Evaluation of swallowing in children with higher grades glottic web.

PURPOSE: to evaluate the swallowing function in children with higher grades of glottic web and to detect the impact of surgical division of the glottic web on the swallowing parameters. We also performed a voice analysis as a secondary objective in this study. METHODS: This prospective case series study included 12 children with higher grades of the glottic web; grades 3 and 4. Evaluation of the swallowing function was done by clinical swallowing evaluation including symptoms and signs of swallowing dysfunction during feeding, such as vomiting, coughing, choking, or cyanosis, and bedside swallowing assessment using the 3-oz water swallow test. Instrumental evaluation of swallowing function was performed using flexible endoscopic evaluation of swallowing (FEES). The evaluation was performed both preoperatively and postoperatively. RESULTS: The number of children suffering from swallowing difficulties significantly increased during the postoperative evaluation where 6 (50%) children demonstrated choking during feeding after the surgical division of the web in comparison to only 3 (25%) preoperatively. Also, coughing and choking during the 3-oz water swallow test significantly increased following the division of the web with P < 0.001. CONCLUSION: Swallowing assessment is mandatory as children with higher grades of the glottic web, requiring reconstructive surgeries, are at risk of swallowing deficit which can be aggravated postoperatively. With improvement in the airway and surgery-specific outcomes, swallowing function is an important secondary outcome that has a significant impact on the lives of these kids and their families.

Assessment Of Serum Vitamin D Level In Children With Type 1 Diabetes Mellitus: A Cross-Sectional Study.

Objectives: To estimate vitamin D levelsin children with type 1 diabetes, and to evaluate itsrole in the pathogenesis and progress of the disease. Method: The cross-sectional study was conducted at the Paediatric Department of Kafrelsheikh University Hospital, Egypt, from November 2019 to August 2021, and comprised children of either gender aged 3-18 years who were either inpatients or visiting the paediatric outpatient clinic. The subjects were enrolled into 3 groups. Those with newly diagnosed type 1 diabetes were in group A, those with established type 1 diabetes were in group B, and healthy children matched for age and gender and randomly selected were in the control group C. Glycated haemoglobin, serum fasting C-peptide, and serum vitamin D levels were evaluated using quantitative colorimetric determination, an automated analyser, and enzyme-linked immunosorbent assay, respectively. Data was analysed using SPSS 25. RESULTS: Of the 80 subjects, 30(37.5%) were in group A; 17(56.7%) boys and 13(43.3%) girls with mean age 7.77±2.95 years. In group B, there were 30(37.5%) subjects; 14(46.7%) boys and 16(53.3%) girls with mean age 9.6±3.62 years. There were 20(25%) subjects in group C; 10(50%) boys and as many girls with mean age 8.38±2.68 years (p>0.05). Glycated haemoglobin,serum fasting C-peptide and serum vitamin D wassignificantly different between the control group and the treatment groups (p<0.05). Between the treatment groups, group B had better markers than group A (p<0.05). CONCLUSIONS: Serum vitamin D deficiency may play a role in the pathogenesis and insulin sensitivity in cases of type 1 diabetes.

Physical Activity Limitations In Children With Severe Haemophilia A. Does Emicizumab Make A Difference?

Objectives: To assess the effect of emicizumab on physical activity in children with severe haemophilia A. METHODS: The prospective cohortstudy was conducted from October 2021 to April 2022 at the Paediatric Department of Kafrelsheikh University Hospital, Egypt, in collaboration with the Haematology out-patient clinic of the Paediatric Department, Zagazig University, Egypt, and the Paediatric Department of Cairo University Hospital, Egypt, and comprised children aged 4-18 years with severe haemophilia A who received emicizumab prophylaxis. Paediatric Haemophilia Activities List was used to assess physical activity at baseline and aftersix months of regular emicizumab prophylaxis. Data was analysed using SPSS 26. RESULTS: There were 29 children, all (100%) boys, with mean age 8.7±3.51 years(range 4-15 years. Of them, 17(58.62%) patients were negative for inhibitors. Median Paediatric Haemophilia Activities Listsum score was 59.54 (interquartile range: 50.15-62.05) at baseline which moved up to 84 (interquartile range: 79.05-86.35) post-intervention (p<0.001). CONCLUSIONS: Emicizumab prophylaxis improved the level of physical activity in children with severe haemophilia A.

Efficacy of Citicoline as a Neuroprotector in children with post cardiac arrest: a randomized controlled clinical trial.

Brain hypoxia after cardiac arrest leads to damage of the neuronal cell membrane. Citicoline is necessary for the synthesis of cell membrane. We planned to assess the neuroprotective effect of citicoline in children after cardiac arrest. This randomized controlled trial was carried out at pediatric intensive care units (PICU) and surgical ICU at Tanta university hospital on 80 consecutive children surviving in-hospital cardiac arrest who were subdivided into two groups. Group I (citicoline group) included 40 children with post-cardiac arrest who received citicoline 10 mg /kg /12 h IV for 6 weeks plus other supportive measures and group II (control group) included 40 children with post-cardiac arrest who were managed with only supportive measures. All patients were evaluated for Glasgow coma score (GCS), modified Rankin scale (mRS) for children, seizures frequency, type and duration, and serum neuron-specific enolase (NSE) before and 3 months after the treatment. GCS and mRS significantly improved in citicholine group compared to the control group. Seizure frequency and duration, mortality, PICU and hospital stay significantly decreased in citicholine group compared to the control group. Serum NSE levels significantly decreased in citicholine group only. No side effects were recorded.Conclusion: Citicoline is a promising neuroprotective drug in children with post-cardiac arrest.Trial Registration: The study was registered at Pan African Clinical Trials Registry (PACTR) www.pactr.samrc.ac.za with trial number PACTR201907742119058. What is known? • Post-resuscitation brain injury is one of the major complications that can lead to death or disability. • CDP-choline has been studied for acute ischemic stroke in several adult studies because of its reparative effect. What is new? • Our study was the first in pediatrics that assessed the neuroprotective effect of CDP-choline on the brain in children after cardiac arrest. • We found that Citicoline is a promising neuroprotective drug in children with post-cardiac arrest.

Bumetanide, a Diuretic That Can Help Children with Autism Spectrum Disorder.

BACKGROUND: Autism Spectrum Disorder (ASD) is a common child neurodevelopmental disorder, whose pathogenesis is not completely understood. Until now, there is no proven treatment for the core symptoms of ASD. However, some evidence indicates a crucial link between this disorder and GABAergic signals which are altered in ASD. Bumetanide is a diuretic that reduces chloride, shifts gamma-amino-butyric acid (GABA) from excitation to inhibition, and may play a significant role in the treatment of ASD. OBJECTIVE: The objective of this study is to assess the safety and efficacy of bumetanide as a treatment for ASD. METHODS: Eighty children, aged 3-12 years, with ASD diagnosed by Childhood Autism Rating Scale (CARS), ⩾ 30 were included in this double-blind, randomized, and controlled study. Group 1 received Bumetanide, Group 2 received a placebo for 6 months. Follow-up by CARS rating scale was performed before and after 1, 3, and 6 months of treatment. RESULTS: The use of bumetanide in group 1 improved the core symptoms of ASD in a shorter time with minimal and tolerable adverse effects. There was a statistically significant decrease in CARS and most of its fifteen items in group 1 versus group 2 after 6 months of treatment (p-value <0.001). CONCLUSION: Bumetanide has an important role in the treatment of core symptoms of ASD.

Docosahexaenoic Acid Plus Piracetam Versus Piracetam Alone for Treatment of Breath-Holding Spells in Children: A Randomized Clinical Trial.

BACKGROUND: Piracetam is the most widely used drug in breath-holding spells (BHS); however, its efficacy might not be satisfying to parents. This study aimed to compare the efficacy of docosahexaenoic acid (DHA) plus piracetam with piracetam alone in reducing the frequency and severity of BHS in infants and preschool children. METHODS: This randomized clinical trial included two groups diagnosed with BHS. Group I included 50 patients who received DHA plus piracetam. Group II (control group) included 50 children who were managed with piracetam plus a placebo. Children were re-evaluated at one, three, and six months after treatment. Occurrences of BHS and drug side effects were recorded. The primary outcome was to evaluate the effect of the combined treatment of piracetam and DHA on the frequency and severity of spells. RESULTS: BHS were reported in only 16% of children six months after treatment with piracetam and DHA compared with 50% of those treated with piracetam only (P value = 0.001). CONCLUSION: DHA plus piracetam is more effective than piracetam alone in decreasing the frequency and severity of BHS in children.

Citicoline in hypoxic ischemic encephalopathy in neonates: a randomized controlled trial.

BACKGROUND: Hypoxic-ischemic encephalopathy (HIE) is one of the major complications that can lead to death or disability in neonates. We assessed the effect of citicoline as a neuroprotector in neonates with moderate and severe HIE. METHODS: This clinical trial was carried on 80 neonates with moderate to severe HIE who were not candidates for therapeutic cooling. They were subdivided randomly into two groups; citicoline treatment group which included 40 neonates who received citicoline 10 mg / kg /12 h IV for 4 weeks plus other supportive measures and the control group which included 40 neonates who were managed with placebo and the same supportive measures. All patients were evaluated for duration of mechanical ventilation (MV), need for inotropes, seizures (type, frequency, and duration), and duration of NICU. Cranial ultrasounds and brain magnetic resonance image (MRI) were performed for all included neonates after 4 weeks of treatment. Follow- ups of all neonates for the neurodevelopmental outcomes were done at 3, 6, 9, and 12 months. RESULTS: There was a significant reduction in the number of neonates having seizures after discharge in the citicoline-treated group (2 neonates) compared to the control group (11 neonates). Cranial ultrasound and MRI findings at 4 weeks were significantly better in the treatment group compared to the control group. Moreover, neurodevelopmental outcome showed significant improvement at 9 and 12 months in the citicoline treated neonates compared to the control group. There was statistically significant reduction in the duration of seizures, NICU stay, inotrope use, and MV in the treatment group compared to the control group. Citicoline was well tolerated with no remarkable side effects. CONCLUSION: Citicoline could be a promising neuroprotector drug in neonates with HIE. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (NCT03949049). Registered at 14 May 2019, https://clinicaltrials.gov/ct2/show/NCT03949049.

YKL-40 in serum: a promising biomarker of juvenile SLE and strongly correlated with disease duration.

BACKGROUND: The biological function of YKL-40 is not well determined in different inflammatory and autoimmune diseases; however, some data highlighted its possible connection with disease activity. AIM: We investigated the diagnostic utility of serum YKL-40 in patients with SLE and examined its correlation with disease activity. Additionally, we examined any differences in serum YKL-40 levels between juvenile and adult SLE patients. METHODS: We included 78 female patients with SLE and 42 controls. The level of YKL-40 in serum was measured by ELISA. RESULTS: The serum YKL-40 level in SLE patients was significantly higher compared to the control group (9 (3) ng/mL vs. 5.5 (0.1) ng/mL; p < 0.001). YKL-40 showed excellent diagnostic utility with an AUC of 1 (p < 0.001) and a cutoff point of 5.6, providing sensitivity and specificity of 100%. YKL-40 was higher in adolescents and those with a positive family history of SLE (p = 0.01 for both) and positively correlated with disease duration (r = 0.45, p < 0.001). YKL-40 level was significantly higher in patients with photosensitivity, fever, vasculitis, blood disorders, positive anti-dsDNA, and APL ab (p < 0.05 for all). Conversely, patients with skin manifestations had a significantly lower YKL-40 (p = 0.004). In juvenile SLE, the AUC was 0.65 and a p-value of 0.01, and at a cutoff value of (8.7) ng/mL, the sensitivity and specificity were 72% and 60%, respectively. CONCLUSION: YKL-40 in serum could be a promising biomarker in patients with SLE, especially in adolescent-onset cases. It is independently influenced by disease duration, anemia, thrombocytopenia, positive anti-dsDNA, and APL ab features.

Parasitic infections as potential risk factors for attention deficit hyperactivity disorder (ADHD) in children.

Attention deficit hyperactivity disorder (ADHD) represents a mysterious neuropsychiatric alarming concern due to indefinite etiopathogenesis among children. Notably, the studies which investigated the correlation between ADHD and parasitic infections are insufficient. Therefore, this research aimed to assess the correlation between ADHD and some tissue dwelling and intestinal parasitic infections in children. The study was conducted on 200 children, including 100 children suffering from ADHD (Group I) and 100 healthy children as a control group (Group II). All caregivers fulfilled predesigned sociodemographic form and Conners parent rating scale (CPRS-48) questionnaire. Blood samples were collected to determine hemoglobin level as well as relative eosinophilic count. The presence of anti-Toxoplasma IgG and anti-Toxocara IgG in serum by Enzyme-Linked Immunosorbent Assay (ELISA) was further investigated. Also, micronutrients as zinc, iron, and copper levels were measured. Schistosoma antigen was investigated in urine samples. Stool samples were subjected to direct wet smear, concentration technique and modified Ziehl-Neelsen (MZN) staining for coccidian parasites detection. Cryptosporidium parvum, Giardia lamblia and Entamoeba histolytica antigens were investigated in stool samples. Group I expressed more liability to sociodemographic risk factors, decreased levels of Hb, iron, zinc, and copper with statistically significant difference (P < 0.001). Comparison between Group I and Group II regarding the detected parasitic infections exhibited statistically significant difference except Schistosoma antigen positivity which expressed no statistical significance. The present study concluded that the parasitic infections with their consequences are potential risk factors in children with ADHD indicating that their early diagnosis and treatment may help in ADHD prevention.

Coenzyme Q10 in the Treatment of Attention Deficit Hyperactivity Disorder in Children: A Randomized Controlled Trial.

BACKGROUND: Attention Deficit Hyperactivity Disorder is a common child neurobehavioral disorder whose pathogenesis is not completely understood. However, some evidence indicates a crucial link between this disorder and the degree of oxidative stress. Coenzyme Q10 (ubiquinol) is an antioxidant that may play a significant role in the treatment of Attention Deficit Hyperactivity Disorder. OBJECTIVE: To assess the safety and efficacy of coenzyme Q10 as an add-on drug treatment for attention deficit hyperactivity disorder. METHODS: Sixty children, aged 6-16 years, with attention deficit hyperactivity disorder, non-responders to atomoxetine treatment for 6 months, were included in this double-blind, randomized, and controlled study. Group 1 received atomoxetine plus coenzyme Q10, and group 2 received atomoxetine plus placebo for 6 months. Follow-up by CONNERS parent rating scale questionnaire (CPRS-48) was performed before and after 1, 3, and 6 months of treatment, and any drug-related side effects were reported. RESULTS: The addition of coenzyme Q10 to atomoxetine in group 1 improved symptoms in a shorter time with minimal adverse effects. Group 1 showed improvement of about 33.87% in CPRS-48 total score versus 18.24% in group 2. There was a statistically significant decrease in CPRS-48 total score and its three subscales (learning problems, impulsive hyperactive subscale, and 10-items hyperactivity index) in group 1 versus group 2 after six months of treatment (p-value <0.001). CONCLUSION: Coenzyme Q10 has an important role as an add-on drug treatment for attention deficit hyperactivity disorder by improving symptoms, particularly hyperactivity, and in minimizing atomoxetine adverse effects.

Adherence to the Mediterranean Diet Improved Clinical Scores and Inflammatory Markers in Children with Active Inflammatory Bowel Disease: A Randomized Trial.

Objective: The Mediterranean diet (MD) is a well-known style of diet that is full of antioxidants and may have anti-inflammatory effects. We evaluated the safety, tolerability, and effects of adherence to MD on disease activity and inflammatory markers in children and adolescents with active inflammatory bowel disease (IBD). Methods: This prospective, randomized study included 100 IBD patients aged twelve to eighteen years with mild to moderate disease activity (PCDAI score 10-45 or PUCAI 10-64). The included patients were divided into two groups of 50 patients each. Group I (26 patients with active CD and 24 patients with active UC) received MD with good adherence over 12 weeks with a KIDMED 8-point score, and group II (28 patients with active CD and 22 patients with active UC) received their usual diet with a KIDMED score ≤7 points. Patients in both groups received treatment similar for IBD activity. Results: Clinical remission was achieved in most of the patients after 12 weeks of treatment. Patients in the first group (adhering to an MD) showed a significant decrease in both clinical scores (PCDAI and PUCAI) and most inflammatory markers (CRP, calprotectin, TNF-α, IL17., IL 12 and IL13) compared to patients in their normal group, with earlier improvement in both PCDAI and CRP. Conclusion: Adherence to the MD improves clinical scores and inflammatory markers in children and adolescents with mild-moderate active IBD.

Obesity phenotype in relation to gene polymorphism among samples of Egyptian children and their mothers.

Obesity is complex heterogeneous disease controlled by genes, environmental factors, and their interaction. Genetic factors account for 40-90% of the body mass index variations. Body mass index (BMI) of children correlates more closely with maternal than paternal BMI. So, this studu was aimed to investigate the role of leptin receptor LEPR Gln223Arg, the uncoupling protein 2 (UCP2 G 866 A) and insulin receptor gene (INSR exon 17) polymorphisms in the pathogenesis of obesity. A cross-sectional study executed on 130 children and their obese mothers; classified into 2 groups according to their BMI. The 2 groups were evaluated regarding the anthropometry. Restriction fragment length analysis for LEPR Gln223Arg, UCP2 -866 G/A and INSR exon 17 polymorphisms were applied. It was reported that increased risk of obesity was found in LEPR AG + AA genotype and the A allele. Significant statistical difference was detected only in female children. Concerning UCP2, the AG followed by the GG genotype was the most frequent in all groups and the G allele was the mostly present in obese mothers and obese male children but with no statistical significance. There was difference in the INSR genotype and alleles between groups, but this difference was not statistically significant. This study concluded that the LEPR Gln223Arg, UCP2 G 866 A and INSR exon 17 polymorphisms are related to obesity in Egyptian population. Further researches on larger population are recommended to ascertain the implications of LEPR, UCP2 and INSR polymorphisms in obesity.