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Aplastic anemia, mental retardation, and dwarfism (AMeD) syndrome, also known as aldehyde degradation deficiency (ADD) syndrome, is an autosomal recessive disorder caused by mutations in the ALDH2 and ADH5 genes, leading to decreased activity of the aldehyde dehydrogenase 2 (ALDH2) and alcohol dehydrogenase 5 (ADH5) enzymes, subsequently triggering enhanced cellular levels of formaldehyde and diverse multisystem manifestations. Herein, we present the case of a 7-year-old girl with AMeD syndrome, characterized by pancytopenia, developmental delay, microcephaly, epilepsy, and myelodysplastic syndrome. Whole-exome sequencing revealed compound heterozygous variants (c.832G>C and c.678delA) in the ADH5 gene and a heterozygous pathogenic variant (c.1510G>A) in the ALDH2 gene. This case underscores the complexity of AMeD syndrome, emphasizing the importance of genetic testing to ensure diagnosis and aid in the development of potential targeted therapeutic approaches.

Esthesioneuroblastoma (ENB) is a slow growing malignant tumour of olfactory neuro-epithelium that is locally aggressive with a tendency to recur years later. Infrequently, it can be associated with paraneoplastic syndrome. Here, we a report a pediatric case of ENB in whom syndrome of inappropriate ADH secretion (SIADH) was detected during ongoing primary treatment which reflected disease progression after initial response to chemotherapy, that was substantiated radiologically. SIADH has been reported in only a few cases of ENB.

Background: Primary malignancies of the thyroid gland are less frequent in the first two decades of life and accounts for only 0.5-3% of all malignant neoplasms in children and adolescents.Methods: A retrospective analysis was undertaken on children less than 18 years of age who were diagnosed with thyroid malignancy from 1st June 2018 to 31st May 2022. The electronic health records were reviewed to determine patient demographics, pathological characteristics, interventions (surgery and radioactive iodine therapy [RAI]) and follow up.Results: Eighteen patients were less than 18 years of age at the time of diagnosis. Mean age at diagnosis was 14.7 years (6-18 years). Majority were females and in post pubertal age group. Among our cohort 83.4% had stage 1 disease, whereas 16.6% had stage II disease. Lung involvement was noted in 16.6%. Risk stratification revealed that 44.6% of the children were in the high-risk group and 38.8% in the intermediate- risk group. Fifteen patients (83.3%) underwent I-131 therapy. Follow up period ranged from 2-51.7 months with a median follow up period of 22.15 months. Complete remission was noted in 15 patients (83.3%). Out of the children with metastatic lung disease, 1 had progressive disease, 2 had stable disease. Overall survival was 100%.Conclusion: Majority of our children in our retrospective data presented with nodal and distant metastasis. With the current advances in the treatment of thyroid malignancies, a good survival was noted even in children with pulmonary metastasis.

Pediatric acute leukemia presenting with osteolytic lesions and hypercalcemia is an unusual and rare occurrence. We are reporting two such cases with atypical presentations. The first case involved a 10-year-old boy who complained of progressively worsening lower back pain. Physical examination revealed restricted flexion and extension of the back due to pain, while complete blood count and peripheral blood smear were normal. CT and MRI spine indicated osteolytic lesions in all vertebrae and pelvic bones. Biopsies from the bone marrow and vertebrae confirmed the presence of lymphoblasts, with flow cytometry results positive for B-ALL. The second case involved a 2-year-old boy who presented with chronic fever, cough, and pain in the left hip region. Physical examination was unremarkable, but chest X-ray and CT thorax revealed mediastinal widening and an anterior mediastinal mass. Skeletal X-rays showed osteolytic lesions in the humerus and femur. Peripheral blood smear was suggestive of acute leukemia. Upon presentation, the child had a serum calcium level of 17 mg/dL, initially managed with fluids and furosemide, but also required zoledronate and calcitonin. Both these cases highlight that osteolytic lesions alone or combined with hypercalcemia can be the sole presentation of leukemia in children. Such cases require a high index of suspicion to diagnose this life-threatening condition promptly and initiate timely treatment for optimal outcomes.

Juvenile xanthogranuloma (JXG) is a rare histiocytic disorder primarily affecting children, typically presenting as self-limiting skin lesions. However, extracutaneous JXG (extra-JXG) or systemic JXG (sJXG) can involve various organs, including the central nervous system (CNS), leading to high morbidity and mortality, especially in cases of CNS involvement. Treatment approaches for CNS–JXG, including surgical resection, chemotherapy, and radiation therapy, lack consensus, with reports of relapsed or refractory cases being rare. Here, we present the case of a 2-year-old girl with refractory extra-JXG involving the CNS, characterized by multiple intracranial lesions. Initial chemotherapy with prednisolone and vinblastine showed no response, and second-line therapy, including cytarabine and vincristine combined with surgical resection, was also ineffective. However, a 6-cycle third-line chemotherapy regimen incorporating vincristine and carboplatin led to a positive response, with stable disease status, and normal growth and neurodevelopment observed. Our findings suggest that combined chemotherapy with carboplatin and vincristine is a feasible and well-tolerated treatment strategy for patients with CNS–JXG.

Background: Pediatric malignant bone tumors constitute an important subgroup of solid tumors and need comprehensive multidisciplinary care for optimal management. We aimed to review our local practice of managing malignant bone tumors and identify gaps to improve service.Methods: We retrospectively reviewed disease characteristics and management of twenty-five pediatric patients with malignant bone tumors from Jan 2000 to Dec 2020.Results: Median age at diagnosis was 8.75 years, male to female ratio of 0.8:1, and median follow-up was 3.6 years. Pain and swelling were the predominant symptoms at presentation, while lung was the most common metastatic site in Osteosarcoma (OS) and Ewing’s Sarcoma Family Tumors (ESFT). Metastatic disease was not associated with developing an event in OS (P=0.26) but was significantly associated with developing an event in the ESFT subgroup (P=0.002). There was no association of tumor necrosis of

Non-Down syndrome pediatric acute megakaryoblastic leukemia (AMKL) may be classified according to the presence of recurrent genetic abnormalities with prognostic relevance. In this case study, we report on a girl with AMKL, 32 months old at the time of diagnosis, in whom we confirmed the presence of the cryptic, poor prognosis NUP98::KDM5A fusion. The patient achieved complete remission (CR) with the first course of chemotherapy, underwent haploidentical family donor hematopoietic stem cell transplantation (HSCT) without event, but relapsed 5 months after HSCT. Through this case report, we emphasize the good initial response to chemotherapy, and the early relapse despite undergoing HSCT in first CR. We review the limited literature on NUP98::KDM5A (+) pediatric AML, and underscore the need for further study to improve the outcome of patients with this rare AML subtype.

Abstract Background The COVID-19 pandemic has had a well-evidenced impact on adolescents, who are especially sensitive to pandemic disruptions given the critical role of socialization in their development. In Chile too, evidence shows increases in mental health complaints among adolescents over the lockdown period. Our study aimed at exploring the experiences of Chilean adolescents regarding their mental health during the lockdown and school closure (March 2020-December 2021), and during the return to on-site education (2022) as informed by adolescents and school staff, with a focus on family, school, and social sources of risk and support for adolescents’ wellbeing during these periods. Methods Using a qualitative approach, we conducted semi-structured interviews with 19 adolescents and 16 staff members from schools in an urban area of Chile. Results Through thematic analysis, we generated five themes: [1] Adolescents in a mental health crisis, comprising a range of distressing experiences and mental health problems. This crisis was fueled by alterations in the functioning of adolescents’ systems: [2] Broken support systems (peers and school); [3] The school agenda must go on, reflecting schools’ strict compliance with the educational curriculum; and [4] Blurred boundaries between home and school life and within the family. Finally [5], Development will (try to) find its way describes how most participants experienced a bouncing back to wellbeing in the course of the school year upon return, and how some developmental milestones took place despite the abnormal conditions, providing evidence for resilience amid pandemic adversity. Conclusions The findings give insight into how the exchanges between the adolescent and the social systems they are embedded in were interfered. The results help us understand the challenges for mental health during and after the pandemic, and highlight adolescents’ capacity to thrive as normality was restored. The results also underscore the importance of upholding stability across adolescents’ systems and routines, in order to mitigate impacts on wellbeing amid abnormal circumstances. The findings are relevant for development-informed initiatives in policy design in the aftermath of the pandemic and in future crisis management responses.

Abstract Background Adolescents face many challenges when coping with out-of-home placement, and life story work can be helpful in this context. Typically conducted in individual settings, life story work’s high resource requirements pose a challenge for implementation in the standard care of youth welfare institutions. To address this issue, the ANKOMMEN intervention was developed as a manualized group program for adolescents in residential care focusing on processing and coping with experiences associated with their out-of-home placement. Method The intervention was evaluated in a single-arm pilot study with questionnaires administered at three time points (pre-intervention, post-intervention, and 3-month follow-up). The primary outcome was self-efficacy, while secondary outcomes included self-esteem, depressive symptoms, posttraumatic stress symptoms, and behavioral problems. A total of 31 intervention groups with 115 adolescents (M = 14.91 years; SD = 1.45; 52.2% male) were conducted between October 2020 and September 2022 in Germany. Data were analysed using mixed effect models. Results Pre-post comparisons revealed increased self-efficacy (d = −0.80) and self-esteem (d = −0.68) among participants with below-average scores prior to the intervention. Additionally, there was a decrease in self-reported depressive symptoms (d = 0.76), self-reported posttraumatic stress symptoms (d = 0.58), self-reported internalizing behavior problems (d = 0.74), caregiver-reported internalizing behavior problems (d = 0.76), and self-reported externalizing behavior problems (d = 0.52) for participants with clinically relevant scores prior to the intervention. These improvements were stable in the 3-month follow-up assessment. Furthermore, the intervention proved its feasibility in standard care within the context of the evaluation study. Conclusions The results of the pilot study provide preliminary evidence for the feasibility and potential effectiveness of ANKOMMEN but further research is needed to obtain valid evidence for the efficacy of the intervention.

Abstract Background Harsh parenting has been recognized as a risk factor for adolescent anxiety; however, the underlying mechanisms of this relationship remain unclear, and it is unknown whether this relationship is influenced by different parental roles and living arrangements. This study aimed to investigate the mediating mechanisms between harsh parenting and adolescent anxiety symptoms using a multiple mediation model and to further compare specific roles of harsh parenting and distinguish between the living arrangements. Methods A total of 3505 adolescents completed this survey, and 3295 adolescents (54.7% girls, Mage = 14.97 years) were included in the study. Participants completed self-assessments measuring harsh parenting, self-efficacy, school connectedness, Internet addiction, sleep problems, and anxiety. They were categorized into three groups based on living arrangements: living with both parents, only with the mother, or only with the father. Results Correlational analyses revealed that both maternal and paternal harsh parenting were associated with increased anxiety symptoms. Structural equation modeling (SEM) mediation analyses and multigroup analyses showed that the independent mediating effects of school connectedness, Internet addiction, and sleep problems, as well as the sequential mediating pathways involving self-efficacy → school connectedness, self-efficacy → Internet addiction, and self-efficacy → sleep problems, vary across the adolescents’ living arrangements in the association between maternal and paternal harsh parenting and adolescent anxiety symptoms. Conclusions This study elucidated the mechanisms linking harsh parenting to adolescent anxiety symptoms and validated the effects of different parental roles and living arrangements. The findings provide important insights for developing targeted interventions to address anxiety symptoms in adolescents exposed to harsh parenting.

Abstract Background Interstitial lung disease (ILD) is a serious complication in systemic juvenile idiopathic arthritis (SJIA). This study aimed to identify the clinical characteristics and prognosis of SJIA-ILD. Methods A two-center retrospective cohort study was conducted on patients newly diagnosed with SJIA in China from October 2010 to December 2021. Clinical characteristics, laboratory parameters, outcomes, and relapse rates were compared between ILD and non-ILD groups. Results A total of 176 children with SJIA were included, including 35 in ILD group and 141 in non-ILD group. The median age at onset of SJIA was 5.8 years (range 4.4–9.5) in patients with SJIA-ILD. It exhibited higher incidences of cervical spine (28.6%) and hip involvement (40.0%) in ILD group (P = 0.031 and P = 0.029, respectively). The incidence of macrophage activation syndrome (MAS) in ILD group reached up to 40%, significantly elevated than that in non-ILD group (P = 0.047). Children with ILD demonstrated a stronger inflammatory response and were more prone to developing lymphopenia (P = 0.009), requiring more combination therapy (P = 0.006) to control disease activity. 54.3% of patients received biologic therapies, with only three patient receiving biologics (one with IL-6 blockade, two with TNF inhibitor) prior to ILD onset and none receiving IL-1 blockade. The median follow-up duration was 6.0 years (range 3.9–9.5). The proportions of patients with SJIA-ILD achieving clinical inactive disease without glucocorticoids within 6 to 12 months of the treatment were significantly lower than control group (45.7% vs. 70.2%, P = 0.006). In ILD group, only 54.3% of patients achieved complete remission, and 17.1% were in a non-remission state, among whom two deaths from respiratory failure. There was no significant difference in disease relapse rates between the two groups (P > 0.05). Conclusions Patients with SJIA-ILD exhibited heightened inflammation, increased hip joint and cervical spine involvement, and were more susceptible to developing lymphopenia and MAS, suggesting a relatively poor prognosis. They required a prolonged time to control inflammation and more aggressive treatment strategies to achieve inactive status. The unsatisfactory rate of complete remission highlighted an urgent need for focused clinical strategies.

Abstract Background Tuberous Sclerosis complex (TSC) is a multisystemic neurocutaneous genetic condition with high rates of morbidity and mortality from subependymal giant cell astrocytoma (SEGA), renal angiomyolipoma, and renal cyst complications. Everolimus is an inhibitor for mTORC1 and is currently used to treat TSC for its main role in rapidly reducing SEGA volume and seizure burden, although mainly studied in the adult population. It has also been shown to stabilize estimated glomerular filtration rate and reduce renal angiomyolipoma size in the adult population. Case presentation This case report illustrates three pediatric patients placed on everolimus for SEGA and seizure control with incidental findings of the disappearance of or decreased burden of cystic kidney disease after everolimus therapy. In one patient, the cyst burden remained stable even after the cessation of everolimus while the SEGA resumed growth. Conclusions This report demonstrates the utility of everolimus in not only renal angiomyolipomas but also cystic kidney disease particularly in pediatric patients with a promising role in preserving renal function and preventing long term sequelae such as hematuria and hemorrhage from larger renal cysts especially if used early on in disease course.

Abstract Background Methotrexate (MTX) intolerance in juvenile idiopathic arthritis (JIA) frequently leads to discontinuation due to anticipatory and associative gastrointestinal symptoms. Eye Movement Desensitization and Reprocessing (EMDR) has successfully been used in MTX intolerance, with lasting effects but frequently diminishing efficacy over time. BLAST (bi-lateral alternating stimulation tactile) wristbands utilize a similar process to EMDR. The aim of this study was to determine if utilization of BLAST wristbands could improve and prolong the effect of EMDR on patients with MTX intolerance. Methods Consecutive patients admitted to the German Center for Pediatric and Adolescent Rheumatology with JIA and signs of MTX intolerance from October 2016 until March 2024 were included in this study. Treatment was performed using an adapted 8 phase EMDR protocol implementing BAST wristbands. Initial patients were treated with EMDR, subsequent patients additionally with BLAST wristbands. Health-related quality of live was determined using the PedsQL. Measurements of MISS (Methotrexate Intolerance Severity Score) and PedsQL were taken at 4 time points: directly before and after (MISS only) treatment, as well as 4 and 12 months after treatment. Changes in MISS and PedsQL were compared using descriptive statistics and repeated measures ANOVA. Results 87 patients with MTX intolerance were included, 53 in group 1 without BLAST wristbands and 34 in group 2 which were concurrently treated with BLAST wristbands. All patients reported marked improvement of MTX intolerance symptoms (mean MISS score group 1: 15.0 ± 5.5 before treatment, 1.3 ± 1.5 after treatment, group 2: 16.8 ± 5.6 and 2.5 ± 2.5, respectively). After 4 and 12 months, MISS in group 1 was 8.1 ± 7.1 and 8.7 ± 8.4, and in group 2: 7.1 ± 6.3 and 6.5 ± 5.7. A repeated measures ANOVA showed a significant difference between the MISS results over time (F(3,114) = 64.6, p

Abstract Background Regular physical activity (PA) has been proven to help prevent non-communicable diseases and is beneficial for disease management in chronically ill populations. Physical inactivity and recreational screen-based media (SBM) use are related to poor health outcomes and common among youth. This study aimed to (1) investigate PA levels and recreational SBM use of adolescents with JIA over time and (2) compare these behaviours with those of their peers. Methods Data from JIA patients and their peers enrolled in the inception cohort study ICON at 11 German centers were analyzed. Individuals aged 13 and over were followed prospectively with questionnaires concerning PA level, recreational SBM use, and health-related quality of life (HRQoL) at a two-year interval. Group by time interactions were analyzed using linear mixed models. Results Data of 214 patients (mean age at first documentation 14.4 ± 0.9 years, female 63%) and 141 peers could be considered. At first documentation, patients were less physically active compared to their peers (p

Abstract Objectives To identify an optimal pediatric musculoskeletal ultrasound (MSUS) protocol for the detection of knee arthritis in patients with juvenile idiopathic arthritis (JIA) including a comparison with existing protocols. Secondary aims were to correlate MSUS-identified B-Mode (BM) and Power Doppler-Mode (PD) synovitis with clinical findings. Methods Consecutive JIA patients with confirmed knee arthritis after clinical examination underwent a thorough MSUS study protocol which included views identified and consented by the Pediatric Rheumatology european Society (PReS) Imaging Working Party for the detection of synovitis. In total eight views including measurement of the suprapatellar recess were included. Scoring of synovitis followed the pediatric OMERACT criteria (BM and PD severity grading 0 to 3). Interobserver reliability of BM and PD was tested before study begin. Previously published MSUS protocols for knee synovitis were also identified from the literature and their scan protocols compared to identify differences in sensitivity for synovitis according to the number and specific type of views included. Finally, a clinically applicable MSUS protocol for knee synovitis could be proposed. Results In 114 patients with clinically active knee inflammation, BM positivity (grading ≥ 1) was most frequently detected in the suprapatellar longitudinal and transverse scans performed in any positioning (frequency 97–99% in suprapatellar longitudinal in 30° or neutral respectively). PD positivity was however higher in these views performed in 30° flexion compared to neutral. Intrasynovial PD positivity (grading ≥ 1) was most frequently detected in the lateral parapatellar (69%, sensitivity 0.68, specificity 0.98), medial parapatellar (frequency 67%, sensitivity 0.67, specificity 1.0), the longitudinal lateral (68%, sensitivity 0.67, specificity 0.98) and suprapatellar transverse in 30° (frequency 64%, sensitivity 0.64, specificity 1.0). A combination of five views was the most sensitive for BM and PD synovitis. The suprapatellar recess size was analyzed by age and gender. For each group, the recess was wider in knees with arthritis than without (p

Abstract Background The developing technology and the rapid increase in the use of the internet, smartphones, and mobile applications can disrupt the daily quality of life of individuals. This research aimed to scrutinize the link between the internet and smartphone addiction of individuals, eating attitude, and loneliness status. This research was carried out in Ankara, Turkey, and cross-sectional study. A total of 643 (M = 240, F = 403) volunteers between the ages of 18 and 50 participated in the study. Eating Attitude Test (EAT-26), Young Internet Addiction Test (YIAT), Smartphone Addiction Scale (SAS), and UCLA Loneliness Scales were used in this study. Results As the age of the participants increased, YIAT (r = − 0.352, p

Abstract Background Preterm birth is a principal reason for perinatal morbidity and mortality increasing the incidence of severe neurodevelopmental deficits. There is growing proof that early postnatal amplitude-integrated electroencephalography (aEEG) has a prognostic value for neurodevelopmental consequence in preterm born neonates. Furthermore, MRI has been widely utilized to enhance comprehension of the brain substrate responsible for neurodevelopmental abnormalities. Thus, this study aims at evaluating the role of early postnatal aEEG and brain MRI in forecasting neurodevelopmental consequence in preterm infants at the age of 1 year. Methods A cohort study performed in the neonatal intensive care unit of a tertiary hospital during the duration from October 2021 to June 2023 including 60 preterm neonates

Abstract Objective Multisystem inflammatory syndrome in children (MIS-C) is a critical childhood disease that is associated with coronavirus disease (COVID-19). We aimed to describe the clinical, laboratory, and echocardiographic characteristics and outcome of critical MIS-C cases in Egyptian children during the first wave of the COVID-19 pandemic. Design A retrospective, observational study. Setting A single-center tertiary pediatric intensive care unit (PICU).In Ain Shams university hospitals Cairo Egypt Methods Children admitted to the PICU diagnosed with severe MIS-C as per the Centers for Disease Control’s definition from June 23, 2020, to August 22, 2020, were included. Results The patient’s mean age was 7.45 (interquartile range [IQR], 4.23) years, and the cause of PICU admission was hypotension and shock. All patients had a fever for 4.8 (IQR, 2.5) days before shock developed. Overall, 68% had a gastrointestinal manifestation, and 55.6% had a rash. Thirty-five of 45 patients had ≥ 4 elevated inflammatory markers. The cardiac troponin I level was elevated in 35 of 45 patients. The most common cardiac condition was valvulitis (tricuspid regurgitation, 29/45; mitral valve regurgitation, 28/45; pulmonary valve regurgitation, 5/45; atrial valve regurgitation, 4/45). Twenty-one patients had an impaired ejection fraction

Abstract Objective The aim of the study is to evaluate the complications and long-term bowel function in Hirschsprung’s disease (HD) patients following total transanal endorectal pull-through (TERPT) surgery operated in a tertiary hospital in Oman. Methods A retrospective data retrieval was done for patients diagnosed with Hirschsprung’s disease and underwent total transanal endorectal pull-through procedure during the period from December 2008 to June 2019 with concomitant prospective phone call questionnaire interview to assess the long-term functional outcome of children aged 3 years and older. Results Total transanal endorectal pull-through was performed in 61 patients. The mean age at the time of operation was 7.71 ± 8.26 months. The most common late complication was anal excoriation (19.7%). Of the patients, 61.5% had a normal to fair score, and the remaining 38% had a poor score in their functional outcome questionnaire. The majority had no social problems (65.4%), while 15.4% had problems causing varying degrees of social restrictions. Conclusion The short-term outcomes of total transanal endorectal pull-through are found to be acceptable. In addition, the long-term functional outcome post total transanal endorectal pull-through was found to be satisfactory; however, longer follow-up studies with larger sample sizes are needed for more accurate functional outcome evaluation.

Abstract Background Antimicrobial stewardship programs (ASP) often function naturally as facilitators within clinical hospital settings, by working with individuals and teams to reduce unnecessary antibiotics. Within implementation science, facilitation has been studied and evaluated as an implementation strategy that can accelerate and improve fidelity to implementation efforts. This study describes a novel, virtual facilitation strategy developed and served as an intervention within the optimizing perioperative antibiotics for children trial (OPERATIC trial). This paper: (1) describes ASP team’s preferences for and use of a facilitation workshop and (2) describes sustained use of facilitation skills throughout the study period. Methods Study participants included antimicrobial stewardship team members from the nine children’s hospitals that participated in this study and completed facilitation training. All individuals who completed facilitation training were asked to evaluate the training through an online survey. Additionally, site leads were interviewed by the site coordinator every other month and asked about their team’s use of facilitation skills throughout the rest of the study period. Survey data were managed and coded in R, and qualitative interview data were analyzed using rapid methodology. Results 30 individuals, including both physicians and pharmacists, completed the evaluation. Individuals largely rated themselves as novice facilitators (53%). Individuals reported satisfaction with virtual facilitation and identified different components of the workshops as valuable. An additional 108 interviews were performed throughout the study period. These interviews found that facilitators reported using all skills throughout the study period and described varied use of skills over time. All nine sites applied facilitation strategies, team building techniques, and communication/conflict skills at some point during the intervention phase. Conclusion We describe the use of virtual facilitation as an acceptable and appropriate strategy to enhance facilitation skills for ASP teams working to reduce unnecessary postoperative antibiotics. Participants reported different useful components of facilitation training and described using differing facilitation skills throughout the trial. Overall, the use of facilitation skills continued throughout the duration of the study period. This paper outlines how facilitation training can be conducted virtually in a way that is feasible and acceptable to clinicians. Trial registration NCT04366440, April 24, 2020.

Abstract Vaccination plays a crucial role in preventing and controlling SARS-CoV-2 infections as well as their associated adverse outcomes. But there is a notable lack of research on the effectiveness of COVID-19 vaccination in children, particularly those young preterm-born children, who are more vulnerable to severe outcomes from SARS-CoV-2 infection. We aimed to determine the effect of vaccination with inactivated vaccines BBIBP-CorV and CoronaVac on symptomatic COVID-19 infection and related symptoms in preterm-born children aged 3–7 years after relaxation of the COVID-19 prevention and control measures in December 2022 in China. We performed a retrospective cohort study involving 242 preterm-born children aged 3–7 years and the data were collected in March 2023. Logistic regression models and modified Poisson regression models combined with entropy balancing were used to explore the associations of vaccination against SARS-CoV-2 with symptomatic COVID-19, specific symptoms, and persistent symptoms one month after recovery from COVID-19. Of the 242 recruited preterm-born children, 156 (64.5%) were vaccinated with inactivated vaccines BBIBP‐CorV and CoronaVac. After entropy balancing, the covariates were balanced between the vaccinated and the unvaccinated groups, with standardized mean difference

Abstract The incidence of eating disorders in children, mainly of anorexia nervosa, is dramatically increased in the last years. A timely identification of the disease is associated with higher rates of recovery. Aim of the work is to underline signs and symptoms that can be used to an early detection of anorexia nervosa in the pediatric age. A scoping review has been conducted by The Italian Pediatric Society Adolescent Study Group according to the PRISMA Extension guidelines for Scoping Reviews, using the search term “anorexia nervosa” and the following filters “review”, “systematic review”, “age 0–18”, “last 4 years”. The strategy search produced 657 studies, of which 52 were included in this revision. Screening and red flags were discussed in 23 reports, genetics in 12, neurological pathways in 11, environmental factors in 10, and gut microbiota in 7. An accurate physiological and pathological anamnesis, physical and psychological examination, including the body perception, should be taken in account as well as the presence of co-morbidities, including chronic functional abdominal pain and autoimmune/autoinflammatory diseases. Evidence suggests the role of familiar predisposition as well as of neurological morphology and pathway in anorexia nervosa development. Gut microbiota has also been included among possible risk factor for developing anorexia nervosa due to a complex direct and indirect interactions between gut and brain. The Italian Pediatric Society Adolescent Study Group suggests performing an accurate familial and personal anamnesis, including psychological evaluation as well as a physical exam including auxological parameters as a screening tool during pediatric checks to better explore the risk of developing anorexia nervosa.

Abstract Background In Italy, exclusive breastfeeding (EBF) rates at hospital discharge range unsatisfactorily between 20–97%. Methods In 2023, the Project for Hospital Policy on Breastfeeding (HPB) has been launched to promote breastfeeding in Italian Maternity Hospitals (MHs) as a joint initiative of the Italian Scientific Societies involved in perinatal care together with the National Midwife (FNOPO) and Nurse (FNOPI) Boards and with Vivere Onlus, a family association. The HBP Project has been designed as an uncontrolled before-after study to increase EBF rate at hospital discharge in the population of healthy, term infant with a normal weight at birth following an intervention bundle comprising: 1) Establishment of a local hospital Working Group; 2) Adoption of a hospital policy; 3) Implementation of breastfeeding monitoring; 4) Training for perinatal care professionals; 5) Enhanced implementation of the practices of skin-to-skin contact (SSC) and mother-baby rooming-in; 6) Development/Improvement of perinatal care protocols. Results We report the pre-intervention assessment of 89 out of the 111 enrolled MHs (80.2%) at the beginning of the Project (Time 1 or T1). Almost all MHs (96.6%) have a multi-professional Breastfeeding Working Group, while a hospital policy on breastfeeding is available only in 48.2%. Moreover, only 56.2% of the 9,777 perinatal health workers have been trained in breastfeeding. Over a 1-month period, SSC has been practiced in the delivery room by 76.9% of 6,304 term healthy newborn infants and rooming-in by 83.4% of 6,735 healthy term newborns of normal weight at birth. Over a 4-month period, 69.1% of 33,367 healthy term newborns of normal birth weight were exclusively breastfed at hospital discharge. Noticeably, EBF rate of MHs ranges from 4% up to 100%, the second quartile being 73%. Conclusion At T1 of the HPB Project, breastfeeding rates at hospital discharge for healthy, term infants with a normal weight at birth appear to be suboptimal among Italians MHs. Particularly, the range of EBF rates among participating centers is wide, with 50% of the MHs having EBF rate lower than 73%. Therefore, the ongoing HPB Project might represent not only an opportunity to increase the initiation of breastfeeding and to improve quality of health care in the whole study group of MHs, but possibly also to level differences between centers.

Abstract Background The use of mobile applications helps improving self-management in adolescents with asthma. However, no evidence is available for children with preschool wheezing. In addition, we have no data on the reliability of medical history collected at visits. The first aim was to assess the feasibility of a smartphone app in the management of preschool wheezing; secondly we aimed to evaluate the reliability of anamnestic data collected during face-to-face medical interviews. Methods Children with recurrent wheezing, age between 25 and 72 months, were randomly assigned to the intervention group, provided with a smartphone app for symptoms monitoring and asthma attack treatment, or to the control group, with a written action plan. At follow-up medical history was collected and the asthma control test and a clinical questionnaire were completed. App acceptability was also explored. Respiratory symptoms, medication and utilization of healthcare resources were collected. Plus, medical information obtained from the paper questionnaires was compared with data daily recorded by the app. Results We enrolled 85 preschool children with recurrent wheezing: 43 assigned to the intervention and 42 to the control group. The average (SD) adherence to e-Diary compilation was 60 (15)%. The acceptance and usability of the intervention was favorable as 70% and 93% of participants in the intervention arm described the app as ‘’simple and intuitive’’ at Visit1 (after 3 months from enrollement) and Visit2 (3 months later than Visit1), respectively and 95% and 98% found it useful in symptoms management. There were no significant differences between the two groups in clinical outcomes. At Visit1, the cACT median score (IQR) was 23,5 (21–25) for the control group (42 patients) and 23 (21–24) for the intervention group (43 patients). At Visit2 (41 controls and 42 in the intervention group) it was 25 (24–25) and 24 (24–25), respectively. Secondary analysis of data from the intervention group showed higher incidence of daily symptoms recorded by the app in comparison with the paper questionnaire, suggesting that collection of retrospective medical history may not be completely reliable. Conclusions The smartphone app is usable and acceptable by families of preschool wheezers. Future controlled trial are needed to prove an impact on clinical outcomes or its efficacy in a telemedicine program. Finally a daily questionnaire could provide physicians with a more reliable clinical picture as reflected better daily asthma symptoms than the written retrospective questionnaire filled at clinical visit.

Abstract Background Over 1.7 billion instances of diarrheal illness in children are reported worldwide yearly. Diarrhea was a major cause of death in children, accounting for 9% of all global under-five child deaths in 2021. The objective of this study was to identify the association between hygiene practices and childhood diarrhea among under-five children in Myanmar. Method This cross-sectional study was conducted in 16 townships from 8 states and regions of Myanmar. 1207 children between the ages of 6 and 59 months were recruited by multistage random sampling. Data were collected with a preformed questionnaire after participants provided consent. Multiple logistic regressions were administered to determine the factors associated with childhood diarrhea. Result This study found that 86 (7.13%) under-five children experienced diarrhea disease. This study identified that children receiving limited hygiene services were 2.85 times (AOR = 2.85, 95% CI: 1.31 to 6.21; p value 0.01) and children without hygiene services were 2.63 times (AOR = 2.63, 95% CI: 1.42 to 4.89; p value 0.01) more likely to have diarrhea disease than those with basic hygiene services. Other factors associated with diarrhea included: fathers who washed their hands less than four steps (AOR = 2.20, 95% CI: 1.29 to 3.74; p value 0.01), families taking more than 15 min to collect water (AOR = 1.77, 95% CI: 1.06 to 2.97; p value 0.03), families sharing toilet usage (AOR = 2.00, 95% CI: 1.15 to 3.48; p value 0.01), mother’s inadequate and problematic hygiene promotion health literacy (AOR = 2.20, 95% CI: 1.24 to 3.90; p value 0.01), houses made of bamboo or lacking floors (AOR = 2.31, 95% CI: 1.38 to 3.89; p value 0.01), families with three or more children (AOR = 1.68, 95% CI: 1.01 to 2.79; p value 0.05) and breastmilk being the primary food after 6 months of age (AOR = 2.07, 95% CI: 1.09 to 3.93; p value 0.03). Conclusions Ensuring access to basic hygiene services, getting water at home 24 h per day, seven days per week, using private toilets, promoting hygiene health literacy, improving house flooring, family planning and introducing a variety of foods after age 6 months could significantly prevent diarrhea among under-five children in Myanmar. This study underscores the critical role of handwashing facilities in reducing the diarrhea incidence in children.

Abstract Background The incidence of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children is increasing, posing a serious threat to life safety. Intravenous immunoglobulin (IVIG) has demonstrated the ability to modulate the immune system and has shown the potential to treat RMPP. This study evaluated the clinical efficacy and safety of azithromycin combined with IVIG in the treatment of RMPP in children through a meta-analysis. Methods A comprehensive search was conducted in seven databases including PubMed and Cochrane Library, and the studies on the treatment of RMPP in children with azithromycin combined with IVIG were screened. After data extraction, meta-analysis and sensitivity analysis were performed to assess heterogeneity and stability. Results Thirteen randomized controlled trials and two cohort studies were included, totaling 1,142 children. The results of meta-analysis showed a higher clinical efficacy rate (RR = 1.18, 95% CI: 1.11–1.25, P

Abstract Background Continuous performance tests (CPTs) are a popular tool for evaluating the symptoms of attention-deficit/hyperactivity disorder (ADHD). Performance measurements are typically linked to the biological features and cognitive functions of individuals. To determine the validity of specific CPT indices in differentiating between school-aged children with ADHD from with non-ADHD, each student’s sex, chronological age, and cognitive abilities should be considered. Methods In this prospective case–control study, a total of 30 non-ADHD students and 26 with ADHD who were aged 6 to 12 years were from general education classrooms. All students completed the Continuous Performance Tests (CPTs) and the Peabody Picture Vocabulary Test-revised (Mandarin-Chinese version). Demographic data were collected from the students’ parents. Results Detectability, Omissions, Commissions, and Hit Reaction Time Standard Deviation (HRT SD) yielded higher T-scores in children with ADHD than those without. Compared with non-ADHD students, those with ADHD had higher classification scores for Detectability, Omissions, Perseverations, and HRT SD. For each CPT index, after individual factors were controlled for, logistic regression revealed that only students with positive scores for Detectability, Omission, and HRT SD (adjusted odds ratios = 4.627, 9.977, and 3.908, Ps

Abstract Background Cardiovascular dysfunction is a significant factor contributing to weaning failure in mechanically ventilated children. Understanding the cardiopulmonary pathophysiological changes that occur during weaning is a prerequisite for the early recognition of weaning failure of cardiovascular origin. This study aimed to assess the effect of weaning trials on central hemodynamics and to identify the indices predictive of cardiac-related weaning failure. Methods This prospective observational study was conducted in the Pediatric Intensive Care Unit (PICU) and included mechanically ventilated patients aged between 2 and 30 months who were on minimal ventilatory settings and ready for weaning. Patients who were hemodynamically unstable, diagnosed with neuromuscular diseases, or diagnosed with cardiac diseases were excluded. Hemodynamic parameters were evaluated during weaning from ventilation via echocardiography and noninvasive cardiometry during pressure support (PS) ventilation and at the end of the spontaneous breathing trial (SBT). Results The study included 50 patients, comprising 30 males (60%) and 20 females (40%) with ages ranging from 2 to 30 months. Echocardiography revealed a significant increase in the cardiac index (CI), tricuspid annular plane systolic excursion (TAPSE), and the E/A ratio at the end of SBT. Moreover, right ventricular systolic pressure (RVSP) significantly decreased. Noninvasive cardiometry revealed a significant increase in the index of contractility (ICON) and CI at the end of SBT (p-value = 0.023 and

Abstract Background Children spend a significant amount of time engaging in sedentary behaviors, defined as activities that do not increase energy expenditure significantly above resting levels, such as watching TV and playing PC/video games. Increased screen time is a significant public health concern because children are in a developmental stage where lifestyle behaviors predict various health outcomes in adulthood and beyond. This study explores the links between parent-child attachment, ego resilience, and children’s screen time. Methods This cross-sectional correlation study uses 1,163 parents and their children data from the 12th Panel Survey of Korean Children. The study instruments were a modified Armsden and Greenberg scale of parent-child attachment and modified the children’s ego resilience scale of the Block and Kremen. Children’s screen time was classified as more than 2 h per day spent watching television, playing on computers, or playing video games in their leisure time. Results Study results show a negative association between father-child attachment and children’s screen time (ß = -0.43, p

Abstract Background Dysuria in children can have various etiologies, including ureteric stones, phimosis, congenital obstructive posterior urethral membrane, and neurogenic bladders. However, there have been no reports of vitamin A deficiency (VAD) causing dysuria due to urethral keratosis. Here, we report two cases of urethral keratosis caused by a VAD. Case presentation An 8-year-old boy (Patient 1) and a 6-year-old boy (Patient 2) presented with multiple episodes of dysuria and epididymitis. Both patients had intellectual disabilities and autism, which prevented voiding cystourethrography. Therefore, the patient was admitted for cystoscopy under general anesthesia. Cystoscopy revealed urethral diastolic dysfunction and a large amount of desquamated epithelium obstructing the urethra in both patients, causing urinary obstruction and dysuria. Catheterization was repeated; however, the symptoms recurred after catheter removal. Although the cause of recurrent urinary obstruction could not be initially identified, an ophthalmologist found Bitot’s spots and suggested the possibility of a VAD. Serum vitamin A levels were extremely low in both patients, leading to the diagnosis of urethral keratosis due to VAD. VAD can be attributed to an unbalanced diet resulting from intellectual disabilities or autism. Vitamin A replacement therapy improved both the urethral symptoms and cystoscopic findings. Conclusion Dysuria due to VAD is extremely rare, and urethral keratosis as a cause of dysuria is likely the first report of its kind worldwide. VAD may develop due to an unbalanced diet in patients with intellectual disabilities or autism. Therefore, it is essential to consider VAD as a potential cause of dysuria in patients with intellectual disabilities and autism.

Abstract Purpose Juvenile systemic lupus erythematosus (J-SLE) is a complex, heterogeneous disease affecting multiple organs. However, the classification of its subgroups is still debated. Therefore, we investigated the aggregated clinical features in patients with J-SLE using cluster analysis. Methods: Patients (≤ 16 years) diagnosed using the Systemic Lupus International Collaborating Clinics (SLICC) classification criteria were identified from the clinical database of the Egyptian College of Rheumatology (ECR) SLE study group. Demographic data, clinical characteristics, laboratory features, and current therapies were selected. A cluster analysis was performed to identify different clinical phenotypes. Results: Overall, 404 patients, of whom 355 (87.9%) were female, had a mean age at diagnosis of 11.2 years and a mean disease duration of 2.3 years. We identified four distinct subsets of patients. Patients in cluster 1 (n = 103, 25.5%) were characterized predominantly by mucocutaneous and neurologic manifestations. Patients in cluster 2 (n = 101, 25%) were more likely to have arthritis and pulmonary manifestations. Cluster 3 (n = 71, 17.6%) had the lowest prevalence of arthritis and lupus nephritis (LN), indicative of mild disease intensity. Patients in cluster 4 (n = 129, 31.9%) have the highest frequency of arthritis, vasculitis, and LN. Cluster 1 and 4 patients had the highest disease activity index score and were less likely to use low-dose aspirin (LDA). The SLE damage index was comparable across clusters. Conclusions: Four identified J-SLE clusters express distinct clinical phenotypes. Attention should be paid to including LDA in the therapeutic regimen for J-SLE. Further work is needed to replicate and clarify the phenotype patterns in J-SLE.

Abstract Background Congenital rib deformity is a common thoracic deformity that has a potentially far-reaching impact on the growth and lung function development of young children. Early diagnosis and accurate assessment of congenital rib deformity is of great importance. This study was to retrospectively analyze the number, location, and types of deformities, imaging features as well as clinical symptoms of children with congenital rib deformities. Methods Children who were diagnosed with congenital rib deformities between October 2019 and October 2021 in our hospital were included in this study. The rib deformities were analyzed according to the imaging results of chest X-ray and 3D volume rendering multidetector computed tomography (MDCT). The data were analyzed using SPSS 22.0. Results A total of 472 male and 186 female children with rib deformities were detected in this study, with a male to female ratio of approximately 2.54:1. Of the deformed ribs, 417 (63.4%) were located on the right side, usually single and unilateral. The most common type of the detected rib deformity were bifid ribs (95.14%). Rib deformity was most common in the fourth rib (46.62%). The majority (76.16%, n = 428) of rib deformities were incidental findings and asymptomatic. Conclusions Congenital rib deformities in pediatric patients included in our hospital were more frequently observed in males than females, more frequently detected on the right than on the left side. The most common type of rib deformity is the bifid rib. MDCT examination are of great value in the diagnosis of rib deformity and can help guide clinical treatment.

Abstract Background The objective was to evaluate refractory respiratory distress syndrome (RDS) risk factors among very-low-birth-weight infants (VLBWIs). Method The data of VLBWIs born between January 2013 and December 2020 registered in the Korean Neonatal Network (KNN) were analyzed. Infants who died within 5 postnatal days or who were not given surfactant were excluded. Infants were divided into a well-responding RDS group, which received surfactant replacement therapy (SRT) only once, and a refractory RDS group, which received SRT twice or more. The associations between perinatal characteristics and refractory RDS were investigated via multivariate logistic regression analysis. Results Multivariate logistic regression analysis revealed that low gestational age (adjusted odds ratio [aOR] = 1.26, 95% confidence interval (CI) [1.23, 1.26], male sex (aOR = 1.17, 95% CI [1.06, 1.29]), cesarean section (aOR = 1.59, 95% CI [1.38, 1.80]), maternal hypertensive disorder (aOR = 1.54, 95% CI[1.35, 1.75]), and low 5-minute Apgar scores (aOR = 1.24, 95% CI [1.12, 1.37]) were significantly associated with refractory RDS. Antenatal corticosteroid use (aOR = 0.81, 95% CI [0.73, 0.89]) and maternal chorioamnionitis (aOR = 0.79, 95% CI [0.71, 0.88]) were significantly inversely associated with refractory RDS. Compared with well-responding RDS, refractory RDS was significantly associated with increased major neonatal morbidity and mortality risk at 5 postnatal days. Conclusion Maternal hypertensive disorder is a significant risk factor for refractory RDS. Refractory RDS was associated with unfavorable neonatal outcomes.

Abstract Objectives to estimate insulin-like growth factor-1 (IGF-1) levels in apparently healthy infants and prepubertal children and compare results among different nutritional statuses. Methods Our cross-sectional work is a sub-study of a screening project for anemia and nutritional status. We included 252 apparently healthy infants and children with a mean age of 3.7 ± 1.3 years (1.1–6.6), with equal gender distribution. Data retrieved included breastfeeding and anthropometric measures. We tested the stored blood samples for IGF-1 levels. The sample size was reached when all kits were consumed. Results abnormal anthropometric measures were detected in 32.9%, either a single or multiple, and 86.5% were breastfed. Girls had significantly higher serum IGF-1 levels than boys (P:

Latar belakang. Kemoterapi merupakan pengobatan utama pada anak leukemia limfoblastik akut (LLA). Kemoterapi fase induksi adalah kemoterapi pertama yang membunuh 95-98% sel leukemik. Pemberian kemoterapi menyebabkan kerusakan hati ditandai dengan peningkatan kadar enzim transaminase dan dapat disertai peningkatan kadar bilirubin. Faktor yang mempengaruhi pengobatan LLA, di antaranya usia dan status gizi. Tujuan. Melihat gambaran kadar enzim transaminase dan bilirubin pada anak LLA berdasarkan usia dan status gizi pada kemoterapi fase induksi. Metode. Penelitian deskriptif retrospektif dengan pendekatan cross-sectional. Pengambilan sampel menggunakan teknik total sampling pasien anak LLA di Rumah Sakit Umum Pusat Dr. M. Djamil, Padang, periode September 2022 sampai Agustus 2023. Data demografis, SGOT, SGPT, dan bilirubin total pasien didapatkan melalui rekam medis. Hasil. Penelitian ini mendapatkan sebanyak 49 sampel, dengan mayoritas responden adalah perempuan (53,1%), usia

Latar belakang. Diagnosis tuberkulosis (TB) paru pada anak sering kali sulit dilakukan. Sifat pausibasiler dari TB pada anak kerap seringkali menyulitkan konfirmasi bakteriologis. Oleh karena itu, rontgen toraks menjadi modalitas penting ketika didapatkan hasil negatif pada pulasan bakteri. Tujuan. Penelitian ini bertujuan untuk melihat tingkat kesesuaian antara hasil rontgen toraks dan GeneXpert MTB/RIF pada kasus TB paru pada anak. Metode. Penelitian ini merupakan studi potong lintang yang dilakukan dengan menelusuri rekam medis pasien anak dengan dugaan TB paru di Rumah Sakit dr. Mohammad Hoesin Palembang pada tahun 2018-2020. Subjek penelitian dikelompokkan sebagai terdeteksi atau tidak terdeteksi TB berdasarkan hasil GeneXpert MTB/RIF dan sugestif atau non-sugestif TB berdasarkan rontgen toraks. Data kemudian dianalisis menggunakan uji Cohen’s Kappa (k). Hasil. Terdapat 207 kasus dugaan TB paru pada anak dengan sebagian besar subjek berusia 0-

Latar belakang. Sindrom Bartter merupakan gangguan tubulus ginjal ditandai dengan hiperaldosteronisme sekunder, alkalosis metabolik hipokalemia, disertai tekanan darah yang normal atau rendah. Gangguan elektrolit akibat kelainan ginjal, berpengaruh pada telinga bagian dalam mengakibatkan gangguan pendengaran. Tujuan. Mengetahui gangguan pendengaran pada anak dengan Sindrom Bartter. Metode. Dilakukan pencarian di PubMed, Google Schoolar, dan Cochrane dengan menggunakan kata kunci “Hearing loss”, “barter syndrome”, dan “hypokalemia”. Hasil pencarian dievaluasi menggunakan kriteria eksklusi dan inklusi. Selanjutnya dilakukan telaah kritis dengan memperhatikan validitas, kepentingan dan penerapan pada pasien terhadap artikel lengkap dari studi yang terseleksi. Hasil. Diperoleh satu studi yang relevan dengan pertanyaan klinis dan memenuhi kriteria inklusi dan eksklusi. Luaran dari studi ini memperlihatkan bahwa terdapat pengaruh gangguan pendengaran pada pasien dengan Sindrom Bartter. Kesimpulan. Gangguan elektrolit pada anak dengan Sindrom Bartter memengaruhi pendengaran. Tata laksana farmakologi dan rehabilitasi dapat mengatasi gangguan komunikasi yang terjadi.

Latar belakang. Insiden sepsis pada negara berkembang sampai saat ini masih tinggi. Banyaknya faktor risiko yang memengaruhi, menjadikan sepsis sebagai penyumbang tingginya angka kematian pada bayi. Diagnosis yang seringkali terlambat ditegakkan karena pemeriksaan kultur darah sebagai Gold Standard baru bisa didapatkan hasilnya setelah beberapa hari. Deteksi dini sepsis neonatorum dapat diltegakkan salah satunya dengan pemeriksaan rasio neutrofil limfosit dan red cell distribution width. Tujuan. Menilai rasio neutrofil limfosit, red cell distribution width, dan faktor risiko pada neonatus dengan diagnosis sepsis di neonatal intensive care unit - NICU Rumah Sakit Zainoel Abidin Banda Aceh dengan luaran kematian. Metode. Penelitian desain kohort retrospektif dengan data rekam medis neonatus di NICU Rumah Sakit Umum Daerah Dr. Zainoel Abidin, Banda Aceh, dari Februari hingga Oktober 2023. Sebanyak 43 neonatus dengan diagnosis sepsis yang memenuhi kriteria inklusi dianalisis. Data yang dikumpulkan meliputi karakteristik demografis, hasil laboratorium, serta luaran klinis. Analisis dilakukan menggunakan uji Chi-square dan analisis multivariat dengan SPSS versi 20.0. Hasil. Diperoleh 88,3% neonatus menunjukkan peningkatan NLR, dan 86,05% mengalami peningkatan RDW. Terdapat hubungan signifikan antara metode persalinan sectio caesaria (p

Latar belakang. Infeksi saluran kemih (ISK) pada anak memiliki manifestasi klinis yang tidak khas sehingga sulit untuk diagnosis dini. Biakan urin memerlukan waktu hingga lima hari sehingga dapat menyebabkan keterlambatan terapi serta tingginya komplikasi ISK. Kelainan urinalisis yang saat ini digunakan masih memiliki spesifisitas yang rendah. Tujuan. Mengetahui nilai diagnostik Neutrophil gelatinase-associated lipocalin (NGAL) urin, kelainan urinalisis, dan kombinasi keduanya untuk mendiagnosis dini ISK pada anak usia 2-5 tahun. Metode. Uji diagnostik menggunakan biakan urin sebagai baku emas dengan desain potong lintang pada anak berusia 2-5 tahun dengan tersangka ISK dan dirawat di Rumah Sakit Dr. Cipto Mangunkusumo. Hasil. Pemeriksaan NGAL urin diketahui memiliki sensitivitas 85,7% (IK95%: 63,6-96,9%), spesifisitas 74,3% (IK95%: 57,8-86,9%), positive predictive value 64,3% (IK95%: 50,6–75,9%), dan negative predictive value 90,6% (IK95%: 76,9-96,5%) pada anak dengan minimal satu kelainan urinalisis. Pemeriksaan NGAL urin hanya meningkatkan spesifisitas kelainan urinalisis berupa leukosituria saja dan tidak meningkatkan spesifisitas pada yang telah memiliki tiga kelainan urinalisis. Kesimpulan. Neutrophil gelatinase-associated lipocalin urin tidak dianjurkan untuk meningkatkan spesifisitas urinalisis dalam diagnosis ISK pada anak usia 2–5 tahun. Gabungan tiga kelainan urinalisis tanpa NGAL urin sudah memiliki spesifisitas yang baik. Perlu dilakukan penelitian biomarker lain untuk mendiagnosis dini ISK dengan lebih baik.

Latar belakang. Fungsi tidur secara tepat hingga kini masih belum jelas, tetapi dipercaya bahwa kekurangan durasi tidur dapat menurunkan kinerja kognitif memori jangka pendek. Namun, hasil beberapa penelitian yang sudah dilaksanakan tidak sejalan dengan teori tersebut. Penelitian ini bertujuan untuk mengetahui apakah terdapat hubungan antara durasi tidur dan memori jangka pendek, dengan harapan mendapatkan hasil yang baru dan signifikan yang sejalan dengan teori yang sudah ada. Tujuan. Mengetahui hubungan antara durasi tidur dengan memori jangka pendek pada siswa SD Al-Islam 2 Jamsaren Surakarta. Metode. Penelitian ini menggunakan studi analitik cross-sectional dengan sampel siswa tingkat sekolah dasar kelas 4-6 SD Al-Islam 2 Jamsaren Surakarta. Instrumen yang digunakan adalah kuesioner SDSC untuk mengetahui durasi tidur dan tes FDST untuk menentukan kualitas memori jangka pendek anak. Teknik analisis yang digunakan adalah uji analisis chi-square dan uji multivariat regresi logistik. Jika pada analisis bivariat terdapat lebih dari 1 variabel bebas/perancu yang signifikan (p

Latar belakang. Asma merupakan penyakit saluran napas akibat adanya peradangan kronis pada saluran napas yang sering terjadi pada anak-anak dengan prevalensi mencapai 20%. Steroid merupakan anti-inflamasi yang dinilai paling efektif dalam terapi penyakit peradangan kronis seperti asma. Akan tetapi, penelitian sebelumnya mengungkapkan bahwa steroid memiliki potensi menyebabkan penurunan kepadatan massa tulang atau osteoporosis. Tujuan. Penelitian ini bertujuan untuk menganalisis hubungan pemakaian steroid inhalasi dengan osteoporosis pada pasien asma anak. Metode. Studi observasional analitik ini menggunakan desain penelitian cross-sectional terhadap 13 pasien asma anak yang berobat di Rumah Sakit Umum Daerah Dr. Saiful Anwar, Malang, yang didapat melalui purposive sampling. Pasien asma anak yang memenuhi kriteria inklusi dalam rentang usia 5-18 tahun serta telah menjalani pengobatan steroid inhalasi minimal 3 bulan dilakukan pemeriksaan bone mass density (BMD) melalui alat dual energy x-ray absorptiometry (DXA) kemudian dicatat hasil z-score. Analisis data menggunakan metode korelasi Rank Spearman untuk variabel bebas, yaitu dosis steroid inhalasi dan durasi pemakaian steroid inhalasi dengan variabel terikat yaitu nilai z-score BMD. Hasil. penelitian ini didapatkan hubungan signifikan berkorelasi negatif kuat antara dosis steroid inhalasi kumulatif dengan nilai z-score BMD (p=0.000, r=-0.827) dan hubungan signifikan berkorelasi negatif sedang antara durasi pemakaian steroid inhalasi dengan nilai z-score BMD (p=0.043, r=-0.568). Kesimpulan. Penelitian ini menunjukkan bahwa pemakaian steroid inhalasi menyebabkan penurunan kepadatan massa tulang dan berisiko menyebabkan osteoporosis.

Latar belakang. Stunting merupakan kondisi gagal tumbuh akibat kekurangan gizi secara kronis. Di Indonesia, prevalensi stunting pada tahun 2021 adalah 24,4 persen. Kondisi prevalensi stunting di Sumatera Utara juga sangat memprihatinkan. Sebanyak 13 dari 33 kabupaten/kota yang berada di Sumatera Utara memiliki prevalensi stunting di atas 30%. Kecamatan Medan Denai adalah salah satu kecamatan di Kota Medan dengan kasus gizi buruk anak tertinggi. Salah satu faktor risiko kejadian stunting adalah tingkat pendidikan ibu. Tujuan. Penelitian ini bertujuan untuk mengetahui hubungan tingkat pendidikan dengan tingkat pengetahuan ibu tentang stunting. Metode. Penelitian analitik observasional dengan desain cross-sectional dengan sampel penelitian terdiri dari 96 responden yaitu ibu anak balita yang berdomisili dan menyekolahkan anaknya di TK/PAUD di Kecamatan Medan Denai yang memenuhi kriteria inklusi dan eksklusi. Analisis data menggunakan uji statistik chi-square. Hasil. Pada 96 responden ditemukan tingkat pengetahuan tentang stunting yang sedang (60,4%), rendah (30,2%), dan tinggi (9,4%). Hasil analisis menunjukkan terdapat hubungan yang signifikan antara tingkat pendidikan dengan tingkat pengetahuan ibu tentang stunting dengan nilai p=0,035 (p

Sindrom nefrotik merupakan penyakit ginjal yang sering ditemukan pada anak-anak, dengan insiden 1-3 per 100.000 anak di bawah usia 16 tahun. Sekitar 10-20% anak dengan sindrom nefrotik mengalami sindrom nefrotik resisten steroid (SNRS), dan 10-30% dari kasus ini disebabkan oleh kelainan genetik. Pada SNRS monogenik, terdapat dua jenis yaitu sindromik (dengan gejala ekstra-renal) dan non-sindromik (tanpa gejala ekstra-renal). Penanganan SNRS memerlukan pendekatan klinis yang berbeda tergantung pada etiologi genetiknya. Pemeriksaan genetik, termasuk gen tunggal, panel multigen, dan genomik komprehensif, dapat mengidentifikasi varian patogenik, menetapkan diagnosis yang akurat, menyesuaikan terapi (termasuk penghentian terapi imunosupresan dan pemberian terapi yang lebih spesifik) konseling genetik, serta penanganan komprehensif terhadap manifestasi ekstra-renal terkait. Oleh karena itu, pendekatan klinis yang efektif harus didasarkan pada hasil pemeriksaan genetik untuk pengelolaan yang optimal dan konseling yang lebih tepat.

Latar belakang. Pemberian ASI eksklusif mulai sejak bayi berusia 0-6 bulan pertama kehidupan, memberikan dampak positif bagi bayi dan juga ibu. Beberapa faktor seperti nutrisi ibu, frekuensi menyusui, pengetahuan ibu, dukungan keluarga, pekerjaan, dan stres yang dialami ibu dapat memengaruhi keberhasilan pemberian ASI eksklusif. Tujuan. Penelitian ini bertujuan untuk mengetahui hubungan tingkat stres pada ibu menyusui dengan keberhasilan pemberian ASI eksklusif di Puskesmas Banda Raya Banda Aceh. Metode. Penelitian ini merupakan penelitian observasional analitik dengan pendekatan cross sectional. Sampel pada penelitian ini adalah ibu yang memiliki bayi usia 6-12 bulan berjumlah 68 orang. Pengambilan sampel dengan menggunakan total sampling. Data tingkat stres ibu diperoleh dari hasil pengisian kuesioner Perceived Stress Scale (PSS-10). Hasil. Responden dengan tingkat stres ringan memberikan ASI eksklusif (84,9%). Responden dengan tingkat stres sedang mayoritas tidak memberikan ASI eksklusif (60,7%), dan responden dengan tingkat stres berat tidak memberikan ASI eksklusif (100%). Analisis data menggunakan uji korelasi Spearman Rank dengan p value sebesar 0,000 (p

Abstract Introduction The purpose of the study is to evaluate the demographic and clinical profile of patients with the diagnosis of pedi- atric traumatic cataract treated at the university clinic, and the results of treatment. Material and Methods The study was conducted with retrospective observation at the ophthalmology clinic of the Azerbaijan Medical University, the data of 24 patients were examined. Infor- mation was collected on patients' age, gender, place of residence (rural, urban), nature of trauma, time elapsed after trauma, visual acuity, causes of visual impairment, tissues damaged by trauma. Cataracts were removed and an intraocular lens was placed in all patients. The results of the treatment were evaluated according to the compli- cations that occurred during and after the operation, vis- ual acuity. Results All of the children's traumatic cataract cases in our obser- vation were associated with one or more comorbidities. The association of crystal only with corneal winter, sclera and anterior chamber damage is 16.7±7.6, respectively; 8.3±5.6; It was found in 12.5±6.7% of patients. The pres- ence of third pathology (sclera, anterior chamber) against the background of joint damage of the cornea and crystal is 8.3±5.6, respectively; It was found in 12.5±6.7% of pa- tients. Against the background of damage to the crystal, cornea and anterior chamber, the association of the fourth pathology (macular, vitreous body) was recorded in 16.7±7.6 and 12.5±6.7% of patients, respectively. Conclusion Summarizing the clinical and demographic characteris- tics of patients treated with pediatric traumatic cataract at the university clinic, the following conclusions can be drawn: the majority of patients are boys (95.8±4.1%) and are in the age range of 5-18 years, the specific weight of rural residents (75%) and urban residents 3 times more compared to; formation of traumatic cataract in children in most cases (50±10.2%) is observed within 3-6 months, the main reason for referral is corneal clouding and a sharp decrease in visual acuity; Damage to several tissues is typical for pediatric traumatic cataract, although all pa- tients have comorbidity, damage to four tissues in several variants (16.7±7.6% cornea + anterior chamber and mac- ula; 12.5±6.7% crystalline, corneal winter +anterior chamber+bone-like body; 8.3±5.6% crystal+sclera+ret- ina; 4.2±4.1% crystal+cornea+retina) is observed; treat- ment of children's traumatic cataract is observed with complications in 20.8±8.3% cases.

Bone is metabolically active tissue where bone formation and bone resorption processes occur throughout life. Bone mass consists of osteoid, mineral component, and bone cells. Bone mineralization is regulated by mineral availability, parathyroid hormone, calcitonin, growth hormone, growth factors, and vitamin D, among others. During pregnancy, fetal skeletal development is influenced by endocrine, environmental, genetic, and epigenetic factors. Advances have been made in understanding the role of enzymes, transcription factors, signaling molecules, and epigenetic mechanisms in bone metabolism. Genetic factors, such as mutations in genes COL1A1, COL1A2, LGR4, LGR6, PTK2B, WNT1, PLS3, xYLT2, SOST, WNT16, ESR1, and RANKL, Sox9, RUNx2, osterix, osteocalcin, bone sialoprotein, PTH, PTHLH, and PTHR1, play an important role in osteoblast differentiation, bone formation, and maintenance. Preterm infants, malnourished or severely ill newborns, those treated with corticosteroids or diuretics, and those lacking mechanical bone growth stimulation are at risk of metabolic bone disease. Management of metabolic bone disease is based on identifying risk factors and quantitatively assessing mineral bone density using radiological and biochemical methods. Treatment involves avoiding risk factors, optimizing nutrition, and the possibility of using medications targeting signaling pathways to increase bone formation or prevent degradation, some of which have been already used in children.

Kostnina je presnovno aktivno tkivo, v katerem se vseživljenj-sko vršijo procesi kostne izgradnje in razgradnje. Kostna masa sestoji iz osteoida, mineralnega dela in kostnih celic. Mineralizacijo kosti uravnavajo razpoložljivost mineralov, parathormon, kalcitonin, rastni hormon, rastni faktorji ter vitamin D in drugi. V nosečnosti je razvoj skeleta pri plodu pod vplivom endokrinih, okoljskih, genetskih in epigenetskih dejavnikov. Napredek znanja na tem področju pa pomeni poznavanje delovanja encimov, transkripcijskih faktorjev in signalnih molekul ter epigenetskih mehanizmov na kostno presnovo. Genetski dejavniki, kot so mutacije v genih COL1A1, COL1A2, LGR4, LGR6, PTK2B, WNT1, PLS3, xYLT2, SOST, WNT16, ESR1 in RAN-KL, Sox9, RUNx2, osteriks, osteokalcin, kostni sialoprotein, PTH, PTHLH in PTHR1, igrajo pomembno vlogo pri diferenciaciji osteoblastov, tvorbi in vzdrževanju kostnine. Tveganje za presnovno bolezen kosti imajo nedonošenčki, neustrezno prehranjeni ali hudo bolni novorojenčki, zdravljeni s kortikosteroidi ali diuretiki, in tisti, ki imajo premalo mehanske stimulacije za rast kosti. Obravnava presnovne bolezni kosti temelji na identificiranju dejavnikov tveganja in kvantitativni oceni mineralne kostne gostote z radiološkimi in biokemičnimi metodami. Pri zdravljenju se izogibamo dejavnikom tveganja, in optimiziramo prehrano. Obstaja pa možnost uporabe zdravil, ki ciljajo na signalne poti za povečanje kostne izgradnje ali preprečevanje razgradnje, pri čemer se nekatera že uporabljajo pri otrocih.

Immaculate Mandera,1 Geoffrey Ayebazibwe,2 Alex Tumusiime,1 Topher Byamukama,3 Valence Mfitumukiza,1 John Bosco Tamu Munezero,1 Timothy Nduhukire,4 Everd B Maniple3 1Department of Nursing Sciences, Kabale University, Kampala, Uganda; 2Department of Pharmacology, Kabale University, Kampala, Uganda; 3Department of Community Health, Kabale University, Kampala, Uganda; 4Department of Pediatrics and Child health, Kabale University, Kampala, UgandaCorrespondence: Immaculate Mandera, Email imandera@kab.ac.ugBackground: Globally, > 1.1 million children had tuberculosis (TB) and > 214,000 died in 2022. The integration of pediatric TB screening should help in the identification and management of cases among children attending clinics at entry points. This study aimed to establish the extent of integrating pediatric TB screening into mainstream childcare activities and the factors affecting integration of TB screening among children.Methods: A cross-sectional design using both quantitative and qualitative methods. Simple random sampling was used to select and observe 40 participants for integration of TB screening in the routine assessment of children. Twenty key informants were interviewed and two focus group discussions conducted on the integration of pediatric TB screening.Results: Of the 302 children assessed, only 41.1% underwent pediatric TB screening integrated in their assessment. A binary logistic regression model using Wald chi-square showed that a cadre having worked at outpatient department (OPD) and young child clinic (YCC) significantly affected integration, with a p-value of 0.002 and 95% CI (1.040– 1.152) and a p-value of 0.002 and 95% CI (1.000– 1.519). Participants who had 3 to 5 years in service were 7.05 times more likely to integrate pediatric TB screening at the OPD and Cadres who had over 6 years in service were 6.32 times more likely at the YCC. Being a nurse or a midwife was associated with an increased likelihood of integrating pediatric tuberculosis screening. Knowledge, skills, and confidence gaps in screening and assessing for tuberculosis in children among staff and lack of necessary logistics were identified barriers.Conclusion: The integration of pediatric TB screening in routine assessments at the OPD/YCC was low. Focus more on HC IIIs to improve health workers’ involvement and capacity to integrate TB screening at entry points in health facilities and provide logistics.Keywords: Pediatric, tuberculosis, integration and screening

Introduction: Patients with sickle cell disease exhibit different patterns in pulmonary function tests. In particular, there is little evidence on the fractional exhaled nitric oxide (FeNO) test, and its value ranges and its interpretation in these patients have been under debate in recent years. Methods: We conduced a cross-sectional, observational and descriptive study between November 2021 and January 2023 including patients aged 6–18 years with sickle cell disease able to perform the FeNO test. We applied the GLI-2012 reference values and the ERS/ATS standards. We defined statistical significance as P < 0.05. Results: The sample included 43 patients with a median age of 12 years (IQR, 10−15). We did not find an association between significantly elevated FeNO (≥25 ppb) and the diagnosis of asthma (P = 0.37), an obstructive pattern in spirometry (P = 0.67), a positive bronchodilator test (P = 0.53), clinical bronchial hyperreactivity in the context of cold or flu-like symptoms (P = 0.48), cough with exercise (P = 0.42) or nocturnal cough (P = 1.0), but found an association with peripheral eosinophilia (P < 0.01). Conclusions: We found no association between FeNO values and the classic features of asthma (clinical or spirometric) in patients with sickle cell disease. Therefore, airway inflammation mechanisms are probably different in these patients. Resumen: Introducción: Los pacientes con enfermedad de células falciformes presentan diferentes patrones en el estudio de función pulmonar. En concreto, el FeNO ha sido poco estudiado y sus valores e interpretación en estos pacientes han sido objeto de debate en los últimos años. Material y métodos: Estudio observacional, descriptivo y de corte transversal realizado entre noviembre de 2021 y enero de 2023 que incluye a pacientes de 6 a 18 años con enfermedad de células falciforme capaces de realizar el examen de FeNO. Se utilizaron valores de referencia GLI-2012 y estándares de ERS/ATS. Significación p