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Objective: To examine if the substitution of different screen time intervals with light physical activity (LPA), moderate to vigorous physical activity (MVPA) and sleep is associated with cardiovascular indicators and inflammatory markers in children. Methods: This is a cross-sectional study developed with 186 children aged between six and 11 years old from public schools in southern Brazil. CRF was measured with the 6-minute running and walking test, following the Brazil Sports Project procedures. The percentage of fat was evaluated through DXA. LPA and MVPA were measured using accelerometers. Sleep and screen time were assessed by questionnaires answered by parents. Leptin and C-reactive protein were measured by fasting blood collection. Systolic and diastolic blood pressure were determined through a digital sphygmomanometer. Isotemporal substitution models were used for statistical analysis. Results: Replacing 1 h of screen time with MVPA was associated with lower BMI, systolic and diastolic blood pressure, fat percentage, leptin, and C-reactive protein. When screen time was substituted for sleep time, lower waist circumference was observed. Regarding the substitution of 1 h of screen time with LPA, significant values were found only for leptin. Conclusion: The replacement of screen time with physical activities of different intensities and sleep time was associated with benefits in cardiovascular indicators and inflammatory markers in childhood.

Similar to the gut microbiome, oral microbiome compositions have been suggested to play an important role in the etiology of autism. However, empirical research on how variations in the oral microbiome relate to clinical-behavioral difficulties associated with autism remains sparse. Furthermore, it is largely unknown how potentially confounding lifestyle variables, such as oral health and nutrition, may impact these associations. To fill this gap, the current study examined diagnosis-related differences in oral microbiome composition between 80 school-aged autistic children (8–12 years; 64 boys, 16 girls) versus 40 age-matched typically developing peers (32 boys, 8 girls). In addition, associations with individual differences in social functioning (SRS-2), repetitive behavior (RBS-R) and anxiety (SCARED) were explored, as well as the impact of several lifestyle variables regarding nutrition and oral health. Results provide important indications that the bacterial genera Solobacterium, Stomatobaculum, Ruminococcaceae UCG.014, Tannerella and Campylobacter were significantly more abundant in autistic compared to non-autistic children. Furthermore, the former four bacteria that were significantly more abundant in the autistic children showed significant associations with parent-reported social difficulties, repetitive and restrictive behavior and with parent-reported anxiety-like behavior. Importantly, associations among oral microbiome and quantitative diagnostic characteristics were not significantly driven by differences in lifestyle variables. This exploratory study reveals significant differences in oral microbiome composition between autistic and non-autistic children, even while controlling for potential confounding lifestyle variables. Furthermore, the significant associations with clinical characteristics suggest that individual differences in microbiome composition might be involved in shaping the clinical phenotype of autism. However, these associations warrant further exploration of the oral microbiome's potential beyond the oral cavity and specifically with respect to neuropsychiatric conditions.

Background: Facial asymmetry results from variation in mandibular linear and angular dimensions on the right and left sides of the face. Mandibular asymmetry is of great significance to oral surgeons and orthodontists as it directly impacts the facial profile of an individual. Aim: The present study aimed to measure the prevalence of mandibular asymmetry and its fluctuations during the mixed dentition growth phase in healthy children aged 6–8 years in the Jazan region of Saudi Arabia. Method: This retrospective observational study was conducted by measuring linear asymmetrical measurements of mandible on orthopantomograms of 390 healthy children (182 boys and 208 girls, aged 6–8 years) with mixed dentition. Linear measurements from orthopantomograms were obtained using a standardized digitizer. Two sets of mandibular measurements were recorded, alongside subjective assessments of mandibular first molar development. An independent t-test was employed to assess the significance between measurements on both sides, while one-way ANOVA was used to demonstrate facial asymmetry significance among different age groups. Result: The result of this study revealed a significant statistical difference (p-value≤ 0.05) for both sides of the mandible across two dimensions: condylar and ramus height (p value = 0.03) and mandibular length (p value = 0.04). The asymmetry index resulted in no asymmetry among most of the included subjects. However, compared to the other three linear measurements, many seven-year-old participants possess mandibular asymmetry on condylar height (54.5 %). Conclusion: Within the limitation it could be concluded that children in growing age have a significant mandibular asymmetry (mainly 7 years), which, however, is only seldom clinically significant. Hence, treatment plan should be cautiously planned.

Objectives: COVID-19, caused by the novel coronavirus, has had a profound and wide-reaching impact on individuals of all age groups across the globe, including children. This review article aims to provide a comprehensive analysis of COVID-19 in children, covering essential topics such as epidemiology, transmission, pathogenesis, clinical features, risk factors, diagnosis, treatment, vaccination, and others. By delving into the current understanding of the disease and addressing the challenges that lie ahead, this article seeks to shed light on the unique considerations surrounding COVID-19 in children and contribute to a deeper comprehension of this global health crisis affecting our youngest population. Methods: A comprehensive literature search was conducted to gather the most recent and relevant information regarding COVID-19 in children. Multiple renowned databases, including MEDLINE, PubMed, Scopus, as well as authoritative sources such as the World Health Organization (WHO), the U.S. Food and Drug Administration (FDA), the European Medicines Agency (EMA), and the National Institutes of Health (NIH) websites and others were thoroughly searched. The search included articles, guidelines, reports, clinical trials results and expert opinions published within the past three years, ensuring the inclusion of the latest research findings on COVID-19 in children. Several relevant keywords, including ''COVID-19,'' ''SARS-CoV-2,'' ''children,'' ''pediatrics,'' and related terms were used to maximize the scope of the search and retrieve a comprehensive set of articles. Results and Conclusion: Three years since the onset of the COVID-19 pandemic, our understanding of its impact on children has evolved, but many questions remain unanswered. While SAR-CoV-2 generally leads to mild illness in children, the occurrence of severe cases and the potential for long-term effects cannot be overlooked. Efforts to comprehensively study COVID-19 in children must continue to improve preventive strategies, identify high-risk populations, and ensure optimal management. By unraveling the enigma surrounding COVID-19 in children, we can strive towards safeguarding their health and well-being in the face of future global health challenges.

Progressive Multifocal Leukoencephalopathy (PML), primarily affecting immunocompromised individuals due to the John Cunningham virus (JC), is common in HIV-positive adults but rare in paediatrics. We present a unique case of a 14-year-old female with PML as the initial manifestation of HIV, with MRI lesions isolated to the posterior fossa. Initial symptoms included fever and rash, progressing to neurological deficits and ataxia. Severe immune suppression due to HIV and JC virus in the cerebrospinal fluid were confirmed. Management included immune reconstitution therapy (antiretroviral treatment) and supportive care. Despite interventions, the patient had a slow recovery with significant residual neurological sequelae. Timely recognition of Immune Reconstitution Inflammatory Syndrome (IRIS) and steroid initiation proved helpful. Antiretroviral therapy improved the survival rate of HIV-related PML, but long-term neurological sequelae, especially in posterior fossa cases, significantly impact the patient's quality of life. This case highlights diagnostic and treatment challenges in paediatric PML, particularly with atypical lesions location.

Aim: To characterize the pediatric population that presented necrotizing soft tissue infection at the Fundación Hospital Pediátrico la Misericordia (HOMI) Methods: This was a retrospective study of pediatric patients with diagnosis of necrotizing soft tissue infections treated by the pediatric surgery service at HOMI, a referral hospital for oncological pediatric patients over a 5-year period (2017 to 2021). A descriptive analysis was performed. Results: The study included 52 patients, 65.4% were female, the average age was 8.1 years (sd: 5.53). The infection was most frequently located in the perineum (59.6%). Early symptoms were present in 88.5% (pain being the most frequent) and late symptoms in 73.1%. All but one patient had identifiable risk factors for infection, immunocompromised was the most frequent (73.1%), followed by oncological diagnosis (51.9%) and surgical procedures (abdominoperineal, colostomy and bone marrow biopsy, with 13.3% each one) All patients underwent surgical debridement (mean 3 procedures per patient, SD: 2.0) and 32.7% underwent colostomy. The most isolated microorganism in the tissues in monomicrobial and polymicrobial infections was Escherichia coli (11.5% in each group). 57.7% required management in the Intensive Care Unit. The average mortality was 23.1%, being higher in patients with acute lymphoblastic leukemia and neutropenia (35.0%). Conclusion: In the present study, the highest frequency of soft tissue infections was in the immunosuppressed and oncological population. The characteristics of our study and mortality were different from those described in the literature due to the predominance of this population.

Aim: To compare the pediatric population that presented with accidental and non-accidental abdominal trauma treated in a reference hospital in Bogotá, Colombia. Methods: Comparative retrospective case series study of children who presented with accidental abdominal trauma (AT) and non-accidental abdominal trauma (NAT) was carried out. The children were treated at HOMI Fundación Hospital Pediatrico la Misericordia from June 2013 to December 2019. Statistical analysis was performed calculating measures of central tendency and dispersion. Results: The study included 175 patients. There was no gender predilection. The most common trauma mechanism in AT was fall (35.17 %) and in NAT was physical aggression (40 %). No difference was found in the dispersion of the Injury Severity Score (ISS). The requirement for surgical approach was higher in the NAT group (63.33 % vs 25.52 %). This group presented with a greater involvement of intra-abdominal organs (75 % vs 52.95 %), greater involvement of the small (20 %) and large (20 %) intestines. NAT children also had more multiple intra-abdominal organs involved (25 % vs 11.76 %), longer intensive care unit stay (56.67 % vs 39.31 %), prolonged hospital stay (7.5 days vs 4 days), and higher complications and mortality (6.67 % vs 2.07 %). Conclusions: Non-accidental abdominal trauma has greater morbidity and mortality in children compared to accidental trauma. For this reason, early identification of these cases is important in order to prevent future complications.

Diabetic ketoacidosis (DKA) is a well-known complication of type 1 diabetes mellitus. Diabetic ketoacidosis predisposes patients into devastating neurological complications. The most common neurologic complication is cerebral edema. Stroke either ischemic or hemorrhagic are uncommon complications of DKA with worse patient's outcome. Hemorrhagic stroke can manifest as subarachnoid or intraparenchymal hemorrhage. We present a 14-year-girl presented with DKA and complicated with both subarachnoid and intraparenchymal hemorrhages. Owing to early diagnosis and prompt treatment the patient had good outcome.

A 7-year-old child with native coarctation of the aorta was treated by transcatheter therapy using a 29-mm balloon-expandable stent. The procedure was successful and free of complications, and the patient was discharged home the same day. This stent has several features making it uniquely advantageous for treating this condition. (Level of Difficulty: Advanced.)

Introduction: No report has been published regarding the recommended surgical treatment in patients presenting with symptomatic primary asymmetrical vesicoureteral reflux (VUR): high grade on one side and low grade on the contralateral side. The aim of this study was to evaluate the effectiveness and outcome of combined Lich-Gregoir extravesical reimplantation and subureteric Deflux® injection, of high grade and low grade VUR respectively. Non-inferiority to bilateral cross-trigonal reimplantation was investigated in terms of surgical complications, number of post-operative fUTIs and need for re-intervention., Patients and Methods: A monocentric retrospective study was undertaken of all consecutive children with primary asymmetrical VUR on MCUG treated over an 18-year period (2004-2022). Surgery was indicated following an episode of febrile urinary tract infection despite appropriate non-operative management. Demographic and clinical such as length of hospital stay for pain management, use of urinary Foley catheter and complications were analyzed., Results: A total of 80 children met the study criteria: 40 patients underwent bilateral cross-trigonal re-implantation (Group 1) and 40 patients the combined Lich-Gregoir extra vesical reimplantation and Deflux® sub ureteric injection (Group 2). Complication and success rates were comparable in the two groups. The median hospital stay was significantly shorter for Group 2, with 50 % of patients who were discharged on day 1. Moreover, the data showed a significant lesser need in number and length of bladder catheter and ureteral stents in Group 2., Discussion: The technique proposed overcome the inconveniences of the other procedures that are commonly used in bilateral RVU: difficulty in retrograde catheterization or ureteroscopy after bilateral cross-trigonal reimplantation, the risk of transient bladder dysfunction after bilateral extravesical reimplantation and the low rate of success for high grade reflux of the sub ureteric Deflux® injection. The main limitation of the study lies in its retrospective nature and in the relatively short median follow-up., Conclusion: The combined Lich-Gregoir extra-vesical ureteral reimplantation and sub-ureteric Deflux® injection for the treatment of primary asymmetrical VUR is an effective alternative to the gold standard cross-trigonal ureteral reimplantation. Moreover, the position of the ureteric orifice is not modified in the eventuality of endourological procedures into adulthood., Competing Interests: Conflict of interest None., (Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Exposure to per- and poly-fluoroalkyl substances (PFAS) is ubiquitous due to their persistence in the environment and in humans. Extreme weight loss has been shown to influence concentrations of circulating persistent organic pollutants (POPs). Using data from the multi-center perspective Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) cohort, we investigated changes in plasma-PFAS in adolescents after bariatric surgery. Adolescents (Mean age = 17.1 years, SD = 1.5 years) undergoing bariatric surgery were enrolled in the Teen-LABS study. Plasma-PFAS were measured at the time of surgery and then 6-, 12-, and 36 months post-surgery. Linear mixed effect models were used to evaluate longitudinal changes in plasma-PFAS after the time of bariatric surgery. This study included 214 adolescents with severe obesity who had available longitudinal measures of plasma-PFAS and underwent bariatric surgery between 2007 and 2012. Underlying effects related to undergoing bariatric surgery were found to be associated with an initial increase or plateau in concentrations of circulating PFAS up to 6 months after surgery followed by a persistent decline in concentrations of 36 months (p < 0.001 for all plasma-PFAS). Bariatric surgery in adolescents was associated with a decline in circulating PFAS concentrations. Initially following bariatric surgery (0-6 months) concentrations were static followed by decline from 6 to 36 months following surgery. This may have large public health implications as PFAS are known to be associated with numerous metabolic related diseases and the significant reduction in circulating PFAS in individuals who have undergone bariatric surgery may be related to the improvement of such metabolic related diseases following bariatric surgery., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Thomas Inge reports a relationship with Standard Bariatrics, Teleflex, and Mediflex, and royalties from Wolters Kluwer (UpToDate) that includes: consulting or advisory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: COVID-19, caused by the novel coronavirus, has had a profound and wide-reaching impact on individuals of all age groups across the globe, including children. This review article aims to provide a comprehensive analysis of COVID-19 in children, covering essential topics such as epidemiology, transmission, pathogenesis, clinical features, risk factors, diagnosis, treatment, vaccination, and others. By delving into the current understanding of the disease and addressing the challenges that lie ahead, this article seeks to shed light on the unique considerations surrounding COVID-19 in children and contribute to a deeper comprehension of this global health crisis affecting our youngest population., Methods: A comprehensive literature search was conducted to gather the most recent and relevant information regarding COVID-19 in children. Multiple renowned databases, including MEDLINE, PubMed, Scopus, as well as authoritative sources such as the World Health Organization (WHO), the U.S. Food and Drug Administration (FDA), the European Medicines Agency (EMA), and the National Institutes of Health (NIH) websites and others were thoroughly searched. The search included articles, guidelines, reports, clinical trials results and expert opinions published within the past three years, ensuring the inclusion of the latest research findings on COVID-19 in children. Several relevant keywords, including "COVID-19," "SARS-CoV-2," "children," "pediatrics," and related terms were used to maximize the scope of the search and retrieve a comprehensive set of articles., Results and Conclusion: Three years since the onset of the COVID-19 pandemic, our understanding of its impact on children has evolved, but many questions remain unanswered. While SAR-CoV-2 generally leads to mild illness in children, the occurrence of severe cases and the potential for long-term effects cannot be overlooked. Efforts to comprehensively study COVID-19 in children must continue to improve preventive strategies, identify high-risk populations, and ensure optimal management. By unraveling the enigma surrounding COVID-19 in children, we can strive towards safeguarding their health and well-being in the face of future global health challenges., Competing Interests: Declaration of Competing Interest No Conflict of interest to declare., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Few studies have evaluated the rapid pain improvement provided by medications for children presenting to an emergency department (ED) with headaches., Objective: Our aim was to evaluate pain reduction provided by intranasal fentanyl (INF) compared with placebo in addition to ibuprofen., Methods: A single-center, double-blinded, randomized, placebo-controlled clinical trial was conducted in a tertiary care pediatric ED. All children aged 8-17 years presenting with a moderate to severe headache were eligible. Study participants were randomly allocated to receive INF 1.5 µg/kg (maximum dose of 100 µg) or similar placebo solution. Co-administration of oral ibuprofen 10 mg/kg (maximum dose of 600 mg) was also provided. The primary outcome was the mean pain rating reduction at 15 min., Results: Among the 62 participants, the median age was 14 years (interquartile range [IQR] 12-16 years in both groups) and the median initial visual analog scale (VAS) score was 64 (IQR 55-72 in the intervention group; IQR 50-81 in the control group). There was no difference in the mean pain score reduction at 15 min between the two groups (mean difference 2 mm; 95% CI -7 to 11 mm). Mean VAS score reductions were also similar at 30 and 60 min. Adverse events were more frequent in the INF group (risk ratio 2.8; 95% CI 1.29 to 6.22), but all events were minor and transient. No significant differences were found in other outcomes., Conclusions: This study did not find a benefit from INF for providing additional pain relief in children presenting to ED with headaches., Competing Interests: Declaration of Competing Interest The authors have indicated they have no potential conflict of interest to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: School-based gardening and nutrition education interventions report improvements in dietary intake, notably through fruit and vegetables. However, gardening, cooking, and nutrition randomized controlled trials are limited in evaluating dietary quality, and none have examined processed food consumption to date., Objectives: The study examined the effects of Texas Sprouts (TX Sprouts), a gardening, cooking, and nutrition education intervention, compared with control on unprocessed and ultra-processed food (UPF) consumption in predominately low-income Hispanic children., Methods: TX Sprouts was a school-based cluster randomized controlled trial that consisted of 16 elementary schools randomly assigned to either the TX Sprouts intervention (n = 8 schools) or control (delayed intervention; n = 8 schools) over 3 y (2016-2019). TX Sprouts schools received an outdoor teaching garden and 18 1-h lessons taught by trained educators throughout the school year. Dietary intake data via 2 24-h dietary recalls were collected on a random subsample (n = 468) at baseline and postintervention. All foods and beverages were categorized using the NOVA food classification system (e.g., unprocessed, processed, ultra-processed). Generalized linear mixed effects modeling tested changes in percent calories and grams of NOVA groups between the intervention and control estimates with schools as random clusters., Results: Of the sample, 63% participated in the free and reduced-price lunch program, and 57% were Hispanic, followed by non-Hispanic White (21%) and non-Hispanic Black (12%). The intervention, compared to the control, resulted in an increase in consumption of unprocessed foods (2.3% compared with -1.8% g; P < 0.01) and a decrease in UPF (-2.4% compared with 1.4% g; P = 0.04). In addition, Hispanic children in the intervention group had an increase in unprocessed food consumption and a decrease in UPF consumption compared to non-Hispanic children (-3.4% compared with 1.5% g; P < 0.05)., Conclusions: Study results suggest that school-based gardening, cooking, and nutrition education interventions can improve dietary intake, specifically increasing unprocessed food consumption and decreasing UPF consumption. This trial was registered at clinicaltrials.gov as NCT02668744., (Copyright © 2023 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Objective: Vein of Galen Malformations (VoGM) are rare vascular malformations, typically seen in pediatric age groups. Even more rarely, VoGM's may be seen later in adulthood. In this case report and systematic review, we provide a thorough description of the current literature as well as provide a case example exploring the diagnosis, imaging, treatment, and management of VoGM in adults., Methods: In accordance with PRISMA guidelines, we performed a systematic literature search for all relevant cases and case series of VoGM in adult patients. The reference list of all articles were reviewed for additional relevant cases. Articles were included if they described a VoGM of a patient over the age of 18 years old and published in English. 149 articles were originally identified and 26 described cases met our inclusion criteria., Results: In our literature review we found 26 patients that met our inclusion criteria. We found 14 male patients and 12 female patients. The mean age at presentation was 37.2 years (median=34 years, SD= 13.6 years). The most common presenting symptoms of patient were headache (n = 9), seizure (n = 6), and vomiting (n = 4). Of the 12 cases which clearly reported the subtype of VoGM, the choroidal type was more frequently seen (n = 10) compared to the mural type (n = 2). In 3 patients, the VoGM was thrombosed at time of diagnosis. Of the 26 patients, endovascular treatment was performed most frequently (n = 8) but some received microsurgical treatment (n = 4) or were treated conservatively (n = 6). Other treatment modalities included (ventriculoperitoneal shunt, ventriculostomy) (n = 5). In 3 cases treatment was not specified. In comparison to VoGM seen in pediatric or neonatal populations, VoGM in adults generally resulted in more favorable outcomes with only 2 patients reported to have passed away following treatment., Conclusion: VoGM remains a rare finding amongst the adult population. Hence, we described the clinical presentation, treatment modalities, and outcomes of the cases described in the English literature. Perhaps due to the rate of thrombosis and the unique angioarchitecture seen in adult VoGM patients, outcomes were generally more favorable than those described in the literature in pediatric or neonate VoGM patients., Competing Interests: Competing Interests No competing interests to declare., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Adolescents are a crucial, yet underrepresented population for health service researchers to study. Nevertheless, youth are rarely included in the design, implementation, and evaluation of research. There is a lack of literature describing adolescents as advisors in health services research in pharmacy. The creation of a youth advisory board (YAB) provides a platform for youth to contribute to the design and implementation of research aimed at improving health and medication use in the pediatric population. This commentary describes the development, benefits, challenges, and lessons learned from the first YAB at the University of Wisconsin-Madison (UW) Collaborative Research on MEdication use & family health (CRoME) Lab alongside feedback from the youth members., Competing Interests: Declaration of competing interest All authors report that they have no financial disclosures and no conflict of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

A anemia falciforme é uma doença genética caracterizada pelo alto índice de morbimortalidade, considerada como a mais grave entre as doenças falciformes. As opções terapêuticas mais eficazes atualmente disponíveis para tratamento desta hemoglobinopatia são transplante de medula óssea (TMO) e hidroxiuréia (HU). O TMO apesar de ser a medida curativa é considerado de alto risco por apresentar diversos graus de complicações e significativo nível de mortalidade. O uso de HU em crianças portadoras de anemia falciforme tem proporcionado redução de complicações clínicas e aumento significativo na expectativa de vida, por promover elevação dos níveis de hemoglobina fetal, da concentração de hemoglobina e do VCM, bem como redução da hemólise e de eventos vaso-oclusivos. Desse modo, a HU é considerada como melhor opção terapêutica atualmente disponível. Porém, por ser apontada como droga potencialmente carcinogênica, há questionamentos quanto aos benefícios e toxicidades quando utilizada por longo período. Este trabalho teve como proposta, avaliar por meio da revisão literária, os riscos, benefícios e efeitos adversos da hidroxiuréia em crianças.Sickle cell anemia is a genetic disease characterized by a high morbimortality rate, it is considered as the most serious among all sickle cell diseases. The most effective therapeutic options available nowadays for the treatment of this hemoglobinopathy are bone morrow transplantation (BMT) and hydroxyurea (HU). BMT is considered a high risk procedure due to the different complications and significant mortality rates. The use of HU for children with sickle cell anemia has reduced the clinical complications and given a significant increase in life expectancy by augmenting the fetal hemoglobin levels and hemoglobin concentrations and reducing cytomegalovirus, as well as reducing hemolysis and vaso-occlusive events. Thus, HU is considered the best therapeutic option currently available. However, as HU has been identified as a potentially carcinogenic drug, there are questions related to the benefits and toxicities when it is used over long periods of time. This work aimed at evaluating, through a review of the literature, the risks, benefits and adverse effects of the use of hydroxyurea in children.

Objetivos: Estimar la carga de enfermedad de las enfermedades inmunoprevenibles y describir su importancia relativa en la salud de la población infantil y juvenil española. Métodos: La unidad de medida es años de vida ajustados por discapacidad (AVAD). Los AVAD resultan de sumar las pérdidas de salud por muerte prematura (AVP) y las pérdidas de salud por discapacidad (AVD). Se ha estimado los AVAD de la población española menor de 15 años para 1999 desagregados por: enfermedades según el sistema de clasificación de Carga Global de Enfermedad (adaptada al objetivo del estudio), por grupos de edad y sexo. Las enfermedades objeto del estudio son las incluidas en calendario vacunal infantil, la varicela y la enfermedad neumocócica. Las fuentes consultadas son: para el cálculo de AVP, el registro de mortalidad nacional; para el cálculo de AVD de las enfermedades inmunoprevenibles, datos de la RENAVE, CMBD y fuentes bibliográficas, y para los AVD de las no inmunoprevenibles, inferencia de las estimaciones de la OMS (Euro-A) y, en su defecto, a partir de datos de incidencia de la EMH. Resultados: La tasa de AVAD global es de 46,57/1.000 habitantes, y las enfermedades objeto del estudio representan el 1,2% del total de la carga de enfermedad: las enfermedades incluidas en el calendario de vacunaciones representan, según el grupo de edad, entre el 0,00 y el 0,03%, excepto la infección meningocócica (entre el 0,5 y el 3,3%). La meningitis neumocócica representa el 0,06-0,65% y la varicela, el 0,00-0,15%, según el grupo de edad. Conclusiones: La carga de enfermedad es un buen indicador para definir la salud de la población infantojuvenil española, ya que es una medida «sintética» que integra información sobre mortalidad, morbilidad y discapacidad de las enfermedades. Los AVAD atribuibles a las enfermedades inmunoprevenibles incluidas en el calendario nos permiten afirmar que los programas de vacunación han conseguido su objetivo.Objectives: To estimate the burden of disease due to vaccinable diseases and the relative importance of these diseases in the health of the Spanish population aged less than 15 years old. Methods: Disease burden was measured in disability-adjusted life years (DALYs). DALYs were computed by adding years of life lost (YLL) to years lived with disability (YLD). The DALYs of the Spanish population aged less than 15 years old were estimated for 1999 and were stratified by diseases according to the classification system of the Global Burden of Disease (adapted to the aim of the study), age group and gender. Diseases included in the childhood vaccination schedule, varicella, and pneumococcal disease were targeted for this study. The sources used were: the national mortality register to compute YLL, the Epidemiologic Surveillance National Network, hospital discharge data (CMBD) and the scientific literature to compute YLD due to vaccinable diseases, and World Health Organization estimates (Euro-A) or, when these were lacking, morbidity hospital data (Hospital Morbidity Survey) to compute the YLD due to non-vaccinable diseases. Results: The burden of disease due to vaccinable diseases was 1.2% of global DALYS (the overall DALYs rate was 46,57/1,000 habitants): diseases included in the vaccination schedule represented 0.00% to 0.03%, depending on age groups, except meningococcal infection (between 0.5% and 3.3%). Pneumococcal meningitis represented 0.06% to 0.65% and varicella 0.00% to 0.15%, also depending on age groups. Conclusions: Disease burden due to vaccinable diseases is a good indicator of the health of the young population in Spain. This measure summarizes and combines information on mortality, morbidity and disability caused by diseases. The DALYs attributable to diseases included in the vaccination schedule demonstrate that immunization programs have achieved their goals.

Purpose: Keratoconus (KC) is a bilateral and often asymmetric disease which can progress to corneal thinning and protrusion. Keratoconus in children appears to be more aggressive than in adults. Research on pediatric keratoconus is limited, and treatments rely on research and experience in adult populations. The current study aimed to provide an analysis on the distribution of the corneal tomography measurements in an underserved, Black and LatinX, primarily low-income pediatric population., Methods: This was a prospective study approved by the Illinois College of Optometry's IRB. A total of 2133 children, presented to a school-based vision clinic within the Chicago Public Schools, were included in the analysis and were classified into three age groups: 3-6 years, 7-12 years, and 13-18 years. Four specific tomography measurements were obtained from the Pentacam (BAD Final D, ART-Max, I-S Ratio, and Thinnest Point Asymmetry)., Results: The mean front corneal astigmatism of the study cohort was -1.39D ± 1.45. Tomography indices means were 0.95 ± 0.74 for BAD Final D, 457.34 ± 94.83 for ART-Max, 0.01 ± 0.68 for I-S ratio, and 9.60 ± 25.55 for Thinnest Point Asymmetry. A statistically significant difference was observed among age groups for BAD Final D (p < 0.001), ART-Max (p < 0.001) and Thinnest Point Asymmetry (p = 0.006)., Conclusion: This study provided the first set of normative data for a pediatric population on the four tomography measurements, offering a reference for potential diagnosis of keratoconus for Black and LatinX children. Further study could include evaluation of additional races along with a comparison with the adult data, which will provide guidance on evaluating the current keratoconus diagnosis criteria to aid early diagnosis of keratoconus in the pediatric population., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

The apparent increase in the prevalence of the attention deficit hyperactivity disorder (ADHD) diagnosis raises many questions regarding the variability of the subjective diagnostic method. This comprehensive review reports findings in studies assessing white matter (WM) bundles in diffusion MRI and symptom severity in children with ADHD. These studies suggested the involvement of the connections between the frontal, parietal, and basal ganglia regions. This review discusses the limitations surrounding diffusion tensor imaging (DTI) and suggests novel imaging techniques allowing for a more reliable representation of the underlying biology. We propose a more inclusive approach to studying ADHD that includes known endophenotypes within the ADHD diagnosis. Aligned with the Research Domain Criteria Initiative, we also propose to investigate attentional capabilities and impulsive behaviours outside of the borders of the diagnosis. We support the existing hypothesis that ADHD originates from a developmental error and propose that it could lead to an accumulation in time of abnormalities in WM microstructure and pathways. Finally, state-of-the-art diffusion processing and novel artificial intelligence approaches would be beneficial to fully understand the pathophysiology of ADHD., Competing Interests: Conflict of Interest M. Descoteaux is CSO and co-founder at Imeka Solutions Inc. (www.imeka.ca) C. Bocti holds an investment in Imeka Solutions Inc., (Copyright © 2022 Elsevier B.V. All rights reserved.)