BACKGROUND There is a possible link between depression and anxiety about suicidal ideation among parents of children with congenital heart disease(CHD).AIM To document the effects of depression and anxiety on parental...BACKGROUND There is a possible link between depression and anxiety about suicidal ideation among parents of children with congenital heart disease(CHD).AIM To document the effects of depression and anxiety on parental suicidal ideation among children with CHD and the associated factors.METHODS This was a cross-sectional study among 50 parents of children with CHD who attended the Cardiac Clinic of University of Nigeria Teaching Hospital Ituku-Ozalla.Information was obtained using the Columbia Suicide Severity Rating Scale and the Hospital Anxiety and Depression Scale.RESULTS A greater percentage of parents whose child had a heart defect had anxiety symptoms(50.0%)than did those whose child had no heart defect(24.0%),and the difference in proportions was statistically significant(χ^(2)=7.250,P=0.007).A greater percentage of parents whose child had a heart defect had suicidal ideation(28.0%)than did those whose child had no heart defect(8.0%),and the difference in proportions was statistically significant(χ^(2)=6.775 P=0.009).A positive correlation was elicited between anxiety and suicide ideation,and this correlation was statistically significant(r=0.748,P<0.001).A positive correlation was elicited between depression and suicidal ideation scores,and this was statistically significant(r=0.617,P<0.001).CONCLUSION There is strong interconnectivity between anxiety and depression with suicidal ideation.There is an urgent need to start screening for the mental health of parents of children with CHD to avert the high propensity of complete suicide.In addition,policy makers may introduce a national clinical practice guideline on the importance of psychotherapy and mental health screening and targeted interventions for parents of children with CHD.展开更多
Objective: To assess emergency department utilization at a semi-urban (resource-limited) Nigerian hospital. Methods: A systematic random sampling technique was adopted. A proforma was used to obtain general informatio...Objective: To assess emergency department utilization at a semi-urban (resource-limited) Nigerian hospital. Methods: A systematic random sampling technique was adopted. A proforma was used to obtain general information such as age, gender, mode of transfer, time of presentation, symptom duration, diagnoses, treatment duration, treatment outcome (transfer to the ward, referral to another hospital, discharge or death) and date and time of discharge. Chi-square test and logistic regression analysis were used to determine the association of variables with mortality and predictors, respectively. Results: Patients were predominantly male (62.2%) with a mean age of (36.0±19.0) years. Most visits occurred in September (49.1%). The median symptom duration was 24 h (interquartile range: 4.0, 72.0 ). More incidences were caused by non-surgical (61.9%) than surgical reasons. Infectious diseases (predominantly malaria, 34.5%) and injuries from road traffic accidents (mostly head injuries, 9.4%) were the commonest non-surgical and surgical cause, respectively. The mortality rate was 9.2%. Typhoid-intestinal-perforation and sepsis contributed 45.2% of overall mortality. Age (x2=16.44, P<0.001), symptom duration (x2=22.57, P<0.001), and visiting month (Fishers exact, P=0.002) were associated with mortality. Moreover, age ( 37 years) (OR=4.60, 95%CI=1.96-10.82, P<0.001) and visiting in September/October (OR=4.01, 95%CI=1.47-10.93, P=0.007) were the predictors of mortality. Conclusions: Though most patients in emergency department survive, the mortality is still high. Appropriate hospital and community interventions should be implemented to reduce mortality.展开更多
Fournier’s gangrene is a form of necrotizing fasciitis that has multiple causes and is relatively uncommon in children. We report a case of Fournier’s gangrene of infectious origin in a 12-month-old infant following...Fournier’s gangrene is a form of necrotizing fasciitis that has multiple causes and is relatively uncommon in children. We report a case of Fournier’s gangrene of infectious origin in a 12-month-old infant following an insect bite. A rapid diagnosis and multidisciplinary care saved the patient.展开更多
BACKGROUND: We assessed whether the paediatric-appropriate facilities were available at Emergency Departments(ED) in community hospitals in a Canadian province.METHODS: We conducted a cross-sectional survey of EDs in ...BACKGROUND: We assessed whether the paediatric-appropriate facilities were available at Emergency Departments(ED) in community hospitals in a Canadian province.METHODS: We conducted a cross-sectional survey of EDs in community hospitals in Ontario, Canada that had inpatient paediatric facilities and a neonatal intensive care unit. Key informants were ED chiefs, clinical educators, or managers. The survey included questions about paediatric facilities related to environment, triage, training, and staff in EDs.RESULTS: Of 52 hospitals, 69%(n=36) responded to our survey. Of them, 14% EDs(n=5) had some separated spaces available for paediatric patients. About 53%(n=19) of EDs lacked children activities, e.g., toys. Only 11%(n=4) EDs were using paediatric triage scales and 42%(n=15) had a designated paediatric resuscitation bay. Only half of the ED(n=18) required from their staff to update paediatric life support training. Only 31%(n=11) had a designated liaison paediatrician for the ED. Paediatric social worker was present in only 8%(n=3) of EDs in community hospitals.CONCLUSION: Most of the Ontario community hospital EDs included in this survey had inadequate facilities for paediatric patients such as specific waiting and treatment areas.展开更多
Introduction: Globally, tuberculosis is the leading cause of death from a single infectious agent ahead of HIV/AIDS. Approximately 10 million people contracted TB in 2017, 10% of whom were children aged 0 - 15 years, ...Introduction: Globally, tuberculosis is the leading cause of death from a single infectious agent ahead of HIV/AIDS. Approximately 10 million people contracted TB in 2017, 10% of whom were children aged 0 - 15 years, or about 1 million with 250,000 deaths in 2016 (including children with HIV-associated TB). The signs of TB in children are not always specific and diagnosis remains difficult unlike in adults. According to a study conducted in 2011 in the paediatric department of the CHU-Gabriel Touré, only seventeen cases of all forms of tuberculosis were found, or approximately 0.2% of hospitalised children. The objective of our study was to investigate the epidemiological and clinical aspects of tuberculosis in children. Materials and Method: This was a prospective, cross-sectional and descriptive study that took place from 24 October 2017 to 23 October 2018, or 12 months in children aged 0-15 years. Data were collected from an individual medical record opened for each patient and an individual survey form established for each child. Results: During the study period, 40,434 children were consulted. Tuberculosis was suspected in 91 children, with a frequency of 0.22%. The age range of 1 to 4 years was 36.3% with a median age of 72 months. The sex ratio was 1.8. Chronic cough with 84.6% and malnutrition with 24.17% were the most frequent symptoms. Chest X-ray revealed bilateral pulmonary lesions in 52.7% and mediastinal adenopathy in 12.1%. TST was positive in 10.9% of patients, microscopy in 26.4%, Gene Xpert in 18.7%, and culture in 16.5%. The biological diagnosis of tuberculosis was retained in 48.4% of the patients, the pulmonary form represented 93.2%. The therapeutic regime (2RHZE/4RH) was used in 81.6% of cases and the evolution was favourable in 65.9% of patients. Conclusion: The diagnosis of tuberculosis in children remains difficult in our context. The clinical signs are not always specific, and further studies are needed to further elucidate this disease.展开更多
Acrodermatitis enteropathica is a rare autosomal recessive genetic disorder characterised by periorificial dermatitis, alopecia and diarrhoea. It is caused by a mutation in the gene that codes for a membrane protein t...Acrodermatitis enteropathica is a rare autosomal recessive genetic disorder characterised by periorificial dermatitis, alopecia and diarrhoea. It is caused by a mutation in the gene that codes for a membrane protein that binds zinc. We report a case in a 7-month-old girl, admitted with altered general condition and scaly, pustular erythematous lesions, initially located in the occipital and cervical regions, and secondarily inguinal and on the knees. Management and outcome in this patient? Genetic assay was not available to confirm this rare genetic disease. A delay in establishing the diagnosis and a disastrous outcome did not save the patient despite the administration of zinc.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 Antibiotic resistance is a growing global health threat,and understanding local trends in bacterial isolates and their susceptibility patterns is crucial for effective infection control and antimicrobial st...BACKGROUND Antibiotic resistance is a growing global health threat,and understanding local trends in bacterial isolates and their susceptibility patterns is crucial for effective infection control and antimicrobial stewardship.The coronavirus disease 2019(COVID-19)pandemic has introduced additional complexities,potentially influencing these patterns.AIM To analyze trends in bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex from 2018 to 2023,with a specific focus on the impact of the COVID-19 pandemic on these trends.METHODS A retrospective analysis of microbiological data was conducted,covering the period from 2018 to 2023.The study included key bacterial pathogens such as Escherichia coli(E.coli),Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa,and Staphylococcus aureus,among others.The antibiotic susceptibility profiles of these isolates were assessed using standard laboratory methods.To contextualize the findings,the findings were compared with similar studies from other regions,including China,India,Romania,Saudi Arabia,the United Arab Emirates,Malaysia,and United States.RESULTS The study revealed fluctuating trends in the prevalence of bacterial isolates,with notable changes during the COVID-19 pandemic.For example,a significant increase in the prevalence of Staphylococcus aureus was observed during the pandemic years,while the prevalence of E.coli showed a more variable pattern.Antibiotic resistance rates varied among the different pathogens,with a concerning rise in resistance to commonly used antibiotics,particularly among Klebsiella pneumoniae and E.coli.Additionally,the study identified an alarming increase in the prevalence of multidrug-resistant(MDR)strains,especially within Klebsiella pneumoniae and E.coli isolates.The impact of the COVID-19 pandemic on these trends was evident,with shifts in the frequency,resistance patterns,and the emergence of MDR bacteria among several key pathogens.CONCLUSION This study highlights the dynamic nature of bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex,particularly in the context of the COVID-19 pandemic.The findings underscore the need for continuous monitoring and effective anti-microbial stewardship programs to combat the evolving threat of antibiotic resistance.Further research and policy initiatives are required to address the identified challenges and improve patient outcomes in the face of these ongoing challenges.展开更多
Background: Severe acute malnutrition (SAM) is one of the major public health problems associated with increased mortality in under-five children. In low-income countries, renal dysfunction (RD) contributes to about 3...Background: Severe acute malnutrition (SAM) is one of the major public health problems associated with increased mortality in under-five children. In low-income countries, renal dysfunction (RD) contributes to about 34% mortality in under-five children with severe acute malnutrition. This study aimed to determine the impacts of severe acute malnutrition on the kidney among the admitted under-five children. Methods: In this prospective longitudinal observational study, a total of 190 children aged 6 to 59 months were enrolled from Iringa and Dodoma tertiary hospitals. Socio-demographic, clinical and laboratory data were collected using a structured questionnaire. Estimated Glomerular Filtration Rate (eGFR) and urine albumin creatinine ratio (uACR) were used to determine RD. Data analysis was done using SPSS version 26 and statistical significance was assumed for factors with p-value Results: Out of 190 children with severe acute malnutrition, 36 (19%) had renal dysfunction. Factors associated with RD in malnourished children were the history of local herbs used within one week (AOR = 5.85, 95% CI [1.41, 24.319], p = 0.0152), Acute watery diarrhea with severe dehydration (AOR = 2.15, 95% CI [1.033, 4.711], p = 0.0166), and positive urine leukocytes (AOR = 19.91, 95% CI [4.09, 96.989], p = 0.0002). At three months of follow up, out of 36 children with RD, 20 (55.56%) attained full recovery, while 4 (11.11%) developed chronic kidney disease (CKD). Children with RD had prolonged hospital stays for more than 14 days with a mean 12.25 ± 5.00 days compared to those with no RD with a mean 6.29 ± 1.68 days (p Conclusion: Renal dysfunction is common among children with severe acute malnutrition. It is associated with prolonged hospital stays and increased mortality. Further studies which can determine the burden of RD in children with severe acute malnutrition as compared to those with no severe acute malnutrition are needed.展开更多
BACKGROUND Cyclic vomiting syndrome(CVS)and its effect on nutritional status has not been well described.AIM To describe the clinical characteristics,treatment and outcomes of children with CVS in Singapore.METHODS Re...BACKGROUND Cyclic vomiting syndrome(CVS)and its effect on nutritional status has not been well described.AIM To describe the clinical characteristics,treatment and outcomes of children with CVS in Singapore.METHODS Retrospective cohort study of pediatric patients aged 1 to 18 years old with CVS diagnosed at KK Women’s and Children’s Hospital in Singapore from 2011 to 2021.RESULTS Thirty-two children(69%female)with CVS were included in the study,with mean age of onset of symptoms at 7(±4)years and mean follow up duration of 5 years.Forty percent(12/32)of patients were underweight at diagnosis with no other identifiable organic cause,with a median body mass index(BMI)z score-3.2(range-2 to-7.5).The incidence of systemic hypertension was 10%(3/32).The overall mean frequency of exacerbations in this cohort of patients was 4(±4)episodes per year.In total,16(50%)patients,who had mean baseline frequency of 6(±5)attacks per year,were commenced on prophylactic treatment.Twelve patients(75%)responded to first-line therapy,whereas 4(25%)required escalation to second-line treatment.With prophylactic treatment,there was an overall improvement in the frequency of attacks with a mean reduction of 5(±3)attacks per year.Also,there was improvement in the BMI z score of these patients from a median of-2.9 to-0.9.CONCLUSION Prophylactic treatment is effective in improving nutritional status as well as reducing symptom frequency and should be considered for patients with complications such as growth failure and significant hypertension.展开更多
Badk ground:The role of cardiothoracic ratio(CTR)from the chest radiograph for assessmentof ventricular enlargement and function in rpaired tetralogy of Fallot(TOF)is conflicting.This study aimnedto determnine the ass...Badk ground:The role of cardiothoracic ratio(CTR)from the chest radiograph for assessmentof ventricular enlargement and function in rpaired tetralogy of Fallot(TOF)is conflicting.This study aimnedto determnine the associations between CTR and cardiac magnetic resonance(CMR)-derived ventricularvolumes and indices of ventricular function in adolescents and young adults with repaired TOF.Methods:The CTR and CMR findings,performed within 12 months of each other,were reviewed in 76 patients aged22.1±6.4 years.Associations between CTR and CMR parameters including right(RV)and left ventricular(LV)volumes and ejecticn fraction were determined.Diagnostic accuracies of CTR in identify ing moderateto severe RV or LV dilation were assessed by calculation of area under the receiver operator characteristiccurves(AUC),Results:Patients with normal CTR and those with increased CTR>0.5 had simnilar right andleft ventricular volumes,ejection fraction,and pulmonary regurgitant fraction(all p>0.05),There wereno significant oorrelations between CTR and RV end-diastolic(r=0.06,p=0.65)and end-systolic(r=0.06,=0.65)volumes,LV end-diastolic(=0.23,p=0.08)and end-systolic(r=0.18,p=0.16)volumes,and LV(r=—0.07,p=0.60)and RV(r<-0.01,p=0.97)ejection fraction.The CTR failed to distinguish betweenpatients with moderate to severe RV(AUC0.50)or LV(AUC 0.46)dilation from patients without ventriculardilation.Condlusions:The CTR based on the chest radiograph failed to reflect dilation or raduced ejectionfraction of either the right or the left ventricle in adolescents and young adults with repaired TOF.展开更多
BACKGROUND Acute respiratory infections(ARI)and diarrhoea are among the leading causes of infant and under-five mortality worldwide.Zinc,the second most abundant trace element in the human body,is widely used in the t...BACKGROUND Acute respiratory infections(ARI)and diarrhoea are among the leading causes of infant and under-five mortality worldwide.Zinc,the second most abundant trace element in the human body,is widely used in the treatment of both conditions.It mitigates diarrhoea by restoring mucosal integrity and enhancing enterocyte brush border enzyme activity.In ARI,zinc boosts immune function,promotes epithelial regeneration,and inhibits the replication of respiratory viruses.AIM To assess the effectiveness of prophylactic intermittent zinc supplementation in preventing acute diarrhoea and ARI in infants.METHODS This open-label,randomized controlled trial with a 1:1 allocation ratio was conducted over 15 months(October 2022 to December 2023)at a tertiary care hospital in Eastern India.A total of 320 infants attending the outpatient department for routine vaccinations were enrolled and randomly assigned to intervention and control groups.The intervention group received zinc drops for two weeks,with the regimen repeated one month later and again at six months during subsequent vaccination visits.The control group received no placebo or alternative treatment.Outcomes were assessed after the final follow-up at nine months.RESULTS The mean annual incidence of ARI and diarrhoea was significantly lower in the zinc group than in the control group[ARI:0.25±0.61 vs 0.92±1.22;mean difference=-0.67(95%CI:-0.88 to-0.45),P<0.001,Cohen’s d=-0.69]and[diarrhoea:1.04±1.30 vs 2.07±2.09;mean difference=-1.03(95%CI:-1.42 to-0.65),P<0.001,Cohen's d=-0.59],respectively.Additionally,the zinc group showed significantly greater gains in length[10±0.6 cm vs 8.6±0.4 cm;mean difference=1.4(95%CI:1.3-1.5),P<0.001,Cohen’s d=2.74]and weight[3150±108 g vs 2818±76 g;mean difference=332(95%CI:310-352),P<0.001,Cohen's d=3.56].CONCLUSION Prophylactic intermittent zinc supplementation administered alongside routine immunization substantially reduces the incidence of ARI and diarrhoea in infants and promotes improved growth.This affordable strategy holds promise for reducing infant morbidity and mortality without increasing healthcare burdens.展开更多
Objective:To study the clinical profiles of children with febrile seizures,comparing those with single episodes to recurrent cases,and identify predictors of recurrence.In addition,to develop a scoring system to predi...Objective:To study the clinical profiles of children with febrile seizures,comparing those with single episodes to recurrent cases,and identify predictors of recurrence.In addition,to develop a scoring system to predict recurrence after the first febrile seizure,and identify modifiable risk factors to mitigate recurrence risks.Methods:This cross-sectional study included children aged 6 months to 5 years with typical febrile seizures,seen as inpatients or outpatients of the Department of Pediatrics at a tertiary care teaching hospital.Data were collected via parent interviews,physical exams,and laboratory tests.The questionnaire covered demographics,antenatal,natal,and postnatal events,seizure history,family history,immunization,daycare attendance,and fever management.Clinical evaluations ruled out central nervous system infections and fever causes were diagnosed per ICD-10 at discharge.Laboratory tests assessed anemia,dyselectrolytemia,and hypoglycemia.Data were analyzed in SPSS Version 25 using descriptive statistics,t-tests,Chi-square tests,and odds ratios with 95%confidence intervals(CI),with significance set at P<0.05.Results:451 children were included in this study.Low birth weight(OR=2.60,95%CI=1.12-6.33,P=0.026),age at first episode>12 months(OR=0.28,95%CI=0.16-0.48,P0.001),family history of febrile seizure(OR=5.21,95%CI=2.92-9.28,P<0.001),no intermittent prophylaxis(OR=15.25,95%CI=7.05-32.90,P<0.001),treatment for fever(OR=0.26,95%CI=0.13-0.51)and low socioeconomic status(OR=5.87,95%CI=3.32-10.38)were significantly associated with recurrent febrile seizures.Conclusions:Low birth weight,age at first episode≤12 months,family history of febrile seizure,no intermittent prophylaxis,inadequate treatment for fever and low socioeconomic status were significant risk factors for having recurrent febrile seizures in children aged from 6 months to 5 years.展开更多
This mini-review explores the transformative potential of artificial intelligence(AI)in improving the diagnosis,management,and long-term care of congenital heart diseases(CHDs).AI offers significant advancements acros...This mini-review explores the transformative potential of artificial intelligence(AI)in improving the diagnosis,management,and long-term care of congenital heart diseases(CHDs).AI offers significant advancements across the spectrum of CHD care,from prenatal screening to postnatal management and long-term monitoring.Using AI algorithms,enhanced fetal echocardiography,and genetic tests improves prenatal diagnosis and risk stratification.Postnatally,AI revolutionizes diagnostic imaging analysis,providing more accurate and efficient identification of CHD subtypes and severity.Compared with traditional methods,advanced signal processing techniques enable a more precise assessment of hemodynamic parameters.AI-driven decision support systems tailor treatment strategies,thereby optimizing therapeutic interventions and predicting patient outcomes with greater accuracy.This personalized approach leads to better clinical outcomes and reduced morbidity.Furthermore,AI-enabled remote monitoring and wearable devices facilitate ongoing surveillance,thereby enabling early detection of complications and provision of prompt interventions.This continuous monitoring is crucial in the immediate postoperative period and throughout the patient’s life.Despite the immense potential of AI,challenges remain.These include the need for standardized datasets,the development of transparent and understandable AI algorithms,ethical considerations,and seamless integration into existing clinical workflows.Overcoming these obstacles through collaborative data sharing and responsible implementation will unlock the full potential of AI to improve the lives of patients with CHD,ultimately leading to better patient outcomes and improved quality of life.展开更多
Inflammatory bowel disease(IBD)is an increasing global health issue that poses specific challenges in Nigeria.Although awareness of IBD is growing in the country,research and resources remain limited.This review aims ...Inflammatory bowel disease(IBD)is an increasing global health issue that poses specific challenges in Nigeria.Although awareness of IBD is growing in the country,research and resources remain limited.This review aims to address this significant gap.To identify key gaps in IBD research within Nigeria and highlight opportunities for advancing future investigations to improve patient outcomes.A comprehensive review of the existing literature was conducted to evaluate current trends in IBD research,healthcare barriers,and potential areas for investigation specific to the Nigerian context.The analysis highlights significant deficiencies,including scarce epidemiological data,low levels of awareness among clinicians and patients,limited access to healthcare,and inadequate diagnostic and treatment resources.Additionally,there is a profound lack of localized research addressing genetic,environmental,and dietary factors relevant to the Nigerian population.Future investigations should prioritize epidemiological studies to assess IBD prevalence in Nigeria,establish specialized care centers for diagnosis and management,and launch public health initiatives to promote awareness and education.Strengthening collaboration between researchers,healthcare providers,and policymakers is imperative to achieving these goals.Bridging these research gaps presents an invaluable opportunity to enhance IBD healthcare delivery and patient outcomes in Nigeria.Collaborative,multidisciplinary efforts are essential for advancing knowledge,improving resources,and ultimately elevating the quality of life for individuals living with IBD in the country.展开更多
Pediatric inflammatory bowel disease(IBD),encompassing Crohn’s disease,ulcerative colitis,and IBD-unclassified,has become increasingly prevalent worldwide,including in previously low-incidence regions.Children often ...Pediatric inflammatory bowel disease(IBD),encompassing Crohn’s disease,ulcerative colitis,and IBD-unclassified,has become increasingly prevalent worldwide,including in previously low-incidence regions.Children often present with more extensive and aggressive disease,creating unique diagnostic and management challenges that differ significantly from adult-onset IBD.This review aims to synthesize current knowledge on pediatric IBD,highlighting historical challenges while exploring emerging frontiers in diagnosis,treatment,and long-term care strategies.A narrative synthesis of global and regional epidemiological data,clinical classifications,diagnostic advancements,management approaches,and psychosocial considerations was conducted,with a particular emphasis on innovations in precision medicine,microbiome-targeted therapy,and multidisciplinary care models.Pediatric IBD continues to rise globally,driven by environmental and genetic interactions,especially in rapidly industrializing regions.Novel diagnostic tools,age-specific treatment protocols,biologics,nutritional strategies,and psychosocial support are reshaping care.Emphasis on very early-onset IBD,transition care,and regional policy adaptations underscores the evolving complexity of managing pediatric IBD.The landscape of pediatric IBD care is rapidly evolving.Addressing the distinct pathophysiology,developmental impact,and healthcare challenges of pediatric patients requires an integrated,child-centered approach.Ongoing research into genetics,immune pathways,and the microbiome will be essential in tailoring precision therapies and improving outcomes globally.展开更多
BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have impr...BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have improved the recognition of this self-limiting condition,but clinical awareness remains critical.AIM To provide a comprehensive update on the epidemiology,anatomy,pathogenesis,clinical presentation,diagnostic strategies,differential diagnosis,and management of epiploic appendagitis,emphasizing its distinguishing features from other causes of acute abdomen.METHODS A review of the literature was conducted,focusing on the clinical characteristics,imaging findings,differential diagnoses,and evidence-based management strategies for epiploic appendagitis.RESULTS Epiploic appendagitis typically presents with acute,localized,non-radiating abdominal pain without significant systemic symptoms.Diagnosis is heavily reliant on imaging,with computed tomography(CT)being the gold standard.Hallmark CT findings include a small,fat-density ovoid lesion adjacent to the colon,with the usual characteristic ring and dot signs.Differential diagnoses include mainly diverticulitis,appendicitis,omental infarction,and many other causes.Management is predominantly conservative with nonsteroidal anti-inflammatory drugs and observation,reserving surgical intervention for rare,complicated cases.CONCLUSION Recognizing the clinical and imaging features of epiploic appendagitis is essential to avoid unnecessary interventions.Increased clinician awareness,coupled with judicious use of imaging,facilitates timely diagnosis and appropriate management,ensuring optimal patient outcomes.展开更多
AIM:To systematically evaluate and update evidence on the efficacy and safety of probiotic supplementation for the treatment of constipation. METHODS:The MEDLINE,EMBASE,CINAHL,and Cochrane Library databases were searc...AIM:To systematically evaluate and update evidence on the efficacy and safety of probiotic supplementation for the treatment of constipation. METHODS:The MEDLINE,EMBASE,CINAHL,and Cochrane Library databases were searched in May 2009 for randomised controlled trials(RCTs)performed in paediatric or adult populations related to the study aim. RESULTS:We included five RCTs with a total of 377 subjects(194 in the experimental group and 183 in the control group).The participants were adults (three RCTs,n=266)and children(two RCTs,n= 111)with constipation.In adults,data suggests a favourable effect of treatment with Bifidobacterium lactis DN-173 010,Lactobacillus casei Shirota,and Escherichia coli Nissle 1917 on defecation frequency and stool consistency.In children,L.casei rhamnosusLcr35,but not L.rhamnosus GG,showed a beneficial effect. CONCLUSION:Until more data are available,we believe the use of probiotics for the treatment of constipation condition should be considered investigational.展开更多
AIM To perform a comprehensive review and provide an up-to-date synopsis of the incidence and trends of inflammatory bowel disease(IBD). METHODS We systematically searched the MEDLINE(source Pub Med), EMBASE and Cochr...AIM To perform a comprehensive review and provide an up-to-date synopsis of the incidence and trends of inflammatory bowel disease(IBD). METHODS We systematically searched the MEDLINE(source Pub Med), EMBASE and Cochrane Library databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines(period: 1985-2018) to identify studies reporting population-based data on the incidence of pediatriconset(< 19 years at diagnosis) IBD in full manuscripts. Two authors carried out screening and data extraction. Choropleth interactive maps and temporal trends were used to illustrate the international differences and incidences of and changes in IBD and subtypes.RESULTS In total, one hundred forty studies reporting data from 38 countries were considered in this review. The highest annual pediatric incidences of IBD were 23/100000 person-years in Europe, 15.2/100000 in North America, and 11.4/100000 in Asia/the Middle East and Oceania. The highest annual incidences of Crohn's disease(CD) were 13.9/100000 in North America and 12.3/100000 in Europe. The highest annual incidences of ulcerative colitis(UC) were 15.0/100000 in Europe and 10.6/100000 in North America. The highest annual incidences of IBD-unclassified(IBD-U) were 3.6/100000 in Europe and 2.1/100000 in North America. In the time-trend analyses, 67% of CD, 46% of UC and 11% of IBD-U studies reported an increasing incidence(P < 0.05). The risk of IBD is increasing among firstgeneration of migrant populations.CONCLUSION Globally, the incidence of IBD varies greatly by geographical areas. The steadily increasing incidence of pediatric IBD over time indicates its emergence as a global disease, suggesting that studies should investigate the environmental risk factors among pediatric cohorts.展开更多
Exclusive enteral nutrition(EEN)is well-established as a first line therapy instead of corticosteroid(CS)therapy to treat active Crohn’s disease(CD)in children.It also has been shown to have benefits over and above i...Exclusive enteral nutrition(EEN)is well-established as a first line therapy instead of corticosteroid(CS)therapy to treat active Crohn’s disease(CD)in children.It also has been shown to have benefits over and above induction of disease remission in paediatric populations.However,other than in Japanese populations,this intervention is not routinely utilised in adults.To investigate potential reasons for variation in response between adult studies of EEN and CS therapy.The Ovid database was searched over a 6-mo period.Articles directly comparing EEN and CS therapy in adults were included.Eleven articles were identified.EEN therapy remission rates varied considerably.Poor compliance with EEN therapy due to unpalatable formula was an issue in half of the studies.Remission rates of studies that only included patients with previously untreated/new CD were higher than studies including patients with both existing and new disease.There was limited evidence to determine if disease location,duration of disease or age of diagnosis affected EEN therapy outcomes.There is some evidence to support the use of EEN as a treatment option for a select group of adults,namely those motivated to adhere to an EEN regimen and possibly those newly diagnosed with CD.In addition,the use of more palatable formulas could improve treatment compliance.展开更多
文摘BACKGROUND There is a possible link between depression and anxiety about suicidal ideation among parents of children with congenital heart disease(CHD).AIM To document the effects of depression and anxiety on parental suicidal ideation among children with CHD and the associated factors.METHODS This was a cross-sectional study among 50 parents of children with CHD who attended the Cardiac Clinic of University of Nigeria Teaching Hospital Ituku-Ozalla.Information was obtained using the Columbia Suicide Severity Rating Scale and the Hospital Anxiety and Depression Scale.RESULTS A greater percentage of parents whose child had a heart defect had anxiety symptoms(50.0%)than did those whose child had no heart defect(24.0%),and the difference in proportions was statistically significant(χ^(2)=7.250,P=0.007).A greater percentage of parents whose child had a heart defect had suicidal ideation(28.0%)than did those whose child had no heart defect(8.0%),and the difference in proportions was statistically significant(χ^(2)=6.775 P=0.009).A positive correlation was elicited between anxiety and suicide ideation,and this correlation was statistically significant(r=0.748,P<0.001).A positive correlation was elicited between depression and suicidal ideation scores,and this was statistically significant(r=0.617,P<0.001).CONCLUSION There is strong interconnectivity between anxiety and depression with suicidal ideation.There is an urgent need to start screening for the mental health of parents of children with CHD to avert the high propensity of complete suicide.In addition,policy makers may introduce a national clinical practice guideline on the importance of psychotherapy and mental health screening and targeted interventions for parents of children with CHD.
文摘Objective: To assess emergency department utilization at a semi-urban (resource-limited) Nigerian hospital. Methods: A systematic random sampling technique was adopted. A proforma was used to obtain general information such as age, gender, mode of transfer, time of presentation, symptom duration, diagnoses, treatment duration, treatment outcome (transfer to the ward, referral to another hospital, discharge or death) and date and time of discharge. Chi-square test and logistic regression analysis were used to determine the association of variables with mortality and predictors, respectively. Results: Patients were predominantly male (62.2%) with a mean age of (36.0±19.0) years. Most visits occurred in September (49.1%). The median symptom duration was 24 h (interquartile range: 4.0, 72.0 ). More incidences were caused by non-surgical (61.9%) than surgical reasons. Infectious diseases (predominantly malaria, 34.5%) and injuries from road traffic accidents (mostly head injuries, 9.4%) were the commonest non-surgical and surgical cause, respectively. The mortality rate was 9.2%. Typhoid-intestinal-perforation and sepsis contributed 45.2% of overall mortality. Age (x2=16.44, P<0.001), symptom duration (x2=22.57, P<0.001), and visiting month (Fishers exact, P=0.002) were associated with mortality. Moreover, age ( 37 years) (OR=4.60, 95%CI=1.96-10.82, P<0.001) and visiting in September/October (OR=4.01, 95%CI=1.47-10.93, P=0.007) were the predictors of mortality. Conclusions: Though most patients in emergency department survive, the mortality is still high. Appropriate hospital and community interventions should be implemented to reduce mortality.
文摘Fournier’s gangrene is a form of necrotizing fasciitis that has multiple causes and is relatively uncommon in children. We report a case of Fournier’s gangrene of infectious origin in a 12-month-old infant following an insect bite. A rapid diagnosis and multidisciplinary care saved the patient.
文摘BACKGROUND: We assessed whether the paediatric-appropriate facilities were available at Emergency Departments(ED) in community hospitals in a Canadian province.METHODS: We conducted a cross-sectional survey of EDs in community hospitals in Ontario, Canada that had inpatient paediatric facilities and a neonatal intensive care unit. Key informants were ED chiefs, clinical educators, or managers. The survey included questions about paediatric facilities related to environment, triage, training, and staff in EDs.RESULTS: Of 52 hospitals, 69%(n=36) responded to our survey. Of them, 14% EDs(n=5) had some separated spaces available for paediatric patients. About 53%(n=19) of EDs lacked children activities, e.g., toys. Only 11%(n=4) EDs were using paediatric triage scales and 42%(n=15) had a designated paediatric resuscitation bay. Only half of the ED(n=18) required from their staff to update paediatric life support training. Only 31%(n=11) had a designated liaison paediatrician for the ED. Paediatric social worker was present in only 8%(n=3) of EDs in community hospitals.CONCLUSION: Most of the Ontario community hospital EDs included in this survey had inadequate facilities for paediatric patients such as specific waiting and treatment areas.
文摘Introduction: Globally, tuberculosis is the leading cause of death from a single infectious agent ahead of HIV/AIDS. Approximately 10 million people contracted TB in 2017, 10% of whom were children aged 0 - 15 years, or about 1 million with 250,000 deaths in 2016 (including children with HIV-associated TB). The signs of TB in children are not always specific and diagnosis remains difficult unlike in adults. According to a study conducted in 2011 in the paediatric department of the CHU-Gabriel Touré, only seventeen cases of all forms of tuberculosis were found, or approximately 0.2% of hospitalised children. The objective of our study was to investigate the epidemiological and clinical aspects of tuberculosis in children. Materials and Method: This was a prospective, cross-sectional and descriptive study that took place from 24 October 2017 to 23 October 2018, or 12 months in children aged 0-15 years. Data were collected from an individual medical record opened for each patient and an individual survey form established for each child. Results: During the study period, 40,434 children were consulted. Tuberculosis was suspected in 91 children, with a frequency of 0.22%. The age range of 1 to 4 years was 36.3% with a median age of 72 months. The sex ratio was 1.8. Chronic cough with 84.6% and malnutrition with 24.17% were the most frequent symptoms. Chest X-ray revealed bilateral pulmonary lesions in 52.7% and mediastinal adenopathy in 12.1%. TST was positive in 10.9% of patients, microscopy in 26.4%, Gene Xpert in 18.7%, and culture in 16.5%. The biological diagnosis of tuberculosis was retained in 48.4% of the patients, the pulmonary form represented 93.2%. The therapeutic regime (2RHZE/4RH) was used in 81.6% of cases and the evolution was favourable in 65.9% of patients. Conclusion: The diagnosis of tuberculosis in children remains difficult in our context. The clinical signs are not always specific, and further studies are needed to further elucidate this disease.
文摘Acrodermatitis enteropathica is a rare autosomal recessive genetic disorder characterised by periorificial dermatitis, alopecia and diarrhoea. It is caused by a mutation in the gene that codes for a membrane protein that binds zinc. We report a case in a 7-month-old girl, admitted with altered general condition and scaly, pustular erythematous lesions, initially located in the occipital and cervical regions, and secondarily inguinal and on the knees. Management and outcome in this patient? Genetic assay was not available to confirm this rare genetic disease. A delay in establishing the diagnosis and a disastrous outcome did not save the patient despite the administration of zinc.
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 Antibiotic resistance is a growing global health threat,and understanding local trends in bacterial isolates and their susceptibility patterns is crucial for effective infection control and antimicrobial stewardship.The coronavirus disease 2019(COVID-19)pandemic has introduced additional complexities,potentially influencing these patterns.AIM To analyze trends in bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex from 2018 to 2023,with a specific focus on the impact of the COVID-19 pandemic on these trends.METHODS A retrospective analysis of microbiological data was conducted,covering the period from 2018 to 2023.The study included key bacterial pathogens such as Escherichia coli(E.coli),Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa,and Staphylococcus aureus,among others.The antibiotic susceptibility profiles of these isolates were assessed using standard laboratory methods.To contextualize the findings,the findings were compared with similar studies from other regions,including China,India,Romania,Saudi Arabia,the United Arab Emirates,Malaysia,and United States.RESULTS The study revealed fluctuating trends in the prevalence of bacterial isolates,with notable changes during the COVID-19 pandemic.For example,a significant increase in the prevalence of Staphylococcus aureus was observed during the pandemic years,while the prevalence of E.coli showed a more variable pattern.Antibiotic resistance rates varied among the different pathogens,with a concerning rise in resistance to commonly used antibiotics,particularly among Klebsiella pneumoniae and E.coli.Additionally,the study identified an alarming increase in the prevalence of multidrug-resistant(MDR)strains,especially within Klebsiella pneumoniae and E.coli isolates.The impact of the COVID-19 pandemic on these trends was evident,with shifts in the frequency,resistance patterns,and the emergence of MDR bacteria among several key pathogens.CONCLUSION This study highlights the dynamic nature of bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex,particularly in the context of the COVID-19 pandemic.The findings underscore the need for continuous monitoring and effective anti-microbial stewardship programs to combat the evolving threat of antibiotic resistance.Further research and policy initiatives are required to address the identified challenges and improve patient outcomes in the face of these ongoing challenges.
文摘Background: Severe acute malnutrition (SAM) is one of the major public health problems associated with increased mortality in under-five children. In low-income countries, renal dysfunction (RD) contributes to about 34% mortality in under-five children with severe acute malnutrition. This study aimed to determine the impacts of severe acute malnutrition on the kidney among the admitted under-five children. Methods: In this prospective longitudinal observational study, a total of 190 children aged 6 to 59 months were enrolled from Iringa and Dodoma tertiary hospitals. Socio-demographic, clinical and laboratory data were collected using a structured questionnaire. Estimated Glomerular Filtration Rate (eGFR) and urine albumin creatinine ratio (uACR) were used to determine RD. Data analysis was done using SPSS version 26 and statistical significance was assumed for factors with p-value Results: Out of 190 children with severe acute malnutrition, 36 (19%) had renal dysfunction. Factors associated with RD in malnourished children were the history of local herbs used within one week (AOR = 5.85, 95% CI [1.41, 24.319], p = 0.0152), Acute watery diarrhea with severe dehydration (AOR = 2.15, 95% CI [1.033, 4.711], p = 0.0166), and positive urine leukocytes (AOR = 19.91, 95% CI [4.09, 96.989], p = 0.0002). At three months of follow up, out of 36 children with RD, 20 (55.56%) attained full recovery, while 4 (11.11%) developed chronic kidney disease (CKD). Children with RD had prolonged hospital stays for more than 14 days with a mean 12.25 ± 5.00 days compared to those with no RD with a mean 6.29 ± 1.68 days (p Conclusion: Renal dysfunction is common among children with severe acute malnutrition. It is associated with prolonged hospital stays and increased mortality. Further studies which can determine the burden of RD in children with severe acute malnutrition as compared to those with no severe acute malnutrition are needed.
文摘BACKGROUND Cyclic vomiting syndrome(CVS)and its effect on nutritional status has not been well described.AIM To describe the clinical characteristics,treatment and outcomes of children with CVS in Singapore.METHODS Retrospective cohort study of pediatric patients aged 1 to 18 years old with CVS diagnosed at KK Women’s and Children’s Hospital in Singapore from 2011 to 2021.RESULTS Thirty-two children(69%female)with CVS were included in the study,with mean age of onset of symptoms at 7(±4)years and mean follow up duration of 5 years.Forty percent(12/32)of patients were underweight at diagnosis with no other identifiable organic cause,with a median body mass index(BMI)z score-3.2(range-2 to-7.5).The incidence of systemic hypertension was 10%(3/32).The overall mean frequency of exacerbations in this cohort of patients was 4(±4)episodes per year.In total,16(50%)patients,who had mean baseline frequency of 6(±5)attacks per year,were commenced on prophylactic treatment.Twelve patients(75%)responded to first-line therapy,whereas 4(25%)required escalation to second-line treatment.With prophylactic treatment,there was an overall improvement in the frequency of attacks with a mean reduction of 5(±3)attacks per year.Also,there was improvement in the BMI z score of these patients from a median of-2.9 to-0.9.CONCLUSION Prophylactic treatment is effective in improving nutritional status as well as reducing symptom frequency and should be considered for patients with complications such as growth failure and significant hypertension.
文摘Badk ground:The role of cardiothoracic ratio(CTR)from the chest radiograph for assessmentof ventricular enlargement and function in rpaired tetralogy of Fallot(TOF)is conflicting.This study aimnedto determnine the associations between CTR and cardiac magnetic resonance(CMR)-derived ventricularvolumes and indices of ventricular function in adolescents and young adults with repaired TOF.Methods:The CTR and CMR findings,performed within 12 months of each other,were reviewed in 76 patients aged22.1±6.4 years.Associations between CTR and CMR parameters including right(RV)and left ventricular(LV)volumes and ejecticn fraction were determined.Diagnostic accuracies of CTR in identify ing moderateto severe RV or LV dilation were assessed by calculation of area under the receiver operator characteristiccurves(AUC),Results:Patients with normal CTR and those with increased CTR>0.5 had simnilar right andleft ventricular volumes,ejection fraction,and pulmonary regurgitant fraction(all p>0.05),There wereno significant oorrelations between CTR and RV end-diastolic(r=0.06,p=0.65)and end-systolic(r=0.06,=0.65)volumes,LV end-diastolic(=0.23,p=0.08)and end-systolic(r=0.18,p=0.16)volumes,and LV(r=—0.07,p=0.60)and RV(r<-0.01,p=0.97)ejection fraction.The CTR failed to distinguish betweenpatients with moderate to severe RV(AUC0.50)or LV(AUC 0.46)dilation from patients without ventriculardilation.Condlusions:The CTR based on the chest radiograph failed to reflect dilation or raduced ejectionfraction of either the right or the left ventricle in adolescents and young adults with repaired TOF.
文摘BACKGROUND Acute respiratory infections(ARI)and diarrhoea are among the leading causes of infant and under-five mortality worldwide.Zinc,the second most abundant trace element in the human body,is widely used in the treatment of both conditions.It mitigates diarrhoea by restoring mucosal integrity and enhancing enterocyte brush border enzyme activity.In ARI,zinc boosts immune function,promotes epithelial regeneration,and inhibits the replication of respiratory viruses.AIM To assess the effectiveness of prophylactic intermittent zinc supplementation in preventing acute diarrhoea and ARI in infants.METHODS This open-label,randomized controlled trial with a 1:1 allocation ratio was conducted over 15 months(October 2022 to December 2023)at a tertiary care hospital in Eastern India.A total of 320 infants attending the outpatient department for routine vaccinations were enrolled and randomly assigned to intervention and control groups.The intervention group received zinc drops for two weeks,with the regimen repeated one month later and again at six months during subsequent vaccination visits.The control group received no placebo or alternative treatment.Outcomes were assessed after the final follow-up at nine months.RESULTS The mean annual incidence of ARI and diarrhoea was significantly lower in the zinc group than in the control group[ARI:0.25±0.61 vs 0.92±1.22;mean difference=-0.67(95%CI:-0.88 to-0.45),P<0.001,Cohen’s d=-0.69]and[diarrhoea:1.04±1.30 vs 2.07±2.09;mean difference=-1.03(95%CI:-1.42 to-0.65),P<0.001,Cohen's d=-0.59],respectively.Additionally,the zinc group showed significantly greater gains in length[10±0.6 cm vs 8.6±0.4 cm;mean difference=1.4(95%CI:1.3-1.5),P<0.001,Cohen’s d=2.74]and weight[3150±108 g vs 2818±76 g;mean difference=332(95%CI:310-352),P<0.001,Cohen's d=3.56].CONCLUSION Prophylactic intermittent zinc supplementation administered alongside routine immunization substantially reduces the incidence of ARI and diarrhoea in infants and promotes improved growth.This affordable strategy holds promise for reducing infant morbidity and mortality without increasing healthcare burdens.
文摘Objective:To study the clinical profiles of children with febrile seizures,comparing those with single episodes to recurrent cases,and identify predictors of recurrence.In addition,to develop a scoring system to predict recurrence after the first febrile seizure,and identify modifiable risk factors to mitigate recurrence risks.Methods:This cross-sectional study included children aged 6 months to 5 years with typical febrile seizures,seen as inpatients or outpatients of the Department of Pediatrics at a tertiary care teaching hospital.Data were collected via parent interviews,physical exams,and laboratory tests.The questionnaire covered demographics,antenatal,natal,and postnatal events,seizure history,family history,immunization,daycare attendance,and fever management.Clinical evaluations ruled out central nervous system infections and fever causes were diagnosed per ICD-10 at discharge.Laboratory tests assessed anemia,dyselectrolytemia,and hypoglycemia.Data were analyzed in SPSS Version 25 using descriptive statistics,t-tests,Chi-square tests,and odds ratios with 95%confidence intervals(CI),with significance set at P<0.05.Results:451 children were included in this study.Low birth weight(OR=2.60,95%CI=1.12-6.33,P=0.026),age at first episode>12 months(OR=0.28,95%CI=0.16-0.48,P0.001),family history of febrile seizure(OR=5.21,95%CI=2.92-9.28,P<0.001),no intermittent prophylaxis(OR=15.25,95%CI=7.05-32.90,P<0.001),treatment for fever(OR=0.26,95%CI=0.13-0.51)and low socioeconomic status(OR=5.87,95%CI=3.32-10.38)were significantly associated with recurrent febrile seizures.Conclusions:Low birth weight,age at first episode≤12 months,family history of febrile seizure,no intermittent prophylaxis,inadequate treatment for fever and low socioeconomic status were significant risk factors for having recurrent febrile seizures in children aged from 6 months to 5 years.
文摘This mini-review explores the transformative potential of artificial intelligence(AI)in improving the diagnosis,management,and long-term care of congenital heart diseases(CHDs).AI offers significant advancements across the spectrum of CHD care,from prenatal screening to postnatal management and long-term monitoring.Using AI algorithms,enhanced fetal echocardiography,and genetic tests improves prenatal diagnosis and risk stratification.Postnatally,AI revolutionizes diagnostic imaging analysis,providing more accurate and efficient identification of CHD subtypes and severity.Compared with traditional methods,advanced signal processing techniques enable a more precise assessment of hemodynamic parameters.AI-driven decision support systems tailor treatment strategies,thereby optimizing therapeutic interventions and predicting patient outcomes with greater accuracy.This personalized approach leads to better clinical outcomes and reduced morbidity.Furthermore,AI-enabled remote monitoring and wearable devices facilitate ongoing surveillance,thereby enabling early detection of complications and provision of prompt interventions.This continuous monitoring is crucial in the immediate postoperative period and throughout the patient’s life.Despite the immense potential of AI,challenges remain.These include the need for standardized datasets,the development of transparent and understandable AI algorithms,ethical considerations,and seamless integration into existing clinical workflows.Overcoming these obstacles through collaborative data sharing and responsible implementation will unlock the full potential of AI to improve the lives of patients with CHD,ultimately leading to better patient outcomes and improved quality of life.
文摘Inflammatory bowel disease(IBD)is an increasing global health issue that poses specific challenges in Nigeria.Although awareness of IBD is growing in the country,research and resources remain limited.This review aims to address this significant gap.To identify key gaps in IBD research within Nigeria and highlight opportunities for advancing future investigations to improve patient outcomes.A comprehensive review of the existing literature was conducted to evaluate current trends in IBD research,healthcare barriers,and potential areas for investigation specific to the Nigerian context.The analysis highlights significant deficiencies,including scarce epidemiological data,low levels of awareness among clinicians and patients,limited access to healthcare,and inadequate diagnostic and treatment resources.Additionally,there is a profound lack of localized research addressing genetic,environmental,and dietary factors relevant to the Nigerian population.Future investigations should prioritize epidemiological studies to assess IBD prevalence in Nigeria,establish specialized care centers for diagnosis and management,and launch public health initiatives to promote awareness and education.Strengthening collaboration between researchers,healthcare providers,and policymakers is imperative to achieving these goals.Bridging these research gaps presents an invaluable opportunity to enhance IBD healthcare delivery and patient outcomes in Nigeria.Collaborative,multidisciplinary efforts are essential for advancing knowledge,improving resources,and ultimately elevating the quality of life for individuals living with IBD in the country.
文摘Pediatric inflammatory bowel disease(IBD),encompassing Crohn’s disease,ulcerative colitis,and IBD-unclassified,has become increasingly prevalent worldwide,including in previously low-incidence regions.Children often present with more extensive and aggressive disease,creating unique diagnostic and management challenges that differ significantly from adult-onset IBD.This review aims to synthesize current knowledge on pediatric IBD,highlighting historical challenges while exploring emerging frontiers in diagnosis,treatment,and long-term care strategies.A narrative synthesis of global and regional epidemiological data,clinical classifications,diagnostic advancements,management approaches,and psychosocial considerations was conducted,with a particular emphasis on innovations in precision medicine,microbiome-targeted therapy,and multidisciplinary care models.Pediatric IBD continues to rise globally,driven by environmental and genetic interactions,especially in rapidly industrializing regions.Novel diagnostic tools,age-specific treatment protocols,biologics,nutritional strategies,and psychosocial support are reshaping care.Emphasis on very early-onset IBD,transition care,and regional policy adaptations underscores the evolving complexity of managing pediatric IBD.The landscape of pediatric IBD care is rapidly evolving.Addressing the distinct pathophysiology,developmental impact,and healthcare challenges of pediatric patients requires an integrated,child-centered approach.Ongoing research into genetics,immune pathways,and the microbiome will be essential in tailoring precision therapies and improving outcomes globally.
文摘BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have improved the recognition of this self-limiting condition,but clinical awareness remains critical.AIM To provide a comprehensive update on the epidemiology,anatomy,pathogenesis,clinical presentation,diagnostic strategies,differential diagnosis,and management of epiploic appendagitis,emphasizing its distinguishing features from other causes of acute abdomen.METHODS A review of the literature was conducted,focusing on the clinical characteristics,imaging findings,differential diagnoses,and evidence-based management strategies for epiploic appendagitis.RESULTS Epiploic appendagitis typically presents with acute,localized,non-radiating abdominal pain without significant systemic symptoms.Diagnosis is heavily reliant on imaging,with computed tomography(CT)being the gold standard.Hallmark CT findings include a small,fat-density ovoid lesion adjacent to the colon,with the usual characteristic ring and dot signs.Differential diagnoses include mainly diverticulitis,appendicitis,omental infarction,and many other causes.Management is predominantly conservative with nonsteroidal anti-inflammatory drugs and observation,reserving surgical intervention for rare,complicated cases.CONCLUSION Recognizing the clinical and imaging features of epiploic appendagitis is essential to avoid unnecessary interventions.Increased clinician awareness,coupled with judicious use of imaging,facilitates timely diagnosis and appropriate management,ensuring optimal patient outcomes.
基金Supported by The Medical University of Warsaw,Poland
文摘AIM:To systematically evaluate and update evidence on the efficacy and safety of probiotic supplementation for the treatment of constipation. METHODS:The MEDLINE,EMBASE,CINAHL,and Cochrane Library databases were searched in May 2009 for randomised controlled trials(RCTs)performed in paediatric or adult populations related to the study aim. RESULTS:We included five RCTs with a total of 377 subjects(194 in the experimental group and 183 in the control group).The participants were adults (three RCTs,n=266)and children(two RCTs,n= 111)with constipation.In adults,data suggests a favourable effect of treatment with Bifidobacterium lactis DN-173 010,Lactobacillus casei Shirota,and Escherichia coli Nissle 1917 on defecation frequency and stool consistency.In children,L.casei rhamnosusLcr35,but not L.rhamnosus GG,showed a beneficial effect. CONCLUSION:Until more data are available,we believe the use of probiotics for the treatment of constipation condition should be considered investigational.
基金Supported by the“On Our Own Feet Movement-P?áteléstonozky”-Endowment Programand Research Project Progress Q-39
文摘AIM To perform a comprehensive review and provide an up-to-date synopsis of the incidence and trends of inflammatory bowel disease(IBD). METHODS We systematically searched the MEDLINE(source Pub Med), EMBASE and Cochrane Library databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines(period: 1985-2018) to identify studies reporting population-based data on the incidence of pediatriconset(< 19 years at diagnosis) IBD in full manuscripts. Two authors carried out screening and data extraction. Choropleth interactive maps and temporal trends were used to illustrate the international differences and incidences of and changes in IBD and subtypes.RESULTS In total, one hundred forty studies reporting data from 38 countries were considered in this review. The highest annual pediatric incidences of IBD were 23/100000 person-years in Europe, 15.2/100000 in North America, and 11.4/100000 in Asia/the Middle East and Oceania. The highest annual incidences of Crohn's disease(CD) were 13.9/100000 in North America and 12.3/100000 in Europe. The highest annual incidences of ulcerative colitis(UC) were 15.0/100000 in Europe and 10.6/100000 in North America. The highest annual incidences of IBD-unclassified(IBD-U) were 3.6/100000 in Europe and 2.1/100000 in North America. In the time-trend analyses, 67% of CD, 46% of UC and 11% of IBD-U studies reported an increasing incidence(P < 0.05). The risk of IBD is increasing among firstgeneration of migrant populations.CONCLUSION Globally, the incidence of IBD varies greatly by geographical areas. The steadily increasing incidence of pediatric IBD over time indicates its emergence as a global disease, suggesting that studies should investigate the environmental risk factors among pediatric cohorts.
文摘Exclusive enteral nutrition(EEN)is well-established as a first line therapy instead of corticosteroid(CS)therapy to treat active Crohn’s disease(CD)in children.It also has been shown to have benefits over and above induction of disease remission in paediatric populations.However,other than in Japanese populations,this intervention is not routinely utilised in adults.To investigate potential reasons for variation in response between adult studies of EEN and CS therapy.The Ovid database was searched over a 6-mo period.Articles directly comparing EEN and CS therapy in adults were included.Eleven articles were identified.EEN therapy remission rates varied considerably.Poor compliance with EEN therapy due to unpalatable formula was an issue in half of the studies.Remission rates of studies that only included patients with previously untreated/new CD were higher than studies including patients with both existing and new disease.There was limited evidence to determine if disease location,duration of disease or age of diagnosis affected EEN therapy outcomes.There is some evidence to support the use of EEN as a treatment option for a select group of adults,namely those motivated to adhere to an EEN regimen and possibly those newly diagnosed with CD.In addition,the use of more palatable formulas could improve treatment compliance.
