Pediatric Ward Research Articles

Clinical and Laboratory Parameters Associated with PICU Admission in Children with Multisystem Inflammatory Syndrome Associated with COVID-19 (MIS-C).

Background/Objectives: Multisystem Inflammatory Syndrome in children (MIS-C) is a rare but severe post-infectious complication of COVID-19 that often requires admission to the Pediatric Intensive Care Unit (PICU). The present study aimed to compare the demographic, clinical, and laboratory characteristics of children diagnosed with MIS-C who were admitted to the PICU and those who did not require PICU admission. Methods: Children diagnosed with MIS-C from September 2020 to April 2023 were included in this case-control study. Demographic, clinical, and laboratory data were collected from medical records. Results: Fifty children with MIS-C were included in the study [median (IQR) age: 7.5 (4.3, 11.4) years, 28/50 (56%) males]. Twenty-two (22/50, 44%) children required admission to the PICU. In the multivariate regression analysis, hepatic (OR: 12.89, 95%CI: 1.35-123.41, p-value = 0.03) and cardiological involvement (OR: 34.55, 95%CI: 2.2-541.91, p-value = 0.01) were significantly associated with hospitalization at the PICU. Regarding the laboratory and imaging parameters during the first 48 h from admission, D-dimer levels higher than 4 μg/mL and decreased Left Ventricular Ejection Fraction (LVEF) were associated with an increased risk of PICU admission (OR: 7.95, 95%CI: 1.48-42.78, p-value = 0.02 and OR = 1.28, 95%CI: 1.07-1.53, p-value = 0.01). Children who were admitted to the PICU were more likely to develop complications during their hospitalization (10/22, 45.5% vs. 3/28, 10.7%, p-value = 0.005) and were hospitalized for more days than children in the pediatric ward (median length of stay (IQR): 20 (15, 28) days vs. 8.5 (6, 14) days, p-value < 0.001). Conclusions: The findings of this study indicate that cardiovascular and hepatic involvement and increased D-dimer levels in children with MIS-C might be associated with admission to the PICU.

Lightning Injury: Case of a 7-Year-Old Child Struck by Lightning in Region 8 Guyana

Background: It is estimated that lightning occurrence frequency worldwide is 50 occurrences per second with 20% of those resulting in ground strikes. It is estimated that approximately 24,000 fatalities occur worldwide due to lightning strikes and in the US 25-50 patients die each year. The mechanisms of injury due to lightning strike are numerous which includes the effects of the electrical current passing through body tissue, burns and mechanical trauma. Cardiac and respiratory arrest are more common with direct lightning strikes and may lead to sudden death. Case Presentation: Here we present a case of child who was struck by lightning in a hinterland region. The child was found in an unconscious state by a passerby. He was then taken to a local health post where he regained consciousness. Initial vitals were stable, and child appeared to have suffered burns about the body. Arrangements were made and he was air dashed to GPHC. He was alert with stable vitals when he arrived, appeared to have suffered minor burns about the body. His ECG, X rays and CT head were all normal. He had an elevated CPK level which caused concern for Rhabdomyolysis. He was admitted to the paediatric ward. Outcome: The child spent 3 days on the ward, where he was monitored closely for any delayed complications related to lightning injuries. His CPK had normalized, he received dressings for his burns and was subsequently discharged home. Keywords: Lightning Strike, Lightening Injuries

Causes of Hospitalization in Children with Down Syndrome.

Background and Objectives: Down syndrome (DS) is the most common chromosomal disorder in the world. It is caused by the imbalance of the chromosomal constitution of 21 by free trisomy, translocation or mosaicism. Children and adolescents with Down syndrome have immune dysregulation and are more susceptible to infections. This study aims to evaluate hospitalizations of children and adolescents with DS in the pediatric ward of Botucatu Clinics Hospital (HCFMB) and to classify the population of children included in the study according to age, diagnosis, outpatient follow-up, length of stay and need for the intensive care unit (ICU). Thus, it will be possible to improve care for these children, aiming to reduce these hospitalizations. Materials and Methods: This study was an observational, cross-sectional study, with retrospective data collected from the last nine years of hospitalization, from January 2013 to December 2021, from children and adolescents with DS in the pediatric ward, emergency room, and the ICU of HCFMB. Children hospitalized in this period in the pediatric ward and ICU, in the age range of 30 days to 15 years, were included in this study. The evaluation of comorbidities that culminated in the need for hospitalization in this population can be the focus of actions to improve the diagnoses and conducts for this population, which can prevent worsening illness and hospitalizations in future populations. Results: In this analysis, 80 children with DS were evaluated, with a total of 283 hospitalizations. The most prevalent age group was 1 to 3 years, and the main cause was due to problems in the respiratory system (99 cases). Among the respiratory causes, the main cause of hospitalization was due to pneumonia in 50% of cases, followed by acute respiratory failure in 14%. The average hospitalization time was 8 days, and in 49 hospitalizations, the children required the ICU. The main cause of hospitalization in the ICU was due to respiratory causes (36%), followed by cardiac malformations (14%). During the ICU hospitalizations, there were 13 deaths, and we observed a higher prevalence of heart conditions and, in some cases, positive urine cultures in these children. Conclusions: The Hospital serves as a reference for pediatric hospitalizations within its region and beyond, owing to its specialized capabilities. The main causes of hospitalization were those related to the respiratory system and cardiac malformations. Roughly one-third of the children required admission to the intensive care unit.

Care Burden and Psychological Resilience of Mothers Accompanying Their Children with Chronic Illnesses Hospitalized in Pediatric Wards

Abstract Background: Psychological resilience plays a pivotal role in managing the caregiving burden experienced by mothers of hospitalized young children with chronic illnesses. The resilience of these mothers is not only critical for their own mental health but also for the well-being and development of their child. Aim: This study aimed to assess the care burden, psychological resilience, and associated factors of mothers with hospitalized children aged 0-2 years who have chronic diseases. Materials and Methods: The participants included 134 mothers of hospitalized children. Data were gathered utilizing a personal information form, the Zarit Burden Interview, and the Brief Resilience Scale. Results: Working mothers with a bachelor’s degree had higher Zarit Burden Interview scores than non-working mothers. Mothers of children with epilepsy and neurological diseases had higher Zarit Burden Interview scores than those with other chronic diseases. Mothers receiving instrumental and spiritual support had significantly higher Brief Resilience Scale scores. Discussion: Among mothers who accompany their children with a chronic illness diagnosis in the hospital, those who are university graduates, employed, or have children diagnosed with epilepsy and neurological diseases are particularly at risk in terms of the burden of care and psychological resilience. Conclusion: Physicians and especially pediatric nurses can enhance the psychological resilience of these mothers identified as a risk group in this study and alleviate their care burden by providing instrumental and moral support in the clinical setting. The support given to these accompanying mothers can contribute more significantly to the child's quality of life and care.

Improving effective coverage of medical-oxygen services for neonates and children in health facilities in Uganda: a before–after intervention study

Medical oxygen services are essential for the care of acutely unwell patients. We aimed to assess the effects of a multilevel, multicomponent health-system intervention on hypoxaemia detection, oxygen therapy, and mortality among neonates and children attending level IV health centres and hospitals in Uganda. For this before-after intervention study, we included children who attended paediatric or neonatal wards of 24 level IV health centres and seven general or regional referral hospitals in the Busoga and North Buganda regions of Uganda between June 1, 2020, and June 30, 2022. All neonates younger than 1 month and children aged 1 month to 14 years were eligible for inclusion. We excluded neonates who were not sick but stayed in the maternity ward for routine postnatal care. The intervention involved clinical training, mentorship, and supportive supervision; provision of pulse oximeters and cylinder-based oxygen sources; biomedical-capacity support; and support to develop and disseminate oxygen supply strategies, oxygen therapy guidelines, and lists of essential oxygen supplies. Trained research assistants extracted individual patient data from case notes using a standardised electronic data collection form. Data were collected on health-facility details, age, sex, clinical signs and symptoms, admission diagnoses, pulse oximetry readings, oxygen therapy details, and final patient outcome. The primary outcome was the proportion of admitted neonates and children with a pulse oximetry oxygen saturation reading documented in their patient case notes on day 1 of health-facility admission (ie, pulse oximetry coverage). We used mixed-effects logistic regression to evaluate the effect of the intervention. We obtained data on 71 997 eligible neonates and children admitted to 31 participating health facilities; the primary analysis included 10 001 patients in the pre-intervention period (ie, June 1 to Oct 30, 2020) and 51 329 patients in the post-intervention period (ie, March 1, 2021, to June 30, 2022). Because 1356 patients had missing data for sex, 4365 (46·7%) of 9347 in the pre-intervention group and 22 831 (46·2%) of 49 410 in the post-intervention group were female; 4982 (53·3%) in the pre-intervention group and 26 579 (53·8%) in the post-intervention group were male. The proportion of neonates and children with pulse oximetry at admission increased from 2365 (23·7%) of 10 001 in the pre-intervention period to 45 029 (87·7%) of 51 328 in the post-intervention period. Adjusted analysis indicated greater likelihood of a patient receiving pulse oximetry during the post-intervention period compared with the pre-intervention period (adjusted odds ratio 40·10, 95% CI 37·38-42·93; p<0·0001). Large-scale improvements in hospital oxygen services are achievable and have the potential to improve clinical outcomes. Governments should be encouraged to develop national oxygen plans and focus investment on interventions that have been shown to be effective, including the introduction of pulse oximetry into routine hospital care and clinical and biomedical mentoring and support. Bill & Melinda Gates Foundation and ELMA Philanthropies. For the Luganda and Lusoga translations of the abstract see Supplementary Materials section.

Effectiveness of a structured handover tool (I-PASS + C) in patients transferred out from pediatric intensive care unit to ward: A single-center, prospective observational study from Western India

Abstract Background: Handover is a process of communication between physicians and, thus, integral to medical practice. Communication failures commonly cause preventable medical errors and adverse events. This study was done to evaluate the effectiveness of a structured handover tool. Subjects and Methods: It is a prospective observational study conducted in pediatric intensive care unit (PICU) of tertiary care hospital of Western India. The errors were noticed in the handover process of patients who were transferred from the PICU to the pediatric ward. A modified handover tool I-PASS + C was implemented as an intervention. The outcome was measured in the form of changes in the number of errors postintervention. Results: The handovers enrolled in the control group were 46 (28.04%) and 40 (24.39%) in the intervention group. Patient’s age ranged from 3 months to 205 months. “Not mentioning information regarding counseling and parent’s response/behavior” and “no cross check by hearing back from the receiver” were the most commonly noticed errors in 40 (86.9%) and 31 (67.4%) patients, respectively, which reduced significantly in the intervention group. Other commonly noticed errors during the stay in the ward were “got phone call from ward to take further information” in 16 (34.78%) patients, followed by “medical errors reported in ward” in 8 (17.4%) patients, which also reduced significantly in the intervention group. Conclusions: A structured handover tool reduces the errors of the handover process as well as adverse events, after transferring the patient from the PICU to the ward.

The Effects of Visual Arts and Animated Film Therapy in Managing Emotional Fatigue in Preschool Children Hospitalized in the Pediatric Ward of RSUD Poso

Preschool-aged children who experience hospitalization in a pediatric ward often face a variety of emotional challenges, including emotional exhaustion. Hospitalization is a frightening and stressful experience for children, especially when they are separated from their family and peers. Visual art and animation film therapy have been recognized as effective therapeutic methods for addressing children's emotional exhaustion and stress. Visual arts play therapy allows children to express their feelings, overcome anxiety, and build emotional connections with their surroundings. The study aimed to look at the effects of visual art play therapy and animated films on managing emotional exhaustion in hospitalized preschool-age children. The data were collected through observation, interviews, and questionnaires given to parents. The result obtained by the treatment group's mean emotional exhaustion score before the action was 32.20, and after the action was 21.80. Wilcoxon statistical analysis, p-value = 0.001. So, it is concluded that there is a significant decrease in children's emotional exhaustion before and after therapy. The conclusion of this study can help improve the care and well-being of preschool children who experience hospitalization, as well as provide valuable insights for health practitioners and educators in supporting the emotional development of children in challenging medical situations.

Issues in Clinical Learning Environment Faced by Female Nursing Students at Jamshoro, Pakistan

Hospital-based education provides a supportive environment for nursing students who accept challenges for their profession. Although nursing is primarily a skill-based profession, clinical training is an important component of the growing nursing field. This empowers nursing students to integrate theoretical information into their psychomotor abilities, which they may then use in patient care. Objective: To identify issues in the clinical learning environment faced by female nursing students at Jamshoro. Methods: A descriptive cross-sectional study was directed at the public sector Liaquat College of Nursing attached to Liaquat University Hospital in Jamshoro from November 2023 to April 2024. A convenience sampling technique was utilized, and the research tool was adopted with some modifications and expert consultations to collect the data. Nursing students enrolled in clinical practice for six months and performed data analysis using IBM SPSS version 25.0. Results: The mean age of the participants in this study was evaluated at 21.5 years, with a standard deviation of 0.664 years. According to our findings, 24.6% of participants assigned their duties to the pediatric ward. 82.4% of participants were overseen by a single teacher, 78.3% lacked personal protection equipment, and 72.5% reported a lack of cooperation between the College of Nursing and the hospital. Conclusions: It was concluded that most participants are dissatisfied with clinical education, thus, reducing the shortage of clinical faculty, providing personal protective equipment, and developing good coordination between nursing colleges and hospitals can reduce issues faced by nursing students in clinical settings, thereby improving patient care.

Predictors of Morbidity and Mortality of Gastrointestinal Perforation in Children

Background: Gastrointestinal perforation is a common surgical problem in paediatric surgical ward in our country. It carries a high morbidity and mortality in children. The predictors of postoperative morbidity and mortality are still not well established. Objectives: The objective of this study was to identify the predictors of morbidity and mortality following surgery for gastrointestinal perforation in children. Methods: This was a single centre cross sectional type of descriptive observational study carried out in the Department of Paediatric Surgery, Mymensingh Medical College Hospital with 16-month duration from 1st January, 2017 to April 30, 2018, in children aged from 2-12 years. Predictors related to postoperative morbidity and mortality were investigated. Results: A total of 40 patients were selected for this study with mean age of 8.92±2.61 years. Male: female was 1.5:1. Analysis indicated that factors associated with postoperative morbidity and mortality were low BMI, poor nutritional status, low serum total protein and albumin, delay in seeking treatment and contaminated peritoneal collection. Appendicular perforation was the highest number perforation in 23(57.5%) patients. Ileal perforation was the second highest number 8(20%). Appendectomy was the highest surgical procedure 21(52.5%), followed by resection-anastomosis and wound excision &amp; repair 3(7.5%) each. Serum total protein and albumin were below normal limit among 15(37.5%) and 35(87.5%) patients respectively. 13(32.5%) patients received treatment 72 hours after onset of symptom and 18(45%) patients undergone operation within 24-48 hours of admission. Postoperative complications developed in 30 patients. Among them SSI were in 20(66.66%), SIRS in 9(30%) and leakage of repair in 1(3.33%) patient. Mortality rate was 5%. Conclusion: Poor nutritional status, low total serum protein and albumin, delay in initiation of treatment, and contaminated peritoneal fluid are the predictors of morbidity and mortality of gastrointestinal perforation in children.

Development and Validation of a Pediatric Hospital-Acquired Malnutrition (PHaM) Risk Score to Predict Nutritional Deterioration in Hospitalized Pediatric Patients: A Secondary Analysis Based on a Multicenter Prospective Cohort Study.

(1) Background: Hospital-acquired malnutrition in pediatric patients leads to adverse outcomes. This study aimed to develop and validate a pediatric hospital-acquired malnutrition (PHaM) risk score to predict nutritional deterioration. (2) Methods: This was a derivative retrospective cohort study for developing a PHaM risk score. The study included data from children aged 1 month-18 years admitted to pediatric wards in four tertiary care hospitals for at least 72 h between December 2018 and May 2019. Data on pediatric patients' characteristics, medical history, nutritional status, gastrointestinal symptoms, and outcomes were used for tool development. Logistic regression identified risk factors for nutritional deterioration, defined as a decline in BMI z-score ≥ 0.25 SD and/or ≥2% weight loss. A PHaM risk score was developed based on these factors and validated with an independent prospective cohort from July 2020 to March 2021. (3) Results: The study used a derivative cohort of 444 patients and a validation cohort of 373 patients. Logistic regression identified gastrointestinal symptoms, disease severity, fever, lower respiratory tract infection, and reduced food intake as predictors. The PHaM risk score (maximum 9 points) showed good discrimination and calibration (AUC 0.852, 95% CI: 0.814-0.891). Using a cut-off at 2.5 points, the scale had 63.0% sensitivity, 88.6% specificity, 76.1% positive predictive value, and 80.6% negative predictive value (NPV) when applied to the derivative cohort. The accuracy improved on the validation cohort, with 91.9% sensitivity and 93.0% NPV. (4) Conclusions: This PHaM risk score is a novel and probably effective tool for predicting nutritional deterioration in hospitalized pediatric patients, and its implementation in clinical practice could enhance nutritional care and optimize outcomes.

Policy brief of the Belgian Europe’s Beating Cancer Plan mirror group: children, adolescents and young adults with cancer

Children and Adolescents and Young Adults with cancer represent a young population with specific needs, which need to be addressed in a patient- and cancer-driven way. There is an urgent need to support and extend the ongoing initiatives in Belgium. First, multidisciplinary care programmes dedicated to children need to be reviewed, and those for Adolescents and Young Adults need to be developed with close collaboration between paediatric and adult oncology and haematology teams. This needs to be done considering the entire patient journey; from cancer prevention, diagnosis, treatment, rehabilitation, follow-up of late effects, transition pathways between paediatric and adult wards, and palliative care. Second, national haemato/oncology precision programmes adapted to this young population with rare cancers, including infrastructure to manage cancer gene predisposition in CAYAs with cancers and their relatives, needs to be developed. This multi-level plan aims to ensure improved outcome with high quality of care for the young population with cancer in Belgium in line with Europe’s Beating Cancer Plan initiatives.

Mid-upper arm circumference as an indicator of nutritional status improvement in children aged 6-59 months with severe acute malnutrition

Background The prevalence of severe acute malnutrition (SAM) in Indonesia remains high, especially in children with pre-existing chronic disease. These children often present with conditions that could interfere with weight measurements, such as edema or organomegaly. Mid-upper arm circumference (MUAC) is a potential indicator of nutritional status improvement. Objective To analyze the correlation between MUAC and body weight as parameters for nutritional improvement in children with SAM. Methods We performed registry analysis of patients admitted to the Pediatric Ward, Cipto Mangunkusumo Hospital, Jakarta, Indonesia from November 2016 to December 2020. We included children aged 6-59 months who were severely wasted (z-score &lt;-3 on the WHO weight-for-height growth chart), had no conditions that could alter weight measurement, and had a 7-day minimum hospital stay. Patients with missing body weight and/or MUAC data were excluded. MUAC and weight increment between admission and discharge were analyzed using bivariate correlation and linear regression analyses. Results Out of 4,746 pediatric inpatients, 1,996 presented with SAM. Of these, 124 were eligible for analysis. Subjects’ median age was 18 (IQR 11-32) months and median length of stay was 16 days (IQR 9-29 days). Weight increment (g/kg/day) and MUAC increment (mm/day) were independently and significantly correlated (P&lt;0.001; Spearman’s rho=0.414). An adequate weight increment of 5-10 g/kg/day was equivalent to a MUAC increment of 0.319-0.439 mm/day (P&lt;0.001; R=0.374). Conclusion MUAC increment has a moderate positive correlated with weight increment. MUAC is a useful parameter of nutritional status improvement in SAM patients, especially in patients with conditions that could interfere with weight measurement.

Management of Solid Medical Waste at Regional Public Hospital of West Papua Province

This study aims to characterize, identify and evaluate the management of solid medical waste in the West Papua Province Regional Public Hospital. This research is descriptive qualitative research conducted in December 2023 -January 2024 at the emergency room, obstetrics ward, pediatric ward, perinatology ward, surgical room, internal disease department and laboratory. The results research are the average amount of solid medical waste in West Papua Province Regional Public Hospital is 282.3 kg/month, consisting of infectious solid medical waste of 229 kg/month and the amount of infectious sharps medical waste of 53.3 kg/month. The process of solid medical waste management of hospitals in West Papua Province Regional Public Hospital has referred to the Government Regulation of the Republic of Indonesia Number 7 of 2019, although the results are not all appropriate.

Child Maltreatment: To Report or Not to Report? It’s More Complex than That

Child maltreatment (CM) is a widespread problem, contributing to health and societal difficulties often throughout the lifespan. Healthcare professionals (HCPs) who see potential warning signs for CM are responsible for protecting the child from future harm, which may involve alerting the authorities. The decision-making is challenging as unwarranted reporting may lead to mistrust and not benefit the child. We sought to explore what factors might influence HCPs’ decisions to report suspected CM in a Norwegian sample. Using a cross-sectional survey among HCPs in Norwegian hospitals with pediatric wards, we presented five case vignettes describing different probabilities of CM and variables assessing experience, knowledge, and confidence. A total of 382 HCPs completed the survey. Despite recognizing warning signs for CM in the case vignettes, a large proportion were reluctant to report to authorities. Recognition of CM and expressed willingness to report four or all five of the case vignettes (high reporters) was associated with the profession, knowledge, experience, and confidence in handling CM cases. Expressed confidence in performing physical examinations for physical or sexual abuse and talking with parents about abuse was significantly associated with high reporting (OR 2.3 to 17.8). Qualitative data further supported the role of self-efficacy. In summary, reporting to the authorities is an important but complex aspect in cases of suspected CM, but many HCPs relate that they fail to do so. This study indicates reporting suspicion of CM is correlated with self-efficacy and knowledge among HCPs, which should inform educational, social, and policy decisions.

The Effect of Watching Cartoon on Pain and Anxiety of Venipuncture in 3-6 Year-Old Children: A Randomized Controlled Clinical Trial

Background: Injection-induced anxiety in children is a significant issue, as the pain from injections creates both physical and psychological stress, reducing the child's tolerance and cooperation. Objectives: To determine the effect of watching a cartoon on venipuncture-induced pain and anxiety among 3 - 6-year-old hospitalized children. Methods: In this randomized controlled clinical trial, children admitted to the pediatric ward of Bu-Alisina Hospital in Sari were randomly allocated to intervention and control groups. For the intervention group, the distraction technique of watching a cartoon was used during venipuncture. The demographic and medical information was collected using a questionnaire, and pain and anxiety were assessed using the Spence Children’s Anxiety Scale (SCAS)-Parents version, the face, legs, activity, cry, and consolability (FLACC) Behavioral Pain Scale, and the Facial Image Scale (FIS) before and during venipuncture. Data analysis was performed using non-parametric tests, with a significance level set at less than 0.05. Results: A total of 140 children were studied in two groups, with 78 (55.71%) being boys. The mean age of children in the intervention group was 52.44 ± 14.37 months, and in the control group, it was 50.91 ± 15.66 months. In the intervention group, the mean pain ranks before and after venipuncture were 4.17 ± 2.36 and 6.0 ± 2.42, respectively, while in the control group, they were 4.40 ± 1.96 and 6.93 ± 2.21, respectively. The mean anxiety ranks before and after venipuncture were 2.61 ± 1.32 and 3.26 ± 1.35 in the intervention group, and 2.80 ± 1.016 and 3.80 ± 0.99 in the control group. The mean pain and anxiety ranks after venipuncture were significantly different between the groups (P &lt; 0.05). Additionally, the mean ranks of pain and anxiety before and after venipuncture were significantly different within both groups (P &lt; 0.001). Conclusions: Based on the results of this study, the cartoon distraction technique effectively reduced pain and anxiety caused by venipuncture in children.

Relationship between Preferred Decorations, Colored Walls and Nurses’ Uniforms to the Hospital Anxiety of Pediatric Patients

Background and Aim Investigates the presence of relationship between preferred decorations, colored walls, and nurse’s uniform to hospital anxiety of 150 pediatric patients admitted in the pediatric ward of Geregorio T. Lluch Memorial Hospital in Iligan City, Philippines.  Design The researchers utilized a cross-sectional correlational approach to explore probable associations between the variables and hospital anxiety, giving an insight into factors that are likely to affect hospital anxiety among the patients.  Results Key findings include a strong preference for ward decorations with themes. Among hobby spaces, crafting area had the highest number of likes. All colors were preferred for colored walls except for black, brown and burgundy. Having no wall art/mural, no natural elements in the decorations, and no decorations in ward rooms were disliked or not preferred. Themed wall mural, and gray and blue colored walls have significant relationship to hospital anxiety. There is also a significant relationship between stripes as nurses’ uniform design and peach orange as a uniform color, and hospital anxiety.  Conclusion The overall finding was that most pediatric patients experienced similar levels of anxiety regardless of their preferences for decorations, colored walls, or nurses’ uniforms. This imply that while children have varied preferences in terms of the hospital environment, these preferences influence their hospital anxiety levels during hospital stays.

Is hyperammonemia helpful in detecting syndromic tubulopathies with early extrarenal manifestations? A case report of Lowe’s syndrome

BackgroundGenerally, it is not well known that Lowe’s syndrome may coexist with hyperammonemia and hipocarnitynemia. The importance of hyperammonemia in the diagnosis of kidney diseases is not completely understood.Case presentationWe present the history of a 13-year-old boy, admitted to the hospital due to proteinuria. In the past, the boy was diagnosed with binocular cataracts in infancy. Then he went through neurological diagnostic tests which diagnosed muscular hypotonia and psychomotor retardation but no inherited errors of metabolism were found. Proteinuria has been observed since the age of 2. Ultrasound imaging at the age of 5 showed the presence of a shading deposit in the kidney. At the age of 13, the boy was referred to the Pediatric Nephrology Ward. The laboratory tests revealed: a reduction of glomerular filtration rate, metabolic acidosis, proteinuria, hypercalciuria, increased activity of AST (SGOT), CK, LDH, hyperammonemia, and decreased concentration of total carnitine in blood serum. Based on the clinical presentation, Lowe’s syndrome was diagnosed. The genetic testing revealed an OCRL gene hemizygous mutation.ConclusionLowe’s syndrome is an example of a disease in which clinical symptoms—although occurring early and in high intensity—may not raise the suspicion of tubulopathy for a long time if they are not analyzed in a complex manner. There is a necessity to educate healthcare practitioners from other fields about the extrarenal symptoms of genetically determined tubulopathies.l-carnitine deficiency may be a symptom of proximal tubulopathy, including Lowe’s syndrome. l-carnitine deficiency leads to disturbances in the efficiency of the urea cycle, which results in hyperammonemia. Hyperammonemia is not only a symptom of inborn errors of metabolism and liver failure, but it may also lead to the diagnosis of tubulopathy.Since carnitine supplementation could have the desired beneficial effect on the patient’s general condition, it is postulated to conduct further studies on larger groups of patients with Lowe’s syndrome.

Retrospective, cross-sectional study of the determinants of acute flaccid paralysis among children in Pakistan

Background: Timely diagnosis of acute flaccid paralysis is very crucial in developing countries like Pakistan, because this will have significant impact on management. Aim: To assess the surveillance, aetiology and epidemiology of acute flaccid paralysis in a tertiary care hospital in Peshawar, Pakistan. Methods: This retrospective, observational study was conducted at the Paediatric Department of Lady Reading Hospital, Peshawar, in 2022. Data on all children aged 1 month to 15 years and diagnosed with acute flaccid paralysis were retrieved from the electronic medical records and patient files of the hospital. The data were analysed using SPSS version 27. Results: Eighty-eight (1.34%) of the 6544 patients admitted to the paediatric ward met the inclusion criteria for acute flaccid paralysis; 63 (71.6%) of them were male, 25 (28.4%) female, mean age 6.68 ± 3.86 (mean ±SD) years. Guillain Barre Syndrome was diagnosed in 36 (40.9%) of them, meningoencephalitis in 26 (29.5%), septic arthritis in 6 (6.8%), and hypokalaemia paralysis and cerebrovascular accidents in 5 (5.7%). Three (3.4%) of the patients had post-diphtheria neuropathy and 1 (1.1%) had poliomyelitis. In-hospital mortality was 2.3% (2). Conclusion: Although acute flaccid paralysis is vaccine-preventable and its infectious aetiology is low, its surveillance in Pakistan should be continued to reduce occurrence and progress towards polio eradication.

Prevalence and causes of medication transcription errors among hospitalized patients: An observational study and survey of nurses at a faith-based hospital in Cameroon

Medication errors are a leading cause of death globally; with the burden on resource-limited countries more than double that in high-income countries. Errors can occur at all stages of the medication use process; however, there is limited information on medication transcription errors (MTEs) among hospitalized patients in Africa. This study sought to determine the prevalence and types of MTEs and to assess nurses&amp;rsquo; perceptions of the likely causes of MTEs within the pediatric and general wards at a faith-based hospital in Cameroon. A prospective chart review of medication orders transcribed for patients admitted from April 1 to April 30, 2021, was conducted. Data analyzed included patient demographics, prevalence and types of MTEs, medication classes involved in MTEs, and nurse&amp;rsquo;s perceptions of the causes of MTEs. A total of 578 medication orders were reviewed for 75 patients, of whom 40 (53%) were female, and 30 were admitted to the pediatric ward. The results revealed that 38 MTEs were recorded, with 47% occurring on the medication administration sheet and dispensing cards. The most frequent MTEs were the omission of new and stop medication orders, involved in 28.9% and 26% of all MTEs, respectively. Antibacterials for systemic use were involved in the majority (55.3%) of MTEs. Illegible prescriptions (90.7%), distractions (87.0%), and high workload (77.8%) were ascribed as the most likely causes of MTEs. In conclusion, MTEs are common and pose a potential risk of patient harm in hospitalized patients. The adoption of a computerized provider order entry system could eliminate illegible prescriptions, reduce transcription processes, and alleviate workload, thereby improving patient safety.

A Local Experience of Antibiotic Lock Therapy as an Adjunctive Treatment for Central Venous Catheter-Related Bloodstream Infections in Pediatric Oncology and Hematology Patients.

One of the main drawbacks of tunneled central venous catheters (CVCs) is catheter-related bloodstream infections (CRBSIs). Antibiotic lock therapy (ALT) can be combined with systemic antibiotics to achieve catheter salvage. Our objectives are to describe cases of CRBSI and our experience with ALT in a pediatric oncology-hematology ward. a retrospective descriptive study of pediatric CRBSI cases in a Spanish oncology-hematology unit from 2007 to 2017 was conducted. We collected demographic, clinical, and microbiological data from all patients. fifty-eight CRBSIs were diagnosed in thirty-nine patients; 72.9% of these patients were male, with a median age of 42.1 months. The main underlying diseases were leukemia/lymphoma (51.7%) and solid tumors (32.7%). Thirty-five (60.3%) CRBSIs were caused by Gram-positive cocci, of which 70.6% were coagulase-negative Staphylococci, and sixteen (27.6%) were caused by Gram-negative bacilli. We treated 41/58 (71%) cases with ALT. A total of 12/17 (71%) CVCs that were not treated with adjunctive ALT were removed, compared with 13/41 (32%) that were treated with ALT (relative risk (RR), 0.449; confidence interval (CI), 95%: 0.259-0.778, p = 0.004). Major reasons to remove the CVC in the CRBSI-ALT group were local insertion/pocket site infection (23%), persistent symptoms (23%), and infectious' relapses (15%). ALT was shown to be an effective approach to keeping the CVC in place, with no added adverse effects.