Pub Date : 2023-11-24DOI: 10.1186/s43054-023-00201-x
A. Alsaeigh, ES. Heji, W. Alamer, MY. Alsubhi, A. Alqurashi, LK. Alsulimani
This study aimed to evaluate the understanding and adherence to child car safety seat (CSS) guidelines among the general population in the Makkah region of Saudi Arabia following the implementation of new traffic regulations. A four-section questionnaire addressing knowledge and attitudes regarding CSSs was distributed among the general population of Makkah city in light of new traffic regulations. Data were collected from 487 respondents, and the chi-square test was utilized for statistical analysis. A total of 144 (29.6%) respondents reported using seat belts before the implementation of new regulations, while 101 (20.7%) started using them afterward. Only 31 (6.4%) stated that they would not use them. A total of 318 (65.3%) reported that their behavior towards using child car safety seats abroad will not change. Additionally, 452 (92.8%) believed that government financial support for car seat costs would increase usage and compliance. The knowledge level among those using CSSs (40.3%) was significantly higher than among those who do not (11.3%) (p = .001). Most of the respondents believed that governmental financial support for CSS costs will lead to increased compliance. Furthermore, there is a direct correlation between knowledge levels and compliance. Therefore, further investment should be focused on raising awareness and enforcing strict regulations.
{"title":"Population knowledge and commitment regarding a child’s car safety seat after implementation of the new traffic regulations in Saudi Arabia: a cross-sectional study","authors":"A. Alsaeigh, ES. Heji, W. Alamer, MY. Alsubhi, A. Alqurashi, LK. Alsulimani","doi":"10.1186/s43054-023-00201-x","DOIUrl":"https://doi.org/10.1186/s43054-023-00201-x","url":null,"abstract":"This study aimed to evaluate the understanding and adherence to child car safety seat (CSS) guidelines among the general population in the Makkah region of Saudi Arabia following the implementation of new traffic regulations. A four-section questionnaire addressing knowledge and attitudes regarding CSSs was distributed among the general population of Makkah city in light of new traffic regulations. Data were collected from 487 respondents, and the chi-square test was utilized for statistical analysis. A total of 144 (29.6%) respondents reported using seat belts before the implementation of new regulations, while 101 (20.7%) started using them afterward. Only 31 (6.4%) stated that they would not use them. A total of 318 (65.3%) reported that their behavior towards using child car safety seats abroad will not change. Additionally, 452 (92.8%) believed that government financial support for car seat costs would increase usage and compliance. The knowledge level among those using CSSs (40.3%) was significantly higher than among those who do not (11.3%) (p = .001). Most of the respondents believed that governmental financial support for CSS costs will lead to increased compliance. Furthermore, there is a direct correlation between knowledge levels and compliance. Therefore, further investment should be focused on raising awareness and enforcing strict regulations.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138515775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-20DOI: 10.1186/s43054-023-00200-y
Hager Barakizou
Early childhood wheezing can evolve to different asthma phenotypes. Prediction of persistent asthma during the preschool years has proven challenging. Through this study, we aimed to identify predictors of persistent asthma in preschooler wheezers. This was a retrospective case series study over 10 years. Patient data from 98 infants diagnosed with infantile asthma were obtained from their medical records. A multivariate logistic regression model was developed to determine predictors of persistent asthma in preschooler wheezers. The sex ratio was 1.72. The mean age at the first episode of wheezing was 7 ± 3.17 months. The mean age at diagnosis was 14.82 ± 4.28. Asthma was well controlled in 71 cases (72.44%) and partly controlled in 27 cases (27.56%). Two groups were identified: transient wheezers (61.33%) and persistent wheezers beyond the age of 5 years old (38.77%). The average age for wheezing disappearance was 24.28 ± 4.1 months. Four predictive factors for persistent asthma were identified: familial atopy (adjusted odds ratio [OR] 4.76; 95% confidence interval [CI] 2.52–12.45; p < 0.001), passive smoking (adjusted OR 5.98; 95% CI 2.48–13.64; p < 0.001), poor control of asthma (adjusted OR 5.23; 95% CI 2.47–14.76; p 0.0013), and aerosensitization (adjusted OR 7.38; 95%CI 3.87–17.84; p < 0.001). The main predictors for persistent asthma among preschooler wheezers were aerosensitization, family history of atopy, early exposure to passive smoking, and poor control of asthma. The detection of such factors allows for earlier diagnosis and targeted prevention strategies.
{"title":"Predictors of persistent asthma among preschooler wheezers: a retrospective case series study","authors":"Hager Barakizou","doi":"10.1186/s43054-023-00200-y","DOIUrl":"https://doi.org/10.1186/s43054-023-00200-y","url":null,"abstract":"Early childhood wheezing can evolve to different asthma phenotypes. Prediction of persistent asthma during the preschool years has proven challenging. Through this study, we aimed to identify predictors of persistent asthma in preschooler wheezers. This was a retrospective case series study over 10 years. Patient data from 98 infants diagnosed with infantile asthma were obtained from their medical records. A multivariate logistic regression model was developed to determine predictors of persistent asthma in preschooler wheezers. The sex ratio was 1.72. The mean age at the first episode of wheezing was 7 ± 3.17 months. The mean age at diagnosis was 14.82 ± 4.28. Asthma was well controlled in 71 cases (72.44%) and partly controlled in 27 cases (27.56%). Two groups were identified: transient wheezers (61.33%) and persistent wheezers beyond the age of 5 years old (38.77%). The average age for wheezing disappearance was 24.28 ± 4.1 months. Four predictive factors for persistent asthma were identified: familial atopy (adjusted odds ratio [OR] 4.76; 95% confidence interval [CI] 2.52–12.45; p < 0.001), passive smoking (adjusted OR 5.98; 95% CI 2.48–13.64; p < 0.001), poor control of asthma (adjusted OR 5.23; 95% CI 2.47–14.76; p 0.0013), and aerosensitization (adjusted OR 7.38; 95%CI 3.87–17.84; p < 0.001). The main predictors for persistent asthma among preschooler wheezers were aerosensitization, family history of atopy, early exposure to passive smoking, and poor control of asthma. The detection of such factors allows for earlier diagnosis and targeted prevention strategies.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138515765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-16DOI: 10.1186/s43054-023-00231-5
Sara Tarek, Ayman E. Eskander, Safa Meshaal, Eman Badr, Asmaa Abd El-Hakeem
Patients with pediatric inflammatory bowel disease (PIBD) are believed to be at higher risk of hepatitis C virus (HCV) infection not only due to using of immunosuppressive drugs but also because of repeated blood transfusion and endoscopic and other invasive procedures used for diagnoses and effective controlling of the disease, so this study aimed to assess the frequency of HCV infection, in patients with PIBD at the New Children’s Hospital, Cairo University, and identify the potential risk factors. This cross-sectional analytic study included 165 IBD patients between 1 and 16 years old of both sexes who were attending the Pediatric Gastroenterology Clinic in the New Children’s University Hospital, Cairo University. All patients were screened for anti-HCV antibodies using ELISA. Factors related to IBD (severity, modalities of the treatment, and invasive procedures), to infection (blood transfusion history and family history of hepatitis), and liver enzymes were registered. The risk factors were evaluated by multivariate logistic regression analysis. Present and/or past HCV infection was found in five (3%) of the IBD patients. The multivariate logistic regression to detect independent predictors of HCV +ve antibodies patients had statistically significant value with number of hospital admission related to IBD with p-value = 0.002, odd ratio (OR) = 1.467, and confidence interval (CI) = 95% (1.145–1.879) and with number of hospital admission unrelated to IBD with p-value = 0.024, OR = 0.750, and CI 95% (0.585–0.963). The frequency of HCV infection in PIBD patients was 3%. Thus, the frequency of HCV infection in PIBD patients is similar to that in the normal population of the developing countries, and it is strongly related to hospital admission due to IBD or non-IBD causes.
{"title":"Frequency of hepatitis C virus infection in patients with pediatric inflammatory bowel disease: a cross-sectional study","authors":"Sara Tarek, Ayman E. Eskander, Safa Meshaal, Eman Badr, Asmaa Abd El-Hakeem","doi":"10.1186/s43054-023-00231-5","DOIUrl":"https://doi.org/10.1186/s43054-023-00231-5","url":null,"abstract":"Patients with pediatric inflammatory bowel disease (PIBD) are believed to be at higher risk of hepatitis C virus (HCV) infection not only due to using of immunosuppressive drugs but also because of repeated blood transfusion and endoscopic and other invasive procedures used for diagnoses and effective controlling of the disease, so this study aimed to assess the frequency of HCV infection, in patients with PIBD at the New Children’s Hospital, Cairo University, and identify the potential risk factors. This cross-sectional analytic study included 165 IBD patients between 1 and 16 years old of both sexes who were attending the Pediatric Gastroenterology Clinic in the New Children’s University Hospital, Cairo University. All patients were screened for anti-HCV antibodies using ELISA. Factors related to IBD (severity, modalities of the treatment, and invasive procedures), to infection (blood transfusion history and family history of hepatitis), and liver enzymes were registered. The risk factors were evaluated by multivariate logistic regression analysis. Present and/or past HCV infection was found in five (3%) of the IBD patients. The multivariate logistic regression to detect independent predictors of HCV +ve antibodies patients had statistically significant value with number of hospital admission related to IBD with p-value = 0.002, odd ratio (OR) = 1.467, and confidence interval (CI) = 95% (1.145–1.879) and with number of hospital admission unrelated to IBD with p-value = 0.024, OR = 0.750, and CI 95% (0.585–0.963). The frequency of HCV infection in PIBD patients was 3%. Thus, the frequency of HCV infection in PIBD patients is similar to that in the normal population of the developing countries, and it is strongly related to hospital admission due to IBD or non-IBD causes.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138515761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-15DOI: 10.1186/s43054-023-00233-3
Hooi Hooi Tan, Shung Ken Tan
Female hypospadias is a rare congenital anomaly and defined as a female urethral opening on the anterior vaginal wall. Diagnosis is challenging due to its rarity. Different anatomical variations exist depending on the location of the urethral opening. Clinical presentation can vary from asymptomatic until end-stage renal disease due to lower urinary tract obstruction. This case highlights the important clinical and radiological features of female hypospadias. Surgical treatment remains the mainstay management for this entity. We report a case of a 5-year-old girl presented with 3 days of lower abdominal pain, vomiting and difficulty in voiding. She was previously well. Abdominal examination revealed a palpable suprapubic mass arising from the pelvis up to the umbilicus. Perineal examination showed a single opening at the introitus. Ultrasound showed a grossly distended urinary bladder and bilateral mild hydroureteronephrosis. Catheterization of the opening failed to decompress the bladder, and a suprapubic catheter was inserted which drained 500 cc of clear urine. She also developed acute kidney injury which resolved after suprapubic drainage. Cystogram and genitogram failed to delineate the communication between the urinary bladder and vagina. However, cystovaginoscopy revealed a normal vagina opening, and the urethral meatus entered the anterior wall of the vagina distally. She underwent a meatoplasty and recovered well after surgery. Attention to important clinical and radiological features helps in the diagnosis of female hypospadias. Female hypospadias should be suspected in female patient with single opening at the introitus, acute urinary retention and failed urinary catheterization. Cystovaginoscopic examination is required to diagnose this condition. Urethroplasty is curative with good outcome for low type of female hypospadias.
{"title":"A rare congenital anomaly in a female child with acute urinary retention—female hypospadias: a case report","authors":"Hooi Hooi Tan, Shung Ken Tan","doi":"10.1186/s43054-023-00233-3","DOIUrl":"https://doi.org/10.1186/s43054-023-00233-3","url":null,"abstract":"Female hypospadias is a rare congenital anomaly and defined as a female urethral opening on the anterior vaginal wall. Diagnosis is challenging due to its rarity. Different anatomical variations exist depending on the location of the urethral opening. Clinical presentation can vary from asymptomatic until end-stage renal disease due to lower urinary tract obstruction. This case highlights the important clinical and radiological features of female hypospadias. Surgical treatment remains the mainstay management for this entity. We report a case of a 5-year-old girl presented with 3 days of lower abdominal pain, vomiting and difficulty in voiding. She was previously well. Abdominal examination revealed a palpable suprapubic mass arising from the pelvis up to the umbilicus. Perineal examination showed a single opening at the introitus. Ultrasound showed a grossly distended urinary bladder and bilateral mild hydroureteronephrosis. Catheterization of the opening failed to decompress the bladder, and a suprapubic catheter was inserted which drained 500 cc of clear urine. She also developed acute kidney injury which resolved after suprapubic drainage. Cystogram and genitogram failed to delineate the communication between the urinary bladder and vagina. However, cystovaginoscopy revealed a normal vagina opening, and the urethral meatus entered the anterior wall of the vagina distally. She underwent a meatoplasty and recovered well after surgery. Attention to important clinical and radiological features helps in the diagnosis of female hypospadias. Female hypospadias should be suspected in female patient with single opening at the introitus, acute urinary retention and failed urinary catheterization. Cystovaginoscopic examination is required to diagnose this condition. Urethroplasty is curative with good outcome for low type of female hypospadias.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138515770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-13DOI: 10.1186/s43054-023-00202-w
Mohamed Abdallah Abd El Megied, Iman Khaled Ayada, Omnia Yahia Abd El Dayem, Ramy Abd El Naser Abd El Wareth, Mohamed Salah Ghonaim, Aya Osama Mohamed, Shereen AbdelMonem Mohamed
Abstract Background Paediatric intensive care units (PICU) experience a big challenge with malnutrition. It significantly impacts the development and prognosis of critically ill patients (CIP). CIP are those who require high reliance or serious medical and/or surgical interventions. For their importance, valid and reliable nutritional markers are mandatory to be implemented in the daily practice of our PICU. The aim of this study was to determine the nutritional status of CIP in PICU through measuring prealbumin level and use it as predictor of malnutrition and clinical outcome. Methods Forty four CIP admitted to the Children's Hospital, Cairo University PICU, throughout six months were the subject of this cross-sectional study. Clinical nutritional status was evaluated using the Z-score, and prealbumin level was measured. Results 50% of children who were critically sick also had malnutrition, with severe malnutrition accounting for the majority of cases (34.1%). Prealbumin did not significantly correlate with malnutrition, nor the mortality in CIP. However, malnutrition is strongly linked to mortality in critically ill children. To predict malnutrition in CIP, serum prealbumin at cutoff > 163.64 exhibited AUC of 0.556 with sensitivity of 90.91% and a specificity of 31.82%. For prediction of the clinical outcome, serum prealbumin at cutoff ≤ 758.37 had an AUC of 0.535 with a sensitivity of 91.67% and a specificity of 21.87%. Conclusions Malnutrition significantly increased the risk of death. Prealbumin was neither a significant predictor for malnutrition nor mortality in CIP.
{"title":"Diagnostic and prognostic utility of prealbumin as a nutritional biomarker in critically ill children: a prospective cross sectional study","authors":"Mohamed Abdallah Abd El Megied, Iman Khaled Ayada, Omnia Yahia Abd El Dayem, Ramy Abd El Naser Abd El Wareth, Mohamed Salah Ghonaim, Aya Osama Mohamed, Shereen AbdelMonem Mohamed","doi":"10.1186/s43054-023-00202-w","DOIUrl":"https://doi.org/10.1186/s43054-023-00202-w","url":null,"abstract":"Abstract Background Paediatric intensive care units (PICU) experience a big challenge with malnutrition. It significantly impacts the development and prognosis of critically ill patients (CIP). CIP are those who require high reliance or serious medical and/or surgical interventions. For their importance, valid and reliable nutritional markers are mandatory to be implemented in the daily practice of our PICU. The aim of this study was to determine the nutritional status of CIP in PICU through measuring prealbumin level and use it as predictor of malnutrition and clinical outcome. Methods Forty four CIP admitted to the Children's Hospital, Cairo University PICU, throughout six months were the subject of this cross-sectional study. Clinical nutritional status was evaluated using the Z-score, and prealbumin level was measured. Results 50% of children who were critically sick also had malnutrition, with severe malnutrition accounting for the majority of cases (34.1%). Prealbumin did not significantly correlate with malnutrition, nor the mortality in CIP. However, malnutrition is strongly linked to mortality in critically ill children. To predict malnutrition in CIP, serum prealbumin at cutoff > 163.64 exhibited AUC of 0.556 with sensitivity of 90.91% and a specificity of 31.82%. For prediction of the clinical outcome, serum prealbumin at cutoff ≤ 758.37 had an AUC of 0.535 with a sensitivity of 91.67% and a specificity of 21.87%. Conclusions Malnutrition significantly increased the risk of death. Prealbumin was neither a significant predictor for malnutrition nor mortality in CIP.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136281429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background Arterial spin-labeling (ASL) imaging is currently the most useful method for diagnosing mitochondrial encephalomyopathy, lactic acidosis, and stroke-like attack syndrome (MELAS). However, ASL is often an optional feature of standard MRI systems. Therefore, not all MRI systems can perform ASL imaging. In contrast, fluid-attenuated inversion recovery (FLAIR) imaging is one of the common sequences in brain MRI because FLAIR imaging can be performed regardless of the specifications of the equipment. This study aimed to compare the diagnostic performance of quantitative analysis of signal intensity obtained from fluid-attenuated inversion recovery (FLAIR) images with ASL images for MELAS with recurrent stroke-like episodes (SLEs). A total of 68 cases with normal magnetic resonance imaging findings and 25 cases diagnosed MELAS with recurrent SLEs were included. We evaluated the frontal lobe and cuneus as target areas and compared the regional cerebral blood flow (rCBF) values obtained from ASL images with the normalized signal intensity (nSI) obtained from FLAIR images. Results The sensitivity and specificity for diagnosing MELAS from linear discriminant analysis (LDA) obtained from the rCBF values were 0.84 and 0.941, respectively, and those of nSI were 0.8 and 0.897, respectively. The area under the ROC curves (AUC) calculated from the receiver operating characteristic (ROC) curve analysis using rCBF values and nSI were 0.889 and 0.804, respectively. Conclusion Quantitative analysis using the signal intensity of the FLAIR image could have a diagnostic performance equivalent to that of rCBF values obtained from ASL images.
{"title":"Proposal for diagnosis using FLAIR image aimed for pediatric MELAS with recurrent stroke-like episodes on MRI system cannot take ASL imaging","authors":"Makoto Shimada, Tae Ikeda, Ryohei Fukui, Katsuhiro Kida, Ryutaro Matsuura, Takuya Akagawa, Sachiko Goto","doi":"10.1186/s43054-023-00232-4","DOIUrl":"https://doi.org/10.1186/s43054-023-00232-4","url":null,"abstract":"Abstract Background Arterial spin-labeling (ASL) imaging is currently the most useful method for diagnosing mitochondrial encephalomyopathy, lactic acidosis, and stroke-like attack syndrome (MELAS). However, ASL is often an optional feature of standard MRI systems. Therefore, not all MRI systems can perform ASL imaging. In contrast, fluid-attenuated inversion recovery (FLAIR) imaging is one of the common sequences in brain MRI because FLAIR imaging can be performed regardless of the specifications of the equipment. This study aimed to compare the diagnostic performance of quantitative analysis of signal intensity obtained from fluid-attenuated inversion recovery (FLAIR) images with ASL images for MELAS with recurrent stroke-like episodes (SLEs). A total of 68 cases with normal magnetic resonance imaging findings and 25 cases diagnosed MELAS with recurrent SLEs were included. We evaluated the frontal lobe and cuneus as target areas and compared the regional cerebral blood flow (rCBF) values obtained from ASL images with the normalized signal intensity (nSI) obtained from FLAIR images. Results The sensitivity and specificity for diagnosing MELAS from linear discriminant analysis (LDA) obtained from the rCBF values were 0.84 and 0.941, respectively, and those of nSI were 0.8 and 0.897, respectively. The area under the ROC curves (AUC) calculated from the receiver operating characteristic (ROC) curve analysis using rCBF values and nSI were 0.889 and 0.804, respectively. Conclusion Quantitative analysis using the signal intensity of the FLAIR image could have a diagnostic performance equivalent to that of rCBF values obtained from ASL images.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136281601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-09DOI: 10.1186/s43054-023-00230-6
Alyaa Ahdy Abdelaziz, Fady Mohammed ElGendy, Alaa Atef Hegazy, Mai Hussein, Ramy Mohamed Ghazy
Abstract Objectives This study assessed the value of measuring both arterial lactate levels and central venous oxygen saturation (ScvO2) in predicting cardiac surgery outcomes in pediatric patients. Methods A prospective cohort study was conducted on 73 patients who underwent surgery for congenital heart disease. Vasoactive-inotropic score (VIS), serial mean arterial blood pressures (MAP), lactate levels, and ScvO 2 were measured immediately and 3, 6, 12, 18, and 24 h after admission to the pediatric intensive care unit (PICU). To test the prognostic values of these markers, we calculated the areas under the receiver operating characteristic curves (AUCs). Binary logistic regression was used to identify the determinants of postsurgical complications. Results The most common complications after cardiac surgery were the prolonged need for mechanical ventilation (38.36%), chest infection (30.14%), prolonged stay in the PICU (24.66%), and sepsis (9.59%). ScvO2 6 h after admission was most predictive of complications ( AUC = 85.5%), followed by ScvO2/lactate ( AUC = 83.0%), lactate level 12 h after admission ( AUC = 75.0%), MAP ( AUC = 73.6%), and VIS ( AUC = 63.4). In multivariate analysis, body weight and ScvO2 6 h after PICU admission were the main predictors of complications ( OR = 0.01, 95% CI 0.001–0.689, p = 0.033), and ( OR = 0.87, 95% CI 0.798–0.948, p = 0.002) respectively. Conclusions To predict complications after pediatric cardiac surgery, lactate measurement does not add value to ScvO2 measurement 6 h after admission. The Cochrane TRN PACTR202104905893217. Date of registration 12 April 2021.
目的本研究评估动脉乳酸水平和中心静脉氧饱和度(ScvO2)在预测儿科心脏手术患者预后中的价值。方法对73例先天性心脏病手术患者进行前瞻性队列研究。在儿童重症监护病房(PICU)入院后立即及3、6、12、18和24小时测量血管活性-肌力评分(VIS)、连续平均动脉血压(MAP)、乳酸水平和ScvO 2。为了检验这些标志物的预后价值，我们计算了受试者工作特征曲线(auc)下的面积。二元逻辑回归用于确定术后并发症的决定因素。结果心脏手术后最常见的并发症为机械通气时间延长(38.36%)、胸部感染(30.14%)、PICU住院时间延长(24.66%)和脓毒症(9.59%)。入院后6 h ScvO2最能预测并发症(AUC = 85.5%)，其次是ScvO2/乳酸(AUC = 83.0%)、入院后12 h乳酸水平(AUC = 75.0%)、MAP (AUC = 73.6%)和VIS (AUC = 63.4)。在多因素分析中，体重和入PICU后6 h ScvO2是并发症的主要预测因素(OR = 0.01, 95% CI 0.001 ~ 0.689, p = 0.033)和(OR = 0.87, 95% CI 0.798 ~ 0.948, p = 0.002)。结论为了预测小儿心脏手术后的并发症，入院后6小时的ScvO2测量并没有增加测量乳酸的价值。Cochrane TRN PACTR202104905893217。注册日期2021年4月12日。
{"title":"Prognostic value of combined central venous oxygen saturation and lactate in pediatric patients after cardiac surgery","authors":"Alyaa Ahdy Abdelaziz, Fady Mohammed ElGendy, Alaa Atef Hegazy, Mai Hussein, Ramy Mohamed Ghazy","doi":"10.1186/s43054-023-00230-6","DOIUrl":"https://doi.org/10.1186/s43054-023-00230-6","url":null,"abstract":"Abstract Objectives This study assessed the value of measuring both arterial lactate levels and central venous oxygen saturation (ScvO2) in predicting cardiac surgery outcomes in pediatric patients. Methods A prospective cohort study was conducted on 73 patients who underwent surgery for congenital heart disease. Vasoactive-inotropic score (VIS), serial mean arterial blood pressures (MAP), lactate levels, and ScvO 2 were measured immediately and 3, 6, 12, 18, and 24 h after admission to the pediatric intensive care unit (PICU). To test the prognostic values of these markers, we calculated the areas under the receiver operating characteristic curves (AUCs). Binary logistic regression was used to identify the determinants of postsurgical complications. Results The most common complications after cardiac surgery were the prolonged need for mechanical ventilation (38.36%), chest infection (30.14%), prolonged stay in the PICU (24.66%), and sepsis (9.59%). ScvO2 6 h after admission was most predictive of complications ( AUC = 85.5%), followed by ScvO2/lactate ( AUC = 83.0%), lactate level 12 h after admission ( AUC = 75.0%), MAP ( AUC = 73.6%), and VIS ( AUC = 63.4). In multivariate analysis, body weight and ScvO2 6 h after PICU admission were the main predictors of complications ( OR = 0.01, 95% CI 0.001–0.689, p = 0.033), and ( OR = 0.87, 95% CI 0.798–0.948, p = 0.002) respectively. Conclusions To predict complications after pediatric cardiac surgery, lactate measurement does not add value to ScvO2 measurement 6 h after admission. The Cochrane TRN PACTR202104905893217. Date of registration 12 April 2021.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135286426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background As double-outlet right ventricle has a wide pathophysiology spectrum, its comprehensive treatment strategy is determined based on relevant factors, such as the location and size of the ventricular septal defect, ventricular volume, and relationship of the great arteries. However, for borderline double-outlet right ventricle cases, it is occasionally difficult to decide the treatment strategy preoperatively. Recently, advances in 3D printing technology based on computed tomography have enabled the creation of 3D heart models of congenital heart disease that can precisely reproduce the anatomical structure of each patient even for complex anomalies. Herein, we describe a young patient in whom univentricular repair could be decided after confirming the 3D heart model and intracardiac structure under direct vision. Case presentation We describe a 3-year-old girl who was diagnosed with double-outlet right ventricle and severe pulmonary valve stenosis at birth and who underwent a left modified Blalock–Taussig shunt at 2 years of age. Preoperative examination revealed a borderline condition for biventricular repair characterized by a small left ventricle volume and side-by-side relationship of the great artery. After a preoperative discussion using a 3D heart model, we concurred that an intraoperative assessment would be made as to whether biventricular repair was possible or not. After confirming the intracardiac structure under direct vision, we assessed that intraventricular rerouting was not possible owing to the high risk of subvalvular aortic stenosis as there was no tissue that could be incised between the right ventricular free wall and the primary interventricular foramen, as indicated in the 3D heart model. Thus, atrial septostomy and Glenn anastomosis were performed. Conclusions We report a 3-year-old girl with a borderline double-outlet right ventricle in whom a univentricular repair strategy could be decided after confirming the 3D heart model and intracardiac structure under direct vision. A 3D-printed heart model can be useful in patients whose repair strategy is difficult to judge for the borderline double-outlet right ventricle.
{"title":"Three-dimensional-printed heart model can determine univentricular repair strategy in borderline double-outlet right ventricle","authors":"Yuzo Katayama, Sho Isobe, Tsukasa Ozawa, Takeshiro Fujii","doi":"10.1186/s43054-023-00229-z","DOIUrl":"https://doi.org/10.1186/s43054-023-00229-z","url":null,"abstract":"Abstract Background As double-outlet right ventricle has a wide pathophysiology spectrum, its comprehensive treatment strategy is determined based on relevant factors, such as the location and size of the ventricular septal defect, ventricular volume, and relationship of the great arteries. However, for borderline double-outlet right ventricle cases, it is occasionally difficult to decide the treatment strategy preoperatively. Recently, advances in 3D printing technology based on computed tomography have enabled the creation of 3D heart models of congenital heart disease that can precisely reproduce the anatomical structure of each patient even for complex anomalies. Herein, we describe a young patient in whom univentricular repair could be decided after confirming the 3D heart model and intracardiac structure under direct vision. Case presentation We describe a 3-year-old girl who was diagnosed with double-outlet right ventricle and severe pulmonary valve stenosis at birth and who underwent a left modified Blalock–Taussig shunt at 2 years of age. Preoperative examination revealed a borderline condition for biventricular repair characterized by a small left ventricle volume and side-by-side relationship of the great artery. After a preoperative discussion using a 3D heart model, we concurred that an intraoperative assessment would be made as to whether biventricular repair was possible or not. After confirming the intracardiac structure under direct vision, we assessed that intraventricular rerouting was not possible owing to the high risk of subvalvular aortic stenosis as there was no tissue that could be incised between the right ventricular free wall and the primary interventricular foramen, as indicated in the 3D heart model. Thus, atrial septostomy and Glenn anastomosis were performed. Conclusions We report a 3-year-old girl with a borderline double-outlet right ventricle in whom a univentricular repair strategy could be decided after confirming the 3D heart model and intracardiac structure under direct vision. A 3D-printed heart model can be useful in patients whose repair strategy is difficult to judge for the borderline double-outlet right ventricle.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135340927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-06DOI: 10.1186/s43054-023-00198-3
Khaled Amin Nasef Ahmed, Iman Ali Abd El Aziz, Sara Tarek, Hager Mahmoud Abd El Fattah, Ahmed Said Behairy
Abstract Background Asthma is a common and potentially serious chronic disease that imposes a substantial burden on patients, their families, and the community. Objectives The aim of this study was to find a correlation between precipitating factors of acute asthma attacks of patients attending to emergency departments and different factors such as socioeconomic status. Methods The study included patients 2–12 years old of both sexes who were already diagnosed with bronchial asthma coming to ER with acute asthmatic attacks. Data were collected by a questionnaire which includes personal data (name, age, and sex), anthropometric data, score for assessment of socioeconomic status (SES), symptoms of asthmatic attack, risk factors, mode and type of treatment, compliance to treatment, or evaluation of asthma severity and outcome of patients attending to ER. Results This study included 170 patients. Males represented 63.5% of the patients. The mean age of the patients was 5.4 ± 2.7 years. Our patients were distributed into the following: 65.9% were low SES, 22.9% were very low SES, and 11.2% were moderate SES. As regards presenting symptoms of the study group, all the patients (100%) presented to ER with cough, while 88.2% of them presented with wheezes, 85.8% presented with dyspnea, 21.2% of them presented with tightness, and only 0.01% presented with cyanosis. As regards precipitating factors of asthma, the most common precipitating factors among our patients causing attending to ER were irritant inhalers (72.4%), passive smoking (60.6%), exercise (70.5%), certain foods (45.3%), upper respiratory tract infection (12.9%), and non-compliance to asthma treatment (85.2%). The most common causes of non-compliance to treatment were family negligence and illiteracy (34.1%) and poor socioeconomic conditions (17.1%). The majority of patients (96.5%) who could be stabilized with medications were discharged, whereas a merged proportion of critically ill patients (3.5%) required ICU admission. However, no deaths were reported. Conclusion The most common precipitating factors of our patients that led to more attending to ER in the previous 6 months were exercise, irritant inhalers, and non-compliance to asthma treatment.
{"title":"Precipitating factors and outcome of acute asthma attack patients attended to the emergency unit at Cairo University Specialized Pediatric Hospital in 2019 “before COVID era”","authors":"Khaled Amin Nasef Ahmed, Iman Ali Abd El Aziz, Sara Tarek, Hager Mahmoud Abd El Fattah, Ahmed Said Behairy","doi":"10.1186/s43054-023-00198-3","DOIUrl":"https://doi.org/10.1186/s43054-023-00198-3","url":null,"abstract":"Abstract Background Asthma is a common and potentially serious chronic disease that imposes a substantial burden on patients, their families, and the community. Objectives The aim of this study was to find a correlation between precipitating factors of acute asthma attacks of patients attending to emergency departments and different factors such as socioeconomic status. Methods The study included patients 2–12 years old of both sexes who were already diagnosed with bronchial asthma coming to ER with acute asthmatic attacks. Data were collected by a questionnaire which includes personal data (name, age, and sex), anthropometric data, score for assessment of socioeconomic status (SES), symptoms of asthmatic attack, risk factors, mode and type of treatment, compliance to treatment, or evaluation of asthma severity and outcome of patients attending to ER. Results This study included 170 patients. Males represented 63.5% of the patients. The mean age of the patients was 5.4 ± 2.7 years. Our patients were distributed into the following: 65.9% were low SES, 22.9% were very low SES, and 11.2% were moderate SES. As regards presenting symptoms of the study group, all the patients (100%) presented to ER with cough, while 88.2% of them presented with wheezes, 85.8% presented with dyspnea, 21.2% of them presented with tightness, and only 0.01% presented with cyanosis. As regards precipitating factors of asthma, the most common precipitating factors among our patients causing attending to ER were irritant inhalers (72.4%), passive smoking (60.6%), exercise (70.5%), certain foods (45.3%), upper respiratory tract infection (12.9%), and non-compliance to asthma treatment (85.2%). The most common causes of non-compliance to treatment were family negligence and illiteracy (34.1%) and poor socioeconomic conditions (17.1%). The majority of patients (96.5%) who could be stabilized with medications were discharged, whereas a merged proportion of critically ill patients (3.5%) required ICU admission. However, no deaths were reported. Conclusion The most common precipitating factors of our patients that led to more attending to ER in the previous 6 months were exercise, irritant inhalers, and non-compliance to asthma treatment.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135585085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-06DOI: 10.1186/s43054-023-00227-1
Shereen A. Mohamed, Hafez M. Bazaraa, Sally K. Ishak, Mohamed H. El-Ghobashy, Maie A. Gommaa
Abstract Background Community-acquired pneumonia represents a noteworthy concern in terms of morbidity and mortality, particularly in countries with lower and middle-income levels. Accurate and timely diagnosis of pneumonia is crucial for optimal management. Chest CT is considered the gold standard imaging for diagnosis of pneumonia, but it is not always readily available and exposes children to radiation hazards, so it becomes important to find easily available and less hazardous imaging tools such as lung ultrasound to diagnose pneumonia. A comparative investigation was carried out to assess the diagnostic capability of lung ultrasound in critically ill pediatric patients presenting with respiratory symptoms. Forty-two patients with community-acquired pneumonia from the pediatric intensive care unit were included. Results Lung ultrasound demonstrated high sensitivity (88.1%) and specificity in diagnosing pneumonia, outperforming chest X-ray (50%) and providing comparable results to chest CT (95.2%). In addition, 45.2% of patients required mechanical ventilation, and 69.1% were diagnosed with viral pneumonia. Conclusion The employment of lung ultrasound is deemed secure, accessible, transferable, and efficacious in the expeditious detection of community-acquired pneumonia and the subsequent monitoring of patients. Its high sensitivity and specificity make it a valuable imaging modality in pediatric pneumonia diagnosis, helping clinicians make informed decisions and improve patient outcomes.
{"title":"The reliability of POCUS in the diagnosis of community-acquired pneumonia in critically ill pediatric patients: a cross-sectional study","authors":"Shereen A. Mohamed, Hafez M. Bazaraa, Sally K. Ishak, Mohamed H. El-Ghobashy, Maie A. Gommaa","doi":"10.1186/s43054-023-00227-1","DOIUrl":"https://doi.org/10.1186/s43054-023-00227-1","url":null,"abstract":"Abstract Background Community-acquired pneumonia represents a noteworthy concern in terms of morbidity and mortality, particularly in countries with lower and middle-income levels. Accurate and timely diagnosis of pneumonia is crucial for optimal management. Chest CT is considered the gold standard imaging for diagnosis of pneumonia, but it is not always readily available and exposes children to radiation hazards, so it becomes important to find easily available and less hazardous imaging tools such as lung ultrasound to diagnose pneumonia. A comparative investigation was carried out to assess the diagnostic capability of lung ultrasound in critically ill pediatric patients presenting with respiratory symptoms. Forty-two patients with community-acquired pneumonia from the pediatric intensive care unit were included. Results Lung ultrasound demonstrated high sensitivity (88.1%) and specificity in diagnosing pneumonia, outperforming chest X-ray (50%) and providing comparable results to chest CT (95.2%). In addition, 45.2% of patients required mechanical ventilation, and 69.1% were diagnosed with viral pneumonia. Conclusion The employment of lung ultrasound is deemed secure, accessible, transferable, and efficacious in the expeditious detection of community-acquired pneumonia and the subsequent monitoring of patients. Its high sensitivity and specificity make it a valuable imaging modality in pediatric pneumonia diagnosis, helping clinicians make informed decisions and improve patient outcomes.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135635183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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