Pediatric Department Research Articles

Epidemiological, clinical characteristics and the association between influenza vaccination, oseltamivir treatment, and complications in children with seasonal influenza

Influenza, a historical and contemporary public health challenge, is an acute respiratory infection caused mainly by influenza A or B viruses. This descriptive case series describes 194 children treated for seasonal influenza at the Department of Pediatrics, 103 Military Hospital, Vietnam Military Medical University, from May 2022 to May 2023. Influenza primarily occurred during winter and early spring, peaking in December and January, 57.2% were aged 12-60 months, boys. Vaccination coverage was limited (36.3%), especially post-COVID-19. Complications were seen in 75.3% of the cases, including febrile seizures (42.3%), bronchopneumonia (40.2%), respiratory failure (8.2%), acute myocarditis, influenza-associated encephalopathy, and septic shock. The study reveals bacterial coinfections, affected 20% of the cases, mainly by Streptococcus pneumoniae and S. aureus, and atypical bacteria Mycoplasma pneumoniae. Non-vaccinated children faced significantly higher risks of complications, oseltamivir within 48 hours reducing the risks of complications. Influenza predominantly affects 12-60 month-olds, males, and peaks annually in winter. Severe conditions stem from bacterial coinfections, emphasizing the importance of vaccination and prompt antiviral treatment to mitigate complications. The study highlights a critical need for increased vaccination, especially in the post-COVID-19 era, to manage influenza in children effectively.

Evaluation of non-malignant neutropenia in children at tertiary care hospital of South Gujarat

: Neutropenia is defined as absolute neutrophil count <1500cells/mm. This condition is observed in different situations - from a variant of the normal to life-threatening acquired and congenital diseases. Diseases like Tuberculosis, malaria, pertussis, typhoid, dengue, HIV, etc. can cause neutropenia. Mild cases are usually asymptomatic. But severe cases are extremely susceptible to infections, mainly viral infections like CMV, EBV, HIV, etc. Clinical manifestations, like complications, depend on the severity of neutropenia. The clinical manifestations of isolated neutropenia are diverse, including the frequency of infectious episodes. A thorough infectious history of neutropenic patients is the initial step of the evaluation. : To enlist the causes and clinical features, to document various treatment modalities, and to assess the outcome of children with non-malignant neutropenia. : Hospital based prospective cross-sectional study was conducted for 20 months among 42 patients at Department of Pediatrics of tertiary care Hospital. Study was conducted from February 2021 to August 2022. : Total 20 were males and 22 were females. Among the study participants, 36 were >2 years of age and 6 were <2 years of age had nonmalignant neutropenia. Among the study participants, 40 were from urban area and 2 were from rural area. More number of patients had come with chief complaint of fever. : The current population of children in India is close to 1.41 billion and 10.2% of it suffering from neutropenia makes it an important health problem that needs to be thoroughly evaluated.

Clinical and Laboratory Profile of Dengue Syndrome in Pediatric patients: Study in a Tertiary Care Hospital, Dhaka, Bangladesh

Introduction: Dengue fever is a mosquito-borne arboviral (arthropod-borne virus) disease which is of global concern. This fever is a benign syndrome caused by an arthropod-borne virus and is characterized by Biphasic fever, myalgia, arthralgia, rash, leukopenia, and lymphadenopathy. Aim of the study: This study aimed to evaluate the clinical and laboratory profile of dengue fever in children less than 15 years old admitted to an urban hospital. Methods: This retrospective study was conducted in the Department of Paediatrics of Anwer Khan Modern Medical College Hospital (AKMMCH), Dhaka, Bangladesh during the period from 4 April 2019 to 9 September 2019. They have followed up on the symptoms, platelet count and management of the patients. Data were analysed by using MS-Excel-2016. Result: In total 98 patients from both groups completed the study. In our study, we found a maximum of 54.08% were male, more than half 53(54.08%) patients were below five years of age, about 95(96.94%) of the patients had a fever. Maximum patients, 81(82.65%), were managed by I/V fluid, more than 72(73.47%) of the patients were managed by paracetamol. Others by antibiotics 16(16.33%), platelet transfusion 14(14.29%) and blood transfusion 12(12.24%). Other management also includes plasma, & dopamine. Conclusion: These study children about 0-15 years of age more commonly suffer from dengue fever. As the vaccine is not available in Bangladesh, these patients need a timely diagnosis and critical monitoring during the disease course to prevent severity and mortality.

Correction of Constricted Ear – Case Report

Introduction. Congenital deformities of the outer ear are common; reported incidence are from 1:6000 to 1:6830 newborns. Multitude of corrective procedures are described in the literature. Purpose of the case study. The adequate surgical treatment of the congenital constricted ear remains a challenge. Selected tailor made approach should be employed on case by case basis, thus, in this study we present our case of moderate constricted ear and the used surgical procedures done under general anesthesia, as well as the outcome of the treatment. Case report. A 6 year old girl presented in pediatric and plastic surgery department with complaint of right ear deformity from birth and additional psychological effects such as increased difficulty in social integration and lack of self- confidence. On clinical examination, we considered as constricted ear grade IIB by Tanzel. Two separate procedures under general anesthesia were done. In the first procedure, advancement of the helix and otoplasty was performed; an effective expansion, of about 1 cm in the length of the pinna was obtained. In the second procedure, about 0.5 cm expansion of the helix was performed, and also the breadth of the pinna. Conclusion. In our case, combination of Mustardé suture, helix advancement and helix cartilage graft in moderate constricted ear were a useful surgical option, producing aesthetically good results in a simple and effective way.

Is It Possible to Use Inflammatory Markers as Potential Biomarkers for Chronic Urticaria?

Background: This study aimed to determine whether the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) at admission affect the transition of pediatric patients diagnosed with acute spontaneous urticaria to chronic urticaria. Methods: This study included 390 patients who presented to the Department of Pediatrics at Akdeniz University Hospital with acute spontaneous urticaria between January 2020 and December 2022. A statistical comparison was made between the hematological parameters of patients who developed chronic urticaria and those who did not. Neutrophil, lymphocyte, and platelet counts, as well as NLR, PLR, and SII ratios, were used for the comparison. Results: It was observed that acute urticaria progressed to chronic urticaria in 5.8% (n = 23) of the patients. No significant differences in lymphocyte, hemoglobin, and platelet counts were observed between the group progressing to chronic urticaria and the control group (P > 0.05). However, the chronic urticaria group had higher leukocyte and absolute neutrophil counts (P = 0.009 and P < 0.001, respectively). In addition, the NLR was significantly higher in the chronic urticaria group (P = 0.029), whereas no statistically significant difference was observed in the PLR (P = 0.180). The chronic urticaria group had a significantly higher SII than the control group (P = 0.011). Conclusion: Hematological parameters, particularly NLR and SII, may be useful indicators of the transition from acute to chronic urticaria in pediatric patients. The early identification of these markers could help monitor patients and guide treatment decisions. Further comprehensive studies are required to validate these findings.

Frequency of Hyponatremia &amp; Hypokalemia in Children under 5 Years with Acute Diarrhoea

Background: Acute diarrhea poses a significant health threat to children globally, often leading to severe morbidity and mortality, particularly in developing countries. Electrolyte imbalances, including hyponatremia and hypokalemia, are common complications associated with acute diarrhea, further exacerbating the risk of adverse outcomes. Objective: This study aimed to evaluate the frequency of sodium and potassium abnormalities, specifically hyponatremia and hypokalemia, in children presenting with acute diarrhea. Methodology: A prospective cohort study was conducted at the Pediatric department of a tertiary hospital from July 2022 to June 2023. A total of 130 pediatric patients aged up to 5 years, presenting with acute diarrhea, were included in the study. Clinical examinations were conducted, and demographic data, including age, gender, residence, and socioeconomic status, were recorded. Serum sodium and potassium levels were determined from venous blood samples, and hyponatremia and hypokalemia were defined as sodium levels &lt;130 mmol/l and potassium levels &lt;3.5 mmol/l, respectively. Statistical analysis was performed using SPSS 24.0. Results: The mean age of the patients was 2.38 years, with a disease duration of 3.54 days. Male patients accounted for 60% of the cohort, and urban residency was predominant (55%). Clinical symptoms included loose motion (100%), abdominal pain (70%), fever (35%), vomiting (31%), and lethargy (27%). Hyponatremia was observed in 30% of patients, while hypokalemia was present in 40% of cases. Conclusion: Sodium and potassium imbalances are prevalent among children with acute diarrhea, highlighting the need for vigilant monitoring and appropriate management strategies to prevent adverse outcomes. The high incidence of hyponatremia and hypokalemia underscores the importance of early recognition and intervention in pediatric patients presenting with acute diarrhea.

Clinical features and ALDH5A1 gene findings in 13 Chinese cases with succinic semialdehyde dehydrogenase deficiency

Background and aimsTo investigate the clinical features, ALDH5A1 gene variations, treatment, and prognosis of patients with succinic semialdehyde dehydrogenase (SSADH) deficiency.Materials and methodsThis retrospective study evaluated the findings in 13 Chinese patients with SSADH deficiency admitted to the Pediatric Department of Peking University First Hospital from September 2013 to September 2023.ResultsThirteen patients (seven male and six female patients; two sibling sisters) had the symptoms aged from 1 month to 1 year. Their urine 4-hydroxybutyrate acid levels were elevated and were accompanied by mildly increased serum lactate levels. Brain magnetic resonance imaging (MRI) showed symmetric abnormal signals in both sides of the globus pallidus and other areas. All 13 patients had psychomotor retardation, with seven showing epileptic seizures. Among the 18 variants of the ALDH5A1 gene identified in these 13 patients, six were previously reported, while 12 were novel variants. Among the 12 novel variants, three (c.85_116del, c.206_222dup, c.762C > G) were pathogenic variants; five (c.427delA, c.515G > A, c.637C > T, c.755G > T, c.1274T > C) were likely pathogenic; and the remaining four (c.454G > C, c.479C > T, c.1480G > A, c.1501G > C) were variants of uncertain significance. The patients received drugs such as L-carnitine, vigabatrin, and taurine, along with symptomatic treatment. Their urine 4-hydroxybutyric acid levels showed variable degrees of reduction.ConclusionsA cohort of 13 cases with early-onset SSADH deficiency was analyzed. Onset of symptoms occurred from 1 month to 1 year of age. Twelve novel variants of the ALDH5A1 gene were identified.

Serum Vitamin D Levels In Pediatric Patients With Familial Mediterranean Fever

Introduction: Familial Mediterranean Fever (FMF) is an autosomal recessive autoinflammatory disorder. Vitamin D deficiency is a common finding in patients with various chronic inflammatory diseases. Several studies have elucidated the correlation between serum vitamin D levels and disease activity in pediatric Familial Mediterranean Fever patients. In this study, we aimed to investigate the role of vitamin D in the development of Familial Mediterranean. Method: This study includes 95 pediatric patients diagnosed with Familial Mediterranean Fever who were followed by the Department of Pediatrics at an Application and Research Hospital in Turkey and agreed to participate in the study. Additionally, 34 healthy children who consented to participate constituted the control group. The diagnosis of patients with FMF utilized the Tel-Hashomer criteria Results: The hormone levels of FMF and control groups were compared. Vitamin D levels, calcium, phosphorus, Parathyroid Hormone and Alkaline Phosphatase levels were analyzed. In the FMF group, the Vitamin D level was found to be significantly lower, while the Ca and phosphorus levels were significantly higher compared to the control group (both with p&lt;0.01). Although the difference in Ca levels between the two groups was statistically significant, the mean Ca levels of both groups remained within the normal range. Conclusion: In conclusion, the significant deficiency of serum vitamin D levels in pediatric FMF patients and its association with disease severity underscores the importance of regular monitoring and potential therapeutic intervention.

Evaluation of the Frequency of Blood Ammonia Test Requests in Pediatric Clinics Before and After the Establishment of the Pediatric Metabolism Department

Abstract Background/Aims: Hyperammonemia causes severe mortality and morbidity when left unnoticed. We aimed to compare the number of ammonia test requests before and after establishing the Pediatric Metabolism Department (PMD) in a pediatric clinic. Methods: The study was conducted retrospectively between 15/11/2022-16/11/2023. Study data were evaluated before (pre-group) and after (post-group) the establishment of PMD. Results: Two hundred eighty-five admissions were assessed in the study. There were 99 admissions in the pre-group and 186 in the post-group. There were 17 admissions for different reasons in the pre-group and 29 in the post-group. The most common reasons for admission were elevated transaminases, seizures, vomiting, and metabolic acidosis. Definitive diagnosis was made in 16 (17.6%) patients admitted in the pre-group and 39 (23.8%) in the post-group. The most common diagnoses were genetic syndromes, mitochondrial diseases, and organic acidemias. Twenty-one patients were diagnosed with inherited metabolic diseases (IMDs). Mitochondrial diseases were the most commonly diagnosed IMD (8(38%)). An ammonia test was requested from 8 of 15 pediatric subunits in the pre-group and 13 in the post-group. In the pre-group, the pediatric subunit where ammonia was requested the most was the Pediatric Neurology Polyclinic (n=25 (25.3%)). In the post-group, the subunit that required the highest number of ammonia tests was the PMD (68(23.9%)). In the ROC analysis conducted for the predictive power of the initial ammonia level in requesting a control ammonia test, the area under the curve is 0.927, and the p-value is 0.001. For the cut-off value of 60.3 µmol/l, the sensitivity was 90.9%, and the specificity was 88.6%. Conclusions: After the establishment of PMD, an increase in ammonia test requests, in the diversity of reasons for requesting ammonia testing from admissions, and in IMD diagnosis were detected, and the positive effect of PMD on pediatricians' awareness of hyperammonemia was found.

Effects of Measles Vaccine and Its Associated Risk Factors Among Children Presenting in a Tertiary Care Hospital, Rawalpindi/Islamabad

Objectives: To identify risk factors associated with the development of measles among children under 12 years of age in a tertiary care hospital in Rawalpindi/Islamabad and to determine the effectiveness of measles vaccination in the study population. Methods: A retrospective case control study was done from January 2022 to January 2023 at the Department of Pediatrics, Holy Family Hospital (HFH), Rawalpindi &amp; PAEC General Hospital, Islamabad. Total 600 children were included in the study. The hospital data record had children under the age of 12 with measles. Case controls were enrolled without measles at the same hospital, matched for age and sex. Study outcomes were analyzed by multivariant regression test adjusted with age and sex. Results: The average age of the children was 32.24±14.58 months. Mothers with low education were mostly have measles [OR: 4.1, 95% CI: 1.9-6.5, for primary schooling and OR: 1.1, 95% CI: 0.7-2.0, for matriculation]. Children with measles were mostly not breastfed during the first 2 years of life [OR: 0.8, 95% CI: 0.5-1.4]. Cases were also more likely to have never been vaccinated [OR: 8.2, 95% CI: 5.5-15.0] and never vaccinated other children at home [OR: 6.5, 95% CI: 4.5-10.0]. Conclusion: The study concluded that breastfeeding and proper weaning practices are necessary to eradicate measles.

Disease Spectrum and Outcome of Patients in PICU of Federal Govt. Polyclinic Hospital (FGPC) Islamabad

Objective: To summarize the spectrum of disease and outcome in children admitted to the Pediatric Intensive Care Unit of FGPCH. Methodology: It is a retrospective descriptive study conducted at Pediatric ward and Intensive care unit of Pediatric department of Federal Govt. Polyclinic Hospital, Islamabad from June’2018 to June’2020. The outcome variables are classified as discharge from PICU, death, shift to the ward after stabilization, and referral to other hospitals due to the unavailability of further specialized services. Results: A total of 424 pediatric patients were included in this study. The overall mean age was 19.6±29.2 months and there were 239 (56.4%) males and 185 (43.6%) females. The most common diagnosis was pneumonia 37.3% (158/424), followed by sepsis and meningitis 14.6% each (62/424 each), and acute gastroenteritis 11.3% (48/424). There were 116 out of 424 (27.4%) who required ventilatory support in the PICU, while the remaining 308 (72.6%) did not require ventilatory support. In terms of outcomes, there were 106 (25.0%) pediatric patients who expired, 277 (65.3%) were shifted to the ward from PICU, 29 (6.8%) were discharged and 12 (2.8%) were referred to a specialized facility. The mean duration of stay was 3.1±2.7 days. Conclusion: The most susceptible age group was under five years with the highest mortality rate and the most common cause of death is pneumonia preceded by other infections which can be controlled with better preventive measures.

Percepcija roditelja o febrilnim konvulzijama u djece

Aim. To examine the perception of parents of children suffering from febrile seizures in relation to management procedures for febrile seizures, parents’ gender, and their opinion regarding the need for additional education.Methods. The cross-sectional study was conducted at the Department of Pediatrics, Osijek Clinical Hospital Centre, in February and March 2023. The respondents were 32 parents of children hospitalized for febrile seizures. A questionnaire on parents’ perception of febrile seizures was used.Results. There were 32 respondents, 15 (47%) male and 17 (53%) female. A total of 20 (62%) respondents were not aware that their child was having a febrile seizure attack, 6 (19%) respondents thought their child was dying, and 4 (13%) respondents thought their child was losing consciousness. During seizure, a significant number of respondents, 16 (50%), of them, felt fear as the dominant emotion, and 13 (41%) respondents felt panic. A total of 9 (28%) respondents felt ready for recurrent febrile seizure, while 6 (19%) respondents were not or could not assess their readiness. A total of 29 (91%) respondents believed that they needed additional education.Conclusion. Parents are mostly unaware that their child is having a febrile seizure and feel fear and panic. Male parents call emergency medical services significantly more often than female parents. Parents are not sufficiently prepared for the recurrent seizures, and most of them believe that they need additional education.

Analysis of the effect of early subcutaneous specific immunotherapy on the levels of dust mite allergen-specific antibodies and polyunsaturated fatty acid metabolism

Objective: To investigate the effects of subcutaneous immunotherapy (SCIT) on patients' immune markers and metabolic levels in the early stage of allergen treatment, and to gain insight into the role of SCIT in regulating immune responses and metabolic levels, so as to provide reference data for the further discovery of potential biomarkers. Methods: A longitudinal study was used to include 40 subjects who underwent SCIT with dust mite allergens in the Department of Pediatrics of the First Affiliated Hospital of Guangzhou Medical University between November 2017 and February 2022, including 20 subjects each of single mite subcutaneous immunotherapy (SM-SCIT) and double mite subcutaneous immunotherapy (DM-SCIT). In this study, levels of dust mite allergen-specific antibodies and polyunsaturated fatty acid metabolism were measured before and 12 months after treatment, while pulmonary function tests were performed. The therapeutic effects of the patients were followed up by visual analogue scale (VAS), asthma control test (ACT) and total medication scores (TMS). The results were statistically analyzed using t-test and Mann-Whitney U-test. Results: After 12 months of treatment with SCIT, both groups showed a significant decrease in total VAS score (SM-SCIT:Z=-2.298, P<0.05; DM-SCIT:Z=-3.411, P<0.001); total ACT score (SM-SCIT:Z=-2.054, P<0.05; DM-SCIT:Z=-2.014, P<0.05) and total medication scores (SM-SCIT:Z=-3.799, P<0.000 1; DM-SCIT:Z=-3.474, P<0.001) were significantly higher, in addition to significantly higher MMEF75/25 values in the DM-SCIT group (t=-2.253, P<0.05). There was no significant change in sIgE in the SM-SCIT group (P>0.05), and the sIgG4 levels of the Der p, Der f, p 1, p 2, f 2, and p 21 fractions were significantly elevated (Z=-2.651, -3.771, -2.949, -2.912, -2.725, -2.128, and -3.285, respectively, all P<0.05); The sIgE of Der p 2, f 2, p 7 and p 23 fractions(Z=-2.651, -3.771, -2.949, -2.912, -2.725, -2.128, -3.285, all P<0.05) and the sIgG4 levels of the Der p, Der f, p 1, p 2, f 1, f 2, p 10, p 21 and p 23 fractions (Z=-3.808, -3.845, -3.061, -2.688, -2.464, -3.211, -2.371, -2.091, -2.427, all P<0.05) of the DM-SCIT group were significantly elevated. Metabolomics analysis showed that arachidonic acid, docosahexaenoic acid, docosapentaenoic acid, eicosapentaenoic acid, 5, 9, 12-octadecatrienoic acid, 5(S)-hydroxylated eicosatetraenoic acid, and dihomo-gamma-linolenic acid were significantly elevated at the beginning of the treatment period after SM-SCIT treatment (Z of -2.191, -2.497, -1.988, -2.090, -2.19, -2.803, -2.073, all P<0.05); 5(S)-hydroxylated eicosatetraenoic acid showed elevated and alpha-linolenic acid, eicosadienoic acid, and eicosapentaenoic acid were significantly decreased in the DM-SCIT group after treatment (Z=-1.988, -2.090, -2.497, -1.988, respectively, all P<0.05). Correlation analysis showed that arachidonic acid was significantly negatively correlated with changes in dust mite-specific IgG4 (r=-0.499, P<0.05), and that alpha-linolenic acid, 5, 9, 12-octadecatrienoic acid, and eicosapentaenoic acid were positively correlated with the ΔsIgG4 of the dust mite der p 2 (r=0.451, 0.420, 0.474, respectively; all P<0.05). Conclusion: Significant changes in allergen-specific antibody levels and polyunsaturated fatty acid metabolism levels occur during SCIT, and the two may interact and influence each other.

Respiratory Distress in Children Aged 6 to 59 Months at the Pediatric Department of the Csref of Commune V of Bamako: Clinical and Therapeutic Aspects

Respiratory Distress in Children Aged 6 to 59 Months at the Pediatric Department of the Csref of Commune V of Bamako: Clinical and Therapeutic Aspects

Cardiac Evaluation before and after Oral Propranolol Treatment for Infantile Hemangiomas.

Background: Most recent clinical practice guidelines addressing the management of infantile hemangiomas (IHs) recommend oral propranolol, a non-selective beta-adrenergic antagonist, as first-line treatment. However, few reports have provided continuous follow-up data regarding cardiac evaluations. Methods: Sixty-four patients diagnosed with IHs and treated with oral propranolol before 2 years of age at the Department of Pediatrics, Kangbuk Samsung Hospital (Seoul, Republic of Korea), with regular examinations between 2017 and 2021, were included. Cardiac evaluations, including electrocardiography, Holter monitoring, chest X-ray, and echocardiography, were performed. Results: Sixty-four patients with IHs successfully underwent continuous follow-up cardiac evaluations. The median age at diagnosis was 2 weeks (1 day to 34.3 weeks). The median age at treatment initiation was 13.6 weeks (2.4-87.9 weeks), the mean longitudinal diameter of hemangioma at diagnosis was 2.8 ± 2.1 cm (0.3-12.0 cm), and the mean percentage of size decrease after 1 year of oral propranolol treatment was 71.8%. None of the 64 patients experienced severe adverse side effects during propranolol treatment. There was no statistically significant differences in echocardiographic function and electrocardiographic data after treatment. Conclusions: Propranolol treatment ≥6 months was effective and safe without significant cardiac toxicity in the treatment of patients with infantile hemangiomas.

Hyperthyroidism in Pediatric Patients in a University Hospital: Ten Years of Experience

Although rare in childhood, hyperthyroidism is diagnosed by suppressed serum thyrotropin (TSH) levels and increased levels of free triiodothyronin (fT3) and free thyroxine (fT4) in addition to history and physical examination findings. In this study, we aimed to investigate the causes of hyperthyroidism and the clinical features of the disease in children and to evaluate the treatment. A total of 39 patients with hyperthyroidism diagnosed between 2010 and 2019 in the pediatric endocrinology department were included in the study.Thirty-one (79.5%) patients were female, and the mean age of admission was 14.4 (4.3-17.5) years. Of the cases, 33 (84.6%) were diagnosed with Graves’ diseases and 6 (16.7%) with Hashimoto thyroiditis. The most frequent complaints of patients diagnosed with hyperthyroidism were irritability (24, 61.5%), palpitation (22, 56.9%), and sweating (21, 53.8%). The most frequent findings were goiter in 31 (79.5%) patients and tachycardia in 27 (69.2%) patients. Serum TSH levels were suppressed in all patients, fT3 levels were increased in 94.4% of them, and fT4 levels were increased in 80.5% of them. In patients with Graves’ disease, TSH receptor antagonist was positive in 31 (93.9%) cases, and at least one of the thyroid autoantibodies was positive in all patients. Antithyroid drug treatment was initiated in all patients; 35 of them received methimazole and 4 of them received propylthiouracil. Radioactive iodine treatment was applied to three patients, and two patients were treated surgically who did not respond to antithyroid drug treatment. Antithyroid drug adverse effects were observed in 7 (21.2%) patients, requiring drug discontinuation in 1 patient. Although hyperthyroidism is rare in childhood, its treatment is difficult and requires close follow-up. Treatment options are different for adult patients. There is a need for multicenter studies to evaluate treatment efficacy and long-term outcomes in children.

Application value of multi-gene mutation detection in the clinical management of pediatric papillary thyroid carcinoma: a preliminary exploration.

Thyroid cancer rarely occurs in children and adolescents. Molecular markers such as BRAF, RAS, and RET/PTC have been widely used in adult PTC. It is currently unclear whether these molecular markers have equivalent potential for application in pediatric patients. This study aims to explore the potential utility of a multi-gene conjoint analysis based on next-generation targeted sequencing for pediatric papillary thyroid carcinoma (PTC). The patients diagnosed with PTC (aged 18 years or younger) in the pediatrics department of Lishui District Hospital of Traditional Chinese Medicine were retrospectively screened. A targeted enrichment and sequencing analysis of 116 genes associated with thyroid cancer was performed on paraffin-embedded tumor tissues and paired paracancerous tissue of fifteen children (average age 14.60) and nine adults (average age 49.33) PTC patients. Demographic information, clinical indicators, ultrasonic imaging information and pathological data were collected. The Kendall correlation test was used to establish a correlation between molecular variations and clinical characteristics in pediatric patients. A sample of 15 pediatric PTCs revealed a detection rate of 73.33% (11/15) for driver gene mutations BRAF V600E and RET fusion. Compared to adult PTCs, the genetic mutation landscape of pediatric PTCs was more complex. Six mutant genes overlap between the two groups, and an additional seventeen unique mutant genes were identified only in pediatric PTCs. There was only one unique mutant gene in adult PTCs. The tumor diameter of pediatric PTCs tended to be less than 4cm (p<0.001), and the number of lymph node metastases was more than five (p<0.001). Mutations in specific genes unique to pediatric PTCs may contribute to the onset and progression of the disease by adversely affecting hormone synthesis, secretion, and action mechanisms, as well as the functioning of thyroid hormone signaling pathways. But, additional experiments are required to validate this hypothesis. BRAF V600E mutation and RET fusion are involved in the occurrence and development of adolescent PTC. For pediatric thyroid nodules that cannot be determined as benign or malignant by fine needle aspiration biopsy, multiple gene combination testing can provide a reference for personalized diagnosis and treatment by clinical physicians.

Melatonin as an add-on anti-seizure medication in children with epilepsy: An open-label randomized controlled trial

Objectives: The primary objective of this study is to measure the effect of melatonin in decreasing seizure frequency in intervention group as compared to controls in children with drug-resistant epilepsy. Materials and Methods: An open-label randomized controlled trial was conducted from July 2020 to June 2022 in children between 2 and 14 years with drug-resistant epilepsy attending Pediatric and Neurology outpatient department and inpatient department. After noting down baseline seizure frequency, children were randomized into the melatonin group and control group. In the melatonin group, add-on melatonin was added to the existing ASM, and in the control group, ASMs were continued. The primary and secondary outcomes were measured after 3 months of follow-up. Results: The percentage change in the seizure frequency between both groups at the end of 3 months of follow-up was not statistically significant, but the percentage reduction of seizure frequency was more than 50% in the melatonin group. Melatonin was well tolerated in our children except for 4 (22%) who developed minor adverse effects. Conclusion: Add-on melatonin decreases seizure frequency to some extent which was not statistically significant with no major side effects. Further studies are needed to assess add-on melatonin’s long-term effectiveness and safety in children with drug-resistant epilepsy.

ASPECTS EPIDEMIOLOGIQUES ET DIAGNOSTIQUES DES MALFORMARTIONS CONGENITALES OBSERVEES DANS DEUX SERVICES DE CHIRURGIE A DAKAR

Congenital malformations pose a real social, economic, coding and prognosis problem in our developing countries. Objectives. To list congenital malformations in two surgical departments of the University Hospital of Dakar and to search for etiological factors. Patients and methods. This was a prospective study in which we collected 100 cases of congenital malformations in a pediatric population during 13 months (January 2013 to January 2014) in the Neurosurgery Department of the Fann University Hospital and the Pediatric Surgery Department of the Aristide Le Dantec University Hospital. Epidemiological and diagnostic parameters were studied. Results. The most represented age group was that of children aged 0 to 4 years (n=87) with an average age of 1.47 years, the predominance of males was clear 68% with a sex ratio of 2.19. The notion of consanguineous marriage was reported in (61%) of cases with (57%) of cases of 2nd degree and (4%) of cases of 3rd degree. Wolofs were the most affected by congenital malformations (42%). The Dakar region was the most represented (37%). The socioeconomic level was low in (75%) of cases. In (93%) of cases, the parents of malformed children said they had no dea about the problem. The congenital malformations encountered were mainly hydrocephalusand visceral diso rders. We noted (13%) of deaths in our study. Conclusion. malformations are of multifactorial origin, which makes it necessary to set up a register of congenital malformations in order to monitor the prevalence, to detect rapidly variations in the frequency of an anomaly and to identify teratogenic factors. Key words: congenital malformations, hydrocephalus, visceral malformations, etiological factors, Dakar

Simulation-based team training for healthcare professionals in pediatric departments: study protocol for a nonrandomized controlled trial

BackgroundHealthcare systems worldwide face challenges related to patient safety, quality of care, and interprofessional collaboration. Simulation-based team training has emerged as a promising approach to address some of these challenges by providing healthcare professionals with a controlled and safe environment to enhance their teamwork and communication skills. The purpose of this study protocol is to describe an intervention using simulation-based team training in pediatric departments.MethodsUsing a parallel-group, non-randomized controlled trial design, a simulation-based team training intervention will be implemented across four pediatric departments in Denmark. Another four pediatric departments will serve as controls. The intervention implies that healthcare professionals engage in simulation-based team training at a higher quantity and frequency than they did previously. Development of the intervention occurred from April 2022 to April 2023. Implementation of the intervention occurs from April 2023 to April 2024. Evaluation of the intervention is planned from April 2024 to April 2025. All simulation activity both before and during the intervention will be registered, making it possible to compare outcomes across time periods (before versus after) and across groups (intervention versus control). To evaluate the effects of the intervention, we will conduct four analyses. Analysis 1 investigates if simulation-based team training is related to sick leave among healthcare professionals. Analysis 2 explores if the simulation intervention has an impact on patient safety culture. Analysis 3 examines if simulation-based team training is associated with the treatment of critically ill newborns. Finally, Analysis 4 conducts a cost-benefit analysis, highlighting the potential return on investment.DiscussionThe implemented simulation-based team training intervention can be defined as a complex intervention. Following the Medical Research Council framework and guidelines, the intervention in this project encompasses feasibility assessment, planning of intervention, implementation of intervention, and rigorous data analysis. Furthermore, the project emphasizes practical considerations such as stakeholder collaboration, facilitator training, and equipment management.Trial registrationRegistered as a clinical trial on clinicaltrials.gov, with the identifier NCT06064045.