Pediatric Disease Research Articles

Pediatric Clinical Influenza Disease by Type and Subtype 2015-2020: A Multicenter, Prospective Study.

Previous investigations into clinical signs and symptoms associated with influenza types and subtypes have not definitively established differences in the clinical presentation or severity of influenza disease. The study population included children 0 through 17 years old enrolled at 8 New Vaccine Surveillance Network sites between 2015 and 2020 who tested positive for influenza virus by molecular testing. Demographic and clinical data were collected for study participants via parent/guardian interview and medical chart review. Descriptive statistics were used to summarize demographic and clinical characteristics by influenza subtype. Multivariable logistic regression and Cox proportional hazard models were used to assess effects of age, sex, influenza subtype, and history of asthma on severity, including hospital admission, need for supplemental oxygen, and length of stay. Retractions, cyanosis, and need for supplemental oxygen were more frequently observed among patients with influenza A(H1N1)pdm09. Headaches and sore throat were more commonly reported among patients with influenza B. Children with influenza A(H1N1)pdm09 and children with asthma had significantly increased odds of hospital admission (adjusted odds ratio (AOR): 1.39, 95% CI: 1.14-1.69 and AOR: 2.14, 95% CI: 1.72-2.67, respectively). During admission, children with influenza A(H1N1)pdm09 had significantly increased use of supplemental oxygen compared to children with A(H3N2) (AOR: 0.60, 95% CI: 0.44-0.82) or B (AOR: 0.56, 95% CI: 0.41-0.76). Among children presenting to the emergency department and admitted to the hospital, influenza A(H1N1)pdm09 caused more severe disease compared to influenza A(H3N2) and influenza B. Asthma also contributed to severe influenza disease regardless of subtype.

Focusing on the Key Factors in the Treatment of Pediatric Crohn's Disease: A Re-Examination of the Relationship Between Body Mass Index and Antitumor Necrosis Factor Treatment Response.

Focusing on the Key Factors in the Treatment of Pediatric Crohn's Disease: A Re-Examination of the Relationship Between Body Mass Index and Antitumor Necrosis Factor Treatment Response.

The Effectiveness of a Parent Empowerment Intervention for Caregivers of Children with Cystic Fibrosis: A Randomized Controlled Trial

ABSTRACT This paper focused on the effectiveness of a parent empowerment intervention based on nursing education (PEINE). This study examined whether the intervention improved the quality of life of children with cystic fibrosis (CF) and improved their caregivers learn about the disease and develop problem-solving and coping skills. This randomized-controlled trial used a pretest-posttest parallel-group research design. The sample consisted of 48 parents (caregivers) of children with CF. Participants were randomly assigned to an intervention (n = 24) and a control group (n = 24). The intervention group received PEINE and standard care and treatment for ten weeks. The control group received standard care and treatment. Data were collected using a Disease Information Survey (DIS), the Ways of Coping Inventory (WCI), the Problem-Solving Inventory (PSI), and the Cystic Fibrosis Questionnaire (CFQ-R). After the intervention, the intervention group DIS scores (d: 1,627 [CI: 0.934,2.305], had more correct answers than the control group. Nursing interventions were effective (p < .001). There was no significant difference in the mean pretest-posttest PSI scores (d: 0.378 [CI: −0.221-0.972], posttest WCI scores (d: 0.239 [CI:-0.356-0.831]) between the intervention and control groups (p>.05). There was a significant difference in the mean posttest CFQ-R scores between the intervention and control groups (d: 1.363 [CI: l.698, 2.015]);(p < .001). PEINE increased the intervention group participants develop disease-management skills. However, the increase in their PSI and WCI scores was statistically insignificant. PEINE also increased the quality of life of children with CF. Parents of children followed in pediatric pulmonary diseases participated in the study. Parents were informed during outpatient clinic visits. After the first meeting, the children and parents who voluntarily agreed to participate in the research were contacted by phone. The outpatient nurse assisted in communicating with children and parents.

Children interstitial lung disease: Assessment and management.

Diffuse parenchymal lung diseases or children interstitial lung disease (chILD) in pediatrics are a heterogenous group of more than 200 rare diseases with an incidence and prevalence around 8.2 and 46.4 cases/million, respectively, higher than previously recognized, probably related to a greater understanding and increased clinical awareness of these diseases. Children under 2 years of age account for 40%-60% of cases. Diseases presenting before the age of 2 years are mainly of genetic origin or associated with disorders of lung development and are very different from those of older children and adults. In 10%-20% of cases, a genetic cause is found, and in approximately 12%, no cause (undefined chILD) is found after performing all diagnostic tests. A multidisciplinary approach in an expert center is essential for diagnosis and treatment. Tests to be performed after lung computed tomography include serological and other blood tests, bronchoscopy and bronchoalveolar lavage, genetic studies and lung biopsy. Although no approved specific treatment for most cases of chILD exists, an improved understanding of the pathophysiology of many of these diseases is facilitating the development of new treatments.

Diagnostic value of syndecan-1 for coronary artery lesions and correlation analysis of laboratory indicators in Kawasaki disease patients

BackgroundTo explore the application value of syndecan-1 (SDC-1) in the diagnosis of coronary artery lesions (CALs) in Kawasaki disease (KD) patients and the correlation of multiple laboratory indicators in KD patients.Methods86 pediatric Kawasaki disease (KD) patients and 52 healthy controls admitted from January 2018 to December 2023 were retrospectively analyzed. Venous blood samples from KD patients were analyzed for white blood cells (WBC), platelets (PLT), C-reactive protein (CRP), interleukin-6 (IL-6), syndecan-1 (SDC-1), coagulation parameters, and lipid profiles. Correlations between these laboratory indicators were assessed. Receiver operating characteristic (ROC) curve analysis determined the diagnostic value of SDC-1 for coronary artery lesions (CALs) in KD patients. SDC-1 levels were further compared across different CAL severity groups.ResultsThe levels of ALT, AST, WBC, PLT, CRP, IL-6, and SDC-1 in the KD group were significantly higher than those in the control group (P < 0.05). Coagulation function analysis showed that APTT, TT and FIB levels were significantly increased in the KD group compared with the control group (P < 0.05). Lipid profile analysis revealed that TC, HDL-C, and ApoA1 were significantly decreased, whereas TG, LDL-C, and ApoB100 were significantly increased in the KD group (P < 0.05). Refractory KD patients exhibited significantly higher levels of ALT, AST, SDC-1, CRP, WBC, and TG compared to responsive KD patients (P < 0.05). Correlation analysis indicated a strong positive correlation between PLT and LDL-C (r = 0.227, P = 0.035) and between IL-6 and TG (r = 0.491, P = 0.000), while CRP was negatively correlated with ApoA1 (r = -0.265, P = 0.014). Among the 86 KD patients, 41 (47.67%) developed CALs, with 19 classified as mild, 15 as moderate, and 7 as severe. For predicting CALs among KD patients, the threshold of SDC-1 was identified as 5.5 ng/ml, with a sensitivity of 70.7%, specificity of 64.4%, positive predictive value of 65.91%, negative predictive value of 69.05%, and an AUC of 0.762 (95% confidence interval 0.662–0.861, P < 0.001). SDC-1 levels significantly differed among the CAL severity groups (P = 0.008), with higher levels observed in moderate compared to mild CALs, and in severe compared to moderate CALs.ConclusionIn conclusion, SDC-1 has strong clinical value in the diagnosis of CALs in KD patients, and there is a close relationship between the levels of inflammatory factors, coagulation function and lipid levels in KD patients.

An altered natural killer cell immunophenotype characterizes clinically severe pediatric RSV infection.

Respiratory syncytial virus (RSV) infects nearly all children by 2 years of age and is a leading cause of pediatric hospitalizations. A subset of children with RSV infection (RSV+ children) develop respiratory failure requiring intensive care, but immune mechanisms distinguishing severe pediatric RSV infection are not fully elucidated. Natural killer (NK) cells are key innate immune effectors of viral host defense. In this study of 47 critically ill RSV+ children, we coupled NK cell immunophenotype and cytotoxic function with clinical parameters to identify an NK cell immune signature of severe pediatric RSV disease. Airway NK cells were increased in intubated RSV+ children with severe hypoxemia and prolonged duration of mechanical ventilation and were correlated with clinical severity scores. Peripheral blood NK cells were decreased in RSV+ patients and had altered activating receptor expression, with increased expression of CD69 and decreased expression of NKG2D. Ex vivo, circulating NK cells from RSV+ patients exhibited functional impairment characterized by decreased cytotoxicity as well as aberrant immune synapse assembly and lytic granule trafficking. NK cell frequency and phenotype correlated with clinical measures that defined disease severity. These findings implicate a role for NK cells in mediating RSV immunopathology and suggest that an altered NK cell immunophenotype is associated with severe RSV disease in young children.

Microbiota-derived short chain fatty acids in pediatric health and diseases: from gut development to neuroprotection.

The infant gut microbiota undergoes significant changes during early life, which are essential for immune system maturation, nutrient absorption, and metabolic programming. Among the various microbial metabolites, short-chain fatty acids (SCFAs), primarily acetate, propionate, and butyrate, produced through the fermentation of dietary fibers by gut bacteria, have emerged as critical modulators of host-microbiota interactions. SCFAs serve as energy sources for colonic cells and play pivotal roles in regulating immune responses, maintaining gut barrier integrity, and influencing systemic metabolic pathways. Recent research highlights the potential neuroprotective effects of SCFAs in pediatric populations. Disruptions in gut microbiota composition and SCFA production are increasingly associated with a range of pediatric health issues, including obesity, allergic disorders, inflammatory bowel disease (IBD), and neurodevelopmental disorders. This review synthesizes current knowledge on the role of microbiota-derived SCFAs in pediatric health, emphasizing their contributions from gut development to neuroprotection. It also underscores the need for further research to unravel the precise mechanisms by which SCFAs influence pediatric health and to develop targeted interventions that leverage SCFAs for therapeutic benefits.

The Clinical Effectiveness and Tolerability of Oseltamivir in Unvaccinated Pediatric Influenza Patients during Two Influenza Seasons after the COVID-19 Pandemic: The Impact of Comorbidities on Hospitalization for Influenza in Children

Antiviral therapy such as oseltamivir has been recommended for hospitalized children with suspected and confirmed influenza for almost 20 years. The therapy is officially authorized for newborns two weeks of age or older, however, questions about its safety and effectiveness still surround it. Our goals were to assess the epidemiological features of two consecutive seasonal influenza cases in children following the COVID-19 pandemic; to observe the clinical effectiveness and tolerability of oseltamivir in hospitalized children who were not vaccinated against influenza and had different influenza subtypes, including A(H1N1), A(H3N2), and B; and to identify specific comorbidities associated with influenza in children. We performed an observational study on 1300 children, enrolled between 1 October 2022 and 30 May 2023 and between 1 October 2023 and 4 May 2024, to the IX Pediatric Infectious Diseases Clinical Section of the National Institute of Infectious Diseases “Prof. Dr. Matei Balș”. During the 2022–2023 influenza season, 791 pediatric patients tested positive for influenza and received oseltamivir. Of these, 89% (704/791) had influenza A, with 86.4% having subtype A(H1N1) and 13.6% of cases having A(H3N2), and for influenza B, 11% (87/791) of the pediatric patients. Of the total group, 59% were male, and the median age was 2.4 years (1.02–9.28). For the 2023–2024 influenza season, 509 pediatric patients tested positive for influenza, with 56.9% being of the male gender and who were treated with oseltamivir. Of these patients, 81.6% had influenza A and 18.4% had influenza B. Treatment with neuraminidase inhibitors, specifically oseltamivir, 2 mg/kg/dose administered twice daily for 5 days, was well tolerated by the children, and we recorded no deaths. The duration of hospitalization for patients with a fever after the oseltamivir administration was significantly longer for patients with A(H1N1) infection than A(H3N2), during both seasons. We identified more complications in the 2022–2023 season and a decreasing number of influenza B for the 2023–2024 season. Among children with comorbidities, the most common were asthma, gastrointestinal diseases, and metabolic and endocrine diseases. In terms of effectiveness, oseltamivir significantly reduced the intensity of influenza symptoms, thus reducing the number of days of hospitalization (p = 0.001) as well as post-infection complications (p = 0.005) in both groups. In this study, we evaluated the clinical effectiveness of oseltamivir therapy for all influenza types/subtypes in children, and the length of hospitalization. We identified comorbidities associated with the prolonged duration of hospitalization. Influenza vaccination should be the main tool in the prevention of influenza and its complications in children, especially those with comorbidities.

Risk factors affecting relapse after discontinuation of biologics in children with Crohn's disease who maintained deep remission.

Biologics are important therapeutic agents for pediatric Crohn's disease. Discontinuation of biologics is known to increase the relapse rate up to 71.4% in these patients; however, their long-term use increases the risk of opportunistic infections and causes economic burden and psychological fatigue. Therefore, taking a drug holiday is meaningful, even if the biologics cannot be completely discontinued. This study aimed to analyze the risk factors affecting relapse after discontinuation of biologics in children with Crohn's disease. We retrospectively reviewed the data of 435 children with Crohn's disease who visited a single health center between March 2013 and March 2021. Subsequently, we analyzed data from the patients who discontinued biologics after deep remission. Among the enrolled patients, 388 were followed up for ≥2 years, and of these, 357 were administered biologics. A total of 103 patients discontinued biologics after deep remission, subsequently 31 maintained remission and 72 relapsed. The shorter the duration of biologic treatment (odds ratio of 0.444, P = 0.029), the higher the ESR (odds ratio of 1.294, P = 0.009) and fecal calprotectin (odds ratio of 1.010, P = 0.032), and the less histological remission at the time of discontinuation of biologics (odds ratio of 0.119, P = 0.026), the greater the risk of relapse after discontinuation of biologics. We identified factors associated with relapse after discontinuation of biologics. The results suggest that biologics can be discontinued in the absence of these factors after deep remission. However, because the relapse rate may increase after the discontinuation of biologics, close monitoring is important, and if necessary, re-administration of biologics should be actively considered.

A Comprehensive Bibliometric Analysis of Research Trends About Congenital Toxoplasmosis.

Toxoplasma gondii is an obligate intracellular protozoon that infects approximately one-third of the human population. The parasite could transmit from mother to fetus in cases of acute infection during pregnancy and cause complications in the fetus. The bibliometric analysis is a popular research area that evaluates all the studies indexed in particular databases on a subject. This article puts forth bibliometric review of the literature on maternal and congenital toxoplasmosis research indexed in the Web of Science database between 1945 and 2024. VOS viewer, Web of Science and MS Office Excel 17 programs were used in the study. The results of the search showed 1476 publications. The countries that most contributed to the literature were France (n=306, 20.73%), the USA (n=229, 15.52%), and Brazil (n=146, 9.89%). The most cited country was also France (n=10271, 35.52%), followed by the USA (n=9113, 31.51%), and England (n=2611, 9.03%). The top three countries by number of citations per document were Denmark (44.88), the USA (39.79) and France (33.57). The five departments with the most publications are Pediatrics (20.26%), General Internal Medicine (18.16%), Infectious Diseases (16.8%), Obstetrics (14.57%), and Immunology (11.86%). Wallon M. (n=57), Peyron F. (n=49), Thulliez P. (n=36) and Vilena I. (n=36) were the leading authors in terms of contribution to the literature. The five most published journals were Pediatric Infectious Disease Journal (3.66%), Journal of Clinical Microbiology (2.78%), Lancet (2.3%), Presse Medicale (1.76%), and American Journal of Obstetrics and Gynecology (1.63%). France is one of the countries that pays the most attention to congenital toxoplasmosis and compatible with this, in our study, the country with the highest number of studies on congenital toxoplasmosis was France. It is thought that drawing more attention to this issue and conducting more studies in countries where the disease is common might yield successful results, as in France.

12288 Diabetes Wearable Technology In Children Less Than Six Years At A Large Urban Diabetes Center

Abstract Disclosure: K. Citron-Zafrin: None. L. Richter: None. K. Williams: None. R. Gandica: None. I. Vargas: None. N. Leibel: None. Introduction/Background: Type 1 diabetes (T1D) is one of the most common chronic diseases in pediatrics. T1D is particularly challenging to manage in children under 6 years old due to unpredictable eating patterns, rapid growth, and risk of extreme blood glucose levels. Diabetes wearable technology (insulin pumps and continuous glucose monitors (CGMs)) has become increasingly prominent, but its use has not been well described in this age group. Objectives: We sought to characterize our experience with technology use in children with T1D less than 6 years old. Design/Methods: Retrospective chart review of 82 youth diagnosed with T1D before 6 years old, seen at our center from 2019-2023. Data was collected on demographic information, insurance type, use of insulin pump and CGM, hemoglobin A1c (A1c), diabetic ketoacidosis (DKA) and hypoglycemic events. We used chi-square statistics to compare variables in our population with reported national data. Results: In this cohort, 80% used insulin pumps and 100% used CGMs, an increase from previously reported data (56% insulin pump use and 44% CGM use in those less than 6yo, p&amp;lt;0.001). 54% had private insurance. There were more individuals with family members with T1D compared to reported data (35% vs. 22%, p=0.0041). The median age at diagnosis was 34 months, median time from diagnosis to pump start was 3.5 months. After diagnosis, 1 pump user and 1 multiple daily injections (MDI) user had DKA. One MDI user had hypoglycemia requiring intervention. Average A1C 12 months after diagnosis was 7.9% in the pump group and 8.2% in the MDI group. Hybrid closed loop pump users had an average A1C 6 months after placement of 7.7%. Conclusions: At our urban academic diabetes center, there was higher use of diabetes wearable technology as compared with previously reported data in this age group. There were more individuals with relatives with T1D compared to reported averages. The low rates of DKA and hypoglycemic events seen in this population support that these technologies can be used safely and soon after diagnosis. Although improved from national data, tight glycemic control remains a challenge in this very young age group. Presentation: 6/1/2024

Intravitreal Injection and Prophylactic Laser Treatment in Pediatric Vitreoretinal Pathologies

Vascular endothelial growth factor (VEGF) is an important mediator of pathological neovascularization and vascular permeability of the eye. The increasing use of intravitreal therapies targeting VEGF has revolutionized the treatment of pediatric vitreoretinal diseases. Laser photocoagulation is the standard treatment method for retinopathy of prematurity. The aim is to ablate the avascular peripheral retina, but ablation of the peripheral retina with traditional laser therapy is destructive, causes complications, and does not prevent all vision loss, especially in cases of retinopathy of prematurity affecting zone 1 of the eye. In Coats disease, retinal telangiectasias are treated early with laser photocoagulation, but with ischemia, high levels of VEGF in the ocular fluid may contribute to increased permeability of telangiectatic blood vessels, leading to lipoprotein leakage and subsequent exudative retinal detachment. Therefore, anti-VEGF has been recommended as adjuvant therapy in the treatment of Coats disease. In this review, intravitreal injection and prophylactic laser treatment applications in Retinopathy of Prematurity and Coats Disease are mentioned.

12431 14-year-old Presenting With Thrombocytopenia-Associated Multi-Organ Failure In The Setting Of Diabetic Ketoacidosis/Hyperosmolar Hyperglycemic Syndrome

Abstract Disclosure: N.C. Gunaratne-Breaux: None. D. Deplewski: None. Title: 14-Year-Old Presenting with Thrombocytopenia Associated Multi-Organ Failure in the setting of Diabetic Ketoacidosis/Hyperosmolar Hyperglycemic Syndrome Background: Coagulation complications are rare in hyperglycemia emergencies in children and adolescents. In patients presenting with severe and atypical hyperglycemia emergencies, special considerations need to be made to rule out life-threatening coagulopathy. Clinical Case: A 14-year-old male with history of Type 1 Diabetes presented in severe Diabetic Ketoacidosis/Hyperosmolar Hyperglycemic Syndrome overlap. Initially had severe hypotension and altered mental status concerning for cerebral edema. Initial venous blood gas showed pH of 6.82, pCO2 17.1, and HCO3 2.8, serum glucose was 1375 mg/dL, serum ketones &amp;gt;7.00 mmol/L, and serum osmolality was 384 mOsm/kg. Once insulin drip was started, glucose, ketones, and serum osmolality improved, but patient continued to be encephalopathic and had worsening tachypnea and desaturations. Patient was eventually intubated. After intubation, patient’s acidosis improved, but patient developed kidney failure (prompting initiation of dialysis), liver injury, decreased cardiac function, and high inflammatory state. A comprehensive multi-specialty team including pediatric intensive care, infectious diseases, rheumatology, neurology, and cardiology were involved in the care. On day three of admission, patient had multiple areas of ischemia on fingertips and ear and clotting of multiple IV and dialysis catheters, prompting a coagulopathy evaluation. Labs showed microcytic anemia (hemoglobin 10.0 g/dL; mean corpuscular volume 75fL), thrombocytopenia (platelet count 17 10e3/uL), coagulopathy (prothrombin time 16.8 sec, INR 1.3, prolonged thrombin time 48.8 sec), and elevated ferritin (507 ng/mL). Given labs and multi-organ involvement, determined by hematology to be Thrombocytopenia Associated Multi-Organ Failure (TAMOF). Patient was started on plasmapheresis and had dramatic improvement – was eventually extubated and returned to neurologic baseline without any notable deficits. Multi-specialty team ruled out all other possible causes of TAMOF; determination that the TAMOF developed secondary to DKA/HHS. Conclusion: Hyperglycemia emergencies can lead to a hyperinflammatory state that can lead to disruption of the coagulation cascade, including disseminated intravascular coagulopathy or thrombotic thrombocytopenia purpura. There have been rare reports of thrombocytopenia associated multi-organ failure provoked by DKA, thought secondary to critical illness mediated low ADAMST13 levels. This is a novel case of TAMOF caused by DKA/HHS overlap syndrome. It is important to screen for coagulopathy in cases of patients with DKA or DKA/HHS who do not show clinical improvement with resolution of ketosis and hyperosmolarity. Presentation: 6/2/2024

Association of endoscopic findings and histological alterations in pediatric Crohn's disease.

Crohn's disease (CD) is a type of inflammatory bowel disease (IBD) characterized by chronic, transmural, and relapsing inflammation that can affect any segment of the gastrointestinal tract, from the oral cavity to the anus (1). The clinicopathological association of various endoscopic abnormalities in CD is under study. An analytical study was conducted on patients under the age of 15 who underwent esophagoscopy and/or colonoscopy for suspected IBD at a pediatric hospital between 2015 and 2022 (Reg. No. 3318-0000206). Subjects with normal histopathological findings and those with a histological diagnosis of CD were included. The prevalence of different endoscopic alterations and their association with histopathological abnormalities were compared between patients with Crohn's disease (CD) and those with normal histology (NCD). Of the 502 endoscopies performed during this period, 22 subjects with CD and 14 children with NCD were included. Endoscopic normality, defined as the absence of mucosal abnormalities, was higher among NCD patients (43%), while the most prevalent macroscopic abnormality in CD patients was the presence of ulcers.

Deregulated Expression of Long Non-coding RNA ZFAS1 as a Predictive Biomarker for Respiratory Failure in Severe Pneumonia Children and Its Impact on Clinical Outcome

Abstract Objective Severe pneumonia is a common pediatric disease, often complicated by respiratory failure (RF). The expression changes of long non-coding RNA zinc finger antisense 1 (ZFAS1) were examined in children with severe pneumonia, as well as their predictive value in the occurrence of RF and poor outcomes. Methods A total of 120 children with severe pneumonia were included, 60 of whom had RF. RT-qPCR was used to detect mRNA levels. Deaths during the follow-up period were recorded through a 28-day follow-up survey. Receiver operating characteristic (ROC) curve and Kaplan Meier (K-M) plot were drawn to display diagnostic and predictive values, with the help of multiple logistic and Cox regression analysis. Results A sharp rise of serum ZFAS1 was tested in severe pneumonia children, providing a area under the receiver operator characteristic curve (AUC-ROC) of 0.920, with a sensitivity of 81.67% and a specificity of 90.00%. Serum ZFAS1 (OR = 5.832, 95% CI = 2.283–14.899) was found to be associated with the occurrence of RF after adjusting other clinical indexes, with an AUC-ROC of 0.843. ZFAS1 (HR = 4.624, 95% CI = 1.318–16.217, P &lt; 0.05) was an independent influence factor for the poor prognosis. Cases with high ZFAS1 levels had worse clinical outcomes. Conclusion Monitoring serum ZFAS1 levels is helpful in assessing severe pneumonia in children, especially for early identification of cases with RF. High serum ZFAS1 levels have a certain predictive value for poor prognosis in patients.

Effect of methimazole treatment on Th1, Th17, and Th22 lymphocytes in pediatric Graves' disease patients.

Graves' disease is the leading cause of autoimmune hyperthyroidism. Thyroid hormones are an essential element of the endocrine system, playing a pivotal role in the body's development, especially important in children with intensified growth. Disturbance within thyroid tissue certainly affected the whole body. Nowadays, numerous research studies indicate different factors contributing to the onset of the disease; however, the exact pathomechanism of Graves' disease is still not fully understood, especially in the context of immune-related processes. Th1, Th17, and Th22 effector lymphocytes were found to be crucial participants in the disease outcome, as well as in autoimmune diseases. Here, our study aimed at assessing selected effector T lymphocytes, Th1, Th17, and Th22, in newly diagnosed pediatric Graves' disease patients, together with their association with thyroid-related parameters and the potential outcome of disease management. We indicated significant increases in the frequencies and absolute numbers of selected effector lymphocytes in Graves' disease patients. In addition, their mutual ratios, as well as Th1/Th17, Th/Th22, and Th17/Th22, seem to be significant in those diseases. Notably, low Th17/Th22 ratio values were distinguished as potential prognostic factors for normalizing TSH levels in response to methimazole treatment. To sum up, our research determines the crucial contribution of Th1, Th17, and Th22 cells in the pathogenesis of Graves' disease. Moreover, the mentioned subset of T cells is highly likely to play a substantial role in the potential prediction of therapy outcomes.

Paediatric rheumatology in Nigeria: history, challenges and the future.

Pediatric rheumatology is a relatively new subspecialty in Nigeria. For many years, rheumatic disease had not been well-recognized or studied in Nigeria, so there has been a low suspicion index. The clinical presentation of most pediatric rheumatic diseases (PRDs) mimics non-rheumatic diseases making it a diagnostic challenge most of the time. The story has changed in Lagos since the creation of a pediatric rheumatology unit at the Lagos State University Teaching Hospital. There is now a high index of suspicion for these diseases in the hospital but no one knows about what is happening in the other 35 states of the country who do not have a pediatric rheumatologist. Major challenges being faced presently are poor awareness among healthcare workers and the community, high cost of investigations and medications, lack of pediatric rheumatologists in most hospitals in the country, lack of pediatric rheumatology training centers for both undergraduate and postgraduate training, and lack of research data. The healthcare community in Nigeria is looking forward to a future where pediatric rheumatology will be highly recognized and established.

Impact of the mother's voice on sedation need and stress during cardiologic examination of children (SMUSS study): a prospective, interventional, randomised, controlled, monocentric study.

Cardiac catheterisation is crucial for diagnosing and treating paediatric heart diseases, but it is poorly tolerated by small children, infants, and newborns without sedation. This study investigated whether maternal voice during sedation could lower stress and pain in children undergoing cardiac catheterisation and also assessed mothers' stress levels before and after the procedure. This was a prospective, monocentric, randomised, controlled interventional study at the University Hospital Bonn. Children aged 4 years or younger scheduled for elective cardiac catheterisation under procedural sedation and American Society of Anaesthesiologists class between 1 and 3 were eligible. At the end of cardiac catheterisation, the intervention group showed a higher Newborn Infant Parasympathetic Evaluation index with an adjusted mean difference of 9.5 (± 4.2) (p = 0.026) and a lower median Children's and Infants Postoperative Pain Scale score of 2.0 (IQR: 0.0-5.0) versus 4.5 (IQR: 3.0-6.0) than the control group (p = 0.027). No difference in the children's cortisol level was found (p = 0.424). The mothers in the intervention group had a lower cortisol level than those in the control group before cardiac catheterisation (adjusted mean difference: -4.5 nmol/l (± 1.8 nmol/l), p = 0.011). Listening to the maternal voice during cardiac catheterisation could lead to less postoperative pain and significantly lower stress and discomfort level in children. Less pain could reduce the incidence of postoperative delirium.Additionally, mothers perceived involvement as positive. A reduced stress level of mothers can positively influence children and possibly reduce pain and anxiety.

Summary of the 15th National Pediatric Gastrointestinal Diseases Conference

Summary of the 15th National Pediatric Gastrointestinal Diseases Conference

Affordable ultra-widefield smartphone PedCam for comprehensive pediatric retinal examination

Widefield fundus photography is critical for the detection, documentation, and management of pediatric eye diseases. Existing clinical pediatric fundus cameras offer a limited field of view (FOV) and suboptimal image contrast, hindering comprehensive peripheral retina examination. Additionally, the high cost and lack of portability of commercial devices restrict their use in resource-limited settings. We introduce a cost-effective smartphone-based pediatric camera (PedCam) that provides a 180° eye angle (126° visual angle) snapshot FOV. Utilizing trans-pars planar illumination, the device enables nonmydriatic imaging by allocating the pupil exclusively for imaging, eliminating the need for pharmacological pupillary dilation. By adjusting the optical axis of the PedCam relative to the ocular axis, the effective FOV can be expanded up to 240° eye angle (180° visual angle), enabling complete retinal evaluation. This innovative smartphone PedCam represents a significant advancement in affordable telemedicine for the screening, monitoring, and management of retinopathy of prematurity and other pediatric eye conditions.