Introduction There is a recent debate regarding the effect of coronavirus disease 2019 (COVID-19) pandemic on the frequency of type 1 diabetes mellitus (T1DM) and its acute complications, mainly diabetic ketoacidosis (DKA). Several reports showed a significant upward trend in the frequency of DKA among children and adolescence with T1DM. Studies showed a significant escalation in the number of cases with severe DKA compared with the previous years. Objectives To assess the effect of COVID-19 on the frequency and severity of DKA among children and adolescents with T1D. Patients and methods A retrospective study was performed between January 2019 and December 2020. It included 177 children and adolescents admitted to the Pediatrics Department at Suez Canal University Hospital. Results In the COVID era, the mean age of the admitted children with diabetes was 8.6±3.9 years. Newly diagnosed T1DM was seen in 67.9% of the patients who had DKA, which was higher than the previous year (56.1%). DKA severity increased and was significantly higher in 2020 compared with those admitted in 2019 (P=0.001). Additionally, moderate and severe DKA grades were significantly frequent among COVID-19-positive compared with negative ones (P=0.041), with significantly lower PH (P=0.016) and lower bicarbonate level (P<0.001). Conclusion The COVID-19 pandemic influenced T1DM presentations and DKA severity, especially during the recorded waves.
{"title":"Diabetic ketoacidosis among Egyptian children and adolescents in the coronavirus disease 2019 era: a single-center retrospective study","authors":"M. Amin, K. Ismail, Samar Elfiky, Enas F. Elngar","doi":"10.4103/ajop.ajop_23_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_23_22","url":null,"abstract":"Introduction There is a recent debate regarding the effect of coronavirus disease 2019 (COVID-19) pandemic on the frequency of type 1 diabetes mellitus (T1DM) and its acute complications, mainly diabetic ketoacidosis (DKA). Several reports showed a significant upward trend in the frequency of DKA among children and adolescence with T1DM. Studies showed a significant escalation in the number of cases with severe DKA compared with the previous years. Objectives To assess the effect of COVID-19 on the frequency and severity of DKA among children and adolescents with T1D. Patients and methods A retrospective study was performed between January 2019 and December 2020. It included 177 children and adolescents admitted to the Pediatrics Department at Suez Canal University Hospital. Results In the COVID era, the mean age of the admitted children with diabetes was 8.6±3.9 years. Newly diagnosed T1DM was seen in 67.9% of the patients who had DKA, which was higher than the previous year (56.1%). DKA severity increased and was significantly higher in 2020 compared with those admitted in 2019 (P=0.001). Additionally, moderate and severe DKA grades were significantly frequent among COVID-19-positive compared with negative ones (P=0.041), with significantly lower PH (P=0.016) and lower bicarbonate level (P<0.001). Conclusion The COVID-19 pandemic influenced T1DM presentations and DKA severity, especially during the recorded waves.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"41 1","pages":"99 - 105"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81437573","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}
Rationale, aim and objectives Data on management of altered level of conscious (ALOC) is more consistent for industrialized countries, than in developing countries. The aim was to determine the current practice of pediatric physicians regarding the management of ALOC among children attending the emergency room, Alexandria University Children’s Hospital. Patients and methods This is a descriptive cross-sectional survey. Situational analysis of current practice in the management of children presented with ALOC was done. Data were collected by a self-administered questionnaire designed for the pediatric residents, for medical records of emergency room. Results As regards history taking; the majority of pediatric residents mentioned that they took history related to the underlying disease (97.5%), history of trauma (95%), duration of medications (92.5%), and duration of symptoms (90%). All mentioned that they took history related to vomiting, headache, fever, and family history. The least percentage (55%) was related to the presence of automatism manifestations. Regarding treatment strategy, none of the physicians followed a treatment guideline for initiating treatment. The most frequently recorded items in the reviewed records were present history (100%) and family history (91%). The least recorded items were nutritional history (28%) and history of allergy (30%). Conclusion There is a big variation in practice regarding the management of ALOC in children among resident physicians at Alexandria University Children’s Hospital. Regular audit is required to highlight the management gap and to improve the quality of services offered to the patients. Establishment of a local clinical practice guideline is required to standardize the practice and to narrow the management gap.
{"title":"Altered level of consciousness emergency management gap: an audit of a tertiary level hospital","authors":"Elham E. Elsakka, Marwa Shehata, Shimaa Anwar","doi":"10.4103/ajop.ajop_27_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_27_22","url":null,"abstract":"Rationale, aim and objectives Data on management of altered level of conscious (ALOC) is more consistent for industrialized countries, than in developing countries. The aim was to determine the current practice of pediatric physicians regarding the management of ALOC among children attending the emergency room, Alexandria University Children’s Hospital. Patients and methods This is a descriptive cross-sectional survey. Situational analysis of current practice in the management of children presented with ALOC was done. Data were collected by a self-administered questionnaire designed for the pediatric residents, for medical records of emergency room. Results As regards history taking; the majority of pediatric residents mentioned that they took history related to the underlying disease (97.5%), history of trauma (95%), duration of medications (92.5%), and duration of symptoms (90%). All mentioned that they took history related to vomiting, headache, fever, and family history. The least percentage (55%) was related to the presence of automatism manifestations. Regarding treatment strategy, none of the physicians followed a treatment guideline for initiating treatment. The most frequently recorded items in the reviewed records were present history (100%) and family history (91%). The least recorded items were nutritional history (28%) and history of allergy (30%). Conclusion There is a big variation in practice regarding the management of ALOC in children among resident physicians at Alexandria University Children’s Hospital. Regular audit is required to highlight the management gap and to improve the quality of services offered to the patients. Establishment of a local clinical practice guideline is required to standardize the practice and to narrow the management gap.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"3 1","pages":"119 - 124"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83562492","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}
Introduction The availability of biosynthetic growth hormone (GH) ensures that children who are deficient can have replacement therapy, but it has also created the opportunity to treat children who are short but do not have a deficiency. The target height of children with short stature who have normal GH secretion, idiopathic short stature (ISS), without treatment, fails to reach their midparental potential. GH therapy for these children has resulted in variable height outcomes. While some children reached or exceeded genetic target height, others did not have a favorable response. Aim The aim of this study was to report the outcome of the children with ISS who had initial height standard deviation score (HtSDS) (Z score) less than −2, with normal stimulated GH levels (>10 μg/l), after treatment with biosynthetic GH for at least 1 year. Patients and methods This retrospective study included 20 children with ISS, with initial HTSDS less than −2, normal stimulated GH levels (>10 μg/l), who were treated with rhGH (0.04 mg/kg/day) for at least 1 year. None had any other systemic or endocrine disorder. All had normal complete blood count, liver, and renal functions. Results Twenty children (15 males and five females) with ISS, aged between 4.3 and 13.8 years (mean=9.88±2.62 years), who had mean peak GH=15.58±6.95 μg, were studied. All received GH treatment (average GH dose was 0.04 mg/kg/day) for a mean duration=2.49±1.61 years. The mean midparental HtSDS (MPHSDS) was −1.23±0.57. Their bone age did not differ significantly compared with their chronological age (the mean difference=−0.13±0.67 years). The mean HSDS before treatment was −2.34±0.41 and after 1 year of GH treatment was −1.83±0.48. This gave a gain of an average of 0.5 SD. At the last visit (after a mean of 2.5 years), the HtSDS −1.57±0.55 SD with a gain of 0.77±0.14 SD versus before treatment. The difference between children HtSDS compared with their MPHSDS was −1.08 SD before treatment that was changed to −0.3 SD at the last visit. The increment in HSDS was positively correlated with the duration of rhGH therapy (r=0.82, P=0.01) and negatively correlated with age at the start of treatment (r=−0.54, P=0.01). Conclusion Growth hormone therapy that benefits short children with normal growth hormone secretion achieves near-normal HSDS and approaches MPHSDS.
{"title":"Evaluation of the growth response to growth hormone therapy in short children with normal growth hormone secretion","authors":"E. Ahmed, A. Soliman","doi":"10.4103/ajop.ajop_30_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_30_22","url":null,"abstract":"Introduction The availability of biosynthetic growth hormone (GH) ensures that children who are deficient can have replacement therapy, but it has also created the opportunity to treat children who are short but do not have a deficiency. The target height of children with short stature who have normal GH secretion, idiopathic short stature (ISS), without treatment, fails to reach their midparental potential. GH therapy for these children has resulted in variable height outcomes. While some children reached or exceeded genetic target height, others did not have a favorable response. Aim The aim of this study was to report the outcome of the children with ISS who had initial height standard deviation score (HtSDS) (Z score) less than −2, with normal stimulated GH levels (>10 μg/l), after treatment with biosynthetic GH for at least 1 year. Patients and methods This retrospective study included 20 children with ISS, with initial HTSDS less than −2, normal stimulated GH levels (>10 μg/l), who were treated with rhGH (0.04 mg/kg/day) for at least 1 year. None had any other systemic or endocrine disorder. All had normal complete blood count, liver, and renal functions. Results Twenty children (15 males and five females) with ISS, aged between 4.3 and 13.8 years (mean=9.88±2.62 years), who had mean peak GH=15.58±6.95 μg, were studied. All received GH treatment (average GH dose was 0.04 mg/kg/day) for a mean duration=2.49±1.61 years. The mean midparental HtSDS (MPHSDS) was −1.23±0.57. Their bone age did not differ significantly compared with their chronological age (the mean difference=−0.13±0.67 years). The mean HSDS before treatment was −2.34±0.41 and after 1 year of GH treatment was −1.83±0.48. This gave a gain of an average of 0.5 SD. At the last visit (after a mean of 2.5 years), the HtSDS −1.57±0.55 SD with a gain of 0.77±0.14 SD versus before treatment. The difference between children HtSDS compared with their MPHSDS was −1.08 SD before treatment that was changed to −0.3 SD at the last visit. The increment in HSDS was positively correlated with the duration of rhGH therapy (r=0.82, P=0.01) and negatively correlated with age at the start of treatment (r=−0.54, P=0.01). Conclusion Growth hormone therapy that benefits short children with normal growth hormone secretion achieves near-normal HSDS and approaches MPHSDS.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"40 7","pages":"137 - 142"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72579967","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. Hassab, Azza Mohamed, Marwa H. Saied, Nehad Hassanein
Background Primary immune thrombocytopenia (ITP) is the most frequent hemorrhagic disease of childhood. It is an autoimmune disease characterized by abnormally increased destruction of platelets and decreased production of megakaryocytes. Stromal-derived factor-1 (SDF-1) plays a role in megakaryopoiesis and may be involved in the pathogenesis of ITP. Aim The aim of this study was to find out the prevalence of single-nucleotide polymorphism (SNP) of SDF-1 gene rs2297630 A&z.urule;G in children with ITP and its relation to chronicity. Participants and methods SNP of the SDF-1 gene (rs2297630) was assessed in 100 ITP children: 50 chronic and 50 nonchronic ITP children (acute and persistent) attending Alexandria University Children’s Hospital in Egypt and in 50 healthy controls of matched age and sex. The genotype was analyzed by PCR after DNA extraction from peripheral blood samples and confirmed by direct sequencing. Results In this study, analysis of the relationship between SDF-1 polymorphisms and clinical features showed that Rs2297630 A/G is not associated with protection from chronicity or steroid dependence in the studied patients [(χ2=0.0, P=1.0) and (P=0.21)]. respectively Conclusions ITP is not uncommon in Egyptian children and has a great financial and psychosocial burden on our community. AG genotype of the SNP (rs2297630) of the SDF gene has no significant relation to ITP chronicity or steroid dependence in the studied groups.
{"title":"Is there a relation between stromal-derived factor 1 polymorphism and ITP chronicity in Egyptian children?","authors":"H. Hassab, Azza Mohamed, Marwa H. Saied, Nehad Hassanein","doi":"10.4103/ajop.ajop_28_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_28_22","url":null,"abstract":"Background Primary immune thrombocytopenia (ITP) is the most frequent hemorrhagic disease of childhood. It is an autoimmune disease characterized by abnormally increased destruction of platelets and decreased production of megakaryocytes. Stromal-derived factor-1 (SDF-1) plays a role in megakaryopoiesis and may be involved in the pathogenesis of ITP. Aim The aim of this study was to find out the prevalence of single-nucleotide polymorphism (SNP) of SDF-1 gene rs2297630 A&z.urule;G in children with ITP and its relation to chronicity. Participants and methods SNP of the SDF-1 gene (rs2297630) was assessed in 100 ITP children: 50 chronic and 50 nonchronic ITP children (acute and persistent) attending Alexandria University Children’s Hospital in Egypt and in 50 healthy controls of matched age and sex. The genotype was analyzed by PCR after DNA extraction from peripheral blood samples and confirmed by direct sequencing. Results In this study, analysis of the relationship between SDF-1 polymorphisms and clinical features showed that Rs2297630 A/G is not associated with protection from chronicity or steroid dependence in the studied patients [(χ2=0.0, P=1.0) and (P=0.21)]. respectively Conclusions ITP is not uncommon in Egyptian children and has a great financial and psychosocial burden on our community. AG genotype of the SNP (rs2297630) of the SDF gene has no significant relation to ITP chronicity or steroid dependence in the studied groups.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"32 1","pages":"125 - 130"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74106580","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. A. Abd Elmaksoud, Amina Elhalawany, Neveen L Mikhael, Rana ElKazaz, Asmaa Elsharkawy, M. Gamaleldin, Y. El Chazli
Background Central nervous system (CNS) disease among patients with hemophagocytic lymphohistiocytosis (HLH) has not been standardized, which complicates the study of CNS-HLH and its management. Aims To investigate cerebrospinal fluid (CSF) ferritin, triglycerides (TG), and lactate dehydrogenase (LDH) levels as laboratory markers of CNS-HLH. Settings and design A study was conducted on available frozen pretreatment CSF samples of children treated for HLH. Inclusion criteria were children younger than 18 years, fulfilled at least five of the HLH-2004 diagnostic criteria, their frozen initial CSF sample was available, and all necessary clinical, radiological, and laboratory data were available. Patients and methods TG, ferritin, and LDH were measured in the CSF samples. CNS disease was positive if abnormal neurologic symptom/sign, abnormal CSF analysis (pleocytosis and/or elevated protein), or abnormal neuroimaging. Results Of 101 children with HLH, 33 met the inclusion criteria. Their age ranged from 1.1 to 196 months at diagnosis with a median of 13.5 months. The majority were females (69.7%). Seven patients were negative for CNS-HLH (19.4%) and 29 (80.6%) patients were positive according to the classical CNS-HLH criteria. At the end of the follow-up, 45% of patients had died. Significant correlations were found between CSF TG and both CSF protein and leukocytes (P=0.036 for both), and between CSF TG and serum ferritin (P=0.037). Only ferritin showed a significant correlation between its serum and CSF levels (P<0.0001). CSF ferritin and LDH were higher in nonsurvivors. Conclusions CSF TG may have a diagnostic value as a marker of CNS-HLH, whereas CSF ferritin and LDH may have a prognostic value. Further larger prospective studies are needed to verify these preliminary findings.
{"title":"Laboratory markers of central nervous system disease activity in children with hemophagocytic lymphohistiocytosis","authors":"M. A. Abd Elmaksoud, Amina Elhalawany, Neveen L Mikhael, Rana ElKazaz, Asmaa Elsharkawy, M. Gamaleldin, Y. El Chazli","doi":"10.4103/ajop.ajop_26_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_26_22","url":null,"abstract":"Background Central nervous system (CNS) disease among patients with hemophagocytic lymphohistiocytosis (HLH) has not been standardized, which complicates the study of CNS-HLH and its management. Aims To investigate cerebrospinal fluid (CSF) ferritin, triglycerides (TG), and lactate dehydrogenase (LDH) levels as laboratory markers of CNS-HLH. Settings and design A study was conducted on available frozen pretreatment CSF samples of children treated for HLH. Inclusion criteria were children younger than 18 years, fulfilled at least five of the HLH-2004 diagnostic criteria, their frozen initial CSF sample was available, and all necessary clinical, radiological, and laboratory data were available. Patients and methods TG, ferritin, and LDH were measured in the CSF samples. CNS disease was positive if abnormal neurologic symptom/sign, abnormal CSF analysis (pleocytosis and/or elevated protein), or abnormal neuroimaging. Results Of 101 children with HLH, 33 met the inclusion criteria. Their age ranged from 1.1 to 196 months at diagnosis with a median of 13.5 months. The majority were females (69.7%). Seven patients were negative for CNS-HLH (19.4%) and 29 (80.6%) patients were positive according to the classical CNS-HLH criteria. At the end of the follow-up, 45% of patients had died. Significant correlations were found between CSF TG and both CSF protein and leukocytes (P=0.036 for both), and between CSF TG and serum ferritin (P=0.037). Only ferritin showed a significant correlation between its serum and CSF levels (P<0.0001). CSF ferritin and LDH were higher in nonsurvivors. Conclusions CSF TG may have a diagnostic value as a marker of CNS-HLH, whereas CSF ferritin and LDH may have a prognostic value. Further larger prospective studies are needed to verify these preliminary findings.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"29 1","pages":"111 - 118"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74237522","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 Patients with juvenile idiopathic arthritis (JIA) seem to be at higher risk of developing immune-mediated diseases like celiac disease (CD) than general population. Aim The aim of this study was to detect the prevalence of CD among children and adolescents with JIA. Patients and methods We carried out a cross-sectional study that included 42 JIA patients under the age of 16 years. In addition to demographic, clinical, and laboratory data, anti-tissue transglutaminase immunoglobulin A (anti-TTG IgA) antibodies were measured using a novel chemiluminescent immunoassay. Results Only one (2.4%) patient had positive anti-TTG IgA. There was no significant correlation between anti-TTG IgA and terms of growth parameters, JIA subtype, or medications. Conclusion JIA patients seem to be at higher risk to develop CD. Being mostly asymptomatic, they should be candidates for periodic screening. Methodologically standardized larger studies are recommended to reach a cost-effective protocol for monitoring JIA patients regarding the development of CD, adding to early diagnosis and control of the disease.
{"title":"Serological screening of celiac disease in children and adolescents with juvenile idiopathic arthritis","authors":"Abobakr A. Abdelgalil, Sara Tarek","doi":"10.4103/ajop.ajop_25_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_25_22","url":null,"abstract":"Background Patients with juvenile idiopathic arthritis (JIA) seem to be at higher risk of developing immune-mediated diseases like celiac disease (CD) than general population. Aim The aim of this study was to detect the prevalence of CD among children and adolescents with JIA. Patients and methods We carried out a cross-sectional study that included 42 JIA patients under the age of 16 years. In addition to demographic, clinical, and laboratory data, anti-tissue transglutaminase immunoglobulin A (anti-TTG IgA) antibodies were measured using a novel chemiluminescent immunoassay. Results Only one (2.4%) patient had positive anti-TTG IgA. There was no significant correlation between anti-TTG IgA and terms of growth parameters, JIA subtype, or medications. Conclusion JIA patients seem to be at higher risk to develop CD. Being mostly asymptomatic, they should be candidates for periodic screening. Methodologically standardized larger studies are recommended to reach a cost-effective protocol for monitoring JIA patients regarding the development of CD, adding to early diagnosis and control of the disease.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"39 1","pages":"106 - 110"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75101865","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}
Arundhathi Shankaralingappa, T. Arun Babu, Ravish Huchegowda
Background Coronavirus disease 2019 (COVID-2019) was declared as a pandemic on March 11, 2020 by the WHO. This disease was complicated by its association with an opportunistic fungal infection, termed as COVID-19-associated mucormycosis (CAM). CAM is well described in adults, but only a few case reports and series were published about pediatric CAM. Objectives This systematic review aimed to describe the clinical spectrum and outcome of CAM cases in children. Patients and methods A systematic review of literature was done in agreement with PRISMA guidelines to understand the clinical profile of pediatric CAM. Pubmed, Scopus, Google Scholar databases, and news websites were searched to identify any relevant article on pediatric CAM..References within the included articles were reviewed. All articles that met the criteria were analyzed for demographics, clinical, laboratory, radiographic, treatment, and outcome data. Results We retrieved a total of 13 cases of pediatric CAM, which were included in this systematic review. The mean age at presentation was 11.6 years (range, 5–16 years). Diabetes mellitus was the underlying cause in four cases, whereas three of them presented with diabetic ketoacidosis. Five children were immunocompromised, which included two cases of acute lymphoreticular malignancy. Rhinocerebral, orbital, and gastrointestinal mucormycosis was seen in three, two, and one case, respectively. Out 13 cases, two succumbed to the illness. Conclusion Most children with CAM had definite underlying risk factors like diabetes mellitus, lymphoreticular malignancies, and immunodeficiency status. The clinical presentation and outcome in children were similar to adults.
{"title":"Coronavirus disease 2019-associated mucormycosis in children: a systematic review of reported cases in the literature","authors":"Arundhathi Shankaralingappa, T. Arun Babu, Ravish Huchegowda","doi":"10.4103/ajop.ajop_32_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_32_22","url":null,"abstract":"Background Coronavirus disease 2019 (COVID-2019) was declared as a pandemic on March 11, 2020 by the WHO. This disease was complicated by its association with an opportunistic fungal infection, termed as COVID-19-associated mucormycosis (CAM). CAM is well described in adults, but only a few case reports and series were published about pediatric CAM. Objectives This systematic review aimed to describe the clinical spectrum and outcome of CAM cases in children. Patients and methods A systematic review of literature was done in agreement with PRISMA guidelines to understand the clinical profile of pediatric CAM. Pubmed, Scopus, Google Scholar databases, and news websites were searched to identify any relevant article on pediatric CAM..References within the included articles were reviewed. All articles that met the criteria were analyzed for demographics, clinical, laboratory, radiographic, treatment, and outcome data. Results We retrieved a total of 13 cases of pediatric CAM, which were included in this systematic review. The mean age at presentation was 11.6 years (range, 5–16 years). Diabetes mellitus was the underlying cause in four cases, whereas three of them presented with diabetic ketoacidosis. Five children were immunocompromised, which included two cases of acute lymphoreticular malignancy. Rhinocerebral, orbital, and gastrointestinal mucormycosis was seen in three, two, and one case, respectively. Out 13 cases, two succumbed to the illness. Conclusion Most children with CAM had definite underlying risk factors like diabetes mellitus, lymphoreticular malignancies, and immunodeficiency status. The clinical presentation and outcome in children were similar to adults.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"14 1","pages":"147 - 152"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82140687","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. Badr, T. Hassan, M. Shehab, Nermin Raafat, D. Hanna
Background Cardiac iron overload is secondary to chronic blood transfusion in patients with sickle cell disease (SCD). Iron overload cardiomyopathy is a restrictive cardiomyopathy associated with systolic and diastolic dysfunction. Matrix metalloproteinases (MMPs) are a family of zinc-dependent endopeptidases responsible for tissue remodeling. Many studies offer strong evidence for the role of MMP-9 in left ventricular (LV) remodeling. Objective The authors aimed to detect the plasma levels of MMP-9 in patients with SCD and its relationship to myocardial iron overload. Materials and methods A case–control study was carried out on 75 patients with SCD and 75 age-matched and sex-matched healthy controls. Assessment of cardiac iron overload in patients by MRI T2FNx01 was performed. Plasma MMP-9 levels were measured for patients and controls using enzyme-linked immunosorbent assay. Results Patients with SCD had significantly higher levels of MMP-9 than controls. There was a highly significant relationship between plasma levels of MMP-9 and each of cardiac T2FNx01 and serum ferritin. Patients with vaso-occlusive crises (VOC) greater than 5/year had significantly higher levels of MMP-9 than those with VOC less than or equal to 5 /year. Conclusion MMP-9 seems to be a useful marker in patients with SCD. Patients with cardiac T2FNx01 less than 20 ms, serum ferritin greater than 1000 ng/ml, and recurrent VOC greater than 5/year had significantly higher MMP-9 serum levels than others.
{"title":"Assessment of plasma level of matrix metalloproteinase-9 in patients with sickle cell disease and its relationship to myocardial iron overload: a case–control study","authors":"M. Badr, T. Hassan, M. Shehab, Nermin Raafat, D. Hanna","doi":"10.4103/ajop.ajop_29_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_29_22","url":null,"abstract":"Background Cardiac iron overload is secondary to chronic blood transfusion in patients with sickle cell disease (SCD). Iron overload cardiomyopathy is a restrictive cardiomyopathy associated with systolic and diastolic dysfunction. Matrix metalloproteinases (MMPs) are a family of zinc-dependent endopeptidases responsible for tissue remodeling. Many studies offer strong evidence for the role of MMP-9 in left ventricular (LV) remodeling. Objective The authors aimed to detect the plasma levels of MMP-9 in patients with SCD and its relationship to myocardial iron overload. Materials and methods A case–control study was carried out on 75 patients with SCD and 75 age-matched and sex-matched healthy controls. Assessment of cardiac iron overload in patients by MRI T2FNx01 was performed. Plasma MMP-9 levels were measured for patients and controls using enzyme-linked immunosorbent assay. Results Patients with SCD had significantly higher levels of MMP-9 than controls. There was a highly significant relationship between plasma levels of MMP-9 and each of cardiac T2FNx01 and serum ferritin. Patients with vaso-occlusive crises (VOC) greater than 5/year had significantly higher levels of MMP-9 than those with VOC less than or equal to 5 /year. Conclusion MMP-9 seems to be a useful marker in patients with SCD. Patients with cardiac T2FNx01 less than 20 ms, serum ferritin greater than 1000 ng/ml, and recurrent VOC greater than 5/year had significantly higher MMP-9 serum levels than others.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"36 1","pages":"131 - 136"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85387432","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 : 2022-05-01DOI: 10.1530/endoabs.81.ep1035
E. Ahmed, A. Soliman, M. Farag
Introduction Thyroid hormones have direct and indirect cellular effects on the cardiovascular system. Chronic administration of L-thyroxine (LT4) to children with hypothyroidism may affect cardiovascular dynamics. Aim This cross-sectional observational study measured the blood pressure (BP) and heart rate (HR) of 25 randomly selected children with hypothyroidism in relation to their serum-free thyroxine (FT4), thyroid-stimulating hormone (TSH) levels, and thyroxine dose μg/kg. Patients and methods In total, 25 randomly selected children with a mean age 9.6±4.5 years with the diagnosis of congenital or acquired hypothyroidism. They were on l-thyroxine therapy to keep serum-FT4 and TSH in the normal range for age. Their BP and HR (average of three readings), weight, height, dose of thyroxine, and their serum level of TSH and free T4 levels within 2 weeks before the clinic visit were recorded. The Z scores of the height, height standard deviation score (HSDS), body mass index standard deviation score (BMISDS), systolic (SBPSDS), and diastolic blood pressure standard deviation score (DBPSDS) were calculated (as per the 2004 guideline report on hypertension from the National Heart and Lung Institute), and HR [as per the Monitoring and Diagnosis Group at Oxford (MADOX) systematic review of 2011] was calculated for age and sex. Results The authors studied 25 children with hypothyroidism. Their dose of thyroxine was 2.11±0.7 μg/kg. Their mean serum-FT4 levels were 15.1±2.5 μg/l and TSH level was 3.9±2.8 mIU/ml. Their HtSDS (−0.57±1.4) and BMISDS (0.63±1.63) were within normal. All had normal diastolic blood pressure readings (within 2 standard deviations of the mean for age and sex). Two of the individuals had systolic BPs greater than 2SDS above the mean for age and sex, with normal BMISDS. Both had normal FT4 and TSH levels. One patient had tachycardia [HR=146/min (Z-score +3.2 for age)]. His FT4 and TSH levels were normal. There was a positive correlation between thyroxine dose/kg and serum level of FT4 (r=0.52), HR (r=0.56), SBPSDS (r=0.38), and DBPSDS (r=0.24). There was no significant correlation between the HtSDS on the one hand and FT4, TSH, or thyroxine dose on the other hand. The BMISDS was negatively correlated with TSH level (r=−0.4). Conclusion In this study on hypothyroid children on l-thyroxine therapy, 2 had high systolic BP and one had tachycardia. The significant correlation between the thyroxine dose, FT4 level, and BP and HR should alert the pediatrician to monitor BP and HR closely in relation to TSH and FT4 levels of these patients.
{"title":"The effect of L-thyroxine replacement on blood pressure and heart rate in children with hypothyroidism: correlation with free thyroxine and thyrotropin levels","authors":"E. Ahmed, A. Soliman, M. Farag","doi":"10.1530/endoabs.81.ep1035","DOIUrl":"https://doi.org/10.1530/endoabs.81.ep1035","url":null,"abstract":"Introduction Thyroid hormones have direct and indirect cellular effects on the cardiovascular system. Chronic administration of L-thyroxine (LT4) to children with hypothyroidism may affect cardiovascular dynamics. Aim This cross-sectional observational study measured the blood pressure (BP) and heart rate (HR) of 25 randomly selected children with hypothyroidism in relation to their serum-free thyroxine (FT4), thyroid-stimulating hormone (TSH) levels, and thyroxine dose μg/kg. Patients and methods In total, 25 randomly selected children with a mean age 9.6±4.5 years with the diagnosis of congenital or acquired hypothyroidism. They were on l-thyroxine therapy to keep serum-FT4 and TSH in the normal range for age. Their BP and HR (average of three readings), weight, height, dose of thyroxine, and their serum level of TSH and free T4 levels within 2 weeks before the clinic visit were recorded. The Z scores of the height, height standard deviation score (HSDS), body mass index standard deviation score (BMISDS), systolic (SBPSDS), and diastolic blood pressure standard deviation score (DBPSDS) were calculated (as per the 2004 guideline report on hypertension from the National Heart and Lung Institute), and HR [as per the Monitoring and Diagnosis Group at Oxford (MADOX) systematic review of 2011] was calculated for age and sex. Results The authors studied 25 children with hypothyroidism. Their dose of thyroxine was 2.11±0.7 μg/kg. Their mean serum-FT4 levels were 15.1±2.5 μg/l and TSH level was 3.9±2.8 mIU/ml. Their HtSDS (−0.57±1.4) and BMISDS (0.63±1.63) were within normal. All had normal diastolic blood pressure readings (within 2 standard deviations of the mean for age and sex). Two of the individuals had systolic BPs greater than 2SDS above the mean for age and sex, with normal BMISDS. Both had normal FT4 and TSH levels. One patient had tachycardia [HR=146/min (Z-score +3.2 for age)]. His FT4 and TSH levels were normal. There was a positive correlation between thyroxine dose/kg and serum level of FT4 (r=0.52), HR (r=0.56), SBPSDS (r=0.38), and DBPSDS (r=0.24). There was no significant correlation between the HtSDS on the one hand and FT4, TSH, or thyroxine dose on the other hand. The BMISDS was negatively correlated with TSH level (r=−0.4). Conclusion In this study on hypothyroid children on l-thyroxine therapy, 2 had high systolic BP and one had tachycardia. The significant correlation between the thyroxine dose, FT4 level, and BP and HR should alert the pediatrician to monitor BP and HR closely in relation to TSH and FT4 levels of these patients.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"51 1","pages":"143 - 146"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91267562","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. Sherbiny, M. Gafar, Hamada Ibrahim, Samah Bayomi, Wesam A. Mokhtar
Background Ionizing radiation-dependent modalities are still the mainstay investigations used in the neonatal intensive care unit (NICU). Neonates are particularly vulnerable to biohazards of ionizing radiation, a fact that renders searching for radiation-free modality a priority in the neonatal care setting. Patients and methods Patients who participated in this case–control study were classified into two groups: 127 neonates who presented to the NICU with respiratory distress manifestations were enrolled as the ‘case’ group, and 80 neonates 80 of comparable age and sex were selected and enrolled as the ‘control’ group, as they all had nonrespiratory manifestations. All participants were subjected to full history taking, thorough physical examinations, and routine investigations. Chest radiograph was performed on first presentation and as needed for follow-up as per the unit protocol; concomitantly, lung ultrasound (LUS) was performed with each radiograph. Throughout our study, if LUS interpretation in the context of clinical data reported the same diagnosis as clinical and radiography did, we considered the case as matching (positive) and vice versa. Results A total of 618 chest radiograph and concomitant LUS images were included in the study, as 207 (127 cases and 80 controls) images for initial diagnosis and 411 for follow-up of neonates presented with respiratory distress. The average number of images was 4.2 images/case during the follow-up (range, 1–22). Cases displayed lighter birth weight, with significantly higher prevalence of low birth weight and very low birth weight, than controls. Moreover, most cases (84%) were delivered by cesarean section. Among cases, transient tachypnea of newborn and respiratory distress syndrome were the most common diagnosis, whereas neonatal hyperbilirubinemia and seizures were the most frequent diagnosis among controls. Plain radiograph was the reference modality for diagnosis and follow-up (100% of cases had radiologic findings, whereas all controls had free chest radiograph). Overall, 8/127 (6%) cases of respiratory distress, clinically and radiologically, displayed normal LUS images at the initial presentation (false negative), whereas 3/80 (4%) of controls, who presented with nonrespiratory manifestations and had free chest radiograph, showed numerous B-lines on LUS (false positive). Nonsignificant differences were confirmed between chest radiograph findings and those of LUS in the initial diagnosis of different neonatal respiratory disorders, with sensitivity of 94%, specificity of 96%, positive predictive value of 97.5%, and negative predictive value of 90.5% for LUS as compared with plain chest radiograph. Similar matching between diagnosis concluded by radiographs and concomitant LUS was appreciated during follow-up of different respiratory diseases. Conclusion LUS is a suitable modality in NICU setting as it is a safe, radiation-free, dynamic, and real-time bedside assessment. It has an accepted
{"title":"Diagnostic value of lung ultrasonography in respiratory disorders of neonates","authors":"H. Sherbiny, M. Gafar, Hamada Ibrahim, Samah Bayomi, Wesam A. Mokhtar","doi":"10.4103/ajop.ajop_21_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_21_22","url":null,"abstract":"Background Ionizing radiation-dependent modalities are still the mainstay investigations used in the neonatal intensive care unit (NICU). Neonates are particularly vulnerable to biohazards of ionizing radiation, a fact that renders searching for radiation-free modality a priority in the neonatal care setting. Patients and methods Patients who participated in this case–control study were classified into two groups: 127 neonates who presented to the NICU with respiratory distress manifestations were enrolled as the ‘case’ group, and 80 neonates 80 of comparable age and sex were selected and enrolled as the ‘control’ group, as they all had nonrespiratory manifestations. All participants were subjected to full history taking, thorough physical examinations, and routine investigations. Chest radiograph was performed on first presentation and as needed for follow-up as per the unit protocol; concomitantly, lung ultrasound (LUS) was performed with each radiograph. Throughout our study, if LUS interpretation in the context of clinical data reported the same diagnosis as clinical and radiography did, we considered the case as matching (positive) and vice versa. Results A total of 618 chest radiograph and concomitant LUS images were included in the study, as 207 (127 cases and 80 controls) images for initial diagnosis and 411 for follow-up of neonates presented with respiratory distress. The average number of images was 4.2 images/case during the follow-up (range, 1–22). Cases displayed lighter birth weight, with significantly higher prevalence of low birth weight and very low birth weight, than controls. Moreover, most cases (84%) were delivered by cesarean section. Among cases, transient tachypnea of newborn and respiratory distress syndrome were the most common diagnosis, whereas neonatal hyperbilirubinemia and seizures were the most frequent diagnosis among controls. Plain radiograph was the reference modality for diagnosis and follow-up (100% of cases had radiologic findings, whereas all controls had free chest radiograph). Overall, 8/127 (6%) cases of respiratory distress, clinically and radiologically, displayed normal LUS images at the initial presentation (false negative), whereas 3/80 (4%) of controls, who presented with nonrespiratory manifestations and had free chest radiograph, showed numerous B-lines on LUS (false positive). Nonsignificant differences were confirmed between chest radiograph findings and those of LUS in the initial diagnosis of different neonatal respiratory disorders, with sensitivity of 94%, specificity of 96%, positive predictive value of 97.5%, and negative predictive value of 90.5% for LUS as compared with plain chest radiograph. Similar matching between diagnosis concluded by radiographs and concomitant LUS was appreciated during follow-up of different respiratory diseases. Conclusion LUS is a suitable modality in NICU setting as it is a safe, radiation-free, dynamic, and real-time bedside assessment. It has an accepted ","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"50 1","pages":"81 - 91"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77574635","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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