Pub Date : 2024-08-12DOI: 10.1186/s43054-024-00298-8
Fatina Ibrahim Fadel, Hafez Mahmoud Bazaraa, Shahira Kamal Anis, Noha Mahmoud Mohamed, Yosra Aboelnaga Fahmy
In critically ill cases, CRRT is a renal replacement intervention. The most common reason why CRRT terminates prematurely (non-electively) is clotting in the extracorporeal circuit, more especially in the filter. To determine the frequency of thrombotic and hemorrhage complications throughout CRRT, the role of antithrombin III level monitoring, the type of anticoagulation, and the dose and laboratory tests utilized to monitor it. The study was carried out on 58 children who were undergoing CRRT. The children underwent a comprehensive history-taking, assessment, CRRT prescription parameters and alterations, vascular access data, anticoagulation type, dose, and adjustment, as well as monitoring of antithrombin III levels. Furthermore, any extracorporeal circuit clotting or bleeding was documented. Of the 58 sessions that were examined, 25 (43.1%) resulted in filter clotting. The indication was cured in 16 cases (27.6%), 8 cases (13.8%) resulted in the patient’s mortality, and 9 cases (15.5%) had life-threatening bleeding. The remaining 33 cases (56.9%) were not terminated with filter clotting. Forty-one (70.7%) of studied sessions used unfractionated heparin as anticoagulation, 22.4% used heparin-protamine, 5.2% was not anticoagulated, and one circuit (1.7%) was anticoagulated using regional citrate. Filter clotting incidence was significantly related to activated partial thromboplastin time (a PTT) value at the end of sessions (P value = 0.000), and platelets count after 4 h of session initiation (P value = 0.048). Antithrombin III levels pre-heparin infusion less than 80 were found in patients who received higher doses of a heparin bolus dose, median dose 35 (IQR 20–35), this relation is statistically significant (P value = 0.042). In the 58 cases that were examined, the incidence of bleeding was 32.8%; however, 19% of the cases were not severe. The incidence of filter clotting was 43.1% in the study group. a PTT value at the end of sessions, and platelets count after 4 h could be predictors of thrombotic complications during CRRT, antithrombin III deficiency before sessions is a predictor of filter clotting.
{"title":"Anticoagulation methods used and role of antithrombin III level monitoring in children on continuous renal replacement therapy: an observational cross-sectional study","authors":"Fatina Ibrahim Fadel, Hafez Mahmoud Bazaraa, Shahira Kamal Anis, Noha Mahmoud Mohamed, Yosra Aboelnaga Fahmy","doi":"10.1186/s43054-024-00298-8","DOIUrl":"https://doi.org/10.1186/s43054-024-00298-8","url":null,"abstract":"In critically ill cases, CRRT is a renal replacement intervention. The most common reason why CRRT terminates prematurely (non-electively) is clotting in the extracorporeal circuit, more especially in the filter. To determine the frequency of thrombotic and hemorrhage complications throughout CRRT, the role of antithrombin III level monitoring, the type of anticoagulation, and the dose and laboratory tests utilized to monitor it. The study was carried out on 58 children who were undergoing CRRT. The children underwent a comprehensive history-taking, assessment, CRRT prescription parameters and alterations, vascular access data, anticoagulation type, dose, and adjustment, as well as monitoring of antithrombin III levels. Furthermore, any extracorporeal circuit clotting or bleeding was documented. Of the 58 sessions that were examined, 25 (43.1%) resulted in filter clotting. The indication was cured in 16 cases (27.6%), 8 cases (13.8%) resulted in the patient’s mortality, and 9 cases (15.5%) had life-threatening bleeding. The remaining 33 cases (56.9%) were not terminated with filter clotting. Forty-one (70.7%) of studied sessions used unfractionated heparin as anticoagulation, 22.4% used heparin-protamine, 5.2% was not anticoagulated, and one circuit (1.7%) was anticoagulated using regional citrate. Filter clotting incidence was significantly related to activated partial thromboplastin time (a PTT) value at the end of sessions (P value = 0.000), and platelets count after 4 h of session initiation (P value = 0.048). Antithrombin III levels pre-heparin infusion less than 80 were found in patients who received higher doses of a heparin bolus dose, median dose 35 (IQR 20–35), this relation is statistically significant (P value = 0.042). In the 58 cases that were examined, the incidence of bleeding was 32.8%; however, 19% of the cases were not severe. The incidence of filter clotting was 43.1% in the study group. a PTT value at the end of sessions, and platelets count after 4 h could be predictors of thrombotic complications during CRRT, antithrombin III deficiency before sessions is a predictor of filter clotting.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"57 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141945029","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 : 2024-08-05DOI: 10.1186/s43054-024-00303-0
Saveshree Govender
Urethral duplication is a rare urogenital anomaly with varying anatomical orientations leading to diverse clinical presentations. We present a case of urethral duplication in a neonate featuring a large dorsal cystic mass on the penis, an unusual presentation. A term male neonate with a prenatally diagnosed 10 × 10 cm genitourinary cystic mass was delivered via caesarean section. Examination revealed a large cystic mass extending dorsally from the pubic symphysis over a flattened, elongated penile shaft with a single urethral opening in the glans and undescended testes. A size 6-French feeding tube inserted into the urethra drained the bladder. Urethral communication with the cystic mass was confirmed via voiding cystourethrogram and cyst enlargement noted during voiding. Cyst fluid analysis indicated a urinary origin. Computed tomography and ultrasound were not diagnostic. Initial imaging revealed a dorsal cystic mass projecting from the pubic symphysis without bladder connection. Surgical intervention at 3 weeks revealed a Type IIA-2 urethral duplication, with a dorsal hypoplastic urethra communicating with the posterior urethra. Correction included resection of the dorsal urethra, cyst excision, and reconstruction of the penis with the orthotopic ventral urethra and bilateral orchidopexies. Satisfactory functional and cosmetic outcomes were observed at 2 and 8 months after surgery. This case highlights the significance of identifying unique urethral duplication presentations. The novel occurrence of Type IIA-2 urethral duplication terminating in a dorsal cystic mass underscores diagnostic complexity, surgical intricacies, and aesthetic considerations associated with such cases.
{"title":"Urethral duplication with a large cystic dorsal penile mass in a newborn: a case report","authors":"Saveshree Govender","doi":"10.1186/s43054-024-00303-0","DOIUrl":"https://doi.org/10.1186/s43054-024-00303-0","url":null,"abstract":"Urethral duplication is a rare urogenital anomaly with varying anatomical orientations leading to diverse clinical presentations. We present a case of urethral duplication in a neonate featuring a large dorsal cystic mass on the penis, an unusual presentation. A term male neonate with a prenatally diagnosed 10 × 10 cm genitourinary cystic mass was delivered via caesarean section. Examination revealed a large cystic mass extending dorsally from the pubic symphysis over a flattened, elongated penile shaft with a single urethral opening in the glans and undescended testes. A size 6-French feeding tube inserted into the urethra drained the bladder. Urethral communication with the cystic mass was confirmed via voiding cystourethrogram and cyst enlargement noted during voiding. Cyst fluid analysis indicated a urinary origin. Computed tomography and ultrasound were not diagnostic. Initial imaging revealed a dorsal cystic mass projecting from the pubic symphysis without bladder connection. Surgical intervention at 3 weeks revealed a Type IIA-2 urethral duplication, with a dorsal hypoplastic urethra communicating with the posterior urethra. Correction included resection of the dorsal urethra, cyst excision, and reconstruction of the penis with the orthotopic ventral urethra and bilateral orchidopexies. Satisfactory functional and cosmetic outcomes were observed at 2 and 8 months after surgery. This case highlights the significance of identifying unique urethral duplication presentations. The novel occurrence of Type IIA-2 urethral duplication terminating in a dorsal cystic mass underscores diagnostic complexity, surgical intricacies, and aesthetic considerations associated with such cases.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"11 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141944979","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}
Familial Mediterranean fever (FMF) is the most prevalent inherited autoinflammatory disease globally. Metabolic syndrome (MetS) is a cluster of interrelated risk factors; insulin resistance, obesity, dyslipidemia, and hypertension are the main constituents of MetS. This study aimed to investigate components of metabolic syndrome among Egyptian children with FMF during the attack-free period. This is a case–control study that was conducted in the Pediatric Rheumatology Outpatient Clinic and Pediatric Endocrinology Clinic, Children’s Hospital, Faculty of Medicine, Cairo University. It was conducted on 40 patients with FMF. The patients included were of both sexes and aged 10 years or older, during the FMF attack-free period; they were compared to 40 apparently healthy age- and sex-matched children as controls. All subjects in this study were subjected to detailed history taking, anthropometric measurements, general and systemic examinations. Laboratory evaluation (at the time of the study) was done at time of study, in the form of CBC with differential, BUN, creatinine, ESR, serum amyloid A, urine analysis, serum insulin, fasting blood glucose, and lipid profile. FMF gene mutations were collected from patients’ files. The mean ± SD age of FMF patients was 12.65 ± 1.82 (10–17) years, while the mean ± SD age of the control group was 12.6 ± 1.82 (10–16) years. Among FMF patients, 50% were males, and 50% were females (F:M = 1:1), while in the control group, 47.5% were females, and 52.5% were males. All FMF patients were during the attack-free period. There was a statistically significant difference between both groups regarding insulin resistance, being more frequent among the FMF patients’ group, with a p-value of 0.025. None of our FMF patients met the criteria for the definition of metabolic syndrome, but there was a significant difference between cases and control regarding insulin resistance with higher frequency among FMF patients, probably due to the ongoing subclinical inflammation. This indicates that children with FMF may be at a higher risk of getting metabolic syndrome later on in life.
{"title":"Metabolic syndrome among Egyptian children with Familial Mediterranean Fever: a case–control study","authors":"Shimaa Atef, Huda Marzouk, Mariam Mahmoud El-khity, Hend Mohamed Abu Shady","doi":"10.1186/s43054-024-00297-9","DOIUrl":"https://doi.org/10.1186/s43054-024-00297-9","url":null,"abstract":"Familial Mediterranean fever (FMF) is the most prevalent inherited autoinflammatory disease globally. Metabolic syndrome (MetS) is a cluster of interrelated risk factors; insulin resistance, obesity, dyslipidemia, and hypertension are the main constituents of MetS. This study aimed to investigate components of metabolic syndrome among Egyptian children with FMF during the attack-free period. This is a case–control study that was conducted in the Pediatric Rheumatology Outpatient Clinic and Pediatric Endocrinology Clinic, Children’s Hospital, Faculty of Medicine, Cairo University. It was conducted on 40 patients with FMF. The patients included were of both sexes and aged 10 years or older, during the FMF attack-free period; they were compared to 40 apparently healthy age- and sex-matched children as controls. All subjects in this study were subjected to detailed history taking, anthropometric measurements, general and systemic examinations. Laboratory evaluation (at the time of the study) was done at time of study, in the form of CBC with differential, BUN, creatinine, ESR, serum amyloid A, urine analysis, serum insulin, fasting blood glucose, and lipid profile. FMF gene mutations were collected from patients’ files. The mean ± SD age of FMF patients was 12.65 ± 1.82 (10–17) years, while the mean ± SD age of the control group was 12.6 ± 1.82 (10–16) years. Among FMF patients, 50% were males, and 50% were females (F:M = 1:1), while in the control group, 47.5% were females, and 52.5% were males. All FMF patients were during the attack-free period. There was a statistically significant difference between both groups regarding insulin resistance, being more frequent among the FMF patients’ group, with a p-value of 0.025. None of our FMF patients met the criteria for the definition of metabolic syndrome, but there was a significant difference between cases and control regarding insulin resistance with higher frequency among FMF patients, probably due to the ongoing subclinical inflammation. This indicates that children with FMF may be at a higher risk of getting metabolic syndrome later on in life.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"40 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141863702","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 : 2024-07-26DOI: 10.1186/s43054-024-00293-z
Rehab Elmeazawy, Ahmed Mohammed Farid EL-Moazen
The aim of this study was to determine whether there are proven associations between CO-RADS categorizations and clinical and laboratory findings in children diagnosed with COVID-19 infection. This is a retrospective observational study that includes the clinical and radiological data of pediatric patients who were admitted to both Minia University Hospital and Minia Insurance Hospital with a confirmed diagnosis of COVID-19, detected via reverse transcriptase PCR (RT-PCR) from nasopharyngeal swabs obtained between June 2022 and February 2023. Patients were divided into 5 groups based on the severity of involvement in chest CT. This study involved a total of 62 children who were confirmed to have COVID-19 infection. The most commonly observed symptoms in these children were fever (91.9%), shortness of breath (88.7%), and cough (87.1%). In addition, vomiting (24.2%), diarrhea (12.9%), impaired consciousness (11.2%), and convulsions (9.7%) were also reported. Significant differences were observed between CO-RADS classes in relation to patient gender, severity of respiratory distress, presence of cough, occurrence of diarrhea, elevated LDH levels, and prognosis. The CO-RADS classification exhibited positive correlations with inflammatory biomarkers such as total leucocytic count, LDH, D-dimer, serum ferritin, and AST. Conversely, the CO-RADS classification showed negative correlations with ionized calcium levels, hemoglobin, and platelet count.
{"title":"Clinical findings and laboratory parameters associated with CO-RADS classification in children with COVID-19","authors":"Rehab Elmeazawy, Ahmed Mohammed Farid EL-Moazen","doi":"10.1186/s43054-024-00293-z","DOIUrl":"https://doi.org/10.1186/s43054-024-00293-z","url":null,"abstract":"The aim of this study was to determine whether there are proven associations between CO-RADS categorizations and clinical and laboratory findings in children diagnosed with COVID-19 infection. This is a retrospective observational study that includes the clinical and radiological data of pediatric patients who were admitted to both Minia University Hospital and Minia Insurance Hospital with a confirmed diagnosis of COVID-19, detected via reverse transcriptase PCR (RT-PCR) from nasopharyngeal swabs obtained between June 2022 and February 2023. Patients were divided into 5 groups based on the severity of involvement in chest CT. This study involved a total of 62 children who were confirmed to have COVID-19 infection. The most commonly observed symptoms in these children were fever (91.9%), shortness of breath (88.7%), and cough (87.1%). In addition, vomiting (24.2%), diarrhea (12.9%), impaired consciousness (11.2%), and convulsions (9.7%) were also reported. Significant differences were observed between CO-RADS classes in relation to patient gender, severity of respiratory distress, presence of cough, occurrence of diarrhea, elevated LDH levels, and prognosis. The CO-RADS classification exhibited positive correlations with inflammatory biomarkers such as total leucocytic count, LDH, D-dimer, serum ferritin, and AST. Conversely, the CO-RADS classification showed negative correlations with ionized calcium levels, hemoglobin, and platelet count.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"36 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141769592","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 : 2024-07-22DOI: 10.1186/s43054-024-00294-y
Samaha S. Mustapha, Aishatu Musa Zaidu, Nanret Tanko Azaria, Shamsudin Aliyu, Isa Abdulkadir
Neonatal sepsis is still a global health concern as it contributes to a high burden of neonatal morbidity and mortality especially in developing countries. The aim of the study is to give an insight into neonatal sepsis: risk factors, sepsis types, clinical features, pathogen burden with their antibiotic sensitivities, and outcome of admission in our facility. The study was a prospective hospital-based study conducted over 10 months, October 2018–July 2019. Of the 248 term neonates with features of sepsis enrolled in the study 94 (37.9%) were confirmed to have sepsis. Late-onset sepsis LOS (68%) was found to be the most common, and most of the neonates were delivered elsewhere. Clinical features were non-specific for both early-onset (EOS) and LOS and include fever, jaundice, poor suck, and depressed primitive reflexes. Infections were mostly caused by gram-negative bacteria, and while Staphylococcus aureus was the single most common isolate for both EOS and LOS. Antibiotic sensitivity was highest with ciprofloxacin for both EOS and LOS. Mortality was high at 14.9% and was mostly contributed to by Staphylococcus aureus infection. Neonatal sepsis is still a burden with mostly non-specific clinical features. The local prevalent organisms were Staphylococcus aureus, Enterobacter agglomerans and Klebsiella pneumonia with good antibiotic susceptibility to ciprofloxacin. Most presented with late-onset sepsis and therefore infection is likely to be community-acquired which to a great extent can be prevented with robust public health interventions.
新生儿败血症仍然是全球关注的健康问题，因为它导致了新生儿的高发病率和高死亡率，尤其是在发展中国家。本研究旨在深入了解新生儿败血症：风险因素、败血症类型、临床特征、病原体负担及其抗生素敏感性，以及本院的入院结果。该研究是一项基于医院的前瞻性研究，历时10个月，即2018年10月至2019年7月。在248名具有败血症特征的足月新生儿中，有94名（37.9%）被证实患有败血症。研究发现，晚期败血症 LOS（68%）最为常见，大多数新生儿在其他地方分娩。早发（EOS）和晚发（LOS）的临床特征均无特异性，包括发烧、黄疸、吸吮不良和原始反射减弱。感染主要由革兰氏阴性菌引起，金黄色葡萄球菌是 EOS 和 LOS 最常见的分离菌。在 EOS 和 LOS 中，环丙沙星的抗生素敏感性最高。死亡率高达 14.9%，主要是金黄色葡萄球菌感染所致。新生儿败血症仍然是一种负担，其临床特征大多不具特异性。当地流行的病原菌是金黄色葡萄球菌、聚合肠杆菌和肺炎克雷伯菌，它们对环丙沙星具有良好的抗生素敏感性。大多数患者都是晚期败血症，因此很可能是社区获得性感染，而这种感染在很大程度上是可以通过强有力的公共卫生干预措施加以预防的。
{"title":"Neonatal sepsis-a peek into our findings in Northwest Nigeria: a prospective study","authors":"Samaha S. Mustapha, Aishatu Musa Zaidu, Nanret Tanko Azaria, Shamsudin Aliyu, Isa Abdulkadir","doi":"10.1186/s43054-024-00294-y","DOIUrl":"https://doi.org/10.1186/s43054-024-00294-y","url":null,"abstract":"Neonatal sepsis is still a global health concern as it contributes to a high burden of neonatal morbidity and mortality especially in developing countries. The aim of the study is to give an insight into neonatal sepsis: risk factors, sepsis types, clinical features, pathogen burden with their antibiotic sensitivities, and outcome of admission in our facility. The study was a prospective hospital-based study conducted over 10 months, October 2018–July 2019. Of the 248 term neonates with features of sepsis enrolled in the study 94 (37.9%) were confirmed to have sepsis. Late-onset sepsis LOS (68%) was found to be the most common, and most of the neonates were delivered elsewhere. Clinical features were non-specific for both early-onset (EOS) and LOS and include fever, jaundice, poor suck, and depressed primitive reflexes. Infections were mostly caused by gram-negative bacteria, and while Staphylococcus aureus was the single most common isolate for both EOS and LOS. Antibiotic sensitivity was highest with ciprofloxacin for both EOS and LOS. Mortality was high at 14.9% and was mostly contributed to by Staphylococcus aureus infection. Neonatal sepsis is still a burden with mostly non-specific clinical features. The local prevalent organisms were Staphylococcus aureus, Enterobacter agglomerans and Klebsiella pneumonia with good antibiotic susceptibility to ciprofloxacin. Most presented with late-onset sepsis and therefore infection is likely to be community-acquired which to a great extent can be prevented with robust public health interventions.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"24 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141746101","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 : 2024-07-19DOI: 10.1186/s43054-024-00292-0
Xavier Chan, Wen Wei Christopher Ho, Sudipta Roy Chowdhury
Scurvy has been a rare condition in the developed world due to the increasing availability of adequate nutrition and easy access to fruits and vegetables. Scurvy is caused by severe vitamin C deficiency and has been historically associated with malnutrition in high-risk populations such as sailors. As it is an uncommon nutritional deficiency, scurvy is seldom suspected and usually under-diagnosed especially in the pediatric population. We report a case of a pediatric patient with a history of autism spectrum disorder presenting with atypical symptoms of scurvy with gait abnormalities, diffuse rash, musculoskeletal deconditioning, and bleeding manifestations. After multiple extensive investigations and a prolonged hospitalization, a detailed dietary analysis revealed a severely restricted diet devoid of fruits and vegetables. Physical examination revealed specific signs of corkscrew hair with peri-follicular hemorrhages, hypertrophic, and bleeding gums with a concurrent low vitamin C level. Treatment with vitamin C supplementation was initiated and he was ambulant within 1 month of discharge. This case highlights the importance of nutrition history for determining micronutrient deficiency in children with special needs. Enhanced physician education and higher index of suspicion regarding nutritional deficiencies will avoid over-investigations and delays for the institution of specific treatment.
由于人们越来越容易获得充足的营养和水果蔬菜，坏血病在发达国家已经很少见了。坏血病是由严重缺乏维生素 C 引起的，历来与水手等高危人群的营养不良有关。由于坏血病是一种不常见的营养缺乏症，因此很少被怀疑，而且通常诊断不足，尤其是在儿科人群中。我们报告了一例有自闭症谱系障碍病史的儿童患者，该患者出现非典型坏血病症状，伴有步态异常、弥漫性皮疹、肌肉骨骼衰弱和出血表现。经过多次广泛的检查和长时间的住院治疗，详细的饮食分析表明患者的饮食严重受限，没有水果和蔬菜。体格检查显示，患者的头发呈开叉状，并伴有毛囊周围出血、牙龈肥厚和出血，同时维生素 C 含量较低。他接受了补充维生素 C 的治疗，出院后 1 个月就能下床活动了。本病例强调了营养史对确定有特殊需求儿童微量营养素缺乏症的重要性。加强对医生的教育和提高对营养缺乏的怀疑指数将避免过度调查和延误具体治疗。
{"title":"The return of the old masquerader—scurvy: a case report of pediatric limping and bone pain","authors":"Xavier Chan, Wen Wei Christopher Ho, Sudipta Roy Chowdhury","doi":"10.1186/s43054-024-00292-0","DOIUrl":"https://doi.org/10.1186/s43054-024-00292-0","url":null,"abstract":"Scurvy has been a rare condition in the developed world due to the increasing availability of adequate nutrition and easy access to fruits and vegetables. Scurvy is caused by severe vitamin C deficiency and has been historically associated with malnutrition in high-risk populations such as sailors. As it is an uncommon nutritional deficiency, scurvy is seldom suspected and usually under-diagnosed especially in the pediatric population. We report a case of a pediatric patient with a history of autism spectrum disorder presenting with atypical symptoms of scurvy with gait abnormalities, diffuse rash, musculoskeletal deconditioning, and bleeding manifestations. After multiple extensive investigations and a prolonged hospitalization, a detailed dietary analysis revealed a severely restricted diet devoid of fruits and vegetables. Physical examination revealed specific signs of corkscrew hair with peri-follicular hemorrhages, hypertrophic, and bleeding gums with a concurrent low vitamin C level. Treatment with vitamin C supplementation was initiated and he was ambulant within 1 month of discharge. This case highlights the importance of nutrition history for determining micronutrient deficiency in children with special needs. Enhanced physician education and higher index of suspicion regarding nutritional deficiencies will avoid over-investigations and delays for the institution of specific treatment.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"179 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141742385","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}
Alarming trends show an increase in referrals of girls with suspected early puberty. However, variations in defining precocious puberty exist. GnRH stimulation test is the gold standard diagnostic test, which is expensive and challenging to interpret. Moreover, intravenous GnRH might not be available. Therefore, we sought to evaluate the diagnostic performance of basal serum Luteinizing Hormone and Anti-Mullerian hormone in girls with central precocious puberty, as an easier alternative to GnRH stimulation test. The study was conducted on 26 Egyptian girls presenting with early puberty at age < 8 years. Several evaluations including Tanner staging and GnRH stimulation test were performed. Basal serum luteinizing hormone, follicle stimulating hormone, and anti-Mullerian hormone were analyzed, and ROC curve was performed. The mean age of the patients at diagnosis was 5 ± 2.8 years. Most patients had breast Tanner 3 (76.9%). Bone age was advanced in 65.4% of patients. Basal luteinizing hormone level significantly differed between central precocious puberty and controls (p < 0.001), with an area under the curve of 0.840. A cut-off of 0.29 IU/L provided 84.62% sensitivity and 76.92% specificity. Basal luteinizing hormone out-performs follicle-stimulating hormone and anti-Mullerian hormone as a screening tool and valuable indicator of central precocious puberty, potentially reducing the necessity of GnRH stimulation test.
{"title":"Evaluation of the diagnostic value of different serum biomarkers in girls with central precocious puberty","authors":"Yasmine Abdelmeguid, Omneya Abdelkarem, Shaymaa Raafat","doi":"10.1186/s43054-024-00291-1","DOIUrl":"https://doi.org/10.1186/s43054-024-00291-1","url":null,"abstract":"Alarming trends show an increase in referrals of girls with suspected early puberty. However, variations in defining precocious puberty exist. GnRH stimulation test is the gold standard diagnostic test, which is expensive and challenging to interpret. Moreover, intravenous GnRH might not be available. Therefore, we sought to evaluate the diagnostic performance of basal serum Luteinizing Hormone and Anti-Mullerian hormone in girls with central precocious puberty, as an easier alternative to GnRH stimulation test. The study was conducted on 26 Egyptian girls presenting with early puberty at age < 8 years. Several evaluations including Tanner staging and GnRH stimulation test were performed. Basal serum luteinizing hormone, follicle stimulating hormone, and anti-Mullerian hormone were analyzed, and ROC curve was performed. The mean age of the patients at diagnosis was 5 ± 2.8 years. Most patients had breast Tanner 3 (76.9%). Bone age was advanced in 65.4% of patients. Basal luteinizing hormone level significantly differed between central precocious puberty and controls (p < 0.001), with an area under the curve of 0.840. A cut-off of 0.29 IU/L provided 84.62% sensitivity and 76.92% specificity. Basal luteinizing hormone out-performs follicle-stimulating hormone and anti-Mullerian hormone as a screening tool and valuable indicator of central precocious puberty, potentially reducing the necessity of GnRH stimulation test.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"2011 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141612465","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 : 2024-07-08DOI: 10.1186/s43054-024-00290-2
Rehab Elmeazawy, Sarah El Shall, Manal Zaki AbdElsamea, Mohammed Helmi Emara
The aim of this study was to investigate the role of systemic immune-inflammatory index and systemic inflammation response index in predicting early renal impairment in children with type 1 diabetes mellitus (T1DM). This is a retrospective cohort study which searched the electronic medical records of patients consecutively admitted to Pediatric Endocrinology Unit with the diagnosis of type 1 diabetes mellitus between August 2022 and July 2023. A total of 100 children with the diagnosis of T1DM were enrolled in the study. Early stage diabetic nephropathy (DN) was found in 34 patients. Patients with DN showed significantly higher HbA1C, microalbuminuria, cholesterol, TLC, platelet, neutrophil count, NLR, PLR, SII, and SIRI than the DM without DN. It was discovered that DN was independently correlated with NLR, PLR, SII, and SIRI. SIRI and SII are easily available and affordable inflammatory markers that may serve as independent early predictors of diabetic nephropathy in individuals with type 1 diabetes.
{"title":"Systemic immune-inflammatory index and systemic inflammation response index in predicting renal impairment in children with type 1 diabetes mellitus","authors":"Rehab Elmeazawy, Sarah El Shall, Manal Zaki AbdElsamea, Mohammed Helmi Emara","doi":"10.1186/s43054-024-00290-2","DOIUrl":"https://doi.org/10.1186/s43054-024-00290-2","url":null,"abstract":"The aim of this study was to investigate the role of systemic immune-inflammatory index and systemic inflammation response index in predicting early renal impairment in children with type 1 diabetes mellitus (T1DM). This is a retrospective cohort study which searched the electronic medical records of patients consecutively admitted to Pediatric Endocrinology Unit with the diagnosis of type 1 diabetes mellitus between August 2022 and July 2023. A total of 100 children with the diagnosis of T1DM were enrolled in the study. Early stage diabetic nephropathy (DN) was found in 34 patients. Patients with DN showed significantly higher HbA1C, microalbuminuria, cholesterol, TLC, platelet, neutrophil count, NLR, PLR, SII, and SIRI than the DM without DN. It was discovered that DN was independently correlated with NLR, PLR, SII, and SIRI. SIRI and SII are easily available and affordable inflammatory markers that may serve as independent early predictors of diabetic nephropathy in individuals with type 1 diabetes.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"35 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141566348","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 : 2024-07-03DOI: 10.1186/s43054-024-00286-y
Amr Abdelhamid AbouZeid, Amr AbdelRahman AbdelMalek
To share our experience in the surgical management of patients with Hirschsprung disease (HD) using the trans-anal endorectal pull-through “Soave” technique. The study included cases diagnosed as HD who were operated during the period 2008 through 2018. Cases of total colonic aganglionosis were excluded to be discussed in a separate report. The study included 67 consecutive cases of HD. All included cases underwent trans-anal endorectal pull-through which was purely trans-anal in 31 (46%), while abdominal-assisted trans-anal endorectal pull-through was applied in the remaining (54%). Early postoperative complications included 2 cases of partial dehiscence at the colo-anal anastomosis; 1 of them deteriorated after re-exploration and unfortunately died. Twenty-six cases were available to assess functional outcomes after corrective surgery. Their age at follow-up ranged between 44 months and 17 years (mean = 78.8 months; median = 72 months). All cases achieved voluntary defecation. However, fecal soiling was a common finding after surgery for HD (69%). Constipation was another common postoperative finding (73%). Lastly, a history of attacks of postoperative enterocolitis was prevalent in 19 cases (73%), which ranged between 1 and 7 attacks usually in the first 2 years after the operation. The trans-anal endorectal pull-through provides an effective surgical treatment for Hirschsprung disease. The high prevalence of fecal soiling after surgery highlights the importance of long-term follow-up to provide the required support for these patients during adolescence and transition into adulthood.
分享我们使用经肛门直肠内拉穿 "Soave "技术手术治疗赫氏胃肠病（Hirschsprung disease，HD）患者的经验。研究对象包括 2008 年至 2018 年期间被诊断为 HD 的手术病例。不包括全结肠绞窄病病例，将在另一份报告中讨论。研究包括 67 例连续的 HD 病例。所有纳入病例均接受了经肛门直肠内牵拉术，其中31例（46%）为纯经肛门手术，其余病例（54%）则采用了腹部辅助经肛门直肠内牵拉术。术后早期并发症包括2例结肠肛门吻合处部分开裂，其中1例在再次探查后病情恶化，不幸死亡。有 26 例病例可用于评估矫正手术后的功能效果。他们的随访年龄从44个月到17岁不等（平均=78.8个月；中位数=72个月）。所有病例均能自主排便。然而，排便不畅是 HD 手术后的常见症状（69%）。便秘是另一种常见的术后症状（73%）。最后，19 例患者（73%）普遍有术后肠炎发作史，通常在术后头两年内发作 1 到 7 次不等。经肛门直肠牵拉术是治疗赫氏prung 病的有效手术方法。术后大便失禁的高发率凸显了长期随访的重要性，以便为这些患者在青春期和向成年过渡期间提供所需的支持。
{"title":"Outcomes following endorectal pull-through for Hirschsprung disease: a retrospective study","authors":"Amr Abdelhamid AbouZeid, Amr AbdelRahman AbdelMalek","doi":"10.1186/s43054-024-00286-y","DOIUrl":"https://doi.org/10.1186/s43054-024-00286-y","url":null,"abstract":"To share our experience in the surgical management of patients with Hirschsprung disease (HD) using the trans-anal endorectal pull-through “Soave” technique. The study included cases diagnosed as HD who were operated during the period 2008 through 2018. Cases of total colonic aganglionosis were excluded to be discussed in a separate report. The study included 67 consecutive cases of HD. All included cases underwent trans-anal endorectal pull-through which was purely trans-anal in 31 (46%), while abdominal-assisted trans-anal endorectal pull-through was applied in the remaining (54%). Early postoperative complications included 2 cases of partial dehiscence at the colo-anal anastomosis; 1 of them deteriorated after re-exploration and unfortunately died. Twenty-six cases were available to assess functional outcomes after corrective surgery. Their age at follow-up ranged between 44 months and 17 years (mean = 78.8 months; median = 72 months). All cases achieved voluntary defecation. However, fecal soiling was a common finding after surgery for HD (69%). Constipation was another common postoperative finding (73%). Lastly, a history of attacks of postoperative enterocolitis was prevalent in 19 cases (73%), which ranged between 1 and 7 attacks usually in the first 2 years after the operation. The trans-anal endorectal pull-through provides an effective surgical treatment for Hirschsprung disease. The high prevalence of fecal soiling after surgery highlights the importance of long-term follow-up to provide the required support for these patients during adolescence and transition into adulthood.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"88 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141507715","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 : 2024-07-01DOI: 10.1186/s43054-024-00287-x
Abla S. Mostafa, Dina H. Hamed, Basma B ELSayed, Amina M Kholeif, Ilham Youssry
Among inherited blood diseases, sickle cell disease (SCD) is the most common, and its prevalence is rising worldwide. People with SCD often have abnormal lung function, which can lead to other health problems and a lower quality of life. This study investigated the lung function problems in Egyptian children with SCD. Our study is cross-sectional analytic, held in the pediatric pulmonology and hematology specialized clinics of Abulrish Children’s Hospital, Faculty of Medicine, Cairo University. A detailed history was taken; then, patients undergone spirometry. A total of 60 children in the steady state were recruited, 58% males and 42% females; 73% of the study population was homozygous SS, 22% was SB+thalassemia, and 5% was SB0 with a mean age of 11.4 years. Spirometry done to the patients showed that 17 of the studied 60 sickle cell patients (28%) exhibited impaired pulmonary functions primarily with a restrictive pattern (16.7%). This study has shown that lung function problems are common in Egyptian children with sickle cell disease (SCD). Restrictive lung disease was predominant in our cohort. Therefore, regular yearly screenings using spirometry might be beneficial for early detection. Additionally, close monitoring by a pediatric lung specialist is recommended.
{"title":"Evaluation of pulmonary function in Egyptian children with sickle cell disease: a single center study","authors":"Abla S. Mostafa, Dina H. Hamed, Basma B ELSayed, Amina M Kholeif, Ilham Youssry","doi":"10.1186/s43054-024-00287-x","DOIUrl":"https://doi.org/10.1186/s43054-024-00287-x","url":null,"abstract":"Among inherited blood diseases, sickle cell disease (SCD) is the most common, and its prevalence is rising worldwide. People with SCD often have abnormal lung function, which can lead to other health problems and a lower quality of life. This study investigated the lung function problems in Egyptian children with SCD. Our study is cross-sectional analytic, held in the pediatric pulmonology and hematology specialized clinics of Abulrish Children’s Hospital, Faculty of Medicine, Cairo University. A detailed history was taken; then, patients undergone spirometry. A total of 60 children in the steady state were recruited, 58% males and 42% females; 73% of the study population was homozygous SS, 22% was SB+thalassemia, and 5% was SB0 with a mean age of 11.4 years. Spirometry done to the patients showed that 17 of the studied 60 sickle cell patients (28%) exhibited impaired pulmonary functions primarily with a restrictive pattern (16.7%). This study has shown that lung function problems are common in Egyptian children with sickle cell disease (SCD). Restrictive lung disease was predominant in our cohort. Therefore, regular yearly screenings using spirometry might be beneficial for early detection. Additionally, close monitoring by a pediatric lung specialist is recommended.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":"184 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141507716","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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