bluuebunny/crossref_metadata_2025 huggingface dataset:
The Diagnostic Role of α-smooth Muscle Actin in Superficial Invasive Laryngeal Squamous Cell Carcinoma
Authors: Zanaty Nourhan E , El-Badawy Nafissa M A , Gabal Huda H Abou , Farid Laila M S
Published: November 2024

Background

Diagnosis of superficial invasion of laryngeal squamous cell carcinoma (LSCC) is a major challenge for pathologists as its confirmation is mainly based on histomorphologic features especially in presence of differentials and in absence of reliable diagnostic immunohistochemical markers. Despite focusing on study of tumor cells, the study of tumor microenvironment (TME) and its major component cancer associated fibroblasts (CAFs) will help to understand the participation of the tumor stroma in tumor development, progression and invasion differentiating it from other premalignant and benign lesions whose features may overlap with superficial invasive LSCC causing diagnostic dilemma. CAFs are characterized by the expression of α-smooth muscle actin protein (α-SMA) which represents the major component used to detect mesenchymal cells during process of TME.

Objective

To assess the diagnostic role of α-smooth muscle actin immunohistochemical expression in superficially invasive laryngeal squamous cell carcinoma.

Methods

The current study was conducted retrospectively on 108 cases of laryngeal biopsy samples as archived formalin fixed paraffin embedded blocks obtained from the Pathology Department lab of Ain Shams University Hospitals (Jan 2020-Dec 2022). The cases included in the current study were divided into 4 groups; Group 1: included 32 superficial invasive LSCC cases, Group 2: included 20 Laryngeal HGD/SIL cases, Group 3: included 36 PEH cases and Group 4: included 20 invasive LSCC cases. Data concerned with gender, age, lesion laterality, site and smoking history were obtained from the electronically archived reports. The histopathological data were re-examined microscopically by at least two authors. After then, the expression of Alpha SMA was evaluated in different groups, followed by statistical evaluation of the obtained results.

Results

Immunoreactivity of α-SMA was expressed in 87.5% of superficial invasive LSCC cases and 100% of invasive LSCC cases, while no reactivity was observed in all cases of HGD/SIL group, and rarely in PEH group (5.6%). There was statistically significant correlation between alpha SMA and both stroma changes and percentage of TILs in stroma of superficial invasive LSCC and no statistically significant relationship between alpha SMA expression and age, sex, lesion’s laterality, site, microscopic growth pattern, smoking, koiliocytic changes and hyperkeratosis in superficial invasive LSCC cases. The α-SMA expression pattern in stroma of superficial invasive LSCC was significantly different from that of HGD/SIL and PEH groups.

Conclusion

Alpha SMA is a potentially valuable marker for labelling CAFs and plays a reliable ancillary role in confirming the invasion for superficial invasive LSCC and differentiating it from HGD/SILs and PEH cases.
Transvesicoscopic Cohen Ureteric Reimplantation for Vesicoureteral Reflux in Children: A Pilot Study
Authors: Hegazy Amr T , Allam Ayman M , Dahab Mohamed M , Radwan Ahmed B , Badawy Haitham E , Hassan Tarek A
Published: November 2024

Background

Cohen’s pneumovesicoscopic reimplantation technique (CPRT) is a minimally invasive procedure that resembles the surgical steps of the open cross-trigonal reimplantation technique with a similar success rate and the inherent benefits of a minimally invasive approach, like less need for analgesia and less morbidity.

Aim of the Work

to evaluate the efficacy and safety of CPRT in 20 pediatric patients with primary VUR presented to 2 pediatric surgery departments, in 2 tertiary centers.

Patients and Methods

a prospective interventional study on 20 children (13 girls, 7 boys, age ranged from 4 to 12 years) with primary vesicoureteral reflux (VUR), grades II-IV (6 bilateral, 9 RT and 5 LT) underwent a CPRT. Suprapubic ports were placed: a 5-mm camera port and two 3- mm working ports. After the ureter(s) have been dissected transvesically a submucosal tunnel is made for ureteric reimplantation to be carried out using 5/0 absorbable sutures. After the procedure, the urethral catheter was taken out two days later, and the patients were released on day three. Clinical evaluation, renal ultrasonography, and voiding cystourethrogram were used to Follow-up the patients.

Results

198.5 min was the average operating time (range 90 – 240 min). Two cases developed postoperative complications (mild suprapubic emphysema-perivesical hematoma) managed conservatively. One case needed conversion to open technique because of intraoperative complications (port displacement- perivesical air leakage). All patients had renal US and VCUG between 3 and 6 months after surgery. All low-grade reflux patients (grade II & III) had their hydronephrosis disappear on postoperative US (13 out of 26 refluxing units), while persistence of grade I VUR on VCUG was in two cases (2 units).

Conclusion

Technically feasible, Cohen’s pneumovesicoscopic reimplantation technique can be carried out safely and effectively in children. It is advisable to select the patients carefully in the primary phase of this technique. Some technical modifications are suggested to overcome the technical obstacles faced, helping us to master this promising technique.
Outcome of Peri-Anal Injury Management in Children and Adolescents
Authors: Muhammad Fahmy Mahmoud Ahmad , El- Sayyed Morad Ahmed , Arafa Ahmed Bassiouny , Girgis Nader Nassef
Published: November 2024

Background

Accidental genital trauma and perineal injury are relatively uncommon in the paediatric population and are often related to accidental falls, motor vehicle crashes and sexual abuse. Blunt perineal trauma causes mechanical compression of the soft tissues against the pelvic bones. Management of perineal injury differs depending on the mechanism of injury and the presence of additional trauma. The severity and extent of injury are often difficult to estimate by only physical examination, and radiological modalities may be insufficient to determine the true extent of damage in severe cases. In such cases, a diagnostic endoscopic examination under anesthesia is useful to fully comprehend the damage.

Objectives

To evaluate and describe outcome of different perineal trauma mechanisms and management in pediatric patients.

Methods

Retrospective descriptive analytic study of outcome of perineal injuries management, was conducted on 11 patients aged under 18 years old with perineal injuries due to perineal trauma, admitted to pediatric surgery department or followed up in colo-rectal clinic of pediatric surgery department, Faculty of Medicine, Ain Shams University Hospitals.

Results

Three patients with isolated genital injury or perineal body injury could be primarily repaired without fecal diversion, one case developed wound dehiscence due to stool contamination so fecal diversion was done. The other seven patients with involvement of ano- rectum underwent fecal diversion from the start, with four cases had their wounds primarily repaired, two cases left to heal by 2ry intention and underwent definitive perineal reconstruction later on, and only one case of impalement that had no any external wounds.

Conclusion

Perineal injury management should start with resuscitation, thorough examination, proctoscopy, vaginoscopy or cystoscopy could be needed, examination under anesthesia is a gold standard measurement. Patients with isolated genital injuries could be primarily repaired without fecal diversion. Patients with ano-rectal involvement mostly will need fecal diversion, with primary repair of the perineal wounds or leaving it to heal with 2ry intention according to the degree of contamination, time of presentation, degree of ano-rectal involvement. Perineal body reconstruction technique based on the principles of the PSARP operation used in ano-rectal malformations.
A Comparative Study between Honey and Alcohol as Topical Skin Disinfectant
Authors: Mohamed Abdul Rhman Mamdouh Abdul Maksoud , Awad Yosra Mohamed Mohsen , Anwar Hafez Maha Ahmad , Mansour Ahmed Badr Nouh
Published: November 2024

Background

Skin antisepsis is essential in every healthcare environment. Alcohol/ chlorhexidine use might disrupt skin microbiota and lead to antibiotic resistance.

Objective

To evaluate the efficacy of honey on reduction of skin microbes, on apparently healthy skin, and to compare the results with those of topical application of 70% isopropyl alcohol.

Subjects and Methods

This study was carried out on 70 children aged 2 to 12 years. Males represented 54.2% of the sample. Patients were recruited from the pediatric outpatient clinic, Children’s Hospital, Ain Shams University, Egypt, during the period from July 2022 to February 2023. A swab was taken from the skin of the dorsum of both hands for culture of skin microbes. Types and number of organisms were documented. Separately, honey and alcohol were applied alternatively on the dorsum of right and left hands. A skin swab was taken for microbiological examination before and 20 seconds after application of honey and alcohol.

Results

mean age of enrolled children is 7.34 (in years). Both honey and alcohol made significant reduction in the number of organisms on the dorsum of the hand (p = <0.001), and this effect was comparable between honey and alcohol with no statistically significant difference (p = 0.874). Before honey application, the median number of organisms is 65 colony forming unit (CFU), while 10 (CFU) is the median number of orgamisms after honey application. Before alcohol application, the median number of organisms is 80 (CFU), while 10 (CFU) is the median number of organisms after alcohol application. Percentage of reduction of organisms on dorsum of the hand after honey application is 62.5%, while 65% after alcohol application (p = 0.370). Staph coagulase negative, staph aureus, E-coli are most three common organisms were detected by swab.

Conclusion

Honey showed to be as effective as alcohol in reduction of skin microbes. We recommend further studies involving following up the rate of infection after minor surgical procedures to confirm the findings of our study.
Evaluation of Plasma D-Lactate Level in Preterm Infants in Necrotizing Enterocolitis
Authors: Farid Ahmed Hamdy , Metwally Mohamed Hussein , Alfattah Dina Tharwat Abd , EL-Deen Ola Galal Badr
Published: November 2024

Background

Necrotizing enterocolitis (NEC) is a severe and potentially lethal intestinal disease that occurs almost exclusively in preterm infants. Currently, the diagnosis of NEC is based on clinical and radiographic findings. Utilization of non-invasive biomarkers for early diagnosis is the preferred attitude in most of the diseases.

Aim of the Work

Measure plasma D-lactate levels in preterm infants diagnosed with NEC in comparison to age-matched controls and also to correlate these levels to severity of intestinal ischemia in these cases.

Patients and Methods

The current study included 30 preterm neonates diagnosed with NEC and 30 preterm neonates who were admitted into NICU (Neonatal intensive care unit) due to other cause rather than NEC (as a control group)., All the cases underwent full history taking, full general examination and full local regional examination(measurement of abdominal girth, intestinal sounds, passage of stool, gastric residual, abdominal tenderness). The laboratory (Hemoglobin level, platlets count, white blood cells count, plasma D-lactate level) and the radiological investigations (Abdominal erect xray) were also conducted. Lactate level was measured at two occasions (on admission and after one week) The cases were followed up to determine the outcome (the mortality).

Results

The D-lactate level (at first sample at onset NEC) in the NEC group was statistically significantly higher as compared to the control group (p < 0.001); median (IQR) : 7.11 (6.79 – 11.82) versus 4.11 (1.99 – 4.96)]. The level of plasma D lactate showed a statistically significant decrease between first and second sample(After one week) in discharged patients with no statistically significant change in died patients. The best cutoff point of D-lactatein the first reading to identify cases with NEC was > 5.45 mmol/L with diagnostic sensitivity 100%, specificity 100% and accuracy 100%.

Conclusion

The use of plasma D-lactate levels as a marker of intestinal injury could be useful as a diagnostic indicator in the early stage of NEC. Moreover, d-lactate can be correlated with the severity of NEC.
Neuropathic Pain and Clinical Sensory Testing in Young Patients with Sickle Cell Disease
Authors: Adly Amira Abdel-Moneim , Makkeyah Sara Mostafa Mohammad , Mohammed Maha Zakariya Ramadan , Wassif Ghada Ossama Mohamed , Nassef Marwa Abdelaziz , Aboata Ahmed Mostafa Ahmed
Published: November 2024

Background

The pathophysiology of pain in sickle cell disease (SCD) is complex and not fully understood. Neuropathic pain (NP) is an emerging theory of chronic pain in SCD. Nevertheless, assessment of NP is not a part of standard care of patients with SCD.

Aim and Objectives

To study the frequency of neuropathic pain among young patients with SCD by ID-P questionnaire and Clinical Sensory Testing (CST).

Patients and Methods

In this cross-sectional study Patients with SCD were recruited and data were collected on sociodemographic and clinical criteria of the disease. ID Pain (ID-P) questionnaire was used as a screening tool for NP. We performed a bedside clinical sensory testing (CST) including cold, warm, and pressure detection, cold, heat, mechanical and pressure pain threshold.

Results

Fifty-six participants were screened for eligibility and twelve of them were excluded; ten had stroke and two patients were diabetic. A total of 44 participants (25 males and 19 females) were included, their mean age was 12.4 years (SD 4.8; range 5.9-25 years). Screening of NP using the ID-P questionnaire revealed that 22.7% of the study cohort likely had NP. On the other hand, 34% of the participants had abnormal CST; 10 patients (22.7%) had abnormal mechanical pain threshold, 6 (13.6%) showed abnormal cold pain threshold, 2 (4.5%) had abnormal heat pain threshold and 2 (4.5%) with abnormal pressure threshold, while only one patient had delayed cold detection.

Conclusion

Neuropathic pain, as assessed by ID-P questionnaire and CST, is not uncommon in young patients with SCD.
Serum Levels of the Systemic and Brain-Specific Antibodies in Autistic Children
Authors: Mostafa Gehan Ahmed , Mehrez Amany Beniameen Ahmed , Shousha Ghada Abdel Haleem , Shehab Abeer Al Sayed , Youssef Azza Mohamed
Published: November 2024

Background

Some autistic children may have an imbalance of the T-helper (Th)1/Th2 lymphocytes toward Th2. Th2 cells are responsible for the allergic response and the production of antibodies.

Aim

We were motivated to investigate the frequency of the brain specific antibodies anti- myelin oligodendrocyte glycoprotein and anti-myelin associated glycoprotein (anti-MoG) and systemic antibodies Anti-Nuclear Antibody (ANA) in the serum of a group of Egyptian autistic children.

Patients and Methods

This pilot case-control study was conducted at the Department of Pediatrics, Children's Hospital, Faculty of Medicine, Ain Shams University over a period of 6 months, from May 2022 to November 2022. Twenty five autistic children aged 4 to 16 years and twenty five age- and sex-matched healthy children were included after excluding children with any chronic, allergic or autoimmune disease. Diagnosis of autism was settled according to 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Serum levels of brain specific antibodies (anti-MoG) and systemic antibodies (ANA) were assessed for the patients and healthy children using Enzyme-linked immunosorbent assay (ELISA) technique.

Results

Male to female ratio was 3.17:1. Family history of Autism spectrum disorder (ASD) was positive in 2 patients. True seizures were detected in 3/25 (12%) of the studied children. Mild ASD was found among 64% and severe illness was detected among the other 36% of the studied patients using Childhood Autism Rating Scale (CARS). According to anti-ANA 23 healthy control children had negative ANA and the other two had positive ANA. However 23 autistic children had negative ANA and two had borderline level. Anti-ANA not detected among autistic children. According to Anti-MOG 25 healthy control children had negative anti-MOG. However 24 autistic children had negative anti-MOG and one had positive anti- MOG. P-Value of anti-MOG was 1.00 and P-Value of anti-ANA was 0.135.

Conclusion

Specific brain antibodies, anti-MOG, and systemic antibodies, ANA were not detected in higher levels among autistic children compared to healthy control. The study was limited by the small sample size. ASD patients and healthy children showed comparable serum levels of ANA. One autistic child had positive anti-MOG. Compared to healthy control group, the difference of results of brain antibodies was statistically non-significant.
Dermatological Manifestations in Pediatric Patients with Chronic Kidney Disease
Authors: Elhakim Ihab Z , Elsayed Mahy E , Elkersh Amr M , Sallam Dina E
Published: November 2024

Background

Dermatological manifestations in pediatric patients with chronic kidney disease (CKD) are diverse and are an important cause of morbidity. There are specific and nonspecific manifestations associated with CKD, however most of the studies have been conducted in adult patients. Data are scarce in in pediatric CKD patients both on conservative management and on renal replacement therapy.

Objective

This study aimed to screen pediatric patients with CKD stage 5 on regular hemodialysis for various dermatological manifestations.

Methods

This was a cross sectional study, conducted at the Pediatric Nephrology and Dialysis unit, Children’s Hospital, Faculty of Medicine, Ain Shams University, on pediatric patients with chronic kidney disease stage 5 on regular hemodialysis. Full clinical dermatological examination was conducted for all patients by the same expert dermatologist.

Results

We included 35 patients with chronic kidney disease stage 5 on regular hemodialysis, their mean (±SD) age was 11 (±2.53) years. They were 44.2% males, and 59.3% females, with median (IQR) dialysis duration of 2.5 (1 - 4) years. Xerosis was found in 80% of our studied patients, followed by pruritis in 60%. Our study found that dermatological manifestations had no significant correlation with the underlying CKD etiology, the age of the patients, and the total duration of dialysis (p > 0.05).

Conclusion

Xerosis and pruritis are not uncommon dermatological manifestations among pediatric patients with chronic kidney disease, meanwhile the age of the patients and the underlying CKD etiology had no direct effect on skin changes. Further studies are needed to detect various skin manifestations in CKD patients with different CKD stages and correlate it with the used dialysis modalities.
Serum Sclerostin among Children and Adolescents with Type 1 Diabetes: Relation to Vascular Complications
Authors: Elhenawy Yasmine Ibrahim , Sallam Dina Ebrahem Darweish , El-Sayed Eman Mohamed , Taha Sara Ibrahim Abdelfattah
Published: November 2024

Background

Sclerostin is a potent soluble inhibitor of the Wnt signalling pathway. Besides its inhibitory role on bone formation, Sclerostin plays an important role in the pathogenesis of vascular calcification in the context of chronic kidney disease.

Aim

To investigate the relationship between serum Sclerostin levels and urinary albumin excretion (UAE) among children and adolescents with type 1 diabetes (T1DM) and assess their relation to the degree of UAE and carotid intimal thickness (CIMT).

Methods

A total of 50 patients with T1DM and 25 healthy controls were enrolled in the current study. Patients with T1DM were equally divided into a normoalbuminuric group and a microalbuminuric group (DN group) according to urinary albumin excretion rate (UAER). Serum Sclerostin level was measured by enzyme-linked immunoassay and carotid intimal thickness (CIMT) was assessed as a marker of subclinical atherosclerotic risk.

Results

The plasma Sclerostin levels were significantly higher in patients with microalbuminuria (90.83) ng/ml) compared with patients with normoalbuminuria (33.29 ng/ml) and healthy control subjects (13.5 ng/ml) (P < 0.001). Similarly, CIMT levels were significantly higher in patients with diabetic nephropathy (P < 0.001). The plasma Sclerostin level had a positive correlation with duration of disease, HbA1C, UAER and CIMT(P < 0.01).

Conclusions

Serum Sclerostin levels could serve as a potential biomarker of diabetic nephropathy among patients with T1DM. Further studies are needed to better understand the involvement of Sclerostin in vascular complications of T1DM and the possibility of a novel therapeutic target.
Etiopathogenesis of Cancer Related Anemia in Children and Adolescents with Malignant Solid Tumors
Authors: Ragab Iman , Kader Salwa Mostafa Abd El , Mohammad Ali AbouElwafa Menna Allah Zakaria , Aleim Aya Tallah Ibrahim Abdel
Published: November 2024

Background

Anemia in cancer patients is a common comorbidity at diagnosis and throughout treatment, which is not solely due to the antineoplastic therapy; but it is multifactorial in origin. Anorexia, malnutrition and lack of specific components (such as iron, vitamins, folic acid, etc.) fundamental for erythropoiesis contribute to the multifactorial pathogenesis of anemia. Cancer related anemia (CRA) is primarily caused by the chronic inflammation associated with the cancer pathogenesis, as cancer cells mediate the activation of immune cells particularly the macrophages increasing the secretion of interleukin 6 (IL-6) among other inflammatory mediators contributing to CRA.

Aims

To evaluate IL 6 levels and iron status among solid tumor children and adolescents presenting with a provisional diagnosis of CRA.

Methods

A 6 months cross sectional study included 30 patients with solid tumors and anemia following at the Hematology/Oncology Clinic, Ain Shams University. Detailed review of the patients' clinical and laboratory data of disease diagnosis, stage at diagnosis, daily iron intake assessed by food frequency questionnaire (FFQ), bone marrow biopsy results were studied. IL6 assay by ELISA, as well as serum ferritin, transferrin saturation index (TSI) were done upon anemia presentation.

Results

Thirty patients with Solid Tumors were recruited with median (IQR) age of 6 (2.5-10) years at presentation, The most common solid tumors among enrolled patients were brain tumors and neuroblastoma representing 26.7 % (n = 8) & 23.3 % (n = 7) respectively. The mean±SD hemoglobin was 9.21±1.33, among which 80% (n = 24) showed inadequate 24 hrs iron intake. After correlating serum ferritin to TSI levels, Nineteen patients (63.3%) had functional iron deficiency anemia, while 36.7% (n = 11) had combined true and functional iron deficiency anemia. IL 6 median (IQR) level was = 88.6 (57.5-156.5), which showed no statistically significant difference (p = 0.561) among patients with true and functional iron deficiency.

Conclusion

Anemia among cancer patient’s can be multifactorial with some patients experiencing true iron deficiency anemia, functional or combined true and functional iron deficiency anemia. IL 6 is elevated in cancer patients, yet was not reflected on patient’s body iron status.
The Effect of Multi-Dose Ondansetron on the Vomiting Associated with Acute Gastroenteritis in Children Less than 5 Years Old
Authors: Abd-Elzaher Eman Atef Awad , E K Emam , Ibrahim Haya E
Published: November 2024

Background

Acute gastroenteritis is a leading cause of emergency department visits and hospitalization among children. Oral rehydration therapy is recommended for children with mild to moderate dehydration, but children who present with vomiting are frequently offered intravenous rehydration in the emergency department. Ondansetron is the only antiemetic agent with consistent, proven efficacy in reducing vomiting from acute gastroenteritis and promote oral rehydration.

Aim of the Work

To evaluate the effect of multiple doses of ondansetron on the control of vomiting associated with acute gastroenteritis in the children in comparison to a single dose.

Patients and Methods

This was a randomized controlled study that was conducted on 70 children less than 5 years old presenting to the emergency department of pediatric hospital, Ain Shams University in a period of 6 months with acute gastroenteritis. They were divided into 2 groups (35 patients in each group): Arm one (odd numbers): received single dose of ondansetron (Zofran-intramascular) the dose 0.15mg/kg to a maximum 8 mg. Arm two (even numbers): received (6 doses) of ondansetron (Zofran- intramascular) the dose 0.15mg/kg to a maximum 8 mg every 8 hours for 48hrs. The modified Vesikari scale score was performed at different times as gastroenteritis severity scale.

Results

Both groups were comparable regarding age, sex, weight and height. There was no statistically significant difference found between group A and group B regarding all parameters of modified Vesikari scale score (MVS) at time of enrollment, at 24 hours, 48 hours and at 7 days with p-value = 0.400, 0.394, 0.451 and 0.746. There was no statistically significant difference found between both groups regarding side effects of ondansetron while there was statistically significant increase in the percentage of patients with diarrhea in group B (17.1%) than group A (0.0%) with p-value = 0.010

Conclusion

No significant difference was found between both groups regarding modified Vesikari scale score (MVS) at different times of measurement. Diarrhea was more prevalent in multiple doses of ondansetron than single dose as a side effect.
The Effect of Carnitine Supplementation on Cardiac Function and Ketogenic Diet Effectiveness in Patients with Drug Resistant Epilepsy on Ketogenic Diet
Authors: El-Rashidy Omnia Fathy , Nassar May Fouad , Ramadan Mohammed Maha Zakariya , Marwa Elhady Nasef Waheed Abd , Mohamed Kamal Esraa Abdelmohsen
Published: November 2024

Background

Ketogenic Diet (KD) is gaining attention as a management line in childhood drug resistant epilepsy (DRE) and it is an effective line of therapy for DRE in children. KD is a strict diet consisting of minimal carbohydrate and adequate protein intake with increased fat content. Although KD is effective for epilepsy management, it is deficient in several minerals, vitamins, and trace elements, which can lead to several early and late complications.

Objective

To demonstrate the effect of carnitine supplementation on cardiovascular functions in patients with DRE on KD and to highlight the effect of carnitine supplementation on efficacy of KD in seizure control.

Methods

This study was a clinical trial (Trial Design: Parallel 1:1) which included 52 patients with DRE on KD following up at Pediatric Neurology and Clinical Nutrition Outpatient Clinics at Ain Shams University children`s Hospital (or admitted as inpatient) in the period from March 2022 to October 2022

Results

There was a statistically significant decrease in the CSSS after 6 months compared to initial presentation among the L-carnitine supplemented group. After 6 months of L-carnitine supplementation, the supplemented group showed significant increase in interventricular wall thickness diameter (IVSD) and significant increase in posterior wall thickness (PWT). Left ventricular end-diastolic diameter (LVED) and left ventricular (LV) mass index showed also increased but didn’t reach significance statistically after L- carnitine supplements. There was no statistically significant difference between carotid intima-media thickness CIMT at initial presentation and after 6 months among L-carnitine supplemented group.

Conclusion

After six months of L-carnitine supplementation in patients with DRE on KD, there was improvement in the frequency and duration of convulsions among L-carnitine group. Regarding ECHO finding, L-carnitine group showed increase in interventricular wall thickness diameter (IVSD) and posterior wall thickness (PWT). Left ventricular end-diastolic diameter (LVED) and left ventricular (LV) mass index also showed increases but didn’t reach statistical significance after L- carnitine supplementation. There was no statistically significant difference in carotid intima-media thickness CIMT at initial presentation and after 6 months among L-carnitine supplemented group.
Insulin Sensitivity in Relation to Serum Magnesium in Obese Children
Authors: Nassar May Fouad , Fouad Nermeen Tayseer Aly , Taha Fatma Elsayed , Elkholy Heba E
Published: November 2024

Background

Childhood obesity is one of the most alarming challenges developing in today's world and is associated with insulin resistance. Magnesium level is inversely correlated with obesity and has a significant role in glucose hemostasis and insulin resistance

Aim of Work

The study aimed to assess the relation between serum magnesium and insulin resistance in obese children

Patients and Methods

This cross sectional study was conducted on 60 obese children recruited from Pediatric Outpatient Clinics at Tur Sinai district, South Sinai. The participants were subjected to nutritional analysis, 24 hours recalls including breakfast, snacks, lunch and dinner was taken from each patient and the data was analyzed using food analysis software program, anthropometric measurements including height, weight, body mass index(BMI) and their z-scores, waist hip ratio(WHR) and waist height ratio (WHtR). Laboratory parameters including magnesium level, fasting insulin, fasting glucose, and homeostatic model assessment for insulin resistance (HOMA-IR) calculation.

Results

All participants in our study were obese with BMI > 95 percentile according to CDC growth charts, with 35 were males (58.3 %) and 25 were females (41.6 %). Nutritional analysis showed low dietary magnesium intake with mean ±SD (330.01 ± 104.07) mg/day. Regarding laboratory investigations, magnesium level was low in 39 cases (65 %), fasting insulin was high in 45 cases (75 %) and HOMA IR was severe in 33 cases (55%) and was moderate in 15 cases (25 %). Also, fasting blood glucose was high reaching prediabetic level in 39 cases (65%). Serum magnesium level had a statistically significant negative correlation with fasting blood glucose (r= -0.369, p = 0.004), fasting insulin (r=-0.537, p = 0.000), HOMA IR (r= -0.458, p = 0.000), waist height ratio (r= -0.285, p = 0.027) and waist hip ratio (r= -0.260, p = 0.045).

Conclusions

Low serum magnesium levels may contribute to the development of insulin resistance in obese children.
Comparative Study between Incidence and Risk Factors of Major and Minor Infections in Early Post-Operative Course of Pediatric Cardiac Surgery: A Single Center Study
Authors: Elmaksoud Mahmoud Atya Hager Karam Abd , Mansour Mervat Gamal El Din , Kamel Waleed Ismail , Bakry Nehad Ahmed
Published: November 2024

Background

Nosocomial infections (NI) also termed as healthcare-associated infections (HCAIs) include infections that are acquired from a hospital or other health care centers, which appear for the first time within 48 hours of hospital admission, 3 days of discharge or 30 days of operation. However, in some cases, the NIs occur within 30 days after discharge, such as surgical site infections.

Aim of the Work

Primary aim: Identifying the frequency and risk factors of major and minor infection in the early postoperative course of pediatric cardiac surgery.

Secondary Aim

Identifying the most prevalent isolated microorganisms and the antimicrobial susceptibility pattern.

Tertiary Aim

Highlighting the points of improvement to reduce the incidence of post- operative infection in the center of study.

Patients and Methods

This study is a prospective cohort observational study conducted on patients who were admitted at post-operative Cardiac Pediatric Intensive Care Unit at Ain Shams University Hospitals over 6 months from May 2022 to November 2022.

Results

The study included 60 pediatric patients (32 males and 28 females) who underwent cardiac surgical intervention for congenital heart disease with ages ranging from 1 to 168 months and a median age of 30 months (IQR between 12 and 108 months). Out of 60 patients, 15% had postoperative major infections, 13.3% had minor infections and the rest (71.7%) developed neither major nor minor infection during the early post-operative period. The most common risk factors of infection (either major or minor) were the long duration on mechanical ventilation, central venous catheterization and postoperative need for blood transfusion (packed RBCs, plasma, PLT transfusion). Of the 350 collected culture samples;23 were positive (incidence 6.5%). The most common isolated gram positive organisms were staph aureus (incidence 1.1%), the most common isolated gram negative organisms were Klebsiella ssp (incidence 2.2%) followed by acintobater cepacia (incidence 1.4%) then E. coli (incidence 1.1%). No isolation of fungal infection was found. Regarding antimicrobial susceptibility pattern of these microorganisms, we found that they were sensitive to different spectrum of antibiotics. Factors assessing in decreasing the risk factors of major and minor infections during post-operative period included: early diagnosis of the type of organism responsible for nosocomial infection and early treatment with suitable antibiotics.

Conclusion

Major postoperative infections caused adverse outcomes in pediatric cardiac surgery and were associated with longer hospital stay. Blood components transfusions, duration of mechanical ventilation and central venous catheterization were associated with higher rates of nosocomial infections.
Hepcidin/Ferritin Ratio in Patients with Beta Thalassemia. A Single-Center Experience
Authors: Andrawes Nevine Gamal , Abdelkader Salwa Mostafa , Yossef Soha Raouf , Georgios Lauris Malak Botros
Published: November 2024

Background

Hepcidin, a main regulator of iron hemostasis, can potentially be used as a marker for iron overload in patients with thalassemia; hence can be used to evaluate the efficacy of chelation therapy.

Aim

We hypothesize that serum hepcidin and hepcidin/ferritin ratio might be better markers for iron load and iron load distribution characteristics in different thalassemia syndromes. Subsequently we aimed to estimate serum hepcidin, ferritin, and hepcidin: ferritin ratio in patients with beta-thalassemia syndromes.

Patients and Methods

A prospective study was conducted on 42 patients with beta- thalassemia major and 40 patients with beta-thalassemia intermedia compared to 20 age and gender-matched healthy controls. For all patients, serum ferritin, and hepcidin were measured by ELISA assay then the hepcidin /ferritin ratio was calculated.

Results

All patients (100%) with beta-thalassemia major and 26 patients (65%) with beta- thalassemia intermedia were transfusion dependent. Sixty-one patients (74%) were on regular iron chelators, 49 of them (80%) were on desafirox with a median dose of 20 mg/kg, 40 patients (100%) of beta thalassemia intermedia were on hydroxyurea. Patients with thalassemia syndromes had higher mean serum ferritin (3000 ng/ml), median serum hepcidin of 162 ng/ml, lower mean hemoglobin (8.2 gm/dl) and hepcidin: ferritin ratio of 0.15 compared to control (P < 0.001) who had median serum ferritin (73 ng/ml), median serum hepcidin of (62.8 ng/ml), mean hemoglobin (11.03 gm/dl) and hepcidin: ferritin ratio of 0.71. Beta thalassemia major patients had a higher median serum hepcidin level of 256 ng/ml, and a lower hepcidin /ferritin ratio of 0.18 compared to patients with beta-thalassemia intermedia (p < 0.001, p < 0.001 respectively). Hepcidin level was negatively correlated with the age of onset, frequency of transfusion.

Conclusion

Serum hepcidin level was elevated in beta-thalassemia children with more evident elevation in beta-thalassemia major patients. Also hepcidin: ferritin ratio was elevated in normal controls and low in thalassemia intermedia differentiating both entities. The younger the age of onset of Thalassemia, the higher the need for transfusion, and the dose of desafirox, the higher was the hepcidin level.
Role of Serum Autotaxin in Estimating Degree of Liver Fibrosis and Disease Severity in Pediatric and Adolescent Chronic Liver Diseases
Authors: Ahmed Lerine Bahy El-Din , Talaat Iman Mohammed , Mohamed Noha Refaat , Aggour Maha Hesham Ahmed
Published: November 2024

Background

Autotaxin (ATX) or ecto-nucleotide pyrophosphatase/ phosphodiesterase-2 is a secreted lysophospholipase D that hydrolyzes extracellular lysophospholipids into the lipid mediator lysophosphatidic acid, a ligand for specific G protein-coupled receptors. Lysophosphatidic acid stimulates the proliferation and contractility of hepatic stellate cells, a key player in liver fibrogenesis, and inhibits their apoptosis.

Objective

To determine serum ATX levels in pediatric and adolescent patients with chronic liver diseases of different etiologies and to compare it with the control group and to correlate between serum ATX level and disease severity, stage of fibrosis in liver biopsy in patients with chronic liver disease.

Patients and Methods

This was a cross sectional- case controlled study carried out in Ain Shams University pediatric Hospital, in the period between January 2023 and December 2023. To all patients and controls, serum sample was withdrawn to assess autotaxin level. For patients with chronic liver disease data was collected from hepatology clinic files including laboratory investigations and liver biopsy done within 1 year, to assess the degree of liver fibrosis and activity.

Results

Regarding serum autotaxin level, it was significantly higher in patients with chronic liver disease(868.8ng/dl) compared to control(30ng/dl, p = 0.000). Serum autotaxin level was higher in females (median 2582.5 ng/dl) than males (median 586) (p = 0.038). The study showed significant correlation in serum autotaxin level and etiology of chronic liver disease (p = 0.008). Also, there was a positive correlation with MELD score(r = 0.563) (p = 0.045), PELD score(r = 0.503) (p = 0.007) and severity of Child Pugh score (p = 0.000). Regarding Ishak fibrosis score there was a significant correlation with serum autotaxin level (r = 0.734) (p = 0.000), METAVIR fibrosis score (0.717) (p = 0.000). Roc analysis curve shows high sensitivity 100% and specificity of 100% of autotaxin to predict fibrosis in patients with chronic liver disease, the cut off value is 97.4ng/ml.

Conclusion

Developments of serum biomarkers have focused on the diagnosis of cirrhosis and the assessment of advanced fibrosis. Serum autotaxin as a biomarker for fibrosis in patients with chronic liver disease. Serum autotaxin level has shown a direct association with stage of fibrosis in patients with chronic liver disease. Also, serum autotaxin can be used to determine the severity of liver fibrosis and to evaluate the prognosis of liver cirrhosis.
Assessment and Significance of Pentraxin (PTX3) Plasma Level in Coagulopathy in Children with Covid19
Authors: Adly Amira Abd Elmonem , Eltonbary Khadiga , Salem Lamyaa , Sobhe Ali Elbagory Mennat-allah Sobhe
Published: November 2024

Background

Pentraxin-3 (PTX3), plays an important role in regulation of inflammation and resistance to a lot of pathogens. It has been recently reported to be correlated with coagulopathy and disease severity in patients with COVID-19

Objective

To assess significance of PTX 3 as a serum biomarker in children with COVID 19 infection and associated coagulopathy, multisystem inflammatory syndrome in children (MIS-C) and short-term disease outcome.

Subjects and Methods

This was a cross sectional study, carried out over 6 months duration, from September 1st, 2021, to March 1st, 2022 and it included 62 COVID-19 pediatric patients whose ages ranged between 2 to 18 years admitted through Pediatric Intensive Care Unit or Emergency room and 25 apparently healthy children as a control group. Clinical features, laboratory work up (complete blood picture, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum ferritin and D-dimer) and imaging studies (chest x-ray, computed tomography of the chest (CTscan), echocardiography with calculation of coronary artery Z-score were done to all patients in addition to a measurement of serum PTX3 by enzyme linked immunosorbent assay to both patients and controls.

Results

The mean (SD) age of the enrolled patients was 8.4±1.71SD. The number of females was 32 and of males was 30. The main presenting symptoms were malaise, sore throat and headache in all patients followed by dry irritative cough (85.5%) and fever (64%). The mean serum PTX3 level was significantly higher in patients compared to controls (13ng/ml (7 – 16.5) versus 0.8ng/ml (0.5 – 1). Serum PTX3 levels were positively correlated with ESR, CRP and serum ferritin as well as with D-dimer (P value=0.007)and INR (P value=0.001). Out of 62 patients, 11 required intensive care unit admission and mortality was 6.5%. PTX3 cut-off level of 8ng/ml had sensitivity of 68.42% and specificity of 100% in predicting significant CT findings categorized as CORAD IV or V. Also PTX3 level with a cut-off of > 2.1ng/ml, has sensitivity of 96.77% and specificity of 100% in detecting the disease severity.

Conclusion

Our data contribute to the accumulating evidence that PTX3 serum concentrations are significantly elevated in COVID-19 pediatric patients and can serve as an early biomarker of disease severity in children. It can predict significant pulmonary involvement and multi-system inflammatory response. Moreover, PTX3 is likely to participate in COVID-19 associated coagulopathy
Relation between Helicobacter pylori Infection and Autoimmune Thyroid Disease in a Sample of Pediatric Patients
Authors: Attallah Mostafa Mohammed Mabrouk , Amr Nermine Hussein , Khalaf Randa Ismail , Hassan Marwa Magdy
Published: November 2024

Background

Autoimmune thyroid diseases (ATDs) are heterogeneous group of acquired disorders that are characterized by the presence of circulating anti-thyroid antibodies, infiltration of the thyroid gland by reactive B and T lymphocytes in addition to altered thyroid function. This study aimed to explore the thyroid function profile and H. pylori infection in a sample of pediatric patients with autoimmune thyroid disease.

Methods

This case control study included 31 pediatric patients diagnosed with ATDs proven by positive thyroid autoantibodies and 31 healthy age and sex matched children were included as control group. Detailed history including clinical manifestations and treatment modalities were taken. Free T4, free T3, TSH, anti-thyroglobulin and anti-tissue peroxidase, H. Pylori stool antigen and thyroid ultrasound were done. None of our included children have received treatment for H. pylori infection.

Results

Out of the 31 patients, 11 were diagnosed with Graves’ disease (35.48%) while 20 were diagnosed with Hashimoto thyroiditis (64.52%) with mean age of 13.515 ± 3.176 and 14.081 ± 2.715 years respectively. There is no statistically significantly difference in thyroid ultrasound findings in children with GD and HT. H. pylori infection was significantly higher in children with ATDs (51.6%) in comparison to healthy children (25.8%). 17 of the 31 children with ATDs had dyspeptic symptoms with insignificant difference between H. pylori positive and negative children. Regarding treatment modalities, 18 of children with ATDs (58.1%) were controlled on medications while 13 were uncontrolled (41.9%) and needed frequent adjustment of doses or surgical intervention. 19 children with HT (95%) and 7 children with GD (63.6%) received medical treatment only, while 1 patient with HT (5%) and 4 children with GD (36.4%) underwent thyroidectomy after a duration ranged from 3 to 6 years of medical treatment.

In Conclusion

Hashimoto thyroiditis was the most prevalent ATD in pediatric age group. H. Pylori infection is more frequent in children with ATDs. Medications alone may be insufficient to achieve symptoms control in children with AUTs and surgical intervention may be required. Further studies are required to evaluate the impact of H. pylori infection eradication on thyroid function in children with ATDs.
Diagnostic Yield of Gastrointestinal Endoscopies in Children
Authors: Hamdy Ahmed M , Radwan Nehal A , Awad Yosra M , Hafez Nourhan J
Published: November 2024

Background

Endoscopies proved to be an indispensable tool in pediatric gastrointestinal practice. With the surge in the number of endoscopies and healthcare expenses, it is imperative to ascertain the diagnostic yield of endoscopies to improve patient selection and reduce unnecessary costs.

Objective

The aim of this study is to evaluate the diagnostic yield of pediatric gastrointestinal endoscopies.

Methods

Patients undergoing diagnostic endoscopy at one tertiary center in Egypt over the past 5 years, from 2018 to 2023, were included in a retrospective study. Demographic, clinical, endoscopic, and histopathological data were collected and studied.

Results

2125 patients aged one month to 16 years, presenting with different symptoms, were evaluated. School age children represented the most common age group (34.6%). The most common indications for upper gastrointestinal(GI) endoscopies were upper gastrointestinal bleed (27.7%) followed by persistent vomiting (24.0%) and failure to thrive and/or chronic diarrhea (17.2%), whereas 77.5% of colonoscopies were performed due to bleeding per rectum. The diagnostic yield (frequency of positive endoscopies) for all GI endoscopies performed is 66.9%. Colonoscopies depicted a higher diagnostic yield of 72.7%, than upper GI endoscopy, of 66.7%. The diagnostic yield of performing both endoscopies together was 62.8%. The most frequent endoscopic diagnoses with upper GI endoscopies alone were gastroduodenitis (27.7%), foreign body ingestion (12.4%), and celiac disease (11.9%). As for colonoscopies alone, GI polyps (48.5%), non-specific colitis (12.1%), and hemorrhoids (7.9%) were most frequent, and for both procedures, suspected inflammatory bowel disease (19.7%), gastroduodenitis (17.4%) and lymphoid nodular hyperplasia were the most common endoscopic diagnoses. GI polyps were found in 40.1% of patients presenting with lower GI bleeds. Failure to thrive and/or chronic diarrhea represented 44.1% of patients undergoing both procedures.

Conclusion

The diagnostic yield for GI endoscopies is 66.9%, and vary based on age, procedure, and indication. Histologic correlation further increases the diagnostic yield.