Large Volume Paracentesis in Patients with Liver Cirrhosis Temporarily Diminishes Blood Cell Count

Background: Large-volume paracentesis is the preferred treatment for patients with severe and refractory ascites. Several complications were reported during therapeutical paracentesis. However, there are very few published studies on the change in blood cell count after paracentesis. This study aimed to evaluate any changes in blood cell counts after ascites fluid drainage. Methods: This study was conducted on patients with severe ascites and chronic liver disease who underwent large-volume paracentesis at Namazi Hospital, in Shiraz, Iran, between March 2021 and February 2022. A data gathering form containing the patient’s medical history, cause of cirrhosis, ascites fluid volume, as well as routine tests including primarily sodium, potassium, and basal creatinine, was filled out. Before and after the surgery, the total blood cell count was measured. Before the procedure, adjustment was made in the case of coagulopathy and albumin deficiency. The effect of factors such as the volume of drained fluid, splenomegaly, antibiotics, and steroid use was assessed on the changes in the number of blood cells. Using the JAMOVI 2.3.9 software, a paired t test and multiple regression were applied for statistical analysis (P0.001).Conclusion: The findings of the present study showed that children with tense ascites who had large-volume paracentesis might experience a sharp drop in blood cell count after the procedure, which was a transient physiological condition

An evaluation of ascitic calprotectin for diagnosis of ascitic fluid infection in children with cirrhosis

The most common infection in children with the hepatic disease with or without cirrhotic ascites is spontaneous bacterial peritonitis (SBP), which occurs in the absence of an evident intra-abdominal source of infection. The present study aims to assess the value of calprotectin in ascitic fluid in the diagnosis of ascitic fluid infection in children with liver cirrhosis. Materials and methods In this cross-section study, 80 children with underlying liver disease who attended the Hepatology and Emergency Department in Shiraz University Hospitals were studied. All the patients were evaluated by a thorough history, clinical examination, laboratory investigations, diagnostic paracentesis with PMNLs count, and Calprotectin, which was measured in 1 mL ascitic fluid by ELISA. Results Thirty-five patients (43.75%) were diagnosed with ascitic fluid infection. Of these children 6 cases had positive ascitic fluid culture (SBP). Calprotectin was high in AFI patients with a statistically significant difference in AFI patients compared to non-AFI patients. The cut-off levels were 91.55 mg /L and the area under the curve was 0.971. So it can serve as a sensitive and specific diagnostic test for detection of AFI in children with underlying liver disease. Conclusion Elevated ascitic calprotectin levels in cirrhotic patients are a diagnostic and reliable marker for the detection of AFI and are considered a surrogate marker for PMN

ASSOCIATION OF POTENTIAL CELIAC DISEASE AND REFRACTORY IRON DEFICIENCY ANEMIA IN CHILDREN AND ADOLESCENTS

ABSTRACT BACKGROUND: Celiac disease is an enteropathy caused by dietary gluten. The combination of serologic, genetic and histologic data has led to description of other categories of this disease. OBJECTIVE: There are a number of patients with iron deficiency anemia (IDA) that do not respond to iron treatment and may be repeated for many times, Therefore, we aimed to investigate celiac disease in this group. METHODS: In this cross sectional transverse prospective study from August 2011 to February 2013, in a Pediatric care clinic affiliated to Shiraz University of Medical Sciences, 184 children including 92 IDA patients who responded to treatment using iron supplement, 45 non-responding iron deficient patients, and 47 healthy individuals, with the maximum age of 18 years, with written consent from their parents, participated in serologic screening (with Anti-TTG antibody and anti-Endomysial antibody) for celiac disease. Patients with at least one positive serology test underwent multiple mucosal biopsy from bulb and duodenum. RESULTS: Among 184 participants, 19 (10.3%) subjects had positive serologic test for celiac disease, including 13 (28.9%) patients in the group with refractory IDA, 5 (5.4%) patients in the group with treated IDA, and 1 patient in the healthy group. The frequency of positive serologic test in the group with IDA resistant to treatment was prominently higher than the other two groups (P<0.001). Among the patients with positive serologic celiac test who underwent endoscopy and biopsy, no histologic evidence of celiac disease was seen. They were diagnosed as potential celiac disease. CONCLUSION: Frequency of potential celiac disease in patients with refractory IDA was higher than control the subjects. Therefore, we recommend serologic screening for early detection and minimizing the complications of celiac disease and repeated iron therapy for this group

Neurological Crises after Discontinuation of Nitisinone (NTBC) Treatment in 3 Cases of Tyrosinemia

Tyrosinemia Type 1 is a hereditary disorder with liver, kidney and nervous system involvement. We report 3 children developed diaphragmatic paralysis requiring mechanical ventilation after discontinuation of NTBC treatment. In patients with Tyrosinemia type 1, combined treatment with NTBC and a low-tyrosine diet have prevented neurological crises. Treatment with NTBC in the first months of life protects against hepatic and neurologic complications. Neurological crises can occur in tyrosinemia without treatment and also occur when treatment stops. We report three patients that developed diaphragmatic paralysis after interruption of NTBC treatment, which finally required mechanical ventilation. It should be emphasized that discontinuation of NTBC can induce diaphragmatic paralysis and respiratory failure. So we should advise patients to use NTBC for long term and not interrupted it

Clinical characteristics of pediatric patients with inborn errors of metabolism admitted to Nemazi hospital, a tertiary referral center in Shiraz, southern Iran

AbstractBackground: Inborn errors of metabolism (IEM) are rare genetic disorders that usually cause the disease by blocking a metabolic pathway. Delayed diagnosis is usually due to nonspecific manifestations. In this study, we aim to evaluate the demographic and clinical characteristics of pediatric patients with IEM admitted in Nemazi hospital, a referral center in southern Iran.Methods: All 1-month- to 18-year-old patients who were admitted in the pediatric ward in Nemazi hospital, a referral center in southern Iran, with the diagnosis of IEM were enrolled. Patients with incomplete information were excluded. We collect demographic and clinical data including age, sex, parents’ consanguinity, family history of IEM, presenting symptoms, number of hospitalization, age of onset, and diagnosis of the disease. All the data were entered into SPSS ver.22 and analyzed.Results: 200 patients were enrolled in the study. 53.5% were male and 46.5% female. The most clinical symptoms were lethargy and vomiting. The most prevalent IEM were aminoacidopathies, organic acidemia, and mitochondrial disease. Consanguinity was seen in 57.5% of them, while the family history of metabolic diseases was observed in 16.5%. There was a statistically significant relationship between consanguinity and the type of the disease.Conclusion: The clinical symptoms of IEM are nonspecific and may be misdiagnosed as other diseases like septicemia. We should always keep IEM in mind to detect the disease earlier and prevent significant morbidities and mortality by appropriate timely treatment. Due to the prevalence of consanguinity marriage in Iran, we should also consider metabolic screening