Effect of cerebrolysin on neurodevelopmental outcome of high risk preterm infants: A randomized controlled trial.

BACKGROUND: A significant proportion of preterm infants experience developmental delay despite receiving a post discharge early interventional care. Cerebrolysin is a peptide mixture which acts similar to endogenous neurotrophic factors through promoting neurogenesis and enhancing neuronal plasticity. OBJECTIVE: To compare the effect of Cerebrolysin plus routine intervention program versus routine intervention program alone on the outcome of preterm infants at high risk for neurodevelopmental delay. METHODS: In a randomized controlled trial, high-risk preterm infants < 32 weeks' gestation who have abnormal neurological assessment at two months corrected post-natal age were randomized at 6 months corrected post natal age to receive either early intervention program or early intervention program plus Cerebrolysin injection of 0.1 mL/kg body weight every week for 3 months as an adjuvant therapy. The primary outcome was the rate of failure of the gross motor assessment at 12 months of corrected age and secondary outcomes included fine motor, language, and personal social development at 12 months corrected post-natal age as assessed by Denver Developmental Screening Test II. RESULTS: Cerebrolysin group had a significant lower number of infants diagnosed with failed gross motor development compared to infants in the routine intervention group [10 (33%) versus 21 (70%), p = 0.009]. Cerebrolysin group had a significant lower number of infants diagnosed with failed fine motor, language and personal social development compared to infants in the routine intervention group. CONCLUSION: Cerebrolysin, as an adjuvant therapy to routine early interventional care, may improve gross motor development of high-risk preterm infants at 12 months corrected post-natal age.

Genetic polymorphisms in XRCC1, OGG1, and XRCC3 DNA repair genes and DNA damage in radiotherapy workers.

DNA damage may develop at any dose of ionizing radiation. DNA damage activates pathways that regulate cell growth and division or coordinate its replication and repair. The repair pathways, base excision repair (BER) and single-strand break repair (SSBR), can repair such damages efficiently and maintain genome integrity. Loss of this repair process or alteration of its control will be associated with serious outcomes for cells and individuals. This study aimed to determine the relationship between XRCC1 (Arg194Trp, Arg280His, and Arg399Gln), OGG1 (Ser326Cys), and XRCC3 (Thr241Met) SNPs and DNA damage and to identify high-risk individuals with reduced DNA repair capacity. This case-control study was conducted on 80 subjects; 50 subjects working in Clinical Oncology and Nuclear Medicine Department in Assiut University Hospital along with 30 controls. A total of 1 mL blood samples were collected for Single-Cell Gel Electrophoresis Technique (Comet Assay) for detection of DNA damage in those subjects. A total of 3 mL fresh blood samples were collected and analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP)-based technique. DNA damage detected by comet test was significantly high in IR-exposed workers than control. Statistically high significant difference was found in exposed subjects versus control subjects regarding the frequencies of the variant alleles of hOGG1326, XRCC1280 & 399, and XRCC3241. The level of DNA damage was not affected by OGG1326 SNPs when comparing subjects of wild genotype with those of (pooled) variants either in the exposed staff or in the control group while XRCC1280, 399 and XRCC3241 variant alleles had an influence on the studied DNA damage biomarker. Moreover, genotyping distribution pattern was highly variable in relation to gender. The present study indicated a relationship between DNA damage detected by comet test and single nucleotide polymorphisms in genes coding for DNA certain repair enzymes. Individuals occupationally exposed to low doses of ionizing radiation could be at great risk and more susceptible to the increased DNA damage if they have inherited genetic polymorphism.

Selective head cooling and acute kidney injury in neonates with hypoxic ischemic encephalopathy.

BACKGROUND: The reno-protective effect of therapeutic hypothermia in infants with hypoxic ischemic encephalopathy (HIE) is still debatable. We aimed to study the effect of therapeutic hypothermia on the development and progress of acute kidney injury (AKI) in neonates with HIE. METHODS: Thirty full term infants with HIE were equally distributed between cooling group (selective head cooling) or non-cooling group (late presentation after 6 hours of birth). Serum creatinine, urine output (UOP), serum neutrophil gelatinase-associated lipocalin (NGAL), and serum cystatin C were measured at baseline, day 4 and day 10 of life. RESULTS: The incidence of AKI as per Acute Kidney Injury Network (AKIN) criteria was comparable in cooling and non-cooling groups (40% versus 53%, respectively). Serum creatinine and UOP were significantly improved on day-4 and day-10 samples compared to base-line samples in both groups regardless of cooling. Therapeutic hypothermia was associated with a significant reduction in serum NGAL, but not cystatin C, level in day-4 and day-10 samples compared to the non-cooling group. Serum NGAL and cystatin C did not show a significant decline in day-4 and day-10 samples compared to baseline samples in both the cooled and non-cooled groups indicating an ongoing AKI. CONCLUSIONS: Therapeutic hypothermia was associated with less renal impairment when compared to infants with HIE who were not cooled. Continuing kidney injury may persist in asphyxiated newborns despite improvement in serum creatinine and UOP. TRIAL REGISTRATION NUMBER: NCT02683915.

Sustained lung inflation at birth for preterm infants at risk of respiratory distress syndrome: The proper pressure and duration.

BACKGROUND: Variations exist among the administered pressure and duration of sustained lung inflation (SLI) in the delivery room (DR). We aimed to evaluate the appropriate pressure and duration needed for SLI in preterm infants with respiratory distress syndrome. METHODS: We prospectively randomized 100 preterm (<32 weeks) infants to receive either conventional therapy of continuous positive airway pressure (CPAP) at 5 cm H2O, or four groups of CPAP plus a single maneuver of SLI at four regimens based on administered pressures and durations; P20D20 (Pressure of 20 cm H2O for a duration of 20 seconds), P20D10 (20 cm H2O for 10 seconds), P15D20 (15 cm H2O for 20 seconds), and P15D10 (15 cm H2O for 10 seconds) using a T-piece ventilator. The primary outcome was the need for endotracheal intubation (ETT) in the DR. Broncho-alveolar lavage (BAL) was obtained from intubated infants for interleukin-10 (IL-10) assessment. RESULTS: SLI decreased the need for ETT in the DR (21% versus 55%, p < 0.01) compared to conventional therapy. ETT requirement was significantly lower in P20D10 (20%), P15D20 (20%), and P15D10 (20%) groups, but not P20D20 (25%) compared to the conventional group (55%, p < 0.05). Group P20D20 had significant higher BAL levels of IL-10 [713.8 (IQR 611-874) versus 535.4 (IQR 480-563) pg/ml, p < 0.05] compared to the conventional group, and to other SLI groups. Pneumothorax was not significantly different among studied groups. CONCLUSION: SLI for a pressure and duration ≥20 cm H2O for 20 seconds is not superior to lower pressures for shorter duration and may be injurious to lungs.

Risk factors and clinical outcomes for carbapenem-resistant Gram-negative late-onset sepsis in a neonatal intensive care unit.

BACKGROUND: Carbapenem-resistant (CR), Gram-negative (GN), late-onset sepsis (LOS) is a serious threat in the neonatal intensive care unit (NICU). AIM: To assess the prevalence of CR-GN-LOS in NICU patients and to identify the risk factors and outcomes associated with its acquisition. METHODS: Neonates with carbapenem-susceptible (CS)-GN-LOS were compared with those with CR-GN-LOS in a two-year observational study. FINDINGS: A total of 158 patients had GN-LOS; 100 infants had CS-GN-LOS and 58 infants had CR-GN-LOS. The incidence rate of CR-GN-LOS was 6.5 cases per 1000 patient-days. The most frequent bacterial strain in both groups was Klebsiella pneumoniae. The duration of total parenteral nutrition (TPN) (P=0.006) and prior carbapenem use (P=0.01) were independent risk factors for CR-GN-LOS acquisition. CR-GN-LOS was associated with higher mortality than CS-GN-LOS (P=0.04). Birth weight, small for gestational age, time to start enteral feeding, exclusive formula feeding, previous surgery, previous antifungal use, central venous device before onset, duration of central venous device, and infectious complications were identified as dependent risk factors for overall mortality. However, only male gender (P=0.04) and infectious complications (P < 0.001) were independent risk factors associated with mortality. Infectious complication rates, duration of mechanical ventilation, and length of hospital stay were significantly higher in infants with CR compared to CS-GN-LOS. CONCLUSION: The duration of TPN and carbapenem use were the independent predictors for CR-GN-LOS acquisition. CR-GN-LOS is associated with higher mortality, infectious complication rates, longer mechanical ventilation, and longer hospital stay. Male gender and infectious complications were the independent risk factors for mortality in neonates with GN-LOS.

Interferon regulatory factor 5 gene polymorphism in Egyptian children with systemic lupus erythematosus.

Background Increased expression of interferon-inducible genes is implicated in the pathogenesis of systemic lupus erythematosus (SLE). Interferon regulatory factor 5 (IRF5) is one of the transcription factors regulating interferon and was proved to be implicated in the pathogenesis of SLE in different populations. Objectives The objective of this study was to investigate the correlation between polymorphisms of the IRF5 gene and SLE susceptibility in a cohort of Egyptian children and to investigate their association with clinico-pathological features, especially lupus nephritis. Subjects and methods Typing of interferon regulatory factor 5 rs10954213, rs2004640 and rs2280714 polymorphisms were done using polymerase chain reaction-restriction fragment length polymorphism for 100 children with SLE and 100 matched healthy controls. Results Children with SLE had more frequent T allele and TT genotype of rs2004640 ( Pc = 0.003 and 0.024, respectively) compared to controls. Patients with nephritis had more frequent T allele of rs2004640 compared to controls ( Pc = 0.003). However the allele and genotype frequencies of the three studied polymorphisms did not show any difference in patients with nephritis in comparison to those without nephritis. Haplotype GTA of rs10954213, rs2004640 and rs2280714, respectively, was more frequent in lupus patients in comparison to controls ( p = 0.01) while the haplotype GGG was more frequent in controls than lupus patients ( p = 0.011). Conclusion The rs2004640 T allele and TT genotype and GTA haplotype of rs rs10954213, rs2004640, and rs2280714, respectively, can be considered as risk factors for the development of SLE. The presence of the rs2004640 T allele increases the risk of nephritis development in Egyptian children with SLE.

Factors influencing parental consent for participation in clinical research involving their children in Egypt.

Factors affecting parents' decision to involve their children in clinical research have not been studied in all cultural backgrounds. We aimed to explore the attitudes and beliefs influencing parents' decision to involve their children in clinical research in Mansoura, Egypt. Of 523 families approached, 357 filled the questionnaire. Only 98 (27.5%) parents consented to involve their child in clinical research. The children of consenters were significantly older than refusers: 8.6 (SD 7.2) versus 2.6 (SD 1.2) years. Factors favouring consent were: research of benefit to child (84.7%), enough explanation about the benefits (40.8%) and to learn more about child's condition (29.6%). Factors favouring refusal were: use of new drugs or vaccines (89.6%) and invasive procedures (84.2%). Parents' rate of consent was positively correlated with the research being non-invasive and the belief that research was of benefit to their child and negatively correlated with belief that refusal may negatively affect the care provided to their child.

Factors influencing parental consent for participation in clinical research involving their children in Egypt

Factors affecting parents' decision to involve their children in clinical research have not been studied in all cultural backgrounds.We aimed to explore the attitudes and beliefs influencing parents' decision to involve their children in clinical research in Mansoura, Egypt.Of 523 families approached, 357 filled the questionnaire.Only 98 [27.5%]parents consented to involve their child in clinical research.The children of consenters were significantly older than refusers:8.6 [SD 7.2]versus 2.6 [SD 1.2]years.Factors favouring consent were:research of benefit to child [84.7%], enough explanation about the benefits [40.8%]and to learn more about child's condition [29.6%]. Factors favouring refusal were:use of new drugs or vaccines [89.6%]and invasive procedures [84.2%]. Parents' rate of consent was positively correlated with the research being non-invasive and the belief that research was of benefit to their child and negatively correlated with belief that refusal may negatively affect the care provided to their child

لم تخضع العوامل التي تؤثر على موافقة الوالدين على إشراك أطفالهم في البحوث السريرية، للدراسة في جميع الخلفيات الثقافية. وهدف الباحثون إلى التعرف على المواقف والمعتقدات التي تؤثر على القرارات التي يتخذها الوالدان حول مشاركة أطفالهم في البحوث السريرية في المنصورة في مصر. وقد تواصل الباحثون مع 523 أسرة، استكملت الاستبيانات منها 357 أسرة، واتضح أن 98 من الوالدين [27.5%]، فقط قد وافقوا على مشاركة أطفالهم في البحوث السريرية، وأن متوسط أعمار الأطفال الذين وافق الوالدان على مشاركتهم بالبحوث وهو 8.6 عاما [7.2 +/- ] أكبر بمقدار يعتد به إحصائيا من متوسط أعمار الأطفال الذين رفض الوالدان مشاركتهم بها وهو 2.6 عاما [1.2 +/- ]، وأن العوامل التي ترجح الموافقة هي:البحوث التي تعود بالنفع على الطفل [84.7 %]والشرح الوافي عن المنافع [40.8%]والتعلم أكثر عن حالة الطفل [29.6 %]أما العوامل التي ترجح رفض الموافقة فهي: استخدام أدوية أو لقاحات جديدة [89.6%]، والإجراءات الباضعة [84.2 %]. وكان هناك ترابطا إيجابي بين معدل موافقة الوالدين مع كون البحوث غير باضعة وكذلك مع الاعتقاد بأن البحوث نافعة لطفلها، وكان هناك ترابط سلبي مع الاعتقاد بأن رفض المشاركة قد يؤثر سلبيا على الرعاية التي تقدم لطفلها

Les facteurs influant sur la décision des parents de laisser leur enfant participer à une étude de recherche clinique n'ont pas été étudiés dans tous les contextes culturels.L'objectif de 'étude était d'examiner les attitudes et les croyances influant sur la décision des parents de laisser participer leur enfant à une étude de recherche à Mansoura [Egypte]. Sur 523 familles contactées, 357 ont rempli le questionnaire.Seuls 98 parents [27, 5 %]consentaient à laisser participer leur enfant a une recherche clinique.Les enfants des parents qui avaient donné leur consentement étaient nettement plus âgés que ceux dont les parents avaient refusé:8, 6 ans [ET 7, 2]contre 2, 6 ans [ET 1, 2]. Les facteurs favorisant le consentement étaient les suivants:une recherche bénéfique pour l'enfant [84, 7 %], des explications suffisantes sur les avantages [40, 8 %]et l'occasion de mieux connaitre l'affection de leur enfant [29, 6%]. Les facteurs favorisant le refus étaient les suivants:l'utilisation de nouveaux médicaments ou vaccins [89, 6 %]et des actes invasifs [84, 2 %]. Le taux de consentement des parents était positivement corrélé à une recherche non invasive et à la croyance que la recherche serait bénéfique pour leur enfant, et négativement corrélé à la croyance selon laquelle un refus pourrait négativement influer sur les soins fournis à leur enfant

Stable neurocutaneous melanosis in a ten-year-old boy with controlled partial-complex seizures. A case report.

Neurocutaneous melanosis (NCM) is a rare neuroectodermal dysplasia that includes both central nervous system (CNS) and integumentary melanocytic abnormalities. NCM can present with varied clinical and imaging findings, classically presenting with large melanocytic nevi involving the posterior axial trunk region. We describe a case with predominant small non-scalp and non posterior axial-trunk nevi, which nevertheless demonstrated typical CNS imaging findings. Our case clinically presented with epilepsy that was controlled by medical treatment. The patient also demonstrated motor developmental delay, and an otherwise stable course.

Enablers and disablers allowing trainees' abstracts to proceed to full manuscripts: lessons from a large neonatal training program.

OBJECTIVE: To study trainee and supervisor perspectives for success or failure of conversion of abstracts to full manuscripts. STUDY DESIGN: Abstracts presented by trainees between 2000 and 2005 were identified from the syllabi of the Paediatric Academic Society, Canadian Paediatric Society and Hot Topics meetings. The trainee and senior supervisor for each abstract were asked to complete a web-based survey that explored enablers and disablers. RESULT: Of the 187 abstracts identified, 62 (33%) had trainees as primary authors. Of these, the responses of 42 (68%) trainees and 50 (81%) supervisors were collected; the responses of 21 (50%) trainees and 19 (38%) supervisors reported success in converting the abstract to a manuscript. According to trainees, good research idea, supportive supervisors and practical design were the main enablers, whereas limited time for research and the limited data collection only for abstracts were the main disablers. According to supervisors, adequate research time and the trainees' interest were the main enablers, whereas limited data collection and lack of trainees' interest were the main disablers. Specified research training, allocation of protected research time and making publication mandatory were suggested by both to enhance publication rate. CONCLUSION: Training programs should consider research training needs and provide dedicated time to improve research productivity by trainees.

Eosinophilic cationic protein: is it useful in assessing control of childhood asthma?

This study evaluated peripheral eosinophil and serum eosinophilic cationic protein (s-ECP) levels as markers of asthma control. A total of 38 children with asthma (16 controlled and 22 partially controlled) were compared with 16 age- and sex-matched healthy children. Total asthma cases had higher eosinophil counts and s-ECP levels than healthy children and partially controlled asthmatics had significantly higher levels of both markers than controlled asthmatics. Controlled asthma cases showed non-significant changes in both parameters versus healthy children. A negative correlation was noted between degree of asthma control and both eosinophil counts and s-ECP levels (r = -0.60 and -0.75 respectively). s-ECP as well as peripheral eosinophil count may be helpful in the assessment of asthma control.

Eosinophilic cationic protein: is it useful in assessing control of childhood asthma?

This study evaluated peripheral eosinophil and serum eosinophilic cationic protein [s-ECP] levels as markers of asthma control. A total of 38 children with asthma [16 controlled and 22 partially controlled] were compared with 16 age- and sex-matched healthy children. Total asthma cases had higher eosinophil counts and s-ECP levels than healthy children and partially controlled asthmatics had significantly higher levels of both markers than controlled asthmatics. Controlled asthma cases showed non-significant changes in both parameters versus healthy children. A negative correlation was noted between degree of asthma control and both eosinophil counts and s-ECP levels [r = -0.60 and -0.75 respectively]. s-ECP as well as peripheral eosinophil count may be helpful in the assessment of asthma control

Progressive stridor: could it be a congenital cystic lung disease?

UNLABELLED: Bronchogenic cyst of the mediastinum, a cause of stridor early in life, is the result of abnormal budding of the ventral segment of the primitive foregut. Bronchogenic cysts are often asymptomatic in older children and adults. However, symptomatic cases usually manifest early in life with cough, stridor or wheezing due to airway compression. We report a female infant aged 4.5 months with a normal full-term pregnancy, who developed respiratory distress with stridor. This stridor was preceded by a history of slowly progressive noisy breathing. Physical examination revealed evidence of bilateral obstructive emphysema. Chest radiograph revealed bilateral overinflation. Fibro-optic bronchoscopy revealed posterior mediastinal compression. Possibility of congenital cystic lung disease (CCLD) was considered, emphasizing the value of computed tomography (CT) chest, which revealed a cyst probably bronchogenic. Surgical excision was performed with evident histological confirmation of bronchogenic cyst. CONCLUSION: we highlight that in any infant, presented with slowly progressive noisy breathing in the first year of life, CCLD should be considered in the differential diagnosis even with normal X-ray chest. CT chest should be performed for exclusion or diagnosis of the case.

Endoscopic calcaneoplasty--rationale, surgical technique, and early results: a preliminary report.

We present our technique and preliminary results with endoscopic calcaneoplasty in ten patients resistant for conservative therapy for more than 6 months. All patients showed a Haglund spur on radiography; none had a cavovarus deformity. Follow-up ranged from 2 to 12 months (mean 5.2). All patients showed clinical improvement and would undergo for the procedure again. Three showed a good and seven an excellent result in Ogilvie-Harris score. Postoperative radiographic follow-up showed sufficient bone removal in all cases. Surgery lasted on average 46 min (range 28-84). There were no intra- or postoperative complications. Endoscopic calcaneoplasty is an effective minimally invasive treatment option for patients with retrocalcaneal bursitis.