bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum Levels of Soluble Vascular Endothelial Cadherin among COVID-19 Children
Authors: Mostafa El-Ganzoury Mona , El-Farrash Rania Ali , Magdy Sondos Mohammed , Nasef Marwa Waheed Abd Elhady , Rahman Eman Ismail Abdel , Ahmed Hadeer Youssry Gameel
Published: November 2024

Background

COVID-19 is an endothelial disease, and the consequent endotheliopathy is responsible for inflammation, cytokine storm, oxidative stress, and coagulopathy. Vascular endothelial cadherin (VE- cadherin) is a strictly endothelial specific adhesion molecule located at junctions between endothelial cells. Aim: serum levels of VE-cadherin was assessed as a marker of endothelial dysfunction among COVID-19 patients compared with healthy controls.

Methods

Thirty patients with COVID-19 with median age 5.6 (3.3-7.0) years old were enrolled. They were compared with 30 healthy controls. Covid-19 polymerase chain reaction, Covid-19 antibodies, complete blood count, blood gases, C-reactive protein, D-dimer, lactate dehydrogenase, serum ferritin and VE-cadherin levels were assessed.

Results

VE-cadherin levels were significantly higher in COVID-19 patients compared with healthy controls. There was a significant negative correlation between VE-cadherin and platelet count while VE-cadherin was positively correlated to creatinine level.

Conclusion

VE-cadherin levels are elevated in children and adolescents with COVID- 19 suggesting the presence of endothelial dysfunction. VE-cadherin levels are mainly related to lung and kidney injury in COVID-19 patients.
Clinico-Epidmological Study and Outcome of COVID 19 Infection in Children with Hemato-Oncological Disorders
Authors: Ebeid Fatma Soliman Elsayed , El-Din Aya Mostafa Kamal , Magdi Sondos Mohamed , Abd El Kader Haidy Mohamed , Aly Nihal Hussien
Published: November 2024

Background

Severe acute respiratory syndrome Coronavirus 2 (SARS-Cov2) outbreak has caused a pandemic rapidly impacting on the way of life of the entire world. Several studies reported the specific role of an immunocompromised status as a possible risk factor for CoV-related pneumonia. The detrimental impacts of COVID-19 pandemic on childhood cancer are multiple including a delay in diagnosis and starting treatment, the impact of infection, and the uncertainty about the decision for chemotherapy in polymerase chain reaction–positive asymptomatic patients.

Aim of the Work

The study aimed to Measure the frequency of COVID-19 infection among children with hemato-oncological disorder in a period from 27 February 2022 till 27 March 2023 and to develop a registry dataset which can be used as a template for national registry for children with hemato-oncological disorder with proven COVID19 infection.

Patients and Methods

This is a retrospective cohort non-interventional study in which we recruited 620 child and adolescents patients who attended the pediatric hematology oncology unit, Ain Shams University, Children’s hospital in a period from 27 February 2022 till 27 March 2023.

Results

This is a cohort study included 620 immunocompromised children including 319 patients with hematological malignancies, 30 patients with solid malignancy, 271 patients with benign hematology. Our findings showed that 620 patients, 87 of them were found to be COVID-19 positive. The median age of COVID-19 the patients was 5 years (range: 0.75–16 years). The median duration of COVID-19 positivity of the patients was 12 days (range: 3–38 days). There was significant increase in the percentage of patients with positive chest X-ray, abnormal echo, patients with organomegaly in abdominal US in COVID-19 group than non COVID-19 group.

Conclusion

The percentage of patients with COVID-19 were higher among patients with hematological malignancies and benign hematological diseases especially acute lymphoplastic leukemia and aplastic anemia respectively. COVID-19 was tolerable among immunocompromised patients. Mortality was associated with abnormal neurological examination in patients with COVID-19 disease.
Myostatin as a Marker of Reduced Muscle Mass in Children and Adolescents with Chronic Liver Disease
Authors: Abass Heba Abd Elkader , Elfaramawy Amel Abdel Magied , Mahmoud Fatma AbdEllah Abdullah , Elkholy Heba Essam
Published: November 2024

Background

Sarcopenia is defined as a decrease in muscle mass, and is a reliable marker of nutritional status of patients with chronic diseases. Multiple factors contribute to malnutrition in chronic liver disease (CLD), such as impaired absorption and/or digestion, increased metabolic demands, anorexia, and decreased oral intake. Changes due to liver cirrhosis are considered potential disruptors of the balance of protein anabolism and catabolism which is a characteristic feature of Sarcopenia.

Aim of the Work

to assess the muscle mass in CLD pediatric patients and evaluate myostatin as a biomarker of sarcopenia in CLD pediatric patients and its association with muscle mass.

Patients and Methods

The study was conducted at the hepatology and nutrition clinics, of Ain Shams Children`s Hospital. It included 42 (20 male and 22 female) CLD patients and 45(26 male and 19 female) healthy controls aging between 2 and 18 years during the period from August 2021 to January 2022. They were subjected to full history taking, clinical evaluation, anthropometric measurements including weight, height, mid upper arm circumference(MUAC) and body mass index(BMI), assessment of body composition and measurement of serum myostatin.

Results

The prevalence of malnutrition in the CLD patients was significantly higher than the controls with p value<0.001 and it was as follow: 50% had abnormal weight, 42.85%were stunted and 42.85% had abnormal BMI. Although the prevalence of malnutrition in the cases detected by MUAC (in age group 2-5years) was 33.33%, yet this was not statistically significant compared to healthy control with p value 0.329. As regards the lean muscle mass measured by body composition scale, we found that the prevalence of decreased lean muscle mass was 57.58% in the cases which was significantly higher than the controls with p value<0.001. Our study showed that CLD patients had significantly higher serum myostatin level with median of 757ng/mL and range of (450-825ng/mL) in comparison to median of 120ng/mL and range of (100-140ng/mL) in healthy controls. There was a negative but non-significant correlation between the serum myostatin and decreased lean muscle mass in the cases with p value 0.253 and r -0.205.

Conclusion

Malnutrition is prevalent in children with CLD and decreased lean muscle mass is significantly evident. Serum myostatin level is significantly higher in patients with CLD compared to healthy controls.
Complications of Central Venous Lines in Egyptian Children and Adolescents with Malignancy
Authors: Ahmed Heba Hussain Mohamed , Elhabashy Safinaz Adel , Ellaboudy Mohamed Abdel-Mohsen , Elraheem Heba Gomaa Abd , Elsayed Eman Mohamed , Fahim Noha Alaa Eldin Mohamed
Published: November 2024

Background

Central venous catheters (CVCs) are currently an important component in pediatric oncohematological care, with a direct influence on outcome. Several types of CVC are available; however, CVCs are often associated with several complications which may affect patients’ morbidity and mortality.

Aim

The aim of this study was to prospectively evaluate the CVC-related complications in pediatric patients with Hematooncologic malignancy in terms of frequency, types, and outcome, and possible risk factors.

Methods

Between January 2020 and January 2023, 384 CVCs were inserted in 142 patients and prospectively evaluated till end of study period. Regarding each catheter, data were recorded on type, date of positioning, age and underlying disease of the patient, date and type of any complication, date of the last examination, and cause of catheter removal, if applicable.

Results

A total of 142 patients with a median age (IQR) at time of insertion of CVCs of 4.512 (7.5) years were evaluated. Patients with hematological malignancy constituted 71.1% (n = 101) and the rest were being treated for solid malignant tumors (n = 41). Complications developed in 98 (25.5%) CVCs. A total of 6357catheter days were screened. Median (range) CVC in-dwelling time was 15 (7- 22) days. In total, 129 complications developed of which 68(52.7%) were infectious complications, 42 (32.5%) were vascular, 16(12.4%) were mechanical and 3 (2.3%) were malfunction. The overall complication rate was 20.29 per 1000 catheter days. Subjects with hematological malignancies had significantly more complications than those with solid tumors (p = 0.040). The most significant risk factors for having a CVC complication were hematological malignancy, neutrophil count, platelet count before insertion and a D-Dimer in excess of 0.83mg/L. At end of study period one patient passed away because of catheter complications.

Conclusion

Appropriate knowledgeable and skilled teams are mandatory in order to address issues regarding indications, placement and removal techniques, choice of the devices, catheter care and possible complications in such a peculiar population. All health care professionals should receive regular and continued education on CVC usage, and complications.
Estimation of Meal-Time Insulin Based on Glycemic Load versus Carbohydrate Counting among Patients with Type 1 Diabetes Using Insulin Pump
Authors: Elsamahy Mona Hussein , Elhenawy Yasmine Ibrahim , Elgendy Yasmine Gamal , Mahmoud Hebatullah Abdelhai Ahmad
Published: November 2024

Background

Dietary carbohydrates have a major effect on postprandial glycemic response. Therefore, the current guidelines recommend the usage of insulin/carbohydrate ratio for calculation of prandial insulin dose based on the carbohydrate count in a given meal. However, some studies pointed to the importance of the quality of carbohydrates, as reflected by their glycemic index, in addition to their quantity on the regulation of postprandial glucose level.

Objectives

To identify a safe, feasible and effective method for calculation of prandial insulin dose based on the glycemic load of a meal. This could minimize postprandial glycemic variability in type 1 diabetic patients.

Patients and Methods

Our study included 15 type 1 diabetic participants; their ages ranged from 8 to 15 years. The participants were given a breakfast with the same amount of fat, protein and carbohydrates, which was prepared similarly in all studied patients. Sequence, quality and amounts of meals consumed during the first week of the study were replicated during the second week. Calculation of prandial insulin doses using one regimen for 1 week and a crossover to the other regimen for an additional week was done. A detailed medical history was collected, including the age of onset of diabetes, disease duration, and symptoms of diabetic complications.

Results

Blood glucose postprandial excursions was significantly lower during the glycemic load counting (GLC) than the carbohydrate counting (CC) period from baseline to 120 min (-10.20 ± 8.18 vs 8.47 ± 6.65 mg/dl, respectively, p = < 0.001), baseline to 180 min (-11.80 ± 8.16 vs 5.13 ± 7.01 mg/dl, respectively, p = < 0.001) and baseline to 240 min (-9.60 ± 6.07 vs -0.53 ± 7.31 mg/dl, respectively, p = 0.007). However, there was no postprandial glucose difference between the two periods from baseline to 60 min (-2.87 ± 8.09 vs 2.53 ± 7.76 mg/dl, respectively, p = 0.083).

Conclusion

The data from this study showed that glycemic load counting for prandial insulin doses is a feasible and effective method in short term glucose control.
Blood-Based Molecular Biomarkers as Predictors for Respiratory Distress Syndrome in Infants of Diabetic Mothers
Authors: El-Farrash Rania A , Mansour Hoda I , Khazragy Nashwa NEl , Ibrahim Mariam J A
Published: November 2024

Background

Respiratory distress (RD) is a primary cause of sickness and mortality in newborns. There is a suggested association between maternal diabetes and respiratory distress in their children, which is directly tied to metabolic and genetic cascades of modifications linked to fetal hyperglycemia.

Aim

To investigate the circulating expression level of surfactant-related mRNA surfactant protein C (SP-C) in neonates born to diabetic mothers and to compare them with healthy newborns. In addition, to evaluate the clinical utility of the above- mentioned circulating biomarker in predicting the development and severity of RD in infants of diabetic mothers.

Patients and Methods

This study was conducted on 66 neonates; 23 neonates of infants of diabetic mothers (IDM) who developed respiratory distress after birth, another group of IDMs who did not develop RD, and a control group of 20 healthy neonates. All neonates were subjected to history taking, Full clinical examination, Biochemical tests, Imaging, gene expression analysis, and assessment of hypoglycemia and degree of respiratory distress in IDMs.

Results

No significant difference was detected in the expression of the SP-C between the IDM group and the healthy group (p = 0.09). However, there was a significant difference between the different degrees of RD (P = 0.04).

Conclusion

SP-C expression level couldn’t be used as a diagnostic biomarker for RD in IDMs. However, it could be used as a prognostic marker to predict the severity of respiratory distress.
Plasma Magnesium in Children and Adolescents with Type 1 Diabetes
Authors: Toaima Dalia N , Salah Nouran Y , Atef Heba M , Abdel-Maksoud Kholoud S
Published: November 2024

Background

Magnesium deficiency in type I diabetes (T1DM) has been associated with multiple cardiovascular implications including arrhythmogenesis, vasospasm, and hypertension.

Aim

This study compared plasma magnesium level in children with T1DM and controls & correlated it with vascular complications in children with TIDM.

Methods

Forty-Six children and adolescents with TIDM & forty-six controls from the Pediatric and Adolescent diabetes unit (PADU), Ain Shams University were studied. Serum magnesium was measured with assessment of microvascular complications.

Results

The mean age of the studied children and adolescents with TIDM was 13.73.1 years; their mean disease onset was 6.7#2.2 years. 39.7% of cases had nephropathy, only 2 cases (4.3%) had neuropathy and 1 case (2.2%) had retinopathy. Children and adolescents with type 1DM had statistically lower levels of magnesium, compared to controls, P < 0.001. Magnesium level correlated negatively with insulin daily dose, HbA1c and microalbumin. Patients who developed diabetic nephropathy had statistically lower levels of magnesium (p < 0.001), compared to patients who didn't have diabetic nephropathy. Longer duration of diabetes, higher HBA1c and lower magnesium were independently associated with higher risk of diabetic nephropathy among the studied children and adolescents with TIDM.

Conclusion

Regular assessment of serum magnesium is mandatory in patients with TIDM. Future studies should assess the efficacy of Mg supplementation in prevention of microvascular complications in patients with T1DM.
Assessment of Serum Levels of Specific IgE to Cow Milk and Gluten Antigens in Autistic Children
Authors: Mostafa Gehan Ahmed , Youssef Azza Mohamed , Shehab Abeer Al Sayed , Beheiry Marwa Nagah , Shousha Ghada Abdel Haleem
Published: November 2024

Background

Regimens of dietary restrictions of cow’s milk protein and wheat showed good impact on autistic children without clear explanation.

Objective

To investigate the possible link between serum levels of specific IgE to cow milk and gluten allergens and the severity of autism in a group of autistic children.

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 four autistic children aged 4 to 12 years and twenty four 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 specific IgE for 4 cow’s milk proteins and gluten protein were assessed for the patients and healthy children using Enzyme-linked immunosorbent assay (ELISA) technique.

Results

Mean age of autistic patients was 6.48±2.54 years with 19 males and 5 females were studies who were age and sex matched with healthy children and served as a control group. Serum levels of specific IgE against cow’s milk protein and gluten were undetectable among the 2 groups as their level was below 0.35 ku/l. Boys had significantly higher levels of specific IgE against beta lactoglobulin compared to autistic girls in female ranging from (0.01-0.2) while in males (0.06-0.33) (p = 0.04). Specific IgE to casein was positively correlated to IQ level of the studied patients (r = 0.499, p = 0.13).

Conclusion

Although milk and gluten intolerance were identified in autistic children, the underlying mechanism is mostly not related to atopy. Further studies should be encouraged to identify the other possible mechanisms.
Study of the Cardiovascular Effects of Ketogenic Diet Regimen in Epileptic Children
Authors: Mohammed Medhat Makhlouf Mohammed , Youssef Sanaa Youssef Shaaban , El Gendy Yasmin Gamal Abdo , Deifalla Shaymaa Ahmed Maher , Nasef Marwa Waheed Abd Elhady
Published: November 2024

Background

Ketogenic diet therapies (KDT) are well-established, non-pharmacologic treatments used for children with drug resistant epilepsy. Cardiac abnormalities have been reported in children on the KD, including cardiomyopathy and prolonged QT interval. ECG should be considered in any child with history of heart disease before starting ketogenic diet therapy.

Aim of the Work

To evaluate the impact of ketogenic diet therapy on the cardiovascular structure, diastolic function as well as assessment of carotid intima-media thickness for a group of children with drug resistant epilepsy.

Patients and Methods

This was a Prospective cohort study that was carried out at Ketogenic Diet Clinic and Epilepsy Clinic, Children’s Hospital, Faculty of Medicine, Ain Shams University on thirty infants and children with drug resistant epilepsy (DRE) aged from 6 months to 16 years old.

Results

There was no statistically significant difference in echocardiographic parameters, carotid intima media thickness (CIMT) or ECG after 6 months of Ketogenic diet therapy KDT inspite of hyperlipidemia and ketosis yet statistically significant negative correlation was found between serum cholesterol and triglyceride with ejection fraction and fractional shortening which could be explained by increased blood viscosity associated with hyperlipidemia. There was statistically significant decrease in seizure frequency and number of anti-epileptic drugs. There was significant increase in almost all anthropometric measurements, lipid profile and serum ketones. While no significant differences found in vital data, blood cells.

Conclusion

The six months ketogenic diet regimen appears to have no disturbing effect on the cardiovascular structure, diastolic functions as well as carotid intima-media thickness in children with drug resistant epilepsy inspite of hyperlipidemia. Cardiovascular monitoring is recommended for patients undergoing ketogenic diet therapy and further research is needed to fully understand the potential risks and benefits of this treatment on a larger population and longer period schedules.
Serum Malondialdehyde Level as a Predictor of Failure of Weaning from Mechanical Ventilation in the Neonatal Intensive Care Units
Authors: EL-Raggal Nehal Mohamed , Mahmoud Tayseer Moustafa , Metwally Mohamed Hussein , Alfattah Dina Tharwat Abd , Hamed Mahmoud Menna Allah
Published: November 2024

Background

Mechanical ventilation is a lifesaving treatment used in critical neonatal patients. It is indicated when the patient's spontaneous ventilation is insufficient to sustain life. Mechanical ventilation expedites and facilitates gas exchange, oxygenation, and CO2 removal. Despite advances in non-invasive ventilatory support methods, intubation and mechanical ventilation are still common treatments in NICUs.

Objective

To evaluate whether or not serum malondialdehyde (MDA), as a marker for oxidative stress, could be used as a mean to predict the neonatal weaning failure from mechanical ventilation.

Methods

This is a prospective cohort study included 31 full and preterm neonates on invasive mechanical ventilation ≥72 hours was conducted in Neonatal Intensive Care Unit Ain Shams University, children Hospital, after approval of the Research Ethics Committee Faculty of Medicine Ain Shams University from 1/3/2022 to 1/11/2022. Inclusion criteria of enrolled neonate includes full term (≥37 weeks) and preterm (33-36 weeks) neonates within their 28 days of life, neonates on invasive mechanical ventilation ≥ 72 hours and neonates ready to be weaned according to weaning Protocol.

Results

Serum level of MDA after half and 72 hours in weaning failure neonates (627 and 2000 ng/ml) compared to serum level of MDA pre-Spontaneous breathing test (SBT) (325.9 ng/ml) with p-value= 0.000. Serum level of MDA in weaning success patient pre-SBT, after half and 72 hours (163,124.2 and 63.9 ng/ml) compared to weaning failure patient (325.9,672 and 2000ng/ml) with p- value= 0.000. Our study revealed highly significant increase in serum level of MDA in weaning failure patients after half and 72 hours of extubation with p-value = 0.000. Pre extubation serum MDA level to Predict weaning failure was >223 ng /ml.

Conclusion

This study demonstrated significant increase in the level of pre-extubation serum MDA in the weaning failure group than weaning success. Serum MDA could be used as mean to predict weaning failure from mechanical ventilation.
UNCD Mutations in Children with Familial Hemophagocytic Lymphohistiocytosis and Systemic Inflammatory Response Syndrome
Authors: Hamdy El-Sayed Manal , Ragab Iman Ahmed , Agwa Sara Hassan , Wahid Tolba Marwa , Refaat Merna Kamal , Elsayed Ebeid Fatma Soliman
Published: November 2024

Background

Familial hemophagocytic lymphohistiocytosis (HLH) results in clinical manifestations of an extreme inflammatory process; leading to an overlap with other diseases with a hyperinflammation process. Implementing HLH criteria without genetic analysis might lead to inadvertent planned therapy with immunosuppressive and unnecessary bone marrow transplantation.

Objectives

This study assessed the frequency and types of UNCD mutations among patients clinically diagnosed with Familial HLH or systemic inflammatory response syndrome and correlated between the genetic mutations and clinical picture.

Methods

This study included 40 patients who were clinically diagnosed as Familial HLH or systemic inflammatory response syndrome with median age 28 months. All patients fulfilled at least 5 out of 8 of HLH criteria. Complete blood count, liver enzymes, total and direct bilirubin, serum ferritin, serum fibrinogen, serum triglycerides, sCD25, bone marrow aspirate, MRI brain and CSF analysis were assessed as well as analysis of UNC13D gene were performed.

Results

The studied population included 24 (60%) males and 16 (40%) females with median age at initial presentation being 26 months. Eighteen (45%) patients had a positive family history. At presentation, 25 (62.5%) patients had systemic manifestations: 36 (90%) patients had fever, 35 (87.5%) patients had hepatosplenomegaly. Nine (22.5%) patients presented with neurological manifestations and six (15%) patients had both systemic and neurological manifestations. Genetic testing of the studied population showed: 10 (25%) patients had UNCD gene mutation, 15 (37.5%) patients were found to have other gene mutations for FHLH, 3 patients had mutations for other genetic conditions while 12 (40%) patients had no any genetic mutations. Among the 15 patients who showed gene mutations for other FHLH subtypes; 12 (40%) patients had Perforin gene mutations, 1 patient had STXBP2 gene mutation, 1 patient had Lyst gene mutation and 1 patient had RAB27A gene mutations. Data showed no significant difference in clinical presentation between patients with UNCD gene mutation and other patients (Pvalue: 0.08). Nearly one third of patients (n = 11, 30.6%) were misdiagnosed and treated as FHLH which was then excluded by genetic study. 8 (32%) patients were diagnosed solely by genetic study to have FHLH and were not suspected upon presentation to have FHLH with a mean interval to diagnosis of 203 days.

Conclusions

Genetic testing is mandatory for diagnosis of FHLH to determine the exact gene mutation and to differentiate from other conditions with hyperinflammatory process to rapidly implement bone marrow transplantation in patients with positive mutations as it is the only radical cure.
Postprandial Glucose Following High Glycemic Index Meals in Children and Adolescents with Type 1 Diabetes on Insulin Pump Therapy
Authors: Sherif Eman Mounir , Elhenawy Yasmine Ibrahim , Fereig Yasmeen Abdelaziz , Fekry Mohamed Akram Mohamed
Published: November 2024

Background

Achieving postprandial normoglycemia is the most challenging part in the management of type 1 diabetes. Meal timing and meal composition affect glycemic outcomes. Nutritional properties of food, including protein, fat and glycemic index significantly impact postprandial glycemic excursions.

Objective

To assess efficacy of continuous subcutaneous insulin infusion (CSII) in optimizing postprandial glycemic excursions following the consumption of a high-glycemic index (high-GI) carbohydrate.

Methods

The current study is a non-blinded single arm randomized controlled trial including 24 participants with type1 diabetes regularly following up at the Pediatric and Adolescent Diabetes Unit (PADU), Pediatrics Hospital, Ain Shams University. All recruited children and adolescents were using the MiniMed® Paradigm Revel TM 523/723. The same high-GI breakfast with standardization of fat and protein content (cereal- cornflakes (contains 50 g carbohydrates, GI = 81±6) and skimmed milk (contains 0.5 g fats, 9 g carbohydrates, 6 g proteins) was given to all participants and prandial insulin dosage was individualized according to participants’ insulin-carb ratio. Insulin was delivered upfront as a standard bolus, given 15 minutes before consuming the test meal. Postprandial glycemic excursions were assessed using flash glucose monitoring system at 1, 2 and 3 hours post meal.

Results

The standard bolus didn’t control the early postprandial excursions, with highly significant postprandial excursions at 60 min and 120 min following consumption of the tested meal. The mean blood glucose level significantly increased from 101.79 ± 19.73 mg/dl at baseline to 167.50 ± 16.64 mg/dl at 60 min (P = 0.000). Similarly, at 120 min after consumption of the test meal, the mean glucose significantly increased to 183.83 ± 19.90 (P = 0.001)

Conclusion

High-GI carbohydrates modifies postprandial glycemic response causing early sharp glycemic rise, which was not controlled by the standard bolus of insulin delivery. Further studies are needed to define the optimal insulin delivery regimen required to optimize postprandial glycemia following the consumption of high-GI carbohydrates.
Evaluation of Quality of Life in Children and Adolescents with Type 1 Diabetes during the COVID-19 Pandemic
Authors: Sayed Matter Randa Mahmoud Asaad , Amin Ghada Essam-Eldin , Fereig Yasmeen Abdelaziz , Youssef Nabil Ragab Ibrahim
Published: November 2024

Background

COVID-19 was announced as a global pandemic in 2020. During the COVID-19 pandemic, children with chronic conditions, especially type 1 diabetes, were expected to be at greater risk of experiencing negative emotions such as uncertainty, distraction, anger, and fear.

Objective

To evaluate the quality of life of type 1 diabetic children and adolescents using the pediatric quality of life (PedQOL) questionnaire during the COVID-19 pandemic.

Methods

This is a questionnaire-based cross-sectional study that included 286 patients with type 1 diabetes who were regularly following up at the Pediatric and Adolescent Diabetes Unit (PADU), Children’s Hospital, Ain Shams University.

Results

A total of two hundred eighty-six patients were included in the study: 141 males (49.3%), 145 females (50.7%), with a mean age of 11.4 ±3.5 years. From the surveyed participants, 261 (91.3%) were on multiple daily injections, and 25 (8.7%) were on subcutaneous continuous infusion (SCCI). On the PedQOL questionnaire, no significant difference was shown as regards mode of insulin injection in pediatric quality of life subscales and total scores. There was better quality of life in children aged 12 years or more with a mean total score of 65.72 over those younger than 12 years with a mean total score of 65.16 and the PedQOL subscales as following PedQOL treatment barriers score (p = 0.025), the PedQOL treatment adherence score (p = 0.025), the PedQOL worry score (p = 0.025), and the PedQOL talking score (p = 0.001).

Conclusion

Participants aged 12 years or more had better quality of life over those younger than 12 years during the COVID-19 pandemic, maybe because of better education and better self monitoring. There was no difference in quality of life between the studied participants as regards the mode of insulin injection.
Autism Spectrum Disorder and Attention - Deficit Hyperactivity Disorder in Children: A Comorbidity
Authors: Elhossiny Reham Mohammed , Elhamid Salwa Amin Abd , Mohammed Nahid Kabashi
Published: November 2024

Background

A diagnosis of autism precludes a diagnosis of Attention- deficit hyperactivity disorder (ADHD), however, despite the difference conceptualization, previous studies reported symptoms overlap and a high rate of ADHD in autism and autism spectrum disorder (ASD).

Objective

To detect the frequency of ADHD in children with ASD and its relation to the severity of autism.

Methods

This study assessed ADHD symptoms and their severity, screened by the Conners' Parent Rating Scale-Revised (CPRS-R), as well as cognitive and adaptive skills, screened by Vineland Adaptive Behavior Scale (VABS), in a sample of 150 children with a primary ASD diagnosis following up at Ain Shams University, Pediatric Department, Developmental and Behavioral clinic.

Results

It was found that the prevalence of ADHD evaluated by the Conners’ Parent Rating Scale is 100% (14.6 mild to moderate ADHD, 85.4 severe ADHD). Severe ADHD is significantly associated with higher incidence of education at special needs schools (P = 0.000), lower maternal education (P = 0.035), jobless fathers (P = 0.035), lower Parity (P = 0.047) as well as a higher incidence of prenatal problems(P = 0.037), presence of family history (P = 0.041), higher Childhood Autism Rating Scale (CARS) scores(P = 0.000), and a higher incidence of severe deficit VABS scores(P = 0.000)).

Conclusion

ADHD frequency is highly prevalent in ASD patients. Clinicians should be aware that ADHD confers additional developmental risk factors on children with ASD. So should be screened and give effective treatment for ADHD symptoms, and what causes them to be severe (higher incidence of special needs schools, lower maternal education, jobless fathers, a high incidence of prenatal problems, consanguinous marriage).
The Ultrasonographic Changes of Intercostal Muscles and Diaphragm in Mechanically Ventilated Preterm Neonates
Authors: Abu-Saif Ibrahim Saad , Shabana Ayah Mohamed , Ashraf Okba Ahmed , Mohamed Noha Saied Ibrahim
Published: November 2024

Background

Although mechanical ventilation is a lifesaving treatment, abundant evidence indicates that its prolonged use (one week or more) promotes respiratory muscle weakness due to both contractile dysfunction and atrophy. Along with the diaphragm, the intercostal muscles are one of the most important groups of respiratory muscles. In recent years, muscular ultrasound has become a useful bedside tool for the clinician to identify patients with respiratory muscle dysfunction related to critical illness and/or invasive mechanical ventilation.

Objective

To assess the impact of mechanical ventilation on diaphragm and intercostal muscles using ultrasonography in preterm neonates.

Patients and Methods

This observational prospective study was conducted at Neonatal Intensive Care Unit (NICU), Children's Hospital Ain Shams University over 6 months from October 2022 to April 2023, It included 60 preterm neonates, divided into two groups; 30 cases of respiratory distress syndrome (RDS) who were on mechanical ventilation for one week or less and 30 preterm infants of matched age and gender who didn’t require respiratory support.

Results

A total of 60 premature neonates participated in the study. Among them, 30 neonates required mechanical ventilation, whereas the other group consisted of 30 spontaneously breathing neonates of matched age and gender. The mean gestational age of both groups was 33 weeks, there was no statistical significant difference between our two groups as regards weight and gestational age. The relation between the right and left diaphragmatic thickness fraction (DTF) and parasternal intercostals muscle thickness fraction (TFiC) in the ventilated group in day 1 and day 3 was of non significance (p-value = 0.089 in left TFiC, p-value = 0.554 in right DTF), while the relation between them from day 1 to day 5 was significantly decreasing (p-value = 0.019 in left TFiC, p-value = 0.008 in left DTF), demonstrating the relation between the duration of ventilation and muscle function and that prolonged ventilation has a great impact on diaphragmatic effort and amplitude, on the other hand the control group measurements were significantly increasing at both right and left diaphragmatic and intercostals muscle fraction from day 1 to day 5 (p-value = 0.001 in left TFiC, p-value = 0.020 in left DTF).

Conclusion

Musculoskeletal ultrasound can detect early diaphragm and intercostals muscle atrophy that was observed in most of the patients treated by invasive mechanical ventilation.
Breast Milk for Treatment of Adhesive Related Skin Injury in Neonates: A Randomised Controlled Trial
Authors: Ismail Rania Ibrahim Hossni , El-Gendy Salma Mohamed Yahia , Elwareth Amira Mohammed Attya Abd , Michael Hany Wifky Gendy , Azzam Nesmahar Tarek Abdelhamed
Published: November 2024

Breast milk is an extremely complex, dynamic and highly variable biofluid. The healing effect of human breast milk has led researchers to increase interest in human breast milk as a natural medicine. Adhesive-related skin injury (ARSI) has a significant negative impact on patient safety.

Aim

to assess the efficacy of breast milk in treatment of ARSI.

Subject and Method

This study is a randomized controlled trial that conducted on neonates admitted to neonatal intensive care units of Ain Shams university Hospitals and El-Galaa Teaching Hospital.

Results

The study included 39 lesions of ARSI from 29 neonates (12 males and 17 females), they divided to breast milk group that enrolled 14 neonates with 20 lesions and routine care group that enrolled 15 neonates with 19 lesions, their gestational age ranged between 36 and 40 weeks and their age were from 5 to 28 days old. When we compared the skin sore score of ARSI before and after treatment between breast milk group and control group it showed that before treatment the breast milk group included 18 lesions with score 2 and 2 lesions with score 1 and the control group included 18 lesions with score 2 and 1 lesion with score 3 and there were no statistical significant difference between both groups with P-value 0.226. Also after treatment the breast milk group included 18 lesions with score 0, 1 lesion with score 1 and 1 lesion with score 2 and the control group included 14 lesions with score 0, 3 lesions with score 1 and 2 lesions with score 2 and there were no statistically significant difference between bothgroups with P-value 0.405. In breast milk group, when compared the skin sore score after treatment with before treatment, we found the skin sore score before treatment included 18 lesions with score 2 and 2 lesions with score 1 which improved significant statistically to 18 lesions with score 0, 1 lesion with score 1 and 1 lesion with score 2 With p value 0.000. this reduction was comparable to the reduction of skin sore score in the control group with no statistical significant difference between both groups as the median number regarding breast milk group was 2 (2 – 2) and the median number regarding routine care group was 2 (1 – 2) and the P-value in comparison between both groups were 0.660.

Conclusion

breast milk was as effective as routine care in treatment of ARSI and showed non inferiority in treatment of ARSI.
Practice for Patent Ductus Arteriosus in Late Preterm and Full Term Infants; A Single Center Experience
Authors: El-samman Nora Hussein , Ibrahim Safaa Shafik Emam , Tahrany Reham Hassan Hassan El , Alhassanin Arwa Hamdy Al sharabasy
Published: November 2024

Background

The arterial ductus is a major communicative pathway which is naturally patent in the fetus. Although usually closing on its own, it may remain open in the second postnatal week due to a lack of prompt diagnosis or absence of prompt treatment.

Methodology

In this observational study, 40 full term and late preterm neonates who have been diagnosed with patent ductus arteriosus (PDA) were recruited from the Neonatal Intensive Care Unit, Ain Shams University over a period of 6 months. The diagnosis of PDA was established both clinically (hemodynamic state) and by echocardiography. The enrolled neonates were observed to evaluate PDA treatment decisions (either ibuprofen, paracetamol or conservative management).

Results

We found significant increased PDA size before treatment in patients who had taken either ibuprofen or paracetamol (2.59 ± 0.59) for treatment of PDA when compared with those who had received no treatment (1.75 ± 0.16) (p = 0.001). In addition, we found significantly longer capillary refill time before treatment in patients treated by ibuprofen (2.2 ± 0.4) when compared to those who were treated by intravenous paracetamol infusion and the third group who received only conservative management (2.7 ± 0.7) (p = 0.026). However, we found no significant difference between the three groups as regard the final outcome (PDA closure, complications, survival and duration of NICU stay) (p- > 0.05).

Conclusions

Our findings showed that choosing certain treatment for closing PDA in our NICU depended mainly on clinical assessment of the baby and PDA size. And, that conservative management of PDA did not compromise survival and is not associated with increased morbidities in near term and full term neonates.
Vascular Endothelial Growth Factor as a Predictor Marker of Progression in Childhood Interstitial Lung Disease
Authors: Ahmed Shaimaa Abdo Elmetwaly , Shaheen Malak Ali , Hassan Safeya Hamdy Zakaria , Abdelkarim Maha Ahmed Sayed , Ahmed Ali Heba Allah
Published: November 2024

Background

Childhood interstitial lung disease (chILD) encompasses a group of heterogeneous diseases characterized by varying degrees of aberrant inflammation and fibrosis of the lung parenchyma. Vascular endothelial growth factor (VEGF) is a signal protein produced by cells that stimulates the formation of blood vessels and might be implicated in the abnormal signaling in the pathogenesis of chILD.

Objectives

To measure the level of VEGF in serum among patients with chILD and determine its relation to the clinical severity.

Patients and Methods

This cross sectional study has been conducted at Pediatric Pulmonology clinic; Ain Shams University Children’s Hospital located in Cairo during the period from January 2023 to June 2023. The study included 35 children compared to 35 sex- and age-matched healthy controls. All patients were assessed in terms of demographic, clinical data and laboratory investigations including serum VGEF using enzyme-linked immunosorbent assay (ELISA) technique along with radiological findings.

Results

The most common clinical finding was cough (93.3%) while the most common systemic symptom was anorexia and weight loss (46.7%). Serum VGEF level was significantly elevated among chILD patients 120 (80 - 200) pg/ml compared to controls 13 (9-16) pg/ml. Moreover, serum VEGF was significantly elevated among severe cases of chILD compared to non severe ones, p-value<0.001.

Conclusion

Serum VGEF was significantly higher among chILD patients especially severe cases.
Evaluation of sRAGE as a New Diagnostic and Prognostic Marker of Sepsis and Septic Shock Cases on Critically Ill Pediatric Patients
Authors: El-Gawad Tarek Ahmed Abd , Abdelhamid Dalia Hosni , Khairy Wafaa Salah , Magdy Sondos Mohammed
Published: November 2024

Background

Serum sRAGE is a soluble isoform of a receptor for advanced glycation end products in different stages of sepsis. The present study will investigate the possible use of sRAGE as a diagnostic and prognostic marker of sepsis and septic shock in pediatric patients.

Objective

To study the role of sRAGE as a potential diagnostic and prognostic marker in sepsis and septic shock in pediatric intensive care unit.

Patients and Methods

This was a case control study that was conducted at Pediatric ICU, Ain Shams University Hospitals. This Studied were divided into 3 groups: 1/ Sepsis group (20 patients). 2/ Septic shock group (20 patients). 3/ healthy control group (40 child).

Results

In Sepsis cases, ROC curve analysis proved good discriminating power of the Serum RAGE between Non Survivor group and Survivor group where Area under the ROC curve (AUC) = 0.760 with (95% Confidence interval 0.52–0.92); p < 0.001. Cutoff point >270 with sensitivity= 80% and specificity=73.3%. In Septic Shock Cases, ROC curve analysis proved good discriminating power of the Serum RAGE between Non Survivor group and Survivor group where Area under the ROC curve (AUC) = 0.955 with (95% Confidence interval 0.76–0.99); p < 0.001. Cutoff point >310.9 with sensitivity= 90% and specificity=91%.

Conclusion

Our study suggests that sRAGE may serve as a valuable biomarker for assessing the severity and prognosis of sepsis and septic shock in pediatric patients, although further research with a larger sample size is warranted to validate these findings.
Assessment of the Presence of Predominantly Antibody Deficiency among Pediatric Patients with Interstitial Lung Disease
Authors: Salama Ashraf Abdel Baky , Radwan Nesrine Mohamed , Hussein Mahitab Morsy , Hamza Mohamed Tarif , Abdelsalam Walaa Eid
Published: November 2024

Background

Predominantly antibody deficiencies (PADs) are frequent primary immunodeficiency diseases (PIDs) that have different etiologies. PAD patients present with various clinical manifestations, including infections and non-infectious disorders such as interstitial lung disease (ILD). The determination of serum Igs (IgG, IgM, IgA) is the first step in the evaluation of humoral immunity, and will help diagnose or at least point to a suspicion of quantitative Ig deficiencies. Lung disease is a frequent clinical manifestation in people living with primary immunodeficiency diseases, the most prevalent of which are common variable immunodeficiency disorders (CVID).

Aim of Work

Screening for Predominantly Antibody Deficiency (PAD) among pediatric patients diagnosed with primary interstitial lung disease.

Patients and Methods

This was a pilot study that was conducted on 30 children diagnosed with primary interstitial lung disease (ILD) following up in the Pediatric chest clinic, Children’s hospital, Ain Shams University in the period from September 2022 to February 2023, their ages ranged between 9-180 months and They were 16 (53.3%) males and 14 (46.7%) females. Tools of assessment included detailed clinical history with stress on history of respiratory symptoms, history of ten warning signs of immunedeficiency, general and chest examination and immunoglobulins (IgA, IgM, IgG) level by ELISA.

Results

There were 2 (6.7%) children with low levels of IgG, As regard IgM 2(6.7%) children had low levels, and 1(3.3%) child had high level. While 5 (16.7%) children had low levels of IgA. based on the criteria of Europian Society For Immunodeficiencies (ESID) 2 children were probable to be Commom Variable Immundeficiency (CVID) and 3 children were possible to be CVID.

Conclusion

Predominantly antibody deficiencies (PADs) may be presented as ILD and ILD may be the first presentation even before PID diagnosis.
Seroprevalence and Parents’ Knowledge about Hepatitis E among a Sample of Egyptian Children and Adolescents
Authors: Elfaramawy Amel Abdel Magied , Mohamed Yasmine Hussein , Salah HebatAllah Mohammed , Taha Sara Ibrahim Abdelfattah
Published: November 2024

Background

Hepatitis E virus is one of the causes of waterborne outbreaks of hepatitis in areas of poor sanitation where it is transmitted predominately by the feco-oral route. HEV is an underdiagnosed self-limiting disease that lasts few weeks following an incubation period of 2 to 6 weeks, hepatitis E infection can be chronic in immunocompromised patients, in rare cases acute hepatitis E can be severe and result in fulminant hepatitis or acute liver failure.

Objectives

To assess the prevalence of anti-HEV IgG antibodies as an indicator of past hepatitis E infection among a group of Egyptian children and adolescents and to evaluate the parents' knowledge about the mode of transmission, symptoms and prevention of Hepatitis E.

Methods

This cross sectional study involved 188 subjects and was conducted in the General Pediatric clinic, Children’s Hospital, Ain Shams University. Sociodemographic characteristics along with socio-economic status classification and medical history were evaluated among participants. Serum anti-HEV IgG of HEV were assessed using enzyme-linked immunosorbent assay (ELISA). Then parents' knowledge about modes of transmission and symptoms combined with preventive practices related to HEV were assessed by a questionnaire.

Results

The included participants were 188, among them 102 male, 86 female with a mean age of 6.56±3.77 years. The Seroprevalence of HEV IgG was 7.4% among the participants, HEV IgG seropositive patients aged more than 6years old and both genders were equally affected the majority of them are living in rural areas and belong to middle social class, animal contact was significantly found in IgG seropositive patients. Parents’ knowledge about acute hepatitis was very low (3.2%) compared to knowledge of chronic hepatitis (33.5%). Parents’ practice was the significant protective factor against infection.

Conclusion

Hepatitis E virus infection is not uncommon in the studied group of children, living in rural areas, animal contact and middle socioeconomic status are risk factors while adequate parents hygienic practice is a protective factor against the infection, general knowledge about acute hepatitis is poor among included parents.