Importance In Pediatrics Research Articles

10 years of CARE guidelines in publishing case reports in paediatrics

Case reports, as an article type in the biomedical field, hold particular importance in paediatrics because it is the optimal way to present new or rare diseases or overlapping syndromes that are usually hard to diagnose clinically (Nissen et al, 2014). The CARE (CAse REport) guidelines are a tool that helps standardise reporting in case reports.Those guidelines were published in 2013 (Gagnier et al., 2013) with the purpose of supporting an increase in the accuracy, transparency, and usefulness of case reports. Given the stated, the aim of this presentation is to examine the actual use of the CARE guidelines in the paediatrics field journals.Using Pubmed and Web of Science databases, journals in the category of Clinical Medicine - Paediatrics were searched and their instructions for authors and selected published case reports were examined. Based on inclusion criteria journals that publish case reports were included in the study and screened for the CARE guidelines using the CARE checklist.A total of 184 journals met the criteria, 130 journals (71%) were in the SCIE (Science Citation Index Expanded) category, while 54 journals (29%) were in the ESCI (the Emerging Sources Citation Index) paediatrics category. Most of the journals, 160 (87.5%) publish case reports, among them 44 journals (27.5%) mention the CARE guidelines in the instructions for authors. There were altogether 10,617 case reports published in 184 journals, of which 3527 in open access.Of the 44 journals that mention CARE guidelines, 27 journals (61%) are in the SCIE database category and 17 (39%) in the ESCI. There is a significant difference regarding the quartiles of SCIE journals that use CARE guidelines (p=0,041), the higher the quartile, the more journals that use the CARE guidelines (Q1=10; Q2=9; Q3=5; Q4=3).For the purpose of the oral presentation, authors will examine 10% of the available free full text case reports (except for the journals that have more than 100 case reports where 10 cases will be examined) and the expected sample size is 144. Two authors will check the compliance of randomly selected case reports with the CARE guidelines using the CARE checklist. As with every study, this one has certain limitations, as it is limited to the field of paediatrics and not all case reports can be examined as they are not available.

Moving toward standardization: physician reporting of sleep studies.

Lastra AC, Ingram D, Park J, etal. Moving toward standardization: physician reporting of sleep studies. J Clin Sleep Med. 2023;19(3):595-603.

Time de acesso vascular e terapia infusional: satisfação da equipe de saúde em hospital pediátrico

Objetivos: Conhecer a satisfação e qualidade do serviço sobre time de acesso vascular e terapia infusional (TAVTI) e identificar a importância do TAVTI para a equipe de saúde. Metodo: Trata-se de uma pesquisa de campo exploratória, descritiva, com abordagem quantitativa e qualitativa. Aplicamos formulários para 149 profissionais. Resultados: Dos participantes, 46,97%(n:70) refere total satisfação frente ao TAVTI; a minoria 0,67%(n:1) demonstra insatisfação total; a maioria considera o serviço muito importante 71,14%(n:106) e excelente atuação para 44,96%(n:67). Apenas 1,34%(2) dos profissionais considerou a qualidade do trabalho regular. Dos participantes, 126 declararam: serviço humanizado; seguro para o paciente; necessita de capacitação e treinamento; material seguro; perí­odo integral. Conclusão: A atuação do TAVTI demonstra ser efetiva. Constatou-se a satisfação da equipe de saúde e a importância na pediatria devido í preservação do acesso venoso e o desejo dos profissionais em manter o TAVTI perí­odo integral. Frente ao percentual de qualidade considerado, excelente e ótimo.

Leukocyte-Related Disorders: A Review for the Pediatrician.

Leukocytes, or white blood cells, are part of the innate immune system that defends against infectious and foreign agents. In pediatrics, it is important to use age-specific laboratory values when interpreting results. Infections are the most common cause of leukocytosis or leukopenia in children. Symptoms suggestive of more serious etiologies include persistent fevers, weight loss, bruising, fatigue, and adenopathy. Neutropenia is of special importance in pediatrics due to associations of severe neutropenia with genetic syndromes and overlapping presentations with primary immunodeficiencies. Although the discovery of novel genetic mutations has aided the hematologist/oncologist and the immunologist in managing these conditions, the relationship between clinical phenotype and mutation is still not well known. [Pediatr Ann. 2020;49(1):e17-e26.].

Automated human-level diagnosis of dysgraphia using a consumer tablet

The academic and behavioral progress of children is associated with the timely development of reading and writing skills. Dysgraphia, characterized as a handwriting learning disability, is usually associated with dyslexia, developmental coordination disorder (dyspraxia), or attention deficit disorder, which are all neuro-developmental disorders. Dysgraphia can seriously impair children in their everyday life and require therapeutic care. Early detection of handwriting difficulties is, therefore, of great importance in pediatrics. Since the beginning of the 20th century, numerous handwriting scales have been developed to assess the quality of handwriting. However, these tests usually involve an expert investigating visually sentences written by a subject on paper, and, therefore, they are subjective, expensive, and scale poorly. Moreover, they ignore potentially important characteristics of motor control such as writing dynamics, pen pressure, or pen tilt. However, with the increasing availability of digital tablets, features to measure these ignored characteristics are now potentially available at scale and very low cost. In this work, we developed a diagnostic tool requiring only a commodity tablet. To this end, we modeled data of 298 children, including 56 with dysgraphia. Children performed the BHK test on a digital tablet covered with a sheet of paper. We extracted 53 handwriting features describing various aspects of handwriting, and used the Random Forest classifier to diagnose dysgraphia. Our method achieved 96.6% sensibility and 99.2% specificity. Given the intra-rater and inter-rater levels of agreement in the BHK test, our technique has comparable accuracy for experts and can be deployed directly as a diagnostics tool.

Cystic Kidney Diseases From the Adult Nephrologist's Point of View.

Cystic kidney diseases affect patients of all age groups with the onset spanning from prenatal disease to late adulthood. Autosomal-dominant polycystic kidney disease (ADPKD) is by far the most common renal cystic disease. However, there are various cystic kidney diseases, the onset of which occurs at different times in life and depends on the type of the disease and the causative genes involved. When genetic kidney diseases are discussed in the adult setting this view is usually limited on autosomal-dominant kidney disease, the most frequent genetic disorder causing adult onset ESRD. Other diseases—such as autosomal-recessive polycystic kidney disease—are often being viewed as a disorder only important in pediatric nephrology. However, more recent data has revealed that, despite clear age peaks of onset for each disorder, all of them can also show highly variable phenotypes with classical adult onset genetic diseases being of importance in pediatrics and vice versa. Furthermore, the affected children need to be seen by adult nephrologists in the long term after transition, requiring knowledge on the underlying pediatric disease, potential extrarenal manifestations, and genetic counseling. Consequently, the view on these diseases should be widened on both ends. Close interaction between pediatric and adult nephrology is key to appropriate care of patients suffering from genetic kidney disease to profit from each other’s experience.

Pediatric Invasive Aspergillosis.

Invasive aspergillosis (IA) is a disease of increasing importance in pediatrics due to growth of the immunocompromised populations at risk and improvements in long-term survival for many of these groups. While general principles of diagnosis and therapy apply similarly across the age spectrum, there are unique considerations for clinicians who care for children and adolescents with IA. This review will highlight important differences in the epidemiology, clinical manifestations, diagnosis, and therapy of pediatric IA.

The gut microbiota and potential importance in paediatrics

Gut microbiota are commensals seen in the gastrointestinal system having both pathogenic and non-pathogenic effects. Some microbiota that are available commercially have benefits in acute gastroenteritis, necrotising enterocolitis in low birth weight babies and in certain types of allergies. The use of probiotics is debatable in clinical use and it is not recommended in seriously ill immunodeficient children. The duration of the use of probiotics and type of organisms that are commercially available to be used in different disease conditions also have varied recommendations.

Evaluation of pain in the pediatric patient by nurse in the hospital

To understand the way pain is produced and perceived is very important for its relief. In recent years, important advances have been made regarding the evaluation of pain, with the validation of objective criteria such as Oucher pain scales, body diagrams, numerical scales, verbal descriptive scales and visual analogue scales. The objective evaluation of pain is of special importance in pediatrics given the difficulties inherent to the patients of this group. The purpose of this study was to determine how nursing professionals evaluate pain in hospitalized children. We employed a questionnaire to nursing professionals (nurse technicians, practical nurses and registered nurses) that work in the pediatric service of a teaching hospital. Fifty-six professionals (100% women) answered the questionnaire. Of these, 55 (98.2%) stated that they knew the methods and cited vital signals, physical examination and patient behaviors as items for evaluation. Although the majority of professionals (98.2%) have reported knowledge of objective methods (scales) for pain assessment in children, there was a predominance of behavioral observation as a method of choice (prevalence ratio 2.27; 95% confidence interval: 0.9 to 2.38). No significant associations or differences were observed between professional category, time of experience, other variables, and the type of method employed. The selected professionals do not use scales or other objective methods to measure pain in children. Therefore, it is necessary to habilitate and train nursing professionals working with pediatric patients in pain so that they will be able to assess their pain in an adequate manner.

Contrast enhanced ultrasound in pediatric patients: a real challenge.

Ultrasound (US) imaging in the paediatric population has been a routine technique for decades, in part because of the advantages it offers over other imaging modalities. Off-label use (and its funding) is of the utmost importance in paediatrics because many drugs have not been evaluated in randomised trials in children. As a consequence such drugs are not specifically approved for use in children. This is also true for the contrast agents used in CEUS. The off-label use of CEUS in paediatric patients illustrates the need to deal with unresolved legal issues while at the same time balancing this with the need for high diagnostic performance in daily clinical routine. In addition to approved indications with a focus on the liver and Doppler enhancement, CEUS is safe and effective for the examination of many organs, as recently highlighted by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). This article provides a summary of the available literature describing the utility of CEUS in paediatric patients. Furthermore, we suggest the establishment of a registry to collect data on safety and applications of ultrasound contrast agents in children. A paediatric registry has recently been introduced by EFSUMB (www.efsumb.org).

Editorial Commentary: Healthcare-Associated Infections: One Size Does Not Fit All.

(See the Original Articles by McCullers et al, on pages 26–34, and Adler et al, on pages 35–43.) Healthcare-associated infections (HAI) have emerged as one of the most pressing problems in patient safety [1]. Our intuition and many studies demonstrate the negative impact HAI exert on patient outcomes, healthcare costs, and public perceptions of the quality and safety of healthcare. To date, adult HAI have received the greatest scrutiny. The majority of epidemiologic studies that define the burden of, risk factors for, and outcomes associated with HAI are primarily based upon adult patients. Because hospitalized children differ from hospitalized adults in the prevalence and array of underlying comorbid conditions, exposure to medical devices, and carriage of resistant organisms [2, 3], we must have pediatric-specific data on the epidemiology of HAI in children. Prevention of HAI in children is no less important than the prevention of HAI in adults [4]. In fact, when one examines the potential impact of HAI upon quality-adjusted life years, a pediatric patient might reasonably be considered to bear a greater risk than an adult patient. To date, most consensusand evidencebased guidelines for the prevention of specific HAI have been adult focused. Efforts to infuse pediatric knowledge into these guidelines have been hampered by the paucity of high-quality studies that evaluate the impact of HAI preventive interventions in pediatric populations and the limited representation of pediatric clinicians on writing groups. Additional factors, including limited availability of devices in pediatric sizes (such as antiseptic-coated catheters), absence of safety data in young populations (such as for chlorhexidine gluconate preparations), and developmental issues have also impeded the evaluation and adoption of many HAI prevention practices in pediatrics [5]. In this issue of the Journal of the Pediatric Infectious Diseases Society, 2 articles shed light on HAIs in high-risk subpopulations of children: those being treated for cancer and those undergoing cardiothoracic surgical procedures [6, 7]. McCullers and colleagues have provided us with an unprecedented portrayal of the HAI experienced by children hospitalized for cancer care over 21⁄2 decades [6]. These data provide us a deeper understanding of the microbiology and types of HAI encountered on pediatric oncology services, demonstrating the distinct epidemiology of HAI in this pediatric patient population. For example, 82 of the HAI identified were caused by common community-associated viral pathogens, such as rotavirus and respiratory syncytial virus, suggesting the unique reservoir of potential pathogens associated with the young families that typically visit hospitalized children. In addition, McCullers et al found that the incidence of HAI in children with severe neutropenia (absolute neutrophil count [ANC] nadir <100 per mm) was 2.5 times higher than in those with lesser degrees of neutropenia (ANC nadir 100–499 per mm). Nearly 60% of all HAIs occurred in children with severe neutropenia. While the finding is not surprising, it may be of particular importance in pediatrics, where children suffer disproportionately from cancers that require intensive cytoablative chemotherapy, which causes severe neutropenia. Finally, McCullers et al demonstrate that the incidence of HAI in their patients has decreased substantially to a level similar to that of other hospitalized patients. As reflected by the list in Table 1 of their article, many interventions likely contributed to this reduction [6]. While it is impossible to determine the role of individual interventions, it would have be informative to better understand the relative impact of Editorial Commentary

Nutritional considerations in pediatric inflammatory bowel disease

Nutrition is a critical part of the management of inflammatory bowel disease (IBD) in children and adults. Malnutrition and micronutrient deficiencies are common at the time of diagnosis and may persist throughout the course of the disease. There are a number of similarities with regards to the nutritional complications and the approach to nutritional management in IBD in both children and adults, but there are also important differences. Growth failure, pubertal delay and the need for corticosteroid-sparing regimens are of higher importance in pediatrics. In the pediatric population, exclusive enteral nutrition may be equivalent to corticosteroids in inducing remission in acute Crohn’s disease, and may have benefits over corticosteroids in children. Adherence with exclusive enteral nutrition is better in children than in adults. Iron deficiency anemia is an important problem for adults and children with IBD. Intravenous iron administration may be superior to oral iron supplementation. Ensuring adequate bone health is another critical component of nutritional management in IBD, but guidelines for screening and therapeutic interventions for low bone mineral density are lacking in children.

Family-oriented and family-centered care in pediatrics.

BackgroundTo humanize the management of children in hospitals has become a serious concern of civil society and one of the main goals of public and private health centers, health care providers and governments.DiscussionThe concepts of family-centered and family-oriented care are discussed with the aim to emphasize their importance in pediatrics. Notions related to family-centered care, such as cultural diversity and cultural competence, are also discussed given the importance they have gained following the recent transformations of socioeconomic, demographic and ethnic characteristics of economically advantaged Countries. Family-centered care has developed as a result of the increased awareness of the importance of meeting the psychosocial and developmental needs of children and of the role of families in promoting the health and well-being of their children. Family-oriented care aims at extending the responsibilities of the pediatrician to include screening, assessment, and referral of parents for physical, emotional, social problems or health risk behaviors that can adversely affect the health and emotional or social well-being of their child.SummaryFamily-centered and family-oriented care concepts should be incorporated into all aspects of pediatricians' professional practice, whether it is private practice or in public hospitals, to better serve the needs of ill children.

Streptococcus pneumoniae penicillin-nonsusceptible strains in invasive infections in Sao Paulo, Brazil.

Streptococcus pneumoniae penicillin-nonsusceptible strains in invasive infections in Sao Paulo, Brazil.

Selected Eye Defects of Special Importance in Pediatrics

This article reviews six defects of special importance in the care of children: aniridia, ectopia lentis, cataracts, glaucoma, colobomata, and optic nerve hypoplasia. In addition to causing potentially serious impairment of vision, these ocular disorders may be associated with significant systemic disease and genetic abnormalities.

Reproducibility of histamine challenge tests in asthmatic children.

The measurement of bronchial reactivity by histamine challenge testing is of increasing clinical importance in paediatrics. By means of a simple tidal breathing technique for the measurement of histamine sensitivity (expressed as PC20--the concentration of histamine which produces a 20% fall in peak flow rate) in childhood asthma, the reproducibility of pairs of tests was estimated over one hour and 24-hour intervals in 22 children. Under carefully controlled conditions the 95% confidence limits of PC20 were 0.8-1.25 X baseline PC20 after one hour and 0.36-2.8 X baseline PC20 after 24 hours.

Basic and Clinical Aspects of the Alpha1-Antitrypsin

A deficiency of the major serum alpha1-globulin, the alpha1-antitrypsin, was first described in five patients by Laurell and Eriksson in Sweden in 1963. It soon became obvious that severe alpha1-antitrypsin deficiency was familial, and highly associated with chronic lung disease, having its onset in the third or fourth decade of life. Since the early descriptions of this common deficiency state, it has become clearly associated with familial emphysema in some families, familial infantile cirrhosis in others, and occasionally with a combination of childhood lung and liver disease in siblings. For the pediatrician, severe alpha1-antitrypsin deficiency now enters into the differential diagnosis of both chronic pulmonary disease in childhood and obstructive jaundice in the newborn period; In addition, low levels of alpha1-antitrypsin in serum are characteristic of respiratory distress syndrome, and elevations of this protein may be found in a variety of clinical situations. The, alpha1-antitrypsin probably functions as a major control protein against the tissue-damaging effects of both endogenous and exogenous enzymes. This review will cover several basic and clinical features of this protein with respect to its importance in pediatrics.

Studies of the molecular basis of congenital malformations

With recent advances in treatment of many acute and chronic diseases, the problems associated with congenital malformations in children have assumed a greater importance in pediatrics. Previous to the work of Warkany and Nelson in 19401, it was recognized that many congenital defects were genetically determined and hereditary. The finding by Warkany and co-workers1-3 that modification of the prenatal environment by severe states of riboflavin deficiency produced congenital malformations in mammals demonstrated clearly the importance of the prenatal environment in the development of the fetus and gave impetus to searches for other environmental factors of importance to the developing organism. The syndrome resulting from severe maternal riboflavin deficiency in rats is characterized mainly by micrognathia and reduction type of defects in the distal extremities of the fetuses, and by a wide number of other anomalies such as cleft palate and hydronephrosis. More recently, Nelson and co-workers4 demonstrated that galactoflavin, a synthetic analog of riboflavin, produced a rapid riboflavin deficiency syndrome in pregnant rats. The addition of galactoflavin to a riboflavin-deficient diet materially shortened the time required to produce riboflavin deficiency, and permitted much better regulation of the experimental model. In other studies of riboflavin deficiency, Miller and co-workers5 showed a lower flavin content in fetuses from riboflavindeficient rats than in control fetuses, suggesting the possibility that there may be corresponding deficiencies in the activities of flavin-dependent enzymes such as the terminal electron transport systems (ETP). Other investigators6 have reported studies of enzymatic activities in liver mitochondria of adult rats fed a riboflavin-deficient diet with added galactoflavin, but with varying results.

STUDIES OF THE MOLECULAR BASIS OF CONGENITAL MALFORMATIONS

With recent advances in treatment of many acute and chronic diseases, the problems associated with congenital malformations in children have assumed a greater importance in pediatrics. Previous to the work of Warkany and Nelson in 19401, it was recognized that many congenital defects were genetically determined and hereditary. The finding by Warkany and co-workers1-3 that modification of the prenatal environment by severe states of riboflavin deficiency produced congenital malformations in mammals demonstrated clearly the importance of the prenatal environment in the development of the fetus and gave impetus to searches for other environmental factors of importance to the developing organism. The syndrome resulting from severe maternal riboflavin deficiency in rats is characterized mainly by micrognathia and reduction type of defects in the distal extremities of the fetuses, and by a wide number of other anomalies such as cleft palate and hydronephrosis. More recently, Nelson and co-workers4 demonstrated that galactoflavin, a synthetic analog of riboflavin, produced a rapid riboflavin deficiency syndrome in pregnant rats. The addition of galactoflavin to a riboflavin-deficient diet materially shortened the time required to produce riboflavin deficiency, and permitted much better regulation of the experimental model. In other studies of riboflavin deficiency, Miller and co-workers5 showed a lower flavin content in fetuses from riboflavindeficient rats than in control fetuses, suggesting the possibility that there may be corresponding deficiencies in the activities of flavin-dependent enzymes such as the terminal electron transport systems (ETP). Other investigators6 have reported studies of enzymatic activities in liver mitochondria of adult rats fed a riboflavin-deficient diet with added galactoflavin, but with varying results.

A new ceruminolytic for use in pediatric ear examinations.

Some degree of involvement of the middle ear is present in practically all upper respiratory infections of infants and small children. 1 It therefore becomes evident that an adequate examination of the tympanic membrane and ear canal is of primary importance in pediatrics. Statistical studies have shown that over 30% of ears in which disease is present may have the tympanic membrane totally obscured by wax. 2 The removal of ear wax in a sick child who is suffering not unusually from a fair degree of pain is a difficult problem. Removal of wax with a blunt curette is safe only if the child is cooperative, which is rarely the case. Irrigation with warm water is a lengthy and inconvenient procedure, which must be done with great caution in young children since only a little pressure may be enough to rupture an inflamed tympanic membrane. Also, in this procedure, cooperation