Pediatric Clinic Research Articles

Diagnostic yield and therapeutic implications of 25 years of specialized pediatric Marfan clinic

Diagnostic yield and therapeutic implications of 25 years of specialized pediatric Marfan clinic

Impact of L-carnitine supplementation on gastric emptying and bowel function in pediatric ketogenic diet therapy: a clinical trial.

Ketogenic diet (KD) is an excess fat, enough protein, and minimal carbohydrate diet. The high fat content in KD lowers the oesophageal sphincter tone, slows gastric emptying, and decreases intestinal transit time. The primary aim of the current clinical trial was to study the effect of L-carnitine supplementation on gastric emptying in children with drug resistant epilepsy (DRE) on KD. Assessment of the protective effect of L-carnitine on bowel function and habits in those patients was a secondary aim. The current study recruited 30 patients aged 12 months to 18 years newly diagnosed with DRE assigned to start KD who were following up at the Pediatric Clinical Nutrition and Neurology Outpatient Clinics or were admitted due to DRE at the Pediatric Neurology Inpatient Department, Children's Hospital, Ain Shams University (Egypt). Participants were assigned randomly into 2 arms; arm I: received KD with L-carnitine supplementation, arm II: received KD only. Patients were assessed at baseline and after 3 months of starting KD, the assessments of children included: 24-hour dietary recall, Chalfont Seizures Severity Scale, gastrointestinal symptoms score and Bristol stool chart, frequency of defecation per week, anthropometric measurements assessment, fasting serum lipid profile and measurement of the antral length by ultrasound. There was significant increase in antral length in the patients who received KD with L-carnitine supplementation compared to the non-supplemented group. The antral length showed a significant negative correlation with GI symptoms score in all cases and the L-carnitine supplemented group. It also showed a significant positive correlation with Bristol stool score in all patients and a significant positive correlation with stool frequency in the L-carnitine supplemented group only. L-carnitine supplementation to children with DRE on KD has a significant role in improving gastric motility and it increases the frequency of defecation. Further studies are recommended to explore additional benefits, meanwhile it is prudent to advise L-carnitine supplementation for such patients.

Addressing tobacco screening and treatment among racially and ethnically minoritized parents in pediatric clinics: barriers and facilitators.

Household secondhand smoke (SHS) exposure remains a significant health issue for racially and ethnically minoritized children in the United States. Delivering parental tobacco treatment during pediatric primary care visits can reduce children's SHS exposure. This study examined current tobacco screening practices and health system stakeholder perceptions of facilitators and barriers to addressing tobacco use during pediatric visits among racially and ethnically minoritized parents. We conducted 25 semi-structured interviews with clinicians, staff, and health system leaders from 5 pediatric primary care clinics in Minneapolis-St. Paul, Minnesota. The study was informed by the Health Equity Implementation Framework. Interviews were analyzed using both directed content and thematic analysis. Participants identified multilevel facilitators and barriers to addressing parental tobacco use in minoritized families. Within the clinical encounter, barriers included linguistic and cultural barriers, health system navigational challenges, medical mistrust, low levels of clinician and staff knowledge, skills, and confidence, time constraints, and lack of alignment with external metrics. Facilitators centered on leveraging interpreters' cultural knowledge and the presence of culturally-congruent clinicians and staff to reduce medical mistrust and stigma, developing linguistically and culturally relevant resources, and integrating prompts and resources into the electronic health record. Participants described how lessons from previous system change mechanisms would facilitate this work. Addressing health system, training and resources, and linguistic and cultural barriers among clinicians and staff is essential to strengthen their capacity to address household SHS exposure among racially and ethnically minoritized populations as a component of pediatric preventive care. Clinicians and health system staff perceive unique barriers to identifying and addressing parental tobacco use among racially and ethnically minoritized parents during pediatric primary care visits. Solutions to expand tobacco treatment access to minoritized parents in pediatric settings must attend to clinician training needs on tobacco treatment, embedding clinical encounter resources and reminders that match the linguistic and cultural needs and preferences of their patient populations, and increasing access to high quality interpreting services and culturally-congruent staff.

Addressing unmet social needs of children with obesity: a pilot randomized controlled trial.

Childhood obesity is an ongoing public health crisis, and recent clinical practice guidelines identify addressing the role of social inequities in the disparity of health among children with obesity as an area to address. This study aimed to assess the feasibility of a community navigation intervention in a pediatric weight management clinic. A single-center pilot randomized controlled trial (RCT) recruiting families from a tertiary hospital pediatric weight management program to evaluate the feasibility of a community navigation intervention. The primary feasibility outcomes were recruitment rates (goal to recruit 80% of the sample in 6months), uptake of the intervention (goal > 80% of participants in the intervention group to have a visit with the navigator), and acceptability (goal > 90% of families in the intervention group complete all follow-up). Eighty participants completed the social needs screening, and 42 (52.5%) participants screened positive for an unmet social need. In the first 6months of recruitment, 18 participants were recruited out of a goal of 40 participants (the recruitment rate was 45% vs. the goal of 80% in 6months), and complete recruitment was achieved in 12months. Of the 21 participants randomized to the intervention arm, 20 completed the intervention (uptake of intervention was 95% vs. goal 80%). Ten participants in the intervention arm completed all four planned follow-up study visits (the acceptability of follow-up was 48% vs. the goal of 90%). We completed a pilot RCT of implementing a community navigator program in a pediatric weight management program. We found feasibility in the intervention's uptake but limited feasibility in recruiting participants and the acceptability of the follow-up. Clinicaltrials.gov, NCT04711707, https://clinicaltrials.gov/ct2/show/NCT04711707.

Implementation of Immunization Services Through a Pediatric Urgent Care Clinic.

Pediatric urgent care (PUC) centers may bolster immunization campaigns by offering vaccination during acute care visits, but few such programs have been described. We conducted a quality improvement initiative at an academically affiliated federally qualified health center that provides primary, specialty, and PUC services to children. Our PUC began offering routine immunizations in July 2020. The percentage of visits by eligible patients age ≤21 years during which immunization screening (process) and administration (outcome) occurred was measured from March 1, 2021, to February 19, 2023. Administration rates were measured across age, sex, race, language, and medical home groups. Data were analyzed with statistical process control methods. Grievance and adverse event data were monitored (balancing). We completed 4 plan-do-study-act cycles. Provider-facing bundles that included training, decision support, electronic health record signaling, and financial incentives were not associated with meaningful changes in screening and administration (cycles 1-3). A dedicated nurse vaccinator (DNV) was added on October 31, 2022 (cycle 4). The mean screening rate increased from 44.7% to 67.4% during the DNV period, and the mean administration rate increased from 26.5% to 50.8%. Lower administration rates were observed during visits by Black and English-speaking patients, and by patients empaneled outside our site. Provider-facing interventions alone were not effective at increasing vaccine screening and administration in our PUC, but marked improvement was observed with the addition of a DNV. Future interventions are needed to address disparities. Additional investigation is needed to determine whether our results are reproducible in other PUCs with access to vaccines.

Abstract 4137053: Association of Childhood Opportunity Index and No Show Rates in a Pediatric Cardiology Clinic.

Introduction: Childhood Opportunity Index (COI) measures access to quality education, safe housing, and healthcare based on zip codes. These scores can influence patient behaviors, such as no-shows (NS), which can affect resource utilization and health outcomes. Objective: To quantify the correlation between COI and NS through odds ratio (OR) in a pediatric cardiology clinic. Methods: Patient data was collected from a single, independent pediatric cardiology practice for all visits between 2019 to 2021. COI was categorized into 3 subdomains; education, health and environment, social and economic according to zipcode from Diversitydatakids. The COI was split into low (<40), moderate (40-60U), and high (>60U). Additional variables included age, insurance type, lead time (time from scheduling to appointment date), and telehealth status. Multiple logistic mixed-effect models, both unadjusted (single predictor) and adjusted (multiple predictors), were used to obtain OR for NS. Results: There were 11,474 total encounters. 92% were completed appointments and 8% were NS. Unadjusted model showed statistical significance (p<.05) with increased odds of NS for low COI education, low COI social and economic, and low COI, compared to high COI as the reference category (Table 1). Adjusted model 2 showed similar significant results for the low COI overall category, while for adjusted models 1 and 3, none of the COI categories were statistically significant. In all 4 models, OR for all age categories, all lead times, and public and mixed insurance types were significant. Conclusion: The unadjusted and adjusted model 2 showed that patients with lower COIs were more likely to NS. Public insurance and longer lead times were indicators of NS while higher ages were indicators for completed appointments. Therefore, efforts need to be made to identify vulnerable patients; younger patients, and those with lower COIs and public insurance; and address barriers such as arranging transport and sending reminders that can help decrease NS. Interestingly, the NS rate was lower than the national average. Future research is needed to assess the impact of NS on patient outcomes.

Culturally Tailored Messages and Trial Registry Enrollment: A Randomized Clinical Trial.

Marginalized populations have lower levels of clinical trial representation than other populations. Tailoring recruitment materials and providing incentives may improve representation. To determine whether culturally tailored video improves parents' decision to enroll (DTE) Black children in a research registry. A randomized clinical trial, using mixed methods and consecutive sampling, was conducted in an urban primary care pediatric clinic. A post hoc study assessed the association of a monetary incentive with DTE. Ninety-three parents were recruited before their child's scheduled clinic visit. Participants completed a survey during which they were randomly assigned to review a paragraph (control group), generic video, or tailored video and received a gift card. Video watchers completed questions about its effectiveness. All participants were invited to join the registry. In the post hoc study, consenting participants followed the control group protocol and the coordinator promised them an ink pen for participating. The study was conducted between November 15, 2022, and August 29, 2023. A survey regarding the importance of being included in research studies was administered after participants watched a culturally tailored video. The primary outcome was DTE. Covariates were message effectiveness, clinical trial knowledge, and trust. Intention-to-treat analysis was performed. A total of 125 individuals were included. All groups had similar mean (SD) parent age (overall, 32.6 [7.35] years), gender (110 [88.0%] women), and race (116 [92.8%] Black or African American). There was no significant difference in the odds of DTE between the appeal video and control (odds ratio [OR], 1.19; 95% CI, 0.38-3.72) or between the generic video and control (OR, 1.91; 95% CI, 0.54-6.71). However, DTE was higher for all 3 gift card groups vs the ink pen incentive group (eg, control vs ink pen incentive: OR, 5.01; 95% CI, 1.68-14.95). After adjusting for trust, monetary incentives were associated with higher odds of DTE (adjusted OR, 5.92; 95% CI, 2.44-14.39). In this randomized clinical trial, targeted messaging was not associated with a higher decision to enroll in a pediatric clinical trial registry. There may be a role for combining holistic messaging with monetary incentives to improve enrollment. ClinicalTrials.gov Identifier: NCT06138145.

Abstract 4143262: Unlocking Value: Revealing the Hidden Cost of Outpatient Interstage Care

Background: Interstage programs decrease morbidity and mortality and are potentially resource intensive. The accurate cost of these programs is unknown. Understanding cost and outcomes of care is necessary to provide high-value care for this population. Time-driven activity-based costing(TDABC) provides an accurate way to understanding costs that occur at the level of the patient. Research Question: What is the outpatient cost of the interstage period to the health care system? Methods: Single-center study of outpatient interstage care. Direct observation (over 9 months) and retrospective review were utilized to develop process maps. Outpatient interstage and pediatric visits were timed by 5 observers. Cost of personnel was calculated in dollars per minute utilizing median national health system salary data. Results: Patients attended a median of 13 cardiology, 5 pediatric, 3 physical therapy(PT), 4 occupational therapy(OT), and 7 speech therapy(SLP) visits while interstage. Total cost of interstage visit personnel was $258.18[$208.59-$389.24] and equipment cost was $1457.79. Total cost of a pediatric visit was $123.55[$130.80-$167.12]. Total cost of outpatient PT, OT, and SLP was $70.58, $66.68 and $72.43, respectively. Total cost of the outpatient interstage period was $6417.38[$5808.94-$8338.96] per patient.(Table) In interstage clinic, patients spent 132[89-165] minutes with providers and 64[41-66] minutes waiting.(Figure) In pediatric clinic, patients spent 73[71-76] minutes with providers and 9[6-13] minutes waiting. Conclusion: This work demonstrates that while challenging, TDABC analysis can be applied to complex interstage care to understand costs and move to deliver high-value care for this population. While caring for a child during the interstage period is time and resource intensive, it carries a relatively low cost to the health care system with a total cost of $6417.38 per patient. Additional work is needed to understand costs of inpatient interstage care.

Adaptation of the ‘’Food Allergy Self-Efficacy Scale for Parents’’(FASE-P) to Turkish: a validity and reliability study

Background. Food allergy is a public health issue that has a significant impact on the lives of families. Parental self-efficacy/confidence is important in managing food allergies. The aim of this study is to validate the “Food Allergy Self-Efficacy Scale for Parents” (FASE-P) and assess parental self-efficacy in managing their child’s food allergy. Methods. Turkish version of the FASE-P (T-FASE-P) was administered to 347 parents of children aged 0-18 who had been followed for at least one month due to food allergy at the Pediatric Allergy Clinic of Prof. Dr. Cemil Taşcıoğlu City Hospital between September 1 and December 31, 2023, through face-to-face interviews and online surveys for parents of children with food allergies from the general population. Content validity, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) were conducted to evaluate the validity of the scale. General Self-Efficacy Scale (GSES) was used for concurrent criterion validity. Internal consistency analysis, test-retest application, and item analysis were conducted to assess its reliability. Results. T-FASE-P scale initially contained 21 items, and the Cronbach’s alpha coefficient (α) calculated in this form was found to be 0.89. Later, when 4 items were excluded, the 17-item version of the scale was calculated as α=0.90. The intra-class correlation coefficient between the test and re-test was found to be 0.972. The content validity index value of the scale was calculated as 0.99, indicating that the content validity was at a sufficient level. In the EFA, it was determined that the scale formed a three-factor structural model and that this model explained 60.82% of the total variance. As a result of the CFA, the fit indices were calculated as χ2/df=2.341, GFI=0.919, TLI=0.950, indicating a good level of fit. Based on the analysis results, T-FASE-P consists of 17 items and three subscales. Conclusion. T-FASE-P scale is a valid and reliable measurement tool that can be used to determine the food allergy self-efficacy of Turkish parents.

Implementing Screening for Eating Disorders in Adolescents and Young Adults with a History of Cancer.

Eating disorders are prevalent in the adolescent and young adult (AYA) population, with 2.7% of adolescents effected. AYAs with cancer possess several risk factors for eating disorders that may place them at an even higher risk. Since these patients see their oncology team frequently, oncology clinics are opportune settings for eating disorder screening. Here, we describe a study to implement screening for eating disorders in AYA patients in an oncology clinic. During regularly scheduled oncology visits, eligible patients were given the SCOFF questionnaire. A total of 163 eligible patients filled out the SCOFF questionnaire with 11 positive results (6.75%). Eating disorder screening was successfully implemented in our pediatric oncology clinic. With a rate more than double than the general population, we observed that AYA patients with a history of cancer are at a higher risk for eating disorders and should undergo routine screening in oncology clinics.

Microalbuminuria in Children With Sickle Cell Disease in the Eastern Province of Saudi Arabia.

Sickle cell disease (SCD) complications, such as sickle cell nephropathy (SCN), may begin in childhood and progress insidiously to chronic kidney disease in adulthood. In Saudi Arabia (SA), there is a lack of studies evaluating kidney function in children with SCD. This study aims to assess microalbuminuria (MA) as an early marker of renal dysfunction in SCD children living in the Eastern region of SA, to potentially institute appropriate early treatment. A prospective cross-sectional study was conducted on 114 Saudi children with SCD under the age of 14 years who attended the pediatric hematology clinic for routine follow-up. Demographic and clinical information were collected from the patients and their parents, who provided informed consent. Morning urine samples were collected and tested for the presence of MA using the urinary albumin/creatinine ratio (ACR). Blood samples were also collected for basic laboratory investigations. The prevalence of MA and its correlation with various clinical and laboratory data were analyzed. Additionally, a comparison of clinical characteristics and MA was conducted between children originating from the Southwestern (SW) and Eastern regions of the country, all of whom lived in the Eastern Province. A total of 114 children with SCD were included in the study. The mean age was 8.8 ± 3.2 years, with a male-to-female ratio of 1.3:1. Based on their region of origin, they were divided into two groups: Eastern (n = 26/114) and SW (n = 88/114). MA was detected in 28 patients (24.6%), with no significant difference in prevalence between the two groups. There was no significant statistical difference in clinical and laboratory data between the groups, except for hemoglobin F (HBF) levels and the use of hydroxyurea (HU). HBF levels were significantly higher in children from the Eastern region, while more SW patients used HU. No correlation was found between MA and any of the studied variables. MA is common in children with SCD in the Eastern region of SA, with no difference in its prevalence between children of the two different ancestries carrying the Arab-Indian (AI) and African haplotypes. It is not associated with any of the studied clinical variables in this report. Further studies are needed to confirm these findings.

Preliminary Evaluation for the Development of a Scoring System to Predict Homozygous M694V Genotype in Familial Mediterranean Fever Patients

Objective The aim of this study was to identify key parameters of a scoring system to be developed to predict the homozygous M694V genotype in patients clinically diagnosed with familial Mediterranean fever. Methods This study was a cross-sectional analysis of 472 pediatric familial Mediterranean fever patients with a homozygous genotype on exon 10, followed at our tertiary pediatric rheumatology clinic between June 2016 and June 2023. The patients were categorized into 2 groups based on their genotypes: group 1 comprised 402 patients (85.2%) with the homozygous M694V genotype, whereas group 2 consisted of 70 patients (14.8%) with other homozygous genotypes. Demographic information, clinical manifestations, MEFV (Mediterranean fever) gene variant analysis, and treatment responses were recorded from the patients' medical charts. Results The odds ratios for age at disease onset, arthritis, and chest pain were 0.892 (95% confidence interval [CI]: 0.832–0.958, p = 0.002), 2.565 (95% CI: 1.109–5.934, p = 0.028), and 2.351 (95% CI: 1.123–4.922, p = 0.023), respectively. A total of 60.7% of patients in group 1 had arthralgia, and 25% had erysipelas-like erythema, with these percentages were higher in group 1 compared with group 2 (p = 0.002, p = 0.001, respectively). Protracted febrile myalgia syndrome was detected in 1.5% of patients, all of whom had homozygous M694V genotype. Colchicine resistance was detected in 13.3% of patients, and all had homozygous M694V genotype. Conclusions This preliminary evaluation identified key parameters for a scoring system designed to predict the homozygous M694V genotype. A multicenter national study will further refine these parameters and develop the scoring system, which will aid clinicians in disease prognosis and therapeutic decision-making.

Food insecurity in a diverse community pediatric gastroenterology clinic: Screening strategies and insights.

We aimed to evaluate the prevalence of food insecurity (FI) in the community pediatric gastroenterology(GI) subspecialty clinic at Texas Children's Hospital (TCH) West Campus and to assess the utilization of services through our partnership with a local food bank. From July 1, 2023, to February 29, 2024, all patients seen in the pediatric GI clinic at TCH West Campus were screened for FI using the validated Hunger Vital Sign tool and given the opportunity to consult with a local food bank representative. A retrospective chart review was then performed on patients who completed the implemented FI screening process. 13.4% of the total patients screened positive for FI. Hispanic patients (p < 0.0001), patients with the preferred language of Spanish (p < 0.0001), those enrolled in Medicaid or Children's Health Insurance Program (p < 0.0001), and patients with obesity (body mass index ≥ 30.0, p = 0.0003) were more likely to screen positive for FI. Poor weight gain/failure to thrive and steatotic liver disease were significantly more common in those with FI (p < 0.0001 and p = 0.0003, respectively), while celiac disease, abdominal pain, and blood in stool were more common in those without FI (p = 0.0003, 0.0475, and 0.0404, respectively). As a result of our implemented FI screening process, 68.4% of those screening positive opted for resource referral, with 50.7% successfully receiving assistance in combating FI. Identifying the potential impact of FI in common pediatric GI conditions calls for proactive screening and more holistic, patient-centered approaches in clinical practice.

Sovrappeso e obesità in età pediatrica: un intervento pragmatico nelle cure primarie

Paediatric clinics are in a unique position to detect chronic diseases, identify at-risk individuals, educate families and implement early preventive interventions. This article aims to provide evidence on how and with what strategies the AUSL of Reggio Emilia has built a programme to combat overweight and obesity in childhood by involving a network of services, starting with paediatricians. A variety of approaches have been taken to address the problem of promoting healthy lifestyles. The BMIF project (Very Fit Children) focuses on early detection and treatment of overweight children using motivational interviewing to help families change their lifestyles. First, second and third level interventions provide treatment for children with obesity according to defined care pathways. Anticipatory guides on responsive feeding and the BeBa (Children's Wellbeing) app promote healthy lifestyles. Effectiveness and equity were the guiding principles for the choices made. This required time and a significant effort, but it also resulted in greater support from both operators and decision-makers.

Evaluation of pediatric migraine triggers: a single-center study.

Pediatric migraines are primarily treated with medications. However, recognizing the triggers related to patient behaviors and lifestyle is also important. This study aimed to evaluate the factors that trigger pediatric migraines. This study included 102 pediatric patients with migraine diagnosed using the third edition of the International Classification of Headache Disorders who visited our pediatric headache clinic between November 2021 and October 2022. We reviewed the patients' clinical features, imaging studies, screening tests for behaviors and emotions, and questionnaires regarding triggers. Statistical analyses were performed using the independent sample Student's t-test and linear-by-linear association test. The 102 patients (44 male, 58 female; mean age, 12.0 ± 2.9 years) were classified into migraine without aura (n = 58) and migraine with aura (n = 44) groups. Sleep disturbances were the most frequent trigger (76.5%). Other triggers included academic stress (66.7%), motion sickness (62.7%), and fatigue (52.9%). Academic stress was the most significant trigger for pain severity in 44.1% of patients. Abnormal behavioral or psychiatric assessment results were associated with a higher number of triggers. This study identified sleep disturbance and academic stress as common triggers of pediatric migraine, with academic stress being the most intense. Clinicians should understand these triggers and advise patients to avoid them by changing their lifestyles, if possible.

Comparative study in distal hypospadias repair: a meatal-based flaps technic vs. tubularized incised plate urethroplasty.

Hypospadias is the most common anomaly of the male genital system after undescended testis. More than 200 surgical repair techniques have been described for the treatment of hypospadias due to many different meatus localisations and other accompanying anomalies. Kutlay defined a new technique in 2010 with 10 patients with distal hypospadias patients. We compared this new technique with tubularized incised plate urethroplasty (TIP) which is one of the most frequently performed methods. 148 patients with hypospadias who underwent surgery at the Urology and Pediatric Surgery Clinic during the period of January 2010 to December 2022 in the first and 2nd clinic, were retrospectively analyzed. The study focused on the remaining 83 patients with distal hypospadias for the purpose of comparison. The mean age of group one was 10.0 (± 6.9, range 2-27), while for group two it was 10.8 (± 5.9, range 3-23). There was no statistically significant difference between the two groups in terms of anatomical position of the meatus, stricture and fistula complications (p > 0.5). The Kutlay technique has been described as an easy-to-learn and feasible method with reliable results. No significant difference in complications was observed in this study compared with TIP, which is known as the standard technique worldwide. We would like to suggest that the method be considered for further evaluation with larger patient groups and different techniques.

INDICATORS OF FREE RADICAL OXIDATION AND ANTIOXIDANT PROTECTION IN THE ORAL FLUID OF CHILDREN WITH CHRONIC CATARRHAL GINGIVITIS AND DIABETIS MELLITUS

Failure of antioxidant mechanisms leads to an increase in lipid peroxidation products in the body, resulting in a non-specific cascade of cellular membrane damage. Proteins play a crucial role in metabolic processes, but when lipid peroxidation intensifies, protein modifications occur, leading to fragmentation, denaturation, and loss of biological activity. This disruption impairs tissue regenerative processes. The objective of this study was to analyze indicators of free radical oxidation and antioxidant protection in the oral fluid of children with chronic catarrhal gingivitis and type I diabetes mellitus. Materials and methods. A total of 170 children aged 12 to 16 were observed, including 130 who were examined and treated at the Endocrinology Department of the Regional Municipal Non-Profit Institution “Chernivtsi Regional Pediatric Clinical Hospital” for type 1 diabetes mellitus. Among them, 74 children had a disease duration of less than 5 years, including 65 with chronic catarrhal gingivitis. Sixty five children had diabetes for more than 5 years, with 44 of them diagnosed to have chronic catarrhal gingivitis. The children with chronic catarrhal gingivitis were further divided into groups based on their level of glycemic control: 1 child with optimal glycemic control, 66 with suboptimal glycemic control, and 42 with glycemic control at a high risk to life. The control group included 40 practically healthy children: 22 of them had clinically healthy periodontal tissues, and 18 children were diagnosed to suffer from chronic catarrhal gingivitis. Results. The study performed found out that children with chronic catarrhal gingivitis present increased indicators of lipid peroxide oxidation (protein oxidative modification, diene conjugates, malondialdehyde) and decreased activity of the enzyme in the antioxidant protective system of the oral fluid (whole protein, НS-groups, ceruloplasmin, activity of supermutase and catalase) in comparison with indicators of children without dental pathology. The most considerable changes were found in patients with chronic catarrhal gingivitis and type 1 diabetes mellitus, especially when the disease lasted more than 5 years (р&lt;0,05).

Clinical Presentation, Treatment, and Outcomes of Pediatric Brain Tumors: A 5-Year Single-Center Experience in Istanbul

Background: Brain tumors are the most common solid tumors in childhood. With the help of increased clinical awareness, improvements in imaging methods, and the identification of molecular characteristics, advances have been made in both diagnosis and treatment. Objectives: In our study, we aimed to discuss the childhood brain tumor cases followed in our clinic, along with their clinical and epidemiological features and treatment outcomes. Methods: The study group comprised children younger than 18 years old who were followed in the Pediatric Hematology and Oncology Clinic of Istanbul Medical Faculty and diagnosed with a brain tumor over the past 5 years (2018 - 2023). Symptoms, age at diagnosis, treatment options (surgery, radiotherapy, chemotherapy), and side effects were reviewed retrospectively. Results: Thirty children were diagnosed with brain tumors. Of the patients, 14 (47%) were male and 16 (53%) were female. The mean age of the children was 8.8 ± 3.1 years, and the mean age at diagnosis was 65.6 ± 37.7 months. The most common symptom was vomiting (40%). The mean duration between the onset of symptoms and diagnosis was 3.8 months, with a median of 1 month. Of the patients, 60% were diagnosed with glial tumors and 40% with non-glial tumors. Gross total resection (GTR) was performed in 26% of patients, subtotal resection (STR) in 37%, and 37% of patients did not undergo surgery. Seventy-seven percent of the patients received chemotherapy, and 57% received radiotherapy. Of the patients, 57% were considered responsive to treatment (complete/partial), 30% had stable disease, and 13% had progressive disease. The overall brain tumor mortality rate in our clinic was 13%. While 73% of our 26 patients had no or mild neurological deficits, 27% had moderate to severe disabilities (gait impairment, hearing impairment, visual impairment). Conclusion: Although the sample size was limited, it may be speculated that the surgery rate was low and long-term side effects were notable. Insufficient surgical resection can affect the treatment response and increase the risk of neurological sequelae and functional impairment. Molecular profiling should be expanded, and a palliative care team should be involved as early as possible to address long-term side effects and improve the quality of life for patients.

Exploring chest wall deformities in childhood and adolescence: insights from a case-control study

BackgroundChest wall deformities, though relatively uncommon in childhood and adolescence, significantly affect aesthetic perception and can impact cardiac and respiratory function. This study aims to compare individuals with pectus deformities to a healthy control group, shedding light on the condition’s etiology and prognosis.MethodConducted as a case-control study between 2020 and 2022, the research included a case group of 71 patients with pectus excavatum or pectus carinatum who were followed up at the Pediatric Cardiology outpatient clinic. The control group consisted of 80 children without chronic diseases. Researchers retrospectively reviewed patient files, recording demographic data, echocardiography findings, and serum levels of calcium, phosphate, vitamin D, and alkaline phosphatase.ResultsPatients with chest wall deformities exhibited significantly lower serum levels of vitamin D, calcium, and phosphorus compared to those without deformities. Males constituted 77% of the case group, with 15.5% exhibiting abnormal echocardiogram results, with mitral valve anomalies being most prevalent.ConclusionWhile pectus deformities may lead to cardiac or respiratory issues, patient concerns often center around aesthetics. Unlike typical studies focused on surgical techniques and postoperative patients, our study focused on all diagnosed patients. Findings emphasize the importance of monitoring calcium, phosphorus, and vitamin D levels in pectus patients to manage surgical risks and facilitate recovery.

"While Everyone Else was Doing Sports, I Used to Sit on the Sidelines." How Do Adolescents Manage Their Asthma?: A Qualitative Study.

Effective asthma management is a necessity for the control and optimal outcomes of the condition. A number of factors may either facilitate or act as barriers to the management of asthma in adolescents. The objective of this study was to assess the feelings, thoughts, and behaviors of adolescents diagnosed with asthma regarding the management of their condition. This exploratory qualitative study was conducted using semi-structured, in-depth interviews with 12 adolescents aged 12-18 years who were followed up with a diagnosis of asthma at a university hospital pediatric allergy clinic between October 15 October 2023, and December 15 December 2023. The study was written using the COREQ checklist. Three main themes were identified in this study: (1) facilitators, (2) barriers, and (3) information. Adolescents reported that they needed more information about medication use and asthma disease to manage asthma. Asthma control ability, positive beliefs, and supportive relationships were facilitators of asthma management. However, poor asthma control, negative beliefs, lack of support, poor communication, and asthma-related stigma were identified as barriers to asthma self-management. Adolescents had information needs in asthma management. This study highlights that barriers to asthma self-management in adolescents are much greater than the facilitators. For adolescents to manage their asthma well, their information needs must be met. Therefore, pediatric nurses should prepare individualized training to meet the specific needs of adolescents.