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Case Report
Spontaneous Rupture of Common Hepatic Duct in an Infant, a Rare Entity
Ranya Herzallah*,
Samer Al-Rahamneh,
Qusay Altarawneh,
Sarah Abuqubu
Issue:
Volume 11, Issue 3, September 2025
Pages:
114-118
Received:
9 May 2025
Accepted:
26 May 2025
Published:
23 June 2025
Abstract: Pediatric spontaneous biliary duct perforation (SBDP) represents a rare clinical condition. The vast majority of pediatric cases typically manifest around 6 months of age; however, the initial onset of this condition has been documented to occur as early as 25 weeks of gestation and, conversely, as late as 7 years postnatally. Despite the encouraging fact that the condition is treatable with appropriate intervention, the often non-specific nature of its associated symptoms and signs can unfortunately result in a significantly delayed diagnosis. This delay, in turn, carries the potential for the development of severe, life-threatening conditions such as biliary peritonitis and sepsis. Therefore, it is of paramount importance for clinicians to establish an early suspicion and achieve a prompt diagnosis to mitigate these risks. An exceptionally uncommon variant within the spectrum of spontaneous biliary duct perforation is the spontaneous rupture of the common hepatic duct. This report presents an illustrative case of a 5-month-old male infant who experienced a spontaneous perforation of the common hepatic duct, leading to the formation of a biloma. This diagnosis was successfully established pre-operatively through the utilization of a contrasted abdominal computed topography (CT) scan. Subsequently, the patient underwent a primary surgical repair of the identified perforation site, in addition to percutaneous drainage facilitated by a biliary T-tube. The postoperative recovery period was remarkably uneventful, and the T-tube was successfully removed on the 12th postoperative day. Six weeks following discharge from the hospital, the patient exhibited entirely satisfactory progress, with a complete absence of any discernible complications.
Abstract: Pediatric spontaneous biliary duct perforation (SBDP) represents a rare clinical condition. The vast majority of pediatric cases typically manifest around 6 months of age; however, the initial onset of this condition has been documented to occur as early as 25 weeks of gestation and, conversely, as late as 7 years postnatally. Despite the encouragi...
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Research Article
Risk Factors for Mortality in Septic Children with Acute Kidney Injury in the Pediatric Intensive Care Unit
Issue:
Volume 11, Issue 3, September 2025
Pages:
119-126
Received:
23 May 2025
Accepted:
9 June 2025
Published:
4 July 2025
Abstract: Acute Kidney Injury (AKI) and sepsis are major causes of morbidity and mortality in pediatric intensive care units (PICUs), especially when they occur concurrently. Despite advancements in critical care, the identification of risk factors remains essential to improve survival outcomes in children. To determine the risk factors associated with mortality in children diagnosed as sepsis with treated in the PICU. This was an observational analytic study with a case-control design, conducted in the PICU of Prof. Dr. I. G. N. G. Ngoerah Hospital from 2022 to 2024. Pediatric patients aged 1 month to <18 years with diagnoses of AKI and sepsis were included. Variables analyzed included nutritional status, duration of PICU stay, requirement of mechanical ventilation, involvement of a pediatric nephrologist, history of nephrotoxic drug use, and the number of nephrotoxic drugs used. Bivariate and multivariate analyses were performed using logistic regression. Total of 126 patients were analyzed. Bivariate analysis showed a significant relationship between mortality and the need for mechanical ventilation (OR 6.2; p 0.001) and the absence of pediatric nephrology care (OR 2.1; p = 0.047). In multivariate analysis, the need for mechanical ventilation (OR 16.5; 95% CI 3.5-77.2; p = 0.001) and pediatric nephrology care (OR 6.7; 95% CI 1.6-28.0; p = 0.009) were independently associated with mortality. The need for mechanical ventilation and the lack of pediatric nephrology consultation are significant risk factors for mortality in septic children with AKI treated in the PICU.
Abstract: Acute Kidney Injury (AKI) and sepsis are major causes of morbidity and mortality in pediatric intensive care units (PICUs), especially when they occur concurrently. Despite advancements in critical care, the identification of risk factors remains essential to improve survival outcomes in children. To determine the risk factors associated with morta...
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Case Report
Dunbar Syndrome: Unusual Cause of Chronic Abdominal Pain in Children
Gihad Alsaeed*
,
Subhi Samm,
Mohamed khabier,
Waiel Habib,
Mohamed Alsaeed,
Rana Nader Himmat
Issue:
Volume 11, Issue 3, September 2025
Pages:
127-133
Received:
30 May 2025
Accepted:
18 June 2025
Published:
16 July 2025
Abstract: Childhood chronic abdominal pain is a diagnostic challenge, with a variety of functional and organic etiologies. Whilst the majority of cases are diagnosed as either functional or dysfunctional, it is imperative that an individual diagnostic assessment is conducted in order to exclude organic causes, thus facilitating a successful management strategy. In instances where alarm-Features are present, it is recommended that investigations be conducted into rare and unusual causes, provided that initial investigations have not yielded a diagnosis. One such rare Entity is Dunbar syndrome, a vascular condition characterized by chronic abdominal pain, which typically manifests during late childhood. This curable cause appears to be more prevalent than what previously hypothesized to be 1.7% in children. We present the case of a 16-year-old female patient has been suffering from severe, unexplained chronic abdominal pain and weight loss for several months. Despite extensive investigations and exploratory laparoscopy, no clear explanation for the patient's symptoms has been found. Our approach was a combination of teamwork, a stepwise approach, and selective investigations. This collaborative effort enabled the successful diagnosis and surgical therapy. We aim to enhance the management of childhood chronic abdominal pain by adapting a cost effective stepwise approach and to raise awareness of Dunbar syndrome.
Abstract: Childhood chronic abdominal pain is a diagnostic challenge, with a variety of functional and organic etiologies. Whilst the majority of cases are diagnosed as either functional or dysfunctional, it is imperative that an individual diagnostic assessment is conducted in order to exclude organic causes, thus facilitating a successful management strate...
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Research Article
Effectiveness of Methylphenidate Plus Integrated Training in Children with Comorbid SLD and ADHD: A Retrospective Pre–Post Intervention Study
Guo Haiwen,
Luo Lirong*
Issue:
Volume 11, Issue 3, September 2025
Pages:
134-140
Received:
12 June 2025
Accepted:
1 July 2025
Published:
18 July 2025
Abstract: Objective: This study aimed to evaluate the effects of methylphenidate controlled-release tablets combined with cognitive and sensory integration training on learning and behavioral outcomes in children with comorbid SLD and ADHD. Methods: A total of 55 children diagnosed with both SLD and ADHD were retrospectively included from a pediatric outpatient clinic in Guangzhou between June 2020 and December 2023. This single-group retrospective design allowed for within-subject comparisons before and after the intervention. All participants received a six-month intervention comprising daily oral methylphenidate and regular sessions of cognitive and sensory integration training. Cognitive and behavioral functioning were systematically assessed at two time points—pre- and post-intervention—using three standardized tools: the Children’s Learning Disability Characteristics Assessment Scale, the SNAP-IV scale, and the Conners’ Child Behavior Scale. This pre-post comparative framework enabled the evaluation of intervention-related changes across multiple domains. Results: Post-intervention, total and subscale scores across all three instruments were significantly reduced compared to baseline (P < 0.01), indicating marked improvements in attention, learning ability, and behavioral regulation. The most substantial gains were observed in attention control, visual perception, and hyperactivity/impulsivity symptoms. Conclusion: The combination of pharmacological treatment and structured non-pharmacological training produced significant improvements in both cognitive-perceptual and behavioral outcomes. This integrated approach may offer synergistic therapeutic benefits for children with co-occurring SLD and ADHD and provides promising clinical evidence to inform future large-scale, multidisciplinary intervention protocols.
Abstract: Objective: This study aimed to evaluate the effects of methylphenidate controlled-release tablets combined with cognitive and sensory integration training on learning and behavioral outcomes in children with comorbid SLD and ADHD. Methods: A total of 55 children diagnosed with both SLD and ADHD were retrospectively included from a pediatric outpati...
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Review Article
Evolution of Artificial Intelligence Is a Revolution in Medical Science
Issue:
Volume 11, Issue 3, September 2025
Pages:
141-149
Received:
12 June 2025
Accepted:
1 July 2025
Published:
18 July 2025
Abstract: Artificial Intelligence (AI) is a prime instance of a technological breakthrough that has widespread medical applicability at present as well as future. This technology has multi-dimensional progression. Modern medical service became vibrant with the use of this technology. AI has its rich history of development which has been contributed by genius people around the globe. History of AI is important to realize its potentiality by analyzing its past, which helps in forecasting future. AI is becoming popular in different arena of medical science. It is now applied in cardiovascular diseases, Pulmonary Medicine, Endocrinology, Nephrology, Gastroenterology, Neurology, Dermatology, Ophthalmology, Pathology, Oncology, Radiology, Surgery and also in Telemedicine. Algorithms like Aidoc’s detect pulmonary embolism in chest CT scans with 85% sensitivity and 99% specificity. AI based (deep-learning model) mammography and skin cancer diagnosis performs at or above human specialist level. It is the need of time to train medical man power in this field. Enhancing the skill of medical professional in this regard will develop a new generation of doctors to fulfill the need of future. It should be noted that the ethical dilemmas, privacy, data protection, informed consent, social gaps, medical consultation, empathy, and sympathy are various challenges in using AI. We should be aware that its negative aspects might not outweigh its benefit. Introduction of AI and machine learning in medicine helped health professionals to improve the quality of care. It has the potential to improve even more in near future and beyond.
Abstract: Artificial Intelligence (AI) is a prime instance of a technological breakthrough that has widespread medical applicability at present as well as future. This technology has multi-dimensional progression. Modern medical service became vibrant with the use of this technology. AI has its rich history of development which has been contributed by genius...
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Research Article
The Use of Total Serum Immunoglobulin M in the Diagnosis of Congenital Infection: A Literature Review and Retrospective Cohort Study
Peter Joslyn*,
Jeffrey Surcouf,
Mary Elizabeth Lago,
Brian Barkemeyer
Issue:
Volume 11, Issue 3, September 2025
Pages:
150-155
Received:
19 June 2025
Accepted:
3 July 2025
Published:
24 July 2025
DOI:
10.11648/j.ajp.20251103.16
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Abstract: Diagnosing congenital infections (CIs) poses challenges due to diverse clinical presentations. Total serum immunoglobulin M (IgM) has been used as a screening tool for CIs, but its efficacy remains uncertain. In this single-center retrospective cohort study conducted between April 2018 and April 2022 at a level III Neonatal Intensive Care Unit (NICU), we aimed to review the literature on and assess the utility of total serum IgM in diagnosing CIs in newborns. Among 53 infants with total serum IgM measurements, only one value was modestly elevated. Further testing for congenital pathogens was negative. The most frequently cited reason for obtaining total serum IgM was isolated small for gestational age (SGA) status; however, alternative explanations for SGA status were present in most cases. Considering no CIs were diagnosed in our cohort, and > 98% of total serum IgM values were normal, we conclude screening infants with isolated abnormalities is of low yield. If testing is pursued, targeted testing is recommended over broad screening.
Abstract: Diagnosing congenital infections (CIs) poses challenges due to diverse clinical presentations. Total serum immunoglobulin M (IgM) has been used as a screening tool for CIs, but its efficacy remains uncertain. In this single-center retrospective cohort study conducted between April 2018 and April 2022 at a level III Neonatal Intensive Care Unit (NIC...
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Research Article
Serum Neutrophil Gelatinase-Associated Lipocalin as a Biomarker of Acute Kidney Injury in Babies with Perinatal Asphyxia in Abia State, South-East Nigeria
Issue:
Volume 11, Issue 3, September 2025
Pages:
156-165
Received:
3 June 2025
Accepted:
24 June 2025
Published:
28 July 2025
DOI:
10.11648/j.ajp.20251103.17
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Abstract: Introduction: Acute Kidney Injury (AKI) is a major cause of mortality and long-term morbidity. It is a very common complication in asphyxiated newborns. Early detection of AKI in these cohort of patients will positively impact outcome. Serum Neutrophil Gelatin-associated lipocalin (NGAL) is a highly sensitive biomarker of AKI. There is paucity of data on the determination of the incidence of AKI in asphyxiated babies using Serum NGAL as a biomarker. Objective: This study was set to evaluate the use of serum NGAL measurement for early detection of AKI in babies with perinatal asphyxia at the Abia State University Teaching Hospital (ABSUTH), Aba. Methods: This was a cross-sectional descriptive study done at the Newborn Special Care Unit of ABSUTH, Aba, Nigeria. Serum NGAL estimation was done within the first six hours of delivery. Also, serum creatinine was done daily for the first week of admission. Results: A total of 155 term neonates with perinatal asphyxia were studied. The male to female ratio was 1.06:1. Among these neonates, 43.9% had mild, 29.0% had moderate and 27.1% had severe perinatal asphyxia respectively. The mean serum NGAL concentration in those with mild, moderate and severe perinatal asphyxia were 345.3ng/ml, 673.1ng/ml, and 866.1ng/ml, respectively. A statistically significant difference was observed in these mean serum NGAL concentrations (p value<0.05). The serum NGAL levels increased with the increasing severity of AKI. There was a higher serum NGAL concentration with a mean of 614.00±22ng/ml in patients with AKI (P<0.05). A cut-off value of 270ng/ml for serum NGAL using the receiver operating curve could detect AKI in asphyxiated neonates, with a sensitivity of 99.3%. The area under the curve of 1.0 was statistically significant. (p = 0.001) Conclusion: Serum NGAL is a highly sensitive biomarker of AKI. Serum NGAL levels measured within the first six hours after birth is elevated in patients with AKI. NGAL estimation in the first 6 hours of the birth of asphyxiated neonates is recommended for early detection of AKI.
Abstract: Introduction: Acute Kidney Injury (AKI) is a major cause of mortality and long-term morbidity. It is a very common complication in asphyxiated newborns. Early detection of AKI in these cohort of patients will positively impact outcome. Serum Neutrophil Gelatin-associated lipocalin (NGAL) is a highly sensitive biomarker of AKI. There is paucity of d...
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Research Article
Epidemiological Profile, Diagnostic Approach and Associated Complications of Ventricular Septal Defect in a Pediatric Population
Mohammad Moniruzzaman*
Issue:
Volume 11, Issue 3, September 2025
Pages:
166-172
Received:
30 June 2025
Accepted:
10 July 2025
Published:
28 July 2025
DOI:
10.11648/j.ajp.20251103.18
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Abstract: Ventricular septal defect (VSD) is the most common congenital heart defect in children, associated with important considerations for disease epidemiology, diagnosis, and long-term outcomes. VSD results from a deficiency in growth or the failure of alignment or fusion of the components of the ventricular septum. This study aimed to describe the epidemiological profile, diagnostic approach, and associated complications of VSD in a pediatric population. This cross-sectional study was conducted in the Department of Pediatric Cardiology, Combined Military Hospital, Dhaka, Bangladesh, from January 2018 to December 2018. This study included 46 pediatric patients less than 12 years old with isolated VSD. The mean age of the participants was 2.78 ± 3.44 years, with a slight male predominance (male-to-female ratio of 1.09:1). Most patients (60.87%) were under one year of age. A family history of congenital heart disease was reported in 13.04% of cases. Common presenting symptoms included feeding difficulty (69.57%), cough (60.87%), poor weight gain (54.35%), and head sweating (50%). Respiratory distress was the most frequently observed clinical sign (71.74%), followed by tachycardia (47.83%) and failure to thrive (41.30%). Echocardiography was the definitive diagnostic tool, performed in all cases. Other investigations included ECG (82.61%), chest X-ray (76.09%), and cardiac catheterization (8.70%). Perimembranous VSD was the most prevalent type (67.39%), and the majority of defects were small in size (58.70%). Pulmonary hypertension was the most common complication, noted in 58.70% of patients, followed by aortic cusp prolapse (23.91%) and aortic regurgitation (17.39%). Ventricular septal defect remains a significant pediatric cardiac condition, predominantly affecting infants. Early diagnosis, with the help of a clinical picture and widely and easily accessible diagnostic tools like echocardiography (ECHO), will help initiate timely treatment and decrease mortality. Pulmonary hypertension was the most frequent complication, followed by aortic cusp prolapse and aortic regurgitation.
Abstract: Ventricular septal defect (VSD) is the most common congenital heart defect in children, associated with important considerations for disease epidemiology, diagnosis, and long-term outcomes. VSD results from a deficiency in growth or the failure of alignment or fusion of the components of the ventricular septum. This study aimed to describe the epid...
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