BACKGROUND Upper respiratory tract infections(URTIs)are one of the most frequent causes of childhood school leave and morbidity.AIM To study the present trend of medications’prescribing pattern utilized in URTIs amon...BACKGROUND Upper respiratory tract infections(URTIs)are one of the most frequent causes of childhood school leave and morbidity.AIM To study the present trend of medications’prescribing pattern utilized in URTIs among the pediatric population attending outpatient clinics in pediatric hospitals.METHODS This analytical observational cross-sectional research was conducted in 200 children aged 1–10 years with URTIs attending the pediatric outpatient clinics in pediatric hospitals,one of which is an educational hospital,from July 2018 to August 2020.RESULTS Most of the prescriptions in our study included antibiotics(116/58%).The most commonly prescribed antibiotic family was ampicillin/sulbactam or amoxici-llin/clavulanic acid(53/26.5%),followed by first-generation cephalosporin(25/12.5%)and third-generation cephalosporin(20/10%).Macrolides and second-generation cephalosporins were prescribed less frequently,in 16(8%)and 2(1%)patients,respectively.Most of our study population(155/77.5%)was satisfied with their prescriptions,whereas the rest of the study population(45/22.5%)was unsatisfied.CONCLUSION Overprescription of antibiotics is a significant issue among clinicians in pediatric outpatient clinics.Stewardship of drugs,particularly antibiotics,is a must to prevent the development of drug resistance.Most cases of URTIs were treated in accordance with the existing national treatment guidelines.展开更多
BACKGROUND Hyponatremia is a prevalent and serious electrolyte imbalance in pediatric pneumonia and is linked to increased disease severity and adverse outcomes.Oral rehydration solution(ORS)is an available,inexpensiv...BACKGROUND Hyponatremia is a prevalent and serious electrolyte imbalance in pediatric pneumonia and is linked to increased disease severity and adverse outcomes.Oral rehydration solution(ORS)is an available,inexpensive,safe,and ready-touse oral solution that can supplement sodium in such cases.AIM To assess the impact of prophylactic sodium supplementation via ORS on clinical and hospital outcomes in infants and children admitted with pneumonia.METHODS A randomized,interventional controlled trial was conducted on 140 infants and children admitted with pneumonia(70 per group).The primary outcome was hospital length of stay,with secondary outcomes including serum sodium and potassium levels,clinical respiratory scores,modified shock index,and nutritional/inflammatory markers.The hospital length of stay and both the laboratory and clinical parameters of the interventional and control groups were compared.RESULTS The hospital stay was longer in the control group than in the intervention group(P value=0.001;effect size=0.59).Clinical respiratory scores on day 4 were significantly lower in the intervention group than in the control group(P value=0.001).Sodium levels were significantly lower in the control group than in the intervention group at discharge(P value=0.002).CONCLUSION Prophylactic oral sodium supplementation through ORS may have a health-promoting effect on infants and children admitted with pneumonia.展开更多
BACKGROUND Heterozygous familial hypobetalipoproteinemia(FHBL)is a semi-autosomal disorder that is caused mainly by an APOB variant.It is usually asymptomatic and rarely leads to non-alcoholic steatohepatitis(NASH).CA...BACKGROUND Heterozygous familial hypobetalipoproteinemia(FHBL)is a semi-autosomal disorder that is caused mainly by an APOB variant.It is usually asymptomatic and rarely leads to non-alcoholic steatohepatitis(NASH).CASE SUMMARY A 12-year-old boy was referred to our hospital after prolonged elevation of liver enzymes was observed during health checkups in Kagawa Prefecture.Abdominal ultrasound showed a bright liver,and laboratory investigations revealed low lowdensity lipoprotein cholesterol and apolipoprotein B protein levels.His family history included fatty liver and hypolipidemia in his father,which led to a clinical diagnosis of FHBL.A liver biopsy was performed on suspicion of liver fibrosis based on biomarkers.The liver tissue showed fatty steatosis,inflammation,hepatocyte ballooning,and fibrosis,indicating NASH.Genetic testing detected the APOB variant,and the patient was treated successfully with vitamin E.CONCLUSION It is important to assess family history and liver dysfunction severity in non-obese patients with hypolipidemia and fatty liver.展开更多
BACKGROUND Familial Mediterranean fever(FMF)is an autosomal recessive autoinflammatory disorder marked by recurrent episodes of fever and serositis.Resistin,a proinflammatory cytokine,may play a role in FMF pathogenes...BACKGROUND Familial Mediterranean fever(FMF)is an autosomal recessive autoinflammatory disorder marked by recurrent episodes of fever and serositis.Resistin,a proinflammatory cytokine,may play a role in FMF pathogenesis by promoting the release of interleukin-1beta,tumour necrosis factor alpha,and interleukin-6.AIM To evaluate serum resistin levels in children with FMF during acute attacks and remission,and to assess its potential as a biomarker for disease activity and progression.METHODS A case-control study was conducted involving 40 pediatric patients with FMF and 40 age-and sex-matched healthy controls.Serum resistin and inflammatory markers—including total leukocyte count(TLC),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),serum amyloid A(SAA),and fibrinogen—were measured using enzyme-linked immunosorbent assay and standard assays.RESULTS No significant differences were found in age or sex between FMF patients and controls.Among FMF patients,fever was the most prevalent symptom(95%),followed by abdominal pain(75%).The most frequently detected genetic mutation was M694I,followed by M694V,E148Q,M680I,and V726A.Compound heterozygous mutations,including M694I/V726A and M694I/M694V,were equally represented.During acute attacks,FMF patients exhibited significantly elevated levels of TLC,ESR,CRP,SAA,and fibrinogen compared to attack-free periods and controls.Serum resistin levels were markedly higher during acute attacks and showed a strong positive correlation with other acute inflammatory markers.Receiver operating characteristic curve analysis demonstrated high sensitivity and specificity of resistin as a potential biomarker for FMF.CONCLUSION Resistin is significantly elevated in children with FMF during acute episodes and correlates with established inflammatory markers.These findings support its potential role as a non-invasive biomarker for disease activity and severity in pediatric FMF.展开更多
Attention-deficit/hyperactivity disorder(ADHD)is one of the most common neurodevelopmental disorders of childhood,yet its diagnosis remains complex and fraught with challenges.Pediatricians,often the first point of co...Attention-deficit/hyperactivity disorder(ADHD)is one of the most common neurodevelopmental disorders of childhood,yet its diagnosis remains complex and fraught with challenges.Pediatricians,often the first point of contact for concerned families,play a pivotal role in the diagnostic process.However,they face numerous obstacles that can hinder accurate and timely diagnosis,particularly in resource-limited or culturally diverse settings such as the Middle East and North Africa(MENA)and Arabian Gulf regions.This narrative review explores the key challenges pediatricians face in diagnosing ADHD and highlights practical and emerging solutions.The article offers both a global perspective and a contextualized view relevant to the MENA region.A narrative literature review was conducted using PubMed,Scopus,and Google Scholar,focusing on peer-reviewed studies,clinical guidelines,and epidemiological data from 2010 to 2025 related to pediatric ADHD diagnosis,especially in MENA regions.The review identifies six major diagnostic barriers:(1)Symptom overlap with other conditions[e.g.,autism spectrum disorder(ASD),anxiety,learning disabilities];(2)Reliance on subjective informant reports;(3)Cultural and societal influences including stigma and gender bias;(4)Variability in ADHD training and time constraints in clinical practice;(5)Limited access to multidisciplinary evaluations;and(6)Systemic referral and communication inefficiencies.Comorbidities are highly prevalent and frequently complicate the diagnostic picture.Delayed or inaccurate diagnosis can lead to academic underperformance,family stress,missed interventions,and long-term psychological consequences.Emerging solutions include digital screening tools,artificial intelligence-assisted analysis,structured reporting platforms,and improved training and referral models.Regional data from the Arabian Gulf highlight variable prevalence rates(1.3%-22%)and underscore the need for culturally sensitive diagnostic strategies.To improve diagnostic accuracy and patient outcomes,pediatricians must be supported through better training,interdisciplinary collaboration,validated tools,and policy-level reforms.Tailoring these approaches to local contexts will be key to addressing the growing burden of ADHD,particularly in the MENA region.展开更多
BACKGROUND Functional neurological disorder(FND)in children is a complex and multifaceted condition characterized by neurological symptoms that cannot be explained by organic pathology.Despite its prevalence,FND in pe...BACKGROUND Functional neurological disorder(FND)in children is a complex and multifaceted condition characterized by neurological symptoms that cannot be explained by organic pathology.Despite its prevalence,FND in pediatric populations remains under-researched,with challenges in diagnosis and management AIM To synthesize the current literature on FND in children,focusing on clinical presentation,diagnostic approaches,treatment strategies,and outcomes.METHODS A comprehensive literature search was conducted across multiple databases,including PubMed,Scopus,and Web of Science,for articles published up to August 2024.Studies were included if they addressed FND in pediatric populations,specifically focusing on review articles,research articles,systematic reviews,meta-analyses,case reports,guidelines,expert opinions,and editorials.Data extraction and quality assessment were performed according to PRISMA guidelines.A total of 308 articles were included in the final analysis.RESULTS The analysis included 189 review articles,57 research articles,3 systematic reviews and meta-analyses,5 case reports,2 guidelines,5 expert opinions,and 2 editorials.Key findings revealed a broad spectrum of symptoms,including motor and sensory disturbances and psychological factors contributing to the onset and persistence of FND.Diagnostic challenges were frequently highlighted,emphasizing the need for interdisciplinary approaches.Treatment strategies varied,with cognitive-behavioral therapy(CBT)and multidisciplinary care emerging as the most effective approaches.The outcomes varied,with early intervention being critical for a better prognosis.CONCLUSION Early diagnosis and multidisciplinary care,including CBT,are critical for improving outcomes in pediatric FND.Standardized diagnostic criteria and treatment protocols are needed to enhance clinical management.展开更多
BACKGROUND Visceral leishmaniasis(VL)is a systemic protozoan infection caused by Leishmania donovani(L.donovani)and transmitted by sand flies,causing macrophage invasion in the liver,spleen,and bone marrow.Diagnosis o...BACKGROUND Visceral leishmaniasis(VL)is a systemic protozoan infection caused by Leishmania donovani(L.donovani)and transmitted by sand flies,causing macrophage invasion in the liver,spleen,and bone marrow.Diagnosis of VL is currently based on clinical signs,symptoms,and specific in-vitro markers and bone marrow investigations.However,VL's specific hematological and bone marrow manifestation in Sudanese pediatric patients is not well studied.AIM To examine the blood and bone marrow characteristics in pediatric patients from Sudan who have VL.METHODS This is a retrospective hospital-based study with a sample of 107 consecutive Sudanese pediatric patients.The data focused on hematological and bone marrow results.We included only the completed records of the pediatric patients with VL in the Tropical Disease Teaching Hospital in Khartoum,Sudan from the period of 2016 to 2020.RESULTS The majority of pediatric patients included in this study are below 5-years-old(n=59,55.2%).Moreover,anemia,thrombocytopenia,and leukopenia were among the prevalent characteristics in the population under study.To further analyze the data,we developed a machine learning model using boosted forest algorithms to predict L.donovani parasites load,with a mean accuracy of 0.88 for the training dataset and an accuracy of 0.46,0.50,and 0.74 for mild,moderate,and severe L.donovani parasite load in the validation dataset.CONCLUSION This study shows that the most common bone marrow change among Sudanese VL children was increased chronic inflammatory cells(n=88,82.2%)with present macrophage hemophagocytes(n=103,96.3%).While anemia and thrombocytopenia were the most common hematological changes.These results will hopefully lead to an early diagnosis and hence better management for Sudanese pediatric patients with suspected VL.展开更多
BACKGROUND Fecal calprotectin is a valuable biomarker for assessing intestinal inflammation in pediatric gastrointestinal diseases.However,its role,pros,and cons in various conditions must be comprehensively elucidate...BACKGROUND Fecal calprotectin is a valuable biomarker for assessing intestinal inflammation in pediatric gastrointestinal diseases.However,its role,pros,and cons in various conditions must be comprehensively elucidated.AIM To explore the role of fecal calprotectin in pediatric gastrointestinal diseases,including its advantages and limitations.METHODS A comprehensive search was conducted on PubMed,PubMed Central,Google Scholar,and other scientific research engines until February 24,2024.The review included 88 research articles,56 review articles,six metaanalyses,two systematic reviews,two consensus papers,and two letters to the editors.RESULTS Fecal calprotectin is a non-invasive marker for detecting intestinal inflammation and monitoring disease activity in pediatric conditions such as functional gastrointestinal disorders,inflammatory bowel disease,coeliac disease,coronavirus disease 2019-induced gastrointestinal disorders,gastroenteritis,and cystic fibrosis-associated intestinal pathology.However,its lack of specificity and susceptibility to various confounding factors pose challenges in interpretation.Despite these limitations,fecal calprotectin offers significant advantages in diagnosing,monitoring,and managing pediatric gastrointestinal diseases.CONCLUSION Fecal calprotectin holds promise as a valuable tool in pediatric gastroenterology,offering insights into disease activity,treatment response,and prognosis.Standardized protocols and guidelines are needed to optimize its clinical utility and mitigate interpretation challenges.Further research is warranted to address the identified limitations and enhance our understanding of fecal calprotectin in pediatric gastrointestinal diseases.展开更多
Background: Idiopathic nephrotic syndrome (INS) is a frequent pathology in children. There is little data on the future of NS in children in sub-Saharan Africa, particularly Cameroon. The aim of our study is to report...Background: Idiopathic nephrotic syndrome (INS) is a frequent pathology in children. There is little data on the future of NS in children in sub-Saharan Africa, particularly Cameroon. The aim of our study is to report the prognosis of children treated for nephrotic syndrome in the city of Yaoundé. Method: This was an analytical cross-sectional study with retrospective collection in 4 reference hospitals in the Cameroonian capital over a period of five years from January 1, 2018 to December 31, 2022. We included all medical records of patients treated for idiopathic INS. We excluded incomplete records and those with a history of chronic kidney disease. The sociodemographic, clinical, paraclinical, and therapeutic data, as well as the short-term evolution were collected in the files. Data was analysed using the software statistical package for social sciences version 25.0. Statistical significance was set at a p-value Results: A total of 131 children (58% boys) were included in our study over a period of 5 years. The median age was 8 [6 - 11] years. Median proteinuria was 5 g/24h [3 - 8.4], median serum protein was 39 [34 - 46] g/l and median estimated glomerular filtration rate was 130.36 [68 - 174.6] ml/min/1.73m2. During steroid therapy, 45.07% were in partial remission at 2 months, 16.9% were in complete remission at 4 and 6 months, and 37.25% had relapsed. Steroid sensitivity was reported in 28.17% of cases, steroid resistance in 64.78% of cases and steroid dependent in 7.04% of cases. The mortality rate was 12.97%. Survival time averaged 48.2 months, with an overall crude survival rate of 99.2% at 3 and 6 months and 98.4% at 1 year. Regarding renal survival, renal function was impaired in 8.33% of patients at 6 months and 9% at 12 months. Conclusion: Idiopathic nephrotic syndrome is a common disease in children. Its evolution depends on corticosteroid therapy. The long-term prognosis is dominated by the risk of progression to end-stage kidney disease or even death. Rigorous and affordable follow-up is essential to reduce the number of patients lost to follow-up and the occurrence of complications.展开更多
Background: The standard echocardiography is limited in detecting subclinical left ventricular (LV) dysfunction in pediatric hemodialysis patients. However, speckle-tracking echo (STE) analysis has emerged as a viable...Background: The standard echocardiography is limited in detecting subclinical left ventricular (LV) dysfunction in pediatric hemodialysis patients. However, speckle-tracking echo (STE) analysis has emerged as a viable alternative. Furthermore, Growth Differentiation Factor-15 (GDF-15) is a stress-responsive biomarker generated by cardiac tissues. Aim: Evaluate left ventricular function using a range of echocardiography modalities and determine the most effective modality. Additionally, it seeks to quantify the diagnostic accuracy of GDF-15 as an early indicator of cardiac dysfunction in pediatric patients undergoing regular hemodialysis and explore the association between GDF-15 levels and left ventricular dysfunction. Subjects and Methods: An assessment of the LV functions and dimensions in a cohort of 40 pediatric patients undergoing regular hemodialysis compared to a control group of 40 healthy children. Our evaluation encompassed the utilization of GDF-15, hsCRP serum levels, conventional Echocardiography, tissue Doppler imaging (TDI), and Speckle Tracking Echocardiography (STE), in conjunction with routine laboratory investigations, to analyze the subjects post-hemodialysis (HD). Results: Children on hemodialysis showed significantly higher levels of GDF-15 and hsCRP. Furthermore, 67.5% of the patients displayed impaired left ventricular function as identified through conventional and TDI, while 82.5% exhibited global left ventricular strain as determined by STE. A strong correlation was found between EF% and serum cholesterol and triglyceride levels. Additionally, a notable association was discovered between GDF-15 and systolic blood pressure, left ventricular interventricular septal diameter (LVIVSD), and serum calcium levels. Conclusion: STE has shown its superiority over conventional and (TDI) in the early identification of LV changes in pediatric hemodialysis patients. GDF-15 is a sensitive indicator for early left ventricular dysfunction and shows a significant correlation with hypertension, left ventricular interventricular septal end-diastolic dimension (LVIVSD), and serum calcium levels.展开更多
Objective:To investigate whether urinary dipstick proteinuria or urine protein creatinine ratio(UPCR)could predict leakage in children with dengue virus infection.Methods:This was a prospective cross-sectional study.A...Objective:To investigate whether urinary dipstick proteinuria or urine protein creatinine ratio(UPCR)could predict leakage in children with dengue virus infection.Methods:This was a prospective cross-sectional study.A total of 141 hospitalized patients with confirmed dengue virus infection were enrolled from three hospitals in Thailand.Once daily,complete blood count,serum albumin,and random morning urine dipstick protein were collected from the day of admission to the day after defervescence.Morning UPCR was only measured in patients from one hospital due to logistic reasons.Results:There were 81 and 60 patients in the dengue fever(DF)and DHF groups,respectively.The proportion of patients with proteinuria detected using urine dipstick in the DHF group was higher than that in the DF group from Day-1(one day before defervescence)to Day+1(one day after defervescence).Urine dipstick for proteinuria of≥1+had sensitivity and specificity of 12.8% and 94.4% on Day-1,and 18.9% and 98.6% on Day 0(the day of defervescence)to differentiate DHF from DF.For UPCR,cut-off values of approximately 0.2 g/g from Day-2 to Day+1 yielded a sensitivity of 71.6%-94.4% and a specificity of 55.6%-100% in differentiating between DF and DHF.Conclusions:Dipstick proteinuria of≥1+on Day-1 to Day+1 after defervescence had poor sensitivity but good specificity in differentiating DHF from DF.UPCR performed better but was less convenient and more expensive than urine dipsticks.展开更多
BACKGROUND Pulse oximetry has become a cornerstone technology in healthcare,providing non-invasive monitoring of oxygen saturation levels and pulse rate.Despite its widespread use,the technology has inherent limitatio...BACKGROUND Pulse oximetry has become a cornerstone technology in healthcare,providing non-invasive monitoring of oxygen saturation levels and pulse rate.Despite its widespread use,the technology has inherent limitations and challenges that must be addressed to ensure accurate and reliable patient care.AIM To comprehensively evaluate the advantages,limitations,and challenges of pulse oximetry in clinical practice,as well as to propose recommendations for optimizing its use.METHODS A systematic literature review was conducted to identify studies related to pulse oximetry and its applications in various clinical settings.Relevant articles were selected based on predefined inclusion and exclusion criteria,and data were synthesized to provide a comprehensive overview of the topic.RESULTS Pulse oximetry offers numerous advantages,including non-invasiveness,real-time feedback,portability,and costeffectiveness.However,several limitations and challenges were identified,including motion artifacts,poor peripheral perfusion,ambient light interference,and patient-specific factors such as skin pigmentation and hemoglobin variants.Recommendations for optimizing pulse oximetry use include technological advancements,education and training initiatives,quality assurance protocols,and interdisciplinary collaboration.CONCLUSION Pulse oximetry is crucial in modern healthcare,offering invaluable insights into patients’oxygenation status.Despite its limitations,pulse oximetry remains an indispensable tool for monitoring patients in diverse clinical settings.By implementing the recommendations outlined in this review,healthcare providers can enhance the effectiveness,accessibility,and safety of pulse oximetry monitoring,ultimately improving patient outcomes and quality of care.展开更多
Mycoplasma pneumoniae(M.pneumoniae)is a common pathogen that causes community-acquired pneumonia in children.The clinical presentation of this pathogen can range from mild self-limiting illness to severe and refractor...Mycoplasma pneumoniae(M.pneumoniae)is a common pathogen that causes community-acquired pneumonia in children.The clinical presentation of this pathogen can range from mild self-limiting illness to severe and refractory cases.Complications may occur,such as necrotizing pneumonia and respiratory failure.Extrapulmonary complications,including encephalitis,myocarditis,nephritis,hepatitis,or even multiple organ failure,can also arise.In this editorial,we dis-cuss the clinical implications of the significant findings from the article"Serum inflammatory markers in children with M.pneumoniae pneumonia and their predictive value for mycoplasma severity"published by Wang et al.They reported that measuring lactic dehydrogenase,interleukin-6 levels,and D-dimer effectively predicts refractory M.pneumoniae pneumonia cases.展开更多
BACKGROUND Diffuse panbronchiolitis(DPB)is a rare,chronic inflammatory lung disease mar-ked by chronic cough,breathlessness,and preceding sinusitis.Symptoms often persist for years and can be misdiagnosed as asthma,pa...BACKGROUND Diffuse panbronchiolitis(DPB)is a rare,chronic inflammatory lung disease mar-ked by chronic cough,breathlessness,and preceding sinusitis.Symptoms often persist for years and can be misdiagnosed as asthma,particularly in children.This report describes a DPB case resolved with long-term azithromycin therapy,em-phasizing the need for a timely and accurate diagnosis.CASE SUMMARY A 12-year-old girl,diagnosed with asthma at age five and managed with inhaled corticosteroids and long-acting beta-2 agonists,developed a history of chronic productive cough and chronic sinusitis for a year.On examination,she exhibited wheezing and coarse crackles.Despite receiving treatment for an asthma exacer-bation,her symptoms did not improve.A chest X-ray revealed reticulonodular infiltration in both lower lungs,prompting further evaluation with high-resolu-tion computed tomography(HRCT).The HRCT confirmed centrilobular nodule opacities,a'tree-in-bud'pattern,and non-tapering bronchi,suggesting DPB.Elevated cold hemagglutinin titers at 128 further supported the diagnosis.Her cough and sinusitis resolved within a month after starting azithromycin therapy,chosen for its anti-inflammatory and immunomodulatory effects.Follow-up HRCT scans after 1 year of continuous treatment showed complete normalization.CONCLUSION This case highlights the importance of early diagnosis and prompt treatment in achieving favorable outcomes for DPB.展开更多
BACKGROUND Managing critical care emergencies in children with autism spectrum disorder(ASD)presents unique challenges due to their distinct sensory sensitivities,communication difficulties,and behavioral issues.Effec...BACKGROUND Managing critical care emergencies in children with autism spectrum disorder(ASD)presents unique challenges due to their distinct sensory sensitivities,communication difficulties,and behavioral issues.Effective strategies and protocols are essential for optimal care in these high-stress situations.AIM To systematically evaluate and synthesize current evidence on best practices for managing critical care emergencies in children with ASD.The review focuses on key areas,including sensory-friendly environments,communication strategies,behavioral management,and the role of multidisciplinary approaches.METHODS A comprehensive search was conducted across major medical databases,including PubMed,Embase,and Cochrane Library,for studies published between 2000 and 2023.Studies were selected based on their relevance to critical care management in children with ASD,encompassing randomized controlled trials,observational studies,qualitative research,and case studies.Data were extracted and analyzed to identify common themes,successful strategies,and areas for improvement.RESULTS The review identified 50 studies that met the inclusion criteria.Findings highlighted the importance of creating sensory-friendly environments,utilizing effective communication strategies,and implementing individualized behavioral management plans.These findings,derived from a comprehensive review of current evidence,provide valuable insights into the best practices for managing critical care emergencies in children with ASD.Sensory modifications,such as reduced lighting and noise,visual aids,and augmentative and alternative communication tools,enhanced patient comfort and cooperation.The involvement of multidisciplinary teams was crucial in delivering holistic care.Case studies provided practical insights and underscored the need for continuous refi-nement of protocols.CONCLUSION The review emphasizes the need for a tailored approach to managing critical care emergencies for children with ASD.Sensory-friendly adjustments,effective communication,and behavioral strategies supported by a mul-tidisciplinary team are integral to improving outcomes.Despite progress,ongoing refinement of care practices and protocols is necessary.This ongoing process addresses remaining challenges and engages healthcare professionals in continuous improvement of care for children with ASD in critical settings.展开更多
BACKGROUND Visual impairment during early childhood can hinder motor,language,and social development,yet data on its developmental impact across common pediatric ocular diseases remain limited.AIM To investigate the d...BACKGROUND Visual impairment during early childhood can hinder motor,language,and social development,yet data on its developmental impact across common pediatric ocular diseases remain limited.AIM To investigate the developmental impact of low vision and blindness on children under six with common ocular diseases.METHODS This retrospective study reviewed records of new patients under six with visual impairment at Siriraj Hospital’s low vision rehabilitation center(January 2017-October 2022).We collected ocular,systemic,and developmental data;recorded visual acuity in the better-seeing eye after refractive correction;and assessed developmental domains with the DenverⅡ.Univariable and multi-variable logistic regression identified factors associated with developmental delay.RESULTS A total of 161 pediatric patients(mean age 24.9±18.9 months)were enrolled and evaluated based on their ability to fix on and follow an object or light source.Some were further assessed using the Allen picture chart and all had visual acuity worse than 1.07±0.58 LogMAR,and 83.2%were identified as having global developmental delay(GDD).The three most common ocular causes were cortical visual impairment(CVI),optic neuropathy/atrophy,and optic nerve hypoplasia.Extremely poor visual acuity(inability to fixate and follow)was significantly associated with GDD[adjusted odds ratio(AOR)41.0]and delays in all developmental domains:Gross motor(AOR 10.0),fine motor(AOR 12.8),language(AOR 5.3),and personal-social skills(AOR 13.4)(P≤0.002).Multiple disabilities,most often visual impairment with cerebral palsy,were also significantly associated with gross motor delays(AOR 7.7)and fine motor delays(AOR 4.0)(P<0.05).CVI was also related to delays in language and personal-social skills(AOR 9.1 each)(P<0.05).CONCLUSION This study underscores the developmental issues in children with visual impairment,especially those with poorer acuity,CVI,and multiple disabilities.Significant delays were observed in all domains,including GDD.A timely referral to specialists is strongly recommended.展开更多
The rise of the“fishing reviewer”phenomenon presents a significant threat to the integrity of academic publishing,undermining the credibility of the peer review process and eroding trust in scientific journals.This ...The rise of the“fishing reviewer”phenomenon presents a significant threat to the integrity of academic publishing,undermining the credibility of the peer review process and eroding trust in scientific journals.This editorial explores the risk factors contributing to this troubling trend and identifies key indicators to recognize such reviewers.To address this issue,we propose strategies,including enhanced reviewer vetting,comprehensive training,and transparent recognition policies to foster a culture of accountability and ethical conduct in scholarly review.By implementing these measures,we can safeguard the quality and credibility of academic research.展开更多
BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated n...BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated neonates and assess associated clinical outcomes.AIM To determine the incidence of GERD,associated risk factors,and morbidities among full-term mechanically ventilated neonates by detecting pepsin in endo-tracheal aspirates(ETA).METHODS This study included 97 full-term neonates admitted to the neonatal intensive care unit at Cairo University Hospitals from April 2023 to March 2024.ETA samples were collected at three intervals:Immediately post-intubation(Sample A),48 hours after intubation(Sample B),and just before extubation(Sample C).Pepsin concentration was measured using enzyme-linked immunosorbent assay.Clinical data,including hospital stay duration and feeding parameters,were correlated with pepsin levels.RESULTS Pepsin was detected in 76(78.4%)of Sample A,78(81.3%)of Sample B,and 47(68.1%)of Sample C.A significant positive correlation was found between pepsin levels and FiO_(2) in Sample B(r=0.203,P=0.047).Prolonged hospital stay was also associated with pepsin detection in Samples B and C(P<0.05).A negative correlation was observed between feeding amount and pepsin levels across all samples(P<0.05).CONCLUSION The incidence of GERD in full-term mechanically ventilated neonates is high,correlating with pepsin levels,FiO_(2),feeding intolerance,and hospital stay,highlighting the importance of early detection.展开更多
BACKGROUND The relationship between diabetes mellitus(DM)and asthma is complex and can impact disease trajectories.AIM To explore the bidirectional influences between the two conditions on clinical outcomes and diseas...BACKGROUND The relationship between diabetes mellitus(DM)and asthma is complex and can impact disease trajectories.AIM To explore the bidirectional influences between the two conditions on clinical outcomes and disease control.METHODS We systematically reviewed the literature on the relationship between DM and asthma,focusing on their impacts,mechanisms,and therapeutic implications.Various studies were assessed,which investigated the effect of glycemic control on asthma outcomes,lung function,and exacerbations.The study highlighted the role of specific diabetes medications in managing asthma.RESULTS The results showed that poor glycemic control in diabetes can exacerbate asthma,increase hospitalizations,and reduce lung function.Conversely,severe asthma,especially in obese individuals,can complicate diabetes management and make glycemic control more difficult.The diabetes-associated mechanisms,such as inflammation,microangiopathy,and oxidative stress,can exacerbate asthma and decrease lung function.Some diabetes medications exhibit anti-inflammatory effects that show promise in mitigating asthma exacerbations.CONCLUSION The complex interrelationship between diabetes and asthma suggests bidirectional influences that affect disease course and outcomes.Inflammation and microvascular complications associated with diabetes may worsen asthma outcomes,while asthma severity,especially in obese individuals,complicates diabetes control.However,the current research has limitations,and more diverse longitudinal studies are required to establish causal relationships and identify effective treatment strategies for individuals with both conditions.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
文摘BACKGROUND Upper respiratory tract infections(URTIs)are one of the most frequent causes of childhood school leave and morbidity.AIM To study the present trend of medications’prescribing pattern utilized in URTIs among the pediatric population attending outpatient clinics in pediatric hospitals.METHODS This analytical observational cross-sectional research was conducted in 200 children aged 1–10 years with URTIs attending the pediatric outpatient clinics in pediatric hospitals,one of which is an educational hospital,from July 2018 to August 2020.RESULTS Most of the prescriptions in our study included antibiotics(116/58%).The most commonly prescribed antibiotic family was ampicillin/sulbactam or amoxici-llin/clavulanic acid(53/26.5%),followed by first-generation cephalosporin(25/12.5%)and third-generation cephalosporin(20/10%).Macrolides and second-generation cephalosporins were prescribed less frequently,in 16(8%)and 2(1%)patients,respectively.Most of our study population(155/77.5%)was satisfied with their prescriptions,whereas the rest of the study population(45/22.5%)was unsatisfied.CONCLUSION Overprescription of antibiotics is a significant issue among clinicians in pediatric outpatient clinics.Stewardship of drugs,particularly antibiotics,is a must to prevent the development of drug resistance.Most cases of URTIs were treated in accordance with the existing national treatment guidelines.
文摘BACKGROUND Hyponatremia is a prevalent and serious electrolyte imbalance in pediatric pneumonia and is linked to increased disease severity and adverse outcomes.Oral rehydration solution(ORS)is an available,inexpensive,safe,and ready-touse oral solution that can supplement sodium in such cases.AIM To assess the impact of prophylactic sodium supplementation via ORS on clinical and hospital outcomes in infants and children admitted with pneumonia.METHODS A randomized,interventional controlled trial was conducted on 140 infants and children admitted with pneumonia(70 per group).The primary outcome was hospital length of stay,with secondary outcomes including serum sodium and potassium levels,clinical respiratory scores,modified shock index,and nutritional/inflammatory markers.The hospital length of stay and both the laboratory and clinical parameters of the interventional and control groups were compared.RESULTS The hospital stay was longer in the control group than in the intervention group(P value=0.001;effect size=0.59).Clinical respiratory scores on day 4 were significantly lower in the intervention group than in the control group(P value=0.001).Sodium levels were significantly lower in the control group than in the intervention group at discharge(P value=0.002).CONCLUSION Prophylactic oral sodium supplementation through ORS may have a health-promoting effect on infants and children admitted with pneumonia.
文摘BACKGROUND Heterozygous familial hypobetalipoproteinemia(FHBL)is a semi-autosomal disorder that is caused mainly by an APOB variant.It is usually asymptomatic and rarely leads to non-alcoholic steatohepatitis(NASH).CASE SUMMARY A 12-year-old boy was referred to our hospital after prolonged elevation of liver enzymes was observed during health checkups in Kagawa Prefecture.Abdominal ultrasound showed a bright liver,and laboratory investigations revealed low lowdensity lipoprotein cholesterol and apolipoprotein B protein levels.His family history included fatty liver and hypolipidemia in his father,which led to a clinical diagnosis of FHBL.A liver biopsy was performed on suspicion of liver fibrosis based on biomarkers.The liver tissue showed fatty steatosis,inflammation,hepatocyte ballooning,and fibrosis,indicating NASH.Genetic testing detected the APOB variant,and the patient was treated successfully with vitamin E.CONCLUSION It is important to assess family history and liver dysfunction severity in non-obese patients with hypolipidemia and fatty liver.
文摘BACKGROUND Familial Mediterranean fever(FMF)is an autosomal recessive autoinflammatory disorder marked by recurrent episodes of fever and serositis.Resistin,a proinflammatory cytokine,may play a role in FMF pathogenesis by promoting the release of interleukin-1beta,tumour necrosis factor alpha,and interleukin-6.AIM To evaluate serum resistin levels in children with FMF during acute attacks and remission,and to assess its potential as a biomarker for disease activity and progression.METHODS A case-control study was conducted involving 40 pediatric patients with FMF and 40 age-and sex-matched healthy controls.Serum resistin and inflammatory markers—including total leukocyte count(TLC),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),serum amyloid A(SAA),and fibrinogen—were measured using enzyme-linked immunosorbent assay and standard assays.RESULTS No significant differences were found in age or sex between FMF patients and controls.Among FMF patients,fever was the most prevalent symptom(95%),followed by abdominal pain(75%).The most frequently detected genetic mutation was M694I,followed by M694V,E148Q,M680I,and V726A.Compound heterozygous mutations,including M694I/V726A and M694I/M694V,were equally represented.During acute attacks,FMF patients exhibited significantly elevated levels of TLC,ESR,CRP,SAA,and fibrinogen compared to attack-free periods and controls.Serum resistin levels were markedly higher during acute attacks and showed a strong positive correlation with other acute inflammatory markers.Receiver operating characteristic curve analysis demonstrated high sensitivity and specificity of resistin as a potential biomarker for FMF.CONCLUSION Resistin is significantly elevated in children with FMF during acute episodes and correlates with established inflammatory markers.These findings support its potential role as a non-invasive biomarker for disease activity and severity in pediatric FMF.
文摘Attention-deficit/hyperactivity disorder(ADHD)is one of the most common neurodevelopmental disorders of childhood,yet its diagnosis remains complex and fraught with challenges.Pediatricians,often the first point of contact for concerned families,play a pivotal role in the diagnostic process.However,they face numerous obstacles that can hinder accurate and timely diagnosis,particularly in resource-limited or culturally diverse settings such as the Middle East and North Africa(MENA)and Arabian Gulf regions.This narrative review explores the key challenges pediatricians face in diagnosing ADHD and highlights practical and emerging solutions.The article offers both a global perspective and a contextualized view relevant to the MENA region.A narrative literature review was conducted using PubMed,Scopus,and Google Scholar,focusing on peer-reviewed studies,clinical guidelines,and epidemiological data from 2010 to 2025 related to pediatric ADHD diagnosis,especially in MENA regions.The review identifies six major diagnostic barriers:(1)Symptom overlap with other conditions[e.g.,autism spectrum disorder(ASD),anxiety,learning disabilities];(2)Reliance on subjective informant reports;(3)Cultural and societal influences including stigma and gender bias;(4)Variability in ADHD training and time constraints in clinical practice;(5)Limited access to multidisciplinary evaluations;and(6)Systemic referral and communication inefficiencies.Comorbidities are highly prevalent and frequently complicate the diagnostic picture.Delayed or inaccurate diagnosis can lead to academic underperformance,family stress,missed interventions,and long-term psychological consequences.Emerging solutions include digital screening tools,artificial intelligence-assisted analysis,structured reporting platforms,and improved training and referral models.Regional data from the Arabian Gulf highlight variable prevalence rates(1.3%-22%)and underscore the need for culturally sensitive diagnostic strategies.To improve diagnostic accuracy and patient outcomes,pediatricians must be supported through better training,interdisciplinary collaboration,validated tools,and policy-level reforms.Tailoring these approaches to local contexts will be key to addressing the growing burden of ADHD,particularly in the MENA region.
文摘BACKGROUND Functional neurological disorder(FND)in children is a complex and multifaceted condition characterized by neurological symptoms that cannot be explained by organic pathology.Despite its prevalence,FND in pediatric populations remains under-researched,with challenges in diagnosis and management AIM To synthesize the current literature on FND in children,focusing on clinical presentation,diagnostic approaches,treatment strategies,and outcomes.METHODS A comprehensive literature search was conducted across multiple databases,including PubMed,Scopus,and Web of Science,for articles published up to August 2024.Studies were included if they addressed FND in pediatric populations,specifically focusing on review articles,research articles,systematic reviews,meta-analyses,case reports,guidelines,expert opinions,and editorials.Data extraction and quality assessment were performed according to PRISMA guidelines.A total of 308 articles were included in the final analysis.RESULTS The analysis included 189 review articles,57 research articles,3 systematic reviews and meta-analyses,5 case reports,2 guidelines,5 expert opinions,and 2 editorials.Key findings revealed a broad spectrum of symptoms,including motor and sensory disturbances and psychological factors contributing to the onset and persistence of FND.Diagnostic challenges were frequently highlighted,emphasizing the need for interdisciplinary approaches.Treatment strategies varied,with cognitive-behavioral therapy(CBT)and multidisciplinary care emerging as the most effective approaches.The outcomes varied,with early intervention being critical for a better prognosis.CONCLUSION Early diagnosis and multidisciplinary care,including CBT,are critical for improving outcomes in pediatric FND.Standardized diagnostic criteria and treatment protocols are needed to enhance clinical management.
文摘BACKGROUND Visceral leishmaniasis(VL)is a systemic protozoan infection caused by Leishmania donovani(L.donovani)and transmitted by sand flies,causing macrophage invasion in the liver,spleen,and bone marrow.Diagnosis of VL is currently based on clinical signs,symptoms,and specific in-vitro markers and bone marrow investigations.However,VL's specific hematological and bone marrow manifestation in Sudanese pediatric patients is not well studied.AIM To examine the blood and bone marrow characteristics in pediatric patients from Sudan who have VL.METHODS This is a retrospective hospital-based study with a sample of 107 consecutive Sudanese pediatric patients.The data focused on hematological and bone marrow results.We included only the completed records of the pediatric patients with VL in the Tropical Disease Teaching Hospital in Khartoum,Sudan from the period of 2016 to 2020.RESULTS The majority of pediatric patients included in this study are below 5-years-old(n=59,55.2%).Moreover,anemia,thrombocytopenia,and leukopenia were among the prevalent characteristics in the population under study.To further analyze the data,we developed a machine learning model using boosted forest algorithms to predict L.donovani parasites load,with a mean accuracy of 0.88 for the training dataset and an accuracy of 0.46,0.50,and 0.74 for mild,moderate,and severe L.donovani parasite load in the validation dataset.CONCLUSION This study shows that the most common bone marrow change among Sudanese VL children was increased chronic inflammatory cells(n=88,82.2%)with present macrophage hemophagocytes(n=103,96.3%).While anemia and thrombocytopenia were the most common hematological changes.These results will hopefully lead to an early diagnosis and hence better management for Sudanese pediatric patients with suspected VL.
文摘BACKGROUND Fecal calprotectin is a valuable biomarker for assessing intestinal inflammation in pediatric gastrointestinal diseases.However,its role,pros,and cons in various conditions must be comprehensively elucidated.AIM To explore the role of fecal calprotectin in pediatric gastrointestinal diseases,including its advantages and limitations.METHODS A comprehensive search was conducted on PubMed,PubMed Central,Google Scholar,and other scientific research engines until February 24,2024.The review included 88 research articles,56 review articles,six metaanalyses,two systematic reviews,two consensus papers,and two letters to the editors.RESULTS Fecal calprotectin is a non-invasive marker for detecting intestinal inflammation and monitoring disease activity in pediatric conditions such as functional gastrointestinal disorders,inflammatory bowel disease,coeliac disease,coronavirus disease 2019-induced gastrointestinal disorders,gastroenteritis,and cystic fibrosis-associated intestinal pathology.However,its lack of specificity and susceptibility to various confounding factors pose challenges in interpretation.Despite these limitations,fecal calprotectin offers significant advantages in diagnosing,monitoring,and managing pediatric gastrointestinal diseases.CONCLUSION Fecal calprotectin holds promise as a valuable tool in pediatric gastroenterology,offering insights into disease activity,treatment response,and prognosis.Standardized protocols and guidelines are needed to optimize its clinical utility and mitigate interpretation challenges.Further research is warranted to address the identified limitations and enhance our understanding of fecal calprotectin in pediatric gastrointestinal diseases.
文摘Background: Idiopathic nephrotic syndrome (INS) is a frequent pathology in children. There is little data on the future of NS in children in sub-Saharan Africa, particularly Cameroon. The aim of our study is to report the prognosis of children treated for nephrotic syndrome in the city of Yaoundé. Method: This was an analytical cross-sectional study with retrospective collection in 4 reference hospitals in the Cameroonian capital over a period of five years from January 1, 2018 to December 31, 2022. We included all medical records of patients treated for idiopathic INS. We excluded incomplete records and those with a history of chronic kidney disease. The sociodemographic, clinical, paraclinical, and therapeutic data, as well as the short-term evolution were collected in the files. Data was analysed using the software statistical package for social sciences version 25.0. Statistical significance was set at a p-value Results: A total of 131 children (58% boys) were included in our study over a period of 5 years. The median age was 8 [6 - 11] years. Median proteinuria was 5 g/24h [3 - 8.4], median serum protein was 39 [34 - 46] g/l and median estimated glomerular filtration rate was 130.36 [68 - 174.6] ml/min/1.73m2. During steroid therapy, 45.07% were in partial remission at 2 months, 16.9% were in complete remission at 4 and 6 months, and 37.25% had relapsed. Steroid sensitivity was reported in 28.17% of cases, steroid resistance in 64.78% of cases and steroid dependent in 7.04% of cases. The mortality rate was 12.97%. Survival time averaged 48.2 months, with an overall crude survival rate of 99.2% at 3 and 6 months and 98.4% at 1 year. Regarding renal survival, renal function was impaired in 8.33% of patients at 6 months and 9% at 12 months. Conclusion: Idiopathic nephrotic syndrome is a common disease in children. Its evolution depends on corticosteroid therapy. The long-term prognosis is dominated by the risk of progression to end-stage kidney disease or even death. Rigorous and affordable follow-up is essential to reduce the number of patients lost to follow-up and the occurrence of complications.
文摘Background: The standard echocardiography is limited in detecting subclinical left ventricular (LV) dysfunction in pediatric hemodialysis patients. However, speckle-tracking echo (STE) analysis has emerged as a viable alternative. Furthermore, Growth Differentiation Factor-15 (GDF-15) is a stress-responsive biomarker generated by cardiac tissues. Aim: Evaluate left ventricular function using a range of echocardiography modalities and determine the most effective modality. Additionally, it seeks to quantify the diagnostic accuracy of GDF-15 as an early indicator of cardiac dysfunction in pediatric patients undergoing regular hemodialysis and explore the association between GDF-15 levels and left ventricular dysfunction. Subjects and Methods: An assessment of the LV functions and dimensions in a cohort of 40 pediatric patients undergoing regular hemodialysis compared to a control group of 40 healthy children. Our evaluation encompassed the utilization of GDF-15, hsCRP serum levels, conventional Echocardiography, tissue Doppler imaging (TDI), and Speckle Tracking Echocardiography (STE), in conjunction with routine laboratory investigations, to analyze the subjects post-hemodialysis (HD). Results: Children on hemodialysis showed significantly higher levels of GDF-15 and hsCRP. Furthermore, 67.5% of the patients displayed impaired left ventricular function as identified through conventional and TDI, while 82.5% exhibited global left ventricular strain as determined by STE. A strong correlation was found between EF% and serum cholesterol and triglyceride levels. Additionally, a notable association was discovered between GDF-15 and systolic blood pressure, left ventricular interventricular septal diameter (LVIVSD), and serum calcium levels. Conclusion: STE has shown its superiority over conventional and (TDI) in the early identification of LV changes in pediatric hemodialysis patients. GDF-15 is a sensitive indicator for early left ventricular dysfunction and shows a significant correlation with hypertension, left ventricular interventricular septal end-diastolic dimension (LVIVSD), and serum calcium levels.
基金supported by the Ramathibodi Research Fund,Faculty of Medicine Ramathibodi Hospital,Mahidol University(Grant number R11065125),for their contribution to research funding.
文摘Objective:To investigate whether urinary dipstick proteinuria or urine protein creatinine ratio(UPCR)could predict leakage in children with dengue virus infection.Methods:This was a prospective cross-sectional study.A total of 141 hospitalized patients with confirmed dengue virus infection were enrolled from three hospitals in Thailand.Once daily,complete blood count,serum albumin,and random morning urine dipstick protein were collected from the day of admission to the day after defervescence.Morning UPCR was only measured in patients from one hospital due to logistic reasons.Results:There were 81 and 60 patients in the dengue fever(DF)and DHF groups,respectively.The proportion of patients with proteinuria detected using urine dipstick in the DHF group was higher than that in the DF group from Day-1(one day before defervescence)to Day+1(one day after defervescence).Urine dipstick for proteinuria of≥1+had sensitivity and specificity of 12.8% and 94.4% on Day-1,and 18.9% and 98.6% on Day 0(the day of defervescence)to differentiate DHF from DF.For UPCR,cut-off values of approximately 0.2 g/g from Day-2 to Day+1 yielded a sensitivity of 71.6%-94.4% and a specificity of 55.6%-100% in differentiating between DF and DHF.Conclusions:Dipstick proteinuria of≥1+on Day-1 to Day+1 after defervescence had poor sensitivity but good specificity in differentiating DHF from DF.UPCR performed better but was less convenient and more expensive than urine dipsticks.
文摘BACKGROUND Pulse oximetry has become a cornerstone technology in healthcare,providing non-invasive monitoring of oxygen saturation levels and pulse rate.Despite its widespread use,the technology has inherent limitations and challenges that must be addressed to ensure accurate and reliable patient care.AIM To comprehensively evaluate the advantages,limitations,and challenges of pulse oximetry in clinical practice,as well as to propose recommendations for optimizing its use.METHODS A systematic literature review was conducted to identify studies related to pulse oximetry and its applications in various clinical settings.Relevant articles were selected based on predefined inclusion and exclusion criteria,and data were synthesized to provide a comprehensive overview of the topic.RESULTS Pulse oximetry offers numerous advantages,including non-invasiveness,real-time feedback,portability,and costeffectiveness.However,several limitations and challenges were identified,including motion artifacts,poor peripheral perfusion,ambient light interference,and patient-specific factors such as skin pigmentation and hemoglobin variants.Recommendations for optimizing pulse oximetry use include technological advancements,education and training initiatives,quality assurance protocols,and interdisciplinary collaboration.CONCLUSION Pulse oximetry is crucial in modern healthcare,offering invaluable insights into patients’oxygenation status.Despite its limitations,pulse oximetry remains an indispensable tool for monitoring patients in diverse clinical settings.By implementing the recommendations outlined in this review,healthcare providers can enhance the effectiveness,accessibility,and safety of pulse oximetry monitoring,ultimately improving patient outcomes and quality of care.
文摘Mycoplasma pneumoniae(M.pneumoniae)is a common pathogen that causes community-acquired pneumonia in children.The clinical presentation of this pathogen can range from mild self-limiting illness to severe and refractory cases.Complications may occur,such as necrotizing pneumonia and respiratory failure.Extrapulmonary complications,including encephalitis,myocarditis,nephritis,hepatitis,or even multiple organ failure,can also arise.In this editorial,we dis-cuss the clinical implications of the significant findings from the article"Serum inflammatory markers in children with M.pneumoniae pneumonia and their predictive value for mycoplasma severity"published by Wang et al.They reported that measuring lactic dehydrogenase,interleukin-6 levels,and D-dimer effectively predicts refractory M.pneumoniae pneumonia cases.
文摘BACKGROUND Diffuse panbronchiolitis(DPB)is a rare,chronic inflammatory lung disease mar-ked by chronic cough,breathlessness,and preceding sinusitis.Symptoms often persist for years and can be misdiagnosed as asthma,particularly in children.This report describes a DPB case resolved with long-term azithromycin therapy,em-phasizing the need for a timely and accurate diagnosis.CASE SUMMARY A 12-year-old girl,diagnosed with asthma at age five and managed with inhaled corticosteroids and long-acting beta-2 agonists,developed a history of chronic productive cough and chronic sinusitis for a year.On examination,she exhibited wheezing and coarse crackles.Despite receiving treatment for an asthma exacer-bation,her symptoms did not improve.A chest X-ray revealed reticulonodular infiltration in both lower lungs,prompting further evaluation with high-resolu-tion computed tomography(HRCT).The HRCT confirmed centrilobular nodule opacities,a'tree-in-bud'pattern,and non-tapering bronchi,suggesting DPB.Elevated cold hemagglutinin titers at 128 further supported the diagnosis.Her cough and sinusitis resolved within a month after starting azithromycin therapy,chosen for its anti-inflammatory and immunomodulatory effects.Follow-up HRCT scans after 1 year of continuous treatment showed complete normalization.CONCLUSION This case highlights the importance of early diagnosis and prompt treatment in achieving favorable outcomes for DPB.
文摘BACKGROUND Managing critical care emergencies in children with autism spectrum disorder(ASD)presents unique challenges due to their distinct sensory sensitivities,communication difficulties,and behavioral issues.Effective strategies and protocols are essential for optimal care in these high-stress situations.AIM To systematically evaluate and synthesize current evidence on best practices for managing critical care emergencies in children with ASD.The review focuses on key areas,including sensory-friendly environments,communication strategies,behavioral management,and the role of multidisciplinary approaches.METHODS A comprehensive search was conducted across major medical databases,including PubMed,Embase,and Cochrane Library,for studies published between 2000 and 2023.Studies were selected based on their relevance to critical care management in children with ASD,encompassing randomized controlled trials,observational studies,qualitative research,and case studies.Data were extracted and analyzed to identify common themes,successful strategies,and areas for improvement.RESULTS The review identified 50 studies that met the inclusion criteria.Findings highlighted the importance of creating sensory-friendly environments,utilizing effective communication strategies,and implementing individualized behavioral management plans.These findings,derived from a comprehensive review of current evidence,provide valuable insights into the best practices for managing critical care emergencies in children with ASD.Sensory modifications,such as reduced lighting and noise,visual aids,and augmentative and alternative communication tools,enhanced patient comfort and cooperation.The involvement of multidisciplinary teams was crucial in delivering holistic care.Case studies provided practical insights and underscored the need for continuous refi-nement of protocols.CONCLUSION The review emphasizes the need for a tailored approach to managing critical care emergencies for children with ASD.Sensory-friendly adjustments,effective communication,and behavioral strategies supported by a mul-tidisciplinary team are integral to improving outcomes.Despite progress,ongoing refinement of care practices and protocols is necessary.This ongoing process addresses remaining challenges and engages healthcare professionals in continuous improvement of care for children with ASD in critical settings.
文摘BACKGROUND Visual impairment during early childhood can hinder motor,language,and social development,yet data on its developmental impact across common pediatric ocular diseases remain limited.AIM To investigate the developmental impact of low vision and blindness on children under six with common ocular diseases.METHODS This retrospective study reviewed records of new patients under six with visual impairment at Siriraj Hospital’s low vision rehabilitation center(January 2017-October 2022).We collected ocular,systemic,and developmental data;recorded visual acuity in the better-seeing eye after refractive correction;and assessed developmental domains with the DenverⅡ.Univariable and multi-variable logistic regression identified factors associated with developmental delay.RESULTS A total of 161 pediatric patients(mean age 24.9±18.9 months)were enrolled and evaluated based on their ability to fix on and follow an object or light source.Some were further assessed using the Allen picture chart and all had visual acuity worse than 1.07±0.58 LogMAR,and 83.2%were identified as having global developmental delay(GDD).The three most common ocular causes were cortical visual impairment(CVI),optic neuropathy/atrophy,and optic nerve hypoplasia.Extremely poor visual acuity(inability to fixate and follow)was significantly associated with GDD[adjusted odds ratio(AOR)41.0]and delays in all developmental domains:Gross motor(AOR 10.0),fine motor(AOR 12.8),language(AOR 5.3),and personal-social skills(AOR 13.4)(P≤0.002).Multiple disabilities,most often visual impairment with cerebral palsy,were also significantly associated with gross motor delays(AOR 7.7)and fine motor delays(AOR 4.0)(P<0.05).CVI was also related to delays in language and personal-social skills(AOR 9.1 each)(P<0.05).CONCLUSION This study underscores the developmental issues in children with visual impairment,especially those with poorer acuity,CVI,and multiple disabilities.Significant delays were observed in all domains,including GDD.A timely referral to specialists is strongly recommended.
文摘The rise of the“fishing reviewer”phenomenon presents a significant threat to the integrity of academic publishing,undermining the credibility of the peer review process and eroding trust in scientific journals.This editorial explores the risk factors contributing to this troubling trend and identifies key indicators to recognize such reviewers.To address this issue,we propose strategies,including enhanced reviewer vetting,comprehensive training,and transparent recognition policies to foster a culture of accountability and ethical conduct in scholarly review.By implementing these measures,we can safeguard the quality and credibility of academic research.
文摘BACKGROUND Gastroesophageal reflux disease(GERD)is common among neonates,particularly those requiring mechanical ventilation.Pepsin,a reliable marker of gastric aspi-ration,may help detect GER episodes in ventilated neonates and assess associated clinical outcomes.AIM To determine the incidence of GERD,associated risk factors,and morbidities among full-term mechanically ventilated neonates by detecting pepsin in endo-tracheal aspirates(ETA).METHODS This study included 97 full-term neonates admitted to the neonatal intensive care unit at Cairo University Hospitals from April 2023 to March 2024.ETA samples were collected at three intervals:Immediately post-intubation(Sample A),48 hours after intubation(Sample B),and just before extubation(Sample C).Pepsin concentration was measured using enzyme-linked immunosorbent assay.Clinical data,including hospital stay duration and feeding parameters,were correlated with pepsin levels.RESULTS Pepsin was detected in 76(78.4%)of Sample A,78(81.3%)of Sample B,and 47(68.1%)of Sample C.A significant positive correlation was found between pepsin levels and FiO_(2) in Sample B(r=0.203,P=0.047).Prolonged hospital stay was also associated with pepsin detection in Samples B and C(P<0.05).A negative correlation was observed between feeding amount and pepsin levels across all samples(P<0.05).CONCLUSION The incidence of GERD in full-term mechanically ventilated neonates is high,correlating with pepsin levels,FiO_(2),feeding intolerance,and hospital stay,highlighting the importance of early detection.
文摘BACKGROUND The relationship between diabetes mellitus(DM)and asthma is complex and can impact disease trajectories.AIM To explore the bidirectional influences between the two conditions on clinical outcomes and disease control.METHODS We systematically reviewed the literature on the relationship between DM and asthma,focusing on their impacts,mechanisms,and therapeutic implications.Various studies were assessed,which investigated the effect of glycemic control on asthma outcomes,lung function,and exacerbations.The study highlighted the role of specific diabetes medications in managing asthma.RESULTS The results showed that poor glycemic control in diabetes can exacerbate asthma,increase hospitalizations,and reduce lung function.Conversely,severe asthma,especially in obese individuals,can complicate diabetes management and make glycemic control more difficult.The diabetes-associated mechanisms,such as inflammation,microangiopathy,and oxidative stress,can exacerbate asthma and decrease lung function.Some diabetes medications exhibit anti-inflammatory effects that show promise in mitigating asthma exacerbations.CONCLUSION The complex interrelationship between diabetes and asthma suggests bidirectional influences that affect disease course and outcomes.Inflammation and microvascular complications associated with diabetes may worsen asthma outcomes,while asthma severity,especially in obese individuals,complicates diabetes control.However,the current research has limitations,and more diverse longitudinal studies are required to establish causal relationships and identify effective treatment strategies for individuals with both conditions.
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.
