Pub Date : 2023-11-02DOI: 10.1186/s43054-023-00228-0
Mona Hassan Eltagui, Hadeel M. Seif Eldein, Marwa Abd Elhady, Dalia El-Sayed, Nouran Momen, Yasmeen M. M. Selim, Mai Mohammed Abd EL Salam
Abstract Objective Early identification of sickle renovascular changes via renal Doppler sonography among sickle cell disease patients to help in early diagnosis and interventions to prevent progression to end-stage renal disease. Methods Forty-five SCD children were included along with 45 healthy control children. Renal Doppler sonography (PI and RI) was performed on all subjects. Laboratory investigations were done: Hb electrophoresis, complete blood picture with blood indices, reticulocyte count, liver enzymes (ALT and AST), HCV serology, serum ferritin, and lactate dehydrogenase (LDH). Urine analysis and albumin/creatinine ratio in urine were done for all patients as well. Results The study group consisted of 45 SCD patients, 27 (60%) males with a mean age of 12 years (± 3 years). By performing renal Doppler sonography, it was found that all study groups had significantly higher Doppler indices (resistivity index and pulsatility index) compared to the control group. Results of renal Doppler sonography revealed that the main renal pulsatility index was positively correlated with the main renal resistance index ( r = 0.454, p = 0.002). Conclusion Doppler indices (resistance index and pulsatility index) were of value to assess reno-vascular changes in SCD, Thus, renal Doppler indices could be an early technique in the assessment of sickle renovascular changes, so treatment can be started at an early stage before progressive affection of renal function.
目的通过肾多普勒超声早期识别镰状细胞病患者的镰状肾血管改变，有助于早期诊断和干预，防止进展为终末期肾脏疾病。方法选取45例SCD患儿和45例健康对照。所有受试者均行肾多普勒超声检查(PI和RI)。实验室检查:Hb电泳，全血图与血液指标，网织红细胞计数，肝酶(ALT和AST)， HCV血清学，血清铁蛋白，乳酸脱氢酶(LDH)。对所有患者进行尿液分析和尿液白蛋白/肌酐比值。结果研究组SCD患者45例，男性27例(60%)，平均年龄12岁(±3岁)。通过肾脏多普勒超声检查发现，各研究组的多普勒指数(电阻率指数和脉搏指数)均明显高于对照组。肾多普勒超声结果显示，主肾搏动指数与主肾阻力指数呈正相关(r = 0.454, p = 0.002)。结论肾多普勒指标(阻力指数和脉搏指数)可作为评价SCD肾血管变化的早期指标，可在肾脏功能受到进展性影响前尽早开始治疗。
{"title":"Renal Doppler sonography as a non-invasive technique for early detection of reno-vascular changes in sickle cell disease in children","authors":"Mona Hassan Eltagui, Hadeel M. Seif Eldein, Marwa Abd Elhady, Dalia El-Sayed, Nouran Momen, Yasmeen M. M. Selim, Mai Mohammed Abd EL Salam","doi":"10.1186/s43054-023-00228-0","DOIUrl":"https://doi.org/10.1186/s43054-023-00228-0","url":null,"abstract":"Abstract Objective Early identification of sickle renovascular changes via renal Doppler sonography among sickle cell disease patients to help in early diagnosis and interventions to prevent progression to end-stage renal disease. Methods Forty-five SCD children were included along with 45 healthy control children. Renal Doppler sonography (PI and RI) was performed on all subjects. Laboratory investigations were done: Hb electrophoresis, complete blood picture with blood indices, reticulocyte count, liver enzymes (ALT and AST), HCV serology, serum ferritin, and lactate dehydrogenase (LDH). Urine analysis and albumin/creatinine ratio in urine were done for all patients as well. Results The study group consisted of 45 SCD patients, 27 (60%) males with a mean age of 12 years (± 3 years). By performing renal Doppler sonography, it was found that all study groups had significantly higher Doppler indices (resistivity index and pulsatility index) compared to the control group. Results of renal Doppler sonography revealed that the main renal pulsatility index was positively correlated with the main renal resistance index ( r = 0.454, p = 0.002). Conclusion Doppler indices (resistance index and pulsatility index) were of value to assess reno-vascular changes in SCD, Thus, renal Doppler indices could be an early technique in the assessment of sickle renovascular changes, so treatment can be started at an early stage before progressive affection of renal function.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"68 11","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135933880","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 : 2023-10-30DOI: 10.1186/s43054-023-00206-6
Ahmed Hassan Al-Ghamdi, Abdelhamid Ahmed Fureeh, Rawan Ibrahim Alshawikhat, Fatimah Ali Alshaikh Jafar, Saad Khalid Alamri, Abdulrhman K. Alzahrani, Abdulghani A. Alzahrani, Ahmed Saleh Alghamdi, Ali Abdulrraheem Almathammi
Abstract Purpose Pediatric endocrine disorders (PED) are a common component of medical health challenges in Saudi Arabia. We aimed to describe the pattern and clinical outcomes of different non-diabetic pediatric endocrine disorders in Al-Baha Region, Saudi Arabia, aiming for early diagnosis and management. Methods The clinical and laboratory data of 744 children and adolescents who presented with non-diabetic endocrine disorders and received medical care at the pediatric endocrine clinic et al.-Baha during the period from 2018 to 2022 were retrospectively analyzed based on the records. Results A total of 744 patients were recruited, 377 were females and 361 were males with a female/male ratio of 1.04/1. The patients’ ages ranged from 2 months to 17 years, with a mean age of 9.87 ± 4.59 years. The commonest endocrine disorders were thyroid disorders 234 (31.5%), short stature 176 (23.7%), obesity 123 (16.5%), and calcium phosphate metabolism disorders 117 (15.7%). Other disorders seen were pubertal disorders 27 (3.6%), adrenal gland disorders 22 (3%), syndromes with endocrine features 14 (1.9%), sex development and gender disorders 6 (0.8%), pituitary and hypothalamic disorders 4 (0.5%), and mixed endocrine disorders 4 (0.5%). PED is a substantial source of morbidity in 26 cases and mortality in 2 cases. Conclusions Thyroid, growth, and obesity disorders were the most common PED. Pediatric endocrine disorders have a substantial source of morbidity and mortality among Saudi children and adolescents. This baseline data is useful for planning PED care at institutional and national levels.
{"title":"The pattern and clinical outcomes of non-diabetic pediatric endocrine disorders, Al-Baha, Saudi Arabia: a retrospective study","authors":"Ahmed Hassan Al-Ghamdi, Abdelhamid Ahmed Fureeh, Rawan Ibrahim Alshawikhat, Fatimah Ali Alshaikh Jafar, Saad Khalid Alamri, Abdulrhman K. Alzahrani, Abdulghani A. Alzahrani, Ahmed Saleh Alghamdi, Ali Abdulrraheem Almathammi","doi":"10.1186/s43054-023-00206-6","DOIUrl":"https://doi.org/10.1186/s43054-023-00206-6","url":null,"abstract":"Abstract Purpose Pediatric endocrine disorders (PED) are a common component of medical health challenges in Saudi Arabia. We aimed to describe the pattern and clinical outcomes of different non-diabetic pediatric endocrine disorders in Al-Baha Region, Saudi Arabia, aiming for early diagnosis and management. Methods The clinical and laboratory data of 744 children and adolescents who presented with non-diabetic endocrine disorders and received medical care at the pediatric endocrine clinic et al.-Baha during the period from 2018 to 2022 were retrospectively analyzed based on the records. Results A total of 744 patients were recruited, 377 were females and 361 were males with a female/male ratio of 1.04/1. The patients’ ages ranged from 2 months to 17 years, with a mean age of 9.87 ± 4.59 years. The commonest endocrine disorders were thyroid disorders 234 (31.5%), short stature 176 (23.7%), obesity 123 (16.5%), and calcium phosphate metabolism disorders 117 (15.7%). Other disorders seen were pubertal disorders 27 (3.6%), adrenal gland disorders 22 (3%), syndromes with endocrine features 14 (1.9%), sex development and gender disorders 6 (0.8%), pituitary and hypothalamic disorders 4 (0.5%), and mixed endocrine disorders 4 (0.5%). PED is a substantial source of morbidity in 26 cases and mortality in 2 cases. Conclusions Thyroid, growth, and obesity disorders were the most common PED. Pediatric endocrine disorders have a substantial source of morbidity and mortality among Saudi children and adolescents. This baseline data is useful for planning PED care at institutional and national levels.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105616","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 : 2023-10-30DOI: 10.1186/s43054-023-00196-5
Gargi Ramesh Rekhawar, M. P. Bhavana, Vishal Dnyaneshwar Sawant, Sushma Save, Alpana Kondekar
Abstract Background Bardet-Biedl syndrome (BBS) is a rare multisystemic autosomal recessive (AR) disorder, which falls under the spectrum of ciliopathic disorders. As BBS is a very rare entity in India, its diagnosis is most often missed during early child visits. The lack of a syndromic approach for diagnosing genetic disorders by health care physicians is being considered a major blackguard. The following case report exemplifies how a patient presenting with multisystemic involvement should be evaluated to rule out syndromic association. Case presentation The authors here report a case of a male child aged 13 years presenting to Pediatrics Outpatient with complaints of learning disability and behavioral disturbances. During his initial assessment, features such as polydactyly, overweight, and vision disturbances were picked up by the pediatrician as an indication towards syndromic association. Soon a complete laboratory workup and various scans were done which revealed hepatic fibrosis and gonadal dysgenesis. Simultaneously, IQ testing was recommended which was suggestive of mild mental retardation. Bringing along all these clinical presentations a diagnosis of BBS was made. Post-diagnosis parents were counseled on recurrence risk and explained the importance of regular follow-ups and screening to improve quality of life. Conclusion This case report emphasizes the role of holistic multidisciplinary approach for diagnosing at early stage and better prognosis of BBS. Prenatal genetic counseling along with next-generation sequencing are a few potential measures to drop the incidence of this condition. Obesity and visual disturbances are a few concerns which if not handled early can result in unfortunate outcomes. Renal involvement in BBS is considered a deadly parameter which surely was not seen in this case. For all learning/intellectual disabilities, the triad of screening, clinical examination, and interdisciplinary approach can clinch in early diagnosis of a genetic syndrome.
{"title":"Bardet-Biedl Syndrome: a case report of delayed diagnosis with variable presentation and role of genetic testing in definitive diagnosis","authors":"Gargi Ramesh Rekhawar, M. P. Bhavana, Vishal Dnyaneshwar Sawant, Sushma Save, Alpana Kondekar","doi":"10.1186/s43054-023-00196-5","DOIUrl":"https://doi.org/10.1186/s43054-023-00196-5","url":null,"abstract":"Abstract Background Bardet-Biedl syndrome (BBS) is a rare multisystemic autosomal recessive (AR) disorder, which falls under the spectrum of ciliopathic disorders. As BBS is a very rare entity in India, its diagnosis is most often missed during early child visits. The lack of a syndromic approach for diagnosing genetic disorders by health care physicians is being considered a major blackguard. The following case report exemplifies how a patient presenting with multisystemic involvement should be evaluated to rule out syndromic association. Case presentation The authors here report a case of a male child aged 13 years presenting to Pediatrics Outpatient with complaints of learning disability and behavioral disturbances. During his initial assessment, features such as polydactyly, overweight, and vision disturbances were picked up by the pediatrician as an indication towards syndromic association. Soon a complete laboratory workup and various scans were done which revealed hepatic fibrosis and gonadal dysgenesis. Simultaneously, IQ testing was recommended which was suggestive of mild mental retardation. Bringing along all these clinical presentations a diagnosis of BBS was made. Post-diagnosis parents were counseled on recurrence risk and explained the importance of regular follow-ups and screening to improve quality of life. Conclusion This case report emphasizes the role of holistic multidisciplinary approach for diagnosing at early stage and better prognosis of BBS. Prenatal genetic counseling along with next-generation sequencing are a few potential measures to drop the incidence of this condition. Obesity and visual disturbances are a few concerns which if not handled early can result in unfortunate outcomes. Renal involvement in BBS is considered a deadly parameter which surely was not seen in this case. For all learning/intellectual disabilities, the triad of screening, clinical examination, and interdisciplinary approach can clinch in early diagnosis of a genetic syndrome.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"101 7","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136019285","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 : 2023-10-24DOI: 10.1186/s43054-023-00223-5
Khaled Amin Nasef Ahmed, Dalia Ahmed Saied, Eman E. L. Sayed Mustafa Megahed, Sara Mahmoud Kamel, Mona Ahmed Kamel
Abstract Background Germinal matrix hemorrhage affects 20 to 25% of infants with a low birth weight (less than 1500 g). About one-tenth of them progress to intra-parenchymal hemorrhage, usually during the first days after birth. Several studies have found a correlation between packed RBC transfusions and a higher frequency of severe germinal matrix hemorrhage in neonatal intensive care units. Transcranial ultrasound is a safe, noninvasive modality that can be used repeatedly in the neonates with ability to detect different grades of germinal matrix hemorrhage. Objective Was to evaluate the impact of packed RBC transfusion on the incidence and grade of germinal matrix hemorrhage, as evaluated by transcranial Doppler, and correlation to outcome. Methods This prospective observational study included one hundred preterm infants admitted to NICU, suffering from GM hemorrhage throughout 9 months duration. Bedside transcranial ultrasound was done for all the patients with a correlation of the grade of hemorrhage to the onset of blood transfusion, different clinical parameters, and the outcome. Results Statistical analysis showed a significant relation between the age of the first PRBC transfusion and GM hemorrhage grade. A positive relation was found between total amounts of PRBC transfusion and increasing grade of GM hemorrhage. A negative relation was found between GM hge grades and Apgar scores. GM hge patients who received PRBC transfusion had lower mean birth weight, lower gestational age, and longer duration of hospital stay than those who have not received PRBC transfusion. Conclusion Close monitoring of preterm neonates receiving packed RBCs, by transcranial ultrasound, as early as possible, is mandatory to early detect GM hge and limit subsequent morbidities.
{"title":"The impact of red blood cell transfusion in preterm neonates on germinal matrix hemorrhage: incidence and grade with correlation to outcome","authors":"Khaled Amin Nasef Ahmed, Dalia Ahmed Saied, Eman E. L. Sayed Mustafa Megahed, Sara Mahmoud Kamel, Mona Ahmed Kamel","doi":"10.1186/s43054-023-00223-5","DOIUrl":"https://doi.org/10.1186/s43054-023-00223-5","url":null,"abstract":"Abstract Background Germinal matrix hemorrhage affects 20 to 25% of infants with a low birth weight (less than 1500 g). About one-tenth of them progress to intra-parenchymal hemorrhage, usually during the first days after birth. Several studies have found a correlation between packed RBC transfusions and a higher frequency of severe germinal matrix hemorrhage in neonatal intensive care units. Transcranial ultrasound is a safe, noninvasive modality that can be used repeatedly in the neonates with ability to detect different grades of germinal matrix hemorrhage. Objective Was to evaluate the impact of packed RBC transfusion on the incidence and grade of germinal matrix hemorrhage, as evaluated by transcranial Doppler, and correlation to outcome. Methods This prospective observational study included one hundred preterm infants admitted to NICU, suffering from GM hemorrhage throughout 9 months duration. Bedside transcranial ultrasound was done for all the patients with a correlation of the grade of hemorrhage to the onset of blood transfusion, different clinical parameters, and the outcome. Results Statistical analysis showed a significant relation between the age of the first PRBC transfusion and GM hemorrhage grade. A positive relation was found between total amounts of PRBC transfusion and increasing grade of GM hemorrhage. A negative relation was found between GM hge grades and Apgar scores. GM hge patients who received PRBC transfusion had lower mean birth weight, lower gestational age, and longer duration of hospital stay than those who have not received PRBC transfusion. Conclusion Close monitoring of preterm neonates receiving packed RBCs, by transcranial ultrasound, as early as possible, is mandatory to early detect GM hge and limit subsequent morbidities.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"37 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135268148","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 : 2023-10-23DOI: 10.1186/s43054-023-00222-6
Varun Ravindra Jagtap, Sushma Save, Praveen Unki
Abstract Background Pediatric intensive care unit (PICU) admissions can have significant repercussions on families, including financial burdens and psychological distress. Not only do they face the overwhelming concern for their child’s health and well-being, but they are also confronted with a range of practical and financial difficulties. Coping strategies play a vital role in mitigating the negative impact of PICU admissions on families. Various coping mechanisms, such as seeking social support, engaging in problem-solving, and utilizing emotional regulation techniques, can help families navigate the challenges they face. The objectives of the study are to understand the array of financial implications in the form of out-of-pocket expenses (OOPE) and to quantify with a better understanding of the composition of out-of-pocket expenses in the form of medical and non-medical expenses. It also aimed to determine the loss of productive hours in a family and to understand the burden of OOPE in relation to the income of the family. Methods This prospective observational study was conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital over a period of 6 months after obtaining permission from the institutional ethics committee. Data pertaining to financial burden was collected with the help of Structured questionnaires which included the following categories travel, meals, accommodation, and incidental expenses were considered as non-medical expenses while all medicine costs and investigations were considered as medical expenses. The quantitative data were presented as the means ± SD as median with 25th and 75th percentiles (interquartile range) and were analyzed using ANOVA (for more than two groups) and independent t test (for two groups). Results More than half of the children (39(55.71%)) were not enrolled under any government scheme. The mean value of total medical and non-medical costs was 2525 ± 4035.28 and 2234.29 ± 846.84 Indian rupees. The mean value of total out-of-pocket expenses incurred per day (Indian rupees) on day 1, day 2, day 3, day 4, and day 5 were 1304 ± 587.2, 1208.86 ± 3773.84, 814.57 ± 565.03, 807.71 ± 522.76, and 699.86 ± 807.02 respectively. Conclusion Families of children admitted to the pediatric intensive care unit incurred catastrophic health expenditure with the cost of medicine contributing a major share. The lowest income brackets had much higher, more than twice the financial burden compared to the higher income group. Almost all families experienced a high loss of productivity in the form of a number of days lost due to the PICU admission of a child. Enrolment in government schemes helped to reduce OOPEs though better coverage of these schemes is needed.
{"title":"Financial burden in the form of medical and non-medical out-of-pocket expenses on the family of children admitted to a pediatric intensive care unit in India","authors":"Varun Ravindra Jagtap, Sushma Save, Praveen Unki","doi":"10.1186/s43054-023-00222-6","DOIUrl":"https://doi.org/10.1186/s43054-023-00222-6","url":null,"abstract":"Abstract Background Pediatric intensive care unit (PICU) admissions can have significant repercussions on families, including financial burdens and psychological distress. Not only do they face the overwhelming concern for their child’s health and well-being, but they are also confronted with a range of practical and financial difficulties. Coping strategies play a vital role in mitigating the negative impact of PICU admissions on families. Various coping mechanisms, such as seeking social support, engaging in problem-solving, and utilizing emotional regulation techniques, can help families navigate the challenges they face. The objectives of the study are to understand the array of financial implications in the form of out-of-pocket expenses (OOPE) and to quantify with a better understanding of the composition of out-of-pocket expenses in the form of medical and non-medical expenses. It also aimed to determine the loss of productive hours in a family and to understand the burden of OOPE in relation to the income of the family. Methods This prospective observational study was conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital over a period of 6 months after obtaining permission from the institutional ethics committee. Data pertaining to financial burden was collected with the help of Structured questionnaires which included the following categories travel, meals, accommodation, and incidental expenses were considered as non-medical expenses while all medicine costs and investigations were considered as medical expenses. The quantitative data were presented as the means ± SD as median with 25th and 75th percentiles (interquartile range) and were analyzed using ANOVA (for more than two groups) and independent t test (for two groups). Results More than half of the children (39(55.71%)) were not enrolled under any government scheme. The mean value of total medical and non-medical costs was 2525 ± 4035.28 and 2234.29 ± 846.84 Indian rupees. The mean value of total out-of-pocket expenses incurred per day (Indian rupees) on day 1, day 2, day 3, day 4, and day 5 were 1304 ± 587.2, 1208.86 ± 3773.84, 814.57 ± 565.03, 807.71 ± 522.76, and 699.86 ± 807.02 respectively. Conclusion Families of children admitted to the pediatric intensive care unit incurred catastrophic health expenditure with the cost of medicine contributing a major share. The lowest income brackets had much higher, more than twice the financial burden compared to the higher income group. Almost all families experienced a high loss of productivity in the form of a number of days lost due to the PICU admission of a child. Enrolment in government schemes helped to reduce OOPEs though better coverage of these schemes is needed.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"7 7","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135367978","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 : 2023-10-23DOI: 10.1186/s43054-023-00197-4
S. S. Dhanawade, R. V. Kawade, V. B. Waghachavare
Abstract Background COVID-19-related lockdowns had resulted in overburdening on health services. The lockdowns along with anxiety of the disease have resulted in delay in routine vaccination of many under-5 children. The current study was undertaken to understand the extent of the delay in under-5 vaccination during COVID-19-related lockdown in March-December 2020. Methods It was a cross-sectional study conducted during January-December 2021. Study population was under five children due for vaccination during the first COVID-19 lockdown at March-December 2020. Vaccination cards were used to confirm the status of vaccination, and questionnaire was used to study the attitude of parents towards vaccination and reasons for delay in vaccination, if any. The calculated sample size was 1434. But cluster random sampling method was applied; hence, 2274 subjects were included in the study. Statistical analysis was done using IBM SPSS-22 ™ , using descriptive statistics and chi-squared test. Results Percentages of children with delayed vaccination ranged from lowest for “at birth dose” (12.47%) to highest for “9th month dose, i.e. MR vaccine” (54.29%). Majority of parents stated lockdown and risk of COVID-19 infection as to be reason of the delay in vaccination. There was no uniform association between vaccination delay and attitude of parents towards vaccination. Conclusion COVID-19 pandemic and subsequent lockdown are the reasons stated by majority of parents with delayed vaccination in their children. This could be important lesson to plan for such contingencies for developing health services in future.
{"title":"Childhood immunization delay during the first wave of COVID-19 in an urban area of Sangli district from Maharashtra, India: a cross-sectional study","authors":"S. S. Dhanawade, R. V. Kawade, V. B. Waghachavare","doi":"10.1186/s43054-023-00197-4","DOIUrl":"https://doi.org/10.1186/s43054-023-00197-4","url":null,"abstract":"Abstract Background COVID-19-related lockdowns had resulted in overburdening on health services. The lockdowns along with anxiety of the disease have resulted in delay in routine vaccination of many under-5 children. The current study was undertaken to understand the extent of the delay in under-5 vaccination during COVID-19-related lockdown in March-December 2020. Methods It was a cross-sectional study conducted during January-December 2021. Study population was under five children due for vaccination during the first COVID-19 lockdown at March-December 2020. Vaccination cards were used to confirm the status of vaccination, and questionnaire was used to study the attitude of parents towards vaccination and reasons for delay in vaccination, if any. The calculated sample size was 1434. But cluster random sampling method was applied; hence, 2274 subjects were included in the study. Statistical analysis was done using IBM SPSS-22 ™ , using descriptive statistics and chi-squared test. Results Percentages of children with delayed vaccination ranged from lowest for “at birth dose” (12.47%) to highest for “9th month dose, i.e. MR vaccine” (54.29%). Majority of parents stated lockdown and risk of COVID-19 infection as to be reason of the delay in vaccination. There was no uniform association between vaccination delay and attitude of parents towards vaccination. Conclusion COVID-19 pandemic and subsequent lockdown are the reasons stated by majority of parents with delayed vaccination in their children. This could be important lesson to plan for such contingencies for developing health services in future.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135365385","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 Furosemide is the foremost drug used in the management of acute decompensated heart failure (ADHF). By tradition, it was administered as repeated intravenous boluses but fluctuations in intravascular volume and blood pressure were noticed in addition to the possibility of toxicity. Hence, continuous intravenous infusion was thought of as an alternative route of administration. In searching the literature, all previously published data concerning the pediatric age group was for infants and children following cardiac surgery. This study aims to compare the efficacy and safety of furosemide repeated injection versus continuous infusion during the management of ADHF in infants with left to right shunt. Methods A prospective parallel-design randomized study was conducted on 54 infants with ADHF, Ross class IV, secondary to left to right shunt. Twenty-seven infants received repeated injections of furosemide and 27 infants had furosemide continuous infusion. Patients were followed clinically for weight, urine output, hours required for resolution of failure symptoms, serum creatinine, sodium and potassium, and length of hospital stay. Results Non-significant differences were observed between both groups regarding preadmission oral furosemide dose and serum creatinine level. A lower daily dose of furosemide was observed in the continuous infusion arm (3.5 ± 0.6 vs 4.7 ± 1.0, p = 0.001) with less fluctuation in urine output and significantly fewer hours required for resolution of failure symptoms (42.1 ± 9 vs 56 ± 18.5, p = 0.001). At the end of furosemide infusion, serum creatinine was significantly higher in the continuous infusion group (0.39 ± 0.06 vs 0.34 ± 0.1, p = 0.030). However, before hospital discharge, non-significant differences were noticed (0.32 ± 0.05 vs 0.33 ± 0.06, p = 0.584). Non-significant differences between both groups regarding serum sodium and potassium levels at the end of furosemide injection were detected ( p = 0.289, 0.890, respectively). Conclusion Continuous infusion of furosemide can be safely administered to infants with ADHF, Ross class IV, secondary to left to right shunt with clinical gradual alleviation of fluid overload symptoms and less hemodynamic instability than repeated injections. Trial registration The study was approved by the Mansoura Faculty of Medicine institutional research board (MS/16.02.41) on August 3rd, 2016.
摘要背景速尿是治疗急性失代偿性心力衰竭(ADHF)的首选药物。传统上，它被反复静脉注射，但除了可能有毒性外，还注意到血管内体积和血压的波动。因此，持续静脉输注被认为是另一种给药途径。在检索文献时，所有先前发表的关于儿科年龄组的数据都是针对婴儿和心脏手术后的儿童。本研究旨在比较呋塞米反复注射与持续输注治疗左向右分流婴儿ADHF的疗效和安全性。方法对54例继发于左向右分流的Ross IV型ADHF患儿进行前瞻性平行设计随机研究。27例患儿重复注射呋塞米，27例患儿连续输注呋塞米。临床随访患者体重、尿量、衰竭症状消退所需时间、血清肌酐、钠和钾以及住院时间。结果两组患者入院前口服速尿剂量及血清肌酐水平无显著差异。连续输注组尿速胺的日剂量较低(3.5±0.6 vs 4.7±1.0,p = 0.001)，尿量波动较小，缓解失败症状所需的时间显著缩短(42.1±9 vs 56±18.5,p = 0.001)。尿速脲输注结束时，连续输注组血清肌酐显著高于对照组(0.39±0.06 vs 0.34±0.1,p = 0.030)。出院前两组比较差异无统计学意义(0.32±0.05 vs 0.33±0.06,p = 0.584)。两组患者注射呋塞米结束时血清钠、钾水平差异无统计学意义(p分别为0.289、0.890)。结论连续输注速尿可安全用于继发于左向右分流的Ross IV级ADHF患儿，临床症状逐渐减轻，血流动力学不稳定性较反复输注低。该研究于2016年8月3日获得曼苏拉医学院机构研究委员会(MS/16.02.41)批准。
{"title":"Furosemide continuous infusion versus repeated injection in the management of acute decompensated heart failure in infants with left to right shunt: a randomized trial","authors":"Marwa Zarzor, Bothina Hasaneen, Mohamed Magdy Abouelkheir, Hanan El-Halaby","doi":"10.1186/s43054-023-00225-3","DOIUrl":"https://doi.org/10.1186/s43054-023-00225-3","url":null,"abstract":"Abstract Background Furosemide is the foremost drug used in the management of acute decompensated heart failure (ADHF). By tradition, it was administered as repeated intravenous boluses but fluctuations in intravascular volume and blood pressure were noticed in addition to the possibility of toxicity. Hence, continuous intravenous infusion was thought of as an alternative route of administration. In searching the literature, all previously published data concerning the pediatric age group was for infants and children following cardiac surgery. This study aims to compare the efficacy and safety of furosemide repeated injection versus continuous infusion during the management of ADHF in infants with left to right shunt. Methods A prospective parallel-design randomized study was conducted on 54 infants with ADHF, Ross class IV, secondary to left to right shunt. Twenty-seven infants received repeated injections of furosemide and 27 infants had furosemide continuous infusion. Patients were followed clinically for weight, urine output, hours required for resolution of failure symptoms, serum creatinine, sodium and potassium, and length of hospital stay. Results Non-significant differences were observed between both groups regarding preadmission oral furosemide dose and serum creatinine level. A lower daily dose of furosemide was observed in the continuous infusion arm (3.5 ± 0.6 vs 4.7 ± 1.0, p = 0.001) with less fluctuation in urine output and significantly fewer hours required for resolution of failure symptoms (42.1 ± 9 vs 56 ± 18.5, p = 0.001). At the end of furosemide infusion, serum creatinine was significantly higher in the continuous infusion group (0.39 ± 0.06 vs 0.34 ± 0.1, p = 0.030). However, before hospital discharge, non-significant differences were noticed (0.32 ± 0.05 vs 0.33 ± 0.06, p = 0.584). Non-significant differences between both groups regarding serum sodium and potassium levels at the end of furosemide injection were detected ( p = 0.289, 0.890, respectively). Conclusion Continuous infusion of furosemide can be safely administered to infants with ADHF, Ross class IV, secondary to left to right shunt with clinical gradual alleviation of fluid overload symptoms and less hemodynamic instability than repeated injections. Trial registration The study was approved by the Mansoura Faculty of Medicine institutional research board (MS/16.02.41) on August 3rd, 2016.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135616055","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 : 2023-10-19DOI: 10.1186/s43054-023-00217-3
Abhishek Mishra, Achinta Kumar Mallick, A. K. Singh, Anushree Mishra
Abstract Background Caroli’s disease is characterized by non-obstructive dilatation of intrahepatic biliary radicals with formation of calculi followed by recurrent episodes of cholangitis. It is a rare congenital malformation and often remains silent, diagnosed accidentally. But if kept unattended, and without any early intervention, it may lead to fatal residual complications. Hence, its early recognition is of utmost importance to prevent recurrent cholangitis, hepatic abscess, liver cirrhosis and cholangiocarcinoma. Hence, we feel that this case must be reported so as to increase awareness among physicians regarding this entity. Case presentation We hereby report a case of 10-year-old boy who reported with complaints of recurrent episodes of fever, breathing difficulty and multiple episodes of epigastric abdominal pain with apparently healthy siblings. His routine investigation, laboratory parameters were within normal limits. Ultrasonography abdomen showed liver with normal echo-texture with varying sized multiple thin walled cysts involving both the lobes, right more than left with saccular dilatation of 2nd and 3rd order intra-hepatic biliary radicals without calcification without any colour flow on Doppler evaluation. The common hepatic and common bile ducts were normal in calibre and lumen. Magnetic resonance imaging abdomen had similar findings and upper GI endoscopy was also normal. He was finally diagnosed to be a case of Caroli’s disease and was managed with broad spectrum antibiotics, ursodeoxycholic acid, multivitamins, and calcium supplements. He made an uneventful recovery thereafter. Parents were counselled about the risk of cholangitis and cholangiocarcinoma and was referred to tertiary care centre for genetic counselling and for future need of liver transplantation. Conclusion Age presentation of Caroli’s disease varies. Majority present during adolescence and early adulthood. This often poses a diagnostic challenge owing its rare entity and silent presentation. A strong index of suspicion and prompt diagnosis is warranted to prevent its fatal residual complications.
{"title":"Early onset Caroli’s disease with associated renal cystic disease presented with recurrent fever and epigastric pain: a case report","authors":"Abhishek Mishra, Achinta Kumar Mallick, A. K. Singh, Anushree Mishra","doi":"10.1186/s43054-023-00217-3","DOIUrl":"https://doi.org/10.1186/s43054-023-00217-3","url":null,"abstract":"Abstract Background Caroli’s disease is characterized by non-obstructive dilatation of intrahepatic biliary radicals with formation of calculi followed by recurrent episodes of cholangitis. It is a rare congenital malformation and often remains silent, diagnosed accidentally. But if kept unattended, and without any early intervention, it may lead to fatal residual complications. Hence, its early recognition is of utmost importance to prevent recurrent cholangitis, hepatic abscess, liver cirrhosis and cholangiocarcinoma. Hence, we feel that this case must be reported so as to increase awareness among physicians regarding this entity. Case presentation We hereby report a case of 10-year-old boy who reported with complaints of recurrent episodes of fever, breathing difficulty and multiple episodes of epigastric abdominal pain with apparently healthy siblings. His routine investigation, laboratory parameters were within normal limits. Ultrasonography abdomen showed liver with normal echo-texture with varying sized multiple thin walled cysts involving both the lobes, right more than left with saccular dilatation of 2nd and 3rd order intra-hepatic biliary radicals without calcification without any colour flow on Doppler evaluation. The common hepatic and common bile ducts were normal in calibre and lumen. Magnetic resonance imaging abdomen had similar findings and upper GI endoscopy was also normal. He was finally diagnosed to be a case of Caroli’s disease and was managed with broad spectrum antibiotics, ursodeoxycholic acid, multivitamins, and calcium supplements. He made an uneventful recovery thereafter. Parents were counselled about the risk of cholangitis and cholangiocarcinoma and was referred to tertiary care centre for genetic counselling and for future need of liver transplantation. Conclusion Age presentation of Caroli’s disease varies. Majority present during adolescence and early adulthood. This often poses a diagnostic challenge owing its rare entity and silent presentation. A strong index of suspicion and prompt diagnosis is warranted to prevent its fatal residual complications.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135779373","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 : 2023-10-18DOI: 10.1186/s43054-023-00221-7
Samar Abd ElHafeez, Mahmoud A. Hassan, Esraa Abdellatif Hammouda, Abdelrahman Omran, Ola Fahmy Esmail, Amira Saad Mahboob, Mohamed Mostafa Tahoun, Dina Hussein El Malawany, Mohamed Kamal Eldwiki, Passent Ehab El-Meligy, Ehab Elrewany, Shaimaa Gadelkarim Ebrahim Ali, Amira Mahmoud Elzayat, Ahmed Ramadan, Abdelhamid Elshabrawy, Naglaa Youssef, Ramy Mohamed Ghazy
Abstract Background Globally, infectious diseases, including pneumonia, diarrhea, and malaria, along with pre-term birth complications, birth asphyxia and trauma, and congenital anomalies remain the leading causes of death for under-five mortality (U5M). This study aimed to identify the geospatial pattern of U5M in Alexandria and its key determinants. Methodology We analyzed the geospatial distribution of 3064 deaths registered at 24 health offices reported from January 1, 2018 to June 30, 2019. We adopted two methods of analysis: geospatial analysis and the structural equation model (SEM). Result Neonates represented 58.7% of U5M, while post-neonates and children were 31.1%, 10.2%respectively. Male deaths were significantly higher compared to females ( P = 0.036). The main leading causes of U5M were prematurity (28.32%), pneumonia (11.01%), cardiac arrest (10.57%), congenital malformation (9.95%), and childhood cardiovascular diseases (9.20%). The spatial distribution of U5M (including the most common three causes) tends to be clustered in western parts of Alexandria (El Hawaria, Bahig, Hamlis, and Ketaa Maryiut). SEM showed the total effects of exogenous and intermediate variables on U5M. The U5M proportionately increased by living in rural areas (8.48), followed by crowding rate (8.35), household size (1.36), population size (0.52), and illiteracy average (0.06). On the contrary, the U5M decreased with increasing access to sanitation (-0.17) and access to drinking water (-4.55). Conclusion Illiteracy, and poor locality characteristics (household size, population density, and access to water supply and sanitation) were statistically significant predictors of U5M.
{"title":"Geospatial distribution of under-five mortality in Alexandria, Egypt: a cross-sectional survey","authors":"Samar Abd ElHafeez, Mahmoud A. Hassan, Esraa Abdellatif Hammouda, Abdelrahman Omran, Ola Fahmy Esmail, Amira Saad Mahboob, Mohamed Mostafa Tahoun, Dina Hussein El Malawany, Mohamed Kamal Eldwiki, Passent Ehab El-Meligy, Ehab Elrewany, Shaimaa Gadelkarim Ebrahim Ali, Amira Mahmoud Elzayat, Ahmed Ramadan, Abdelhamid Elshabrawy, Naglaa Youssef, Ramy Mohamed Ghazy","doi":"10.1186/s43054-023-00221-7","DOIUrl":"https://doi.org/10.1186/s43054-023-00221-7","url":null,"abstract":"Abstract Background Globally, infectious diseases, including pneumonia, diarrhea, and malaria, along with pre-term birth complications, birth asphyxia and trauma, and congenital anomalies remain the leading causes of death for under-five mortality (U5M). This study aimed to identify the geospatial pattern of U5M in Alexandria and its key determinants. Methodology We analyzed the geospatial distribution of 3064 deaths registered at 24 health offices reported from January 1, 2018 to June 30, 2019. We adopted two methods of analysis: geospatial analysis and the structural equation model (SEM). Result Neonates represented 58.7% of U5M, while post-neonates and children were 31.1%, 10.2%respectively. Male deaths were significantly higher compared to females ( P = 0.036). The main leading causes of U5M were prematurity (28.32%), pneumonia (11.01%), cardiac arrest (10.57%), congenital malformation (9.95%), and childhood cardiovascular diseases (9.20%). The spatial distribution of U5M (including the most common three causes) tends to be clustered in western parts of Alexandria (El Hawaria, Bahig, Hamlis, and Ketaa Maryiut). SEM showed the total effects of exogenous and intermediate variables on U5M. The U5M proportionately increased by living in rural areas (8.48), followed by crowding rate (8.35), household size (1.36), population size (0.52), and illiteracy average (0.06). On the contrary, the U5M decreased with increasing access to sanitation (-0.17) and access to drinking water (-4.55). Conclusion Illiteracy, and poor locality characteristics (household size, population density, and access to water supply and sanitation) were statistically significant predictors of U5M.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135884276","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 : 2023-10-18DOI: 10.1186/s43054-023-00220-8
Galila Mokhtar, Ashraf Abdel Baky, Ilham Youssry, Iman Ragab, Laila Sherief, Marwa Zakaria, Mervat Hesham, Nouran Salah, Rasha Abdel-Raouf, Sara Makkeyah, Sherein Shalaby, Sonia Adolf Habib, Tarek Omar, Yasser Amer, Niveen M. Salama
Abstract Background Acute hemolytic anemia (AHA) is a common emergency in pediatric emergency departments, hence the need to adapt pre-existing high-quality practice guidelines for the diagnosis, management, and prevention of AHA to be available for national use. Methods The guideline panel used the adapted ADAPTE methodology. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to be used in low-resource countries. Results The guideline provided approach to a child with AHA: laboratory diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency, autoimmune hemolytic anemia (AIHA), and hemolytic uremic syndrome (HUS); treatment of AHA including indications for red cell transfusion, medical treatment, plasma exchange, and indications of antibiotic in HUS; how to avoid further episodes of hemolysis; and when to refer to a hematologist. Implementation tools included a checklist for history and examination, lists of differential diagnoses, flow charts for the diagnosis of AHA, and a list of medications and food to be avoided in patients with G6PD deficiency. Conclusion This adapted guideline will aid decision-making related to the diagnosis, management, and prevention of AHA.
{"title":"Diagnosis, management and prevention of Pediatric Acute Hemolytic Anemia: Egyptian adapted evidence-based clinical practice guidelines","authors":"Galila Mokhtar, Ashraf Abdel Baky, Ilham Youssry, Iman Ragab, Laila Sherief, Marwa Zakaria, Mervat Hesham, Nouran Salah, Rasha Abdel-Raouf, Sara Makkeyah, Sherein Shalaby, Sonia Adolf Habib, Tarek Omar, Yasser Amer, Niveen M. Salama","doi":"10.1186/s43054-023-00220-8","DOIUrl":"https://doi.org/10.1186/s43054-023-00220-8","url":null,"abstract":"Abstract Background Acute hemolytic anemia (AHA) is a common emergency in pediatric emergency departments, hence the need to adapt pre-existing high-quality practice guidelines for the diagnosis, management, and prevention of AHA to be available for national use. Methods The guideline panel used the adapted ADAPTE methodology. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to be used in low-resource countries. Results The guideline provided approach to a child with AHA: laboratory diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency, autoimmune hemolytic anemia (AIHA), and hemolytic uremic syndrome (HUS); treatment of AHA including indications for red cell transfusion, medical treatment, plasma exchange, and indications of antibiotic in HUS; how to avoid further episodes of hemolysis; and when to refer to a hematologist. Implementation tools included a checklist for history and examination, lists of differential diagnoses, flow charts for the diagnosis of AHA, and a list of medications and food to be avoided in patients with G6PD deficiency. Conclusion This adapted guideline will aid decision-making related to the diagnosis, management, and prevention of AHA.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135884061","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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