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BackgroundDecision-making in initiating life-sustaining health technology is complex and often conducted at time-critical junctures in clinical care. Many of these decisions have profound, often irreversible, consequences for the child and family, as well as potential benefits for functioning, health and quality of life. Yet little is known about what influences these decisions. A systematic review of reasoning identified the range of reasons clinicians give in the literature when initiating technology dependence in a child, and as a result helps determine the range of influences on these decisions.MethodsMedline, EMBASE, CINAHL, PsychINFO, Web of Science, ASSIA and Global Health Library databases were searched to identify all reasons given for the initiation of technology dependence in a child. Each reason was coded as a broad and narrow reason type, and whether it supported or rejected technology dependence.Results53 relevant papers were retained from 1604 publications, containing 116 broad reason types and 383 narrow reason types. These were grouped into broad thematic categories: clinical factors, quality of life factors, moral imperatives and duty and personal values; and whether they supported, rejected or described the initiation of technology dependence. The majority were conceptual or discussion papers, less than a third were empirical studies. Most discussed neonates and focused on end-of-life care.ConclusionsThere is a lack of empirical studies on this topic, scant knowledge about the experience of older children and their families in particular; and little written on choices made outside ‘end-of-life’ care. This review provides a sound basis for empirical research into the important influences on a child’s potential technology dependence.

In the field of psychiatry diagnoses are primarily based on the report of symptoms from either the patient, parents, or both, and a psychiatrist's observations. A psychiatric diagnosis is currently the most widely used basis for medication selection and the brain is seldom investigated directly as a source of those symptoms. This study addresses the request from the National Institute of Mental Health (NIMH) Research Domain Criteria Project (RDoC) for scientific research into neurological abnormalities that can be linked to psychiatric symptoms for the purpose of predicting medication response. One such neurological abnormality that has been the focus of many studies over the last three decades is isolated epileptiform discharges (IEDs) in children and adolescents without seizures. We conducted a systematic review of the literature to determine prevalence rates of IEDs within diagnostic categories. We then compared the prevalence of IEDs in the selected literature to our IRB-approved data archive. Our study found a consistent high prevalence of IEDs specifically for ADHD (majority > 25%) and ASD (majority > 59%), and consistent low prevalence rates were found for Depression (3%). If children and adolescents have failed multiple medication attempts, and more than one-third of them have IEDs, then an EEG would be justified within the RDoC paradigm.

The current experiment investigated whether counter-attitudinal information can alter a pre-existing attitude and the accompanying confirmation bias. Sixty-three non-clinical children (9–12 years) were shown pictures of a positive animal (quokka) or a dangerous-looking animal (aye aye). For both animals attitudes and information seeking patterns were obtained. Next, they received counter-attitudinal information of each animal; attitudes and seeking patterns were reassessed. We found that the aye aye was perceived as more dangerous and less kind compared to the quokka. A negative confirmation bias was observed for the aye aye, more negative than positive or neutral information was requested. For the quokka this pattern was absent, more positive and negative than neutral information was selected. The counter-attitudinal information decreased the scariness of the aye aye, but did marginally alter that of the quokka. Additionally, for the aye aye counter-attitudinal information increased search for positive and neutral information and decreased search for negative information. For the quokka the counter-attitudinal information only increased search for neutral information. The animals no longer differed from each other and no clear confirmation bias patterns were present. These results indicate that it is possible to change pre-existing values and their accompanying information search patterns.

Fosfomycin tromethamol (FT) was reintroduced as an option for the treatment of low urinary tract infection (UTI) in children. In this study, we described the antibiotic sensitivity and mechanisms of resistance to fosfomycin in isolates from children older than 6 years with UTI. Urine culture and antibiotic susceptibility study were performed. In fosfomycin resistant strains, PCR for fos, blaCTX-M was performed followed by classification by phylogenetic group and sequencetyping. Escherichia coli was the most frequent etiological agent (89.2%). The susceptibility percentages were: fosfomycin 97.9%; amoxicillin-clavulanate 92.7%; cefuroxime and ceftriaxone 99%; nitrofurantoin 94.4%. An E. coli strain (ST69, phylogenetic group D) was resistant to fosfomycin (MIC 256mg/l) and carried the blaCTX-M-14 and fosA3 genes in a 45kb IncN-type plasmid. Resumen La fosfomicina-trometamol (FT) se reintrodujo como una opción para el tratamiento de la infección del tracto urinario (ITU) baja en niños. En este estudio describimos la sensibilidad antibiótica y los mecanismos de resistencia a FT en aislamientos de niños mayores de 6 anos con ITU. Se realizaron urocultivos y estudios de sensibilidad antibiótica. En las cepas resistentes a fosfomicina se realizó la técnica de PCR para fos, blaCTX-M, y su identificación según su grupo filogenéticoy secuenciotipo. Escherichiacoli fue el agente etiológico más frecuente (89,2%). Los porcentajes de sensibilidad fueron: fosfomicina 97,9%; amoxicilina-clavulánico 92,7%; cefurox-ima y ceftriaxona 99%; nitrofurantoína 94,9%. Una cepa de E. coli (ST69, grupo filogenético D) fue resistente a fosfomicina (CIM 256mg/l) y portaba los genes blaCTX-M-14 y fosA3 en un plás-mido de 45 kb del tipo IncN. Este es el primer reporte de E. coli ST69 con blaCTX-M-14/fosA3 de origen humano.

Cognitive Behavioural Therapy (CBT) programs adapted to children with Autism Spectrum Disorder (ASD) effectively reduce anxiety when run in university clinics. Forty-nine children aged 8-14 years participated in a waitlist controlled study in a general child psychiatric hospital setting. Post-treatment 30% of the children were free of their primary anxiety diagnoses and 5% were free of all anxiety diagnoses. No statistically significant difference between the two trial conditions were found on primary outcomes. However, statistically significant differences were found on secondary outcomes indicating clinically meaningful treatment responses. Together with high program satisfaction this study shows the CBT program to be feasible and potentially efficacious in treating anxiety in children with ASD in a general child psychiatric hospital setting.

Background: Assessment of nutritional status of paediatric oncology patients is crucial, as it may influence treatment and clinical outcomes. Concurrent malnutrition and cancer in children may lead to reduced chemotherapy delivery due to impaired tolerance and increased toxicity. Aim: This study aimed to determine the relationship between nutritional status and the prevalence, frequency and duration of treatment-related neutropenia in a cohort of South African children with nephroblastoma. Methods: Seventy-seven children between the ages of 1 and 12 years diagnosed with nephroblastoma at Inkosi Albert Luthuli Central Hospital (IALCH), Durban, between 2004 and 2012, were studied prospectively. Nutritional status was assessed using weight, height, mid-upper arm circumference (MUAC), triceps skinfold thickness (TSFT) and serum albumin. The administration of filgastrim (Neupogen®) was used as a surrogate for neutropenia and the frequency and duration of its use was recorded. Results: There was a significant relationship between the prevalence of treatment-induced neutropenia and malnutrition defined by MUAC. The mean frequency and duration of neutropenia was significantly higher in those classified as malnourished using MUAC. There was a positive correlation between frequency and duration of neutropenia. Conclusions: Malnutrition was prevalent among children with nephroblastoma. The prevalence of treatment-induced neutropenia was higher in those with poor nutritional status, identified by MUAC. Poor nutritional status according to MUAC was also linked to an increased frequency and duration of neutropenia. It is important to include MUAC in the nutritional assessment of children with nephroblastoma.

Introduction: Obstructive sleep apnea syndrome is a common condition in childhood and if left untreated can result in many health problems. An accurate diagnosis of the etiology is crucial for obstructive sleep apnea treatment success. Functional orthodontic appliances that stimulate mandibular growth by forward mandibular positioning are an alternative therapeutic option in growing patients. Objective: To perform a literature review about the effects of functional orthodontic appliances used to correct the mandibular deficiency in obstructive sleep apnea treatment. Methods: The literature search was conducted in June 2020 using Cochrane Library; PubMed, EBSCO (Dentistry & Oral Sciences Source), LILACS Ovid; SciELO Web of Science; EMBASE Bireme and BBO Bireme electronic databases. The search included papers published in English, until June 2020, whose methodology referred to the types and effects of functional orthopedic appliances on obstructive sleep apnea treatment in children. Results: The search strategy identified thirteen articles; only four articles were randomized clinical studies. All studies using the oral appliances or functional orthopedic appliances for obstructive sleep apnea in children resulted in improvements in the apnea-hypopnea index score. The cephalometric (2D) and tomographic (3D) evaluations revealed enlargement of the upper airway and increase in the upper airspace, improving the respiratory function in the short term. Conclusion: Functional appliances may bean alternative treatment for obstructive sleep apnea, but it cannot be concluded that they are effective in treating pediatric obstructive sleep apnea. There are significant deficiencies in the existing evidence, mainly due to absence of control groups, small sample sizes, lack of randomization and no long-term results. Resumo Introdução: A síndrome da apneia obstrutiva do sono é uma condição comum na infância e, se não tratada, pode resultar em muitos problemas de saúde. Um diagnóstico preciso da etiologia é crucial para o sucesso do tratamento dessa condição clínica. Aparelhos ortodônticos funcionais que estimulam o crescimento mandibular através do anteroposicionamento mandibular são uma opção terapêutica para pacientes em crescimento. Objetivo: Fazer uma revisão da literatura sobre os efeitos do aparelho ortodôntico funcional usado para corrigir a deficiência mandibular no tratamento da apneia obstrutiva do sono. Método: A pesquisa bibliográfica foi feita em junho de 2020 nos os bancos de dados eletrônicos da Cochrane Library; PubMed, EBSCO (Dentistry & Oral Sciences Source), Lilacs Ovid; SciELO Web of Science; Embase Bireme e BBO Bireme. A busca incluiu artigos publicados em inglês, até junho de 2020, cuja metodologia referia-se aos tipos e efeitos dos aparelhos ortopédicos funcionais no tratamento da apneia obstrutiva do sono em crianças. Resultados: A estratégia de busca identificou 19 artigos; apenas quatro eram estudos clínicos randomizados. Todos os estudos que usaram aparelhos orais ou aparelhos ortopédicos funcionais para apneia obstrutiva do sono em crianças resultaram em melhorias no índice de apneia-hipopneia. As avaliações cefalométrica (2D) e tomográfica (3D) mostraram alargamento das vias aéreas superiores e aumento do espaço das vias aéreas superiores, que melhoraram a função respiratória em curto prazo. Conclusão: Os aparelhos funcionais podem ser um tratamento opcional para apneia obstrutiva do sono, mas não é possível concluir que sejam eficazes na população pediátrica. Existem deficiências significativas nas evidências existentes, principalmente devido à ausência de grupos de controle, tamanho pequeno das amostras, falta de randomização e ausência de resultados em longo prazo.

Publisher Copyright: © 2021 The Authors. Nursing Open published by John Wiley & Sons Ltd. Aims: To describe a study protocol for a randomized controlled trial which will evaluate the effectiveness of a gamified mobile health intervention for children in whole day surgery care. Design: A study protocol for a two-arm randomized controlled trial. Methods: Participants will be randomly assigned to the intervention group (N = 62), in which patients receive routine care and play a mobile game designed for children or the control group (N = 62), in which patients receive routine care, including a mobile phone application that supports parents during the care path. The primary outcome is children's pre-operative anxiety, while the secondary outcome measures included fear and postoperative pain, along with parental satisfaction and anxiety. Data collection started in August 2020. Results: The results of the ongoing randomized controlled trial will determine whether the developed gamified mobile health intervention can be recommended for hospital use, and whether it could be used to educate children about their surgical treatment to decrease anxiety.

Objective To evaluate the accuracy of an antibody point-of-care lateral flow immunoassay (LFI - Wondfo Biotech Co., Guangzhou, China) in a pediatric population. Methods Children and adolescents (2 months to 18 years) with signs and symptoms suggestive of acute SARS-CoV-2 infection were prospectively investigated with nasopharyngeal RT-PCR and LFI at the emergency room. RT-PCR was performed at baseline, and LFI at the same time or scheduled for those with less than 7 days of the clinical picture. Overall accuracy, sensitivity and specificity were assessed, as well as according to the onset of symptoms (7-13 or ≥14 days) at the time of LFI test. Results In 175 children included, RT-PCR and LFI were positive in 51 (29.14%) and 36 (20.57%), respectively. The overall sensitivity, specificity, positive and negative predictive value was of 70.6% (95%CI 56.2-82.5), 96.8% (95%CI 91.9-99.1), 90.0% (95%CI 77.2-96.0), and 88.9% (95%CI 83.9-92.5), respectively. At 7-13 and ≥14 days after the onset of symptoms, sensitivity was 60.0% (95%CI 26.2-87.8) and 73.2% (95%CI 57.1-85.8) and specificity was 97.9% (95%CI 88.7-99.9) and 96.1% (95%CI 89.0-99.2), respectively. Conclusion Despite its high specificity, in the present study, the sensitivity of LFI in children was lower (around 70%) than most reports in adults. In acute care settings, although a positive result is informative, a negative LFI test cannot rule out COVID-19 in children.

Behavioral parent and teacher training and stimulant medication are recommended interventions for children with attention-deficit/hyperactivity disorder (ADHD). However, not all children with ADHD receive this evidence-based care, and the aim of the current study was to find out why. More specifically, we investigated clinicians’ policy, guideline use, and attitudes towards medication and parent training when treating children with ADHD, as well as several factors that could affect this. A total of 219 Dutch clinicians (mainly psychologists, psychiatrists and educationalists) completed a survey. Clinicians were likely to recommend medication more often than parent training, and clinicians’ policy to recommend medication and parent training was positively associated with their attitudes towards these interventions. Less experienced clinicians and those with a non-medical background reported lower rates of guideline use, whereas clinicians with a medical background reported less positive attitudes towards parent training. Furthermore, a substantial portion of the clinicians based their decision to recommend parent training on their clinical judgement (e.g., prior estimations of efficacy, perceived low abilities/motivation of parents), and many clinicians reported barriers for referral to parent training, such as waiting lists or a lack of skilled staff. To achieve better implementation of evidence-based care for children with ADHD, guidelines should be communicated better towards clinicians. Researchers and policy-makers should further focus on barriers that prevent implementation of parent training, which are suggested by the discrepancy between clinicians’ overall positive attitude towards parent training and the relatively low extent to which clinicians actually advise parent training.

Closed treatment of paediatric diaphyseal forearm fractures carries the risk of re-displacement, which can lead to symptomatic malunions. This is because growth will not correct angulation deformity as it does in metaphyseal fractures. The purpose of this prospective cohort study was to evaluate the outcomes after 3-D-planned corrective osteotomy with patient-specific surgical guides for paediatric malunited forearm fractures causing impaired pro-supination. Our primary outcome measure was the gain in pro-supination at 12 months follow-up. Fifteen patients with a mean age at trauma of 9.6 years and time until osteotomy of 5.9 years were included. Preoperatively, patients displayed a mean pro-supination of 67° corresponding to 44% of the contralateral forearm. At final follow-up, this improved to 128°, achieving 85% of the contralateral side. Multivariate linear regression analysis revealed that predictors of greater functional gain after 3-D corrective osteotomy are severe preoperative impairment in pro-supination, shorter interval until 3-D corrective osteotomy and greater angulation of the radius.Level of evidence: III. ispartof: JOURNAL OF HAND SURGERY-EUROPEAN VOLUME vol:47 issue:2 pages:164-171 ispartof: location:England status: published

Background/purpose: Acute gastroenteritis (AGE) remains a significant health issue in children. The worldwide evolution of pediatric AGE pathogens had been recorded since the introduction of rotavirus vaccine. Ten years after the rotavirus vaccine was introduced to the private sectors in Taiwan, a nationwide study was conducted to elucidate the epidemiological changes among major AGE pathogens. Methods: From January 2014 to December 2017, children younger than 5 years old, hospitalized with AGE at 10 hospitals across Taiwan were enrolled. Stool specimens were tested for Salmonella spp., Campylobacter spp., Clostridiodes difficile, norovirus, and rotavirus by polymerase chain reaction (PCR). The epidemiological and clinical information was collected. Results: Enteric pathogen were detected in 1983 (42.2%) of 4700 subjects, with Salmonella spp. (12.5%) being the leading cause of AGE, followed by norovirus (11.2%), rotavirus (8.7%), C. difficile (4.2%), Campylobacter spp. (1.0%), and a mixture of at least 2 of 5 above-mentioned pathogens (4.6%). The case distributions varied across different regions. In eastern Taiwan, rotavirus (21/131, 16.0%) remained the most common pathogen detected. The rotavirus vaccine uptake rate is significantly lower in patients with rotavirus AGE. Besides, rotavirus AGE frequently occurred in children with foreign parent(s), Taiwanese indigenous people, and those with the household monthly income

The article presents the literature data and the results of own observations of features of Lyme disease in children at the present stage. Questions of diagnosis, treatment and prevention of Lyme disease in children are considered., В статье представлены литературные данные и результаты собственных наблюдений особенностей болезни Лайма у детей на современном этапе. Рассмотрены вопросы диагностики, лечения и профилактики болезни Лайма у детей., В статті наведені дані літератури та власних спостережень особливостей хвороби Лайма у дітей на сучасному етапі. Розглянуті питання діагностики, лікування та профілактики хвороби Лайма у дітей.

In the article results of own researches concerning peculiarities of the course of asthenic syndrome in school-aged children with chronic hepatitis B, C and mixed forms are provided. It is established that chronic hepatitis C as well as a mixed hepatitis are accompanied by more evident symptoms of deadaptation and somatogenic asthenia than hepatitis B in which psychogenic manifestations prevailed. The degree of endogenous intoxication was also higher at hepatitis C.

Human brain mapping 43(1), 37-55 (2022). doi:10.1002/hbm.25029 special issue: "Special Issue: The ENIGMA Consortium: the first 10 years / Issue Edited by: P.M. Thompson, N. Jahanshad, L. Schmaal, J.A. Turner, A. Winkler, S.I. Thomopoulos, G.F. Egan, P. Kochunov", Published by Wiley-Liss, New York, NY

Resumen: Introducción: El objetivo del estudio fue determinar los niveles séricos y fecales de plomo en niños con distintos trastornos digestivos funcionales (TDF) en comparación con controles sanos. Pacientes y métodos: La muestra incluyó a 102 niños de 4-18 años con TDF definidos mediante los criterios de Roma IV y a 102 controles sanos emparejados por edad y sexo. Los niños con TDF se dividieron en 3 subgrupos: estreñimiento funcional (EF) (n = 36), dolor abdominal funcional (DAF) (n = 36) y náuseas funcionales (NF) (n = 30). Los niveles de plomo se midieron mediante espectrometría de absorción atómica. Resultados: El nivel de plomo en sangre (NPS) mediano fue significativamente mayor en niños con TDF en comparación con controles (5,12 vs. 1,77 μg/dl). Los NPS superaron los 5 μg/dl en el 51,9% del grupo TDF. Se observó una diferencia estadísticamente significativa en los NPS entre el subgrupo con EF y los otros 2 subgrupos (DAF y NF) (p = 0,003 y p

Objective: To quantify goal-directed behavior and ADHD symptoms in naturalistic conditions, we developed a virtual reality task, EPELI (Executive Performance in Everyday LIving), and tested its predictive, discriminant and concurrent validity. Method: We collected EPELI data, conventional neuropsychological task data, and parent-ratings of executive problems and symptoms in 38 ADHD children and 38 typically developing controls. Results: EPELI showed predictive validity as the ADHD group exhibited higher percentage of irrelevant actions reflecting lower attentional-executive efficacy and more controller movements and total game actions, both indicative of hyperactivity-impulsivity. Further, the five combined EPELI measures showed excellent discriminant validity (area under curve 88 %), while the correlations of the EPELI efficacy measure with parent-rated executive problems ( r = .57) and ADHD symptoms ( r = .55) pointed to its concurrent validity. Conclusion: We provide a proof-of-concept validation for a new virtual reality tool for ecologically valid assessment of ADHD symptoms.

Background:Research to date has mainly focused on burn injuries treated in secondary care. This study aims to provide knowledge on the epidemiology of burn injuries in primary care, to give directions for burn prevention.Methods:Data were derived from routine electronic health records of general practices and their out-of-hours service organisations in the Netherlands that participated in the Nivel Primary Care Database 2010–2015. We studied risk factors and trends.Results:The average burn injury prevalence rate was 4.40 (95% CI 4.27–4.53) per 1000 person-years in daytime general practice care and 1.47 (95% CI 1.46–1.49) per 1000 inhabitants in out-of-hours care. Children of 0−4 years old, especially boys, and young adult women had a higher risk. Burn injury risk was higher during the summer months and around New Year’s Eve. Living in low socioeconomic and strongly urbanised neighbourhoods was associated with a higher risk of burn injury than living in other neighbourhoods.Conclusion:Dutch general practitioners have a large share in burn care and therefore can play a significant role in burn prevention. Prevention may be most effective in the summer and around New Year’s Eve, and specific attention seems to be warranted for low socioeconomic groups and strongly urbanised neighbourhoods.

Item does not contain fulltext Fears are common in the general population and particularly among children. The number of fear subtypes (animals, natural environment, situational, blood–injection–injury or other type) has been shown to be associated with psychopathology. Furthermore, there is evidence suggesting that some subtypes may be more often associated with mental disorders than others. The present study uses data from a large cross sectional survey, the School Children Mental Health in Europe (SCMHE) study, conducted in eight European countries on children ages 6 through 13-years-old attending elementary school (n = 9613). Fear subtypes and self-reported mental health were assessed using the Dominic Interactive (DI), a self-administered computerized image-based questionnaire. The findings show that the number of fear subtypes is strongly associated with self-reported internalizing and externalizing problems. In addition, adjusting for the number of subtypes, fear of animals was less likely than other fears to be associated with psychopathology. The findings support the notion that children who report excessive and generalized fear should be targeted for prevention, consistent with research identifying childhood onset generalized specific phobia as a probable precursor to subsequent psychopathology. 11 p.

Contains fulltext : 287522.pdf (Publisher’s version ) (Open Access) Impaired emotion recognition is common in individuals with attention-deficit/hyperactivity disorder (ADHD) and may, via deficient emotion self-regulation, relate to the frequently co-occurring affective and social problems. The present study used an emotional face-matching task and functional magnetic resonance imaging (fMRI) to investigate neural responses during the processing of angry and fearful faces and visuo-spatial control stimuli. Additionally, measures for emotion dysregulation, ADHD type, and age were investigated in relation to the behavioral and neural fMRI data. We utilized a sample of 61 adolescents/young adults with ADHD and 51 age-matched healthy controls (age range: 12-28 years). Participants with ADHD had higher emotion dysregulation scores than controls. They also reacted slower and less accurate in response to emotional but not visuo-spatial control stimuli. Neural response differences between emotional and visuo-spatial trials were significantly smaller in cases, particularly in the left amygdala. While coupling between the right amygdala and bilateral ventromedial prefrontal cortex was stronger for emotional than visuo-spatial stimuli in control subjects, levels of positive coupling between the trial types did not significantly differ in participants with ADHD. Neither emotion dysregulation scores, nor ADHD type or age were related to the behavioral and neural processing alterations during the emotional face-matching task. Results indicate that emotion recognition deficits in ADHD are particularly associated with lower amygdala activation to emotional stimuli and alterations in the functional connections of the amygdala to medial prefrontal areas. Emotion recognition deficits and associated neural alterations were unrelated to emotion dysregulation, ADHD type, or age.

Objective: To evaluate longitudinal associations between recreational screen time and sleep in early childhood, and attention-deficit/hyperactivity disorder (ADHD) at age 8 to 10 years. Method: Questionnaires from 2,768 mother-child pairs from the Dutch KOALA Birth Cohort Study were used. General estimating equation logistic regression analyses examined associations between screen time and sleep at age 2, 4, and 6, and ADHD at age 8 to 10. Linear regression analysis examined associations between television time, sleep and CBCL/2-3 scores at age 2. Results: Longitudinally, neither screen time nor sleep were associated with ADHD. Cross-sectionally, CBCL/2-3 externalizing symptom scores increased by 0.03 with every hour television time (95% CI 0.002–0.05) and increased by 0.02 per hour of less sleep (95% CI −0.03–−0.01). Conclusion: Despite an association with externalizing symptoms at age 2, screen time and sleep in early childhood were not associated with ADHD. Carefulness is warranted when extrapolating cross-sectional associations at early age to an ADHD diagnosis.

Introduction Portal vein obstruction (PVO) is a significant vascular complication after liver transplantation (LT) in pediatric patients. Current treatment strategies include percutaneous transluminal angioplasty (PTA), with or without stent placement, mesorex bypass (MRB), splenorenal shunt, mesocaval shunt, endovascular recanalization (EVR), splenic artery embolization and splenectomy. However, specific characteristics of patients undergoing intervention and selection of individual treatment and its efficacy have remained unclear. This review systematically analyzed biochemical and clinical characteristics, selection of treatment, efficacy, and post-procedural complications. Methods We systematically searched PubMed and Embase between January 1995 and March 2021 for studies on the management of PVO after LT. We analyzed the reports for biochemical and clinical characteristics at the timing of the intervention in different patients, selection of treatment, and reported efficacies. Results We found 22 cohort studies with 362 patients who had the following characteristics: biliary atresia (83%), living-donor LT (85%), thrombocytopenia (73%), splenomegaly (40%), ascites (16%), or gastrointestinal bleeding (26%). The 3-year primary patency of PTA without stent placement was similar to that with stent placement (70%–80% and 43%–94%, respectively). MRB was used as an initial treatment with a 3-year patency of 75% to 100%. One study showed that 5-year primary patency of EVR was 80%. Secondary patency was 90% to 100% after 3 years in all studies with PTA alone, PTA/stent placement, and stent placement alone. Conclusion This is the first review of all treatment protocols in PVO after pediatric LT. We showed that an important group of patients has severe symptoms of portal hypertension. Efficacy of all treatment modalities was high in the included studies which make them important modalities for these patients.

Testis-sparing surgery (TSS) has been increasingly used for treating a variety of testicular tumors (TTs) in children. However, the indications and feasibility associated with TSS remain uncertain. This study aimed to present the clinical outcomes of TSS in children with TTs. The PubMed, Cochrane Library, and Embase databases were reviewed for relevant articles on the clinical outcomes of TSS in children. Recurrence rate, benign rate, rate of TSS and its 95% confidence interval (CI) were calculated. A total of nine relevant studies with 320 patients were included in this study. The recurrence rate was 5.8% (95% CI: 2.3%-14.1%), benign rate was 70.9% (95% CI: 56.3%-82.1%), the rate of TSS (RTSS) was 36.2% (95% CI: 26.1%-47.8%), RTSS in benign tumor was 48.4% (95% CI: 34.3%-62.9%) and rate of elevated AFP was 29.3% (95% CI: 19.7%-41.3%) in children with TTs. Regarding the distribution of TTs, 159 (49.6%) were teratomas, 74 (23.1%) were yolk sac tumors, 36 (11.3%) were epidermoid cysts, 3 (0.9%) were rhabdomyosarcomas, 7 (2.2%) were leydig cell tumor, 6 (1.8%) were sex-cord stromal tumor, 8(2.5%) were mixed malignant germ cell tumors, 3(0.9%) were hemangioma, and 4(1.3%) were adrenal rest tumors. The findings of this meta-analysis suggested that most of the TTs in children were benign, and the most common histologic subtype was teratoma. TSS should be provided to children with benign lesions. This study confirmed that very low rates of tumor recurrence were observed in children with TTs.

Background: Gastroesophageal reflux disease (GERD) may cause airway symptoms and some airway diseases exacerbate GERD symptoms. Asthma and allergic rhinitis (AR) have been identified as united airway disease because of their similar epidemiology and pathophysiology. Asthma has been considered a risk factor to develop GERD. However, the association between AR and GERD is not clear. We tried to investigate whether AR could increase the development of GERD. Methods: Children diagnosed as AR without a prior history of GERD were conducted from the National Health Insurance Research Database between 2000 and 2005. After propensity score matching, we enrolled 36,588 children with AR and 36,588 non-AR children as the controls. Cox regression models were adopted to calculate the hazard ratio (HR) of GERD. Results: AR children had a significantly increased risk of GERD than non-AR children (adjusted HR 1.91, 95% CI = 1.73–2.11, p

Children have the right to grow up free from the hazards associated with tobacco smoking. Tobacco smoke exposure can have detrimental effects on children’s health and development, from before birth and beyond. As a result of effective tobacco control policies, European smoking rates are steadily decreasing among adults, as is the proportion of adolescents taking up smoking. Substantial variation however exists between countries, both in terms of smoking rates and regarding implementation, comprehensiveness and enforcement of policies to address smoking and second-hand smoke exposure. This is important because comprehensive tobacco control policies such as smoke-free legislation and tobacco taxation have extensively been shown to carry clear health benefits for both adults and children. Additional policies such as increasing the legal age to buy tobacco, reducing the number of outlets selling tobacco, banning tobacco display and advertising at the point-of-sale, and introducing plain packaging for tobacco products can help reduce smoking initiation by youth. At societal level, health professionals can play an important role in advocating for stronger policy measures, whereas they also clearly have a duty to address smoking and tobacco smoke exposure at the patient level. This includes providing cessation advise and referring to effective cessation services.Conclusion: Framing of tobacco exposure as a child right’s issue and of comprehensive tobacco control as a tool to work towards the ultimate goal of reaching a tobacco-free generation can help accelerate European progress to curb the tobacco epidemic. What is Known:• Tobacco exposure is associated with a range of adverse health effects among babies and children.• Comprehensive tobacco control policies helped bring down smoking rates in Europe and benefit child health. What is New:• Protecting the rights and health of children provides a strong starting point for tobacco control advocacy.• The tobacco-free generation concept helps policy-makers set clear goals for protecting future generations from tobacco-associated harms.

Symptoms of psychopathology lie on a continuum ranging from mental health to psychiatric disorders. Although much research has focused on progression along this continuum, for most individuals, subthreshold symptoms do not escalate into full-blown disorders. This study investigated how the stability of psychopathological symptoms (attractor strength) varies across severity levels (homebase). Data were retrieved from the TRAILS TRANS-ID study, where 122 at-risk young adults (mean age 23.6 years old, 57% males) monitored their mental states daily for a period of six months (± 183 observations per participant). We estimated each individual’s homebase and attractor strength using generalized additive mixed models. Regression analyses showed no association between homebases and attractor strengths (linear model: B = 0.02, p = 0.47, R2 2

Background. In recent years, there have been increasing reports of vitamin B12 deficiency in patients with vasovagal syncope. Therefore, homocysteine levels in these patients may also differ from those in the healthy population. The purpose of the research was to study the peculiarities of serum homocysteine concentration in children with vasovagal syncope. Materials and methods. The main group consisted of 28 children aged 8–17 years with a diagnosis of vasovagal syncope. The control group included 23 apparently healthy children of the same age who had no signs of chronic diseases. The determination of vitamin B6, B12, folic acid, and homocysteine in the blood serum was performed by means of a colorimetric enzyme-linked immunosorbent assay using the Monobind test system. Hyperhomocysteinemia was diagnosed at the level of serum homocysteine above 15 μmol/l. Results. There were decreased serum levels of vitamins B6 and B12 with unchanged folic acid levels in children with vasovagal syncope compared to healthy respondents. In the vasovagal syncope group, an increased level of homocysteine was observed compared to the controls (13.86 ± 0.97 μmol/l; 7.81 ± 0.36 μmol/l; p = 0.000003). The prevalence of hyperhomocysteinemia among children with vasovagal syncope was 46.4 %, whereas in the control group it was not recorded at all (χ2 = 14.33; p = 0.0002). Homocysteine correlates with P-Q interval (moda and mean), Q-T interval (moda), vitamin B6 (p < 0.05). An increase in serum homocysteine concentration is accompanied by deterioration of some quality of life indicators according to the PedsQLTM (general well-being scale, multifactorial fatigue scale, family impact module). Conclusions. Vasovagal syncope in childhood is associated with increased serum homocysteine. The prevalence of hyperhomocysteinemia among children with vasovagal syncope is 46.4 %., Актуальность. В последние годы появляется все больше сообщений о развитии дефицита витамина B12 среди пациентов с вазовагальными обмороками, следовательно, уровень гомоцистеина у этих пациентов тоже может отличаться от показателей в здоровой популяции. Цель: изучить особенности концентрации гомоцистеиина в сыворотке крови детей с вазовагальными обмороками. Материалы и методы. Основную группу составили 28 детей в возрасте 8–17 лет с диагнозом вазовагального обморока, контрольную — 23 практически здоровых ребенка аналогичного возраста, не имевших признаков хронических заболеваний. Уровни витаминов В6, В12, фолиевой кислоты и гомоцистеина в сыворотке крови определяли с помощью колориметрического метода иммуноферментного анализа с использованием тест-системы Monobind. Гипергомоцистеинемию диагностировали при уровне гомоцистеина в крови выше 15 мкмоль/л. Результаты. У детей с вазовагальными обмороками были обнаружены сниженные показатели витаминов В6 и В12 при неизменном уровне фолиевой кислоты по сравнению со здоровыми респондентами. В группе вазовагальных обмороков регистрировался повышенный уровень гомоцистеина по сравнению с контролем (13,86 ± 0,97; 7,81 ± 0,36 мкмоль/л; р = 0,000003). Распространенность гипергомоцистеинемии среди детей с вазовагальными синкопе составила 46,4 %, тогда как в контрольной группе не регистрировалась (χ2 = 14,33; р = 0,0002). Показатель гомоцистеина коррелирует с модой и средним значением интервала P-Q, модой интервала Q-T, витамином В6 (р < 0,05). Увеличение концентрации сывороточного гомоцистеина сопровождается ухудшением отдельных показателей качества жизни по данным опросников PedsQLTM (шкала общего благополучия, многофакторная шкала усталости, модуль влияния на семью). Выводы. Вазовагальные синкопе в детском возрасте ассоциируются с повышенной концентрацией гомоцистеина в сыворотке крови. Распространенность гипергомоцистеинемии среди детей с вазовагальным синкопе составляет 46,4 %., Актуальність. Останніми роками з’являється все більше повідомлень щодо розвитку дефіциту вітаміну B12 серед пацієнтів із вазовагальними синкопе, а отже, рівень гомоцистеїну у цих пацієнтів теж може відрізнятися від показників у здоровій популяції. Мета: вивчити особливості концентрації гомоцистеіїну у сироватці крові дітей із вазовагальними синкопе. Матеріали та методи. Основну групу становили 28 дітей віком 8–17 років із діагнозом вазовагального синкопе, контрольну — 23 практично здорові дитини аналогічного віку, які не мали ознак хронічних захворювань. Рівні вітамінів В6, В12, фолієвої кислоти та гомоцистеїну у сироватці крові визначали за допомогою колориметричного методу імуноферментного аналізу з використанням тест-системи Monobind. Гіпергомоцистеїнемію діагностували у разі, якщо рівень гомоцистеїну в крові був вище 15 мкмоль/л. Результати. У дітей із вазовагальними синкопе виявлено знижені показники вітамінів В6 та В12 при незміненому рівні фолієвої кислоти порівняно зі здоровими респондентами. У групі вазовагальних синкопе реєструвався підвищений рівень гомоцистеїну проти групи контролю (13,86 ± 0,97; 7,81 ± 0,36 мкмоль/л; р = 0,000003). Поширеність гіпергомоцистеїнемії серед дітей із вазовагальними синкопе становила 46,4 %, тоді як у контрольній групі жодного випадку не реєструвалося (χ2 = 14,33; р = 0,0002). Показник гомоцистеїну корелює з модою та середнім значенням інтервалу P-Q, модою інтервалу Q-T, вітаміном В6 (р < 0,05). Зростання концентрації сироваткового гомоцистеїну супроводжується погіршенням окремих показників якості життя за даними опитувальників PedsQLTM (шкала загального благополуччя, багатофакторна шкала втомлюваності, модуль впливу на родину). Висновки. Вазовагальні синкопе у дитячому віці асоціюються з підвищеною концентрацією гомоцистеїну у сироватці крові. Поширеність гіпергомоцистеїнемії серед дітей із вазовагальними синкопе становить 46,4 %.

BACKGROUND: This is the first large study of onabotulinumtoxinA as treatment for pediatric upper limb spasticity. OBJECTIVE: Evaluate efficacy and safety of a single treatment with onabotulinumtoxinA plus occupational therapy (OT). METHODS: In this registrational phase III, multinational study (NCT01603602), participants were randomized 1:1:1 to onabotulinumtoxinA 3 U/kg/OT, 6 U/kg/OT, or placebo/OT. Primary endpoint was average change from baseline at weeks 4 and 6 in Modified Ashworth Scale-Bohannon (MAS) score. Secondary endpoints included Modified Tardieu Scale (MTS), Clinical Global Impression of Change (CGI) and functional Goal Attainment Scale (GAS). RESULTS: 235 participants were randomized. At weeks 4 and 6, onabotulinumtoxinA groups had greater mean reductions in MAS (both –1.9; p

To determine the viral etiology of severe lower respiratory tract infections (LRTIs), their clinical significance and prognosis among critically ill children.A prospective descriptive study was carried out.Pediatric Intensive Care Unit (PICU) of Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.A total of 115 patients hospitalized in the PICU were evaluated for inclusion in the study. Children with underlying comorbidities and those who did not require mechanical ventilation were excluded.Demographic, clinical, laboratory test and radiographic data were recorded.A total of 63 patients were eligible for the study. The most common diagnosis was bronchiolitis (57.1%). Respiratory syncytial virus (RSV) was the most frequent causal virus (36.5%). The most common complication was acute respiratory distress syndrome (ARDS) (28.6%). Multiple viral infection was identified in 20.6% of the patients, the most common in this subgroup being rhinovirus. Patients with bocavirus infection had a higher likelihood of needing invasive mechanical ventilation (IMV) at presentation. Children who died were likely to be12 months old, have ARDS, hepatitis, pneumomediastinum, multiple viral infection, and required IMV support with an increased duration of MV. Additionally, they were found to have a high Pediatric Risk of Mortality III score, Predicted Death Rate and increased need for inotropic support at admission.Our study showed critically ill children with LRTI without known risk factors to have high mortality when aged12 months, in the presence of multiple agents and when certain complications (ARDS, hepatitis) and X-ray findings were identified.Objetivo: determinar la etiología vírica de las infecciones graves de las vías respiratorias bajas (IGVRB), su importancia clínica y su pronóstico en niños críticamente enfermos.Diseño: estudio descriptivo prospectivo.Ámbito: unidad de cuidados intensivos pediátricos (UCIP) del Hospital Universitario y de Investigación Goztepe, Universidad Medeniyet de Estambul (Turquía).Pacientes y participantes: se evaluó a un total de 115 pacientes ingresados en la UCIP para su posible inclusión en el estudio. Se excluyó a los niños con comorbilidades subyacentes y a aquellos que no requerían ventilación mecánica.Variables de interés principales: se registraron datos demográficos, clínicos, de laboratorio y radiológicos de los pacientes.Resultados: un total de 63 pacientes eran elegibles para participar en el estudio. El diagnóstico más habitual era bronquiolitis (57,1%). El virus sinticial respiratorio era el más común de los virus (36,5%). La complicación más habitual era el síndrome de dificultad respiratoria aguda (SDRA) (28,6%). Se identificaron múltiples infecciones víricas en el 20,6% de los pacientes, siendo la infección por el rinovirus la más común en este subgrupo. Los pacientes con infección por bocavirus presentaban una mayor probabilidad de necesitar ventilación mecánica invasiva (VMI) en el momento de la presentación. Los niños que murieron tenían una mayor probabilidad de presentar: edad12 meses, SDRA, hepatitis, neumomediastino, infección multiviral y requerir MVI, con una mayor duración de la VM. Además, se observó que presentaban unos valores altos de puntuación III del riesgo pediátrico de mortalidad y tasa de mortalidad predecida, además de necesidad apoyo inotrópico en el momento del ingreso.

Objective To evaluate parents’ knowledge about halitosis, and to compare parents’ perception of halitosis in their children to the presence of halitosis clinically. Methods Children between 3 and 8 years attended to Dental University Hospital, King Saud University, were screened. Children satisfying inclusion criteria and their parents agreed to participate were included. Questionnaires regarding parents’ knowledge and perception about halitosis in their children were filled by attending parents. Then, the assessment of halitosis in the participating children carried out by portable gas chromatograph device (OralChromaTM). Results A total of 67 children (44 girls and 23 boys) were included in this study with a mean age of 5.3 years (SD = 1.7). The majority of the questionnaires (n = 44, 65.7%) were filled by accompanying fathers. One in two (52.2%) parents obtained high knowledge score about halitosis. Parents’ knowledge was significantly associated with the mean age of the children (P = 0.02). Thirty-nine (58.2%) parents perceived halitosis in their children. Gender, child’s age, parents’ education level, or family income were not associated with parents’ perception of halitosis. Halitosis was detected clinically in 58 children (86.6%). Thirty-eight (57%) of parents’ perception of halitosis was in consistency with OralChromaTM readings; however, there was no significant association between parents’ perception and the OralChromaTM score. Conclusion Half of the parents had good knowledge about halitosis and 6 in 10 parents perceived halitosis in their children which is quite less than the presence of halitosis detected clinically. Moreover, parents’ perception was not associated with the OralChromaTM score.

Purpose We aimed to compare COVID-19 imaging findings of young adults (19–35 years of age) with those of children (0–18 years) and to correlate imaging findings of young adults with their laboratory tests. Materials and methods This retrospective study included Real Time-Polymerase Chain Reaction (RT-PCR) confirmed 130 young adults (mean age: 28.39 ± 4.77; 65 male, 65 female) and 36 children (mean age: 12.41 ± 4.51; 17 male, 19 female), between March and June 2020. COVID-19 related imaging findings on chest CT were examined in young adults and compared with children by the Mann-Whitney U, and Chi-square or Fisher's exact test. Laboratory examinations of young adults were assessed in terms of correlation with radiological findings by the Spearman's correlation analysis. Results Bilateral multiple distributions (p = 0.014), subpleural involvement, and pleural thickening (p = 0.004), GGOs with internal consolidations were more frequent in adults (p = 0.009). Infiltrations were significantly larger than 20 mm in young adults (p = 0.011). The rates of feeding vessel sign, vascular enlargement, and halo sign were significantly higher in young adults (p

In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.

We assessed the prevalence of Lyme neuroborreliosis in children with acute facial nerve palsy in a Lyme-endemic region and patient characteristics associated with this. All children visiting one of three participating hospitals between January 2010 and December 2016 were included in the study. Of 104 children referred to the hospital with facial nerve palsy, 43% had Lyme neuroborreliosis and 57% idiopathic facial palsy. Characteristics significantly associated with Lyme neuroborreliosis were headache (55% versus 18%), meningeal irritation (21% versus 5%), presentation in summer months (69% versus 37%), and a previous tick bite (33% versus 7%).

Resumen: Introducción: La neumonía necrotizante (NN) es una complicación grave de la neumonía adquirida en la comunidad caracterizada por la destrucción del parénquima pulmonar normal. Ningún estudio ha evaluado las consecuencias de este daño pulmonar en los años posteriores al episodio. El objetivo es investigar el impacto a largo plazo sobre la función pulmonar y los síntomas respiratorios en niños ingresados por NN. Métodos: Seguimiento de niños diagnosticados de NN desde enero-2003 hasta abril-2016. Se seleccionó a los mayores de 4 años, capaces de realizar una función pulmonar, y un seguimiento durante más de 2 años. Los pacientes recibieron un cuestionario respiratorio y completaron una prueba de función pulmonar. Resultados: Se incluyeron 24 pacientes (12 hombres). La edad mediana en el momento del diagnóstico fue de 26 meses, 15 días de hospitalización y 18 pacientes necesitaron drenaje pleural. Los pacientes fueron seguidos durante un promedio de 8,75 años después de la NN. Durante la evaluación, ningún paciente tuvo asma, tos o sintomatología inducida por el ejercicio. Tres niños sufrieron una segunda neumonía, que no requirió hospitalización. Los resultados de la espirometría fueron (media ± desviación estándar): Z-score FEV1 −0,47 ± 0,65, Z-score FVC −0,56 ± 0,73, Z-score FEV1/FVC 0,19 ± 0,98. No hubo evidencia de enfermedad pulmonar obstructiva o patrones restrictivos. Conclusiones: Los resultados a largo plazo de la NN pediátrica son buenos. Sin embargo, los pacientes tienen una función pulmonar ligeramente disminuida varios años después del episodio. Es aconsejable hacer un seguimiento de estos pacientes debido a la posible disminución de la función pulmonar en edad adulta. Abstract: Introduction: Necrotizing pneumonia (NP) is a serious complication of community-acquired pneumonia characterised by the destruction of normal lung parenchyma. No study has evaluated the repercussions of the lung damage in the years following the episode. The aim of this study was to assess the long-term impact on lung function and respiratory symptoms in children hospitalised due to NP. Methods: We analysed outcomes in children given a diagnosis of NP between January 2003 and April 2016. We selected patients aged more than 4 years capable of undergoing a lung function test, that had been followed up for at least 2 years. The patients completed a respiratory questionnaire and underwent a lung function test. Results: We included a total of 24 patients (12 male). The median age at the time of diagnosis was 28 months, the median length of stay was 15 days, and 18 patients required pleural drainage. The mean duration of follow-up after NP was 8.75 years. During the evaluation, none of the patients exhibited asthma, cough, or exercise-induced symptoms. Three children had a second episode of pneumonia that did not require hospital admission. The spirometry results were the following (given as mean ± standard deviation): FEV1 z-score, −0.47 ± 0.65; FVC z-score, −0.56 ± 0.73; and FEV1/FVC z-score, 0.19 ± 0.98. We found no evidence of obstructive pulmonary disease or restrictive patterns. Conclusions: The long-term outcomes of paediatric NP are good. However, patients exhibited mildly impaired lung function several years after the episode. We recommend follow-up of these patients due to potential impairments in lung function in adulthood.

Purpose Quantifying changes in shoulder external rotation range of motion and strength after lower trapezius transfer in children with obstetric brachial plexus palsy (OBPP). Methods This prospective study included five children with sequelae of OBPP, with a mean age of 6.4 years (range: 4-12 years) who underwent lower trapezius tendon transfer to restore active external rotation (ER) of the shoulder. Pre-operatively and at a 12-month follow-up assessment, we analyzed the passive and active shoulder ER, the modified Mallet score, and the shoulder rotator muscles strength using an isokinetic device. Results Clinical parameters improved significantly after trapezius transfer pre-operative passive ER from -8° (range: -20-0°) to 37° (range: 15-50°) (p = 0.035), the modified Mallet score from 13 (range: 10-15) to 18 (range: 17-19) (p = 0.035). Strength testing revealed improved ER muscle strength in all five cases; the mean Peak Torque increased from 1.95 to 4.46 N·m, albeit non-significantly (p = 0.062). Two patients exhibited a winged scapula post-operatively. Conclusion Lower trapezius transfer seems encouraging to restore shoulder external rotation in OBPP children but with non-significant strength improvement. Trial registration 18/07/31/5783, December 22, 2018.

We investigated the effect of a live online educational program in 93 Dutch Youth and Family Center (YFC) physicians who were screening for Autism Spectrum Disorder (ASD) in the general child population. The educational program raised the physicians' level of specific ASD knowledge and it remained higher at six months follow-up (p < .01). Their self-confidence in detecting ASD was also higher and maintained at follow-up (p < .01). The educational program had no effect on the physicians' stigmatizing attitudes toward mental illness nor on the number of potential ASD referrals in children of 4-6 years of age. In conclusion, the online educational program on early detection of ASD has a six month long effect on YFC physicians' level of ASD knowledge and self-confidence.

Background: Norovirus is a common acute gastroenteritis (AGE) pathogen across all age groups worldwide, which is difficult to differentiate from other pathogens. This study aimed to understand the clinical characteristics and risk factors of norovirus gastroenteritis among children in Taiwan. Methods: A prospective AGE surveillance study was conducted in children aged ≤5 years who were hospitalized in 10 major hospitals in Taiwan between 2014 and 2017. The non-AGE control group included healthy children who were matched based on age, gender, season, and geographic area. Results: Overall, 674 norovirus gastroenteritis patients were enrolled. Fever (p

Objectives: Norovirus is associated with one-fifth of all gastroenteritis cases, but basic epidemiological data is lacking, especially in developing countries. As long-term surveillance on norovirus gastroenteritis is scarce in western China, this study aims to update the epidemiological knowledge of norovirus gastroenteritis and to characterize the genotypes of norovirus strains. Methods: Stool samples were collected from hospitalized children under 5 years old with gastroenteritis in Chengdu, China. All samples were tested for norovirus as well as rotavirus, sapovirus, enteric adenovirus, and astrovirus by real-time RT-PCR. RdRp and VP1 genes were sequenced in norovirus-positive samples to investigate viral phylogenies. Results: Of the 1181 samples collected from 2015 to 2019, 242 (20.5%) were positive for norovirus.Among norovirus-positive cases, 65 cases had co-infection with another virus; norovirus/enteric adenovirus was most frequently detected (50.8%, 33/65). The highest positive rate was observed in children aged 13–18 months (23.7%, 68/287). Norovirus infection peaked in autumn (36.6%, 91/249), followed by summer (20.3%, 70/345). Pearson correlation analysis showed significant correlation between the norovirus-positive rate and humidity (r = 0.773, P

Objective: We conducted this study to determine the associations of possible risk factors and prevalence of recurrent otitis media with effusion (OME) in a cohort of children in Upper Egypt. Methods: This was a cross-sectional study undertaken in two tertiary referral centers in Upper Egypt. Associations of possible risk factors with prevalence of recurrent OME were studied. Multi-factor logistic regression analysis was done to recognize the statistically significant risk factors associated with recurrent OME. Results: We collected the data of 2003 pediatric patients, of which 1016 were males (50.7%). A total number of 310 children have OME, including 159 males (51.3%). The prevalence rate of OME in our cohort was 15.5%. Multi-factor logistic regression analysis of the risk factors related to recurrent OME showed it was strongly associated with adenoid hypertrophy (P

ObjectiveIn Germany, children with life-limiting conditions and complex symptoms are eligible for specialised outpatient palliative care (SOPC). In the federal state of Hesse, SOPC for children (SOPPC) is delivered by teams with paediatric expertise. While burdened by the life-limiting condition of their child, parents must also fulfill their roles as main care providers and decision makers. Collaboration between parents and SOPPC teams is important, as the intermittent care and uncertainty it entails often lasts for several months or years. We explored parents’ experiences and their demands of collaboration with SOPPC teams.MethodsWe conducted nine narrative interviews with 13 parents of children and adolescents with life-limiting conditions and used a grounded theory approach to analyse interview data.ResultsParents stressed the importance of paediatric expertise, honesty, psychosocial support, an individualised approach, experience of self-efficacy and the need to be recognised as experts for their children. The narrative interviews showed that collaboration between parents and SOPPC teams was characterised by parents’ need for specialised professional assistance and their simultaneous empowerment by SOPPC teams.ConclusionsParents’ perceptions of what good collaboration with SOPPC teams entails are manifold. To meet these complex needs, SOPPC requires time and specialised expertise.

Objectives The Pain Catastrophizing Scale-Child version (PCS-C) allows to identify children who are prone to catastrophic thinking. We aimed to adapt the Brazilian version of PCS-C (BPCS-C) to examine scale psychometric properties and factorial structure in children with and without chronic pain. Also, we assessed its correlation with salivary levels of Brain-Derived Neurotrophic factor (BDNF). Methods The Brazilian version of PCS-C was modified to adjust it for 7–12 years old children. To assess psychometric properties, 100 children (44 with chronic pain from a tertiary hospital and 56 healthy children from a public school) answered the BPCS-C, the visual analogue pain scale, and questions about pain interference in daily activities. We also collected a salivary sample to measure BDNF. Results We observed good internal consistency (Cronbach’s value = 0.81). Parallel analysis retained 2-factors. Confirmatory factor analysis of our 2-factor model revealed consistent goodness-of-fit (IFI = 0.946) when compared to other models. There was no correlation between visual analogue pain scale and the total BPCS-C score; however, there was an association between pain catastrophizing and difficulty in doing physical activities in school (p = 0.01). BPCS-C total scores were not different between groups. We found a marginal association with BPCS-C (r = 0.27, p = 0.01) and salivary BDNF levels. Discussion BPCS-C is a valid instrument with consistent psychometric properties. The revised 2-dimension proposed can be used for this population. Children catastrophism is well correlated with physical limitation, but the absence of BPCS-C score differences between groups highlights the necessity of a better understanding about catastrophic thinking in children.

Background. Mechanical ventilation (MV) can cause diaphragmatic injury, which is called ventilator-induced diaphragmatic dysfunction and is associated with adverse treatment outcomes, prolonged weaning from respiratory therapy, and prolonged stay in the intensive care unit. The purpose of the study was to determine the prevalence of diaphragmatic dysfunction in children depending on the strategy of mechanical ventilation. The study hypothesis was that the occurrence of diaphragmatic dysfunction does not depend on the strategy of mechanical ventilation. Materials and methods. We conducted a prospective cohort single-center study at the Department of Anesthesiology and Intensive Care at Lviv Regional Children’s Clinical Hospital “OHMATDYT”. We included patients with acute respiratory failure who were mechanically ventilated for more than 3 days. Exclusion criteria for the study were: the refusal of the patient’s legal representatives to participate in the study at any of its stages, the patient’s agonizing state upon admission, and the onset of MV less than 48 h after prior weaning. The study included 89 indivi­duals aged 1 month — 18 years. All patients were randomly divided into 2 groups (using random.org). Group I included people who received lung-protective ventilation strategy, group II — patients who received diaphragm-protective in addition to lung-protective ventilation strategy. Eighty-two patients were included in the data analysis. We studied indicators of diaphragmatic function (amplitude of diaphragm movement, thicke­ning fraction, and it was considered that decrease of this indicator for less than 15 % was a marker of diaphragmatic weakness; its increase up to more than 35 % was a marker of high respiratory function and a potentially damaging factor for diaphragm; and inspiration time), parameters of acid-base balance and mechanical ventilation. To assess age-dependent data, patients were divided into age subgroups: subgroup 1— children aged 1 month — 1 year; subgroup 2 — children aged 1–3 years; subgroup 3 — children aged 3–6 years; subgroup 4 — children 6–13 years; subgroup 5 — children aged 13–18 years. Stages of the study: days 1 (d1), 3 (d3), 5 (d5), 7 (d7), 9 (d9), 14 (d14), 28 (d28). Results. Thus, we identified age-specific features of diaphragmatic dysfunction during MV: in patients of the first age subgroup in group I, there were found weakness for the right hemidiaphragm with compensatory excessive level of work for the left dome at the beginning of weaning and at stage d9, while in group II diaphragmatic overload was registered only at stage d5. In patients of the second age subgroup in group I, changes were the opposite to those described previously: we found excessive work of the right hemidiaphragm with low contractions of left dome at all stages of study in group I, while in group II the only episode of diaphragmatic weakness was in stage d3. In the third age subgroup, the proper diaphragmatic activity in group I of patients was restored later than in II group. In the fourth age subgroup in group I, there was an episode of high work of the diaphragm at stage d5, whereas in group II all data of diaphragmatic function were within the recommended parameters for diaphragm-protective strategy of MV at all stages of our study. In the fifth age subgroup in group I, an excessive work of both right and left domes of the diaphragm was significantly more often registered during weaning than in group II; however, in group II episodes of both types of changes — diaphragmatic weakness and excessive work — were detected. It was found that adding diaphragm-protective strategy of weaning from mechanical ventilation in comprehensive intensive care allowed us to reduce the duration of mechanical ventilation: in patients of the first age subgroup — by 1.5 times (p = 0.08); in patients of the second subgroup — by 2.4 times (p = 0.18); in the fourth age subgroup — by 1.75 times (p = 0.1); in fifth age subgroup — by 4.25 times (p = 0.009). In patients of the third age subgroup, duration of mechanical ventilation increased by 1.1 times (p = 0.68). The frequency of complications (reintubations) was reduced in the first age subgroup by 4.3 times (p = 0.02); in the second age subgroup — by 3.4 times (p = 0.04). Conclusions. The prevalence and variety of manifestations of diaphragmatic dysfunction depend on the strategy of mechanical ventilation. Comprehensive approach during weaning from respiratory therapy, which includes diaphragm-protective strategy of ventilation, reduces the incidence of diaphragmatic dysfunction and the duration of weaning from MV., Актуальность. Искусственная вентиляция легких (ИВЛ) может приводить к повреждению диафрагмы, которое называют вентилятор-индуцированной диафрагмальной дисфункцией и связывают с неблагоприятными результатами лечения, длительным отлучением от респираторной терапии и длительным пребыванием в отделении интенсивной терапии. Целью нашего исследования было установить распространенность диафрагмальной дисфункции среди детей в зависимости от стратегии ИВЛ. Рабочей была гипотеза, что возникновение диафрагмальной дисфункции не зависит от стратегии проведения ИВЛ. Материалы и методы. Нами проведено проспективное когортное одноцентровое исследование в отделении анестезиологии с койками интенсивной терапии КНП «Львовская областная детская клиническая больница «ОХМАТДЕТ». В исследование включали пациентов с острой дыхательной недостаточностью, требующих ИВЛ более 3 суток. Критериями исключения из исследования были: отказ законных представителей пациента от участия в исследовании на любом из его этапов, агональное состояние пациента при поступлении на лечение. В исследование были включены 89 пациентов в возрасте от 1 мес. до 18 лет. Все пациенты были разделены случайным образом на 2 группы (с помощью сервиса random.org). В I группу вошли пациенты, у которых применяли легочно-протективную стратегию ИВЛ, во II группу — пациенты, у которых применяли легочно-протективную и диафрагм-протективную стратегии ИВЛ. В анализ данных включены 82 пациента. Для оценки показателей, зависящих от возраста, пациенты были разделены на возрастные подгруппы: 1-я подгруппа — дети в возрасте 1 мес. — 1 год; 2-я подгруппа — дети 1–3 лет; 3-я подгруппа — дети 3–6 лет; 4-я подгруппа — дети 6–13 лет; 5-я подгруппа — дети 13–18 лет. Этапы исследования: 1-е сутки (d1), 3-и сутки (d3), 5-е сутки (d5), 7-е сутки (d7), 9-е сутки (d9), 14-е сутки (d14), 28-е сутки (d28). В обеих группах пациентов изучали: изменения амплитуды движений диафрагмы в ходе исследования; контрактильные свойства диафрагмы с помощью определения фракции ее истончения и динамику в ходе исследования; рассматривали снижение данного показателя менее 15 % как маркер диафрагмальной слабости; повышение его более 35 % как маркер высокой работы дыхания и потенциально повреждающий фактор для диафрагмы; время вдоха по ультразвуковым данным; мониторировали показатели кислотно-щелочного равновесия крови и параметры искусственной вентиляции легких. Результаты. Нами выявлены специфические возрастные особенности: среди пациентов 1-й возрастной подгруппы в І группе мы регистрировали слабость правого купола диафрагмы с компенсаторным чрезмерным сокращением левого купола в начале отлучения и на этапе d9, тогда как во II группе эпизод чрезмерной работы диафрагмы был зарегистрирован только на этапе d5. Среди пациентов 2-й возрастной подгруппы I группы изменения были диаметрально противоположными по сравнению с 1-й возрастной подгруппой — преобладала чрезмерная работа правого купола с низкими показателями сокращения левого купола на всех этапах исследования, тогда как во II группе был зарегистрирован эпизод диафрагмальной слабости на этапе d3. В 3-й возрастной подгруппе достоверно позже восстанавливалась надлежащая диафрагмальная активность в І группе пациентов по сравнению со II группой. В 4-й возрастной подгруппе среди пациентов I группы отмечен эпизод высокой работы диафрагмы на этапе d5, тогда как во II группе все показатели были в пределах, рекомендованных диафрагм-протективной стратегией. В 5-й возрастной подгруппе в І группе достоверно чаще регистрировали чрезмерную работу как правого, так и левого куполов диафрагмы, во II группе были эпизоды как диафрагмальной слабости, так и чрезмерной ее работы. Использование в комплексе интенсивной терапии диафрагм-протективной стратегии при проведении отлучения от ИВЛ позволило снизить продолжительность ИВЛ: у пациентов 1-й возрастной подгруппы — в 1,5 раза (p = 0,08); у пациентов 2-й возрастной подгруппы — в 2,4 раза (p = 0,18); в 4-й возрастной подгруппе — в 1,75 раза (p = 0,1); в 5-й возрастной подгруппе — в 4,25 раза (p = 0,009). У пациентов 3-й возрастной подгруппы продолжительность ИВЛ возросла в 1,1 раза (p = 0,68). Выводы. Распространенность и разнообразие проявлений диафрагмальной дисфункции зависят от стратегии проведения механической вентиляции легких. Комплексный подход на этапе отлучения от респираторной терапии, включающей проведение диафрагм-протективной стратегии ИВЛ, позволяет уменьшить инцидентность возникновения дисфункции диафрагмы и снизить продолжительность отлучения от ИВЛ., Актуальність. Штучна вентиляція легень (ШВЛ) може призводити до ушкодження діафрагми, що називають вентилятор-індукованою діафрагмальною дисфункцією та пов’язують з несприятливими результатами лікування, тривалим відлученням від респіраторної терапії і тривалим перебуванням у відділенні інтенсивної терапії. Метою нашого дослідження було встановити поширеність діафрагмальної дисфункції серед дітей залежно від стратегії проведення ШВЛ. Робочою була гіпотеза, що виникнення діафрагмальної дисфункції не залежить від стратегії проведення ШВЛ. Матеріали та методи. Нами проведено проспективне когортне одноцентрове дослідження у відділенні анестезіології з ліжками інтенсивної терапії КНП «Львівська обласна дитяча клінічна лікарня «ОХМАТДИТ». До дослідження включали пацієнтів із гострою дихальною недостатністю, які потребували ШВЛ понад 3 доби. Критеріями виключення з дослідження були: відмова законних представників пацієнта від участі у дослідженні на будь-якому з його етапів, агональний стан пацієнта при надходженні на лікування. До дослідження було включено 89 пацієнтів віком від 1 міс. до 18 років. Усіх пацієнтів було розподілено випадковим чином на 2 групи (за допомогою сервісу random.org). До І групи ввійшли пацієнти, у яких застосовували легенево-протективну стратегію ШВЛ, до ІІ групи — пацієнти, у яких застосовували легенево-протективну та діафрагм-протективну стратегії ШВЛ. До аналізу даних включені 82 пацієнти. Для оцінювання показників, що залежали від віку, пацієнтів було розподілено на вікові підгрупи: 1-ша підгрупа — діти віком 1 міс. — 1 рік; 2-га підгрупа — діти 1–3 років; 3-тя підгрупа — діти 3–6 років; 4-та підгрупа — діти 6–13 років; 5-та підгрупа — діти 13–18 років. Етапи дослідження: 1-ша доба (d1), 3-тя доба (d3), 5-та доба (d5), 7-ма доба (d7), 9-та доба (d9), 14-та доба (d14), 28-ма доба (d28). В обох групах пацієнтів вивчали: зміни амплітуди рухів діафрагми впродовж дослідження; конт­рактильні властивості діафрагми за допомогою визначення фракції її стоншення та динаміку впродовж дослідження; розглядали зниження даного показника менше 15 % як маркер діафрагмальної слабкості; підвищення його понад 35 % як маркер високої роботи дихання та потенційно ушкоджуючий чинник для діафрагми; час вдиху за ультразвуковими даними; моніторували показники кислотно-лужної рівноваги крові та параметри штучної вентиляції легень. Результати. Нами виявлено специфічні вікові особливості: серед пацієн­тів 1-ї вікової підгрупи в І групі реєстрували слабкість для правого купола діафрагми з компенсаторним надмірним рівнем скорочень лівого купола на початку відлучення та на етапі d9, тоді як у ІІ групі епізод надмірної роботи діафрагми був зареєстрований лише на етапі d5. Серед пацієнтів 2-ї вікової групи І групи зміни були діаметрально протилежними порівняно з 1-ю віковою підгрупою щодо куполів діафрагми — переважала надмірна робота правого з низькими показниками скорочення лівого купола на всіх етапах дослідження, тоді як у ІІ групі — епізод діафрагмальної слабкості на етапі d3. У 3-й віковій підгрупі вірогідно пізніше відновлювалася належна діафрагмальна активність у І групі пацієнтів порівняно з ІІ групою. У 4-й віковій підгрупі серед пацієнтів І групи відмічено епізод високої роботи діафрагми на етапі d5, тоді як у ІІ групі всі показники були в рекомендованих діафрагм-протективною стратегією межах. У 5-й віковій підгрупі в І групі вірогідно частіше реєстрували надмірну роботу як правого, так і лівого купола діафрагми, у ІІ групі були епізоди як діафрагмальної слабкості, так і надмірної її роботи. Використання в комплексній інтенсивній терапії діафрагм-протективної стратегії дозволило знизити тривалість відлучення від ШВЛ: у пацієнтів 1-ї вікової підгрупи — в 1,5 раза (p = 0,08); у пацієнтів 2-ї вікової підгрупи — у 2,4 раза (p = 0,18); у 4-й віковій підгрупі — в 1,75 раза (p = 0,1); у 5-й віковій підгрупі — у 4,25 раза (p = 0,009). У пацієнтів 3-ї вікової підгрупи тривалість ШВЛ зросла в 1,1 раза (p = 0,68). Висновки. Поширеність та різноманітність проявів діафрагмальної дисфункції залежить від стратегії проведення механічної вентиляції легень. Комплексний підхід на етапі відлучення від респіраторної терапії, що включає проведення діафрагм-протективної стратегії ШВЛ, дозволяє зменшити інцидентність виникнення дисфункції діафрагми та знизити тривалість відлучення від ШВЛ.

Background. The postoperative analgesia method can affect gastrointestinal motility, the level of intra-abdominal pressure (IAP) and lead to intra-abdominal hypertension (IAH). The purpose was to study the effect of different postoperative analgesia methods on gastrointestinal motility in children with appendicular peritonitis complicated with IAH. Materials and me­thods. One hundred and fifteen children operated for appendicular peritonitis were randomized into three groups depending on the postoperative analgesia method: opioids (n = 36, intravenous morphine infusion), lidocaine (n = 40, intravenous lidocaine infusion) and EDA (n = 39, epidural analgesia). The patients in each group were retrospectively divided into subgroups according to the IAP level and the presence of organ dysfunction: without IAH (IAP 10 mmHg) and ACS (abdominal compartment syndrome, IAH with organ dysfunction). IAP level and motor function of the gastrointestinal tract were evaluated in postoperative period in all children. Results. The time needed to restore bowel motility and first feces were significantly shorter and the gastric residual volume was lower in all subgroups of EDA group compared to opioid (Р 10 mmHg were registered significantly more often in opioid group than in lidocaine and EDA groups (Р 10 mmHg correlated positively with the time for moti­lity restoration in all groups, and the strength of such correlation was most pronounced in opioid (rs = 0.78, p = 0.001, and rs = 0.76, p = 0.01) and lidocaine groups (rs = 0.58, p = 0.008, and rs = 0.95, p = 0.01), and moderate — in EDA group (rs = 0.39, p = 0.16, and rs = 0.46, p = 0.43). Conclusions. EDA is the most optimal method of postoperative analgesia for children with peritonitis and IAH. EDA accelerated restoration of gastrointestinal motility and prevents further increase in IAP. Intravenous lidocaine infusion can be used as an alternative method of postoperative analgesia in these patients. Systemic opioid analgesia has a negative effect on gastrointestinal motility., Актуальность. Метод послеоперационного обез­боливания может влиять на скорость восстановления моторной функции желудочно-кишечного тракта, уровень интраабдоминального давления (ИАД) и способствовать развитию интраабдоминальной гипертензии (ИАГ). Цель: исследовать влияние методов послеоперационного обезболивания на моторную функцию кишечника у детей с перитонитом, осложненным ИАГ. Материалы и методы. 115 детей, которым были проведены оперативные вмешательства по поводу аппендикулярного перитонита, рандомизированы на группы в зависимости от метода послеоперационного обезболивания: «Опиоиды» (n = 36, инфузия морфина), «Лидокаин» (n = 40, инфузия лидокаина), «ЭДА» (n = 39, эпидуральная аналгезия). В зависимости от уровня ИАД и наличия органной дисфункции дети каждой группы были разделены на подгруппы: «без ИАГ» (ИАД 10 мм рт.ст.) и «АКС» (абдоминальный компартмент-синдром, ИАГ с органной дисфункцией). Всем детям в послеоперационном периоде проводилось измерение уровня ИАД и оценка скорости восстановления моторной функции желудочно-кишечного тракта. Результаты. Во всех подгруппах группы «ЕДА» время до восстановления перистальтики и первых испражнений и объем остатка по назогастральному зонду были статистически значимо меньшими по сравнению с аналогичными показателями в подгруппах группы «Опиоиды» (Р 10 мм рт.ст. значительно чаще встречались у детей в группе «Опиоиды», чем в группах «Лидокаин» и «ЭДА» (Р 10 мм рт.ст. имело прямую корреляцию с длительностью времени восстановления перистальтики, но сила такой корреляции была выше в группах «Опиоиды» (rs = 0,78; p = 0,001 и rs = 0,76; p = 0,01) и «Лидокаин» (rs = 0,58; p = 0,008 и rs = 0,95; p = 0,01), чем в группе «ЭДА» (rs = 0,39; p = 0,16 и rs = 0,46, p = 0,43). Выводы. ЭДА является оптимальным методом послеоперационного обезболивания у детей с перитонитом, осложненным ИАГ, который приводит к раннему восстановлению моторной функции ЖКТ и предотвращает дальнейший рост ИАД. Инфузия лидокаина может быть использована как альтернативный метод обезболивания. Системная опиоидная аналгезия оказывает негативное влияние на моторику желудочно-кишечного тракта., Актуальність. Метод післяопераційного знеболювання може впливати на швидкість відновлення моторної функції шлунково-кишкового тракту, рівень інтраабдомінального тиску (ІАТ) і розвиток інтраабдомінальної гіпертензії (ІАГ). Мета: дослідити вплив методів післяопераційного знеболювання на моторну функцію кишечника в дітей з перитонітом, ускладненим ІАГ. Матеріали та методи. 115 дітей, яким були проведені оперативні втручання з приводу апендикулярного перитоніту, рандомізовано на групи залежно від методу післяопераційного знеболювання: «Опіоїди» (n = 36, внутрішньовенна інфузія морфіну), «Лідокаїн» (n = 40, внутрішньовенна інфузія лідокаїну), «ЕДА» (n = 39, епідуральна аналгезія). Залежно від рівня ІАТ і наявності органної дисфункції дітей кожної групи було поділено на підгрупи: «без ІАГ» (ІАТ 10 мм рт.ст.) і «АКС» (абдомінальний компартмент-синдром, ІАГ з органною дисфункцією). Усім дітям у післяопераційному періоді проводилось вимірювання рівня ІАТ та оцінка швидкості відновлення моторної функції шлунково-кишкового тракту. Результати. У всіх підгрупах групи «ЕДА» час до відновлення перистальтики й перших випорожнень та об’єм залишку по назогастральному зонду були статистично значуще меншими порівняно з аналогічними показниками в підгрупах групи «Опіоїди» (Р 10 мм рт.ст. значно частіше спостерігались у групі «Опіоїди», ніж у групах «Лідокаїн» та «ЕДА» (Р 10 мм рт.ст. мала пряму кореляцію зі швидкістю відновлення перистальтики в усіх групах, але сила такої кореляції була найбільш вираженою в групах «Опіоїди» (rs = 0,78; p = 0,001 і rs = 0,76; p = 0,01) і «Лідокаїн» (rs = 0,58; p = 0,008 і rs = 0,95; p = 0,01) і помірною — у групі «ЕДА» (rs = 0,39; p = 0,16 і rs = 0,46; p = 0,43). Висновки. ЕДА є оптимальним методом післяопераційного знеболювання в дітей з перитонітом, ускладненим ІАГ, що призводить до раннього відновлення моторної функції шлунково-кишкового тракту й запобігає подальшому зростанню ІАТ. Внутрішньовенна інфузія лідокаїну може бути використана як альтернативний метод знеболювання. Системна опіоїдна аналгезія має негативний вплив на моторику шлунково-кишкового тракту.

Ebola virus disease — natural focal, extremely dangerous infection with severe course characterized by fever, hemorrhagic syndrome and multiple damage to vital organs and body systems. The article describes the epidemiological situation related with the registration of cases, provides the characteristics of the pathogen, mechanisms of development, peculiarities of disease in children. Methods of the treatment and prevention of this disease are described from the modern point of view., В статье освещена эпидемиологическая ситуация, связанная с регистрацией случаев геморрагической лихорадки Эбола, охарактеризованы возбудители, механизмы развития, особенности течения болезни у детей. С современных позиций описаны методы лечения и профилактики заболевания. Геморрагическая лихорадка Эбола — природно-очаговая особо опасная инфекция с тяжелым течением, характеризующаяся лихорадкой, геморрагическим синдромом и полиорганными повреждениями жизненно важных органов и систем организма., У статті висвітлено епідеміологічну ситуацію, пов’язану з реєстрацією випадків геморагічної лихоманки Ебола, охарактеризовано збудник, механізми розвитку, особливості перебігу хвороби в дітей. Із сучасних позицій описано методи лікування й профілактики захворювання. Геморагічна лихоманка Ебола — природно-вогнищева особливо небезпечна інфекція з тяжким перебігом, що характеризується лихоманкою, геморагічним синдромом і поліорганними пошкодженнями життєво важливих органів і систем організму.

Current molecular detection methods for single or multiplex pathogens by real-time PCR generally offer great sensitivity and specificity. However, many infectious pathogens often result in very similar clinical presentations, complicating the test-order for physicians who have to narrow down the causative agent prior to in-house PCR testing. As a consequence, the intuitive response is to start empirical therapy to treat a broad spectrum of possible pathogens. Syndromic molecular testing has been increasingly integrated into routine clinical care, either to provide diagnostic, epidemiological or patient management information. These multiplex panels can be used to screen for predefined infectious disease pathogens simultaneously within a 1 h timeframe, creating opportunities for rapid diagnostics. Conversely, syndromic panels have their own challenges and must be adaptable to the evolving demands of the clinical setting. Firstly, questions have been raised regarding the clinical relevance of some of the targets included in the panels and secondly, there is the added expense of integration into the clinical laboratory. Here, we aim to discuss some of the factors that should be considered before performing syndromic testing rather than traditional low-plex in-house PCR.

In this article we analyzed current antibiotic resistance of S.pneumoniae. We showed local (region) data on sensitivity of pneumococcus to aminopenicillins, macrolides and cephalosporines traditionally used in schemes of empirical antibiotic therapy of community-acquired pneumonia in children under 5 years. We laid basic principles of rational antibiotic therapy based on the analysis of current national and foreign guidelines on the treatment of community-acquired pneumonia. Insignificant differences in the schemes of empirical antibiotic therapy are marked due to peculiarities of local resistance of S.pneumoniae in different countries. We discussed propriety of some positions of empirical antibiotic therapy in children of early and preschool age., В статье проанализирована текущая ситуация с антибиотикорезистентностью S.pneumoniae. Представлены локальные (региональные) данные о чувствительности пневмококка к аминопенициллинам, макролидам, цефалоспоринам, традиционно используемым в схемах эмпирической антибиотикотерапии внебольничной пневмонии у детей в возрасте до 5 лет. Изложены основные принципы рациональной антибиотикотерапии, основанные на анализе современных отечественных и зарубежных руководств по лечению внебольничной пневмонии. Отмечены незначительные отличия в схемах эмпирической антибиотикотерапии, обусловленные особенностями локальной резистентности S.pneumoniae в разных государствах. Обсуждается корректность некоторых положений эмпирической антибиотикотерапии внебольничных пневмоний у детей раннего и дошкольного возраста., У статті проаналізована поточна ситуація з антибіотикорезистентністю S.pneumoniae. Наведені локальні (регіональні) дані щодо чутливості пневмокока до амінопеніцилінів, макролідів, цефалоспоринів, які традиційно використовуються в схемах емпіричної антибіотикотерапії позалікарняної пневмонії у дітей віком до 5 років. Викладені основні принципи раціональної антибіотикотерапії, основані на аналізі сучасних вітчизняних і зарубіжних настанов з лікування позалікарняної пневмонії. Відзначені невеликі відмінності в схемах емпіричної антибіотикотерапії, що зумовлені особливостями локальної резистентності S.pneumoniae в різних країнах. Обговорюється коректність деяких положень емпіричної антибіотикотерапії позалікарняних пневмоній у дітей раннього та дошкільного віку.

This article is based on the analysis of current domestic and foreign literature and deals with the problem of diagnostics of influenza-associated pneumonia in children. Clinical features of primary viral and viral-bacterial pneumonia are described. We presented a critical characteristic of laboratory and imaging methods for the diagnosis of influenza-associated pneumonia, we justified the possibility and the feasibility of their use in pediatric practice, depending on the purpose of the study and the stage of monitoring., Статья основана на анализе современной отечественной и зарубежной литературы и посвящена проблеме диагностики грипп-ассоциированных пневмоний у детей. Описаны особенности клинического течения первично-вирусных и вирусно-бактериальных пневмоний. Представлена критическая характеристика лабораторных и визуализирующих методов диагностики грипп-ассоциированных пневмоний, обоснована возможность и целесообразность их использования в педиатрической практике в зависимости от цели исследования и этапа наблюдения., Стаття основана на аналізі сучасної вітчизняної і зарубіжної літератури та присвячена проблемі діагностики грип-асоційованих пневмоній у дітей. Описані особливості клінічного перебігу первинно-вірусних та вірусно-бактеріальних пневмоній. Наведена критична характеристика лабораторних і візуалізуючих методів діагностики грип-асоціованих пневмоній, обоснована можливість і доцільність їх використування в педіатричній практиці залежно від цілі дослідження й етапу спостереження.

Antibiotic therapy is recognized as the only scientifically valid method for the treatment of pneumonia, the outcome of which depends on proper antibiotic and the optimal duration of its administration that ensures the achievement of microbial eradication. The article discusses the duration of antibiotic therapy in uncomplicated community-acquired pneumonia in children. There was a trend to a reduction in the duration of antibiotic use, even with severe cases of the disease course. It is shown that currently there is no serious evidence base that would reliably show the enough duration of 5-day course of antibiotic therapy. It is proposed to consider 7–10 day course of treatment as the optimal duration of effective therapy for uncomplicated pneumonia. Implementation of the concept of short courses of antibiotic therapy is possible only under the supervision of the procalcitonin level., Антибиотикотерапия признана единственным научно обоснованным методом лечения пневмонии, конечный результат которой зависит от правильно выбранного антибиотика и оптимальной продолжительности его введения, что гарантирует достижение микробной эрадикации. В статье обсуждаются вопросы продолжительности антибиотикотерапии при внебольничной неосложненной пневмонии у детей. Отмечена тенденция к сокращению сроков использования антибиотиков даже при тяжелых вариантах течения заболевания. Показано, что в настоящее время серьезная доказательная база, которая бы надежно аргументировала достаточную продолжительность 5-дневных курсов антибиотикотерапии, отсутствует. Предложено рассматривать 7–10-дневный курс лечения как оптимальную продолжительность эффективной терапии неосложненной пневмонии. Реализация концепции коротких курсов антибактериальной терапии возможна только под контролем уровня прокальцитонина., Антибіотикотерапія визнана єдиним науково обґрунтованим методом лікування пневмонії, кінцевий результат якої залежить від правильно обраного антибіотика й оптимальної тривалості його введення, що гарантує досягнення мікробної ерадикації. У статті обговорюються питання тривалості антибіотикотерапії при позалікарняній неускладненій пневмонії в дітей. Відзначено тенденцію до скорочення термінів використання антибіотиків навіть при тяжких варіантах перебігу захворювання. Показано, що на сьогодні серйозна доказова база, яка б надійно аргументувала достатню тривалість 5-денних курсів антибіотикотерапії, відсутня. Запропоновано розглядати 7–10-денний курс лікування як оптимальну тривалість ефективної терапії неускладненої пневмонії. Реалізація концепції коротких курсів антибактеріальної терапії можлива тільки під контролем рівня прокальцитоніну.

We present a review of current literature and findings of our own surveys of 35 children and 182 adults with ankylosing spondylitis. Compared with the disease in adults, juvenile ankylosing spondylitis has a number of clinical features, which occurs only in boys, manifests by a more frequent lesion of axial joints (shoulder, hip), development of systemic bone deficiency (osteopenia, osteoporosis), enthesitis (in particular, of the femoral condyles and the vertebral joints, but not achillodynia), uveitis, and cardiopathy, proliferation (and not destruction) of bone sections during the onset of spondylopathy and a rare involvement in the process of the lumbar spine and the formation of epiphyseal osteoporosis, higher blood concentrations of interleukin-8 and -17, but lower values of interleukin-1β, circulating immune complexes, fibrinogen, immunoglobulins А and G. It may be desirable to separate ankylosing spondylitis as a nosological form, such as juvenile idiopathic arthritis (in the recent past, juvenile rheumatoid arthritis)., Представлены обзор современной литературы и данные собственных обследований 35 детей и 182 взрослых, страдающих анкилозирующим спондилитом. По сравнению с заболеванием у взрослых людей ювенильный анкилозирующий спондилит (ЮАС) имеет целый ряд особенностей клинического течения, который возникает исключительно у мальчиков, проявляется более частым поражением осевых суставов (плечевых, тазобедренных), развитием системного остеодефицита (остеопении, остеопороза), энтезитов (в частности, мыщелков бедренной кости и позвонковых сочленений, но не ахиллодинитов), увеита и кардиопатии, пролиферацией (а не деструкцией) участков кости в дебюте спондилопатии и редким вовлечением в процесс поясничного отдела позвоночника и формированием эпифизарного остеопороза, более высокими концентрациями в крови интерлейкинов-8 и -17, но меньшими значениями интерлейкина-1β, циркулирующих иммунных комплексов, фибриногена, иммуноглобулинов А и G. Возможно, будет целесообразным выделение ЮАС в отдельную нозологическую форму, как, например, ювенильного идиопатического артрита (в недавнем прошлом — ювенильного ревматоидного артрита)., Наведено огляд сучасної літератури і дані власних обстежень 35 дітей та 182 дорослих, що страждають від анкілозуючого спондиліту. Порівняно із захворюванням у дорослих людей ювенільний анкілозуючий спондиліт (ЮАС) має низку особливостей клінічного перебігу, що виникає виключно у хлопчиків, виявляється частішим ураженням вісьових суглобів (плечових, кульшових), розвитком системного остеодефіциту (остеопенії, остеопорозу), ентезитів (зокрема, виростків стегнової кістки й хребцевих зчленувань, але не ахіллодинітів), увеїту і кардіопатії, проліферацією (а не деструкцією) ділянок кістки в дебюті спондилопатії та рідкісним залученням до процесу поперекового відділу хребта й формуванням епіфізарного остеопорозу, більш високими концентраціями в крові інтерлейкінів-8 і -17, але меншими значеннями інтерлейкіну-1β, циркулюючих імунних комплексів, фібриногену, імуноглобулінів А і G. Можливо, буде доцільним виділення ЮАС в окрему нозологічну форму, як, наприклад, ювенільного ідіопатичного артриту (в недавньому минулому — ювенільного ревматоїдного артриту).

Introduction For children with haemophilia, early initiation of prophylaxis is crucial to prevent life-threatening bleeds and maintain joint health throughout life. Options for prophylaxis have recently increased from replacement therapy with standard or extended half-life coagulation factor products to include other haemostasis products, such as the non-replacement therapy emicizumab. Aim To review key factors that determine the choice of prophylaxis in young children. Methods Key clinical questions on the implementation of prophylaxis for haemophilia in children were identified and PubMed was searched for evidence supporting guidance on the implementation of prophylaxis. Results The results of the literature search and the practical experience of the authors were used to build consensus on when to start prophylaxis, the pros and cons of the products available to guide the choice of product, and practical aspects of starting prophylaxis to guide the choice of regimen. Conclusions In this era of increasing therapeutic choices, available information about the range of treatment options must be considered when initiating prophylaxis in young children. Parents or care givers must be sufficiently informed to allow informed shared decision making. Although plentiful data and clinical experience have been gathered on prophylaxis with clotting factor replacement therapy, its use in young children brings practical challenges, such as the need for intravenous administration. In contrast, our relatively brief experience and limited data with subcutaneously administered non-replacement therapy (i.e., emicizumab) in this patient group imply that starting emicizumab prophylaxis in young children requires careful consideration, despite the more convenient route of administration.