Asymptomatic School Children Research Articles

Molecular Diversity of Giardia duodenalis, Cryptosporidium spp., and Blastocystis sp. in Symptomatic and Asymptomatic Schoolchildren in Zambézia Province (Mozambique).

Infections by the protist enteroparasites Giardia duodenalis, Cryptosporidium spp., and, to a much lesser extent, Blastocystis sp. are common causes of childhood diarrhoea in low-income countries. This molecular epidemiological study assesses the frequency and molecular diversity of these pathogens in faecal samples from asymptomatic schoolchildren (n = 807) and symptomatic children seeking medical attention (n = 286) in Zambézia province, Mozambique. Detection and molecular characterisation of pathogens was conducted by polymerase chain reaction (PCR)-based methods coupled with Sanger sequencing. Giardia duodenalis was the most prevalent enteric parasite found [41.7%, 95% confidence interval (CI): 38.8–44.7%], followed by Blastocystis sp. (14.1%, 95% CI: 12.1–16.3%), and Cryptosporidium spp. (1.6%, 95% CI: 0.9–2.5%). Sequence analyses revealed the presence of assemblages A (7.0%, 3/43) and B (88.4%, 38/43) within G. duodenalis-positive children. Four Cryptosporidium species were detected, including C. hominis (30.8%; 4/13), C. parvum (30.8%, 4/13), C. felis (30.8%, 4/13), and C. viatorum (7.6%, 1/13). Four Blastocystis subtypes were also identified including ST1 (22.7%; 35/154), ST2 (22.7%; 35/154), ST3 (45.5%; 70/154), and ST4 (9.1%; 14/154). Most of the genotyped samples were from asymptomatic children. This is the first report of C. viatorum and Blastocystis ST4 in Mozambique. Molecular data indicate that anthropic and zoonotic transmission (the latter at an unknown rate) are important spread pathways of diarrhoea-causing pathogens in Mozambique.

Molecular Investigation of Genetic Signatures of Selection in </i>Plasmodium falciparum</i> Actin-Binding Protein Coronin, Cysteine Desulfurase, and Plasmepsin 2 Gene in Mbita Field Isolates, Western Kenya

Background: Plasmodium falciparum (Pf) resistance to antimalarial drugs is a major impediment to malaria control. The Pf.Kelch 13 (PfK13) gene has been largely reported to be associated with artemisinin resistance. However, recent studies have shown artemisinin resistance without Kech13 mutations suggesting the implication of others genes in artemisinin resistance. In this current study, we focused on mutations in Pf.actin-binding protein coronin, Pf.cysteine desulfurase and Pf.plasmepsin 2 gene, three putative candidates recently were reported to be involved in artemisinin, lumefantrine and piperaquine resistance respectively. Method: Archived blood samples previously collected from asymptomatic school children from December 2016 to October 2018 were used in this study. Genomic DNA was extracted using ISOLATE II Genomic DNA kit. After PCR amplification, amplicons were purified and sequenced by capillary sequencing. Reads were analyzed for the identification of point mutations previously reported to be involved in drug selection. Results: Mutations R100K, and G50E involved in reduced artemisinin susceptibility were detected in Pfcoronin. From 2016/17 to 2018 the allele 100k increased frequency (11.2%); while 50E was only observed in 2018 time point reaching 11.1%. Lumefantrine selection marker K65, in codon (K65Q) was observed at 14.2% in Pfcysteine desulfurase, and the mutant’ allele 65Q gradually increased frequency from 28.5% in 2016/17 to 57.1% in 2018. Pf.plasmepsin 2 was the less polymorphic gene. Several other polymorphism codons and single nucleotide variants were detected. Conclusion: The findings indicate the presence of mutations associated with reduced artemisinin susceptibility and lumefantrine selection marker. Therefore, the results call for continuous monitoring of molecular makers in Mbita parasites.

Prevalence of the common intestinal parasitic infections and predisposing factors among the asymptomatic primary school children in Finoteselam town, West Gojam Zone, Amhara region (Ethiopia).

Background: Intestinal parasitic infections (IPIs) have been still quite common in developing countries including Ethiopia, particularly in children with low socio-economic and poor living conditions. Previous studies in Ethiopia have shown high burden of intestinal parasitic infections among the primary school children. The effective prevention and control of parasitic infections require research work based on the identification of intestinal parasites including associated predisposing factors. Objective: The aim of the present study was to investigate the prevalence of common intestinal parasitic infections and predisposing factors among the asymptomatic primary school children. Methods: A school based cross- sectional study was conducted from September, 2019- January, 2020 and a total of 422 asymptomatic primary school children were involved in the study. Specimens of the stool samples were examined using the standard parasite and ova method. Direct microscopy using saline and iodine wet mount preparation was used to examine the presence of eggs and larvae of helminthes and trophozoites and cysts of protozoan parasites and formalin ether concentration method was used for quality assurance. Structured questionnaires were also used to collect quantitative data on socio-demographic characteristics and predisposing factors. Analysis of the data was made manually using the thematic framework method including descriptive statistics. Results: Among the 422 students (aged 5-14 years) participated in the study, 245(58%) were positive for one or more intestinal parasites. Of the total infected participants, 192(45.5%) were single infections and 53(12.6%) were double infections identified. Seven types of intestinal parasitic infections were identified in the present study. The most prevalent parasite was Giardia lamblia 95(22.5%) followed by hook worm 58(13.7%). Age groups 5-9 years old were more infected, 173 (70.6%) than age groups 10-14 years old 72(29.4%). This result also showed parasitic infections were associated with predisposing factors related to infectious cycles. Concluding Remarks and Recommendations: The present study revealed that there was a high prevalence of intestinal parasitic infection among students in the targeted primary schools. Therefore, all stakeholders should give attention to raise awareness about the prevention and control mechanisms of intestinal parasitic infections. Moreover, the health services of the local government should develop a habit of mass public health education and deworming intervention to improve the level of parasitic infection and environmental hygiene in the study area.

Prevalence of the common intestinal parasitic infections and predisposing factors among the asymptomatic primary school children in Finoteselam town, West Gojam Zone, Amhara region (Ethiopia).

Prevalence of the common intestinal parasitic infections and predisposing factors among the asymptomatic primary school children in Finoteselam town, West Gojam Zone, Amhara region (Ethiopia).

Prevalence of asymptomatic P. falciparum gametocyte carriage in schoolchildren and assessment of the association between gametocyte density, multiplicity of infection and mosquito infection prevalence

Background: Malaria is a major public health threat in sub-Saharan Africa. Asymptomatic Plasmodium falciparum gametocyte carriers are potential infectious reservoirs for sustaining transmission in many malaria endemic regions. The aim of the study was to assess the prevalence of gametocyte carriage and some of its associated risk factors among asymptomatic schoolchildren in Western Kenya and further analyse the association between gametocyte density, multiplicity of infection (MOI) and mosquito infection prevalence. Methods: Rapid diagnostic tests were used to screen for P. falciparum parasite infection among schoolchildren (5-15 years old) and the results were verified using microscopy. Microscopy positive gametocyte carriers were selected to feed laboratory reared An. gambiae s.l. mosquitoes using membrane feeding method. Genomic DNA was extracted from dry blood spot samples and P. falciparum populations were genotyped using 10 polymorphic microsatellite markers. Assessment of the association between MOI and gametocyte density and mosquito infection prevalence was conducted. Results: A significantly higher prevalence of P. falciparum infection was found in males 31.54% (764/2422) (p-value < 0.001) compared to females 26.72% (657/2459). The microscopy gametocyte prevalence among the study population was 2% (84/4881). Children aged 5-9 years have a higher prevalence of gametocyte carriage (odds ratios = 2.1 [95% CI = 1.3–3.4], P = 0.002) as compared to children aged 10-15 years. After challenging An. gambiae s.l. by membrane feeding assay on gametocyte positive patient blood, our results indicate that 68.1% of the variation in mosquito infection prevalence is accounted for by gametocyte density and MOI (R-SQR. = 0.681, p < 0.001). Conclusions: Age was a significant risk factor for gametocyte carriage, as indicated by the higher risk of gametocyte carriage among the younger children (5-9 years). Gametocyte density and MOI statistically significantly predicted mosquito infection prevalence. Both of the variables added significantly to the prediction (p < 0.05).

Dipstick urine analysis for detection of renal abnormalities among school children

Background: Urine analysis by dipstick is a useful tool to identify children with asymptomatic renal diseases. Dipstick urinalysis screening was conducted in asymptomatic school children to detect prevalence of renal disease.Methods: A cross sectional study was carried out in 862 children of age 6 to 15 years studying in different schools of Birgunj, Nepal between January 2019 to June 2019. First morning mid-stream urine samples were obtained from students and tested by dipstick method. Children with abnormal findings were re-tested after fifteen days.Results: Ninety-six (11.13%) children had urinary abnormalities at the first screening; 8 children had specific urinary abnormalities after second screening. 4 children had urinary tract infection, followed by glomerulonephritis, type 1 diabetes, hydronephrosis and nephrotic syndrome. Urinary abnormalities were more common in females than in males.Conclusions: Asymptomatic urinary abnormalities are detected by urine screening program at school age. Further work-up reveals the specific diagnosis and effective interventions help reduce the renal disease in future.

Risk associations for intestinal parasites in symptomatic and asymptomatic schoolchildren in central Mozambique

ObjectivesChronic infections by enteric parasites including protist and helminthic species produce long-term sequelae on the health status of infected children. This study assesses potential associations linked with enteric parasite infections in symptomatic and asymptomatic children in Zambézia province, Mozambique. MethodsIn this prospective cross-sectional study, stool samples and epidemiological questionnaires on demographics and risk associations were collected from symptomatic children (n = 286) from clinical settings and asymptomatic (n = 807) children from 17 schools and creches aged 3‒14 years. We detected enteric parasites using PCR-based methods. We calculated prevalence (adjusted for age, sex, house construction, drinking water, and latrine use) and odds ratios (ORs) for risk associations with logistic regression, after adjusting for district, neighbourhood and symptoms. ResultsNumbers and adjusted prevalence (95% confidence intervals in parentheses) for the symptomatic and asymptomatic populations were Giardia duodenalis 120, 52% (22–82), 339, 42% (25–59); followed by Strongyloides stercoralis 52, 14% (9‒20), 180, 20% (15–25). Risk associations for G. duodenalis included drinking untreated river/spring water, OR 2.91 (1.80–4.70); contact with ducks, OR 14.96 (2.93‒76.31); dogs, OR 1.92 (1.04–3.52); cats, OR 1.73 (1.16–2.59), and a relative with diarrhoea, OR 2.59 (1.54‒4.37). Risk associations for S. stercoralis included having no latrine, OR 2.41 (1.44–4.02); drinking well water, OR 1.82 (1.02–3.25), and increasing age, OR 1.11 (1.04–1.20). ConclusionsWe found a high prevalence of intestinal parasites regardless of the children's symptoms. Drinking well or river water, domestic animals, and latrine absence were contributing factors of human infections.

Correlations between clinical measures and symptoms: Report 1: Stereoacuity with accommodative, vergence measures, and symptoms

AimThe aim of this study was to explore associations between reduced stereoacuity and clinical measures of accommodation, vergences, and symptoms which could facilitate the development of quick and reliable screening tools. MethodsUsing a multi-stage random cluster sampling, 1211 high school students (481 males and 730 females) between 13 and 18 years of age, were selected and examined. Visual acuity, stereoacuity and suppression, refractive errors, near point of convergence, heterophoria and fusional vergences, as well as, amplitude of accommodation, accommodative response, facility and relative accommodation were evaluated. Correlations among variables and the validity of Randot stereoacuity to distinguish between children with and without defective clinical measures as well as symptomatic versus asymptomatic children were characterized by the sensitivity and specificity of the tests. ResultsThe overall mean stereoacuity was 43.9 ± 25.23 s arc, and 18.9% [95% Confidence Interval, 16.6−21.4%)] of the participants had reduced stereoacuity (defined as ≥60). Stereoacuity values and symptoms scores were worse in children with defective clinical measures. The Receiver Operation Curve showed that maximum sensitivity and specificity was obtained with near point of convergence break (≥10 cm) of (0.70 95% confidence interval: 0.63–0.77) with Randot stereoacuity test (defined as ≥60 s arc). The correlations between reduced stereoacuity and symptoms scores was moderately strong and statistically significant (Pearson’s, r = 0.507, p = 0.01). The Receiver Operation Curve showed that maximum sensitivity and specificity obtained with the Convergence Insufficiency Symptoms Survey was 0.57 (95% Confidence interval = 0.53–0.62, p = 0.001), sensitivity of 90.26%, and specificity 15.26% with the Randot stereoacuity test. ConclusionReduced stereoacuity, defective clinical measures and symptoms of asthenopia were prevalent among sample of school children studied. Randot stereoacuity test could fairly distinguish between defective and normal clinical measures; though the accuracy to differentiate between symptomatic and asymptomatic school children is poor. These findings highlight the need for validation of a simple and fast screening tool in school settings. Further studies to confirm above findings will be needed.

The Burden and Socio-demographic Differentials of Malaria Infection among Asymptomatic School Children in Gombe State, Nigeria

Background: As a foremost disease of public health significance, malaria has wrecked untold havoc among children and pregnant women in developing countries with Africa and Nigeria being worst affected.
 Objective: This study was aimed at documenting the prevalence and socio-demographic differences in the pattern of malaria infection among asymptomatic primary school children in Gombe state, Nigeria.
 Methodology: Using a cross sectional study design 745 pupils aged 6 to 15 years were assessed from March to June 2019. The subjects were selected from 12 public and 6 private schools in 6 Local Government Areas (LGAs) of the state, using multi-stage sampling technique. Malaria rapid diagnostic test (mRDT) kits were deployed in screening the subjects for malaria parasites positivity or otherwise. Data was analyzed using IBM SPSS version 21 analytical software. And the findings were presented in tables and charts. Proportions were compared using chi square, with alpha significance level set at 0.05.
 Results: The mean age of the participants was 9.96±2.26 and 379 (50.9%) of them were boys while the rest 366 (49.1%) were girls (about 1:1 male-female sex ratio). A total of 101 (13.6%) of the 745 school children screened yielded positive to malaria rapid diagnostic test (mRDT), with children from the public primary schools being significantly (p=0.000) more affected than their counterparts in the private schools (18.2% vs. 4.1%). Though male children were more affected by malaria, the difference was not statistically significant (15.0% vs. 12.0%, P=0.229). Similarly, significantly higher proportion (p=0.000) of pupils from the rural schools were affected and were about three times more at risk of malaria (OR=3.362, CI: 2.169-5.212) than their urban counterparts (22.4% vs. 7.9%). Low academic performance was found to be associated with malaria infection (p=0.012). Other socio-demographic factors associated with malaria infection among the pupils include; senatorial district, family size, source of parental care, tribe etc. However, from the evidence of this study there was no significant association between the prevalence of malaria infection and birth order, age group and gender of the school children.
 Conclusion: In view of the high and disproportionate distribution of the burden of malaria among the subjects, it is hereby recommended that concerned authorities should include primary schools in the design and implementation of malaria control/ elimination programmes.

Diversity and Multiplicity of P. falciparum infections among asymptomatic school children in Mbita, Western Kenya

Multiplicity of infection (MOI) and genetic diversity of P. falciparum infections are important surrogate indicators for assessing malaria transmission intensity in different regions of endemicity. Determination of MOI and diversity of P. falciparum among asymptomatic carriers will enhance our understanding of parasite biology and transmission to mosquito vectors. This study examined the MOI and genetic diversity of P. falciparum parasite populations circulating in Mbita, a region characterized as one of the malaria hotspots in Kenya. The genetic diversity and multiplicity of P. falciparum infections in 95 asymptomatic school children (age 5–15 yrs.) residing in Mbita, western Kenya were assessed using 10 polymorphic microsatellite markers. An average of 79.69% (Range: 54.84–95.74%) of the isolates analysed in this study were polyclonal infections as detected in at least one locus. A high mean MOI of 3.39 (Range: 2.24–4.72) and expected heterozygosity (He) of 0.81 (Range: 0.57–0.95) was reported in the study population. The analysed samples were extensively polyclonal infections leading to circulation of highly genetically diverse parasite populations in the study area. These findings correlated with the expectations of high malaria transmission intensity despite scaling up malaria interventions in the area thereby indicating the need for a robust malaria interventions particularly against asymptomatic carriers in order to attain elimination in the region.

Molecular Diversity of Giardia duodenalis, Cryptosporidium spp. and Blastocystis sp. in Asymptomatic School Children in Leganés, Madrid (Spain).

Enteric parasites including Giardia duodenalis, Cryptosporidium spp., and to a lesser extent, Blastocystis sp. and Enterocytozoon bieneusi, are major worldwide contributors to diarrhoeal disease. Assessing their molecular frequency and diversity is important to ascertain the sources of infection, transmission dynamics, and zoonotic potential. Little molecular information is available on the genotypes of these pathogens circulating in apparently healthy children. Here, we show that asymptomatic carriage of G. duodenalis (17.4%, 95% CI: 15.5–19.4%), Blastocystis sp. (13.0%, 95% CI: 11.4–14.8%), and Cryptosporidium spp. (0.9%, 95% CI: 0.5–1.5%) is common in children (1–16 years; n = 1512) from Madrid, Spain. Our genotyping data indicate that; (i) the observed frequency and diversity of parasite genetic variants are very similar to those previously identified in Spanish clinical samples, so that the genotype alone does not predict the clinical outcome of the infection, (ii) anthroponotic transmission accounts for a large proportion of the detected cases, highlighting that good personal hygiene practices are important to minimizing the risk of infection, (iii) Blastocystis ST4 may represent a subtype of the parasite with higher pathogenic potential, and (iv) Enterocytozoon bieneusi does not represent a public health concern in healthy children.

Molecular and epidemiological characterization of Giardia Intestinalis assemblages detected in Djelfa, Algeria.

Giardia intestinalis is a flagellated protozoan that lives and proliferates in the small intestine of the host causing giardiasis. The route of transmission is the fecal-oral route, either directly or indirectly. Limited genetic information on G. intestinalis is known in Algeria. This study aimed to estimate the prevalence of G. intestinalis assemblages in the city of Djelfa. A total of 355 fecal samples were collected from symptomatic and asymptomatic school children aged ranged between 6 and 11years old. Genotyping was done to the Giardia positive samples (n = 30) targeting the beta-giardin gene by applying PCR/RFLP assay. Our data showed that most of the cases were asymptomatic (56.7%). Co-infection with other intestinal parasites was found in 16.6% of cases. We obtained 28/30 positive PCR products while two samples only showed false-negative results, and only 20 samples have shown strong PCR products suitable for RFLP analysis. Assemblage A (70%) was more prevalent than assemblage B (30%) and was more expressed by signs than assemblage B. Moreover, only assemblage A was associated with close contacts with domestic animals and birds. In conclusion, this study gave the first molecular data on G. intestinalis isolates in the city of Djelfa. Further expanded studies using more genes and covering other cities in Algeria are mostly needed.

Screening asymptomatic school children for early asthma by determining airway narrowing through peak expiratory flow rate measurement.

BACKGROUND:Peak expiratory flow rate (PEFR) is widely used as a predictor of treatment of asthma patients. Peak expiratory flow and forced expiratory volume in first second (FEV1) are the most useful parameters for the diagnosis of asthma. Spirometry is not often available in the primary care setting, and economic factors may limit its testing. Mild airway narrowing may be present in asymptomatic children, which can be identified by determining their PEFR. This will enable us to initiate early treatment.MATERIALS AND METHODS:We selected 200 asymptomatic children at the age of 10–15 years without a history of smoking, tuberculosis, or other respiratory illness. A family history about asthmatic symptoms was sought. PEFR values of all children were recorded, and 40 children showed PEFR values less than 80% of their predicted values. To confirm whether the low observed values were because of airway obstruction, their spirometry was performed.RESULTS:Nine out of 47 (19.14%) children from asthmatic families and 31 out of 153 (20.26%) from nonasthmatic families showed PEFR values <80% of the predicted value (P > 0.05). Considering a decrease in the FEV1/forced vital capacity (FVC) ratio to <80% for the diagnosis of obstructive disease, only two out of 35 children were found to have it. Correlation between PEFR and FEV1/FVC ratio was not significant (r = 0.314 and P = 0.065).CONCLUSIONS:Asymptomatic children with low PEFR values may not show abnormal lung functions on spirometry. However, these children, particularly those having the risk of family history of asthma, may be followed for the development of airway obstruction.

Genetic Polymorphisms of Pfcrt K76T and Pfmdr1 N86Y among Asymptomatic School Children in Forest Communities of Ekondo Titi Subdivision along the Cameroon-Nigeria Border Area

Aims: The study sought to quantify Plasmodium infection and molecular markers for chloroquine resistance among asymptomatic school children.&#x0D; Study Design: The study was cross-sectional.&#x0D; Place and Duration of Study: The study was carried out in Ekondo Titi Subdivision near Cameroon's south-western border with Nigeria from March to May and from September to October 2014.&#x0D; Methodology: The prevalence of human Plasmodium species was determined by nested PCR (Polymerase Chain Reaction) using DNA from dried blood spot in six primary schools. A PCR/RFLP analysis (Restriction Fragment Length Polymorphism) was used to determine the prevalence of chloroquine resistance (CQR) associated pfcrt 76T and pfmdr 1 56Y point mutations in Plasmodium falciparum asymptomatic school children.&#x0D; Results: A nested PCR amplifying the 18S small-subunit ribosomal RNA (SSU rRNA) gene of Plasmodium in 205 samples confirmed 76.1% of the isolates as asymptomatic P. falciparum infections, with a substantial proportion 22% of P. malariae infection. Among these, 3.6% were single P. malariae infections and 15.1% were P. falciparum and P. malariae mixed infections. Mixed P. falciparum and P. ovale infections were 2.0%. Of the 156 Plasmodium falciparum, positive samples by species-specific PCR, 107 samples with P. falciparum mono-infection were analyzed for the presence of drug resistant alleles pfcrt 76T and pfmdr1- Y 86. The prevalence of pfcrt 76T mutation (74.6%) was higher than that of the pfmdr1-Y86 mutation (25.4%). Logistic regression analysis of socio-demographic factors predicted no significant association between pfcrt 76T mutation with gender and communities.&#x0D; Conclusions: The results indicated a high prevalence of P. malariae and mixed infection in the area under study. The high-level distribution of the pfcrtT76 observed in the study could be possibly attributed to the fact that CQ remained widely used at the community level more than 14 years after withdrawal.

Comparison of the newer proposed diagnostic score with the World Heart Federation criteria for echocardiographic detection of rheumatic heart disease.

Echocardiography has been found to be a much better screening tool compared to clinical examination for the detection of rheumatic heart disease (RHD) in asymptomatic school children living in the RHD endemic areas. Recently, World Heart Federation (WHF) published echocardiographic criteria for the diagnosis of RHD. The present study was done to compare the performance of the newer proposed, quantitative diagnostic score against the qualitative WHF criteria in a field survey of asymptomatic school children belonging to the district having high prevalence of RHD. 3000 asymptomatic school children studying in rural and urban schools of Bikaner district were screened both by clinical examination and echocardiography performed in parallel. The WHF criteria and the proposed diagnostic score were applied simultaneously for the diagnosis of RHD. A high prevalence of subclinical RHD was found. There was complete agreement between the two sets of criteria for the diagnosis of RHD. However, there was discrepancy in grading the severity of disease. The diagnostic score proved superior to the WHF criteria in grading the disease severity accurately. Diagnostic score captures the disease spectrum of RHD better than WHF criteria and reduces the subjectivity in the diagnosis of RHD.

Screening for celiac disease in school aged children in Croatia

Abstract Background Celiac disease primarily affects small intestine and occurs as an immune-based reaction to dietary gluten in wheat, barley and rye. There has been a significant increase in prevalence and an increase in diagnosis rate due to diagnostic tests improvements. Celiac disease can present with gastrointestinal and non-gastrointestinal abnormalities, but also many individuals may have no symptoms at all. Early diagnosis of celiac disease is essential, because untreated disorder may result in serious complications. The aim of this study was to detect celiac disease in asymptomatic school-aged children and to determine prevalence rate. Methods Cross sectional study was conducted on a sample of 2000 children in school year 2018/2019 in school health service. The sample comprised 15.8% of elementary school first grade population in City of Zagreb, aged 6-7 years. SimtomaX in-vitro rapid screening test was used to detect IgA and IgG deamidated gliadin peptide and/or IgA deficiency. Children with positive tests were referred to clinical diagnostic. Data were analysed by descriptive statistic. Results The study comprised 1404 children (51% girls, response rate 70%). Positive result was found in 5.6% children (42 girls and 37 boys). Up to now, celiac disease was confirmed with duodenal biopsy in 0.5% asymptomatic children (3 girls, 4 boys). Conclusions The results of the study showed prevalence of celiac disease of 0.5% in asymptomatic first grade school children. Children diagnosed with celiac disease require gluten-free diet and follow-up of gastroenterologist, nutritionist and school doctor. The results of the study will be used to raise the awareness and encourage more active search for celiac disease among asymptomatic school children. Key messages Recognition of celiac disease in asymptomatic children reduces risk of complications. Adequate diet for individuals with celiac disease should be ensured from kindergarten through school time.

Screening for Urine Abnormalities Among School Children in Qalubyia

Background Early identification of kidney diseases in children and adolescents is an important initial step in prevention of chronic kidney diseases (CKD). The current study was undertaken to screen asymptomatic school children in Qalubyia governate, Egypt, and to detect the prevalence of renal disorders using urine dipstick method. Aim of Work The purpose of the study was to determine the prevalence of urinary abnormalities by dipstick test (reagent strips) in asymptomatic school children. Patients and Method This cross sectional study, was carried out in Qalubyia Governorate, from September 2018 to February 2019. It comprised (1000) school children of both sexes after obtaining an informed consent from the children's care givers. Ages of the children included in the study ranged from 6 to 12 years and they were 411 males (41.1%) and 589 females (58.9%). Results Out of total 1000 children, 411 (41.1%) were male children and remaining 589 (58.9%) were female students. During the first screening by urine dipstick method, 66 (6.6%) children were found to having urinary abnormalities which were further investigated by confirmatory complete urine analysis. Finally 33 were diagnosed having urinary abnormalities. The prevalence rate of isolated hematuria (IH) was 0.9%; isolated proteinuria (IP) was 0.4%; combined hematuria and proteinuria (CHP) was 0.1% and urinary tract infection (UTI) was 1.8% and Glycosuria was 0.1%. In microscopic urine examination, crystals was found positive in 0.8% of the cases. Abnormality in sonography of kidneys were found in 5 cases. Urine culture results were positive in 8 cases. Conclusions In conclusion, asymptomatic urinary abnormalities might be detected by urine screening program at school age.

Modulation of immune responses by Plasmodium falciparum infection in asymptomatic children living in the endemic region of Mbita, western Kenya

Individuals living in malaria endemic areas become clinically immune after multiple re-infections over time and remain infected without apparent symptoms. However, it is unclear why a long period is required to gain clinical immunity to malaria, and how such immunity is maintained. Although malaria infection is reported to induce inhibition of immune responses, studies on asymptomatic individuals living in endemic regions of malaria are relatively scarce. We conducted a cross-sectional study of immune responses in asymptomatic school children aged 4–16years living in an area where Plasmodium falciparum and Schistosoma mansoni infections are co-endemic in Kenya. Peripheral blood mononuclear cells were subjected to flow cytometric analysis and cultured to determine proliferative responses and cytokine production. The proportions of cellular subsets in children positive for P. falciparum infection at the level of microscopy were comparable to the negative children, except for a reduction in central memory-phenotype CD8+ T cells and natural killer cells. In functional studies, the production of cytokines by peripheral blood mononuclear cells in response to P. falciparum crude antigens exhibited strong heterogeneity among children. In addition, production of IL-2 in response to anti-CD3 and anti-CD28 monoclonal antibodies was significantly reduced in P. falciparum-positive children as compared to -negative children, suggesting a state of unresponsiveness. These data suggest that the quality of T cell immune responses is heterogeneous among asymptomatic children living in the endemic region of P. falciparum, and that the responses are generally suppressed by active infection with Plasmodium parasites.

Urine Analysis as a Screening Tool in Early Detection of Renal Abnormalities in Asymptomatic School Children

Background: Early identification of kidney diseases in children and adolescents is an important initial step in prevention of chronic kidney diseases (CKD). The current study was undertaken to screen asymptomatic school children in Nellore, Andhra Pradesh, and to detect the prevalence of renal disorders using urine dipstick method and associated risk factors. Method: Out of total 1,626 children, 883 (54.31%) were male children and remaining 743 (45.69%) were female students. During the first screening by urine dipstick method, 45 (2.77%) children were found to having urinary abnormalities which were further investigated by confirmatory complete urine analysis. Results: Finally 37 were diagnosed having urinary abnormalities. The prevalence rate of isolated hematuria (IH) was 0.62%; isolated proteinuria (IP) was 0.18%; combined hematuria and proteinuria (CHP) was 0.18% and urinary tract infection (UTI) was 1.23%. Renal stone was the cause in 20% cases while post-infectious golmerulonephritis (PIGN) and IgA nephropathy (IgAN) were the causes of hematuria in 10% cases each. Out of three cases of CHP, two (66.67%) cases were due to PIGN and one was due to membranoproliferative glomerulonephritis (MPGN). Totally 26 cases were confirmed having UTI. Out of these 26 cases, gram-negative bacilli were detected in 11 (42.31%) cases and gram-positive were detected in five (19.23%) cases. The prevalence rate of renal abnormalities among 6 - 7 years, 8 - 9 years, 10 - 11 years and 12 - 13 years students was 2.07%, 2.43%, 2.19 and 2.41% respectively. Out of 889 urban students, 19 were having confirmed renal abnormalities which indicated that the prevalence of renal problem in asymptomatic urban student was 2.14%. Out of 737 rural students, 18 were having confirmed renal abnormalities which indicated that the prevalence of renal problem in asymptomatic rural student was 2.44%. Prevalence of hematuria in male was 0.23 and in female 1.08 and the difference was statistically significant (P < 0.05) which indicated hematuria more in female asymptomatic students compared to male asymptomatic students. Age wise prevalence of IP ranged from 0% in 6 - 7 years age group and 12 - 13 years age group to 0.44% in 10 - 11 years age group. Prevalence of UTIs in male was 0.57 and in female 2.02, and the difference was statistically significant (P < 0.05) indicating that the prevalence of UTIs was significantly more in female asymptomatic students compared to male asymptomatic students. Conclusions: In conclusion, asymptomatic urinary abnormalities might be detected by urine screening program at school age. Further work-up should be offered to define the exact etiology of any abnormal finding. World J Nephrol Urol. 2018;7(1):17-24 doi: https://doi.org/10.14740/wjnu325w

Epidemiology of Helicobacter pylori infection in asymptomatic schoolchildren in Bhutan.

Bhutan is a small mountainous country between Tibet and India with relatively homogenous population. According to the World Health Organization, gastric cancer is the most frequent cause of cancer death in Bhutan. This study examined the prevalence of Helicobacter pylori among children in Bhutan with emphasis on water source and living conditions. A cross-sectional sero-epidemiologic study was conducted among schoolchildren who attended public schools in Thimphu, Bhutan. Between 2015 and 2016, blood samples from schoolchildren were collected after obtaining an informed consent from the school management and the children's parents. Demographic information, parents' education, family size living in the same household, and aspects of household environment including type of latrines, boiling drinking water were collected. All serum samples were tested for H.pylori immunoglobulin G (IgG) by commercial ELISA kits. There were 327 children between 4 and 19years of age participated, 44% boys, mean age=13.6±3years. The overall prevalence of H. pylori was 66% with no difference between boys and girls (66 vs 64%, respectively), P=.42. H. pylori prevalence was 75% among both 4-7 and 15-19years and not statically different from that of the 8-10 or 11-14 age groups (59% and 63%, respectively), P=.1. H. pylori prevalence was inversely correlated with the level of mother's education (70% vs 55%) for those without and with a college education, respectively (OR=2.3; 95%CI=0.9-1.7), P=.08. The total number of people living in the same household did not correlate with H. pylori sero-prevalence, but households had less than 3 children had lower prevalence than those with 3 or more children (62% vs 71%, respectively OR=1.7, 95% CI=[1.0-2.6], P=.05). H. pylori infection is prevalent among all age group children in Bhutan. The results suggest that transmission of H. pylori is related to personal care practices that directly correlate with the mothers' education and crowded living condition with children. Our results are important to developing prevention strategies for gastric cancer in Bhutan.