System In Children Research Articles

Use of Continuous Glucose Monitoring System in Children with Type 1 Diabetes Mellitus in a Resource Limited Setting.

Regular self-monitoring of blood glucose (SMBG) remains the mainstay method for diabetes monitoring. The major limitation of SMBG is poor compliance and it only provides a snapshot of glucose values at that point of time. Continuous glucose monitors (CGMs) are non-invasive devices which measure subcutaneous interstitial glucose for every five minutes and provide glucose variability throughout the day. To assess the effectiveness of intermittent continuous blood glucose monitoring in comparison with SMBG on the percentage reduction in HbA1c level in children with type 1 diabetes mellitus (DM). Children diagnosed with type 1 DM of age group 3-18 years were enlisted into the study. Participants were randomised to the study arm (CGMs+SMBG) or the control arm (SMBG alone). Subjects in the study group were given CGM along with regular SMBG for 14 days. The control group was asked to perform SMBG. HbA1c levels were measured in both groups after three months of intervention. There were 62 children in each group. After three months, in the intervention group HbA1c level dropped from 11.23% ± 1.53% (Mean ± SD) to 10.14% ± 1.99%, in control group HbA1c level dropped from 11.62% ± 1.62% to 11.32% ± 1.57%. The fall in HbA1c level in intervention group is significant (p value -0.01). In a resource-limited setting, intermittent use of CGMs atleast once every two to three months will help in understanding the factors influencing glucose variation throughout the day and, with appropriate therapeutic modifications, will aid in achieving optimal glycaemic control.

Determinants for Predicting Polyorganic Functional Changes of the Musculoskeletal System in Children with Various Degrees of Joints Hypermobility

Aim: The aim of the work was to study the presence of determinants for predicting the local structures involvement of the musculoskeletal system against the background of joint hypermobility in children. Materials and Methods: The study involved 446 children aged from four to six years. The study plan includes: copying the data of a comprehensive medical examination; determination of joint hypermobility by goniometry and evaluation according to the criteria of presence and degree of joint hypermobility by the method of C. Carter, J. Wilkinson – in the modification of P. Beighton; application of clinical and physiological methods (functional testing, genealogical analysis) and methods of mathematical data processing. Results: The significance hierarchy of morpho-functional features in relation to the further development of the pathological process in children with one of the main manifestations of undifferentiated connective tissue dysplasia – joint hypermobility – is predicted. Determinants of predicting local involvement of musculoskeletal structures (mobility of the spine in the sagittal plane, muscles endurance of the dorsal torso surface) were determined. Conclusions: Against the background of the study of a wide range of clinical features of several generations’ orthopaedic lesions, the fact of highly-progressing risk of scoliotic disease and flat foot was established.

Outcomes of Overt and Non-overt Disseminated Intravascular Coagulation Using the ISTH DIC Scoring System in Children: A Single-Center Study.

Several disseminated intravascular coagulation (DIC) scoring systems are used for prognosticating the clinical outcomes of patients with DIC. However, research on children is scarce. Therefore, this study compared the clinical outcomes of overt and non-overt DIC using the International Society on Thrombosis and Hemostasis (ISTH) DIC scoring system. This retrospective study reviewed data on children aged one month to 15 years diagnosed with DIC between 2003 and 2014. Of 244 patients, 179 (73.4%) had overt DIC, and 65 (26.6%) had non-overt DIC. The most common causes were infection (84.8%), tissue injury (7%), and malignancies (2.9%). The 28-day case fatality rate was significantly higher for overt than non-overt DIC (76% vs. 15.6%; P < 0.001). DIC scores were significantly associated with mortality (R2 = 0.89). Each clinical parameter (platelet count, prothrombin time, and fibrin degradation products) was associated with mortality (P = 0.01). On multivariable analysis, the factors associated with death were platelet counts ≤ 50 000 cells/mm3 (OR, 2.42; 95% CI, 1.08-5.42; P = 0.031); overt DIC score (OR, 7.62; 95% CI, 2.94-19.75; P < 0.001); renal dysfunction (OR, 2.92; 95% CI, 1.34-6.37; P = 0.007); shock (OR, 39.62; 95% CI, 4.99-314.84; P = 0.001); and acute respiratory distress syndrome (OR, 25.90; 95% CI, 3.12-214.80; P = 0.003). The 28-day case-fatality rate was significantly higher for patients with overt than non-overt DIC and concordant with ISTH scores. ISTH DIC scores can be used as a clinical predictor for DIC in children.

The Main Causes of the Development of Diseases of the Biliary System in Children, Their Importance and Relevance in Medicine

The Main Causes of the Development of Diseases of the Biliary System in Children, Their Importance and Relevance in Medicine

An Update on the Diagnosis and Treatment of Invasive Mold Disease of the Central Nervous System in Children.

Epidemiological data of CNS IMD in pediatrics are limited. Aspergillus is the most frequently identified species, followed by other rare molds. Prompt diagnosis is of importance to define the optimal therapeutic management with respect to antifungal agent, dose, and evaluation of surgical intervention. The mortality rate of CNS IMD remains high. In this mini review we summarize the current knowledge on diagnosis and treatment of CNS IMD in pediatrics.

Changes In The Dental System In Children And Adolescents With Hearing Loss

The article presents an analysis of the prevalence of malocclusion pathology and the nature of morphological changes in the dental apparatus in children and adolescents with hearing loss living in the Bukhara region. The prevalence of dental anomalies and deformities in schoolchildren with hearing impairment was 76.5 ± 0.03%, dental anomalies were diagnosed in 78.9%, dental anomalies in 30.3% of students. The prevalence of dental anomalies and deformities in children and adolescents with hearing loss exceeded the corresponding indicator in conditionally healthy children of the corresponding age groups living in the Bukhara region. In connection with the above, the expediency of developing and implementing preventive measures in this contingent of the child population is justified.

Evaluation of the Functional Status of the Posture Control System in Children with Detected Disorders in Body Posture.

Screening tests for body posture defects and abnormalities conducted over the past several decades have revealed a significant and constantly increasing problem of health risks in children. A sedentary lifestyle, which is considered to be the primary cause, can result in proprioceptive disorders leading to postural instability. The aim of the study was to find the correlation between the level of proprioceptive control and the number of postural disorders. The study involved a representative group of 1090 children aged 8-10 years, from randomly selected primary schools. Subjects who scored from 1 to 5 points in a prior postural screening test were qualified for the examination of the postural control system. The examination of the postural control system was carried out using an electronic station enabling assessment of postural stability and proprioception. A single leg stance test showed that the number of postural disorders does not significantly impact proprioceptive control. Proprioceptive control was found to significantly increase with the age of the children, and girls presented significantly better proprioceptive control in relation to the boys in each age group.

Validity of the American College of Radiology Thyroid Imaging Reporting and Data System in Children.

To assess the validity of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) for evaluating thyroid nodules in children. Patients aged <19 years with thyroid nodule(s) evaluated by ultrasound (US) from 2007-2018 at a tertiary children's hospital were included. Two radiologists scored de-identified thyroid US images using ACR TI-RADS (from 1, "benign" to 5, "highly suspicious"). The radiologists recorded size and rated vascularity for each nodule. Ultrasound findings were compared to pathology results (operative cases, n=91) and clinical follow-up without disease progression (non-operative cases, n=15). Thyroid images from 115 patients were reviewed. Nine patients were excluded due to the absence of an evaluable nodule. Forty-seven benign and 59 malignant nodules were included. Median age at ultrasound was 15 years (range 0.9-18 years). Twenty (18.9%) patients were male. There was moderate agreement between TI-RADS levels assigned by the two raters (kappa=0.57, p< 0.001). When the raters' levels were averaged, >3 as the threshold for malignancy correctly categorized the greatest percentage of nodules (68.9%). Eleven (18.6%) malignant nodules received a TI-RADS level of 2 (n= 3) or 3 (n= 8). Sensitivity, specificity, and positive and negative predictive values were 81.4%, 53.2%, 68.6%, and 69.4%, respectively. Although not part of TI-RADS, vascularity was similar between benign and malignant nodules (p=0.56). In a pediatric population, TI-RADS can help distinguish between benign and malignant nodules with comparable sensitivity and specificity to adults. However, the positive and negative predictive values suggest TI-RADS alone cannot eliminate the need for FNA. 3 Laryngoscope, 133:2394-2401, 2023.

Basic Differences and Most Common Findings in Ultrasound Examinations of Musculoskeletal System in Children: A Narrative Literature Review.

We present basic differences in the musculoskeletal ultrasound examinations between adults and children. Examiners who deal with adults on a daily basis have shared concerns about examining children. Such concerns may arise from the different approach to child ultrasounds, but they also come from differences in anatomical characteristics according to developmental age. We discuss the presence of growth plates, as well as non-mineralized parts of the bones. We also refer to the pathologies most often found in ultrasounds in early developmental stages. In the PubMed database, the set of keywords: “msk ultrasound in children”, “pediatric msk sonoanatomy”, “coxitis fugax”, “pediatric Baker’s cyst”, “Baker’s cyst ultrasonography”, “bone septic necrosis in ultrasonography”, “ultrasonography in juvenile idiopathic arthritis”, and “ultrasonography in juvenile spondyloarthropathies”, was used to identify a total of 1657 results, from which 54 was selected to be included in the article. We discuss the problem of osteochondritis dissecans, Osgood-Schlatter disease, examples of ligament injuries (especially in relation to the knee and ankle joints), exfoliation of growth cartilages, osteochondroma, exudates and inflammations affecting joints, and Baker’s cysts. In this way, we have collected useful information about the most common diseases of the musculoskeletal system in children.

Effects of Mitral Valve Prolapse on Heart Rate Variability and the Autonomic Nervous System in Children.

Patients with mitral valve prolapse (MVP) may reveal symptoms of autonomic dysfunction and heart rate variability (HRV). We sought to explore the autonomic nervous system in children with MVP. This cross-sectional study enrolled 60 children aged between 5 and 15 years with MVP and 60 age- and sex-matched healthy children as controls. Two cardiologists performed electrocardiography and standard echocardiography. HRV parameters were explored via 24-hour rhythm 3-channel Holter monitoring. The depolarization of ventricular and atrial parameters, comprising QT max and min, QTc intervals, QT dispersion, P maximum and minimum, and P-wave dispersion, was measured and compared. The mean age was 13.12±1.50 years in the MVP group (F/M: 34/26) and 13.20±1.81 years in the control group (F/M: 35/25). The maximum duration and P-wave dispersion in the MVP group were significantly different from the healthy children (P<0.001). The longest and shortest QT dispersion values and QTc values were significantly different between the 2 groups (P=0.004, P=0.043, P<0.001, and P<0.001, respectively). The HRV parameters were significantly different between the 2 groups, too. Decreased HRV and inhomogeneous depolarization showed that our children with MVP were prone to atrial and ventricular arrhythmias. Furthermore, P-wave dispersion and QTc could be used as prognostic markers of cardiac autonomic dysfunction before it is diagnosed by 24-hour Holter monitoring.

From the practice of using clinical interviews in the study of mentality

Introduction. The relevance of the study is due to the depth and breadth of the concept of "mentality" in psychology. Based on this, the empirical study of mentality presents certain difficulties. In our study, we proceed from the understanding that mentality is a superstructure that determines the existential meaning of phenomena, processes that distinguish the psychological makeup of a particular society. The research is aimed at studying the yakut mentality through the prism of family relations. It is assumed that the family, as the primary institution of socialization, is the most important mechanism ensuring the continuity of traditional cultural values and the stability of mentality in a changing world.Materials and Methods. The article describes the results of a clinical interview conducted within the framework of psychological counseling. The advantages of a clinical interview in the study of the deep, qualitative features of the mentality of the people are revealed. The study was conducted in Yakutia from 2018 to 2021. The sample size is 99 people. The age of respondents is from 54 to 82 years. Of these, 87 are women, 12 are men.Results. The results of psychological consultations are presented in the form of detailed texts and tables reflecting the quantitative results of content analysis. Clinical interview protocols are analyzed using microsemantic analysis and content analysis.Discussion and Conclusions. It is revealed that the traditional values of the sakha people are preserved in the yakut mentality: respect for elders, family as an extended family. Modern yakut families adhere to the norms of the traditional yakut family: child-centrism, parenting in the children's system, the active participation of grandparents in the upbringing of children, the choice of an informal head of the family not by gender, but by personal characteristics. The participation of several generations in the upbringing of children, the expansion of family resources at the expense of the genus are mechanisms that ensure the continuity of mentality in the yakut culture.

A Novel Hospital-to-Home System for Children With Medical Complexities: Usability Testing Study.

BackgroundChildren with medical complexity (CMC) are a group of young people who have severe complex chronic conditions, substantial family-identified service needs, functional limitations, and high health care resource use. Technology-enabled hospital-to-home interventions designed to deliver comprehensive care in the home setting are needed to ease CMC family stress, provide proactive and comprehensive care to this fragile population, and avoid hospital admissions, where possible.ObjectiveIn this usability testing study, we aimed to assess areas of strength and opportunity within the DigiComp Kids system, a hospital-to-home intervention for CMC and their families and care providers.MethodsHospital-based clinicians, family members of medically complex children, and home-based clinicians participated in DigiComp Kids usability testing. Participants were recorded and tasked to think aloud while completing usability testing tasks. Participants were scored on the metrics of effectiveness, efficiency, and satisfaction, and the total usability score was calculated using the Single Usability Metric. Participants also provided insights into user experiences during the postusability testing interviews.ResultsA total of 15 participants (5 hospital-based clinicians, 6 family members, and 4 home-based clinicians) participated in DigiComp Kids usability testing. The participants were able to complete all assigned tasks independently. Error-free rates for tasks ranged from 58% to 100%; the average satisfaction rating across groups was ≥80%, as measured by the Single Ease Question. Task times of participants were variable compared with the task times of an expert DigiComp Kids user. Single Usability Metric scores ranged from 80.5% to 89.5%. In qualitative interviews, participants stressed the need to find the right fit between user needs and the effort required to use the system. Interviews also revealed that the value of the DigiComp Kids system was in its ability to create a digital bridge between hospital and home, enabling participants to foster and maintain connections across boundaries.ConclusionsUsability testing revealed strong scores across the groups. Insights gained include the importance of tailoring the implementation of the system to match individual user needs, streamlining key system features, and consideration of the meaning attached to system use by participants to allow for insight into system adoption and sustainment.

Behavioral gender differences in school-age children with autism.

This study examined differences in internalizing and externalizing behaviors between school-aged boys and girls diagnosed with autism spectrum disorder (ASD). Eighty-nine children between the ages of 8 and 16years participated in this study: 17 girls (M = 11.5years, SD = 2.3) and 72 boys (M = 11.3years, SD = 2.2). Participantswere matched onthe Autism Diagnostic Observation Schedule, Second Edition and Full-Scale IQ (FSIQ > 64). The results indicated that, girls had higher reported instances of Bullying, less Anger Control, and poorer Emotional Self-Control than boys on the Behavior Assessment System for Children, Second Edition. Groups did not differ on subscales of the Social Communication Scale. While evidence of increased externalizing behaviors is less common in girls, there is evidence supporting these differing behaviors that warrant further research.

Analysis of "Accuracy of a Seventh-Generation Continuous Glucose Monitoring System in Children and Adolescents With Type 1 Diabetes".

In an article in the Journal of Diabetes Science and Technology, Laffell et al examined the accuracy and performance of a seventh-generation "G7" continuous glucose monitor (CGM) system in participants with type 1 diabetes aged 2 to 17 years. The study had notable points which increase the generalizability of the authors' findings to usual clinical practice, such as accuracy assessment across a wide range of glycemia in the arm and abdominal area, at variable rates of change and time periods (beginning and end of sensor wear). However, accuracy measurements in the younger cohort (2-6 years old) were relatively few. Overall and per-sensor accuracy assessments using standard accuracy metrics were consistently high. The authors also highlighted the enhanced features of the G7 system compared to earlier generation systems, which support better usability.

Efficiency of Audiovisual Distraction Eyewear and Computer Controlled Local Anesthesia Delivery System in Children

Efficiency of Audiovisual Distraction Eyewear and Computer Controlled Local Anesthesia Delivery System in Children

Dynamics of Neuromodulatory and Hormonal Systems in Children with Autism Spectrum Disorders under the Dolphin Therapy Influence

An important part of the rehabilitation process in children with autism is the search for effective methods that affect the main pathogenetic mechanisms. Aim. To evaluate the effect of dolphin therapy (DT) on the monoaminergic and hormonal systems in children with autism spectrum disorders (ASD). Material and methods. 47 children with ASD – (F84) aged 3 to 14 years were examined. The I group – 23 children who received the basic sanatorium-resort treatment (SRT); the II group – 24 children got a course of DT. The checkup included examination by specialists, evaluation of serotonin, norepinephrine and cortisol in the blood serum before and after the treatment complexes. Results and discussion. There was a significant decrease in serotonin and norepinephrine, an increase in cortisol in children with ASD. After the treatment, there was a significant increase in norepinephrine levels and decrease in cortisol with an average degree of ASD in the group I, increasing in serotonin, norepinephrine and decrease in cortisol with all degrees of ASD severity in the II group. Many mental disorders are controlled not by the levels of serotonin and norepinephrine, but by their balance in content. The conducted basic SRT increases the level of norepinephrine and reduces the cortisol content in children with moderate severity of autism, without affecting severe forms of ASD. The use of DT in the basic HRT contributed to an increase in the content of serotonin and norepinephrine and a decrease in cortisol in moderate and severe autism, which had a positive effect on clinical indicators (manifestations of hyperactivity, phobias, aggression and autoaggression decreased, cognitive abilities, attention, speech functions improved). Conclusions. A close relationship has been established between monoamines and cortisol in children with ASD and their participation in the pathogenetic mechanisms of the disease. The inclusion of the DT in the SRT course contributes to breaking the vicious circle and normalizing the relationship between monoamines and cortisol in children with ASD.

Design and Evaluation of an Exergaming System for Children With Autism Spectrum Disorder: The Children’s and Families’ Perspective

Children with autism spectrum disorder (ASD) have lower levels of physical activity than their typically developing peers. Barriers to participation include deficits in motor function and in social interaction, both of which reduce opportunities to engage in leisure activities that incorporate physical exertion. Because children with ASD also have higher than average levels of media use, exergames—video games that require bodily interaction to play—are a promising form of exercise. While studies have examined exergaming interventions for children with ASD, to date there has been little research on exergames that have been specifically designed for children with neurodevelopmental disorders, or qualitative analysis of players’ and families’ experience with exergaming programs. In this paper we present Liberi, an exergaming system involving kinaesthetic interaction within a virtual world, and designed explicitly for children with neurodevelopmental disorders. We report the results of a 6-week study where Liberi was played from the home by five children with ASD. The paper describes those aspects of the design that were successful and unsuccessful; how children and parents viewed the exergames; how the games were incorporated into the children’s lives; and how parents envisaged exergames could be best deployed for children with ASD.

Primary Melanocytic Tumors of the Central Nervous System in Children: Imaging Features with Pathologic Correlation

Primary melanocytic tumors of the central nervous system are rare neoplasms arising from proliferation of multipotent melanin-containing neural crest cells found in the leptomeninges. This review describes the imaging appearance of the entire spectrum of primary melanocytic tumors of the brain and spine in the pediatric population, in correlation with histopathology, clinical features, and prognosis, using sample cases from our institution. These tumors are subclassified by the World Health Organization on the basis of disease distribution and pathologic aggressiveness into the following 4 subtypes: meningeal melanocytoma, meningeal melanoma, meningeal melanocytosis, and meningeal melanomatosis. They can occur in any age group, though the diffuse form of the disease is more prevalent in children and has an association with giant cutaneous melanocytic nevi. Imaging is characterized by hyperattenuation on CT and intrinsic T1 hyperintensity on MR imaging from the presence of melanin and/or hemorrhage. The focal forms usually manifest as dural-based hemorrhagic masses, and the diffuse forms demonstrate dural thickening and enhancement, with or without hydrocephalus. There is a predilection for the medial temporal lobes, posterior fossa, and upper cervical spine. The prognosis is often poor, with a high incidence of malignant transformation of benign disease.Learning Objective: To describe the imaging appearance of the spectrum of primary melanocytic tumors of the brain and spine in the pediatric population and to review the histopathology, clinical, and prognostic data available

Experience of performing pancreatoduodenal resection in children

Introduction. The article is devoted to the experience of treating children with pancreatic tumors who underwent pancreatoduodenal resection (PDR) at the Department of Pediatric Surgery, Faculty of Pediatrics, N. I. Pirogov Russian National Research Medical University and at the Center for the Treatment of Developmental Anomalies and Diseases of the Hepatopancreatobiliary System in Children on the basis of the N. F. Filatov Children’s City Clinical Hospital. This type of operation was performed in children with tumors of the head of the pancreas, with the spread of fibroinflammatory changes to nearby organs in chronic pancreatitis and with complicated forms of chronic duodenal obstruction. Materials and methods. For the period from 2010 to 2021 9 PDEs were performed in patients aged 1 to 16 years. The results of treatment in this category of patients were assessed as satisfactory. It is noted that the postoperative period has a number of features: prolonged restoration of gastric motility and passage through the gastrointestinal tract (100% of patients), exacerbation of chronic pancreatitis (100% of patients). Against the background of conservative therapy in all children (100% of patients), the symptoms of pancreatitis were stopped in the period from 26 to 41 postoperative days, the evacuation function of the stomach was fully restored within 2-4 weeks after the operation. Discussion and conclusions. Among the postoperative complications, there were: stenosis of biliary and pancreatic-digestive anastomoses (22% and 11% of those studied, respectively), adhesive intestinal obstruction (11% of cases), intra-abdominal bleeding (11% of patients). One patient had a lethal outcome after repeated surgical interventions for pancreatic head limphangioma complicated by intra-abdominal bleeding and biliary peritonitis. The prognosis in this category of patients is favorable - in the follow-up after surgical treatment in all children (100% of patients), the passage through the gastrointestinal tract is not disturbed, the endo- and exocrine function of the pancreas is preserved (100% of patients), there were no indications for prescribing enzyme therapy and insulin preparations …

Functional Reorganization of the Central Auditory System in Children with Single-Sided Deafness: A Protocol Using fNIRS.

In children, single-sided deafness (SSD) affects the development of linguistic and social skills and can impede educational progress. These difficulties may relate to cortical changes that occur following SSD, such as reduced inter-hemispheric functional asymmetry and maladaptive brain plasticity. To investigate these neuronal changes and their evolution in children, a non-invasive technique is required that is little affected by motion artifacts. Here, we present a research protocol that uses functional near-infrared spectroscopy (fNIRS) to evaluate the reorganization of cortical auditory asymmetry in children with SSD; it also examines how the cortical changes relate to auditory and language skills. The protocol is designed for children whose SSD has not been treated, because hearing restoration can alter both brain reorganization and behavioral performance. We propose a single-center, cross-sectional study that includes 30 children with SSD (congenital or acquired moderate-to-profound deafness) and 30 children with normal hearing (NH), all aged 5–16 years. The children undergo fNIRS during monaural and binaural stimulation, and the pattern of cortical activity is analyzed using measures of the peak amplitude and area under the curve for both oxy- and deoxyhemoglobin. These cortical measures can be compared between the two groups of children, and analyses can be run to determine whether they relate to binaural hearing (speech-in-noise and sound localization), speech perception and production, and quality of life (QoL). The results could be of relevance for developing individualized rehabilitation programs for SSD, which could reduce patients’ difficulties and prevent long-term neurofunctional and clinical consequences.