Clinical factors predicting rotavirus diarrhea in children: A cross-sectional study from two hospitals

BACKGROUND

Rotavirus is still a significant contributing morbidity and mortality in pediatric patients.

AIM

To look at clinical signs and symptoms and laboratory findings that can predict rotavirus gastroenteritis compared to non-rotavirus gastroenteritis.

METHODS

This was a cross-sectional study with medical records obtained from December 2015 to December 2019. Inclusion criteria for this study include all hospitalised pediatric patients (0-18 years old) diagnosed with suspected rotavirus diarrhea. The receiver operating curve and Hosmer-Lemeshow test would be used to assess the final prediction findings' calibration (goodness of fit) and discrimination performance.

RESULTS

This study included 267 participants with 187 (70%) rotavirus-diarrhea cases. The patients were primarily male in both rotavirus (65.2%) and non-rotavirus (62.5%) groups. The median age is 1.33 years old (0.08-17.67 years old). Multivariate analysis shows that wet season (ORadj = 2.5; 95%CI: 1.3-4.8, Padj = 0.006), length of stay (LOS) ≥ 3 days (ORadj = 5.1; 95%CI: 1.4-4.8, Padj = 0.015), presence of abdominal pain (ORadj = 3.0; 95%CI: 1.3-6.8, Padj = 0.007), severe dehydration (ORadj = 2.9; 95%CI: 1.1-7.9, Padj = 0.034), abnormal white blood cell counts (ORadj = 2.8; 95%CI: 1.3-6.0, Padj = 0.006), abnormal random blood glucose (ORadj = 2.3; 95%CI: 1.2-4.4, Padj = 0.018) and presence of fecal leukocytes (ORadj = 4.1, 95%CI: 1.7-9.5, Padj = 0.001) are predictors of rotavirus diarrhea. The area under the curve for this model is 0.819 (95%CI: 0.746-0.878, P value < 0.001), which shows that this model has good discrimination.

CONCLUSION

Wet season, LOS ≥ 3 d, presence of abdominal pain, severe dehydration, abnormal white blood cell counts, abnormal random blood glucose, and presence of fecal leukocytes predict rotavirus diarrhea.

Childhood gastroesophageal reflux disease: A comprehensive review of disease, diagnosis, and therapeutic management

Gastroesophageal reflux disease (GERD) affects both adults and children, although the symptoms differ significantly between these groups. While adults typically experience heartburn and regurgitation, children may present with more subtle signs, such as failure to thrive, chronic cough, wheezing, and Sandifer syndrome. Diagnosing GERD in children necessitates a multifaceted approach due to the diverse symptomatology and challenges in communication. Clinical assessment serves as the cornerstone of diagnosis, supported by tools like pH monitoring, esophageal impedance testing, and upper gastrointestinal endoscopy. Imaging studies, such as barium swallow, can also provide valuable insights into anatomical abnormalities and the extent of reflux. Treatment strategies for pediatric GERD include lifestyle adjustments, pharmacotherapy, and, in severe cases, surgical interventions. Lifestyle adjustments may involve changes in feeding patterns, positional therapy, and weight management. Pharmacological options range from acid suppression with proton pump inhibitors or histamine-2 receptor antagonists to surgical procedures like fundoplication for refractory cases. Personalized management is essential, considering the child's age, symptom severity, and the presence of complications. This article aims to offer a comprehensive understanding of pediatric GERD by utilizing current research to enhance clinical approaches and improve patient outcomes.

Migration of the distal ventriculoperitoneal shunt catheter into the stomach with or without trans-oral extrusion: A systematic literature review and meta-analysis

BACKGROUND

Intra-gastric migration of the distal ventriculoperitoneal shunt (VPS) catheter clinically presenting with or without trans-oral extrusion is one of the rare complications of VPS catheter insertion.

AIM

To identify the demographics, clinical presentation, clinical findings, and results of surgical therapy offered for the treatment of intra-gastric migration of the distal VPS catheter, clinically presented with or without trans-oral extrusion.

METHODS

An online search was performed for the extraction/retrieval of the published/ available literature pertaining to the above-mentioned VPS complication. Manuscripts were searched from PubMed, PMC (PubMed Central), ResearchGate, and Google Scholar databases using various terminology relating to the VPS complications. The first case of migration of a VPS catheter into the stomach was reported in the year 1980, and the data were retrieved from 1980 to December 2022. Cases were categorized into two groups; Group A: Cases who had migration of the distal VPS catheter into the stomach and clinically presented with trans-oral extrusion of the same, and Group B: Cases who had migration of the distal VPS catheter into the stomach, but presented without trans-oral extrusion.

RESULTS

A total of n = 46 cases (n = 27; 58.69% male, and n = 19; 41.3% females) were recruited for the systematic review. Group A included n = 32, and Group B n = 14 cases. Congenital hydrocephalus was the indication for the primary VPS insertion for approximately half of the (n = 22) cases. Approximately sixty percent (n = 27) of them were children ≤ 5 years of age at the time of the diagnosis of the complication mentioned above. In seventy-two percent (n = 33) cases, this complication was detected within 24 mo after the VPS insertion/last shunt revision. Clinical diagnosis was evident for the entire group A cases. Various diagnostic modalities were used to confirm the diagnosis for Group B cases. Various surgical procedures were offered for the management of the complication in n = 43 cases of both Groups. In two instances, intra-gastric migration of the distal VPS catheter was detected during the autopsy. This review documented four deaths.

CONCLUSION

Intra-gastric migration of the peritoneal end of a VPS catheter is one of the rare complications of VPS catheter implantation done for the treatment of hydrocephalus across all age groups. It was more frequently reported in children, although also reported in adults and older people. A very high degree of clinical suspicion is required for the diagnosis of a case of an intra-gastric migration of the distal VPS catheter clinically presenting without trans-oral extrusion.

Decoding the genetic landscape of autism: A comprehensive review

BACKGROUND

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by heterogeneous symptoms and genetic underpinnings. Recent advancements in genetic and epigenetic research have provided insights into the intricate mechanisms contributing to ASD, influencing both diagnosis and therapeutic strategies.

AIM

To explore the genetic architecture of ASD, elucidate mechanistic insights into genetic mutations, and examine gene-environment interactions.

METHODS

A comprehensive systematic review was conducted, integrating findings from studies on genetic variations, epigenetic mechanisms (such as DNA methylation and histone modifications), and emerging technologies [including Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-Cas9 and single-cell RNA sequencing]. Relevant articles were identified through systematic searches of databases such as PubMed and Google Scholar.

RESULTS

Genetic studies have identified numerous risk genes and mutations associated with ASD, yet many cases remain unexplained by known factors, suggesting undiscovered genetic components. Mechanistic insights into how these genetic mutations impact neural development and brain connectivity are still evolving. Epigenetic modifications, particularly DNA methylation and non-coding RNAs, also play significant roles in ASD pathogenesis. Emerging technologies like CRISPR-Cas9 and advanced bioinformatics are advancing our understanding by enabling precise genetic editing and analysis of complex genomic data.

CONCLUSION

Continued research into the genetic and epigenetic underpinnings of ASD is crucial for developing personalized and effective treatments. Collaborative efforts integrating multidisciplinary expertise and international collaborations are essential to address the complexity of ASD and translate genetic discoveries into clinical practice. Addressing unresolved questions and ethical considerations surrounding genetic research will pave the way for improved diagnostic tools and targeted therapies, ultimately enhancing outcomes for individuals affected by ASD.

Association of breastfeeding with tidal breathing analysis in infants with bronchiolitis

BACKGROUND

Tidal breathing flow-volume (TBFV) analysis provides important information about lung mechanics in infants.

AIM

To assess the effects of breastfeeding on the TBFV measurements of infants who recover from acute bronchiolitis.

METHODS

In this cross-sectional study, TBFV analysis was performed in infants with bronchiolitis prior to hospital discharge. The ratio of time to peak expiratory flow to total expiratory time (tPEF/tE) at baseline and after the administration of 400 mcg salbutamol was evaluated.

RESULTS

A total of 56 infants (35 boys), aged 7.4 ± 2.8 mo, were included. Of them, 12.5% were exposed to tobacco smoke and 41.1% were breastfed less than 2 mo. There were no differences in baseline TBFV measurements between the breastfeeding groups; however, those who breastfed longer than 2 mo had a greater change in tPEF/tE after bronchodilation (12% ± 10.4% vs 0.9% ± 7.1%; P < 0.001). Moreover, there was a clear dose-response relationship between tPEF/tE reversibility and duration of breastfeeding (P < 0.001). In multivariate regression analysis, infants who breastfed less (regression coefficient -0.335, P = 0.010) or were exposed to cigarette smoke (regression coefficient 0.353, P = 0.007) showed a greater change in tPEF/tE after bronchodilation, independent of sex, prematurity, and family history of asthma or atopy.

CONCLUSION

Infants who recover from bronchiolitis and have a shorter duration of breastfeeding or are exposed to cigarette smoke, have TBFV measurements indicative of obstructive lung disease.

Clinical, laboratory, and therapeutic differences between immunoglobulin E-mediated and non-immunoglobulin E-mediated cow’s milk protein allergy in children

BACKGROUND

Although breast milk is ideal for newborns, in some cases, it is replaced with cow’s milk, which contains proteins that increase the risk of cow’s milk protein allergy (CMPA).

AIM

To evaluate CMPA prevalence in Bahrain and compare clinical characteristics of children with immunoglobulin E (IgE)- and non-IgE-mediated CMPA.

METHODS

This retrospective cohort study examined children with CMPA diagnosed at the pediatric gastroenterology outpatient clinic of the Salmaniya Medical Complex, Bahrain, between 2014 and 2022, and assessed CMPA prevalence. Clinical presentations, laboratory findings, dietary modifications, and outcomes were compared between children with IgE-mediated and non-IgE-mediated CMPA. Categorical variables were compared using Fisher’s exact test or Pearson’s χ² test, whereas continuous variables were compared using Student’s t-test or the Mann-Whitney U test.

RESULTS

Of 8332 patients, 6022 (72.3%) adhered to their appointment. Of them, 618 (10.3%) were suggested of having CMPA and 595 (96.3%) were included; CMPA prevalence was 2%. Most patients were Bahraini (93.8%) and males (55.3%). Non-IgE-mediated type accounted for 77.3% cases and IgE-mediated type, 22.7%. IgE-mediated CMPA presented more in boys (P = 0.030), and later in life (5.1 months ± 4.5 months vs 4.2 months ± 4.2 months, P = 0.016, 95%CI: 0.08-1.73), had more associated diseases (P < 0.001); and presented with more cutaneous (P = 0.024) and respiratory (P = 0.003) manifestations, severe symptoms [rash/dry skin (P = 0.031), facial swelling/angioedema (P = 0.003), failure to thrive (P = 0.013), apparent life-threatening event (P < 0.001)], and positive physical findings (P = 0.002) than non-IgE-mediated CMPA. Most patients were exclusively fed cow milk formula (50.3%). The amino acid-based formula (AAF) was most prescribed (60.5%) with no difference between the two types (P = 0.173). Although breastfeeding was recommended to 49.6%, only 8.2% were exclusively breastfed. IgE-mediated CMPA was associated with a longer follow-up duration than non-IgE-mediated CMPA (17.3 months ± 14.0 months vs 13.5 months ± 13.4 months, P = 0.005, 95%CI: 1.1-6.3).

CONCLUSION

This study revealed a high CMPA prevalence with clinical differences between both types that can influence treatment. AAF was most prescribed, while breastfeeding with dietary modification is rarely applied.

Clinical course and management of hypertriglyceridemia thalassemia syndrome: A case-based systematic review

BACKGROUND

Hypertriglyceridemia thalassemia syndrome is a rare condition that occurs in patients with thalassemia. It typically presents with a combination of profound anemia and milky serum. Although previous case series have demonstrated the benefit of blood transfusions in reducing serum triglycerides, information regarding clinical outcomes and standard management in this setting remains limited.

AIM

To identify the clinical course, treatment strategies, and outcomes of patients with hypertriglyceridemia thalassemia syndrome.

METHODS

We performed a comprehensive search of the Scopus, PubMed, and Embase databases. We included only English-language articles and did not apply any publication date limits. The databases were last accessed on September 1, 2024. This study was registered under number CRD420250587918 and included studies involving children and adults with thalassemia, hypertriglyceridemia, and available data on clinical course.

RESULTS

A total of 14 publications were included in the analysis, all of which were case reports or case series. No higher-quality evidence was available. Among 28 children with hypertriglyceridemia thalassemia syndrome, there were 22 cases of β-thalassemia major and 6 cases of hemoglobin E/β-thalassemia, including our illustrative case. The median age of onset was 11 months, and 92.3% of cases presented prior to the first blood transfusion. The common clinical manifestations included pallor (100%) and hepatosplenomegaly (67.9%). For hypertriglyceridemia-related symptoms, lipemia retinalis and xanthomas were observed in 25.0% and 10.7% of cases, respectively. The median hemoglobin level was 5.5 g/dL, while the median triglyceride level was 935 mg/dL. For management, 92.9% of cases received blood transfusions with or without other interventions. At a median of 12 months' follow-up, all patients responded to the treatment without lipid-lowering agents, and 85.7% of cases were alive.

CONCLUSION

Hypertriglyceridemia thalassemia syndrome occurs exclusively in young children and usually presents with anemia and severe hypertriglyceridemia prior to the first transfusion. Management with blood transfusions provides a favorable response. However, long-term regular monitoring is warranted.

Ethnic heterogeneity of juvenile arthritis in the Republic of Sakha (Yakutia) related to a high human leukocyte antigen B27 frequency

BACKGROUND

Prevalence of the main rheumatic diseases in the Republic of Sakha (Yakutia) [RS(Y)], one of the regions of the Russian Federation, differs from the other regions of the Russian Federation due to its ethnic and geographic features. Knowledge regarding the prevalence and structure of juvenile idiopathic arthritis (JIA) allows us to shape the work of the pediatric rheumatology service in the region correctly, and optimize the healthcare system and the need for medications.

AIM

To describe the epidemiological, demographic, clinical, and laboratory characteristics of children with JIA in the RS(Y) and evaluate the main outcomes.

METHODS

This retrospective cohort study assessed all the data from the medical histories of the patients (n = 225) diagnosed with JIA (2016-2023) in the Cardiorheumatology Department of the M.E. Nikolaev National Center of Medicine. Pearson's χ² test, Fisher's exact test, Mann-Whitney and Kruskal-Wallis tests were used for statistical analyses.

RESULTS

The ethnic prevalence of JIA is higher in Sakha than in Russian children at 110.1 per 100000 children and 69.4 per 100000 children, respectively. The prevalence of JIA among boys and girls in Sakha was similar, unlike in Russians, where the number of girls predominated. The JIA categories were as follows: (1) Systemic arthritis: 3.5%; (2) Oligoarthritis (persistent and extended): 33.8%; (3) Rheumatoid factor (RF) (+) polyarthritis: 0.9%; (4) RF (-) polyarthritis: 14.7%; (5) Enthesitis-related arthritis (ERA): 44%; and (6) Psoriatic arthritis: 3.1%. Prevalence of the ERA category was 4.4 times higher in Sakha children, but the prevalence of systemic arthritis was 2.9 times lower compared to Russians (P = 0.0005). The frequency of uveitis was 10.2%, and the frequency of human leukocyte antigen (HLA) B27 was 39.6% in JIA children. Biologic treatment was received by 40.4% of JIA children and 45.3% achieved remission.

CONCLUSION

Higher JIA prevalence, male and ERA predominance, related to a higher frequency of HLA B27 are typical in RS(Y). These data might improve the pediatric rheumatology health service.

Evaluation of thyroid profile among children aged 1-15 years with nephrotic syndrome: An observation study

BACKGROUND

The interaction between the kidney and the thyroid is important for normal function of both organs. In nephrotic syndrome, proteinuria leads to loss of several proteins, which in turn causes hypothyroidism.

AIM

To assess the thyroid function in children with nephrotic syndrome.

METHODS

This cross-sectional study was conducted in a tertiary center, Bhopal, from February 2020 to January 2021. Consecutive children aged 1-15 years admitted with nephrotic syndrome (first-time diagnosed and all relapse cases) were included in the study. A thyroid profile was sent along with routine investigations, and thyroid hormone status was assessed in nephrotic syndrome children.

RESULTS

Of the 70 patients, 39 (55.7%) showed abnormal thyroid profiles; 19 (27.1%) had overt hypothyroidism, and 20 (28.6%) had subclinical hypothyroidism. Overt hypothyroidism was seen in 16.1% of newly diagnosed cases, 40% of second relapses, and 2.7% of frequently relapsed cases (P < 0.001). The mean serum free T3 and free T4 levels in frequent relapses were 2.50 ± 0.39 ng/dL and 0.78 ± 0.12 ng/dL, respectively, which were significantly lower than in newly diagnosed cases (2.77 ± 0.37 ng/dL and 0.91 ± 0.19 ng/dL, respectively). The mean thyroid-stimulating hormone (TSH) level was significantly higher in frequent relapses 5.86 ± 1.56 µIU/mL) and second relapse (5.81 ± 1.78 µIU/mL) than in newly diagnosed cases (4.83 ± 0.76 µIU/mL) and first relapse cases (4.74 ± 1.17 µIU/mL), (P < 0.01).

CONCLUSION

An abnormal thyroid profile was commonly observed in children with nephrotic syndrome, and overt hypothyroidism was more common in frequent relapse cases. Therefore, thyroid screening should be a part of the management of nephrotic syndrome so that hypothyroidism can be detected and managed at an early stage.

Unveiling childhood asthma: Exploring biomarkers, zinc, and beyond

This editorial discusses a case-control study by Ibrahim et al, published in the recent issue of the World Journal of Clinical Pediatrics. Childhood bronchial asthma is a chronic inflammatory respiratory disease. It was found that an increase in oxidative stress leads to a decrease in antioxidants causing oxidative damage to mitochondrial respiratory chain complexes resulting in the inflammation of the airway, hypersecretion of mucus causing a cascade of clinical manifestations ranging from recurrent episodes of coughing, wheezing, and breathlessness to shortness of breath. Since oxidative stress mediates the inflammatory response in asthma, the supplementation of anti-oxidants can be one strategy to manage this disease. Zinc is one such antioxidant that has attracted much attention about asthma and airway inflammation. Zinc is a crucial trace element for human metabolism that helps to regulate gene expression, enzyme activity, and protein structure. Apart from zinc, free serum ferritin levels are also elevated in case of inflammation. Several previous studies found that ferritin levels may also help determine the pathology of disease and predict prognosis in addition to tracking disease activity. However, this study's results were different from the findings of the previous studies and the zinc levels did not show a significant difference between asthmatic children and non-asthmatic children but ferritin levels were significantly high in asthmatic children as compared to the controls. Hence, the possible role of the biochemical nutritional assessment including zinc and ferritin as biomarkers for asthma severity should be assessed in the future.

Glans ischemia after circumcision in children: Two case reports

BACKGROUND

Circumcision refers to the removal of the skin covering the tip of the penis and is one of the most common surgical procedures performed in childhood. Even though circumcision is a well-standardized operation, several minor and major complications may be experienced by paediatric surgeons. Glans ischemia (GI) has been widely reported in the paediatric literature as a complication following circumcision. Nonetheless, etiopathogenesis of GI is not well defined and management guidelines are lacking.

CASE SUMMARY

We describe our experience with this rare and scary complication using subcutaneous enoxaparin alone or in association with a topical vasodilator.

CONCLUSION

Hypothetical causes and different management strategies are discussed.

Role of photon-counting computed tomography in pediatric cardiovascular imaging

Photon-counting computed tomography (PCCT) represents a significant advancement in pediatric cardiovascular imaging. Traditional CT systems employ energy-integrating detectors that convert X-ray photons into visible light, whereas PCCT utilizes photon-counting detectors that directly transform X-ray photons into electric signals. This direct conversion allows photon-counting detectors to sort photons into discrete energy levels, thereby enhancing image quality through superior noise reduction, improved spatial and contrast resolution, and reduced artifacts. In pediatric applications, PCCT offers substantial benefits, including lower radiation doses, which may help reduce the risk of malignancy in pediatric patients, with perhaps greater potential to benefit those with repeated exposure from a young age. Enhanced spatial resolution facilitates better visualization of small structures, vital for diagnosing congenital heart defects. Additionally, PCCT’s spectral capabilities improve tissue characterization and enable the creation of virtual monoenergetic images, which enhance soft-tissue contrast and potentially reduce contrast media doses. Initial clinical results indicate that PCCT provides superior image quality and diagnostic accuracy compared to conventional CT, particularly in challenging pediatric cardiovascular cases. As PCCT technology matures, further research and standardized protocols will be essential to fully integrate it into pediatric imaging practices, ensuring optimized diagnostic outcomes and patient safety.

Potential applications of 7 Tesla magnetic resonance imaging in paediatric neuroimaging: Feasibility and challenges

The integration of 7 Tesla magnetic resonance imaging (7 T MRI) in adult patients has marked a revolutionary stride in radiology. In this article we explore the feasibility of 7 T MRI in paediatric practice, emphasizing its feasibility, applications, challenges, and safety considerations. The heightened resolution and tissue contrast of 7 T MRI offer unprecedented diagnostic accuracy, particularly in neuroimaging. Applications range from neuro-oncology to neonatal brain imaging, showcasing its efficacy in detecting subtle structural abnormalities and providing enhanced insights into neurological conditions. Despite the promise, challenges such as high cost, discomfort, and safety concerns necessitate careful consideration. Research suggests that, with precautions, 7 T MRI is feasible in paediatrics, yet ongoing studies and safety assessments are imperative.

Autologous cord blood vs individualized supplements in autistic spectrum disorder: CORDUS study results

BACKGROUND

Cellular therapies have started an important new therapeutic direction in autistic spectrum disorder (ASD), and the ample diversity of ASD pathophysiology and the different types of cell therapies prompt an equally ample effort to employ clinical studies for studying the ASD causes and cell therapies. Stem cells have yielded so far mixed results in clinical trials, and at patient level the results varied from impressive to no improvement. In this context we have administered autologous cord blood (ACB) and a non-placebo, material intervention represented by an individualized combination of supplements (ICS) to ASD children.

AIM

To compare the efficacy of ACB vs ICS and find markers correlated with the child's progress in order to better predict ACB efficacy.

METHODS

CORDUS clinical study is a crossover study in which both oral ICS and intravenous ACB were sequentially administered to 56 children; ACB was infused as an inpatient procedure. Treatment efficacy was evaluated pre-treatment and post-treatment at 6 months by an independent psychotherapist with Autism Treatment Evaluation Checklist, Quantitative Checklist for Autism in Toddlers and a 16-item comparative table score, after interviewing the children’s parents and therapists. Before and after each intervention participants had a set of blood tests including inflammatory, metabolic and oxidative markers, and the neuronal specific enolase.

RESULTS

No serious adverse reactions were noted during and after cord blood or supplement administration. ACB improved evaluation scores in 78% of children with age 3–7-years (n = 28), but was much less effective in kids older than 8 years or with body weight of more than 35 kg (n = 28; only 11% of children improved scores). ICS yielded better results than ACB in 5 cases out of 28, while in 23 kids ACB brought more improvement than ICS (P < 0.05); high initial levels of inflammation and ferritin were associated with no improvement. Ample individual differences were noted in children's progress, and statistically significant improvements were seen after ACB on areas such as verbalization and social interaction, but not on irritability or aggressive behavior.

CONCLUSION

ACB has superior efficacy to ICS in ASD; high inflammation, ferritin, age and body weight predict less improvement; more clinical studies are needed for studying ACB efficacy in ASD.

Selenoprotein-p and insulin resistance in children and adolescents with obesity

BACKGROUND

Insulin resistance and obesity present significant challenges in pediatric populations. Selenoprotein P1 (SEPP1) serves as a biomarker for assessing selenium levels in the body. While its association with metabolic syndrome is established in adults, its relevance in children remains underexplored.

AIM

To ascertain SEPP1 blood levels in children and adolescents diagnosed with obesity and to assess its correlation with insulin resistance and adiposity indices.

METHODS

170 children participated in this study, including 85 diagnosed with obesity and an equal number of healthy counterparts matched for age and sex. Each participant underwent a comprehensive medical evaluation, encompassing a detailed medical history, clinical examination, and anthropometric measurements like waist circumference and waist-to-height ratio. Furthermore, routine blood tests were conducted, including serum SEPP1, visceral adiposity index (VAI), and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) level.

RESULTS

Our findings revealed significantly lower serum SEPP1 levels in children with obesity compared to their healthy peers. Moreover, notable negative correlations were observed between serum SEPP1 levels and body mass index, VAI, and HOMA-IR.

CONCLUSION

The study suggests that SEPP1 could serve as a valuable predictor for insulin resistance among children and adolescents diagnosed with obesity. This highlights the potential utility of SEPP1 in pediatric metabolic health assessment and warrants further investigation.

Importance of celiac disease oral manifestations in pediatric patients: A systematic review

BACKGROUND

Celiac disease (CD) is an autoimmune disease triggered by the ingestion of gluten in genetically predisposed individuals. It is more commonly diagnosed in children presenting typical clinical signs and symptoms but most of the CD patients diagnosed in the developed world are silent cases with no prominent gastrointestinal features. Thus, there are silent forms of the disease in which oral manifestations are the first sign. In the pediatric population oral health can affect growth and self-esteem and have a negative impact in their life quality.

AIM

To assess the prevalence and types of oral manifestations in pediatric patients with CD.

METHODS

We performed a comprehensive literature search in PubMed, Scielo, Cochrane Library and Lilacs databases from 2014-2024. Three independent researchers screened and extracted the information, applying the eligibility criteria and bias was assessed using Joanna Briggs Institute tools.

RESULTS

Of the initial 241 articles, 14 studies fulfilled the proposed objectives and were included in the review. The main oral manifestations found were recurrent aphthous stomatitis and enamel defects. Additionally, delayed tooth eruption, angular cheilitis, glossodynia and xerostomia were also reported.

CONCLUSION

Assessing oral manifestations is crucial, especially in underdiagnosed cases of children with CD. Recognizing these signs helps pediatricians or general practitioners identify them during routine exams, enabling early diagnosis and treatment to prevent negative impacts on the child's and family's quality of life.

Drug prescribing pattern in upper respiratory tract infections among the pediatric population attending outpatient clinics in pediatric hospitals

BACKGROUND

Upper respiratory tract infections (URTIs) are one of the most frequent causes of childhood school leave and morbidity.

AIM

To study the present trend of medications' prescribing pattern utilized in URTIs among the pediatric population attending outpatient clinics in pediatric hospitals.

METHODS

This analytical observational cross-sectional research was conducted in 200 children aged 1-10 years with URTIs attending the pediatric outpatient clinics in pediatric hospitals, one of which is an educational hospital, from July 2018 to August 2020.

RESULTS

Most of the prescriptions in our study included antibiotics (116/58%). The most commonly prescribed antibiotic family was ampicillin/sulbactam or amoxicillin/clavulanic acid (53/26.5%), followed by first-generation cephalosporin (25/12.5%) and third-generation cephalosporin (20/10%). Macrolides and second-generation cephalosporins were prescribed less frequently, in 16 (8%) and 2 (1%) patients, respectively. Most of our study population (155/77.5%) was satisfied with their prescriptions, whereas the rest of the study population (45/22.5%) was unsatisfied.

CONCLUSION

Overprescription of antibiotics is a significant issue among clinicians in pediatric outpatient clinics. Stewardship of drugs, particularly antibiotics, is a must to prevent the development of drug resistance. Most cases of URTIs were treated in accordance with the existing national treatment guidelines.

Clinical and genetic diagnosis and management of Silver-Russell syndrome: Report of four cases

BACKGROUND

Silver-Russell syndrome (SRS) is a clinically heterogeneous entity characterized by intrauterine and postnatal growth restriction, relative macrocephaly at birth, distinct facial features, and body asymmetry combined with other malformations.

CASE SUMMARY

Herein, we describe four individuals with SRS, focusing on their prenatal phenotype, postnatal presentation, diagnosis, and management. All cases had a typical phenotype, including postnatal growth failure, short stature (chronic malnutrition), and protruding forehead. Individually, they presented with feeding difficulties, leg length discrepancy, triangular face, or relative macrocephaly at birth, and each one exhibited distinct SRS features, including motor and/or speech delay, experiencing frequent hypoglycemic episodes. The fact that each patient exhibited a different combination of clinical findings underlines the heterogeneity of the syndrome.

CONCLUSION

SRS is diagnosed clinically. However, only 60% of cases are genetically confirmed, while most are sporadic. Although SRS is a well-described syndrome, a delayed diagnosis can have grave consequences on a child's growth. Recombinant human growth hormone treatment is often initiated shortly after the diagnosis. The follow-up requires a multidisciplinary approach.

Disorders of gut-brain interaction are a new challenge of our increasingly complex society, with worldwide repercussions

The term disorders of gut-brain interaction (DGBIs) encompasses gastrointestinal disorders that globally affect more than one third of all people. The Rome IV criteria replaced the former term "functional gastrointestinal disorders." DGBIs can seriously challenge health and quality of life (QoL). A traditional but outdated approach differentiated "organic" vs "functional" disorders, seen by some as real vs psychiatric or undefined ones. This traditional distinction did not help patients whose health and QoL are seriously affected. DGBIs include motility disturbance; visceral hypersensitivity; altered mucosal and immune function; altered central nervous system processing, and more. Several DGBIs affect both children and adolescents. DGBIs are characterized by clusters of symptoms. Their pathophysiology relates to combinations of altered motility, visceral sensitivity, mucosal immune function, and more. Routine investigations find no structural abnormality that would easily explain the symptoms. Symptom-based criteria were developed to better understand patients where no mechanistic explanation was available for clinical practice and inclusion into clinical trials. To understand DGBIs and to find ways to treat them, these rigid mechanistic views fall short.

Indoor smoke and prenatal and childhood growth: The role of (gestational) age

Growth at birth and during infancy predicts several outcomes in the immediate future as well as in the long term. Weight and height are commonly used surrogates of growth, however, infants and young children are constantly growing unlike adults. Hence, weight and height alone are insufficient measures of growth if the time component is not associated with them. Recent studies have investigated the relationship between indoor air pollution and growth using height and weight. In this commentary, I have argued using a directed acyclic graph, that a causal association between indoor pollution exposure and growth at birth cannot be established unless birth weight is adjusted for gestational age. Furthermore, to make any causal inference between growth during the first few years of life and indoor exposure, in addition to age standardization, studies must also account for fetal growth to discount any continuation of prenatal effects, which may be in the causal pathway. A careful consideration is warranted from future studies investigating these relationships.

Rational use of antibiotics in children with diabetic ketoacidosis needs attention

Diabetic ketoacidosis (DKA) in children may lead to acute kidney injury (AKI). Among 45 children with DKA in our center, eight cases had AKI on admission, and in one child, his kidney function did not recover until 3 mo after discharge. This child was treated with antibiotics (cephalosporin), and we cannot rule out delayed AKI recovery due to the combined effects of the drug and the disease. Pediatricians should be concerned about the impact of nephrotoxic drug and disease interactions on children's kidney function, and need to follow up children with DKA and AKI to determine the development of AKI.

Pediatrician-friendly perspectives on cognitive behavioral therapy for anxious youth: Current status and clinical implications for the next normal

Pediatric anxiety disorders are common and often debilitating conditions. Cognitive is a psychosocial intervention that represents a potentially powerful antidote to these disorders. This article reviews data from treatment outcome studies, meta-analyses, and systematic reviews as well as from moderation/mediational investigations. The literature supports the efficacy, effectiveness, and durability of positive treatment outcomes for pediatric anxiety disorders. Recommendations for clinical applications are suggested.

What is the purpose of launching the World Journal of Clinical Pediatrics?

The first issue of the World Journal of Clinical Pediatrics (WJCP), whose preparatory work was initiated on January 10, 2011, will be published on June 8, 2012. The WJCP editorial board has now been established and consists of 100 distinguished experts from 31 countries. Our purpose of launching the WJCP is to publish peer-reviewed, high-quality articles via an open-access online publishing model, thereby acting as a platform for communication between peers and the wider public, and maximizing the benefits to editorial board members, authors and readers.

Transabdominal intestinal ultrasound and its parameters used in the assessment of pediatric inflammatory bowel disease

This article extends on the use of transabdominal intestinal ultrasound in diagnosing pediatric inflammatory bowel disease. Some of the more essential features used in assessing bowel inflammation, such as hyperemia and wall thickness on ultrasound, are expanded upon from the publication on imaging and endoscopic tools in pediatric inflammatory bowel disease.

Clinical and laboratory features of juvenile idiopathic arthritis with wrist involvement: Results of a retrospective cohort study

BACKGROUND

Previous studies in the pre-biological era showed an association of wrist inflammation in juvenile idiopathic arthritis (JIA) with progressive disease course, polyarticular involvement and failure of methotrexate treatment.

AIM

To describe features of JIA, associated with wrist arthritis.

METHODS

Data from about 753 JIA patients were included in this retrospective cohort study. The clinical and laboratory features of patients with and without wrist involvement were analyzed.

RESULTS

Wrist involvement was found in oligoarthritis (5.8%), RF(-)/RF(+) polyarthritis (44.9%/15.0%), enthesitis-related arthritis (17.7%), and systemic (58.6%) JIA categories. Unilateral wrist involvement was typical for oligoarthritis patients, bilateral involvement was either equal to that of unilateral involvement or was more frequent in other categories. Wrist arthritis was found to be associated with female sex, a low incidence of uveitis, and more indications of systemic inflammation, including elevated levels of C-reactive protein, erythrocyte sedimentation rate, and platelets, as well as involvement of the cervical spine, temporomandibular, shoulder, elbow, metacarpophalangeal, proximal interphalangeal, distal interphalangeal, hip, ankle, and tarsus arthritis. The number of patients with hip osteoarthritis and hip replacement was also higher. Wrist arthritis was associated with a lower probability of achieving remission [hazard ratio (HR) = 1.3 (95%CI: 1.0-1.7), P = 0.055], and a higher probability of being treated with biologics [HR = 1.7 (95%CI: 1.3-2.10, P = 0.00009)].

CONCLUSION

Wrist arthritis in JIA patients is a marker of a severe disease course, characterized by more intensive inflammation, unfavorable outcomes, and. requiring more intensive treatment with early administration of biologics. Close monitoring of wrist inflammation with ultrasound and MR assessment with early biological treatment might improve the outcomes.