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BMJ Open Is Committed to Open Peer Review. As Part of This Commitment We Make the Peer Review History of Every Article We Publish Publicly Available BMJ Open: first published as 10.1136/bmjopen-2017-020609 on 25 July 2018. Downloaded from BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. When an article is published we post the peer reviewers’ comments and the authors’ responses online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay-per-view fees (http://bmjopen.bmj.com). If you have any questions on BMJ Open’s open peer review process please email [email protected] http://bmjopen.bmj.com/ on September 29, 2021 by guest. Protected copyright. BMJ Open BMJ Open: first published as 10.1136/bmjopen-2017-020609 on 25 July 2018. Downloaded from Establishment of Blood Pressure Nomograms Representative for Egyptian Children and Adolescents ForJournal: peerBMJ Open review only Manuscript ID bmjopen-2017-020609 Article Type: Research Date Submitted by the Author: 15-Nov-2017 Complete List of Authors: El-shafie, Ali; Menoufia University Faculty of Medicine, Pediatrics El-gendy, Fady; Menoufia University Faculty of Medicine, Pediatrics Allhony, Dalia; Menoufia University Faculty of Medicine, Pediatrics Abo El Fotoh, Wafaa; Menoufia University Faculty of Medicine, Pediatrics Omar, Zein; Menoufia University Faculty of Medicine, Pediatrics Samir, Mohamed; Menoufia University Faculty of Medicine, Pediatrics Bahbah, Wael; Menoufia University Faculty of Medicine, Pediatrics Zannoun, Mohamed; Al-Azhar University Faculty of Medicine, Pediatrics Abdallah, Sameh; Menoufia University Faculty of Medicine, pediatrics Saleh, Nagwan; Menoufia University Faculty of Medicine, pediatrics Said, Nahla; Menoufia University Faculty of Medicine, pediatrics El-Gazar, Basem; Menoufia University Faculty of Medicine, pediatrics Kasemy, Zeinab; Menoufia University Faculty of Medicine, Public Health and Community Epidemiology and Biostatistics Division http://bmjopen.bmj.com/ El-bazzar, Ahmed; Menoufia University Faculty of Medicine, pediatrics Abd El-nour, Mohamed; Menoufia University Faculty of Medicine, pedatrics Abd El-monsef, Amir; Cairo University Kasr Alainy Faculty of Medicine, Pediatrics Kairallah, Amir; Alexandria University Faculty of Medicine, pediatrics Raafet, Hythem; Al-Azhar University Faculty of Medicine, pediatrics Baz, Ghada; Menoufia University Faculty of Medicine, pediatrics Gaber, Amany; Menoufia University Faculty of Medicine, pediatrics Salah, Walaa; Ain Shams University Faculty of Medicine, pediatrics on September 29, 2021 by guest. Protected copyright. <b>Primary Subject Paediatrics Heading</b>: Secondary Subject Heading: Epidemiology, Paediatrics Keywords: Adolescence, Children, Nomograms, Blood pressure, Egyptian For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 27 BMJ Open Original article BMJ Open: first published as 10.1136/bmjopen-2017-020609 on 25 July 2018. Downloaded from 1 2 3 Establishment of Blood Pressure Nomograms Representative for Egyptian Children 4 5 and Adolescents 6 7 1 1 1 1 1 8 Ali M El-Shafie, Fady M El-Gendy, Dalia M Allhony, Wafaa Moustafa M. Abo El Fotoh*, Zein A 9 1 1 2 1 10 Omar, Mohamed A Samir, Wael A Bahbah, Mohamed A Zannoun, Sameh Abdallah Abd el naby, 11 1Nagwan Yossery Saleh, 1Nahla M Said Abd El Hady, 1Basem A El Gazar, 3Zeinab A Kasemy, 1 Ahmed N 12 1 4 5 6 13 El-Bazzar, Mohamed Abd El-nour Abd El-Fattah , Amir A Abdel Monsef, Amir M Kairallah, Hythem M 14 Raafet, 1Ghada M Baz, 7Amany G Salah, 1Walaa S Galab. 1Department of Paediatrics, Faculty of Medicine, 15 For peer review only 16 Menoufia University, Egypt.2Department of Paediatrics, Faculty of Medicine, Al-Azhar University, 17 3 18 Egypt. Department of Public Health and Community Epidemiology and Biostatistics Division, Faculty of 19 4 20 Medicine, Menoufia University, Egypt. Department of Paediatrics, Faculty of Medicine, Cairo University 21 Kasr Alainy, Egypt.5Department of Paediatrics, Faculty of Medicine, Alexandria University, 22 6 7 23 Egypt. Department of Paediatrics, Faculty of Medicine, Al-Azhar University, Egypt. Department of 24 25 Paediatrics, Faculty of Medicine, Ain Shams University, Egypt. 26 --------------------------------------------------------------------------------------------------------------------------------- 27 28 *For correspondence and reprint: 29 30 Wafaa Moustafa M. Abo El Fotoh 31 Assistant professor of Pediatrics 32 33 Faculty of Medicine http://bmjopen.bmj.com/ 34 35 Menoufia University Hospital 36 Egypt. 37 38 Mobile: +201020418099 39 40 E-mail: [email protected] 41 ---------------------------------------------------------------------------------------------------------------------------------- on September 29, 2021 by guest. Protected copyright. 42 43 Data Sharing Statement: None declared 44 45 ---------------------------------------------------------------------------------------------------------------------------------- 46 47 Disclosure 48 49 The authors declare no financial or other conflicts of interest related to this work. 50 51 Ethical approval 52 53 All procedures performed in the study were in accordance with the ethical standards of the institutional 54 55 56 research committee 57 58 ------------------------------------------------------------------------------------------------------------------------------- 59 60 1 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 27 Abstract: BMJ Open: first published as 10.1136/bmjopen-2017-020609 on 25 July 2018. Downloaded from 1 2 Objective: Till now no available blood pressure nomograms for children and adolescents in Egypt. 3 4 5 Methods and study design: A total of 60025 Egyptian children from birth to 19 years were enrolled in this 6 7 cross sectional randomized study from December 2015 to March 2017. They were selected from diverse 8 9 geographical districts in Egypt. Healthy children who fulfilled the inclusion criteria, which included good 10 11 nutritional history, the absence of fever or documented underlying disease at the time of examination, no 12 13 evidence of hemodynamically significant illness, no antihypertensive drugs or other chronic drug 14 15 For peer review only 16 administration, were included in the study. Body weight, recumbent length (for less than 24 months), and 17 18 height (from 2 years to 19 years), blood pressure were measured using standard mercury 19 20 sphygmomanometers. 21 22 Results: Blood pressure rises with age in both boys and girls. The 90th percentiles of SBP and DBP among 23 24 25 Egyptian children were different from other ethnic population (American and Turkish children) among both 26 27 sexes. Systolic and diastolic blood pressure showed a positive correlation with weight and height in both 28 29 sexes (P<0.001). 30 31 Conclusion: We assumed that normal BP curves should be utilized cautiously in childhood, and it is 32 33 recommended that every population should handle their own normal standard curves to define a measured http://bmjopen.bmj.com/ 34 35 36 blood pressure levels in children. These centiles increase our knowledge and awareness of normal blood 37 38 pressure among Egyptian children and adolescents. The percentiles will distinguish children and young 39 40 adolescents with increased blood pressure and will be of value to both medical practice and scientific 41 on September 29, 2021 by guest. Protected copyright. 42 research. 43 44 45 Keywords 46 47 Egyptian; Blood pressure; Nomograms; Children; Adolescence 48 49 50 51 52 53 54 55 56 57 58 59 60 2 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 27 BMJ Open Strengths and limitations of this study BMJ Open: first published as 10.1136/bmjopen-2017-020609 on 25 July 2018. Downloaded from 1 2 - Appropriate sample size estimation 3 4 5 - The other strength is the multicentre representation of diverse geographical districts in Egypt 6 7 - Use of standard accurate mercury sphygmomanometers for BP records 8 9 - BP measurements were obtained in usual settings for children such as school and home overcoming 10 11 the phenomenon of white coat hypertension 12 13 - The first study to specify BP values and curves in Egyptian boys and girls 14 15 For peer review only 16 Funding: This research received no specific grant from any funding agency in the public, commercial or 17 18 institutional funds 19 20 Ethical approval: all procedures performed in the study were in accordance with the ethical standards of 21 22 our institutional research committee 23 24 25 Competing interests: None declared 26 27 Contributors: Idea and design: Ali M El-Shafie, Fady M El-Gendy, Dalia M Allhony, Wafaa Moustafa M. 28 29 Abo El Fotoh, Sameh Abdallah Abd el naby, Mohamad A Zannoun. Participant enrollment and data 30 31 collection: Ahmed N El-Bazzar, Mohamed A Abd El-Fattah, Amir A Abdel Monsef, Amir M Kairallah, 32 33 Hythem M Raafet, Ghada M Baz, Amany G Salah, Walaa S Galab. Data interpretation: Zein A Omar, http://bmjopen.bmj.com/ 34 35 36 Mohamed A Samir, Wael A Bahbah.
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