Disease In Pediatric Population Research Articles

Impact of COVID-19 pandemic on prescription of psychotropic medications in the Italian paediatric population during 2020

BackgroundThere is a global perception that psychotropic utilization in children and adolescents is increasing, especially with the onset of COVID-19 pandemic. Available literature data on paediatric psychotropic medication prescriptions in Italy are limited to one or few regions and not updated. The aim of this study was to provide updated data on psychotropic prescriptions referred to the whole Italian paediatric population, as overall and by subgroups of medications and to evaluate if the COVID-19 pandemic during 2020 had an impact on prescription rates.MethodsA descriptive study on psychotropic drug utilization in children and adolescents (< 18 years) resident in all Italian regions during 2020 was performed. Patients registered in the Pharmaceutical Prescriptions database with at least one prescription/dispensing of a psychotropic medication (antipsychotics-N05A), (antidepressants-N06A) and (psychostimulants-N06BA) during the study period were considered. The indicators used were the prescription rate (number of prescriptions per 1000 children) and prevalence of use (proportion of the paediatric population with at least one prescription in the relevant year).ResultsDuring the 2020 the prevalence of psychotropic drug use in the paediatric population was 0.3%, increased of 7.8% if compared to 2019. The same trend was observed for the prescription rate, which recorded an average of 28.2 per 1000 children with an increase of 11.6% if compared to previous year, representing the 0.6% of the overall drug use in this age group. The data showed a growing trend prescription by age, reaching the peak in adolescents aged 12–17 years old, with a prescription rate of 65 per 1000 children and a prevalence of 0.71%. Considering the subgroups of psychotropic medications, the highest prevalence of use was found for antipsychotic drugs, received by the 0.19% of the paediatric population during 2020.ConclusionsPsychotropic drug utilization in children and adolescents has grown during 2020 in Italy and worldwide, raising alarms from health care clinicians and patient advocates about the increase of burden of mental diseases in paediatric population during the COVID-19 pandemic. A more systematic monitoring of the use of psychotropic medications should be implemented in all countries for collecting relevant information about children and adolescents taking psychotropic drugs, in order to address the present and the future of the mental health of the paediatric population.

Neonatal Scurvy- A Rare Case Report

Scurvy, a disease of vitamin C deficiency, is now considered as a rare disease in paediatric population. The human body is dependent on the external supply of vitamin C. The newborn infant receives this from breast milk. Therefore, infantile scurvy is generally observed only in infants over the age of three months. The occurrence of scurvy before that age is extremely rare. We described a case of neonatal scurvy in a 28 days old boy who was on parenteral nutrition for initial 10 days of age due to neonatal sepsis with perinatal asphyxia. BANGLADESH J CHILD HEALTH 2022; VOL 46 (2) : 92-94

Panretinal handheld OCT angiography for pediatric retinal imaging

Comprehensive visualization of retina morphology is essential in the diagnosis and management of retinal diseases in pediatric populations. Conventional imaging techniques often face challenges in effectively capturing the peripheral retina, primarily due to the limitations in current optical designs, which lack the necessary field of view to characterize the far periphery. To address this gap, our study introduces a novel ultra-widefield optical coherence tomography angiography (OCTA) system. This system, specifically tailored for pediatric applications, incorporates an ultrahigh-speed 800 kHz swept-source laser. The system’s innovative design achieves a 140° field of view while maintaining excellent optical performance. Over the last 15 months, we have conducted 379 eye examinations on 96 babies using this system. It demonstrates marked efficacy in the diagnosis of retinopathy of prematurity, providing detailed and comprehensive peripheral retinal angiography. The capabilities of the ultra-widefield handheld OCTA system in enhancing the clarity and thoroughness of retina vascularization assessments have significantly improved the precision of diagnoses and the customization of treatment strategies. Our findings underscore the system’s potential to advance pediatric ophthalmology and broaden the scope of retinal imaging.

Pediatric Considerations in Pompe Disease: A Comprehensive Review

Pompe disease, also known as glycogen storage disease type II, is a rare inherited disorder caused by a deficiency of the enzyme acid alpha-glucosidase (GAA), leading to the accumulation of glycogen in various tissues, particularly muscles. While Pompe disease can affect individuals of all ages, its presentation and management in pediatric patients present unique challenges. This review aims to provide a comprehensive overview of the clinical manifestations, diagnosis, and management of Pompe disease in pediatric populations. Special considerations in the areas of respiratory support, nutrition, physical therapy, and long-term outcomes will be discussed. Understanding these aspects is crucial for optimizing the care and quality of life for children with Pompe disease

Atypical Presentation of Infantile Bullous Pemphigoid with Isolated C3 Deposits

Bullous pemphigoid is an acquired autoimmune bullous disorder with autoantibodies targeting distinctive antigenic components of the skin and mucous membrane. It occurs mostly in the elderly, with the incidence of disease increasing with age and rare in children and infants. The clinical features are extremely polymorphous characterized by tense blisters and intense itching. The disease in pediatric population usually has a favorable outcome with appropriate treatment. Here, we present a case of infantile bullous pemphigoid with a rare presentation, triggered by vaccination and showing only linear C3 deposits.

Childhood dental caries and obesity: Opportunities for interdisciplinary approaches to prevention

AbstractDental caries and obesity are prevalent and preventable chronic childhood diseases. Evidence shows a strong connection between these two diseases, with overlapping common risk factors, including diet as a key driver of risk. Dental professionals are well‐positioned to perform nutritional counseling and obesity prevention in dental clinic settings, but training and clinical integration remain key challenges. This paper highlights the potential for leveraging the common risk factor approach (CRFA) framework and its principles to reduce the impact of childhood dental caries and obesity. Strategies and methods are provided to integrate meaningful didactic and clinical training experiences in dental academia, and the need to include effective and evidence‐based nutritional counseling techniques in dental settings is also described. Additionally, the potential for integrating CRFA and engaging health care providers across the spectrum of care, including primary care settings, to reduce the prevalence of these diseases in pediatric populations is highlighted. Finally, the authors propose future directions for multidisciplinary research to advance the scientific knowledge in this area and to inform effective and comprehensive interventions for dental settings.

Assessment of medication discrepancy, medication appropriateness, and cost analysis among patients with pediatric nephrotic syndrome: An ambispective cohort observational study

BackgroundNephrotic syndrome (NS) is a commonly encountered chronic kidney disease in pediatric populations, with South Asian children being at high risk and requiring long-term pharmacological management. Thus, identifying medication discrepancies and evaluating the appropriateness of therapy and its economic burden are vital for inpatient management. The aim of the study was to assess medication reconciliation, medication appropriateness, and cost analysis in NS cases. MethodsAn ambispective cohort observational study was carried out with 150 NS patients where medication discrepancies were identified retrospectively and prospectively using the best possible medication history and following up patients correspondingly. Further, the Medication Appropriateness Index and cost variation analysis were used to assess the prescribed therapy and cost analysis, respectively. ResultsOut of 150 patients with NS included, 67.3% were male and the mean age was 7.2 years. In total, 36.7% medication discrepancies were found at baseline and 6% discrepancies at follow-up. The majority of discrepancies were unintentional and due to dosing error both at baseline and follow-up. Further, in only 2% of the patients was there inappropriately prescribed medication, and the majority of patients spent between INR (Indian Rupees) 500 and 1000. ConclusionChronic conditions like NS require continuous monitoring by the specialist pediatric clinical pharmacist, who can contribute significantly by minimizing the medication discrepancies, by assessing the appropriateness of therapy, and lessening the economic burden.

Venous malformations in children - a literature review

Introduction: Venous malformations are congenital, the most occurring subtype of vascular malformations. They are characterized by slow flow, tortuosity and lack of macular layer within the vessel. Venous malformations can be highly problematic to diagnose and treat, thus differentiation the venous malformations with other diseases in pediatric population is important. Aim of the study: The aim of the study is to summarize the available knowledge about venous malformation in pediatric population. The options in diagnosis, treatment and potential new methods were summarized and described. Materials and methods The literature available in the PubMed database was reviewed using the following keywords: “Vascular malformations”, “Venous Malformations”, “Venous malformations treatment, “Children”. Conclusions: Venous malformations are an important problem in pediatric population, as a seldom affliction they can be easily misdiagnosed as other diseases and treated inadequately. Widening of awareness of venous malformations and possible methods of diagnosing and treating them is very important to raise quality of health care in children.

A Case Report Study at the Miangul Abdul Haq Jahanzeb Kidney Hospital in Swat Found Glomerular Basement Membrane Antibody Disease with Normal Renal Function.

Background: Anti-glomerular basement membrane (GBM) antibody disease is a rare autoimmune condition causing rapidly progressive glomerulonephritis, typically affecting adults. We present an unusual case of anti-GBM nephritis in a 7-year-old child, initially identified through a routine school urine screening. This young patient displayed no overt signs of renal impairment but testing revealed the atypical presence of GBM antibodies.. Objective: The purpose of this case report is to draw attention to the uncommon occurrence of anti-GBM disease in pediatric populations presenting with normal renal function. Diagnosis and management in such cases poses challenges given our understanding of anti-GBM nephritis derives mainly from adult patients. This anomaly prompts consideration of alternate screening and treatment approaches for younger patients who may manifest the disease atypically compared to older populations. Study design: A Case Report Study. Place and duration of study: department of nephrology at the MiangulAbdul Haq Jahanzeb Kidney Hospital From January 2021 to July 2021 Methods: This Case Report study was conducted in the department of nephrology at the MiangulAbdul Haq Jahanzeb Kidney Hospital From January 2021 to July 2021 after ethical clearance for hospital administration of this study. Results: (anti-GBM) illness in infants with intact renal function is uncommon. For this reason, professionals must carefully pick an appropriate therapy for youngsters since the prognosis is grim. Conclusion: Figures 1 to 3 show that things are true of (anti-GBM) illness. (anti-GBM) infection was suspected eventhough her kidneys were in good shape. A VUR might have caused this with a bladder issue as a secondary conditionsource. As an (anti-GBM) medication, DFPP works well for those with normal renal function. Keywords: Anti-GBM, Pediatrics, Normal renal function, School urine screening programmed, case report

Predictive modeling for infectious diarrheal disease in pediatric populations: A systematic review.

Diarrhea is still a significant global public health problem. There are currently no systematic evaluation of the modeling areas and approaches to predict diarrheal illness outcomes. This paper reviews existing research efforts in predictive modeling of infectious diarrheal illness in pediatric populations. We conducted a systematic review via a PubMed search for the period 1990-2021. A comprehensive search query was developed through an iterative process and literature on predictive modeling of diarrhea was retrieved. The following filters were applied to the search results: human subjects, English language, and children (birth to 18 years). We carried out a narrative synthesis of the included publications. Our literature search returned 2671 articles. After manual evaluation, 38 of these articles were included in this review. The most common research topic among the studies were disease forecasts 14 (36.8%), vaccine-related predictions 9 (23.7%), and disease/pathogen detection 5 (13.2%). Majority of these studies were published between 2011 and 2020, 28 (73.7%). The most common technique used in the modeling was machine learning 12 (31.6%) with various algorithms used for the prediction tasks. With change in the landscape of diarrheal etiology after rotavirus vaccine introduction, many open areas (disease forecasts, disease detection, and strain dynamics) remain for pathogen-specific predictive models among etiological agents that have emerged as important. Additionally, the outcomes of diarrheal illness remain under researched. We also observed lack of consistency in the reporting of results of prediction models despite the available guidelines highlighting the need for common data standards and adherence to guidelines on reporting of predictive models for biomedical research. Our review identified knowledge gaps and opportunities in predictive modeling for diarrheal illness, and limitations in existing attempts whilst advancing some precursory thoughts on how to address them, aiming to invigorate future research efforts in this sphere.

Çocukluk Çağı Membranöz Glomerülonefrit Tanılı Hastaların Klinik Değerlendirmesi

Objective: Membranous nephropathy (MN) is a rare immune complex disease in pediatric population then adults. The prognosis of MN is variable, ranging from spontaneous complete remission to end-stage renal disease (ESRD). The lack of large multicenter studies precludes the possibility of examining in detail the treatment options and clinical outcomes in these patients. The present study aimed to expand the literature on the clinical findings, treatment, and prognosis of MN in pediatric patients. Material and Methods: This single-center retrospective study included 13 patients with a diagnosis of primary and secondary membranous nephropathy. Results: The mean age of the sample was 12.29±3.67 years. Complete remission occurred in 7 (53.8%) patients (of which 1 case was spontaneous remission), and partial remission occurred in 4 (30.8%) patients. In long-term follow-ups; one patient had chronic kidney disease (CKD) and one patient had end-stage renal disease (ESRD). At the last-follow up, proteinuria was noted in 6 (46.2%) patients and microscopic hematuria was noted in 4 (30.8%) and 9 patients were still using low-dose steroids. Conclusion: The current findings have not identified any significant risk factors associated with the prognosis of MN in pediatric patients, but are thought to contribute to the limited data on pediatric MN. Most of the available data on the natural history, treatment options, and long-term outcomes of MN in the pediatric population consists of small, uncontrolled case series. Therefore, we think that larger-scale clinical trials are necessary to clearly elucidate the factors related to the prognosis of pediatric MN.

Bacterial Microbiota of Asthmatic Children and Preschool Wheezers’ Airways—What Do We Know?

Asthma is the most chronic pulmonary disease in pediatric population, and its etiopathology still remains unclear. Both viruses and bacteria are suspected factors of disease development and are responsible for its exacerbation. Since the launch of The Human Microbiome Project, there has been an explosion of research on microbiota and its connection with various diseases. In our review, we have collected recent data about both upper- and lower-airway bacterial microbiota of asthmatic children. We have also included studies regarding preschool wheezers, since asthma diagnosis in children under 5 years of age remains challenging due to the lack of an objective tool. This paper indicates the need for further studies of microbiome and asthma, as in today’s knowledge, there is no particular bacterium that discriminates the asthmatics from the healthy peers and can be used as a potential biological factor in the disease prevalence and treatment.

Tilianin Protects against Nonalcoholic Fatty Liver Disease in Early Obesity Mice.

Non-alcoholic fatty liver disease (NAFLD) has emerged as one of the most frequent types of liver disease in pediatric populations with obesity. Tilianin has multiple biological activities including anti-inflammatory and antioxidant. Here, we aim to explore the functions and possible mechanisms of tilianin on NAFLD in obese children. A high-fat high-carbohydrate (HFHC) diet was used to feed 21-d-old mice. Tilianin was administered at a dose of 10 or 20 mg/kg daily. HFHC-fed mice gained weight, increased liver index. The liver showed hepatocyte ballooning, inflammatory infiltration, and steatosis. Elevated levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) and reduced the high-density lipoprotein cholesterol (HDL-C) level were found in HFHC-fed mice. Administration of tilianin significantly reduced these impairments. We further evaluated proteins related to lipid metabolism and observed that LXRα, SREBP-1c, FAS and ACC1 expression were blunted following tilianin administration. In addition, tilianin suppressed reactive oxygen species (ROS) overproduction and lipid peroxide 4-Hydroxynonenal expression, ascribed to its oxidative stress-modulating capacity. Tilianin also reversed the increase in F4/80 expression and proinflammatory cytokine levels. Of note, tilianin administration resulted in decreased protein levels of active caspase-1 and NOD-like receptor protein 3 (NLRP3) in HFHC-fed mice. Our study suggests that tilianin may ameliorate NAFLD in early obese mice by modulating lipids metabolism, oxidative stress, and inflammation, which may in part involve inhibiting NLRP3 inflammasome activation.

Invasive Disease in Pediatric Population - 10 Year Review

Invasive Disease in Pediatric Population - 10 Year Review

Idiopathic Nephrotic Syndrome in Pediatrics: An Up-to-date.

Idiopathic or Primary Nephrotic Syndrome (INS) is a common glomerular disease in pediatric population, characterized by proteinuria, edema and hypoalbuminemia with variable findings in renal histopathology. This review aims to summarize current data on the etiopathogenesis diagnosis, protocols of treatment and potential therapeutic advances in INS. This narrative review searched for articles on histopathology, physiopathology, genetic causes, diagnosis and treatment of INS in pediatric patients. The databases evaluated were PubMed and Scopus. INS is caused by an alteration in the permeability of the glomerular filtration barrier with unknown etiology. There are several gaps in the etiopathogenesis, response to treatment and clinical course of INS that justify further investigation. Novel advances include the recent understanding of the role of podocytes in INS and the identification of genes associated with the disease. The role of immune system cells and molecules has also been investigated. The diagnosis relies on clinical findings, laboratory exams and renal histology for selected cases. The treatment is primarily based on steroids administration. In case of failure, other medications should be tried. Recent studies have also searched for novel biomarkers for diagnosis and alternative therapeutic approaches. The therapeutic response to corticosteroids still remains the main predictive factor for the prognosis of the disease. Genetic and pharmacogenomics tools may allow the identification of cases not responsive to immunosuppressive medications.

Association of Metabolic Signatures with Nonalcoholic Fatty Liver Disease in Pediatric Population.

Several adult omics studies have been conducted to understand the pathophysiology of nonalcoholic fatty liver disease (NAFLD). However, the histological features of children are different from those of adults, and the onset and progression of pediatric NAFLD are not fully understood. In this study, we aimed to evaluate the metabolome profile and metabolic pathway changes associated with pediatric NAFLD to elucidate its pathophysiology and to develop machine learning-based NAFLD diagnostic models. We analyzed the metabolic profiles of healthy control, lean NAFLD, overweight control, and overweight NAFLD groups of children and adolescent participants (N = 165) by assessing plasma samples. Additionally, we constructed diagnostic models by applying three machine learning methods (ElasticNet, random forest, and XGBoost) and multiple logistic regression by using NAFLD-specific metabolic features, genetic variants, and clinical data. We identified 18 NAFLD-specific metabolic features and metabolic changes in lipid, glutathione-related amino acid, and branched-chain amino acid metabolism by comparing the control and NAFLD groups in the overweight pediatric population. Additionally, we successfully developed and cross-validated diagnostic models that showed excellent diagnostic performance (ElasticNet and random forest model: area under the receiver operating characteristic curve, 0.95). Metabolome changes in the plasma of pediatric patients with NAFLD are associated with the pathophysiology of the disease and can be utilized as a less-invasive approach to diagnosing the disease.

Demographic Characteristics of Children with Biliary Atresia in dr. Kariadi General Hospital, Semarang

Background: Biliary atresia (BA) is a progressive fibrosing obstructive cholangiopathy involving both the intrahepatic and extrahepatic biliary system; resulting in obstruction of bile flow and neonatal jaundice. Early diagnosis of biliary atresia and Kasai procedure improves patients outcome. Data form several studies revealed that BA is the most common cause of neonatal cholestasis (25%) and the leading cause of end-stage liver disease in pediatric population. The aim of this study is to determine the outcome and characteristics of children with biliary atresia in dr. Kariadi General Hospital, Semarang.&#x0D; Methods: In this study, a retrospective database analysis of 80 infants diagnosed with biliary atresia was conducted. Patient’s demographic data including age, sex, age at disease onset, were collected from year 2018 to 2022; including all comorbidities and complications. Data regarding procedure performed for each patient and their outcome were included in this study. &#x0D; Results: Eighty children were included in this study. The mean age of children referred with biliary atresia was 1.89 month, while the mean age at diagnosis was 2.5 month. Most of the patients were girls. The incidence of cytomegalovirus infection comorbidity in patients with biliary atresia is quite high, which were reported at 82%. Children diagnosed with biliary atresia and cytomegalovirus infection resulted in worse prognosis than those without.&#x0D; Conclusion: Our study support the theories that biliary atresia may be caused by the exposure of external environment during perinatal period such as viral infection. The prognosis of patients with cytomegalovirus comorbidity is worse than that without.

Prevalence and Pattern of Congenital Heart Disease in Pediatric Population—A Study from Central India

Abstract Introduction Prevalence of congenital heart disease (CHD) is variable depending on the region and setting of study ranging from 0.8 to 6/1,000. Age of presentation depends on types of CHD and its severity. Burden of CHD is not known in this tribal belt of Central India. Main objective of this study was to find out prevalence of CHD in children. We have also studied the pattern and age of presentation of various types of CHDs. Methods This retrospective observational study was conducted at tertiary care teaching institute in tribal belt of Central India. Children aged 0 to 15 years reported to pediatric outpatient department (OPD) were included. CHD was confirmed by echocardiography in suspected cases. Prevalence rate was calculated as number of CHDs per 1,000 OPD patients. Pattern of CHD was categorized as per standard guidelines and age-wise presentations of various types of CHD were studied. Results The prevalence rate of CHD in our study population was 27.7/1,000, which is high when compared with most of the other hospital-based studies. Most of the patients, 60.36 and 83.26% were detected before the age of 1 year and 5 years, respectively. All critical CHD cases were detected in early infancy. Conclusion There is a high burden of CHD seen in this study. Possible cause of this may be lack of specialized facility in this reason and study period included first and second wave of COVID. Further, large sample size studies and/or nationwide registry/database are needed to know the exact burden of CHD.

Effect of Concomitant Tuberculosis Infection on COVID-19 Disease in Children: A Matched, Retrospective Cohort Study.

BackgroundCoronavirus disease 2019 (COVID-19) has had devastating effects on the health of millions globally. Patients with tuberculosis (TB) are a vulnerable population. There is paucity of data to assess association between the 2 diseases in Pediatric population.ObjectiveTo elucidate the effect of concomitant TB on clinical course of pediatric COVID-19 disease.MethodsRetrospective matched cohort study was conducted at dedicated tertiary COVID-19 hospital in India. All consecutive patients aged <18 y admitted with COVID-19 were line listed. Patients with current or recently diagnosed TB were included. Consecutive age and sex matched COVID-19 patients with no history of TB were included as controls. Medical records were retrieved, clinical data entered in pre-determined proforma.ResultsDuring study period, 327 pediatric COVID-19 patients were admitted. Study group included 17 patients with TB. These patients, tended to be referred from other hospitals, be sicker, had lower SpO2 at arrival and higher severity of COVID-19 as compared to controls (All P < 0.05). They required more mechanical ventilation, had longer length of stay and worse outcome.ConclusionCOVID-19 may secondarily affect and modify the course of TB in children. Given the high case fatality rate in this association and potentially treatable nature of TB, attention of the policy makers is drawn to this.Name of IEC committeeMaulana Azad Medical College and Associated Hospital Institutional Ethics Committee. IEC no: F.1/IEC/MAMC/(80/8/2020/No274). Dated 9 November 2020.Trial registrationCTRI/2021/02/031197 [Registered on: 10 February 2021].

The Clinical Spectrum of Autoimmune-Mediated Neurological Diseases in Paediatric Population.

Neurological autoimmune diseases have various origins and pathogeneses. Specific antibodies are associated with paraneoplastic syndromes, other infectious agents, or inherited disorders. We aim to evaluate the relation between the autoantibodies, the chosen symptoms, demographic characteristics, and infection history. We retrospectively analysed 508 children during neurological diagnostics. We investigated serum antineuronal, IgG, IgM anti-ganglioside, and anti-aquaporin-4 in both the serum and cerebrospinal fluid (CSF) anti-cell surface and anti-synaptic protein antibodies in 463, 99, 44, 343, and 119 patients, respectively. The CSF polymerase chain reaction detection of Herpesviridae, enterovirus, B19 parvovirus, adenovirus, and parechovirus involved 261 patients. We included available clinical information and electroencephalographic, radiologic, and microbiological results. The IgM anti-ganglioside antibodies increased the risk of tics and positive symptoms (p = 0.0345, p = 0.0263, respectively), the anti-glutamic acid decarboxylase particle of paresis (p = 0.0074), and anti-neuroendothelium of mutism (p = 0.0361). Anti-neuroendothelium, IgM anti-ganglioside, and CSF anti-N-methyl-D-aspartate antibodies were more often associated with consciousness loss (p = 0.0496, p = 0.0044, p = 0.0463, respectively). Anti-myelin antibodies co-occured with Herpes simplex virus (HSV)-2 IgG (p = 0.0415), anti-CV2 with HSV-1 IgM (p = 0.0394), whereas anti-glial fibrillary acidic protein was linked with past Epstein-Barr virus infection. The anti-ganglioside IgM and anti-myelin particles were bilaterally correlated (p = 0.0472). The clinical pictures may overlap, requiring specialistic diagnostics. We noticed the links between the infection aetiology and the specific autoantibody’s positivity.