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The autumn and winter bronchiolitis epidemics have virtually disappeared in the first year of the COVID-19 pandemic.Our objectives were characterised bronchiolitis during fourth quarter of 2020 and the role played by SARS-CoV-2.Prospective multi-centre study performed in Madrid (Spain) between October and December 2020 including all children admitted with acute bronchiolitis. Clinical data were collected and multiplex PCR for respiratory viruses were performed.Thirty-three patients were hospitalised with bronchiolitis during the study period: 28 corresponded to rhinovirus (RV), 4 to SARS-CoV-2, and 1 had both types of infection. SAR-CoV-2 bronchiolitis were comparable to RV bronchiolitis except for a shorter hospital stay. A significant decrease in the admission rate for bronchiolitis was found and no RSV was isolated.SARS-CoV-2 infection rarely causes acute bronchiolitis and it is not associated with a severe clinical course. During COVID-19 pandemic period there was a marked decrease in bronchiolitis cases.La epidemia de bronquiolitis de otoño e invierno prácticamente desapareció durante el primer año de la pandemia de COVID-19.Nuestros objetivos eran caracterizar la bronquiolitis durante el cuarto trimestre de 2020 y determinar el papel desempeñado por el virus SARS-CoV-2.Estudio multicéntrico prospectivo realizado en Madrid (España) entre los meses de octubre y diciembre de 2020, que incluyó a todos los niños ingresados con bronquiolitis aguda. Se recogieron los datos clínicos y se realizó una PCR múltiple para virus respiratorios.Se hospitalizó a treinta y tres pacientes con bronquiolitis durante el periodo del estudio: 28 correspondieron a rinovirus, 4 a SARS-CoV-2 y uno presentaba ambos tipos de infección. Las bronquiolitis por SAR-CoV-2 fueron comparables a las bronquiolitis por rinovirus, salvo por una estancia hospitalaria más corta. Se detectó una reducción significativa en la tasa de ingresos por bronquiolitis y no se aisló VSR.Es raro que la infección por SARS-CoV-2 cause bronquiolitis aguda y no se asocia a una evolución clínica grave. Durante la pandemia de COVID-19 se produjo un descenso pronunciado de los casos de bronquiolitis.

Objective: To evaluate sleep characteristics of parents and their children during the COVID-19 pandemic and predictors for sleep disturbances. Methods: Cross-sectional web-based study using an online survey made available for dyads of parents and their children during the 7th week of quarantine in southern Brazil. Parents' and adolescents’ sleep were characterized using the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. For children aged 0-3 years parents completed the Brief Infant Sleep Questionnaire, for those aged 4-12 years the Sleep Disturbance Scale for Children. Parents also informed, subjectively, their perception about sleep habits during social distancing. Multiple regression was run to predict sleep disturbances in adults using independent variables: sex, income, education, children age, and children with sleep disturbances. Results: Data from 577 dyads showed sleep alterations in 69,8% of adults, in 58,6% of children aged 0-3 years, 33,9% in the 4-12 years range (with a predominance of disorders of initiating or maintaining sleep), and 56,6% in adolescents. Sex (female) and children with sleep disturbances were significant predictors of a sleep problem in parents (p < 0.005). Subjective perception revealed complaints related to emotional concerns such as anxiety and fear in adults and due to alterations in routine in children and adolescents. Conclusion: The present study’s data showed an increased rate of sleep problems among families during quarantine both measured by validated instruments and also based on personal perception.

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.

Background Children often suffer from congenital or acquired diseases. Ambulatory cases represent the vast majority of pediatric surgical cases. COVID-19 pandemic-associated regulatory precautions had made the process of seeking medical advice at a suitable appointment such a big problem. We utilized telemedicine (online encounter) to deliver the required healthcare service for sorting and guiding pediatric ambulatory surgical patients. In this article, we aimed to: (1) present our experience, (2) evaluate the effectiveness, and (3) document the results of this technology to solve the problem of difficult healthcare accessibility. Materials and Methods In this study, we compared the utilization of telemedicine (virtual clinic via video consultation) prospectively in the current era of the COVID-19 pandemic in the period from June 2020 to July 2021 to the in-person clinic encounter at the outpatient department (OPD) retrospectively in the previous year (from June 2019 until the end of May 2020) for perioperative management of pediatric ambulatory surgical patients. The study was conducted at 3 tertiary care pediatric surgery centers. The information recorded for analysis included: demographic data, surgical condition distribution, time interval from the appointment request till the actual encounter with the surgeon, conversation duration, distance traveled, and ultimate fate of the consultations. For both groups, service was evaluated after the first follow-up visit by a patient survey questionnaire (Patient Experience Assessment form) including questions relevant to each encounter. Results A total of 1124 pediatric patients with various ambulatory surgical conditions had been scheduled for virtual clinic video encounters. Of them, 1056 cases were evaluated by video consultation, supervised by their parents or caregivers, thus, achieving an attendance rate of 94%. Of the remaining cases, 2% (n=23) were canceled and 4% (n=45) did not attend the virtual clinic. Two-thirds of the cases live in rural /remote areas. Patients’ overall satisfaction was 92%. This was in comparison to 872 pediatric ambulatory surgical patients scheduled for in-person clinic visits before the implementation of the virtual clinic. Of them, only 340 cases had attended the clinic, thus, achieving an attendance rate of 39%. Of the remaining cases, 450 cases (51.6%) were canceled and 82 cases (9.4%) did not attend the clinic (no show). About 48% of the cases live in rural areas. For this group, patients’ overall satisfaction was 63%. The mean encounter duration was similar for both groups (∼ 5 minutes). Surgical condition distribution was also similar (p-value: 0.694). For new cases, the time interval from appointment request till the actual encounter was very short for the virtual clinic group (range: 6-15 days) as compared to the in-person clinic group (range: 30-180 days). Patients were followed up for a median period of 14±3.25 months (range: 6-22 months) with no patient loss to follow-up. Conclusion Telemedicine can effectively bridge the patient-physician communication gap caused by the regulatory precautions mandated by the current COVID-19 pandemic. It achieved an attendance rate of 94% and parents’ / patients’ overall satisfaction of 92%.

Background: This project aims to review the spectrum and outcome of penetrating trauma in children and adolescents with the objective of defining the extent of the problem and of developing strategies to reduce the incidence and severity of this form of trauma. Methods: All patients less than eighteen years of age who were admitted to the Pietermaritzburg Metropolitan Trauma Service (PMTS) following penetrating trauma between December 2012 and December 2018 were identified from the Hybrid Electronic Medical Registry (HEMR). Results: During the five-year period under review, a total of 164 patients less than eighteen years of age sustained penetrating trauma and were admitted to the PMTS. There were 138 males and 26 females. The mean age was 13.29 years and the median age 15 years. There were 70 stab wounds (SW) and 73 gunshot wounds (GSW). There were 21 non-intentional impalement injuries. The mean ISS was 9.04 and the median was 9. A total of 155 plain X-rays were performed, 50 CT scans and 51 CT angiograms in this cohort of patients. Only two ultrasound examinations were performed. A total of 76 patients required an operation, which included 50 laparotomies. Of the patients who underwent a laparotomy, 18 required a repeat laparotomy. There were 46 other procedures undertaken in this cohort of patients, which included two thoracotomies, three laparoscopies and two thoracotomies. The median hospital stay was 2 days and 17 (10%) patients required ICU admission and 7 (4%) died. Conclusion: Penetrating trauma in children and adolescents is associated with significant mortality and morbidity. There are similarities with the management of these injuries in adults, but further work is required to ensure that paediatric management algorithms are evidence based.&nbsp

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.

Objective: Advances in knowledge of neurotrophic factors are now revealing the complex control of energy homeostasis and appetite, as well as the crucial role these factors play in nervous system function. The aim of this study was to assess serum levels of neudesin in adolescents with obesity and to examine the relationship between these levels and metabolic outcomes. Methods: Adolescents, aged 10-17 years were enrolled. Subjects were divided into normal weight, obese and morbidly obese subgroups. Serum neudesin concentrations were compared between the groups. Results: In total, 88 adolescents were recruited, of whom 30 (34.1%) were normal weight, 15 (17.0%) were obese and 43 (48.9%) were morbidly obese. Neudesin levels were significantly lower in obese adolescents than in the control group (p=0.013). A correlation analysis applied to the whole study group revealed a negative correlation between serum neudesin concentration and body mass index (BMI) z scores (r=-0.40, p

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.

Levosimendan increasingly has been used to treat heart failure and cardiac dysfunction in pediatric patients. Currently, there is only limited evidence that this drug positively affects outcomes. The authors' aim was to investigate the effects of levosimendan on hemodynamic parameters and outcomes in pediatric patients in all clinical settings. The study design was a systematic review of randomized and nonrandomized studies. Randomized clinical trials (RCTs) were included in a meta-analysis. The primary outcome of the meta-analysis was the effect of levosimendan on central venous oxygen saturation (ScvO) and lactate values as surrogate markers of low-cardiac-output syndrome. The study setting was any acute care setting. Study participants were pediatric patients (age

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: Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinic-radiological syndrome characterized by neurological deficiencies and reversible magnetic resonance imaging findings in the splenium of the corpus callosum. Usually, it has a good prognosis, and patients recover without any sequelae. A viral infection has caused most MERS cases, and bacterial agents have rarely been reported as a cause of MERS. Case report: A 5-month-old male was admitted to the hospital with fever, poor feeding, decreased activity and groaning. He had focal seizures and required mechanical ventilation. A lumbar puncture was performed, and nucleic acid amplification tests (NAATs) of cerebral spinal fluid was positive for non-typeable serogroup of Neisseria meningitidis. Cranial magnetic resonance imaging (MRI) performed on day 3 of admission showed T2 hyperintensity and diffusion restriction at the splenium of corpus callosum (SCC). Diffusion restriction in the occipital horn of the left ventricular compatible with empyema was also obvious. According to the findings on cranial MRI, this clinical course was diagnosed as MERS associated with meningitis. His fever resolved in one week, cefotaxime was discontinued after 14 days, and the patient completely recovered. A follow-up MRI performed after three weeks of admission showed complete resolution of the signal intensity changes in the SCC and the occipital horn of the left lateral ventricle. Conclusion: To the best of our knowledge, this is the first report of MERS associated with Neisseria meningitidis in children. Bacterial agents as a cause of MERS should be kept in mind, and we should avoid unnecessary treatment strategies due to the good prognosis of MERS in children. (C) 2021 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Introduction: In primary hyperoxaluria type 1 (PH1), oxalate overproduction frequently causes kidney stones, nephrocalcinosis, and kidney failure. As PH1 is caused by a congenital liver enzyme defect, combined liver–kidney transplantation (CLKT) has been recommended in patients with kidney failure. Nevertheless, systematic analyses on long-term transplantation outcomes are scarce. The merits of a sequential over combined procedure regarding kidney graft survival remain unclear as is the place of isolated kidney transplantation (KT) for patients with vitamin B6-responsive genotypes.Methods: We used the OxalEurope registry for retrospective analyses of patients with PH1 who underwent transplantation. Analyses of crude Kaplan–Meier survival curves and adjusted relative hazards from the Cox proportional hazards model were performed.Results: A total of 267 patients with PH1 underwent transplantation between 1978 and 2019. Data of 244 patients (159 CLKTs, 48 isolated KTs, 37 sequential liver–KTs [SLKTs]) were eligible for comparative analyses. Comparing CLKTs with isolated KTs, adjusted mortality was similar in patients with B6-unresponsive genotypes but lower after isolated KT in patients with B6-responsive genotypes (adjusted hazard ratio 0.07, 95% CI: 0.01–0.75, P = 0.028). CLKT yielded higher adjusted event-free survival and death-censored kidney graft survival in patients with B6-unresponsive genotypes (P = 0.025, P < 0.001) but not in patients with B6-responsive genotypes (P = 0.145, P = 0.421). Outcomes for 159 combined procedures versus 37 sequential procedures were comparable. There were 12 patients who underwent pre-emptive liver transplantation (PLT) with poor outcomes.Conclusion: The CLKT or SLKT remains the preferred transplantation modality in patients with PH1 with B6-unresponsive genotypes, but isolated KT could be an alternative approach in patients with B6-responsive genotypes.

The patient’s destiny often depends on the pediatrician infectious disease specialist’s ability to appraise the abdominal pain. In this article we analyzed the incidence of development of the intussusception in children with dyspepsia, also we represented the clinical features of this surgical disease., От умения врача педиатра-инфекциониста правильно интерпретировать абдоминальную боль нередко зависит судьба пациента. В статье анализируется частота развития инвагинации у детей, возникшей на фоне диспептических проявлений, отображены клинические особенности данной хирургической патологии., Від уміння лікаря педіатра-інфекціоніста інтерпретувати абдомінальний біль часто залежить доля пацієнта. У статті аналізується частота розвитку інвагінації у дітей, що виникла на тлі диспептичних явищ, відображені клінічні особ­ливості цієї хірургічної патології.

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.

The article deals with the problem of chronic constipation in children. Recommendations for the prevention of this condition are provided. It is stressed that drug administration is recommended to be used only when there is no effect of diet therapy, which is not reduced to a strict diet or compliance with certain medical diet, but to a physiological diet. There are currently available formulas meeting the guidelines of the European Union concerning the nutrition of special medical purposes which combines multiple functional components that enables to solve the problem of functional constipations in infants who are bottle-fed. An example of such innovative formula is Nutrilon Comfort., Статья посвящена проблеме хронического запора у детей. Даны рекомендации по профилактике этого состояния. Подчеркнуто, что к медикаментозной терапии рекомендуют прибегать только при отсутствии эффекта от диетотерапии, которая сводится не к строгой диете или соблюдению определенного лечебного стола, а к физиологическому рациону питания. В настоящее время доступны смеси, соответствующие рекомендациям Европейского союза относительно питания специального медицинского назначения, сочетающие в себе одновременно несколько функциональных компонентов, что позволяет решить проблему функциональных запоров у детей раннего возраста, находящихся на искусственном вскармливании. Примером такой инновационной смеси является Нутрилон Комфорт., Стаття присвячена проблемі хронічного запору в дітей. Подано рекомендації з профілактики цього стану. Підкреслено, що до медикаментозної терапії рекомендують вдаватися тільки за відсутності ефекту від дієтотерапії, яка зводиться не до суворої дієти або дотримання певного лікувального столу, а до фізіологічного раціону харчування. У цей час доступні суміші, якi відповідають рекомендаціям Європейського союзу щодо харчування спеціального медичного призначення та поєднують в собі одночасно декілька функціональних компонентів, що дозволяє вирішити проблему функціональних запорів у дітей раннього віку, які перебувають на штучному вигодовуванні. Прикладом такої інноваційної суміші є Нутрилон Комфорт.

This article provides information on the impact of persistent intracellular infection on airway remodeling in asthma in children. There were described the effect of matrix metalloproteinase, tissue inhibitor of matrix metalloproteinase, transforming growth factor antibodies to collagen type III, endothelin-1 on the process of morphological airway remodeling such as hypertrophy of smooth muscles, the enhanced neovascularization, epithelial cell hyperplasia, collagen deposition and compression of the basal membrane observed in bronchial asthma in children. There were determined the etiopathogenetic methods of treatment, in particular putting on acyclic nucleosides or macrolide depending on diagnosed infections, immunomodulators and α2β-interferon to reduce airway remodeling processes and the severity of the disease and to decrease disability., В статье представлены сведения о влиянии персистирующих внутриклеточных инфекций на процессы ремоделирования дыхательных путей при бронхиальной астме у детей. Описано влияние матричных металлопротеиназ, тканевого ингибитора матричных протеиназ, трансформирующего фактора роста, аутоантител к коллагену III типа, эндотелина-1 на процессы морфологической перестройки дыхательных путей в виде гипертрофии гладких мышц, усиленного образования новых сосудов, гиперплазии эпителиальных клеток, отложения коллагена, уплотнения базальной мембраны, наблюдаемые при бронхиальной астме у детей. Указаны методы этиопатогенетического лечения, в частности, назначение ациклических нуклеозидов или макролидов в зависимости от диагностированной инфекции, иммуномодуляторов и α2β-интерферона с целью уменьшения процессов ремоделирования дыхательных путей, снижения тяжести заболевания и уменьшения инвалидизации., У статті наведені відомості про вплив персистуючих внутрішньоклітинних інфекцій на процеси ремоделювання дихальних шляхів при бронхіальній астмі у дітей. Описано вплив матричних металопротеїназ, тканинного інгібітора матричних протеїназ, трансформуючого фактора росту, автоантитіл до колагену III типу, ендотеліну-1 на процеси морфологічної перебудови дихальних шляхів у вигляді гіпертрофії гладких м’язів, посиленого утворення нових судин, гіперплазії епітеліальних клітин, відкладення колагену, ущільнення базальної мембрани, що спостерігаються при бронхіальній астмі у дітей. Вказані методи етіопатогенетичного лікування, зокрема, призначення ациклічних нуклеозидів або макролідів залежно від діагностованої інфекції, імуномодуляторів та ­α2β-інтерферону з метою зменшення процесів ремоделювання дихальних шляхів, зниження тяжкості захворювання і зменшення інвалідизації.

The article deals with a rare clinical case of a combination of corrected transposition of the great vessels with ventricular septal defect, pulmonary valve stenosis, abnormal position of the heart and visceral inversion in an adolescent. Terminology, diagnostic techniques of this anomaly are considered. Morphological features of the recognition of the heart chambers, nature of hemodynamics are described. Article demonstrates the natural course of congenital heart disease in a patient and is of interest for pediatricians and pediatric cardiologists., Статья посвящена редкому клиническому случаю сочетания корригированной транспозиции магистральных сосудов с дефектом межжелудочковой перегородки, клапанным стенозом легочной артерии, аномальным положением сердца и обратным расположением внутренних органов у подростка. Изложены терминология, методы диагностики аномалии. Приводятся морфологические особенности распознавания камер сердца, характер гемодинамики. Статья демонстрирует естественное течение врожденного порока сердца у больного и представляет интерес для педиатров и детских кардиологов., Стаття присвячена рідкісному клінічному випадку поєднання коригованої транспозиції магістральних судин із дефектом міжшлуночкової перегородки, клапанним стенозом легеневої артерії, аномальним положенням серця і зворотним розташуванням внутрішніх органів у підлітка. Викладенi термінологія, методи діагностики аномалії. Наводяться морфологічні особливості розпізнавання камер серця, характер гемодинаміки. Стаття демонструє природний перебіг уродженої вади серця у хворого і становить інтерес для педіатрів та дитячих кардіологів.

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.

The article describes the data on vitamin D metabolism. The causes and clinical picture of its deficiency, the role of the latter in the development of rickets, osteoporosis, some diseases of childhood are discussed. The guidelines on the treatment and prevention of vitamin D deficiency in the population of Central Europe countries relative to the recommended doses of vitamin D preparations are presented., В статье приведены данные о метаболизме витамина D. Рассматриваются причины и клиническая картина его дефицита, роль последнего в развитии рахита, остеопороза, ряда заболеваний детского возраста. Приведены данные методических рекомендаций по лечению и профилактике дефицита витамина D у населения стран Центральной Европы относительно рекомендованных доз препаратов витамина D., У статті наведені дані про метаболізм вітаміну D. Розглядаються причини й клінічна картина його дефіциту, роль останнього в розвитку рахіту, остеопорозу, ряду захворювань дитячого віку. Наведені дані методичних рекомендацій із лікування та профілактики дефіциту вітаміну D в населення країн Центральної Європи щодо рекомендованих доз препаратів вітаміну D.

Specific characteristics of bronchial asthma course in 100 patients have been studied taking into account food allergy and complex clinico-immunological examination. It was established that the most significant distinctions in those patients were burdened familial allergic history, presence of antenatal pathology, negative reserve of oxygen-dependent microbicidity of eosinophilic blood granulocytes. Noted characteristic have made it possible to formulate a diagnostic constellation pattern aimed at detecting food allergy in children with bronchial asthma, it may facilitate optimization of remedial-rehabilitation measures.

This article provides information about the processes of airway remodeling in children with bronchial asthma. There are described the changes in the levels of matrix metalloproteinases, tissue inhibitor of matrix metalloproteinase, transforming growth factor, autoantibodies to collagen type III, endothelin-1 in bronchial asthma in children, uninfected and infected with intracellular infections caused by herpes simplex virus types I–II, cytomegalovirus, Epstein-Barr virus, Сhlamydophila pneumoniae and Mycoplasma pneumoniae., В статье представлены сведения о процессах ремоделирования дыхательных путей при бронхиальной астме у детей. Описаны изменения уровней матричных металлопротеиназ, тканевого ингибитора матричных протеиназ, трансформирующего фактора роста, аутоантител к коллагену III типа, эндотелина-1 у детей с бронхиальной астмой, не инфицированных и инфицированных внутриклеточными инфекциями, вызванными вирусом простого герпеса І–ІІ типов, цитомегаловирусом, вирусом Эпштейна — Барр, Сhlamydophila pneumoniae и Mycoplasma pneumoniae., У статті представлені відомості про процеси ремоделювання дихальних шляхів при бронхіальній астмі. Описано зміни рівнів матричних металопротеїназ, тканинного інгібітора матричних протеїназ, трансформуючого фактора росту, аутоантитіл до колагену III типу, ендотеліну-1 у дітей із бронхіальною астмою, не інфікованих та інфікованих внутрішньоклітинними інфекціями, викликаними вірусом простого герпесу І–ІІ типів, цитомегаловірусом, вірусом Епштейна — Барр, Сhlamydophila pneumoniae і Mycoplasma pneumoniae.

В статье предпринята попытка анализа и систематизации имеющихся в современной научной литературе данных об этиологии, патогенезе и эффективной терапии синдрома дефицита внимания и гиперактивности у детей. Публикация ориентирована на врачей общей практики и педиатров и ставит перед собой цель помочь выработать тактику рационального и безопасного ведения данных пациентов.

The article presents the published data on the prevalence, etiology, the main clinical manifestations, modern methods of early neonatal and postnatal diagnosis, treatment and prognosis of coarctation of the aorta — a congenital malformation of cardiovascular system., В статье представлены литературные данные о частоте, этиологии, основных клинических проявлениях, современных методах ранней неонатальной и постнатальной диагностики, лечении и прогнозе коарктации аорты — врожденном пороке сердечно-сосудистой системы., У статті наведено літературні дані щодо частоти, етіології, основних клінічних проявів, сучасних методів ранньої неонатальної та постнатальної діагностики, лікування та прогнозу коарктації аорти — уродженої аномалії серцево-судинної системи.

The article deals with fermentopathy as one of the possible causes of atopic dermatitis in children. Functional disorders of the digestive organs lead to the absorption of inadequately broken down food components, especially proteins, and thereby to organism sensitization to different types of allergens. Children with atopic dermatitis have the following functional disorders of the digestive organs: reflux, dyskinesia, di­seases of the mucous membrane, cholestasis, relative pancreatic insufficiency, intestinal dysbiosis. The doctor’s task consists in the in-depth examination of these patients, and in the administration of combined therapy for atopic dermatitis in view of the identified changes in the gastrointestinal tract., Статья посвящена ферментопатиям как одной из возможных причин атопического дерматита у детей. Функциональные нарушения органов пищеварения приводят к всасыванию неполноценно расщепленных компонентов пищи, особенно белков, и тем самым способствуют сенсибилизации организма к различным видам аллергенов. При атопическом дерматите у детей встречаются следующие функциональные нарушения органов пищеварения: рефлюксы, дискинезии, заболевания слизистой оболочки, холестаз, относительная панкреатическая недостаточность, дисбиоз кишечника. Задача врача состоит в углубленном обследовании таких пациентов и назначении комплексной терапии атопического дерматита с учетом выявленных изменений со стороны желудочно-кишечного тракта., Стаття присвячена ферментопатіям як однієї з можливих причин атопічного дерматиту в дітей. Функціональні порушення органів травлення призводять до всмоктування неповноцінно розщеплених компонентів їжі, особливо білків, і тим самим сприяють сенсибілізації організму до різних видів алергенів. При атопічному дерматиті в дітей зустрічаються такі функціональні порушення органів травлення, як рефлюкси, дискінезії, захворювання слизової оболонки, холестаз, відносна панкреатична недостатність, дисбіоз кишечника. Завданням лікаря є поглиблене обстеження таких пацієнтів та призначення комплексної терапії атопічного дерматиту з урахуванням виявлених змін з боку органів шлунково-кишкового тракту.

The paper provides a review of current regulatory documents of international organizations, which deals with the organizational aspects of optimizing physical activity among children. It is shown that according to the World Health Organization (WHO; 2015), the major causes of death are cardiovascular diseases and their complications, the formation of which is most strongly associated with obesity, which has its roots in childhood. The global WHO recommendations for physical activity to promote health (2010) and the guidelines of the American Heart Association regarding the organization of physical activity among children (2014) are provided. The criteria of selecting the type of physical activity for children and adolescents according to the Centers for Disease Control and Prevention (2011) are presented. The results of the WHO working group activity to end childhood obesity (2015) were analyzed. The need for a multisectoral government, educational and social activities was stressed., В статье приведен обзор текущих регламентирующих документов международных организаций, посвященный организационным вопросам оптимизации физической активности детей. Показано, что, по данным Всемирной организации здравоохранения (ВОЗ; 2015), основной причиной смертности населения являются кардиоваскулярные заболевания и их осложнения, формирование которых в наибольшей степени связано с ожирением, имеющим корни в детском возрасте. Приведены глобальные рекомендации ВОЗ относительно физической активности для укрепления здоровья (2010) и рекомендации Американской кардиологической ассоциации относительно организации физической активности детей (2014). Представлены критерии выбора типа физической активности для детей и подростков по данным Centers for Disease Control and Prevention (2011). Проанализированы результаты работы рабочей группы ВОЗ по прекращению детского ожирения (2015). Сделаны акценты на необходимости проведения мультисекторальных государственных, образовательных и социальных мероприятий., У статті наведено огляд поточних регламентуючих документів міжнародних фахових товариств, присвячений організаційним питанням оптимізації фізичної активності дітей. Показано, що, за даними Всесвітньої організації охорони здоров’я (ВООЗ; 2015), основною причиною смертності населення є кардіоваскулярні захворювання та їх ускладнення, формування яких найбільшою мірою пов’язане з ожирінням, що має коріння в дитячому віці. Наведено глобальні рекомендації ВООЗ щодо фізичної активності для зміцнення здоров’я (2010) та рекомендації Американської кардіологічної асоціації стосовно організації фізичної активності дітей (2014). Наведено критерії вибору типу фізичної активності для дітей і підлітків за даними Centers for Disease Control and Prevention (2011). Проаналізовано результати звіту робочої групи ВООЗ із припинення дитячого ожиріння (2015). Зроблено акценти на необхідності проведення мультисекторальних державних, освітніх і соціальних заходів.

The article presents the data on the etiology, pathogenesis, clinical manifestations and treatment of mixed connective tissue disease — Sharp syndrome, describes a hard-to-diagnose case of our own clinical observation of the disease in a 3-year-old child., Представлены данные об этиологии, патогенезе, клинике и лечении смешанного заболевания соединительной ткани — синдрома Шарпа, описан сложный для диагностики случай собственного клинического наблюдения болезни у ребенка 3 лет., У статті представлені дані про етіологію, патогенез, клініку та лікування змішаного захворювання сполучної тканини — синдрома Шарпа, описаний складний для діагностики випадок власного клінічного спостереження хвороби в дитини 3 років.

The article presents data on the prevalence, molecular and genetic aspects and potential mechanisms of idiopathic CD4+-lymphocytopenia occurrence, as well as the criteria for diagnosis in children and variants of the clinical course of this pathology. This is a rare immunity disorder with heterogeneous clinical manifestations (from asymptomatic course to severe opportunistic infections and deaths) and immunological profile. Practical observation of a clinical case of CD4+-lymphocytopenia in a child — a boy between the ages of 4 and 10 months of life has been described.

Background Iron deficiency anemia (IDA) is a public health problem in children and adolescents that is characterized by reduced hemoglobin (Hb) levels. Non-invasive monitoring devices can measure Hb levels continuously without pain or discomfort; however, little is known about their accuracy in children and adolescents. This study estimated the accuracy of a non-invasive Hb monitor in this age group. Methods Participants were outpatients visiting the Tokyo Metropolitan Children's Medical Center for blood tests between January and March 2019. Hb levels were measured using both non-invasive Astrim Fit monitoring devices and invasive blood collection followed by automated analysis. Bland–Altman analysis assessed the agreement between the two measurements. Results Overall, 120 schoolchildren (9–15 years old, 51 % female) were enrolled. The non-invasive measuring device recorded Hb levels of 13.5 ± 1.6 g/dL (mean ± standard deviation [SD]), while the mean Hb level obtained from the collected blood was 13.7 ± 1.7 g/dL. Therefore, the mean difference of bias and SD of precision was 0.17 ± 1.95 g/dL. Values of lower and upper limits of agreement were −3.65 and 3.99, respectively. There was no systematic fixed or proportion bias. Fifty-nine participants (49 %) had a relative error of ± 0.10. Conclusion The Astrim Fit non-invasive Hb monitor can be used to evaluate Hb levels among schoolchildren for health promotion or research purposes because of its extremely low bias (or precision), no systematic biases (including fixed or proportion biases), and positive correlation between non-invasive monitoring and blood drawing. However, it is difficult to assess Hb levels in children and adolescents using the Astrim Fit device for diagnostic purposes.

While data on the efficacy and safety of continuous glucose monitoring (CGM) exist across a broad age spectrum, it is limited in very young children with type 1 diabetes (T1D). We aimed to assess real-world data in this high-risk population, focusing on glycemic variability and metrics beyond HbA1c. A 12-month multi-national, prospective, observational, registry-based cohort study in children with T1D aged 1-7 years compared glucose control using real-time CGM and using fingerstick blood glucose monitoring (BGM) alone. The prespecified primary endpoint was a difference in coefficient of variation (CV) between the CGM users and BGM-only cohort. Among 227 individuals using insulin pumps (42% female, age 5.3 years), 175 were CGM and 52 were BGM-only users. The median (IQR) CV was 39.1% (36.6-41.9) among CGM and 46.8% (42.3-51.2) among BGM-only users (P

The novel coronavirus disease (COVID-19) has emerged as a global pandemic. This was a prospective, case-control study conducted in Izmir, Turkey. The aim of this study was to assess the relationship between COVID-19 and new-onset T1DM. We included pediatric patients (aged 6 mo–18 yr) with new-onset type-1 diabetes mellitus (T1DM) diagnosed during the COVID-19 pandemic, between April 2020 and January 2021. Polymerase chain reaction was used to diagnose COVID-19 after hospital admission. An enzyme-linked immunoassay for IgM and IgG against SARS-CoV-2 was performed after the diagnosis was confirmed. In the control group, the blood antibody test was conducted as close as possible to the time of the T1DM patient referral. A total of 118 participants were included in the study, comprising 57 (48%) patients with new-onset T1DM and 61 (52%) healthy controls. Of the 57 patients, 36 (63.2%) presented with DKA, 17 (29.7%) with diabetic ketosis, and four (7%) incidentally. The SARS-CoV-2 antibody test was positive in five (8.7%) patients with T1DM and six (10%) controls. The rate of positivity did not differ between the two groups (p = 0.901). It was not possible to demonstrate a clear association between SARS-CoV-2 infection and new-onset T1DM. Whether SARS-CoV-2 increases susceptibility to diabetes by triggering islet cell autoimmunity and affects the timing of overt diabetes in patients with existing autoimmunity should be studied in large cohorts.

Summary Objective This study aimed to evaluate management and prognosis in children with pheochromocytoma who were treated at an Egyptian tertiary center. Methods The authors conducted an 8-year retrospective analysis for 17 patients who were presented from January 2013 to January 2021. Clinical criteria, operative details, and follow-up data were assessed. Overall (OS) and event-free survival (EFS) were estimated by the Kaplan–Meier method. An event was assigned with the occurrence of recurrence or metachronous disease, or death. Results Median age at diagnosis was 14 years (range: 6–17.5 years). Ten patients (58.8%) were males and seven (41.2%) were females. Hypertension-related symptoms were the main presentations in 15 patients (88%). None of the included children underwent genetic testing. Sixteen patients (94%) had unilateral tumors (right side: 12), whereas only one was presented with bilateral masses. The median tumor size was 7 cm (range: 4–9 cm). Metastatic workup did not reveal any metastatic lesions. All patients underwent open adrenalectomy, and clinical manifestations were completely resolved after surgery. Adjuvant therapy was not administered to any patient. There were no deaths or relapses at a median follow-up time of 40 months, whilst two children had metachronous disease after primary resection. Both were managed by adrenal-sparing surgery, and they achieved a second complete remission thereafter. Five-year OS and EFS were 100% and 88%, respectively. Conclusions Complete surgical resection achieves excellent clinical and survival outcomes for pheochromocytoma in children. Meticulous, long-term follow-up is imperative for early detection of metachronous disease to facilitate adrenal-sparing surgery. Genetic assessment for patients and their families is essential; however, it was not available at our institution.

Background: Neurocutaneous Melanosis (NCM) is a rare nonfamilial phakomatosis characterized by the presence of congenital melanocytic nevi and abnormal melanocyte infiltration of the leptomeninges. Objective & Methods: This paper shows the importance of early diagnosis and the most important imaging features of the disease on CT and MR scans. PubMed database was searched from January 1972 to September 2020. Papers including imaging findings of NCM, clinical, follow-up, and treatment features were collected, selecting only 89 studies. Discussion: NCM is a term used for the first time by van Bogaert in 1948. It refers to a condition caused by an error during morphogenesis and migration leading to leptomeningeal melanocytic accumulation. Although histological findings are the gold standard for diagnosis confirmation, neuroimaging and clinical features strongly support the suspect of NCM. Localization and extension of the lesions are predictive of neurological manifestations related to increased intracranial pressure, mass lesions, or spinal cord compression. CT demonstrates sites of increased density in the anterior temporal lobe, mainly the amygdala, thalami, cerebellum, and frontal lobes base. However, MRI is the best imaging method to diagnose central nervous system lesions, often appearing as T1-short signal areas of the cerebral parenchyma, indicative of central nervous system melanosis. MRI can also reveal associated intracranial and intraspinal abnormalities. Conclusion: Early imaging, when available, is helpful if NCM suspect is raised and may be of guidance in comparing later studies. NCM requires a multidisciplinary approach since it is a multisystem disease with a genetic component.

PURPOSE: To investigate the: (1) percent of children with spina bifida (SB) complaining of pain, (2) frequency, duration, and cause of pain by sex, level of lesion type of SB, and ambulation status, (3) body sites reported to hurt, by variables in objective 2, and (4) associations between physical and mental/emotional health between caregiver and child. METHODS: Cross-sectional study of 101 caregivers of children (3 to 6 years old) with SB. Survey data and information from medical records were included. Pearson chi-square, one-way ANOVA, Fisher’s exact test, logistic regressions, and bivariate correlations were used. RESULTS: Seventy percent reported that their child complained of pain, which did not significantly differ by sex, level of lesion, type of SB, or ambulation status. Most (86%) were reported to have experienced pain for less than 24 hours. The most frequently reported pain site was the head, followed by the abdomen and the lower body. Number of pain sites was moderately correlated with frequency of pain complaints. Correlations between how caregivers reported their own physical/mental/emotional health and how they rated that of their children ranged from weak (r = 0.22) to moderate (r = 0.55). CONCLUSION: Almost seven of ten children reportedly complained of pain ranging from at least once a month to everyday. Pain needs to be routinely assessed and treated in this population.

Objective : The first aim of this study was to determine whether adolescents with asymptomatic Generalized Joint Hypermobility (GJH) have a lower level of physical functioning (physical activity level, muscle strength and performance) compared to non-hypermobile controls. Secondly, to evaluate whether the negative impact of perceived harmfulness on physical functioning was more pronounced in adolescents with asymptomatic GJH. Methods : Cross-sectional study. Sixty-two healthy adolescents (mean age 16.8, range 12-21) participated. Hypermobility (Beighton score), perceived harmfulness (PHODA-youth) and muscle strength (dynamometry), motor performance (Single-Leg-Hop-for-Distance) and physical activity level (PAL) (accelerometry) were measured. Hierarchical regression analyses were used to study differences in physical functioning and perceived harmfulness between asymptomatic GJH and non-hypermobile controls. Results : Asymptomatic GJH was associated with increased knee extensor muscle strength (peak torque/body weight; PT/BW), controlled for age and gender (dominant leg; ß = 0.29; p = .02). No other associations between asymptomatic GJH and muscle strength, motor performance and PAL were found. Perceived harmfulness was not more pronounced in adolescents with asymptomatic GJH. Conclusions : Adolescents with asymptomatic GJH had increased knee extensor muscle strength compared to non-hypermobile controls. No other differences in the level of physical functioning was found and the negative impact of perceived harmfulness was not more pronounced in adolescents with asymptomatic GJH.

Background. Mobile flat foot etiology and its correlations with postural imbalance remain topical issues for now, especially in children with generalized joint hypermobility. Additionally, it is poorly known that complaints prevail in children with mobile flat foot and joint hypermobility, and whether existing complaints are associated with foot deformation.Objective. The aim of the study is to estimate medium-term effects of body balance trainings on the height of longitudinal arch of the foot and on the complaints structure in primary school-aged children with generalized joint hypermobility.Methods. The study included 114 primary school-aged children (7–11 years old) with mobile symptomatic flat foot who were divided into four groups: I — control group of children who did not perform training; II — children who performed standard complex of rehabilitation exercises recommended for flat foot; III — children who performed a specially designed complex of exercises for body balance training; IV — children exercised on unstable platform. The foot examination included: clinical assessment of feet shape and position (FPI-6 scale), visual and manual mobility tests, computer scanning with calculation of anthropometric indices (basic anthropometric parameters were calculated from scanned foot images). Clinical evaluation of balance was carried out according to the BESS (Balance Error Scoring System) scale and computer pedobarometry. Assessment of complaints structure was carried out according to the Oxford Child Foot Condition Questionnaire.Results. Children of control group significantly increased the number of errors in performing tests compared to the baseline data (p = 0.034) according to the BESS scale. No statistically significant changes were obtained in children of the second group (p = 0.08). Total number of errors committed by children of third and fourth groups on unstable platform decreased by 2.9 times and 3.4 times, respectively (p = 0.022 and p = 0.044). Decrease in partial load on medial longitudinal arch of foot in step cycle in average by 2.0–3.5 times compared to baseline parameters was revealed in children of third and fourth groups. Moreover, children of third and fourth groups have shown improvement in parameters regarding the shape and position of the feet by average of 1.3–1.7 times higher compared to the parameters of the feet of children performing standard complex of rehabilitation exercises (p = 0.036).Conclusion. This study has shown the efficacy of body balance training in increasing the height of longitudinal arch of the foot and good dynamics in the structure of complaints in primary school-aged children with generalized joint hypermobility and symptomatic mobile flat foot.

Background. Antimicrobial resistance is one of the most crucial problems in human health care worldwide. The main cause of this crisis is the excessive and misuse of antibacterial drugs (ADs). The highest rate of improper antibiotics' prescriptions in pediatric practice is observed at treatment of respiratory tract infections in outpatient clinics.Objective. The aim of the study is to analyze the clinical practice of management of patients with acute respiratory infections (ARI) and the use of ADs in children's outpatient clinics across the regions of Russian Federation.Methods. Multicenter retrospective study was conducted. All ARI cases documented in 969 medical records (form 112/y) of children born in 2015–2017 yy. in 16 regions of Russian Federation (selected randomly) were analyzed.Results. Acute viral infection was diagnosed in 79.6% cases of referencing to doctor with ARI symptoms. Systemic ADs were prescribed in 23% cases of ARI. Antibacterial therapy was received by 14% of children diagnosed with acute respiratory viral infection, 35% with acute laryngotracheitis, 80% with acute bronchitis, 76% with acute rhinosinusitis, 94% with ARI associated with otitis media, 52% with tonsillopharyngitis, and 100% with community-acquired pneumonia. Amoxicillin (35%), amoxicillin/clavulanic acid (24%), azithromycin (20.2%) were prescribed most often. Parenteral administration of ADs was prescribed in 3.9% of cases, mostly for children with community-acquired pneumonia. Prescribed antibacterial therapy was unreasonable in 84% of analyzed cases. Polypragmasy occurred in 50.5% of cases. Clinical protocols violations were mostly common for management of patients with laryngotracheitis and tonsillopharyngitis.Conclusion. There is favorable trend towards the decrease in ADs prescribing frequency in outpatient clinics for children with ARI. Thus, polypragmasy and irrational choice of antibacterial therapy frequency remains quite high.

Background The pathology, treatment and prognosis of malignant non-Wilms tumors (NWTs) are different, so it is necessary to differentiate these types of tumors. The purpose of this study was to review the clinical and imaging features of malignant NWTs and features of tumor metastasis. Methods We retrospectively analyzed the CT images of 65 pediatric patients with NWTs from March 2008 to July 2020, mainly including clear cell sarcoma of the kidney (CCSK), malignant rhabdomyoma tumor of the kidney (MRTK) and renal cell carcinoma (RCC). Available pretreatment contrast-enhanced abdominal CT examinations were reviewed. The clinical features of the patients, imaging findings of the primary mass, and locoregional metastasis patterns were evaluated in correlation with pathological and surgical findings. Results The study included CCSK (22 cases), MRTK (27 cases) and RCC (16 cases). There were no significant differences observed among the sex ratios of CCSK, MRTK and RCC (all P > 0.05). Among the three tumors, the onset age of MRTK patients was the smallest, while that of RCC patients was the largest (all P P P = 0.017). For calcification in tumors, the proportion of calcification in RCC was highest (P = 0.009). Only MRTK showed subcapsular fluid (P P = 0.007), and the proportion of marked enhancement was the highest (P = 0.002). In the venous phase, the proportion of slight enhancement in RCC was lower than that in the other two tumors (P Conclusions NWTs have their own imaging and clinical manifestations. CCSK can cause vertebral metastasis, MRTK can cause subcapsular effusion, and RCC tumor density is usually high and calcification. These diagnostic points can play a role in clinical diagnosis.

Objective To describe the clinical characteristics and outcomes of pediatric COVID-19 in Thailand, where favipiravir is the mainstay of antiviral treatment. Methods We conducted a hospital based observational cohort study of COVID-19 among children. The study included children (age

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.

Lin Mei,1,&ast; Xiaodan Li,1,&ast; Shengcai Wang,1,&ast; Run Si,2 Tingting Ji,1 Zhifei Xu,3 Yun Peng,4 Yue Liu,4 Hongbin Li,1 Jie Zhang,1 Yongli Guo,5 Jinghong Tian,6 Guifei Zhou,2 Huifang Huang,2 Jun Tai,1,7,&ast; Jiangang Liu,8,9 Xin Ni1 1Department of Otolaryngology, Head and Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China; 2School of Computer and Information Technology, Beijing Jiaotong University, Beijing, People’s Republic of China; 3Department of Respiration, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing, People’s Republic of China; 4Department of Radiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China; 5Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health (NCCH), Beijing, People’s Republic of China; 6Department of Neurorehabilitation, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China; 7Department of Otorhinolaryngology, Children’s Hospital, Capital Institute of Pediatrics, Beijing, People’s Republic of China; 8Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, People’s Republic of China; 9Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jiangang LiuBeijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, 100191, People’s Republic of ChinaEmail jgliu@buaa.edu.cnXin NiDepartment of Otolaryngology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, No. 56 Nanlishilu, Beijing, People’s Republic of ChinaTel +86-139-1011-1999Email nixin@bch.com.cnObjective: To investigate the impacts of obstructive sleep apnea (OSA) on white matter (WM) integrity and cognitive functions of pediatric patients with different levels of OSA severity.Methods: Fifty-eight children with OSA and thirty-four healthy controls (HC) were recruited. All participants underwent diffusion tensor imaging (DTI) examination, polysomnography (PSG), and neurocognitive assessments. Patients were divided into mild OSA (MG) and moderate-severe OSA (SG) groups. WM integrity, PSG data, and neurocognitive assessment scores were compared among those groups.Results: For apnea hypopnea index (AHI), obstructive apnea hypopnea index (OAHI), arousal index, SpO2 nadir, and attention, SG was worse than both MG and HC with MG worse than HC. For baseline SpO2 and intelligence, SG was worse than both MG and HC with no significant difference between MG and HC. Impaired WM integrity was observed in bilateral anterior thalamic radiation, bilateral inferior fronto-occipital fasciculus, bilateral inferior longitudinal fasciculus, right superior longitudinal fasciculus, right hippocampus, left cingulate gyrus, right uncinate fasciculus, callosum forceps major, and callosum forceps minor only for SG than for HC. WM integrity was significantly correlated with OSA severity and neurocognitive assessment scores only for SG, but not for MG.Conclusion: Decreased baseline SpO2, WM impairment, and intelligence decline were all observed only for SG, but not for MG, implying an associated relationship among decreased SpO2, WM impairment and WM impairment. Thus, for SG, additional assessments of brain damage and cognitive function decline are needed for prognostic evaluation of OSA.Keywords: diffusion tensor imaging, obstructive sleep apnoea, children, tract-based spatial statistics, white matter

Diabetes care at school has recently appeared on the agenda of international diabetes organizations, the basic principles of which have been newly determined. The aim of this review was to summarize the activities and output of the Diabetes at School Program - a program that has been delivered in Turkey for the last 10 years - and to focus on different aspects of Diabetes Care at School through a national model. Recently, a detailed set of national regulations, including the basic principles proposed by the International Society for Pediatric and Adolescent Diabetes and the experience in Turkey, was prepared and has come into force. The future agenda includes giving priority to socio-economically disadvantaged regions, provision of an Individual Treatment Plan at School for each child with diabetes and ensuring that each school has an action plan for the care of children with diabetes. We believe that if all countries have programs and structured national regulations similar to the Diabetes at School Program, this will enable significant progress in the level of care delivered to children with diabetes.

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.

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

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

Paroxysmal cold haemoglobinuria (PCH) is a rare acquired cause of intravascular haemolysis in children. We are reporting an unusual case of PCH, a 7-year-old boy who presented with acute febrile illness, severe anaemia and passage of red colored urine. His initial haemolytic workup had shown positive direct agglutination test along with evidence of ongoing haemolysis with severe leukocytosis. Further evaluation for autoimmune haemolytic anaemia revealed positivity for Donath Landsteiner Antibody, hence establishing a diagnosis of PCH. During the hospital stay, the child required multiple red blood cells, crossmatched although “P” antigen untyped transfusions. Child gradually improved and became transfusion independent within one week. The child has been under regular follow-up since last six months and all his laboratory parameters are within normal limits.

The aim of this scoping review is to outline the published literature on exercise-based treatment methods used in the rehabilitation of dysphagia secondary to an acquired brain injury across the lifespan. This will be used to identify intervention differences and gaps between adult and paediatric populations and guide discussions with clinicians about what rehabilitative approaches might be applicable for further trials in paediatrics. For the purposes of this study cerebral palsy is included in the definition of acquired brain injury. Methods: Scoping Review: The review will follow the five stages included when conducting a scoping review as outlined by Arksey & O’Malley, 2015 Inclusion Criteria 1. Children and adults of any age. 2. Participants with dysphagia secondary to an acquired brain injury including but not restricted to: Stroke, traumatic and non-traumatic brain injury, cerebral palsy, brain neoplasm, autoimmune disorders. 3. Direct oropharyngeal exercises. These are defined as exercises involving the oropharyngeal musculature with the aim of changing participant swallowing physiology. These include, but are not be restricted to, strength-based exercises (e.g. effortful swallow, Mendelsohn manoeuvre), respiratory coordination exercises (e.g. expiratory muscle strength training), skill-based programmes (e.g. BiSSKiT protocol) 4. Exercise protocols that use external devices as an adjunct to rehabilitation (e.g. biofeedback technology / electrical stimulation / oral appliances). Exclusion Criteria 1. Dysphagia arising from other causes such as head and neck cancers, structural abnormalities, idiopathic myopathies, genetic or inherited conditions. 2. Children with a primary aversive or sensory behavioural feeding difficulties which prevent them from wanting to eat and drink. 3. Interventions involving pharmaceutical management (e.g. Botox); cortical stimulation (e.g. repetitive transcranial stimulation); peripheral stimulation in isolation (e.g. pharyngeal electrical stimulation); surgery or alternative treatments (acupuncture) will not be included in this review. There may be scope for analysing these interventions in a future scoping review. 4. Compensatory strategies which do not involve adaptation of the oro-pharyngeal musculature. For example, the chin tuck manoeuvre or texture / taste modifications. 5. External compensatory equipment 6. Animal studies. Information Sources: The breadth of a scoping review means that multiple data sources can be considered, over and above what would typically be included in a systematic review (30). As a method of ensuring robust data is reviewed, the following inclusion and exclusion criteria will be applied to the type of information sources obtained in this review. Inclusion: · Case reports, case series, experimental studies, randomised control trials, observational studies.. Exclusion: · Commentaries, opinion pieces and systematic reviews will be excluded, but their reference lists will be reviewed for appropriate references that fulfil the outlined criteria. · Articles not written or available in English; · Where a full text article cannot be obtained using University access, the 1st author will be contacted. If no copy is made available prior to final analysis, then the paper will be excluded. · Articles will need to report sufficient treatment information including treatment type, dosage and intensity. Articles without sufficient protocol information as outlined will be excluded. · As this review aims to identify recent evidence, papers dated before 2005 will not be included. Databases to be searched Initial searches will be conducted via the following electronic databases: Table 1: Electronic databases Platform Databases EBSCOhost Medline PubMed CINAHL Plus Ovid Online AMED Cochrane Database of Systematic Reviews The principal reviewer will hand-search reference lists of included articles and relevant articles will be included. Grey literature identified via social media, open access thesis, conference proceeding abstracts, dissertations or from clinical experts in this field will also be considered if they meet the outlined inclusion/exclusion criteria. Search Strategy: The search strategy has been developed with the Institute of Child Health, University College London librarian. Identified terms will be searched within the medical subject heading (MeSH), followed by a keyword search for each database. Two searches will be run, on each database to ensure no papers including the child population are excluded. Search one includes search terms for level 1, 2, 3 and this search will be repeated with level 4 search terms added. A record of the number of articles found on each database will be made. Table 2: Search strategy levels Level 1: Rehabilitation exp Rehabilitation/ OR Stroke Rehabilitation/ OR rehabilitation.fs OR rehabilitat* Level 2: Dysphagia “Deglutition Disorders/” OR “deglutition disorder*” OR swallow* OR dysphagia Level 3: Brain Injury “Brain Injuries/” OR “Brain Damage, Chronic/” OR “Brain Neoplasms/” OR Stroke/ OR “Cerebral Palsy/” OR infarc* OR embolism OR h?emorrhag* OR aneurysm* OR anoxi* OR hypoxi* OR isch?emi*OR thrombos* OR occlus* OR bleed* OR concuss* OR TBI OR ABI OR OR “brain neoplasm*” OR “brain cancer*” OR “brain tumo?r*” OR “intracranial neoplasm*” OR “cerebral palsy” OR “spastic diplegia” OR stroke OR “cerebrovascular accident*” OR “cerebral vascular accident*” OR “brain vascular accident*” OR CVA Level 4: Paediatric Adolescent/ OR Child/ OR Infant/ OR Pediatrics/ OR Disabled Children/ OR p?ediatric* or child* or infant* or adolescen* OR toddler* OR school* OR schoolchild* OR teen* OR youth* OR “young person*” OR “young people*” OR juvenile* Study Selection The primary reviewer will run the initial searches and export the titles and abstracts into Rayyan QCRI (35). Duplicate copies will be deleted. The reviewer will then screen the title and abstracts of each paper for inclusion or exclusion. Two further reviewers will each check 10 % of these decisions using the Rayyan online software. Reviewers will be blinded to decisions. Conflicts and further questions will be discussed and clarified, and a majority decision will be taken if these conflicts cannot be resolved. A record of decisions will be kept on Rayyan QCRI. If there is a disagreement greater than 20 % then a second reviewer will screen all papers. Data extraction Following initial screening, whole text articles for included articles will be sought. The following data will be extracted from each article and collated by the primary researcher: Title; methodology; participant demographics; baseline aetiology; outcome measures. Details of exercise protocol will also be extracted including type of exercises, dosage, intensity and format. This data will be reviewed and analysed against the outlined inclusion / exclusion criteria by the primary researcher. Two further reviewers will each check 20 % of these decisions. A majority decision will be taken if there is a disagreement between reviewers. If there is a disagreement greater than 20 % then a second reviewer will screen all papers. Rayyan QCRI online software will be used to record the final decisions. Results Data Presentation and Dissemination: Data will be separated into studies involving children under the age of 18 years old and adults 18 years and above. Based on the pilot literature review and experience in clinical practice, it is anticipated that certain sub-groups of treatments will be found. These include: 1. Exercises in isolation targeting the oral / pharyngeal or respiratory systems used in swallowing 2. Exercises combined with biofeedback 3. Exercises used in conjunction with electrical stimulation The number of articles in each area and the type of data source will be presented in written and visual format. Comparison between literature in adult and child populations will then be made and discussed. Although the specific rigor of each paper will not be discussed in detail, information about the level of each review paper (e.g. randomised control trial / case report) will be made. The inclusion criteria and protocol design of each paper will also be analysed in order to determine the possibility of trialing certain methods with a new population. For example, trialing a method used in adult post-stroke dysphagia with children with cerebral palsy.

Objectives Whole body-MRI is helpful in directing diagnostic and treatment approaches, and as a research outcome measure. We describe our initial consensus-driven phase towards developing a whole body-MRI scoring system for juvenile idiopathic arthritis. Methods An iterative approach using three rounds of anonymous Delphi surveys followed by a consensus meeting was used to draft the structure of the whole body-MRI scoring system, including the relevant anatomic joints and entheses for assessment, diagnostic item selection, definition and grading, and selection of appropriate MRI planes and sequences. The surveys were completed independently by an international expert group consisting of pediatric radiologists and rheumatologists. Results Twenty-two experts participated in at least one of three rounds of Delphi surveys and a concluding consensus meeting. A first iteration scoring system was developed which ultimately included the assessment of 100 peripheral, 23 chest, and 76 axial joints, and 64 entheses, with 2–4 diagnostic items graded in each of the items, using binary (presence/absence) and 2-3-level ordinal scores. Recommendations on anatomic MRI planes and sequences were specified as the minimally necessary imaging protocol for the scoring system. Conclusion A novel whole body-MRI scoring system for juvenile idiopathic arthritis was developed by consensus among members of MRI in JIA OMERACT working group. Further iterative refinements, reliability testing, and responsiveness are warranted in upcoming studies.

Background: Ruxolinitib has been used as an effective salvage agent in steroid refractory acute and chronic graft versus host disease (GVHD). We aimed to analyze data on ruxolitinib as front-line therapy in children. Patients and methods: We included children up to 18 years of age who underwent hematopoietic stem cell transplantation (HSCT), from December 2017 to April 2020, where ruxolitinib was administered in children up to 18 years of age, at 48 hours of diagnosis with acute and within two weeks in chronic GVHD. The dose was 2.5 mg and 5 mg twice daily for children weighing 15 kg respectively. Results: A total of 80 out of 335 transplanted children were included. The indication was acute GVHD (aGVHD) in 41 and chronic GVHD (cGVHD) in 39 children. Response rates were 90% in aGVHD, with 92% in skin and 46% in acute gut GVHD. Overall response rate in cGVHD was 74.3%, with 80%, 67% and 100% in skin, lung and liver respectively. Thrombocytopenia was the predominant drug related side effect, noted in 65% children. Three children needed drug withdrawal, two due to uncontrolled hyponatremia in aGVHD, and one due to nephrotic syndrome in the cGVHD setting. The 100-day mortality in the historical cohort (January 2014 to October 2017) was 29/279 (10.4%) versus 17/335 (5%) in the study cohort (p = 0.029). Conclusion: Ruxolitinib used early in acute and chronic GVHD results in excellent response rates and is safe to use in children.

PHACE(S) syndrome combines: posterior fossa brain malformations, face hemangioma, arterial cerebrovascular abnormalities, cardiovascular abnormalities, eye abnormalities, and ventral developmental defects (Sternal defects or supra-umbilical rope). The diagnosis is based on the association of an infant hemangioma exceeding 5cm in size on the face, neck, scalp with 1 major criteria or 2 minor criteria. Imaging, especially Gadolinium MRI and MRA of the brain, neck, and aortic arch, transthoracic echocardiography, or even cardiac MRI play a key role in the detection of associated neurological and cardiovascular abnormalities. We report 2 cases of PHACE syndrome revealed by 2 different clinical presentations.