Male infant circumcision and associated factors in Konso Zone Southern Ethiopia: community based survey

BACKGROUND

Infant male circumcision reduces urinary tract infections during infancy and sexually transmitted infections during adulthood. However, people in varous communities challenge male infant circumsizion in Ethiopia. Data regrading male infant circumsion is crucial component of designing preventive strategy, resource allocation and planning mainly in rural communities. Despite its importance, no study is conducted on male infant circumsion practice and associated factors in the study setting so far.

OBJECTIVE

To assess prevalence and factors associated with male infant circumcision in Konso Zone, South Nation Nationality People Regional State of Ethiopia, in 2022.

METHODS AND MATERIALS

Community-based cross-sectional survey was conducted among randomly selected districts in Konso Zone, Southern Nation Nationality and Peoples Regional States, Ethiopia, from 30 June to 30 July 2022. A multi-stage sampling technique was applied to enrol study subjects. Data was collected through face-to-face interviews using a structured questionnaire. Then, it was entered into epi-data 4.6 and exported to STATA version 14 for analysis. Descriptive statistics were presented using tables,charts and texts. Bivariate and multivariable logistic regression analysis were used to evaluate association between each independent variable and dependent variable. All explanatory variables with P-value less than 0.25 in bivariate regression were fitted into multi-variable regression. Variables whose P-value less than 0.05 with 95% confidence intervals (CI) was used to declare statically significance.

RESULTS

Prevalence of male infant circumcision was 24.9% in this study. Factors such as women with good knowledge of male circumcision (AOR = 7.3; 95% CI: 4.3, 12.5), women age more than 36 years (AOR = 2.2; 95% CI: 1.1, 4.3) and women with a favourable attitude to male circumcision (AOR = 9.2; 95% CI: 4.5, 18.8) were significantly associated with male infant circumcision practice in this study.

CONCLUSION

Prevalence of male infant circumcision was lower in this study compared to national threshold. Women knowledge towards male infant circumcision, aged more than 36 years, and women with favourable attitude to male circumcision are factors positively associated with male infant circumcision. Hence, stakeholders should empower women using health education about male infant circumcision and mobilise the community.

Genetic Diversity in the Fusion Gene of Respiratory Syncytial Virus (RSV) Isolated From Iraqi Patients: A First Report

Molecular evaluation of the respiratory syncytial virus (RSV) genome is one of the common strategies applied to understand the viral pathogenicity and control its spreading. In this study, we carried out molecular evaluation on the targeted fusion (F) gene region in the RSV-positive samples of Iraqi patients during the autumn and winter of 2022/2023. One hundred and fifty patients with lower respiratory tract infections were screened for RSV using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Sanger sequencing was performed on the RSV-positive samples targeting 1061 nucleotides (from nucleotide 6168 to 7228 within the RSV genome) and 1000 nucleotides (from nucleotide 6122 to 7121 within the RSV genome) of the F gene region for RSV-A and RSV-B, respectively. The results showed some nucleotide changes within the targeted F gene, which were grouped in distinct clade, closely related to isolates from Austria, Argentine, Finland, and France through phylogenetic analysis. In silico protein modeling using the SWISS-MODEL and I-TASSER web tools based on nonsynonymous changes of amino acid sequence showed some good-predicted models that can be utilized for antiviral screening. In summary, the identified nucleotide variations in the F gene could influence vaccine development as the F protein is the primary target for the major antigen of RSV. Molecular surveillance data of RSV local isolates are also essential for studying new genomic changes and enable the prediction of potential new antiviral agents.

Mapping Along-Tract White Matter Microstructural Differences in Autism

Previous diffusion magnetic resonance imaging (dMRI) research has indicated altered white matter microstructure in autism, but the implicated regions are highly inconsistent across studies. Such prior work has largely used conventional dMRI analysis methods, including the traditional microstructure model, based on diffusion tensor imaging (DTI). However, these methods are limited in their ability to precisely map microstructural differences and accurately resolve complex fiber configurations. In our study, we investigated white matter microstructure alterations in autism using the refined along-tract analytic approach, BUndle ANalytics (BUAN), and an advanced microstructure model, the tensor distribution function (TDF). We analyzed dMRI data from 365 autistic and neurotypical participants (5-24 years; 34% female) from 10 cohorts to examine commissural and association tracts. Autism was associated with lower fractional anisotropy and higher diffusivity in localized portions of nearly every commissural and association tract examined; these tracts inter-connected a wide range of brain regions, including frontal, temporal, parietal, and occipital. Taken together, BUAN and TDF allow robust and spatially precise mapping of microstructural properties in autism. Our findings rigorously demonstrate that white matter microstructure alterations in autism may be greater within specific regions of individual tracts, and that the implicated tracts are distributed across the brain.

School Performance and Learning Challenges in Children and Adolescents with Congenital Heart Disease

Children with congenital heart disease are at risk for neurocognitive and neurodevelopmental challenges, learning disabilities, and psychosocial difficulties. Our narrative review draws literature-based evidence for the effect of congenital heart disease on school performance. We conducted a literature review and extracted relevant articles from Google Scholar, Medline, and PubMed. Evidence showcases that school performance is impacted directly by congenital heart disease. This seems to be underlined by different factors inherent to congenital heart disease, like inattention, language difficulties, and decreased fine and gross motor skills. Moreover, the operative and postoperative periods present various physical challenges that can hinder development, ultimately affecting daily activities and quality of life. The consequent stressors in childhood can have long-lasting effects, leading to an increased prevalence of anxiety and depression affecting patients as they transition into adolescence and adulthood and placing significant social and emotional burdens on their direct environment. Children with congenital heart disease face both direct and indirect challenges related to their disease. These challenges are most likely to be the source of poor school performance and learning, as suggested by the literature. Close monitoring, early interventions, and multidisciplinary care are essential to address these vulnerabilities and improve educational outcomes in children with congenital heart disease.

Efficacy of anal botulinum toxin injection in children with functional constipation

OBJECTIVES

Functional constipation (FC) is a common diagnosis in the pediatric age group. In addition to laxative regimens and behavioral interventions, some have reported the use of anal botulinum toxin (BTX) injections to treat FC, with limited data regarding its efficacy.

METHODS

This is a retrospective, multicenter study including patients who received BTX for FC refractory to medical therapy. Demographic data, results of anorectal manometry, and BTX data (number of sessions, dose, and side effects) were collected. Patients were divided into three groups based on the indication for BTX: group 1 (FC with FI [fecal incontinence]), group 2 (FC without FI), and group 3 (FI alone). Response to therapy was assessed for whole cohort and for each group based on improvement in weekly frequency of BM (bowel movements) to 3 or more per week and/or resolution of FI. We also compared the response to therapy to the parental and provider report.

RESULTS

A total of 63 patients were included in the study. Median age was 6.4 years and 32 (51%) were female. The median dose of BTX was 100 units, and most patients (55/63) received a single BTX injection. Medical therapy was continued after BTX injections in most patients (60/63 or 95%). After BTX, the frequency of BM increased to >3/week in 29/56 (52%) and FI improved in 8/47 (17%) for the whole cohort. We observed a response rate of 10% in group 1, 50% in group 2 and 14% in group 3. No factors (age, gender, anal resting pressure) were associated with BTX response except for prolonged time of therapy before BTX and shorter median follow up after BTX. Parents/primary provider reported improvement in 44/63 (70%) after BTX, which was significantly higher than the actual observed response to therapy (70% vs. 21%, p = 0.003, kappa = 0.202). We found no association between response to BTX and presence of developmental delay and/or behavioral disorders (p = 0.531). Side effects were minimal and noted in seven (11%) patients, mainly FI. No factors were associated with the development of side effects.

CONCLUSIONS

Anal BTX injections improved BM frequency with minimal effect on FI with an overall symptom resolution in 21% of patients. BTX does not seem to have a notable effect in patients with FC and developmental delay and/or behavioral disorders. Provider and parental reported success were significantly higher than the actual observed response.

The Role of Short-Chain Fatty Acids in Metabolic Dysfunction-Associated Steatotic Liver Disease and Other Metabolic Diseases

With its increasing prevalence, metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a major global public health concern over the past few decades. Growing evidence has proposed the microbiota-derived metabolites short-chain fatty acids (SCFAs) as a potential factor in the pathophysiology of MASLD and related metabolic conditions, such as obesity and type 2 diabetes mellitus (T2DM). By influencing key pathways involved in energy homeostasis, insulin sensitivity, and inflammation, SCFAs play an important role in gut microbiota composition, intestinal barrier function, immune modulation, and direct metabolic signaling. Furthermore, recent animal and human studies on therapeutic strategies targeting SCFAs demonstrate their potential for treating these metabolic disorders.

Cross-sectional comparison of risk factors associated with mental illness and learning difficulties in kindergarten and elementary, middle, and high school children in the United States: a socio-ecological resilience framework

Aim

Mental illness and learning difficulties in children can be explained using the socio-ecological resilience (SER) model, which states that personal characteristics and an individual’s social relationships coupled with environmental factors of adverse life events influence mental health. We aimed to identify factors associated with anxiety, depression, and learning difficulties in kindergarten and elementary, middle, and high school children.

Subject and methods

This study utilized data collected from the 2019 National Health Interview Survey (NHIS) questionnaire administered across the United States. Children aged 4 to 17 were included. Risk factors were categorized into personal characteristics, lack of peer support, adverse family events, and socioeconomic status (SES). Logistic regression was used to estimate the risk for each risk factor and SER layers for anxiety, depression, and learning difficulties.

Results

In relation to the SER model, factors from personal, relational, and structural layers all influenced the likelihood of anxiety, depression, and learning difficulties in children across all ages. Negative personal characteristics of emotional dysregulation were the most significant risk factor associated with anxiety and depression. For children in kindergarten, relational factors of poor peer relations were more significant in influencing learning difficulties, while behavioural dysregulation measured by hyperactivity had a greater influence on learning difficulties for older children in elementary, middle, and high school. Having experienced adverse family events was significantly associated with worse mental health, while low SES was associated with worse depression and learning difficulties.

Conclusion

Comprehensive interventions that strengthen personal characteristics, peer interactions, and environmental stressors are needed to address mental illness in children.

The Influence of Recreational Hiking on the Prevalence of Cardiovascular and Psychiatric Diseases Among Population of Republic of Serbia

Background: Hiking is a physical activity recommended for people of all ages. In an era of increased incidence of cardiovascular and psychiatric diseases, directing individuals to hiking can be very important from both public health and socioeconomic perspectives. Since the health status of recreational hikers and the general population in the Republic of Serbia has not been compared yet, our objectives are to compare the health-related characteristics of those two groups, including the prevalence of comorbidities, pharmacotherapy, and drug consumption. Methods: A descriptive epidemiological study was conducted. Research questions were asked via two specially prepared questionnaires distributed through the Google Forms platform. The means of the two groups were tested by a two-sample Student t-test for independent variables. Results: The sample consisted of 259 hikers and 292 people from the general population. A total of 199 hikers (76.8%) and 218 people from the general population group (74.7%) were declared as healthy. The statistically significant differences between the groups included age, sex, education level, and body mass index. In both groups, the majority of those with pre-existing medical conditions had at least one cardiovascular disease (23.5% of the hikers and 19.5% of the individuals in the general group). Pre-existing psychiatric diseases were noted in 6% of the hikers and in 12% of those in the general group. The average durations of the disease in the hiker and general population were 11.9 and 8.4 years, respectively (p < 0.05), whereas, there were no differences in drug consumption. Conclusions: This pilot study represents the comparison of the cardiovascular and mental health among hikers and the general population in the Republic of Serbia. Although psychiatric diseases were clearly less prevalent among hikers, the prevalence and burden of cardiovascular diseases must be interpreted with caution, due to big age difference between the respondents from both groups. However, our future studies will employ objective measurements and clinical parameters rather than self-reported surveys, so that the health benefits of hiking appear more clearly.

A Longitudinal Study on the Influence of Parental Interaction on Preschool Children's Cognitive Development: A Retrospective Analysis

To investigate the impact of parental interaction on cognitive development in preschool children, a study was conducted involving 198 preschool children selected between June 2021 and January 2022. These children were divided into a control group and an observation group based on their participation in parent-child interaction education. The propensity score matching method was employed to ensure baseline equivalence between the 2 groups. Post-matching, comparisons were made regarding language ability, social communication skills, social life skills, intelligence, and neurodevelopment. No significant differences were observed between the groups at baseline. Following the intervention, the observation group demonstrated significantly higher scores in language ability (P < .05), communication and life skills (P < .05), as well as intelligence and neurodevelopment, compared with the control group (P < .05). These findings suggest that parental interaction interventions can effectively enhance language abilities, social skills, social life skills, intelligence, and neurodevelopment in preschool children, and thus, are recommended for adoption.

Quality of Life in Children with Celiac Disease: An Observational Study

Background/Objectives: Celiac disease (CD) is one of the most common chronic autoimmune disorders affecting children worldwide. The aim is to explore the significance of quality of life (QOL) research in pediatric CD, highlighting the importance of assessing both physical and psychosocial aspects of well-being. Materials and Methods: The study used a self-administered questionnaire, which consisted of questions on sociodemographic and clinical characteristics, as well as a general assessment of the QOL by using the validated PedsQL™ 4.0. Results: Dietary restrictions were associated with social challenges, as reported by 43% of respondents who indicated their child had experienced exclusion or distress during family gatherings, while 48% encountered difficulties in the school setting. The overall QOL score had a mean of 68.9 (SD = 15.00), with a median of 67.4, and ranged from 41.3 to 100.0, reflecting individual variations in perceived well-being. Age is a significant factor influencing children's social interactions and experiences within educational settings, likely due to increased academic demands, social pressures, or developmental changes. Conclusions: The study suggests that the study factor significantly influences physical functioning and overall quality of life, while its impact on emotional, social, and school domains is comparatively lower.

Kawasaki disease complicated with acute focal bacterial nephritis

We report a young child who contracted acute focal bacterial nephritis (AFBN) in the acute phase of Kawasaki disease (KD). She was initially admitted with a diagnosis of KD with pyuria, which was interpreted as one of the findings typically characteristic of KD. Her fever resolved after the first intravenous immunoglobulin (IVIG) treatment. However, her fever recurred and did not respond to the second IVIG. Additional history revealed several episodes of fever of unknown origin and vesicoureteral reflux in her relatives. This led us to re-examine the urinalysis and perform a contrast-enhanced CT, which revealed urinary tract infection and AFBN. This case highlights the importance of careful history-taking and continuously reviewing the differential diagnosis for other potential sources of fever throughout KD treatment.

Hub-and-Spoke regional system supported by telehealth for managing coeliac disease in Liguria: a mixed-methods survey followed by an observational pilot study

BACKGROUND

Due to the need to reorganize the care network for the national screening mandated by law, a new healthcare model was required for the management of coeliac disease. The hub-and-spoke model is a new healthcare organizational system, here we describe its application (supported by telehealth), in the management of pediatric coeliac disease (CD) in Liguria. The results of the pilot phase are presented and the system's strengths and weaknesses discussed.

METHODS

A mixed-methods survey followed by an observational pilot study was performed. A multiphase approach was used including preparation setting, operative planning and application. The pilot phase involves a single primary center. The reduction of families' expenditure and environmental impact was assessed using the Viamichelin calculator.

RESULTS

A regional meeting followed by a survey (specifically developed for this study) and a needs analysis highlighted the priority to have an efficient, up to date and homogeneous model of care assistance throughout the network. A diagnostic and therapeutic care pathway (PDTC) was developed by the regional working group. The project involved 986 Ligurian families and allowed a 90% reduction in the distance traveled by families residing within the pilot center's catchment area, saving €177 and 113 kg of CO2 on average per family per year.

CONCLUSIONS

The Gaslini Diffuso hub-and-spoke system for managing CD in Liguria exemplifies a commitment to enhancing healthcare efficiency and patient care, reducing environmental impact and cost for both family and healthcare system.

Assessment of Knowledge of Celiac Disease and Associated Conditions Among Dietitians in Jordan

BACKGROUND

Celiac disease (CD) is a type of systemic autoimmune condition triggered by gluten consumption among genetically predisposed individuals.

AIM

To assess the knowledge, awareness, and practices pertaining to CD and associated conditions among dietitians in Jordan.

METHOD

A cross-sectional web-based survey was carried out between April and October 2023. The survey was an internet-based questionnaire with closed-ended questions.

RESULTS

The majority of dietitians answered correctly that CD is caused due to an immunological reaction to gluten, gliadin, and protamine (91.7%); it is an autoimmune disease (71.2%); and the risk of developing an autoimmune disease is higher among CD patients (78.8). The majority of respondents (93.6%) correctly identified that a strict gluten-free diet is the treatment approach for CD patients. However, only (18.9%) of dietitians correctly identified the FDA guidelines for "Gluten Free" food labeling. Approximately 53.4% of respondents identified immunoglobulin (IgA) antibody testing as the most reliable way to diagnose patients with CD.

CONCLUSIONS

The dietitians have a good understanding of CD topics. The development of credentials in CD would ensure that dietitians practicing in CD are skilled.

Role of genetic variants and DNA methylation of lipid metabolism-related genes in metabolic dysfunction-associated steatotic liver disease

Metabolic dysfunction-associated steatotic liver disease (MASLD), is one of the most common chronic liver diseases, which encompasses a spectrum of diseases, from metabolic dysfunction-associated steatotic liver (MASL) to metabolic dysfunction-associated steatohepatitis (MASH), and may ultimately progress to MASH-related cirrhosis and hepatocellular carcinoma (HCC). MASLD is a complex disease that is influenced by genetic and environmental factors. Dysregulation of hepatic lipid metabolism plays a crucial role in the development and progression of MASLD. Therefore, the focus of this review is to discuss the links between the genetic variants and DNA methylation of lipid metabolism-related genes and MASLD pathogenesis. We first summarize the interplay between MASLD and the disturbance of hepatic lipid metabolism. Next, we focus on reviewing the role of hepatic lipid related gene loci in the onset and progression of MASLD. We summarize the existing literature around the single nucleotide polymorphisms (SNPs) associated with MASLD identified by genome-wide association studies (GWAS) and candidate gene analyses. Moreover, based on recent evidence from human and animal studies, we further discussed the regulatory function and associated mechanisms of changes in DNA methylation levels in the occurrence and progression of MASLD, with a particular emphasis on its regulatory role of lipid metabolism-related genes in MASLD and MASH. Furthermore, we review the alterations of hepatic DNA and blood DNA methylation levels associated with lipid metabolism-related genes in MASLD and MASH patients. Finally, we introduce potential value of the genetic variants and DNA methylation profiles of lipid metabolism-related genes in developing novel prognostic biomarkers and therapeutic targets for MASLD, intending to provide references for the future studies of MASLD.

Behavioural disorders and sleep problems in Sanfilippo syndrome: overlaps with some other conditions and importance indications

Sanfilippo syndrome (MPS III) is one of the types of mucopolysaccharidoses (MPS), a group of inherited metabolic diseases in which the accumulation of glycosaminoglycans (GAGs) results from deficiency of different lysosomal enzymes. The hallmarks of MPS III are relatively minor somatic abnormalities with severe and progressive central nervous system (CNS) symptoms. An analysis of the literature showed that the biggest problems for carers of people with MPS III are behavioural disorders and sleep disorders. Despite extensive discussions on improving the quality of life of patients, little attention was paid to the families/carers of patients. The families/carers are providing appropriate medical and palliative care to the patient every day due to their loss of mobility, self-care skills, tube feeding, airway clearance and other supports continue to have an adverse effect on the quality of life of families/carers. However, a literature review of possible solutions showed that effective methods (both pharmacological and non-pharmacological) exist. The needs of carers of MPS III patients should receive as much attention as the search for new treatments. There are many options for dealing with such problems. The key issue is to identify the source of the problem and choose the most effective therapy. Alleviating behavioural disorders, pain complaints and sleep problems will have a positive impact not only on the quality of life of carers/families, but also on the patients themselves.

Heated high flow nasal cannula and bilevel positive airway pressure in pediatric asthma exacerbations

OBJECTIVE

Heated High Flow Nasal Cannula (HHFNC) and Bilevel Positive Airway Pressure (BPAP) are noninvasive respiratory support modalities used in pediatric asthma exacerbations. We aim to examine differences in characteristics and outcomes for patients admitted to the Pediatric Intensive Care Unit (PICU) on standard therapy (ST) alone (continuous albuterol and systemic corticosteroids), ST plus HHFNC, and ST plus BPAP.

METHODS

This is a retrospective and prospective observational cohort study. Chi-Squared/Fisher's exact and Kruskal Wallis tests were used for categorical and continuous outcomes, respectively.

RESULTS

129 patients were included. Younger patients were placed on HHFNC while more severe patients were placed on BPAP. A multiple linear regression controlling for age, sex, race, ethnicity, and exacerbation severity revealed that patients admitted on BPAP had a longer duration of continuous albuterol compared to patients on ST alone (p = 0.02). No differences were found in respiratory support escalation, duration of respiratory support, or adverse events. The BPAP group had the most sedation use and longest length of stay (LOS). Median hourly respiratory rates (RR) increased in the HHFNC group over the first 12 h of admission and remained stable or decreased in the ST and BPAP groups.

CONCLUSIONS

This study found that BPAP use in pediatric asthma exacerbations is associated with increased exacerbation severity, longer duration of continuous albuterol, increased sedation use, and longer LOS. Although a multiple linear regression analysis was performed to control for multiple covariates including exacerbation severity, it is possible that intrinsic patient characteristics influenced these outcomes rather than BPAP usage.

The use of neural networks to determine factors affecting the severity and extent of retinopathy in preterm infants

BACKGROUND

Retinopathy of prematurity (ROP) is a leading cause of visual impairment and blindness in preterm infants. Early identification of key risk factors is essential for effective screening and timely intervention. This study utilizes an artificial neural network (ANN) to analyze and identify the most influential factors affecting the severity and extent of ROP in preterm neonates.

METHODS

This descriptive-analytical study was conducted on 367 preterm infants in Bojnord, Iran, in 2021. The study examined multiple variables, including sex, history of multiple births, number of prior abortions, type of pregnancy and delivery, gestational age, oxygen therapy, severity of retinopathy, and disease extent within the retina. Statistical analyses were performed using one-way analysis of variance (ANOVA), Pearson's correlation coefficient, and an ANN to determine the relationships between independent variables and ROP progression.

RESULTS

The findings indicate that the severity of ROP was significantly associated with the type of pregnancy, gestational age, birth weight, and postnatal age (P < 0.05). Similarly, disease extent was significantly correlated with maternal parity, gestational age, birth weight, and postnatal age (P < 0.05). Among all factors examined, postnatal and gestational age exhibited the highest coefficient effects on ROP severity and disease extent. Additionally, follow-up evaluations revealed that infant age and birth weight were crucial in disease progression.

DISCUSSION

The results suggest that targeted interventions focusing on gestational age and neonatal weight may significantly reduce the incidence and severity of ROP in preterm infants. Integrating ANNs enhances predictive accuracy, enabling early diagnosis and improved clinical outcomes.

CONCLUSION

The findings of this study contribute to the advancement of ROP screening and treatment strategies in preterm neonates. Future research should focus on multi-center studies with larger sample sizes to refine predictive models and identify additional risk factors influencing ROP progression.

Adherence to the Mediterranean Diet in Paediatric Patients with Inflammatory Bowel Disease and Functional Abdominal Pain Disorders-Comparative Study

Background/Objectives: There is a limited body of evidence regarding dietary intake in children with inflammatory bowel disease despite increasing research about the nutritional implications in the disease pathogenesis. Functional abdominal pain disorders (FAPDs) are also chronic disorders marked by chronic abdominal pain, currently described with the ROME IV criteria. This study was aimed to investigate the adherence to healthy eating habits in an inflammatory bowel disease pediatric population when compared to a matched population with functional abdominal pain gastrointestinal disorders. Methods: We performed a single centre study focused on dietary patterns in children with IBD and FAPDs between January 2021 and April 2024. Data collected included general information, disease phenotype, and the KIDMED index regarding healthy eating. Results: The final analysis was based on full data from the KIDMED index available for 122 (57 vs. 65) participants. Overall, the average KIDMED score did not vary significantly between the study population, meaning 6.89 ± 2.33 for the IBD group and 7.11 ± 2.67 for FAPDs group, p = 0.34. In the same KIDMED index group, mean values were higher for FAPDs patients, but results differ statistically significant only for "medium" adherence to healthy diet, showing that larger proportion of IBD patients were previously exposed to non-healthy diets: 8.99 vs. 11.1, p = 0.45, 5.02 vs. 6.92, p = 0.05, 2.89 vs. 2.56, p = 0.43, for group 1, 2, and 3, respectively. Conclusions: This study showed in our cohort that overall adherence to a healthy pattern diet is poor prior to diagnosis of different gastrointestinal pathologies in children.

Evidence-based practice of hypnosis in dentistry: Narrative summary of reviews and meta-analysis

The purpose of this article is to provide a concise summary of the scientific literature in the form of a narrative review to highlight areas where the use of clinical hypnosis is supported by scientific evidence in dentistry. A literature review was carried out to identify relevant peer-reviewed articles on PubMed, written in French or in English, with time limitation from 2000 to May 2023, and updated in December 2024. Articles had to be systematic reviews or meta-analysis linked with the management of dental anxiety and acute dental pain, as well as chronic orofacial pain. Twelve articles were selected for analysis, with 8 on dental anxiety, 3 on temporomandibular disorders, and 1 on burning mouth syndrome. Several literature reviews and meta-analyses published on the subject support the use of hypnosis in several clinical contexts, including local anesthesia, dental extraction and dental anxiety in adults and children. Evidence is also presented to improve the condition of patients suffering from pain associated with temporomandibular disorders. However, the literature remains somewhat fragmented because of the diversity of hypnosis techniques applied, and the different dental procedures or conditions explored. Hypnosis can have a considerable impact in the management of dental anxiety and acute dental pain. It also seems promising for the management of orofacial pain, but further research would be necessary. This research highlights that the available evidence is sufficient to encourage the integration of evidence-based hypnosis training to improve the management of acute stress and pain in dental practice.

Neural markers of methylphenidate response in children with attention deficit hyperactivity disorder and the impact on executive function

Background

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. A core cognitive deficit in ADHD is executive function (EF) impairment, which significantly impacts daily life. Methylphenidate (MPH) is a widely used first-line treatment for ADHD, but objective biomarkers to assess treatment response are lacking. The aim of this study was to investigate the effects of MPH on executive function and identify potential neural biomarkers of response in children with ADHD using electroencephalogram (EEG).

Methods

A total of 26 boys with ADHD (mean age 8.64 ± 1.30 years) participated in the study. All participants were treated with 18 mg/day of oral extended-release MPH in the morning for 8 weeks. Executive function was assessed using the BRIEF2 and Digit Span Test (DST), and event-related potentials (ERP) were measured at baseline and after 8 weeks of MPH treatment.

Results

After 8 weeks of MPH treatment, significant improvements were observed in several executive function domains. BRIEF2 scores, including inhibition, self-monitoring, shifting, emotional control, initiation, working memory, planning/organization, task monitoring, and material organization, were significantly reduced (P < 0.05). Behavioral performance in the Go/NoGo task also improved, with shorter correct response times and higher accuracy rates (P = 0.002, P = 0.009). EEG results revealed a reduction in Nogo-P300 latency at Fz, Cz and Pz compared to baseline (P<0.05).

Conclusions

The normalization of P300 latency following MPH treatment appears to be a reliable neural biomarker of positive treatment response in children with ADHD. MPH was associated with improvements in executive function, particularly in inhibitory control and working memory.

Elemental Formulas: Indications of Use in Pediatric Clinical Practice

Background: Elemental or amino-acid-based formulas play a crucial role in pediatric nutrition, offering a therapeutic alternative when human milk is poorly tolerated or in specific disease states. Mostly used in various cases of allergy, maldigestion, or malnutrition, elemental formulas serve as a special therapeutic regimen in clinical practice to promote growth and development. Methods: This narrative review briefly surveys the literature of the past decade available on PubMed, Scopus, and Google Scholar, encompassing original research, review articles, and position papers. Results: The indications for using elemental formulas in pediatric clinical practice extend beyond cow's milk allergy to conditions such as eosinophilic esophagitis, intestinal failure, Crohn's disease, hepatic failure, chronic pancreatitis, and various neurological and other malnutrition-related disorders. Conclusions: Elemental formulas are associated with potential health benefits for pediatric patients in certain conditions, either as a first-line feeding option or under conditional use. Despite their drawbacks, they are regarded as a therapeutic tool with numerous indications, requiring careful implementation by a multidisciplinary team of healthcare experts. Future expert guidelines, including dosage, timing, and long-term effects of elemental diets, are needed for pediatric clinical practice.

The association between the Mediterranean Diet and the prime diet quality score and new-diagnosed irritable bowel syndrome: a matched case-control study

Background

Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder with multifactorial etiology. Dietary patterns, including the Mediterranean Diet (Med-Diet) and the Prime Diet Quality Score (PDQS), may play a role in IBS risk. This study examined the association between adherence to the Med-Diet and PDQS and new-diagnosed IBS in an Iranian population.

Methods

A matched case-control study was conducted on 170 newly diagnosed IBS patients and 340 age- and sex-matched controls recruited from outpatient clinics in Zanjan, Iran. Dietary intake was assessed using a semiquantitative food frequency questionnaire. The Med-Diet score and PDQS were calculated, with higher scores indicating better diet quality. Conditional logistic regression was used to determine the odds of IBS across quartiles of Med-Diet and PDQS, adjusting for sociodemographic and clinical factors.

Results

Higher adherence to the Med-Diet was associated with 51% lower odds of IBS (OR: 0.49; 95% CI: 0.30-0.73, P < 0.001) in the highest quartile compared to the lowest. Similarly, participants in the highest PDQS quartile showed a significantly 59% lower odds of IBS (OR: 0.41; 95% CI: 0.26-0.51, P < 0.001) compared to the lowest quartile. Both associations remained significant after adjusting for potential confounders, including total energy intake. These findings highlight the potential clinical relevance of dietary quality in IBS prevention.

Conclusion

Higher adherence to the Med-Diet and a higher PDQS were both inversely associated with IBS risk. Specifically, individuals with higher Med-Diet scores and higher PDQS scores had a lower risk of developing IBS compared to those with lower adherence or scores. These findings suggest a potential role of these dietary patterns in modulating IBS risk, although causal relationships cannot be established from this study.

Glycerol intoxication syndrome in young children, following the consumption of slush ice drinks

INTRODUCTION

Slush ice drinks are commonly available refreshments, aimed at children and young people. Glycerol is used to maintain the slush effect in the absence of a high sugar content.

OBJECTIVE

To describe a series of children who became acutely unwell shortly after consuming a slush ice drink; their presentation mimics specific inherited metabolic diseases (IMDs).

METHODS

A retrospective case review of 21 children who presented to centres across the UK and Ireland from 2009 through 2024 was carried out.

RESULTS

Almost all of the children (93%) became unwell within 60 min of slush ice drink consumption. None had any relevant past medical history. The median age at presentation was 3 years 6 months (range 2 years - 6 years 9 months). Presenting features include acute decrease in consciousness (94%), hypoglycaemia (95%), metabolic (lactic) acidosis (94%), pseudohypertriglyceridaemia (89%) and hypokalaemia (75%). Glyceroluria was present in all acute urine organic acid samples. No underlying IMD was found in the 14 patients who underwent further enzymatic or genetic testing. The majority (95%) subsequently avoided slush ice drinks and did not have reoccurrence.

CONCLUSION

Consumption of slush ice drinks containing glycerol may cause a clinical syndrome of glycerol intoxication in young children, characterised by decreased consciousness, hypoglycaemia, lactic acidosis, pseudohypertriglyceridaemia and hypokalaemia. This mimics inherited disorders of gluconeogenesis and glycerol metabolism. Clinicians and parents should be alert to the phenomenon, and public health bodies should ensure clear messaging regarding the fact that younger children, especially those under 8 years of age, should avoid slush ice drinks containing glycerol.

Effects of Different Hemicellulose Components on Fermentation Kinetics and Microbial Composition in Fecal Inoculum from Suckling Piglets In Vit ro

This study investigated the fermentation characteristics of different hemicellulose components using a fecal inoculum derived from suckling piglets. The results showed that after 60 h of fermentation, the arabinogalactan (Ara-gal), glucomannan (Glu-man), galactomannan (Gal-man), and mannan (Man) groups exhibited similar levels of gas production, which were higher than those of the β-glucan (β-Glu) group. The β-Glu group had the lowest pH value. After 48 h of fermentation, the Ara-gal group had the highest microbial crude protein content and the lowest ammonia nitrogen content. The Glu-man, Gal-man, and Man groups produced similar amounts of acetate, propionate, and total short-chain fatty acids (SCFAs), which were higher than those in the Ara-gal and β-Glu groups. Furthermore, the Man and Ara-gal groups showed the highest butyrate production. Significant differences in the microbial community composition were observed among the groups. Correlation analyses further revealed that the abundance of specific bacteria, such as Prevotella_9 and Parabacteroides, was closely related to the production of acetate, propionate, and butyrate. These results suggest that Glu-man, Gal-man, and Man undergo rapid fermentation, with Ara-gal following, while β-Glu ferments the slowest. The distinct fiber compositions and fermentation properties of different hemicellulose components significantly influence the microbial composition and SCFA production. Our findings offer valuable theoretical insights for selecting fiber components in the diets of suckling piglets and potentially in infants.

Celiac Disease-Narrative Review on Progress in Celiac Disease

Celiac disease is defined as a systemic immunological disorder caused by gluten (gliadin and other prolamin) in genetically predisposed individuals, who present with a variety of gluten-dependent symptoms, specific antibodies, the presence of the HLA DQ2 and DQ8 histocompatibility antigen, and enteropathy. Its prevalence, depending on the studied population and methodology, is estimated at 0.75-1.6% of the general population. During the complex immune reaction it induces, most cells involved in inflammatory processes are activated, which leads to the gradual atrophy of intestinal villi and the proliferation of enterocytes within intestinal crypts. The pathogenesis of celiac disease is extremely complicated and is still the subject of research. According to the current diagnostic guidelines, the following criteria should be taken into account: clinical symptoms (intestinal and extraintestinal), the presence of antibodies against tissue transglutaminase in the IgA class, the level of total IgA, and the presence of typical histological changes in duodenal biopsies. Diet-resistant celiac disease is one of the most important clinical challenges, causing serious complications. Currently, the basic method for treating celiac disease is an elimination diet (i.e., the exclusion of products that may contain gluten from the diet), however, new therapeutic strategies are still being sought, mainly based on supplementation with exogenous endopeptidases, modification of the immune response, and the use of zonulin inhibitors and transglutaminase 2 inhibitors. Clinical trials of new drugs are ongoing. The gradually expanding knowledge about the pathogenesis of celiac disease may allow for the development of new therapeutic strategies for both patients with a mild disease course, as well as those that are diet-resistant.

Global scientific research landscape on binge drinking: a comprehensive bibliometric and visualization analysis of trends, collaborations, and future directions

BACKGROUND

Binge drinking constitutes a significant public health concern. Defined as the consumption of five or more alcoholic beverages on a single occasion, binge drinking leads to acute cognitive and motor impairments and is associated with a multitude of detrimental health consequences. Therefore, the aim of this study was to analyse globally published peer-reviewed literature on binge drinking.

METHODS

A thorough search of the Scopus database was conducted to gather all the relevant research. Keywords related to binge drinking were used to locate a wide range of studies. Specific criteria were subsequently applied to narrow the results, ensuring the inclusion of only the most relevant articles. This process yielded a collection of 2,763 research papers. Finally, a software program called VOSviewer was utilized to analyse and visualize the connections between these studies.

RESULTS

A bibliometric analysis was performed to investigate trends in binge drinking research literature published between 1980 and 2024. The findings revealed a significant increase in publications (R²=0.916; p < 0.001), with a peak in 2018 (191 articles). The majority (89.65%, n = 2,477) were research articles, followed by review articles (4.74%, n = 131). Authors from 139 countries contributed to binge-drinking research, with the USA (n = 1,550; 56.1%) and the UK (n = 216; 7.82%) leading in the volume of publications. The National Institute on Alcohol Abuse and Alcoholism (n = 65; 2.35%) and the University of North Carolina at Chapel Hill (n = 63; 2.28%) emerged as the main institutional contributors. The National Institute on Alcohol Abuse and Alcoholism in the United States was the main funding source, supporting 599 articles (21.68%), followed by the National Institutes of Health in the United States, with 544 articles (19.69%). In particular, the post-2016 period witnessed a shift in research themes toward mechanistic investigations alongside studies on societal interventions, reflecting a growing focus on mitigating the broader social impact of binge drinking.

CONCLUSIONS

This study is the first comprehensive analysis of trends in binge drinking research. Over the past decade, binge drinking has increased dramatically, led by the United States, the UK, and Spain. Initially, focused on social and cultural factors, research shifted after 2016 to mechanistic and animal models, shaping future research directions and strategies.

White Matter Microstructural Abnormalities in Children with Familial vs. Non-Familial Attention-Deficit/Hyperactivity Disorder (ADHD)

Background: Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent, heterogeneous neurodevelopmental disorder. Methods: This study presents, for the first time, a comprehensive investigation of white matter microstructural differences between familial ADHD (ADHD-F) and non-familial ADHD (ADHD-NF) using advanced diffusion tensor imaging analyses in a large community-based sample. Results: Children with ADHD-F exhibited significantly greater volume in the right anterior thalamic radiations and the left inferior fronto-occipital fasciculus compared to controls, and greater volume in the left inferior longitudinal fasciculus relative to ADHD-NF. The ADHD-NF group showed reduced fractional anisotropy in the left inferior longitudinal fasciculus compared to the controls. In both the ADHD-F and ADHD-NF groups, a greater volume of anterior thalamic radiation significantly contributed to reduced ADHD symptoms. Conclusions: Our findings suggest that white matter microstructural alterations along the frontal-thalamic pathways may play a critical role in hereditary factors among children with ADHD-F and significantly contribute to elevated inattentive and hyperactive/impulsive behaviors in the affected children.

Selenoprotein P1 as a biomarker of insulin resistance in pediatric obesity: Insights and implications

This editorial discusses the findings of Elbarky et al on the role of selenoprotein P1 (SEPP1) in pediatric obesity and insulin resistance. Their study uncovered significantly lower SEPP1 Levels in children who were obese compared with healthy peers, demonstrating a negative correlation between SEPP1 levels and measures of adiposity and insulin resistance. These findings suggest that SEPP1 is a biomarker useful in the early identification of insulin resistance in pediatric populations. This editorial emphasizes the clinical implications of the study and calls for further research to validate and explore the role of SEPP1 in metabolic health.

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

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

Importance of neonatal screening: A case study of sickle cell disease and cystic fibrosis coexistence

BACKGROUND

Neonatal screening (NS) is a public health policy to identify genetic pathologies such as cystic fibrosis (CF), sickle cell disease, and other diseases. Sickle cell disease is the comprehensive term for a group of hemoglobinopathies characterized by the presence of hemoglobin S. CF is an autosomal recessive multisystemic disease with pathophysiology involving deleterious mutations in the transmembrane regulatory gene that encodes a protein that regulates the activity of chloride and sodium channels in the cell surface epithelium. NS is crucial for early diagnosis and management, which ensures a better quality of life.

AIM

To report a case of the coexistence of sickle cell anemia (SCA) and CF and perform an integrative literature review.

METHODS

This is an observational study and a review of the literature focusing on two rare genetic pathologies identified simultaneously in NS from the perspective of a clinical case. The authors identified only 5 cases of SCA associated with CF. No clinical trials or review articles were identified considering the rarity of the coexistence of these two pathologies.

RESULTS

Herein, the authors reported the case of a girl who after undergoing NS on day 8 of life was diagnosed with SCA with an alteration in the dosage of immunoreactive trypsin. The diagnosis of CF was confirmed by the Coulometry Sweat Test. The rarity of the co-occurrence of these two severe genetic pathologies (CF and SCA) is a challenge for medical science.

CONCLUSION

This study adds to the few case reports present in the literature that highlight the identification of two severe diseases via NS.

Runchangningshen paste activates NLRP6 inflammasome-mediated autophagy to stimulate colonic mucin-2 secretion and modulates mucosal microbiota in functional constipation

BACKGROUND

Runchangningshen paste (RCNSP) is a paste made of four medicinal and edible homologous Chinese medicine mixed with honey. It is known for its ability to nourish yin and blood as well as to loosen the bowel to relieve constipation. The pathophysiology of functional constipation (FC) is associated with a reduction in mucin-2 (MUC2) secretion and microbial dysbiosis.

AIM

To investigate the underlying mechanism of RCNSP against FC through MUC2 and the gut mucosal microbiota.

METHODS

Ultra-performance liquid chromatography tandem mass spectrometry characterized RCNSP composition to elucidate the material basis of action. FC model was induced via loperamide gavage (16 mg/kg) twice daily for 7 days. Applying defecation function and gastrointestinal motility to assess constipation severity. Hematoxylin and eosin and Alcian blue-periodic acid-schiff staining analyzed colonic mucosal morphology. Transmission electron microscope was used to observe the ultrastructure of goblet cells (GCs). Immunofluorescence colocalization, quantitative PCR, and western blot assessed the impact of RCNSP on gene and protein expression within the NLRP6/autophagy pathway. 16S rDNA was employed to sequence the gut mucosal microbiota.

RESULTS

RCNSP contained 12 components with potential laxative effects. It enhanced defecation function, accelerated gastrointestinal motility, and maintained colonic mucosal integrity. RCNSP treatment significantly increased GC abundance and MUC2 production while preserving GC ultrastructure. At the molecular level, RCNSP enhanced the colocalized expression of key regulatory proteins and modulated mRNA and protein expressions in the NLRP6/autophagy pathway. Through 16S rDNA sequencing analysis, RCNSP significantly altered the mucosal microbiota composition. Specifically, it increased beneficial bacterial strains while reducing harmful ones. Simultaneously, RCNSP reduced butyrate-producing bacteria like Proteobacteria, Enterobacteriaceae, Blautia, and Eubacterium and decreased hydrogen sulfide-producing species, such as Prevotellaceae. It also reduced bile acid-inhibiting species, such as g_Eubacter_coprostanoligenes_group and Erysipelotrichaceae while increasing bile acid-producing species, such as Colidextribacter.

CONCLUSION

Our findings suggested that RCNSP ameliorated constipation through a dual mechanism: It stimulated colonic MUC2 secretion by activating NLRP6 inflammasome-mediated autophagy and modulated the composition of the mucosal microbiota.

Oxidative Stress Indicated by Nuclear Transcription Factor Nrf2 and Glutathione Status in the Blood of Young Children with Autism Spectrum Disorder: Pilot Study

This pilot study investigated the relationship between nuclear transcription factor Nrf2 and glutathione homeostasis in children with autism spectrum disorder (ASD), addressing the role of oxidative stress in ASD pathophysiology. Oxidative stress, characterized by an imbalance between reactive oxygen species and antioxidant defenses, has been implicated in ASD and may contribute to neuroinflammation and mitochondrial dysfunction. Nrf2, a key regulator of the antioxidant response, influences glutathione synthesis and recycling, making it critical for cellular redox balance. This study included 23 children with ASD and 21 neurotypical healthy controls, and measured levels of Nrf2, Keap1 (Kelch-like ECH-associated protein 1), reduced glutathione (GSH), oxidized glutathione (GSSG), glutathione reductase (GR), and peroxidase (GPx3) in blood samples. Our study reveals altered antioxidant defense in children with autism spectrum disorder, as evidenced by reduced levels of Nrf2, Keap1, GSH, and GR, along with elevated GSSG and a lower GSH/GSSG ratio. These findings indicate an increased oxidative stress burden in this population. Additionally, the observed positive correlation between Nrf2, GSH, and GR levels suggests an important role for Nrf2 in maintaining glutathione homeostasis. Our results underscore the potential involvement of oxidative stress in ASD and emphasize the need for further research into targeted therapeutic approaches to address this imbalance.

Determination and Comparison of Fat and Fibre Contents in Gluten-Free and Gluten-Containing Flours and Breads: Nutritional Implications

The absence of gluten is a technological challenge that requires the addition of components to replace the unique viscoelastic properties of gluten, thus altering the nutritional composition of gluten-free (GF) breads. Moreover, GF flours may have different compositions as compared to gluten-containing (GC) counterparts because of a different origin. This may impact the nutritional quality of GF diets. The aim of the study is to provide updated analytical data on moisture, fat, and fibre contents in GF flour and bread samples, and compare them with their GC counterparts, as well as to analyse ingredients and how they impact nutritional quality. A total of 30 different flours and 24 types of bread were analysed using AOAC methods. GF cereal flours contain more fat than GC flours (3.5 ± 2.1% vs. 2.5 ± 2.1%, p < 0.001), as well as GF flours from pseudocereals, except for wholemeal buckwheat (2.6 ± 0.1%). Fibre content is lower in GF flours (3.6 ± 3.1% vs. 7.1 ± 3.9%, p = 0.03), except for GF pseudocereal and legume flours. GF breads contain almost twice as much fat 6.6 ± 2.3% vs. 1.4 ± 0.2%, p < 0.001, and 4.2 ± 1.2%, p < 0.001) and fibre (7.3 ± 2.4% vs. 2.8 ± 0.5%, p < 0.001, and 4.9 ± 2.1%, p = 0.002) as GC breads. This is due to the raw materials themselves and to the addition of ingredients, such as regular and high oleic sunflower oil, and psyllium. Fibre ingredients and additives are more frequently used in ready-to-eat GF flours and breads, and more GF breads also contain fat-based ingredients, as compared to GC. Amaranth and chickpea flours are good alternatives to produce breads with better nutritional quality. Analysis of GF products for critical nutrients is peremptory because of continuing technological and nutritional innovation.

Impact of probiotic supplements on behavioural and gastrointestinal symptoms in children with autism spectrum disorder: A randomised controlled trial

OBJECTIVE

To investigate whether probiotic supplementation can improve behavioural and gastrointestinal (GI) symptoms in children with autism spectrum disorder (ASD) aged 2-9 years and further explore the correlation between these symptoms.

DESIGN

Single-blinded, randomised, placebo-controlled study.

SETTING

Five developmental paediatric outpatient clinics of 'Continua Kids'.

PATIENTS

Children aged 2-9 years diagnosed with ASD along with their caregivers.

INTERVENTIONS

Probiotic or placebo sachet reconstituted in 50 mL of lukewarm milk/water, taken two times per day for 3 months.

MAIN OUTCOME MEASURES

Change in behavioural (measured by Social Responsiveness Scale-2 (SRS-2) and Aberrant Behaviour Checklist-2 (ABC-2) tools) and GI (measured by GI Severity Index (GSI) score) symptoms after receiving intervention for 3 months.

RESULTS

A total of 180 children with ASD were enrolled in the study (probiotic group: 90 and placebo group: 90). All children completed the study. The probiotic group showed a significant reduction in behavioural symptom severity as measured by the SRS-2 tool (47.77% vs 23.33%; p=0.000) compared with the placebo. Probiotic-treated children demonstrated significant reductions in severe symptoms, including social withdrawal/lethargy (40%), stereotypic behaviour (37.77%), hyperactivity (34.44%) and inappropriate speech (32.22%) post-intervention (p=0.000). They also had marked improvements in constipation (p=0.003) and diarrhoea (p=0.043) compared with the placebo group. Both groups exhibited a statistically significant correlation between behavioural and GI symptoms.

CONCLUSIONS

Probiotic supplementation improved behavioural and GI symptoms in children with ASD with no adverse effects. Both symptoms were significantly correlated. However, these results need to be validated in a larger sample size.

TRIAL REGISTRATION NUMBER

CTRI/2021/11/038213.

Concordance of Helicobacter pylori Detection Methods in Symptomatic Children and Adolescents

BACKGROUND

Helicobacter pylori is the most prevalent chronic bacterial infection globally, acquired mostly during childhood. It is associated with chronic gastritis, peptic ulcer disease, and gastric cancer. Due to challenges in culturing H. pylori, diagnostic reference standards often rely on combining ≥2 non-culture, biopsy-based methods. Histology with Giemsa staining is widely used in clinical settings due to its low cost and reliable performance.

METHODS

This study evaluated the concordance between histology with Giemsa staining as the reference standard and other diagnostic methods, including the rapid urease test (RUT), ureA RT-PCR, 16S sequencing, and anti-H. pylori serum IgG. Positive percent of agreement (PPA), negative percent of agreement (NPA) and concordance kappa index were calculated.

RESULTS

A total of 120 patients (41 positive and 79 negative by Giemsa staining) were analyzed. Among the methods tested, RT-PCR for ureA showed the best performance (PPA = 94.7%, NPA = 98.6%, kappa = 0.939), while RUT underperformed compared with expectations (PPA = 65.9%, NPA = 97.5%, kappa = 0.681). Serology had the lowest performance (PPA = 53.7%, NPA = 96.1%, kappa = 0.548).

CONCLUSIONS

The combination of histology with Giemsa staining and ureA RT-PCR achieved the highest detection rate and strongest agreement.

The relationship between below average cognitive ability at age 5 years and the child's experience of school at age 9

Background

At age 5, while only embarking on their educational journey, substantial differences in children's cognitive ability will already exist. The aim of this study was to examine the causal association between below average cognitive ability at age 5 years and child-reported experience of school and self-concept, and teacher-reported class engagement and emotional-behavioural function at age 9 years.

Methods

This longitudinal cohort study used data from 7,392 children in the Growing Up in Ireland Infant Cohort, who had completed the Picture Similarities and Naming Vocabulary subtests of the British Abilities Scales at age 5. Principal components analysis was used to produce a composite general cognitive ability score for each child. Children with a general cognitive ability score more than 1 standard deviation (SD) below the mean at age 5 were categorised as 'Below Average Cognitive Ability' (BACA), and those scoring above this as 'Typical Cognitive Development' (TCD). The outcomes of interest, measured at age 9, were child-reported experience of school, child's self-concept, teacher-reported class engagement, and teacher-reported emotional behavioural function. Binary and multinomial logistic regression models were used to examine the association between BACA and these outcomes.

Results

Compared to those with TCD, those with BACA had significantly higher odds of never liking school [Adjusted odds ratio (AOR) 1.82, 95% CI 1.37-2.43, p < 0.001], of being picked on (AOR 1.27, 95% CI 1.09-1.48) and of picking on others (AOR 1.53, 95% CI 1.27-1.84). They had significantly higher odds of experiencing low self-concept (AOR 1.20, 95% CI 1.02-1.42) and emotional-behavioural difficulties (AOR 1.34, 95% CI 1.10-1.63, p = 0.003). Compared to those with TCD, children with BACA had significantly higher odds of hardly ever or never being interested, motivated and excited to learn (AOR 2.29, 95% CI 1.70-3.10).

Conclusion

Children with BACA at school-entry had significantly higher odds of reporting a negative school experience and low self-concept at age 9. They had significantly higher odds of having teacher-reported poor class engagement and problematic emotional-behavioural function at age 9. The findings of this study suggest BACA has a causal role in these adverse outcomes. Early childhood policy and intervention design should be cognisant of the important role of cognitive ability in school and childhood outcomes.

Adherence to global diet quality score in relation to gastroesophageal reflux disease and flatulence in Iranian adults

INTRODUCTION

Gastroesophageal reflux disease (GERD) and flatulence are both prevalent afflictions and negatively impact the quality of life. This study aims to determine the relationship between the Global Diet Quality Score (GDQS), a novel metric based on the Prime Diet Quality Score with GERD and flatulence in Iranian adults.

METHODS

The cross-sectional study was conducted among 6202 adults in the context of the Shahedieh cohort study accomplished. Dietary intakes of participants were collected by food frequency questionnaires (FFQs). To calculate GDQS, 25 food groups were comprised (16 healthy and 7 unhealthy food groups and two food groups categorized as unhealthy when consumed excessively). GERD and flatulence were assessed by a self-reported questionnaire. To examine the association between GDQS with GERD and flatulence, logistic regression was performed in crude and adjusted models (Model I: adjustments for age and energy intake; Model II: gender, physical activity, marital status, occupation, educational levels, WSI, and BMI; and Model III: smoking status, depression, diabetes, hypertension, and cardio events.) RESULTS: Participants in the highest quintile of GDQS had 20% higher odds of having GERD than individuals in the lowest one (OR: 1.20; 95% CI: 0.88-1.65, P trend = 0.508). Compared to the lowest quintile, the participants in the highest quintile had no significant reduction in probability of having flatulence in the crude model (OR: 0.94; 95% CI: 0.81-1.11, P trend = 0.578). These associations remained non-significant after adjustments for confounding variables.

CONCLUSION

No significant associations were observed between higher adherence to GDQS with odds of GERD and flatulence in Iranian adults. To better understand these findings, longitudinal studies especially randomized clinical trials are needed.

Persistence of anemia in patients with Celiac disease despite a gluten free diet: a retrospective study

BACKGROUND

The main treatment for Celiac Disease (CD) is the gluten-free diet (GFD). However, in some CD patients, iron deficiency anemia can be persistent despite a GFD.

AIM

In this study, we aim to evaluate the prevalence of anemia in both adults and children with CD at the diagnosis and during the GFD.

METHODS

In this cross-sectional study including both adults and children with CD, the demographic characteristics and hemoglobin, iron, folate and vitamin B12 levels were retrospectively retrieved from patients' medical records at the time of diagnosis (T0); after 3-5 years (T1) and after 8-10 years (T2) of GFD.

RESULTS

311 CD patients (184 adults and 127 pediatric patients) were included in the study. No difference was observed in the prevalence of anemia in the overall population after 3-5 years of GFD in both adult and pediatric patients compared to the diagnosis. At 8-10 years, in the adult patient's group, a significant reduction in the prevalence of anemia was observed (24% vs. 17.8% p = 0.043).

CONCLUSIONS

Despite the GFD and a very long observational period the diagnosis of anemia persists in 17.8% and 4.4% of adult and pediatric patients, respectively. The diagnostic delay (longer in adult patients) and a more pronounced ultrastructural mucosal injury could play a role in the persistence of anemia despite the GFD.

Nigella sativa monophosphoryl lipid A nanoliposome: a promising antibiotic alternative and immunomodulator to control virulent pandemic drug-resistant Salmonella pullorum infection in broiler chicks

BACKGROUND

Salmonella enterica serovar Pullorum, the causative agent of pullorum disease, is one cause of the economic losses in the global poultry industry. Vaccination and antibiotics are still the most effective methods of controlling Salmonella, even though the vaccine contains the causative agent, and the antibiotic therapy has limited efficacy. We provide a novel immunostimulator and antibiotic substitute to protect against and avoid Salmonella pullorum (SP) infection.

METHODS

Nigella sativa-purified oil (NS) and monophosphoryl lipid A (MPLA) were formulated as nanoliposomal compounds (NS-MPLA). Their protective and immunomodulatory efficacies were experimentally tested orally in broiler chicks against challenge with virulent pandemic drug-resistant SP. Four chick groups were utilized: control; NS-MPLA-supplemented; SP-challenged; and SP-challenged, then NS-MPLA-treated. Clinical signs, organ gross pathology, colony-forming counts, and tissue histopathological alterations were investigated. The relative fold-changes in the expression of IL-1β, IL-4, IL-17, IL-22, TLR-4, INF-γ, IgA, and MUC2 genes were evaluated.

RESULTS

The SP-challenged chicks showed notable symptoms and extensive pathological lesions in their internal organs. The bacteria colonized the challenged chicks' livers and continued to shed in their feces for 5-6 days. A minor amount of immune cell tissue trafficking was noted. The NS-MPLA-treated chicks displayed opposing patterns after being challenged with SP. They exhibited mild clinical signs with modest gross pathology in the internal organs. After 3-4 days, the liver and the fecal droppings were cleared of SP. Significant heterophilic aggregation, lymphocytic infiltration, and lymphoid follicle enlargement were observed. Additionally, chicks challenged with SP and then NS-MPLA-treated showed a 5- to tenfold increase in immune-related cytokines, immunoglobulin A, and mucosal relative gene expression folds compared to the SP-challenged non-NS-MPLA-treated, which showed a sharp decline in IL-4 and IL-22 and a minor rise in the rest of the tested gene relative expressions. Chicks given NS-MPLA supplementation showed a significant upregulation of these genes compared to the control group.

CONCLUSION

In this first report on poultry, it is possible to draw the conclusion that NS-MPLA supplementation in SP-infected chicks boosts immunity and provides protection. It promoted bacterial clearance and tissue repair and stimulated the expression of genes linked to immunity and the mucosal surface. These findings suggest the potential application of NS-MPLA in salmonella control programs as an antibiotic substitute or in immunization strategies.

The Increasing Prevalence of Food Allergies in the Pediatric Populations: A Rising Concern

N/A

Unraveling the role of early coeliac disease diagnosis in the risk of developing immune-mediated renal diseases

BACKGROUND

coeliac disease (CD) is an inflammatory condition of the small intestine caused by immunological intolerance towards dietary gluten. Associations between CD and other autoimmune disorders have been extensively reported. However, the risk in CD patients of developing immune-mediated renal diseases (IMRDs) as a function of the duration of exposure to gluten remains uncharacterized.

METHODS

we used data from the Swedish national patient register to retrospectively construct two subcohorts of CD patients by either years before or after CD diagnosis, matched by sex and age to reference individuals (ratio 1:6). Adopting cox regressions, we assessed the risk in CD to develop IMRDs.

RESULTS

we found that unrecognized CD patients had a higher risk to develop the majority of the IMRDs here investigated compared with matched reference individuals. Following a CD diagnosis, the risk was reduced in eight of the twelve IMRDs. Furthermore, if patients were diagnosed with CD earlier in childhood they showed less or no increased risk to develop IMRDs compared with reference individuals. CD patients diagnosed by the age of 15 had an overall 12% increased risk of developing any IMRD, (HR: 1.12; CI = 1.02, 1.24; p < 0.02), as those with a CD diagnosis between 16 and 30 years of age had a 60% increased risk of developing IMRD (HR: 1.61; CI = 1.36, 1.91; p < 0.001).

CONCLUSIONS

Our data show that individuals diagnosed with CD at an earlier age have a lower risk of developing immune-mediated kidney conditions.

Positivity and Follow-Up Testing of Chlamydia trachomatis and Neisseria gonorrhoeae Infections in Universally Screened Female Basic Military Trainees

INTRODUCTION

Follow-up testing is recommended 3 months after patients initially test positive with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Follow-up testing adherence in the United States has been reported below one-third of women, even in universally insured populations. We assessed both the positivity of CT and GC infections in female basic military trainees and the rates of follow-up testing for those who tested positive.

METHODS

Between January 1, 2006, and December 31, 2021, female Air Force Basic Military Trainees were universally screened with urinary nucleic acid amplification testing for CT and GC. Those who tested positive were evaluated to determine demographic information as well as follow-up testing rates. Patients who were evaluated with a repeat CT/GC nucleic acid amplification test within 12 months after a positive CT/GC test result were considered to have received appropriate follow-up.

RESULTS

A total of 5022 (5.2%) of 97,168 trainees tested positive for only CT (4749 [4.8%]), only GC (138 [0.1%]), or both CT/GC (135 [0.1%]) during the study period. Those at increased risk of infection were those <24 years of age, Hispanic and Black individuals, those with high school education level, and single women. Of the 4687 still in the military at 3 months after diagnosis, 3268 (69.7%) had repeat testing within 12 months. There was no significant difference in follow-up testing by age, race, educational level, marital status, or organism causing original infection.

CONCLUSIONS

Follow-up testing among female United States Air Force basic military trainees is higher than in other universally insured populations. This study demonstrates remaining barriers to adherence to recommended guidelines.

Assessing Internal Consistency of the Autism Spectrum Disorder Gastrointestinal and Related Behaviors Inventory and the Frequency and Socio-Emotional Correlates of Gastrointestinal Difficulties in Children With the Autism Spectrum Disorder: A Cross-Sectional Study

Gastrointestinal (GI) difficulties are common in children diagnosed with autism spectrum disorder (ASD). However, these difficulties can frequently remain unrecognized. Therefore, we aimed to translate a newly developed instrument, The Autism Spectrum Disorder Gastrointestinal and Related Behaviors Inventory in Children (ASD-GIRBI), to assess its reliability and to explore the frequency of various gastrointestinal difficulties and related behaviors, as well as to explore the association of GI difficulties with the measures of social functioning and emotional and behavioral difficulties in children with ASD. A total of 98 children and adolescents (aged 4-18 [M age = 10.67 ± 3.705], 82.7% male), previously diagnosed with ASD at the Institute of Mental Health in Belgrade, Serbia, took part in this research. Their parents filled out the following questionnaires: ASD-GIRBI (an assessment of gastrointestinal and related symptoms), Stanford Social Dimensions Scale (SSDS) (a measure of social functioning) and Strengths and Difficulties Questionnaire (SDQ) (a measure of emotional and behavioral problems). Our results indicate that the ASD-GIRBI is a reliable instrument for GI difficulties assessment (Cronbach's α = 0.841) with the total score successfully discriminating between the participants with and without a GI disorder diagnosis (p = 0.040). Any gastrointestinal symptom was present in 54.1% of the participants, most commonly flatulence, diarrhea, and constipation. The severity of gastrointestinal difficulties correlated to emotional problems (r = 0.261, p < 0.01), conduct problems (r = 0.219, p < 0.05), hyperactivity (r = 0.381, p < 0.01), peer problems (r = 0.266, p < 0.01), total difficulties (r = 0.454, p < 0.01) and total difficulties impact (r = 0.321, p < 0.01). Our data emphasize the potential importance of GI difficulties for various areas of functioning of individuals with ASD.

Evaluation of Gastroesophageal Reflux in Symptomatic Young Infants Using Multichannel Intraluminal pH-Impedance Testing: A large Cohort Study from a Single Center

OBJECTIVE

 This study aimed to assess the use of combined multichannel intraluminal impedance and pH studies (MII-pH) in a large group of symptomatic young infants, to characterize the occurrence of gastroesophageal reflux disease (GERD), and to establish temporal association of the reflux behaviors with gastroesophageal reflux using symptom indices.

STUDY DESIGN

 This is a retrospective cohort study on 181 infants who underwent MII-pH studies for clinical behaviors that were suggestive of GERD. Symptom index (SI) and symptom association probability (SAP) were used to establish symptom association with reflux. More than 100 GER episodes in 24 hours or acid reflux index > 10% was considered pathological reflux.

RESULTS

 A total of 181 infants (median age: 60 days, interquartile range [IQR]: 34-108) underwent MII-pH studies with median study duration of 22.41 hours (IQR: 21.5-23.32). A total of 4,070 hours of data were analyzed, with 8,480 reflux events (2,996 [35%] acidic, 5,484 [65%] nonacidic). A total of 2,541 symptoms were noted, 894 (35%) were temporally related to reflux events. A total of 113 infants (62.4%) had positive symptom association with SI > 50% and/or SAP > 95% for at least one symptom. There was modest symptom association for choking and gagging, but apnea, bradycardia, and desaturations had poor symptom association. Only 29 infants (16%) had pathological reflux, and only 18 infants (10%) had both pathological reflux and positive symptom association.

CONCLUSION

 MII-pH can be used to characterize GERD in young infants, along with establishing temporal association with symptoms. Pathological reflux in symptomatic young infants is not common, but symptom association may occur without frequent or acidic reflux.

KEY POINTS

· Gastroesophageal reflux (GER) disease can be studied in young infants using MII-pH, to characterize the frequency and nature of GER events.. · The probability of GER events being associated temporally with GER symptoms can also be determined using MII-pH in this population.. · Using frequency of GER events, reflux indices, and symptom association indices with MII-pH, infants having true GER disease can be identified, thereby reducing unnecessary therapy.. · Symptom association may occur even without frequent or severe acidic reflux..

Link Between Ferritin, Vitamin D, Performance, and Eating Attitudes in Female Athletes

Iron and vitamin D deficiencies can affect athletes' health and performance. However, the epidemiology and associated risk factors remain unclear. Forty-three elite female athletics athletes (20.2±1.9 years) were included. A survey regarding the training schedule and Eating Attitudes Test-26, body composition, bone mineral density, and serum 25-hydroxyvitamin D (25(OH)D) and ferritin levels were assessed. Mean serum 25(OH)D and ferritin levels were 25.2±5.5 ng/mL and 29.0±13.2 ng/mL, respectively, and 83.7% and 41.9% of athletes had vitamin D and ferritin insufficiency, respectively. Serum 25(OH)D level was negatively correlated with the number of rest days per week (Coefficient,-6.19; 95% confidence interval [CI],-9.82--2.57; p=0.002), and serum ferritin level was negatively correlated with body mass index (Coefficient,-3.87; 95% CI,-7.57--0.16; p=0.041). Performance levels were positively correlated with serum vitamin D levels (Coefficients, 7.25; 95% CI, 0.25-14.25; p=0.043) and negatively correlated with EAT-26 scores (Coefficient,-7.30; 95% CI,-12.61--1.98; p=0.009) and body fat percentage (Coefficient,-13.26; 95% CI,-24.66--1.86; p=0.025). Vitamin D and ferritin insufficiencies are prevalent among Japanese female athletics athletes. Serum vitamin D level was related to performance level.

Assessment Factors for Managing First Permanent Molars in Children with Poor Prognosis: A Systematic Mapping of Clinical Evidence

Background

Managing the first permanent molar (FPM) with a poor prognosis can be challenging as it depends on several modifying factors that must be considered, and each approach has potential implications and clinical outcomes.

Aim

This review aimed to systematically review the assessment factors that should be considered prior to managing FPM with poor prognosis in children.

Methods

A computerized database search was conducted using Cochrane, PubMed, and Scopus with predefined search terms related to "management, treatment, extraction, restoration, endodontic, and orthodontic" involving the "FPM." The search included studies published in English between 1990 and 2024. Two reviewers independently extracted data and assessed whether the studies met the inclusion criteria. The inclusion criteria specified management approaches for FPM with poor prognosis in children aged 6-16. Any disagreement between reviewers was resolved through discussion.

Results

A total of 1815 studies were screened, and 37 full-text articles were retrieved. Seven retrospective observational studies met the inclusion criteria. All the included studies focused on orthodontic assessment factors, such as the presence of a third molar and angulation of the second permanent molar, aimed at achieving spontaneous space closure following FPM extraction. However, no studies have addressed restorative perspectives on managing this problem, particularly in pediatric patients.

Conclusion

This review highlights a lack of well-established and robust studies on managing poor prognosis in FPM. The absence of research on long-term functional outcomes, patient-reported experiences, and the role of restorative alternatives, especially in children, reveals significant gaps in the current literature. Incorporating these findings into clinical practice could lead to more personalized and effective treatment strategies that focus on both immediate and long-term oral health outcomes for children. Given the complexity of FPM management, a multidisciplinary approach combining restorative, orthodontic, and preventive strategies is crucial. Therefore, further studies with stronger evidence are needed to explore a comprehensive clinical approach that could enhance treatment outcomes.

A Case Report on Protease Serine 1 (PRSS1)-Related Acute Pancreatitis

Acute pancreatitis (AP) is a multifactorial disease. Genetic predisposition as the etiology of AP is rare. We report the case of a 29-year-old male patient who presented with symptoms suggestive of AP. A complete workup, including genetic analysis, revealed the presence of both protease serine 1 (PRSS1) and UDP Glucuronosyltransferase family 1 member A1 (UGT1A1) mutations. Both PRSS1 and UGT1A1 mutations can cause AP by different mechanisms. This case has been reported because of the novelty of the two different genetic mutations in the same individual that could independently increase pancreatitis risk. The possible synergistic effect has not been reported previously. Understanding this interaction emphasizes the importance of genetic testing in AP.