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Introduction: Since it is necessary to detect changes in lung function for the follow-up of the patients with respiratory and functional complications caused by COVID-19, in this study, we decided to examine the results of spirometry in children over 5 years old with Covid-19. Methods: In this cross-sectional study, 52 over-five-year-old children, hospitalized due to COVID-19 for at least six past months, were examined. The participants’ demographic information, respiratory symptoms, underlying diseases, severity of COVID-19 according to WHO, severity of lung involvement in CT scan, type of lung involvement, oxygen saturation at admission as well as FEV1, FVC, and FEV1/FVC were collected and analyzed, the results were analyzed using SPSS version 16 software and t-test and Chi-square tests. Results: Of all investigated patients،, 26 were boys (50%) and 38 (73.1%) were 5-12 years old. The minimum age of the children was 5 years and the maximum was 18 years. The mean age of children was 3.41±10 years. The FEV1/FVC ranged from 61% to 79% in five patients (9.6%) and from 80% to 100% in 47 patients (90.4%). The FEV1 was lower than 80% in 28 and higher than 80% in 24 patients. FEV1/FVC had no significant relationship with the participants’ age, gender, clinical manifestations, and disease severity in terms of pulmonary involvement, but it had a significant association with blood oxygen saturation level (P: 0.001). Conclusion: The changes in pulmonary function tests vary in different months following contamination with COVID-19. In the present study, 9% of the patients, who were examined in the sixth month after infection, had abnormal pulmonary function test results. Based on the findings, the pulmonary function test results had no significant relationship with the patients’ age, gender, and clinical symptoms, while it was significantly associated with their blood oxygen saturation intensity.

Abstract Background Matrix metalloproteinase-7 (MMP-7) is associated with biliary injury. This study aimed to evaluate the relationships of serum MMP-7 with clinical characteristics in choledochal cysts (CDC) children. Methods Between June 2020 and July 2022, we conducted a prospective study of CDCs who underwent one-stage definitive operation at our center. Serum MMP-7 was measured using an enzyme-linked immunosorbent assay. We evaluated the relationships between serum MMP-7 and age, laboratory tests, imaging examinations, liver fibrosis, MMP-7 expression, and perforation. Results A total of 328 CDCs were enrolled in the study, with a median serum MMP-7 of 7.67 ng/mL. Higher serum MMP-7 was correlated with younger age at diagnosis (p

Chenlu Wang,1,2 Lanxin Li,1,2 Gang Xiao,1– 3 Yuanyuan Chen,1,2 Yingshuo Wang,1,2 Zhimin Chen,1,2 Yunlian Zhou1,2 1Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 2National Clinical Research Center for Child Health, Hangzhou, Zhejiang, People’s Republic of China; 3Department of Pediatrics, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, People’s Republic of ChinaCorrespondence: Yunlian Zhou; Zhimin Chen, Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, No. 3333. Binsheng Road, Hangzhou, Zhejiang, People’s Republic of China, Email zhouyunlian@zju.edu.cn; zmchen@zju.edu.cnPurpose: To explore the clinical characteristics, treatment, and long-term prognosis of mycoplasma pneumoniae pneumonia (MPP) combined with pulmonary embolism (PE) in children.Patients and Methods: The medical records of 16 children who were diagnosed with MPP associated with PE between January 2016 and January 2023 at Children’s Hospital, Zhejiang University School of Medicine were retrospectively reviewed.Results: The average age patients were 8.24 ± 1.99 years. All cases were diagnosed with refractory mycoplasma pneumoniae pneumonia (RMPP) and presented complications in the form of necrotizing pneumonia (NP). The main symptoms observed were cough and fever (n = 16, 100%), chest pain (n = 8, 50%), dyspnea (n = 8, 50%), and hemoptysis (n = 4, 25%). In these cases, 12 patients had involvement of the pulmonary artery, 3 patients experienced issues with the pulmonary vein, and 1 patient had simultaneous involvement of both the pulmonary artery and pulmonary vein. Among the 12 pulmonary artery embolism cases, 6 involved the right pulmonary artery, 4 involved the left pulmonary artery, and 2 involved both the right and left pulmonary arteries. The mean D-dimer level was 8.50 ± 4.76 mg/L. All patients received anticoagulant therapy, and after treatment, there was a significant improvement in their symptoms and lung lesions.Conclusion: Children with RMPP, chest pain, hemoptysis, and elevated D-dimer levels should be closely monitored for the potential development of PE. The co-occurrence of MPP and PE often involves the presence of NP. In cases of confirmed PE, anticoagulation therapy may be a suitable consideration. PE and NP resulting from MPP generally had a favorable overall prognosis.Keywords: mycoplasma pneumoniae, pulmonary embolism, necrotizing pneumonia, children

Background: Progressive respiratory muscle weakness and ineffective cough contribute to morbidity and mortality in children with neuromuscular disorders (NMD). Inspiratory muscle training (IMT) aims to preserve or improve respiratory muscle strength and reduce respiratory morbidity. This study aimed to determine the safety and efficacy of IMT in children with NMD. Methods/design: A randomised cross-over study compared a 3-month intervention (IMT) with control periods (no IMT). Children diagnosed with NMD (5 years – 18 years) performed 30 breaths (at 30% of maximum inspiratory mouth pressure [Pimax]) with an electronic threshold device, twice daily. During the control period, participants did not perform any IMT. Discussion: Twenty three children (median [interquartile range {IQR}] age of 12.33 [10.03–14.17] years), mostly male (n = 20) and non-ambulant (n = 14) participated. No adverse events related to IMT were reported. No difference in median patient hospitalisation and respiratory tract infection (RTI) rates between non-training and intervention periods (p = 0.60; p = 0.21) was found. During IMT, Pimax and peak cough flow improved with a mean ± standard deviation (s.d.) of 14.57 ± 15.67 cmH2O and 32.27 ± 36.60 L/min, compared to 3.04 ± 11.93 cmH2O (p = 0.01) and −16.59 ± 48.29 L/min (p = 0.0005) during the non-training period. Similar to other studies, spirometry did not show a significant change. Conclusion: A 3-month IMT programme in children with NMD appears safe and well-tolerated, with significant improvement in respiratory muscle strength and cough efficacy. Clinical implications: Inspiratory muscle training could be considered a cost-effective adjunct to respiratory management in children with NMD. Trial Registration: Pan African Clinical Trial Registry, PACTR201506001171421, https://pactr.samrc.ac.za.

Recent years have seen an increase in the prevalence of cardiac arrhythmias and conduction disorders in children, which are not always diagnosed in time. In order to verify the nature of arrhythmias in pediatrics as well as in therapy, an accessible and informative method of daily Holter ECG monitoring (DHECGM) is widely used. Aim of the study was to assess the practical value of DHECGM in the algorithm for diagnosing heart rhythm and conduction disorders in pediatric patients. Materials and Methods: Analysis of DHECGM was performed in 48 children who were hospitalized in the pediatric department of the Specialized Pediatric Care Center (SPCC) of the Poltava Regional Clinical Hospital (PRCH) in 2022-2023. Research results. Sinus tachyarrhythmia or bradyarrhythmia, wandering atrial pacemaker was detected in half of the patients studied. Supraventricular and/or ventricular extrasystoles were detected in 87.5 % of children. Bi-, tri- and quadrigeminy were observed in 14 (27.1 %) of the patients. First or second degree sinoatrial block was observed in 25 % of patients. Atrioventricular block of 1st or 2nd degree (Mobitz type) with Wenkenbach- Samoilov periods was observed in 8 patients (16.6 %). Combined rhythm and conduction disturbances were observed in 82.3 % of the children studied. The article is illustrated by clinical cases of cardiac rhythm and conduction disorders in children of diff erent ages. Conclusions: DHECGM has broad capabilities for diagnosing cardiac rhythm and conduction abnormalities, allowing early detection of arrhythmias in pediatric patients and providing personalized recommendations.

The eruption of permanent teeth in children is a complex physiological process that is important for the development of the dentoalveolar system. The timing of eruption is a key indicator of biological age and prenosological diagnosis of children’s health. The need to update research on this topic is due both to changes in society and the importance of modern data for pediatric dentistry and public health. The aim of the study was to determine the regional characteristics of the terms of eruption of permanent teeth in early mixed dentition among children of Odesa. Material and methods. Dental examination was performed on children aged 4 to 8 years of both sexes. The examination was performed according to the generally accepted methodology, using standard dental instruments included in the examination kit. The children were divided into groups according to age and sex. Patients were examined on the basis of age and period of teeth eruption. Results. The results of the study of the eruption of the permanent teeth of the upper and lower jaws in children aged 4.5-8.5 years in Odesa indicate an earlier eruption of the permanent teeth in girls. Thus, in girls the eruption of the first permanent molars began at the age of 4.5 years and ended at the age of 6 years. In boys, the age of onset of fi rst molar eruption was 5 years and the age of completion was 6.5 years. It was found that the timing of the beginning and the end of the eruption of the central permanent incisors of the upper jaw was the same in boys and girls (6 years), but the average duration of eruption was different. The timing of the beginning and end of eruption of the upper lateral incisors was identical in boys and girls. However, diff erences in the average terms of eruption of permanent upper lateral incisors were obtained. The analysis of the results of the terms of eruption of the central permanent incisors of the lower jaw in boys and girls shows the same terms of beginning of eruption and average terms of eruption of these teeth. However, there were diff erences in the time of the end of eruption. The beginning of the eruption of the permanent central incisors of the upper jaw was noted earlier (at the age of 6 years) than the data given in the modern dental manuals of Ukraine and was completed at the age of 8 years. The age of the beginning and the end of eruption was one year earlier than the generally accepted data. The data on the time of eruption of the fi rst permanent molars and incisors obtained as a result of the study are necessary for planning programs for prevention of dental caries in children in the period of early replacement dentition. The data obtained as a result of the study indicate the need for further epidemiological studies in other regions of Ukraine in order to establish the current national norms for the eruption of permanent teeth in children. Conclusion. The discrepancy between the dates of eruption of permanent incisors and molars in Odesa children and the standard dates of eruption of teeth was revealed, which indicates the need to clarify them in each region. Gender diff erences were found – earlier eruption of permanent teeth in girls. The data of the conducted research substantiate the necessity to revise the terms of caries prophylaxis in Odessa children and the necessity to conduct in-depth examination of children with violation of the terms of teeth eruption.

Background: In Iran, there is a lack of information and studies on acute rheumatic fever (ARF), a global health issue. The limited understanding of ARF's prevalence and primary clinical symptoms has led to confusion. This research investigates the characteristics of children aged 3-17 years who experience ARF with monoarthritis as their initial symptom. Methods: A retrospective evaluation of medical records of children diagnosed with ARF was conducted. The study aimed to determine the prevalence of monoarthritis as the first manifestation of ARF and its association with age, gender, family history, and cardiac involvement. Categorical variables were analyzed using the chi-square test with a significance level of < 0.05 and a confidence interval of 95%, using SPSS software (Version 23). Results: The study included 62 patients with ARF, comprising 41 (66.1%) boys with an average age of 8.48±3.27 years. Among these patients, 12 exhibited cardiac involvement according to the revised Jones criteria, with 5 clinical carditis and 7 cases of subclinical carditis. Monoarthritis was the initial symptom in seven patients (11.29%); five (71.4%) also had carditis. There was a significant association (p

Bogus&lstrok;awa Orzechowska-Wyl&eogon;ga&lstrok;a,1 Adam Wyl&eogon;ga&lstrok;a,2 Jolanta Zalejska Fiolka,3 Zenon Czuba,4 Michal Toborek5 1Department of Pediatric Otolaryngology, Head and Neck Surgery, Chair of Pediatric Surgery, Medical University of Silesia (SUM), Katowice, Poland; 2Health Promotion and Obesity Management, Department of Pathophysiology in Katowice, SUM, Katowice, Poland; 3Department of Biochemistry Faculty of Medical Science in Zabrze, SUM, Katowice, Poland; 4Department and Division of Microbiology and Immunology in Zabrze, SUM, Katowice, Poland; 5Department of Biochemistry and Molecular Biology, University of Miami, School of Medicine, Miami, FL, USACorrespondence: Bogus&lstrok;awa Orzechowska-Wyl&eogon;ga&lstrok;a, Email borzechowska-wylegala@sum.edu.plAim: Saliva contains various proteins that are important in developing inflammatory processes and their prevention. One key aspect of saliva research is the relationship between oral infections and inflammation, and the role of some salivary proteins.The Work Aims: To demonstrate which salivary cytokines can be biomarkers of acute odontogenic oral and facial infections in children.Material and Methods: The study included two groups of patients: a study group of 28 children: 7 girls and 21 boys aged 3 − 17 years with acute dentofacial inflammation (DI) and a control group of 52 children: 16 girls and 36 boys aged 4– 17 years with uncomplicated dental caries (CE). The levels of Interleukin-5 (IL-5), Interleukin − 10 (IL-10), Interleukin-17A (IL-17A), Interleukin-12p70 (IL-12p70), Eotaxin, Rantes, Vascular Endothelial Growth Factor (VEGF), and Interferon gamma-induced protein 10 (IP10) in the saliva of children in DI and CE groups were compared. Statistical analysis was performed with Statistica 13. The Student’s t-test and the Wilcoxon signed-rank test were used.Results: The results show that IL-10, IL-17A, and Eotaxin showed a statistically significant increase in the DI group compared to the CE group. The significance level for IL-10 was p=0.02, for IL-17A was equal to Eotaxin and p=0.04. The other measured parameters did not differ statistically significant between the two groups.Conclusion: IL-10, IL-17A, and Eotaxin can be used as potential biomarkers for tooth-related inflammatory states of the oral cavity and face in children. These biomarkers can be useful in identifying and monitoring the presence of inflammation in the oral cavity and face.Keywords: salivary cytokines and chemokines, odontogenic oral and facial inflammation, children

Xiaolu Li,1,&ast; Yizhong Wang,1,2,&ast; Rong Cao,1 Fangfei Xiao,1 Xufei Wang,1 Lin Ye,1 Yongmei Xiao,1 Dan Li,1 Ting Zhang1,2 1Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 2Gut Microbiota and Metabolic Research Center, Institute of Pediatric Infection, Immunity and Critical Care Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yizhong Wang; Ting Zhang, Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, 355 Luding Road, Shanghai, 200062, People’s Republic of China, Tel/Fax +86 2152976335, Email wangyz@shchildren.com.cn; zhangt@shchildren.com.cnBackground: Our previous study reported a high rate of recurrence in children with Clostridioides difficile (C. difficile) infection (CDI) after conventional antibiotic therapy. Here, we aimed to explore whether metronidazole and vancomycin resistant C. difficile isolates are circulating in pediatric CDI.Methods: Antimicrobial susceptibility testing (AST) using the agar dilution method according to the Clinical and Laboratory Standard Institute (CLSI) were performed on C. difficile isolates collected from children with CDI between 2019 and 2022 at the Shanghai Children’s Hospital. Whole-genome sequencing (WGS) was performed on all C. difficile isolates, and the presence of antibiotic resistance genes (ARGs) were identified using Resfinder and the Comprehensive Antibiotic Resistance Database (CARD). The presence of plasmid pCD-METRO was detected using SRST2 (v0.2.0) against 8 pCD-METRO coding sequences.Results: A total of 50 C. difficile isolates were collected from stools of CDI children. The overall resistance rate on all isolates was 30.00% for metronidazole, 6.00% for vancomycin, 0% for rifaximin, 2.00% for rifampin, 24.00% for meropenem, 100.00% for ceftriaxone and clindamycin, 86.00% for erythromycin, 30.0% for levofloxacin, and 50.0% for tetracycline. Multidrug-resistant (MDR) was presented in 44 isolates (88.00%). Sixteen reported potential ARGs relating with resistance to antibiotic classes of aminoglycoside (AAC(6’)-Ie-APH(2”)-Ia, aad(6), ANT(6)-Ib, APH(2”)-If, APH(3’)-IIIa), lincosamide-clindamycin-erythromycin (ErmB, ErmQ), fluoroquinolones (CdeA), glycopeptides (vanRG), nucleoside (SAT-4), tetracycline (tetM, tetA(P), tetB(P), tetO), and trimethoprim (dfrF) were identified. However, the pCD-METRO plasmid and vanA/B were not detected in any isolates.Conclusion: C. difficile isolates from children with reduced susceptibility to metronidazole and vancomycin are emerging in pediatric CDI in China. The lack of pCD-METRO plasmid and vanA/B associated with reduced antibiotic susceptibility suggests there are additional mechanisms of resistance.Keywords: Clostridioides difficile, antibiotic resistance, metronidazole, vancomycin, children

Ming Zhang,1,&ast; Feng Chen,2,&ast; Shaoguang Feng,3,&ast; Xu Liu,4 Zhen Wang,5 Nan Shen,6 Lingjian Meng,7 Dongsheng Zhu,1 Zhitao Zhu8 1Department of Pediatric Surgery, The First People’s Hospital of Lianyungang, Lianyungang, People’s Republic of China; 2Department of Pediatric, Luodian Hospital, Shanghai, People’s Republic of China; 3Department of Pediatric Surgery, The Children’s Hospital of Hangzhou, Hangzhou, People’s Republic of China; 4Department of Pediatric Surgery, The Children’s Hospital of Xuzhou, Xuzhou, People’s Republic of China; 5Department of Pediatric, the Maternal and Child Health Hospital of Zibo, Zibo, People’s Republic of China; 6Department of Pediatrics, Suqian Hospital Affiliated to Xuzhou Medical University, Suqian, People’s Republic of China; 7Department of Pediatrics, Hospital Affiliated to Xuzhou Medical University, Xuzhou, People’s Republic of China; 8Department of Radiology, The Second People’s Hospital of Lianyungang, Lianyungang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhitao Zhu; Dongsheng Zhu, Email zhuzhitao621@126.com; zhudongsheng@tmu.edu.cnObjective: To investigate the role of FBLN5in renal clear cell carcinoma (KIRC), in particular on the tumor’s immune microenvironment, including children and young adults.Methods: FBLN5 expression in tumor and normal samples was explored using SangerBox, TIMER2.0, GEPIA, UALCAN, HPA databases. The Linkedomics database was used to obtain FBLN5 co-expressed genes in KIRC tissue. SangerBox was also used to estimate immune infiltration of FBLN5 in KIRC. The Kaplan-Meier plotter was used to investigate the survival effects of FBLN5 expression in the presence of immune infiltration. We then collected 48 cases from 7 hospitals over a-20 year period to calculate the impact of FBLN5 on the prognosis of children and young adults with KIRC.Results: FBLN5 expression was significantly reduced in KIRC tissue compared to normal adjacent tissue. FBLN5 was potentially involved in the immune-related biological processes. In addition, FBLN5 expression has been linked to a number of immune checkpoints, cytokines, chemokines and chemokine receptors in KIRC. At the same time, the expression of FBLN5 affected the survival rates differently in KIRC patients with high or low levels of immune infiltration. High expression of FBLN5 in children and young adults with KIRC was associated with a favorable prognosis.Conclusion: This study shed light on the potential of FBLN5 as a prognostic marker in children and young adults with KIRC and as an immune-related target for clinical treatment.Keywords: FBLN5, immune microenvironment, prognostic biomarker, kidney cancer, children

A clinical observation of a child with a severe combined defect of the reproductive system and reproductive system (cAKuT syndrome) is presented. cAKuT syndrome accounts for more than 20% of birth defects. congenital anomalies of the urinary system account for 40–50% of cases of end-stage renal disease in children and 7% in adults worldwide. early diagnosis and treatment of cAKuT syndrome in children is one of the most important tasks of pediatric nephrology at present. It is necessary to monitor the course of the disease and assess the rate of development of unfavorable outcomes of chronic kidney disease. clinical observation of cAKuT syndrome is to optimize the therapeutic tactics of the underlying disease and reduce the disability of the child population.

Irene Paraboschi,1 Michele Gnech,1 Dario Guido Minoli,1 Erika Adalgisa De Marco,1 Giovanni Parente,2 Guglielmo Mantica,3,4 Vincenzo Bagnara,5 Gianantonio Manzoni,1 Marc-David Leclair,6 Alfredo Berrettini1 1Department of Pediatric Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy; 2Department of Pediatric Surgery, ASST Papa Giovanni XXIII Hospital, Bergamo, 24127 Italy; 3IRCCS Ospedale Policlinico San Martino, Genoa, Italy; 4Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genoa, Genoa, Italy; 5Department of Pediatric Surgery, Policlinico G.B.Morgagni, Catania, Italy; 6Chirurgie Infantile, CHU de Nantes, Nantes, FranceCorrespondence: Guglielmo Mantica, Consultant Urologist, Dirigente Medico, IRCCS Ospedale Policlinico San Martino, Genova, Italy, Email guglielmo.mantica@gmail.comAbstract: The vascular supply of the pelvic structures and the external genitalia can be easily injured during the one-stage delayed bladder closure and radical soft-tissue mobilization (Kelly procedure) for bladder exstrophy surgical repair. Aiming to help surgeons assessing and confirming tissue perfusion and viability, indocyanine green (ICG)-based laser angiography was incorporated into the operative approach to reduce the risk of ischemic injuries. The EleVision IR system (Medtronic Ltd) was adopted to confirm the identification of the vascular pedicles and assess the tissue perfusion in real-time in a 5-month-old with bladder exstrophy undergoing the one-stage delayed bladder closure and radical soft-tissue mobilization (Kelly procedure). ICG (0.15 mg/kg) was intravenously administered at 6 key steps during surgery with the ability to be re-dosed every 15 minutes. ICG-based laser angiography helped to confirm the correct identification of the vascular structures during surgery and to assess tissue perfusion in real-time. Blood flow did not change considerably after initial dissection or upon approximating the pubis symphysis. At the end of the procedure, good penile perfusion was shown, proving that no direct injury or substantial compression of the pudendal vessels had occurred following the mobilization and the reconstructive phase. ICG-based laser angiography proved to be safe, effective, and easy to employ and should be considered as a reasonable adjunct for tissue perfusion assessment and operative decision-making in patients undergoing bladder exstrophy Kelly repair.Keywords: bladder exstrophy, radical soft-tissue mobilization, fluorescence-guided surgery, indocyanine green, children

Aim of the study Chronic kidney disease (CKD) is a complex pathology with an increased prevalence worldwide, described by a progressive and irreversible alteration of renal function. This study evaluates the correlation between the oral health status of children with chronic kidney disease and their general health. Material and methods A review of basic science and clinical studies was made, using PubMed, Web of Science and Google scholar databases. The search included key words like: chronic kidney disease, chronic renal failure, general health, oral health, children. Results The general health status of children with CKD is altered in different degrees of severity, according to the disease’s stage. Oral manifestations associated with these stages vary from salivary changes, mucosal lesions, gingivitis, enamel defects or even fluorosis. Conclusions Considering the important changes of oral health status in children suffering from chronic kidney disease, an interdisciplinary approach of these patients is necessary, with a tight collaboration between the paediatric dentist and paediatric nephrologist.

Introduction: Despite efforts for improvement of oral health in the world during recent years, dental caries remained one of the most common chronic diseases in the childhood. One of the most important factors that can play a significant role in the success of oral health promotion programs is the adherence and collaboration of non dental staff of pediatric health providers such as pediatricians. The present study aimed to evaluate pediatricians’ knowledge and practice regarding oral health and its related factors. Materials and Methods: In this cross-sectional descriptive-analytical study conducted in 2020, 90 pediatricians that were working in Tehran city participated. A newly designed valid and reliable questionnaire comprised of three sections of demographics (8 questions), knowledge (30 questions) and practice (8 questions) was provided to the participants. The knowledge questions consisted of five domains about primary teeth (8 questions), dental visits (3 questions), dental caries determinants (8 questions), eating habits (7 questions), and fluoride (4 questions). Data analysis was performed using SPSS software version 22. The significance level was considered to be less than 0.05 (p

Nowadays in the educational classrooms there are children who have some difficulty in their learning. Generally, these cases are overlooked because they are thought to be somewhat slow to understand. However, there are cases of dyslexia, dyscalculia or dysgraphia disorder within the classroom. These disorders cause some problems such as the physical act of being able to write, difficulty in reading, difficulty in making sense of mathematics. Therefore, propose the implementation of a Web site to help children suffering from these disorders to improve their learning. The purpose of the website is to help them through the recreational and didactic games presented. In addition, educational materials are available in PDF format for quick and easy printing. Also, you can find graphical reports on the student's continuous improvement. On the other hand, it is also proposed the implementation of a forum in which parents can resolve their doubts regarding these disorders. Thus, they can be connected on any device, whether tablet, laptop, computer, smartphone or other. Therefore, the research involves the implementation of a Web Application that will benefit the child in his school learning.

cystic fibrosis is a chronic, genetic, systemic disease, the pathogenesis of which is based on a defect in the apical transporter of chlorine ions, which leads to pathological thickening of mucus and its accumulation in the lumen of hollow organs, mainly bronchi, pancreas and others. Among genetic diseases, cystic fibrosis is quite common. In this regard, since 2007 in the territory of the russian Federation, all newborns are screened for cystic fibrosis. neonatal screening makes it possible to establish a diagnosis at an early stage, which significantly improves the further prognosis. However, not all patients manage to confirm the diagnosis from birth. This clinical case shows how late diagnosis of the disease leads to the development of severe complications and deterioration of the prognosis.

Whooping cough is a highly contagious respiratory disease. despite ongoing vaccination, the disease is endemic in developing and developed countries. newborns and children who are not vaccinated or partially immunized become most severely ill. The severity of symptoms depends on factors such as the patient's age, the strength of the immune response, and the degree of systemic bacterial dissemination. The most severe form of pertussis is malignant pertussis, which is characterized by large leukocytosis, refractory hypoxemia, pulmonary hypertension and cardiopulmonary impairment. This article is devoted to the clinical observation of a patient with a malignant course of whooping cough.

This research aims to determine how the government implements policies for protecting and developing children in Makassar City. The research method used is qualitative to examine the relationship between variables. Data collection techniques include interviews and documentation. The data analysis technique follows the steps outlined in the theories of Miles, Huberman, and Saldana, which involve data condensation, data presentation, and drawing conclusions or verification. The research findings based on interviews and observations indicate that the implementation is not efficient and effective in terms of human resources. According to Edwards III's theory, efficient and effective implementation requires sufficient resources. Therefore, Makassar Mayor Regulation Number 45 of 2020, which aims to provide support for street children, has not been fully optimized because the Department of Women's Empowerment and Child Protection still needs more optimized resources, especially in terms of budget allocation. However, when considering the indicators of communication, disposition, and bureaucratic structure, the implementation is deemed fairly effective, as all four dimensions are functioning as intended.

Reversible pulmonary artery banding (rPAB) was proposed as an innovative therapy for young children with end-stage heart failure due to dilated cardiomyopathy (DCM). We report our early experience with rPAB in 2 infants with DCM and preserved right ventricle (RV) function to evaluate the effectiveness of this treatment. Pre- and postoperative echocardiography included standard evaluation of right (RV) and left (LV) ventricle global systolic function. Moreover, we applied the LV global longitudinal strain for better analysis of LV systolic function. During 15 months of follow-up, clinical and echocardiographic improvement was observed. Our early experience indicates that rPAB may be an effective alternative to heart transplantation or recovery in selected children with DCM.

The aim of the study is to investigate the effect of family upbringing methods on the formation of health awareness in children by examining the correlation between family upbringing methods and dimensions of health awareness. The research adopts a correlational methodology and includes the development of a scale for family upbringing methods consisting of 20 items distributed among four styles and a scale for health awareness consisting of 15 items distributed among three dimensions. These scales are applied to a random sample of 80 male and female respondents. One of the key findings of the research is the lack of a statistically significant correlation between authoritarian, democratic, and neglectful family upbringing styles and the level of health awareness in children. However, there was a statistically significant relationship between the overprotective style of upbringing and the level of health awareness in children who are subjected to it. The results also showed no statistically significant differences in the sample's responses based on variables such as gender, age, and birth order within the family. Doi: 10.28991/HEF-2023-04-02-05 Full Text: PDF

Background: Idiopathic nephrotic syndrome (INS) is one of the chronic diseases in children and it is important to identify its related factors. The present study aimed at investigating the relationship between H. pylori infection and the incidence and recurrence of idiopathic nephrotic syndrome in children. Methods: The total number of case participants was 40 and the total number of control participants was 41. Based on the number of cases of nephrotic syndrome (NS), the same number of healthy children of the same age and gender were selected as the control group. The information and data collected include demographic characteristics of patients, duration of disease, number of recurrences, blood pressure and blood excretion in urine, height, and weight, and presence of gastrointestinal symptoms on the checklist. The data were entered into SPSS and analyzed at a significance level of 05. Results: From 81 participants in the study, 11 (13.75%) cases were H. pylori positive, of whom 7 (17.5%) cases were in the control group and 4 (10%) cases were in the patients’ group. There was no significant difference between the two groups in terms of H. pylori infection rate (P = 0.863). Moreover, there were no significant differences between the patients suffering from the nephrotic syndrome in terms of height, weight, blood pressure, hematuria, duration and recurrence of the disease (p>0.05). Conclusion: According to the evaluations performed in the present study, there was no relationship between low birth weight, blood pressure, disease duration, and disease recurrence with NS.

Introduction. Persistent postsurgical pain (PPSP) or chronic postsurgical pain (CPSP) is recognized as a relevant postoperative complication. Inadequate pain management in the early postoperative period may contribute to the development of hyperalgesia and the use of local anesthetics in regional anesthesia can help in its treatment and prevention. The aim of the study was to study the eff ectiveness of regional analgesia techniques in preventing PPSP and hyperalgesia in children after anterior abdominal wall surgery and to assess quality of life (QoL) using the Cognitive Functioning Scale. Material and Methods. The study included 87 children at the age of 7-18 years who underwent anterior abdominal wall surgery with diff erent anesthetic techniques. Group I included 27 children who underwent anterior abdominal wall surgery under general anesthesia using the transversalis fascia plane block (TFPB), combined with the quadratus lumborum block 4 (QLB-4). Group II comprised 33 children who underwent anterior abdominal wall surgery under general anesthesia using fentanyl. Group III consisted of 27 children who underwent anterior abdominal wall surgery under general anesthesia using the TFPB. General anesthesia included either inhalation anesthesia or propofol infusion. The control group included 30 healthy children whose cognitive functioning was assessed. All clinical and laboratory studies were conducted in accordance with the World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects”. According to the Law, prior to a subject’s participation in the study, a written informed consent form was signed by each subject (parents/adult guardians). The manuscript was approved by the Ethics Committee of the Communal Non- Profi t Enterprise “Ivano- Frankivsk Regional Children’s Clinical Hospital of Ivano-Frankivsk Regional Council”, as evidenced by an Excerpt from the Minute of the Committee Meeting No. 2 dated February 24, 2022. The results obtained were statistically processed using statistical measures of variation, correlation analysis, Student’s t-test. Diff erences were considered statistically signifi cant at p

Background: Low physical activity (PA) participation levels and increasing non-communicable diseases in children are concerning in South Africa and globally. Objectives: We sought to assess the mediating role of perceived social support factors on the relationship between PA enjoyment and PA levels among rural, peri-urban and urban school children. Method: A cross-sectional study was adopted to assess peer, family and teacher encouragement as mediators on the relationship between perceived PA enjoyment and perceived physical activity participation among children, using the Physical Activity Questionnaire for Older Children (PAQ-C). The sample comprised a random sample of primary school learners aged 9–14 years. Results: The sample consisted of 870 primary school learners with a mean age of 11.0 ± 1.49 years. Most participants were girls (n = 519; 59.7%). The findings suggest low levels of perceived PA participation (mean = 2.33, standard deviation [s.d.]: 0.43). Peer (β = 0.0187, 95% confidence interval [CI]: 0.0088, 0.0307), family (β = 0.0280, 95% CI: 0.0155, 0.0425) and teacher (β = 0.0242, 95% CI: 0.0127, 0.0378) encouragement partially mediates the relationship between perceived PA enjoyment and perceived PA participation. Family encouragement (β = 0.0158, 95% CI: 0.0017, 0.0311) has the most considerable mediating effect, followed by teacher encouragement (β = 0.0125, 95% CI: 0.0010, 0.0269). Conclusion: The findings demonstrated low levels of perceived PA participation in school learners. Therefore, we recommends including social factors as mediators in PA intervention programmes in primary schools. Clinical implications: Social support factors as mediators on the relationship between PA enjoyment and PA participation among children may improve children’s PA participation levels and help prevent non-communicable diseases in future.

Serum ferritin is one of the most widely used laboratory tests and is associated with both iron deficiency and iron overload. Currently, more and more attention is paid to the involvement of ferritin in processes other than iron metabolism. Low serum ferritin is unanimously associated with iron deficiency, while elevated serum ferritin may be a consequence of various medical conditions such as iron overload, an inflammatory process, SARS-CoV-2, organ failure, cancer, and endocrine disorders, including metabolic syndrome. We present a review of the literature on the role of ferritin in a variety of less obvious disease states in children.

Background and Objective: Urinary reflux is the most common urological abnormality in children. About half of the children with urinary infection have urinary reflux at the same time. Considering the importance of urinary reflux in children and contradictory results reported regarding the relationship between different grades of vesicoureteral reflux and recurrent urinary tract infection, this study was conducted with the aim of comparing recurrent urinary tract infection in children with different grades of vesicoureteral reflux. Methods: This cross-sectional study was conducted on 150 children with pyelonephritis and vesicoureteral reflux who refered to Amirkola Children's Hospital in 2011-2019. Reflux grades were determined by voiding cystourethrogram (VCUG) or direct radionuclide cystography (DRNC). Children were followed up for 2 years and in case of clinical symptoms with positive urine culture, they were considered as recurrent urinary tract infection. Findings: Of the 150 children studied, 126 (84%) were girls and 24 (16%) were boys with a mean age of 27.17±11.53 months. 95 people (63.3%) had once, 37 people (24.7%) twice, 8 people (5.3%) three times, and 10 people (6.7%) four times experience of recurrent urinary tract infection. The odds ratio of recurrent urinary tract infection was more than two times higher in children with grade 3 and 4 reflux involvement than in children with grade 1 and 2 reflux (OR=3.20, 95% CI=1.05-9.75, p=0.041). However, there was no significant difference in recurrent urinary tract infection in children based on age at diagnosis, gender, and whether the reflux was unilateral or bilateral. Conclusion: The results of the study showed that children with moderate and severe involvement of vesicoureteral reflux experience higher recurrent urinary tract infection compared to mild involvement.

Introduction: Accidental ingestion of caustic substances can cause serious damage to the digestive system. This study was conducted with the aim of investigating the incidence of esophageal stricture within one year after accidental ingestion of caustic substances and its relationship with the first endoscopic findings in children. Methods: The present study was a retrospective and cross-sectional study that has been conducted for 3 years on children with accidental ingestion of caustic substances referred to Shahid Sadoughi Hospital in Yazd City (August 2015-2015). Demographic information, type and amount of ingested material, initial symptoms, initial endoscopic findings and degree of esophageal tissue burn were recorded and the patients were followed up for one year. Finally, the data were analyzed by SPSS version 22 software. Results: In this study, 55 children were evaluated, their average age was 3.19 years. Participants consisted of 23 (41.8%) girls and 32 (58.2%) boys. Children had ingested pipe openers chemicals (30.9%), bleach liquid (29.1%) and hydrochloric acid (12.7%), respectively. Initial endoscopic findings were normal in 45.5% of children, and the most damage was grade IIb and IIa. The incidence rate of esophageal stricture in month later was 47.3%, and in the year later, the total incidence of stricture and GOO was 27.3% (16.4% of esophageal stricture and 7.3% of stricture and GOO). Conclusion: The present study showed that esophageal injury following the accidental ingestion of caustic substances is common in children, and the presence of symptoms in the patients at the beginning of the visit can be associated with higher grade injuries, and the occurrence of stricture is more common after severe injuries.

This study aims to find the concept of prevention and treatment for citizens related to human trafficking carried out by local governments. Empirically, the problem of human trafficking is a violation of human rights related to the right to personal freedom. The majority of these crimes afflict vulnerable groups, such as women and children. On this basis, this study uses a qualitative approach with a descriptive method. The data in this study were taken using in-depth interviews, observation, and documentation techniques. This study uses a constructivist perspective, which is to build ideas through data so as to produce a complete picture. The results show that the model for preventing and handling human trafficking must be collaborative with the central government and institutions dealing with human trafficking issues at the local level. An important aspect that local governments need to focus on is obtaining valid data on maps of human trafficking problems in their administrative areas. This will support efforts to prevent and handle victims of human trafficking involving government and non-government elements. An important aspect of the model for preventing and dealing with human trafficking is that local governments need to increase public participation in campaigning against human trafficking.

Background: The perceptions of mothers and caregivers of children attending early childhood development (ECD) centres play a very critical role in promoting healthy eating habits in children and impact long-term health consequences. Food preferences that are developed during childhood continue into adolescence and adulthood and are difficult to change. Aim: The aim of the study was to assess the perception of mothers and caregivers of children attending ECD centres regarding healthy eating practices. Setting: The study was conducted in ECD centres in Gauteng, North West and Limpopo. Methods: A quantitative descriptive design was used to collect data among 290 respondents using a structured, researcher-administered questionnaire. Results: The findings indicated that the majority (77%) of respondents did not believe that choosing a healthy diet is a matter of knowing foods that are good and bad for health. The majority (59%) of respondents believed that the food they eat and drinks are healthy and see no need to make changes. Conclusion: The study findings showed that the majority of respondents lack awareness about choosing healthy diets. Furthermore, the current dietary patterns of respondents and their children will remain the same as long as the mothers and caregivers feel that the food they eat is healthy. Contribution: The findings of the study contribute to the appropriate measures of educating mothers and caregivers in offering healthy diets to children at home and in early childhood centres.

Canine impactions are frequently encountered in the pediatric population. Impacted canines may pose a functional and esthetic problem for patients and can affect the neighboring teeth (incisors and premolars). Early detection and management of such pathology may help the pediatric dentist and orthodontist to prevent many unwanted local and regional complications. Various surgical and orthodontic techniques may be used to recover impacted maxillary canines. The decision to surgically correct these impacted teeth is usually made by the orthodontist. The treatment of impacted teeth requires a multidisciplinary team comprising orthodontist, pediatric dentist, dento-alveolar surgeon, and sometimes a periodontist.

Introduction: Microbial resistance due to antibiotics overuse can endanger the general health of society. Various factors play a role in mothers' overuse of antibiotics for their children. This study aimed to investigate mothers' attitude and behavior about the use of antibiotics in children under five years old in Yazd City. Methods: In this cross-sectional descriptive study, 302 mothers with children under five years old were included in 2019-2020; a questionnaire of mothers' attitudes and practices regarding antibiotic use was completed. Then, the obtained data were analyzed by SPSS software version 16 and P-value less than 0.05 was considered statistically significant. Results: The mothers' attitude level was poor, moderate, and good in 60 (20%), 180 (59.5%), and 62 patients (20.5%), respectively. Furthermore, mothers' practice level was poor in 55 (18.2%), moderate in 210 (69.5%) and good in 37 (12.3%). The level of attitude (P = 0.000) and practice (P = 0.007) in mothers with a higher level of education was significantly higher. With increasing the number of children, mothers' attitude (P = 0.03) and practice (P = 0.02) were significantly lower. Conclusion: The study results showed that most mothers have a moderate level of attitude and practice in using antibiotics in their children. A significant number of them also mentioned antibiotic use without a prescription. Therefore, to reduce the improper use of antibiotics, it is recommended to pay attention to educational programs with proper planning by the public media. It makes sense to train physicians, monitor their performance and closely monitor the sale of antibiotics in pharmacies to reduce their use without a doctor's prescription.

Aim and Background: Therefore, conducting research on children's behavioral problems is important. Therefore, the aim of the present study was to compare the effectiveness of mindful parenting training program plus parental management training (combined education) with mindful parenting training and parental management training alone on reducing externalized and internalized behavioral problems of children. Methods and Materials: The present study was a quasi-experimental design with pre-test, post-test and two-month follow-up with a control group. The statistical population included all preschool children in Kashmar in 2021-2022, from which 120 people were selected by purposive sampling and randomly assigned to four groups. All completed the pre-test, post-test, and follow-up questionnaires of the Achenbach and Rescorla (2001) Child Behavior Inventory. Finally, the data were analyzed by repeated measures analysis of variance using SPSSV19 software. Findings: The results showed that there was a significant difference in both variables of externalized and internalized behavioral problems between groups (P

The goal of our research was to examine how parents evaluate their pedagogical actions regarding their children. The research was conducted on a sample of 198 parents of children attending final grades of primary school in Eastern Serbia (Negotin, Bor, Zaječar, Kladovo, and Knjaževac). Survey method and theoretical analysis method were used in the research. The researchers developed a fivelevel Likert type scale, the Parents’ Self-Evaluation of Pedagogical Actions, consisting of 30 items referring to different pedagogical actions relative to affective dimensions and control dimensions. The results show the prevalence of affective dimension in parents’ self-evaluation. When it comes to parents’ level of education, the results indicate that parents with college and university degrees are more in the zone of responsible parenthood than parents who finished only primary school or have high-school diplomas. The results of this research can be a special challenge in terms of including children in some future research to examine the problem of parents’ pedagogical actions from both perspectives. The research findings can also be used in the context of the development of educational programmes that can be implemented through cooperation between schools and parents.

Introduction: Diabetes mellitus is one of the most common metabolic diseases that is associated with many complications. Type 1 diabetes is an autoimmune disease caused by a lack of insulin production due to high blood glucose levels. It is the third most severe and chronic childhood illness, affecting approximately 15 million children worldwide. Given the importance of controlling type 1 diabetes, especially in children, in this study we aimed to examine the status of diabetes control in children 3 to 18 with type 1 diabetes. Methods: This study was a retrospective analytical cross-sectional study. The study population included 121 children aged 3-18 years with type 1 diabetes referred to Yazd Diabetes Center in 2018 to 2019. The information, including age, sex, BMI, patient maturity stage, duration of diabetes, mean A1C, daily insulin dose, number of blood glucose measurements per day and number of DKA attacks were extracted. The collected data were entered into SPSS version 16, using statistical tests were analyzed. Results: The results showed that the mean age of participants was 12.92± 3.96 years and the mean of A1c in patients was 8.63 ± 1.94. The results of our study on diabetes control status in the studied patients showed that 38.8% of patients had partial diabetes control status, 32.2% had good diabetes control status and 28.9% had poor diabetes control status. In addition, according to the results of the study, there was no statistically significant difference was found among the frequency distribution of diabetes control status in terms of variables of puberty stage (p = 0.228), BMI (p = 0.508), age (p = 0.275), daily dose of bisal / bolus insulin (p = 0.479), dose Daily NPH / regular insulin (p = 0.386), number of blood glucose checks (p = 0.090), number of hospitalizations due to DKA (p = 0.539), duration of diabetes (p = 0.093) and gender (p = 0.263). . Conclusion: According to the results of the study, it can be concluded that none of the studied variables affect the control status of diabetes in children aged 3-18 years with type 1 diabetes.

In this article, we aimed to problematize the image performances carried out by 3-year-old children and how these productions cross the context in which they were created: an Early Childhood Education school and a doctoral research in progress. We discuss the intertwining and reverberations of the conceptions of childhood that direct education and the potencies of the images fraught with childhood that create possibilities of cracking the singular and adult-centric ways of being, feeling, and living. It is concluded that, guided by an ethical, aesthetic and political intention, the children's performances create possibilities and announce the urgency of other postures when inhabiting childhood spaces.

Motor skills during childhood are extremely important for having an active lifestyle in adulthood; however, with the technological advance several plays and even the family environment have undergone changes, which affected the lifestyle adopted by the population. The present study aimed at investigating motor proficiency and blood pressure, as well as assessing the mediating role of nutritional status in such a correlation. This is a cross-sectional study carried out with 374 children aged 7 to 10 from the city of Maringá-PR. The nutritional status was measured by using the Body Mass Index (BMI) according to age and sex. The Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, (BOT-2), was used to evaluate motor proficiency; the blood pressure was measured by using the Omron Deluxe HEM-7200® digital meter. The results showed a negative correlation between motor proficiency and body mass index and systolic and diastolic blood pressure. The analysis of structural equations revealed that there was no statistically significant direct impact of motor proficiency on blood pressure. However, when the mediation of nutritional status was included, a significant negative correlation between motor proficiency and nutritional status was seen, but positive in relation to systolic and diastolic blood pressure. In conclusion, motor proficiency has no direct influence on blood pressure; however, when mediated by nutritional status, the effect becomes significant. It is worth mentioning that the lower the motor proficiency and the higher the body mass, the higher the systolic and diastolic blood pressure was.

Catalina Bover-Bauza,1,2 Maria Antonia Rosselló Gomila,1 David Díaz Pérez,1 Aina Rosa Millán Pons,3 Jose Antonio Gil Sánchez,1,2 Jose Antonio Peña-Zarza,1,4 Joan Figuerola Mulet,1,2 Borja Osona1,2 1Division of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases, Palma, Balearic Islands, Spain; 2Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain; 3Department of Statistic and Methodological Support, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, Spain; 4Research Group in Sleep Apnea and Hypopnea Syndrome, Balearic Islands Health Research Institute (IdISBa), Palma, Balearic Islands, SpainCorrespondence: Catalina Bover-BauzaDivision of Pediatric Respiratory Medicine, Department of Pediatrics, University Hospital Son Espases Carretera Valldemossa 79, Palma, 07120, SpainTel +34 871205000Fax +34 871909712Email catalina.bover2@ssib.esIntroduction: Asthma exacerbation is among the commonest causes for pediatric emergency room visits, and respiratory viruses are frequent triggers of such exacerbations. Few studies have evaluated the consequences of the novel human coronavirus that causes the illness currently known as COVID-19, in the pediatric population.Purpose: The objective of this study was to analyze the impact of the COVID-19 pandemic and lockdown measures on the emergency department in the pediatric asthmatic patient.Patients and Methods: This retrospective observational study evaluated pediatric patients treated at the Pediatric Emergency Service for wheezing episodes. Changes in the number and characteristics of these patients over the same period of 2019 as compared to 2020 during the month following the alarm declaration (March 14 to April 15) were evaluated.Results: In total, data of 30 asthma patients managed in the period after the declaration of the coronavirus pandemic and of 158 asthma patients managed in the pre-COVID-19 period were included. In 2020, patient visits decreased by 82% in 2019. No statistically significant differences among age, sex, oxygen saturation, fever status, or number of severe bronchospasm episodes were found. Nebulized medication usage was reduced significantly since the alarm declaration. No significant increase in requests for complementary testing in the COVID-19 period was found. No patient requiring hospital admission was found to be PCR SARS-CoV-2 positive. Median time spent in the emergency department decreased from 180 minutes in 2019 to 85 minutes in the COVID-19 era.Conclusion: The COVID-19 pandemic and ensuing lockdown measures have led to an extraordinary reduction in emergency visits to the pediatric service. The ongoing pandemic has also led to improvements in the approach to asthma exacerbations and wheezing, to reduce the risk of exposure to the virus, such as increased use of pressurized metered dose inhaler and decreased time in the Emergency Department.Keywords: COVID-19, pandemic, asthma, wheezing, children

Tomás de Oliveira Loureiro, Sandra Rodrigues-Barros, Diogo Lopes, Ana Rita Carreira, Filipe Gouveia-Moraes, Ana Vide-Escada, Nuno Patricio Campos Ophthalmology Department, Hospital Garcia de Orta, Almada, PortugalCorrespondence: Tomás de Oliveira LoureiroOphthalmology Department, Hospital Garcia de Orta, Avenida Torrado da Silva, Almada, 2805-267, PortugalTel +351 913 513 175Email loureiro.tomas@gmail.comIntroduction and Objective: To evaluate corneal epithelial thickness (ET) and corneal thickness (CT) profiles in healthy eyes of Portuguese children and provide information to establish the first normative Caucasian database for these age group.Methods: Sixty healthy eyes of 60 children aged between 8 and 18 were evaluated using the Cirrus high-definition optical coherence tomography device. The average ET and CT were assessed using Cirrus Review Software with predefined concentric corneal ring-shaped zones. Specific regions of ET (central, superior, inferior, temporal, nasal, superonasal, inferotemporal, superotemporal and inferonasal) were also assessed. The mean ET, the mean CT and the difference of ET in corresponding octants were compared by gender. Correlations between central epithelial thickness (CET), age and refractive error were evaluated.Results and Discussion: The average ET was lower in the peripheric zones, whereas the average CT was higher. ET was thinner in the superior area than in the inferior (p< 0.05). ET was thicker in boys than in girls (p< 0.05), but CT did not differ. CET was not correlated with older age or refractive error.Conclusion: Optical coherence tomography analysis of ET reveals that it is thinner in the periphery, where the CT is thicker. Unlike CT, ET seems to be influenced by gender. ET profile proved to be a useful tool in keratoconus diagnosis and subclinical keratoconus detection in adults. As epithelial changes occur early in the disease and keratoconus is more aggressive in pediatric population, a normative database of ET profile could contribute to enhance early recognition of the disease in this age group.Keywords: epithelial thickness, AS-OCT, keratoconus, children

The adipose tissue has been recognized as an active organ involved in numerous metabolic, hormonal and immunological processes. Obesity and associated chronic inflammation leads to many metabolic and autoimmune disorders. The number of cells, their phenotype and distribution in adipose tissue depends on the degree of obesity. Polarization of macrophages towards M1, neutrophils influx to adipose tissue, activation of Th1 and Th17 cells and increased level of proinflammatory cytokines are characteristic for obesity-induced inflammation. Several mechanisms, such as adipocytes’ hypoxia, oxidative stress, endoplasmic reticulum stress, impairment of PPAR receptors, inflammasomes’ activation and activation of TLR are involved into development of chronic obesity-induced inflammation. A better understanding of this processes can provide new treatments for obesity and related disorders.

OBJECTIVE: The mortality of dengue hemorrhagic fever (DHF) infection in children is still high. Discriminating dengue fever (DF) and DHF during the early phase is difficult, especially with limited diagnostic tools in peripheral areas. Hence, early identification of significant factors in DHF is important, with rapid disease progression may lead to mortality. This study aims to determine early clinical and laboratory parameters significant in differentiating DF and DHF. MATERIALS AND METHODS: This is a cross-sectional study using secondary data from medical records collected by purposive sampling from January 2015 to December 2020. This study included children aged 0-18 years old diagnosed with DF and DHF based on World Health Organization (WHO) 2011 criteria. RESULTS: From multivariate analysis of 528 dengue patients, presence of prior dengue infection (OR =7.1; 95% CI: 2.1-23.7, p=0.001), transfusion administration (OR = 34; 95% CI: 8.7-132, p

Background/Aims: Review: Suicide is important and high prevalent problem in the world especially in adolescent. And it is one of the dangerous issue for epileptic children and adolescent. Also Epilepsy is a prevalent problem in the world, mostly among children and adolescent. It seems that epi-lepsy is the most common neurological disorder in children and adolescents. They suffer from seizures, traumas and with some degree of dysfunction. Due to epileptic seizures, low quality of life, social and emotional problems and maturing issues, so epileptic children and adolescents are at risk of affection. The purpose of this study was to investigate the prevalence of suicidal thoughts among epileptic children and adolescents in Herat city of Afghanistan. In addition epilepsy is a high cost disorder, because contin-ues long time and need continuous treatment. In epilepsy treatment both pharmacotherapy & surgery is used. Many authors point to a link between epilepsy and an increased risk of suicide.Methods and Materials: A cross-sectional study using a probability sampling process, by completing questionnaires and direct observation of the subjects during the first five months of 2020 was conducted at neurological center in Herat city.Results: Among the 300 samples, 287 samples have completed the questionnaire (response rate was 95.6%). 92 individual with epilepsy had suicidal thoughts 32%. 56.5% of subjects was male and 43.5% was female. In this study the participants age was (7-18 year), assessment by questionnaire and direct observation was measured.

Adela Chirita-Emandi,1,2,* Costela Lacrimioara Serban,2,3,* Corina Paul,4,5,* Nicoleta Andreescu,1,2 Iulian Velea,4,5 Alexandra Mihailescu,1 Vlad Serafim,1,6 Diana-Andreea Tiugan,1 Paul Tutac,1 Cristian Zimbru,1,7 Maria Puiu,1,2 Mihai Dinu Niculescu1,8 1Department of Microscopic Morphology - Genetics, Center of Genomic Medicine, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania; 2Regional Center of Medical Genetics Timis, Clinical Emergency Hospital for Children “Louis Turcanu”, Timisoara, Romania; 3Department of Functional Sciences, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania; 4Pediatrics Department – Pediatrics Discipline II, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania; 5Pediatrics, Endocrinology and Diabetes Department, Clinic II Pediatrics, “Pius Branzeu” Clinical Emergency County Hospital, Timisoara, Romania; 6The National Institute of Research and Development for Biological Sciences, Bucharest, Romania; 7Department of Automation and Applied Informatics, Politehnica University of Timisoara, Timisoara, Romania; 8Advanced Nutrigenomics, Cary, NC 27511, USA*These authors contributed equally to this workCorrespondence: Nicoleta AndreescuDepartment of Microscopic Morphology - Genetics, Center of Genomic Medicine, University of Medicine and Pharmacy “Victor Babes”, Timisoara, RomaniaEmail andreescu.nicoleta@umft.roIntroduction: Insulin resistance plays a major role in metabolic syndrome and is recognized as the most common risk factor for non-alcoholic fatty liver disease (NAFLD). Identifying predictors for insulin resistance could optimize screening and prevention.Purpose: To evaluate the contribution of multiple single nucleotide polymorphisms across genes related to NAFLD and choline metabolism, in predicting insulin resistance in children with obesity.Methods: One hundred fifty-three children with obesity (73 girls), aged 7– 18 years, were evaluated within the NutriGen Study (ClinicalTrials.gov-NCT02837367). Insulin resistance was defined by Homeostatic Model Assessment for insulin-resistance cut-offs that accommodated pubertal and gender differences. Anthropometric, metabolic, intake-related variables, and 55 single nucleotide polymorphisms related to NAFLD and choline metabolism were evaluated. Gene–gene interaction effects were assessed using Multiple Data Reduction Software.Results: Sixty percent (93/153) of participants showed insulin resistance (58.7% of boys, 63% of girls). Children with insulin resistance presented significantly higher values for standardized body mass index, triglycerides, transaminases and plasma choline when compared to those without insulin resistance. Out of 52 single nucleotide polymorphisms analysed, the interaction between genotypes CHDH(rs12676) and PNPLA3(rs738409) predicted insulin resistance. The model presented a 6/10 cross-validation consistency and 0.58 testing accuracy. Plasma choline levels and alanine aminotransferase modulated the gene interaction effect, significantly improving the model.Conclusion: The interaction between genotypes in CHDH and PNPLA3 genes, modulated by choline and alanine aminotransferase levels, predicted insulin-resistance status in children with obesity. If replicated in larger cohorts, these findings could help identify metabolic risk in children with obesity.Keywords: insulin-resistance, obesity, gene–gene interaction, CHDH-PNPLA3, choline, children

Chronic Fatigue Syndrome/Myalgic Encephalomyelits (CFS/ME) is a chronic disease with complex pathophysiology and unknown etiology. It occurs both in children and adolescents, as well as in adults, with equal frequency. The clinical course is characterized by progressive fatigue, a significant reduction in the body's efficiency, lack of relief despite rest, and numerous accompanying symptoms. Pathognomonic symptom for PE is the increase in fatigue after physical or mental exertion and the persistence of these symptoms for several hours or days. The basis for effective treatment is primarily non-pharmacological treatment, including determining the optimal balance between physical activity and rest, which is aimed at preventing post-workout fatigue. Pain, insomnia, IO, and other symptoms can be treated with medication. So far, little research has been done on the diagnosis and treatment of this disease in children. This publication aims to summarize the knowledge currently available on the Chronic Fatigue Syndrome in children and adolescents.

Dog Assisted Therapy is a prevalent part of therapeutic process in pediatric population. It is a modern and constantly developing intervention. Dog Assisted Therapy is utilized with pervasive development disorders. Most of studies confirmed that Autistic Spectrum Disorder, Down Syndrome or Celebral Palsy may benefit from Dog Assisted Therapy. It is important to emphasise the role od Dog Assisted Therapy in improving children mental and physical development.

Background. Typically, the step test is used to assess the physical performance that is determined by the condition of the cardio-respiratory system. The latter, in turn, is associated with the nervous, endocrine and immune systems, which collectively determine the level of adaptation of the body. The purpose of this study is to analyze the effect on the step test of natural adaptogens and associated changes in a number of parameters of cardio-respiratory, autonomic nervous and immune systems and metabolism. Material and methods. The target was 80 children of both sexes, ages 10-17, arriving at the clinical sanatorium "Dzherelo" of Truskavets spa from radionuclide contaminated territories. The main subject of the study was the Popovych’s step test. State of autonomous nervous and immune systems was assessed as well as others functional and metabolic tests. Results. The contingent surveyed was retrospectively divided into three qualitatively distinct groups. The largest group (53,7%) was the group of children with initially reduced or normal levels of Popovych’s Step Test Index (PSI), in which it increased. However, in 28,8% of children PSI remained stable at different initial levels, and in 17,5% even decreased, without falling below the lower limit of normal. Discriminant analysis was subsequently applied to identify constellations of parameters that change are characteristic of each cluster. The program selected as characteristic changes in 2 parameters of autonomous nervous system, 2 functional, 4 metabolic and 3 immune parameters as well as blood trombocytes level. The correct classification of the positive actotropic effect is 93,0%; neutral 65,2%; negative 64,3%, and total correctness is 80,0%. Conclusion. Balneotherapy causes multivariate changes in Popopvych’s step test, which accompanied by characteristic changes in certain parameters of autonomous nervous and immune systems as well as others functional and metabolic tests.

Odontogenic myxoma is a benign mesenchymal tumor that appears to be associated with odontogenic ectomesenchyme of the growing teeth. This tumor, which often occurs in the second and third decades of life, is extremely rare and often asymptomatic in children. However, no theoretical consensus exists in the literature over the diagnosis and treatment of this disease. In this study, we investigated the diagnostic and therapeutic methods of a rare case of odontogenic myxoma in a 13-year-old child. Keywords: Odontogenic myxoma; Maxilla; Children.

School education is crucial for personal/social development. To confirm the demand for special education any child is required to be assessed. Instruments that measure children’s intellectual abilities aid teachers to adapt their teaching environments once pupils with special needs are recognized. This correlational study’s intention was developing, validating and implementing a psychometric test to assess reasoning skill among children. Some of the influencing factors such as age, gender and parents’ educational level were meanwhile investigated. Hence, three subtests that assess abstract, quantitative, nonverbal, matrix and visual reasoning were selected under the supervision of scholars of the field to develop a psychometric test whose internal consistency was calculated through Pearson Coefficient Correlation by giving the test to 150 volunteer participants. All the calculated values declared high internal consistency. Then, 222 male and female preschool, first grade and second grade students were selected through multiple stage stratified sampling to participate in the study. Their reasoning ability was compared based on age, gender and parents’ educational level using ANOVA and tukey tests in SPSS22. The findings regarding age and parents’ educational level were controversial: younger children had better reasoning skills also children of fathers with lower academic degrees outperformed their peers. No statistically significant difference was observed regarding gender. Such findings could help educational policy makers and scholars of educational psychology to fill the gaps of educational contents and environments specifically during early school education. The developed instrument assists teachers modify teaching methods and environments to help weaker children flourish cognitively.

Purpose: to develop and prove the effectiveness of a comprehensive physical therapy program for children with systemic visual and musculoskeletal lesions based on the undifferentiated connective tissue dysplasia. Material and methods: the study involved 24 children of 6 years old. The study was conducted at the special educational complex. Research methods: medical histories review; clinical examination by the criteria of T. Milkovsky-Dimitrov and A. Karkashov; definition of the joint hypermobility degree by the Carter-Wilkinson criteria in the modification of Beiton; assessment of the back extensor muscles’ and abdominal press’ strength endurance (by A.M. Reisman and F.I. Bagrov tests); visometry. Results: During a preliminary study a tendency of an increase in the joint hypermobility degree in accordance with the myopia degree was established: children with mild myopia had mild form of joint hypermobility; children with moderate myopia had mild and moderate degrees of joint hypermobility; joint hypermobility at children with a high degree of myopia varied from mild to severe (generalized). A tendency of an increase in the number of children with impaired posture in accordance with an increase in the myopia degree was also established. A comprehensive physical therapy program was developed and implemented. It included modern technologies and recovery tools: therapeutic exercises for the eye muscles (solarization, palming); musculosceletal system training on the BOSU platform; balanced daily diet; self-massage of the circular eye muscles and eyelids; art therapy (fairy tale therapy); Su-Jok therapy. This methods made up the essence of the author’s program named «Sleepy Kittens». This program affected the visual analyzer and the musculoskeletal system positively. Conclusions: As a result of physical therapy measures in the main group, a number of children with high degree of myopia decreased; strength endurance of the back extensor muscles and abdominals increased; a number of children with joint hypermobility of moderate degree decreased; joint hypermobility of high degree was absent.

The purpose of this study was to provide evidence of the construct and concurrent validity of the Social Emotional School Readiness Scale (SESRS) among Iranian preschool children. Using a sample of 193 parents of Iranian kindergarten children, evidence for the SESRS’s construct validity was provided using confirmatory factor analysis, with four factors confirmed. Evidence for the SESRS’s concurrent validity was also presented by analyzing the relationship between subscales of the social emotional school readiness scale and home to school transition scale. Factor analysis indicated that self-awareness, self-regulation, social relationships, coping skills subscales items loaded on their respective factors, and internal reliability coefficients at all levels were satisfactory to good. Support for validity was shown by associations in the expected direction of home to school transition. This inventory shows promise as a measure of social emotional school readiness in students from Iran.