DIAGNOSTIC VALUE OF PRESEPSIN IN DETECTION OF EARLY-ONSET NEONATAL SEPSIS
Khaled
Mahmoud Zayed
author
Ahmed
Abd ELmoez Ali Saad
author
Wafaa
Mohamed Amin
author
Mostafa
Gamal Abo El-Nasr
author
text
article
2020
eng
Background: The diagnosis of neonatal sepsis requires careful clinical suspicion, detailed physical examination, and a combination of laboratory tests and radiological tests. Although there isn't one single test that can reliably diagnose sepsis in all neonates, the above combination will establish the diagnosis in most cases.
Objective: To evaluate the efficacy of Presepsin in both diagnosis and follow-up of early-onset neonatal sepsis.
Patients and Methods: This prospective study aimed to determine the diagnostic utilities [sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV)] of Presepsin for early detection of neonatal sepsis, and to define the optimal cutoff value for Presepsin using the receiver operating characteristics (ROC) curve, so that it may be used as a reference with which future studies can be compared. This prospective study had been carried out in the Neonatal Intensive Care Unit at El-Galaa Teaching hospital during the period from October 2018 to April 2019. This study was conducted on 45neonates; 25 cases and 20 healthy neonates were enrolled as a healthy control group.
Results: There was significant correlation between both Presepsin and the hematological data (Total leucocytic count, band cells, segmented neutrophils, platelets and immature to total ratio) of the cases. Presepsin had a significant correlation with CRP level which is a laboratory marker of neonatal sepsis. We found that the median level of Presepsin was higher in cases group than control group. ROC curve shows Presepsin value of 0.64 ng/dl was established as a cut off value with 88% sensitivity and 100% specificity. The positive and negative predictive values were 100% and 87%respectively
Conclusion: Presepsin is a novel biomarker with high sensitivity and good specificity for sepsis and its measurement can be useful for early diagnosis of neonatal sepsis. Also it was found to be beneficial as a prognostic tool to predict outcome of sepsis in neonatal intensive care and shown to have a correlation with survival.
Al-Azhar Journal of Pediatrics
Al-Azhar University, Al-Azhar Pediatric Society
1110-7774
23
v.
2
no.
2020
825
851
https://azjp.journals.ekb.eg/article_85889_ba6120c6151f78f4d1b09d63a0e08d97.pdf
dx.doi.org/10.21608/azjp.2020.85889
THE VALUE OF NEUTROPHIL TO LYMPHOCYTE RATIO AND PLATELET TO LYMPHOCYTE RATIO AND PROCALCITONIN LEVEL FOR DETECTING EARLY-ONSET NEONATAL SEPSIS
Nasser
MM
author
Afia
AA
author
EL-Khatib
GZ
author
Ibrahim
MI
author
text
article
2020
eng
Background: Early-onset sepsis remains a common and serious problem for neonates. The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are easily accessible biomarkers that have been reported to have meaningful correlations with inflammatory markers and some diseases severity in adult trials.
Objectives: We aimed to evaluate the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and procalcitonin as a diagnostic adjunct tests for early detection of neonatal early-onset sepsis (EOS).
Patients and Methods: This study was carried out on 60 term infants at the Neonatal Intensive Care Unit (NICU) of Al-Hussien University Hospital. They were divided into two groups: Group A (patients group) which included thirty term AGA neonates, suffering from EOS and group B (controls group) which included thirty healthy term AGA neonates. Neonates with prematurity, postmaturity, small for gestational age (SGA), large for gestational age (LGA), multiple pregnancies, major congenital anomalies, cyanotic congenital heart disease, negative values of together C-reactive protein (CRP), and procalcitonin, and neonates who had mothers with hypertension or preeclampsia, diabetes mellitus (pre-existing or gestational)and tobacco use during pregnancy were excluded. History-taking, complete clinical examination, chest x-ray, blood culture, complete blood count (CBC), C-reactive protein (CRP), procalcitonine level, immature to total neutrophil ratio (I/T ratio), neutrophil/lymphocyte ratio ( NLR) and platelet/lymphocyte ratio (PLR) were done.
Results: There were no significant differences between the study groups regarding age, gender, mode of delivery, GA, BW, length and HC. As regard vital data, patients group had higher RR, HR and SPO2. Respiratory distress and tachycardia were the most common clinical signs of EOS. There was a significant difference between patients and controls as regard platelet count and I/T ratio. Patients group had significantly higher absolute neutrophil counts, NLR, PLR, C-reactive protein, and procalcitonin levels compared with the controls group. As regard blood culture, Klebsiella was the most common organism followed by Staphylococcus aureus. An NLR of 2.52 was determined as the predictive cutoff value of neonatal EOS (sensitivity 96.7%; specificity 100%; P=0.001). A PLR of 47.4 was determined as the predictive cutoff value of neonatal EOS (sensitivity 90.0%; specificity 100%; P=0.001). Procalcitonin (PCT) showed a sensitivity of 96.7 % and specificity 100% at a cut-off point of 1.04 ng/mL. I/T ratio, at a cut-off value at (0.12), had sensitivity of 76.7% and specificity of 96.7%. CRP, at a cut-off value at (5), had sensitivity of 100% and specificity of 96.7%.
Conclusion: Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), I/T ratio, serum CRP and procalcitonin levels had high sensitivity and specificity as diagnostic markers for early-onset neonatal sepsis.
Al-Azhar Journal of Pediatrics
Al-Azhar University, Al-Azhar Pediatric Society
1110-7774
23
v.
2
no.
2020
852
874
https://azjp.journals.ekb.eg/article_85895_820c42d8bac3c5ef9220830d7ceac43e.pdf
dx.doi.org/10.21608/azjp.2020.85895
LIPID PROFILE AMONG CHILDREN AND ADOLESCENTS WITH TYPE 1 DIABETES MELLITUS AT AL-HUSSEIN AND SAYED GALAL UNIVESITY HOSPITALS
Nayera
Mahmoud Alakkad
author
Sabry
Mohammad Ghanem
author
Tarek Abdel
kareem El-Dahshan
author
Ahmed
Ramadan El-Sayed
author
text
article
2020
eng
Al-Azhar Journal of Pediatrics
Al-Azhar University, Al-Azhar Pediatric Society
1110-7774
23
v.
2
no.
2020
875
888
https://azjp.journals.ekb.eg/article_85897_9d85859703be71c48ab884350ea1ec50.pdf
dx.doi.org/10.21608/azjp.2020.85897
RETROSPECTIVE STUDY OF EGYPTIAN CHILDREN REFERRED TO THE ENDOSCOPY UNIT AT AL-HUSSEIN UNIVERSITY HOSPITAL FOR COLONOSCOPY
Mohamed
Ahmed Abdel Azeem
author
Hany
Ali Hussein Samy
author
Ahmed
Abd Allah Mohamed
author
text
article
2020
eng
Background: Colonoscopy is the "gold standard" procedure in diagnosis and management of lower gastrointestinal problems. All reports have shown that this procedure is safe and useful diagnostic tool in children of all age groups.
Objectives: We aimed of this retrospective study is to find out the prevalence of different colonic diseases in children. Also, this work will highlight the usefulness of colonoscopy in the recognition of diseases of the colon in children in our community and identify some of the problems associated with the performance of this procedure in our department.
Patients and Methods: A retrospective study conducted during the period from January 2016 to December 2017 to analyze the colonoscopic findings of patients presented with lower gastrointestinal manifestations to the Gastrointestinal Endoscopy Unit of Al-Hussein University Hospital. It included 40 cases, 20 were males (50%) and 50 females (50%). Their ages ranges from 1 year to 15 years with a mean age of 5.65±2.8 SD years.
Results: Bleeding per rectum was the commonest presentation representing (80%) of cases, followed by abdominal pain 10%, weight loss was 5.0 %, chronic diarrhea was 2.5%. Biopsy was taken in 34 cases (85%) and histopathological findings were juvenile rectal polyp in 17 cases (42%), nonspecific colitis in 15 cases (37.5%), ulcerative colitis in 7 cases (4.7%), diffuse colitis in 1 case (2.5%), esinophilic colitis in 2 cases (5%), normal in 5 cases (12.5%).
Conclusion: Colonic diseases are not uncommon in our part of the world. Colonoscopy is a rewarding procedure in those patients referred with lower gastrointestinal manifestations
Al-Azhar Journal of Pediatrics
Al-Azhar University, Al-Azhar Pediatric Society
1110-7774
23
v.
2
no.
2020
889
902
https://azjp.journals.ekb.eg/article_85900_5c309f1a696102b37feaba9ada57cb1a.pdf
dx.doi.org/10.21608/azjp.2020.85900
COMPARISON BETWEEN INHALATION AND SYSTEMIC STEROID THERAPY IN ACUTE EXACERBATION OF MODERATE TO SEVERE BRONCHIAL ASTHMA IN CHILDREN
Hesham
Ahmed Mohamed Ali
author
Al Hassan
Mostafa Zahran
author
Ramy
Mohamed Zakarya
author
text
article
2020
eng
Background: Corticosteroids are by far the most effective controllers used in the treatment of asthma and the only drugs that can effectively suppress the characteristic inflammation in asthmatic airways. They play an important role in the treatment of acute asthma exacerbations in the ED as well as post discharge from the ED.
Objectives: To compare the effects of inhaled corticosteroids (ICS) against systemic corticosteroids (SC) in children consulting in emergency department (ED) for acute asthma exacerbation.
Methods: This was a prospective study done on children with acute asthma exacerbation coming to the emergency room of Al-Sayed Galal university hospital for evaluation and treatment. The study was carried out from July 2018 to January 2019.
Results: 60 children were evaluated; 34 cases (56.7%) were males while 26 cases (43.3%) were females with age ranging between 2 and 14 years. No significant statistical difference was found between inhaled corticosteroids and systemic corticosteroids in treatment of acute exacerbation of moderate to severe bronchial asthma in children.
Conclusion: There is no evidence of a difference between ICS and SC in terms of hospital admission rate, return to hospital within week, length of stay in ED and adverse effects in children consulting for asthma exacerbations.
Al-Azhar Journal of Pediatrics
Al-Azhar University, Al-Azhar Pediatric Society
1110-7774
23
v.
2
no.
2020
903
924
https://azjp.journals.ekb.eg/article_85901_e7483b3c94991295fa942b484fd7abbe.pdf
dx.doi.org/10.21608/azjp.2020.85901
STUDYING THE RISK FACTORS FOR EPILEPSY IN THE FIRST FIVE YEARS OF LIFE IN CHILDREN
Hossam Mohammed
El-Borai Zaghloul
author
El-Sayed
Mohamed El-Nagar
author
Sameh Abd El-Aziz
Ahmed Mansour
author
text
article
2020
eng
Background: Epilepsy is a disorder of the brain defined by any of the following conditions: At least two unprovoked seizures occurring greater than 24 hours apart, one unprovoked seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years and Diagnosis of an epilepsy syndrome (Fisher et al., 2014).
Objectives: We aimed to determine the prevalence of the different risk factor for epilepsy in children below five years.
Design: A descriptive cross sectional study that was carried out on 200 epileptic children attending Outpatient Clinic of Neurology Unit of Pediatric Department, Al Hussein and Bab Elsheaia University Hospital.
This research was continued until fulfillment of the study from April 2017 to June 2019.
Patient and Methods: All the patients were diagnosed as epileptic patients.
Inclusion criteria:-
• Age: above 4 weeks and below 5 years.
• Epileptic patient, with history of 2 or more seizures.
Exclusion criteria:-
• Age: children are at or above 5year.
• Non – epileptic patient.
Results: 54% of children began to suffer from epilepsy at less than one year age while 29% began to suffer from epilepsy between 1year to <3 year and 17% began to suffer from epilepsy between 3 years and <5 years with a mean of 22±8.78 months.
- Age ranged from 1 to 3 years with a mean of 22±8.78 months.
- As regards the residence, we found that children were living in rural areas 55 (55%) and urban areas 45 (45%).
- Social standard was low in 50%, medium in 40% and high in 10%.
- Pre-term was reported in 27 cases out of 100 cases (27%), while full-term was reported in 63 cases out of 100 cases (63%) and post-term was reported in 10 cases out of 100 cases (10%).
- 71% of the cases have generalized seizures, 21% of the cases have partial seizures and 8% of the cases have unclassified seizures.
- family history of epilepsy were the main known reported risk factors of epilepsy (by 24 %) and 20% of the patients had the family history of epilepsy in their first and second-degree relatives , while febrile convulsions was reported in 22% of epileptic children. 21% reported head trauma as a risk factor. Central nervous system (CNS) infection was 8% of the epileptic children.
- 66% of the cases are controlled with anti- epileptic drugs, while 34% of the cases are uncontrolled with anti- epileptic drugs.
- 8% of mothers during pregnancy had hemorrhage, 6% of them had diseases as D.M. and hypertension while 8% of them were on medications.
Conclusion: Epilepsy is a common neurological disorder. Decision makers must take effective steps to limit the causes and risk factors of the problem.
It is important for pre-natal monitoring to be performed in a regular and accurate manner, for birth to take place under appropriate conditions with the help of health personnel and for the baby to be regularly monitored after birth if the child is to be protected from factors that can impair brain development during or after birth.
Al-Azhar Journal of Pediatrics
Al-Azhar University, Al-Azhar Pediatric Society
1110-7774
23
v.
2
no.
2020
924
944
https://azjp.journals.ekb.eg/article_85902_d41d8cd98f00b204e9800998ecf8427e.pdf
dx.doi.org/10.21608/azjp.2020.85902
USEFULNESS OF SERUM LIPID PEROXIDE AS A DIAGNOSTIC TEST FOR HYPOXIC ISCHEMIC ENCEPHALOPATHY IN FULL TERM NEONATE
El Sayed
Mohamed El Nagar
author
Hasan
Ali Hasan
author
Kamel
Soliman Hammad
author
Ahmed
Ibrahim Semary
author
text
article
2020
eng
Backgrounds: Hypoxic-ischemic encephalopathy (HIE) significantly increased mortality and morbidity.
Objectives: The aim of this study is to evaluate the usefulness of serum lipid peroxide (LPO) as an early prediction of HIE in full-term neonates.
Methods: This case control study was conducted on group 1 which included 30 asphyxiated full term infants delivered at Dar Al Shefaa hospital and Sayed Galal university hospital during a period of ten months from November 2018 to August 2019. These cases were compared to group 2 which included 30 age matched apparently healthy term neonates as a control group. Both groups of patients and control were subjected to:
1. Full maternal history with special emphasis on medical and obstetric data at delivery, including the mode of delivery, Apgar score at 1 and 5 min and resuscitation data
2. Assessment of gestational age, anthropometric measurements (head circumference, weight and length), vital signs and full systemic examination.
3. Neurological examination with assessment of severity of hypoxic ischemic encephalopathy using Sarnat and Sarnat staging (1976).
Results: There was a highly significant difference in serum lipid peroxide between cases and control groups (P value < 0.001). Lipid peroxide was statistically highly significant in cases delivered by caesarean section rather than by vaginal delivery (p=0.017). There was a significant negative correlation between lipid peroxide level and 5th minute Apgar score & blood pH and a significant positive correlation with base excess, sarnat stage and mortality.
Conclusion: LPO level is a useful marker for early detection of HIE in full-term neonate, the grade of hypoxia and the outcome prediction.
Al-Azhar Journal of Pediatrics
Al-Azhar University, Al-Azhar Pediatric Society
1110-7774
23
v.
2
no.
2020
945
963
https://azjp.journals.ekb.eg/article_85903_f4c316c03f1a3042da0e30784e650300.pdf
dx.doi.org/10.21608/azjp.2020.85903
CORRELATION OF FOOT LENGTH AND HAND LENGTH AND OTHER ANTHROPOMETRIC MEASURMENTS WITH GESTIONAL AGE ASSISTED BY NEW BALLARD SCORE
Raafat
abdel- Raouf Khattab
author
Fathi
khalil Nawar
author
Mohamed
Farouk Ahmed
author
Mohamed
Hussein hashad
author
text
article
2020
eng
Background: Gestational age is a cornerstone piece of clinical data used by physicians to conclude the timing of various screening investigations and assessments of the fetus and mother all through pregnancy. It is important to know an infant’s gestational age because its behavior and anticipated problems can be predicted on this basis. It is also important for prediction of morbidity, mortality and further management.
Objectives: to study correlation of foot length and hand length and gestational age among preterm and term neonate.
Methods: This is prospective study was carried out on 1000 neonates who delivered at sayed galal hospital 24 hours of life. Their gestational age ranged from 27 to 40 weeks. Gestational assessment will be done using modified Ballard’s scoring on day one. Foot Length will be measured using sliding caliper from December 2017 to November2018.
Results: This study showed that hand length was higher in males than in females, the differences were statistically significant beginning from week-30 until week-40.also it shows No statistical significant difference between males and females regarding Ballard score at all gestational weeks 27 till 40th also there is no statistical significant difference between males and females regarding Ballard and gestational age also there were statistical significant correlations between GA and anthropometric characteristics.(weight ,head circumference ,chest circumference ,hand length, foot length, Ballard score GA).
Conclusion: male fetuses have more gestational weight gain and growth patterns than female particularly from 31 gestational weeks onward .head circumference , chest circumference , foot length and hand length statistically significant higher among male than females particularly around 30 and 33 gestational weeks onwards.. No statistically significant difference was observed between males and females as regard Ballard scoring system throughout all gestations investigated.
Al-Azhar Journal of Pediatrics
Al-Azhar University, Al-Azhar Pediatric Society
1110-7774
23
v.
2
no.
2020
964
980
https://azjp.journals.ekb.eg/article_85904_ee16887c5848e1fb6cc281a8a4e61546.pdf
dx.doi.org/10.21608/azjp.2020.85904
Relationship between problematic Internet use, body mass index and psychiatric morbidities in Egyptian high school adolescent students
Shaimaa
M. Arafa
author
Asmaa
M. Elaidy
author
Mohammed
A. Hassan
author
text
article
2020
eng
Background: Problematic internet use (PIU) is an emergent universal problem amongst students. The problem is growing in Egypt with the progressively mounting internet usage. Also, overweight of adolescents remains serious and alarming national and international health problem.
Objective: To study the prevalence and coincidence of PIU, obesity and psychiatric disorders amongst students in governmental Egyptian high schools.
Subjects and Methods: A cross sectional study was performed on randomly chosen 828 students from 2 governmental high schools in urban Gamalia town - Dakahlia governorate – Egypt. Students were classified into theoretical educational group and scientific educational group. the students in each group were requested to fill Young Internet Addiction Test (YIAT) and General Health Questionnaire (GHQ-12) to assess problematic internet use and presence of psychiatric morbidity. Prior to that, sociodemographic data, medical reports and anthropometric measurements of the students had been obtained.
Results: We noted that 12% (100 students) of the study candidates were obese, 24.3% (201 students) were overweight and 63.7% (527 students) represent normal and underweight adolescents. As well, it was found that 13.2 % (109 students) of the students were problematic internet users (PIUs). Prevalence of PIU was found higher among young ages, males and obese students. Also, students with higher father’s educational degree, those who frequently use internet and those using internet for relieving loneliness, had a higher prevalence of PIU. Impaired relation with classmate friends with poor parents’ satisfaction were also found in PIUs. The result also revealed that 31.9% of the total students suffering from distress and 6.1% having severe problem and psychological distress. Also, our results showed that the PIU and psychological distress had a highly significant positive correlation [r (p-value) = 0.975 (<0.001)]. Similarly, a highly significant positive correlation was observed between PIU and body mass index (BMI) [r (p-value) = 0.914 (<0.001)]. Furthermore, a highly significant positive correlation was found between psychological distress and BMI [r (p-value) = 0.881 (<0.001)].
Conclusion: Problematic internet use and obesity are common and -associate each other- among high school students in Egypt which may affect their psychological health.
Al-Azhar Journal of Pediatrics
Al-Azhar University, Al-Azhar Pediatric Society
1110-7774
23
v.
2
no.
2020
981
998
https://azjp.journals.ekb.eg/article_110457_ab8057686d4d55dd54d8cdc834d1fb3e.pdf
dx.doi.org/10.21608/azjp.2020.110457