Abnormalities In Children Research Articles

Forming Children Character from View Person Centered and Al-Qur'an

The child's religious's mental, and moral development is not a process that can occur quickly and be forced. Still, it must be gradual, reasonable, healthy, and following the growth, abilities, and nature of the age that is being passed. Here, parents must be able to capture the positive trends of child development to be very important. Parents' obligation is to motivate and direct children to a positive outcome, even though the tendency is not following the parents' wishes. This, Islam teaches that in caring for children not to differentiate between boys and girls, eldest or youngest children, normal or abnormal children, parents still provide the same opportunity to obtain educational services following their potential, talents, and interests. Children must be treated fairly and not discriminatory. Hadith of the Prophet Muhammad says that "Educate your children (girls and boys), not according to your wishes, because they are children of their time.

A rare interstitial deletion (2)(p11.2p13) in a child with pericentric inversion (2)(p11.2q13) of paternal origin

An unbalanced 46,XY,der(2)del(2)(p11.2p13)inv(2)(p11.2q13) karyotype was found in a phenotypically abnormal child. A de novo interstitial deletion resulting in loss of band 2p12 was present on a chromosome 2 with an inv(2)(p11.2q13) inherited from the father. The inv(2) is generally considered a benign familial variant without significant reproductive consequences. However, our findings led us to consider a previously proposed mechanism of unequal meiotic crossing over at the base of a parental inversion loop, which could lead to either duplication or deletion of a segment adjacent to the inverted region in offspring. This phenomenon has been reported in association with inversions of chromosomes 7, 13, 15 and 17 and may explain origin of the deletion in our case. Alternatively, repetitive sequences might be present around such inversions which could predispose to de novo deletions independently of the inversion.Although the mechanism of origin of the deletion in our proband cannot be proven, our review of similar imbalances with other inversions and the findings in the family described in this report suggest there could be a small risk for a related imbalance in offspring of couples with an inv(2)(p11q13). Further monitoring of pregnancy outcome in families with the inversion should be considered. However, at this point, it seems premature to recommend prenatal diagnosis for all couples in this situation.For del(2)(p11.2p13), which is rare, an emerging phenotype is proposed. Our patient shared several features with four previously published cases, namely a broad nasal bridge, abnormal ears, highly-arched palate, psychomotor retardation, and micrognathia. However, our patient also had sensorineural hearing loss and significant hypotonia which have not been previously reported.

Moving to The Beats: The Effect of Dance Education on Early Self-Regulation

Self-regulation in children is an important thing that needs to be prepared from an early age. Besides affecting children's school readiness, this also makes it easier for children to have good academic achievements. This study aims to determine the influence of moving to the beat of early childhood self-regulation. This research was conducted on kindergarten group B students in East Jakarta. The research method used is a quasi-experiment method with a sample of 20 students. The data collection technique uses observations by analysing paired t-test statistical data. The results of the study explained that there was a significant effect of moving to the beat of early childhood self-regulation. The significance level is 0.000 < 0.05, which means that H0 is rejected and H1 is accepted, this indicates a significant difference between the pre-test and post-test. For further research, it is recommended to look at the influence of other factors on early childhood self-regulation.
 Keywords: Beats, Early childhood, Moving, Self-Regulation

Epilepsy and EEG Abnormalities in Children with Autism Spectrum Disorders.

To evaluate the prevalence of epilepsy and electroencephalographic abnormalities in children with autism spectrum disorders (ASD) and determine their risk factors. This cross-sectional study was conducted over one year in children with ASD aged between 3 and 14 y. Classification of epilepsy and routine electroencephalography (EEG) recordings were done for all the patients. Developmental and cognitive assessments were done using Developmental Profile 3. Children were divided into three groups: ASD with epilepsy, ASD with isolated electroencephalographic abnormalities, and ASD with neither epilepsy nor electroencephalographic abnormalities. One hundred children with ASD were enrolled. Epilepsy was reported in 23% and subclinical electroencephalographic abnormalities were documented in 8%. The most common seizure types were generalized-onset tonic-clonic (48%), focal-onset with impaired awareness (17%), and focal to bilateral tonic-clonic seizures (17%). In children with subclinical epileptiform discharges, focal abnormalities were most common (75%) and were maximally seen over the temporal region (50%). Subnormal intellect (88.6%) and abnormal global developmental score (82%) were noted in the majority of children. Female gender, abnormal neurological examination, and adverse perinatal events were significantly associated with epilepsy. Of these, female gender and adverse perinatal events were independent predictors of epilepsy. Isolated EEG abnormalities were significantly associated with abnormal neurological examination in comparison with autistic children without epilepsy/EEG abnormalities. Epilepsy is seen in up to one-fourth children with ASD. Female gender and adverse perinatal events are independent risk factors for epilepsy. Subclinical or isolated EEG abnormalities are associated with abnormal neurological examination.

Prenatal Tests Undergone by Moslem Women who Live with an Abnormal Child Compared to Women who Live with Normal Child

Objective: To determine whether Moslem women with an abnormal child at home perform more prenatal tests and pregnancy termination compared to Moslem women who had only a normal child at home. Study Methods: Moslem women (704) participated; 67% (470) lived at home with an abnormal child; 33% (234) only with a normal child. Of the women with an abnormal child, 50% lived in the cities, 47% were nonreligious, 49% had no academic education, and most (95%) had experienced a natural pregnancy. Of the women with a normal child, 49% lived in the cities, 44% were religious, and 50% had no academic education, most (80%) experienced a nonspontaneous pregnancy. Ages: 18-42 (mean 31). Results: Most women with an abnormal child experienced spontaneous pregnancy; however, only 8% were aware of an abnormal fetus. Women with a normal child had experienced a nonspontaneous pregnancy (80%), however, most (97%) had undergone prenatal testing and chose to terminate the pregnancy (p<0.001) due to an abnormality. Conclusion: Moslem women who live at home with a normal child, performed significantly more prenatal tests and terminated most pregnancies when diagnosed with an abnormal fetus, compared to women who lived with an abnormal child. Most of the women with a normal child experienced a non-spontaneous pregnancy which could explain why they received more counseling relating to existing prenatal tests.

Prevalence and Factors Associated with Echocardiographic Abnormalities in Children with Sickle Cell Disease; Results from the Displace Study

IntroductionCardiopulmonary complications remain a leading cause of morbidity and mortality in adults with sickle cell disease (SCD) particularly for people with sickle cell anemia (SCA) who have lower hemoglobin and higher baseline hemolysis. Many cardiovascular complications are not identified until adulthood when patients have developed irreversible pathology. Previous studies have suggested that SCD-specific therapies like hydroxyurea (HU) may be beneficial in reducing the hemolysis associated vascular dysfunction and reducing cardiopulmonary complications. This study describes the prevalence of and factors associated with left ventricular hypertrophy (LVH), left atrial dilation and high tricuspid regurgitant jet velocity (TRJV) in children with SCA. We also describe the association between patent foramen ovale (PFO) and ischemic stroke in children with SCA.MethodThis crossectional study used data collected as part of the Dissemination and Implementation Stroke Prevention Looking at the Care Environment (DISPLACE) study. American society of echocardiography (ASE) guidelines and cutoff values were used to define abnormalities in the echocardiographic variables.ResultsA total of 1414 children were included in the analysis. The median age was 9 years (range 5-12 years) and median hemoglobin of 8.6 g/dl. The most common abnormal findings on echocardiogram was left atrial dilatation (61% of the children), LVH (20% of children) and high TRJV (23% of children). Children with abnormal echocardiographic variables were more likely to have lower hemoglobin level. Children with LVH were more likely to have left atrial dilation, high TRJV and abnormal left ventricular end diastolic diameter (LVIDD). Multivariable analysis of LVH was conducted and included variables: age, sex, hemoglobin, reticulocyte count, treatment with chronic red cell transfusion therapy (CRCT) or hydroxyurea therapy (HU). Baseline hemoglobin levels were associated with the lower odds of having LVH (OR: 0.71, 95% CI: 0.60 - 0.84). The odds of LVH increases for every one-year increase in age (OR: 1.07, 95%CI: 1.02-1.13). Similarly, the odds of LVH was lower among males than females (OR:0.59, 95%CI: 0.38-0.93). The odds of LVH were higher among those on HU compared to no therapy (OR: 1.83, 95% CI: 1.41 - 2.37).Although not all children had a bubble, study, a total of 90(6.3%) had an identified PFO. We assessed the relationship between PFO and ischemic stroke. 102 (7.2%) of the 1414 children had an ischemic stroke. Out of this 5 (5.6%) had PFO. We also assessed the relationship between PFO and abnormal TCD. 142 (10.0%) of the 1414 had abnormal TCD and only 9 (10%) of the 142 had PFO. There is no evidence that the odds of having stroke was higher among those with PFO compared to those without (OR: 1.49, 95% CI: 0.20- 11.03, p = 0.6994). Similarly, no evidence that the odds of having abnormal TCD is higher among those with PFO compared to those without (OR: 0.85, 95% CI: 0.17- 4.25, p = 0.8463).ConclusionOverall results of the study showed echocardiographic abnormalities are common in and occur at an early age in children with SCA. The risk of LVH increases with increasing age and with lower hemoglobin. Further, we found higher use of HU among those with LVH, suggesting that possibly children with more severe disease requiring HU are also at increased risk of cardiopulmonary complications.Given the fact that high TRJV is an independent risk factor for death in adults with SCD and left atrial dilatation has been shown to be an independent predictor of cardiac events, our data support further investigation into identifying early biomarkers of cardiovascular morbidity in children with SCD. [Display omitted] DisclosuresKanter: Fulcrum Therapeutics, Inc.: Consultancy; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Forma: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Agios: Honoraria, Membership on an entity's Board of Directors or advisory committees; Beam: Honoraria, Membership on an entity's Board of Directors or advisory committees; Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees; Graphite Bio: Consultancy; GuidePoint Global: Honoraria; Fulcrum Tx: Consultancy.

Mobility and Muscle Strength in Recipients of Hematopoietic Cell Transplantation for Sickle Cell Disease: A Preliminary Report from Sickle Transplant Evaluation of Longterm and Late Effects Registry (STELLaR)

IntroductionRecipients of Hematopoietic Cell Transplantation (HCT) are at risk for treatment related late effects including cardiovascular disease and diabetes. Physical fitness including mobility and muscle strength are important predictors of cardiovascular health and quality of life. Physical fitness has been described in children and adults who are long term survivors of HCT for malignant disease [1]. Patients with sickle cell disease (SCD) are likely to be subject to unique morbidity post-HCT as a consequence of the pathophysiology of SCD which is characterized by anemia, inflammation, pain, bone infarcts and neurological complications. A systematic assessment of physical fitness is required to understand some of the long-term outcomes HCT for SCD.MethodsWe enrolled patients with SCD ≥ 1-year post-HCT in Sickle Transplantation Evaluating Long Term And Late Effects Registry (STELLaR). We assessed physical fitness including mobility using the timed up and go (TUG) test, and muscle strength using the handgrip strength (HGS) test. TUG scores were compared with published normative data for children (mean 9.2s; SD = 0.8) and young adults (mean 10.5s, SD = 1.1) [2]. TUG scores ≥ mean+ 2SD were considered abnormal (children: ≥10.8s, young adults ≥12.7s). The HGS of each patient was compared to published normative data of children and adults [3,4]. Patients ≤12 years were abnormal if they had a HGS of two standard deviations below the mean. Patients ≥13 years were considered abnormal if they had a HGS lower than the lower limit of the 85% age-sex standard. Additionally, patients were also assessed for chronic graft versus host disease (cGvHD) by means of the Lee Chronic GvHD Symptom Scale [5]. Patients rated their extent of being bothered by cGvHD symptoms on a scale from 1 to 5, with 1 being not at all and 5 being extremely. These scores were then organized into 7 categories of cGVHD symptoms and normalized to a 0-100 scale. We report the results of an interim analysis of physical fitness in these HCT recipients.ResultsOut of 121 patients enrolled in the study, 37 HCT recipients were assessed for mobility using the TUG test, and for muscle strength using the HGS test. Children were defined as being below the age of 18 and young adults between 18 and 40 years of age. Patient demographic and clinical results for TUG and HGS are presented in Table 1. Young adult participants were more likely to have abnormal TUG and HGS results than pediatric study participants. Patient self-reporting of overall (summary) cGvHD symptoms was found to be statistically significant between children and young adults (p=0.037) with young adults iappearing to be slightly more bothered by GvHD symptoms. There was no correlation in length of time in years between a patient's transplant and whether or not there was abnormal physical fitness (TUG and HGS) for both the young adult and children cohorts.ConclusionsThese data suggest the existence of impaired physical fitness in the long term in SCD patients who are HCT recipients. They provide the rationale for systematic evaluation of physical fitness and other risk factors for cardiovascular disease post-HCT.

Screening Sleep Abnormalities in Children with Prader–Willi Syndrome: Challenges in the Indian Scenario

There is a high prevalence of sleep-related breathing disorders in the form of obstructive and central sleep apnea as well as spontaneous oxygen desaturation in children with Prader–Willi syndrome (PWS). Most cases are asymptomatic and if untreated go on to develop unfavorable neurodevelopmental, cardiovascular, and cerebrovascular outcomes. Hence, sleep study or polysomnography (PSG) is recommended in all children at the time of diagnosis as well as with the development of certain risk factors including symptoms of sleep apnea, before and after initiation of recombinant growth hormone (rGH) therapy. The use of rGH in children with PWS has been shown to improve central sleep apnea but also shown to be associated with worsening of OSA. PSG is ideally performed in a sleep laboratory. Various types of PSG devices are available depending on the biological parameters that are desired to be monitored. Sleep disorders in children are distinct from those seen in adults and have different diagnostic scoring criteria necessitating a trained pediatric sleep specialist to analyze the PSG recording. Through the clinical case vignette of a 14-year-old girl with PWS, severe obesity, and sleep disordered breathing, this review aims to highlight the need, timing, types, analysis, and interpretation of sleep studies in infants and older children with PWS, particularly in relation to rGH therapy. There is a paucity of literature on sleep studies in children with PWS in the local setting. Thus this review also suggests the need for adapting the existing Western guidelines for PSG in Indian children with PWS.

Cardiac Abnormalities in Children with Pre-Dialysis Chronic Kidney Disease in a Resource-Limited Setting: A Cross-Sectional Observational Study.

Cardiovascular disease is the leading cause of morbidity and mortality in children with chronic kidney disease (CKD). We aim to estimate the prevalence of cardiac abnormalities in children up to age 16 years with CKD and their association with various risk factors. This cross-sectional observational study was conducted on 107 CKD children. We assessed the systolic and diastolic function using 2D echocardiographic evaluation and M-mode measurements of the left ventricle (LV) indexed for BSA and z-scores were calculated. Results were compared with age, sex, stage of CKD, anaemia, estimated glomerular filtration rate (eGFR) and various laboratory parameters. LV diastolic dysfunction was seen in 88%, followed by increased LV dimensions in 33.6%, LV systolic dysfunction in 16%, right ventricle systolic dysfunction in 11.2% while increased pulmonary artery (PA) systolic pressure was seen in 9.3% of cases. LV dimensions correlated directly with parathormone levels and inversely with eGFR, serum calcium and haemoglobin levels. Left ventricular hypertrophy correlated directly with parathormone while inversely with eGFR, serum calcium and haemoglobin. Ejection fraction directly correlated to eGFR and serum calcium while inversely related to parathormone. Left PA pressure directly correlated with age and inversely with eGFR. Right ventricular systolic function assessed by tricuspid annular plane systolic excursion correlated inversely with haemoglobin. LV diastolic dysfunction and increased LV dimensions were the most common cardiac abnormality in children with CKD. LV dimensions correlated directly with parathormone levels and inversely with eGFR, serum calcium and haemoglobin. Diastolic dysfunction positively correlated with serum creatinine and parathormone levels.

Thematic Learning for Children with Special Needs at Inclusion School During the Covid-19 Pandemic

This study discusses thematic learning for children with special needs which is carried out online or online learning which is part of distance learning with contemporary special methods that consciously combine internet-based technologies to support the success of students in learning even though it is done remotely. far. As for the benefits of implementing inclusive education for both children with special needs and normal children, they will learn to interact and help each other, teach students that there is no difference and we are all the same. In order to carry out thematic education for children with special needs to the fullest. For this reason, knowing the thematic learning abilities of students with special needs online is very important although basically it is not easy to implement because it requires special supervision from both parents and other families who are at home. Inclusive education does not discriminate in educating normal and abnormal children. Thus, the characteristics of inclusive schools are, among others: having physical accessibility and non-physical accessibility, which aims to maximize services for all children.

Physeal Abnormalities in Children With High-risk Neuroblastoma Intensively Treated With/Without 13-Cis-Retinoic Acid.

This study aimed to investigate the presence of physeal abnormality and its effect on growth in children with high-risk neuroblastoma treated by intensive multimodal treatment with/without 13-cis-retinoic acid (13-CRA). Fifteen patients diagnosed with high-risk neuroblastomas at the age of 1 to 10 years, who received treatment such as high-dose chemotherapy and autologous stem cell transplantation with/without 13-CRA, and with complete data during their >2-year follow-up were retrospectively reviewed. The physeal abnormalities were investigated by whole-body magnetic resonance imaging, serially performed every 3 to 6 months. The patients' height growth was also investigated and compared with that of age-and-sex-matched patients with brain tumors who also underwent high-dose chemotherapy and autologous stem cell transplantation. Six of 15 patients presented multifocal physeal abnormalities during follow-up, and all lesions occurred in patients with 13-CRA use. The lesions in 3 patients completely resolved spontaneously without any adverse effect on growth, but some lesions in the other 3 patients progressed to disturb the bony growth. Height growth of matched patients with brain tumors were not significantly different, and none of the matched controls showed definite bony deformity during the follow-up. Some children who were treated for high-risk neuroblastomas experienced multifocal physeal insults, probably due to the use of 13-CRA. Most lesions resolved spontaneously, but some led to bony deformity. If the lesions are not followed by premature physeal closure, there seems to be no further adverse effect of 13-CRA on leg length growth. Routine periodic screening for physeal status is needed for the patients with high-risk neuroblastomas using 13-CRA. Level IV-prognostic study.

Fat Mass Index Associated with Blood Pressure Abnormalities in Children with Chronic Kidney Disease.

Cardiovascular disease (CVD) risk factors are present early in life in children with chronic kidney disease (CKD), consequently cardiovascular morbidity presents in early adulthood. However, risk factors of CVD have been rarely addressed in children with early stage of CKD. This study included 63 children and adolescents aged 8- to 18 years-old with CKD stage G1–G4. Cardiovascular assessments consisted of 24-h ambulatory blood pressure monitoring (ABPM), arterial stiffness index, and echocardiography. We also applied dual-energy x-ray absorptiometry (DXA) scanning to analyze percentage body fat (PBF), lean body mass index (LBMI), fat mass index (FMI), and the android to gynoid fat ratio (A/G ratio). Up to 63.5% of CKD children had abnormal changes in BP detected by ABPM. CKD children with abnormal ABPM were older, had higher numbers of CKD stage G2 to G4, hyperuricemia, obesity, and higher FMI z-score and A/G ratio compared to individuals with normal ABPM (all p < 0.05). Among these factors, only FMI z-score showed an independent association with abnormal ABPM using multivariate logistic regression analysis (p = 0.037). Our data highlight that body fat plays a key role for an abnormal ABPM in CKD children. The assessment of FMI may have clinical utility in discriminating CV risk in children and adolescents with early stages of CKD.

Effects of Fluid Rehydration Strategy on Correction of Acidosis and Electrolyte Abnormalities in Children With Diabetic Ketoacidosis.

Fluid replacement to correct dehydration, acidosis, and electrolyte abnormalities is the cornerstone of treatment for diabetic ketoacidosis (DKA), but little is known about optimal fluid infusion rates and electrolyte content. The objective of this study was to evaluate whether different fluid protocols affect the rate of normalization of biochemical derangements during DKA treatment. The current analysis involved moderate or severe DKA episodes (n = 714) in children age <18 years enrolled in the Fluid Therapies Under Investigation in DKA (FLUID) Trial. Children were assigned to one of four treatment groups using a 2 × 2 factorial design (0.90% or 0.45% saline and fast or slow rate of administration). The rate of change of pH did not differ by treatment arm, but Pco2 increased more rapidly in the fast versus slow fluid infusion arms during the initial 4 h of treatment. The anion gap also decreased more rapidly in the fast versus slow infusion arms during the initial 4 and 8 h. Glucose-corrected sodium levels remained stable in patients assigned to 0.90% saline but decreased in those assigned to 0.45% saline at 4 and 8 h. Potassium levels decreased, while chloride levels increased more rapidly with 0.90% versus 0.45% saline. Hyperchloremic acidosis occurred more frequently in patients in the fast arms (46.1%) versus the slow arms (35.2%). In children treated for DKA, faster fluid administration rates led to a more rapid normalization of anion gap and Pco2 than slower fluid infusion rates but were associated with an increased frequency of hyperchloremic acidosis.

Urinary Klotho Abnormalities in Children with Sickle Cell Disease

Background: Klotho is a trans membrane protein expressed in the renal tubules and serves as an obligatory co-receptor for fibroblast growth factor 23(FGF23) to aid in phosphorus excretion. Prior studies have shown FGF23 resistance in sickle cell disease (SCD). The purpose of the study is to investigate urinary klotho/creatinine (Ur Kl/Cr) in pediatric SCD with normal traditional markers of renal function (eGFR &gt; 90 ml/min and no micro albuminuria) and to compare it with the healthy control population. Methods: Cross-sectional observational study to compare Ur Kl/Cr in pediatric SCD and controls. To do a subgroup analysis among the study population to assess the effect of hydroxyl urea (HU) on Ur Kl/Cr. Results: 20 controls and 22 pediatric SCD were enrolled. In the SCD group, 13 were on treatment with HU. The baseline characteristics of the study and control group were the same. Wilcoxon rank-sum test was used to compare the levels of Ur Kl/Cr ratio between SCD and control. For P value of 0.05, the levels of Ur Kl/Cr were statistically significantly higher in the sickle cell group (752.7 ± 1101.0) over the control group (216.8 ± 225.3). Subgroup analysis in the SCD group showed high Urinary Kl excretion in the non-HU group (1346.7 ± 1523.4) vs. non HU group (341.4 ± 355.3) but not statistically significant. Conclusion: Children with SCD tend to have increased secretion of Ur Kl/Cr compared to control likely due to tubular receptor resistance. HU may reverse this phenomenon by its effect on preventing tubular damage.

Brain MRI Abnormalities in Children with Wilson's Disease: Is it Indicator for Liver Transplantation?

Abstract Background: Wilson's Disease (WD) is an autosomal recessive disorder of copper metabolism with a prevalence of about 1in 30000 people.It's more common with parental consanguinity. The adenosine triphosphate 7B (ATP7B) gene, coding the copper transporting P-type ATPase has been reported to have 380 variants. Copper leads to tissue damage by accumulating in many organs includingmainly the liver and brain. Neurological manifestations of WD are ascribed toab-normal deposition of copper in brain tissues, especially deep gray matter (basal ganglia and thalamus) and subcortical white matter. Wilson's disease can present clinically by liver disease, neurological disorderor psychiatric illness. In childhood, hepatic manifestations predominate with ahighly variable spectrum ranging from self-limiting hepatitis to fulminanthe-patic failure. Aim of Study: The aim of this study was to detect brain changes by magnetic resonance imaging in children with Wilson's disease and their correlation with clinical and bio-chemical findings. Patients and Methods: This study included 70 patients. 35 patients with WD and 35 patients with other Chronic Liver Disease (CLD) as control. WD group involved 20 males and 15 females. Their mean age was (12.73±2.86) year. Control group included 35 patients with CLD (20 with Autoimmune Hepatitis (AIH), two with sclerosing cholangitis and 13 with chronic HCV. Results: Among WD group, we reported 15 patients (42.8%) had abnormal MRI. T1 weighted images showed bilateral symmetrical hyperintensity signal of globuspallidus in two patients (5.7%), hypointensity signal of left globuspal-lidus in one patient (2.8%) and bilateral symmetrical hyper-intensity in thalami in one patient (2.8%). T2 and FLAIR hyperintensity signals mainly involving basal ganglia were present in 11 patients (31.4%). Ventricular system was affected in two patients (5.7%), it was prominent in one patient and the other patient had hydrocephalus. Patients were followed-up over a period of 6-18 months and we reported that three WD patients (20%) from those who had abnormal MRI deteriorated rapidly and were candidates for LT, while none of other patients needed LT. Conclusions: Bilateral symmetrical hyperintense signals in T2 weighted and FLAIR images mainly involving basal ganglia are specific for WD and represent CNS involvement of WD. Abnormal MRI may be a bad prognostic factor as 20% from abnormal MRI WD subgroup deteriorated rapidly and were candidates for LT.

A Novel Radiologic Finding to Predict Ophthalmic Abnormalities in Children With Congenital Zika Syndrome.

The Zika virus (ZIKV) epidemic had devastating consequences in Brazil. We investigated whether a radiologic finding (ie, infratentorial abnormalities) was associated with sight-threatening defects in children born with congenital Zika syndrome (CZS). We also investigated whether ophthalmic abnormalities correlated with head circumference (HC) and gestational age of infection. Cross-sectional evaluation based upon a previous cohort from March 2016 to December 2018, in Paraíba, Brazil. The study population was comprised of children born to mothers with laboratory-confirmed ZIKV infection during pregnancy (ZIKV reverse transcriptase polymerase chain reaction [RT-PCR]+) and children born with clinical and radiologic features of CZS. A total of 75 infants had complete data. All 75 had brain calcifications. Microcephaly was present in 53 (71%) of them. Infratentorial abnormalities were present in 17 infants (22.7%). Ophthalmic abnormalities were seen in 16 of the 17 children (94%) with infratentorial abnormalities, while 28% of children without infratentorial abnormalities had ophthalmic findings (odds ratio [OR]: 42.0; 95% confidence interval [CI]: 5.1-342.9). Similar associations were observed when macular chorioretinal atrophy and optic nerve abnormalities were analyzed individually (OR: 23.7; 95% CI: 6.0-93.3 and OR: 11.5; 95% CI: 3.3-40.0, respectively). Infratentorial abnormalities were more frequently associated with ophthalmic abnormalities (94%) than microcephaly (43.4%) (P < .001). Mean HC was statistically different between groups with and without ophthalmic abnormalities (P = .01). A statistically significant difference in gestational age between both groups was not noted (P = .12). In children with CZS, the presence of infratentorial abnormalities is a significant predictor of ophthalmic abnormalities. All neonates whose mothers had ZIKV exposure during pregnancy should have an ophthalmologic examination.

617 Electrocardiogram Abnormalities in Children Undergoing Polysomnography

Abstract Introduction Monitoring electrocardiogram (EKG) is an integral component of pediatric polysomnography (PSG). There is limited data regarding arrhythmia and conduction disturbances in the pediatric population undergoing a PSG. In this work we will present abnormal EKG findings during PSG in our sleep center. Methods A retrospective chart review from children at Seattle Children’s Hospital who underwent PSG read by a single Sleep Medicine physician (LD) in the last year was carried out. Data included age, sex, type of EKG abnormality, sleep diagnosis from PSG. Data from children with 1st or 2nd degree atrioventricular block (AVB) were compared to those from children with premature ventricular contractions (PVC). Results A total of 1,235 PSG were included. Twenty-four children (9 girls and 15 boys) aged 2–17 years (median 9 years) were identified with arrhythmias or conduction disturbances (1.9%). Nineteen out of 24 of these children (79.2%) had oAHI &amp;gt;1/hour; this frequency was not significantly different from that found in the whole group of 1,235 children (Chi-square test p=0.16). When comparing PSG parameters from children with AVB with those with PVC, we found no statistically significant difference. Seven out of nine children with AVB and seven out of ten with PVC had oAHI &amp;gt;1/hour (Fisher exact test p=0.56) while eight children with AVB out of nine and four out of ten with PVC were males, and this difference was the only statistically significant difference found (Fisher exact test p=0.04). None of the children were found to have a structural or conduction abnormality when referred to cardiology. Conclusion Our study found ECG abnormalities in 1.9 % of children undergoing PSG. None of the children were found to have abnormal findings after cardiology referral. Our study supports that EKG abnormalities are rare in PSGs of children and not associated with cardiac disease or sleep disorders, but appear more commonly in males. Support (if any):

Disability and Normalcy as Constructs in Doris Lessing’s The Fifth Child

This paper aims to analyze Doris Lessing’s The Fifth Child as story with a special focus on abnormal child Ben who is born with Down’s syndrome and how society fear his difference and play an important role in constructing what is termed as disability. The young English couple, Harriet and David Lavatt move from a romanticized ideal to hazardous situations with the conception and birth of the fifth child, Ben who is described throughout the novel as an animal, an alien or a kind of monstrous baby or the baby of a monster. The disabled baby exercises an evil and destructive force upon the family. The novel ends with the formerly happy couple and family scattered across England and the family members have been physically and emotionally traumatized due to the birth of the abnormal baby ‘Ben’. The mother’s desire for a unconventionally large family is also a sign of abnormality. She refuses the social and class conventions that dictate small families. She also refuses medical technologies and interventions during conception and at birth. This serves to prove that concepts like normalcy and disability are socially constructed and can be challenged. For the purpose of theory the paper draws on the ideas related to normalcy and disability from The Disability Studies Reader edited by Lennard J Davis.

Clinical Implications of Hematologic and Hemostatic Abnormalities in Children With COVID-19.

Leukopenia, thrombocytopenia, elevated D-dimer, and prolonged prothrombin time are considered poor prognostic factors in adults with acute Coronavirus Disease 2019. The prognostic significance of these abnormalities among pediatric patients remains underreported in the literature. This retrospective cohort study evaluates the prognostic implications of hematologic and hemostatic derangements in patients younger than 22-years-of-age who were admitted to a tertiary-care referral institution for management of acute Coronavirus Disease 2019 infection. Leukopenia and thrombocytopenia were identified as independent prognostic factors of disease severity. Although the majority of children, with available results, had elevated D-dimer or prolonged prothrombin time upon initial presentation, these markers were not found to be associated with the development of severe clinical complications.

Recognition and Classification of Fetal Brain Abnormalities

In today’s world, not only adults, children, teenage suffer from different diseases but also the yet to be born babies suffer from various abnormalities. We hear many cases that the child was born with some disability and because of the delay in the discovery and operation of the disability, the disability becomes permanent. Out of one thousand, three women are pregnant with abnormal child. If somehow, we detect the abnormality in the child when it is in the fetal stage and operate and medicate according to that then the abnormality can be treated very effectively and efficiently. Our paper deals with the same concept of detecting and classifying the brain abnormalities in the fetus using various deep learning techniques and algorithms. There have been previous works on the same but the technique used by others included machine learning and it had some drawbacks which can be resolved using deep learning techniques. Deep learning has greater efficiency and advantage over machine learning. In our method of detection, we take the help of MRI (Magnetic Resonance Imaging) technique to first capture the brain image of the fetus. Then we perform various preprocessing steps to extract the ROI (Region of Interest). Then we use feature extraction and reduction techniques to obtain more developed and detailed image of the fetus. We compare the image with the normal fetal brain images to classify and detect abnormalities. We make the use of CNN (Convolutional Neural Network) classifier algorithm of the deep learning technique to achieve high level of accuracy. CNN algorithm is better than k means clustering and SVM classifier algorithm of machine learning techniques. Our work has shown higher accuracy than previous models and our future work will involve increasing of classification and data.