Awareness Of Pediatricians Research Articles

Thirdhand Smoke Exposure Ignored by Pediatricians: A Cross-sectional Study.

Thirdhand smoke (THS) is defined as the harmful substances in cigarette smoke that are absorbed into objects, people, and surfaces after smoking. This study aimed to determine the level of awareness of pediatricians working in a tertiary healthcare institution about THS exposure. In this cross-sectional study, participants were asked to fill out an information form in which we questioned the participant's age, sex, occupation in the institution, the exposure of pediatric patients to cigarette smoke during daily healthcare, tobacco product use status, smoking status in their home and car, behavior in case of smoking in closed areas where smoking is prohibited, and whether they knew the term of THS. Also, the Turkish version of The Beliefs About Third-Hand Smoke was used. Eighty-one participants, with a mean age of 34.2 ± 7.6 years, were included in the study. Fifty-six (69.1%) participants said they had never used tobacco products. Participants who had never used tobacco products (P = .005), never allowed smoking in their homes (P = .017) and cars (P = .001), had heard the definition of THS before (P = .013), and thought they knew it (P = .005) had higher total scale scores. There was no significant difference between the THS awareness levels of pediatricians who questioned children's exposure to cigarette smoke in their daily practice and those who did not (P = .491). Determining the awareness levels of pediatricians about THS will be an important step in preventing THS exposure in children.

Knowledge and awareness of pediatricians about early interventions performed by pediatric dentists in the management of cleft lip and palate – A questionnaire-based study

ABSTRACT Background and Introduction: Cleft lip and palate (CL/P) is one of the most common congenital anomalies which require multidisciplinary care. Patients with CL/P require appropriate corrective treatment to improve health, function, and esthetics. Knowledge about the various treatment procedures available and the timing of the procedures among pediatricians is vital for them to refer the patient at the correct stage to the appropriate specialist for the best possible rehabilitation. Aim: The aim of this study was to evaluate the knowledge and awareness of pediatricians about early interventions performed by pediatric dentists in the management of CL/P. Materials and Methods: A closed-ended questionnaire that included questions regarding the knowledge and awareness of obturators, lip taping, and nasoalveolar moldings was formulated. A questionnaire with 20 questions was circulated among the pediatricians through a web-based portal. Their knowledge and awareness about early interventions performed by pediatric dentists in the management of CL/P were assessed. Results: Results showed that out of 323 pediatricians who participated in the survey, 99.4% had heard of obturators. Awareness about lip taping was 78.3% while that of nasoalveolar molding was 55.1%. The benefits of the procedure and appliance were not well known. Conclusion: To improve the health, psychological, and social support of patients with CL/P, more awareness needs to be created among pediatricians regarding the management to provide better and timely oral rehabilitation.

Pediatricians’ Awareness and Knowledge of Young Children’s Oral Health: A Cross Sectional Study

Background: Most childhood oral diseases can be prevented, and the indispensable role of pediatricians in childcare uniquely positions them to champion standard oral and dental healthcare for children. This study aimed to evaluate the knowledge, attitudes, and awareness of pediatricians regarding early childhood caries (ECC), oral health, and the treatment needs of their young patients. Subject & Methods: A total of 449 pediatricians were randomly shared in an online self-reported cross-sectional survey which covered personal details, their approach to pediatric dentistry, and their knowledge of oral health. Results: Importantly, 67.9% of surveyed pediatricians recognized the significance of pediatric dentistry, and 88.9% reported conducting regular oral examinations. However, only 22.3% demonstrated familiarity with ECC, and a mere 5.6% acknowledged the cariogenic nature of medicated syrups. All pediatricians who participated in this study did not advise bottle feeding, nearly 91.75% of the pediatricians could relate the importance of breastfeeding and oral health, 60.1% of pediatricians reported that health education should be given to mothers about nursing caries starting early in life. Conclusion: The study highlights a notable deficiency in the surveyed pediatricians' knowledge concerning ECC, oral health, and the dental treatment needs of children. The identified knowledge gaps emphasize the imperative for pediatricians to enhance their understanding by staying current with recent recommendations. Continuous education initiatives, workshops, or other professional development avenues are essential for pediatricians to address these deficiencies effectively, enabling them to contribute significantly to the standardization of oral and dental healthcare for children and ultimately promoting improved overall health outcomes.

Williams Syndrome: A Rare Case Report

We report a rare case of Williams Syndrome diagnosed at an age of two months based on subtle facial dysmorphism (elfin facies) and a pulmonary systolic murmur at birth. Echocardiogram revealed mild supravalvular aortic stenosis and mild supravalvular pulmonary stenosis extending into branch pulmonary arteries. Mild developmental delay, hypotonia, feeding problems, constipation and failure to thrive were present. In view of distinctive facial phenotype in combination with cardiac abnormalities, Williams Syndrome was strongly suspected. It was confirmed by fluorescence in situ hybridisation test demonstrating a deletion of elastin gene on chromosome 7. This case highlights the importance of pediatricians awareness about malformation syndromes which can help in early diagnosis, timely genetic counselling to the family and better patient outcomes.

Use of Genetically Modified Organism (GMO)-Containing Food Products in Children.

Families increasingly raise questions about the use of genetically modified organism (GMO)-containing food products. These products are widely found in the US food supply but originate from a narrow list of crops. Although GMO technology could be used to increase the micronutrient content of foods, this does not occur in the United States; instead, GMO technology has been used to make crops resistant to chemical herbicides. As a result, herbicide use has increased exponentially. The World Health Organization's International Agency on Research for Cancer has determined that glyphosate, an herbicide widely used in producing GMO food crops, is a probable human carcinogen. Measurable quantities of glyphosate are detected in some GMO foods. Families who wish to minimize GMO food products can do so by focusing on a dietary pattern of primarily whole, plant-based foods while minimizing ultra-processed foods. Pediatricians play a vital role in their efforts to minimize fear-based messaging and support families through shared decision-making. Pediatrician awareness of GMO labeling can guide individualized conversations, particularly that non-GMO labeling does not indicate organic status and that increased cost of some non-GMO foods, especially if also organic, may limit this choice for many families.

Analysis of disease spectrum for abnormal 3-hydroxyisovalerylcarnitine metabolism identified through newborn screening and clinical diagnosis

To explore the disease spectrum for abnormal 3-hydroxyisovalerylcarnitine (C5OH) metabolism identified through newborn screening and clinical diagnosis patients and the key points for differential diagnosis so as to raise the awareness of pediatricians for such diseases. Clinical data of 85 neonates with abnormal C5OH metabolism identified from February 2004 to January 2022 at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were collected. Their clinical manifestations and results of tandem mass spectrometry (MS/MS), gas chromatography mass spectrometry (GC-MS) and genetic testing were retrospectively analyzed. Among the 85 cases, 46 (54.1%) were identified by neonate screening, whilst 39 (45.9%) were clinically diagnosed patients. Five diseases were diagnosed, including 28 cases with multiple carboxylase deficiency (MCD, 32.9%), 29 cases with 3-methylcrotonyl-coenzymeAcarboxylasedeficiency (MCCD, 34.1%), 4 cases with 3-methylglutaconic acid (3-MGA, 4.7%), 7 cases with 3-hydroxy-3-methylglutaric acid (3-HMG, 8.2%), and 17 cases with beta-ketothiolase deficiency (BKD, 20.0%). The disorders were characterized by sudden onset, anorexia, vomiting, diarrhea, abnormal breathing, consciousness disorder, spasm and developmental delay. Among newborns with abnormal C5OH metabolism, MCCD is the most common disorder, which was followed by BKD and MCD. For patients with abnormal C5OH metabolism, MCD is the most common, followed by BKD and 3-HMG. C5OH related diseases have great heterogeneity. Combination of blood acylcarnitine levels, urinary organic acid levels and genetic testing based on clinical characteristics can help to attain the diagnosis.

Perspective of pediatricians about early childhood caries (ECC) in lumbini province Nepal: A major virulent dental problem

Early childhood caries (ECC) is a significant worldwide oral health problem that needs to be looked after by parents. Some parents do not care about the oral health of their children, and they more frequently visit pediatricians. So, pediatricians are one of the most reliable profession for preventing children’s oral diseases, and promoting awareness. The aim of the study was to know the knowledge and awareness of pediatricians’ about early childhood caries (ECC) in lumbini province, Nepal.A total of 40 pediatricians were selected by using census sampling method and were requested to fill out an objective questionnaire pertaining to individual’s knowledge about ECC, without providing any oral health information taking duration of the study from March 2021 to September 2021.About 23(56.5%) of pediatricians understood the importance of pediatric dentistry. About 34(86.2%) of pediatricians performed oral examination regularly. Around 17% of pediatricians had knowledge of the ECC. Only 14(33.3%) of pediatricians acknowledged the cariogenicity of sugar containing medical syrups.The study shows poor knowledge regarding ECC, oral health, and dental treatment need in children among the surveyed pediatricians although having good knowledge about pediatric speciality and importance of primary dentition. Thus, there is a need to update the Pediatricians on recent recommendations about ECC and its early screening.

Роль педіатра у формуванні зубощелепної системи та збереженні стоматологічного здоров’я дітей

Purpose - to analyze the role of the pediatrician in the formation of the dentition and the preservation of dental health in children, reviewing world research on this topic. The data of scientific literature on the awareness of pediatricians in the prevention of children's oral health diseases and timely referral to a pediatric dentist are analyzed. Untreated tooth decay is known to negatively affect a child's overall health and well-being, causing pain, impairing the ability to bite and chew, and thus affecting weight gain and growth, self-esteem, and communication skills. Chronic pain and discomfort caused by dental caries also negatively affects cognitive development and is associated with school absenteeism and lack of concentration. Since the youngest children visit pediatricians much more often than dentists, it is very important that pediatricians have the appropriate knowledge of the development and progression of caries, the principles of its prevention, and ways to maintain and improve the child's oral health. The cooperation of a pediatric dentist, parents and pediatrician is a three-way process for the sake of a child's oral health. Most studies have shown that pediatricians have insufficient knowledge of caries and its transmission, and that pediatricians have limited knowledge and understanding of the initial clinical signs of caries, the recommended age for the first visit to the dentist, the etiology of caries, and recommendations for the use of fluoride toothpastes. No conflict of interests was declared by the authors.

Mitochondrial Fatty Acid Beta-Oxidation Disorders in Children: Literature Review

Congenital mitochondrial fatty acid beta-oxidation disorders are a heterogeneous group of metabolic disorders characterized by impaired fatty acid metabolism in mitochondria. It results in central nervous system, skeletal muscle, cardiovascular system, and liver damage, as well as the development of nonketotic hypoglycemia. The age of disease manifestation and its severity range from severe (neonatal) to milder myopathic (adult) forms. The extension of the mass screening program in Russian Federation allows to detect these diseases during the first weeks of life. The availability of effective therapy for mitochondrial fatty acid beta-oxidation disorders, especially during early diagnosis, enables timely stabilization of the patient's condition and prevention of severe complications. Awareness of pediatricians, neonatologists, neurologists, and cardiologists about such diseases is the urgent task of modern pediatrics.

Prevalence, Risk Factors, and Pediatrician Awareness of Infant Dyschezia in Indonesia.

This study aimed to evaluate the prevalence and risk factors of infant dyschezia as well as pediatrician awareness regarding this disease in Indonesia. This is a two-part cross-sectional study, which was divided into study A and B. Study A: Parents whose infants were under 9 months old and attended well-baby clinics were recruited at two randomly selected primary health centers. Parents also provided information on the infant's previous medical history, and socio-demographic and family details. The Rome IV criteria was translated and validated to be used for diagnosis of infant dyschezia. Study B: Randomly selected pediatricians were surveyed by using a questionnaire to evaluate their knowledge regarding infant dyschezia. The prevalence of infant dyschezia based on the result of this study was 11.8%. Three risk factors had a significant relationship with infant dyschezia i.e., the number of children in the family (odds ratio [OR], 5.619; 95% confidence interval [CI], 2.194-14.390; p<0.001), complementary food diet (OR, 4.238; 95% CI, 1.902-9.443; p<0.001), and social-emotional disturbance (OR, 5.670; 95% CI, 2.550-12.609; p<0.001). The percentage of pediatricians correctly diagnosed infant dyschezia was 71.5%. Most pediatricians agreed that they did not perform any diagnostic testing (79.7%) and only provided education in cases of infant dyschezia (58.5%). The prevalence of infant dyschezia identified in our study was higher than that in other neighboring Asian countries, with the highest prevalence observed in infants 7-9 months old. Being an only child, receiving complementary food diet, and sociao-emotional disturbances were significant risk factors of infant dyschezia.

Синдром втомлюваності після перенесеної вірусної хвороби. Постковідна екзантема інфікована. Іхтіоз шкіри ніг. (Клінічний випадок)

The COVID-19 pandemic has posed many challenges to the medical community, a number of which will remain in the near future. Analysis of clinical cases helps to identify problems, to plan future research, which can change the understanding of the consequences of the disease. As the first year of the pandemic progresses, there is a better understanding of the pathophysiology of the virus and the varied results of imaging COVID-19 in affected organs, which is crucial for improving the treatment of this complex disease and improving health outcomes. It is described a clinical case of exanthema in an 11-year-old patient after COVID-19. Clinical and immunological methods of investigation are used. The child’s condition was of the moderate severity, caused by skin and asthenovegetative syndromes. The child was diagnosed with COVID-19; fatigue syndrome after a viral illness; post COVID-19 exanthema infection crustal ichthyosis of the legs. A particular feature of this case is the occurrence of exanthema on the skin of the child after COVID-19. In these cases, the awareness of pediatricians should be raised to increase the level of knowledge of the correct diagnostic algorithm. No conflict of interests was declared by the authors.

RETRACTED: Pediatricians' Knowledge of Children's Oral Health: A National Survey

A high percentage of dental caries (∼70%) was reported amongst 4- and 5-year-old Kuwaiti kindergarten children. Parents contact paediatricians several times during the child's early life. Paediatricians can play an important role in improving the oral health of their patients. The objective of the study is to evaluate the knowledge level and awareness of paediatricians and paediatric residents regarding children's oral health in Kuwait. A national cross-sectional survey was distributed to paediatricians and paediatric residents practicing in Kuwait. Data concerning demographic variables, knowledge on dental caries preventive measures, current anticipatory guidance, and experience with dental problems and oral care were collected using online and paper-based surveys. A total of 230 participants completed the survey, with a response rate of 50.1%. Most respondents (81%) had frequently noticed dental caries in children in their practice. Two-thirds of respondents felt confident in detecting dental caries. However, more than two-thirds were unfamiliar with preventive dental practices and the management of dental trauma. Only 16.5% of the respondents got a satisfactory knowledge score on the preventive measure questions, and nearly 51% had satisfactory knowledge on the recent anticipatory guidance questions. No significant correlations were found between gender or years of practice and knowledge scores. Respondents' confidence in detecting caries was significantly associated with the knowledge score of the anticipatory guidance (P=.003). Fewer than half of the respondents considered prescribing sugar-free syrup (47.4%) and counselled patients regarding the use of mouthguards during sports for schoolchildren (39%). The majority of paediatricians have adequate knowledge of the current anticipatory guidance of oral health issues, but they have insufficient knowledge of oral preventative measures and dental trauma. Adequate education and training in oral health are highly recommended.

Malignant Hyperthermia and Absence of Ryanodine Receptors in a Child Presenting for Ptosis Repair

Introduction: Malignant hyperthermia (MH) is a hypermetabolic condition caused by a genetic cell membranes channel disruption leading to increased calcium release from the sarcoplasmic reticulum after exposure to triggering agents. Central Core Disease (CCD) is a rare inherited neuromuscular disorder with a wide spectrum of phenotypic presentations. Clinically, there is muscle weakness of variable degree and histopathologically there is evidence of core formation in the muscle fibers. Additional features may occur, including skeletal abnormalities such as foot deformities, scoliosis, or hip displacement. Association of CCD with a mutation of the ryanodine receptor RYR1 and MH is high. If not properly treated, MH could be fatal. Purpose: This study aims towards increasing the awareness of pediatricians, surgeons and anesthesiologists about possible occurrence of MH in patients presenting with only mild “clinical” signs of congenital myopathies such as CCD. Careful diagnostic investigations should be performed prior to surgical interventions and extreme caution during anesthesia. Material and Methods: We report the case of a 3 years old girl, with a history of ptosis, scoliosis, and good muscle tone, who developed unexpected MH during the surgical repair of her ptosis. The critically ill child was transferred to Pediatric Intensive Care Unit (PICU) for management of her MH. The management was done following the guidelines of the European Malignant Hyperthermia Group published in the British Journal of Anesthesia 2010. The patient responded well to treatment. She had a muscle biopsy done after recovery. Discussion: Early management and dantrolene administration are the most important factors to minimize MH morbidity and mortality. MH susceptibility is known in patients carrying mutations in the RYR1 receptors. In our case, RYR1 staining was negative on the muscle biopsy specimen suggesting abnormal or absent RYR1 function, with the presence of occasional cores. These findings, in addition to the ophthalmological and orthopedic history were diagnostic of CCD. In Vitro Contracture Testing (IVCT) was not done because it was not available. Genetic testing was refused by the parents due to financial reasons. Conclusion: In patients presenting with symptoms suggestive of muscle weakness, such as ptosis and scoliosis, and variable muscle tone; congenital myopathies should be considered. CCD and RYR1 receptors deficiency or mutation, if present, may lead to a possible risk of fatal MH, which can be prevented.

АБДОМИНАЛЬНАЯ АТАКА В ДЕБЮТЕ НАСЛЕДСТВЕННОГО АНГИООТЕКА У ДЕВУШЕК С ПЕРВИЧНОЙ ДИСМЕНОРЕЕЙ НА ФОНЕ ТЕРАПИИ КОМБИНИРОВАННЫМИ ОРАЛЬНЫМИ КОНТРАЦЕПТИВАМИ

Hereditary angioedema (HAE) is an orphan potentially life-threatening disease characterized by recurrent edema of the skin, mucous/submucosal membranes and is genetically determined. In most cases, there are peripheral edemas and manifestations of marginal erythema at the onset of the disease, much less often - abdominal syndrome. Among patients with HAE, there is a clear predominance of women. In this regard, girls in puberty with primary dysmenorrhea and various menstrual disorders are of particular interest. In the treatment of adolescent girls suffering from these nosologies, combined oral contraceptives (COCs) are often used. The debut of manifestations of HAE in the form of severe abdominal attacks in girls with dysmenorrhea during COC therapy has not yet been described. The article presents descriptions of cases of patients with the outset of HAE in the form of abdominal attacks that developed against the background of treatment of primary dysmenorrhea with COCs. The importance of awareness of pediatricians, pediatric surgeons, gynecologists and doctors of other profiles about this nosology is demonstrated using the examples of these clinical cases’ data.

Knowledge and Awareness of Pediatricians About Rotavirus Infection and Vaccine

Knowledge and Awareness of Pediatricians About Rotavirus Infection and Vaccine

Knowledge and Awareness of Pediatricians About Rotavirus Infection and Vaccine

Knowledge and Awareness of Pediatricians About Rotavirus Infection and Vaccine

Current Recommendations on the Management of Pediatric Asthma and Allergic Rhinitis during the COVID-19 Pandemic versus Real-Life Practice

Introduction: Several statements and position papers on the management of childhood asthma and allergies during the COVID-19 pandemic have been published of late. The aim of this study was to evaluate the knowledge and awareness of pediatricians and family physicians regarding the management of asthma and allergic rhinitis during the pandemic according to recently published updated guidelines. Method: We conducted an online survey among pediatricians and family physicians in Turkey, using a questionnaire designed to evaluate 4 items: (1) the relationship between COVID-19 infection risk and pediatric asthma/allergic rhinitis and medications used in treatment; (2) the follow-up and management of asthma/allergic rhinitis according to published updated recommendations; (3) pediatricians’ and family physicians’ observations and perceptions of treatment compliance and the attitudes of their pediatric asthma patients; and (4) pediatricians and family physicians’ attitudes to using telehealth in the follow-up and management of pediatric asthma patients during the pandemic. Results: A total of 346 participants responded to the survey. The relationship between the risk of COVID-19 and asthma was known by less than 25% of the participants. More than 33% of family physicians and 20% of pediatricians were unaware that asthma medication does not lead to a susceptibility to COVID-19 infection; 55% of family physicians and 48% of pediatricians thought that patients showed better compliance with asthma controller medication; over 33% of pediatricians and approximately 50% of family physicians stated that they could not distinguish between an asthma attack and lung involvement in COVID-19 infection; of the respondents, over 75% stated that they prefer face-to-face visits with patients, even in situations that do not require a physical examination. Conclusion: The overall knowledge and awareness of pediatricians and, especially, family physicians regarding the management of pediatric asthma/allergic rhinitis during the pandemic is not at a satisfactory level. There is an urgent need to inform them about updated recommendations appearing in recent guidelines published by allergy organizations.

THE RETROSPECTIVE EVALUATION OF CASES DIAGNOSED WITH KAWASAKI DISEASE

Aim: Kawasaki disease (KD) is an acute febrile disease of childhood with vasculitis. We aimed to evaluate the epidemiological and clinical characteristics of KD cases diagnosed and treated in the Pediatric Clinic of our hospital in the last decade. Material and Method: Forty five patients diagnosed with KD and treated between 01 January 2010 and 01 January 2020 was included in the study. The demographic characteristics, clinical and laboratory findings, and treatment processes of the patients were evaluated retrospectively. Results: Of the 45 patients 23 (51.2%) were male. The mean age was 35.26 ± 28.16 months. The average duration of fever was 7,16±3.5 day. The patients were most frequently admitted in the spring (31.1%; 14 patients), and winter (31.1%; 14 patients). Twenty two (71.1%) of the patients diagnosed as complete KD, 13 (28.8%) patients were diagnosed as incomplete KD. While coronary involvement was present in 16 patients (35.5%), 29 patients (64.4%) didn’t. The mean platelet count was higher in patients with coronary involvement (p=0.006). Conclusion: Cardiac involvement was observed at a rate of 35.5%. Platelet levels were higher in those with cardiac involvement. Considering that the platelet level increases in the subacute period in KD, it can be inferred as a result of an increase in cardiac involvement in patients who were admitted to the hospital late. Therefore the awareness of pediatricians about incomplete KD forms should be increased in addition to KD.

Direct Oral Anticoagulants: Overcoming the Challenges of Managing Venous Thromboembolism in Children

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism, is relatively common among adults, with estimated incidence rates ranging from approximately 10 to 1200 per 100 000 adults aged ≥30 years. 1 Raskob G.E. Angchaisuksiri P. Blanco A.N. Büller H. Gallus A. Hunt B.J. et al. Thrombosis: a major contributor to global disease burden. Semin Thromb Hemost. 2014; 40: 724-735 Crossref PubMed Scopus (73) Google Scholar VTE is less common in children than in adults, with estimated incidence rates ranging from 0.7 to 4.9 per 100 000 children. 2 Andrew M. David M. Adams M. Ali K. Anderson R. Barnard D. et al. Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood. 1994; 83: 1251-1257 Crossref PubMed Google Scholar , 3 van Ommen C.H. Heijboer H. Büller H.R. Hirasing R.A. Heijmans H.S. Peters M. Venous thromboembolism in childhood: a prospective two-year registry in The Netherlands. J Pediatr. 2001; 139: 676-681 Abstract Full Text Full Text PDF PubMed Scopus (517) Google Scholar , 4 Stein P.D. Kayali F. Olson R.E. Incidence of venous thromboembolism in infants and children: data from the National Hospital Discharge Survey. J Pediatr. 2004; 145: 563-565 Abstract Full Text Full Text PDF PubMed Scopus (237) Google Scholar , 5 Tuckuviene R. Christensen A.L. Helgestad J. Johnsen S.P. Kristensen S.R. Pediatric venous and arterial noncerebral thromboembolism in Denmark: a nationwide population-based study. J Pediatr. 2011; 159: 663-669 Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar However, it can have serious consequences, such as death, recurrence of thrombosis, loss of vessel patency required for future intravascular cannulation or organ transplantation, chronic pulmonary hypertension, or post-thrombotic syndrome. 2 Andrew M. David M. Adams M. Ali K. Anderson R. Barnard D. et al. Venous thromboembolic complications (VTE) in children: first analyses of the Canadian Registry of VTE. Blood. 1994; 83: 1251-1257 Crossref PubMed Google Scholar ,6 Goldenberg N.A. Donadini M.P. Kahn S.R. Crowther M. Kenet G. Nowak-Göttl U. et al. Post-thrombotic syndrome in children: a systematic review of frequency of occurrence, validity of outcome measures, and prognostic factors. Haematologica. 2010; 95: 1952-1959 Crossref PubMed Scopus (137) Google Scholar , 7 Greene L.A. Goldenberg N.A. Deep vein thrombosis: thrombolysis in the pediatric population. Semin Intervent Radiol. 2012; 29: 36-43 Crossref PubMed Scopus (18) Google Scholar , 8 Pelland-Marcotte M.C. Tucker C. Klaassen A. Avila M.L. Amid A. Amiri N. et al. Outcomes and risk factors of massive and submassive pulmonary embolism in children: a retrospective cohort study. Lancet Haematol. 2019; 6: e144-e153 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar Despite its relative rarity, the incidence of pediatric VTE has increased in recent years. 5 Tuckuviene R. Christensen A.L. Helgestad J. Johnsen S.P. Kristensen S.R. Pediatric venous and arterial noncerebral thromboembolism in Denmark: a nationwide population-based study. J Pediatr. 2011; 159: 663-669 Abstract Full Text Full Text PDF PubMed Scopus (61) Google Scholar ,9 Sandoval J.A. Sheehan M.P. Stonerock C.E. Shafique S. Rescorla F.J. Dalsing M.C. Incidence, risk factors, and treatment patterns for deep venous thrombosis in hospitalized children: an increasing population at risk. J Vasc Surg. 2008; 47: 837-843 Abstract Full Text Full Text PDF PubMed Scopus (127) Google Scholar ,10 Carpenter S.L. Richardson T. Hall M. Increasing rate of pulmonary embolism diagnosed in hospitalized children in the United States from 2001 to 2014. Blood Adv. 2018; 2: 1403-1408 Crossref PubMed Scopus (38) Google Scholar This increase is considered related to a number of factors, including the increased use of central venous catheters (CVCs), improved survival rates for children with chronic or critical conditions, and more frequent VTE diagnoses through improved pediatrician awareness and imaging techniques. 11 Raffini L. Huang Y.S. Witmer C. Feudtner C. Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001 to 2007. Pediatrics. 2009; 124: 1001-1008 Crossref PubMed Scopus (569) Google Scholar ,12 Malec L. Young G. Treatment of venous thromboembolism in pediatric patients. Front Pediatr. 2017; 5: 26 Crossref PubMed Scopus (18) Google Scholar First to the public, next to youThe Journal of PediatricsVol. 240PreviewThanks to direct-to-consumer marketing, snappy jingles, familiar spokespeople, and ubiquitous slogans, you are probably familiar with some direct oral anticoagulants (as well as any number of other classes of medications), such as rivaroxaban (Xarelto) and apixaban (Eliquis). You might not have focused on their use, however, since they were initially developed for use in adults. This volume of The Journal includes a Medical Progress report on direct anticoagulants (DOACs) for use in children with venous thromboembolism, including data from the latest trials and projected approval by the US Food and Drug Administration. Full-Text PDF

Urogenital tuberculosis in children 0 - 14 years old in the structure of other localizations of tuberculosis

Introduction. Extrapulmonary tuberculosis (EPTB) still has many features: there is a different approach to its definition in different countries, there is no screening, diagnosis is extremely difficult and requires financial costs, and bacteriological verification does not exceed 46%, complex restorative and reconstructive operations are used in treatment. the proportion of patients with isolated extrapulmonary localizations among tuberculosis patients is low.Purpose of the study. To study the structure of tuberculosis (TB) in children with the accentuation of EPTB in the current conditions to determine the development areas of preventive and diagnostic measures.Materials and methods. A retrospective two-stage study was carried out in the period from 1989 to 2018 among in-patient children aged 0 - 14 yrs. At the first stage, the structure of clinical forms of TB was assessed in 2306 children. Three comparison groups were formed following ten-year periods. At the second stage, 4 groups were identified according to age: early age, preschool age, primary school age, prepubertal age. The data obtained in the course of the study were statistically processed using the Microsoft Office 2007 (Microsoft Corp., USA) and Biostat 2009 (AnalystSoft Inc., USA) software package. The differences between the groups were determined using the χ2 test, and significant differences were considered when the value of the p &lt; 0.05 criterion.Results. It was found that throughout the entire observation period in the region, the predominant localization of the specific process was respiratory TB. The proportion of isolated extrapulmonary lesions in children decreased from 11.1% in the period from 1999 to 2008 to 3.4% in the period from 2009 to 2018 (p = 0.000). At the same time, the most frequent localization (60.4 - 77.8% of cases) among EPTB remains urinary TB. In the dynamics from 1989 to 2018, the number of cases of the disease with combined forms of tuberculosis increased (from 3.1% to 7.2%; p = 0.000), mainly due to the establishment of several localizations of the lesion. The frequency of bacteriological confirmation of the diagnosis was significantly different at various localizations of the specific process. In children of the compared periods of childhood, the predominant localization of the specific process was isolated respiratory TB. The isolated extrapulmonary process localizations were more common in the age groups 7 - 11 and 12 - 14 yo, where it accounted for 10.8 - 12.4% of TB cases (p = 0.000). The localization of the EPTB also depended on the children's age. So, young children often developed damage to the osteoarticular system, in preschool children - the genitourinary and lymphatic (peripheral lymphadenopathy) systems, in younger schoolchildren and preschoolers - the genitourinary system. The frequency of bacteriological confirmation of the EPTB increased with the age. The combined forms of a specific process were more often observed in the age group of 7 - 11 yo, in the other groups their share was 77.4%, 87.1%, and 95.0% of cases. Respiratory TB and TB of other organs was confirmed bacteriologically more often in the age group 7 - 11 yo (19.4%), and in the group 12 - 14 yo in 12.9%, 4 - 6 yo in 10.0%, early age in 9.7%, which is much more frequent than confirmation of isolated respiratory TB.Conclusions. EPTB in children has not lost its position and due to the widespread introduction of the recombinant TB allergen and CT into clinical practice. It has become more often detected in combination with respiratory TB. Among the EPTB, genitourinary tuberculosis prevailed, which can be verified in contrast to damage to other organs. Raising the level of awareness of paediatricians and phthisiatrician-paediatricians about the frequency of EPTB occurrence makes it possible to form alertness in terms of the possibility of their development and to timely detect the disease at an early stage.