The American Society of Anesthesiologists Physical Status (ASA-PS) classification system is widely used to classify patient comorbidities prior to surgery and is often used as a marker of perioperative risk. Since its inception in 1941, it has undergone modifications to adapt to changing clinical needs and to improve its reliability. In 2020, a version of the ASA-PS was released with pediatric-specific case examples. To explore inter-rater reliability in ASA-PS scoring in the pediatric population. This single-center retrospective study evaluated the assigned ASA-PS scores of 364 patients at a quaternary pediatric hospital. Each patient was assigned three ASA-PS scores-one by the case anesthetist and one each by two independent consultant anesthetists using the ASA guidance issued in 2020. Concordance was measured between the assigned scores, and potential reasons for discordant scores were identified. There was strong concordance of ASA-PS scores between the two independently scoring anesthetists (weighted kappa coefficient 0.76), but only moderate concordance between the case anesthetist and the independent anesthetists (weighted kappa coefficient 0.5). Where there was a discrepancy, the case anesthetist had usually underscored the ASA-PS by 1 point. Patients who had symptomatic cardiac disease, abnormal body mass index for age, an oncologic state, brain malformation, or a difficult airway were more likely to be assigned an incorrect ASA-PS score. Moderate inter-rater variability exists in the assignment of ASA-PS scores in the pediatric population, and many patients are being underscored. Use of ASA guidance to assist with pediatric ASA-PS scoring improves the reliability of scoring and may improve accurate communication of perioperative risk.

People with Epilepsy exhibit low levels of physical activity compared with the general population, despite evidence suggesting potential benefits for seizure control, physical fitness and psychosocial well-being. Persistent barriers such as fear of seizures, limited access to supervised programs, transportation difficulties, and time constraints contribute to sedentary behaviour. Telecoaching (TC), which delivers structured exercise programs through digital technologies, may help overcome these barriers. This systematic review aimed to evaluate the feasibility and potential effects of TC-based training physical activity interventions in individuals with epilepsy, focusing on adherence, QoL, physical fitness and psychological outcomes. A systematic search of PubMed, Web of Science, and Scopus identified 1086 records, of which 7 studies involving 342 participants met the inclusion criteria. Interventions included remotely delivered aerobic, resistance, flexibility, and combined exercise programs. Study quality ranged from "fair" to "good". TC-based interventions were generally safe and feasible, with no major adverse events reported. Evidence suggest potential benefits for physical fitness and psychosocial outcomes, particularly in paediatric populations, although the limited number and heterogeneity of studies preclude definitive conclusions, especially regarding seizure-related outcomes. Future research should focus on standardized TC programs, long-term follow-up, and adequately powered randomized trials to confirm effectiveness and sustainability.

Ultrasonography is the recommended first-line investigation for the diagnosis of pediatric nephrolithiasis. Despite higher sensitivity and specificity for this condition, computed tomography is reserved for more complex cases due to its radiation exposure. Despite increasing stone prevalence in the pediatric population, there is a lack of low-dose computed tomography pediatric urolithiasis protocols and descriptions of low-dose protocols are sparse. Herein we report the development and implementation of a low-dose protocol to reduce radiation exposure to this vulnerable population. A novel low-dose computed tomography protocol was designed through multidisciplinary collaboration, literature review, and phantom trials. Patients undergoing computed tomography for urolithiasis assessment were evaluated using the novel low-dose protocol and were compared to a retrospective cohort. Radiation reduction was characterized using descriptive statistics and comparative analysis. Mean (± standard deviation) age for the low-dose group was 12.6 ± 4.2 years (n = 26) compared to 12.4 ± 3.7 years for the standard-dose group (n = 15). The low-dose protocol reduced radiation dose when compared to the standard-dose group by 55.5 % (≥45 kg) (p = 0.02) and 27.8 % (<45 kg) (p = 0.03). The low-dose protocol visualized stones seen on ultrasound with 100 % accuracy (n = 6), and in 61.5 % (n = 16/26) of patients. There was no difference in stone sizes between groups. Reduced-dose computed tomography protocols are effective for assessing urolithiasis while reducing radiation exposure. Implementation of reduced-dose computed tomography protocols in cases of suspected urolithiasis is advised to limit radiation exposure while maintaining diagnostic imaging detail.

An increase in cerebrospinal fluid macrophage migration inhibitory factor levels in pediatric patients with acute neuroinflammatory diseases: A preliminary study.

Polygenic risk scores for pediatric obsessive-compulsive symptoms: Mediating effects in samples clinically diagnosed with mental disorders.

Early inotropic support in pediatric shock: evidence and challenges in prehospital setting and interfacility transport.

Cardiovascular responses to a 3-minute Harvard step test in Paediatric competitive athletes.

Genomic diversity of human adenoviruses in Tanzanian children under five: Insights into F40, F41, B, and rare A18 genotypes.

Long term cardiovascular effects on COVID-19 infection in children. The need for monitoring.

Impact of pediatric epilepsy on sleep architecture: A systematic review and meta-analysis.

Hematologic indices in pediatric sleep-disordered breathing: a retrospective case-control study.

Cumulative incidence of schizophrenia-spectrum disorders in children and adolescents with neurodevelopmental disorders: A retrospective cohort study.

Typhoid fever remains a significant public health challenge in many low- and middle-income countries, including Indonesia, where inadequate sanitation, limited access to clean water, and suboptimal hygiene practices continue to facilitate disease transmission. Although typhoid fever is more commonly reported in school-aged children and adolescents, its occurrence in toddlers poses unique diagnostic and management challenges due to atypical clinical presentations and increased vulnerability to dehydration and complications. Early recognition and comprehensive management at the primary health care level are therefore critical. This study describes the holistic primary care–based management of typhoid fever in a 14-month-old boy presenting to a community health center in Bandar Lampung, Indonesia. The patient was brought with a three-day history of persistent fever and a one-week history of watery diarrhea, accompanied by decreased appetite, irritability, and generalized weakness. A holistic diagnostic approach integrating clinical symptoms, physical examination, environmental exposure, and family hygiene practices was applied. Key clinical features included a fever pattern worsening in the late afternoon to evening, prolonged diarrhea, and a coated tongue with erythematous margins, strongly suggestive of typhoid fever in the absence of other focal infections. Management combined pharmacological and non-pharmacological interventions tailored to the toddler age group and primary care setting. Pharmacological therapy consisted of first-line antibiotic treatment with cotrimoxazole, antipyretic therapy, zinc supplementation, and oral rehydration therapy to prevent dehydration. Non-pharmacological interventions emphasized continued breastfeeding, adequate fluid intake, safe food preparation, access to clean drinking water, and strict hand hygiene practices within the household. Family members were actively involved in the care process to ensure adherence to treatment and implementation of preventive measures. Clinical improvement was observed following the integrated intervention, with resolution of fever and gastrointestinal symptoms and restoration of appetite and activity levels. This approach highlights the importance of combining clinical management with family-centered hygiene education and environmental risk assessment. The findings underscore the critical role of primary health care services in early detection, effective treatment, and prevention of typhoid fever among vulnerable pediatric populations.

BACKGROUND Malnutrition is a common issue among hospitalised patients that contributes to increased risk of hospital readmission post-discharge. Current studies show that nutritional interventions improve recovery, but there is still limited literature on which specific type of nutritional intervention is most effective in reducing readmission rates. AIM To investigate the effectiveness of various post-discharge nutritional interventions in reducing hospital readmissions. METHODS We systematically searched PubMed, EMBASE, and other databases for relevant studies including patients discharged home after hospitalisation for acute illnesses, any nutritional intervention beyond usual care, and hospital readmission with any definition. Paediatric populations, elective admissions, and in-hospital nutritional interventions were excluded. Included studies were grouped by nutritional intervention type, with key findings extracted for qualitative synthesis. We also assessed risk of bias (Cochrane risk-of-bias 2 tool) and certainty of evidence (grading of recommendations assessment, development, and evaluation framework). RESULTS Thirteen studies involving 1543 participants were included and categorised into five subgroups: (1) Follow-up counselling (n = 7); (2) Pre-planned meals (n = 1); (3) Individualised nutrition care plans (n = 3); (4) Oral nutritional supplementation with whey protein (n = 1); and (5) Diet supplementation with watermelon (n = 1). Evidence for follow-up counselling was mixed, with only 3 of 7 studies reporting reduced 3-month and 6-month readmission rates. Studies on individualised nutrition care plans also show mixed results, with only 1 of 3 studies observing reduced 6-month readmission rates. The single study of oral nutritional supplementation with whey protein also saw a reduction of 1-month readmission rates. The remaining single studies of pre-planned meals and diet supplementation with watermelon did not demonstrate clear benefit. CONCLUSION Some nutritional interventions show potential in reducing readmission rates but generalisability is limited by inconsistent findings, inadequate sample sizes, and risk of bias. Further research with larger, high-quality randomised controlled trials is required to strengthen the body of evidence.

To assess the effectiveness and safety of corticosteroid injections (CSI) for pediatric patients with non-rheumatologic peripheral musculoskeletal pain conditions. Systematic review. A comprehensive search of PubMed, Embase, Web of Science, and Cochrane Central was performed through August 2024 in alignment with PRISMA 2020 guidelines. Eligible studies included pediatric patients receiving CSI for peripheral musculoskeletal pain unrelated to rheumatologic disease. Primary outcomes were pain relief and functional improvement; secondary outcomes consisted of safety and adverse events. MASTER and GRADE scales evaluated risk of bias and certainty of evidence. 1,061 studies were identified, six of which met inclusion criteria, encompassing 267 pediatric patients. Interventions targeted hip pain related to dislocation or femoroacetabular impingement (n = 4 studies), sacroiliac pain (n = 1), and acute anterior cruciate ligament tears (n = 1). Across most studies, CSI provided short-term pain relief and functional improvement, with post-injection follow-up ranging from 5 days to 5 years. However, the randomized controlled trial in ACL tear patients found no significant difference between CSI and saline placebo. Rare adverse events were reported, including localized swelling, pain flare, and one transient sciatic nerve block post-SI joint injection. There were no long-term complications reported. Evidence certainty was rated "very low" due to small sample sizes, heterogeneity, and risk of bias. CSI may provide temporary pain relief for select pediatric peripheral musculoskeletal conditions, albeit with limited and low quality supporting evidence. Despite current data suggesting a favorable short-term safety profile, longer-term effects and standardized dosing guidelines are insufficient. Larger, higher-quality trials with more varied pediatric pathologies are required in order to elucidate the role of CSI in non-rheumatologic pediatric pain management.

Diffusion tensor imaging (DTI) offers a non-invasive window into kidney microstructure by measuring directional water diffusion. In pediatric populations, where early detection of kidney dysfunction is crucial, DTI shows promise for evaluating structural integrity, diagnosing conditions, and monitoring chronic diseases such as autosomal recessive polycystic kidney disease (ARPKD). This review briefly presents the principles of renal DTI, key acquisition techniques, and important nuances in applying this modality to kidney evaluation. We provide an overview of representative post-acquisition processing pipelines for diffusion tensor generation, tractography, and quantitative analysis. We then summarize current applications of DTI in assessing kidney structure, including its use in select diseases, with focused emphasis on pediatric conditions such as ureteropelvic junction obstruction (UPJO), polycystic kidney disease, and pediatric kidney transplantation. Applications for other renal disorders are also reviewed. Finally, we outline current challenges related to standardization and highlight future research directions needed to refine methodology and further establish the clinical utility of renal DTI.

Autoantibodies can predict clinical type 1 diabetes, impacting early diagnosis, prevention, and management. While integrating antibody testing into routine practice is debated globally, ethical considerations are often overlooked. This paper explores these ethical concerns through qualitative analysis based on a literature review.A PubMed literature search provided the foundation for a qualitative ethical analysis. Arguments regarding type 1 diabetes screening were extracted from 92 eligible articles and categorized using Beauchamp and Childress's four ethical principles. A thematic and principle-oriented ethical analysis was conducted.Key ethical concerns include decision-making for children, risk determination, screening timepoints, psychological aspects, DKA rates, treatment options, and monetary and personnel aspects. Addressing these issues ensures general population screening aligns with autonomy, beneficence, nonmaleficence, and justice.Conclusions;General population antibody screening for type 1 diabetes presents ethical challenges requiring careful consideration. While early detection offers benefits, risks such as psychological distress, stigmatization, and resource diversion must be taken into consideration. Further research should assess feasibility, including human resource demands, parental and child anxiety, optimal screening timepoints, development of educational material, children's involvement in screening, and expanding options for prevention, including teplizumab approval in the EU. What is Known: • Autoantibodies can identify individuals at risk for Type 1 Diabetes before symptom onset, and population screening is increasingly discussed as a strategy to reduce complications such as diabetic ketoacidosis at diagnosis. What is New: • This study provides a structured ethical analysis of general population antibody screening for Type 1 Diabetes using the four-principle framework of Beauchamp and Childress (autonomy, beneficence, nonmaleficence, justice) • It identifies key ethical domains, including decision-making for children, psychological impact, screening timing, resource allocation, and emerging preventive options such as Teplizumab, that should guide future implementation and research on population screening programs.

Supernumerary teeth (ST) are developmental anomalies. However, factors associated with ST have not been extensively reported in the literature. The aim of the present study was to identify factors associated with single supernumerary teeth (SST) and multiple supernumerary teeth (MST) in a non-syndromic Brazilian sample. A cross-sectional study was conducted with a convenience sample of 305 non-syndromic patients with ST seen over a 10-year period at a paediatric oral surgery service in Southeast Brazil. The outcome variable was the classification of ST as SST or MST. Covariates included age, race, sex, morphology, location, position, eruption status, orientation, associated complications, and treatment modality of ST. The Mann-Whitney test, chi-squared test, and both simple and multiple logistic regression analyses were performed. A total of 460 ST were identified among the 305 patients, with male predominance (68.2%). Mean age was 9.3years. Most patients had SST (62.2%) and 37.8% had MST. ST were primarily located in the maxilla (93.1%), with fewer cases in the mandible or both arches. MST were strongly associated with specific position, eruption, orientation, clinical complication, morphological, and treatment characteristics (p < 0.001). Tuberculate and supplemental ST, palatal positioning, and eruption status were significantly associated with an increased likelihood of MST. Moreover, MST were associated with a greater risk of adjacent tooth displacement and greater need for combined orthodontic treatment and extraction.

Dermatomyofibroma (DMF), rare in the pediatric population, is a benign dermal tumor composed of myofibroblasts and fibroblasts. We identified 21 histologically confirmed cases of pediatric DMF from our institution's dermatopathology database. Most cases occurred in male children, were located on the neck, and were difficult to distinguish clinically from lesions such as dermatofibromas and cysts. Following chart review of seven patients who received dermatologic care at our institution, we report unusual presentations of DMF and describe post-biopsy follow-up evaluations.

Super-refractory status epilepticus (SRSE) is a neurological emergency defined as status epilepticus persisting for more than 24h despite conventional management with anesthetics or recurrence with withdrawal of anesthesia. It is associated with high morbidity and mortality, and contemporary literature on treatment is limited. We present a systematic review of surgical interventions and outcomes for SRSE. We performed a multidatabase literature search according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using an International Prospective Register of Systematic Reviews (PROSPERO)-registered protocol, to identify published literature through February 2024. Four reviewers independently screened citations, abstracts, and manuscripts of SRSE with surgical or neuromodulatory interventions in pediatric and adult populations, with a senior reviewer resolving discrepancies. The primary outcomes were the resolution of SRSE and Engel I classification at the last reported follow-up. We screened 1436 citations, reviewed 66 manuscripts, and identified 114 patients who underwent acute neurosurgical intervention for SRSE. Of the 114 cases, 111 had resolution of SRSE after the intervention, and 57 of 114 patients were reported to be Engel class I (free of disabling seizures) at the last follow-up. Among the remaining half (57), 8 patients did not survive, 3 had recurrence of status epilepticus, and 46 continued to have medically refractory seizures, with 29 experiencing fewer seizures than before. Our subgroup analyses also highlighted that surgical interventions were effective even in patients with underlying autoimmune and genetic etiologies. An additional striking finding was that the patients who had surgical interventions delayed beyond 3weeks from the SRSE onset were less likely to achieve resolution of SRSE and had poorer longitudinal seizure freedom (40.7%), in contrast to earlier intervention groups (70%), favoring early intervention. Our work demonstrates that surgical interventions may be considered for the treatment of SRSE, even in cases with a known genetic and autoimmune etiology, and earlier intervention may lead to better outcomes.