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   Table of Contents - Current issue
January-April 2018
Volume 31 | Issue 1
Page Nos. 1-41

Online since Friday, September 7, 2018

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Studying a possible relationship among serum leptin, serum zinc and BMI in children p. 1
Lamia M Hafez, Manal M.Abd El-Gawad, Ola H Elgaddar, Amenh B Yousif
Background Developing countries are facing the double burden of nutritional transition, malnutrition and micronutrient deficiencies, as well as a rapidly growing epidemic of childhood obesity. Leptin is a key hormone in the regulation of BMI, and a relation between zinc and leptin was detected. Aim This study aimed to investigate the relationship among serum leptin, serum zinc and BMI in children. Patients and methods A cross-sectional study was carried out on a total of 82 children of both sexes aged from 2 to 14 years attending the outpatient clinic at Alexandria University Children’s Hospital, Egypt, over 3 months from September 2016 to November 2016. All participants were clinically evaluated for weight, height and BMI. Serum leptin and serum zinc were measured. Results From the total sample of 82 children, it was found that the high percent of overweight children were found in the age group between 9 and at least 14 in both sexes (48% in boys and 37.5% in girls). The mean serum leptin level was insignificantly higher in girls in the age group from 9 to up to 14 years; it was 10.67 μg in girls, whereas it was 9.0 in boys. There was no significant difference in serum zinc level between boys and girls at all age groups. There was an insignificant negative correlation between serum leptin and serum zinc in boys and girls at all age groups. The correlation between serum leptin and BMI was significantly positive in girls at age group 9 to up to 14 years (r=0.644, P=0.013). Serum zinc was insignificantly negatively correlated with BMI in boys and girls at age group 9 to up to 14 years, but the relation was positively significant in boys in the age group 2 to less than 3 (r=0.757, P=0.049). Conclusion The correlation between leptin and BMI in girls was significant at age group 9 to up to 14 years. A negative insignificant correlation was found between serum leptin and serum zinc. Insignificant positive correlation was found between serum zinc and BMI.
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Short-term outcome of patent ductus arteriosus in the neonatal period p. 8
Salah R Zaher, Manal A.M Antonios, Adham O Badib, Mahmoud M.B Nadder
Background Patent ductus arteriosus (PDA) is a common problem in neonates. It has a very high incidence especially in infants weighing 1000 g or less reaching in some studies up to 60%. Aim The current study aimed at assessing the short-term outcome of PDA in the first 28 days of neonatal life. Patients and methods All neonates admitted to Alexandria University Children’s Hospital Newborn unit at El-Shatby were assessed (n=410). Two-hundred fifty were preterm and 160 were term. Sixty cases were proved by echocardiography to have PDA at day 4 including 47 preterm and 13 term neonates who were followed up at day 10 and day 28 to assess the outcome of PDA. Results The incidence of PDA was 18.8 and 8.1% in the preterm and in the term babies, respectively. The incidence in preterm neonates 32 weeks of gestational age or less was 29.1% and in neonates weighting 1000 g or less was 36.6%. It was also noted that the lower the gestational age and birth weight, the higher the incidence of PDA. Females were more common to have PDA in the term group. On following up these cases, the closure rate at 10 days was 62.2% in the preterm in comparison with 61.5% in the term, but at 28 days, the closure rate was 94.4% in the preterm in comparison with 66.7% in the term. Ten cases were not given any medical treatment and their closure rate was 70%, and no cases developed heart failure. It was also noticed that the closure rate is higher in cases that received ibuprofen (72%) in comparison with paracetamol (60%) at the age of 10 days. Conclusion PDA in the neonatal period is a very common cardiac malformation that frequently closes spontaneously. The rate of closure is higher among preterm, low-birth-weight and small-for-gestational-age babies.
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Impact of pre-pediatric ICU management on prognosis of sepsis and septic shock at Alexandria University Children’s Hospital p. 14
Hassan A El-Kinany, Amel A.A Mahfouz, Lamiaa E Abd El-Fattah
Background Pre-pediatric ICU (PICU) management in cases of severe sepsis and septic shock is an extremely important factor in the outcome of the patients. Pre-PICU management can also be the direct cause of better outcome of cases with severe sepsis and septic shock. Aim The purpose of this study was to evaluate the pre-PICU management in cases of severe sepsis and septic shock at Alexandria University Children’s Hospital and its association with the survival rate of the cases. Patients and methods A cross-sectional study was conducted on 40 patients during 12 months period at PICU of Alexandria University Children’s Hospital with the diagnosis of severe sepsis and/or septic shock. Their age ranged from 1 month to 12 years, 21 were males and 19 were females. All cases were subjected to history taking stressing on time from the start of illness until the patient arrived to the hospital, pre-referral treatment, number and kind of medical centers that took care of the patient before admission. The clinical condition of the patient on admission was evaluated (with respect to the degree of sepsis) and the mortality probability on admission was performed using Pediatric Index of Mortality 2 (PIM-2) score. Routine investigations were done at admission. Follow-up of the cases in PICU was evaluated by PIM-2 score, length of stay and the prognosis of cases whether improvement or death. Results Twenty-three (57.5%) cases presented with septic shock and 17 (42.5%) cases presented with severe sepsis. Gastrointestinal tract infection and chest infection were the most common clinical sources of sepsis (16 and 10 cases, respectively). The mean of the duration from start of illness until patient arrived to the hospital was 7 days in nonsurvivors versus 3 days in survivors. Eighteen (45%) patients did not receive any antibiotic therapy before admission, whereas 22 (55%) received antibiotics via different routes before admission. Conclusion The results indicated that gastrointestinal tract infections and chest infection were the most common clinical sources of sepsis. Administration of intravenous antimicrobial therapy with the onset of sepsis is an important factor in better prognosis of septic shock and PIM-2 score is a good predictor of mortality on the first day of admission to PICU. Referral from a tertiary hospital to PICU is a good indicator for better prognosis.
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Disseminated intravascular coagulation scoring in children with newly diagnosed acute leukemia p. 22
Hoda M.A Hassab, Mostafa A.S Salama, Wessam M El Gendy, Yasmine F El Chazli
Background Patients with acute leukemia (AL) commonly present with abnormalities in laboratory tests of blood coagulation. Coagulation abnormalities and disseminated intravascular coagulation (DIC) have been extensively studied in acute promyelocytic leukemia, but only a limited number of studies addressed this issue in children with other types of AL. Objective The aim of this study was to detect DIC by using the International Society of Thrombosis and Haemostasis scoring system, for both nonovert and overt DIC, among newly diagnosed children with AL. Participants and methods The study was a diagnostic test accuracy study including 25 children presenting with newly diagnosed AL (lymphoblastic and myeloid) and admitted to the Hematology–Oncology Unit at Alexandria University Children’s Hospital. They were consecutively recruited between October 2016 and March 2017. Coagulation studies including prothrombin time, D-dimer, fibrinogen, antithrombin III, and protein C levels were assessed, and the International Society of Thrombosis and Haemostasis scoring system was used for defining nonovert and overt DIC. Results The age of patients included in the present study ranged from 17 to 149 months, with a median of 48 months; males and females were almost equally represented. At baseline assessment, 10 (40%) of 25 patients had a positive overt DIC score and only seven (28%) of 25 had a positive nonovert DIC score. Bleeding manifestations were a common problem in the present study, as 16 (64%) patients presented with bleeding symptoms, being more frequently in patients with an overt DIC positive score (P=0.040). The median platelet count (P=0.023), D-dimer level (P=0.000), and fibrinogen level (P=0.010) showed a significant statistical difference between patients with either positive or negative overt DIC score, whereas neither white blood cells count, absolute blasts count, hemoglobin, prothrombin time, antithrombin III nor protein C levels did. Conclusion Our data confirm that children with AL have some hemostatic derangement at baseline. A positive overt or nonovert DIC score was not statistically related to a worse end of induction remission status or a significantly higher 28-day mortality rate. Larger multicenter studies are needed to determine the most clinically relevant hemostatic abnormalities and adapt more sensitive and specific scoring system for DIC in children with hematological malignancies.
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Prevalence, determinants, and health service utilization of ‘at risk’ under-five children attending a Family Health Center, Egypt 2017 p. 34
Eman A Sultan, Nagwa F Shokair, Karima M Teba
Background More than half of under-five child deaths are due to the diseases that are preventable and treatable through simple and affordable interventions. Owing to lack of resources, all under-five cannot be given equal time and attention. Therefore, ‘at risk’ concept has gained importance where health care is provided to all children., whereas children with high risk are given special attention. Aim This study aims to determine the prevalence and identifying determinants of ‘at risk’ under-five children attending Rasheed Family Health Center and to determine the pattern of utilization of available health services. Participants and methods This cross-sectional study included 300 under-five children with their mothers. Data were collected using an interviewing questionnaire including personal-social characteristics, obstetric history, and child characteristics. ‘At risk’ children were identified based on the recommendations of WHO Expert Committee and accordingly, the ‘at risk’ group was compared with those ‘not at risk’. Results Results show that the prevalence of ‘at risk’ children among the studied group was 77.7%. The most frequent risk factors were recurrent or chronic gastrointestinal and/or respiratory tract infections followed by delay in receiving supplementary feeds, birth spacing less than 2 years and early lactation failure. Formula feeding and attacks of gastroenteritis were significant predictors of ‘at risk’ children. The main factors behind low utilization of the services were the long distance between home and the center, unpaved roads, and high costs of transportation, health care service, and medications.
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