Using Comfort Theory for Addressing the Psychosocial Needs of an Afghan Refugee Child with Thalassemia: A Case Report

Psychological and social support is one of the factors that promote resilience in refugee children. Immigrant children with thalassemia have special psychosocial needs in the host country. The comfort model can help identify psychosocial needs. We applied Kolcaba's comfort theory to an 8-year-old Afghan boy with a history of thalassemia in Iran. According to Kolcaba's model, the taxonomy of psychological and social comfort needs were separation from mother, anxiety due to unfamiliarity with the hospital, fear of interaction and preference for silence, different culture and place of living, language barrier. To address his psychospiritual and sociocultural comfort care, we used coaching and comfort food interventions recommended by Kolcaba. The use of Kolcaba's Comfort Theory was helpful in promoting the child's emotional and social comfort in the case of an Afghan refugee child with thalassemia in Iran.

Dissecting the dynamics of cell death pathways in Hirschsprung's disease: a comparative analysis of viable and non-viable cells under proinflammatory conditions

PURPOSE

The present study explores the dynamics of cell death in Hirschsprung's disease (HSCR) and control (CO) groups under inflammatory stress conditions.

METHODS

Using flow cytometry, we analyzed intestinal colonic organoid cultures derived from the ganglionic segment of the HSCR and CO groups. Our analysis focused on the quantification of RIPK1-independent and RIPK1-dependent apoptosis, as well as necroptosis in both viable and non-viable cells under acute and chronic inflammatory stress.

RESULTS

Our findings indicate that HSCR cells are particularly vulnerable to inflammation during acute proinflammatory stress, as evidenced by an increase in dead cells (Zombie +). Under chronic conditions, adaptive changes are observed in both HSCR and CO groups, indicating survival mechanisms. These adaptations are uniquely altered in HSCR, suggesting an impaired response to chronic inflammation. HSCR cells show significantly decreased RIPK1-dependent apoptosis in acute scenarios compared to chronic ones, unlike the CO group, implying varied responses to different inflammatory stresses. In non-viable cells, considerable changes in RIPK1-dependent apoptosis under chronic conditions in HSCR indicate a heightened inflammatory response compared to CO.

CONCLUSION

This research provides insights into cell death regulation in HSCR under inflammatory stress by using patient-derived organoids, underscoring the complexity of its inflammatory response.

EEG activation in preschool children: Characteristics and predictive value for current and future mental health status

BACKGROUND

Previous research has characterised EEG changes associated with resting activation in primary school children and adults, while task-related activation has only been considered in adults. The current study characterises physiological activation in preschool children and examines the potential value of activation indices for predicting mental health status at two time points.

AIMS

To investigate how resting activation and task-related activation are represented in 4- to 5-year-old preschool children and examine if these activation indices can predict current and future mental health status.

METHODS AND PROCEDURES

Frontal EEG was recorded from 81 preschool children during eyes-closed resting, eyes-open resting, and an inhibitory control task to allow calculation of activation indices. The Child Behaviour Checklist was completed by the child's parent at this time, and again 6-8 months later after the child's transition to kindergarten.

OUTCOMES AND RESULTS

Resting activation was represented by reductions in frontal delta, theta, and alpha power in the eyes-open compared to eyes-closed condition, and an increase in frontal beta power. Task-related activation was represented by increases in frontal delta, theta, and alpha power and a decrease in beta power. Frontal delta and theta task-related activation significantly predicted externalising behaviours in both preschool and kindergarten, with stronger prediction in kindergarten.

CONCLUSIONS AND IMPLICATIONS

This study characterised resting and task-related activation in preschool children, and reported similar effects to those found in older children and adults for resting activation, with novel effects for task-related activation. As task-related activation indices were predictive of externalising behaviours in both preschool and kindergarten, these results have implications for early identification of children who experience externalising behavioural problems across the transition to school period. WHAT DOES THIS STUDY ADD?: This study provides new data on how the fundamental physiological processes of resting and task-related activation, both of which are theorised to contribute to "upstream" processes such as executive functions and broader behaviour, are represented in the frontal EEG of preschool aged children. We also learn that the top-down task-related activation indices for delta and theta activity were predictive of current mental health status and future status after the transition to kindergarten, while the bottom-up resting activation indices were not.

Evaluation and Management of Biliary Dyskinesia in Children and Adolescents: A Systematic Review From the APSA Outcomes and Evidence-Based Committee

INTRODUCTION

The diagnosis and management of biliary dyskinesia in children and adolescents remains variable and controversial. The American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee (APSA OEBP) performed a systematic review of the literature to develop evidence-based recommendations.

METHODS

Through an iterative process, the membership of the APSA OEBP developed five a priori questions focused on diagnostic criteria, indications for cholecystectomy, short and long-term outcomes, predictors of success/benefit, and outcomes of medical management. A systematic review was conducted, and articles were selected for review following Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Risk of bias was assessed using Methodologic Index for Non-Randomized Studies (MINORS) criteria. The Oxford Levels of Evidence and Grades of Recommendation were utilized.

RESULTS

The diagnostic criteria for biliary dyskinesia in children and adolescents are not clearly defined. Cholecystectomy may provide long-term partial or complete relief in some patients; however, there are no reliable predictors of symptom relief. Some patients may experience resolution of symptoms with non-operative management.

CONCLUSIONS

Pediatric biliary dyskinesia remains an ill-defined clinical entity. Pediatric-specific guidelines are necessary to better characterize the condition, guide work-up, and provide management recommendations. Prospective studies are necessary to more reliably identify patients who may benefit from cholecystectomy.

LEVEL OF EVIDENCE

Level 3-4.

TYPE OF STUDY

Systematic Review of Level 3-4 Studies.

Intracranial vein of Galen malformation and its management: A case report

Vein of Galen malformation (VOGM) is a rare congenital arteriovenous malformation affecting the pediatric population, characterized by a fistula between the diencephalon and a dilated vein of Galen. The present study reports the case of a 6-month-old male infant referred for developmental delays and abnormal head circumference. A clinical examination revealed macrocephaly, dilated scalp veins and neurological abnormalities. Neuroimaging confirmed a large VOGM with associated hydrocephalus. A multidisciplinary team devised a treatment plan involving endovascular embolization and ventriculoperitoneal shunt placement. The post-operative recovery exhibited an improvement in neurodevelopmental milestones and a reduced head circumference. Generally, the management of VOGM requires a comprehensive approach, including early diagnosis, precise imaging and timely intervention. The case described herein highlights the importance of interventional radiology in planning a management plan and the novel kissing microcatheter endovascular embolization technique.

Heteroatom cobalt-based metal-organic framework and reduced graphene oxide nanocomposite for dispersive solid phase extraction of caffeine from exhaled breath condensate samples of premature infants prior to HPLC-PDA

A cobalt-based metal-organic framework and graphene oxide were combined to prepare a new nanocomposite for extracting of caffeine from exhaled breath condensate (EBC) samples. Dispersive micro solid phase extraction of caffeine was conducted using the nanocomposite as a sorbent by adding 10 mg of it to the sample solution and vortexing for 3 min. After extracting of the analyte, it was eluted using the mobile phase. The analyte was then analyzed using high performance liquid chromatography-photodiode array detector. Under optimal conditions, the limit of detection, limit of quantification, and linear range of the calibration curve were found to be 1.7, 5.9, and 10-500 µg/L, respectively. To assess the precision of the method, five replicates of standard solutions containing caffeine at two different concentration levels (50 and 100 µg/L) were tested. The relative standard deviations for intra- and inter-day precisions ranged from 4.3 to 6.8 %. The applicability of the method was demonstrated by analyzing the samples obtained from premature infants undergoing caffeine treatment and caffeine concentrations were 4.9 ± 0.6, 2.7 ± 0.2 µg/L in the EBC samples of who were under treatment by a 5-mg dose. Also, caffeine concentrations were 5.9 ± 0.3 and 18 ± 0.6 µg/L in the the infants who obtained the 10-mg and 25-mg doses, respectively. The results indicated a satisfactory, extraction recovery of 86 % showcasing the method's reliability and effectiveness in analyzing real samples.

Effectiveness and safety of chlorhexidine gluconate double-cleansing for surgical site infection prevention in neonatal intensive care unit surgical patients

Purpose

This study assessed the efficacy and safety of preoperative chlorhexidine gluconate (CHG) double-cleansing in reducing the incidence of surgical site infections (SSI) in surgical patients in neonatal intensive care units.

Methods

A retrospective chart review involved 56 patients who underwent 73 surgical procedures in the neonatal intensive care unit (NICU) from 2013 to 2022. CHG double-cleansing involves the following 2 processes. Firstly, preoperative cleansing with 0.5% CHG for elective surgeries the night before or at least 1 hour before emergency surgery. The anterior trunk cleansing spanned from the neck to the pubis, including both axillary lines. Secondly, the surgical site underwent skin preparation using 2% CHG with 72% isopropyl alcohol before an incision. A control group (2013-2018) that used iodine and a CHG group (2019-2022) employing CHG double-cleansing were compared. The occurrence of SSIs within 30 days after the surgical procedure was assessed.

Results

The overall SSI rate was 16.4% (n = 12) in the total procedures. The SSI rate was significantly higher (22.6%) in the control group; no SSI occurred in the CHG group (P = 0.029). No significant differences were observed in the other parameters. No adverse effects were observed in the CHG group.

Conclusion

CHG double-cleansing, a modified approach for surgical patients in the NICU, effectively reduced the incidence of SSI compared to traditional iodine-based skin preparations. This study supports the safe use of CHG in neonates, including premature infants, without significant complications.

Comparing Penile Problems in Circumcised vs. Uncircumcised Boys: Insights From a Large Commercial Claims Database With a Focus on Provider Type Performing Circumcision

OBJECTIVES

To compare penile problems in circumcised relative to uncircumcised boys, and to determine which providers performing the circumcision have fewer post-circumcision problems.

METHODS

CPT codes in the 2011-2020 MarketScan database were used to identify boys who had a circumcision. Uncircumcised control subjects of the same age, state of residence, and insurance type were selected. The primary outcome was a penile problem, defined as penis-specific infection, inflammation, and urethral stricture/stenosis, among others. The secondary outcomes were procedure-related complications limited to 28 days after circumcision, and whether post-circumcision problems varied by the clinician performing the procedure. ICD-9/10 diagnostic codes were used to identify these problems.

RESULTS

We identified ∼850,000 cases and ∼850,000 matched controls. Overall, the rate of penile problems within the first five years of life was 1.7% in circumcised boys versus 0.5% in uncircumcised boys (p < 0.05). Multivariable regression models showed that the risk of penile problems was 2.9-fold higher among circumcised compared to uncircumcised males (95%CI [2.8-3], p < 0.001). Compared to males circumcised by pediatricians, those circumcised by surgeons had 2.1-fold higher penile problems in the year after circumcision (95% CI [2-2.3], p < 0.001). Procedure-related complications within 28 days of circumcision were infrequent (0.5%), with the most common being penile edema (0.2%).

CONCLUSIONS

Penile problems are very infrequent in boys in the first five years of life. However, when they occur, they are 3x more likely to occur in circumcised boys relative to uncircumcised boys. Penile problems are more likely to occur in boys circumcised by surgeons.

LEVELS OF EVIDENCE

Level II.

TYPE OF STUDY

Prognosis study.

Intestinal Fatty Acid-binding Protein as a Marker of Necrotizing Enterocolitis Incidence and Severity: a Scoping Review

INTRODUCTION

Necrotizing enterocolitis (NEC) is a severe inflammatory disease of the gastrointestinal tract and one of the most common life-threatening emergencies affecting newborns. Intestinal fatty acid-binding protein (I-FABP) has been used as a possible marker of intestinal damage in NEC. We aimed to carry out a scoping review of all publications that explore the role of I-FABP in NEC to inspire new research into the potential utility of I-FABP as a marker of NEC.

METHODS

We searched for relevant publications using the keywords "necrotizing enterocolitis," "intestinal fatty acid binding protein," "NEC," and "I-FABP" in the National Library of Medicine (PubMed/MEDLINE), Embase, SCOPUS, and Web of Science. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was used for reporting findings.

RESULTS

We identified 61 relevant articles, which we divided into clinical (n = 47) and experimental (n = 14) groups.

CONCLUSIONS

I-FABP is a promising marker of NEC, especially for NEC stage 2 and 3. Urinary I-FABP follows the same patterns as serum and plasma I-FABP. The definitive roles of I-FABP in early diagnosis of NEC, differential diagnosis in breast feeding, alimentary intolerance, and screening of surgical NEC need clarification and remain a challenge to investigators.

Intestinal Symptoms Among Children aged 2-7 Years with Autism Spectrum Disorder in 13 Cities of China

BACKGROUND

Autism spectrum disorder (ASD) is a multifactorial, pervasive, neurodevelopmental disorder, of which intestinal symptoms collectively represent one of the most common comorbidities.

METHODS

In this study, 1,222 children with ASD and 1,206 typically developing (TD) children aged 2-7 years were enrolled from 13 cities in China. Physical measurement and basic information questionnaires were conducted in ASD and TD children. The Childhood Autism Rating Scale (CARS), Social Responsiveness Scale (SRS), and Autism Behavior Checklist (ABC) were used to evaluate the clinical symptoms of children with ASD. The six-item Gastrointestinal Severity Index (6-GSI) was used to evaluate the prevalence of intestinal symptoms in two groups.

RESULTS

The detection rates of constipation, stool odor, and total intestinal symptoms in ASD children were significantly higher than those in TD children (40.098% vs. 25.622%, 17.021% vs. 9.287%, and 53.601% vs. 41.294%, respectively). Autistic children presenting with intestinal comorbidity had significantly higher scores on the ABC, SRS, CARS, and multiple subscales than autistic children without intestinal symptoms, suggesting that intestinal comorbidity may exacerbates the core symptoms of ASD children.

CONCLUSION

Intestinal dysfunction was significantly more common in autistic than in TD children. This dysfunction may aggravate the core symptoms of children with ASD.

Symbiont Acquisition Strategies in Post-Settlement Stages of Two Co-Occurring Deep-Sea Rimicaris Shrimp

At deep-sea hydrothermal vents, deprived of light, most living communities are fueled by chemosynthetic microorganisms. These can form symbiotic associations with metazoan hosts, which are then called holobionts. Among these, two endemic co-occurring shrimp of the Mid-Atlantic Ridge (MAR), Rimicaris exoculata and Rimicaris chacei are colonized by dense and diversified chemosynthetic symbiotic communities in their cephalothoracic cavity and their digestive system. Although both shrimp harbor similar communities, they exhibit widely different population densities, distribution patterns at small scale and diet, as well as differences in post-settlement morphological modifications leading to the adult stage. These contrasting biological traits may be linked to their symbiotic development success. Consequently, key questions related to the acquisition of the symbiotic communities and the development of the three symbiotic organs are still open. Here we examined symbiotic development in juveniles of R. exoculata and R. chacei from TAG and Snake Pit using 16S metabarcoding to identify which symbiotic lineages are present at each juvenile stage. In addition, we highlighted the abundance and distribution of microorganisms at each stage using Fluorescence in situ Hybridization (FISH) and Scanning Electron Microscopy (SEM). For the first time, Candidatus Microvillispirillaceae family with Candidatus Rimicarispirillum spp. (midgut tube), Candidatus Foregutplasma rimicarensis and Candidatus BG2-rimicarensis (foregut) were identified in late juvenile stages. However, these lineages were absent in early juvenile stages, which coincides for the midgut tube with our observations of an immature tissue, devoid of microvilli. Conversely, symbiotic lineages from the cephalothoracic cavity were present from the earliest juvenile stages of both species and their overall diversities were similar to those of adults. These results suggest different symbiont acquisition dynamics between the cephalothoracic cavity and the digestive system, which may also involve distinct transmission mechanisms.

Assessing the Impact of Celiac Disease on the Quality of Life in Jordan

INTRODUCTION

Celiac disease profoundly impacts individuals' daily lives, prompting the need to assess health-related quality of life (HRQoL) in affected children. This study aimed to evaluate HRQoL among Jordanian children with celiac disease, considering sex, dietary adherence, presence or absence of growth issues, concurrent chronic diseases, and duration since diagnosis.

METHODS

A cross-sectional study invited children from the Celiac Disease Care Providers Society to complete an online Kidscreen-52 questionnaire in Arabic. Descriptive statistics and T-scores for 10 health domains were analyzed against international benchmarks. Cohorts were stratified by concurrent diseases, disease duration, dietary adherence, and growth issues, with comparisons made using t-tests and Cohen's ds.

RESULTS

Among 400 registered members, 126 children (31.5%) participated. Males exhibited inferior HRQoL in multiple domains compared to the general population, with recent studies corroborating findings in females. Males with chronic diseases reported significantly worse moods and self-perception. Females with growth issues faced academic challenges and financial constraints, while those not strictly adherent to a gluten-free diet reported strained parental relationships and challenges in their home environment.

CONCLUSION

This study reveals a marked decline in HRQoL among Jordanian children with celiac disease, emphasizing the need for educational initiatives targeting patients and healthcare providers, alongside broader advocacy for gluten-free diet support. Further research is imperative to identify additional contributing factors and implement community-level interventions.

Exploiting CO2 laser to boost graphite inks electron transfer for fructose biosensing in biological fluids

The possibility to print electronics by means of office tools has remarkedly increased the possibility to design affordable and robust point-of-care/need devices. However, conductive inks suffer from low electrochemical and rheological performances limiting their applicability in biosensors. Herein, a fast CO2 laser approach to activate printed carbon inks towards direct enzymatic bioelectrocatalysis (3rd generation) is proposed and exploited to build biosensors for D-fructose analysis in biological fluids. The CO2 laser treatment was compared with two lab-grade printed transducers fabricated with solvent (SB) and water (WB) based carbon inks. The use of the laser revealed significant morpho-chemical variations on the printed inks and was investigated towards enzymatic direct catalysis, using Fructose dehydrogenase (FDH) integrated into entirely lab-produced biosensors. The laser-driven activation of the inks unveils the inks' direct electron transfer (DET) ability between FDH and the electrode surface. Sub-micromolar limits of detection (SB-ink LOD = 0.47 μM; WB-ink LOD = 0.24 μM) and good linear ranges (SB-ink: 5-100 μM; WB-ink: 1-50 μM) were obtained, together with high selectivity due to use of the enzyme and the low applied overpotential (0.15 V vs. pseudo-Ag/AgCl). The laser-activated biosensors were successfully used for D-fructose determination in complex synthetic and real biological fluids (recoveries: 93-112%; RSD ≤8.0%, n = 3); in addition, the biosensor ability for continuous measurement (1.5h) was also demonstrated simulating physiological D-fructose fluctuations in cerebrospinal fluid.

LEGO®-Based Therapy in School Settings for Social Behavior Stimulation in Children with Autism Spectrum Disorder: Comparing Peer-Mediated and Expert Intervention

BACKGROUND

LEGO®-based therapy is a social development protocol that uses LEGO® activities to support the development of a wide range of interaction skills, enhancing prosocial behaviors and mitigating the challenges associated with mental health difficulties and behavioral issues commonly observed in children with autism spectrum disorder (ASD).

OBJECTIVES

This study aimed to explore the effects of LEGO®-based therapy on the social behavior and mental health of children with ASD, comparing stimulation mediated by expert and stimulation mediated by non-autistic peers. This study was approved by the Ethical Committee at Mackenzie Presbyterian University, ensuring adherence to ethical standards throughout the research process.

METHODS

This study involved 18 children with ASD, levels 1 or 2, with an intelligence quotient (IQ) above 70, and three typically developing peers, intelligence quotient (IQ) above 80, aged between 5 and 8 years old, of both sexes. Participants were randomized into three groups for stimulation (stimulation mediated by expert, by a non-autistic peer and control group). The measures were the Wechsler Abbreviated Scale of Intelligence, the Strengths and Difficulties Questionnaire (parent and teacher versions), the Inventory of Difficulties in Executive Functions, Regulation, and Aversion to Delay-Child Version, the Developmental Coordination Disorder Questionnaire, the Autism Behavior Checklist, and the Autistic Behavior Inventory.

RESULTS

After 14 sessions of 45 min in school settings, the participants of both groups (mediated by experts and non-autistic children) showed significant gains on social behavior. A statistically significant difference was observed between baseline sessions and probes (χ2 (5) = 25.905, p < 0.001). These gains were maintained in both follow-up points, 30 and 90 days after the completion of the stimulation sessions. Additionally, maladaptive behavior showed a significant decline when compared pre- and post-intervention. These improvements were sustained during follow-up assessments at 30 and 90 days.

CONCLUSIONS

The results suggest that a structured intervention combined with peer-mediated stimulation may be an effective method for promoting adaptive and prosocial behaviors in children with ASD.

Neonatal encephalopathy due to suspected hypoxic ischemic encephalopathy: pathophysiology, current, and emerging treatments

BACKGROUND

Neonatal encephalopathy (NE) due to suspected hypoxic-ischemic encephalopathy (HIE), referred to as NESHIE, is a clinical diagnosis in late preterm and term newborns. It occurs as a result of impaired cerebral blood flow and oxygen delivery during the peripartum period and is used until other causes of NE have been discounted and HIE is confirmed. Therapeutic hypothermia (TH) is the only evidence-based and clinically approved treatment modality for HIE. However, the limited efficacy and uncertain benefits of TH in some low- to middle-income countries (LMICs) and the associated need for intensive monitoring have prompted investigations into more accessible and effective stand-alone or additive treatment options.

DATA SOURCES

This review describes the rationale and current evidence for alternative treatments in the context of the pathophysiology of HIE based on literatures from Pubmed and other online sources of published data.

RESULTS

The underlining mechanisms of neurotoxic effect, current clinically approved treatment, various categories of emerging treatments and clinical trials for NE are summarized in this review. Melatonin, caffeine citrate, autologous cord blood stem cells, Epoetin alfa and Allopurinal are being tested as potential neuroprotective agents currently.

CONCLUSION

This review describes the rationale and current evidence for alternative treatments in the context of the pathophysiology of HIE. Neuroprotective agents are currently only being investigated in high- and middle-income settings. Results from these trials will need to be interpreted and validated in LMIC settings. The focus of future research should therefore be on the development of inexpensive, accessible monotherapies and should include LMICs, where the highest burden of NESHIE exists.

A "one in a million" case of colorectal carcinoma - A case report from a tertiary care centre in Mumbai, India

INTRODUCTION

Colorectal Carcinoma (CRC) has recently been on the rise among children, bearing a prevalence of 1-2 children/adolescents per million people. Here, we present a rare case of CRC in a 14-year-old male, emphasizing the need for development of better screening techniques to diagnose CRC earlier and with adequate time for intervention.

CASE PRESENTATION

A 14-year-old male visited our hospital with constipation, intermittent per rectal bleed and dull-aching pain abdomen for 2 months. On per rectal examination, a hard mass was identified, approximately 3 cm above the anal verge. Contrast-enhanced CT (Chest and Abdomen) and MRI Pelvis identified a circumferential thickening in the rectum predominantly involving the anterior rectal wall with effacement of fat planes with the Urinary Bladder without infiltrating it. Colonoscopic biopsy identified Signet Ring Adenocarcinoma. A multi-disciplinary decision was taken to treat him with neoadjuvant chemotherapy and radiotherapy (NACT-RT). MRI Pelvis, post-NACT-RT, showed that the previously- effaced fat plane was now clear and an Abdominoperineal Resection (APR) with permanent end- descending-colostomy was done. Histopathology report of the specimen identified a poorly undifferentiated mucin-secreting adenocarcinoma.

DISCUSSION

At presentation, the patient could have been either planned for extensive surgery or NACT-RT. The choice of NACT-RT was justified in our patient and was advantageous as extensive surgery was prevented.

CONCLUSION

We implore vigilance in cases of rectal masses due to the rising incidence of CRC among children. We also advocate that there must be no hesitation in subjecting adolescents to Chemotherapy and/or radiotherapy, as the benefits significantly outweigh the risks of with-holding.

Latent factors underlying the symptoms of adult-onset myotonic dystrophy type 1 during the clinical course

BACKGROUND

Myotonic dystrophy type 1 (DM1) is a multisystem genetic disorder that classically presents with symptoms associated with myotonia, early onset cataracts, and muscular weakness, although the presentation and pattern of disease progression is quite varied. Presenting symptoms are well documented among adults with DM1. However, less is known about the co-occurrence of symptoms over time. We aimed to use factor analysis to explore the correlation pattern of signs and symptoms (S/S) that emerged during the clinical course.

RESULTS

Clinical records of 228 individuals with adult onset DM1 were abstracted using the Muscular Dystrophy Surveillance, Tracking, and Research Network (MD STARnet) from a six-site cohort in the United States during an eight-year study period. Factor analysis was used to group the correlated S/S into latent factors. Three factors were identified. Group 1: 'Facial Weakness/Myotonia' includes the two most common S/S, as indicated by its name. Group 2: 'Skeletal Muscle Weakness' includes eight muscular S/S and is more frequently reported by males and those with older age at onset. Group 3: 'Gastrointestinal distress/Sleepiness' includes four non-muscular S/S and hand stiffness. The abstracted medical records reported that over 63% of individuals had S/S from all three groups. Associations of covariates with factor scores were also examined using linear regression. CTG repeat length was significantly positively associated with higher factor scores for all three factors.

CONCLUSIONS

This study identified three latent factors of S/S which accumulated during the clinical course of adult onset DM1.

Evaluating the Economic and Epidemiological Impact of RSV Hospitalizations in Southern Austria [Southern Austria Respiratory Syncytial Virus INpatient Investigation (ARNI Study)]

OBJECTIVE

RSV bronchiolitis is a leading cause of hospitalization in infants and young children. We aimed to document the economic burden and epidemiology of RSV over seven seasons in Southern Austria.

PATIENTS AND METHODS

All RSV-associated hospitalized (PCR-proven) children ≤ 5 years of age between 1 October 2015 and 30 April 2022 were collected retrospectively. Demographic and epidemiologic data, along with hospitalization costs (direct and indirect), were calculated.

RESULTS

Among 976 children hospitalized due to RSV infection, 87% were healthy term infants, and 79% were < 12 months old. Prematurity (13%) and pre-existing conditions (11%) significantly impacted older children-59% of cases in the 2nd compared with 68% in the 1st year of live. RSV-related hospital costs were approximately €2.0 millions per year (of a total of 60 millions per year). RSV accounted for 19% of hospitalizations due to acute respiratory illness (ARI) in children ≤ 5 years, 37% of all ARI < 6 months, 28% of all ARI < 12 and 6.3% of all-cause hospitalizations < 12 months of age, respectively.

CONCLUSIONS

Every 5th hospitalization due to respiratory illness in children ≤ 5 years of age was associated with RSV, representing 7.9% of all hospitalizations and 3.3% of all paediatric hospitalization costs.

Investigating the Prevalence of Hypercalciuria in Children Aged 2-16 Years With Asymptomatic Microscopic Hematuria in 2020 in Tehran Children's Medical Center

The prevalence of hypercalciuria in children is 3%-10% globally and up to 35% in the United States. Hypercalciuria in children has many presentations; it causes different metabolic disorders and can negatively affect a child's growth. It also increases the risk of low bone mineral density and urinary tract infections. In addition, it is the most widespread cause of persistent microscopic hematuria. Changes in the diet and medications in cases of advanced stage can be useful to prevent further complications. This study aimed to determine the prevalence of hypercalciuria and to investigate its relationship with different factors in children aged 2-16 years with asymptomatic microscopic hematuria in 2020 in the Children's Medical Center hospital. This retrospective cross-sectional study was performed in a population of children aged 2-16 years old with asymptomatic microscopic hematuria who were referred to the Children's Medical Center clinic in 2020. Data such as age, sex, serum creatinine level, and proteinuria were extracted from the patient's medical records, and their relationship with hypercalciuria was analyzed using logistic regression analysis. According to the inclusion criteria, 166 children with asymptomatic microscopic hematuria (72 boys and 94 girls) were included in this study. The prevalence of hypercalciuria (ratio of random urine calcium to creatinine more than 0.2) in these patients was estimated at 25% with a confidence interval of 18%-32%. In order of prevalence, the most common conditions accompanying microscopic hematuria were kidney stones, urinary tract infections, and proteinuria. The age of patients with hypercalciuria was 2 years younger on average. Each year of age increase and every 5 years of age increase between the ages of 2 and 16 years reduced the chance of hypercalciuria in this category of patients by 12% and 45%, respectively. Our findings also showed that children with a positive history of kidney stones were about 2.2 times more likely to have hypercalciuria than their counterparts, which is considered a medium effect size. Our results showed that hypercalciuria in children with hematuria is significantly related to younger age and a positive history of kidney stones.

Imaging Outcomes of MRI After CT in Pediatric Spinal Trauma: A Single-center Experience

BACKGROUND

Imaging has an essential role in the diagnostic workup of suspected pediatric spinal trauma. The most suitable imaging method is still being debated and needs to be considered regarding the patient, injury, and local resources. Magnetic resonance imaging (MRI) is often performed after computed tomography (CT) in case of neurological symptoms or suspected ligamentous disruption. However, it is unclear if the MRI yields significant additional value after CT if the spinal cord injury is not suspected and if the MRI could be used as the sole imaging modality in an emergency department. This study aimed to assess the diagnostic value of emergency MRI after CT in suspected spinal trauma in children and adolescents.

METHODS

The imaging data and medical records of patients 17 years of age and younger with emergency spinal CT and MRI over 8 years were retrospectively reviewed. The primary study outcome was the diagnostic accuracy of the 2 imaging modalities in detecting surgically treated spinal injuries.

RESULTS

The study population consisted of 100 patients. Computed tomography and magnetic resonance imaging demonstrated all 7 surgically treated injuries, although one of the injuries was initially missed with CT. Magnetic resonance imaging revealed more injuries, but none of the injuries visible on CT required surgical fixation. Magnetic resonance imaging was able to exclude unstable injuries in patients who had highly suspicious or unequivocal findings on CT.

CONCLUSIONS

Magnetic resonance imaging and computed tomography were both highly accurate in detecting unstable pediatric spinal injuries requiring surgical treatment. Magnetic resonance imaging seems not to reveal additional unstable injuries after adequately interpreted spinal CT.

LEVEL OF EVIDENCE

Level III-retrospective observational study.

Diagnosis of Hereditary Pancreatitis Following the Initial Acute Episode With Multiple Pseudocyst Complications

Hereditary pancreatitis (HP) is an unusual form of pancreatitis inherited as an autosomal dominant disorder. Patients typically present with recurrent acute pancreatitis-like symptoms that eventually progress to chronic pancreatitis, resulting in pancreatic exocrine insufficiency or diabetes mellitus, and a high risk of developing pancreatic cancer. As such, early diagnosis is crucial. Herein, we present the case of an 11-year-old boy with no significant medical history, but a family history of type 1 diabetes and pancreatic cancer, who presented with intermittent epigastric pain and nausea. Imaging revealed multiple pancreatic pseudocysts, pancreatic stones, and pancreatic duct dilation, resulting in the diagnosis of acute-on-chronic pancreatitis. Genetic testing confirmed the presence of a mutation in the PRSS1 gene, ultimately resulting in the diagnosis of HP. The patient remained symptom-free for five years during follow-up post-treatment. This case highlights the importance of considering HP in young patients presenting with pseudocysts and other signs of chronic pancreatitis even during the initial acute episode.

Navigating the landscape of HPV-associated cancers: From epidemiology to prevention

Human Papillomavirus (HPV) is a widespread infection associated with various cancers, including cervical, oropharyngeal, anal, and genital cancers. This infection contributes to 5 % of global cancer cases annually, affecting approximately 625,600 women and 69,400 men. Cervical cancer remains the most prevalent HPV-linked cancer among females, with the highest incidence seen in low and middle-income countries (LMICs). While most HPV infections are transient, factors such as HPV variants, age, gender, and socioeconomic status influence transmission risks. HPV is categorized into high-risk (HR-HPV) and low-risk types, with strains like HPV 16 and 18 displaying distinct demographic patterns. The intricate pathogenesis of HPV involves genetic and epigenetic interactions, with HPV oncogenes (E6 and E7) and integration into host DNA playing a pivotal role in driving malignancies. Early diagnostics, utilizing HPV DNA testing with surrogate markers such as p16, and advanced molecular techniques like PCR, liquid biopsy, and NGS, significantly impact the management of HPV-induced cancers. Effectively managing HPV-related cancers demands a multidisciplinary approach, including immunotherapy, integrating current therapies, ongoing trials, and evolving treatments. Prevention via HPV vaccination and the inclusion of cervical cancer screening in national immunization programs by conventional Pap smear examination and HPV DNA testing remains fundamental.Despite the preventability of HPV-related cancers, uncertainties persist in testing, vaccination, and treatment. This review article covers epidemiology, pathogenesis, diagnostics, management, prevention strategies, challenges, and future directions. Addressing issues like vaccine hesitancy, healthcare disparities, and advancing therapies requires collaboration among researchers, healthcare providers, policymakers, and the public. Advancements in understanding the disease's molecular basis and clinical progression are crucial for early detection, proper management, and improved outcomes.

Empowerment-based Teddy Bear Clinic for Pre-school Children: A Student-led Educational Project

Nurses are at the forefront of providing health education for the general public and are leaders in developing health education programs for all ages. Research has shown that the pediatric population often experience anxiety surrounding common medical procedures. However, evidence-based health education has been shown to enhance self-management, increase knowledge, and decrease anxiety in the pediatric population. One such successful evidence-based health education approach designed for the pediatric population is the Teddy Bear Clinic. The purpose of this article is to report on the efficacy of a nursing student-led Teddy Bear Clinic designed to increase the awareness of common medical equipment and procedures in the pre-school pediatric population. This quality improvement project used a program evaluation design to assess the children's knowledge of common medical procedures and equipment. Participants were a convenience sample of 16 children aged 3-5 years old, attending one daycare center in a large city in Atlantic Canada. Findings showed that after participation in the clinic, the pre-schoolers reported a high level of knowledge of common medical equipment and procedures. This project shows that a Teddy Bear Clinic run by senior nursing students can promote community partnerships and enhance health knowledge in pre-school children.

The Relationship Between Perceived Parenting Practices and Anxiety in Adults With Congenital Heart Disease

BACKGROUND

Patients with congenital heart disease (CHD) and their parents face challenges throughout their lives that can lead to anxiety lasting into adulthood. We aim to assess the association between perceived parenting practices and anxiety beyond paediatric medical-surgical histories in adults with CHD.

METHODS

A cross-sectional study of adults with CHD was conducted at the Montreal Heart Institute (MHI). Perception of parental practices during childhood was retrospectively assessed with the use of validated self-report questionnaires, and anxiety in adulthood was assessed with the use of the Hospital Anxiety and Depression Scale. Sociodemographic and medical information were collected from a questionnaire and medical records. Hierarchic multiple linear regression was conducted.

RESULTS

Of the 223 participants, the mean age was 46 ± 14 years and 59% were female. Perceived parenting practices explained more variance (11%) in the anxiety score than paediatric medical-surgical history (2%). In our final model, anxiety was significantly associated with age, parental history of anxiety, and positive parenting practices, but not with overprotection.

CONCLUSIONS

Parenting practices are associated with anxiety in adults with CHD beyond paediatric medical-surgical history and sociodemographic. Positive parenting practices may be protective against anxiety in adulthood. Longitudinal studies are needed to determine causality.

Endoscopic characterization of gastrointestinal manifestations in children with undifferentiated recurrent fever

BACKGROUND AND STUDY AIMS

Systemic autoinflammatory diseases are characterized by recurrent or chronic inflammation, and monogenic forms are increasingly defined. However, a group of patients without genetic diagnosis is called the syndrome of undifferentiated recurrent fever (SURF). This study analyzed the clinical and endoscopic features of patients with SURF presenting with gastrointestinal (GI) symptoms.

PATIENTS AND METHODS

Between 2019 and 2022, GI endoscopy were performed in patients with SURF who presented with GI symptoms. Clinical, genetic, laboratory, and endoscopy findings were analyzed.

RESULTS

Fifteen patients were included in the study, eight (53.3 %) were girls. The mean age was 10.5 ± 5.80 years, and the median age at symptom onset was 4 (0.3-16) years. All patients experienced fever and abdominal pain. Thirteen patients (86.7 %) experienced diarrhea, 11 (73.3 %) reported myalgia, and 10 (66.7 %) had joint involvement. Lymphoid follicles in the terminal ileum mucosa were detected in 10 patients (66.7 %), and nodular lymphoid hyperplasia in the terminal ileum was the histopathological finding in 12 patients (80 %).

CONCLUSIONS

The current study found that patients with SURF experiencing gastrointestinal symptoms have excessive lymph node formation in the terminal ileal mucosa due to an exaggerated inflammatory response. This may be the cause of their GI symptoms.

Assessment of parental self-efficacy in managing child food-induced anaphylaxis and using adrenaline autoinjectors

BACKGROUND

Anaphylaxis is a life-threatening allergic reaction, associated with mental health burden in patients and caregivers. Intramuscular adrenaline via autoinjector (AAI) is the recommended treatment for the management of anaphylaxis in non-hospital settings; however, AAIs are underused. This study aimed to assess parental self-efficacy in managing child's anaphylaxis and administering AAI to understand how to effectively support families.

METHODS

Seventy-five parents of children with severe food allergy completed a questionnaire to measure parental self-efficacy in managing child food-induced anaphylaxis (PSEMA). We conducted an exploratory factor analysis with 12 items, using principal axis factoring as the extraction method. We used Cronbach's alpha to assess the internal consistency of the factors. We used the Anderson-Rubin approach to estimate the factors' scores and provide a kernel density estimate of their distributions. An assessment through linear regression between the total factors' score and total score was performed.

RESULTS

A five-factor model was identified. The factors that emerged were conceptually related to "F1. Manage Injection," "F2. Manage AAI Device," "F3. Manage Anaphylaxis," "F4. Manage Emergency," and "F5. Manage Emotions." The questionnaire demonstrated high internal consistency, with a Cronbach's alpha of 0.91 (95% CI: 0.87-0.94) The variation in the total score explained 90% of the variation in the factor score.

CONCLUSIONS

The PSEMA questionnaire promises to be an easy and effective tool for measuring parents' self-efficacy in managing anaphylaxis and AAI, allowing clinicians to identify gaps in education and provide effective training.

Suboptimal Vaccination Coverage and Serological Screening in Western Australian Children With Inflammatory Bowel Disease Receiving Immunosuppressive Therapy: An Opportunity for Improvement

Background Patients with inflammatory bowel disease (IBD) face an increased likelihood of severe illnesses, including those caused by vaccine-preventable diseases. Consequently, the purpose of this study was to evaluate both vaccination rates and serological screening in children with IBD in Western Australia, focusing on compliance with routine and additional vaccines, and pre-treatment screening for infections before starting immunosuppressive (IS) treatment. Method The study was conducted at Perth Children's Hospital (PCH) from June 2021 to February 2022, focusing on children aged 0-18 with confirmed IBD diagnoses. Demographic and medical data were collected and matched with immunization records from the Australian Immunisation Register (AIR) to audit compliance with routine childhood vaccinations and additional vaccines (23-valent pneumococcal, human papillomavirus (HPV), and annual influenza). Data from medical records were analyzed for compliance with serologic testing (QuantiFERON TB, Hep B and C, Varicella, and Epstein-Barr virus (EBV)) before initiating IS therapy, which included immunomodulators, biologics, or small molecules. Results Of the 243 patients, 120 (52%) were diagnosed with Crohn's disease and 106 (43%) with ulcerative colitis. A total of 181 patients (74.5%) were treated with immunomodulators, while 62 (26%) received biologic therapies. Incomplete routine vaccination coverage was identified in 71 (29.2%) patients, with no notable differences observed between the IS and non-IS groups (p=0.3). Specific vaccines with incomplete coverage included HPV in 49 (24%) patients, Varicella in 39 (16%) patients, and diphtheria-tetanus-pertussis (DTP in 16 (6.5%) patients. Pre-treatment serological screening was also suboptimal, with the lowest testing rate for EBV at 32 (13.2) patients and the highest for Varicella at 181 (74.6%) patients. Conclusion The results emphasized the importance of targeted interventions to enhance vaccination and screening practices, enhancing disease management, and reducing the possibility of preventable infections in the vulnerable populace.

A 6-Week-Old Boy With Irritability and Abdominal Distension

A 6-week-old boy is brought to the hospital for fussiness and abdominal distension. He was febrile on presentation and was admitted to the hospital for further evaluation. On subsequent examinations, he continued to demonstrate abdominal distension and tenderness to palpation. Ultrasonography of the abdomen was performed and revealed a heterogeneous liver mass. With further diagnostics, a diagnosis was made and treatment initiated, with the infant experiencing resolution of his symptoms. Our panel of experts first discuss the management of an infant with abdominal distension, then discuss the evaluation of a liver mass in an infant, including oncologic, vascular, and infectious etiologies.

Salivary IL-1 Beta Level Associated with Poor Sleep Quality in Children/Adolescents with Autism Spectrum Disorder

BACKGROUND

Sleep disorders are common in youths with autism spectrum disorders. Inflammatory cytokines such as Il-1 beta and Il-6 in saliva have been associated with alterations in sleep quality in various conditions. We assessed whether there were associations between the salivary concentration of IL-1 beta and IL-6 and sleep quality in youths with ASD versus typically developing (TD) age- and gender-matched youths.

METHOD

Forty children and adolescents with ASD or TD participated in this study (20% females). Their parents answered the items of a validated questionnaire on sleep quality (Pittsburgh Sleep Quality Index).

RESULTS

The mean Pittsburgh score was significantly higher (i.e., the quality of sleep was poorer) in the ASD group (8.68 ± 0.35 (SEM), ranging from 7 to 12 points), compared to the TD group (7.35 ± 0.54 (SEM), ranging from 2 to 12 points) (p = 0.02, Mann-Whitney U test). There were no significant differences in the salivary concentration of Il-1 beta and IL-6 receptor between the two groups, but salivary IL-1 beta concentration was inversely associated with poor sleep quality in the ASD group. No associations between the salivary Il-6 concentration and sleep quality were found in either group. Linear regression analysis by separate groups revealed significant associations between the sleep quality score and the concentration of IL-1 beta in the ASD group (p = 0.01, OR = -0.53, 95% CI -0.008-0.001). In contrast, no significant associations were observed in the TD group, or for IL-6 in either group. No significant effects of sex, age, or use of psychotropic medications were found.

CONCLUSIONS

Children and adolescents with ASD showed significantly poorer sleep quality based on their parents' reports compared to the TD group, and the salivary IL-1 beta concentration was inversely associated with sleep quality only in the ASD group. Further studies on the associations between inflammatory cytokines and sleep in ASD are needed.

Reply to Garnemark et al. The Swedish National Formulary for Children ePed. Comment on "Shaniv et al. A Callout for International Collaboration. Reply to Giger, E.V.; Tilen, R. Comment on "Shaniv et al. Neonatal Drug Formularies-A Global Scope. Children 2023, 10, 848". Children 2023, 10, 1803"

We received the comment from our Swedish colleagues and have read it with interest [...].

Epidemiological assessment of diabetes mellitus in children of Ukraine during the last 20 years (2002-2021) of peacetime

Objectives

Nowadays, there is a global trend towards an increase in the prevalence and incidence of diabetes mellitus, including among children, which is a significant health problem in many countries. The analysis of data on diabetes among children is important for training medical personnel and planning preventive measures. The aim is to determine the trends in the prevalence and incidence of diabetes mellitus, as well as the gender and age structure among the paediatric population of different regions of Ukraine over the last 20 years (2002-2021) of peacetime.

Methods

The results of statistical evaluation and epidemiological analysis of the data of the Centre for Medical Statistics of the Ministry of Health of Ukraine on the prevalence and incidence of diabetes mellitus among children during 2002-2021 are presented. Statistical processing of the results was carried out using MS Excel (Microsoft Corporation, USA), XLSTAT-Pro (Addinsoft, USA).

Results

According to the Ministry of Health of Ukraine, as of 2021, 11,193 children aged 0-17 years inclusive with diabetes mellitus were registered, which is 15.0 cases per 10 thousand of the relevant population. Compared to 2002, the prevalence and incidence rates increased by 93% and 80%, respectively; the fastest rates were among children aged 0-6 years, and the lowest among adolescents aged 15-17 years. In 2021, the highest incidence of diabetes among infants over the past 15 years was recorded (0.05 per 1000 of the relevant population).

Conclusions

In Ukraine, over the past 20 years (2002-2021) of peacetime, there has been an annual gradual increase in the prevalence and incidence of diabetes mellitus among children in all age groups with gender balance, which generally corresponds to the global trend.

Coinfection of pulmonary lophomoniasis, tuberculosis, and hydatid cyst in a pediatric autism patient: a case report and literature review

INTRODUCTION

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition marked by difficulties in social interaction, communication, and repetitive behaviors or restricted interests. Although research on the link between ASD and parasitic diseases is limited, immune deficiency and inflammation may contribute to the development of parasitic infections.

CASE REPORT

We admitted a 14-year-old boy to the hospital who had a known history of ASD because he was presenting with respiratory symptoms, including cough and hemoptysis. During his time in the hospital, after conducting a series of tests and evaluations, we made a critical diagnosis of co-infection of lophomonas, tuberculosis, and hydatid cyst. In response to this diagnosis, we initiated a treatment plan that involved administering appropriate antibiotics as well as preparing for surgical intervention.

CONCLUSION

This case report highlights the complexities and challenges of managing such a rare combination of co-infections with TB, pulmonary hydatid disease and lophomonas in a pediatric patient with underlying developmental considerations such as ASD.

GastroSmart: Precision GI Health Monitoring with Non-Invasive GMR

Pathological conditions affecting the gastroenterological tract such as GERD, gastroparesis, gastric cancer, type 2 diabetes, and obesity among others present alarming levels of health risks. Conventional imaging methods such as ultrasonic imaging have a very high cost and do not provide real-time monitoring. To overcome these challenges, we present a new system based on GMR sensor capable of non-invasively measuring gastric volume over prolonged periods of time. This system uses Rational Dilation Wavelet Transformation in order to enhance the accuracy of the evaluated gastric dynamics. With the help of polynomial regression, gastric volume changes can be predicted very accurately by our model, which makes it possible to prevent exacerbation of gastrointestinal diseases in early stages. The continuous evaluation of the condition of the patients and their physical activity performed by this non-invasive method will allow individualized treatment to each patient in the best possible way and will improve healing without sacrificing safety. This investigation is a response for implementing low-cost and effective solutions for constant monitoring of patients with gastrointestinal distresses in the direction of preventive nursing and clinical care for patients.

Gut microbial and human genetic signatures of inflammatory bowel disease increase risk of comorbid mental disorders

The high prevalence of comorbid mental disorders (CMDs) in patients with inflammatory bowel disease (IBD) is well-documented. This study delves into the intricate CMD-IBD relationship through comprehensive analyses using human variants, gut microbiome, and anxiety/depression estimates from a cohort of 507 IBD patients and 75 controls. Notably, patients with IBD, especially those with CMD, exhibited lower diversity than controls. We identified 106 differentially abundant taxa (DATs) in IBD patients compared to controls and 21 DATs distinguishing CMD-affected from CMD-free IBD patients. Microbial IBD-risk scores, reflecting an individual's microbial burden for IBD, revealed a significant enrichment of IBD-risk signatures in CMD-affected patients compared to CMD-free patients. Additionally, there was an IBD-risk variant potentially regulating the abundance of an IBD/CMD-associated DAT, suggesting an interplay between IBD-risk variants and dysbiosis in CMD. Our investigation underscores the pivotal role of IBD-associated gut dysbiosis in predisposing IBD patients to CMD, partially through genetic variant-mediated mechanisms.

Heliotherapy for neonates with severe-to-hazardous hyperbilirubinemia: a randomized controlled, non-inferiority trial

Filtered-sunlight phototherapy (FSPT) that blocks ultraviolet light and reduces infrared radiation is safe and non-inferior to intensive electric phototherapy (IEPT) for treating mild-to-severe neonatal hyperbilirubinemia. In this randomized non-inferiority trial, the safety, efficacy, exchange transfusion (ET), and mortality rates of FSPT versus IEPT among Nigerian neonates with severe-to-hazardous hyperbilirubinemia were investigated. Safety was defined as the absence of hyperthermia, hypothermia, dehydration, or sunburn; efficacy by the proportion of assessable treatment days during which total serum or plasma bilirubin (TSB) increased by < 0.2 mg/dL/hr for newborns aged ≤ 72 h-old or decreased for newborns > 72 h-old. A treatment day was deemed assessable if a neonate received phototherapy for ≥ 4 h, and non-inferiority was inferred for differences within a 10% margin. We enrolled 192 newborns (admission TSB ≤ 62 mg/dL), assigned to FSPT (n = 98) or IEPT (n = 94). FSPT was effective on 94.2% of the assessable treatment days compared with 97.1% for IEPT. The mean difference in efficacy between FSPT and IEPT was -2.9%, 95% CI: -7.6, 1.9). 2.6% of newborns who received FSPT developed controlled hyperthermia, and no baby met the criteria for withdrawal for safety reasons. Overall, 50.6% (39/77) of newborns who received FSPT and 53.7% (51/95) of newborns who received IEPT had ET (p = 0.89) and 7 in each group (9.1% vs 7.4%; p = 0.86) died. In conclusion, FSPT is safe and non-inferior to IEPT for treating neonates with severe-to-hazardous hyperbilirubinemia, it is not associated with significantly higher rates of ET and mortality and should be considered where practicable when IEPT cannot be assured. Clinical Trials.gov Number: NCT02612727 (24/11/2015).

Trans-Oral Protrusion of the Distal End of a Ventriculoperitoneal Shunt: A Case Report of an Unusual Complication

Ventriculoperitoneal shunting (VPS) is the surgical technique of choice to manage pediatric hydrocephalus. Despite having good results, it is prone to complications, some of which are rare. This is the case report of a 2-year-old male, with an uncomplicated VPS done at 6 months of age, presenting with vomiting, irritability, anorexia, and drooling. There was an oral protrusion of a tube dripping clear fluid. Imaging studies demonstrated evidence of gastric perforation with a cephalic migration and transoral protrusion of the distal end of the shunt tubing. A gastroplasty, and immediate revision of the distal shunt were done free of any complications. This case report underlines the importance of recognizing and managing trans-oral protrusion of the distal end of VPS system in a timely manner, and raises awareness of this uncommon complication and its potential influence on patient health and survival, given ventriculitis' high lethality.

Clinical management and complications of acute appendicitis in 3 children with SARS-CoV-2 infection: Case report

RATIONALE

Sporadic cases of acute appendicitis (AA) in children with SARS-CoV-2 infection were still recorded at the end of COVID-19 pandemics. We consider that analyses of clinical courses and outcomes is useful to improve the clinical management of such cases in the setting of a general hospital.

PATIENT CONCERNS

Patient #1 was a 14-year-old girl who presented with nausea, right lower quadrant (RLQ) pain, myalgia, ad low-grade fever for 24 hours. Patient #2 was a 7-year-old boy with a 3-day history of abdominal pain, nausea and vomiting, and fever lasting for 4 days. Patient # 3 was a 16-year-old girl RLQ pain, nausea and vomiting, and fever lasting for 7 days.

DIAGNOSES

The patients were diagnosed with acute appendicitis (AA) based on the clinical picture, labs and abdominal ultrasound (US) findings. SARS-CoV- 2 infection was diagnosed using rapid antigen test performed at admission.

INTERVENTIONS

The patients were started on i.v. Ceftriaxone and Metronidazole, antalgics and i.v. fluids at admission. Appendectomy was performed the day after admission in patients # 1 and #2, and after 48 hours in patient #3.

OUTCOMES

Patient #1 had no complications and was discharged on postoperative day (POD) #5. Patient #2 developed a cecal fistula on POD #4 which was treated conservatively with Ertapenem, i.v. fluids, and local placement of colostomy bag. The fistula closed spontaneously on POD #12. He was discharged on POD #17. Patient #3 developed a postoperative abscess on POD # 6 and required laparoscopic surgical drainage of the abscess. She was discharged after another 6 days (POD #12). No patient required ICU admission, steroids, or supplemental O2 use during their hospitalization. There were no late complications or readmissions in these patients.

LESSONS

We consider that AA in these SARS-CoV-2 positive children had a similar course with SARS-CoV-2 negative cases. Compliance to previously established COVID-19 protocols was useful to improve the outcome. The parents should bring the sick child early to the hospital in order to avoid complications related to delayed presentation and not to SARS-CoV-2 infection itself.

Voluntary Neonatal Medication Incident Reporting-A Single Centre Retrospective Analysis

Background: Medication errors in neonatal intensive care units (NICUs) are prevalent, with dosage and prescription errors being the most common. Aims: To identify the common medication errors reported over twelve years using a voluntary, nonanonymous incident reporting system (RiskMan clinical incident reporting information system) at an Australian tertiary NICU. Methods: This was a single-centre cohort study conducted at a tertiary NICU. All medication-related incidents (errors) reported prospectively through the RiskMan online voluntary reporting database from January 2010 to December 2021 were included. The medication incidents were grouped into administration, prescription, pharmacy-related, and others, which included the remaining uncommon incidents. Results: Over the study period, 583 medication errors were reported, including administration-related (41.3%), prescription-related (24.5%), pharmacy-related (10.1%), and other errors (24%). Most incidents were reported by nursing and midwifery staff (77%) and pharmacists (17.5%). Most outcomes were minor or insignificant (98%), with only a few resulting in major or significant harm. There was one extreme incident that may have contributed to the death of a neonate and nine moderate incidents. Conclusions: Our results demonstrate that medication errors are common and highlight the need to support improvement initiatives and implement existing evidence-based interventions in routine practice to minimise medication errors in the NICU.

Effect of castor oil on esophageal stricture in rats and expression of ST-2, neopterin proteins in corrosive burn model

Corrosive esophageal burn (CEB) is a disease with high mortality and morbidity rates. The aim of this study was to determine the efficacy of castor oil, in preventing stricture development at the experimental CEB model. In addition to studying standard histopathological damage data, neopterin, IL-33, and ST-2 proteins were also studied for the first time. Fifty Wistar-Albino rats were divided into randomized 5 groups. [Sham group (G1) (n:10), Control group (G2) (n:10), Early Stage Topical Application group (G3)(n:10), Late Stage Topical Application group (G4) (n:10), Oral Application group (G5) (n:10)]. Weight measurement, esophageal length, histopathological damage score (HDS) and total stenosis score (TSS), tissue caspase-3 and VEGF staining, tissue hydroxyproline (HYP), blood TNF-alpha, IL-6, IL-33, Neopterin, and ST-2 levels were measured. In the castor oil application groups, weight gain was observed, the acute phase reaction decreased, submucosal/tunica muscularis fibrosis (TMF) and muscularis mucosal damage (MMD) were reduced, and TSS and HDS decreased. While no significant difference was detected in the ST-2 protein, which was used for the first time in this study model, a significant increase in neopterin protein was observed in the application groups. Results indicate the nutritional contribution of castor oil, as well as its tissue healing and esophageal stricture-preventing efficacy at histopathological and immune-histochemical levels.

Gray Matter Volume Correlates of Co-Occurring Depression in Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) involves neurodevelopmental syndromes with significant deficits in communication, motor behaviors, emotional and social comprehension. Often, individuals with ASD exhibit co-occurring depression characterized by a change in mood and diminished interest in previously enjoyable activities. Due to communicative challenges and a lack of appropriate assessments in this cohort, co-occurring depression can often go undiagnosed during routine clinical examinations and, thus, its management neglected. The literature on co-occurring depression in adults with ASD is limited. Therefore, understanding the neural basis of the co-occurring psychopathology of depression in ASD is crucial for identifying brain-based markers for its timely and effective management. Using structural MRI and phenotypic data from the Autism Brain Imaging Data Exchange (ABIDE II) repository, we examined the pattern of relationship regional grey matter volume (rGMV) has with co-occurring depression and autism severity within regions of a priori interest in adults with ASD (n = 44; age = 17-28 years). Further, we performed an exploratory analysis of the rGMV differences between ASD and matched typically developed (TD, n = 39; age = 18-31 years) samples. The severity of co-occurring depression correlated negatively with the rGMV of the right thalamus. Additionally, a significant interaction was evident between the severity of co-occurring depression and core ASD symptoms towards explaining the rGMV in the left cerebellum crus II. The results further the understanding of the neurobiological underpinnings of co-occurring depression in adults with ASD towards exploring neuroimaging-based biomarkers in the same cohort.

Validity and reliability of the new NIMHANS intellectual disability screening instrument (NID-Screener) for children and adolescents in India

INTRODUCTION

There is a gap in tools specifically designed for assessing Intellectual Disability (ID) in Indian settings. To address this, the NIMHANS intellectual disability screening instrument (NID-Screener) was developed by the Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences.

METHODS

Ten non experts/language and ten experts rated face and content validity of NID-Screener respectively. Content validity was measured by Content Validity Ratio, Content Validity Indices (I-CVI, S-CVI) and Modified Kappa statistics. Construct validity was calculated by performing Exploratory Factor Analysis(EFA) on responses from 275 parent(s)/guardian(s) of children and adolescents (6-17 years). Criterion Validity was tested against Brief Intellectual Disability Scale (BIDS) and Clinical Diagnosis by Child and Adolescent Psychiatrist. Kappa Statistics was used to calculate inter - method and inter-Rater Reliability. Cronbach's alpha was used to assess Internal Consistency. This study was approved by NIMHANS ethics committee.

RESULTS

Findings revealed that NID-Screener has good face and content validity (S-CVI/Average = 0.917). Criterion Validity was excellent (Kappa Value=0.862, p-value<0.001) when compared with BIDS. Sensitivity and specificity were found to be 84.7 %, 89 % respectively against Clinical Diagnosis. On EFA, only one underlying factor with Eigen value > 1 was identified (55.8 % of total variance). Kappa value was found to be 0.971 and 0.942 for inter- rater and inter -method reliability respectively(p-value<0.001). NID-Screener has good internal consistency [Cronbach's alpha = 0.841].

CONCLUSIONS

NID-Screener is a reliable and valid tool for screening ID among children and adolescents in India, facilitating its early detection through diagnostic assessments and subsequent interventions.

The role of gut microbiome and its metabolites in pancreatitis

Gut microbiome plays a vital role in the intestinal ecosystem and has close association with metabolites. Due to the development of metabolomics and microbiomics, recent studies have observed that alteration of either the gut microbiome or metabolites may have effects on the progression of pancreatitis. Several new treatments based on the gut microbiome or metabolites have been studied extensively in recent years. Gut microbes, such as Bifidobacterium, Akkermansia, and Lactobacillus, and metabolites, such as short-chain fatty acids, bile acids, vitamin, hydrogen sulfide, and alcohol, have different effects on pancreatitis. Some preliminary studies about new intervention measures were based on the gut microbiome and metabolites such as diet, prebiotic, herbal medicine, and fecal microbiota transplantation. This review aims to summarize the recent advances about the gut microbiome, metabolites, and pancreatitis in order to determine the potential beneficial role of the gut microbiome and metabolites in pancreatitis.

The effects of nutrition on mesenteric oxygenation among neonates with neonatal encephalopathy: a randomized clinical trial

BACKGROUND

We aimed to evaluate the effects of minimal enteral nutrition (MEN) on mesenteric blood flow and oxygenation with Doppler USG and Near Infrared Spectroscopy (NIRS) during therapeutic hypothermia (TH) in babies with HIE.

METHODS

This prospective, randomized-controlled study was composed of infants receiving MEN (study group, n = 30) and infants who were not fed (control group, n = 30) during hypothermia. Infants were monitored continuously with NIRS and mesenteric blood flow velocities were measured with Doppler USG before and after feeding.

RESULTS

The mean gestational age and birth weight for the study and control group were 38.73 ± 1.5-39.09 ± 1.02 weeks and 3076 ± 280.4-3295 ± 391 grams, respectively. Time to reach full enteral nutrition and hospital stay were significantly shorter in the study group (p = 0.049, p = 0.016). Infants in the study group experienced less feeding intolerance (p = 0.006). No infant developed necrotizing enterocolitis (NEC) in both groups. No difference was determined in pre- and post-feeding cerebral rSO2 measurements during TH and normothermia. Mesenteric rSO2, CSOR, and mesenteric blood flow measurements in the study group during normothermia were significantly increased, respectively (p = 0.03, p < 0.01, p < 0.01).

CONCLUSION

In our study, we observed that MEN during TH does not lead to a significant change in cerebral and mesenteric oxygenation. Although we did not observe an increase in blood flow and oxygenation, the absence of NEC and a lower incidence of feeding intolerance in the study group may suggest that feeding during TH is safe and feasible.

IMPACT

MEN during TH treatment does not lead to a significant change in cerebral and mesenteric oxygenation. This is the first study evaluating the effects of MEN on mesenteric oxygenation and blood flow velocities in infants with hypoxic-ischemic encephalopathy during TH with Doppler USG and NIRS, concomitantly. MEN during TH may be safe and feasible.

Gastrointestinal effects of caffeine in preterm infants: a systematic review and Bayesian meta-analysis

OBJECTIVE

Caffeine is widely used in preterm infants to prevent or treat apnoea of prematurity. Adverse gastrointestinal effects of caffeine have not been thoroughly researched in preterm infants. With this systematic review and meta-analysis, we aim to summarise the results of trials on the gastrointestinal effects of caffeine in preterm infants.

DESIGN

We searched MEDLINE, Web of Science, Scopus and ClinicalTrials.gov up to 21 April 2023. We included randomised controlled trials assessing caffeine versus placebo in preterm neonates and reporting gastrointestinal side effects. Risk of bias was assessed using the Cochrane Risk of Bias tool. A Bayesian meta-analysis was performed to estimate the pooled OR of gastrointestinal side effects.

RESULTS

Nine trials involving 2746 preterm infants were analysed. Seven trials assessing necrotising enterocolitis and four trials assessing feeding intolerance in our meta-analysis found no differences between caffeine and placebo (OR=1.007 (95% credible interval 0.021, 5.462), I2=97.4%, and OR=1.266 (95% credible interval 0.064, 28.326), I2=84.8%, respectively). Four trials assessed the outcomes spontaneous intestinal perforation, constipation, gastrointestinal disorder (composite outcome: gastro-oesophageal regurgitation or dilated bowel loops), age at oral feeding and cholestasis syndrome and found no differences between groups. One trial assessed the outcomes gastro-oesophageal symptoms and duration of tube feeding and found that caffeine was associated with a reduced burden of gastro-oesophageal reflux symptoms at 2 weeks (p<0.05), but not at term.

CONCLUSIONS

According to this systematic review and meta-analysis, the use of caffeine at usual doses in preterm infants does not seem to be associated with significant gastrointestinal adverse effects.

Embedding the 'CoolCuddle' intervention for infants undergoing therapeutic hypothermia for hypoxic-ischaemic encephalopathy in NICU: an evaluation using normalisation process theory

OBJECTIVES

Newborn infants exposed to lack of oxygen and blood flow to the brain around birth may develop brain dysfunction (hypoxic-ischaemic encephalopathy-HIE). These infants undergo 72 hours of cooling therapy and most are not held by their parents in the UK. We examined the implementation of 'CoolCuddle', identifying factors that impact embedding of this complex intervention in neonatal intensive care units (NICUs) across England.

DESIGN

Process evaluation and qualitative study using a standard questionnaire and interviews. Normalisation Process Theory (NPT) core constructs were used to assess relevant issues to staff embedding 'CoolCuddle', to discern change over time and different settings. Qualitative interviews provided valuable contextual exploration of implementation.

SETTING AND PARTICIPANTS

Six tertiary NICUs in England. Thirty-seven families with a newborn baby undergoing cooling therapy for HIE were recruited from September 2022 to August 2023; 17 NICU staff Normalisation MeAsure Development (NoMADs) at six NICUs over 6 months were included; 14 neonatal/research nurses from three participating NICUs were interviewed.

INTERVENTION

The family-centred intervention 'CoolCuddle' was developed to enable parents to hold their infant during cooling, without affecting the cooling therapy or intensive care.

OUTCOME MEASURES

NoMAD questionnaires at three timepoints over 6 months and NPT informed qualitative interviews.

RESULTS

NoMAD questionnaires at baseline showed more variation between units, for intervention acceptability, than those at 3 and 6 months. Qualitative data highlighted that staff understood the benefits of CoolCuddle but were apprehensive due to perceived risks involved in moving cooling babies. A rigorous standard operating procedure was flexible enough to incorporate the use of local processes and equipment and provided the relevant procedural knowledge to deliver CoolCuddle safely.

CONCLUSIONS

The CoolCuddle intervention can be implemented safely under the supervision of standard neonatal teams as part of usual practice in diverse NICU settings in England. The importance of having a rigorous standard operating procedure, which can be adapted to support local settings, is highlighted.

TRIAL REGISTRATION NUMBER

ISRCTN10018542; Results: registered on 30 August 2022.

Multiclass classification of Autism Spectrum Disorder, attention deficit hyperactivity disorder, and typically developed individuals using fMRI functional connectivity analysis

Neurodevelopmental conditions, such as Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD), present unique challenges due to overlapping symptoms, making an accurate diagnosis and targeted intervention difficult. Our study employs advanced machine learning techniques to analyze functional magnetic resonance imaging (fMRI) data from individuals with ASD, ADHD, and typically developed (TD) controls, totaling 120 subjects in the study. Leveraging multiclass classification (ML) algorithms, we achieve superior accuracy in distinguishing between ASD, ADHD, and TD groups, surpassing existing benchmarks with an area under the ROC curve near 98%. Our analysis reveals distinct neural signatures associated with ASD and ADHD: individuals with ADHD exhibit altered connectivity patterns of regions involved in attention and impulse control, whereas those with ASD show disruptions in brain regions critical for social and cognitive functions. The observed connectivity patterns, on which the ML classification rests, agree with established diagnostic approaches based on clinical symptoms. Furthermore, complex network analyses highlight differences in brain network integration and segregation among the three groups. Our findings pave the way for refined, ML-enhanced diagnostics in accordance with established practices, offering a promising avenue for developing trustworthy clinical decision-support systems.

Development of Personalised Immediate-Release Gel-Based Formulations Using Semi-Solid Extrusion

Precision in dosing is crucial for optimizing therapeutic outcomes and preventing overdosing, especially in preterm infants. Traditional manual adjustments to adapt the dose often lead to inaccuracies, contamination risks, and reduced precision. To overcome these challenges, semi-solid extrusion 3D printing was used to create personalised gel-based caffeine dosage forms. The hydrogels, made from agar and hydroxypropyl methylcellulose, demonstrated excellent rheological properties, ensuring uniform extrusion and accurate shape retention during and after printing. This gel formulation allowed for precise adjustments of caffeine volume and content tailored to a neonate weighing 1.36 kg, achieving a recovery of 103.46%, well within acceptable limits. Additionally, three production batches confirmed the process's reproducibility with minimal variability. Forced degradation studies showed that both pure caffeine and caffeine in the gel matrix exhibited similar stability profiles, confirming the drug's chemical integrity. The printed gel dosage forms also displayed immediate-release characteristics, with over 80% of caffeine released within 45 min, highlighting their suitability for rapid therapeutic action. These findings emphasise the potential of SSE 3DP and gel-based formulations to produce personalised drug delivery systems with high precision, reproducibility, and reliability.

Sentiment analysis of post-COVID-19 health information needs of autism spectrum disorder community: insights from social media discussions

OBJECTIVE

This study explores the health information needs of individuals with autism spectrum disorder (ASD) and their caregivers in the post-COVID-19 era by analyzing discussions from Reddit, a popular social media platform.

METHODS

Utilizing a mixed-method approach that integrates qualitative content analysis with quantitative sentiment analysis, we analyzed user-generated content from the "r/autism" subreddit to identify recurring themes and sentiments.

RESULTS

The qualitative analysis uncovered key themes, including symptoms, diagnostic challenges, caregiver experiences, treatment options, and stigma, reflecting the diverse concerns within the ASD community. The quantitative sentiment analysis revealed a predominance of positive sentiment across discussions, although significant instances of neutral and negative sentiments were also present, indicating varied experiences and perspectives among community members. Among the machine learning models used for sentiment classification, the Bi-directional Long Short-Term Memory (Bi-LSTM) model achieved the highest performance, demonstrating a validation accuracy of 95.74%.

CONCLUSIONS

The findings highlight the need for improved digital platforms and community resources to address the specific health information needs of the ASD community, particularly in enhancing access to reliable information and fostering supportive environments. These insights can guide future interventions and policies aimed at improving the well-being of autistic persons and their caregivers.

Probiotics and other adjuvants in allergen-specific immunotherapy for food allergy: a comprehensive review

This review delves into the potential of manipulating the microbiome to enhance oral tolerance in food allergy, focusing on food allergen-specific immunotherapy (FA-AIT) and the use of adjuvants, with a significant emphasis on probiotics. FA-AIT, including oral (OIT), sublingual (SLIT), and epicutaneous (EPIT) immunotherapy, has shown efficacy in desensitizing patients and achieving sustained unresponsiveness (SU). However, the long-term effectiveness and safety of FA-AIT are still under investigation. Probiotics, particularly strains of Lactobacillus, play a crucial role in enhancing immune tolerance by promoting regulatory T cells (Tregs) and modulating cytokine profiles. These probiotics can induce semi-mature dendritic cells, enhance CD40 expression, inhibit IL-4 and IL-5, and promote IL-10 and TGF-β, thus contributing to mucosal defense and immunological tolerance. Clinical trials combining probiotics with FA-AIT have demonstrated improved desensitization rates and immune tolerance in food-allergic patients. For example, the combination of Lactobacillus rhamnosus with peanut OIT resulted in a significantly higher rate of SU compared to the placebo group, along with notable immune changes such as reduced peanut-specific IgE and increased IgG4 levels. The review also explores other adjuvants in FA-AIT, such as biologic drugs, which target specific immune pathways to improve treatment outcomes. Additionally, nanoparticles and herbal therapies like food allergy herbal formula 2 (FAHF-2) are discussed for their potential to enhance allergen delivery and immunogenicity, reduce adverse events, and improve desensitization. In conclusion, integrating probiotics and other adjuvants into FA-AIT protocols could significantly enhance the safety and efficacy of FA-AIT, leading to better patient outcomes and quality of life.

Coeliac Disease in Children-A Clinical Review Including Novel Treatment Agents

Coeliac disease (CD) affects almost of 1% of the population, yet remains undiagnosed in the majority. Though the demonstration of enteropathy in duodenal biopsy was traditionally the essential criterion for the diagnosis of coeliac disease, the guidelines published by the European Society of Paediatric Gastroenterology and Nutrition (ESPGHAN) in 2012, and revised in 2020, paved the way to a no-biopsy approach to diagnosis. In a select group of children meeting certain criteria, a definitive diagnosis of CD can now be made without the need for duodenal biopsies. This is being increasingly applied in clinical practice. It is well established that untreated coeliac disease is associated with several chronic adverse health conditions. At present, a strict gluten-free diet remains the only effective treatment for CD. The advances in our understanding of the pathogenesis of CD have led to a search for alternative treatment agents. Several investigational agents are in various phases of clinical trials at present. In this review, we outline the clinical aspects of coeliac disease and summarise various investigational treatment agents.