THE ROLE OF THE CAROTID DOPPLER EXAMINATION IN THE EVALUATION OF ATHEROSCLEROTIC CHANGES IN BETA THALASSEMIA PATIENTS

Iron over- load in patients with beta-thalassemia major lead to alterations in the arterial structures and in the thickness of the carotid arteries. Doppler ultrasound scanning of extra-cranial internal carotid arteries is non-invasive and fairly quick to perform and may identify children at increased risk of stroke who would otherwise be missed. Increased carotid artery intima media thickness (cIMT) is a structural marker for early atherosclerosis and it correlates with the vascular risk factors and to the severity and extent of coronary artery disease. Objective: To evaluate the role of carotid Doppler examination and cIMT measurement as a predictive to atherosclerotic changes in  BTM children with iron overload.   Patients and Methods: Sixty two children with (BTM) and 30 healthy normal controls of matched age and sex were included. Complete blood count, serum iron, ferritin, serum cholesterol and hemoglobin electrophoresis were performed as well as carotid Doppler ultrasonography to measure the (cIMT) in both patients and controls. Results: By using carotid Doppler we found that cIMT of thalassemic patients was significantly increased compared to normal controls and there was significant positive correlation between CIMT and patient's age, weight, height, BMI, duration of illness, serum cholesterol, iron overload parameters as serum iron, serum ferritin, frequent blood transfusion, irregular use of iron chelating agents and in those who had splenectomy. Significant negative correlation was found between CIMT and hematocrit value but no significant correlation was found between CIMT and Hb level. Conclusion:  Carotid  Doppler is very useful method in measurement of cIMT that increased in thalassemic patients which  shows a strong relationship with features of iron overload. We recommend the routine use of Doppler measurement of cIMT in these patients to predict early atherosclerotic changes as well as in the follow-up to prevent progression of atherosclerosis

Assessment of peripheral blood lymphocyte subsets in children with iron deficiency anemia

Abstract Background Iron plays an important role in body defense and essential for normal immune system development where its deficiency may result in an inadequate immune response. We aimed to assess the lymphocyte subsets in childhood iron deficiency anemia (IDA) with their laboratory correlations. Methods Fifty IDA (< 18 years) and 25 age and sex-matched healthy children were enrolled and a complete history was obtained and clinical examination was performed. Complete blood count, serum iron, total iron binding capacity and serum ferritin, were performed. Flow cytometric determination of peripheral blood CD3+, CD4+, CD8+ T-lymphocytes and CD19+ B-lymphocytes and CD4/CD8 ratio were done. Results Patients had significantly lower hemoglobin, Serum iron, ferritin levels and higher lymphocytic count in patients compared with controls (p = 0.001, 0.03, 0.001, 0.001 respectively). CD3 count and percentage were significantly lower in IDA patients compared to controls (p = 0.007 and 0.005 respectively). There was a Significant reduction in the CD4 count, percentage and CD4/CD8 ratio in patients compared with controls (p = 0.001, 0.001 and 0.005 respectively) while there was no significant difference regarding CD8 count and percentage. No significant difference between the two studied groups regarding either CD19 count or percentage (p = 0.28 and 0.18 respectively) were found. Conclusions IDA is associated with impaired cell-mediated immune response specifically T-cell mediated immunity

Assessment of Subclinical Pancreatitis in Epileptic Children With Different Treatment Modalities

Acute pancreatitis differ in pediatrics and adults. Drug-induced pancreatitis is one of the common causes of pancreatitis in children. This case–control study aimed to assess subclinical pancreatitis in patients with epilepsy treated with different drug regimens. Eighty known patients with epilepsy were enrolled. Forty patients were treated with monotherapy (group I) and 40 were treated with multitherapy (group II) regimens. Twenty age- and sex-matched healthy children were enrolled as control (group III). Serum lipase and amylase were assayed in all included children. Significant differences were found between groups I and III and between groups II and III regarding serum amylase and lipase ( P < .001 for all). Significant difference were found between groups I and II ( P = .024) and between groups II and III ( P = .01) regarding pancreatic duct and body diameters. Significant difference were found between patients with controlled and uncontrolled fits regarding serum amylase ( P = .008). In conclusion, subclinical pancreatitis can complicate the treatment with different antiepileptic regimens

The utility of 64-multidetector computed tomography in the diagnosis and staging of hepatoblastoma patients

Objective: To assess the utility of 64 MDCT in the diagnosis, staging and follow-up of HB patients. Patients & methods: This study included 17 children, 9 males and 8 females with HB from multiple centers aged 6 months- 3 years. Patients were subjected to complete clinical examination and laboratory investigations at presentation and during follow-up. Patients were evaluated, staged and treated according to SIOPEL HB protocols for management. Imaging evaluation was conducted using abdominal U/S, bone scan and MDCT for chest and abdomen. Results: All patients were presented with abdominal mass and elevated AFP level, Jaundice seen in only 1 patient. On MDCT, 13 patients had single focal lesion, 2 patients had multiple foci and 2 patients showed diffuse disease. MDCT was more accurate than US in detecting site, multiplicity, density and lymph nodes (LNs). Regarding tumor staging, MDCT findings were confirmed surgically. In follow-up of patients MDCT was detected with accuracy residual or recurrent lesions in 3 cases. Conclusion: MDCT in children with HB accurately displayed the extent of hepatic involvement by tumor, tumor staging and its proximity to vascular structures that help the surgeon to identify the tumor resectability and can be used in follow-up

Egyptian Pediatric Guidelines for the Management of Children with Isolated Thrombocytopenia Using the Adapted ADAPTE Methodology—A Limited-Resource Country Perspective

Background: Thrombocytopenia is a prevalent presentation in childhood with a broad spectrum of etiologies, associated findings, and clinical outcomes. Establishing the cause of thrombocytopenia and its proper management have obvious clinical repercussions but may be challenging. This article provides an adaptation of the high-quality Clinical Practice Guidelines (CPGs) of pediatric thrombocytopenia management to suit Egypt’s health care context. Methods: The Adapted ADAPTE methodology was used to identify the high-quality CPGs published between 2010 and 2020. An expert panel screened, assessed and reviewed the CPGs and formulated the adapted consensus recommendations based on the best available evidence. Discussion: The final CPG document provides consensus recommendations and implementation tools on the management of isolated thrombocytopenia in children and adolescents in Egypt. There is a scarcity of evidence to support recommendations for various management protocols. In general, complete clinical assessment, full blood count, and expert analysis of the peripheral blood smear are indicated at initial diagnosis to confirm a bleeding disorder, exclude secondary causes of thrombocytopenia and choose the type of work up required. The International Society of Hemostasis and thrombosis–Bleeding assessment tool (ISTH-SCC BAT) could be used for initial screening of bleeding manifestations. The diagnosis of immune thrombocytopenic purpura (ITP) is based principally on the exclusion of other causes of isolated thrombocytopenia. Future research should report the outcome of this adapted guideline and include cost-analysis evaluations