bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of Intra-Articular Procedures through Safe Surgical Hip Dislocation Approach to Manage Residual Hip Deformities Secondary to Legg-Calv-Perthes Disease: A Systematic Review and Meta-Analysis
Authors: Gebeily Mohamed E L , Rayan Ahmed , Mohamed Salah Mohamed Mohamed
Published: July 2024

Background

Legg-Calve-Perthes disease (LCPD) is a childhood condition characterized by femoral head osteonecrosis. The osteonecrotic lesion eventually heals, but persistent deformity to the proximal femur and acetabulum might induce hip discomfort and dysfunction following recovery. Previous reports have noted that between 30% and 50% of individuals affected by LCPD to have residual hip symptoms that persist and a frequent precursor to hip osteoarthritis in young adulthood.

Aim of the Work

The aim of the present study is to review the efficacy of intra-articular procedures through surgical hip dislocation approach to residual hip deformity secondary to Legg- Calve-perthes disease.

Patients and Methods

A Systematic Review and Meta-Analysis, We will include: Randomized control trails (RCTs), controlled clinical trials, retrospective cohort studies and we will exclude: case reports, case series studies, cross sectional studies and non English studies.

Results

The surgical hip dislocation approach allows the surgeon to dynamically evaluate the hip, identify sources of impingement, and treat intraarticular and extraarticular abnormalities.

Conclusion

Head and neck osteochondroplasty performed through the surgical dislocation approach, combined with other procedures such as FHRO, RFNL, ITO and acetubular osteotomies relieved pain, improved ROM and restored function in most patients with no major complications.
Volar versus Dorsal Plating for Fracture Distal Radius (A Systematic Review/Meta-Analysis)
Authors: Diab Ramy Ahmed , Mohamed Amr Moustafa , Razmy Rophael Mina Mansour
Published: July 2024

Background

Fractures of the distal radius are the most common of all orthopedic injuries accounting for nearly 16–20% of all fractures presenting to the emergency department. Treatment of distal radius fractures historically has been predominantly by inexpensive means as some surgeons advocate treatment by manipulation and plaster immobilization.

Aim of the Work

This study aims to review systematically and to meta-analyze the currently available literature regarding volar and dorsal plating for distal radial fractures regarding functional outcome and complications.

Patients and Methods

This study was approved by the Ethical Committee of Ain Shams University Faculty of Medicine. Written informed consent was not needed because of the study design(systematic review).

Results

The results of our study showed that there were significant difference between volar and dorsal groups regarding ROM (Flexion, Extension, Ulnar deviation and Radial deviation). Also we found significant difference regarding PRWE Score, DASH Score and complication rate. Also the results showed non significant difference between volar and dorsal plating groups regarding VAS Score for Pain, Grip Strength and ROM (Supination and Pronation). We also found the dorsal fixation offers a lower risk of neuropathy and carpal tunnel syndrome than the volar fixation, But a higher risk of tendon irritation and rupture in dorsal group so we recommend removal of dorsal plates after good healing and regain good range of motion.

Conclusion

In conclusion, Based on our outcomes of current systematic review and meta-analysis, it appears that fractures of distal radius treated previously with dorsal plating showed poor outcomes and unclear results, meanwhile more recent studies favored volar plating for fixation compared to indicated dorsal plating biased by these studies.
A Systematic Review & Meta-Analysis on Criteria for Transcranial Motor Evoked Potential for Intraoperative Neuromonitoring during Spine Surgeries
Authors: Ahmed Abdelrahman Wagdy , Elsayed Mohamed Nabil , Elzahlawy Hany Nabil
Published: July 2024

Background

Spine Surgery is the definitive treatment and indication for many traumatic spine illnesses, as well as several pathologies and deformities. Surgery in such a vital organ, formed in its core of the neural pathway that controls the whole of the human body, must be as safe, and least risky as possible, so as to prevent injuries to the neural pathway, or the surrounding vessels, or vital organs. Such great importance of the spine and the spinal cord, has urged surgeons and researchers to create techniques through which spine surgeries are well monitored, and the efficacy and normal physiology is well assessed intraoperatively.

Objective

to conduct a systematic review and meta-analysis of what has been published of the studies using transcranial motor evoked potential for intraoperative neuromonitoring during spine surgeries. This is for acquiring the best criteria for transcranial motor evoked potential (TcMEP) utilization for intraoperative neuromonitoring, as well as identifying the most accurate alarm point for TcMEP during intraoperative neuromonitoring.

Patients and Methods

a comprehensive and detailed search of literature was conducted through the Pubmed, Google Scholar, and Research Gate databases including articles related to intraoperative neuromonitoring modalities and transcranial motor evoked potential alarm points and criteria. Searches were performed with a combination of MeSH (medical subject headings). Only Studies published in the English Language with no lower date limit were included. The following search string was used in all databases; (“Intraoperative Neuromonitoring” or “Transcranial Motor Evoked Potential”).

Results

In a prospective study conducted in 2018, performed on 2867 patients, using a 70 % decrease in amplitude of the TcMEP curve as an alarm point during high-risk spinal surgeries, the number of true positive to false positive cases was found to be 126/234, while the number of true negative cases to false negative cases was found to be 2362/9 cases in total. The study demonstrates the necessity of intraoperative neuromonitoring for high-risk spinal surgery. 136 cases in this study were identified as rescue cases, as intraoperative TcMEP alert occurred and intraoperative maneuverings were done to overcome those alerts, hence hindering occurrence of postoperative neural deficit.

Conclusion

As regards different TcMEP alarm point values, it has been concluded that an alarm point of 50-60% decrease in amplitude of TcMEP is a more sensitive alarm point, than a higher value alarm point of the same modality. An alarm point of > 70% decrease in amplitude has a much less sensitivity value than lower alarm points, which in turn will result in a lot of missed adverse events, and a higher percentage of false negative values.
A Systematic Review of Methods of Fixation of Greater Trochanter Fracture during Hip Arthroplasty
Authors: Farag Osama , Mehasseb Ahmed , Mohamed Islam , Taalb Ahmed
Published: July 2024

Background

The rigid fixation of greater trochanter has been supported by more and more surgeons, but the choice of fixation is still controversial. Traditional steel wires and titanium is widely used because of its relatively simple procedure and low cost. But the high failure rate of internal fixation also led orthopedists to seek for other more effective fixation methods.

Objective

To compare between methods of fixation of greater trochanter during hip arthroplasty according to type and postoperative outcome.

Patients and Methods

Studies that meet the inclusion criteria were reviewed and data were analysed. We assessed the participants, methods, and intervention effects of included studies for heterogeneity. This enabled us to determine whether results can be pooled across studies.

Results

This review was on Non randomized and randomized controlled trials, prospective and retrospective studies which compare different methods of fixation of trochanter during hip arthroplasty. The search strategy identified 780 unique citations. Screening of titles and Abstracts identified 93 potentially relevant articles. Full text review of these articles identified 10 studies meeting the inclusion criteria. 10 studies were included 8 were retrospective and 2 prospective studies.

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2021.

Data Extraction

If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures.

Conclusion

The different fixation methods were successful in achieving proper reduction and fixation of greater trochanteric fractures during hip arthroplasty. We preferred the cable plates, which not only provides strongest fixation but also results in lower rate of postoperative complications. But further prospective randomized and cohort studies are needed to validate their safety and efficacy.
Functional Outcomes of Primary Subtalar Arthrodesis versus Late Subtalar Arthrodesis in Sanders Type IV Calcaneal Fractures
Authors: Naguib Bishoy Emil , ElShazly Ossama Abdelraouf , Abd-Ella Mohamed Mokhtar , Abdelrahman Amr Farouk
Published: July 2024

Background

Sanders type IV calcaneal fractures are challenging. They are more likely to result in painful subtalar arthritis and subsequent subtalar arthrodesis. There is no consensus about the best management, so our study was conducted to compare the functional outcomes of primary subtalar arthrodesis with those of late subtalar arthrodesis.

Methods

From 2019 till 2022, 34 patients with Sanders type IV calcaneal fractures were included. Seventeen patients were managed by open reduction and internal fixation plus primary subtalar arthrodesis, while the other seventeen patients were treated conservatively followed by calcaneoplasty and late subtalar arthrodesis. Outcomes were measured by two scores: (1) the American Orthopaedic Foot and Ankle Society’s Ankle-Hindfoot scale (AOFAS-AHS) and (2)Foot and Ankle Ability Measure - Activities of Daily Living sub scale (FAAM-ADL). We also documented the union rate at one year, the wound complications and the need for second surgeries.

Results

Twenty-nine patients were followed for at least two years. At one-year follow up, the mean AOFAS-AHS for group A and group B were 72.86 (SD 3.13) and 70.80 (SD 3.63) (P = .12) respectively, while the mean FAAM score for group A and B were, respectively, 57.29/84 (68.20%) (SD 2.27) and 55.27/84 (65.80%) (SD 2.74) (P = .04). At two-year follow up, the mean AOFAS-AHS for group A and group B were 74.42 (SD 1.95) and 73.80 (SD 1.9) (P = .88) respectively, while the mean FAAM score for group A and B were, respectively, 59.21/84 (70.49%) (SD 1.6) and 58.73/84 (69.92%) (SD 1.7) (P = .44). The complications were comparable.

Conclusion

Primary subtalar arthrodesis is a successful treatment option for these severe life-changing fractures. It may reduce the overall disability time.

Level of Evidence

Level II
Total Hip Arthroplasty versus Hemiarthroplasty for the Treatment of Displaced Femoral Neck Fracture in Elderly
Authors: Bassiony Ayman Abdelaziz , Elshabrawy Waleed El Sayed , Sayed Afifi Abdelrahman Abdelsalam
Published: July 2024

Background

Displaced intracapsular hip fractures are most commonly treated using either total hip arthroplasty (THA) or hemiarthroplasty.

Aim of the Work

To review systematically studies about the use of Total hip arthroplasty Versus hemiarthoplasty in management of displaced femoral neck fracture in elderly.

Patients and Methods

We included randomized controlled trials, including cluster RCTs, controlled (non-randomized) clinical trials or cluster trials, prospective and retrospective comparative cohort studies, and case-control or nested case-control studies. We excluded cross-sectional studies, case series, and case reports. Search results were uploaded to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart were produced based on the search results and the inclusion/exclusion criteria.

Results

In our study there was statistically significant increase in the incidence of Reoperation in total hip arthroplasty (3.5%) than hemiarthroplasty (2.3%) with p-value < 0.001. Regarding Dislocation, there was statistically significant increase in the incidence of Dislocation in total hip arthroplasty (3.2%) than hemiarthroplasty (1.7%) with p-value < 0.001. Regarding Infection there was statistically significant increase in the incidence of Infection in total hip arthroplasty (4.5%) than hemiarthroplasty (3.4%) with p- value < 0.001. Regarding General Complications including: (Pneumonia – DVT- Pulmonary embolism- Myocardial infarct- Cerebral vascular lesion- Acute kidney failure- life threatening complications there was statistically no significant difference in the incidence of General complications in hemiarthroplasty (5.5%) and total hip arthroplasty (5.4%) with p-value = 0.608.

Conclusions

The authors concluded that DMTHA offered a better functional outcome than BA with no significant complications or mortality, and there was no significant difference between DMTHA and BA in the rate of dislocation.
Use of Tranexamic Acid versus Use of Drain in Total Knee Arthroplasty: A Systematic Review, and Meta-Analysis
Authors: Kamal Asal Mohamed , Elshabrawy Waleed , Nazer Ibrahim Raef Khalaf
Published: July 2024

Background

Total knee replacement (TKR) is a very common operation to deal with advanced osteoarthritis to relieve pain and disability. Undergoing TKR may necessitate allogenic blood transfusion and patients remain concerned about the potential serious complications of transfusion. tranexamec acid (TXA), antifibrinolytic which can minimise the need for blood transfusion.

Objective

To assess the therapeutic importance and side effects of tranexamic acid and the use of drain in TKR and to conduct a systematic review and meta-analysis of what has been published about this topic.

Patients and Methods

This is a systematic review study and meta-analysis on human subjects studied in different literatures collected from different medical websites up to August 2022 that dealing with the therapeutic importance and side effects of tranexamic acid and the use of drain in TKR. The study was performed in the Orthopedic Surgery Department, Faculty of Medicine, Ain Shams University along the period from December 2021 to August 2022.

Results

The study showed that the incidence of females was more than that of males; 53.65% and 17.03% in TXA group, respectively and 6.897% and 22.45% in non-TXA group, respectively. The total incidence was 70.65% in TXA group and 29.35% in non-TXA group. The study showed that the mean ages were 66.15 ± 4.53 and 67.98 ± 5.91 y in TXA and drain groups, respectively with insignificant difference. The mean weights were 64.98 ± 3.24 and 67.79 ± 5.198 Kg in TXA and drain groups, respectively. The mean BMI was 26.89 ± 1.99 26.72 ± 1.49 kg/m2 in the two groups, respectively.

Data Sources

Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2023.

Conclusion

Tranexamic acid is effective and safe in reducing blood loss, the requirement for blood transfusion, and drain output in patients undergoing knee arthroplasty with less total postoperative complications.
Evaluation of Therapeutic Efficacy of Mucus and Tissue Extracted from Biomphalaria alexandrina Snails on Mice Infected with Schistosoma mansoni
Authors: Abou-Gamra Maha M , Mossalem Hanan S , Sarhan Rania M , Anwar Mona M , Nafie Esraa H
Published: July 2024

Schistosomiasis is a neglected tropical disease with considerable morbidity. Praziquantel though safe and efficacious does not prevent reinfection and the emergence of drug resistance is of great concern. This study was done to evaluate the therapeutic efficacy of mucus and nucleoproteins extracted from Biomphalaria alexandrina snails on miracidia, cercariae and Schistosomamansoni adults in vitro and assess their in vivo effect on mice experimentally infected with Schistosoma mansoni through parasitological, pathological and biochemical parameters.The in vitro study proved that the mucus had a better lethal effect on cercariae than miracidia, on contrast to NPs which was better on miracidia. The mucus effect surpassed the NPs as regard the lethal effect on adults in vitro. The effect of mucus on S. mansoni females and males was almost equivocal except for the effect after 72 hours where 80 µg/ml caused 100% lethal effect on adult females. The effect of NPs on S. mansoni adult females was better than adult males at the highest used concentration of 100 µl/ml after 72 hours with a 60% lethal effect. However, at 48 hours the same concentration had a better lethal impact on males (25%) than females (20%). The in vivostudy proved that the combined NPs or mucus to PZQ added to the effect of individual PZQ considering its effect on ova count, oogram pattern and granuloma parameters. The histopathological results denoted a relevant potential for NPs when compared to the rest of the groups and the control though, the PZQ still showed the best findings. The effect of PZQ alone or combined with mucus or NPs was equivocal resulting in 100% TWB reduction. As regard oxidative stress markers, NO decreased level was best shown by combined PZQ and NPs, while, as regard GSH level, the individual PZQ showed the best increased level. This study concluded that mucus and NPs had cercaricidal, miracidial and antischistosomal effect in vitro and that their combination could be considered as a sharing therapeutic adding to PZQ potentiality in vivo for the treatment of schistosomiasis for further investigations.
Potential Efficacy of Toxoplasma gondii Extracellular Vesicles in Protection against Acute Experimental Toxoplasmosis
Authors: Hassan Eman M E , Tawfeek Gihan M , Abou-El-Naga Iman F , Abd El Fattah Dina S , Meselhey Rasha A
Published: July 2024

Toxoplasmosis is a zoonotic disease thought to infect 1.5 billion people worldwide. It is a significant food- and water-borne illness that can lead to a major opportunistic infection in patients with impaired immune systems. As a result, there is a pressing need to provide better alternatives for effective long-term disease control, such as vaccinations, as there is no treatment that can eradicate bradyzoites within tissue cysts.

Exosomes are multivesicular entities that fuses with plasma membranes to form nanograde membrane-bound vesicles that are secreted by the majority of cell types. Exosomes play important functions in intercellular communication and several of them are well described and known to have immunomodulatory capabilities. Exosomes generated from Toxoplasma gondii (T. gondii) were isolated and their protective effectiveness and immunological responses against acute T. gondii infection in mice was investigated.

T. gondii exosomes were isolated and identified by transmission electron microscopy. Mice were immunized with T. gondii tachyzoites derived exosomes (100 μg, 3 doses intramuscular with 2 weeks interval) to investigate the vaccine’s efficiency by challenging the mice with T. gondii RH strain tachyzoites administered intraperitoneal.

Exosomes from T. gondii were successfully isolated and characterized. T. gondii exosome-immunized mice showed a longer survival rate compared to the unimmunized group. T. gondii derived exosomes could be a promising vaccine candidate for protection against toxoplasmosis.
Health Related Quality of Life of Children with Pediatric Mental Disorders and Their Caregivers
Authors: Mohamed Zaky Eman Ahmed , Adly Amira Abdel-Monaem , Ahmed Mahmoud Rana Abdelhakim , Abdel Ghani Ahmed Fadl Elkareem
Published: July 2024

Background

Studies have shown that the presence of pediatric mental disorders causes great impairment in academic, social, and professional activities as well as in the quality of life (QoL) of the patients as well as their caregivers.

Aim of the Work

Compare the health related quality of life (HRQoL) scores of children with pediatric mental disorders and their caregivers to those of apparently healthy children of comparable sex and age.

Patients and Methods

This was an observational study that included seventy-five (75) children with various pediatric mental disorders of different diagnoses (25 cases ASD, 25 cases nocturnal enuresis, 25 cases ADHD) represented the patient group (1). They were 25 females and 50 males. Their ages ranged between 4–15 years with mean ± SD of 9.32 ± 4.72 years. Another 25 healthy children matched in age and sex with the patients’ group (1) were selected as a control group (2).

Results

Caregivers of children with ASD, nocturnal enuresis and ADHD had an elevated risk of experiencing mental health problems. Children with ASD, enuresis and ADHD have a higher risk for additional behavioral problems tested by Pediatric Symptom Checklist, Child Behavior Checklist and DSM-V. Female cases, in all subgroups, had lower scores than male cases in the three subgroups regarding PSC and CBCL of attention, internalizing and externalizing subscales; however, results didn’t reach level of significance

Conclusion

Children with ASD, enuresis and ADHD and their caregivers have a higher risk for additional behavioral problems than children without mental disorders.
The Effectiveness of High versus Low Dose Corticosteroid therapy in Pediatric Patients with Acute Respiratory Distress Syndrome
Authors: Ibrahim Hanan M , Ahmed Ahmed R , Sakr Hossam M , Abd Al Aziz Manal M , Abdelaty Oun Habeba M
Published: July 2024

Background

When the lungs fill with fluid as a result of an infection or injury, acute respiratory distress syndrome ensues. Inflamed and fluid-filled lungs occur. They become rigid as a result, making it difficult for them to breathe fully. Blood oxygen levels will fall, endangering the health of other organs. Patients will require a ventilator to help them breathe while their lungs mend. The aim of this study was: to evaluate safety and efficacy of high dose therapy in acute respiratory distress syndrome pediatric patients and to compare safety and efficacy of high dose versus low dose therapy in Acute respiratory distress syndrome patients.

Patients and Methods

A Prospective open label randomized trial included 15 patients as group1 received high dose corticosteroid therapy for 3 consequent days, high dose Methyl prednisone 30 mg/kg/day and 15 patients as group 2 received low dose corticosteroid therapy for 3 consequent days, low dose Methyl prednisone 2 mg/kg/day. Clinical and laboratory data chest ultrasound and bronchoalveolar lavage to measured pre collagen peptide were studied in each group before and after corticosteroid therapy.

Results

In the present study 15(50%) patients received high dose steroid and 15 (50%) patients received low dose steroid, male 23 (70%), female 7 (30%), age 7 (3.0-30.0), weight (9.55 ± 6.63), there was no significant difference in prognosis and total days in pediatric intensive care unit between high and low dose corticosteroid therapy as prognosis improving 17 patients (55%), death 13(45%) and As regards total days in pediatric intensive care unit median in high dose corticosteroid therapy 24.0 (15.50-33.0) and median in low dose corticosteroid therapy 18.50 (11.0-23.50) less days in pediatric intensive care unit in low dose steroid therapy group than high dose steroid therapy group but no significant difference between two groups as regarding decrease in chest ultrasound (BLUE Score) and increase in pre collagen peptide in bronchoalveolar lavage between study groups .

Conclusion

there was no significant difference in prognosis and total days in pediatric intensive care unit between high and low dose corticosteroid therapy as regarding change in chest ultrasound (BLUE Score) and change in pre collagen peptide in bronchoalveolar lavage between study groups.
Final Height in Patients with Congenital Adrenal Hyperplasia
Authors: El Kholy Mohamed Salah , Elsedfy Heba Hassan , Ahmed Rana Abdelhakim , Hassan Nawar Marwa Magdy , El-Desouky Ashour Mohammed Kamel
Published: July 2024

Background

The final adult height of patients with congenital adrenal hyperplasia (CAH) is usually less than the target height (TH). This could be attributed to androgen excess or treatment with steroids. Androgen excess can occur at any age leading to accelerated growth, early epiphyseal closure and compromised final adult height (Webb and Krone, 2015), (Charmandari et al., 2004).

Aim

evaluate growth and final height in children and adolescents with CAH.

Methodology

This retrospective study was conducted on 36 patients diagnosed with CAH, data was collected from patients' records within endocrinology clinic, Children's Hospital, Ain Shams University.

Result

Our patients had a mean final height and final height SDS of (161.68±6.48 cm and -0.41) and (151.03±6.1 cm and -0.67) for males and females respectively. Final adult height was less than target height (mean target heights were 168.8± 3.54 cm and 157.1± 6 cm for males and females respectively). The median target height in our study was 158.4 cm and mean target height SDS corrected to mid-parental target height was -0.43 ± (1.26). The mean daily hydrocortisone was 15.67 (± 3.26 SD) mg/m2 per day with range (9.9 – 24) mg/m2. There was no correlation between final heights and the cumulative doses and mean daily doses of hydrocortisone. There was no correlation between final height SDS in both sexes and age of starting steroid therapy. The bone age of our patients was advanced on average by 2 years compared to chronological age at final height.

Conclusion

the final height of CAH patients treated with glucocorticoids is lower than the population norms and is lower than what would be predicted based on parental height.
Abnormal Glucose Tolerance Among Children with Cystic Fibrosis
Authors: El Seify Magda Yahia , Ahmed Mahmoud Rana Abdelhakim , Zakaria Hassan Safeya Hamdy , Mohamed Salim Ahmed Esam , Ahmed Ali Heba Allah
Published: July 2024

Background

Cystic fibrosis (CF) is a severe, autosomal recessive disease of high prevalence caused by mutations of the cystic fibrosis transmembrane conductance regulator (CFTR) gene which is located on the long arm of chromosome 7.

Objective

to screen for glucose tolerance abnormalities among children with cystic fibrosis.

Patients and Methods

This was a cross-sectional study conducted on 25 cystic fibrosis patients in the age group from 1 – 15 years in the Pediatric pulmonology clinic, from the first of July 2020 to the end of January 2022. The patients were classified according to their glucose tolerance results into CF patients with normal glucose tolerance and CF patients with abnormal glucose tolerance.

Results

Our analysis also showed that the most important factor associated with abnormal glucose tolerance test was found to be higher age and glycosylated hemoglobin. The previous findings highlight the need for routine screening of CF patients to exclude CFRD or any abnormality in glucose tolerance in these patients.

Conclusion

The current study demonstrated that abnormal glucose tolerance is not uncommon among the studied CF patients. Our results concluded that abnormal glucose tolerance was significantly associated with older age and higher glycosylated hemoglobin.
Comparison of Vitamin D2 and Vitamin D3 Supplementation Parenterally in Raising Serum 25-Hydroxy vitamin D Status in Pediatric Patients
Authors: Elsedfy Heba Hassan , Ahmed Mahmoud Rana Abd Elhakim , Hassan Nawar Marwa Magdy , Habib Diana Rashad
Published: July 2024

Background

There is a controversy regarding the effect of vitamin D2 and D3 in elevating and sustaining 25(OH)D levels. Aim: This study will concentrate on the effect of parenteral administration of both vitamins on serum 25(OH)D levels.

Methods

Randomized controlled clinical trial, conducted in Pediatric Endocrinology Unit, Ain Shams University, Cairo, Egypt, where 50 participants who had vitamin D deficiency were recruited. Subjects were divided into two groups, 25 patients per group (group A received a single dose of 200,000 IU of intramuscular vitamin D2 and group B received 200,000 IU of intramuscular vitamin D3). History of sun exposure and dietary intake of calcium, assessment of anthropometric measures and tanner staging, laboratory investigations were documented. Follow up of serum level of 25(OH)D was done every month for three consecutive months.

Results

Parenteral vitamin D3 supplementation in group B patients resulted in significantly higher increments in 25(OH)D level than that achieved by parenteral vitamin D2 supplementation in group A after 1st, 2nd, and 3rd months of the supplement (p = 0.000). Vitamin D3 supplementation resulted in a significantly greater increment in serum 25(OH)D levels from 1st to 2nd month and from 1st to 3rd month than Vitamin D2 supplementation with a P value of 0.039 and 0.018 respectively. One hundred percent of group B participants who received vitamin D3 reached sufficient level (41.04 ± 10.04) after 1 month while 80% of participants in group A who received vitamin D2 reached a sufficient level after 1 month and 20% of participants after 2 months (P = 0.018).

Conclusion

We can conclude that parenteral vitamin D3 supplementation was more effective in raising serum 25(OH)D status in pediatric patients than parenteral vitamin D2 supplementation.
Relation of Total Antioxidant Capacity to Clinical Severity of COVID-19 Infection in Paediatric Patients
Authors: Ahmed Hoda Nasser , Emam Ehab Khairy , Nassar Maie Fouad , Awad Yosra Mohsen
Published: July 2024

Objectives

The pathogenesis of COVID-19 infection is still not well clarified. In this regard oxidative stress and its relation to disease severity is one of the topics that need to be investigated.

Aim

This study was carried out to investigate the relationship between the oxidant stress and antioxidant system represented by total antioxidant capacity and clinical severity of COVID19 infection in pediatric age group.

Methods

The current cross-sectional study included 45 patients with COVID 19 PCR-proven infection admitted at the Children’s Hospital, Faculty of Medicine, Ain Shams University compared to 45 healthy age and sex matched control group. Detailed medical history, thorough examination and recording of all infection related laboratory parameters were done for each enrolled case. Measurement of total antioxidant capacity (TAC) in the serum of all studied patients and controls was done by ELISA.

Results

TAC levels were considerably lower in pediatric patients (median 24u/l, IQR 9-37u/l) compared to healthy individuals (median 90u/l, IQR 77-100u/l, p < 0.001) and the levels were statistically lower in severe cases compared to those with mild disease (p = 0.008). In this regard, 100% of controls showed normal TAC while only 31.1% from cases exhibited normal TAC levels and 68.9% of cases had low TAC levels. There was strong statistical significance between PICU admission and low TAC levels (p = 0.035). Additionally, the TAC showed negative correlation with the initial CRP of patients (r= -0.433, p = 0.003). There was also a significant inverse correlation between TAC and time needed for viral clearance (r=- 0.418, p = 0.004) as well as a significant positive correlation between body mass index z-score and TAC levels (r = 0.423, p value 0.004).

Conclusion

Total antioxidant capacity could serve as a novel prognostic marker of COVID -19 infection severity in pediatric patients.
Value of Combination of Heart Rate Observation (HeRO) Score and The Newborn Early Warning (NEW) System in Early Diagnosis of Sepsis in Preterm Infants
Authors: Shafik Safaa , Mahmoud Mrihan , Ibrahim Mariam
Published: July 2024

Background

Although all newborns are at an increased risk of developing sepsis, this is particularly true for premature infants because of their immune systems haven’t fully matured. Early detection of sepsis, prior to overt clinical deterioration, would allow earlier institution of antibiotics and supportive therapies will result in better outcomes.

Aim of the Work

The aim of this study was to determine the effectiveness of combination of HeRO score and NEW system in early detection of neonatal sepsis in preterm infants by using HeRO score and NEW chart combined together.

Methods

The study included 170 preterm infants at Ain Shams Children Hospital, Cairo, Egypt: Prospective observational study. All studied neonates were subjected to NEW and HeRO scores which displayed a number or score, which represented the risk that a patient would experience clinical deterioration. Confirmation of neonatal sepsis done by withdrawal of C-reactive protein (CRP) and Blood culture. NEW system and HeRO scores followed throughout their hospital stay. The NEW system score chart divided into 3 colours (white, Amber and red). These colours used for identifying the risk for the patient. A HeRO score of 1 is “normal” for healthy preterm infants, and a score of 5 indicates a five-fold increased risk that the patient will be diagnosed with sepsis within the next 24 hours up to 5 days.

Results

The total number of our studied neonates were divided according to the sepsis or not into 80 neonates were sepsis free, 69 neonates who had initial sepsis and 21 who developed sepsis and NEW and HeRO scores showed statistically higher significance in patients with initial sepsis and developed sepsis than non-septic patients. NEW and HeRO score were significantly higher in septic patients than non- septic patients as cut of value of NEW and HeRO scores was >1 and >0 respectively.

Conclusion

The combination of HeRO score and NEW system can be used for early detection of neonatal sepsis in preterm infants.
The Effect of Therapeutic Hypothermia on Serum Carboxy-Terminal Hydrolase L1 and Amplitude EEG Changes in Hypoxic-Ischemic Neonates
Authors: Oshaiba Zeinab Farag , El Wakeel Ibrahim Asmaa Abd , Abdel Kader Mohamed Salah EldinMohamed , Ibrahim Reyad Noha Reyad
Published: July 2024

Background

Hypoxia-ischemic encephalopathy (HIE) is one of the most important complications of the newborn period. It is the result of depriving nerve tissue of oxygen and glucose, which may be the result of either hypoxia or ischemia.

Objective

To assess effect of therapeutic hypothermia (TH) on EEG changes and Carboxy-terminal hydrolase L1level in neonatal HIE at Al-Zahraa university and El Haram hospitals.

Patients and Methods

This was a prospective comparative study that was conducted at the NICU unit Al ZahraaUniversity and El Haram hospitals for a period from (May 2020 till June 2022). This study included 50 full term newborns (37 to 40 weeks of gestational age) with clinical and laboratory evidence of HIE II–III, They were divided into two groups: Group 1: 25 HIE neonates who were treated with therapeutic hypothermia and group 2: 25 HIE neonates who weren’t received therapeutic hypothermia. Newborns with congenital anomalies, intracranial lesion, epileptic seizure, spinal cord injury or cardiac arrest were excluded from the study. We record EEG changes during 72 hrs by an electroencephalogram with a bioelectric amplifier (Deltamed, Bourgogne), (Philips) Screen. Blood samples were analyzed for UCH-L1 levels by (SEG945Mi). The neonates involved in cooling group were placed over a cooling blanket (Blanketrol III), for 72 hours.

Results

The results showed there was statistically significant relation between high UCH-L1 level and higher grades of the Sarnat score and primitive reflexes of both the cooling group and non cooling group. The results also showed that there were lower levels of UCH-L1 in cooling group compared to non cooling group of the studied neonates Also there was significant negative correlation found between UCH-L1 level and PH, and HCO3 values. This study showed that there was statistically significant relation found between UCH-L1 level and EEG recording on the 3rd day of both the studied groups. This study showed that (84%) of the non cooling group had EEG abnormalities compared to (68%) of the cooling group. Among both groups of the studied neonates, 76% had EEG abnormalities in form of (34%) had suppression EEG, (16%) were occipito-temporal, (20%) fronto-temporal and (6%) centro-parital. Regarding the site of EEG abnormality (18%) were right sided, (24%) were left sided. The study showed that 72% of cooling group were discharged compared to 48% of non cooling group.

Conclusion

From our study we concluded significant improvement in EEG records in ischemic neonates who were treated with therapeutic hypothermia. UCH- L1 is a good early neuronal injury biomarker for detecting severity of HIE P value < 0.001 and is a good predictor of hypoxia with specificity 92% and ppv 86.7% and NPV 65.7%. Therapeutic hypothermia has been noted to reduce severe disability among survivors.
Urinary Kidney Injury Molecule 1 and Urinary Monocyte Chemotactic Protein 1 as Novelbiomarkers for Early Detection of Sickle Cell Nephropathy
Authors: Elalfy Mohsen Saleh , Moneam Adly Amira Abdel , Aly NihalHussien , Ali Mansour Mahmoud Yasin
Published: July 2024

Background

Sickle cell disease (SCD) is one of the most common genetic disorders, it not onlyhas hematological pathophysiological consequences, but also has systemic pathologicalmanifestations such as Sickle cell nephopathy(SN). There are no randomized control trials thatexamined the utility of screening test for renal disease in individuals with SCD.

Aim of the Work

To evaluate urinary monocyte chemoattractant protein-1 (MCP-1) and urinarykidney injury molecule 1 (KIM-1) as biomarkers for early detection of sickle cell nephropathy and correlate them with proteinuria and decline in estimate glomerular filtration rate ( eGFR).

Patient and Methods

This study was a cross sectional study, conducted at Pediatrics Hematology-Oncology Unit at Ain Shams University Children’s Hospital, where 45 children with sickle cell disease were enrolled aged 6 months - 16 years. Urine samples were collected to measure MCP-1and KIM-1 levels and compared to age and sex matched control.

Results

There was a statistically significant difference found between control group and patients’group regarding the level of MCP-1 in urine as it was found higher in patients than control group with median(IQR) values of 600 pg/ml (300–780) vs. 47.5 pg/ml (30–80, p < 0.001). Regarding the level of KIIM-1 in urine, it was found higher in patients than control group with median (IQR)values of 2.8 ng/ml (1.6–5.6) vs. 0.4 ng/ml (0.4–0.55, p<0.001) respectively.

Conclusion

Our data shows a distinct biomarker pattern in children with SCD, identifying KIM-1and MCP-1 as two potential biomarkers of early SN and its progression.
Diagnostic Outcome of Rome IV Criteria in Infant Regurgitation
Authors: El Deeb Marwa Talaat , Mohsen Yosra Mohamed , Soliman Emara Nehal Elsayed
Published: July 2024

Background

Infant regurgitation is the most prevalent functional gastrointestinal disorder (FGID) occurring in the first year of life. In 2016 Rome IV criteria was launched with criteria for diagnosis of infantile FGIDs including regurgitation.

Objectives

The aim of this study is to follow up cases of infant regurgitation diagnosed by applying Rome IV criteria among neonates and toddlers and reevaluate them to uncover any organic causes among them.

Methods

A prospective cohort study was conducted at the general outpatients’clinic, Children’s Hospital, Ain-Shams University included 280 cases fulfillingRome IV criteria with 3 months for recruitment of patients followed by 3 months follow of each case. Full history and clinical examination were performed with special focus on anthropometric measurements.

Results

from 280 cases 42.9% totally cured (stopped regurgitation), 49.6% partially improved (decreased number of regurgitation episodes per day) and 7.5% didn’t improve (still have the same number of regurgitations per day) with proper weight gain. However, only 3 cases showed failure to thrive which is not related to regurgitation.

Conclusion

None of our cases diagnosed as infant regurgitation by Rome IVcriteria developed any organic diseases during period of follow up indicating the accuracy of Rome IV criteria in excluding organic diseases.
Evaluation of Child Oral Health Related Quality of Life in Bleeding Disorders
Authors: Elsayed Ebeid Fatma Soliman , Khalil El Sherif Nayera Hazaa , Wassel Mariem Osama , Abd El Kader Salwa Mostafa , Abd El Maged Fatma Rezk Refaey
Published: July 2024

Background

Oral bleeding is a common symptom for many inherited and acquired bleeding disorders in children. Understanding oral health and treatment needs of patients with bleeding disorders is necessary for patients' primary oral health prevention.

Aim of the Work

To evaluate the oral health problems in children with bleeding disorders both clinically and with child oral health related quality of life questionnaire score. To assess the effect of intervention (education and any necessary dental procedure) on the child oral health related quality of life questionnaire score.

Patients and Methods

This cross-sectional study was conducted on 70 patients aged from (2-18 years), males represent n = 47 (67.1%), females n = 23 (32.9%). Inherited bleeding disorders represent n = 37 (52.9%) and acquired bleeding disorders represent n = 33 (47.1%). ITP n = 33 (47.1%), hemophilia A n = 27 (38.6%), Von Willebrand’s disease n = 7 (10%) and Glanzmann n = 3 (4.3%) and all subjected to full history taking, examination, dental health estimation, oral health education, dental management and replacement therapy as needed at baseline and after 6 months of follow up from October 2021 to April 2022. ITP bleeding score (ISTH SSC bleeding assessment tool) used to assess severity of ITP patients. Child oral health related quality of life and child oral health impact profile questionnaires were filled by patients/parents at base line and after 6 months follow up.

Results

The current study revealed that (57.1%) of patients have dental caries. Regarding oral hygiene status, (10%) of patients have poor oral hygiene. Regarding gingival health, (50%) of patients have moderate gingivitis and (11.4%) have severe gingivitis. Oral symptomatology, Psychological domain for child, Psychological domain for family, Social domain for child and Total oral health score were significantly affected more with long duration of disease (p-value =0.0005, 0.0015, 0.010, 0.022 and 0.0045 respectively). There was statistically significant improvement in oral health related quality of life questionnaire score after 6 months of follow up with total oral health score (p-value = 0.000).

Conclusion

Oral health was significantly affected among patients with acquired and inherited bleeding disorders. Oral health education and management had significant impact on oral health related quality of life scores after 6 months of follow up.
Cerebral Small Vessel Disease in Children and Adolescents with Type 1 Diabetes Presenting with Diabetic Ketoacidosis during COVID-19 Era
Authors: Matter Randa M , Salah Nouran Y , Ismail Eman A , Ahmed Khaled S , Abdrabo Shimaa S
Published: July 2024

Aim

Cerebrovascular insult (CVI) is a known and significant morbidity of diabetic ketoacidosis (DKA); yet, its prevalence is underestimated. Untreated cerebral hypoperfusion in DKA may lead to cerebral injury, arterial ischemic stroke, cerebral venous thrombosis, and hemorrhagic stroke. This study assesses the cerebral perfusion status among children and adolescents with DKA during and after the resolution of DKA.

Methodology

Forty children and adolescents with type 1 diabetes mellitus (T1DM) presenting with DKA were assessed for severity of DKA, diabetes-duration, insulin therapy, Rappaport coma/ Near coma scale, Rancho los amigos levels of cognitive functioning scale, glycated-hemoglobin (HbA1c), D-dimer, INR and brain magnetic resonance imaging (MRI) during DKA and repeated neuro cognitive scoring, laboratory and MRI after resolution of the DKA.

Results

The mean age of the children and adolescents with T1DM presenting with DKA was 11.40 ± 2.82 years; their median diabetes-duration was 3 year; their mean HbA1c was 13.54 ± 2%. There was significant increase in platelet (P = 0.005), D-dimer (P < 0.001), Creatinine (P < 0.001) and Pulse wave velocity (P = 0.004) during attack of DKA while there was significance decrease in Apparent diffusion coefficient (P < 0.001). There was 30% of children and adolescents with T1DM had ischemic MRI changes during DKA. In children and adolescent with ischemic changes there was significant increase in severity of DKA (P = 0.003), HbA1c (P = 0.016), INR (P = 0.002), D-dimer (P < 0.001), Creatinine (P = 0.003).

Conclusion

Significant cerebral hypoperfusion occur during the DKA which is correlated with the DKA severity and D-dimer levels.
Arabic Translation of The Caregiver Priorities and Child Health Index of Life with Disabilities CPCHILD Scale
Authors: Mostafa Mohamed Duaa Mohamed , Ahmed Hassanein Sahar Mohamed , Eldin Amin Ghada Essam , Abdelaziz Asmaa Wafeeq , El-Gharbawy Nermin Hassan
Published: July 2024

Background

Children with cerebral palsy have difficulties in daily life activities (feeding, toilet training, dressing), communication, and mobility. The children’s independence and quality of life decrease when their performance in activities of daily living is reduced. Evaluation of motor function for affected children with cerebral palsy (CP), individual needs and goals of these patients and their parents is still lacking and needs to be further addressed. The CPCHILD is a multidimensional patient centered assessment tool.

Aim of the Work

Our aim is to translate and provide an Arabic version of the CPCHILD for assessing the caregivers’ perceptions of the health status, comfort, wellbeing, functional abilities, and quality of life for their children with cerebral palsy.

Patient and Methods

This study was a cross sectional study, conducted at Pediatric Neurology Clinic at Children’s Hospital, and Physical Medicine Outpatient Clinic at Ain Shams University Hospitals. The CPCHILD was translated from English to Arabic with the agreement of the scale's owner. The Arabic version was provided through translation and back translation process, which was then presented to the caregivers of CP children for evaluation of the perspectives and quality of life for their children.

Results

An Arabic version of the CPCHILD scale was created. The enrolled caregivers for children with CP were the biological mothers. The mothers of the CP children were able to understand and respond to the translated scale and reported poor mean total CPCHILD score 26.45 (0-58.3).

Conclusion

The Arabic version of the scale was provided through translation and back translation process and the version was prepared for subsequent validation tests. The translated version will help in applying the scale in the caregivers' language in a culture proper setting and can be helpful in the assessment of health-related quality of life of children with CP.