Open Access Case Report

Permanent Junctional Reciprocating Tachycardia in Infants from Myocarditis-like Presentation to Simple Tachycardia: A Case Series

Mohmmed A. Mohmmedahmed, Bashir A. Yousef, Abdullah B. Alshehri, Elhoury M. Eltayeb

Asian Journal of Pediatric Research, Page 1-9
DOI: 10.9734/ajpr/2022/v10i3195

Permanent Junctional Reciprocating Tachycardia (PJRT) is a rare type of supraventricular tachycardia. It can be misdiagnosed and hence under-treated in infants and children, leading to significant cardiac morbidities and mortalities. We describe four cases of young infants who presented with a wide range of clinical scenarios from neonatal tachycardia to overtly decompensated heart failure, all caused by PJRT. All cases showed complete recovery with appropriate medical treatment. In this case series, we aim to discuss the diversity of clinical presentations, and the challenges surrounding the diagnosis, management, and prognosis. To achieve this aim, we have also performed a detailed literature review and reflected on our cases presented to our center between 2016 to 2020. PJRT is rare; it is often missed or diagnosed late in the presentation. Hence, the key is to keep it in mind in infants presenting with acute cardiac problems from simple tachycardia to a myocarditis-like presentation. Anti-arrhythmic medications are safe and effective as first-line therapy for PJRT in neonates and infants. They can prevent or delay the need for invasive cardiac ablation, which is more challenging in these age groups and should be considered in cases refractory to medical treatment.

Open Access Case Study

The Nutcracker Syndrome: Rare Cause of Pediatric Abdominal Pain

J. Elmahi, S. Amhager, Y. Kriouel

Asian Journal of Pediatric Research, Page 10-12
DOI: 10.9734/ajpr/2022/v10i3196

Nutcracker syndrome results from compression of the left renal vein (LRV), usually in the fork formed by the abdominal aorta and the superior mesenteric artery (SMA), leading to stenosis of the aorto-mesenteric part of the left renal vein and dilation of its distal part. We report the case of a 10-year-old child, with no family history of renal disease, diabetes or hematuria. He was admitted to our clinic for paroxysmal abdominal pain in the epigastric area that was not improved by the usual analgesics, associated with vomiting without transit disorders or hematuria, and had been evolving for 10 days prior to his admission. The clinical examination was normal, the normal biological check-up, the abdominal CT scan was in favor of the Nutcracker syndrome. The treatment was symptomatic with a good evolution.

Nutcracker syndrome is a rare entity, to be evoked in the diagnostic range of rare etiologies of unexplained abdominal pain.

Open Access Original Research Article

Blood Ammonia Concentration in Children with Chronic Liver Disease: A Tool for Prediction of Esophageal Varices

Mohuya Mondal, Md. Rukunuzzaman, Khan Lamia Nahid, Luthfun Nahar, Kamrun Nahar, Parisa Marjan, Subarna Rani Das, Binoy Krishna Golder

Asian Journal of Pediatric Research, Page 21-30
DOI: 10.9734/ajpr/2022/v10i3198

Background: Esophageal varices (EVs) are a serious complication of portal hypertension in patient with chronic liver disease (CLD). The major portion of ammonia carried by portal blood is shunted into systemic circulation in chronic liver disease. The upper GI endoscopy is currently the best reliable method to diagnose the presence of esophageal varices. But it is invasive, relatively expensive and not easily available. Blood ammonia is a noninvasive and easily accessible laboratory parameter that can predict the presence of esophageal varices.

Objectives: To observe the blood ammonia concentration in children with chronic liver disease: a tool for prediction of esophageal varices.

Methods: This cross sectional observational study was conducted at the Department of Paediatric Gastroenterology and Nutrition, BSMMU, Dhaka, Bangladesh from January 2018 to December 2019.  A total of 63 cases of CLD were selected. Study sample were selected according to the inclusion and exclusion criteria. Along with proper clinical history, examination & initial investigation, fasting venous blood ammonia level and upper GI endoscopy were done in all patients. Receiver-Operator Characteristic (ROC) curve was analysis to set up a cut-off value of blood ammonia for prediction of esophageal varices. Sensivity, specificity, positive predictive value, negative predictive value and accuracy were determined to see the performance of blood ammonia value as a diagnostic test for esophageal varices.

Results: Among the 63 patients, (74.6%) had esophageal varices. Wilson disease was the most common etiology of CLD (43; 68.3%) among the studied patients. The mean blood ammonia level were 40.5± 18.0 (µmol/L), 50.5± 14.3 (µmol/L), 50.7± 9.9 (µmol/L), 53.1± 26.9 (µmol/L) and 71.9± 19.0 (µmol/L) in absent esophageal varices, grade-I, grade-II, grade-III and grade-IV esophageal varices respectively. The difference was statistically significant (<0.05). Moderate correlation (r= 0.452; p value = 0.001) between blood ammonia level and grades of esophageal varices was found.  It was observed that wasting of thenar and hypothenar muscle was the most common stigmata, seen in 15 (23.8%) cases, 2 (3.2%) had clubbing, 7 (11.1%) had leuconychia, 1 (1.6%) had palmer erythema, 3 (4.8%) had gynacomasia and 1 (1.6%) had testicular atrophy. Wilson disease was the most common 43 (68.3%). It was observed that 45 (71.4 %) patients had raised serum ALT and 45 (71.4%) had low serum albumin (<3.5 g/dl). Low haemoglobin (<9 gm/dl) was found in 47 (74.6%) cases, raised serum bilirubin level (>1.2 mg/dl) in 29 (46.03%) cases, thrombocytopenia (platelet count <1.50×109/mm3) in 36 (57.1%) patients and prolonged INR (>1.5) in 29 (46.03%) cases, blood ammonia was raised (>32 µmol/L) in 52 (82.5%) cases. It was observed that the mean ± SD blood ammonia level was 56.2± 17.9 µmol/L in   esophageal varices present group (n = 47) and 40.5± 18.0 µmol/L in absent esophageal varices group (n = 16). Here p value is 0.004, which is statistically significant.

Conclusion: Blood ammonia concentration is a biochemical predictor for assessing the grading of esophageal varices. In the present study, a moderate positive correlation was found between blood ammonia concentration and grades of esophageal varices in children with CLD.

Open Access Original Research Article

A Study of Plasma Homocysteine Level in Children with Autism

Shahenda Bdair Al-Beltagy, Hesham Ahmed El-Serogy, Sahar Abd ElAzim Abd Elaziz, Tarek Mohammed Al-Gohary

Asian Journal of Pediatric Research, Page 31-37
DOI: 10.9734/ajpr/2022/v10i3199

Background: Autism is a neurodevelopmental disorder that appears in early life. B6 and B12, and folate support homocysteine (Hcy) metabolism. Hence, any defect to them leads to Hcy accumulation in the body. Hcy, vitamins B12, B6 and folate are important in psychiatric disorders such dementia, schizophrenia, and autism. This study intended to compare the plasma Hcy levels in normal and autistic cases to find out whether there is difference between the levels of Hcy in plasma of autistic and normal children.

Methods: This case control study enrolled 60 children who were allocated in two groups 30 with autism and other 30 as controls. All patients were exposed to full history taking, physical examination, mental status examination, hearing test, routine lab investigations and specific lab investigations (serum folic acid, plasma vitamin B12 and Hcy level).

Results: Childhood Autism Rating Scale (CARS) level among autistic children was 49.400 ± 5.840. The mean plasma Hcy level was considerably higher in children with autism than controls (P value< 0. 01). The mean serum folic acid level and vit B12 level was significantly reduced in autistic cases than controls (P value< 0. 01). There was a statistically significant positive correlation between plasma Hcy level (µmol/L) and CARS level in children with autism (P value< 0. 01).

Conclusions:  Children with autism have increased levels of Hcy, and decreased levels of folic acid and vit B12. So, Hcy may be used as a clinical biomarker for early diagnosis and managing of autistic children.

Open Access Review Article

Further Review of Aspirin in the Treatment of Kawasaki Disease

Zhaoling Shi, Kai-Sheng Hsieh, Hong Wang, Xiaodong Yang, Ling Zhang, Xiangyue Kong, Jianying Feng, Juyan Wang, Fuyong Jiao

Asian Journal of Pediatric Research, Page 13-20
DOI: 10.9734/ajpr/2022/v10i3197

Aspirin only prevents platelets from accumulating in the dilated coronary arteries and prevents thrombosis, thus minimizing thrombosis as much as possible, and does not shrink the already dilated coronary artery tumor. Therefore, it plays an important role in the treatment of Kawasaki disease, but it is not the cause of treatment. Aspirin is common in the treatment of Kawasaki disease in children, and its effect is to reduce acute inflammatory response and alleviate platelet aggregation. Aspirin has been used to treat Kawasaki disease for more than 50 years. Since 1961, when Kawasaki discovered the first reported case of hemorrhagic shock caused by aspirin in children with Kawasaki disease, we need to re-explores the use of aspirin in the treatment of Kawasaki disease.