priya walabh - Academia.edu (original) (raw)

Papers by priya walabh

SAMJ. South African medical journal/South African medical journal, Apr 24, 2024

Authorea (Authorea), Jan 31, 2024

Transplant Infectious Disease, Dec 27, 2023

BMC Pediatrics, Mar 31, 2022

Background: Tenofovir disoproxil fumarate (TDF) is effectively used as the first-line antiviral f... more Background: Tenofovir disoproxil fumarate (TDF) is effectively used as the first-line antiviral for chronic hepatitis B virus (HBV) infection in adults and children older than 12 years. To date, no confirmed case of virologic breakthrough (VBT) in a pediatric case has been reported. Case presentation: Here we describe a case of a 5-year old, asymptomatically infected with HBV infection two months after chemotherapy for precursor B acute lymphoblastic leukemia (ALL). Although the 5-year old male is South African, his family originated from Guinea. At the end of the one-year follow-up, the infection progressed to chronic HBV infection, with a high viral load. At 36 weeks (8 months) post-treatment with lamivudine (LAM), there was a partial virologic response (PVR) and after 61 weeks (14 months), he was switched to TDF rescue monotherapy. Even with TDF treatment, he still experienced VBT and subsequent PVR. The full-length genome of HBV isolated 78 weeks after the switch to rescue TDF monotherapy was sequenced and belonged to genotype E. In addition to the LAM mutations (rtS256G and rtM267L), missense mutations in B-cell, T-cell, HLA class I and II-restricted epitopes emerged, which were to evade and escape host surveillance, leading to delayed viral clearance, persistence and disease progression. Two further events of VBT occurred between weeks 113 and 141 of TDF rescue-therapy. Viral loads and liver enzymes are normalizing progressively with long-term therapy. Conclusion: Although the host immune reconstitution may be delayed, prolonged TDF treatment was effective in treating this pediatric case of HBV infection with VBT and PVR.

Pediatric Transplantation

BackgroundDespite South Africa's rich heritage as pioneers in organ transplantation, access t... more BackgroundDespite South Africa's rich heritage as pioneers in organ transplantation, access to organs remains a major issue in the Gauteng province. This is secondary to an array of socioeconomic and political factors that have implications for organ distribution. Our aim was to assess the contribution of the public sector to solid organ transplantation in Gauteng province and compare the distribution of solid organs between the recipient groups.MethodsThis was a retrospective registry review of consented brain‐dead donors from the public sector within Gauteng from January 1, 2016, to June 30, 2021, coordinated at Charlotte Maxeke Johannesburg Academic Hospital, a tertiary academic hospital.ResultsRecords of 49 deceased donors were analyzed. Mean donor age was 31.5 years with the age group 30–39 years constituting the majority of deceased donors at 15/49 (30.6%); 10/49 (16%) were from pediatric donors. There was a significant discrepancy in allocation between public and private ...

South African Journal of Child Health, 2021

Alagille syndrome (ALGS) and von Willebrand disease (vWD) are both genetic conditions. An individ... more Alagille syndrome (ALGS) and von Willebrand disease (vWD) are both genetic conditions. An individual presenting with two independent genetic conditions is rare and there are no reported cases of these two conditions occurring in a single individual. ALGS often manifests with cholestasis and could lead to end-stage liver disease and associated complications, such as a variceal bleed. vWD is a bleeding disorder. This case report describes the rarity of these two genetic conditions and the management of a potential life-threatening bleed secondary to oesophageal varices and high bleeding risk.

SAJCH, 2022

Biliary atresia, a destructive inflammatory cholangiopathy, leads to liver cirrhosis and subseque... more Biliary atresia, a destructive inflammatory cholangiopathy, leads to liver cirrhosis and subsequent death by the age of 2 years if left untreated.
Biliary atresia splenic malformation (BASM) syndrome makes up 10% of all cases of biliary atresia. Kasai hepatoportoenterostomy (KPE) may
establish continuity of bile flow and slow down progression to cirrhosis if the procedure is performed early in infancy. We describe an 8.5-yearold
boy with known BASM syndrome (polysplenia, intestinal malrotation, interrupted inferior vena cava, shortened pancreas, centralised
liver and left atrial isomerism) who underwent a successful KPE at the age of 3 months. He presented with features suggestive of a late onset
ascending cholangitis (AC) complicated by cholangitic liver abscesses. Resolution of the abscesses with prolonged antibiotic therapy avoided
the need for percutaneous drainage. Once the abscesses resolved, the child underwent a successful cadaveric liver transplantation.

SAJCH, 2021

Alagille syndrome (ALGS) and von Willebrand disease (vWD) are both genetic conditions. An individ... more Alagille syndrome (ALGS) and von Willebrand disease (vWD) are both genetic conditions. An individual presenting with two independent
genetic conditions is rare and there are no reported cases of these two conditions occurring in a single individual. ALGS often manifests
with cholestasis and could lead to end-stage liver disease and associated complications, such as a variceal bleed. vWD is a bleeding disorder.
This case report describes the rarity of these two genetic conditions and the management of a potential life-threatening bleed secondary
to oesophageal varices and high bleeding risk.

BMC paediatrics, 2022

Background: Tenofovir disoproxil fumarate (TDF) is effectively used as the first-line antiviral f... more Background: Tenofovir disoproxil fumarate (TDF) is effectively used as the first-line antiviral for chronic hepatitis B virus (HBV) infection in adults and children older than 12 years. To date, no confirmed case of virologic breakthrough (VBT) in a pediatric case has been reported. Case presentation: Here we describe a case of a 5-year old, asymptomatically infected with HBV infection two months after chemotherapy for precursor B acute lymphoblastic leukemia (ALL). Although the 5-year old male is South African, his family originated from Guinea. At the end of the one-year follow-up, the infection progressed to chronic HBV infection, with a high viral load. At 36 weeks (8 months) post-treatment with lamivudine (LAM), there was a partial virologic response (PVR) and after 61 weeks (14 months), he was switched to TDF rescue monotherapy. Even with TDF treatment, he still experienced VBT and subsequent PVR. The full-length genome of HBV isolated 78 weeks after the switch to rescue TDF monotherapy was sequenced and belonged to genotype E. In addition to the LAM mutations (rtS256G and rtM267L), missense mutations in B-cell, T-cell, HLA class I and II-restricted epitopes emerged, which were to evade and escape host surveillance, leading to delayed viral clearance, persistence and disease progression. Two further events of VBT occurred between weeks 113 and 141 of TDF rescue-therapy. Viral loads and liver enzymes are normalizing progressively with long-term therapy. Conclusion: Although the host immune reconstitution may be delayed, prolonged TDF treatment was effective in treating this pediatric case of HBV infection with VBT and PVR.

BMC Pediatrics, Aug 31, 2022

Background: Pediatric acute liver failure (PALF) is an uncommon, devastating illness with signifi... more Background: Pediatric acute liver failure (PALF) is an uncommon, devastating illness with significant mortality. Liver transplantation remains the mainstay of treatment for irreversible PALF. The purpose of this study was to determine the etiology and prognostic factors associated with outcome of PALF in South Africa and to evaluate prognostic scoring systems used. Methods: Records of 45 pediatric patients younger than 16 years of age who presented with PALF from 1 January 2015 till 31 October 2020 were analysed. Patients were divided into two groups with one group consisting of patients with spontaneous recovery of the liver with supportive treatment (6/45:13.3%) and the second group consisting of patients with poor outcomes who demised (19/45: 42%) or underwent liver transplantation (20/45: 44%). Results: The median age of presentation was 3.3 years (IQR 1.8-6.9) with the 1-5 years age group constituting majority of patients (55.6%). Median time to follow up was 6.1 months (IQR 0.2-28.8). Higher liver injury unit scores were observed in patients who had poorer outcomes (P = 0.008) with a threshold of greater than 246 having a sensitivity of 84% and specificity of 83% (P < 0.001). Higher peak PELD/MELD (P = 0.006) and admission UKELD (P = 0.002) scores, were found in patients with poorer outcomes. Kings College Hospital criteria (KCHC) was useful in predicting which patients would die without liver transplantation (P = 0.002). Liver transplantation was performed in 20/45 (44%) patients with a post transplantation 1 year patient and graft survival of 80%. Conclusion: Although, survival of PALF patients was lower than high and other low-middle income countries, outcomes post transplantation were good. Our study demonstrates the utility of dynamic scoring systems in PALF patients, it underscores the need for early referral and clinical monitoring in a tertiary center once the criteria for PALF have been met.

Transplant Infectious Disease

Case Reports in Pediatrics, 2017

Hepatic hemangiomas are considered to be the most common benign tumors of the liver. They are oft... more Hepatic hemangiomas are considered to be the most common benign tumors of the liver. They are often found incidentally while investigating for other causes of liver disease. Hemangiomas that are less than 10 cm are not expected to cause any problems. Typically, they do not enlarge and, apart from regular follow-up, no definitive treatment is indicated. This is a posthumous case report of a male child with a medium-sized hemangioma from infancy, complicated by cryptogenic cirrhosis and hepatopulmonary syndrome. It demonstrates the challenges of managing a child with such complicated conditions in a resource-limited setting.

SAMJ. South African medical journal/South African medical journal, Apr 24, 2024

Authorea (Authorea), Jan 31, 2024

Transplant Infectious Disease, Dec 27, 2023

BMC Pediatrics, Mar 31, 2022

Background: Tenofovir disoproxil fumarate (TDF) is effectively used as the first-line antiviral f... more Background: Tenofovir disoproxil fumarate (TDF) is effectively used as the first-line antiviral for chronic hepatitis B virus (HBV) infection in adults and children older than 12 years. To date, no confirmed case of virologic breakthrough (VBT) in a pediatric case has been reported. Case presentation: Here we describe a case of a 5-year old, asymptomatically infected with HBV infection two months after chemotherapy for precursor B acute lymphoblastic leukemia (ALL). Although the 5-year old male is South African, his family originated from Guinea. At the end of the one-year follow-up, the infection progressed to chronic HBV infection, with a high viral load. At 36 weeks (8 months) post-treatment with lamivudine (LAM), there was a partial virologic response (PVR) and after 61 weeks (14 months), he was switched to TDF rescue monotherapy. Even with TDF treatment, he still experienced VBT and subsequent PVR. The full-length genome of HBV isolated 78 weeks after the switch to rescue TDF monotherapy was sequenced and belonged to genotype E. In addition to the LAM mutations (rtS256G and rtM267L), missense mutations in B-cell, T-cell, HLA class I and II-restricted epitopes emerged, which were to evade and escape host surveillance, leading to delayed viral clearance, persistence and disease progression. Two further events of VBT occurred between weeks 113 and 141 of TDF rescue-therapy. Viral loads and liver enzymes are normalizing progressively with long-term therapy. Conclusion: Although the host immune reconstitution may be delayed, prolonged TDF treatment was effective in treating this pediatric case of HBV infection with VBT and PVR.

Pediatric Transplantation

BackgroundDespite South Africa's rich heritage as pioneers in organ transplantation, access t... more BackgroundDespite South Africa's rich heritage as pioneers in organ transplantation, access to organs remains a major issue in the Gauteng province. This is secondary to an array of socioeconomic and political factors that have implications for organ distribution. Our aim was to assess the contribution of the public sector to solid organ transplantation in Gauteng province and compare the distribution of solid organs between the recipient groups.MethodsThis was a retrospective registry review of consented brain‐dead donors from the public sector within Gauteng from January 1, 2016, to June 30, 2021, coordinated at Charlotte Maxeke Johannesburg Academic Hospital, a tertiary academic hospital.ResultsRecords of 49 deceased donors were analyzed. Mean donor age was 31.5 years with the age group 30–39 years constituting the majority of deceased donors at 15/49 (30.6%); 10/49 (16%) were from pediatric donors. There was a significant discrepancy in allocation between public and private ...

South African Journal of Child Health, 2021

Alagille syndrome (ALGS) and von Willebrand disease (vWD) are both genetic conditions. An individ... more Alagille syndrome (ALGS) and von Willebrand disease (vWD) are both genetic conditions. An individual presenting with two independent genetic conditions is rare and there are no reported cases of these two conditions occurring in a single individual. ALGS often manifests with cholestasis and could lead to end-stage liver disease and associated complications, such as a variceal bleed. vWD is a bleeding disorder. This case report describes the rarity of these two genetic conditions and the management of a potential life-threatening bleed secondary to oesophageal varices and high bleeding risk.

SAJCH, 2022

Biliary atresia, a destructive inflammatory cholangiopathy, leads to liver cirrhosis and subseque... more Biliary atresia, a destructive inflammatory cholangiopathy, leads to liver cirrhosis and subsequent death by the age of 2 years if left untreated.
Biliary atresia splenic malformation (BASM) syndrome makes up 10% of all cases of biliary atresia. Kasai hepatoportoenterostomy (KPE) may
establish continuity of bile flow and slow down progression to cirrhosis if the procedure is performed early in infancy. We describe an 8.5-yearold
boy with known BASM syndrome (polysplenia, intestinal malrotation, interrupted inferior vena cava, shortened pancreas, centralised
liver and left atrial isomerism) who underwent a successful KPE at the age of 3 months. He presented with features suggestive of a late onset
ascending cholangitis (AC) complicated by cholangitic liver abscesses. Resolution of the abscesses with prolonged antibiotic therapy avoided
the need for percutaneous drainage. Once the abscesses resolved, the child underwent a successful cadaveric liver transplantation.

SAJCH, 2021

Alagille syndrome (ALGS) and von Willebrand disease (vWD) are both genetic conditions. An individ... more Alagille syndrome (ALGS) and von Willebrand disease (vWD) are both genetic conditions. An individual presenting with two independent
genetic conditions is rare and there are no reported cases of these two conditions occurring in a single individual. ALGS often manifests
with cholestasis and could lead to end-stage liver disease and associated complications, such as a variceal bleed. vWD is a bleeding disorder.
This case report describes the rarity of these two genetic conditions and the management of a potential life-threatening bleed secondary
to oesophageal varices and high bleeding risk.

BMC paediatrics, 2022

Background: Tenofovir disoproxil fumarate (TDF) is effectively used as the first-line antiviral f... more Background: Tenofovir disoproxil fumarate (TDF) is effectively used as the first-line antiviral for chronic hepatitis B virus (HBV) infection in adults and children older than 12 years. To date, no confirmed case of virologic breakthrough (VBT) in a pediatric case has been reported. Case presentation: Here we describe a case of a 5-year old, asymptomatically infected with HBV infection two months after chemotherapy for precursor B acute lymphoblastic leukemia (ALL). Although the 5-year old male is South African, his family originated from Guinea. At the end of the one-year follow-up, the infection progressed to chronic HBV infection, with a high viral load. At 36 weeks (8 months) post-treatment with lamivudine (LAM), there was a partial virologic response (PVR) and after 61 weeks (14 months), he was switched to TDF rescue monotherapy. Even with TDF treatment, he still experienced VBT and subsequent PVR. The full-length genome of HBV isolated 78 weeks after the switch to rescue TDF monotherapy was sequenced and belonged to genotype E. In addition to the LAM mutations (rtS256G and rtM267L), missense mutations in B-cell, T-cell, HLA class I and II-restricted epitopes emerged, which were to evade and escape host surveillance, leading to delayed viral clearance, persistence and disease progression. Two further events of VBT occurred between weeks 113 and 141 of TDF rescue-therapy. Viral loads and liver enzymes are normalizing progressively with long-term therapy. Conclusion: Although the host immune reconstitution may be delayed, prolonged TDF treatment was effective in treating this pediatric case of HBV infection with VBT and PVR.

BMC Pediatrics, Aug 31, 2022

Background: Pediatric acute liver failure (PALF) is an uncommon, devastating illness with signifi... more Background: Pediatric acute liver failure (PALF) is an uncommon, devastating illness with significant mortality. Liver transplantation remains the mainstay of treatment for irreversible PALF. The purpose of this study was to determine the etiology and prognostic factors associated with outcome of PALF in South Africa and to evaluate prognostic scoring systems used. Methods: Records of 45 pediatric patients younger than 16 years of age who presented with PALF from 1 January 2015 till 31 October 2020 were analysed. Patients were divided into two groups with one group consisting of patients with spontaneous recovery of the liver with supportive treatment (6/45:13.3%) and the second group consisting of patients with poor outcomes who demised (19/45: 42%) or underwent liver transplantation (20/45: 44%). Results: The median age of presentation was 3.3 years (IQR 1.8-6.9) with the 1-5 years age group constituting majority of patients (55.6%). Median time to follow up was 6.1 months (IQR 0.2-28.8). Higher liver injury unit scores were observed in patients who had poorer outcomes (P = 0.008) with a threshold of greater than 246 having a sensitivity of 84% and specificity of 83% (P < 0.001). Higher peak PELD/MELD (P = 0.006) and admission UKELD (P = 0.002) scores, were found in patients with poorer outcomes. Kings College Hospital criteria (KCHC) was useful in predicting which patients would die without liver transplantation (P = 0.002). Liver transplantation was performed in 20/45 (44%) patients with a post transplantation 1 year patient and graft survival of 80%. Conclusion: Although, survival of PALF patients was lower than high and other low-middle income countries, outcomes post transplantation were good. Our study demonstrates the utility of dynamic scoring systems in PALF patients, it underscores the need for early referral and clinical monitoring in a tertiary center once the criteria for PALF have been met.

Transplant Infectious Disease

Case Reports in Pediatrics, 2017

Hepatic hemangiomas are considered to be the most common benign tumors of the liver. They are oft... more Hepatic hemangiomas are considered to be the most common benign tumors of the liver. They are often found incidentally while investigating for other causes of liver disease. Hemangiomas that are less than 10 cm are not expected to cause any problems. Typically, they do not enlarge and, apart from regular follow-up, no definitive treatment is indicated. This is a posthumous case report of a male child with a medium-sized hemangioma from infancy, complicated by cryptogenic cirrhosis and hepatopulmonary syndrome. It demonstrates the challenges of managing a child with such complicated conditions in a resource-limited setting.