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To investigate the effectiveness of nebulized magnesium sulfate in treating persistent pulmonary hypertension of newborn (PPHN). Twenty-eight mechanically ventilated term neonates with severe PPHN were randomized into two groups: NebMag group (n = 14), who receiving nebulized isotonic magnesium (1024 mg/h), and IVMag group (n = 14), who received intravenous magnesium (200 mg/kg over 30 min, followed by 50 mg/kg/h). The study time frame was 24 h. Outcome measures were the changes in oxygenation index (OI), mean arterial blood pressure (MABP), vasoactive inotropic score (VIS), and serum magnesium level. Baseline demographic, ventilatory, and hemodynamic characteristics were comparable between the two groups. At the end of the study, the OI decreased by 44.3% in the NebMag group compared with 35.3% in the IVMag group (mean difference −3.14; 95%CI −5.08, −1.19; p 0.003). The NebMag group had a higher MABP (mean difference 2.29 mmHg; 95% CI 1.80, 2.77; p 0.000) and lower VIS (mean difference −14.64; 95% CI −16.52, −12.77; p 0.000) at the 24-h study time point. The increase in serum magnesium level, measured at 12-h study time point, was lower in the NebMag group (mean difference −2.26 mmol/L; 95% CI −2.58, −1.96; p 0.000). Nebulized magnesium sulfate may be an effective therapeutic modality for neonates with severe PPHN on mechanical ventilation, but this should be confirmed by larger studies. Retrospectively registered at www.clinicaltrials.gov (identifier: NCT04328636).

Background. Nephrotic syndrome is a common kidney disease among children which is characterized by proteinuria, hypercholesterolemia, hypoproteinemia, and edema. The urinary losses of proteins including albumin and thyroid-binding globulin might affect the thyroid hormone levels in those children. Objective. To assess the thyroid function in children with nephrotic syndrome during the nephrotic attack and after remission.Methods. This was a prospective study conducted at the Pediatrics department, Sohag University Hospital, Sohag, Egypt over a one-year period (from January to December 2017). Data were collected from 51 children with nephrotic syndrome aged between 1 and 12 years old. The study participants were subjected to investigations including thyroid-stimulating hormone (TSH), thyroxin (T4), triiodothyronine (T3), serum urea, creatinine, cholesterol, triglycerides, albumin, total proteins, urinary albumin-to-creatinine ratio and 24 hours urinary proteins during the nephrotic attack and after remission.Results. The mean age for the study participants was 6.1 ± 2.9 years. Thirty-one participants were males (60.8%). The study found that serum TSH levels were elevated while serum Total T3 and Total T4 were reduced during the nephrotic attack. As regards the thyroid hormone status, we found true hypothyroidism in 12 patients (23.52%) and subclinical hypothyroidism in 24 patients (47.06%) during the nephrotic attack. However, only one patient (1.96%) had true hypothyroidism and 14 patients (27.45%) had subclinical hypothyroidism after remission. Conclusion. A large proportion of children with nephrotic syndrome had thyroid dysfunction in the form of either true (overt) or subclinical hypothyroidism. Therefore, monitoring the thyroid function in those children is important.

Background: To estimate the various indications, values and misuses of Holter monitoring in the diagnosis and management of pediatric patients. Methods: The study was a prospective observational study, carried out at Pediatric Arrhythmia Clinic and at PICU of Sohag University Hospital over two years from 09/2017 to 09/2019. It encountered 80 pediatric patients (34 females), their age ranged from 29 days to 15 years with mean age of 6.18 years. All patients were subjected to echocardiography, 12 leads ECG and holter monitoring for 24 hours. Minimum, mean, maximum heart rate, rhythms and corrected QT were evaluated. Indications of Holter examination, its abnormalities were analyzed, also its positive diagnosis and management were defined. Results: Palpitations and syncopy were the main indications for holter examination 22 (27.50%) patients for each, abnormal examination in 17 (21.25%), chest pain in 13 patients (16.25%) and cardiomyopathy (7.5%) (one with Hypertrophic Cardiomyopathy and five with Dilated Cardiomyopathy). There were 50 (62.50%) patients had abnormalities in Holter recordings. The highest contribution to diagnosis was in cardiomyopathy (83.3%) where the most common abnormalities were ventricular tachycardia (50%) and ventricular premature beats in (33.3%). An abnormal ECG was significantly associated with a higher diagnostic yield (p = 0.0001). Conclusion: The most important indications for Holter monitoring include palpitations, syncope, abnormal physical exam findings, chest pain, and cardiomyopathy. Holter monitoring is an extremely important tool in the assessment of patients with dilated cardiomyopathy. HM detects serious arrhythmias to identify patients who are at increased risk for subsequent morbid events. The abnormal ECG findings were associated with having an abnormal Holter, therefore Holter monitoring can be used to help select which patients should get this screening tool especially in low budget programs countries.

Background: arrhythmia" refers to any change from the normal sequence of electrical impulses. Cardiac arrhythmias have been classified into tachycardia and bradycardia. Pediatric arrhythmias account for approximately 55 per 100,000 patients evaluated in pediatric emergency departments. Sinus tachycardia is by far the most commonly reported arrhythmia, followed by supraventricular tachycardia (SVT) which represents about 13%, and bradycardia accounting for about 6% of all cases Objective: To characterize patients attending pediatric arrhythmia outpatient clinic as regards the presence of cardiac rhythm abnormalities, the pattern of cardiac rhythm abnormalities and the impact of diagnosis and treatment on the patient morbidity.Methods: This prospective observational study was conducted on 500 pediatric patients from October 2016 to September 2017 in the Pediatric arrhythmia outpatient Clinics of the Pediatric Department. All patients in this study were subjected to complete clinical history including the cause of the referral, complete clinical examinations and twelve leads ECG. The following investigations were requested when indicated and its results were included in the study: Serum electrolyte, Echocardiography, Holter cardiac rhythm monitoring and Electrophysiological studies (EPS), and finally data was analyzed by SPSS software.

Background: Cardiac defects are the most common type of birth defects . Atrial Septal Defect (ASD) is a common cardio-vascular malformation, it is caused by the spontaneous malformation of the interatrial septum resulting in one or more openings, commonly referred to as holes in the heart .Patients and methods : This study is a prospective hospital based study involving all children at the age from 0 to 18 years diagnosed by echo-cardiography as having isolated atrial septal defect and admitted to paediatric department , intermediate care and neonatal intensive care unit (NICU) ; also out patient clinic at Sohag university hospital during the period from January 2012 to January 2013 .Results : We studied [65] patients diagnosed by trans-thoracic echo-cardiography as isolated atrial septal defect (ASD) ,Their ages ranged from 5 days to 13 years with Mean ± SD ( 2.27 ± 2.8 years) . The main presenting Symptoms included ; reccurent chest infections , respiratory distress, feeding difficulties, exertional dyspnea,failure to thrive, manifestations of heart failure , and permanent cyanosis . Echo findings demonstrated that,the majority of cases had ASDII , followed by ASDI , then combined ASD , and less common type was sinus venosus ASD . Conclusion : The great majority of infants with ASDII are most often asymptomatic. Frequently,the condition is detected by a murmur on routine physical examination when they are school-aged children.

ZrO2 was treated with 10% S O 2 - 4 from different metal sulfate precursors for methanol dehydration to dimethyl ether. All the samples exhibited tetragonal phase and no diffraction peaks corresponding to metal sulfates or metal oxides were observed. The FT-IR results revealed that there were different interactions between sulfate and ZrO2, and this had a great effect on the surface area of the samples. The catalytic activity was measured over the catalysts in the temperature range of 100–300°C. The results revealed that sulfated zirconia with CuSO4·5H2O and Al2(SO4)3·16H2O showed the best catalytic activity. The maximum yield of DME ≈ 87% was obtained over CuSZ at a reaction temperature of 275°C. Moreover, the catalytic activity of the catalysts was correlated well with their surface acidity that measured by dehydration of isopropanol.

Beta-ketothiolase (mitochondrial acetoacetyl-CoA thiolase, T2) deficiency is an autosomal recessive disorder characterized by impaired metabolism of ketones and isoleucine. In this study, we report on the first two siblings with T2 deficiency from Libya. Both siblings presented with ketoacidosis, but the severity and outcomes were quite distinctive. T2 deficiency in patient 1, the younger sister, manifested as recurrent severe episodes of ketoacidosis during the first year of life. She unfortunately experienced neurodevelopmental complications, and died at 14 months old, after her 5th episode. In contrast, patient 2, the elder brother, experienced only one ketoacidotic episode at the age of 4 years. He recovered uneventfully and has continued to achieve age-appropriate development to date. Upon analysis, the siblings’ blood acylcarnitine profiles had shown increased levels of C5:1 and C5-OH carnitine. ACAT1 mutational analysis revealed patient 2 is homozygotic for a novel mutation–c.674C > A (p.Ala225Glu); this mutation was then confirmed by familial analysis. Transient expression analysis of c.674C > A mutant T2 cDNA revealed neither potassium ion-activated acetoacetyl-CoA thiolase activity, which represents T2 activity, nor mutant T2 protein. Therefore, this mutation is truly pathogenic. Interestingly, the incidence of T2 deficiency may be high among the Arab population. This disease should be considered in the differential diagnosis for unexplained ketoacidosis in children. Patients with T2 deficiency could have a favorable outcome if diagnosed and treated early.

Background and objectives: Growth failure is common among children with congenital heart disease (CHD). This study aimed at the assessment of the effect of therapeutic cardiac catheterization on the growth status of children with CHD.Patients and Method: This was a prospective observational study conducted at pediatric cardiac catheterization unit-Sohag university hospital, from October-2016 to September-2017, on children with congenital acyanotic heart diseases who were admitted for therapeutic cardiac catheterization. We assessed the growth parameters as a weight for age Z-score (WAZ), height for age Z-score (HAZ), body mass index and upper arm circumference before catheterization, at one month, three months and six months after catheterization. The growth status was considered normal when WAZ and HAZ were from -2 SD, underweight if WAZ was ≤ -2 SD and stunting if HAZ was ≤ -2 SD. Results: One-hundred and two children with congenital acyanotic heart diseases were included. The mean age was 3.95 ±3.11 years. Sixty participants(58.8%) were females. Before catheterization,70 patients (68.6%) had normal growth status, 20 patients (19.6%) had underweight and 19 patients (18.6%) had stunting. The prevalence of underweight significantly diminished to3.92% (p < 0.001) at the 6th month after catheterization. However, no significant differences in the prevalence of stunting were found during the follow-up period.Conclusion: Therapeutic cardiac catheterization had a significantly positive impact on weight gain shortly after catheterization. However, improvement in the height could not be detected in the first 6 months after catheterization and longer follow-up periods are required.

Background: persistent pulmonary hypertension of the newborn (PPHN) is a serious medical emergency in the neonatal period which occurs because of failure of transition of the fetal circulation into the normal circulation. The condition is characterized by persistently elevated pulmonary vascular pressures and carries with it a high rate of mortality and morbidity.Objective: to evaluate the effect of inhaled versus intravenous magnesium sulfate (MgSO4) as a treatment of pulmonary hypertension in neonates.Methodology: this is an observational prospective study done in Sohag university hospital in the neonatal intensive care unit during the period from January 2016 to December 2017 on 50 neonates who were diagnosed to have PPHN by echocardiography. In this study, we compared the effect of intravenous versus the inhalational MgSO4 on reducing the PHN and SILDENAFIL was used as an adjuvant treatment.Results: there was a statistically significant difference between the three studied groups as regard: age, sex, the degree of respiratory distress, the pulmonary artery pressure before treatment, side effects of treatment, duration of treatment and the SpO2 after treatment. Also there was a great difference in SpO2 in the right hand before and after treatment. Pulmonary artery pressure as well differs greatly before and after treatment in the three groups.Conclusion: based on this study we don't recommend the use of nebulized MgSO4 alone as a treatment of PPHN in neonates.

WO3 catalyst was prepared by thermal decomposition of ammonium metatungstate (AMT) in a static air atmosphere for 3h at 450, 550, 650 and 750℃. The techniques employed for characterization of the catalyst were TG, DTA, XRD, FTIR, N2-sorption measurements. The surface acidity of the catalyst was investigated by adsorption of pyridine and 2, 6-dimethyl pyridine. The catalytic properties of the catalyst were carried out for the dehydration of isopropyl and methyl alcohols. The results revealed that WO3 is more active toward isopropanol dehydration than methanol dehydration. Also reflect that the reaction mechanism and the yield of propene and dimethyl ether produced from dehydration of isopropyl and methyl alcohols are controlled by the strength of acid sites.

Samples of WO3 supported on γ-Al2O3 with loadings w(WO3) = 1–30 % were prepared by impregnation method and subjected to heat treatment at 500 and 550 °C for 3 h in a static air atmosphere. The catalysts were characterized by TG, DTA, XRD, TEM, TPD-pyridine, and N2 sorption measurements. The surface acidity of the catalysts was investigated by the dehydration of isopropanol and the adsorption of pyridine and 2,6-dimethylpyridine. Catalytic activity and selectivity of the catalysts were investigated for the dehydration of methanol to dimethyl ether at 230 °C in a conventional fixed bed flow type reactor at atmospheric pressure using nitrogen or air as a carrier gas. The results revealed that the catalysts with w(WO3) = 1–5 % loadings, calcined at 500 °C, exhibit a considerable increase in the catalytic performance toward methanol dehydration. The increase was, however, much more pronounced with the catalyst containing w(WO3) = 5 %, which attained dimethyl ether in 89 % yield.

A series of ZrO2/γ-Al2O3 catalysts were prepared by incipient wetness impregnation of zirconyl nitrate hydrate aqueous solutions on nano-γ-Al2O3 with ZrO2 loadings (1–30 % w/w) and calcined at 450 and 550 °C for 3 h in a static air atmosphere. Physicochemical properties of the catalysts were determined using TG, DTA, XRD, FT-IR, Raman spectroscopy, TEM, and N2 sorption measurements. The surface acidity of the catalysts was investigated by dehydration of isopropanol and adsorption of pyridine, 2,6-dimethyl pyridine and TPD–pyridine. This series of catalysts was used for vapor-phase dehydration of methanol to dimethyl ether in a fixed bed reactor. It was found that all catalysts in this study were active and selective for DME synthesis. According to the experimental results, 1 % ZA catalyst exhibited the highest activity with selectivity of 100 % toward DME.

Sulfated zirconia catalysts were prepared by wetness impregnation of zirconium hydroxide with an aqueous solution of (NH 4 ) 2 SO 4 with SO 4 2− loadings (1–30%, w/w) and calcined at 450 °C for 3 h in a static air atmosphere. The catalysts were characterized by FT-IR, XRD, TEM and BET measurements. The surface acidity of the catalysts was investigated by the dehydration of isopropanol and the adsorption of pyridine (PY) and 2,6-dimethyl pyridine (DMPY). The catalysts were tested for dehydration of methanol in a fixed-bed reactor at 230 °C using air as a carrier gas. The results revealed that among different catalysts, 10% SO 4 2− supported onto zirconia showed the highest catalytic activity with 83% conversion and 100% selectivity toward dimethyl ether. A good correlation was found between the acidity of the catalysts and their ability to dehydrate methanol.

Beta-ketothiolase deficiency (mitochondrial acetoacetyl-CoA thiolase (T2) deficiency) is an inherited disease of isoleucine catabolism and ketone body utilization caused by ACAT1 mutations. We identified ten Indian patients who manifested with ketoacidotic episodes of variable severity. The patients showed increased urinary excretion of isoleucine-catabolic intermediates: 2-methyl-3-hydroxybutyrate, 2-methylacetoacetate, and tiglylglycine. Six patients had a favorable outcome, one died, and three developed neurodevelopmental sequela. Mutational analysis revealed a common (p.Met193Arg) and four novel (p.Ile323Thr, p.Ala215Asn, c.1012_1015dup, and c.730+1G>A) ACAT1 mutations. Transient expression analyses of wild-type and mutant cDNA were performed at 30, 37, and 40°C. A p.Ile323Thr mutant T2 was detected with relative enzyme activity and protein amount of 20% and 25%, respectively, compared with wild type at 37°C; it was more prevalent at 30°C but ablated at 40°C. These findings showed that p.Ile323Thr had a significant residual T2 activity with temperature-sensitive instability. Neither residual enzymatic activity nor mutant T2 protein was identified in p.Met193Arg, p.Ala215Asn, and c.1012_1015dup mutations using supernatants; however, these mutant T2 proteins were detected in insoluble pellets by immunoblot analysis. Expression analyses confirmed pathogenicity of these mutations. T2 deficiency has a likely high incidence in India and p.Met193Arg may be a common mutation in the Indian population.

Obesity is an emerging health problem in world wide countries. High fat diet (HFD), which is the main cause of obesity, induces inflammation and affects both lipid and carbohydrate metabolism. This study investigates the effect of inflammation induced by HFD on lipid and carbohydrate metabolism. This study involves two parts, in vivo and in vitro. In the in vivo part, adult male albino rats were fed a HFD for 8 and 14 weeks. After each feeding period, the following parameters were measured (body weight, blood glucose levels, oral glucose tolerance, serum insulin, insulin resistance, total cholesterol, HDLc, LDLc, triglycerides, free fatty acids, neutrophils percentage and serum CRP levels) in addition to pancreas tissue histopathology. In the in vitro part, insulin release from isolated perfused pancreas preparations was measured. Pancreas preparations were isolated from adult male albino rats fed a HFD for 16 weeks. Feeding rats a HFD for 8 and 14 weeks induced inflammation, impaired lipid profile and carbohydrate metabolism. Feeding rats a HFD for 16 weeks increased in vitro glucose-stimulated insulin release. HFD induces inflammation which plays an important role in the impairment of lipid and carbohydrate metabolism.

Beta-ketothiolase deficiency is an inherited disorder of ketone body metabolism and isoleucine catabolism. It typically manifests as recurrent ketoacidotic episodes with characteristic abnormalitie...

Tuberculosis is more prevalent in developing countries, in which up to 95% of cases occur. It remains a major challenge to global public health in the 21st century. Aim: The study aimed to evaluate the effect of nursing intervention program for tuberculosis patients by using epidemiological model. Setting: The study was conducted at outpatient clinics in Benha Chest Hospital and El-Fayoum University Hospital. Sample: A simple random sample of 95 tuberculosis patients who attended to the previous mentioned settings; 45 patients from El-Fayoum University Hospital and 50 patients from Benha Chest Hospital, were selected randomly and representing 15% of 1425 attended patients over six months in the year 2013. Tool: An interviewing questionnaire included four parts 1): Socio-demographic characteristics. 2): Patient past and present medical history. 3): Patient knowledge regarding tuberculosis. And 4): Patient knowledge about practices through asking questions related to tuberculosis, which included: a) Patient health practices regarding tuberculosis. b): Patient knowledge regarding epidemiological model as person (host), agent, and environment. Results: 84.2% of the study sample were males while 48.4% their age ranged from 20 to 40 years, and 83.2% of them were smokers. 34.7% of study sample had especial equipment compared to 85.3% of them post intervention program. Furthermore 65.3% of the study sample avoided overcrowding places pre intervention program compared to 74.7% of them post intervention program. Statistically significant differences were detected between pre and post program regarding epidemiological model. Conclusion: The present study concluded that the patients' knowledge were increased after implementing the program and their practices were improved regarding health practices and epidemiological model. Recommendations: Health education program should be provided for tuberculosis patients regarding epidemiological model during treatment phases and follow-up visits.