Pediatric Clinic Research Articles

Are you asleep? Comparing sleep metrics in pediatric cardiac patients with objective and subjective indicators

BackgroundExamination of sleep in pediatric cardiology patients has typically relied on self-reports with unknown reliability to objective assessments. Wearable technologies provide an objective data source to evaluate sleep. Improved understanding and treatment of sleep in pediatric heart patients may be an untapped aspect that could improve health-related quality of life. ObjectivesThe purpose of this study was to identify patterns of duration and quality of sleep in pediatric cardiology patients using both subjective and objective assessment. MethodsPatients were recruited in a pediatric cardiology clinic and completed a set of sleep and quality of life questionnaires including the Pittsburg Sleep Quality Index (PSQI), the Pediatric Cardiac Quality of Life Inventory (PCQLI), and the Cardiac Anxiety Questionnaire (CAQ). Patients also agreed to wear an actigraphy watch for 7 days, and caregivers were also recruited as proxy raters. ResultsThe sample included 31 patients with a mean age of 15.58 (SD = 1.89). Patients self-reported an average sleep duration of 7.61 h (SD = 1.67, range = 3–11). In contrast, objective sleep data indicated that patients obtained an average of 5.98 h of sleep nightly (SD = 1.01, range = 3.23–7.46) with a sleep efficiency score of 73.2 (SD = 6.23) and a sleep latency period of 21.04 min (SD = 19.16, range = 1–63). Parent-reported sleep duration on the PSQI had a mean of 8.10 h (SD = 1.34, range = 6–11). Thirty four percent of patients met PSQI cut off score for poor sleep based on self-report and 30 % based on parental-report. ConclusionsPediatric cardiac patients report better sleep duration than objective assessments. These data suggest that sleep complaints from pediatric cardiac patients may benefit from objective assessment and may need enhanced clinical attention since complaints may over-estimate the duration of sleep.

Implementation of a Nurse-led Paediatric Epistaxis Clinic at a tertiary hospital

IntroductionReferrals for recurrent epistaxis constitute a significant proportion of paediatric ENT consultations. In order to improve access to secondary care, a nurse-led paediatric epistaxis clinic (NPEC) was developed in collaboration with ENT specialist nurses. The purpose of this study was to describe the structure of NPEC at our institution and to assess the impact including safety, parental satisfaction and referral-to-clinic times. MethodsENT specialist nurses were trained by an ENT Consultant through teaching sessions and clinic observations. Standard operating procedure was developed, and competencies were granted before commencement of NPEC. Service evaluation was done to assess the impact of NPEC including safety, parental satisfaction and referral-to-clinic times. All patients who attended NPEC from March 2022-February 2023 were included. Parental satisfaction questionnaires completed at the end of the clinic visit were prospectively collected for first 25 consecutive patients. Patient chart review was performed to assess for complications, need for consultant reviews and waiting times. ResultsForty-seven patients attended NPEC during the study period (77 clinic visits). Median age was 10 years (range 3-16 years). Management included antibiotic ointment (25/77), silver nitrate cautery (28/77) and 3 were listed for nasal cautery under general anaesthesia. Among cases which underwent silver nitrate cautery, there was one minor complication reported. Consultant review was required in 18 clinic visits (23.3 %), including 5 patients requiring fiberoptic nasal endoscopy. Over the study period, median referral-to-clinic time for new patients was 77 days, compared to 229 days for consultant clinic (p= 0.003, Wilcoxon rank sum test). Overall quality of care in NPEC was described as "very satisfactory" and “fairly satisfactory” by 92% and 8% parents respectively. ConclusionNurse led paediatric epistaxis clinics are safe and is associated with high parental satisfaction. Critical to success of NPEC is appropriate patient selection, training and availability of clinician support. These clinics offer a sustainable option to improve access to secondary care for paediatric epistaxis patients.

The Knowledge, Perception And Practices Of Myths Encountered Among Caregivers In Enugu, Nigeria: A Cross-Sectional Study

Introduction: Many beliefs concerning child care abound and these vary across all walks of life. Assessed the knowledge, perception and practice of these myths among care- givers of children living in Enugu. Our survey found that, there is still a high level of belief in myths and local practices among caregivers in Enugu. Methods:Study population- caregivers visiting paediatric outpatient clinics in Enugu. Sampling method- a hospital-based, cross-sectional study. Self- administered questionnaires were used to obtain information from the caregivers. Analysis-Data collected was analyzed using SPSS version 26.0 Results: shows that 83.7% of the study participants are females while 16.3% are males, giving the male to female ratio as 1:5. Most of the study participants (75.2%) were within the age bracket of 21 and 40 years and the mean ± SD age was 32.42 ± 9.83. The most prevalent belief is that the breast nipple must be washed before every feeding, reported by 64.2% of participants. The most commonly practiced belief is that teething causes symptoms, reported by 49.2% of respondents. This is followed by the belief that breast milk can become sour if not consumed for a long period, practiced by 46.6% of respondents. The third most practiced belief is related to "Jedi jedi" (30.6%), a condition locally associated with gastrointestinal distress.These findings highlight that, while traditional beliefs are pervasive across all age groups, younger participants are more likely to adhere to certain beliefs, particularly those related to dietary restrictions and traditional remedies for convulsions. Conclusion: It can be inferred from the findings of this survey that, there is still a high level of belief in myths and local practices among caregivers of children in Enugu, despite efforts to educate the general public about childhood illnesses. This study also shows that maternal education is an important factor for improved outcomes in paediatric care in our environment

Narrative Accounts of Youth and Their Mothers With Chronic Headache: Application of a Socio-narratology Framework to Pain Narratives.

This study was the first to apply a socio-narratology framework to the narratives about child pain as told by youth with chronic pain and their parents, all of whom experience chronic headaches. Storytelling is a powerful social transaction that occurs within systems (eg, families, clinical encounters) and is both shaped by, and can shape, the pain experience. Narrative can be harnessed as a clinical tool to aid in the ability to listen, understand, and improve clinical encounters. Twenty-six youth (aged 11 to 18y) and their mothers, both with chronic headaches, recruited from a tertiary level pediatric pain clinic separately completed in-depth interviews about children's pain journey narratives. Data were analyzed using narrative analysis, which incorporated elements of socio-narratology to compare similarities and differences between and within dyads' narratives. Five narrative types were generated: (1) The trauma origin story-parents, but not youth, positing traumatic events as the causal link to children's pain; (2) mistreated by the medical system-neglect, harm, and broken promises resulting in learned hopelessness or relying on the family system; (3) the invalidated-invalidation of pain permeated youth's lives, with mothers as empathic buffers; (4) washed away by the pain-challenges perceived as insurmountable and letting the pain take over; and (5) taking power back from pain-youth's ability to live life and accomplish goals despite the pain. Findings support the clinical utility of narrative in pediatric pain, including both parents' and youths' narrative accounts to improve clinical encounters and cocreate more youth-centred, empowering narratives.

The integral co-management role of the medical pediatric urologist: Improving the care of children with urological conditions

The complexities of modern medicine prompt a re-evaluation of traditional patient care models to enhance safety and quality. We implemented a one-year pilot Medical Pediatric Urology fellowship, jointly developed by Urology and Pediatric Hospital Medicine, where a pediatrician received postgraduate training in both specialties. This innovative program aimed to augment knowledge and expertise in non-surgical aspects of pediatric urology. Upon completion of the fellowship, the trained pediatrician assumed the role of medical pediatric urologist (MPU), integrating into both Pediatrics and Urology faculties. Unlike the traditional specialist consultation model, the MPU became integral member of the Urology Division, working full-time and sharing responsibilities for both inpatient and outpatient pediatric urology care at a tertiary pediatric hospital in Canada. This study aims to delineate the training curriculum, role, clinical outcomes, and educational impact of the MPU over eight years. We retrospectively analyzed clinical outcomes, including patient volumes seen annually by MPU, urologists, and nurse practitioners from 2021 to 2023. Clinic wait times and patient satisfaction were compared between MPU's community and tertiary hospital pediatric urology clinics. Educational impact was assessed through pediatric residents' ratings for the MPU as a clinical teacher during urology rotations using a Likert scale. Integration of MPU led to the establishment of specialized clinics, including those for neurogenic bladder and posterior urethral valves. MPU accounted for approximately 34.7% of all outpatient clinic visits. Subjective feedback highlighted enhanced quality of care with MPU co-management in the inpatient setting. Additionally, in a community-based medical urology clinic (CUC) staffed by the MPU and a pediatric urology nurse practitioner, patients experienced shorter wait times and higher satisfaction (53±36 days and 194±108 days) (p<0.01), with 97% vs. 91% of families reported feeling highly satisfied with care (p<0.01) compared with hospital clinics, respectively. The MPU received ratings of 4/5 or 5/5 as a clinical teacher from 81.82% of pediatric residents. Our novel co-management approach in pediatric urology integrates medical and surgical expertise. However, limitations include the retrospective design and single-center setting. Nonetheless, this framework presents a potential model for other surgical specialties, offering a unique practice niche for trainees interested in the medical management of surgical conditions. The medical pediatric urologist plays a pivotal role as an educator, hospitalist, and director of the outpatient clinic, effectively integrating medical and surgical expertise. The MPU model is promising for optimizing safety and quality of care in pediatric urology.

Clean intermittent catheterisation determinants and caregiver adherence in paediatric patients with spinal dysraphism and spinal cord injury in a paediatric spinal differences clinic: a mixed methods study protocol

IntroductionClean intermittent catheterisation (CIC) is the standard of care for treating neurogenic lower urinary tract dysfunction (NLUTD), the most common bladder dysfunction in children diagnosed with spinal dysraphism (SD) and...

Amplified pain and complex regional pain syndrome in children: clinical cases and literature review

BACKGROUND: Musculoskeletal pain is a common reason for visiting pediatric clinics. Causes of chronic musculoskeletal pain include various inflammatory or noninflammatory conditions. Amplified pain syndrome refers to a wide range of conditions manifested by chronic pain, the common feature of which is central and/or peripheral sensory amplification of pain. Complex regional pain syndrome is characterized by spontaneously occurring or provoked by irritating stimuli pain of high intensity, disproportionate to the actual injury or other stimulus, and the presence of several concomitant vegetative and motor disorders. CLINICAL CASES: This article presents three clinical cases of pediatric patients with chronic musculoskeletal pain and an analysis of the current literature on chronic pain in children. DISCUSSION: Complex regional pain syndrome is more common in adolescent girls, and conflict or psychological trauma is a common trigger. Symptoms of disproportionate burning pain (causalgia) with trophic changes may indicate complex regional pain syndrome. To date, there are no generally accepted pharmacological treatments recommended for children with complex regional pain syndrome. Nonsteroidal anti-inflammatory drugs (ibuprofen) and paracetamol and their combination are commonly administered in cases wherein symptoms of chronic pain first appear. CONCLUSIONS: Currently, a multidisciplinary approach, including physical, psychological, medical, and invasive methods, appears to be the most adequate treatment method for musculoskeletal pain. The use of analgesics should comply with approved protocols of pain management in pediatric practice.

Relevance of ACE Scores in Teens with Depression and Anxiety: A Maui Pilot Study.

In the aftermath of the Covid pandemic and the notable rise of teen depression and anxiety (DA), there is an urgent need to focus on youth mental health. Another important variable to consider is the presence of adverse childhood experiences (ACE), which can be associated with chronic mental and physical health conditions. This pilot study explores how ACEs relate to DA for adolescents in Maui, Hawai'i. The cohort was 75 patients seen at a Kaiser Pediatric Clinic in the spring of 2022. Data was collected from standard questionnaires and the Pediatric ACEs and Life-Events Screener (PEARLS). There were significant associations between DA and a high ACE score (4+), as well as female sex. A high ACE score can alert providers to initiate a trauma informed dialogue with patients. The effects of trauma are not often discussed at routine visits. Mental health care needs and community support can also be addressed as needed. The PEARLS questionnaire is a standard tool to help clinicians be more trauma-informed. This study explores its relevance at routine adolescent visits.

Effect of Smart Pill Box on Improving Adherence to 6-Mercaptopurine Maintenance Therapy in Pediatric ALL

Abstract Introduction 6-Mercaptopurine (6-MP) forms the backbone of maintenance chemotherapy for acute lymphoblastic leukemia (ALL). A Children's Oncology Group study found 3.9-fold increased risk of relapse in children with 6-MP adherence less than 90%. Objective This article estimates the impact of smart pill box in improving adherence to 6-MP during maintenance phase chemotherapy in children with ALL. Material and Methods It is a prospective interventional study done at pediatric oncology clinic of a tertiary care hospital. Participants being 40 newly diagnosed children with ALL. Baseline adherence was assessed and impact of smart pill box was estimated after using it for 60 days. Subjective and objective assessment of baseline adherence and adherence after intervention was done by subjecting the parents of the children to Morisky Medication Adherence Score 8 (MMAS-8) and measurement of patient's red blood cells (RBC) 6-MP metabolites (6-thioguanine [TGN] and 6-methylmercaptopurine [MMP]) levels, respectively, pre- and postintervention. Results The mean age was 7.39 ± 4.29 years. NUDT15*3 polymorphism was present in 10.26%, and none had TPMT polymorphism. Baseline assessment of adherence to 6-MP by MMAS-8 revealed low, medium, and high adherence in 7.5, 35, and 57.5%, respectively. Baseline 6-TGN and 6-MMP levels by cluster analysis revealed poor adherence in 10%. Following intervention, mean MMAS-8 improved from 7.34 ± 0.78 to 7.66 ± 0.55 (p-value &lt; 0.015) and the median 6-TGN level improved from 150 to 253 pmol/8 × 108 RBCs (p-value &lt; 0.001). Conclusion Nonadherence to 6-MP is widely prevalent in Indian children. Simple measures like smart pill box can improve adherence.

Development and Psychometric Evaluation of the Symptom Assessment Scale for Turkish Children with Cancer

Objective: The present study was conducted to developed the Symptom Assessment Scale for Children with Cancer (SAS-CC) and assessed its reliability and validity for Turkish children. Methods: This research was conducted among in 497 children with cancer who were between 7 and 18 years old. The data were collected with a demographic form and SAS-CC. Descriptive statistics, reliability and validity analysis were used to analyze the data. Results: The mean age of children with cancer was 12.02 +3.38 years. The scale consists of 16 items and 3 sub-dimensions. Total factor loads were more than 0.30 in factor analyses. The confirmatory factor analysis revealed all fit indexes as higher than 0.91, and the root mean square error of approximation (RMSEA) was less than 0.080. Cronbach’s alpha values of total was 0.96. According to the split-half analysis, α values of the first and second halves were 0.94 and 0.93, respectively. Conclusions: This study demonstrated that SAS-CC is the first study to develop and test and a valid scale to evaluate symptoms in children with cancer. Effective strategies of coping with symptoms in children with cancer are required to improve prognosis, increase survival, and improve the quality of life. Therefore, assessing symptoms and their frequency in children with cancer is an majority initiative of nurses working in the pediatric oncology clinic.

Children presenting with toe walking: when should concern arise?

Purpose: This study aimed to evaluate children who present with tiptoe walking (TW) and to identify potential indicators of underlying medical conditions. Materials and Methods: Out of the 248 patients who visited the Pediatric Neurology Outpatient Clinic for gait disturbances, 90 individuals aged 1-17 years were identified as exhibiting TW. After excluding those with systemic neurological diseases and pervasive developmental disorders (PDD), the study ultimately included 47 patients. Results: Among the participants, 19 were female (40.5%) and 28 were male (59.5%). The mean age of the patients was 4.9 years (SD ± 3.53). When evaluating the etiology of TW, 30 patients (63.8%) were found to have idiopathic tiptoe walking (ITW), 8 (17%) had cerebral palsy (CP), 6 (12.7%) had Achilles tendon shortness (ATS), 2 (4.2%) had hereditary spastic paraplegia (HSP), and 1 (2.1%) had syringomyelia. Imaging was not performed for 17 patients (36.1%), while cranial magnetic resonance imaging (MRI) was conducted for 13 (27.6%), spinal MRI for 2 (4.2%), and both cranial and spinal MRI for 15 (31.9%). Pathology was detected in 5 of the patients who underwent imaging (10.6%): 4 (8.5%) showed hypoxic-ischemic processes, and 1 (2.1%) showed syringomyelia. Conclusion: In cases where patients exhibit normal neurological examinations and neuromotor development, TW is often identified as idiopathic. However, for patients presenting with risk factors in their personal or family history, delays in neuromotor milestones, or abnormal neurological findings, a diagnosis should be pursued at an earlier stage.

Using Neuropsychological Profiling to Tailor Mental Health Care for Children and Youth: a Quality Improvement Project to Measure Feasibility.

Precision child and youth mental healthcare has great potential to improve treatment success by tailoring interventions to individual needs. An innovative care pathway in a pediatric mental health outpatient clinic was designed to allow for neuropsychology data to be integrated in psychotherapeutic care. This paper describes the feasibility of this new pathway, including implementation outcomes, acceptability, and potential for future integration. The target population was outpatients 6-17years old referred for individual treatment to a tertiary outpatient mental health (OPMH) clinic. The new care pathway was co-developed by neuropsychologists and mental health practitioners. A logic model was created to guide the evaluation, which was informed by the Reach Effectiveness Adoption Implementation Maintenance framework. As part of the logic model, a stepped assessment protocol was implemented, and reports on neuropsychological function were shared with patients, caregivers, and care providers. Evaluation data were collected from phone surveys, questionnaires, a focus group, and administrative records. Forty-two patients scheduled to receive therapy over a 6-month period were offered the opportunity to participate in the new care pathway and 39 (93%) agreed. Self-reported outcome data showed that 83% of patients and 94% of caregivers valued neuropsychology-informed care, with some describing it as transformative. Almost all practitioners (91%) reported that the project added value to their clinical care. There were no adverse effects on participants nor the flow of patients through the system. Neuropsychology-informed pediatric OPMH care was feasible and well-received. Clinical effectiveness should be studied in an experimental trial.

The impact of life events on child and adolescent psychiatry consultations

Purpose: Children are exposed to many adverse life events, and this may cause psychiatric disorders. In this study, we aimed to investigate the effects of two different life events, the COVID-19 pandemic and the earthquake, on the consultations requested. Materials and Methods: 1268 consultations requested from the child and adolescent psychiatry department between March 2019 and March 2023 were reviewed from hospital records. The specified period was divided into four distinct parts with one-year intervals: pre-pandemic, the first year of the pandemic, the second year of the pandemic, and post-pandemic. The age, gender, diagnoses of the cases, the department requesting consultation and the reason for consultation were recorded. Results: There were statistically significant differences between periods in terms of departments requested consultation, consultation reasons, and diagnoses. Compared to previous periods, a decrease was found in pediatric emergency and general pediatric clinic consultations in the post-pandemic period. In contrast, an increase was seen in nephrology and intensive care unit department consultations because of earthquakes. In the first year of the pandemic, more consultations were requested from the hematology &amp; oncology department compared to other years. While the rate of consultations requested for suicide attempts decreased in the post-pandemic period, consultations for psychiatric assessment increased. Conclusion: Consultation-liaison psychiatry, which is at the center of interdisciplinary interaction, maintains its importance in the prevention and early diagnosis of psychological symptoms that can develop due to both organic events and the effect of trauma itself after the life events.

Investigation of perceived parental attitude in children exposed to sexual abuse: A case-control study.

The enduring impact of children being subjected to sexual abuse is characterized by lasting traumatic effects. This study aims to assess the influence of perceived parental attitudes on the incidence of sexual abuse in children who have experienced such abuse, comparing them with a control group. The research took place at the Child Advocacy Center (CAC) of a hospital in northern Turkey and in the pediatric outpatient clinics of the same institution. The study evaluated 101 children who were exposed to sexual abuse and 100 children who were not. Data collection took place between November 2022 and August 2023. The study employed a 'Descriptive Information Form' and the 'Parental Attitude Scale' for both case and control groups. The t-test for independent samples, descriptive statistics, and logistic regression analysis were used for data analysis. Analysis of scores from the Parental Attitude Scale revealed significantly lower mean scores in acceptance-involvement and strictness-supervision in the case group (p < .05). The mean scores for 'acceptance-involvement' (X¯ = 22.82 ± 6.26, X¯ = 25.71 ± 3.89) were highest in the case and control groups. Neglectful attitude (38.6%) was more prevalent in the case group, while the control group exhibited a higher frequency of democratic attitude (37%). In terms of predictors, acceptance-involvement (OR = 1.091, p = .005) and maternal employment (OR = 4.410, p < .001) were identified as the most significant predictors of exposed to sexual abuse. The study's Cronbach's alpha value for the scale was α = .743. The study's findings on parental attitudes suggest a potential connection between children's exposure to sexual abuse and inadequate parental acceptance, involvement, supervision, and control.

Assessment of Mothers' Shaking Behavior of their Babies and Related Factors: An Experimental Approach Using an Accelerometer and an Infant Manikin.

Our study aimed to investigate the factors associated with mothers' shaking behavior of their babies. Sixty-three mothers who stated that they shook their babies (Group B) and 91 mothers who stated that they did not (Group A) among those who applied to or were followed up from the Pediatric Outpatient Clinics of our University Hospital were included. The mothers (with a baby aged 0-30 months) completed the Brief Symptom Inventory (BSI) and psychiatric rating scales measuring attachment styles, empathic tendency, perceived social support, and self-esteem. The severity of the simulated shaking of the mothers was measured by an accelerometer placed on an infant manikin and separately scored on a Numerical Rating Scale by the researchers and an Illustrated Numeric Rating Scale by the mothers. In group B, babies' crying frequency was higher (P = .008); soothing the babies when they cried was more difficult (P = .019), mothers reported that they were exposed to physical violence more in their childhood (P = .003), BSI hostility scores (P = .004) and BSI-anxiety scores (P = .034) of the mothers were higher when compared with the group A. The age of the babies (P = .002, OR = 1.096), moderate crying frequency (P = .035, OR = 2.900), the mothers' difficulty in soothing their babies (sometimes P = .018, OR = 3.705, often/always P = .014, OR = 7.777), and the mothers' experience of physical violence in childhood (P = .002, OR = 5.674) were found to be factors affecting the shaking behavior. Clarifying the factors associated with the mothers' shaking behavior of their babies would be helpful in terms of protecting future generations.

Uric Acid Levels in Overweight and Obese Children, and Their Correlation With Metabolic Risk Factors.

Obesity is an ongoing medical condition that continues to rise on a global scale. Numerous metabolic disorders, such as type 2 diabetes mellitus, hyperlipidemia, and hyperuricemia, are closely associated with obesity. This particular study aims to investigate the occurrence of hyperuricemia and its association with other metabolic factors among children and adolescents aged 6 to 14 years who are overweight or obese residing in Riyadh, Saudi Arabia. In this research, a cross-sectional, descriptive, and analytical study was carried out on 339 children and adolescents. These participants were selected randomly from a list of patients who had sought medical care for overweight and obesity at the pediatric endocrinology, general pediatrics, and family medicine clinics in King Abdulaziz Medical City (KAMC), located in Riyadh, Saudi Arabia, in the period from January 2020 to January 2022. To gather the necessary data, the electronic medical records of the participating individuals were carefully reviewed, encompassing various relevant variables, including demographic characteristics, anthropometric measurements, serum uric acid levels, lipid profiles, and fasting blood sugar. Out of the total 339 participants, 48 (14.2%) were identified as overweight, while 291 (85.8%) were classified as obese. The study revealed that the overall prevalence of hyperuricemia among the participants was 54%. There was an increased risk of hyperuricemia associated with male gender and elevated levels of LDL and TG. The significant prevalence of hyperuricemia among children and adolescents who are overweight or obese is evident. In order to improve control and management of this condition, it is crucial to prioritize the promotion of a healthy lifestyle among these individuals.

Semaglutide treatment for children with obesity: an observational study

ObjectiveTo assess efficacy and tolerability of semaglutide as a weight loss treatment for children living with comorbid obesity.DesignRetrospective observational study of the first 50 children from a weight management service...

Clinical profile and management of pediatric hereditary angioedema in resource-constrained settings: our experience from a single centre in North India.

Hereditary angioedema (HAE) is a rare genetic disorder. The pattern of HAE is different in children as compared to adults. There is limited literature from developing countries where all first-line treatments are either unavailable or not easily accessible.Data of children with HAE were retrieved from medical records of patients registered in the Pediatric Immunodeficiency Clinic at our institute.Of the 206 patients with HAE, 61 were diagnosed before the age of 18years. Male: female ratio was 1.1:1. Median age at onset of symptoms and diagnosis were 6.2years (range 1-17years) and 10.7years (range 1.5-18years) respectively. Median delay in diagnosis was 4.9years (range 0-16years). The commonest presentation was facial swelling (51/61) followed by swelling of extremities (47/61). Laryngeal edema and abdominal symptoms were reported in 28/61 and 31/61 patients respectively. Abdominal attacks were found to be less common in children as compared to adults. Most patients in our cohort received fresh-frozen plasma (n = 5/61) as on-demand therapy. Long-term prophylaxis included attenuated androgens (n = 25/61) and tranexamic acid (n = 23/61). Median duration of follow-up was 2242 patient months. One patient died on follow-up in this cohort.This is the largest single-centre cohort of pediatric HAE from resource-constrained settings. Facial attacks were more common, and there were significant delays in diagnosis when the age of onset of symptoms was younger. Gastrointestinal symptoms were less common in children than adults. HIGHLIGHTS: One of the largest single-centre cohorts of pediatric HAE and the only one from resource-constrained settings. There were significant delays in diagnosis when the age of onset of symptoms was younger. Abdominal attacks were found to be less common in children as compared to adults.

Human Tails and Whole Exome Sequencing Findings: Is There any Association? A Case Report

Introduction: The human tail is a rare congenital condition characterized by a caudal cutaneous appendage, primarily located in the lumbosacral region. These tails are often associated with other congenital malformations, most notably spinal dysraphism. Case Presentation: A 3-week-old male neonate was referred to the Baqiyatallah Pediatric Clinic in Tehran, Iran, due to a 12-cm-long congenital tail-like appendage in his lumbosacral region, which contained only soft tissue upon palpation. There was no apparent neurological deficit on physical examination or magnetic resonance imaging. No other concomitant malformations were present. The parents were consanguineous, and a previous pregnancy had been terminated at 18 weeks of gestation due to a prenatal diagnosis of a neural tube defect. As a result, genetic consultation and whole exome sequencing were performed. Some phenotype-related variants of uncertain significance were detected, and the baby was also found to be heterozygous for oculocutaneous albinism. Conclusions: Although some genetic variants of uncertain significance and a pathogenic variant associated with albinism were identified in this case, the absence of other manifestations beyond the tail and the lack of literature on this topic make the clinical implications of genetic testing in human tails unclear. Further investigation is required to understand these implications.

Zarażenia pasożytami jelitowymi u dzieci ukraińskich − uchodźców wojennych mieszkających w Warszawie

Introduction and objectiveThe war and the humanitarian crisis in Ukraine have resulted in a mass migration of millions of Ukrainians into the EU countries. According to the data obtained from Statistics Poland, a governmental agency collecting and publishing the country’s statistical data, the number of Ukrainian children currently living in Poland is approximately 500,000. The massive influx of immigrants into Poland poses a considerable challenge to the national health care sector. The aim of this study was to assess the prevalence of intestinal parasitic infections among Ukrainian child war refugees living in Warsaw.Material and methodsThe study involved a total of 25 Ukrainian children, patients of the Clinic of Paediatrics, Nephrology and Paediatric Allergology at the Military Institute of Medicine – National Research Institute in Warsaw. Parasitological diagnostic work-up was carried out in October 2023 at the Department of Epidemiology and Tropical Medicine, the Military Institute of Medicine – National Research Institute in Gdynia. Stool tests for the presence of intestinal parasites were conducted by light microscopy using three different methods (direct smear in Lugol’s solution, decantation with distilled water, Fülleborn’s flotation).ResultsA total of 20% of the children studied (5/25) were found to be infected with potentially pathogenic stramenopile &lt;i&gt;Blastocystis&lt;/i&gt; spp. In addition, two of the children were also infected with non-pathogenic &lt;i&gt;Endolimax&lt;/i&gt; nana and &lt;i&gt;Entamoeba&lt;/i&gt; coli protozoa. There were no infections with nematodes, cestodes or trematodes among the study participants.ConclusionsThe confirmation of potentially pathogenic &lt;i&gt;Blastocystis&lt;/i&gt; spp. in stool samples collected from Ukrainian children, war refugees living in Warsaw, justifies the necessity to re-introduce a large-scale routine screening for intestinal parasites in the paediatric population in Poland.