Pediatric Clinic Research Articles

Frequency of Scabies in Pediatric Allergy Clinic and Evaluation of Demographic Characteristics of Affected Patients

Objective: There has been an increase in the number of cases as pediatricians mistakenly refer scabies to an allergy clinic, misdiagnosing it as allergic illnesses, particularly atopic dermatitis (AD), because of the presence of symptoms such as itching and eczematous lesions. The objective of our study was to examine the prevalence of scabies in children who were referred to the pediatric allergy clinic after being misdiagnosed with AD. We also aimed to determine the clinical and demographic distinctions between individuals with AD and scabies. Methods: The files of 610 patients those referred to Sakarya Training and Research Hospital Pediatric Allergy Clinics between February-December 2022 with complaints of 'itching and rash' were documented retrospectively. Cases of acute urticaria, chronic urticaria, mastocytosis, insect bite, maculopapular rash with viral infection, drug-induced reactions were excluded. Patients whose final diagnosis was AD and who were diagnosed with 'definite scabies' were included in the study. Results: A total of 404 patients were included in the study. The rate of definite diagnosis of scabies was 18.5% (n:75/404). The median age at presentation was 19 months (IQR 8-51) in patients diagnosed with AD and 53 months (IQR 17-117) in patients diagnosed with scabies (p<0.005). The median time from symptom onset to diagnosis was seven months (IQR 2.5-24) in the AD group and two months (IQR 1-4) in the scabies group (p<0.005). Only 20% (n:15/75) of patients with scabies had family history, 16% of patients (n:12/75) had received one or more treatments before. Pruritis was present in only 72% (54/75) of children. Hospitalization rate was 0.05% (n:4/75). Conclusion: We recommend that scabies should be considered as a potential diagnosis for patients who visit to any clinic with symptoms of itching and a skin rash. Timely identification and medical intervention for scabies in children is crucial in order to minimize the spread of the disease throughout the community and prevent potential complications.

The development of the Sensory Emotional Engagement Checklist (SEE-C): Preliminary reliability and validity

ABSTRACT The Sensory Emotional Engagement Checklist (SEE-C) was developed to assess social emotional challenges in children whose sensory integration and sensory processing differences impact daily life. Thus, the purpose of this study was to assess the validity and reliability of the SEE-C for identifying social emotional patterns. Retrospective data were used from parent interviews and consultations at a pediatric clinic in the northeast with occupational therapists that produced items representative of hypothesized social-emotional behavioral subtypes. Factor analysis was conducted to explore construct validity, followed by internal consistency reliability of factor groupings. Correlational analyses were computed for factors within the SEE-C as well as between the SEE-C and the Sensory Processing 3 Dimensions Checklist (SP3D-C). Data were collected from 167 individuals’ charts of children ranging from 4.5 to 13.5 years who were evaluated for sensory integration and sensory processing differences. Factor analysis revealed a four-factor solution that explained the proposed structure of the SEE-C. Internal reliability for SEE-C factors ranged from α = .7 to .8. Correlations were weak but significant within the SEE-C, as well as between factors of the SEE-C and the SP3D-C subscales. Evidence supports the preliminary reliability and validity of the SEE-C as well as suggesting a link between children’s social emotional styles and sensory-related behaviors. The proposed social emotional behavior patterns of the SEE-C also suggest behaviors commonly considered in the mental health field may be reflective of sensory integration and sensory processing differences. These sensory-emotional patterns can further justify the inclusion of pediatric Occupational Therapists as part of the therapeutic intervention team for social emotional challenges in children.

Bridging oral health and nutrition: Assessing produce prescription programs in pediatric dental clinics serving low-income communities.

This study assesses the needs and feasibility of conducting a produce prescription (produce Rx) program in a pediatric dental clinic setting serving low-income patients. We conducted a cross-sectional quantitative survey examining several household characteristics including demographics, benefits received, fruit and vegetable intake patterns, food security, feasibility of a produce Rx program, and respondents' answers to questions based on social cognitive theory constructs. The survey was administered at the University of Nebraska Medical Center (UNMC) pediatric dental clinic, a pediatric dental residency clinical training site. One hundred adult respondents with low income completed a 36-item questionnaire during their child's dental appointment. Almost half of respondents reported experiencing food insecurity (45%). Respondents who were food insecure experienced higher levels of nutrition insecurity (p = 0.012), less confidence in choosing fruits and vegetables (FVs) (p = 0.026), difficulty in purchasing FVs in their neighborhood (p = 0.012), and more concern that FVs cost too much (p < 0.001) when compared to respondents who were food secure. Notwithstanding the barriers they face, almost all respondents reported that they eat FVs because of health benefits (95%) and to set a good example for their family (91%). Additionally, most respondents expressed an interest in produce Rx programs (80%) and nutrition education activities (81%). This study demonstrated the potential for produce Rx program uptake in a pediatric dental clinic setting through positive caregiver-reported need and interest. Future studies should explore how produce Rx programs can be adapted most effectively in this novel setting.

Outcomes from a Multidisciplinary Otolaryngology and Rheumatology Clinic for the Management of Chronic Sialadenitis.

Determine the outcomes in children with recurrent sialadenitis after establishment of a multidisciplinary pediatric otolaryngology and rheumatology clinic. Retrospective review. Single-center tertiary medical center. We reviewed all children presenting to a multidisciplinary pediatric otolaryngology/rheumatology clinic with recurrent parotitis between December 2019 and April 2023. Thirty-three children presented with recurrent parotitis to a multidisciplinary clinic. Seventy-seven percent of those with childhood Sjögren's disease (cSjD) had xerophthalmia, and 67% had xerostomia. The cSjD group was more likely to have both abnormal parotid and submandibular findings when compared to the non-cSjD group (P < .001). Sixteen percent of the cSjD group had a positive SSA/SSB autoantibody and 47% were antinuclear antibody positive. Fifty percent of the cSjD cohort had a focus score of ≥1 from a minor salivary gland biopsy. There were no significant differences from sialendoscopy outcome between the 2 groups. Seventy percent with juvenile recurrent parotitis showed partial response (PR) or complete response (CR) to sialendoscopy. In the cSjD cohort 3 (27%) reported a CR and 5 (45%) reported a PR. In the non csSjD cohort 5 (42%) reported a CR and 3 (25%) reported a PR. Ten of the 12 cSjD patients on hydroxychloroquine have shown symptom improvement. The establishment of a multidisciplinary otolaryngology and rheumatology clinic can provide a more comprehensive evaluation and treatment of the child with recurrent or persistent parotitis than from a regular ENT clinic.

Psychiatric Difficulties in Children with Celiac Disease and the Relationship between Adherence to Treatment and Parental Attitudes.

Our knowledge of the factors related to parenting styles affecting adherence to diet in children with celiac diseases (CDs) and the association between psychiatric difficulties and diet compliance is largely based on limited data. Therefore, our work aims to examine primarily coexisting psychiatric difficulties in children with CD and raising attitudes of their parents and secondarily the relationship among adherence to treatment, psychiatric difficulties, and parental attitudes. Children aged 4-12 years (n = 42) who have been followed up with the diagnosis of CD in a Paediatric Gastroenterology Outpatient Clinic were compared with those of healthy controls (n = 31). One of the parents was asked to fill out the socio-demographic information form, Diet Compliance Form (only the patient group), "Parental Attitude Research Instrument" (PARI) and Strengths and Difficulties Questionnaire-parent form (SDQ). The scores from "emotional problems," "peer relationship problems," and "total difficulties" areas were statistically significantly higher in the disease group than healthy controls. The average score of SDQ subscales and none of the PARI subscales differed between dietary compliance +/- groups. Significant positive correlations were detected between disease duration and PARI-overprotection/extreme motherhood (r = .421, P = .017) and PARI-strict/hard discipline (r = .368, P = .038) subscales. Clarifying the factors related to parenting that may affect patients' adherence to a gluten-free diet will contribute positively to the course of the disease and the quality of life of patients and their families.

Predictors of Unplanned Health Care Utilization Among Children with Inflammatory Bowel Disease in a Rural Region of the Southeastern US.

Pediatric Inflammatory Bowel Disease (IBD) imposes significant healthcare costs and strains emergency services. This study aimed to identify factors associated with unplanned healthcare usage among children with IBD in a rural, medically underserved region in the southeastern United States. In this retrospective cohort study, we analyzed children (<18years) with moderate or severe IBD followed at an academic pediatric gastroenterology clinic between 2016 and 2021. Each planned visit was treated as a separate observation, and patients were followed after each planned visit until the occurrence of the earliest unplanned healthcare event, until the next planned visit, or until censoring. In our analysis of 471 planned visits from 70 children with IBD, we observed 84 (18%) unplanned visits within 12months, with 39 of these visits related to IBD. Unplanned visits occurred at a median interval of 39 days, predominantly to the emergency department (ED). Multivariate Cox proportional hazards analysis revealed a higher hazard of unplanned visits among female patients, individuals with elevated C-reactive protein levels and anemia, those covered by Medicaid insurance, and those residing closer to the clinic. This study elucidates the challenges faced by children with IBD in rural settings. By identifying factors associated with unplanned healthcare utilization, we can better pinpoint patients who may benefit from targeted interventions to reduce such visits.

Implementation of a Secure Firearm Storage Program in Pediatric Primary Care

Increased secure firearm storage can reduce youth firearm injury and mortality, a leading cause of death for children and adolescents in the US. Despite the availability of evidence-based secure firearm storage programs and recommendations from the American Academy of Pediatrics, few pediatric clinicians report routinely implementing these programs. To compare the effectiveness of an electronic health record (EHR) documentation template (nudge) and the nudge plus facilitation (ie, clinic support to implement the program; nudge+) at promoting delivery of a brief evidence-based secure firearm storage program (SAFE Firearm) that includes counseling about secure firearm storage and free cable locks during all pediatric well visits. The Adolescent and Child Suicide Prevention in Routine Clinical Encounters (ASPIRE) unblinded parallel cluster randomized effectiveness-implementation trial was conducted from March 14, 2022, to March 20, 2023, to test the hypothesis that, relative to nudge, nudge+ would result in delivery of the firearm storage program to an additional 10% or more of the eligible population, and that this difference would be statistically significant. Thirty pediatric primary care clinics in 2 US health care systems (in Michigan and Colorado) were included, excluding clinics that were not the primary site for participating health care professionals and a subset selected at random due to resource limitations. All pediatric well visits at participating clinics for youth ages 5 to 17 years were analyzed. Clinics were randomly assigned in a 1:1 ratio to receive either the nudge or nudge+. Patient-level outcomes were modeled to estimate the primary outcome, reach, which is a visit-level binary indicator of whether the parent received both components of the firearm storage program (counseling and lock), as documented by the clinician in the EHR. Secondary outcomes explored individual program component delivery. A total of 47 307 well-child visits (median [IQR] age, 11.3 [8.1-14.4] years; 24 210 [51.2%] male and 23 091 [48.8%] female) among 46 597 children and 368 clinicians were eligible to receive the firearm storage program during the trial and were included in analyses. Using the intention-to-treat principle, a higher percentage of well-child visits received the firearm storage program in the nudge+ condition (49%; 95% CI, 37-61) compared to nudge (22%; 95% CI, 13-31). In this study, the EHR strategy combined with facilitation (nudge+) was more effective at increasing delivery of an evidence-based secure firearm storage program compared to nudge alone. ClinicalTrials.gov Identifier: NCT04844021.

Potty Stools, a Pilot Study to Step Up the Management of Functional Constipation in Children.

Functional constipation (FC) comprises 30% of pediatric gastroenterology clinic visits. FC results from withholding behaviors that can be worsened by poor toileting posture. The use of a defecation posture modification device (DPMD)-a potty stool-has demonstrated benefit in adults. The aim of this study was to assess the risks and benefits of incorporating a DPMD as an adjunct to the FC treatment plan for children. Toilet-trained children aged ≥4 years meeting the Rome IV criteria for FC were enrolled and offered a DPMD at no cost and were followed for 4 months. There were no injuries or treatment-related adverse events reported by the 43 subjects who completed the study. Notably, 98% (n = 42) of respondents would recommend the DPMD to assist other children with FC. DPMD users showed a 33% reduction in fecal incontinence compared with 60% non-users. The DPMD represents a safe adjunct to incorporate into the FC management plan of children.

The effect of virtual reality glasses used in dental treatment on anxiety and fear in children: A randomized controlled study

IntroductionVirtual reality glasses can be used as a distraction method in dental practices for children. This study was carried out to evaluate the effect of virtual reality glasses used during tooth extraction and extirpation treatment under local anesthesia on anxiety and fear in children aged 7–10 years. MethodsThis study is a randomized controlled trial. The sample of the study consisted of 120 seven to ten-year-old children, including 60 in the EG and 60 in the CG, who received tooth extraction and extirpation treatment in the pediatric dental clinic. Data collection tools included the Children's Fear Scale, the Child Anxiety Scale-State. Data were analyzed using the Chi-square test, t-test, Shapiro-Wilk, mean and percentage distributions. ResultsThe assessments made by the researcher and the children indicated a statistically significant difference between experimental and control groups in terms of their mean anxiety and fear scores following tooth extraction and extirpation treatment (p < 0.001). After tooth extraction and extirpation treatment, it was determined that the children in the EG had lower mean anxiety and fear scores than the children in the CG. ConclusionIt was found that virtual reality glasses used during tooth extraction and extirpation treatment in children aged 7–10 years were effective in reducing their anxiety and fear levels. Virtual reality glasses can be used as a distracting method to relieve children's anxiety and fears during dental treatment procedures.

CN49 Staying or leaving the pediatric oncology clinic: Nurses' challenges in care and voices of struggle: A qualitative study

CN49 Staying or leaving the pediatric oncology clinic: Nurses' challenges in care and voices of struggle: A qualitative study

Comparing the effect of letrozole on the growth of boys aged 12–16 years with constitutional short stature: A clinical randomized trial study

Objectives This study aimed to compare the effect of letrozole on the height of boys aged 12–16 years with constitutional short stature after the onset of the third stage of puberty. Methods This clinical randomized trial study was performed on 93 boys with constitutional short stature referring to the Pediatric Endocrine Clinic in Qazvin, Iran. The measurements of patient height and predicted adult height (PAH) were assessed after 1 and 2 years. The patients were treated using letrozole (2.5 mg/day) or placebo (control). Results The level of letrozole increased the PAH compared to control. The predicted height in patients with constitutional short stature increased significantly by 5.52 cm, only 1 year after the administration of letrozole, compared to the placebo group (P = 0.03). However, after receiving letrozole in the second year, the predicted height in boys with constitutional short stature increased by 2.34 cm (P &gt; 0.05) compared to the first year. In boys with constitutional short stature, the predicted height increased by 7.86 cm after 2 years in the intervention group receiving letrozole and 3.1 cm in the control group (P &gt; 0.05). Furthermore, no significant difference was observed between the groups receiving letrozole and placebo before and after the intervention in terms of laboratory findings, such as hemoglobin level and serum cholesterol level (P &gt; 0.05). Conclusions The results showed that the administration of letrozole at the third stage of puberty in boys aged 6–12 with constitutional short stature caused a statistically significant increase in the mean of PAH compared to placebo.

Transportation Barriers in Pediatric Orthopaedic Clinic Visits.

To identify what transportation barriers pediatric patients face when traveling to a major metropolitan orthopaedic center, how these barriers affect care, and what changes can be made to address this issue. A cross-sectional transportation survey was administered to 107 caregivers of patients being seen in the orthopaedic clinic at a tertiary children's hospital in a large metropolitan area. Using logistic regression analysis, we compared socioeconomic characteristics, transportation methods, and scheduling practices among caregivers who reported missing at least one visit in the past and those who reported never missing a visit. 13% (14/108) of caregivers reported missing one or more past visits due to late arrival or transportation issues. Families that traveled more than 45 minutes to clinic (P = 0.04), waited more than one week to schedule a visit (P = 0.002), or reported difficulty scheduling a visit (P = 0.02) were significantly more likely to have a history of nonattendance. In addition, patients who were nonambulatory (P = 0.007), used a mobility device (P = 0.007), or were non-White (P < 0.05) were significantly more likely to have missed a visit. Travel time, difficult or delayed scheduling, and patient ambulatory status were all associated with missing orthopaedic clinic visits although other socioeconomic factors were not related. Interventions to improve orthopaedic clinic attendance should focus on promoting accessibility for patients with mobility limitations and encouraging simple and timely scheduling practices.

Abstract P187: Obesity predicts left ventricular mass in youth undergoing ambulatory blood pressure monitoring

Background: Left ventricular hypertrophy (LVH) is a risk factor for cardiovascular disease in adults. In youth, elevated blood pressure (BP) is associated with LVH, but independent effects of adiposity and hypertension on LVH are not well defined. The purpose of our study was to investigate relationships among LVH, LV mass, BMI, and other clinical parameters in pediatric patients referred for elevated BP. We hypothesized both BP and BMI to be associated with LV mass. Methods: We conducted an IRB-approved retrospective chart review of all patients ages 6-18 years who underwent 24-hour ambulatory BP monitoring via the pediatric nephrology clinic at Kentucky Children’s Hospital from August 2012-December 2023 (excluding those with secondary HTN). Obesity was defined by BMI and weight-for-length percentiles according to CDC guidelines. LV mass was assessed by standard echocardiography. We compared LVMI and BP measures among groups stratified by obesity stage. Associations among BP, obesity, and LVMI were determined using descriptive statistics, correlational analyses, and multivariable logistic modeling using a backwards elimination variables selection criteria with α=0.05. Results: Of the 520 patients, 66% (n=342) were male, 76% (n=395) were obese, and 46% (n=238) had LVH. LVMI was strongly correlated with 24-hr systolic BP, however there was no difference in mean LVMI across BP severity category. In contrast, there was a near stepwise increase in LVMI across obesity stage with the strongest effect in girls – Normal: 29.7 ± 5.3 (girls) v. 34.8 ± 11.4 (boys) g/m 2.7 ; OB-1: 36.5 ± 6.6 (girls) v. 43.2 ± 10.3 (boys) g/m 2.7 ; OB-2: 41 ± 11.6 (girls) v. 44.2 ± 9.2 (boys) g/m 2.7 ; OB 3: 48 ± 11.6 (girls) v. 43.5 ± 9.4 (boys) g/m 2.7 . LVMI was positively correlated with TSH, creatinine, uric acid, cystatin, and inversely correlated with HDL. Multivariable logistic modeling revealed obesity stage and HDL cholesterol, but not BP or laboratory variables, as significant independent predictors of LVH. Conclusions: We report a high incidence of LVH in youth with obesity and demonstrate a strong association between obesity and LVMI. Our data, in agreement with previous studies, indicate that adiposity is a significant determinant of left ventricular mass, and suggest the need for cardiac screening of youth with obesity even in the absence of elevated blood pressure.

Parents' views on pediatric COVID-19 vaccine in Saudi Arabia.

To end the COVID-19 pandemic, we need to reach herd immunity. A successful pediatric COVID-19 immunization program is the only way to achieve this goal. The objective of this study was to determine the views of parents in Saudi Arabia on the COVID-19 vaccine in children. This cross-sectional study took place within the Family Medicine Pediatric clinics at the King Faisal Specialist Hospital and Research Center (KFSH and RC). All parents of patients of Family Medicine Pediatric Clinics at KFSH and RC, Riyadh, were invited to participate in this study between January 2022 and June 2022. A culturally sensitive and specially designed questionnaire was administered using an interview-based model. Safety concerns were the primary reason for vaccine hesitancy among parents, with 29.7% of parents expressing concerns about side effects and 25.1% not knowing where to get reliable information about vaccines. Negative information and lack of perceived need were also important factors, with 17.1% and 18.3% of parents citing these reasons, respectively. Poor knowledge about vaccines was a significant predictor of parental vaccine hesitancy. Mothers had more concerns about the efficacy and safety of vaccines than fathers. Our study demonstrated a negative attitude toward the pediatric COVID-19 vaccine among parents in Saudi Arabia. A higher level of awareness about the vaccine was significantly associated with planning on having the vaccine. There is a need for effective awareness programs for better pediatric COVID-19 vaccine-related education to increase the acceptance of the vaccine among parents in Saudi Arabia.

Validation of Serbian version of the LittlEARS® Early Speech Production Questionnaire for the assessment of early language development in typically developing children.

The LittlEARS® Early Speech Production Questionnaire (LEESPQ) was developed to provide professionals with valuable information about children's earliest language development and has been successfully validated in several languages. This study aimed to validate the Serbian version of the LEESPQ in typically developing children and compare the results with validation studies in other languages. The English version of the LEESPQ was back-translated into Serbian. Parents completed the questionnaire in paper or electronic form either during the visit to the paediatric clinic or through personal contact. A total of 206 completed questionnaires were collected. Standardized expected values were calculated using a second-order polynomial model for children up to 18 months of age to create a norm curve for the Serbian language. The results were then used to determine confidence intervals, with the lower limit being the critical limit for typical speech-language development. Finally, the results were compared with German and Canadian English developmental norms. The Serbian LEESPQ version showed high homogeneity (r = .622) and internal consistency (α = .882), indicating that it almost exclusively measures speech production ability. No significant difference in total score was found between male and female infants (U = 4429.500, p = .090), so it can be considered a gender-independent questionnaire. The results of the comparison between Serbian and German (U = 645.500, p = .673) and Serbian and English norm curves (U = 652.000, p = .725) show that the LEESPQ can be applied to different population groups, regardless of linguistic, cultural or sociological differences. The LEESPQ is a valid, age-dependent and gender-independent questionnaire suitable for assessing early speech development in children aged from birth to 18 months.

Association Between Postpartum Depression Symptoms and Social Determinants of Health in Outpatient Pediatric Clinic

IntroductionWe aimed to (1) identify the prevalence of postpartum depression (PPD) symptoms using the Patient Health Questionnaire-2 (PHQ-2) and the Edinburgh Postnatal Depression Scale (EPDS), and (2) analyze the relationship between PPD symptoms and social determinants of health (SDoH). MethodWe obtained data from 1327 infant/mother dyads at 1 and 6-month well-child checks. We used Chi-square and T-tests to compare social determinants between PPD screening groups and logistical regression to construct predictive models for PPD. ResultsThe prevalence of positive PPD screens was 5–7%, but only 1.85% screened positive at both periods. Although the EPDS and PHQ-2 were correlated (Pearson 0.66), the PHQ-2 missed 65% of those identified by the EPDS. Positive PPD screens were associated with greater SDoH concerns. DiscussionOur study highlights the importance of repeated PPD screening. The EPDS detected more mothers at risk than the PHQ-2. Multiple SDoH were associated with PPD symptoms.

Assessment of micronutrients in pediatric vertigo

Aim: This study aimed to evaluate the clinical characteristics of patients admitted to the pediatric neurology outpatient clinic with the complaint of vertigo and to investigate the role of micronutrients in the etiology of vertigo Materials and Methods: This study retrospectively evaluated the patients aged four to 18 years who were admitted to the pediatric neurology outpatient clinic with the complaint of vertigo to evaluate the clinical characteristics and the role of micronutrients in the etiology of vertigo. Patients, for whom the Z00.1 code, the routine child health examination code, was entered in the pediatric outpatient clinic in the same period when the patients presented with the complaint of vertigo were included as the healthy control group. Hemogram and hormone profiles [25(OH)D, FT4, TSH, vitamin B12, folic acid and ferritin] of the groups were compared. Results: There was no statistically significant difference between the study group and healthy controls in terms of age and gender. Hematocrit (p&amp;lt;0.001), platelet (p&amp;lt;0.001), vitamin B12 (p=0.015), vitamin D (p=0.043) and TSH (p=0.013) levels were found to be significantly lower in the vertigo group compared to the control group. Conclusion: The importance of micronutritional deficiencies cannot be denied in patients presenting with vertigo symptoms. Main point that makes our study valuable is that there are limited number of studies in the literature comparing laboratory parameters of pediatric patients with vertigo symptoms and healthy controls. There is a need for prospective studies, involving more cases and awareness on this issue.

Dizziness and Imbalance Across the Lifespan: Findings of a Pediatric and Adult Vestibular Clinic.

To evaluate diagnostic trends in pediatric and adult patients presenting for multidisciplinary subspecialty evaluation of dizziness and imbalance across the lifespan. Retrospective chart review. Single pediatric and single adult academic tertiary care hospital. Retrospective review of electronic health record for patients presenting to an adult or pediatric multidisciplinary vestibular clinic from 2017 to 2020, including clinical data, physical therapy evaluation, and audiovestibular testing. A total of 1934 patients aged 1 to 95 were evaluated. Most patients were female (n = 1188, 61%); the largest cohort was in the fifth decade of life (n = 321, 17%). Seventy-six percent of patients (n = 1470) were assigned a pathologic diagnosis. Central causes of dizziness were most common in children and young adults, comprising 38% to 54% of all diagnoses in ages 1 to 30. The proportion of peripheral vestibular disorders increased with age, peaking at 32% in ages 61 to70. Vestibular migraine was the most common pathologic diagnosis in ages 6 to 20 (n = 110, 39%) and 31 and 50 (n = 69, 17%) regardless of gender, but was more prevalent in females (21% vs 14%; P < .0001). The prevalence of benign paroxysmal positional vertigo (BPPV) increased throughout the lifespan, peaking at age 71 to 80. Meniere's disease (MD) did not occur within the first decade of life, but increased thereafter, peaking at ages 51 to 60. Multidisciplinary vestibular evaluation resulted in a diagnosis for the majority of patients. Vestibular diagnoses vary across the lifespan however among most age groups, central disorders, including migraine disorders, outnumber peripheral vestibulopathies. The prevalence of peripheral vestibular disorders such as BPPV and MD increased with age. Level IV.

Prevalence of HLA-B27, clinical characteristics and treatment outcomes in children with enthesitis-related arthritis

BackgroundEnthesitis-related arthritis (ERA) is a subtype of juvenile idiopathic arthritis with high disease burden. The objectives of this study were to explore the prevalence of HLA-B27, clinical characteristics, and treatment outcomes in children with ERA and compare the differences between HLA-B27 positive and negative patients.MethodsA retrospective cohort study at a pediatric rheumatology clinic in a tertiary referral hospital in Bangkok, Thailand, including ERA patients with at least 6 months of follow-up (July 2011-April 2022) was performed. Data were collected from medical records from diagnosis to recent follow-up, assessing disease activity and treatment outcomes, with an analysis comparing HLA-B27 positive and negative patients. Descriptive statistics were used for data analysis.ResultsThere were 59 ERA patients with mean age ± SD at diagnosis 11.2 ± 2.5 years, 53 males (89.8%), and positive HLA-B27 in 38 patients (64.4%). The HLA-B27 positive group had significantly higher levels of inflammatory markers at initial diagnosis (p = 0.001), lower baseline hemoglobin (p = 0.001) and hematocrit (p = 0.002), higher disease activity assessed by the Juvenile Spondyloarthritis Disease Activity score at 6 and 12 months of follow-up (p = 0.028 and 0.040, respectively), increased utilization of bridging systemic corticosteroids (60.5% vs. 14.3%, p = 0.001) and anti-TNF (39.5% vs. 9.5%, p = 0.018), and longer duration of methotrexate (median[IQR] 1.7[1.1–3.1] vs. 1.3[0.6–1.9] years, p = 0.040). The HLA-B27 negative group had more prevalent hip arthritis than the positive group at initial diagnosis (66.7% vs. 28.9%, p = 0.005) and during the course of the disease (71.4% vs. 36.8%, p = 0.011).ConclusionMost of the ERA patients tested positive for HLA-B27. Throughout the follow-up period, these patients demonstrated greater disease activity, greater use of corticosteroids and anti-TNF, and longer duration of methotrexate to control the disease.

Changes of oxidative stress in 3D film to be prepared for echocardiography: A randomized controlled study.

Echocardiography (ECHO) is a nonprocedure that causes acute stress in children. Fear, anxiety, and fluctuations in children's blood pressure and heart rate can potentially lead to alterations in echocardiographic measurements. The insufficient research on virtual reality pediatric preparation applications, particularly in the context of echocardiographic procedures, underscores the necessity for additional studies focusing on pediatric patients. This study sought to assess the impact of virtual reality applications tailored explicitly for ECHO on children's oxidative stress levels. This was a prospective, randomized, controlled experimental study. Forty-eight children (experimental/24, control/24) aged 7 to 12 years who had an ECHO appointment in the pediatric cardiology outpatient clinic in the 3 months from June to August 2019 participated in the study. Participants whose blood analyses showed hemolysis were eliminated, and the study was completed with 37 children in total: 16 children in the experiment and 21 children in the control. Post hoc power analysis was performed for sample adequacy, and the power of the study was found to be 0.99. A 3D film was prepared for the research and applied to the experimental group before the procedure. All children's oxidative stress levels (cortisol, malondialdehyde, nitric oxide) and glutathione levels were checked after ECHO. The stress hormone cortisol and malondialdehyde levels were lower in the 3D-applied experimental group than in the control group. As another crucial anti-stress antioxidant factor, glutathione level increased in the experimental group compared to the control group (P < .05). The research revealed that the 3D film used to prepare ECHO reduces the stress parameters associated with heart risk and may affect the ECHO measurements. At the same time, the study also proved the positive effect of 3D film preparation by increasing the anti-stress factor.