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Since the World Health Organization (WHO) announced coronavirus disease-2019 (COVID-19) to be a pandemic, children's COVID-19 cases were generally less severe than adults. The aim of the study was to determine the prevalence of COVID-19 cases among children with hemoglobinopathies and other inherited anemias living in El-Minya Governorate, Egypt, who are at high risk of exposure to infection. This cross-sectional study evaluated data from 258 children with hemoglobinopathies and inherited anemias. A questionnaire was used to collect data about COVID-19 symptoms coupled with appropriate investigations (complete blood count, d-dimer, anti-COVID antibodies, chest computed tomography scans, and polymerase chain reaction). We found 38 of 258 (14.7%) children had mild to moderate COVID-19, while there were no cases with severe form of COVID-19. COVID-19 cases were significantly older (8.63±3.37 vs. 6.71±3.56 y, P=0.01), noncompliant to iron chelators (63.2% vs. 11.8%, P=0.01), had higher serum ferritin (2639.47±835.06 vs. 1038.95±629.87 ng/mL, P

Children cannot be considered as miniature adults regarding to hemostatic balance. There is a great difference between neonatal, pediatric, and adult hemostatic systems. The concept of developmental hemostasis is now accepted on a wide range. It ensures accurate prevention, diagnosis, and treatment of thrombotic and hemorrhagic diseases in neonates and children. Developmental hemostasis could affect multiple physiological processes within the body other than hemostasis, such as angiogenesis, inflammation, and wound repair, as well as the interaction between different drugs and the coagulation system. “The Perinatal and Pediatric Hemostasis Subcommittee of the Scientific and Standardization Committee of the International Society on Thrombosis and Hemostasis (ISTH)” recommended for each laboratory to define reference ranges which are age-adjusted using its own technical conditions. Adding to that, accurate sampling techniques are mandatory for correct interpretation of laboratory results. New assays should be developed putting into consideration the fundamentals of developmental hemostasis.

BackgroundSepsis is still one of the main causes of infants and children mortality especially in developing, economically challenged countries with limited resources. Our objective in this study was to determine, the prognostic value of platelet count, mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT) in critically ill infants and children with severe sepsis, as they are readily available biomarkers, that can guide clinicians during managing of severe sepsis.MethodsSixty children were included; they were diagnosed with severe sepsis according to the international pediatric sepsis consensus conference criteria. At admission to Pediatric intensive care unit, complete blood count with platelet count and parameters (MPV, PDW and PCT) and C-reactive protein (CRP) level were determined for all children. Also, assessment of the Pediatric Risk of Mortality (PRISM III) score was done to all. These children were followed up till discharge from hospital or death. Accordingly, they were grouped into: (1)Survivor group:included 41 children. (2)Non-survivor group:included 19 children.ResultsPlatelet count and PCT were significantly lower (p p = 0.004). MPV/PLT, MPV/PCT, PDW/PLT, PDW/PCT ratios were found to be significantly higher in the non-survivors than survivor (p ConclusionThrombocytopenia, platelet indices and their ratios, especially plateletcrit and MPV/PCT, are readily available, sensitive, prognostic markers, that can identify the severe sepsis patients with poorest outcome.

Background: Neonatal sepsis is an important cause of neonatal morbidity and mortality worldwide. Early diagnosis is the cornerstone of management and favorable outcome. The wide variations of presenting signs of neonatal sepsis make reaching a diagnosis very challenging.Objectives: Our aim was to study serum pancreatic stone protein (PSP) in late-onset neonatal sepsis and its relation to the clinical score and C-reactive protein (CRP).Results: We found that the definite sepsis group had significantly higher PSP and CRP levels than the other two groups (p < 0.001). Moreover, the probable sepsis group had significantly higher PSP and CRP levels than controls (p < 0.001). The PSP had significant positive correlations with the clinical score (r=0.32, P =0.01) and CRP level (r=0.47, P =0.001). The PSP was more sensitive than both clinical score and CRP in detecting neonatal sepsis, as its sensitivity was 98.3% and a specificity of 100%.Conclusion: PSP is a valuable biomarker to detect late-onset neonatal sepsis. It is more sensitive than traditionally used acute phase reactant as CRP.

BackgroundChildren with transfusion-dependent thalassemia (TDT) suffer from secondary hemosiderosis and the delirious effects this iron overload has on their different body organs, including the pancreas. They are also more prone to develop zinc deficiency than the general pediatric population. This study aimed to determine the effect of zinc deficiency and iron overload on the endocrine and exocrine pancreas in TDT children.MethodsEighty children, already diagnosed with TDT, were included in this study. We assessed the following in the participant children: serum ferritin, serum zinc, endocrine pancreatic function (oral glucose tolerance test (OGTT), fasting insulin level and from them, HOMA-IR was calculated), and exocrine pancreatic function (serum lipase and serum amylase).ResultsForty-four TDT children had a subnormal zinc level, while 36 of them had a normal serum zinc level. TDT children with low serum zinc had significantly more impaired endocrine pancreatic function and an abnormally high serum lipase than children with normal serum zinc,p p = 0.02. TDT children, having a serum ferritin ≥2500 ng/ml, had significantly more frequently impaired endocrine pancreatic function and abnormally high serum lipase than TDT children below the ferritin threshold,p ConclusionIn children with transfusion-dependent thalassemia,zinc deficiency aggravates iron-induced pancreatic exocrine and endocrine dysfunction.

Introduction The differentiation between systemic inflammatory response syndrome and sepsis is very important as it determines essential treatment decisions, such as selection, initiation, and duration of antibiotic therapy. Objectives We aimed to investigate the diagnostic value of Procalcitonin, Monocyte Chemoattractant Protein-1, soluble Mannose Receptor, Presepsin as early biomarkers of pediatric sepsis in comparison to systemic inflammatory response syndrome in severely ill children. Patients and methods This study included 58 children diagnosed as sepsis (group 1), 24 children with systemic inflammatory response syndrome without infection (group 2), and 50 healthy children as controls (group 3). All the plasma levels of the studied biomarkers were measured and ROC curves were created for all the tested parameters to discriminate between sepsis and SIRS. Results The area under the curve for Monocyte Chemoattractant Protein-1 was 0.926 (0.846-0.927) with sensitivity 100% and specificity 62.5%. The soluble Mannose Receptor had the highest sensitivity (100%), with AUC equals 1(.0.956-1.0) and specificity of 100%. The cut-off values for Procalcitonin, Presepsin, soluble Mannose Receptor, and Monocyte Chemoattractant Protein-1 and were: 0.62 ng/ml, 100 pg/ml, 13 ng/ml and 90 pg/ml, respectively. In septic cases, both soluble Mannose Receptor and Procalcitonin have positive correlations with the severity of sepsis, low Glasgow Coma Scale, ventilatory support, use of inotropic drugs and mortality rate (r = 0.950, 0.812, 0.795, 0.732 and 0.861respectively) for soluble Mannose Receptor and (0.536, 0.473, 0.422, 0.305 and 0.474 respectively) for Procalcitonin. Conclusion Soluble Mannose Receptor, Presepsin, and Monocyte Chemoattractant Protein-1 can be used to differentiate between sepsis and SIRS in critically ill children.

To investigate the effect of iron overload on macular perfusion among transfusion-dependent thalassemia (TDT) patients using optical coherence tomography angiography (OCTA) METHODS: The study is a prospective observational case-control study. It included 27 eyes from 27 children with transfusion-dependent β-thalassemia and 25 eyes from 25 age-matched controls. All participants were evaluated clinically and with OCTA Avanti RTVue-XR system (Optovue) to assess macular microvascular changes, by measuring vessels density (VDs) and foveal avascular zone (FAZ) area, at both superficial and deep retinal plexuses and at choriocapillaris level.Foveal and parafoveal zones were significantly thinner among thalassemia patients, with significantly larger FAZ area at the level of both superficial and deep retinal plexuses when compared with control group. The thalassemia group showed significant lower values compared with the controls regarding whole-image, foveal, and parafoveal deep VD. There were significant negative correlations between serum ferritin and deep (whole image and parafoveal) VD (r = - 0.429, P = 0.026, and r = - 0.452, P = 0.018, respectively). Choriocapillaris VDs (whole image and foveal) showed significant negative correlations with serum ferritin levels (r = - 0.390, P = 0.044 and r = - 0.401, P = 0.038, respectively) CONCLUSIONS: Macular microvascular changes were detected by OCTA examination in patients with TDT, mostly due to iron overload effect, as we selected patients on iron-chelating agent with the least harmful effect on the retina. The most affected layer is the DCP. Changes at the deep layer could be used as a sensitive biomarker for early macular perfusion changes in those patients.Study registration number is UMIN000042657, date of registration: 2020/12/04 (retrospectively registered).

Diarrheal disease is considered a significant health problem, principally in developing countries as it is one of the leading causes of morbidity and mortality especially in infants. Studies found that STES and EPEC strains are among the most predominant causative agents in acute diarrhea. The aim of the study was to investigate the presence of certain virulence factors and antibiotic resistances of STEC and EPEC originating from infants with diarrhea in Egypt. A total of 200 infants of different ages suffering from diarrhea between August 2017 and February 2019 were registered in this study. Standard cultural and biochemical methods were used to isolate E. coli species while; PCR was applied for the detection of virulence genes (stx1, stx2, eae and pfb A) for STEC and EPEC isolates, respectively. Eighty nine (44.5%) E. coli strains were isolated from 200 stool samples. A total of 40 (44.9%) strains were identified as STEC, and 1(1.12%) strain was atypical EPEC. Fourteen of the STEC serotypes were O157:H7. Susceptibilities of 40 STEC and 1 aEPEC isolates were determined for ten antimicrobial drugs. STEC O157:H7 strains and STEC Non-O157:H7 exhibited the highest resistance against cefazolin and no resistance against imipnem and Amikacin, respectively while, the isolated strain of aEPEC was sensitive to all the studied antibiotics except cefazolin. Results showed that STEC is one of the major causes of diarrhea that showed resistant to commonly used antibiotics so representatives must pay great attention to this matter in order to increase the health of the community.

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

Primary immune thrombocytopenia (ITP) is the most common cause of acquired thrombocytopenia in children. Anti-thyroid antibodies (aTA) have previously been found to be present in various autoimmune diseases. Our aim was to study the effect of aTA positivity (which are anti-thyroid peroxidase (aTPo) and/or anti-thyroglobulin (aTg)) on children with primary immune thrombocytopenia and their relation to treatment response. Sixty-one children with primary ITP were enrolled in the present study. They were further subdivided into: NDP group (newly diagnosed and persistent) and chronic ITP group. Seventy-five apparently healthy children were enrolled as control group. aTPo and aTg antibodies were significantly higher and more frequently positive in all children with ITP and in each ITP group than the control group (P.05 in all). But, there were no statistically significant differences between the two ITP subgroups (P.05). aTA positive children with ITP had significantly lower platelet count: at the start of treatment (P =.009), after receiving methylprednisolone or intravenous immunoglobulin (P =.02) and at one month follow-up (P =.003) than aTA negative children with ITP. Lastly, aTA positive children had more relapses (P =.03), continued more frequently to have relapses after one year in the NDP group (P =.02) and required immunosuppressive therapy more frequently in the chronic ITP group (P =.005).

Background: Pediatric sepsis is a life-threating condition that requires instant management. The choice of the best biomarker and its best cut-off value is critical for diagnosis of infection in children especially with the delay in obtaining the culture results. Objective: The main objective of this study was to evaluate the diagnostic value of neutrophil CD64 in early diagnosis of sepsis among children. Methodology: This prospective study was conducted on 50 children with suspected sepsis and 50 control children without infection. Blood samples were taken on admission for blood culture. Detection of neutrophil CD64 (nCD64) was carried out by flow cytometry and CRP was measured by ELISA. Results: CD64 was elevated significantly in sepsis compared to the control group. There was a significant difference between the levels of nCD64 in culture positive cases (80%) compared to culture negative ones (20%). Neutrophil CD64% was highly predictive of childhood sepsis with are under the curve (AUC) =1. Conclusion: Neutrophil CD64% is a very good diagnostic marker for early diagnosis of sepsis with a higher sensitivity than CRP.

Background Thalassemia is a major health problem that disturbs the lifestyle of the affected patient. The aim of this work is to detect the impact of thalassemia on the quality of life regarding physical, social, emotional, psychological scored assessment. Methods A case-control survey was conducted in Minia University children’s hospital on 64 patients recruiting pediatric hematology outpatient clinic from July 2014 to February 2017. PedsQL™ 4.0 Generic Core Scale (Arabic version) was used to assess HRQOL in 64 thalassemia patients between 8 and 18 years of ages. Other related clinical data of the involved patients were collected from the pediatric hematology records. Results Mean physical, emotional, social, school performance, psychological and total scores (− 36.9 ± 20.9, 49.4 ± 17, 47.2 ± 21.3, 38.5 ± 15.5, 45.3 ± 13.8, 47.9 ± 38.8 respectively) were significantly decreased compared with control (p = 0.001 for all). The younger age group had better scores regarding social, emotional, psychological and total scores compared to older ones (p = 0.01, 0.03, 0.01 and 0.009 respectively). Older age of starting transfusion was statistically significant protecting factor from poor physical QOL in thalassemia patients (OR = 0.96, p = 0.03). The presence of hepatomegaly was a statistically significant predictor for poor physical QOL (OR = 8.5, p = 0.02). Household income was the statistically significant predictor for poor emotional QOL (OR = 5.03, p = 0.04). High serum ferritin was the statistically significant predictor for poor social QOL (OR = 1.1, CI 95%=, p = 0.04). Regarding poor psychological QOL (OR = 0.94, p = 0.01) and total QOL (OR = 0.94, p = 0.01) scores, older age of starting transfusion was the statistically significant protecting factor. Conclusion Scheduled programs giving psychosocial help and a network connecting between the patients, school officials, thalassemia caregivers and the physician is required especially in developing countries where the health services are not integrated with social organizations. Special school services for thalassemia patients are required to deal with the repeated absence and anemia induced low mental performance of thalassemia children.

Background Although delayed cord clamping (DCC) is a recent WHO recommendation, early cord clamping (ECC) is still a routine practice in many countries. Limited researches studied the effect of delayed cord clamping on oxidative stress in term neonates; In this study we aim to assess the influence of cord clamping either early or late on oxidative stress in term neonates and to evaluate the association of oxidative stress and cord blood lipids. Methods One-hundred mothers and their term neonates were included in the present study. Umbilical cord blood samples were collected from the umbilical vein and umbilical artery immediately following labor. Results Total cholesterol, total triglycerides and phospholipids levels were significantly higher in the ECC group than the DCC group (p

Background Many studies indicated that mean platelet volume (MPV) and platelet distribution width (PDW) may be valuable in the diagnosis and management of clinical disorders; also, serum butyrylcholinesterase activity (BChE) was suggested to be linked to systemic inflammation and oxidative stress. Limited studies measured these readily available markers in children with diabetic ketoacidosis (DKA). Our objectives were to measure MPV, PDW and BChE in children with DKA; and to assess if any of these markers reflects the severity of DKA. Methods Our study included: 30 children with DKA (DKA group), 30 diabetic children (Non-DKA group) and 30 apparently healthy children (control group). MPV, PDW and BChE were measured in all children. Additional blood samples were withdrawn from the DKA group to assess these markers at discharge from hospital. Results MPV, PDW and BChE were significantly altered in the DKA group than the other two groups; and their levels improved significantly at discharge of the DKA group (p 0.05). Conclusion DKA in children is associated with changes in MPV, PDW and BChE activity, which improve after resolution of the condition. Elevated MPV can be a suitable risk marker for DKA. None of the studied markers correlated with the severity of DKA.

Purpose Neonatal sepsis has wide variations of clinical presentations, which may not reflect the severity of the disease. Our objective was to investigate the prognostic value of the hematological scoring system (HSS), red cell distribution width (RDW), mean platelet volume (MPV), and platelet distribution width (PDW) in neonatal sepsis at the time of admission to the neonatal ICU. Patients and methods The study included two groups: the neonatal sepsis group which included 64 neonates with neonatal sepsis and the control group which included 60 neonates with sex, gestational, and postnatal ages matched with the previous group. RDW, MPV, and PDW were measured for all included neonates. Score for Neonatal Acute Physiology-II score and HSS were determined for the sepsis group within 12 h of admission to the neonatal ICU. Results RDW, MPV, and PDW were significantly higher in the sepsis group than the control group (P 0.05). But on comparing their levels in survivors with the nonsurvivors, all of them were significantly higher in the nonsurvivors (P 0.05). Conclusion RDW is the most sensitive hematological marker to predict mortality in neonatal sepsis, followed by MPV and PDW. HSS is still a diagnostic rather than a prognostic score.

Background Thalassemia is associated with the generation of labile iron in the red blood cells, which promotes the formation of reactive oxygen species, leading to cumulative cell damage. Ischemia modified albumin (IMA) is now suggested to reflect generalized oxidative stress. Objectives The aim of this study was to evaluate IMA in children with transfusion-dependent (TD) β-thalassemia and its relation with serum ferritin and iron chelation therapies. Patients and methods A total of 60 children with TD thalassemia were divided into three groups on the basis of the type of iron chelation therapy received: group A received oral deferiprone (DFP), group B received effervescent deferasirox (DFX), and group C did not receive any type of iron chelation therapy. A total of 20 age-matched and sex-matched healthy children were included as controls. Serum ferritin and IMA were determined for all participants. Results There were significant increases in serum ferritin and IMA levels in thalassemic children than in controls (P Conclusion IMA was higher in children with TD thalassemia than in controls. Moreover, its level in thalassemic children on either DFP or DFX was significantly lower than its level in children not receiving any chelation therapy. Therefore, IMA may be a possible marker of iron-induced oxidative stress in β-thalassemia.