Pub Date : 2023-12-20DOI: 10.1186/s43054-023-00219-1
Muhammad Said El-Mekkawy, Sara Mahmoud El-Deeb, Maha Fawzy El-Hanafy
Growing evidence implicates a pro-thrombotic state, caused by ADAMTS13 deficiency, in sepsis-associated organ dysfunction, but pediatric data is limited. Our purpose was to evaluate association of ADAMTS13 with prognosis of pediatric sepsis. This was prospective observational study, conducted on 70 children with sepsis and 18 healthy controls. Patients were classified upon Pediatric Intensive Care Unit (PICU) admission into sepsis, severe sepsis, and septic shock groups. Serum ADAMTS13 was measured within 24 h of admission. The primary outcome was all-cause PICU mortality. ADAMTS13 was lower among patients than controls [median and interquartile range (IQR): 1.30 (0.88–3.13ng/mL) vs. 6.00 (5.55–6.50 ng/mL); p < 0.001]. ADAMTS13 was lower in both severe sepsis and septic shock than sepsis [median (IQR): 0.90 (0.80–1.75 ng/mL); 1.0 ng/ml (0.90–1.20); and 2.80 (1.00–3.85ng/mL), p = 0.026 and 0.006 respectively]. ADAMTS13 was lower among non-survivors compared with survivors [median (IQR): 0.9 (0.80–1.18 ng/mL) vs. 2.45 (0.98–3.50 ng/mL); p < 0.001]. ADAMTS13 had area under Receiver Operating Characteristic Curve (AUC) of 0.77 for mortality prediction. Lower ADAMTS13 level was associated with mechanical ventilation; vasoactive medications; acute respiratory distress syndrome; and multiple organ dysfunction syndrome. ADAMTS13 correlated with pediatric Sequential Organ Failure Assessment (pSOFA) score (rs = -0.46, p < 0.001); vasoactive infusion days ((rs = -0.48, p < 0.001); and vasoactive-inotropic score on day1 (rs = -0.43, p < 0.001) and day2 ((rs = -0.41; p < 0.001). In pediatric sepsis, lower ADAMTS13 level is a risk factor for organ dysfunction and mortality, lending theoretical foundations to therapeutic interventions aiming at reversing the pro-thrombotic state in sepsis.
{"title":"ADAMTS13 in pediatric sepsis: a prognostic biomarker with potential therapeutic implications","authors":"Muhammad Said El-Mekkawy, Sara Mahmoud El-Deeb, Maha Fawzy El-Hanafy","doi":"10.1186/s43054-023-00219-1","DOIUrl":"https://doi.org/10.1186/s43054-023-00219-1","url":null,"abstract":"Growing evidence implicates a pro-thrombotic state, caused by ADAMTS13 deficiency, in sepsis-associated organ dysfunction, but pediatric data is limited. Our purpose was to evaluate association of ADAMTS13 with prognosis of pediatric sepsis. This was prospective observational study, conducted on 70 children with sepsis and 18 healthy controls. Patients were classified upon Pediatric Intensive Care Unit (PICU) admission into sepsis, severe sepsis, and septic shock groups. Serum ADAMTS13 was measured within 24 h of admission. The primary outcome was all-cause PICU mortality. ADAMTS13 was lower among patients than controls [median and interquartile range (IQR): 1.30 (0.88–3.13ng/mL) vs. 6.00 (5.55–6.50 ng/mL); p < 0.001]. ADAMTS13 was lower in both severe sepsis and septic shock than sepsis [median (IQR): 0.90 (0.80–1.75 ng/mL); 1.0 ng/ml (0.90–1.20); and 2.80 (1.00–3.85ng/mL), p = 0.026 and 0.006 respectively]. ADAMTS13 was lower among non-survivors compared with survivors [median (IQR): 0.9 (0.80–1.18 ng/mL) vs. 2.45 (0.98–3.50 ng/mL); p < 0.001]. ADAMTS13 had area under Receiver Operating Characteristic Curve (AUC) of 0.77 for mortality prediction. Lower ADAMTS13 level was associated with mechanical ventilation; vasoactive medications; acute respiratory distress syndrome; and multiple organ dysfunction syndrome. ADAMTS13 correlated with pediatric Sequential Organ Failure Assessment (pSOFA) score (rs = -0.46, p < 0.001); vasoactive infusion days ((rs = -0.48, p < 0.001); and vasoactive-inotropic score on day1 (rs = -0.43, p < 0.001) and day2 ((rs = -0.41; p < 0.001). In pediatric sepsis, lower ADAMTS13 level is a risk factor for organ dysfunction and mortality, lending theoretical foundations to therapeutic interventions aiming at reversing the pro-thrombotic state in sepsis.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138821788","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}
Many years ago, it was proposed that prone positioning and infant massage would benefit preterm and babies with low birth weight. Evaluating the effectiveness of massage therapy and the neonatal prone position on the heart rate (HR) and blood oxygen saturation level (SPO2) of premature neonates in neonatal intensive care units. Our study was conducted as a single-center, randomized controlled clinical trial at the NICUs of Menoufia University Hospital. After enrollment, the (240) cases were divided into group A: (80) infants with prone position, group B: (80) infants with massage therapy (as intervention groups), group C: (80) infants as a control group (without intervention). Regarding group A, there was a significant difference between the first and last days of intervention regarding HR and SPO2 at 15, 30, 45, and 60 min. Regarding group B, there was a significant difference between the first and last days of intervention regarding HR and SPO2 at 15, 30, 45, and 60 min. Regarding group C, there was no significant difference between the First and last days of intervention regarding HR at 15, 30, 45, and 60 min. Prone position and infant’s massage equally reduce Heart Rate and increase preterm babies' blood oxygen saturation level neonates admitted in NICU.
多年前，有人提出俯卧位和婴儿按摩对早产儿和出生体重不足的婴儿有益。评估按摩疗法和新生儿俯卧位对新生儿重症监护室早产儿心率（HR）和血氧饱和度（SPO2）的影响。我们的研究是在梅努菲亚大学医院新生儿重症监护室进行的单中心随机对照临床试验。入选后，240 个病例被分为 A 组：（80 个）采用俯卧位的婴儿；B 组：（80 个）采用按摩疗法的婴儿（作为干预组）；C 组：（80 个）婴儿作为对照组（未进行干预）。就 A 组而言，在 15、30、45 和 60 分钟时，干预第一天和最后一天的心率和 SPO2 有显著差异。关于 B 组，在 15、30、45 和 60 分钟的心率和 SPO2 方面，干预的第一天和最后一天之间存在显著差异。至于 C 组，在 15、30、45 和 60 分钟的心率方面，干预第一天和最后一天之间没有明显差异。俯卧位和婴儿按摩同样能降低早产儿的心率，提高新生儿重症监护室新生儿的血氧饱和度。
{"title":"Comparison of massage and prone position on heart rate and blood oxygen saturation level in preterm neonates hospitalized in neonatal intensive care units","authors":"Hanan Mostafa El-sayd, Ghada Mohamed El-Mashad, Mohamed Zakaria Elsaied Mohamed, Zeinab Sabri Abouzouna","doi":"10.1186/s43054-023-00214-6","DOIUrl":"https://doi.org/10.1186/s43054-023-00214-6","url":null,"abstract":"Many years ago, it was proposed that prone positioning and infant massage would benefit preterm and babies with low birth weight. Evaluating the effectiveness of massage therapy and the neonatal prone position on the heart rate (HR) and blood oxygen saturation level (SPO2) of premature neonates in neonatal intensive care units. Our study was conducted as a single-center, randomized controlled clinical trial at the NICUs of Menoufia University Hospital. After enrollment, the (240) cases were divided into group A: (80) infants with prone position, group B: (80) infants with massage therapy (as intervention groups), group C: (80) infants as a control group (without intervention). Regarding group A, there was a significant difference between the first and last days of intervention regarding HR and SPO2 at 15, 30, 45, and 60 min. Regarding group B, there was a significant difference between the first and last days of intervention regarding HR and SPO2 at 15, 30, 45, and 60 min. Regarding group C, there was no significant difference between the First and last days of intervention regarding HR at 15, 30, 45, and 60 min. Prone position and infant’s massage equally reduce Heart Rate and increase preterm babies' blood oxygen saturation level neonates admitted in NICU.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138740996","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 : 2023-12-18DOI: 10.1186/s43054-023-00216-4
Santosh Chavan, Nilima Narkhede, Rajaram Weling
Congenital complete absence of sternal bone or cleft sternum or absent sternum is a very rare and potentially life-threatening birth defect. An association of cleft sternum with tetralogy of Fallot, right aortic arch, and bilateral superior vena cava is extremely rare, and not many cases have been reported. A 2-year-old child was brought for routine checkup. He was a known case of congenital heart disease and midline thoracic defect at age of 3 months. Further investigations revealed absent sternum with tetralogy of Fallot, large cono-ventricular defect with bidirectional shunt, severe infundibular pulmonary stenosis, superiorly located right aortic arch, and bilateral superior vena cava. Congenital absence of the sternum with intracardiac defects like tetralogy of Fallot with right aortic arch and bilateral superior vena cava is extremely rare malformation. Early diagnosis and surgical correction give the infant the best chance of survival.
{"title":"Congenital absence of sternum with tetralogy of Fallot, right aortic arch, and bilateral superior vena cava","authors":"Santosh Chavan, Nilima Narkhede, Rajaram Weling","doi":"10.1186/s43054-023-00216-4","DOIUrl":"https://doi.org/10.1186/s43054-023-00216-4","url":null,"abstract":"Congenital complete absence of sternal bone or cleft sternum or absent sternum is a very rare and potentially life-threatening birth defect. An association of cleft sternum with tetralogy of Fallot, right aortic arch, and bilateral superior vena cava is extremely rare, and not many cases have been reported. A 2-year-old child was brought for routine checkup. He was a known case of congenital heart disease and midline thoracic defect at age of 3 months. Further investigations revealed absent sternum with tetralogy of Fallot, large cono-ventricular defect with bidirectional shunt, severe infundibular pulmonary stenosis, superiorly located right aortic arch, and bilateral superior vena cava. Congenital absence of the sternum with intracardiac defects like tetralogy of Fallot with right aortic arch and bilateral superior vena cava is extremely rare malformation. Early diagnosis and surgical correction give the infant the best chance of survival.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138714907","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 : 2023-12-15DOI: 10.1186/s43054-023-00212-8
Antoine AbdelMassih, Sonia El-Saiedi, Rana Hendawy, Reem Esmail, Manal AbdelHameed, Alaa Sobeih, Ahmed Kharabish, Nourine Diab, Hanya Gaber, Nadine El-Husseiny, Hala M. Agha
Differentiating acute myocarditis (AMY) from dilated cardiomyopathy (DCM) in a patient presenting with acute heart failure and poor systolic function is of utmost importance to initiate timely anti-inflammatory treatment in AMY. Using cardiac magnetic resonance (CMR) or endomyocardial biopsies (EMB) as gold standards might be limited due to the likelihood of hemodynamic compromise. Eccentric myocardial remodeling as measured by sphericity index (SPI) might be useful in differentiating AMY from DCM, due to the progressive increase in transverse LV diameter in DCM. The primary outcome parameter of our study was to test the diagnostic accuracy of SPI in the differentiation of AMY from DCM, while the secondary outcome parameter was to compare the diagnostic accuracy of SPI to troponin I in the same context. For this purpose, we conducted a retrospective study involving a chart review of the files of sixty patients admitted with acute heart failure due to hypokinetic left ventricle in our hospital. Patients were divided after CMR imaging into two groups: group 1 with AMY (n = 30) and group 2 with DCM (n = 30). Demographic and clinical characteristics of the patients, including heart rate, need for mechanical ventilation, use of milrinone, epinephrine and norepinephrine, troponin I, and 2D-derived sphericity index, were collected from patients’ files. Patients with AMY had a higher need for mechanical ventilation inopressors and vasopressors; 73% of AMY patients required mechanical ventilation and epinephrine use, compared to less than 50% of DCM patients. Troponin I elevation was more marked in AMY compared to DCM patients (0.25 ± 0.04 vs. 0.21 ± 0.03, respectively). SPI was significantly higher in DCM compared to AMY cases, denoting a spherical configuration of the myocardium acquired due to progressive remodeling, because of the chronicity of the pathology. ROC analysis revealed that an SPI ≤ 0.38 was 100% sensitive in differentiating DCM from AMY, compared to a 53% sensitivity with the commonly used troponin I. AMY diagnosis can be achieved by the assessment of sphericity index rather than troponin I. The bedside nature and noninvasiveness of SPI should reshape the practice in this context. SPI assessment can be part of point-of-care echocardiography, taught to emergency room (ER) physicians and intensivists.
{"title":"Sphericity index for bedside diagnosis of acute myocarditis","authors":"Antoine AbdelMassih, Sonia El-Saiedi, Rana Hendawy, Reem Esmail, Manal AbdelHameed, Alaa Sobeih, Ahmed Kharabish, Nourine Diab, Hanya Gaber, Nadine El-Husseiny, Hala M. Agha","doi":"10.1186/s43054-023-00212-8","DOIUrl":"https://doi.org/10.1186/s43054-023-00212-8","url":null,"abstract":"Differentiating acute myocarditis (AMY) from dilated cardiomyopathy (DCM) in a patient presenting with acute heart failure and poor systolic function is of utmost importance to initiate timely anti-inflammatory treatment in AMY. Using cardiac magnetic resonance (CMR) or endomyocardial biopsies (EMB) as gold standards might be limited due to the likelihood of hemodynamic compromise. Eccentric myocardial remodeling as measured by sphericity index (SPI) might be useful in differentiating AMY from DCM, due to the progressive increase in transverse LV diameter in DCM. The primary outcome parameter of our study was to test the diagnostic accuracy of SPI in the differentiation of AMY from DCM, while the secondary outcome parameter was to compare the diagnostic accuracy of SPI to troponin I in the same context. For this purpose, we conducted a retrospective study involving a chart review of the files of sixty patients admitted with acute heart failure due to hypokinetic left ventricle in our hospital. Patients were divided after CMR imaging into two groups: group 1 with AMY (n = 30) and group 2 with DCM (n = 30). Demographic and clinical characteristics of the patients, including heart rate, need for mechanical ventilation, use of milrinone, epinephrine and norepinephrine, troponin I, and 2D-derived sphericity index, were collected from patients’ files. Patients with AMY had a higher need for mechanical ventilation inopressors and vasopressors; 73% of AMY patients required mechanical ventilation and epinephrine use, compared to less than 50% of DCM patients. Troponin I elevation was more marked in AMY compared to DCM patients (0.25 ± 0.04 vs. 0.21 ± 0.03, respectively). SPI was significantly higher in DCM compared to AMY cases, denoting a spherical configuration of the myocardium acquired due to progressive remodeling, because of the chronicity of the pathology. ROC analysis revealed that an SPI ≤ 0.38 was 100% sensitive in differentiating DCM from AMY, compared to a 53% sensitivity with the commonly used troponin I. AMY diagnosis can be achieved by the assessment of sphericity index rather than troponin I. The bedside nature and noninvasiveness of SPI should reshape the practice in this context. SPI assessment can be part of point-of-care echocardiography, taught to emergency room (ER) physicians and intensivists.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138693301","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 : 2023-12-14DOI: 10.1186/s43054-023-00215-5
Olivia Kameel Shokrey Bastaoros, Mostafa Ahmed Gad, Ayman Emil Eskander, Mourad Alfy Ramzy, Amera Hasnoon
Constipation is an underestimated but common health problem worldwide, decreasing the quality of life. Functional constipation (FC) is a common pediatric problem, with reported prevalence ranging from 0.7 to 29.6%. In Egypt, there are no established guidelines for the treatment of constipation in children. The aim of this study was to investigate the efficacy of polyethylene glycol (PEG) as a maintenance treatment for functional constipation (FC) in comparison with the classic treatment using (lactulose and senna) in children living in Egypt. This is a randomized single-blinded clinical trial study on pediatric patients who presented with functional constipation at the outpatient clinic of Cairo University Specialized Pediatric Hospital. The study was conducted on 80 children with functional constipation, who were divided into 2 groups: group 1 (40 children), who received polyethylene glycol as maintenance treatment; group 2 (40 children), who received classic treatment in the form of osmotic laxative (lactulose) with or without stimulant (senna-sennosides or senna-glycoside) according to the stool consistency. Our data showed significant improvement in the fecal masses and the number of defecation, fecal pseudo incontinence, painful or hard bowel movement, history of retentive posturing or excessive violation, and large fecal masses in the rectum between group 1 and group 2 after treatment. In group 1, there was a significant improvement in anthropometric measures, CBC parameters, abdominal circumference, and anal fissures and piles after treatment; also, there was a significant decrease in the number of patients that need to continue treatment in group 1 in comparison with group 2 and number of patients that had impaction during treatment. However, there was a statistically significant increase in the number of patients who complained of palatability in group 1. PEG has long-term efficacy in the management of pediatric functional constipation. Significant improvement of results in comparison with the classic treatment (lactulose or senna-lax).
{"title":"The use of polyethylene glycol as a maintenance treatment of functional constipation in children living in Egypt","authors":"Olivia Kameel Shokrey Bastaoros, Mostafa Ahmed Gad, Ayman Emil Eskander, Mourad Alfy Ramzy, Amera Hasnoon","doi":"10.1186/s43054-023-00215-5","DOIUrl":"https://doi.org/10.1186/s43054-023-00215-5","url":null,"abstract":"Constipation is an underestimated but common health problem worldwide, decreasing the quality of life. Functional constipation (FC) is a common pediatric problem, with reported prevalence ranging from 0.7 to 29.6%. In Egypt, there are no established guidelines for the treatment of constipation in children. The aim of this study was to investigate the efficacy of polyethylene glycol (PEG) as a maintenance treatment for functional constipation (FC) in comparison with the classic treatment using (lactulose and senna) in children living in Egypt. This is a randomized single-blinded clinical trial study on pediatric patients who presented with functional constipation at the outpatient clinic of Cairo University Specialized Pediatric Hospital. The study was conducted on 80 children with functional constipation, who were divided into 2 groups: group 1 (40 children), who received polyethylene glycol as maintenance treatment; group 2 (40 children), who received classic treatment in the form of osmotic laxative (lactulose) with or without stimulant (senna-sennosides or senna-glycoside) according to the stool consistency. Our data showed significant improvement in the fecal masses and the number of defecation, fecal pseudo incontinence, painful or hard bowel movement, history of retentive posturing or excessive violation, and large fecal masses in the rectum between group 1 and group 2 after treatment. In group 1, there was a significant improvement in anthropometric measures, CBC parameters, abdominal circumference, and anal fissures and piles after treatment; also, there was a significant decrease in the number of patients that need to continue treatment in group 1 in comparison with group 2 and number of patients that had impaction during treatment. However, there was a statistically significant increase in the number of patients who complained of palatability in group 1. PEG has long-term efficacy in the management of pediatric functional constipation. Significant improvement of results in comparison with the classic treatment (lactulose or senna-lax).","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138631182","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 : 2023-12-12DOI: 10.1186/s43054-023-00240-4
Tarek A. Abdelaziz, Mohamed Ali Abdou Mohamed, Weaam Ibrahim Ismail, Ibrahim Ali Ibrahim Idreis, Eman Gamal Baz
The dyslipidemia and changes in D-dimer values that occur in children with severe sepsis remain unidentified. The current research aimed to explore the relationship between D-dimer and lipid profile values, including total cholesterol (TC), lipoproteins, apolipoprotein A-V (Apo A-5), triglycerides (TG), and in-hospital nonsurvival in children with severe sepsis or septic shock in pediatric intensive care. The study design is as follows: prospective cohort study. Children with severe sepsis or septic shock who were admitted to the intensive care unit of a university pediatric hospital. Vital signs, sepsis assessment, pediatric sequential organ failure assessment (PSOFA) score, high-density lipoprotein (HDL), Apo A-5, TG, low-density lipoprotein (LDL), TC, D-dimer, mortality outcome, and pediatric risk of mortality (PRISM) III score were evaluated. The primary outcome was in-hospital nonsurvival. The nonsurvivors had significantly higher D-dimer levels than the survivors, with a significant cutoff level of 0.87 μg/mL (AUC: 0.85, sensitivity: 93.3%, PVN: 90.6%, accuracy: 79.0%, PVP: 72.5%, and specificity: 64.7%). D-dimer was inversely correlated with WBC count and positively correlated with patient age, PRISM III score, PSOFA score, and INR. However, nonsurvivors had higher TG levels and lower TC, HDL, LDL, and Apo A-5 levels than survivors, but this variation was insignificant. Apo A-5 levels were inversely correlated with HDL and positively correlated with TG levels. This study suggests that D-dimer is a promising biomarker for severe sepsis in children, with a mortality cutoff level of 0.87 μg/mL. However, lipid profiles are not predictors of sepsis-related mortality.
{"title":"A prospective cohort study of severe sepsis-induced dyslipidemia and changes in D-dimer levels in children: do they affect the prognosis?","authors":"Tarek A. Abdelaziz, Mohamed Ali Abdou Mohamed, Weaam Ibrahim Ismail, Ibrahim Ali Ibrahim Idreis, Eman Gamal Baz","doi":"10.1186/s43054-023-00240-4","DOIUrl":"https://doi.org/10.1186/s43054-023-00240-4","url":null,"abstract":"The dyslipidemia and changes in D-dimer values that occur in children with severe sepsis remain unidentified. The current research aimed to explore the relationship between D-dimer and lipid profile values, including total cholesterol (TC), lipoproteins, apolipoprotein A-V (Apo A-5), triglycerides (TG), and in-hospital nonsurvival in children with severe sepsis or septic shock in pediatric intensive care. The study design is as follows: prospective cohort study. Children with severe sepsis or septic shock who were admitted to the intensive care unit of a university pediatric hospital. Vital signs, sepsis assessment, pediatric sequential organ failure assessment (PSOFA) score, high-density lipoprotein (HDL), Apo A-5, TG, low-density lipoprotein (LDL), TC, D-dimer, mortality outcome, and pediatric risk of mortality (PRISM) III score were evaluated. The primary outcome was in-hospital nonsurvival. The nonsurvivors had significantly higher D-dimer levels than the survivors, with a significant cutoff level of 0.87 μg/mL (AUC: 0.85, sensitivity: 93.3%, PVN: 90.6%, accuracy: 79.0%, PVP: 72.5%, and specificity: 64.7%). D-dimer was inversely correlated with WBC count and positively correlated with patient age, PRISM III score, PSOFA score, and INR. However, nonsurvivors had higher TG levels and lower TC, HDL, LDL, and Apo A-5 levels than survivors, but this variation was insignificant. Apo A-5 levels were inversely correlated with HDL and positively correlated with TG levels. This study suggests that D-dimer is a promising biomarker for severe sepsis in children, with a mortality cutoff level of 0.87 μg/mL. However, lipid profiles are not predictors of sepsis-related mortality.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138580461","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}
Immature central nervous system, extended stay in the neonatal intensive care unit, and sensory experience deficiency may contribute to oral and gross motor delay in preterm infants. Current study aimed to investigate oral and motor development in preterm infants. Twenty-nine preterm infants and 28 term infants were evaluated within the scope of the study. Oral motor feeding development was assessed with the Schedule for Oral Motor Assessment, and motor development was evaluated with the Alberta Infant Motor Scale. All analyses were performed using SPSS 22. The study was approved by the Gazi University Clinical Researches Ethics Committee (no: 25901600–23). There was a correlation between the Schedule for Oral Motor Assessment categories (solid, semisolid, cracker, puree, bottle, and cup) and the Alberta Infant Motor Scale score (p < 0.05). There was a significant difference between groups in the Schedule for Oral Motor Assessment’s solid, semisolid, cracker, and puree categories and total score (p < 0.05). There was a significant difference between groups regarding the Alberta Infant Motor Scale score (p < 0.05). Preterm infants come behind their term peers in motor and oral motor feeding performance. These two areas of development can influence each other. For this reason, oral motor feeding problems should be emphasized as well as motor problems in physiotherapy rehabilitation evaluations.
{"title":"Investigation of the relationship between oral motor feeding development and gross motor development between preterm and term infants at 10- to 12-month postnatal age","authors":"Erkan Erol, Umut Apaydın, Numan Demir, Bülent Elbasan","doi":"10.1186/s43054-023-00213-7","DOIUrl":"https://doi.org/10.1186/s43054-023-00213-7","url":null,"abstract":"Immature central nervous system, extended stay in the neonatal intensive care unit, and sensory experience deficiency may contribute to oral and gross motor delay in preterm infants. Current study aimed to investigate oral and motor development in preterm infants. Twenty-nine preterm infants and 28 term infants were evaluated within the scope of the study. Oral motor feeding development was assessed with the Schedule for Oral Motor Assessment, and motor development was evaluated with the Alberta Infant Motor Scale. All analyses were performed using SPSS 22. The study was approved by the Gazi University Clinical Researches Ethics Committee (no: 25901600–23). There was a correlation between the Schedule for Oral Motor Assessment categories (solid, semisolid, cracker, puree, bottle, and cup) and the Alberta Infant Motor Scale score (p < 0.05). There was a significant difference between groups in the Schedule for Oral Motor Assessment’s solid, semisolid, cracker, and puree categories and total score (p < 0.05). There was a significant difference between groups regarding the Alberta Infant Motor Scale score (p < 0.05). Preterm infants come behind their term peers in motor and oral motor feeding performance. These two areas of development can influence each other. For this reason, oral motor feeding problems should be emphasized as well as motor problems in physiotherapy rehabilitation evaluations.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138573988","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 : 2023-12-11DOI: 10.1186/s43054-023-00211-9
Walid Alhussin, Sukena Susnerwala
Non-traumatic depressed skull fracture in a neonate delivered by cesarean section is a rare phenomenon. The incidence reported in literature varies between 1 and 2.5 in every 10,000 live births. The skull is transformed from its normal convex shape to a more concave form due to easy malleability. This is secondary to the lack of complete ossification in the neonatal period. Hence, it is commonly known as ping-pong fracture. The clinical presentation may vary depending on the severity of the fracture and underlying parenchymal injury. Most cases reported in literature have been managed conservatively. However, surgical elevation and the use of medical devices may be advised in severe cases. We report the presentation, course, and management of a term female neonate with a spontaneous ping-pong fracture. The neonate had no history suggestive of antenatal insult, difficult labor, or trauma due to instrumentation during delivery. The infant was thoroughly investigated for underlying parenchymal injury, observed for neurological abnormality, and managed conservatively. Thus, ping-pong fractures or spontaneous neonatal skull fractures are rare but can be encountered in clinical practice. A thorough clinical examination and neurological assessment can aid management decisions.
{"title":"Spontaneous ping-pong fracture in a full-term neonate—a case report","authors":"Walid Alhussin, Sukena Susnerwala","doi":"10.1186/s43054-023-00211-9","DOIUrl":"https://doi.org/10.1186/s43054-023-00211-9","url":null,"abstract":"Non-traumatic depressed skull fracture in a neonate delivered by cesarean section is a rare phenomenon. The incidence reported in literature varies between 1 and 2.5 in every 10,000 live births. The skull is transformed from its normal convex shape to a more concave form due to easy malleability. This is secondary to the lack of complete ossification in the neonatal period. Hence, it is commonly known as ping-pong fracture. The clinical presentation may vary depending on the severity of the fracture and underlying parenchymal injury. Most cases reported in literature have been managed conservatively. However, surgical elevation and the use of medical devices may be advised in severe cases. We report the presentation, course, and management of a term female neonate with a spontaneous ping-pong fracture. The neonate had no history suggestive of antenatal insult, difficult labor, or trauma due to instrumentation during delivery. The infant was thoroughly investigated for underlying parenchymal injury, observed for neurological abnormality, and managed conservatively. Thus, ping-pong fractures or spontaneous neonatal skull fractures are rare but can be encountered in clinical practice. A thorough clinical examination and neurological assessment can aid management decisions.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138566699","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}
Neurocysticercosis (NCC) is thought to be the most common helminthic infection of central nervous system in India. In children, it has pleomorphic clinical and radiological presentations depending on location and stage of lesion. Solitary cystic granuloma appearing as a single ring enhancing lesion is the most frequently encountered neuroimaging finding in patients with neurocysticercosis or tuberculoma in India. This series reports unusual clinico-radiological aspects of pediatric neurocysticercosis patients of Asian ethnicity. In the present case series, we have described socio-demographic and clinico-radiological profile of eight cases of neurocysticercosis with parenchymal lesions in varying stages of development. Among these two had single discrete ring enhancing lesion (SDREL), two had single conglomerated ring enhancing lesion (SCREL), and five cases reported to have multiple ring enhancing lesions (MREL). Two cases with recurrent neurocysticercosis have been reported which is quite rare. Magnetic resonance spectroscopy helps to differentiate between neurocysticercosis and tuberculoma and may avoid brain biopsies or unnecessary anti-tubercular treatment. Magnetic resonance spectroscopy (MRS) was done in three cases with findings of absence of lipid peak and choline/creatinine ratio less than 1.2. Despite the advances in neuroimaging, accurate diagnosis of NCC is still sometimes difficult, which is related to the pleomorphic nature of disease and significant overlapping features with tuberculoma. A combination of proper diagnostic criteria and neuroimaging findings are helpful in making the diagnosis without invasive and potentially harmful investigations in paediatric patients.
{"title":"Paediatric parenchymal neurocysticercosis with pleomorphic clinico-radiological presentations: a case series","authors":"Sanjay Kumar, Radhamohan Rana, Mahesh Kumar, Aakash Yadav","doi":"10.1186/s43054-023-00207-5","DOIUrl":"https://doi.org/10.1186/s43054-023-00207-5","url":null,"abstract":"Neurocysticercosis (NCC) is thought to be the most common helminthic infection of central nervous system in India. In children, it has pleomorphic clinical and radiological presentations depending on location and stage of lesion. Solitary cystic granuloma appearing as a single ring enhancing lesion is the most frequently encountered neuroimaging finding in patients with neurocysticercosis or tuberculoma in India. This series reports unusual clinico-radiological aspects of pediatric neurocysticercosis patients of Asian ethnicity. In the present case series, we have described socio-demographic and clinico-radiological profile of eight cases of neurocysticercosis with parenchymal lesions in varying stages of development. Among these two had single discrete ring enhancing lesion (SDREL), two had single conglomerated ring enhancing lesion (SCREL), and five cases reported to have multiple ring enhancing lesions (MREL). Two cases with recurrent neurocysticercosis have been reported which is quite rare. Magnetic resonance spectroscopy helps to differentiate between neurocysticercosis and tuberculoma and may avoid brain biopsies or unnecessary anti-tubercular treatment. Magnetic resonance spectroscopy (MRS) was done in three cases with findings of absence of lipid peak and choline/creatinine ratio less than 1.2. Despite the advances in neuroimaging, accurate diagnosis of NCC is still sometimes difficult, which is related to the pleomorphic nature of disease and significant overlapping features with tuberculoma. A combination of proper diagnostic criteria and neuroimaging findings are helpful in making the diagnosis without invasive and potentially harmful investigations in paediatric patients.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138556025","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 : 2023-12-07DOI: 10.1186/s43054-023-00209-3
Miriam Magdy Aziz, Hafez Bazaraa, Aly Sayed Aboulmakarem, Dalia Helal
Vascular access is a mainstay of pediatric critical care. The selection of the route of access and equipment used will depend on patient- and provider-specific factors, which constantly need revision to achieve more effective assessment and management. To evaluate the use, indication, and outcome of different vascular access modalities in critically ill children in the Emergency Pediatric Intensive Care Unit (ER-PICU) of a tertiary university hospital. This cross-sectional descriptive study was based on data collected by reviewing all modes of vascular access used for 168 consecutive patients admitted to ER-PICU during a 6-month period from May to October 2020. Among the study group (n = 168), there were 92 males (54.8%) and 76 females (45.2%). The median age of cases was 18 months. 333 vascular access devices were observed: 219 peripheral (65.8%) and 114 central catheters (34.2%). Catheters lasted a total of 1920 catheter days. Central venous catheters lasted significantly more than peripheral lines (P < 0.001); median of 8.5 and 3 days, respectively. The incidence of peripheral line complications (35.2%) was found significantly higher compared to central venous catheters (22.8%) (P. = 0.021). Longer dwell time of central access was associated with a higher incidence of catheter-related bloodstream infection. The incidence of catheter-related bloodstream infection was 9.05 per 1000 catheter days. Mortality rate was 24.4%. Despite having lower incidence of complications than peripheral lines, central venous catheters’ complications are considered more serious. Dwell time of central venous catheters (CVC) should be revised daily to avoid the occurrence of infection.
{"title":"Vascular access modalities in a pediatric intensive care unit in tertiary hospital indications and outcomes: a single-center cross-sectional study","authors":"Miriam Magdy Aziz, Hafez Bazaraa, Aly Sayed Aboulmakarem, Dalia Helal","doi":"10.1186/s43054-023-00209-3","DOIUrl":"https://doi.org/10.1186/s43054-023-00209-3","url":null,"abstract":"Vascular access is a mainstay of pediatric critical care. The selection of the route of access and equipment used will depend on patient- and provider-specific factors, which constantly need revision to achieve more effective assessment and management. To evaluate the use, indication, and outcome of different vascular access modalities in critically ill children in the Emergency Pediatric Intensive Care Unit (ER-PICU) of a tertiary university hospital. This cross-sectional descriptive study was based on data collected by reviewing all modes of vascular access used for 168 consecutive patients admitted to ER-PICU during a 6-month period from May to October 2020. Among the study group (n = 168), there were 92 males (54.8%) and 76 females (45.2%). The median age of cases was 18 months. 333 vascular access devices were observed: 219 peripheral (65.8%) and 114 central catheters (34.2%). Catheters lasted a total of 1920 catheter days. Central venous catheters lasted significantly more than peripheral lines (P < 0.001); median of 8.5 and 3 days, respectively. The incidence of peripheral line complications (35.2%) was found significantly higher compared to central venous catheters (22.8%) (P. = 0.021). Longer dwell time of central access was associated with a higher incidence of catheter-related bloodstream infection. The incidence of catheter-related bloodstream infection was 9.05 per 1000 catheter days. Mortality rate was 24.4%. Despite having lower incidence of complications than peripheral lines, central venous catheters’ complications are considered more serious. Dwell time of central venous catheters (CVC) should be revised daily to avoid the occurrence of infection.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138547589","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：