Dina Tawfeek Sarhan

COVID-19 virus as pandemic threat is finished, but the virus mutations are still considered as health hazard. The original virus and some of its mutations disappeared from the environment, but the current prevalent mutation is ECX strain. In this statement we are describing the epidemiology of the current strain, clinical presentation, methods of investigations and management specially in children.

Background: Cystic fibrosis (CF) is an autosomal recessive disorder affecting the exocrine functions of many organs including the pancreas. Clinical and laboratory recognition of pancreatic insufficiency is important for proper treatment. Early radiologic detection of pancreatic pathologic changes can help better evaluation. Objectives: To correlate exocrine pancreatic function with pancreatic ultrasound changes in CF children. Methods: This was a prospective cross-sectional study to assess the exocrine pancreatic function by measuring fecal elastase-1 (FE-1) level and doing pancreatic ultrasound for CF patients. Results: A total of 30 CF patients with age range from 3 months to 10 years were included in the study. They were categorized into three age groups; below one year, from 1 to 4 years and above 4 years old. None of our cases was exocrine pancreatic sufficient regarding FE-1 level and most of them (86.7%) had severe fecal elastase deficiency. Before 1 year of age there was no detected abnormal ultrasound findings in pancreas; only 8 older patients had abnormal US detected as hyper-echogenicity of pancreas. Abnormal US was more detected among patients with severe pancreatic insufficiency. The sensitivity of ability of fecal elastase level to predict abnormal ultrasound was 80%, with 84% specificity at cut of point 15.2 µg/g. Conclusions: Fecal-elastase-1 measurement in cystic fibrosis children can diagnose the exocrine pancreatic insufficiency even without clinical manifestations of steatorrhea. FE-1 level can predict pathologic changes of pancreas detected by transabdominal ultrasound.

Background: In children, indoor allergens play a significant role in the development of asthma. Allergen immunotherapy for the treatment of allergic respiratory diseases has traditionally been administrated by subcutaneous Immunotherapy (SCIT) injections, with certain precautions in administration. Sublingual Immunotherapy (SLIT) could be an alternative to SCIT.Objectives: To evaluate the efficacy, safety and cost of SLIT versus SCIT among asthmatic children. Patients and methods: 46 asthmatic children were divided into two groups. Group 1 received SLIT and group 2 received SCIT with close follow up of the patients every 3 months for 9 months regarding the efficacy and safety of allergen immunotherapy using asthma symptoms score, asthma medication scores and quality of life using a validated questionnaire. A cost-effectiveness analysis was done for both routes at the end of the study.Results: Both routes have nearly equal effects on the course of bronchial asthma. SLIT was the easier route of administration (painless and not needing attendance at the doctor's clinic for each dose). Even though its direct cost was more than SCIT, it eliminates the indirect costs of travel expenses for each dose, stable for a longer time in higher temperatures, with less probability of contamination.Conclusion: Allergen immunotherapy in addition to controller medicines significantly improves both symptoms and medication scores with minimal side effects in atopic asthmatic children with the advantage of SLIT over SCIT in this age group.

Background: One of the heterogenous chronic diseases affecting the lungs is asthma. Etiology of asthma could be attributed to altered functions of forkhead box p3 Gene (FOXP3) through epigenetic mechanism and genetic polymorphism. Objective: To assess the frequency of two FOXP3 polymorphism rs3761548 and rs2232365 among asthmatic children in comparison with healthy children. Patients and methods: A total of 202 Egyptian children were recruited and divided into 2 separate groups, 1st one of asthmatic contained 101 children with asthma and a control group of 101 non-asthmatic apparently healthy children. Results: We found a statistically significant difference in FVC, FEV1 concerning degree of asthma. The lowest values were reported among sever asthmatic cases. The genotype analysis of patients and controls revealed non-statistical significant difference was found in patients when compared to control concerning foxp3 polymorphism for 2 different single nucleotide polymorphisms (SNPs) rs 3761548 and rs 2232365. The AC genotype of rs3761548 and the GG genotype of rs2232365 polymorphisms were the most frequent genotypes among the studied children. The rs3761548 C allele carriers could be more susceptible to have asthma since it could be considered a bronchial asthma allele risk factor. Conclusion: We investigated the association between FOXP3 polymorphism in (rs 3761548 and rs2232365) and occurrence of asthma in Egyptian children. The AC genotype of rs3761548 and the GG genotype of rs2232365 polymorphisms were the most frequent genotypes among the studied children. The rs3761548 C allele carriers could be more susceptible to have asthma since it could be considered a bronchial asthma allele risk factor.

Background: Initial reports from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic described children as being less susceptible to coronavirus disease (COVID-19) than adults. Later on, a severe and novel pediatric disorder termed multisystem inflammatory syndrome in children (MIS-C) emerged. Pediatric patients with SARS-CoV-2 are at risk for critical illness with severe pulmonary COVID-19 and MIS-C. Both are described as two distinct conditions, and the differentiation between them was the scope of many studies. In this report from Egypt, we will describe two unique pediatric cases presented by combined manifestations of severe pulmonary COVID-19 and MIS-C. Case presentation: Two patients presented with severe pulmonary COVID-19 evident by pulmonary symptoms, signs, and advanced CO-RADS stage in lung CT were simultaneously fulfilling the clinical criteria of MIS-C including fever, multi-system affection, increased inflammatory markers in addition to the proved COVID-19 by positive serologic tests for SARS-CoV-2 but PCR was negative. Both patients responded well to immune-modulation therapy by IVIG and steroids and discharged well under closed follow-up. Conclusions: Although it is debatable to present simultaneously, MIS-C should be considered in patients presenting with typical clinical findings and concerns for pulmonary COVID-19 once the criteria for MIS-C diagnosis is fulfilled. Starting treatment without delay can favor better prognosis.

Human faced a lot of pandemics, and WHO has a definition as well as regulations for different phases of pandemic. The aim of this commentary is giving an attention of the value to change these current definitions and regulations hoping to save people in the future and stop global spread of any infection. Outbreak of a novel corona virus was reported in China on December 2019. Sooner, a global spread was reported and WHO announced a public health emergency of international concern on 30 January 2020. WHO declared it as a pandemic on 11 March 2020. If the current definitions and regulations of pandemic are changed, a global cooperative and supportive actions must be announced by secretary general of UN in any future health hazards with a possible global pandemic. Including support for global health care, economical support and local action plan to control outbreaks at site with UN support both medical and financial aiming to prevent further spread worldwide.‎‎‎‎‎‎‎‎

Context: Middle lobe syndrome (MLS) is a special clinical and radiographic condition that is commonly misdiagnosed in the routine pediatric clinical workup. Delay in the diagnosis may cause irreversible damage of the middle lobe with poor response to medical treatment and may indicate its surgical resection. Aims: To evaluate the clinical presentations, diagnostic lines, and surgical management of right MLS in children. Settings and design: This is a retrospective descriptive study that involved the records of 26 patients diagnosed as having MLS and referred for surgical resection of middle lobe in the period between March 2012 and May 2019. Patients and methods: We reviewed the hospital data of the selected patients in a retrospective manner regarding age, sex, symptoms, duration of these symptoms and the underlying etiology, the findings of chest radiograph, computed tomography, sputum culture, and pathology used for diagnosis. Fiberoptic or rigid bronchoscopy was performed before surgery for diagnostic and/or therapeutic purposes. Standard right middle lobectomy was done in all cases, and postoperative follow-up of clinical symptom improvement and complications was done. Statistical analysis used: Graphical representation of the numerical data is present in the form using bar charts. Results: We studied 18 (69.2%) females and eight (30.8%) males, with a mean age of 8.09±2.9 years. Clinical findings were cough in 76.9% of patients, expectoration in 38.5%, intermittent hemoptysis in 11.5%, chest pain in 19.2%, dyspnea in 34.6%, and 30.7% presented with recurrent or prolonged fever. The mean duration of symptoms was 27.4±16.7 months. Asthma is the most frequent underlying illness (23%). Bronchiectasis of the middle lobe was the most common radiologic (50%) and pathologic finding (42.3%). Tuberculosis was the final pathology in one patient and hydatid cyst was the cause in other one. Surgical resection of the middle lobe was done without reported mortality and with only few minor complications. Conclusion: Lobectomy of the right middle lobe is a good choice for management of children with MLS who did not respond to medical treatment with low rate of complications.

Background: Outbreak of a novel corona virus was reported in China on December 2019. Sooner, a global spread was reported and WHO announced a public health emergency of international concern and then declared it as a pandemic. Egypt announced the first case on February 14, 2020, and since that time, cases are increasing. Main body: There is increasing need to simplify the practical approach for pediatricians and other health care workers in a step wise manner; how to deal with COVID-19 cases, how to care for the newborn babies as regards to breastfeeding, and how to ensure safety of health care workers assess their risk of infection and management accordingly. A national practical approach guideline was prepared including case definition, diagnosis, and management of pediatric COVID-19 suspected and confirmed cases in an algorithmic pattern. Conclusion: Up to the current knowledge, this is a simple and practical guidance for clinical management of children during the current pandemic.

Background: Asthma is the most common chronic respiratory disorder in childhood with worldwide increasing in its prevalence and global burden. The International Study of Asthma and Allergies in Childhood (ISAAC) provides a standardized methodology to describe the prevalence and severity of childhood asthma symptoms all over the world using simple standardized questionnaires that allow comparisons across geographic and linguistic boundaries. This study aimed to find a suitable application of ISAAC asthma questionnaire to improve the perception and response of the middle (preparatory) school students in Al-Sharkiya Governorate as a step to update the Egyptian prevalence of asthma among children through the translation of the ISSAC written questionnaire into Arabic and to compare the student’s response to the translated questionnaire with their response to the same questionnaire after showing ISAAC videos. Results: The percentage of student’s positive answers for asthma symptoms in the written questionnaire after watching ISAAC videos was significantly lower when compared to their written questionnaire answers without watching videos with no significant agreement between the student’s answers in the two methods. Conclusion: Using ISAAC videos before filling the written questionnaire improved the students’ understanding of and dealing with the written questionnaire.

A febrile seizure (FS) is the most common convulsive disorder in children. Activation of cytokine network is involved in FS pathogenesis. Adiponectin, leptin and IL-6 are the major adipocytokines secreted by fat cells. To date, only a few studies concerned the association of adipocytokines with febrile seizures. In this study, we tried to investigate serum and CSF levels of adiponectin, leptin, and interleukin-6 (IL-6); as adipocytokines, for the first time in Egyptian children with febrile seizures. This was a prospective cross-sectional study included one hundred patients with febrile seizure, and matched with age, gender, 100 children with febrile illness without seizures (febrile control, FC) and 100 healthy control group (HC). Serum and cerebrospinal fluid (CSF) levels of adiponectin, leptin, and (IL-6) were measured by enzyme-linked immunosorbent assay (ELISA) method. Serum adiponectin was significantly higher in children with FS (16.8 ± 3.7 ug/ml) and the FC group (18.3 ± 4.3 ug/ml) compared to the HC group (9.5 ± 2.2 ug/ml); P < 0.05, respectively. Serum leptin was significantly lower in children with FS (0.9 ± 0.3 ng/ml) compared to both the FC group (4.7 ± 1.2 ng/ml) and the HC group (1.8 ± 0.4 ng/ml); P < 0.01, respectively. Children with FS had significantly higher serum IL-6 levels (43.7 ± 11.7 ng/ml) than the FC group (21.9 ± 4.5 ng/ml) and the HC group (6.5 ± 1.8 ng/ml); P < 0.01, respectively. Patients with simple febrile seizures (SFS) had serum and CSF adiponectin levels similar to those with complex febrile seizures (CFS); (P > 0.05). Serum and CSF leptin levels were significantly lower in patients with CFS compared to the SFS group (P < 0.05). Serum and CSF IL-6 levels were significantly higher in patients with CFS compared to the SFS group (P < 0.01). On multivariate logistic regression analysis, the high serum IL-6 levels was the most significant risk factor associated with febrile seizures among studied children (OR: 6.2; 95 % CI: 3.58 –10.57; P = 0.0001). Our data brought a novel observation that some adipocytokines like leptin and IL-6 could be, at least in part, an aetiopathogenetic factor in the manifestation of febrile seizures in susceptible Egyptian children. Moreover, we observed a significant association between high CSF IL-6 levels and susceptibility to complex febrile seizures as did the low CSF leptin levels.