Query: sam hassan

title: Leucopenia, Neutropenia, Lymphopenia and Monocytopenia in a 15 year Old Girl with Iron Deficiency Anemia Responding to Iron Therapy: A Case Report
abstract: Despite the high prevalence of iron deficiency anemia (IDA) in children, extensive information about its impact on growth and cognitive functions, less is known about how it affects the non erythrocytes cell lines and its implications. High erythropoietin levels in severe iron deficiency anemia may down regulate the production of non erythroid precursors resulting in various cytopenia, however, the mechanism of this is not fully understood. Reports depicting the association of iron deficiency anemia with cytopenia is quite scarce in pediatric population. We report a case of a 15 year old girl presented with severe iron deficiency anemia and leucopenia, lymphopenia, neutropenia and monocytopenia who has no other evidence of bone marrow dysfunction. The patient responded to iron therapy with prompt reversal of all cell counts. It is therefore recommended to include iron study and plasma erythropoietin concentration in the evaluation of otherwise healthy children presenting with cytopenia. Likewise, to consider iron deficiency in the causative list of non erythroid cytopenia such as neutropenia.

title: Current and Future Issues in Global Children Health and Care

title: Newborn BCG Vaccinations: Scar Formation and Tuberculin Conversion Rates: A Retrospective Study
abstract: Through this study, we aimed to determine the Bacillus Calmette Guerin (BCG) vaccination uptake by scar formation rate following newborn BCG vaccinations and tuberculin conversion in a tertiary hospital setting in Dubai, United Arab Emirates. A retrospective cohort analysis was conducted on 945 babies vaccinated with BCG during 1 January and 31 December 2017. All babies were administered with intradermal 0.05 ml of BCG in the left deltoid. The descriptive variables include vaccination coverage. The outcome data includes follow up at 2, 4, and 6 months for scar formation, Mantoux test results, and revaccination data. Out of 945 babies, 911 (96.4% were vaccinated by trained nurses with BCG after birth and before being discharged. This was following written consent from parents who were well informed by the details of the vaccinations. The non vaccinated babies 34 (3.6% were from different resident nationalities and the parents declined the BCG vaccine. Reason for such decline is not documented but it is likely because in their home country such vaccines are not routinely given. The number of babies who did not return for follow up was 483 (53% These babies were followed by other centers or outside the country hence were not included in the study. The number of babies followed up with no record on BCG scar was 334 out of the total number of 482 (78% BCG scar formation was recorded in 84 babies (19.6% followed up. Scar formation failure was recorded in 10 (2.3% Six babies (60% of those who had no scar had Mantoux test performed. The association between absence of scar and negative Mantoux results were highly significant (P< 0.05) with 100% of babies having negative Mantoux results, therefore, no immunity. It is concluded that BCG scar is poorly recorded similarly to other high income countries. There is a good correlation between lack of BCG scar and no immunity to Tuberculosis. Improvement of newborn BCG uptake is importantly needed. It is recommended to introduce mandatory recording of the outcome of BCG scar formation and resultant outcomes in the vaccinations books. Training of personnel administering the BCG vaccination is an important element for successful vaccination in this vulnerable age group.

title: Recurrent Peeling of Skin Following Post Streptococcal Atypical Kawasaki Disease: A Case Report and Literature Review
abstract: Kawasaki disease (KD) is a systemic vasculitis occurring due to collective immune mechanisms in a genetically susceptible individual, triggered by infections, though the actual cause is yet to be determined. KD is the most common cause of coronary heart disease in children. Typical diagnostic criteria are fever more than 4 days plus four of clinical criteria of cervical lymphadenopathy, skin rashes, mucus membrane redness and lip changes, non purulent conjunctivitis, peripheral changes in palms and feet. In atypical cases three criteria with fever are enough to commence treatment and echocardiograph early. An often reported association with KD is streptococcal infections. Skin peeling occurs in both conditions, however in streptococcal infections it occurs early while late during convalescence stage in KD except peeling of the genitocrural area that may occurs early. Skin peeling in the streptococcal infection is related to exotoxin while the cause of the peeling in KD is not well known; but it is likely related to the immunological pathogenesis. Another type of skin peeling that occurs recurrently following the initial attack of KD in many months is of an unknown reason. The presentation in this report is exceptional; it is for the first time reporting association of atypical KD presented with post streptococcal complications and vitamin D deficiency followed by the skin re peeling 6 months after the patients fully resolved. Moreover, it is for the first time reporting nail changes, painful micturition due to urethral involvement and mucus membrane erythema that all resolved without treatment. The cause possibly is related to innate immune mechanism post infections and possible role for vitamin D deficiency paving the way for the post group A streptococcal (GAS) vasculitis which is an immune response that later acted to trigger the skin peeling. Patient initially presented with significant peeling of streptococcal infections and features of KD responding to monoclonal antibody. This case highlights that clinicians need to know about recurrent peeling following KD in many months and to make the parents aware about its harmless course. It is the first report of association of post streptococcal atypical KD vasculitis, vitamin D deficiency, skin harmless post KD skin peeling, nail changes, mucus membrane erythema and painful micturition due to urethral involvement.

title: Radio Nuclear Investigations in Children Aged 16 Years and Younger with Confirmed Urinary Tract Infection: A Cross Sectional Retrospective Study
abstract: A retrospective cross sectional study conducted at Mediclinic City Hospital; a teaching hospital in collaboration with Mohammad Bin Rashid University for Medicine and health sciences in Dubai, United Arab Emirates (UAE) The aim of this study is to ascertain conduction of renal radio nuclear investigations, explicitly Kidney ureter bladder ultrasound scans (KUB US) Micturating cystourethrogram (MCUG) and Dimercaptosuccinicacid (DMSA) in children following Urinary Tract Infection (UTI) based on; age, type of UTI, and recurrence. Medical records of 421 patients aged 0 16 years with UTI were retrospectively studied. Sociodemographic variables were age, gender, type of UTI, and recurrence. Results showed that the most carried out investigation was KUB US (38.2% (n=161) In children aged between 7 months and 3 years, 15% (n=8) of them had VUR or renal scarring, while only12% (n=11) of children aged 3 years showed abnormal MCUG or DMSA regardless of the KUB US results. Interestingly more than half (56% (n=236) of all patients (n=421) with recurrent UTI showed abnormalities by MCUG and or DMSA, while only 12.3% (n=14) of children with atypical UTI showed abnormalities. It is concluded that VUR and renal scarring predominantly occurred in patients with recurrent UTI and atypical UTI. Thus, children presenting with recurrent UTI are recommended to undergo MCUG and DMSA after the second recurrent episode rather than waiting for the third UTI incident. This study suggests that children aged 7 months to 3 years post UTI should undergo KUB US, MCUG (if it was a recurring UTI) plus DMSA or MAG3 with post micturition study instead. Children older than 3 years presenting with recurrent UTI are recommended to undergo DMSA (regardless of the US results) and MAG3 with post micturition study or MCUG especially if DMSA is abnormal. Keeping in mind, evaluating risk factors like family and past medical history are crucial before conducting any investigation, this is to avoid unnecessary scans, and at the same time implement measures to reduce risks resulting from complicated UTIs.

title: Onychomadesis (Nails Shedding) Secondary to Enterovirus Herpangina Like Infection and Without the Skin Manifestations of Hand Foot Mouth Disease
abstract: Onychomadesis or onycholysis is a newly recognized complication in the course of viral infections particularly the Hand Foot Mouth Disease (HFMD) in children and adults. Onychomadesis is characterized by proximal separation of the nail plate from the nail matrix due to temporary cessation of growth of the nail matrix. The etiology of onychomadesis is including infections, trauma, medications side effects, systemic diseases and idiopathic. The association of the HFMD and the onychomadesis first reported in the year 2000. Since then, few studies and case reports published illustrating the relationship of the HFMD and the resultant onychomadesis 4 to 8 weeks after the resolution of the HFMD. HFMD is a relatively common viral infection, especially in children of preschool age. It is usually presented with characteristic eruption on hands, feet and mouth. Out breaks may happen in nurseries and schools. HFMD usually caused by enteroviruses, most commonly, Coxsackie virus A (CVA) and enterovirus 71 (EV71) It is usually self limiting disease however; serious neurological complications have been reported with EV71. The enteroviruses that cause HFMD and nail changes may cause herpangina which is unlike the HFMD, usually characterized by mouth spots on the soft palate without the skin manifestations, however onychomadesis was not reported before with herpangina. This case presented with no HFMD eruption but small red spots on the soft palate consistent with herpangina. Enterovirus was isolated from throat swab and the onychomadesis occurred 1 month after the resolution of the soft palate spots. It is the first case report about nail changes occurring after herpangina presentation. It is therefore important that in patients presented with onychomadesis to consider the review of the patient's history not only for HFMD but herpangina and possible other EV infections, 8 weeks before the nail changes, to avoid unnecessary referrals, concerns and over investigations. The exact mechanism of the nail changes is not yet known and a review of theories behind the nail damage will be considered in this report.

title: Stimulating rooting of guava cuttings by chemical and physical treatments
abstract: This study was conducted during two successive seasons 2014 and 2015 at the nursery of Pomology department, Faculty of Agriculture, Cairo University, Egypt. It is aimed to investigate the influence of wounding, sucrose (1% and antioxidant (mixture of 5% citric acid 5% ascorbic acid) either alone or in combination with 0, 3000 and 5000 ppm IBA on rooting of guava softwood cuttings. Results showed that IBA at 3000 ppm was more efficient compared with the IBA at 5000 in promoting rooting, root length, weight and number. Wounding and antioxidant improved rooting and root parameters. The application of IBA at 3000 either alone or accompanied with antioxidant significantly increased rooting percent, root length, and number. Results indicated that IBA increased root weight through increasing root number rather than root length of guava cuttings.

title: Renal Tuberculosis in a 14 Years Old Boy Presented as Pyrexia of an Unknown Origin (PUO) A First Case Report
abstract: Tuberculosis remains an important public health problem, especially in developing countries. Mycobacterium Tuberculosis mainly affects the lungs but extra pulmonary Tuberculosis is not uncommon. However, renal involvement is very rare particularly in paediatric age group. This article is reporting a case of 14 years old Emirati boy who presented with history of fever, mild cough and night sweats after admission. The patient was treated as a case of fever of unknown origin, most likely secondary to community acquired pneumonia. On further investigations, he was found to have pulmonary tuberculosis with miliary pattern of the both lungs and also renal tuberculosis as the urine culture grew Acid Fast Bacilli (AFB) (Mycobacterium Tuberculosis) The patient responded very well to the Anti tuberculosis treatment and became symptom free.

title: Post Streptococcal Syndrome in a 5 Years Old Boy with Sever Vitamin D Deficiency Only Responding to Monoclonal Antibody: First Case Report
abstract: Despite the reduction in incidence of Group A Streptococcal (GAS) infections in the last few decades its global burden on mortality and morbidity remained significantly high and represent major concerns in many developing countries. These morbidities and mortalities can be serious in immunocompromised individuals. It has been shown for the last two decades that vitamin D plays an important role in the immune system modulation and its deficiency were associated with recurrent and sever infections. Only few literatures were written about the vitamin D deficiency and GAS infections and very scarce about its complications. One of the rarely reported complications of GAS infections is post streptococcal systemic vasculitis. The association of this complications and the vitamin D deficiency was not reported before. We report for the first time a 5 years old boy presented with sever post scarlet fever vasculitis with sever vitamin D deficiency, only responded to monoclonal antibody infusion. The presentation was complicated by more than one complications of GAS infection, hence difficult to diagnose initially and found to have sever vitamin D deficiency which we concluded is the causative factor for these complications. On correction of vitamin D level the deranged immunological and other factors causing the vasculitis were corrected subsequent to vitamin D correction. It is therefore recommended to check vitamin D concentration in cases of sever GAS especially in association with its complications such as the systemic vasculitis.

title: Unusual Case of Coloboma of the Iris with Dextrocardia and Criss Cross Heart Presented Later with Left Sided Diaphragmatic Hernia: First Case Report
abstract: Coloboma of the iris (CI) is an embryonic condition resulted from an incomplete formation of the iris which either presented unilateral or bilateral and as a single eye defect or in association of other eye anomalies. It happens either as an isolated condition or as part of syndromic features or other associations that are well reported in literatures. Coloboma of the iris has been reported in association with diaphragmatic hernia and in some syndromes with dextrocardia. It can happen in families with genetic presentation looks like autosomal dominant pattern, however other genetic pattern were also reported. The combination of CI, dextrocardia, Criss Cross Heart (CCH) which is a rare condition by itself and the congenital diaphragmatic hernia (CDH) has not been reported before. This report is about an unusual case of a boy presented after birth with left sided CI associated with dextrocardia and CCH, who presented later at the age of 16 months with left sided congenital diaphragmatic hernia that was not been diagnosed early. As far as this search for the English literatures concerned, this is the first report of this exclusive association. It is therefore, highly recommended to investigate cases of CI for an associated CDH especially if it is associated with congenital heart defects such as dextrocardia and CCH.