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Background: Community acquired pneumonia (CAP) is a serious illness with significant costs to the society. Clinical decisions based on evidence based medicine (EBM) improve the outcome of management in an approach for appropriate treatment and prompt referral for care. Objective: Observing cases managed on EBM and comparing the outcomes with cases managed without EBM in a community hospital, providing approach for the clinician in evaluating and treating children. Methodology: A descriptive study on 56 children divided into 28 children EBM group and 28 children Non- EBM group, from June 2015 to May 2016 at Abo El Resh hospital, reviewing demographic, clinical data, observing therapies and outcomes. Results: EBM group showed statistically significant short days (6.8+2.1 days) for antimicrobial therapy than NEBM group (P= 0.001). Outcomes of Non-EBM group who needed admission to ICU for 4.2+ 2.6 days, while no children of EBM group need admission (P= 0.001). Conclusion: Effective case management is strategy to reduce pneumonia- related morbidity. Guidelines based on sound evidence are available but used variably. Recommendation: Unifying clinical practice and scientific evidence could rationalize the use of health resources, improving health care quality

Background: Neonatology is a specialty that has undergone dramatic advances in the last 50 years and continues to strive for ways to improve outcomes for sick newborn infants. Survival of infants with birth weight <1000 grams has increased from <10% to >70%. The availability of neonatal intensive care has improved the outcomes of high- risk infants born either preterm or with medical or surgical problems. Computerized provider order entry (CPOE), can reduce total medication error rates by 80%, and adverse (serious with harm to patient) errors by 55%. Aim of study: using of electronic records to detect morbidity& mortality in neonatal intensive care unit. Methods: Prospective study. Results: Number of cases admitted to ElWarrak central hospital Neonatal ICU (NICU) from Jan. 2019 to the end of Dec. , 2019 are 579; 193 cases are included in the study; number of deaths cases 107 cases at rate of 18.5%, number of short stay cases are 73 ( stay in NICU less than 10 days), number of long stay cases are 13 (stay in NICU more than 10 days). Number of short stay cases have RD are 50, 66.7%. Long stay cases have RD include n= 13, 92.09%. Mortality cases have RD include n= 88, 84.6%. The results are highly significance, p= 0.003. Number of mothers did not receive antenatal corticosteroids of mortality cases= 85, 82.5%. The results are highly significance, p= 0.002. Number of long stay neonates had respiratory system abnormality include n= 14, 100%. Number of neonatal deaths had respiratory system abnormality include n= 91, 87.5%. The results are highly significance, p=0.002. Conclusion: Most of long stay cases have respiratory system abnormality. Most of mortality cases have respiratory system abnormality. Most of mothers of mortality cases did not receive antenatal corticosteroids per history include.

Background: Early diagnosis of neonatal sepsis decreases morbidity and mortality in neonates. Recently, serum procalcitonin (PCT) has been investigated as a new marker for the detection of bacterial infection. Objectives: to evaluate procalcitonin (PCT) as an early marker of neonatal infections, and to compare procalcitonin with interleukin- 6 (IL- 6), C- reactive protein (CRP), hematological scoring systems (HSS). Methods: This cross sectional study included 90 neonates divided into three groups: 30 neonates as proved septic group, 30 neonates as suspected septic group and 30 healthy control neonates. All studied neonates were investigated at age of 1-2 days of life for serum PCT, IL- 6, CRP, hematological score by using HSS. Results: Serum PCT, IL- 6, CRP were significantly elevated in septic groups in comparison to the control group. The area under the ROC curve for PCT was 0.97, with specificity of 96.7%, sensitivity of 93.3%. Negative predictive value of 93.5% positive predictive value of 96.6%, diagnostic efficacy of 95%, which is significantly higher than that of IL- 6 and CRP. No correlation was found between PCT, IL- 6, CRP. HSS was not an early tool for diagnosing of neonatal sepsis. Conclusion: PCT is superior to IL- 6 and CRP in diagnosis of early onset neonatal sepsis

Introduction: Autoimmune diseases are frequently associated with growth impairment. This may be a consequence of the inflammatory process associated with disease activity and is also caused by the high- dose corticosteroids that are often used for treatment. Aim: Screening of growth impairment in juvenile rheumatoid arthritis, systemic lupus erythematosus and autoimmune chronic liver disorders. Subjects and methods: One thousand cases of school age children of both sexes of juvenile rheumatoid arthritis, systemic lupus erythematosus and autoimmune chronic liver disorders, the study will be conducted in the 4 main pediatric hospitals in Alexandria, to detect growth impairment in those children as indicated by auxological parameters from June 2010 to August 2015. Results: In the studied juvenile rheumatoid arthritis (No. 593) group of school male (No. 118) and female (No. 475) children <3rd- < 10th height for age percentile category (short stature) the percentage in males and females were 51.7 and 46,5 respectively, which were the highest percentages are statistically significant and in the studied autoimmune chronic liver disorders (ACLD) group of school age female (No. 69) children and adolescents in the short stature category (<3rd- <10th height for age percentile) a high percentage was observed which was 45.5 that is statistically significant. Pubertal assessment (Tanner staging) of the studied systemic lupus erythematosus (SLE) group of school age male children and adolescents (No. 69) shows that 48% of cases were in the Tanner stage 1 category is statistically significant which means delayed puberty was in a large number of this cases. Conclusion: Juvenile rheumatoid arthritis, systemic lupus eryth-ematosus and autoimmune chronic liver disorders are frequently associated with growth impairment and delayed puberty. It is important to regularly monitor physical development and control inflammation associated with disease activity.

Background: Meningitis is defined as an inflammation of the membranes and cerebrospinal fluid that cover completely and bathes the brain and spinal cord, If is a'senous disease arid may result in permanent complications if not diagnosed and treated early, the initial treatment: approach to the patient with suspected acute bacterial meningitis depends on early recognition of the meningitis syndrome, rapid diagnostic evaluation,'and emergent antimicrobial and :adjunctive therapy. Objectives: To compare the short course antimicrobial treatment of acute bacterial meningitis versus long course; wheather the organism identified of not in Abbassia Fever Hospital. Methodology: Prospective.study; in Abbassia Fever Hospital from June 2013 till December 2014. Results: N. meninigitidis were only three cases (three from 84cases); mean 14.33 and SD ± 6.03. All these cases received R, V as line of treatment while other organisms as enterococci most of them received the same line (i. e. R, V) 45.8% and only two cases (2.8%) received R, U, and E. The patients whom fully recovered most of them used the treatment plan R, V {38, 63.3%) followed by R, V, E (9, 15%) and to a lesser extent R, U (7,11.7%). There was statistical highly significance between the treatment plan chose and the outcomes of the patients and the p value was 0.010. R, V is the most common.treatment plan used (44 cases) followed by R, V, E (17 cases) and the least common plan used was R, U, E (2 cases). The absence of hydrocephalus or shunt operation was the most prevalent (81 cases) where the mean was 11.63 and SD ± 3.93. Conclusions: The most commonly used treatment plan was ceftriaxone and vancomycin. Only 10 patients received short duration of therapy. Recommendations: Further studies should be conducted on more national level to discuss the importance of short course therapy and which cases can receive it

Background: Meningitis is inflammation of the meninges. The inflammation may be caused by infection, and by certain drugs. Neopterin better with C-reactive protein is suited to support the differential diagnosis of viral versus bacterial infections. Aim: The study aimed at determination of epidemiological profile of admitted cases of meningitis (from two to twelve years old) and to evaluate the role of serum neopterin in differentiation between septic & aseptic meningitis. Patients & Methods: Nignty meningitis cases admitted in Imbabah Fever Hospital in one year (May/2012-May/2013) and eighty one meningitis cases admitted in 1 year (May/2013-May /2014). The following had been done for all patients: 1-Full medical history and Clinical examination 2- Laboratory investigation including: a- CBC. b-Serum neopterin by ELISA of the second phase. c-CSF analysis.3-Statistical analysis SPSS. Results: risk factors among cases of meningitis are age <5 years, males more affected(63.3%)in the 1st phase in comparison to the 2nd phase(56.8%), there was a statistical significant difference as regard contact to ill relative with a higher percent in the 1st phase 66.2% in comparison to the 2nd phase 33.8%. There was a higher percent of viral meningitis in the 2nd phase (67.9%) in comparison to the 1st (47.8%). CSF culture: no growth (32.2% in the 1st phase comparison to the 2nd phase 14.8%), followed by St. pneumonia (9.9% in th2nd phase comparison to the 1st phase 5.6%), then H influenza (7.8% in the 1st phase in comparison to the 2nd phase 2.5%) , the lowest percentage was TB meningitis with a percent of 1% and 0% in 1st and 2nd phase respectively. There was positive correlation between the bacterial meningitis occurrence and the higher level of serum neopetrin. Conclusion: Meningitis is increasing worldwide in an alarming rate. Neopterin is a diagnostic marker to differentiate between viral and bacterial infections.

Objective: to describe the pattern of sleep disturbances among children with CP (the age > 3 years) and to evaluate the relationship between sleep disturbances and neurological state. Methodology: This descriptive study included 124 children with CP; (80 males and 44 females) with an age ranging from 4 to 10 years. Children were randomly recruited from Pediatric Outpatient Clinic (IPGCS (throughout the period from June 2015 till the end of January 2016. All participants were subjected to IQ test (Stanford- Binet Scale V5), EEG, the CSHQ and hemoglobin measurement. Results: Out of 124 children, 92.7% had spastic CP, 6.5% had dyskinetic CP and0.8% had hypotonic CP. Topographically spastic CPs were; 55.6% diplegic, while quadriplegia and hemiplegia were found in 28.2% and 8.9% of studied cases, respectively. Degree of intellectual disability among cases was0.8% low average (89- 80), 8.1% were borderline (79- 70), 56.5% were mildly impaired, 14.5% were moderately impaired (54- 40), 12.1% were severely impaired (39- 25) and 8.1% were profound. Hemoglobin estimation revealed that 8.1% were anemic. Abnormal EEG was found in 70.2% of cases, 81.36% of the epileptic CP children and 60% of the non- epileptics had abnormal EEG findings, 27.4% had focal epileptiform, 18.5% had generalized slow wave, 16.9% had generalized epileptiform and 7.3% had multi- focal epileptiform. Among the epileptic CP children; 52.54% experienced partial seizures and 47.46% experienced generalized seizures. Out of all studied children, 48.38% showed abnormal total CSHQ score indicating a clinically distinct sleep disturbance. There were significant correlation between sleep disturbance score and the degree of intellectual disability and also presence of epilepsy. Conclusion: sleep disturbance was significantly correlated to several co- morbid conditions including the degree of intellectual disability and the presence of epilepsy.

Aim: Was to examine the time effects on these leading causes of death from non-Communicable diseases in Egypt. Methodology: It is a cross, sectional historical National Egyptians secondary data [CAPMAS. Egypt] study along the years 2008 to 2014. Results: Diseases of the circulatory system (48.1%, 2014) and GIT system, 11.1%, 2014 by far were the leading causes of death in Egypt. This study shows an escalation from 36.5% in 2008 up to 48.1% in 2014 in Egypt, with a notable increase in females more than males. 1.0 to 0.9 respectively. Second to cardiovascular diseases were GIT system leading causes of death in Egypt, raising from 9.3% in 2008 up to 11.1% in 2014 more predominantly in males (from 10.7% in 2008 to 12.3 in 2014) than females (from 7.5 in 2008 to 9.5 in 2014). Respiratory system diseases leading to death increased from 5.3% at 2008 up to 8% at 2014 in Egypt. The fourth leading cause in Egypt is cancers (about 6.7% at 2014). Moreover, the study provides information about the relative distribution of deaths caused by car accidents in Egypt from 2011 to 2015 per 100000 populations.Conclusion: Deaths due to cardiovascular diseases [CVDs] make up around one-half of the population mortality. GIT diseases come second in rank, followed by respiratory system diseases and cancers.