Effect of nutrition-related infodemics and social media on maternal experience: A nationwide survey in a low/middle income country

BACKGROUND Undernutrition is a crucial cause of morbidity and mortality among children in low-or middle-income countries(LMICs).A better understanding of maternal general healthy nutrition knowledge,as well as misbeliefs,is highly essential,especially in such settings.In the current era of infodemics,it is very strenuous for mothers to select not only the right source for maternal nutrition information but the correct information as well.AIM To assess maternal healthy nutritional knowledge and nutrition-related misbeliefs and misinformation in an LMIC,and to determine the sources of such information and their assessment methods.METHODS This cross-sectional analytical observational study enrolled 5148 randomly selected Egyptian mothers who had one or more children less than 15 years old.The data were collected through online questionnaire forms:One was for the general nutrition knowledge assessment,and the other was for the nutritional myth score.Sources of information and ways of evaluating internet sources using the Currency,Relevance,Authority,Accuracy,and Purpose test were additionally analyzed.RESULTS The mean general nutrition knowledge score was 29±9,with a percent score of 70.8%±12.1%(total score:41).The median myth score was 9(interquartile range:6,12;total score:18).The primary sources of nutrition knowledge for the enrolled mothers were social media platforms(55%).Half of the mothers managed information for currency and authority,except for considering the author's contact information.More than 60%regularly checked information for accuracy and purpose.The mothers with significant nutrition knowledge checked periodically for the author's contact information(P=0.012).The nutrition myth score was significantly lower among mothers who periodically checked the evidence of the information(P=0.016).Mothers dependent on their healthcare providers as the primary source of their general nutritional knowledge were less likely to hold myths by 13%(P=0.044).However,using social media increased the likelihood of having myths among mothers by approximately 1.2(P=0.001).CONCLUSION Social media platforms were found to be the primary source of maternal nutrition information in the current era of infodemics.However,healthcare providers were the only source for decreasing the incidence of maternal myths among the surveyed mothers.

Prevalence and risk factors of asymptomatic hepatitis C virus infection in Egyptian children

AIM: To identify the prevalence, risk factors and manifestations of asymptomatic hepatitis C virus (HCV) infection in Egyptian children. METHODS: Children at the age of 1-9 years were screened for HCV antibodies and alanine aminotransferase (ALT) levels. Every child with elevated ALT and/or detectable HCV antibodies was tested for HCV RNA by RT-PCR and compared with two negative controls for risk factors and signs and symptoms of liver disease.RESULTS: We screened 1042 children, six of them had elevated ALT, negative HCV antibody and positive RNA, likely representing acute hepatitis C cases. Fifteen children were HCV seropositive, 5 of them were HCV RNA positive. Asymptomatic HCV infection was present in 2.02% (positive results for either HCV antibodies or HCV-RNA or both). Symptoms such as diarrhea, abdominal pain, history of fatigue and school absence because of illness and risk factors such as dental care were significantly more common among HCV positive cases than among controls. None of the HCV positive children was diagnosed as having signs of advanced liver disease upon clinical or ultrasonographic examination. CONCLUSION: Asymptomatic HCV infection is detectable in 2.02% Egyptian children.

Safety and efficacy of Hansenula-derived PEGylated-interferon alpha-2a and ribavirin combination in chronic hepatitis C Egyptian children

AIM: To investigate the safety and efficacy of a Hansenula-derived PEGylated (polyethylene glycol) interferon (IFN)-alpha-2a (Reiferon Retard) plus ribavirin customized regimen in treatment-naïve and previously treated (non-responders and relapsers) Egyptian children with chronic hepatitis C infection.

Assessment of hepatic fibrosis in pediatric cases with hepatitis C virus in Egypt

AIM: To assess hepatic fibrosis and factors associated with its progression in children with HCV infection. METHODS: At the Hepatology Unit,Cairo University Children's Hospital,a single liver biopsy was performed to 43 children with HCV infection after an informed consent between 1998-2004. Their mean age at liver biopsy was 8.67 ± 4.3 years. RESULTS: Among the 43 patients' biopsies,12 (27.9%) were having no fibrosis,20 (46.5%) mild fibrosis and 11 (25.6%) moderate to severe fibrosis. The median time for development of fibrosis was estimated to be 5.5 years. Developing fibrosis was significantly associated with shorter duration from first detected ALT elevation to biopsy (12 mo vs 1.2 mo,P = 0.015) and having higher levels of direct serum bilirubin (0.3 mg/dL vs 0.5 mg/dL,P = 0.048). No association was found between fibrosis stage and the presence of co-morbid conditions (P = 0.33). CONCLUSION: Hepatic fibrosis was present in 72.1% of children with HCV infection. The development of fibrosis was associated with higher levels of direct serum bilirubin. There was no significant association between fibrosis and age,duration of infection,risk factors,co-morbid conditions and most biochemical parameters.

Value of duplex doppler ultrasonography in non-invasive assessment of children with chronic liver disease

AIM:To investigate the value of duplex Doppler ultrasonography (US) in the assessment of the hemodynamics of the portal and hepatic veins in a cohort of children with chronic liver disease (CLD) and to detect any relationship between the US changes,etiology and severity (or stage) of CLD. METHODS:We prospectively enrolled 25 children with biopsy-proven CLD. Thirteen had cirrhosis (aged 8.9 ± 2.0 years) and 12 had chronic hepatitis (aged 9.3 ± 2.3 years). Gray scale and color-coded duplex Doppler US were performed for all,as well as 30 healthy age and sex-matched controls. Findings were correlated with clinical,laboratory and histopathological characteristics. RESULTS:Prominent caudate lobe was detected in 100% of cirrhotics,but none of the chronic hepatitis or controls. Thickened lesser omentum and loss of the triphasic waveform of the hepatic vein were present in 69.2% and 53.8% of cirrhotics vs 33.3% and 8.3% of chronic hepatitis respectively. Portal vein flow velocity was significantly lower (P < 0.0001) and the congestion index was significantly higher (P < 0.005) in both patient groups compared to controls. Child-Pugh's staging showed a positive correlation with both abnormal hepatic vein waveform and direction of portal blood flow; and a negative correlation with both hepatic and portal vein flow velocities. No correlation with the etiology of CLD could be detected. CONCLUSION:Duplex Doppler added to grayscale US can detect significant morphologic and portal hemodynamic changes that correlate with the severity (stage) of CLD,but not with etiology.

Safety and effi cacy of hepatitis A vaccine in children with chronic liver diseas

AIM： To study the safety and efficacy of hepatitis A vaccine （HAV） in children with chronic liver disease of various etiologies. METHODS： Eleven children with chronic liver disease and thirteen age- and sex-matched controls negative for HAV antibodies were vaccinated against hepatitis A after they gave their informed consent. Children with uncontrolled coagulopathy or signs of hepatic decompensation were excluded. The vaccine （Havrix： 720 ELISA units in 0.5 mL, from GlaxoSmithKline Biologicals） was given intramuscularly in the deltoid in 2 doses 6 mo apart. Children were tested for HAV antibodies one and six months after the ist dose and one month after the 2^nd dose. Total serum bilirubin, alanine aminotransferase （ALT）, and aspartate aminotransferase （AST） were determined immediately before and after one month of the 1st dose of the vaccine. RESULTS： Only 7 out of the 11 patients were positive for HAV antibodies after the 1^st dose of the vaccine, as compared to 100% of the controls. One month after the 2nd dose, all patients tested were positive for HAV antibodies. No deterioration in liver functions of patients was noted after vaccination. No adverse events, immediate or late, were reported by the mothers after each dose of the vaccine. CONCLUSION： Hepatitis A vaccine is both safe and effective in this small studied group of children with chronic liver disease. Given the high seroconversion rate, post-vaccination testing for HAV antibodies is not needed.

Clinical Outcome of Children with Post Bacillus Calmette and Guerin Vaccination Complications: A Single Center Experience

Background: Bacillus Calmette ET Guerin (BCG) vaccine, compulsory in endemic areas, remains the only available vaccine for prevention of Tuberculosis (TB) despite its modest protective value. Complications may arise in healthy/ immunocompromized hosts. Methods: Children presenting with BCG vaccine related complications in the form of local/distant complications were enrolled from 2007-2010 at Cairo University Pediatric hospital. Objectives: assess outcome of BCG related complications in a group of children with post vaccination incidents, identify risk factors for complications among vaccinated children and identify cases of underlying Primary Immunodeficiency (PID) among presenting cases. Results: Fifty one eligible patients were included, forty three were proved immunocompetent, and eight had underlying primary immunodeficiency disorders. Presentations included localized axillary lymphadenopathy, cervical sinuses, granulomatous lesions and disseminated forms Faulty injection sites were strongly associated with complications (p value < 0.001).Patients without underlying PID had larger scar size and younger age at presentations (p values: 0.02, 0.0001 respectively).Resolution of lesions was observed in 97 % (95% CI 97% ± 3%) of cases without underlying PID versus fatal outcome in all cases with underlying immune defects. Conclusion: Local BCG related complications do not necessarily indicate underlying PID, disseminated complications are more serious and warrant further investigations. If PID is suspected, vaccination should be deferred to avoid its potentially fatal outcome.