Treatment Outcomes In Children Research Articles

The evolving nature of asthma and contemporary management of this respiratory disorder

wheezing and increased airway responsiveness to a variety of environmental stimuli. The definition of asthma involves various phenotypes and endotypes.The immunopathogenesis of asthma involves many immune cell sand involves the airway epithelium as well as both innate and adaptive components of the immune system. Understanding the Immunology of asthma is essential in its treatment.Asthma is a rising significant global public health burden. The annual prevalence of severe asthma episodes is estimated from 1% to 21% for adults and over 20% for children aged 6–7 years. The prevalence of asthma varies widely around the world, ranging from 0.2% to 21.0% in adults and from 2.8% to 37.6% in 6- to 7-year-old children. The development of novel asthma phenotyping & endo typing plus better classification of patients using machine learning and big data have markedly improved asthma treatment outcomes in both children and Adults.Several research groups have developed cluster analyses of phenotypes and endo-types in severe asthma. These clusters support the importance of disease heterogeneity in asthma and suggest differences in pathophysiologic mechanisms that define these clusters.Biomarkers of asthma include Serum Immunoglobulin, Fractional excretion of nitric oxide and blood eosinophils amongst others. There are five food and drug administration approved biologicals for the treatment of severe asthma.

English

BACKGROUND Autism is a complex developmental disorder that is not fully understood and is still debated. Till recently, there is no standardised treatment option for autism, earlier the diagnosis better the prognosis but there are only few Indian studies to establish the relationship between early diagnosis and effectiveness of treatment in autistic children and hence this study was conducted. METHODS This was a cross sectional study. Parents of 51 autistic children were asked to fill the Childhood Autism Rating Scale (CARS-2) questionnaire,1 which is a standard screening questionnaire and the CARS-0 and CARS-1 scores were studied. The therapists of the respondents were asked to fill CARS-2 questionnaire based on the characteristics of the respondent when he / she was diagnosed and before he / she started his / her treatment. This score has been documented as CARS-0 score. Then another CARS-2 test was scored by the therapists / researcher based on the present characteristics of the respondent. The relationship between CARS0 score and CARS-1 score, the age of diagnosis and the difference in CARS score were investigated based on paired t-test and Pearson’s correlation. Analysis was done using SPSS and Microsoft Excel. RESULTS CARS scores decreased after treatment and the decrease in CARS 1 scores was more in age groups of 0 - 3 and 3 - 5 years as compared to 5 - 10 years. Pearson’s correlation was done to study the association between the age of diagnosis and the difference between CARS-0 and CARS-1 scores and a negative correlation was seen. CONCLUSIONS There was a significant correlation between the age of diagnosis and the treatment outcome in autistic children. KEYWORDS Autism, Autism Spectrum Disorder, CARS Questionnaire, CARS 0, CARS 1

A combined application of extracorporal detoxification techniques in children at the acute stage of severe concomitant traumtic brain injury

Introduction. In modern literature, there is a limited information on the techniques of extracorporeal detoxification in children with severe concomitant injuries. Moreover, in fact there are no data on their application in children with severe concomitant traumatic brain injuries. It has defined the relevance of this research.Purpose. To improve outcomes of treatment in children with severe concomitant traumatic brain injuries who have manifestations of toxic-resorptive syndrome (TRS), septic complications, acute renal failure of mixed genesis using a combined application of extracorporeal detoxification techniques.Material and methods. The article describes authors’ experience in a combined application of extracorporeal detoxification techniques, including continuous veno-venous hemodiafiltration (CVVHDF) and membrane plasma separation (MPS) in ICU patients with severe concomitant traumatic brain injuries complicated by toxic-resorptive syndrome, sepsis and septic shock.Results. The combined application of extracorporeal detoxification techniques promoted the regression of toxic-resorptive syndrome, shock reversal, stabilization of hemodynamic parameters, parameters of internal homeostasis as well as the regression of multiple organ failure.Conclusion. Early extracorporeal detoxification improves clinical course at the acute stage of trauma. The authors underline that the key requirement for safety in extracorporeal detoxification in patients with severe concomitant traumatic brain injury is the invasive monitoring of intracranial pressure.

Experience in teaching cancer alertness to primary care doctors in the Republic of Kazakhstan

Malignant neoplasms (MN) lead the structure of childhood mortality worldwide. At that, most cases are detected at advanced stages. Early diagnostics is required to improve treatment outcomes in children with cancer. The success mainly depends on oncological alertness and knowledge of primary care doctors.
 The study aimed to analyze the results of training primary care doctors in early diagnostics of oncological and hematological diseases in children using MN staging.
 Results: The paper shares the experience of teaching primary care doctors on early diagnostics of oncological and hematological diseases in children. The analysis used the patient data with staged diagnosed MNs. 3,092 primary care doctors were trained according to the programs we developed and implemented for training trainers and primary care and specialized doctors on early diagnostics of oncological and hematological diseases in children. The training of
 many primary care specialists has improved early children cancer detection rates. Thus, early cancer detection (stage I-II) in children has improved from 29% in 2015 to 37.2% in 2016, 38.2% in 2017, 40.3% in 2018, and 41.4% in 2019. Since 2020, early detection of MN in children prevails (53%).
 Conclusion: Despite the extensive experience and fairly good results comparable to international indicators, the problem of late cancer detection in children remains urgent since it worsens survival forecasts and increases the cost of treatment of oncohematological diseases in children.

Association Between NR3C1 Mutations and Glucocorticoid Resistance in Children With Acute Lymphoblastic Leukemia.

Treatment outcomes in children with acute lymphoblastic leukemia (ALL) have been improved substantially, with a cure rate exceeding 80% using conventional therapy. However, the outcome for patients with relapsed/refractory ALL remains unsatisfactory, despite the fact that these patients generally receive more intense therapy. Glucocorticoid (GC) resistance is a leading cause of treatment failure and relapse in ALL. Abnormal NR3C1 transcription and/or translation is strongly associated with GC resistance, but the underlying molecular mechanism and the clinical value of NR3C1 alterations with GC resistance in ALL treatment remain unclear. This study applied panel sequencing to 333 newly diagnosed and 18 relapsed ALL samples to characterize the link between NR3C1 and ALL further. We identified NR3C1 mutations in three patients with newly diagnosed ALL (0.9%) and two patients with relapsed ALL (11.1%). Functional analyses revealed that four of these five NR3C1 mutations (p. R477H, p. Y478C, p. P530fs, and p. H726P) were loss-of-function (LoF) mutations. A drug sensitivity test further showed that LoF NR3C1 mutations influence GC resistance. Saturated mutagenesis of hotspot R477 demonstrated the importance of this residue for NR3C1 function. The dominant-negative effect of p. R477C and p. R477S and the non-dominant negative effect of p. R477H and p. Y478C suggests multiple mechanisms underlying GC resistance. Thus, primary or acquired genomic lesions in NR3C1 may play a critical role in GC resistance and contribute to ALL treatment failure and/or relapse.

Short course chemotherapy in children suffering from drug resistant tuberculosis

The objective: to study the effect of short course chemotherapy regimens on treatment outcomes in children with drug resistant tuberculosis.Subjects and methods. In 2017-2019, 31 children at the age from 3 to 17 years old, received short course chemotherapy which lasted for 12-15 months. Children of both genders were enrolled in the study, they all were new pulmonary tuberculosis cases with multiple drug resistance or at risk of MDR, with no history of previous treatment with reserve anti-tuberculosis drugs, and without severe concomitant diseases. Before the treatment was prescribed, all children underwent lung computed tomography additionally to general clinical and laboratory tests.Results. The chemotherapy regimen for each child consisted of 4-6 drugs selected individually with the consideration of resistance pattern of the child or suspected index case. In all cases, the combination of drugs included fluoroquinolones (levofloxacin or moxifloxacin). Amikacin (67.7%), aminosalicylic acid (80.6%) and prothionamide (74.2%) were frequently prescribed. 54.8% of children received pyrazinamide and 48.4% – cycloserine. Given the limited lesions, only 16.1% of children received linezolid and 9.7% of children received bedaquiline. The main chemotherapy course made 13.2 ± 0.5 months (from 12 to 15 months depending on the form of tuberculosis and changes during treatment). The duration of the intensive phase made 4.8 ± 0.3 on the average. 2 (6.5 ± 4.4%) of 31 children developed adverse events requiring the cancellation of the drugs causing them.Conclusion. This study has demonstrated satisfactory tolerability and good efficacy of these short course regimens for treatment of multiple drug resistant tuberculosis. No relapses of tuberculosis were reported.

Experience in teaching cancer alertness to primary care doctors in the Republic of Kazakhstan

Relevance: Malignant neoplasms (MN) lead the structure of childhood mortality worldwide. At that, most cases are detected at advanced stages. Early diagnostics is required to improve treatment outcomes in children with cancer. The success mainly depends on oncological alertness and knowledge of primary care doctors. The study aimed to analyze the results of training primary care doctors in early diagnostics of oncological and hematological diseases in children using MN staging. Results: The paper shares the experience of teaching primary care doctors on early diagnostics of oncological and hematological diseases in children. The analysis used the patient data with staged diagnosed MNs. 3,092 primary care doctors were trained according to the programs we developed and implemented for training trainers and primary care and specialized doctors on early diagnostics of oncological and hematological diseases in children. The training of many primary care specialists has improved early children cancer detection rates. Thus, early cancer detection (stage I-II) in children has improved from 29% in 2015 to 37.2% in 2016, 38.2% in 2017, 40.3% in 2018, and 41.4% in 2019. Since 2020, early detection of MN in children prevails (53%). Conclusion: Despite the extensive experience and fairly good results comparable to international indicators, the problem of late cancer detection in children remains urgent since it worsens survival forecasts and increases the cost of treatment of oncohematological diseases in children. Keywords: malignant neoplasms (MN), early diagnostics, children, oncological diseases.

Treatment outcomes of children and adolescents receiving drug-resistant TB treatment in a routine TB programme, Mumbai, India.

BackgroundChildhood and adolescent drug-resistant TB (DR-TB) is one of the neglected infectious diseases. Limited evidence exists around programmatic outcomes of children and adolescents receiving DR-TB treatment. The study aimed to determine the final treatment outcomes, culture conversion rates and factors associated with unsuccessful treatment outcome in children and adolescents with DR-TB.MethodsThis is a descriptive study including children (0–9 years) and adolescents (10–19 years) with DR-TB were who were initiated on ambulatory based treatment between January 2017-June 2018 in Shatabdi hospital, Mumbai, India where National TB elimination programme(NTEP) Mumbai collaborates with chest physicians and Médecins Sans Frontières(MSF) in providing comprehensive care to DR-TB patients. The patients with available end-of-treatment outcomes were included. The data was censored on February 2020.ResultA total of 268 patients were included; 16 (6%) of them were children (0–9 years). The median(min-max) age was 17(4–19) years and 192 (72%) were females. Majority (199, 74%) had pulmonary TB. Most (58%) had MDR-TB while 42% had fluoroquinolone-resistant TB. The median(IQR) duration of treatment (n = 239) was 24(10–25) months. Median(IQR) time for culture-conversion (n = 128) was 3(3–4) months. Of 268 patients, 166(62%) had successful end-of-treatment outcomes (cured-112; completed treatment-54). Children below 10 years had higher proportion of successful treatment outcomes (94% versus 60%) compared to adolescents. Patients with undernutrition [adjusted odds-ratio, aOR (95% Confidence Interval, 95%CI): 2.5 (1.3–4.8) or those with XDR-TB [aOR (95% CI): 4.3 (1.3–13.8)] had higher likelihood of having unsuccessful DR-TB treatment outcome.ConclusionHigh proportion of successful treatment outcome was reported, better than global reports. Further, the nutritional support and routine treatment follow up should be strengthened. All oral short and long regimens including systematic use of new TB drugs (Bedaquiline and Delamanid) should be rapidly scaled up in routine TB programme, especially for the paediatric and adolescent population.

Transdiagnostic Associations Among Parental Causal Locus Attributions, Child Behavior and Psychosocial Treatment Outcomes: A Systematic Review.

Parents' interpretations of the cause of their children's behavior, i.e., parental attributions, are linked to parenting behavior and child development. However, it is not yet known whether parental attributions are systematically associated with children's internalizing and externalizing symptoms and behavior or psychosocial treatment engagement and outcomes across diagnostic categories. This systematic review aimed to fill this knowledge gap using a transdiagnostic perspective to synthesize the literature on the associations between parent-causal and child-responsible attributions and children's internalizing and externalizing behavior, treatment engagement, and treatment outcomes for parents and children. A total of 67 studies were identified. Overall, biased child-responsible attributions were associated with elevated child internalizing and externalizing symptoms and behavior across diagnoses, while findings on the association between parent-causal attributions and child behavior were inconsistent. The link between parental attributions and treatment engagement was also mixed, varying across treatment type, child diagnosis, and focus of attributions. Regarding treatment outcomes, less biased parent-causal and child-responsible attributions were linked to post-treatment improvements in children's behaviors, while mixed findings were reported on post-treatment improvements in parental attributions. Findings are discussed with a focus on approaches to enhance the effectiveness of assessment and psychosocial treatment approaches across diagnostic categories with consideration of parental attributions.

Predictors of unsuccessful tuberculosis treatment outcomes in children from a prospective cohort study in Pakistan.

BackgroundEvery year, about 239 000 children die from tuberculosis (TB), despite availability of highly effective regimens. Few studies have evaluated predictors for poor treatment outcomes in children treated for TB.MethodsWe assessed predictors of unsuccessful TB treatment outcomes in a prospective cohort of children diagnosed by an intensified TB patient-finding intervention at four facilities in Pakistan between 2014 and 2016. A case of TB disease was determined through either bacteriologic confirmation of disease or a clinical diagnosis. To estimate characteristics predictive of experiencing an unsuccessful treatment outcome, we used a multi-level model with a modified Poisson approach, accounting for clustering at the facility level. We report estimated relative risks (RR) and 95% confidence intervals (CI).ResultsDuring the study period, 1404 children less than 15 years old were initiated on treatment for drug-susceptible TB. In total, 709 (50.5%) were 0-4, 406 (28.9%) were 5-9 years, and 289 (20.6%) were 10-14 years old; 614 (43.7%) were female; and of the 1377 children assessed for malnourishment, 1161 (84.3%) were malnourished. A total of 1322 (94.2%) children experienced a successful treatment outcome, 14 (1.0%) children transferred out to a different facility, and 68 (4.8%) children experienced an unsuccessful treatment outcome: 14 (1.0%) died, 20 (1.4%) failed treatment, and 34 (2.4%) were lost to follow-up. After adjustment for age group, sex, and malnutrition status, we identified increased risk of unsuccessful treatment outcome in children presenting with fever (RR = 2.56, 95% CI = 1.02-6.44; P = 0.05) or an abdominal examination suggestive of TB disease (RR = 2.34, 95% CI = 1.20-4.58; P = 0.01), and a decreased risk in children who initiated treatment at a rural facility (RR = 0.05, 95% CI = 0.00-0.74; P = 0.03).ConclusionsMore than 94% of children experienced successful treatment outcomes. We identified individual-, facility-, and clinical-factors predictive of experiencing unsuccessful treatment outcomes. Children with fevers and abdominal findings suggestive of TB disease should be tested for TB and followed closely throughout treatment to ensure necessary support for successful completion of treatment.

Teicoplanin Therapeutic Drug Monitoring and Treatment Outcomes in Children With Gram-Positive Infections.

This is a retrospective audit of teicoplanin dosing, drug-level monitoring, and outcomes in 29 children who received 31 courses of teicoplanin. Our study of noncritically ill children showed that the majority (35/43, 81%) of trough concentrations were within the therapeutic range (10-30 mg/L) contrasting previous studies in children. Overall, 21 of the 24 (88%) children with Gram-positive infections achieved cure.

Mothers' Views About Lumbar Puncture for Their Children in a Maternity and Children's Hospital in Najran, Saudi Arabia.

BackgroundRefusal rates for offered pediatric lumbar puncture (LP) are high in many parts of the world, potentially hindering diagnosis and treatment for thousands of children. There is relatively little research about why such rates are so high. Understanding the formation and development of mothers’ opinions about LP could help identify barriers to accessing this modality to improve diagnostic and treatment outcomes in children with neurological and systemic diseases.MethodsWe surveyed mothers of hospitalized children in the Maternity and Children’s Hospital in Najran in November and December 2018. We queried their familiarity with LP and their decision to accept or refuse LP when it was offered. The team recorded demographic data on survey respondents, as well as their stated reasons for their LP decisions, and used chi-square tests to evaluate the correlation between patient or parent characteristics and the decision to accept or refuse LP.ResultsA total of 202 mothers responded to the survey, with a mean age of 30.7 (± 6.9); nearly all women were stay-at-home mothers (93.1%). Most (61.4%) lived in urban settings. Four in 10 respondents (40.6%) were not familiar with LP. A sizable minority of 89 mothers (44.0%) refused LP for their children when offered, most commonly citing fear of paralysis (39.3%) as the reason for refusal. Those who accepted LP were more likely to do so following physician advice than for any other reason (p <0.001).ConclusionLumbar puncture refusal rates may be even higher than previously reported, and there is a pressing need to educate women on the diagnostic and therapeutic benefits of LP for their children. Maternal education from physicians may help improve acceptance rates for the procedure.

Clinical Presentation and Treatment Outcomes of Children and Adolescents With Pheochromocytoma and Paraganglioma in a Single Center in Korea.

PurposePheochromocytoma (PCC) and paraganglioma (PGL) (PPGL) are rare neuroendocrine tumors, and data on managing these conditions in children and adolescents are lacking. The objective of this study was to demonstrate the clinical presentation and treatment outcomes in children and adolescents with PPGL in a single tertiary care center in Korea.MethodsThis retrospective study included 23 patients diagnosed with PCC (n = 14) and PGL (n = 9) before the age of 21 at Samsung Medical Center (from June 1994 to June 2019). We describe age, gender, family history, clinical characteristics, laboratory findings, pathologic findings, therapeutic approaches, and treatment outcomes.ResultsOf the 23 patients, 14 had PCC and nine had PGL. The median age at diagnosis was 16.8 years (range, 6.8–20.8 years). The common presenting symptoms were hypertension (n = 10), headache (n = 9), palpitation (n = 4), and sweating (n = 4). The plasma or 24-hour urine catecholamine and/or metabolite concentrations were markedly elevated in 22 patients with PPGL, but were normal in one patient with carotid body PGL. All tumors were visualized on computed tomography. Genetic tests were performed in 15 patients, and seven patients showed mutations in RET (n = 3), SDHB (n = 3), and VHL (n = 1). All patients underwent surgery, and complete excision was performed successfully. Three patients with metastasis underwent postoperative adjuvant therapy.ConclusionThis study suggests that pediatric PPGL tends to be extra-adrenal and bilateral and shows a higher potential for genetic mutations. Considering the hereditary predisposition of pediatric PPGL, genetic screening tests are strongly recommended, and lifelong follow-up is needed to detect recurrence and metastasis. Further research with a larger sample size and routine genetic screening is needed to better understand the genetic conditions and long-term prognosis of PPGL.

Clinical characteristics, treatment outcomes, and occurrence of diabetes mellitus after pancreatic resection of solid pseudopapillary tumor in children and adolescents: A single institution experience with 51 cases

BackgroundSolid pseudopapillary tumors (SPTs) are rare, but they comprise the majority of pediatric pancreatic neoplasms. However, studies on these conditions in pediatric patients are lacking. The aim of this study was to investigate the clinical characteristics and treatment outcomes in children and adolescents with SPTs. MethodsThis retrospective study included 51 patients with SPTs who had undergone pancreatic tumor resection before the age of 19 years at Samsung Medical Center in Korea (from November 1994 to August 2020). We investigated the postoperative outcomes. ResultsOf the 51 patients with SPTs (female, 88.2%), the median age at diagnosis was 14 years (range, 8–19). The most common symptom was abdominal pain (60.8%), and 14 patients (27.5%) were asymptomatic. The median maximal tumor diameter was 7 cm (range, 1.4–14), and the pancreatic body and/or tail were involved in 68.6% of patients. The short-term complication rate was 21.5%, and the recurrence rate was 5.9%. New-onset diabetes mellitus (NODM) occurred in four patients. ConclusionsThe ideal treatment for SPTs is complete resection of the tumor; however, long-term postoperative complications including NODM should be monitored carefully, particularly in children and adolescents.

Visual outcomes of surgical and conservative treatment in children with small posterior polar cataracts and posterior lenticonus.

To compare the visual outcomes of children with small (≤3 mm) posterior polar cataracts (PPC) and posterior lenticonus who had cataract extraction surgery with the visual outcomes of those who were managed conservatively. Children who initially had small PPC and posterior lenticonus who were followed up over 1-year period were retrospective reviewed in the study. Patients receiving surgery were compared with those receiving conservative therapy. The axial length, keratometry, refraction, best-corrected visual acuity (BCVA), and strabismus measurements were recorded. Lens morphology, i.e., the location, size, and depth of the cataract lesion, was measured with a Scheimpflug imaging system. To help control for baseline differences in the groups, patients were matched with controls by propensity score methodology. The study evaluated 60 patients (30 in the surgery group and 30 in the conservative therapy group) after matching by propensity score. Patients who underwent cataract surgery showed greater BCVA improvements (0.36±0.24 logMAR) than patients who were treated without surgery (0.22±0.26 logMAR; P=0.036). Surgery was effective in patients with a rear projection length (RPL) less than 1.0 mm and a pretreatment BCVA worse than 0.52 logMAR. Children with small PPC and posterior lenticonus who undergo cataract surgery experience greater BCVA improvements than those managed conservatively. Certain patients presenting with a RPL less than 1.0 mm and a pretreatment BCVA of 0.52 logMAR or worse may benefit from surgery.

Choice of surgical treatment for slipped capital femoral epiphysis with severe chronic displacement of the epiphysis

Background. The spatial relationship between the epiphysis and the acetabulum in slipped capital femoral epiphysis (SCFE) with severe chronic epiphysis displacement is restored by different corrective extra-articular femoral osteotomies and a standard Dunn procedure. Severe residual deformity of the femoral component of the joint with symptoms of femoroacetabular impingement and a large number of severe ischemic complications forced the surgeons to improve the technique of these surgical interventions. In particular, a modified Dunn procedure was proposed using a low traumatic surgical hip dislocation. However, the selection of surgical treatment in these patients remains a subject of discussion.&#x0D; Aim. This study aimed to improve the results of treatment in children with SCFE with severe chronic epiphysis displacement.&#x0D; Materials and methods. Data of preoperative and postoperative clinical and radiological studies of 40 patients (24 male and 16 female) aged 1215 years who were suffering from SCFE with severe chronic epiphysis displacement were analyzed. In all cases, on the lesion side, displacement was found in typical directions (posterior-downward or only posterior), and in the contralateral joint, the disease was still at its initial stage (pre-slip). In group 1 (n = 20 children), a corrective extra-articular femoral (anterior-rotational or rotational-valgus) osteotomy was performed according to the method we have proposed in 2011 [22], and in group 2 (n = 20 children), the modified Dunn procedure that strictly followed our technique was performed. The follow-up period after surgery in both groups ranged from 1 month to 2.5 years.&#x0D; Results. At 2.5 years after surgery, good anatomical and functional outcomes were observed only in 1 (12.5%) of 8 patients in group 1, while they were observed in 7 (87.5%) of 8 patients in group 2. Poor results were determined by residual epiphyseal displacement (from 22 to 28) and/or step-like transition of the anterior femoral neck surface to the head in 5 (62.5%) children in group 1 and by femoral head avascular necrosis (diagnosed in 6 months after surgery) in 1 (12.5%) child in group 2.&#x0D; Conclusion. The results allow us to make a preliminary conclusion about the high efficiency of the modified Dunn procedure and the low efficiency of the corrective extra-articular femoral osteotomy in SCFE with severe chronic displacement of the epiphysis. The modified Dunn procedure corrects the pronounced deformity of the femoral component of the affected joint and femoroacetabular impingement in the above-mentioned anatomical situations.

Clinical Profile and Outcome of Childhood Autoimmune Hemolytic Anemia: A Single Center Study

ObjectiveTo analyze clinical and laboratory parameters, and treatment outcomes of children with autoimmune hemolytic anemia (AIHA).MethodsRetrospective analysis of 50 children aged 0–18 years. Monospecific direct antiglobulin test (DAT) and investigations for secondary causes were performed. Disease status was categorized based on Cerevance criteria.ResultsMedian (range) age at diagnosis was 36 (1.5–204) months. AIHA was categorized as cold (IgM+,C3+/cold agglutinin+) (35%), warm (IgG+ with/without C3+) (28%), mixed (IgG+, IgM+, C3+) (15%) and paroxysmal cold hemoglobinuria (4%). Primary AIHA accounted for 64% cases. Treatment modalities included steroid (66%), intravenous immunoglobulin (IVIg) (4%), steroid+IVIg (4%), and steroid+rituximab (4%). Treatment duration was longer for secondary AIHA than primary (11 vs 6.6 months, P<0.02) and in patients needing polytherapy than steroids only (13.3 vs 7.5 months, P<0.006). During median (range) follow-up period of 73 (1–150) months, 29 (58%) remained in continuous complete remission, 16 (32%) remained in complete remission.ConclusionInfants with AIHA have a more severe presentation. Monospecific DAT and a thorough search for an underlying cause help optimize therapy in most patients of AIHA.

Clinical Analysis of the Effects of Cranial Suture Reconstruction and Frontal Frame Retraction in the Operation of Premature Closure of the Sagittal Suture in Infants.

To compare and analyze the effects of cranial suture reconstruction and frontal frame retraction for surgical treatment of premature closure of the sagittal suture. Infants with premature closure of the sagittal suture were included in this study. All infants underwent preoperative skull model reconstruction using imaging techniques and 3D printing. The infants were then allocated to either the experiment group, where the frontal frame retraction was used to guide the surgical treatment of cranial stenosis, or the control group, where traditional cranial suture reconstruction was performed. All interventions were performed by the same operator. The surgical effects of the two groups were compared. Overall, 28 infants were enrolled in this study, with 15 infants in the experimental group and 13 in the control group. In the one-year post-operative follow-up visit, the cephalic index of scaphoid malformation was 78.3 ± 1.4 in the experimental group and 69.0 ± 4.2 in the control group. The difference between the two groups was statistically significant. Frontal frame retraction surgery can guide the surgical procedure for cranial stenosis, significantly improve the treatment outcome in children with premature closure of the sagittal suture, and improve the form of the head aesthetically in children, and the effect is better than traditional operation; therefore, the technique is worth popularizing in the clinic.

Хирургическое лечение детей с клапаном задней уретры

Objective. To assess treatment outcomes in children with posterior urethral valve (PUV). Patients and methods. We analyzed treatment outcomes in 60 children with PUV within a non-randomized, retrospective, single-center, pilot study. Sixty patients have undergone PUV ablation; 8 of them required repeated ablation. Endoscopic treatment of vesicoureteral reflux (VUR) was performed in 31 ureters; 5 children had botulinum toxin therapy. Results. Type 1 PUV was diagnosed in 49 patients (81.6%), whereas type 3 PUV was identified in 11 patients (18.3%). VUR was detected in in 65 ureters (54.1%); obstructive ureterohydronephrosis was diagnosed in 40 ureters (33.3%). Ablation of the valve flaps improved lower urinary tract (LUT) urodynamics in 27 children. Thirty-three patients had valve bladder syndrome (VBS). Improvement of the upper urinary tract (UUT) condition was achieved in 54 cases. Fifteen children have undergone nephroureterectomy. There was a significant decrease in the activity of pyelonephritis in children after endoscopic ablation of the PUV. Fifty-three patients (88.3%) demonstrated severe UUT urodynamic disorders. The baseline grade of UUT lesions affected treatment outcome (p = 0.0009). Children with VBS symptoms had progressive UUT pathology and persistent urinary incontinence. Six patients eventually required replacement therapy. Conclusion. The majority of PUV children (88.3%) presented with severe UUT impairments. More than half of the patients (55.0%) had VBS symptoms. Their treatment should be comprehensive and include long-term monitoring of urodynamics and kidney function. Key words: posterior urethral valve, valve bladder syndrome, vesicoureteral reflux

Paediatric neck masses in Zaria: A review of clinical profile and treatment outcome.

Background:A neck mass is any abnormal lesion in the neck that can be seen, palpated, or identified on imaging. It is one of the most common reasons for presentation to the surgical clinics.Aim:the aim is to analyse the clinical presentation and treatment outcome in children who were diagnosed and managed for neck masses in a tertiary centre in Northwestern Nigeria.Materials and Methods:The records of patients managed for neck masses over 7 years between January 2013 and December 2019 were reviewed. Demographic and clinical data were retrieved and analysed using Statistical Product and Service Solution version 23.0 software (SPSS Inc., Chicago, Illinois, USA).Results:A total of 99 cases were reviewed and there were 52 (52.5%) males and 47 (47.5%) females with male-to-female ratio of 1.1:1, and mean age ± standard deviation of 4.4 ± 3.9 years, the primary complaints of all the patients were neck swellings. The anterior triangle was the most common region involved in 86 (86.9%) patients. The majority of the neck masses were congenital, accounting for 71 (71.8%) patients. Ultrasound scanning was the most commonly requested radiological investigation done in 87 (87.8%) patients. Thyroglossal duct cyst was the most common paediatric neck mass seen in 41 (41.4%) patients. The majority of the patients 68 (68.7%) had an excisional biopsy of the lesion. Surgical site infection was the most common complication noted in 7.1% of the study population.Conclusion:Most of the neck masses were congenital and were managed surgically. Prompt diagnosis with appropriate treatment may result in a good outcome.