Clinical Characteristics Of Children Research Articles

Response to Letter to the Editor: Clinical Characteristics of Children with Acute Post-Streptococcal Glomerulonephritis and the Re-Evaluation of Patients with Artificial Intelligence

Response to Letter to the Editor: Clinical Characteristics of Children with Acute Post-Streptococcal Glomerulonephritis and the Re-Evaluation of Patients with Artificial Intelligence

Hospital-based cross-sectional study on the clinical characteristics of children with severe acute respiratory infections in Hungary

BackgroundSevere acute respiratory infection (SARI) is a major cause for hospital admission and associated with high mortality among children worldwide. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza viruses and respiratory syncytial virus (RSV) are the most frequently identified pathogens in children with SARI. The duration of care can be affected by the type of infection and patient characteristics. Therefore, the objective of this study was to identify factors affecting the length of hospitalization in children infected with SARS-CoV-2, influenza A and RSV.MethodsWe collected data on 713 children with SARI from the medical databases of a university hospital in Hungary. To examine whether there is a difference in the length of hospitalization in children with the SARI Kruskal-Wallis test was performed. To determine the factors that may have an impact on the duration of care a multiple logistic regression analysis was executed.ResultsOur results showed that among RSV infected patients the proportions of children requiring intensive care (8.94%), mechanical ventilation (8.94%) and oxygen therapy (13.01%) and suffering from pneumonia (29.27%) were larger than among cases with SARS-CoV-2 and influenza A infection. Considering the age distribution and the duration of care in children with SARI, cases with RSV were significantly younger (p < 0.001) and stayed longer in the hospital (median: 5 days, IQR: 4–7 days, p < 0.001) than those with SARS-CoV-2 and influenza A virus. Multiple logistic regression analysis showed that RSV infection (adjusted odds ratio (aOR): 3.25, 95% confidence interval (CI): 1.43–7.38; p = 0.005), pneumonia (aOR: 3.65, 95% CI: 2.14–6.24; p < 0.001), mechanical ventilation or oxygen therapy (aOR: 3.23, 95% CI: 1.29–8.11; p = 0.012) and underlying illnesses (aOR: 2.39, 95% CI: 1.35–4.23; p = 0.003) significantly increased the odds of hospitalization for more than 4 days.ConclusionsOur research showed that of the viruses causing SARI, RSV had the greatest clinical relevance, contributing to hospital stays of more than 4 days in a large share of paediatric patients below 1 year of age. Our results supply new information on children with SARI, and provide evidence for health policy makers to allocate additional resources to hospitals during SARI epidemics.

Frequency and clinical characteristics of children and young people with type 2 diabetes at diagnosis from five world regions between 2012 and 2021: data from the SWEET Registry.

The diagnosis of type 2 diabetes is increasing in young people worldwide. This study evaluated the frequency and clinical characteristics of young people presenting with type 2 diabetes from the multinational SWEET e.V Registry 2012-2021, including the first years of the COVID-19 pandemic. This is a longitudinal observational study based on the SWEET Registry, which collects demographic and clinical data on children and adolescents with diabetes from centres worldwide, with the diagnosis and classification of diabetes provided locally by each centre according to International Society for Paediatric and Adolescent Diabetes definitions. By July 2022, the SWEET Registry included 96,931 individuals from 130 centres with a total of 1,154,555 visits. Data were analysed by region: Europe (EU), Australia and New Zealand (AU/NZ), South America (SA), North America (NA) and Asia/Middle East and Africa (AS/AF). Trends in proportions for the two-year periods, calculated as cases with type 2 diabetes diagnoses over all cases with diabetes diagnoses, were estimated using logistic regression models adjusted for age at onset and sex. Overall, there were 2819 of 58,170 new cases (4.8%) with type 2 diabetes: 614 in EU, 293 in AU/NZ, 79 in SA, 1211 in NA and 622 in AS/AF. The proportion of type 2 diabetes increased from 3.2% to 6.0% from 2012/2013 to 2020/2021, a relative rate of increase of 9% per two-year period (95% CI 5.9, 12.3; p<0.001). In the two-year period of the COVID-19 pandemic, type 2 diabetes continued to follow the observed trend, with a proportion of 6.0% in 2020-2021 compared with 5.4% in 2018-2019. High variability in the proportion of type 2 diabetes was observed across regions, with the lowest values observed in EU and the highest in NA. A significant increase in the proportion of type 2 diabetes was observed in EU, AU/NZ and NA. The median HbA1c was not uniform and was highest in AS/AF (85 mmol/mol [9.9%]; IQR 55-111 [7.2-12.3%]) and lowest in EU (63 mmol/mol [7.9%]; IQR 48-99 [6.5-11.2%]), and the difference between EU and NA (median value 73 mmol/mol [8.8%]; IQR 50-105 [6.7-11.8%]) was statistically significant (p=0.047). There was also a difference in BMI SD score by region: the lowest median BMI SD score was 2.2 (IQR 1.4-2.7) in AS/AF and the highest was 3.1 (IQR 2.5-3.6) in AU/NZ. The multinational SWEET data from the years 2012 to 2021 inclusive support recent findings of a worldwide increase in type 2 diabetes in young people, albeit with regional differences. This increase highlights the need for ongoing preventive measures and available advanced treatment modalities worldwide.

Prevalence of respiratory viruses in children in Northeast Brazil: the scenario before the COVID-19 pandemic

ObjectiveTo investigate the prevalence of nine respiratory viruses and their clinical characteristics in children aged up to 5 years old in the state of Sergipe, Northeast of Brazil, in the pre-COVID-19 pandemic period. MethodsChildren with suspected influenza virus infection were included in the study. Clinical samples were screened using real-time qPCR for the diagnosis of AdV, PIV1, PIV2, PIV3 and hMPV. In addition, data were collected for FluA (H1N1 and H3N2), FluB and RSV. ResultsFrom January 2018 to December 2019, 1,081 samples were selected. Of these, 64.1% (n= 693) were positive for at least one of the nine screened respiratory viruses. The most prevalent etiologic agent in the study period was respiratory syncytial virus, detected in 31.8% (344/1,081) of cases, and the least prevalent was FluB, detected in 0.6% (6/1,081) of cases. Single infections were found in 85.5% (594/693) of the cases, while 14.4% (100/693) had coinfections. There was no correlation when comparing reported signs and symptoms with real-time qPCR positivity and the type of virus detected. The study highlights the importance of monitoring the etiological agents responsible for respiratory infections in children, before the COVID-19 pandemic.

Comparison of the effectiveness of prepubertal growth hormone treatment on height and predicted adult height in children with short stature born small for gestational age vs. with a growth hormone deficiency.

We compared the effects of growth hormone (GH) treatment on height and predicted adult height in children with short stature born small for gestational age (SGA-SS) vs. with a growth hormone deficiency (GHD). This retrospective study analyzed the background and clinical characteristics of children who presented to Tanaka Growth Clinic for short stature and were diagnosed with either SGA-SS or GHD and underwent treatment with GH. We compared differences in height, height velocity, GHdose increases, insulin-like growth factor-1 levels, and bone-age/chronological-age ratio between the two groups. Out of these children, 33 SGA-SS and 54 GHD children started GH treatment before the age of 8 years, witha mean dose of 0.25 mg/kg/week and 0.20 mg/kg/week, respectively. At treatment initiation, the age and height standard deviation scores (SDS) of the SGA-SS group were significantly lower than those of the GHD group. The height velocity was significantly greater in the SGA-SS group for 3 years owing to higher GH doses and younger age. No notable differences in puberty onset height or predicted adult height were observed between the two groups for boys or girls. The increase in height SDS from the start of GH treatment until the onset of puberty was substantially greater in the SGA-SS group than in the GHD group for both sexes. Adult height of patients with SGA-SS is expected to resemble that of patients with GHD but may notreach the-1.0 SD achieved with GH treatment of those patients in Western countries.

Health disparities continue to report in DEIS schools: Irish COSI Round 6 study

Abstract Background Previous reports have identified clear differences in the prevalence of overweight and obesity among children living with disadvantaged compared to those living in advantaged circumstances. Childhood obesity is influenced by factors in the home environment, including lifestyle behaviours and socio-economic status. The Childhood Obesity Surveillance Initiative (COSI) family survey provides insights into these factors, particularly in children that attend disadvantaged (DEIS) and non-disadvantaged (non-DEIS) schools. Aim This study aims to compare various demographic and socioeconomic factors within the home environment of primary school children across DEIS and non-DEIS schools in Ireland, elucidating the differences in their performance with implications for health policy. Methods Parents of 1st and 2nd class children (mean age 7) from 121 sentinel schools invited to participate in the family survey, returned it by post or online using Lime Survey. Ethical approval was secured for COSI R6, with consent from families. Data on demographics, diet, transportation, activities, and clinical characteristics of children in Ireland were collected, anonymised and analysed in SPSS, comparing children from DEIS (n = 147) and non-DEIS (n = 1014) schools. Results Around 88% of respondents of returned surveys included in the study (n = 1161) were mothers. Significant disparity in families with diabetes diagnosis or treatment observed between DEIS and non-DEIS schools (10.6% vs. 5.4%, p = 0.016). Breastfeeding rates were higher in non-DEIS schools (57.0% vs. 46.9%, p = 0.015). Children consuming at least 3 portions of fruits and vegetables daily were also higher in non-DEIS schools (58.9% vs. 46.0%, p &amp;lt; 0.001). More children in non-DEIS schools engaged in physical activities outside of school hours (93.7% vs. 74.5%, p &amp;lt; 0.001). Conclusions The findings underscore the significant socioeconomic disparities between families whose children attend DEIS and non-DEIS schools in Ireland. Key messages • Irish COSI R6 reveals disparities in health-related factors between disadvantaged and advantaged schools. • Targeted interventions and policies are necessary to address factors influencing child health.

Impact of the COVID-19 pandemic on epidemiological and clinical characteristics of Mycoplasma pneumoniae pneumonia in children: a multicenter study from Hubei, China.

To investigate the epidemiological and clinical characteristics of children with Mycoplasma pneumoniae pneumonia (MPP) in Hubei, China. We retrospectively analyzed inpatients with MPP from 20 hospitals in Hubei, China from January 2021 to December 2022. The co-detected pathogens of Mycoplasma pneumoniae (M. pneumoniae) were investigated using targeted next-generation sequencing (tNGS), and 23S rRNA gene mutations were analyzed to assess the macrolide resistance. M. pneumoniae infected 20.7% of patients with CAP, with cough (96.59%) and fever (80.28%) being the most prevalent symptoms. The infection rates in children younger than 1, 1-2, 3-6, 7-12, and older than 12 years were 6.17%, 19.98%, 26.97%, 43.93%, and 2.95%, respectively. Among 1,349 patients undergoing tNGS, the overall co-detection rate was 59.45%, with Streptococcus pneumoniae (29.30%), Haemophilus influenzae (23.57%), and Human rhinovirus (17.21%) being the most commonly co-detected pathogens. In 635 patients undergoing the 23S rRNA gene mutation test, 86.30% exhibited positive mutations (A2063G, 98.00%; A2064G, 1.50%; A2067G, 0.50%). Despite a significant age difference (P = 0.037) between macrolide-resistant M. pneumoniae and macrolide-sensitive M. pneumoniae groups, there were no significant differences in symptoms, lab data, or disease severity. In Hubei Province, the prevalence of exhibited consistent changes during the COVID-19 pandemic. MPP was prevalent year-round, particularly in summer and autumn, with school-age children being more susceptible. Co-detections of viruses and bacteria were frequent in MPP cases, and macrolide resistance exceeded 85%. Ongoing surveillance of M. pneumoniae in children is crucial for understanding the healthcare impact of MPP.

The relationship between uropathogens and clinical characteristics of children with urinary tract infection

Urinary tract infections (UTI) are common bacterial infections in children. This study aimed to examine the relationships between different microorganisms and both clinical and laboratory findings in pediatric patients with UTIs. We conducted a retrospective evaluation of children with UTI between 2019 and 2024. Patients were divided into four main groups as normal anatomy, vesicoureteral reflux (VUR), ureteropelvic junction obstruction (UPJO), and neurogenic bladder (NB). Information on clean intermittent catheterization (CIC) and prophylactic antibiotic use was recorded. Laboratory results were compared across these patient groups. The study included 266 patients, with a female predominance (female/male ratio: 7.33). NB was the most common urinary tract condition (43.3%), followed by VUR (10.9%) and UPJO (9%). Prophylactic antibiotics were used by 9% of the patients. Acute phase reactants in patients with CIC were significantly higher (p=0.023 for white blood cell (WBC) and p=0.002 for C-reactive protein (CRP) levels). They were also higher in patients with prophylactic antibiotics compared to those without (p=0.001 for both). The most frequently detected bacteria in urine cultures were E. coli (65%), followed by Klebsiella spp. (18.8%), Pseudomonas spp. (7.5%), and Proteus spp. (4.9%). Klebsiella spp., Enterococcus spp., and Morganella spp. were not isolated from patients receiving prophylaxis (p=0.022). Risk factors for UTIs need to be carefully assessed for every patient, and treatment should be customized according to clinical and laboratory results. Individual patient factors should guide drug selection, and treatment plans should account for potential resistance patterns.

Uncovering etiologic genes through whole exome sequencing in pediatric epilepsy: A case series from Thailand

Introduction Developmental and epileptic encephalopathy (DEE) is characterized by seizures that are difficult to control for a long time and affect development in children who are previously normal or delayed. Therefore, children with DEE should be diagnosed promptly because certain types of the disease respond well to specific medications. In developing countries with limited universal coverage for whole exome sequencing (WES), identifying key clinical features in this patient group will help us make more accurate selections for investigations. The purpose of this study was to determine the prevalence of WES and its common clinical features in children with epileptic encephalopathy. Methods Ten volunteers aged 0-15 years were diagnosed with epilepsy with two or more symptoms of drug-resistant epilepsy, developmental delays, and abnormal nervous system/or dysmorphic features, and their electroencephalogram (EEG) showed abnormal background or specific patterns of epileptiform discharges. These were subjected to WES for the standard &gt; 400 genes in the epilepsy panel. Results The established diagnosis was 4/10. Two known pathogenic variants, SCN2A and PCDH19. Two novel pathological variants, CHD2 and SCN1A. These are drug-resistant epilepsy, which is initially difficult to control and cannot stop antiseizure medications. Out of the 2/4 had moderate to severe intellectual disability. 3/4 had generalized epileptiform discharge activities. Conclusions This study showed a similar detection rate to that of a previous WES study. All the patients had difficult-to-treat epilepsy. For those who have not found abnormalities with the same clinical symptoms, further examinations using other methods should be conducted.

Prevalence of chronic urticaria: A study in the pediatric population of a general hospital.

Introduction. Chronic urticaria is an inflammatory skin condition characterized by the presence of evanescent wheals or angioedema that last for ≥ 6 weeks. Objective. To determine the prevalence of urticaria and describe its clinical characteristics in children and adolescents under 19 years of age in a general hospital. Population and methods. This was a cross-sectional study carried out between 2015 and 2020 in a population of children and adolescents seen at a private healthcare facility. Results. A total of 1567 medical records of patients with urticaria seen during the study period were reviewed. Thirty-six patients with chronic urticaria were identified; the prevalence was 0.16% (95% CI: 0.11-0.22). Conclusion. The prevalence of chronic urticaria in children and adolescents was 0.16%. A higher frequency was observed among girls and adolescents.

A two-institution pilot study on the psychological burden and distress of parents caring for children with shunted hydrocephalus.

Little is known about the emotional health of parents caring for children with shunted hydrocephalus. The aim of this pilot study was to find out whether parents caring for shunt-treated hydrocephalic children experience serious psychological problems and psychosocial distress and whether these problems are related to the sociodemographic background of the caregivers, the clinical characteristics of their children, and parents' illness-related concerns and perceived burden of their children's illness. This pilot study was performed in an outpatient setting at two German hospitals. The following questionnaires were handed out to parents of children with shunted hydrocephalus (< 21 years of age): the Patient Health Questionnaire (PHQ-9) for depression, the Generalized Anxiety Disorder Scale (GAD-7) for anxiety, the Distress Thermometer (DT) for psychosocial distress, the Hydrocephalus Concerns Questionnaire (HCQ) for assessment of parents' illness-related concerns, and the Hydrocephalus Outcome Questionnaire (HOQ) for assessment of perceived children's disease burden. Clinical data of the respective children were collected from electronic charts. Parents' demographic data were evaluated via questionnaires. Parents' psychological variables were correlated with demographic and clinical data and HCQ and HOQ scores. Regression analyses of HCQ and HOQ scores with psychological items were performed. Sixty-three parents were included in this study. Of these, 60% reported clinically relevant levels of either depression (11%), anxiety (10%), and/or psychosocial distress (57%). There were no associations between parental sociodemographic or children's clinical characteristics with parents' psychosocial well-being or psychosocial distress. Depression, anxiety, and DT scores were highly intercorrelated and significantly correlated with HCQ scores (r = 0.508, r = 0.516, r = 0.442; p < 0.01). Thereby, worries about shunt-related complications were the most reported concern in the HCQ. Depression and anxiety correlated with the scores of some HOQ subcategories. In preliminary regression analyses, higher illness-related concerns predicted occurrence of parents' anxiety. The authors' results support the notion that there is a need for psychosocial support for a proportion of parents who care for shunted hydrocephalic children. Perceived child symptom burden and parental illness concerns were identified as relevant correlates of parental psychological well-being. Thus, concerns specific to shunt-related problems could be a first starting point for the development of individual support measures.

The Effect of Levetiracetam and Valproic Acid Treatment on Anger and Attention Deficit Hyperactivity Disorder Clinical Features in Children and Adolescents with Epilepsy: A Prospective Study.

Antiseizure medications (ASMs) can potentially trigger psychobehavioral adverse events associated with the onset or exacerbation of psychiatric symptoms such as irritability, aggression, and hyperactivity. The objective of this study was to evaluate the effects of levetiracetam and valproic acid on changes in clinical features of anger, attention deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD). The purpose was to furnish guidance on rational drug selection in children and adolescents with epilepsy to minimize psychiatric comorbidity in the treatment of epilepsy. This was a prospective, observational, cohort study involving treatment-naïve children aged 7-18 years with newly diagnosed generalized or focal epilepsy who were prescribed levetiracetam or valproic acid as monotherapy for a 6-month period and regularly followed up. Psychiatric assessment was conducted at the time of the new epilepsy diagnosis and at the six-month follow-up. These assessments were performed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children Current and Lifetime Version (DSM-5), a structured psychiatric interview, as well as the State-Trait Anger Expression Style Inventory and Turgay DSM-IV Based Disruptive Behaviour Disorders Screening and Rating Scale. Anger subscores, ADHD symptoms, change in diagnosis, focal and generalized epilepsy groups, continuous seizures and seizure-free periods before and 6 months after treatment with valproic acid and levetiracetam were compared. A total of 50 children, 25 in the valproic acid group and 25 in the levetiracetam group, with a mean age of 11.92 ± 3.08 years, were included in the study. There was a statistically significant increase in the ADHD subscale score post-treatment among patients receiving levetiracetam (p = 0.045) and valproic acid (p = 0.034) compared with pre-treatment. The change in both anger-in and anger-out expression scores with treatment was significantly higher in patients receiving levetiracetam (p = 0.035) compared with those receiving valproic acid (p = 0.026). Statistically, there was a significant difference in the diagnostic criteria of the levetiracetam group pre- and post-treatment (p = 0.026). The proportion of patients in whom the diagnostic criteria for ADHD+ODD were fulfilled increased from 16% before treatment to 48% after treatment, a statistically significant increase (p = 0.026). This study found an increase in internalized anger features and ADHD symptom severity in children with epilepsy treated with valproic acid and levetiracetam. In those prescribed levetiracetam, there was a statistically significant rise in the proportion meeting the diagnostic criteria for ADHD + ODD. Our research is one of the first to prospectively examine the psychiatric assessment of children diagnosed with epilepsy. The remarkable results demonstrate changes in psychiatric diagnoses associated with the treatment of levetiracetam and valproic acid. Furthermore, a considerable rise in ADHD symptoms was observed in those treated with valproic acid.

Family History of Diabetes and Clinical Characteristics in Children at Diagnosis of Type 1 Diabetes-A Swedish Population-Based Study.

To compare the prevalence of parental diabetes between children with and without type 1 diabetes (T1D), and to compare clinical characteristics at diagnosis of T1D in children with, versus without, a family history of diabetes. Parental diabetes among children with T1D was compared with a general population cohort. Clinical characteristics were compared by family history of diabetes in parents and grandparents of 3,603 children with T1D using relative risk (RR) and ANOVA. Children with T1D more often had parents with type 2 diabetes (T2D) (RR 1.88; P < 0.001) than did children without diabetes. Children with T1D and a family history of T2D were more likely to be overweight or obese (P = 0.002). A family history of T2D and being overweight may contribute to increased risk of T1D.

Clinical Characteristics of Children with Acute Post-Streptococcal Glomerulonephritis and Re-Evaluation of Patients with Artificial Intelligence.

Acute post-streptococcal glomerulonephritis (APSGN) is a common cause of acute glomerulonephritis in children. The condition may present as acute nephritic and/or nephrotic syndrome and rarely as rapidly progressive glomerulonephritis. ChatGPT (OpenAI, San Francisco, California, United States of America) has been developed as a chat robot supported by artificial intelligence (AI). In this study, we evaluated whether AI can be used in the follow-up of patients with APSGN. The clinical characteristics of patients with APSGN were noted from patient records. Twelve questions about APSGN were directed to ChatGPT 3.5. The accuracy of the answers was evaluated by the researchers. Then, the clinical features of the patients were transferred to ChatGPT 3.5 and the follow-up management of the patients was examined. The study included 11 patients with an average age of 9.08±3.96 years. Eight (72.7%) patients had elevated creatinine and 10 (90.9%) had hematuria and/or proteinuria. Anti-streptolysin O was high in all patients (955±353 IU/mL) and C3 was low in 9 (81.8%) patients (0.56±0.34 g/L). Hypertensive encephalopathy, nephrotic syndrome, and rapidly progressive glomerulonephritis were observed in three patients. Normal creatinine levels were achieved in all patients. Questions assessing the definition, epidemiologic characteristics, pathophysiologic mechanisms, diagnosis, and treatment of APSGN were answered correctly by ChatGPT 3.5. All patients were diagnosed with APSGN, and the treatment steps applied by clinicians were similarly recommended by ChatGPT 3.5. The insights and recommendations offered by ChatGPT for patients with APSGN can be an asset in the care and management of patients. With AI applications, clinicians can review treatment decisions and create more effective treatment plans.

Clinical and molecular findings in children with retinitis pigmentosa

ABSTRACT Purpose To study the clinical and genetic features of a cohort of RP children. Methods We identified 46 RP patients with pathogenic or likely pathogenic mutations among 96 patients with a clinical diagnosis of retinitis pigmentosa. All of the patients underwent comprehensive clinical examinations and genetic testing. A retrospective study was conducted on 46 children with retinitis pigmentosa. The genetic and clinical characteristics of children with different genotypes were analyzed. Results Among the 46 children, 13 inherited X-linked gene mutations, including 9 RPGR and 4 RP2 mutations. There were 10 cases of autosomal dominant genes and 23 cases of autosomal recessive genes. XLRP accounted for a larger proportion of children, as observed in previous studies on RP. We found that RPGR genes were the most commonly mutated genes in RP children. The most frequently mutated gene was RPGR (9.3%), followed by RP2 (4.2%) and RPE65 (4.2%). Forty-six patients had mutations in 21 different genes, 19 of which were novel mutations. Most children with XLRP have a high degree of myopia, poor vision, and severe clinical symptoms. Frameshift mutations were more common in XLRP, followed by nonsense mutations. The onset of XLRP is relatively serious since childhood. Most children with ADRP have relatively good visual acuity and mild clinical symptoms, and missense mutations are common. The clinical manifestations of ARRP in children are more severe than those of ADRP in children but milder than those of XLRP in children, and missense mutations are common. The manifestations of RPE65 mutations are also severe and appear early. Conclusions Our results revealed that XLRP gene mutations were more common in children than in adults, as observed in previous studies on RP. The proportion of RP children with ADRP is relatively small. The new findings in our study polished the spectrum of novel mutations and the proportions of different genotypes in pediatric patients. The onset of XLRP occurred earlier. The genes with a high incidence in children were all relatively severe gene types of RP. This comprehensive database may provide essential information regarding the initial stage of RP.

Clinical characteristics of children with congenital anomalies of kidney and urinary tract and predictive factors for Chronic Kidney Disease in a tertiary hospital, Addis Ababa, Ethiopia

Clinical characteristics of children with congenital anomalies of kidney and urinary tract and predictive factors for Chronic Kidney Disease in a tertiary hospital, Addis Ababa, Ethiopia

Non-random distribution of Plasmodium Species infections and associated clinical features in children in the lake Victoria region, Kenya, 2012–2018

BackgroundWhile Plasmodium falciparum (Pf) stands out as the most lethal malaria parasite species in humans, the impact of other species should not be dismissed. Moreover, there is a notable lack of understanding of mixed-species infections and their clinical implications.MethodsWe conducted eight school-based cross-sectional malariometric surveys in the Lake Victoria region of western Kenya between January–February 2012 and September–October 2018. In each survey, a minimum of 100 children aged 3 to 15 years were randomly chosen from a school in Ungoye village on the mainland and as well as from each school selected in every catchment area on Mfangano island. Plasmodium infection was determined by microscopy and nested polymerase chain reaction (PCR). The multiple-kind lottery (MKL) model calculated the expected distribution of Plasmodium infections in the population and compared it to observed values using a chi-squared test (χ2).ResultsThe Plasmodium prevalence was 25.9% (2521/9724) by microscopy and 51.1% (4969/9724) by PCR. Among all infections detected by PCR, Pf, P. malariae (Pm), and P. ovale (Po) mono-infections were 58.6%, 3.1%, and 1.8%, respectively. Pf/Pm, Pf/Po, Pm/Po, and Pf/Pm/Po co-infections were 23.5%, 4.3%, 0.1%, and 8.6%, respectively. MKL modelling revealed non-random distributions, with frequencies of Pf/Pm and Pf/Pm/Po co-infections being significantly higher than expected (χ2 = 3385.60, p < 0.001). Pf co-infections with Pm and Po were associated with a decreased risk of fever (aOR 0.64, 95% CI 0.46–0.83; p = 0.01) and increased risks of splenomegaly (aOR 12.79, 95% CI 9.69–16.9; p < 0.001) and anaemia (aOR 2.57, 95% CI 2.09–3.15; p < 0.001), compared to single-species infections.ConclusionThis study sheds light on the potential interaction between Pf and Pm and/or Po. Given the clinical significance of mixed-species infections, improved diagnostics, and case management of Pm and Po are urgently needed.

Macrophage-Stimulating 1 Polymorphism rs3197999 in Pediatric Patients with Inflammatory Bowel Disease.

Background and Objectives: Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), often necessitates long-term treatment and hospitalizations and also may require surgery. The macrophage-stimulating 1 (MST1) rs3197999 polymorphism is strongly associated with the risk of IBD but its exact clinical correlates remain under investigation. We aimed to characterize the relationships between the MST1 rs3197999 genotype and the clinical characteristics in children and adolescents with IBD within a multi-center cross-sectional study. Materials and Methods: Clinical data included serum C-reactive protein (CRP), albumin, activity indices (PUCAI, PCDAI), anthropometric data, pharmacotherapy details, surgery, and disease severity. Genotyping for rs3197999 was carried out using TaqMan hydrolysis probes. Results: The study included 367 pediatric patients, 197 with Crohn's disease (CD) (40.6% female; a median age of 15.2 years [interquartile range 13.2-17.0]) and 170 with ulcerative colitis (UC) (45.8% female; a median age of 15.1 years [11.6-16.8]). No significant relationships were found between MST1 genotypes and age upon first biologic use, time from diagnosis to biological therapy introduction, PUCAI, PCDAI, or hospitalizations for IBD flares. However, in IBD, the height Z-score at the worst flare was negatively associated with the CC genotype (p = 0.016; CC: -0.4 [-1.2-0.4], CT: -0.1 [-0.7-0.8], TT: 0.0 [-1.2-0.7)]). The TT genotype was associated with higher C-reactive protein upon diagnosis (p = 0.023; CC: 4.3 mg/dL [0.7-21.8], CT 5.3 mg/dL [1.3-17.9], TT 12.2 mg/dL [3.0-32.9]). Conclusions: This study identified links between MST1 rs3197999 and the clinical characteristics of pediatric IBD: height Z-score and CRP. Further studies of the associations between genetics and the course of IBD are still warranted, with a focus on more extensive phenotyping.

Pediatric Respiratory Infections ‎After the COVID-19 Pandemic: A Single-Center Experience.

Background Pediatric respiratory infections, mainly bronchiolitis, are a substantial clinical burden. The most common etiology is respiratory syncytial virus (RSV). Other viruses include human rhinovirus, human metapneumovirus, influenza, adenovirus, coronavirus, and parainfluenza viruses. Objective We aimed to study the epidemiology and clinical characteristics of children with confirmed viral bronchiolitis and flu after the COVID-19 pandemic season and compare the behavior of each virus. Methods This retrospective observation study was done over seven months, from October 2022 to April 2023. All children (0-14) were included in the study if they met the clinical diagnosis of bronchiolitis or flu. Viral etiology is confirmed by PCR, using the respiratory panel available in our center which included the detection of four viruses: COVID-19, RSV, influenza A, and B. Clinical data, lab results, and X-rays were collected and correlated with each viral infection for all admitted patients. Results We recruited 237 children with bronchiolitis and flu symptoms from October 2022 to April 2023. The peak of infections (41%) was in November. Seasonal variations for each virus showed distinct patterns across the year. RSV peaked at the beginning of the season, gradually declining after that. In contrast, influenza A and B maintained a relatively consistent presence throughout the season. Meanwhile, COVID-19 reached its peak during March and April. One hundred forty-four (60%) of the patients were under two years of age. RSV was predominant in 150 patients (63.3%). COVID-19 was only detected in 25 patients (10%), whereas influenza A and B were equally isolated in 31 (13%) patients each. Fifty-one children (21%) were initially sick and required pediatric intensive care unit (PICU) admission, with no deaths reported. Notably, COVID-19 had a milder disease course, a shorter length of stay (LOS) in the hospital (two days) and a shorter duration of illness (five days) compared to other viruses. RSV infection was linked to more profound hypoxia and more sick children with more extended hospital stays. Conclusion Our study showed that, following the pandemic and the release of lockdown measures, there was another peak of upper respiratory tract infections (URTI) and flu, which was more aggressive, primarily due to other viruses, especially RSV. This resurgence was associated with more severe respiratory symptoms and an increased need for hospitalization. Notably, children with COVID-19 were in better condition compared to those with RSV.

Clinical features and prognostic factors of advanced myelodysplastic syndromes in children

Objective: To investigate the clinical features and prognostic factors of advanced myelodysplastic syndromes (MDS) in children. Methods: Clinical data of children diagnosed with advanced MDS in the Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, between September 2009 and April 2022 were retrospectively collected. Follow-up assessments were performed through telephone interviews and the review of medical records until May 1, 2023. The clinical features of children with advanced MDS were summarized by analyzing chromosomal karyotype tests, second-generation gene sequencing results. Multivariate Cox regression analysis was used to investigate the prognostic factors of advanced MDS in children. Results: A total of 69 children, comprising 49 males and 20 females, aged [M (Q1, Q3)] 8 (5, 10) years, were enrolled in the study. Sixty-seven cases underwent chromosomal karyotype testing, of which 42 cases (62.7%) had abnormal karyotypes, with monosomy 7 the most common in 17 cases (25.4%). Forty-three cases underwent next-generation sequencing, with mutations in the SETBP1, NRAS, PTPN11 and RUNX1 genes more common, identified in 12 cases (27.9%), 9 cases (20.9%), 8 cases(18.6%), and 8 cases(18.6%), respectively. The follow-up time [M (Q1, Q3)] was 26 (13, 56) months and the 5-year overall survival rate was 56%(95%CI: 44.4%-70.5%). The 5-year overall survival rate for children who underwent hematopoietic stem cell transplantation (HSCT) was higher than that of children who did not undergo HSCT (73.9% vs 29.1%, P<0.001). HSCT (HR=0.118, 95%CI: 0.037-0.372, P<0.001) was a protective factor for the overall survival rate of children with advanced MDS. Serum ferritin level>356.3 μg/L (HR=6.497, 95%CI: 2.068-20.415, P=0.001) and moderate to severe splenomegaly (HR=4.075, 95%CI: 1.174-14.141, P=0.027) were risk factors for the overall survival rate of children with advanced MDS. Conclusions: Monosomy 7 was the most common abnormal karyotype and SETBP1 was the gene that had the highest mutation frequency in children with advanced MDS. HSCT, increased ferritin and moderate to severe splenomegaly are prognostic factors influencing the overall survival rate of children with advanced MDS.