bluuebunny/crossref_metadata_2025_split huggingface dataset:
Insulin Resistance in Pediatric Migraine
Authors: Ibrahim Omnia Samy , Tomoum Hoda Yahya , Elhenawy Yasmine Ibrahim , Halim Michael Nabil 
Published: July 2024

Abstract

Background
Migraine is a common complaint in the pediatric population with a prevalence ranging from 3% to 10%. Several studies among adult population defined a link between migraine and insulin resistance (IR), however data among pediatric population is scarce, thus the aim of the current study is to assess the relation between IR and migraine among pediatric patients with migraine.

Patients and Methods
A case control study that was conducted on children aged between 4 and 16 years; 30 were patients with migraine who were recruited from the pediatric neurology department and 40 were healthy. The diagnosis of migraine was according to the criteria of the International Classification of Headache Disorders (ICHD) -II criteria. Anthropometric measurements of all patients were assessed. Insulin resistance was assessed by Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and Quantitative Insulin Sensitivity Check Index (QUICKI equation).

Results
The mean age of patients with migraine was 10.03 ± 2.16 years with male predominance. Most of the patients (80%) were pre-pubertal. Headache with aura was present in 13 (43.3%), family history was present in 24 (80%), bilateral headache was the most common among our patients (71.4%). There was significant increase in BMI among migraine group (P = 0.03). 50% of migraine patients were overweight, 20% were obese. Incidence of insulin resistance by HOMA-IR and by QUICKI was significantly higher among patients with migraine (P = 0.007 and 0.033) respectively.

Conclusion
based on our results, it can be concluded that migraine is associated with insulin resistance in 36.7% of patients.
Screen Time and its Relation to Toddlers’ Development
Authors: Mohamed Zaky Eman Ahmed , Maher Deif-Allah Shaymaa Ahmed , Abdelaziz Asmaa Wafeeq , Ramadan Mohammed Maha Zakariya , Soliman Ibrahim Asmaa Mohammed , Abd Elhamid Salwa Amin 
Published: July 2024

Abstract

Background
Screen-time or digital-screen exposure is the duration of time spent by the individual in using electronic/digital media like television (TV), smartphone, tablet or computer. Even background television exposure has been shown to impact development by reducing the amount and quality of interactions between parents and children. Studies showed that while babies do not absorb content from TV, it can catch and hold their attention.

Aim of the Work
The aim of the current study was to determine the effect of screen time on different developmental aspects of toddlers.

Patients and Methods
This was a cross sectional observational study that was conducted in the outpatients’ and Neurodevelopment Clinics, Children’s Hospital, Faculty of Medicine, Ain Shams University on 83 toddlers aged from 1 year to 3 years old who were exposed to screens for a longer duration than the recommended according to the American Academy of Paediatrics (AAP) guidelines. Of 13 months’ time frame, total duration of screen exposure was calculated in minutes/day and was correlated to the composite scores of Bayley scales of infants’ and toddlers’ development third edition.

Results
A significant negative correlations were found between duration of screen time exposure and all Bayley scales (cognitive, language and motor) composite scores and language scale is more affected.

Conclusion
The results of this study supported the directional association between screen time and child development. Parents and all the society should be educated about the hazards of screen time exposure on infants and toddlers’ development.
Prognostic Value of Pentraxin 3 and Procalcitonin in Late onset Neonatal Sepsis
Authors: Abo Seif Ibrahim Saad , Abd El Aal Mohamed Omar , Abdel- Wahed Ali Marwa Ali , El Kareem Shimaa Ahmed Abd 
Published: July 2024

Abstract

Background
Sepsis is a major cause of intensive care unit (ICU) admission. Procalcitonin (PCT) could be an important prognostic marker for sepsis. Pentraxin 3 (PTX3) and PCT are detectable in patients with sepsis within a large time window after the onset of sepsis.

Objective
To assess the prognostic value of the PTX3, PCT in neonatal sepsis in comparison with other sepsis screen.

Patients and Methods
A prospective study included 40 neonates with sepsis. The study had been conducted in the neonatal intensive care units of Ain Shams University, Children’s Hospital during the period from January 2020 to May 2022. All neonates had been subjected to clinical examination, anthropometric measurements and sepsis scoring by neonatal sequential organ failure assessment (nSOFA). Laboratory investigations were collected from all pediatrics including Complete blood count (CBC), quantitative C- reactive protein (CRP), blood culture, serum pentraxin 3 (PTX3) and serum procalcitonin (PCT). Sepsis markers had been obtained from neonates at the day of being with suspected sepsis before starting the antimicrobial therapy (Day 0). While blood samples for sepsis markers reobtained only from neonates with positive blood cultures on the 3rd (Day3), accordingly our patients divided into improved and deteriorated groups.

Results
There was a significant decrease in CRP level and increase in procalcitonin and pentraxin 3 levels in deteriorated group than improved group at baseline with p-value = 0.004, 0.016 and 0.019; respectively. Also, the study shows that there was a significant increase in CRP, procalcitonin and pentraxin 3 levels in deteriorated group than improved group after 3 days with p-value = 0.002, &lt;0.001 and &lt;0.001; respectively. Furthermore, in improved group, there was a significant decrease in the level of CRP, procalcitonin and pentraxin 3 after 3 days than at baseline with p-value = 0.001, &lt;0.001 and 0.001; respectively. Also in deteriorated group, there was statistically significant increase in the CRP and pentraxin 3 levels after 3 days than at baseline in deteriorated group with p- value = 0.002 and 0.019; respectively while no change found in procalcitonin level.

Conclusion
Serum pentraxin 3 and procalcitonin levels seem to be promising prognostic markers in neonatal sepsis with higher sensitivity and specificity for procalcitonin than pentraxin at 3 days.
Cardiac Disease in Egyptian Thalassemia Major and Sickle Cell Disease Adolescents in relation to Vitamin D Status Using Echocardiogram & Ultrafast Magnetic Resonance Imaging
Authors: Gad Nada Ayman , Pennell Dudley John , Samir Ahmed , Salama Dina Husseiny , Salah El Din Nanies Mohamed , El-Sayed Ebeid Fatma Soliman , Elalfy Mohsen Saleh 
Published: July 2024

Abstract

Background
Cardiovascular complications are well recognized in patients with β-thalassemia major (β-TM) and sickle cell disease (SCD). Vitamin D deficiency is prevalent in patients with transfusion-dependent thalassemia and there is an association between vitamin D deficiency and both left ventricular function and iron overload in thalassemia. However, the relationship between vitamin D and cardiac iron is not well studied in Egypt and the role of vitamin D in cardiac disease in SCD and β-TM needs to be assessed.

Aim
To assess vitamin D status in children and adolescents with SCD and β-TM in relation to cardiac complications using echocardiography and cardiac magnetic resonance (CMR) T2*.

Methods
Forty-one patients with SCD and 35 patients with β-TM without symptomatic cardiac disease were studied stressing on history of splenectomy and transfusion history. Markers of hemolysis, serum ferritin and vitamin D levels were measured. Liver iron concentration (LIC) was assessed by magnetic resonance imaging (MRI). Screening for cardiovascular abnormalities was performed by the non-invasive Doppler echocardiography and CMR was used to assess myocardial iron overload.

Results
Echocardiography showed that cardiac functions were significantly impaired in β-TM patients compared with SCD while the frequency of pulmonary hypertension risk (elevated TRV ≥2.5 m/sec) was consistent between both β-TM and SCD groups. Cardiac T2* (which reflects cardiac iron overload) was significantly lower while myocardial iron concentration (MIC) was significantly higher in β -TM patients compared with SCD group. Vitamin D levels were decreased in both SCD and β-TM patients than control levels; however, SCD patients had significantly lower vitamin D levels. Low vitamin D levels were significantly associated withincreased risk of pulmonary hypertension in the SCD group while In β-TM group, vitamin D levels were significantly lower in patients with cardiac disease and those with serum ferritin levels ≥ 2500 µg/L. A significant evidence of diastolic dysfunction was found in SCD and β-TM patients who had low serum vitamin D level &lt; 20 ng/mL. Vitamin D levels were negatively correlated to serum ferritin and LIC while positively correlated to cardiac T2*.

Conclusion
Low vitamin D levels were associated with cardiopulmonary dysfunction in adolescents with SCD and β-TM. Vitamin D deficiency in those patients was linked to cardiac iron overload leading to iron induced cardiomyopathy. Proper chelation therapy is mandatory to improve cardiac disease, iron overload and consequently, vitamin D status in β-TM patients.
Serological Screening for Severe Acute Respiratory Syndrome Coronavirus-2 in Type 1 Diabetic Children and Adolescents
Authors: Aly Hanan Hassan , Elhabashy Safinaz Adel , Azeem Mansour Roaa Abdel , Hassan Azza Mohammed , Fahmy Mahmoud Basma Sherif 
Published: July 2024

Abstract

Background
Diabetes was identified as a risk factor for many infections. In the SARS-CoV-2 pandemic, diabetes is one of the leading comorbidities associated with infection severity.

Aim of the Work
To determine the severity of COVID-19 symptoms in type 1 diabetic children and adolescents. To Determine the effect of SARS-CoV-2 lockdown on glycemic control.

Patients and Methods
A cross sectional observational study was carried out in Pediatric and Adolescent Diabetology Unit (PADU), Children's Hospital, Ain Shams University between September 2020 and January 2022. The study included 500 randomly selected diabetic children and adolescents. They were tested for Hemoglobin A1C and SARS-CoV-2 IgM and IgG antibody.

Results
There is a significant relation between myalgia (p = 0.012 ), diarrhea( p = 0.007) and IgM positivity, and a significant relation between diarrhea and both IgG and IgM positivity (p = 0.005). Other symptoms had a non-significant relation with COVID-19 IgM or IgG. All symptoms suggestive of COVID-19 infection that were detected in our patients were not severe. During COVID-19 pandemic, glycemic control deteriorated in our patients as mean HbA1c reached 9.6% as compared to a mean level of 8.8% before COVID-19 pandemic.

Conclusion
Diabetes comorbidity did not increase the severity of COVID-19 symptoms to our patients. Glycemic control as indicated by HbA1c level showed deterioration during lockdown due to impaired access to care.
New Pro-inflammatory Cytokines in Children and Adolescents with Type 1 Diabetes Patients with Microvascular Complications
Authors: Moharram Sarhan Alaa Sarhan , Elbyoumi Afify Mohamed Abo El-Asrar Mohamed , Shaaban Elmetwally Rasha Eladawy , Awad Abdelhady Doaa Mostafa 
Published: July 2024

Abstract

Background
Type 1 diabetes mellitus has become a global health burden, and poor glycemic control, in combination with prolonged diabetes duration, leads to the early development of microvascular complications, including diabetic kidney disease, retinopathy, and neuropathy. Therefore, it is urgent to establish new biomarkers for the early identification of at-risk patients.

Objectives
To investigate the role of inflammatory proteins (human growth differentiation factor 15 and interleukin 29) in the course of microvascular complications and glycemic control in T1DM.

Patients and Methods
Our study included 40 children with T1DM (18 T1DM patients had microvascular complications and 22 T1DM patients were free of these complications; their ages ranged from 8 to 18 years); there was also another T1DM subgroup based on glycemic control (11 T1DM patients had controlled HbA1c &lt; 7% and 29 patients had uncontrolled HbA1C &gt; 7%). 40 children of the same age were selected as a control group. The diagnosis of TIDM was made based on the criteria of the International Society of Pediatric and Adolescent Diabetes (ISPAD) (2022). A detailed medical history was collected, including the age of onset of diabetes, disease duration, and symptoms of diabetic complications. In the study, GDF15 and IL29 values in serum blood were investigated using the ELISA method.

Results
The mean age was 14.05 years in the diabetic group and 13.25 years in the control group (P = 0.178). In the T1DM patient group, the GDF15 and IL29 values were found to be significantly higher than those in the control group (P = 0.041 and 0.013, respectively). In diabetic patients, GDF15 was significantly higher in the complicated T1DM group versus the uncomplicated group (P = 0.001). Furthermore, GDF15 levels were significantly higher in uncontrolled patients with HbA1C &gt; 7% than in the control group with HbA1C &lt; 7% (P = 0.004); however, no significant statistical differences in IL29 levels were found between diabetic patient subgroups (P &gt; 0.05).

Conclusion
The data from this study showed that GDF15 has an impact on glycemic control and that the presence of microvascular complications in the course of T1DM is very possible, but IL29 does not appear to play a role in the course of microvascular complications.
Studying Hemodynamics during Weaning from Mechanical Ventilation among Critically ill Pediatric Patients
Authors: Abdelhamid Nehad Salah , Abd El Gawad Tarek Ahmed , Ibrahim Youssef Hanan Mohammed , Elsaid Mohamed Iman Mohamed , Hassan Bawady Somia Abdel Hamid , Ahmed Rezk Ahmed Rezk 
Published: July 2024

Abstract

Background
Among the multiple causes of weaning failure from mechanical ventilation, cardiovascular dysfunction is increasingly recognized as a quite frequent cause that can be treated successfully. Knowledge of the changes in the cardiopulmonary pathophysiology occurring during mechanical ventilation and its withdrawal is a prerequisite for early recognition of weaning failure of cardiovascular origin and optimal patient management.

Aim of the Work
Identification of hemodynamic and biomarkers changes during weaning process from mechanical ventilation and how these changes predict weaning success

Methodology
This cross sectional study was conducted on 50 children who were admitted to Pediatric Intensive Care Units and were mechanically ventilated and ready to be weaned according to weaning criteria. assessment of hemodynamic changes during weaning was done by tracing and comparing vital data, echocardiography parameters and levels of serum BNP and troponin in all patients during pressure support ventilation and at the end of spontaneous breathing trial (SBT) for identification of changes during weaning and risk factors for weaning failure.

Results
There was statistically significant increase in heart rate, cardiac index and E/A ratio at the end of SBTin all studied patients with lower cardiac index in patients who failed weaning, significant increase in TAPSE at the end of SBT with lower TAPSE in patients who failed weaning. Levels of BNP1 during pressure support were significantly higher in patients who failed weaning however levels of troponin didn’t show significant changes.

Conclusion
Transthoracic echocardiography can accurately detect changes in central hemodynamics induced by the SBT. It helps the attending physician to identify patients at high risk of weaning failure, when documenting a lower cardiac index, low TAPSE values.
The Diagnostic and Prognostic Values of Soluble CD14 Subtype (Presepsin) in Early Detection of Early Onset Neonatal Sepsis in Preterm Newborns
Authors: El Sherif Dalia Fathi Ali , Ibrahim Elkholy Ahmed Nasser , Atif Ismail Heba Mohamed , Amin Ibrahim Mariam John 
Published: July 2024

Abstract

Background
The diagnosis of “suspected sepsis” in neonates in the NICU is one of the most common and challenging diagnoses due to the nonspecific signs of sepsis. therefore, laboratory investigation is necessary in cases of doubt or if there are risk factors. A promising biomarker: Presepsin (P-SEP), or Soluble Cluster of Differentiation 14 Subtype (sCD14-ST) is generated as a part of the body’s response to bacterial infection. It is effective in the early phase of inflammation, and it is detected as an early marker of sepsis in neonates.

Aim and Objectives
to evaluate the diagnostic value of presepsin in early neonatal sepsis and prognostic value for severity, mortality and hospital stay length.

Subjects and Methods
This prospective observational study include two groups, one group included 36 neonates with risk factors for early-onset sepsis, along with 20 uninfected neonates as the control group. Both groups were subjected to the calculation of Rodwell score, SNAP II score, serum presepsin levels, CRP measurement, and blood culture and assessed for clinical severity, mortality, and hospital stay length.

Result
Serum baseline presepsin was significantly elevated in sepsis group (P &lt; 0.001), Presepsin showed the best diagnostic performance over Rodwell score (AUC 0.989; sensitivity of 93.8% and specificity of 95%). Presepsin levels on day 3 were significantly elevated in non-survived patients (P &lt; 0.001), with better predictive performance for 28-day mortality and rapid progression to death than SNAP II score (AUC 0.880; sensitivity of 83.3% and specificity of 87.5%).

Conclusion
presepsin day 1 was useful diagnostic tools in culture proven early onset neonatal sepsis, presepsin at day 3 could be a good predictor for gram negative infections, 28-day mortality, and sepsis severity.
Different Regimens of Vitamin D in treatment of children with chronic liver disease
Authors: Mahmoud Ahmed Hebatallah Saad , Eldin Lerine Bahey , EL Masry Shereen Mohamed , Naguib Gina Gamal , Toaima Nadin Nabil , Abdel-Ghaffar Tawhida Yassin 
Published: July 2024

Abstract

Background
Vitamin D is a steroid based hormone that has crucial role in calcium metabolism and bone homeostasis and potential role in fibrosis including liver. Patients with chronic liver disease has tendency for vitamin D deficiency with possible sequalae including hepatic osteodystrophy. Safe and effective regime of vitamin D that can be used in children with chronic liver disease is still not well established. Moreover, the potentiality of reversing fibrosis process or halting it by correction of vitamin D is still not well studied.

Aim of work
The primary aim of the study is to assess the efficacy and safety of vitamin D regime using two different mode of administration. The secondary aim is to assess the possible antifibrotic effect of vitamin D therapy by assessment of fibroscan.

Methodology
Twenty four children with different etiologies of chronic liver disease but age and sex matched as well as anthropometric measures are enrolled in the study. They were distributed randomly among the two arms of the study and followed up for 6 months using different laboratory and imaging variables. The two regimes were group A who received intramuscular stoss dose once (200.000 IU) vitamin D therapy while group B received oral vitamin D therapy with dose 50.000 IU for four weeks. All children received maintenance vitamin D (600 IU) and Ca doses thereafter for the whole follow up period. All patients were subjected to complete history taking, complete clinical examination including abdominal examination, signs of liver decompensation and signs of vitamin D deficiency. As regard laboratory investigations done were CBC, liver function tests, serum calcium and phosphorous. Serum vitamin D level and fibroscan were also done at the beginning and the end.

Results
There were significant improvement of vitamin D level in both arms with no development of toxic s/o of vitamin D toxicity with p-value of &lt; 0.001 and 0.000 respectively in group A and B. The difference of improvements between both arms were not significant display the equal efficacy of both regimes (P = 0.885). There were no significant improvement of fibroscan parameters following vitamin D treatment in either group A or B with p-value 0.637 and 0.931 respectively.

Conclusion
Stoss and oral vitamin D regimes suggested in the study are both equally effective and safe in the treatment of vitamin D deficiency among children with chronic liver disease. Despite no proof of antifibrotic effect upon vitamin D correction, further study is required to evaluate this issue.
Role of Serum Procalcitonin in Monitoring the Response to Treatment of Pediatric Bacterial Meningitis
Authors: Elhaddad Eman , Shatla Rania , Mohammed Maha Z 
Published: July 2024

Abstract

Background
Early diagnosis and initial therapy are important to reduce the complications of acute bacterial meningitis (ABM). The gold standard in diagnosing bacterial meningitis is by demonstrating the presence of bacteria in cerebrospinal fluid (CSF) samples via CSF cultures. However, CSF culture requires at least a day or more, and has limited sensitivity. Serum procalcitonin (PCT) is one of the most sensitive biomarkers for identification of bacterial from non-bacterial meningitis. This study was done to evaluate serum PCT as a marker to help in ABM diagnosis specially after oral antibiotics intake or when cerebrospinal fluid (CSF) culture is negative and to assess its correlation with outcome of ABM in children.

Methods
This is a prospective cohort study that included children who presented to Ain Shams University Children hospital over a period of 6 months. Participants were confirmed cases of ABM (laboratory- confirmed by culture) or suspected to have ABM (presented with sudden onset high fever and signs of meningeal irritation with CSF examination showing at least one of the following: 1. turbid appearance; 2. leukocytosis (&gt; 100cells/mm3); 3. leukocytosis (10-100 cells/mm3) and either an a) elevated protein (&gt; 100 mg/dl) or b) decreased glucose (&lt; 40mg/dl)). The PCT levels were measured on admission and 72hours after treatment.

Results
A total of 38 ABM cases participated in this study. All the 38 cases showed elevated levels of PCT on admission. There was a significant drop in the mean of PCT level after 72h of treatment compared to level on admission (7.1±6.5 vs. 11.4±3.7, p = 0.001) respectively. There was a significant difference in the mean of PCT level between cases with good outcome (full recovery) versus poor outcome (death or neurological sequalae), on admission (7.2±2.8 vs. 13.2±4.4, p &lt; 0.001) and 72h after treatment (4.2±3.5 vs. 12.9±5.3, p &lt; 0.001) respectively.

Conclusion
Serum PCT levels were high in all patients with ABM, including those who received oral antimicrobials for 1-3 days before admission. The decline in PCT levels after treatment was associated with good outcome in our cohort.