Finding specific serum biomarkers linked to rheumatoid arthritis (RA) can help us understand the
course of the disease, and the prognosis. Here, we aimed to explore the potential use of arginine,
ornithine, tryptophan, citrulline, serotonin and several other biochemical markers for early
diagnosis of rheumatoid arthritis (RA). We examined serum samples from 30 controls and 60 RA
patients to achieve this goal. According to our findings, there was a statistically significant difference
in the serum levels of ornithine and arginine between RA patients and controls, with
higher ornithine and lower arginine in RA patients compared to controls. Furthermore, we found
that only patients with high disease activity index had considerably greater levels of serotonin.
Additionally, we found that using arginine alone can predict RA disease with 96.7% sensitivity
and 80.8 % specificity, while ornithine can predict RA disease with 100% sensitivity and 66.7%
specificity. Interestingly, the ornithine to arginine ratio (OR/AR) could identify people with RA
disease with 100% sensitivity and 83.3% specificity and this clear discrimination is not affected
by the disease index or duration. Hence, RA patients can be distinguished using the ornithine to
arginine ratio as a biomarker, which has higher specificity than each analyte alone. Our results
can undoubtedly serve as a foundation for additional research and multicenter studies in the
future to support accurate therapeutic management strategies for RA patients.

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. 
 

Background: Helicobacter pylori is a common gastrointestinal pathogen in low- and middle-income countries, linked to childhood dyspepsia, anemia, and long-term gastrointestinal sequelae. The aim was to determine the prevalence, risk factors, and endoscopic features of H. pylori infection in symptomatic children in a tertiary care setting. Methods: This cross-sectional study was conducted among children (aged 3–18 years) with chronic dyspepsia or hematemesis referred for endoscopy. H. pylori infection was diagnosed via histopathological examination of gastric biopsies. Sociodemographic, environmental, and behavioral risk factors were assessed and analyzed using multivariate logistic regression to identify independent predictors. Results: A total of 100 children were included. Mean age was 7.5±3.0 years and 62% were males. H. pylori infection was confirmed in 70% of the children. Multivariate analysis identified five independent predictors: low socioeconomic status (adjusted odds ratio [aOR]=1.97, 95% CI: 1.02–4.39, p=0.041), maternal education below tertiary level (aOR=1.76, 95% CI: 1.13–4.21, p=0.009), irregular handwashing (aOR=7.83, 95% CI: 4.66–18.55, p<0.001), utensil sharing (aOR=2.18, 95% CI: 1.01–3.20, p=0.041), and positive family history (aOR=7.99, 95% CI: 3.54–19.88, p<0.001). Infected children frequently had antral nodularity and lower hemoglobin levels. Conclusions:H. pylori infection is highly prevalent in cohort of dyspeptic children referred for endoscopy at a University-affiliated center. Modifiable risk factors, particularly poor hygiene and intrafamilial transmission, are strongly associated with infection. These results underscore the need for targeted, household-centered public health interventions focusing on hygiene education for mothers and caregivers, and family-based prevention strategies for symptomatic children and their households.

Background: Children's gastrointestinal problems are frequently caused by Helicobacter pylori infections. A non-invasive method of diagnosing H. pylori infection is stool antigen testing.
Aim of the study: to evaluate the diagnostic accuracy of stool antigen tests in children and their correlation to upper endoscopy and gastric mucosal biopsies.
Methodology: Children and adolescents with persistent or recurring unexplained dyspeptic symptoms and/or non-variceal hematemesis were the subjects of this cross-sectional investigation. The study was conducted over one year, from June 2023 to June 2024, and participants were recruited from the Gastroenterology, Hepatology, and Endoscopy Unit at Assiut University Children's Hospital.
Results: Based on the histology of the stomach biopsy, patients were divided into two groups: 19 (30.2%) were H. pylori-negative, and 44 (69.8%) were H. pylori-positive. There were 33.3% males and 66.7% females, with an average age of 8.43±2.9 years. The most prevalent symptom in H. pylori-positive cases was epigastric pain, and the two most important endoscopic findings were antral nodularity and nodular duodenal bulb. The stool antigen test demonstrated 91% sensitivity, 95% specificity, and 92% accuracy. Infected cases with stool antigen-positive results and moderate-to-severe H. pylori colonization density were significantly correlated.
Conclusion: The H. pylori stool antigen test is a reliable, cost-effective, and non-invasive diagnostic test for detecting H. pylori infection in children, owing to its high sensitivity and specificity.

Wilson’s disease (WD) is a rare genetic disorder of copper metabolism that results in dysfunction of copper excretion into bile leading to its accumulation in the liver, brain, cornea, and kidney. Only a few epidemiological studies about WD have been carried out, with limited available data about the disease. The most common liver disease in Egypt is viral hepatitis, which masks other liver diseases, especially in adults. This review describes the establishment of the first specialized WD clinic in the Assiut Liver Center, Upper Egypt. This multidisciplinary clinic comprises stakeholders working in WD management from different specialties, including hepatologists, pediatric hepatologists, neuropsychiatrists, dieticians, radiologists, pathologists, and ophthalmologists. Over 2 years since the launch of the WD clinic in February 2020, a total of 64 WD suspected cases were referred to our center. The WD clinic at the Assiut Liver Center is a step to provide an integrated service for neglected diseases like WD. Besides the provided integrated services for WD patients, a family screening program is applied with satisfying results.

Background: Prevalence of inflammatory bowel disease (IBD) is increasing in Egypt. Multiple lines of biological treatment have been but still there is failure of treatment to these medications and because of high cost it is of great importance to personalize treatment options. Aim of the study: This study aimed to assess the factors that can predict the response to biological treatment. Subjects and methods: This study included 133 patients with IBD who were indicated to biological treatment (AntiTNF), and followed up for 2 years. All demographic, clinical laboratory data and disease activity were recorded at 1st presentation. Patient were classified into 2 groups one group who showed nonresponse to treatment and the other one who responded well to treatment. All factors were analyzed as predictors of nonresponse using univariate and multiple regression. Results: Out of 133 patients of IBD, 77 patient showed non-response. Younger age, family history of IBD, long duration of disease, previous surgical resection and presence of extraintestinal manifestation could be predictors of non-response. Increased levels of inflammatory markers of ESR, CRP and fecal calprotectin were associated with poor response to therapy (p value < 0.001, < 0.001 and 0.001 respectively). Moreover, increased activity and colonic extent in UC associated with nonresponse also marked activity and behavior of CD patients could be predictive factors of relapse. In multivariable analysis the factors independently associated with non-response were younger age, long duration of disease, presence of extraintestinal manifestations, elevated ESR and fecal calprotectin. Conclusions: Multiple disease related factors can be associated and could predict the response to anti-TNF treatment. Keywords: Inflammatory bowel disease, biological treatment, Anti-TNF, non-response to treatment.

Background

Helicobacter pylori (H. pylori) proved to be highly prevalent all over the world. H. pylori may modify the absorption of many nutrients. Studies have suggested that, beyond iron, H. pylori infection may affect the homeostasis of other micronutrients such as vitamins and trace elements. Our study’s aim was to assess the effect of H. pylori infection on some blood micronutrient level including zinc, selenium, vitamin C, and vitamin B₁₂ in children with chronic or recurrent unexplained dyspeptic symptoms and/or non-variceal hematemesis.

Results

A cross-sectional case-control study was carried out in 32 children (4–18 years) with chronic or recurrent unexplained dyspeptic symptoms and/or non-variceal hematemesis. Patients were divided according to the results histopathology and rapid urease test into two groups, H. pylori-positive patients (18 patients) and H. pylori-negative patients (14 patients). Another control group of 18 children was included. Serum levels of zinc, selenium, vitamin C, and vitamin B₁₂ were measured in all children. Prevalence of H. pylori infection was 56.2%. The mean serum zinc levels were significantly lower in H. pylori-positive cases than in control group (84.2 ± 13.85 versus 94.6 ± 6.52 with P = 0.009) and lower than in H. pylori-negative cases but not statistically significant (84.2 ± 13.85 versus 92.2 ± 8.53 with P = 0.054). The mean serum vitamin C levels were significantly lower in H. pylori-positive cases than in negative cases and control group (220.7 ± 46.16 versus 305.1 ± 28.83 and 313.1 ± 31.43 with P < 0.0001). The mean serum vitamin B₁₂ levels were significantly lower in H. pylori-positive cases than in negative cases and control group (167.8 ± 76.98 versus 290.1 ± 69.92 and 326.1 ± 38.67 with P < 0.0001). The mean serum selenium level was slightly higher in H. pylori-positive patients than in H. pylori-negative patients and control group but not statistically significant (118.2 ± 11.13 versus 112.1 ± 8.69 and 113.1 ± 13.76 with P = 0.096, 0.243 respectively).

Conclusion

Helicobacter pylori infection in children has a significant negative effect on the serum levels of zinc, vitamin C, and vitamin B₁₂.