Browsing by Author "Dašić, Ivana (57203320596)"

Introduction Celiac crisis is a rare and life-threatening complication of celiac disease. Although it occurs in all ages, the most common affects children within the first two years. Outline of cases We report three infants (two female, one male, age range 9–12) with celiac crises as an initial presentation of celiac disease precipitated with rotavirus gastroenteritis. Celiac crisis was preceded by failure to thrive caused by anorexia, occasional vomiting and frequent abundant stools for 4–8 weeks, and 1–2 days before admission with fever, frequent vomiting and profuse watery diarrhea. They were admitted in a very severe general condition, severely dehydrated, markedly malnourished, with an enormously distended abdomen, edema of the lower legs and feet, and perianal erythema. After correction of dehydration and hypoalbuminemia, they were placed on a gluten-and disaccharide-free diet and within the first two weeks on additional parenteral nutrition. The applied therapeutic measures resulted in stabilization and further rapid improvement of the patient’s condition. In all three patients the latex agglutination test for rotavirus was positive, IgA anti-TTG antibodies elevated (58.6–78 U/ml) and all three were homozygous carriers of the HLA DQ2 gene. Enterobiopsy was performed two weeks after the admission and total villous atrophy (Marsh IIIc) was registered in all three patients. In the further course, the complete recovery of the patient was accomplished by a strict gluten-free diet. Conclusion Our experience indicates that rotavirus gastroenteritis in timely unrecognized classical celiac disease in infants can lead to celiac crisis. © 2021, Serbia Medical Society. All rights reserved.

Introduction/Objective The objective was to evaluate sonographic and laboratory findings as predic-tors of complicated and uncomplicated appendicitis in order to decide on further treatment options. Methods This is a retrospective cohort study of 174 pediatric patients who had laboratory tests and ultrasound done before appendectomy during a one-year period. Results were compared with the intra-operative and histopathological findings of complicated (gangrenous or perforated) or uncomplicated (phlegmonous) appendicitis and assessed by binary logistic regression with backward elimination. The initial model included eight predictors. After backward elimination four remained: periappendiceal fluid, hyperechoic periappendiceal fat, white blood cell (WBC) count and C-reactive protein (CRP). The final model included the interaction between periappendiceal fluid and hyperechoic periappendiceal fat. Diagnostic performance of each parameter was presented with sensitivity and specificity. Results Out of all patients, 86 had uncomplicated and 88 had complicated appendicitis (37 gangrenous, and 51 perforated). In the final model three predictors were significantly associated with complicated appendicitis: interaction between periappendiceal fluid and hyperechoic periappendiceal fat, WBC count > 11 × 109 /l, and CRP > 100 mg/l. Inclusion of interaction between periappendiceal fluid and hyper-echoic periappendiceal fat excluded them as individual predictors. The maximum outside appendiceal diameter of more than 6 mm had the highest sensitivity (93.2%), while wall thickness > 3 mm was the most specific (95.2%). Conclusion Using periappendiceal fluid and hyperechoic periappendiceal fat as sonographic predictors and WBC and CRP as laboratory predictors can differentiate uncomplicated from complicated appendicitis in children and help a physician decide on antibiotic or surgical treatment. © 2024, Serbia Medical Society. All rights reserved.