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Allergic rhinitis (AR) is a common pediatric disease, that involves up to the 25% of children worldwide. Environmental pollution, passive smoke, and many viruses are actively involved in the chronic inflammation of the nasal mucosa.As described previously in the literature, novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection in children is uncommon and often asymptomatic or mild.

Proton radiotherapy has promised an advantage in safely treating pediatric malignancies with an increased capability to spare normal tissues, reducing the risk of both acute and late toxicity. The past decade has seen the proliferation of more than 30 proton facilities in the United States, with increased capacity to provide access to approximately 3,000 children per year who will require radiotherapy for their disease. We provide a review of the initial efforts to describe outcomes after proton therapy across the common pediatric disease sites. We discuss the main attempts to assess comparative efficacy between proton and photon radiotherapy concerning toxicity. We also discuss recent efforts of multi-institutional registries aimed at accelerating research to better define the optimal treatment paradigm for children requiring radiotherapy for cure.

Allogeneic hematopoietic stem cell transplantation (HSCT) is widely performed in children and adolescents with hematologic diseases, including very high-risk leukemia. With increasing success and survival rates, the long-term sequelae of HSCT have become important. Here, we provide guidance to the prevention and treatment of the most common bone morbidities—osteoporosis and osteonecrosis—emerging in the context of HSCT in children and adolescents. We give an overview on definitions, symptoms, and diagnostics and propose an algorithm for clinical practice based on discussions within the International Berlin Frankfurt Munster (BFM) Stem Cell Transplantation Committee and the Pediatric Disease Working Party of the European Society for Blood and Marrow Transplantation, our expert knowledge, and a literature review.

One of the best-known examples of a campaign to raise awareness about pediatric disease is childhood cancer awareness month (CCAM). This study uses cross-sectional, descriptive-analytical methodology to explore how Twitter was employed during CCAM. We collected childhood cancer-related tweets from August 30 to October 2, 2015, which coincided with CCAM and several days before and after the awareness month. Using MALLET, we applied Latent Dirichlet allocation statistical modeling to extract the main topics of the collected tweets. We then explored how four different types of accounts—organizations, news agencies, celebrities, and individuals—used social media to talk about childhood cancer during CCAM using qualitative content analysis. Our research showed that celebrities were the group whose tweets had the most average impressions. The results also showed that tweets authored by organizations and celebrities were retweeted at greater rates than individuals and even news agencies. This suggests that organizations and celebrities have greater potential to raise awareness about issues like childhood illnesses.

Background A number of serious human adenovirus (HAdV) outbreaks have been recently reported: HAdV-B7 (Israel, Singapore, and USA), HAdV-B7d (USA and China), HAdV-D8, -D54, and -C2 (Japan), HAdV-B14p1 (USA, Europe, and China), and HAdV-B55 (China, Singapore, and France). Methods To understand the epidemiology of HAdV infections in Singapore, we studied 533 HAdV-positive clinical samples collected from 396 pediatric and 137 adult patients in Singapore from 2012 to 2018. Genome sequencing and phylogenetic analyses were performed to identify HAdV genotypes, clonal clusters, and recombinant or novel HAdVs. Results The most prevalent genotypes identified were HAdV-B3 (35.6%), HAdV-B7 (15.4%), and HAdV-E4 (15.2%). We detected 4 new HAdV-C strains and detected incursions with HAdV-B7 (odds ratio [OR], 14.6; 95% confidence interval [CI], 4.1–52.0) and HAdV-E4 (OR, 13.6; 95% CI, 3.9–46.7) among pediatric patients over time. In addition, immunocompromised patients (adjusted OR [aOR], 11.4; 95% CI, 3.8–34.8) and patients infected with HAdV-C2 (aOR, 8.5; 95% CI, 1.5–48.0), HAdV-B7 (aOR, 3.7; 95% CI, 1.2–10.9), or HAdV-E4 (aOR, 3.2; 95% CI, 1.1–8.9) were at increased risk for severe disease. Conclusions Singapore would benefit from more frequent studies of clinical HAdV genotypes to identify patients at risk for severe disease and help guide the use of new antiviral therapies, such as brincidofovir, and potential administration of HAdV 4 and 7 vaccine., Human adenovirus (HAdV) outbreaks are often inexplicable with sparse clinical epidemiological data. We sought to describe clinical HAdV genotypes and identify risk factors associated with severe disease among HAdV-positive patients seen at 2 hospitals in Singapore.

Some clinical trialists, especially those working in rare or pediatric disease, have suggested borrowing information from similar but already-completed clinical trials. This paper begins with a case study in which relying solely on historical control information would have erroneously resulted in concluding a significant treatment effect. We then attempt to catalog situations where borrowing historical information may or may not be advisable using a series of carefully designed simulation studies. We use an MCMC-driven Bayesian hierarchical parametric survival modeling approach to analyze data from a sponsor’s colorectal cancer study. We also apply these same models to simulated data comparing the effective historical sample size, bias, 95% credible interval widths, and empirical coverage probabilities across the simulated cases. We find that even after accounting for variations in study design, baseline characteristics, and standard-of-care improvement, our approach consistently identifies Bayesianly significant differences between the historical and concurrent controls under a range of priors on the degree of historical data borrowing. Our simulation studies are far from exhaustive, but inform the design of future trials. When the historical and current controls are not dissimilar, Bayesian methods can still moderate borrowing to a more appropriate level by adjusting for important covariates and adopting sensible priors.

Brazilian purpuric fever is a febrile hemorrhagic pediatric disease caused by Haemophilus influenzae biogroup aegyptius , a bacterium which was formerly associated with only self-limited purulent conjunctivitis. Here, we present draft genomes of strains from five Brazilian purpuric fever cases and one conjunctivitis case.

Background We designed and initiated a pilot comparative effectiveness study for juvenile localized scleroderma (jLS), for which there is limited evidence on best therapy. We evaluated the process we used, in relation to the specific protocol and to the general task of identifying strategies for implementing studies in rare pediatric diseases. Methods This was a prospective, multi-center, observational cohort study of 50 jLS patients initiating treatment, designed and conducted by the jLS group of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) from 2012 to 2015. A series of virtual and physical meetings were held to design the study, standardize clinical assessments, generate and refine disease activity and damage measures, and monitor the study. Patients were initiated on one of three standardized methotrexate-based treatment regimens (consensus treatment plans, CTPs) and monitored for 1 year. An optional bio-banking sub-study was included. Results The target enrollment of 50 patients was achieved over 26 months at 10 sites, with patients enrolled into all CTPs. Enrolled patients were typical for jLS. Study eligibility criteria were found to perform well, capturing patients thought appropriate for treatment studies. Minor modifications to the eligibility criteria, primarily to facilitate recruitment for future studies, were discussed with consensus agreement reached on them by the jLS group. There were marked differences in site preferences for specific CTPs, with half the sites treating all their patients with the same CTP. Most patients (88%) completed the study, and 68% participated in the bio-banking substudy. Conclusions We demonstrate the feasibility of our approach for conducting comparative effectiveness research in a rare pediatric disease. Multi-center collaboration by dedicated investigators who met regularly was a key factor in the success of this project. Other factors that facilitate these studies include having a sufficient number of investigators to enroll in each regimen, and streamlining study approval and management.

Billions of microorganisms, or “microbiota”, inhabit the gut and affect its homeostasis, influencing, and sometimes causing if altered, a multitude of diseases. The genomes of the microbes that form the gut ecosystem should be summed to the human genome to form the hologenome due to their influence on human physiology; hence the term “microbiome” is commonly used to refer to the genetic make-up and gene−gene interactions of microbes. This review attempts to provide insight into this recently discovered vital organ of the human body, which has yet to be fully explored. We herein discuss the rhythm and shaping of the microbiome at birth and during the first years leading up to adolescence. Furthermore, important issues to consider for conducting a reliable microbiome study including study design, inclusion/exclusion criteria, sample collection, storage, and variability of different sampling methods as well as the basic terminology of molecular approaches, data analysis, and clinical interpretation of results are addressed. This basic knowledge aims to provide the pediatricians with a key tool to avoid data dispersion and pitfalls during child microbiota study.

Intravenous fluid administration has been occurring for well over one hundred years for a variety of pediatric disease processes. Surprisingly, clinicians have yet to agree upon a standardized intravenous solution. There is ongoing debate regarding the administration of isotonic versus hypotonic fluids as maintenance solutions. In this article, we will review what is known about different maintenance solutions, discuss the potential complications with their use, and summarize the available evidence to help guide clinicians in their choice of maintenance fluids for their patients.

OSA occurs in approximately 1% to 5% of children in the United States. Long-term cardiovascular risks associated with OSA in the adult population are well documented. Although changes in BP regulation occur in children with OSA, the pathways leading to chronic cardiovascular risks of OSA in children are less clear. Risk factors associated with cardiovascular disease in adult populations could carry the same future risk for children. It is imperative to determine whether known mechanisms of cardiovascular diseases in adults are like those that lead to pediatric disease. Early pathophysiologic changes may lead to a lifetime burden of cardiovascular disease and early mortality. With this perspective in mind, our review discusses pathways leading to cardiovascular pathology in children with OSA and provides a comprehensive overview of recent research findings related to cardiovascular sequelae in the pediatric population.

Prader-Willi syndrome (PWS) is a rare disease associated with cognitive impairment, hypotonia, hyperphagia (an insatiable hunger), and obesity. Therapies that target hyperphagia are in development, but understanding the value of these therapies to inform patient-focused drug development (PFDD) requires valid data on disease burden. We estimated disease burden by measuring and comparing quality-adjusted life-years (QALYs) for 3 PWS health states relevant to current PFDD initiatives.Time trade-off (TTO) and a visual analog scale (VAS) were used to elicit PWS caregivers' values for 3 fixed health states for a standardized patient described with (1) untreated PWS, (2) PWS with controlled obesity, and (3) PWS with controlled obesity and hyperphagia. We excluded participants who left at least 1 TTO or VAS question blank or incomplete (noncompleters) and respondents who reported the same answer for all TTO scenarios (nontraders). The remaining group of respondents (traders) were used for all primary analyses. We assessed validity and bias of QALY estimates by comparing differences in health state valuations, treatment priorities, and characteristics among respondents who did and did not complete the TTO.A total of 458 respondents completed the survey, including 226 traders, 93 nontraders, and 139 noncompleters. Traders valued untreated PWS at 0.69 QALYs, PWS with controlled obesity at 0.79 QALYs, and controlled hyperphagia/obesity at 0.91 QALY (P0.01 for differences among health state values). Reported VAS ratings were similar for traders versus nontraders for untreated PWS (38.64 vs 38.95, P = 0.89) and PWS with controlled obesity (57.36 vs 55.14, P = 0.35) but varied for PWS with controlled obesity and hyperphagia (70.70 vs 64.46, P = 0.02). Exclusion of noncompleters did not introduce obvious bias because traders and noncompleters were similar in treatment priorities and characteristics. The exclusion of nontraders did not meaningfully alter mean or distribution of valuations.This study found that avoiding hyperphagia decreases the burden of PWS and that these results are robust, even once imposing strict inclusion criteria. Use of fixed health states to estimate QALYs addresses many of the complexities of measuring disease burden in rare and pediatric conditions, indicating the potential value of this approach to inform premarket decision makers in identifying outcome importance.

Diffuse intrinsic pontine gliomas (DIPGs) are invariably fatal tumors found in the pons of elementary school aged children. These tumors are grade II-IV gliomas, with a median survival of less than 1 year from diagnosis when treated with standard of care (SOC) therapy. Nanotechnology may offer therapeutic options for the treatment of DIPGs. Multiple nanoparticle formulations are currently being investigated for the treatment of DIPGs. Nanoparticles based upon stable elements, polymer nanoparticles, and organic nanoparticles are under development for the treatment of brain tumors, including DIPGs. Targeting of nanoparticles is now possible as delivery techniques that address the difficulty in crossing the blood brain barrier (BBB) are developed. Theranostic nanoparticles, a combination of therapeutics and diagnostic nanoparticles, improve imaging of the cancerous tissue while delivering therapy to the local region. However, additional time and attention should be directed to developing a nanoparticle delivery system for treatment of the uniformly fatal pediatric disease of DIPG.

Remarkable advances in the management of individuals born with cystic fibrosis (CF) would not have been realized without empiric trial and error by CF clinicians with treatments developed and available for other purposes. As the testing and registration of CF-specific treatments have increased, so too have associated health care costs, particularly those of chronic medications. The transition of CF from a lethal pediatric disease to a life-shortening one with an adult majority, concurrent with sharp increases in chronic medication costs, has placed many CF treatments under increased scrutiny by third-party payers, particularly when prescribed to individuals from CF subpopulations that may not have been included in registration trials. Despite overall health improvements in the CF cohort and the increasing availability of CF-specific therapies, many physicians remain tasked with managing the health of patients from subpopulations that may be too young, too sick, or too complicated to have been included in clinical trials. An understanding of why particular CF subpopulations may have been excluded from registration trials, as well as consideration of a treatment's described mechanism of action, can support assessment for the potential for benefit (and risk) in these populations and help physicians advocate for patient access to treatments.

There has been a recent expansion of preclinical models to predict the efficacy of regimens to treat adults with tuberculosis. Despite increasing global interest in childhood tuberculosis, these same tools have not been employed to develop pediatric regimens. Children differ from adults in bacillary burden, spectrum of disease, the metabolism and distribution of antituberculosis drugs, and the toxicity experienced. The studies documented in this series describe a proof-of-concept approach to pediatric regimen development. We propose a program of investigation that would take this forward into a systematic and comprehensive method to find optimal drug combinations to use in children, ideal exposures, and required dosing. Although the number of possible drug combinations is extensive, a series of principles could be employed to select likely effective regimens. Regimens should avoid drugs with overlapping toxicity or linked mechanisms of resistance and should aim to include drugs with different mechanisms of action and ones that are able to target different subpopulations of mycobacteria. Finally drugs should penetrate into body sites necessary for treating pediatric disease. At an early stage, this body of work would need to engage with regulatory agencies and bodies that formulate guidelines, so that once regimens and dosages are identified, translation into clinical studies and clinical practice can be rapid. The development of child-friendly drug formulations would need to be carried out in parallel so that pharmacokinetic studies can be undertaken as formulations are created. Significant research and development would be required and a wide range of stakeholders would need to be engaged. The time is right to consider a more thoughtful and systematic approach toward identifying, testing, and comparing combinations of drugs for children with tuberculosis.

MR imaging plays an important role in the detection and characterization of several pediatric disease entities that can occur in the emergent setting because of its cross-sectional imaging capability, lack of ionizing radiation exposure, and superior soft tissue contrast. In the age of as low as reasonably achievable, these advantages have made MR imaging an increasingly preferred modality for diagnostic evaluations even in time-sensitive settings. In this article, the authors discuss the current indications, techniques, and clinical applications of MR imaging in the evaluation of pediatric emergencies.

Pharmacogenomic (PGx) information is increasingly being incorporated into US Food and Drug Administration-approved drug labels. We reviewed the data source (adults vs. pediatrics) of PGx information in approved drug labels and assessed the suitability of applying adult-derived PGx information and related prescribing recommendations to the care of pediatric patients. We identified 65 drugs with labels containing PGx information and that have also been evaluated in children and found that in the majority of cases (56/65, 86%), the PGx information described was derived from adult studies. The application of PGx information from adults to pediatrics was deemed suitable for 71.4% (n = 40) of the drugs and unclear for 28.6% (n = 16). An ontogeny effect, limited or conflicting data regarding ontogeny of the genetic biomarker, or a difference in the pathophysiology or progression of the adult vs. pediatric disease were the primary reasons for deeming direct application from adults to pediatrics unclear.

A factitious disorder (FD) is a diagnostic entity in which patients intentionally act physically or mentally ill without obvious benefits and without being consciously aware of a clear underlying motive. Most pediatric FD cases have been reported as Munchausen syndrome by Proxy; however, pediatric disease symptoms can also be intentionally falsified by child and adolescent patients. To our knowledge, in the medical literature, an FD patient presenting with stuttering has not been previously reported. In this case report, we aimed to discuss the diagnosis and treatment process of FDs in children and adolescents by reporting the cases of two FD patients presenting with stuttering according to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition. Both patients improved with psychoeducation and early confrontation.

The authors present clinical and angiographic findings in a 12-year-old girl with achondroplasia who presented with bilateral retinal peripheral nonperfusion and unilateral rhegmatogenous retinal detachment, which has not been previously described in achondroplasia. This report contributes incremental knowledge regarding aberrant retinal vascular phenomena observed in pediatric disease states and implicates the possible role of mutations in the FGFR3 gene in peripheral vascular abnormalities. [ Ophthalmic Surg Lasers Imaging Retina. 2017;48:272–274. ]

7503 Background: Characteristics such as disease, disease status and cytogenetic abnormalities impact relapse and survival after transplantation for acute myeloid (AML) and acute lymphoblastic (ALL) leukemia. In adults, these attributes were used to derive the disease risk index for survival. Thus, the current analysis sought to develop and validate a pediatric disease risk index (p-DRI). Methods: Eligible were patients aged

Although appendicitis remains a common pediatric disease, making the diagnosis may be difficult. Obtaining a thorough history and physical exam remains of the utmost importance in determining whether a patient has appendicitis. The use of clinical scoring systems can improve the predictive value of our clinical assessment and aid in making the correct diagnosis. This chapter will discuss the approach to clinical diagnosis and the current scoring systems commonly used.

Typical hemolytic uremic syndrome (HUS) in adults is an uncommon clinical occurrence and has been rarely reported in the literature. Typical HUS is mainly caused by Shiga toxin-producing Escherichia coli (STEC) and is typically a pediatric disease. Worldwide outbreaks have been reported, one of the largest and most recent being in Germany. We are reporting a case of a 55-year-old male who presented with acute diarrhea. His laboratory parameters were suggestive of HUS and molecular testing was positive for STEC in stools. The patient received supportive therapy, and he recovered clinically with an improvement in his laboratory parameters. We hereby highlight the importance of timely diagnosis of typical HUS in guiding management and avoiding unnecessary testing and treatment. The mainstay of therapy is aggressive and prompt intravenous hydration to help alleviate the acute kidney injury and improve the clinical outcomes.

Background CLN6-Batten disease is a rare neurodevelopmental disorder characterized pathologically by the accumulation of lysosomal storage material, glial activation and neurodegeneration, and phenotypically by loss of vision, motor coordination, and cognitive ability, with premature death occurring in the second decade of life. In this study, we investigate whether sex differences in a mouse model of CLN6-Batten disease impact disease onset and progression. Results A number of noteworthy differences were observed including elevated accumulation of mitochondrial ATP synthase subunit C in the thalamus and cortex of female Cln6 mutant mice at 2 months of age. Moreover, female mutant mice showed more severe behavioral deficits. Beginning at 9 months of age, female mice demonstrated learning and memory deficits and suffered a more severe decline in motor coordination. Further, compared to their male counterparts, female animals succumbed to the disease at a slightly younger age, indicating an accelerated disease progression. Conversely, males showed a marked increase in microglial activation at 6 months of age in the cortex relative to females. Conclusions Thus, as female Cln6 mutant mice exhibit cellular and behavioral deficits that precede similar pathologies in male mutant mice, our findings suggest the need for consideration of sex-based differences in CLN6 disease progression during development of preclinical and clinical studies. Electronic supplementary material The online version of this article (10.1186/s13023-019-0994-8) contains supplementary material, which is available to authorized users.

Different tacrolimus (TAC) population pharmacokinetic (PPK) models have been established in various pediatric disease populations. However, a TAC PPK model for pediatric refractory nephrotic syndrome (PRNS) has not been well characterized. The current study aimed to establish a TAC PPK model in Chinese PRNS and provide a summary of previous literature concerning TAC PPK models in different pediatric diseases. A total of 147 TAC conventional therapeutic drug monitoring (TDM) data from multiple blood samples obtained from 65 Chinese patients with PRNS were characterized using nonlinear mixed-effects modeling. The impacts of demographic features, biological characteristics and drug combination were evaluated. Model validation was assessed using the bootstrap method. A one-compartment model with first-order absorption and elimination was determined to be the most suitable model for TDM data in PRNS. The absorption rate constant (Ka) was set at 4.48 h-1. The typical values of apparent oral clearance (CL/F) and apparent volume of distribution (V/F) in the final model were 5.46 l/h and 57.1 l, respectively. The inter-individual variability of CL/F and V/F were 22.2 and 0.2%, respectively. The PPK equation for TAC was: CL/F = 5.46 × exponential function (EXP)(0.0323 × age) × EXP(-0.359 × cystatin-C) × EXP(0.148 × daily dose of TAC). No significant effects of covariates on V/F were observed. In conclusion, the current study developed and validated the first TAC PPK model for patients with PRNS. The study also provided a summary of previous literature concerning other TAC PPK models in different pediatric diseases.

Objectives : This research aimed to analyze studies on pediatric disease treated by kampo drug, kind of kampo drug used in children, treatment period, and the result of kampo drug treatment for children in Japan. Methods : We got 263 search result with searching word `kampo medicine` and `小兒`, `children`, `乳兒` in J-stage. We selected 34 articles among them which were related to objective of research to analyze studies by type of pediatric disease treated with kampo drug, kinds of kampo drug for each disease, treatment period and result of kampo drug treatment for children. We considered frequency of kampo drug use & pediatric disease treated with kampo drug and significance of research. Results : According to analyzed results, respiratory diseases are the most frequent diseases that are healed by kampo drug. Next sequenced diseases are skin disease. In Kind of kampo drug for pediatric disease. Goreisan and Shosaikoto (柴胡桂枝湯), Shokenchuto (小建中湯) are used frequently. Also, various disease treated with kampo drug were improved. Conclusions : Japanese Doctors consider the Kampo drug is safe and has a lot of merit compared to modern medication. Especially for symptom with unknown origin & immune diseases such as upper respiratory tract infections. Referring to clinical cases of kampo drug in Japan, we will use kampo drug for various pediatric diseases in future.

T helper (Th) cell cytokines modulate inflammation and play a role in biliary atresia (BA). The aim of the study is a cross-sectional assessment of the levels of Th cytokines in the jaundice-free post Kasai procedure patients.There were 40 jaundice-free patients with BA and 28 normal controls enrolled. Patients were divided into 3 groups, including normal liver function, impaired liver function, and portal hypertension. Plasma concentration of Th1 [interferon-γ (INF-γ), interleukin (IL)-2], Th2 (IL-4, IL-10), Th3 [transforming growth factor-β1 (TGF-β1)], Th17 (IL-17) cytokines, and stromal cell-derived factor-1α (SDF-1α) were investigated.The IFN-γ level was significantly higher in the BA patients with impaired liver function and portal hypertension than controls (P0.0001 and P0.0001, respectively). There was a significantly increase of TGF-ß1 in all BA groups compared with controls (P=0.003). The reduction of SDF-1α expression was found in BA groups (P0.0001). IL-10 levels significantly correlated with aspartate aminotransferase to platelet ratio index (r=0.496, P=0.001). For the cytokine correlations, there were no correlations of Th1, Th2 and Th17 cytokine with the other measured cytokines, but TGF-ß1 was negatively correlated with SDF-1α levels (r=-0.327, P=0.039).IFN-γ and IL-10 are likely to be involved in the disease progression in BA. Besides, TGF-β1 is found to be a suppression marker associated with SDF-1α levels and reduced production of TGF-β1 may be associated with the disease progression.

Nasopharyngeal carcinoma (NPC) is a rare malignancy of epidermoid origin, one that is especially uncommon in children in low risk areas such as the United States. The relative rarity in children makes the diagnosis of this malignancy difficult, and therefore childhood nasopharyngeal carcinoma is associated with advanced locoregional disease and higher prevalence of distant metastasis. A case of pediatric nasopharyngeal carcinoma is described here to highlight a possible presentation of this uncommon pediatric disease and reasons for delayed diagnosis. This is followed by a brief discussion of epidemiology, diagnosis, treatment, and outcomes for this malignancy in children.

Celiac disease, once deemed to be primarily a pediatric disease, is accepted nowadays as a lifelong disease that increasingly affects the elderly. In older patients it is late and underdiagnosed, it is hypo- or asymptomatic and case finding strategy is recommended. Gluten restrictive therapy is problematic but manageable and beneficial, improving symptoms, serology, histology and preventing complications. Increased knowledge and awareness on CD in the third age and a comprehensive, multidisciplinary and holistic approach will improve their outcome.

Eighty-five percent of the world’s children live in areas of limited resources. The poorest continent, Africa, accounts for 23% of pediatric disease but only employs 1.3% of the world’s health workers. Pediatric neuro-oncology requires highly specialized teams, and in countries where there are inadequate resources for even the most common diseases, such as infections, malnutrition, and HIV-related disease, it is understandable that children with central nervous system (CNS) tumors are not a priority.

Childhood is a critical time to develop hopeful thinking that can help children cope with challenges in general and those related to maintaining or improving their health. The purpose of this chapter is to (a) define hope as it applies to children and the growth of hope across developmental stages; (b) describe the way family members, teachers, and other significant adults can foster hope in children; (c) review studies on the relationship between hope and pediatric health and illness, including studies on health promotion, adherence to chronic pediatric diseases, and coping with a chronic pediatric disease; and (d) share knowledge related to patients with chronic pediatric diseases and how they maintain hope given the additional challenges they face in their lives.

There is a growing threat in the re-emergence of diseases that impact pediatric demographics. While major strides have been made in the field of childhood cancers, there are still more questions than answers. In addition, public resistance to recommended practices related to childhood vaccinations fueled by misinformation has allowed infectious diseases to resurface in developed nations. Meanwhile, climate change and other destabilizing factors are shifting vector populations and driving the emergence of new diseases. Herein we call upon the community of human health researchers to confront the evolving specter of pediatric disease.

There is a significant number of children around the world suffering from the consequence of the misdiagnosis and ineffective treatment for various diseases. To facilitate the precision medicine in pediatrics, a database namely the Pediatric Disease Annotations & Medicines (PedAM) has been built to standardize and classify pediatric diseases. The PedAM integrates both biomedical resources and clinical data from Electronic Medical Records to support the development of computational tools, by which enables robust data analysis and integration. It also uses disease-manifestation (D-M) integrated from existing biomedical ontologies as prior knowledge to automatically recognize text-mined, D-M-specific syntactic patterns from 774 514 full-text articles and 8 848 796 abstracts in MEDLINE. Additionally, disease connections based on phenotypes or genes can be visualized on the web page of PedAM. Currently, the PedAM contains standardized 8528 pediatric disease terms (4542 unique disease concepts and 3986 synonyms) with eight annotation fields for each disease, including definition synonyms, gene, symptom, cross-reference (Xref), human phenotypes and its corresponding phenotypes in the mouse. The database PedAM is freely accessible at http://www.unimd.org/pedam/.

Purpose of review Contact dermatitis is an economically burdensome pediatric disease, and it is important to know the top allergens that have remained as top offenders for over the last decade. Recent findings A comparative analysis of the 20-allergen screen was done against the current top 40 pediatric allergens, and it revealed that the 20-allergen screening series would have theoretically only captured 47.5% of the relevant contact allergens (52.5% failure to detect rate). In addition, the T.R.U.E. Test (SmartPractice, Phoenix, Arizona, USA) would have revealed 60% of the top 40 allergens (40% failure to detect rate). Summary Patch testing in children has become a more common practice, and management requires the identification and avoidance of the offending allergen from the sensitized person's environment.

Low levels of the survival of motor neuron (SMN) protein cause the neurodegenerative disease spinal muscular atrophy (SMA). SMA is a pediatric disease characterized by spinal motor neuron degeneration. SMA exhibits several levels of severity ranging from early antenatal fatality to only mild muscular weakness, and disease prognosis is related directly to the amount of functional SMN protein that a patient is able to express. Current therapies are being developed to increase the production of functional SMN protein; however, understanding the effect that natural stresses have on the production and function of SMN is of critical importance to ensuring that these therapies will have the greatest possible effect for patients. Research has shown that SMN, both on the mRNA and protein level, is highly affected by cellular stress. In this review we will summarize the research that highlights the roles of SMN in the disease process and the response of SMN to various environmental stresses.

To use novel geographic methods and large-scale claims data to identify the local distribution of pediatric chronic diseases in New York City.Using a 2009 all-payer emergency claims database, we identified the proportion of unique children aged 0 to 17 with diagnosis codes for specific medical and psychiatric conditions. As a proof of concept, we compared these prevalence estimates to traditional health surveys and registry data using the most geographically granular data available. In addition, we used home addresses to map local variation in pediatric disease burden.We identified 549,547 New York City children who visited an emergency department at least once in 2009. Though our sample included more publicly insured and uninsured children, we found moderate to strong correlations of prevalence estimates when compared to health surveys and registry data at prespecified geographic levels. Strongest correlations were found for asthma and mental health conditions by county among younger children (0.88, P = .05 and 0.99, P .01, respectively). Moderate correlations by neighborhood were identified for obesity and cancer (0.53 and 0.54, P .01). Among adolescents, correlations by health districts were strong for obesity (0.95, P = .05), and depression estimates had a nonsignificant, but strong negative correlation with suicide attempts (-0.88, P = .12). Using SaTScan, we also identified local hot spots of pediatric chronic disease.For conditions easily identified in claims data, emergency department surveillance may help estimate pediatric chronic disease prevalence with higher geographic resolution. More studies are needed to investigate limitations of these methods and assess reliability of local disease estimates.

Asthma is the most common pediatric disease in the USA. It has been consistently demonstrated that asthma symptoms are exacerbated by exposure to ozone. Ozone (O3) is a secondary pollutant produced when volatile organic compounds (VOCs) are oxidized in the atmosphere in the presence of nitrogen oxides (NOx). At ground level, elevated ozone is typically formed as a result of human activities. However, wildfires represent an additional source of ozone precursors. Recent evidence suggests that smoke can increase ozone concentrations. We estimated the number of excess asthma-related emergency department (ED) visits in children with asthma that may be attributed to elevated ozone associated with smoke (EOAS) in the USA. We conducted a quantitative burden assessment (BA) using a Monte Carlo approach to estimate the median number of excess pediatric asthma ED visits that may be attributed to EOAS among children with asthma in the continental USA between 2005 and 2014, as well as 95% confidence bounds (95% CB). We estimated that a median of 2403 (95% CB 235-5382) pediatric asthma ED visits could be attributed to EOAS exposure between 2005 and 2014 in the continental USA. Furthermore, the impact of EOAS on estimated asthma ED visits was greatest in the eastern half of the continental USA. We found a significant increase in pediatric asthma ED visits that may be attributed to exposure to EOAS. EOAS may have a measurable negative impact on children with asthma in the USA.

Typically considered a pediatric disease entity, the treatment of spondylolysis and spondylolisthesis in children and adolescent patients is different from that of adults due to the pathogenesis, skeletal size and immaturity, and mobility of the adjacent spinal segments. This article discusses the classification, natural history, presentation and physical exam findings, and imaging characteristics, as well as nonsurgical and common surgical treatments for low- and high-grade spondylolisthesis, in children and adolescents.

There is emerging interest in the ability of the intestinal microbiome—the collective genome of resident microbes—to impact host function. Given the dynamics of development, the pediatric microbiome is of particular importance as alteration of microbial communities (microbiota) early in life may deeply influence long-term health and disease. This review explores the current understanding of the establishment and evolution of the microbiome in early life. It then discusses the evidence for three key spheres of microbiome-mediated disease in pediatrics: inflammatory bowel disease, obesity and atopic disease. The role of microbiota-derived therapeutics is also examined through the lens of future care for children. Probiotics and fecal microbiota transplant, a novel therapy to restore the microbiome, are explored and the rationale for caution outlined for infants and children. Ultimately, there is potential for research born out of the field to alter our paradigm of pediatric disease and its treatment.

Myeloproliferative neoplasms are uncommon disorders in children, for which we have limited understanding of the pathogenesis and optimal management. JAK2 and MPL mutations, while common drivers of myeloproliferative neoplasms in adult patients, are not clearly linked to pediatric disease. Management and clinical outcomes in adults have been well delineated with defined recommendations for risk stratification and treatment. This is not the case for pediatric patients, for whom there is neither a standard approach to workup nor any consensus regarding management. This review will discuss thrombocytosis in children, including causes of thrombocytosis in children, the limited knowledge we have regarding pediatric primary thrombocytosis, and our thoughts on potential risk stratification and management, and future questions to be answered by laboratory research and collaborative clinical study.

Abdominal pain is a common symptom in individuals with cystic fibrosis (CF). As prognosis has improved, CF has changed from a pediatric disease to the current situation wherein most people with CF are adults. With improved survival, the spectrum of pathologies causing abdominal pain in CF has shifted. Despite this, there have been relatively few previous publications focusing on gastrointestinal disease in CF adults. The aim of this review was to examine the characteristics, differential diagnosis, investigation, and optimal management of adults with CF presenting with abdominal pain.

Ipsen will acquire the Montreal-based rare-disease specialist Clementia Pharmaceuticals in a deal valued at up to $1.3 billion. The deal will net the French drugmaker palovarotene, which it expects...

Associate professor, Department of the periodentology, Dental material research center and Implant, Dental School, Babol University of Medical Sciences, Babol, Iran Assistant professor, Department of the periodontology, Dental material research center and Implant, Dental School, Babol University of Medical Sciences, Babol, Iran Dentist, Amol, Iran Physician, Department of Non-communicable Pediatric Disease Research Center, School of Dentistry, Babol University of Medical Sciences, Babol, Iran Undergraduate student, Department of the periodontology, Dental material research center, Babol University of Medical Sciences, Babol, Iran

CAM therapies have become increasingly popular in pediatric populations. phytotherapy are the most common CAM used in children. Yet, little is known about children’s preferences for CAM. But It is expected to become more widely integrated into the modern medical system, including the medical curriculum.The aim of this study is to introduce the prevalence and characteristics of CAM use in Pediatrics disease. Further research is warranted to examine the safety and effectiveness of this popular non-allopathic approach to children’s health.

The application of existing optical coherence tomography (OCT) technology to the pediatric population is limited in both the design specification of the device and its hardware. However, the potential of OCT in the pediatric population has not been fully realized. The authors review the literature, highlighting the currently available spectral-domain OCT technology and summarizing the reported normal pediatric OCT parameters for retinal nerve fiber layer and macular thickness. They also review the pediatric ophthalmological conditions in which OCT has been used and discuss advancements in OCT design and their potential applications to the pediatric population. The use of OCT in pediatric populations is likely to increase greatly in the coming years, aiding clinical decision-making and providing new insights into pediatric disease pathophysiology.

Role of zinc in human health including growth, development, immune status and acute diarrhea is indisputable. Zinc deficiency is well known because of poor dietary habits, increased secretion and poor absorption of zinc during diarrhea. Present review will demonstrate role of zinc in various pediatric disorders and newer update. We have tried to include recent review on role of zinc in childhood diseases as per evidences available on electronic databases.

In this paper, we present a clinically pediatric disease prediction system based on a new efficient hybrid knowledge graph. Firstly, we automatically extract a set of triples by modeling and analyzing 1454 clinically pediatric cases, building a weighted knowledge graph based Naive Bayes. Secondly, to extract new prediction opportunities from heterogeneous data sources, we model and analyze both classically professional pediatrics textbooks and clinical experiences of pediatric doctors respectively in order to derive prediction rules. Thirdly, we mix up those rules with the weighted knowledge graph we built to propose a new hybrid knowledge graph which can carry on both the Bayesian reasoning and the logic calculation at the same time. Fourthly, in term of that hybrid knowledge graph, we further design a new multi-label classifier based on the well-known Bayesian Ranking for the disease prediction. Finally, we implement such a hybrid knowledge graph based disease pediatric prediction system (HKDP) which uses the descriptions of the patients’ symptoms as the inputs so as to return the predicted candidates of diseases for a child. In our experiments, the comparisons with classical prediction methods prove the validity and advantage of our system, especially guaranteeing good balance between the interpretability and precision of predictions in HKDP.