Acute mesenteric lymphadenitis in children: findings related to differential diagnosis and hospitalization

Value of conventional ultrasound and shear‑wave elastography in the assessment of mesenteric lymphadenitis in a paediatric population

The present retrospective study was designed to explore the value of conventional ultrasound (US) and Virtual Touch Tissue Imaging and Quantification (VTIQ) in the assessment of mesenteric lymphadenitis (ML) in a paediatric population. A total of 103 patients with ML and 60 healthy paediatric patients were examined. VTIQ was performed to assess mesenteric lymph node (MLN) stiffness via shear-wave velocity (SWV). Univariate and multivariate logistic regression analyses were conducted to reveal independent variables for the identification of ML. The diagnostic performance of US, and US combined with VTIQ, were compared. All the quantitative VTIQ parameters (including the SWVMean, SWVMax and SWVMin) were significantly greater for MLNs in the control group than for MLNs in the ML group (all P<0.001). The SWV values in the control group were nearly 2-fold greater than that in the ML group. According to the multivariate logistic regression analysis, the longest diameter [odds ratio (OR)=6.042; P=0.046] was revealed to be the strongest independent predictor for ML, followed by the CRP level (OR=2.310; P<0.001) and the SWVMean (OR=0.106; P<0.001). According to the receiver operating characteristic analysis, the area under the curve (AUC) for US combined with VTIQ was 0.890 (95% CI: 0.831-0.949) with a greater sensitivity of 91.26% and a greater specificity of 86.67% than that for US alone (AUC: 0.798; 95% CI: 0.724-0.872; sensitivity: 79.61%; specificity: 80.00%). A significant negative correlation between increased VTIQ parameters and ML was observed. Utilizing VTIQ to assess MLN stiffness offers a non-invasive, convenient, reliable and reproducible approach for identifying mesenteric lymphadenopathy.

Vitamin D combined with compound glutamine for treatment of mesenteric lymphadenitis in preschool children: Efficacy and effect on cellular immune function

BACKGROUND

Mesenteric lymphadenitis (ML) is a major cause of acute diarrhoea in children and affects their health. The etiology of ML is not fully understood and is generally thought to be caused by respiratory viral or bacterial infections, which are closely related to immunocompromise. Vitamin D and compound glutamine have been shown to have immune-regulating effects. This study was conducted to investigate the effects of vitamin D combined with compound glutamine in children with ML.

AIM

To evaluate the efficacy of vitamin D combined with compound glutamine in the treatment of ML in preschool children and analyze its influence on cellular immune function.

METHODS

A total of 180 preschool children with ML treated at our hospital from December 2019 to December 2022 were included and randomly divided into either a control group or a study group. The control group (90 cases) was treated with compound glutamine alone, and the study group (90 cases) was treated with vitamin D combined with compound glutamine for 7 d. The therapeutic effects, adverse reactions, time to improvement of clinical symptoms, serum inflammatory factors [tumor necrosis factor-α (TNF-α), procalcitonin (PCT), and interleukin-8 (IL-8)], immune function indicators [immunoglobulin (Ig)A, IgG, CD3⁺ T cells, and CD4⁺/CD8⁺ ratio], and imaging indicators (lymph) were compared between the two groups. The patients were followed for 2 mo after treatment, and the recurrence rate of abdominal pain was statistically compared between the two groups.

RESULTS

The total effective rate of the study group was 92.22% (83/90) compared with 86.67% (78/90) of the control group (P > 0.05). Fever subsided, abdominal pain disappeared, nausea/vomiting disappeared, and lymph node enlargement disappeared in a shorter time in the study group than in the control group (P < 0.05). The levels of serum PCT, TNF-α, and IL-8 in the study group were significantly lower than those in the control group after 3 days of treatment (P < 0.05). The serum levels of IgA, IgG, CD3⁺ T cells and CD4⁺/CD8⁺ ratio in the study group were higher than those in the control group after 3 days of treatment (P < 0.05). After 3 days of treatment, the longitudinal and transverse diameters of lymph nodes in the study group were shorter than those in the control group (P < 0.05). The incidence of adverse reactions in the study group was 2.22% (2/90) compared with 3.33% (3/90) in the control group (P > 0.05), and the recurrence rate of abdominal pain in the study group was 5.56% (5/90), lower than that in the control group (14.44%, 13/90) (P < 0.05).

CONCLUSION

Vitamin D combined with compound glutamine in the treatment of preschool children with ML is safe and effective, can significantly inhibit the inflammatory response, improve immune function, promote the regression of symptoms, accelerate the recovery of disease, and reduce the recurrence rate.

Diagnostic value of monocyte-lymphocyte ratio and red cell distribution width- lymphocyte ratio against other biomarkers in children with acute appendicitis, cross-sectional study

Our study aims to ascertain the diagnostic value of the Monocyte-lymphocyte ratio (MLR) and red cell distribution width (RDW)-lymphocyte ratio (RLR) by comparing them with other biomarkers in distinguishing patients with and without acute appendicitis (AA). A total of 223 children were recruited in the study conducted according to the Cross-Sectional Study design. Patients under 18 years were assigned to 3 groups; AA, nonspecific abdominal pain (NAP), and a control group. According to the outcome of our research, while C-reactive protein (CRP), white blood cell (WBC), neutrophil count (NEU), neutrophil to lymphocyte ratio (NLR), and MLR had excellent diagnostic power, RLR had acceptable diagnostic power, and platelet to lymphocyte ratio (PLR) had only fair diagnostic power. MLR and NLR, which are simple, inexpensive, and easily accessible parameters, can be recommended to be used together with other biomarkers in diagnosing AA in children.

Rare appendiceal escapades in childhood: the Grande experience!

Acute appendicitis in children is known to present in two broad forms: (1) uncomplicated and (2) complicated. Apart from this, a variety of atypical presentations can occur that may pose difficulty in diagnosis or treatment approach. We hereby present a series of such rare experiences namely appendiceal oxyuriasis, sub-hepatic appendicitis and appendiceal mucocele that were encountered and managed accordingly.