Disease In Children Research Articles

Resistant Graves’ Disease in Childhood, A Rare but Complicated Situation, through a Clinical Case

Graves’ disease is by far the most common cause of hyperthyroidism in children [1]. In this specific population, the hyperthyroidism is willingly biochemically overt and clinically severe [2]. Childhood hyperthyroidism may also cause accelerated growth and bone maturation, and eventually deterioration in academic performance, hence the need for a good screening and a better management. children with GD require prompt treatment, for the most of cases it’s initially medical. But once this fails or is not possible, a definitive treatment should be considered [3]. For the antithyroid drugs use, we currently consider no difference in biochemical control between DT and BR [2,4], unlike previous approaches which argue in favor of the use of bloc-replace method in children [5-6]. However, for a curative treatment, total thyroidectomy is the preferred option for GD patients younger than 10 years [3]. We report the case of a girl who was 2 and a half years old in the moment of diagnose, and whom we followed for Graves' disease for 1 and a half years. Ethical considerations: In accordance with the regulations in force, informed consent, written and verbal, was provided to the parents of the child before the publication of this work.

Clinical epidemiology of Epstein-Barr virus-associated Lymphoproliferative Disorders (EBV-LPDs) in hospitalized children: A six-year multi-institutional study in China

BackgroundEpstein-Barr virus-associated lymphoproliferative disorders (EBV-LPDs) are a group of disorders involving lymphoid tissues or lymphocytes. The epidemiology and economic burden of hospitalized children with EBV-LPDs in China have not been well studied. This study aimed to reveal the epidemic characteristics and disease burden of EBV-LPDs among the Chinese hospitalized children, providing strategies for the prevention and management.MethodsThis study was based on the FUTang Updating medical REcords (FUTURE) database of China and collected the medical records from 27 tertiary children’s hospitals between January 2016 and December 2021 in China, counting five types of EBV-LPDs, namely EBV-positive T-cell lymphoproliferative disease, NK/T cell lymphoma, extranodal NK/T-cell lymphoma (nasal type), systemic EBV-positive T-cell lymphoproliferative disease of childhood and posttransplant lymphoproliferative disorders. We conducted a retrospective syhthesis and analysis of the epidemiological characteristics, expenses, length of stay (LOS), as well as complications among hospitalized children diagnosed with five types of EBV-LPDs and compared parameters using appropriate statistical tests.ResultsThe study described 153 children aged 0–18 years hospitalized with EBV-LPDs from 2016 to 2021 in the FUTURE database. The male-to-female ratio was 1.10:1, and more than half of the age distribution was in the 6–12 y group. Among EBV-LPDs cases, EBV+ T-LPD accounted for the largest proportion (65.36%). Complications were presented in 93 children with EBV-LPDs, mainly hemophagocytic lymphohistiocytosis (HLH). The median LOS of NKTL was 26.5 days [interquartile range (IQR) = 3–42], which was the longest among EBV-LPDs. The median hospitalization cost of PTLD was 10 785.74 United States dollars (IQR = 7 329.38–16 531.18), which was the heaviest among EBV-LPDs.ConclusionsCompared with the total number of hospitalized children in China during the same period and in the same age group, the proportion of EBV-LPD is very low. EBV-LPD can develop in all age groups, but it is more common in school-age children. Among 5 EBV-LPDs, the disease with the highest proportion is EBV+ T-LPD. The overall disease burden of EBV-LPD was heavy, especially the economic burden. HLH was one of the most common complications, which could directly affect the burden of patients because of prolonged hospitalization. These data are taken from a very large database, illustrating the epidemiological and economic burden of EBV-LPDs hospitalized children in China, which enriched the existing epidemiological and disease burden content of EBV-LPDs.

Atopic diseases-Diagnostics, mechanisms, and exposures.

Epidemiological data suggest that atopic diseases begin in early life and that most cases present clinically during early childhood. The diseases are highly prevalent and increase as communities adopt western lifestyles. Disentangling the pathophysiological mechanisms leading to disease debut is necessary to identify beneficial/harmful exposures so that successful prevention and treatment can be generated. The objective of this review is to explore the definition of atopy and mechanisms of atopic diseases, and to investigate the importance of environmental factors in early life, prior to disease development. First, the distribution of sIgE levels in children is investigated, as this is one of the main criteria for the definition of atopy. Thereafter, it is explored how studies of parental atopic status, sensitization patterns, and early debut and severity of atopic dermatitis have substantiated the theory of an early-life window of opportunity for intervention that precedes the development of atopic diseases in childhood. Then, it is examined whether early-life exposures such as breastfeeding, dogs, cats, and house dust mites in the home perinatally constitute important influencers in this crucial time of life. Finally, it is discussed how these findings could be validated in randomized controlled trials, which might prepare the ground for improved diagnostics and prevention strategies to mitigate the current atopic pandemic.

Prevalence of Chronic Obstructive Pulmonary Disease and Its Associated Risk Factors in Yunnan Province, China: A Population Based Cross-Sectional Study.

Chronic obstructive pulmonary disease (COPD) is a significant disease impacting health and quality of life. Yunnan Province, a major tobacco producer, lacks comprehensive COPD studies. The purpose of this study is to describe the epidemic situation of COPD in Yunnan province and explore its influencing factors. This study is a cross-sectional research conducted in a representative sample of adults aged 20 and older from 13 prefectures and cities in Yunnan Province, China. COPD was diagnosed using post-bronchodilator pulmonary function tests. Demographics were analyzed with descriptive statistics. The influencing factors of COPD were examined by using the multivariate logistic regression models. Our study found that high-risk individuals for COPD accounted for 20.30% of the screened population aged 20 and above, with a COPD prevalence of 27.18% among this high-risk group. Male had a higher prevalence (33.01%) than did female (16.35%; p<0.001 for sex difference). Additionally, the proportion of severe and extremely severe COPD cases in Yunnan Province was higher than the national average and other provinces. After considering the potential confounding variables, male (OR=2.291, 95% CI: 1.584-3.313), age (OR=1.501, 95% CI: 1.338-1.685), underweight (OR=1.747, 95% CI: 1.225-2.491), previous smoking (OR=1.712, 95% CI: 1.182-2.478), passive smoking (OR=1.444, 95% CI: 1.159-1.800), and a history of respiratory system diseases in childhood (OR=2.010, 95% CI: 1.346-3.001) were significantly associated with an increased risk of COPD. Conversely, being overweight (OR=0.636, 95% CI: 0.489-0.828), and residing in high-altitude counties (OR=0.445, 95% CI: 0.263-0.754) were negatively correlated with the risk of COPD. There is significant prevalence of COPD (27.18%) among high-risk population aged 20 and above in Yunnan Province, China. Apart from male, smoking, BMI and other known risk factors for COPD. We found that high-altitude residence had a lower prevalence of COPD. There is no significant difference in COPD prevalence between Han and ethnic minority populations.

The Burden of Respiratory Disease in Childhood

Respiratory disease is an acute or chronic illness affecting the airways and other structures of the lungs. Asthma, bronchitis, pneumonia, pulmonary hypertension, allergic rhinitis, and sinusitis are the most common respiratory diseases which affect children. Respiratory disease strains health-care resources due to the doctor and hospital visits and the cost of treatment. Further, it can significantly impact on child’s health and is a fundamental cause of missed school days, limitations of activities, and social interaction. The prevalence of respiratory diseases in children increased significantly over the last decade, possibly because of different exposure to indoor and outdoor pollution, lifestyle, and respiratory infection. Certain risk factors appear to predispose children to develop respiratory disease, including genetic predisposition and exposure to environmental triggers. This article discusses the burden, prevalence, risk factors, and treatment associated with a pediatric respiratory disorder.

Clinical Profile, Laboratory Characteristics and Treatment of Wilson’s Disease in Children from Western India

To study the clinical profile and laboratory characteristics and treatment of children with Wilson’s disease (WD). The current study was done at Department of pediatrics, Sir Padampat Institute of Neonatology and Pediatric Health, Sawai Man Singh Medical College, Jaipur. It was an observational study and institution ethics committee approved the study. Patients visiting the outpatient department or admitting in wards with clinical presentation suggestive of WD were enrolled in the study after obtaining a valid informed written consent. Patients subjected to detailed clinical history and physical examination. All patients subjected to routine blood count, biochemistry including liver function tests and specific laboratory investigations. They underwent ophthalmological examination. Ultrasonography abdomen and liver biopsy performed in enrolled patients. Magnetic resonance imaging brain carried out in patients with neurological WD. Ferenci score was calculated for each of the patients. Total 50 patients were included in the study. Mean age at the time of diagnosis was 9.4 years with delay of 11 months after onset of symptoms. Male is to female ratio was 2/1. Hepatic manifestation were seen in 76% patients and 24% patients presented with neurological disease. Kayser-Fleischer ring was seen in 44% patients with hepatic disease and 83% patients with neurological disease. Twenty-four hour urinary copper was more than 2 time of upper limit of normal in all patients. Fifty-four percent patients showed improvement with chelation therapy and 9 patients died during the study period. WD in children has varied clinical manifestation and early diagnosis is necessary for good prognosis. It requires wide range of tests as genetic testing is not easily available. Acute liver failure has high mortality. Early chelation therapy reverses the clinical and biochemical abnormalities.

The Correlation of Human Leukocyte Antigen (HLA) Haplotypes with Clinical and Laboratory Profiles of Celiac Disease in Children

The Correlation of Human Leukocyte Antigen (HLA) Haplotypes with Clinical and Laboratory Profiles of Celiac Disease in Children

Long-Term Cost-Effectiveness of Case Finding and Mass Screening for Celiac Disease in Children

Background and aimsCeliac disease (CD) is a common yet underdiagnosed autoimmune disease with substantial long-term consequences. High-accuracy point-of-care tests (POCTs) for CD antibodies conducted at youth primary healthcare centers (YHCCs) may enable earlier identification of CD, but evidence about the cost-effectiveness of such strategies is lacking. We estimated the long-term cost-effectiveness of active case-finding and mass-screening compared to clinical detection in the Netherlands. MethodsA decision tree and Markov model were used to simulate a cohort of three-year-old children with CD according to each strategy, taking into account their impact on long-term costs (from a societal perspective) and quality-adjusted life-years (QALYs). Model parameters incorporated data from the GLUTENSCREEN project, the Dutch Celiac Society, the Dutch Pediatric Surveillance Unit, and published sources. The primary outcome was the incremental cost-effectiveness ratio (ICER) between strategies. ResultsMass-screening produced 7.46 more QALYs and was € 28,635 more costly compared to current care (ICER: € 3841/QALY), and case-finding produced 4.33 more QALYs and was € 15,585 more costly compared to current care (ICER: € 3603/QALY). At a willingness to pay of € 20,000 per QALY, both strategies were highly cost-effective compared to current care. Scenario analyses indicated that mass-screening is likely the optimal strategy, unless no benefit in detecting asymptomatic cases is assumed. ConclusionAn earlier identification of CD through screening or case-finding in children using a POCT leads to improved health outcomes and is cost-effective in the long-term compared to current care. If the feasibility and acceptability of the proposed strategies are successful, implementation in Dutch regular care is needed.

Poster 199: High Prevalence of Elevated Beighton Scores in Females Undergoing FAI Surgery

Objectives: Femoroacetabular impingement (FAI) is classically described as restricted internal rotation in flexion resulting in labral and cartilage pathology. Despite 20 years of FAI research, there is still limited understanding of the drivers of symptomatology in the subset of patients with underlying FAI morphology. While the prevalence of FAI morphologies is substantially higher in men, numerous studies have shown more women being treated for FAI compared to men. Soft-tissue laxity and hip instability are increasingly recognized as a potential contributor to symptoms in addition to FAI. The Beighton score is a well-accepted means to quantify soft-tissue laxity and has been validated for self-scoring. The purpose of the current study was to (1) investigate the prevalence of soft-tissue laxity in male and female patients presenting with symptomatic FAI in a multicenter prospective cohort study, and (2) correlate soft-tissue laxity with patient primary complaints of either mobility, stability, or pain. Methods: A prospective multicenter cohort study of 696 FAI patients undergoing primary hip arthroscopy surgery was performed and utilized for the current study. Inclusion criteria are patients aged 14 to 45 years old with idiopathic FAI not caused by childhood disease. Exclusion criteria are previous ipsilateral hip procedures or disease processes such as neuromuscular disease or Tonnis 2 or greater osteoarthritis. The Beighton score was assessed by electronic patient self-scoring. Beighton scores &gt;4 were considered a marker of soft-tissue laxity. The MSP index was utilized to have patients rank from most to least the biggest problems with their hip: Mobility (M), Stability (S), or Pain (P). The chi-square or Fisher exact test were utilized to compare groups. Results: The prevalence of Beighton scores &gt;4 was 57.2% in female patients, compared to 29.3% in male patients (p &lt; 0.001). In female patients, 44.4%, 22.6%, and 7.7% had Beighton scores of 5+, 7+, and 9 respectively, compared to 16.7%, 5.8%, and 1.8% in male patients (all p &lt; 0.005). In the overall FAI cohort, pain was the primary complaint in 72.1% of patients, compared to 24.2% complaining primarily of mobility and 3.7% complaining primarily of stability. Among female patients, the presence of soft-tissue laxity (relative to thresholds of Beighton 4, 5, 7, and 9) did not significantly influence the patient primary complaints (with pain being the predominant complaint). Overall, 85 female patients had a Beighton score of 7 or greater and only 2.4% reported stability of the hip as a primary complaint, compared to 2.4% of female patients with a Beighton &lt;7. Stability was more commonly indicated as a second most important factor in the setting of soft-tissue laxity, compared to mobility. Among female patients with a Beighton &gt;7, 29.5% reported stability as a primary or secondary complaint, compared to 15.2% of female patients with a Beighton score &lt;7. Conclusions: Over half of female patients undergoing FAI surgery have underlying soft-tissue laxity as measured by the Beighton score. In the setting of soft-tissue laxity, patient primary symptomatic complaint remains pain, but a secondary complaint is significant more likely to be stability rather than mobility (compared to FAI patients without soft tissue laxity complain of mobility secondarily over stability). Further research is needed to better understand the role of soft-tissue laxity in the pathophysiology of FAI and the outcomes of surgical treatment.

Poster 189: Does Patient Resiliency Influence Patient-Reported Outcomes at Presentation in Symptomatic Femoroacetabular Impingement?

Objectives: The role of psychological factors in the clinical presentation and outcomes of treated is increasingly recognized in orthopaedic surgery. Particularly, in prearthritic hip disorders, young adult hip patients often have significant psychological undertones. Patient resiliency, as quantified by the brief resiliency scale (BRS), is a static patient characteristic and has been increasingly recognized for its potential role in pain and symptomatology. The purpose of the current study was to investigate the correlation between BRS and traditional hip patient-reported outcome measures (PROMs). Methods: A prospective multicenter cohort study of 696 patients undergoing femoroacetabular impingement (FAI) primary hip arthroscopy surgery was performed and utilized for the current study. Inclusion criteria are patients aged 14 to 45 years old with idiopathic FAI not caused by childhood disease. Exclusion criteria are previous ipsilateral hip procedures or disease processes such as neuromuscular disease or high-grade osteoarthritis. PROMs included the Patient-Reported Outcomes Measurement Information System (PROMIS) domains of pain interference, physical function, mobility, anxiety, and depression, as well as hip disability and osteoarthritis and outcome score (HOOS), modified Harris hip score (mHHS), international hip outcome tool (iHOT-12), and short form-12 (SF-12). Resiliency was divided into low resiliency (score &lt; 3), normal resiliency (score 3 to 4.3), and high resiliency (score &gt; 4.3) as described by Smith et al1 to use as categorical variables to compare to the other patient-reported scores. The Pearson correlation coefficient (r) was calculated and the Kruskall Willis test was used to measure association between BRS and the other PROMs for continuous and categorical values, respectively. R values ≥0.7, ≥0.4, and ≥0.1 signify a strong, moderate, and weak correlation, respectively. For categorical analysis, P values &lt; 0.05 were considered significant. Results: The cohort of 696 patients had mean age was 24.9 ± 7.9 years and a female predominance at 56%. Average BRS scores were 3.7 ± 0.7. Overall, 13.7% of patients had low resiliency, while 65.8% had normal resiliency and 20.5% had high resiliency. Linear correlation, using Pearson coefficients, found associations between BRS and all other scores. There were only weak associations between BRS scores and PROs (all r &lt; 0.25) except a moderate correlation with PROMIS depression (r = -0.476, p &lt; 0.001) and PROMIS anxiety (r = -0.481, p &lt; 0.001). Patients in higher resiliency groups reported less severe symptoms in HOOS – quality of life (p &lt; 0.001), HOOS – sports and recreation (p = 0.004), HOOS – activities of daily living (p = 0.004), HOOS – pain (p = 0.026), iHOT-12 (p = 0.01), mHHS (p = 0.004), SF-12 mental (p &lt; 0.001), PROMIS physical function (p = 0.003), PROMIS pain (p &lt; 0.001), PROMIS mobility (p &lt; 0.001), PROMIS depression (p &lt; 0.001), and PROMIS anxiety (p &lt; 0.001). Patients with higher activity levels (UCLA ≥9) demonstrated higher resiliency (p = 0.04). Conclusions: In FAI patients, patient resiliency appears to influence baseline PROs. Overall, 14% of patients had low resiliency while 21% had high resiliency. Further studies are needed to investigate this relationship and whether concurrent psychological treatment will help improve patient outcomes after hip arthroscopy for FAI. [Figure: see text]

Profile of Micronutrients in Patients Presenting with Pityriasis Alba in a Tertiary Care Center: A Case–control Study

Abstract Background: Pityriasis alba (PA) is a common, self-limiting skin disease of childhood. Several micronutrient deficiencies have been attributed to causing PA. Few studies have found a decreased level of serum zinc to be associated with PA, whereas other studies have found a deficiency of serum copper, magnesium, ferritin, and Vitamin D3 to be associated with PA. Aims and Objectives: The objective of the study was to estimate the serum levels of micronutrients (zinc, copper, magnesium, and ferritin), hemoglobin (Hb), serum albumin, and Vitamin D3 in patients of PA and compare the same with that of controls. Materials and Methods: A total of 36 patients with PA and 36 controls were enrolled in the study. Five milliliters of venous blood will be obtained from both cases and controls to conduct the investigations. The serum levels of zinc, ferritin, magnesium, copper, Vitamin D3, hemoglobin, and serum albumin levels were detected. The data were analyzed statistically. Results: In this study, we observed a low serum level of zinc associated with PA patients, when compared to healthy controls with P &lt; 0.042. The serum levels of magnesium in cases were significantly low compared to controls with P &lt; 0.002, which was statistically significant. Vitamin D and Hb levels were also significantly reduced in the PA patients. However, we did not find statistical significance between serum levels of copper, albumin, and ferritin in cases and controls with P = 0.408, P = 0.055, and P = 0.082, respectively. Conclusion: PA is a multifactorial etiological condition, in which micronutrient deficiency is an important cause and supplementation of micronutrients among these patients may be beneficial.

Key Issues of Economic Evaluations for Health Technology Assessment in China: A Nationwide Expert Survey

ObjectivesHealth technology assessment (HTA) is increasingly crucial in medicine price negotiations in China, yet previous appraisals revealed national discrepancies on key economic evaluation issues: willingness-to-pay threshold, pricing models for multi-indication medicines, and comparator selection principles. This study aimed to collect expert opinions on these issues for future HTA evaluations. MethodsA nationwide anonymous web-based survey encompassing experts across academia, HTA, consultancy/contract research organization/industry, service provider, and payer. In 2023, a generic invitation containing a web link to the questionnaire was disseminated via WeChat using convenience and snowball sampling. Agreement rates for questionnaire views were analyzed using descriptive statistics. The relationship between participants’ responses and demographics was examined using appropriate logistic models. ResultsA total of 303 responses were received from experts in 34 cities. Key expert views include a suggested base willingness-to-pay threshold ranging from 0.5 to 1.5 times gross domestic product (52.1% agreement); elevated thresholds for childhood diseases, rare diseases, end-of-life diseases, and first-in-class medicines (>78.0% agreement); a single pricing model for multi-indication medicines (60.4% agreement); consideration of multiple medicines as comparators (79.9% agreement); and avoiding the use of centrally procured medicines as comparators for medicines with a time to market of less than 3 years (71.0% agreement). Participants who are service provider had lower odds of selecting higher thresholds (odds ratio 0.26; P < .01) than responders from consultancy/contract research organization/industry. ConclusionsExpert views indicate the need for substantial changes in China’s current HTA methods, highlighting the need for increased investment in HTA processes and expertise cultivation.

Successful Anesthesia Management in Landau–Kleffner Syndrome Undergoing Laparoscopic Surgery: A Case Report

Abstract Landau–Kleffner syndrome (LKS), also known as acquired epileptic aphasia, is a childhood disease associated with acquired aphasia and epileptiform abnormalities on the electroencephalographic. We report the uneventful anesthesia management of a 17-year-old female patient with LKS syndrome. Her vital signs and laboratory results were normal, and plasma levels of valproic acid (73.6 µg/mL) were within therapeutic limits. She had mild micrognathia, short thyromental distance, and normal neck movements and mouth opening. An intravenous induction was performed with 100 mg lidocaine, 100 µg fentanyl, 200 mg propofol, and 60 mg rocuronium intravenously. After preoxygenation with 80% O2 for 3 min, she was intubated without complications with a number 7.5 mm endotracheal tube connected to a ventilator. Anesthesia maintenance was provided with 2.2% sevoflurane and 50% oxygen–50% air mixture, 0.01–0.05 μg/kg/min infusion of remifentanil. The target partial pressure of carbon dioxide was 30–35 mm Hg. Care was taken to ensure that intra-abdominal pressure did not exceed 14 mm Hg. Spontaneous breathing returned in 5 min after discontinuation of sevoflurane. She was extubated after following commands and transferred to the post-anesthesia care unit. It is unknown whether general anesthesia has a short- or long-term effect on patients with LKS. Since epileptic seizures are essential in patients with LKS, the correct selection of anesthetic agents is significant. In addition, hypoxemia, hypercarbia, hypocapnia, high positive end-expiratory pressure, and acidosis should all be avoided as they may trigger seizure activity.

The Association Between Markers of Inflammation and the Progression of Chronic Kidney Disease in Children with Congenital Anomalies of the Kidney and Urinary Tract (CAKUT).

The Association Between Markers of Inflammation and the Progression of Chronic Kidney Disease in Children with Congenital Anomalies of the Kidney and Urinary Tract (CAKUT).

Appendiceal Diseases in Children in a University Teaching Hospital in Southwest Nigeria

Appendiceal Diseases in Children in a University Teaching Hospital in Southwest Nigeria

Beyond the Gut: Extraintestinal Manifestations of Inflammatory Bowel Disease in Children and Adolescents

Beyond the Gut: Extraintestinal Manifestations of Inflammatory Bowel Disease in Children and Adolescents

Asthma prevention and recent advances in management

Asthma is the most frequent chronic disease of childhood, affecting up to 20 % of children worldwide. The authors present the current literature focusing on primary and secondary prevention of both early and late childhood asthma and the recent advances in management. The therapeutic tools for pediatric asthma have expanded significantly for both the non-severe and severe forms. The use of anti-inflammatory treatment, even for the mildest cases, and the withdrawal of symptomatic bronchodilation as monotherapy have been included in the most recent guidelines. The different biological therapies have revolutionized the therapeutical approach for severe uncontrolled asthma in children and adolescents.The main guidelines on asthma maintenance therapy in pediatrics suggest different approaches and describe different stages of asthma to determine the most appropriate treatment.

Hepatitis A virus infection associated with bilateral pleural effusion, ascites, and acalculous cholecystitis in childhood: a case report

BackgroundAcute hepatitis A infection is common among children in developing nations. The clinical presentation in children is usually asymptomatic and anicteric, and it is a self-limiting infection. Rarely, it can be associated with extrahepatic complications such as pleural effusion, acalculous cholecystitis, and ascites.Case presentationAn 8-year-old middle eastern child presented with abdominal pain, jaundice in the sclera, yellowish color of urine, and poor appetite. In the last two days, abdominal distension developed. After conducting diagnostic investigations, the child was diagnosed with HAV hepatitis associated with bilateral pleural effusion, acalculous cholecystitis, and ascites. He was managed conservatively with vitamin K supplementation and supportive parenteral fluids. After 4 days, clinical improvement was observed.ConclusionHepatitis A infections presented with extrahepatic manifestations like pleural effusion, acalculous cholecystitis, and ascites are very rare, especially in children. There have been some reports of these manifestations occurring in isolation, but for them to co-exist to our knowledge, this has only been reported in two cases in the literature, and this is the third case with all these three rare complications being presented simultaneously in a single child. Although HAV infection is an asymptomatic and self-limiting viral disease in childhood, it can manifest with rare extrahepatic complications, so pediatricians should be aware of this rare association to avoid unnecessary investigations.

A case study to investigate the effects of Chlorhexidine mouthwash on serum cytokines levels in children with Asthma

Asthma is an airways inflammatory disease and the most common chronic disease of childhood, which causes most hospital visits and placing a heavy financial burden on families and communities. Interleukins 4, 5 and 13, play a central role in the pathogenesis of asthma. Given the importance of oral hygiene in asthmatic patients and IL-4 and 5 are involved in the inflammatory process of periodontitis, the effect of chlorhexidine as mouthwash on asthma attacks in children on serum cytokines is necessary. In this study, 375 children with asthma were divided into two groups using or non-using chlorhexidine. Blood samples were taken and cytokines were measured by ELISA. From 375 patients, 17 patients were excluded. In this study, 171 males and 187 females participated and there were 180 patients in asthma group and 178 patients in asthma/Chlorhexidine group. The levels of IL-4, IL-5 and IL-13 had no significant difference (p > 0.05) between Asthma and Asthma/Chlorhexidine groups. Using chlorhexidine as mouthwash in children with asthma had no effect on the type 2 cytokines and may not trigger an asthma attack via allergo-inflammatory mechanism.

Clinical and epidemiological analysis of intestinal infections in a children's infectious diseases hospital, experience in using the PEWS scale

Purpose of the work: to conduct a clinical-epidemiological analysis of intestinal infections in a pediatric infectious diseases hospital and the effectiveness of the PEWS scale.Materials and methods: a retrospective study was conducted at the Moscow City Clinical Hospital «Communarka» and City Clinical Hospital No. 1 in the pediatric infectious disease departments from June 1, 2023, to August 31, 2023. Laboratory, clinical, and anamnestic data were obtained from the medical information system «EMIAS» and the laboratory information system (LIS) «ALISA». The study analyzed 838 medical records of children with acute respiratory infections.Results: when conducting a statistical analysis of indicators in two groups (group 1 — PEWS ≥ 3 points, recorded at least once during the entire period of hospitalization, group 2 — PEWS from 1 to 2 points, recorded at least once during hospitalization period) no significant differences were observed in terms of etiology, age, day of illness, blood test results, and length of hospital stay. All patients had a moderate form of acute respiratory infection, however, patients with PEWS ≥ 3 points required increased attention from medical staff and had a higher risk of deterioration without additional medical intervention, with the most significant risk in predicting deterioration being related to changes in the cardiovascular system. All children were discharged home in satisfactory condition with PEWS = 0.Conclusion: In our conducted research, for the first time in the Russian Federation, the experience of using the PEWS scale in pediatric practice for patients with gastrointestinal infections was applied with the aim of early detection of the risk of clinical deterioration. It can be assumed that the most significant risk in predicting deterioration in the condition of a child with acute gastrointestinal infection, as well as with acute respiratory infection, is predominantly due to disturbances in the cardiovascular system.