Al-Azhar University, Al-Azhar Pediatric Society
Al-Azhar Journal of Pediatrics
1110-7774
3009-7770
21
1
2018
01
01
SERUM MAGNESIUM IN CHILDREN WITH TYPE 1 DIABETES AND ITS CORRELATION TO GLYCEMIC CONTROL
1846
1857
EN
Abd-Alraouf
M. Abd-Alraouf
Nadia Y.
Ismail
Sabry M.
Ghanem
Ahmed F.
Abd-Elaziz
10.21608/azjp.2018.70300
<strong>Background:</strong> Type 1 diabetes mellitus (T1DM) is highly prevalent endocrinal disorder. with incidence of around 8/100,000 per year in Egyptian children under the age of 15 years. Evidence indicate that Magnesium (Mg) plays an important role in prevalence of T1DM. and its complications. Thus we aimed to find out the effect of T1DM. on serum Mg level.
<strong>Methods: </strong>We included 50 Egyptian children with type 1diabetes at Pediatric outpatient clinic, Al-Hussein University Hospital and El-Sahel Teaching Hospital, during the period from May, 2017 to December, 2017, and 25 age- and sex-matched healthy individuals in a case-control study. We measured Serum magnesium, HbA1c, random blood suger, serum urea, and creatinine level and CBC.
<strong>Results: </strong>Diabetic children had significantly lower serum magnesium level compared to control children (1.91 ± 0.22 mg/dL in diabetic children versus 2.08 ± 0.19 mg/dL in control children). Hypomagnesemia was detected in 26% of diabetic children compared to 8% of control children. Significant negative correlation between serum Mg and HbA1c was detected. (p<sub>=</sub> 0.000 r<sub>=</sub> -0.703). also negative correlations between Mg and each of age and duration of DM. (p<sub>=</sub> 0.016; r<sub>=</sub> -0.339); (p= 0.000; r<sub>=</sub> -0.339) respectively.
<strong>Conclusion:</strong> patients with T1DM more liable to develop hypomagnesemia specially with poor glycemic control.
<strong>Recommendations:</strong> Proper glycemic control and regular monitoring of serum magnesium in children with T1DM.
children,diabetes,Magnesium
https://azjp.journals.ekb.eg/article_70300.html
https://azjp.journals.ekb.eg/article_70300_43276e056e8c8c652c415ac5f8661fd4.pdf
Al-Azhar University, Al-Azhar Pediatric Society
Al-Azhar Journal of Pediatrics
1110-7774
3009-7770
21
1
2018
01
01
THYROID PROFILE AMONG LATE WELL PRETERM NEONATES
1858
1870
EN
Mohammed Kamal
Fayez El Tohami
Dr. Mohammed
Abd El Maleek Hasan
Mohammed Mohammed
Abo El Fotouh
Bassem Ahmed Mohammed
Ahmed
10.21608/azjp.2018.70303
<strong><em>Background: </em></strong><em>Thyroid hormones are essential for brain development. Transient hypothyroxinemia early in life may increase the risk of neurodevelopment disabilities in preterm infant.</em>
<strong><em>Objectives:</em></strong><em> Examine the characteristics of thyroid function of preterm infants, and to determine the validity of a repeat thyroid function test for preterm infants.</em>
<strong><em>Methods: </em></strong><em>This prospective comparative study was carried out during the period from Septemper 2016, to March 2017, at Al-Hussein University Hospital and Sohag General Hospital (neonatal care unit), done on 50 preterm neonates, their gestational age ranged from 34 to 36 weeks, (group <strong>1),</strong> and 20 prterm neonates their gestational age less than 34 weeks,( group<strong> 2</strong>), on randomized base. Initial serum levels of free thyroxine (FT4), free triiodothyronine (FT3), and thyrotropin (TSH) were measured within the first 10 days of life and were repeated every 2 and 4 weeks after the first test. The study was carried out on either gender, delivered vaginally or by cesarean section, to apparently healthy mothers.This Study was carried out at Al-Hussein University Hospital and Sohag General Hospital (neonatal care unit). Factors related to the neonate as gestational age ,birth weight, sex and mode of delivary were studied in relation with the results of thyroid function tests.</em>
<strong><em>Results: </em></strong><em>This study shows that 42 (84%) of preterm neonates in group<strong>1</strong> have normal thyroid function test, and 3 (6%) have transient hypothyroxinemia, and 5 (10%) have transient TSH elevation. In group<strong> 2, </strong>our study shows that 13 (65%) of preterm neonates have normal thyroid function test and 3 (15%) have transient hypothyroxinemia and 5 (20%) have transient TSH elevation, the study shows no cases of congenital hypothyroidism in both (two) groups. Statistical analysis was done by using IBM SPSS software package version 20.0.Comparison between different groups regarding categorical variables was tested using Chi-squara test.</em>
<strong><em>Conclusion: </em></strong><em>Although the study shows no statistical relation between gestational age and the weight of neonates with thyroid function test results, but there was statistically significant deference between the elevation in TSH and weight of neonates</em>
https://azjp.journals.ekb.eg/article_70303.html
https://azjp.journals.ekb.eg/article_70303_27c3cd51e6fddeb548548d9bac4fc31d.pdf
Al-Azhar University, Al-Azhar Pediatric Society
Al-Azhar Journal of Pediatrics
1110-7774
3009-7770
21
1
2018
01
01
SAFETY AND EFFICACY OF TRANSCATHETER VERSUS SURGICAL CLOSURE OF VENTRICULAR SEPTAL DEFECTS IN CHILDREN
1871
1889
EN
Mohamed Sayed
Hemida
Mohsen Taha
El Keiy
Amal Mahmoud
El Sisi
Doaa Mohamed
Abdelaziz
Ahmed
Abdelsamei Fadl
10.21608/azjp.2018.70306
<strong><em>Background: </em></strong><em>While surgical repair of VSDs has been successful over 60 years, operative and late complications still occur and there are inherent risks associated with sternotomy and exposure to cardiopulmonary bypass . A desire to avoid these risks as well as the successful application of catheter –based device closure has led to an interest in developing a less invasive means by which to close VSDs. <strong>Objectives:</strong> To evaluate the safety and efficacy of trans-catheter versus surgical approach to correct VSD in a prospective comparative study. <strong>Patients and Methods:</strong> we performed this 2 years prospective observational study of 30 patients with VSD who were referred to Pediatric Cardiology Division of Cairo University and Al-Azhar university Pediatric Hospital to do either surgical or transcatheter VSD closure between 01/07/2014 to 01/07/2016 . After clinical and TTE examination we revised the criteria of the case upon which the decision was taken to close the VSD (surgery is indicated in patients with uncontrolled congestive heart failure symptoms, evidence of increased pulmonary vascular resistance or the development of aortic valve insuffiency secondary to leaflet prolapse). Their age ranged from 6 months to 18 years, weights from 6 Kg to 60 Kg and heights ranged from 60 to 160 cm. <strong>Results:</strong> In our study, success rate of trans-catheter and surgical closure was 100 %, The mean age of our prospective study was 3.01± 2.9 and 4.1± 2 years in surgery and cathter groups repectively , their body surface area was 0.4 ± 0.18 m2 and 0.6 ± 0.2 m2 in surgery and catheter groups respectively, the most common clinical presentations were, recurrent chest infection in 15(100%) vs. 13(86.7%) cases in surgery and catheter groups respectively, there were statistically significant difference between surgery and catheter before closure regarding LA/AO ratio (1.43 ±0.423 vs 1.17± 0.212 ) ,LVEDD (3.82+.608 vs 3.17+.704 respectively) and LVEDD Z-Score (2.61+1.16 vs 1.5+1.39 respectively ), no mortality , stroke nor neurological deficit was observed ,no major adverse events were occurred in the trans-catheter group, only 1major event was observed in the surgical group ( complete AV block postoperative , that needed pacemaker) ,the average hospital stay in surgical group 5.40+1.12 days vs 1.13+.35 days in catheter group , all patients in surgery group (100%) needed blood transfusion, ventilation and inotropic support, no one needed in catheter group (0%), LVEDD Z-Score showed statistical significant differences between surgery and catheter groups immediately after ( mean 3.41+0.924 vs 1.52+1.39 respectively),3 days after( mean 3.61+1.06 vs 1.45+1.39 respectively) and 1month after (mean 1.45+1.03 vs 0.768+1.44 respectively ) .cardiac enzymes ,systolic and diastolic functions were affected immediately post- operative and on 3<sup>rd</sup> day follow up in surgery not in catheter group and returned to normal after one month follow up. <strong>Conclusion:</strong> Trans-catheter device closure of VSD is more safe and efficient than surgical closure, trans-catheter device closure had fewer myocardial injuries, shorter hospital stays and faster recovery times, also trans-catheter device closure had no systolic nor diastolic dysfunction as in surgical closure on short term follow up.</em>
safety,VSD,transcatheter closure,surgical closure
https://azjp.journals.ekb.eg/article_70306.html
https://azjp.journals.ekb.eg/article_70306_df993960a4b92d963002caa34069f6de.pdf
Al-Azhar University, Al-Azhar Pediatric Society
Al-Azhar Journal of Pediatrics
1110-7774
3009-7770
21
1
2018
01
01
OUTCOME OF NON INVASIVE POSITIVE PRESSURE VENTILATION IN MANAGEMENT OF ACUTE RESPIRATORY DISTRESS IN PEDIATRIC ICU IN BAB EL SHAEREYA UNIVERSITY HOSPITAL
1890
1903
EN
Mohamed Ibrahiem Mohamed
Elzobiry
Abd El Rahman Ahmady
Awad
Mohamed
Ahmed El Feky
Hisham Ahmed
Mohamed Ali
Mosaad Mohamed
Ibraheim Mohamed
10.21608/azjp.2018.70310
<strong><em>Introduction:</em></strong><em> Acute respiratory distress is one of the most common pediatric emergencies. In fact, it is a very common symptom between a lot of diseases. Oxygen therapy remains the most important treatment of all causes of respiratory distress.</em>
<strong><em>Aim of work:</em></strong><em> Evaluation the usefulness of non invasive continuous positive airway pressure (n CPAP) in conditions of respiratory distressed infants & children in comparison to conventional O2 therapy (nasal pronge, oxygen mask, venturi mask).</em>
<strong><em>Patients and methods: </em></strong><em>the study was conducted on 100 infants and children between 1 month and 5 years old having nearly the same causes of respiratory distress in Bab El Shaerea University hospital. They were divided into two groups, group I (50 patients) treated by n CPAP, and group II (50 patients) treated by conventional O2 therapy, and evaluated after 48 hours by ABG and clinically using PRISM score, CRS score and asthma score.</em>
<strong><em>Results of the study</em></strong><em>: showed that there was statistically significant improvement in ABG finding in group I more than group II after 48 hours of oxygen therapy. Also, duration of oxygen therapy and hospital stay was statistically significant less in group I. Clinically, the improvement in group I was more significant than group II. Asthma patients showed no difference in asthma score in both groups.</em>
<strong><em>Conclusion:</em></strong><em> CPAP was associated with improved respiratory rate and decreased morbidity & mortality in children younger than 5 years with undifferentiated respiratory distress. There were fewer serious adverse events. CPAP was associated with more improvement in ABG finding, less hospital stay and shorter duration of O2 treatment than conventional O2 therapy.</em>
<strong><em>Recommendations: </em></strong><em>more studies should be done on asthmatic patients to identify if there is an upper hand of CPAP over conventional O2 therapy in asthma treatment.</em>
respiratory distress,n CPAP,conventional O2 therapy
https://azjp.journals.ekb.eg/article_70310.html
https://azjp.journals.ekb.eg/article_70310_baa02c1a5a09b338a27efe3ac5712e5a.pdf
Al-Azhar University, Al-Azhar Pediatric Society
Al-Azhar Journal of Pediatrics
1110-7774
3009-7770
21
1
2018
01
01
THYROID FUNCTION IN OBESE CHILDREN AND ADOLESCENCE
1904
1917
EN
Mahmoud Abbas
Abd-Elmaqsoud
Hassan Saad
Abu Saif
Sabry Mohamed
Ghanem
Ahmed Abdelhamed
Abo-Zaid
10.21608/azjp.2018.70312
<strong><em>Background</em></strong><em>: Childhood obesity is one of the most serious public health challenges of the 21st century. The problem is global and is steadily affecting many low- and middle-income countries, particularly in urban settings. The prevalence has increased at an alarming rate. Globally, in 2010 the number of overweight children under the age of five is estimated to be over 42 million. Close to 35 million of these are living in developing countries</em><em>.</em>
<strong><em>Objectives:</em></strong><em> The aim of this prospective study to find out if there is any abnormalities in thyroid function in simple obese children and adolescence or not.</em>
<strong><em>Patient and method:</em></strong><em> This prospective randomized case- control study is carried out on a 60 children with simple obesity selected from Al-Hussen University Hospital including f38 obese children (55.6%) with a BMI of more than 95th percentile for age and sex, and 22 children (44.4%) with a BMI between (15<sup>th</sup> percentile-85<sup>th</sup> percentile) for age and sex serving as controls. group of the sixthly children, 27 were males (45.6%) and 33 were females (54.4%). The mean age of control and obese children, was 8.40 ± 1.32, and 8.28 ± 1.47 years respectively.</em>
<strong><em>Conclusion</em></strong><em>: </em><em>Obesity is associated with increased TSH levels breastfeeding is very important as children who did not receive breast milk are at great risk of obesity, TV watching may be a contributing factor in the development of obesity, unhealthy eating habits are one of the risk factors of obesity, elevated blood pressure is not uncommon in obese children even in young age.</em>
https://azjp.journals.ekb.eg/article_70312.html
https://azjp.journals.ekb.eg/article_70312_8bb2df0572ffafe8b7999f43621023b5.pdf
Al-Azhar University, Al-Azhar Pediatric Society
Al-Azhar Journal of Pediatrics
1110-7774
3009-7770
21
1
2018
01
01
DIFFICULT WEANING FROM MECHANICAL VENTILATION IN PEDIATRIC INTENSIVE CARE UNIT
1918
1933
EN
Noha N.
Ramadan
Sherif M.
Reda
Ahmad Y.
Al-Sawah
Mohammed
A. Aboud
Reda S.
Arafa
Adel M.
Abdo
10.21608/azjp.2018.70314
<strong><em>Introduction:</em></strong><em> Weaning from mechanical ventilation is defined as the gradual process of transferring the respiratory work of breathing from the ventilator to the patient. <sup> </sup>It is easily obtained in about 70-80% of the patients. However 20–30% present with difficult weaning<strong>. </strong></em><strong><em>Aim of the work</em></strong><em>: To </em><em>identify the causes of difficult weaning from mechanical ventilation of different reasons and predicts the variables responsible for this difficulty. To avoid these variables and decreasing the mortality, the morbidity associated with mechanical ventilation</em><strong><em>. Patients and methods</em></strong><strong><em>: </em></strong><em>This study was a prospective study, which conducted on fifty (50) ventilated critically ill children, 23 (46%) male, and 27 (54%) females their ages ranged from 4-15 months of different reasons in the pediatric intensive care unit of Al-Hussein 20 (40%) Al-Azhar University Hospital, and Benha Children Hospital (BENCH) 30 (60%) during the period from July 2015 to June 2017. <strong>Results:</strong> </em><em>Increasing duration of mechanical ventilation more than 7days increases risk for difficult weaning. </em><em>Regarding risk factors for failure of weaning, percentage of Pneumonia was significantly lower among simple weaning than difficult weaning (30.0%, 65.0% respectively) p=0.021 Convulsions due to hypoxic ischemic insult one of most common causes of difficult weaning, anemia ,heart failure, laryngeal edema have a rule in difficult weaning.</em><strong><em>Conclusion</em></strong><em>: </em><em>Increasing duration of mechanical ventilation more than 7days increase risk for difficult weaning.</em><em> </em><em>Percentage of Pneumonia was significantly lower among simple weaning than difficult weaning</em><em>. Convulsions due to hypoxic ischemic insult one of most common causes of difficult weaning, anemia, heart failure, laryngeal edema have a rule in difficult weaning.</em><strong><em> Recommendations</em></strong><strong><em>:</em></strong><em> Good monitoring of patients on MV and early management of any problem interferes with good ventilation.</em>
Weaning,Mechanical Ventilation,paediatric intensive care unit
https://azjp.journals.ekb.eg/article_70314.html
https://azjp.journals.ekb.eg/article_70314_d41d8cd98f00b204e9800998ecf8427e.pdf
Al-Azhar University, Al-Azhar Pediatric Society
Al-Azhar Journal of Pediatrics
1110-7774
3009-7770
21
1
2018
01
01
EVALUATION OF URINARY MONOCYTE CHEMOTACTIC PROTEIN -1 IN CHILDHOOD NEPHROTIC SYNDROME
1934
1952
EN
Moftah
Mohamed Rabeea
Nayera
Mahmoud Al-Akkad
Gamal
Zakariya El-Morsi
Moawia
Esam Kamal El-Din
10.21608/azjp.2018.70328
<strong><em>Background/aim</em></strong><strong>:</strong> The role of pro-inflammatory cytokines in the immunopathogenesis of idiopathic nephrotic syndrome had been widely postulated. Reports on the release of cytokines, during idiopathic nephrotic syndrome (INS) activation, were conflicting in defining a specific interleukin pattern during relapse and remission of the disease<em>.</em> The monocyte chemoattractant protein -1 (MCP-1) is a member of the CC chemokine family, and a potent chemotactic factor for monocytes. It plays an important role in the recruitment of monocytes/macrophages into renal tubulointerstitium .
<em> <strong>Aim:</strong></em>The present study was designed to check urinary MCP-1 levels in pediatric patients with idiopathic nephrotic syndrome, and to detect effect of disease remission and activity on these levels.
<strong><em>Patients and methods:</em></strong> the present work included fourty children with idiopathic nephrotic syndrome, subdivided into 2 groups: group A(cases in remission) & group B(cases in activity). Also twenty apparently healthy children age and sex matched with the cases have been included as a control group. All patients in this work beside assessment of renal functions were clinically evaluated together with routine laboratory investigations. Levels of urinary monocyte chemotactic protein-1 were measured in the urine of patients during activity and remission of the disease. Urine samples from 20 age- and sex matched controls were checked for the same cytokine.
<strong><em>Results:</em></strong> mean age for the studied cases were 8.14±2.50 years. In the present study, group (B) had the highest level of serum cholesterol and pr/cr ratio then group (A) and control group, the differences between the three groups were statistically significant. In contrast, group (B) had the lowest level of the serum albumin followed by group (A) then control group, again, the differences were statistically significant between the three groups. Also , the mean values of protein of 24 hours urine were significantly lower among group A than group B, and the differences between the two groups were statistically highly significant . this work show that Group (B) had the highest levels of uMCP-1 followed by group (A) then control group. The difference between the three group was statistically highly significant. Our work shows that 40% of cases in activity in group B were in relapse of NS and the remaining -60%- were in the 1<sup>st</sup> attack of NS, and there was no significant difference between them regarding to uMCP-1. The current study shows that uMCP-1 level in group B and group A were highly positively correlated with Pr/Cr ratio ,Protein of 24 hours urine and serum cholesterol and highly negatively correlated with serum albumin. On the other hand uMCP-1 levels in control subjects were positively correlated with Pr/Cr ratio but not correlated with serum cholesterol or serum albumin.
<strong><em>Conclusion:</em></strong> Our results support the role of monocyte chemotactic protein-1 in the pathogenesis of INS.
Childhood Nephrotic Syndrome,Urinary Monocyte Chemotactic Protein -1(uMCP-1),relapse,Remission
https://azjp.journals.ekb.eg/article_70328.html
https://azjp.journals.ekb.eg/article_70328_a7f97ae95cd8148213a76cec04ed6a56.pdf
Al-Azhar University, Al-Azhar Pediatric Society
Al-Azhar Journal of Pediatrics
1110-7774
3009-7770
21
1
2018
01
01
THE ROLE OF IMPULSE OSCILLOMETRY IN THE EVALUATION OF SMALL AIRWAYS ABNORMALITIES IN ASTHMATIC CHILDREN
1953
1969
EN
. Zeinab Abd El-aziz
El-Ramly
Ehab Ibrahim
Sorour
Asmaa Alhusseiny
Ahmed
10.21608/azjp.2018.70331
<strong><em>Background:</em></strong> <em>Asthma has been considered a disease that predominantly involves the large airways. Today, this concept is being challenged, and increasing evidence has become available showing that abnormalities in the small airways also contribute to the clinical expression of asthma.</em>
<strong><em>Objectives:</em></strong> <em>To provide an overview of impulse oscillometry and its application to the evaluation of children with diseases of the airways and detection of bronchodilator response regarding the levels of asthma control in asthmatic children.</em>
<strong><em>Methods:</em></strong> <em>this study was done on 50 asthmatic patients diagnosed according to the clinical manifestations and pulmonary functions<strong>. </strong>Children performed IOS and spirometry before and after 200 mcg salbutamol inhalation. Because of the possible effects of forced expiratory maneuvers on the bronchial motor tonus,</em> <em>first IOS, and then spirometry was performed. This study was carried out at Pediatric Chest Clinic, Children’s Hospital, Ain Shams University. The asthmatic patients were recruited from both Al-Hussein and Ain shams pulmonology and allergy outpatient clinics,</em> <em>from December 2016 to November 2017.</em>
<strong><em>Results:</em></strong><em> this study showed that the prevalence of small airways dysfunction when utilizing a spirometric cut-off value (i.e<60% in MEF25-75) was 64% and when employing IOS cut-off value (>0.1 kPa/L/s for R5-R20, >15 Hz for Fres) a prevalence of 82% and 78% were observed respectivelyand showed that the best index with +ve BDR was X5 which detected 63.6% of controlled , 52.6% of partly controlled and 66.7% of uncontrolled asthmatic patients compared with 40.9%, 63.2% and 66.7% for the same patients respectively when assessed by spirometry using ∆ FEV1%. Statistical analysis was done by using IBM SPSS software package version 20.0.</em>
<strong><em>Conclusion:</em></strong> <em>IOS is a noninvasive, rapid and safe technique that may be used to diagnose, evaluate, and determine treatment response in those with asthma.</em>
https://azjp.journals.ekb.eg/article_70331.html
https://azjp.journals.ekb.eg/article_70331_49c941f331c35ffaf4ba34058c035cf8.pdf
Al-Azhar University, Al-Azhar Pediatric Society
Al-Azhar Journal of Pediatrics
1110-7774
3009-7770
21
1
2018
01
01
GENETIC POLYMORPHISMS AND THERAPEUTIC RESPONSE TO ATOMOXETINE IN EGYPTIAN CHILDREN WITH ATTENTION-DEFICIT HYPERACTIVITY DISORDER
1970
1989
EN
Dr. Hassan Ali
Hassan
Salama
Abdo Mohammed
Khalda Sayed
Amr
Mohammed
Abdel-Malik
Mahmoud
Rabie
10.21608/azjp.2018.70333
<strong>Background: </strong>Attention Deficit Hyperactivity Disorder (ADHD) is highly prevalent in school age children worldwide and we need to improve response to atomoxetine drug (non stimulant ) which used for treatment of ADHD.
<strong>Objective: </strong>This study was undertaken to Study of possibly existing genetic polymorphisms of (CYP2D6, CYP2C19) the main enzymes involved in atomoxetine metabolism and their relations with therapeutic response to atomoxetine in a sample of Egyptian children with ADHD disorder, and try to correlate their phenotype-genotype status.
<strong>Patients and Methods: </strong>150 children (100 cases+ 50 control) attended to outpatient pediatric neurology clinic in Bab Al Sha<sup>’ </sup>reya hospital of Al-Azhar University were evaluated by history, general and systemic examination stressing on neuro- psychatric examination, DSM-5 criteria for diagnosis of ADHD , Conner's Abbreviated Rating Scale for the follow up of ADHD and genetic polymorphisms of CYP2D6 and CYP2C19 study by using (PCR) / (RFLPS) techniques.
<strong>Results: </strong>There was genetic polymorphisms of the CYP2D6 and CYP2C19 enzymes in ADHD children that possibly influence the response to atomoxetine, P <0.001.
<strong>Conclusion: </strong>These results suggest that CYP2D6, CYP2C19 poor metabolizers taking atomoxetine optimal doses are likely to have greater efficacy, greater increases in side effects and some differences in tolerability compared with CYP2D6, CYP2C19 extensive metabolizers taking similar dose.
Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition (DSM-5),polymerase chain reaction (PCR),Restriction Fraction Length Polymorphisms (RFLPS),cytochrome p450 2D6(CYP2D6),cytochrome p450 2C19(CYP2C19)
https://azjp.journals.ekb.eg/article_70333.html
https://azjp.journals.ekb.eg/article_70333_5d1e365979215e887df6de162f40085c.pdf
Al-Azhar University, Al-Azhar Pediatric Society
Al-Azhar Journal of Pediatrics
1110-7774
3009-7770
21
1
2018
01
01
ROLE OF PROADRENOMEDULLIN AS A BIOMARKER OF PEDIATRIC PNEUMONIA
1990
2002
EN
. Fahima
Mohammed Hassan
Rania Salah
EL Zayat
Al Zahraa Ahmed
Abdel Aziz Mostafa
10.21608/azjp.2018.70335
<strong>Background:</strong> Community acquired pneumonia (CAP), is an important cause of childhood mortality. Proadrenomedullin (ProADM), is a new regulatory peptide extracted from pheochromocytoma and is a precursor of adrenomedullin but a more stable form. Adult studies found that ProADM is elevated in patients with pneumonia and it is found to be correlated with severity and complications. Also other studies investigated ProADM as prognostic marker for many diseases as sepsis,dengue shock and heart failure.
<strong>Objective: </strong>The aim of this study was to measure the levels of ProADM in children with CAP and to correlate its levels with the severity and complications.
<strong>Methods:</strong> This study was done on 90 children (60 children were diagnosed as having CAP and 30 age & sex matched healthy controls). All children were subjected to history taking, clinical examination and investigations ( chest x ray, Complete Blood Count, C-reactive protein, serum levels of ProADM by enzyme-linked immuno-sorbent assay ELIZA).
Modified Respiratory Distress Assessment Instrument (RDAI) score was used to classify out cases into mild, moderate and severe.
<strong>Results: </strong> Serum level of ProADM was found to be higher in CAP cases than in controls and the difference was statistically significant (Mean ± SD = 1.52±0.62 and 0.05±0.04 respectively). Also ProADM was found to be higher in complicated cases, (4 pleural effusion, 1 collapse, 1 pneumothorax ) than uncomplicated cases and the difference was statistically significant (2.50±0.24 and 1.41±0.05) respectively. ProADM was increasing with increasing severity of pneumonia. Cutoff point>2.2 nmol/l was the best level to distinguish between complicated and uncomplicated cases (P=0.01 , sensitivity100%, specificity 81.5% , positive predictive value 37.5% , negative predictive value 100% ).
<strong>Conclusion: </strong> level of ProADM was elevated in CAP patients than in controls and higher levels were found in severe and complicated cases.
https://azjp.journals.ekb.eg/article_70335.html
https://azjp.journals.ekb.eg/article_70335_45164f1e1ed8a4c5f6cbf06bb97981d8.pdf
Al-Azhar University, Al-Azhar Pediatric Society
Al-Azhar Journal of Pediatrics
1110-7774
3009-7770
21
1
2018
01
01
EFFECT OF MINIMAL ENTERAL NUTRITION ON SUPERIOR MESENTERIC ARTERY (SMA) BLOOD FLOW VELOCITY IN PREMATURE INFANT
203
2019
EN
Koraa
a
Maghraby H
H
Mamdouh
F
10.21608/azjp.2018.70343
<strong>Background:</strong> Minimal Enteral Nutrition (MEN) is reported to improve gastrointestinal disaccharides activity, hormone release, motility, and microbial flora. Clinical benefits include improved milk tolerance, greater postnatal growth, reduced systemic sepsis and shorter hospital stay. Very little is known about its effect on Superior Mesenteric Artery (SMA) blood flow velocity in premature infants.
<strong>Aim:</strong> the aim of this study is to detect changes in superior mesenteric artery blood flow occurring in preterm infant after MEN.
<strong>Patient and Method:</strong> It is a pretest-posttest prospective cohort study. SMA blood flow parameters were measured with Doppler Ultrasonography on SMA for analysis of Doppler flow velocity waveforms, that includes end-diastolic velocity, peak-systolic velocity, time-averaged mean velocity, resistive index and pulsatility index on 40 stable preterm neonates (gestational age range 28-33 weeks, weight at examination range 1000-2800 g, postnatal age range 1-4 days). They were admitted to the neonatal intensive care unit of Al-ZahraUniversityHospital during the period from July 2016 to December 2017. Measurements were performed before and after minimal enteral feeding. The baseline SMA blood flow was measured before test feed (10 to 15 ml/kg/day) and repeated 30 minutes after the feed.
<strong>Results:</strong> Comparing SMA velocities and indices before and after minimal enteral nutrition indicated a significant increase in peak systolic velocity (PSV), end diastolic velocity (EDV) and time- average mean velocity (TAMV), and a significant decrease in pulsatility index (PI) and resistance index (RI) after 30 min from MEN. the mean flow velocities of the (SGA) group were significantly higher than (AGA) group. the mean flow velocities of the early fed group were significantly higher than late fed group No correlation has been found between SMA parameters and studied vital signs or SpO2.
<strong>Conclusion</strong>: MEN improves SMA blood flow especially in small for gestational age, thus it might influence the structure and promote development of the premature infant’s gastrointestinal tract.
<strong>Recommendation: </strong> use of early minimal enteral nutrition especially in very premature baby and should be used as an adjunct to parenteral nutrition.
Duplex ultrasound,Preterm,minimal enteral feeding,SMA
https://azjp.journals.ekb.eg/article_70343.html
https://azjp.journals.ekb.eg/article_70343_d872a0c6672b78e3bc4bf93cfb09e174.pdf