Background and Objectives. Benign strictures are the main cause of esophageal strictures in children. They can be managed by different modalities but endoscopic dilatation is the standard therapy. This study is aimed at reviewing the efficacy and safety of endoscopic dilatations in children with esophageal strictures. Materials and Methods. In this retrospective cross-sectional single center study, records of patients with esophageal strictures presented to the pediatric department, Salmaniya Medical Complex, Bahrain, in the period between 1995 and 2019 were reviewed. Demographic data, indications of endoscopic dilatations, the procedure success rate, and possible complications were assessed. Results. Forty-six children were found to have esophageal strictures. Twenty-five (54.3%) patients were males. Most patients presented during infancy (86.5%, 32/37 patients). Twenty-six (56.5%) patients required 88 dilatation sessions, while the remaining 20 (43.5%) patients did not require dilatations. The median number of dilatation sessions per patient was three (interquartile range = 2 –5). Savary-Gilliard bougienages were the main dilators used (80.8%, 21/26 patients). Anastomotic stricture (post esophageal atresia/tracheoesophageal fistula repair) was the main cause of esophageal strictures and was found in 35 (76.1%) patients. Patients with nonanastomotic strictures had more frequent dilatations compared to those with anastomotic strictures ( P = 0.007 ). The procedure success rate was 98.8%. Yet, it was operator dependent ( P = 0.047 ). Complete response to dilatation was found in 18 (69.2%) patients, satisfactory in seven (26.9%), and an inadequate response in one (3.9%). Those with satisfactory responses still require ongoing dilatations based on their symptoms and radiological and endoscopic findings. No perforation or mortality was reported. Patients with dilatations had more recurrent hospitalization ( P < 0.0001 ), more dysphagia ( P = 0.001 ), but shorter hospital stay ( P = 0.046 ) compared to those without dilatations. Surgical intervention was required in one patient with caustic strictures. The median follow-up period was six years (interquartile range = 2.25 –9.0). Conclusions. Endoscopic esophageal dilatation in children with esophageal strictures is effective and safe. Yet, it was operator dependent. Nonanastomotic strictures require more dilatations compared to anastomotic strictures. Findings of this study are comparable to those reported worldwide.
Introduction The novel coronavirus disease 2019 (COVID-19) pandemic had an impact on different health services due to the lockdowns, curfews, or reducing provision of some clinical services to infection control. Aims This study looked at the impact of the pandemic on the pediatric diabetes services in Arab countries during the first 6 months of pandemic. Methods and Material An online survey using SurveyMonkey was e-mailed to the pediatric endocrine consultants practicing in Arab countries. The survey was active for the last 2 weeks of August 2020. Results Responses received from 34 consultants. Most responses were from Saudi Arabia, Iraq, and Oman. 18% of consultants have more than 500 pediatric patients with type-1 diabetes mellitus (T1DM) under each of their care. A quarter of responding consultants had suspended their clinics completely during the pandemic period. The median number of children live with diabetes used to be seen in diabetes clinics has dropped significantly from 22 to only 4 patients per week during the pandemic. Half of respondents fed back those virtual clinics were useful. The number of elective and urgent admissions during the studied period were less than before the pandemic. A total of 17.6% of responders reported an increased incidence of Diabetic Ketoacidosis (DKA) during the pandemic. Also, 36.4% thought the research activity had markedly decreased during the COVID-19 pandemic. Conclusion The pandemic has led to reducing the number of patients attending the diabetes clinic in Arab countries. However, virtual clinics and tele-consultations emerged evidently during the pandemic. It is expected to continue using the virtual clinics when the pandemic is over.
Rickets, a growth plate disorder, is classified into calcipenic and phosphopenic types based on the etiology. Phosphopenic rickets can be further classified into fibroblast growth factor 23 (FGF23) mediated and non-FGF23 mediated. FGF-23 has a phosphaturic effect which results in hypophosphatemia and, therefore, the accumulation of hypertrophied chondrocytes, leading to rachitic changes in the bones. One of the most common causes of inherited hypophosphatemic rickets is X-linked hypophosphatemia (XLH), mainly due to a mutation in the PHEX gene that ends in the extended release of FGF-23. During the 60th annual meeting of the European Society for Pediatric Endocrinology, held in Rome between September 15 and 19, 2022, approximately 15 presentations were made either as free communication or poster. In addition, there was a dedicated satellite symposium focusing on XLH. This article has been prepared mainly to share knowledge and updates discussed during the meeting about hypophosphatemic rickets, as we feel this disease is still to be focused on in the MENA region, since there are some gaps in the recognition and management of FGF23 hypophosphatemic rickets and osteomalacia.
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