Hashim, M. E. S., R. N. Said, E. A. A. Abdallah, and H. A. F. Elghafar, "Evaluation of phototherapy with reflectors: A randomized controlled trial", International Journal of Pediatrics and Adolescent Medicine: Elsevier, 2015. Abstract1-s2.0-s2352646715001039-main.pdfWebsite

Abstract
Background and objectives

Neonatal jaundice is one of the most prevalent clinical conditions requiring evaluation and management within the first few days of life. Phototherapy is the single most common intervention used for the treatment of neonatal jaundice. The aim of our study was to evaluate the efficacy and tolerability of phototherapy with reflectors compared to conventional phototherapy in controlling neonatal hyperbilirubinaemia.

Patients and methods

In this randomized controlled study, we studied neonates for one year (from June 2010 to June 2011) who were full term and healthy with uncomplicated jaundice and who were admitted to the neonatal intensive care unit (NICU) of El-Nasr General Hospital, Port-Said, Egypt. The subjects were randomized in two groups: group A (n = 30) received phototherapy with reflectors and group B (n = 30) received conventional phototherapy. Serum bilirubin levels were measured on admission and every 12 h thereafter. With declining readings, bilirubin was measured once daily until hospital discharge.

Results

There was no significant difference in total serum bilirubin on admission between the two groups. On discharge, bilirubin levels significantly decreased in group A compared to group B. There was a reduction in the duration of the hospital stay in group A compared to group B. The only observed complication in the groups was hyperthermia, which was not significantly different between the two groups.

Conclusion

The present study examined the efficacy and tolerability of phototherapy with reflectors in comparison to conventional phototherapy and found that phototherapy with reflectors was significantly better at controlling bilirubin levels in neonates with indirect hyperbilirubinaemia and at shortening hospitalization time.

El-Shabrawi, M. H., N. M. Kamal, M. A. Elhusseini, L. Hussein, E. A. A. Abdallah, Y. Z. A. Ali, A. A. Azab, M. A. Salama, M. Kassab, and M. Krawinkel, "Folic Acid Intake and Neural Tube Defects: Two Egyptian Centers Experience", Medicine, vol. 94, no. 37: Wolters Kluwer Health, 2015. Abstractmedi-94-e1395.pdfWebsite

Neural tube defects (NTDs) are a group of congenital malformations with worldwide distribution and complex etiopathogenesis. Folic acid plays a pivotal role in their prevention. We aimed to identify the protective effect of folic acid intake against NTDs and its dependence on different socioeconomic and environmental factors in a cohort of mothers in Egypt. A cross-sectional study was carried over a period of 12 months on mothers who gave birth to babies with NTDs (group 1) and a control group with healthy offsprings (group 2). Both groups completed 2 questionnaires: food frequency questionnaire targeting the daily folate intake, and socioeconomic status and medical history questionnaire. Both groups of mothers received folate <800 μg/day, recommended for pregnant women. A strong association was detected between NTDs and urban residency with medium educated mothers, with negative consanguinity, who had folate intake < 400 μg daily, and who had their food long cooked. Each of these factors separately had a limited impact to cause NTDs, but when present together they did augment each other. Interestingly enough is the role of fava bean, cauliflower, spinach, and mango in predisposing of NTDs in the presence of the above-mentioned factors. The protective effect of folic acid intake against NTDs may depend on the synergism of different socioeconomic and environmental factors (which differ from country to another). In Egypt, females especially the medium-educated who live in urban areas should be well-informed with the value of folate intake in the periconceptional period.
PMID: 26376380 [PubMed - in process] PMCID: PMC4635794 Free PMC Article

Moawad, E. M. I., and E. A. A. Abdallah, "Botulinum Toxin in Pediatric Neurology Switching Lanes From Death to Life", Global Pediatric Health, vol. 2: SAGE Publications, pp. 2333794X15590149, 2015. Abstractglobal_pediatric_health-2015-moawad-2333794x15590149.pdfWebsite

Botulinum neurotoxins are natural molecules produced by anaerobic spore-forming bacteria called Clostradium boltulinum. The toxin has a peculiar mechanism of action by preventing the release of acetylcholine from the presynaptic membrane. Consequently, it has been used in the treatment of various neurological conditions related to muscle hyperactivity and/or spasticity. Also, it has an impact on the autonomic nervous system by acting on smooth muscle, leading to its use in the management of pain syndromes. The use of botulinum toxin in children separate from adults has received very little attention in the literature. This review presents the current data on the use of botulinum neurotoxin to treat various neurological disorders in children.

Talaat, I. M., N. M. Kamal, E. H. K. El Melegy, H. A. Alghamdi, M. F. Aljabri, E. A. A. Abdallah, M. Sarar, and M. A. Alshahrani, "First report of Co-morbidity of Pantothenate kinase-associated neurodegeneration and three types of chronic hemolytic anemias", Annals of Medicine and Surgery: Elsevier, 2015. Abstractpiis2049080115001144.pdfWebsite

Background
Pantothenate kinase-associated neurodegeneration (PKAN), sickle cell anemia, and thalassemia are autosomal recessive disorders that can cause iron deposition in tissues during childhood. PKAN is characterized by accumulation of iron in the basal ganglia causing progressive extrapyramidal manifestations. Thalassemia and sickle cell disease can cause iron overload and deposition in tissues, including central nervous system.

Presentation of case
we herein report the first report of comorbidity of PKAN, β-thalassemia-major, sickle cell and glucose-6-phosphate dehydrogenase deficiency (G6PD) anemias in a 9 years old Saudi female patient who presented with gait disturbance, speech difficulty, and progressive movement disorders of the neck, upper and lower limbs.

Conclusion
Although extremely rare, β-thalassemia-major, sickle cell and G6PD anemias can be associated with PKAN. It is unknown whether this association is random or due to an unknown factor that may have caused several mutations.

Ibrahim, M. H., A. A. Azab, N. M. Kamal, M. A. Salama, S. A. Ebrahim, A. M. Shahin, A. E. El-Sadek, W. E. Abdulghany, L. M. Sherief, and E. A. A. Abdallah, "Early detection of myocardial dysfunction in poorly treated pediatric thalassemia children and adolescents: Two Saudi centers experience.", Annals of medicine and surgery (2012), vol. 9, pp. 6-11, 2016 Aug. Abstractpiis2049080116300577.pdfWebsite

BACKGROUND & OBJECTIVE: Cardiac complications are among the most serious complications in Beta Thalassemia Major Patients. Our aim was to evaluate the value of tissue Doppler imaging (TDI) for early detection of myocardial dysfunction in pediatric and adolescent patients with B-TM before development of overt heart failure or cardiomyopathy.

PATIENTS AND METHODS: 100 thalassemic patients below 18 years old and 100 healthy, age & sex matched controls were enrolled in our case-control study. Cases were selected from those attending outpatient clinics and inpatient wards, King Abdulaziz University hospital and Alhada Armed Forces Hospital, Saudi Arabia, between January 2014 and January 2015. They were subjected to echo-Doppler examination for both septal and lateral walls of the basal mitral and tricuspid annuli assessing the systolic myocardial velocity (S wave), early diastolic myocardial velocity (Ea wave) and late diastolic myocardial velocity (Aa wave).

RESULTS: Patients with thalassemia have RV and LV dysfunction on the basis of abnormal TDI derived myocardial velocities. There was a statistically significant differences between patients and controls regarding (Aa) and (S) of the septal wall of the basal mitral annulus and (Ea) of the lateral wall of the mitral annulus. Also patients with thalassemia have significantly higher (S) of the basal tricuspid annulus. These abnormalities were not detected by conventional echo-Doppler.

CONCLUSION: Clinically asymptomatic thalassemic children and adolescents who had normal global functions by conventional echo-Doppler were found to have abnormal left ventricular and right ventricular dysfunctions detected by TDI. TDI is superior to Echo-Doppler in detection of early myocardial damage in asymptomatic thalassaemic patients.

El-Sadek, A. E., E. G. Behery, A. A. Azab, N. M. Kamal, M. A. Salama, W. E. Abdulghany, and E. A. A. Abdallah, "Arginine dimethylation products in pediatric patients with chronic kidney disease.", Annals of medicine and surgery (2012), vol. 9, pp. 22-7, 2016 Aug. Abstractpiis2049080116300619.pdfWebsite

BACKGROUND: arginine and its metabolites have been linked to pediatric chronic kidney disease (CKD). We aimed to estimate serum levels of argninine (Arg), asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) in pediatric CKD patients and its relation to altered kidney function.

PATIENTS AND METHODS: 132 pediatric patients with CKD and 120 healthy age and sex matched controls were compared regarding; serum Arg, ADMA and SDMA levels.

RESULTS: In comparison to their values in control subjects, serum Arg levels were significantly lower; serum ADMA levels were non-significantly higher, but serum SDMA levels were significantly higher in CKD patients (p values: < 0.000; = 0.054; <0.000, respectively). Calculated Arg/ADMA and Arg/SDMA ratios were significantly higher in patients compared to controls (p values: 0.001, and <0.000, respectively). However ADMA/SDMA ratio was significantly lower in patients compared to controls (p = 0.001. Serum Arg levels showed positive significant correlation, while serum ADMA and SDMA levels showed negative significant correlation with eGFR. Moreover, Arg/ADMA ratio showed negative significant correlation, while ADMA/SDMA ratio showed positive significant correlation with eGFR of patients. Regression analysis defined high serum SDMA level as persistently significant predictor for low eGFR.

CONCLUSION: Disturbed serum levels of arginine and its dimethyl derivatives may underlie development and/or progression of CKD. Elevated serum SDMA level is strongly correlated with impaired kidney functions and could be considered as a predictor for kidney functions deterioration and CKD progression.

Ibrahim, M. H., A. A. Azab, N. M. Kamal, M. A. Salama, H. H. Elshorbagy, E. A. A. Abdallah, A. Hammad, and L. M. Sherief, "Outcomes of Early Ligation of Patent Ductus Arteriosus in Preterms, Multicenter Experience", Medicine, vol. 94, issue 25, no. 25: Wolters Kluwer Health, pp. e915, 2015. Abstractmedi-94-e0915.pdfWebsite

Abstract
Persistent ductal patency may have serious effects in preterm infants. Analysis of the results of different trials were inconclusive in determining whether medical or surgical closure of the ductus is preferable and what is the best timing for surgical intervention.The aim of this study was to evaluate the effect of timing of surgical closure of patent ductus arteriosus (PDA) on ventilatory, hemodynamic, and nutritional status of preterm infants.The authors retrospectively looked at the outcomes of surgical ligation of PDA from January 2010 to June 2014 at 2 Saudi neonatal intensive units at 2 tertiary care centers and the authors compared the results of early ligation (before 3 weeks) to the late ligation (after 3 weeks) regarding different hemodynamic, ventilatory, and nutritional parameters.A total of 120 preemies were included (75 preemies with early ligation and 45 with late ligation of PDA). The early ligation group had shorter duration of assisted ventilation of 10 (8-37) days as compared with 37 (26-90) days in the late ligation group (P < 0.05). The median fraction of inspired oxygen, needed to maintain good oxygen saturation in patients, was higher in the late ligation group [0.29 (0.21-0.70)] than in the early group [0.23 (0.21-0.55)] at 24  hours postoperatively. Full oral feeding was achieved earlier in the early ligation group than in the late group, 29 (15-73) days of life versus 53 (34-118) days of life, respectively (P < 0.05). Body weight at 36 weeks postconceptional age was higher in the early group--2100 (1350-2800) g--than in the late group-1790 (1270-2300) g--(P < 0.05).Our study demonstrated that earlier surgical ligation of the PDA in preterm infants has a more favorable nutritional and ventilatory outcome.

Ramy, N., E. Abdallah, and Y. Mansi, "Does Oral Glucose 10% have an Analgesic Effect on Full Newborns: a Double Blinded Study", ALEXANDRIA JOURNAL OF PEDIATRICS, vol. 25, issue 2, no. 2: THE EGYPTIAN PEDIATRIC ASSOCIATION - ALEXANDRIA, pp. 1–8, 2011. AbstractDoes Oral Glucose 10% have an Analgesic Effect on Full Newborns: a Double Blinded Study

Abstract
The aim of this study was to determine whether oral glucose 10% administered 2 minutes prior to puncture could have a pain relieving effect on full term newborns.
Studies have shown that orally administered sweet-tasting solutions reduce signs of plain during painful procedures such as venipuncture and cannulation on newborns. This effect has not yet been proven on 10% glucose. Design: prospective, randomized, double-blinded, control study.
Fifty full-term newborns (≥37weeks) were randomized to receive 2ml of either glucose 10% or distilled water. Researchers were blinded to the solutions used, and assessment was carried out over 4 consecutive days. Pain scores were assessed using the Neonatal Facial Coding System (NFCS), heart rate, and sleep wake state.
There were no statistically significant differences between the two groups, neither in the NFCS, heart rates, nor in their alertness state.
In conclusion, this study showed that oral 10% glucose solution administered before venipuncture is ineffective for pain reduction in the newborn.

Doss, S. S. W., D. S. Mosallam, E. A. A. Abdallah, and M. M. M. Moro, "Pulse Oximetry in Comparison to Arterial Blood Oxygen Saturation in Respiratory Distress in Neonates", Alexandria Journal of Pediatrics, vol. 25, issue 2, pp. 77-81, 2011. AbstractPulse Oximetry in Comparison to Arterial Blood Oxygen Saturation in Respiratory Distress in Neonates

Monitoring oxygen saturation is important to the newborns receiving supplemental oxygen so to
decrease the incidence of exposure to hyperoxemia and the risk of potential deleterious effects of radical
oxygen species. Pulse oximetry is a non invasive, medical device that indirectly measures the oxygen
saturation of a patient's blood. An arterial blood gas (ABG) is a blood test that is performed using blood
from an artery. ABG testing is used to determine the pH of the blood, the partial pressure of carbon
dioxide and oxygen(PaO2), and the bicarbonate level.: This study aimed at studying the relationship of
PaO2 and pulse oxygen saturation values in newborn with respiratory distress to evaluate whether pulse
oxygen saturation value can reflect significant changes in PaO2. Prospective comparison of PaO2 and
pulse oxygen saturation values in 80 patients (mean gestational age 35 ± 3.6 weeks) was performed. The
PaO2 measurements were obtained from blood gas analyzer; simultaneous pulse oxygen saturation
values were recorded. We evaluated PaO2/ pulse oxygen saturation values in the 80 neonates. Of the 80
samples, 30 (37.5 %) of cases were breathing supplemental oxygen by CPAP, 27 (33.7 %) of cases were
on nasal prong, 21 (26.3 %) were on ventilator and 2 (2.5 %) were on head box. A mean pulse oxygen
saturation of (93.7 ± 7.1%) and a mean PaO2 of (34.9 ± 10) mmHg was observed. There was a statistically
significant positive (direct) correlation between PO2 and SpO2. An increase in PO2 is associated with an
increase in SpO2 (p<0.001). In conclusion: pulse oximetry measured from neonates and infants with
respiratory distress has statistically significant positive (direct) correlation with PO2.