Impact of Cardiac Injury on the Clinical Outcome of Children with Convulsive Status Epilepticus.

OBJECTIVES: the aim of this study was to determine the impact of cardiac injury on clinical profile, cardiac evaluation and outcome in patients hospitalized with convulsive status epilepticus (CSE). MATERIALS AND METHODS: this prospective observational study included 74 children with CSE. Cardiac injury was evaluated and defined using combination of cardiac troponin, electrocardiography (ECG) and echocardiography. Clinical outcome and mortality rates were compared in patients with and without cardiac injury. RESULTS: A total of 74 patients with CSE were included in the study. Thirty-six (48.6%) patients demonstrated markers of cardiac injury. ECG changes occurred in 45.9% and echocardiographic signs of left ventricular systolic and diastolic dysfunction reported in 5.4% and 8.1%, respectively. The mean length of hospital stays and need for ICU admission were significantly higher in patients with cardiac injury compared to others. One third of patients with cardiac injury needed mechanical ventilation and this was significantly higher than patients without (p = 0.042). hypotension and/or shock developed in 25% of cardiac injury patients and most of them required inotropic support; this was significantly higher than others without markers of cardiac injury. The overall mortality in cardiac injury group was higher (13.9% vs. 2.6%); however, this difference was not statistically significant. CONCLUSION: Markers of cardiac injury were common and associated with poor clinical outcome and higher risk of mortality in patients with CSE, so extensive routine cardiovascular evaluation is essential in these patients.

Maternal and neonatal vitamin D deficiency and transient tachypnea of the newborn in full term neonates.

AIM: To investigate the association between maternal and neonatal serum 25-hydroxyvitamin D (25-OHD) levels and development of transient tachypnea of the newborn (TTN) in full term infants. METHODS: This was a prospective case-control study carried out on 30 neonates with TTN and their mothers and 30 control neonates and their mothers. Levels of 25-OHD were measured in maternal and neonatal blood samples that were obtained in the first 12-24 h of postnatal age. RESULTS: Both maternal and neonatal 25-OHD levels in the TTN group were significantly lower compared to the control group (P=0.0001). A negative correlation was observed between neonatal 25-OHD level and average hospital stay (P=0.0001). CONCLUSION: We observed that lower maternal and neonatal vitamin 25-OHD levels were associated with TTN development in full term infants.

Salivary C-reactive protein and mean platelet volume in diagnosis of late-onset neonatal pneumonia.

BACKGROUND: Neonatal pneumonia is an important and major cause of neonatal morbidity and mortality worldwide therefore; its early detection plays a crucial role in successful therapy. Analysis of saliva as a non-invasive method for detection of neonatal diseases holds great promise for improving health care. Till now, salivary C-reactive protein (CRP), mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR) and platelets/lymphocytes ratio (PLR) have not been studied as markers of diagnosis in neonatal pneumonia. OBJECTIVE: To assess the applicability of salivary CRP, MPV, NLR and PLR as diagnostic markers in late-onset neonatal pneumonia. METHODS: A prospective case control study of 70 full-term neonates, 35 with late-onset neonatal pneumonia and 35 healthy controls, was enrolled. Serum and salivary CRP concentrations were measured by ELISA, while MPV, NLR and PLR were measured by automated blood cell counter. RESULTS: This study showed a statistically significant difference between salivary CRP means in neonates with late-onset neonatal pneumonia vs control neonates (6.2 ± 4.6 and 2.8 ± 1.9 ng/L) respectively. At the cutoff point of 3.8 ng/L, salivary CRP showed 91.4% sensitivity and 80.9% specificity. Salivary CRP also showed accuracy in predicting elevated serum CRP in neonates with pneumonia. MPV showed a significant difference between pneumonia and controls (mean = 10.2 ± 0.7, 8 ± 0.5) respectively. At cutoff point 9.0, it has 80% sensitivity and specificity. CONCLUSIONS: The present study showed for the first time that both salivary CRP and MPV are suitable as diagnostic markers in late-onset neonatal pneumonia.

The effectiveness of the WHO training course on complementary feeding counseling in a primary care setting, Ismailia, Egypt.

BACKGROUND: The adequacy and timing of complementary feeding of the breastfed child are critical for optimal child growth and development.Considerable efforts have been made to improve complementary feeding in the first 2 years of life. One of them was the WHO complementary feeding counseling course (CFC). OBJECTIVES: To evaluate the effectiveness of the WHO CFC on knowledge and counseling abilities of primary healthcare physicians; on caretaker's knowledge and adherence to physicians' recommendations and their feeding practices; and on children's growth. PARTICIPANTS AND INTERVENTIONS: A single-blinded randomized-controlled study was carried out in 40 primary healthcare centers divided into matched pairs according to their location, either in rural or urban areas, and training of the selected physicians on integrated management of childhood illness. One center from each pair was selected randomly for its physician to receive CFC training in nutrition counseling and the matched center was selected as a control. Forty primary healthcare center physicians and 480 mother-child (6-18 months) pairs were included in the study. The mother-child pairs recruited were visited at home within 2 weeks, 90, and 180 days after the initial consultation with trained health workers. Special questionnaires were used to collect information on healthcare providers' knowledge of nutrition counseling and practice (counseling skills); maternal knowledge of basic nutrition-counseling recommendations, maternal compliance with the recommended feeding practice; child dietary intake; and gains in weight and length. RESULTS: CFC-trained physicians were more likely to engage in nutrition counseling and to deliver more appropriate advice. This was reflected in improvements in maternal recall of complementary feeding messages, which were higher in the intervention group compared with the control group. Six months after the consultation, children in the intervention group had significantly greater weight gains compared with the control group (0.96 vs. 0.78 kg; P=0.038). Children in the intervention group, who were 12-18 months of age at the time of recruitment, had significantly less faltering in length gain compared with the control group (height/age Z-score; 0.23 vs. 0.04; P=0.004). CONCLUSION AND RECOMMENDATIONS: Nutrition counseling training improved counseling abilities of primary healthcare physicians and led to improvements in mothers' knowledge and practices of complementary feeding. In turn, this led to improved growth of children. We recommend wide and regular utilization of the CFC course to improve the knowledge and skills of health workers who provide counseling to mothers for complementary feeding.

The association between Helicobacter pylori infection, type 1 diabetes mellitus, and autoimmune thyroiditis.

BACKGROUND: Type 1 diabetes mellitus (T1DM) can be associated with an increased prevalence of Helicobacter pylori infection, which could contribute to the pathogenesis of autoimmune thyroiditis observed in this disease. AIM: The aim of this study was to assess the relationship between H. pylori infection and T1DM and to identify of the interconnection between H. pylori infection and autoimmune thyroiditis in patients with T1DM. METHODS: A case-control design was used. The study group included 60 children and adolescents with T1DM who were selected from the pediatric outpatient clinic of Suez Canal University Hospital by a systematic random sampling method. The control group included 60 healthy children and adolescents matched for age and sex and selected from among relatives (brothers or cousins) of the patients with T1DM. The study participants were subjected to several investigations including estimation of levels of HbA1c, thyroid stimulating hormone (TSH), T3, T4, anti-thyroglobulin (anti-Tg), and anti-thyroid peroxidase (anti-TPO). RESULTS: The mean age of the patients with T1DM was 12.53±2.35 years, whereas that of the control group was 12.30±1.98 years, with no statistically significant difference between the two groups. The patients with diabetes had significantly higher levels of H. pylori IgG, TSH, anti-TPO, and anti-Tg (20.43±14.84 µ/ml, 4.03±1.53 mIu/l, 14.98 ±5.04 Iu/ml, and 5.66±3.37 Iu/ml, respectively) and significantly lower levels of T3 and T4 (120±15.86 µg/dl and 4.93±0.93 µg/dl, respectively) compared with the control group. In addition, the seroprevalence rate of H. pylori, anti-Tg, and anti-TPO was significantly higher in diabetic patients, and the duration of diabetes was significantly longer in H. pylori-positive patients with higher levels of HbA1c, insulin requirement, TSH, anti-TPO, and anti-Tg. CONCLUSION AND RECOMMENDATIONS: The association between H. pylori infection and autoimmune thyroiditis in patients with T1DM was revealed in this study. Hence, screening and treatment of H. pylori infection in T1DM patients is recommended.