Evolving strategies: Enhancements in managing eosinophilic esophagitis in pediatric patients

Eosinophilic esophagitis is a newly recognized disease first described about 50 years ago.The definition,diagnosis,and management have evolved with new published consensus guidelines and newly approved treatment available to pediatricians,enabling a better understanding of this disease and more targeted treatment for patients.We describe the definition,presentation,and diagnosis of eosinophilic esophagitis including management,challenges,and future directions in children.The definition,diagnosis,and management of eosinophilic esophagitis have evolved over the last 50 years.Consensus guidelines and newly approved biologic treatment have enabled pediatricians to better understand this disease and allow for more targeted treatment for patients.We describe the definition,presentation,diagnosis,management,and treatment in addition to the challenges and future directions of eosinophilic esophagitis management in children.

A Cross-Sectional Study on Current Practice of the Management of Pregnancy Induced Hypertension and Its Maternal and Foetal Complications and Outcome in the Western Part of the State of Libya

Background: Maternal and perinatal mortality and morbidity are mainly affected by hypertension during pregnancy (pre-eclampsia). Haemorrhage and cerebral bleeding are the primary and significant complications of pre-eclampsia. Abruption of the placenta and renal failure are among the major complications caused by this disease. The perinatal complications include Intrauterine Growth Restriction (IUGR), Intrauterine Foetal Death (IUFD), neonatal death, and prematurity. Objective: The purpose of the present study was to examine the incidence of Pregnancy-Induced Hypertension (PIH), pre-eclampsia, the management of PIH, including the early diagnosis, the pharmacological drug management used, and the prevalence of maternal and perinatal complications. Methods and Patients: This cross-sectional study took place in Aljalaa maternity hospital, which represented the west of the state of Libya in the period from 1st January 2012 to 31st December 2012, with patients who were diagnosed, managed, and terminated according to protocol management of the hospital. Results: In the present study, from the total deliveries in Aljalaa Maternity hospital, the incidence of PIH is 8.4% and pre-eclampsia is 5.1%. No maternal mortality, CNS haemorrhaged, hepatic failure, or renal failure. The reported maternal complications included: Eclampsia, HELLP syndrome (Haemolysis, Elevated Liver enzymes and Low platelets), abruption placenta, and pulmonary oedema see in eighteen percent, six percent, nine percent, four percent and less than one percent, respectively. The foetal complications were preterm babies and Intrauterine Growth Restriction (IUGR) in nineteen percent, Low Birth Weight (LBW) in twenty-five percent, Intrauterine Foetal Death (IUFD) in five percent, neonatal death in two percent and, perinatal death in six percent. In the PIH patients, the presence of associated symptoms such as headache, blurred vision, irritability, and the presence of signs such as severe hypertension, generalized oedema, exaggerated reflexes, and abnormal investigations (protein urea, high uric acid, abnormal LFT, haemoconcentration, and low pits) increased the risk of maternal and foetal complications. Conclusion: To decrease mother and newborn mortality and morbidity in PIH patients, a rigorous management protocol is required to implement evidence-based guidelines.

Food allergy in children-the current status and the way forward

Food allergy in children is a major health concern,and its prevalence is rising.It is often over-diagnosed by parents,resulting occasionally in unnecessary exclusion of some important food.It also causes stress,anxiety,and even depression in parents and affects the family’s quality of life.Current diagnostic tests are useful when interpreted in the context of the clinical history,although cross-sensitivity and inability to predict the severity of the allergic reactions remain major limitations.Although the oral food challenge is the current gold standard for making the diagnosis,it is only available to a small number of patients because of its requirement in time and medical personnel.New diagnostic methods have recently emerged,such as the Component Resolved Diagnostics and the Basophil Activation Test,but their use is still limited,and the latter lacks standardisation.Currently,there is no definite treatment available to induce life-long natural tolerance and cure for food allergy.Presently available treatments only aim to decrease the occurrence of anaphylaxis by enabling the child to tolerate small amounts of the offending food,usually taken by accident.New evidence supports the early introduction of the allergenic food to infants to decrease the incidence of food allergy.If standardised and widely implemented,this may result in decreasing the prevalence of food allergy.

Barriers and challenges affecting parents’use of adrenaline autoinjector in children with anaphylaxis

BACKGROUND Anaphylaxis is a life-threatening condition that develops as a reaction to exposure to an allergen which can be found in common foods such as cow's milk,egg,fish,and nuts in children.The use of an intramuscular adrenaline auto-injector(AAI)is considered the most essential treatment in these situations and parents and caregivers are always encouraged to carry this device for use in an emergency which commonly takes place in public places such as restaurants,schools,and parks,where medical staff are not guaranteed to be available.However,previous studies,in different settings,have reported underuse of the AAI by parents.AIM To explore the reasons for underutilisation of the AAI in our community.METHODS A cohort of parents attending the paediatric allergy clinic at Al Ain Hospital in the United Arab Emirates completed a questionnaire survey aimed at assessing their understanding and knowledge of their child's allergy management,including their aptitude with the use of the AAI,as well as their competence and comfort in providing this treatment in an emergency.RESULTS Of 47 parents participating in the study,39 were Emirati parents(83%and most parents who completed the survey were mothers(66%).As expected,food was the main cause of allergic reactions requiring prescription of the auto-injector device.Tree nuts and peanuts were noted to be the most common offending food in these children(62%and 38%,respectively).A doctor provided demonstrations and training on using the auto-injector device to 94%of the parents.More than two-thirds of the parents and caregivers(79%)were deemed knowledgeable on the indication for use of the device.Reluctance to administer the device was expressed by many of the parents,despite their satisfaction with the coaching they received on using the device in the study.CONCLUSION Ongoing coaching and teaching of parents on use of the AAI is paramount.However,this should be carried out together with psychological support to aid the parents to eliminate their hesitancy and acquire sufficient confidence in using the device when needed.Group teaching and sharing experiences is an excellent educational technique in a non-formal setting.Paediatric clinic play therapists can also have a role in needle phobia desensitisation for parents and children.More research is needed to explore the lack of empowerment and other reasons behind their fear and anxiety in using the device to plan effective interventions.