Ruptured splenic abscess as an extremely rare cause of pneumoperitoneum: A comprehensive review with a case report.

Splenic abscess leading to rupture and pneumoperitoneum is a very rare condition that is limited to a few case reports. In this study, we first introduced a case of an adolescent girl with a medical history of diabetes mellitus who presented with left upper quadrant abdominal pain and fever. Ultrasound revealed an abscess in the spleen and a computed tomography (CT) scan of the abdomen revealed evidence of pneumoperitoneum secondary to the rupture of this abscess. The patient underwent splenectomy without postoperative complications. Secondly, we reviewed and discussed the current literature on this topic which predominantly denotes that the pneumoperitoneum following splenic abscess rupture mostly occurs in the immunocompromised status, without a specific predominant infectious agent but the culprit is a gas-forming organism, acute abdomen ensues if the diagnosis is delayed, diagnosis is via abdominal CT when there is hemodynamic stability otherwise exploratory laparotomy uncovers the diagnosis, and splenectomy with broad-spectrum antibiotic therapy is the mainstay of treatment.

Torsion of epididymal Cyst as a cause of acute Scrotum in a child.

Epididymal cyst is commonly seen in adults and sometimes in children. In most cases of the epididymal cyst, there are no symptoms and the diagnosis is made incidentally during ultrasonography. However, in rare circumstances, such as infection, trauma, or torsion, an epididymal cyst could become painful and require surgical or medical intervention. We report the case of an 11-year-old boy admitted to our hospital with acute right scrotal pain and treated surgically for epidydimal cyst torsion. Torsed epididymal cysts may cause symptoms exactly like testicular torsion. Therefore, It should be considered a differential diagnosis of testicular torsion in pediatrics.

Giant pedunculated hepatoblastoma mimicking neuroblastoma in a 4-month-old infant: a case report.

BACKGROUND: Hepatoblastoma is the most common primary malignancy of hepatic origin in children, with an estimated incidence of 0.5-1.5 per million children. Hepatoblastoma classically has an intraparenchymal location, and pedunculated hepatoblastoma is a relatively rare entity. Accurate diagnosis can be challenging due to its extrahepatic location and possibly its thin peduncle, which is not easily identified in imaging. CASE PRESENTATION: Here, we report a case of asymptomatic giant palpable hepatoblastoma in the LUQ of a four-month-old male infant, initially suspected of neuroblastoma based on abdominal ultrasound findings. The final diagnosis of giant pedunculated hepatoblastoma was made based on the abdominal CT scan and the diagnosis was confirmed by percutaneous biopsy. Due to the size of the tumor, complete removal of the tumor was not initially possible. Therefore, the patient was treated with several courses of chemotherapy. The tumor was shrunk and then completely removed. The patient was treated, and no complications were found in the 6-month follow-up. CONCLUSION: Pedunculated hepatoblastoma is rare but should be considered as a possibility in the case of a perihepatic mass in a pediatric patient that can be confused with other upper abdominal masses such as an adrenal mass. Therefore, in such cases, we must look for the vascular pedicle in the imaging and keep the AFP check in mind.

Prevalence of fatty liver and its related factors in children.

Background: Fatty liver disease is a severe liver condition that affects youngsters. Liver disease in children increases the incidence of liver fibrosis in their adulthood. Due to the importance of this disease and related factors in children, such as diabetes and obesity, our study was conducted to investigate the prevalence of fatty liver in children. Materials and Methods: This is a descriptive cross-sectional study done in Ali Asghar Hospital from June 2020 to December 2020. Demographic characteristics and prevalence of fatty liver were assessed. Blood samples were obtained after ten hours of fasting to assess AST, ALT, ALP, and blood glucose levels. Ultrasound was also used to check the health of the liver. Walking to school and exercising were also assessed. Data were analyzed using statistical software. Results: This research included 2526 children, and 37 of them had fatty liver. Fatty liver was more common in children with a BMI greater than 30, as well as metabolic and hypoparathyroid illness (P = 0.02). A significant association was observed between exercise and walking with fatty liver disease (P < 0.05). The majority of the individuals had grade 1 fatty liver (75.5%). Grade 1 fatty liver was seen in 90% of those who did not participate in athletics and 95% of those who did not walk to school. In addition, 94% of patients who exercised for less than ten minutes had grade 1fatty liver. Conclusion: Initially, exercise and weight loss had an essential effect on fatty liver disease. In fact, lifestyle changes and prevention of obesity may reduce liver damage.

Therapeutic effectiveness of green tea leaf extract on clinical symptoms in children suffering viral gastroenteritis: A randomized clinical trial.

The use of tea plant extract has been reported to reduce viral complications, but its role in improving viral gastritis has not been investigated. The aim of this randomized clinical trial was to evaluate the effect of green tea consumption in improving pediatric viral gastroenteritis. This clinical trial study was performed on children aged 12 to 17 years with diarrhea who were not treated within 48 hours of the onset of clinical symptoms during September 2019 to September 2020. The children were randomly assigned to a green tea leaf extract (GTE) tablet. The placebo group was considered as a control. Treatment (prescribing the tablets) was continued until a Bristol Stool Scale of 3 or 4 was obtained. Two groups were compared in terms of clinical symptoms. The complete and partial improvement was revealed in 63.2% and 31.6% respectively in the GTE group while only in 15.8% and 57.9% respectively in control group indicating a significant difference (p <0.001). The increase in the number of tablets led to higher improvement rate in response to GTE prescription. The mean hospital stay in GTE and control groups was also 1.66 ± 0.63 days and 3.36 ± 0.4 days indicated shorter hospitalization in former group (p < 0.001). The use of GTE leads to effectively improve the diarrhea as well as to reduce the hospital stay in children suffering viral gastroenteritis.

A novel metabolic disorder in the degradation pathway of endogenous methanol due to a mutation in the gene of alcohol dehydrogenase.

BACKGROUND: A small amount of methanol is produced endogenously in the human body but it is efficiently metabolized by alcohol dehydrogenase (ADH) and other enzymes, and the products eliminated without harm. In this study, we present a new entity of inborn error of methanol metabolism due to a mutation in the ADH1C gene coding for the γ subunit that is part of several ADH isoenzymes. RESULTS: This disorder was discovered in an 11.58-year-old boy. During one 9-month hospital admission, he had periods of 1-4 days during which he was comatose, and between these periods he was sometimes verbose and euphoric, and had ataxia, dysarthria. Following hemodialysis treatments, he became conscious and appeared healthy. Organ evaluations and his laboratory tests were normal. Toxicological evaluation of his blood showed a high methanol level [12.2 mg/dL (3.8 mmol/L), normal range up to 3.5 mg/dL (1.09 mmol/L) while the formaldehyde level was undetectable. The finding of liver function tests that were within normal limits, coupled with a normal eye examination and size of the liver, elevated blood methanol levels and an undetectable formaldehyde level, suggested ADH insufficiency. Adding zinc to the drug regimen 15 mg/daily dramatically reduced the patient's methanol level and alleviated the abnormal symptoms. When zinc supplementation was discontinued, the patient relapsed into a coma and hemodialysis was once again required. A homozygous mutation in ADH1C gene located at exon 3 was found, and both parents were heterozygous for this mutation. CONCLUSION: Accumulation of methanol due to mutation in ADH1C gene may result in drunkenness and ataxia, and leads to coma. This condition can be successfully treated with zinc supplementation as the cofactor of ADH.