Clinical epidemiology of non-alcoholic fatty liver disease in children and adolescents. The LiverKids: Study protocol.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is rapidly increasing alongside overweight and obesity, not only in adults but also in children and adolescents. It is unknown what impact the development of NAFLD in childhood may have in later life. The importance of early detection and treatment lies in its potential for progression to cirrhosis, liver cancer and liver-related death, as well as its associated extrahepatic comorbidities. Vibration-Controlled Transient Elastography (VCTE) with Controlled Attenuation Parameter (CAP) is an effective, non-invasive and safe diagnostic method to estimate the degree of fibrosis and steatosis in the liver, but little is known about its applicability in the paediatric population. AIMS: 1) To assess the prevalence of significant liver fibrosis (Liver Stiffness Measurement (LSM) ≥6.5 kPa) using VCTE, and that of non-alcoholic fatty liver disease (≥225 dB/m) using CAP in children and adolescents. 2) To determine the optimal cut-off points of the CAP to achieve maximum concordance with the Magnetic Resonance Imaging (MRI) findings in the diagnosis of mild, moderate and severe NAFLD in children and adolescents. METHODS: Cross-sectional population-based study which will include 2,866 subjects aged between 9 and 16 years. Participants will undergo: anamnesis, physical examination, blood extraction, VCTE, MRI and questionnaires on socio-demographic data, personal and family medical history and lifestyle assessment. APPLICABILITY AND RELEVANCE: The study aims to establish the foundations for the use of VCTE in children and adolescents in order to achieve early diagnosis of NAFLD. Moreover, it will serve to understand in further detail the disease and to identify the risk groups of children and adolescents who may be at risk of developing it. Ultimately, this will help determine to which subgroups of the population we need to target resources for prevention and early detection of this entity, as well as possible intervention for its treatment. TRIAL REGISTRATION: The LiverKids study is registered on Clinicaltrials.gov (NCT05526274).

Social, Academic, and Health Status Impact of Long COVID on Children and Young People: An Observational, Descriptive, and Longitudinal Cohort Study.

There is a lack of evidence of the health impacts due to long COVID among children and young people (CYP). The objective of this study is to determine the main clinical characteristics of long COVID in CYP and to investigate the academic, social, and health status impacts of long COVID in this population. An observational, descriptive, and longitudinal study on CYP who presented COVID-19 symptoms for more than twelve weeks after SARS-CoV-2 infection was performed between December 2020 and May 2021. Fifty CYP were included, with a median age of 14.1 years, 33 (66%) were female, and 17 (34%) had a relative diagnosed with long COVID. Since the initial infection and up to the first visit, CYP had persisting symptoms for a median of 4.1 months, and for 18 (36%) CYP these symptoms persisted for more than 6 months. Fatigue (100%), neurocognitive disorders (74%), muscular weakness (74%), and headache (72%) were the most reported symptoms. A total of 9 (18%) CYP could not attend school, 17 (34%) had a reduced schedule, 33 (66%) showed a decreased school performance, and 68% had stopped extracurricular activities. This preliminary study shows the impact that long COVID has on the health, academic, and social life of CYP.

Should Dientamoeba fragillis be looked for in pediatric digestive pathology of an unknown cause? A proposed pilot case-control study.

INTRODUCTION: Dientamoeba (D.) fragilis is a common intestinal protozoan with an unresolved clinical significance. The association between D. fragilis and the etiology of gastrointestinal symptoms in children is unclear. Metronidazole is often used for treatment. The aims of this study are to clarify the clinical relevance of D. fragilis in children with gastrointestinal symptoms, and to determine the clinical and microbiological efficacy of metronidazole in D. fragilis-infected children with gastrointestinal complaints. METHODS: A prospective case-control study was performed from October 2017 to February 2019. A total of 106 individuals aged 1-17 were included. Out of the 106; 59 showed gastrointestinal symptoms (case group), and 47 were without gastrointestinal symptoms (control group). We excluded 2 patients from the case group. D. fragilis was diagnosed by real-time PCR in stool samples. A 10-day course of oral Metronidazole was prescribed in D. fragilis positive children with GI symptoms. Clinical data before and after the treatment as well as peripheral eosinophilia in previous blood samples, were recorded. RESULTS: Of the 104 participants, D. fragilis was found in 17 (29.8%) children from the case group, whereas in the control group the parasite was detected in 11 patients (23.4%) with an odds ratio (OR) of 1.39 (IC 95% 0.53-3.75, p=0.46). The most prevalent clinical manifestation was abdominal pain (46/57, 80.7%). Seventeen cases with a positive PCR received anti-parasitic treatment according to the established protocol, although during the collection period we received only 11 stool samples to perform the post-treatment follow-up. The PCR of the D. fragilis remained positive in 3 patients (3/11, 27.27%). Despite achieving the eradication of the parasite, 4/8 patients (50%) continued with digestive symptoms. CONCLUSIONS: According to our study there were no differences between the D. fragilis infection in children with or without gastrointestinal symptoms. No relation was found between the clinical and microbiological responses after said D. fragilis treatment. Therefore, we conclude that it is not justified to look specifically for D fragilis in pediatric patients with abdominal symptoms.

Should Dientamoeba fragillis be looked for in pediatric digestive pathology of an unknown cause? A proposed pilot case–control study / Se debe investigar la infección por Dientamoeba fragilis en niños con enfermedad digestiva de causa desconocida? Estudio piloto caso-control

Introduction: Dientamoeba (D.) fragilis is a common intestinal protozoan with an unresolved clinical significance. The association between D. fragilis and the etiology of gastrointestinal symptoms in children is unclear. Metronidazole is often used for treatment. The aims of this study are to clarify the clinical relevance of D. fragilis in children with gastrointestinal symptoms, and to determine the clinical and microbiological efficacy of metronidazole in D. fragilis-infected children with gastrointestinal complaints. Methods: A prospective case–control study was performed from October 2017 to February 2019. A total of 106 individuals aged 1–17 were included. Out of the 106; 59 showed gastrointestinal symptoms (case group), and 47 were without gastrointestinal symptoms (control group). We excluded 2 patients from the case group. D. fragilis was diagnosed by real-time PCR in stool samples. A 10-day course of oral Metronidazole was prescribed in D. fragilis positive children with GI symptoms. Clinical data before and after the treatment as well as peripheral eosinophilia in previous blood samples, were recorded. Results: Of the 104 participants, D. fragilis was found in 17 (29.8%) children from the case group, whereas in the control group the parasite was detected in 11 patients (23.4%) with an odds ratio (OR) of 1.39 (IC 95% 0.53–3.75, p=0.46). The most prevalent clinical manifestation was abdominal pain (46/57, 80.7%). Seventeen cases with a positive PCR received anti-parasitic treatment according to the established protocol, although during the collection period we received only 11 stool samples to perform the post-treatment follow-up. The PCR of the D. fragilis remained positive in 3 patients (3/11, 27.27%). Despite achieving the eradication of the parasite, 4/8 patients (50%) continued with digestive symptoms.(AU)

Introducción: Dientamoeba (D.)fragilis es un protozoo intestinal muy común pero con una relevancia clínica incierta. El papel etiopatogénico de la D. fragilis en sintomatología gastro-intestinal no está claramente establecido. El metronidazol es con frecuencia el fármaco de elección. El objectivo de nuestro estudio fue determinar la relación entre D. fragilis y la presencia de clínica digestiva en población pediátrica así como valorar la eficacia del metronidazol en la resolución de los síntomas. Material y métodos: Estudio prospectivo caso-control realizado entre octubre 2017 y febrero 2019. Se incluyeron un total de 106 pacientes entre 1-17 años. 59 pacientes presentaban síntomas digestivos (grupo caso) y 47 pacientes asintomáticos (grupo control). Se excluyeron 2 pacientes del grupo caso. La presencia de D. fragilis se determinó por técnica de PCR real-time(PCR-RT) en muestra de heces. En los pacientes del grupo caso con PCR-RT positiva se realizó tratamiento con metronidazol durante 10 dias. Se recogieron datos clínicos antes y después del tratamiento asi como presencia de eosinofilia periférica. Resultados: De los 104 participantes, se detectó D. fragilis en el 17/59 (29,8%) en el grupo caso y en 11/47 pacientes del grupo control (23,4%) con una odds ratio (OR) de 1.39 (IC95% 0.53-3.75, p=0.46). El síntoma más frecuente fue el dolor abdominal (46/57, 80,7%). Los 17 pacientes del grupo caso recibieron metronidazol según protocolo y se realizó PCR-TR D. fragilis post-tratamiento en 11/17 pacientes. La PCR-RT persistió positiva en 3 pacientes (3/11, 27,27%). De los 8 pacientes que negativizaron PCR-RT, 4 (50%) continuaron con dolor abdominal. Conclusión: Según nuestro estudio no se encontró relación significativa entre la presencia de infección por D.fragillis y la existencia de sintomatología digestiva. Tampoco se observó mejoría clínica significativa en aquellos pacientes infectados que recibieron tratamiento.(AU)

Case report of a gallbladder agenesis, a diagnostic challenge.

INTRODUCTION AND IMPORTANCE: Agenesis of the gallbladder is an underdiagnosed entity. It can be an asymptomatic pathology, usually diagnosed incidentally as a finding on imaging techniques or in necropsies. There are symptomatic cases presenting as biliary colic too, attributed to cholecystitis or cholangitis, leading to exploratory surgeries. CASE PRESENTATION: We present a 14-year-old boy admitted to the outpatient Pediatric Gastroenterology Department with a history of daily abdominal pain for the past 2 months. Blood and fecal tests were normal. Coeliac disease, inflammatory intestinal diseases and Helicobacter pylori infection were ruled out. An abdominal US was informed of a hypodistensed gallbladder with no other findings. A CT scan was performed, which reported of an absent gallbladder. Upon these findings, a Magnetic Resonance Cholangiopancreatography (MRCP) was carried out, confirming the diagnosis of agenesis of the gallbladder. CLINICAL DISCUSSION: Its diagnosis still poses a challenge, as an absent gallbladder may not always be apparent by US, with the MRCP being the gold-standard test for examining the biliary tract. The prognosis is usually good, and the treatment of choice consists of antispasmodics when needed. There are few cases reported in literature, for this reason, our article discusses the most important aspects of agenesis of the gallbladder in order to suspect it, request the appropriate tests and saving unnecessary surgical interventions. CONCLUSION: Gallbladder agenesis is a rare entity that can lead to unnecessary diagnostic tests and interventions. The MRCP is the gold-standard test. Despite its benign nature, symptomatic treatment might be required in order to improve the patient's quality of life.

'Long COVID': Making The Invisible Visible.

After recovering from acute COVID-19 infection, a physician is stricken with the debilitating symptoms of long COVID.

Development and validation of a new simplified diagnostic scoring system for pediatric autoimmune hepatitis.

BACKGROUND: Children with autoimmune hepatitis (AIH) often exhibit particular features. Accordingly, seven pediatric-specific criteria have been proposed. AIM: To develop a prediction model based on them, transform it into a scoring system and study its accuracy. METHODS: A cohort of children under study for liver disease was consecutively selected. AIH diagnosis was based on classical criteria. Already proposed pediatric criteria were recorded. The best possible regression model was selected, and the beta coefficient of each criterion was translated into a whole number (points). Total scores were obtained following the points system and the best cut-off was calculated. Subsequently, accuracy of the diagnostic score was studied in the validation set. RESULTS: Among 212 included patients, 100 had AIH. The score included 5 criteria: autoantibodies (0-2 points), hypergammaglobulinemia, exclusion of viral hepatitis, exclusion of Wilson's disease (1 point each) and liver histology (3 points). In addition, a normal cholangiogram is mandatory. The validation set was formed of 70 patients (24 with AIH). In this subsample, a score of ≥6 renders a sensitivity/specificity of 95.8%/100%. The area under the receiver operating characteristic curve was 97.1%. CONCLUSION: Pediatric-specific criteria for the diagnosis of AIH can be reliably used as a scoring system.