Hasil untuk "Pediatrics"

Wei Y, Wang Y, Cao P et al.

Yuxuan Wei,1,2,* Yongli Wang,3,* Peichun Cao,4,* Yuanyuan Gong,1 Jingjing Gong,1 Li Yang,1 Jin Chen,5 Jingli Wang,4 Xiaodan Li1 1Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, People’s Republic of China; 2School of Nursing, Hebei University, Baoding, People’s Republic of China; 3Department of Pediatrics, Peking University People’s Hospital, Beijing, People’s Republic of China; 4Department of Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing, People’s Republic of China; 5Department of Breast Center, Peking University People’s Hospital, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiaodan Li, Email lixiaodan@pkuph.edu.cnObjective: To examine the mediating role of medical coping in the relationship between social support and illness uncertainty among patients with malignant tumors, and to explore differences across age groups.Methods: A secondary analysis was conducted using cross-sectional data from 905 hospitalized patients. Patient-reported outcomes were measured using the Mishel Uncertainty in Illness Scale–Adult, the Social Support Rating Scale, and the Medical Coping Modes Questionnaire. Pearson correlation analyses were conducted using SPSS version 25.0, and mediation effects were tested using the PROCESS macro with bootstrap resampling.Results: In the overall sample, medical coping partially mediated the relationship between social support and illness uncertainty (indirect effect: β = 0.177, SE = 0.061, bootstrap 95% CI [0.067, 0.306]). Age-stratified analyses showed a full mediation effect in younger patients (β = 1.362, SE = 0.218, 95% CI [0.875, 1.737]). In contrast, the mediation effects were weaker in middle-aged and older patients, accounting for only 2.96% and 17.65% of the total effect, respectively. These findings indicate that the mediating role of medical coping varies across age groups, with distinct patterns observed among younger, middle-aged, and older patients.Conclusion: In this cross-sectional sample, the results were statistically consistent with an indirect association between social support and illness uncertainty via medical coping, with age-related differences. Younger patients showed a stronger indirect association via coping, whereas middle-aged and older patients showed relatively stronger direct associations between social support and illness uncertainty.Keywords: neoplasms, uncertainty in illness, social support, adaptation, psychological, nursing care

A. Hersh, Daniel J. Shapiro, A. Pavia et al.

Ting-Rong Hsu, Pei-Hao Chen, Wei-Sheng Lin

Epilepsy is one of the most common neurological disorders in both children and adults, characterized by significant clinical heterogeneity and dynamic natural course. The pathophysiological roles of astrocytes in epilepsy have been increasingly recognized. Fluid biomarkers derived from astrocytes are actively studied in epileptic disorders, although their use remains limited in clinical practice. This review aims to compile and analyze clinical and experimental findings concerning astrocytic biomarkers in epilepsy and related conditions, with a focus on glial fibrillary acidic protein (GFAP) and S100 calcium-binding protein B (S100B). Herein we examine their roles in assessing seizure burden and temporal dynamics, explore their potential in distinguishing epileptic from psychogenic non-epileptic seizures, and discuss their therapeutic, prognostic, and mechanistic implications in the context of epileptic disorders.

Dewi Novitasari Arifin, Pramana Adhityo, Nabila Ardia Pramono et al.

Abstract Background Intussusception is a common cause of intestinal obstruction in pediatric patients. Early recognition and treatment are essential to prevent potentially fatal complications. Identifying the risk of failure of hydrostatic reduction as non-operative management in children with intussusception would provide significant clinical advantages. It would allow prompt identification of the need for early surgical intervention and potentially prevent complications that can arise from prolonged intestinal strangulation. To address this issue, our study proposed a scoring system that evaluates the likelihood of hydrostatic reduction failure in pediatric intussusception cases. Methods The medical records of 61 children with intussusception who underwent hydrostatic reduction were analyzed retrospectively to determine a scoring system using the following variables: age, weight, vomiting, duration of symptoms, currant jelly stool, abdominal distention, mass location, and pseudoportio sign. Results Among the 61 eligible patients, hydrostatic reduction was successful in 23 (37.7%) and failed in 38 (62.3%). There was a significant association between the failure of hydrostatic reduction with age ≤12 months (p=0.002), body weight ≤10 kg (p=0.001), vomiting (p=0.0006), duration of symptoms >48 hours (p=0.003), abdominal distension (p=0.001), location of mass (p=0.00004), currant jelly stool (p=0.00005), and pseudoportio sign (p=0.001). Multivariate analysis showed that the onset of symptoms >48 hours (p=0.014; OR=17.34 [95% CI=1.76-170.45]), left-sided mass (p=0.003; OR=17.74 [95% CI=2.66-118.17]), and currant jelly stool (p=0.029; OR=9.05 [95% CI=1.26-65.03]) were strongly associated with failure of hydrostatic reduction. Prediction scores ranged from 0 to 3. A score of ≥2 predicted a higher possibility of reduction failure, while a score of <2 predicted a lower possibility of reduction failure (p<0.000). Conclusion The scoring system might serve as a valuable prognostic tool for pediatric surgeons in evaluating the risk of hydrostatic reduction failure in children with intussusception. Our findings indicate that three critical indicators—the duration of symptoms exceeding 48 hours, the presence of currant jelly stool, and a left-sided mass of the abdomen—are associated with the failure of hydrostatic reduction. This scoring system may facilitate patients' decision-making and guide the need for early surgical intervention.

Haya Hayek, Justin Z. Amarin, Olla Hamdan et al.

ABSTRACT Inappropriate antibiotic use drives antimicrobial resistance, a global health threat causing increased morbidity and mortality. Understanding antibiotic practices in low-resource settings is essential to identify intervention targets. This study investigates antibiotic prescription practices in Amman, Jordan. We conducted three prospective viral surveillance studies at the largest public hospital in Amman, Jordan (2010–2013, 2020, and 2023) and included children <2 years old hospitalized with fever or respiratory symptoms. The data collected included antibiotic use and the results of blood, urine, and cerebrospinal fluid (CSF) cultures performed. We classified antibiotics according to the 2023 WHO AWaRe system. Nasal or throat samples were tested in a research laboratory for respiratory viruses using RT-PCR. The median age of the 4,724 children included was 3.5 months (IQR, 1.6–8.4). A clinical blood, urine, or CSF sample was collected from 2,565/4,712 children (54.4%), 356 (13.9%) of whom tested positive. During hospitalization, 4,375 children (92.6%) received at least one antibiotic, and 4,245 (97.0%) received at least one antibiotic from the Watch group. One or more respiratory viruses were detected in 3,911 children (82.8%). Providers ordered cultures most often for children 0–2 months old (n = 1,579 [73.5%]) and those with an admission diagnosis of rule-out sepsis (n = 1,164 [95.4%]). Antibiotic use and testing practices were consistent across study years, age groups, and admission diagnoses. In conclusion, widespread antibiotic use despite the preponderance of viral infections highlights a significant discrepancy in aligning treatment practices with disease etiology. Strengthening diagnostic and preventive capabilities in low-resource settings is crucial to combat antimicrobial resistance.IMPORTANCEIn this study of 4,724 children under 2 years old hospitalized in the largest public hospital in Jordan between 2010 and 2023, 92.6% received antibiotics despite 82.8% testing positive for respiratory viruses and only 13.9% of collected cultures suggesting bacterial infection. Despite the predominance of viral infections, the widespread use of antibiotics, particularly from the World Health Organization Watch group, highlights the need for improved antibiotic stewardship and diagnostic capabilities in Jordan.

April A. Edwell

Elif Sinem Yazıcı, Arzu Okur, Özge Vural et al.

Objective: The aim of this study was to evaluate the sociodemographic properties, clinical, laboratory, and radiological findings, and diagnosis of patients with head and neck lymphadenopathy (LAP) who applied to the Department of Pediatric Oncology of Medical Faculty of Gazi University. Material and Methods: Cases who applied to the Gazi University Faculty of Medicine, Department of Pediatric Oncology between January 2009 and December 2019 due to head and neck LAP were evaluated. The sociodemographic properties and clinical, laboratory, and radiologic findings of the patients were retrospectively assessed by scanning their records. Results: Seven hundred patients with head and neck LAP between the ages of 0-18 were included in this study. Four hundred seventy nine (68.4%) of the cases were males and 221 (316%) were females. The mean age of the patients was 7.08±4.25 years. Localized LAP was present in 509 (72.7%) cases and generalized LAP were present 191 (27.3%) cases. Of 700 cases, benign causes were detected in 581 (83.1%) cases, malignant causes were detected in 54 (7.7%) cases, and LAP-like masses were detected in 65 (9.2%) cases. Lymph node diameter over 3 cm, accompanying fever and weight loss, supraclavicular region involvement, fixed, firm, and rubbery lymph nodes, leukocytosis, elevation of C-reactive protein, erythrocyte sedimentation rate, and uric acid levels, accompanying hepatomegaly, weakness, itching, and hearing loss were significant malignancies. The most frequent cause in the benign group was upper respiratory tract infections. The most frequent cause in the malignant group was Hodgkin’s lymphoma. Biopsy was performed from 125 of the cases for diagnosis. Malign causes were detected in 54 (43.2%) patients and benign causes were detected in the remaining 71 (56.8%). Conclusion: Head and neck LAP is a frequently encountered finding in childhood. Benign causes are the more frequently detected causes in its etiology. However, malignant causes are detected less frequently; therefore, early diagnosis is important in the prognosis of the patient.

LIANG Xueyao, GE Qianyi, WANG Weibing et al.

ObjectiveTo investigate the etiology and epidemiological characteristics of pneumonia in children of different ages, to better characterize the co-infection patterns of pneumonia and their association with severe diseases.MethodsChildren aged 28 days to 13 years with pneumonia who were hospitalized in the Department of Pediatrics, Dongyang People's Hospital, Zhejiang Province from April 1 to December 28, 2023 were selected as the research subjects. Oropharynx swabs were collected from the patients within 24 hours of hospital admission, and PCR tests were conducted for 18 respiratory pathogens. Binary multivariate logistic regression analysis was used to analyze the status of viral and bacterial infection, patterns of co-infection in patients with different ages, and the risk factors for the outcome of severe pneumonia.ResultsA total of 2 191 hospitalized children with pneumonia were enrolled in the study. Severe cases were more common in children aged 5 years and older (53.3%) and in the second quarter of the year (46.5%). An average of (1.31±0.90) pathogens were detected in severe cases. Mycoplasma pneumoniae (44.4%, 973 cases) had the highest detection rate of pathogens. Streptococcus pneumoniae (21.7%, 476 cases) and rhinovirus (10.1%, 222 cases) were the most common bacteria and viruses, respectively, in hospitalized children with pneumonia in Dongyang City. Multivariate logistic regression analysis indicated positive interactions between different viral and bacterial pathogens. The adjusted OR (aOR) values for different respiratory pathogens in children with severe pneumonia varied significantly (all P<0.04). Among them, Chlamydia pneumoniae (aOR=9.74, 95%CI=2.36‒49.32, P<0.01), Mycoplasma pneumoniae (aOR=2.62, 95%CI=2.04‒3.37, P<0.01), and RSV (aOR=1.69, 95%CI=1.12‒2.54, P<0.01) were the risk factors for severe pneumonia.ConclusionIn the pathogen spectrum of children with pneumonia in Dongyang City, Zhejiang Province from April to December 2023, most viruses and bacteria exhibited positive interactions. Chlamydia pneumoniae, Mycoplasma pneumoniae, and RSV maybe the significant risk factors for severe pneumonia.

Sezin Naiboğlu, Selami Ulaş, Işılay Turan et al.

Светлана Ивановна Елгина, Светлана Витальевна Кабанова, Ольга Александровна Ситникова et al.

Pregravidar preparation includes a complex of studies carried out without fail during pregnancy planning. According to the WHO bulletin «Policy of pre-conception training», pre-pregnancy counseling should be carried out for all women of reproductive age at any planned and unscheduled visit to an obstetrician-gynecologist, if the patient does not use reliable contraception, or is not against pregnancy (will not interrupt it). Unfortunately, awareness of the pre-gravidar training of medical university students is insufficient. The solution to this problem can be the active promotion of the need for family planning at the level of educational institutions, women's consultations, gynecological departments.

Lisa Göschl, Daniel Mrak, Katharina Grabmeier-Pfistershammer et al.

BackgroundPatients with inborn errors of immunity (IEI) are at increased risk for severe courses of SARS-CoV-2 infection. COVID-19 vaccination provides effective protection in healthy individuals. However, it remains unclear whether vaccination is efficient and safe in patients with constitutional dysfunctions of the immune system. Thus, we analyzed the humoral response, adverse reactions and assessed the disease activity of the underlying disease after COVID-19 vaccination in a cohort of patients suffering from IEIs or mannan-binding lectin deficiency (MBLdef).MethodsVaccination response was assessed after basic immunization using the Elecsys anti-SARS-CoV-2 S immunoassay and via Vero E6 cell based assay to detect neutralization capabilities. Phenotyping of lymphocytes was performed by flow cytometry. Patient charts were reviewed for disease activity, autoimmune phenomena as well as immunization status and reactogenicity of the vaccination. Activity of the underlying disease was assessed using a patient global numeric rating scale (NRS).ResultsOur cohort included 11 individuals with common variable immunodeficiency (CVID), one patient with warts hypogammaglobulinemia immunodeficiency myelokathexis (WHIM) syndrome, two patients with X-linked agammaglobulinemia (XLA), one patient with Muckle Wells syndrome, two patients with cryopyrin-associated periodic syndrome, one patient with Interferon-gamma (IFN-gamma) receptor defect, one patient with selective deficiency in pneumococcal antibody response combined with a low MBL level and seven patients with severe MBL deficiency. COVID-19 vaccination was generally well tolerated with little to no triggering of autoimmune phenomena. 20 out of 26 patients developed an adequate humoral vaccine response. 9 out of 11 patients developed a T cell response comparable to healthy control subjects. Tested immunoglobulin replacement therapy (IgRT) preparations contained Anti-SARS-CoV-2 S antibodies implicating additional protection through IgRT.SummaryIn summary the data support the efficacy and safety of a COVID-19 vaccination in patients with IEIs/MBLdef. We recommend evaluation of the humoral immune response and testing for virus neutralization after vaccination in this cohort.

Ya Chai, José R. Chimelis-Santiago, Kristy A. Bixler et al.

Background: Sex-specific neurobiological underpinnings of impulsivity in youth with externalizing disorders have not been well studied. The only report of functional connectivity (FC) findings in this area demonstrated sex differences in fronto-subcortical connectivity in youth with attention-deficit/hyperactivity disorder (ADHD). Methods: The current study used functional magnetic resonance imaging (fMRI) to examine sex differences in resting-state seed-based FC, self-rated impulsivity, and their interactions in 11-12-year-old boys (n = 43) and girls (n = 43) with externalizing disorders. Generalized linear models controlling for pubertal development were used. Seeds were chosen in the ventral striatum, medial prefrontal cortex, middle frontal gyrus and amygdala. Results: Impulsivity scores were greater in boys than girls (p < 0.05). Boys showed greater positive connectivity within a ventromedial prefrontal-ventral striatal network. In addition, boys demonstrated weaker connectivity than girls within two medial–lateral prefrontal cortical networks. However, only boys showed greater medial–lateral prefrontal connectivity correlated with greater impulsivity. Conclusions: The findings provide evidence supporting sex differences in both ventral striatal-ventromedial prefrontal and medial–lateral prefrontal functional networks in youth with externalizing disorders. These important networks are thought to be implicated in impulse control. Medial-lateral prefrontal connectivity may represent a male-specific biomarker of impulsivity.

A. Hersh, M. Jackson, L. Hicks

Most upper respiratory tract infections are caused by viruses and require no antibiotics. This clinical report focuses on antibiotic prescribing strategies for bacterial upper respiratory tract infections, including acute otitis media, acute bacterial sinusitis, and streptococcal pharyngitis. The principles for judicious antibiotic prescribing that are outlined focus on applying stringent diagnostic criteria, weighing the benefits and harms of antibiotic therapy, and understanding situations when antibiotics may not be indicated. The principles can be used to amplify messages from recent clinical guidelines for local guideline development and for patient communication; they are broadly applicable to antibiotic prescribing in general.

Nidhi Mahajan, Arti Khatri, Parveen Kumar et al.

Introduction: Adipocytic tumors and its variants are common neoplasms of adults; however, they are rarely seen in paediatric age group, too.  Lipoblastoma typically occurs in children and are diagnosed by the presence of a multivacuolated lipoblast. However, things get complicated when one has to search for these lipoblasts in a background of classical lipoma. As a result, such cases are misdiagnosed and managed inappropriately. We report the first case of a congenital lipoma like lipoblastoma with an unusual presentation. Case Presentation: A 10-day-old male was admitted to the Paediatric Surgery Outpatient Department with a mass in his perianal region since birth. On examination, the mass was non-tender, pedunculated, and located at the margin of the anal opening. A provisional clinical diagnosis of anal tag was made, and swelling was excised. Grossly, we received a skin covered soft tissue mass measuring 1.2cm in diameter. The cut section was yellow and had a soft to firm consistency. Histopathological examination showed a well-delineated moderately cellular lesion comprising of lobules of adipocytes in varying stages of maturation; large number of mature adipocytes and few interspersed multivacuolated lipoblasts. A final diagnosis of lipoma-like lipoblastoma was made.  Conclusion: Lipoma-like lipoblastoma can be seen as a congenital mass and at unusual sites like the perianal region. An accurate diagnosis of this entity is essential for appropriate management. Histopathology is the gold standard for diagnosis and calls for increased awareness.

Odira C Ewuzie

Introduction: Pediatrics is a vast field with many facets. The importance of having dedicated specialists trained in the treatment and care of pediatric patients has long been recognized. It is necessary to determine if the profession of radiography is making similar progress in improving on the pediatric radiography services offered in the country. Objective: The objective of this study was to establish if there was a perceived need for specialized pediatric radiographic education in Nigeria. Subjects and Methods: This was a descriptive cross-sectional survey, which accessed radiographers′ take on the need for specialized education in pediatric imaging. A Google Form link was distributed through various Nigerian radiographers′ WhatsApp groups, inviting interested radiographers to participate in stating their opinions on the need for specialized pediatric radiographic education in the country and other related questions. Data were analyzed using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. Results were presented using tables and charts. Results: Seventy-six radiographers working in 25 states across the federation participated in the online survey. A total of 90.8% of the respondents stated there was a need for specialized radiographic education in pediatric imaging, and 64.5% felt that this education or training opportunities for radiographers was inadequate. Only 43.4% were comfortable performing pediatric imaging. Conclusion: Majority of the radiography departments in Nigeria do not have dedicated equipment or staff for pediatric radiography. Undergoing specialized pediatric imaging training will benefit radiographers who are keen on improving the radiography services offered to pediatric patients.

C. Milési, M. Boubal, A. Jacquot et al.

High-flow nasal cannula (HFNC) is a relatively new device for respiratory support. In pediatrics, HFNC use continues to increase as the system is easily set up and is well tolerated by patients. The use of nasal cannula adapted to the infant’s nares size to deliver heated and humidified gas at high flow rates has been associated with improvements in washout of nasopharyngeal dead space, lung mucociliary clearance, and oxygen delivery compared with other oxygen delivery systems. HFNC may also create positive pharyngeal pressure to reduce the work of breathing, which positions the device midway between classical oxygen delivery systems, like the high-concentration face mask and continuous positive airway pressure (CPAP) generators. Currently, most of the studies in the pediatric literature suggest the benefits of HFNC therapy only for moderately severe acute viral bronchiolitis. But, the experience with this device in neonatology and adult intensive care may broaden the pediatric indications to include weaning from invasive ventilation and acute asthma. As for any form of respiratory support, HFNC initiation in patients requires close monitoring, whether it be for pre- or inter-hospital transport or in the emergency department or the pediatric intensive care unit.

J. Epstein, K. Kelleher, Rebecca A. Baum et al.

BACKGROUND: Although many efforts have been made to improve the quality of care delivered to children with attention-deficit/hyperactivity disorder (ADHD) in community-based pediatric settings, little is known about typical ADHD care in these settings other than rates garnered through pediatrician self-report. METHODS: Rates of evidence-based ADHD care and sources of variability (practice-level, pediatrician-level, patient-level) were determined by chart reviews of a random sample of 1594 patient charts across 188 pediatricians at 50 different practices. In addition, the associations of Medicaid-status and practice setting (ie, urban, suburban, and rural) with the quality of ADHD care were examined. RESULTS: Parent- and teacher-rating scales were used during ADHD assessment with approximately half of patients. The use of Diagnostic and Statistical Manual of Mental Disorders criteria was documented in 70.4% of patients. The vast majority (93.4%) of patients with ADHD were receiving medication and only 13.0% were receiving psychosocial treatment. Parent- and teacher-ratings were rarely collected to monitor treatment response or side effects. Further, fewer than half (47.4%) of children prescribed medication had contact with their pediatrician within the first month of prescribing. Most variability in pediatrician-delivered ADHD care was accounted for at the patient level; however, pediatricians and practices also accounted for significant variability on specific ADHD care behaviors. CONCLUSIONS: There is great need to improve the quality of ADHD care received by children in community-based pediatric settings. Improvements will likely require systematic interventions at the practice and policy levels to promote change.