The coronavirus disease 2019 (COVID-19) pandemic is a threat worldwide for individuals of all ages, including children. Gastrointestinal manifestations could be the initial presenting manifestation in many patients, especially in children. These symptoms are more common in patients with severe disease than in patients with non-severe disease. Approximately 48.1% of patients had a stool sample that was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral RNA. Children typically form 1%-8% of all laboratory-confirmed cases of SARS-CoV-2. Gastrointestinal manifestations of COVID-19 in children are not rare, with a prevalence between 0 and 88%, and a wide variety of presentations, including diarrhoea, vomiting, and abdominal pain, can develop before, with or after the development of respiratory symptoms. Atypical manifestations such as appendicitis or liver injury could also appear, especially in the presence of multisystem inflammatory disease. In this review, we discussed the epidemiology of COVID-19 gastrointestinal diseases in children as well as their implications on the diagnosis, misdiagnosis, prognosis, and faecal-oral transmission route of COVID-19 and the impact of gastrointestinal diseases on the gut microbiome, child nutrition, and disease management.

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Background Pilocytic astrocytoma, medulloblastoma, and ependymoma are the most common pediatric CNS tumors seen at posterior cranial fossa and final diagnosis obtained by histopathology after surgical excision. Routine MRI study gives an idea about site and extension of the tumors but provide a little information about type and grade of tumors. ADC ratio had high sensitivity and specificity in differentiation between these tumors as regard type and grade according to tumor cellularity. Patients and methods Prospective study conducted on thirty pediatric patients (11 males and 19 females) with CNS posterior fossa masses, their ages ranged from 2 to 17 years (mean age of 8.7 years), conventional MRI, DWI, ADC value, and ADC ratio were done for all patients. Results ADC values were significantly different between pilocytic astrocytomas (1.43 ± 0.28 × 10−3) and medulloblastomas (0.71 ± 0. 21 × 10−3) with a P value < 0.001, also there was a significant difference when comparing medulloblastomas (0.71 ± 0.21 × 10−3) with ependymomas (1.04 × 10−3 ± 0.21) with a P value < 0.001. ADC ratio at a cutoff > 1.7 showed significant good power of discrimination of astrocytoma (AUC = 0.85) from ependymoma with 87.5% sensitivity and 93.3% specificity. Similarly, at cutoff ≤ 1.6-> 1.2 was a significant good predictor of ependymoma (AUC = 0.85) with 87.8% sensitivity and 99.5% specificity. While, ADC ratio ≤ 1.2 was significant excellent discriminator of medulloblastoma (AUC = 0.99) with 100% sensitivity and 90% specificity. Conclusion ADC ratio is a simple way used in distinguishing juvenile pilocytic astrocytoma, ependymoma, and medulloblastoma, which are the most frequent pediatric posterior fossa tumors. Cutoff ADC ratio of more than 1.7 characteristic of JPA with 87.5% sensitivity and 93.3% specificity, ADC ratio less than 1.1 characteristic of medulloblastoma with 100% sensitivity and 90% specificity. ADC ratios more than 1.1 and less than 1.7 characteristic of ependymoma with 87.8% sensitivity and 99.5% specificity. We recommended ADC ratio as a routine study in evaluation of pediatric CNS posterior fossa tumors.

Background and aimSpontaneous bacterial peritonitis (SBP) is defined as an ascitic fluid infection without an evident intra-abdominal surgically treatable source. SBP is a common and potentially life-threatening complication in patients with cirrhosis. This prospective study was undertaken to evaluate the usefulness of leukocyte esterase reagent strips and ascitic fluid lactoferrin in the diagnosis of SBP in cirrhotic patients with ascites. Patients and methods A total of 168 patients with cirrhotic ascites were enrolled. Patients with SBP and culture-negative neutrocytic ascites variant were considered positive as SBP. Full history was taken and complete medical examination was performed. All participants were subjected to full laboratory investigations to assess SBP. Paracentesis was performed, and immediately after, fresh ascitic fluid specimen was collected and tested using a dipstick for granulocyte esterase designed for urine analysis. Quantitative measurements of ascitic fluid lactoferrin concentration were determined using a polyclonal antibody-based enzyme-linked immunosorbent assay specific for human lactoferrin. ResultsThe addition of ascitic fluid lactoferrin levels to leukocyte esterase reagent strips yielded statistically significant effects on the diagnostic accuracy compared with each test alone. Thus, the combination of both tests yielded (considering ascitic fluid lactoferrin concentrationZ200 ng/ml and/or dipstick testZ2 +) sensitivity, specificity, positive predictive value, and negative predictive value of 91. 84, 94.96, 88.24, and 96.58%, respectively. ConclusionCombining both ascitic fluid lactoferrin and leukocyte esterase reagent test strips was found to facilitate very rapid identification of patients with SBP. Specifically, these tests can be performed efficiently to speed up the bedside diagnostics of this clinical entity.