factors among selected Filipino high school students in Quezon City
Hazel V Arnaldo, Randy P Urtula, Maria Estela R Nolasco
July-September 2016, 1(3):8-15
Aim: To determine the vitamin D status and its association with physical and sociocultural factors among Filipino high school students in selected schools in Quezon City. Methods: A cross-sectional study of Filipino high school students was undertaken. Ninety-seven boys and girls, 11- 18 years old, attending selected private and public secondary schools in Quezon City participated in the study. Serum 25-hydroxyvitamin D levels were determined by electrochemiluminescence immunoassay. Results: The total serum 25-hydroxyvitamin D levels of the students ranged from 19.92 nmol/L to 88.63 nmol/L with a mean of 52.43 nmol/L. There was a prevalence of hypovitaminosis D (serum 25-hydroxyvitamin D levels <50nmol/L) of 41.2% with 20.6% having deficient (<37.5 nmol/L) and 20.6% insufficient (37.5 - <50 nmol/L) serum 25-hydroxyvitamin D levels. Low vitamin D intake (p=0.019), Body mass index Z-score outside the normal range of 0 to <1SD (p=0.012) and upper socioeconomic status (p=0.001) were significantly associated with hypovitaminosis D. Conclusion: Hypovitaminosis D is highly prevalent among Filipino high school students in selected schools in Quezon City despite abundance of sunlight. Low vitamin D intake, Body mass index Z-score outside the normal range of 0 to <1SD and upper socioeconomic status were significantly associated with hypovitaminosis D. Given the characteristics of the adolescent population, appropriate interventions are needed to address the problem of poor vitamin D status in schoolchildren.
[ABSTRACT]   Full text not available  [PDF]
  30 6 -
Magnesium deficiency: carbohydrate and lipid metabolism disorders and risk of type 2 diabetes
Ghouini Ahmed, Djoghlaf Djamel El Harb
October-December 2016, 1(4):23-26
In the pathophysiology of non-insulin dependent diabetes, characterized by hyperglycemia, at least three factors seem to be involved: a defect in insulin secretion, increased hepatic glucose production and insulin target. Over the past decade, significant advances in knowledge about the cellular mechanisms of action of insulin were performed. This has led to a better understanding of the mechanisms that could explain the insulin resistance in the type 2 diabetes, regardless of their primary or secondary origin. The deficit of magnesium is frequently associated with diabetes mellitus. This depletion ubiquitous cation in the body, alters glucose metabolism and insulin sensitivity and, is also implicated in the occurrence of complications and the risk of diabetes occurred among subjects predisposed who should receive a follow-up search of a magnesium deficiency, expression of a lack of intake and / or increased urinary loss. In our study, we found a correlation between magnesium deficiency and metabolic disorders affecting carbohydrate and lipid metabolism, labeled with revealing glycemic levels, insulin resistance, and lipid profile. The cause of magnesium deficiency in diabetic patients is not fully known. As the beneficial effects of magnesium supplementation, the long-term studies are needed before recommending routine supplementation in type 2 diabetes and subjects at risk with subclinical magnesium deficiency.
[ABSTRACT]   Full text not available  [PDF]
  32 4 -
The H-type anorectal malformations in girls
FA Otamuradov, N Sh Ergashev
July-September 2016, 1(3):16-19
The anorectal malformations are presented by wide spectrum of nosological forms. Many aspects of the surgical treatment of the rectogenital fistulas in normally formed anus remain to be debatable because they are described insufficiency in the literature. Material and methods: During the period from 2004 to 2015 in the clinic there were treated 210 girls of the age from one day to 15 years with ARM, of them 17 (8,1%) girls were with H-type. The patients were examined and underwent the operative treatment by the developed technique. Results: In 4 (23.5%) patients localization of the malformation was related to the anovestibular type, in 8(47,1%) – to rectovestibular –intermediate form, in 5 (29,4%) –high form of which 2 had rectovaginal fistula. Invaginational extirpation by A.I.Lyonushkin was performed in 3 (17,6%) patients, fistula liquidation by anterior-sagittal approach – 5 (29,4%). In 8(47,1%) patients including repeated surgeries in the recurrences were carried out by the technique developed in the clinic. Conclusion: In intermediate forms and lower localizations of the fistulas there were indicated one-step correction, comparatively better results were obtained in liquidation of the fistula with pulling-through of the anterior wall of the rectum. In high (rectovaginal) fistulas this type of operation should be performed after application of the preventive double sigmostoma.
[ABSTRACT]   Full text not available  [PDF]
  30 5 -
Nutritional and Environmental Factors of Overweight and Child Obesity in Kenitra city, Morocco
Meriem Sbai, Youssef Aboussaleh, Rachid Bengueddour
April-June 2016, 1(2):34-40
Background: Obesity has reached an epidemic proportions world-wide. Its risk factors are poorly studied, especially among children in developing countries such as Morocco. Objectives: The aim of this study was to identify the associations between socioeconomic status, food consumption, dietary diversity score and BMI classes in a sample of preschool children in Kenitra city. Methods: A cross-sectional study was conducted on 338 of preschool children aged 5 to 6 years in urban area of Kenitra, North West Morocco. The weight and height were measured with standard method and the socio economic factors and nutritional data were collected using an appropriate questionnaire completed by parents. Results: It reveal an independence between some factors of the socio-economic status (the level of education of mother; the function of the father and mother; number of children in the family; sibling rank; housing nature, type of habitat) and staturo-ponderal status by gender according to body mass index (BMI) for age (p>0.05), the only associations were found between the father’s educational level and nutritional status among boys (p = 0.033). Conclusions: SES impacts well-being at multiple levels, including both family and children. In our study, a strong relationship between educational level of father’s and childhood obesity specifically among boys was found.
[ABSTRACT]   Full text not available  [PDF]
  30 4 -
Isolated rectal tuberculosis - a case report
F Nejjari, F Rouibaa, A Aomari, T Adioui, M Tamzaouarte, A Aourarh
January-March 2019, 4(1):1-2
Gastrointestinal tract (GIT) is commonly affected by tuberculosis; however isolated tuberculous involvement of the rectum is rare. A tuberculosis origin must be considered when the cause of perianal and rectal lesion is unclear to avoid delay in the diagnosis and treatment. We report an uncommon case of primary isolated rectal tuberculosis. Case report : Patient 45 years old, with no pathological history, who has been presenting low abundance hematochezia associated with abdominal pain, The rectoscopy is indicated, which showed a rectal ulcer at 8 cm from the anal margin, with erythematous mucosa. Multiple biopsies were performed, with the result of histological examination in favor of rectal tuberculosis. The search for mycobacterium tuberculosis by PCR technique (genexpert test) was positive. The patient was started on Anti- Koch’s Treatment (AKT) for six months. He responded very well to this anti tuberculosis therapy and after six months of follow-up he was completely asymptomatic. Conclusion : Rectal tuberculosis is a rare location difficult to diagnosis, usually improve after administration of an anti-bacillary treatment.
[ABSTRACT]   Full text not available  [PDF]
  26 6 -
Assessment of auditory function in obese children
Asmaa Abd El Wakeel Elsehmawy, Amal Mahmoud Hassan Ewida, Amal Gaber Mohammed, Nora Mohammed Ahmed Seliem
October-December 2018, 3(4):1-13
Obesity is a chronic condition, associated with multiple comorbidities. Great attention has been paid to the obesity comorbidities such as cardiovascular disease and insulin resistance up to diabetes mellitus (T2DM), there’s evidence suggests that obesity affects hearing. The aim of the current study was to evaluate the relationship between obesity and hearing in a group of obese children. The present study was a controlled study that was carried out on 80 children of both genders and divided into study group, 40 healthy obese children, they were subdivided after the study has been completed into; group I, 26 healthy obese children with normal middle ear function. Group II 14 obese children with middle ear dysfunction. Control group included forty non- overweight children. Our study revealed that there was significant increase of the pure tone threshold in obese children with middle ear affection in comparison to obese with normal middle ear and the control group. Positive correlation between pure tone with the anthropometric measures, lipid profile and insulin resistance in obese children with diseased middle ear. Cochlear affection in obese children with normal middle ear evidenced by a negative correlation between transient otoacoustic emission with the anthropometry, liver enzymes and insulin resistance. Obesity considered as a risk for conductive hearing loss and cochlear affection.
[ABSTRACT]   Full text not available  [PDF]
  28 4 -
Protrusion of VP shunt through anus a rare complication after shunt insertion at French Medical Institute for Children (FMIC), Kabul, Afghanistan (Case Report)
Dunya Moghul, Mohammad Trariq Rahim
April-June 2016, 1(2):70-72
Ventriculoperitoneal (VP) shunt is one of the most common treatments for diverting the cerebrospinal fluid (CF), but it is accompanied by many complications that protrusion through anus is one of the rare ones, a 5 year old baby girl presents with excessive irritability and anorexia to the outpatient department of surgery department, French Medical Institute for Children, and mother of child was complaining from protrusion of shunt through anus two days ago, after performing laperatomy distal end of shunt found in the sigmoid colon. So total removal of shunt is done for this baby and planed for re-shunting after a month.
[ABSTRACT]   Full text not available  [PDF]
  26 4 -
Tuberculosis complicating Crohn's disease treated by anti-TNFα with negative quantiFERON
Youssef Touibi, Ayman El Farouki, Hicham Naji Amrani, Tarik Ziadi, Taoufik Lamsiah
October-December 2017, 2(4):25-27
Anti-TNFα has reported an enormous Progress in the management of chronic inflammatory bowel disease, but this therapy is not without side effects. Infectious risk is the main side effect, especially tuberculosis. Hence the need for a pre-therapeutic assessment before starting the treatment. Materials and methods: These are two cases of tuberculosis complicating the treatment with anti-TNFα in patients monitored for crohn's disease. RESULTS: Two men followed for Crohn's disease with indication of anti-TNFα biotherapy, who had a complete phthisiological assessment with negative quantiFERON. Both patients showed respiratory signs with fever after the attack treatment. Imaging showed an appearance of tuberculous miliary disease in both patients. The search for mycobacteria was negative. The anti-TNFα treatment was interrupted with the introduction of an anti-bacillary treatment. Conclusion: Treatment with anti-TNFα requires careful attention, so following the recommendations is fundamental, with rigorous monitoring throughout the treatment period, since a normal pre-therapeutic assessment including a negative quantiFERON does not eliminate a potential risk.
[ABSTRACT]   Full text not available  [PDF]
  26 4 -
Anthropometric and metabolic profile of obesity
Ghouini Ahmed, Djoghlaf Djamel El Harb, Rahal Lotfi
July-September 2016, 1(3):5-7
Introduction: Obesity is excess fat with adverse health consequences, because of the many complications that it generates during its evolution. Objective: We aim to establish the correlation between anthropometric parameters and metabolic profile. In Algeria, the correlations between the morphological and metabolic and nutritional status are not enough documented. Material and methods: Our study included a cohort of 208 subjects aged between 40 and 60 including 67 subjects at normal weight and 141 subjects with an overweight of a body mass index BMI (weight in kg/height in m2) at 26 to 35. Assessment of anthropometric profile took into account the BMI and waist circumference. Body composition and energy expenditure were determined by bioelectrical impedance kind QUADSCAN 4000. Measurements of blood glucose and insulin were performed on COBAS INTEGRA 400 plus ROCHE; HOMA index was calculated by the following formula: insulin (mU / L) X glucose (mmol / L) /22.5, The Statistical Package of Social Sciences (SPSS 17.0) was used to perform statistical analysis. Results: It is found in our study, an increase in basal energy expenditure in obese subjects compared to other statutes weight is 1827 Kcal / versus 1570 kcal / (P < 0.001). It is also observed an increase in lean body mass in obese subjects (59 kg) compared to overweight subjects (51 kg) and normal weight subjects (47 kg); the difference is significant at P < 0.001. On the other hand, there is a significant difference between insulin levels in overweight subjects compared to controls (P <0.05). Conclusion: The results of our study support the following assumptions: lean mass rate is proportional to the weight., the distribution of body fat has no direct influence on the basis of energy expenditure. furthermore, there is a positive correlation between HOMA insulin resistance index and anthropometric parameters. Therefore, a nutrition and sports education program could positively impact on comorbidities accompanying this disease that poses a major public health problem.
[ABSTRACT]   Full text not available  [PDF]
  26 4 -
Fecoprevalence and determinants of Helicobacter pylori infection among asymptomatic children in Myanmar
Hnin Mya Swe, Nwe Ni, Lwin Lwin Soe, Aye Aye Myint, Thi Tar
April-June 2016, 1(2):50-54
Objective: The aim of this study was to determine fecoprevalence of Helicobacter pylori infection and find out association between Helicobacter pylori infection and its determinants among asymptomatic 6 - 12 years old school children. Methods: This study was a school-based cross-sectional analytic study involving 90 asymptomatic 6 -12 years old school children in No. (2) Basic Education High School (BEHS), Chan-Aye-Thar-San township, Mandalay. Age, gender distribution and determinants of Helicobacter pylori infection were studied. Detection of H. pylori stool antigen was performed by using monoclonal stool antigen test kit (SD BIOLINE, Korea). The fecoprevalence of H. pylori infection was enumerated. Association between Helicobacter pylori infection and its determinants was analysed. Results: Overall fecoprevalence of Helicobacter pylori infection among asymptomatic school children was 17.8%. The most prevalent age group was 6-8 years (24.2%) followed by >10-12 years (18.8%) and >8-10 years (8%). There was no significant gender preponderance in all age groups. Higher frequency of fecopositivity in children living in overcrowded houses and those who drink non-purified water were noted (p<0.001). Eleven (28.9%) from low socioeconomic status and 5 (9.6%) from middle socioeconomic status were noted to be fecopositive. There was no significant association between domestic water source and H. pylori infection. Conclusion: Helicobacter pylori infection is prevalent in asymptomatic school children in this study. Low socioeconomic status, overcrowding and drinking non-purified water were significant determinants of H. pylori fecoprevalence. This findings may lead to key insights into the transmission of H. pylori infection in developing countries and method of reducing rates of transmission of infection.
[ABSTRACT]   Full text not available  [PDF]
  26 4 -
Chronic diarrhea: four decades experience in resource-limited settings
Suraj Gupte
April-June 2016, 1(2):78-84
Objective: In view of the paucity of information in the literature, this article aims at providing a simplified and yet state-of-the-art approach for the management of chronic diarrhea in children in resource-limited settings. Resource and Design: Systematic review of literature supported with our own experience spread over four decades. Salient Features: Etiology of chronic diarrhea, implying diarrhea of 2 weeks or more, usually secondary to a malabsorptive cause, is exhaustive. However, in clinical practice in resource-limited settings, only a few conditions such as malnutrition, intestinal infestations, cow’s milk protein allergy (CMPA), celiac disease, cystic fibrosis and endemic tropical sprue monopolize the situation. Diagnostic evaluation needs to be step-by-step with good history-taking and clinical examination followed by select investigations depending on the individual merits of the cases. High index of suspicion is a forerunner in detecting CMPA. Mild to moderate steatorrhea is usually indicative of malnutrition, iron-deficiency anemia or intestinal parasites (L. giardia, A. duodenale). Gross steatorrhea is due to celiac disease, cystic fibrosis or tropical sprue. In cystic fibrosis, despite significant steatorrhea, D-xylose test is usually normal. Conclusion: A good idea about the pattern of etiology of chronic diarrhea/ malabsorption in different regions together with an individualized approach and an adequate follow-up is likely to resolve a large majority of the diagnostic as well as therapeutic problems. Treatment depends on the etiology of chronic diarrhea.
[ABSTRACT]   Full text not available  [PDF]
  29 1 -
Outcomes of gastric transposition for esophageal replacement among children at french medical institute for children, Kabul, Afghanistan (Case Series Study)
Abdul Jalil Wardak, Dunya Moghul
January-March 2016, 1(1):34-36
Introduction: The technique is limited to benign conditions in children. The esophageal replacement includes intestinal interposition, gastric tube-Graviliu, and gastric transposition. Pulling stomach to neck as an esophagus has been accepted widely because of its stretch ability and the rich submucosal vasculature. Conditions such as esophageal atresia, caustic ingestion with persistent stricture, persistent peptic stricture, tumors, foreign body injury (battery) and Achalasia could affect the development and function of esophagus. Objectives: This research basically emphasizes on the procedure of gastric transposition and its indications, planning, and outcomes; therefore this study is aimed to determine the Gastric transposition for esophageal replacement outcomes among children. Methodology: Study was conducted in all the patients who underwent gastric transposition for esophageal replacement from 2012 to 2015. A total of 11 patients were included, 5 males and 6 females, age ranged from 4 days - 7 year old. Out of 11 patients 3 had type-1 esophageal atresia, 7 had persistent stricture due to caustic ingestion and 1 had foreign body injury. Results: No major complications during the surgery. The last patient has been followed for one year. Only 3 out of 11 patients underwent esophageal dilatation twice, therefore, the technique was accomplished successfully with excellent long-term outcome. Conclusion: With the relative high frequency of esophageal conditions, and the high mortality with late diagnosis, there is inherent importance in understanding the condition in pediatrics surgery practice in Afghanistan so as to improve survival.
[ABSTRACT]   Full text not available  [PDF]
  26 3 -
Maintenance of remission in paediatric Crohn's disease using mesalazine monotherapy: a single centre experience
Vadamalayan Babu, Saha Amit
January-March 2020, 5(1):1-6
Mesalazine is a 5-aminosalicylic acid (5-ASA) used to induce and maintain remission in inflammatory bowel disease (IBD). It is metabolised to its active form by the intestinal mucosa, thus more useful in treating ulcerative colitis (UC) than transmural Crohn disease (CD). There is little published evidence that mesalazine is effective in maintaining remission in paediatric CD. A retrospective study was done in 19 children diagnosed with CD and prescribed mesalazine monotherapy after successful induction therapy in our centre. Four children had ileal disease, 9ileocolonic disease and 6 had colonic disease only. Out of the total of 19 children, the number of children in remission on mesalazine alone was 18, 14 and 5 at 3, 6 and 12 months respectively. The commonest reason to start additional therapy was on-going disease activity. Adverse effects were rare, leading to cessation of the drug in only one child. This study shows that a proportion of CD patients will enter a significant period of remission while taking mesalazine as sole maintenance drug. The beneficial effect of mesalazine in CD does not appear to be restricted to those with disease limited to the colon. Our results suggest a role for mesalazine in paediatric CD.
[ABSTRACT]   Full text not available  [PDF]
  22 7 -
To study the prevalence of iron deficiency anemia in children aged 6 months – 6 years presenting with febrile seizures in Department of Pediatrics
Balram Meena, Jaswir Singh, Maninder Kaur
July-September 2016, 1(3):20-23
Background: Febrile seizure is a common cause of seizures in young children but with an excellent prognosis. In addition to genetic predisposition, febrile seizures are generally thought to be induced by elemental changes such as iron deficiency. Regarding the high prevalence of febrile seizures with iron deficiency anemia in children, the aim of our study is to investigate the role of iron deficiency anemia in febrile seizures patients. Iron deficiency (ID) is the most common nutritional deficiency. The peak age for ID is between 1 and 2 years, which coincides with the peak incidence for febrile seizures. Aim: To study the prevalence of iron deficiency anemia in children aged 6 months to 6 years having febrile seizures. Study design: It is a prospective observational case control study. Material & Method: The present study was included 50 children aged 6 months to 6 years with febrile seizures (cases) and 30 febrile children without seizures (controls), coming to Pediatrics OPD and emergency, RAJINDRA HOSPITAL PATIALA. Hemoglobin level (Hb) and serum ferritin levels were estimated in all the patients. Results: In cases the mean serum ferritin levels was25.52±29.8 ng/dl and in controls was61.36±77.5 ng/dl. It was seen that serum ferritin levels were significantly low in children with febrile seizures as compared to controls (p < 0.004). Conclusion: Prophylactic iron supplementation should be considered in all children who are anemic as it may have a preventable role in febrile seizures.
[ABSTRACT]   Full text not available  [PDF]
  26 2 -
Unusual metastasis of hepatocellular carcinoma
L Talioua, I Benelbarhdadi, O Haidouri, FZ Ajana, R Afifi, A Essaid
October-December 2016, 1(4):1-4
Hepatocellular carcinoma is the most common primary tumor of the liver and is estimated to cause more than a quarter of a million deaths each year throughout the world. Extrahepatic metastasis of HCC occurs in about 30-50% of patients, and it depends on HCC stages. Materials and methods: We carried out a retrospective study including 16 patients, 10 men and 6 women with a mean age of 58.5 years ranging from 37 years to 75 years. 13 patients had cirrhosis due to hepatitis C virus, 1 patient had cirrhosis due to viral B infection and 2 patients had HCC within a non-cirrhotic liver. All patients had one or more HCC, ranging in size from 2 to 10 cm. The AFP was normal in 11 cases and elevated in 4 cases (> 200 ng / ml). We collected 4 cases of adrenal metastases, 3 costovertebral metastases, 2 gastric metastases, 2 brain metastases, 1 cranial metastasis, 1 clavicular metastasis, 1 ovarian metastasis, 1 nasopharyngeal metastasis, and a case of metastasis in the path of percutaneous biopsy of HCC. In 4 cases the diagnosis of HCC and metastasis was synchronous while in 12 cases median time from diagnosis of hepatocellular carcinoma and extrahepatic HCC was 15.5 months. Therapeutic abstention was decided in 14 patients for the advanced stage of the disease. Cutaneous metastasis was resected surgically and HCC occurring in healthy liver was treated by lumpectomy and upper pole gastrectomy in gastric metastasis. The average survival was estimated at 14 months with a decline of 17.3 months, 6 cases were lost to follow and 6 deaths occurred in our series. Conclusion: The incidence of unusual and extrahepatic metastasis of HCC diagnosed during clinical course was not frequent. The diagnostic procedures for extrahepatic metastasis have not been standardized, however considering the substantial advances in treatment of HCC, the detection of extrahepatic HCC is crucial for patients to receive appropriate therapy, which ultimately determines patient survival.
[ABSTRACT]   Full text not available  [PDF]
  22 6 -
Energy balance of the obese subject
Ghouini Ahmed, Djoghlaf Djamel El Harb, Benrekia Youcef, Khelfat Khireddine, Graine Karima
January-March 2017, 2(1):1-4
Obesity is a real epidemic with significant health effects. The pathophysiology of obesity involves environmental factors such as excess diet and/or decreased physical activity. In all cases, the energy balance of the obese subject is positive. As part of an efficient management of this ever-increasing pathology, we wanted to measure the energy balance of a population of algerian adults (402 subjects aged 30 to 60 years followed in medical consultation). Body composition and energy metabolism were assessed by bioelectrical impedancemetry; the energy intake and the level of physical activity were assessed on codified interrogation. It turns out that obese subjects underestimate their dietary intake and are in their great majority inactive. The therapeutic management of these patients requires a nutritional education program combined with recommendations of adapted sports practice.
[ABSTRACT]   Full text not available  [PDF]
  24 4 -
Towards managing and controlling food safety based on contamination with fungi and its mycotoxins
Afaf A Amin, Gulsen S Ahmed, Hoda H Abo Ghalia, Amera A Hamed
April-June 2017, 2(2):4-13
A significant portion of the agricultural produce in the countries and the world over become unfit for human consumption due to mycotoxins contamination of grains and cereals. The main toxic effects are carcinogenicity, genotoxicity, teratogenicity, nephrotoxicity, hepatotoxicity, reproductive disorders and imunosuppression. This study was done to identify the molds and aflatoxins that contaminate cereal–based baby foods and corn–based snacks products. The most frequent fungal genera found in the samples were Aspergillus, Penicillium, Alternaria, Fusariumand Cladosporium with frequencies of 41, 16, 10, 8 and 3%, respectively. Additionally, the numbers of contaminated cereal–based baby foods samples with AFB1, B2, G1 and G2 were 14, 2, 6 and 4%. Also, 34, 14, 18 and 8% of corn-based snack samples respectively. Ten essentials oils of (cinnamon, cumin, clove, fennel, garlic, lemon grass, marjoram, peppermint, rosemary and thyme) plants using in combating aflatoxigenic mold A. flavus growth and its aflatoxins production. The ten essential oils showed notable inhibitory effects on A. flavus growth and its aflatoxins production. Cinnamon and garlic essential oils caused complete inhibition to all types of aflatoxins at concentrations of 60 and 80μl respectively. There were some alterations produced by cinnamon, garlic and cumin essential oils at sub-lethal inhibitory concentrations such as abnormal cell shape, leakage of cell wall and the membranous organelles were disrupted.
[ABSTRACT]   Full text not available  [PDF]
  24 4 -
Ulcerative colitis in a Nigerian child: a case report
R Ewah-Odiase, I Omoike, G Akpede, R Udaze, C Omuemu, D Obaseki
July-September 2016, 1(3):29-31
Background: Ulcerative colitis (UC) is an idiopathic chronic inflammatory disorder characterized by unpredictable exacerbations and remissions. It is thought to be rare in Africans especially amongst paediatric age group and there has been only one presumed paediatric case report from Nigeria. Case Presentation: We report the case of a 13.5 year old boy who presented with typical symptoms and in whom the diagnosis of UC was confirmed by endoscopic examination and histology. He responded well to treatment with sulfasalazine tablets. Conclusion: This plus an earlier report suggest that UC may not be as rare in Nigeria as it was previously thought to be perhaps due to under-diagnosis caused by a lack of diagnostic facilities. A high index of suspicion is required in diagnosis and epidemiologic studies are required to determine its actual prevalence.
[ABSTRACT]   Full text not available  [PDF]
  24 3 -
pH-metryin children: Moroccan experience
Delsa Hanane, Serraj Ilham, Kabbaj Nawal
April-June 2016, 1(2):6-9
Ambulatory pH-metry has long been one of the main diagnostic tools used for the diagnosis of gastroesophageal reflux disease (GERD) in adults and is also increasingly used in children. The aim of this study is to describe the clinical data of children, the indications and results of pH-metry in a Moroccan unit. Methods: Over five years, 78 children underwent pH-metry in our unit. We analyzed their clinical data and their examination results. Results: 78 children underwent pH-metry were included. 48,7% are boys and 51,3% are girls. The mean age is 8.2 years (2-17 years).53 pH-metry (78,2%) were realized in children with respiratory symptoms. Other indications are represented by assessment of GERD in 8 patients, vomiting in 4 patients and ear-nose-throat symptoms in 3 patients. The mean recording time was 23 hours. 28patients (35,9%) were diagnosed with GERD and 49 patients (62,8%) had a normal pH-metry. For patients with GERD, the mean time with reflux was 156,7minutes and average EAO was 9,1%. It was noted a diurnal and nocturnal GERD in 10 cases (35,7%), a diurnal GERD in 10 cases (35,7%) and a nocturnal GERD in 8 cases (28,6%). The respiratory symptoms were the main indication of pH-metry represented in 61 children (78,2%). 34,4% had a pathological GERD with a mean De Meester index of 37,3. Conclusion: Ambulatory esophageal pH monitoring is the “gold standard” for diagnosis of acid GERD. In our series, pH-metry assess the diagnosis of pathological GERD in a third of children with respiratory symptoms.
[ABSTRACT]   Full text not available  [PDF]
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Clinical profile and outcome of choledochal cysts in a pediatric tertiary hospital from 2000 to 2013
Odessa C del Rosario-Bayani, Sarabeth V de Castro, Randy P Urtula, Maria Estela R. Nolasco, Mary Ann F. Aison
April-June 2016, 1(2):15-33
Background: In spite of early surgical intervention of choledochal cysts to prevent adverse outcomes, a few still develop significant morbidity and mortality. Determining which factors affect outcome will aid in the management and care of patients with choledochal cysts. Objective: This study aims to determine the clinical profile of patients with choledochal cyst and determine the factors affecting its outcome. Methodology: A retrospective cohort study of patients with choledochal cysts 0-18years old was done. Clinical data were correlated with the outcome which include immediate postoperative complications, portal hypertension and mortality. Results: A total of 77 patients with choledochal cyst were studied. Majority were >2-5 years old at 31% (n=24/77). The mean age at onset of symptoms was at 2.75 years old. The most common cyst type was type I at 79% (n=61) followed by 16% type IV (n=12), 3% type III (n=2) and 1% type V (n=1). There was no type II cyst. Age had a significant association with the clinical manifestations with jaundice, abdominal distention and hepatosplenomegaly found in less than 2 years old and abdominal pain in 5-7 years old (P≤0.05). Classic triad was significantly associated with cyst type III (50%) and IV (20%). 91% underwent surgery (n=70/77) with cyst excision and hepaticoenterostomy being the most commonly used (n=51/77, 66%).17% had immediate postoperative complications (n=12/70) with infection (n=7/12) being the most common complication significantly found in less than 2years old (n=5/7). 13% had portal hypertension (n=10/77) significantly found in those whose onset of symptoms was less than 2 years old (n=9/10) and Type I cysts (n=6/10). 6.5% died (n=5/77) and was significantly highest in those whose onset of symptom was less than 2 years old (n=4/5). Conclusions: Particular attention to diagnose, provide timely intervention and anticipatory care of possible complications should be given to infants with choledochal cysts because they were significantly associated with immediate postoperative complication particularly infection, development of portal hypertension and mortality. Recommendations: It is recommended to include a bigger population size and follow-up studies to monitor long-term complications of patients with choledochal cysts.
[ABSTRACT]   Full text not available  [PDF]
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Association of increased oxidative burden and excessive fluoride exposure in obese children
Balvir Singh Tomar, Deepak Nathiya, Dushyant Singh Chauhan, Sandeep Tripathi
July-September 2018, 3(3):1-6
Background: The modern scientific evidence representing that obesity associated with fluoride exposure may be a risk of reduced health quality in paediatric population. Obesity is an independent risk factor for cardiovascular diseases and markedly elevated risk of morbidity and mortality. Presence of higher levels of fluoride in drinking water (>1.5ppm) may be serious problems in health of the obese children. In the state of Rajasthan, almost all districts have high fluoride (up to 18.0 ppm) in their drinking / ground water sources. An estimated 66.6 million people (17 states in India) including 6 million less than 14 years children are at risk Aim: The aim of the present study was to evaluate the effect of fluoride in obese child of high endemic fluoride areas. Method: In the present study, we selected 54 obese children from the selected area of Jaipur- India, twenty seven children (n=27) from high fluoride (F > 2.5ppm) region and twenty seven (n=27) obese children (disease control) from, where fluoride content was normal (F< 1.5ppm) in their source of drinking water. Moreover, age matched healthy controls were selected from the Jaipur district where fluoride content in water was less than 1.5 ppm. After clinical examination, lipid profiles, oxidative stress parameters namely, lipid peroxide level (LPO), superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase and reduced glutathione content. Results: The concentration of fluoride in serum was significantly correlates with their water concentration. Increased LPO levels and reduced antioxidant status in obese and fluoride exposed obese. Moreover, obese and fluoride exposed obese were more comparable. Conclusion: On the basis of the results it may conclude that fluoride enhances the severity of disease and fluoride promotes oxidative stress in obese paediatric population. However, further in depth of studies is required for the understanding of pathophysiology of child obesity those residing in endemic area of fluoride.
[ABSTRACT]   Full text not available  [PDF]
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Role of zinc in malnutrition
Parveen Mittal, B Dipti
October-December 2016, 1(4):45-48
Malnutrition is a globally prevalent disease, more so in the developing countries. It includes both macronutrient and micronutrient or trace element deficiency. Of late, zinc has been recognized as an essential trace element, required for maintaining normal body homeostasis. Zinc deficiency is associated with growth retardation (height and weight), delayed sexual and bone maturation, impaired immune function, recurrent infections, dermatitis, diarrhea, alopecia, anorexia and mental disturbances.1 Serum zinc levels have been found to be low in protein energy malnutrition globally. Zinc supplementation during the rehabilitation phase of malnutrition has been associated with rapid weight gain.
[ABSTRACT]   Full text not available  [PDF]
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