Browsing by Author "West Virginia University School of Medicine Morgantown"

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    Anterior pituitary hormone effects on hepatic functions in infants with congenital hypopituitarism
    (2007-04-01) Wikrom Karnsakul; Pairunyar Sawathiparnich; Saroj Nimkarn; Supawadee Likitmaskul; Jeerunda Santiprabhob; Prapun Aanpreung; West Virginia University School of Medicine Morgantown; Mahidol University; Icahn School of Medicine at Mount Sinai
    Background: Congenital hypopituitarism is an uncommon cause of neonatal cholestasis. Little is known about the effect of anterior pituitary hormone on hepatic functions. Methods: A retrospective review of the medical charts of eight infants with congenital hypopituitarism and neonatal cholestasis was performed. The results of endocrinological investigations, eye examinations, and magnetic resonance imaging were used to classify these infants. Results: Eight infants (4 male and 4 female; mean age, 1.7 weeks) who presented with cholestatic jaundice subsequently (mean age, 7.6 weeks) developed isolated or multiple anterior pituitary hormone deficiencies. Persistent hypoglycemia, ocular abnormalities, and microphallus were often clinical signs prompting further endocrinological and radiological investigations. Septo-optic dysplasia was prevalent, occurring in five cases. Cholestasis and hepatosplenomegaly resolved within a mean of 9.7 and 10 weeks, respectively, in the majority of cases after replacement of glucocorticoid and thyroid hormones. However, transaminase levels remained high after hormone replacement. Cortisol deficiency and hypoglycemia were noted in all cases, often following stress. Hyperlipidemia persisted in one case after the resolution of cholestasis and after corticosteroid and thyroid hormone replacement therapy. Growth hormone deficiency was not corrected due to the absence of hypoglycemia after corticosteroid hormone, an infant's age, and/or a lack of financial resources. Conclusions: In our series, it appears that glucocorticoid and thyroid hormones play a significant role in the resolution of cholestasis and hepatosplenomegaly. A persistently elevated transaminase level and hyperlipidemia after corticosteroid and thyroid hormone replacement may indicate the need for long-term follow-up and/or growth hormone therapy.
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    Vanishing bile duct syndrome in a child with toxic epidermal necrolysis: An interplay of unbalanced immune regulatory mechanisms
    (2006-06-19) Wikrom Karnsakul; Thaschawee Arkachaisri; Kanit Atisook; Wanee Wisuthsarewong; Yudhtana Sattawatthamrong; Prapun Aanpreung; West Virginia University School of Medicine Morgantown; Mahidol University; Department of Pediatrics
    Vanishing bile duct syndrome (VBDS) is a rare disorder and requires a liver biopsy for a diagnosis. The condition has not been reported in children with toxic epidermal necrolysis (TEN). The etiology of VBDS in our patient with TEN is most likely from drug hypersensitivity. A high index of suspicion will prompt clinicians to start more specific investigations and treatments. The use of immunosuppressive agents, intravenous immunoglobulin and ursodeoxycholic acid has not been consistently successful in these patients. A new approach with biologic agents such as anti-tumor necrosis factor-α may be a promising therapy and reduce severe adverse outcomes.
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    Willingness to be vaccinated against shigella and other forms of dysentery: A comparison of three regions in Asia
    (2006-01-23) Robert Pack; Yaping Wang; Amber Singh; Lorenz Von Seidlein; Al Pach; Linda Kaljee; Piyarat Butraporn; Gong Youlong; Lauren Blum; Zulfiqar Bhutta; Siti Sapardiyah Santoso; Dang Duc Trach; Imam Waluyo; Andrew Nyamete; John Clemens; Bonita Stanton; West Virginia University School of Medicine Morgantown; International Vaccine Institute, Seoul; University of Maryland, Baltimore; Mahidol University; Fudan University; ICDDR, B Centre for Health and Population Research; The Aga Khan University; Badan Penelitian Dan Pengembangan Kesehatan, Kementerian Kesehatan Republik Indonesia; National Institute of Hygiene and Epidemiology Hanoi; Wayne State University
    We conducted a cross sectional survey of 3163 women and men in six Asian countries to examine willingness for children and adults to be vaccinated against shigellosis and other forms of dysentery. The six sites were clustered into three regions for ease of comparison. The regions are: Northeast Asia (China), Southeast Asia (Thailand, Vietnam, and Indonesia) and South Asia (Bangladesh and Pakistan). We used multiple logistic regression to identify region-specific models for vaccination willingness for both adults and children. A vaccine to protect against dysentery, if available would be very much in demand throughout the three Asian regions for children. For adults, the responses indicate that vaccine uptake by adults will vary. A large proportion of respondents in all regions, specifically in China, do not perceive themselves at risk yet still consider a shigellosis vaccine desirable. © 2005 Elsevier Ltd. All rights reserved.