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.

Outpatient Management of Clinical Comorbidities in Children With Cerebral Palsy in Low- and Middle-Income Countries

BACKGROUND

Cerebral palsy (CP) is the most common physical disability of childhood. Its prevalence in low-and middle-income countries (LMICs) is over 3/1000 live births, about double the 1.6/1000 in high income countries (HICs). Multimorbidity is highly prevalent in CP. In LMICs, there are higher rates of prevalence, severity, comorbidities and mortality in children with CP. The evidence base for the recommendations in CP emanates overwhelmingly from studies conducted in HICs. Research conducted in LMICs settings, involving local clinicians, considering local context and investigating local solutions are urgently needed.

METHODS

This scoping review aimed to identify and synthesise current evidence on management of clinical comorbidities in children with CP in LMICs. The Joanna Briggs Institute guidelines were followed for the data extraction and analysis phases. The following questions guided the scoping review: What are the main clinical comorbidities in children with CP? What are the gold standards for diagnosis and treatment of these comorbidities? What options do we have to diagnose and treat these comorbidities in LMICs when gold standards are not available?

RESULTS

A total of 22 188 citations were identified by our search strategy, with 21 380 remaining after the removal of 808 duplicates. After screening titles and abstracts, 1918 citations progressed to full text review. A total of 194 articles met the eligibility criteria and were included in the review. The guiding questions of the review were answered for the following morbidities: respiratory impairments, dysphagia and aspiration, gastroesophageal reflux disease, drooling, obstructive sleep apnea syndrome, malnutrition, constipation, epilepsy, sleep disorders, spasticity, dystonia, pain, hip disorders, scoliosis and osteoporosis.

CONCLUSION

This article highlights the need for interventions adapted to the realities of LMICs. Empowering paediatricians and healthcare professionals in LMICs is crucial for early diagnosis and proactive interventions. Specific guidelines for LMICs can better guide professionals in managing these complex conditions.

Factors predictive of recurrence, metastasis and death in node-negative penile squamous cell carcinoma: A retrospective multicentre cohort study

BACKGROUND

Penile squamous cell carcinoma (PSCC) carries significant morbidity and mortality. Literature is limited regarding prognostic factors, especially prognostic factors for development of metastasis.

OBJECTIVES

To identify independent prognostic factors associated with poor outcomes, defined as local recurrence (LR), metastasis and disease-specific death (DSD) in clinically node-negative PSCC undergoing local therapy.

METHODS

Thirty-two-year Retrospective Multicenter Cohort Study of 265 patients with histologically diagnosed PSCC at three tertiary care centres. Predictive models based on patient or tumour characteristics were developed.

RESULTS

Local recurrence occurred in 56 patients, metastasis in 52 patients and DSD in 40 patients. In multivariable models, the following five factors were independent prognostic factors based on subhazard ratio (SHR): history of balanitis (LR SHR: 2.3; 95% CI 1.2-4.2), poor differentiation (metastasis SHR 1.9; 95% CI 1.0-3.6), invasion into the corpora (metastasis SHR: 3.0; 95% CI 1.5-5.8 and DSD SHR: 4.5; 95% CI 1.7-12.1), perineural invasion (PNI) (metastasis SHR: 2.8; 95% CI 1.4-5.5 and DSD SHR: 3.5; 95% CI, 1.6-7.8) and a history of phimosis (DSD SHR: 2.5; 95% CI 1.2-5.3). The 5-year cumulative incidence of metastasis was higher for tumours with PNI [cumulative incidence function (CIF) = 55%, 95% CI 38-75 vs. CIF 15%, 95% CI 11-22], corporal invasion (CIF: 35%, 95% CI 26-47 vs. 12%, 95% CI 7-19) and poorly differentiated tumours (CIF = 46%, 95% CI 31-64 vs. CIF 15%, 95% CI 11-22).

CONCLUSIONS

History of balanitis, history of phimosis, PNI, corporal invasion and poor differentiation are independent risk factors associated with poor outcomes. Since poor differentiation and PNI currently constitute only T1b disease, prognostic staging can likely be improved.

Overlap Diagnostic Odyssey and Full Mouth Rehabilitation of a Juvenile Patient With IFIH1-Related Disorder: A Case of Aicardi-Goutières and Singleton Merten Syndromes Overlap

OBJECTIVE

This case report describes the prosthetic rehabilitation of a 15-year-old female patient with a rare IFIH1-related interferonopathy, presenting features from both Aicardi-Goutières Syndrome (AGS) and Singleton-Merten Syndrome (SMS). The report highlights the unique dental and maxillofacial challenges, and the multidisciplinary treatment approach required in such patients.

METHODS

The patient underwent a comprehensive prosthetic rehabilitation, which included two stages of extractions, followed by the fabrication of a complete upper denture and a two-implant-retained mandibular overdenture. Pre- and post-treatment assessments, including panoramic radiographs and cone beam computed tomography (CBCT), were utilized to guide treatment.

RESULTS

Initial assessments revealed root formation anomalies, multiple impacted teeth, internal resorption, and associated dental anomalies. Following extractions and ridge augmentation, two freestanding implants were successfully placed in the anterior mandible, with no complications during osseointegration. The patient reported satisfaction with the function, esthetics, and stability of her dental prostheses.

CONCLUSIONS

This case underscores the importance of a multidisciplinary approach for managing dental anomalies and bone fragility in patients with IFIH1-related disorders. Early genetic diagnosis and thorough treatment planning are critical for successful prosthetic rehabilitation and optimal patient outcomes.

Diagnostic value of the derived neutrophil-to-lymphocyte ratio for acute appendicitis

BACKGROUND

The diagnosis of appendicitis in children can present several challenges, leading to an increased risk of complications. Herein, we aimed to evaluate the diagnostic value of the derived neutrophil-to-lymphocyte ratio (dNLR) as a novel adjunctive diagnostic tool for appendicitis.

METHODS

Diagnostic study of patients with appendicitis and non-surgical abdominal pain (AP) admitted to our hospital between 2020 and 2022. White blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), and dNLR were compared between the two groups of patients.

RESULTS

Overall, 202 patients were enrolled: 101 with appendicitis (69% male, age 9.9 years) and 101 with AP (56% male, age 9.4 years). WBC, NLR, and dNLR were higher in patients in the appendicitis group than in those in the AP group (16.47 versus 11.18 × 103 cells/mm3; 9.5 versus 3.3; and 5.2 versus 2.3; P ≤ 0.0001, respectively). The sensitivity, specificity, positive predictive value, area under ROC curve, and cutoff point of dNLR for the diagnosis of appendicitis were 71%, 74%, 73%, 0.811, and 3.78, respectively. The positive likelihood ratios for WBC, NLR, and dNLR were 1.95, 2.05 and 2.77.

CONCLUSION

dNLR is a novel and noninvasive biomarker with high accuracy for diagnosing appendicitis. Its inclusion as an additional diagnostic tool in clinical practice may aid in determining the need for further studies in cases with ambiguous presentations and a dNLR value ≥3.78.

Implementation of an Anxiety Management Process in Pediatric Primary Care: An Evidence-Based Practice Quality Improvement Initiative

INTRODUCTION

Pediatric anxiety is rapidly increasing, and in 2022, the US Preventive Services Task Force recommended universal anxiety screening using a validated tool for children 8-18 years.

METHOD

This evidence-based practice quality improvement initiative integrated an educational process, a validated anxiety screening tool, and a Caregiver Satisfaction Survey into all primary care wellness visits for patients aged 8-18 years.

RESULTS

Significant increases in screening and referrals for mental healthcare were observed postinitiative implementation, especially in ages 8-11 years. Anxiety diagnosis and referral for treatment increased from 6.1% to 21.3%, demonstrating the importance of screening and early action at a younger age than previously recommended. However, many telephone follow-ups to caregivers for mental health referrals were unanswered.

DISCUSSION

Integrating mental health services within pediatric primary care settings is recommended to increase timely treatment accessibility. Results from this initiative may be transferable to other primary care practices.

Technical Tips: Recommendations for Reducing Emotional Distress Through a Trauma Informed Approach to EEG Lead Placements in the Pediatric Population

When faced with challenging behaviors from pediatric patients, technologists can often feel unprepared. This can lead to poor appointment outcomes as well as unintended traumatic experiences for patients. It is important to understand the role the technologist plays in providing high-quality care that addresses behavioral concerns while minimizing trauma; however, training and education in this area of patient care is limited in the field of neurodiagnostics. This lack of training and education can deter technologists from working with the pediatric population. This article aims to address core reasons for displayed behaviors in pediatric patients as well as the risks associated with not addressing the behaviors during EEG lead placements. In an effort to continue striving for high-quality, family-centered care in the field of pediatric neurodiagnostics, proposed interventions such as the CARE process and distraction are outlined and discussed.

Convergence on CaMK4: A Key Modulator of Autism-Associated Signaling Pathways in Neurons

Although the precise underlying cause(s) of autism spectrum disorder remain unclear, more than 1000 rare genetic variations are associated with the condition. For many people living with profound autism, this genetic heterogeneity has impeded the identification of common biological targets for therapy development for core and comorbid traits that include significant impairments in social communication and repetitive and restricted behaviors. A substantial number of genes associated with autism encode proteins involved in signal transduction and synaptic transmission that are critical for brain development and function. CAMK4 is an emerging risk gene for autism spectrum disorder that encodes the CaMK4 (calcium/calmodulin-dependent protein kinase 4) enzyme. CaMK4 is a key component of a Ca2+-activated signaling pathway that regulates neurodevelopment and synaptic plasticity. In this review, we discuss 3 genetic variants of CAMK4 found in individuals with hyperkinetic movement disorder and comorbid neurological symptoms including autism spectrum disorder that are likely pathogenic with monogenic effect. We also comment on 4 other genetic variations in CAMK4 that show associations with autism spectrum disorder, as well as 12 examples of autism-associated variations in other genes that impact CaMK4 signaling pathways. Finally, we highlight 3 environmental risk factors that impact CaMK4 signaling based on studies of preclinical models of autism and/or clinical cohorts. Overall, we review molecular, genetic, physiological, and environmental evidence that suggest that defects in the CaMK4 signaling pathway may play an important role in a common autism pathogenesis network across numerous patient groups, and we propose CaMK4 as a potential therapeutic target.

Histamine Intolerance: An Overlooked Diagnosis of Recurrent Anaphylaxis-Like Symptoms

Histamine intolerance is a common disorder associated with an impaired histamine metabolism. It should be considered in individuals with sporadic or repeated anaphylaxis-like symptoms after seafood consumption. We encountered a 26-year-old male patient who experienced recurrent episodes of anaphylaxis-like symptoms after ingesting seafood. A detailed history-taking and a histamine 50-skin-prick test confirmed the diagnosis of histamine intolerance. In addition, a low-histamine diet and prophylactic antihistamine medication did not result in symptom recurrence. Proper management of histamine intolerance can improve the individual's quality of life.

Assessment of Intraepithelial Lymphocytes Count in Potential Celiac Disease

Intraepithelial lymphocytes (IELs) count, central for coeliac disease (CD) diagnosis, can be performed either directly on hematoxylin and eosin (H&E)-stained paraffined sections or on optimal-cutting-temperature-compound (OCT)-embedded frozen sections stained by immunohistochemistry (IHC) with anti-CD3. We evaluated the concordance in Marsh grading between these two techniques on a large sample of sections. A total of 280 patients with a normal intestinal architecture, 210 potential celiac disease (PCD) patients, and 70 controls (CTR) were included. At the H&E histological evaluation, 136/280 were classified as Marsh-0 (showing < 25 IELs/100 enterocytes) and 144 Marsh-1, while at the IHC evaluation, 191 were classified as Marsh-0 (showing ≤ 34 CD3+/mm of epithelium) and 89 Marsh-1. The overall concordance was 66.8% (48.6% Marsh-1 and 86% Marsh-0) with a Cohen Kappa value of 0.33. In the PCD group, the overall concordance was 63% (45.6% Marsh-1 and 84% Marsh-0) with a Cohen Kappa value of 0.26, while in the CTR group it was 77% (60% Marsh-1, 90% Marsh-0) with a Cohen Kappa value of 0.54. Differences between the two groups were statistically significant (p < 0.05). In conclusion, the concordance of IELs counts between histological and IHC evaluation is low (Kappa Cohen 0.54) in no-CD and even more in PCD patients (0.26). Caution must be paid when classifying a patient as Marsh-0 or Marsh-1 according to the technique used.

WFUMB Commentary Paper on Artificial intelligence in Medical Ultrasound Imaging

Artificial intelligence (AI) is defined as the theory and development of computer systems able to perform tasks normally associated with human intelligence. At present, AI has been widely used in a variety of ultrasound tasks, including in point-of-care ultrasound, echocardiography, and various diseases of different organs. However, the characteristics of ultrasound, compared to other imaging modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI), poses significant additional challenges to AI. Application of AI can not only reduce variability during ultrasound image acquisition, but can standardize these interpretations and identify patterns that escape the human eye and brain. These advances have enabled greater innovations in ultrasound AI applications that can be applied to a variety of clinical settings and disease states. Therefore, The World Federation of Ultrasound in Medicine and Biology (WFUMB) is addressing the topic with a brief and practical overview of current and potential future AI applications in medical ultrasound, as well as discuss some current limitations and future challenges to AI implementation.

The resurgence of synthetic cannabinoid receptor agonists as adulterants in the Era of Cannabis legalization: Lessons from prior epidemics and clinical implications

Momentum towards legalization of medical and recreational cannabis drives a convergence between natural cannabinoids and their synthetic counterparts, creating new clinical challenges in a second wave of exposures. This review critically examines the emerging challenges posed by synthetic cannabinoid receptor agonists (SCRAs) and semi-synthetic cannabinoids, emphasizing their clinical implications. SCRAs are potent full agonist activity that have been identified as adulterants in several recreational substances, including cannabis and opioids. Adulteration often leads to unpredictable clinical outcomes and exacerbates the potential for drug interactions. Drawing parallels with other drug epidemics, this paper highlights the urgent need for clinical preparedness to address the nuanced presentations of cannabinoid toxicity, stressing the importance of patient history, physical examination, and judicious use of supportive laboratory tests. This review serves as a cautionary tale and call to action for researchers and policymakers. There is a clear need for robust quality control measures, enhanced public awareness campaigns, and development of evidence-based clinical guidelines to mitigate the health risks associated with intentional and unintentional use of synthetic cannabinoids.

Emotional and psychosocial functioning in youngsters with a congenital heart disease (CHD) in comparison to healthy controls

OBJECTIVE

Due to their medical vulnerability, youngsters with congenital heart disease (CHD) may experience more overwhelming emotions than healthy peers. This multi-informant-based study aims to examine differences between these youngsters and their peers in psychosocial functioning, attachment and emotion regulation.

STUDY DESIGN

217 youngsters (8-18 years) with CHD (53.9 % boys, 46.1 % girls) were compared to 232 healthy controls (52.6 % boys, 47.4 % girls) matched for gender, age and education. Participants and parents completed online self-report questionnaires assessing psychosocial functioning (SDQ), attachment (ECR-RC), and maladaptive Emotion Regulation Strategies (ERS; FEEL-KJ).

RESULTS

Based on child's self-reports MANOVA's showed no significant differences between the groups in psychosocial functioning. However, based on parent reports, differences were found between the groups in psychosocial functioning for the total scales and overarching subscales. No differences were found between the groups for insecure attachment to either parent. However, youngsters with CHD and their fathers reported more use of self-devaluation compared to controls (p = .03). Other maladaptive ERS (giving up, withdrawal, rumination, aggressive actions) showed no differences.

CONCLUSIONS

Care interventions for children with CHD should address medical, emotional, and social needs, with a focus on multi-informant evaluations to support emotional well-being. Nurses are important partners in detecting psychosocial difficulties and providing family support. Patient- and family-centered care involves patients, parents and caregivers in the care plan, recognizing their key role, especially as youngsters often perceive their psychosocial health differently than their parents. Although differences were noted compared to the control group, the study's cross-sectional design limits conclusions on evolution with time.

Metal Dyshomeostasis as a Driver of Gut Pathology in Autism Spectrum Disorders

Despite being classified as neurodevelopmental disorders, in recent years, there has been a growing interest in the association between autism spectrum disorders (ASDs) and gut pathology. This comprehensive and systematic review explores a potential mechanism underlying gut pathology in ASDs, including alterations in gut microbiota, intestinal permeability, immune dysregulation, and gastrointestinal (GI) symptoms. Specifically, it delves into the role of toxic and essential metals and their interplay, affecting the development and function of the GI tract. The review also discusses the potential implications of this gut pathology in the development and management of ASDs. Studies have shown that heavy metal exposure, whether through environmental sources or dietary intake, can disrupt the delicate balance of trace elements in the gut. This disruption can adversely affect zinc homeostasis, potentially exacerbating gut pathology in individuals with ASDs. The impaired zinc absorption resulting from heavy metal exposure may contribute to the immune dysregulation, oxidative stress, and inflammation observed in the gut of individuals with ASDs. By shedding light on the multifaceted nature of gut pathology, including the impact of metal dyshomeostasis as a non-genetic factor in ASD, this review underscores the significance of the gut-brain axis in the etiology and management of ASDs.

Determining rates of genetic testing in the evaluation of autism spectrum disorder and intellectual and developmental disorder

Genetic tests, such as Fragile X and Chromosomal Microarray, are recommended as a standard of care during the evaluation of autism spectrum disorder (ASD) and other neurodevelopmental disorders. However, previous research demonstrates low rates of genetic testing. This study aimed to identify the rates of genetic testing and patient demographic factors that may be associated by conducting a retrospective chart review of 7539 electronic health records of patients who were evaluated for ASD or other neurodevelopmental disorders within a university healthcare network. Researchers created a database that listed patient demographics (race, gender, insurance, zip code), records of ordered but not completed tests, genetic test results and reasons for declining genetic tests (if noted), and other known barriers to genetic testing. Statistical analyses were conducted to determine associations between genetic testing rates and sociodemographic factors. 30.57% of patients received at least one indicated genetic test, while 11.31% received recommended concordant genetic testing. Findings suggest that while gender did not impact whether a patient received at least one genetic test, race and insurance did. Our review demonstrates that genetic testing is not sufficiently offered by physicians, and there are multiple barriers preventing patients from receiving genetic testing, which must be further investigated.Lay abstractGenetic testing is recommended by various professional organizations as part of clinical guidelines during the evaluation of autism spectrum disorder (ASD) and other neurodevelopmental disorders. However, previous studies demonstrate that rates of genetic testing are low. This study aimed to identify the rates of genetic testing within a large university healthcare network and factors that may be associated with higher or lower rates. Researchers reviewed over 7500 electronic health records of patients who were evaluated for ASD or other neurodevelopmental disorders. Some factors that were recorded include patient demographics (race, gender, insurance, zip code), ordered but not completed tests, genetic test results and reasons for declining genetic tests if noted, and other known barriers to genetic testing such as blood draws and specialties of providers seen by patients. Statistical analysis was conducted to determine associations between rates of genetic testing and different factors recorded in our database. Our results demonstrate that less than half of patients received at least one indicated genetic test, while a smaller percentage received recommended genetic tests. While sex assigned at birth and gender did not impact whether a patient received at least one indicated genetic test, race and insurance did. Our review reveals that genetic testing is not sufficiently offered by physicians, and we have identified multiple obstacles that prevent patients from receiving genetic testing which must be further investigated.

The relation between clutter and visual fatigue in children with cerebral visual impairment

PURPOSE

Cerebral visual impairment (CVI) is a brain-based condition which can be exacerbated by clutter. This study aimed to explore the relation between clutter and visual fatigue in children with CVI and evaluate the effectiveness of clutter algorithm metrics in assessing visual clutter in photographs of children's play areas and the relation to visual fatigue.

METHODS

Visual clutter was measured using algorithmic metrics, subjective observations by a clinical researcher (who also observed visual fatigue) and a Qualtrics survey.

RESULTS

Seventy-two children (mean performance age = 7 years 4 months) were included. Visual fatigue was present in over 90% of children. Results revealed a relation between clutter and visual fatigue observations (rs = 0.29; p = 0.01) and between visual clutter observations from researchers and Qualtrics participants (rs = 0.32; p = 0.02). Certain metrics were correlated with visual clutter observations (rs ranging from -0.30 to 0.51, p-values ranging from <0.001 to 0.03), but not with visual fatigue.

CONCLUSIONS

Children with CVI presented with visual fatigue, particularly in cluttered environments. Therefore, parents, caregivers, teachers and clinicians should be attentive to visual fatigue signs, as early recognition and intervention can help address the child's needs more effectively. Algorithms that effectively quantify visual clutter are valuable tools that can be integrated to enhance the assessment of clutter and its relation with visual fatigue to advance CVI research methodology. However, a clinician is required to assess visual fatigue and to obtain detailed information on environmental clutter, which algorithms alone may not fully capture. Finally, we recognise that visual fatigue and the impact of clutter should be integrated into psychoeducation and the comprehensive assessment of individuals with CVI.

Magnetic resonance imaging of masticatory muscles in patients with duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) is the most common muscular dystrophy in children. Impairment of masticatory function and swallowing disorders, potentially leading to aspiration and gastrostomy, are linked to fatty infiltration in the masticatory muscles, as previously observed in muscle ultrasound. This study aims to quantify muscle volume and fat fraction in muscle magnetic resonance imaging (MRI) in the masticatory muscles in non-ambulant DMD patients compared to healthy controls and evaluate their correlation with maximum bite force (MBF), which has not been previously described. Fifteen patients with DMD and 16 controls were included. MBF was measured with an oral dynamometer and total muscle volume (TMV) and fat signal fraction (FSF) were quantified using MRI with the Dixon technique. Four DMD patients presented with masticatory or swallowing difficulties. DMD patients had a significantly lower median MBF (141.8 N) compared with healthy controls (481.6 N, p < 0.0001). Additionally, median FSF was significantly higher in DMD patients (47.07 %) compared to controls (5.31 %, p < 0.0001). A strong negative correlation between TMV and MBF was observed in DMD patients (ρ = -0.70, p = 0.0048). A significant negative correlation between MBF and normalized FSF was observed in healthy controls (ρ = -0.5487, p = 0.300) and DMD patients (ρ = -0.5893, p = 0.0224). A non-significant positive correlation between age and FSF in DMD was detected (ρ = 0.38, p = 0.17). MBF, TMV and FSF quantified with the Dixon MRI are sensitive measures to evaluate masticatory function in DMD patients and may serve as biomarkers for clinical follow up. Studies in older patients are needed to evaluate the predictive role of MBF, TMV and FSF in the nutritional status of patients and the need for therapeutic interventions such as gastrostomy.

Medication Errors and Error Chains Involving High-Alert Medications in a Paediatric Hospital Setting: A Qualitative Analysis of Self-Reported Medication Safety Incidents

BACKGROUND

Paediatric patients are prone to medication errors, but an in-depth understanding of errors involving high-alert medications remains limited.

OBJECTIVE

We aimed to investigate incident reports involving high-alert medications to describe medication errors, error chains and stages of the medication management and use process where the errors occur in paediatric hospitals.

METHODS

A retrospective document analysis of self-reported medication safety incidents in a paediatric university hospital in 2018-20. The incident reports involving high-alert medications were investigated using an inductive qualitative content analysis and quantified (frequencies and percentages). A systems approach to medication risk management based on the Theory of Human Error was applied.

RESULTS

Altogether, 560 medication errors were identified within the study sample (n = 426 incident reports). Most medication errors were associated with administration (43.1 %, n = 241/560) and prescribing (25.2 %, n = 141/560). Error chains involving two to four medication errors in one or more stages of the medication management and use process were present in 26.1% (n = 111/426) of reports, most of which originated from prescribing (62.2%; n = 69/111). The medication errors (n = 560) were classified into 14 main categories, the most common of which were wrong dose (13.9%; n = 78/560), omission of a drug (12.9%; n = 72/560) and documentation errors (10.0%; n = 56).

CONCLUSIONS

Paediatric medication error chains often start from prescribing and pass through the medication management and use process. Systemic defences are especially needed for manual tasks leading to wrong doses, drug omission and documentation errors. Intravenous medications and chemotherapeutic agents, optimising drug formularies and handling, and high-alert drug use at home require further actions in paediatric medication risk management.

Approach to anaemia in gastrointestinal disease: A position paper by the ESPGHAN Gastroenterology Committee

Anaemia is a frequent consequence of many gastrointestinal (GI) diseases in children and it can even be the initial presenting symptom of underlying chronic GI disease. The definition of anaemia is age and gender-dependent and it can be classified based on pathophysiology, red cell morphology, and clinical presentation. Although nutritional deficiencies, including GI malabsorption of nutrients and GI bleeding, play a major role, other pathophysiologic mechanisms seen in chronic GI diseases, whether inflammatory (e.g., inflammatory bowel disease) or not (e.g., coeliac disease and dysmotility), are causing anaemia. Drugs, such as proton pump inhibitors, mesalamine, methotrexate and sulfasalazine, are also a potential cause of anaemia. Not uncommonly, due to a combination of factors, such as iron deficiency and a chronic inflammatory state, the underlying pathophysiology may be difficult to decipher and a broad diagnostic work-up is required. The goal of treatment is correction of anaemia by supplementation of iron and vitamins. The first therapeutic step is to treat the underlying cause of anaemia including bleeding control, restoration of intestinal integrity and reduction of inflammatory burden. The route of iron and vitamin supplementation is guided by the severity of anaemia.

Otorhinolaryngological manifestations of autoinflammatory diseases. Systematic review

OBJECTIVES

To detail the main otorhinolaryngological manifestations of autoinflammatory diseases, aiming to contribute to early diagnosis and treatment.

DATA SOURCES

Searches were conducted in PubMed, LILACS, Cochrane Library.

REVIEW METHODS

A systematic review of the medical literature on autoinflammatory diseases was conducted to identify characteristic head and neck manifestations, using PRISMA criteria. Observational studies or systematic reviews with a minimum of 10 cases per disease were included. Qualitative synthesis and a risk assessment were carried out.

RESULTS

Our review included 29 articles that met the inclusion criteria, with 10 to 486 patients per study. Autoinflammatory diseases with characteristic head and neck manifestations included VEXAS syndrome (auricular, nasal, or laryngotracheal chondritis), NPRL3-AID (hearing loss), NPRL12-AID (cervical lymphadenopathies, hearing loss and oral ulcers), HIDSs syndrome (painful cervical nodes and oral ulcers), haploinsufficiency A20 (oral ulcers), TRAPS (pharyngitis, aphthous stomatitis, periorbital edema, and cervical lymphadenopathies), Behcet's disease (oral and pharyngeal ulcers), PFAPA syndrome (recurrent tonsillitis, oral ulcers, and painful cervical adenopathies), Kawasaki disease (cervical nodes, pharyngitis and changes in oral mucosa) and undefined periodic fever (pharyngitis, oral ulcers, and painful cervical nodes).

CONCLUSION

Given their complex diagnosis and unique head and neck manifestations, otolaryngologists must be well-versed in these diseases for early detection and treatment. ENT specialists should consider the possibility of an autoinflammatory disease when encountering symptoms such as auricular, nasal, or laryngeal chondritis, recurrent oral ulcers, painful inflammatory lymphadenopathies, periorbital edema, recurrent pharyngitis, or hearing loss within the context of compatible systemic conditions.

Emergency Management of Intoxication-Type Inherited Metabolic Disorders

In many intoxication-type inherited metabolic disorders, the accumulation of the toxic chemical can cause acute life-threatening emergencies. Sometimes this is the inevitable consequence of a severe metabolic defect, but it is often triggered by catabolism. In this article, we consider the acute management when these conditions cause encephalopathy, seizures, stroke-like episodes, thromboses, liver failure, cardiac failure, arrhythmias and rhabdomyolysis. Treatment is available for most intoxication-type disorders, though it is seldom entirely satisfactory. The emergency management involves general measures for the immediate problem (such as liver failure, thrombosis or an arrhythmia) and specific treatment for the metabolic disorder. The latter usually aims to reduce the accumulation of the toxic small molecule. Often this involves preventing or reversing catabolism. Sometimes the formation of the toxic chemical can be reduced by removing dietary precursors, by diverting precursors to alternative pathways, or by inhibiting an earlier step in the affected pathway. Another strategy is to remove the toxic chemical by binding it to a drug or by extracorporeal blood purification. Occasionally, the block in the pathway can be ameliorated and some disorders, specific treatment may prevent the consequences of the accumulating chemical. Despite all these treatment strategies, outcomes are often disappointing, particularly if an intoxication disorder first presents as an emergency. Newborn screening has greatly improved the prognosis for some disorders. For others, outcomes can only be improved by earlier recognition and treatment.

The Impact of Positive Childhood Experiences: A Systematic Review Focused on Children and Adolescents

Childhood and adolescence are crucial stages of life, characterized by significant changes that profoundly influence overall development. While positive childhood experiences (PCEs) can help mitigate the effects of adverse events during these formative years, they have not been as thoroughly researched. Then, this systematic review aims to address this gap by organizing the existing literature on PCEs and examining their impact on both positive and negative outcomes in children and adolescents. A search through databases such as B-On, PsycINFO, PubMed, SCOPUS, and Scielo, as well as supplementary searches, identified 30 studies that met the inclusion criteria. The results indicate that most studies were published in the last 4 years, primarily in the USA, and focused on community populations with mixed samples. In addition, the results reveal that among children and adolescents, higher levels of PCEs were associated with better mental health outcomes (e.g., reduced depressive symptoms, anxiety, self-harm, substance use, and suicidal ideation), improved psychosocial outcomes (e.g., enhanced adult functioning and future orientation), better academic achievement (e.g., reduced absenteeism and fewer academic difficulties), and some improvements in physical health (e.g., reduced chronic pain). However, the relationship between PCEs and behavioral outcomes showed mixed results. Strengthening efforts to promote PCEs and resources that support child and adolescent resilience is crucial. Further research involving diverse samples is needed to gain a deeper understanding of the role of PCEs.

Comparing safety and efficacy of Bevacizumab, Ranibizumab and Ranibizumab biosimilar in Retinopathy of prematurity

PURPOSE

To compare the safety and efficacy of Bevacizumab, Ranibizumab and Ranibizumab biosimilar in treatment of Retinopathy of prematurity (ROP) METHODS: Retrospective study that included newborns with type 1 ROP who received intravitreal Bevacizumab (Avastin) or Ranibizumab (Accentrix) or Ranibizumab biosimilar (Razumab). Babies were followed up as per protocol and retreatment with laser or repeat anti vascular endothelial growth factor (VEGF) was done in case of reactivation and surgery in case of progression to traction. Outcome measures include need for retreatment, proportion of eyes achieving vascularization up to ora and adverse events RESULTS: 148 eyes of 75 babies, received intravitreal injection of which 139 eyes of 70 babies were included in our analysis. 68 eyes received bevacizumab (IVB), 31 eyes received Accentrix (IVA), 40 eyes received Razumab(IVR). The rate of retreatment was 17.6%, 32.2% and 25% for IVB, IVA and IVR respectively (p = 0.1). IVB group showed a significantly delayed reactivation (p < 0.001), while Ranibizumab and its biosimilar Razumab were comparable (p = 0.17). Vascularization up to ora was observed in 60%, 61% and 50% eyes (p = 0.76) at a median of 27, 28 and 24 weeks post-treatment (p = 0.09) in IVB, IVA and IVR groups respectively. No eyes developed intraocular inflammation or cataract.

CONCLUSION

All three drugs were similar in their efficacy and safety profile with bevacizumab showing a later reactivation.

Caffeine use in preterm neonates: national insights into Turkish NICU practices

Objective

Caffeine is a proven medication used for the prevention and treatment of apnea in premature infants, offering both short- and long-term benefits. International guidelines provide a range of recommendations regarding the preterm population eligible for caffeine prophylaxis, including the timing, dosage, and duration of treatment. Our national guidelines, published prior to the most recent updates of the international guidelines, recommend the use of caffeine citrate starting from the first day after delivery for preterm infants with a gestational age of <28 weeks. For infants up to 32 weeks, if positive pressure ventilation is required, the decision should be made on an individual basis. This study aims to describe the variability in caffeine usage across neonatal intensive care units in our country.

Methods

An online survey was sent to neonatologist who are members of the Turkish Neonatology Society to describe the variability in caffeine usage in neonatal intensive care units in our country.

Results

We collected responses from 74 units. Prophylactic caffeine usage was observed as; GA ≤276/7: 98.6%, GA 280/7-286/7: 89.0%, GA 290/7-296/7: 75.3%, GA 300/7-316/7: 53.4%. 62.2% of units reported administering loading dose within the first two hours. The initial maintenance dose was 5 mg/kg in 64.8% of units, 10 mg/kg in 32.4% of units, and intermediate dose in 5.3% of units. 47.3% of units reported no routine dose adjustment. The postmenstrual age that caffeine treatment was stopped was found to be 34 (min-max; 32-36) weeks for infants without apnea and respiratory support, 36 (min-max; 34-52) weeks for infants without apnea but any respiratory support. The time to discharge after treatment cessation was found as; 1-4 days: 37.8%, 5-7 days: 68.9%. Among the 56 units with multiple responsible physicians, 32.1% reported intra-unit variations.

Conclusion

The significant differences in caffeine usage characteristics between and within units highlight the need for clear recommendations provided by standardized guidelines.

Glans ischemia in a 7-month-old boy who underwent correction of megaprepuce: case report and review of the literature

Acute glans ischemia is a severe complication that can occur after penile surgery, such as circumcision, hypospadias repair, or disassembly of the corpora in epispadias. This rare condition is described in the current literature, especially after circumcision, although it is the less invasive procedure among those previously mentioned. We present a case of 7-month-old boy who developed glans ischemia after correction of megaprepuce. The condition was treated by intravenous unfractionated heparin. In our case, the complication of ischemia was complete dehiscence of the suture line at the coronal sulcus. Glans penis recovered completely and secondary intention wound healing occurred within 4 weeks. We reviewed the literature over the past 43 years (1981-2023) to describe the current options of surveillance, treatment, and outcome of glans ischemia after penile surgery in boys.

Prevalence, Socio-Demographic Characteristics, and Co-Morbidities of Autism Spectrum Disorder in US Children: Insights from the 2020-2021 National Survey of Children's Health

BACKGROUND

The primary goal of our study is to assess the national US prevalence of autism spectrum disorder (ASD), along with its socio-demographic characteristics, severity, and co-occurring medical and psychiatric disorders, using data from the 2020-2021 National Survey of Children's Health (NSCH).

METHODS

We analyzed 2020-2021 NSCH data to estimate the prevalence of ever-diagnosed and current ASD among 79,182 children and adolescents (3-17 years). Univariate and multivariate regression models were used to examine associations between medical and psychiatric co-morbidities, socio-demographic factors, and ASD severity.

RESULTS

Adolescents (11-17 years) and males were more likely to have ASD, with males comprising 78.7% of the ASD group. The mean age of the sample was 10.1 ± 4.6 years, and 3.2% had an ASD diagnosis. Children from lower-income households and those with caregivers who completed only a high school education were more likely to have ASD. Nearly 96.4% of children with ASD had at least one co-morbid condition. The most common neuropsychiatric co-morbidities were developmental delay (64%), behavioral and conduct problems (57.8%), and anxiety disorder (45.7%), while the most common medical conditions were allergies (32.4%), genetic disorders (26.2%), and asthma (12.6%). Gender disparities in ASD presentation were evident that females with ASD were more likely to experience vision problems, cerebral palsy, epilepsy, depression, and intellectual disability but had lower odds of ADHD and anxiety problems. Greater ASD severity was linked to higher odds of intellectual disability (OR: 5.8, p < 0.001), developmental delay (OR: 5.0, p < 0.001), epilepsy, Down syndrome (OR: 3.4, p < 0.001), vision problems (OR: 2.5, p < 0.001), and genetic disorders (OR: 2.3, p < 0.001).

CONCLUSIONS

This study provides updated prevalence estimates of ASD and highlights the high burden of co-morbidities, emphasizing the need for comprehensive, multidisciplinary approaches in ASD management. Additionally, our findings emphasize gender differences in ASD presentation, which should be considered in future research and clinical practice to ensure more tailored diagnostic and intervention strategies.

The Role of Acute Phase Reactants, Including α1-Acid Glycoprotein, in Predicting Onset and Severity of Retinopathy of Prematurity

Background: Retinopathy of prematurity (ROP) is a serious disease causing blindness in childhood. Gestational age (GA) and birth weight are major factors associated with the development and progression of ROP, but postnatal systemic inflammation is also an important well-known risk factor. Methods: This study retrospectively analyzed the relationship between systemic inflammation and ROP severity using the corrected GA (CGA), which reflects the intrinsic immaturity of the infant, rather than days of life. Three acute phase reactants (APRs) were analyzed using discriminant probability and compared with conventional ROP prediction models: C-reactive protein, α1AG, and haptoglobin. Results: Alpha 1AG was the best predictor of ROP onset and progression, and could be predicted with blood samples up to 30 weeks (30 W) CGA (p = 0.006). Incorporation of APR into the conventional GA + body weight (BW), ROP score, and Children's Hospital of Philadelphia (CHOP) predictive models improved the decision to treat (4-5% increase in discrimination probability) and helped determine whether treatment of ROP was necessary by CGA 30 W. Conclusions: Therefore, simply adding α1AG protein to the assessment is useful for predicting the need to treat ROP.

Sleep-Disordered Breathing and Central Respiratory Control in Children: A Comprehensive Review

Background/Objectives: Sleep-disordered breathing (SDB) is a primary concern in children's health. Research suggests that repeated oxygen drops during sleep-common in SDB-may harm the brainstem's breathing control centres. This damage likely occurs through oxidative stress, inflammation, and cell death, which weaken the brain's ability to regulate breathing. Over time, these effects could lead to functional changes (e.g., disrupted chemical signalling) and physical damage in critical brain regions, creating a cycle of unstable breathing. However, much of this evidence comes from animal or lab studies, leaving gaps in our understanding of how these mechanisms work in humans. This review synthesises existing research on how breathing disruptions during sleep-particularly episodes of intermittent hypoxia-affect the brain's ability to control respiration in children and adolescents. Methods: We analysed studies from medical databases PubMed, Scopus, and Web of Science, focusing on how SDB (obstructive or central sleep apnoea) impacts the brain's respiratory centres in young populations. Animal studies and research involving children on mechanical ventilation were excluded to focus on natural sleep patterns. Results: After removing duplicates, 54 studies remained. Additionally, 43 record were excluded for various reasons. Ultimately, 11 articles were selected for the final analysis, including three that focused on genetic conditions, such as Down syndrome, Prader-Willi syndrome, and Pierre Robin sequence. The findings suggest that repeated oxygen dips during sleep may harm the brainstem's respiratory control areas, especially during critical developmental stages. This damage could lead to long-term issues, such as unstable breathing, cardiovascular strain, or neurological problems. However, most studies only captured the immediate effects of low oxygen, leaving uncertainty about permanent harm due to a lack of long-term follow-up. Conclusions: Repeated oxygen deprivation during sleep appears to damage the brainstem and disrupt breathing regulation. However, small study sizes and short observation periods limit the strength of these conclusions. Future research should use advanced imaging tools to clarify long-term risks, develop effective treatments, and track children over extended periods. More significantly, longer-term studies are urgently needed to guide clinical care for vulnerable populations.

Mediating role of organized sports participation on the relationship between body fatness and arterial wall thickness among adolescents: ABCD Growth Study

BACKGROUND

Participation in sports is the main manifestation/subdomain of physical exercise in adolescents and affects cardiovascular health in different ways.

OBJECTIVES

To analyze the relationship between body fatness and arterial wall thickness as well as the mediating role of sports participation in this relationship among adolescents.

METHODS

This cross-sectional study is linked to the ABCD-Growth Study conducted in Presidente Prudente, Brazil. The study sample included 402 adolescents (275 boys and 127 girls) aged 11-17 years recruited from schools (non-sport group) and sports clubs (sports group). Sex-stratified multivariate model was created using structural equation modelling (SEM) with carotid (CIMT) and femoral arterial wall thickness (FIMT) as dependent variables were assessed by an ultrasound device. Body fatness percentage (BF) as the independent variable and was assessed by whole-body dual-energy X-ray absorptiometry, and sports participation as a moderator was assessed by face-to-face interviews. The maturity offset and dyslipidemia were treated as confounders in the mediation models.

RESULTS

In girls, body fatness was positively associated with FIMT (r = 0.210 [95%CI: 0.035; 0.372]) but not with CIMT (r= -0.148 [95%CI: -0.314; 0.027]), whereas sports participation was not associated with vascular structure. In boys, body fatness was inversely related to CIMT (r= -0.285 [95%CI: -0.390; -0.172]) and positively to FIMT (r = 0.129 [95%CI: 0.011; 0.244]), whereas sports participation was inversely related to FIMT (r= -0.142 [95%CI: -0.256; -0.024]). Among boys, sports participation mediated 7.4% of the relationship between body fatness and FIMT, and the association between body fatness and FIMT remained significant (r = 0.168 [95%CI: 0.037; 0.299]).

CONCLUSIONS

Sports participation mediates the relationship between BF and arterial thickness in adolescent boys.

G-ROP versus WINROP for retinopathy of prematurity screening: a Calgary perspective

OBJECTIVE

Retinopathy of prematurity (ROP) remains one of the leading causes of childhood blindness. The current screening criteria in Canada have extremely high sensitivity but low specificity, leading to unnecessary examinations of neonates. Moreover, a screening algorithm that reduces the burden of screening is urgently needed owing to the increase in neonatal survival after extreme premature delivery, combined with the limited number of physicians qualified to screen for ROP. This retrospective study aimed to validate and compare the accuracy of the postnatal growth and ROP (G-ROP) and Weight, Insulin-like growth factor-1, Neonatal Retinopathy of Prematurity (WINROP) models for identifying neonates at risk for developing treatment-requiring ROP in a Canadian cohort.

DESIGN

Single-center retrospective cohort study conducted in Calgary, Alberta, Canada. Data from preterm infants born between 23- and 31-week gestational age or birth weight less than or equal to 1 250 grams were analyzed. A total of 1 001 infants were included in the study. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value for WINROP, and G-ROP algorithms were assessed in identifying neonates at risk of treatment-requiring ROP.

RESULTS

The WINROP algorithm yielded 95.7% sensitivity in identifying infants requiring ROP treatment compared to 100% sensitivity with the G-ROP model. Specificity for treatment-requiring ROP for WINROP was 41.7% and G-ROP was 30.4%.

CONCLUSIONS

The G-ROP model was found to be more appropriate in our cohort, lending itself seamlessly to clinical care, while providing 100% sensitivity and greater specificity compared to current screening guidelines in our cohort.

Impact of dexmedetomidine on agitation and inflammatory response during recovery from anesthesia in young children following cochlear implantation surgery

OBJECTIVE

To evaluate the impact of dexmedetomidine (Dex) on agitation and inflammatory response during recovery from anesthesia in young children following cochlear implantation surgery.

METHODS

We randomly divided 80 children who underwent unilateral cochlear implantation into two equal groups. Group D received an intravenous infusion of Dex after induction of anesthesia, while those in group C received an equal volume of saline infusion. The mean arterial pressure (MAP) and heart rate (HR) of children in the two groups were recorded at four different time intervals: before induction of anesthesia (T0); 30 min after intravenous infusion of Dex (T1); upon admission to the post-anesthesia care unit (PACU) (T2); and at the time of being transferred out of the PACU (T3). At T3, we also recorded general information.

RESULTS

The MAP and HR in group D showed more consistent trends during the anesthesia recovery period when compared to those in group C. Children in group D had a significantly lower crying, requires increased O2 administration, increased vital signs, expression and sleepless score (CRIES score), pediatric anesthesia emergence delirium (PAED) score, and incidence of agitation than in group C (P < 0.01). The rate of supplementary pain relief for the children was lower in group D than in group C (P < 0.01). At T3, serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were lower in children in group D than in group C (P < 0.01). Compared to T0, the levels of serum IL-6 and TNF-α were higher in both groups at T3 (P < 0.01).

CONCLUSION

We found that the use of Dex helped reduce the occurrence and severity of agitation during anesthesia recovery in children after cochlear implantation surgery and improved postoperative inflammatory reactions.

CLINICAL REGISTRATION NUMBER

Registration website: https://www.chictr.org.cn/searchproj.html .

REGISTRATION NUMBER

ChiCTR2400080937.

Kidney involvement during the course of febrile urinary tract infection

Febrile urinary tract infections (fUTIs) are among the most common severe infections in the pediatric population, posing a significant risk to kidney health. The pathophysiology of fUTIs involves the direct bacterial invasion of kidney tissue, which triggers an inflammatory response. While this response is effective in eradicating the infection, it can also cause substantial kidney damage at multiple levels. In this review, we explore the various forms of kidney involvement in fUTIs, along with their clinical, radiological, and biochemical presentations. We also discuss the implications of these events for the long-term prognosis of kidney function. Understanding these manifestations can assist clinicians in making prompt diagnoses and initiating appropriate treatment to minimize complications such as sepsis, kidney scarring, and long-term kidney damage.

Chronic obstructive Pulmonary Disease (COPD) in non-smoking Sri Lankan adults; a cross-sectional study

OBJECTIVE

To estimate the prevalence of Chronic Obstructive Pulmonary Disease (COPD) among non-smoking Sri Lanka adults as part of a larger study which assessed the burden of obstructive lung disease (BOLD) in Sri Lanka.

RESULTS

The prevalence of COPD among non-smokers was 5.3%, with mild to moderate disease. Among spirometry-diagnosed COPD patients, a higher proportion was females and above age 40. Use of biomass (Odds Ratio (OR) = 1.339, 95% Confidence Interval (CI) 1.070-1.821), exposure to passive smoking (OR = 2.376, 95% CI 1.557-3.397) and female sex (OR = 1.353, 95% CI 0.992-1.648) significantly increased the odds of developing COPD and/or related symptoms. Having a chimney, reduced the risk of COPD and/or related symptoms by 29% when cooking with biomass/kerosene.

Validation of child drawing hospital (CD: H) scale and the role of drawing in the evaluation of Dental anxiety

BACKGROUND

Child Drawing: Hospital (CD: H) was developed as a tool to measure the emotional state of hospitalized school-age children. This scale consists of sections A, B and C, which allow understanding of anxiety through children's drawings. The CD: H Scale, which is widely used in medicine, has only been validated in two different cultures. The adaptation and validation of the scale in the field of dentistry has recently started to take place in the literature. In our study, we aimed to conduct a Turkish validation study of the Child Drawing: Hospital (CD: H) Scale and to evaluate dental anxiety and pain experienced during treatment through drawing.

METHODS

Pediatric patients between the ages of 5-12 who attended the Pediatric Dentistry Department between 2018 and 2020 were included in the study. Following the translation of the CD: H Scale into Turkish and linguistic-cultural validation, the behaviors of pediatric patients during treatment were evaluated with the Frankl Behavior Rating Scale, the pain they experienced during treatment with the Wong- Baker Face Rating Scale, and their anxiety levels were evaluated with the pictures drawn by the patients at the end of the treatment. The data were analyzed with IBM SPSS v23, and the significance level was taken as p < 0.05.

RESULTS

Within the scope of the scale's reliability-validity study, the Intra-Class Correlation Coefficient (ICC) was evaluated with test-retest consistency. For section A, B,C and total score reliability was found to be positive and strong level correlation.

CONCLUSIONS

The Turkish version of the CD: H Scale is a reliable and valid scale that can be used to evaluate the dental anxiety of Turkish pediatric patients.

TRIAL REGISTRATION

ClinicalTrials (NCT05236101/11.02.2022), 'retrospectively registered'.

Antibiotic treatment of acute and recurrent otitis media in children: an Italian intersociety Consensus

Acute Otitis Media (AOM) typically affects previously healthy children and can be recurrent. This inter-society consensus aims to provide evidence-based recommendations for the antibiotic therapy of mild, severe and recurrent otitis media in previously healthy children in Italy.A systematic literature review was conducted to identify the most recent/relevant evidence. The Embase, Scopus, PubMed, and Cochrane databases were used with the terms "children," "acute otitis media", "recurrent otitis media", and "antibiotics," from 2012 to April 2024, with no language restrictions. The review focused on studies conducted in high-income countries involving antibiotic therapy in children over 3 months of age diagnosed with AOM or Recurrent AOM (RAOM). The GRADE ADOLOPMENT was used to assess the possibility of adopting or adapting recommendations from two evidence-based guidelines: 'NICE guideline Otitis media (acute): antimicrobial prescribing', updated to 2022 and SIP Intersocietal GL 2019 "Management of acute otitis media in paediatric age: diagnosis, therapy and prevention" The certainty of the evidence was assessed using the GRADE approach. Final recommendations were formulated through a Delphi consensus process with an expert panel.All major randomised trials and international guidelines promote the appropriate use of antibiotics and advocate a therapy with narrow-spectrum molecules (amoxicillin). The amoxicillin-clavulanic acid is only envisaged when there is a risk of infection by β-lactamase-producing bacteria. In healthy children, amoxicillin should be initiated as a first-line treatment only after a 48-72-h period of appropriate "watchful waiting", during which symptoms are treated while monitoring the patient clinically to see if symptoms resolve. Amoxicillin-clavulanate or second-generation cephalosporins should be reserved for non-immunized children, those with immune deficiencies or those with underlying conditions. In these cases, the use of a clavulanic acid-protected amoxicillin is preferred even though there is no specific scientific evidence to support this choice.The recommended amoxicillin dosage is 90 mg/kg/day, divided into three doses, though two doses may be considered to improve compliance. A five-day duration of therapy is advised.In conclusion the diagnosis of AOM/RAOM relies primarily on clinical assessment, which often introduces uncertainty in distinguishing between viral and bacterial infections whereby there remains significant potential to improve antibiotic utilisation. Future studies could play a key role in enhancing the management of AOM/RAOM in children, ensuring that antibiotic treatments are appropriate and effective.

Array of micro-epidermal actuators for noninvasive pediatric flexible conductive hearing aids

Corrective surgeries and implantable aids are highly invasive for pediatric patients with conductive hearing loss. Flexible hearing aids are a noninvasive solution to address pediatric hearing loss. These aids generate vibrations on epidermal layer of skin behind the ear using micro-epidermal actuators to bypass the auditory canal. However, the major challenge is to generate a strong level of vibrations that can reach cochlea. Here, we designed, fabricated, and characterized arrays of micro-epidermal actuators to increase the vibration level from the flexible aids, improve frequency response and control the directionality of vibrations. Our human subject study showed that the flexible hearing aid with an array of actuators improved the hearing threshold by an average of 13.8 dB at 500 Hz, compared to a device with a single actuator. Also, the flexible aid with two actuators enhanced the hearing threshold by 30.5 dB at 1 kHz and 20.5 dB across 0.25-8 kHz versus unaided hearing.

Histopathologic Concerns and Diagnostic Challenges in Hirschsprung's Disease: An Eastern European Single-Center Observational Study

BACKGROUND

We proposed a comprehensive clinicopathological study involving the characterization of the study cohort and a comparative analysis of biopsies and surgical specimens from patients with Hirschsprung's disease. The study was complemented by the diagnostic value of calretinin, CD56, and S-100 immunohistochemistry.

METHODS

Descriptive statistical analysis of diagnostic variables in the group of biopsy specimens (n = 32) and bowel resection specimens (n = 16) was performed. The pattern of calretinin and CD56 expression in Meissner's plexus elements was analyzed and the maximum thicknesses of the nerve fibers were measured using morphometry with S100-immunostained sections.

CONCLUSIONS

Coupled calretinin-CD56 immunohistochemistry is useful in diagnosing ganglion cell paucity biopsies or specimens with incomplete submucosa. In cases where there are no ganglion cells but there are calretinin-positive nerve fibrils in the lamina propria without nerve trunk (NT) hypertrophy, re-biopsy is the best solution. The significant differences in NT size between biopsies and surgical specimens highlight the importance of assessing NT diameter in all tissue samples examined.