Background: Acute necrotizing encephalopathy of children (ANEC) is a rare fulminant type of acute encephalopathy that mainly occurs in children with a characteristic clinico-radiological pattern. It is commonly preceded by viral infections. The condition carries a poor prognosis with high morbidity and mortality rates. We highlight the relationship between diagnostic multi-parametric magnetic resonance imaging (MRI) findings and correlate them with the clinical outcome of children with ANEC by enrollment of MRI scoring. Results: The thalami were involved in all 30 patients, brain stem in 80%, basal ganglia (13.3%), cerebral white matter (WM) in 73%, and cerebellar WM in 33%. Hemorrhage was present in 86.7% patients, edema 80%, and necrosis in 13.3%. We found that the patients having the highest MRI scores were in the poor outcome category; whereas the patients with lower MR score (1 or 2) had better outcomes. Statistically positive correlation (r= 0.1198) was found between the multi-parametric MR score and the outcome category. Conclusion: An extended multi-parametric MRI should be performed in ANEC, allowing early detection and scoring of the disease for better prognosis. There is a positive correlation between the clinical outcome and the MR scoring.
Background: Evaluation of renal microstructure is pivotal for diagnosing and monitoring chronic renal disease. DWI has been proved to be practicable and reliable examination for the assessment of renal function and parenchymal damage in some renal diseases. Our aim is to appraise DWI sequence and ADC measurement as a potential tool of renal function assessment as well as establishing a possible relationship between the different CKD stages and the renal parenchymal ADC values changes. Results: Regarding the cause of CKD, nine patients (45%) had glomerulonephritis, 5 patients (25%) had hemolytic uremic syndrome, 2 patients (10%) had lupus nephritis, 2 patients (10%) had nepheronophthisis, and 1 patient (1.5%) had infantile nepherosis, whereas the cause of CKD was unknown in 1 patient (1.5%). The stages of CKD were classified according to KIDGO guidelines: 6 patients (30%) were stage 1, 4 patients (20%) were stage 2, 3 patients (15%) were stage 3, 2 patients (10%) were stage 4, and 5 patients (25%) were stage 5. The patients' group (group A) had a mean ADC value (1.85 × 10 −3 ± 0.24) which was significantly lower than that of the control group (group B) (2.21 × 10 −3 ± 0.12). As for the correlation between stage of CKD and ADC, we found it to be a moderate negative one with r' value of − .655 and a significant p value of < 0.001. Conclusion: DWI is recognized as a promising imaging tool that can take part in the assessment of the morphological and functional changes in diffuse renal parenchymal disease, hence playing an important role in the early diagnosis and staging of chronic kidney disease.
Background
Autoimmune thyroiditis (AIT) is the most common thyroid pathology in pediatric patients among which Hashimoto’s thyroiditis has the highest prevalence. Along with size, measuring mechano-acoustic tissue elasticity is evolving as an important parameter in the evaluation of diffuse thyroid pathology. This study aims to investigate the role of shear wave elastography (SWE) in the diagnosis of autoimmune thyroid disease (AITD) in the pediatric population and also compare the elasticity between them and healthy individuals.
Results
This case–control analytical study was carried out on 64 pediatric subjects ranging in age from 7 to 17 years. All the cases were diagnosed as AIT by anti-thyroid antibodies, and their thyroid function was evaluated by thyroid hormones. We performed thyroid Ultrasonography and Shear wave elastography. Patients with AIT had significantly higher elasticity values (35.6 kPa, IQR 8.43–103.7 kPa) than the control group (9.35 kPa, IQR 5.73–13.21 kPa). There was no correlation of elasticity values of thyroid gland in patients with AIT with autoantibodies and thyroid function test, respectively. The cutoff value for elasticity was 12.317 kPa with sensitivity and specificity of 96.9% and 100%, respectively.
Conclusions
SWE is a highly sensitive imaging method integrating routine ultrasonography in the diagnosis of AITD which estimates the extent of fibrosis in numerical value.
Background
Chronic kidney disease stage 5 (CKD 5) populations have peculiar risk for severe Covid-19 infection. Moreover; pediatric data are sparse and lacking. The aim of this study is to report our experience in CKD 5 children treated by hemodialysis (CKD 5D) and CKD 5 children after kidney transplantation (KTR) during one year of Covid-19 pandemic.
Methods
Retrospective analysis of 57 CKD 5 children with Covid-19 like symptoms during 1 year pandemic was performed. A cohort of 19 confirmed patients (13 CKD 5D and 6 KTR) was analyzed in details as regard clinical, laboratory, radiological criteria, management and their short term outcome.
Results
Conclusion
Pediatric patients on regular HD (CKD 5D) are at higher risk and worse outcome of Covid-19 infection than KT recipients (KTR). Pre-existing HTN and shorter duration after KT are potential risk factors. Reversible AGD after KT and CVC related infections in HD patients are additional presenting features of Covid-19 infection.
Background: Hepatic iron overload in pediatric population with repeated blood transfusion is an important morbidity warranting the evolution of a noninvasive method of liver iron quantification. MR T2*/R2* relaxometry technique has shown promising results in this domain.
Aim of Study:To show the value of MR T2*/R2* relaxometry technique, in assessment of hepatic iron overload in a sample pediatric patient population at our hospital on repeated blood transfusions therapy for thalassemia and sickle cell anemia.Patients and Methods: A total of 44 patients, mean age 11.14±3.38 (range: 6-17 years old) patients with thalassemia and sickle cell anemia who had received more than 20 blood transfusions and on chelation therapy at the time of the examination, underwent MRI T2*/R2* relaxometry study. The corresponding iron overload was calculated for each patient, then correlation between R2* and serum ferritin level was done by using Pearson's correlation coefficient.Results: Serum ferritin levels ranged between 56.7 and 11524ng/mL (mean 3605.8ng/mL). R2* values ranged between 77.1 and 11426Hz (mean 2361Hz). Based on the calculated Liver Iron Concentrations (LIC) values which ranged between 0.47 and 42.55mg/g (mean 11.38mg/g) 9 patients (20.45%) showed normal hepatic iron load, 10 patients (22.73%) showed mild iron overload, 13 patients (29.55%) showed moderate overload and 12 patients (27.27%) showed severe overload. The correlation between R2* and serum ferritin was a weak positive one with a Pearson's coefficient of 0.49 (p=0.000645). The correlation between LIC and serum ferritin was a moderate positive one with a Pearson's correlation of 0.5 ( p=0.000494).
Conclusion:Quantification of liver iron deposition in children with chronic hemolytic anemia receiving multiple blood transfusions is empirical for chelation therapy monitoring. R2* relaxometry shows promising results as an effective quantitative tool for estimation of hepatic iron overload when compared to serum ferritin levels, therefore providing a safer alternative in contrast to tissue biopsy.
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