Prevalence of gastroesophageal reflux disease in children with extraesophageal manifestations using combined-video, multichannel intraluminal impedance-pH study

BACKGROUND

Gastroesophageal reflux disease (GERD) might be either a cause or comorbidity in children with extraesophageal problems especially as refractory respiratory symptoms, without any best methods or criterion for diagnosing it in children.

AIM

To evaluate the prevalence of extraesophageal GERD using conventional and combined-video, multichannel intraluminal impedance-pH (MII-pH), and to propose novel diagnostic parameters.

METHODS

The study was conducted among children suspected of extraesophageal GERD at King Chulalongkorn Memorial Hospital between 2019 and 2022. The children underwent conventional and/or combined-video MII-pH. The potential parameters were assessed and receiver operating characteristic was used for the significant parameters.

RESULTS

Of 51 patients (52.9% males), aged 2.24 years were recruited. The common problems were cough, recurrent pneumonia, and hypersecretion. Using MII-pH, 35.3% of the children were diagnosed with GERD by reflux index (31.4%), total reflux events (3.9%), and symptom indices (9.8%) with higher symptom recorded in the GERD group (94 vs 171, P = 0.033). In the video monitoring group (n = 17), there were more symptoms recorded (120 vs 220, P = 0.062) and more GERD (11.8% vs 29.4%, P = 0.398) by symptom indices. Longest reflux time and mean nocturnal baseline impedance were significant parameters for diagnosis with receiver operating characteristic areas of 0.907 (P = 0.001) and 0.726 (P = 0.014).

CONCLUSION

The prevalence of extraesophageal GERD in children was not high as expected. The diagnostic yield of symptom indices increased using video monitoring. Long reflux time and mean nocturnal baseline impedance are novel parameters that should be integrated into the GERD diagnostic criteria in children.

Influence of social media on maternal decision-making and breastfeeding practices

Breastfeeding practices are influenced by multifactorial determinants including individual characteristics, external support systems, and media influences. This commentary emphasizes such complex factors influencing breastfeeding practices. Potential methodological limitations and the need for diverse sampling in studying breastfeeding practices are highlighted. Further research must explore the interplay between social influences, cultural norms, government policies, and individual factors in shaping maternal breastfeeding decisions.

Gastrointestinal tolerability of organic infant formula compared to traditional ‎infant formula: A systematic review

BACKGROUND

Infants' nutrition significantly influences their growth, development, and overall well-being. With the increasing demand for organic infant formula driven by the perception of health benefits and growing awareness of natural feeding options, it is crucial to conduct a comparative analysis of the gastrointestinal tolerability between organic and traditional infant formulas.

AIM

To provide a concise and precise analysis of the gastrointestinal tolerability of organic infant formula compared to traditional infant formula. Due to limited direct comparisons, the review synthesizes available literature on each formula type, presenting insights into their potential effects on infants' digestive health.

METHODS

An extensive literature search was conducted, compiling studies on organic and traditional infant formulas, their compositions, and reported effects on gastrointestinal tolerability. We searched academic databases such as PubMed and Google Scholar and specialized ‎nutrition, paediatrics, and infant health journals using relevant keywords till October 1, 2023. ‎.

RESULTS

Although specific comparative studies are scarce and formula heterogeneity is a significant limitation, this systematic review provides an in-depth understanding of organic infant formulas' composition and potential benefits. While scientific evidence directly comparing gastrointestinal tolerability is limited, organic formulas strive to use carefully selected organic ingredients to imitate breast milk composition. Potential benefits include improved lipid profiles, higher methionine content, and decreased antibiotic-resistant bacteria levels. Understanding the gastrointestinal tolerability of organic and traditional infant formulas is crucial for parents and healthcare providers to make informed decisions.

CONCLUSION

Despite limitations in direct comparisons, this systematic review provides insights into the composition and potential benefits of organic infant formulas. It emphasizes the need for further research to elucidate their gastrointestinal effects comprehensively.

Serologic, endoscopic and pathologic findings in pediatric celiac disease: A single center experience in a low/middle income country

BACKGROUND

Studies in Africa, Asia, and Latin America are needed to provide a comprehensive picture of the global incidence of celiac disease (CD).

AIM

To describe the serology, endoscopic and histological findings in typical and atypical presentations of pediatric CD at a tertiary referral hospital in an African low/middle income country (LMIC).

METHODS

This observational study was conducted on 199 patients with CD from 2010 to 2019. The patients were divided into typical and atypical groups according to the presenting symptoms including 120 and 79 patients respectively. Serology, upper gastrointestinal endoscopy with duodenal biopsy were performed for patients who had symptoms suggestive of CD. The severity of the intestinal damage was graded according to the histo-pathologic Marsh-Oberhuber classification.

RESULTS

Chronic diarrhea was the main intestinal presentation in the typical group. Anemia was the most common extraintestinal symptom in both the typical and atypical group. Marsh-Oberhuber type 3b and 3c was significantly higher in the seropositive patients with a P value of 0.007. A significant correlation was observed between the histological grade of the biopsied duodenal mucosa and the clinical presentation (P < 0.001). Age was significantly higher in the atypical group (P value < 0.001).

CONCLUSION

Although typical CD was observed in 120 patients in this study, the clinical variability of the condition was frequently observed. Age only was a significant predictor for the appearance of atypical CD. Therefore, CD presentations in LMIC are not different from industrialized countries.

Challenges and solutions in managing dental problems in children with autism

BACKGROUND

Children with autism spectrum disorder (ASD) face unique challenges in maintaining oral health due to sensory sensitivities, communication difficulties, and behavioral barriers. These factors, along with limited access to ASD-trained dental professionals, increase their risk of dental caries, periodontal disease, bruxism, and other oral health issues. Despite growing awareness of these challenges, a comprehensive synthesis of evidence-based solutions remains lacking.

AIM

To review synthesizes existing research on dental problems in ASD, barriers to care, management strategies, and future directions for improved oral health outcomes.

METHODS

A systematic search of PubMed, Cochrane Library, and Scopus was conducted using predefined search terms. Related to ASD, dental health, and management strategies. Inclusion criteria encompassed studies focusing on children with ASD, dental health issues, and interventions. Data extraction included study design, participant characteristics, key findings, and intervention outcomes. The quality of studies was assessed using appropriate tools such as the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. A narrative synthesis approach, incorporating thematic analysis, was utilized to evaluate the findings.

RESULTS

A total of 165 studies met the inclusion criteria. Children with ASD exhibited a higher prevalence of dental caries, gingivitis, bruxism, and malocclusion compared to neurotypical peers. Barriers to dental care included sensory sensitivities, communication difficulties, financial constraints, and a shortage of ASD-trained dental professionals. Effective interventions included desensitization programs, behavioral therapy, digital applications, and interdisciplinary collaboration. Parental education and professional training were crucial for improving oral health outcomes.

CONCLUSION

Tailored dental care strategies, including sensory adaptations, behavioral interventions, and interdisciplinary collaboration, are essential for children with ASD. Standardized guidelines and long-term studies are needed to refine evidence-based protocols. Future research should explore digital interventions and probiotic applications in ASD dental care.

Phocomelia: Bilateral limb deficiency in a neonate: A case report

BACKGROUND

Phocomelia is a rare congenital disorder characterized by the absence or underdevelopment of the proximal limbs. Phocomelia can occur as a syndrome or a limb-specific deformity. While historically linked to thalidomide, non-thalidomide causes include genetic mutations, vascular disruptions, and teratogenic exposures. This case highlights the diagnostic and therapeutic challenges in a neonate with bilateral phocomelia, low birth weight, asphyxia and jaundice.

CASE SUMMARY

We report a 2-week-old term neonate with bilateral phocomelia, micrognathia, jaundice, and low birth weight. The pregnancy was unremarkable, with no thalidomide exposure. The mother had a history of early pregnancy losses. Clinical evaluation revealed absent humeri and radii bilaterally, with hands attached proximally to the trunk. Genetic testing was not performed, limiting the identification of underlying etiology. The patient was managed with supportive care, parental counseling, and planning for long-term rehabilitation. This case underscores the importance of multidisciplinary care in managing congenital anomalies. Genetic evaluation is crucial in unexplained congenital anomalies. Routine detailed ultrasounds in high-risk pregnancies aid in early diagnosis and parental preparedness.

CONCLUSION

Bilateral phocomelia presents significant functional challenges. Comprehensive diagnostic workups and early rehabilitation strategies are essential for optimizing patient outcomes.

Validating a novel scoring system for the assessment and treatment of functional gastrointestinal disorders in children

BACKGROUND

Functional gastrointestinal disorders (FGIDs), defined as ‘Disorders of Gut-Brain Interaction’, are now considered a global health problem. There is a dearth of concepts and scales to assess the severity of the different symptoms encountered while dealing with the variety of FGIDs as described in the ROME IV classification. We introduced a novel scoring system with the incorporation of 16 different symptoms called Bacharyya’s Questionnaire Scale and started using it while dealing with children suffering from FGIDs.

AIM

To verify the usefulness and applicability of this recently developed scale, this study was undertaken with the objectives to establish the validity of this scoring system in assessing the severity of symptoms associated with a specific FGID in children and to determine the scoring system's applicability in assessing the treatment response.

METHODS

The study included children aged 5 to 18 years diagnosed with any FGID based on ROME IV criteria. They completed the newly developed scale and a Visual Analog Scale at initial diagnosis and after a 2-month treatment period. A control group without FGID participated for comparative baseline purposes. Treatment response was defined as a less than or equal to 50% reduction in the total score, which is statistically significant.

RESULTS

Results from a comprehensive cohort of 190 cases and 90 controls indicated a female preponderance (57.9%) and prevalent disorders such as functional constipation (28%) and functional abdominal pain, not otherwise specified (21%). The grade of FGID (mild, moderate, severe) experienced by the patients was also derived. Post-treatment, 96 children demonstrated symptom improvement. The Spearman rank correlation coefficient for pre (r = 0.72, 95%CI: 0.65-0.77, P value < 0.0001) and post (r = 0.49, 95%CI: 0.3-0.64, P value < 0.0001) treatment data showed positive results with significant P values.

CONCLUSION

The novel scoring system shows high comprehensibility and gives an objective view of the symptomatology of FGIDs. The use of this novel score in clinical settings will be helpful to typify the FGIDs and may significantly improve decision-making processes to initiate appropriate treatment.

Cross-sectional association of fitness, fatness, and dyslipidemia with metabolic syndrome in youth

BACKGROUND

The prevalence of metabolic syndrome (MetS) in adolescents is rising, correlating with the global increase in obesity and physical inactivity.

AIM

To examine the individual and combined associations of fitness, fatness, visceral adiposity index (VAI), and lipid ratios with MetS risk in Nigerian adolescents.

METHODS

This cross-sectional study included a sample of 403 adolescents (201 girls and 202 boys) aged 11-19 years. Participants were assessed for cardiorespiratory fitness, body mass index (BMI), VAI, triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C), and total cholesterol-to-high-density lipoprotein cholesterol ratio (TC/HDL-C). Regression models adjusted for age and sexual maturity were used to determine the associations between these health markers and MetS risk.

RESULTS

Among the 177 high-risk adolescents, 56.6% were at risk of central obesity, 49.1% had low fitness, 33.3% had dyslipidemia, and 11.7% were obese. After controlling for confounding variables, all health markers were independently and jointly associated with MetS risk, with VAI displaying the strongest explanatory power (girls: β = 1.308, P < 0.001; boys: β = 2.300, P < 0.001). Unfit girls were 5.1% more likely to be at risk of MetS, while the odds of unfit boys being at risk of MetS is 3.6. Boys with elevated VAI were 22.3 times more likely to be at risk of MetS, while the likelihood of girls with elevated VAI developing MetS risk is 2.78.

CONCLUSION

Health markers were independently and jointly associated with MetS risk in adolescents, with VAI and dyslipidemia contributing most significantly. Promoting healthy eating and also aerobic activities among adolescents is crucial for improving metabolic health.

Analysis of fatal outcomes of patients with mucopolysaccharidosis type II according to the Russian mucopolysaccharidosis registry

BACKGROUND

Mucopolysaccharidosis type II (MPS II) is a chronic inherited disease with multiorgan involvement, a progressive course, and restricted life expectancy.

AIM

To evaluate the predictors of fatal outcomes in MPS II patients.

METHODS

In the retrospective cohort study, the clinical, laboratory data and enzyme replacement therapy (ERT) (84.2%) of about 160 patients were extracted and analyzed from the Russian MPS II registry, with death as a primary outcome. We compared patients who died (n = 20; 12.5%) with severe form (n = 13; 68.4%) and attenuated form (n = 6, 31.6%) to 140 alive patients.

RESULTS

Fatal outcomes occurred in 5%, 35%, 20%, and 40% of patients before 10, 10-14, 15-19, and ≥ 20 years. The most common causes of death were cardiovascular (29.4%), respiratory failure (17.6%), including pneumonia (17.6%), and their associations (17.6%) and MPS II progression (11.8%). Acute or chronic respiratory failure was in 53%. Died patients had higher birth weight, higher age of diagnosis, and start of ERT. Hydrocephalus, hydrocephalus bypass surgery, epilepsy, difficulty swallowing, and impaired movement after 12 years of age were significantly more common in the deceased patients. Cox regression analysis has revealed the following time-dependent covariates of the lethal outcome: 1^st-year psychomotor development delay, delayed mental and speech development, hydrocephalus, swallow disorders, impossible walking at age > 12 years, respiratory disorders, tracheostomy, neuronopathic form.

CONCLUSION

Increased birth weight, delayed diagnosis and the start of ERT, and development of neuronopathic form with impossible walking after 12 years were the main predictors of the fatal outcome.

Diagnostic and management challenges in a partially infarcted borderline phyllodes tumor in an adolescent female: A case report and review of literature

BACKGROUND

Fibroadenomas (FA) and phyllodes tumors (PT) are fibroepithelial neoplasms and are difficult to differentiate radiographically and histologically. We present a partially infarcted borderline PT in an adolescent with rapid tumor enlargement within 24 hours. Tumor infarction made the diagnostic work-up difficult. Complete surgical excision is the standard of care for PTs. There is controversy regarding margin re-excision for borderline PTs. In this report, we discuss the diagnostic challenges of PT and the evolving concept of margin status on PT recurrence rate.

CASE SUMMARY

A 14-year-old healthy female with no medical history presented with a painful right breast mass with no nipple discharge, trauma, or skin findings. The mass showed rapid enlargement over 24 hours, prompting a workup with ultrasound and core needle biopsy. The initial biopsy was limited due to large areas of infarction. Based on the scant viable tissue and considering the patient’s age, the mass was favored to be a juvenile FA. The patient underwent excision of the mass. Final pathology confirmed a borderline PT with positive surgical margins. The patient underwent margin re-excision, which did not show any residual tumor. At the 6-month post-op visit, there was a mass-forming lesion on the breast ultrasound. Subsequent core needle biopsy showed benign breast parenchyma with scar formation. The primary goal of evaluation in pediatric breast masses is to do no harm. However, rapidly growing and symptomatic masses require a more extensive work-up including biopsy and surgical excision. We present a rapidly growing breast mass in a 14-year-old female which was diagnosed as a borderline PT on her excision specimen. The mass rapidly enlarged over 24 hours. The initial biopsy pathology was limited due to a large area of infarction. The patient underwent excision of the mass. Final pathology confirmed a borderline PT that extended into the surgical margin, resulting in an additional re-excision procedure. Accurate diagnosis prior to surgical intervention is crucial to avoid additional procedures. Although histological morphology remains the gold standard for diagnosis, immunohistochemistry and molecular studies have recently shown to improve the accuracy of diagnosis of PTs. Long-term clinical and pathologic follow-up of PTs in adolescent patients should be collectively studied to examine whether our current diagnostic criteria for PT can reliably predict tumor behavior in this age group.

CONCLUSION

Accurate diagnosis of PTs requires surgical excision. Tumor infarction may lead to rapid tumor enlargement, hindering the correct diagnosis. More research is needed on margin status and recurrence rate, especially in adolescent patients, to help establish the best possible care for this age group.

Outcomes and adverse events following intra-arterial chemotherapy for retinoblastoma: A single center study in South India

BACKGROUND

Intra-arterial chemotherapy (IAC) has become a first-line standard treatment for retinoblastoma (RB). However, studies describing its adverse events are sparse, especially from the developing world. Our study described the outcomes and adverse events from a single center in South India.

AIM

To describe the challenges, treatment outcomes, and complications of selective IAC for RB in Indian eyes.

METHODS

This study was a single center, retrospective study that included 17 patients with RB who underwent IAC using melphalan (5/7.5 mg) and topotecan (1/2 mg) (n = 12) or melphalan (5 mg) alone (n = 3) or triple therapy that included carboplatin (30 mg) along with these drugs (n = 2) between January 2018 and December 2023. In all, 17 IAC procedures were performed using selective ophthalmic artery cannulation. Treatment outcomes were evaluated in terms of tumor control, vitreous and subretinal seed control, complications, and globe salvage rates.

RESULTS

Out of the 17 patients, 11 were diagnosed with unilateral RB and 6 were diagnosed with bilateral RB. The mean age at the time of diagnosis was 19.8 months. The mean interval between the first symptom and presentation was 6.5 months. IAC was employed as the primary (n = 9) or secondary (n = 8) modality of treatment. Each eye received a mean of 1.5 IAC sessions (median: 1 session; range: 1-3 sessions). Eyes were classified according to the international classification of RB as group B (n = 5), group C (n = 1), group D (n = 4), and group E (n = 7). Following IAC, complete regression of the main tumor was seen in 15 eyes (88%) and partial regression in 2 eyes (12%). Globe salvage was achieved in 15 eyes (88%). Adverse effects included vitreous hemorrhage (n = 3), rhegmatogenous retinal detachment (n = 2), choroidal ischemia (n = 1), isolated subretinal hemorrhage (n = 2), retinal pigment epithelium degeneration (n = 2), forehead pigmentation (n = 1), third nerve palsy with complete ptosis (n = 1), and 30-degree exotropia (n = 1). The mean follow-up period was 28.6 months (median: 24 months, range: 1–72 months).

CONCLUSION

IAC is an effective way to control RB and globe preservation. In the Indian context we encountered many challenges highlighting the importance of case selection. Further studies in India are required to thoroughly understand IAC as a treatment for RB.

Human milk oligosaccharide secretion dynamics during breastfeeding and its antimicrobial role: A systematic review

BACKGROUND

Human milk oligosaccharides (HMOs) are bioactive components of breast milk with diverse health benefits, including shaping the gut microbiota, modulating the immune system, and protecting against infections. HMOs exhibit dynamic secretion patterns during lactation, influenced by maternal genetics and environmental factors. Their direct and indirect antimicrobial properties have garnered significant research interest. However, a comprehensive understanding of the secretion dynamics of HMOs and their correlation with antimicrobial efficacy remains underexplored.

AIM

To synthesize current evidence on the secretion dynamics of HMOs during lactation and evaluate their antimicrobial roles against bacterial, viral, and protozoal pathogens.

METHODS

A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library focused on studies investigating natural and synthetic HMOs, their secretion dynamics, and antimicrobial properties. Studies involving human, animal, and in vitro models were included. Data on HMO composition, temporal secretion patterns, and mechanisms of antimicrobial action were extracted. Quality assessment was performed using validated tools appropriate for study design.

RESULTS

A total of 44 studies were included, encompassing human, animal, and in vitro research. HMOs exhibited dynamic secretion patterns, with 2'-fucosyllactose (2'-FL) and lacto-N-tetraose peaking in early lactation and declining over time, while 3-fucosyllactose (3-FL) increased during later stages. HMOs demonstrated significant antimicrobial properties through pathogen adhesion inhibition, biofilm disruption, and enzymatic activity impairment. Synthetic HMOs, including bioengineered 2'-FL and 3-FL, were structurally and functionally comparable to natural HMOs, effectively inhibiting pathogens such as Pseudomonas aeruginosa, Escherichia coli, and Campylobacter jejuni. Additionally, HMOs exhibited synergistic effects with antibiotics, enhancing their efficacy against resistant pathogens.

CONCLUSION

HMOs are vital in antimicrobial defense, supporting infant health by targeting various pathogens. Both natural and synthetic HMOs hold significant potential for therapeutic applications, particularly in infant nutrition and as adjuncts to antibiotics. Further research, including clinical trials, is essential to address gaps in knowledge, validate findings, and explore the broader applicability of HMOs in improving maternal and neonatal health.

Systematic comparison of Kawasaki disease Z-score formulas: Enhancing diagnostic accuracy and clinical applicability across populations

This study aims to evaluate the performance of six distinct Z-score formulas in diagnosing coronary artery dilation in Kawasaki disease (KD) patients, with a focus on their clinical applicability across diverse populations. A retrospective analysis was conducted using comparative statistical methods to assess the sensitivity and specificity of each formula. The Kobayashi and Dallaire formulas demonstrated the highest sensitivity in China, particularly in younger patients with prolonged fever duration. Our findings provide evidence-based recommendations for selecting Z-score formulas to optimize diagnostic precision in KD patients.