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Background: Pediatric patients infected with coronavirus disease 2019 (COVID-19) have unique clinical characteristics. Tumor necrosis factor (TNF) is a proinflammatory cytokine that greatly contributes to tumor pathogenesis.Purpose: To describe the presenting characteristics of COVID-19 infection among pediatric patients, and investigate the possible role of the TNF-α signaling pathway.Methods: This prospective case-control study included 50 Egyptian pediatric patients with COVID-19 and 50 healthy controls. Clinical, laboratory, and radiological assessments were performed. Serum TNF-alpha (TNF-α), TNF-α-converting enzyme (TACE), and angiotensin-converting enzyme 2 (ACE2) were measured using enzyme-linked immunosorbent assay. ACE (I/D) (rs4646994), ACE2 rs2285666, and TNF-α-308G/A single nucleotide polymorphisms (SNPs) were performed using conventional polymerase chain reaction techniques with or without restriction fragment length polymorphism.Results: The median age was 1 year (interquartile range [IQR], 0.31–2.50 years) in the case group and 1.45 years (IQR, 1.00–3.00) in the control group. The main presenting symptoms were fever (92%), dry cough (74%), and dyspnea (72%). The lymphocytic count was normal in 14 patients (28%), decreased in 16 patients (32%), and increased in 20 patients (40%) of the case group. Positive chest computed tomography finding of COVID-19 infection were demonstrated among 40% of patients using COVID-19 Reporting and Data System categories (ground-glass opacity with or without consolidations in the lungs). There were significant increased serum TACE and TNF-α with decreased ACE2 levels among cases versus controls (P< 0.001). The GG genotype and G allele of the TNF-α-308G/A SNP were significantly higher in patients than in controls (P<0.05 for both), with insignificant differences in genotype and allelic frequencies in the ACE (I/D) (rs4646994) and ACE2 rs2285666 SNPs.Conclusion: The TNF signaling pathway was significantly activated in pediatric COVID-19 infection. Only the TNF-α-308G/A SNP was significantly associated with pediatric COVID-19 infection.

Respiratory diseases in newborns are considered major causes of neonatal morbidity and mortality especially in developing countries. Its causes are diverse and require early detection and management. This study aimed for detection of the prevalence and risk factors of respiratory diseases in addition to outcome among neonates admitted in neonatal intensive care unit. Our study was a prospective observational study that was undertaken at the neonatal intensive care unit of Qena University Hospital, Egypt from July 2017 to July 2018. Demographic and clinical data of newborns and their mothers were evaluated and tabulated. In this period, 312 neonates were admitted to the neonatal intensive care unit, out of them 145 suffered respiratory diseases giving a prevalence of (46.5%), and (55.9%) were males. The mean neonatal age at admission was 4.33 ± 7.19 days and mean gestational age was 34.49 ± 3.31 weeks. The most common detected respiratory diseases were respiratory distress syndrome (RDS; 49.6%), transient tachypnea of newborn (TTN; 22%), neonatal pneumonia (17.2%) and meconium aspiration syndrome (MAS; 6.21%). Premature rupture of membrane (PROM), maternal diabetes and fetal prematurity had the highest risk factors for respiratory diseases occurrence in neonates. Neonatal mortality rate was 26.2%, mainly due to hyaline membrane disease and pneumonia. Respiratory diseases constitute major part of total admission in neonatal intensive care unit especially RDS, TTN, pneumonia and MAS. Prematurity and maternal diabetes were the most important risk factors associated with respiratory diseases. Respiratory distress syndrome carried the highest risk of mortality and TTN carried the highest survival rate.

Background: In preterm newborns, neonatal respiratory distress syndrome (RDS) is among the main causes of respiratory failure and mortality. However, the effect of macrophage migration-inhibitory factor (MIF) on neonatal developmental lung disease is not well documented in the literature. Moreover, little is known about the effects of growth differentiation factor-15 (GDF-15) on lung maturity in preterm infants.Purpose: To evaluate serum MIF and GDF-15 levels in preterm infants with and without RDS and analyze the genetic profile of single nucleotide polymorphisms (SNPs) for MIF rs755622 G>C and GDF-15 rs4808793 C>GMethods: In this case-control study, 90 preterm newborns were categorized into 3 groups: group A included 30 preterm newborns with mild to moderate RDS, group B included 30 preterm newborns with severe RDS, and group C included 30 healthy preterm newborns. Enzyme-linked immunosorbent assay methods were used to measure serum MIF and GDF-15 levels. The MIF rs755622 G>C and GDF-15 rs4808793 C>G SNPs were analyzed by restriction fragment length polymorphism-polymerase chain reaction.Results: Significantly higher median MIF and GDF-15 blood levels were noted among neonates with severe RDS (17.32 μg/L and 3.19 pg/mL, respectively) versus those with mild to moderate RDS (5.50 μg/L and 0.71 pg/mL, respectively) (P<0.05 for both). A significantly higher frequency of a mutant C-allele of MIF rs755622 G>C was noted among cases (37.5%) versus controls (13.3%) (P=0.001; odds ratio [OR], 0.256; 95% confidence interval [CI], 0.112–0.589). A significantly higher frequency of a mutant G-allele of GDF-15 rs4808793 C>G SNPs was noted among cases (49.2%) versus controls (30%) (OR, 0.443; 95% CI, 0.229–0.856).Conclusion: These findings suggest that serum MIF and GDF-15 levels are strongly associated with RDS severity among preterm neonates. Moreover, polymorphisms of MIF and GDF-15 could be genetic risk factors for the development of neonatal RDS among preterm babies.

Background Sepsis is a dysregulated host response to infection, which is considered a critical health problem with significant morbidity and mortality in pediatric age group. It continues to pose a significant burden in low- and middle-income countries. This study aimed to investigate the prevalence, characteristics, and outcome of severe sepsis in pediatric patients admitted to pediatric intensive care units (PICUs) at three of the largest tertiary care hospitals, Cairo, Egypt, to identify the predictors associated with morbidity and mortality in severe sepsis in a limited-resource setting. Methods This prospective cohort study included critically ill infants and children aged 29 days to 18 years admitted to the 3 PICUs with a confirmed diagnosis of sepsis during a 6-month period from April to October 2021. Detailed history, comprehensive clinical examination, laboratory and radiological investigations as well as management and outcome were recorded. Results A total of 432 patients were prospectively enrolled. The most common presentations were disturbed consciousness, respiratory distress, shock, and status epilepticus (61.6%, 56.5%, 38%, and 25% respectively). Community-acquired infections predominated (62%) over hospital-acquired infections (38%). Over half of the patients (56%) recovered without sequelae, while overall mortality was 17.6%. A pSOFA score > 10 was associated with the highest mortality. Impaired kidney function, elevated bilirubin, and high CRP levels were strongly correlated with sepsis related mortality. Conclusions Pediatric sepsis remains a major health problem with high mortality rate in limited-resource countries as Egypt. The current study aimed to set an epidemiological profile of severe sepsis in a big cohort Egyptian infants and children admitted to 3 PICUs. The resulting data can offer foundation for crafting predictive models targeting sepsis in pediatric age group, as well as for designing interventions to enhance outcome in limited resource countries.

To determine the bacteriological pattern and antibiotic susceptibility of bacterial isolates causing neonatal sepsis in Qena University Hospitals and compare polymerase chain reaction (PCR) and blood culture results in a trial for rapid diagnosis. Blood samples from 75 clinically suspected cases of neonatal sepsis were subjected to identification of bacteria and determination of their antibiotic sensitivity through blood culture, and rapid detection of 16S rRNA and the uidA gene (to confirm the presence of ) by PCR from extracted bacterial DNA. Most patients were preterm (64%) and low birth weight (LBW) (68%). In total, 42.7% presented with early onset sepsis (EOS). LBW was significantly associated with EOS ( -value=0.03). Although the blood culture and PCR results were similar in EOS, the PCR results were significantly higher than those of blood culture in detecting bacteria (85.3% vs 68%, respectively, -value=0.001). Blood culture showed 100% specificity. The most common pathogen was (86.2%) in EOS and . (45.5%) in late-onset sepsis (LOS) ( -value=0.001 and 0.02, respectively). The most effective antibiotics against Gram-negative bacteria were ofloxacin, ciprofloxacin, imipenem, and amikacin, while vancomycin, oxacillin, and imipenem were the most effective antibiotics against Gram-positive bacteria. EOS was mainly caused by , while LOS was mainly caused by . The 16S rRNA PCR showed higher sensitivity with rapid and accurate diagnosis. Blood culture is the most suitable method for antimicrobial sensitivity testing.

In preterm newborns, neonatal respiratory distress syndrome (RDS) is among the main causes of respiratory failure and mortality. However, the effect of macrophage migration inhibitory factor (MIF) on neonatal developmental lung disease is not well documented in the literature. Moreover, little is known about the effects of growth differentiation factor-15 (GDF-15) on lung maturity in preterm infants.BackgroundIn preterm newborns, neonatal respiratory distress syndrome (RDS) is among the main causes of respiratory failure and mortality. However, the effect of macrophage migration inhibitory factor (MIF) on neonatal developmental lung disease is not well documented in the literature. Moreover, little is known about the effects of growth differentiation factor-15 (GDF-15) on lung maturity in preterm infants.To evaluate serum MIF and GDF-15 levels in preterm infants with and without RDS and analyze the genetic profile of single nucleotide polymorphisms (SNPs) for MIF rs755622 G>C and GDF-15 rs4808793 C>G.PurposeTo evaluate serum MIF and GDF-15 levels in preterm infants with and without RDS and analyze the genetic profile of single nucleotide polymorphisms (SNPs) for MIF rs755622 G>C and GDF-15 rs4808793 C>G.In this case-control study, 90 preterm newborns were categorized into three groups: group A included 30 preterm newborns with mild-to-moderate RDS, group B included 30 preterm newborns with severe RDS, and group C included 30 healthy preterm newborns. Enzyme-linked immunosorbent assay methods were used to measure serum MIF and GDF-15 levels. The MIF rs755622 G>C and GDF-15 rs4808793 C>G SNPs were analyzed by restriction fragment length polymorphism-polymerase chain reaction.MethodsIn this case-control study, 90 preterm newborns were categorized into three groups: group A included 30 preterm newborns with mild-to-moderate RDS, group B included 30 preterm newborns with severe RDS, and group C included 30 healthy preterm newborns. Enzyme-linked immunosorbent assay methods were used to measure serum MIF and GDF-15 levels. The MIF rs755622 G>C and GDF-15 rs4808793 C>G SNPs were analyzed by restriction fragment length polymorphism-polymerase chain reaction.Significantly higher median MIF and GDF-15 blood levels were noted among neonates with severe RDS (17.32 µg/L and 3.19 pg/mL, respectively) versus those with mild to moderate RDS (5.5 µg/L and 0.71 pg/mL, respectively) (p <0.05 for both). A significantly higher frequency of a mutant C-allele of MIF rs755622 G>C was noted among cases (37.5%) versus controls (13.3%) (p=0.001; odds ratio, 0.256; 95% confidence interval, 0.112-0.589). A significantly higher frequency of a mutant G-allele of GDF-15 rs4808793 C>G SNPs was noted among cases (49.2%) versus controls (30%) (odds ratio, 0.443; 95% confidence interval, 0.229-0.856).ResultsSignificantly higher median MIF and GDF-15 blood levels were noted among neonates with severe RDS (17.32 µg/L and 3.19 pg/mL, respectively) versus those with mild to moderate RDS (5.5 µg/L and 0.71 pg/mL, respectively) (p <0.05 for both). A significantly higher frequency of a mutant C-allele of MIF rs755622 G>C was noted among cases (37.5%) versus controls (13.3%) (p=0.001; odds ratio, 0.256; 95% confidence interval, 0.112-0.589). A significantly higher frequency of a mutant G-allele of GDF-15 rs4808793 C>G SNPs was noted among cases (49.2%) versus controls (30%) (odds ratio, 0.443; 95% confidence interval, 0.229-0.856).These findings suggest that serum MIF and GDF-15 levels are strongly associated with RDS severity among preterm neonates. Moreover, polymorphisms of MIF and GDF-15 could be genetic risk factors for the development of neonatal RDS among preterm babies.ConclusionThese findings suggest that serum MIF and GDF-15 levels are strongly associated with RDS severity among preterm neonates. Moreover, polymorphisms of MIF and GDF-15 could be genetic risk factors for the development of neonatal RDS among preterm babies.