bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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 = &lt; 0.001), baseline to 180 min (-11.80 ± 8.16 vs 5.13 ± 7.01 mg/dl, respectively, p = &lt; 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

Abstract

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

Abstract

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 &lt; 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 &lt; 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

Abstract

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

Abstract

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

Abstract

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 &gt;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

Abstract

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

Abstract

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

Abstract

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

Abstract

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).