Childhood Onset Conduct Disorder [CD] is a condition characterized by at least one symptom of conduct disorder (based on Diagnostic and Statistical Manual of Mental Disorders criteria—Fifth Edition) prior to 10 years...Childhood Onset Conduct Disorder [CD] is a condition characterized by at least one symptom of conduct disorder (based on Diagnostic and Statistical Manual of Mental Disorders criteria—Fifth Edition) prior to 10 years of age. Children affected exhibit disruptive behaviors, usually negative, hostile, and defiant behavior similar to Oppositional Defiant Disorder [ODD]. As the child gets older they begin to display more characteristic of Conduct Disorder (lying, fighting, and stealing, vindictive behavior). These children are also likely to have comorbidities including Attention Deficit Hyperactivity Disorder (ADHD), learning disabilities, poor academic achievement, and substance abuse. Distinguishing early between symptoms of Conduct Disorder versus other differential diagnoses is essential in effective treatment. Early intervention with these children leads to a better prognosis and likelihood of functioning in society. This case illustrates the difficulty of diagnosing a young child with Childhood Onset Conduct Disorder.展开更多
Background: In Bolivia there are few probiotic preparations available in the market, practically without alternatives to the use of freeze-dried products. An alternative used as a good alternative in other parts of th...Background: In Bolivia there are few probiotic preparations available in the market, practically without alternatives to the use of freeze-dried products. An alternative used as a good alternative in other parts of the world is yogurt with a probiotic strain added. In this study we report the use of a locally prepared yogurt with a lyophilized probiotic added. Methods: This is randomized, double-blind and controlled clinical trial in children hospitalized with acute diarrhoea carried out at the Paediatric Centre Albina Pati?o in Cochabamba, Bolivia with children 10 to 35 months participating. Children were randomly assigned to receive an oral rehydration solution and Saccharomyces boulardii (positive control) or the same solution plus yogurt preparation containing Lactobacillus rhamnosus (yogurt group). The primary outcome was the duration of diarrhoea. Secondary outcomes were the duration of fever, vomiting and hospitalization. Results: Of the 74 children incorporated 42 completed the protocol;baseline characteristics were similar in both groups. The median duration of diarrhoea was similar in children who received yogurt (71 hours) and controls (79 hours) (p = 0.3). The mean duration of fever was also similar in both groups: S. boulardii (24 hours) or yogurt (11 hours) (p = 1.02), as was the duration of vomiting: 17 hours vs. 32 hours in the control group (p = 0.37). A significant difference in the numbers of daily bowel movements was observed in the third day, the probiotic group was lower (p = 0.01). There was no effect on the duration of hospitalization (p = 0.26). Conclusions: The use of a yogurt containing L. rhamnosus has an effect comparable to S. boulardii. Introduction of yoghurt with a probiotic in the diet of patients hospitalized with acute diarrhoea may help reduce its duration, regardless of its aetiology.展开更多
Purpose: Determine the safety and efficacy of early enteral feeding after distal elective bowel anastomoses (DEBA) in children. Methods: Controlled randomized trial including pediatric patients with DEBA, excluding no...Purpose: Determine the safety and efficacy of early enteral feeding after distal elective bowel anastomoses (DEBA) in children. Methods: Controlled randomized trial including pediatric patients with DEBA, excluding non-elective and high risk patients. Variables: Demographics, operative time, anastomosis placement, beginning peristalsis and bowel movement, time to full diet intake, post-operative stay, persisting vomiting and abdominal distention, wound infection or dehiscence, anastomotic leak, reoperation, death. Randomization into: 1) Experimental group (EG): early feeding group, after a minimum 24 hours fasting period, oral fluids and diet was started;2) Control group (CG): obligatory 5-day fasting. Descriptive Statistics: Student’s t test for quantitative and Chi square for qualitative variables, a p-value 0.05 was considered significant. Results: 60 patients were included since June 2003 to May 2004, 30 ineach group. Mean age 2 years, weight16 kg, malnutrition 33%. Stomal Ethiology: Anorectal-malformation 46%, Hirschsprung 13%, inflammatory 35%, tumoral 5%. Mostly in colon 71%. Mean surgical time 142 min. None developed vomiting or required nasogastric-tube. Mild abdominal distension 13%, mild fever 16.5% and wound complications 18%. Anastomosis leakage 6.5%, none required reoperations. Demographic variables showed no statistical differences. Full oral intake was in the 2nd postoperative day in the EG vs CG (p = 0.001). Postoperative hospital stay was 6.0 ± 3 in the EG vs 9.8 ± 4 days in the CG with clinical but not statistical significance. Peristalsis beginning, first flatus passage and bowel movements showed no statistical differences. The complication incidence was low and equally distributed. Conclusions: Early feeding after DEBA is safe and well tolerated in children.展开更多
·AIM:To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).·METHODS:This observational case-control study included a case gro...·AIM:To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).·METHODS:This observational case-control study included a case group of 122 children less than two years of age with CNLDO who underwent probing and irrigation treatment at the ophthalmology department of Imam Khomeini Hospital in Ahvaz,Iran,from June 2022 to June2024.A control group of 122 age-matched children without CNLDO was also included for comparison.Data was collected from the children's medical records.·RESULTS:The study found a significant correlation between the occurrence of CNLDO and several maternal factors,such as preeclampsia,the use of levothyroxine,hypothyroidism,having more than three pregnancies(gravidity>3),natural pregnancy,and gestational diabetes mellitus.Additionally,in children,factors,such as oxygen therapy,anemia,reflux,jaundice,and a family history of CNLDO in first-degree relatives were associated with CNLDO,and maternal preeclampsia and hypothyroidism were found to significantly increase the risk of developing CNLDO in children.·CONCLUSION:Given that CNLDO affects both premature and full-term children,the present findings may potentially facilitate the early identification of children and infants at risk of nasolacrimal duct obstruction,thereby preventing the onset of chronic dacryocystitis.展开更多
Brain-derived neurotrophic factor is a crucial neurotrophic factor that plays a significant role in brain health. Although the vast majority of meta-analyses have confirmed that exercise interventions can increase bra...Brain-derived neurotrophic factor is a crucial neurotrophic factor that plays a significant role in brain health. Although the vast majority of meta-analyses have confirmed that exercise interventions can increase brain-derived neurotrophic factor levels in children and adolescents, the effects of specific types of exercise on brain-derived neurotrophic factor levels are still controversial. To address this issue, we used meta-analytic methods to quantitatively evaluate, analyze, and integrate relevant studies. Our goals were to formulate general conclusions regarding the use of exercise interventions, explore the physiological mechanisms by which exercise improves brain health and cognitive ability in children and adolescents, and provide a reliable foundation for follow-up research. We used the Pub Med, Web of Science, Science Direct, Springer, Wiley Online Library, Weipu, Wanfang, and China National Knowledge Infrastructure databases to search for randomized controlled trials examining the influences of exercise interventions on brain-derived neurotrophic factor levels in children and adolescents. The extracted data were analyzed using Review Manager 5.3. According to the inclusion criteria, we assessed randomized controlled trials in which the samples were mainly children and adolescents, and the outcome indicators were measured before and after the intervention. We excluded animal experiments, studies that lacked a control group, and those that did not report quantitative results. The mean difference(MD;before versus after intervention) was used to evaluate the effect of exercise on brain-derived neurotrophic factor levels in children and adolescents. Overall, 531 participants(60 children and 471 adolescents, 10.9–16.1 years) were included from 13 randomized controlled trials. Heterogeneity was evaluated using the Q statistic and I^(2) test provided by Review Manager software. The meta-analysis showed that there was no heterogeneity among the studies(P = 0.67, I^(2) = 0.00%). The combined effect of the interventions was significant(MD = 2.88, 95% CI: 1.53–4.22, P < 0.0001), indicating that the brain-derived neurotrophic factor levels of the children and adolescents in the exercise group were significantly higher than those in the control group. In conclusion, different types of exercise interventions significantly increased brain-derived neurotrophic factor levels in children and adolescents. However, because of the small sample size of this meta-analysis, more high-quality research is needed to verify our conclusions. This metaanalysis was registered at PROSPERO(registration ID: CRD42023439408).展开更多
Mycoplasma pneumoniae(M.pneumoniae)is a common pathogen that causes community-acquired pneumonia in children.The clinical presentation of this pathogen can range from mild self-limiting illness to severe and refractor...Mycoplasma pneumoniae(M.pneumoniae)is a common pathogen that causes community-acquired pneumonia in children.The clinical presentation of this pathogen can range from mild self-limiting illness to severe and refractory cases.Complications may occur,such as necrotizing pneumonia and respiratory failure.Extrapulmonary complications,including encephalitis,myocarditis,nephritis,hepatitis,or even multiple organ failure,can also arise.In this editorial,we dis-cuss the clinical implications of the significant findings from the article"Serum inflammatory markers in children with M.pneumoniae pneumonia and their predictive value for mycoplasma severity"published by Wang et al.They reported that measuring lactic dehydrogenase,interleukin-6 levels,and D-dimer effectively predicts refractory M.pneumoniae pneumonia cases.展开更多
BACKGROUND Emotional reactions,such as anxiety,irritability,and aggressive behavior,have attracted clinical attention as behavioral and emotional problems in preschool-age children.AIM To investigate the current statu...BACKGROUND Emotional reactions,such as anxiety,irritability,and aggressive behavior,have attracted clinical attention as behavioral and emotional problems in preschool-age children.AIM To investigate the current status of family rearing,parental stress,and behavioral and emotional problems of preschool children and to analyze the mediating effect of the current status of family rearing on parental stress and behavioral/emo-tional problems.METHODS We use convenience sampling to select 258 preschool children in the physical examination center of our hospital from October 2021 to September 2023.The children and their parents were evaluated using a questionnaire survey.Pearson's correlation was used to analyze the correlation between child behavioral and emotional problems and parental stress and family rearing,and the structural equation model was constructed to test the mediating effect.RESULTS The score for behavioral/emotional problems of 258 preschool children was(27.54±3.63),the score for parental stress was(87.64±11.34),and the score for parental family rearing was(31.54±5.24).There was a positive correlation between the behavioral and emotional problems of the children and the“hostile/mandatory”parenting style;meanwhile,showed a negative correlation with the“support/participation”parenting style(all P<0.05).The intermediary effect value between the family upbringing of parents in parental stress and children's behavior problems was 29.89%.CONCLUSION Parental family upbringing has a mediating effect between parental stress and behavioral and emotional problems of children.Despite paying attention to the behavioral and emotional problems of preschool-age children,clinical medical staff should provide correct and reasonable parenting advice to their parents to promote the mental health of preschool-age children.展开更多
BACKGROUND Although breast milk is ideal for newborns,in some cases,it is replaced with cow’s milk,which contains proteins that increase the risk of cow’s milk protein allergy(CMPA).AIM To evaluate CMPA prevalence i...BACKGROUND Although breast milk is ideal for newborns,in some cases,it is replaced with cow’s milk,which contains proteins that increase the risk of cow’s milk protein allergy(CMPA).AIM To evaluate CMPA prevalence in Bahrain and compare clinical characteristics of children with immunoglobulin E(IgE)-and non-IgE-mediated CMPA.METHODS This retrospective cohort study examined children with CMPA diagnosed at the pediatric gastroenterology outpatient clinic of the Salmaniya Medical Complex,Bahrain,between 2014 and 2022,and assessed CMPA prevalence.Clinical presentations,laboratory findings,dietary modifications,and outcomes were compared between children with IgE-mediated and non-IgE-mediated CMPA.Categorical variables were compared using Fisher’s exact test or Pearson’sχ2 test,whereas continuous variables were compared using Student’s t-test or the Mann-Whitney U test.RESULTS Of 8332 patients,6022(72.3%)adhered to their appointment.Of them,618(10.3%)were suggested of having CMPA and 595(96.3%)were included;CMPA prevalence was 2%.Most patients were Bahraini(93.8%)and males(55.3%).Non-IgE-mediated type accounted for 77.3%cases and IgE-mediated type,22.7%.IgE-mediated CMPA presented more in boys(P=0.030),and later in life(5.1 months±4.5 months vs 4.2 months±4.2 months,P=0.016,95%CI:0.08-1.73),had more associated diseases(P<0.001);and presented with more cutaneous(P=0.024)and respiratory(P=0.003)manifestations,severe symptoms[rash/dry skin(P=0.031),facial swelling/angioedema(P=0.003),failure to thrive(P=0.013),apparent life-threatening event(P<0.001)],and positive physical findings(P=0.002)than non-IgE-mediated CMPA.Most patients were exclusively fed cow milk formula(50.3%).The amino acid-based formula(AAF)was most prescribed(60.5%)with no difference between the two types(P=0.173).Although breastfeeding was recommended to 49.6%,only 8.2%were exclusively breastfed.IgE-mediated CMPA was associated with a longer follow-up duration than non-IgE-mediated CMPA(17.3 months±14.0 months vs 13.5 months±13.4 months,P=0.005,95%CI:1.1-6.3).CONCLUSION This study revealed a high CMPA prevalence with clinical differences between both types that can influence treatment.AAF was most prescribed,while breastfeeding with dietary modification is rarely applied.展开更多
BACKGROUND Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental growth.Although common characteristics distinguish peaky eaters,including food selectivity...BACKGROUND Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental growth.Although common characteristics distinguish peaky eaters,including food selectivity,food neophobia,and food avoidance,there is no clear definition to assess this behavior.Due to the unavailability of data regarding picky eating,it wasn’t easy to estimate its prevalence.AIM To develop a regional protocol to help healthcare professionals identify and manage mild and moderate picky eating cases.METHODS A virtual roundtable discussion was held in April 2021 to gather the opinions of seven pediatricians and two pediatric dietitians from eight Middle Eastern countries who had great experience in the management of picky eating.The discussion covered different topics,including clearly defining mild and moderate picky eating,identifying the role of diet fortification in these cases,and the possibility of developing a systematic approach to diet fortification.RESULTS The panel identified picky eating as consuming an inadequate amount and variety of foods by rejecting familiar and unfamiliar food.Most of the time,moderate picky eating cases had micronutrient deficiencies with over-or undernutrition;the mild cases only showed inadequate food consumption and/or poor diet quality.Paying attention to the organic red flags like growth faltering and development delay and behavioral red flags,including food fixation and anticipatory gagging,will help healthcare professionals evaluate the picky eaters and the caregivers to care for their children.Although dietary supplementation and commercial food fortification play an important role in picky eating,they were no benefit in the Middle East.CONCLUSION The panel agreed that food fortification through a food-first approach and oral nutritional supplements would be the best for Middle Eastern children.These recommendations would facilitate identifying and managing picky-eating children in the Middle East.展开更多
BACKGROUND In multisystem inflammatory syndrome in children(MIS-C)with coronavirus disease 2019,there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal ...BACKGROUND In multisystem inflammatory syndrome in children(MIS-C)with coronavirus disease 2019,there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal outcomes.We planned to estimate the pattern of cardiovascular involvement among children with MIS-C and its mid-term outcomes.AIM To determine association between cardiovascular abnormalities and clinical and laboratory parameters.To study the time-line for resolution of various abnormalities.METHODS In this prospective study done in a tertiary care hospital,270 were recruited from June 2020 to January 2022.Baseline demographic data and clinical presentation were recorded.Laboratory parameters and echocardiography were done at admission.Follow-up was done at 2 weeks,3 months,6 months and 1 year after diagnosis.Descriptive statistics were used for parametric and non-parametric data.Risk factors were identified by multivariate regression analysis.RESULTS The 211(78.2%)had cardiac involvement and 102 needed intensive care unit(ICU)admission.Cardiovascular abnormalities observed were shock 123(45.6%),coronary dilatation 28(10.4%),coronary aneurysm 77(28.5%),left ventricular(LV)dysfunction 78(29.3%),mitral regurgitation(MR)77(28.5%)and pericardial effusion 98(36.3%).Coronary artery aneurysm/dilatation during follow-up at 2 weeks and 1 year were 25.7%and 0.9%respectively.Multivariate regression analysis revealed breathlessness[odds ratio(OR)=3.91,95%CI:1.25-12.21,P=0.019]and hi-flow nasal cannula(HFNC)support(OR=8.5,95%CI:1.06-68.38,P=0.044)as predictors of cardiovascular involvement.Higher mean age(OR=1.16,95%CI:1.02-1.32,P=0.026),breathlessness(OR=4.99,95%CI:2.05-12.20,P<0.001),gallop(OR=4.45,95%CI:0.41-2.52,P=0.016),MR(OR=3.61,95%CI:1.53-8.53,P=0.004)and invasive ventilation(OR=4.01,95%CI:1.28-12.58,P=0.017)were predictive of LV dysfunction.Altered sensorium(OR=4.96,95%CI:2.23-11.02,P<0.001),headache(OR=6.61,95%CI:1.46-29.92,P=0.014),HFNC(OR=7.03,95%CI:2.04-24.29,P=0.002),non-rebreathing mask usage(OR=21.13,95%CI:9.00-49.61,P<0.001)and invasive ventilation(OR=5.64,95%CI:1.42-22.45,P=0.014)were risk factors for shock.Anemia was a risk factor for coronary involvement(OR=3.09,95%CI:1.79-5.34,P<0.001).CONCLUSION Significant number of children with MIS-C had cardiovascular involvement contributing to higher ICU management.Although shock resolved quickly,resolution of ventricular function and coronary abnormalities were slower,and hence warrants a structured long-term follow-up protocol.展开更多
Determining the predictors of screen media use will assist nurses and clinicians to identify the children that are in most need for intervention. There is limited literature regarding the predictors of screen media us...Determining the predictors of screen media use will assist nurses and clinicians to identify the children that are in most need for intervention. There is limited literature regarding the predictors of screen media use among children. This study aimed to examine the association between selected predictors and screen media use among children aged 3 - 13. The findings of this study are based on 192 children aged 3 - 13 and their caregivers recruited from Facebook and WhatsApp groups. A descriptive cross-sectional design was employed. The participants filled a demographic questionnaire and the Problematic Media Use Measure Short Form to obtain data about parents’ and children characteristics, screen time and problematic use of media. The screen time for 83% of the children was more than two hours. Mobile ownership (beta (β) = 0.22) and conflict about mobile use (beta (β) = 0.16) have significantly predicted the child total screen time. Child age (beta (β) = 0.17) and conflict about mobile use (beta (β) = −0.33) have significantly predicted the problematic use of media. Most children in the current study exceeded the recommended screen time. There is an urgent need to implement interventions that mitigate children’s excessive use of media.展开更多
Background: In children, acute bacterial rhinosinusitis (ABRS) is often complicated by ophthalmological and/or neurological involvement. These complications should be known and recognized, as they require urgent treat...Background: In children, acute bacterial rhinosinusitis (ABRS) is often complicated by ophthalmological and/or neurological involvement. These complications should be known and recognized, as they require urgent treatment with intravenous antibiotics and close in-hospital monitoring. In this study, we aimed to identify the main risk factors associated with the development of complications in children aged 2 - 17 years with ABRS. Methods: We conducted a retrospective cohort study of patients with ABRS complications in a primary hospital. Participants were divided into two groups: the control group comprising patients without complications (Group 1, n = 82) and the study group comprising patients with complications requiring hospitalization (Group 2, n = 41). We assessed the sociodemographic, clinical, and imaging data of both groups. Using multivariate logistic regression, we assessed risk factors of ABRS complications. Results: No socio-demographic characteristics were associated with ABRS complications (p ≥ 0.05). Factors associated with complications were delay in consultation (t = 5.282;p Conclusions: Intracranial and extracranial complications of ABRS in children have become rare in our setting. These complications can be serious and potentially fatal. Risk factors of these complications are delays in consultation, the presence of ophthalmological signs, and more than one affected sinus. Controlling modifiable factors would improve the treatment success of ABRS complications in children.展开更多
Fever is the primary reason for consultation and admission to pediatric emergency departments. The aim of this study was to describe the clinical, etiological and prognostic aspects of acute fever in children aged 0 -...Fever is the primary reason for consultation and admission to pediatric emergency departments. The aim of this study was to describe the clinical, etiological and prognostic aspects of acute fever in children aged 0 - 15 years. Patients and Methods: This was a prospective cross-sectional study from April 1, 2021 to March 31, 2022 and affected all children aged 0 to 15 years old with a temperature of 39˚C or higher (≥), having less than five days and hospitalized in the pediatric department of the Gabriel Touré University Hospital. Results: During the study period, 150 children were included, the sex-ratio was 0.85. Children aged 0 - 5 years represented 71.4% of the sample. References represented more than half of the sample, or 58% of cases. Body temperature was above 40˚C in 18.7% of cases. Functional signs were dominated by respiratory signs in 28% and digestive signs in 18%. Clinical pallor was found in 55.3% of children associated with signs of respiratory struggle in 70% of cases and tachycardia in 40% of patients. Anemia was present in 65.3% of patients. Hyperleucocytosis and leukopenia were found in 45.3% and 43.3% of patients respectively. The C-reactive protein was positive in 44.7% of patients and Cytobacteriological Examination and Chemistry of Cerebrospinal Fluid was positive in 8.7% of cases. The thick drop was positive in 44.7% of patients and blood cultures grew in 6 patients. Etiology was dominated by severe malaria 54 cases (36%), pneumonia (19.3%), meningitis (12.6%), and in those under one month it was bacterial neonatal infection (8.6%). In our study, slightly more than one patient out of three died during hospitalization, 36% (54 cases/150) and among these 70% (38 cases/54) were under 5 years old. The most lethal pathologies were severe malaria (36%), bacterial pneumonia (19.3%), meningitis (12.6%), bacterial neonatal infections (8.6%) and measles complicated by pneumonia (5.3%). Mortality during hospitalization was 36% of deaths (54 out of 150 patients) and 70.3% (38/54) of the deceased patients were under 5 years old. Conclusion: This study shows that fever is a frequent symptom and a sign of serious and very lethal pathologies. The cause of fever can be a diagnostic challenge for health workers. However, early identification of children at risk for serious illness could allow for prompt and appropriate management in appropriate settings.展开更多
Purpose: To evaluate open lower limb trauma management in children. Me-thod: We conducted a twelve-month cross-sectional prospective study. Results: Open trauma of lower limb had 7.9% of hospital frequency. Mean age w...Purpose: To evaluate open lower limb trauma management in children. Me-thod: We conducted a twelve-month cross-sectional prospective study. Results: Open trauma of lower limb had 7.9% of hospital frequency. Mean age was 8 years with a sex ratio of 2.45. In 68.4% of cases, trauma occurred in road traffic accidents. Average consultation time was 2.4 hours. Trauma mainly affected the leg in 39.5% of cases, and the thigh in 34.2%. Soft tissue wounds occurred in 52.6% of cases, and open fractures in 47.4%. Average response time was one hour. Wound trimming and suturing were performed in 76.3% of cases and combined with bone nailing in 15.8%. The outcome was favorable in 92.1% of cases. Average hospital stay was 4.37 days. Conclusion: Open trauma to the lower limb is a frequent and occurs mainly in road traffic accidents. Management was early, with a favorable outcome for most patients and a short hospital stay.展开更多
Objective: To study the effects of starting antiretroviral treatment (ART) prior the age of two years on the growth (height and weight) of HIV-infected children. Methodology: This was a retrospective cohort study. HIV...Objective: To study the effects of starting antiretroviral treatment (ART) prior the age of two years on the growth (height and weight) of HIV-infected children. Methodology: This was a retrospective cohort study. HIV-infected children on ART aged less than 15 years were divided into two groups Group 1 (G1) comprising children who started ART prior 2 years and Group (G2) those put on treatment thereafter. Main Measures: Percentage of children with growth retardation measured by Height for Age (H/A) and Weight for Age (W/A) Results: In total, we included 90 subjects. The median age was 10 years with a slight female predominance (51.2%). Most children were asymptomatic at the time of the study (96.6%), compliant with treatment (81%), 54.8% of children were on cotrimoxazole, 33% knew their status. At initiation, underweight was predominant in group 1 compared to group 2 (52% versus 29.5%;p = 0.015). Conversely, stunted growth predominated in G2 compared to G1 but without significant difference (38% versus 50%;p = 0.147). At the time of our study (median age of 10 years), catch-up height and weight predominated in G1 compared to G2;only a small proportion remained below −2SD (4% versus 18.2%;p = 0.015 and 9% versus 29.5%;p = 0.006 respectively for underweight and stunted growth). Conclusion and Global Health Implications: Growth retardation was common at ART initiation. Catch-up in height was more evident in the early treatment group. Initiation of ART before the age of 2 years rather influences children’s height than weight. The result of this study further emphasizes the need of early ART and closed clinical monitoring to better assess the impact of ART in areas with high rates of undernutrition.展开更多
Introduction: Reducing and maintaining viral load is crucial to reducing morbidity and mortality associated with HIV infection in children. The aim of this study was to determine the factors influencing the maintenanc...Introduction: Reducing and maintaining viral load is crucial to reducing morbidity and mortality associated with HIV infection in children. The aim of this study was to determine the factors influencing the maintenance of children and adolescents on antiretroviral therapy in the continuum of care. Methodology: This was a descriptive and analytical cross-sectional study conducted from August 1 to August 31, 2023. It included all children living with HIV, under 15 years of age, with at least two viral load results and whose parents consented to participate in the study. Participants were recruited during their child’s treatment renewal consultations. Results: The study included 143 children, mostly boys (55.2%), with a mean age of 11.54 years (±2.8). More than half (55.2) were unaware of their HIV-positive status, and most treatments were administered by parents (60.8%). Of the 99 children with an undetectable viral load at the first test, 23 (23.2%) showed a viral rebound at the last test, mainly due to poor treatment compliance (p Conclusion: Virological rebound after suppression in children is worrying. It is crucial that the national AIDS program improves Therapeutic Education, trains health workers to communicate results and encourages ongoing dialogue with young people to reinforce adherence and maintain viral suppression.展开更多
Introduction: Vitamin D plays a key role in phosphocalcic metabolism, in normal functioning of the immune system and in the prevention of certain forms of cancer. Systematic vitamin D supplementation has been implemen...Introduction: Vitamin D plays a key role in phosphocalcic metabolism, in normal functioning of the immune system and in the prevention of certain forms of cancer. Systematic vitamin D supplementation has been implemented in most Western countries, which has drastically reduced the prevalence of rickets. In Senegal, a country with enough sunshine, no large-scale data exists on vitamin D deficiency in children. In addition, there are no guidelines from the Ministry of Health and Social Action (MoHSA) on vitamin D supplementation. Our objective was to determine the prevalence of vitamin D deficiency in children aged 6 to 59 months and to analyze the factors associated with it at the Institute of Social Pediatrics in Pikine-Guédiawaye, a suburb of Dakar. Patients and Methods: This was a prospective, descriptive and analytical cross-sectional study over a 3-month period (from January to March 2024) at the Institute of Social Pediatric (IPS) of Pikine-Guédiawaye. The study population consisted of all children aged 6 to 59 months free from any acute or chronic pathology, whose parents had agreed to answer the questionnaires after having consented and signed the consent and children who had had a sample taken for vitamin D dosage. Results: We included 102 children, 35 of whom had vitamin D deficiency, i.e. a prevalence of 34.31% with a slight male predominance (sex ratio 1.05). Infants aged 13 - 24 months were more affected (41.67%), but the difference was not statistically significant (p-value = 0.385). Patients with acute malnutrition had a significantly higher prevalence of vitamin D deficiency (54.17% of cases versus 28.38%) in those without acute malnutrition (p = 0.02). On the other hand, chronic malnutrition, underweight and diversification foods were not significantly associated with vitamin D deficiency (p of 0.60, 0.42 and 0.09 respectively). Conclusion: Vitamin deficiency affects one-third of apparently healthy children under 5 and this deficiency has no significant relationship with diversification foods. This suggests that the observed vitamin D deficiencies are less related to diet than to lack of sun exposure.展开更多
Purpose This study aimed to provide comparative evidence on the effectiveness of various lifestyle interventions on body composition management for preschool and school-aged children.Methods PubMed(MEDLINE),Embase,CIN...Purpose This study aimed to provide comparative evidence on the effectiveness of various lifestyle interventions on body composition management for preschool and school-aged children.Methods PubMed(MEDLINE),Embase,CINAHL,and Web of Science were systematically searched for this network meta-analysis.Randomized controlled studies(RCTs)that included children aged 4-12 years with no physical or mental conditions;performed at least 1 type of lifestyle intervention;reported change in body mass index(BMI),BMI z-score,or body fat percentage(BFP);and were published between January 2010 and August 2023 were included.Results The final analysis included 91 RCTs with aggregate data for 58,649 children.All interventions were categorized into single-arm approaches(physical activity,diet,and behavioral and informational support)and combined arms approaches(bicomponent and multicomponent treatment).Multicomponent treatment showed significant effectiveness on the reduction of BMI(mean deviation(MD)−0.49,95%confidence interval(95%CI):-0.88 to-0.12),BMI z-score(MD=-0.11,95%CI:-0.18 to-0.04),and BFP(MD=-1.69,95%CI:-2.97 to-0.42)compared to the usual care condition.Bicomponent treatment also significantly reduced BMI(MD=-0.28,95%CI:-0.54 to-0.04)and BMI z-score(MD=-0.07,95%CI:-0.12 to-0.02)compared to usual care.Conclusion Interventions targeting multiple lifestyle components achieved greater reductions in children's BMI and BFP.Among single-component approaches,physical activity engagement emerged as the most effective.These findings should guide practitioners in recommending comprehensive lifestyle modifications for children.Moreover,children with higher initial BMI and body fat levels tend to exhibit more positive responses to lifestyle interventions aimed at managing obesity.展开更多
BACKGROUND Diffuse panbronchiolitis(DPB)is a rare,chronic inflammatory lung disease mar-ked by chronic cough,breathlessness,and preceding sinusitis.Symptoms often persist for years and can be misdiagnosed as asthma,pa...BACKGROUND Diffuse panbronchiolitis(DPB)is a rare,chronic inflammatory lung disease mar-ked by chronic cough,breathlessness,and preceding sinusitis.Symptoms often persist for years and can be misdiagnosed as asthma,particularly in children.This report describes a DPB case resolved with long-term azithromycin therapy,em-phasizing the need for a timely and accurate diagnosis.CASE SUMMARY A 12-year-old girl,diagnosed with asthma at age five and managed with inhaled corticosteroids and long-acting beta-2 agonists,developed a history of chronic productive cough and chronic sinusitis for a year.On examination,she exhibited wheezing and coarse crackles.Despite receiving treatment for an asthma exacer-bation,her symptoms did not improve.A chest X-ray revealed reticulonodular infiltration in both lower lungs,prompting further evaluation with high-resolu-tion computed tomography(HRCT).The HRCT confirmed centrilobular nodule opacities,a'tree-in-bud'pattern,and non-tapering bronchi,suggesting DPB.Elevated cold hemagglutinin titers at 128 further supported the diagnosis.Her cough and sinusitis resolved within a month after starting azithromycin therapy,chosen for its anti-inflammatory and immunomodulatory effects.Follow-up HRCT scans after 1 year of continuous treatment showed complete normalization.CONCLUSION This case highlights the importance of early diagnosis and prompt treatment in achieving favorable outcomes for DPB.展开更多
BACKGROUND Pediatric perforated appendicitis(PPA)is a severe acute condition requiring surgical intervention and postoperative antibiotic therapy.Antibiotic selection differs significantly among pediatric centers,and ...BACKGROUND Pediatric perforated appendicitis(PPA)is a severe acute condition requiring surgical intervention and postoperative antibiotic therapy.Antibiotic selection differs significantly among pediatric centers,and an ideal postoperative antiinfective approach for PPA management has yet to be established.AIM To examine the spectrum of pathogenic bacteria in pediatric PPA and to summarize the postoperative experience with carbapenem(CBP)and cephalosporin(CPS)antibiotics.METHODS We retrospectively analyzed medical records of 65 children(43 boys,22 girls;mean age 6.92±3.41 years)with PPA who underwent surgery at our hospital between December 2019 and August 2022.Data were collected in September 2023.Based on postoperative antibiotic selection,patients were divided into CBP(32 cases)and CPS(33 cases)groups.Chi-square and T-tests compared recovery outcomes,while univariate and multivariate regression models identified independent factors affecting postoperative recovery.RESULTS There were no significant differences between the two groups in gender,age,weight,height,body mass index,baseline ear temperature,or heart rate(P>0.05).Escherichia coli(40.00%)and Pseudomonas aeruginosa(24.62%)were the most common pathogens in PPA.Postoperative analysis showed significantly shorter C-reactive protein(CRP)recovery times in the CPS group than in the CBP group[(6.18±1.84)vs(8.12±3.48)days,P=0.009].Univariate logistic regression indicated CPS selection(OR=0.32,95%CI:0.10-0.97,P=0.044)was significantly associated with a higher CRP recovery rate within 7 days.Multivariate analysis confirmed CPS selection(OR=3.49,95%CI:1.19-10.24,P=0.023)as an independent factor affecting CRP recovery within 7 days postoperatively.CONCLUSION The choice of CBP or CPS independently affects CRP recovery within 7 days.CBP offers no advantage over CPS in treating PPA,with CPS also demonstrating favorable clinical outcomes.展开更多
文摘Childhood Onset Conduct Disorder [CD] is a condition characterized by at least one symptom of conduct disorder (based on Diagnostic and Statistical Manual of Mental Disorders criteria—Fifth Edition) prior to 10 years of age. Children affected exhibit disruptive behaviors, usually negative, hostile, and defiant behavior similar to Oppositional Defiant Disorder [ODD]. As the child gets older they begin to display more characteristic of Conduct Disorder (lying, fighting, and stealing, vindictive behavior). These children are also likely to have comorbidities including Attention Deficit Hyperactivity Disorder (ADHD), learning disabilities, poor academic achievement, and substance abuse. Distinguishing early between symptoms of Conduct Disorder versus other differential diagnoses is essential in effective treatment. Early intervention with these children leads to a better prognosis and likelihood of functioning in society. This case illustrates the difficulty of diagnosing a young child with Childhood Onset Conduct Disorder.
文摘Background: In Bolivia there are few probiotic preparations available in the market, practically without alternatives to the use of freeze-dried products. An alternative used as a good alternative in other parts of the world is yogurt with a probiotic strain added. In this study we report the use of a locally prepared yogurt with a lyophilized probiotic added. Methods: This is randomized, double-blind and controlled clinical trial in children hospitalized with acute diarrhoea carried out at the Paediatric Centre Albina Pati?o in Cochabamba, Bolivia with children 10 to 35 months participating. Children were randomly assigned to receive an oral rehydration solution and Saccharomyces boulardii (positive control) or the same solution plus yogurt preparation containing Lactobacillus rhamnosus (yogurt group). The primary outcome was the duration of diarrhoea. Secondary outcomes were the duration of fever, vomiting and hospitalization. Results: Of the 74 children incorporated 42 completed the protocol;baseline characteristics were similar in both groups. The median duration of diarrhoea was similar in children who received yogurt (71 hours) and controls (79 hours) (p = 0.3). The mean duration of fever was also similar in both groups: S. boulardii (24 hours) or yogurt (11 hours) (p = 1.02), as was the duration of vomiting: 17 hours vs. 32 hours in the control group (p = 0.37). A significant difference in the numbers of daily bowel movements was observed in the third day, the probiotic group was lower (p = 0.01). There was no effect on the duration of hospitalization (p = 0.26). Conclusions: The use of a yogurt containing L. rhamnosus has an effect comparable to S. boulardii. Introduction of yoghurt with a probiotic in the diet of patients hospitalized with acute diarrhoea may help reduce its duration, regardless of its aetiology.
文摘Purpose: Determine the safety and efficacy of early enteral feeding after distal elective bowel anastomoses (DEBA) in children. Methods: Controlled randomized trial including pediatric patients with DEBA, excluding non-elective and high risk patients. Variables: Demographics, operative time, anastomosis placement, beginning peristalsis and bowel movement, time to full diet intake, post-operative stay, persisting vomiting and abdominal distention, wound infection or dehiscence, anastomotic leak, reoperation, death. Randomization into: 1) Experimental group (EG): early feeding group, after a minimum 24 hours fasting period, oral fluids and diet was started;2) Control group (CG): obligatory 5-day fasting. Descriptive Statistics: Student’s t test for quantitative and Chi square for qualitative variables, a p-value 0.05 was considered significant. Results: 60 patients were included since June 2003 to May 2004, 30 ineach group. Mean age 2 years, weight16 kg, malnutrition 33%. Stomal Ethiology: Anorectal-malformation 46%, Hirschsprung 13%, inflammatory 35%, tumoral 5%. Mostly in colon 71%. Mean surgical time 142 min. None developed vomiting or required nasogastric-tube. Mild abdominal distension 13%, mild fever 16.5% and wound complications 18%. Anastomosis leakage 6.5%, none required reoperations. Demographic variables showed no statistical differences. Full oral intake was in the 2nd postoperative day in the EG vs CG (p = 0.001). Postoperative hospital stay was 6.0 ± 3 in the EG vs 9.8 ± 4 days in the CG with clinical but not statistical significance. Peristalsis beginning, first flatus passage and bowel movements showed no statistical differences. The complication incidence was low and equally distributed. Conclusions: Early feeding after DEBA is safe and well tolerated in children.
文摘·AIM:To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).·METHODS:This observational case-control study included a case group of 122 children less than two years of age with CNLDO who underwent probing and irrigation treatment at the ophthalmology department of Imam Khomeini Hospital in Ahvaz,Iran,from June 2022 to June2024.A control group of 122 age-matched children without CNLDO was also included for comparison.Data was collected from the children's medical records.·RESULTS:The study found a significant correlation between the occurrence of CNLDO and several maternal factors,such as preeclampsia,the use of levothyroxine,hypothyroidism,having more than three pregnancies(gravidity>3),natural pregnancy,and gestational diabetes mellitus.Additionally,in children,factors,such as oxygen therapy,anemia,reflux,jaundice,and a family history of CNLDO in first-degree relatives were associated with CNLDO,and maternal preeclampsia and hypothyroidism were found to significantly increase the risk of developing CNLDO in children.·CONCLUSION:Given that CNLDO affects both premature and full-term children,the present findings may potentially facilitate the early identification of children and infants at risk of nasolacrimal duct obstruction,thereby preventing the onset of chronic dacryocystitis.
基金supported by the STI 2030-Major Projects,No. 2021ZD0200500 (to XS)。
文摘Brain-derived neurotrophic factor is a crucial neurotrophic factor that plays a significant role in brain health. Although the vast majority of meta-analyses have confirmed that exercise interventions can increase brain-derived neurotrophic factor levels in children and adolescents, the effects of specific types of exercise on brain-derived neurotrophic factor levels are still controversial. To address this issue, we used meta-analytic methods to quantitatively evaluate, analyze, and integrate relevant studies. Our goals were to formulate general conclusions regarding the use of exercise interventions, explore the physiological mechanisms by which exercise improves brain health and cognitive ability in children and adolescents, and provide a reliable foundation for follow-up research. We used the Pub Med, Web of Science, Science Direct, Springer, Wiley Online Library, Weipu, Wanfang, and China National Knowledge Infrastructure databases to search for randomized controlled trials examining the influences of exercise interventions on brain-derived neurotrophic factor levels in children and adolescents. The extracted data were analyzed using Review Manager 5.3. According to the inclusion criteria, we assessed randomized controlled trials in which the samples were mainly children and adolescents, and the outcome indicators were measured before and after the intervention. We excluded animal experiments, studies that lacked a control group, and those that did not report quantitative results. The mean difference(MD;before versus after intervention) was used to evaluate the effect of exercise on brain-derived neurotrophic factor levels in children and adolescents. Overall, 531 participants(60 children and 471 adolescents, 10.9–16.1 years) were included from 13 randomized controlled trials. Heterogeneity was evaluated using the Q statistic and I^(2) test provided by Review Manager software. The meta-analysis showed that there was no heterogeneity among the studies(P = 0.67, I^(2) = 0.00%). The combined effect of the interventions was significant(MD = 2.88, 95% CI: 1.53–4.22, P < 0.0001), indicating that the brain-derived neurotrophic factor levels of the children and adolescents in the exercise group were significantly higher than those in the control group. In conclusion, different types of exercise interventions significantly increased brain-derived neurotrophic factor levels in children and adolescents. However, because of the small sample size of this meta-analysis, more high-quality research is needed to verify our conclusions. This metaanalysis was registered at PROSPERO(registration ID: CRD42023439408).
文摘Mycoplasma pneumoniae(M.pneumoniae)is a common pathogen that causes community-acquired pneumonia in children.The clinical presentation of this pathogen can range from mild self-limiting illness to severe and refractory cases.Complications may occur,such as necrotizing pneumonia and respiratory failure.Extrapulmonary complications,including encephalitis,myocarditis,nephritis,hepatitis,or even multiple organ failure,can also arise.In this editorial,we dis-cuss the clinical implications of the significant findings from the article"Serum inflammatory markers in children with M.pneumoniae pneumonia and their predictive value for mycoplasma severity"published by Wang et al.They reported that measuring lactic dehydrogenase,interleukin-6 levels,and D-dimer effectively predicts refractory M.pneumoniae pneumonia cases.
基金Supported by the Shijiazhuang Science and Technology Research and Development Program,No.221460383.
文摘BACKGROUND Emotional reactions,such as anxiety,irritability,and aggressive behavior,have attracted clinical attention as behavioral and emotional problems in preschool-age children.AIM To investigate the current status of family rearing,parental stress,and behavioral and emotional problems of preschool children and to analyze the mediating effect of the current status of family rearing on parental stress and behavioral/emo-tional problems.METHODS We use convenience sampling to select 258 preschool children in the physical examination center of our hospital from October 2021 to September 2023.The children and their parents were evaluated using a questionnaire survey.Pearson's correlation was used to analyze the correlation between child behavioral and emotional problems and parental stress and family rearing,and the structural equation model was constructed to test the mediating effect.RESULTS The score for behavioral/emotional problems of 258 preschool children was(27.54±3.63),the score for parental stress was(87.64±11.34),and the score for parental family rearing was(31.54±5.24).There was a positive correlation between the behavioral and emotional problems of the children and the“hostile/mandatory”parenting style;meanwhile,showed a negative correlation with the“support/participation”parenting style(all P<0.05).The intermediary effect value between the family upbringing of parents in parental stress and children's behavior problems was 29.89%.CONCLUSION Parental family upbringing has a mediating effect between parental stress and behavioral and emotional problems of children.Despite paying attention to the behavioral and emotional problems of preschool-age children,clinical medical staff should provide correct and reasonable parenting advice to their parents to promote the mental health of preschool-age children.
文摘BACKGROUND Although breast milk is ideal for newborns,in some cases,it is replaced with cow’s milk,which contains proteins that increase the risk of cow’s milk protein allergy(CMPA).AIM To evaluate CMPA prevalence in Bahrain and compare clinical characteristics of children with immunoglobulin E(IgE)-and non-IgE-mediated CMPA.METHODS This retrospective cohort study examined children with CMPA diagnosed at the pediatric gastroenterology outpatient clinic of the Salmaniya Medical Complex,Bahrain,between 2014 and 2022,and assessed CMPA prevalence.Clinical presentations,laboratory findings,dietary modifications,and outcomes were compared between children with IgE-mediated and non-IgE-mediated CMPA.Categorical variables were compared using Fisher’s exact test or Pearson’sχ2 test,whereas continuous variables were compared using Student’s t-test or the Mann-Whitney U test.RESULTS Of 8332 patients,6022(72.3%)adhered to their appointment.Of them,618(10.3%)were suggested of having CMPA and 595(96.3%)were included;CMPA prevalence was 2%.Most patients were Bahraini(93.8%)and males(55.3%).Non-IgE-mediated type accounted for 77.3%cases and IgE-mediated type,22.7%.IgE-mediated CMPA presented more in boys(P=0.030),and later in life(5.1 months±4.5 months vs 4.2 months±4.2 months,P=0.016,95%CI:0.08-1.73),had more associated diseases(P<0.001);and presented with more cutaneous(P=0.024)and respiratory(P=0.003)manifestations,severe symptoms[rash/dry skin(P=0.031),facial swelling/angioedema(P=0.003),failure to thrive(P=0.013),apparent life-threatening event(P<0.001)],and positive physical findings(P=0.002)than non-IgE-mediated CMPA.Most patients were exclusively fed cow milk formula(50.3%).The amino acid-based formula(AAF)was most prescribed(60.5%)with no difference between the two types(P=0.173).Although breastfeeding was recommended to 49.6%,only 8.2%were exclusively breastfed.IgE-mediated CMPA was associated with a longer follow-up duration than non-IgE-mediated CMPA(17.3 months±14.0 months vs 13.5 months±13.4 months,P=0.005,95%CI:1.1-6.3).CONCLUSION This study revealed a high CMPA prevalence with clinical differences between both types that can influence treatment.AAF was most prescribed,while breastfeeding with dietary modification is rarely applied.
文摘BACKGROUND Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental growth.Although common characteristics distinguish peaky eaters,including food selectivity,food neophobia,and food avoidance,there is no clear definition to assess this behavior.Due to the unavailability of data regarding picky eating,it wasn’t easy to estimate its prevalence.AIM To develop a regional protocol to help healthcare professionals identify and manage mild and moderate picky eating cases.METHODS A virtual roundtable discussion was held in April 2021 to gather the opinions of seven pediatricians and two pediatric dietitians from eight Middle Eastern countries who had great experience in the management of picky eating.The discussion covered different topics,including clearly defining mild and moderate picky eating,identifying the role of diet fortification in these cases,and the possibility of developing a systematic approach to diet fortification.RESULTS The panel identified picky eating as consuming an inadequate amount and variety of foods by rejecting familiar and unfamiliar food.Most of the time,moderate picky eating cases had micronutrient deficiencies with over-or undernutrition;the mild cases only showed inadequate food consumption and/or poor diet quality.Paying attention to the organic red flags like growth faltering and development delay and behavioral red flags,including food fixation and anticipatory gagging,will help healthcare professionals evaluate the picky eaters and the caregivers to care for their children.Although dietary supplementation and commercial food fortification play an important role in picky eating,they were no benefit in the Middle East.CONCLUSION The panel agreed that food fortification through a food-first approach and oral nutritional supplements would be the best for Middle Eastern children.These recommendations would facilitate identifying and managing picky-eating children in the Middle East.
文摘BACKGROUND In multisystem inflammatory syndrome in children(MIS-C)with coronavirus disease 2019,there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal outcomes.We planned to estimate the pattern of cardiovascular involvement among children with MIS-C and its mid-term outcomes.AIM To determine association between cardiovascular abnormalities and clinical and laboratory parameters.To study the time-line for resolution of various abnormalities.METHODS In this prospective study done in a tertiary care hospital,270 were recruited from June 2020 to January 2022.Baseline demographic data and clinical presentation were recorded.Laboratory parameters and echocardiography were done at admission.Follow-up was done at 2 weeks,3 months,6 months and 1 year after diagnosis.Descriptive statistics were used for parametric and non-parametric data.Risk factors were identified by multivariate regression analysis.RESULTS The 211(78.2%)had cardiac involvement and 102 needed intensive care unit(ICU)admission.Cardiovascular abnormalities observed were shock 123(45.6%),coronary dilatation 28(10.4%),coronary aneurysm 77(28.5%),left ventricular(LV)dysfunction 78(29.3%),mitral regurgitation(MR)77(28.5%)and pericardial effusion 98(36.3%).Coronary artery aneurysm/dilatation during follow-up at 2 weeks and 1 year were 25.7%and 0.9%respectively.Multivariate regression analysis revealed breathlessness[odds ratio(OR)=3.91,95%CI:1.25-12.21,P=0.019]and hi-flow nasal cannula(HFNC)support(OR=8.5,95%CI:1.06-68.38,P=0.044)as predictors of cardiovascular involvement.Higher mean age(OR=1.16,95%CI:1.02-1.32,P=0.026),breathlessness(OR=4.99,95%CI:2.05-12.20,P<0.001),gallop(OR=4.45,95%CI:0.41-2.52,P=0.016),MR(OR=3.61,95%CI:1.53-8.53,P=0.004)and invasive ventilation(OR=4.01,95%CI:1.28-12.58,P=0.017)were predictive of LV dysfunction.Altered sensorium(OR=4.96,95%CI:2.23-11.02,P<0.001),headache(OR=6.61,95%CI:1.46-29.92,P=0.014),HFNC(OR=7.03,95%CI:2.04-24.29,P=0.002),non-rebreathing mask usage(OR=21.13,95%CI:9.00-49.61,P<0.001)and invasive ventilation(OR=5.64,95%CI:1.42-22.45,P=0.014)were risk factors for shock.Anemia was a risk factor for coronary involvement(OR=3.09,95%CI:1.79-5.34,P<0.001).CONCLUSION Significant number of children with MIS-C had cardiovascular involvement contributing to higher ICU management.Although shock resolved quickly,resolution of ventricular function and coronary abnormalities were slower,and hence warrants a structured long-term follow-up protocol.
文摘Determining the predictors of screen media use will assist nurses and clinicians to identify the children that are in most need for intervention. There is limited literature regarding the predictors of screen media use among children. This study aimed to examine the association between selected predictors and screen media use among children aged 3 - 13. The findings of this study are based on 192 children aged 3 - 13 and their caregivers recruited from Facebook and WhatsApp groups. A descriptive cross-sectional design was employed. The participants filled a demographic questionnaire and the Problematic Media Use Measure Short Form to obtain data about parents’ and children characteristics, screen time and problematic use of media. The screen time for 83% of the children was more than two hours. Mobile ownership (beta (β) = 0.22) and conflict about mobile use (beta (β) = 0.16) have significantly predicted the child total screen time. Child age (beta (β) = 0.17) and conflict about mobile use (beta (β) = −0.33) have significantly predicted the problematic use of media. Most children in the current study exceeded the recommended screen time. There is an urgent need to implement interventions that mitigate children’s excessive use of media.
文摘Background: In children, acute bacterial rhinosinusitis (ABRS) is often complicated by ophthalmological and/or neurological involvement. These complications should be known and recognized, as they require urgent treatment with intravenous antibiotics and close in-hospital monitoring. In this study, we aimed to identify the main risk factors associated with the development of complications in children aged 2 - 17 years with ABRS. Methods: We conducted a retrospective cohort study of patients with ABRS complications in a primary hospital. Participants were divided into two groups: the control group comprising patients without complications (Group 1, n = 82) and the study group comprising patients with complications requiring hospitalization (Group 2, n = 41). We assessed the sociodemographic, clinical, and imaging data of both groups. Using multivariate logistic regression, we assessed risk factors of ABRS complications. Results: No socio-demographic characteristics were associated with ABRS complications (p ≥ 0.05). Factors associated with complications were delay in consultation (t = 5.282;p Conclusions: Intracranial and extracranial complications of ABRS in children have become rare in our setting. These complications can be serious and potentially fatal. Risk factors of these complications are delays in consultation, the presence of ophthalmological signs, and more than one affected sinus. Controlling modifiable factors would improve the treatment success of ABRS complications in children.
文摘Fever is the primary reason for consultation and admission to pediatric emergency departments. The aim of this study was to describe the clinical, etiological and prognostic aspects of acute fever in children aged 0 - 15 years. Patients and Methods: This was a prospective cross-sectional study from April 1, 2021 to March 31, 2022 and affected all children aged 0 to 15 years old with a temperature of 39˚C or higher (≥), having less than five days and hospitalized in the pediatric department of the Gabriel Touré University Hospital. Results: During the study period, 150 children were included, the sex-ratio was 0.85. Children aged 0 - 5 years represented 71.4% of the sample. References represented more than half of the sample, or 58% of cases. Body temperature was above 40˚C in 18.7% of cases. Functional signs were dominated by respiratory signs in 28% and digestive signs in 18%. Clinical pallor was found in 55.3% of children associated with signs of respiratory struggle in 70% of cases and tachycardia in 40% of patients. Anemia was present in 65.3% of patients. Hyperleucocytosis and leukopenia were found in 45.3% and 43.3% of patients respectively. The C-reactive protein was positive in 44.7% of patients and Cytobacteriological Examination and Chemistry of Cerebrospinal Fluid was positive in 8.7% of cases. The thick drop was positive in 44.7% of patients and blood cultures grew in 6 patients. Etiology was dominated by severe malaria 54 cases (36%), pneumonia (19.3%), meningitis (12.6%), and in those under one month it was bacterial neonatal infection (8.6%). In our study, slightly more than one patient out of three died during hospitalization, 36% (54 cases/150) and among these 70% (38 cases/54) were under 5 years old. The most lethal pathologies were severe malaria (36%), bacterial pneumonia (19.3%), meningitis (12.6%), bacterial neonatal infections (8.6%) and measles complicated by pneumonia (5.3%). Mortality during hospitalization was 36% of deaths (54 out of 150 patients) and 70.3% (38/54) of the deceased patients were under 5 years old. Conclusion: This study shows that fever is a frequent symptom and a sign of serious and very lethal pathologies. The cause of fever can be a diagnostic challenge for health workers. However, early identification of children at risk for serious illness could allow for prompt and appropriate management in appropriate settings.
文摘Purpose: To evaluate open lower limb trauma management in children. Me-thod: We conducted a twelve-month cross-sectional prospective study. Results: Open trauma of lower limb had 7.9% of hospital frequency. Mean age was 8 years with a sex ratio of 2.45. In 68.4% of cases, trauma occurred in road traffic accidents. Average consultation time was 2.4 hours. Trauma mainly affected the leg in 39.5% of cases, and the thigh in 34.2%. Soft tissue wounds occurred in 52.6% of cases, and open fractures in 47.4%. Average response time was one hour. Wound trimming and suturing were performed in 76.3% of cases and combined with bone nailing in 15.8%. The outcome was favorable in 92.1% of cases. Average hospital stay was 4.37 days. Conclusion: Open trauma to the lower limb is a frequent and occurs mainly in road traffic accidents. Management was early, with a favorable outcome for most patients and a short hospital stay.
文摘Objective: To study the effects of starting antiretroviral treatment (ART) prior the age of two years on the growth (height and weight) of HIV-infected children. Methodology: This was a retrospective cohort study. HIV-infected children on ART aged less than 15 years were divided into two groups Group 1 (G1) comprising children who started ART prior 2 years and Group (G2) those put on treatment thereafter. Main Measures: Percentage of children with growth retardation measured by Height for Age (H/A) and Weight for Age (W/A) Results: In total, we included 90 subjects. The median age was 10 years with a slight female predominance (51.2%). Most children were asymptomatic at the time of the study (96.6%), compliant with treatment (81%), 54.8% of children were on cotrimoxazole, 33% knew their status. At initiation, underweight was predominant in group 1 compared to group 2 (52% versus 29.5%;p = 0.015). Conversely, stunted growth predominated in G2 compared to G1 but without significant difference (38% versus 50%;p = 0.147). At the time of our study (median age of 10 years), catch-up height and weight predominated in G1 compared to G2;only a small proportion remained below −2SD (4% versus 18.2%;p = 0.015 and 9% versus 29.5%;p = 0.006 respectively for underweight and stunted growth). Conclusion and Global Health Implications: Growth retardation was common at ART initiation. Catch-up in height was more evident in the early treatment group. Initiation of ART before the age of 2 years rather influences children’s height than weight. The result of this study further emphasizes the need of early ART and closed clinical monitoring to better assess the impact of ART in areas with high rates of undernutrition.
文摘Introduction: Reducing and maintaining viral load is crucial to reducing morbidity and mortality associated with HIV infection in children. The aim of this study was to determine the factors influencing the maintenance of children and adolescents on antiretroviral therapy in the continuum of care. Methodology: This was a descriptive and analytical cross-sectional study conducted from August 1 to August 31, 2023. It included all children living with HIV, under 15 years of age, with at least two viral load results and whose parents consented to participate in the study. Participants were recruited during their child’s treatment renewal consultations. Results: The study included 143 children, mostly boys (55.2%), with a mean age of 11.54 years (±2.8). More than half (55.2) were unaware of their HIV-positive status, and most treatments were administered by parents (60.8%). Of the 99 children with an undetectable viral load at the first test, 23 (23.2%) showed a viral rebound at the last test, mainly due to poor treatment compliance (p Conclusion: Virological rebound after suppression in children is worrying. It is crucial that the national AIDS program improves Therapeutic Education, trains health workers to communicate results and encourages ongoing dialogue with young people to reinforce adherence and maintain viral suppression.
文摘Introduction: Vitamin D plays a key role in phosphocalcic metabolism, in normal functioning of the immune system and in the prevention of certain forms of cancer. Systematic vitamin D supplementation has been implemented in most Western countries, which has drastically reduced the prevalence of rickets. In Senegal, a country with enough sunshine, no large-scale data exists on vitamin D deficiency in children. In addition, there are no guidelines from the Ministry of Health and Social Action (MoHSA) on vitamin D supplementation. Our objective was to determine the prevalence of vitamin D deficiency in children aged 6 to 59 months and to analyze the factors associated with it at the Institute of Social Pediatrics in Pikine-Guédiawaye, a suburb of Dakar. Patients and Methods: This was a prospective, descriptive and analytical cross-sectional study over a 3-month period (from January to March 2024) at the Institute of Social Pediatric (IPS) of Pikine-Guédiawaye. The study population consisted of all children aged 6 to 59 months free from any acute or chronic pathology, whose parents had agreed to answer the questionnaires after having consented and signed the consent and children who had had a sample taken for vitamin D dosage. Results: We included 102 children, 35 of whom had vitamin D deficiency, i.e. a prevalence of 34.31% with a slight male predominance (sex ratio 1.05). Infants aged 13 - 24 months were more affected (41.67%), but the difference was not statistically significant (p-value = 0.385). Patients with acute malnutrition had a significantly higher prevalence of vitamin D deficiency (54.17% of cases versus 28.38%) in those without acute malnutrition (p = 0.02). On the other hand, chronic malnutrition, underweight and diversification foods were not significantly associated with vitamin D deficiency (p of 0.60, 0.42 and 0.09 respectively). Conclusion: Vitamin deficiency affects one-third of apparently healthy children under 5 and this deficiency has no significant relationship with diversification foods. This suggests that the observed vitamin D deficiencies are less related to diet than to lack of sun exposure.
文摘Purpose This study aimed to provide comparative evidence on the effectiveness of various lifestyle interventions on body composition management for preschool and school-aged children.Methods PubMed(MEDLINE),Embase,CINAHL,and Web of Science were systematically searched for this network meta-analysis.Randomized controlled studies(RCTs)that included children aged 4-12 years with no physical or mental conditions;performed at least 1 type of lifestyle intervention;reported change in body mass index(BMI),BMI z-score,or body fat percentage(BFP);and were published between January 2010 and August 2023 were included.Results The final analysis included 91 RCTs with aggregate data for 58,649 children.All interventions were categorized into single-arm approaches(physical activity,diet,and behavioral and informational support)and combined arms approaches(bicomponent and multicomponent treatment).Multicomponent treatment showed significant effectiveness on the reduction of BMI(mean deviation(MD)−0.49,95%confidence interval(95%CI):-0.88 to-0.12),BMI z-score(MD=-0.11,95%CI:-0.18 to-0.04),and BFP(MD=-1.69,95%CI:-2.97 to-0.42)compared to the usual care condition.Bicomponent treatment also significantly reduced BMI(MD=-0.28,95%CI:-0.54 to-0.04)and BMI z-score(MD=-0.07,95%CI:-0.12 to-0.02)compared to usual care.Conclusion Interventions targeting multiple lifestyle components achieved greater reductions in children's BMI and BFP.Among single-component approaches,physical activity engagement emerged as the most effective.These findings should guide practitioners in recommending comprehensive lifestyle modifications for children.Moreover,children with higher initial BMI and body fat levels tend to exhibit more positive responses to lifestyle interventions aimed at managing obesity.
文摘BACKGROUND Diffuse panbronchiolitis(DPB)is a rare,chronic inflammatory lung disease mar-ked by chronic cough,breathlessness,and preceding sinusitis.Symptoms often persist for years and can be misdiagnosed as asthma,particularly in children.This report describes a DPB case resolved with long-term azithromycin therapy,em-phasizing the need for a timely and accurate diagnosis.CASE SUMMARY A 12-year-old girl,diagnosed with asthma at age five and managed with inhaled corticosteroids and long-acting beta-2 agonists,developed a history of chronic productive cough and chronic sinusitis for a year.On examination,she exhibited wheezing and coarse crackles.Despite receiving treatment for an asthma exacer-bation,her symptoms did not improve.A chest X-ray revealed reticulonodular infiltration in both lower lungs,prompting further evaluation with high-resolu-tion computed tomography(HRCT).The HRCT confirmed centrilobular nodule opacities,a'tree-in-bud'pattern,and non-tapering bronchi,suggesting DPB.Elevated cold hemagglutinin titers at 128 further supported the diagnosis.Her cough and sinusitis resolved within a month after starting azithromycin therapy,chosen for its anti-inflammatory and immunomodulatory effects.Follow-up HRCT scans after 1 year of continuous treatment showed complete normalization.CONCLUSION This case highlights the importance of early diagnosis and prompt treatment in achieving favorable outcomes for DPB.
基金Supported by Jiaxing Science and Technology Plan Project,No.2024AD30035.
文摘BACKGROUND Pediatric perforated appendicitis(PPA)is a severe acute condition requiring surgical intervention and postoperative antibiotic therapy.Antibiotic selection differs significantly among pediatric centers,and an ideal postoperative antiinfective approach for PPA management has yet to be established.AIM To examine the spectrum of pathogenic bacteria in pediatric PPA and to summarize the postoperative experience with carbapenem(CBP)and cephalosporin(CPS)antibiotics.METHODS We retrospectively analyzed medical records of 65 children(43 boys,22 girls;mean age 6.92±3.41 years)with PPA who underwent surgery at our hospital between December 2019 and August 2022.Data were collected in September 2023.Based on postoperative antibiotic selection,patients were divided into CBP(32 cases)and CPS(33 cases)groups.Chi-square and T-tests compared recovery outcomes,while univariate and multivariate regression models identified independent factors affecting postoperative recovery.RESULTS There were no significant differences between the two groups in gender,age,weight,height,body mass index,baseline ear temperature,or heart rate(P>0.05).Escherichia coli(40.00%)and Pseudomonas aeruginosa(24.62%)were the most common pathogens in PPA.Postoperative analysis showed significantly shorter C-reactive protein(CRP)recovery times in the CPS group than in the CBP group[(6.18±1.84)vs(8.12±3.48)days,P=0.009].Univariate logistic regression indicated CPS selection(OR=0.32,95%CI:0.10-0.97,P=0.044)was significantly associated with a higher CRP recovery rate within 7 days.Multivariate analysis confirmed CPS selection(OR=3.49,95%CI:1.19-10.24,P=0.023)as an independent factor affecting CRP recovery within 7 days postoperatively.CONCLUSION The choice of CBP or CPS independently affects CRP recovery within 7 days.CBP offers no advantage over CPS in treating PPA,with CPS also demonstrating favorable clinical outcomes.
