Background Diabetes mellitus is a major illness in which cardiac problems play a significant role in patient mortality. Objectives We aimed to evaluate whether children with diabetes mellitus type 1 have early echocardiographic signs of subclinical cardiac dysfunction and whether their sex, metabolic control, and duration of diabetes have an effect. Patients and methods A case–control study was performed from January 2022 to November 2022 that included 29 children and adolescents with type 1 diabetes aged from 4 to 15 years. A control group of 15 healthy children was also included. They were recruited from the pediatric endocrinology clinic, Al-Fayoum University Children’s Hospital, Al-Fayoum University, Egypt. Conventional echocardiographic study and tissue Doppler imaging measurements were done. Results With glycated hemoglobin levels less than 7%, the study group of diabetic children had inadequate glycemic control. There was a statistically significant low mean of fractional shortening and high mean of left ventricular septal wall thickness in diastole among diabetic children in comparison with controls, with P values of 0.04 and 0.038, respectively, but still within normal range. Conclusion Children with diabetes have poor glycemic control and scanty echocardiographic evidence of subclinical cardiac dysfunctions. According to the study, cardiac dysfunction in children with diabetes is uncommon. For the early identification of any potential cardiac dysfunctions, distant periodic cardiac examination using both conventional and tissue Doppler echocardiography is advised.
{"title":"Do type 1 diabetic children have echocardiographic signs of subclinical cardiac dysfunction?","authors":"Heba Safar, Remon Magdy","doi":"10.4103/ajop.ajop_42_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_42_22","url":null,"abstract":"Background Diabetes mellitus is a major illness in which cardiac problems play a significant role in patient mortality. Objectives We aimed to evaluate whether children with diabetes mellitus type 1 have early echocardiographic signs of subclinical cardiac dysfunction and whether their sex, metabolic control, and duration of diabetes have an effect. Patients and methods A case–control study was performed from January 2022 to November 2022 that included 29 children and adolescents with type 1 diabetes aged from 4 to 15 years. A control group of 15 healthy children was also included. They were recruited from the pediatric endocrinology clinic, Al-Fayoum University Children’s Hospital, Al-Fayoum University, Egypt. Conventional echocardiographic study and tissue Doppler imaging measurements were done. Results With glycated hemoglobin levels less than 7%, the study group of diabetic children had inadequate glycemic control. There was a statistically significant low mean of fractional shortening and high mean of left ventricular septal wall thickness in diastole among diabetic children in comparison with controls, with P values of 0.04 and 0.038, respectively, but still within normal range. Conclusion Children with diabetes have poor glycemic control and scanty echocardiographic evidence of subclinical cardiac dysfunctions. According to the study, cardiac dysfunction in children with diabetes is uncommon. For the early identification of any potential cardiac dysfunctions, distant periodic cardiac examination using both conventional and tissue Doppler echocardiography is advised.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"75 1","pages":"194 - 200"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80917452","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}
M. El-Baz, Samar Sawey, E. Mogahed, E. Taher, Sara Saleh
Introduction Bronchial asthma strongly affects the health-related quality of life (HRQOL) of children in many aspects including physical, emotional, social, and school functioning. Child self-reports of QOL are valid for measuring HRQOL, but the parent proxy reports also provide additional important information. Aim To assess the agreement between the child self-reports of HRQOL and the parent proxy reports among the children and adolescents with well-controlled bronchial asthma. Patients and methods This cross-sectional study was conducted on 75 asthmatic patients aged between 8 and 18 years and their parents who were being followed up in the allergy outpatient clinic in the Department of Pediatrics, Cairo University. HRQOL was assessed by the PedsQL 3.0 asthma module. Results The mean±SD age of the patients was 10.08±1.70 years. Distribution of agreement between patients and parents showed that 40 (53.3%) cases showed agreement in different domains. Agreement between child and parent-by-proxy was 54.3% in the asthma domain, 45.3% in the treatment domain, 34.7% in the worry domain, and 17.3% in the communication domain. A statistically significant correlation was found between QOL in child and parent in all domains; the correlation was strong in the asthma and worry domains and weak in the treatment and the communication domains, where in the asthma domain, confidence interval (CI) was 0.803 (0.690–0.875), with a P value of 0.000; in the treatment domain, CI was 0.305 (0.080–0.499), with a P value of 0.009; in the worry domain, CI was 0.539 (0.357–0.682), with a P value 0.000; and finally, in the communication domain, the CI was 0.374 (0.163–0.552), with a P value of 0.000. Conclusion There was a lack of convergence between the child self-report and the parent’s report of the PedsQL 3.0 asthma module. Asthmatic children’s self-reports were more accurate than parent proxy reports for the assessment of HRQOL. Parent proxy reports should be spared to very young children or children who lack the logical or analytical ability needed for answering the questionnaire.
{"title":"Comparing health-related quality-of-life scores in well-controlled asthmatic children and adolescents with their parents using PedsQL 3.0 asthma scales in our practice","authors":"M. El-Baz, Samar Sawey, E. Mogahed, E. Taher, Sara Saleh","doi":"10.4103/ajop.ajop_43_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_43_22","url":null,"abstract":"Introduction Bronchial asthma strongly affects the health-related quality of life (HRQOL) of children in many aspects including physical, emotional, social, and school functioning. Child self-reports of QOL are valid for measuring HRQOL, but the parent proxy reports also provide additional important information. Aim To assess the agreement between the child self-reports of HRQOL and the parent proxy reports among the children and adolescents with well-controlled bronchial asthma. Patients and methods This cross-sectional study was conducted on 75 asthmatic patients aged between 8 and 18 years and their parents who were being followed up in the allergy outpatient clinic in the Department of Pediatrics, Cairo University. HRQOL was assessed by the PedsQL 3.0 asthma module. Results The mean±SD age of the patients was 10.08±1.70 years. Distribution of agreement between patients and parents showed that 40 (53.3%) cases showed agreement in different domains. Agreement between child and parent-by-proxy was 54.3% in the asthma domain, 45.3% in the treatment domain, 34.7% in the worry domain, and 17.3% in the communication domain. A statistically significant correlation was found between QOL in child and parent in all domains; the correlation was strong in the asthma and worry domains and weak in the treatment and the communication domains, where in the asthma domain, confidence interval (CI) was 0.803 (0.690–0.875), with a P value of 0.000; in the treatment domain, CI was 0.305 (0.080–0.499), with a P value of 0.009; in the worry domain, CI was 0.539 (0.357–0.682), with a P value 0.000; and finally, in the communication domain, the CI was 0.374 (0.163–0.552), with a P value of 0.000. Conclusion There was a lack of convergence between the child self-report and the parent’s report of the PedsQL 3.0 asthma module. Asthmatic children’s self-reports were more accurate than parent proxy reports for the assessment of HRQOL. Parent proxy reports should be spared to very young children or children who lack the logical or analytical ability needed for answering the questionnaire.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"69 1","pages":"168 - 179"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74088104","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}
Nada El-Din Elshalkami, N. Salem, W. Elshabrawy, Samir Abou-Elhassan
Background Diabetes represents one of the most common diseases in school-aged children. Poor glycemic control in type 1 diabetes mellitus (T1DM) usually leads to more oxidative stress, increased production of oxygen-free radicals, and more diabetic complications. Oxidative stress plays a pivotal role in the development of diabetes complications, both microvascular and cardiovascular. The metabolic abnormalities of diabetes cause mitochondrial superoxide overproduction in endothelial cells of both large and small vessels and also in the myocardium. Aim The aim of the current study was to assess the oxidative status and its relationship with glycemic state of T1DM in children. Patients and methods This was a case–control study conducted on 50 children. The first group enrolled 30 children aged 2–12 years of both sexes with T1DM selected from patients attending the outpatient clinic of endocrinology unit of Mansoura University Children’s Hospital in the period between December 2020 and December 2021 and were compared with 20 age-matched and sex-matched children who served as healthy controls. Results The malondialdehyde (MDA) and MDA/total antioxidant capacity ratio were significantly increased among cases compared with the control group. MDA and MDA/total antioxidant capacity ratio could be used as reliable predictors for differentiating between cases and controls with high sensitivity and specificity. However, they could not be used as a reliable indicator for differentiation between cases with microalbuminuria from case without. Oxidant/antioxidant status seemed to be significantly increased among cases with poor diabetic control followed by controlled diabetic group and lastly the healthy control group. Conclusion Cases with T1DM were associated with a significant increase in oxidative stress, especially in poor controlled ones. Additionally, oxidative stress markers could be used as valid markers for T1DM.
{"title":"Oxidative status and its relationship with glycemic state in children with type 1 diabetes mellitus","authors":"Nada El-Din Elshalkami, N. Salem, W. Elshabrawy, Samir Abou-Elhassan","doi":"10.4103/ajop.ajop_39_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_39_22","url":null,"abstract":"Background Diabetes represents one of the most common diseases in school-aged children. Poor glycemic control in type 1 diabetes mellitus (T1DM) usually leads to more oxidative stress, increased production of oxygen-free radicals, and more diabetic complications. Oxidative stress plays a pivotal role in the development of diabetes complications, both microvascular and cardiovascular. The metabolic abnormalities of diabetes cause mitochondrial superoxide overproduction in endothelial cells of both large and small vessels and also in the myocardium. Aim The aim of the current study was to assess the oxidative status and its relationship with glycemic state of T1DM in children. Patients and methods This was a case–control study conducted on 50 children. The first group enrolled 30 children aged 2–12 years of both sexes with T1DM selected from patients attending the outpatient clinic of endocrinology unit of Mansoura University Children’s Hospital in the period between December 2020 and December 2021 and were compared with 20 age-matched and sex-matched children who served as healthy controls. Results The malondialdehyde (MDA) and MDA/total antioxidant capacity ratio were significantly increased among cases compared with the control group. MDA and MDA/total antioxidant capacity ratio could be used as reliable predictors for differentiating between cases and controls with high sensitivity and specificity. However, they could not be used as a reliable indicator for differentiation between cases with microalbuminuria from case without. Oxidant/antioxidant status seemed to be significantly increased among cases with poor diabetic control followed by controlled diabetic group and lastly the healthy control group. Conclusion Cases with T1DM were associated with a significant increase in oxidative stress, especially in poor controlled ones. Additionally, oxidative stress markers could be used as valid markers for T1DM.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"65 1","pages":"201 - 207"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89578849","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}
H. Abdelnabi, E. Ashaat, N. Baiomy, Mona F Sokkar, K. Hamed, Neveen A Ashaat, H. El-Bassyouni, H. Dawoud
Background The most common hereditary autoinflammatory disease is the familial Mediterranean fever (FMF). The aim of the current study was to estimate the serum level of interleukin 1β (IL-1β) in FMF children and compare them with healthy controls in correlation to other disease inflammatory markers. Patients and methods This cross-sectional study was conducted on 40 Egyptian FMF children and 40 healthy controls with matching age and sex. Mutational analysis has been performed for all patients. Blood samples were collected from the newly diagnosed FMF children and controls to estimate IL-1β quantitatively by the enzyme-linked immunosorbent assay technique. Results The mean age of the patients was 9.89 years. There were 21 (52.5%) males and 19 (47.5%) females. There was statistically significant increase (P=0.001) in the IL-1β of patients (1442.59±749.24 pg/l) compared with controls (85.63±58.02 pg/l) and significantly correlated with the serum amyloid A and C-reactive protein levels. The best cutoff of serum IL-1β level to predict the disease activity was more than or equal to 775 pg/l with a sensitivity of 90%, a specificity of 86%, and an accuracy of 89%. Conclusions Mutations in the MEFV gene can result in uncontrolled production of IL-1β and an exaggerated inflammatory response. This study highlights the importance of IL-1β as an inflammatory biomarker in FMF children.
{"title":"Interleukin 1β as an inflammatory biomarker in Egyptian children with Familial Mediterranean Fever","authors":"H. Abdelnabi, E. Ashaat, N. Baiomy, Mona F Sokkar, K. Hamed, Neveen A Ashaat, H. El-Bassyouni, H. Dawoud","doi":"10.4103/ajop.ajop_24_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_24_22","url":null,"abstract":"Background The most common hereditary autoinflammatory disease is the familial Mediterranean fever (FMF). The aim of the current study was to estimate the serum level of interleukin 1β (IL-1β) in FMF children and compare them with healthy controls in correlation to other disease inflammatory markers. Patients and methods This cross-sectional study was conducted on 40 Egyptian FMF children and 40 healthy controls with matching age and sex. Mutational analysis has been performed for all patients. Blood samples were collected from the newly diagnosed FMF children and controls to estimate IL-1β quantitatively by the enzyme-linked immunosorbent assay technique. Results The mean age of the patients was 9.89 years. There were 21 (52.5%) males and 19 (47.5%) females. There was statistically significant increase (P=0.001) in the IL-1β of patients (1442.59±749.24 pg/l) compared with controls (85.63±58.02 pg/l) and significantly correlated with the serum amyloid A and C-reactive protein levels. The best cutoff of serum IL-1β level to predict the disease activity was more than or equal to 775 pg/l with a sensitivity of 90%, a specificity of 86%, and an accuracy of 89%. Conclusions Mutations in the MEFV gene can result in uncontrolled production of IL-1β and an exaggerated inflammatory response. This study highlights the importance of IL-1β as an inflammatory biomarker in FMF children.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"71 1","pages":"163 - 167"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85899973","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}
Amina Abd-Elwahab, M. Tawfik, S. El-Sharkawy, Zerf Mohammed
Background Diabetic nephropathy is a syndrome characterized by a secondary renal disease in patients with diabetes mellitus (DM). It is a serious complication of DM and is the most common cause of the end-stage renal disease. Aim To evaluate the diagnostic value of serum cystatin C level as an early biomarker of nephropathy in children with type 1 diabetes mellitus (T1DM) attending Suez Canal University Hospital. Patients and methods This was a descriptive cross-sectional study that included 49 children with T1DM attending the pediatric endocrinology outpatient clinic of at Suez Canal University Hospital, Ismailia, Egypt, and 49 matched healthy controls during the period from 1/12/2020 to 1/3/2021. The target population was children with T1DM aged between 6 and 18 years of both sexes who were attending the pediatric endocrinology outpatient clinic of Suez Canal University Hospital, Ismailia, Egypt. All studied patients and healthy controls were subjected to history taking and general and systemic examination. The following investigations were done: fasting blood sugar, serum creatinine, estimated glomerular filtration rate, albumin/creatinine ratio (ACR), urine analysis, hemoglobin A1C, and serum cystatin C level). Results ACR and cystatin C levels were significantly higher in albuminuric than nonalbuminuric diabetic patients. There was a significant positive correlation between serum cystatin C and duration of diabetes, hemoglobin A1C, and ACR. For serum cystatin C, regarding detection of microalbuminuria, the sensitivity was 66.7%, specificity was 75%, the positive predictive value was 49%, and the negative predictive value was 0.52%, with the best cut-off value of 0.98 (mg/l). Conclusion Microalbuminuric diabetic patients showed an increased serum cystatin C levels, whereas their creatinine levels were still within normal. Serum cystatin C levels well reflect the severity of renal damage caused by DM. The serum cystatin C measurement might become a useful, practical, noninvasive, and accurate tool for early detection of microalbuminuria and renal insufficiency in T1DM.
{"title":"Evaluation of serum cystatin C level as an early biomarker of nephropathy in children with type 1 diabetes mellitus attending Suez Canal University Hospital","authors":"Amina Abd-Elwahab, M. Tawfik, S. El-Sharkawy, Zerf Mohammed","doi":"10.4103/ajop.ajop_40_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_40_22","url":null,"abstract":"Background Diabetic nephropathy is a syndrome characterized by a secondary renal disease in patients with diabetes mellitus (DM). It is a serious complication of DM and is the most common cause of the end-stage renal disease. Aim To evaluate the diagnostic value of serum cystatin C level as an early biomarker of nephropathy in children with type 1 diabetes mellitus (T1DM) attending Suez Canal University Hospital. Patients and methods This was a descriptive cross-sectional study that included 49 children with T1DM attending the pediatric endocrinology outpatient clinic of at Suez Canal University Hospital, Ismailia, Egypt, and 49 matched healthy controls during the period from 1/12/2020 to 1/3/2021. The target population was children with T1DM aged between 6 and 18 years of both sexes who were attending the pediatric endocrinology outpatient clinic of Suez Canal University Hospital, Ismailia, Egypt. All studied patients and healthy controls were subjected to history taking and general and systemic examination. The following investigations were done: fasting blood sugar, serum creatinine, estimated glomerular filtration rate, albumin/creatinine ratio (ACR), urine analysis, hemoglobin A1C, and serum cystatin C level). Results ACR and cystatin C levels were significantly higher in albuminuric than nonalbuminuric diabetic patients. There was a significant positive correlation between serum cystatin C and duration of diabetes, hemoglobin A1C, and ACR. For serum cystatin C, regarding detection of microalbuminuria, the sensitivity was 66.7%, specificity was 75%, the positive predictive value was 49%, and the negative predictive value was 0.52%, with the best cut-off value of 0.98 (mg/l). Conclusion Microalbuminuric diabetic patients showed an increased serum cystatin C levels, whereas their creatinine levels were still within normal. Serum cystatin C levels well reflect the severity of renal damage caused by DM. The serum cystatin C measurement might become a useful, practical, noninvasive, and accurate tool for early detection of microalbuminuria and renal insufficiency in T1DM.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"49 1","pages":"186 - 193"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73293205","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}
Background The inability of the heart to satisfy the demands of the target tissues’ metabolism as a result of alterations to the cardiac anatomy or function is known as heart failure (HF). Objective With a focus on the relationship between HF grade and other factors, the study sought to investigate clinical, laboratory, mortality, and severity of HF in children. Patients and methods From April 2022 to September 2022, an analytical cross-sectional study was conducted in the Pediatric Department of the Fayoum University, Faculty of Medicine. A total of 30 children with congestive HF, ranging in age from 3 days to 10 years, made up the study group. The patients’ medical information was gathered from medical records kept in hospital patient files. For grading, the original Ross Classification for pediatric HF was applied. The diagnosis was clinically and echocardiographically verified. Results and conclusion For clinical and therapy evaluation, the severity of HF was determined according to Ross classification. HF cases of classes II, III, and IV were reported in 53.3, 33.3, and 13.3% of the current study population, respectively. A large proportion of the research group patients had anemia (80%), hypoalbuminemia (73.3%), and higher creatinine levels (40%), whereas a lesser proportion had lower sodium and calcium levels. Hypokalemia brought on by diuretics is uncommon in the research group (6.7%). Because anemia correlates well with Ross classification and the quantity of cardiac drugs taken, it has a negative effect on the severity of congestive HF and treatment regimens, with P value less than 0.05. The other side of the coin is that additional adverse effects are brought on by higher drug use. The main causes of death in patients with congestive HF were verified to be severe infections and malnutrition by the high mean of C-reactive protein and low mean of albumin, among nonsurvived cases, with P value less than 0.05.
{"title":"Clinical grading of pediatric heart failure in Egypt: a single-center study","authors":"Heba Safar","doi":"10.4103/ajop.ajop_2_23","DOIUrl":"https://doi.org/10.4103/ajop.ajop_2_23","url":null,"abstract":"Background The inability of the heart to satisfy the demands of the target tissues’ metabolism as a result of alterations to the cardiac anatomy or function is known as heart failure (HF). Objective With a focus on the relationship between HF grade and other factors, the study sought to investigate clinical, laboratory, mortality, and severity of HF in children. Patients and methods From April 2022 to September 2022, an analytical cross-sectional study was conducted in the Pediatric Department of the Fayoum University, Faculty of Medicine. A total of 30 children with congestive HF, ranging in age from 3 days to 10 years, made up the study group. The patients’ medical information was gathered from medical records kept in hospital patient files. For grading, the original Ross Classification for pediatric HF was applied. The diagnosis was clinically and echocardiographically verified. Results and conclusion For clinical and therapy evaluation, the severity of HF was determined according to Ross classification. HF cases of classes II, III, and IV were reported in 53.3, 33.3, and 13.3% of the current study population, respectively. A large proportion of the research group patients had anemia (80%), hypoalbuminemia (73.3%), and higher creatinine levels (40%), whereas a lesser proportion had lower sodium and calcium levels. Hypokalemia brought on by diuretics is uncommon in the research group (6.7%). Because anemia correlates well with Ross classification and the quantity of cardiac drugs taken, it has a negative effect on the severity of congestive HF and treatment regimens, with P value less than 0.05. The other side of the coin is that additional adverse effects are brought on by higher drug use. The main causes of death in patients with congestive HF were verified to be severe infections and malnutrition by the high mean of C-reactive protein and low mean of albumin, among nonsurvived cases, with P value less than 0.05.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"92 1","pages":"208 - 215"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76274582","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}
Amira M Sabry, Doaa Hassouna, Zahraa E. Osman, M. El-Baz
Background Respiratory distress syndrome (RDS) of prematurity is a major cause of morbidity and mortality in preterm infants, caused by deficiency of pulmonary surfactant and structural immaturity of the lungs. Preterms with RDS should be given a natural surfactant as early as possible. Early surfactant therapy (within 2 h of birth) should be considered for preterms with gestation periods less than or equal to 31 weeks if the need for intubation in the delivery room arises. Lack and unavailability of surfactant in middle-income and low-income countries can occur, and preterms with RDS are treated with ventilation only. Aim The aim of this study was to study the effectiveness of surfactant application in preterms less than 36 weeks with RDS. Short-term effectiveness was monitored by improvement of chest radiograph, oxygen saturation (SpO2), and blood gases with decreasing ventilatory settings after 6 h. Long-term effectiveness was monitored by fate, duration of oxygen therapy, and duration of hospital stay. Moreover, the adverse effects of surfactant were detected. Patients and methods This cross-sectional study was carried out over a period of 18 months in the neonatal ICUs of the Department of Pediatrics, Cairo University hospitals, and included 180 preterms less than 36 weeks of gestational age. We compared 90 preterms less than 36 weeks with RDS who received more than or equal to one dose of surfactant therapy, with 90 controls who had RDS and were eligible for the criteria of administration of surfactant but could not receive surfactant because of its unavailability in the unit at their time of admission. The two groups were compared regarding the period of ventilation, the improvement in ventilator settings and the capillary blood gases after surfactant application, hospital stay, and complications of prematurity. Results Surfactant application significantly improved the preterms, as seen in improvement of radiograph, capillary blood gases, and SpO2. Six hours after administration of surfactant in the case group, 59 (65.6%) cases showed an improvement in capillary blood gases, and after 6 h of ventilation in the control group, only 21 (23.3%) showed improvement in capillary blood gases, with a P value of 0.001. A total of 60 (66.7%) cases had an improved SpO2 after 4 h, but this was seen in only 17 (18.9%) controls, with a P value less than 0.001. Findings of RDS in chest radiograph showed improvement in 60 (66.7%) preterms in the cases group, whereas in the control group, 37 (41.1%) preterms were only improved. However, the mortality rates and the incidence of bronchopulmonary dysplasia were slightly higher in the group that received surfactant, with P values of 0.488 and 0.530, respectively. Conclusion Surfactant application showed significant improvement in preterms with RDS, as seen in improvement of radiograph, capillary blood gases, and SpO2. The mortality rate and the incidence of bronchopulmonary dysplasia were significantly higher i
{"title":"Clinical auditing for surfactant therapy in preterms with respiratory distress syndrome: a single-center study","authors":"Amira M Sabry, Doaa Hassouna, Zahraa E. Osman, M. El-Baz","doi":"10.4103/ajop.ajop_38_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_38_22","url":null,"abstract":"Background Respiratory distress syndrome (RDS) of prematurity is a major cause of morbidity and mortality in preterm infants, caused by deficiency of pulmonary surfactant and structural immaturity of the lungs. Preterms with RDS should be given a natural surfactant as early as possible. Early surfactant therapy (within 2 h of birth) should be considered for preterms with gestation periods less than or equal to 31 weeks if the need for intubation in the delivery room arises. Lack and unavailability of surfactant in middle-income and low-income countries can occur, and preterms with RDS are treated with ventilation only. Aim The aim of this study was to study the effectiveness of surfactant application in preterms less than 36 weeks with RDS. Short-term effectiveness was monitored by improvement of chest radiograph, oxygen saturation (SpO2), and blood gases with decreasing ventilatory settings after 6 h. Long-term effectiveness was monitored by fate, duration of oxygen therapy, and duration of hospital stay. Moreover, the adverse effects of surfactant were detected. Patients and methods This cross-sectional study was carried out over a period of 18 months in the neonatal ICUs of the Department of Pediatrics, Cairo University hospitals, and included 180 preterms less than 36 weeks of gestational age. We compared 90 preterms less than 36 weeks with RDS who received more than or equal to one dose of surfactant therapy, with 90 controls who had RDS and were eligible for the criteria of administration of surfactant but could not receive surfactant because of its unavailability in the unit at their time of admission. The two groups were compared regarding the period of ventilation, the improvement in ventilator settings and the capillary blood gases after surfactant application, hospital stay, and complications of prematurity. Results Surfactant application significantly improved the preterms, as seen in improvement of radiograph, capillary blood gases, and SpO2. Six hours after administration of surfactant in the case group, 59 (65.6%) cases showed an improvement in capillary blood gases, and after 6 h of ventilation in the control group, only 21 (23.3%) showed improvement in capillary blood gases, with a P value of 0.001. A total of 60 (66.7%) cases had an improved SpO2 after 4 h, but this was seen in only 17 (18.9%) controls, with a P value less than 0.001. Findings of RDS in chest radiograph showed improvement in 60 (66.7%) preterms in the cases group, whereas in the control group, 37 (41.1%) preterms were only improved. However, the mortality rates and the incidence of bronchopulmonary dysplasia were slightly higher in the group that received surfactant, with P values of 0.488 and 0.530, respectively. Conclusion Surfactant application showed significant improvement in preterms with RDS, as seen in improvement of radiograph, capillary blood gases, and SpO2. The mortality rate and the incidence of bronchopulmonary dysplasia were significantly higher i","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"5 1","pages":"153 - 162"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89349706","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}
COVID-19 is a novel coronavirus infection that can cause a severe respiratory illness and has been declared a pandemic by the WHO. Compared with adults, most pediatric patients with COVID-19 are mostly asymptomatic, whereas others show distinctive characteristics in clinical presentation and imaging. Most of the pulmonary lesions were ambiguous on chest radiographs. The routine use of computer tomography of chest in the evaluation of children with suspected or confirmed COVID-19 is useful in diagnosing and monitoring pediatric COVID-19 pneumonia. Clinicians and radiologists should become familiar with the computed tomography findings of COVID-19, as the early detection of lesions by computed tomography is conducive to reasonable management and early treatment for pediatric patients. This minireview examines the most recent evidence to recommend usage of chest imaging modalities in children with COVID-19.
{"title":"The role of chest imaging in the management of children with COVID-19","authors":"P. Annapureddy, T. Babu","doi":"10.4103/ajop.ajop_12_21","DOIUrl":"https://doi.org/10.4103/ajop.ajop_12_21","url":null,"abstract":"COVID-19 is a novel coronavirus infection that can cause a severe respiratory illness and has been declared a pandemic by the WHO. Compared with adults, most pediatric patients with COVID-19 are mostly asymptomatic, whereas others show distinctive characteristics in clinical presentation and imaging. Most of the pulmonary lesions were ambiguous on chest radiographs. The routine use of computer tomography of chest in the evaluation of children with suspected or confirmed COVID-19 is useful in diagnosing and monitoring pediatric COVID-19 pneumonia. Clinicians and radiologists should become familiar with the computed tomography findings of COVID-19, as the early detection of lesions by computed tomography is conducive to reasonable management and early treatment for pediatric patients. This minireview examines the most recent evidence to recommend usage of chest imaging modalities in children with COVID-19.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"2 1","pages":"223 - 226"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84496041","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}
Amany El-Hawary, Y. Mosaad, Ibrahim K Ibrahim, Engy Osman
Background Type 1 diabetes mellitus (T1DM) and immunoglobulin E (IgE)-mediated allergy belong to the most common diseases in the pediatric population, in which they are caused by multifactorial causes. Growing evidence proposes that there is a change in Th1/Th2 balance, and subsequently their associated cytokine response, which is essential during the pathogenesis of autoimmune disorders such as T1DM. Aim To assess clinical characteristics and subsequently risk factors potentiating the IgE-mediated allergy among Egyptian children with T1DM and also to assess serum level of interleukin 5 (IL5) among them. Patients and methods An interviewer-administrated questionnaire was designed to take history of allergy in diabetic children who come to the outpatient clinic fulfilling inclusion criteria and used to collect data. The age range was 5–17 years, with at least 2 years duration of T1DM. Skin prick testing was performed for all diabetic children with history of allergy. Patients were divided into allergic diabetic group (45 patients) and nonallergic diabetic group (45 patients). Laboratory assessment of serum total IgE, IL5, and eosinophils% was carried out. Results Among the 45 allergic diabetic group, 82% were asthmatic cases, 40% of them have allergic rhinitis, and 30% of them have skin allergy. Skin test results showed that allergy to house dust mite showed the highest percentage among the diabetic allergic group (51.1%). The allergic diabetic group showed significantly higher levels of IL5, total IgE, and eosinophils than nonallergic diabetic group (Z=8.13, P<0.001; Z=7.18, P<0.001; and Z=8.02, P<0.001). Conclusion Bronchial asthma is considered the most common type of IgE-mediated allergy that may occur in children with T1DM. Developing IgE allergy in T1DM is dependent on the increased levels of IL5. IL5 was an independent predictor of developing asthma, allergic rhinitis, and skin allergy among our studied cases.
{"title":"Immunoglobulin E-mediated allergies among children with type 1 diabetes mellitus: a single-center observational study","authors":"Amany El-Hawary, Y. Mosaad, Ibrahim K Ibrahim, Engy Osman","doi":"10.4103/ajop.ajop_41_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_41_22","url":null,"abstract":"Background Type 1 diabetes mellitus (T1DM) and immunoglobulin E (IgE)-mediated allergy belong to the most common diseases in the pediatric population, in which they are caused by multifactorial causes. Growing evidence proposes that there is a change in Th1/Th2 balance, and subsequently their associated cytokine response, which is essential during the pathogenesis of autoimmune disorders such as T1DM. Aim To assess clinical characteristics and subsequently risk factors potentiating the IgE-mediated allergy among Egyptian children with T1DM and also to assess serum level of interleukin 5 (IL5) among them. Patients and methods An interviewer-administrated questionnaire was designed to take history of allergy in diabetic children who come to the outpatient clinic fulfilling inclusion criteria and used to collect data. The age range was 5–17 years, with at least 2 years duration of T1DM. Skin prick testing was performed for all diabetic children with history of allergy. Patients were divided into allergic diabetic group (45 patients) and nonallergic diabetic group (45 patients). Laboratory assessment of serum total IgE, IL5, and eosinophils% was carried out. Results Among the 45 allergic diabetic group, 82% were asthmatic cases, 40% of them have allergic rhinitis, and 30% of them have skin allergy. Skin test results showed that allergy to house dust mite showed the highest percentage among the diabetic allergic group (51.1%). The allergic diabetic group showed significantly higher levels of IL5, total IgE, and eosinophils than nonallergic diabetic group (Z=8.13, P<0.001; Z=7.18, P<0.001; and Z=8.02, P<0.001). Conclusion Bronchial asthma is considered the most common type of IgE-mediated allergy that may occur in children with T1DM. Developing IgE allergy in T1DM is dependent on the increased levels of IL5. IL5 was an independent predictor of developing asthma, allergic rhinitis, and skin allergy among our studied cases.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"2 1","pages":"180 - 185"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73609551","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}
Background Routine electroencephalography (EEG) is a widely used test in children for the evaluation of many neurological conditions. It is specifically important in the diagnosis of epilepsy and the differentiation of epilepsy from nonepileptic events. Aim This study aimed to evaluate the current situation of EEG recording at Alexandria University Children’s Hospital. Patients and methods All patients who had a routine EEG recording during a period of 6 months were included in the study. Review of the records was done including personal data, place and indication of referral, and initial diagnosis. EEG data included condition during recording, activation procedures, EEG interpretation regarding background activity, presence or absence of epileptiform activity, type and origin of epileptiform discharges, and the final yield of EEG. Results The study included 570 children, comprising 336 males and 234 females, with a mean age of 5.5±4.1 years. The main indication for referral was epilepsy in 69.8%. Most of the cases (83.3%) had an awake recording. Photic stimulation and hyperventilation were done in 93.3 and 31.9%, respectively, and abnormal response to hyperventilation was observed in 9.9% of them. Ictal recording was done in 22 (3.8%) cases. Abnormal epileptiform discharges were detected in 173 (30.4%) of the studied children; of them, 162 cases were initially referred for established epilepsy and 11 cases for other reasons. The abnormality was generalized in 53.8% and focal in 46.2% of the cases. The commonest types of epileptiform discharges were spikes (65.9%) followed by spike-and-wave complexes (56.1%). Hypsarrhythmia, 3-Hz spike-and-wave complexes, and nonconvulsive status epilepticus were detected in 12.7, 10.4, and 2.9%, respectively. Phase reversal, sharp waves, and polyspikes were detected in 15.6, 5.2, and 2.3%, respectively. Conclusion Routine EEG is a valuable test for evaluation of seizures and epilepsy. Specific abnormal epileptiform discharges are diagnostic for certain epileptic syndromes. EEG finding may be normal in children with epilepsy and should be interpreted in the context of the clinical settings.
{"title":"Pediatric electroencephalography: a tertiary care university hospital experience","authors":"M. Khalil","doi":"10.4103/ajop.ajop_44_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_44_22","url":null,"abstract":"Background Routine electroencephalography (EEG) is a widely used test in children for the evaluation of many neurological conditions. It is specifically important in the diagnosis of epilepsy and the differentiation of epilepsy from nonepileptic events. Aim This study aimed to evaluate the current situation of EEG recording at Alexandria University Children’s Hospital. Patients and methods All patients who had a routine EEG recording during a period of 6 months were included in the study. Review of the records was done including personal data, place and indication of referral, and initial diagnosis. EEG data included condition during recording, activation procedures, EEG interpretation regarding background activity, presence or absence of epileptiform activity, type and origin of epileptiform discharges, and the final yield of EEG. Results The study included 570 children, comprising 336 males and 234 females, with a mean age of 5.5±4.1 years. The main indication for referral was epilepsy in 69.8%. Most of the cases (83.3%) had an awake recording. Photic stimulation and hyperventilation were done in 93.3 and 31.9%, respectively, and abnormal response to hyperventilation was observed in 9.9% of them. Ictal recording was done in 22 (3.8%) cases. Abnormal epileptiform discharges were detected in 173 (30.4%) of the studied children; of them, 162 cases were initially referred for established epilepsy and 11 cases for other reasons. The abnormality was generalized in 53.8% and focal in 46.2% of the cases. The commonest types of epileptiform discharges were spikes (65.9%) followed by spike-and-wave complexes (56.1%). Hypsarrhythmia, 3-Hz spike-and-wave complexes, and nonconvulsive status epilepticus were detected in 12.7, 10.4, and 2.9%, respectively. Phase reversal, sharp waves, and polyspikes were detected in 15.6, 5.2, and 2.3%, respectively. Conclusion Routine EEG is a valuable test for evaluation of seizures and epilepsy. Specific abnormal epileptiform discharges are diagnostic for certain epileptic syndromes. EEG finding may be normal in children with epilepsy and should be interpreted in the context of the clinical settings.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"125 1","pages":"216 - 222"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85398661","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：