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
Introduction: Acute otitis media is an acute inflammation of the mucosa of the middle ear cavities. It is often secondary to nasopharyngitis, which favors the passage of infection through the Eustachian tube to the mi...Introduction: Acute otitis media is an acute inflammation of the mucosa of the middle ear cavities. It is often secondary to nasopharyngitis, which favors the passage of infection through the Eustachian tube to the middle ear. The aim of our study was to improve the management of AOM in the Paediatric Department of the Hospital National Ignace Deen (Conakry). Patients and Methods: This was a prospective descriptive study lasting 6 months from 01 July to 31 December 2011;the study covered 525 cases out of a total of 6276 children, i.e. a frequency of 8.36%. Results: The most affected age group was 6 to 11 months. Males predominated (69.71%). 82.29% had a history of recurrent rhinopharyngitis. The most frequent reason for consultation was incessant crying (66.29%). Rhinopharyngitis and malaria were the most commonly associated pathologies (87.62% and 39.62% respectively). 72.19% of our patients were admitted with congestive AOM and received medical treatment. We recorded one case of otomastoiditis which was treated surgically. Conclusion: AOM is more common in children aged between 6 and 24 months. Good collaboration between paediatricians and ENT specialists is essential to reduce the morbidity of AOM.展开更多
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
Inborn errors of metabolism(IEM)are rare disorders,most are liver-based with liver transplantation(LT)emerging as an effective cure in the pediatric population.LT has been shown to offer a cure or deter disease progre...Inborn errors of metabolism(IEM)are rare disorders,most are liver-based with liver transplantation(LT)emerging as an effective cure in the pediatric population.LT has been shown to offer a cure or deter disease progression and provide symptomatic improvement in patients with IEM.Each metabolic disorder is unique,with the missing enzyme or transporter protein causing substrate deficiency or toxic byproduct production.Knowledge about the distribution of deficient enzymes,the percentage of enzymes replaced by LT,and the extent of extrahepatic involvement helps anticipate and manage complications in the perioperative period.Most patients have multisystem involvement and can be on complex dietary regimens.Metabolic decompensation can be triggered due to the stress response to surgery,fasting and other unanticipated complications perioperatively.Thus,a multidisciplinary team’s input including those from metabolic specialists is essential to develop disease and patient-specific strategies for the perioperative management of these patients during LT.In this review,we outline the classification of IEM,indications for LT along with potential benefits,basic metabolic defects and their implications,details of extrahepatic involvement and perioperative management strategies for LT in children with some of the commonly presenting IEM,to assist anesthesiologists handling this cohort of patients.展开更多
BACKGROUND Small intestinal bacterial overgrowth(SIBO)is suspected and excluded frequently in functional gastrointestinal(GI)disorders.Children presenting with various esophago-gastro-duodenal(upper GI)symptoms are ra...BACKGROUND Small intestinal bacterial overgrowth(SIBO)is suspected and excluded frequently in functional gastrointestinal(GI)disorders.Children presenting with various esophago-gastro-duodenal(upper GI)symptoms are rarely subjected to investig-ations for SIBO.AIM To estimate the frequency of SIBO in children having functional upper GI sym-ptoms(as cases)and to compare the result of the SIBO status to that of the con-trols.METHODS Children aged 6 to 18 who presented with upper GI symptoms were selected for the study.All children were subjected to upper GI endoscopy before being advised of any proton pump inhibitors(PPIs).Children with normal endoscopy were assigned as cases,and children having any endoscopic lesion were design-ated as controls.Both groups were subjected to a glucose-hydrogen breath test by Bedfont Gastrolyser.RESULTS A total of 129 consecutive children who were naive to PPIs and had normal ba-seline investigations were included in the study.Among them,67 patients had endoscopic lesions and served as the control group,with six cases being excluded due to the presence of Helicobacter pylori in gastric biopsies.Sixty-two children with normal endoscopy results formed the case group.In the case group,35 children(59%)tested positive for hydrogen breath tests,compared to 13 children(21%)in the control group.The calculated odds ratio was 5.38(95%confidence interval:2.41-12.0),which was statistically significant.Further analysis of symptoms revealed that nausea,halitosis,foul-smelling eructation,and epigastric fullness were positive predictors of SIBO.CONCLUSION It is worthwhile to investigate and treat SIBO in all children presenting with upper GI symptoms that are not explained by endoscopy findings.展开更多
BACKGROUND Post-streptococcal acute glomerular nephritis(PSAGN)is mostly a benign condition.The usual sequelae of PSAGN include hypertension,its complications,and acute kidney injury.Severe PSAGN is associated with si...BACKGROUND Post-streptococcal acute glomerular nephritis(PSAGN)is mostly a benign condition.The usual sequelae of PSAGN include hypertension,its complications,and acute kidney injury.Severe PSAGN is associated with significant long-term morbidity,and histological abnormalities such as crescentic glomerulonephritis are infrequently reported.PSAGN has also been linked to late-onset chronic kidney disease in some populations due to high levels of proteinuria.METHODS This prospective observational study was conducted at Lady Ridgeway Hospital(Colombo,Sri Lanka)over 15 months.Children with PSAGN were enrolled based on clinical and laboratory criteria.Persistent proteinuria≥2+for 2 weeks and serum creatinine>100μmol/L warranted renal biopsy,assessed via light microscopy and immunofluorescence.Normalization of complement 3(C3)within 6 to 8 weeks was required for inclusion.Data on clinical features,urine protein levels,and renal function were collected from patient records,and potential associations were analysed using Statistical Package for the Social Sciences and R language for statistical computing.Ethical approval was obtained from the Ethical Review Committee,Lady Ridgeway Hospital for Children(Ref No:LRH/ERC/2021/60).RESULTS Forty-four patients were recruited.There were 27(61.4%)male patients and 17(38.6%)female patients.Thirty-seven(84%)of them were above 5 years of age.Twenty(45%)patients had a history of skin sepsis,and eighteen(41%)had a history of throat infection.Among patients with proteinuria≥2+,53%had serum creatinine>100µmol/L,while among those with proteinuria<2+,7%had serum creatinine>100µmol/L.The association of high-degree proteinuria with elevated serum creatinine was significant(χ²=7.8,P=0.005)in PSAGN.The odds ratio of the logistic regression model was 1.049(95%confidence interval:1.003-1.098),indicating a positive direction with statistically significant association(P=0.037).There was no significant association between proteinuria and the degree of hypertension or estimated creatinine clearance.Ten children underwent renal biopsy.Crescents(less than 50%)were demonstrated in five children,while three children had typical diffuse proliferative glomer-ulonephritis.One child had severe acute tubular necrosis,and another had crescentic glomerulonephritis(crescents>50%).The immunofluorescence studies revealed deposition of immunoglobulin G and C3 in all biopsy specimens.CONCLUSION High-degree proteinuria was significantly associated with elevated serum creatinine(>100μmol/L)in children with PSAGN.The majority of children with persistent proteinuria≥2+for more than 2 weeks and the highest recorded serum creatinine>100μmol/L had atypical renal histological findings.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 Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental growth.Although common characteristics distinguish peaky eaters,including food selectivity...BACKGROUND Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental growth.Although common characteristics distinguish peaky eaters,including food selectivity,food neophobia,and food avoidance,there is no clear definition to assess this behavior.Due to the unavailability of data regarding picky eating,it wasn’t easy to estimate its prevalence.AIM To develop a regional protocol to help healthcare professionals identify and manage mild and moderate picky eating cases.METHODS A virtual roundtable discussion was held in April 2021 to gather the opinions of seven pediatricians and two pediatric dietitians from eight Middle Eastern countries who had great experience in the management of picky eating.The discussion covered different topics,including clearly defining mild and moderate picky eating,identifying the role of diet fortification in these cases,and the possibility of developing a systematic approach to diet fortification.RESULTS The panel identified picky eating as consuming an inadequate amount and variety of foods by rejecting familiar and unfamiliar food.Most of the time,moderate picky eating cases had micronutrient deficiencies with over-or undernutrition;the mild cases only showed inadequate food consumption and/or poor diet quality.Paying attention to the organic red flags like growth faltering and development delay and behavioral red flags,including food fixation and anticipatory gagging,will help healthcare professionals evaluate the picky eaters and the caregivers to care for their children.Although dietary supplementation and commercial food fortification play an important role in picky eating,they were no benefit in the Middle East.CONCLUSION The panel agreed that food fortification through a food-first approach and oral nutritional supplements would be the best for Middle Eastern children.These recommendations would facilitate identifying and managing picky-eating children in the Middle East.展开更多
Residual atrioventricular valve regurgitation after correction of complete atrioventricular septal defect(cAVSD)is still not ideal.As a modification of the double-patch method,our technique comprises a suture-bite-wid...Residual atrioventricular valve regurgitation after correction of complete atrioventricular septal defect(cAVSD)is still not ideal.As a modification of the double-patch method,our technique comprises a suture-bite-wide strip of a third patch that is incorporated to the upper margin of the left side of the ventricular septal defect(VSD)patch.This third patch counteracts not only the valvular tissue loss caused by the suture bites but also the rightward displacement of the VSD patch in a bulged fashion that occurs with increased left ventricular pressure after weaning from cardiopulmonary bypass.This unfavorable outcome was addressed with the current technique through augmentation of the left-sided bridging leaflets serving to prevent the separation of them from their corresponding mural leaflets.The concept was applied in two cases with Down syndrome aged 5 months and 6 months,respectively,as a rescue procedure in the same session just after a failed cAVSD repair.Since the immediate-and short-term outcomes of the atrioventricular valves in regard to regurgitation are satisfying,we believe that the technique proposed herein holds promise for the future in terms of tackling residual atrioventricular valve regurgitation.展开更多
BACKGROUND Human milk oligosaccharides(HMOs)are bioactive components of breast milk with diverse health benefits,including shaping the gut microbiota,modulating the immune system,and protecting against infections.HMOs...BACKGROUND Human milk oligosaccharides(HMOs)are bioactive components of breast milk with diverse health benefits,including shaping the gut microbiota,modulating the immune system,and protecting against infections.HMOs exhibit dynamic secretion patterns during lactation,influenced by maternal genetics and environ-mental factors.Their direct and indirect antimicrobial properties have garnered significant research interest.However,a comprehensive understanding of the secretion dynamics of HMOs and their correlation with antimicrobial efficacy remains underexplored.AIM To synthesize current evidence on the secretion dynamics of HMOs during lactation and evaluate their antimicrobial roles against bacterial,viral,and protozoal pathogens.METHODS A systematic search of PubMed,Scopus,Web of Science,and Cochrane Library focused on studies investigating natural and synthetic HMOs,their secretion dynamics,and antimicrobial properties.Studies involving human,animal,and in vitro models were included.Data on HMO composition,temporal secretion patterns,and mechanisms of antimicrobial action were extracted.Quality assess-ment was performed using validated tools appropriate for study design.RESULTS A total of 44 studies were included,encompassing human,animal,and in vitro research.HMOs exhibited dynamic secretion patterns,with 2′-fucosyllactose(2′-FL)and lacto-N-tetraose peaking in early lactation and declining over time,while 3-fucosyllactose(3-FL)increased during later stages.HMOs demonstrated significant antimicrobial properties through pathogen adhesion inhibition,biofilm disruption,and enzymatic activity impairment.Synthetic HMOs,including bioengineered 2′-FL and 3-FL,were structurally and functionally comparable to natural HMOs,effectively inhibiting pathogens such as Pseudomonas aeruginosa,Escherichia coli,and Campylobacter jejuni.Additionally,HMOs exhibited synergistic effects with antibiotics,enhancing their efficacy against resistant pathogens.CONCLUSION HMOs are vital in antimicrobial defense,supporting infant health by targeting various pathogens.Both natural and synthetic HMOs hold significant potential for therapeutic applications,particularly in infant nutrition and as adjuncts to antibiotics.Further research,including clinical trials,is essential to address gaps in knowledge,validate findings,and explore the broader applicability of HMOs in improving maternal and neonatal health.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
Clinical hypnosis has been proposed as a non-pharmacological intervention in pediatric healthcare,drawing on children’s natural capacity for imagination and focused attention.It has been applied across a broad spectr...Clinical hypnosis has been proposed as a non-pharmacological intervention in pediatric healthcare,drawing on children’s natural capacity for imagination and focused attention.It has been applied across a broad spectrum of medical and psychological conditions,yet its true clinical value remains a matter of debate.This narrative review synthesizes findings from randomized controlled trials,cohort studies,systematic reviews,and clinical case series on pediatric hypnotherapy.Literature was selected based on relevance,methodological quality,and diversity of application.Evidence suggests that pediatric hypnosis may reduce acute and chronic pain,support management of functional gastrointestinal disorders,alleviate anxiety and habit disorders,improve sleep,and provide symptom relief in chronic diseases such as cancer and cystic fibrosis.Techniques are individualized and developmentally tailored,often using guided imagery,storytelling,and self-hypnosis.Reported benefits include reduced symptom burden,decreased reliance on medications,and improved quality of life.However,the strength of evidence varies considerably across conditions.Limitations include a shortage of large-scale trials,variability in individual responsiveness,limited availability of trained clinicians,and ongoing skepticism from healthcare providers and caregivers.While pediatric hypnosis may show promise as a safe and empowering adjunctive therapy,its clinical efficacy remains to be firmly established across all conditions.Further large-scale,methodologically rigorous research is required to clarify its actual benefits,cost-effectiveness,and role within integrative,evidence-based pediatric care.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
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
BACKGROUND In our day-to-day practice,constipation is a common problem in the pediatric population and cause of frequent visit in outpatient and emergency department.But occult constipation(OC)remains as the most unad...BACKGROUND In our day-to-day practice,constipation is a common problem in the pediatric population and cause of frequent visit in outpatient and emergency department.But occult constipation(OC)remains as the most unaddressed problem.AIM To investigate the clinical profile of OC in children.METHODS It was a prospective observational study,done in Bangladesh from January 2022 to December 2024.It included all consecutive children diagnosed as OC and were treated accordingly.Before diagnosis,secondary causes of the presenting symptoms were excluded with appropriate investigations.They were followed up monthly for 4 months and treatment response were measured by improvement of symptoms.RESULTS A total of 404 children were included in this study with mean age group of 76.50±36.62 months,and male-female ratio of 1.67:1.The most common presenting complaint was abdominal pain(66%),followed by anorexia(49%),vomiting(24%),nausea(17%),frequent defecation with small volume stool(17%),altered bowel habit(16%),failure to thrive(14%)and recurrent helminthiasis(12%).Interestingly,2.5%children presented with persistent diarrhea.CONCLUSION Abdominal pain is the most common presentation of OC.When symptoms cannot be explained by other etiology,OC should be kept in mind.展开更多
The present article reviews the emerging role of melatonin(MT)and the Hippo-Yes-associated protein signaling pathway in periodontal regeneration,high-lighting their potential to delay the aging process of periodontal ...The present article reviews the emerging role of melatonin(MT)and the Hippo-Yes-associated protein signaling pathway in periodontal regeneration,high-lighting their potential to delay the aging process of periodontal ligament stem cells(PDLSCs).Oxidative stress and cellular senescence are major obstacles in regenerative therapies,especially in an aging population.MT,a potent antioxidant,restores the morphology,proliferation,and osteogenic differentiation potential of PDLSCs under oxidative stress conditions.Recent research highlights how MT enhances PDLSC stemness by upregulating Yes-associated protein ex-pression,offering a promising therapeutic strategy to antagonize tissue dege-neration.In addition,the article discusses the growing interest in probiotics as a complementary approach to improve oral microbiota and support tissue regeneration.The integration of MT with traditional and novel therapeutic approaches may pave the way for innovative preventive or active treatments in periodontology,aimed at reducing oxidative stress.Future research needs to focus on translating these findings into clinical applications and promoting a deeper understanding of periodontal regeneration and cellular aging.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
Progressive familial intrahepatic cholestasis(PFIC)is a group of rare,inherited cholestatic liver disorders presenting in infants and children and are associated with impaired bile flow(i.e.,cholestasis),pruritus and ...Progressive familial intrahepatic cholestasis(PFIC)is a group of rare,inherited cholestatic liver disorders presenting in infants and children and are associated with impaired bile flow(i.e.,cholestasis),pruritus and progressive liver disease.Historically there has been no effective or approved pharmacologic treatments for these disorders and standard medical treatment has only been supportive.The impaired bile flow within the liver,leads to accumulation in the liver and inflammation.Historically there has been no effective or approved pharmacologic treatments for these disorders and standard medical treatment has only been supportive.A potential for reducing pathologic bile accumulation in the liver is surgical biliary diversion,with an aim to interrupt the enterohepatic circulation.These procedures have demonstrated a positive effect in PFIC by normalizing serum bile acids,reducing pruritus and liver injury and improving the patient quality of life.Nonsurgical approach to interrupting the enterohepatic circulation is inhibition of the ileal bile acid transporter(IBAT).IBAT inhibition has demonstrated efficacy in reducing serum bile acids and pruritus.We aim to present the 13 types of PFIC and the current evidence on the use of IBAT inhibitors in treating children with PFIC.展开更多
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Introduction: Acute otitis media is an acute inflammation of the mucosa of the middle ear cavities. It is often secondary to nasopharyngitis, which favors the passage of infection through the Eustachian tube to the middle ear. The aim of our study was to improve the management of AOM in the Paediatric Department of the Hospital National Ignace Deen (Conakry). Patients and Methods: This was a prospective descriptive study lasting 6 months from 01 July to 31 December 2011;the study covered 525 cases out of a total of 6276 children, i.e. a frequency of 8.36%. Results: The most affected age group was 6 to 11 months. Males predominated (69.71%). 82.29% had a history of recurrent rhinopharyngitis. The most frequent reason for consultation was incessant crying (66.29%). Rhinopharyngitis and malaria were the most commonly associated pathologies (87.62% and 39.62% respectively). 72.19% of our patients were admitted with congestive AOM and received medical treatment. We recorded one case of otomastoiditis which was treated surgically. Conclusion: AOM is more common in children aged between 6 and 24 months. Good collaboration between paediatricians and ENT specialists is essential to reduce the morbidity of AOM.
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Inborn errors of metabolism(IEM)are rare disorders,most are liver-based with liver transplantation(LT)emerging as an effective cure in the pediatric population.LT has been shown to offer a cure or deter disease progression and provide symptomatic improvement in patients with IEM.Each metabolic disorder is unique,with the missing enzyme or transporter protein causing substrate deficiency or toxic byproduct production.Knowledge about the distribution of deficient enzymes,the percentage of enzymes replaced by LT,and the extent of extrahepatic involvement helps anticipate and manage complications in the perioperative period.Most patients have multisystem involvement and can be on complex dietary regimens.Metabolic decompensation can be triggered due to the stress response to surgery,fasting and other unanticipated complications perioperatively.Thus,a multidisciplinary team’s input including those from metabolic specialists is essential to develop disease and patient-specific strategies for the perioperative management of these patients during LT.In this review,we outline the classification of IEM,indications for LT along with potential benefits,basic metabolic defects and their implications,details of extrahepatic involvement and perioperative management strategies for LT in children with some of the commonly presenting IEM,to assist anesthesiologists handling this cohort of patients.
文摘BACKGROUND Small intestinal bacterial overgrowth(SIBO)is suspected and excluded frequently in functional gastrointestinal(GI)disorders.Children presenting with various esophago-gastro-duodenal(upper GI)symptoms are rarely subjected to investig-ations for SIBO.AIM To estimate the frequency of SIBO in children having functional upper GI sym-ptoms(as cases)and to compare the result of the SIBO status to that of the con-trols.METHODS Children aged 6 to 18 who presented with upper GI symptoms were selected for the study.All children were subjected to upper GI endoscopy before being advised of any proton pump inhibitors(PPIs).Children with normal endoscopy were assigned as cases,and children having any endoscopic lesion were design-ated as controls.Both groups were subjected to a glucose-hydrogen breath test by Bedfont Gastrolyser.RESULTS A total of 129 consecutive children who were naive to PPIs and had normal ba-seline investigations were included in the study.Among them,67 patients had endoscopic lesions and served as the control group,with six cases being excluded due to the presence of Helicobacter pylori in gastric biopsies.Sixty-two children with normal endoscopy results formed the case group.In the case group,35 children(59%)tested positive for hydrogen breath tests,compared to 13 children(21%)in the control group.The calculated odds ratio was 5.38(95%confidence interval:2.41-12.0),which was statistically significant.Further analysis of symptoms revealed that nausea,halitosis,foul-smelling eructation,and epigastric fullness were positive predictors of SIBO.CONCLUSION It is worthwhile to investigate and treat SIBO in all children presenting with upper GI symptoms that are not explained by endoscopy findings.
文摘BACKGROUND Post-streptococcal acute glomerular nephritis(PSAGN)is mostly a benign condition.The usual sequelae of PSAGN include hypertension,its complications,and acute kidney injury.Severe PSAGN is associated with significant long-term morbidity,and histological abnormalities such as crescentic glomerulonephritis are infrequently reported.PSAGN has also been linked to late-onset chronic kidney disease in some populations due to high levels of proteinuria.METHODS This prospective observational study was conducted at Lady Ridgeway Hospital(Colombo,Sri Lanka)over 15 months.Children with PSAGN were enrolled based on clinical and laboratory criteria.Persistent proteinuria≥2+for 2 weeks and serum creatinine>100μmol/L warranted renal biopsy,assessed via light microscopy and immunofluorescence.Normalization of complement 3(C3)within 6 to 8 weeks was required for inclusion.Data on clinical features,urine protein levels,and renal function were collected from patient records,and potential associations were analysed using Statistical Package for the Social Sciences and R language for statistical computing.Ethical approval was obtained from the Ethical Review Committee,Lady Ridgeway Hospital for Children(Ref No:LRH/ERC/2021/60).RESULTS Forty-four patients were recruited.There were 27(61.4%)male patients and 17(38.6%)female patients.Thirty-seven(84%)of them were above 5 years of age.Twenty(45%)patients had a history of skin sepsis,and eighteen(41%)had a history of throat infection.Among patients with proteinuria≥2+,53%had serum creatinine>100µmol/L,while among those with proteinuria<2+,7%had serum creatinine>100µmol/L.The association of high-degree proteinuria with elevated serum creatinine was significant(χ²=7.8,P=0.005)in PSAGN.The odds ratio of the logistic regression model was 1.049(95%confidence interval:1.003-1.098),indicating a positive direction with statistically significant association(P=0.037).There was no significant association between proteinuria and the degree of hypertension or estimated creatinine clearance.Ten children underwent renal biopsy.Crescents(less than 50%)were demonstrated in five children,while three children had typical diffuse proliferative glomer-ulonephritis.One child had severe acute tubular necrosis,and another had crescentic glomerulonephritis(crescents>50%).The immunofluorescence studies revealed deposition of immunoglobulin G and C3 in all biopsy specimens.CONCLUSION High-degree proteinuria was significantly associated with elevated serum creatinine(>100μmol/L)in children with PSAGN.The majority of children with persistent proteinuria≥2+for more than 2 weeks and the highest recorded serum creatinine>100μmol/L had atypical renal histological findings.
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 Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental growth.Although common characteristics distinguish peaky eaters,including food selectivity,food neophobia,and food avoidance,there is no clear definition to assess this behavior.Due to the unavailability of data regarding picky eating,it wasn’t easy to estimate its prevalence.AIM To develop a regional protocol to help healthcare professionals identify and manage mild and moderate picky eating cases.METHODS A virtual roundtable discussion was held in April 2021 to gather the opinions of seven pediatricians and two pediatric dietitians from eight Middle Eastern countries who had great experience in the management of picky eating.The discussion covered different topics,including clearly defining mild and moderate picky eating,identifying the role of diet fortification in these cases,and the possibility of developing a systematic approach to diet fortification.RESULTS The panel identified picky eating as consuming an inadequate amount and variety of foods by rejecting familiar and unfamiliar food.Most of the time,moderate picky eating cases had micronutrient deficiencies with over-or undernutrition;the mild cases only showed inadequate food consumption and/or poor diet quality.Paying attention to the organic red flags like growth faltering and development delay and behavioral red flags,including food fixation and anticipatory gagging,will help healthcare professionals evaluate the picky eaters and the caregivers to care for their children.Although dietary supplementation and commercial food fortification play an important role in picky eating,they were no benefit in the Middle East.CONCLUSION The panel agreed that food fortification through a food-first approach and oral nutritional supplements would be the best for Middle Eastern children.These recommendations would facilitate identifying and managing picky-eating children in the Middle East.
文摘Residual atrioventricular valve regurgitation after correction of complete atrioventricular septal defect(cAVSD)is still not ideal.As a modification of the double-patch method,our technique comprises a suture-bite-wide strip of a third patch that is incorporated to the upper margin of the left side of the ventricular septal defect(VSD)patch.This third patch counteracts not only the valvular tissue loss caused by the suture bites but also the rightward displacement of the VSD patch in a bulged fashion that occurs with increased left ventricular pressure after weaning from cardiopulmonary bypass.This unfavorable outcome was addressed with the current technique through augmentation of the left-sided bridging leaflets serving to prevent the separation of them from their corresponding mural leaflets.The concept was applied in two cases with Down syndrome aged 5 months and 6 months,respectively,as a rescue procedure in the same session just after a failed cAVSD repair.Since the immediate-and short-term outcomes of the atrioventricular valves in regard to regurgitation are satisfying,we believe that the technique proposed herein holds promise for the future in terms of tackling residual atrioventricular valve regurgitation.
文摘BACKGROUND Human milk oligosaccharides(HMOs)are bioactive components of breast milk with diverse health benefits,including shaping the gut microbiota,modulating the immune system,and protecting against infections.HMOs exhibit dynamic secretion patterns during lactation,influenced by maternal genetics and environ-mental factors.Their direct and indirect antimicrobial properties have garnered significant research interest.However,a comprehensive understanding of the secretion dynamics of HMOs and their correlation with antimicrobial efficacy remains underexplored.AIM To synthesize current evidence on the secretion dynamics of HMOs during lactation and evaluate their antimicrobial roles against bacterial,viral,and protozoal pathogens.METHODS A systematic search of PubMed,Scopus,Web of Science,and Cochrane Library focused on studies investigating natural and synthetic HMOs,their secretion dynamics,and antimicrobial properties.Studies involving human,animal,and in vitro models were included.Data on HMO composition,temporal secretion patterns,and mechanisms of antimicrobial action were extracted.Quality assess-ment was performed using validated tools appropriate for study design.RESULTS A total of 44 studies were included,encompassing human,animal,and in vitro research.HMOs exhibited dynamic secretion patterns,with 2′-fucosyllactose(2′-FL)and lacto-N-tetraose peaking in early lactation and declining over time,while 3-fucosyllactose(3-FL)increased during later stages.HMOs demonstrated significant antimicrobial properties through pathogen adhesion inhibition,biofilm disruption,and enzymatic activity impairment.Synthetic HMOs,including bioengineered 2′-FL and 3-FL,were structurally and functionally comparable to natural HMOs,effectively inhibiting pathogens such as Pseudomonas aeruginosa,Escherichia coli,and Campylobacter jejuni.Additionally,HMOs exhibited synergistic effects with antibiotics,enhancing their efficacy against resistant pathogens.CONCLUSION HMOs are vital in antimicrobial defense,supporting infant health by targeting various pathogens.Both natural and synthetic HMOs hold significant potential for therapeutic applications,particularly in infant nutrition and as adjuncts to antibiotics.Further research,including clinical trials,is essential to address gaps in knowledge,validate findings,and explore the broader applicability of HMOs in improving maternal and neonatal health.
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Clinical hypnosis has been proposed as a non-pharmacological intervention in pediatric healthcare,drawing on children’s natural capacity for imagination and focused attention.It has been applied across a broad spectrum of medical and psychological conditions,yet its true clinical value remains a matter of debate.This narrative review synthesizes findings from randomized controlled trials,cohort studies,systematic reviews,and clinical case series on pediatric hypnotherapy.Literature was selected based on relevance,methodological quality,and diversity of application.Evidence suggests that pediatric hypnosis may reduce acute and chronic pain,support management of functional gastrointestinal disorders,alleviate anxiety and habit disorders,improve sleep,and provide symptom relief in chronic diseases such as cancer and cystic fibrosis.Techniques are individualized and developmentally tailored,often using guided imagery,storytelling,and self-hypnosis.Reported benefits include reduced symptom burden,decreased reliance on medications,and improved quality of life.However,the strength of evidence varies considerably across conditions.Limitations include a shortage of large-scale trials,variability in individual responsiveness,limited availability of trained clinicians,and ongoing skepticism from healthcare providers and caregivers.While pediatric hypnosis may show promise as a safe and empowering adjunctive therapy,its clinical efficacy remains to be firmly established across all conditions.Further large-scale,methodologically rigorous research is required to clarify its actual benefits,cost-effectiveness,and role within integrative,evidence-based pediatric care.
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BACKGROUND In our day-to-day practice,constipation is a common problem in the pediatric population and cause of frequent visit in outpatient and emergency department.But occult constipation(OC)remains as the most unaddressed problem.AIM To investigate the clinical profile of OC in children.METHODS It was a prospective observational study,done in Bangladesh from January 2022 to December 2024.It included all consecutive children diagnosed as OC and were treated accordingly.Before diagnosis,secondary causes of the presenting symptoms were excluded with appropriate investigations.They were followed up monthly for 4 months and treatment response were measured by improvement of symptoms.RESULTS A total of 404 children were included in this study with mean age group of 76.50±36.62 months,and male-female ratio of 1.67:1.The most common presenting complaint was abdominal pain(66%),followed by anorexia(49%),vomiting(24%),nausea(17%),frequent defecation with small volume stool(17%),altered bowel habit(16%),failure to thrive(14%)and recurrent helminthiasis(12%).Interestingly,2.5%children presented with persistent diarrhea.CONCLUSION Abdominal pain is the most common presentation of OC.When symptoms cannot be explained by other etiology,OC should be kept in mind.
文摘The present article reviews the emerging role of melatonin(MT)and the Hippo-Yes-associated protein signaling pathway in periodontal regeneration,high-lighting their potential to delay the aging process of periodontal ligament stem cells(PDLSCs).Oxidative stress and cellular senescence are major obstacles in regenerative therapies,especially in an aging population.MT,a potent antioxidant,restores the morphology,proliferation,and osteogenic differentiation potential of PDLSCs under oxidative stress conditions.Recent research highlights how MT enhances PDLSC stemness by upregulating Yes-associated protein ex-pression,offering a promising therapeutic strategy to antagonize tissue dege-neration.In addition,the article discusses the growing interest in probiotics as a complementary approach to improve oral microbiota and support tissue regeneration.The integration of MT with traditional and novel therapeutic approaches may pave the way for innovative preventive or active treatments in periodontology,aimed at reducing oxidative stress.Future research needs to focus on translating these findings into clinical applications and promoting a deeper understanding of periodontal regeneration and cellular aging.
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Progressive familial intrahepatic cholestasis(PFIC)is a group of rare,inherited cholestatic liver disorders presenting in infants and children and are associated with impaired bile flow(i.e.,cholestasis),pruritus and progressive liver disease.Historically there has been no effective or approved pharmacologic treatments for these disorders and standard medical treatment has only been supportive.The impaired bile flow within the liver,leads to accumulation in the liver and inflammation.Historically there has been no effective or approved pharmacologic treatments for these disorders and standard medical treatment has only been supportive.A potential for reducing pathologic bile accumulation in the liver is surgical biliary diversion,with an aim to interrupt the enterohepatic circulation.These procedures have demonstrated a positive effect in PFIC by normalizing serum bile acids,reducing pruritus and liver injury and improving the patient quality of life.Nonsurgical approach to interrupting the enterohepatic circulation is inhibition of the ileal bile acid transporter(IBAT).IBAT inhibition has demonstrated efficacy in reducing serum bile acids and pruritus.We aim to present the 13 types of PFIC and the current evidence on the use of IBAT inhibitors in treating children with PFIC.
