الفهرس 
Chapter 1: PneumoniaOnly 14 pages are availabe for public view
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Abstract
Pneumonia is an inflammation of the lung parenchyma, where the lungs become inflamed and congested, thus reducing oxygen exchange, and lead to cough and shortness of breath. It’s the leading cause of death among children less than five years of age, despite effective vaccines and environmental and nutritional interventions.
Zinc is an important micronutrient supporting growth and normal function of the immune system. Zinc deficiency results in growth impairment, anorexia, behavioral changes, and impaired immune function, leading to susceptibility to infections. Children in developing countries are at a high risk of deficiency due to inadequate zinc in their diets. The evidence regarding the role of zinc as an adjunct therapy in children with severe pneumonia is controversial. As discussed above, where some major clinical trials have cast zinc in a promising light, others have shown no clinical benefit to patients. While this study reported robust results, it was not without certain limitations. Therefore, the aim of the present work was to determine the prevalence of zinc deficiency among hospitalized children with pneumonia as well as assess the impact of adjuvant zinc supplementation on pneumonia outcomes.
To achieve such aim, an interventional study (double blinded, placebo-controlled randomized clinical trial) that included children of both genders aged 2 months to less than 5 years who were admitted to the wards of Menoufia university hospital’s pediatric department with a clinical diagnosis of pneumonia between May 2021 and June 2022.
The sample size was calculated to include patients that admitted in the pediatric ward with confirmed pneumonia diagnoses classified according to the revised WHO guidelines, children as presence of cough or difficulty breathing associated with fast breathing or chest indrawing in children 2–59 months of age. This was confirmed by the radiological finding of a consolidation.
After enrolment, the children were randomized to two groups. first group were received zinc supplementation 10 mg (1 ml/ kg in children younger than 12 months, and 20 mg/day every 12 hours for children of 1359 months (number=40). Second group were received a placebo (number=40).
Baseline data, a full medical history, and clinical assessments were completed prior to the intervention. The same physician performed the physical examinations at the onset and next twice daily till release. Daily monitoring of zinc intake was also performed. The serum zinc levels were measured for all the patients within 24 hours of admission and, for the case group at their discharge from the hospital, or up to a maximum of 7 days. Also, complete blood count, renal, liver function and CRP was recorded from the patient file as it is routinely done to all admitted children. In addition, chest radiograph was done for all participants.
The primary outcome of the study was the time to the cessation of pneumonia, including the time from enrollment to the elimination of tachypnea, chest in-drawing, and abnormal air entry. Secondary outcomes were the length of the patient’s hospital stay.
from this study, the results showed that:
1. The overall prevalence of zinc deficiency among the studied children was 17.5%.
2. The mean age of the studied group was (12.906±11.23) months. Most of them were males& more than two thirds of them from rural areas 3. There is no significant relationship between zinc and placebo groups regards the base line Demographic data of the studied children including age, child number, arrangement, socioeconomic status, parent smoking and consanguinity.
4. The most common presenting symptoms among children with pneumonia were cough and dyspnea followed by fever at time of hospital admission.
5. There was no statistically significant difference between zinc and placebo groups regards the clinical features including duration of symptom before admission, body temperature, heart rate, respiratory rate at the time of hospital admission.
6. There was no statistically significant relation between zinc and placebo groups regards laboratory investigations of the studied children at time of hospital admission including hemoglobin, white blood cell and platelet counts at the time of hospital admission. The mean serum zinc concentrations did not differ significantly between the two groups.
7. The study found a statistically significant difference between the zinc and placebo groups in terms of the mean days to disappearance of chest in-drawing group. All lower respiratory infection symptoms vanished significantly faster in the zinc group than in the control group.
8. There was also a statistically significant difference between the two groups in terms of the mean duration of tachypnea in Zinc group versus and the time to normal bilateral air entry (p=0.043).
9. The mean duration of hospitalization in the zinc group was shorter than in the control group.