Children Mean Age Research Articles

Predicting Social Competence in Autistic and Non-Autistic Children: Effects of Prosody and the Amount of Speech Input.

Autistic individuals often face challenges perceiving and expressing emotions, potentially stemming from differences in speech prosody. Here we explore how autism diagnoses between groups, and measures of social competence within groups may be related to, first, children's speech characteristics (both prosodic features and amount of spontaneous speech), and second, to these two factors in mothers' speech to their children. Autistic (n = 21) and non-autistic (n = 18) children, aged 7-12 years, participated in a Lego-building task with their mothers, while conversational speech was recorded. Mean F0, pitch range, pitch variability, and amount of spontaneous speech were calculated for each child and their mother. The results indicated no differences in speech characteristics across autistic and non-autistic children, or across their mothers, suggesting that conversational context may have large effects on whether differences between autistic and non-autistic populations are found. However, variability in social competence within the group of non-autistic children (but not within autistic children) was predictive of children's mean F0, pitch range and pitch variability. The amount of spontaneous speech produced by mothers (but not their prosody) predicted their autistic children's social competence, which may suggest a heightened impact of scaffolding for mothers of autistic children. Together, results suggest complex interactions between context, social competence, and adaptive parenting strategies in driving prosodic differences in children's speech.

Prepandemic Factors Associated With Pandemic Impact and Psychosocial Distress Among Mothers of Young Children

ObjectiveTo describe the Coronovirus 19 (COVID-19) pandemic impact among mothers of young children (0–8 years) and assess prepandemic factors associated with greater pandemic impact and psychosocial distress. MethodsMothers from 3 US birth cohorts (n = 301, mean child age 2.4 years) reported on demographics and psychosocial distress (anxiety, perceived stress, financial stress) before the pandemic (February 2015–February 2020). During the pandemic (July 2020–June 2021), they completed a supplemental survey about the impact of the pandemic on their families (Coronavirus Impact Scale) and psychosocial distress. Multivariable linear and ordinal logistic regression were used to evaluate prepandemic factors associated with pandemic impact overall and by domain. ResultsCompared to prepandemic reports, maternal anxiety symptoms increased by 9.4%, perceived stress increased by 13.3%, and financial stress increased by 41.7%, of which all were statistically significant changes. Participants reported the most severe pandemic impact in family routines (72.4%), experiences of stress (40.2%), and social support (38.6%). Mothers with some college or a 4-year degree experienced higher overall pandemic impact compared to mothers with the least and highest education. Prepandemic distress was not associated with pandemic impact; however, midpandemic, all 3 distress measures were significantly positively associated with overall Coronavirus Impact Scale, with the largest effect size noted for perceived stress (B = 1.36, 95% CI: 0.90,1.82). ConclusionsWhile, on average, mothers of young children experienced worsening psychosocial stress during the COVID-19 pandemic, prepandemic psychosocial stress alone was not prospectively associated with greater pandemic impact, suggesting that the COVID-19 pandemic may have both elaborated existing systemic social inequalities and created new burdens.

Paternal peri-conceptional physical activity and the risk of congenital heart disease in offspring: A case-control study.

Genetic and environmental factors have been shown to contribute to the development of congenital heart disease (CHD). To date, the focus of scientific articles has primarily centered on genetics and maternal environmental factors, with comparatively less attention given to paternal risk factors. This study aims to investigate the potential association between paternal pre-conceptional physical activity levels (PA), along with paternal peri-conceptional smoking and alcohol consumption, and the risk of CHD in offspring. An observational case-control study was conducted in Lebanon, with 279 participants, aiming to investigate potential risk factors for CHD. We included children with confirmed CHD, born between 2012 and 2022. Controls born in the same timeframe were selected randomly from the general population using online questionnaire forms. Mean age of children included was 6 years old (0-10). The pre-conceptional PA was assessed using the Global Physical Activity Questionnaire validated in Arabic. In addition, paternal smoking, alcohol consumption, and maternal risk factors were collected. The study included 128 CHD cases (45.9%) and their parents, as well as 151 healthy infants (54.1%) and their parents. There were no statistically significant variations in the alcohol consumption noted between the fathers in the case and control groups (p=0.18). The paternal involvement in recreational-related PA during the peri-conception period was associated with a reduced risk of the CHD development in offspring by 46.9% (OR=0.531, 95% CI: 0.301-0.936, p=0.029). Additionally, increasing paternal total sitting time by 1 h above the average, which was approximately 260 min (4h), increased the risk of CHD in offspring by 0.4% (p=0.001). Moreover, paternal smoking exhibited an apparent association with a 56% increased risk of offspring developing CHD, notwithstanding that the confidence intervals included the null (OR=1.56, 95% CI: 0.86-2.8, p=0.136). This observational study is the first to report a potential association between paternal PA, and CHD in offspring. This study aligns with previous reports, advocating for the paternal engagement in PA and the adoption of healthy lifestyle habits, especially during the critical stages of conception. Such practices are strongly recommended to enhance fertility and promote optimal health for offspring. However, due to the subjectivity in reporting PA and lack of molecular proof, additional prospective and molecular studies are required to validate these findings.

Direct and Indirect Longitudinal Associations of Mother and Father Engagement in Middle Childhood on Adolescent Externalizing and Internalizing Behaviors.

Parent engagement is an important aspect of parenting during childhood. However, little is known about the unique longitudinal associations of mother and father engagement with adolescents' externalizing and internalizing problem behaviors. This study uses Future of Families and Child Wellbeing Study data to examine the potential direct and indirect associations of parent engagement at age 9 on adolescent externalizing and internalizing behaviors at age 15. The analytic sample size is 1349, and at age 9, the mean age of children was 9.40 years (SD = 0.37). Forty-eight percent of children were female and 68% of them were from the married families. The results show that while controlling for mother engagement, higher father engagement at age 9 was directly associated with fewer adolescent internalizing behaviors, only among adolescent boys and in married families. In addition, among adolescent boys, father engagement had an indirect association with externalizing behaviors through father-child closeness. Mother engagement, however, is only found to have an indirect association with adolescents' externalizing and internalizing behaviors through maternal hostility (while controlling for father engagement). The results for mother engagement held for boys and in married families only. The findings indicate that both mother and father engagement during childhood is important and helpful to prevent adolescent problem behaviors directly or indirectly via parent-child relationship.

Quality of life in children and adolescents with beta thalassemia

IntroductionChildren and adolescents with thalassemia suffer from chronicity of the disease and its treatment, including transfusion dependence and complications of iron overload.ObjectivesTo investigate the quality of life of children and adolescents with Beta Thalassaemia.MethodsThis study is a cross-sectional study conducted at the Greek public Children’s Hospital. PedsQL ™ 4.0 Generic Core Scale (Greek version) was used to evaluate HRQOL in 41 thalassemia patients aged between 5 and 18 years and in 41 healthy controls of the same age range. For the analysis, the Statistic Package (SPSS ver.24) was used. Using Spearman’s correlation coefficient, t-test and MannWhitney tests were used, while for variables with three or more levels the Anova and Kruskall-Wallis. In order to investigate the relationship between two quantitative variables, Spearman’s correlation coefficient was used, while the relationship between two qualitative variables was used to control x2. As a statistical significance level, α = 5% was defined.Results Of the 41 children with beta Thalassemia who participated in the study, 48.8% (n = 20) were boys and 51.2% (n = 21) girls. The mean age of children was 10.02 ± 4.10 years. For healthy children who participated in the study 51.2% (n = 21) were boys while 48.8% (n = 20) were girls. The mean age of the children was 9.63 ± 3.77 years. Children with Beta Thalassaemia have a lower quality of life in Physical Health and Activity(<0,001), Emotional Health(0,031), School Activities(0,008), Psychosocial Health(0,014), and the overall PedsQL 4.0 (<0,001)questionnaire compared to healthy children. Children between the ages of 5 and 7 have higher levels of quality of life in physical health and activity than older children(<0,001). In addition, children aged 5 to 7 have higher quality of life and overall PedsQL 4.0 score than older children(0,033) Children receiving combination therapy show better quality of life than children receiving subcutaneous therapy (total PedsQL 4.0 <0,001).ConclusionsChildren and adolescents in all five categories had a better quality of life, after improved iron chelating methods and other psychosocial interventions.Disclosure of InterestNone Declared

Low birth weight, household socio-economic status, water and sanitation are associated with stunting and wasting among children aged 6-23 months: Results from a national survey in Ghana.

Stunting and wasting are key public health problems in Ghana that are significantly linked with mortality and morbidity risk among children. However, information on their associated factors using nationally representative data is scanty in Ghana. This study investigated the influence of Infant and Young Child Feeding (IYCF) indicators, socio-demographic and economic related factors, and water and sanitation on stunting and wasting, using nationally representative data in Ghana. This is a secondary data analysis of the most recent (2017/2018) Ghana Multi-Indicator Cluster Survey (MICS) datasets. The multi-indicator cluster survey is a national cross-sectional household survey with rich data on women of reproductive age and children under the age of five. The survey used a two-stage sampling method in the selection of respondents and a computer-assisted personal interviewing technique to administer structured questionnaires from October 2017 to January 2018. The present study involved 2529 mother-child pairs, with their children aged 6 to 23 months. We used the Complex Sample procedures in SPSS, adjusting for clustering and stratification effects. In a bivariate logistic regression, variables with P-values ≤ 0.05 were included in a backward multivariate logistic regression to identify the significant factors associated with stunting and wasting. The mean age of children was 14.32 ± 0.14 months, with slightly more being males (50.4%). About 12% and 16% of the children were wasted and stunted, respectively. There were 39.4%, 25.9%, and 13.7% of children who, respectively, satisfied the minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). None of the IYCF indicators was significantly associated with stunting or wasting in the multivariate analysis but low socio-economic status, low birth weight, being a male child and unimproved toilet facilities were significantly associated with both wasting and stunting. Our findings suggest that aside from the pre-natal period, in certain contexts, household factors such as low socio-economic status and poor water and sanitation, may be stronger predictors of undernutrition. A combination of nutrition-specific and nutrition-sensitive interventions including the pre-natal period to simultaneously address the multiple determinants of undernutrition need strengthening.

The Outcome of Emergency Admissions and Associated Factors Among Children Admitted to the Pediatric Emergency Unit at Selected Public Hospitals at Addis Ababa, Ethiopia — Retrospective Cross-Sectional Study

BACKGROUND: A pediatric emergency condition is a life-threatening process that, without timely and standard clinical intervention, may lead to death. Therefore, this study aimed to assess the outcomes of emergency admissions and associated factors among children admitted to the pediatric emergency of selected public hospitals. METHODS: An institutional-based retrospective cross-sectional study design was conducted on children admitted to the emergency unit of randomly selected public hospitals from January 02, 2020, to January 08, 2022. Data were extracted from admitted Childrens’ chart using prepared checklists from February 1 to March 1, 2022. RESULT: A total of 303 admitted children’s charts were reviewed with 100% coverage. The mean age of children was 37.47 months, and the male-to-female ratio was 1.16:1. The study revealed that the most common causes of emergency admission were pneumonia (22.4%), surgical emergencies (14.5%), and late-onset sepsis (9.2%), respectively. More than half (53.8%) of children were admitted to the Pediatric Emergency Department for less than 24 hours, and the mean length of stay was 2 days. 39.6% of children were discharged with clinical improvement. Known comorbidity and length of stay less than 24 hours were strongly associated with the health care intervention. CONCLUSION: The study indicates that mortality rate of children at the Pediatric Emergency Department of study hospitals is high, with known comorbidity showing a significant association with mortality. FMOH recommended to develop national pediatric emergency care guidelines as standard document and providing skill gap training for healthcare workers.

Invalidating environment and meaning in life: The Chain Mediating Effects of regulatory emotional self-efficacy and basic psychological needs satisfaction

BackgroundAlthough people strive for meaning in life, life is full of experiences that challenge meaning. According to Bowen's family systems theory, the family is both a relational and an emotional system in which family members influence and are influenced by each other. Invalidating environment, reflecting a deficient family emotional setting, may be a key influencing factor in diminishing meaning in life. Existing studies have not directly explored the effects of the invalidating environment on meaning in life and its underlying mechanism. ObjectiveGuided by Bowen's family systems theory, this study aims to explore the relationship between invalidating environment and meaning in life, as well as the mediating effects of regulatory emotional self-efficacy and the satisfaction of basic psychological needs. MethodsA sample of 555 university students (62.5 % female, 37.5 % male; Mage =19.13 years old, SD = 1.72) completed questionnaires regarding demographics, invalidating environment, meaning in life, regulatory emotional self-efficacy, and basic psychological needs satisfaction. ResultsResults revealed that: (a) invalidating environment negatively predicts meaning in life; (b) regulatory emotional self-efficacy and basic psychological needs satisfaction serve as both independent and chain mediators between invalidating environment and meaning in life. ConclusionInvalidating environment affects meaning in life through regulatory emotional self-efficacy and basic psychological needs satisfaction. This finding has significant theoretical implications and provides a feasible pathway to improve children's meaning in life at both the parent and child levels.

Effect of non-vascularized fibular harvest on the donor limb: radiological evaluation at a mean follow-up of twelve point eightyears.

The study is aimed at evaluating the long-term (at a minimum follow-up of 10years) impact of non-vascularized fibular harvest on the donor limbs. There were 27 donor limbs (n = 19 children) available for retrospective radiological review. The graft was obtained bilaterally in eight patients. The following parameters were evaluated in the follow-up radiographs: continuity/non-continuity of fibular regenerate, width of the regenerated fibula, distal fibular station, medial proximal tibial angle, posterior proximal tibial angle, lateral distal tibial angle (LDTA), anterior distal tibial angle, and tibia diaphyseal angulation (interphyseal angles). For analysis and comparisons, the donor limbs were compared to the healthy limbs (controls) of the children with unilateral harvest. Additionally, the impact of continuous and non-continuous fibular regeneration was separately analyzed. The mean child's age at the time of fibular harvest was fouryears. The mean follow-up was 12.8years. The fibula was found regenerated in continuity in 22 limbs of 15 children (81.5%). When analyzed as a combined group (both continuous and non-continuous fibular regenerations), all the donor limb radiological parameters matched those of healthy limbs except LDTA (p = 0.04). In the subgroup analysis between non-continuous and continuous fibulae, significant abnormalities were again obvious in LDTA (p = 0.0001). The non-continuous fibulae were significantly lesser in width. All limbs with non-continuous fibular regeneration manifested ankle valgus. The non-vascularized fibula emerged as a relatively safe procedure in the long term with minimal affections of the knee, ankle, or tibial anatomy when longitudinal integrity of fibula was restored. The non-regenerations of the fibula may be prone to developing ankle valgus.

The Outcomes of Emergency Admissions and Associated Factors Among Children Admitted to the Pediatric Emergency Unit at Selected Public Hospitals in Addis Ababa, Ethiopia — A Retrospective Cross-Sectional Study

BACKGROUND: A pediatric emergency condition is a life-threatening process that, without timely and standard clinical intervention, may lead to death. Therefore, this study aimed to assess the outcomes of emergency admissions and associated factors among children admitted to the pediatric emergency of selected public hospitals. METHODS: An institutional-based retrospective cross-sectional study design was conducted on children admitted to the emergency unit/ward from January 02, 2020, to January 08, 2022, in the emergency units of randomly selected public hospitals. Data were extracted with prepared checklists from February 1 to March 1, 2022. RESULT: A total of 303 admitted children’s charts were reviewed with 100% coverage. The mean age of children was 37.47 months, and the male-to-female ratio was 1.16:1. The study revealed that the most common causes of emergency admission were pneumonia (22.4%), surgical emergencies (14.5%), and late-onset sepsis (9.2%), respectively. More than half (53.8%) of children were admitted to the Pediatric Emergency Department for less than 24 hours, and the mean length of stay was 2 days. 39.6% of children were discharged with clinical improvement. Known comorbidity (AOR=4.65, 95% CI (1.23-17.64)) and length of stay less than 24 hours (AOR=4.2, 95% CI (1.2-14.7)) were strongly associated with the outcome. CONCLUSION: Pneumonia is still the most common cause of pediatric emergency admission, and the mortality rate of children at the Pediatric Emergency Department is high, with known comorbidity showing a significant association with mortality. FMOH recommended developing national pediatric emergency care guidelines and providing skill gap training for healthcare workers.

Tugas Dan Tanggung Jawab Orangtua Dalam Mendidik Iman Anak Pada Masa Kini

Parents as the main educators of their children's faith means that parents must actively educate their children and be involved in their children's faith education process. Parents themselves must practice their faith, strive to live holy lives, and continue to apply the teachings of the faith in family life at home. Educating children in matters of faith is actually not difficult, because it can start from simple things. However, it requires commitment and sacrifice on the part of the parents, for example: praying with the children and reading the Holy Bible to them, bringing the children to the Holy Mass and afterward explaining to the children its meaning, giving warnings if the children make mistakes using the language of love.

Distribution of Normative Keratoconus (KC) indices for patients aged 6 to 21 Years using Pentacam HR in the Riyadh area

Objectives: To determine the distribution of Normative Keratoconus (KC) indices in normal Saudi patients aged between 6-21 years in the Riyadh area. Method: The present study employed a prospective, cross-sectional, observational, multicenter design to gather data from patients aged 6 to 21 who were seen in several non-ophthalmic emergency departments in Riyadh, Kingdom of Saudi Arabia, in 2017. Scheimpflug corneal tomography system in rotation was used to measure the cornea. Following optometric exams, corneal imaging and KC index measurements were performed using the Pentacam. Results: 366 study participants were analyzed after the exclusion criteria were applied. All children's mean and standard deviation (SD) ages were 17.41±4.83 (6–21). All the KC indices percentiles for pediatric, adolescent, and young adult groups are within normal ranges. Comparison between KC indices and age groups reveals statistically significant differences for most indices with P <0.05. As the age increases, the ISV, IVA, KI, CKI, IHA, IHD, BFS Front, BFS Back, ART Min, ART Max, ART Avg, and AC Depth decrease. Also, As the age increases, the topographic astigmatism (Topo Astig), PPI Min, PPI Max, and PPI Avg increase. There was a statistically significant correlation between KC indices and age, with most indices with P <0.05. The correlation coefficient ranges from 0.14 negative weak to 0.65 negative moderated, and from positive weak 0.22 to negative strong 0.82. Moreover, compression between KC indices and Topo Astig groups reveals statistically significant differences for most indices P <0.05. As the Topo astig increase, the K1, RSagMin PPIMax, and PPIAvg decrease. As the Topo Astig increases, the K2, ISV, IVA, CKI, IHA, BFS Back, and ACD increase. Also, there was a statistically significant correlation between Topo Astig groups and indices with P <0.05. The correlation coefficient ranges from 0.13 positive weak to 0.70 positive strong and from negative weak 0.11 to negative moderate 0.42. Conclusion: The KC indices of the current study were within normal range and comparable to prior studies. However, some indices were related to age, refractive error, and location. The normative values of multiple Pentacam indices showed statistically significant variations throughout the age groups and Topo astig subgroups.

Duration and Sociodemographic Factors Associated with Exclusive Breastfeeding Among Mothers in Urban and Semi-Rural Areas of Libreville and Lambaréné in Gabon

Background: Exclusive breastfeeding from birth to six months of age has an unparalleled benefit on a child's growth and development. This survey aimed to assess the practice of exclusive breastfeeding (EBF) in Libreville and Lambaréné. Method: This is a prospective study, including mother-child pairs of infants taken to vaccination centers in Libreville (urban area) and Lambaréné (semi-rural area). The data collected included sociodemographic aspects of families, the children's characteristics, and the duration of EBF in months. Result: We included 552 mother-child pairs, 58% of whom were recruited (n = 320) in Libreville. The average age of mothers was 26.5 ± 6.4 years, while fathers were 33.3 ± 7.8 years. The mean age of children was 4.2 ± 3.1 months. Male participants were accounted for 52.2% (n = 288), while females 47.8% (n = 264). The mean duration of exclusive breastfeeding in the whole was 0.9 months. Six-month EBF was generally performed at 9.2% (n = 51, 95% CI = 7.1%-11.9%). The factors influencing the EBF were father’s level of education (all classes combined) (p = 0.025), marital status (p = 0.011), and residential area (OR = 3.40, p <0.001) Conclusion: The duration of exclusive breastfeeding in the two studied is lower than the WHO recommendations. The associated factors found are areas of work to be explored to encourage this important practice for our infants.

Age Estimation and Gender Attribution in Typically Developing Children and Children With Dysarthria.

The purposes of this study were (a) to investigate adult listeners' perceptions of age and gender in typically developing children and children with dysarthria and (b) to identify predictors of their estimates among auditory-perceptual parameters and an acoustic measure of vocal pitch (F0). We aimed to evaluate the influence of dysarthria on the listeners' impressions of age and gender against the background of typical developmental processes. In a listening experiment, adult listeners completed age and gender estimates of 144 typically developing children (3-9 years of age) and 25 children with dysarthria (5-9 years of age). The Bogenhausen Dysarthria Scales for Childhood Dysarthria (BoDyS-KiD) were applied to record speech samples and to complete auditory-perceptual judgments covering all speech subsystems. Furthermore, each child's mean F0 was determined from samples of four BoDyS-KiD sentences. Age estimates for the typically developing children showed a regression to the mean, whereas children with dysarthria were systematically underestimated in their age. The estimates of all children were predicted by developmental speech features; for the children with dysarthria, specific dysarthria symptoms had an additional effect. We found a significantly higher accuracy of gender attribution in the typically developing children than in the children with dysarthria. The prediction accuracy of the listeners' gender attribution in the preadolescent children by the included speech characteristics was limited. Children with dysarthria are more difficult to estimate for their age and gender than their typically developing peers. Dysarthria thus alters the auditory-perceptual impression of indexical speech features in children, which must be considered another facet of the communication disorder associated with childhood dysarthria.

Various Malignancies Amongst Children Presenting to Pediatric Unit of Tertiary Care Center

Childhood malignancies are slowly rising critical medical issue with low rate of survival. Despite of its variability in frequency and distribution with respect to its types, very few studies have addressed this aspect in Pakistan. In order to understand the factors to help in management and increase success rate of treatment, frequency and patterns of different types of malignancies in our settings should be understood well. Aim and Objective: To find out the frequency of various malignancies amongst children presenting to pediatric unit of tertiary care center. Materials and Methods: This descriptive cross sectional study was conducted in pediatric unit of Jinnah Hospital, Lahore, between 08-04-2021 to 08-04-2022 on 240 children. The data was collected using non-probability consecutive sampling after taking consent from the parent/guardian of the patient. Socio-demographic and clinical data was collected on a semi-structured proforma and was analyzed using SPSS v.17. Mean, Standard deviation, frequency and percentages were given for quantitative and qualitative data respectively while Chi Square test was used to find association of types of cancers with age and gender keeping a p-value<0.05 as significant. Results: The mean age of children was 8.05 ± 4.077 years with 53.8% males. Acute leukemia (20.8%) was the commonest type of malignancy among other including Burkitt lymphoma in 18.8%, Rhabdomyosarcoma in 18.3, Non Hodgkin lymphoma in 9.2%,Hodgkin lymphoma in 7.1%,Wilms tumor in 14.2%,Neuroblastoma in 5%, Retinoblastoma in 3.3% and Yolk sac tumor in 3.3% children. Only Rhabdomyosarcoma and Acute leukemia had significant association with age groups (p-values= 0.043 & 0.014 respectively). Conclusion: This study concludes that acute leukemia was commonest observed type of childhood malignancy (20.8%), whereas Retinoblastoma and Yolk sac tumor were the least observed ones. Only age was associated with Rhabdomyosarcoma and Acute leukemia among all types of malignancies. Keywords: Childhood malignancies, Age group, Acute leukemia, Rhabdomyosarcoma, Retinoblastoma.

Impact of nirsevimab prophylaxis on paediatric respiratory syncytial virus (RSV)-related hospitalisations during the initial 2023/24 season in Luxembourg.

After Luxembourg introduced nirsevimab immunisation against respiratory syncytial virus (RSV), estimated neonatal coverage was 84% (1,277 doses/1,524 births) in 2023. That year, paediatric RSV-related hospitalisations, especially concerning infants < 6 months old (n = 72) seemed to decrease compared to the same period in 2022 (n = 232). In 2023, hospitalised children's mean age increased (14.4 months vs 7.8 months in 2022; p < 0.001) and hospital-stay length decreased (3.2 days vs 5.1 days; p < 0.001). In infants < 6 months old, intensive-care unit admissions appeared to drop (n = 28 vs 9). This suggests that nirsevimab prophylaxis reduced severe RSV infections, particularly in infants < 6 months old, thereby alleviating healthcare strain.

Correlation between tympanometric findings and adenoid hypertrophy among children without hearing loss in tertiary care hospital

Adenoid hyperplasia is a common cause of nasal obstruction in children. Chronic infection and hypertrophy result in mouth breathing, snoring, sleep apnoea, hyponasality, sinusitis, and otitis media with effusion (OME). Some children with adenoid hypertrophy have OME in spite of having no complaints of hearing loss. Untreated OME may adversely affect the speech and intellectual development of the child.Aim To determine whether there is a correlation between tympanometric findings and various radiological and endoscopic grades of adenoid hypertrophy.To propose a combination of radiological and/or endoscopic assessment of adenoids and tympanometry as a screening program in patients with suspicion of adenoid hypertrophy.Materials and methods One hundred children, presenting with one or more complaints of upper airway obstruction (UAO), suggestive of adenoid hypertrophy, without a history of hearing loss, to the OPD, were chosen for the study. X-ray nasopharynx soft tissue lateral view was done for all patients. Rigid diagnostic nasal endoscopy with 0° endoscope was conducted in only children who were cooperative and with parental consent. Tympanometry was carried out for all patients and plotted on tympanograms.Results In our study, the mean age of children is 9.43 ± 2.430 years with gender distribution being 57% males and 43% females. The majority of children tend to present with nasal obstruction (100%), mouth breathing (83%), and snoring (56%). On both radiological and endoscopic evaluation of adenoids and correlation with tympanogram, a significantly higher number of patients with Grade 1 adenoids have a type A curve, while a significantly higher number of grade 3 adenoids patients have a type B curve and type C is significantly more prevalent in grade 2 and grade 4 adenoids (p < 0.05).Conclusion In our study, adenoid size as measured from both adenoid X-ray and adenoid endoscopy, showed a significant association with the presence of middle ear effusion and also with eustachian tube dysfunction. This helps in early detection, prior to the development of hearing loss, making it easy to plan early intervention, and curbing the possibility of aggravation of the condition and occurrence of complications.

Goal-directed therapeutic exercise for paediatric posterior fossa brain tumour survivors: a qualitative analysis of experiences

PurposeTo explore child and parent experiences of a 12-week goal-directed therapeutic exercise intervention in paediatric posterior fossa brain tumours survivors and to identify features of the program that influenced program adherence and acceptability.MethodsEleven interviews were conducted; five parent-child dyads (mothers = 83%) and one parent only (mean child age = 10.6 ± 3.0 years; 83% male). Posterior fossa brain tumour survivors, who participated in a weekly goal-directed exercise program for 12 weeks, completed semi-structured interviews to discuss their experience of the program. An inductive content analysis was undertaken. Interviews were transcribed, imported into NVivo and independently coded by two reviewers. Code and content categories were iteratively discussed and refined.ResultsFive content categories were generated: (1) perceived improvements, (2) program logistics, (3) activity selection, (4) connection with the therapist and (5) options for technology. All participants valued the tailored exercise program and described improvements in movement competence. Children and their parents discussed preferring home- and community-based locations and favoured face-to-face delivery. Occasionally, parents reported difficulty completing the home program due to low child motivation or family time restrictions. Multiple families suggested an interactive digital application would be an effective delivery channel for the supplemental home-based program.ConclusionA goal-directed exercise program delivered at home and in community-based locations was considered valuable and helpful for improving movement competence in paediatric survivors of posterior fossa brain tumour.Trial registrationACTRN12619000841178 June 12, 2019

A Single Center Description of Adult and Pediatric Endoscopic Posterior Costal Cartilage Grafting.

Posterior glottis impairment alters breathing, voicing, and swallowing. Bilateral vocal fold movement impairment (BVFMI) occurs when the vocal cords are fixed/remain midline. Studies inadequately assessed endoscopic posterior costal cartilage grafting (enPCCG) for BVFMI across broad ages. We aim to assess decannulation and prosthesis free airway in children and adults who have undergone enPCCG. Retrospective cohort. Referral center. This study included adults and children who received enPCCG for BVFMI (2010-2018) and were followed for 35 months on average. The main outcome was successful decannulation of patients, or airway improvement in those without tracheostomy. Data on comorbidities, surgical complications, and interventions following surgery were collected. Ten children and 11 adults underwent enPCCG for BVFMI. Eighty-one percentof patients had a tracheostomy at surgery; adults were more likely to have a tracheostomy at surgery (P = 0.035), and to undergo double-staged procedure (P = 0.035) and stent (P = 0.008). Average stent duration was 29.7 days. Overall decannulation rate was 76% (90% for children; 70% for adults). Children were more likely to receive postoperative intensivecareunit care (P = 0.004). Adults had mean 4.4 post-enPCCG interventions per patient compared to children's mean 3.91 interventions. The most common interventions were steroid injection (17.6%) and balloon dilation (16%). Preliminary analysis suggests postoperative dysphonia was reported in 66.7% of patients; postoperative dysphagia was rare. EnPCCG was more successful at achieving decannulation in children. Adults required additional interventions. A double-staged operation with prolonged stenting is recommended for adult patients. A majority of patients were decannulated at last follow-up.

The Impact of Consanguinity on Severity of Posterior Urethral Valve

Background: Posterior urethral valve (PUV) is one of the frequent causes of obstructive uropathies at birth. When inadequately managed, it leads to vesicoureteric reflux disease, recurrence of UTIs, voiding disorder and chronic renal insufficiency. These valves have been observed among the siblings, twin children and also in the subsequent generation. However, their occurrence rate and association with consanguineous have never been investigated. Objective: To assess the frequency and impact of kinship on the severity of the posterior urethral valve at our centre. Study Design: A Retrospective Study Place and duration of study: Diagnosed cases of posterior urethral valves who underwent valve fulguration from Jan 2012 to April 2020 were assessed in this study, conducted at Shifa International Hospital, Islamabad. Material and method: Patients were diagnosed via voiding symptoms, ultrasound, and confirmation by VCUG and cystoscopy. In all patients, the history of consanguineous marriage and any history of PUV in the family was inquired. All cases were evaluated for renal function with BUN and creatinine, including eGFR, as per Schwartz's formula. A nuclear scan was performed in all patients to rule out renal scaring and split renal function. Results: The mean age of children who underwent valve fulguration was 4.34 + 2.7 years. Family history of first-degree cousin marriage was found in 56 (33.0%) patients. Statistical analysis of clinical parameters of the posterior urethral valve, including the degree of hydronephrosis, vesicoureteric reflux and chronic kidney disease, showed that the product of cousin marriage had more severe disease. Conclusion: One-third of PUV patients had a history of consanguineous marriages in this study. These cases develop early renal insufficiency as well as a more severe disease. Keywords: Posterior urethral valve, Consanguinity, Severity, Renal insufficiency, Retrospective Study