Treatment Modality For Children Research Articles

Advances in Psychodermatology: Pediatric Trichotillomania

Trichotillomania (TTM) is a complex disease that often presents first to pediatric dermatologists. Despite its high prevalence in childhood, limited recommendations and treatment modalities are available for pediatric TTM. While Habit Reversal Therapy and Cognitive Behavioural Therapy are the most commonly used treatments for children with trichotillomania, pediatric dermatologists are more likely to prescribe medications as a primary treatment modality. Mind-skin disorders, now referred to as psychodermatologic or psychocutaneous disorders, affect the pediatric population in both a visible and psychological manner. The rise of psychodermatology in pediatric dermatology provides the opportunity to not only address any visible skin conditions such as TTM, but also any additional psychological aspects of the disorder. This review focuses on the differences in treatment modalities for children with trichotillomania utilized by pediatric dermatologists and behavioural health specialists, as well as the most recent recommendations for dermatologists and mental health providers working in conjunction with a shared goal of providing the best long-term support for these patients. Objective: Discuss the differences in treatment modalities for children with trichotillomania by pediatric dermatologists and behavioural health specialists, as well as the most recent recommendations for dermatologists and mental health providers working in conjunction with a shared goal of providing the best long-term support for these patients Raise awareness of the discrepancies that exist between pediatric dermatologists and behavioural health specialists (psychologists, mental health counsellors, school counsellors) in the treatment of trichotillomania in children Facilitate further discussion between pediatric dermatologists and behavioural health specialists when treating trichotillomania in the pediatric population.

Menenjit ve Ensefalitli Çocuklarda Etiyoloji, Klinik Özellikler ve Tedavi Yöntemleri: Türkiye‘den Retrospektif Tek Merkezli Bir Çalışma

Menenjit ve Ensefalitli Çocuklarda Etiyoloji, Klinik Özellikler ve Tedavi Yöntemleri: Türkiye‘den Retrospektif Tek Merkezli Bir Çalışma

Menenjit ve Ensefalitli Çocuklarda Etiyoloji, Klinik Özellikler ve Tedavi Yöntemleri: Türkiye‘den Retrospektif Tek Merkezli Bir Çalışma

Menenjit ve Ensefalitli Çocuklarda Etiyoloji, Klinik Özellikler ve Tedavi Yöntemleri: Türkiye‘den Retrospektif Tek Merkezli Bir Çalışma

Effectiveness of various treatment modalities in children with vesicoureteral reflux grades II–IV: a systematic review and network meta-analysis

BackgroundVesicoureteral reflux (VUR) is one of the most common risk factors of urinary tract infection (UTI) among children. Various treatment modalities including antibiotic prophylaxis, surgical or endoscopic corrections and conservative...

Hidradenitis Suppurativa in Children and Adolescents: An Update on Pharmacologic Treatment Options.

Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory skin condition that manifests as painful, deep-seated, inflamed nodules and abscesses in the axillary, groin, perianal, perineal, and inframammary regions. The associated pain, malodour, and disfigurement contribute to its profound negative impact on psychosocial spheres and overall quality of life in affected individuals. Although the symptoms of HS classically begin in the second or third decade of life, HS affects children and adolescents as well. Despite this, there are limited pediatric data on treatment, which are largely based on expert opinion, extrapolation of efficacy data in adults with HS, and safety information from medication use in other pediatric diseases. On this basis, there exist several pharmacological modalities in the treatment of children and adolescents with HS including topical therapies, systemic therapies, and biologics. The goals of this review article are to: (1) review the efficacy of different pharmacological treatment modalities in children and adolescents with HS, and (2) review the safety and monitoring considerations of the different treatment options in children and adolescents with HS.

Effects of twin-block appliance on upper airway parameters in OSA children with class II malocclusion and mandibular retrognathia: a CBCT study.

Correction of class II mandibular retrognathic skeletal malocclusion with twin-block appliance resulted in a significant increase in upper airway volume, MCA, anteroposterior and lateral distances of the MCA at the level of the oropharynx, MCA at the level of the hypopharynx and upper airway length, and a significant decrease in AHI, but it had no effect on nasopharynx parameters. • CBCT imaging has been shown to be an effective and precise diagnostic tool for analyzing the upper airways and craniofacial structures. • Twin block appliance may be an effective treatment modality in children with OSA. • Minimal cross-sectional area of upper ways may be the most relevant potential parameter when explaining how the upper airway anatomy plays role of in the pathogenesis of pediatric OSA. • Twin block appliance induced favorable changes in upper airway morphology (oropharynx area mainly) and respiratory parameters in OSA children with class II malocclusion.

Six years of experience with the nationwide newborn ultrasonographic hip screening program in Turkey: a considerable change in the type of surgical interventions in developmental dysplasia of the hip.

This study aims to assess whether or not the nationwide newborn ultrasonographic hip screening program has influenced the rate of different types of surgical interventions performed in developmental dysplasia of the hip (DDH) in children in Turkey. A retrospective analysis of the nationwide data obtained from the National Registry System between January 1, 2015, and December 31, 2020, was carried out. The rate of minor and major surgical interventions was calculated by dividing the total number of primary closed/open reductions with or without tenotomies and the total number of primary pelvic or periacetabular osteotomies with or without femoral osteotomies by the total number of live births in the country per year, respectively. The rates of primary minor surgical interventions were found to be 0.47/1000 in 2015, 0.71/1000 in 2016, 1.07/1000 in 2017, 1.00/1000 in 2018, 1.06/1000 in 2019, and 0.89/1000 in 2020. The rates of primary major surgical intervention were found to be 0.74/1000 in 2015, 0.40/1000 in 2016, 0.33/1000 in 2017, 0.31/1000 in 2018, 0.32/1000 in 2019, and 0.21/1000 in 2020. The introduction of the nationwide newborn hip screening program has significantly changed the surgical treatment modalities in children with DDH. A nearly twofold increase in the rate of primary closed/open reduction and hip spica casting and nearly three quarters decrease in the rate of primary bony procedures were observed within 6 years.

Electroconvulsive Therapy Is an Effective Treatment Modality in Children With Lupus Cerebritis With Persistent Catatonia.

A 13-year-old girl with neuropsychiatric systemic lupus erythematosus presenting with psychosis and persistent catatonia unresponsive to immunosuppressive agents and a benzodiazepine was successfully treated with ECT.

Current concepts in management of amblyopia- A major review

Amblyopia is the leading cause of preventable blindness in children and young. The prevalence of amblyopia in childhood varies between 1-5%, although these values may differ. Most of the visual impairment in amblyopia is reversible if treated early at appropriate time. Various treatment modalities in children include: refractive correction, patching, atropine penalization, binocular therapy, liquid crystal display eyeglasses and transcranial magnetic stimulation. Motive of this article is to give an emphasis on newer management strategy and newer trends in amblyopia therapy. A thorough search of literature was done in PubMed, Scopus, Embase and reference list of articles until December 15, 2020 containing “amblyopia treatment or therapy” was retrieved.

INTERSTITIAL LUNG DISEASE IN A TODDLER WITH ANTI-MDA5 JUVENILE DERMATOMYOSITIS THAT IMPROVED WITH AGGRESSIVE, EARLY TREATMENT WITH STEROIDS AND MULTIPLE IMMUNOSUPPRESSANTS

INTERSTITIAL LUNG DISEASE IN A TODDLER WITH ANTI-MDA5 JUVENILE DERMATOMYOSITIS THAT IMPROVED WITH AGGRESSIVE, EARLY TREATMENT WITH STEROIDS AND MULTIPLE IMMUNOSUPPRESSANTS

EP-393 Antegrade Colonic Enema (ACE) Stoma beyond Childhood: A Literature Review

Abstract Background Refractory constipation and faecal incontinence among adults is a common presentation to surgical clinics. ACE stoma has been tried and proven as a successful treatment modality in children. Although it is an acceptable treatment modality in adults, there is little prospective evidence available regarding its use and hence it has not yet come in vogue. Methods A literature review was carried out using PubMed, Cochrane Library, Embase, Cinahl and Scopus for studies involving ACE stoma in adults with refractory constipation or faecal incontinence; with a view to determine ACE Stoma as a safe treatment modality among adult population. Results A total of 27 studies were identified through database searches. 6 full text articles were included in the literature review describing a total of 209 adult patients; with male to female ratio of 1:3.4, mean age of 35 years and a mean follow up of 42.9 months. Complications discussed include perioperative and long-term stenosis (29%) and leak rates (60%); affecting the quality of life. No statistical difference was noted among the different types of ACE Conduit used. There was significant heterogeneity amongst the studies. Conclusions ACE stoma is not without complications; however studies reveal that this can be offered as a safe treatment modality among carefully selected adult patients for the treatment of refractory constipation or fecal incontinence. Keywords Adults, Refractory Constipation, Faecal Incontinence, Antegrade Colonic Enema (ACE) Stoma

Clinical Features and Surgical Outcomes of the Children With Urolithiasis at a Tertiary Care Hospital: First Report From Somalia.

IntroductionThere are very few studies regarding pediatric urolithiasis (PU) reported from Africa, and to date, no data have been presented from Somalia. This study evaluated the sociodemographic and radiological characteristics, treatment, and outcome data of the PU patients treated at Somalia's only tertiary care center.MethodThe data of all patients diagnosed with urolithiasis during a 6-year period were reviewed. Only pediatric (age <18) urolithiasis patients were included. Demographic parameters, radiological features, stone characteristics, treatment, and outcome data were collected and analyzed.ResultsOverall, 227 (127 male, 100 female) patients were included. The rate of PU was 8.1%. The mean patient age was 12.7 ± 3.2. More than two-thirds of the patients (n = 161, 70.9%) were adolescents. The stones were located in the kidney in 50.7%, the ureter in 33%, and the bladder in 14.5%. Distal ureteral stones (36%) accounted for the majority of ureteral stones, followed by the ureterovesical junction (26.7%) and proximal ureteral (24%) stones. The mean stone size was 16.2 mm. Most (42.3%) stones had a 10–20 mm diameter, while 23.3% were sized between 6 and 10 mm. Renal insufficiency was present in 5.3%. Among 227 patients, 101 (44.5%) underwent minimally invasive procedures including ureterorenoscopic lithotripsy (n = 40, 18%), retrograde intrarenal surgery (n = 30, 13.2%) and percutaneous nephrolithotomy (n = 31, 14%). Open pyelolithotomy was the most common surgery performed (n = 53, 22.3%). Surgical site infection developed following 3.5% of the open surgery cases. The stone-free rate was 91.3%. It was significantly higher in open cases (98%) compared to the cases performed via a minimally invasive approach (83%) (p = 0.02).ConclusionIn Somalia, PU is more common than in many other countries. Open surgery continues to be the primary treatment modality for children with urolithiasis due to the restricted endourology resources. However, minimally invasive approaches have evolved over the last years.

Endoscope-Assisted Fronto-Orbital Distraction Osteogenesis.

Anterior cranial vault fronto-orbital distraction osteogenesis is a promising treatment modality for children with unicoronal craniosynostosis. A minimally invasive, endoscope-assisted approach offers the additional potential benefits of less scalp scarring, decreased blood loss, and decreased scalp dissection. In this article, the authors present a novel technique for minimally invasive, endoscope-assisted fronto-orbital distraction osteogenesis.

Clinical implications of facial psoriasis in children and adolescents.

The clinical implications of facial involvement in pediatric patients with psoriasis have not been adequately studied. The objectives of this study are to evaluate the association between facial involvement and clinical features including disease severity of psoriasis in children and adolescents. The clinical features of patients aged below 20 years diagnosed with psoriasis were retrospectively evaluated and grouped based on the presence or absence of facial involvement at presentation. Demographic and clinical data were compared between groups. Of the 175 patients, 110 patients (62.9%) had facial involvement of psoriasis at presentation. The group with facial involvement was significantly younger at disease onset (p=.032) and had a higher body mass index (BMI) (p=.043) and psoriasis area and severity index (PASI) score (p <.001). The severity of pruritus was significantly higher in the facial than in the non-facial group (p=.020). Involvement of the nose was associated with the highest disease severity as assessed by the PASI score and affected body surface area. A significantly higher number of treatment modalities were used in the facial group than in the non-facial group (p=.013). The BMI (odds ratio (OR), 1.39; 95% CI (confidence interval), 1.07-1.80) and PASI score (OR, 1.45; 95% CI, 1.03-2.03) were independent factors associated with facial involvement of psoriasis. Facial involvement in psoriasis was associated with higher disease severity and more treatment modalities in children and adolescents.

Therapeutic plasma exchange in pediatric patients with acute demyelinating syndromes of the central nervous system: A single-center experience

BackgroundTherapeutic plasma exchange (TPE) is an extracorporeal treatment that can be used in adult and pediatric patients with acute demyelinating syndromes of the central nervous system. In this study, the efficacy and safety of TPE was evaluated in 10 pediatric patients who underwent TPE that were unresponsive to corticosteroid treatment. MethodsRecords of 10 pediatric patients who underwent TPE in our pediatric intensive care unit (PICU) between May 2017 and June 2020 were used. Expanded Disability Status Scale (EDSS), Gait Scale (GS), and Visual Outcome Scale (VOS) were applied to the patients before and after TPE. ResultsOf the 10 patients who underwent TPE, five were diagnosed with multiple sclerosis (MS), three with transverse myelitis (TM), and two with acute disseminated encephalomyelitis (ADEM). The median age of the patients was 13.3 years (IQR 8-15), and the median day from symptom onset to onset of TPE was 12.5 days (IQR 7-28). A total of 104 TPE sessions were performed successfully. While no complications were encountered in three patients during the sessions, the most common complication was hypofibrinogenemia. The decrease in EDSS and GS scores was found to be consistent with the clinical response of the patients. There was no statistically significant decrease in the VOS. ConclusionsWith this study, we can say that TPE is a feasible, effective, and safe treatment modality in children with acute demyelinating syndromes of the central nervous system.

Effect of Medical History on Different Treatment Modalities in Children Treated under General Anesthesia: A Retrospective Study

Effect of Medical History on Different Treatment Modalities in Children Treated under General Anesthesia: A Retrospective Study

51.1 The Role of Pain Education in the Treatment of Pediatric Chronic Pain

Chronic pain is a common condition, with social and economic implications. Treatment modalities in children include pharmacological and nonpharmacological approaches. The nonpharmacological approaches range from outpatient to inpatient approaches, are beneficial, and lack the side effects caused by pharmacological interventions. In adults, involving education in multidisciplinary care for chronic pain has shown immediate improvement as well as sustained and long-term benefits. In this poster, we will investigate the impact of pain physiology education in the management of pediatric chronic pain and its outcomes.

5.14 Efficacy of Computer Game–Based Executive Functioning/Attention Training in Children and Adolescents With ADHD: A Systematic Review

ADHD is common among children and adolescents, affecting 5% to 7% of the population worldwide. The core symptoms of ADHD are inattentiveness, hyperactivity, and impulsivity. Recent studies discovered that ADHD patients have impairment in executive functioning associated with goal setting and planning, which are essential for school performance and social functioning. Although medications effectively reduce ADHD core symptoms, due to stigma, side effects, and medication cost, medication adherence is low in this population. This systematic review focused on determining the effectiveness of computer games–based training programs as a treatment modality for children and adolescents with ADHD.

External Sphincter Injection of Onabotulinum-A Toxin in Treatment of Children with Bladder- Sphincteric Dyssynergia

Abstract Background: The first application of Onabotulinum-A Toxin in urology was its injection into the urinary sphincter to treat neurogenic detrusor-sphincter dyssynergia in quadri-plegic men. Since that first report by Dyskatra et al., in 1988, the results of focal Onabotulinum-A Toxininjections into the sphincter, the bladder wall and lately into the prostate have raised the interest of the urology community in this promising new therapeutic modality. This is an evidence-based review of the current indications, techniques and outcomes of Ona-botulinum-A Toxin injections into the urethral sphincter. Aim of Study: We evaluated the effect of detrusor injection of onabotulinum-A toxin into the urethral urinary sphincter in children with bladder-external sphincter dyssynergia to decrease urethral resistance and improve voiding. Material and Methods: Prospective treatment was per-formed in 25 children 4 to 15 years old (mean age 7) with bladder-neck dyssynergia using onabotulinum-A toxin. Pre-operatively all children were evaluated by ultrasound, voiding cystourethrography, excretory urography, magnetic resonance imaging and urodynamic studies, including pressure flow, electromyography and uroflowmetry. Using a rigid pediatric endoscope and a 4Fr injection needle 50 to 100 IU onabotu-linum-A toxin was injected into the external sphincter at the 5 and 7 o'clock positions. Follow-up was 6 to 15 months. Repeat injections every 6 months were given according to the response with a maximum of 3 injections. Results: Immediately after onabotulinum-A toxin injection all except 1 patient were able to void without catheterization. No acute complications occurred. Postoperatively post-void residual urine decreased by 30%, detrusor leak point pressure decreased significantly by a mean ± SD of 66±18 vs 37±4cm H2O and uroflowmetry showed a marked increase in maximum urine flow of 7±2 vs 17.3±8ml per second. Conclusions: Urethral sphincter onabotulinum-A toxin injection could be considered a reliable treatment modality in children with nonneurogenic neurogenic bladder after the failure of conservative therapy.

Gastrointestinal bleeding due to pseudoaneurysms in children.

Radiological embolization is the treatment of choice in adults with visceral artery pseudoaneurysm (PSA) and gastrointestinal bleeding, but pediatric data is scanty. We analyzed the etiology, clinical presentation, and outcome of radiological intervention in children with PSA of celiac (CA) or superior mesenteric artery (SMA) branches. Electronic records of children with PSA of CA or SMA branches were reviewed and data on clinical and laboratory profile, radiological intervention, and outcome was recorded. Eleven children with PSA (5 boys, 11 [7-17] years) were studied. Etiology was liver abscess (n 4), abdominal trauma (n 3), pancreatitis (n 3), and indeterminate in 1 case. Ten (91%) patients were symptomatic: abdominal pain (10, 91%), hematemesis/melena (9, 81%), and Quincke's triad (1, 9%). One child with pancreatic pseudocyst was diagnosed incidentally on imaging. Doppler ultrasound identified PSA only in 3 cases, while computed tomography angiography (CTA) picked all cases. Children with liver abscess, trauma, and unknown etiology had PSA from CA (right hepatic artery 7, left hepatic artery 1). Of the 3 pancreatitis cases, 2 had PSA from SMA (inferior pancreatico-duodenal artery and ileal branch) and 1 from CA (left gastric artery). Radiological embolization was done in 9 (81%) cases (coil 6, glue 2, both 1), without any complications or failure. One case resolved spontaneously and 1 died pre-intervention. Nine intervened cases were asymptomatic in follow-up [6 (1-24) months].Conclusion: Liver abscess, trauma, and pancreatitis are causes of PSA of CA and SMA branches in children. A majority present with gastrointestinal bleeding and are identified on CTA. Radiological embolization was safe with 100% success. What is Known: • Pseudoaneurysm of visceral artery is an uncommon cause of gastrointestinal bleeding. • Endoluminal intervention is an established and efficacious treatment modality in adults and preferred over surgery. What is New: • Liver abscess, abdominal trauma and pancreatitis are common causes of celiac artery and superior mesenteric artery branch pseudoaneurysm in children and computed tomography angiography has high sensitivity in identifying these pseudoaneurysms. •Minimally invasive radiological angio-embolization, in the hands of trained radiologists, is a safe and successful modality of treatment in children.