Endoscopic resection of polypoid solitary rectal ulcer: A novel first-line therapeutic strategy using snare-assisted mucosal and fibrosis resection

Objectives

To propose a novel first-line endoscopic therapy for treating polypoid lesions in solitary rectal ulcer syndrome (P-SRUS), the rarest and most challenging subtype of SRUS, which encompasses various endoscopic findings including mucosal erythema, superficial or deep ulcers, and polypoid lesions.

Methods

A prospective, single-arm study was conducted on 56 patients with histologically confirmed SRUS and broad-based polypoid lesions in the rectum and anal canal. These patients were referred to the Department of Motility Disorders of the Lower Gastrointestinal Tract. The lesions were removed using snare-assisted mucosal and fibrosis resection. Patients were monitored for clinical and endoscopic responses at 1, 3, 6, and 12 months post-treatment.

Results

The study observed improvement in clinical symptoms, a complete endoscopic response, and the absence of late complications following endoscopic resection. Endoscopic evaluations revealed no recurrence of lesions in the follow-up period.

Conclusion

Endoscopic resection using the snare-assisted mucosal and fibrosis resection method appears to be an effective and safe treatment option for polypoid SRUS. (Clinical Trial Registration Number: IRCT20211101052935N2).

Cross-feeding-based rational design of a probiotic combination of Bacterides xylanisolvens and Clostridium butyricum therapy for metabolic diseases

The human gut microbiota has gained interest as an environmental factor that contributes to health or disease. The development of next-generation live biotherapeutic products (LBPs) is a promising strategy to modulate the gut microbiota and improve human health. In this study, we identified a novel cross-feeding interaction between Bacteroides xylanisolvens and Clostridium butyricum and developed their combination into a novel LBP for treating metabolic syndrome. Using in-silico analysis and in vitro experiments, we demonstrated that B. xylanisolvens supported the growth and butyrate production of C. butyricum by supplying folate, while C. butyricum reciprocated by providing pABA for folate biosynthesis. Animal gavage experiments showed that the two-strain combination LBP exhibited superior therapeutic efficacy against metabolic disorders in high-fat diet-induced obese (DIO) mice compared to either single-strain treatment. Further omics-based analyses revealed that the single-strain treatments exhibited distinct taxonomic preferences in modulating the gut microbiota, whereas the combination LBP achieved more balanced modulation to preserve taxonomic diversity to a greater extent, thereby enhancing the stability and resilience of the gut microbiome. Moreover, the two-strain combinations more effectively restored gut microbial functions by reducing disease-associated pathways and opportunistic pathogen abundance. This work demonstrates the development of new LBP therapy for metabolic diseases from cross-feeding microbial pairs which exerted better self-stability and robust efficacy in complex intestinal environments compared to conventional single-strain LBPs.

Risk factors for retinopathy of prematurity among preterm infants with bronchopulmonary dysplasia

BACKGROUND

This study was designed to investigate the risk factors for retinopathy of prematurity (ROP) among the preterm infants with bronchopulmonary dysplasia (BPD).

METHODS

This retrospective study included 225 preterm infants with BPD who were admitted to our hospital between January 2016 and March 2022. These preterm infants were divided into ROP group and non-ROP group based on the presence of ROP. Logistic regression analysis was given to analyze the risk factors for ROP in the preterm infants with BPD. Spearman correlation analysis was performed to investigate the correlation between ROP severity and BPD.

RESULTS

Logistic regression analysis indicated that noninvasive ventilation and oxygen therapy increased the risk of ROP among preterm infants with BPD. Low gestational age and low birth weight increased the risk of ROP among preterm infants with BPD. There was a positive correlation between severity of ROP and BPD.

CONCLUSIONS

Low gestational age, low birth weight, noninvasive ventilation, oxygen therapy via mask and nasal catheter were risk factors for ROP among preterm infants with BPD.

The impact of gut microbial short-chain fatty acids on colorectal cancer development and prevention

Cancer is a long-term illness that involves an imbalance in cellular and immune functions. It can be caused by a range of factors, including exposure to environmental carcinogens, poor diet, infections, and genetic alterations. Maintaining a healthy gut microbiome is crucial for overall health, and short-chain fatty acids (SCFAs) produced by gut microbiota play a vital role in this process. Recent research has established that alterations in the gut microbiome led to decreased production of SCFA's in lumen of the colon, which associated with changes in the intestinal epithelial barrier function, and immunity, are closely linked to colorectal cancer (CRC) development and its progression. SCFAs influence cancer progression by modifying epigenetic mechanisms such as DNA methylation, histone modifications, and non-coding RNA functions thereby affecting tumor initiation and metastasis. This suggests that restoring SCFA levels in colon through microbiota modulation could serve as an innovative strategy for CRC prevention and treatment. This review highlights the critical relationship between gut microbiota and CRC, emphasizing the potential of targeting SCFAs to enhance gut health and reduce CRC risk.

Influence of lifestyle and family environment factors on mental health problems in Hong Kong preschoolers

BACKGROUND AND AIMS

Existing studies that simultaneously consider the effects of lifestyle and family environment factors on mental health problems (MHPs), particularly in preschoolers, are limited. This study aims to explore lifestyle and family environment factors associated with MHPs, externalising problems (EPs) and internalising problems (IPs) in preschoolers.

METHODS

This territory-wide, school-based study conducted from 2020 to 2022 involved 1926 preschoolers. MHPs, EPs, and IPs and factors such as sleep duration, sleep latency, entertainment screen time, educational screen time, parent-child recreation and learning activities were assessed. Linear and logistic regression analyses were used to explore the relationships between these factors and MHPs, EPs, and IPs.

RESULTS

The average sleep duration was 9.94 h per day, average screen time of 2.53 h per day, and 42.6 % experienced sleep latency exceeding 20 min per day among preschoolers (mean age: 4.39 years, 49.1 % female). Adjusted analyses showed that decreased parent-child recreation activities, prolonged sleep latency and excessive entertainment screen time were associated with increased MHPs, EPs, and IPs (β: 0.05 to 0.20, all p < 0.05). Weekend sleep duration of <10 h per day, sleep latency of >20 min per day, and educational screen time of >30 min per day were identified as risk factors for MHPs, EPs, and IPs, with an adjusted odds ratio ranging from 1.32 to 2.32 (all p < 0.05).

CONCLUSIONS

Preschoolers' lifestyle and family environment factors are associated with MHPs, EPs, and IPs respectively. Ensuring adequate sleep duration, avoiding sleep latency exceeding 20 min per day, reducing entertainment screen time, limiting educational screen time to 30 min per day, and increasing parent-child interactions may help to minimise mental health problems.

Clinical correlations with unmet social needs in critically ill children with asthma

Background

Social drivers of health have been implicated as playing a major role in determining pediatric asthma outcomes. However, the impact of self-reported, family-level unmet social needs on asthma outcomes in critically ill pediatric patients is unknown.

Objective

Our aim was to determine whether the presence of unmet social needs at the time of intensive care unit (ICU) admission are associated with ICU-related and postadmission outcomes.

Methods

This was a 12-month (February 2022-January 2023) prospective cohort study at a single, urban pediatric health care system. Families of patients admitted to the pediatric ICU for asthma were screened for unmet social needs in multiple domains. Regression analyses were performed to correlate unmet needs with the following clinical outcomes: duration of bilevel positive airway pressure use; lengths of ICU and hospital stay; and rates of 6-month outpatient follow-up, ED visitation, and hospital readmission.

Results

Of 164 screened families, 57% reported at least 1 unmet social need. Unmet needs were significantly associated with longer hospitalizations (ie, a 3% increase per year of age (odds ratio =1.03 [95% CI = 1.00-1.07]) and a higher likelihood of returning for emergency care (adds ratio =2.6 [95% CI = 1.1-6.2]), even after accounting for race, insurance payer, and medical comorbidities. Additionally, patients provided with resources reported fewer needs when rescreened at outpatient follow-up (median = -1 need [P = .001]).

Conclusion

Families of critically ill pediatric patients with asthma reported a high rate of unmet social needs. Furthermore, those with needs were vulnerable to longer stays and repeat asthma exacerbations requiring emergency care. Identification of these families presents an opportunity to target a high-risk population with durable medical and social interventions.

Influenza virus: Genomic insights, evolution, and its clinical presentation

Influenza viruses belong to the family Orthomyxoviridae and have been a concern for public health due to frequent epidemics and sporadic waves of pandemics. According to WHO, seasonal strains of the influenza A virus (IAV) infect 3 to 5 million people every year and result in 0.29-0.65 million deaths globally. Among all proteins of IAV, the hemagglutinin (HA) and neuraminidase (NA) have high mutation rates and have been reported to undergo antigenic drift and shift leading to novel strains. Hence continuous revision in drugs and vaccines regime is an economic burden as these reassortments can cause high morbidity among the immunologically naive population. Infection rates are higher among older age groups, infants and patients reported with other respiratory distress. Routine diagnostic tests include reverse transcription polymerase chain reaction (RT-PCR), viral culture, and immunofluorescence assays; however, the diagnosis may be hindered due to the resemblance of the clinical presentation of other respiratory viruses with influenza viruses. Here we present a comprehensive review which sheds light on the genomic structure, evolution, pathogenicity and clinical presentation of influenza virus that can help to distinguish it from other respiratory viruses. A detailed analysis will ultimately pave the way for the development of more effective antiviral drugs and a universal vaccine.

Socioeconomic inequalities in mental health difficulties over childhood: a longitudinal sex-stratified analysis using the UK Millennium Cohort Study

Stark socioeconomic inequalities in childhood mental health have been widely reported. Understanding whether they vary with age, by type of difficulty or sex can inform public health policies to tackle socioeconomic inequalities. We investigated the effects of early life childhood socioeconomic circumstances (SECs) (maternal education and household income) on developmental trajectories of externalising and internalising difficulties in childhood and adolescence, in males and females from the UK-representative Millennium Cohort Study (N = 15383). We estimated the Slope Index of Inequality (SII) (absolute difference between the most versus least advantaged) using linear mixed-effects regression models, on parent-reported Strengths and Difficulties Questionnaire externalising and internalising difficulties score, at 5, 7, 11, 14, and 17 years(y). The mean externalising score was high at 5y (4.8 [95 %CI: 4.7, 4.9]) and decreased slightly, while mean internalising score increased over childhood, reaching 3.9 [3.8, 4.1] by 17y, with a steeper trend for females in adolescence. Lower maternal education was associated with greater externalising scores at 5y (SII, Male: 3.0 [2.7 to 3.3]; Female: 2.7 [2.4, 3.0]) with inequalities decreasing slightly up to 17y (SII Male: 2.4 [2.0 to 2.7], Female: 2.5 [2.1, 2.8]). Inequalities in internalising scores increased slightly over childhood (SII Female 5y: 1.3 [1.1, 1.6]; 17y: 1.9 [1.5, 2.3]; SII Male 5y = 1.6 [1.3, 1.8], 17y = 1.8 [1.5, 2.2]). Patterns were similar using household income. Disadvantaged SECs are associated with persistently higher levels of parent-reported mental health difficulties up to 17y, with larger effects on externalising than internalising difficulties, but little differences by sex or socioeconomic measure.

Sleep-related problems and sleep disorders in ataxia telangiectasia

OBJECTIVE

Ataxia telangiectasia (AT) is a rare neurodegenerative disorder and sleep-related problems may be expected. We investigated sleep-related problems in children with AT in relation to their clinical status.

METHODS

We administered Children's Sleep Habits Questionnaire and Sleep Disturbance Scale for Children to patients with AT (n = 46) and a matched healthy control (HC) (n = 92). We defined clinical subgroups of AT as mild (n = 10) and moderate/severe (n = 36) according to patients' clinical scores. We compared the results between the groups.

RESULTS

The median age was 130.5 (104.8-175.0) months in AT patients and 125.5 (85.0-177.0) months in HC. The frequency (6.5 % in AT, 0 % in HC), risk of sleep disturbance (60 % in AT, 25 % in HC), and sleep problems (80 % in AT, 50 % in HC) were higher in AT than in HC. As the male/female ratio differed between AT and HC in our study, we applied further analyses adjusting for gender and age; AT patients were almost 4.5 times more likely to develop sleep disturbances and 6 times more likely to have sleep problems than HC. Sleep-related problems decreased with increasing age in HC; sleep problems partially decreased in AT, but sleep disturbances did not decrease in AT.

CONCLUSION

Sleep architecture, behavior, and habits may be disturbed in AT, justifying the inclusion of sleep screening tools in the clinical follow-up of these patients even if no symptoms are reported in the medical history. Further clinical studies in large cohorts are needed to develop sleep screening tools specific to AT and similar neurodegenerative diseases.

Chinese postpartum mothers' perspectives about the usage of donor milk and human milk banks: A qualitative study

INTRODUCTION

Human milk banks (HMBs) were established to provide safe human milk for infants in need. However, the number and volume of donors are insufficient in China. This study aimed to explore Chinese postpartum mothers perspectives on the use of donor milk and the implementation of HMBs.

METHOD

A descriptive phenomenology design with semi-structured interviews was used to collect data involving 18 postpartum mothers from January to June 2021.

RESULTS

The study revealed that participants had limited knowledge of donor milk and human milk banks, faced multiple barriers to accessing donor milk, and exhibited diverse motivations for considering its use. Key barriers included misconceptions about the value of donor milk for premature infants, concerns over quality and safety, psychological hesitations, and limited access to human milk banks. However, some participants saw donor milk as a way to support breastfeeding beliefs and alleviate the burdens associated with breastfeeding.

DISCUSSION

This study explored challenges in HMBs and donor milk use, emphasizing the necessity for targeted education.

The effect of laboratory critical value reporting on patient management at Siriraj Hospital - Thailand's largest national tertiary referral center

Critical laboratory values are life-threatening results that necessitate immediate medical intervention. Reporting these values according to established guidelines is essential for ensuring optimal patient safety and care quality. The aim of this study was to evaluate the laboratory critical value reporting system and the actions taken at Siriraj Hospital - Thailand's oldest and largest teaching hospital - during January 2018. This study reviewed critical values from hematology, coagulation, and clinical chemistry tests over a one-month period. Patient management actions in response to critical values were classified into five categories: treatment, further investigation, monitoring, treatment combined with investigation, and other. Descriptive statistics were used to analyze the data in Microsoft Excel 2019, calculating the incidence of critical values, notification rates, and management actions. Of the 253,537 tests that were performed, 2,722 critical levels were found, indicating an incidence rate of 1.1%. Hemoglobin and potassium were the most frequently observed critical parameters, accounting for 25.61% and 23.99% of cases, respectively. The rate of notification varied depending on the specific parameter and patient category. For critical glucose and potassium levels, the most common response was close monitoring within 30 minutes, followed by treatment in 80% of cases. Hypermagnesemia, a condition linked to preeclampsia and treated with magnesium sulfate, required particularly careful monitoring. The 1.1% incidence of critical values in this study is high compared to previously published international data; however, this may be explained by the high volume of complex cases referred to our national tertiary referral center. Critical value reporting criteria should be established based on patient conditions and hospital management practices to reduce unnecessary alerts, optimize laboratory workload, and ensure high-quality patient care.

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.

Management of critical care emergencies in children with autism spectrum disorder

BACKGROUND

Managing critical care emergencies in children with autism spectrum disorder (ASD) presents unique challenges due to their distinct sensory sensitivities, communication difficulties, and behavioral issues. Effective strategies and protocols are essential for optimal care in these high-stress situations.

AIM

To systematically evaluate and synthesize current evidence on best practices for managing critical care emergencies in children with ASD. The review focuses on key areas, including sensory-friendly environments, communication strategies, behavioral management, and the role of multidisciplinary approaches.

METHODS

A comprehensive search was conducted across major medical databases, including PubMed, Embase, and Cochrane Library, for studies published between 2000 and 2023. Studies were selected based on their relevance to critical care management in children with ASD, encompassing randomized controlled trials, observational studies, qualitative research, and case studies. Data were extracted and analyzed to identify common themes, successful strategies, and areas for improvement.

RESULTS

The review identified 50 studies that met the inclusion criteria. Findings highlighted the importance of creating sensory-friendly environments, utilizing effective communication strategies, and implementing individualized behavioral management plans. These findings, derived from a comprehensive review of current evidence, provide valuable insights into the best practices for managing critical care emergencies in children with ASD. Sensory modifications, such as reduced lighting and noise, visual aids, and augmentative and alternative communication tools, enhanced patient comfort and cooperation. The involvement of multidisciplinary teams was crucial in delivering holistic care. Case studies provided practical insights and underscored the need for continuous refinement of protocols.

CONCLUSION

The review emphasizes the need for a tailored approach to managing critical care emergencies for children with ASD. Sensory-friendly adjustments, effective communication, and behavioral strategies supported by a multidisciplinary team are integral to improving outcomes. Despite progress, ongoing refinement of care practices and protocols is necessary. This ongoing process addresses remaining challenges and engages healthcare professionals in continuous improvement of care for children with ASD in critical settings.

Breaking the cycle: Psychological and social dimensions of pediatric functional gastrointestinal disorders

BACKGROUND

Functional gastrointestinal disorders (FGIDs) in children present with chronic symptoms like abdominal pain, diarrhea, and constipation without identifiable structural abnormalities. These disorders are closely linked to gut-brain axis dysfunction, altered gut microbiota, and psychosocial stress, leading to psychiatric comorbidities such as anxiety, depression, and behavioral issues. Understanding this bidirectional relationship is crucial for developing effective, holistic management strategies that address physical and mental health.

AIM

To examine the psychiatric impacts of FGIDs in children, focusing on anxiety and depression and their association with other neurodevelopmental disorders of childhood, such as attention-deficit/hyperactivity disorder, emphasizing the role of the gut-brain axis, emotional dysregulation, and psychosocial stress. Key mechanisms explored include neurotransmitter dysregulation, microbiota imbalance, central sensitization, heightening stress reactivity, emotional dysregulation, and symptom perception. The review also evaluates the role of family dynamics and coping strategies in exacerbating FGID symptoms and contributing to psychiatric conditions.

METHODS

A narrative review was conducted using 328 studies sourced from PubMed, Scopus, and Google Scholar, covering research published over the past 20 years. Inclusion criteria focused on studies examining FGID diagnosis, gut-brain mechanisms, psychiatric comorbidities, and psychosocial factors in pediatric populations. FGIDs commonly affecting children, including functional constipation, abdominal pain, irritable bowel syndrome, gastroesophageal reflux, and cyclic vomiting syndrome, were analyzed concerning their psychological impacts.

RESULTS

The review highlights a strong connection between FGIDs and psychiatric symptoms, mediated by gut-brain axis dysfunction, dysregulated microbiota, and central sensitization. These physiological disruptions increase children's vulnerability to anxiety and depression, while psychosocial factors - such as chronic stress, early-life trauma, maladaptive family dynamics, and ineffective coping strategies - intensify the cycle of gastrointestinal and emotional distress.

CONCLUSION

Effective management of FGIDs requires a biopsychosocial approach integrating medical, psychological, and dietary interventions. Parental education, early intervention, and multidisciplinary care coordination are critical in mitigating long-term psychological impacts and improving both gastrointestinal and mental health outcomes in children with FGIDs.

Visceral adiposity index and cardiorespiratory fitness: Unmasking risk of impaired fasting glucose among adolescents

Type 2 diabetes mellitus (T2DM) is increasing among adolescents, but paediatric risk predictors are relatively underdeveloped. This study aimed to establish the associations of visceral adiposity index (VAI) and cardiorespiratory fitness (CRF) with fasting plasma glucose in 418 Nigerian adolescents aged 11 years to 19 years. Using a cross-sectional design, participants were stratified by VAI and CRF tertiles to examine variations in impaired fasting glucose (IFG) risk. The findings of this study revealed significant gender differences: In the case of boys, high VAI and low CRF is associated with IFG, while no association was present in girls. CRF, measured by the 20-meter shuttle run, was a stronger predictor of IFG than VAI, suggesting that physical fitness is a protective factor against glucose dysregulation. These findings point to VAI and CRF as useful, non-invasive predictors of risk for T2DM in youth, supporting school-based fitness programs that promote CRF and attenuate visceral adiposity, particularly in males. Future work must validate these predictors across various ethnic populations and identify other risk factors that can augment plans for early interventions aimed at the prevention of adolescent T2DM.

African minors' health challenges are comparable to those in the rest of the world

Today's youth in rich and poor countries faces comparable health risks and challenges. There is the temptation to enjoy too much food that is advertised as delicious and to eat too little healthier food. An increasingly sedentary lifestyle makes physical activity voluntary, no longer based on the daily need for physical activity in rural production. This is a serious medical problem, as today's young people are threatened tomorrow (and sometimes, already today) by cardiovascular disease and type 2 diabetes mellitus, later by further challenges including arthritis, stroke, and more. But this is a challenge far beyond medicine. Young people need to be empowered to distinguish between good and bad lifestyles and be strengthened in their willingness to make an effort for future health. It may not seem very sexy to eat mostly fruits and high-fiber traditional foods instead of hamburgers, snacks, sweets, or to eat in posh restaurants. Everyone needs a certain resistance to advertising today, whether they grow up in Nigeria, Europe or anywhere else. Medical doctors, teachers, and many other professionals with responsibilities for young people have a key role in this endeavour.

Gut microbiota diversity and composition in children with autism spectrum disorder: associations with symptom severity

Background

Autism spectrum disorder (ASD) is a prevalent neurodevelopmental disorder impairing social and communication skills. Gut microbiota has become key in understanding ASD pathophysiology. However, the relationship between the ASD symptoms and alternation of gut microbiota still remains unknow. We hypothesize that the composition of gut microbiota in children with ASD may be strongly associated with the severity of their symptoms.

Methods

Here, fecal samples from children (divided in to three groups: neurotypical, severe ASD and mild ASD) at a hospital were collected. The symptoms of ASD were assessed by an experienced pediatric neurologist, and the severity of the symptoms in children with ASD was determined based on the assessment scores. Then the diversity and composition of gut microbiota were detected by high-throughput sequencing.

Results

In total, 2,021 amplicon sequence variants (ASVs) were obtained from 46 fecal samples, with highest in the neurotypical group. Alpha diversity in bacteria differed between severe and mild ASD. Microbiota health and dysbiosis indices varied with ASD severity. Beta diversity indicated that severe ASD differed from others, and mild ASD was closer to neurotypical in community structure. At the phylum level, Firmicutes was the dominant bacteria but abundances differed in different groups, and Ascomycota increased in severe ASD fungi. At the genus level, groups had distinct dominants, and mild ASD microbiota resembled that of neurotypical children. Function prediction revealed differences in bacteria and fungi, with severe ASD having higher amino acid metabolism, lower cofactor/vitamin metabolism, and more undefined saprotrophs.

Conclusion

This study revealed gut microbiota differences between ASD children (varying symptoms) and neurotypical ones, showing milder ASD closer in microbiota aspects. It offers insights for exploring ASD pathogenesis and devising interventions.

Disparities in Pediatric Bone Health

Bone mass which is attained during childhood is a key determinant of bone health throughout the life span. Primary and secondary bone health pathologies that affect normal bone accretion can have lasting effects on bone health and increase the risk for osteoporosis and osteomalacia in adulthood. Health disparities in race, socioeconomic status, and geopolitical factors impact timely screening and diagnosis, treatment, disease burden, and long-term health outcomes. Acknowledging these disparities can inform global policy change and improve care for patients in these vulnerable populations.

Irritable bowel syndrome, the gut microbiome, and diet

PURPOSE OF REVIEW

To provide an update of recent studies exploring the role of the gut microbiota and diet in the pathogenesis and treatment of irritable bowel syndrome (IBS).

RECENT FINDINGS

The human gut microbiome has been recognized as an important, active source of signaling molecules that explain in part the disorder of the gut brain interaction (DGBI) in IBS. Subsequent changes in the metabolome such as the production of short-chain fatty acids (SCFA) and serotonin are associated with IBS symptoms. Dietary components are recognized as important triggers of IBS symptoms and a diet low in fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs) has been shown effective and safe, even when used long-term. Fecal microbiota transplantation (FMT) in IBS has not shown sustained and effective IBS symptom reduction in controlled clinical trials.

SUMMARY

This update elucidates recent developments in IBS as it relates to clinical trial results targeting dietary and gut microbiota interventions. The gut microbiome is metabolically active and affects the bi-directional signaling of the gut-brain axis.

Intellectual disability and genotype-phenotype correlation between full-scale intelligence quotient and mutation characteristics in boys with dystrophinopathy

BACKGROUND

Neuropsychological evaluations of dystrophinopathy patients indicate a decrease in mean full-scale intelligence quotient (FSIQ) compared to the general population. However, large-scale studies with longitudinal follow-up in this regard are yet to be conducted in the Indian subcontinent.

METHODS

Verbal, performance, and FSIQ of children with dystrophinopathy, aged 6-16 years were prospectively compared with age/socioeconomic status matched healthy controls, using the Malin's Intelligence Scale for Indian children (MISIC). Additionally, cognitive assessments were repeated in dystrophinopathy boys who completed at least one year of follow-up during study period. Genotype-phenotype correlation was also explored between FSIQ and mutational characteristics by dividing the dystrophinopathy group into Dp427, Dp140, and Dp71 isoforms. Furthermore, other clinical/genetic predictors of cognitive status were explored in dystrophinopathy cases.

RESULTS

A total of 154 and 77 boys were enrolled in the dystrophinopathy and control groups, respectively. While the dystrophinopathy group had lower scores in verbal, performance, FSIQ, and all sub-tests compared to the control group (p < 0.001), their performance IQ was paradoxically better than verbal IQ (86.9 ± 12.3 vs 83.6 ± 11.4, p = 0.008). The Dp71 group had significantly lower verbal, performance, and FSIQ, and this isoform was found to be an independent predictor of intellectual disability in the dystrophinopathy group in multivariate analysis. Follow-up IQ assessment after one year (n = 47) showed a non-significant reduction in FSIQ (85.1 ± 10.7 vs 84.3 ± 11.2, p = 0.64).

CONCLUSION

Boys with dystrophinopathy exhibit lower IQ compared to healthy controls, and the degree of cognitive impairment is more pronounced in cases with the Dp71 isoform.

Prevalence and associated factors for retinopathy of prematurity at a tertiary hospital in Dar es Salaam, Tanzania

BACKGROUND

Retinopathy of prematurity (ROP) is one of the leading causes of preventable childhood blindness worldwide. There has been a rapid increase in neonatal units in Tanzania leading to increased survival of preterm babies, which lead to increasing number of babies at risk of ROP. ROP screening started in Tanzania for the first time in Muhimbili National Hospital in Dar es Salaam in late 2019. This study determines the prevalence and factors associated with ROP in Muhimbili hospital from June 2020 to February 2021.

METHODS

A prospective cohort study was conducted among 193 preterm newborns with ≤34 weeks gestational age and ≤2000 g birth weight. ROP screening was performed using an indirect ophthalmoscope and 20D Volk lens on dilated fundus. Prevalence was determined as the proportion of babies with ROP. Cox regression model was used to assess the contribution of risk factors to the occurrence of ROP.

RESULTS

The prevalence of ROP was 29% (56/193), and of type 1 ROP was 8.8%. Majority had zone two (73.2%) and 41.1% had stage two disease. Aggressive ROP constituted 8.9%. Significant factors for ROP development were gestational age <32 weeks (hazard ratio 6.8, p value 0.00), birth weight <1500 g (hazard ratio 2.1, p value 0.02), Apgar score <7 (hazard ratio 1.9, p value 0.03), RDS (hazard ratio 3.3, p value 0.01) and oxygen supplementation for >1 week (hazard ratio 0.74, p value 0.03). Surfactant use had a protective effect (hazard ratio 0.2, p value 0.03).

CONCLUSION

Prevalence of ROP is fairly high in our setting. Screening is essential to prevent visual morbidity and blindness resulting from ROP in the country.

Hypotonia in the Neonatal Intensive Care Unit

Hypotonia is a common presenting symptom in the neonatal intensive care unit (NICU). Hypotonia can be a manifestation of an underlying systemic illness, a primary nervous system disease, or a peripheral nervous system disease. Examination and history can suggest specific causes, but rapid and accurate diagnosis remains challenging due to the broad spectrum of causes. Options for disease-targeted therapies have increased the importance of early diagnosis. This article focuses on the evaluation and diagnostic approach of the hypotonic newborn in the NICU, with an emphasis on rapid identification of treatable conditions and updated recommendations on the utilization of genetic testing.

Guidelines for Complicated Urinary Tract Infections in Children: A Review by the European Society for Pediatric Infectious Diseases

BACKGROUND

Complicated urinary tract infections (cUTI) present a challenge to the clinician because of the variety in clinical syndromes included and consequent difficulties in synthesizing evidence. A harmonized definition of cUTI does not exist. In national guidelines, management recommendations for cUTI are often neglected. We aimed to define the four most important controversies and formulate management recommendations for cUTI in children and adolescents.

METHODS

The European Society of Pediatric Infectious Diseases Guideline Committee convened a working group of experts from microbiology, pediatric nephrology and infectious diseases with expertise in managing children with UTI. A comprehensive literature review was done using PubMed, Embase and the Cochrane library to find studies in children under 18 years published until December 2024. Four controversies were defined from experience and available evidence. Children with cUTI were categorized into 5 subgroups: anatomical/functional urological abnormalities, multiple UTI recurrences, severe clinical presentation, nonurological underlying conditions and neonates. Respective management guidelines were formulated through the evidence and by consensus of working group members. Recommendations were made using GRADE criteria.

RESULTS

The term cUTI is generally used to define children with UTI with an increased likelihood of failing conventional management. The included 5 subgroups are the most likely to need additional investigations at diagnosis and during the course of infection, initial intravenous antibiotics, longer treatment duration, antibiotic prophylaxis, follow-up imaging and surgical referral. These are detailed for each subgroup.

CONCLUSIONS

These comprehensive guidelines offer evidence-graded recommendations specifically for pediatric cUTI, addressing gaps that exist in current guidelines.

Should We Continue to Tell Autistic People that Their Brains are Different?

Autism is often considered to reflect categorically 'different brains'. Neuropsychological research on autism spectrum disorder (ASD) however, has struggled to define this difference, or derive clear-cut boundaries between autism and non-autism. Consequently, restructuring or disbanding the ASD diagnosis is becoming increasingly advocated within research. Nonetheless, autism now exists as a salient social construction, of which 'difference' is a key facet. Clinical and educational professionals must influence this cautiously, as changes to autism's social construction may counterproductively affect the quality of life of autistic people. This paper therefore reviews ASD's value as both neuropsychological and social constructs. Although lacking neuropsychological validity, the autism label may be beneficial for autistic self-identity, reduction of stigma, and administering support. Whilst a shift away from case-control ASD research is warranted, lay notions of 'different brains' may be preserved.

Reducing childhood externalizing behavior: A feasibility RCT of the being a Parent program

OBJECTIVE

Rising rates of childhood behavioral problems are a global concern and in Portugal cases of behavioral problems in youth have been following international trends. Parenting interventions are widely regarded as one of the most effective ways to address externalizing behaviors early on, and thus their dissemination is crucial. This paper presents a feasibility randomized controlled trial (RCT) conducted in Portugal to evaluate the effectiveness of a parenting intervention for childhood behavioral problems. Our goals were threefold: a) assess feasibility parameters; b) evaluate program fidelity and acceptability; and c) examine the program's potential impact on child behavior, parenting skills, parental concern, and parental competence.

METHOD

A double-blinded, two-arm design was employed. Fifty-five families of children aged 2-11 years old who reported difficulties managing their child's behavior were included. Parents were randomly assigned to either the intervention group or a waitlist control group, and the intervention group participated in the eight-week "Being a Parent" program (Portuguese version: Ser Pai & Ser Mãe). Data were collected at two time points (pre- and post-intervention) using quantitative measures.

RESULTS

Findings confirmed the program's successful implementation in Portugal and demonstrated significant positive effects, particularly in reducing externalizing behavior, as well as aggressive behavior, and increasing parental competence, more specifically parental satisfaction.

CONCLUSIONS

This study represents the first trial of the Being a Parent program conducted outside the UK, and highlights its potential for broader international application. Key challenges and clinical implications are also addressed.

TRIAL REGISTRATION

ClinicalTrials.gov (nº NCT05626244).

Feeding development in healthy infants: A comparative framework for children with Spinal Muscular Atrophy - The DySMAnorm study

OBJECTIVES

Normative data for swallowing parameters in non-dysphagic, healthy children for instrumental and clinical diagnostics are limited. In children with SMA, where due to the degenerative nature a deterioration in swallowing function in the first months of life is possible despite disease-modifying therapy, regular monitoring is required. The DySMA (Dysphagia in Spinal Muscular Atrophy) is a tool available to assess both physiological feeding development and specific abnormalities in children with SMA. We aimed to generate normative data for the DySMA in a sample of healthy infants to facilitate comparisons with children with SMA.

METHODS

Healthy infants and toddlers aged zero to 24 months were recruited and divided into seven age groups. Two speech-language pathologists assessed the children according to the DySMA study protocol. The data were evaluated descriptively and the inter-rater reliability was calculated.

RESULTS

A total of 92 healthy children were included. The DySMA total score ranged from 21 to 35 and showed excellent inter-rater reliability (ICC = .936; 95 % CI .752 to .984). The maximum score of 35 was first reached from 16 months onwards. Categories representing physiological development showed the most significant age-dependent changes, while no age-related development was observed in categories expressing pathology.

CONCLUSION

The DySMA effectively captures physiological feeding development. A higher total score reflects more comprehensive skills in children, while a lower score indicates a reduced range of abilities. By analyzing the normative sample, this tool makes it possible to represent a deviation from the norm for children with SMA.

Pitfalls and considerations in the diagnosis of Hirschsprung's disease: A focus on pathological assessment

Hirschsprung's disease (HSCR) is a congenital disorder of the intestine characterized by the absence of ganglion cells (GCs) in the myenteric and submucosal plexuses of the distal colon, leading to functional obstruction. The diagnosis of HSCR relies heavily on histopathological examination, yet pitfalls abound. Underdiagnosis can lead to delayed diagnosis, the need for reoperation, or risk of complications; conversely, overdiagnosis can lead to unnecessary surgery and its associated side effects. This comprehensive pictorial review addresses common diagnostic challenges using cases from our hospital, a tertiary pediatric facility and referral center for HSCR patients, and emphasizes the need for close cooperation among pathologists, surgeons, pediatric gastroenterologists, and radiologists to achieve optimal management for patients with HSCR.

Exploring the role of exosomal and non-exosomal non-coding RNAs in Kawasaki disease: Implications for diagnosis and therapeutic strategies against coronary artery aneurysms

Kawasaki disease (KD) is an acute vasculitis primarily affecting children, with a potential risk of developing coronary artery aneurysms (CAAs) and cardiovascular complications. The emergence of non-coding RNAs (ncRNAs), including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), has provided insights into Kawasaki disease pathogenesis and opened new avenues for diagnosis and therapeutic intervention. Furthermore, polymorphism analysis of ncRNA genes offers significant insights into genetic predisposition to Kawasaki disease, facilitating tailored treatment approaches and risk assessment to improve patient outcomes. Exosomal ncRNAs, which are ncRNAs encapsulated within extracellular vesicles, have garnered significant attention as potential biomarkers for Kawasaki disease and CAA due to their stability and accessibility in biological fluids. This review comprehensively discusses the biogenesis, components, and potential of exosomal and non-exosomal ncRNAs in Kawasaki disease diagnosis and prognosis prediction. It also highlights the roles of non-exosomal ncRNAs, such as miRNAs, lncRNAs, and circRNAs, in Kawasaki disease pathogenesis and their implications as therapeutic targets. Additionally, the review explores the current diagnostic and therapeutic approaches for Kawasaki disease and emphasizes the need for further research to validate these ncRNA-based biomarkers in diverse populations and clinical settings.

Children and Adolescents with Severe Tyrannical Behaviour: Profile of Youth and Their Parents

This study focused on a subtype of child-to-parent violence, severe tyrannical behaviour (STB). The aim was to examine the clinical characteristics of children and adolescents who physically and/or verbally abuse their parents and the sociodemographic characteristics and generalities of those families. Clinical and sociodemographic data from 73 children and adolescents with STB and their parents have been collected from a randomized control trial. Results showed a specific profile of youth with tyrannical behaviour (aggressive behaviour only in-home settings, only-child, previously mental health care), as well as differential characteristics of these families (late parenthood, high socio-economic status and conjugal family). Children with tyrannical behaviour frequently had psychiatric conditions, such as attention deficit hyperactivity disorder, separation anxiety, sleeping disorders and severe irritability was frequently described. These clinical patterns of combined neurodevelopmental, externalized and internalized symptoms suggest that the combination of individual characteristics, parenting style and parent-child relationship play essential roles in children's STB development.

Efficacy and safety of transcranial direct current stimulation (tDCS) in patients with obsessive-compulsive disorder (OCD): A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Transcranial direct current stimulation (tDCS) is gaining traction for treating obsessive-compulsive disorder (OCD), but its effectiveness and safety remain uncertain. A systematic review of randomized controlled trials (RCTs) will assess its clinical benefits for symptom reduction.

METHODS

Six databases-Scopus, PubMed, Web of Science, Cochrane, PsycINFO, and Cochrane Central-were searched to identify relevant studies. The included studies were RCTs that assessed the effects of tDCS on OCD symptoms, as well as its impact on anxiety and depression, while also evaluating adverse events (AEs). The risk of bias (ROB) was analyzed using the ROB-2 tool. A meta-analysis was performed utilizing Stata-17 software.

RESULTS

Immediately following treatment, the analysis revealed that tDCS significantly reduced the Y-BOCS score (SMD = -0.56 [-0.87, -0.26]), anxiety scores (SMD = -1.11 [-1.85, -0.37]), and depression scores (SMD = -1.57 [-2.64, -0.50]), while increasing CGI-S scores (SMD = 0.40 [0.08, 0.72]) in OCD patients compared to the sham group. During the follow-up period (1-2 months post-treatment), tDCS continued to decrease the Y-BOCS score (SMD = -0.69 [-1.22, -0.17]), anxiety scores (SMD = -1.13 [-3.05, -0.78]), and depression scores (SMD = -2.02 [-3.00, -1.04]), but showed no effect on CGI-S scores when compared to the sham group. Additionally, the analysis indicated no significant differences in AEs between active tDCS and the sham group (OR: 1.20 [0.86, 1.68]).

CONCLUSIONS

This review suggests that tDCS may effectively alleviate OCD symptoms, along with related depression and anxiety, both acute and at follow-up, while causing minimal AEs.

Evaluation of the effect of different infant formulas on Streptococcus mutans biofilm formation: an in-vitro study

Considering the increase in the prevalence of early childhood caries, the effect of various types of frequently consumed infant milk formulas on the development of Streptococcus mutans biofilm was examined. Three samples of cow's milk-based formula (Aptamil, Bebelac, Nan), two samples of soy-based formula (Biomil soy and Isomil soy), and three samples of formulas containing hydrolyzed proteins (Aptamil HA, Bebelac HA, Nan HA) were selected. After adding the formulas to the Streptococcus mutans (ATCC 35668) culture media, the degree of bacterial biofilm formation was explored by assessing the optical density (OD) of the Cristal Violet dye in the decolorizing solution using an ELISA reader device. The analysis of the data was conducted using independent sample T-tests, ANOVA, and subsequently Fisher's LSD test using SPSS 22 software. A statistically significant difference was observed in the average levels of biofilm formation of Streptococcus mutans for the three types of understudy formulas (P < 0.001). In the presence of cow's milk-based formulas, the mean amount of biofilm formation was significantly greater than that of the soy-based (P = 0.003) and protein hydrolysate (P < 0.0001) formulas. However, no significant statistical difference was detected between the soy-based and protein hydrolysate formulas (P = 0.42). Aptamil exhibited the highest amount of biofilm formation with a mean OD of 1.81 whereas Aptamil HA showed the lowest amount of biofilm formation (OD = 0.61). The level of biofilm formation by Streptococcus mutans when exposed to cow's milk-based formula was noted to be greater than that observed with the soy-based and protein hydrolysate formulas.

Incidence and risk factors of retinopathy of prematurity in Palestine: a retrospective cohort study, 2024

BACKGROUND

Retinopathy of prematurity (ROP) is a major, yet preventable, cause of childhood blindness. This study aimed to determine the incidence in Palestine and the risk factors for ROP development.

METHODS

We conducted a retrospective cohort study involving 520 preterm infants born between January 2020 and December 2023 in 7 major Palestinian Neonatal Intensive Care Units (NICUs) who were screened for ROP. We examined a range of clinical variables from medical records to explore their relationship with the development of the disease.

RESULTS

The incidence of ROP and severe type 1 ROP was 42.9% and 8.8%, respectively. Many risk factors were significant in univariate analysis, such as respiratory distress syndrome (RDS), the duration of mechanical ventilation, the number of blood transfusions needed, and the need for supplemental oxygen at 28 days. However, only lower gestational age (OR, 10.4; 95% CI, 3.66-29.9; p < 0.001), lower birth weight (OR, 2.5; 95% CI, 1.3-4.7; p = 0.006), lower postmenstrual age at the time of diagnosis, and multiple gestations were significant in multivariate analysis.

CONCLUSION

ROP is a significant problem in Palestine, with a relatively higher incidence than in neighboring countries. Considering the statistically significant variables in the clinical practice will prevent missing severe cases that may progress to blindness.

Late-onset diagnosis of SHINE syndrome in an adolescent with developmental delay: Case report

Sleep disturbances, hypotonia, intellectual disability, neurological disorders, and epilepsy (SHINE) syndrome is a rare autosomal dominant neurodevelopmental disorder. A mutation in the DLG-4 gene on chromosome 17 causes SHINE syndrome. SHINE are characteristic feature of the disease. This case recounts a 16-year-old female patient who presented with a longstanding history of developmental delay and intellectual disability since the age of two. At various points throughout her childhood, she was diagnosed with pervasive developmental disorder, autism spectrum disorder, attention-deficit hyperactivity disorder, and severe intellectual delay, undergoing extensive testing and imaging. Fourteen years after the initial presentation, additional genetic testing revealed a de-novo mutation in the DLG4 gene, confirming a diagnosis of SHINE syndrome. Due to its characteristic features, SHINE syndrome should be considered part of the differential diagnosis in children with unexplained developmental delays.

Bidirectional and longitudinal relationship between nature contact and children's problem behavior: The mediating role of prosocial behavior

Previous studies have suggested that nature contact is a protective factor for problem behavior in children. However, there remains a significant gap in research exploring the reciprocal relationship between nature contact and children's problem behavior, as well as the underlying mechanisms driving this relationship. This study employed a longitudinal three-wave design involving 516 children in China (268 girls, Mage = 10.88 ± 0.66 years old at Time 3). Cross-lagged analyses indicated that nature contact and problem behavior negatively predicted each other over time, and prosocial behavior bidirectionally mediated the relationship between nature contact and problem behavior. These results provided evidence for the relationships among nature interaction, social development, and behavioral development in children. These findings suggested that promoting prosocial behavior could reduce problem behavior and enhance nature engagement, potentially serving as a strategy to foster comprehensive development in children.

Endogenous Endophthalmitis in Children: A 5-Year Retrospective Study in Vietnam

PURPOSE

To describe the findings and outcomes in pediatric endogenous endophthalmitis cases over a 5-year period in Vietnam.

METHODS

All cases of pediatric endogenous endophthalmitis seen at Vietnam National Eye Hospital from 2016 to 2020 (n = 157) were retrospectively studied. Data on epidemiology, microbiology, clinical manifestations, ultrasound findings, and outcomes were collected and analyzed. Success was defined as visual acuity of counting fingers at 1 meter or better if visual acuity testing could be done, and a fully attached retina, controlled intraocular pressure, and no phthisis bulbi.

RESULTS

The mean patient age was 6.0 ± 3.8 years. Gram-positive cocci were the most common causative agents (45.2%), followed by Gram-negative bacilli (10.8%). Among 31 cases in which both vitreous and aqueous specimens were collected, 17 (54.8%) showed discordant microbiological results. The overall treatment success rate was 38.2%. An initial visual acuity better than light perception was associated with a higher success rate (45.8% vs 16.7%, P < .05). Children presenting with ultrasound grade 3 vitreous opacity had a lower success rate compared to those with grades 1 and 2 combined (38.1% vs 69.6%, P < .05).

CONCLUSIONS

Gram-positive cocci were the most frequently identified pathogens in children with endogenous endophthalmitis in Vietnam. The low agreement between smear stain and culture results indicates that using both methods could enhance diagnostic accuracy. Initial visual acuity at admission and the degree of vitreous opacity were recognized as important prognostic factors for treatment outcomes. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Genetic heterogeneity in patients with enlarged vestibular aqueduct and Pendred syndrome

BACKGROUND

Pathogenic variants in the SLC26A4 gene, encoding for Cl-/HCO3- and I- anion transporter pendrin, are associated with non-syndromic hearing loss with enlarged vestibular aqueduct (NSEVA) and Pendred syndrome (PDS). In the Caucasian population, up to 75% of patients fail to identify a genetic cause through biallelic mutations in the SLC26A4 gene. The CEVA haplotype could therefore play an important role in the diagnostics of NSEVA. The aim of the study was to determine the genetic etiology of hearing loss with EVA or with fully developed PDS in 37 probands and the functional characterization of novel variants identified in the SLC26A4 gene.

METHODS

To determine the genetic etiology, Sanger sequencing, WES and KASP genotyping assay were used. Functional characterization of SLC26A4 variants c.140G>A (p.R47Q), c.415G>A (p.G139R), c.441G>A (p.M147I), c.481T>A (p.F161I), c.1589A>C (p.Y530S) and c.2260del (p.D754Ifs*5) involved determination of iodide influx, total and plasma membrane pendrin expression level and subcellular localization of pendrin by confocal imaging. The nanopore sequencing of nasopharyngeal swab samples was performed to confirm the pathogenic effect of potential splice site variant c.415G>A.

RESULTS

Biallelic variants in the SLC26A4 gene (M2 genotype) were identified in ten probands and a complete CEVA haplotype was confirmed in three probands harbouring SLC26A4 monoallelic variants (M1 genotype). Fifteen variants in the SLC26A4 gene were identified in total, three of which are novel. The functional characterization of the novel variants and variants which were not yet functionally characterized confirmed the pathogenic potential of five out of six tested variants (p.G139R, p.M147I, p.Y530S, p.D754Ifs*5, and p.F161I). Analysis of nasopharyngeal swab samples confirmed exon 4 skipping due to novel variant SLC26A4:c.415G>A. Probands with biallelic SLC26A4 variants had significantly larger thyroid volume per m2 of body surface area than subjects with monoallelic SLC26A4 variants and the CEVA haplotype.

CONCLUSIONS

The genetic aetiology was determined in 13 out of 37 probands (35%), seven manifested with PDS and six with NSEVA. The present study highlights the importance of functional testing to confirm the pathogenicity of SLC26A4 variants and the phenotype-genotype correlation in SLC26A4-related disorders.

Pharmacological management for insomnia in children and adolescents with autism and attention deficit and hyperactivity disorder

INTRODUCTION

Insomnia is common in children and adolescents with autism spectrum disorder (ASD) and/or attention deficit and hyperactivity disorder (ADHD), with significant implications for quality of life and prognosis. Although non-pharmacological interventions represent the first-line approach, they are not always effective. Therefore, it is important to determine when a pharmacological treatment can be indicated and which compound to prefer based on evidence of efficacy and safety.

AREAS COVERED

The literature evidence related to the pharmacological treatment of insomnia in ASD and/or ADHD is discussed. We present data on drugs and supplements used and considerations about the choice of starting a pharmacological therapy, suggesting clinical advice that may guide clinicians.

EXPERT OPINION

Untreated insomnia can worsen ASD and ADHD symptoms, impair cognitive function, and reduce quality of life. Targeted interventions are essential. Behavioral strategies, with or without melatonin, are recommended after evaluating comorbidities and medications. Off-label treatments for children with ASD include antihistamines, alpha-adrenergics, trazodone, antidepressants, antipsychotics, anticonvulsants, and hypnotics. For ADHD, options include iron supplementation for restlessness and low ferritin levels, and alpha2-adrenergics like guanfacine and clonidine for their sedative effects.

Acceptability and safety of a probiotic beverage supplementation (Bio-K +) and feasibility of the proposed protocol in children with a diagnosis of autism spectrum disorder

BACKGROUND

Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders defined by stereotyped behavior and challenges in social communication and social interaction. ASD is associated with various comorbidities, including anxiety, gastrointestinal (GI) symptoms and sleep disorders. Evidence supports an association between intestinal dysbiosis and the severity of ASD-related symptoms. Probiotic intake was suggested to restore microbial homeostasis and decrease neurobehavioral, GI and sleep symptoms in individuals diagnosed with autism.

METHODS

This study aims to evaluate the acceptability and safety of a Bio-K + probiotics beverage in autistic children aged 4 to 11 years and the feasibility of the proposed research protocol to measure its impact on behaviors and comorbidities. The 30-week study consisted of daily supplementation with Bio-K + probiotics for 14 weeks. Acceptability and safety were monitored throughout the study. Feasibility was assessed by comparing recruitment and completion rates to pre-established thresholds. Preliminary impact of supplementation on behaviors (Autism Treatment Evaluation Checklist (ATEC) score), GI symptoms and sleep disorders was evaluated.

RESULTS

Of the 23 children recruited (mean age 6.7 ± 2.2 years, 70% males), 65% had GI problems and 91% had sleep disorders. Probiotic supplementation was accepted by all participants and no product-related adverse event was reported. Feasibility rates exceeded pre-established thresholds for almost all study outcomes including recruitment rate, compliance, electroencephalography, actigraphy and completion of questionnaires. Preliminary data suggest an improvement in behaviors associated with autism assessed with the total ATEC score, and in GI symptoms and sleep disorders.

CONCLUSION

This study demonstrates probiotic beverage acceptability and safety and protocol feasibility in autistic children. To further support our data, a double-blinded placebo-controlled study is needed to determine its efficacy.

Severe hyperlactatemia from Warburg effect due to post-transplant lymphoproliferative disorder after paediatric heart transplantation with resolution following thiamine administration

Hyperlactatemia is a common and concerning finding in the paediatric cardiac ICU as it may signify tissue hypoperfusion and/or hypoxia. However, it is important to include other aetiologies for an elevated lactate in the differential, especially when the lactate is significantly elevated (> 8 mmol/L). We present the case of metabolic acidosis with severe hyperlactatemia secondary to Warburg effect and presumed thiamine deficiency in a paediatric heart transplant patient with post-transplant lymphoproliferative disorder.

Assessment of the Diet Quality Index and Its Constituents in Preschool Children Diagnosed with a Food Allergy as Part of the "Living with an Allergy" Project

Pediatric food allergies (FAs) are health conditions that adversely impact the quality of life of children and their caregivers.

AIM

The primary objective of the present study was to assess the quality of the diets administered to allergic children based on the Healthy Diet Index (HID-10), to determine the influence of parental knowledge about FAs and the elimination diet, and to identify the factors that contribute to healthy food choices.

MATERIAL AND METHODS

This study was conducted as part of the "Living with an Allergy" research and educational program for preschool children, which was implemented between June 2021 and June 2023 in the city of Lublin.

RESULTS

Food allergies were diagnosed and confirmed in 241 children, including 106 boys (44%). A higher number of unhealthy dietary factors (DQI-1) was significantly associated with gender, and lower DQI values were more often noted in boys (p < 0.05). In turn, a higher number of health-promoting dietary factors (DQI-3) was significantly associated with a younger age in children (OR 1.54; 95%CI 1.17-1.74, p < 0.01) and with an older age in parents (OR 1.43; 95%CI 1.2-1.67, p < 0.05).

CONCLUSIONS

Children whose diets, including the necessary modifications, were recommended by a physician or a dietitian were characterized by significantly higher DQI values and a higher number of health-promoting dietary factors. The diets of children with FAs should consist mainly of unprocessed foods to control the intake of unhealthy products that suppress immunity.

Rhinosinusitis: Evidence and experience - 2024

It has been 10-years since the publication of Rhinosinusitis: evidence and experience, and since then a lot has changed in our understanding of the disease. Advances in pathophysiology, endotyping and new treatments such as biologics brought a new era in the management of our patients. This new guideline, developed jointly by ABR and ABORL-CCF, with the help of ASBAI presents an updated, evidence-based approach to the different forms of rhinosinusitis that aims to improve the diagnosis and treatment of this complex disease. The document covers a wide range of topics, including clear definitions of the different stages of acute sinusitis. It also introduces a new term called Prolonged Acute Viral Rhinosinusitis. Reviews phenotypes and endotypes of chronic rhinosinusitis, recommending methods for clinical and laboratory investigation, clinical and surgical treatment. We also discuss in detail fungal sinusitis and pediatric sinusitis. The objective of this updated Consensus is to clarify some already established and recent concepts, highlighting the importance of an accurate diagnosis to promote treatment approaches that reflect the best practices based on solid evidence. Therefore, we seek not only to improve the results of patients care, but also to guide thealth professionals through a clinical panorama that is in constant transformation.

Associations between the gut microbiota and the metabolism rate of tacrolimus in kidney transplant recipients during the early posttransplant period

The use of tacrolimus (TAC), a critical immunosuppressant post transplantation, is complicated by its high pharmacokinetic variability. While the gut microbiota has gained attention as a potential contributor, few studies have assessed its role in TAC metabolism variability. This study investigated the associations between the gut microbiota and TAC metabolism rates in kidney transplant recipients during the first month post transplantation-a crucial period for adjusting TAC to achieve therapeutic levels. We recruited 20 kidney transplant recipients and profiled their gut microbiota diversity and composition from stool samples collected before transplantation and at weeks 1 and 4 post transplantation via 16S rRNA sequencing. The TAC pharmacokinetic parameters were also collected. Associations between TAC metabolism status or pharmacokinetic parameters and gut microbiota diversity and composition were evaluated. Recipients with a fast TAC metabolism rate (C0/D ratio < 1.05 ng/mL × 1/mg) presented significantly greater changes in both bacterial alpha and beta diversity metrics at 1 week post transplantation than did those with a slow metabolism rate (C0/D ratio ≥ 1.05 ng/mL × 1/mg). Compared with slow metabolizers, fast metabolizers were associated with a significant increase in the abundance of three bacterial genera (Faecalibacterium, Clostridia vadinBB60, and Ruminococcus) and a significant decrease in the abundance of two bacterial species (Bacteroides plebeius and Parabacteroides goldsteinii). This study revealed links between gut microbiota diversity and composition and TAC metabolism rates in kidney transplant recipients during the early posttransplant period, underscoring the importance of investigating the gut microbiota as a contributor to TAC pharmacokinetic variability. Clarifying this causal relationship could better predict inter- and intraindividual TAC pharmacokinetic variability.

Unraveling genetic etiologies in complex pediatric neurological diseases: A genetic investigation using whole exome sequencing

Pediatric neurological disorders are a diverse group of conditions affecting the nervous system in children, often challenging to diagnose due to their nonspecific and overlapping clinical features. Advances in molecular diagnostics, particularly whole exome sequencing (WES), have significantly improved the identification of genetic causes, enabling precise diagnoses and personalized treatments. This study explores the application of WES in diagnosing pediatric neurological disorders within Moroccan childrens with undiagnosed or challenging pediatric neurological conditions to uncover genetic causes of complex pediatric neurological conditions unresolvable by traditional diagnostic methods. The study included 188 pediatric patients with complex neurological conditions from the Children's Hospital of Rabat who underwent exome sequencing to investigate suspected genetic causes. WES revealed a diagnostic yield of 45%, identifying conditions such as intellectual disabilities, hereditary metabolic disorders and epilepsies. It also uncovered neurodevelopmental and neurodegenerative disorders, neuromuscular diseases, and genetic syndromes. A total of 157 variants were detected: 34% were classified as pathogenic, 28.5% as likely pathogenic, and 37.5% as variants of uncertain significance (VUS). These findings underscore the utility of WES as a robust diagnostic tool, providing insights into genetic causes and enabling tailored treatment strategies. They also highlight the importance of expanding genetic research to improve diagnostic accuracy and clinical management of pediatric neurological disorders.

Urine Metabolomic Profiling and Machine Learning in Autism Spectrum Disorder Diagnosis: Toward Precision Treatment

BACKGROUND

Autism spectrum disorder (ASD) diagnosis traditionally relies on behavioral assessments, which can be subjective and often lead to delayed identification. Recent advances in metabolomics and machine learning offer promising alternatives for more objective and precise diagnostic approaches.

METHODS

First-morning urine samples were collected from 52 children (32 with ASD and 20 neurotypical controls), aged 5.04 ± 1.87 and 5.50 ± 1.74 years, respectively. Using liquid chromatography-mass spectrometry (LC-MS), 293 metabolites were identified and categorized into 189 endogenous and 104 exogenous metabolites. Various machine learning classifiers (random forest, logistic regression, random tree, and naïve Bayes) were applied to differentiate ASD and control groups through 10-fold cross-validation.

RESULTS

The random forest classifier achieved 85% accuracy and an area under the curve (AUC) of 0.9 using all 293 metabolites. Classification based solely on endogenous metabolites yielded 85% accuracy and an AUC of 0.86, whereas using exogenous metabolites alone resulted in lower performance (71% accuracy and an AUC of 0.72).

CONCLUSION

This study demonstrates the potential of urine metabolomic profiling, particularly endogenous metabolites, as a complementary diagnostic tool for ASD. The high classification accuracy highlights the feasibility of developing assistive diagnostic methods based on metabolite profiles, although further research is needed to link these profiles to specific behavioral characteristics and ASD subtypes.

Exploring Glyoxalase Strategies for Managing Sugar-Induced Chronic Diseases

The liver's crucial role in methylglyoxal (MG) metabolism is frequently overlooked in the literature. We present a perspective that enhances the current understanding of the role of methylglyoxal (MG) and the glyoxalase cycle in the pathogenesis of insulin resistance and obesity, ultimately leading to type 2 diabetes mellitus (DM) and cardiovascular disease (CVD). Fructose may be a significant substrate contributing, particularly in contemporary times, to the flux of trioses in the liver, accounting for a substantial portion of MG production. The steady-state concentration of MG-and the subsequent modification of proteins-would then be determined by the flux of trioses, their utilization in lipogenesis, and their decomposition into MG, which is further converted into D-lactate by glyoxalase enzymes GLO1 and GLO2. Consequently, enhancing the activity and/or expression of GLO1 could potentially mitigate the adverse effects of fructose in the liver. Additional research and validation are required to confirm these biological pathways. These arguments are in favor of further research into safe and efficient ways to activate the glyoxalase pathway to lessen the negative effects of fructose metabolism that lead to insulin resistance (IR) and its related repercussions.

Bioengineering Innervated Esophagus With Improved Motility: Limitations and Future Directions

BACKGROUND

Over the past decade, research involving the bioengineering of esophageal tissue replacements for repair of congenital defects, cancer, and caustic injuries has advanced rapidly. This is due to the development of innovative biomaterials combined with stem cells that recapitulate tissue ultrastructure, mechanics, and biochemical properties. However, a limitation in the field is a lack of data demonstrating development of innervated tissue exhibiting peristalsis. Currently, no clinically available stem cell therapies/esophageal tissue substitutes exist that restore motility.

PURPOSE

This review will discuss advances and limitations in the assessment of esophageal motility in bioengineered tissues along with metrics of success. Additionally, innovative technologies (i.e., 3D bioprinting, electrospinning, and AI) and neuronal cellular approaches for promoting gut innervation will be highlighted to reveal their use for the development of clinical therapies for esophageal replacement. Future directions for development of patient-specific implants will also be discussed to emphasize the importance of access to all populations.

Understanding Glycogen Storage Disease Type IX: A Systematic Review with Clinical Focus-Why It Is Not Benign and Requires Vigilance

BACKGROUND/OBJECTIVES

Glycogen storage disease type IX (GSD IX) is a group of inherited metabolic disorders caused by phosphorylase kinase deficiency affecting the liver or muscle. Despite being relatively common among GSDs, GSD IX remains underexplored.

METHODS

A systematic review of GSD IX was conducted per PRISMA guidelines using SCOPUS and PubMed, registered with PROSPERO. Inclusion focused on human clinical studies published up to 31 December 2024.

RESULTS

A total of 400 patients with GSD IX were analyzed: 274 IXa (mean age at diagnosis 5.1 years), 72 IXc (mean age at diagnosis 4.9 years), 39 IXb (mean age at diagnosis 4.2 years), and 15 IXd (mean age at diagnosis 44.9 years). Hepatomegaly was commonly reported in types IXa, IXb, and especially IXc (91.7%), but was rare in IXd. Elevated transaminases were frequently observed in types IXa, IXb, and particularly IXc, while uncommon in IXd. Fasting hypoglycemia was occasionally observed in types IXa and IXb, more frequently in IXc (52.7%), and was not reported in IXd. Growth delay or short stature was observed in a substantial proportion of patients with types IXa (43.8%), IXb, and IXc, but was rare in IXd. Muscle involvement was prominent in IXd, with all patients showing elevated CPK (mean 1011 U/L). Neurological involvement was infrequently reported in types IXa and IXc.

CONCLUSIONS

This systematic review includes the most extensive clinical case history of GSD IX described in the literature. The clinical spectrum of GSD IX varies widely among subtypes, with IXc being the most aggressive. While liver forms are generally present in early childhood, muscle-type IXd shows delayed onset and milder symptoms, often leading to diagnostic delays. For diagnosis, it is essential not to underestimate key clinical features such as hepatic involvement and hypoglycemia in a child under 5 years of age. Other manifestations, including the as-yet unexplored systemic involvement of bone and kidney, remain insufficiently understood and require further investigation. Next-generation sequencing has improved diagnostic precision over traditional biopsy. Dietary management, including uncooked cornstarch, Glycosade®, and high-protein intake, remains the cornerstone of treatment. However, there is a paucity of well-designed, evidence-based studies to determine the most effective therapeutic approach. Despite its historically perceived benign course, the broad phenotypic variability of GSD IX, including progressive liver involvement and potential neurological complications, highlights its substantial clinical relevance and underscores the need for accurate diagnostic classification and long-term multidisciplinary follow-up.

Irritable Bowel Syndrome with Diarrhea (IBS-D): Effects of Clostridium butyricum CBM588 Probiotic on Gastrointestinal Symptoms, Quality of Life, and Gut Microbiota in a Prospective Real-Life Interventional Study

Diarrhea-predominant irritable bowel syndrome (IBS-D) is a functional gastrointestinal disorder characterized by altered motility, abdominal pain, and dysbiosis-particularly reduced biodiversity and a lower abundance of butyrate-producing bacteria. Strategies that modulate the gut microbiota may offer therapeutic benefit. Clostridium butyricum (C. butyricum) CBM588 is a butyrate-producing probiotic with immunomodulatory properties and potential efficacy in treating gastrointestinal disorders. This pragmatic, prospective, open-label, single-arm interventional study assessed the clinical, microbial, and safety-related effects of an 8-week CBM588 supplementation, along with a low-fiber and low-residue diet, in 205 patients with IBS-D who attended Quisisana Nursing Home Hospital, Rome, Italy, between November 2024 and February 2025. The primary outcomes included the global symptom response, the Bristol Stool Scale (BSS), stool frequency, diarrhea episodes, abdominal pain (severity and frequency), bloating, bowel dissatisfaction, quality of life (QoL), safety, and treatment tolerability-measured using the IBS Symptom Severity Scale (IBS-SSS) and a standardized tolerability scale. CBM588, in patients treated with a low-fiber and low-residue diet, significantly improved all clinical endpoints, with a >80% reduction in diarrhea episodes; ~60% reductions in stool frequency and abdominal pain; and >50% improvements in bloating, bowel dissatisfaction, and QoL. Treatment was well tolerated (mean tolerability score 8.95 ± 0.88), with >95% adherence, and no serious adverse events were reported. The secondary outcomes included changes in gut microbiota. In a subset of patients, 16S rRNA gene sequencing showed increased α-diversity and enrichment of butyrate-producing genera (Agathobacter, Butyricicoccus, Coprococcus), which correlated with symptom improvement. Bloating increased in some patients, possibly related to fermentation activity. These findings support the C. butyricum CBM588 probiotic strain as a safe, well-tolerated, and microbiota-targeted intervention for IBS-D. Randomized controlled trials are warranted to confirm efficacy.