bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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 &gt; 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

Abstract

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 &lt; 0.001). Similarly, CIMT levels were significantly higher in patients with diabetic nephropathy (P &lt; 0.001). The plasma Sclerostin level had a positive correlation with duration of disease, HbA1C, UAER and CIMT(P &lt; 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

Abstract

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

Abstract

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

Abstract

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

Abstract

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 &gt; 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

Abstract

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

Abstract

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 &lt; 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 &lt; 0.001, p &lt; 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

Abstract

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.