Risk factors for viral hepatitis b and c infection in children

Objective: To determine the frequency of different predisposing illnesses and risk factors responsible for spread of chronic viral hepatitis in children. Study Design: Descriptive study. Place and Duration of Study: Department of Pediatric Gastroenterology, Hepatology, The Children's Hospital and the Institute of Child Health Lahore, from Jan to Dec 2016

Material and Methods: Patients screened positive for HBV and HCV by HBsAg and Anti HCV were included in the study and further confirmation of infection was done by PCR and/or HBeAg. History regarding various risk factors and pre-existing illnesses was taken and all data was analyzed using SPSS version 20

Results: Total 122 patients, mean age 9.86 +/- 3.63 years, 89 male and 33 female; were included. Hepatitis B was found in 31 [25%] while hepatitis-C 91 [75%] patients. HCV genotype 3 was most frequent [69/91, 78%]. Common pre-existing illnesses were: acute lymphoblastic leukemia 19 [15.57%], thalassemia 11 [9.02%], non-Hodgkin lymphoma 3 [2.46%], Hodgkin disease 2 [1.64%] and Celiac Disease 3 [2.46%]. Hyperbilirubinemia [bilirubin >1.2mg/dL] was found in 15 [12.29%], elevated ALT [>42 iu/mL] in 49 [40.16] patients and ultrasound abnormalities in 21 [17%] patients. Most frequent risk factor was blood component transfusion present in 62 [51%] patients followed by perinatal transmission in 33[26%], history of viral hepatitis in father in 6 [6%] and history of surgery or dental procedure was present in 19 [16%] patients

Conclusion: Hematological malignancies and thalassemia are the commonest predisposing conditions of HBC and HCV infection in children. Most common mode of transmission was blood transfusion present in nearly half the patients followed by perinatal transmission

Upper gastrointestinal tract foreign bodies in children: presentation and management

Objective: To describe the presentation and outcome of upper gastrointestinal [GI] foreign bodies in children. Study Design: Descriptive case series. Place and Duration of Study: Department of Pediatric Gastroenterology, Hepatology and Nutrition, the Children's Hospital and the Institute of Child Health Lahore, from Jan 2016 to Dec 2016

Material and Methods: Fifty eight children with history of foreign body ingestion were included in the study through non probability purposive sampling technique. Children underwent upper GI endoscopy flexible endoscope under general anesthesia. The data such as age, sex, mode of presentation, type of foreign body and site of impaction was recorded on a specially designed proforma. Qualitative variables including gender, type of foreign body, clinical features, site of impaction etc were expressed in term of frequencies and percentages while age was expressed as mean and standard deviation

Results: Among 58 patients 53.4% [n=31] were male and 46.6% [n=27] were female with age range from 2 months to 15 years. Majority of cases had developed dysphagia [70.7%]. Coins were the most common foreign bodies encountered [32.8%] followed by button batteries [31%]. Lower esophagus was the most common site of impaction of foreign bodies [65.5%]

Conclusion: Coins and button batteries are the common upper GI foreign bodies with lower esophagus being the most common site of impaction. Commonest presenting feature was dysphagia. Endoscopic retrieval of foreign bodies under general anesthesia is a safe mode of treatment

Effectiveness and safety of sofosbuvir in treatment-Naive children with hepatitis C infection

Objective: To determine the effectiveness and safety of Sofosbuvir and Ribavirin combination in treatment-n?ive children with HCV infection

Study Design: An experimental study

Place and Duration of Study: Gastroentrology, Hepatology Department, The Children's Hospital and The Institute of Child Health, Lahore, from January to December 2016

Methodology: HCV PCR positive treatment-n?ive patients, 5 to 18 years of age, were enrolled by consecutive nonprobability sampling. Clinical features and investigations including complete blood count, bilirubin, ALT, PT and HCV genotyping were done. All patients were started on Sofosbuvir 400 mg once daily and Ribavirin 10-15 mg/kg/day. Patients were followed on 4-weekly basis. PCR was done after 4 weeks; if positive then again at 12 weeks. End of treatment and 12 weeks post treatment PCR was done in all patients. Total duration of therapy was 24 weeks. Computer program SPSS version 20 was used for data analysis

Results: A total of 35 patients with mean age of 10.24 +/-2.80 years, including 22 boys [62.86%], and 13 girls [37.14%] were included. The most common HCV genotype was genotype 3 encountered in 27 [77.15%], followed by genotype 1 in 6 [17.14%], while 2 [5.71%] patients were untypable. Thirty [85.71%] patients achieved rapid virological response while the rest 5 [14.28%] had early virological response. End-of-treatment PCR was negative in all patients. SVR was achieved by 34 [97.14%] patients. The treatment was well tolerated. Headache was observed in 8 [22.86%] patients, which improved spontaneously

Conclusion: Sofosbuvir and Ribavirin combination is highly effective in HCV genotypes 1 and 3 with no major undesirable short-term side effects

Mesosigmoid hernia presenting as irreducible inguinal hernia

We report a rare case of a sixty-year-old male who presented with an irreducible right inguinal hernia of 6-h duration, associated with vomiting and abdominal pain. Later in the course the hernia spontaneously reduced. After resuscitation and appropriate work-up, the patient was taken to operating room for a diagnostic laparoscopy. Consequent to finding hemorrhagic ascites and a loop of infracted bowel, a lower midline laparotomy was performed, which revealed a loop of intestine herniating through a tight defect in sigmoid mesocolon. Resection of the affected bowel with primary anastomosis was performed. Patient made an uneventful recovery and was discharged home on the 8th post-operative day. Patient was followed up at 2 and 4 weeks intervals in the surgical clinic and remained symptom-free

Silver staining nucleolar organizer region [Agnor] typing in buccal mucosal cytology of smokers and non-smokers

Background: Argyrophilic nucleolar organizer region [AgNOR] size and distribution are related to malignant potential in a tissue or cell. Typing of AgNOR has been attempted in cytological specimens and found useful in grading dysplasia from mild to severe in oral lesions. This study was conducted in an attempt to find any difference between smokers and non-smokers oral mucosal cells as regards AgNOR size and distribution

Methods: The cytological smears of buccal mucosa in 75 smokers and 75 nonsmokers were stained for AgNORs. Ag NOR typing based on size and distribution was performed in both smokers and nonsmokers using Ahsan's criteria

Results: No statistically significant difference was found between smokers and nonsmokers. AgNORs were round and had clustered distribution in both groups

Conclusion: It is not possible on the basis of AgNOR typing to differentiate between smoker's buccal mucosal cells and that of nonsmoker's. This study also indicates that AgNOR technique is simple, inexpensive and easily reproducible. Moreover Ahsan's criteria for AgNOR typing is simplest and don't depend on the availability of expensive precision instruments