Pediatric Clinic Research Articles

8137 Prevalence Of Overweight And Obesity In Dominican Children With Congenital Heart Disease

Abstract Disclosure: L.D. Rojas Rodríguez: None. M.J. Mateo Pérez: None. L.C. López Sención: None. V.T. San Martin: None. A. Grullón: None. Background: Overweight and obesity can be detrimental to the health of children with congenital heart disease, potentially leading to or contributing to other chronic medical conditions such as hypertension. This, in turn, may increase the cardiovascular demands of these patients whose lives are already affected by a defective heart anatomy. Objective: To determine the prevalence of overweight and obesity in Dominican children with congenital heart disease. Methods: An observational cross-sectional study was conducted to determine the prevalence of overweight and obesity in children with congenital heart disease attending the Pediatric Cardiology Department at Children's Hospital (Santo Domingo, Dominican Republic), from July to December 2022. The study population was classified into categories of underweight, normal weight, overweight or obesity using the CDC Body Mass Index-for-age growth chart (2022), based on their age, weight, height, and sex. The parents of the patients were interviewed to gather information about their children’s medical history, as well as their diet type and level of physical activity. Diet type was assessed through a questionnaire about daily meals; diets in which processed foods and simple carbohydrates were predominant were categorized as unhealthy, while those with a predominance of proteins and complex carbohydrates were categorized as healthy. Physical activity levels were measured using the Assessment of Physical Activity Level Questionnaire (APALQ). Additionally, blood pressure values were categorized as normal or elevated/high based on the American Academy of Pediatrics Clinical Practice Guidelines for Screening and Management of High Blood Pressure in Children and Adolescents (2017). Results: A total of 84 patients with congenital heart disease were analyzed, with 11.9% (10/84) categorized as having overweight and 23.8% (20/84) categorized as having obesity. Among patients with overweight or obesity, unhealthy eating habits predominated in 66.7% (20/30), while a sedentary level of physical activity was reported in 56.7% (17/30). Additionally, among patients with overweight or obesity, 36.7% (11/30) had elevated/high blood pressure. Conclusion: About one-third of Dominican patients with congenital heart disease were found to have overweight or obesity. Additionally, about one-third of those with excess weight were found to have elevated/high blood pressure. These findings stress the need for urgent implementation of personalized interventions and educational programs focused on fostering healthier lifestyles. The ultimate goal is to reduce cardiovascular risks and improve the overall well-being of children living with congenital heart disease. Presentation: 6/1/2024

Implementation and analysis of clinic administered behavioural health screen in an outpatient paediatric cardiology clinic.

Previous studies investigating behavioural health screening processes have focused on selected diagnoses within paediatric cardiology and focused on a smaller number of potential concerns. We developed and administered a brief survey in our paediatric heart centre to assess the presence of a wider variety of behavioural health concerns and to connect patients with resources. A cohort of 305 patients aged 2-29 years (M = 11.97 years; SD = 6.00 years; 50.49% female), representing a variety of indications for a cardiology clinic visit, or a parent, completed a survey of 14 common behavioural health concerns. Behavioural health concerns were included based on practice patterns within paediatric psychology. Respondents indicated if they were currently receiving behavioural health services and if they were interested in behavioural health follow-up. Surveys were administered during check in and collected by clinic staff. A behavioural health provider attempted to reach all those who indicated interest by phone. Approximately 45% of the sample endorsed one or more behavioural health concerns and 30.16% of the sample endorsed at least one concern but were not already connected to services. Only 27.17% of this group requested follow-up. Most commonly endorsed concerns were anxiety, sleep problems, depressed/irritable mood, and somatic complaints. Survey results converge with existing literature to indicate that behavioural health concerns are common among youth seen in a paediatric cardiology clinic but most patients are not connected to appropriate services. Screening programmes can help meet this need but challenges remain. Clinical implications and future directions are discussed.

Investigating the Impact of Caregiver Adverse Childhood Experiences Screening and Pediatrician-Led Discussions on Posttraumatic Stress Disorder Symptoms in a Majority-Hispanic Pediatric Primary Care Clinic Setting

Background: Evidence suggests that screening and provider-led discussions of parental adverse childhood experiences (ACEs) may help identify at-risk families and be linked to positive health outcomes in caregivers and their children. However, the direct effect of ACEs screening and discussions on posttraumatic stress disorder (PTSD) has yet to be studied. Objectives: To determine if screening or provider-led discussions of parental ACEs are associated with inadvertent worsening of PTSD symptoms 1 week after screening. Research Design: Data was obtained as part of a cluster randomized controlled trial to examine the effects of ACEs screening and provider-led discussions on child health care utilization outcomes. Baseline surveys were completed before scheduled infant well child checks (WCCs). Providers were randomized into the standard of care or intervention (discussion) conditions. Intervention providers were trained in delivering brief trauma-informed discussions about the impact of ACEs on parenting during WCCs. Subjects: Caregivers in a pediatric primary care clinic serving predominantly Hispanic and low socioeconomically resourced families (N=179, 93% female, 87% Hispanic). Measures: The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), Brief Resilience Scale (BRS), and ACEs screening were completed at baseline. PC-PTSD-5 was repeated 1-week after screening. Results: Mixed-effects ordinal logistic regression analysis of PTSD scores from baseline to 1-week postscreening with the full sample showed no significant effect of time [odds ratio (OR)=1.21, P=0.68], group (OR=1.68, P=0.33), or their interaction (OR=0.48, P=0.21). Conclusions: Screening or brief discussion of ACEs with providers trained in trauma-informed care were not associated with worsening PTSD symptoms.

Retrospective Cohort Study Demonstrates Tolerance and Adherence to Pea-Based Complete Enteral Formula When Transitioned from a Previous Hypoallergenic Product.

Plant-based formulas have become increasingly popular due to their health benefits, environmental concerns, cultural beliefs, improved palatability, and decreased cost. A retrospective chart review of medically stable children transitioning from a hypoallergenic formula to a yellow pea protein plant-based formula (PPPBF) was included. This study aimed to assess gastrointestinal tolerance, weight changes, and adherence to receiving a unique PPPBF. Healthcare providers (HCPs) from pediatric clinics across the United States who requested increased PPPBF samples between the dates of 1 November 2021and 31 January 2022 and again from 1 February 2022 to 15 April 2022 inputted survey data. The HCPs selected participants based on the inclusion criteria. Seventy-three completed patient surveys were included of children (ages 1-18 years old, 41% females, 59% males). After the transition to PPPBF, 38.4% experienced improvement in GI tolerance, 56.2% experienced no change, and 5.5% reported worsening GI tolerance. There was a 95% adherence rate, and 98.9% reported no adverse reactions or allergic manifestations after formula transition. Transitioning from a hypoallergenic formula to a PPPBF showed a trend toward stable GI tolerance, weight gain or stability, and adherence. A PPPBF offers a first-choice option for children who are on hypoallergenic formulas due to intolerance.

Mental health among parents and their children with eczema in Hong Kong.

This cross-sectional survey research investigated mental health symptoms and quality of life among Chinese parents and their children with eczema at a paediatric dermatology clinic in Hong Kong from November 2018 to October 2020. Health-related quality of life, eczema severity, and mental health among children with eczema, as well as their parents' mental health, were studied using the Children's Dermatology Life Quality Index (CDLQI), Infants' Dermatitis Quality of Life Index (IDQOL), Nottingham Eczema Severity Score (NESS), Patient-Oriented Eczema Measure (POEM), and the Chinese version of the 21-item Depression, Anxiety, and Stress Scales (DASS-21). In total, 432 children and 380 parents were recruited. Eczema severity (NESS and POEM) and health-related quality of life (CDLQI) were significantly positively associated with parental and child depression, anxiety, and stress levels according to the DASS-21, regardless of sex (children: r=0.28- 0.72, P<0.001 to 0.007; parents: r=0.20-0.52, P<0.001 to 0.034). Maternal depression was marginally positively associated with increased anxiety in boys with eczema (r=0.311; P=0.045). Younger parents had higher risk of developing more anxiety and stress compared with the older parents (adjusted odds ratio [aOR]=-0.342, P=0.014 and aOR=-0.395, P=0.019, respectively). Depression level of parents with primary to secondary education was 58% higher than their counterparts with post-secondary education or above (aOR=-1.579; P=0.007). Depression, anxiety, and stress among children with eczema and their parents were associated with eczema severity and impaired quality of life in those children. These findings regarding impaired mental health in children with eczema and their parents highlight the need to include mental well-being and psychosocial outcomes in future studies and clinical practice.

Impact of COVID19 on Availability of Anti-Epileptic Medications in Pediatric Neurology Clinic

Abstract Background In epilepsy patients, the pandemic has led to postponement of outpatient visits, cancellation of epilepsy-related tests, such as electroencephalograms (EEG) and magnetic resonance imaging (MRI) studies, and even difficulties in attending emergency situations due to saturation of the healthcare services, which can create life threatening situations for patients who present to the emergency rooms with non-COVID related complaints. Aim of the Work To evaluate effect of COVID-19 pandemic on supplying anti-epileptic medications for children following in the Pediatric Neurology Clinic, Ain Shams University. Patients and Methods An observational cross-sectional study was carried out at Pediatric Neurology Clinic, Children’s hospital, Ain Shams University. The study included 126 care givers of children with epilepsy who were aged 2 to 18 years, have a diagnosis of Epilepsy (including idiopathic and cryptogenic epilepsy) for at least one year before the onset of the COVID19 pandemic. I.e., Epilepsy diagnosed at or before March 2019 and are following up at the Pediatric Neurology Clinic, Children’s Hospital, Ain Shams University. Results Our study showed only 22% of the epileptic children had trouble in obtaining the anti- epileptic drug/drugs; where the most common problem was financial problems followed by drug shortage. Most of the epileptic children didn’t have a change in the treatment regimen during the last year. Conclusion Most children with epilepsy did not experience a significant change in their clinical conditions because of healthcare reorganization during the COVID-19 emergency.

Comparison of Telemedicine Usage at Two Distinct Medicaid-Focused Pediatric Clinics.

Objective: To compare telemedicine versus office visit use at two Medicaid-focused pediatric primary care clinics. Methods: Retrospective cohort study from March 15, 2020 - March 15, 2021 at two Medicaid-focused pediatric primary care clinics. Site A and Site B care for different populations (Site B care for mostly immigrant families with preferred language Spanish). Outcomes included the percent of visits conducted through telemedicine and reason for visit. Descriptive statistics, univariable and multivariable mixed multilevel logistic regression, were used to assess relationship between patient demographics and telemedicine use. Results: Out of 17,142 total visits, 13% of encounters at Site A (n = 987) and 25% of encounters at Site B (n = 2,421) were conducted using telemedicine. Around 13.8% of well-child care (n = 1,515/10,997), 36.2% of mental health care (n = 572/1,581), and 25.0% of acute care/follow-up (n = 1,893/7,562) were telemedicine visits. After adjustment for covariates, there was no difference in odds of a patient having any telemedicine use by preferred language, sex, or payor. Patients 1-4 years of age had the lowest odds of telemedicine use. At Site A, patients who identified as Non-Hispanic Black (odds ratio [OR] = 0.33, 95% confidence interval [CI] = 0.24-0.45), Hispanic/Latinx (OR = 0.40, 95% CI = 0.24-0.66), or other race/ethnicity (OR = 0.35, 95% CI = 0.23-0.55) had lower odds of telemedicine use in comparison to Non-Hispanic White. Conclusions: Telemedicine was successfully accessed by Medicaid enrollees for different types of pediatric primary care. There was no difference in telemedicine use by preferred language and payor. However, differences existed by age at both sites and by race/ethnicity at one site. Future research should explore operational factors that improve telemedicine access for marginalized groups.

Improving routine mental health screening for depression and anxiety in a paediatric lupus clinic: a quality improvement initiative for enhanced mental healthcare

BackgroundMental health (MH) conditions are prevalent in adolescents with childhood-onset SLE (cSLE). Early identification is crucial in preventing poor patient outcomes; however, MH screening rates remain low.Local problemFrom July 2021–January...

Effect of Health Education on Knowledge and Attitude of Parents towards Paediatric Epilepsy in Egyptian Children

Abstract Background Epilepsy remains one of the most common neurological diseases in the world but seems to be widely misunderstood, especially in low-income countries. Patients with epilepsy can face considerable stigma in society, Parents’ knowledge on care of children greatly influences the health status of a child by reducing the mortality and morbidity rate. Aim of the Work Assess the attitude and knowledge toward paediatric epilepsy amongst parents of paediatric patients with epilepsy and other parents seeking advice in the out-patient clinic, Assess the effect of educational program of home management of seizures on knowledge and practice of parents. Patients and Methods This comparative cross-sectional study included 100 parents of children with epilepsy who follow up in Paediatric neurology clinic, Ain Shams University (Group A) and 300 parents of normal children who sought advice in Paediatric outpatient clinic, Ain Shams University (Group B) in which sociodemographic characteristics were collected and a validated questionnaire was distributed before and after an educational session about epilepsy facts and its first aid. Results The study revealed significant difference between study and control groups in their baseline knowledge about epilepsy, in terms of “epilepsy being an organic disease, rather than a psychiatric illness or an evil spirit” (67.0% vs. 39.8%, P &amp;lt; 0.001) respectively, and management of a child experiencing a seizure where 6% of group A answered “do not know” vs 74.6% of group B, P &amp;lt; 0.001). Regarding attitude towards epilepsy, both groups showed negative attitude towards epilepsy; 78% of group A and 66% of group B agreed that epilepsy is a factor that strongly impair child learning. Similarly, 81% of group A and 65% of group B reported that epilepsy can strongly limit sports and leisure activities. In terms of effect of educational effect, group A showed significant difference in number of correct answers regarding manifestation and first aid measures for a child with seizure before and after education (12% vs 51% P &amp;lt; 0.001 &amp; 45% vs 75% P = 0.009) respectively. Moreover, group B showed significant difference in correct answers for both topics after education (0% vs. 49.2 % P, 0.001 &amp; 0% vs 71.2% P &amp;lt; 0.001). Conclusion Our results highlight the need for educational programs and targeted awareness campaigns, to reduce misconceptions and promote a more supportive environment for individuals with epilepsy.

Calvarial Thickening in Tuberous Sclerosis Complex

IntroductionTuberous sclerosis complex (TSC)-related skeletal abnormalities are under-studied. Awareness of skull thickening in TSC patient is important from the surgical standpoint because thick skull might complicate craniotomy. This study, aimed at revealing if TSC patients are generally prone to skull thickening, had led us to retrospectively investigate the frequency and characteristics of skull thickening in these patients. MethodTSC patients aged 10 to 60 years who underwent MRI were identified from the neurosurgery, dermatology or pediatrics clinic between 2010 and 2021. Two control groups were used for comparison: one with unruptured intracranial aneurysms to serve as control without anti-seizure medications (ASMs) exposure and another with non-TSC epilepsy as control with ASM exposure. Thickness of frontal, parietal, temporal, and occipital bones was measured at a fixed location of each bone across patients on T2-weighted axial images. Result29 patients fulfilled the inclusion criteria. Frontal and temporal bones of the TSC group were significantly thicker than those of either control group. Skull thickening was significantly associated with intracerebral calcification, but not with age, sex, or ASM exposure. Focal skull thickening was associated with the presence of a subcortical calcification. ConclusionsTSC patients have thickened skull that is often linked to intracerebral calcification. The presence of skull thickening may require modification of surgical approach during craniotomy. Skull thickening and the underlying intracerebral calcification likely share a common precipitating factor given their relationship. Future studies are warranted to clarify the genetic underpinnings of this relationship and even broader skeletal abnormalities in TSC.

Nutritional screening in children with cerebral palsy in Tanta University Hospitals

Background Cerebral palsy (CP) in children can lead to malnutrition due to growth hormone dysregulation, muscle spasticity, and feeding difficulties, which can worsen CP limitations and lead to multiple negative impacts on general health. Aim To screen the nutritional status of children with CP at the University Hospitals. Patients and methods This cross-sectional observational study included 100 CP children of both sexes, aged less than 17 years old, who attended the Pediatric Clinical Nutrition and Neurology Clinics at the University Hospitals. They underwent a comprehensive medical history, which included a detailed feeding history, a thorough clinical examination, and an assessment of their anthropometric measurements. Results Lack of weight gain for 2–3 months was the most common indicator of feeding and swallowing difficulties (74%), followed by stressful mealtimes with caregivers (61%). The main gastrointestinal tract comorbidity was dysphagia (40%). The median daily water, energy, carbohydrate, protein, fat, and fiber intakes as percentages of the recommended dietary allowance were 45, 66, 76, 67, 78, and 19%, respectively. The prevalence of malnutrition was 24% for wasting (6% severe) based on the Gomez classification and 93% for stunting (57% severe) based on the Waterlow classification. Conclusion Most of the studied CP patients had red flags indicating feeding and swallowing difficulties. They consumed less water, calories, and macronutrients than the recommended dietary allowances for their ages. In addition, they had varied degrees of malnutrition.

The Effect of Carnitine Supplementation on Cardiac Function and Ketogenic Diet Effectiveness in Patients with Drug Resistant Epilepsy on Ketogenic Diet

Abstract Background Ketogenic Diet (KD) is gaining attention as a management line in childhood drug resistant epilepsy (DRE) and it is an effective line of therapy for DRE in children. KD is a strict diet consisting of minimal carbohydrate and adequate protein intake with increased fat content. Although KD is effective for epilepsy management, it is deficient in several minerals, vitamins, and trace elements, which can lead to several early and late complications. Objective To demonstrate the effect of carnitine supplementation on cardiovascular functions in patients with DRE on KD and to highlight the effect of carnitine supplementation on efficacy of KD in seizure control. Methods This study was a clinical trial (Trial Design: Parallel 1:1) which included 52 patients with DRE on KD following up at Pediatric Neurology and Clinical Nutrition Outpatient Clinics at Ain Shams University children`s Hospital (or admitted as inpatient) in the period from March 2022 to October 2022 Results There was a statistically significant decrease in the CSSS after 6 months compared to initial presentation among the L-carnitine supplemented group. After 6 months of L-carnitine supplementation, the supplemented group showed significant increase in interventricular wall thickness diameter (IVSD) and significant increase in posterior wall thickness (PWT). Left ventricular end-diastolic diameter (LVED) and left ventricular (LV) mass index showed also increased but didn’t reach significance statistically after L- carnitine supplements. There was no statistically significant difference between carotid intima-media thickness CIMT at initial presentation and after 6 months among L-carnitine supplemented group. Conclusion After six months of L-carnitine supplementation in patients with DRE on KD, there was improvement in the frequency and duration of convulsions among L-carnitine group. Regarding ECHO finding, L-carnitine group showed increase in interventricular wall thickness diameter (IVSD) and posterior wall thickness (PWT). Left ventricular end-diastolic diameter (LVED) and left ventricular (LV) mass index also showed increases but didn’t reach statistical significance after L- carnitine supplementation. There was no statistically significant difference in carotid intima-media thickness CIMT at initial presentation and after 6 months among L-carnitine supplemented group.

A Comparative Study between Honey and Alcohol as Topical Skin Disinfectant

Abstract Background Skin antisepsis is essential in every healthcare environment. Alcohol/ chlorhexidine use might disrupt skin microbiota and lead to antibiotic resistance. Objective To evaluate the efficacy of honey on reduction of skin microbes, on apparently healthy skin, and to compare the results with those of topical application of 70% isopropyl alcohol. Subjects and Methods This study was carried out on 70 children aged 2 to 12 years. Males represented 54.2% of the sample. Patients were recruited from the pediatric outpatient clinic, Children’s Hospital, Ain Shams University, Egypt, during the period from July 2022 to February 2023. A swab was taken from the skin of the dorsum of both hands for culture of skin microbes. Types and number of organisms were documented. Separately, honey and alcohol were applied alternatively on the dorsum of right and left hands. A skin swab was taken for microbiological examination before and 20 seconds after application of honey and alcohol. Results mean age of enrolled children is 7.34 (in years). Both honey and alcohol made significant reduction in the number of organisms on the dorsum of the hand (p = &amp;lt;0.001), and this effect was comparable between honey and alcohol with no statistically significant difference (p = 0.874). Before honey application, the median number of organisms is 65 colony forming unit (CFU), while 10 (CFU) is the median number of orgamisms after honey application. Before alcohol application, the median number of organisms is 80 (CFU), while 10 (CFU) is the median number of organisms after alcohol application. Percentage of reduction of organisms on dorsum of the hand after honey application is 62.5%, while 65% after alcohol application (p = 0.370). Staph coagulase negative, staph aureus, E-coli are most three common organisms were detected by swab. Conclusion Honey showed to be as effective as alcohol in reduction of skin microbes. We recommend further studies involving following up the rate of infection after minor surgical procedures to confirm the findings of our study.

Single-Center Experience in Establishing a Pediatric Kidney Genetics Clinic

Single-Center Experience in Establishing a Pediatric Kidney Genetics Clinic

Effect of Treatment with Bisphosphonates on Bone Turnover Markers in Osteogenesis Imperfecta

Abstract Background Bisphosphonates are used as standard treatment in patients with osteogenesis imperfecta (OI) in childhood and adolescence. N-terminal collagen type I extension propeptide (PINP) has been identified as the most promising marker of bone formation. Aim and Objectives Our study aimed to use PINP as a marker of bone formation in patients with OI receiving bisphosphonates treatment. Patients and Methods This observational study included 28 with OI patients (12 boys &amp; 16 girls) on bisphosphonates treatment following up at Pediatric Endocrinology Clinic, Ain Shams University Children's Hospital during the period from March 2021 till April 2022. PINP was measured at baseline and one year after treatment. Clinical severity score was evaluated. Results (53.6%) of patients were classified as moderate degree of clinical severity score. Clinical severity score domains were as follows: (67.9%) of patients were classified as grade I regarding number of fractures per year (0-1), (50.0%) of patients were classified as grade II regarding motor milestones (delayed with catch up), (46.4%) of patients were classified as grade III regarding long bone deformities (noticed by both clinical examination and X-rays affecting isolated long bones) and regarding height SDS (-3.1 to -5.0), while (46.4%) of patients were classified as grade I regarding DXA Z-score (&amp;lt; -1.5 SD). PINP decreased &amp;lt;20% in 6 patients (21.4%) and increased &amp;lt;20% in 5 patients (17.9%). There was no change in 17 patients (60.7%). Furthermore, there was no significant relation between PINP and clinical severity score. Conclusion PINP change in patients with OI on bisphosphonates treatment might not be pronounced or sustained after treatment, thus might not reflect the clinical status of the patients on short term basis.

Insulin Sensitivity in Relation to Serum Magnesium in Obese Children

Abstract Background Childhood obesity is one of the most alarming challenges developing in today's world and is associated with insulin resistance. Magnesium level is inversely correlated with obesity and has a significant role in glucose hemostasis and insulin resistance Aim of Work The study aimed to assess the relation between serum magnesium and insulin resistance in obese children Patients and Methods This cross sectional study was conducted on 60 obese children recruited from Pediatric Outpatient Clinics at Tur Sinai district, South Sinai. The participants were subjected to nutritional analysis, 24 hours recalls including breakfast, snacks, lunch and dinner was taken from each patient and the data was analyzed using food analysis software program, anthropometric measurements including height, weight, body mass index(BMI) and their z-scores, waist hip ratio(WHR) and waist height ratio (WHtR). Laboratory parameters including magnesium level, fasting insulin, fasting glucose, and homeostatic model assessment for insulin resistance (HOMA-IR) calculation. Results All participants in our study were obese with BMI &amp;gt; 95 percentile according to CDC growth charts, with 35 were males (58.3 %) and 25 were females (41.6 %). Nutritional analysis showed low dietary magnesium intake with mean ±SD (330.01 ± 104.07) mg/day. Regarding laboratory investigations, magnesium level was low in 39 cases (65 %), fasting insulin was high in 45 cases (75 %) and HOMA IR was severe in 33 cases (55%) and was moderate in 15 cases (25 %). Also, fasting blood glucose was high reaching prediabetic level in 39 cases (65%). Serum magnesium level had a statistically significant negative correlation with fasting blood glucose (r= -0.369, p = 0.004), fasting insulin (r=-0.537, p = 0.000), HOMA IR (r= -0.458, p = 0.000), waist height ratio (r= -0.285, p = 0.027) and waist hip ratio (r= -0.260, p = 0.045). Conclusions Low serum magnesium levels may contribute to the development of insulin resistance in obese children.

Assessment of the Presence of Predominantly Antibody Deficiency among Pediatric Patients with Interstitial Lung Disease

Abstract Background Predominantly antibody deficiencies (PADs) are frequent primary immunodeficiency diseases (PIDs) that have different etiologies. PAD patients present with various clinical manifestations, including infections and non-infectious disorders such as interstitial lung disease (ILD). The determination of serum Igs (IgG, IgM, IgA) is the first step in the evaluation of humoral immunity, and will help diagnose or at least point to a suspicion of quantitative Ig deficiencies. Lung disease is a frequent clinical manifestation in people living with primary immunodeficiency diseases, the most prevalent of which are common variable immunodeficiency disorders (CVID). Aim of Work Screening for Predominantly Antibody Deficiency (PAD) among pediatric patients diagnosed with primary interstitial lung disease. Patients and Methods This was a pilot study that was conducted on 30 children diagnosed with primary interstitial lung disease (ILD) following up in the Pediatric chest clinic, Children’s hospital, Ain Shams University in the period from September 2022 to February 2023, their ages ranged between 9-180 months and They were 16 (53.3%) males and 14 (46.7%) females. Tools of assessment included detailed clinical history with stress on history of respiratory symptoms, history of ten warning signs of immunedeficiency, general and chest examination and immunoglobulins (IgA, IgM, IgG) level by ELISA. Results There were 2 (6.7%) children with low levels of IgG, As regard IgM 2(6.7%) children had low levels, and 1(3.3%) child had high level. While 5 (16.7%) children had low levels of IgA. based on the criteria of Europian Society For Immunodeficiencies (ESID) 2 children were probable to be Commom Variable Immundeficiency (CVID) and 3 children were possible to be CVID. Conclusion Predominantly antibody deficiencies (PADs) may be presented as ILD and ILD may be the first presentation even before PID diagnosis.

Assessment of Risk Factors for Cerebrovascular Accidents in Children with Congenital Heart Diseases

Abstract Background Children with congenital heart disease (CHD) are at an increased risk of cerebrovascular accidents (CVA), including arterial ischemic stroke (AIS), cerebral venous sinus thrombosis (CVST), and hemorrhagic stroke. The risk varies depending on age, comorbidities, underlying cardiac defect, and other factors, such as changing hemodynamics, cardiac procedures, and the need for mechanical circulatory support devices. Aim To determine the risk factors and neurological outcome of cerebrovascular accidents, that occur either spontaneously or peri-procedurally in children with congenital heart diseases. Patients and Methods A retrospective case-control study was conducted on the records of 72 patients collected from the patients' files between 2015 and 2023 at the Pediatric Neurology Clinic, and Pediatric Cardiology Clinic, Children's Hospital, Cardiothoracic Surgery Academy, Radio-diagnosis Department, Faculty of Medicine, Ain Shams University Hospitals with age ranged from 2 months to 18 years. Children with CHD and radiologically confirmed CVA (case group) were compared to CHD children without CVA (control group). Results Seventy-two children with CHD were included, 30 of whom had radiologically confirmed CVA (case group), and the remaining studied children (42 patients) who had CHD without CVA (control group). In the case group, they were 12 females (40%) and 18 males (60 %), 29 females (69%) and 13 males (31%) in the control group. The age at diagnosis of CVA in case group ranged from (2 months to 1 year) in 17 patients (56.7%), (2 – 6 years) in 7 patients (23.3%), and(7 – 12 years) in 3 (10.0%),and (13 – 18 years) in 3 (10.0%). Males in patients with stroke (60.0%) than in patients without stroke (31.0%) with p-value = 0.014. Twenty-four (57.1%) without stroke and 15 (50.0%) with stroke had acyanotic cardiac disease with the most common being VSD in 7 (23.3%) of those with stroke. there was no statistically significant difference between patients with and without stroke regarding cardiac cyanotic and acyanotic cardiac diagnosis. Twenty-one (70%) out of 30 were diagnosed AIS, 2 (6.7%) CVST, and 7 (23.3%) with hemorrhagic stroke. Stroke occurred following cardiac procedures in 20 patients (66.7%): 15 after cardiac surgery and 5 after cardiac catheterization. Risk factors for CVA were high blood pressure at admission in 12 patients (16.7%), hypoperfusion in 7 patients (9.7%), thrombus on the tip of central venous line (CVL) in 2 patients (2.8%), deep vein thrombosis (DVT) in 1 patient (1.4%), a hypercoagulable state in 1 patient (1.4%), high hematocrit level in 1 patient (1.4%), previous brain insult in 2 patients (2.8%), intracardiac mass in 1 patient (1.4%), infective endocarditis in 2 patients (2.8%), abnormal heart valve in 1 patient (1.4%), disseminated intravascular coagulation (DIC) in 1 patient (1.4%), and chronic disease in 10 patients (13.9%). Taking into consideration that more than one risk factor was found in the same patients. The results revealed that there was a statistically significant increase in the percentage of risk factors in patients with stroke (66.7%) than in patients without stroke (26.2%) with p-value = 0.001. Conclusions Individuals with CHD are at a higher risk of CVA, and this suggests that the risk assessment for CVA based on conventional cardiovascular risk factors should be considered in these patients. Early diagnosis of CHD is important to prevent further recurrences of stroke, and because they are potentially curable. Prospective cohort studies are required to determine effective primary and secondary prevention strategies.

Knowledge, attitude and practice for a group of Egyptian interns about infection control in different pediatric dental clinics: a cross-sectional study

Knowledge, attitude and practice for a group of Egyptian interns about infection control in different pediatric dental clinics: a cross-sectional study

Vascular Endothelial Growth Factor as a Predictor Marker of Progression in Childhood Interstitial Lung Disease

Abstract Background Childhood interstitial lung disease (chILD) encompasses a group of heterogeneous diseases characterized by varying degrees of aberrant inflammation and fibrosis of the lung parenchyma. Vascular endothelial growth factor (VEGF) is a signal protein produced by cells that stimulates the formation of blood vessels and might be implicated in the abnormal signaling in the pathogenesis of chILD. Objectives To measure the level of VEGF in serum among patients with chILD and determine its relation to the clinical severity. Patients and Methods This cross sectional study has been conducted at Pediatric Pulmonology clinic; Ain Shams University Children’s Hospital located in Cairo during the period from January 2023 to June 2023. The study included 35 children compared to 35 sex- and age-matched healthy controls. All patients were assessed in terms of demographic, clinical data and laboratory investigations including serum VGEF using enzyme-linked immunosorbent assay (ELISA) technique along with radiological findings. Results The most common clinical finding was cough (93.3%) while the most common systemic symptom was anorexia and weight loss (46.7%). Serum VGEF level was significantly elevated among chILD patients 120 (80 - 200) pg/ml compared to controls 13 (9-16) pg/ml. Moreover, serum VEGF was significantly elevated among severe cases of chILD compared to non severe ones, p-value&amp;lt;0.001. Conclusion Serum VGEF was significantly higher among chILD patients especially severe cases.