Aetiology, Clinical Profiles, Laboratory Profile, Outcome and Prognostic Factors of Pediatric Acute Liver Failure: Experience at a Tertiary Hospital of Bangladesh

Introduction: Acute liver failure is one of the common causes of death in pediatric gastroenterology and hepatology department. Outcome is different according to aetiology. Objective: To observe the aetiology, outcome and prognostic factors of pediatric acute liver failure. Methods: Consecutive 62 children aged 2 to 16 years of age who were diagnosed as acute liver failure from November 2015 to April 2018 were included in this study. All the clinical profiles, laboratory data and outcome were recorded in a preformed data sheet. Data were analysed by SPSS for Windows version 20. Results: Mean age was 8.5 years. Thirty-nine (62.9%) patients were between 5-10 years of age. Male were 53%. We made a diagnosis of 39 (63%) patients as Wilson disease alone, Another 3 Wilson disease acute liver failure patients had concomitent with either HAV, HEV or HSV in each one. HAV only was responsible for 17 patients and HEV for 1. One patient was Haemophagocyic lymphohistiocytosis and aetiology could not be identified in 1 patient. The overall death in study population was 48% (30). Twenty-four (57%) of 42 acute liver failure patients due to Wilson disease had died. Five (29%) of 17 patients due to HAV infection and 1 patient with HLH died. Ascites, high total bilirubin, high INR and etiology like Wilson disease were the worse pronostic factors for outcome of acute liver failure in children. Conclusion: Wilson disease was the most common aetiology of acute liver failure in children in this study. Early diagnosis is essential as outcome was worse. Majority of viral etiology improved with supportive care. Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 56-61

Les Pathologies Chirurgicales Néonatales À l'Hôpital National De Lamordé De Niamey: Aspects Diagnostiques, Thérapeutiques Et Pronostiques

Purpose: The purpose of this study is to describe the characteristics of the newborn and its surgical pathologies managed in the service of pediatric surgery of the National Hospital of Lamordé. Patients and Methods: It is a retrospective and descriptive study within a period of 10 years (from January 1st 2007 till December 31st 2016). The epidemiological, diagnostic, therapeutic, and evolutionary aspects were also studied. Results: The surgical pathologies of the newborn child represented 12.8 % of the hospitalized patients. The average annual incidence was 47.5 newborn children a year. The average age was of 8.71 days. The newborn children were especially old from 0 to 7 days (60,2 %) and were male (66.1 %). The most frequent pathologies were the malformations anorectales (32,2 %), the omphalocele (18.3 %), and the gastrochisis (6.5 %). The surgical operations, realized for 67.7 % patients, were especially emergencies (58.2 %). The colostomy was the most realized intervention (41.9 %). The mortality rate was 25.8 % (n=123). The post-operative mortality was 16.9 % and the nonoperative mortality was 45%. The premature mortality established 70 % of deaths (n=75). The omphalocele was the main pathology supplier of death (26 %). Conclusion: The neonatal surgical pathologies are characterized by their frequency, their diversity, the predominance of digestive system pathologies, and a high mortality. An evaluation of pronostic factors which determines the morbi-mortality is necessary.

Stereotactic body radiotherapy for patients with relapsing prostate cancer with bones or nodes oligometastases.

263 Background: To analyze patients treated by stereotactic body radiotherapy (SBRT) for node or bone oligometastatic recurrence of a prostate cancer previously locally treated, To identify possible pronostic factors of early biochemical failure (BF) after SBRT. Methods: We reviewed patients with a rising PSA treated by SBRT between November 2011 and April 2016 for bone or node oligometastases, diagnosed on a 18F Fluorocholine positron emission tomography-computed tomography (PET-CT) following biochemical failure of a prostate cancer after a local curative treatment. Recurrence-free survival (RFS) was the primary end-point defined as the time interval between SBRT and biochemical failure. Biochemical failure was defined as 2 consecutive elevations of PSA with last dosage superior to PSA dosage before treatment, or clinical failure. PSA value before SBRT, location of metastases, number of lesions treated, concomitant androgen deprivation therapy were analyzed to identify pronostic factors of poor response to SBRT. Results: With a median follow-up from time of SBRT of 12 months, we treated 40 patients and 56 metastatic lesions, with a local-control rate of 85%. 19 patients were treated for 1 to 3 bone lesions and 21 patients for 1 to 3 node lesions. 8 patients with bone oligometastases and 13 patients with node oligometastases had a recurrence (p=0.55). The main sites of failure after SBRT were lymph nodes only (7 ; 33%), bone only (7 ; 33 %), and synchronous node and bone (4 ; 19%). A 2nd and 3rdcourse of radiotherapy was delivered in 8 and 1 patients. Median RFS was 345 days (134-426) in the node SBRT group and 494 days (85-877) in the bone SBRT group (p=0.27). On bivariate analysis, a PSA nadir up to 0.51 ng/mL after SBRT was identified as a pronostic factor of a worse RFS (p=0.0038). This result was not confirmed in multivariate analysis (p=0.87). Conclusions: SBRT for node oligometastases showed a non significant lower rate of RFS when compared to SBRT in bone oligometastases. A larger cohort with a longer follow up is needed to determine whether node and bone oligometastases have similar outcomes after SBRT.

STUDY OF  PRONOSTIC FACTORS AFTER 30 DAYS IN PATIENTS WITH INTRACRANIAL HEMORRAGIA

Background and purpose: Intracerebral hemorrhage (ICH) constitutes 10% to 15% of all strokes and remains without a treatment of proven benefit. Despite several existing outcome prediction models for ICH, there is no standard clinical grading scale for ICH analogous to those for traumatic brain injury, subarachnoid hemorrhage, or ischemic stroke. Methods: Records of all patients with acute ICH presenting to the Neurology Department, Binh Dinh General Hospital from July 2014-March 2015. Clinical outcome assessed by mRankin score and was compared with each item of ICH scale. ROC-AUC was realized to evaluated the value of ICH in prognostic the outcome of cerebral hemorrhage at day 30. Results: In the day 30: mortality rate was evaluated compared with mRS: In the group with ICH 0-1: no mortality, good outcome was 92.8% and 72.7%. ICH 2-3: mortlity rate increased 47.9% and 84.4%. ICH 4-5: mortality rate 100%. The prognostic predictor of ICH was high with Se 95%, Sp 59%. ROC-AUC 0.908, p<0.0001. Conclusions: The ICH Score is a simple clinical grading scale that allows risk stratification on presentation with ICH. The use of a scale such as the ICH Score could improve standardization of clinical treatment protocols and clinical research studies in ICH. Key words: Intracerebral hemorrhage (ICH), ischemic stroke