Abstract Background Sepsis is one of the main causes of death in newborns worldwide. Vitamin D levels during fetal and neonatal periods have a significant role in the development of the immunological system. The study aims to evaluate the association between vitamin D levels and the risk of early-onset neonatal sepsis in full-term neonates in a developing country. Methods This case–control study was conducted at the Neonatal Intensive Care Units (NICUs) of Kasr Alainy Hospital, Cairo, Egypt. The study was composed of two groups; the sepsis group involved full-term neonates appropriate for gestational age with sepsis-related clinical signs. The control group included newborns with no signs of clinical/laboratory infection within 72 h of life. Blood samples were collected on admission during the first three days of life in both groups for the measurement of 25-hydroxyvitamin D levels, Complete Blood Count (CBC), C reactive protein (CRP), and blood culture. Results Forty-five newborns with clinical and laboratory findings of early-onset neonatal sepsis within 72 h of life were enrolled, and the control group included forty-five newborns with no evidence of sepsis. Vitamin D levels in the sepsis group were significantly lower than in the control group. Apgar score at the first minute was significantly lower in the sepsis group. 57.8% of neonates with sepsis had positive blood cultures. There was a statistical difference between deficient, insufficient, and sufficient vitamin D levels regarding the duration of the NICU stay, which was longer in neonates with deficient vitamin D levels. CRP was significantly higher in neonates with deficient vitamin D levels. The area under the receiver operating characteristic curve for serum vitamin D in the prediction of neonatal sepsis was 0.76 at a cutoff < 19.7(ng/ml). Conclusion In the current study, full-term newborns with EOS had considerably lower vitamin D levels than healthy controls. Through appropriate vitamin supplementation of the mothers during pregnancy, it could be possible to ensure adequate vitamin D levels for newborns. This may contribute to the reduction of the risk of EOS, together with the other well-known preventive measures (i.e. breastfeeding and intrapartum antibiotic prophylaxis).

Oxidative stress is a sophisticated situation that orignates from the accumulation of reactive free radicals within cellular compartments. The antioxidant mechanism of the MnSOD enzyme facilitates the removal of these lethal oxygen species from cellular components. The main goal of this pertained work is to study the contribution of the SOD2 (rs4880; p.Val16Ala) variant to the development of bronchial asthma among children. The study’s design was carried out based on a total of 254 participants including 127 asthmatic children (91 atopic and 36 non-atopic) along with 127 unrelated healthy controls. Allelic discrimination analysis was executed using the T-ARMS-PCR protocol. This potential variant conferred a significant association with decreased risk of bronchial asthmatic children under allelic (OR = 0.56, P-value = 0.002), recessive (OR = 0.32, P-value = 0.011), and dominant (OR = 0.51, P-value = 0.040) models. Additionally, atopic and non-atopic asthmatic children indicated a protection against bronchial asthma development under allelic, and dominant models (p-value < 0.05). Our findings suggested that the SOD2*rs4880 variant was correlated with decreased risk of childhood bronchial asthma.

Background Community-acquired pneumonia represents a noteworthy concern in terms of morbidity and mortality, particularly in countries with lower and middle-income levels. Accurate and timely diagnosis of pneumonia is crucial for optimal management. Chest CT is considered the gold standard imaging for diagnosis of pneumonia, but it is not always readily available and exposes children to radiation hazards, so it becomes important to find easily available and less hazardous imaging tools such as lung ultrasound to diagnose pneumonia. A comparative investigation was carried out to assess the diagnostic capability of lung ultrasound in critically ill pediatric patients presenting with respiratory symptoms. Forty-two patients with community-acquired pneumonia from the pediatric intensive care unit were included. Results Lung ultrasound demonstrated high sensitivity (88.1%) and specificity in diagnosing pneumonia, outperforming chest X-ray (50%) and providing comparable results to chest CT (95.2%). In addition, 45.2% of patients required mechanical ventilation, and 69.1% were diagnosed with viral pneumonia. Conclusion The employment of lung ultrasound is deemed secure, accessible, transferable, and efficacious in the expeditious detection of community-acquired pneumonia and the subsequent monitoring of patients. Its high sensitivity and specificity make it a valuable imaging modality in pediatric pneumonia diagnosis, helping clinicians make informed decisions and improve patient outcomes.

Introduction: Therapeutic plasma exchange (TPE) is an extracorporeal therapy, used in a wide spectrum of diseases. The aim of our study is to analyze the indications and outcomes of TPE in critically ill children at a University Children Hospital. Methods: This is a retrospective study including all patients admitted to pediatric intensive care unit (PICU), who underwent TPE starting from 2018 to 2022. Demographic data, vital signs, laboratory investigations at PICU admission and upon discharge were recorded. The number of PE sessions needed for each patient, volume of exchange, replacement fluid, site of IV access, complications during sessions, and the outcomes were documented. Results: Seventy-five critically ill pediatric patients who underwent 450 TPE sessions were enrolled. Guillain-Barré syndrome (GBS) was the commonest indication for TPE in 45(60%) patients, 23(30.7%) of them were with severe motor axonal degeneration subtype. Severe autoimmune hemolytic anemia (AIHA) with failed first line of management accounted for 21(28%) children. The mean number of TPE sessions needed for every patient was 6±4 sessions. TPE sessions related complications were minimally significant. Mortality was 12% of the study group and related to respiratory support. Conclusion: TPE carries the hope for cure of many autoimmune disorders, even as a first line of therapy in many conditions. GBS patients account for the majority of our TPE indication, and a satisfactory outcome was observed in AIHA patients. Further studies are needed to augment our results that more than 5 TPE sessions are sometimes needed in selected severe GBS patients

Background Paediatric intensive care units (PICU) experience a big challenge with malnutrition. It significantly impacts the development and prognosis of critically ill patients (CIP). CIP are those who require high reliance or serious medical and/or surgical interventions. For their importance, valid and reliable nutritional markers are mandatory to be implemented in the daily practice of our PICU. The aim of this study was to determine the nutritional status of CIP in PICU through measuring prealbumin level and use it as predictor of malnutrition and clinical outcome. Methods Forty four CIP admitted to the Children's Hospital, Cairo University PICU, throughout six months were the subject of this cross-sectional study. Clinical nutritional status was evaluated using the Z-score, and prealbumin level was measured. Results 50% of children who were critically sick also had malnutrition, with severe malnutrition accounting for the majority of cases (34.1%). Prealbumin did not significantly correlate with malnutrition, nor the mortality in CIP. However, malnutrition is strongly linked to mortality in critically ill children. To predict malnutrition in CIP, serum prealbumin at cutoff > 163.64 exhibited AUC of 0.556 with sensitivity of 90.91% and a specificity of 31.82%. For prediction of the clinical outcome, serum prealbumin at cutoff ≤ 758.37 had an AUC of 0.535 with a sensitivity of 91.67% and a specificity of 21.87%. Conclusions Malnutrition significantly increased the risk of death. Prealbumin was neither a significant predictor for malnutrition nor mortality in CIP.

This study investigates the effect of sudden loss on corporate governance structure (CGS), and its implications on earnings management technique “big bath” in the Egyptian context. A matched sample of 208 firm-year observations in the Egyptian Stock Exchange (EGX) has been examined. Using the same methodology as in Mulcahy and Donnelly (2015) and Cheng, Park, Pierce, and Zhang (2019), the difference-in-differences (DID) approach is applied to measure the response of CGS to sudden loss versus profit incident, while binary logistic regression is used to investigate big bath following. Results indicate a significant association of sudden loss on changes in the loss firms’ CGS following the loss, although these changes do not significantly differ from those made by profit firms. This indicates that sudden loss may trigger changes in corporate governance (CG), but other conditions also play a role in evoking such changes. Results also show a significant positive association of sudden loss on increasing the likelihood of engaging in a big bath behavior. The findings of this study are expected to help Egyptian firms’ managers to improve firms’ performance and governance structure that lead to high-quality earnings and provide financial reports that rationalize investors’ decisions. This study is the first to test the influence of sudden loss on CGS and link it to big bath in Egyptian setting.

Primary immunoglobulin A vasculitis (IgAV) is one the most common childhood vasculitis. A 5-year and 10-month-old girl child patient presented with confluent palpable purple red rash, mainly over both ankles. This was associated with edematous, tender ankles, limited range of movement, and inability to walk. A concomitant coronavirus disease 2019 (COVID-19) was documented by nasopharyngeal swab. This case suggested that COVID-19 can trigger IgAV in children. Hence, awareness of COVID-19 infection in IgAV should be present, and it may be useful to investigate COVID-19 as one of the causes of IgAV, especially in the presence of an epidemic.

Critical illness hyperglycemia (CIH) is common in the pediatric intensive care unit (PICU). Increased glucose production, insulin resistance (IR), and pancreatic β-cell dysfunction are responsible mechanisms. We aimed to investigate β-cell function in the PICU and to uncover its relation to clinical and laboratory variables and ICU mortality. We prospectively recruited 91 children. Pancreatic β-cell function was assessed by using a homeostasis model assessment (HOMA)-β. Patients with β-cell function <40.0% had significantly higher Pediatric Risk of Mortality III (PRISM III) scores, higher rates of a positive C-reactive protein (CRP), lower IR, and a longer hospital stay. The patients with 40–80% β-cell function had the highest IR. Intermediate IR was found when the β-cell function was >80%. ICU survivors had better β-cell function than ICU non-survivors. A multivariate logistic regression analysis revealed that higher PRISM III score and HOMA-β <80.0% were significant predictors of mortality. In conclusion, β-cell dysfunction is prevalent among PICU patients and influences patient morbidity and mortality.

Abstract It is necessary to stratify the risk of pediatric patients at the time of intensive care unit (ICU) admission and to predict their outcomes. This helps to allocate the scarce ICU resources to start the appropriate treatment. The objective of this study was to evaluate the prognostic value of C-reactive protein/albumin ratio on admission to pediatric intensive care unit (PICU) in predicting mortality, PICU length of stay, the need for mechanical ventilation, and the use of inotropic drugs. This cohort study was conducted at Pediatric Cairo University Hospital. The study included 178 critically ill children. Pediatric Risk of Mortality–III (PRISM-III) score was calculated; CRP and serum albumin levels were assessed within 24 hours from admission. The median CRP/albumin ratio was significantly higher in nonsurvivors than survivors (18.60 and 4.65, respectively). The CRP/albumin ratio at a cutoff of ≥25.83 had significant discriminatory power in predicting mortality (area under the curve [AUC] = 0.795 and p < 0.001) with 85.4% accuracy. Furthermore, CRP/albumin ratio alone showed a comparable discriminatory power to that of PRISM-III score (AUCs = 0.795 and 0.793, respectively). A multivariable logistic regression analysis revealed that each unit of increase in the CRP/albumin ratio increased the risk of mortality by 1.075 (odds ratio [OR] = 1.075). CRP/albumin ratio showed a significantly higher median in ventilated (6.86) compared with non-ventilated (5.22) patients. Patients supported with inotropes showed significantly higher median CRP/albumin ratio (11.70 and 3.68, respectively). CRP/albumin ratio at admission to PICU was a good independent predictor of mortality.

Elevated cortisol level is an component of the stress response. However, some patients have low cortisol levels; a condition termed: critical illness-related corticosteroid insufficiency (CIRCI). Basal cortisol levels during PICU admission may be related to outcome. This prospective cohort study aimed to assess basal total serum cortisol levels and their relation to outcome in PICU. The study included 81 children over 6 months. Total serum cortisol was assessed using an early morning sample. The severity of illness was assessed using the PRISM-III score. Outcome measures included mechanical ventilation duration, use of inotropic support, length of stay, mortality. Comparison between patients’ subgroups according to total serum cortisol levels revealed significantly higher PRISM-III score in patients with total serum cortisol levels. In addition, those patients had a significantly higher mortality rate when compared with patients with low and normal total serum cortisol levels. Multivariate logistic regression analysis recognized high total serum cortisol level and PRISM-III score as significant predictors of mortality. We concluded that PRISM-III score and elevated total serum cortisol levels are significant predictors of mortality in the PICU. Although CIRCI is prevalent in this population, it wasn’t associated with an increased mortality rate.

Background: Guillain-Barre syndrome is the most common cause of acute flaccid paralysis worldwide since the eradication of poliomyelitis. Severe cases may require intensive care and mechanical ventilation. Purpose: was to study pediatric patients with severe GBS requiring intensive care unit (ICU) admission, to assess their course and response to initial treatment modality plasma exchange (PE) or intravenous immunoglobulins (IVIg) and their final outcome. Methods: children with severe GBS who had either actual or impending respiratory failure, bulbar involvement or rapid progression of acute flaccid paralysis with trunk, upper limb and neck involvement within 24 h of the onset of weakness were enrolled. Results: 40 children were included. Following the initial treatment (33 subjects had 5 PE sessions each and IVIg in 7), 16 patients improved (40%), two died and 22 (55%) showed initial treatment failure. Axonal neuropathy, rapid progression and severe motor weakness significantly predicted poor response to therapy. At discharge, favorable outcomes (patient can walk unaided) were present in 22 cases (58%). Conclusion: Despite relatively low mortality, critically ill children with severe GBS have increased prevalence of axonal neuropathy and guarded response to initial therapy with PE or IVIg.

BackgroundAn accurate rehabilitation program of diabetic polyneuropathy (DPN) depends on a precise assessment of cognition and determination of its relation to gait using different objective and valid methods.ObjectiveOur aim was to assess cognitive function and analyze the influence of cognitive dysfunction on the spatiotemporal gait parameters under three different gait conditions (walking without a cognitive task, walking with verbal fluency, and walking with an arithmetic task) in DPN patients.Patients and methodsTwenty patients with type II diabetes mellitus with moderate polyneuropathy (PN) (group 1) and 20 matched patients with type II diabetes mellitus without PN (group 2) represented the sample of this study. Different cognitive domains of cognition were assessed using a computer-based RehaCom procedure. Spatiotemporal gait parameters were assessed using a 2D video-based motion analysis under the three different gait conditions.ResultsThe results showed a significant decrease in all cognitive domains in the DPN patients (group 1) (P<0.05). All spatiotemporal gait parameters were significantly affected in the DPN (group 1), especially during dual-task performance (P<0.05).ConclusionThere is an association between cognitive dysfunction and PN complications in diabetic patients. Spatiotemporal gait parameters are affected more in DPN patients, especially under dual-task conditions, than in diabetic patients without PN.

Background: Little is known on the impact of risk factors that may complicate the course of critical illness. Scoring systems in ICUs allow assessment of the severity of diseases and predicting mortality.Objectives: Apply commonly used scores for assessment of illness severity and identify the combination of factors predicting patient's outcome.Methods: We included 231 patients admitted to PICU of Cairo University, Pediatric Hospital. PRISM III, PIM2, PEMOD, PELOD, TISS and SOFA scores were applied on the day of admission. Follow up was done using SOFA score and TISS.Results: There were positive correlations between PRISM III, PIM2, PELOD, PEMOD, SOFA and TISS on the day of admission, and the mortality rate (p< 0.0001). TISS and SOFA score had the highest discrimination ability (AUC: 0.81, 0.765, respectively). Significant positive correlations were found between SOFA score and TISS scores on days 1, 3 and 7 and PICU mortality rate (p< 0.0001). TISS had more ability of discrimination than SOFA score on day 1 (AUC: 0.843, 0.787, respectively).Conclusion: Scoring systems applied in PICU had good discrimination ability. TISS was a good tool for follow up. LOS, mechanical ventilation and inotropes were risk factors of mortality. (C) 2014 The Authors. Production and hosting by Elsevier B. V. on behalf of The Egyptian Pediatric Association.