Propranolol in Treatment of Huge and Complicated Infantile Hemangiomas in Egyptian Children

Background. Infantile hemangiomas (IHs) are the most common benign tumours of infancy. Propranolol has recently been reported to be a highly effective treatment for IHs. This study aimed to evaluate the efficacy and side effects of propranolol for treatment of complicated cases of IHs. Patients and Methods. This prospective clinical study included 30 children with huge or complicated IHs; their ages ranged from 2 months to 1 year. They were treated by oral propranolol. Treatment outcomes were clinically evaluated. Results. Superficial cutaneous hemangiomas began to respond to propranolol therapy within one to two weeks after the onset of treatment. The mean treatment period that was needed for the occurrence of complete resolution was 9.4 months. Treatment with propranolol was well tolerated and had few side effects. No rebound growth of the tumors was noted when propranolol dosing stopped except in one case. Conclusion. Propranolol is a promising treatment for IHs without obvious side effects. However, further studies with longer follow-up periods are needed

Role of 128 slice MSCT angiography in evaluation of congenital extra-cardiac intra-thoracic vascular anomalies in children

Purpose: To investigate the value and highlight the role of multi slice computed tomography (MSCT) angiography in evaluation of extra-cardiac intra thoracic vascular anomalies in children. Patients and methods: This study included 24 patients (13 males and 11 females) with an age range of 1 monthâ13 years. All of these patients were clinically diagnosed to have congenital heart disease with suspected extracardiac vascular anomalies. All underwent prospective ECG-gated MSCT angiography after trans-thoracic echocardiography (TTE). Iterative reconstruction techniques were applied to reduce the radiation dose in MSCT angiography with the mean radiation dose of (4 mSv). The diagnostic accuracy and sensitivity of MSCT angiography and TTE were compared in comparison with surgical outcome. Results: The most common congenital extra cardiac vascular anomalies are PDA (45.8%) and aortic coarctation (37.5%). The major CT angiographic findings missed by TTE were coronary artery anomalies, absence of a pulmonary artery and pulmonary artery stenosis. The overall sensitivity of the MSCT angiography in diagnosis of the extra-cardiac vascular anomalies was 98.1% which was higher than that of TTE 80%. Conclusion: CG gated MSCT angiography is an accurate modality for demonstrating extra cardiac structures in complex CHD. It provides important complementary information to TTE with regard to extra cardiac vascular structures and coronary artery anatomy. This modality may reduce the need for high radiation dose invasive diagnostic cardiac catheterization. Keywords: MSCT, TTE, Iterative reconstruction, CHD, Congenital extra cardiac vascular lesion

Nutritional Status in Children with un-operated Congenital Heart Diseases:An Egyptian Center Experience

Background: Malnutrition is a common cause of morbidity and mortality in children with congenital heart disease (CHD).This study aimed to identify prevalence and predictors of malnutrition in Egyptian children with symptomatic CHD.Methods: This case-control study included 100 children with symptomatic CHD (76 acyanotic and 24 cyanotic) and 100 age and sex-matched healthy children as a control group. Clinical Evaluation and Laboratory Assessment of Nutritional Status were done. Anthropometric measurements were recorded and Z scores for weight for age (WAZ), weight for height (WHZ) and height for age (HAZ) were calculated. Malnutrition was defined as weight, height and weight/ height z-score ≤ –2.Results: The overall prevalence of malnutrition was 84.0% in patients with CHD and 20% in controls. Severe malnutrition was diagnosed in 71.4% of cases. All anthropometric measurements and levels of biochemical markers of nutritional state were significantly lower in the patients group compared to controls. In patients with acyanotic CHD, stunting was proportionately higher (57.89%) than in cyanotic CHD, while wasting was predominant (45.83%) in the latter. Malnutrition correlated significantly with low hemoglobin level, low arterial oxygen saturation, heart failure, pulmonary hypertension and poor dietary history. Conclusion: Malnutrition is a very common problem in children with symptomatic CHD and predicted by the presence of low hemoglobin level, low arterial oxygen saturation, heart failure, poor dietary history and pulmonary hypertension

Low risk of recurrence following artesunate–Sulphadoxine–pyrimethamine plus primaquine for uncomplicated Plasmodium falciparum and Plasmodium vivax infections in the Republic of the Sudan

Abstract Background First-line schizontocidal treatment for uncomplicated malaria in the Republic of the Sudan is artesunate (total dose 12 mg/kg) plus Sulphadoxine/pyrimethamine (25/1.25 mg/kg) (AS/SP). Patients with Plasmodium vivax are also treated with 14 days primaquine (total dose 3.5 mg/kg) (PQ). The aim of this study was to assess the efficacy of the national policy. Methods Patients above 1 year, with microscopy-confirmed, Plasmodium falciparum and/or P. vivax malaria were treated with AS/SP. Patients with P. falciparum were randomized to no primaquine (Pf-noPQ) or a single 0.25 mg/kg dose of PQ (Pf-PQ1). Patients with P. vivax received 14 days unsupervised 3.5 mg/kg PQ (Pv-PQ14) on day 2 or at the end of follow up (Pv-noPQ). Primary endpoint was the risk of recurrent parasitaemia at day 42. G6PD activity was measured by spectrophotometry and the Accessbio Biosensor™. Results 231 patients with P. falciparum (74.8%), 77 (24.9%) with P. vivax and 1 (0.3%) patient with mixed infection were enrolled. The PCR corrected cumulative risk of recurrent parasitaemia on day 42 was 3.8% (95% CI 1.2–11.2%) in the Pf-noPQ arm compared to 0.9% (95% CI 0.1–6.0%) in the Pf-PQ1 arm; (HR = 0.25 [95% CI 0.03–2.38], p = 0.189). The corresponding risks of recurrence were 13.4% (95% CI 5.2–31.9%) in the Pv-noPQ arm and 5.3% (95% CI 1.3–19.4%) in the Pv-PQ14 arm (HR 0.36 [95% CI 0.1–2.0], p = 0.212). Two (0.9%) patients had G6PD enzyme activity below 10%, 19 (8.9%) patients below 60% of the adjusted male median. Correlation between spectrophotometry and Biosensor™ was low (rs = 0.330, p < 0.001). Conclusion AS/SP remains effective for the treatment of P. falciparum and P. vivax. The addition of PQ reduced the risk of recurrent P. falciparum and P. vivax by day 42, although this did not reach statistical significance. The version of the Biosensor™ assessed is not suitable for routine use. Trial registration https://clinicaltrials.gov/ct2/show/NCT0259240