bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Oral N-Acetyl Cysteine in Prevention of Necrotizing Enterocolitis in Preterm Neonates with Feeding Intolerance
Authors: Naguib Youssef Ekram El-Hassan , EL-Ganzoury Mona Mostafa , EL-Farash Rania Ali , Allam Rabab Gameel 
Published: November 2024

Abstract

Background
Necrotizing enterocolitis (NEC) is one of the most challenging diseases in neonates. Prematurity alone is believed to be a major risk factor for NEC. Feeding intolerance can be the first clinical presentation of NEC, it can progress rapidly into fulminating disease. Therefore, identification of new strategies for prevention of NEC is needed.

Objective
The aim of this study was to evaluate the preventive effect of enteral N-acetylcysteine (NAC) on the development of necrotizing enterocolitis (NEC) in preterm neonates with feeding intolerance.

Patient and Methods
The study was a double blinded randomized controlled trial that was conducted on preterm neonates with feeding intolerance at Neonatal intensive care unit (NICU) department, Ain Shams University. Hundred and eight preterm neonates with feeding intolerance were randomly divided into two groups, intervention group and control group. The intervention group received enteral NAC by a dose (20mg/kg/6h) while the control group received placebo distilled water (1cc/6h) for either 10 days or when all signs and symptoms of feeding intolerance resolve, whichever comes first. Both groups were monitored clinically for improvement or progression to NEC.

Results
Our findings showed that there was a significant decrease in the incidence of NEC in the intervention group, who received enteral NAC, in comparison to the control group (n = 8 vs n = 26), with p value (&lt;0.01). As well as significant reduction in the time needed to reach half, two-third and full enteral feeding, in the intervention group in comparison to the control group.

Conclusion
Enteral administration of N-acetylcysteine might reduce the incidence of NEC in preterm neonates with feeding intolerance.
Assessment of Neutrophil Activation in Children with Chronic Kidney Disease Stage 5 on Hemodialysis: Effect of a Single Procedure
Authors: Edris Eman R , Kasem Mohammed F , Hashem Noha U , Mohammed Noha R , Said Ragia M 
Published: November 2024

Abstract

Background
Hemodialysis (HD) process can trigger inflammation and induce cytokines activation. Neutrophils extrude neutrophil extracellular traps (NETs) which are extracellular chromatin containing a variety of granular proteins that have been implicated in infection, as well as vascular inflammation and occlusion.

Objective
To assess the effect of a single HD session on the level of circulating NETs in children with chronic kidney disease stage 5 (CKD-5) on regular HD treatment.

Methods
This is a cross sectional study done at Pediatric Dialysis Unit (PDU), Children’s Hospital, Ain Shams University during the period from April 2023 to July 2023. It included 26 CKD-5 cases receiving 3 hours HD session 3 times per week using low flux polysulfone dialyzer and 26 age and sex matched children as controls. Patients with the following medical conditions were excluded: failed renal graft, active infection, autoimmune disease, active thrombosis, diabetes mellitus, malignancy, cardiovascular disease like (infective endocarditis, vegetation and intracardiac mass) and patients on immunosuppressants. Complete blood cell (CBC), C-reactive protein (CRP) and serum NETs measured by enzyme-linked immunosorbent assay were done for all cases pre- and post-dialysis as well as the control group.

Results
The mean±SD age of the patient was 12.2±2.8 years. They were 16 males (61.5%) and 10 females (38.5%). The mean age of the controls was 10.9±2.7 years. They were 13 males (50%) and 13 females (50%). There was significantly elevated pre-HD (Median= 535.95ng/L, IQR= 519.6ng/L) and post-HD (Median=1310.5ng/L, IQR=916.4ng/L) serum NETs compared to its level (Median=149.1ng/L, IQR=69.7ng/L) in controls (p &lt; 0.001 for both). There was also significantly higher post-HD level of serum NETs than its pre-HD one (p &lt; 0.001). Gender did not have significant effect on serum NETs levels (p = 0.089). The age of patients, dialyzer surface area, pump blood flow rate, and duration of HD didnot correlate significantly with serum NETS levels (p = 0.95, 0.68, 0.23 and 0.83, respectively). In addition, there was no significant correlation between serum NETs and total leukocyte count, absolute neutrophil count and lymphocyte count (p = 0.29, 0.17 and 0.6, respectively).

Conclusion
Children with CKD-5 on regular HD had higher basal levels of circulating NETs than normal controls. These levels were further increased after HD session using low flux polysulfone membrane implying the associated subclinical inflammation.
Specific Epstein-Barr Virus Infection Immune Response in Children with Hemophagocytic Lymphohistiocytosis and B cell Lymphoid Malignancies
Authors: el-RaoufWahba Esraa Mohamed Abd , Aly Nihal Hussien , Ismail Mona Ahmed , Abdelwahab Hoda Ezz Elarab , Ragab Iman Ahmed 
Published: November 2024

Abstract

Background
Epstein Barr Virus Infection (EBV) is associated with significant morbidity and mortality in immunocompromised patients causing a wide spectrum of EBV associated immunopathologic conditions including lymphoproliferative disorders, hemophagocytic lymphohistiocytosis (HLH) and malignancy. The CD27/CD70 axis has a critical role in EBV immune surveillance. The clinical and immunological features of CD27 deficiency in patients presenting with B-cell malignancy and HLH remains to be identified

Aim
to evaluate of the frequency of CD27 deficiency in B cell lymphoid malignancy and HLH and to study its relation to EBV positivity.

Methods
A pilot study including twenty-one patients diagnosed with B cell lymphoid malignancy and HLH aged 4-10 years old (median 6 years) were initiated. EBV status was determined by detection of EBV nuclear antigen 1 (EBNA1) IgG by enzyme linked immune sorbent assay (ELISA) then quantification of CD27 on total lymphocytes and on CD3 by flow cytometry was performed. Immunoglobulin and HLH markers were reported from patients records in selected patients

Results
Patients with positive EBNA-1 IgG (n = 12) has significantly low percentage of CD27 expression on CD3 cells compared EBNA-1 negative ones (P = 0.028). CD27 expression did not differ according to EBV PCR status of the studied patients. The percentage of CD27 on lymphocytes showed a significant positive correlation with total leucocytic count and triglycerides level (p = 0.033 and 0.037 respectively) and a significant negative correlation with the fibrinogen level (p = 0.037) while absolute CD27 on lymphocytes was negatively correlated with age and fibrinogen level (p = 0.007, p &lt; 0.001).

Conclusion
CD27 deficiency was found among chronic EBV infection in children with B cell lymphoid malignancy; However, further studies with higher sample size need to be pursued.
Pancreatic Affection in Children on Ketogenic Diet
Authors: Ward Hala Saeed Ahmed , Nassar May Fouad , Mohammed Maha Zakariya Ramadan , Awadallah Shrouk Mohammed , Mohammed Bassma Abdel Nasser 
Published: November 2024

Abstract

Background
The ketogenic diet (KD), a high-fat, low-carbohydrate, adequate-protein diet is an established, effective non-pharmacological treatment for children with drug resistant epilepsy (DRE). Relatively few serious complications have been reported in the more than 70 years use of KD. Hypertriglyceridemia, malnutrition, vit D and vit A deficiency are known complications of KD and are considered risk factors for pancreatitis as well.

Aim of the Study
The aim was to highlight the pancreatic affection during KD use in treatment of pediatric DRE patients.

Patients and Methods
This is a prospective observational (pilot) study conducted at pediatric ketoclinic, Ain Shams university children’s hospital, Cairo, Egypt during the period from September 2022 till October 2023. Twenty pediatric patients with DRE who were assigned to start KD were followed up for possibility of pancreatic affection. Pancreatic enzyme levels (amylase/lipase) were measured initially and after 3 and 6-months.

Results
In the current study, serum amylase and lipase levels increased significantly after 3- months interval (p value &lt;0.001), and then decreased after 6-months KD usage, and was not significantly higher than baseline. However, there were no documented cases of clinical pancreatitis in our patients during the study period time.

Conclusion
Our study found that KD use in children with DRE led to significant increases in serum amylase, lipase, particularly in the first three months. Although no cases of pancreatitis were observed, close monitoring and further research are needed to assess the long-term safety of KD in this population.
The Value of Complete Blood Count Indices for Early Detection of Sepsis in Preterm Infants
Authors: Shabana Ayah M , Mahmoud Hassan A , Fattah Sarah I Abdel , El-Farghali Ola G 
Published: November 2024

Abstract

Background
Early-onset sepsis (EOS) remains a common and serious problem in neonates. The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are easily accessible biomarkers that have been reported to have meaningful correlations with inflammatory markers.

Objectives
We aimed to evaluate the NLR, PLR and systemic immune-inflammation (SII) as a diagnostic tests for early detection of EOS.

Patients and Methods
This study was carried out on 100 preterm infants at the Neonatal Intensive Care Unit (NICU) of Ain Shams University Children’s Hospital. They were divided into two groups: Group A (patient group) which included 45 preterm, suffering from EOS and group B (controls group) which included 55 healthy preterm. History-taking, complete clinical examination, blood culture, complete blood count (CBC), C-reactive protein (CRP), NLR, PLR and SII were done.

Results
Patients group (high CRP, Rodwell Score positive, positive blood cultures) had significantly higher NLR, PLR, and SII at first and third day of life compared with the controls group(negative CRP, Rodwell Score non sepsis and negative blood cultures). NLR of 1.9 was determined as the predictive cutoff value of EOS (sensitivity 91.11%; specificity 92.73%). A PLR of 53.79 was determined as the predictive cutoff value of neonatal EOS (sensitivity 93.33%; specificity 43.64%). A SII of 333.97 was determined as the predictive cutoff value of neonatal EOS (sensitivity 97.98%; specificity 90.91%).

Conclusion
NLR, PLR and SII had high sensitivity and specificity as diagnostic markers for earlyonset neonatal sepsis.
Relation between Irritable Bowel Syndrome and Acute Infectious Gastroenteritis in Children
Authors: Wahed Mohamed Ashraf Abdel , Abdelhamid Dalia Hosni , Awad Yosra Mohamed Mohsen , Nabhan Dina Abdelhamid , Hussein Mai Hussein Mohamed Ali 
Published: November 2024

Abstract

Background
Post-infectious irritable bowel syndrome (PI-IBS) has been defined as a new onset of IBS following an episode of acute infectious diarrhea.

Objective
To determine the frequency of postinfectious irritable bowel syndrome (PI-IBS) among children who have an episode of acute infectious diarrhea.

Subjects and Methods
A case control longitudinal study was conducted on 93 children who fulfilled the criteria for diagnosis of acute infectious gastroenteritis. Patients were recruited from the Outpatient Clinic, Children’s Hospital, Ain Shams University, during a period of 6 months and were followed up for 3 months for the development of symptoms of IBS according to Rome IV criteria for diagnosis of IBS. They were compared to 100 age- and sex-matched controls who do not have history of acute infectious gastroenteritis during the last 3 months before enrollment.

Result
The age of studied cases ranged between (4-15) years old with a mean ±SD=9.26 ± 3.20 years. Females represented 61.3% of cases. PI-IBS occurred in 14%of cases with age ranged between (4-14) years old and females represented 61.5% of PI-IBS cases. Meanwhile, the incidence of IBS 3.2% of uninfected controls (relative risk, RR = 4.33). Most cases of PI-IBS were diarrhea prominent. There was no significant association with the causative organism identified among cases. Rota virus represented the most common organism among our patients with incidence of (32.3%) followed by campylobacter, salmonella, adeno virus, and giardia with incidence of (9.7%), (8.6%), (5.4%), (6.5%), respectively, while (37.6%) of patients have negative stool cultures for the mentioned organisms.

Conclusion
The frequency of PI-IBS is common among pediatrics but does not seem to be associated with the causative organism of the preceding episode of infectious diarrhea. Raising the awareness about this entity is of outmost importance as this will allow targeted treatment.
Maternal Voice Effect on Preterm Neonates in Neonatal Intensive Care Unit
Authors: Shatla Rania Hamed Mahmoud , Ismail Rania Ibrahim Hossni , Rabie Dina Essam Abdelhamid , Abuelazaim Marwa Magdy Ismail 
Published: November 2024

Abstract

Background
The mother's voice, along with other developmentally appropriate sensory events (ie, touch, light, smells), stimulates maturation of the sensory systems and helps shape normal fetal development. Few studies have addressed the effects of exposure to maternal voice for preterm infants’ stress.

Objective
To evaluate the effect of maternal voice on neonatal stress as assessed by NICU Network Neurobehavioral Scale (NNNS) scale.

Patients and Methods
This randomized controlled interventional study included 64 preterm infants (&lt;36 weeks gestational age). They were divided into two groups; intervention group included 32 preterms who were exposed to mothers’ voice and standardized group included 32 preterms who were not exposed to mothers’ voice then neurobehavioral assessment was done through the NNNS scoring system through thirteen summary scores which are habituation, tolerance of handling, quality of movement, selfregulation skills, non-optimal reflexes, stress signs, arousal, hypertonia, hypotonia, asymmetry, excitability, lethargy and orientation, with exposure to recorded maternal voice for 30 minutes and assessment immediately before, after and at 60 minutes after exposure versus no intervention at all. Cases were recruited and assessed for eligibility from Ain Shams University NICUs.

Results
There was a statistically significant neurobehavioral improvement according to NNNS scoring system among cases in the intervention group immediately and after 60 minutes of exposure to the mother’s voice (P value&lt;0.001).

Conclusion
Exposure to maternal voice has positive effects on the preterm infants’ behavior and emotions as assessed by thirteen summary scores of NNNS.
Level of CD11a among Newly Diagnosed ITP Patients and after 6 Months Follow Up
Authors: Elalfy Mohsen Saleh , Hamza Mohammad Tarif , Dakhel Medhat Saleh , Tolba Marwa Waheed 
Published: November 2024

Abstract

Background and Objectives
Immune thrombocytopenia (ITP) is a relatively frequent acquired bleeding disorders. Etiology is not yet well understood. Lymphocytic function associated antigen-1(LFA-1) might play an important role in signal coordination and lymphocyte activation. The aim of this study was to assess CD11a expression on lymphocytes in newly diagnosed ITP patients and to correlate it with bleeding severity in ITP and to evaluate the effect of immunomodulation medications on CD11a expression in children with ITP.

Patients and Methods
This is a prospective case-control study enrolling children with ITP attending pediatric Hematology clinic, Ain Shams University Hospitals through November 2021-November 2022 and near equal number of age and sex matched control subjects were randomly selected. All necessary laboratory tests for diagnosis of ITP were performed and the expression of CD11a on lymphocytes was analyzed by flow cytometry at the start of the study and after 6 months of follow up and assessment of bleeding manifestations according to ITP- specific bleeding assessment tool (ITP-BAT).

Results
Thirty-five patients aged (2-15) years with median age 6.5 years. 21 males and 14 females were enrolled as newly diagnosed primary ITP. The mean platelet count in these patients was 13(103/ul) initially and 239(103/ul) at follow up with response rate of 94.1%. The treatment received in ITP patients was corticosteroid (97.1%),IVIG (11.6%),thrombopoietin receptor agonist (17.4%) and anti CD20 monoclonal antibody (5.8%). The mean fluorescence intensity (MFI) of CD11a was 95.7% initially and 94.7 % at follow up and it was 94.3% in the control group. The mean fluorescence intensity (MFI) of CD11a on lymphocytes showed significant difference in ITP patients initially compared to healthy controls (p value= 0.001) and (MFI) of CD11a on lymphocytes show significant difference between patients before and after treatment (p value=0.001).

Conclusion
CD11a had a possible role in the pathogenesis of ITP. Immune-modulatory therapy for ITP affects the level of CD11a expression on lymphocytes. CD11a expressions on lymphocytes were not correlated with the platelet counts nor the bleeding score in ITP.
Testing Tolerance in Cow Milk Protein Allergy Patients: Milk Ladder or Direct Milk Administration?
Authors: Saber Ahmed Mohamed Hamdy , El-Gendy Yasmine Gamal , Awad Yosra Mohamed Mohsen , Hammad Nesreen Mahmoud Mohamed 
Published: November 2024

Abstract

Background
Cow’s milk protein allergy (CMPA) is a major health concern; its prevalence is between 1.9% and 4.9% in the first year of life. Tolerance to cow’s milk is tested after at least 6 months of elimination diet through two common approaches which are the milk ladder method and direct milk administration.

Aim
To compare tolerance frequency between those who had milk products reintroduced via milk ladder to those who were directly exposed to pure milk antigen after 6 months of elimination diet, and to assess the factors affecting the overall tolerance frequency of cow’s milk after 6 months elimination diet.

Methods
A randomized controlled clinical trial involving 116 children recruited from the Pediatric Gastroenterology Clinic, Children’s Hospital, in Shams University, diagnosed as non-IgE mediated cow’s milk protein allergy proven by elimination re-challenge test and followed six months of elimination diet. The included children were randomly assigned into 2 groups, where one group had milk products reintroduced via 6 steps milk ladder, and the second group had direct milk antigen administration in gradual increments. They were followed up for 2 months after the introduction of milk or milk containing products to confirm resolution of allergy.

Results
The overall tolerance rate after 6 months elimination diet was 81% with no significant difference between the two approaches (Direct milk 84.5%, and milk ladder 77.6%), in addition, the regression analysis showed that weight was a significant factor influencing the resolution of CMPA patients, with normal weight patients having higher chance of resolution than underweight patients (odds ratio=3.73).

Conclusion
Non-IgE medicated CMPA has high rate of resolution after 6 months elimination diet. Both approaches of introduction were equivalent.
Clinical Presentation of Type 1 Diabetes among a Cohort of Children and Adolescents from El-Beheira Governorate
Authors: Salem Mona Abdelkader , Elhenawy Yasmine Ibrahim , Zereban Nema Hussien , Arafat Omnia Elsayed Elsayed 
Published: November 2024

Abstract

Background
Type 1 diabetes (T1DM) is multifactorial; family history and genetic predisposition, presence of autoantibodies, physical stress, and exposure to illnesses such as viral infections, disease of the pancreas, age, race, geography, and early diet are the main T1DM risk factors that have been identified.

Objective
To identify the patterns of clinical presentation among patients with type 1 diabetes from El-Beheira Governorate and to explore family history of type 2 diabetes (T2DM) and its impact on the presentation of type 1 diabetes among offspring.

Patients and Methods
This cross-sectional study was conducted at the diabetes clinic in El-Beheira Governorate and included 119 children with T1DM regularly following up during the period from March 2023 until June 2023. The study assessed the age of onset of diabetes, insulin dosage, the presence of a family history of both type 1 and type 2 diabetes among the study population, the initial presentation of diabetes, and the presence of complications.

Results
During the study period, a total of 119 patients were included, with a female predominance (64.7%). The median age at presentation was 6 years old. Hyperglycemia was the most frequent presentation in the studied population (66.4%), followed by DKA. Children with a positive family history of T2DM were significantly older at the onset of the diagnosis of T1DM, and they required significantly higher basal and mealtime insulin dosages to achieve glycemic control (P &lt; 0.05). Furthermore, patients with a positive family history of T2DM had higher levels of cholesterol and triglycerides (P &lt; 0.05).

Conclusion
Patients with a positive family history of T2DM required more insulin to achieve glycemic control, which could be attributed to factors related to insulin resistance. Further studies on a larger geographical scale with a larger sample size are required to emphasise our results. This may help to figure out the effect of family history of T2DM on the presentation of patients with T1DM.