Pre-procedural Topical Antisepsis in the Neonate: A Systematic Review Evaluating Risk Factors for Skin Injury

BACKGROUND

Pre-procedural antisepsis is a critical component of hospital-acquired infection prevention in the neonatal intensive care unit (NICU). However, broadly utilized topical antiseptic agents pose an elevated risk of disruption to neonatal skin integrity, and evidence-based guidelines are lacking. This systematic review of the literature sought to assess and characterize the predisposing risk factors for and types of neonatal skin injury from topical antiseptic agents.

METHODS

A systematic search of Medline Ovid, Embase, Web of Science, CINAHL, and Cochrane Library was conducted, including academic literature providing data on neonatal skin injuries related to topical antisepsis in the NICU.

RESULTS

A total of 19 articles (99 patients) met the inclusion criteria. Of the available data, most reported skin injuries were described in extremely preterm (98.1%) and very low birth weight (98.4%) infants. The majority of reported adverse cutaneous events were attributed to chlorhexidine preparations (74.8%), followed by octenidine (18.2%), povidone-iodine (6.1%), and isopropyl alcohol (2.0%). Erythema (40.1%), skin breakdown (23.4%), and chemical burns (17.5%) were the skin reactions reported most frequently, followed by skin irritation (8.3%), and skin necrosis (2.8%).

CONCLUSIONS

Our findings indicate that both extremely preterm and very low birth weight infants are particularly susceptible to skin toxicities from pre-procedural antiseptic preparations. These data underscore the need for future research to support the development of guidelines which minimize iatrogenic cutaneous injuries in the neonatal population, specifically for the care of infants under 2 months of age, for whom current recommendations are lacking due to a paucity of data.

Emotional and Behavioural Problems of HIV-infected Children: Findings from a Southeastern Nigeria Tertiary Healthcare Facility

Background

In children, HIV infection presents with grave consequences, including a predisposition to emotional and behavioural problems (EBP). These are mental health problems affecting thoughts, emotions, behaviours and relationships, and may be categorised into emotional problems (EP) and behavioural problems (BP). Studies have shown a high burden of EBP in children; however, knowledge gaps still exist regarding the burden of EBP on HIV-infected children. Our study seeks to address these gaps by determining the prevalence and type of EBP among HIV-infected children.

Methodology

This cross-sectional and comparative study enrolled 386 participants (193 subjects and 193 controls). The subjects were HIV-infected children aged 2-15 years attending the Paediatric HIV Clinic of Federal Medical Centre, Umuahia. The controls were age and sex-matched HIV-negative children attending primary or secondary schools in Umuahia. Sociodemographic characteristics were assessed, and EBP was determined using the strengths and difficulties questionnaire.

Results

Sixty-one subjects (31.6%) had EBP compared to 15 controls (7.8%) and this difference was significant (p<0.001). The subjects were three times more likely to have EBP than the controls (aOR=3.03; CI=1.17-7.82). The EBP type showed that, while there was no significant difference in the multivariate analysis of the behavioural problems, emotional problems were significantly higher in the subjects than in the controls (p = 0.001). The subjects were six times more likely to have emotional problems than the controls (aOR=6.26; CI=2.80-13.97).

Conclusion

There is a high burden of EBP among HIV-infected children in Umuahia with emotional problems as the common type.

Effect of Cashew Nut Consumption on Biomarkers of Copper and Zinc Status in Adolescents with Obesity: A Randomized Controlled Trial

BACKGROUND

Children and adolescents with obesity have altered serum copper (Cu) and zinc (Zn) levels, which are associated with oxidative stress, inflammation, and health outcomes. The inclusion of cashew nuts in an adequate diet may provide health benefits and help improve the mineral status of individuals with obesity.

OBJECTIVE

To evaluate the effects of cashew nut consumption on biomarkers of Cu and Zn status in adolescents with obesity.

METHODS

This was a randomized controlled trial conducted in adolescents. The participants were divided into a control group (CON) and a cashew nut group (CASN). The CASN group received 30 g/day of roasted cashew nuts for 12 weeks, and both groups received nutritional counseling during the study. Anthropometric, dietary, and biochemical parameters (Zn, Cu, and superoxide dismutase (SOD)) were assessed at the baseline and at the end of the study. Association tests, within-group and between-group mean comparisons, and analyses of variation between study periods (Δ T12-T0) were performed.

RESULTS

The sample consisted of 81 adolescents who completed the intervention period, resulting in 54 in the CASN group and 27 in the CON group. After the intervention, the CASN group presented a decrease in plasma Cu (p = 0.004) and an increase in SOD (p = 0.030). Both groups showed an increase in plasma Zn (p < 0.050) and a decrease in the Cu/Zn ratio (p < 0.001). CASN had a negative effect on the Cu concentration, which was significantly different from that of CON (p = 0.004).

CONCLUSIONS

The consumption of cashew nuts for 12 weeks reduced plasma Cu levels in adolescents with obesity. Nutritional counseling may have contributed to the increase in plasma Zn levels in all the study participants.

Preconceptional and Periconceptional Folic Acid Supplementation in the Visegrad Group Countries for the Prevention of Neural Tube Defects

Neural tube defects (NTDs) are malformations of the central nervous system that represent the second most common cause of congenital morbidity and mortality, following cardiovascular abnormalities. Maternal nutrition, particularly folic acid, a B vitamin, is crucial in the etiology of NTDs. FA plays a key role in DNA methylation, synthesis, and repair, acting as a cofactor in one-carbon transfer reactions essential for neural tube development. Randomized trials have shown that FA supplementation during preconceptional and periconceptional periods reduces the incidence of NTDs by nearly 80%. Consequently, it is recommended that all women of reproductive age take 400 µg of FA daily. Many countries have introduced FA fortification of staple foods to prevent NTDs, addressing the high rate of unplanned pregnancies. These policies have increased FA intake and decreased NTD incidence. Although the precise mechanisms by which FA protects against NTDs remain unclear, compelling evidence supports its efficacy in preventing most NTDs, leading to national recommendations for FA supplementation in women. This review focuses on preconceptional and periconceptional FA supplementation in the female population of the Visegrad Group countries (Slovakia, Czech Republic, Poland, and Hungary). Our findings emphasize the need for a comprehensive approach to NTDs, including FA supplementation programs, tailored counseling, and effective national-level policies.

Effects of diet and ovariectomy on Toxoplasma gondii brain infection: functional alterations and neuronal loss in rats

Epidemiological evidence associates Toxoplasma gondii latent infection with the development of neuropsychiatric disorders, and various immunological and environmental factors play key pathophysiological roles through host immune response alterations. We investigated the cognitive and motor alterations occurring in the terminal stage of T. gondii infection in rats, and whether a low-protein diet, a high-fat diet or ovariectomy may accelerate their development, given the role of malnutrition and menopause on immunity and resistance to infection. In two sets of experiments, 2-month-old (157.5 ± 4.3 g, n = 42) male (n = 18) and female (n = 24) Wistar rats were infected with T. gondii (ATCC 40050). Open-field and elevated plus maze tests were performed in the terminal stage of infection first and then in the early stage in low-protein diet-fed, high-fat diet-fed and ovariectomized infected rats. Late-stage (90 days) infected and early-stage (17 days) low-protein diet-fed groups showed significant decreases in body weight (42.42%↓, P = 0.016 and 57.14%↓, P < 0.001 versus non-infected, respectively), increases in body temperature (P = 0.001 and P < 0.001, respectively), decreases in blood glucose levels (P = 0.006 and P = 0.020, respectively), signs of cognitive and motor impairment and lower neuron counts. The alterations observed in high-fat diet-fed and ovariectomized infected animals were milder. Low-protein diet feeding to T. gondii-infected rats accelerated the occurrence of the infection terminal stage. Thus, a diet low in proteins could transform a slow early-stage T. gondii infection into an active neurotoxoplasmosis with neuropsychiatric manifestations and possible neurodegeneration in rats.

Exploring Gut Microbiota Imbalance in Irritable Bowel Syndrome: Potential Therapeutic Effects of Probiotics and Their Metabolites

Irritable bowel syndrome is a common functional gastrointestinal disorder characterized by recurrent abdominal discomfort, bloating, cramping, flatulence, and changes in bowel movements. The pathophysiology of IBS involves a complex interaction between motor, sensory, microbiological, immunological, and psychological factors. Diversity, stability, and metabolic activity of the gut microbiota are frequently altered in IBS, thus leading to a situation of gut dysbiosis. Therefore, the use of probiotics and probiotic-derived metabolites may be helpful in balancing the gut microbiota and alleviating irritable bowel syndrome symptoms. This review aimed to report and consolidate recent progress in understanding the role of gut dysbiosis in the pathophysiology of IBS, as well as the current studies that have focused on the use of probiotics and their metabolites, providing a foundation for their potential beneficial effects as a complementary and alternative therapeutic strategy for this condition due to the current absence of effective and safe treatments.

Prevalence and risk factors associated with birth asphyxia among neonates delivered in China: a systematic review and meta-analysis

BACKGROUND

Birth asphyxia is a critical condition caused by an insufficient oxygen supply during delivery, and it poses a major threat to the health of newborns. The present meta-analysis aimed to estimate the prevalence of birth asphyxia among neonates and identify its risk factors in China.

METHODS

PubMed, EMBASE, Scopus, Web of Science, the China Academic Journals (CNKI), the Chinese Biomedical Literature (CBM), the China Science and Technology Journal Database (VIP), and the WanFang database were searched for related publications. Two researchers independently selected the literature, extracted the relevant data, and assessed its methodological quality. The meta-analysis applied a random-effects model with Stata 17.0 software to calculate the pooled prevalence of birth asphyxia among neonates delivered in China and to merge the odds ratios (ORs) of risk factors. Subgroup analysis was performed on the included studies. Publication bias was assessed by funnel plots and Egger's test.

RESULTS

Eighty studies were eligible for inclusion. The overall prevalence of birth asphyxia in newborns was 4.8% (95% CI, 4.5%-5.2%). In the subgroup analyses, the northern area presented the highest prevalence (5.1%; 95% CI, 4.1%-6.3%), followed by the southern area (4.1%; 95% CI, 3.3%-5.1%). The rural setting presented the highest prevalence (6%; 95% CI, 4.6%-7.4%), followed by the urban (4.2%; 95% CI, 4.6%-7.4%) and mixed (5.8%; 95% CI, 5.3%-6.3%) settings. The Apgar score demonstrated the highest prevalence (4.6%; 95% CI, 3.8%-5.4%), followed by the Apgar score with the umbilical artery blood pH (3.7%; 95% CI, 2.2%-5.7%). A significant difference in prevalence was found between studies with sample sizes greater than 5,000 (2.2%; 95% CI, 1.6%-3%) and those with 5,000 or fewer participants (6.2%; 95% CI, 5.5%-7.1%). Furthermore, there was a significant decrease in the incidence of birth asphyxia from 1995-2016 (4.9%; 95% CI, 4.2%-5.9%) to 2017-2023 (3.7%; 95% CI, 2.6%-5%). Placental abruption (OR = 5; 95% CI, 3.08-8.13), placenta previa (OR = 2.57; 95% CI, 1.84-3.58), advanced maternal age (OR = 3.94; 95% CI, 1.46-10.62), primigravida (OR = 5.33; 95% CI, 0.41-68.71), premature birth (OR = 3.36; 95% CI, 2.61-4.32), intrauterine distress (OR = 4.48; 95% CI, 3.47-5.80), stained amniotic fluid (OR = 3.28; 95% CI, 2.25-4.79), macrosomia (OR = 6.30; 95% CI, 0.61-65.22), foetal malformation (OR = 7.44; 95% CI, 1.46-38.02), breech birth (OR = 2.42; 95% CI, 1.24-4.73), caesarean section (OR = 1.72; 95% CI, 0.91-3.24), assisted delivery (OR = 13.62; 95% CI, 5.50-33.73), prolonged second stage of labour (OR = 1.43; 95% CI, 0.68-3.01), and malpresentation (OR = 4.20; 95% CI, 2.21-7.99) were major risk factors.

CONCLUSIONS

The prevalence of birth asphyxia among newborns in China is relatively high. In addition, 14 risk factors are related to neonatal birth asphyxia. Urgent attention needs to be focused on regionalized maternal and child management to address this problem in China.

Food Related Quality of Life in Children with Chronic Gastrointestinal Disorders: Comparative Study Between Inflammatory Bowel Disease and Celiac Disease-Reports from a Romanian Center

Background/Objectives: Chronic gastrointestinal disorders often involve nutritional management strategies. On the one hand, inflammatory bowel disease (IBD) is a condition in which most of the patients experience frequent diet manipulation in order to obtain long term remission. On the other hand, for celiac disease (CelD), diet is the only known treatment strategy so far, requiring a life-long gluten-free diet. We aimed to evaluate the comparative food-related quality-of-life (FR-QoL) in light of these dietary interventions between these two conditions. Methods: This is a cross-sectional study, involving children aged 7-18 years diagnosed with IBD and CelD. Assessment of this aspect was performed using the self-reported FR-QoL 29 questionnaire. For CelD, the questionnaires were modified with "CelD" instead of "IBD". Results: Fifty-one patients were included, 17 in each subgroup (Crohn's disease (CD), ulcerative colitis (UC), and Celd). FR-QoL scores were negatively correlated with age at inclusion (Spearman's ρ = -0.284, p = 0.04) and also with age at diagnosis (Spearman's ρ = -0.291, p = 0.038). The scores were significantly lower in the CD group (64.1 ± 13.4) compared with CelD patients (78.6 ± 20.3), p = 0.036 and UC, p = 0.294. For the IBD group, the scores were not influenced by disease activity. Furthermore, we identified a negative significant correlation between anthropometric indices and FR-QoL scores. Conclusions: The burden of dietary intervention is highest for the CD patients, regardless of their disease activity when compared with UC and CelD patients, most probably because of the unpredictable course and fast response to dietary changes. Although it requires incessantly vigilant eating behavior, CelD has apparently become more "manageable" in recent years.

Decoding Pediatric Laryngopharyngeal Reflux: Unraveling Symptoms Through Multichannel Intraluminal Impedance and pH Insights

Background: The relationship between symptoms of laryngopharyngeal reflux (LPR) and objective reflux measurements obtained through multichannel intraluminal impedance-pH (MII-pH) monitoring remains unclear. Objectives: The aim of this study was to investigate the relationship between LPR symptoms and objective reflux episodes and possible associations between fibreoptic ENT findings, eosinophil counts, and serum IgE levels with reflux episodes detected by MII-pH. Methods: In this prospective study, MII-pH monitoring, fiberoptic laryngoscopy, nasal swabs for eosinophils, total serum IgE levels, and symptom assessment (Reflux Symptom Index, RSI) were performed in all children with suspected LPR. The Reflux Findings Score (RFS) was determined based on the laryngoscopy findings. Results: A total of 113 patients (mean age, 8 years) with LPR symptoms were included in the study. The number of reflux episodes was highest in children with chronic cough and recurrent broncho-obstruction. Secondary outcomes showed positive correlations between reflux episodes and ENT findings, particularly hypopharyngeal hyperemia, arytenoid hyperemia, and arytenoid erythema (p < 0.01, p < 0.001, and p < 0.001, respectively). The number of total, acidic, and weakly acidic reflux episodes was significantly positively correlated with RSI and RFS. Proximal total, acidic, and weakly acidic reflux episodes showed significant correlations with eosinophil counts in nasal swabs but negative correlations with serum IgE levels. Conclusions: This study highlights the significant role of weakly acidic reflux in pediatric LPR and its association with respiratory symptoms. Our findings emphasize the importance of objective monitoring techniques in the assessment of LPR and provide insights for refining diagnostic and management strategies.

Celiac in the twenty-first century-the change in BMI of children at diagnosis over the last two decades

This study examined the prevalence of different BMI categories among newly diagnosed pediatric celiac disease (CD) patients in Israel from 2002 to 2018. A retrospective cross-sectional study using the database of Clalit Health Services in Israel included 5520 newly diagnosed CD children aged 2-18 between 2002 and 2018. Data on BMI, gender, ethnicity, and socioeconomic status (SES) were collected and analyzed Of the 5520 CD patients, 57.5% were female, 39.7% had low SES, and 77.1% were Jewish. At diagnosis, 13.1% were underweight, 73% had normal BMI, 9.1% overweight, and 4.8% were obese. Underweight and obese patients tended to be older at diagnosis (9 years) compared with normal and overweight patients (8 years) (P < 0.001). A higher proportion of Arab patients were underweight, while more Jewish patients were obese. Lower SES was significantly associated with increased underweight risk (P < 0.001). Over time, diagnosed patients had improved SES and were less underweight (P < 0.001). Male gender increased obesity risk (OR 1.36 [95% CI 1.06-1.74], P = 0.017), while Arab ethnicity was protective for obesity (OR 0.67 [95% CI, (0.45-0.99)], P = 0.047)Conclusion: Underweight prevalence significantly decreased in the second decade, but no significant change in overweight and obesity was noted. Underweight was associated with older age at diagnosis, poverty, and Arab ethnicity. Obesity was associated with older age and was more frequent in Jewish and male patients. Physicians should have a low threshold for CD screening regardless of BMI status to enable timely diagnosis and treatment to prevent long-term health consequences. What Is Known: • Celiac disease is traditionally associated with underweight due to malabsorption, but recent reports suggest an increasing prevalence of overweight and obesity in pediatric patients at diagnosis What Is New: • This study found that underweight prevalence decreased significantly over time, while overweight and obesity prevalence remained unchanged. Underweight was associated with older age, poverty, and Arab ethnicity, while obesity was more common in Jewish and male patients.

Exploring the Hearing Improvement and Parental Stress in Children with Hearing Loss Using Hearing Aids or Cochlear Implants

Objectives: This study aims to describe the stress levels experienced by parents of children with hearing loss who use conventional hearing aids or cochlear implants, and to assess the correlation between parental stress and the auditory skills acquired by the children. Methods: The study was conducted at the Policlinic "Gaetano Martino" in Messina, evaluating data from 42 pairs of parents of children using hearing aids or cochlear implants. Parents completed the LittlEARS Auditory Questionnaire (LEAQ) and the Parental Stress Scale (PSS) 18 months after the initial device (hearing aid or cochlear implant) had been activated. Additionally, information was collected regarding the presence of peripartum issues (including preterm birth) or associated conditions, congenital hearing loss, the total number of children in the family, and the number of children with hearing loss in the family. Results: Significant differences were found in the months to effective stimulation (p = 0.026), the age of the children at the time of the survey (p = 0.024) and the PSS score (p = 0.029). Univariate and multivariate logistic regression revealed significant correlations between LEAQ scores and both the months to effective stimulation and the age of the children at the time of the survey; univariate and multivariate linear regression revealed significant correlations between PSS scores and the type of device, months to effective stimulation, age of the children at the time of the survey, peripartum issues, and the number of children. A Spearman correlation showed a positive relationship between LEAQ and age of the children at the time of the survey, and a negative correlation between the PSS scores and the age of the children at the time of the survey. Conclusions: Parents of children with cochlear implants reported higher stress levels than those with children using hearing aids, although auditory performance was comparable between groups. Improved auditory performance was associated with reduced parental stress. The PSS and LEAQ are effective tools used in clinical practice for assessing parental stress and tracking auditory recovery, respectively.

Cannabinoid hyperemesis syndrome in pregnancy: a case series and review

Background

Cannabinoid hyperemesis syndrome (CHS) is a syndrome of cyclic nausea and vomiting in the setting of chronic cannabis use. To date, only 11 cases of CHS in pregnancy have been reported.

Case presentation

We describe two cases of uncontrolled vomiting in pregnancy due to CHS. Case 1 represents a 30-year-old Caucasian woman presenting in the 5th week of gestation with nausea, vomiting and abdominal pain intermittently of 1 week duration. Physical work-up was normal, and symptoms resolved with supportive treatment within 3 days, only to occur again at the 14th week of gestation, and again at the 30th week of gestation. Link between symptom relief and hot bathing led to suspicion for CHS, confirmed with positive cannabis urine toxicology screening. Nausea, vomiting and pain subsided with cannabis cessation, and baby was born healthy at 38 + 5 weeks gestation. Case 2 describes a 28-year-old Caucasian woman presenting in the 16th week of gestation with nausea, vomiting and abdominal pain. Physical examination was normal, and symptoms self-resolved. Two weeks later, in the 18th week of gestation, the patient re-presented to the emergency room with sudden re-occurrence of nausea, vomiting and abdominal pain. Once again, a link between symptom relief and hot bathing was noted on admission. The patient was educated on possible links of chronic cannabis use with CHS symptoms and subsequently relayed extensive (>14 years) cannabis use history. Symptoms resolved with cannabis cessation. Baby was born at 37 weeks gestation, with low birth weight of 2180 g requiring 5 days neonatal intensive care unit (NICU) treatment. Regular follow-up up to 5 months post-partum confirmed no CHS relapse with cannabis cessation.

Conclusion

CHS in pregnancy is likely under-reported, reflective possibly of limited physician and patient awareness of this condition, as well as patient concealment of cannabis use in pregnancy. In cases of severe, cyclic nausea and vomiting in pregnancy unresponsive to typical anti-emetic treatment, comprehensive social history including cannabis use should be sought, and associated hot bathing for symptomatic relief out-ruled.

The Association Between In Utero Exposure to Painkillers and Trajectories of Hyperactivity and Emotional Problems in Children with Autism Compared with Neurotypical Peers

Background/Objectives: In utero exposure to painkillers has raised concerns regarding its potential impact on neurodevelopmental disorders, such as autism spectrum disorder (ASD). This study investigates the association between in utero exposure to painkillers and trajectories of hyperactivity and emotional problems in children with and without ASD, separately. Methods: Data were drawn from 5107 participants enrolled in the Longitudinal Study of Australian Children. Emotional and behavioral problems were assessed using the Strengths and Difficulties Questionnaire at ages 4, 6, and 8 years. ASD diagnosis was determined based on parental self-report by age 12. To examine the association between the exposure and the outcomes, mixed linear models were applied to assess the impact of in utero exposure to painkillers on hyperactivity and emotional problems, controlling for sex, time, and other perinatal risk factors. The interaction term between exposure and time was included to evaluate the effect of exposure on the trajectory over time. Results: In utero exposure to painkillers did not significantly affect hyperactivity or emotional problem trajectories in children with ASD. However, in non-ASD children, painkiller exposure was associated with worsening emotional problems by age 8, with males being affected to a greater extent than females. Further, emotional problem scores increased over time by gender, reflecting developmental challenges in early childhood. Conclusions: These findings indicate that prenatal painkiller exposure is unlikely to be a major determinant of the severity of neurodevelopmental outcomes in autistic children, but its role in neurodevelopmental outcomes among neurotypical children warrants further investigation. Future research should prioritize precise exposure assessments and integrate multi-environment interactions to further elucidate the long-term impacts of prenatal painkiller use.

In-hospital mortality among neonates with necrotising enterocolitis in Ethiopia: a systematic review and meta-analysis

OBJECTIVE

To assess the pooled in-hospital mortality among neonates with necrotising enterocolitis (NEC) in Ethiopia.

DESIGN

This was a systematic review and meta-analysis reported based on the Preferred Reporting Items for Systematic Review and Meta-analysis guideline.

DATA SOURCES

African Journals Online, PubMed/Medline, Google Scholar, Cochrane Library and repositories of Ethiopian Universities.

ELIGIBILITY CRITERIA

Published and unpublished articles that had reported the in-hospital mortality among neonates with NEC in Ethiopia were included, whereas, articles with no abstracts and/or inaccessible full texts, citations, reviews, commentaries editorials, conference abstracts, anonymous reports and articles reported in non-English language were excluded.

DATA EXTRACTION AND SYNTHESIS

Articles that passed the eligibility criteria were assessed for their quality using the quality appraisal criteria for prevalence studies. Data extraction and cleaning were done by using the Microsoft Excel work sheet, and data were analysed by STATA V.11.0 using the random effects model at 95% CI. Test of heterogeneity, publication bias, sensitivity analysis, subgroup analysis and meta-regression were performed.

RESULTS

A total of 12 articles involving 588 neonates were included. The pooled in-hospital mortality among neonates with NEC in Ethiopia was found to be 70.0% (95% CI=60.0% to 80.0%; I2=87.5%). There was significant difference in mortality by study population as the in-hospital mortality among neonates with NEC was 83.0% (95% CI=76.0% to 89.0%; I2=42.8%; five studies) in preterm neonates and 73.0% (95% CI=60.0% to 86.0%; I2=66.3%; four studies) in low birthweight neonates (p<0.001).

CONCLUSION

The in-hospital mortality of neonates with NEC in Ethiopia was found to be high in which 7 out of 10 neonates diagnosed with NEC ends with death. Therefore, the currently available NEC prevention strategies should be evaluated for individual units and introduced where possible.

Call for Decision Support for Electrocardiographic Alarm Administration Among Neonatal Intensive Care Unit Staff: Multicenter, Cross-Sectional Survey

BACKGROUND

Previous studies have shown that electrocardiographic (ECG) alarms have high sensitivity and low specificity, have underreported adverse events, and may cause neonatal intensive care unit (NICU) staff fatigue or alarm ignoring. Moreover, prolonged noise stimuli in hospitalized neonates can disrupt neonatal development.

OBJECTIVE

The aim of the study is to conduct a nationwide, multicenter, large-sample cross-sectional survey to identify current practices and investigate the decision-making requirements of health care providers regarding ECG alarms.

METHODS

We conducted a nationwide, cross-sectional survey of NICU staff working in grade III level A hospitals in 27 Chinese provinces to investigate current clinical practices, perceptions, decision-making processes, and decision-support requirements for clinical ECG alarms. A comparative analysis was conducted on the results using the chi-square, Kruskal-Wallis, or Mann-Whitney U tests.

RESULTS

In total, 1019 respondents participated in this study. NICU staff reported experiencing a significant number of nuisance alarms and negative perceptions as well as practices regarding ECG alarms. Compared to nurses, physicians had more negative perceptions. Individuals with higher education levels and job titles had more negative perceptions of alarm systems than those with lower education levels and job titles. The mean difficulty score for decision-making about ECG alarms was 2.96 (SD 0.27) of 5. A total of 62.32% (n=635) respondents reported difficulty in resetting or modifying alarm parameters. Intelligent module-assisted decision support systems were perceived as the most popular form of decision support.

CONCLUSIONS

This study highlights the negative perceptions and strong decision-making requirements of NICU staff related to ECG alarm handling. Health care policy makers must draw attention to the decision-making requirements and provide adequate decision support in different forms.

Predictive factors for the diagnosis of coeliac disease in children and young people in primary care: A systematic review and meta-analysis

BACKGROUND

Coeliac Disease (CD) often has its onset in childhood and affects 1% of the population. This review aimed to identify important predictive factors for coeliac disease in children and young people which could help GPs decide when to offer testing.

METHODS

We searched MEDLINE, Embase and Cochrane Library to April 2024. Included studies were observational or randomized trials reporting the risk of CD when exposed to predictive factor(s) in people ≤25 years of age. Genetic factors were excluded. Risk of Bias was assessed using the Newcastle-Ottawa Scale. Random effects meta-analysis was performed for factors reported in ≥5 studies to calculate pooled odds ratios (OR) or standardized mean differences (SMD).

RESULTS

Of 11,623 unique abstracts, 183 were included reporting on 140+ potentially associated factors. Meta-analyses of 28 factors found 14 significant associations with CD diagnosis: having type 1 diabetes (OR 8.70), having a first degree relative with coeliac disease (OR 5.19), being of white ethnicity (OR 2.56), having thyroid disease (OR 2.16), being female (OR 1.53), more frequent gastroenteritis in early childhood (OR 1.48), having frequent respiratory infections in early childhood (OR 1.47), more gluten ingestion in early life (OR 1.25), having more infections in early life (OR 1.22), antibiotic use in early childhood (OR 1.21), being born in the summer (OR 1.09), breastfeeding (OR 0.79) older age at diagnosis of type 1 diabetes (OR 0.64), and heavier weight (SMD -0.21). The final three were associated with lower risk of CD diagnosis.

DISCUSSION

This is the first systematic review and meta-analysis of predictive factors for CD in children. Amongst the 14 factors we identified that were significant, three were potentially modifiable: breast feeding, antibiotic use and amount of gluten ingestion in early childhood. This work could inform the development of clinical support tools to facilitate the early diagnosis of CD.

Care providers' view of the barriers in providing care for adolescents with emotional and behavioral problems

Objectives

Emotional and behavioral problems (EBP) during adolescence are a major public health issue due to its high prevalence and long-lasting consequences. The knowledge of the barriers in providing psychosocial care can be a starting point for subsequent efficiency improvement. Therefore, the aim of this study is to assess which barriers do care providers experience while providing psychosocial care for adolescents with EBP.

Methods

We performed a qualitative assessment that was embedded in the Slovak Care4Youth study mapping the system of care provided for adolescents with EBP. We conducted 25 semi-structured individual and group interviews with a total of 49 care providers from 17 institutions that provided preventive counselling, social, and mental healthcare for adolescents with EBP. We focused on the care provider's perception of barriers in providing care for these adolescents. The interviews were audiotaped and transcribed verbatim. We coded the data using the consensual qualitative research approach in combination with conventional content analysis.

Results

We found that care providers experienced several barriers in providing care for adolescents with EBP which relate to six themes-legislative framework and legislative changes; financing of the care system; coordination of care; workforce development, education, methodical guidance and supervision; personnel and institutional capacities; and administrative burden.

Conclusion

Addressing these barriers within the care system from the "front line" perspective provides clues to efficiently improve the psychosocial care for adolescents with EBP. According to the care providers, the organization and financing of the care system requires adaptation; the burden of the care providers should be reduced; and care providers require quality practical education, training, and methodological guidance.

Parvovirus B19 infection in children: a comprehensive review of clinical manifestations and management

Parvovirus B19 (B19V) is a significant pathogen responsible for a wide range of clinical manifestations, particularly in children and pregnant women. While B19V is most commonly recognized as the cause of Fifth disease, a mild erythematous illness in children, its clinical impact extends far beyond this condition. B19V can lead to severe complications, including transient aplastic crisis in individuals with chronic hemolytic anemias, arthralgia, and more severe joint diseases. During pregnancy, B19V infection poses serious risks, such as spontaneous abortion, non-immune hydrops fetalis, and fetal anemia, particularly when infection occurs between 9 and 20 weeks of gestation. Moreover, B19V is associated with a variety of organ system involvements, including cardiac, neurological, hepatic, and renal complications. These manifestations can range from mild to life-threatening, necessitating a broad spectrum of therapeutic approaches, including symptomatic care, immunoglobulins, corticosteroids, and supportive therapies. Despite the significant clinical burden posed by B19V, no specific antiviral treatment or vaccine is currently available, making early recognition and prompt management crucial for improving patient outcomes. This review provides a comprehensive overview of the diverse clinical presentations of B19V infection, with a focus on pediatric and pregnancy-related complications. It underscores the need for ongoing research into targeted therapies and highlights the importance of vigilant clinical management to mitigate the severe consequences of this pervasive virus.

The Mediating Role of Gut Microbiota on the Association Between Dietary Quality and Cancer-Related Fatigue Among Breast Cancer Patients: A Cross-Sectional Study

OBJECTIVES

Cancer-related fatigue (CRF) is highly prevalent in patients with breast cancer, resulting in undesirable outcomes and even reduced survival rates. This cross-sectional study investigated the relationship between dietary quality and CRF in patients with breast cancer, and the potential role of gut microbiota (GM) in this association.

METHODS

Dietary intake and CRF were evaluated in 342 patients, with 64 fecal samples collected for 16sRNA sequencing and 106 plasma samples for tryptophan (TRP) metabolite determination.

RESULTS

A total of 149 (43.6%) patients experienced CRF, which was significantly associated with low intakes of protein, vitamin A, vitamin E, dietary fiber, phosphorus, magnesium, potassium, iron, and copper (p < 0.05), and a remarkably low Chinese Healthy Eating Index (CHEI) score (p < 0.05). CRF patients had decreased GM diversity, an unhealthier GM composition, lower TRP concentrations, and a higher kynurenine (KYN)/TRP ratio (p < 0.05). Mediation analyses revealed that both the Sobs index (ACME = -0.0005; 95% CI -0.0051, -0.0001; p = 0.034) and the Chao index (ACME = -0.0005; 95% CI -0.0050, -0.0001; p = 0.033) were significant mediators of the correlation between total CHEI score and CRF.

CONCLUSIONS

The presence of CRF in patients with breast cancer might be correlated with inadequate nutrient intake and low dietary quality via GM-dependent pathways.

Behavioral problems in children with unoperated rheumatic heart disease at national referral hospital in Ethiopia: an observational study

BACKGROUND

The behavioral disorder is characterized by a profound abnormality in an individual's cognition, emotion or behavior that reflects in psychological, biological or developmental dysfunction. Rheumatic heart disease (RHD) is a long-term sequel of single or recurrent acute rheumatic fever. Children with RHD are thought to be at increased risk for behavioral problems due to autoimmunity seen in pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Behavior disorder is not well studied among children with RHD. Hence, this study aimed to assess the pattern and predictors of behavioral problems among children with RHD enrolled in chronic care at a national cardiac referral Hospital.

METHODS

This cross-sectional study used a validated parental-reported Amharic Strengths and Difficulties Questionnaire (SDQ) to assess behavior problems. Children with RHD aged 6-17 years on chronic outpatient cardiac care at Tikur Anbessa Specialized Hospital, Ethiopia between February and May 2023 were included. Factors associated with behavior problems were assessed using logistic regression models.

RESULTS

The study included 166 children with a median age of 15 years [Interquartile range (IQR):13-17 years]. One-fourth of children, 24.7% (95% CI: 18.34-31.98), had behavioral problems. Of these, 46.4% (77) emotional, 35.5% (59) peer, 18.1% (30) conduct and 6.6% (11) hyperactivity problems were documented. Children who had good medication adherence, adjusted odds ratio AOR 0.29(95% CI: 0.09-0.94, P 0.040) and on New York Health Association (NYHA) class I, AOR 0.28(95% CI: 0.11-0.79, P 0.016) had lower odds for behavioral problems.

CONCLUSION

One-fourth of children with RHD had behavioral abnormalities. Medication adherence and NYHA predicted behavioral abnormality. Better physical symptom control was associated with fewer behavioral problems. Behavioral abnormalities should be considered and assessed among children with RHD. Further multi-center mixed studies are recommended to uncover the unseen behavioral problem and guide health policy action on modalities of integration of behavioral problems assessment tools in clinical care.

HYPERVIRULENT KLEBSIELLA PNEUMONIAE OSTEOMYELITIS IN A CHILD

An 18-month-old boy presented with septic arthritis and osteomyelitis caused by Hypervirulent Klebsiella pneumoniae harboring cardinal virulence genes. The condition necessitated several surgical interventions, and a prolonged course of antibiotic therapy to effectively manage the severe infection and prevent complications, highlighting the challenges posed by Hypervirulent Klebsiella pneumoniae in pediatric cases.

A conserved role for ALG10/ALG10B and the N -glycosylation pathway in the sleep-epilepsy axis

Congenital disorders of glycosylation (CDG) comprise a class of inborn errors of metabolism resulting from pathogenic variants in genes coding for enzymes involved in the asparagine-linked glycosylation of proteins. Unexpectedly to date, no CDG has been described for ALG10 , encoding the alpha-1,2-glucosyltransferase catalyzing the final step of lipid-linked oligosaccharide biosynthesis. Genome-wide association studies (GWAS) of human traits in the UK Biobank revealed significant SNP associations with short sleep duration, reduced napping frequency, later sleep timing and evening diurnal preference as well as cardiac traits at a genomic locus containing a pair of paralogous enzymes ALG10 and ALG10B . Modeling Alg10 loss in Drosophila, we identify an essential role for the N -glycosylation pathway in maintaining appropriate neuronal firing activity, healthy sleep, preventing seizures, and cardiovascular homeostasis. We further confirm the broader relevance of neurological findings associated with Alg10 from humans and flies using zebrafish and nematodes and demonstrate conserved biochemical roles for N -glycosylation in Arabidopsis . We report a human subject homozygous for variants in both ALG10 and ALG10B arising from a consanguineous marriage, with epilepsy, brain atrophy, and sleep abnormalities as predicted by the fly phenotype. Quantitative glycoproteomic analysis in our Drosophila model identifies potential key molecular targets for neurological symptoms of CDGs.

Intricate mechanism of anxiety disorder, recognizing the potential role of gut microbiota and therapeutic interventions

Anxiety is a widespread psychological disorder affecting both humans and animals. It is a typical stress reaction; however, its longer persistence can cause severe health disorders affecting the day-to-day life activities of individuals. An intriguing facet of the anxiety-related disorder can be addressed better by investigating the role of neurotransmitters in regulating emotions, provoking anxiety, analyzing the cross-talks between neurotransmitters, and, most importantly, identifying the biomarkers of the anxiety. Recent years have witnessed the potential role of the gut microbiota in human health and disorders, including anxiety. Animal models are commonly used to study anxiety disorder as they offer a simpler and more controlled environment than humans. Ultimately, developing new strategies for diagnosing and treating anxiety is of paramount interest to medical scientists. Altogether, this review article shall highlight the intricate mechanisms of anxiety while emphasizing the emerging role of gut microbiota in regulating metabolic pathways through various interaction networks in the host. In addition, the review will foster information about the therapeutic interventions of the anxiety and related disorder.

A mouse model for the study of diet-induced changes in intestinal microbiome composition on renal calcium oxalate crystal formation

Currently available animal models for calcium oxalate kidney stones are limited in their translational potential. Particularly with increasing interest in gut microbiota involvement in kidney stone disease, there are limited animal models which can be used. As such, we have developed a novel diet-induced hyperoxaluria murine model which addresses some of the shortcomings of other currently available models. Mice C57BL/6 mice were fed a 1.5% sodium oxalate supplemented chow for two weeks and showed no morbidity or mortality. Mice fed the sodium oxalate diet consistently had renal calcium oxalate crystal deposits as confirmed by polarized light microscopy, and energy-dispersive X-ray spectroscopy. We developed a isotope dilution high-performance liquid chromatography/mass spectrometry protocol which confirmed that our model produced both urinary and enteric hyperoxaluria. 16 S ribosomal RNA sequencing of stool samples and cecal contents showed that sodium oxalate is a disruptor of the gut microbiome, and may interfere with commensal microbes in the gut microbiome. With consistent results this mouse model is superior to other models of kidney stone disease, as this model can be applied to investigate topics of oxalate absorption, transport, metabolism, excretion, crystal formation, the gut microbiome and testing of various therapeutic agents for translation to early stages of renal crystal formation in kidney stone disease.

Survival and Risk Factor for Mortality of Infants with Trisomy-21 and Pulmonary Hypertension: A Population-Based Study from a Middle-Income Country

Limited studies are available on the outcome of infants with trisomy-21 and pulmonary hypertension (PHT) in lower- and middle-income countries. This population-based cohort study aims to determine the outcome and survival from birth to 5 years of infants with trisomy-21 and PHT born between 2016 and 2021. The mortality rate and Kaplan-Meier survival analysis were calculated to assess survival rates at 1 and 5 years. Multivariate Cox regression analysis was used to examine mortality-related factors. A total of 488 trisomy-21 infants were identified, with 176 (36%) having PHT and 245 (50%) having congenital heart disease (CHD). Of 176 PHT, 74 (42%) had moderate to severe PHT, and 115 (65%) patients had their PHT resolved at a median age of 7 weeks (Interquartile range [IQR]: 3 to 16.8 weeks), and 48 (27%) died at a median age of 3.6 months (IQR: 0.6 to 7.1 months). The survival at 1 and 5 years was 74% and 71%, respectively. The independent factors for mortality were infants with birth weight less than 2.5 kg (adjusted Hazard Ratio [aHR] 2.1 95% confidence interval [CI] 1.1-4.2, p = .02), symptomatic infants (aHR 3.3 95% CI 1.4-7.6, p = .006), late-onset PHT (aHR 3.8 95% CI 1.6-8.9, p = .002), with CHD (aHR 2.1 95% CI 1.1-4.2, p = .03) and those with Persistent Pulmonary Hypertension of Newborn [PPHN] (aHR 2.1 95% CI 1.0-4.3, p = .047). One-third of infants with trisomy-21 experienced PHT, with seven out of ten surviving until age five. Those with low birth weight, symptomatic infants, CHD, late-onset PHT, and PPHN were associated with low survival rates.

Assessing the Relationship of Brain Metabolites to Cortical Thickness and Dementia Symptoms in Adults with Down Syndrome: A Pilot Study

BACKGROUND/OBJECTIVES

Those with the genetic disorder Down syndrome are at high risk of developing Alzheimer's disease. Previous work shows group differences in magnetic resonance spectroscopy metabolite measures in adults with Down syndrome who have Alzheimer's disease-related dementia compared to those who do not. In this pilot study, we assess relationships between metabolites and measures related to dementia status in a sample of adults with Down syndrome.

METHODS

Seventeen adults with Down syndrome were scanned using a 3 tesla MRI scanner. Magnetic resonance spectroscopy scans focused on the hippocampus and dorsal lateral prefrontal cortex. Metabolites of interest, including myo-inositol and N-acetyl-aspartate, were correlated with scores on the Dementia Questionnaire for People with Learning Disabilities, cortical thickness, and a measure of cognitive ability. In addition, cortical thickness was compared to an age- and sex-matched cohort of 17 previously scanned adults without Down syndrome.

RESULTS

Metabolite measures were not significantly related to cognitive/behavioral measures or to cortical thickness in this small cohort. Participants with Down syndrome showed widespread increases in cortical thickness compared to controls, even after accounting for potential differences in grey matter/white matter contrast.

CONCLUSIONS

Metabolite values were not related to two continuous measures that have previously been associated with dementia status in those with Down syndrome.

Nutritional management and autism spectrum disorder: A systematic review

BACKGROUND

Autism spectrum disorder (ASD) presents unique challenges related to feeding and nutritional management. Children with ASD often experience feeding difficulties, including food selectivity, refusal, and gastrointestinal issues. Various interventions have been explored to address these challenges, including dietary modifications, vitamin supplementation, feeding therapy, and behavioral interventions.

AIM

To provide a comprehensive overview of the current evidence on nutritional management in ASD. We examine the effectiveness of dietary interventions, vitamin supplements, feeding therapy, behavioral interventions, and mealtime practices in addressing the feeding challenges and nutritional needs of children with ASD.

METHODS

We systematically searched relevant literature up to June 2024, using databases such as PubMed, PsycINFO, and Scopus. Studies were included if they investigated dietary interventions, nutritional supplements, or behavioral strategies to improve feeding behaviors in children with ASD. We assessed the quality of the studies and synthesized findings on the impact of various interventions on feeding difficulties and nutritional outcomes. Data extraction focused on intervention types, study designs, participant characteristics, outcomes measured, and intervention effectiveness.

RESULTS

The review identified 316 studies that met the inclusion criteria. The evidence indicates that while dietary interventions and nutritional supplements may offer benefits in managing specific symptoms or deficiencies, the effectiveness of these approaches varies. Feeding therapy and behavioral interventions, including gradual exposure and positive reinforcement, promise to improve food acceptance and mealtime behaviors. The findings also highlight the importance of creating supportive mealtime environments tailored to the sensory and behavioral needs of children with ASD.

CONCLUSION

Nutritional management for children with ASD requires a multifaceted approach that includes dietary modifications, supplementation, feeding therapy, and behavioral strategies. The review underscores the need for personalized interventions and further research to refine treatment protocols and improve outcomes. Collaborative efforts among healthcare providers, educators, and families are essential to optimize this population's nutritional health and feeding practices. Enhancing our understanding of intervention sustainability and long-term outcomes is essential for optimizing care and improving the quality of life for children with ASD and their families.

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

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

Knockdown of ketohexokinase versus inhibition of its kinase activity exert divergent effects on fructose metabolism

Excessive fructose intake is a risk factor for the development of obesity and its complications. Targeting ketohexokinase (KHK), the first enzyme of fructose metabolism, has been investigated for the management of metabolic dysfunction-associated steatotic liver disease (MASLD). We compared the effects of systemic, small molecule inhibitor of KHK enzymatic activity with hepatocyte-specific, N-acetylgalactosamine siRNA-mediated knockdown of KHK in mice on an HFD. We measured KHK enzymatic activity, extensively quantified glycogen accumulation, performed RNA-Seq analysis, and enumerated hepatic metabolites using mass spectrometry. Both KHK siRNA and KHK inhibitor led to an improvement in liver steatosis; however, via substantially different mechanisms, KHK knockdown decreased the de novo lipogenesis pathway, whereas the inhibitor increased the fatty acid oxidation pathway. Moreover, KHK knockdown completely prevented hepatic fructolysis and improved glucose tolerance. Conversely, the KHK inhibitor only partially reduced fructolysis, but it also targeted triokinase, mediating the third step of fructolysis. This led to the accumulation of fructose-1 phosphate, resulting in glycogen accumulation, hepatomegaly, and impaired glucose tolerance. Overexpression of wild-type, but not kinase-dead, KHK in cultured hepatocytes increased hepatocyte injury and glycogen accumulation after treatment with fructose. The differences between KHK inhibition and knockdown are, in part, explained by the kinase-dependent and -independent effects of KHK on hepatic metabolism.

Skin Sceneries of Thyroid Disorders and Impact of Thyroid on Different Skin Diseases: A Scoping Review Focused on Pediatric Patients

Thyroid function plays a seminal role in the growth and development of children, and alterations in signaling pathways which interfere with the biosynthesis, transport, and metabolism of thyroid hormones might impact on the skin of such patients: this review explores the relationship between different thyroid disorders and dermatological manifestations with a particular focus on the pediatric population. Common cutaneous conditions associated with thyroid dysfunction may include chronic urticaria, vitiligo, and alopecia, which can be early harbingers of an underlying endocrine disruption. This review also highlights the growing cognizance of a "thyroid-skin axis", with thyroid hormones influencing many physiologic processes within the skin such as keratinocyte proliferation, hair growth, and epidermal differentiation. A precocious recognition of abnormal dermatological signs can be crucial in pediatric patients for a timely diagnosis before any development of complications and for personalized treatments of an underlying thyroid disorder, which can even be symptomless at an initial phase. Despite the lack of standardized guidelines for managing dermatologic manifestations occurring in thyroid diseases, a regular screening to identify endocrine dysfunction is recommended in those children who present chronic urticaria, vitiligo, or alopecia, though further research is needed to decipher mechanisms involved in the thyroid-skin partnership and develop more targeted management approaches.

Pre-autism: Advancing early identification and intervention in autism

Autism spectrum disorder (ASD) is often diagnosed long after symptoms have become noticeable. This delay can make it difficult to provide early intervention, which can impact long-term outcomes. The concept of "pre-autism" highlights the phase before a formal diagnosis of ASD, providing an opportunity for earlier identification and intervention, which could be a turning point in ASD management. In a previous article, we explored different ways of diagnosing pre-autism, including historical records, physical markers, laboratory tests, and radiological evidence. This manuscript builds on that foundation by emphasizing the importance of early diagnosis and intervention in ASD. Recent research advancements have clarified that ASD presentations can be complex, and individualized support strategies are necessary. The significance of pre-autism lies in its potential to alter the trajectory of ASD through early detection and intervention despite challenges such as limited awareness and variability in symptom presentation. Biomarkers and diagnostic tools have shown promise as avenues for early detection, but it is essential to exercise caution and not rely too heavily on yet-to-be-established markers. Addressing these challenges requires a collaborative effort to increase awareness, improve access to diagnostic tools, and foster inclusive environments. Ultimately, this manuscript calls for ongoing research, advocacy, and resource allocation to enhance early detection and intervention efforts, ensuring optimal outcomes for individuals on the autism spectrum.

A preparation program for psychological safety of hospitalized adolescents

INTRODUCTION

The study aimed to investigate the impact of an information-based preparation program on the psychological safety of adolescents admitted to pediatric wards, emphasizing the importance of enhancing patient safety.

METHODS

This quasi-experimental study was conducted among 98 adolescents admitted to pediatric wards at Namazi Hospital, managed by Shiraz University of Medical Sciences, in 2021. The participants were randomly assigned to either an intervention group or a control group using an electronic randomization table. The intervention group received an information-based preparation program, while the control group followed routine care. Adolescents completed the Psychological Safety Questionnaire after admission and at discharge. Data were analyzed using SPSS (Version 22), with a significance level of 0.05.

RESULTS

The mean psychological safety scores before the intervention were 136.73 ± 17.30 in the control group and 141.03 ± 16.34 in the intervention group, with no significant difference between the two groups (p = 0.20). After the intervention, the mean scores were 136.65 ± 19.01 in the control group and 145.50 ± 14.05 in the intervention group. A comparison of the mean psychological safety scores showed a significant difference between the two groups after the intervention (p = 0.01).

CONCLUSIONS

The findings of this study indicate that the information-based preparation program positively affected the psychological safety of hospitalized adolescents. Therefore, it is recommended that nurses incorporate this method into therapeutic programs for hospitalized adolescents to enhance their psychological safety effectively.

Butyrate as a Potential Modulator in Gynecological Disease Progression

This review investigates the therapeutic potential of butyrate, a short-chain fatty acid (SCFA) produced by gut microbiota, in the prevention and treatment of various gynecological diseases, including polycystic ovary syndrome (PCOS), endometriosis, and gynecologic cancers like cervical and ovarian cancer. These conditions often pose treatment challenges, with conventional therapies offering limited and temporary relief, significant side effects, and a risk of recurrence. Emerging evidence highlights butyrate's unique biological activities, particularly its role as a histone deacetylase (HDAC) inhibitor, which allows it to modulate gene expression, immune responses, and inflammation. In PCOS, butyrate aids in restoring hormonal balance, enhancing insulin sensitivity, and reducing chronic inflammation. For endometriosis, butyrate appears to suppress immune dysregulation and minimize lesion proliferation. Additionally, in cervical and ovarian cancers, butyrate demonstrates anticancer effects through mechanisms such as cell cycle arrest, apoptosis induction, and suppression of tumor progression. Dietary interventions, particularly high-fiber and Mediterranean diets, that increase butyrate production are proposed as complementary approaches, supporting natural microbiota modulation to enhance therapeutic outcomes. However, butyrate's short half-life limits its clinical application, spurring interest in butyrate analogs and probiotics to maintain stable levels and extend its benefits. This review consolidates current findings on butyrate's multifaceted impact across gynecological health, highlighting the potential for microbiota-centered therapies in advancing treatment strategies and improving women's reproductive health.

Maternal Supplementation with Lacticaseibacillus rhamnosus GG Improves Glucose Tolerance and Modulates the Intestinal Microbiota of Offspring

INTRODUCTION

Consuming hypercaloric diets during pregnancy induces metabolic, immune, and maternal intestinal dysbiosis disorders. These conditions are transferred to the offspring through the placenta and breastfeeding, increasing susceptibility to metabolic diseases. We investigated the effect of L. rhamnosus GG supplementation on offspring maternally programmed with a hypercaloric diet.

METHODS

Our study involved sixteen female Wistar rats aged ten weeks, which were divided into four groups based on their diets: control (Ctrl), cafeteria (CAF), control + probiotic (PRO), and cafeteria + probiotic (CPRO). The control + probiotic and cafeteria + probiotic groups received a daily oral administration of 250 μL of L. rhamnosus GG cell suspension (equivalent to 109 UFC) for nine weeks. The body weight of the animals was recorded weekly, and their food intake was monitored every 24 h. An oral glucose tolerance test was conducted on the offspring at seven weeks of age. At the ninth week of age, animals were euthanized, and blood, tissues, and organs were collected.

RESULTS

Maternal supplementation with L. rhamnosus GG decreased food intake and the average birth weight, improved glucose sensitivity, and lowered the levels of LDL, cholesterol, triglycerides, and mesenteric adipose tissue in offspring compared with the control and cafeteria groups.

CONCLUSIONS

Our findings indicate that supplementing with LGG during maternal programming could protect offspring from metabolic disruptions caused by a hypercaloric maternal diet.

An Update on Kawasaki Disease

PURPOSE

To summarize advances in research on the epidemiology, pathogenesis, diagnosis, and treatment of Kawasaki Disease (KD), a systemic inflammatory illness of unknown etiology that affects children globally.

RECENT FINDINGS

The epidemiology of KD was affected by the COVID-19 pandemic and advances in molecular immunology and machine learning have enabled research into its pathogenesis. There is ongoing research into agents that can be used to intensify initial treatment and accumulating evidence supporting the use of certain rescue regimens for refractory disease over others. There is promise surrounding a new coronary artery aneurysm prediction model. Research into the post-acute morbidity of KD continues. The COVID-19 pandemic temporarily reduced the incidence of KD. The NLRP3 inflammasome plays a key role in KD pathogenesis. Intensified initial treatment benefits high-risk patients, yet no intensification regimen shows superiority over another. Corticosteroids, infliximab, or combination therapy with IVIg plus another agent may be superior rescue regimens compared to IVIg alone for refractory KD. The Son score, developed in North America, predicted coronary artery lesions in Japanese and Italian cohorts. Patients with a history of KD may carry long-term physical and emotional burdens that persist into adulthood yet appear to have typical neurocognitive development. Successful transition to adult healthcare presents a challenge.

Gut-Microbiota-Derived Butyric Acid Overload Contributes to Ileal Mucosal Barrier Damage in Late Phase of Chronic Unpredictable Mild Stress Mice

Intestinal mucosal barrier damage is regarded as the critical factor through which chronic unpredictable mild stress (CUMS) leads to a variety of physical and mental health problems. However, the exact mechanism by which CUMS induces intestinal mucosal barrier damage is unclear. In this study, 14, 28, and 42 d CUMS model mice were established. The indicators related to ileal mucosal barrier damage (IMBD), the composition of the ileal microbiota and its amino acid (AA) and short-chain fatty acid (SCFA) metabolic functions, and free amino acid (FAA) and SCFA levels in the ileal lumen were measured before and after each stress period. The correlations between them are analyzed to investigate how CUMS induces intestinal mucosal barrier damage in male C57BL/6 mice. With the progression of CUMS, butyric acid (BA) levels decreased (14 and 28 d) and then increased (42 d), and IMBD progressively increased. In the late CUMS stage (42 d), the degree of IMBD is most severe and positively correlated with significantly increased BA levels (p < 0.05) in the ileal lumen and negatively correlated with significantly decreased FAAs, such as aspartic, glutamic, alanine, and glycine levels (p < 0.05). In the ileal lumen, the abundance of BA-producing bacteria (Muribaculaceae, Ruminococcus, and Butyricicoccus) and the gene abundance of specific AA degradation and BA production pathways and their related enzymes are significantly increased (p < 0.05). In addition, there is a significant decrease (p < 0.05) in the abundance of core bacteria (Prevotella, Lactobacillus, Turicibacter, Blautia, and Barnesiella) that rely on these specific AAs for growth and/or are sensitive to BA. These changes, in turn, promote further colonization of BA-producing bacteria, exacerbating the over-accumulation of BA in the ileal lumen. These results were validated by ileal microbiota in vitro culture experiments. In summary, in the late CUMS stages, IMBD is related to an excessive accumulation of BA caused by dysbiosis of the ileal microbiota and its overactive AA degradation.

Childhood trauma distribution and behavioural problems among Pakistani adolescents

BACKGROUND

Childhood trauma adversely impacts adolescents, and consequently, they develop behavioural problems. Understanding the distribution of childhood traumas and their association with behavioural problems among adolescents is paramount for the preventive efforts.

AIM/OBJECTIVE

The present research aimed to investigate this association among adolescents.

METHODS

This association was investigated among adolescents (N = 200) between 12 and 18 years. Childhood Trauma Questionnaire and Strength and Difficulty Questionnaire was used to assess the distribution of trauma and internalizing and externalizing behavioural problems among adolescents through purposive and convenience sampling technique.

RESULTS

The findings across trauma distribution indicated higher distribution of childhood abuse and neglect across males as compared to females. Males further significantly scored higher on sexual abuse and emotional neglect. Apparently, a large number of adolescents experienced all five sub types of childhood traumas (sexual abuse, emotional abuse, physical abuse, emotional and physical neglect). Additionally, across the severity continuum of childhood traumas, male scored higher on the severe to extreme continuum for all subtypes except physical abuse, where females scored higher. Lastly, logistic regression analysis indicated higher peer problems among those adolescents who have experienced all types of childhood traumas.

CONCLUSION

These findings could be beneficial for intervention-based programs and policies to help trauma-exposed adolescents cope with their lives.

Outcomes After Total Knee Arthroplasty in Patients With Autism: A Retrospective Database Study

BACKGROUND

Autism spectrum disorder (ASD) is a neurodevelopmental disorder associated with osteoarthritis for which total knee arthroplasty (TKA) may be considered. The safety and efficacy of TKA in patients with ASD had been poorly characterized.

METHODS

Total knee arthroplasty patients were identified using the M157 PearlDiver database. Patients with autism spectrum disorder were matched 1:4 with control TKA patients based on age, sex, and Elixhauser Comorbidity Index (ECI). 90-day adverse events were compared by multivariable regression, controlling for age, sex, and ECI. 5-year rates of revision were compared using Kaplan-Meier survival analyses.

RESULTS

Of 1,194,063 TKA patients, ASD was identified in 352 (0.02%). Patients with autism spectrum disorder were younger (60.0 vs. 65.8 years, P < 0.001) with higher ECIs (7.8 vs. 4.2, P < 0.001) than control patients. Patients with autism spectrum disorder had higher odds of aggregated adverse events driven by sepsis (odds ratio [OR] 3.11), pneumonia (OR 3.55), and urinary tract infection (OR 3.02) (P < 0.0036 for each). 5-year revision rates were not significantly different for the matched cohorts (P = 0.8000).

CONCLUSION

Total knee arthroplasty patients with ASD had elevated odds of several infectious adverse events and may warrant additional perioperative precautions. No notable differences were observed in most adverse outcomes investigated, nor in 5-year implant survival, suggesting that patients with ASD can safely be considered for TKA.

MRI Diagnosis of Coronary Artery Lesions in Children With Kawasaki Disease and Their Correlation With Inflammatory Factors

BACKGROUND

Ultrasonography (US), as a routine examination for evaluating coronary artery lesions (CAL) in children with Kawasaki disease (KD), has strong subjectivity and limitations. Non-contrast enhanced coronary magnetic resonance angiography (NCE-CMRA) is sensitive and reliable in displaying the segments of coronary arteries (CA).

PURPOSE

To evaluate the CA using NCE-CMRA, to compare NCE-CMRA with US, and to assess the correlation between KD-related inflammatory factors and the occurrence of CAL.

STUDY TYPE

Retrospective.

POPULATION

61 children with KD who had undergone NCE-CMRA. Ultimately, 52 cases were included (32 males and 20 females), with an average of 5.9 ± 0.3 years old.

FIELD STRENGTH/SEQUENCE

3-T, 3D balanced turbo field echo sequence.

ASSESSMENT

NCE-CMRA and US coronary visualization rates were compared in 41 children who were imaged with both techniques. Inflammatory factors were compared between CAL and normal coronary artery (NCA) subgroups. In the CAL group, correlations of these inflammatory factors with CAL parameters were investigated.

STATISTICAL TESTS

Comparison between groups was performed by the two independent samples t-test; the comparison of enumeration data between groups was performed by chi-square test. Receiver operating characteristic (ROC) curve analysis was performed to determine the sensitivity of inflammatory factors for detecting CAL. The correlation between CAL and inflammatory indexes was analyzed by multiple linear regression. A P value <0.05 was considered statistically significant.

RESULTS

NCE-CMRA visualized significantly more segments than US (76% vs. 46%). There were significant differences in PLT, CRP, ESR, and D-dimer between the CAL and NCA groups. ROC curve analysis showed that the sensitivities of these four indicators in diagnosing CAL were 39%, 44%, 72%, and 61%, respectively, at cut-off points of 562.5 × 109/L, 48.93 mg/L, 45.5 mm/h, and 0.5 mg/L, respectively.

DATA CONCLUSION

The combination of NCE-CMRA and inflammatory factors is helpful for the early diagnosis and disease severity of CAL in children with KD.

LEVEL OF EVIDENCE

3 TECHNICAL EFFICACY: Stage 2.

Identification of severe acute pediatric asthma phenotypes using unsupervised machine learning

RATIONALE

More targeted management of severe acute pediatric asthma could improve clinical outcomes.

OBJECTIVES

To identify distinct clinical phenotypes of severe acute pediatric asthma using variables obtained in the first 12 h of hospitalization.

METHODS

We conducted a retrospective cohort study in a quaternary care children's hospital from 2014 to 2022. Encounters for children ages 2-18 years admitted to the hospital for asthma were included. We used consensus k means clustering with patient demographics, vital signs, diagnostics, and laboratory data obtained in the first 12 h of hospitalization.

MEASUREMENTS AND MAIN RESULTS

The study population included 683 encounters divided into derivation (80%) and validation (20%) sets, and two distinct clusters were identified. Compared to Cluster 1 in the derivation set, Cluster 2 encounters (177 [32%]) were older (11 years [8; 14] vs. 5 years [3; 8]; p < .01) and more commonly males (63% vs. 53%; p = .03) of Black race (51% vs. 40%; p = .03) with non-Hispanic ethnicity (96% vs. 84%; p < .01). Cluster 2 encounters had smaller improvements in vital signs at 12-h including percent change in heart rate (-1.7 [-11.7; 12.7] vs. -7.8 [-18.5; 1.7]; p < .01), and respiratory rate (0.0 [-20.0; 22.2] vs. -11.4 [-27.3; 9.0]; p < .01). Encounters in Cluster 2 had lower percentages of neutrophils (70.0 [55.0; 83.0] vs. 85.0 [77.0; 90.0]; p < .01) and higher percentages of lymphocytes (17.0 [8.0; 32.0] vs. 9.0 [5.3; 14.0]; p < .01). Cluster 2 encounters had higher rates of invasive mechanical ventilation (23% vs. 5%; p < .01), longer hospital length of stay (4.5 [2.6; 8.8] vs. 2.9 [2.0; 4.3]; p < .01), and a higher mortality rate (7.3% vs. 0.0%; p < .01). The predicted cluster assignments in the validation set shared the same ratio (~2:1), and many of the same characteristics.

CONCLUSIONS

We identified two clinical phenotypes of severe acute pediatric asthma which exhibited distinct clinical features and outcomes.

A matched analysis of the use of high flow nasal cannula for pediatric severe acute asthma

RATIONALE

The high-flow nasal cannula (HFNC) device is commonly used to treat pediatric severe acute asthma. However, there is little evidence regarding its effectiveness in real-world practice.

OBJECTIVES

We sought to compare the physiologic effects and clinical outcomes for children treated for severe acute asthma with HFNC versus matched controls.

METHODS

This was a single-center retrospective matched cohort study at a quaternary care children's hospital. Children ages 2-18 hospitalized for severe acute asthma from 2015 to 2022 were included. Encounters receiving treatment with HFNC within the first 24 h of hospitalization were included as cases. Controls were primarily treated with oxygen facemask. Logistic regression 1:1 propensity score matching was done using demographics, initial vital signs, and medications. The primary outcome was an improvement in clinical asthma symptoms in the first 24 h of hospitalization measured as percent change from initial.

MEASUREMENTS AND MAIN RESULTS

Of 693 eligible cases, 443 were matched to eligible controls. Propensity scores were closely aligned between the cohorts, with the only significant difference in clinical characteristics being a higher percentage of patients of Black race in the control group (54.3% vs. 46.6%; p = 0.02). Compared to the matched controls, the HFNC cohort had smaller improvements in heart rate (-11.5% [-20.9; -0.9] vs. -14.7% [-22.6;-5.7]; p < 0.01), respiratory rate (-14.3% [-27.9;5.4] vs. -16.7% [-31.5;0.0]; p = 0.03), and pediatric asthma severity score (-14.3% [-28.6;0.0] vs. -20.0% [-33.3;0.0]; p < 0.01) after 24 h of hospitalization. The HFNC cohort also had longer pediatric intensive care unit (PICU) length of stay (LOS) (1.5 days [1.1;2.1] vs. 1.2 days [0.9;1.8]; p < 0.01) and hospital LOS (2.8 days [2.1;3.8] vs. 2.5 days [1.9;3.4]; p < 0.01). When subgrouping to younger patients (2-3 years old), or those with the highest severity scores (PASS > 9), those treated with HFNC had no difference in clinical symptom improvements but maintained a longer PICU LOS.

CONCLUSIONS

Encounters using HFNC for severe acute pediatric asthma had decreased clinical improvement in 24 h of hospitalization compared to matched controls and increased LOS. Specific subgroups of younger patients and those with the highest severity scores showed no differences in clinical symptom improvement suggesting differential effects in specific patient populations.

I can be a “normal” student: the role of lecture capture in supporting disabled and neurodivergent students’ participation in higher education

After the return to on-campus teaching post-Covid, reports of student disengagement and low attendance are common and anxieties over the relationship between lecture recordings and attendance have re-emerged, leading some educators to remove recordings. To understand the potential impact of such decisions, this study explored how neurodivergent and disabled students use recordings using a qualitative survey approach. Reflexive thematic analysis emphasised the need for learning flexibility and questioned traditional lectures. Neurodivergent and disabled students raised concerns over accessibility, highlighting the crucial nature of recordings beyond attendance. For example, features such as pausing or speed adjusted were described as vital for managing learning among disabled and neurodivergent participants. Our findings do not support an uncritical view of lecture recordings. Participants discussed the self-discipline required for effective use and responses reflected prior concerns discussed in the literature regarding recordings leading to focusing on lectures to the detriment of other sources of information. However, despite challenges, we found multiple examples of students using recordings to maintain engagement as a successful self-regulated learner. In line with Universal Design for Learning, our findings support the provision of lecture recordings as an inclusive and accessible technology for all students, not just those with declared disabilities. All data and analysis code is available at https://osf.io/ue628/.

The association between internet addiction and sleep quality among medical students in Saudi Arabia

BACKGROUND

Sleep is one of the fundamental human needs, essential for maintaining a high quality of life and mental and physical well-being across all age groups. Poor sleep quality often stems from negative lifestyle habits, including excessive internet usage. Therefore, it is important to determine the prevalence of internet gaming disorder among youth in Saudi Arabia and to examine the relationship between internet addiction levels and sleep quality.

METHODS

Data were collected from 338 medical students in the southern region of Saudi Arabia (mean age = 21.2 years, standard deviation = 3.29 years). Participants completed an online questionnaire comprising the Internet Addiction Test (IAT) and the Pittsburgh Sleep Quality Index (PSQI). Data analysis employed iterations, chi-square tests, Pearson correlation coefficients, and ANOVA.

RESULTS

The results revealed that 21% of the participants exhibited severe internet addiction, while 31% displayed moderate internet addiction. Furthermore, the findings indicated a positive correlation between sleep quality and the severity of internet addiction. Sleep quality symptoms explained 75% of the variance in Internet addiction scores, even after controlling for demographic variables. Additional bivariate analyses revealed that individuals who spent six or more hours online daily were more likely to experience symptoms of poor sleep quality and exhibit a higher severity of internet addiction. Additionally, Men were more susceptible to developing internet addiction compared to women. Moreover, students with internet addiction tended to have lower academic achievements.

CONCLUSION

These findings, while exploratory, offer valuable insights into potential interventions, strategies, and programs for mitigating internet addiction and enhancing sleep quality among medical college students.

Child outcomes after prenatal exposure to platinum and taxane-based chemotherapy: an unplanned interim analysis of the international network on cancer, infertility, and pregnancy study

Background

Platina and taxanes are frequently used chemotherapeutic agents to treat cancer, also when diagnosed during pregnancy. This report presents an interim analysis of the largest series of children prenatally exposed to platinum and/or taxane agents and aims to determine their physical health and neurocognitive outcomes.

Methods

As part of a multicentre, prospective cohort study (ClinicalTrials.gov: NCT00330447), children born between 2000 and 2022 were assessed between 2005 and 2024 at ages 1.5-18 years (interim analysis; median length of follow-up, 3.2 years (IQR 3.0-6.4)) by a comprehensive neurocognitive test battery, parent-reported questionnaires, and a physical assessment. Mixed-effects regression and Type III Analysis of Variance models were used to investigate associations between these outcomes and platinum/taxane cumulative dose and agent type, with best-fit models corrected for age and covariates (gestational age at birth, chemotherapy timing, other chemotherapy, sex, parental education level, maternal death).

Findings

In total, 144 children were included (13% exposed to platinum, 62% to taxanes, 25% to both). Of these, 101 were assessed at age 1.5 years, 96 at age 3, 63 at age 6, 32 at age 9, 18 at age 12, 7 at age 15, and 2 at age 18 years. Neurocognitive outcomes were within normal ranges across all ages, compared with test-specific normative data. Eight children (6%) reported ototoxicity, seven (5%) reported chronic medical conditions, three (2%) had congenital malformations, and two (1%) were diagnosed with Attention-Deficit Hyperactivity Disorder. Thirty-three children (23%) needed extra neurocognitive support, of which 64% were born preterm. Children prenatally exposed to paclitaxel scored lower on visuospatial (β = 0.64 ± 0.21, p = 0.0052) and verbal memory (β = 0.68 ± 0.27, p = 0.015) than those exposed to docetaxel.

Interpretation

In this interim analysis, we found normal neurocognitive outcomes and no increase in congenital malformations nor medical conditions after prenatal exposure to platinum/taxane-based chemotherapy. However, owed to the limited number of older children, further investigation regarding their potential neurotoxicity and its long term effects is necessary in follow-up studies with larger samples.

Funding

Kom Op Tegen Kanker, KWF Kankerbestrijding, Stichting Tegen Kanker, Cooperatio program, Research Foundation Flanders.

A novel injection device to administer repository corticotropin injection for inflammatory disease treatment: findings from a market research study

Aim: The goal of this market research study was to determine the usability of a single-dose prefilled injector (SelfJect™) for administration of Acthar® Gel (manufactured by Mallinckrodt Pharmaceuticals, UK) in patients with inflammatory diseases by obtaining feedback from patient and practitioner user groups in the US. Materials & methods: Patients and healthcare professionals (HCPs) representing relevant therapeutic areas were enrolled in the study between February and March 2021. SelfJect was mailed to patients and HCPs prior to 90-min virtual video-recorded focus group sessions and 60-min 1:1 virtual interviews, respectively. Patients completed an online assignment prior to the group session, which included instructions on how to use SelfJect and questions about their initial reaction while handling the device. HCPs were instructed to not open the package until the interview. Feedback from patients and HCPs were captured by open-ended questions and ranking scales. Results: Twelve patients and 42 HCPs participated in the study. Most patients (9/12 [75%]) and HCPs (38/42 [90%]) had experience with injectable medications, and 7/12 (58%) and 30/42 [71%] had experience with Acthar injections, respectively. Most patients and HCPs reported that key benefits of SelfJect were accurate dose delivery and ease of use, including the ergonomic handle and elimination of drawing Acthar from a vial into a syringe. Patients expressed some concerns about storage and disposal, but the need to store SelfJect would not deter them from using it. Most patients (9/12 [75%]) felt prepared to inject Acthar after reviewing the instructions. HCPs anticipated that 75% to 100% of patients would benefit switching from the vial to SelfJect. Conclusion: All participants expressed positive perceptions for SelfJect including easy use, few preparation steps and potential reduced anxiety due to needle phobia. These attributes may help treatment adherence for patients and caregivers.

The Relationship Between Prenatal, Perinatal, and Postnatal Factors and ADHD: The Role of Nutrition, Diet, and Stress

Attention-Deficit Hyperactive Disorder (ADHD) is a neurobehavioral syndrome affecting children aged 6-17 with symptoms manifesting before age 12. ADHD presents heterogeneously and is associated with various psychiatric disorders. The cause remains elusive, but genetic and environmental factors, brain region maturation delays, and neurotransmitter dysregulation are implicated. Effective treatment requires a multi-disciplinary approach, primarily involving pharmacological and behavioral intervention. Stimulants like methylphenidate and amphetamines are first-line medications, but non-stimulants may be considered for some patients. However, stimulants face challenges related to misuse, dependence, and long-term tolerability issues. The etiology of ADHD involved genetic predisposition, environmental influences, and prenatal, perinatal, and postnatal factors. Prenatal causes encompass maternal diet, alcohol consumption, viral infections, and stress. Postnatal factors include head trauma, meningitis, toxin, nutritional deficiencies, as well as iodine deficiency and hypothyroidism. The gut microbiome's role in ADHD is emerging, influencing neurodevelopment through microbiota-gut-brain axis. Understanding these diverse etiological factors is essential for comprehensive ADHD management.