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Objectives: This study aims to evaluate the relationship between the oxidative stress induced by obesity and metabolic changes in the cognitive functions of obese children. Methods: Thirty-three obese children and adolescents (age: 8-18); and 33 healthy children similar in terms of age and gender were enrolled. Children were diagnosed with obesity according to the Turkish children's body mass index (BMI) curves. Patients over the 95th percentile in terms of Turkish children's BMI curves considering their genders and age were called obese children. Obese children were excluded whose obesity was related to any syndrome or disease. Neurocognitive functions including the Visual Memory Test, Finger Tapping Test, Memory Test, Symbol Digit Coding, Stroop Test, Continuous Performance Test, and Shifting Attention Test were evaluated with the battery tests of Central Nervous System Vital Signs (CNSVS) via computer. Malondialdehyde (MDA) and protein carbonyl (PC) were analyzed to determine the oxidative stress. After 10 hours overnight fast, blood samples were collected to determine Fasting glucose, total cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, liver enzymes aspartate aminotransferase and alanine aminotransferase by using enzymatic methods. Results: MDA and PC levels in obese children were founs significantly higher (0.78±0.16 μmol/L;198.30±84.45 nmol/mL) than the controls (0.5±0.10 μmol/L; 125.35±43.52 nmol/mL) (P<0.001). All of the cognitive performance domains were statistically significantly different between the study and control groups. A statistically significant correlation was found between neurocognitive indexes and MDA and PC levels. Conclusions: Obese children's cognitive functions must be evaluated. Elevated oxidative stress may be the reason for the bad cognitive performance in children with obesity. However, this cognitive performance study in obese children should be supported with large study groups. [ABSTRACT FROM AUTHOR]

Background: Riding lawn mower injuries are the most common cause of major limb loss in young U.S. children. Our study objective was to investigate the circumstances surrounding pediatric riding lawn mower injuries and to identify potential contributing risk factors and behaviors leading to these events. Methods: Followers/members of both a public and a private lawn mower injury support and prevention Facebook page who had or were aware of children who had suffered a lawn mower-related injury were invited to complete an electronic survey on Qualtrics. Duplicate cases and those involving push mowers were removed. Frequencies and chi-square analyses were performed. Results: 140 injured children were identified with 71% of surveys completed by parents and 19% by an adult survivor of a childhood incident. The majority of injured children were Caucasian (94%), male (64%), and ≤ 5 years of age at the time of the incident (63%). Bystanders were 69% of those injured, 24% were lawn mower riders, and mower operators and others accounted for 7%. The lawn mower operator was usually male (77%), being the father/stepfather in almost half. Overall, 59% of injuries occurred while traveling in reverse, 29% while moving forward. Nearly all (92%) had an amputation and/or permanent disability. Subgroup analysis (n = 130) found injured bystanders were younger than injured passengers with 71% versus 45% being < 5 years of age, respectively (p = 0.01). Over three-quarters of bystander incidents occurred while moving in reverse as compared to 17% of passenger incidents (p < 0.01). Amputations and/or permanent disabilities were greater among bystanders (97%) as compared to passengers (79%, p = 0.01). Only 3% of bystanders had an upper extremity injury as compared to 21% of passengers (p = 0.01). Seventy-three percent of bystander victims had received at least one ride on a lawn mower prior to their injury incident. Conclusions: Child bystanders seriously injured by riding lawn mowers were frequently given prior rides likely desensitizing them to their inherent dangers and leading them to seek rides when mowers were being used. Engineering changes preventing blade rotation when traveling in reverse and not giving children rides (both when and when not mowing) may be critical in preventing mower-related injuries. [ABSTRACT FROM AUTHOR]

The objective of this study is to elucidate the effectiveness of home based rehabilitation (HBR) and compare its results with those obtained in conventional rehabilitation (CR) programs, carried out in clinics and/or outpatient clinics. Searches were conducted in five databases of randomized clinical trials. Study selection, data extraction, and assessment of the methodological quality of included studies were conducted independently by two reviewers, with discrepancies resolved by a third reviewer. The results demonstrate post-intervention values favorable to the use of HBR when compared to control group in the outcomes of forced expiratory volume in 1 second (FEV1) (MD = 14% CI: 5.42 to 22.58, p = 0.001), forced vital capacity (FVC) (MD = 8.00% CI: 0.83 to 15.17, p = 0.03) and quality of life by the Cystic Fibrosis Questionnaire – revised in the categories (Child version score" (MD= 0.71%CI: 0.15 to 1.27, p = 0.01) and "Parent version score" (MD= 0.67%CI: 0.11 to 1.23, p = 0.02). Furthermore, we noticed an increase in the distance covered in the 6-minute walk test (MD= 34.75%CI: −8.00 to 77.50, p = 0.14), in favor of HBR. We found that supervised or partially supervised HBR promotes improvements in FEV1, FVC and related quality of life in children and/or adolescents with cystic fibrosis. [ABSTRACT FROM AUTHOR]

Objective: To develop an expert consensus statement regarding persistent pediatric obstructive sleep apnea (OSA) focused on quality improvement and clarification of controversies. Persistent OSA was defined as OSA after adenotonsillectomy or OSA after tonsillectomy when adenoids are not enlarged. Methods: An expert panel of clinicians, nominated by stakeholder organizations, used the published consensus statement methodology from the American Academy of Otolaryngology‐Head and Neck Surgery to develop statements for a target population of children aged 2‐18 years. A medical librarian systematically searched the literature used as a basis for the clinical statements. A modified Delphi method was used to distill expert opinion and compose statements that met a standardized definition of consensus. Duplicate statements were combined prior to the final Delphi survey. Results: After 3 iterative Delphi surveys, 34 statements met the criteria for consensus, while 18 statements did not. The clinical statements were grouped into 7 categories: general, patient assessment, management of patients with obesity, medical management, drug‐induced sleep endoscopy, surgical management, and postoperative care. Conclusion: The panel reached a consensus for 34 statements related to the assessment, management and postoperative care of children with persistent OSA. These statements can be used to establish care algorithms, improve clinical care, and identify areas that would benefit from future research. [ABSTRACT FROM AUTHOR]

Background: Exercise training is a cornerstone of care for people with cystic fibrosis (pwCF); it improves exercise capacity and health-related physical fitness, but no meta-analysis has investigated its effects on muscle function in young pwCF. The objective of this meta-analysis was to assess the effects of exercise on peripheral muscle strength in young pwCF. Methods: An electronic search was conducted in four databases (Pubmed, Science Direct, CENTRAL, and PEDRO) from their inception to July 2022. Grey literature databases (OpenGrey, the European Respiratory Society, the American Thoracic Society, and the European Cystic Fibrosis Society) were also consulted. Randomized controlled trials comparing any type of exercise with standard care in young pwCF (5 to 19 years old) were included. Two authors independently selected the relevant studies, extracted the data, assessed the risk of bias (using the Rob2 tool), and rated the quality of the evidence. Results: Ten studies met the inclusion criteria, involving 359 pwCF. Exercise training improved both lower and upper limb muscle strength (SMD 1.67 (95%CI 0.80 to 2.53), I2 = 76%, p < 0.001 and SMD 1.30 (95%CI 0.66 to 1.93), I2 = 62%, p < 0.001, respectively). Improvements were also reported in muscle mass and maximal oxygen consumption. Results regarding physical activity levels were inconclusive. The overall risk of bias for the primary outcome was high. Conclusions: Exercise training may have a positive effect on peripheral muscle strength in young pwCF. The evidence quality is very low and the level of certainty is poor. There is a need for high-quality randomized controlled studies to confirm these results. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a leading cause of global child mortality. Until the turn of the 21st century, Mycobacterium bovis bacille Calmette-Guerin (BCG) was the only vaccine to prevent TB. The pediatric TB vaccine pipeline has advanced in the past decade to include the evaluation of novel whole cell vaccines to replace infant BCG and investigation of subunit and whole cell vaccines to boost TB immunity during adolescence. We describe the history of BCG, current TB vaccine candidates in clinical trials, and the challenges and opportunities for future TB vaccine research in children. Children are a critical target population for TB vaccines, and expansion of the pediatric TB vaccine pipeline is urgently needed to end the TB pandemic. [ABSTRACT FROM AUTHOR]

Background: Ovarian teratomas are the most common type of ovarian mass during childhood and adolescence. There is no clear guidance for the management of the ovarian teratomas in children and adolescents. It is necessary, however, to understand the feature of these tumours and the indications for operating on them, and to put subjective criteria for the management in elective or emergency presentations. Methods: Medical records of patients between the age of 12 and 20 years old that underwent surgery for ovarian teratomas at the Department of Obstetrics and Gynaecology in University Hospital of Ioannina, between January 2000 and August 2022, were reviewed. A medical database was searched between January 2000 and August 2022 with the following keywords: ovarian teratoma, paediatrics and adolescents. Results: We present the results of forty patients, with a mean age of 11.8 years of age. All patients had surgery, where three out of four underwent oophorectomy and only one out of four underwent ovary-sparing operation; similar results were found in the literature. Conclusion: Ovary-sparing treatment is more common recently compared with the past, such as MIS compared with laparotomy. Better-organised and -planned prospective multi-centre studies are necessary to gain a deeper knowledge of the physiology and prognostic factors of teratomas in children. [ABSTRACT FROM AUTHOR]

Despite the availability of more than 30 antiseizure medications (ASMs), the proportion of patients who remain refractory to ASMs remains static. Refractory seizures are almost universal in patients with epileptic encephalopathies. Since many of these patients are not candidates for curative surgery, there is always a need for newer ASMs with better efficacy and safety profile. Recently, the anti-obesity medication fenfluramine (FFA) has been successfully repurposed, and various regulatory agencies approved it for seizures associated with Dravet and Lennox–Gastaut syndromes. However, there is a limited in-depth critical review of FFA to facilitate its optimal use in a clinical context. This narrative review discusses and summarizes the antiseizure mechanism of action of FFA, clinical pharmacology, and clinical studies related to epilepsy, focusing on efficacy and adverse effects. [ABSTRACT FROM AUTHOR]

Children can be unreliable witnesses, and they are especially vulnerable to questionable interview practices. However, in some crimes like child sexual abuse, children may be the only person capable of providing testimonial evidence. States must balance the needs of bringing criminals who target children to justice and ensuring that due process is upheld to reduce the chances of false convictions. The Office of Juvenile Justice and Delinquency Prevention has published a set best-practices for the interviewing of children to achieve this balance. This article conducts a statutory analysis to determine if states are currently following the recommendations of the OJJDP. [ABSTRACT FROM AUTHOR]

This study examines how children's age, gender and interviewer gender affected children's testimony after witnessing a theft. Children (N = 127, age = 6–11 years) witnessed an experimenter (E1) find money, which he/she may/may not have taken. E1 then asked the children to falsely deny that the theft occurred, falsely accuse E1 of taking the money, or tell the truth when interviewed by a second experimenter. Falsely denying or falsely accusing influenced children's forthcomingness and quality of their testimony. When accusing, boys were significantly more willing than girls to disclose about the theft earlier and without being asked directly. When truthfully accusing, children gave lengthier testimony to same-gendered adults. When denying, children were significantly more willing to disclose the theft earlier to male interviewers than to females. As children aged, they were significantly less likely to lie, more likely to disclose earlier when accusing, and give lengthier and more consistent testimony. [ABSTRACT FROM AUTHOR]

Cystic echinococcosis is a parasitic infection of major public health concern. The infection is generally acquired during childhood and the disease incubation period can last many years. The occurrence and characteristics of the disease in children were not well studied. The present study aimed to explore the pattern and features of cystic echinococcosis in children in rural and urban environments in Morocco. A total of 338 children diagnosed and treated for cystic echinococcosis were investigated. The trend of the infection, risk and exposure factors and the distribution of the anatomic locations of cysts were studied. A non-uniform decrease in proportions of infected children was found. Children from rural environs had significantly higher infection rates than children from urban environs (p < 0.001). Males were significantly more infected than females. Children aged 7–11 years were the most affected. For cysts locations, single organ involvement was found in 94.4% of the children versus 5.6% with multi-organ localization. Despite control program, active transmission of echinococcosis still occurred in children and remains a major public health problem. The infection in younger population may have some features that need to be considered in the prevention and control programs in endemic areas. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the international literature for studies reporting outcomes for obstructive sleep apnea (OSA) in children undergoing isolated tongue surgeries. Methods: Two authors searched from inception through November 14, 2016 in four databases including PubMed/MEDLINE. Results: 351 studies were screened. Eleven studies (116 children) met criteria. Most children were syndromic and had craniofacial disorders, co-morbidities, or other serious medical issues. Surgeries included base-of-tongue (BOT) reduction ( n = 114), tongue suspension ( n = 1), and hypoglossal nerve stimulation ( n = 1). The pre- and post-BOT reduction surgeries decreased apnea-hypopnea index (AHI) from a mean ( M) and standard deviation (SD) of 16.9 ± 12.2/h to 8.7 ± 10.6/h (48.5% reduction) in 114 patients. Random effects modeling (109 patients) demonstrated a standardized mean difference for AHI of −0.78 (large magnitude of effect) [95% CI −1.06, −0.51], p value <0.00001. For BOT surgery in 53 non-syndromic children, the AHI decreased 59.2% from 14.0 ± 11.4 to 5.7 ± 6.7/h, while in 55 syndromic children, the AHI decreased 40.0% from 20.5 ± 19.1 to 12.3 ± 18.2/h. BOT reduction improved lowest oxygen saturation from M ± SD of 84.7 ± 7.4-87.9 ± 6.5% in 113 patients. Hypoglossal nerve stimulation and tongue-base suspension are limited to case reports. Conclusions: Most children undergoing tongue surgeries in the literature were syndromic and had craniofacial disorders, co-morbidities, or other serious medical issues. Children with a body mass index <25 kg/m and non-syndromic children have had the most improvement in AHI. The specific type of surgery must be tailored to the patient. Patients with co-morbidities should undergo treatment in centers that are equipped to provide appropriate perioperative care. [ABSTRACT FROM AUTHOR]

The article discusses the application of low-density lipoprotein cholesterol in children with type 1 diabetes. It mentions that one of the strongest risk factors of cardiovascular disease is a high concentration of low-density lipoprotein cholesterol (LDL-C). It notes the importance of accurate measurement of LDL-C concentration in children.

The ‘gold standard’ techniques used to measure insulin sensitivity in children are the hyperinsulinaemic-euglycaemic clamp and Bergman’s minimal model. Although precise, these techniques are complex, invasive and time consuming. Alternative indirect measures of insulin sensitivity have been developed that utilize fasting glucose and insulin data in algorithms or computer programs. These methods include homeostatic model assessment (HOMA), the quantitative insulin sensitivity check index (QUICKI) and the glucose to insulin ratio (G:I). Each of these three fasting techniques has been developed and validated in adults, with little or no validation in children. Increasingly, HOMA and QUICKI are being used in childhood studies to assess insulin sensitivity. In a group of 79 pre-pubertal children, we found that the correlation between the minimal model and RHOMA (r = –0.4) was no better than that between the minimal model and fasting insulin (r = 0.4), with an even weaker correlation between the minimal model and QUICKI (r = 0.2). In addition, neither HOMA nor QUICKI were able to detect a reduction in insulin sensitivity with obesity or during growth hormone therapy, unlike the minimal model. In children with normal glucose levels, neither HOMA nor QUICKI was superior to fasting insulin. Validation of the derivation formulae for these methods in children is needed before they are more widely used. The potential benefits of these simple fasting techniques is that they are useful in large field studies. However, if the study groups are small or longitudinal changes in insulin sensitivity are sought, more precise techniques such as the clamp or minimal model should be used. Copyright © 2005 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

This study examined the extent to which children believe that truth telling is compromised by negative outcome expectancies. It also investigated the efficacy of two types of appeals, externally and internally directed, for encouraging truth telling. Seventy-two children from three age groups (5, 7, and 10 years of age) participated in a vignette study designed to examine these issues. Results showed that children believed that truth telling about an adult's transgression would be more likely if negative outcomes were not expected than if they were expected. Further, children believed that either externally or internally focused encouragement would facilitate truth telling when negative outcomes were expected for truth telling. Beliefs about the propensity for truth telling were associated more with positive evaluations of truth telling than with negative evaluations of lying. These results have important implications for court cases in which children testify about an adult who has sworn them to secrecy and they are afraid to speak the truth. [ABSTRACT FROM AUTHOR]

Laparoscopic adrenalectomy (LA) is now the gold standard for the treatment of small, benign adrenal tumors in adults. In Cushing’s syndrome (CS), LA is difficult and seldom done, especially in younger children. A 6-year-old girl was diagnosed with CS due to a juxtaadrenal tumor. She underwent LA and made an uneventful recovery. The histopathology was reported as paraganglioma which is a very rare cause of CS. LA is seldom done in younger children with CS owing to extreme obesity, abundant perinephric fat and a high incidence of pre- and postoperative complications. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]