Yeter Düzenli Kar, İmran Sağlık, Gökalp Rüstem Aksoy
et al.
IntroductionRespiratory tract infections (RTI) are a leading cause of hospitalization in children and remain a significant contributor to morbidity. Our study aimed to examine the epidemiology of RTI in children with hemato-oncologic disease during and after the coronavirus 2019 (COVID-19) pandemic.MethodsThis retrospective study evaluated nasopharyngeal swab samples that were tested using multiplex PCR from 185 children hospitalized with respiratory symptoms between January 2020 and March 2025.ResultsA total of 313 RTI agents were identified in 185 children with hemato-oncologic disorders across 271 infectious episodes. The median age was 6 years. The infection rates for upper respiratory tract infections (URTI) and lower respiratory tract infections (LRTI) were 45% and 55%, respectively. A statistically significant difference was found between patients with URTI and LRTI in terms of CRP, tachypnea, dyspnea, duration of fever, duration of hospital stay due to infection, need for intensive care unit, and oxygen requirements (p < 0.05). The most common pathogens causing RTI were rhinovirus/enterovirus and influenza A/B, and their frequencies increased significantly in the post-pandemic period. Co-infections were significantly more common in the LRTI group during the post-pandemic period. Nine out of 185 children (5%) died.ConclusionChildren with hematologic-oncologic disease are at risk for RTI. The most common agent was found to be rhinovirus/enterovirus. RTI outbreaks were observed especially as a result of the reductions in non-pharmacological measures implemented during the pandemic. In our study, the largest RTI outbreak was seen between November 2023 and May 2024 following the end of the COVID-19 pandemic.
Introduction
The aim was to present effective approaches utilizing novel hematological parameters for early diagnosis of juvenile-onset systemic lupus erythematosus (jSLE).
Material and methods
Our study at Ümraniye Training and Research Hospital involved a jSLE patient cohort from 2016 to 2022 and matched healthy controls aligning with sex and age. We use the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) for disease activity. Our approach was to analyze leukocyte, neutrophil, lymphocyte, monocyte, and platelet counts, along with ratios such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and monocyte-to-platelet ratio (MPR). We also explored novel indices: the systemic inflammatory index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI) to identify relationships between systemic indices and jSLE activity.
Results
Upon comparative analysis with the healthy control group, systemic lupus erythematosus (SLE) patients exhibited significantly elevated levels of the hematological parameters NLR, SII, and SIRI ( p -values: 0.010, 0.048, 0.025, respectively). Among SLE patients, neutrophil, lymphocyte, and platelet distribution width (PDW) values were notably higher, while hemoglobin, red blood cell distribution width (RDW), and procalcitonin (PCT) values were significantly lower. In comparison, C-reactive protein (CRP) and sedimentation values were markedly elevated in the SLE group in contrast to the healthy control cohort. Patients with significantly elevated disease activity had notably higher values of NLR ( p = 0.010) and SII ( p = 0.048). Among patients with positive anti-nuclear antibodies (ANA), elevated levels of NLR, SII, and SIRI were noted ( p -values: 0.018, 0.021, 0.035).
Conclusions
In this study, the novel hematological markers SII, SIRI, and AISI were found to effectively reflect inflammation in SLE patients, exhibit associations with high disease activity, and demonstrate heightened sensitivity in detecting cases with high disease activity.
Beatrice Valeriani, Jacopo Pruccoli, Francesca Chiavarino
et al.
Background: Atypical Anorexia Nervosa (AAN) is a Feeding and Eating Disorder characterized by fear of gaining weight and body image disturbance, in the absence of significantly low body weight. AAN may present specific clinical and psychopathological features. Nonetheless, the literature lacks data concerning the nutritional characteristics and body composition of children and adolescents with AAN and their variation over time. Methods: Case series, including 17 children and adolescents with AAN. All the patients were assessed at the first evaluation (T0) with a standardized dietary assessment (24 h Dietary Recall, 24 hDR). Nutritional data were compared with European dietary reference values (DRVs). Body composition parameters (weight, fat mass, fat-free mass) and their changes over time at two (T1) and six (T2) months were collected as well, using a Bioelectrical impedance analysis (Wunder WBA300 with four poles and foot contact; impedance frequency 50 kHz 500 μA; impedance measurement range 200~1000 Ω/0.1 Ω). Results: The included individuals presented eating behaviors oriented towards significantly low daily energy intake (<i>p</i> < 0.001) compared with DRVs set by the European Food Safety Authority (EFSA) (with low carbohydrates and fats), and increased proteins (<i>p</i> < 0.001). A longer latency before observation (illness duration before observation) correlated with a negative change in weight. Body composition parameters were described, with no significant changes across the six-month outpatient assessment. Discussion: This is the first research to systematically assess the body composition and nutritional features of a group of individuals with AAN in the developmental age. Further research should assess the effect of targeted treatment interventions on body composition and nutritional features.
BackgroundLow birth weight is a key determinant of child survival, significantly influencing rates of infant and childhood mortality, morbidity, and disability. While some studies have been conducted in our region, there is still a gap in evidence regarding the maternal characteristics associated with low birth weight. Hence, this study aimed to determine the proportion of newborns with low birth weight and determinant factors, particularly focusing on maternal characteristics.MethodA facility-based cross-sectional study was conducted from 21 March to 20 April 2020 involving mothers and their newborns at selected public health facilities in Mekelle City. The sample included 447 participants, with two public hospitals and three health centers chosen by a lottery method. Systematic random sampling was applied to select mother–newborn pairs. Data were collected using a structured, interviewer-administered questionnaire and analyzed using the Statistical Package for Social Sciences version 21. Bivariate and multivariate logistic regression analyses, with a 95% confidence interval (CI), were used to identify factors associated with low birth weight.ResultsThe study included 447 mothers of newborns, achieving a 100% response rate. The proportion of low birth weight was 14.3%. Significant factors associated with low birth weight included attending the first antenatal care (ANC) visit in the third trimester [adjusted odds ratio (AOR) = 3.66, 95% CI: 1.28–10.44], not receiving additional nutrition during pregnancy (AOR = 4.16, 95% CI: 1.38–12.58), experiencing obstetric complications during the current pregnancy (AOR = 7.72, 95% CI: 2.76–21.59), and a gestational age at birth of less than 37 weeks (AOR = 5.36, 95% CI: 1.96–14.67).Conclusion and recommendationThis study revealed a substantial incidence of low birth weight. The initiation of the first antenatal care visit in the third trimester, failure to supplement nutrition during pregnancy, the occurrence of obstetric complications during pregnancy, and a gestational age at birth less than 37 weeks were all found to be significantly correlated with this condition. It is recommended that policymakers strengthen maternal and child health services, especially through the focused ANC program, to improve outcomes. Health facilities should promote awareness of the importance of initiating ANC visits early, with an emphasis on nutritional counseling throughout pregnancy.
AbstractObjective To evaluate the clinical outcomes of using the extra-uterine placental transfusion (EPT) approach in very preterm infants (VPIs, gestational age <32 weeks) and compare this to delayed cord clamping (DCC) after birth.Methods In this matched pairs study, we compared the clinical outcomes of the EPT group to those of the DCC group. EPT were performed in fifty-three VPIs, of whom 27 were singletons and 25 were twins. The singleton VPIs were matched for gestational age (±5 days) and delivery mode, and the twin VPIs were matched between each other with the first twin subjected to DCC and the second twin to EPT. Data on the infants were collected and analysed as an overall group. A twin subgroup consisting of DCC and EPT groups was also analysed separately. The primary study outcome was either death or major morbidities.Results In total, 100 infants were included (n = 50 EPT group, n = 50 DCC group). The gestational ages of the DCC and EPT groups were (29.16 ± 1.76) and (29.12 ± 1.84) weeks, respectively. There were no differences in either deaths or major morbidities and other clinical outcomes, including the resuscitation variables, haemoglobin levels and red blood cell transfusion, between the two groups. In twin subgroups (gestational age 29.05 ± 1.89 weeks), EPT was associated with a higher rate of necrotizing enterocolitis (NEC) when compared with DCC (odds ratio = 7 (95% CI, 1.06 to 56.89), p = 0.031).Conclusions In twin subgroups, the incidence of NEC was higher in the EPT group when compared to the DCC group and therefore based on an abundance of caution the use of EPT in very preterm twins is not recommended.
Abstract Background To examine whether the levels of aggressive behaviors and other individual and contextual variables differ between left-behind adolescents (LBA) and not left-behind adolescents (NLBA) and explore associations between aggression and other constructs among them. Methods A cross-sectional study was conducted and 4530 school adolescents aged 9–18 years in north and south of China were randomly selected. The levels of aggressive behavior, personality and family and classroom environment were compared between LBA and NLBA and also the associated factors of aggression. Results The total scores of aggressive behaviors were 6.33 ± 6.35 (Mean ± SD) in LBA and 5.78 ± 6.16 (Mean ± SD) in NLBA. Multiple linear regression models revealed that neuroticism and psychoticism were positively associated with aggressive behaviors for LBA with similar results of NLBA. Cohesion was negatively associated with aggressive behaviors, and conflict and achievement had positive effects in NLBA. Organization had a negative effect in LBA. Uncertainty and dissatisfaction had positive effects on aggression both in LBA and NLBA. Conclusion This study found a slightly higher level of aggressive behaviors in LBA comparing with NLBA. Personality was the mainly associated factor of aggression, but class-based interventions were more practical for aggressive behaviors in Chinese LBA.
Graham Chamberlain, Ronish Gupta, Anna-Theresa Lobos
In-hospital pediatric cardiopulmonary arrest is rare. With more than 50% of patients not surviving to discharge following cardiopulmonary arrest, it is important that health-care providers (HCPs) respond appropriately to deteriorating patients. Our study evaluated the performance of basic life support skills using non-acute HCPs during pediatric inpatient resuscitation events. We conducted a retrospective chart review of all code blue team (CBT) activations in non-acute care areas of a tertiary care children’s hospital from 2008 to 2017. The main outcomes were frequency of life support algorithmic assessments and interventions (critical actions) performed by non-acute HCPs prior to the arrival of CBT. CBT activation and outcome data were summarized descriptively. Logistic regression was used to assess for an association of outcomes with the presence of established leadership. A total of 60 CBT activations were retrieved, 48 of which had data available on isolated non-acute HCP performance. Most children (93%) survived to discharge. Critical action performance review revealed that an airway, breathing and pulse assessment was documented to have occurred in 33%, 69% and 29% of cases, respectively. A full primary assessment was documented in 6% of cases. The presence of established leadership was associated with the performance of a partial ABC assessment. Our results suggest that resuscitation performance of pediatric inpatient non-acute HCPs often does not adhere to standard life support guidelines. These results highlight the need to reconsider the current approaches used for non-acute HCP resuscitation training.
SARS-CoV-2 vaccine breakthrough infections frequently occurred even before the emergence of Omicron variants. Yet, relatively little is known about the impact of vaccination on SARS-CoV-2-specific T cell and antibody response dynamics upon breakthrough infection. We have therefore studied the dynamics of CD4 and CD8 T cells targeting the vaccine-encoded Spike and the non-encoded Nucleocapsid antigens during breakthrough infections (BTI, n=24) and in unvaccinated control infections (non-BTI, n=30). Subjects with vaccine breakthrough infection had significantly higher CD4 and CD8 T cell responses targeting the vaccine-encoded Spike during the first and third/fourth week after PCR diagnosis compared to non-vaccinated controls, respectively. In contrast, CD4 T cells targeting the non-vaccine encoded Nucleocapsid antigen were of significantly lower magnitude in BTI as compared to non-BTI. Hence, previous vaccination was linked to enhanced T cell responses targeting the vaccine-encoded Spike antigen, while responses against the non-vaccine encoded Nucleocapsid antigen were significantly attenuated.
Background: This study investigates the effect of chronic kidney disease (CKD) stage on fatigue and health-related quality of life (HRQoL) in the pediatric population. Material and Methods: The PedsQL (Pediatric Quality of Life Inventory) Multidimensional Fatigue Scale (subcategories: general, sleep/rest, and cognitive fatigue) and HRQoL Generic Core Scales (subcategories: physical, emotional, social, and school functioning) questionnaires were completed by 30 patients aged from 7 to 18 years old with CKD stage 2–4, CKD stage 5 on dialysis (CKD 5D), and kidney transplantation (KTx), as well as their parents. Results: Both low “Total Fatigue” and “Total HRQoL” scores were reported in 16.7% of patients. “Sleep/Rest Fatigue”, “Emotional Functioning”, and “School functioning” were the lowest scored subcategories. CKD 5D/KTx patients presented lower “Sleep/Rest Fatigue” (<i>p</i> = 0.022) and, more frequently, low “School Functioning” scores (<i>p</i> = 0.029). The “Total HRQoL” score was correlated to the “Total Fatigue” score (rs = 0.625, <i>p</i> < 0.001). A low “Sleep/Rest Fatigue” score was associated with low “Physical Functioning”, “School Functioning”, and “Total HRQoL” scores (<i>p</i> = 0.016, <i>p</i> = 0.001, and <i>p</i> = 0.047 respectively). Parents’ HRQoL score was lower than patients’ score on “Physical Functioning” (<i>p</i> = 0.040) and “School Functioning” subcategories (<i>p</i> = 0.045). Conclusions: Fatigue and disturbed HRQoL are mostly observed in CKD 5D and KTx pediatric patients, and are associated with sleep disorders and school dysfunction. Fatigue affects HRQoL, which is perceived as more deteriorated by the patients’ parents.
Resumen: Introducción y objetivos: México posee instituciones públicas y privadas para atender a 120 millones de habitantes. Nuestro hospital pediátrico es una institución pública del Instituto Mexicano del Seguro Social. Presentamos nuestra experiencia en el tratamiento quirúrgico de cardiopatía congénita en el periodo neonatal. Métodos: Se analizó la base de datos del servicio, incluyendo a pacientes con menos de 30 días de vida, con cardiopatía congénita, que fueron intervenidos de cirugía cardiaca de septiembre de 2015 a septiembre de 2020. Resultados: Se incluyeron un total de 350 casos (171 masculinos, 179 femeninos), 111 pretérminos (31,7%). El cierre quirúrgico del ductus arterioso fue el procedimiento más frecuente, con 138 casos (39,4%), seguido de fístula sistémico-pulmonar Blalock-Taussig modificada en 92 casos (26,3%). Las operaciones cerradas o sin apoyo de circulación extracorpórea representaron el 68,6% del total. También realizamos cirugía de Jatene (n = 38), corrección de conexión anómala de venas pulmonares (n = 37), corrección de tronco arterioso, coartectomía y cirugía de Norwood. El riesgo quirúrgico RACHS-1 fue: I en 139 casos (39,7%) y ≥ III en 211 casos (60%). La mortalidad hospitalaria fue del 20% (70 defunciones) y la causa principal de muerte fue el shock cardiogénico (92%). El tiempo medio de estancia postoperatoria en cuidados intensivos neonatales fue de 20 ± 11 días. Conclusiones: Nuestro departamento de cardiocirugía pediátrica dispone de experiencia en el tratamiento de cardiopatías congénitas del neonato. El análisis de nuestros resultados nos permite identificar áreas de mejora en el manejo de estos pacientes tan complejos. Abstract: Introduction and objectives: Mexico has public and private institutions to provide healthcare to 120 million of habitants. Our pediatrics hospital is a public institution of the Mexican Social Security Institute. We report our experience in the surgical treatment of congenital heart disease during the neonatal period. Methods: From our service database, we included patients < 30 days of life with congenital heart disease, receiving heart surgery during the period from September 2015 to September 2020. Results: A total of 350 cases were included (171 male and 179 female), 111 were preterm babies (31.7%). Surgical closure of the persistent arterious duct was the most common procedure in 138 cases (39.4%), followed by modified Blalock-Taussig systemic pulmonary shunt in 92 cases (26.3%). Closed cardiac surgery (without extracorporeal circulation support) accounted for 68.6% of our surgeries. Other surgical techniques performed were arterial switch operation (N = 38), anomalous pulmonary veins connection repair (N = 37), truncus correction, coarctectomy, and Norwood palliation. Score surgical risk RACHS-1 were: I with 139 cases (39.7%), and ≥ III with 211 cases (60%). Inhospital mortality was 20% with 70 deaths, mainly related to cardiogenic shock (92%). Mean postoperative hospital stay in neonatal intensive care area was 20 ± 11 days. Conclusions: Our department of pediatric heart surgery has experience in the treatment of neonates with congenital heart disease. Our data analysis let us to identify some areas of improvement in this complex neonatal management.
Surviving sepsis campaign (SSC) mengeluarkan pedoman tata laksana klinis pasien sepsis. Pedoman tata laksana ini dibuat atas dasar ilmu kedokteran berbasis bukti berdasarkan data pasien sepsis dewasa. Dalam panduannya, terdapat target-target tata laksana yang perlu dicapai dalam batas waktu tertentu, termasuk target hemodinamik sebagai panduan resusitasi, seperti jumlah cairan resusitasi, rerata tekanan arteri, dan tekanan vena sentral. Makalah ini bertujuan untuk mengupas permasalahan dari adaptasi target SSC, khususnya pada pasien anak di Indonesia.
Background. Maternal satisfaction is considered one of the most frequently used indicators to measure the quality and efficiency of childhood immunization service. Evaluating maternal satisfaction towards childhood immunization service is very relevant as it likely affects the clinical and revisit adherence, service quality, and its coverage. In countries like Ethiopia, where childhood immunization coverage is below average (39%) with low maternal satisfaction on the service, identifying factors associated with maternal satisfaction is very critical. Despite the acknowledgement made on the importance of maternal satisfaction for the successful provision of child immunization services, there is limited knowledge in Ethiopia on its contributing factors. Objective. The aim of this study was to assess maternal satisfaction towards childhood immunization service and its associated factors among mothers’ having children aged less than 1 year in Wadla district, North Wollo, Ethiopia, 2019. Methods. A community-based cross-sectional study was conducted among 682 mothers from March to April 2019 in Wadla district, North Wollo, Ethiopia. A two-stage cluster sampling technique was used to select households of the study participants. A pretested interviewer-administered structured questionnaire was used. During the period of data collection, every questionnaire was cross-checked and the collected data were checked for completeness and consistency on a daily basis. Then, the cleaned data was coded and entered in to Epi Info software version 7.2.2.2 and exported to SPSS software version 23.0 for analysis. Bivariable and multivariable logistic regression analysies were done to identify variables having a significant association with maternal satisfaction. Variables with a p value of ≤ 0.05 and adjusted odds ratio with 95% CI were considered having a statistically significant association during multivariable logistic regression analysis. Then, the findings were presented using tables, graphs, and charts. Result. The overall proportion of maternal satisfaction towards childhood immunization service was found to be 68.2% [95%CI=64.7%−71.7%]. The finding revealed that attending secondary education [adjusted odds ratio AOR=0.26; 95%CI=0.13−0.53], being divorced [AOR=0.46; 95%CI=0.23−0.91], and having favorable attitude towards child immunization [AOR=1.58; 95%CI=1.05–2.33] were found to be significantly associated with maternal satisfaction. Furthermore, the multivariable logistic regression analysis showed that short waiting time before receiving service [AOR=1.83; 95%CI=1.21−2.79], greeting from care providers, [AOR=5.69; 95%CI=3.36−9.65], having information about the current vaccine [AOR=2.03; 95%CI=1.25−3.32], dose of vaccine [AOR=2.24; 95%CI=1.40−3.58], and next immunization schedule [AOR=3.21; 95%CI=1.70−6.04] were also significantly associated with maternal satisfaction towards childhood immunization services. Conclusion and Recommendation. Generally, the study showed that more than two-thirds of the mothers were satisfied by the immunization service rendered. The level of satisfaction was higher with respect to the health workers’ relationship, communication, and immunization system aspects. However, more efforts need to be put towards improving the service waiting time for immunization, and provision of health information and communication is also recommended to enhance the level of favorable attitude among mothers towards childhood immunization services.
Kevin J. Goodwin, Jule Muegge, Daniel A. Saltzman
et al.
We report the case of a 16-year-old who presented after intentional ingestion of elemental iron (approximately 48 mg/kg). Iron levels at presentation were 4388 mcg/dl. The patient demonstrated symptoms of severe toxicity including hypotension, metabolic acidosis, and multiple organ failure. Fourteen days after ingestion, the patient suffered multiple punctate bowel perforations that were not related to ischemia and appeared to have been the result of local tissue injury from ingested iron. The bowel was successfully primarily repaired. However, the patient eventually succumbed due to the severity of multisystem organ failure and a systemic fungal infection. We report this case to highlight the risk of local tissue trauma from ingested iron, resulting in bowel perforation. This case highlights the need to eliminate ingested iron to limit systemic absorption and to prevent local tissue trauma and bowel perforation. Keywords: Iron poisoning, Bowel perforation
Abstract Background Kawasaki disease is a common childhood vasculitis which may result in cardiovascular morbidity if not adequately treated. Its epidemiology in the African region is not well described. Its features may mimic other childhood infections and hemoglobinopathies and it is rarely diagnosed in the East African region. These are the first reports of this disease from Tanzania. Case presentation We present two cases of complete Kawasaki disease seen over a 2 year period and diagnosed as per the criteria defined by the American Heart Association. One child was and infant and the other a 3 year old. Both of them presented with a prolonged fever and mucocutaneous findings. None of the children developed coronary artery aneurysms. One was treated with aspirin alone and the other with both aspirin and intravenous immunoglobulin. Both children had complete recovery and did not have any cardiovascular sequelae. Conclusion Kawasaki disease may be more common in the East African region than previously thought. It should be considered as a differential diagnosis in children who present with a prolonged fever of greater than 5 days and mucocutaneous findings. More awareness about this condition, its epidemiology, diagnosis and management are required in order to prevent the cardiovascular morbidity associated with it.
Maria José Menal, Ignasi Jorba, Ignasi Jorba
et al.
BackgroundEvidence from patients and animal models suggests that obstructive sleep apnea (OSA) may increase the risk of Alzheimer’s disease (AD) and that AD is associated with reduced brain tissue stiffness.AimTo investigate whether intermittent hypoxia (IH) alters brain cortex tissue stiffness in AD mutant mice exposed to IH mimicking OSA.MethodsSix-eight month old (B6C3-Tg(APPswe,PSEN1dE9)85Dbo/J) AD mutant mice and wild-type (WT) littermates were subjected to IH (21% O2 40 s to 5% O2 20 s; 6 h/day) or normoxia for 8 weeks. After euthanasia, the stiffness (E) of 200-μm brain cortex slices was measured by atomic force microscopy.ResultsTwo-way ANOVA indicated significant cortical softening and weight increase in AD mice compared to WT littermates, but no significant effects of IH on cortical stiffness and weight were detected. In addition, reduced myelin was apparent in AD (vs. WT), but no significant differences emerged in the cortex extracellular matrix components laminin and glycosaminoglycans when comparing baseline AD and WT mice.ConclusionAD mutant mice exhibit reduced brain tissue stiffness following both normoxia and IH mimicking sleep apnea, and such differences are commensurate with increased edema and demyelination in AD.
Central precocious puberty (CPP) is caused by premature activation of the hypothalamic-gonadal axis, and must be treated adequately. In particular, CPP that occurs at a relatively young age or in boys is likely to be caused by an organic lesion. Hypothalamic hamartoma (HH) is the most common organic cause of CPP. The present case report describes an 11-month-old female infant who presented with vaginal bleeding and rapidly progressive secondary sex characteristics from the age of 6 months. She was diagnosed with CPP following the detection of HH via magnetic resonance imaging. The infant girl was successfully treated with gonadotropin-releasing hormone agonist. After 6 months, her breast had regressed and clinical and radiological follow-up demonstrated stable findings with no evidence of tumor growth or secondary sexual characteristics until the fourth year after the initiation of treatment. This patient is the one of the youngest infants presenting with CPP and HH in Korea; treatment was successful over a relatively long follow-up period.