Clinical Conditions In Children Research Articles

Central Sleep Apnea in Children-10 Years Experience at a Tertiary Sleep Laboratory.

Central sleep apnea (CSA) is a rare condition in children; however, it can cause significant morbidity if not diagnosed early. We aimed to increase the knowledge about CSA in children by describing the clinical characteristics of children diagnosed with CSA at our sleep center. We retrospectively reviewed 1263 polysomnographies (PSG) performed between 2012 and 2023 at our tertiary sleep center and evaluated the clinical characteristics of the patients with CSA. Underlying diseases, clinical symptoms, sleep parameters, and short-term management of the patients were recorded. Of the 1263 patients aged between 1 month and 18 years, 122 (9.65%) had CSA, with 54.9 % (n = 67) of them being female. Only 56.6% (n = 69) of the patients' parents had reported a symptom indicating sleep-disordered breathing. The most common underlying disease was genetic, including Down and Prader-Willi syndromes, followed by neurological diseases . Obstructive sleep apnea was detected in addition to CSA in 103 of the patients (84.4%). Bi-level positive airway pressure with a backup rate was the most common treatment modality. While CSA is a rare clinical condition in children, it occurs more commonly in those with an underlying disease. Awareness of the disease and timely referral of the patients for sleep studies are critical to prevent long-term sequelae.

Evaluation of Cella Media Index by Computed Tomography in Hydrocephalic Children in Tertiary Hospital of TelanganaA Retrospective Study

Introduction: Hydrocephalus is a common clinical condition in children with a mortality rate of 0-3%. Any obstruction in the flow of Cerebrospinal Fluid (CSF) in the ventricular system leads to its collection and accumulation in the brain causing its compression. Such ventricular enlargement can be studied by many linear and volumetric measurements out of which the Cella Media Index (CMI) is one. Computed Tomography (CT) scan is the safest non invasive investigation commonly used by radiologists to study the ventricular system. Aim: To evaluate CMI in hydrocephalic children by CT and also to compare with the control group, attending tertiary hospital in Telangana state. Materials and Methods: A retrospective study was conducted by obtaining CT Scans of 50 normal children and 50 hydrocephalic children within the age group of 0-12 years, from the Department of Radiology, Niloufer Hospital, Hyderabad, Telangana from November 2013 to August 2014. The CT scans were studied and analysed between August 2014 to November 2014. Maximum transverse inner diameter of the skull and maximum width of the cella media were measured and cella media index was calculated. The data was statistically analysed by using T test. One way Analysis of Variance (ANOVA) was used to check for differences in ventricular dimensions across age groups. Results: The mean age of the subjects was 2.9±3.0 years with 51 female and 49 male children. Mean of cella media index in cases (3.02±1.24, 95%CI 2.66-3.37) was less than in controls (11.9±2.87, 95%CI 11.1-12.7) with p-value<0.001. The mean cella media index of males (2.74±0.93, 95%CI 2.66-3.14) was less than in females (3.28±1.40, 95 %CI 2.88-3.37) with p-value=0.1. Among the hydrocephalic children there was no significant difference of mean of cella media index between males and females. The mean cella media index in children below three years (2.81±1.36, 95%CI 2.66-3.12) was less than in children above three years (3.43±0.87, 95%CI 3.09-3.37) with p-value=0.049. Among the hydrocephalic children there was significant difference of mean of cella media index between two age groups. Conclusion: The present study concluded that cella media index in hydrocephalic children was decreased in comparison with the control group.

A rare cause of intestinal obstruction in children trichobezoar: How to diagnose?

Trichobezoar is a rare clinical condition in children, which is caused by the accumulation of swallowed hair mass in the digestive tract. This condition is most common in young women with psychiatric histories who suffer from trichotillomania (TTM), where they have an irresistible urge to pull out their hair. Diagnosis and treatment of this pathology, which is already extremely rare, and its variable clinical presentations are challenging. The aim of this study was to increase awareness of trichobezoar in the differential diagnosis of signs of intestinal obstruction in children and to evaluate the diagnosis and management of this rare pathology. The clinical data of six patients who were treated for trichobezoars in the pediatric surgery department of our hospital between 2009 and 2022 were retrospectively analyzed. Six female patients were treated with the diagnosis of trichobezoar during this period. Patients were diagnosed with the help of anamnesis, physical examination, abdominal ultrasonography (USG), and finally, endoscopy. USG can predict the intestinal wall infiltration and the tail extended to the duodenum through pylorus in the series. All patients were evaluated with contrast-enhanced abdominal radiography. Five surgical interventions were performed in four of the cases. In a case who underwent surgery twice, the distal intestinal satellite bezoar was not noticed in the first operation. Two patients were diagnosed to have trichobezoar, but surgery was not required. These patients were younger and had early-onset TTM (before 10 years old). The patients were followed for an average of 10.8 years and no recurrence was detected. Trichobezoar is a rare cause of intestinal obstruction in children with fatal complications when diagnosed late. Failure to follow an algorithm for the management of the disease causes difficulties in the diagnosis and treatment. Especially in pa-tients with a known psychiatric history, whole abdominal USG and laparoscopy performed with awareness can prevent unnecessary examinations.

Cholestatic Hepatitis Secondary to Epstein–Barr Virus Infection in Children: Case Series and Review of the Literature

Abstract Objective Cholestatic hepatitis (CH) secondary to Epstein–Barr virus (EBV) infection is a rare clinical condition in children and adolescents, which was reported in 5% of patients. Herein, we aimed to present our pediatric cases of EBV-induced CH with a comprehensive review of previously reported patients. Methods Three cases of EBV-induced CH diagnosed in our department were included in the study. EBV diagnosis was established with positive viral capsid antigen immunoglobulin M and immunoglobulin G. A search of English literature on pediatric cases with EBV-induced CH was conducted on common search engines (PubMed and GoogleScholar). Results We report three novel cases (aged 6, 15, and 16 years) presented with infectious mononucleosis and jaundice. The physical examination revealed mild hepatomegaly in all of them. In our cases, a total of 21 pediatric patients with EBV-induced CH were reported until now (52.4% male), with a median age of 15 (1–18) years. Regarding all patients, the most common symptoms were fever (94.1%) and jaundice (84.6%). In laboratory results, aspartate aminotransferase [308 (62–2,148) IU/L], alanine aminotransferase [312 (79–899) IU/L], and γ-glutamyl transpeptidase [328.9 ± 198.6 IU/L] levels were elevated. Hyperbilirubinaemia was observed in all cases with a median direct bilirubin level of 3.9 (1.9–21.8) mg/dL. A thickened gallbladder wall was the most common (50%) finding in the abdominal ultrasonography of the cases. Most of the reported patients recovered under supportive treatment without any further morbidity. Conclusions Although EBV-induced CH is an atypical presentation for children, it should be considered in the differential diagnosis of cholestasis. Supportive therapies are the mainstay of treatment in most of these cases.

Campylobacter jejuni subdural hygroma infection in a 2-year old boy: case report and a brief literature review

BackgroundCampylobacter jejuni is a common cause of acute gastroenteritis, but central nervous system infections are rare manifestations of Campylobacter infection. Therefore, C. jejuni trauma-related subdural hygroma infection in children is poorly described in the literature.Case presentationWe described a 2-year old boy with lobar holoprosencephaly presenting with subdural hygroma following head trauma. C. jejuni infection was confirmed from a subdural hygroma sample by culture as well as by DNA sequencing of a broad range 16S rDNA PCR product. Cerebrospinal fluid from the ventriculoperitoneal shunt remained sterile. Combined neurosurgical and antimicrobial treatment led to complete recovery. Review of the literature showed that the most common manifestation of Campylobacter central nervous system infection is meningitis, mostly in neonates, and subdural hygroma infection was described for only one case.ConclusionsSubdural hygroma infection caused by C. jejuni is a rare clinical condition in children. Molecular methods represent an important tool for the detection of rare or unexpected pathogens. No standard recommendations for antimicrobial treatment of C. jejuni subdural space infection in children are available, but meropenem treatment combined with surgery seems to be an effective approach.

Clinical Usefulness of Serum Lactate Dehydrogenase Levels in Mycoplasma pneumoniae Pneumonia in Children.

To elucidate the clinical usefulness of lactate dehydrogenase (LDH) levels in children with Mycoplasma pneumoniae(MP) pneumonia and identify cut-off levels in various clinical conditions. The study was retrospectively performed in 145 children who were hospitalized with MP pneumonia. Laboratory findings, including LDH levels at admission and clinical features were retrospectively reviewed from patients' electronic medical records. The mean age of the study population was 5.9 y, and the mean value of LDH was 809.7 U/L. Poor response to treatment for MP pneumonia, respiratory virus coinfection, severe MP pneumonia, development of postinfectious bronchiolitis obliterans (PIBO) after MP pneumonia, pleural effusion, and oxygen need during illness were significantly associated with serum LDH levels. The cutoff levels of LDH for predicting poor response to treatment for MP pneumonia and respiratory virus coinfection were 1058 U/L [area under the curve (AUC), 0.729] and 803 U/L (AUC, 0.682), respectively. Those for pneumonic lesions involving at least one-third of the total lung volume, prediction of PIBO development, and extrapulmonary manifestations were 1098 U/L (AUC, 0.715), 676 U/L (AUC, 0.714), and 859 U/L (AUC, 0.710), respectively. The cutoff levels for pleural effusion during illness and for the prediction of oxygen need were 894 U/L (AUC, 0.699) and 1114 U/L (AUC, 0.771), respectively. LDHlevels areelevatedin diverse clinical conditions in children with MP pneumonia and may be useful in the identification of severe clinical courses of MP pneumonia in children.

The Pharmacological Treatment of Pediatric Vertigo.

Vertigo in children is a challenging topic. The lack of dedicated trials, guidelines and papers causes inhomogeneity in the treatment of vertigo in children. Meniere’s disease, migraine equivalents, vestibular neuritis, paroxysmal positional benign vertigo (BPPV), persistent postural-perceptual dizziness (PPPD) and motion sickness may affect children with various degrees of incidence and clinical severity compared to adults. Several drugs are proposed for the management of these conditions, even if their use is subordinated to the child’s age. In this review, we summarize the existing evidence related to the use of drugs for this clinical condition in children as a start point for new trials, stating the urgent need for international guidelines.

FREQUENCY AND ANTIBIOTIC SENSITIVITY OF MOST COMMON ORGANISMS CAUSING URINARY TRACT INFECTIONS IN CHILDREN

Background: Urinary tract infections (UTIs) are common and significant clinical condition in children. This study was conducted to determine the frequency of most common organisms causing urinary tract infections (UTI) and their sensitivity to various antibiotics in children admitted in a tertiary care health facility. Methods: In this retrospective study, 225 patients of both genders, aged 1–15 years and diagnosed as a case of UTI of any duration were included. Relevant data was collected from hospital electronic patients’ record section. The data was analysed using SPSS-16. Results: There were 38% male and 62% female patients in the study. Mean age of the patients was 6±1.26 years. Mean duration of symptoms was 3±2.21 days. Escherichia coli was found in 45%, Klebsiella pneumoniae in 20%, Staphylococcus aureus in 18%, Pseudomonas aeruginosa in 11%, Proteus mirabilis in 3%, and Enterococcus in 3% of patients. All organisms were sensitive to most of the commonly used antimicrobial agents. Conclusion: The most common organism causing UTIs in our setup was Escherichia coli, followed by Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa and Proteus mirabilis, and these pathogens were sensitive to Ceftriaxone, Amikacin, Tetracycline, Ciprofloxacin, Augmentin, Ceftazidime and Nitrofurantoin. Resistance to these antibioticd was low in our setup. Pak J Physiol 2022;18(1):29?31

Il modello di gestione del bambino sovrappeso e obeso in Regione Emilia-Romagna: primi risultati

Child and adolescent obesity is a complex, multifactorial but also largely preventable disease; as a consequence its management needs a multilevel and integrated approach to be successful. This article describes the Preventive Diagnostic Therapeutic Assistance Pathways (PPDTA) for children with overweight and obesity delivered by trained multidisciplinary teams in the Emilia-Romagna Region. The regional “Guidelines for early detection, assessment and treatment of childhood obesity” were launched in 2013 (DGR 783/2013) and in 2017 WHO/Europe mentioned them as good practice and Country example. Training in childhood obesity prevention and management was delivered for all the primary care paediatricians (PCPs) and the members of the multidisciplinary teams. The PPDTA is based on three progressive levels: Level 1: PCPs. Level 2: a multidisciplinary team consisting of paediatricians, sports medicine doctors, exercise specialists, dieticians and psychologists experienced in paediatric obesity defines the clinical condition of children referred by the PCPs and runs the lifestyle change multi-component interventions. Level 3: is carried out by specialized clinicians in the hospital setting on a multidisciplinary basis for children with more severe and complicated obesity. In case of therapeutic failure, the PCP refers the child to the second-level multidisciplinary team. The second-level assessment and intervention are conducted at public health departments or at public health centres. During treatment, each team member uses the same tools, such as motivational interviewing for encouraging behaviour change. A standard evaluation framework is in place to assess the quality and effectiveness of the weight multidisciplinary management services, with three types of regional evaluation indicators: anthropometrics, lifestyle changes (eating habits, sedentary and physical activity) and equity. An improvement in weight status was observed in both children and adolescents with overweight and obesity. Interventions targeting at specific behaviours, such as increasing fruit and vegetable intake, habitually eating a balanced breakfast and reducing sedentary behaviour have been found effective as well.

Modern approaches to the diagnostics and treatment of the consequences of traumatic brain injury in children and adolescents

The article is devoted to an important problem of modern pediatric neurology and rehabilitation, - the issues of diagnosis and comprehensive restorative treatment of the consequences of traumatic brain injury (TBI) in children and adolescents. It is known that TBI is characterized by a high frequency of disability, while asthenic, vegetative, cognitive, emotional, motor and postural disorders are leading in the clinical picture. It is shown that the factors influencing the severity of the consequences of TBI in children are not only the severity of the injury itself, but also the age at which the injury occurred, as well as the localization of the lesion. The article describes modern methods of complex diagnosis and rehabilitation of the consequences of TBI in children, as well as pathogenetically justified approaches to drug therapy, while showing the high effectiveness of the drug choline alfoscerate (Cereton) in restoring cognitive functions and improving the clinical condition in children with the consequences of TBI, according to the results of a double-blind placebo-controlled multicenter randomized trial.

Exercise tolerance in school-age children with hypertension based on body weight

Hypertension and obesity are important problems among adolescents. In clinical practice, these diseases are often combined and worsen the quality of life, so the study on indicators of tolerance to exercise is of great scientific and practical importance. The aim. To determine the state of tolerance to physical activity among school-age children with stable hypertension depending on body weight. Materials and methods. The study involved 95 children aged from 9 to 18 years who were divided into four groups: the first – 18 patients with normal blood pressure and body weight; the second – 39 with stable hypertension and normal body weight; the third – 20 with normal blood pressure and obesity; the fourth – 18 children with stable hypertension and obesity. Exercise tolerance was examined during cycling ergometry according to the PWC 170 protocol; the maximum myocardial oxygen uptake index – VO2peak (the “gold standard” for determining tolerance) was evaluated. Results. According to the study results, among children with a combination of primary hypertension and obesity, the clinical picture of the condition is characterized by significantly more frequent complaints of dizziness, heart pain, headache and loss of consciousness. The total score of complaints was 5.8 ± 1.9 points in the combined pathology of primary hypertension and obesity group, which is significantly higher (P < 0.01) than that among children with primary hypertension or obesity. In primary hypertension and obesity, there is a decrease in VO2peak, which is most pronounced in the combination of these conditions (up to 26.4 ± 6.7 ml/min/kg among boys and up to 22.7 ± 3.6 ml/min/kg among girls) indicating a significant decrease in exercise tolerance. Conclusions. It has been proven that the combined pathology of primary arterial hypertension and obesity among adolescents greatly worsens the clinical condition of children and significantly reduces exercise tolerance more pronounced than in primary arterial hypertension or obesity.

A Data Science Approach to Analyze the Association of Socioeconomic and Environmental Conditions With Disparities in Pediatric Surgery.

Background: Scientific evidence confirm that significant racial disparities exist in healthcare, including surgery outcomes. However, the causal pathway underlying disparities at preoperative physical condition of children is not well-understood.Objectives: This research aims to uncover the role of socioeconomic and environmental factors in racial disparities at the preoperative physical condition of children through multidimensional integration of several data sources at the patient and population level.Methods: After the data integration process an unsupervised k-means algorithm on neighborhood quality metrics was developed to split 29 zip-codes from Memphis, TN into good and poor-quality neighborhoods.Results: An unadjusted comparison of African Americans and white children showed that the prevalence of poor preoperative condition is significantly higher among African Americans compared to whites. No statistically significant difference in surgery outcome was present when adjusted by surgical severity and neighborhood quality.Conclusions: The socioenvironmental factors affect the preoperative clinical condition of children and their surgical outcomes.

Markers of bone metabolism in children with rickets

The problem of rickets remains relevant due to the widespread prevalence of the disease and unsatisfactory results of diagnosis and treatment. Objective. To identify changes in the biochemical parameters of bone metabolism and to establish their relationship with the clinical condition of children with rickets. Materials and methods . The authors conducted a simultaneous controlled clinical comparative study of 108 children aged from 5 months to 2 years. C-terminal telopeptide of type I collagen (CrossLaps), calcitriol, calcitonin, osteocalcin, and blood osteoprote-gerin were analyzed by the enzyme-linked immunosorbent assay method. The level of calcium was determined by colorimetric method, phosphorus — by photometric test. Alkaline phosphatase activity was evaluated in blood serum by an optimized kinetic method. Results . We determined a decrease in the level of serum calcitriol, calcitonin, calcium and phosphorus, as well as an increase in the concentration of the C-terminal telopeptide of type I collagen, osteocalcin, parathyroid hormone, osteoprotegerin, acid and alkaline phosphatase activity. The greatest increase in the level of osteoprotegerin was recorded in children with the II degree of rickets, both in acute and subacute course. The concentration of osteocalcin was increased in all groups of patients with the highest values in patients with the II degree of rickets, regardless of the course of the disease. The activity of acid phosphatase in the blood of patients was also increased. A decrease in the concentration of calcitriol, calcitonin, calcium and phosphorus in the blood was observed in all groups of children with rickets. Conclusion. The authors recorded the correlations between the studied indicators of bone metabolism in patients with rickets. An increase in the level of osteoprotegerin is apparently a new link in the pathogenesis of rickets.

Depression, anxiety and quality of life impairment in parents of children with functional lower urinary tract dysfunction

Lower urinary tract dysfunction (LUTD) is a common clinical condition in children, frequently associated with emotional issues both among the patients and their families. The objective of the present study was to measure depressive and anxious symptoms and quality of life (QoL) in parents of LUTD patients. This cross-sectional study applied Beck Depression and Anxiety Inventories and WHOQOL-Bref to 88 caregivers of children with LUTD followed at a tertiary care center. The prevalence of mental disorders in children and adolescents was assessed using the Child Behavior Check List (CBCL 6-18) answered by their caregivers. The association of clinical features and emotional aspects related to the caregivers' quality of life was evaluated through non-parametric correlation (Spearman) and multiple linear regression analysis. Most of the caregivers were mothers (88%), with a mean age of 41.5 (SD 8.7 years), 67% of them married or in a stable union, and 38% had not completed elementary school. Considering 19 as the cutoff point for the Beck scale, 44% of the sample had a clinical score for depressive symptoms and 43% for anxious symptoms. According to the parents' report, 56% of children with LUTD had a clinical score for behavioral problems in CBCL. Parents' QoL was impaired, and the predictors of poor QoL were the age of the patients and presence of depressive/anxious symptoms in caregivers. Parents' depression/anxiety symptoms and poor QoL significantly correlated with behavioral problems in their children. The CBCL total problems score correlated both to depression (r=0.38, p<0.01) and to anxiety in parents (r=0.49, p<0.01) (Figure). These findings indicate a possible emotional impact of LUTD in patients' caregivers. Our study suggests that an approach to the family of LUTD patients' may be an important therapeutic resource for an effective clinical control of this condition.

Adaptation of cognitive behaviour therapy in childhood obsessive-compulsive disorder: a case study

Cognitive behaviour therapy (CBT) has been proved to be one of the most well-researched and effective therapy. It has been found effective in many clinical conditions in children and adolescents as well. Application of therapeutic processes gets complicated by the facts that childhood and adolescent problems do not come in neat packages and tend to overlap and/or coexist. For instance, there is much overlap among clinical problems like anxiety, depression, behavioural problems, and between reading and writing difficulties, and attention and hyperactivity. Many behavioural and emotional disturbances in children are also associated with specific medical conditions. The relationship between physical and/or medical conditions and emotional and behavioural disorders in children and adolescent has been documented in various studies. This demands attention to the therapeutic intervention to the childhood problems with greater monitoring and modulation. Use of CBT in childhood and adolescent problems for efficiency and convenience may be grouped into externalising and internalising disorders, and the management techniques may be formulated and tailored to meet the two opposing dimensions. In this case study, index client was an eight years old girl who presented with compulsive behaviour along with anxiety and fear, and the application of CBT techniques, its adaptability and efficacy in this case of obsessive-compulsive disorder (OCD), with specific phobia would be discussed.

Factors associated with abnormal cerebral blood flow in Egyptian children with sickle cell disease

Background: Transcranial Doppler (TCD) is a well-established tool for cerebrovascular assessment. Estimating the flow velocity across the intracranial arteries helps to identify children with sickle cell anaemia who are at risk for stroke. Objective: Our aim is to correlate TCD findings with clinical condition in children with sickle cell disease (SCD) to determine the value of TCD assessment as a predictive tool for stroke in SCD and to identify any association of TCD findings with disease severity, transfusion therapy and treatment administered. Methods: Eighty-five paediatric SCD patients aged from 3 years to 18 years of both genders who were followed up at the Hematology Clinic of New Children’s Hospital at Cairo University were included in this cross-sectional observational study. All our participants underwent routine laboratory investigations and TCD assessments. Results: Oof the 85 patients, two patients (2.3%) died before completing the TCD study and eventually 83 patients were included in the analysis. Seventeen (20.5%) patients had abnormal TCD findings, seven (8.4%) patients showed high-risk findings and 10 (12.1%) patients had conditional flow pattern. Logistic linear regression analysis confirmed that annual frequency of blood transfusion and hydroxyurea (HU) dose were associated with a decreased risk of abnormal TCD findings. Conclusion: The current study demonstrates that our TCD data reproduce the findings of other studies and that it is very likely the results from large trials are applicable for Egyptian children. The annual frequency of blood transfusion and HU dose were associated with a decreased frequency of abnormal TCD findings.

Prevalence estimates of neurodevelopmental disorders in Japan: A community sample questionnaire study.

Prevalence estimates of neurodevelopmental disorders have been calculated by questionnaire surveys scored by a single rater, which introduces inherent rater biases. The present study aimed to estimate the prevalence and comorbidity rates of four neurodevelopmental disorders based on both parent and teacher rating scales. We performed a community sample survey recruiting 3852 children aged 6 to 9 years. Parents and teachers evaluated clinical conditions in children using questionnaire-style scales. These scales with cut-off values were used to estimate the prevalence and comorbidity rates of attention deficit hyperactive disorder, autism spectrum disorder, specific learning disorder (or developmental dyslexia), and developmental coordination disorder. The prevalence estimates were separately confirmed according to the raters. Some estimates were higher than those in previous studies conducted in other countries. We also found a large disagreement between the parent and teacher rating scores. Moreover, the degree of agreement between two raters varied depending on the severity of the child's clinical condition. These estimates are the first findings based on evaluating children by two different raters. The prevalence and comorbidity estimates are informative for researchers and clinicians of pediatric neurology. The disagreements between two different raters raise questions about previous estimates of neurodevelopmental disorders.

PSYCHIATRIC NONADHERENCE: SOLVING THE DILEMMA

Attendees will have a better appreciation of the reasons for psychiatric nonadherence along a variety of clinical conditions in children and adolescents.

Clinical Audit on Management of Hematemesis in Children Admitted to Pediatric Gastroenterology and Hepatology Unit of Assiut University Children Hospital

AbstractBackground: Hematemesis is an uncommon but potentially serious and life-threatening clinical condition in children. It indicates that the bleeding origin is above the Treitz angle, i.e., that it constitutes an Upper Gastrointestinal Bleeding (UGIB).Aim of Study: To assess for how much the adopted proto-cols of management of children with upper gastrointestinal bleeding were applied at Gastroenterology & Hepatology Unit of Assiut University Children Hospital.Patients and Methods: This study is a an audit on man-agement of children with upper gastrointestinal bleeding admitted to pediatric Gastroenterology and Hepatology Unit, Assiut University Children Hospital during the period from the 1st of March 2016 to the 28th of February 2017 and it included 80 children with hematemesis.Results: Detailed history intake was recorded in most cases except history of drug intake which was not recorded in 30% of cases, history of epigastric pain and food pain relationship were not recorded in 38.7% of cases. Data of examination were recorded in 100% of cases. Basic and mandatory investigations in diagnosis of hematemesis were done in 100% of cases except coagulation profile and liver function tests and upper endoscopy. The standard treatment of hematemesis has been applied in most treatment lines except admission to the Intensive Care Unit. Also intravenous vitamin K was not given to all patients.Conclusion: The international guidelines for the manage-ment of hematemesis have been followed by the Gastroenter-ology and Hepatology Unit of Assiut University Children Hospital in most treatment lineswith some defaults due to poor resources and lack of medication.

Prognosis and Early Prediction of Acute Kidney Injury in Critically Ill Children

Background: Acute kidney injury (AKI) is a serious clinical condition in children admitting to the pediatric intensive care unit. Beside having the risk of significant morbidity and mortality, AKI has also increased the risk for chronic kidney disease. However, there is paucity of data regarding AKI epidemiology in children. Herein, we aimed to describe the incidence, risk factors, and outcome of AKI in critically ill children. Methods: The records of patients, who were hospitalized in our pediatric intensive care unit between October 2016 and March 2018 were investigated retrospectively. The relationship between AKI and the need of invasive mechanical ventilation and non-invasive mechanical ventilation, inotropic and nephrotoxic drug use, initial laboratory findings, continuous renal replacement need, pediatric risk of mortality-III score (PRISM-III), duration of hospitalization, and mortality rate were investigated. Results: Totally, 447 patients were found to have been included in the study. The AKI developed in 111 patients. The sepsis was the most common underlying disease with 27 patients (24.3 %). There was a statistical significance between development of AKI and the need of invasive mechanical ventilation, inotropic and nephrotoxic drug use, PRISM-III score, continuous renal replacement need, plasma exchange, blood component transfusion, duration of hospitalization, and mortality. Conclusions: The AKI is associated with prolonged hospitalization and increased mortality. AKI should be considered as a medical emergency that should be diagnosed and managed accurately.