Disease In Pediatric Population Research Articles

Is there fungal infestation in paediatric chronic otitis media – Mucosal disease?

ObjectivesTo determine the prevalence of fungal infestation in paediatric chronic otitis media (COM)-mucosal disease and to study the various factors that might influence the said infestation. MethodsA cross-sectional study was done on the cited subject in a sample size of 66 paediatric patients [Age group: 1–18 years] suffering from active COM-mucosal disease. In all we had 75 ears from which swab samples were taken as some patients had bilateral disease. Clinical record was documented in each case. Three sample swabs were analysed for aerobic, anaerobic and fungal infection respectively from the discharging ear. Fungal infection was diagnosed by culture. The data was tabulated and statistically analysed for any correlation of fungal infestation with age, sex, background, duration of COM, previous antibiotic/steroid usage and intractable otorrhoea. ResultsWe recorded a prevalence of 32% for fungal colonization of COM-mucosal disease in paediatric population i.e., 24 out of 75 ears. There was no association observed between fungal infestation and specific paediatric age group, sex, background or duration of the disease. However, a distinct statistical correlation was present between fungal infestation and previous antibiotic/steroid usage and intractable otorrhoea. ConclusionFindings of this study lead us to conclude that all cases of paediatric COM-mucosal disease should be analysed for fungal colonization, especially those with intractable otorrhoea and there should be judicious use of antibiotics and steroid ear drops in COM-mucosal disease.

A Scoping Review of Galectin-3 as a Biomarker of Cardiovascular Diseases in Pediatric Populations.

Galectin-3 as a cardiac biomarker has proven to be a significant prognostic tool in adults. However, it has not yet been established in the pediatric population as a biomarker in daily clinical practice. The aim of the study was to summarize the current knowledge on galectin-3 as a biomarker in children with cardiac conditions by reviewing the literature. Bibliographic databases such as PubMed, Web of Science and Embase were searched, and consequently twelve articles met the inclusion criteria. Supplemental handsearching of references delivered one additional source. These prospective studies concerning galectin-3 as a cardiac biomarker present analyses performed in cohorts composed of healthy children and children with cardiovascular diseases. The results, despite being based on small cohort studies, inform that galectin-3 could serve as a potential biomarker in cardiovascular risk stratification in children with heart failure, arrhythmia, Kawasaki disease or in patients undergoing cardiac surgery. The evidence for the usefulness of galectin-3 in the assessment of such pathologies as idiopathic dilated cardiomyopathy, coarctation of the aorta, functionally univentricular heart or tetralogy of Fallot were not completely confirmed. Galectin-3 seems to be a promising biomarker; however, there is a need for further research to establish its use in daily clinical practice.

Primary antiphospholipid syndrome in pediatrics: beyond thrombosis. Report of 32 cases and review of the evidence

ObjectiveDescribe the frequency of thrombotic and non-thrombotic clinical manifestations, laboratory, treatment and prognosis in patients with pediatric primary antiphospholipid syndrome.Material and methodsA retrospective study was carried out in patients with a diagnosis of primary antiphospholipid antibody syndrome, under 16 years of age, under follow-up by the pediatric rheumatology service of the General Hospital, National Medical Center, La Raza, from January 2013 to December 2020. The antiphospholipid syndrome was defined when it met the laboratory criteria of the Sidney criteria and the presence of thrombosis or non-criteria manifestations of the disease (hematological, neurological, cutaneous, renal, cardiac or pulmonary). Demographic, clinical, laboratory, treatment, and prognosis data were collected.ResultsWe report 32 patients, 21 female (65%) and 11 male (35%), mean age 11.75 years, evolution time 16 weeks. Thrombosis 9 patients (28%), 1 arterial and 8 venous. Non-thrombotic manifestations; Hematologic: thrombocytopenia 22 patients (69%), autoimmune hemolytic anemia 13 (40%), Fisher-Evans syndrome 6 (19%), lupus anticoagulant with hypoprothrombinemia syndrome 2 (6%). Dermatological: livedo reticularis 20 (62%), skin ulcers 2 (6%), Raynaud's phenomenon 8 (25%). Neurological: epilepsy 1 (3%), migraine 3 (9%), chorea 1 (3%) and cognitive impairment 3 (9%). Renal in 4 (13%). Laboratory: prolonged aPTT 30 (93%), lupus anticoagulant 32 (100%), positive IgG anticardiolipin 20 (62%), positive IgM anticardiolipin 19 (60%). AntiB2GPI was performed in only 3 patients, being positive in all. Treatment: anticoagulation in patients with thrombosis, antiplatelet in 23 (72%), steroid 30 (94%), immunosuppressant 30 (94%) and rituximab 4 (12.5%). No deaths were reported.ConclusionsThe clinical characteristics of patients with pediatric primary antiphospholipid syndrome differ from those presented in adults, since non-thrombotic manifestations are more frequent in children, for which classification criteria that include these manifestations are necessary for a better characterization of the disease in pediatric population.

Association between nailfold capillaroscopy abnormalities and autoimmune disease in pediatric populations.

Time to diagnosis of autoimmune disease in pediatric populations can take years but nailfold capillaroscopy (NFC) may identify early signs of autoimmune disease. The aim of this study is to assess the association between nailfold capillary abnormalities and autoimmune disease in children. A systematic search of PubMed, EMBASE, and Scopus was performed to identify all studies published before March 17, 2021. Observational studies reporting NFC outcomes in children with autoimmune disease and healthy controls (HC) were eligible for inclusion. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using a random-effects meta-analytical model. Nine of 3665studies reporting on 641 patients (398subjects, 243 controls) were included. Pediatric patients with autoimmune disease were 9.88 (95% CI 3.16-30.87, I2 =80.1%) times more likely to have abnormal nailfold capillaries than HC. Of the capillaroscopic features, dilated capillaries (OR 27.90, 95% CI 2.17-349.05, I2 =59.9%) were the most likely abnormality observed on NFC. This was followed by the likelihood of reduced capillary density (<7capillaries/mm) (OR 19.91, 95% CI 3.79-105.52, I2 =0%), giant capillaries (OR 12.87, 95% CI 2.38-69.45, I2 =0%), hemorrhages (OR 13.89, 95% CI 5.34-36.16, I2 =0%), and avascularity (OR 10.38, 95% CI 2.20-49.04, I2 =0%). Children with autoimmune disease are significantly more likely to have nailfold capillary abnormalities. NFC may be useful in identifying early signs of underlying rheumatic disease and potentially decrease the time to diagnosis for this patient population.

Systemic autoinflammatory diseases in pediatric population.

BackgroundSystemic autoinflammatory diseases (SAID) are monogenic and polygenic inherited conditions characterized by dysregulation of the innate immune system.ObjectiveWe aimed to characterize the clinical features of patients with SAID.MethodsThis study was a retrospective chart review on the clinical and genetic features of the pediatric population with SAID observed from 1998 to 2020 in our center.ResultsA total of 54 patients were evaluated: 18 with periodic fever, aphthous stomatitis, pharyngitis and adenitis syndrome; 16 with Behçet disease; 13 with systemic juvenile idiopathic arthritis; 4 with syndrome of undifferentiated recurrent fever; 1 with cryopyrin associated periodic syndrome; 1 with chronic nonbacterial osteomyelitis; and 1 with Muckle-Wells syndrome.ConclusionThe analysis of clinical features of our patients are similar to other studies. Our goal was to aware the medical community to early recognize and treat SAID to improve quality of life of pediatric patients.

Skin Manifestations and Coeliac Disease in Paediatric Population.

Celiac disease (CD) is an immune-mediated enteropathy caused by gluten ingestion, affecting approximately 1% of the worldwide population. Extraintestinal symptoms may be present as the first signs of CD, years before the CD diagnosis is made. A great variety of extraintestinal manifestations may be associated with CD. Cutaneous manifestations represent the main extraintestinal manifestations, with dermatitis herpetiformis being the most common in patients with CD. In adults, it has been demonstrated that the role of a gluten-free diet is crucial not only for the recovery of signs and symptoms associated with CD but also for cutaneous manifestations, which often improve after gluten avoidance. In children with CD, the association with skin disorders is well documented regarding dermatitis herpetiformis, but studies considering other dermatological conditions, such as psoriasis and atopic dermatitis, are few. The prevalence and manifestations of dermatological disorders in celiac children are often different from those in adults, explaining the gap between these populations. In addition, the therapeutic role of a gluten-free diet in the improvement in skin alterations is not fully understood in children and in adult population except for dermatitis herpetiformis. Therefore, cutaneous CD symptoms need to be known and recognized by physicians despite their specialties to improve early CD diagnosis, which is critical for a better prognosis. This review describes the current scientific evidence on skin manifestations associated with CD in the pediatric population.

Epidemiology of Gastrointestinal Disease among Children and Adolescents in Kazakhstan: 2012–2019

BACKGROUND: Gastrointestinal diseases are important trigger of public health concern in pediatric population. Non treated pathologies led to chronic inflammatory processes in adulthood. AIM: With respect to the lack of international studies on epidemiology of gastrointestinal disease in pediatric population, this study was aimed at analysis of national and local incidence rates of gastrointestinal disorders among children and adolescents in Kazakhstan over the period from 2012 to 2019. METHODS: This was a retrospective cross-sectional study located on South part of Kazakhstan and based on the data obtained from the Republican Center for Health Development – the major data source on the country’s health statistics. From this, we extracted information on children (0–14 years) and adolescents (15–17 years) with gastrointestinal disease (K00-K95 International Classification of Diseases, Revision 10 codes). We calculated incidence rates for the whole country and Turkestan province. RESULTS: The national incidence of pediatric disease was characterized by relative stability, and was 7760.4 per 100,000 population in 2017. The incidence of peptic ulcers and gallbladder disease in adolescents substantially exceeded that in children. At provincial level the incidence of gastritis/duodenitis and peptic ulcers was gradually declining, while that of gallbladder disease was subjected to growth over the past years. Adolescents had higher rates of gastrointestinal disease both at national and provincial levels. CONCLUSION: The analysis of national and local incidence rates of gastrointestinal disorders among children and adolescents in Kazakhstan showed that more studies are needed to obtain in-depth understanding of risk factors associated with gastrointestinal disease in child and adolescent population of Kazakhstan, including the prevalence of Helicobacter pylori infection. Besides, a national registry on pediatric gastrointestinal disease should be envisaged to overcome the lack of essential data.

Efficacy of micro pcnl for renal stones in pediatric age group

Background: Renal calculi is mineral deposit in the renal calyces and pelvis that are found free or attached to the renal papillae. Management of kidney stone disease in pediatric population is a challenging condition in urology practice. While the incidence of kidney stone is increasing in those group, technological innovations have contributed to the development of minimally invasive treatment of urinary stone disease such as mini-percutaneous nephrolithotomy (mini-PCNL), micro-PCNL, ultra mini-PCNL. Aim: To find the frequency of stone clearance and post op hematoma after micro PCNL in pediatric patients with renal stones. Place and duration of study: Department of Urology, Shaikh Zayed Hospital, Lahore from 25-01-2020 to 25-07-2020. Methodology: After approval from the hospital ethical committee, 60 all the children of 18 years presenting in Department of Urology fulfilling the inclusion criteria were included. An informed consent was obtained from patients. Before performing micro PCNL renal stone was confirmed on CT-Scan KUB plain. After proper selection of the patients, they were prepared for surgery. After preparation patients were put on list for micro-PCNL. Surgery was performed. Post operatively CT-Scan KUB plain was performed to see the stone clearance four weeks after surgery. Post hematoma was noted according to Clavien Grading Scoring. Results: Out of 60 patients, 19(31.7%) were in group ≤10 years of age whereas 41(68.3%) in were in group 11-18 years of age, mean age was calculated as 12.90±3.16 years. There were 44(73.3%) were male whereas 16(26.7%) were females. Frequency of stone clearance was 56(93.33%) and post op hematuria was 4(6.66%) after micro PCNL in pediatric patients with renal stones. Conclusion: We found that, after Micro PCNL in pediatric patients with renal stones there were good stone clearance rate and less hematuria. So micro PCNL is good technique for stone clearance and less complications occurred. Keywords: Urinary tract stone, PCNL, Renal Calculi.

Profile of congenital heart disease in Pediatric population: two years' experience at a teaching hospital

Background: CHDs (Congenital heart defects) are a major morbidity and mortality cause in children with a substantial worldwide health burden. Therefore, this is significant for determining their spectrum as well as identifies treatable heart defects. Aims: To study the CHD's profile in a semi urban along with rural community between age group 0 to 12 years and study different forms and frequency of occurrence of congenital heart diseases in selected cases using echocardiography as diagnostic tool. Methods: In this retrospective study, case records of 154 cases of proven cases of CHD were analyzed in detail. The relative frequency of occurrence of each acyanotic and cyanotic CHD has been noted in selected cases. The study period was between January 2015 to December 2016. Results: Of 154 cases analyzed ventricular septal defect has been found the mainly diagnosis.42 cases were detected to have ventricular septal defect followed in frequency by tetralogy of fallot which was echocardiography diagnosis in 38 cases. PDA followed by ASD were the next common acyanotic congenital heart diseases detected. In cyanotic cases, TOF was followed by transposition pathology complex. Males outnumbered females. Conclusion:We observed that CHD's profile was comparable to the published literature in our population. CHGs are widespread in our set-up, and echocardiographic early CHD detection is a safe and reliable method to diagnose CHD in children,which significantly enhances the assessment of critically sick children

Profile of congenital heart disease in Pediatric population: two years' experience at a teaching hospital

Background: CHDs (Congenital heart defects) are a major morbidity and mortality cause in children with a substantial worldwide health burden. Therefore, this is significant for determining their spectrum as well as identifies treatable heart defects. Aims: To study the CHD's profile in a semi urban along with rural community between age group 0 to 12 years and study different forms and frequency of occurrence of congenital heart diseases in selected cases using echocardiography as diagnostic tool. Methods: In this retrospective study, case records of 154 cases of proven cases of CHD were analyzed in detail. The relative frequency of occurrence of each acyanotic and cyanotic CHD has been noted in selected cases. The study period was between January 2015 to December 2016. Results: Of 154 cases analyzed ventricular septal defect has been found the mainly diagnosis.42 cases were detected to have ventricular septal defect followed in frequency by tetralogy of fallot which was echocardiography diagnosis in 38 cases. PDAfollowed by ASD were the next common acyanotic congenital heart diseases detected. In cyanotic cases, TOF was followed by transposition pathology complex. Males outnumbered females. Conclusion:We observed that CHD's profile was comparable to the published literature in our population. CHGs are widespread in our set-up, and echocardiographic early CHD detection is a safe and reliable method to diagnose CHD in children, which significantly enhances the assessment of critically sick children.

Use of off-label and unlicensed drugs in pediatric patients: A longitudinal prevalence survey from Lahore, Pakistan

Purpose: To assess the extent of use of unlicensed/off-label drug in the children hospitalized in The Children’s Hospital and Institute of Child Health, Lahore, Pakistan.&#x0D; Methods: A prospective prevalence study was carried out in the selected hospital. A total of 1946 pediatric patients were hospitalized during study period. The patients’ demographic data and unlicensed/off-label drug use were noted by the researcher using a structured questionnaire and then analyzed.&#x0D; Results: During the survey period, 102 (5.24 %) pediatric patients received at least one off-label drug/unlicensed drug. The unlicensed drug was administered to 65 patients (63.7 %) while off-label drug was administered to 37 patients (36.3%). Milrinone (23.5%) was the most frequently prescribed unlicensed drug.&#x0D; Conclusion: The administration of unlicensed/off-label drug to treat different diseases in pediatric population is widespread in the health facility studied. These findings will provide guidance to new researchers in clinical trials, especially on cardiovascular drugs, opioid analgesic, antiemetic and anticancer drugs.

Rheumatic Heart Disease in Indian Paediatrics: A Review

Rheumatic heart disease (RHD) is a condition in which the valves of the heart are damaged, it is mainly caused by Group A Streptococcus, it mainly affects the paediatrics and young adults. Inflammation occurs in the joints, heart and blood vessels due to group A streptococcus. The exact pathogenesis of rheumatic heart disease is unknown. It is manifested as fatigue, chest pain and shortness of breath; pulmonary hypertension, heart failure are some of the complications of the disease. Endocarditis, viral myocarditis and prolapse of the mitral valve are the differential diagnosis of rheumatic heart disease. It is diagnosed by revised Jones and World Heart Federation criteria. Benzylpenicillin is the first-line drug for rheumatic heart disease, followed by oral Penicillin V, Erythromycin can be recommended. Paediatrics who are allergic to Penicillin Azithromycin, Erythromycin can be recommended based on Indian paediatrics and World Health Organization guidelines. It is prevented by reducing the exposure to infection in high-risk regions; treat with appropriate antibiotics; prevent recurrence of infections and complications. The aim of this review is to highlight rheumatic heart disease in paediatric population.

Spectrum of Clinical Presentation of Celiac Disease in Pediatric Population.

BackgroundClassic form of celiac disease (CCD) presents with diarrhea and is traditionally taught as malabsorption syndrome. This form of CD is diagnosed with ease but non-classical form presenting without diarrhea is often missed and heavily underdiagnosed.ObjectiveTo determine the clinical spectrum of patients with CD.MethodsThis study was conducted in the Department of Gastroenterology & Hepatology at the Children’s Hospital, Lahore. Confirmed CD children according to NASPGHAN (North American Society of Pediatric Gastroenterology, Hepatology & Nutrition) criteria were enrolled in this study from June to September, 2020. Initial positivity followed by small bowel biopsy with Modified Marsh 2 and above is considered consistent with the diagnosis of CD.ResultsA total of 90 patients were selected according to NASPGHAN criteria, 77 (85.6%) patients had CCD whereas 13 (14.4%) patients had non-classical CD (NCCD). The mean ± SD age at diagnosis of CCD was 2.6 ± 2.3 years whereas mean ± SD in NCCD was 9 ± 1.8 years. Females clearly predominate in our cohort in general. Chronic diarrhea followed by failure to thrive (85%) were the most common symptoms in CCD whereas short stature (69%) was the most frequent feature in NCCD. Among CD patients, tissue transglutaminase-​immunoglobulin A (TTG-IgA) titre was significantly high (>10 times) in 80% of CD patients and the rest had positivity but not up to 10 times. There was no significant difference in titre of anti-TTG between CCD and NCCD.ConclusionClassical CD is still the most common in developing countries like Pakistan. High index of suspicion of CD should be maintained for patients who present with short stature, recurrent abdominal pain and refractory anemia.

Factors Contributing to Delayed Diagnosis of Congenital Heart Disease in Pediatric Population

Objective: To analyze various factors contributing to delayed diagnosis of congenital heart disease (CHD) in pediatric population. Study Design: Cross-sectional study. Place and Duration of the Study: Department of Pediatrics and Department of Cardiology, Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawalakot from January to December 2020. Material and Methods: A total of 265 children of both genders aged up to 15 years and presenting for the 1st time with the echocardiography confirmed diagnosis of CHD were enrolled. A special proforma was designed and questions were asked from parents/guardians of all study participants. Socio-demographic profile along with improper referral status and inadequate health facilities were noted. SPSS version 26.0 was used for statistical analysis. Qualitative variables like gender, area of residence, literacy status, socio-economic status, types of CHDs, delayed diagnosis (yes/no) and reasons for delayed diagnosis were represented as frequency and percentages. Results: In a total of 265 children included in the study, there were 156 (58.9%) male. Majority of the children, 184 (69.4%) were less than 2 years of age. Body weight below 3rd centile was noted in 164 (61.9%) children. Maternal fetal echocardiography was done in 13 (4.9%). Acyanotic CHD was noted in 180 (67.9%) children while remaining had cyanotic CHD 85 (32.1%). Delayed diagnosis of CHD was noticed in 211 (79.6%) children. Most common factor contributing to delayed diagnosis of CHD was found to be delayed 1st consultation in 85 (40.3%). Delayed or missed diagnosis by the doctor was the 2nd most frequent factor contributing to delayed diagnosis of CHD noted in 52 (24.6%) children. Delayed referrals were observed in 42 (19.9%) children. Conclusion: Delayed diagnosis of CHD was noted among 79.6% cases. Acyanotic CHD was the commonest type of CHD in the present study. Most common factors contributing to delayed diagnosis of CHD were delayed 1st consultation, delayed diagnosis by the doctor and delayed referrals. Keywords: Congenital heart disease, fetal echocardiography, delayed referrals

Ultrasound screening for cervical, abdominal and scrotal malignant and benign abnormalities in children

IntroductionUltrasonography plays an important role in evaluation of many diseases in pediatric population. The noninvasiveness of the method allows to its wide use in children. It is a first-line diagnostic test for detecting lymphadenopathy, benign and malignant abnormalities of the thyroid gland, abdominal structures or testes in boys. The Ultrasound Screening Program “No to Cancer in Children” was introduced to detect neoplastic lesions and possible developmental disorders in children with no symptoms to allow early diagnosis.Material and methodsThe children were scanned in special mobile ambulance - Ronald McDonald Care Mobile, equipped with two high-tech ultrasound devices. Ultrasound scans, including cervical, abdominal, pelvical and scrotal ultrasound were performed in population of asymptomatic children. In the years 2006-2019, 67.594 children, 34.892 boys and 32.702 girls aged from 9 months to 6 years were examined.ResultsTotally, 18.544 various abnormalities were detected. In case of the neck they were found in 7542 children, which represent nearly 11.2% of all patients. Changes in abdominal ultrasound were found in 4.496 cases (6.65%). Abnormalities of the male reproductive system were detected in 6.474 boys (18.5%). Twelve tumors were detected.ConclusionsScreening has proved to be very useful for the early identification cancerous as well as precancerous lesions. It is also worth continuing for a reason of effective detection of other childhood anomalies.

Current and emerging pharmacotherapy for Gaucher disease in pediatric populations

ABSTRACT Introduction The past decades have witnessed a remarkable improvement in the health of patients with Gaucher disease, the inherited deficiency of the lysosomal enzyme glucocerebrosidase, resulting from the availability of enzyme replacement and substrate reduction therapies. Especially in pediatric populations, early diagnosis and initiation of treatment is essential to achieving optimal outcomes. Areas Covered The authors review the literature pertaining to the effectiveness of currently available therapies and describe new pharmacotherapies under development, especially for young patients. Expert opinion For pediatric patients with non-neuronopathic Gaucher disease, there may be new therapeutic options on the horizon in the form of gene therapy or small molecule glucocerebrosidase chaperones. These have the potential to result in a cure for systemic disease manifestations and/or to reduce the cost and convenience of treatment. For children with neuronopathic Gaucher disease, the challenge of targeting therapy to the central nervous system is being explored through new modalities including brain-targeted gene therapy, in-utero therapy, brain-penetrant small molecule chaperones, and other methods that convey enzyme across the blood-brain barrier. Indeed, these are exciting times for both pediatric patients with Gaucher disease and those with other lysosomal storage disorders.

Metabolic Syndrome in the Development of Gallstone Disease in Children

Backrounds: Several studies carried out in the adult population have concluded to a correlation between metabolic syndrome and the development of gallstones which has not really been demonstrated in children. Objective: To investigate the association between metabolic syndrome and the development of gallstone disease in children. Methods Retrospective review of patients aged less than 14 years treated for gallstones from January 2014 to 2019 at the department of pediatric surgery of Hedi Chaker Hospital, Sfax, TUNISIA. Results Thirteen cases were conllected reparted in eight girls and five boys. The mean age at operation was 11,1 years (range: 3-14 years). Females were older than males at the time of surgery (12,3 vs 9,2 years). Symptomatic chlolelithiasis was the indication for cholecystectomy in 11 cases. The clinical presentation was marked by the presence of hepatic colic in all patients, presence of vomiting in 54% of patients and epigastralgia in 15% of patients. The mean weight was 38,5 Kg with five patients whose BMI was >97percentile. The gallstones were idiopathic in 61%, due to hemolytic anemia in 31% and due to hypercholesterolemia in 7,6% of cases. Complications were acute cholecystitis in one patient and pancreatitis in one case. All patients underwent single site laparoscopic surgery. One patient had perioperative cholangiography. The mean time of hospitalization was 2 days. Patients were asymptomatic. Conclusion: As reported in adult population we found that obesity is correlated with the development of gallstones disease in pediatric population. Further studies are necessary to confirm our findings.

A sociodemographic, anthropometric and lifestyle-based prediction score for screening children with overweight and obesity for hepatic steatosis: The HEPAKID index.

Hepatic steatosis (HS) is currently the most prevalent hepatic disease in paediatric population and a major risk factor for type 2 diabetes and cardiovascular diseases. The proper identification of children with HS is therefore of great public health interest. To develop a new prediction score using anthropometric, sociodemographic and lifestyle factors to identify children with HS (the HEPAKID index). Previously published biochemical paediatric screening tools were validated in the same cohort. A total of 115 pre-adolescent children aged 8 to 12 years with overweight/obesity, recruited at hospital paediatric units were enrolled in this cross-sectional study. HS (≥5.5% hepatic fat) was assessed by magnetic resonance imaging (MRI). Anthropometric, sociodemographic and lifestyle variables were collected by validated tests/questionnaires. Forty-one children had MRI-diagnosed HS (35.6%, 49% girls). These children had (P < .01) a higher waist-height ratio, a lower cardiorespiratory fitness, a younger gestational age, and consumed more sugar-sweetened beverages than their HS-free peers. Children with HS were more likely to belong to an ethnic minority (P < .01) and to spend longer viewing screens than recommended (P < .05). The addition of these variables to the multivariate logistic regression model afforded a HEPAKID index with high discriminatory capacity (area under the receiver-operating characteristic curve: 0.808, 95% CI 0.715-0.901), and score of ≥25.0 was associated with high sensitivity (82%, 95% CI 68%-96%). Biochemical biomarker-based paediatric tools for identifying HS showed only moderate discriminatory capacity and low sensitivity (5%-41%) in this cohort. The HEPAKID index is the first simple, non-invasive, sensitive, inexpensive and easy-to-perform screening that can identify children with overweight or obesity who have HS.

Clinico-pathological Outcomes of Hirschsprung Disease in Pediatric Population: A Retrospective Cohort Study and Brief Review of Literature

Clinico-pathological Outcomes of Hirschsprung Disease in Pediatric Population: A Retrospective Cohort Study and Brief Review of Literature

Multisystem inflammatory syndrome in children associated with Coronavirus Disease-2019: An overview

Coronavirus disease-2019 has been ravaging the world since the past several months with devastating consequences. Although it is seen that specific categories of patients with comorbidities are especially vulnerable, the risks from the acute disease in pediatric population have been consistently lower. However, the alarming rise in pediatric admissions in intensive care units with varied clinical presentation during this pandemic gave an insight to a new hyperinflammatory response called as multisystem inflammatory syndrome in children. Although overlapping symptoms may mimic toxic shock syndrome, macrophage activation syndrome, secondary hemophagocytic lymphohistiocytosis, myocarditis, or Kawasaki-like illness, clinical findings are relatively consistent across geographically distinct regions. Diagnosis is essentially clinical, and laboratory investigations are suggestive of increased inflammatory markers. Early recognition and appropriate institution of inotropes, intravenous immunoglobulins, corticosteroids, and antibiotics apart from general supportive treatment are required for a favorable outcome.