B regulatory cells (Breg) refer to characteristic subsets of B cells that generally exert anti-inflammatory functions and maintain peripheral tolerance mainly through their ability to secrete interleukin-10 (IL10). Dysregulation in the function of Breg cells was reported in several autoimmune diseases. However, the relation between Breg and children with type 1 diabetes (T1D) is poorly understood. Thus, this study is aimed at determining whether Breg cells play a role in T1D in children or not, so we hypothesized that an altered phenotype of B cell subsets is associated with T1D in children. Children with T1D (n=29) and control children with normal blood glucose levels (n=14) were recruited. The percentages of different circulating IL10-producing Breg subsets, including B10, immature transitional, and plasmablasts were determined using flow cytometry analysis. Furthermore, the association between different IL10-producing B cells and patient parameters was investigated. The percentage of circulating IL10+CD24hiCD27+ (B10) and IL10+CD24hiCD38hi (immature transitional) subsets of Breg cells was significantly lower in T1D patients than in healthy controls. Moreover, these cells were also negatively correlated with fasting blood glucose and HbA1c levels. Breg cells did not correlate with autoantibody levels in the serum. These findings suggest that certain Breg subsets are numerically deficient in children with T1D. This alteration in frequency is associated with deficient islet function and glycemia. These findings suggest that Breg cells may be involved in the loss of auto-tolerance and consequent destruction of pancreatic cells and could, therefore, be a potential target for immunotherapy.

Purpose This prospective study aimed to identify the incidence of retinopathy of prematurity (ROP) in premature infants in a neonatal ICU in a tertiary care hospital and to evaluate the risk factors predisposing to it. Patients and methods All preterm babies admitted to the neonatal ICU, during the study period, with gestational age (GA) less than 37 weeks and low birth weight (LBW) of less than or equal to 2.00 kg, were included in this study. Examination and follow-up of patients were done by binocular indirect ophthalmoscopy using a 28 D lens with a speculum and scleral depressor to examine the retinal periphery after efficient pupillary dilatation. Results Of 216 screened neonates, 66 (30.6%) developed ROP. Of these, 27 (40.9%) had stage 1, 35 (53.0%) had stage 2, and four (6.1%) had stage 3 ROP. The incidence was high in the GA group less than 28 (86.7%) weeks and in LBW neonates (100.0%). ROP was associated with LBW (1280±435 g, P<0.001), GA (30.4±1.9 weeks, P=0.005), sepsis (P=0.006), anemia (P=0.007), blood transfusion (P=0.018), bronchopulmonary dysplasia (P=0.001), and O2 therapy (P=0.006) as well as its duration (P<0.0001) by multiple logistic regression analysis. Conclusion ROP incidence in our tertiary care hospital was 30.6%. The main risk factors for ROP development were low GA, LBW, anemia, blood transfusion, sepsis, bronchopulmonary dysplasia, and O2 therapy and its duration. Prevention of prematurity, control of infection, reduction of blood sampling to prevent occurrence of anemia with subsequent blood transfusion, and judicious use of O2 therapy may be promising factors that may decrease the incidence and severity of ROP.

Background: Congenital anomalies (CA) are common causes of infant's and childhood deaths and disability. Objectives: The aim of the study is to determine the frequency, describe the types and risk factors of congenital anomalies among newborns admitted to Neonatal Intensive Care Unit (NICU) of Assiut University Children's Hospital. Study design: It is a prospective observational study (analytic cross sectional study) was performed and screening of the newborns admitted at NICU of Assiut University Children's Hospital (for 6 months) during the period from 1 st December 2017 to 31 st May 2018. The sample included 346 newborns, 173 cases and 173 controls. We collected data using a record checklist and an interviewing questionnaire. Results: There were significant differences between cases and controls concerning gestational age (P=0.001), single or multiple babies (P=0.002), residence (P=0.001), consanguineous marriage (P=0.01) and family history of unfavorable outcome (P=0.001).We also found that the most common type of congenital anomalies was gastrointestinal anomalies 63 cases (36.4%) with tracheoesophageal fistula 17 cases (27%) being the most common GIT anomalies.Then the musculoskeletal anomalies being the second common anomalies 14.5% with diaphragmatic hernia 10 cases being the most common in musculoskeletal anomalies followed by other anomalies (22 multiple and 1Conjoined Twins) 23 cases (13.3%) followed by cardiovascular anomalies 22 cases (12.7%), followed by CNS anomalies 18 cases (10%). Conclusions: The frequency of congenital anomalies was 22.97%. The most common anomalies were gastrointestinal anomalies (GIT), musculoskeletal anomalies, multiple anomalies and cardiovascular system anomalies. The risk factors were consanguineous marriage, positive family history, urban areas, full-term and singleton pregnancies.

Background: Adequate nutrition is important for optimum growth and neurological outcome. Aim of work: To evaluate the effect of rapid versus slow enteral feeding advancements on the clinical outcomes of preterm infants. Patients and methods: This is a prospective-observational study over a period of six months. It included all preterm neonates with gestational age less than 37 weeks and haemodynamically stable from September, 2017 to March, 2018. Neonates (<37 weeks) were divided into two groups Group I with slow advancement and group II with rapid advancement. All included neonates in this study underwent the followings: Full history taking, examination and Investigations. Results: The study included 100 neonates were divided into two groups -50 cases slow group (I) and 50 cases rapid group (II). There was a statistically significant difference as regarding, duration of hospital stay with mean 19.37±10.36 and17.89±9.58 days in group I and II respectively, and time taken to reach full enteral feeding with mean 14.89±3.89 and 9.18±3.58 days between slow & rapid feeding groups respectively. The mortality was 18(36.0%) deaths in group I versus 7(14.0%) deaths in group II.Conclusions: Rapid advancement of enteral feeding is associated with shorter duration of hospital stay, shorter duration to achieve full enteral feeding, and decreased mortality in comparison to slow advancement group.

Background: Neonatal ventilator associated pneumonia (VAP) is a major hospital-acquired infection in acute care settings, associated with high mortality and poor outcome. Objectives: The purpose of this study is to evaluate the frequency of ventilator associated pneumonia, its causative organisms, its risk factors and outcomes at a tertiary care NICU. Methods: This is a prospective observational cohort study used Centers for Disease Control (CDC) guidelines for infant's ≤1 year old to diagnose neonatal VAP.All inborn and out-borne neonates who admitted to our NICU from April 2018 to March 2019 were screened for study enrollment and were considered eligible if ventilated for more than 48 hours. They were classified into: Group A: cases with suspected VAP and Group B: cases without VAP. Results: Thirty eight out of 140 patients admitted to NICU were VAP with frequency 27.2%. There were significant changes in the vital signs, respiratory manifestation, ventilator settings, radiologic progression and laboratory findings in VAP group. The risk factors were birth weight less than 1500g (P=0.002), prematurity (P< 0.05), duration of ventilation (26.0 ± 11.5 days, P<0.001) and duration of hospital stay (40.3±14.9). Microorganisms associated with bloodstream infection in the VAP-diagnosed group were Klebsiella spp., Staphylococcus aureus, Candida spp. and other Gram negative bacilli (26.3, 5.2, 31.5, and 15.7% respectively). Klebsiella spp. was the most commonly isolated pathogen in nonbronchoscopic bronchoalveolar lavage. In-hospital mortality rates in VAP and non-VAP groups were 65% and 25.5% respectively (P<0.001). Conclusions: The frequency of ventilator acquired pneumonia (VAP) in NICU was 27.2%. The most common risk factors of VAP were very low birth weights, prematurity, longer duration of ventilation and duration of hospital stay while Klebsiella spp. was the most common microorganism associated with bloodstream infection.