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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.

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.

Background Pyelonephritis is one of the most serious bacterial illnesses during childhood. Gram-negative organisms account for up to 90% of the cases. Gram-positive bacteria are uncommon causes of urinary tract infections, and only a few cases caused by Facklamia hominis have been reported in the literature. Case presentation A five-year-old girl with tracheostomy and gastrostomy and past medical history of congenital lymphangioma presented with a two-week history of with intermittent fever, frequent urination, and vesical tenesmus. Diagnosis of pyelonephritis was made. Urine culture reported colonies with alpha-hemolysis in blood agar at 48-h of incubation and Facklamia hominis was identified by MALDI-TOF. The patient was successfully treated with gentamicin. Conclusions This is the first reported case of pyelonephritis by Facklamia hominis in a child, and the second involving infection in a pediatric patient. Although this pathogen is uncommon, current treatment of F. hominis is a challenge for physicians. This case illustrates the requirement to standardize identification and treatment of care to avoid treatment failure and antimicrobial resistance.

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.

Вступ. За останні роки значно збільшилась чисельність безплідних чоловіків, фактори розвитку цього стану значною мірою пов’язані з дитячим та юнацьким періодами. Мета. Прогнозувати роль перенесених оперативних втручань у дитячому віці та розробити заходи щодо профілактики чоловічої безплідності. Матеріали та методи. Діагностика цих захворювань включає фізикальне, ультразвукове, допплерографічне обстеження яєчок. При абдомінальних формах крипторхізму та агенезіях проводиться комп’ютерна томографія, магнітно-резонансна терапія, дослідження гормонів та біоптатів. Результати. За 3 роки прооперовано 370 дітей із крипторхізмом, 490 дітей із гострими захворюваннями яєчка та 393 із варикоцеле. Зберігається тенденція пізніх діагностики та проведення оперативних втручань: 28–38 %. При крипторхізмі проведено 350 (89 %) низведень яєчка за Петривальським, виконано 8 етапних оперативних втручань. При гострих захворюваннях яєчка здійснені 592 скрототомії, із них 52 через перекрут яєчка. Збільшилась кількість дітей із перекрутом яєчка, кількість орхектомій зменшилась з 46,5 до 15,4 %. Висновки. Ця проблема потребує активного раннього виявлення та корекції патології сечостатевих органів, диспансеризації та реабілітаційних заходів щодо відновлення репродуктивної системи. Діти, які перенесли оперативні втручання, потребують нагляду дитячого уролога та реабілітаційних заходів. Назріла необхідність в організації андрологічної служби.

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.

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.

За результатами вивчення особливостей перебігу хронічного гастродуоденіту залежно від наявності субклінічного гіпотиреозу у 120 дітей та підлітків встановлено, що у дітей з його ознаками збільшується тривалість больового синдрому, частіше виявляється астеновегетативний синдром і більш виражені функціональні порушення серцево-судинної системи.

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 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 Early start of highly active antiretroviral therapy (HAART) in perinatally HIV-1 infected children is the optimal strategy to prevent immunological and clinical deterioration. To date, according to EMA, only 35% of antiretroviral drugs are licenced in children Methods An observational retrospective study investigating the rate and the outcomes of off-label prescription of HAART was conducted on 225 perinatally HIV-1 infected children enrolled in the Italian Register for HIV Infection in Children and followed-up from 2001 to 2018. Results 22.2% (50/225) of included children were receiving an off-label HAART regimen at last check. Only 26% (13/50) of off-label children had an undetectable viral load (VL) before the commencing of the regimen and the 52.0% (26/50) had a CD4 + T lymphocyte percentage > 25%. At last check, during the off label regimen, the 80% (40/50) of patients had an undetectable VL, and 90% (45/50) of them displayed CD4 + T lymphocyte percentage > 25%. The most widely used off-label drugs were: dolutegravir/abacavir/lamivudine (16%; 8/50), emtricitbine/tenofovir disoproxil (22%; 11/50), lopinavir/ritonavir (20%; 10/50) and elvitegravir/cobicistat/emtricitabine/ tenofovir alafenamide (10%; 10/50). At logistic regression analysis, detectable VL before starting the current HAART regimen was a risk factor for receiving an off-label therapy (OR: 2.41; 95% CI 1.13–5.19; p = 0.024). Moreover, children Conclusion The prescription of an off-label HAART regimen in perinatally HIV-1 infected children was common, in particular in children with detectable VL despite previous HAART and in younger children, especially those receiving their first regimen. Our data suggest similar proportions of virological and immunological successes at last check among children receiving off-label or on-label HAART. Larger studies are needed to better clarify efficacy and safety of off-label HAART regimens in children, in order to allow the enlargement of on-label prescription in children.

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

As the COVID-19 pandemic continues, children can be infected with the virus that causes COVID-19. Clinical symptoms of children with COVID from China, where the disease was first reported, generally were less severe than adults. However, at the end of April 2020 in Europe, it was observed that some children with SARS-CoV-2 infection developed fever, abdominal pain, shock, myocardial insufficiency and they needed to be taken care of in intensive care unit. This new disease has been called multisystem inflammatory syndrome in children (MIS-C). Although the pathogenesis of MIS-C is unclear, it progresses with signs of multiorgan involvement as a result of uncontrolled inflammation of the immune system and even causes death. Therefore, the diagnosis and treatment of patients with MIS-C should be managed quickly. In this review, the pathophysiology, clinical and laboratory findings, diagnostic methods, and treatment regimens of MIS-C were discussed.

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

Aim:This study aimed to examine the status of vitamin D in children, to compare vitamin D levels according to the seasons, and to estimate vitamin D testing trends during the years of the study.Materials and Methods:Blood 25-hydroxyvitamin D [25(OH)D] levels of 51,560 children aged between 0-18 years who had been admitted to nine hospitals between 2015 and 2017 were evaluated. Comparisons of 25(OH)D levels with age groups, gender, and seasons were made. Additionally, vitamin D testing was compared year by year in terms of frequency.Results:Of the patients, 20% (n=10,611) had vitamin D deficiency and 34% (n=17,385) had vitamin D insufficiency. Serum 25(OH)D levels were significantly higher in boys than in girls (p

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.

Aim: The purpose of this study was to examine the effects of antiepileptics on thyroid function tests and to compare these effects among different antiepileptics. Materials and Methods: Two hundred and twenty patients (102 female and 118 male) aged 1-17 years indicated for antiepileptic drug (AED) therapy for epilepsy were enrolled in this study which was performed in a child neurology clinic between January 2014 and January 2018. Those patients using a single AED and with complete seizure control were included. In this study period, according to the local protocol, we measured free thyroxine (fT4) and thyroid-stimulating hormone (TSH) levels at the beginning of treatment and at the 12th month of AED therapy. Results: The mean age of the patients was 10.2 +/- 4.4 years. TSH elevation was observed in only eight patients. These eight patients' thyroid autoantibodies were negative and their thyroid ultrasonography were normal. Subclinical hypothyroidism (TSH: 5-10, fT4 normal) was present in three of these eight patients, and they were therefore not started on medication. The other five were started on L-thyroxine. Four of these were using valproic acid and one was using carbamazepine. We found no significant difference between TSH and fT4 levels measured before the start and at the 12th month of drug therapy, nor among the different AEDs used. Conclusion: AEDs have no marked effects on thyroid function, and may therefore be safely used from that perspective. WOS:000718894700005

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.

Aim: It can be challenging to distinguish between influenza and coronavirus disease-2019 (COVID-19) during the influenza season. Therefore, we aimed to compare the clinical symptoms, laboratory findings, and outcomes of these two diseases in children. Materials and Methods: Thirty-two children with COVID-19 and 22 children with influenza who were hospitalized in our clinic were included in this study. The demographic, clinical, and laboratory findings of these patients were retrospectively reviewed. Results: The median age of patients with influenza and COVID-19 was 1.4 and 15.3 years, respectively. Fever (77.3% vs 46.9%, p=0.02), nasal obstruction (27.3% vs 0%, p=0.003), wheezing (54.5% vs 3.1%, 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.

Introduction:Drug poisoning in childhood is one of the leading preventable health problems worldwide. This study aimed to evaluate the epidemiological characteristics, factors facilitating poisoning, and post-poisoning follow-up of the patients who applied to our emergency department with drug intoxication.Methods:Between January 2010 and August 2011, of the total number of 894 patients applying with drug intoxication to the Pediatric Emergency Clinic of the University of Health Sciences Turkey, Kartal Dr. Lütfi Kırdar Training and Research Hospital, 314 patients who gave consent were included in the study. The patients were evaluated retrospectively.Results:Of the 894 patients presenting with drug intoxication, results for 314 patients with consent were evaluated. The mean age of the 314 cases was 4.6±4.0 years. The sex distribution was 138 girls (43.9%) and 176 boys (56.1%). The mean age was 5.7±4.8 years for girls and 3.8±3.1 years for boys. In the preschool period (0-5 years) and age group of 5-10 years, boys were predominant, while at the age group of 10-14 years, girls were at the forefront. While the most common drug group causing poisoning was central nervous system drugs, analgesic-antipyretic drugs took the second place. During adolescence, drug intoxications with suicidal intentions were especially prominent.Conclusion:As in all over the world, drug intoxication cases are one of the most important preventable emergency causes in Turkey. The most common cause of childhood intoxication is accidental, it is seen more in boys in the preschool and school-age, and it occurs mostly in the 0-5 age group. Girls are more affected at adolescence. During adolescence, intoxications with suicidal intentions are common. Thus, poisonings during this period should be evaluated from a psychiatric point of view.

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.

Aim:Due to restrictions during the Coronavirus disease-2019 (COVID-19) pandemic, smartphone, tablet and computer (STC) overuse might occur. There were some concerns that light sources which emit blue light might affect anterior and posterior segment structures. We investigated the effects of STC overuse on children’s eyes during the pandemic.Materials and Methods:Sixty-four children’s findings at baseline (the early period of the pandemic) (group 1) were compared with those after 1 year (group 2). Correlations between daily STC use time (DSTCUT) and the ocular parameters in group 2 were evaluated.Results:Compared to group 1, group 2 had longer DSTCUT (1.49±0.33 vs 5.62±0.57 hours, p0.05). In group 2 as DSTCUT increased, TBUT (r=-0.368, p=0.034) decreased, OSDI score (r=0.384, p=0.028) increased and more myopic SER (r=0.340, p=0.045) occurred.Conclusion:To our knowledge, this is the first study in children to comprehensively investigate the effects of STC overuse during a pandemic on ocular surface, anterior and posterior segment structures together. We found that STC overuse during the pandemic might increase the tendency to dry-eye and myopia, and might cause axial elongation. We also determined that at 1-year follow-up, STC overuse had no effect on CCT, keratometry, ACD, LT, and posterior segment parameters.

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.

Hepatitis A virus (HAV) infection is one of the important causes of hepatitis in developing countries. It is transmitted through feco-oral route. This poses major health problems in children. Serum samples of the patients from pediatrics department suspected of acute viral hepatitis presenting with clinical features like fever, nausea, vomiting, and jaundice were collected and analyzed by using commercially available mini VIDAS 307 (Biomeriux) to detect anti HAV IgM antibodies. A nine months prospective study was conducted in the Department of Microbiology and immunology of Shri Guru Ram Rai Institute of Medical and health science Dehradun, India. Of the 47 serum samples received during the study period, 23 (48.93%) were found to be positive for anti-HAV IgM (VIDAS 307 Biomeriux). The prevalence was found to be more in male patients than in female patients, that is,14 (60.8%) and 9 (39.13%) respectively, and was predominantly seen in the 5–10 years of the age group (60%). Peak cases were found in the month of October and November. The study showed a high positivity (48.93%) of HAV in this sub-Himalayan region indicating the role of preventive measures including safe drinking water, improved sanitation and vaccination in preventing infection. Thus, detection of anti-HAV IgM becomes the cornerstone entity for diagnosis.

The COVID-19 pandemic has been associated with unprecedented changes to societal structure. School closures, unstable employment, and inaccessible health services have caused enormous disruptions to child and family wellbeing. This study identifies major themes illustrating how child and family wellness were impacted by COVID-19, including unique effects experienced by Indigenous families. In-depth interviews were conducted with key informants (n = 31) recruited from organizations providing healthcare and social services in Kingston, Ontario. Interview transcripts and written survey responses were analyzed using a phenomenological approach to explore themes related to child and family wellbeing. Three major themes identified include school closures, home safety, and outdoor spaces. School closures were generally reported as negatively impacting learning and social development; however, school closures allowed for some Indigenous children to be removed from a colonized education system, contributing to cultural and spiritual growth. Second, respondents reported increased severity and frequency of domestic violence, which negatively impacted child wellbeing. Third, the closure of public outdoor spaces created barriers to maintaining good physical health for children. This study recommends the prioritization of (1) child learning and development by avoiding school closures in pandemic settings and (2) the safety of Indigenous students by decolonizing education. To address the increased exposure to adverse childhood experiences (ACEs) during COVID-19, we recommend improved training for identifying and reporting domestic violence amongst service providers. Our study also reflects the broader need to redefine “essential services”, considering culturally specific services for Indigenous Peoples.

[Background]: Currently, data on treatment, outcome, and prognostic factors in children with tuberculous meningitis (TBM) in Europe are limited. To date, most existing data on TBM originate from adult studies, or studies conducted in low-resource settings., [Methods]: We designed a multicenter, retrospective study involving 27 pediatric healthcare institutions in 9 European countries via an established pediatric TB research network, before and after the 2014 revision of World Health Organization (WHO) dosing recommendations., [Results]: Of 118 children, 39 (33.1%) had TBM grade 1, 68 (57.6%) grade 2, and 11 (9.3%) grade 3. Fifty-eight (49.1%) children received a standard 4-drug treatment regimen; other commonly used drugs included streptomycin, prothionamide, and amikacin. Almost half of the patients (48.3%; 56/116) were admitted to intensive care unit, with a median stay of 10 (interquartile range [IQR] 4.5–21.0) days. Of 104 children with complete outcome data, 9.6% (10/104) died, and only 47.1% (49/104) recovered fully. Main long-term sequelae included spasticity of 1 or more limbs and developmental delay both in 19.2% (20/104), and seizure disorder in 17.3% (18/104). Multivariate regression analyses identified microbiological confirmation of TBM, the need for neurosurgical intervention, and mechanical ventilation as risk factors for unfavorable outcome., [Conclusions]: There was considerable heterogeneity in the use of TB drugs in this cohort. Despite few children presenting with advanced disease and the study being conducted in a high-resource setting, morbidity and mortality were high. Several risk factors for poor outcome were identified, which may aid prognostic predictions in children with TBM in the future., TPtbnet is supported by the Deutsche Gesellschaft für Internationale Zusammenarbeit. M. Te. was supported by a Clinical Lectureship provided by the UK National Institute for Health Research (NIHR), and by a grant from the Technology Strategy Board/Innovate UK. R. B. R. is funded by an NIHR Academic Clinical Lectureship at the London School of Hygiene & Tropical Medicine (grant number CL-2018-20-001). A. N.-J. was supported by Subvencions per a la Intensificació de Facultatius Especialistes (Departament de Salut de la Generalitat de Catalunya, Programa PERIS 2016–2020; ref. SLT008/18/00193). O. N. is supported by Consejeria de Salud y Familias, Servicio Andaluz de Salud 2020 (grant number A1-0049-2020).

There is a paucity of reports on the characteristics of SARS-CoV-2 infection in infants, since most studies have grouped infants with older children. We analyzed the viral loads of 45,318 SARS-CoV-2-positive nasopharyngeal swab samples obtained in Buenos Aires, Argentina. Infants younger than 6 months old presented higher viral loads than any other age group. Children older than 6 months showed significantly lower viral loads, similar to those founds in adults. This observation raises new questions regarding the role of infants in the spreading of SARS-CoV-2 infection. Fil: Ochoa, Valeria Pilar. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; Argentina Fil: Erra Diaz, Fernando Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; Argentina Fil: Ramirez, Joaquin Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; Argentina Fil: Fentini, María Clara. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; Argentina Fil: Carobene, Mauricio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; Argentina Fil: Geffner, Jorge Raúl. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; Argentina Fil: Arruvito, Maria Lourdes. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; Argentina Fil: Remes Lenicov, Federico. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; Argentina

Backgraund: Children with type 1 diabetes mellitus (T1DM) need more insulin late in the evening (reverse dawn phenomenon (RDP)), and adolescents need more insulin yearly in the morning (dawn phenomenon (DP)); these cause blood glucose variability. Modern long acting insulin analogues allow to achieve satisfactory glycemic control.Aims: To study the characteristics of insulin therapy in children and adolescents with T1DM using insulin analogues detemir and degludec to overcome blood glucose variability caused by DP and RDP in different age periods.Materials and methods: We analyzed medical documents of 200 patients using detemir, admitted to pediatric endocrinology department in 2013–2019, at mean age 9.0 years (5.4; 13.0), with T1DM for 1.3 years (0.5; 3.0); and medical documents of 50 patients switched to degludec in 2018–2019 at mean age 12.0 years (10.5; 14.5) with T1DM for 3.0 years (1.5; 6.0). Before degludec they were on intensive insulin therapy with glargine (22), detemir (26), or insulin pump (2); 16 patients (32%) presented with clinical characteristics of DP, and 5 (10%) — RDP.Results: 67 children of 108 (62%) aged 1–9 years had redistribution of detemir doses to daytime; 58 adolescents of 92 (63%) aged 10–17 лет — to nighttime. Patients switched to degludec demonstrated decrease in HbA1с from 8.7% (7.8; 9.9) to 8.0% (7.4; 9.0) (рConclusions: Compensation of T1DM may be complicated due to DP and RDP. Switching to degludec allowed to achieve better glycemic control and lowering of blood glucose variability caused by DP and DRP.

The 22q11.2 deletion syndrome (22q11.2DS) is a multisystem disorder with an estimated prevalence of 1:3000 live births. Manifestations show a marked variability in expression and include speech- and language delay, intellectual disability, and neuropsychiatric disorders. We aim to provide an overview of ocular findings in 22q11.2DS in order to optimize recommendations for ophthalmic screening. We combined results from a systematic literature review with results from a multicenter cross-sectional study of patients with 22q11.2DS who were assessed by an ophthalmologist. Our systematic literature search yielded four articles, describing 270 patients. We included 132 patients in our cross-sectional study (median age 8.9 [range 0–56] years). Most reported ocular findings were retinal vascular tortuosity (32%–78%), posterior embryotoxon (22%–50%), eye lid hooding (20%–67%), strabismus (12%–36%), amblyopia (2%–11%), ptosis (4%–6%), and refractive errors, of which hyperopia (6%–48%) and astigmatism (3%–23%) were most common. Visual acuity was (near) normal in most patients (91%–94%). Refractive errors, strabismus, and amblyopia are treatable conditions that are frequently present in patients with 22q11.2DS and should be corrected at an early stage. Therefore, in 22q11.2DS, we recommend ophthalmic and orthoptic screening at the age of 3 years or at diagnosis, and a low-threshold referral in adults.

Background. Antineoplastic treatment can have late toxic manifestations that can often appear after end of treatment. Children after treatment for acute lymphoblastic leukemia (ALL) have a risk of developing both obesity and undernutrition, which may be concealed by increased fat mass.Objective: to explore the incidence of obesity and hidden undernutrition in children with ALL and to describe the effect of enteral feeding using in these children.Materials and methods. In a retrospective study the data of 62 children with obesity that was revealed by standard examination was analyzed. The criterion of obesity was increased value of fat mass received by bioimpedance analysis. For this evaluation Russian bioimpedance analysis standards were used. Additionally, the included data were following: presence of endocrine pathology, weight change during latter 6 months before admission, physical activity and alimentary characteristics (usual regimen and structure of daily feed).Results. Only 54.8 % of patients with an actual excess of fat body mass index detected obesity (Z‑score higher than +2.00) and another 29 % body mass index was within the normal range (Z‑score from –1.00 to +1.00). This was the result of a tissue imbalance: reduce fat‑free mass. Some patients were diagnosed with insulin resistance and hyperinsulinemia. 83.7 % have a completely passive lifestyle. 49.0 % almost do not eat fruits and berries, 79.6 % – vegetables and 91.8 % – fish and seafood. Frequent intake of sweet dishes – 22.4 %, sausage products – 49.0 %, bakery products – 42.9 %, dishes from fast food restaurants – 42.9 %. 55.1 % of patients had more than 5 meals a day, while 18.4 % – less than 3. In or‑ der to correct hidden nutritional deficiencies, 22 patients received artificial nutritional formulas. They had a significant increase in fat‑free mass and a decrease in fat, in comparison with those who did not receive enteral feeding.Conclusion. Treatment‑associated factors, physical activity and alimentary causes play an important role in formation of not only obesity, but also hidden nutritional insufficiency in children with ALL after treatment. Enteral feeding using artificial polymeric formulas showed its effectiveness. An integrated and multidisciplinary approach to solving the problem is appropriate of prevention and treatment of obesity.

Aim:Kidney transplantation is the most preferred long-term treatment of children with end stage renal disease since 1954. Graft dysfunction has been divided into three categories based on timing of presentation. In this article, we aim to present the etiologic factors of acute graft dysfunction in the first year of renal transplantation in children.Materials and Methods:The patients, diagnosed with acute allograft dysfunction in first year of kidney transplantation, in University of Health Sciences Turkey, Tepecik Training and Research Hospital between March 2005 and October 2017 were analyzed prospectively in this study.Results:Over the 15 year period, 56 pediatric renal allograft patients were followed in University of Health Sciences Turkey, Tepecik Training and Research Hospital. During this period, 25 patients had diagnosed with early allograft dysfunction. Five patients were admitted two times in a year with allograft dysfunction. The mean age of patients was 12.6 (4.0±21.0) years, with a male and female ratio of 17:8. Delayed graft function was occurred in four patients (16%). Among 25 renal allograft recipients showed early graft dysfunction on average of 4.2 months (1-10 months) after transplantation. The etiology of early graft dysfunction showed 10% immunologic diseases and 90% non-immunologic factors. Five patients (16.7%) diagnosed with urinary tract infection, one patient (3.3%) diagnosed with cytomegalovirus nephropathy, five patients (16.7%) diagnosed with BK nephropathy, eight patients (26.7%) diagnosed with acute cyclosporine toxicity, seven patients (23.3%) were diagnosed with dehydration and one patient (3.3%) diagnosed with urologic anomalies. Twelve patients had performed renal allograft biopsy. The histological findings were consistent with T-cell mediated rejection in two patients; B-cell mediated rejection in one patient and viral nephropathy in five patients. Non-specific histological findings were determined in five patients.Conclusion:Early recognition of the etiology of graft dysfunction that develops at 1 year and appropriate treatment will contribute to the preservation of long-term graft dysfunction.

Background. This article discusses issues of diagnosis and management of pustular psoriasis in a child associated with recurrent dermatomycosis, immunopathogenetic mechanisms of pustular psoriasis, its course and prognosis. Clinical Case Description. The clinical case of infiltrative-suppurative form of scalp microsporia in 11 years old child with long-term psoriasis vulgaris and its transformation to generalized pustular psoriasis (von Zumbusch) is described. The need of immunosuppressive therapy prescription for severe psoriasis was challenged with fungal skin infection as immune suppression would lead to its recurrent course. Conclusion. Combination treatment (systemic glucocorticosteroids, methotrexate, antibiotics, and griseofulvin) resulted in clinical and laboratory recovery for microsporia in a child with generalized pustular psoriasis.

Background. Celiac disease (gluten enteropathy) is relatively rare disease. However, such patients have higher risk of skin pathology than general the population, and their therapy efficacy is limited by the use of gluten-free diet. Therefore, screening of dermatologic patients on celiac disease may be relevant. Objective. Our aim was to study the prevalence of celiac disease among children with skin pathology. Methods. The study included children hospitalized in dermatology department. Screening for celiac disease included detection in blood serum of antibodies (IgA, IgG, IgM) to tissue transglutaminase via rapid tests. In case of positive result of rapid test, we have repeated the estimation of antibodies (IgA, IgG) to tissue transglutaminase via immunochemiluminescent method with ImmunoCAP technology or via enzyme immunoassay. In case of positive serological test, we have performed HLA typing to determine haplotypes of DQ2 and DQ8, as well as esophagogastroduodenojejunoscopy (EGDJS) with biopsy of the duodenal and jejunal mucosa for further histological verification of the diagnosis. Results. We examined 1,000 children with various dermatologic pathologies. Rapid tests showed positive result in 21 patients (2.1%; 95% C11.3-3.2%). The presence of antibodies to tissue transglutaminase was confirmed via additional serological examination in all cases. HLA-haplotypes DQ2/8 were revealed in all patients with positive rapid test results. Typical form of gluten enteropathy was confirmed in 18/21 patients (86%) according to a histological study, thus, estimated prevalence of celiac disease is 1.8% (95% C11.1-2.8%). Conclusion. The prevalence of celiac disease remains underestimated among children with skin diseases. More studies are needed on the diagnostic features of rapid tests on tissue transglutaminase, as well as the benefits of screening for celiac disease to achieve patient-relevant clinical outcomes of skin pathology with wider gluten-free diet.

Background. Patients with epidermolysis bullosa (EB) have higher risk of developing infectious diseases. Its prevention requires timely vaccination. For now, there are no studies showing vaccination coverage for this category of children. Objective. Our aim was to study vaccination coverage of children with EB according to national preventive vaccination programmes. Methods. This retrospective cross-sectional study examined medical records of patients with EB from Russian Federation and neighbouring countries. Vaccination coverage (completeness and timeliness) and age of immunization initiation were analyzed. Moreover, we have studied the spectrum of early post-vaccine reactions and the course of the post-vaccine period in children with EB vaccinated for the first time. Results. The study included medical records of 134 patients with EB aged from 8 months to 17 years 8 months. Vaccination was performed according to national immunization programs in 37 (28%) children, only 21 cases were carried out in a timely manner. Medical exemptions were the major reason for the refusal of vaccination in most cases (82%). 48 patients with EB were vaccinated against 12 vaccine preventable diseases in the hospital. The post-vaccine period was asymptomatic in 36 (76%) patients, 10 (20%) patients had tenderness and hyperemia at the injection site, 2 (4%) patients had subfebrile fever. Conclusion. Most children with EB are still unvaccinated or vaccinated untimely. Immunization of such children against vaccine preventable disease according to the individual plan can be pretty useful.

Psoriatic arthritis is pending issue in modern pediatric dermatology. This review highlights issues of epidemiology, clinical signs, classification, diagnosis, management of comorbid conditions of psoriatic arthritis, as well as social aspects of the disease.

The spread of new coronavirus infection (COVID-19) changes specialists' approaches to patients with chronic diseases, including those with chronic dermatoses. The high risk of COVID-19 complications in patients with psoriasis is connected to the features of disease pathogenesis (such as high activity of proinflammatory cytokines) and used immunosuppressive therapy. Psoriasis affects up to 1% of children in Europe, while 10-20% of them have moderate or severe form of disease. These children may require immunosuppressive treatment, including genetically engineered biological therapy. There is only limited data on adults and children with psoriasis during the COVID-19 pandemic.

Atopic dermatitis (AD) is a disease characterized by chronic skin inflammation and epidermal barrier dysfunction leading to decrease in patients' quality of life. AD is widespread in general population including children. This article covers the disease pathophysiological mechanisms including those that depend on the endotype, as well as core principles of systemic therapy for children with moderate and severe AD. Features of targeted therapy of such patients with dupilumab (IL-4 and IL-13 inhibitor) are presented. The studies' results on dupilumab efficacy and safety in the short- and long-term are shown.

Background Evidence suggests severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may be associated with appendicitis or clinical symptoms that mimic appendicitis, but it is not clear if the findings or utility of imaging in pediatric patients with suspected appendicitis have changed since the onset of the coronavirus disease 2019 (COVID-19) pandemic. Objective To evaluate for potential differences in SARS-CoV-2 positive and SARS-CoV-2 negative pediatric patients imaged for suspected appendicitis to determine the reliability of the existing medical imaging approach for appendicitis in a population that contains both SARS-CoV-2 positive and SARS-CoV-2 negative pediatric patients. Materials and methods Patients imaged for suspected appendicitis Apr. 1, 2020, to Dec. 31, 2020, were identified via an electronic medical records search. Differences in ultrasound (US) diagnostic performance, use of computed tomography (CT) following US, rates of appendicitis, imaging findings of appendicitis and perforation were compared between SARS-CoV-2 positive and SARS-CoV-2 negative tested patients, using pathology and surgery as reference standards for appendicitis and perforation, respectively. Fisher exact test and Student’s t-test were used for statistical analysis. Results One thousand, six hundred and ninety-three patients

Pancreatitis in children has become more recognized over the past decade. Recent studies published by the INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In Search for a CuRE) Group categorizes pediatric pancreatitis according to various etiologies and clinical course of disease in acute pancreatitis (AP), acute recurrent pancreatitis (ARP) and chronic pancreatitis. Imaging modalities help fulfill the diagnosis of AP in cases of atypical clinical context, while imaging also completes the major diagnostic criteria in CP. Ultrasound is the modality of choice to evaluate children with AP. Computed tomography should be reserved to assess the severity of complicated AP, or in the acute traumatic setting due to radiation concerns in children. Magnetic resonance cholangiopancreatography is used for the evaluation of underlying pancreaticobiliary structural abnormalities and for diagnosing CP. The etiologies of pediatric pancreatitis are diverse and unique including biliary stones, pancreaticobiliary structural abnormalities, genetic mutationrelated, drugs, trauma, systemic diseases and autoimmune-related cause. This article provides a pictorial review of the imaging modalities and findings related to the clinical course and etiologies of pediatric pancreatitis (AP, ARP and CP).

Background. The purpose was to present a differentiated approach and analysis of the results of surgical treatment of mobile planovalgus deformity in children with cerebral palsy. Materials and methods. There was performed a retrospective analysis of the cases of 39 patients with mobile planovalgus deformity and spastic cerebral palsy, who underwent various surgical treatment options. According to the applied regimen of surgical treatment with mobile planovalgus deformity, the patients were divided into 3 groups. Results. It was found that surgical treatment of mobile planovalgus deformity in children aged 7–11 years with cerebral palsy using techniques that are isolated aimed at correcting contractures and tendon-muscle balance of the ankle joint and foot is accompanied by a significant percentage of relapses (66.7 %). Additional use of a minimally invasive surgical technique for arthroereisis of the talocalcaneus joint allows improving the clinical and radiological results of surgical correction of mobile planovalgus deformity, but 80 % cases are accompanied by the development of chronic pain syndrome. In patients older than 12 years, it was clinically and radiographically confirmed the effectiveness of surgical treatment of mobile planovalgus deformity of a moderate and severe degree in children with cerebral palsy using corrective lateral lengthening osteotomy of the calcaneus bone. A hollow two-stage cone implant for arthroereisis has been developed and implemented to prevent the occurrence of pain syndrome, reduce the frequency of migrations and the need for repeated surgical interventions. The effectiveness of the developed implant for arthroereisis of the talocalcaneus joint has been proven during clinical testing. Conclusions. The developed algorithm of differentiated choice of surgical treatment methods for mobile planovalgus deformity in children with cerebral palsy, depending on age, level of gross motor functions and clinical characteristics of mobile planovalgus deformity, allows making a choice between minimally invasive techniques (arthroereisis, soft tissues surgery) and surgical interventions on the bones and joints of the foot (corrective lateral osteotomy of the calcaneus bone, arthrodesis of large joints of the posterior and middle compartments of the foot)., Цель работы: предоставить дифференцированный подход и анализ результатов хирургического лечения мобильной плосковальгусной деформации стоп (МПВДС) у детей, больных детским церебральным параличом (ДЦП). Материалы и методы. Проведен ретроспективный анализ историй болезни 39 пациентов с мобильной плосковальгусной деформацией стоп, со спастическим типом ДЦП, которым были выполнены различные варианты хирургического лечения. Согласно примененному варианту хирургического лечения МПВДС, пациенты были разделены на 3 группы. Результаты. Установлено, что хирургическое лечение МПВДС у детей в возрасте 7–11 лет, больных ДЦП, с использованием методик, изолированно направленных на коррекцию контрактур и сухожильно-мышечного баланса голени и стопы, сопровождается значительным процентом рецидивов (66,7 %). Дополнительное использование малоинвазивной хирургической методики артроэреза подтаранного сустава (АЭПТС) позволяет улучшить клинико-рентгенологические результаты хирургической коррекции МПВДС, однако в 80 % случаев сопровождается развитием хронического болевого синдрома. Клинико-рентгенологически подтверждена эффективность хирургического лечения МПВДС среднего и тяжелой степени у детей старше 12 лет, больных ДЦП, с использованием корректирующей латеральной удлиняющей остеотомии пяточной кости. Разработан и внедрен полый двуступенчатый конусный имплантат для подтаранного артроэреза, который позволяет предупредить возникновение болевого синдрома, снизить частоту миграций и необходимость повторных хирургических вмешательств. Эффективность разработанного имплантата для артроэреза подтаранного сустава доказана при клинической апробации. Выводы. Разработанный алгоритм дифференцированного выбора методики хирургического лечения МПВДС у детей, больных ДЦП, в зависимости от возраста, уровня моторных функций и клинических характеристик МПВДС позволяет провести выбор между малоинвазивными методиками (АЭПТС, вмешательство на мягких тканях) и хирургическими вмешательствами на костях и суставах стопы (корректирующая латеральная остеотомия пяточной кости, артродез крупных суставов заднего и среднего отделов стопы)., Мета роботи: навести диференційований підхід та аналіз результатів хірургічного лікування мобільної плосковальгусної деформації стоп (МПВДС) у дітей, хворих на дитячий церебральний параліч (ДЦП). Матеріали та методи. Проведено ретроспективний аналіз історій хвороби 39 пацієнтів із мобільною плосковальгусною деформацією стоп, зі спастичним типом ДЦП, яким були виконано різні варіанти хірургічного лікування. Відповідно до застосованого варіанта хірургічного лікуванням МПВДС, пацієнти були розподілені на 3 групи. Результати. Встановлено, що хірургічне лікування МПВДС у дітей віком 7–11 років, хворих на ДЦП, із використанням методик, що ізольовано спрямовані на корекцію контрактур та сухожилково-м’язового балансу гомілки та стопи, супроводжується значним відсотком рецидивів (66,7 %). Додаткове використання малоінвазивної хірургічної методики артроерезу піднадп’яткового суглоба (АЕПНС) дозволяє покращити клініко-рентгенологічні результати хірургічної корекції МПВДС, проте у 80 % супроводжується розвитком хронічного больового синдрому. Клініко-рентгенологічно підтверджена ефективність хірургічного лікування МПВДС середнього та тяжкого ступеня у дітей віком понад 12 років, хворих на ДЦП, із використанням коригуючої латеральної подовжуючої остеотомії п’яткової кістки. Розроблено та впроваджено порожнистий двоступеневий конусний імплантат для піднадп’яткового артроерезу, який дозволяє запобігти виникненню больового синдрому, знизити частоту міграцій і необхідність повторних хірургічних втручань. Ефективність розробленого імплантату для АЕПНС доведено при клінічній апробації. Висновки. Розроблений алгоритм диференційованого вибору методики хірургічного лікування МПВДС у дітей, хворих на ДЦП, що залежно від віку, рівня великих моторних функцій і клінічних характеристик МПВДС дозволяє провести вибір між малоінвазивними методиками (АЕПНС, втручання на м’яких тканинах) та хірургічними втручаннями на кістках і суглобах стопи (коригуюча латеральна остеотомія п’яткової кістки, артродези великих суглобів заднього та середнього відділів стопи).

The impact of the COVID-19 pandemic, and implemented restrictions on the frequency of pediatric rheumatic diseases remain unknown, while they have probably prevented common infections in children. We present the effects of the COVID-19 on our pediatric rheumatology practice in a main referral center. We retrospectively reviewed the medical records of patients presenting to pediatric rheumatology department in 4 years before March 2020 and compared it to the pandemic year (March 2020–March 2021). Since there was an overall decrease in patient numbers, we calculated the percentage according to the total number of that year. A total of 32,333 patients were evaluated. The mean annual number of patients decreased by 42% during the COVID-19 pandemic. When follow-up visits (25,156) were excluded, there were 2818 new diagnoses of rheumatic diseases. In the pre-pandemic period, familial Mediterranean fever (FMF) (n = 695, 28.1%) was the most frequent, whereas in the pandemic period multisystem inflammatory syndrome in children (MIS-C) (n = 68, 19.2%) was the most common diagnosis. There were no significant differences in the percentages of juvenile idiopathic arthritis, autoimmune diseases, rare autoinflammatory diseases, and other vasculitides. However, there was a significant decrease in patients diagnosed with FMF, IgA vasculitis (IgAV), acute rheumatic fever (ARF), classic Kawasaki disease (KD), and macrophage activation syndrome (MAS) (all p

While ataxia is a relatively common presenting feature in pediatric patients, it represents only one possible cause of uncoordinated movements. Other possible causes of uncoordinated movements include ingestion of toxic substances, musculoskeletal diseases, psychogenic disorders, extrapyramidal movement disorders, peripheral neuropathies, spasticity from any cause, and epilepsy. Therefore, primary health care providers must recognize and exclude other etiologies of uncoordinated movements before attaching the label “ataxia” to any patient presenting with poor coordination. Once the presence of ataxia is confirmed, the cause should be investigated. As ataxia may be vestibular, sensory, or cerebellar in origin, medical practitioners must evaluate the diverse symptoms and signs to effectively differentiate the various types of ataxia. Three case studies are presented to illustrate the complexity associated with the assessment of ataxia. Each case will discuss a pediatric patient who displays cerebellar ataxia as a concurrent feature of a gene-specific developmental and epileptic encephalopathy. These cases will provide an example of how ataxia may be differentiated from other causes of uncoordinated movements related to epilepsy and anti-seizure medications, namely: nonconvulsive seizures, postictal state, and medication side effects or toxicity. The assessment of poor balance can be challenging at times; however, with knowledge of the differential diagnosis of poor balance, medical practitioners will be able to confidently determine the presence of true ataxia from various ataxia mimickers, thereby allowing for timely and accurate diagnosis, and appropriate management.

Background. There is a need to study genetically engineered biological therapy (GEBT) survivability and identify any significant risk factors for its ineffectiveness due to the increasing prevalence of psoriasis among children and the spreading GEBT administration. Such information has practical importance, it can be used to predict treatment outcomes and to develop individual therapeutic approaches.Objective. Our aim was to study biological therapy survivability and to identify risk factors for its ineffectiveness in children with moderate and severe forms of psoriasis.Methods. The study included data from 4-17 years old patients with moderate and severe forms of psoriasis vulgaris. Groups were formed according to the biological medication used. Statistical analyses were performed via SPSS Statistics. Biologic therapy survivability was determined via Kaplan-Meier method with the assessment of differences significance using log-rank test. Significant factors affecting cumulative risk growth were determined by Cox multiple regression method.Results. The study analysed data from the medical records of 105 patients. The average survivability of ustekinumab was 28.7 months, etanercept — 23.1, and adalimumab — 18.4. In the group of bio-naive patients, the survivability was higher: 30.8 months for ustekinumab and 24.4 months for ethanercept, while in the group of patients administrated previously with biological medication the survivability was 24.2 and 8.3 months, respectively. No statistically significant difference was revealed for adalimumab therapy. Significant risk factors for therapy ineffectiveness were the following: high body mass index (BMI) at the time of GEBT onset, aggravated family history, and prior use of one or several subsequent GEBT lines.Conclusion. The therapy survivability is inevitably declining over time. The best results were noted in bio-naive patients treated with ustekinumab that allows us to recommend it as the first-line drug in children with severe and moderate forms of psoriasis.

Background Ventricle septal defect (VSD) is the most common type of congenital heart disease in children. If definitive therapy delayed, failure to thrive and developmental delays can lead to decreased quality of life. The options for VSD closure include surgical and minimally invasive procedures with transcatheterization. Although transcatheterization is considered to be the safest therapy, the risk of complications can lead to cancellation of procedure. Objective To determine whether nutritional status, body height, VSD type and size, and type of device used were predictors of cancellation of transcatheter closure of VSD. Methods A retrospective cohort study using medical records was performed for all children who underwent transcatheter closure of VSD at Dr. Sardjito Hospital, Yogyakarta, Central Java, between January 2017 to March 2020. Cancellation of closure was defined as complications occurring during the procedure, such as cardiac conduction problems, valve regurgitation, and device embolization. Multivariate logistic regression analysis was done to determine independent predictors of closure cancellation. Results One hundred thirty-four children were enrolled. Independent variables that were significant predictors were doubly committed subarterial (DCSA) VSD type (OR 5.98; 95%CI 1.52 to 23.61; P=0.045), moderate VSD size (OR 15.59; 95%CI 4.67 to 52.06; P=0.001), and types of devices used: symmetric (OR 27.06; 95%CI 2.75 to 266.17; P=0.001), asymmetric (OR 16.46; 95%CI 2.15 to 210.0; P=0.001), and coil (OR 21.26; 95%CI 2.15 to 210.0; P=0.001). Taller body height was a protective factor against cancellation of the procedure (OR 0.98; 95%CI 0.96 to 1.00; P=0.008). Conclusion Significant predictors of cancellation of transcatheter VSD closure are DCSA VSD, moderate VSD size, as well as coil, symmetric, and asymmetric devices, and increased body height.

Resumen: Introducción y objetivos: El control glucémico postprandial es fundamental para conseguir los objetivos metabólicos en pacientes con diabetes mellitus tipo 1 (DM1). La nueva insulina faster aspart presenta un perfil farmacológico caracterizado por una absorción e inicio de acción más rápidos, mayor disponibilidad precoz y menor incremento de la glucosa postprandial. El objetivo principal del estudio fue analizar su eficacia en pacientes con DM1 tratados con un sistema integrado. Pacientes y métodos: Estudio analítico, longitudinal, prospectivo y multicéntrico, evaluando el empleo de faster aspart durante tres meses en pacientes en edad pediátrica con DM1 con sistema integrado MiniMed640G® tratados previamente con insulina aspart. Al inicio y final del estudio se analizaron para posterior comparación: glucosa media, porcentajes de tiempo en objetivo, tiempo en hipoglucemia e hiperglucemia, área bajo la curva (AUC) 180 mg/dL, glucosa media pre y postprandial en comidas principales, necesidades diarias de insulina, porcentaje basal/bolo y HbA1c. Se registraron complicaciones agudas y eventos adversos, y se evaluó grado de satisfacción mediante encuesta. Resultados: Se incluyeron 31 pacientes de 13,49 ± 2,42 años de edad con DM1 de 7,0 ± 3,67 años de evolución. Faster aspart se asoció con menor porcentaje de tiempo en hiperglucemia > 180 mg/dL (25,8 ± 11,3 vs. 22,4 ± 9,5; p = 0,011) y > 250 mg/dL (5,2 ± 4,9 vs. 4,0 ± 3,6; p = 0,04) y AUC > 180 mg/dL (10,8 ± 6,5 vs. 9,3 ± 6,1; p = 0,03), incrementándose el tiempo en objetivo (71,4 ± 10,0 vs. 74,3 ± 9,2; p = 0,03) sin aumentar hipoglucemias. Las necesidades de insulina, porcentajes basal/bolo y HbA1c no se modificaron significativamente. Faster aspart fue bien tolerada y valorada por los participantes. Conclusiones: Faster aspart consigue un mejor control glucémico, aumentando el tiempo de glucosa en objetivo en niños y adolescentes con DM1 en tratamiento con un sistema integrado. Abstract: Background and aims: Post-prandial glucose control is essential to achieve metabolic goals in patients with type 1 diabetes mellitus (T1DM). The new «faster aspart» insulin has a pharmacological profile noted for its faster absorption and onset of action, and increased early availability, resulting in improved blood glucose control after meals. The main objective of the study was to analyse the efficacy of «faster aspart» vs. «insulin aspart» in children and adolescents with DM1 on sensor-augmented pump treatment. Patients and methods: Multicentre, longitudinal and prospective analytical trial evaluating the use of faster aspart insulin for three months in children with T1DM with MiniMed640G® sensor-augmented pumps previously treated with aspart insulin. At the beginning and end of the study the following variables were analysed for subsequent comparison: mean sensor glucose, percentage of time in range, hypoglycaemia and hyperglycaemia, area under the curve (AUC) 180 mg/dL, mean sensor glucose pre and postprandial in main meals, daily insulin requirements, basal/bolus percentage, and HbA1c. Acute complications, adverse events and satisfaction survey were assessed. Results: The study included 31 patients with a mean of 13.49 ± 2.42 years of age and with T1DM of 7.0 ± 3.67 years of onset. The use of faster aspart was associated with lower time in hyperglycaemia > 180 mg/dL (25.8 ± 11.3 vs. 22.4 ± 9.5; p = 0.011) and > 250 mg/dL (5.2 ± 4.9 vs. 4.0 ± 3.6; p = 0.04), lower AUC > 180 mg/dL (10.8 ± 6.5 vs. 9.3 ± 6.1; p = 0.03), and increased time in range (71.4 ± 10.0 vs. 74.3 ± 9.2; p = 0.03). No significant changes in hypoglycaemia, HbA1c, insulin requirements, and basal/bolus percentages were detected. Faster aspart was safe and well-evaluated by patients and caregivers. Conclusions: Faster aspart achieves better glycaemic control by increasing glucose time in range in children and adolescents with T1DM on treatment with sensor-augmented pumps.

Background: Poisoning by household cleaning products(HCPs) is common in children. Some HCPs are toxic and may cause severe complications. We assessed HCP poisonings treated in a pediatric emergency department(PED). Methods: This was a retrospective study of patients aged under 18 years with HCP poisoning admitted to the largest PED in Taiwan from 2011 to 2020 were recruited. Results: The records over a 10-year period from 103 children admitted to the PED because of HCP poisoning(70 boys [68%] and 33 girls [32%]), mean age 3.54 years(standard deviation [SD] = 3.15 years) were evaluated. Most poisonings were unintentional(99%, n = 102) and occurred at home(96%, n = 99). The HCPs included alkaline(74%, n = 76), acidic(25%, n = 26), and neutral(1%, n = 1) agents. Most were orally ingested(86%, n = 89). Panendoscopy was performed in 25 patients(24%), and the endoscopic(Zargar) grade was used to determine the severity of injury. Medications(steroids [9%, n = 9], antibiotics [10%, n = 10], or antacids [30%, n = 23]) were prescribed. Alkaline HCP ingestion induced severe esophageal injury(p = 0.04) and esophageal stricture(p = 0.04). Five patients(5%) exhibited esophageal strictures and required balloon dilation. On multivariate analysis, alkaline HCP ingestion(p = 0.04), severe esophageal caustic injury(Zargar grade ≥ 3) (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.