Death In Children Research Articles

Ultrasound-guided versus palpation-guided techniques for vessel catheterization in children undergoing cardiac surgery. A systematic review and meta-analysis of randomized controlled trials

Abstract Background Pediatric heart surgery is the first treatment option for congenital heart disease, which is the leading cause of death in Children. Arterial cannulation (AC) and Central venous catheter (CVC) are required in pediatric cardiac surgery for continuous monitoring of the central venous pressure (CVP), replacement of fluid and blood products, close hemodynamic monitoring, and frequent sampling for arterial blood gases (ABG). Purpose We aim to assess the efficacy and safety of the ultra-sound guided technique compared to the traditional palpation-guided technique for vessel catheterization in children undergoing cardiac surgery. Methods A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) studies obtained from PubMed, Embase Cochrane, Scopus, and WOS until February 2024. We used the fixed-effects model to report dichotomous outcomes using risk ratio (RR) and continuous outcomes using mean difference (MD) with a 95% confidence interval (CI). Results Thirteen RCTs with 1060 children were included. Regarding arterial cannulation, ultrasound-guided technique was associated with a statistically significant increase in successful cannulation [RR: 1.31 with 95% CI (1.10, 1.56), P< 0.0001], and first-attempt success [RR: 1.88 with 95% CI (1.35, 2.63), P< 0.0001]; however, it was not associated with any statistically significant difference in venous cannulation in both outcomes with [RR: 1.13 with 95% CI (0.98, 1.30), P= 0.10], [RR: 1.53 with 95% CI (0.86, 2.71), P= 0.15] respectively. Moreover, ultrasound-guided technique was associated with a statistically significant decrease in the number of attempts either in arterial cannulation with [MD: -0.73 with 95% CI (-1.00, -0.46), P< 0.0001] or in venous cannulation with [MD: -1.34 with 95% CI (-2.55, -0.12), P= 0.03], and the time of attempted cannulation also either in arterial cannulation with [MD: -2.27 with 95% CI (-3.38, -1.16), P< 0.0001] or in venous cannulation with [MD: -4.13 with 95% CI (-7.06, -1.19), P< 0.0001]. Finally, ultrasound-guided technique was associated with a statistically significant decrease in the incidence of any complications either in arterial cannulation with [RR: 0.36 with 95% CI (0.18, 0.71), P< 0.001] or in venous cannulation with [RR: 0.30 with 95% CI (0.11, 0.84), P= 0.02]. Conclusion Ultrasound-guided arterial catheterization increases the number of successful catheterizations and first-attempt success rate; however, there was no significant difference in venous cannulation, while both arterial and venous cannulation were associated with decreased number of attempts, reduced overall procedure time, and decreased incidence of complications.

Knowledge, Attitude and Practice Regarding Use of ORS in Diarrhoea by Mothers in an Island of Bangladesh

Introduction: The second leading cause of death in under-five children is diarrhea. ORS is a simple and highly effective therapy for managing diarrhea. However inappropriate knowledge of preparation and lack of use of ORS leads to health hazards including increased rate of mortality and morbidity. So aim of this study to assess the knowledge, attitude, and Practice of mothers towards the use of oral rehydration solution in the treatment of acute diarrhea in children. Methods: A cross-sectional study was carried out over eight months (1st May to 30th December 2023) among 510 mothers who had children of six months to five years and had recent episodes of diarrhea. Data were collected by using a semi-structured questionnaire in face-to-face interview. Data were analyzed by using SPSS software program.Results: Among 510 mothers, 47.05% were 20-30 years old, 29.80% were below 20 years and 23.13% were over 30 years. One fourth of them had no institutional education and 36.27% had primary, 20.78% and 18.23% had secondary and tertiary level of education respectively. 40.39% were from lower socioeconomic condition, 31.97% were from middle and 27.64% from upper socioeconomic condition. 100% of family used sanitary latrine though 73.72% use safe drinking water as a preventive part of diarrhea.89.98% of mother was aware about ORS but only 75.88% used ORS in recent episode of diarrhea, among them 63.03% prepared ORS correctly and 60.98% used adequate amount. Age of mothers was not corresponds with the correct preparation and practice of ORS but socioeconomic condition and level of education carried statistically significant value. Conclusion: Knowledge and practice of ORS preparation and used of ORS in recent episode of diarrhea among the mother was unsatisfactory. Improve the Maternal education and socioeconomic status will improve ORS correct preparation and use. Mothers should be taught the importance of optimal use and correct preparation of ORS in diarrhea. EWMCJ Vol. 12, No. 1&2, January-July 2024: 43-49

Long-term disability following childhood injury: an imperative to monitor and address the continuum of trauma care

Abstract Background While injuries remain a leading cause of childhood death, increasing proportions of children survive life-threatening injuries. However, robust epidemiological data on their risks of long-term disability are scant, undermining comprehensive injury control efforts. This population-based prospective cohort study investigated the functional status and health-related quality of life of seriously injured Australian children over a 5-year period. Methods Patients aged <18 years hospitalised for major trauma (Injury Severity Score >12) in the State of Victoria over a 12-month period were followed-up at 6, 12, 24, 36, 48 and 60-months post-injury. Primary outcomes were assessed using the PedsQL, King’s Outcome Scale for Childhood Head Injury and the Glasgow Outcome Scale-Extended. Multivariable regression models investigated factors associated with outcomes. Results Of the 186 participants, 71% were retained to 60 months post-injury. At five years post-injury, only 39% had fully recovered while 39% experienced moderate to severe disability. Despite gains in functional status across the five years, psychosocial recovery lagged improvements in physical health. Factors associated with adverse outcomes included older age at injury, female sex, socio-economic disadvantage, remote/regional (versus urban) residence, pre-existing comorbidities, and injuries deemed compensable, intentional, or involving head trauma. Implications The high risks of long-term disability following serious childhood injury highlight the need for robust injury control efforts that monitor and address the inequitable burden of childhood injury, including the social determinants influencing the occurrence as well as sequelae following injury.

Elevated levels of PDGF-BB and VEGF are associated with a decreased risk of readmission or death in children with severe malarial anemia.

Children with severe malarial anemia (SMA) typically have low in-hospital mortality but have a high risk of post-discharge readmission or death. We hypothesized that the dysregulation of hematopoiesis, vascular growth factors, and endothelial function that occurs in SMA might affect risk of readmission or death. Plasma was obtained from children 18 months to 12 years old with SMA (N=145) in Kampala, Uganda on admission, and outcomes were assessed over 12-month follow-up. Admission plasma levels of ten biomarkers of vascular growth, hematopoiesis, and endothelial function were compared to risk of readmission or death over 12-month follow-up. Over 12-month follow-up, 19 of 145 children with SMA were either readmitted or died: 15 children were readmitted (13 with malaria) and 4 children died. In multivariable analyses adjusted for age and sex, elevated plasma levels of platelet-derived growth factor-BB (PDGF-BB) and vascular endothelial growth factor (VEGF) on admission were independently associated with a decreased risk of all-cause readmission or death (adjusted hazard ratios [95% confidence intervals], 0.28 [0.16-0.51] and 0.19 [0.08-0.48], respectively) and a decreased risk of readmission due to severe malaria (0.27 [0.15, 0.51] and 0.16 [0.05, 0.47]) but not with risk of uncomplicated malaria (1.01 [0.53, 1.95] and 2.07 [0.93-4.64]). In children with severe malarial anemia, elevated plasma levels of PDGF-BB and VEGF, two factors that promote angiogenesis, are associated with a decreased risk of readmission or death in the year following admission, primarily driven by a decrease in the risk of recurrent severe malaria.

Новый электрокардиографический феномен при синдроме удлиненного интервала QT: клиническое наблюдение

Long QT syndrome (LQTS) is a disease with a high risk of sudden death in children. Individual prognosis is based on additional, primarily electrocardiological markers. Authors represent a clinical case of a rare variant of electrocardiographic manifestation of LQTS in children that wasn’t described previously. A 6 y/o female patient with LQTS, had no complaints, no syncope or sudden death familial cases. The molecular genetic study revealed a de novo mutation in the SCN5A gene which is typical for the third molecular genetic variant of LQTS (LQT3). Holter monitoring noted “hyperadaptation” of the QT interval (slope QT/RR 0.37 with a norm of up to 0.24). During night sleep, episodes of combined T-wave and QRS complex alternans (AT/AQRS) were detected. This pattern has not been previously described in patients with LQTS. Possible mechanisms and prognostic value for the revealed ECG pattern, issues of treatment of patients with LQT3 are discussed. Conclusion: combined T-wave and QRS complex alternans (AT/AQRS) is a new, previously undescribed ECG phenomenon in patients with LQTS that is highly likely to increase the risk for cardiac events. Thus the “hyperadaptation” of the QT interval may be one of the electrocardiological signs of LQT3.

Primary Bone Tumors and Breast Cancer-Induced Bone Metastases: In Vivo Animal Models and New Alternative Approaches

Bone is the preferential site of metastasis for the most common tumors, including breast cancer. On the other hand, osteosarcoma is the primary bone cancer that most commonly occurs and causes bone cancer-related deaths in children. Several treatment strategies have been developed so far, with little or no efficacy for patient survival and with the development of side effects. Therefore, there is an urgent need to develop more effective therapies for bone primary tumors and bone metastatic disease. This almost necessarily requires the use of in vivo animal models that better mimic human pathology and at the same time follow the ethical principles for the humane use of animal testing. In this review we aim to illustrate the main and more suitable in vivo strategies employed to model bone metastases and osteosarcoma. We will also take a look at the recent technologies implemented for a partial replacement of animal testing.

Hygiene practice and diarrhea prevalence among underfive children in Myanmar: a cross-sectional study

BackgroundOver 1.7 billion instances of diarrheal illness in children are reported worldwide yearly. Diarrhea was a major cause of death in children, accounting for 9% of all global under-five child deaths in 2021. The objective of this study was to identify the association between hygiene practices and childhood diarrhea among under-five children in Myanmar.MethodThis cross-sectional study was conducted in 16 townships from 8 states and regions of Myanmar. 1207 children between the ages of 6 and 59 months were recruited by multistage random sampling. Data were collected with a preformed questionnaire after participants provided consent. Multiple logistic regressions were administered to determine the factors associated with childhood diarrhea.ResultThis study found that 86 (7.13%) under-five children experienced diarrhea disease. This study identified that children receiving limited hygiene services were 2.85 times (AOR = 2.85, 95% CI: 1.31 to 6.21; p value 0.01) and children without hygiene services were 2.63 times (AOR = 2.63, 95% CI: 1.42 to 4.89; p value 0.01) more likely to have diarrhea disease than those with basic hygiene services. Other factors associated with diarrhea included: fathers who washed their hands less than four steps (AOR = 2.20, 95% CI: 1.29 to 3.74; p value 0.01), families taking more than 15 min to collect water (AOR = 1.77, 95% CI: 1.06 to 2.97; p value 0.03), families sharing toilet usage (AOR = 2.00, 95% CI: 1.15 to 3.48; p value 0.01), mother’s inadequate and problematic hygiene promotion health literacy (AOR = 2.20, 95% CI: 1.24 to 3.90; p value 0.01), houses made of bamboo or lacking floors (AOR = 2.31, 95% CI: 1.38 to 3.89; p value 0.01), families with three or more children (AOR = 1.68, 95% CI: 1.01 to 2.79; p value 0.05) and breastmilk being the primary food after 6 months of age (AOR = 2.07, 95% CI: 1.09 to 3.93; p value 0.03).ConclusionsEnsuring access to basic hygiene services, getting water at home 24 h per day, seven days per week, using private toilets, promoting hygiene health literacy, improving house flooring, family planning and introducing a variety of foods after age 6 months could significantly prevent diarrhea among under-five children in Myanmar. This study underscores the critical role of handwashing facilities in reducing the diarrhea incidence in children.

Bereaved parents’ perceptions of their cancer-ill child’s last month with or without palliative care - a nationwide study

BackgroundCancer is still the leading cause of non-accidental death in childhood, although the majority of children diagnosed in high-income countries survive their illness. In accordance with international standards, equal and early access to palliative care should be available to children and adults. Yet communication and prognostic disclosure may influence the timing of involvement in palliative care. Purpose: To investigate whether parents perceived that their child received palliative care and to what extent that contrasted parents’ perceptions of their child’s care and symptoms in the last month of life.MethodsA nationwide population-based parental questionnaire study in Sweden, one to five years after their child’s death (n=226). Descriptive statistics were used.ResultsA majority of parents (70%) reported that they were aware that their child received palliative care and they were informed about the incurable disease (57%) within 3 months before the child died. The most common diagnosis among children receiving palliative care was a brain tumor (45%) with a disease related death (90%) and the care was often received at home (44%). Based on the reports of parents who felt that their child did not receive palliative care, 45% were informed within days or hours about the child’s incurable disease, 45% of these children were diagnosed with leukemia, 60% died at the intensive care unit, and 49% died of treatment-related complications. It was most common for families who lived in urban areas (28%) to report their child received palliative care, in comparison to families living in sparsely populated areas (11%). A significant proportion of parents whose child received palliative care (96%) stated that the healthcare professionals were competent in caring for their child, for those who reported no palliative care it was slightly lower (74%). In both groups many children were affected by multiple symptoms the last month of life.ConclusionsThe study findings highlight the role of understanding parental perceptions of pediatric palliative oncology care, the role of initiating palliative care early, the need of access to national equitable PC and professional competence across the lifespan, regardless of diagnosis and place of residence.

Regional patterns in minimum diet diversity failure and associated factors among children aged 6-23 months in India.

Background About 35% of the global child deaths and 11% of the total disease burden are due to inadequate nutrition. While in India, 1 in 3 children are underweight and stunted, and 1 in 5 children are wasted. Methods Using multivariate and descriptive statistical analysis, we examined the prevalence, determinants of minimum diet diversity failure (MDDF) and trends of MDDF across different regions of India among children aged 6-23 months. Dietary pattern in 8 food groups was also examined using the National Family and Health Survey (NFHS) data from 2005-06 to 2019-21. Results Overall, MDDF in India has decreased from 87.4% (2005-06) to 77.1% (2019-21). The central region (84.6%) reported the highest prevalence of MDDF in 2019-21. Children of illiterate and rural residing mothers with no mass media exposure, children of the first birth order and children not exposed to counselling and health check-ups at Anganwadi/Integrated Child Development Services (ICDS) centres, children with low birth weight and anaemic, and who belonged to a large family had greater likelihood for MDDF. Conclusion To tackle the high prevalence of MDDF, a holistic action is needed from the government, i.e. improved public distribution system (PDS), intensified Integrated Child Development Scheme (ICDS) programme, use of social media, and nutrition counselling through local self-governance.

Using a Fluorescent Concretization Intervention Improves Hand Hygiene Training in Primary School Students: A Randomized Controlled Study

Introduction: Inadequate hand hygiene increases the rates of childhood infectious diseases and deaths, leading to the death of one child per minute. Aim: To examine the effects of an educational strategy, “using a fluorescent concretization intervention,” on the hand-washing skills of primary school students. Method: This single-center randomized controlled trial using a pretest and posttest design was conducted with 35 intervention and 35 control participants. Data were collected with Dermalux Test Lotion containing fluorescently detectable under ultraviolet light, Hand Washing Skill Checklist, Hand Washing Skill Efficacy, and Hand Hygiene Assessment Question Form in School Children. Results: After the training for both hands, the intervention group participants created a difference in the effectiveness of hand washing from dirty to clean in all areas (p < 0.001). The scores regarding psychomotor skills and duration of hand washing increased in all participants. Total score percentage changes increased more in the intervention group participants when the first and final follow-ups were compared (p < 0.001). Hand washing skills and durations increased after hand washing training using the fluorescent concretization method. Conclusion: Visual concretization and explanation to the students increase handwashing effectiveness. For this reason, it is highly recommended that technological devices that provide such visual feedback be used in schoolchildren's education.

Uncovering Diaphragm Cramp in SIDS and Other Sudden Unexpected Deaths.

The diaphragm is the primary muscle of respiration. Here, we disclose a fascinating patient's perspective that led, by clinical reasoning alone, to a novel mechanism of spontaneous respiratory arrests termed diaphragm cramp-contracture (DCC). Although the 7-year-old boy survived its paroxysmal nocturnal "bearhug pain apnea" episodes, essentially by breathing out to breathe in, DCC could cause sudden unexpected deaths in children, especially infants. Diaphragm fatigue is central to the DCC hypothesis in SIDS. Most, if not all, SIDS risk factors contribute to it, such as male sex, young infancy, rebreathing, nicotine, overheating and viral infections. A workload surge by a roll to prone position or REM-sleep inactivation of airway dilator or respiratory accessory muscles can trigger pathological diaphragm excitation (e.g., spasms, flutter, cramp). Electromyography studies in preterm infants already show that diaphragm fatigue and sudden temporary failure by transient spasms induce apneas, hypopneas and forced expirations, all leading to hypoxemic episodes. By extension, prolonged spasm as a diaphragm cramp would induce sustained apnea with severe hypoxemia and cardiac arrest if not quickly aborted. This would cause a sudden, rapid, silent death consistent with SIDS. Moreover, a unique airway obstruction could develop where the hypercontracted diaphragm resists terminal inspiratory efforts by the accessory muscles. It would disappear postmortem. SIDS autopsy evidence consistent with DCC includes disrupted myofibers and contraction band necrosis as well as signs of agonal breathing from obstruction. Screening for diaphragm injury from hypoxemia, hyperthermia, viral myositis and excitation include serum CK-MM and skeletal troponin-I. Active excitation could be visualized on ultrasound or fluoroscopy and monitored by respiratory inductive plethysmography or electromyography.

Analysis of early and treatment related deaths among children and adolescents with acute myeloid leukemia in Poland: 2005–2023

BackgroundA personalised approach to the treatment of acute myeloid leukemia (AML) in children and adolescents, as well as the development of supportive therapies, has significantly improved survival. Despite this, some patients still die before starting treatment or in an early phase of therapy before achieving remission. The study analysed the frequency, clinical features and risk factors for early deaths (ED) and treatment related deaths (TRD) of children and adolescents with AML.MethodsFrom January 2005 to November 2023, 646 children with AML treated in the centers of the Polish Pediatric Leukemia and Lymphoma Study Group according to three subsequent therapeutic protocols were evaluated: AML-BFM 2004 Interim (385 children), AML-BFM 2012 Registry (131 children) and AML-BFM 2019 (130 children).ResultsOut of 646 children, early death occurred in 30 children, including 15 girls. The median age was 10.7 years (1 day to 18 years). More than half of the patients (53%) were diagnosed with acute myelomonocytic leukemia (M5) and 13% with acute promyelocytic leukemia (M3). The ED rate for the three consecutive AML-BFM protocols was 4.9% vs. 5.3% vs. 3.1%, respectively. In 19 patients, death occurred before the 15th day of treatment, in 11 between the 15th and 42nd day. The most common cause of death before the 15th day (ED15) was leukostasis and bleeding, whereas between the 15th and 42nd day (ED15-42), infections, mainly bacterial sepsis. A significant association was found between ED15 and high leukocyte count (>10 × 109/L), M3 leukemia (p < 0.001), and ED15-42 and age <1 year (p = 0.029). In the univariate analysis only initial high leukocyte count >100 × 109/L, was a significant predictor of early death. The overall TRD for the entire study period was 3.4%. The main cause of death were infections, mainly bacterial sepsis (10 children out of 22, 45.4%).ConclusionsHyperleukocytosis remains significant factor of early mortality in patients with AML, despite the introduction of various cytoreductive methods. Infections are still the main cause of treatment related deaths. A more individualized approach by using new targeted drugs may be the therapeutic option of choice in the future.

Development and validation of Parents’ Health Literacy Scale on Preventing Road Traffic Injuries for children aged 0–6 years in China

BackgroundRoad traffic injuries are the leading cause of death in children. Parents’ health literacy (HL) is closely related to child safety, especially for the young children. This study aimed to...

Driven by Purpose: Exploring Spirituality in Black Mothers’ Coping with Loss of Children to Gun Homicide

The death of a Black child to gun homicide presents unique and ongoing coping challenges for Black parents. Current studies have provided insights into the role of spirituality in facilitating adjustment after homicide loss. However, the extent to which spirituality serves as a viable coping resource for Black mothers, who are disproportionately affected by gun homicide deaths of their children, remains unexplored. This exploratory phenomenological study explored the role of spirituality as a healing resource in 15 Black mothers’ grief experiences following the loss of their children to gun homicide. Thematic analysis revealed the role of spirituality in helping Black mothers find purpose in their loss. Following the loss of their children, mothers’ spiritual values enabled them to come to the realization that the deaths served a purpose. Spirituality served as the fuel to strengthen and renew their purpose in their grief journey. Gun homicide grief experience is an entanglement of systemic inequality and racial oppression. Exploring spirituality as a coping resource in the grieving experiences of Black survivors serves as an opportunity for enhancing community-based, culturally relevant, and spiritually-informed interventions, to adequately meet their coping needs.

Profile Of Infectious Complications in Pediatric Oncology Patients: Experience from Tertiary Referral Hospital in Low and Middle-Income Country

Abstract Background Cancer patients are at higher risk of infections and more likely to have higher morbidity and mortality than the general population, While cancer itself is still the main cause of death in children around the world, in countries with limited health facilities, that might cause delay in seeking treatment, cancer death rate in children could reach 90%; most of them are caused by infectious complications such as typhilitis and mucositis, and febrile neutropenia might contribute to it. The aim of the study was to describe that infectious complications that occur in pediatric oncology patients does correlate with febrile neutropenia and prognosis. Methods We collected data using Hospital Information System from October 1, 2022, to October 31, 2023, in pediatric oncology patients aged 1 to 18 years admitted to Hasan Sadikin General Hospital. Data collected included patient characteristics, diagnosis, typhlitis and mucositis, and neutropenia. Mortality data were also collected after auditing by experts from Hasan Sadikin General Hospital. Results There were 1982 pediatric oncology patients admitted, 90 (4,5%) were consulted to infectious diseases because of neutropenia; most of these patients (34.4%) were diagnosed with acute myeloblastic leukemia, with acute lymphoblastic leukemia second (24,4%). Most of the patients were <5 years old (42,25%); 77/90 (85,5%) had ANC<500 and most were categorized as high-risk group 62/77 (80,5%). Mucositis and typhlitis occurred more commonly in this group with 17/67 (25,3%) and 2/67 (2,9 %) respectively compared to 3 cases of mucositis and no case of typhlitis in the low-risk group. Mortality rate was 10,4% (7/67) in the high-risk group, and all of them had mucositis and/or typhlitis. Conclusion Better quality of care including infection prevention and control is important, especially in high-risk group population with low ANC because infectious complications such as typhlitis and mucositis are much likely to occur and could affect prognosis.

Genomic Determinants of Outcome in Acute Lymphoblastic Leukemia.

Although cure rates for childhood acute lymphoblastic leukemia (ALL) exceed 90%, ALL remains a leading cause of cancer death in children. Half of relapses arise in children initially classified with standard-risk (SR) disease. To identify genomic determinants of relapse in children with SR ALL, we performed genome and transcriptome sequencing of diagnostic and remission samples of children with SR (n = 1,381) or high-risk B-ALL with favorable cytogenetic features (n = 115) enrolled on Children's Oncology Group trials. We used a case-control study design analyzing 439 patients who relapsed and 1,057 who remained in complete remission for at least 5 years. Genomic subtype was associated with relapse, which occurred in approximately 50% of cases of PAX5-altered ALL (odds ratio [OR], 3.31 [95% CI, 2.17 to 5.03]; P = 3.18 × 10-8). Within high-hyperdiploid ALL, gain of chromosome 10 with disomy of chromosome 7 was associated with favorable outcome (OR, 0.27 [95% CI, 0.17 to 0.42]; P = 8.02 × 10-10; St Jude Children's Research Hospital validation cohort: OR, 0.22 [95% CI, 0.05 to 0.80]; P = .009), and disomy of chromosomes 10 and 17 with gain of chromosome 6 was associated with relapse (OR, 7.16 [95% CI, 2.63 to 21.51]; P = 2.19 × 10-5; validation cohort: OR, 21.32 [95% CI, 3.62 to 119.30]; P = .0004). Genomic alterations were associated with relapse in a subtype-dependent manner, including alterations of INO80 in ETV6::RUNX1 ALL, IKZF1, and CREBBP in high-hyperdiploid ALL and FHIT in BCR::ABL1-like ALL. Genomic alterations were also associated with the presence of minimal residual disease, including NRAS and CREBBP in high-hyperdiploid ALL. Genetic subtype, patterns of aneuploidy, and secondary genomic alterations determine risk of relapse in childhood ALL. Comprehensive genomic analysis is required for optimal risk stratification.

Rocky Mountain Spotted Fever in Children along the US‒Mexico Border, 2017-2023.

Rocky mountain spotted fever (RMSF) causes significant illness and death in children. Although historically rare in California, USA, RMSF is endemic in areas of northern Mexico that border California. We describe 7 children with RMSF who were hospitalized at a tertiary pediatric referral center in California during 2017-2023. Five children had recent travel to Mexico with presumptive exposure, but 2 children did not report any travel outside of California. In all 7 patients, Rickettsia rickettsii DNA was detected by plasma microbial cell-free next-generation sequencing, which may be a useful diagnostic modality for RMSF, especially early in the course of illness, when standard diagnostic tests for RMSF are of limited sensitivity. A high index of suspicion and awareness of local epidemiologic trends remain most critical to recognizing the clinical syndrome of RMSF and initiating appropriate antimicrobial therapy in a timely fashion.

Healthcare-seeking behavior for diarrhea in under-five children and associated factors in sub-Saharan Africa: a multilevel robust Poisson regression model.

Diarrhea is one of the leading causes of child death in sub-Saharan Africa (SSA). Children with diarrhea who do not receive medical advice or treatment are at high risk of poor health outcomes and increased mortality. Prompt and adequate treatment is essential to mitigate these risks. However, studies that have been conducted on the factors influencing healthcare-seeking behavior (HSB) for diarrhea in under-five children in SSA are scarce. Therefore, the purpose of this research was to determine the variables related to HSB for diarrhea in children under the age of five. A secondary data analysis was conducted on the most recent data from the Demographic and Health Surveys in 35 SSA countries. The study included a total weighted sample of 51,791 children under the age of five with diarrhea. We presented the adjusted prevalence ratio and the 95% confidence interval in the multivariable multilevel robust Poisson regression analysis to show the statistical significance and strength of the association between HSB and its determinants. The pooled prevalence of HSB for diarrhea in under-five children was 58.71% (95%CI: 55.39 to 62.04). Factors found to be associated with HSB included maternal age, education and working status, antenatal care visits, postnatal checkups for the child, wasting, distance to a health facility, SSA region, and country income level. More than 40% of under-five children with diarrhea in SSA did not receive medical advice or treatment. To improve healthcare-seeking behavior, effective health policy interventions are necessary. These include enhancing the education and employment status of mothers, promoting regular antenatal and postnatal care visits, building health facilities in close proximity, and raising awareness in the community about the importance of seeking healthcare services for malnourished children.

Challenges and Considerations in Selecting Animal Models for Evaluating a Live, Cold-Chain-Free, Dual-Use Vaccine (MyChol) for Diarrhoeal Diseases: A Comprehensive Review.

Diarrhoeal diseases are the second leading cause of death for children under 5 years old in 69 low- and middle-income countries, with an annual economic burden of US$ 4 billion and over 525,000 lives lost. Cholera and enterotoxigenic Escherichia coli (ETEC) traveller's diarrhoea are major diarrhoeal diseases caused by Vibrio cholerae (O1 and O139 serogroups) and ETEC, which have similar pathogeneses and can co-infect. There is no exclusive vaccine for ETEC, but cholera vaccines containing the cholera toxin B (CT-B) component offer short-term cross-protection. However, licensed oral cholera vaccines are expensive due to cold-chain supplies and the need for multiple doses. A cost-effective, dual-protection, live, cold-chain-free vaccine is, therefore, required for vaccination campaigns in low-resource settings, and MyChol - a prototype cold-chain-free live attenuated cholera vaccine, targeting V. cholerae O139 and ETEC H10407 - was developed in this context. The vaccine was evaluated in three animal models (Sprague Dawley [SD] rats, BALB/c mice and New Zealand white rabbits) for safety, colonisation capacity, reactogenicity and immunogenicity against challenge strains. In suckling mice, MyChol displayed high colonisation potential compared to unformulated VCUSM14P (the vaccine candidate) and wild-type O139. In the acute toxicity assessment, the SD rats with the highest MyChol dose (1 × 107 colony-forming unit [CFU]/kg) demonstrated no adverse effects or mortality. Mice vaccinated with MyChol exhibited elevated antibody levels, including anti-CT, anti-heat-labile enterotoxin (LT), anti-CT-B and anti-LT-B. Anti-CT antibodies neutralised LT toxin in ETEC H10407 in challenge studies and cross-protected against ETEC H10407 in both mice and rabbits, preventing weight loss and diarrhoea. Ileal loop experiments in rabbits and BALB/c mice showed no reactogenicity. This review, based on our previous research, therefore provides valuable insights into improving the selection of animal models to advance preclinical evaluations of diarrhoeal vaccines.

Developmental changes in how pedestrians cross streets in single- vs. dual-lane traffic conditions.

Pedestrian injury is a leading contributor to childhood deaths. This study compared the crossing behaviors of children with adults when crossing in virtual single-lane vs. two-lane traffic conditions. Using a fully immersive virtual reality system, children 7-10 years and adults crossed streets with traffic in one lane (near lane) or in two lanes (near and far lane) with 0 offset so cars from opposing directions arrived at the child's crossing line at the same time. On each trial, pedestrians made a decision on when to cross and then completed the crossing, with measures of attention and crossing behaviors automatically recorded by the system as they did so. In comparison to crossing a single lane of traffic, crossing two-lane roads increased injury risk for all pedestrians, though children experienced significantly greater risk than adults. Children predominantly crossed by stopping before entering the far lane, whereas adults showed greater synchronization of self-movement to traffic flow and more often crossed both lanes without stopping. Children experience more high-risk outcomes than adults when crossing single-lane roads. Crossing two-lane roads elevates risk for pedestrians of both ages, though this risk is significantly greater for child than adult pedestrians. The predominant strategy used to cross two lanes of traffic shows significant developmental changes. Implications for injury prevention are discussed.