Disease In Children Research Articles

Risk factors and cardio-metabolic outcomes associated with metabolic-associated fatty liver disease in childhood

Non-Alcoholic Fatty Liver Disease (NAFLD) is defined as increased liver fat percentage, and is the most common chronic liver disease in children. Rather than NAFLD, Metabolic-Associated Fatty Liver Disease (MAFLD), defined as increased liver fat with presence of adverse cardio-metabolic measures, might have more clinical relevance in children. We assessed the prevalence, risk-factors and cardio-metabolic outcomes of MAFLD at school-age. This cross-sectional analysis was embedded in an ongoing population-based prospective cohort study started in 2001, in the Netherlands. In 1910 children of 10 years, we measured liver fat fraction by magnetic resonance imaging (MRI), body mass index (BMI), blood pressure, and lipids, insulin, and glucose concentrations. Childhood lifestyle factors were obtained through questionnaires. MAFLD was defined as ≥2% liver fat in addition to excess adiposity (BMI or visceral adiposity), presence of metabolic risk (blood pressure, triglycerides and HDL-concentrations) or prediabetes (glucose). Of all children, 49.6% had ≥2% liver fat, and 25.2% fulfilled the criteria of MAFLD. Only non-European descent was associated with increased odds of MAFLD at nominal significance (Odds Ratio 1.38, 95% Confidence Interval 1.04, 1.82). Compared to children with <2% liver fat, those with MAFLD had increased odds of cardio-metabolic-risk-factor clustering (Odds Ratio 7.65, 95% Confidence Interval 5.04, 11.62). In this study, no NAFLD-associated childhood risk factors were associated with increased odds of childhood MAFLD, yet the findings suggest that ethnicity could be, despite mostly explained by socio-economic factors. Use of MAFLD criteria, rather than NAFLD, may identify children at risk for impaired cardio-metabolic health. Erasmus University MC, the Netherlands Organisation for Health Research and Development, the Ministry of Health, Welfare, and Sport, and the European Research Council.

THU339 Neutrophil Gelatinase-associated Lipocalin And B2-microglobulin May Reflect Early Diabetic Nephropathy In Asymptomatic Patients With Type 1 Diabetes

Abstract Disclosure: N. Papadopoulou: None. M. Arkoumani: None. I. Papassotiriou: None. A. Mantzou: None. G.P. Chrousos: None. N. Tentolouris: None. C. Kanaka-Gantenbein: None. Type 1 diabetes (T1D) is a frequent autoimmune disease in childhood, adolescence and young adulthood and may cause microvascular complications. Several studies have shown that increased serum or urine Neutrophil Gelatinase-Associated Lipocalin (NGAL) and beta 2 microglobulin (b2-microglobulin) are associated with microvascular complications like nephropathy. Hypothesis and Underlying Question the Research Addresses: We assessed the role of serum and urine NGAL and b2-microglobulin, biomarkers of renal dysfunction, in unravelling early renal dysfunction in T1D. Overview of Experimental Design and Methodology: Two patient groups who took part in two-centers’ prospective cohorts were studied. Sixty-one patients with T1D, aged 5-17 years from the Diabetes Center of Aghia Sophia Children’s Hospital, University of Athens, Greece, and 34 patients with T1D aged 18-44 years from the Diabetes Center, 1st Propaedeutic Department Laiko of the Laikon University Hospital of Athens, Greece were recruited. Sixty age- and sex-matched apparently healthy controls were also included in the study . Along with standard blood and urine chemistry, serum and urine NGAL concentrations and serum b2-microglobulin were determined by means of immunoenzymatic techniques. Estimated glomerular filtration rate (eGFR) was calculated with CKD EPI. Both physical and laboratory examinations were obtained in 2 time-points, at baseline and 12 months later. Main Results: In both young and adult groups with T1D, urine NGAL correlated positively with microalbuminuria (r=0.33, p=0.003) and decreased eGFR (r= -0.37, p=0.0008) irrespectively of gender or age. Decreased values of eGFR were correlated with increased values of b2-microglobulin (r= -0.30, p=0.002). Interpretation of Results and Conclusions: Urine NGAL as well as serum b2-microglobulin levels, proposed biomarkers of renal dysfunction, correlated with indices of early diabetic nephropathy, characterized by both microalbuminuria and decreased eGFR in patients with T1D, showing similar results in a broad patients’ age range. Thus, this marker may unmask early reversible renal dysfunction before overt nephropathy appears. However, prior to its clinical application, this biomarker must undergo thorough validation in several cohorts. Presentation: Thursday, June 15, 2023

Association between pertussis vaccination in infancy and childhood asthma: A population-based record linkage cohort study.

Asthma is among the commonest noncommunicable diseases of childhood and often occurs with other atopic comorbidities. A previous case-control study found evidence that compared to children who received acellular pertussis (aP) vaccines in early infancy, children who received one or more doses of whole-cell pertussis (wP) vaccine had lower risk of developing IgE-mediated food allergy. We hypothesized that wP vaccination in early infancy might protect against atopic asthma in childhood. Retrospective record-linkage cohort study of children between 5 and < 15 years old and born between January 1997, and December 1999, in the Australian states of Western Australia (WA) and New South Wales (NSW), receiving wP versus aP vaccine as the first pertussis vaccine dose. The main outcome and measures were first and recurrent hospitalizations for asthma; hazard ratios (HRs) and 95% confidence intervals (CIs) were computed by means of Cox and Andersen and Gill models. 274,405 children aged between 5 and < 15 years old (78.4% NSW-born) received a first dose of either wP (67.8%) or aP vaccine before 4 months old. During the follow-up period, there were 5,905 hospitalizations for asthma among 3,955 children. The incidence rate for first hospitalization was 1.5 (95% CI 1.4-1.5) per 1,000 child-years among children receiving wP vaccine as a first dose, and 1.5 (95% CI 1.4-1.6) among those vaccinated with aP vaccine as a first dose. The adjusted HRs for those who received wP vaccine versus aP vaccine as the first dose were 1.02 (95% CI 0.94-1.12) for first hospitalizations and 1.07 (95% CI 0.95-1.2) for recurrent hospitalizations for asthma. We found no convincing evidence of a clinically relevant association between receipt of wP versus aP vaccines in early infancy and hospital presentations for asthma in childhood.

Spinal Muscular Atrophy: An Evolving Scenario through New Perspectives in Diagnosis and Advances in Therapies.

Spinal muscular atrophy (SMA) linked to 5q is a recessive motor neuron disease characterized by progressive and diffuse weakness and muscular atrophy. SMA is the most common neurodegenerative disease in childhood with an incidence of approximately 1 in 6000-10,000 live births, being long considered a leading cause of hereditary mortality in infancy, worldwide. The classification of SMA is based on the natural history of the disease, with a wide clinical spectrum of onset and severity. We are currently in a new therapeutic era, that, thanks to the widespread use of the newly approved disease-modifying therapies and the possibility of an early administration, should lead to a deep change in the clinical scenario and, thus, in the history of SMA. With the aim to achieve a new view of SMA, in this review we consider different aspects of this neuromuscular disease: the historical perspective, the clinical features, the diagnostic process, the psychological outcome, innovation in treatments and therapies, the possibility of an early identification of affected infants in the pre-symptomatic phase through newborn screening programs.

A Comparative Clinical Study on the effect of Vachadi Avaleha versus Mustakadi Avaleha in the management of Pratishyaya (~Recurrent Rhinitis) in school going children: A Single-blind Randomized Control Trial

Background: In Ayurveda, Pratishyaya (~Recurrent Rhinitis) is described in Shiro-roga (Head disease).Pratishyaya (~Recurrent Rhinitis) is a common disease of childhood and it is well known for its recurrence. Immature Dhatu (tissues) state in children makes them more susceptible to recurrent infections. Clinical features of Pratishyaya (~Recurrent Rhinitis) can be correlated with rhinitis. Aim &amp; Objective: To study the effect of vachadi avaleha and mustakadi avaleha in management of pratishyaya (~recurrent rhinitis). To study comparative efficacy of vachadi avaleha and mustakadi avaleha in management of pratishyaya(~recurrent rhinitis). Material &amp; Method: Study comprises total 60 patients of Pratishyaya (~recurrent rhinitis) randomly divided into two equal groups. Group A (Experimental group) was treated with Vachadi avaleha two times a day after meal with honey and Group B (Control group) was treated with Mustakadi Avaleha administered two times a day after meal for 90 days. Patients were assessed for subjective parameters like rhinorrhoea, sneezing, nasal congestion, recurrence of rhinitis, duration of rhinitis per episode. Patients were assessed on every 30th day till completion of study period. Result- The effect of Mustakadi Avaleha (Group B) is significant at p&lt;0.05 for subjective criteria such as nasastrava (rhinorrhoea), kshavathu (sneezing), and nasavarodha (nasal congestion) of pratishyaya (~Recurrent Rhinitis). Conclusion: Vachadi Avaleha is not as significant as Mustakadi avaleha in Pratishyaya (~Recurrent Rhinitis).

Knowledge Of Families Toward Type 1 Diabetes Among Children In AL-Diwaniyah City, Iraq: Cross-Sectional Study –College of Medicine/ University Of AL-Qadisiyah

Background: Type 1 diabetes is one of the most common chronic diseases in childhood, that is considered a challenge for parents especially when the child is not developmentally able to manage the disease independently. Since optimal glycemic control is required to prevent acute and long-term diabetes-related complications and enhance school performance, the importance of involving adults in the child diabetes management is essential. Aim of the study: The current study aimed to evaluate the knowledge, regarding children with T1DM among families living in Diwaniyah city. Subjects and Method: A cross sectional study conducted in Al Diwaniyah governate, Iraq on a sample of 400 caregivers of type 1 diabetes mellitus diagnosed children for a period of three months. Structured questionnaires were used for Knowledge. Chi -square test was applied to find the significant association between qualitative variables. Independent t test and one way ANOVA were applied to illustrate a significant difference between quantitative variable. In all Statistical analyses, a p value equal or below 5% was considered significant. Results: Majority of caregivers; 192 (48%), were in their forties and married. Mothers 239 (59.8%) were the main caregivers, more than half of the studied sample 237(59.3%) had university or institute educational attainment. The average score for knowledge was 9.39±2.9 scores ranging from 0-12 score. Poor knowledge was found among 64 (16%) of caregivers, while 42(10.5%) and 294(73.5%) scored moderate and good knowledge respectively. Education and urban residency were significantly associated with good knowledge. Lower HbA1C level was seen associated with good diabetes knowledge. Conclusion: Although good knowledge were reported. Such discrepancy requires an increase in public awareness about the T1DM. Using modern technology to disseminate the correct information to caregivers.

Recent developments in the assessment and management of inflammatory bowel disease in childhood: a narrative review

Recent developments in the assessment and management of inflammatory bowel disease in childhood: a narrative review

Lengthening sleep reduces pain in childhood arthritis: a crossover randomised controlled trial

ObjectivesJuvenile idiopathic arthritis (JIA) is a common chronic childhood disease and chronic pain is a debilitating feature. A strong link has been shown between poor sleep and pain in JIA....

Administrative Databases: Friend or Foe in Paediatric Cardiomyopathy

BackgroundCardiomyopathy (CM) is a rare childhood disease associated with morbidity and mortality. Limited data exist on paediatric CM in Canada. Given the rare nature, single-centre studies are not sufficiently powered to address important questions. Therefore, administrative health data may serve as a resource for the study of childhood CM. The goal of this study was to validate the accuracy of International Classification of Diseases (ICD)-based algorithms to identify paediatric CM in health databases using a clinical registry as the gold standard. MethodsThe clinical registry was compiled from outpatient and inpatient records at the Stollery Children’s Hospital (January 1, 2013, to December 31, 2021). Patients were categorized as having CM or screened without CM. Data were linked to administrative health databases using the patient’s Unique Lifetime Identifier. Algorithms based on the presence of ICD, 10th Revision, codes for CM were then evaluated, and cross-tabulations against the clinical registry were generated. Accuracy, positive predictive value, negative predictive value, sensitivity, and specificity were calculated. ResultsThe clinical registry had 90 patients with CM and 249 screened without CM. The algorithms ruled out CM (high negative predictive value) but had variability in the ability to diagnose CM positive predictive value. The algorithm that performed the best was based on a diagnosis of CM in a hospitalization or 2 ambulatory visits. ConclusionsA combination of inpatient and outpatient databases can be used, with acceptable accuracy, to identify paediatric patients with CM. This finding allows for the use of the identified algorithm for the comprehensive study of paediatric CM in Canada.

Short Stature as a Major Manifestation of Celiac Disease in Children 1-14 years of age at Shaikh Zayed Hospital Lahore

Aim: To find the frequency of asymptomatic celiac disease in children with proportionately short stature. Methodology: This prospective study was carried out at the Department of Paediatrics, Shaikh Zayed Hospital, Lahore. A total of 151 cases of proportionate short stature were selected according to selection criteria and informed consent. Their history, examination, and detailed demographics were recorded. They were tested for anti-Tissue Transglutaminase2 IgA antibody levels, and the results were interpreted. Results: Fifty (33.1%) were males and 101(66.9%) were females, with a mean age of 7.7±3.3 and a mean height of 106.9±17.0. Anti-TG2 IgA levels were positive in 15 (9.9%) patients and negative in 136(90.1%) patients. The frequency of asymptomatic celiac disease among proportionately short statures is 9.9%. Conclusion: The frequency of 9.9% cases of asymptomatic CD among children with pathologically proportionately short stature. Keywords: Extra-intestinal manifestations, Asymptomatic celiac disease, Short stature, Children

PERCEIVED KNOWLEDGE, ATTITUDE, AND BEHAVIOR OF PARENTS/CAREGIVERS TOWARDS ROUTINE IMMUNIZATION IN DISTRICT PISHIN, BALOCHISTAN PAKISTAN: A CROSS-SECTIONAL SURVEY

Abstract Background: This study evaluates the perception, attitude, and behavior of parents/caregivers towards the vaccination of their child. vaccination is the greatest impactful steps, determining the real goal for public health. Material and Methods: A cross-sectional survey was conducted among the sample of 403 Parents/caregivers of children aged under 5 years by using a two-stage random sampling technique in the period between February to March 2022 in district Pishin of Baluchistan, Pakistan. Results: Community health workers were used to administer the questionnaire to parents or caregivers, to seek information about 1) Socio-demographic characteristics 2) knowledge regarding vaccines and their types; 3) behavior regarding the administration of vaccination. The knowledge regarding vaccine-preventable diseases was higher in parents who attend higher levels of education. HCPs were the primary source of information and the majority of sources are verbal. Parents/caregivers show a positive attitude toward vaccines and 59% are aware of vaccine importance and 39% are aware of childhood diseases with their names. Conclusion: The positive attitude was significantly higher in those who considered vaccines boost immunity and protect against diseases. Greater attention from policymakers and healthcare providers is needed to increase the knowledge-seeking behavior of parents/caregivers on recommended vaccines and their importance on timeliness and completion to increase immunization coverage. Keywords: Vaccine-preventable diseases, Immunization, Childhood

The Implementation of Integrated Management of Childhood Illness (IMCI) in Sick Children from 2 Months up to 5 Years Age Old with Diarrhea in Community Health Center

Integrated Management of Childhood Illnesses (IMCI) is a program that focuses on the main childhood diseases that occur in children under five years of age with a focus on pneumonia (acute respiratory infection), diarrhea, malaria, measles, dengue hemorrhagic fever (DHF), ear and malnutrition. Diarrhea is a global health problem that causes high morbidity and mortality in developing countries due to poor environmental sanitation and hygiene, inadequate water supply, poverty and limited access to education. IMCI is a strategy that focuses on child as a whole, not on a single disease or condition, but on a combination of illnesses that need to be treated in an integrated manner at home and in primary health care facilities. Based on the Becora Community Health Center report that cases handled using the IMCI strategy totaled 2,204 cases in 2021, 4,273 cases in 2022 and 3,160 cases, from January to June 2023. Diarrhea cases ranked first, namely 584 cases in 2021, and in 2022 experienced an increase to 758 cases and until June 2023 cases of diarrhea reached 416 cases. The purpose of this residency is to know the management of cases of diarrhea by using IMCI strategies at the Becora Health Center, Dili, Timor Leste. Using descriptive studies because they only wanted to know the frequency distribution of cases handled with IMCI and specifically wanted to observe the management procedures in cases with diarrhea. Based on the results residence from 17-29 July 2023, 598 cases were not handled according to the IMCI strategy, of which 10.37% (n=62) cases had diarrhea and 0.5% (n=3) dysentery cases. In accordance with the results of observations that the IMCI management procedures are not in accordance with ministry standards or policies issued by the Ministry of Health Timor Leste. During residence it appears that health professionals conducting consultations are more directed to using general consultations than using the IMCI strategy.

Epidemiological, Genetic, and Phenotypic Characteristics of Non-Typhoidal Salmonella in Young Children, as Obtained from a Tertiary Hospital in Guangzhou, China.

Gastroenteritis caused by non-typhoidal Salmonella (NTS) is a significant disease in childhood, ranking as the seventh-leading cause of diarrhea mortality in children aged < 5 years. To understand the epidemiological, genetic, and phenotypic characteristics of NTS, 465 anal swabs from children aged < 5 years in a tertiary hospital in Conghua District, Guangzhou, China, were collected from June to October 2021. An average prevalence of 35.27% (164/465) was observed, with whole genome sequencing identifying 11 serotypes, among which Salmonella 1,4,[5],12:i:- was the most prevalent (65.24%, 107/164). Meanwhile, ST34 was found to be the predominant subtype. Children who are breastfed, eat fresh food, and have good hygiene habits show a relatively low prevalence of NTS. Fever is a common symptom that may be caused by NTS infection. Antimicrobial resistance testing revealed that the majority of strains were resistant to tetracycline (83.5%) and ampicillin (82.3%), with multi-drug resistance (MDR) observed in 50.61% (83/164) of all strains tested. The predominant resistance spectrum presents as tetracycline-ampicillin-chloramphenicol-trimethoprim-sulfamethoxazole (30.49%, 50/164). The antimicrobial resistance rates (2.4%, 9.8%, 9.8%, 10.4%, 9.1%, and 3.7%, respectively) of cephalosporins (cefepime, cefuroxime, cefuroxime axetil, ceftriaxone, ceftazidime, and cefoxitin) were low. Therefore, continued surveillance of the prevalence and MDR profiles of NTS, along with the rational use antibiotics, is required. This protocol is significant for preventing further dissemination of NTS and formulating effective prevention and control strategies.

Relationship between prenatal and postnatal exposure to BPA and its analogues (BPS, BPF) and allergic diseases.

Bisphenols, endocrine disrupting chemicals, are widely used in daily life. Continued exposure during key developmental periods of life (pregnancy, infancy and early childhood) can contribute to adverse health consequences such as decreased lung function, wheezing/asthma, the occurrence of allergies or changes in immune system responses. The purpose of this review is to present the current state of knowledge on the effects of prenatal or postnatal exposure to bisphenol A (BPA), bisphenol S (BPS) and bisphenol F (BPF) on the development of allergic diseases in childhood. A com- prehensive and systematic search of PubMed, Scopus and Web of Science databases was conducted. The review is restricted to studies published since 2015, in English in peer-reviewed journals. Based on keywords, 2648 studies were identified and reviewed for eligibility. Finally, 8 epidemio- logical studies were found to be appropriate for inclusion in this publication. The data collected in this review suggests that there is an associa- tion between maternal exposure during pregnancy or childhood to BPA and the development of allergic diseases. Most studies reported positive relationships between BPA exposure and at least one of the types of allergic disease. The paucity of studies and the observed differences in findings regarding the association between prenatal/postnatal exposure to BPS and/or BPF do not allow firm conclusions to be drawn. Further research is needed to identify the vulnerable population and the mechanisms responsible for the development of undesirable health consequences. Int J Occup Med Environ Health. 2023;36(5):575-86.

A-322 Implementation of Three Age- and Sex-Dependent Equations to Estimate Glomerular Filtration Rates (eGFR) at a Pediatric Institution

Abstract Background The National Kidney Foundation estimates that 37 million people in the United States are affected by kidney disease, although 90% of them are unaware of it. While kidney disease is less common in children and adolescents, early diagnosis and treatment is important due to the significant long-term impact it can have on growth, cognitive development, and cardiovascular disease. Unlike adults, the estimated glomerular filtration rate (eGFR) for pediatric patients is not routinely reported by clinical laboratories. The process of estimating GFR is cumbersome and time-consuming for clinicians, requiring data extraction to use estimating equations with variable accuracy. The Chronic Kidney Disease in Children (CKiD) Study has developed and published new, more precise, estimating equations for use in children and young adults that utilize a sex- and age-dependent constant (k) in conjunction with height and serum creatinine and/or serum cystatin-C. In collaboration with Nephrology and Laboratory Information Technology, we implemented three eGFR equations into our laboratory information system (LIS) and currently report the results in the patient's electronic medical record (EMR). Methods The three equations that were implemented were named eGFR-creatinine (eGFR = k x (height/sCr) with height in m and serum creatinine in mg/dL), eGFR-cystatin (eGFR = k×(1/cysC) with serum cystatin-C in mg/L), and eGFR-average, which reports the average of the creatinine and cystatin-C estimating equations when both are ordered. The k constant is dependent on the patient's age and sex. An eGFR value of &amp;gt;90 mL/min|1.73m2 is considered normal. When an eGFR is ordered, the system identifies the most recent creatinine or cystatin-C result. If one has not been resulted in the last 2 hours, the system reflexes an order for a basic metabolic panel or a cystatin-C. For the eGFR-creatinine equation, the system looks back up to 3 months for a height and uses the most current value. Concordance and discordance were determined in patients who had all three equations ordered and compared as to whether all three values gave a result above or below 90 mL/min|1.73 m2. Results The eGFR-creatinine equation went live in June 2022. As of January 2023, 287 eGFR-creatinine values have been resulted. The cystatin-C assay, eGFR-cystatin equation, and e-GFR average equations went live in November 2022. As of January 2023, 114 eGFR-averages and 167 eGFR-cystatins have been resulted. When both equations were ordered and the eGFR-average was calculated, all three values were concordant 69 times (61%) and discordant 45 times (39%). In 26 instances, the eGFR-creatine value was discrepant compared with the other two equations and in 19 instances, the eGFR-cystatin value was discrepant. The differences between the eGFR equations ranged from 1.1–41.9%, however 65% of the values varied by less than 10% and 88% varied by less than 20%. Conclusion Implementation of pediatric eGFR equations into the LIS and reporting of eGFR in the EMR will allow more accurate assessment of pediatric patients’ kidney function and improved clinician and patient awareness of impaired kidney function. Availability of this information will allow an earlier diagnosis and treatment of chronic kidney disease.

Associations between anemia and FGF23 in the CKiD study

BackgroundFibroblast growth factor 23 (FGF23) is a bone-derived hormone that plays a central role in chronic kidney disease-mineral bone disorder and is associated with CKD progression and cardiovascular morbidity. Factors related to CKD-associated anemia, including iron deficiency, can increase FGF23 production. This study aimed to assess whether anemia and/or iron deficiency are associated with increased circulating concentrations of FGF23 in the large, well-characterized Chronic Kidney Disease in Children (CKiD) study cohort.MethodsHemoglobin concentrations, iron parameters, C-terminal (total) FGF23, intact FGF23, and relevant covariables were measured in cross-sectional analysis of CKiD study subjects.ResultsIn 493 pediatric patients with CKD (median [interquartile range] age 13 [9, 16] years), the median estimated glomerular filtration rate was 48 [35, 61] ml/min/1.73 m2, and 103 patients (21%) were anemic. Anemic subjects had higher total FGF23 concentrations than non-anemic subjects (204 [124, 390] vs. 109 [77, 168] RU/ml, p < 0.001). In multivariable linear regression modeling, anemia was independently associated with higher total FGF23, after adjustment for demographic, kidney-related, mineral metabolism, and inflammatory covariables (standardized β (95% confidence interval) 0.10 (0.04, 0.17), p = 0.002). In the subset of subjects with available iron parameters (n = 191), iron deficiency was not associated with significantly higher total FGF23 concentrations. In the subgroup that had measurements of both total and intact FGF23 (n = 185), in fully adjusted models, anemia was significantly associated with higher total FGF23 (standardized β (95% CI) 0.16 (0.04, 0.27), p = 0.008) but not intact FGF23 (standardized β (95% CI) 0.02 (−0.12, 0.15), p = 0.81).ConclusionsIn this cohort of pediatric patients with CKD, anemia was associated with increased total FGF23 levels but was not independently associated with elevated intact FGF23, suggesting possible effects on both FGF23 production and cleavage. Further studies are warranted to investigate non-mineral factors affecting FGF23 production and metabolism in CKD.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Diagnostic performance of renal cortical elasticity by supersonic shear wave imaging in pediatric glomerular disease

PurposeTo explore the diagnostic performance of renal cortical elasticity expressed by Young’s modulus (YM) using the supersonic shear wave imaging (SSI) technique in pediatric glomerular disease. Materials and methodsSeventy-one children with glomerular disease confirmed by renal biopsy and sixty healthy volunteers were enrolled in this study. Conventional and SSI ultrasound examinations were performed in all individuals for both kidneys. We measured renal length, renal width, renal thickness, parenchyma thickness, interlobar arterial resistive index (RI) and the YM of the middle and lower pole. ResultsRegardless of which pole and which side of the kidney, the YM in the disease group was significantly higher than that in the control group (P < 0.001). The YM of the middle pole in the left kidney demonstrated the largest AUC (0.936, P < 0.001), and the corresponding cut-off value was 15.48 kPa with a sensitivity of 87.3% and a specificity of 86.7%. There was no significant difference in the YM among different pathological types of pediatric glomerular disease in the disease group, and the same in different grades of patients with Immunoglobulin A (IgA) nephropathy by Lee classification and the Oxford Classification as well as Henoch-Schonlein purpura nephritis (HSPN) by International Study of Kidney Disease in Children (ISKDC) classification (P > 0.05). We found positive but weak correlations between the YM and renal length (r = 0.299, P = 0.001), renal width (r = 0.408, P < 0.001), renal thickness (r = 0.299, P = 0.001), and parenchyma thickness (r = 0.212, P = 0.015), whereas the YM had no significant correlations with age, sex, BMI, interlobar arterial RI, and laboratory findings (P > 0.05). ConclusionsSSI technology is a non-invasive and feasible method for the diagnosis of pediatric glomerular disease. However, SSI did not show good performance in distinguishing different pathological types and disease grades in our study.

Pattern of Congenital Heart Diseases in Children in a Tertiary Care Hospital of Bangladesh

The most common congenital anomaly and a major contributor to infant and toddler mortality is congenital heart disease (CHD). Although it has high mortality rate but majority of the cases are asymptomatic during early life and usually discovered during routine checkup. To determine the incidence and pattern of congenital heart disease in children in a tertiary care hospital of Bangladesh. This cross-sectional study was conducted among children aged 1 day to 10 years old with cardiac problems who were hospitalized to the Paediatric department of Rajshahi Medical College Hospital, Rajshahi, Bangladesh from August 2018 to August 2021. Early detection of CHD is possible by thoroughly analyzing heart murmurs, clinical manifestations, and outcomes. The data were analyzed utilizing IBM SPSS (version-23). A total of 3512 children under the age of 10 years were evaluated. Here 1.54% of the patients had a CHD murmur. In this study, the most common type of congenital heart illness was a ventricular septal defect (VSD) (37.05%). Atrial septal defect (ASD) (24.07%) was found second most common CHD. Rapid breathing (63%) and poor growth (44.4%) were major clinical presentation. According to types of murmur among patients, 27(50%) had pansystolic murmur, 15(27.77%) had ejection systolic murmur and 12(22.23%) had continuous murmur. Congenital heart disease is a major health concern for Paediatricians due to its significant health hazards and high mortality rate. Early identification of congenital cardiac disease is crucial for preventing complications, lowering mortality, and for proper therapy. J. Bio-Sci. 30(2): 39-45, 2022

Urticaria in childhood—what’s new?

AbstractUrticaria can manifest at any age, including infants and young children. Urticaria is one of the most prevalent skin diseases in childhood. As in adults, a distinction is made between acute and chronic urticaria, with chronic urticaria further classified into chronic spontaneous urticaria and inducible urticaria. According to the current German S3 guideline for classification, diagnosis, and treatment of urticaria, existing literature suggests that the prevalence, disease characteristics, causes, and also the response to treatment are very similar in children and adults. The clinical hallmark of urticaria is the subjective sensation of itch. In young children who may have difficulty expressing itching, it is crucial to observe their scratching behavior during clinical examinations. Particularly in children, mastocytosis and autoinflammatory syndromes (cryopyrin-associated periodic syndromes [CAPS], especially Muckle–Wells syndrome and childhood Still’s disease) are important differential diagnoses. Autoinflammatory syndromes are characterized by additional symptoms such as fever, bone pain, muscle pain, and joint complaints. Cryopyrin-associated periodic syndromes usually manifest in infancy, so that these diseases must be considered, especially if cold-associated urticarial skin lesions are present. Appropriate and early treatment can prevent serious sequelae. In maculopapular mastocytosis (urticaria pigmentosa), reddish macules are characteristic for the disease; especially after elicitation of the Darier’s sign, differentiation from urticaria can be difficult, but the macules are permanent. Clinically, wheals and/or angioedema are found similarly to adults, indicating that mast cell-induced angioedema is also associated with childhood urticaria. In the case of exclusive angioedema, hereditary angioedema must also be considered, which usually manifests for the first time during puberty, often linked to hormone preparation usage.

Thyroid Function in Children with Cyanotic and Non-Cyanotic Congenital Heart Disease.

Congenital heart disease (CHD) is one of the common diseases of childhood, which is classified into non-cyanotic and cyanotic types. It can affect thyroid function and lead to disruptions in thyroid hormone secretion and hypofunction. This study aimed to evaluate thyroid function in patients younger than 2 years old with cyanotic and non-cyanotic CHD. In our study, 101 patients (female/male: 50/51) were included. The thyroid-stimulating hormone and thyroid hormones such as thyroxine (T4) and triiodothyronine (T3) were measured using the electrochemiluminescence method, and thyroid peroxidase antibodies were measured by an enzyme-linked immunosorbent assay. Subclinical hypothyroidism referred to normal levels of T4, with elevated levels of thyroid-stimulating hormone in the serum. The frequency of subclinical hypothyroidism and hypothyroidism in patients with cyanotic CHD was estimated at 27.5% and 10%, respectively, and 1 patient had hyperthyroidism. The majority of cyanotic and non-cyanotic CHD cases were diagnosed with tetralogy of Fallot (30%) and patent ductus arteriosus (32.79%). There were no significant differences between cyanotic and non-cyanotic groups regarding T3, T4, free T3, free T4, and anti-thyroid peroxidase antibody levels (0.389, 0.142, 0.354, 0.248, and 0.333, respectively). Based on the present findings, subclinical hypothyroidism is a common finding in cyanotic CHD patients during childhood, which is associated with increased levels of oxygen saturation, severity of cyanosis, and age.