No abstract

Nephrotic syndrome (NS) is the most common primary glomerular disease among children. It runs a relapsing course involving prolonged periods of treatment with corticosteroids and other immunosuppressive medications. Soluble urokinase plasminogen activator receptor (suPAR) has been regarded as an inflammatory as well as a permeability factor. The aim of our study was to evaluate serum suPAR levels in children with NS and its relation to steroid responsiveness. Our study was carried out on 75 children who were already diagnosed as having NS; they were classified into three groups (steroid sensitive, steroid dependent, and steroid resistant). Furthermore, 40 apparently healthy children, age and sex matched with the NS patients, were enrolled as controls. All children had undergone assessment of serum suPAR, renal function tests (urea and creatinine), serum albumin, C-reactive protein, and 24-h protein in urine. The study found that suPAR level was significantly different between the studied groups (P <0.05), being highest in steroid-resistant NS (66.52 ± 9.7 ng/mL), followed by steroid dependent (56.82 ± 11.09 ng/mL), and steroid-sensitive patients (26.22 ± 3.86 ng/mL), and lowest in the control group (20.29 ± 0.69 ng/mL). When receiver operating characteristics curves were plotted, suPAR had high sensitivities and specificities in predicting steroid responsiveness, [area under the curve (AUC) = 0.99, 95% confidence interval (CI) = 0.911-1.000, P <0.001], steroid dependence (AUC = 1.00, 95% CI = 0.929-1.000, P <0.001), and predicting steroid resistance. Our study indicates that suPAR is significantly higher in children with primary NS and varies according to their response to steroid therapy. It may act as a marker for steroid responsiveness in these children.

Background: Epilepsy, the most common neurological disorder in children, may present with many psychiatric comorbidities, the most common of which is depression. Aim of the Work: We evaluated the frequency of depressive symptoms in epileptic children, with regard to the possible association between depression and their demographic data or seizure-related variables. Patients and Methods: This cohort study was conducted on 80 children (6-13 years old) diagnosed as idiopathic epilepsy and were regularly recruiting the pediatric neurology clinic at Minya University Children Hospital. The Structured Birleson Depression Scale Questionnaire was used for assessment of presence of depressive symptoms, and Quality Of Life in Epilepsy (QOLIE-31) score was used to assess quality of life in those patients. Results: Depressive symptoms were found in 37.5% of enrolled patients. There were statistically significant differences between the patients with depressive symptoms and the other group regarding age (p=0.001), residence (p=0.006) and past history of mood disorders (p=0.03). Sleep disturbance was the highest predictor of depression in cases with depressive symptoms, detected in 90% of cases, followed by appetite disturbance in 86.6% of cases, while delusions and hallucinations were the lowest, detected in only 10% of cases. Both duration of epilepsy and frequency of seizures were significantly higher in cases with depressive symptoms than the other group (p=0.001) for both. QOLIE score was significantly lower in cases with depressive symptoms than the other group (p= 0.01 for all). Conclusion: Depressive symptoms are common in epileptic children, and it is often challenging and underestimated. It should be screened during the management of such children. Early diagnosis and more comprehensive package of care for depression in epileptic children will enable them to have a better quality of life.

Background: In children with the nephrotic syndrome, acquired deficiency of anticoagulant proteins due to loss in the urine has been proposed as one of the major thrombogenic alterations. Low levels of protein Z, which is a single chain vitamin K-dependant glycoprotein synthesized by the liver, were reported to be a risk factor for increased incidence of thrombosis. Another biologic antagonist of coagulation is antithrombin III which has a relatively low molecular weight and expected to be lost in urine in patients with nephritic syndrome. Objectives: Evaluation of both plasma protein Z levels, and antithrombin III activity as markers of thrombogenic disorders in children with minimal change nephrotic syndrome, and to elicit the relationship between their plasma levels in nephrotic children and different stages of the disease. Methods: This study was carried out on 30 children with minimal change nephrotic syndrome with no thromboembolic manifestations. They were classified into 2 groups; group (I) included 15 children in the acute stage of nephrotic syndrome, and group (II) included 15 children in the remission stage of nephrotic syndrome under treatment with corticosteroids only. Fifteen healthy age and sex matched children were chosen as a control group; group 111. Results: The mean plasma levels of both protein Z and of antithrombin III activity (%) in children with acute stage (group I) were significantly lower than those of children in remission (group II) and control group (group III) while there was no significant difference in these levels when group II was compared to group III. In group I, there was a significant positive correlation between protein Z and antithrombin III activity (%) (r-value = 0.83, p-value = 0.0001). Also, there were significant positive correlations between both parameters and total serum protein, serum albumin while there were significant negative correlations of both protein Z and antithrombin III to 24 hours protein in urine. Conclusion: Even though there were no clinically detectable thromboembolic complications in the studied children with nephrotic syndrome, the plasma levels of protein Z and antithrombin III activity (%) were significantly decreased in children in the acute stage of the nephrotic syndrome, while those in the remission stage, plasma levels of protein Z and antithrombin III returned to normal values. Thus, children in the acute stage of nephrotic syndrome are still susceptible to thromboembolic complications and need close observation.

Introduction: Ventilatory assistance allows for the recovery and maintenance of the patient with cardiorespiratory failure. Thanks to this intervention, many neonatal patient`s lives are saved in the neonatal intensive care units (NICUs). Objectives: This study is a prospective study to analyze the rate of failure and response of management of those patients on mechanical ventilation and relation between the response of cases on MV and different studied demographic, clinical and laboratory data. Patients and methods: All neonates with respiratory distress admitted from February 2018 to February 2019.Clinical response of mechanical ventilation cases was observed. Demographic and clinical data of neonates included in the study were collected and analyzed. Results: Among of 316 neonates, 162 cases (51.26%) treated with o2 only, 28 cases (8.86%) treated with bubble CPAP ,126 cases (39.87%) treated with mechanical ventilation. The cases on MV who survived were (23%) and cases who died were (77%). Low birth weight <2.5 kg: outcome is poor for VLBW and ELBW than NBW and LBW. Small gestational age < 34 weeks GA showed higher mortality .RDS were the most common cause for usage of MV. In MV settings with initial high Fio2 and PEEP were more in died group. Sepsis, shock and pulmonary hemorrhage were most common complications and both are associated with higher risk for mortality than other complications. Conclusion: It was found that predictors of mortality in mechanically ventilated neonates concluded from this study were: low birth weight <2.5 kg with poorer outcome for VLBW and ELBW than NBW and LBW also small gestational age with poor outcome for neonates below 34 weeks GA especially with lack of use of lung surfactant in cases with RDS in VLBW and ELBW.