The global concern of increasing number of children presenting with multisystem inflammatory syndrome in children (MIS-C) related to the coronavirus disease (COVID-19) has escalated the need for a case-oriented clinical approach that provides timely diagnosis and management. The aim of this study is to share our experience in managing 64 MIS-C patients of North African ethnicity guided by a risk-based algorithm. Sixty-four patients met the inclusion criteria, 19 (30%) patients were categorized as mild and moderate risk groups and cared for in an isolation ward and 45 patients who belonged to the high-risk group (70%) were admitted to the pediatric intensive care unit (PICU). Positive laboratory evidence of COVID-19 was found in 62 patients. Fever and dysfunction in 2 or more organs were confirmed in all cases (100%). Fifty patients (78%) presented with gastrointestinal symptoms, meanwhile only 10 patients (16%) had respiratory manifestations. Cardiac involvement was reported in 55 (86%) cases; hypotension and shock were found in 45 patients (70%) therein circulatory support and mechanical ventilations were needed for 45 and 13 patients respectively. Intravenous immunoglobulins (IVIG) were used for all cases and methylprednisolone was used in 60 patients (94%). Fifty-eight (91%) patients were discharged home after an average of 9 days of hospitalization. The mortality rate was 9% (6 patients). Conclusion. A single Egyptian center experience in the management of MIS-C patients guided by a proposed bed side algorithm is described. The algorithm proved to be a helpful tool for first-line responders, and helped initiate early treatment with IVIG.

Variable therapy of asthma is not sufficient yet to achieve good asthma control. Therapy decision requires serial investigations. Low-level laser acupuncture is a suitable non-invasive modality of complementary medicine. The exhaled breath condensate (EBC) is easy and useful to evaluate the efficacy of drugs or novel therapy. This study aimed to evaluate the effectiveness of low-level laser biostimulation of acupuncture points on asthma improvement in children. Forty-eight asthmatic children were subdivided into case (laser) group, which received 12 direct contact low-power laser acupuncture sessions (three sessions/week) on specific traditional Chinese acupuncture points for bronchial asthma, and control asthmatic group, which received sham laser acupuncture on the same acupoints and number of sessions of the case (laser) group. Low-power Multichannel Aculas-AM laser (grade II) of wave length 780 nm, output power 800 mw, and beam spot size 0.1 cm with continuous mode was used. Eighteen acupoints were stimulated for 2 min, giving energy of 9.6 J/cm/acupoint. The total session time was 3 min. Both groups were evaluated pre- and post-laser acupuncture intervention by recording levels of asthma control, pulmonary function, and EBC nitric oxide. In the case (laser) group, 91.7 % of patients experienced an improvement in the level of asthma control versus 25 % in the control group (p < 0.001). This was associated with a significant decrease of the breath condensate FENO concentration (p < 0.001) and significant increase of spirometry parameters (p < 0.001) in the case (laser) group. Application of laser acupuncture treatment given with conventional therapy can effectively improve bronchial asthma more than prescription of medications alone could.

low-intensity laser acupuncture can be safe and effective treatment in asthmatic children.

Traditional medicine may not control bronchial asthma. Many patients have uncontrolled symptoms and the underlying ongoing inflammation is persistent. Objective: to assess efficacy of laser acupuncture in improving asthma symptoms and underlying oxidative stress through monitoring exhaled 8-isoprostane. Method: 48 asthmatic (case group) received successive low level laser acupuncture sessions to stimulate acupoints for chronic asthma and 24 asthmatics received deactivated laser acupuncture sessions (control group). Asthma symptoms, asthma control questionnaire, concentration of 8-Isoprostane in exhaled breath condensate and airway resistance were assessed before and after laser acupuncture therapy. Results: After the completion of the course of laser acupuncture therapy, we observed significant improvement of asthma symptoms. Asthma control questionnaire improved from 9.7 ± 3.3 to 21.8 ± 3.6 (p 0.001). EBC 8-Isoprostane dropped from 14.7 ± 5.4 to 8.1 ± 5.0 (p 0.001). The airway resistance at R5 and R20 significantly decreased from 116.6 ± 25.8 & 124.5 ± 31.2 to 101.5 ± 25.6 &110.9 ± 29.9 respectively (p 0.001). Control patients who received sham acupuncture therapy did not show such improvement. Conclusion: Laser acupuncture is an effective modality in treating bronchial asthma as evidenced by improved symptoms, airway resistance, and oxidative biomarkers.

Abbreviations: FEV1, expiratory volume in the 1st second; FVC, forced vital capacity; MMEF, forced expiratory volume in the 1st second/ forced vital capacity ratio, maximum mid-expiratory flow75/25; PEF, peakexpiratory flow. AbstractIntroduction: Recurrent hypoxia makes asthmatics at risk for pulmonary hypertension and ventricular dysfunction. Early stages of these cardiovascular diseases cannot be detected by conventional echocardiography. Tissue Doppler imaging has been introduced recently as a more sensitive and more accurate tool for investigating cardiovascular diseases. Objective: Investigating ventricular functions in asymptomatic asthmatic children using tissue Doppler echocardiography. Method: Fifty asthmatic children and 50 controls were examined by conventional echocrdiography. Tissue Doppler echocardiography was performed to measure the myocardial performance (Tei) index at the lateral mitral, septal and tricuspid annuli. Results: Septal Tei indices among patients and uncontrolled asthmatics were significantly higher than healthy subjects and controlled asthmatics, respectively (P < 0.05).Septal and tricuspid Tei indices were significantly higher among severe asthmatics and patients with concomitant nasal allergy than those with mild asthma and those without concomitant nasal allergy, respectively (P < 0.05). Septal Tei index correlated negatively with daily inhaled corticosteroid dose (r = -0.412, P = 0.003) and forced expiratory volume in the 1st second/forced vital capacity (r = -0.877, P < 0.001). Lateral Tei index correlated positively with the patient age (r = 0.312, P = 0.027) and duration of asthma (r = 0.359, P = 0.011). Conclusion: Tei index can detect subclinical ventricular dysfunction in asthmatics and is affected by asthma duration, control and severity. It can be used for future scoring of asthma severity. Septal annulus seems to be the best location for assessing Tei index in asthmatics. K E Y W O R D S asthma, cardiology, chest, echocardiology, pediatric, spirometry, Tei index | 2677 ELSEIFY ET AL. How to cite this article: Elseify MY, Alsharkawy AA, Al-Fahham MM, ElHady MM. Assessment of lateral mitral, septal and tricuspid myocardial performance indices by tissue Doppler imaging in asthmatic children. Clin Respir J.