Search

Aim/IntroductionThe relationship between nutritional status upon admission to a pediatric intensive care unit (PICU) and clinical outcomes remains unclear. We examined the relationship between nutrition status, as indicated by body mass index-for-age (BMI-for-age), and clinical outcomes in the PICU.MethodIn this retrospective study at a tertiary care center, records of 1,015 critically ill children and adolescents aged one month to 18 years old with available anthropometric parameters were included. The nutritional status upon admission was determined by calculating the BMI-for-age z-score using the WHO growth charts as the reference. The participants were categorized as underweight (BMI-for-age z-score +1). Multi-variate odds ratios (OR) with 95% confidence intervals (CI) were used to investigate the association between malnutrition (being underweight and overweight/obese) and odds of Prolonged PICU stay (≥7 days) and PICU mortality after controlling for descriptive characteristics, Glasgow Coma Scale score status, fluctuations in serum sodium, and acute kidney injury confounders.ResultsThe proportions of patients in underweight, normal weight, and overweight/obese categories were 34.2%, 45.8%, and 20%, respectively. During the study period, 21.5% of patients had prolonged PICU stay, and 5.6% of patients in PICU died. Compared to normal-weight patients, underweight patients had higher odds of prolonged PICU stay (OR: 1.52; 95% CI: 1.05–2.22) and PICU mortality (OR: 2.12; 95% CI: 1.22–4.01). Age- and gender-stratified full-adjusted analysis showed that the increased odds of prolonged PICU stay remained significant among underweight boys and underweight individuals aged 5–19 years old. Furthermore, the increased odds of PICU mortality remained significant among underweight individuals aged 2–5 years old. However, being overweight or obese during PICU admission did not demonstrate a significant association with our outcomes in the total sample or subgroup analysis.ConclusionOur findings showed that PICU patients who were underweight had higher odds of prolonged PICU stay and PICU mortality than their normal-weight counterparts. This underscores the importance of closely monitoring underweight patients in the PICU upon admission in order to improve clinical outcomes.

Conclusion: The study identifies key factors influencing toileting activity performance in individuals with CP. “Main caregiver” emerges as a pivotal factor, followed by neuromusculoskeletal functions, personal factors, attitudes toward menstruation, the toilet environment, and support and relationships.

Key Clinical Message Most children with nephrotic syndrome heal without any sequelae. However, rare life‐threatening complications such as thromboembolism may occur in pediatric nephrotic syndrome and should be considered in those with a new‐onset neurologic deficit. Abstract The thromboembolism (TE) as a complication of nephrotic syndrome (NS) is rare and serious, and may involve renal, cerebral, pulmonary, or peripheral venous and/or arterial thrombosis. Here, we describe a 4.5‐year‐old male with a history of nephrotic syndrome, who developed hemorrhagic stroke in the territory of middle cerebral artery (MCA).

Background: Methicillin-resistant Staphylococcus Aureus (MRSA) stands for methicillin-resistant Staphylococcus aureus, a type of bacteria that is resistant to several antibiotics. Non-intact skin, such as when there are abrasions or incisions, is often the site of an MRSA infection. MRSA has become endemic in hospitals over the past years. The current recommendation for MRSA decolonization is to use a daily chlorohexidine skin wash for five days. Tea Tree Oil (TTO) can also be considered for the eradication of MRSA on the skin. However, no study has evaluated the TTO potential for MRSA decolonization in hospitalized children. Methods:In this single-center, comparative prospective, open-label clinical trial, the effect of TTO body wash on MRSA decolonization was compared to that of chlorhexidine body wash at Loghman-e-Hakim Hospital (Tehran, Iran). Several samples were taken from the catheter sites of children for MRSA detection. Patients were assigned to receive either TTO or chlorhexidine. After five days of applying the solutions, resampling was conducted to assess the colonization of MRSA. Results: Both TTO and chlorhexidine groups showed favorable results for MRSA decolonization. From 382 patients, 91 were MRSA-positive (about 23.82%), and of these 91 patients, 41 (45%) were female and 59 (55%) were male. The mean ± SD of the growth inhibition zone against MRSA was 19.20 ± 3.73 and 33.41 ± 9.53 for chlorhexidine and TTO, respectively. Conclusion: TTO body wash proved to be more effective than chlorhexidine in MRSA decolonization in hospitalized children. Implementation of such decolonization can improve patients’ outcomes and prevent MRSA transmission.

Purpose : Hepatitis B virus (HBV) vaccination is recommended for all human immunodeficiency virus (HIV)-infected patients without HBV immunity. However, serological response to standard HBV vaccination is frequently suboptimal in this population and the appropriate strategy for revaccination of HIV-infected nonresponders remained controversial. We aimed to determine the serological response to one booster dose of HBV vaccine given by intradermal (ID) or intramuscular (IM) route in HIV-positive nonresponders to standard HBV vaccination. Materials and Methods : In this study, 42 HIV-infected nonresponders were enrolled. We randomized them to receive either 10 μg (0.5 mL) for ID (20 cases) or 20 μg (1 mL) for IM (22 cases) administration of HBV vaccine as a one booster dose. After 1 month, anti-HBs titer was checked in all cases. A protective antibody response (seroconversion) defined as an anti-HBs titer ≥10 IU/L. Results: Seroconversion was observed in 47.6% of subjects after 1 ID dose. A total of 30% showed antibody titers above 100 IU/L. Except one case, all responders had CD4 + >200 cells/mm 3 . Mean anti-HBs titer was 146.5 ± 246 IU/L. After the one IM booster dose, seroconversion was observed in 50% of cases. A total of 36.3% of subjects had anti-HBs ≥100 IU/L. All responders had CD4 + >200 cells/mm 3 , except one case. Mean anti-HBs titer was 416.4 ± 765.6 IU/L. Responders showed significantly higher CD4 + cell counts, in comparison to nonresponders (P < 0.001). Conclusions: One booster dose administered IM or ID to HIV-infected nonresponders resulted in similar rates of seroconversion, overall response rate 50%. However, higher anti-HBs titers observed more frequently in IM group.

Background: Acute intoxication with ALP is extremely lethal. The present study was conducted to determine the range of serum cortisol levels in ALP poisoning and its correlation with patient outcome. Methods: This study was carried out on patients who were intoxicated with ALP. Their demographic data and pertinent findings in their history and physical examination were recorded at the time of arrival and also when shock and severe metabolic acidosis emerged. 5cc blood was taken from the patients to measure blood cortisol level, when shock and severe metabolic acidosis developed. Blood cortisol level analysis was performed using ELISA method. Data analysis was done using SPSS software version 16.0. Results: The average ingested dose was 1.98+1.79 tablets each containing 3 grams of ALP. Overall, 77% of the patients presented tachycardia and hypotension. Blood cortisol level less than 15 µg/dl, 15-33 µg/dl, and more than 34 µg/dl were regarded as adrenal insufficiency, critical illness-related corticosteroid insufficiency, and adequate adrenal response, respectively. Eventually, 3 patients fell within the first category, 24 patients matched with the second category, and 3 patients corresponded to the last category. Conclusion: Blood cortisol concentration is satisfactory only in 10% of the patients. In majority of the patients although it is not apparently low, it has not shown the expected rise comparable to the shock and stress state of such patients. It defines a role for corticosteroids therapy in management of ALP poisoning, particularly if it does not respond to conventional treatments.

Background: Brucellosis is a world-wide disease, which has a diverse clinical manifestation, and its diagnosis has to be proven by laboratory data. Serum agglutination test (SAT) is the most-widely used test for diagnosing brucellosis. The enzyme linked immunosorbent assay (ELISA) can also determine specific antibody classes against brucella. It is a sensitive, simple and rapid test, which could be an acceptable alternative to SAT with fewer limitations, however, like any other new test it should be further evaluated and standardized for various populations. This study was planned to determine an optimal cut-off point, for ELISA which would offer maximum sensitivity and specificity for the test when compared to SAT.Methods: Four hundred and seven patients with fever and other compatible symptoms of brucellosis were enrolled in the study. Serum agglutination test, 2-Mercaptoethanol test, and ELISA were performed on their sera. Results: The cut-off point of 53 IU/ml of ELISA-IgG yielded the maximal sensitivity and specificity comparing to the other levels of ELISA-IgG, and was considered the best cut off-point of ELISA-IgG to diagnose acute brucellosis. At this cut-off, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were 84.09%, 85.38%, 62.20, 94.90, 5.75, 0.18, respectively.Conclusion: The best cut-off point of ELISA-IgG is 53 IU/ml, which yields the maximal sensitivity and specificity to diagnose acute brucellosis.

Importance: Toileting difficulties have a significant impact on the daily lives of children with cerebral palsy (CP), yet research on this issue remains inadequate. There is a critical need to better understand the challenges health care professionals face in addressing toileting difficulties., Objective: To explore challenges faced by health care professionals in toileting evaluation and interventions for children with CP ages 6-18 yr., Design: A mixed-methods study with a two-phase exploratory sequential design and using a global Delphi consensus technique., Setting: Email communication., Participants: Fifty-two national and international allied health professionals and 16 mothers of children with CP were involved in the preparation of the Delphi questionnaire. Additionally, 162 professionals participated in the Delphi study., Outcomes and Measures: Challenges were identified and refined iteratively through the Delphi questionnaire. Consensus was measured using a Likert scale, considering agreement percentages and median scores., Results: The study revealed strong consensus (94.4%), emphasizing the need for comprehensive training, particularly in working with pediatric populations. Concerns about limited research on and training in toileting function (88.9%) and challenges such as inadequate assessment environments and sanitation facilities (96.9%) underscore the need for practical and innovative educational methods to illustrate toileting procedures. Additionally, the findings highlight concerns about toileting issues and diverse commitment levels among professionals., Conclusions and Relevance: This study pinpointed critical challenges in toileting management for children with CP. These high-consensus findings stress the urgent need for holistic strategies, comprehensive education, and interdisciplinary collaboration to improve the quality of life and independence of these children. Plain-Language Summary: Toileting difficulties have a significant impact on the daily lives of children with cerebral palsy (CP), yet research on this issue remains inadequate. This study highlights significant gaps faced by health care professionals in understanding and addressing challenges in toileting evaluation and intervention for children with CP. Insights from professionals stress the critical need for global collaboration, standardized assessments, and improved education to effectively tackle CP-related toileting issues for children., (Copyright © 2025 by the American Occupational Therapy Association, Inc.)