The international scientific literature presents still incipient results regarding the management of cancer symptom clusters by oncology nursing,especially in pediatric oncology.This is a promising field of investigat...The international scientific literature presents still incipient results regarding the management of cancer symptom clusters by oncology nursing,especially in pediatric oncology.This is a promising field of investigation for clinical nurses and researchers,and when it is subsidized by medium-range theories,they co-rroborate the diagnoses and interventions of nursing in oncology,enhancing the science of nursing care.This minireview article aims to discuss the utilizing the hospital clowns as a complementary therapy,to enhance quality of life and reduce stress and fatigue in pediatric cancer patients.Overall,the evidence presented so far pointed out that complementary therapy might help improve the quality of life of pediatric cancer patients,and that complementary therapy usage should be part of a health comprehensive care model,delivering therapeutic approaches that might enhance the mind-body during a pediatric cancer patients’life span.The results of scientific investigations by nurses,particularly those linked to the basic sciences,play a critical role in advancing personalized care in pediatric integrative oncology.展开更多
Objective:This article employs a scoping review methodology,integrates knowledge and information about current pediatric nurses'practices and perceptions regarding family-centered care in pediatric settings.Method...Objective:This article employs a scoping review methodology,integrates knowledge and information about current pediatric nurses'practices and perceptions regarding family-centered care in pediatric settings.Methods:Published articles were retrieved from databases including EBSCO host,PubMed,Springer,Science Direct,Ovid,and CINAHL between 2013 and 2023.Results:The finding shows a better understanding of pediatric nurses'perceptions of family-centered care in association with their clinical settings.However,the evidence indicates that integrating family-centered care components into health care services is difficult and confusing to nurses and is often not implemented in a clinical setting.As evidenced by this review,studies have consistently reported similar results;family-centered care was a good perception and understood by pediatric nurses as a concept but inconsistently used in a daily practice setting.Conclusions:This scoping review is the first phase in promoting a strategic plan to provide educational interventions for pediatric nurses to implement family-centered care in their daily practice settings.It's necessary to recognize pediatric nurses'perceptions and practices concerning family-centered care to provide optimal healthcare services in pediatric settings.展开更多
BACKGROUND Although critically ill pediatric patients can benefit from the use of sedation,it can cause side effects and even iatrogenic complications.Since pediatric patients cannot adequately express the intensity o...BACKGROUND Although critically ill pediatric patients can benefit from the use of sedation,it can cause side effects and even iatrogenic complications.Since pediatric patients cannot adequately express the intensity or location of the pain,discriminating the cause of their irritability and agitation can be more complicated than in adults.Thus,sedation therapy for children requires more careful attention.AIM To evaluate the association of the internal parental care protocol and the reduction in pediatric intensive care unit(PICU)postoperatively.METHODS This retrospective cohort study was carried out in the PICU of the tertiary medical center in Kazakhstan.The internal parental care protocol was developed and implemented by critical care team.During the pandemic,restrictions were also placed on parental presence in the PICU.We compare two groups:During restriction and after return to normal.The level of agitation was evaluated using the Richmond Agitation-Sedation Scale.Univariate and multivariate logistic regression analyses were performed to examine associations of parental care with sedation therapy.RESULTS A total of 289 patients were included in the study.Of them,167 patients were hospitalized during and 122 after the restrictions of parental care.In multivariate analysis,parental care was associated with lower odds of prescribing diazepam(odds ratio=0.11,95%confidence interval:0.05-0.25),controlling for age,sex,cerebral palsy,and type of surgery.CONCLUSION The results of this study show that parental care was associated only with decreased odds of prescribing sedative drugs,while no differences were observed for analgesics.展开更多
BACKGROUND The management of pediatric choledocholithiasis is complicated by anatomical constraints and the subsequent risks of conventional therapies requiring external drainage.This case report introduces a novel la...BACKGROUND The management of pediatric choledocholithiasis is complicated by anatomical constraints and the subsequent risks of conventional therapies requiring external drainage.This case report introduces a novel laparoscopic microincision tech-nique at the cystic duct confluence,designed to eliminate T-tube dependence,minimize ductal trauma,and expedite recovery,which are critical priorities for active children.We present this innovation to address unmet pediatric-specific surgical needs and demonstrate its feasibility as a tailored,minimally invasive solution for choledocholithiasis in children.A 12-year-old girl with a 5-year history of recurrent upper abdominal pain was diagnosed with choledocholithiasis,cholelithiasis,and biliary pancreatitis based on imaging and laboratory tests.After failed conservative management,laparo-scopic cholecystectomy with a microincision at the cystic duct confluence enabled choledochoscopic extraction of seven stones without T-tube placement.Primary closure using absorbable sutures with cystic duct confluence preserved biliary integrity.Postoperatively,liver function and amylase levels normalized by day 3,and abdominal ultrasonography confirmed no complications.The patient promptly resumed normal activity with no recurrence observed at the 16-month follow-up visit.This approach avoids external drainage,minimizes ductal manipulation,and optimizes recovery,which are key advantages for pediatric patients.CONCLUSION Microincision at the cystic duct confluence safely eliminates T-tubes,ensures stone clearance,and accelerates pediatric recovery.展开更多
Pediatric liver masses encompass a diverse spectrum of benign and malignant lesions,with distinct patterns based on patient age.Optimal imaging is critical for timely diagnosis,management,and prognosis.This pictorial ...Pediatric liver masses encompass a diverse spectrum of benign and malignant lesions,with distinct patterns based on patient age.Optimal imaging is critical for timely diagnosis,management,and prognosis.This pictorial minireview cate-gorizes pediatric liver masses by age group to guide hepatology and radiology practice,with an emphasis on imaging characteristics.In children from birth to six years of age,the most common liver masses include hepatoblastoma,the most common primary hepatic malignancy in this age group;infantile hemangioma,a benign vascular tumor with a characteristic appearance on imaging;and mesen-chymal hamartoma,a rare developmental lesion.For children older than six years,liver masses are distinct,with hepatocellular carcinoma being the predo-minant malignant lesion.Benign masses such as focal nodular hyperplasia and hepatocellular adenoma also emerge in this age range,often linked to hormonal influences or metabolic disorders.The masses observed across all pediatric age groups include hepatic cysts,choledochal cysts,hydatid cysts,pyogenic and amebic abscesses,tuberculosis,lymphoma,and metastases,each presenting with unique imaging features essential for differential diagnosis.This minireview provides a comprehensive,age-based overview of pediatric liver masses,focusing on clinical presentation and key imaging findings to support accurate diagnosis and optimize management strategies in clinical hepatology,particularly in low resource settings.展开更多
Background of the Study: Femoral shaft fracture is the most common pediatric injury requiring hospitalization. For children less than 5 years old, non-surgical approach is recommended. For pediatric patients 5 - 14 ye...Background of the Study: Femoral shaft fracture is the most common pediatric injury requiring hospitalization. For children less than 5 years old, non-surgical approach is recommended. For pediatric patients 5 - 14 years old, the most common mode of treatment is flexible intramedullary nailing with a known complication of pain at post-op site, inflammatory reaction/bursitis at the entry site, superficial and deep infection, knee synovitis, knee stiffness, leg length discrepancy, proximal nail migration, angulation or malunion, delayed and non-union, implant breakage. This study aims to present a rare complication of a femoral fracture fixed with flexible intramedullary nail. Methodology: We report the outcome of a 12-year-old male with peri implant fracture of the left femur. He underwent removal of plates and screws and subsequently fixed with flexible intramedullary nails. Patient was followed up at 1, 3, 7, and 10 months post-operatively. Varus-valgus, sagittal angulation, and limb shortening were measured pre- and post-operatively. Complications were recorded on each visit. Results: Pre-operative varus angulation was 10˚, pro-curvatum of 55˚ with limb shortening of 4 cm. Postoperatively, varus was maintained to 10˚ but pro-curvatum was corrected to 4˚ and limb shortening was reduced to 1 cm. However, after 1 month the varus angulation increased to 30˚ while maintaining sagittal pro-curvatum. Limb shortening also increased to 2 cm. New bone formation started to appear along the mechanical axis of the left femur which is apparent at 3 months post-op and pro-curvatum increased to 20˚. At 7 and 10 months post-op no signs of union was noted at the fracture site but the callus formation along the mechanical axis gradually matured and appeared as a new femoral shaft. Conclusion: Formation of new bone in response to unstable flexible intramedullary fixation in pediatric femoral shaft fracture is a very rare complication.展开更多
BACKGROUND Knowledge-based systems(KBS)are software applications based on a knowledge database and an inference engine.Various experimental KBS for computerassisted medical diagnosis and treatment were started to be u...BACKGROUND Knowledge-based systems(KBS)are software applications based on a knowledge database and an inference engine.Various experimental KBS for computerassisted medical diagnosis and treatment were started to be used since 70s(VisualDx,GIDEON,DXPlain,CADUCEUS,Internist-I,Mycin etc.).AIM To present in detail the“Electronic Pediatrician(EPed)”,a medical non-machine learning artificial intelligence(nml-AI)KBS in its prototype version created by the corresponding author(with database written in Romanian)that offers a physiopathology-based differential and positive diagnosis and treatment of ill children.METHODS EPed specifically focuses on the physiopathological reasoning of pediatric clinical cases.EPed has currently reached its prototype version 2.0,being able to diagnose 302 physiopathological macro-links(briefly named“clusters”)and 269 pediatric diseases:Some examples of diagnosis and a previous testing of EPed on a group of 34 patients are also presented in this paper.RESULTS The prototype EPed can currently diagnose 269 pediatric infectious and noninfectious diseases(based on 302 clusters),including the most frequent respiratory/digestive/renal/central nervous system infections,but also many other noninfectious pediatric diseases like autoimmune,oncological,genetical diseases and even intoxications,plus some important surgical pathologies.CONCLUSION EPed is the first and only physiopathology-based nml-AI KBS focused on general pediatrics and is the first and only pediatric Romanian KBS addressed to medical professionals.Furthermore,EPed is the first and only nml-AI KBS that offers not only both a physiopathology-based differential and positive disease diagnosis,but also identifies possible physiopathological“clusters”that may explain the signs and symptoms of any child-patient and may help treating that patient physiopathologically(until a final diagnosis is found),thus encouraging and developing the physiopathological reasoning of any clinician.展开更多
Photon-counting computed tomography(PCCT)represents a significant advancement in pediatric cardiovascular imaging.Traditional CT systems employ energy-integrating detectors that convert X-ray photons into visible ligh...Photon-counting computed tomography(PCCT)represents a significant advancement in pediatric cardiovascular imaging.Traditional CT systems employ energy-integrating detectors that convert X-ray photons into visible light,whereas PCCT utilizes photon-counting detectors that directly transform X-ray photons into electric signals.This direct conversion allows photon-counting detectors to sort photons into discrete energy levels,thereby enhancing image quality through superior noise reduction,improved spatial and contrast resolution,and reduced artifacts.In pediatric applications,PCCT offers substantial benefits,including lower radiation doses,which may help reduce the risk of malignancy in pediatric patients,with perhaps greater potential to benefit those with repeated exposure from a young age.Enhanced spatial resolution facilitates better visualization of small structures,vital for diagnosing congenital heart defects.Additionally,PCCT’s spectral capabilities improve tissue characterization and enable the creation of virtual monoenergetic images,which enhance soft-tissue contrast and potentially reduce contrast media doses.Initial clinical results indicate that PCCT provides superior image quality and diagnostic accuracy compared to conven-tional CT,particularly in challenging pediatric cardiovascular cases.As PCCT technology matures,further research and standardized protocols will be essential to fully integrate it into pediatric imaging practices,ensuring optimized diagnostic outcomes and patient safety.展开更多
In China pediatric liver transplantation(PLT)has become a safe and standardized procedure.Innovations and measures to further improve long-term survival and quality of life for children should be the next focus.In par...In China pediatric liver transplantation(PLT)has become a safe and standardized procedure.Innovations and measures to further improve long-term survival and quality of life for children should be the next focus.In particular better strategies related to the surgical treatment of high-risk recipients as well as the long-term follow-up of pediatric liver recipients have to be addressed.A particular attention should be given to children presenting significant co-morbidities and those needing retransplantation.A tight mul-tidisciplinary follow-up system addressing both short-and long-term issues of pediatric liver recipients is still a challenge for the Chinese pediatric transplant community.展开更多
BACKGROUND Functional gastrointestinal disorders(FGIDs)in children present with chronic symptoms like abdominal pain,diarrhea,and constipation without identifiable structural abnormalities.These disorders are closely ...BACKGROUND Functional gastrointestinal disorders(FGIDs)in children present with chronic symptoms like abdominal pain,diarrhea,and constipation without identifiable structural abnormalities.These disorders are closely linked to gut-brain axis dysfunction,altered gut microbiota,and psychosocial stress,leading to psychia-tric comorbidities such as anxiety,depression,and behavioral issues.Under-standing this bidirectional relationship is crucial for developing effective,holistic management strategies that address physical and mental health.AIM To examine the psychiatric impacts of FGIDs in children,focusing on anxiety and depression and their association with other neurodevelopmental disorders of childhood,such as attention-deficit/hyperactivity disorder,emphasizing the role of the gut-brain axis,emotional dysregulation,and psychosocial stress.Key mechanisms explored include neurotransmitter dysregulation,microbiota imbalance,central sensitization,heightening stress reactivity,emotional dysregulation,and symptom perception.The review also evaluates the role of family dynamics and coping strategies in exacerbating FGID symptoms and contributing to psychiatric conditions.METHODS A narrative review was conducted using 328 studies sourced from PubMed,Scopus,and Google Scholar,covering research published over the past 20 years.Inclusion criteria focused on studies examining FGID diagnosis,gut-brain mechanisms,psychiatric comorbidities,and psychosocial factors in pediatric populations.FGIDs commonly affecting children,including functional constipation,abdominal pain,irritable bowel syndrome,gastroesophageal reflux,and cyclic vomiting syndrome,were analyzed concerning their psychological impacts.RESULTS The review highlights a strong connection between FGIDs and psychiatric symptoms,mediated by gut-brain axis dysfunction,dysregulated microbiota,and central sensitization.These physiological disruptions increase children’s vulnerability to anxiety and depression,while psychosocial factors-such as chronic stress,early-life trauma,maladaptive family dynamics,and ineffective coping strategies-intensify the cycle of gastrointestinal and emotional distress.CONCLUSION Effective management of FGIDs requires a biopsychosocial approach integrating medical,psychological,and dietary interventions.Parental education,early intervention,and multidisciplinary care coordination are critical in mitigating long-term psychological impacts and improving both gastrointestinal and mental health outcomes in children with FGIDs.展开更多
BACKGROUND In pediatric age group patients(<18 years old)treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period-particularly in uncomplicated cases-appea...BACKGROUND In pediatric age group patients(<18 years old)treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period-particularly in uncomplicated cases-appears to provide limited additional benefit.AIM To determine the necessary number of follow-up X-rays to use resources efficiently.METHODS Participants included in this study are pediatric age group patients who were treated operatively for distal radius/both bone fractures and were identified from a prospected collected data from the operating room database between the years 2009 and 2017.The data in the study included patients who had distal radius fractures and underwent fixation surgery(n=88).RESULTS When assessing the difference in the odds of conducting 1 or less X-ray compared to 2 or more X-rays in regard to the type of fixation,the only significant difference is the closed reduction fixation method.Patients who underwent closed reduction method procedure have significantly lower odds of having 2 more X-rays compared to those who didn’t have closed reduction method.Open reduction,internal fixation,and other fixation methods(close reduction and internal fixation,debridement,or epiphysiodesis)have higher odds of having two or more X-rays compared to patients who did not receive these methods;however,these odds are not statistically significant.CONCLUSION The findings of this study reveal notable absence of a statistically significant association between the frequency of postoperative X-rays and the outcome of children with distal radius fractures.展开更多
Pediatric pancreatic tumors,though rare,pose significant diagnostic and manage-ment challenges.The recent,22-year nationwide survey on pediatric pancreatic tumors in Japan by Makita et al offers valuable insights into...Pediatric pancreatic tumors,though rare,pose significant diagnostic and manage-ment challenges.The recent,22-year nationwide survey on pediatric pancreatic tumors in Japan by Makita et al offers valuable insights into this uncommon enti-ty,revealing striking geographical variations and questioning current treatment paradigms.This editorial commentary analyzes the study's key findings,inclu-ding the predominance of solid pseudopapillary neoplasms and their younger age of onset,which contrast sharply with Western data.It explores the implications for clinical practice and research,emphasizing the need for population-specific approaches to diagnosis and treatment.The revealed limited institutional expe-rience and surgical management patterns prompt a reevaluation of optimal care delivery for these complex cases,suggesting benefits of centralizing healthcare services.Furthermore,the commentary advocates for international collaborative studies to elucidate the genetic,environmental,and lifestyle factors influencing the development and progression of pediatric pancreatic tumors across diverse populations.It also outlines future directions,calling for advancements in precision medicine and innovative care delivery models to improve global patient outcomes.Unraveling Makita et al's findings within the broader landscape of pediatric oncology can stimulate further research and clinical advancements in managing pancreatic and other rare tumors in children.展开更多
This editorial discusses the findings of Elbarky et al on the role of selenoprotein P1(SEPP1)in pediatric obesity and insulin resistance.Their study uncovered si-gnificantly lower SEPP1 Levels in children who were obe...This editorial discusses the findings of Elbarky et al on the role of selenoprotein P1(SEPP1)in pediatric obesity and insulin resistance.Their study uncovered si-gnificantly lower SEPP1 Levels in children who were obese compared with hea-lthy peers,demonstrating a negative correlation between SEPP1 levels and mea-sures of adiposity and insulin resistance.These findings suggest that SEPP1 is a biomarker useful in the early identification of insulin resistance in pediatric populations.This editorial emphasizes the clinical implications of the study and calls for further research to validate and explore the role of SEPP1 in metabolic health.展开更多
BACKGROUND Childhood obesity is a significant public health concern,particularly amongst children with chronic kidney disease requiring kidney transplant(KT).Obesity,defined as a body mass index(BMI)of 30 kg/m^(2) or ...BACKGROUND Childhood obesity is a significant public health concern,particularly amongst children with chronic kidney disease requiring kidney transplant(KT).Obesity,defined as a body mass index(BMI)of 30 kg/m^(2) or greater,is prevalent in this population and is associated with disease progression.While BMI in-fluences adult KT eligibility,its impact on pediatric transplant outcomes remains unclear.This study investigates the effect of BMI on graft survival and patient outcomes,addressing gaps in the literature and examining disparities across BMI classifications.AIM To assess the impact of BMI classifications on graft and patient survival following KT.METHODS A retrospective cohort study analyzed 23081 pediatric transplant recipients from the Standard Transplant Analysis and Research database(1987-2022).Patients were grouped into six BMI categories:Underweight,healthy weight,overweight,and Class 1,2,and 3 obesity.Data were analyzed using one-way way analysis of variance,Kruskal-Wallis tests,Chi-squared tests,Kaplan-Meier survival analysis with log-rank tests,and Cox proportional hazard regressions.Statistical significance was set at P<0.05.RESULTS Class 3 obese recipients had lower 1-year graft survival(88.7%)compared to healthy-weight recipients(93.1%,P=0.012).Underweight recipients had lower 10-year patient survival(81.3%,P<0.05)than healthy-weight recipients.Class 2 and 3 obese recipients had the lowest 5-year graft survival(67.8%and 68.3%,P=0.013)and Class 2 obesity had the lowest 10-year graft survival(40.7%).Cox regression identified increases in BMI category as an independent predictor of graft failure[hazard ratio(HR)=1.091,P<0.001]and mortality(HR=1.079,P=0.008).Obese patients experienced longer cold ischemia times(11.6 and 13.1 hours vs 10.2 hours,P<0.001).Class 3 obesity had the highest proportion of Black recipients(26.2%vs 17.9%,P<0.001).CONCLUSION Severe obesity and underweight status are associated with poorer long-term outcomes in pediatric KT recipients,emphasizing the need for nuanced transplant eligibility criteria addressing obesity-related risks and socioeconomic disparities.展开更多
BACKGROUND Pediatric cataract is a public health concern,and it causes long-term functional impairment and impacts the quality of life of the child with cataract.Visual impairment in children due to cataract has devas...BACKGROUND Pediatric cataract is a public health concern,and it causes long-term functional impairment and impacts the quality of life of the child with cataract.Visual impairment in children due to cataract has devastating consequences on their health,social life,and academic performance and places a socio-economic burden on the child’s family and society as a whole.Globally,pediatric cataract is a significant contributor to ocular morbidity and blindness.Findings from this study will help quantify the visual benefits of pediatric cataract surgical interventions and identify opportunities for improving pediatric cataract services.AIM To evaluate the visual acuity outcomes of children after cataract surgery.METHODS The study employed a retrospective electronic review of pediatric cataract surgeries from January 2019 to July 2021 at the pediatric unit of the eye department at Komfo Anokye Teaching Hospital(KATH),Ghana.Patient clinical data including demographics,cataract presentation,pre-operative and post-operative visual acuity,surgical procedure,postoperative complications,interventions and refraction were collected and analyzed using the Statistical Package and Service Solution.Pearson'sχ2 test and regression statistics were used to summarize data at a significance of P<0.05.RESULTS 163 children(257 eyes)underwent cataract surgery at KATH.The overall mean age was 3.81±3.56 years.Congenital cataract was commonly observed(56.4 All children underwent keratometry and phacoemulsification procedures.A few children(9.8%)experienced postoperative complications while 90.8%did not require further intervention after the surgery.After the surgery 27.0%of the children had refraction and the majority were corrected for myopia and near addition(12.9%).An analysis of the association of postoperative visual acuity and the type of cataract was statistically significant(P value<0.05).There was a significant improvement in the visual outcomes following cataract surgery.CONCLUSION Timely pediatric cataract surgery improves postoperative visual outcomes.Creating awareness and implementing screening programs is important to ensure that the prevalence of childhood blindness is reduced to the barest minimum.展开更多
BACKGROUND MURCS association,an acronym for Müllerian duct aplasia/hypoplasia,congenital renal agenesis/ectopia,and cervical somite dysplasia,presents unique anaesthetic challenges,particularly for airway control...BACKGROUND MURCS association,an acronym for Müllerian duct aplasia/hypoplasia,congenital renal agenesis/ectopia,and cervical somite dysplasia,presents unique anaesthetic challenges,particularly for airway control due to cervical spine anomalies.This case report adds to the limited literature by detailing airway management strategies in a paediatric patient with MURCS,emphasising the need for thorough preoperative evaluation and curated planning.CASE SUMMARY This report describes the successful anaesthetic and airway management of a 6-year-old girl with MURCS undergoing dental extraction.To address the complexities of the patient’s condition,a multidisciplinary approach involving comprehensive preoperative assessment,meticulous planning,and advanced airway management techniques was adopted.CONCLUSION This report emphasizes individualized anesthetic strategies and interprofessional collaboration for managing rare congenital syndromes.展开更多
Hydrocephalus is a medical condition caused by an abnormal cerebrospinal fluid (CSF) buildup in the brain’s ventricles. This excess fluid causes the ventricles to enlarge, increasing pressure within the brain. CSF ty...Hydrocephalus is a medical condition caused by an abnormal cerebrospinal fluid (CSF) buildup in the brain’s ventricles. This excess fluid causes the ventricles to enlarge, increasing pressure within the brain. CSF typically flows through the ventricles and around the spinal column, bathing the brain. However, the increased pressure from excess CSF associated with hydrocephalus can damage brain tissue and lead to various problems with cognitive function. While it can occur at any age, hydrocephalus is the most common in infants and adults over 60. It has been a subject of fascination for physicians throughout history due to its striking presentation. Two main types of hydrocephalus exist: obstructive (noncommunicating) and communicating. A blockage in the CSF flow causes obstructive hydrocephalus, while communicating hydrocephalus occurs when the body’s ability to absorb CSF is impaired. The review delves into the intricacies of hydrocephalus, exploring its causes, symptoms, and pathophysiology. The latest research on the topic has been examined, including innovative treatment approaches and ongoing challenges in managing this complex condition.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential diagnostic and therapeutic procedure for pancreatobiliary disorders.However,few large-scale studies from South Asia have examined long-ter...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential diagnostic and therapeutic procedure for pancreatobiliary disorders.However,few large-scale studies from South Asia have examined long-term ERCP outcomes,particularly using established quality benchmarks.AIM To evaluate ERCP indications,success rates,complications,and quality performance at a high-volume tertiary care center in Pakistan over a 17-year period.METHODS This retrospective study analyzed 13215 ERCP procedures performed between 2006 and 2023.Data included demographics,indications,cannulation rates,complications,and pediatric cases.Findings were assessed against American Society of Gastroenterology/European Society of Gastrointestinal Endoscopy quality indicators.RESULTS Biliary ERCP accounted for 93.1%of procedures;choledocholithiasis was the most common indication(40%).Cannulation success was 93.9%for biliary and 94.2%for pancreatic ERCP.Pediatric ERCP comprised 4%of cases,mostly for stones and chronic pancreatitis.Bleeding(1.7%)and post-ERCP pancreatitis(2.3%)were the most frequent complications.Performance met or exceeded most American Society of Benchmarks.CONCLUSION This study offers insight into nearly two decades of ERCP practice within a public sector hospital.Our experience echoes the quality and efficiency of ERCP not previously available in Pakistan.As healthcare systems in resourcelimited sectors expand,our findings serve as a reference point.Continued training and quality improvement studies can further enhance ERCP effectiveness in the region and beyond.展开更多
BACKGROUND Malnutrition among patients admitted to a pediatric intensive care unit(PICU)is common.However,there is a lack of data on its impact on the critically ill.AIM To assess the impact of nutritional status on t...BACKGROUND Malnutrition among patients admitted to a pediatric intensive care unit(PICU)is common.However,there is a lack of data on its impact on the critically ill.AIM To assess the impact of nutritional status on the outcome of critically ill children admitted to PICU.METHODS This observational study was conducted in a tertiary care teaching institute for one year,including 210 children aged 1 month to 14 years admitted to a 15-bed PICU for a minimum of 24 hours.Patients with less than 24 hours of PICU stay,who received palliative care,or with syndromic short stature were excluded.Relevant data were collected including anthropometric details,demographic data,duration of mechanical ventilation(MV),PICU,and hospital stay and outcome.Malnourished and well-nourished groups were compared using an independent t-test,one-way analysis of variance,andχ2 test.RESULTS Among 210 patients,there were 129 males and 81 females.There were 57(27.1%)children less than 6 months of age,95(45.2%)between 6 months and 5 years,and 58(27.6%)more than 5 years of age.The prevalence of malnutrition in the study sample was 51.9%(n=109).The overall mortality was 22.9%(48/210),26.6%(29/109)among malnourished,and 18.8%(19/101)among well-nourished children(P=0.241).A significant association was found between the severity of malnutrition and duration of MV(P=0.001),PICU stay(P=0.001),and hospital stay(P=0.021).CONCLUSION Malnutrition is common in critically ill children and contributes to poor clinical outcomes such as duration of MV,PICU,and hospital stay.However,mortality was comparable in both groups.展开更多
The gut microbiome plays a pivotal role in immune homeostasis and systemic inflammatory regulation,both of which are critically involved in the pathogenesis and progression of pediatric leukemias.Recent evidence revea...The gut microbiome plays a pivotal role in immune homeostasis and systemic inflammatory regulation,both of which are critically involved in the pathogenesis and progression of pediatric leukemias.Recent evidence reveals that children with leukemia often exhibit distinct gut microbiome profiles at diagnosis,marked by reduced microbial diversity and the enrichment of pro-inflammatory taxa such as Enterococcus and Streptococcus.This microbial dysbiosis may promote leukemogenesis by disrupting immune regulation and driving chronic inflammation.Chemotherapy significantly alters the gut microbiome,inducing dysbiosis characterized by a loss of beneficial commensals and the dominance of pathobionts.Specific microbial signatures,such as the enrichment of Bacteroides,correlate with reduced inflammation and improved prognosis,underscoring the gut microbiome's prognostic value.Emerging therapies,including dietary adjustments,probiotics,and fecal gut microbiome transplantation,aim to restore microbial balance and reduce treatment-related complications.Moreover,gut microbiome profiling shows potential for identifying biomarkers linked to leukemia predisposition,paving the way for early diagnosis and tailored preventive strategies.This mini-review explores recent advancements in understanding the influence of the gut microbiome on pediatric leukemias,emphasizing its role as both a therapeutic target and a prognostic biomarker.Integrating gut microbiome research into clinical practice may help optimize treatment outcomes and improve quality of life for children with leukemia.展开更多
基金Supported by the Coordination of Improvement of Higher Education Personnel(CAPES)and National Council for Scientific and Technological Development(CNPq),No.311427/2023-5.
文摘The international scientific literature presents still incipient results regarding the management of cancer symptom clusters by oncology nursing,especially in pediatric oncology.This is a promising field of investigation for clinical nurses and researchers,and when it is subsidized by medium-range theories,they co-rroborate the diagnoses and interventions of nursing in oncology,enhancing the science of nursing care.This minireview article aims to discuss the utilizing the hospital clowns as a complementary therapy,to enhance quality of life and reduce stress and fatigue in pediatric cancer patients.Overall,the evidence presented so far pointed out that complementary therapy might help improve the quality of life of pediatric cancer patients,and that complementary therapy usage should be part of a health comprehensive care model,delivering therapeutic approaches that might enhance the mind-body during a pediatric cancer patients’life span.The results of scientific investigations by nurses,particularly those linked to the basic sciences,play a critical role in advancing personalized care in pediatric integrative oncology.
文摘Objective:This article employs a scoping review methodology,integrates knowledge and information about current pediatric nurses'practices and perceptions regarding family-centered care in pediatric settings.Methods:Published articles were retrieved from databases including EBSCO host,PubMed,Springer,Science Direct,Ovid,and CINAHL between 2013 and 2023.Results:The finding shows a better understanding of pediatric nurses'perceptions of family-centered care in association with their clinical settings.However,the evidence indicates that integrating family-centered care components into health care services is difficult and confusing to nurses and is often not implemented in a clinical setting.As evidenced by this review,studies have consistently reported similar results;family-centered care was a good perception and understood by pediatric nurses as a concept but inconsistently used in a daily practice setting.Conclusions:This scoping review is the first phase in promoting a strategic plan to provide educational interventions for pediatric nurses to implement family-centered care in their daily practice settings.It's necessary to recognize pediatric nurses'perceptions and practices concerning family-centered care to provide optimal healthcare services in pediatric settings.
文摘BACKGROUND Although critically ill pediatric patients can benefit from the use of sedation,it can cause side effects and even iatrogenic complications.Since pediatric patients cannot adequately express the intensity or location of the pain,discriminating the cause of their irritability and agitation can be more complicated than in adults.Thus,sedation therapy for children requires more careful attention.AIM To evaluate the association of the internal parental care protocol and the reduction in pediatric intensive care unit(PICU)postoperatively.METHODS This retrospective cohort study was carried out in the PICU of the tertiary medical center in Kazakhstan.The internal parental care protocol was developed and implemented by critical care team.During the pandemic,restrictions were also placed on parental presence in the PICU.We compare two groups:During restriction and after return to normal.The level of agitation was evaluated using the Richmond Agitation-Sedation Scale.Univariate and multivariate logistic regression analyses were performed to examine associations of parental care with sedation therapy.RESULTS A total of 289 patients were included in the study.Of them,167 patients were hospitalized during and 122 after the restrictions of parental care.In multivariate analysis,parental care was associated with lower odds of prescribing diazepam(odds ratio=0.11,95%confidence interval:0.05-0.25),controlling for age,sex,cerebral palsy,and type of surgery.CONCLUSION The results of this study show that parental care was associated only with decreased odds of prescribing sedative drugs,while no differences were observed for analgesics.
文摘BACKGROUND The management of pediatric choledocholithiasis is complicated by anatomical constraints and the subsequent risks of conventional therapies requiring external drainage.This case report introduces a novel laparoscopic microincision tech-nique at the cystic duct confluence,designed to eliminate T-tube dependence,minimize ductal trauma,and expedite recovery,which are critical priorities for active children.We present this innovation to address unmet pediatric-specific surgical needs and demonstrate its feasibility as a tailored,minimally invasive solution for choledocholithiasis in children.A 12-year-old girl with a 5-year history of recurrent upper abdominal pain was diagnosed with choledocholithiasis,cholelithiasis,and biliary pancreatitis based on imaging and laboratory tests.After failed conservative management,laparo-scopic cholecystectomy with a microincision at the cystic duct confluence enabled choledochoscopic extraction of seven stones without T-tube placement.Primary closure using absorbable sutures with cystic duct confluence preserved biliary integrity.Postoperatively,liver function and amylase levels normalized by day 3,and abdominal ultrasonography confirmed no complications.The patient promptly resumed normal activity with no recurrence observed at the 16-month follow-up visit.This approach avoids external drainage,minimizes ductal manipulation,and optimizes recovery,which are key advantages for pediatric patients.CONCLUSION Microincision at the cystic duct confluence safely eliminates T-tubes,ensures stone clearance,and accelerates pediatric recovery.
文摘Pediatric liver masses encompass a diverse spectrum of benign and malignant lesions,with distinct patterns based on patient age.Optimal imaging is critical for timely diagnosis,management,and prognosis.This pictorial minireview cate-gorizes pediatric liver masses by age group to guide hepatology and radiology practice,with an emphasis on imaging characteristics.In children from birth to six years of age,the most common liver masses include hepatoblastoma,the most common primary hepatic malignancy in this age group;infantile hemangioma,a benign vascular tumor with a characteristic appearance on imaging;and mesen-chymal hamartoma,a rare developmental lesion.For children older than six years,liver masses are distinct,with hepatocellular carcinoma being the predo-minant malignant lesion.Benign masses such as focal nodular hyperplasia and hepatocellular adenoma also emerge in this age range,often linked to hormonal influences or metabolic disorders.The masses observed across all pediatric age groups include hepatic cysts,choledochal cysts,hydatid cysts,pyogenic and amebic abscesses,tuberculosis,lymphoma,and metastases,each presenting with unique imaging features essential for differential diagnosis.This minireview provides a comprehensive,age-based overview of pediatric liver masses,focusing on clinical presentation and key imaging findings to support accurate diagnosis and optimize management strategies in clinical hepatology,particularly in low resource settings.
文摘Background of the Study: Femoral shaft fracture is the most common pediatric injury requiring hospitalization. For children less than 5 years old, non-surgical approach is recommended. For pediatric patients 5 - 14 years old, the most common mode of treatment is flexible intramedullary nailing with a known complication of pain at post-op site, inflammatory reaction/bursitis at the entry site, superficial and deep infection, knee synovitis, knee stiffness, leg length discrepancy, proximal nail migration, angulation or malunion, delayed and non-union, implant breakage. This study aims to present a rare complication of a femoral fracture fixed with flexible intramedullary nail. Methodology: We report the outcome of a 12-year-old male with peri implant fracture of the left femur. He underwent removal of plates and screws and subsequently fixed with flexible intramedullary nails. Patient was followed up at 1, 3, 7, and 10 months post-operatively. Varus-valgus, sagittal angulation, and limb shortening were measured pre- and post-operatively. Complications were recorded on each visit. Results: Pre-operative varus angulation was 10˚, pro-curvatum of 55˚ with limb shortening of 4 cm. Postoperatively, varus was maintained to 10˚ but pro-curvatum was corrected to 4˚ and limb shortening was reduced to 1 cm. However, after 1 month the varus angulation increased to 30˚ while maintaining sagittal pro-curvatum. Limb shortening also increased to 2 cm. New bone formation started to appear along the mechanical axis of the left femur which is apparent at 3 months post-op and pro-curvatum increased to 20˚. At 7 and 10 months post-op no signs of union was noted at the fracture site but the callus formation along the mechanical axis gradually matured and appeared as a new femoral shaft. Conclusion: Formation of new bone in response to unstable flexible intramedullary fixation in pediatric femoral shaft fracture is a very rare complication.
文摘BACKGROUND Knowledge-based systems(KBS)are software applications based on a knowledge database and an inference engine.Various experimental KBS for computerassisted medical diagnosis and treatment were started to be used since 70s(VisualDx,GIDEON,DXPlain,CADUCEUS,Internist-I,Mycin etc.).AIM To present in detail the“Electronic Pediatrician(EPed)”,a medical non-machine learning artificial intelligence(nml-AI)KBS in its prototype version created by the corresponding author(with database written in Romanian)that offers a physiopathology-based differential and positive diagnosis and treatment of ill children.METHODS EPed specifically focuses on the physiopathological reasoning of pediatric clinical cases.EPed has currently reached its prototype version 2.0,being able to diagnose 302 physiopathological macro-links(briefly named“clusters”)and 269 pediatric diseases:Some examples of diagnosis and a previous testing of EPed on a group of 34 patients are also presented in this paper.RESULTS The prototype EPed can currently diagnose 269 pediatric infectious and noninfectious diseases(based on 302 clusters),including the most frequent respiratory/digestive/renal/central nervous system infections,but also many other noninfectious pediatric diseases like autoimmune,oncological,genetical diseases and even intoxications,plus some important surgical pathologies.CONCLUSION EPed is the first and only physiopathology-based nml-AI KBS focused on general pediatrics and is the first and only pediatric Romanian KBS addressed to medical professionals.Furthermore,EPed is the first and only nml-AI KBS that offers not only both a physiopathology-based differential and positive disease diagnosis,but also identifies possible physiopathological“clusters”that may explain the signs and symptoms of any child-patient and may help treating that patient physiopathologically(until a final diagnosis is found),thus encouraging and developing the physiopathological reasoning of any clinician.
文摘Photon-counting computed tomography(PCCT)represents a significant advancement in pediatric cardiovascular imaging.Traditional CT systems employ energy-integrating detectors that convert X-ray photons into visible light,whereas PCCT utilizes photon-counting detectors that directly transform X-ray photons into electric signals.This direct conversion allows photon-counting detectors to sort photons into discrete energy levels,thereby enhancing image quality through superior noise reduction,improved spatial and contrast resolution,and reduced artifacts.In pediatric applications,PCCT offers substantial benefits,including lower radiation doses,which may help reduce the risk of malignancy in pediatric patients,with perhaps greater potential to benefit those with repeated exposure from a young age.Enhanced spatial resolution facilitates better visualization of small structures,vital for diagnosing congenital heart defects.Additionally,PCCT’s spectral capabilities improve tissue characterization and enable the creation of virtual monoenergetic images,which enhance soft-tissue contrast and potentially reduce contrast media doses.Initial clinical results indicate that PCCT provides superior image quality and diagnostic accuracy compared to conven-tional CT,particularly in challenging pediatric cardiovascular cases.As PCCT technology matures,further research and standardized protocols will be essential to fully integrate it into pediatric imaging practices,ensuring optimized diagnostic outcomes and patient safety.
文摘In China pediatric liver transplantation(PLT)has become a safe and standardized procedure.Innovations and measures to further improve long-term survival and quality of life for children should be the next focus.In particular better strategies related to the surgical treatment of high-risk recipients as well as the long-term follow-up of pediatric liver recipients have to be addressed.A particular attention should be given to children presenting significant co-morbidities and those needing retransplantation.A tight mul-tidisciplinary follow-up system addressing both short-and long-term issues of pediatric liver recipients is still a challenge for the Chinese pediatric transplant community.
文摘BACKGROUND Functional gastrointestinal disorders(FGIDs)in children present with chronic symptoms like abdominal pain,diarrhea,and constipation without identifiable structural abnormalities.These disorders are closely linked to gut-brain axis dysfunction,altered gut microbiota,and psychosocial stress,leading to psychia-tric comorbidities such as anxiety,depression,and behavioral issues.Under-standing this bidirectional relationship is crucial for developing effective,holistic management strategies that address physical and mental health.AIM To examine the psychiatric impacts of FGIDs in children,focusing on anxiety and depression and their association with other neurodevelopmental disorders of childhood,such as attention-deficit/hyperactivity disorder,emphasizing the role of the gut-brain axis,emotional dysregulation,and psychosocial stress.Key mechanisms explored include neurotransmitter dysregulation,microbiota imbalance,central sensitization,heightening stress reactivity,emotional dysregulation,and symptom perception.The review also evaluates the role of family dynamics and coping strategies in exacerbating FGID symptoms and contributing to psychiatric conditions.METHODS A narrative review was conducted using 328 studies sourced from PubMed,Scopus,and Google Scholar,covering research published over the past 20 years.Inclusion criteria focused on studies examining FGID diagnosis,gut-brain mechanisms,psychiatric comorbidities,and psychosocial factors in pediatric populations.FGIDs commonly affecting children,including functional constipation,abdominal pain,irritable bowel syndrome,gastroesophageal reflux,and cyclic vomiting syndrome,were analyzed concerning their psychological impacts.RESULTS The review highlights a strong connection between FGIDs and psychiatric symptoms,mediated by gut-brain axis dysfunction,dysregulated microbiota,and central sensitization.These physiological disruptions increase children’s vulnerability to anxiety and depression,while psychosocial factors-such as chronic stress,early-life trauma,maladaptive family dynamics,and ineffective coping strategies-intensify the cycle of gastrointestinal and emotional distress.CONCLUSION Effective management of FGIDs requires a biopsychosocial approach integrating medical,psychological,and dietary interventions.Parental education,early intervention,and multidisciplinary care coordination are critical in mitigating long-term psychological impacts and improving both gastrointestinal and mental health outcomes in children with FGIDs.
文摘BACKGROUND In pediatric age group patients(<18 years old)treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period-particularly in uncomplicated cases-appears to provide limited additional benefit.AIM To determine the necessary number of follow-up X-rays to use resources efficiently.METHODS Participants included in this study are pediatric age group patients who were treated operatively for distal radius/both bone fractures and were identified from a prospected collected data from the operating room database between the years 2009 and 2017.The data in the study included patients who had distal radius fractures and underwent fixation surgery(n=88).RESULTS When assessing the difference in the odds of conducting 1 or less X-ray compared to 2 or more X-rays in regard to the type of fixation,the only significant difference is the closed reduction fixation method.Patients who underwent closed reduction method procedure have significantly lower odds of having 2 more X-rays compared to those who didn’t have closed reduction method.Open reduction,internal fixation,and other fixation methods(close reduction and internal fixation,debridement,or epiphysiodesis)have higher odds of having two or more X-rays compared to patients who did not receive these methods;however,these odds are not statistically significant.CONCLUSION The findings of this study reveal notable absence of a statistically significant association between the frequency of postoperative X-rays and the outcome of children with distal radius fractures.
文摘Pediatric pancreatic tumors,though rare,pose significant diagnostic and manage-ment challenges.The recent,22-year nationwide survey on pediatric pancreatic tumors in Japan by Makita et al offers valuable insights into this uncommon enti-ty,revealing striking geographical variations and questioning current treatment paradigms.This editorial commentary analyzes the study's key findings,inclu-ding the predominance of solid pseudopapillary neoplasms and their younger age of onset,which contrast sharply with Western data.It explores the implications for clinical practice and research,emphasizing the need for population-specific approaches to diagnosis and treatment.The revealed limited institutional expe-rience and surgical management patterns prompt a reevaluation of optimal care delivery for these complex cases,suggesting benefits of centralizing healthcare services.Furthermore,the commentary advocates for international collaborative studies to elucidate the genetic,environmental,and lifestyle factors influencing the development and progression of pediatric pancreatic tumors across diverse populations.It also outlines future directions,calling for advancements in precision medicine and innovative care delivery models to improve global patient outcomes.Unraveling Makita et al's findings within the broader landscape of pediatric oncology can stimulate further research and clinical advancements in managing pancreatic and other rare tumors in children.
文摘This editorial discusses the findings of Elbarky et al on the role of selenoprotein P1(SEPP1)in pediatric obesity and insulin resistance.Their study uncovered si-gnificantly lower SEPP1 Levels in children who were obese compared with hea-lthy peers,demonstrating a negative correlation between SEPP1 levels and mea-sures of adiposity and insulin resistance.These findings suggest that SEPP1 is a biomarker useful in the early identification of insulin resistance in pediatric populations.This editorial emphasizes the clinical implications of the study and calls for further research to validate and explore the role of SEPP1 in metabolic health.
文摘BACKGROUND Childhood obesity is a significant public health concern,particularly amongst children with chronic kidney disease requiring kidney transplant(KT).Obesity,defined as a body mass index(BMI)of 30 kg/m^(2) or greater,is prevalent in this population and is associated with disease progression.While BMI in-fluences adult KT eligibility,its impact on pediatric transplant outcomes remains unclear.This study investigates the effect of BMI on graft survival and patient outcomes,addressing gaps in the literature and examining disparities across BMI classifications.AIM To assess the impact of BMI classifications on graft and patient survival following KT.METHODS A retrospective cohort study analyzed 23081 pediatric transplant recipients from the Standard Transplant Analysis and Research database(1987-2022).Patients were grouped into six BMI categories:Underweight,healthy weight,overweight,and Class 1,2,and 3 obesity.Data were analyzed using one-way way analysis of variance,Kruskal-Wallis tests,Chi-squared tests,Kaplan-Meier survival analysis with log-rank tests,and Cox proportional hazard regressions.Statistical significance was set at P<0.05.RESULTS Class 3 obese recipients had lower 1-year graft survival(88.7%)compared to healthy-weight recipients(93.1%,P=0.012).Underweight recipients had lower 10-year patient survival(81.3%,P<0.05)than healthy-weight recipients.Class 2 and 3 obese recipients had the lowest 5-year graft survival(67.8%and 68.3%,P=0.013)and Class 2 obesity had the lowest 10-year graft survival(40.7%).Cox regression identified increases in BMI category as an independent predictor of graft failure[hazard ratio(HR)=1.091,P<0.001]and mortality(HR=1.079,P=0.008).Obese patients experienced longer cold ischemia times(11.6 and 13.1 hours vs 10.2 hours,P<0.001).Class 3 obesity had the highest proportion of Black recipients(26.2%vs 17.9%,P<0.001).CONCLUSION Severe obesity and underweight status are associated with poorer long-term outcomes in pediatric KT recipients,emphasizing the need for nuanced transplant eligibility criteria addressing obesity-related risks and socioeconomic disparities.
文摘BACKGROUND Pediatric cataract is a public health concern,and it causes long-term functional impairment and impacts the quality of life of the child with cataract.Visual impairment in children due to cataract has devastating consequences on their health,social life,and academic performance and places a socio-economic burden on the child’s family and society as a whole.Globally,pediatric cataract is a significant contributor to ocular morbidity and blindness.Findings from this study will help quantify the visual benefits of pediatric cataract surgical interventions and identify opportunities for improving pediatric cataract services.AIM To evaluate the visual acuity outcomes of children after cataract surgery.METHODS The study employed a retrospective electronic review of pediatric cataract surgeries from January 2019 to July 2021 at the pediatric unit of the eye department at Komfo Anokye Teaching Hospital(KATH),Ghana.Patient clinical data including demographics,cataract presentation,pre-operative and post-operative visual acuity,surgical procedure,postoperative complications,interventions and refraction were collected and analyzed using the Statistical Package and Service Solution.Pearson'sχ2 test and regression statistics were used to summarize data at a significance of P<0.05.RESULTS 163 children(257 eyes)underwent cataract surgery at KATH.The overall mean age was 3.81±3.56 years.Congenital cataract was commonly observed(56.4 All children underwent keratometry and phacoemulsification procedures.A few children(9.8%)experienced postoperative complications while 90.8%did not require further intervention after the surgery.After the surgery 27.0%of the children had refraction and the majority were corrected for myopia and near addition(12.9%).An analysis of the association of postoperative visual acuity and the type of cataract was statistically significant(P value<0.05).There was a significant improvement in the visual outcomes following cataract surgery.CONCLUSION Timely pediatric cataract surgery improves postoperative visual outcomes.Creating awareness and implementing screening programs is important to ensure that the prevalence of childhood blindness is reduced to the barest minimum.
基金Supported by Far-Eastern Memorial Hospital,No.FEMH-2025-C-016.
文摘BACKGROUND MURCS association,an acronym for Müllerian duct aplasia/hypoplasia,congenital renal agenesis/ectopia,and cervical somite dysplasia,presents unique anaesthetic challenges,particularly for airway control due to cervical spine anomalies.This case report adds to the limited literature by detailing airway management strategies in a paediatric patient with MURCS,emphasising the need for thorough preoperative evaluation and curated planning.CASE SUMMARY This report describes the successful anaesthetic and airway management of a 6-year-old girl with MURCS undergoing dental extraction.To address the complexities of the patient’s condition,a multidisciplinary approach involving comprehensive preoperative assessment,meticulous planning,and advanced airway management techniques was adopted.CONCLUSION This report emphasizes individualized anesthetic strategies and interprofessional collaboration for managing rare congenital syndromes.
文摘Hydrocephalus is a medical condition caused by an abnormal cerebrospinal fluid (CSF) buildup in the brain’s ventricles. This excess fluid causes the ventricles to enlarge, increasing pressure within the brain. CSF typically flows through the ventricles and around the spinal column, bathing the brain. However, the increased pressure from excess CSF associated with hydrocephalus can damage brain tissue and lead to various problems with cognitive function. While it can occur at any age, hydrocephalus is the most common in infants and adults over 60. It has been a subject of fascination for physicians throughout history due to its striking presentation. Two main types of hydrocephalus exist: obstructive (noncommunicating) and communicating. A blockage in the CSF flow causes obstructive hydrocephalus, while communicating hydrocephalus occurs when the body’s ability to absorb CSF is impaired. The review delves into the intricacies of hydrocephalus, exploring its causes, symptoms, and pathophysiology. The latest research on the topic has been examined, including innovative treatment approaches and ongoing challenges in managing this complex condition.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential diagnostic and therapeutic procedure for pancreatobiliary disorders.However,few large-scale studies from South Asia have examined long-term ERCP outcomes,particularly using established quality benchmarks.AIM To evaluate ERCP indications,success rates,complications,and quality performance at a high-volume tertiary care center in Pakistan over a 17-year period.METHODS This retrospective study analyzed 13215 ERCP procedures performed between 2006 and 2023.Data included demographics,indications,cannulation rates,complications,and pediatric cases.Findings were assessed against American Society of Gastroenterology/European Society of Gastrointestinal Endoscopy quality indicators.RESULTS Biliary ERCP accounted for 93.1%of procedures;choledocholithiasis was the most common indication(40%).Cannulation success was 93.9%for biliary and 94.2%for pancreatic ERCP.Pediatric ERCP comprised 4%of cases,mostly for stones and chronic pancreatitis.Bleeding(1.7%)and post-ERCP pancreatitis(2.3%)were the most frequent complications.Performance met or exceeded most American Society of Benchmarks.CONCLUSION This study offers insight into nearly two decades of ERCP practice within a public sector hospital.Our experience echoes the quality and efficiency of ERCP not previously available in Pakistan.As healthcare systems in resourcelimited sectors expand,our findings serve as a reference point.Continued training and quality improvement studies can further enhance ERCP effectiveness in the region and beyond.
文摘BACKGROUND Malnutrition among patients admitted to a pediatric intensive care unit(PICU)is common.However,there is a lack of data on its impact on the critically ill.AIM To assess the impact of nutritional status on the outcome of critically ill children admitted to PICU.METHODS This observational study was conducted in a tertiary care teaching institute for one year,including 210 children aged 1 month to 14 years admitted to a 15-bed PICU for a minimum of 24 hours.Patients with less than 24 hours of PICU stay,who received palliative care,or with syndromic short stature were excluded.Relevant data were collected including anthropometric details,demographic data,duration of mechanical ventilation(MV),PICU,and hospital stay and outcome.Malnourished and well-nourished groups were compared using an independent t-test,one-way analysis of variance,andχ2 test.RESULTS Among 210 patients,there were 129 males and 81 females.There were 57(27.1%)children less than 6 months of age,95(45.2%)between 6 months and 5 years,and 58(27.6%)more than 5 years of age.The prevalence of malnutrition in the study sample was 51.9%(n=109).The overall mortality was 22.9%(48/210),26.6%(29/109)among malnourished,and 18.8%(19/101)among well-nourished children(P=0.241).A significant association was found between the severity of malnutrition and duration of MV(P=0.001),PICU stay(P=0.001),and hospital stay(P=0.021).CONCLUSION Malnutrition is common in critically ill children and contributes to poor clinical outcomes such as duration of MV,PICU,and hospital stay.However,mortality was comparable in both groups.
文摘The gut microbiome plays a pivotal role in immune homeostasis and systemic inflammatory regulation,both of which are critically involved in the pathogenesis and progression of pediatric leukemias.Recent evidence reveals that children with leukemia often exhibit distinct gut microbiome profiles at diagnosis,marked by reduced microbial diversity and the enrichment of pro-inflammatory taxa such as Enterococcus and Streptococcus.This microbial dysbiosis may promote leukemogenesis by disrupting immune regulation and driving chronic inflammation.Chemotherapy significantly alters the gut microbiome,inducing dysbiosis characterized by a loss of beneficial commensals and the dominance of pathobionts.Specific microbial signatures,such as the enrichment of Bacteroides,correlate with reduced inflammation and improved prognosis,underscoring the gut microbiome's prognostic value.Emerging therapies,including dietary adjustments,probiotics,and fecal gut microbiome transplantation,aim to restore microbial balance and reduce treatment-related complications.Moreover,gut microbiome profiling shows potential for identifying biomarkers linked to leukemia predisposition,paving the way for early diagnosis and tailored preventive strategies.This mini-review explores recent advancements in understanding the influence of the gut microbiome on pediatric leukemias,emphasizing its role as both a therapeutic target and a prognostic biomarker.Integrating gut microbiome research into clinical practice may help optimize treatment outcomes and improve quality of life for children with leukemia.
