The IX t h Makassed Medical Congress - American University of Beirut

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T h e I X t h M a k a s e d M e d i c a l C o n g r e s s Hepatitis B VIRAL HEPATITIS Florence Lacaille MD Chronic hepatitis B remains a public health problem in many countries, due to the very efficient neonatal and sexual transmission of the virus, the low rate (increased by alcohol drinking) of severe complications before late adulthood, and despite the extension of vaccination programs. Acute hepatitis B is rare in childhood, and may occur very rarely after neonatal transmission, or after sexual exposure in adolescents. In children, chronic hepatitis B is mostly asymptomatic, and the children are often « tolerant » to the virus. However, hepatocarcinoma may develop even at a young age. Cirrhosis may be seen from adolescence. The treatment in childhood is difficult. It is most often not the treatment of a disease, but the prevention of possible complications in adulthood. Therefore it is neither mandatory nor urgent. Screening for complications of hepatitis B should be done once or twice a year. Vaccination of people in close contact with the patient (family) is mandatory, in order to prevent horizontal transmission. Interferon (preferentially long-acting = pegylated) is efficient only in children with elevated transaminases and a low viral load. It is not very well tolerated, should not be used before 3-4 years of age and avoided at adolescence, and should be strictly monitored. Nucleot(s)ide analogues are increasingly used in adults, but the duration of treatment is not well defined, and may be very long (life long ?). Lamivudine leads to the frequent emergence of resistant mutants and should not be used alone. Adefovir is not very efficient. Tenofovir, entecavir and telbivudine have not yet been studied in children. They should not be used outside of a protocol. Hepatitis C The virus is only parenterally transmitted, explaining the high rate of contamination in Egypt due to massive antischistomiasis treatment. Unsafe blood transfusion can also be a cause. The rate of mother-to-child transmission during pregnancy is low (5%), but it is nowadays nearly the only way of contamination for children in countries with a safe blood bank system. The risk of complications in childhood is even lower than for hepatitis B. Cancer has not been seen, and cirrhosis is extremely rare. Alcohol use should be prevented, and vaccination against hepatitis A and B implemented. The treatment, pegylated interferon and ribavirin, depends on the viral genotype. It is very efficient in genotypes 2 and 3 (over 80% success rate), and totally eliminates the virus. In genotype 1 (the more frequent), it is only 50% efficient. Like in hepatitis B, it does not cure a disease, but prevents complications later in life. It is therefore neither mandatory nor urgent. It should be discussed individually, according to the symptoms (usually none), the child’s age, the genotype, the viral load (to determine the duration, 6 or 12 months), the additional risk factors for the liver (hepatotoxic treatment, iron overload of a chronic anemia, co-infection with another virus…). 52
EXPLORATION OF AN HEPATOMEGALY Florence Lacaille MD The liver is palpable beneath the costal rib only in infants. The span is measured clinically by palpation and percussion, and can be controlled by ultrasonography. The characteristics are defined: normal, firm, hard, soft; painful or not. Other symptoms of liver disease are looked for. The complete interview and examination is completed by the first line of tests: - Ultrasonography - AST and ALT - Alphafoetoprotein The cause can be a: - tumour o cancer : especially hepatoblastoma in young children o benign : focal nodular hyperplasia in teenage girls - acute or chronic liver disease o acute viral hepatitis o cirrhosis o congenital hepatic fibrosis - metabolic liver disease o glycogen storage disease - infection o hydatid cyst - heart failure : in infants - vascular disease : Budd-Chiari syndrome The first tests allow for a specific orientation, and the diagnosis of emergencies (cancer, heart failure) and further specialized explorations. PEDIATRIC GASTROENTEROLOGY HEPATOLOGY AND NUTRITION Firas Semaan MD How should Helicobacter pylori infected children be managed? It is now recognized that Helicobacter pylori, like most enteric infections, is mainly acquired in Childhood. The findings in a number studies suggest that infection is acquired before the age of five. The prevalence of infection is highest in children in the developing world where up to 75% of children may be infected by the age of 10. In the developed world the prevalence of infection is noticeably increased among socially deprived children. The diagnosis of H pylori infection in childhood is most often made at endoscopy, for which there are many indications. Symptoms such as abdominal pain, vomiting, and haematemesis may be associated with duodenal ulcer and H pylori infection. 53
Page 1 and 2: The IX th Makassed Medical Congress
Page 3 and 4: CONGRESS PRESIDENT Said Sayegh, MD,
Page 5 and 6: GENERAL INFORMATION
Page 7 and 8: • Target Audience: Physicians, Pr
Page 9 and 10: Durriya Sinno, MD Pediatrics Americ
Page 11 and 12: Moderators
Page 13 and 14: PEDIATRICS Bassem Abou Merhi, MD Pe
Page 15 and 16: Maroun Sokhn, MD Pediatrics Saint G
Page 17 and 18: Scientific Program
Page 19 and 20: Session 3: Intensive Care Neonatolo
Page 21 and 22: Session 1: Pediatric Intensive Care
Page 23 and 24: 8:00 - 8:05 08:05 - 08:10 Welcome r
Page 25 and 26: Cardiology Session III: Interventio
Page 27 and 28: Cardiology Session VI: Intervention
Page 29: Cardiology Symposia (NON-CME) Frida
Page 32 and 33: T h e I X t h M a k a s e d M e d i
Page 102 and 103:
T h e I X t h M a k a s e d M e d i
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The IX t h Makassed Medical Congress - American University of Beirut

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