Aims: To show the benefit of chymotrypsin as an adjuvant therapy in cases of moderate parapneumonic pleural effusion in children. Study Design: Randomized controlled trial. Place and Duration of Study: Pulmonology Unit, Pediatric Department and Radiology Department, Tanta University Hospital, Egypt between Februray, 2019 to Februray, 2020. Methodology: Subjects comprised of 60 children randomized into three groups 20 children each (41 males, 19 females; age range 1-14 years) with moderate parapneumonic pleural effusion by chest ultrasound. Clinical as well as complete blood count, C-reactive protein and chest ultrasonography at time of presentation, after one week (first end point) and after two weeks (second end point). Management with antibiotics, analgesics, antipyretics, chest tube insertion and oral chymotrypsin in group 2 and intramuscular chymotrypsin in group 3. Results: There was statistically significant decrease in fluid thickness by chest u/s (mm) in group 2 (Mean ±SD= 6.400±3.872) and group 3 (Mean ±SD= 6.150±2.720) after one week and after two weeks group 2 (Mean ±SD= 15.3±4.658) while group 3 (Mean ±SD= 3.3±1.559) in comparsion to group 1 after one week (Mean ±SD= 16.100±10.351) and after two weeks (Mean ±SD= 11.35±7.066) ( P < 0.001), duration of hospitalization (days) and chest tube (days) were statistically significant lower in group 2 (Mean±SD= 15.200±4.112 ), (Mean±SD= 9.100±2.808) respectively and group 3 (Mean±SD= 14.050±3.300), (Mean±SD= 7.400±1.698 ), in relative to group 1 (Mean±SD= 18.65±3.329 ), (Mean±SD= 9.85±3.265 ), (P <0.001, P=0.017 respectively) and percentage of decortication was statistically significant lower in group 2 and 3 in relative to group 1. (P =0.017). Conclusion: Chymotrypsin has an adjuvant role in management of moderate parapneumonic pleural effusion evidenced by earlier recovery less hospital stay, derease in chest tube insertion and need for decortication and intramuscular chymotrypsin injection has better effect than oral chymotrypsin in moderate parapneumonic pleural effusion.
Background: Leptin balances body weight, but its role in the negative energy imbalance is unclear. Increased energy expenditure reduces newborn with cyanotic congenital heart disease development. Aim and objectives:The researchers wanted to see how much leptin was in the blood of kid's congenital heart disease (CHD), both cyanotic and acyanotic, as well as to look into its involvement in their growth. Subjects and methods: In this study, 38 Egyptian patients with congenital heart disease participated (18 with acyanotic CHD and 20 with cyanotic CHD), as well as (20) seemingly normal youngsters of same age, gender, and socioeconomic level as a control group. Results: A total sample of 58 with mean age 7.7± 4.2, 8.3± 4.1 and 9.1± 3.8 in cyanotic, acyanotic and control groups. Mean of serum leptin among control group was 3.7± 1.3. The mean of serum ghrelin among acyanotic group was 5.3± 1.8. There was positive correlation between age, BMI, O2 saturation, MAC, and serum leptin. But there was negative correlation between age, BMI, O2 saturation, mid upper arm circumference (MAC), and serum ghrelin. There was negative moderate statistically significant correlation between serum leptin and serum ghrelin. Conclusion: Elevated leptin and reduced gherlin levels were found in children with congenital heart diseases, whether cyanotic or acyanotic, suggesting a role for both hormones in regulation of nutrient intake, energy balance and maintenance of body weight in those children.
Background: Pneumonia is the most frequent reason for morbidity and mortality in children worldwide. As many as ten times as many children die from childhood pneumonia in developing countries, compared to developed countries. Aim: This study was conducted to investigate severe recurrent pneumonia in children. Subjects and methods: This prospective & descriptive research were conducted on 200 patients at Tanta University Hospital, Pediatrics Department during the period from the beginning of May 2019 to April 2022. We recruited all patients with advanced recurrent pneumonia (RP). Results: Mean age of advanced RP children is 15.4 months, while the age at 1st episode of pneumonia was 12.7 months. Between children with advanced RP, the majority were males, being twice compared with females. Cough was the prevalent symptom in 99% of cases then wheezing (63%) and fever (60%). Respiratory abnormalities were the most prevalent (28%) as underlying causes of advanced RP patients, then immune disorders (22%) and congenital heart diseases (16%). The pulmonary hemorrhagic syndrome was the least prevalent cause as it was observed in only 2 cases. Conclusion:Children with underlying diseases had more serious diseases & poorer clinical results because they were more likely to get recurrent pneumonia & were susceptible to resistant microorganisms. As a result, more emphasis can be placed on clinical severity & therapeutic plan.
Background: There are few biomarkers that can be easily accessed in clinical settings and may reflect refractory Th2-eosinophlic inflammation and remodeling of the asthmatic airways. Serum periostin may be one such biomarker to aid our understanding of the patho-bio-physiology of asthma and exercise induced asthma. The aim of the study is to explore the relationship between serum periostin level and exercise induced bronchoconstriction in asthmatic children. Materials and Methods: This cross-sectional study was carried out on (90) children both sexes aged from 6 to 15 years including, (60) children with bronchial asthma and (30) children were enrolled as control group in the period from January 2018 to January 2019. Patients were randomly classified into two groups: I) Patient group: divided into 2 groups according to standardized treadmill exercise challenge test: Group A: (30) asthmatic children with positive test. Group B: (30) asthmatic children with negative test. II-Control group: (30) children apparently healthy with no personal or family history of asthma. All children were subjected to the following Investigations: Chest x-ray, pulmonary functions tests (FEV1 & PEFR) except controls, Laboratory investigations as CBC and Serum periostin level. Results: The mean values of both the percentage of PEFR and FEV1 after exercise in group A were significantly lower than those in group B and the percentage of PEFR and FEV1 after exercise in each group were significantly lower than the percentage before exercise in the same group. The mean value of eosinophilic count in group A was significantly higher than (group B and control group) and the mean value of eosinophilic count in group B was significantly higher than control group. The mean value of serum level of periostin in group A was significantly higher than (group B and control group), however, there was no significant difference between group B and control group as regard to serum level of periostin. Chest tightness, cough and wheezes after exercise and eosinophilic count in patients with high serum periostin level were significantly higher than patients with low serum periostin level, and both PEFR and FEV1 after exercise in patients with high serum periostin level were significantly lower than patients with low serum periostin level. Also the normal serum periostin levels vary among different age groups. Conclusion: Serum periostin level can be considered as a useful biomarker for diagnosis of Exercise induced bronchospasm (EIB) in asthmatic children especially when lung function test cannot be done However, cautious is required in evaluating serum periostin levels in children because it varies with age.
Background: Serological testing is urgently required since COVID-19 is the pandemic that is spreading the fastest in recent times, Although RT-PCR is an effective and specific method for diagnosing acute patients, serological tools are urgently required for examining antibody responses and evaluating both individual and prospective herd immunity. The aim of this study was divided into primary objectives were to assess serum IgM antibodies for SARS-Cov-2 in febrile children attending ER in Tanta University Hospital and secondary objectives were to assess computed tomography (CT) findings in febrile SARS-Cov-2 IgM antibody-positive individuals. Methods: This cross-section study was carried out on sixty children presented by fever with any respiratory symptom as cough and dyspnea and fever with non-respiratory and cutaneous symptoms. The patients were divided into three equal groups: group 1: included healthy children, group 2: included febrile children with respiratory symptoms as cough and dyspnea and group3: included febrile children with fever alone or with non-respiratory symptoms as Gastrointestinal symptoms as vomiting and diarrhea, cutaneous manifestations as rash, and CNS manifestations. Results: IgM were significantly higher in group II compared to other groups, significantly higher in group III compared to group I (P value <0.001).CO-RADS 2,4 and 5 were significantly higher in group II compared to other groups, CO-RADS 3 was insignificantly different between groups II and III. Patients with positive CXR at time of presentation were significantly higher in group II compared to other groups. (P value 0.005). Conclusions: In children with COVID-19, Serum IgM to SARS-COV-2 was significantly higher in febrile children in Tanta University during the period from March 2021 to February 2022. According to CT findings, CO-RADS 2,4 and 5 were significantly higher in febrile patients with positive SARS-Cov-2 serum Igm Ab.
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