Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Pneumonia is an infection of the lower airways (distal bronchi and alveoli) caused by both viruses and bacteria. Community Acquired Pneumonia (CAP) specifically refers to clinical signs and symptoms of pneumonia acquired outside a hospital setting (Harris et al., 2011). In other words, CAP occurs within 48 hours of hospital admission or in a patient presenting with pneumonia who has no features of healthcare-associated pneumonia (i.e., admission to hospital for two or more days within three months of infection or residency in a long-care facility or received recent chemotherapy or wound care within the past 30 days of the current infection (Pahal et al., 2021). It is one of the most common serious infections in childhood, accounting for more than 900.000 deaths among children younger than 5 years of age in 2015 (World Health Organization, 2016). Vitamin C is a water-soluble vitamin with a variety of antioxidant, (Padayatty &Levine, 2016)anti-inflammatory, (Sorice et al., 2014)and microvascular effects (Tyml, 2017). Widely used in over-the- counter formulations for common cold and general well-being, (Hemila, 2013)in recent years, there has been an expanding role for the use of vitamin C in the hospital setting. Although the overall prevalence of hypovitaminosis C is around 7.1% in the general population, (Schleicher et al., 2009)up to 47.3% of undifferentiated hospitalized patients are deficient in vitamin C (Fain et al., 2003). Vitamin C levels are known to be decreased in critical illness (Polidori et al., 2001)and are associated with the severity of the illness (Zhang & Jativa, 2018). Although vitamin C requirements are greater in this population due to increased oxidative stress, (Berger et al., 2009)levels may be restored to normal, (Wilson, 2013)or even brought to supra-normal, with parenteral supplementation (Bell et al., 2005). Vitamin C is proved to improve endothelial function (Thosar et al., 2015), lower blood pressure (Juraschek et al., 2012),increase left ventricular ejection fraction (Ramos et al., 2017), decrease the incidence of atrial fibrillation (Shi et al., 2020), protect against contrast-induced acute kidney injury (Xu et al., 2018), decrease bronchoconstriction (Hemilä et al., 2014)and prevent pain (Carr et al., 2017).

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