BACKGROUND:Late onset sepsis is a life-threatening condition wich occurs after 72 hours of birth caused by systemic infections that prompt a cascade of often fatal inflammatory immune responses. It has a broad range of symptoms and signs including respiratory signs like apnea, bradypnoea, tachypnea and/or increase in ventilatory support and may present with temperature instability, feeding intolerance, tachycardia, bradycardia, hypotension, poor perfusion, lethargy, hypotonia and seizures. AIM OF THE WORK:To determine the diagnostic value of monocyte MxA expression in neonates to differentiate between viral and bacterial infections. To determine MxA/CRP ratio in viral infection in neonates. PATIENTS AND METHODS:The study was conducted as a cross-sectional study in the Neonatal Intensive Care Unit at the Children's Hospital & Maternity Hospital, Ain Shams University, Cairo, Egypt, over a period of 6 to 9 months. RESULTS:This study analyzed neonates with late-onset sepsis (LOS) to distinguish bacterial from viral infections using the Myxovirus Resistance Protein A (MxA) biomarker. Bacterial infections were predominant (54.0%), with Klebsiella as the most common pathogen, while RSV accounted for 28.0% of viral infections. Co-infections (6.0%) posed additional diagnostic challenges. LOS was prevalent among preterm and low-birth-weight neonates, consistent with global trends. Fever was more common in bacterial cases, though not a reliable indicator. MxA levels and MxA/CRP ratios were significantly higher in viral infections, with ROC analysis showing both biomarkers had 100% sensitivity and specificity for differentiating between bacterial and viral causes. An MxA cut-off >150.30 and MxA/CRP ratio >8.37 offered optimal diagnostic accuracy. The findings emphasize MxA's value in guiding treatment, reducing unnecessary antibiotic use, and improving clinical outcomes. The study also highlights the importance of GBS screening and the growing concern over multidrug-resistant pathogens in neonatal care settings. CONCLUSION:This study supports the use of MxA and the MxA/CRP ratio as effective diagnostic tools for distinguishing between viral and bacterial infections in neonates with late-onset sepsis. The significant differences in clinical, laboratory, and radiological findings between the two infection types underscore the importance of integrating multiple diagnostic approaches.
BACKGROUND:Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in pediatric patients with chronic kidney disease (CKD). Online hemodiafiltration (OL-HDF) is a modality of hemodialysis (HD) improving CVD by enhancing hemodynamic stability, and endothelial function. OBJECTIVE:To assess the baseline CV status in pediatric patients, stable maintenance HD and at 12 months from being shifted to OL- HDF modality. METHODS:This was a prospective cohort study including a total of 38 patients; 21 males & 17 females with median (IQR) age of 11.32 (2.86) years. They were stable for at least 3 months on thrice weekly 3-hour HD sessions through an arteriovenous fistula using polysulphone membrane. HD vintage duration median (IQR) was 16.13 (28.4) months. Thirty- eight age, and sex matched healthy children served as a control group. Patients having congenital or acquired cardiac or vascular diseases, unsuitable vascular access blood flow, active inflammation or failed kidney graft were excluded. All selected patients were shifted to post-dilutional OL-HDF and followed up prospectively for 12 months. Cardiovascular status using conventional and speckle echocardiography, and common and internal carotid intima media thickness (cIMT) using ultrasound were assessed and measured at the baseline and at 12 months after being shifted to OL-HDF. RESULTS:All recruited patients (100%) completed 12-month follow-up duration on post-dilution OL-HDF without any dropouts. OL-HDF resulted in significant decrease in left ventricular mass index Z score (p = 0.016) but remained higher than controls (p < 0.0001). OL-HDF had also improved the left ventricular (LV) systolic function parameters including ejection fraction % (EF%), fractional shortening % (FS%), global longitudinal strain % (GLS%) (p < 0.0001 for all). Notably, by the end of the study, the EF% and FS% were significantly higher than the controls (p < 0.0001 for both), but GLS% was comparable to controls (p = 0.067). Regarding left ventricular (LV) diastolic function, both deceleration time (DT) and the E/A ratio showed significant improvement (p < 0.0001 for both). However, DT remained significantly lower compared to controls (p = 0.001), while the E/A ratio became comparable to that of the control group (p = 0.074). Despite that OL-HDF resulted in a significant reduction in both common and internal cIMT (p < 0.0001) yet, they remained significantly higher than controls (p < 0.0001). CONCLUSION:This study demonstrates that OL-HDF in children on maintenance HD due to CKD resulted in significant reduction of LVMI, significant improvement of LV systolic function, significant improvement of some LV diastolic function parameters and reduction of common and internal cIMT. These findings highlight OL-HDF as a promising HD modality for enhancing both cardiac and vascular health in this vulnerable population.
BACKGROUND:Cryptosporidiosis, mainly caused by Cryptosporidium hominis and C. parvum, is a waterborne disease posing significant risks to immunosuppressed individuals. The limited efficacy of Nitazoxanide in such cases highlights the need for alternative and combination therapies. Paromomycin inhibits parasite protein synthesis, while statins show promising anti-cryptosporidial effects. OBJECTIVES:The study evaluates combined Atorvastatin and Paromomycin therapy for treating cryptosporidiosis in immunosuppressed mice, focusing on intestinal and extra-intestinal pathology and oxidative stress biomarkers. METHODOLOGY:Fifty immunosuppressed male CD1 Swiss albino mice were randomly assigned into five groups: control non-infected, infected control, and three treatment groups (Paromomycin, Atorvastatin, combination). All infected groups received 1 × 104 C. parvum oocysts. The combination group received Atorvastatin (20 mg/kg/day) and Paromomycin (250 mg/kg/day) for five days. Efficacy was assessed by oocyst shedding, histopathology, and biomarker levels at day 14 post-infection. RESULTS:Combination therapy reduced oocyst shedding by 72.3% and showed near-normal tissue architecture. Atorvastatin monotherapy was more effective than Paromomycin alone (49.3% vs. 30.2%). Combination therapy resulted in minimal pathological changes and lower inflammation across organs (intestine, liver, and lung). Oxidative stress biomarkers indicated ongoing oxidative stress with Paromomycin, whereas Atorvastatin suggested an antioxidant effect at the time point of the research. CONCLUSION:Combined Atorvastatin and Paromomycin showed superior efficacy over monotherapies, reducing parasite load, improving tissue pathology, and modulating oxidative stress in immunosuppressed mice.
BACKGROUND:Bacterial infections significantly worsen the prognosis of children with chronic liver disease, yet traditional inflammatory markers such as C-reactive protein (CRP) and total leukocyte count (TLC) often lack the specificity needed to reliably distinguish bacterial sepsis from non-infectious inflammation. Procalcitonin (PCT) has emerged as a promising biomarker because its synthesis is selectively upregulated in bacterial infections, providing an early and reliable indicator in this vulnerable population. AIMS:This study aims to evaluate the diagnostic accuracy of serum procalcitonin in differentiating bacterial infections from non-infectious inflammatory states among pediatric patients with chronic liver disease. Also, it aims to compare the performance of procalcitonin with conventional parameters to establish a reliable cutoff for clinical decision making. METHODS:A prospective case-control study was conducted involving 44 children with chronic liver disease subdivided into two groups-22 patients with clinical and laboratory evidence of bacterial infection and 22 without-were recruited from hepatology clinic, Children's Hospital, Ain Shams University and 23 age- and sex-matched healthy controls. All participants underwent detailed clinical assessments including vital signs, comprehensive liver function tests, and inflammatory marker measurements. Serum procalcitonin levels were determined using an enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal procalcitonin cutoff, with its sensitivity, specificity, and predictive values assessed. RESULTS:Procalcitonin levels were found to be significantly higher in the bacterial infection group (median: 0.95 ng/mL; interquartile range [IQR]: 0.70-1.90) compared to both the non-infected chronic liver disease group (median: 0.04 ng/mL; IQR: 0.02-0.06) and the control group (median: 0.05 ng/mL; IQR: 0.02-0.07) (p < 0.001). At a cutoff value of 0.07 ng/mL, procalcitonin achieved a sensitivity of 95.5% and a specificity of 77.3% (area under the curve [AUC]: 0.901, 95% confidence interval: 0.773-0.970, p < 0.001) for detecting bacterial infection in these patients. Moreover, statistically significant positive correlations were observed between procalcitonin levels and both CRP and INR as a marker of liver dysfunction, while an inverse correlation was noted with platelet count. CONCLUSION:Serum procalcitonin is a highly sensitive and specific biomarker for detection of bacterial infections in children and adolescents with chronic liver disease with a lower cut off value compared to normal population. Despite specificity to bacterial infection, still its value is comparable to conventional inflammatory markers. Future larger studies are warranted to validate these findings and optimize clinical protocols.
An 11-year-old girl presented with progressive visual diminution in the right eye, with previous left cataract surgery. Slit-lamp examination revealed multiple discrete, circular lenticular opacities with central dark zones and dense white peripheral halos, producing a distinctive "bubble-wrap" appearance. The lesions were predominantly nuclear and varied in size. Although bubble-like cataract morphologies have been described following ocular trauma and in retinitis pigmentosa, this appearance has not, to our knowledge, been reported in a developmental cataract. This may represent a novel morphological variant, expanding the phenotypic spectrum of pediatric cataracts.
BACKGROUND:Zinc deficiency is common among critically ill children; but there is still debate about zinc deficiency and severity of illness in PICU. OBJECTIVE:The study aimed to measure the serum zinc level in critically ill children on admission and to correlate the effect of zinc deficiency on outcome of critically ill children. METHODS:A prospective observational cohort study was conducted at a Children's Hospital on 82 patients aged between 1 month to 3years, admitted to the PICU with acute illness, excluding chronic medical conditions that affect zinc status. All were subjected to physical examination, anthropometric measurements, laboratory investigation (Complete blood count, C-reactive protein, serum albumin, serum zinc level) and outcomes. RESULTS:The study included 82 patients; their mean age was (10.5 ± 9.6) months, 53.7% were males, 46.3% were females. The study found that 43.9% of patients had low serum zinc levels. There was a statistically significant positive correlation between adequate zinc intake and head circumference Z-score (p-value=0.012). No correlation was found between zinc level and illness severity as measured by antibiotics duration, respiratory support duration, and Glasgow Coma Scale score (p-value = 0.258, 0.214, 0.138) respectively. Moreover, no correlation was found between the zinc level and PICU stay (p-value=0.216). CONCLUSION:zinc deficiency was prevalent among critically ill pediatric patients, but its impact on clinical outcomes and severity of illness was not statistically significant.
BACKGROUND:Dyslexia is defined as reading achievement below the expected level for a child's age, education, and intelligence, with the impairment interfering significantly with academic success or the daily activities that involve reading. It is present in 5-17% of the population. It describes a kind of difficulty that some people have with reading that does not necessarily extend to other skills such as math. AIM OF THE WORK:Evaluation of the effect of vitamin D supplementation on the dyslexic symptoms in children. PATIENTS AND METHODS:This study conducted over a period of six months at the Developmental and Behavioral Pediatrics clinic, Children's Hospital, and the Phoniatrics Unit of the ENT Department, Faculty of Medicine, Ain Shams University. , a controlled cross-sectional study included 80 children in 2 groups: 40 diagnosed with dyslexia as the case group, alongside 40 age- and sex-matched children without dyslexia serving as the control group, dyslexic children received rehabilitation sessions and vitamin D supplementation in the form of vitamin D3 drops, 300 IU/Kg/day not to exceed 5,000 IU/day for 3 months. Illinois test used to find out the efficiency of vitamin D supplementation in improvement of symptoms of dyslexic children, the test done for every case twice, the first time before starting vitamin D therapy and the second one after completing 3 months of vitamin D therapy side by side rehabilitation sessions. RESULTS:Dyslexic children who received vitamin D3 supplementation and rehabilitation for 3 months showed statistically significant difference between pre- and post-vitamin D therapy in multiple neurobehavioral domains of the Illinois test (p < 0.05), including auditory reception, visual association, verbal expression, manual expression, visual closure, and auditory closure. In contrast, no significant differences were found in the remaining parameters, so vitamin D supplementation may support symptom improvement in dyslexic children when combined with rehabilitation therapy. CONCLUSION:This study suggests a potential link between vitamin D and dyslexia symptoms in children. Vitamin D supplementation combined with rehabilitation lead to notable improvements in several neurobehavioral domains. These findings support the role of vitamin D in cognitive and language development and highlight the need for further research on its therapeutic potential.
OBJECTIVE:To elucidate the mechanism of Yiqi Fumai Formula (YQFM) in acute decompensated heart failure (ADHF) via the Nrf2/SLC7A11/GPX4 pathway in regulating ferroptosis. METHODS:Network pharmacology was employed to predict the underlying mechanisms of YQFM in ADHF. Rat models of ADHF were established, incorporating agonists or inhibitors of key ferroptosis pathways. The therapeutic mechanism of Yiqifumai Formula was investigated by assessing cardiac structure/function, myocardial injury biomarkers, lipid peroxidation, iron metabolism, ultrastructural changes, and key ferroptosis pathways. RESULTS:Network pharmacology analysis suggested that YQFM might intervene in ADHF by modulating key processes of ferroptosis, including lipid metabolism, inflammatory response, and cell survival. Experimental validation confirmed that YQFM improved cardiac function, reduced myocardial lipid peroxidation, and inhibited cardiomyocyte ferroptosis in rat models. This cardioprotective effect is likely associated with the regulation of the Nrf2/SLC7A11/GPX4 signaling pathway. CONCLUSION:YQFM exerts the cardioprotective effect in ADHF by suppressing ferroptosis through the modulation of the Nrf2-SLC7A11/GPX4 pathway.
BACKGROUND:Respiratory virus infections are a major cause of morbidity in asthma. Although biologic therapies targeting type 2 inflammation are widely used for severe asthma, their comparative effects on respiratory virus infection risk remain unclear. METHODS:We conducted a retrospective cohort study using the TriNetX US Collaborative Network, including adults with asthma who newly initiated benralizumab, omalizumab, dupilumab, or mepolizumab. Using an active comparator, new-user design with 1:1 propensity score matching, we compared benralizumab with each biologic. The primary outcome was a composite of respiratory virus infections (COVID-19, influenza, RSV infection, and viral pneumonia) over three years. Hazard ratios (HRs) were estimated using Cox proportional hazards models. RESULTS:After matching, 5,663 benralizumab-omalizumab pairs, 7,075 benralizumab-dupilumab pairs, and 6,492 benralizumab-mepolizumab pairs were included. Benralizumab was associated with a higher risk of composite respiratory virus infection than omalizumab (HR 1.49, 95% CI 1.33-1.66), dupilumab (HR 1.24, 95% CI 1.11-1.39), and mepolizumab (HR 1.24, 95% CI 1.12-1.38; all p < 0.001). Risks of COVID-19 and influenza were consistently higher with benralizumab across all comparisons. Viral pneumonia risk was higher versus dupilumab (HR 1.59, 95% CI 1.18-2.14) but not versus omalizumab or mepolizumab. RSV infection risk did not differ significantly. CONCLUSIONS:Benralizumab was associated with a higher risk of respiratory virus infections than omalizumab, dupilumab, and mepolizumab. These findings suggest that profound eosinophil depletion may impair antiviral host defense and should be considered when selecting biologic therapy for patients at increased risk of respiratory viral infections.
BACKGROUND:Chronic obstructive pulmonary disease (COPD) is frequently complicated by acute respiratory failure, pneumonia, exacerbations, and premature mortality, particularly in patients with comorbid type 2 diabetes (T2D). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) possess anti-inflammatory and metabolic properties that may confer protective effects against COPD-related respiratory complications, but comparative evidence remains limited. METHODS:We conducted a retrospective cohort study using data from the TriNetX global federated health research network. Adults aged 40 years or older with both COPD and T2D who newly initiated GLP-1RAs, dipeptidyl peptidase-4 inhibitors (DPP-4is), sulfonylureas (SUs), or metformin between January 1, 2017, and May 31, 2025, were identified. An active-comparator, new-user design with 1:1 propensity score matching was applied. The primary outcome was incident acute respiratory failure. Secondary outcomes included all-cause mortality, all-cause hospitalization, acute exacerbation of COPD, and pneumonia, assessed over one year of follow-up. RESULTS:After propensity score matching, GLP-1RA use was associated with significantly lower risk of acute respiratory failure compared with DPP-4is (HR, 0.77; 95% CI, 0.73-0.81), SUs (HR, 0.80; 95% CI, 0.76-0.84), and metformin (HR, 0.91; 95% CI, 0.85-0.98). GLP-1RA use was also consistently associated with reduced risks of all-cause mortality, all-cause hospitalization, acute exacerbation of COPD, and pneumonia across all three comparator groups. Subgroup analyses demonstrated consistent protective trends across sex, age, exacerbation history, and inhaled bronchodilator regimen. CONCLUSIONS:In patients with COPD and T2D, initiation of GLP-1RAs was associated with significantly lower risks of acute respiratory failure, pneumonia, acute exacerbation, hospitalization, and all-cause mortality compared with DPP-4is, SUs, and metformin. These findings suggest that GLP-1RA therapy may offer meaningful respiratory and survival benefits in this high-risk population.
