Background: About 25–50% of multisystem inflammatory syndrome in children (MIS-C) patients meet the criteria for diagnosis of Kawasaki disease (KD). The differentiation of both conditions is so challenging on clinical practice as the management of both is time dependant and precise diagnosis is fundamental. Method: Data were collected from children < 18 years old hospitalized with MIS-C or KD. Patient demographics, clinical, and laboratory data were compared, and a discrimination score was created to assist in clinical differentiation. Results: 72 patients with MIS-C and 18 with KD were included in the study. Patients with MIS-C had a higher prevalence of abdominal pain (p = 0.02), vomiting (p = 0.03), and cervical lymphadenopathy (p = 0.02) compared with KD cases. MIS-C patients had higher liver enzymes (aspartate aminotransferase (AST) (p = 0.04), alanine aminotransferase (ALT) (p = 0.03), serum creatinine (p = 0.03), and lower platelet count nadir (p = 0.02) than KD. Four variables were detected in the regression analysis model, and the independent predictors were utilized to generate a scoring model that distinguished MIS-C from KD with an area under the curve of 0.70. Conclusion: This study constructed a prediction model for differentiation of MIS-C from KD based on clinical and laboratory profiles. This model will be valuable to guide clinicians in the treatment decisions. Key Points• Children with MIS-C are more likely to have gastrointestinal symptoms, cervical lymphadenopathy, and respiratory involvement than KD patients.• Elevated liver enzymes and lower platelet count are more pronounced laboratory findings in MIS-C than KD.• This study constructed a prediction model for differentiation of MIS-C from KD based on clinical and laboratory profiles. This model will be valuable to guide clinicians in the treatment decisions.

Children with Down syndrome (DS) exhibit higher overweight/obesity rates than their typically developing peers. Apelin-12 is a bioactive adipokine that exerts vital roles in obesity-related cardiometabolic comorbidities. To date, apelin-12 has not been investigated in obese-DS. This study aimed to explore the possible association between serum apelin-12 and obesity-related markers and to evaluate the efficiency of apelin-12 in the prediction of metabolic syndrome (MetS) in obese-DS compared to BMI Z-score matched obese-control. The cross-sectional study included 150 prepubertal children classified into three groups; obese-DS (n = 50), obese-control (n = 50), and normal-weight-control (n = 50). Anthropometric parameters, body adiposity, fasting serum levels of blood glucose (FBG), insulin, lipid profile, and apelin-12 were evaluated. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated from FBG and insulin. MetS was defined using Adult Treatment Panel III criteria modified for the pediatric age group. ROC curves were analyzed to evaluate the efficiency of apelin-12 in predicting MetS in obesity groups. Obese-DS exhibited higher body adiposity with marked central fat distribution, atherogenic lipid profile, and higher HOMA-IR compared to obese-control. Apelin-12 was significantly higher in obese-DS and obese-DS with MetS compared to obese-control and obese-control with MetS respectively (p < 0.001). The increase in apelin-12 with higher obesity grades was pronounced in obese-DS. Apelin-12 strongly correlated with body adiposity, several MetS risk factors, and HOMA-IR in obese-DS. Significantly higher AUC for apelin-12 in the diagnosis of MetS among obese-DS than obese-control (AUC = 0.948 vs. AUC = 0.807; p = 0.04).Conclusions: The current study supports the crucial role of apelin-12 in obesity-related clinical and biochemical markers and in MetS in obese-DS and obese-control. Serum apelin-12 is a potential diagnostic biomarker for MetS with greater performance in obese-DS than obese-control raising its potential for clinical and therapeutic applications. What is Known:• Obese-DS children displayed excess body adiposity, Pronounced central fat distribution, atherogenic lipid profile, higher HOMA-IR, and higher prevalence of MetS than obese-control. What is New:• Higher serum apelin-12 was observed in obese-DS and obese-DS with MetS than obese-control and obese-control with MetS respectively. The increase in apelin-12 level with increasing obesity grades was more pronounced in obese-DS.• Apelin-12 strongly correlated with obesity-related markers and MetS components in obese-DS. Apelin-12 performed better as a diagnostic biomarker for MetS in obese-DS than obese-control.

Background: Malnutrition is a frequent complication in pediatric cases with chronic liver disease (CLD), exerting detrimental effects on overall growth and especially on neurocognitive outcomes. Objective: To assess the nutritional status of pediatric cases with CLD attending Mansoura University Children’s Hospital. Patients and methods: This case-control investigation enrolled 100 CLD pediatric cases attending the hepatology outpatient clinic at Mansoura University Children’s Hospital, along with 100 sex- and age-matched healthy children as controls. Eligible participants were 4–18 years and were stratified into three groups based on the Child-Pugh classification of disease severity. All subjects underwent detailed history taking, thorough clinical examination, anthropometric assessment, and bioelectrical impedance analysis. Results: All anthropometric measurements were affected with statistically significant lower Z-score values for weight, height, BMI, MUAC, and triceps SFT scores among children with CLD compared to control. Children with liver disease exhibited a substantially lower mean total body fat percentage relative to controls. In addition, both trunk fat mass (kg) and fat mass (kg) were reduced in cases relative to controls. Conclusion: Malnutrition in pediatric chronic liver disease is evident from lower anthropometric measures, reduced BMD, and altered body composition compared with controls.

The link between ABO/Rh blood groups and COVID-19 severity remains a topic of debate. We aimed to investigate the role ABO/Rh blood groups, rs8176746 and rs495828 single nucleotide polymorphisms (SNPs), in COVID-19 severity among COVID-19 patients in Mansoura City, Egypt. A total of 306 Egyptian patients were included in this cross-sectional study. They were grouped into 86 cases with non-severe infection and 220 with severe infection according to clinical, laboratory, and radiological findings. ABO/Rh blood groups were confirmed. A TaqMan real-time PCR SNP genotyping assay was used to examine the allelic discrimination of rs8176746 and rs495828 SNPs. Older age, male gender, and the presence of comorbidities were associated with severe COVID-19. AB blood group was significantly associated with a protective effect against severe COVID-19 (p = 0.029) in the unadjusted analysis. There was no statistically significant association between Rh type and disease severity. GT genotype was significantly associated with a higher frequency of AB blood groups in both rs8176746 and rs495828 (p < 0.001). However, there was no statistically significant association between the studied SNPs and COVID-19 severity. After adjusting for age, gender, and the presence of comorbidities, the protective effect of the AB blood group with severe COVID-19 did not remain significant. No association was observed between Rh type rs8176746 and rs495828 SNPs and COVID-19 severity. The impact of ABO/Rh blood types and related SNPs on COVID-19 severity can vary by the ethnic group and population being studied. This diversity emphasizes the need for specialized research approaches to better understand the demographic, clinical, and genetic factors that lead to variations in COVID-19 outcomes among various groups.