Urinary tract infections(UTIs)are among the most prevalent pediatric bacterial infections,and undertreated episodes may lead to renal scarring,hypertension,or chronic kidney disease.Multidrug-resistant(MDR)Enterobacte...Urinary tract infections(UTIs)are among the most prevalent pediatric bacterial infections,and undertreated episodes may lead to renal scarring,hypertension,or chronic kidney disease.Multidrug-resistant(MDR)Enterobacterales have been increasingly reported in children,with higher rates in Asian and Middle Eastern settings than in high-income countries[1,2].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 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
Upper gastrointestinal(GI)endoscopy is considered an essential procedure in pediatric gastroenterology.It has evolved over many decades into a state where it plays a crucial role in providing diagnostic and therapeuti...Upper gastrointestinal(GI)endoscopy is considered an essential procedure in pediatric gastroenterology.It has evolved over many decades into a state where it plays a crucial role in providing diagnostic and therapeutic advantages across a broad spectrum of diseases.This review examines its role in diagnosing and managing common pediatric GI conditions,emphasizing notable advancements in techniques,clinical use,and future directions.We conducted a detailed literature survey using PubMed,Scopus,and Google Scholar,and English-language articles were reviewed.This review process included the latest articles,guidelines,and conference papers on pediatric and adult upper GI endoscopy.An upper GI endoscopy is imperative in diagnosing many pediatric GI diseases as it enables visualization of the gut mucosa,obtaining mucosal biopsies from suspicious areas or lesions for histological assessment,and selecting an effective management and follow-up plan.New advancements,including high-resolution endoscopy,narrow-band imaging,and confocal laser endomicroscopy,have revolutionized pediatric endoscopy by improving precision and reducing the need for invasive interventions.Furthermore,recent therapeutic developments in the field,such as endoscopic submucosal dissection and endoscopic mucosal resection,are now being utilized to treat preneoplastic lesions or refractory esophageal strictures.However,despite its usefulness,performing this procedure in children is challenging for various reasons,including the need for sedation,anesthesia,and smaller instrument sizes,the unavailability of trained staff,lack of training facilities,and the absence of dedicated endoscopy suites for children.In conclusion,pediatric upper GI endoscopy plays a pivotal role in pediatric gastroenterology,offering both therapeutic and diagnostic benefits.Progress in the field leads to the development of novel techniques that improve overall patient care,such as artificial intelligence in pattern recognition,which enhances lesion detection,predicts premalignant or pre-inflammatory areas,and minimizes investigator-related errors.Additionally,refining protocols and guidelines is essential to improve the safety,efficacy,and precision of upper GI endoscopy,ensuring the best possible care for children.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 Functional abdominal pain disorders(FAPDs)are common gut–brain interaction disorders with unclear pathophysiology.While impaired gastrointestinal motility is thought to play a key role,small intestinal dys...BACKGROUND Functional abdominal pain disorders(FAPDs)are common gut–brain interaction disorders with unclear pathophysiology.While impaired gastrointestinal motility is thought to play a key role,small intestinal dysmotility remains largely unexplored.Orocecal transit time(OCTT),an indirect indicator of small intestinal transit,offers an insight into its potential contribution to FAPD's pathophysiology.AIM To assess OCTT in children with FAPDs compared with healthy children using the lactulose breath hydrogen test.METHODS Thirty-four children(44.1%males,age 5–12 years,mean 7.2±2.4 years)with FAPDs attending North Colombo Teaching Hospital,Ragama,Sri Lanka,were included in the analysis.FAPDs were diagnosed using the Rome IV criteria.None had clinical or laboratory evidence of organic diseases.They were compared with 19 healthy controls(47.1%males,age 5-12 years,mean 7.8±2.7 years)from the same geographical area.OCTT was calculated after an 8-hour fast using a previously validated technique.Breath hydrogen levels were measured at baseline and 15-minute intervals for 180 minutes post-lactulose ingestion(10 g in 10%solution).At each time point,3 breath samples were collected and analyzed.OCTT was quantified as the time taken to achieve a sustained breath hydrogen increase>10 parts per million above baseline.Symptoms were recorded using the Rome IV questionnaire,and symptom severity was graded on a 0-4 Likert scale.RESULTS Patients with FAPDs had increased OCTT(median,90 minutes;interquartile range,75-120 minutes)compared to controls(median,75 minutes;interquartile range,60-75 minutes)(P=0.0045,Mann-Whitney U-test).Children with functional dyspepsia had the longest mean OCTT(110.8±26.7 minutes).There was no significant correlation between abdominal pain severity and OCTT(r=0.18,P=0.35,Spearman correlation coefficient).OCTT did not differ between those exposed to stressful events and those not exposed to such events(P>0.05).CONCLUSION Children with FAPDs have longer OCTT than healthy controls.However,the lack of a significant correlation between OCTT and symptom severity suggests that delayed small intestinal transit alone is not a substantial contributor to FAPD pathophysiology.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
Traditional serrated adenoma(TSA)is a type of serrated polyp of the colorectum and is thought to be a precancerous lesion.There are three types of serrated polyps,namely,hyperplastic polyps,sessile serrated adenomas/p...Traditional serrated adenoma(TSA)is a type of serrated polyp of the colorectum and is thought to be a precancerous lesion.There are three types of serrated polyps,namely,hyperplastic polyps,sessile serrated adenomas/polyps,and TSAs.TSA is the least common of the three types and accounts for about 5% of serrated polyps.Here we report a pediatric case of TSA that was successfully resected by endoscopic submucosal dissection(ESD).This rare case report describes a pediatric patient with no family history of colonic polyp who was admitted to our hospital with hematochezia.On colonoscopy,we found a polypoid lesion measuring 10 mm in diameter in the lower rectum.We selected ESD as a surgical option for en bloc resection,and histopathological examination revealed TSA.The findings in this case suggest that TSA with precancerous potential can occur in children,and that ESD is useful for treating this lesion.展开更多
Background:Pediatric acute pancreatitis(AP)is rare but increasing.Severe AP is associated with higher morbidity and mortality.However,there are no universally accepted prognostic criteria for AP.Methods:This retrospec...Background:Pediatric acute pancreatitis(AP)is rare but increasing.Severe AP is associated with higher morbidity and mortality.However,there are no universally accepted prognostic criteria for AP.Methods:This retrospective study included children with AP admitted to an intensive care unit(ICU)of our tertiary pediatric center between January 2009 and December 2018.The severity of organ dysfunction in AP was assessed according to the modified Atlanta criteria using the Pediatric Sequential Organ Failure Assessment(p SOFA)and Computed Tomography Severity Index(CTSI).Results:Seventy acute episodes of AP were evaluated in 55 children with primary pancreatitis.In addition,secondary AP was diagnosed in 15 patients originally admitted to ICU for different indications.Mild AP[no organ dysfunction,normal computed tomography(CT)finding]was the most prevalent(64/85 episodes in 49 children),followed by moderate AP(15 children;p SOFA 2-9 points,CTSI 3-4 points on admission).Severe AP(p SOFA 4-17 points,CTSI 6-10 points)was diagnosed in 6 children with traumatic or secondary AP.The most frequent etiologies of primary AP episodes were idiopathic(39%)and biliary(31%).Children with idiopathic AP had frequent relapses and comorbidities.Hereditary AP was typically mild,but presented with high pancreatic enzyme levels and recurrence rates.Admission at ICU and an interval without enteral nutrition(EN)were relatively short in drug-induced AP and relatively long in secondary and traumatic AP.Endoscopic retrograde cholangiopancreatography(ERCP)was performed in 13 patients with biliary AP and in 4 patients with traumatic AP.No AP-related death was observed.Conclusion:p SOFA score accurately reflects the severity and prognosis of AP in children.展开更多
BACKGROUND: Triage system in children seems to be more challenging compared to adults because of their different response to physiological and psychosocial stressors. This study aimed to determine the best triage syst...BACKGROUND: Triage system in children seems to be more challenging compared to adults because of their different response to physiological and psychosocial stressors. This study aimed to determine the best triage system in the pediatric emergency department.METHODS: This was a prospective observational study. This study was divided into two phases. The fi rst phase determined the inter-rater reliability of fi ve triage systems: Manchester Triage System(MTS), Emergency Severity Index(ESI) version 4, Pediatric Canadian Triage and Acuity Scale(CTAS), Australasian Triage Scale(ATS), and Ramathibodi Triage System(RTS) by triage nurses and pediatric residents. In the second phase, to analyze the validity of each triage system, patients were categorized as two groups, i.e., high acuity patients(triage level 1, 2) and low acuity patients(triage level 3, 4, and 5). Then we compared the triage acuity with actual admission.RESULTS: In phase I, RTS illustrated almost perfect inter-rater reliability with kappa of 1.0(P<0.01). ESI and CTAS illustrated good inter-rater reliability with kappa of 0.8–0.9(P<0.01). Meanwhile, ATS and MTS illustrated moderate to good inter-rater reliability with kappa of 0.5–0.7(P<0.01). In phase II, we included 1 041 participants with average age of 4.7±4.2 years, of which 55% were male and 45% were female. In addition 32% of the participants had underlying diseases, and 123(11.8%) patients were admitted. We found that ESI illustrated the most appropriate predicting ability for admission with sensitivity of 52%, specifi city of 81%, and AUC 0.78(95%CI 0.74–0.81).CONCLUSION: RTS illustrated almost perfect inter-rater reliability. Meanwhile, ESI and CTAS illustrated good inter-rater reliability. Finally, ESI illustrated the appropriate validity for triage system.展开更多
BACKGROUND Liver transplantation(LT)has become an acceptable curative method for children with several liver diseases,especially irreversible acute liver failure and chronic liver diseases.King Chulalongkorn Memorial ...BACKGROUND Liver transplantation(LT)has become an acceptable curative method for children with several liver diseases,especially irreversible acute liver failure and chronic liver diseases.King Chulalongkorn Memorial Hospital is one of Thailand’s largest liver transplant centers and is responsible for many pediatric cases.AIM To report the experience with pediatric LT and evaluate outcomes of livingrelated vs deceased-donor grafts.METHODS This evaluation included children who underwent LT between August 2004 and November 2019.Data were retrospectively reviewed,including demographics,diagnoses,laboratory values of donors and recipients,the pediatric end-stage liver disease(PELD)or model for end-stage liver disease(MELD)score,graft source,wait time,perioperative course,postoperative complications,and survival rates.Continuous data were reported using the median and interquartile range.The Mann–Whitney U-test was used to compare the wait time between the living-related and deceased-donor groups.The chi-square or Fisher's exact test were used to compare the frequencies of between-group complications.Survival rates were calculated using the Kaplan–Meier method.RESULTS Ninety-four operated pediatric liver transplant patients were identified(54%were females).The median age at transplantation was 1.2(0.8-3.8)years.The median PELD and MELD scores were 20(13-26.8)and 19.5(15.8-26.3),respectively.Most grafts(81.9%)were obtained from living-related donors.The median wait time for the living donors was significantly shorter compared with the deceased donors at 1.6(0.3-3.1)mo vs 11.2(2.1-33.3)mo(P=0.01).Most patients were diagnosed with biliary atresia(74.5%),and infection was the most common complication within 30 d posttransplantation(14.9%).Without a desensitization protocol,9%of transplants were ABOincompatible.Eight hepatitis B core antibodies(anti-HBc)-negative recipients received positive anti-HBc grafts without different observed complications.The overall survival rate was 93.6%and 90.3%at 1 and 5 years,respectively.No graft loss during follow-up was noted among survivors.CONCLUSION A significant number of pediatric LT cases were reported in Thailand.Based on relatively comparable outcomes,ABO-incompatible and HBc antibody-positive grafts may be considered in an organ shortage situation.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
Objectives:We aimed to evaluate the effect of percutaneous atrial septal defect(ASD)closure in children using right heart indices and serum galectin-3(Gal-3),as potential biomarkers of right heart remodeling.Methods:T...Objectives:We aimed to evaluate the effect of percutaneous atrial septal defect(ASD)closure in children using right heart indices and serum galectin-3(Gal-3),as potential biomarkers of right heart remodeling.Methods:This case–control prospective study included 40 children with ASD and 25 control subjects.An echocardiographic evaluation was performed before the procedure,as well as 24 h,1 month,and 6 months after intervention.Serum Gal-3 was measured before,and 1 month after the procedure.Results:Serum Gal-3 concentration,right atrial(RA)dimensions,right ventricular(RV)dimensions,indexed RA area,and right index of myocardial performance(RIMP)were significantly increased in children with ASD compared with control subjects while tricuspid annular plane systolic excursion(TAPSE)was significantly decreased.Six months after closure,RA,and RV dimensions significantly decreased and RVfunction improved(RIMP decreased and TAPSE increased).Gal-3 oncentration significantly decreased 1 month after ASD closure,but it did not reach normal range compared with control subjects.A positive correlation between Gal-3 and age at closure,RA area,RV dimensions,and RIMP was observed.A positive correlation was observed between the decrease in Gal-3 concentration and the decrease in RA area and RV dimensions 1 month after ASD closure.A significant negative correlation was observed between TAPSE and Gal-3 concentration before and after intervention.Conclusions:Percutaneous ASD closure can improve right-sided indices and decrease serum Gal-3 concentration.Gal-3 can be used as a sensitive biomarker of right heart remodeling,with a decrease in Gal-3 concentration suggesting reversal of maladaptive remodeling.展开更多
Background: Burnout syndrome is a common professional problem causing mental fatigue, depersonalization, and diminished self-value. Burnout during pediatric residency can significantly influence the resident’s perfor...Background: Burnout syndrome is a common professional problem causing mental fatigue, depersonalization, and diminished self-value. Burnout during pediatric residency can significantly influence the resident’s performance and the quality of their training. Objectives: To evaluate the burnout status of pediatric residents across Jeddah, KSA. Methods: A cross-sectional, descriptive study involving pediatric residents across Jeddah, Saudi Arabia was conducted from the 1st of August to 1st of December, 2012. The Maslach Burnout Inventory was utilized in addition to questions about their work environment and lifestyle. Results: Sixty pediatric residents (67% females) were included with ages ranging between 25 - 30 years (mean 26.5). They practiced in various institutions, mostly (41%) in ministry of health hospitals. Burnout scores were abnormal in 49 (82%) and in 19 (32%) the syndrome was severe. Males were more likely to reach a severe burnout category when compared to females (32% vs 19%, p = 0.01). Residents working in the university hospital (23%), were more likely to have severe burnout when compared to those working in other hospitals (p = 0.002). Junior residents (R1 and R2) were also more likely to have severe burnout when compared to senior residents (34% vs 21%, p = 0.013). Conclusions: Many pediatric residents are suffering from burnout syndrome. It is more common among males, junior residents, and those working in a university hospital setting. Specific strategies should be developed to prevent resident burnout.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
</span><b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"></b></span><b> </b><span style=&...</span><b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"></b></span><b> </b><span style="font-family:Verdana;">Pancreatic tuberculosis (TB) is very rare, mostly due to the antibacterial effects of the pancreatic enzymes. The association of thrombosis and tuberculosis ha</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> been reported but that of inferior vena cava (IVC) thrombosis and pancreatic tuberculosis is extremely rare and has only been reported once. <b></span><b><span style="font-family:Verdana;">Case presentation:</span></b><span style="font-family:Verdana;"></b></span><b> </b><span style="font-family:Verdana;">A case of pancreatic Tuberculosis and IVC thrombosis presented with constitutional symptoms. Ultrasonography and computerized tomography showed a lesion in the head of the pancreas and a large lymph mass. Magnetic resonance imaging (MRI) of (IVC) showed thrombosis in the IVC. Histological examination revealed necrotizing granulomas after a laparotomy. The patient received antituberculosis chemotherapy and low molecular weight heparin. <b></span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"></b></span><b> </b><span style="font-family:Verdana;">Pancreatic TB is a challenge to diagnose especially in Resource-poor countries, which might lead to delay in treatment </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and worse complications.展开更多
<strong>Background:</strong> Pediatric observation ward (OW) is the area where the patient can be monitored or have early investigation/management and observe part of emergency department (ED);patients are...<strong>Background:</strong> Pediatric observation ward (OW) is the area where the patient can be monitored or have early investigation/management and observe part of emergency department (ED);patients are admitted to this area with an expectation of discharge within 24 hours. Observation ward was beneficial in preventing avoidable hospitalizations, due to the high volume of patients in ED, OW increasing demands, overcrowding, and prolonged stay. <strong>Objective:</strong> This study aimed to examine the characteristics and factors associated with prolonged length of stay (LOS) more than 24 hours in the pediatric observation ward. General demographic data were recorded including age, sex, LOS, diagnosis and disposition. <strong>Results:</strong> This is a retrospective study of children 15 years old or younger who admit to Pediatric OW at urban university hospital and prolonged stay more than 24 hours during January 2014 to June 2015. There were 670 patients admitted at OW during the study period (median age of 5 years;53% were male). Mean length of stay in OW was 61 hours. The most common top 5 diagnoses were respiratory problem (32%), gastrointestinal problem (29%), infectious disease (11%), neurological (7%), and dental problem (6%). The majority of patients were discharge home 602/670 cases (90%), and 10% (68/670 cases) were admitted to inpatient ward. There were 552 patients (82%) who had prolonged OW more than 24 hours. Compared with the factors in both group, we found that the associated factor for prolonged OW stay was the age of patient, which seems to be younger in the prolonged stay group (median age of 4 years 3 months vs 3 years 5 months, p = 0.04). Younger children had significant factors for prolonged stay in OW (p < 0.001) compared to all age categorized less than 1 year, 1 - 5 years, 5 - 10 years, 10 - 15 years and more than 15 years respectively. <strong>Conclusion:</strong> This was the study for report of pediatric observation ward utilization. The younger patient was the associated factor for prolonged stay in OW. Understanding this related issue will be the starting points for assessing patients carefully before admitting to OW for improving efficiency and quality of care in pediatric OW.展开更多
文摘Urinary tract infections(UTIs)are among the most prevalent pediatric bacterial infections,and undertreated episodes may lead to renal scarring,hypertension,or chronic kidney disease.Multidrug-resistant(MDR)Enterobacterales have been increasingly reported in children,with higher rates in Asian and Middle Eastern settings than in high-income countries[1,2].
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 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Upper gastrointestinal(GI)endoscopy is considered an essential procedure in pediatric gastroenterology.It has evolved over many decades into a state where it plays a crucial role in providing diagnostic and therapeutic advantages across a broad spectrum of diseases.This review examines its role in diagnosing and managing common pediatric GI conditions,emphasizing notable advancements in techniques,clinical use,and future directions.We conducted a detailed literature survey using PubMed,Scopus,and Google Scholar,and English-language articles were reviewed.This review process included the latest articles,guidelines,and conference papers on pediatric and adult upper GI endoscopy.An upper GI endoscopy is imperative in diagnosing many pediatric GI diseases as it enables visualization of the gut mucosa,obtaining mucosal biopsies from suspicious areas or lesions for histological assessment,and selecting an effective management and follow-up plan.New advancements,including high-resolution endoscopy,narrow-band imaging,and confocal laser endomicroscopy,have revolutionized pediatric endoscopy by improving precision and reducing the need for invasive interventions.Furthermore,recent therapeutic developments in the field,such as endoscopic submucosal dissection and endoscopic mucosal resection,are now being utilized to treat preneoplastic lesions or refractory esophageal strictures.However,despite its usefulness,performing this procedure in children is challenging for various reasons,including the need for sedation,anesthesia,and smaller instrument sizes,the unavailability of trained staff,lack of training facilities,and the absence of dedicated endoscopy suites for children.In conclusion,pediatric upper GI endoscopy plays a pivotal role in pediatric gastroenterology,offering both therapeutic and diagnostic benefits.Progress in the field leads to the development of novel techniques that improve overall patient care,such as artificial intelligence in pattern recognition,which enhances lesion detection,predicts premalignant or pre-inflammatory areas,and minimizes investigator-related errors.Additionally,refining protocols and guidelines is essential to improve the safety,efficacy,and precision of upper GI endoscopy,ensuring the best possible care for children.
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.
基金Supported by The University of Kelaniya,No.RP/03/04/13/01/01.
文摘BACKGROUND Functional abdominal pain disorders(FAPDs)are common gut–brain interaction disorders with unclear pathophysiology.While impaired gastrointestinal motility is thought to play a key role,small intestinal dysmotility remains largely unexplored.Orocecal transit time(OCTT),an indirect indicator of small intestinal transit,offers an insight into its potential contribution to FAPD's pathophysiology.AIM To assess OCTT in children with FAPDs compared with healthy children using the lactulose breath hydrogen test.METHODS Thirty-four children(44.1%males,age 5–12 years,mean 7.2±2.4 years)with FAPDs attending North Colombo Teaching Hospital,Ragama,Sri Lanka,were included in the analysis.FAPDs were diagnosed using the Rome IV criteria.None had clinical or laboratory evidence of organic diseases.They were compared with 19 healthy controls(47.1%males,age 5-12 years,mean 7.8±2.7 years)from the same geographical area.OCTT was calculated after an 8-hour fast using a previously validated technique.Breath hydrogen levels were measured at baseline and 15-minute intervals for 180 minutes post-lactulose ingestion(10 g in 10%solution).At each time point,3 breath samples were collected and analyzed.OCTT was quantified as the time taken to achieve a sustained breath hydrogen increase>10 parts per million above baseline.Symptoms were recorded using the Rome IV questionnaire,and symptom severity was graded on a 0-4 Likert scale.RESULTS Patients with FAPDs had increased OCTT(median,90 minutes;interquartile range,75-120 minutes)compared to controls(median,75 minutes;interquartile range,60-75 minutes)(P=0.0045,Mann-Whitney U-test).Children with functional dyspepsia had the longest mean OCTT(110.8±26.7 minutes).There was no significant correlation between abdominal pain severity and OCTT(r=0.18,P=0.35,Spearman correlation coefficient).OCTT did not differ between those exposed to stressful events and those not exposed to such events(P>0.05).CONCLUSION Children with FAPDs have longer OCTT than healthy controls.However,the lack of a significant correlation between OCTT and symptom severity suggests that delayed small intestinal transit alone is not a substantial contributor to FAPD pathophysiology.
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Traditional serrated adenoma(TSA)is a type of serrated polyp of the colorectum and is thought to be a precancerous lesion.There are three types of serrated polyps,namely,hyperplastic polyps,sessile serrated adenomas/polyps,and TSAs.TSA is the least common of the three types and accounts for about 5% of serrated polyps.Here we report a pediatric case of TSA that was successfully resected by endoscopic submucosal dissection(ESD).This rare case report describes a pediatric patient with no family history of colonic polyp who was admitted to our hospital with hematochezia.On colonoscopy,we found a polypoid lesion measuring 10 mm in diameter in the lower rectum.We selected ESD as a surgical option for en bloc resection,and histopathological examination revealed TSA.The findings in this case suggest that TSA with precancerous potential can occur in children,and that ESD is useful for treating this lesion.
基金supported by grants from the European Regional Development Fund-Project ENOCH(CZ.02.1.01/0.0/0.0/16_019/0000868)the Ministry of Health,Czech Republic-conceptual development of research organization(MH DRO,grant FNOL,0098892)。
文摘Background:Pediatric acute pancreatitis(AP)is rare but increasing.Severe AP is associated with higher morbidity and mortality.However,there are no universally accepted prognostic criteria for AP.Methods:This retrospective study included children with AP admitted to an intensive care unit(ICU)of our tertiary pediatric center between January 2009 and December 2018.The severity of organ dysfunction in AP was assessed according to the modified Atlanta criteria using the Pediatric Sequential Organ Failure Assessment(p SOFA)and Computed Tomography Severity Index(CTSI).Results:Seventy acute episodes of AP were evaluated in 55 children with primary pancreatitis.In addition,secondary AP was diagnosed in 15 patients originally admitted to ICU for different indications.Mild AP[no organ dysfunction,normal computed tomography(CT)finding]was the most prevalent(64/85 episodes in 49 children),followed by moderate AP(15 children;p SOFA 2-9 points,CTSI 3-4 points on admission).Severe AP(p SOFA 4-17 points,CTSI 6-10 points)was diagnosed in 6 children with traumatic or secondary AP.The most frequent etiologies of primary AP episodes were idiopathic(39%)and biliary(31%).Children with idiopathic AP had frequent relapses and comorbidities.Hereditary AP was typically mild,but presented with high pancreatic enzyme levels and recurrence rates.Admission at ICU and an interval without enteral nutrition(EN)were relatively short in drug-induced AP and relatively long in secondary and traumatic AP.Endoscopic retrograde cholangiopancreatography(ERCP)was performed in 13 patients with biliary AP and in 4 patients with traumatic AP.No AP-related death was observed.Conclusion:p SOFA score accurately reflects the severity and prognosis of AP in children.
文摘BACKGROUND: Triage system in children seems to be more challenging compared to adults because of their different response to physiological and psychosocial stressors. This study aimed to determine the best triage system in the pediatric emergency department.METHODS: This was a prospective observational study. This study was divided into two phases. The fi rst phase determined the inter-rater reliability of fi ve triage systems: Manchester Triage System(MTS), Emergency Severity Index(ESI) version 4, Pediatric Canadian Triage and Acuity Scale(CTAS), Australasian Triage Scale(ATS), and Ramathibodi Triage System(RTS) by triage nurses and pediatric residents. In the second phase, to analyze the validity of each triage system, patients were categorized as two groups, i.e., high acuity patients(triage level 1, 2) and low acuity patients(triage level 3, 4, and 5). Then we compared the triage acuity with actual admission.RESULTS: In phase I, RTS illustrated almost perfect inter-rater reliability with kappa of 1.0(P<0.01). ESI and CTAS illustrated good inter-rater reliability with kappa of 0.8–0.9(P<0.01). Meanwhile, ATS and MTS illustrated moderate to good inter-rater reliability with kappa of 0.5–0.7(P<0.01). In phase II, we included 1 041 participants with average age of 4.7±4.2 years, of which 55% were male and 45% were female. In addition 32% of the participants had underlying diseases, and 123(11.8%) patients were admitted. We found that ESI illustrated the most appropriate predicting ability for admission with sensitivity of 52%, specifi city of 81%, and AUC 0.78(95%CI 0.74–0.81).CONCLUSION: RTS illustrated almost perfect inter-rater reliability. Meanwhile, ESI and CTAS illustrated good inter-rater reliability. Finally, ESI illustrated the appropriate validity for triage system.
文摘BACKGROUND Liver transplantation(LT)has become an acceptable curative method for children with several liver diseases,especially irreversible acute liver failure and chronic liver diseases.King Chulalongkorn Memorial Hospital is one of Thailand’s largest liver transplant centers and is responsible for many pediatric cases.AIM To report the experience with pediatric LT and evaluate outcomes of livingrelated vs deceased-donor grafts.METHODS This evaluation included children who underwent LT between August 2004 and November 2019.Data were retrospectively reviewed,including demographics,diagnoses,laboratory values of donors and recipients,the pediatric end-stage liver disease(PELD)or model for end-stage liver disease(MELD)score,graft source,wait time,perioperative course,postoperative complications,and survival rates.Continuous data were reported using the median and interquartile range.The Mann–Whitney U-test was used to compare the wait time between the living-related and deceased-donor groups.The chi-square or Fisher's exact test were used to compare the frequencies of between-group complications.Survival rates were calculated using the Kaplan–Meier method.RESULTS Ninety-four operated pediatric liver transplant patients were identified(54%were females).The median age at transplantation was 1.2(0.8-3.8)years.The median PELD and MELD scores were 20(13-26.8)and 19.5(15.8-26.3),respectively.Most grafts(81.9%)were obtained from living-related donors.The median wait time for the living donors was significantly shorter compared with the deceased donors at 1.6(0.3-3.1)mo vs 11.2(2.1-33.3)mo(P=0.01).Most patients were diagnosed with biliary atresia(74.5%),and infection was the most common complication within 30 d posttransplantation(14.9%).Without a desensitization protocol,9%of transplants were ABOincompatible.Eight hepatitis B core antibodies(anti-HBc)-negative recipients received positive anti-HBc grafts without different observed complications.The overall survival rate was 93.6%and 90.3%at 1 and 5 years,respectively.No graft loss during follow-up was noted among survivors.CONCLUSION A significant number of pediatric LT cases were reported in Thailand.Based on relatively comparable outcomes,ABO-incompatible and HBc antibody-positive grafts may be considered in an organ shortage situation.
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Objectives:We aimed to evaluate the effect of percutaneous atrial septal defect(ASD)closure in children using right heart indices and serum galectin-3(Gal-3),as potential biomarkers of right heart remodeling.Methods:This case–control prospective study included 40 children with ASD and 25 control subjects.An echocardiographic evaluation was performed before the procedure,as well as 24 h,1 month,and 6 months after intervention.Serum Gal-3 was measured before,and 1 month after the procedure.Results:Serum Gal-3 concentration,right atrial(RA)dimensions,right ventricular(RV)dimensions,indexed RA area,and right index of myocardial performance(RIMP)were significantly increased in children with ASD compared with control subjects while tricuspid annular plane systolic excursion(TAPSE)was significantly decreased.Six months after closure,RA,and RV dimensions significantly decreased and RVfunction improved(RIMP decreased and TAPSE increased).Gal-3 oncentration significantly decreased 1 month after ASD closure,but it did not reach normal range compared with control subjects.A positive correlation between Gal-3 and age at closure,RA area,RV dimensions,and RIMP was observed.A positive correlation was observed between the decrease in Gal-3 concentration and the decrease in RA area and RV dimensions 1 month after ASD closure.A significant negative correlation was observed between TAPSE and Gal-3 concentration before and after intervention.Conclusions:Percutaneous ASD closure can improve right-sided indices and decrease serum Gal-3 concentration.Gal-3 can be used as a sensitive biomarker of right heart remodeling,with a decrease in Gal-3 concentration suggesting reversal of maladaptive remodeling.
文摘Background: Burnout syndrome is a common professional problem causing mental fatigue, depersonalization, and diminished self-value. Burnout during pediatric residency can significantly influence the resident’s performance and the quality of their training. Objectives: To evaluate the burnout status of pediatric residents across Jeddah, KSA. Methods: A cross-sectional, descriptive study involving pediatric residents across Jeddah, Saudi Arabia was conducted from the 1st of August to 1st of December, 2012. The Maslach Burnout Inventory was utilized in addition to questions about their work environment and lifestyle. Results: Sixty pediatric residents (67% females) were included with ages ranging between 25 - 30 years (mean 26.5). They practiced in various institutions, mostly (41%) in ministry of health hospitals. Burnout scores were abnormal in 49 (82%) and in 19 (32%) the syndrome was severe. Males were more likely to reach a severe burnout category when compared to females (32% vs 19%, p = 0.01). Residents working in the university hospital (23%), were more likely to have severe burnout when compared to those working in other hospitals (p = 0.002). Junior residents (R1 and R2) were also more likely to have severe burnout when compared to senior residents (34% vs 21%, p = 0.013). Conclusions: Many pediatric residents are suffering from burnout syndrome. It is more common among males, junior residents, and those working in a university hospital setting. Specific strategies should be developed to prevent resident burnout.
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</span><b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"></b></span><b> </b><span style="font-family:Verdana;">Pancreatic tuberculosis (TB) is very rare, mostly due to the antibacterial effects of the pancreatic enzymes. The association of thrombosis and tuberculosis ha</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">s</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> been reported but that of inferior vena cava (IVC) thrombosis and pancreatic tuberculosis is extremely rare and has only been reported once. <b></span><b><span style="font-family:Verdana;">Case presentation:</span></b><span style="font-family:Verdana;"></b></span><b> </b><span style="font-family:Verdana;">A case of pancreatic Tuberculosis and IVC thrombosis presented with constitutional symptoms. Ultrasonography and computerized tomography showed a lesion in the head of the pancreas and a large lymph mass. Magnetic resonance imaging (MRI) of (IVC) showed thrombosis in the IVC. Histological examination revealed necrotizing granulomas after a laparotomy. The patient received antituberculosis chemotherapy and low molecular weight heparin. <b></span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"></b></span><b> </b><span style="font-family:Verdana;">Pancreatic TB is a challenge to diagnose especially in Resource-poor countries, which might lead to delay in treatment </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">and worse complications.
文摘<strong>Background:</strong> Pediatric observation ward (OW) is the area where the patient can be monitored or have early investigation/management and observe part of emergency department (ED);patients are admitted to this area with an expectation of discharge within 24 hours. Observation ward was beneficial in preventing avoidable hospitalizations, due to the high volume of patients in ED, OW increasing demands, overcrowding, and prolonged stay. <strong>Objective:</strong> This study aimed to examine the characteristics and factors associated with prolonged length of stay (LOS) more than 24 hours in the pediatric observation ward. General demographic data were recorded including age, sex, LOS, diagnosis and disposition. <strong>Results:</strong> This is a retrospective study of children 15 years old or younger who admit to Pediatric OW at urban university hospital and prolonged stay more than 24 hours during January 2014 to June 2015. There were 670 patients admitted at OW during the study period (median age of 5 years;53% were male). Mean length of stay in OW was 61 hours. The most common top 5 diagnoses were respiratory problem (32%), gastrointestinal problem (29%), infectious disease (11%), neurological (7%), and dental problem (6%). The majority of patients were discharge home 602/670 cases (90%), and 10% (68/670 cases) were admitted to inpatient ward. There were 552 patients (82%) who had prolonged OW more than 24 hours. Compared with the factors in both group, we found that the associated factor for prolonged OW stay was the age of patient, which seems to be younger in the prolonged stay group (median age of 4 years 3 months vs 3 years 5 months, p = 0.04). Younger children had significant factors for prolonged stay in OW (p < 0.001) compared to all age categorized less than 1 year, 1 - 5 years, 5 - 10 years, 10 - 15 years and more than 15 years respectively. <strong>Conclusion:</strong> This was the study for report of pediatric observation ward utilization. The younger patient was the associated factor for prolonged stay in OW. Understanding this related issue will be the starting points for assessing patients carefully before admitting to OW for improving efficiency and quality of care in pediatric OW.
