2024-03-29T12:19:59Z
https://azjp.journals.ekb.eg/?_action=export&rf=summon&issue=10666
Al-Azhar Journal of Pediatrics
1110-7774
1110-7774
2019
22
4
EFFICACY AND TOLERABILITY OF PULSE STEROID AS AN ADD-ON THERAPY IN MANAGEMENT OF REFRACTORY CHILDHOOD EPILEPSY
Kotb AM
Nasser MM
Alsawah
AY
Elsayeh
AA
Background: Epilepsy is one of the commonest neurological conditions, with an estimated prevalence of 0.5%–1% in developed countries. Steroids have been used for the treatment of certain epilepsy types, such as infantile spasms; however, the use in the treatment of other intractable epilepsies has received limited studies. Objectives: We aimed to evaluate efficacy and adverse effects of high dose intravenous methylprednisolone (pulse steroid therapy) as an add-on therapy for refractory childhood epilepsy and its impact on both clinical and electroencephalographic aspects. Patients and Methods: This interventional comparative study was carried out on 30 patients with refractory epilepsy, at PICU and Pediatric Neurology Unit of Al-Hussein University Hospital, during the period from December 2017 to November 2018. They were divided into two groups: Group A (intervention group) and group B (control group). All patients were aged from 2 months up to 18 years and of both genders. Patients with infantile spasms, autoimmune disorders, or progressive degenerative or metabolic disorders were excluded. History-taking, complete clinical examination and laboratory investigations were registered. Electroencephalography was done on admission and post-control therapy. Adequate rationals of AED polytherapy were given. For the intervention group (group A), intravenous methylprednisolone was added at 30 mg/kg once daily, for 3 consecutive days, followed by oral prednisolone 2 mg/kg/day, in 3 divided doses, for 2 weeks then gradually tapered over 4 weeks. Results: There were no significant differences between the study groups regarding age, gender and onset of seizures. Two main etiologies were recorded among the study groups; Lennox-Gastaut Syndrome (LGS) and idiopathic epilepsy. All patients among group A (100%) had daily seizures while among group B 80% had daily seizures and 20% had weekly seizures. The seizures-type among the study groups was comparable; with 2 main types were recorded, Generalized Tonic Clonic (GTC) and multiple seizures-type. Follow up of all patients for 6 months after start of treatment revealed a significant improvement regarding EEG findings among group A more than among group B. After treatment among group A, 9 patients showed full improvement (normal EEG), 4 patients showed fair control (less frequent spikes on EEG) and 2 patients showed no improvement (same EEG abnormalities). There was no statistically significant difference, before and after treatment, among group B. After treatment among group B, 3 patients showed full improvement (normal EEG), 2 patients showed fair control (less frequent spikes on EEG) and 10 patients showed no improvement (same EEG abnormalities). A significant seizures-reduction was recorded among group A more than among group B after treatment, 66.67% seizures-reduction among group A vs 20% seizures-reduction among group B. Adverse effects of steroids were infrequent, mild and transient with no major adverse effects. Conclusion: Intravenous methylprednisolone as an add-on therapy for refractory childhood epilepsy is effective on both clinical (frequency of seizures) and electroencephalographic aspects.
Methylprednisolone
Child
Intractable
Epilepsies
Seizures
2019
10
01
503
523
https://azjp.journals.ekb.eg/article_70251_d0cc689d5f4398adfd0eae8fd81a7bc4.pdf
Al-Azhar Journal of Pediatrics
1110-7774
1110-7774
2019
22
4
ECHOCARDIOGRAPHIC ASSESSMENT OF SUPERIOR VENA CAVA FLOW IN TERM AND PRETERM NEONATES
Karim
Hassan saad
Khaled
Mahmoud Zayed
Hatem
Refat Hablas
Amr
Hemida Mostafa
Background: Despite significant advances in our ability to monitor complex and clinically relevant hemodynamic parameters, in most neonatal intensive care units (NICUs), cardiovascular function is assessed only by continuous heart rate, invasive blood pressure monitoring, and poorly validated clinical signs such as capillary refill time. Indirect measures for assessment of tissue perfusion, including urine output and serum lactate levels, are especially problematic with the very early preterm neonate in the first postnatal days when complex hemodynamic changes occur during the transition to postnatal life. Functional echocardiography can provide a direct assessment of hemodynamics on bedside, and may be considered as an extension of the clinical examination to evaluate cardiovascular wellbeing in the critically-ill infant. Objectives: The study is designed to assess the superior vena cava flow in normal term, preterm and low birth weight. Patients and Methods: This is a case control study of 50 patient were selected and divided into three groups: full term, preterm and low birth weight. In each patient we measured SVC maximum, minimum, mean dimension from parasternal view while velocity time integral measured from subcostal view and calculate SVC flow from the formula. Results: We found that significant decrease in SVC max, SVC min, SVC mean and SVC flow of preterm and low birth weight groups, compared to control group. While VTI was significant decrease in preterm group, compared to control group, but low birth weight was show non-significant decrease, compared to control group. And a significant decrease in gestational age, Apgar score, weight and length of preterm and low birth weight groups, compared to control group. But there was non-significant difference in heart rate, respiratory rate and capillary refill time in both preterm and low birth weight groups, compared to control group. Systolic and diastolic blood pressure show significant decrease in the mentioned groups, compared to control group. Conclusion: Measurement of SVC flow is important for assessment of hemodynamic status in full term, preterm and low birth weight neonates.
Superior vena cava
Echocardiography
Preterm
2019
10
01
524
539
https://azjp.journals.ekb.eg/article_70253_85895242ceb4a9f2e19fe774ad126ebe.pdf
Al-Azhar Journal of Pediatrics
1110-7774
1110-7774
2019
22
4
ASSESSMENT OF DIASTOLIC FUNCTION OF RIGHT AND LEFT VENTRICLES IN INFANTS OF DIABETIC MOTHERS WITH RESPIRATORY DISTRESS SYNDROME
Mahmoud Mohamed
Radwan El meligy
Raafat Abd Elraouf Mohamed
Khattab
Mohamed
Farouk Ahmed
Nagah Mohamed
Abu Mohamed
Background: The present study was a Descriptive case-control study done that included infants of diabetic mothers with respiratory distress syndrome and infants of diabetic mothers without respiratory distress syndrome. Healthy full-term neonates were also included as a control. Infants of diabetic mothers are frequently suffered from several cardiac and respiratory complications. Cardiovascular compromise is a common complication of neonatal respiratory distress syndrome (RDS). Our study assessed the diastolic function in infants of diabetic mothers with RDS and report that they are more likely to develop increase diastolic dysfunction than infants of non-diabetic mothers. Aim: The purpose of this study was to assess the diastolic function of right and left ventricles using Conventional Doppler and Tissue Doppler Imaging (TDI) in infants of diabetic mothers with RDS and infants of diabetic mothers without RDS. Methods: The study was conducted in neonatal intensive care unit (NICU) in Bab-Alsheria hospital, Pediatric department, Faculty of medicine, Al-Azhar University, cairo, in the period from June 2018 to February 2019 . The present work was conducted on forty neonates IDM ( 20 with RDS, 20 without RDS) and 20 (control), the degree of RDS was clinically scored by Downes’ score All have: Detailed history- clinical examination-Plain X-ray- Tissue Doppler Imaging (TDI) and Doppler echocardiographic . Results: Show significant higher value in IVS, Mitral A wave velocity and Tricuspid A wave velocity in IDMs with RDS compared to IDMs without RDS and control group. And significant lower values in Mitral E-wave velocity, Mitral E/A ratio, Tricuspid E-wave velocity, and Tricuspid E/A ratio in IDMs with RDS compared to IDMs without RDS and control group . Tissue Doppler Imaging (TDI) shows both the left and right ventricle myocardial velocities were found to be lower in the infant of diabetic mothers with RDS compared to the control group. Conclusion: Infants of diabetic mothers with RDS are more prone to diastolic dysfunction and increase myocardial thickness compared with AGA- infants of diabetic mothers without RDS and control group.
Echocardiogram
Infants of diabetic mothers (IDM)
Respiratory distress syndrome (RDS)
2019
10
01
540
559
https://azjp.journals.ekb.eg/article_70258_2d92d8cd0d926461270e12aaa324dc04.pdf
Al-Azhar Journal of Pediatrics
1110-7774
1110-7774
2019
22
4
COGNITIVE FUNCTIONS IN CHILDREN WITH TYPE I DIABETES
Ahmed
Awad Eldamom
Ali
Abd-Ellatif Afia
Ali
Abdul Fattah Alnabawy
Abdelsattar
Abdullah Elsayeh
Nabil
Fathy Esmael
Background: Type 1 diabetes mellitus (T1DM) is a common chronic disease characterized by hyperglycemia as a cardinal biochemical feature caused by deficiency of insulin secretion due to pancreatic β-cell damage. T1DM is the most common endocrine-metabolic disorder of childhood and adolescence, with important consequences on physical and emotional development. There is increasing agreement that children with T1DM are at higher risk of developing slight cognitive disabilities compared to healthy age-matched peers. Objectives: To quantify the magnitude and pattern of cognitive difficulties in pediatric type 1 diabetes as well as the effects associated with earlier disease onset and longer duration of diabetes. Research design and methods: This is a case-control study. The study was conducted over a period from November 2016 to November 2018. Our study included fifty patients with T1DM matched with age and gender of fifty apparently healthy controls. All cases were subjected to history, clinical examination, investigations and cognitive functions which assessed by Modified Mini-Mental State examination (3MS), Intelligence Quotient (IQ) test and Pediatric Symptoms Checklist (PSC). Results: The present study shows high significant differences between patients and control groups as regard to IQ, Modified Mini-Mental State examination (3MS) and Pediatric Symptoms Checklist (PSC). The best cut off point for IQ to detect cognitive dysfunction in diabetic patients was found ≤ 83 with sensitivity of 88%, specificity of 86% and area under curve (AUC) of 91.4. The best cut off point for 3MS to detect cognitive dysfunction in diabetic patients was found ≤ 27 with sensitivity of 58%, specificity of 76% and AUC of 74.4. Finally the best cut off point for PSC to detect cognitive dysfunction in diabetic patients was found ≤ 42 with sensitivity of 84%, specificity of 92% and AUC of 96.1%. The PSC was found the better predictor of cognitive dysfunction in diabetes with area under curve (AUC) 96.1% followed by IQ with AUC of 91.4% and lastly the 3MS with AUC of 74.4%. Conclusion: From our study we concluded that diabetic children have lower cognitive performance than non- diabetic and those cognitive dysfunction increased in diabetic patient with disease duration >5 years and in those with poor glycemic control.
Child
HbA1c
executive functioning
intelligence
memory
type 1 diabetes mellitus
2019
10
01
560
581
https://azjp.journals.ekb.eg/article_70259_39cf62d417b07fbdce29f80c657dc095.pdf
Al-Azhar Journal of Pediatrics
1110-7774
1110-7774
2019
22
4
VITAMIN D STATUS OF PEDIATRIC INTENSIVE CARE UNIT PATIENTS WITH PNUMONIA
Mostafa
Ezzat Mohamed
Mohamed Kama
l Fayez Eltohamy MD
Mohamed
Abdel-malik Hassan
Ahmed Mohamed
Mahmoud Elgamal
Introduction: Vitamin D plays an important role, not only for bone health, but also for the immune system. Both in vitro and clinical studies have demonstrated that vitamin D is important for the innate and adaptive immune response. Adequate nutritional support has been a mainstay in pediatric intensive care unit (PICU) management with research showing improved outcomes and fewer PICU stay. However, there have been few studies to investigate the prevalence of vitamin D deficiency in critically ill children.Aim of the work: This study aims to examine vitamin D status in the children with pneumonia who will be admitted to pediatric intensive care unit and correlate it to the severity and occurrence of complications.Patients and Methods: This study was conducted in Pediatric intensive care unit at Al-Hussein University Hospital on 60 children; divided into two groups: group I (study group) including 40 patients presented with pneumonia. These patients aged from one month to fifteen years and admitted to the PICU of El-Hussein University Hospital (This group had been furtherly sub-classified to group Ia and group Ib according to occurrence of complications) and group II (control group) including 20 apparently healthy children of matched age and sex with no evidence of pneumonia or history of lower respiratory tract infection. Serum vitamin D was estimated.Results: Statistically, the vitamin D level was significantly lower in study group than in control group, vitamin D level was significantly very low in cases with complications (group Ia) than in cases without complications (group Ib).There was a significant negative correlation between vitamin D level and occurrence of complications as well as duration of hospitalization.Conclusion: This study concluded that vitamin D level was significantly lower in severe pneumonia which admitted to pediatric intensive care unit. There were correlation between vitamin D level and occurrence of complications and severity of pneumonia in children, and these patients with lower vitamin D level had longer duration of hospital stay.Recommendations: We recommend appropriate vitamin D supplementation and sun exposure to decrease the risk of respiratory tract infections, also recommend using vitamin D in addition to antibiotic as a treatment of pneumonia cases in children which has an important role in the production of anti-microbial peptides for innate immunity.
pneumonia
vitamin D deficiency
relation between vitamin D and pneumonia
2019
10
01
582
599
https://azjp.journals.ekb.eg/article_70266_80124411cc32e016c9a0f360439e79d6.pdf
Al-Azhar Journal of Pediatrics
1110-7774
1110-7774
2019
22
4
KNOWLEDGE, ATTITUDE AND PRACTICE AMONG MEDICAL STAFF TOWARDS BREASTFEEDING MANAGEMENT
Hossam
Weshahy
Mahmoud
Rashad
Mohamed
Abul-fadl
Ahmed
Mohammed
Background: Breastfeeding (BF) is an important public health strategy for improving infant and child health and reducing morbidity and mortality, improving maternal morbidity, and helping to control health care costs. Breastfeeding is associated with a reduced risk of otitis media, gastroenteritis, respiratory illness, sudden infant death syndrome, necrotizing enterocolitis, obesity, and hypertension. (James & Lessen, 2009). Aim of the Work: To assess knowledge, attitude and practice (KAP) among medical staff regarding BF management and to identify needs for improving their practice in lactation management. Subjects and Methods: Cross-sectional study including 150 medical staff (100 physicians and 50 nurses) randomly selected at pediatric departments of Al Hussein & Benha university hospitals and El Alamein Ministry of Health Public Hospital (Alexandria). The study was carried out during the duration from February 2018 to March 2019. All the study populations were subjected to self-administered questionnaire (attached) that include questions to measure the knowledge, attitude and practice (including questions from number 1 to 20, 21 to 40 and 41 to 60 respectively). Results: The overall percent score for knowledge (67.03 ± 11.28) was higher than that for attitude and practice (60.62 ± 4.74 and 52.17 ± 8.87 respectively). However percent score for practice was the lowest (52.17 ± 8.87). Percent scores of physician practice (62.90 ± 14.77) and attitude (65.25 ± 13.94) were significantly higher than that of nursing staff (49.70 ± 12.14 and 61.73 ± 4.96 respectively) regarding breastfeeding, p Conclusion: External assessment of knowledge, attitude and practice among medical staff toward breastfeeding management is a valuable tool for validating the quality of maternity and newborn services.
KAP
Exclusive breastfeeding
BFHI
Ten steps to successful breastfeeding
2019
10
01
600
616
https://azjp.journals.ekb.eg/article_70272_3085043a8ff61f1fbc213c13e104f927.pdf
Al-Azhar Journal of Pediatrics
1110-7774
1110-7774
2019
22
4
IMPACT OF PROBIOTICS ON NEONATAL HYPERBILIRUBINEMIA
Tamer
Ramadan kamel
Ali
Abd Ell atif Afia
Hatem
Rifaat Hablas
Mohammed
Said Al-Shorbagy
Background: Jaundice is one of the most common conditions requires medical care in neonates. The yellow colour of the skin and the sclera in neonates is the result of the accumulation of bilirubin, the most common natural consequence of the first week of life as indicated by Bhutani Hour-specific bilirubin nomogram, Bilirubin encephalopathy is a devastating brain injury, which can cause permanent neurodevelopmental handicaps, so prevention& treatment of neonatal hyperbilirubinemia is very important . Objectives: The aim of this study was to evaluate the efficacy and safety of probiotics on neonatal hyper bilirubinemia. Methods: It is randomized controlled clinical trial; it included 100Full term neonates who were admitted immediately or shortly after birth due to pathological Hyperbilirubinemia as indicated by Bhutani Hour-specific bilirubin nomogram. To NICU of Al-AZHAR university hospitals the cases dived into Group (A) 50 cases treated by phototherapy in combination with probiotics and group (B) 50 as control treated by Phototherapy only. The serum bilirubin levels were done before and the1st, 4th, 7th days after treatment with probiotics (lactobacillus 5 billion/ sachets) divided into 3 doses daily for 7 days). The time when therapy showed effects and jaundice faded, Clinical outcomes as well as adverse reactions were recorded. Results: Serum bilirubin levels of the two groups were similar before treatment. The levels significantly decreased at the 4th and 7th days after treatment of probiotics in group(A )(P<0.05), but there was no significant different after the 1st day of treatment with probiotics (P>0.05) between the two groups, In group (A) the therapy exerted effects after (2.7±0.8) day and jaundice faded after (4.8±0.9) day) while in group (B)) the therapy exerted effects after (3.9±1.7) day and jaundice faded after (5.9±1.8) day, the effective rate of decrease in group (A) significantly exceeded that in group (B), (P=0.007, 0.002). Conclusion: The use of probiotics is an important adjuvant to phototherapy during management of neonatal hyper bilirubinemia this combination reduce the side effects of phototherapy and the duration of hospital stay for cases of neonatal hyper bilirubinemia.
Full term Neonate
Neonatal hyperbilirubinemia
phototherapy
probiotics
2019
10
01
617
628
https://azjp.journals.ekb.eg/article_70275_9d701c6929afce04ff87fbed8f1c266e.pdf
Al-Azhar Journal of Pediatrics
1110-7774
1110-7774
2019
22
4
Incidence and Risk Factors of Brief Resolved Unexplained Events in Infants presenting to Pediatrics Department of Bab Elsharya University Hospital
Background: Infants who present with a history of an acute event (an unexpected change in an infant's breathing, appearance, or behavior), reported by their parent or caregiver, represent a heterogeneous group of patients of varying ages with diverse pathophysiology. A BRUE is diagnosed only when there is no explanation for the described event after a thorough history and physical examination.
Aim of the study: to detect the incidence of Brief Resolved Unexplained events and differentiate Risk Factors according to initial presentation of cases and follow-up.
Methods: Prospective application of BRUE criteria on infants younger than 12 months old who presented to emergency room of Bab El Shaaria University Hospital from 1 June 2018 to 1 December 2018. BRUE patients were classified into Lower-risk (LR-BRUE) and Higher-risk (HR-BRUE). History was taken from all caregivers and all patients underwent physical examinations and o2 saturation monitoring by pulse oximetry on room air. Studied infants were followed up 3 to 6 months after discharge either by regular visits or by phone.
Results: study included 2462 Infants below 1 years old, the inclusion criteria of BRUE met 39 patients ( 1.58%) 18 of them are males (46 %) and 21 are females(54%), 23 of BRUE cases classified as low Risk BRUE(59%), and 16 cases as High Risk BRUE(41%) all were admitted for further investigations . prematurity was conducted in 9 cases (23%). The entire BRUE group was monitored by pulse oximetry for 4 hours, O2 saturation was above 90% in 36 cases (93%), while 3 cases (7%) were below 90% and all had been admitted for further assessment and investigations. The incidence of death was in 3 cases (8%) all of them was HR-BRUE. Recurrence occurred in 8 patients (10%) , 2 of them were initially classified as LR-BRUE. The most frequent diagnosis of HR-BRUE was pertusis in 4 cases (25%), GER in 3 cases (19%) and epilepsy in 2 cases (13%).
Conclusion: Diagnosis of BRUE represent 1.58 % of the studied cases, the risk of Recurrence is statistically significant in patient below 2 months old , preterm infants , infants with history of underlying diseases , and those whose O2 saturation above 90%. While the Risk of death was statistically significant in infants with history of underlying diseases, History of NICU admission and those who's presented by high Risk BRUE.
2019
10
01
629
653
https://azjp.journals.ekb.eg/article_303590_a05a82481e8831db8c4d58d07bd85d9b.pdf