Urinary tissue inhibitor of metalloproteinase-2 as an early predictor for acute kidney injury in critically ill children

Objectives

Acute kidney injury (AKI) is one of the most devastating complications of critical illness in children. Serum creatinine (Scr) is considered the gold standard for AKI diagnosis yet noted to be late and inaccurate. This raises the need for an early and accurate biochemical parameter for the early detection of AKI. This research aimed to explore the role of urinary tissue inhibitor metalloproteinase 2 (TIMP-2) in the early prediction of AKI, compared to standard biomarkers, in critically ill children admitted to pediatric intensive care unit (PICU). Urine TIMP2 was previously explored in multiple adult studies and showed promising results; however, the study of its role in pediatric population was limited.

Methods

This study was a prospective cohort study including 42 critically ill children who are at increased risk of AKI. Cases were recruited from the PICU in the Children's Hospital of Ain-Shams University, Cairo - Egypt over 10 months' duration. Urine samples were collected to measure urinary TIMP-2 and blood samples were taken to measure the levels of Scr, creatinine clearance, and blood urea nitrogen. Urine output in 24 h was also calculated.

Results

Urinary TIMP-2 showed considerably higher levels in AKI compared to non-AKI patients as early as day 1, whereas increased levels of Scr and decreased urine output were noticed later (day 3 and day 5, respectively). A notable correlation existed between TIMP-2 at day 1 and creatinine at day 3.

Conclusion

The present study revealed that urinary TIMP-2 could have an important role in the early prediction of AKI before the increase in Scr and more deterioration in kidney functions.

Prevalence of viral pathogens in a sample of hospitalized Egyptian children with acute lower respiratory tract infections: a two-year prospective study

BACKGROUND

Viral pneumonias are a major cause of childhood mortality. Proper management needs early and accurate diagnosis. This study objective is to investigate the viral etiologies of pneumonia in children.

RESULTS

This prospective study enrolled 158 and 101 patients in the first and second year, respectively, and their mean age was 4.72 ± 2.89. Nasopharyngeal swabs were collected and subjected to virus diagnosis by reverse transcription polymerase chain reaction (RT-PCR). Viral etiologies of pneumonia were evidenced in 59.5% of the samples in the first year, all of them were affirmative for influenza A, 2 samples were affirmative for Human coronavirus NL63, and one for Human coronavirus HKU1. In the second year, 87% of patients had a viral illness. The most prevalent agents are human metapneumovirus which was detected in 44 patients (43.6%) followed by human rhinovirus in 35 patients (34.7%) and then parainfluenza-3 viruses in 33 patients (32.7%), while 14 patients had a confirmed diagnosis for both Pan coronavirus and Flu-B virus.

CONCLUSIONS

Viral infection is prevalent in the childhood period; however, the real magnitude of viral pneumonia in children is underestimated. The reverse transcriptase polymerase chain reaction has to be a vital tool for epidemiological research and is able to clear the gaps in-between clinical pictures and final diagnoses.

Impact of Coronavirus Disease-19 Lockdown on Egyptian Children and Adolescents: Dietary Pattern Changes Health Risk

BACKGROUND: Lockdown and school closure related to the coronavirus disease 2019 (COVID-19) have unfavorable effects on children and adolescents. AIM: This study was conducted to survey the changes in dietary pattern and related health factors in Egyptian children and adolescents during the COVID-19 outbreak closure. MATERIALS AND METHODS: Data were collected through a dietary pattern, eating behavior, and physical activity electronic questionnaire conducted through social media sites, targeting parents of children and adolescents after two whole months of lockdown and school closure in Egypt. RESULTS: This study included 765 participants, 31.8% noted increased appetite, 45.6% reported increased sweets and unhealthy food consumption, and 37.6% showed increased frequent snacking between meals. Alongside 53.1% showed increase in late snacks during night after COVID-19 closure. The majority of our participants 82.0% noted associative change in eating behavior with boring and 94.6% revealed increased usage of electronics and screen time. This study showed significant positive correlation between increased appetite and mobile screen time, laptop screen time, and video gaming. Increased sweets and unhealthy food consumption was positively correlated with TV watching and mobile screen time. A significant positive correlation was revealed between uncaring about eating fruits and vegetables and increase screen time for each of mobile, and laptop and remote learning. Furthermore, there was positive correlation between decreased protein serving intake and each of mobile screen time and remote learning. TV watching and laptop screen times showed positively significantly association with frequent snacking between meals. Mobile screen time, TV screen time, and video gaming were positively significantly correlated with late night snacking. CONCLUSIONS: The present study concluded prolonged lockdown leads to changes in eating patterns, related to contributing factors of physical inactivity and prolonged screen time.

Respiratory Viruses and Atypical Bacteria Co-Infection in Children with Acute Respiratory Infection

BACKGROUND

Acute respiratory infections (ARI) are one of the prevalent pediatric diseases. Coinfections of respiratory viruses and atypical bacterial respiratory pathogens are common.

AIM

This study aimed to determine the prevalence of co-infection between respiratory pathogens including viruses, bacteria and atypical bacteria in a sample of Egyptian children presenting with symptoms of acute respiratory tract infection.

METHODS

This one-year prospective cohort study conducted in Abo El Rish Pediatric Hospital, Cairo University over one year included children presenting with symptoms of acute respiratory infection. Enrolled children were subjected to nasopharyngeal swabs or throat swabs and then processed to detect viral, bacterial and atypical bacterial causative agents by culture), retrotranscription polymerase, Monoplex polymerase chain reaction (PCR) and Multiplex PCR.

RESULTS

Viral etiological agents were detected in 20 cases (20.8%), while 76 patients (79.2%) had no definite viral aetiology. The most abundant virus detected was Rhinovirus in 36 (27.3%), followed by 21 (15.9%) were positive for RSV, 12 (9.1%) were positive for HMPV, 6 (4.5%) were positive for adenovirus and 3 (2.3%) were positive for influenza B. For Atypical bacterial causes Mycoplasma were positive for 9 (6.8%) cases and one case was positive for Bordetella parapertussis. Viral and atypical bacteria Co infection were detected in 14 (10.6%) of cases.

CONCLUSION

These results suggest that coinfection with bacteria or atypical bacteria in children with acute respiratory tract infection is common and this co-infection can induce serious illness. The multiplex reverse-transcriptase polymerase chain reaction should become an essential tool for epidemiological studies and can fill the gap between clinical presentation and definitive diagnosis.

Serum Zinc Level and Its Correlation with Vesikari System Scoring in Acute Pediatric Diarrhea

BACKGROUND

Diarrhea remains the most common infectious disease worldwide. Zinc has been studied extensively recently for its potential effect on prevention, control and treatment of acute diarrhoea.

AIM

This study was designed to correlate the level of zinc with the severity of pediatric diarrhoea estimated by Vesikari Scoring System.

PATIENTS AND METHODS

The present study included 80 children aged two months to 30 months from those suffering from the acute diarrheal episode and admitted to Pediatric Hospital "Abo El Rish" Cairo University. Serum Zinc level was assessed by a colorimetric method with a spectrophotometer.

RESULTS

Zinc deficiency was detected in 45 (56.2%) patient of the studied group Significant negative correlations were found between serum zinc level and severity of dehydration and duration of hospitalization (p < 0.05).

CONCLUSION

Zinc level has an essential role in acute pediatric diarrhoea. Zinc therapy should be considered beside Oral rehydration salts (ORS) to achieve maximum impact on diarrheal diseases; clinical trials are recommended to support the zinc supplementation in developing countries.

Ketamine Sedation in Gastrointestinal Endoscopy in Children

BACKGROUND

Moderate sedation for gastrointestinal endoscopy has traditionally been provided by the endoscopist. Controversy has ensued over safe and efficient sedation practice as endoscopy has increased in numbers and complexity.

AIM

To evaluate the safety of ketamine sedation given by non-anesthesiologist during gastrointestinal endoscopy in children.

METHODS

A prospective study of 100 paediatric patients with gastrointestinal symptoms who were a candidate for upper or lower gastrointestinal endoscopy in paediatric endoscopy unit at Abo El-Reesh Paediatric Hospital, Cairo University. All children were > 2 years old and weighed > 6 kg. The analysis was performed in terms of sedation-related complications.

RESULTS

A total 100 paediatric patients including 53 males and 47 females with mean age of 5.04 years were involved in the study. All children were medicated with ketamine with a mean dose of 3.77mg/kg. No complications occurred in 87% of cases. Desaturation occurred in 13% of the cases and was reversible by supplemental nasal oxygen. Desaturation was more frequent during Upper GI Endoscopy and with the intramuscular route (p value=0.049). No apnea, bradycardia, arrest or emergence reactions were recorded.

CONCLUSION

Ketamine sedation found to be safe for paediatric gastrointestinal endoscopy in Egyptian children without co-morbidities. Transient Hypoxia (13%) may occur but easily reversed by nasal oxygen therapy.

Glutathione Transferase as a Potential Marker for Gut Epithelial Injury versus the Protective Role of Breast Milk sIgA in Infants with Rota Virus Gastroenteritis

BACKGROUND:

Secretory immunoglobulin A (SIgA) plays an important protective role in the recognition and clearance of enteric pathogens.

AIM:

This study was designed to assess if mucosal integrity “measured by secretory IgA (SIgA)” is a protective factor from more epithelial alteration “measured by glutathione transferase” in infants with Rota gastroenteritis and its relation to infants’ feeding pattern.

PATIENTS AND METHODS:

This study was conducted on 79 infants aged 6 months and less from those diagnosed as having gastroenteritis and admitted to Gastroenteritis Department in Abo El Rish Pediatric Hospital, Cairo University. Plasma glutathione s-transferases and Stool SIgA were measured using ELISA technique. Rota virus detection was done by Reverse transcriptase PCR.

RESULTS:

SIgA was found to be significantly positive in exclusive breast fed infants, Glutathione transferase was significantly more frequently positive in Rota positive cases than Rota negative cases by Reverse transcriptase PCR. A significant negative correlation between Glutathione transferase and Secretory IgA was found, (p < 0.05).

CONCLUSION:

Breast feeding should be encouraged and highly recommended in the first two years of life as it provides Secretory IgA to breast fed infants who in turn protect them against epithelial damage caused by Rota viral gastroenteritis.