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}
Background Mucopolysaccharidosis is an inherited lysosomal-storage disease, due to deficiency in lysosomal enzymes degrading glycosaminoglycans, causing accumulation of undegraded substrate within the lysosomes. These substrates are related to widespread inflammation, as well as the release of various proinflammatory immune mediators and autophagy dysfunction. Oxidative stress, abnormal mitochondrial function, and disruption in homeostasis also play a role in mucopolysaccharide (MPS) pathogenesis. Defects in immunological parameters in MPS have been described and postulated as explanations for the increased severity of infections seen in MPS children. Most of these infections are of the respiratory tract. Aim The aim was to estimate the total level of immunoglobulin G (IgG) and its subclasses in children with MPS and find out the relation if any between the estimated levels and the recurrence of infections. Patients and methods The study was conducted on 35 children with MPS, either newly diagnosed or previously diagnosed cases attending the genetic clinic of Alexandria University Children’s Hospital for follow-up in the period from July 2019 to July 2020. ELISA was used for estimation of the levels of total IgG and its subtypes (IgG1, IgG2, IgG3, and IgG4). Results The levels of total IgG and its subtypes (IgG1, IgG2, IgG3, and IgG4) were measured in all studied cases. A positive significant correlation between IgG3 and repeated upper respiratory-tract infections (URTIs), that 68.2% of cases with high levels of IgG3 had repeated URTIs, while only 31.8% of cases with normal levels of IgG3 had repeated URTIs with P value of 0.001. Conclusion Children with MPS are especially prone to repeated URTIs more than six times/year, this increased susceptibility to infections has been linked to abnormal parameters of the immune system. IgG subclasses are a significant predictor of recurrent URTIs in patients with MPS disease. Therefore, measurement of IgG subclass level, especially IgG3 level, provides a new strategy to more aggressive treatments for high-risk groups.
{"title":"Immunoglobulin-G subclass pattern among children with mucopolysaccharidosis attending the genetic clinic of Alexandria University Children’s Hospital","authors":"G. Elderiny, Iman Marzouk, Ola Elbanna","doi":"10.4103/ajop.ajop_11_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_11_22","url":null,"abstract":"Background Mucopolysaccharidosis is an inherited lysosomal-storage disease, due to deficiency in lysosomal enzymes degrading glycosaminoglycans, causing accumulation of undegraded substrate within the lysosomes. These substrates are related to widespread inflammation, as well as the release of various proinflammatory immune mediators and autophagy dysfunction. Oxidative stress, abnormal mitochondrial function, and disruption in homeostasis also play a role in mucopolysaccharide (MPS) pathogenesis. Defects in immunological parameters in MPS have been described and postulated as explanations for the increased severity of infections seen in MPS children. Most of these infections are of the respiratory tract. Aim The aim was to estimate the total level of immunoglobulin G (IgG) and its subclasses in children with MPS and find out the relation if any between the estimated levels and the recurrence of infections. Patients and methods The study was conducted on 35 children with MPS, either newly diagnosed or previously diagnosed cases attending the genetic clinic of Alexandria University Children’s Hospital for follow-up in the period from July 2019 to July 2020. ELISA was used for estimation of the levels of total IgG and its subtypes (IgG1, IgG2, IgG3, and IgG4). Results The levels of total IgG and its subtypes (IgG1, IgG2, IgG3, and IgG4) were measured in all studied cases. A positive significant correlation between IgG3 and repeated upper respiratory-tract infections (URTIs), that 68.2% of cases with high levels of IgG3 had repeated URTIs, while only 31.8% of cases with normal levels of IgG3 had repeated URTIs with P value of 0.001. Conclusion Children with MPS are especially prone to repeated URTIs more than six times/year, this increased susceptibility to infections has been linked to abnormal parameters of the immune system. IgG subclasses are a significant predictor of recurrent URTIs in patients with MPS disease. Therefore, measurement of IgG subclass level, especially IgG3 level, provides a new strategy to more aggressive treatments for high-risk groups.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"37 1","pages":"1 - 7"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79344490","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}
A. El Awwa, A. Soliman, Suhair El Siddig, M. Farag
Introduction Physiologically, growth hormone (GH) increases lean body mass and has a lipolytic function. However, long-term changes in weight status during GH treatment, as a function of pretreatment weight status have not previously been reported in large data sets. Aim To identify the growth response to GH therapy in those who were before treatment underweight versus normal weight short children. Patients and methods A retrospective study, we studied the auxologic data of 78 short, prepubertal children [height standard deviation score (HtSDS) less than −2 SDS below the mean for age and sex] with normal GH secretion [idiopathic short stature (ISS)]. Two groups were identified according to their pretreatment body mass index standard deviation score (BMISDS). Nineteen children were underweight (BMISDS < −2) and 59 children had normal BMISDS (>−2). All children received daily subcutaneous dose of GH (0.03–0.05 mg/kg/day) to keep their insulin-like growth factor-1 (IGF-1) level between 0 and 2 SD for 2 years. Results Before GH treatment, the underweight ISS group had significantly lower IGF-1 level versus the normal weight group with IGF-1 SD −1.633±0.766 SD versus −0.749±1.197 SD, respectively. Age and HtSDS did not differ among the two underweight and normal weight groups. Treatment with GH for 2 years was associated with a significant increase in the BMISDS in the underweight group (BMISDS increased by 0.45 SD) from −2.063±0.344 before treatment with GH versus −1.633±0.766 after treatment but not in the normal weight group. The HtSDS increased significantly in both groups after GH therapy, but the increase was greater in children with normal weight versus those with underweight as the increment in HtSDS was 0.42 and 0.374 SD, respectively. The difference of HtSDS from mid-parental HtSDS in low BMI versus normal BMI groups was −0.91 and −1.212 SD, respectively Conclusions GH therapy for 2 years significantly increased the IGF-1 level and improved BMISDS and HtSDS in underweight children with ISS. The BMISDS was better in the underweight group, but their HtSDS was less compared with the normal weight group.
{"title":"Linear growth response to growth hormone therapy in underweight versus normal weight short children","authors":"A. El Awwa, A. Soliman, Suhair El Siddig, M. Farag","doi":"10.4103/ajop.ajop_15_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_15_22","url":null,"abstract":"Introduction Physiologically, growth hormone (GH) increases lean body mass and has a lipolytic function. However, long-term changes in weight status during GH treatment, as a function of pretreatment weight status have not previously been reported in large data sets. Aim To identify the growth response to GH therapy in those who were before treatment underweight versus normal weight short children. Patients and methods A retrospective study, we studied the auxologic data of 78 short, prepubertal children [height standard deviation score (HtSDS) less than −2 SDS below the mean for age and sex] with normal GH secretion [idiopathic short stature (ISS)]. Two groups were identified according to their pretreatment body mass index standard deviation score (BMISDS). Nineteen children were underweight (BMISDS < −2) and 59 children had normal BMISDS (>−2). All children received daily subcutaneous dose of GH (0.03–0.05 mg/kg/day) to keep their insulin-like growth factor-1 (IGF-1) level between 0 and 2 SD for 2 years. Results Before GH treatment, the underweight ISS group had significantly lower IGF-1 level versus the normal weight group with IGF-1 SD −1.633±0.766 SD versus −0.749±1.197 SD, respectively. Age and HtSDS did not differ among the two underweight and normal weight groups. Treatment with GH for 2 years was associated with a significant increase in the BMISDS in the underweight group (BMISDS increased by 0.45 SD) from −2.063±0.344 before treatment with GH versus −1.633±0.766 after treatment but not in the normal weight group. The HtSDS increased significantly in both groups after GH therapy, but the increase was greater in children with normal weight versus those with underweight as the increment in HtSDS was 0.42 and 0.374 SD, respectively. The difference of HtSDS from mid-parental HtSDS in low BMI versus normal BMI groups was −0.91 and −1.212 SD, respectively Conclusions GH therapy for 2 years significantly increased the IGF-1 level and improved BMISDS and HtSDS in underweight children with ISS. The BMISDS was better in the underweight group, but their HtSDS was less compared with the normal weight group.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"25 1","pages":"47 - 51"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89493387","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 Midparental height (MPH) can be used as a crude prediction of the child’s adult height. Familial short stature (FSS) is a condition in which the final adult height achieved is less than the third percentile for the patient’s age, sex, and population. Nevertheless, it is consistent with parental height in the absence of nutritional, hormonal, acquired, genetic, and iatrogenic causes. The rationale for treating childhood short stature includes increasing height and alleviating psychosocial disability while maintaining favorable risk/benefit and cost/benefit ratios. Selection among management options may therefore depend on the degree to which each meets these goals. Inappropriately, ascribing a child’s extreme shortness to relatively short parents could thus result in delayed investigations or failure to appreciate the seriousness of a child’s situation. Aim The aim of this study is to evaluate the response to growth hormone (GH) therapy when the decision of treatment was made based on their relation to MPH whether FSS or much shorter than their MPH standard deviation score (SDS). Patients and methods This is a retrospective study; we studied the auxologic data of 21 children with FSS [height SDS (HtSDS) <−2, MPHSDS <−2 SD] and 14 children who were not short [HtSDS >−2, but ≥1 SD shorter than their MPHSDS who were treated with recombinant GH (somatropin/norditropin] 0.03–0.05 mg/kg/day daily for more than 1 year, and the dose was adjusted to keep the insulin-like growth factor-1 (IGF-1) level in the upper quartile of normal for age. Results In the FSS group, after an average of 3.27 years on GH treatment, the HtSDS increased by 0.92 SD, and IGF-1 SD increased by 2.87 SD. Difference between the HtSDS and MPHSDS improved significantly from −0.18 to 0.74 SD. In the other group, after GH therapy the HtSDS increased by 0.5 and IGFSDS increased by 3.24 SD. Difference between the HtSDS and MPHSDS improved significantly from −1.26 to −0.72 SD. However, the HtSDS was still more than 0.5 or more lower than the MPHSDS. In both groups, the HtSDS gain was positively correlated with the duration of GH therapy (r=0.52, P=0.01) and negatively correlated with the age at the start of treatment (r=−0.34, P=0.01) and the pretreatment IGF-1 level (r=−0.37, P=0.04). Conclusion GH therapy improved HtSDS even to exceed MPHSDS in children with FSS. Children with normal stature while far below MPHSDS had their HtSDS improved with GH therapy while did not reach their MPHSDS. The duration and age at the start of GH therapy are important parameters for the favorable outcome. MPHSDS is an important parameter in GH therapy decision.
{"title":"Evaluation of the response to growth hormone therapy when the decision of treatment was done based on the relation to the mid parental height","authors":"A. El Awwa, A. Soliman, Suhair Siddig","doi":"10.4103/ajop.ajop_4_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_4_22","url":null,"abstract":"Introduction Midparental height (MPH) can be used as a crude prediction of the child’s adult height. Familial short stature (FSS) is a condition in which the final adult height achieved is less than the third percentile for the patient’s age, sex, and population. Nevertheless, it is consistent with parental height in the absence of nutritional, hormonal, acquired, genetic, and iatrogenic causes. The rationale for treating childhood short stature includes increasing height and alleviating psychosocial disability while maintaining favorable risk/benefit and cost/benefit ratios. Selection among management options may therefore depend on the degree to which each meets these goals. Inappropriately, ascribing a child’s extreme shortness to relatively short parents could thus result in delayed investigations or failure to appreciate the seriousness of a child’s situation. Aim The aim of this study is to evaluate the response to growth hormone (GH) therapy when the decision of treatment was made based on their relation to MPH whether FSS or much shorter than their MPH standard deviation score (SDS). Patients and methods This is a retrospective study; we studied the auxologic data of 21 children with FSS [height SDS (HtSDS) <−2, MPHSDS <−2 SD] and 14 children who were not short [HtSDS >−2, but ≥1 SD shorter than their MPHSDS who were treated with recombinant GH (somatropin/norditropin] 0.03–0.05 mg/kg/day daily for more than 1 year, and the dose was adjusted to keep the insulin-like growth factor-1 (IGF-1) level in the upper quartile of normal for age. Results In the FSS group, after an average of 3.27 years on GH treatment, the HtSDS increased by 0.92 SD, and IGF-1 SD increased by 2.87 SD. Difference between the HtSDS and MPHSDS improved significantly from −0.18 to 0.74 SD. In the other group, after GH therapy the HtSDS increased by 0.5 and IGFSDS increased by 3.24 SD. Difference between the HtSDS and MPHSDS improved significantly from −1.26 to −0.72 SD. However, the HtSDS was still more than 0.5 or more lower than the MPHSDS. In both groups, the HtSDS gain was positively correlated with the duration of GH therapy (r=0.52, P=0.01) and negatively correlated with the age at the start of treatment (r=−0.34, P=0.01) and the pretreatment IGF-1 level (r=−0.37, P=0.04). Conclusion GH therapy improved HtSDS even to exceed MPHSDS in children with FSS. Children with normal stature while far below MPHSDS had their HtSDS improved with GH therapy while did not reach their MPHSDS. The duration and age at the start of GH therapy are important parameters for the favorable outcome. MPHSDS is an important parameter in GH therapy decision.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"1 1","pages":"40 - 46"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84770088","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}
Hamdy Bedar, A. Mansour, Doaa S. Ahmed, Elham E. Elsakka
Background and aim The relation between vitamin D, the use of antiepileptic drugs (AEDs), and bone integrity has been found in patients with epilepsy. The aim of the work was to study the prevalence of vitamin D insufficiency and deficiency among children with epilepsy, and to identify some possible risk factors. Patients and methods A comparative cross-sectional study was done on randomly chosen 60 children with epilepsy aged 3–15 years attending the neurology out-patient clinic and 20 healthy age-matched and sex-matched children, attending the pediatric outpatient clinic at Alexandria University Children’s Hospital from September 2014 to March 2015. They were divided into three groups: group I included 40 children receiving AED monotherapy for more than 1 year; group II included newly diagnosed epileptic children before receiving medications; group III included 20 healthy children as controls. History taking included patients’ age, sex, seizure history, nutritional history, sunlight exposure, associated illness or drug intake and history of vitamin D or calcium supplementation. Clinical examinations were done (systematic and neurological examination, weight and BMI). Laboratory investigations [liver and kidney function tests, serum calcium, phosphorus, alkaline phosphatase, and serum 25-hydroxyvitamin D (25(OH)D) levels] were done. Electroencephalogram was done for groups I and II. Results There was no significant difference between all groups regarding age and sex. The BMI was significantly different between groups II and III. Laboratory tests (alanine aminotransferase, aspartate aminotransferase, urea, creatinine, serum calcium, phosphorus, and alkaline phosphatase levels) showed no significant differences between the three studied groups. The mean of 25(OH)D among children in group I was significantly lower compared with children in group III. Females were associated with insufficient and deficient levels of vitamin D. There were statistically significant relations between 25(OH)D levels and BMI and the duration of AED treatment in group I. Conclusion The present study provides evidence of the increased prevalence of vitamin D insufficiency and deficiency among newly diagnosed children with epilepsy and in those on treatment with AEDs. In addition, the study has indicated that female sex, high BMI, AED use (carbamazepine, Na valproate) and prolonged duration of treatment are risk factors for vitamin D insufficiency and deficiency.
{"title":"Prevalence of vitamin D insufficiency and deficiency among children with epilepsy","authors":"Hamdy Bedar, A. Mansour, Doaa S. Ahmed, Elham E. Elsakka","doi":"10.4103/ajop.ajop_9_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_9_22","url":null,"abstract":"Background and aim The relation between vitamin D, the use of antiepileptic drugs (AEDs), and bone integrity has been found in patients with epilepsy. The aim of the work was to study the prevalence of vitamin D insufficiency and deficiency among children with epilepsy, and to identify some possible risk factors. Patients and methods A comparative cross-sectional study was done on randomly chosen 60 children with epilepsy aged 3–15 years attending the neurology out-patient clinic and 20 healthy age-matched and sex-matched children, attending the pediatric outpatient clinic at Alexandria University Children’s Hospital from September 2014 to March 2015. They were divided into three groups: group I included 40 children receiving AED monotherapy for more than 1 year; group II included newly diagnosed epileptic children before receiving medications; group III included 20 healthy children as controls. History taking included patients’ age, sex, seizure history, nutritional history, sunlight exposure, associated illness or drug intake and history of vitamin D or calcium supplementation. Clinical examinations were done (systematic and neurological examination, weight and BMI). Laboratory investigations [liver and kidney function tests, serum calcium, phosphorus, alkaline phosphatase, and serum 25-hydroxyvitamin D (25(OH)D) levels] were done. Electroencephalogram was done for groups I and II. Results There was no significant difference between all groups regarding age and sex. The BMI was significantly different between groups II and III. Laboratory tests (alanine aminotransferase, aspartate aminotransferase, urea, creatinine, serum calcium, phosphorus, and alkaline phosphatase levels) showed no significant differences between the three studied groups. The mean of 25(OH)D among children in group I was significantly lower compared with children in group III. Females were associated with insufficient and deficient levels of vitamin D. There were statistically significant relations between 25(OH)D levels and BMI and the duration of AED treatment in group I. Conclusion The present study provides evidence of the increased prevalence of vitamin D insufficiency and deficiency among newly diagnosed children with epilepsy and in those on treatment with AEDs. In addition, the study has indicated that female sex, high BMI, AED use (carbamazepine, Na valproate) and prolonged duration of treatment are risk factors for vitamin D insufficiency and deficiency.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"1994 1","pages":"67 - 77"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89080701","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, O. Aly, Magdy Abd Elfatah, Aml Mahfouz
Background Breastfeeding (BF) was suggested as an environmental factor that may confer a protective role against autism. Aim The primary aim was to compare the patterns of BF in children with autism spectrum disorder (ASD) with their typically developing siblings. The secondary objective was to conduct a pilot study to investigate the effect of BF on the severity of the core ASD symptoms and the intellectual functions among children with ASD. Patients and methods A comparative cross-sectional study was conducted at the Outpatient Clinic of Alexandria University Children’s Hospital on 100 children; 50 children with ASD (group A, n=50) and 50 typically developing children; siblings of children of group A (group B, n=50) using a designed semistructured questionnaire. Results The comparison between both groups revealed that neither BF ever, early initiation, prolonged duration, nor exclusive BF were statistically different in children with autism and their siblings. Among children with ASD, there was a significant positive relationship between early BF initiation and less severe core symptoms of autism on Childhood Autism Rating Scale scores (U=405, P=0.017) and better intellectual functions on intelligence quotient score (U=18, P=0.03). Exclusive BF had a weak significant positive correlation (r=0.31, P=0.03) with higher intellectual functions on the intelligence quotient score. Conclusion In conclusion, BF practices are not linked to autism in children at risk. However, because early BF initiation is connected to less severe ASD core symptoms, our study implies that BF can be regarded a predictive factor of optimal outcomes for children with ASD. Future research with a prospective design and a large sample size could aid in establishing a cause-and-effect relationship.
{"title":"Breastfeeding and autism spectrum disorder: a cross-sectional study from Egypt","authors":"M. A. Abd Elmaksoud, O. Aly, Magdy Abd Elfatah, Aml Mahfouz","doi":"10.4103/ajop.ajop_10_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_10_22","url":null,"abstract":"Background Breastfeeding (BF) was suggested as an environmental factor that may confer a protective role against autism. Aim The primary aim was to compare the patterns of BF in children with autism spectrum disorder (ASD) with their typically developing siblings. The secondary objective was to conduct a pilot study to investigate the effect of BF on the severity of the core ASD symptoms and the intellectual functions among children with ASD. Patients and methods A comparative cross-sectional study was conducted at the Outpatient Clinic of Alexandria University Children’s Hospital on 100 children; 50 children with ASD (group A, n=50) and 50 typically developing children; siblings of children of group A (group B, n=50) using a designed semistructured questionnaire. Results The comparison between both groups revealed that neither BF ever, early initiation, prolonged duration, nor exclusive BF were statistically different in children with autism and their siblings. Among children with ASD, there was a significant positive relationship between early BF initiation and less severe core symptoms of autism on Childhood Autism Rating Scale scores (U=405, P=0.017) and better intellectual functions on intelligence quotient score (U=18, P=0.03). Exclusive BF had a weak significant positive correlation (r=0.31, P=0.03) with higher intellectual functions on the intelligence quotient score. Conclusion In conclusion, BF practices are not linked to autism in children at risk. However, because early BF initiation is connected to less severe ASD core symptoms, our study implies that BF can be regarded a predictive factor of optimal outcomes for children with ASD. Future research with a prospective design and a large sample size could aid in establishing a cause-and-effect relationship.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"11 1","pages":"59 - 66"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86984823","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}
Bello Kumo, Mado Sani, Borodo Musa, Manko Muhammad, S. Musa
Background Endoscopy is an important diagnostic and interventional procedure for children presenting with gastrointestinal (GI) symptoms. In resource-limited countries like Africa, the practice of pediatric endoscopy remains rudimentary, lacking in trained pediatric endoscopists and appropriate-sized endoscopes. Patients and methods This was a retrospective study of the findings in all children and adolescents referred for upper gastrointestinal endoscopy (UGIE) within a period of 2 years from February 2014 to February 2016. Results In all, 86 children and adolescents were referred for UGIE. There were 32 (37.2%) males and 54 (62.8%) females. The mean age was 13 years. Upper abdominal pain (47.7%), dyspepsia (19.8%), and upper GI bleeding (11.6%) were the major indications for referral. Fourteen (15.1%) patients were found to have normal UGIE findings. Commonest abnormalities seen at endoscopy were gastritis in 18 (22.1%), 14 (16.2%) had hiatus hernia, eight (9.3%) esophageal varices, seven (8.1%) gastric erosions, six (7.0%) had duodenitis, while five (5.8%) patients had esophagitis. Foreign body and duodenal ulcer were seen in three (3.5%) patients each, gastric ulcer and bile reflux in two patients each, while duodenal worms, esophageal atresia, caustic ingestion, and antral diverticular were seen in one (1.2%) patient each. Conclusion This study shows that endoscopy as an investigative tool in pediatric patients has high diagnostic yield with vital therapeutic potential, and is safe in the assessment of GI diseases.
{"title":"Pediatric upper gastrointestinal endoscopic findings in Kaduna, Nigeria","authors":"Bello Kumo, Mado Sani, Borodo Musa, Manko Muhammad, S. Musa","doi":"10.4103/ajop.ajop_7_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_7_22","url":null,"abstract":"Background Endoscopy is an important diagnostic and interventional procedure for children presenting with gastrointestinal (GI) symptoms. In resource-limited countries like Africa, the practice of pediatric endoscopy remains rudimentary, lacking in trained pediatric endoscopists and appropriate-sized endoscopes. Patients and methods This was a retrospective study of the findings in all children and adolescents referred for upper gastrointestinal endoscopy (UGIE) within a period of 2 years from February 2014 to February 2016. Results In all, 86 children and adolescents were referred for UGIE. There were 32 (37.2%) males and 54 (62.8%) females. The mean age was 13 years. Upper abdominal pain (47.7%), dyspepsia (19.8%), and upper GI bleeding (11.6%) were the major indications for referral. Fourteen (15.1%) patients were found to have normal UGIE findings. Commonest abnormalities seen at endoscopy were gastritis in 18 (22.1%), 14 (16.2%) had hiatus hernia, eight (9.3%) esophageal varices, seven (8.1%) gastric erosions, six (7.0%) had duodenitis, while five (5.8%) patients had esophagitis. Foreign body and duodenal ulcer were seen in three (3.5%) patients each, gastric ulcer and bile reflux in two patients each, while duodenal worms, esophageal atresia, caustic ingestion, and antral diverticular were seen in one (1.2%) patient each. Conclusion This study shows that endoscopy as an investigative tool in pediatric patients has high diagnostic yield with vital therapeutic potential, and is safe in the assessment of GI diseases.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"491 1","pages":"52 - 58"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75528570","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}
Dina H. Hamed, Amira M Sabry, Neama Al-Amir, Iman Abdelaziz
Background Community-acquired pneumonia (CAP) is one of the most common infections of infants and children in developing and developed countries, given the clinical, social, and economic importance of CAP for this specific age group. Aim To highlight the most important factors affecting the outcome of CAP either clinical, laboratory, or radiological. Patients and methods This prospective cohort study included 120 patients, aged 2–59 months admitted with CAP in the Pediatric Department, Children’s Hospital, Cairo University from November 2016 till February 2017. History, demographic, clinical, laboratory [complete blood count, C-reactive protein (CRP), urea, creatinine, sodium, random blood sugar, sputum and blood culture], and radiological data were assessed. Results A statistically significant relationship was detected between each of the history of exclusive breastfeeding, patient’s age, and weight as well as lower pO2 on admission and between the need for ICU admission. Also, significant correlation was noted between patients’ height, temperature, respiratory rate, hemoglobin, total leukocyte count and CRP, blood culture and chest radiographic finding, and between the duration of hospital admission. Conclusion Weight, height, temperature, respiratory rate, conscious level, initial O2 saturation, capillary filling time, and presence of crepitation were closely related to the CAP outcome as well as, some laboratory findings such as hemoglobin level, total leukocyte count, CRP, blood culture, arterial blood gas parameters, and the chest radiographic finding.
{"title":"Outcome predictors of community-acquired pneumonia in children","authors":"Dina H. Hamed, Amira M Sabry, Neama Al-Amir, Iman Abdelaziz","doi":"10.4103/ajop.ajop_8_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_8_22","url":null,"abstract":"Background Community-acquired pneumonia (CAP) is one of the most common infections of infants and children in developing and developed countries, given the clinical, social, and economic importance of CAP for this specific age group. Aim To highlight the most important factors affecting the outcome of CAP either clinical, laboratory, or radiological. Patients and methods This prospective cohort study included 120 patients, aged 2–59 months admitted with CAP in the Pediatric Department, Children’s Hospital, Cairo University from November 2016 till February 2017. History, demographic, clinical, laboratory [complete blood count, C-reactive protein (CRP), urea, creatinine, sodium, random blood sugar, sputum and blood culture], and radiological data were assessed. Results A statistically significant relationship was detected between each of the history of exclusive breastfeeding, patient’s age, and weight as well as lower pO2 on admission and between the need for ICU admission. Also, significant correlation was noted between patients’ height, temperature, respiratory rate, hemoglobin, total leukocyte count and CRP, blood culture and chest radiographic finding, and between the duration of hospital admission. Conclusion Weight, height, temperature, respiratory rate, conscious level, initial O2 saturation, capillary filling time, and presence of crepitation were closely related to the CAP outcome as well as, some laboratory findings such as hemoglobin level, total leukocyte count, CRP, blood culture, arterial blood gas parameters, and the chest radiographic finding.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"3 1","pages":"19 - 25"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89014140","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}
Nehad Hassanein, Mohamed El Din Thabet, D. Maarouf, Nevien Mikhail
Background It is evident that high cell turnover rate is present in patients suffering from β-thalassemia. This is mainly the result of not only chronic hemolysis but also ineffective erythropoiesis. It is thus expected that hyperuricemia will occur. Aim Our study was conducted to study uric acid excretion in β-thalassemia major patients and to determine its relationship to tubular dysfunction in those patients. Patients and methods This case–control study was performed on 60 patients with β-thalassemia major and 15 children who were healthy and well, playing the role of the control group. Thorough history taking, review of medical records, and complete physical examination were done for all patients. Evaluation of uric acid excretion, glomerular and tubular renal functions were performed and compared between patients and the control group. Results Hyperuricemia was found in 48.8% of patients; however, none of the patients had evidence of gouty arthritis or nephrolithiasis. Serum uric acid (SUA) levels in patients who had positive correlation with serum creatinine, urine P/Cr ratio and urine uric acid/glomerular filtration rate (UUA/GFR), negative correlation with eGFR and no correlation with urine calcium/creatinine (UCa/UCr) ratio, blood urea nitrogen (BUN), urine β2 MG, and urinary uric acid/creatinine (UUa/UCr) ratio were assessed. The mean SUA level, BUN, serum creatinine, and levels of eGFR were significantly higher in β-thalassemia patients in comparison to the control group. Urinary P/Cr ratio, urine uric acid/ glomerular filtration rate (UUA/GFR) ratio, β-2 microglobulin levels, UCa/UCr, and UUa/UCr were also higher in β-thalassemia patients in comparison to the control group. The present study has a mean age of 8.62 years for the cases studied, and investigations in patients revealed the following results: mean SUA 5.17 mg/dl, mean BUN 16.58 mg/dl, mean serum creatinine 0.49 mg/dl, mean urine P/Cr ratio 1.40, mean eGFR 141.42 ml/min/1.73 m2, mean UUA/GFR 0.55, mean urine β2 MG 0.18 µg/ml, mean UCa/UCr 0.44, UUa/UCr 1.46, and these results were statistically significantly higher in patients compared with controls. Conclusion Renal dysfunction and hyperuricemia are prevalent among patients with β-thalassemia major, mostly related to hyperfiltration and tubular dysfunction. Early markers of tubular dysfunction (urine β2 MG, UCa/UCr, UUa/UCr) and glomerular dysfunction (urine P/Cr ratio and urinary uric acid/GFR ratio) should be followed up regularly in β-thalassemia major patients.
{"title":"Study of uric acid excretion in children with beta-thalassemia major attending Alexandria University Children’s Hospital","authors":"Nehad Hassanein, Mohamed El Din Thabet, D. Maarouf, Nevien Mikhail","doi":"10.4103/ajop.ajop_6_22","DOIUrl":"https://doi.org/10.4103/ajop.ajop_6_22","url":null,"abstract":"Background It is evident that high cell turnover rate is present in patients suffering from β-thalassemia. This is mainly the result of not only chronic hemolysis but also ineffective erythropoiesis. It is thus expected that hyperuricemia will occur. Aim Our study was conducted to study uric acid excretion in β-thalassemia major patients and to determine its relationship to tubular dysfunction in those patients. Patients and methods This case–control study was performed on 60 patients with β-thalassemia major and 15 children who were healthy and well, playing the role of the control group. Thorough history taking, review of medical records, and complete physical examination were done for all patients. Evaluation of uric acid excretion, glomerular and tubular renal functions were performed and compared between patients and the control group. Results Hyperuricemia was found in 48.8% of patients; however, none of the patients had evidence of gouty arthritis or nephrolithiasis. Serum uric acid (SUA) levels in patients who had positive correlation with serum creatinine, urine P/Cr ratio and urine uric acid/glomerular filtration rate (UUA/GFR), negative correlation with eGFR and no correlation with urine calcium/creatinine (UCa/UCr) ratio, blood urea nitrogen (BUN), urine β2 MG, and urinary uric acid/creatinine (UUa/UCr) ratio were assessed. The mean SUA level, BUN, serum creatinine, and levels of eGFR were significantly higher in β-thalassemia patients in comparison to the control group. Urinary P/Cr ratio, urine uric acid/ glomerular filtration rate (UUA/GFR) ratio, β-2 microglobulin levels, UCa/UCr, and UUa/UCr were also higher in β-thalassemia patients in comparison to the control group. The present study has a mean age of 8.62 years for the cases studied, and investigations in patients revealed the following results: mean SUA 5.17 mg/dl, mean BUN 16.58 mg/dl, mean serum creatinine 0.49 mg/dl, mean urine P/Cr ratio 1.40, mean eGFR 141.42 ml/min/1.73 m2, mean UUA/GFR 0.55, mean urine β2 MG 0.18 µg/ml, mean UCa/UCr 0.44, UUa/UCr 1.46, and these results were statistically significantly higher in patients compared with controls. Conclusion Renal dysfunction and hyperuricemia are prevalent among patients with β-thalassemia major, mostly related to hyperfiltration and tubular dysfunction. Early markers of tubular dysfunction (urine β2 MG, UCa/UCr, UUa/UCr) and glomerular dysfunction (urine P/Cr ratio and urinary uric acid/GFR ratio) should be followed up regularly in β-thalassemia major patients.","PeriodicalId":7866,"journal":{"name":"Alexandria Journal of Pediatrics","volume":"131 1","pages":"33 - 39"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76268252","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：