Background Exclusive breastfeeding is highly recommended in early infancy; however, there are concerns about breast milk meeting the vitamin D requirements of infants during this period. Objective This study aimed to determine the serum 25-hydroxyvitamin D (25-OHD) level of lactating mothers and their healthy exclusively breastfeeding young infants, and to ascertain the predictors of deficient 25-OHD (<20 ng/ml) in these infants in a tropical setting. Participants and methods Mother–infant pairs at the Federal Medical Centre, Keffi North Central Nigeria, were consecutively recruited over a 7-month period. The study participants were characterized and their serum 25-OHD was assayed using the chromatography method. Results A total of 111 mother–infant pairs were recruited. The mean (SD) infant age was 3.0 (1.4) months, while the mean (SD) maternal age was 27.5 (5.1) years, with 3.6% being teenagers. The mean (SD) 25-OHD of infants and mothers were 39.7 (25.7) and 33.9 (20.4) ng/ml, respectively. Twenty-six (23.4%) infants and 33 (30.6%) mothers had deficient 25-OHD. Low birth weight and underweight infants, as well as inadequate maternal diet and maternal 25-OHD deficiency were associated with deficient 25-OHD status in infants. Only inadequate maternal diet (odd ratio=3.529; 95% confidence interval=1.100–11.168; P=0.033) and maternal vitamin D deficiency (odd ratio=10.168; 95% confidence interval=3.455–29.920; P=0.001) independently predicted deficient 25-OHD levels in the infants. Conclusion About one of every five exclusively breastfeeding recruited infants had deficient 25-OHD levels and this is associated with modifiable factors. Maternal intake of vitamin D-rich food and vitamin D supplementation may be necessary to meet the vitamin D requirements of these mother–infant pairs.

Background and aim Vitamin D is essential for growth, development, and health. It works as a paracrine and autocrine signaling molecule that affects nearly all systems in the body. Vitamin-D deficiency (VDD) may be overlooked due to the variable clinical presentations. This study was conducted to assess vitamin-D status among children and adolescents, and to find out predictors for its deficiency/insufficiency among the studied groups. Patients and methods A cross-sectional analytical study was conducted on 88 patients (47 children and 41 adolescents). All participants were subjected to history, clinical examination, and estimation of serum vitamin D, alkaline phosphatase, calcium, and phosphorous levels. The patients were divided into four groups according to serum vitamin-D level: severely deficient less than 10 ng/ml, deficient 10–less than 20 ng/ml, insufficient 20–30 ng/ml, and sufficient vitamin D more than 30 ng/ml. Results VDD was prevalent in the studied group, where 58% of them showed VDD and 25% showed insufficiency. Children showed 8.6% severe deficiency, 46.8% deficiency, and 31.9% insufficiencies. The adolescents showed 21.1% severe deficiency, 48.8% deficiency, and 17.7% insufficiency. Muscle cramps were significant among children only. Multivariable linear-regression analysis revealed that BMI (P=0.01) and fast food (P=0.016) were associated with the increased risk of deficiency. Conclusions VDD and insufficiency are prevalent in Egyptian children and adolescents among both sexes. The severity of deficiency is associated with muscle cramps. Vitamin-D status was affected by increased BMI and fast-food intake.

Background Neonatal encephalopathy (NE) is a clinical syndrome characterized by abnormal neurobehavioral status of the newborn. Aim This study was conducted to evaluate the role of MRI in identifying vascular causes of NE. Patients and methods The study was conducted on 50 full-term neonates admitted to the neonatal ICU at Alexandria University Children’s Hospital with clinical picture suggestive of encephalopathy. MRI examinations were performed on a 1.5-T General Electric (GE) machine. Results In the current study, the causes of non-hypoxic–ischemic encephalopathy NE were categorized into six groups, each group displayed specific MRI features. P value was calculated, and the results revealed that MRI was successful in reaching the final diagnosis with P value of 0.045, confidence interval 95%, and RR_F=1.385. Conclusion Those with vascular insults had 1.39 times the rate of reaching a final diagnosis compared with those with nonvascular insults.

Background Renal function − as many other organ functions − is immature in the early neonatal period. Aim A prospective study was carried out that aimed at determining serum creatinine and glomerular filtration rate (GFR) in apparently healthy full-term newborns (NBs) on the first and seventh days of postnatal life. Participants and methods This study included 50 apparently healthy full-term neonates born to healthy mothers at Damanhour Medical Institute in AL-Behera governorate. Half of the neonates were males; 27 babies were delivered vaginally and the remaining by cesarian section. All NBs were subjected to a full assessment of history and clinical examination. Complete blood count, C-reactive protein, alanine transaminase, aspartate transaminase, and abdominal ultrasound were performed for all NBs. Serum creatinine and GFR were estimated on the first and seventh days of life. Maternal serum creatinine was determined for all mothers on day 1. Results Serum creatinine showed a significant decrease on the seventh day. GFR was significantly increased by the seventh day of life. NBs’ serum creatinine showed a negative correlation with the postnatal age, while GFR showed a positive correlation.

Objective The present study was conducted to evaluate interleukin-16 (IL-6)–174 G/C polymorphism (rs1800795) as a predictor of outcomes of pediatric septic shock. Patients and methods This prospective observational study included 101 children having severe sepsis or septic shock admitted to the Pediatric Intensive Care Unit of a teaching university hospital starting from September 1, 2019 to March 31, 2020. A blood sample of 2 ml of whole blood was collected in EDTA tube on day 1 of admission. Genomic DNA was extracted from peripheral-blood mononuclear cells. IL-6–174G/C single-nucleotide polymorphism (rs1800795) genotyping was carried out using real-time quantitative-PCR by 5’-nuclease allelic-discrimination assay. Results The observed genotype frequencies are in equilibrium with Hardy–Weinberg equation (P=0.525). Regarding IL-6 genotypes, CC, CG, and GG represents 5, 39.6, and 55.4%, respectively. There was no significant difference between survived and deceased group as regards the polymorphisms CC, CG, or GG. There was no significant difference between both groups as regards C and G allele. There was no significant difference between CC, CG, and GG polymorphisms as regards mechanical-ventilation days, duration of Pediatric Intensive Care Unit stay, Pediatric Index of Mortality 2 score, C-reactive protein, white blood cells, as well as cultures. Conclusion IL-6–174G/C polymorphism (rs1800795) cannot predict mortality and did not affect outcomes in pediatric septic shock.

Objectives The objectives of this study were to assess ocular changes in β-thalassemia major patients who have received multiple transfusions and different chelating agents. Patients and methods A cross-sectional study of 90 β-thalassemia major patients from age group 14 to 24 years were selected as case group, and 90 age-matched and sex-matched healthy participants were considered as a control group. Full medical history and thorough physical examinations were done to all patient groups. Ocular examination, including visual acuity, refraction testing, slit-lamp examination, funduscopy, tonometry, perimetry, tear-breakup time test, and color-vision testing, was performed for all the participants. We computed the frequency and duration of blood transfusion, the mean serum ferritin level, pretransfusion hemoglobin concentration, the type, duration, and daily dose of chelation therapy for thalassemia patients based on their records. Results All thalassemic patients were asymptomatic, but abnormal ocular findings [dry eye (13.3%), cataract (10%), retinal changes (16.7%), color-vision deficiency (3.33%), ocular hypertension (6.67%), and visual acuity (8.88%)] were seen in 58.9% of thalassemic group. The prevalence of ocular abnormalities in the control group was 19.4%, which was significantly lower than that in thalassemia patients (P=0.000). No significant correlation was found between ocular abnormalities and mean serum ferritin level (P=0.627) and mean hemoglobin concentration (P=0.143). A positive correlation between the number of blood transfusions with the presence of ocular abnormalities was found to be statistically significant (P=0.005). Recommendations As life expectancy for β-thalassemia patients extends, regular ophthalmologic evaluation to detect early changes in their ocular system is recommended.

Background Febrile convulsion (FC) is the most common type of seizure in children aged 6 months to 5 years. Many risk factors that increase the occurrence of seizures have been identified. There is some evidence of the association between iron-deficiency anemia, iron status, and FC during childhood. Patients and methods A prospective case–control study was carried out in 45 admitted FC patients and 37 febrile nonconvulsive patients admitted to the hospital as a control group. Serum iron, ferritin, and transferrin saturation were compared in two groups. Iron deficiency is defined as serum ferritin lower than 30 ng/ml; serum iron more than 20 ng/dl and hemoglobin were adjusted according to age. Results The mean age of the patients in the febrile seizure group was 22.7±11.5 months and that in the control group was 18.8±11.3 months. The mean hemoglobin levels were 10.79±0.75 g/dl in the FC group and 11.56±0.6 g/dl in the control group. The mean ferritin in the FC group was 19.8 versus 51.2% ng/ml in the control group and the mean serum iron was 18.4% in the FC group versus 61.6% ng/ml in the control group. Conclusion This study suggests that iron-deficiency anemia and low serum ferritin levels may be associated with an increased risk of FCs.

Background The intelligence quotient of a child is determined to a large extent by genetic factors. However, the social context in which a child is brought up also plays a significant role in the overall cognitive capabilities of the child. Patients and methods This cross-sectional descriptive study enrolled 1122 school-aged children between the ages 6 and 12 years in the Enugu-East local government area of Enugu State over a 3-month period using the multistage sampling method. Raven’s Standardized Progressive Matrices and the Draw-A-Person Test (DAPT) were used to assess the intelligence quotient of the study participants. It aimed to assess the relatability of the two intelligent quotient (IQ) assessment system and sociodemographic determinants of IQ in school pupils. Results With the Raven system of IQ assessment, 73 pupils (7.6%) were noted to be above average intelligence, 150 (15.7%) had above average intelligence, 293 (30.6%) were considered to have average intelligence, while 340 (35.5%) and 101 (10.6%) were below average and intellectually defective, while the DAPT system categorized 258 of the pupils surveyed (27%) as having above average intelligence, 593 (62%) were considered to have average intelligence, while 82 (8.6%) and 24 (2.4%) were considered mentally deficient, respectively. Both scoring systems showed slight agreement with an interagreement reliability coefficient (қ) of 0.093 [95% confidence interval (CI) 0.001–0.003]. Pupils’ socioeconomic class [odds ratio (OR) 1.82 (95% CI 1.21–2.73), P=0.004], maternal educational [OR 0.38 (95% CI 0.23–0.63) P=0.001], and school type [OR 2.23 (95% CI 1.45–3.43) P=0.001] significantly predicted suboptimal IQ in study participants under the Raven assessment system. Conclusion Our study identified poor interrater agreement between the Raven and DAPT IQ assessment systems and factors that correlate with suboptimal IQ under the Raven system of IQ assessment.

Background The coronavirus (COVID-19) pandemic has caused tremendous disruption to patients with chronic diseases. Aim To detect prevalence of anxiety and depression among adolescents with juvenile idiopathic arthritis (JIA) during the COVID-19 pandemic. Patients and methods We conducted a cross sectional study included59 participants aged 12–18 years old (29 JIA patients and 30 healthy controls). An Arabic validatedform of the Hospital Anxiety and Depression Scale (HADS) as a measure of degree of anxiety and depression was used. Results Out of 29 JIA patients during the COVID-19 pandemic, 13.8% and 17.2% were consistent with diagnosis of anxiety and borderline anxiety respectively. Also, 3.4% and 17.2% reported symptoms consistent with diagnosis of depression and borderline depression respectively. There was no significant difference between patients’ anxiety and depression on one hand and control group on the other hand (for all P>0.05) Additionally, patients on biological infusion therapy requiring hospitalizationexhibited a significant increase in HADS-A score for anxiety (P value = 0.027). Conclusion A considerable proportion of JIA adolescent patients exhibited symptoms of either borderline or diagnosis consistent with anxiety and to a lesser extent with depression during the COVID-19 pandemic but with no significant difference with the control group. JIA and its related variables had no effect on psychological outcome of the patients compared to control. JIA patients who necessitated hospital admission were more likely to show higher anxiety levels. Attention should be paid to patients with JIA particularly those requiring frequent hospital admissions and their psychiatric symptoms during such pandemics to avoid unfavorable psychiatric hazards.

Background Coronavirus disease (COVID-19) pandemic and lockdown may influence children and adolescents’ quality of life (QoL). Aim To assess the impact of COVID-19 pandemic and lockdown on QoL of school-aged children and adolescents. Patients and methods A cross-sectional survey was conducted in Alexandria, on children and adolescents, fulfilling inclusion and exclusion criteria, during June 1st–10th, by an anonymous online questionnaire, sent through social media to participants, to assess their negative impact, feelings, and QoL. QoL was classified as poor, fair, or good. Results The study included 423 participants. Mean age 13.36±13.3 years. About 77.7% of participants adhered to lockdown completely. Around half of participants were negatively impacted by feeling bored, cannot leave the house, go to restaurants or cafes, see their friends, go on holidays, or go shopping. More than half felt bored, wanted their life to return to normal, afraid that they or a family member catches the disease, or want this to end. About 76.6% of participants had poor QoL, 23.2% had fair QoL, and 0.2% had good QoL. QoL was statistically significantly associated with age of participants, caregivers they are living with, and the number of their siblings, following lockdown, being negatively impacted by being unable to go shopping or go on holidays and feeling afraid to catch the disease. Conclusion COVID-19 pandemic and lockdown have an impact on school-aged children and adolescents’ feelings and a significant negative impact on their QoL changing it to fair or poor. Their QoL is influenced by their age, sex, their caregivers, unable to go shopping or go on holidays, and their fear to catch the disease, with a statistically significant association.

Objective The aim of this study was to explore the relationship between age at the time of diagnosis of pediatric phenylketonuria (PKU) and clinical manifestations in a sample of Egyptian children. Patients and methods This retrospective cohort included children diagnosed as PKU. The collected data included the time, age, and phenylalanine (Phe) level at diagnosis, sex, serial plasma Phe levels, neurological and behavioral problems, developmental quotient, and anthropometric measurements. Results Sixty-six patients were included. Compared with early diagnosed patients, late cases had significantly lower median Phe levels (P<0.001) and higher rates of neurological complications (P<0.001) and behavioral problems (P<0.001). Compared with compliant patients, noncompliance was significantly associated with late diagnosis (P=0.001), neurological complications (P=0.001), and hyperactivity (P=0.017). Conclusions Stature and head circumference were not significantly affected by time of diagnosis or compliance with treatment. Early diagnosis and compliance with dietary treatment have a potential impact on neurological and behavioral problems in pediatric PKU patients.

Background Community-acquired pneumonia (CAP) is one of the most important causes of mortality and morbidity in children worldwide. Identification of the microbial etiology in childhood CAP is impeded by difficulties in obtaining the proper samples. Limited data have been reported on bacterial pathogens that cause childhood CAP in Saudi Arabia. Objectives The authors aim to investigate the bacteriological causes of childhood CAP in Saudi Arabia and the value of serum biomarkers in the identification of bacterial CAP. Materials and methods A retrospective analysis of the electronic data of children with CAP aged 1 month to 14 years who were admitted between January 1, 2017 and December 31, 2019 was carried out. Demographic, clinical, laboratory, radiological, and sputum culture data were extracted. Results A total of 163 children with documented bacterial sputum culture results were identified; 43 (26.4%) had positive sputum. Staphylococcus aureus was the most frequently isolated organism in children with bacterial CAP (37.2%), followed by Klebsiella pneumonia (30.2%), streptococcus pyogens (14%), pseudomonas (14%), enterococci (2.3%), and streptococcus pneumonia (2.3%). A total leukocyte count of 11 000/mm³ has 60% sensitivity and 67% specificity for the prediction of positive bacterial sputum culture. An absolute neutrophil count of 7000/mm³ and C-reactive protein of 30 mg/L have low sensitivities of 36% and 38%, but high specificities of 78% and 80% in predicting positive bacterial sputum culture, respectively. Conclusion S. aureus and Klebsiella pneumonia are the most common bacteria that cause CAP in children in Saudi Arabia, with a lower prevalence of streptococcus pneumonia. Serum biomarkers such as total leukocyte count, absolute neutrophil count, and C-reactive protein have adequate specificity to identify patients with positive bacterial sputum culture.

In children, acute viral hepatitis-A infection is usually a self-limiting illness. In most children, it resolves uneventfully within weeks from the onset of disease. However, rare presentations like acute acalculous cholecystitis and persistent cholestatic jaundice have been reported. We report on a 7-year-old boy with prolonged cholestatic jaundice, which resolved without steroid treatment.