Tei Index and its Relation to Outcome of Critically Ill Children on Continuous Renal Replacement Therapy.

OBJECTIVES: To evaluate echocardiographic parameters, especially the Tei index as a predictor of outcome in critically ill children on continuous renal replacement therapy (CRRT). METHODS: This cohort study included all critically ill patients admitted at the Pediatric intensive care unit (PICU) and underwent CRRT. Functional echocardiography and Pediatric Risk of Mortality Index (PRISM) III were used to evaluate the participants. Both the Tei index and the Vasoactive inotropic score (VIS) were estimated. RESULTS: The study included 35 patients with an age range of 6 mo to 14 y. The Tei indexes, VIS, and PRISM III were reported as predictors of mortality with a sensitivity of 88%, 83%, and 94% and a specificity of 73%, 79%, and 89% respectively. In survivors, the mean Tei index score, median VIS, and mean PRISM values were 0.44 ± 0.1, 3.8 (0-40), and 12.06 ± 3.35, respectively. However, in non-survivors, the mean Tei index, median VIS, and mean PRISM score were 0.59 ± 0.16, 0.60 (0-342.5), and 22.94 ± 8.93, respectively. CONCLUSIONS: The Tei index could be used as a predictor for poor outcomes in children receiving CRRT. It is correlated to the PRISM score and VIS.

Clinical and neurophysiological characterization of early neuromuscular involvement in children and adolescents with nephropathic cystinosis.

BACKGROUND: Nephropathic cystinosis is a rare autosomal recessive lysosomal storage disorder characterized by kidney and extra-renal complications due to the accumulation of cystine crystals in various tissues and organs. Herein, we describe the early neuromuscular complications in a cohort of pediatric nephropathic cystinosis patients. METHODS: We prospectively evaluated the clinical, biochemical, and neurophysiological data of 15 cystinosis patients. Neurophysiological evaluation was performed to confirm or exclude presence of neuropathy and/or myopathy. RESULTS: Patients' age ranged between 20 and 216 months at time of examination. Nine patients were males. Three patients had early abnormal neurophysiological features consistent with neuromuscular involvement (clinically asymptomatic proximal myopathy with a patchy distribution in one patient and isolated asymptomatic sensory nerve conduction changes in two patients). A fourth patient had mixed abnormal motor and sensory axonal neuropathic changes associated with overt clinical features (predominantly motor symptoms). Patients with abnormal neuromuscular features were significantly older in age than the unaffected group (P = 0.005) and had a diagnosis of cystinosis with subsequent cysteamine therapy at a significantly older age than the unaffected group (P = 0.027 and 0.001, respectively). CONCLUSIONS: We expanded the recognized phenotypes of cystinosis neuromuscular complications with early proximal skeletal myopathy and symptomatic motor and sensory axonal neuropathy. Early asymptomatic neuromuscular complications could develop in pediatric patients and would require neurophysiological studies for early detection prior to development of overt clinical manifestations. Prompt diagnosis and timely initiation of cysteamine therapy with recommended dose can delay the development of neuromuscular complications. A higher resolution version of the Graphical abstract is available as Supplementary information.

Pediatric kidney transplantation in Egypt: Results of 10-year single-center experience.

Pediatric kidney transplantation is a multidisciplinary therapy that needs special consideration and experience. In this study, we aimed to present CUCH experience; over a 10-year period, as a specialized center of kidney transplantation in children. We studied 148 transplantations performed at a single center from 2009 to 2018. Pretransplant and follow-up data were collected and graft/patient survival rates were evaluated. A total of 48 patients developed at least one rejection episode during 688 patient-years of follow-up. Infections, recurrence of original disease, and malignancy were the most important encountered medical complications (20%, 2%, and 1.4%, respectively). One-year patient survival was 94.1%, while graft and patient survival was 91.9%. Graft/patient survival at 5, 7, and 9 years was 90%, 77%, and 58%, respectively. Infections were the main cause (69%) of mortality. Death with a functioning graft and CR were the main causes of graft loss (48% and 33%, respectively). Pediatric kidney transplantation in Egypt is still a challenging yet successful experience. Rejections and infections are the most frequent complications. Short-term outcomes surpass long-term ones and graft survival rates are similar to the international standard.

Dielectric spectroscopy study of water hyacinth collected from different media.

X-ray fluorescence (XRF) study has been shown that the water hyacinth plant is an effective tool for the removals of heavy metals (As, Ba, Cr, Cu, Ni, Pb, Rb, Sr, Zn and Zr) and metal oxides (SiO2, K2O, CaO, Al2O3, Fe2O3, MgO, Na2O, MnO, P2O5, SO3 and TiO2) from agriculture (media 1) and agriculture wastewaters drainage polluted with municipal wastewater (media 2). As a general description, the heavy metals and metal oxides were found at higher levels in the plant collected from media 1 than those in the plant collected from media 2. Similarly, these pollutants were found at higher levels in the plant roots than those in the plant shoots. The dielectric properties were investigated for the plant samples before (control) and after treating by microwave heating power. They were found at higher values in the control roots than those in the control shoots. Furthermore, the properties were found at relatively higher values in the control roots collected from media 1 (ε'=13 at 103Hz) than those in the control roots collected from media 2 (ε'=9 at 103Hz). The electrical conductivity of the microwave treated samples remarkably increased due to appearance of OH group through which the plant interacts with heavy metals. Accordingly, the pollutants removing ability could be enhanced upon treating the plant by microwave heating power. The plant-pollutant mixture behaves like highly conductive disordered polymers. The conductivity and dielectric properties of all plant samples are dominated by the media and concentration of pollutants.

Dielectric spectroscopic studies on the water hyacinth plant collected from agriculture drainage.

The present paper aims to investigate the sensitivity of dielectric spectroscopy to changes in concentrations of pollutants (heavy metals and metal oxides) uptake by the water hyacinth plant collected from agriculture wastewater drainage. The measurements were carried out on the dried root and shoot plant parts before and after subjecting to different microwave heating powers for different times. Dielectric properties of the untreated root were investigated at temperature range (30-90°C). X-ray fluorescence spectroscopy (XRF) results showed that the concentration of metals and metals oxides are higher in plant root than in plant shoot. Accordingly, the obtained dielectric properties were found to depend on the applied electric field frequency, magnitude of heating power as well as concentrations of pollutants. Analysis of experimental data represented by the imaginary part of the dielectric modulus M″ (ω) revealed to the presence of three different relaxation processes. The lower frequency relaxation process was associated to charge carriers conduction whereas those appeared at higher frequencies were associated to different types of interfacial polarization. The plant ability for removing heavy metals and metal oxides from the aquatic environments would be enhanced upon subjecting to microwave heating power with 400 W for 30 min.