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The presented evidence-based clinical practice guideline (CPG) is proposed as a National CPG where we adapted the international recommendations for the emergency management of seizures in children beyond the neonatal period to suit the health care in Egypt. The quality of evidence and the strength of recommendations are indicated. This study aimed to standardize the treatment of acute epileptic seizures and to provide an easy-to-apply acute treatment protocol that will allow immediate and appropriate seizure control. This is part of a larger program by the Egyptian Pediatric Clinical Practice Guidelines Committee (EPG) in collaboration with the staff of pediatric departments of 15 Egyptian universities and the National Research Centre. EPG was affiliated later to the Supreme Council of the Egyptian University Hospitals aiming to define the topics of, assign authors to, and assist in the adaptation of pediatric evidence-based CPGs according to a national strategic plan (http://epg.edu.eg). The committee is guided by a formal CPG adaptation methodology: the "Adapted ADAPTE." The Egyptian Childhood Seizure Group (ECSG) reviewed the results of the Appraisal of Guidelines for Research and Evaluation II assessment and decided to adapt the recommendations of three source CPGs: American Epilepsy Society, Italian League Against Epilepsy, Neurocritical Care Society, and Neurologic & Psychiatric Society of Zambia. Eight implementation tools were included. A comprehensive set of multifaceted CPG implementation strategies was provided for the clinicians, patients, nurses, and other relevant stakeholders contextualized to the national settings. Our experience with this adaptation methodology provides useful insight into its national utilization in Egypt. [ABSTRACT FROM AUTHOR]

Aim: To compare the efficacy of intravenous clonazepam (CLZ) for the initial management of convulsive status epilepticus (CSE) in children as a function of the first‐line in‐hospital dose used. Method: This monocentric retrospective study included children who received a first dose of CLZ for CSE at Montpellier University Hospital, France, between January 2016 and June 2019. Data from medical records (clinical, treatment, course) were collected and compared as a function of the first CLZ dose used. Results: Among the 310 children treated for CSE, 105 received at least one CLZ dose (median age 3 years; quartile 1–quartile 3 [Q1–Q3] = 1 years 2 months–6 years 6 months). Among these 105 patients, 24 (22%) received a dose less than 0.03 mg/kg (low dose) and 69 (65%) received a dose of at least 0.03 mg/kg (high dose). Seizure cessation rate was not different between the low‐ and high‐dose groups (62.5% vs 76%; odds ratio 0.53, 95% confidence interval [CI] 0.19–1.44, p = 0.29). The administration of a second dose of CLZ was more frequent in the low‐ than the high‐dose group (37.5% vs 16%; odds ratio 3.2, 95% CI 1.1–9.1, p = 0.04). Interpretation: Our study did not find any difference in seizure termination rate as a function of CLZ dose in children with CSE. However, a second CLZ dose was more frequently needed in the group receiving low (less than 0.03 mg/kg) CLZ. [ABSTRACT FROM AUTHOR]

Background: Endoscopic callosotomy has emerged as a promising and minimally invasive technique for the treatment of refractory epilepsy. This paper aims to review the clinical outcomes and advancements associated with endoscopic callosotomy as a therapeutic option. Materials and methods: This study includes 14 Paediatric patients diagnosed and managed at Al-azhar university hospitals. Those 14 patients were studied over 2 years. All patients underwent a corpus callosotomy using the bimanual endoscopic technique. Results: Endoscopic anterior corpus callosotomy was done in 13 patients while one case underwent endoscopic complete callosotomy. The most frequent complication was transient disconnection syndrome followed by transient Urinary incontinence and one case had minor CSF leak. As regard seizure freedom outcome (Engel's Outcome Scale): 4 cases (28.6%) became seizure free (Engle class I), 5 cases (35.7%) with Engle class II, 1 case (7.1%) with Engle class III and 4 cases (28.6%) classify as Engle class IV. Conclusion: As a minimally invasive technique with a favorable impact on cognitive function, less complications and a significant reduction in seizure frequency and severity in the majority of paediatric patients, endoscopic corpus callosotomy offeres substantial benefits in managing refractory epilepsy in paediatric. [ABSTRACT FROM AUTHOR]

Background: Lung illnesses account for the majority of problems that affect newborns and children, as well as the main cause of death for children under the age of five. Thus, prompt and precise diagnosis is critical to effective therapy and better patient outcomes for those suffering from lung conditions. This study aimed to assess the role of lung ultrasonography as a diagnostic tool in different pediatric lung diseases. Patients and Methods: This case-control study was conducted at Pediatric Department, Benha University Hospital during the period from December 2022 to December 2023. It included 120 participants presenting with symptoms and signs suggesting lung diseases, the average age of the participants was 5.27 years with a standard deviation of 2.21. Results: Chest X-ray was (100%) diagnostic in different studied lung diseases, except for bronchitis where it was diagnostic in 69.7% of cases. Chest ultrasound was diagnostic in 84.8% of patients with bronchitis and (75%) of patients with pneumonia, while it was 100% diagnostic in cases with pneumonia complicated with effusion, collapse, and pneumothorax. In diagnosis of bronchitis, based on chest radiography (CXR), as a reference standard, US had overall sensitivity, specificity, and diagnostic accuracy of 100%, 50% and 84.8% respectively. Kappa statistics revealed significant moderate agreement between LUS and X-ray (kappa =0.582, p<0.001). In diagnosis of pneumonia, US had overall sensitivity, and diagnostic accuracy of 75% and 75% respectively. Conclusion: LUS has good sensitivity and specificity in diagnosing and following up common pediatric lung diseases at least as accurate as chest X-ray. [ABSTRACT FROM AUTHOR]

The coronavirus disease and the subsequent pandemic that followed drastically changed human civilization with disruptive effects on health and overall wellbeing of mankind. This disruptive effect has been shown to include changes in epidemiology of burn injuries. This study therefore aimed to determine the impact of covid-19 on acute burn presentation at the University College Hospital (UCH), Ibadan. This was a retrospective study carried out between April 1, 2019 and March 31, 2021. The period was divided into two: April 1, 2019 to March 31, 2020 and April 1, 2020 to March 31, 2021. Data obtained from the burn unit registry were analyzed using the Scientific Package For Social Sciences version 25. The only statistically significant finding from this study was the marked reduction in burn ICU admission during the pandemic (P < 0.001). A total of 144 patients presented to the burn intensive care unit at UCH, Ibadan during the period under review with 92 patients in the prepandemic year, and 52 patients in the pandemic year. Patient group from 0- to 9-year-olds representing 42% in prepandemic, and 30.8% in the pandemic period was the most affected age group. Scald was predominantly among the pediatric age group in both groups. Males were more likely to suffer flame burn in both study periods with a near gender equilibration during the pandemic. Burn injury during the pandemic resulted in more total body surface area burned. The lockdown effect of the pandemic resulted in a significant reduction in acute burn admissions at the UCH, Ibadan. [ABSTRACT FROM AUTHOR]

Introduction: Auditing of paediatric deaths has rarely been evaluated in hospitals especially in low and middle-income countries. The aim of the study is to describe the characteristics of paediatric death in hospitalised children and determine the predictors of death location in Hospital Universiti Sains Malaysia (USM). Method: Paediatric mortality cases for children aged between 29 days and 18 years old at the time of death were analyzed. These were documented cases between the year 2013 and 2020 at Hospital USM. Case notes were reviewed, and data were captured retrospectively. Multiple Logistic Regression was used to assess predictors of the location of death especially in the ward setting. Results: Out of 841 paediatric deaths identified during the period of the study, 544 cases were enrolled. The male gender has a higher proportion (1.4:1). The median age was 56 months, with infancy being the predominant age group. The median length of hospital stay was 10.5 days. More than half of the cases (58.3%) had underlying life-limiting illnesses. The majority of the patients had "Do Not Resuscitate" orders. A longer length of stay (prevalence odds ratio (POR 0.99, 95% CI 0.98, 0.99), being on ventilator (POR 3.42,95% CI 1.95, 6.01), being terminally ill (POR 0.40,95% CI 0.23, 0.70) and having underlying life limiting illness (POR 0.50, 95% CI 0.33, 0.75) were the significant predictors for the ward death. Conclusion: Understanding the characteristics of child death and the factors associated with death location is critical for improving paediatric care and treatment. [ABSTRACT FROM AUTHOR]

Aim: Clinical trials and the need for new treatments were recently listed among the most important factors for child health. The aim of the present study was to describe some of our experiences with budget preparations in paediatric clinical trials. Methods: We selected 10 trials sponsored by the pharmaceutical industry at the Pediatric Clinical Research Center at Sahlgrenska University Hospital in Gothenburg, Sweden. We compared the sponsor's initial budget (budget proposal from the sponsor), with the final budget (negotiated and agreed between sponsor and site) and identified areas where discrepancies may arise. Results: The mean difference in total budget amount between the initial budget and the final budget was +60% (mean 59%, range 31%–139%). The costs for preparation of the clinical trial, time spent for study activities and costs for examinations were identified as key budget items for these differences. Conclusion: Our findings indicate that a substantial part of the trial‐related costs would not be covered by the sponsor, had the initial budget been accepted. A thorough review and budget negotiation, as well as to have a dedicated team member for this task, are essential to ensure equitable responsibility for the study‐related costs and to avoid discontinuation of trials. [ABSTRACT FROM AUTHOR]

Background: Fellowship programs offer training in a subspecialty focusing on distinct and advanced clinical/academic skills. This advanced postgraduate training allows physicians, who desire a more specialized practice, to further develop clinical, academic, research, and leadership/administrative skills. The Aga Khan University (AKU) is one of the few institutes offering paediatric sub-specialty training in Pakistan. We aimed to evaluate the current Paediatric fellowship programs at AKU. Methods: Process evaluation of six paediatric fellowship programs (cardiology, neurology, endocrinology, critical care medicine, neonatology, and infectious disease) was conducted from September 2020 to April 2021 by senior clinicians and medical educationists. Evidence was collected through document review (using existing postgraduate medical education program information form), observation of teaching and learning support, and focused group discussions/interviews with program faculty and fellows were conducted. A review of the evaluation report was done as part of this study. This study received an exemption from the ethical review committee. The quantitative data were analyzed using SPSS (22.0) while the reports of discussion with fellows and friends underwent content analysis. Results: All fellowship programs met the criteria for having a robust competency-based fellowship curriculum as per the institutional and national guidelines. Formative assessment in the form of continuous evaluation was found to be integrated into all the fellowship programs, however, most of the programs were found to lack a summative assessment plan. Fellows in training and program faculty were satisfied with the opportunities for mentorship, teaching, and learning. Thematic analysis of the discussion reports with faculty and fellows revealed three key themes including, program aspects translating into strengthening the training, gaps in the training program in delivering the expectations, and making ways to reach par excellence. Conclusions: The process evaluation of paediatric fellowship programs provided an opportunity to holistically review the current strengths and quality of the training in individual programs along with the unmet needs of the trainees. This will help the program stakeholders to prioritize, align and allocate the resources to further enhance the quality of training and outcome of individual fellowship programs to ensure wider impacts at a regional, national, and international health system level. [ABSTRACT FROM AUTHOR]

Introduction: After six years of medication errors' (MEs) collection and analysis in a pediatric unit of a French University Hospital, the number of MEs was no longer decreasing. We then decided to set up pharmaceutical training and tools and evaluate their impact on the occurrence of ME. Materials and methods: This monocentric prospective study was carried out in the form of audits of prescriptions, preparations, and administrations before and after intervention (A1 and A2). After the analysis of A1 results, feedback was given to the teams, some tools for the proper use of medication (PUM) were distributed, and A2 was conducted. Finally, A1 and A2 results were compared. Results: Each audit included 202 observations. A total of 120 MEs were identified during A1 and 54 for A2 (p < 0.0001). The observation rate with at least 1 ME decreased from 39.11% to 21.29% (p < 0.0001), and no observation had more than two MEs during A2 in contrast to A1 (n = 12). Human factors were responsible for the majority of MEs. The audit feedback allowed professionals to feel concerned about ME. The PUM tools received an average satisfaction rating of 9/10. The staff had never participated in this type of training, and all felt it was useful to apply PUM. Conclusion: This study showed a significant impact of pharmaceutical training and tools on the pediatric PUM. Clinical pharmaceutic actions allowed us to reach our objectives and satisfied all the staff. They must, therefore, be continued to limit human factors' impact and thus contribute to the safety of drug management in pediatrics. [ABSTRACT FROM AUTHOR]

Background: About one in 200 to one in 300 male births has hypospadias. The prevalence of this congenital anomaly varies worldwide. The meatus is located distally in approximately 70% of cases. Several surgical techniques were described for distal hypospadias repair; despite this, there is no ideal approach. This study compares urethral advancement &glanuloplasty, and TIP techniques in terms of feasibility, duration of operation, and complications. Patients and. Methods: This prospective randomized comparative study was conducted at Al-Azhar University Hospitals from April 2022 to October 2022. Fifty-seven cases with different types of hypospadias were assessed for eligibility. Among them, seven cases were excluded due to the presence of severe chordee (n = 3), proximal variant (n = 2), and recurrent cases of hypospadias (n = 2). Fifty cases were randomly divided into two groups using a 1:1 ratio (computer-generated randomization). Twenty-five cases were subjected to urethral advancement and glanuloplasty, and the rest were subjected to tubularized incised plate (TIP) urethroplasty. Results: The mean age of all studied cases was 4.2 years. Approximately 52% had coronal or sub-coronal meatus, whereas 48% had glandular meatus. Both groups were matched according to age and meatus location (p > 0.05). No statistically significant difference was observed between the two groups regarding duration of operation, postoperative pain, and postoperative hospital stay. In addition, both groups did not differ significantly in late complications (meatal stenosis, meatal retraction, fistula, and glans dehiscence). Conclusions: Both urethral advancement &glanuloplasty, and TIP urethroplasty have comparable short-term outcomes. Urethral advancement and glanuloplasty is preferred in certain conditions, especially in circumcised children or those with a narrow urethral plate. Trial registration: The study protocol was approved by the Pan African Clinical Trials Registry (number for the registry is: PACTR202211757905870) on (29/11/2022). All procedures were performed per the Helsinki Declaration. [ABSTRACT FROM AUTHOR]

As pilomatricoma is a common adnexal skin tumor often occurring in exposed areas, dermatologists focus on minimizing postsurgical scarring. This retrospective study included patients aged < 19 years who underwent surgical treatment for pilomatricoma at a single university hospital from 2015 to 2021. Patient demographics, tumor characteristics, and surgical outcomes were analyzed according to the surgical methods including punch incision and elliptical excision. Overall, 75 patients and 79 lesions were included in the study. The mean age of the patients was 8.4 years, and 48 patients (64.0%) were females. The face was the most common site of pilomatricoma (51.9%), and within the face, the cheeks were the most common sites. No recurrence was observed in the elliptical excision group, while one case of recurrence (4.5%) was observed in the punch incision group. The mean length of the wound was 2.00 cm in the elliptical excision group, which was longer than that in the punch incision group (0.49 cm; p <.001). Considering that surgery is the gold standard treatment for pilomatricoma, punch incision may be useful as an alternative surgical option for pilomatricoma in children. [ABSTRACT FROM AUTHOR]

Background: Patients with end-stage renal disease (ESRD) receiving regular hemodialysis (HD) may experience acute or chronic pulmonary problems, which are one of the leading causes of death in this population. Physical deconditioning, muscular atrophy from lack of usage, weakness, exhaustion, lower-limb edema, and back discomfort can all contribute to a decline in the lung's functional capacity, which makes it difficult for these kids to accomplish everyday tasks. Objective: The aim of the current work was to examine pulmonary function testing in kids with ESRD receiving routine HD. Patients and Methods: This comparative cross-sectional study included a total of 26 Children with ESRD on regular HD and equal number of age and gender matched controls, attending at Inpatient Clinic, Pediatric Nephrology Department, Pediatric Hospital, Benha University Hospitals. Results: The present study showed that, mean values of forced expiratory volume in 1 second (FEV1) (%), forced vital capacity (FVC) (%), Peak expiratory flow (PEF) (%), maximal voluntary ventilation (MVV) (%), forced expiratory flow (FEF) (25-75) were statistically lower among hemodialysis group than Control group. However, there was no statistically significant difference in FEV1/FVC (%) between the hemodialysis group and the Control group. In the current study, 57.7% of the ESRD patients evaluated had restrictive spirometric patterns, 7.7% had mixed obstructive and restrictive patterns, and 7.7% had obstructive patterns. Conclusion: Our results support the notion that pulmonary function tests considerably decline in ESRD patients receiving HD compared to controls, with a strong negative connection between this and the length of dialysis. The majority of ESRD patients first displayed aberrant pulmonary functions, with a restrictive pattern predominating. [ABSTRACT FROM AUTHOR]

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Background: Among kids older than a year old, trauma is the primary cause of illness and death. Injuries to two or more organ systems that could prove fatal or disabling are unfortunately not out of the ordinary in pediatric patients who have sustained multiple severe injuries. Objective: To improve the circulatory management in pediatric polytrauma by detection of pitfalls according to international guidelines in Suez Canal University Hospital. Patients and Methods: All children with polytrauma who were brought to the Emergency Department (ED) at Suez Canal University Hospital were included in a cross-sectional study. Patients were evaluated and cared for with an emphasis on circulatory management in accordance with Advanced Trauma Life Support (ATLS) standards. Next, the patient's outcome was documented. Results: Obstruction of the airway, breathing difficulties, bradycardia, and extended capillary refill were substantially linked with the 9.5% death rate among pediatric polytrauma patients who presented to ED at Suez Canal University Hospital. Survival of the studied patients was statistically significant associated with higher frequency of performing chest X-ray (p < 0.001), pelvis X-ray (p < 0.012) and Focused Assessment with Sonography for Trauma (FAST) study (p=0.024). Conclusion: Adherence to the international guidelines in evaluation and management of pediatric polytrauma patients is a cornerstone in improving outcomes and decreasing mortality. [ABSTRACT FROM AUTHOR]

Background Routine electroencephalography (EEG) is a widely used test in children for the evaluation of many neurological conditions. It is specifically important in the diagnosis of epilepsy and the differentiation of epilepsy from nonepileptic events. Aim This study aimed to evaluate the current situation of EEG recording at Alexandria University Children's Hospital. Patients and methods All patients who had a routine EEG recording during a period of 6 months were included in the study. Review of the records was done including personal data, place and indication of referral, and initial diagnosis. EEG data included condition during recording, activation procedures, EEG interpretation regarding background activity, presence or absence of epileptiform activity, type and origin of epileptiform discharges, and the final yield of EEG. Results The study included 570 children, comprising 336 males and 234 females, with a mean age of 5.5±4.1 years. The main indication for referral was epilepsy in 69.8%. Most of the cases (83.3%) had an awake recording. Photic stimulation and hyperventilation were done in 93.3 and 31.9%, respectively, and abnormal response to hyperventilation was observed in 9.9% of them. Ictal recording was done in 22 (3.8%) cases. Abnormal epileptiform discharges were detected in 173 (30.4%) of the studied children; of them, 162 cases were initially referred for established epilepsy and 11 cases for other reasons. The abnormality was generalized in 53.8% and focal in 46.2% of the cases. The commonest types of epileptiform discharges were spikes (65.9%) followed by spike-and-wave complexes (56.1%). Hypsarrhythmia, 3-Hz spike-and-wave complexes, and nonconvulsive status epilepticus were detected in 12.7, 10.4, and 2.9%, respectively. Phase reversal, sharp waves, and polyspikes were detected in 15.6, 5.2, and 2.3%, respectively. Conclusion Routine EEG is a valuable test for evaluation of seizures and epilepsy. Specific abnormal epileptiform discharges are diagnostic for certain epileptic syndromes. EEG finding may be normal in children with epilepsy and should be interpreted in the context of the clinical settings. [ABSTRACT FROM AUTHOR]