Purpose Colonoscopy is considered the most reliable method for the diagnosis of juvenile polyps. However, colonoscopic screening is an invasive and expensive procedure. Fecal calprotectin (FCP), a marker of intestinal inflammation, has been shown to be elevated in patients with polyps. Therefore, this study aimed to evaluate FCP as a screening biomarker for the diagnosis of juvenile polyps. Methods This cross-sectional, observational study was conducted at the Pediatric Gastroenterology and Nutrition Department, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. For children with polyps, colonoscopic polypectomy and histopathology were performed. FCP levels were analyzed before and 4 weeks after polypectomy in all patients. Information was recorded in a datasheet and analyzed using the computer-based program SPSS. Results The age of the children was between 2.5 and 12 years. Approximately 93% of the polyps were found in the rectosigmoid region. Children with juvenile polyps had elevated levels of FCP before polypectomy that subsequently normalized after polypectomy. The mean FCP levels before and after polypectomy were 277±247 µg/g (range, 80–1,000 µg/g) and 48.57±38.23 µg/g (range, 29–140 µg/g) ( p <0.001), respectively. The FCP levels were significantly higher in patients with multiple polyps than in those with single polyps. Moreover, mean FCP levels in patients with single and multiple polyps were 207.6±172.4 µg/ g and 515.4±320.5 µg/g ( p <0.001), respectively. Conclusion Colonic juvenile polyps were found to be associated with elevated levels of FCP that normalized after polypectomy. Therefore, FCP may be recommended as a noninvasive screening biomarker for diagnosis of colonic juvenile polyps.
This article has no abstract. The first 100 words appear below: A 9-year-old girl of non-consanguineous parents presented at the outpatient department with the history of jaundice and abdominal distension for 20 days and respiratory distress for 7 days. She also complained of bloody vomiting without any melena. The mother gave the history of abdominal pain for 2 days which was diffuse in nature. Her menarche had not started yet. Her younger sister is healthy. She had no history of fever, constipation, family history of liver disease, sib death, contact with known tuberculosis patient, blood transfusion or parenteral medication. On examination, she was afebrile, moderately pale, dyspnea and leukonychia. Bilateral pedal edema was present.
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.
A 12-year-old boy of nonconsanguineous parents presented with the history of fever and left sided upper abdominal pain for 1 month. His fever was high grade, intermittent, associated with chills and rigor. The abdominal pain was dull aching in nature without any radiation, aggravating or relieving factors. His bowel habit was normal. The child had no history of jaundice, cough, respiratory distress, burning sensation during micturition, earache, skin infection, contact with tubercular patient, blood transfusion or parenteral medication.On examination, she was fretful, febrile, moderately pale, and anicteric. Tachycardia was present. Per abdominal examination revealed tenderness at the left hypochondriac region. There were splenomegaly (4 cm) and nontender hepatomegaly (just palpable). Ascites was absent. Other systemic examinations were normal.The complete blood count showed moderate anemia, neutrophilic leukocytosis and thrombocytosis (Table I). The erythrocyte sedimentation rate was high. Urine routine microscopy and widal test, serum alanine amino transferase were normal. Immunochromatography for kala -azar, immunochromatography for malaria and serology for dengue virus were negative. Blood and urine culture showed no growth of the organism. Montoux test was positive and the X -ray chest and abdomen were normal.The ultrasonography of the abdomen showed spleen was enlarged, size-12.8 cm, multiple small hypoechoic lesion in splenic parenchyma, large one 8.2 x 0.6 mm, suggestive of multiple splenic abscess (Figure 1).Based on history, examination findings and investigations, the diagnosis was splenic abscess. As other common causes of fever and upper abdominal pain were excluded (urinary tract infection, malaria, kala-azar, dengue) and the ultrasonography of the abdomen was suggested as splenic abscess.
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