Introduction: New Delhi metallo-β-lactamase (NDM)-producing K. pneumoniae poses a high risk, especially among Egyptian pediatric patients who consume carbapenems antibiotics very widely and without adequate diagnostic sources. In addition, presence of efflux pump genes such as OqxAB increases resistance against many groups of antimicrobials which exacerbates the problem faced for human health. This study aimed to determine NDM variants among K. pneumoniae strains isolated from pediatric patients in Egypt, analyze the presence of OqxAB genes, and molecular characterization of blaNDM-5-positive K. pneumoniae. Methods: Fifty-six K. pneumoniae isolates were recovered from pediatric patients, and tested for carbapenemase by modified carbapenem inactivation methods (mCIM) test. Minimum inhibitory concentrations of meropenem and colistin were determined by meropenem E-test strips and broth microdilution, respectively. PCR was used for the detection of the resistant genes (ESBL gene (blaCTX-M), carbapenemase genes (blaNDM, blaKPC) colistin resistant (mcr1, mcr2)) and genes for efflux pump (oqxA and oqxB). BlaNDM was sequenced. The effect of efflux pump in NDM-5-producing isolates was assessed by measuring MIC of ciprofloxacin and meropenem before and after exposure to the carbonyl cyanide 3-chlorophenylhydrazone (CCCP). The horizontal gene transfer ability of blaNDM-5 was determined using liquid mating assay and PCR-based replicon typing (PBRT) was done to determine the major plasmid incompatibility group. Results: Twenty-nine isolates were positive for blaNDM-1, nine isolates were positive for blaNDM-5, and 15 isolates were positive for blaKPC. There is a significant increase of meropenem MIC of NDM-5-positive isolates compared with NDM-1-positive isolates. In addition, 38 isolates were positive for CTX-M, and 15 isolates were positive for mcr1. Both OqxA and OqxB were detected in 26 isolates and 13 isolates were positive for OqxA while 11 isolates were positive for OqxB only. All NDM-5-producing isolates except one isolate could transfer their plasmids by conjugation to their corresponding transconjugants (E. coli J53). Plasmid replicon typing showed that FII was predominant in NDM-5-producing K. pneumoniae. Similar strains were found between the three isolates and similarity was also detected between the two isolates. Conclusion: The highly resistant K. pneumoniae producing blaNDM-5 type was firstly isolated from pediatric patients. The association of efflux pump genes such as OqxAB is involved in resistance to ciprofloxacin. This highlighted the severity risk of blaNDM-5-positive K. pneumonia as it could transfer blaNDM-5 to other bacteria and has more resistance against carbapenems. This underlines the importance of continuous monitoring of infection control guidelines, and the urgent need for a national antimicrobial stewardship plan in Egyptian hospitals. 
 

Background: Celiac disease (CD) is the most prevalent food intolerance caused by genetics in the world.

Aim: To evaluate the validity of a feasible, noninvasive test, i.e., serum anti-tissue transglutaminase IgA antibodies as a diagnostic test for patients with CD, compared to the gold standard diagnostic test for such cases, i.e., intestinal biopsy histopathology.

Methods: This is a prospective observational study conducted at Gastroenterology Unit at Assiut University Children Hospital from December 2019 to November 2020. The study included 60 children who were suspected clinically to have CD. Serum level of antitissue transglutaminase IgA (tTGIgA) antibodies were analyzed by enzyme-linked immunosorbent assay (ELISA). Duodenal histopathology using gross endoscopic pictures and Marsh-Ober Huber criteria, were determined.

Results: Histological examination found 16 patients (26.7%) exhibited positive findings consistent with CD. Serological analysis showed that 14 patients (25%) had positive antibody results. The diagnostic performance of tTG-IgA was evaluated using the receiver operating characteristic (ROC) curve, yielding an area under the curve (AUC) of 0.81. The sensitivity of tTG-IgA was 87.7%, while the specificity was 97.7%. The positive predictive value (PPV) was calculated to be 75%, whereas the negative predictive value (NPV) was 98%, indicating a high level of diagnostic accuracy.

Conclusion: The study emphasized the clinical utility of tTG-IgA antibodies as a highly specific and reliable non-invasive diagnostic tool for identifying children at risk of CD. Early identification and appropriate management of CD through serological screening can significantly improve outcomes and quality of life for affected children. 
 

Introduction: Anemia is a global public health issue that affects children's health, cognitive and physical development, immunity, and increases the risk of infections and infant mortality. This study aimed to assess the prevalence of anemia and its associated demographic, nutritional, and growth-related factors among children under two years of age hospitalized with acute gastroenteritis at Assiut University Children Hospital.

Material and methods: A cross-sectional study was conducted on 311 pediatric patients admitted with acute gastroenteritis at Assiut University Children Hospital between December 2023 and November 2024, utilizing a well-structured questionnaire.

Results: Among the 311 pediatric patients, the mean age was 7.9 ± 4.9 months. Anemia was identified in 198 children (63.7%). Anemic children were significantly older, more likely to be exclusively breastfed, and had later introduction of complementary feeding compared with non-anemic children. By using multivariate analysis, increasing age (adjusted OR 1.48 per month, 95% CI 1.11–1.98), exclusive breastfeeding without iron supplementation (adjusted OR 1.78, 95% CI 1.12–2.85), and delayed introduction of complementary foods (adjusted OR 1.26 per month, 95% CI 1.03–1.55) were independently associated with anemia. Anemic children demonstrated a higher prevalence of underweight, stunting, and abnormal head circumference for age.

Conclusions: Anemia is highly prevalent among children under two years of age admitted with acute gastroenteritis. Its association with suboptimal feeding practices and impaired growth highlights the need for early nutritional interventions, timely introduction of ironrich complementary foods, and routine anemia screening.