Pediatric Fever Research Articles

Cost-saving approach with screening of selected variants in genetic diagnosis in Turkish pediatric familial Mediterranean fever patients: a single center longitudinal study.

The aim of this study was to investigate whether a short exon screening consisting of selected variants could confirm the diagnosis in patients with a preliminary diagnosis of familial Mediterranean fever (FMF), thus providing a cost-saving alternative to a comprehensive MEditerranean FeVer (MEFV) gene sequence analysis test. This observational study on pediatric patients focused on clinically suspected FMF cases without prior genetic analysis. Participants met the Turkish pediatric FMF criteria. They underwent short exon screening for M694V, M680I, V726A, and E148Q variants. Those who were heterozygous or negative on short exon screening received further MEFV gene sequence analysis. The study involved 1557 patients. Pathogenic variants in both alleles of the MEFV gene were found in 611 patients (39.2%), and a high-penetrance variant in heterozygosity or an E148Q variant on the other allele was found in 643 patients (41.3%). A further 189 patients (12.1%) had one or two E148Q variants. Short-exon screening was negative in 114 patients (7.6%). Of the 876 patients who underwent MEFV gene sequence analysis, additional variants were found in 72 of the 762 initially heterozygous patients. Of the 114 initially negative patients, 34 had homozygous or compound heterozygous variants, and 74 had heterozygous variants. Ultimately, only 6 patients yielded negative results in the MEFV gene sequence analysis. The short exon screening for common MEFV mutations offers a practical and cost-saving alternative to comprehensive MEFV gene sequence analysis in populations with a high prevalence of FMF.

Reliability of a generative artificial intelligence tool for pediatric familial Mediterranean fever: insights from a multicentre expert survey

BackgroundArtificial intelligence (AI) has become a popular tool for clinical and research use in the medical field. The aim of this study was to evaluate the accuracy and reliability of a generative AI tool on pediatric familial Mediterranean fever (FMF).MethodsFifteen questions repeated thrice on pediatric FMF were prompted to the popular generative AI tool Microsoft Copilot with Chat-GPT 4.0. Nine pediatric rheumatology experts rated response accuracy with a blinded mechanism using a Likert-like scale with values from 1 to 5.ResultsMedian values for overall responses at the initial assessment ranged from 2.00 to 5.00. During the second assessment, median values spanned from 2.00 to 4.00, while for the third assessment, they ranged from 3.00 to 4.00. Intra-rater variability showed poor to moderate agreement (intraclass correlation coefficient range: -0.151 to 0.534). A diminishing level of agreement among experts over time was documented, as highlighted by Krippendorff’s alpha coefficient values, ranging from 0.136 (at the first response) to 0.132 (at the second response) to 0.089 (at the third response). Lastly, experts displayed varying levels of trust in AI pre- and post-survey.ConclusionsAI has promising implications in pediatric rheumatology, including early diagnosis and management optimization, but challenges persist due to uncertain information reliability and the lack of expert validation. Our survey revealed considerable inaccuracies and incompleteness in AI-generated responses regarding FMF, with poor intra- and extra-rater reliability. Human validation remains crucial in managing AI-generated medical information.

Analysis of the Role of Management in the Implementation of Clinical Pathways for Pediatric Dengue Hemorrhagic Fever (DHF) Inpatients at Hospital X

Analysis of the Role of Management in the Implementation of Clinical Pathways for Pediatric Dengue Hemorrhagic Fever (DHF) Inpatients at Hospital X

Exploring Traditional Antipyretic Practices: Shallot Poultice (Allium cepa L.) for Fever Management in Infants

Fever is a common symptom in infants, often causing distress to both the child and caregivers. While pharmacological interventions like acetaminophen are widely used, concerns about potential side effects and the growing interest in natural remedies have led to a resurgence in exploring traditional practices. The use of shallot poultice for fever management has been documented in various cultures, but its efficacy and safety require rigorous scientific evaluation. This study aimed to investigate the antipyretic effect of shallot poultice in infants and contribute to evidence-based decision-making in pediatric fever management. A quasi-experimental study with a pretest-posttest control group design was conducted. Infants aged 0-12 months presenting with fever (≥37.5°C) at a primary healthcare center were recruited. Eligible infants were randomly assigned to either the intervention group (receiving shallot poultice application) or the control group (receiving standard care). The primary outcome was the change in body temperature after 30 minutes of intervention. Secondary outcomes included parental satisfaction and adverse events. A total of 60 infants were enrolled (30 per group). The intervention group demonstrated a statistically significant reduction in body temperature compared to the control group (p < 0.05). Parental satisfaction was high in both groups, with no significant difference observed. No adverse events related to the shallot poultice were reported. Shallot poultice appears to be a safe and effective non-pharmacological intervention for reducing fever in infants. These findings support the potential integration of this traditional practice into holistic fever management strategies. Further research is warranted to explore the underlying mechanisms and long-term effects.

The Assessment of Knowledge, Attitude, and Practice of Paracetamol and Ibuprofen Administration Among Saudi Parents in the Makkah Region.

Introduction Paracetamol and ibuprofen, widely used for pediatric fever and pain, are safe when administered correctly. However, the caregiver's lack of understanding poses risks such as overdose. Addressing knowledge gaps is crucial due to reported variations in over-the-counter medication practices. "Fever phobia" underscores parental anxiety, stressing the ongoing need for research in this healthcare domain. Methodology This is a descriptive cross-sectional design targeting Saudi parents and caregivers from the Makkah regionwho have children aged 0-10 years. Data was collected via a self-administered validated online questionnaire in the Arabic language using a convenient sampling technique. The data was cleaned in Excel and analyzed using SPSS version 29 (IBM Inc., Armonk, New York). Results Our study included 449 parents and caregivers in the Makkah Region, of whom 337 (75.1%) were female, 179 (39.9%) were aged 18-29, and 425 (94.7%) were Saudi nationals. Knowledge assessment revealed gaps; e.g., only 86 (26.6%) identified baby weight as a dosage factor. Attitudes varied, with 152 (47.1%) associating paracetamol/ibuprofen with liver harm. Logistic regression showed no significant predictors for high-level knowledge, positive attitudes, or good practices, except for gender-influencing good practices (p=0.035, aOR=1.839). Significantly, males exhibited better practices regarding using of paracetamol. Conclusion Our study highlights knowledge gaps among parents and caregivers in the Makkah Region regarding pediatric fever management with paracetamol and ibuprofen. Attitudes varied, and gender significantly influenced good practices, with males demonstrating better adherence to the proper practice of managing children using paracetamol and ibuprofen.

Clinical profile of paediatric acute rheumatic fever and rheumatic heart disease in Western Australia: 1987 to 2020.

To describe the clinical profile of acute rheumatic fever (ARF) presentations to paediatric cardiology tertiary services in Western Australia (WA). A retrospective clinical audit of individuals with confirmed ARF referred to the only paediatric tertiary cardiac service in WA (1 January 1987 to 31 December 2020). Comparisons between inpatient, outpatient, remote and non-remote groups were assessed. Four hundred seventy-one episodes of ARF in 457 individuals (235 male; median age = 8 years) met clinical criteria. The majority were Aboriginal and Torres Strait Islander children (91.2%), with 62.1% living in remote areas. The number of ARF and rheumatic heart disease (RHD) diagnoses per year increased from 1987 to 2017 with notable peaks in 2013 and 2017. The average annual incidence of tertiary-referred ARF in WA of 4-15-year-olds from 1987 to 2020 was 4.96 per 100 000. ARF features included carditis (59.9%), chorea (31%), polyarthritis (30%) and polyarthralgia (24.2%). RHD was evident in 61.8% of cases and predominantly manifested as mitral regurgitation (55.7%). Thirty-four children (7.4%) with severe RHD underwent valvular surgery. 12% had at least one recurrent ARF episode. Remote individuals had more than double the rate of recurrence compared to non-remote individuals (P = 0.0058). Compared to non-remote episodes, remote presentations had less polyarthritis (P = 0.0022) but greater proportions of raised ESR (P = 0.01), ASOT titres (P = 0.0073), erythema marginatum (P = 0.0218) and severe RHD (P = 0.0133). The high proportion of Aboriginal and Torres Strait Islander Australians affected by ARF/RHD in WA reflects the significant burden of disease within this population. Children from remote communities were more likely to present with concurrent severe RHD. Our study reinforces the persisting need to improve primary and secondary ARF initiatives in rural and remote communities.

Altered expression of miR-17 and miR-148b in pediatric familial mediterranean fever patients.

Familial Mediterranean fever (FMF) is a recessively inherited autoinflammatory disorder with wide phenotypic variation that has been observed among individuals who have the same genotype.Modifying genes, epigenetic factors, or environmental factors might all have an impact on genotype-phenotype correlation in FMF. The current research aims to determine the expression levels of microRNAs (miR-148b and miR-17) in Egyptian FMF participants. We also aimed to investigate Caspase -1 gene expression to make a correlation with disease severity. The study comprised 25 clinically diagnosed FMF cases and 25 healthy subjects matched for age and sex. The molecular diagnosis of FMFcases was assessed using real-time SNP genotyping assay. MiR-148b and miR-17 expression were profiled using TaqMan assay technology. The expression level of Caspase -1 gene was also verified using qRT-PCR. MiR-17 in the studied cases was significantly upregulated compared to healthy individuals (P = 0.006), whereas miR-148b was significantly downregulated in the examined patients (P = 0.030). Moreover, statistically significant upregulation of Caspase-1 expression was also elucidated in relation to normal subjects (P = 0.033). The results obtained indicated that miR-17 and miR-148b might be potential regulatory biomarkers in FMF cases. We further hypothesized that the upregulation of Caspase-1 could hint at its significance as a future therapeutic target to alleviate the inflammatory process in these patients. Key Points • The role of miRNAs in FMF and various mechanisms involved in FMF pathogenesis has received increasing attention. • Studying the expression profiles of miR-17 and miR-148b in FMF patients revealed their potential role as regulatory biomarkers in these patients. • Significant upregulation of Caspase-1 expression in FMF cases could hint at its significance as a future therapeutic target. • Future studies on larger cohorts are warranted to clarify and better understand the role of miRNAs in the pathogenesis and severity of FMF.

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<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.

Knowledge mapping of paediatric fever-a visual analysis based on CiteSpace.

This study aimed to analyse the research hotspots and frontiers in the field of paediatric fever between 2013 and 2023. The included articles were visually analysed using CiteSpace 6.1.R6 software. A total of 2,662 Chinese-language articles and 1,456 English-language articles were included in the study. Based on the Chinese literature, research groups were identified represented by Xinmin Li, Jinling Hong and Hongshuang Luo. Based on the English literature, research groups were formed represented by Henriette Moll, Santiago Mintegi and Elizabeth Alpern. Tianjin University of Traditional Chinese Medicine was the institution with the largest number of publications in the Chinese literature, and the Centers For Disease Control And Prevention was the institution with the largest number of publications in the English literature. The research on paediatric fever mainly focused on mechanism exploration, green treatment and clinical management. Several relatively stable research groups have been formed. Future studies on the differential diagnosis, rational drug use, standardised management and clinical practice guidelines for paediatric fever are needed.

Unravelling the clinical heterogeneity of undefined recurrent fever over time in the European registries on Autoinflammation

BackgroundSystemic autoinflammatory disorders (SAIDs) represent a growing spectrum of diseases characterized by dysregulation of the innate immune system. The most common pediatric autoinflammatory fever syndrome, Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis (PFAPA), has well defined clinical diagnostic criteria, but there is a subset of patients who do not meet these criteria and are classified as undefined autoinflammatory diseases (uAID). This project, endorsed by PRES, supported by the EMERGE fellowship program, aimed to analyze the evolution of symptoms in recurrent fevers without molecular diagnosis in the context of undifferentiated AIDs, focusing on PFAPA and syndrome of undifferentiated recurrent fever (SURF), using data from European AID registries.MethodsData of patients with PFAPA, SURF and uSAID were collected from 3 registries including detailed epidemiological, demographic and clinical data, results of the genetic testing and additional laboratory investigations with retrospective application of the modified Marshall and PRINTO/Eurofever classification criteria on the cohort of PFAPA patients and preliminary SURF criteria on uSAID/SURF patients.ResultsClinical presentation of PFAPA is variable and some patients did not fit the conventional PFAPA criteria and exhibit different symptoms. Some patients did not meet the criteria for either PFAPA or SURF, highlighting the heterogeneity within these groups. The study also explored potential overlaps between PFAPA and SURF/uAID, revealing that some patients exhibited symptoms characteristic of both conditions, emphasizing the need for more precise classification criteria.ConclusionsPatients with recurrent fevers without molecular diagnoses represent a clinically heterogeneous group. Improved classification criteria are needed for both PFAPA and SURF/uAID to accurately identify and manage these patients, ultimately improving clinical outcomes.

FeverApp for Parents: A Multilingual and Socially Accountable Approach to Paediatric Fever Management in Germany

ABSTRACT Policymakers and practitioners are increasingly focused on achieving health equity and meeting the specific health needs of diverse populations, including vulnerable groups such as children. To address these challenges, the Fever App for Parents has emerged as a solution to guide parents through the complexities of managing fever in their children by improving fever management in children through real-time data collection and comprehensive educational support. This systematic approach aims to reduce unnecessary medical interventions and overuse of antibiotics, thereby improving the overall quality of pediatric care and reducing parental anxiety. In Germany, almost every second child aged 0-10 is a child with migration status and/or migration experience. This means that the parents of these children also need to be targeted in fever management and informed about the correct behavior in case of fever. This information will also be monitored anonymously to provide a feedback loop on the parent’s experience with the menu navigation and information design. The FeverApp provides parents with a structured, step-by-step guide to accurately track their child’s temperature and medication intake to encourage adherence to established fever management protocols. This study examines how the FeverApp embodies the principles of social responsibility through its multilingualism and digital development stages that incorporate user feedback. It shows why this app can be a resource to promote health equity through social responsibility in medical education and practice for parents, but also what barriers need to be considered at different stages of app development for parents from different cultural backgrounds to enable informal medical learning through apps.

The Use of Azithromycin in Pediatric Typhoid Fever without Complication: A Case Report

Typhoid fever is an infection caused by the bacterium Salmonella typhi. The prevalence is still high among emerging countries, such as Indonesia. There are limited options for the treatment of typhoid fever in children and more so is complicated by the emergence of antimicrobial resistance. The use of azithromycin has evolved as an important drug in the treatment of typhoid. A male, aged 7 years and 2 months, was admitted to our hospital with remittent fever 4 days prior. The patient also presented with a period of cough since 2 days, and constipation, with full consciousness. The child had basic immunization completed for his age. He had a history of frequent consumption of street food. The diagnosis of typhoid fever was confirmed by serologic testing of positive 8 IgM Salmonella. Initially, the patient was treated with intravenous antibiotics of ceftriaxone for 8 days but shoed no clinical improvement, then the treatment was changed to intravenous azithromycin for 4 days and his condition improved greatly. The patient showed a better response with the use of azithromycin. The management of typhoid fever remains challenging up to this day with variations in treatment response. From this case, we can conclude that azithromycin in some patients may show better improvement in the management of typhoid fever in pediatric patients. Although, ceftriaxone and other third-generation cephalosporins are still highly effective against Salmonella typhi.

Distinct patterns of postoperative fever in paediatric neurosurgery patients.

Postoperative fever is a common problem following neurosurgery but data on the causes among paediatric patients is sparse. In this report, we determined the incidence, causes, and outcomes of postoperative fever in paediatric neurosurgical patients (< 18years), and contrasted the findings with an adult cohort published recently from our unit. We recruited 61 patients who underwent 73 surgeries for non-traumatic neurosurgical indications over 12months. A standard protocol was followed for the evaluation and management of postoperative fever. We prospectively collected data pertaining to operative details, daily maximal temperature, clinical features, and use of surgical drains, urinary catheters, and other adjuncts. Elevated body temperature of > 99.9 °F or 37.7°C for > 48h or associated with clinical deterioration or localising features was considered as "fever"; elevated temperature not meeting these criteria was classified as transient elevation in temperature (TET). Twenty-six patients (35.6%) had postoperative fever, more frequent than in adult patients. TET occurred in 12 patients (16.4%). The most common causes of fever were aseptic meningitis (34.6%), followed by urinary tract infections (15.4%), pyogenic meningitis, COVID-19, and wound infections. Postoperative fever was associated with significantly longer duration of hospital admission and was the commonest cause of readmission. In contrast to adults, early temperature elevations in paediatric patients may portend infectious and serious non-infectious causes of fever, including delayed presentation with aseptic meningitis, a novel association among paediatric patients. Investigation guided by clinical assessment and conservative antibiotic policy in keeping with the institutional microbiological profile provides the most appropriate strategy in managing paediatric postoperative fever.

Antibiotic Sensitivity Patterns in Pediatric Enteric Fever: A Cross-Sectional Study at a Tertiary Care Hospital in Bangladesh

Background: This cross-sectional study aimed to investigate the antibiotic sensitivity patterns among pediatric patients with enteric fever at the Department of Paediatrics, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, during the period from July 2005 to June 2006. The primary objective was to identify the prevalent antibiotic sensitivities in order to enhance the efficacy of treatment strategies for typhoid fever in children. Methods: Ninety-eight suspected cases of enteric fever, aged between 2 and 12 years, were selected from admissions to the above-mentioned hospital. Blood culture and sensitivity testing were performed for Salmonella typhi and paratyphi. Demographic information, pre-admission antibiotic usage, and sensitivity profiles to various antibiotics, including Ceftriaxone, Cefixime, Chloramphenicol, Ciprofloxacin, Azithromycin, Amoxicillin, Imipenem, Nalidixic acid, and Ampicillin, were analyzed. Results: The majority of patients (62.2%) were in the 5-9 years age group, and males constituted 61.22% of the study population. Blood cultures revealed 71.44% sensitivity for Salmonella typhi and 28.57% for paratyphi. Among the antibiotics tested, Ceftriaxone exhibited 100% sensitivity, followed by Cefixime (80.2%), Chloramphenicol (78.57%), Ciprofloxacin (65.20%), Azithromycin (60%), Amoxicillin (54.6%), Imipenem, Nalidixic acid (Intermediate sensitive, 56.3%), Ciprofloxacin (Intermediate sensitive, 25%), and Ampicillin (Intermediate sensitive, 18.8%). Nearly half of the patients (47.3%) received antibiotics before admission, and 43.8% of culture-positive patients had a history of pre-admission antibiotic use. Conclusion: The study concludes that understanding antibiotic sensitivity patterns is crucial for successful typhoid fever treatment in children. Ceftriaxone and Cefixime emerged as highly effective, while the unnecessary use of antibiotics prior to admission may influence sensitivity patterns. This information underscores the importance of judicious antibiotic prescribing practices to ensure optimal therapeutic outcomes in pediatric enteric fever cases.&#x0D; ; , , &#x0D;

Invasive fungal sinusitis: A comparison of pediatric versus adult cases

BackgroundInvasive fungal sinusitis (IFS) is a rare infection with high mortality, mainly impacting immunocompromised patients. Given its significant mortality, timely recognition and treatment is crucial. This study aims to highlight the differences in presentation of IFS between pediatric and adult patients to aid in prompt diagnosis and treatment of this condition. MethodsA comprehensive literature search of PubMed, EMBASE, Web of Science, Global Index Medicus, Global Health (EBSCO) and Cochrane Database of Systematic Reviews was conducted to identify articles relating to IFS. Patient demographics, comorbidities, presentation, disease characteristics, treatments and outcomes were extracted from the studies, and statistical analyses were conducted to compare these variables between pediatric and adult patients. Results111 studies identified 22 pediatric and 132 adult patients worldwide. Children were more likely to have hematologic malignancies compared to adults (59.1 % vs. 15.2 %, p < 0.001). Facial symptoms such as pain, edema, and numbness were the most common symptoms for both age groups. In the pediatric population, fever and nasal or oral mucosal lesions were more common presenting symptoms (both p < 0.001). Pediatric patients were more likely to present without disease extension beyond the sinuses (p < 0.001). There was no significant difference in either medication treatment or mortality between the two cohorts. ConclusionIFS often presents with non-specific symptoms and a unique presentation in pediatric and adult populations. Clinical awareness of the varying presentations in both populations is important to treat in a timely manner given the rapid progression and high mortality rates of IFS.

Limited protection of pneumococcal vaccines against emergent Streptococcus pneumoniae serotype 14/ST876 strains

PurposeStreptococcus pneumoniae (Spn) is a major cause of child death. We investigated the epidemiology of S. pneumoniae in a pediatric fever clinic and explored the genomics basis of the limited vaccine response of serotype 14 strains worldwide.MethodsFebrile disease and pneumonia were diagnosed following criteria from the WHO at the end of 2019 at a tertiary children’s hospital. Spn was isolated by culture from nasopharyngeal (NP) swabs. The density was determined by lytA-base qPCR. Isolates were serotyped by Quellung and underwent antimicrobial susceptibility testing. Whole-genome sequencing was employed for molecular serotyping, MLST, antibiotic gene determination, SNP calling, recombination prediction, and phylogenetic analysis.ResultsThe presence of pneumococcus in the nasopharynx (87.5%, 7/8, p = 0.0227) and a high carriage (100%, 7/7, p = 0.0123) were significantly associated with pneumonia development. Living with siblings (73.7%, 14/19, p = 0.0125) and non-vaccination (56.0%, 28/50, p = 0.0377) contributed significantly to the Spn carriage. Serotype 14 was the most prevalent strain (16.67%, 5/30). The genome analysis of 1497 serotype 14 strains indicated S14/ST876 strains were only prevalent in China, presented limited vaccine responses with higher recombination activities within its cps locus, and unique variation patterns in the genes wzg and lrp.ConclusionWith the lifting of the one-child policy, it will be crucial for families with multiple children to get PCV vaccinations in China. Due to the highly variant cps locus and distinctive variation patterns in capsule shedding and binding proteins genes, the prevalent S14/ST876 strains have shown poor response to current vaccines. It is necessary to continue monitoring the molecular epidemiology of this vaccine escape clone.

Analyzing and Forecasting Pediatric Fever Clinic Visits in High Frequency Using Ensemble Time-Series Methods After the COVID-19 Pandemic in Hangzhou, China: Retrospective Study.

The COVID-19 pandemic has significantly altered the global health and medical landscape. In response to the outbreak, Chinese hospitals have established 24-hour fever clinics to serve patients with COVID-19. The emergence of these clinics and the impact of successive epidemics have led to a surge in visits, placing pressure on hospital resource allocation and scheduling. Therefore, accurate prediction of outpatient visits is essential for informed decision-making in hospital management. Hourly visits to fever clinics can be characterized as a long-sequence time series in high frequency, which also exhibits distinct patterns due to the particularity of pediatric treatment behavior in an epidemic context. This study aimed to build models to forecast fever clinic visit with outstanding prediction accuracy and robust generalization in forecast horizons. In addition, this study hopes to provide a research paradigm for time-series forecasting problems, which involves an exploratory analysis revealing data patterns before model development. An exploratory analysis, including graphical analysis, autocorrelation analysis, and seasonal-trend decomposition, was conducted to reveal the seasonality and structural patterns of the retrospective fever clinic visit data. The data were found to exhibit multiseasonality and nonlinearity. On the basis of these results, an ensemble of time-series analysis methods, including individual models and their combinations, was validated on the data set. Root mean square error and mean absolute error were used as accuracy metrics, with the cross-validation of rolling forecasting origin conducted across different forecast horizons. Hybrid models generally outperformed individual models across most forecast horizons. A novel model combination, the hybrid neural network autoregressive (NNAR)-seasonal and trend decomposition using Loess forecasting (STLF), was identified as the optimal model for our forecasting task, with the best performance in all accuracy metrics (root mean square error=20.1, mean absolute error=14.3) for the 15-days-ahead forecasts and an overall advantage for forecast horizons that were 1 to 30 days ahead. Although forecast accuracy tends to decline with an increasing forecast horizon, the hybrid NNAR-STLF model is applicable for short-, medium-, and long-term forecasts owing to its ability to fit multiseasonality (captured by the STLF component) and nonlinearity (captured by the NNAR component). The model identified in this study is also applicable to hospitals in other regions with similar epidemic outpatient configurations or forecasting tasks whose data conform to long-sequence time series in high frequency exhibiting multiseasonal and nonlinear patterns. However, as external variables and disruptive events were not accounted for, the model performance declined slightly following changes in the COVID-19 containment policy in China. Future work may seek to improve accuracy by incorporating external variables that characterize moving events or other factors as well as by adding data from different organizations to enhance algorithm generalization.

Evaluation of Gastrointestinal System Complaints and Comorbidities in Pediatric Familial Mediterranean Fever Patients.

Familial Mediterranean fever (FMF) is the most prevalent hereditary autoinflammatory disease among children. Abdominal pain and various gastrointestinal system (GIS) manifestations may arise directly from FMF or concomitantly with FMF. This study aimed to evaluate GIS complaints and findings other than classic peritonitis attacks in patients with FMF and to interpret concomitant GIS and hepatic disorders in these patients. The medical and genetic findings of patients with FMF who attended our clinic between December 2011 and December 2021 were reviewed. Gastrointestinal system symptoms, liver function tests, abdominal images, and endoscopic and histopathological data were extracted from medical records. A total of 576 pediatric patients (female, 52.3%) diagnosed with FMF were included. Among them, almost one-fifth displayed GIS complaints, such as abdominal pain, defecation problems, and dyspepsia, distinct from typical FMF attacks. High serum aminotransferase levels were detected in 18.4% of the patients, with viral infections being the most common cause of moderate/severe hypertransaminasemia. In addition, during follow-up, 26.9% of them were referred to the pediatric gastroenterology department. At least 1 gastroenterological and hepatobiliary disorder was detected in 17.5% of the patients because of organic and functional GIS disorders or hepatobiliary disorders, such as gastroesophageal reflux disease, esophagitis, functional dyspepsia, and inflammatory bowel diseases. Various GIS and hepatic disorders can be encountered in children with FMF. The spectrum of these complaints and pathologies can range from frequently observed health problems to more severe diseases.

Increase in pediatric recurrent fever evaluations during the first year of the COVID-19 pandemic in North America.

The impact of the COVID-19 pandemic on new diagnoses of recurrent fevers and autoinflammatory diseases is largely unknown. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) PFAPA/AID Working Group aimed to investigate the impact of the COVID-19 pandemic on the number of pediatric patients evaluated for recurrent fevers and autoinflammatory diseases in North America. The absolute number of new outpatient visits and the proportion of these visits attributed to recurrent fever diagnoses during the pre-pandemic period (1 March 2019-29 February 2020) and the first year of the COVID-19 pandemic (1 March 2020-28 February 2021) were examined. Data were collected from 27 sites in the United States and Canada. Our results showed an increase in the absolute number of new visits for recurrent fever evaluations in 21 of 27 sites during the COVID-19 pandemic compared to the pre-pandemic period. The increase was observed across different geographic regions in North America. Additionally, the proportion of new visits to these centers for recurrent fever in relation to all new patient evaluations was significantly higher during the first year of the pandemic, increasing from 7.8% before the pandemic to 10.9% during the pandemic year (p < 0.001). Our findings showed that the first year of the COVID-19 pandemic was associated with a higher number of evaluations by pediatric subspecialists for recurrent fevers. Further research is needed to understand the reasons behind these findings and to explore non-infectious triggers for recurrent fevers in children.

SPECTRUM OF FEBRILE THROMBOCYTOPENIA AMONG CHILDREN IN A TROPICAL COUNTRY: A HOSPITAL BASED OBSERVATIONAL STUDY IN DHAULADHAR REGION

Background: Pediatric admissions often involve febrile thrombocytopenia. Infections are the main cause however noninfectious reasons occur. This study estimated the prevalence of thrombocytopenia in pediatric fever patients, its etiologies, presentations, and the association between platelet count and disease severity and prognosis. Methods: Retrospective observational study done by collecting data fromhospital records of children admitted inRPGMC Tanda from January 2021 to December 2022. Children in the age group of 6 months to15 years with fever and thrombocytopenia at admission were included in the study. Children on treatment with antiplatelet drugs, other chronic diseases and infants less than 6 months were excluded. Results: 48% had high-grade fever at presentation. Fever averaged 4–6 days and peaked at 14 days. Constitutional symptoms (vomiting, abdominal pain) followed. Respiratory and diarrheal manifestations were rare. Seizures and altered sensorium were present in 4%. The next most common clinical finding was hepatomegaly with right hypochondrial tenderness (44%), followed by fluid leak (ascites, pleural effusion) (40%), periorbital puffiness (30%), subcutaneous bleeds (20%), conjunctival congestion (14%) and splenomegaly (14%). Conclusions: Dengue-endemic children have febrile thrombocytopenia. Thrombocytopenia with abdominal pain, vomiting, or oliguria suggests dengue. Enteric fever, scrub typhus, and chikungunya induce similar symptoms. Leukemia, idiopathic thrombocytopenic purpura, hemolytic uremic syndrome, and sepsis can induce febrile thrombocytopenia. Blood and antibiotics are unusual.