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Jun 2026 DOI 10.14302/issn.2766-8681.jcsr-26-6296
Background Acute diarrhea is the major cause of health public problem among paediatric patients in Tanzania. And in Low income countries (LICs), studies have shown, Acute watery Diarrhea (AWD) is the cause of morbidity and mortality which can be prevented by immediate identification and treatment of complications. Methods A prospective cohort study was done between December 2021 and April 2022 to determine the risks, complications, management strategies and predictors of mortality among paediatric patients ≤12 years of age with severe diarrhea. We excluded those who arrived in cardiac arrest at the Emergency Medicine Department (EMD) of Muhimbili National Hospital (MNH). Proportion was used to summarize the counts and frequency of participants who were at risk of complications and management strategies given and for predictors of outcomes. A Modified Poisson log linear model with a robust estimation test was used to test for significant associations between predictors and outcomes. Multivariate logistic regression was used to adjust for confounders. Results A total 6,570 paediatric patients presented to EMD during study period, and we recruited 144 (2.2%). The median age was 1 (IQR 0.7-2.0) years and most were male 86 (59.7%). Among the study participants with diarrhea, 120 (83.3%) had dehydration, acidosis 60 (42.3%), hypoglycemia 8 (5.6%), hypokalemia 76 (53.1%), and Acute renal failure 11 (7.6%). Those patients with complications received appropriate management, including IV crystalloid solution given to 131 (90.97%), and correction of acidosis 60 (42.3%), hypoglycemia correction with IV dextrose 10% 6 (4.2%), and hypokalemia and infections were corrected with IV potassium chloride 52 (36.1%) and IV antibiotic treatment 84 (58.3%) respectively. Conclusion Pediatric patients under 2 years of age are at high risk of severe diarrhea with dehydration as compared to other ages. Early referral and availability of point care tests are essential in early recognition of accompanied complications.
Jun 2024
Multiple Sclerosis has traditionally been considered an inflammatory and autoimmune disease of the central nervous system. However, peripheral cranial nerve involvement has been described previously in eight cases, raising the hypothesis of a disease spectrum between central and peripheral nervous system. We hereby present a case of a 12 years old girl diagnosed with Multiple Sclerosis who presents with complete unilateral third cranial nerve palsy. Complete clinical, laboratory and radiological work-up was consistent with demyelinating disease. We conclude that demyelination in Multiple Sclerosis can affect in some cases both the central and peripheral nervous system.
Apr 2023 DOI 10.14302/issn.2694-1201.jsn-23-4385
Background Traumatic brain injury in pediatrics is one of the commonest causes of morbidity, disability and mortality worldwide. In low- and middle-income countries Study showed that death of pediatrics from traumatic brain injury was 7.3%. However, there is limited data towards the outcome of traumatic brain injury and its associated factors in Ethiopia. Objective To assess the outcome of traumatic brain injury and associated factors among pediatrics patients in Amhara National Regional State Comprehensive Specialized Hospitals, Ethiopia. Methods An institution based retrospective cross-sectional study was conducted among 423 pediatrics patients from January 1, 2019 to December 30, 2021, and data extraction period was from May 16 to June15, 2022. Systematic random sampling technique was employed to select the study participants. Data were collected from patient charts and registry books by using a data extraction tool. Data were entered into the Epi-info version 7 and analysis was done by SPSS Version 25. Both Bi-variable and multi-variable analyses were employed to identify factors associated with outcome of traumatic brain injury. Result From 423 sampled study participant charts 404 of them had complete information with response rate of 95.5% and included in the final analysis. The overall unfavorable outcome of traumatic brain injury at discharge was found that 12.13% (95% CI: 9.1% - 15.7 %). Sever traumatic brain injury (AOR: 5.11(CI :1.8-14.48), moderate traumatic brain injury (AOR:2.44(CI:1.07-5.58), Hyperglycemia (AOR: 3.01 (CI:1.1-8.04), sign of increased intracranial pressure (AOR:7.4(CI:3.5-15.26), and medical comorbidity (AOR: 2.65(CI:1.19-5.91) were predicted of unfavorable outcome of traumatic brain injury pediatrics patient. Conclusion and recommendations twelve present of traumatic brain injury results unfavorable outcome. Sever and moderate form of traumatic brain injury, hyperglycemia, signs of increased intracranial pressure, and medical comorbidity were factors associated with unfavorable outcome of traumatic brain injury in children. Therefore, it is preferable to improve accesses to acute and post-acute care services to lower the unfavorable outcome of traumatic brain injury in children.
Dec 2022 DOI 10.14302/issn.2641-4538.jphi-22-4369
An opinion revisits definitions of success in pediatric Hodgkin lymphoma, balancing survival metrics with late effects and quality of life to inform patient‑centered care.
Nov 2021 DOI 10.14302/issn.2470-0436.jos-21-4003
This is a case of a pediatric patient who presented with a sudden onset of right abducens nerve palsy with contralateral hemiplegia with no facial paralysis. With the constellation of symptoms aided by the presence of enhancing pontine mass on magnetic resonance imaging, the presence of diffuse intrinsic pontine glioma (DIPG) was presumed to have caused the findings consistent with the common type of Raymond syndrome.
Oct 2021 DOI 10.14302/issn.2691-5014.jphn-21-3923
We report 2 cases of vitamin B12 deficiency in children due to deficient intake. These were 2 girls aged 4 years (case 1) and 6 years (case 2), respectively, hospitalized in December 2020 and March 2021 in the pediatric ward of Le Dantec hospital. Both patients presented with aregenative anemia, melanoderma and undernutrition. The bone marrow count in case 1 showed a dysmyelopoiesis with megablastosis. The blood vitamin B12 level was low in both cases. Folic acid blood levels were normal in both patients, but an associated martial deficiency was found in case 2. The dietary survey revealed a lack of intake of animal products rich in vitamin B12. Vitamin B12 replacement therapy was effective with rapid regression of all clinical signs observed in both children. The control of the vitamin B12 level after 1 month of treatment was normal in both patients. The disappearance of the symptoms under substitute treatment confirmed the deficiency of Vitamin B12 intake in both patients. Conclusion: Both of our patients had a profound Vitamin B12 deficiency in a context of deficiency in nutrition. The regression of the symptoms was spectacular under vitamin B12 replacement therapy, confirming the deficiency. We recommend in our context a contribution in micronutrients such as vitamins in children after weaning to avoid dietary errors.
Dec 2020 DOI 10.14302/issn.2470-5020.jnrt-20-3629
Introduction The extra dural hematoma is a blood collection between the cranial vault and the dura mater. It is a neurosurgical emergency whose statistical data are poorly known in the Republic of Benin. Objective The aims of this study are to assess epidemiology, therapeutic and outcome of traumatic extra dural hematomas for children admitted to the surgical department of CHUD-B/A from 2012 to 2017. Methods This was a cross-sectional, descriptive and retrospective study over a period from January 1st, 2012 to December 31st, 2017. Results One hundred and seventy-eight cases of children aged between 0-15 years were examined for brain traumatic injury. Twenty-seven 27 (15.2%) cases of extra dural hematomas were retained. The most represented age group was between 11-15 years with a frequency of 42.1%. The male sex was more represented (78.9%). Road traffic accidents were the main aetiology (57.9%). 52.6% had a mild head injury, 26.3% had a moderate head injury and 21.1% had a severe head injury. On brain scan the frequently observed location was temporo-parietal (31.6%). Acute anemia was observed in 16 children. Seventeen children were operated on. The operation involved evacuation of extra dural hematoma by cranial bone flap with suspension of the dura mater. There were no deaths. Conclusion The availability of brain CT makes the diagnosis of extra dural hematoma easier. Its management is neurosurgical with a favourable post-operative evolution in all cases in this series.
Nov 2020 DOI 10.14302/issn.2766-8630.jrnm-20-3288
Introduction Given the high radiation tissue sensitivity of pediatric patients, it is necessary to monitor their received dose in order to optimize radiation protection. The first aim of this study was to evaluate of the entrance surface dose (ESD) in pediatric patients undergoing chest x-ray at the main hospital of Dezful, Iran. The second aim was to compare our results with the established dose reference levels (DRL). Materials and Methods The studied population included 204 pediatric patients less than 15 year who were referred to chest x-ray. A calibrated dose area product meter (DAP-meter) with permanent installation on x-ray unit was used to radiation dose measurements. For each patient, the demographic data, exposure parameters and the dose read by DAP-meter were recorded and ESD was calculated using standard mathematical formula. Results The average value of ESD was 119 μGy in patients less than 15 years. This value was 51.3, 122.3, 131.5 and 171.2 μGy for the age groups less than 1 year, 1 to 5 year, 5 to 10 year and 10 to 15 year, respectively. A statistical significant difference was seen between ESD values in different age groups (P<0.001), whereas no statistical difference was seen between ESD values in girls and boys (P =0.993). Conclusion Pediatric patients in hospital investigated (except age group less than 1 year) are subjected to unnecessary radiation exposure, especially due to use of non-optimize x-ray protocols.
Feb 2020 DOI 10.14302/issn.2470-5020.jnrt-20-3226
Charcot Marie Tooth disease is a is a very chronic progressive hereditarymotor and sensory neuropathy characterized by progressive weakness andloss of touch sensation across various parts of the body. There are no curative or effective medical therapies that can ameliorate the disability associated with Charcot Marie Tooth disease. The aim of this paper is to describe the safe novel use of cerebrolysin in an Iraqi patient with Charcot Marie Tooth disease. Patients and Methods A boy who was born on the seventh of November, 2009, and was first seen on 29th of January, 2018 at the Children Teaching Hospital of Baghdad Medical City and had Charcot Marie Tooth disease was observed. He had difficulty in walking and abnormal gait that made him left first grade primary school. The nerve conduction study and electromyography study supported the clinical diagnosis of chronic symmetric sensori-motor polyneuropathy of moderated severity. The boy was treated with a safe novel therapy for one month. He receivedten doses of 3 ml intra-muscular cerebrolysin every three days. Results The short term effect of the therapy was dramatic with noticeable improvement that has never been reported before with this condition. Conclusion Further studies enrolling more patients are highly recommended.
Apr 2019 DOI 10.14302/issn.2688-5328.ijp-19-2717
Objective The current clinical case series assess the clinical outcome of the use of low-level laser in the treatment of painful pediatric fractures not solidly consolidated and re-modelled after casting for a standard of 4-6 weeks Materials and Methods The patient cohort consisted of 17 consecutive unselected patients in pediatric age group with delayed fracture consolidation and/or undesirable angulation despite casting for a standard period of 4-6 weeks in whom the parents refused any surgical intervention and/or bone grafting options. All subjects were referred from other medical centers after inadequate healing of the fracture ends upon repeating the x ray after the cast was off at the 4-6 weeks mark. Low-level laser therapy (LLLT) on alternate days for 8weeks in upper limb fracture cases, and 12 weeks in lower limb fracture cases were administered with a view of enhancing bone healing and/or re-modelling since both previous clinical and basic science studies on LLLT showed a stimulatory effect on fracture healing. Results All patients had solid union, mean time for union for upper and lower limb fractures were 6 and 10 weeks respectively. The calculated p value is statistically significant at p < 0.05. No patient defaulted follow up. All parents were satisfied with the clinical and radiological result of the LLLT treatment. Conclusion LLLT was found not only to enhance bone healing potential but in fact improved bone re-modelling when used in the proper wavelength and energy density in pediatric upper and lower limbs fractures, thereby also rapidly resolve the intolerable pain in paediatric fracture population
Dec 2018 DOI 10.14302/issn.2640-6403.jtrr-18-2442
Background: Lyell Syndrome (TEN, Toxic epidermal necrolysis) represents a medical emergency particularly in pediatric patients in whom the massive skin damage can quickly lead to multi-organ dysfunction and death. Prompt restoration of the physiologic mucosal/cutaneous barrier is mandatory. The use of amniotic membranes has been described in the treatment of ophthalmic Lyell Syndrome, but its use has not yet been adopted for the management of larger cutaneous wounds. Study Hypothesis: Here we report the use of amniotic membranes in a pediatric case of severe Lyell Syndrome with complete skin surface, ocular and mucosal involvement with life threating presentation. Methods: A 7-year old female was admitted to our Burn Centre for severe cutaneous/mucosal exfoliation (100% Total body surface area, TBSA) as a result of an adverse reaction to ibuprofen administration. Supportive fluid administration, cardiac-pulmonary assistance and pain management were complemented by serial grafting of amniotic membranes on all affected areas to provide coverage of the exfoliated skin/mucosa. Biopsies were obtained to monitor histological skin changes. Results: The patient showed an excellent response to amniotic membrane treatment, with rapid restoration of mucosal and cutaneous layers in the grafted areas. This resulted in a decreased need for dressing changes, avoidance of additional surgeries and a reduced dependence on supportive therapy. Lower pain levels than usually expected led to a reduced need for narcotic pain medications and allowed for early physical rehabilitation and a short hospital stay. Histology confirmed evidence of topical immune-modulation in treated areas (reduction of inflammatory infiltrate). Conclusion: As we tested in numerously TEN and burn pediatric injuries Amniotic membranes with their regenerative and immune-modulatory effects may represent an life saving treatment even in the worst cases of pediatric Lyell syndrome.
Nov 2018 DOI 10.14302/issn.2474-3585.jpmc-18-2359
Objective: This study aimed to assess the knowledge and attitude levels of pediatricians in terms of the pertussis vaccine. Materials and Methods: A survey study was carried out to evaluate the knowledge and attitude levels of pediatricians working in Istanbul in terms of the pertussis vaccine between May 1, 2015 and July 1, 2015. Results: A total of 104 pediatricians who comprised of 53 male and 51 female physicians, participated in this study. It was found that 35.6% of them at low-level, 51% at middle-level and 13.5% at a high-level of knowledge. The knowledge-level scores of the pediatricians who had children were significantly higher than those of pediatricians who had not a child on pertussis vaccine. Moreover, the knowledge-level scores of the specialist doctors in terms of the pertussis vaccine were significantly higher than those of the assistant doctors. It was significant that pediatricians who had children suffering from chronic diseases had greater knowledge-level scores in terms of the pertussis vaccine than those who had children without any disease. Conclusion: The knowledge and awareness of physicians in terms of the pertussis vaccine should be increased with in-service trainings, as the surveyors presented an insufficient knowledge level.
Jun 2018 DOI 10.14302/issn.2574-4518.jsdr-18-2071
Study Objectives: Narcolepsy diagnosis has been associated with a long lag time between the onset of the disorder and the diagnosis itself among patients with the disorder. This article reviews the childhood epidemiology of idiopathic narcolepsy, including its prevalence, subtypes, and disease progression. Methods: A literature review was conducted to include both published and unpublished data on pediatric narcolepsy. All English language articles were included through April, 2015. Results: Time from symptom onset to diagnosis for children is approximately three years. The prevalence of cataplexy appears to be lower in children compared to adults, suggesting a later onset of cataplexy. The presence of cataplexy, however, was unrelated to demographic factors and laboratory findings. Conclusion: There is a substantial lag-time between initial symptom presentation and diagnosis in children with narcolepsy. A less quintessential presentation of narcolepsy might occur in children relative to adults, making diagnosis more challenging. Continued improvements in narcolepsy education for both pediatricians and parents might facilitate earlier identification and diagnosis of the disease, thus leading to improved outcome.
Dec 2016 DOI 10.14302/issn.2474-3585.jpmc-16-1281
Objectives This study describes and compares the epidemiological criteria of children with diabetes from 2007 to 2014. Methods A prospective study conducted with 372 children with diabetes mellitus. An access program was used for data collection, and SPSS 17 was used to analyses the results. Results A total of 372 cases with diabetes were studied and were divided into three groups according age. The first age group was between one day and six years and comprised 128 (34.4%) patients. The second group aged 7- 12 years of age comprised 174 (46.7%) patients. The third group aged 13-18 years of age comprised 58 (15.59%) patients. The average age was 8.32 years. Females constituted 52 % (194 cases) of all cases. T1DM constituted 95.4%, equal to 355 patients, T2DM constituted 1.88%, equal to seven cases. Monogenic diabetes affected three patients or 0.79%, with one case of monogenic neonatal diabetes confirmed by genetic study, and two other cases suspected to be MODY. The highest incidence was observed in the autumn months, with 105 children affected, constituting 27.8 % cases. The year 2012 had the highest incidence rate, with 59 children and adolescents affected at an incidence rate of 25.48 / 100000.Al-Baha region had the highest number of cases constituting 37.7 % of cases. Diabetic ketoacidosis was the first presentation and constituted 44.2% of cases. Conclusion. Diabetes in children is increasing significantly in recent years, requiring more detailed analysis of its epidemiological factors to find out any significant correlations which may help in its prevention.
Oct 2015 DOI 10.14302/issn.2379-8572.joa-15-691
Background. Nasopharyngeal carcinoma (NPC) is a rare disease in the pediatric age group; it represents 1% of all pediatrics malignancies, however, it is the predominant malignancy arising in the nasopharynx in this age group. Although NPC is a chemo-radiosensitive disease yet, the optimal dose of radiotherapy and optimal timing of chemotherapy is still not standardized. Methods. This is a retrospective study including all the newly diagnosed pediatric NPC who were diagnosed and treated at the Children Cancer Hospital Egypt (CCHE) during the period from July 2007 to December 2012. All imaging studies (e.g., CT or MRI scans) were reviewed by a senior head and neck radiologist for proper staging and assessment of tumor response. Patients were staged according to AJCC staging system. Modified version of the Response Evaluation Criteria in Solid Tumor (RECIST) was used to assess response. Results. Twenty-six patients were diagnosed and received treatment as NPC in CCHE. Median age was 12 years (range 7.8-17 years). There was a male predominance. Eleven patients (42.3%) were stratified as stage 4, and 11 (42.3%) as stage 3. All patients received 3 cycles of neo-adjuvant chemotherapy followed by concurrent chemo-radiotherapy. IMRT was used to deliver radiotherapy in all patients. The overall response rate (CR and PR) to induction therapy was 73%, 19.3% had SD, while 7.7% had PD. By the end of the study, 18 patients (69.2%) were alive in CR, 5 patients (19.2%) had PD, and 3 patients (10%) lost for follow up. The Mean duration of follow up was 35 months, range 5-66 months. The 3 year OS and EFS and rates were 84.6% and 69.3 % respectively. OS for M0 was 91.3% and for M1 33.3% with statistical significance (p =0.032). Conclusion. Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy using IMRT lead to good clinical end results with limited toxicity. Metastatic disease at presentation was identified as the adverse prognostic factor.
Feb 2014 DOI 10.14302/issn.2372-6601.jhor-13-358
Acute lymphoblastic leukemia (ALL) is a rapid form of leukemia characterized by clonal proliferation and accumulation of immature hematopoietic stem cells of the lymphoid lineage in the bone marrow as well as peripheral blood. Chromosomal aberrations identified in childhood ALL have an important role in disease diagnosis, prognosis and management. We present the results of hematologic, immunophenotypic, cytogenetic, FISH and Multiplex RT-PCR analysis of a 6-year-old boy diagnosed with B-cell precursor Acute Lymphoblastic Leukemia (BCP- ALL). In this study, we identified a novel chromosomal translocation t(10;15)(q22;q22) by cytogenetic and FISH analysis. To the best of our knowledge, this is the first report of this novel chromosomal translocation in this subset of ALL and has not yet been reported elsewhere. This rearrangement may include certain cancer associated tumor suppressor gene(s) or genes involved in apoptosis and transcription regulation, which on loss of normal function may lead to leukaemogenesis.
Dec 2025 DOI 10.14302/issn.2574-4496.jtc-25-5497
Our study gathered information on the diagnosis, treatment, and long-term outcome in adult and pediatric Hispanic patients with Well Differentiated Thyroid Cancer. Methods We performed a retrospective review of the clinical and imaging nuclear medicine records of cases of WDTC evaluated and treated in the Nuclear Medicine CLINICc. Evaluation included the clinical PROFILE, histology, radioiodine (RAI) therapies and treatment response, long-term outcome and survival. The data was ASSESED using the 2015 ATA Risk level guidelines and recommendations. Results Three hundred eleven cases were reviewed, 81% females, 19% males, median age of 41 years. Eleven percent (34 patients) of the patients were in the pediatric group and 49% were between 16-45 years. The tumor histology was 60.5% Papillary, 28.2% Papillary-Follicular variant and 11.3% Follicular type. All patients had a total thyroidectomy. A total of 287 (92%) of the patients were treated with RAI. The median RAI dose was 128 mCi. Patients in the low risk group received a dose range of 25-105 mCi, 73 cases in the intermediate RISK group received 106-160mCi and 104 cases in the high-risk group received doses greater than 160 mCi. The overall median cumulative dose was 151 mCi (55-926 mCi). Annual follow up was done in all cases , WITH A median follow-up OF 5-10 years. Residual functioning tissue in the neck was found in 52% of the cases by US and/or RAI imaging. of those, 43% belonged to the low risk group, while 57% were in the intermediate and high-risk groupS. The mean treatment dose received by those with persistent functional thyroid tissue in the neck was 157 mCi. Recurrent disease was found in 15% of the patients, 85% of them belonged to the intermediate and high-risk GROUPS. Forty-seven percent of the patients with recurrent disease had residual disease. Conclusion We believe ablative and/or adjuvant RAI treatment early in the disease is important to decrease residual thyroid tissue and/or residual disease, and to improve disease-free survival. We recommend total thyroid surgery in all tumors above 1 cm, post-operative evaluation with RAI Whole Body (with 123-I or 131-I), planar and SPECT/CT imaging and RAI ablation to remnant tissue. Follow-up post treatment evaluation is also recommended.
Oct 2024 DOI 10.14302/issn.2691-5014.jphn-24-5310
Cystic neck masses are uncommon in children, and a minority of them are soft. Internal jugular vein phlebectasia (IJVP) is a rare cause of soft neck cysts. It presents usually as a unilateral soft neck mass of changing size. In most cases it is unilateral, right sided and predominantly in males. Imaging study modalities are diagnostic and helpful for observation and follow up. In the vast majority of cases, it decreases in size with time requiring only conservative treatment. However, surgery might be necessary in large or complicated phlebectasia. IJVP is underdiagnosed or misdiagnosed especially in pediatrics, with few cases documented in medical literature. To improve awareness of presentation and management-plan of this rare case, the authors present an extremely rare case of huge left internal jugular phlebectasia in a 14 year-old boy worsened and complicated over years of wait and see approach that needed surgical treatment.
Aug 2024
Ambulatory blood pressure monitoring is widely used in pediatric patients to identify hypertension and its complications. Previous studies correlating obesity and hypertension using ABPMs showed increasing blood pressure loads with increasing BMI. However, BMI percentiles are more reliable indicators of obesity in children. Our study aimed to describe the association between BMI percentiles and systolic and diastolic blood pressure load using ABPM in children and adolescents. Retrospective analysis of ABPMs (Welch Allyn) was performed on a total of 115 patients between 7 and 18 years of age who were referred for elevated BP without a diagnosis of hypertension at our institution from Jan 2011 to Oct 2013. Patients were divided into 4 groups based on BMI percentile: <94th percentile, 94–98th percentile, 98–99th percentile, and >99th percentile. Analysis between blood pressure loads and BMI percentiles revealed greater mean systolic and diastolic loads with increasing BMI percentiles, but the P value was not statistically significant. Analysis of the systolic loads between children from different racial backgrounds revealed higher values in African American children than in Hispanic and Caucasian children, but the P value was not statistically significant.
Apr 2024 DOI 10.14302/issn.2641-4538.jphi-24-5044
Objective To study changes of cell morphology in BALF in children with Mycoplasma pneumoniae pneumonia (MPP). Methods From December 2021 to May 2022, a group of 32 children diagnosed with Acute MPP and admitted for treatment in the Pediatrics Department and PICU of the First Affiliated Hospital of Xinxiang Medical University were selected for our study. These patients underwent bronchoalveolar lavage as part of their clinical assessment. For comparison, we included a control group comprising 10 children who were not infected but had bronchial foreign bodies. We investigated the cellular composition in the bronchoalveolar lavage fluid (BALF) using Wright-Giemsa staining and microscopic evaluation, aiming to understand the relationship between shifts in cell proportions and extra-pulmonary symptoms associated with MPP. Results In this study, a total of 42 cases were enrolled, with 32 cases in the study group and 10 cases in the control group. There were no statistically significant differences in gender, age, height, weight, and BMI between the two groups (p > 0.05). The study group exhibited significantly higher levels of neutrophil percentage (GRA%), CRP, D-dimer, and LDH in blood routine tests compared to the control group (p < 0.05). Furthermore, the proportions of neutrophils (%) and macrophages (%) in BALF were significantly higher in the study group compared to the control group (p< 0.05), while the proportion of lymphocytes (%) in BALF showed no statistically significant difference between the two groups (p> 0.05). Conclusion In the acute phase of MPP in children, BALF is predominantly composed of neutrophils. A lower proportion of lymphocytes in BALF is associated with a higher incidence of extra-pulmonary manifestations and longer hospitalization duration.
Feb 2023 DOI 10.14302/issn.2379-7835.ijn-23-4441
A practical review compares growth chart standards and references for pediatric monitoring after the COVID era. It advises on selection, interpretation, and equity considerations in diverse populations.
Oct 2022 DOI 10.14302/issn.2381-862X.jwrh-22-4228
Background Gender based violence (GBV) refers to any violence targeted at an individual or group on the basis of their gender. It could occur in different forms with several clinical manifestations. The authors have described several clinical manifestations of GBV in a tertiary health centre, knowledge of which would help in case identification and early clinical management. Methods Retrospective descriptive study of all clients seen at a gbv clinic over a sixteen months period.Data was obtained from case records and clinical presentations were entered into excel. Data analysis was done usingIBM SPSS Statistics for Windows, version 25. The results were presented in frequency tables and graphs Results Of 86 clients studied, 56(65.1%) were of pediatric age (< 18years) while 30(34.9%) were adults with a mean age of 18.33+11.64(range 1-64years).72(82.6%) belonged to the low social class. Physical abuse in the forms of battering, human bite, walking and sitting disturbances, hearing loss possibly from slapping or hitting and red eye possibly from trauma on the eye, constituted 37.6% of the clinical presentations. Other presentations were; sexual abuse in the form of forced sex which constituted 34.9%, while gynaecological / obstetrics presentations in the forms of bleeding per vagina, pregnancy due to forced sex and vaginal pain made up 13.9%. Emotional/psychological abuse was observed in all clients irrespective of their different presenting complaints. Conclusion While various forms of physical abuse were common, emotional abuse was present in all clients but masked probably due to prioritization of physical injuries. Therefore we recommend that all GBV survivors be screened for psycholocal abuse and psychotherapy given.
Apr 2020 DOI 10.14302/issn.2691-5014.jphn-20-3297
A concise overview synthesizes early knowledge on COVID‑19 in pediatrics, covering transmission, clinical spectrum, diagnostics, and prevention, and pointing to priorities for longitudinal study.
Mar 2019 DOI 10.14302/issn.2474-3585.jpmc-19-2655
Reverse Shapiro’s syndrome is described as unexplained hyperthermia coexisting with agenesis of the corpus callosum. Its pathophysiology dwells on the role of dopaminergic hypersensitivity caused by hypothalamic dysfunction. Until now, only 5 cases have been described in the literature as reverse Shapiro’s syndrome. We present a case of a 6-month-old girl who is now the sixth patient described in the literature. A 6-month-old female patient was admitted to the pediatrics unit for fever of unknown origin. Her fever occurred 2-3 times a day on average between 38°C and 39.5°C, and lasted for 1-2 hours. The fever was not diurnal, and antipyretics or staying in an air-conditioned room had no effect. She also had 2 convulsions during her hospital stay. Cranial magnetic resonance imaging (MRI) was requested owing to the patient’s convulsion history and retarded development. The cranial MRI showed diffuse hypoplasia of the corpus callosum in the midline sagittal T2-weighted image. T1-weighted imaging showed hypointensity due to delayed myelination of the genu of the corpus callosum (Figure 2, white arrow), which should normally appear hyperintense like the posterior limb of the internal capsule. Although dopamine agonists and serotonin agonists are recommended for the treatment, the rate of response to medical treatment is very low. Our patient did not benefit from cyproheptadine and methyl prednisolone.
Nov 2018
Intestinal malrotation is the incomplete rotation of the midgut during embryogenesis. The reported prevalence is 1 in 500 live births, however some studies report a prevalence as high as 1% of the population1, 2. Traditionally it is though as a disease of the pediatric population presenting as bilious emesis during the first year of life but can present with different symptoms even in adulthood. Presentation in older populations tends to be atypical, chronic abdominal pain, nausea and diarrhea being the most commonly reported symptoms 3. However, as these symptoms accompany almost all-gastrointestinal pathology it is difficult to determine if abnormalities of rotation and fixation of the intestine are the cause for the symptoms in a given patient given its relative rarity. It therefore is important to have a high index of suspicion in patients with non-specific gastrointestinal symptoms. We report laparoscopic management of a patient with abnormal rotation/fixation who was treated for many years as celiac disease (CD). Celiac disease is an immune mediated systemic disorder elicited by gluten in genetically susceptible individuals4. It can present as chronic abdominal pain, chronic diarrhea, failure to thrive, weight loss, stunted growth, distention and fatigue. His symptoms immediately resolved after surgery.
Feb 2018 DOI 10.14302/issn.2766-6204.jmpt-17-1913
The three most common elbow fractures classically reported in pediatric orthopedic literature are supracondylar (50–70%), lateral condylar (17–34%), and medial epicondylar fractures (10%). The mechanism of injury varies, but the most commonly described mechanism involves a fall on an outstretched hand with varus, valgus or rotational force or a combination thereof. The vectors of force and the degree of chondro-osseous development dictate the type of injury incurred. A review of the literature was conducted to see the most frequent injuries and complications.
Feb 2018 DOI 10.14302/issn.2639-1716.jn-18-1965
Lipomatous tumors are among the most common primary musculoskeletal neoplasms affecting both pediatric and adult patient populations. Patient age, tumor location, and imaging features all contribute to the differential diagnosis of musculoskeletal tumors. Tumors identified outside of common patient demographics or in unusual locations may lead to preoperative misdiagnosis. We present an uncommon adipocytic tumor occurring at an uncommon age which was proven at surgery to represent a preoperatively unexpected diagnosis. A 13 year old male presented with a fatty anterior proximal thigh mass; age and magnetic resonance findings suggested lipoblastoma. However, following complete surgical resection, histopathology confirmed hibernoma, a benign lipomatous tumor characterized by the presence of white and multivacuolated brown fat cells, the vast majority of which occur in adult patients.
Dec 2017 DOI 10.14302/issn.2576-9383.jhhr-17-1788
Integration of music therapy into medical treatment facilities is very uneven in different countries. Scientific evidence of successful examples and sharing of good practices between countries is essential for the further development of music therapy and the improvement of the quality of complex medical services. The goal of this study was to analyse the situation of music therapy implementation into the health services in Lithuania. Analysis of historical background, legislation and overview on music therapy training has been made. Music therapy in Lithuania has gone through more than thirty years of development. Acqaintance and acceptance of music therapy as a relevant and fruitful component to the complexity of the existing medical services was long but successful process. Overview of current initiatives and achievements of the implementation of music therapy into clinical practice and research has shown promissing positive results in developmental pediatrics, psychiatry, special education, neurology, neonatology, oncology, somatic and preventive medicine, rehabilitation. The Music Therapy Master program in Lithuania is being implemented. Possibilities to use music therapy as an inovative service and resourse in various medical settings are in the process of the rapid growth. Collaboration involving music therapists in interdisciplinary teams would help to achieve a comprehensive, versatile patient-centered and health-centered complex service.
Apr 2017 DOI 10.14302/issn.2470-0436.jos-17-988
Photorefraction (PR) methods have beenwidely used for pediatric vision screening since the 1980’s. While PR is easy to implement, the accuracy of refractive error measurements in humans has been unsatisfactory, largely due to the variations of intraocular scattering, the retinal reflectance, and pupil size. The objective of our studies was to clinically evaluate the accuracy of refraction measurements of an improved PR-based device, the Dynamic Ocular Evaluation System (DOES), and to investigate whether the accuracy is affected by the patient’s age, race, and pupil size, which are relevant to individual intraocular scattering and retinal reflectance. We performed DOES measurements in 99 volunteers (198 eyes) under two environmental light conditions and using four fixation targets. These results were compared to the standard clinical refraction testing performed the same day. The correlation and standard deviation were determined by Bland-Altman analysis. The influence of intraocular scattering, retinal reflectance, and pupil size was evaluated by comparing results from different age groups, races, and lighting conditions. In the region between -4 diopter (D) and +4D, the device showed a binocular refraction measurement accuracy of 0.45 D, 0.3 D, and 0.18 D root-mean-square (RMS) error (n=1337) for spherical equivalent and cross cylinders Jo and J45, respectively. Inaccuracy increased at high refraction (>4D). Age, race, and pupil size did not appear to significantly affect DOES PR measurement. This suggests that enhancements in the PR system and analysis may satisfactorily correct intersubject variability that currently limits the clinical use of PR devices and measurements.
Dec 2016 DOI 10.14302/issn.2372-6601.jhor-16-1070
Introduction: Post-transplant lymphoproliferative disease (PTLD) is a collection of conditions associated with abnormal proliferation of lymphoid tissues in patients after solid organ transplants (SOT). Its clinical presentations are quite variable and non-specific. Otolaryngological signs and symptoms, manifested as adenotonsillar hypertrophy or cervical lymphadenopathy, may guide to early detection and treatment. Methods: We conducted a retrospective review of all pediatric SOT recipients with the diagnosis of PTLD, age 0-18, between 2005 and 2014 at the Loma Linda University Children’s Hospital. The patient’s age, type of organ transplant, immunosuppression, head and neck signs and symptoms, imaging modality, EBV status, histology as well as treatment regimen information were recorded. Results: A total of 21 pediatric patients were included in this retrospective review with a history of solid organ transplant and a diagnosis of PTLD. The most commonly associated type of transplanted organ is heart (57.1%), followed by kidneys (33.3%) and liver (9.5%). Neck swelling (28.6%) was the main head and neck complaint while one patient developed upper airway obstruction with respiratory distress. Cervical lymphadenopathy was found in 66.7% and tonsillar hypertrophy in 9.5% of the patients. Monomorphic PTLD (46.2%) was the most common pathological diagnosis, followed by reactive hyperplasia (30.8%), Hodgkin lymphoma (15.4%) and polymorphic PTLD (7.7%). Majority of the PTLD patients were treated with rituximab and cyclophosphamide combination therapy with and without prednisone. Conclusion: Adenotonsillectomy and cervical lymph node biopsies are easy to perform with low complication rates. They serve an important role in the armamentarium in the early detection of PTLD in its early stage, allowing prompt treatment and prevention of further progression.
Mar 2016 DOI 10.14302/issn.2577-137X.ji-15-834
The Expanded Program on Immunization (EPI) in India delivers vaccines under its policy, through government hospitals, health centers and outreach clinics. However, the national average full immunization coverage is stagnating at about 70%. The days and times of clinics are not always convenient for mothers working at home or employed outside. Moreover, vaccines not under EPI, but recommended by the Indian Academy of Pediatrics (IAP), are unavailable there, forcing mothers to go to private sector immunization clinics to get them. Recognizing the local need for user-friendly immunization clinic, we designed one in the Department of Child Health. The impetus came from local demand by a civil society organization (Rotary Club of Vellore). Our immunization clinic is open every working day (8.30 am to 4.00 pm) offering both groups of vaccines. Its success is illustrated by the fact that over 7000 children per month receive immunization in this clinic. We describe its design and operation so that this model may be replicated in other urban hospitals with pediatric sections.
Jun 2013 DOI 10.14302/issn.2324-7339.jcrhap-12-74
HIV infected children who started antiretroviral therapy (ART) in public health facilities in South Africa have survived to older age and disclosure has become an essential part of their care. Available data on HIV disclosure to children were collected much earlier in the provision of ART in South Africa. The aim of the study was to (a) determine the characteristics of caregivers of pediatric HIV patients in Gauteng, South Africa, (b) estimate the prevalence and timing of HIV disclosure among these patients, and (c) assess the factors associated with disclosure status. A cross-sectional study was conducted among 286 caregivers of paediatric ART children aged 4–17 in two centres in Gauteng, South Africa. Bivariate and multivariate logistic regression analyses were carried out. The highest proportion of care givers were biological mothers (n=140, 49.3%). The mean age of the children was 8.5 years, (range 4-17 years). More than a third (n=99, 34%) were disclosed their HIV status, and the mean age at disclosure was 9.3 years, (SD = 2.7). Child’s age older than 10 years (OR =1.63; 95% CI: 1.44–1.85), having a nonbiological caregiver (OR=1.75; 95% CI: 1.06-2.89), caregiver educational level (OR =0.64; 95% CI: 0.47–0.87), and caregiver’s age older than 60 years (OR=1.02; 95% CI: 1.01-1.04), were significantly associated with HIV disclosure to infected children. The relatively higher prevalence of disclosure is attributed to increasing access to paediatric ART. Training healthcare providers to support caregivers in disclosure will increase the rate of disclosure to HIV infected children receiving ART in public health facilities.