Children Mean Age Research Articles

Epidemiology and Sensitivity Profile of Blood Culture Isolates at The Pediatric University Hospital of Bangui

Background: Bacteremia are serious and dreaded diseases, due to their high associated mortality, for which blood culture is the key examination for establishing the diagnosis. Little is known about the epidemiology of sepsis in the Central African Republic (CAR). Objective: To determine the epidemiology and antibiotic susceptibility profile of bacteria isolated from blood cultures in the CHUPB, in order to optimize the probabilistic antibiotic therapy used in first line. Methodology: This was a cross-sectional study conducted at the University Hospital of Bangui (CHUPB) over a period of 12 months (January 1 to December 31, 2021), covering all bacteria isolated from blood cultures taken from children hospitalized in intensive care and neonatal intensive care units. The data were analyzed with the STATA version 14 software. The Chisquare test and ANOVA test were used to compare proportions at the p<0.05 threshold. Results: Out of four hundred and fifty-five blood cultures performed during the 12 months, the positivity rate was 13.17% (n=56/425). The neonatal intensive care unit had a positivity rate of 75% (n=42) versus 25% (n=14) for the intensive care unit. The mean age of the blood culture positive children was 19 days (3 days to 15 years) and the sex ratio was 1.94. Among the 56 isolates, a high prevalence of gram-negative bacilli 98.21% (n=55) was noted. The most frequently isolated species were Klebsiella pneumoniae 75% (n=42) and Escherichia coli 19.64% (n=11). Staphylococcus aureus 1.78%(n=1) was the only Gram-positive cocci isolated. Enterobacteriaceae were multi-resistant to empirical antibiotics at CHUPB. Only Tigecycline and Amikacin were still more than 90% sensitive to Klebsiella pneumoniae. Escherichia coli had a sensitivity greater than 80% for Ertapenem, Imipenem and chloramphenicol. Conclusion: This study, which was the first at the CHUPB, underlined the importance of regular monitoring of blood culture isolates, while determining antibiotic sensitivities in order to better guide the probabilistic antibiotic therapy of bacteremia. Key words : Blood cultures - epidemiology - isolates - CHUPB.

Predicting Language in Children with ASD Using Spontaneous Language Samples and Standardized Measures.

This longitudinal study examined the degree to which standardized measures of language and natural language samples predicted later language usage in a heterogeneous sample of children with autism spectrum disorder (ASD), and how this relationship is impacted by ASD severity and interventions. Participants with a diagnosis of ASD (N = 54, 41 males) completed standardized assessments of language and social functioning; natural language samples were transcribed from play-based interactions. Findings indicated that standardized language measures, natural language measures, and ADOS severity were each unique predictors of later lexical use. Intervention types also appeared to impact later language; in particular, participation in mainstream inclusion accounted for significant amounts of variance in children's mean length of utterance at T3.

Prevalence, Types, and Outcomes of Cerebral Palsy at a Tertiary Center in Jeddah, Saudi Arabia.

Background: In developed countries, cerebral palsy (CP) is the most common neurological disorder in children. It is defined as a non-progressive disturbance to the developing brain leading to motor impairment that affects the child’s activity. CP is classified into three main subtypes: ataxic, spastic, and mixed. Objectives: This study aimed to estimate the prevalence of CP and its subtypes in a single tertiary center located in Jeddah, Saudi Arabia. Method: This retrospective record review study included 98 patients diagnosed with CP from 2004 to 2019. Data were extracted from the hospital medical record and assessed using various tools. Result: The total number of patients was 98, with an estimated CP prevalence of 1.6 per 1000 lives. Most of the patients (74.8%) had spastic CP subtype, and 54.8% had quadriplegia. The mean age of the live children was 7.45 ± 3.76 years. Moreover, gastrostomy was the most favorable feeding method. Conclusion: The prevalence of CP is almost equivalent to the national and worldwide figures. Spastic CP has the highest rates. Furthermore, the male gender has been identified as a significant risk factor for CP in the local community.

Ultrasound screening of kidney size in children with and without vesicoureteral reflux

"Evaluation of the size of the kidney's parameters of patients with vesicoureteral reflux (VUR) can provide relevant knowledge about the prognosis factors of VUR's complications. The study aimed to assess the size of the renal parameters of children with VUR and compare the results with healthy matched cases by the ultrasound method. Methods: In this case-control study, children under 14 years of age with VUR in our pediatric urology practice from May 2019 to May 2020 were included. Eighty children were included in the two groups (case (40 cases) and control group (40 cases)) in the study. The case group included children with VUR, while the control group included healthy children. The data regarding Urinary Tract Infection (UTI), the length and width of the kidney, the size of the pelvis, parenchyma thickness, and volume of the kidney were recorded. Results: The mean age of children was 3.07 ± 3.05 years, and 35.0% of them were male. The mean number of UTIs in the VUR group was 1.90 ± 1.15 and in the control group was 1.10±0.30 (P=0.031). The incidence of UTIs was significantly higher in the VUR group than in the control group (P<0.001). Length, width, the posterior-anterior diameter of kidney, renal parenchyma thickness, and renal volume in the VUR group were significantly lower than the control group (P< 0.001). There was no difference between case and control groups in terms of anterior-posterior diameter of the pelvis (P= 0.653). Conclusions: The results showed that the size of kidneys parameters in children with VUR was less than in the control group. Also, the incidence of UTIs in the VUR group was significantly higher than in the control group. Ultrasound is a safe and non-invasive tool that can use for checking the size of the children's kidneys with VUR for predict of possible complications "

Out Like a Light: Feasibility and Acceptability Study of an Audio-Based Sleep Aide for Improving Parent-Child Sleep Health.

Our study examines the acceptability and feasibility of Moshi, an audio-based mobile application, among children 3–8 years old using a parent–child dyadic approach. Our 10-day within-subject pre–post study design consisted of five nights of a normal bedtime routine and a subsequent five nights exposed to one story on the Moshi application during the intervention. Each five-night period spanned three weeknights and two weekend nights. The Short-Form Children’s Sleep Habits Questionnaire (SF-CSHQ) was used to measure children’s sleep at baseline and post-intervention. The PROMIS, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index were used to assess parents’ sleep. Among the 25 child–parent dyads, the mean child age was 4 (SD = 1.23) and 63% were male (n = 15). Mean parent age was 35 (SD = 5.83), 84% were female (n = 21), and 48.0% were Black (n = 12). For child-only comparisons, mean post-SF-CSHQ measures were lower compared to baseline. A trend in parent sleep is reported. This study shows the potential of an audio-based mobile sleep aid to improve sleep health in a racially diverse parent and child dyad sample.

Severity of Hospitalized Children with Anti-NMDAR Autoimmune Encephalitis.

Background: Information on the clinical characteristics and severity of autoimmune encephalitis with antibodies against the N-methyl-d-aspartate receptor (NMDAR) in children is attracting more and more attention in the field of pediatric research. Methods: In this retrospective cohort study, all cases (n = 67) were enrolled from a tertiary children's hospital, from 2017 to 2020. We compared severe cases that received intensive care unit (ICU) care with nonsevere cases that did not receive ICU care and used machine learning algorithm to predict the severity of children, as well as using immunologic and viral nucleic acid tests to identify possible pathogenic triggers. Results: Mean age of children was 8.29 (standard deviation 4.09) years, and 41 (61.19%) were girls. Eleven (16.42%) were admitted to the ICU, and 56 (83.58%) were admitted to neurology ward. Ten individual parameters were statistically significant differences between severe cases and nonsevere cases (P < .05), including headache, abnormal mental behavior or cognitive impairment, seizures, concomitant tumors, sputum/blood pathogens, blood globulin, blood urea nitrogen, blood immunoglobulin G, blood immunoglobulin M, and number of polynucleated cells in cerebrospinal fluid. Random forest regression model presented that the overall prediction power of severity reached 0.806, among which the number of polynucleated cells in cerebrospinal fluid contributed the most. Potential pathogenic causes exhibited that the proportion of mycoplasma was the highest, followed by Epstein-Barr virus. Conclusion: Our findings provided evidence for early identification of autoimmune encephalitis in children, especially in severe cases.

Fear of hypoglycemia and quality of life in young people with type 1 diabetes and their parents in the era of sensor glucose monitoring.

IntroductionIt is crucial to understand psychosocial outcomes in children and adolescents with type 1 diabetes (T1D) and their families to provide optimal family-centered care. Hence, the aim of this study was to explore psychosocial outcomes in young people with T1D and their parents using currently available glucose monitoring devices in a real-life clinic setting.MethodsChildren and adolescents aged 2-18 years with T1D for more than 6 months and their parents were recruited into a cross-sectional study to complete the Hypoglycemia Fear Survey (HFS) and the Pediatric Quality of Life Inventory (PedsQL) Generic Score Scales, Diabetes Module and Family Impact Module. Demographics and diabetes-specific parameters were obtained from medicals records.ResultsFifty-nine children and adolescents (mean age 15.1 ± 3.0 years) and 49 parents of children (mean age of children 12.5± 3.3 years) of which 44 were child-parent dyads completed the questionnaires. Parents had a higher mean (SD) FOH total and worry subscore than children, total score was 37.9 (14.6) vs. 32.2 (11.9), p = 0.047 and worry subscore was 17.8 (10.4) vs. 12.8 (9.0), p = 0.01. Furthermore, lower parental diabetes-specific QoL score was observed in parents, 78.8 (12.2) vs. 82.7 (10.3), p=0.02. No difference in FOH and QoL between real-time continuous glucose monitoring (rtCGM) and intermittently scanned glucose monitoring (isCGM) users and users of devices with and without alerts was observed. In isCGM users (n=36 completing the child questionnaires, n=33 completing parent questionnaires), higher parental FOH and lower parental diabetes-specific QoL correlated with higher scanning frequency, r = 0.399, p = 0.021, and r = -0.464, p = 0.007 respectively. No significant correlation was documented between scanning frequency and child questionnaire scores.ConclusionsParents are more likely to perceive higher levels of psychosocial burden related to their child’s diabetes than children and adolescents with T1D, especially parents of younger children. This highlights the need for family-based education and treatment resources to support parents in diabetes management in addition to rapidly advancing diabetes technology. In isCGM users, higher parental FOH and lower parent-perceived QoL correlated with a higher scanning frequency, indicating the potential impact of glucose monitoring modality on psychosocial outcomes or vice versa.

EFFECT OF CAREGIVERS’ HIV DISCLOSURE TRAINING ON PEDIATRIC HIV STATUS DISCLOSURE AND ART ADHERENCE IN HOMABAY COUNTY, KENYA: A COMPARATIVE LONGITUDINAL STUDY.

Purpose: The study objective was to establish the effect of HIV disclosure training on children’s HIV status disclosure and on ART adherence.&#x0D; Methodology:This was a comparative longitudinal study in ten health facilities in Homabay County with 860 non-disclosed HIV positive children on ART aged 6-10 years between 2016 to 2018.A randomized sample of 430 caregivers was trained on HIV status disclosure while another 430 caregivers not trained. All caregivers then performed HIV status disclosure to their HIV positive children, and children’s disclosure and adherence to ART status established. We used semi structured questionnaires, FGDs and KIIs for data collection and IBM SPSS version 20, logistic regression, chi-square and Nvivo software for data analysis.&#x0D; Results: Mean child age was 8 years for both groups, 35 and 37years for caregivers in control and intervention respectively. 409(95%) interventional caregivers had good overall knowledge on disclosure process compared to control (116(27%). Longitudinal viral suppression increased in both groups; intervention group 345(80.2%) to 384(90.1%), control (279(64.9%) to 296(70.1%). Trained caregivers were 2 times (OR-2.369) likely to disclose children’s HIV status. Disclosure training had significant effect (P&lt;0.05) on child’s adherence. Children of trained caregivers were nine times (OR-9.145) likely to have good adherence. Level of education of caregivers (p=0. 035) and knowledge of care givers on the disclosure process (p=0.05) were significantly associated with ART adherence. Disclosure knowledge and lack of disclosure skills were cited in FGDs and KIIs as the major facilitator and barrier to disclosure and ART adherence respectively.&#x0D; Unique contribution to theory, practice and policy: The findings provide evidence – based interventions that will guide caregivers, the Ministry of Education and Ministry of Health on how and when to disclose to a child his own HIV status. Disclosure culminates into behavior change which is anticipated to enhance the reduction in the spread of HIV to the next generation and it is one way of sustaining the fight against HIV and AIDS.The study recommends all children in the age bracket of 6-10 years be disclosed to their own HIV status in order to increase their level of adherence to ART.

Comprehensive assessment of cardiovascular disease risk in children with short stature due to isolated growth hormone deficiency: a case-control study.

Growth hormone deficiency (GHD) in adults is associated with an increased risk of cardiovascular morbidity and mortality. Although children with GHD are also believed to have a similar cardiovascular disease (CVD) risk beginning at an early age, the available data in children is scarce. We aimed to determine the various CVD risk parameters in children with isolated GHD (IGHD). A cross-sectional case-control study was conducted at a tertiary care centre in North India comparing various auxological, biochemical, and echocardiographic parameters between 20 IGHD children aged 5-15 years and their age and sex-matched healthy controls. The mean age of children with IGHD and controls was similar (10.5±2.6yr vs. 9.9±2.7yr, p=0.48). Children with IGHD had significantly higher waist-hip-ratio (p=0.01), total cholesterol (p=0.02), non-high-density lipoprotein-cholesterol (p=0.02), serum homocysteine (p<0.001), C-reactive protein (CRP) (p=0.01) and pro-brain natriuretic peptide (pro-BNP) (p=0.04) levels as compared to healthy controls. Left ventricular mass (LVM) and interventricular septal thickness were significantly lower (p=0.04; p=0.02) in IGHD children. Correlation analysis showed that pro-BNP and CRP levels had negative correlation (p<0.001, r=-0.70; and p=0.04, r=-0.44, respectively) and LVM had a positive correlation (p=0.02, r=0.53) with height SDS among IGHD children. Children with IGHD showed abnormalities in several biochemical and cardiac parameters that may be associated with an increased CVD risk in later life. More extensive studies, including younger children with IGHD, are needed to determine the lower ages at which the CVD risk is detectable.

Clinical Profile, Evaluation of Imaging Guidelines, and Management of Pediatric Traumatic Brain Injury at a Tertiary Care Center in India: A Review of 269 Patients

Abstract Background: Traumatic brain injury (TBI) is associated with considerable morbidity and mortality in the pediatric population. Literature regarding management of TBI in children is scarce in the Indian setting. Our study aims to bridge the existing literary gap. Materials and Methods: This study is a retrospective analysis of 269 children below 12 years of age presenting to a tertiary care hospital in India with head injury between January 2018 and January 2021. Pearson’s χ2 test, Kruskal–Wallis test, and Mann–Whitney U-test were used for statistical analysis. Results: The mean age of children admitted with head injury was 4.7 years. TBI was mild in 92.2% of children. A fall from height was the most common cause of injury (81.8%). The most common finding on computed tomography (CT) was skull fracture in 38%. Ten children (3.8%) required neurosurgical intervention. The median duration of hospital stay was 4 days. Statistically significant differences in median duration of hospital stay were obtained based on skull fracture and Glasgow Coma Scale on arrival. About 43.1% (n = 116) of children received a CT scan despite lack of indication as per NICE (National Institute of Health Care and Excellence) guidelines, and positive findings were obtained in 47.4% (n = 55). Prophylactic anticonvulsants were given to 39.8% of children (n = 107), of which 86.8% (n = 92) had positive findings. Fourteen children (13.2%) with a normal CT scan received anticonvulsants due to the presence of seizures following head injury. Conclusion: Strict implementation of guidelines issued by NICE would have led to non-detection of intracranial injury in many patients. A modification of this guideline to suit the Indian perspective may be necessary. The use of anticonvulsants in children following head injury needs further characterization.

Profile and Outcome of Children with Opsoclonus Myoclonus Ataxia: A Tertiary Care Hospital Experience from India

AbstractOpsoclonus myoclonus ataxia syndrome (OMAS) is a rare but treatable, often paraneoplastic neuroimmunologic condition. This is a retrospective chart review of 8 patients diagnosed in the past 11 years at a tertiary care hospital. The mean age of children with OMAS was 21.2 ± 8 months. There was a female preponderance (62.5%). Median symptom duration was 24.5 days (interquartile range [IQR] 12.7; 97.5). All patients had ataxia and irritability; 6 had opsoclonus.An underlying neurogenic tumor was identified in 87.5% (⅞) of the patients by computed tomography (CT)/magnetic resonance imaging. Neuroblastoma was detected in ⅘ with normal 24-hour urinary vanillylmandelic acid and 2 had negative metaiodobenzylguanidine scan.All patients received adrenocorticotropic hormone/steroids for a median of 9.5 months (IQR 5.3; 13.5) with clonazepam. Five received intravenous immunoglobulin (IVIG), including repeated cycles in ⅘. Two received rituximab. One child with relapsing-remitting course received pulse dexamethasone and cyclophosphamide, resulting in improvement. Clonazepam restored ambulation in one with delayed diagnosis and failure of response to steroids. Six patients underwent tumor resection and four needed chemotherapies.Median follow-up was 15 months (IQR 10.7; 23.2). Mean OMAS-severity scale reduced from 10 to 1.4 in the IVIG group and 10.6 to 5.3 in those who did not receive IVIG. Cognitive delay and behavioral issues were seen in 100% treated with steroids only; 50 and 25%, respectively, treated with multimodal immunotherapy. Five had relapses, one with tumor recurrence.Thorax and abdomen CT scan was found to be a sensitive tool for tumor detection. Better motor and cognitive behavioral outcome were noted in patients who received adjunctive IVIG.Future studies on optimum investigation and treatment protocol in various resource settings are needed.

Self-regulation and frontal EEG alpha activity during infancy and early childhood: A multilevel meta-analysis.

Integrating behavioral and neurophysiological measures has created new and advanced ways to understand the development of self-regulation. Electroencephalography (EEG) has been used to examine how self-regulatory processes are related to frontal alpha power during infancy and early childhood. However, findings across previous studies have been inconsistent. To address this issue, the current meta-analysis synthesized all prior literature examining associations between individual differences in self-regulation and frontal EEG alpha power (baseline and/or task). In total, 23 studies consisting of 1275 participants between 1 month and 6 years of age were included, which yielded 149 effect sizes. Findings of the three-level meta-analytic model demonstrated a non-significant overall association between self-regulation and frontal alpha power. Yet, significant moderating effects were found for self-regulation construct (emotion regulation, effortful control, executive function), self-regulation measurement (behavioral task, computer assessment, lab observation, questionnaire), and children's mean age. Self-regulation was only significantly correlated with frontal alpha power when studies focused on the executive functioning construct. Moreover, the use of behavioral tasks or questionnaires and a higher mean age of the children resulted in small but significant effect size estimates. Higher frontal alpha power values were related to higher order top-down mechanisms of self-regulation, indicating that these mechanisms might become stronger when the frontal cortex is sufficiently developed. The findings of the current meta-analysis highlight the importance of longitudinal analyses and multimethod approaches in future work to reach a more comprehensive understanding of the role of frontal EEG alpha activity in the etiology of individual differences in early self-regulation. RESEARCH HIGHLIGHTS: The first meta-analysis of individual differences in self-regulation and frontal EEG alpha power during infancy and early childhood demonstrated a non-significant overall association. Moderation analyses revealed that variations in frontal alpha power were significantly associated with executive function, but not with effortful control and emotion regulation. Frontal alpha power was related to variations in self-regulation when measured by behavioral tasks and questionnaires, but not via computer assessments and lab observations. The association between individual differences in self-regulation and frontal alpha power becomes significantly stronger with age.

Development of children born after in vitro maturation with a prematuration step versus natural conception: a prospective cohort study.

IVM preceded by a prematuration step (capacitation [CAPA]-IVM) improves the acquisition of oocyte developmental competence and can enhance embryo quality. There is currently no follow-up data on babies born from CAPA-IVM. This study investigated developmental outcomes in children born after CAPA-IVM versus natural conception. This prospective cohort study was conducted at a fertility clinic in Vietnam in August/September 2019. Children born after CAPA-IVM were propensity score-matched with those born after natural conception. All parents were asked to complete the Developmental Red Flags and Ages & Stages Third Edition (ASQ-3) questionnaires. A total of 46 parents (23 in each group) of 55 babies (31 CAPA-IVM and 24 natural conception) were included in the study. Baseline characteristics, including mother's age and body mass index, gestational age at delivery, and birth weight, were comparable. The mean age of children at the end of follow-up was 15months. The overall proportion of children with any abnormal ASQ-3 score was 6.5% in the CAPA-IVM group and 20.8% in the natural conception group (p = 0.24). The proportion of children with a developmental red flag did not differ significantly between the CAPA-IVM and natural conception groups (9.7% vs. 4.2%; p = 0.80). The use of CAPA-IVM did not have any significant impact on childhood physical and mental development compared with children born as a result of natural conception.

Eating and sleep problems, related factors, and effects on the mental health of the parents in children with autism spectrum disorder

This study aimed to evaluate the frequency of sleep and eating problems in children with autism spectrum disorder (ASD), the factors associated with these problems, and the relationship with the risk of developing depression and anxiety in their parents. In the study, 156 children with ASD and their parents were included. The Brief Autism Mealtime Behavior Inventory (BAMBI), the Children's Sleep Habits Questionnaire (CSHQ), the Hospital Anxiety Depression Scale (HADS) were completed by the parents. The Childhood Autism Rating Scale (CARS) was administered by the researchers to evaluate the severity of ASD in children. The mean age of children was 8.08 ± 2.84, and 87.2% of the children were male. The mean score of CARS was 41.25 ± 6.16, the mean score of BAMBI was 45.67 ± 11.87, and the mean score of CSHQ was 51.67 ± 10.17. According to the CSHQ, 83.3% of the children had sleep problems. The response rate above the cut-off point in the HAD-A subscale was 59.6%, whereas it was 67.3% in the HAD-D subscale. There was a positive correlation between CARS and BAMBI, CSHQ, HAD-A, and HAD-D subscales. There was a positive correlation between BAMBI and CHSQ, HAD-A, and HAD-D subscales. There was a positive correlation between the CSHQ, HAD-A, and HAD-D subscales. There was a negative correlation between the age of the child with ASD, food refusal, and resistance to bedtime. As sleeping and eating problems affect a large portion of children diagnosed with ASD and their caregivers, large population-based studies evaluating both these problems must be designed and carried out to understand factors affecting the prevalence, development, and persistence of sleeping and eating problems and to determine interventions to reduce these issues.

Burnout Among Caretakers of Paediatric Patient with Chronic Kidney Disease

Introduction: Caring for children who have chronic kidney disease (CKD) is challenging. The goal of this study was to find out the prevalence of burnout and what factors contribute to it. We also want to know the correlation between caretaker’s strain and burnout. Methods: This was a cross-sectional study that involved caretakers of children with CKD. They were recruited from a university hospital in Kelantan, Malaysia. Self-administered questionnaire in Malay language comprised of Demographic Information Form, Copenhagen Burnout Inventory (CBI-M) and Caregiver Strain Index (CSI-M) was used. Results: Eighty-eight caretakers were involved in this study. The mean age of caretakers was 42 years old, majority were female (72.4%), Malay (99.0%) and Muslim (99.0%). The mean age of children with CKD was 11 years old, most of them were on medication (69.3%) and mean duration of illness was 4.6 years. The prevalence of burnout in all domains (personal, work-related, client-related) among the caretakers was 5.7%. Eight caretakers had personal burnout (9.1%) while five (5.7%) had client-related and work-related burnout respectively. Multiple linear regression showed positive association of duration since the initial diagnosis and total ward admission within six months with total burnout score. Pearson correlation revealed a positive and fair correlation between strain and burnout. Conclusion: Prevalence of burnout among caretakers was generally low, but personal burnout outnumbered other domains. Children with CKD with longer duration of illness and more frequent ward admission are the important factors leading to burnout among caretakers. A high number of caretakers having significant strain indicated that there were possibilities of developing burnout later on.

Comparison of Open reduction and internal fixation by Stabilization with cross K-wires in early versus late presentation of Supracondylar Humeral Fractures in Children

Objective: To compare open reduction and internal fixation by stabilization with cross k-wires in early (within 6 days of injury) versus late (2 to 4 weeks) presentation of supracondylar humeral fractures in children. Study Design: A quasi experimental study Place and Duration: Department of Orthopedic, Lahore General Hospital, Lahore from 1st January 2021 to 30th June 2021. Methodology: A total of 42 cases (21 children in Group-A with early presentation and 21 in Group-B with late presentation) of Gartland’s type II and III humeral supracondylar fracture were included. All open reduction and internal fixation procedures were done by a single surgical team while post-surgical follow up consisted of 3-months. Functional and cosmetic outcome of surgery were observed in terms of decrease in carrying angle and elbow movements as per Flynn’s criteria. Results: Out of a total of 42 cases, there were 71.4% male and 28.6% female. The mean age of children in Group-A was 8.29±1.85 years while it was 7.43±2.06 years in Group-B. Mean procedure time was noted to be 0.91±0.35 hours in Group-A and 1.38±0.25 hours in Group-B (p&lt;0.001). All cases were found to have satisfactory wound condition and bony union. Decrease in range of motion of elbow as 0-50, 6-100,and 11-150 in 10, 9 and 2 cases in Group-A respectively in comparison to 4, 14 and 3 cases in Group-B respectively (p=0.145). Functional outcome in 33.3% cases was excellent, good in 54.8% and fair in 11.9% cases while there was no difference in between both study groups (p=0.145). Conclusion: There is no significant difference in functional outcomes of early or late presentation in children undergoing open reduction and internal fixation for supracondylar fractures. Keywords: Supracondylar fracture, Humerus, Children, Early presentation, Late presentation, Open reduction, Internal fixation, K-wire stablization, Functional outcome.

Challenges Faced by Post-Treatment Childhood Cancer Patients and Families; The Children's Hospital, Lahore Experience

Objective: To assess challenges faced by post-treatment childhood cancer patients and families in a developing country.&#x0D; Study Design: cross-sectional study.&#x0D; Place and Duration of Study: The Children's Hospital and the Institute of Child Health Lahore, from Jul to Dec 2020.&#x0D; Methodology: 105 children and their parents were enrolled on OPD of the Department of Paediatric Hematology and Oncology. The parents were questioned regarding the duration of follow-up after treatment and the challenges they faced during this interval in association with socioeconomic dynamics, education and awareness of parents, travelling distance from the hospital, behavioural changes in children, toxicities/disabilities due to treatment, effect on other siblings, and various factors.&#x0D; Results: In this study, the mean age of children was 9.40 ± 2.90 years. There were 55 (52.4%) males while 50 (47.6%) females. There were 35 (33.3%) children who had acute lymphocytic leukaemia, while 15 (14.3%) with Hodgkin Lymphoma, 12 (11.4%) with Wilms tumour, 10 (9.5%) with Non-Hodgkin Lymphoma, 9 (8.6%) with germ cell tumour and 7 (6.7%) with acute myeloid leukaemia. Mostly, 89 (84.8%) children received chemotherapy, while 12 (11.4%) children received chemotherapy as well as radiotherapy, and 4 (3.8%) children underwent surgery along with other treatments. The distance from the hospital was more than 50 km in &gt;90 cases. Moreover, 42 (40.0%) children were found malnourished. Out of 105, 71 parents reported that the treatment affected their jobs, while 52 (49.5%) parents had to change their residence. The family's economic status wasaffected in 77 (73.3%) cases because of the treatment...........

The primary caregiver&amp;rsquo;s stress: its correlation with the chronological and diagnostic age of children with autism spectrum disorder

&lt;p&gt;&lt;strong&gt;Background and Objective:&lt;/strong&gt; Autism is a neurodevelopmental and heterogeneous disorder that affects people of all ages; also known as autism spectrum disorder (ASD). Nurturing these children puts a tremendous burden on the primary caregivers. It may be due to some compelling reasons, including existential concerns to unknown etiology of autism and lack of understanding of its nature. The aim of the study was to evaluate the stress level in the primary caregivers and its relationship with child&amp;rsquo;s chronological and diagnosis age.&lt;/p&gt;&#x0D; &lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This cross-sectional study included 96 primary caregivers (mothers, fathers, siblings, and grandparents) of children diagnosed with ASD reporting at government and non-government institutes of Lahore city. The childhood autism rating scale was used to confirm the diagnosis of autistic children. The parent stress scale was used to evaluate stress levels in primary caregivers.&lt;br /&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean age of the autistic children was 5.1 &amp;plusmn; 2.5 years, while the mean age at the time of diagnosis was 3.2 &amp;plusmn; 1.1 years. The mean stress score was recorded as 52.3 &amp;plusmn; 7.3, with the range of 36.0-70.0. No correlation (r = 0.015) was observed between stress score of primary caregivers and duration after diagnosis of autism in these children. However, negative associations (r = -0.044) were seen between primary caregiver&amp;rsquo;s stress and child&amp;rsquo;s chronological age.&lt;br /&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; The majority of primary caregivers indicated bearing a significant level of stress, especially in managing the child in earlier years after diagnosis. Appropriate education, counseling, and rehabilitation services may play an important role in reducing the anxiety and stress over time in caregivers as the child&amp;rsquo;s age increases.&lt;/p&gt;

Study of Multidimensional and High-Precision Height Model of Youth Based on Multilayer Perceptron.

Predicting the adult height of children accurately has great social value for the selection of outstanding athlete as well as early detection of children's growth disorders. Currently, the mainstream method used to predict adult height in China has three problems: its standards are not uniform; it is stale for current Chinese children; its accuracy is not satisfactory. This article uses the data collected by the Chinese Children and Adolescents' Physical Fitness and Growth Health Project in Zhejiang primary and secondary schools. We put forward a new multidimensional and high-precision youth growth curve prediction model, which is based on multilayer perceptron. First, this model uses multidimensional growth data of children as predictors and then utilizes multilayer perceptron to predict the children's adult height. Second, we find the Table of Height Standard Deviation of Chinese Children and fit the data of zero standard deviation to obtain the curve. This curve is regarded as Chinese children's mean growth curve. Third, we use the least-squares method and the mean curve to calculate the individual growth curve. Finally, the individual curve can be used to predict children's state height. Experimental results show that this adult height prediction model's accuracy (between 2 cm) of boys and girls reached 90.20% and 88.89% and the state height prediction accuracy reached 77.46% and 74.93%. Compared with Bayley–Pinneau, the adult height prediction is improved 19.61% for boys and 13.33% for girls. Compared with BoneXpert, the adult height prediction is improved 25.49% for boys and 6.67% for girls. Compared with the method based on the bone age growth map, the adult height prediction is improved 15.69% for boys and 24.45% for girls.

Neutrophil gelatinase-associated lipocalin is elevated in children with acute kidney injury and sickle cell anemia, and predicts mortality

Urine neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker of acute kidney injury that has been adapted to a urine dipstick test. However, there is limited data on its use in low-and-middle-income countries where diagnosis of acute kidney injury remains a challenge. To study this, we prospectively enrolled 250 children with sickle cell anemia aged two to 18 years encompassing 185 children hospitalized with a vaso-occlusive pain crisis and a reference group of 65 children attending the sickle cell clinic for routine care follow up. Kidney injury was defined using serial creatinine measures and a modified-Kidney Disease Improving Global Outcome definition for sickle cell anemia. Urine NGAL was measured using the NGAL dipstick and a laboratory reference. The mean age of children enrolled was 8.9 years and 42.8% were female. Among hospitalized children, 36.2% had kidney injury and 3.2% died. Measured urine NGAL levels by the dipstick were strongly correlated with the standard enzyme-linked immunosorbent assay for urine NGAL (hospitalized children, 0.71; routine care reference, 0.88). NGAL levels were elevated in kidney injury and significantly increased across injury stages. Hospitalized children with a high-risk dipstick test (300ng/mL and more) had a 2.47-fold relative risk of kidney injury (95% confidence interval 1.68 to 3.61) and 7.28 increased risk of death (95% confidence interval 1.10 to 26.81) adjusting for age and sex. Thus, urine NGAL levels were found to be significantly elevated in children with sickle cell anemia and acute kidney injury and may predict mortality.