Hospital Pediatric Department Research Articles

Genetic, Clinical, and Biochemical Characterization ofa Large Cohort of Palestinian Patients With Fanconi-Bickel Syndrome.

This study aims to investigate the clinical, biochemical, and genetic characteristics of Fanconi-Bickel syndrome (FBS) in a cohort of 20 individuals from Palestine and to identify novel pathogenic variants. A retrospective analysis was conducted on medical records from Al-Makassed Hospital's pediatric department spanning 2015 to 2023. Individuals diagnosed with FBS via molecular genetic testing were included in the study. Among the 20 genetically confirmed FBS patients, hepatomegaly was prevalent in 95%, whereas 70% exhibited both developmental delay and hypophosphatemic rickets, and 68.4% experienced growth retardation. Hypertriglyceridemia (HTG) was universal. Elevated liver enzymes and alkaline phosphatase were common, along with hypophosphatemia (95%) and urinary abnormalities. Genetic analysis revealed five distinct SLC2A2 pathogenic variants, including three previously unreported variants: p.Gln23Arg (c.68A > G), p.Thr353Arg (c.1058_1059delinsGG), and an exon 7 deletion. This study presents the largest single-center cohort of FBS patients, expanding our understanding of the disorder's phenotypic and genotypic spectrum. Despite FBS generally carrying a favorable prognosis, timely diagnosis remains crucial to prevent severe complications.

The state of malaria in a rural-mission hospital in Nkhoma, Malawi

Introduction: In recent times, malaria has fallen out of the limelight due to an economical migration of populations into medium and higher income settings. Despite this, it remains endemic in 31 countries with 228 million cases per annum. In Malawi, the WHO have reported that all of its citizens are at risk of contracting the disease. In this study we hope to expand on the clinical data available at a rural mission hospital in Malawi, as well as highlight some of the external global health factors in such environments. Methods: An observational retrospective cohort study looking at severe malaria admission in a paediatric population was conducted. The Nkhoma hospital Paediatric department was the centre of the data collection which focused on the diagnosis of severe malaria, as well as the signs and symptoms and treatment regimens of same. Results: Severe malaria accounted for over 40% of all paediatric admissions in the month of May 2019. Patients suffered from anaemia (80%) and cerebral malaria (41%), as well as a host of generalised symptoms such as fever (95%), vomiting (36%), malaise (30%), and diarrhoea (21%). Promisingly, a strict and comprehensive treatment regime for severe malaria was in practice with artesunate, Lumefantrine used in ~100% of cases. Conclusion: Sadly, malaria continues to create horrendous amounts of morbidity and mortality, but our united commitment to eradicating malaria is stronger than ever.

Improving Safety through a Virtual Learning Collaborative.

Frontline healthcare safety leaders require expertise and confidence to manage local safety programs effectively yet are confronted with substantial challenges in identifying risk and reducing harm. We convened a multidisciplinary safety learning collaborative in a children's hospital pediatric department and used the Institute for Healthcare Improvement's Breakthrough Series model. Participants attended four virtual education sessions over 13 months (September 2020-September 2021) focused on identifying harm and using tools to improve safety. We analyzed departmental safety data monthly throughout the collaborative. The primary outcome was the development of improvement projects using direct application of the session content. The secondary outcome was participant confidence in improving safety via pre- and postsurveys. Seventy clinicians and quality consultants participated. Fifteen divisional safety improvement projects were initiated. The percentage of survey respondents who reported feeling "completely confident" in their ability to improve safety increased from 26% (n = 39) to 58% (n = 26) from September 2020 to September 2021 (P = 0.01) and maintained at 65% 1 year after the end of the collaborative. We observed a decrease in the mean rate of reported inpatient preventable and possibly preventable moderate/serious/catastrophic events per 1000 bedded days from 1.10 (baseline) to 0.71 (intervention period). Through a collaborative effort in a virtual learning environment, we facilitated the development of fifteen safety projects, increased leaders' confidence in improving safety, and saw improved inpatient safety. This approach, which involves healthcare professionals from various disciplines, may be effectively adapted to other settings.

PHYSICIAN HEALTH AND WELLNESS- ASSESSMENT OF A PEER SUPPORT PROGRAM IN A WESTERN CANADIAN TERTIARY HOSPITAL PEDIATRIC DEPARTMENT

Physicians experience high rates of burnout due to the job related demands and emotional stressors . As a result, physician health and wellness initiatives have been sought out to mitigate burn out, and work towards advocating for physician well-being. Peer support programs have been used, and found to be effective, in mitigating burn out by utilizing the innate tendency to respond and empathized with shared difficulty. Our study evaluated the effectiveness of peer support and the recommendations needed to implement such a program on a larger scale. 14 physicians from the Regina General Hospital Pediatric department were paired to have informal virtual meetings (during COVID-19) every two weeks for three months. Following the program, physicians were individually interviewed and participated in a short cross sectional survey to understand the experience and perception of the program. Results showed a perceived benefit and value towards the program with an interest in continuing in a more formal fashion. The small department and the inability to meet naturally in person (due to COVID-19) provided limitations. Future indications of the program include continuation, expansion, and advocacy for the program. While providing a more formal structure with administrative support for schedule integration.

IgA vasculitis in adults, pediatrics and non-vasculitic IgA nephropathy, retrospective analysis from 2 centers.

Renal involvement represents the major long-term morbidity associated with IgA vasculitis (IgAV). Our aim was to evaluate clinical characteristics and long-term renal outcomes of IgAV in pediatrics and adults comparing to IgA nephropathy (IgAN). Our retrospective study included children and adults with IgAV and IgAN patients, admitted in a 13-year period (2007-2019) to rheumatology clinics and in hospital pediatric and internal medicine departments. We compared frequencies of clinical manifestations, laboratory findings, treatments, long-term outcomes at 1 year follow-up, including all-cause mortality and dialysis until the end of follow-up time. A total of 60 adult IgAV, 60 pediatric IgAV and 45 IgAN patients were evaluated. Adult IgAV patients were significantly older than IgAN patients (53.1 ± 17.4 years vs 45.1 ± 15.7 years respectively, P = .02) and had significantly higher rates of cardiovascular comorbidities. The risk and time to dialysis were similar among IgAN and adult IgAV groups. Yet, overall mortality at long term follow up was higher in IgAV adult group compared to IgAN. No dialysis or renal transplantation were reported in pediatric IgAV patients. IgAV and IgAN adult patients were comparable regarding risk of end stage renal disease. Of note, high mortality rates were observed among adult IgAV group.

Routine immunization experience and practices during the COVID-19 pandemic of caregivers attending a tertiary hospital in Cape Town.

Immunizations are successful, cost-effective interventions for the control of infectious diseases and preventing mortality. Lockdown restrictions during the COVID-19 pandemic had adverse effects on child-health including access to immunizations. Our study aimed to document immunization status, describe caregiver experiences around accessing immunizations during the COVID-19 pandemic and identify any significant factors associated with immunization status. Caregivers, with children between the ages of 10 to 33 months, attending Tygerberg Hospital Paediatric Department were invited to complete an anonymous survey from 15th September-15th December 2022. Data was captured using a REDCap questionnaire and analysed using Stata Version 17. 171 caregivers completed the survey. Immunizations were up to date in 81%. Most (155, 88%) agreed it was important to immunize their child. A third of caregivers (55) felt it was unsafe to attend the clinic and 37% (62) agreed it was difficult to attend. Caregivers receiving a social grant (p = 0.023) or who felt safe attending clinic (p = 0.053) were more likely to be up to date with immunizations. Three-quarters (128, 78%) were aware of recommendations to continue immunization. These caregivers were more likely to think it was important to immunize on time (p = 0.003) and to receive family encouragement (p = 0.001). Caregivers were more likely to attend clinic if they felt it was important to vaccinate on time (p < 0.001) or felt safe attending clinic (p = 0.036). Immunization rates were higher than expected but below global targets. Although caregivers feel immunizations are important, unknowns still instilled fear of attending clinics. Social factors such as family support and social grants improve vaccine seeking behaviour.

Prevalence of pediatric sepsis in hospitalized children of Maiwand Teaching Hospital, Kabul, Afghanistan

BackgroundSepsis is a clinical syndrome associated with a systemic reaction to infection that is seen as a bacteremia with systemic symptoms. Sepsis is one of the most important problems in children and is associated with many deaths, so recognizing this disease and it’s causing factors and identifying the predisposing factors for it is of great importance. Globally, the prevalence and occurrences of sepsis and septic shock are increasing, while the incidence of deaths from them has decreased with the improvement of diagnostic and treatment facilities. According to a 2015 World Health Organization report, approximately 5.9 million children under 5 years old have lost their lives due to sepsis worldwide, the majority of which have occurred in developing countries.MethodsThis study was conducted in the pediatric department of Maiwand Teaching Hospital (MTH) in 2020 as a descriptive cross-sectional study. All children who were admitted to the pediatric department of Maiwand Teaching Hospital during 2020 were included in the research. Among them, the prevalence of sepsis in children with respect to age and sex was studied. The study included children over the age of 28 days who were admitted to the Maiwand Teaching Hospital pediatrics department in 2020. However, in this study, patients have been categorized into five categories according to age: less than two months, two months to one year, one to three years, three to five years old, and older than five years old.ResultsThis study was conducted in the pediatric department of Maiwand Teaching Hospital in 2020 as a descriptive cross-sectional study, and it was found that the prevalence of sepsis in children who were admitted to the pediatric department at this year was 50.5%, including the highest prevalence in males (65.75%) and at the age of two months to one year (37.9%). In this study, it was found that the prevalence of sepsis was higher (88.46%) among urban children than children who were living in villages (11.53%). In this study, the mortality rate was 2.44% for patients admitted to Maiwand Teaching Hospital.ConclusionsIn this study, it was found that the prevalence of sepsis was 50.5% in children admitted to the pediatrics department of Maiwand Teaching Hospital, of whom 67.75% were boys, 37.94% were aged two months to three years old, and it was more prevalent (88.46%) among children living in cities. The mortality rate was 2.44%.

Evaluation of Ain Shams University Hospitals Clinical Pathway for Pulmonary Artery Banding

Abstract Background Pulmonary artery banding (PAB) remains a useful surgical palliation for small neonates and early infants with excessive pulmonary blood flow who are unable or difficult to withstand an open heart surgery using cardiopulmonary bypass or in developing countries where the facilities not suitable for primary corrective surgery in those infants. Objectives In our current study we aimed to study clinical pathway of cases underwent PAB at ASU hospital pediatric cardiac surgery department with discussion of different causes of mortality and morbidity. Patients and Methods Study done by data collection retrospectively of 50 patients underwent pulmonary artery banding in the period from January 2018 to December 2019 who fulfilling the inclusion criteria with evaluation of different clinical pathways for the outcome mainly morbidities and mortality. Results We found that the major risk factors of mortality in cases underwent PAB in ASU hospitals includes patients diagnosed with TGA, low preoperative so2 ≤85, ventilation is high risk factor for mortality so it is recommended to extubate those patients on table or shortly after discharge to ICU as soon as possible, duration of intubation: the longer the duration of intubation, the higher the mortality, postoperative PG across band ≤45.that indicator for a loose band with still persistent pulmonary overflow, re-intubation, post operative morbidities are highly associated with mortality, 11 out of 12 mortality cases suffered from postoperative complications (91.7 % of mortality cases) that includes poor chest condition, stroke, postoperative convulsions and pulmonary hemorrhage. These morbidities result in prolonged intubation and prolonged ICU stay. Conclusion Pulmonary artery banding is palliative procedure done in infants with pulmonary artery overflow with unprotected pulmonary circulation in variable congenital cardiac diseases (VSD, single ventricle, TGA) as a primary stage for total repair when the infant gain weight and get older, the suitable age for banding is &amp;lt; 6 months.

The role of pediatric oncologist in prenatal diagnosis: A 10-year retrospective study at Assistance Publique Hôpitaux de Marseille (AP-HM)

Solid tumors or predisposition syndromes are increasingly suspected before birth. However optimal management and outcomes remain unclear. We have performed a ten-year retrospective study of oncologic indications of prenatal diagnosis in public hospitals in Marseille. Data were obtained from prenatal diagnosis center and hospital imaging databases and pediatric oncology department files. Fifty-one cases were identified, 40 with mass: adrenal 17, sacrococcygeal 9, cardiac 7, abdominal 4, ovarian 1, cervical 2; 8 with developmental abnormalities (omphalocele 4, macroglossia 4), 3 WITH familial predisposition syndromes (familial rhabdoid 2, Li-Fraumeni 1). Median detection time was 30 week. Termination of pregnancy was decided for 9 fetuses (4 cardiac lesions and suspected tuberous sclerosis, 2 sacrococcygeal tumors, 1 Beckwith–Wiedemann Syndrome, 2 SMARCB1 mutations. Preterm birth occurred in 8 cases. Eleven newborns (26,1%) required intensive care (8 for mechanical complications). Of of 17 adrenal mass ES, 4 disappeared before birth and 5 before one year. Seventeen newborns underwent surgery: 13 masses (teratoma 7, myelomeningocele 2, cystic nephroma 1, neuroblastoma 2), 4 omphaloceles, one biopsy. Surgery performed after one year for incomplete regression identified 1 neuroblastoma, 2 bronchogenic cysts and 2 nonmalignant masses. Three newborns received chemotherapy. Except one patient with BWS who died of obstructive apnea, all children are alive disease free with a median follow-up of 60 months [9–131 months]. Twelve have sequelae. Various solid tumors and cancer predisposition syndromes can be detected before birth. A multidisciplinary collaboration is strongly recommended for optimal management before and after birth.

Pediatric Outpatient, Urgent-care Emergency and Disaster Planning

Introduction:Children are frequently victims of disasters; however important gaps remain in pediatric disaster planning. This includes a lack of resources for pediatric preparedness planning for patients in outpatient/urgent-care facilities. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to improve NYC’s pediatric disaster preparedness and response.After creating planning resources in Pediatric Long-Term Care Facilities, Hospital Pediatric Departments, Pediatric and Neonatal Intensive Care Units, and Obstetric/Newborn Services within NYC hospitals, the NYCPDC partnered with leaders and experts from outpatient/urgent-care facilities caring for pediatric patients and created the Pediatric Outpatient Disaster Planning Committee (PODPC). PODPC’s goal was to create guidelines and templates for use in disaster planning for pediatric patients at outpatient/urgent-care facilities.Method:The PODPC includes physicians, nurses, administrators and emergency planning experts who have experience working with outpatient facilities. There were 21 committee members from eight organizations (the NYCPDC, DOHMH, Community Healthcare Association of NY State, NY State DOH, NYC Health and Hospitals, Maimonides Medical Center and Presbyterian/Columbia University Medical Center). The committee met six times over a four-month period and shared information to create disaster planning tools that meet the specific pediatric challenges in the outpatient setting.Results:Utilizing an iterative process including literature review, participant presentations, discussions review and improvement of working documents, the final guidelines and templates for surge and evacuation of pediatric patients in outpatient/urgent care facilities were created in 2018. Subsequently model plans were completed and implemented at five NYC Outpatient/Urgent-care facilities.Conclusion:An expert committee utilizing an iterative process successfully created disaster guidelines and templates for pediatric outpatient/urgent care facilities. They addressed the importance of matching the special needs of children to available space, staff and equipment needs and created model plans for site-specific use.

A Comprehensive Coalition-Based Regional Approach to Pediatric Disaster Planning

Introduction:Children, who comprise 25% of the US population, are frequently victims of disasters and have special needs during these events. To prepare NYC for a large-scale Pediatric Disaster, NYCPDC has worked with an increasing number of providers that initially included only a small number of hospitals and agencies. Through a cooperative team approach, stakeholders now include local public health, emergency management and emergency medical services, 28 hospitals, community-based providers, and the Medical Reserve Corps.Method:The NYCPDC utilized an inclusive iterative process model whereby a desired plan was achieved by stakeholders reviewing the literature and current practice through repeated discussion and consensus building. NYCPDC used this model in developing a comprehensive regional pediatric disaster plan.Results:The plan included disaster scene triage (adapted for pediatric use) to transport (with prioritization) to surge and evacuation. Additionally, site-specific plans utilizing guidelines and templates now include Pediatric Long-Term Care Facilities, Hospital Pediatric Departments including Pediatric and Neonatal Intensive Care Services and Outpatient/Urgent Care Centers. A force multiplier course in critical care for non-intensivists has been provided. An extensive Pediatric Exercise program has been used to develop, operationalize and revise plans based on lessons learned. This initially included pediatric tabletop, functional and full-scale exercises at individual hospitals leading to citywide exercises at 13 and subsequently all 28 hospitals caring for children.Conclusion:The NYCPDC has comprehensively planned for the special needs of children during disasters utilizing a pediatric coalition based regional approach that matches pediatric resources to needs to provide best outcomes.The NYCPDC has responded to real time events (H1N1, Haiti Earthquake, Superstorm Sandy, Ebola), and participated in local (NYC boroughs and executive leadership) and nationwide coalitions (including the National Pediatric Disaster Coalition). The NYCPDC has had the opportunity to present their Pediatric Disaster Planning and Response efforts at local, national and International conferences.

Predominance of Multidrug-Resistant Gram-Negative Bacteria on Contaminated Surfaces at a Tertiary Hospital in Tanzania: A Call to Strengthening Environmental Infection Prevention and Control Measures.

The spreading of multidrug resistance (MDR) strains in the hospital settings via contaminated surfaces have been increasingly reported where Gram-negative bacteria have been implicated in causing most nosocomial infections. This study aimed to determine the rate of contamination with multi-resistant gram-negative bacteria in the hospital environment. A cross-sectional study was conducted at Muhimbili National Hospital paediatric department, between July and August 2020. Non-repetitive surface swab samples were collected from predefined surfaces and medical device surfaces, and cultured on MacConkey agar with and without antibiotics. Isolates were identified using biochemical test and tested for antibiotic susceptibility using the Kirby-Bauer disk diffusion method. The rate of hospital contamination with Gram-negative bacteria across the Pediatrics units was 30%, with a high rate observed in oncology units (34.8%) and the malnutrition/diarrhoea ward (32.1%). Sink/washing basin had the highest frequency of bacterial contamination (74.2%). We observed a high rate of ESBL (32.5%), with Acinetobacter baumannii, Klebsiella pneumoniae, and E. coli being the predominant ESBL-producing Gram-negative bacteria, while carbapenemase-producing Gram-negative bacteria was detected at 22.8%. Highest resistance rates (63-100%) were observed against ceftriaxone and trimethoprim-sulfamethoxazole. Up to 51% of the Gram-negative bacteria showed resistant to meropenem. MDR strains were detected in 61.4% of Gram-negative bacteria isolated. In conclusion, we observed a high rate of MDR bacteria contaminating hospital surfaces. The higher rate of MDR calls for a need to strengthen infectious prevention control measures, including cleaning practices in the hospital environment, to reduce the risk of transmission of resistant strains to patients and healthcare workers.

Application of a forecasting model to mitigate the consequences of unexpected RSV surge: Experience from the post-COVID-19 2021/22 winter season in a major metropolitan centre, Lyon, France.

The emergence of COVID-19 triggered the massive implementation of non-pharmaceutical interventions (NPI) which impacted the circulation of respiratory syncytial virus (RSV) during the 2020/2021 season. A time-series susceptible-infected-recovered (TSIR) model was used early September 2021 to forecast the implications of this disruption on the future 2021/2022 RSV epidemic in Lyon urban population. When compared to observed hospital-confirmed cases, the model successfully captured the early start, peak timing, and end of the 2021/2022 RSV epidemic. These simulations, added to other streams of surveillance data, shared and discussed among the local field experts were of great value to mitigate the consequences of this atypical RSV outbreak on our hospital paediatric department. TSIR model, fitted to local hospital data covering large urban areas, can produce plausible post-COVID-19 RSV simulations. Collaborations between modellers and hospital management (who are both model users and data providers) should be encouraged in order to validate the use of dynamical models to timely allocate hospital resources to the future RSV epidemics.

Descriptive Analysis of Rheumatic Heart Disease Related Complications in Pediatric Patients at Tertiary Hospital, Addis Ababa, Ethiopia.

Rheumatic heart disease continues to be a public health problem worldwide. In developing countries such as Ethiopia where rheumatic heart disease is endemic, most of the patients present with complaints related to complications including heart failure, arrhythmias, pulmonary hypertension, stroke, systemic embolic events and infective endocarditis. To identify the types and magnitude of complications in pediatric patients with rheumatic heart disease. Hospital-based cross-sectional study was conducted at Saint Paul Hospital Millennium Medical College, pediatric and child health department. All pediatric cardiac patients with rheumatic heart disease seen from January 1, 2018 to December 30, 2021 were included in the study. The majority of patients presented to our health facility with complications which implies the need for action at the community level to detect the disease at early stage. We recommend a similar large-scale study to be conducted at the national level and introduce a national RHD registry to better understand the magnitude of the problem, based on which necessary action will be undertaken. There is also a need to assess the proper implementation of screening and preventive RHD programmes.

Neuroblastoma-related severe hypoperfusion in the cerebellum of an infant: A case of opsoclonus-myoclonus syndrome.

A 2-year-old girl started to wobble without any specific triggers, so the patient was admitted to our hospital's pediatric department. The entire cerebellum showed severe atrophy on MRI and much lower uptake than that in the cerebral cortex on perfusion SPECT. The diagnosis of opsoclonus-myoclonus syndrome (OMS) was suspected. MRI visualized a small mass behind the inferior vena cava. Although its uptake on I-123 MIBG scintigraphy was inconclusive, the mass was surgically removed, and the diagnosis of neuroblastoma was pathologically confirmed. OMS is one of the paraneoplastic neurological syndromes with cerebellar ataxia, myoclonus of the trunk and extremities, and opsoclonus as its main symptoms. Approximately 50% of children cases with OMS are associated with neuroblastoma. The prognosis for neuroblastoma itself with OMS is relatively good, but the neurological prognosis is very poor. If there is decreased blood flow in the cerebellum of an infant, it may be necessary to search for neuroblastoma.

К 50-летнему юбилею кафедры госпитальной педиатрии Самарского государственного медицинского университета

The article is dedicated to the 50th anniversary of the Hospital Pediatrics Department. The main events in the history of the Department since its foundation in 1973 and the achievements of its members are presented.

Current childhood chronic myeloid leukemia management under tyrosine kinase inhibitor treatment.

Chronic myeloid leukemia (CML) is very rare during childhood. Tyrosine kinase inhibitors (TKI) provide very good results in terms of survival. The medical records of 15 chronic phase (CP)-CML patients in a university hospital pediatric hematology department between 1997 and 2022 were reviewed retrospectively. Complete hematological response was documented in all patients between 20 and 68 (median 30) days of treatment. Major molecular response was achieved in seven patients within 6months. Median follow-up for the study group was 79 (range 3-330) months and overall survival was 100%. Three patients (2 blastic transformation, 1 therapy resistant) underwent bone marrow transplantation (BMT) and one with blastic transformation is scheduled to undergo BMT. TKI were discontinued in three patients after a median of 86 (range 73-177) months. The complete molecular remission maintenance period before discontinuation of TKI was 81 (range 62-122) months. While no molecular relapse was seen before the last follow-up, the median overall follow-up period was 152 (range 131-300) months. In conclusion, recent advances have led to a very good prognosis for children with CP-CML. With TKI treatment, most patients continue their lives without disease progression. Additionally, in selected patients TKI can be discontinued without molecular relapse.

Skin temperature response to thermal stimulus in patients with hyperhidrosis: A comparative study

Primary hyperhidrosis (HH), the excessive sweating exceeding physiological demand, has been associated to a complex dysfunction of the autonomic nervous system which may explain the disfunction in sweating but may also cause unrevealed alterations in skin blood flow regulation. In fact, HH patients present a sympathetic over-function with less reflex bradycardia in response to the Valsalva maneuver and higher sympathetic skin responses. We aimed to identify response patterns to room thermal stimulus in HH patients compared to a control group in order to investigate putative differences in blood flow assuming that skin temperature in glabrous (non-hairy) areas reflect the sympathetic tone in arteriovenous anastomoses (AVAs). Infrared thermography images were obtained from a cohort of patients diagnosed with HH, followed at a hospital pediatric surgical department and to a sex- and age-matched control group of patients admitted for other surgical procedures. With the participants in Fowler's position, a set of 3 images were captured simultaneously and 44 regions of interest were analyzed, distributed on the palms of the hands, soles of the feet, axilla, and inner canthus. After an acclimatization period at 20 °C, the room temperature was increased to 24, 28 and 32 °C to obtain similar sets of thermograms. A total of 37 patients with HH and 16 participants in the control group were included in the study. At baseline (20 °C), body core temperature (measured in the inner canthus) was significantly higher in the HH patients compared to the controls (p = 0.019 and p = 0.003 in right and left inner canthi, respectively), without any significant differences in the other thermograms. When room temperature was increased, differences in core temperature disappeared, while differences appeared in axilla and palms of the hands with HH patients presenting significantly lower temperature at the three thermal stimulus stages. Patients with HH presented a lower thermoregulatory response when submitted to room temperature increase, which may reflect a vasomotor sympathetic over-function in AVAs.

Current Epidemiological Data on Community Acquired Pneumonia in Children After Improvements in the Health System and Socioeconomic Changes in Turkiye

In this study, it was investigated that current epidemiological situation and risk factors of community-acquired pneumonia (CAP) in pediatric patients in Türkiye, after socioeconomic changes and health system improvements in the past two decades. In total 1,488 children treated with a diagnosis of pneumonia in Gulhane Training and Research Hospital (Ankara) Pediatrics Department between 2016 to 2021 were included in the present study. The patients’ demographic data, personal and family histories, and socioeconomic status were recorded. Of the 1,488 pediatric patients (mean age; 43.20±41.04 months and 46.8% girls); 108 were aged 0-6 months (7.3%), 672 were aged &gt;6-24 months (45.2%), 444 were aged &gt;24-60 months (29.8%), and 264 were aged &gt;60 months (17.7%). In total, 98.4% of patients underwent routine vaccination and the rate of seasonal influenza vaccination was 5.6%. Additionally, 444 patients (29.8%) had chronic disease; asthma and cerebral palsy were the most common chronic diseases, 276 and 84 patients respectively. A family history of asthma in first-degree relatives was present in 396 patients (26.6%). There have been substantial changes in the epidemiology of CAP in Türkiye, due to socioeconomic changes, increasing urbanization, and health system improvements and the current effects of these changes are presented in our study with comprehensive data that can be used in further comparative studies.

Early childhood caries sequelae and relapse rates in an Australian public dental hospital.

Early childhood caries (ECC) remains one of the most prevalent childhood diseases in Australia, disproportionately affecting disadvantaged populations. To investigate the ECC experience including risk factors, incidence of caries, pain and infection as well as relapse rates of caries and secondary dental general anaesthesia (GA). A retrospective cohort study included dental records of children with ECC, aged <72 months at an Australian public dental hospital paediatric dentistry department from 2013 to 2015 (n= 102). Dental caries, pain, infection, referral patterns, demographic and caries risk factor data were recorded for 24 months. Descriptive statistics were used for patient characteristics and clinical data, and Kaplan-Meier curves and parametric exponential survival models for time-to-event series. The study population demonstrated higher-than-national average dmft and disease progression at baseline. Major risk factors for the development of caries, pain and infection were daily consumption of sweetened beverages, poor oral hygiene, residing in lower socio-economic areas, older age and being male. Rates of caries relapse and new referral for secondary treatment under general anaesthesia were relatively high. A high degree of ECC progression and recurrence in this population indicates a need for a more comprehensive approach to ECC addressing multilevel root causes and systemic risk factors.