Positive Results In Children Research Articles

Results of Integrated Transmission Assessment Surveys for Lymphatic Filariasis and Malaria in Haiti, 2017-2022.

Haiti is endemic for lymphatic filariasis (LF) and malaria, two mosquito-transmitted parasitic diseases targeted for elimination. The World Health Organization recommends a transmission assessment survey (TAS-1) to determine if LF prevalence is significantly beneath putative transmission thresholds (<2% antigen prevalence in Haiti, where Culex is the primary vector for Wuchereria bancrofti) to stop mass drug administration (MDA). Repeated TASs (TAS-2 and TAS-3) are recommended at 2-3-year intervals during post-treatment surveillance. From 2017 to 2022, The Carter Center assisted the Haitian Ministry of Public Health and Population in conducting 15 TASs in 11 evaluation units (EUs) encompassing 54 of the country's 146 districts. Children 6-7 years old were assessed for circulating filarial antigen (CFA) by Filariasis Test Strip: n = 5,239 in TAS-1; n = 11,866 in TAS-2; and n = 1,842 in TAS-3, of whom eight (0.15%), 20 (0.17%), and eight (0.43%) tested positive, respectively. The number of positive results in children was less than the threshold in each EU. When available, participants (n = 16,663) were also tested for malaria by rapid diagnostic test, with 31 (0.19%) children testing positive for Plasmodium falciparum. Integrated TASs provided an efficient means to collect epidemiological data for LF and malaria in Haiti. Results indicated thresholds for stopping and maintaining the halt of MDA for LF have been achieved in all EUs, with the halt of MDA for 571,358 people in four districts and the first TAS-3 surveys conducted in Haiti. Investigations are needed to assess the potential of ongoing LF transmission, especially in areas where CFA-positive samples were detected in TAS-3.

Effects of Educational Intervention on Dental Plaque Index in 9-Year-Old Children.

119 students of third-grade elementary (65 girls and 54 boys) from government and private schools of Qazvin city participated. The dental plaque index of every participant was primarily recorded by Silness and Loe method. Students were trained by a dental student by face-to-face method, and after 2 weeks, dental plaque indices were recorded again for every individual. After index recording and coding, data analysis was done using SPSS version 21. Results showed that the dental plaque index was statistically significantly different before and after training (p < 0.001). Based on the results of this study, students' motivation in addition to proper training, can have a significant impact on oral and dental health. Furthermore, this study shows that face-to-face training along with involving the individual in training and learning was seen as quite helpful.

A Review of Patients with False Positive Cystic Fibrosis Screening Tests in the Light of Current Literature

Amaç: Kistik fibrozis (KF); tekrarlayan akciğer enfeksiyonları, mekonyum ileusu, pankreatik yetmezlik gibi bulgularla seyreden ve birden fazla sistemi tutabilen, yenidoğan döneminden başlayabilen kronik bir hastalıktır. Kistik fibrozis otozomal resesif geçişli bir hastalık olup ülkemizde sıklığının 1/2500-1/3000 olduğu düşünülmektedir1. Hastalığın erken tanısını koyup erken tedaviye başlayabilmek için Türkiye’de 2015 yılında yenidoğan tarama programlarına KF tarama programı eklendi ve İmmünoReaktif Tripsinojen (IRT) enzimini ölçmeye dayanan bir testtir2. Araştırmamızda, iki KF tarama testide pozitif olup Çocuk Sağlığı İzlem Polikliniği’ne gönderilen bebekleri klinik ve ter testi sonucuyla beraber değerlendirerek KF tarama testi yanlış pozitifliklerin nedenlerini irdelemeyi amaçladık. Yöntem: Retrospektif yaptığımız bu çalışmada KF yenidoğan tarama testleri pozitif olduğu için 2018 yılında gönderilen bebeklerimizin ter testleri sonuçlarını ve klinik bilgilerini dosya kayıtlarından elde ettik. Çalışmaya başlamadan önce Etik Kurulu onayı alındı. Klinik ve ter testi sonuçlarına göre KF riski yüksek olan hastalarımız kesin tanı için KF referans hastanesine yönlendirilmişti. KF tanısı almayan ve tarama testleri yanlış pozitif olan vakaların sosyodemografik bilgileri, öykü, fizik muayene, prognozları ve test bilgileri ile tarama testleri sonuçları birlikte değerlendirilerek yanlış pozitifliğe neden olan faktörler istatiksel olarak analiz edildi. Bulgular: Çalışmaya aldığımız 16 vakanın demografik bilgileri ve prognozları çizelgelerde belirtilmektedir. Polikliniğe başvurdukları ilk gün yaşları ortalama 133,75±82,15 günlüktü (%57’si erkek bebekti). Doğum haftası ve tartısı, YDYBÜ’ sine yatış ve antibiyotik alma süresi, uzamış sarılık, kardeş ölümü ve ilk mekonyumun gecikme öyküsü tarama testleriyle istatiksel olarak anlamlı ilişkili bulunurken diğer bulgularla aralarında anlamlı ilişki bulunmadı. Sonuç: Bu çalışmada KF tarama testinde yanlış pozitifliğin olabileceği ve bunu açıklayan faktörler olduğu tekrar vurgulanmış oldu. KF tarama testinin yanlış pozitifliğinin fazla olduğu bilinmesine rağmen tarama testi pozitif olan her hastaya ter testi kesinlikle yapılmalıdır. Kliniğinde şüpheli bir bulgusu olan ve/veya ter testi arada bir değerde olan ve/veya KF risk faktörü taşıyan her bebek tekrar değerlendirmeli ve kliniğinin ilerleyen aylarda da çıkabileceği unutulmamalıdır.

Motor Task Processing After Constraint-Induced Movement Therapy in Children With Cerebral Palsy: A Case Series

Constraint-induced movement therapy (CIMT) has shown positive results in children with hemiplegic cerebral palsy (CP). However, studies on neural basis of such functional gains are limited. This study reports the event-related potential (ERP) changes in two children with hemiplegic CP after receiving CIMT for three weeks. Both cases were nine years old, had a diagnosis of left hemiplegic CP, had normal intelligence, and were able to extend the wrist at least 20° and the metacarpophalangeal joint at least 10° from full flexion. Before and after the three-week intervention, the children participated in ERP sessions with a choice reaction task to capture the changes in neural mechanism after intervention. Both children exhibited improvement in reaction time (RT) in both hand tasks after the intervention. The improvement was larger in the affected hand than the unaffected hand. Improved accuracy rate (AC) and shortened P300 latencies in the affected hand were also demonstrated in both cases. Topographical maps showed that in centro-parietal regions, patterns shifted from central and left-lateralized to more central and right-lateralized. CMIT was a useful method in improving upper limb function in our cases.

Multisystem Inflammatory Syndrome in Children and Kawasaki Disease: Two Different Illnesses with Overlapping Clinical Features

Multisystem Inflammatory Syndrome in Children and Kawasaki Disease: Two Different Illnesses with Overlapping Clinical Features

391. Septic Arthritis and Acute Hematogenous Osteomyelitis in Children: Disease-Specific Antibiogram and Implications for Treatment

BackgroundOsteomyelitis and septic arthritis are common pediatric musculoskeletal infections with potential to cause significant morbidity. Empiric antibiotic selection is made prior to the availability of microbiologic data. The aim of this study was to compare the epidemiology of osteoarticular infections (OAI) to antibiotic regimens and local antibiograms.MethodsA retrospective study was performed on patients aged 6 months to 18 years with a diagnosis of septic arthritis or acute hematogenous osteomyelitis in a large, free-standing children’s hospital between July 2012 and July 2017. Exclusion criteria were chronic osteomyelitis, prior trauma or surgery at the site, noninfectious arthritis, and Lyme arthritis. Data collected from the electronic medical record included demographics, initial and discharge antibiotic therapy, and microbiologic results. Data were compared with the local antibiogram during the same time period.ResultsA total of 207 patients were included: 66 patients <4 years (< 4Y) and 141 patients ≥4 years (≥4Y). Causative pathogens were identified in 70% of patients. Staphylococcus aureus comprised 55% of positive results in children < 4Y and 73% in children ≥4Y. Among S. aureus cultures, 70–76% were methicillin sensitive (MSSA). Overall clindamycin susceptibility was 97%, with all resistant strains detected in children ≥4Y with MSSA. This is strikingly different than the institutional antibiogram showing 79% overall clindamycin sensitivity in S. aureus [82% in MSSA, 72% in methicillin resistant (MRSA)]. Kingella kingae was exclusively identified in children <4Y (21% of positives), which was also the group with the highest rate of culture-negative infection (41%). Intravenous clindamycin alone was the most frequent initial antibiotic regimen, prescribed for 41% of all patients. Initial antibiotic regimens matched organism susceptibilities in 90% of MRSA and 100% of MSSA infections.ConclusionOur study revealed high rates of clindamycin-susceptible S. aureus in older children and K. kingae and culture-negative infection in children < 4 years with OAI. Antibiotic susceptibilities differing from our institutional antibiogram suggest that disease-specific antibiograms will aid with empiric treatment decisions.Disclosures All authors: No reported disclosures.

KAMUTHE video microanalysis system for use in Brazil: translation, cross-cultural adaptation and evidence of validity and reliability

&lt;b&gt;Background&lt;/b&gt;&lt;br /&gt; KAMUTHE is a video microanalysis system which observes preverbal communication within the music therapy setting. This system is indicated for children with autism spectrum disorder (ASD) or multiple disabilities. The purpose of this study was to translate, adapt to Brazilian Portuguese language and analyze some psychometric properties (reliability and validity evidence) of KAMUTHE administration in Brazil for individuals with ASD.&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Participants and procedure&lt;/b&gt;&lt;br /&gt; Translation, back translation, analysis by judges, and pilot application were performed to obtain evidence of content and face validity. The second part of this study was to administer KAMUTHE in 39 consecutive children with ASD. An individual session of improvisational music therapy was applied to assess the different behaviors included in KAMUTHE. The intra-rater reliability, concurrent validity and convergent validity were analyzed.&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;&lt;br /&gt; Translation and cross-cultural adaptation were followed and some cultural adaptations were needed. Inter-rater reliability was very good (ICCs 0.95-0.99) for the three child’s behaviors analyzed. Criteria validity with a moderate negative association was found (r = –.38, p = .017) comparing the behavior “Gazes at therapist” and the level of ASD along with the Childhood Autism Rating Scale (CARS). Convergent validity was established between the behavior “Gazes at therapist” and the two nonlinguistic communication scales (social interaction and interests) of the Children’s Communication Checklist (CCC) with a moderate correlation (r = –.43, p = .005).&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Conclusions&lt;/b&gt;&lt;br /&gt; The administration of the KAMUTHE video microanalysis system showed positive results in children with ASD. Further studies are needed to improve the reliability and validity of the instrument in Brazil.

Physical therapy guideline for children with malnutrition in low income countries: clinical commentary.

Physical therapy intervention along with nutritional rehabilitation has recently become an inevitable combo after recent evidences suggesting a strong interaction between malnutrition and neuro-muscular disabilities which contribute to a significant burden in global settings. Recent studies confirm that appropriate physical assessment of neuro-musculo skeletal system, developmental assessment or cognitive tools along with nutritional assessments followed by exercise rehabilitation will yield positive results in children with malnutrition. There is an obvious need to make available a simple physical therapy exercise guidelines with simple measure and exercise to be used in resource limited settings of developing countries. The purpose of this clinical commentary is to summarize simple assessment tools to evaluate activity impairment, participation restriction, gross motor activity and simple physical therapy intervention program for children with disability secondary to malnutrition.

Pulmonary metastasectomy in pediatric patients.

BackgroundThis study aims to evaluate the outcomes of pulmonary metastasectomy resections in pediatric patients.MethodsWe retrospectively reviewed the medical records of 43 children who were operated on in the Pediatric Surgery Clinic between January 1988 and 2014. Forty-three children (26 boys; 17 girls; mean age 10 ± 4.24 years, range 6 months–18 years) who underwent pulmonary metastasectomy resection were included in the study. The patients were evaluated based on age, gender, history of disease, surgical procedures, complications, duration of hospitalization, duration of chest tube placement, and procedure outcome.ResultsIndications for pediatric resections were oncological. Metastasis was secondary to Wilms’ tumor in 14 patients, osteosarcoma in 7 patients, Ewing’s sarcoma in 5 patients, rhabdomyosarcoma in 5 patients, lymphoma in 3 patients, hepatoblastoma in 2 patients, and other tumors in 7 patients. A total of 59 thoracotomies were performed. Approaches utilized included unilateral posterolateral thoracotomy (n = 33), bilateral posterolateral thoracotomy (n = 8), and sternotomy (n = 2). Wedge resection was the procedure of choice (n = 44). In selected cases, 11 segmentectomies, 3 lobectomies, and 1 pneumonectomy were performed. There was no perioperative mortality. One patient suffered prolonged air leak and three patients from fever. All patients received chemotherapy. Radiotherapy was administered to 16 patients (37.2 %). Of those 16 patients, 7 had Wilms’ tumor, 6 had Ewing’s sarcoma/PNET, and 3 were rhabdomyosarcoma patients. During a median follow-up of 3 years, the overall survival was 74.4 %.ConclusionsMultidisciplinary treatment involving pediatric oncologists, surgeons, and radiation oncologists is necessary to obtain positive results in children who have pulmonary metastases of oncological diseases. Wedge resection is a suitable option for children because less lung tissue is resected.

IS-029 Neonatal Stroke

Neonatal stroke may be defined as cerebrovascular injury, which occurs around birth. Neonatal stroke is most often referred to as perinatal cerebral injury of ischaemic origin. Two common subtypes are perinatal arterial ischaemic stroke (PAIS, 70%) and cerebral sinovenous thrombosis (CSVT, 30%). PAIS has an incidence between 1/1600 and 1/5000. PAIS may affect both full-term and preterm born infants. Several studies have reported a male predominance of approximately 60%, and PAIS is known to more often involve the left hemisphere. Seizures are the most common first clinical sign of PAIS, occurring in 70–90% of all infants with PAIS and are often focal (hemiconvulsions). The diagnosis is made with neuro-imaging techniques. MRI is the most sensitive imaging modality for detection of PAIS. Diffusion weighted imaging (DWI) plays the most important role in the diagnosis of PAIS due to its high sensitivity for detecting ischaemic lesions in the acute phase. MRI and especially DWI (restricted diffusion on DWI at the level of the corticospinal tracts) play an important role in the prediction of motor outcome, especially for development of unilateral spastic cerebral palsy (USCP). During the acute phase, therapeutic options are limited and mainly involve supportive. Beyond the neonatal period, therapy is aimed at treatment of sequelae. Constraint induced movement therapy (CIMT), which addresses the non-use of the affected hand has shown positive results in children with USCP and can already be applied at a young age.

Noninvasive ventilation in pediatric acute respiratory failure: Two case reports

Acute respiratory failure (ARF) is the main cause of cardiac arrest in children. Many studies suggest noninvasive ventilation (NIV) without endotracheal tube intubation (ETI) in the treatment of pediatric ARF. However, there are many important considerations, such as identifying the patient, proper timing for the NIV procedure, and the appropriate setting. We used NIV in a 6-year-old ARF patient and a 14-year-old ARF patient. NIV can produce positive results in children with ARF as well as adults. In our two cases, we showed the acute setting and the use of NIV at the right time.

Detecting Respiratory Viruses in Asymptomatic Children

Viral respiratory infections are among the most common reasons for hospitalization of children in the United States. Our objective was to compare molecular and conventional methods in a cohort of hospitalized children with and without symptoms of respiratory viral illness (RVI). We conducted a retrospective cohort study of infants and toddlers hospitalized between December 2007 and March 2008 at Johns Hopkins Hospital. Five hundred sixty-nine of 641 patient visits (89%) were tested on admission. Conventional tests (immunochromatography, direct fluorescent antibody, shell vial and tube culture) were performed on all patients and nucleic acid tests (NATs) were performed on available samples (n = 306). Viruses were grouped into those routinely (group 1) and those not routinely (group 2) detected by conventional methods. In children with RVI symptoms (n = 148), NATs identified a virus in 83% of specimens compared with 49% by conventional methods (P < 0.001), but detected a similar percentage of specimens with group 1 viruses (48.6% and 55.4%; P = 0.13) compared with conventional tests. In children without RVI symptoms (n = 158), NATs identified a virus in 41.7% of specimens compared with 4.4% by conventional tests (P < 0.001) and identified more group 1 viruses (9.5% and 4.4%; P = 0.03) compared with conventional tests. Group 2 viruses were identified by NATs in a similar percentage of symptomatic and asymptomatic patients (25% and 32.3%; P = 0.20). Molecular assays may have several advantages over conventional methods for detecting respiratory viruses, including improved sensitivity and rapid detection, but given the high prevalence of positive results in children without RVI symptoms, results should be interpreted cautiously.

Tinea capitis in a dermatology center in the city of Fortaleza, Brazil: the role of Trichophyton tonsurans.

Over a 3-year period (March 1999 to March 2002), 944 patients with scalp lesions attended a dermatology reference center in the city of Fortaleza, Ceará, Brazil. Clinical specimens were examined at the Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza-CE, Brazil, to detect patients with tinea capitis. Specimens were obtained from pus, scales, and hairs from suspected lesions of tinea capitis. Mycologic analyses were conducted by direct microscopy and by fungal culture on Sabouraud dextrose agar, with or without chloramphenicol and Mycosel agar. The culture tubes were incubated at 28 degrees C and examined daily for 1 month. Fungi were seen in 438 (46.4%) of the 944 clinical specimens. The percentage of positive direct microscopic examinations of the clinical specimens was 83.7%. Of those patients with tinea capitis, 157 (35.8%) were males and 281 (64.2%; P < 0.001) were females. The distribution of dermatophyte species in males, from 136 positive cultures, was Trichophyton tonsurans (54.41%), Microsporum canis (38.97%), T. rubrum (4.41%), T. mentagrophytes var. mentagrophytes (1.47%), and M. gypseum (0.74%). On the other hand, only three species, from 251 positive cultures, were present in females: T. tonsurans (80.08%), M. canis (17.53%), and T. rubrum (2.39%). There was a high proportion of positive results in children under 10 years of age (n = 309). No significant difference was detected in the seasonal distribution of tinea capitis. Our data show that T. tonsurans is the main etiologic agent of tinea capitis, and is more likely to be found in females and in the prepubertal population.

Different methods of local allergen-specific immunotherapy.

In the treatment of allergic disorders, specific immunotherapy (SIT) occupies a central role as the only currently available causal method of treatment. The concept of ‘‘local immunotherapy’’ includes all nonsubcutaneous forms of SIT, which are used to treat allergic disorders such as rhinitis and asthma. Nasal, bronchial, oral and sublingual administration of allergen extracts is regarded as local immunotherapy (LIT). Attempts were made very early to produce tolerance to certain allergens by the oral route. Dakin reported in1829 that North American Indians regularly chewed small amounts of leaves of the ‘‘poison ivy’’ (Rhus toxicodendron) in order to prevent or weaken the severe dermatitides that occur after contact with this plant (Dakin, 1829 quoted after (1)). In 1900, 11 years before the first work on subcutaneous immunotherapy, Curtis published an article about the efficacy of oral allergen-specific immunotherapy (OIT) in hay fever (2). This was followed five years later by other reports about the success of OIT in cow’s milk allergy (3). In the 1920s and 1930s, too, reports of positive experiences with this method appeared again and again. However, a negative, multicentre comparative study of ragweed pollinosis (4) (in which, interestingly, good results were reported in children!) severely limited the use of OIT in adults in the Anglo-Saxon countries. In the early 1950s, Schuppli in Basel, Switzerland took up OIT again. His positive results in children ensured that this method soon became widespread (5–12). New methods of local application were sought, because various studies in recent years showed that OIT is clearly inferior to allergen-specific subcutaneous (injected) immunotherapy (SIT) with regard to both clinical and immunological efficacy. From a clinical aspect however, there is a whole series of arguments to explain the preference for LIT compared to injected IT. Poor compliance can limit the applicability of injected SIT (13). Because LIT can be carried out at home by the patient and the injections in the doctor’s office are no longer necessary, greater compliance is ascribed to LIT than to SIT. However, more precise studies of this subject are lacking, so the effective compliance of LIT patients is not known. Severe systemic side-effects restrict the broad use of SIT, although the risk in hay fever patients is lower compared to asthma patients (14, 15). When SIT is carried out correctly, severe systemic side-effects in patients with allergic rhinitis, who are treated with potent extracts, occur in about 5% of all the SIT injections (16). Based on the published data, on the other hand, systemic side-effects appear to occur only very rarely with LIT. The rapid development of molecular biology and progress not only in general allergen characterization but also in the production of large quantities of recombinant allergens have reawakened interest in recent years in local immunotherapy (LIT), both in science and among the producers of allergen extracts. At present there appears to be a trend away from oral towards sublingual allergen-specific IT (SLIT).