Pub Date : 2023-12-07DOI: 10.1186/s43054-023-00235-1
Murad Habib, Mansoor Ahmed, Rafi Raza, Sibghatullah Babar, Muhammad Amjad Chaudhary
The incidence of SARS-CoV-2 infection in pediatric population is less than 7% that too when associated with a urinary tract infection, the presentation is very rare. There have been numerous case reports in adults and adolescent population but very few in pediatrics and none in our socioeconomic. We present here the case of a 1-year-old boy with SARS-CoV-2 induced urinary tract infection whose urine biochemistry showed severe urinary tract infection but no hematuria. His COVID-PCR was positive. His chest radiograph showed bilateral lung infiltrates with peri-hilar lymphadenopathy. His computerized tomography scan showed infiltrates with lung fibrosis. He was admitted to the isolation ward, successfully managed, and discharged home after 5 days of in-hospital treatment. Pediatricians and pediatric emergency physicians should be vigilant and well aware of the atypical presentation of SARS-CoV-2 infection in infants and children, as they can present with both gastrointestinal and renal manifestations. And once missed, the patient may end up with devastating complications.
{"title":"SARS-CoV-2 induced urinary tract infection in an infant: a rare case","authors":"Murad Habib, Mansoor Ahmed, Rafi Raza, Sibghatullah Babar, Muhammad Amjad Chaudhary","doi":"10.1186/s43054-023-00235-1","DOIUrl":"https://doi.org/10.1186/s43054-023-00235-1","url":null,"abstract":"The incidence of SARS-CoV-2 infection in pediatric population is less than 7% that too when associated with a urinary tract infection, the presentation is very rare. There have been numerous case reports in adults and adolescent population but very few in pediatrics and none in our socioeconomic. We present here the case of a 1-year-old boy with SARS-CoV-2 induced urinary tract infection whose urine biochemistry showed severe urinary tract infection but no hematuria. His COVID-PCR was positive. His chest radiograph showed bilateral lung infiltrates with peri-hilar lymphadenopathy. His computerized tomography scan showed infiltrates with lung fibrosis. He was admitted to the isolation ward, successfully managed, and discharged home after 5 days of in-hospital treatment. Pediatricians and pediatric emergency physicians should be vigilant and well aware of the atypical presentation of SARS-CoV-2 infection in infants and children, as they can present with both gastrointestinal and renal manifestations. And once missed, the patient may end up with devastating complications.","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":"138547747","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 : 2023-12-06DOI: 10.1186/s43054-023-00208-4
Maha M. A. Abo-Hashish, Azza Mohamed Ahmed, Mohammad Ali Hegazi, Naglaa Abdel Rahman Mosaad, Mona Hammed Ibrahim, Nagwan Yehia Abdel Salam
Rheumatic fever is a long-term inflammatory disease that can happen if group A beta-hemolytic streptococci bacteria are not treated well enough. Rheumatic fever is recognized globally as the leading cause of heart disease in the pediatric population. This disease destroys the heart muscle, progressively deteriorating its structure and impairing the function of its valves over time. The aim of this study is to determine the role of serum tenascin-C in the diagnosis of acute rheumatic fever and chronic rheumatic heart disease. This case–control study involved a group of 60 Egyptian children. Among them, 20 were diagnosed with acute rheumatic fever, identified using the updated Jones criteria from 2015. Another 20 children, who were suffering from chronic rheumatic heart disease, were also act as a part of the study. The remaining 20 participants, healthy children carefully matched in age and sex, served as the control group. Serum tenascin-C level was significantly increased in acute rheumatic fever (ARF) and highly significantly increased in chronic rheumatic heart disease (CRHD) groups when compared with control group (P = 0.04, 0.01), respectively. There were highly significant difference between and within the studied groups regarding the mean of serum tenascin-C. Serum tenascin-C mean of ARF, CRHD, and control was 4.82 ± 18.7, 5.46 ± 1.6, and 3.78 ± 2.4, respectively, P = 0.02. Level of serum tenascin-C was lower in cases with severe mitral valve insufficiency. No significant link was found between the level of serum tenascin-C and C-reactive protein (CRP), ESR, and ASO titer, with a P-value greater than 0.5. ROC curve for serum tenascin-C in ARF patients was area under the curve = 0.682 (P = 0.05) with optimal serum tenascin-C cut-off point (> 3.76 ng/ml); ROC curve for serum tenascin-C in CRHD patients was AUC = 0.73 (P = 0.01) with cut-off point level (73.76 ng/ml). Patients with ARF and CRHD have increased level of serum tenascin-C. Serum tenancin-C is superior in the diagnosis of ARF in comparison to CRP, ESR, and ASOT. Tenascin-C level can be used as a diagnostic marker for ARF and CRHD.
{"title":"Tenascin-C: as a diagnostic biomarker for rheumatic heart disease","authors":"Maha M. A. Abo-Hashish, Azza Mohamed Ahmed, Mohammad Ali Hegazi, Naglaa Abdel Rahman Mosaad, Mona Hammed Ibrahim, Nagwan Yehia Abdel Salam","doi":"10.1186/s43054-023-00208-4","DOIUrl":"https://doi.org/10.1186/s43054-023-00208-4","url":null,"abstract":"Rheumatic fever is a long-term inflammatory disease that can happen if group A beta-hemolytic streptococci bacteria are not treated well enough. Rheumatic fever is recognized globally as the leading cause of heart disease in the pediatric population. This disease destroys the heart muscle, progressively deteriorating its structure and impairing the function of its valves over time. The aim of this study is to determine the role of serum tenascin-C in the diagnosis of acute rheumatic fever and chronic rheumatic heart disease. This case–control study involved a group of 60 Egyptian children. Among them, 20 were diagnosed with acute rheumatic fever, identified using the updated Jones criteria from 2015. Another 20 children, who were suffering from chronic rheumatic heart disease, were also act as a part of the study. The remaining 20 participants, healthy children carefully matched in age and sex, served as the control group. Serum tenascin-C level was significantly increased in acute rheumatic fever (ARF) and highly significantly increased in chronic rheumatic heart disease (CRHD) groups when compared with control group (P = 0.04, 0.01), respectively. There were highly significant difference between and within the studied groups regarding the mean of serum tenascin-C. Serum tenascin-C mean of ARF, CRHD, and control was 4.82 ± 18.7, 5.46 ± 1.6, and 3.78 ± 2.4, respectively, P = 0.02. Level of serum tenascin-C was lower in cases with severe mitral valve insufficiency. No significant link was found between the level of serum tenascin-C and C-reactive protein (CRP), ESR, and ASO titer, with a P-value greater than 0.5. ROC curve for serum tenascin-C in ARF patients was area under the curve = 0.682 (P = 0.05) with optimal serum tenascin-C cut-off point (> 3.76 ng/ml); ROC curve for serum tenascin-C in CRHD patients was AUC = 0.73 (P = 0.01) with cut-off point level (73.76 ng/ml). Patients with ARF and CRHD have increased level of serum tenascin-C. Serum tenancin-C is superior in the diagnosis of ARF in comparison to CRP, ESR, and ASOT. Tenascin-C level can be used as a diagnostic marker for ARF and CRHD.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138515766","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}
Since inflammatory mediators play a crucial role in the pathophysiology of neonatal sepsis. Montelukast, as an anti-inflammatory drug, could be a beneficial therapy. In searching the literature, no previous research addressed the role of Montelukast in neonatal sepsis; hence, this study aimed to explore the adjuvant role of Montelukast in regulating the inflammatory response associated with neonatal sepsis and its associated effect on the clinical outcomes. An open-label, randomized controlled intervention trial conducted on 40 late preterm newborn infants (gestational age 340/7 to 366/7 weeks) admitted to NICU, with clinical evidence of sepsis. In the Montelukast group (n = 20), infants received oral Montelukast once daily for 10 days (infant's weight < 2 kg received 1.5 mg whereas > 2 kg received 2 mg) with antibiotics plus routine supportive care. In the routine care group (n = 20), infants received antibiotics plus routine supportive care. Primary outcome was the serum level of tumor necrosis factor (TNF) alpha at day 10 of therapy. Secondary clinical and laboratory outcomes were reported along hospital admission. Baseline characteristics were non-significantly different between both groups. After 10 days of therapy, TNF alpha level was significantly lower in the Montelukast group (80.73 ± 50.25 versus 119.54 ± 58.46; p = 0.03). There were non-significant differences between both groups regarding duration of NICU admission, antibiotics duration or modalities and duration of respiratory support. C-reactive protein didn’t differ between both groups (p = 0.256). No documented significant adverse effects of Montelukast during the study period. In late preterm neonates with sepsis, 10 days of Montelukast therapy as an adjuvant to antibiotics lowered TNF alpha level without any impact on clinical outcomes. The study was approved by Mansoura Faculty of Medicine institutional research board (IRB) (MS/17.06.95) and it was registered in clinical trials database (clinicaltrials.gov, ID: NCT04474327 ; registered July 16, 2020).
{"title":"Role of Montelukast in modulation of response to sepsis in preterm infants: a randomized-controlled trial","authors":"Nouran El-Shehaby, Heba Abdelhameed El-Shahawy, Nehad Nasef, Shadia El-Sallab, Hanan EL-Halaby","doi":"10.1186/s43054-023-00210-w","DOIUrl":"https://doi.org/10.1186/s43054-023-00210-w","url":null,"abstract":"Since inflammatory mediators play a crucial role in the pathophysiology of neonatal sepsis. Montelukast, as an anti-inflammatory drug, could be a beneficial therapy. In searching the literature, no previous research addressed the role of Montelukast in neonatal sepsis; hence, this study aimed to explore the adjuvant role of Montelukast in regulating the inflammatory response associated with neonatal sepsis and its associated effect on the clinical outcomes. An open-label, randomized controlled intervention trial conducted on 40 late preterm newborn infants (gestational age 340/7 to 366/7 weeks) admitted to NICU, with clinical evidence of sepsis. In the Montelukast group (n = 20), infants received oral Montelukast once daily for 10 days (infant's weight < 2 kg received 1.5 mg whereas > 2 kg received 2 mg) with antibiotics plus routine supportive care. In the routine care group (n = 20), infants received antibiotics plus routine supportive care. Primary outcome was the serum level of tumor necrosis factor (TNF) alpha at day 10 of therapy. Secondary clinical and laboratory outcomes were reported along hospital admission. Baseline characteristics were non-significantly different between both groups. After 10 days of therapy, TNF alpha level was significantly lower in the Montelukast group (80.73 ± 50.25 versus 119.54 ± 58.46; p = 0.03). There were non-significant differences between both groups regarding duration of NICU admission, antibiotics duration or modalities and duration of respiratory support. C-reactive protein didn’t differ between both groups (p = 0.256). No documented significant adverse effects of Montelukast during the study period. In late preterm neonates with sepsis, 10 days of Montelukast therapy as an adjuvant to antibiotics lowered TNF alpha level without any impact on clinical outcomes. The study was approved by Mansoura Faculty of Medicine institutional research board (IRB) (MS/17.06.95) and it was registered in clinical trials database (clinicaltrials.gov, ID: NCT04474327 ; registered July 16, 2020).","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138515767","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}
Vaccination against severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) has gained recognition as a crucial strategy to prevent and reduce the risk of infection, including emerging variants, due to its proven safety, immunogenicity, and effectiveness. This study aimed to evaluate the vaccination hesitancy (VH) among Egyptian parents towards SARS-CoV-2 vaccination, specifically focusing on parents with chronically ill children. A multicentered cross-sectional survey was conducted at outpatient clinics of El-Raml Pediatric Hospital, Ministry of Health and Population (MOHP) in Alexandria, Alexandria Main University Hospital for Maternity and Children (AMUH), Al-Galaa Teaching Hospital, General Organization for Teaching Hospitals and Institutes (GOTHI) Cairo, and Pediatric Department, Menoufia University Hospital from May 1st till December 15th, 2022. Parents of children with chronic diseases were recruited using a simple random sampling technique to respond to the validated Arabic version of parental attitudes about childhood vaccination (PACV). In this study, we enrolled 527 caregivers, 55.4% of them were aged 30–39 years old, 85.2% were females, and 46.9% had chronic diseases. Commonly mentioned information sources included television and radio (69.8%), and social media (35.3%). Among the parents studied, 59.6% refused vaccination. The predictors of the PACV score were governorate, Menoufia (β = 11.30, 95%CI [5.32, 17.27], p < 0.001), study setting, Menoufia University Hospital (β = -20.07, 95%CI [-25.40, -14.75] and El-Raml Hospital (β = -10.74, 95%CI [-14.50, -6.98], p < 0.001), income; not enough and loans repaid (β = 3.18, 95%CI [0.54, 5.82], p = 0.018) and not enough and loans not repaid (β = 3.57,95%CI [0.08, 7.07], p = 0.045). The study reveals geographic and economic factors as predictors of PACV, and emphasizes the need for region-specific interventions and financial barriers to improve vaccine acceptance and child well-being.
针对严重急性呼吸窘迫综合征冠状病毒2 (SARS-CoV-2)的疫苗接种已被证实具有安全性、免疫原性和有效性，已被认为是预防和降低感染风险(包括新出现的变异)的一项关键战略。本研究旨在评估埃及父母对SARS-CoV-2疫苗接种的疫苗接种犹豫(VH)，特别关注患有慢性疾病儿童的父母。2022年5月1日至12月15日，在亚历山大卫生和人口部El-Raml儿科医院门诊、亚历山大主要大学妇幼医院(AMUH)、Al-Galaa教学医院、开罗教学医院和研究所总组织(GOTHI)和Menoufia大学医院儿科进行了多中心横断面调查。使用简单的随机抽样技术招募患有慢性疾病儿童的父母，以回应经过验证的阿拉伯语版本的父母对儿童疫苗接种的态度(PACV)。本研究共纳入527名护理人员，其中年龄在30-39岁的占55.4%，女性占85.2%，有慢性疾病的占46.9%。通常提到的信息来源包括电视和广播(69.8%)，以及社交媒体(35.3%)。在调查的父母中，59.6%的人拒绝接种疫苗。PACV评分的预测因子为省、Menoufia (β = 11.30, 95%CI [5.32, 17.27]， p < 0.001)、研究环境、Menoufia大学医院(β = -20.07, 95%CI[-25.40， -14.75]和El-Raml医院(β = -10.74, 95%CI [-14.50， -6.98]， p < 0.001)、收入;不够用和贷款未偿还(β = 3.18, 95%CI [0.54, 5.82]， p = 0.018)，不够用和贷款未偿还(β = 3.57,95%CI [0.08, 7.07]， p = 0.045)。该研究揭示了地理和经济因素作为PACV的预测因素，并强调需要采取针对特定区域的干预措施和消除财政障碍，以提高疫苗接受度和儿童福祉。
{"title":"Intention to vaccinate chronic disease children against COVID-19; a multicenter survey","authors":"Ramy Mohamed Ghazy, Sally Waheed Elkhadry, Engy Saad Elkaragy, Mona Sayed Aly Hassan Makhlouf, Alyaa Ahdy Abdelaziz, Esraa Abdellatif Hammouda","doi":"10.1186/s43054-023-00237-z","DOIUrl":"https://doi.org/10.1186/s43054-023-00237-z","url":null,"abstract":"Vaccination against severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) has gained recognition as a crucial strategy to prevent and reduce the risk of infection, including emerging variants, due to its proven safety, immunogenicity, and effectiveness. This study aimed to evaluate the vaccination hesitancy (VH) among Egyptian parents towards SARS-CoV-2 vaccination, specifically focusing on parents with chronically ill children. A multicentered cross-sectional survey was conducted at outpatient clinics of El-Raml Pediatric Hospital, Ministry of Health and Population (MOHP) in Alexandria, Alexandria Main University Hospital for Maternity and Children (AMUH), Al-Galaa Teaching Hospital, General Organization for Teaching Hospitals and Institutes (GOTHI) Cairo, and Pediatric Department, Menoufia University Hospital from May 1st till December 15th, 2022. Parents of children with chronic diseases were recruited using a simple random sampling technique to respond to the validated Arabic version of parental attitudes about childhood vaccination (PACV). In this study, we enrolled 527 caregivers, 55.4% of them were aged 30–39 years old, 85.2% were females, and 46.9% had chronic diseases. Commonly mentioned information sources included television and radio (69.8%), and social media (35.3%). Among the parents studied, 59.6% refused vaccination. The predictors of the PACV score were governorate, Menoufia (β = 11.30, 95%CI [5.32, 17.27], p < 0.001), study setting, Menoufia University Hospital (β = -20.07, 95%CI [-25.40, -14.75] and El-Raml Hospital (β = -10.74, 95%CI [-14.50, -6.98], p < 0.001), income; not enough and loans repaid (β = 3.18, 95%CI [0.54, 5.82], p = 0.018) and not enough and loans not repaid (β = 3.57,95%CI [0.08, 7.07], p = 0.045). The study reveals geographic and economic factors as predictors of PACV, and emphasizes the need for region-specific interventions and financial barriers to improve vaccine acceptance and child well-being.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138515748","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 : 2023-12-04DOI: 10.1186/s43054-023-00205-7
Khyati Gupta, Vishal Dnyaneshwar Sawant, Sushma Save
Systemic lupus erythematosus is an autoimmune connective tissue disorder that is common among women of age group 15–40 years. The novelty in our case is owed to the deceptive demographic characteristics, not only the sex (F > > M) but also of the age profile (common in 15–44 years age group) along with deviation from typical disease presentation of skin rash/arthritis/nephritic syndrome. We aim to emphasize the importance of having a high index of suspicion in any child presenting with nephrotic range proteinuria in order to prevent delay in diagnosis. Eight-year-old boy presented with generalized swelling, proteinuria, hypoalbuminemia and hypertriglyceridemia and was found to be unresponsive to systemic steroid therapy. Further testing revealed low complement levels(C3/C4) along with ANA positive, homogenous pattern (titre ≥ 1:80) and anti-dsDNA positive (titre 229:24) pointing towards the diagnosis of childhood SLE, which was made based on EULAR/ACR criteria. Subsequent renal biopsy was done in order to stage the disease and for initiation of appropriate treatment protocol. SLE is a highly heterogenous disorder in terms of clinical presentation. All patients with steroid resistant nephrotic syndrome should undergo renal biopsy as a part of their workup. This case is a learning opportunity which demonstrates that even in absence of typical disease manifestations and demographic profile, a high index of suspicion will help in rapid diagnosis and prevention of complications. Knowledge about the varied presentations of renal lupus is of utmost importance for the same.
{"title":"Unusual presentation of systemic lupus erythematosus in a male child: a case presentation","authors":"Khyati Gupta, Vishal Dnyaneshwar Sawant, Sushma Save","doi":"10.1186/s43054-023-00205-7","DOIUrl":"https://doi.org/10.1186/s43054-023-00205-7","url":null,"abstract":"Systemic lupus erythematosus is an autoimmune connective tissue disorder that is common among women of age group 15–40 years. The novelty in our case is owed to the deceptive demographic characteristics, not only the sex (F > > M) but also of the age profile (common in 15–44 years age group) along with deviation from typical disease presentation of skin rash/arthritis/nephritic syndrome. We aim to emphasize the importance of having a high index of suspicion in any child presenting with nephrotic range proteinuria in order to prevent delay in diagnosis. Eight-year-old boy presented with generalized swelling, proteinuria, hypoalbuminemia and hypertriglyceridemia and was found to be unresponsive to systemic steroid therapy. Further testing revealed low complement levels(C3/C4) along with ANA positive, homogenous pattern (titre ≥ 1:80) and anti-dsDNA positive (titre 229:24) pointing towards the diagnosis of childhood SLE, which was made based on EULAR/ACR criteria. Subsequent renal biopsy was done in order to stage the disease and for initiation of appropriate treatment protocol. SLE is a highly heterogenous disorder in terms of clinical presentation. All patients with steroid resistant nephrotic syndrome should undergo renal biopsy as a part of their workup. This case is a learning opportunity which demonstrates that even in absence of typical disease manifestations and demographic profile, a high index of suspicion will help in rapid diagnosis and prevention of complications. Knowledge about the varied presentations of renal lupus is of utmost importance for the same.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138515755","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 : 2023-12-04DOI: 10.1186/s43054-023-00234-2
Ahmed Behairy, Amira Esmat El Tantawy, Asmaa Mahmoud Hamed, Antoine AbdelMassih, Sara Tarek
Conventional signs of tamponade include right ventricular and atrial collapse and respiratory variation in mitral inflow velocities. Despite being reliable, they are qualitative in nature and are not well correlated with clinical signs of deterioration or improvement. Tamponade is invariably preceded and associated with diastolic dysfunction, and tissue Doppler imaging (TDI) can help in early detection of it, earlier than conventional signs. For this purpose, 36 patients presenting with pericardial effusion have been subjected to echocardiography, including effusion dimensions, presence or absence of routine signs of tamponade and TDI-derived LV and RV E/E′ ratios, as well as clinical signs of tamponade to test the diagnostic accuracy of echocardiographic parameters against them. Right atrial and ventricular collapse were the least accurate in the detection of tamponade, while effusion dimension > 14 mm was the most accurate among conventional parameters to point toward tamponade. RV and LV diastolic dysfunction as evidenced by E/E′ ratio showed 100% sensitivity in predicting tamponade, while LV E/E′ ratio showed the highest specificity (100%) in the same context. The higher diagnostic accuracy of LV E/E′ ratio might be also related to the presence of chronic kidney disease patients, with an already jeopardized LV function. TDI technology is now available in most of the portable echocardiography machines and can serve as part of point-of-care echocardiography in the early detection of cardiac tamponade and in decision making for pericardiocentesis. Larger studies can help in consolidating the impression driven from our small-scale cross-sectional study.
{"title":"Tissue Doppler vs. conventional parameters for diagnosis of tamponading pericardial effusion: a cross-sectional study in tertiary referral center","authors":"Ahmed Behairy, Amira Esmat El Tantawy, Asmaa Mahmoud Hamed, Antoine AbdelMassih, Sara Tarek","doi":"10.1186/s43054-023-00234-2","DOIUrl":"https://doi.org/10.1186/s43054-023-00234-2","url":null,"abstract":"Conventional signs of tamponade include right ventricular and atrial collapse and respiratory variation in mitral inflow velocities. Despite being reliable, they are qualitative in nature and are not well correlated with clinical signs of deterioration or improvement. Tamponade is invariably preceded and associated with diastolic dysfunction, and tissue Doppler imaging (TDI) can help in early detection of it, earlier than conventional signs. For this purpose, 36 patients presenting with pericardial effusion have been subjected to echocardiography, including effusion dimensions, presence or absence of routine signs of tamponade and TDI-derived LV and RV E/E′ ratios, as well as clinical signs of tamponade to test the diagnostic accuracy of echocardiographic parameters against them. Right atrial and ventricular collapse were the least accurate in the detection of tamponade, while effusion dimension > 14 mm was the most accurate among conventional parameters to point toward tamponade. RV and LV diastolic dysfunction as evidenced by E/E′ ratio showed 100% sensitivity in predicting tamponade, while LV E/E′ ratio showed the highest specificity (100%) in the same context. The higher diagnostic accuracy of LV E/E′ ratio might be also related to the presence of chronic kidney disease patients, with an already jeopardized LV function. TDI technology is now available in most of the portable echocardiography machines and can serve as part of point-of-care echocardiography in the early detection of cardiac tamponade and in decision making for pericardiocentesis. Larger studies can help in consolidating the impression driven from our small-scale cross-sectional study.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138515749","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}
Measles is a common infection in children. Measles infection in children less than 6 months of age is very rare since maternal antibodies play a major role in the prevention of the disease. Here we present a rare case of a 34-day-old infant, who had a history of fever with a rash on the 18th day of life and significant history of measles contact with mother and elder brother. The patient presented to us with septic shock and multiorgan involvement in the form of pneumonia, acute gastroenteritis with severe dehydration, mucopurulent conjunctivitis, and post-measles encephalitis. The patient had a strong measles contact and epidemiological linkage to the measles epicenter, Govandi (a locality in the Mumbai region of western India), so measles IgM antibody was obtained which were significantly raised. The patient was successfully revived from this critical presentation with early and appropriate resuscitation, timely ionotropic support, and the use of empirical broad-spectrum antibiotics. The patient required intensive unit care for four days and was started on feeds and discharged after 12 days of hospital stay. On follow-up, the patient is doing well and gaining weight. Uncommon presentation and the epidemiology of the disease should alert the clinician of having a high index of suspicion. Early intervention and prompt treatment can help reduce morbidity and mortality.
{"title":"A rare presentation of measles and post-measles complications in a neonate: case report","authors":"Suraksha Ramakrishna Sharma, Vishal Sawant, Sushma Uttam Save, Alpana Santosh Kondekar","doi":"10.1186/s43054-023-00203-9","DOIUrl":"https://doi.org/10.1186/s43054-023-00203-9","url":null,"abstract":"Measles is a common infection in children. Measles infection in children less than 6 months of age is very rare since maternal antibodies play a major role in the prevention of the disease. Here we present a rare case of a 34-day-old infant, who had a history of fever with a rash on the 18th day of life and significant history of measles contact with mother and elder brother. The patient presented to us with septic shock and multiorgan involvement in the form of pneumonia, acute gastroenteritis with severe dehydration, mucopurulent conjunctivitis, and post-measles encephalitis. The patient had a strong measles contact and epidemiological linkage to the measles epicenter, Govandi (a locality in the Mumbai region of western India), so measles IgM antibody was obtained which were significantly raised. The patient was successfully revived from this critical presentation with early and appropriate resuscitation, timely ionotropic support, and the use of empirical broad-spectrum antibiotics. The patient required intensive unit care for four days and was started on feeds and discharged after 12 days of hospital stay. On follow-up, the patient is doing well and gaining weight. Uncommon presentation and the epidemiology of the disease should alert the clinician of having a high index of suspicion. Early intervention and prompt treatment can help reduce morbidity and mortality.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138515762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-30DOI: 10.1186/s43054-023-00204-8
Mohamed Abdallah Abd El Megied, Laila Hussein Mohamed, Basant Salah Saad Meligy, Yasmin Mohamed Ramadan Eissawy, Hanaa Elsayed Mohammed Ahmed, Ola Soliman Emam Soliman Younis
Despite the paucity of data supporting their indications, plasma transfusions (PT) are regularly administered for critically ill patients (CIP) in pediatric intensive care units (PICU). The aim of this study was to identify the actual indications for PT in the Egyptian’s PICUs and determine to what extent it affects the clinic-laboratory outcomes for CIP. A prospective observational study was conducted for 6 months on 180 CIP in PICUs of Cairo University Hospital who received plasma for at least one time during their length of stay (LOS). Full history, examination, and investigations were obtained from the medical records. Plasma was transfused in 64.4% of the studied population to support moderate and severe critical illness identified by multiple organ dysfunction score (MODS). Meanwhile, subjective-based physician conceptions accounted for 12.8% of all indications for plasma transfusion. PT in CIP was associated with a significant reduction in platelet count, prothrombin time, partial thromboplastin time, and international normalized ratio with p-value < 0.001, while there was a significant increase in hemoglobin level with p-value < 0.001. A statistically positive correlation exists between the time interval between admission and 1st PT and LOS with a p-value < 0.001 being shorter with earlier transfusion. Of the 180 patients enrolled in this study, seventy patients (38.9%) died, while 110 patients (61.1%) survived. A statistically significant increase in mechanical ventilation (MV) (p = 0.004), total number of PT (p < 0.001), and MODS score (p < 0.001) were recorded in dead CIP compared with survivors. Moderate and severe critical illness identified by MODS was the most frequent cause for PT in the Egyptian’s PICUs. Early, precise, and objectively based PT has a strong role in improving the outcomes in CIP.
{"title":"Clinico-laboratory outcomes of plasma transfusion in the Egyptian’s pediatric intensive care units—a prospective observational study","authors":"Mohamed Abdallah Abd El Megied, Laila Hussein Mohamed, Basant Salah Saad Meligy, Yasmin Mohamed Ramadan Eissawy, Hanaa Elsayed Mohammed Ahmed, Ola Soliman Emam Soliman Younis","doi":"10.1186/s43054-023-00204-8","DOIUrl":"https://doi.org/10.1186/s43054-023-00204-8","url":null,"abstract":"Despite the paucity of data supporting their indications, plasma transfusions (PT) are regularly administered for critically ill patients (CIP) in pediatric intensive care units (PICU). The aim of this study was to identify the actual indications for PT in the Egyptian’s PICUs and determine to what extent it affects the clinic-laboratory outcomes for CIP. A prospective observational study was conducted for 6 months on 180 CIP in PICUs of Cairo University Hospital who received plasma for at least one time during their length of stay (LOS). Full history, examination, and investigations were obtained from the medical records. Plasma was transfused in 64.4% of the studied population to support moderate and severe critical illness identified by multiple organ dysfunction score (MODS). Meanwhile, subjective-based physician conceptions accounted for 12.8% of all indications for plasma transfusion. PT in CIP was associated with a significant reduction in platelet count, prothrombin time, partial thromboplastin time, and international normalized ratio with p-value < 0.001, while there was a significant increase in hemoglobin level with p-value < 0.001. A statistically positive correlation exists between the time interval between admission and 1st PT and LOS with a p-value < 0.001 being shorter with earlier transfusion. Of the 180 patients enrolled in this study, seventy patients (38.9%) died, while 110 patients (61.1%) survived. A statistically significant increase in mechanical ventilation (MV) (p = 0.004), total number of PT (p < 0.001), and MODS score (p < 0.001) were recorded in dead CIP compared with survivors. Moderate and severe critical illness identified by MODS was the most frequent cause for PT in the Egyptian’s PICUs. Early, precise, and objectively based PT has a strong role in improving the outcomes in CIP.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138515754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-29DOI: 10.1186/s43054-023-00238-y
Francesca Caroppo, Roberto Mazzetto, Anna Belloni Fortina
Lichen sclerosus is a chronic, progressive, inflammatory skin disease that presents unique challenges, particularly in the pediatric population, where limited data exist regarding its manifestation and optimal management. This retrospective observational monocentric study aims to provide insights into the clinical characteristics and therapeutic strategies employed, in a cohort of children and adolescents with genital lichen sclerosus. A comprehensive analysis was conducted involving a cohort of 60 pediatric patients ranging from 1 to 15 years old, all diagnosed with lichen sclerosus. These cases were referred to the Pediatric Dermatology Regional Center of the University of Padua, Italy, between January 2018 and January 2022. Moreover, we propose a treatment protocol that showed beneficial outcomes in all of our patients. Specifically, the initial use of mid-potency topical corticosteroids has proven effective in addressing severe acute flares. Following this acute phase, transitioning to long-term treatment with topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, has demonstrated effectiveness in maintaining remission of the disease and also shown efficacy in treating mild cases. The therapeutic effectiveness was assessed by considering various clinical aspects, including erythema, paleness, skin erosions, and specific symptoms such as itching, burning, and pain. Erythema emerged as the predominant clinical sign, reported in 43 (78.3%) patients, followed by paleness, reported in 17 (28.3%) patients. Pruritus was observed in 25 girls (58.1% of females) and 2 boys (11.8% of males), while pain and burning sensations were predominantly reported in female children. Among females, we observed a higher prevalence of cutaneous comorbidities, such as atopic dermatitis, psoriasis, alopecia areata, and linear scleroderma, as opposed to autoimmune systemic diseases, that were more prevalent in males. Regarding therapeutic approaches, 21 (35.0%) patients applied topical corticosteroids, 28 (46,7%) applied topical tacrolimus and 21 (35,0%) applied topical pimecrolimus. All treated patients experienced notable benefits following the initiation of treatment proposed by our protocol. This study provides further insights into the clinical presentation and management of lichen sclerosus in the pediatric population, shedding light on potential therapeutic pathways for optimizing patient outcomes in this specific demographic. The proposed protocol appears to be a promising strategy, especially when the onset of the disease occurs during childhood.
{"title":"Clinical features and therapeutic approaches of genital lichen sclerosus in children: results of an observational monocentric study","authors":"Francesca Caroppo, Roberto Mazzetto, Anna Belloni Fortina","doi":"10.1186/s43054-023-00238-y","DOIUrl":"https://doi.org/10.1186/s43054-023-00238-y","url":null,"abstract":"Lichen sclerosus is a chronic, progressive, inflammatory skin disease that presents unique challenges, particularly in the pediatric population, where limited data exist regarding its manifestation and optimal management. This retrospective observational monocentric study aims to provide insights into the clinical characteristics and therapeutic strategies employed, in a cohort of children and adolescents with genital lichen sclerosus. A comprehensive analysis was conducted involving a cohort of 60 pediatric patients ranging from 1 to 15 years old, all diagnosed with lichen sclerosus. These cases were referred to the Pediatric Dermatology Regional Center of the University of Padua, Italy, between January 2018 and January 2022. Moreover, we propose a treatment protocol that showed beneficial outcomes in all of our patients. Specifically, the initial use of mid-potency topical corticosteroids has proven effective in addressing severe acute flares. Following this acute phase, transitioning to long-term treatment with topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, has demonstrated effectiveness in maintaining remission of the disease and also shown efficacy in treating mild cases. The therapeutic effectiveness was assessed by considering various clinical aspects, including erythema, paleness, skin erosions, and specific symptoms such as itching, burning, and pain. Erythema emerged as the predominant clinical sign, reported in 43 (78.3%) patients, followed by paleness, reported in 17 (28.3%) patients. Pruritus was observed in 25 girls (58.1% of females) and 2 boys (11.8% of males), while pain and burning sensations were predominantly reported in female children. Among females, we observed a higher prevalence of cutaneous comorbidities, such as atopic dermatitis, psoriasis, alopecia areata, and linear scleroderma, as opposed to autoimmune systemic diseases, that were more prevalent in males. Regarding therapeutic approaches, 21 (35.0%) patients applied topical corticosteroids, 28 (46,7%) applied topical tacrolimus and 21 (35,0%) applied topical pimecrolimus. All treated patients experienced notable benefits following the initiation of treatment proposed by our protocol. This study provides further insights into the clinical presentation and management of lichen sclerosus in the pediatric population, shedding light on potential therapeutic pathways for optimizing patient outcomes in this specific demographic. The proposed protocol appears to be a promising strategy, especially when the onset of the disease occurs during childhood.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138515768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-24DOI: 10.1186/s43054-023-00236-0
Amr Abdelhamid AbouZeid, Shaimaa Abdelsattar Mohammad, Nihal Hussein Aly, Wael Ahmed Ghanem, Mohammad Seada, Iman A. Ragab, Osama El-Naggar, Mohamed Aly AbdelBaky
To share our experience in the management of a specific type of vascular malformations (lymphatic) at a specialized multidisciplinary clinic for vascular anomalies. Data of patients attending the vascular anomaly clinic during the period 2015 through 2023 were retrospectively analyzed. The study included cases diagnosed primarily as lymphatic malformations (LMs). We excluded cases associated with complex/syndromic vascular malformations. Available data included regional distribution of the LMs, age at presentation, sex, imaging studies, and different modes of treatment. The study included 131 cases of LMs whose data were available for retrospective analysis. Generally, LMs had a benign course with good prognosis apart from two recorded mortalities (1.5%) during the 9-year period of the study. In this series, 93 cases were managed by injection sclerotherapy (Bleomycin). About 57 cases showed satisfactory response to injection sclerotherapy alone without the need to add other treatment modalities. Forty cases underwent surgical excision/debulking. Postoperative wound complications were recorded in 5 cases (12.5%). Sirolimus was offered for patients with LMs after the failure of conventional treatment (injection/surgery) to control associated significant complications. Lymphatic malformations represent a common presentation at the vascular anomaly clinic, which usually have a benign course. Complications are mainly cosmetic especially when involving the face, and sometimes superadded infections may occur. Airway compromise is a potential serious complication with submandibular lymphatic malformations in the neck.
{"title":"Lymphatic malformations: a 9-year experience at the vascular anomaly clinic","authors":"Amr Abdelhamid AbouZeid, Shaimaa Abdelsattar Mohammad, Nihal Hussein Aly, Wael Ahmed Ghanem, Mohammad Seada, Iman A. Ragab, Osama El-Naggar, Mohamed Aly AbdelBaky","doi":"10.1186/s43054-023-00236-0","DOIUrl":"https://doi.org/10.1186/s43054-023-00236-0","url":null,"abstract":"To share our experience in the management of a specific type of vascular malformations (lymphatic) at a specialized multidisciplinary clinic for vascular anomalies. Data of patients attending the vascular anomaly clinic during the period 2015 through 2023 were retrospectively analyzed. The study included cases diagnosed primarily as lymphatic malformations (LMs). We excluded cases associated with complex/syndromic vascular malformations. Available data included regional distribution of the LMs, age at presentation, sex, imaging studies, and different modes of treatment. The study included 131 cases of LMs whose data were available for retrospective analysis. Generally, LMs had a benign course with good prognosis apart from two recorded mortalities (1.5%) during the 9-year period of the study. In this series, 93 cases were managed by injection sclerotherapy (Bleomycin). About 57 cases showed satisfactory response to injection sclerotherapy alone without the need to add other treatment modalities. Forty cases underwent surgical excision/debulking. Postoperative wound complications were recorded in 5 cases (12.5%). Sirolimus was offered for patients with LMs after the failure of conventional treatment (injection/surgery) to control associated significant complications. Lymphatic malformations represent a common presentation at the vascular anomaly clinic, which usually have a benign course. Complications are mainly cosmetic especially when involving the face, and sometimes superadded infections may occur. Airway compromise is a potential serious complication with submandibular lymphatic malformations in the neck.","PeriodicalId":43064,"journal":{"name":"Egyptian Pediatric Association Gazette","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138515774","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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