Dietary phenolics are known for their potent antioxidant and anti-inflammatory activities, making them promising candidates for protection against neuroinflammation and neurodegeneration. Hydroalcohol extract of Egyptian species of Corchorus olitorius L. (Co) leaves was investigated for its neuroprotective effects in a lipopolysaccharide-induced neuroinflammatory mouse model. Twenty five metabolites were characterized from the bioactive extract using highperformance liquid chromatography HPLC/PDA/HRESI/MS n , revealing 1,5-dicaffeoylquinic acid (Co11) as one of the major constituents (5.7%), which was isolated and its identity was confirmed by spectral data as first report. Co significantly protected microglia against H 2 O 2 -induced cytotoxicity and immunohistochemistry showed reduced expression of the astrocytic marker, glial fibrillary acidic protein, and the inflammatory marker, cyclooxygenase-2. These findings correlated with significant improvement of cognitive functions and reduction of LPS-induced neurodegeneration in Co-treated mice as revealed by histopathology. The current study shows promising effects of Co in limiting neurodegeneration and cognitive impairment caused by neuroinflammation and glial cell activation.Practical Application: Information presented here shed light on the promising effects of Corchorus olitorius (Co) for the modulation of neuroinflammatory pathways improving the neuroinflammation-related neurodegeneration and cognitive decline. This makes Co a promising candidate as a nutraceutical supplement to be used against neuroinflammation-related disorders.

Acute painful crisis is the most frequent complication of sickle cell disease (SCD) in children. Recurrent vaso-occlusion may be associated with cardiac injury. The study aimed to assess silent myocardial injuries for sickle cell children during acute painful crisis by measuring serum level of troponin I and galectin-3. The study included 87 participates; study group (n = 44) sickle cell children presented at Jeddah hospitals in Saudi Arabia by painful crisis or acute illness as fever or cough (2017-2018). The controls were healthy children (n = 43). Demographic and history data were collected from the cases. Troponin I and galectin-3 were measured. Galectin-3 values were higher among cases with significant difference when compared to controls (7.5 ± 3.1 versus 3.2 ± 1.6, < 0.001). Galectin-3 at a cutoff > 5.1 ng/ml, the sensitivity was 88.64 and specificity was 88.37. Galectin-3 levels were higher for the pain crisis subgroup in comparison to acute illness group with significant difference (r 0.551*, p < 0.001*. Galectin-3 values were higher among troponin-positive cases with significant difference (p = 0.046) to troponin-negative cases.Conclusion: Positive results of troponin I and high levels of galectin-3 in sickle cell children during acute painful crisis were potent indicators for subclinical myocardial injury. What is Known: • The hallmark of sickle cell disease is recurrent episodes of vaso-occlusive crisis which had deleterious effects on many organs. • Cardiac changes in pediatric sickle cell disease whether structural or functional are mainly attributed to chronic anemia and or pulmonary hypertension. What is New: • The observed positive results of cardiac troponin I and high values of galectin-3 in sickle cell children during vaso-occlusive crisis are strong indicator of myocardial ischemia and ongoing cardiac fibrosis respectively. • The observed correlation between biological markers (positive troponin and high galectin-3) could be an indication of subclinical cardiac injury.

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IntroductionDespite the development of non-invasive tools of investigations for congenital heart diseases (CHDs), still the role of diagnostic cardiac catheterization (DCC) cannot be undermined. The study aimed to analyze the clinical profile of indicated CHDs cases at our center for DCC to evaluate the contribution of DCC in patients’ management plans.Material and methodsThe study checked files of cases performed DCC between 2011 and 2012 at the pediatric catheterization unit of Alexandria University Children’s Hospital by the same operator. Demographic, laboratory and hemodynamic data were collected and analyzed.ResultsFiles of 61 children were included in the study. They were grouped into: group I (GI) (n = 25) with pulmonary hypertension (PH), and group II (GII) (n = 36) cases with obstructive pulmonary artery diseases. For the PH group, ventricular septal defect (VSD) was the most common (55%), and patients’ outcome plans were based on angiography – operable subgroup GI-A: (84%) (n = 21) and non-operable (16%) GI-B: (4% inoperable, 12% recommended for sildenafil). GI-B cases were significantly older, with higher PVRI and PVRI/SVRI (3.62, 0.68, p = 0.002) compared to GI-A (0.89, 0.23, p = 0.002, respectively). For group II, tetralogy of Fallot (TOF) was predominant (60%) among the disease spectrum, and the McGoon ratio ranged from 0.7 to 3.2 (median: 1.8). Outcome for GII: 63% operable, 25% shunt, 12% stent. Only pulmonary atresia cases showed a significant difference in the unmatched plans between echocardiography and catheterization reports (χ2 = 7.438, p = 0.023).ConclusionsDiagnostic cardiac catheterization had a positive contribution for determination of the management plans for more than 84% of cases. The utility of pediatric cardiac catheterization in diagnosis should be adjusted according to the local needs of every cardiac center.

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Background: An effective approach to improve antimicrobial use for hospitalized patients is an antimicrobial stewardship program (ASP). The present study aimed to implement ASP for inpatient children based on prospective-audit-with-feedback intervention in order to evaluate the impact on patient’s outcome, antimicrobial use, and the hospital cost.Methods: The study was conducted throughout 6 months over 275 children admitted with different infections at Main Children’s hospital in Alexandria included; group I (with ASP) and group II (standard antimicrobials as controls).Results: The study revealed that on patient’s admission, single antibiotic use was higher among the ASP group while double antimicrobial therapy was higher among the non-ASP with significant difference (p=0.001). Less percentage of patients who consumed vancomycin, meropenem amoxicillin-clavulanic and metronidazole was observed among ASP group with a significant difference of the last two drugs when compared to controls (p=<0.001, 0.011, respectively). The study reported the higher percent of improved ASP patient’s after 72 hours of admission with a significant difference to controls (73.2% versus 62.5%, p=0.038). Complications occurred more likely for the non-ASP group (odds ratio 7.374 with 95% CI 1.68-32.33). In general, there was a clear reduction of the patient antibiotic cost/day and overall cost per patient, however, it was not significant among the studied patients.Conclusions:  Our local ASP model provided a high quality of care for hospitalized children and effectively reduced the antimicrobial consumption.

Background: Severe asthma exacerbation is one of the common pediatric medical emergencies that necessitates hospital visits. The study aimed to identify risk factors associated with pediatric severe asthma exacerbations that might have the potential to guide the parents for early medical consultations and physicians at primary health care centers for proper management.Methods: A case-control study was conducted on over 100 asthmatic children below 12 years attending the Emergency Department of Alexandria University Children’s Hospital in acute exacerbation. Based on a modified pulmonary index score, the patients were allocated into 2 groups; study group (50 patients with severe asthma exacerbation) and control group (50 patients with mild asthma exacerbations). Demographic data, history of illness, alarming clinical signs, medications, and outcome of all participants were recorded.Results: Severe asthma exacerbations were more encountered among males, older age, and with a longer duration of asthma (X±SD=28.4±15.9 months) with significant differences when compared to controls. Comparing the studied groups revealed higher risk for severe asthma exacerbations mainly with; history of sudden onset of severe respiratory distress (Odds ratio “OR”=30.13, 95% CI, 13.78-66.69) and chronic steroid-dependent asthma (OR=14.46, 95% CI, 3.97-52.65). Cyanosis, lethargy, and inability to talk were alarming signs in patients with severe asthma exacerbation when compared to those with mild asthma exacerbation (p<0.05).Conclusions: Severe asthma exacerbation in children is still associated with many risk factors that may alert the patients’ caregivers and physicians prospectively for early proper management.

Background Bronchial asthma is a global health problem with rising prevalence in developing countries. Children with severe asthma can experience cor pulmonale later in life, but little is known about the cardiac changes that might be present earlier in mild or moderate severity of disease. This study aimed to evaluate biventricular function among children suffering from persistent asthma by Tissue Doppler Echocardiography (TDE). Results Thirty-five asthmatic children enrolled from Alexandria Children’s Hospital between September 2021 to May 2022; they were compared to 35 healthy matched children. Chronic respiratory disease, cardiac disease, or other comorbidities were excluded. The mean age of cases was 8.87 ± 2.03 years with a male/female ratio of 54.3%:45.7%. There were 28.3% mild cases, 45.7% moderate, and 25.7% severe. Conventional echocardiographic variables of cardiac function were normal for both ventricles. The TDE indices of medial mitral annulus (S’ velocity and peak E’) were significantly reduced (14.55 ± 2.30 and 14.69 ± 2.30) versus controls (15.68 ± 1.96, 15.69 ± 1.76, P; 0.044, P < 0.0045) but with preserved LV function. The lateral tricuspid annulus (S’ velocity and peak E’) was significantly reduced (11.53 ± 3.24 and 11.56 ± 3.18) versus controls (15.71 ± 0.98, 16.02 ± 1.75, < 0.001*), while E/A and IVRT were significantly increased (1.49 ± 0.06 versus 1.70 ± 0.18 and 102.39 ± 5.37 versus 140.10 ± 34.35, respectively, P < 0.001*) with impaired RV function. Peak expiratory flow rate (PEFR) was negatively correlated with the IVRT of the tricuspid annulus (P = 0.002, r = −0.503*) and to the E'/A' (P = 0.036, r =−0.355*). All TDE variables of lateral tricuspid annulus of severe subgroups were significantly  changed versus moderate or mild subgroups. Conclusions Tissue Doppler echocardiography is the recommended modality for early detection of biventricular cardiac dysfunction among children with different levels of asthma severity. Periodic screening is advised through the use of IVRT especially for RV.