Background Asthma and iron deficiency are common pediatric conditions. In addition, iron deficiency may affect spirometry results in asthmatic children. So, we aimed to assess the effect of ion status on lung function in childhood asthma. Results In this cross-sectional study, fifty asthmatic pediatric patients aged from 6 to 16 years presented to our institute during the period from (June 2018 to December 2018) were enrolled. Asthmatic patients were classified according to their complete blood count and iron profile into 2 groups: group 1, asthmatic children without iron deficiency anemia (IDA); and group 2, asthmatic children with IDA. All patients underwent full history taking, clinical examination, laboratory investigations, asthma control test, and pulmonary function tests (PFTs). The study showed that PFTs’ parameters (forced expiratory volume in one second (FEV1) % of predicted, FEV1/forced vital capacity, and maximal mid expiratory flow (MMEF) 25–75% of predicted) were significantly lower among asthmatics with IDA (80.62 ± 18.13, 78.36 ± 11.22, 62.35 ± 26.67) than among asthmatics without IDA (93.45 ± 15.51, 87.68 ± 10.81, 82.10 ± 24.74), respectively ( p =0.012, 0.006, 0.012). Also, poorly controlled asthma was significantly higher among asthmatics with IDA ( p =0.001). In addition, there was a statistically significant positive correlation between forced spirometry parameters, hemoglobin, and ferritin level ( p =0.012, 0.042). Moreover, there was a significant positive correlation between hemoglobin level and MMEF 25–75% of predicted ( p =0.012). Conclusions Lower iron status negatively affects the lung function in asthmatic children with a more obstructive pattern among asthmatics with IDA.

Objectives: This work aimed to highlight a challenging asymptomatic problem which is early detection of hearing impairment in toddlers with protein energy malnutrition (PEM) as a neuro-cognitive effect of PEM on developing brain in relation to hemoglobin level.Methods: 100 toddlers, aged 6-24 months, fifty with moderate/severe PEM and fifty healthy children, were included in study. Both TEOAEs and ABR testing were used to assess auditory function.Results: Study reported an association between malnutrition and hearing impairment, 26% of cases had conductive deafness secondary to otitis media with effusion using tympanometry; 84.6% showed type B and 15.4% type C which may suggest developing or resolving otitis media. Their ABR showed 46% mild and 53% moderate impairment. 32% of PEM cases had sensory neural hearing loss and with type (A) tympanometry. Those were assessed using ABR; 58% had mild, 34% moderate and 8% profound impairment. 10% of PEM cases had mixed hearing loss with 50% type B and 50% type C tympanometry and their ABR showed moderate to profound impairment. TEOAEs latencies at different frequencies correlate negatively with hemoglobin level.Conclusions: Toddlers with moderate/severe PEM had hearing impairments of different types and degrees. Neuro-physiological methods could be early and safe detectors of auditory disorders especially in high-risk toddlers. Anemia increases risk for auditory dysfunction. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

Ventilator-Associated Pneumonia (VAP), is defined by the Centers for Disease Control and prevention (CDC) as pneumonia that occurs in a patient receiving mechanical ventilation that develops 48 hours or more after initiation of ventilation. We aimed in this study to evaluate the effect of oropharyngeal colonization on the occurrence and outcome of VAP in critically ill children. This prospective, cohort, study was performed in pediatric intensive care unit, Ain Shams university hospital in Cairo, Egypt. A total of 50 children were selected: 30 children acquired VAP (VAP group) and 20 children didn't acquire VAP (non-VAP group). Assessment of oropharyngeal colonization was done by using a microbiological culture of samples from the tonsillar area at day (0), (2), (4) of admission. VAP was clinically confirmed by Clinical Pulmonary infection Score (CPIS) score and bacterial endotracheal culture. Most of studied cases were admitted due to chest diseases (Asthma and COPD). Duration of mechanical ventilation did not vary significantly among both groups. The actual mortality rate was higher among the patients who acquired VAP (46.7%). There was a significant relationship between microbiological growth of the endotracheal culture of patients of VAP group and the oropharyngeal swab done for those patients on day 2 intubation p<0.05 and that done on day 4 intubation p<0.01. Conclusion: VAP resulted in considerable increase in mortality rate. Oropharyngeal colonization was a significant risk factor for development of VAP.

Haemophilus influenzae (Hi) causes more than 3 million cases of serious disease, mainly meningitis and pneumonia in children less than 5years old with approximately 386,000 deaths each year worldwide. The presence or absence of a polysaccharide capsule is an important distinguishing characteristic of H. influenzae species. The polysaccharide capsule can be serologically classified into six serotypes (a to f). Invasive Hi diseases in children were almost exclusively caused by serotype b (Hib). To the best of our knowledge, the real burden of Hib pneumonia in Egypt is not clarified. Yet, few studies are published and concerned with Hib sepsis among neonates or Hib meningitis in children. We aimed in this study to identify the frequency of Hib pneumonia among Egyptian children below five years by the use of real-time polymerase chain reaction (PCR) technique, with insight on antimicrobial resistance of Hib strains in the Egyptian community. One hundred patients with community-acquired pneumonia were investigated for Hib by both real-time PCR and bacterial culture. Haemophilus influenzae type b was diagnosed in 31% of the examined population by PCR, with sensitivity of 100% (95% CI: 0.86–1), specificity 100% (65% CI: 0.93–1), positive predictive value (PPV) 100% (95% CI: 0.83–1), and negative predictive value (NPV) 100% (95% CI: 0.93–1). Blood culture was positive in 12 patients only, with a sensitivity of 38% (95% CI: 0.22–0.57), a specificity of 100% (65% CI: 0.93–1), PPV 100% (95% CI: 0.69–1), and NPV 77% (95% CI: 0.68–0.86). Isolated Hib strains were sensitive to ceftriaxon in 91% of cases, followed by ampicillins in 31% and cotrimoxazole in 17%. Three patients had multidrug resistant strains of Hib.

Respiratory syncytial virus (RSV) type A and B, influenza A and B cause about 80% of viral lower respiratory tract infections. Multiplex RT-PCR has a significant advantage in that it permits simultaneous amplification of several viruses in a single reaction facilitating cost-effective diagnosis and perhaps improved clinical management. In this study, our aim was to determine the frequency of Influenza A and B, and RSV types A and B among children with community-acquired pneumonia (CAP), by the use of the newly developed rapid, accurate, and pathogen-specific technique of multiplex RT-PCR. This study is a cross-sectional study involving 24 children admitted to Children’s Hospital of Ain Shams University due to severe lower respiratory tract infection (LRTI). Clinical and radiological assessment of all patients were performed followed by molecular analysis of both respiratory and blood samples of all enrolled patients simultaneously by the use of Reverse Transcription-Multiplex PCR technique (RT-m PCR). Viral pneumonia was detected in one third of enrolled patients (8/24), with predominance of respiratory syncytial virus A (4/8), followed by Influenza A virus (3/8) and Influenza B virus (1/8) while no cases of respiratory syncytial virus B were detected. The same results were identified in both blood and respiratory specimens. Conclusion Reverse Transcription-Multiplex PCR technique Multiplex has a significant advantage in that it permits simultaneous amplification of several viruses in a single reaction making this well suited for use in epidemiological studies and to improve etiology-directed clinical management of viral pneumonia.

BACKGROUND:Allergic rhinitis is among the most common chronic disorders of childhood with prevalence of up to 40% in children. Clara cell secretory protein (CCSP) is secreted by Clara cells in the lining fluid of airways. It has an immune-modulatory and anti-inflammatory activity. AIM OF WORK:Study aimed at evaluating CCSP as a biomarker in serum and nasal lavage fluid of children with allergic rhinitis. METHODS:A case-control study was conducted on sera and nasal lavage fluid samples from 15 children with allergic rhinitis and 15 healthy children as a control group. RESULTS:Children with allergic rhinitis had a male to female ratio 2 to 1, with a mean age of 9.47±2.75 years, while among the healthy group, six were males and nine were females, with a mean age of 8.63±2.28 years. Rhinorrhea and nasal obstruction were the most frequent symptoms (100%) followed by itching (93.3%) then sneezing (73.3%). Among allergic rhinitis patients serum CCSP mean±SD was 2.03±0.59μg/l; it was reliable to predict allergic rhinitis (P<0.0001); while nasal lavage CCSP mean±SD was 12.73±8.25μg/l and it was not reliable to predict allergic rhinitis. Its best cut-off value was 3.75μg/l with a sensitivity of 100%, specificity 80%, with a diagnostic accuracy of 90%. CONCLUSION:Clara cell secretory protein is a new peripheral sensitive marker of airway injury. Furthermore, serum CCSP level is a predictor of allergic rhinitis but not nasal lavage fluid CCSP.

Respiratory syncytial virus (RSV) types A and B and influenza A and B cause about 80–90% of viral lower respiratory tract infections. It is impossible to distinguish the cause of viral respiratory infections by their clinical presentation. Multiplex RT-PCR has a significant advantage in that it permits the simultaneous amplification of several viruses in a single reaction facilitating cost-effective diagnosis and perhaps improved clinical management. In this study, our aim was to determine the prevalence of influenza A and B, and RSV types A and B among children with CAP, by the use of the newly developed rapid, accurate, and pathogen-specific technique of multiplex RT-PCR in order to accomplish the greatest positive effect on patient care and health care costs. This study is a cross-sectional study involving 24 children admitted to the Children’s Hospital of the Ain Shams University due to severe lower respiratory tract infection (LRTI). Clinical and radiological assessment of all patients was performed followed by the molecular analysis of both respiratory and blood samples of all enrolled patients simultaneously by the use of the newly available reverse transcription-multiplex PCR technique (RT-m PCR). Viral pneumonia was detected in one-third of enrolled patients (8/24), with the predominance of respiratory syncytial virus A (4/8), followed by influenza A virus (3/8) and influenza B virus (1/8) while no cases of respiratory syncytial virus B was detected. The same results were identified in both blood and respiratory specimens. Reverse transcription-multiplex PCR technique – multiplex has a significant advantage in that it permits the simultaneous amplification of several viruses in a single reaction making it well suited for use in epidemiological studies and to improve etiology-directed clinical management of viral pneumonia.

ObjectiveTo compare the effectiveness of oral montelukast and that of inhaled corticosteroid (ICS) for controlling mild-persistent asthma after 8 weeks of treatment. ParticipantsThe study included 50 children of both sexes, who suffered from mild-persistent asthma, with a mean age of 7.72±2.4 years. Randomly, 25 patients were chosen to receive oral montelukast for 8 weeks, whereas the other 25 patients received ICS for the same period. Fifty children, who were apparently healthy, and age-matched and sex-matched with the study population, served as a control group. MethodsAll children were subjected to full clinical evaluation, assessment of pulmonary function tests, and measurement of fractional exhaled nitric oxide (FENO) and percentage of eosinophilic count before and after treatment. ResultsAfter 8 weeks of treatment, both groups of asthmatic children showed significantly higher levels of all pulmonary function tests and significantly lower levels of both FENO and percentage of eosinophilic count as compared with those before treatment. However, the ICS-treated group showed significantly higher levels of forced expiratory volume at the first second and significantly lower levels of eosinophilic count percentage and FENO when compared with the oral montelukast-treated group. ConclusionICS are the preferable primary long-term treatment for mild-persistent asthma. However, the state of efficacy of montelukast in this study, besides its oral route, may make it an alternative controller therapy for these patients. In addition, FENO appeared as a good indicator for airway inflammation in asthmatic patients.

Background: Asthma is the most common chronic inflammatory disease in childhood and some reports have demonstrated systemic inflammation. The relevance of high-sensitivity assays for C-reactive protein (hs-CRP), which are known to be a sensitive marker of low-grade systemic inflammation, has not been fully studied in childhood asthma. Aim of study: This cross sectional case-control study aimed at evaluating serum hs-CRP in asthmatic children with different grades of severity and control. Methods: Serum hs-CRP, sputum cytology study, and forced expiratory volume in 1 sec (FEV1) % of predicted for age and sex were estimated in 60 asthmatic children (30 uncontrolled steroid-naive, and 30 controlled on inhaled steroid). They were recruited from Pediatric Chest Clinic, Children's Hospital, Ain Shams University. Sixty healthy children-age and sex-matched were included as a control group. Results: Serum hs-CRP concentrations were significantly higher in asthmatics than in controls with a median of 1.93 mg/L and 0.24 mg/L, respectively. Serum hs-CRP levels were significantly higher in uncontrolled steroid-naive asthmatics than those controlled on inhaled steroid with a median of 3.15 mg/L and 1.55 mg/L, respectively. Serum hs-CRP showed a sensitivity of 72% and a specificity of 93%. Conclusions: Despite that pulmonary function tests and clinical classification are the gold standard for grading of asthma, hs-CRP can be considered as a new marker for assessment of different grades of asthma severity and control. It can be used for indirect detection and monitoring of airway inflammation, disease severity, and response to steroid treatment in asthmatic children. Pediatr Pulmonol. 2012; 47:220-225. (C) 2011 Wiley Periodicals, Inc.

Normal sleep; no impairment of daily leisure, or sport activities; normal work or school; no troublesome symptoms Mild Normal sleep; no impairment of daily leisure, or sport activities; normal work or school; no troublesome symptoms Moderate-severe One or more of the following: abnormal sleep; impairment of daily leisure, or sport activities; abnormal work or school; troublesome symptoms Moderate-severe One or more of the following: abnormal sleep; impairment of daily leisure, or sport activities; abnormal work or school; troublesome symptoms ≤4 days/week or ≤ 4 weeks

Objective: Diagnosis of atypical pathogens as an aetiology for community-acquired pneumonia (CAP) in children is a challenge world wide. The aim of this study was to detect the frequency of atypical pathogens as a cause of community-acquired pneumonia (CAP) in Egyptian children. Methods: From 50 children (with age ranged from 2 months to 12 years) hospitalized for community-acquired pneumonia; respiratory sputum samples were collected by induction or spontaneously. All samples were subjected to conventional cultures and Polymerase Chain Reaction (PCR) technique DNA extraction for identification of Mycoplasma, Chlamydia pneumoniae and Legionella pneumophila. Results: A definite pathogen was identified in 78% of the studied children; 30% typical bacteria, 8% candida albicans and atypical bacteria in 40% of the pneumonic children. Chlamydia pneumoniae was isolated from 26% of the children while Mycoplasma pneumoniae was isolated from 14%, whereas Legionella pneumophilla was not isolated at all. Conclusion: Atypical pathogens are evident as a potential aetiology for community-acquired pneumonia in (13.3%) of young and (80%) of older Egyptian children.