Airway obstruction refers to suffocation caused by blockage of the airway due to a foreign body and is a common cause of accidental death in infants below one year of age. However, the current infant CPR manikins used for training in first aid for foreign body airway obstruction can only be applied to one single scenario. Furthermore, trainees’ first aid skills cannot be recorded and quantified with a digital system and, consequently, assessment of their skills is difficult to conduct. This study aims to overcome the technical limitations by developing an AR-based assessment system for training in first aid for infant airway obstruction. With this assessment system, trainees can learn first aid more efficiently and correctly and conduct a quantitative assessment of their skills digitally. For instructors, the time required for assessment, potential human error, and the cost of training can also be reduced. The system can be a practical learning tool that helps trainees assess emergencies and integrate their knowledge and skills. Full article

In recent years, the study of dyslexia has seen rapid progress in definition and classification, neuropsychological correlates, neurobiological factors, and intervention. However, there are few studies on how virtual reality can affect improving cognitive domains and cross-cutting pedagogical skills. We, therefore, tested intervention through the use of a virtual reality rehabilitation system (VRRS) in children with dyslexia. Twenty-eight patients diagnosed with dyslexia were enrolled in this study. One-half underwent conventional neuropsychological treatment, and the other half performed VR neurorehabilitation training using the VRRS. All patients were evaluated by neuropsychological assessment at baseline (T0) and at the end of the protocol (T1). The assessment included the administration of the Wechsler Intelligence Scale for Children-IV and the Italian Battery for the Assessment of Dyslexia and Dysorthography. Our results showed a significant difference in word-reading test scores as well as in homophonic writing. In addition, treatment type was found to affect some domains of the WISC. We believe that the VRRS led to improved outcomes through the use of VR, which encourages active exploration, improves engagement, and provides motivation and enjoyment, allowing longer training sessions and improving treatment adherence. Full article

INTRODUCTION: The SARS-CoV-19 (COVID-19) pandemic has become a global problem but has affected the paediatric population less so than in adults. The clinical picture in paediatrics can be different to adults but nonetheless both groups have been subject to frequent imaging. The overall aim of this study was to comprehensively summarise the findings of the available literature describing the chest radiograph (CXR) findings of paediatric patients with confirmed COVID-19. The COVID-19 landscape is rapidly changing, new information is being constantly brought to light, it is therefore important to appraise clinicians and the wider scientific community on the radiographic features of COVID-19 in children. METHODS: Four databases, which included, PubMed; Medline; CINAHL; ScienceDirect were searched from the 30 November 2020 to the 5 March 2021. The review was conducted using the “Preferred Reporting Items for Systematic Reviews and Meta-Analysis, PRISMA” guidelines. Studies were included for (1) publications with full text available, (2) patients with confirmed COVID-19 diagnoses, (3) CXR imaging features of COVID-19 were reported, (4) the age of patients was 0–18 years, (5) studies were limited to human subjects and (6) a language restriction of English was placed on the search. Quality assessment of included articles used the National of Health Quality Assessment Tool for Case Series Studies. RESULTS: Eight studies met our criteria for inclusion in the review. All eight studies documented the number of CXRs obtained, along with the number of abnormal CXRs. Seven out of the eight studies noted greater than 50% of the CXRs taken were abnormal. Opacification was the number one feature that was recorded in all eight studies, followed by pleural effusion which was seen in six studies. Consolidation and peri-bronchial thickening features were both evident in four studies. Opacification was sub-divided into common types of opacities i.e., consolidation, ground glass opacities, interstitial, alveolar and hazy. Consolidation was reported in half of the studies followed by ground glass opacities and interstitial opacities which was seen in three out of the eight studies. CONCLUSION: This systematic review provides insight into the common COVID-19 features that are seen on CXRs in paediatric patients. Opacification was the most common feature reported, with consolidation, ground glass and interstitial opacities the top three opacifications seen. Peri-bronchial thickening is reported. in the paediatric population but this differs from the adult population and was not reported as a common radiographic finding typically seen in adults. ADVANCES IN KNOWLEDGE: This systematic review highlights the CXR appearances of paediatric patients with confirmed SARS-CoV-19, to gain insight into the disease pathophysiology and provide a comprehensive summary of the features for clinicians aiding optimal management. Full article

Adolescent idiopathic scoliosis (AIS) is a three-dimensional malformation of the spine of unknown cause that develops between 10 and 18 years old and affects 2–3% of adolescents, mostly girls. It has been reported that girls with AIS have a taller stature, lower body mass index (BMI), and bone mineral density (BMD) than their peers, but the causes remain unexplained. Energy metabolism discrepancies, including alterations in adipokine and incretin circulatory levels, could influence these parameters and contribute to disease pathophysiology. This pilot study aims to compare the anthropometry, BMD, and metabolic profile of 19 AIS girls to 19 age-matched healthy controls. Collected data include participants’ fasting metabolic profile, anthropometry (measurements and DXA scan), nutritional intake, and physical activity level. AIS girls (14.8 ± 1.7 years, Cobb angle 27 ± 10°), compared to controls (14.8 ± 2.1 years), were leaner (BMI-for-age z-score ± SD: −0.59 ± 0.81 vs. 0.09 ± 1.11, p = 0.016; fat percentage: 24.4 ± 5.9 vs. 29.2 ± 7.2%, p = 0.036), had lower BMD (total body without head z-score ± SD: −0.6 ± 0.83 vs. 0.23 ± 0.98, p = 0.038; femoral neck z-score: −0.54 ± 1.20 vs. 0.59 ± 1.59, p = 0.043), but their height was similar. AIS girls had higher adiponectin levels [56 (9–287) vs. 32 (7–74) μg/mL, p = 0.005] and lower leptin/adiponectin ratio [0.042 (0.005–0.320) vs. 0.258 (0.024–1.053), p = 0.005]. AIS participants with a Cobb angle superior to 25° had higher resistin levels compared to controls [98.2 (12.8–287.2) vs. 32.1 (6.6–73.8), p = 0.0013]. This pilot study suggests that adipokines are implicated in AIS development and/or progression, but more work is needed to confirm their role in the disease. Full article

In recent years, the dental treatment of children under sedation and/or general anesthesia on an outpatient basis has been developed as a behavioral management model in pediatric dentistry. The objective of this study was to establish the percentage of pediatric patients who required deep sedation on an outpatient basis in dental offices in the city of Cuenca, Ecuador. An observational study was conducted with a sample of 450 records of school- and preschool-age patients, where the variables were type and time of treatment, age, and sex. Statistical data were analyzed using the statistical program SPSS V.27 (IBM, Armonk, NY, USA). The highest percentage of children who received sedation were of preschool age. In general, there were three types of procedures per session, the most frequent being restorations (67%), followed by pulp treatment (49.8%) and, less frequently, minor surgery. The need for sedation for dental procedures is high in preschool patients, and ambulatory sedation has contributed to meeting this need. However, a regulation for its use is required at a national level. Full article

Introduction: Brain tumors are the second most frequent type of all pediatric malignancies. Depending on their localization, patients with brain tumors may present neurological or ophthalmological symptoms, but also weight anomalies and endocrine disorders ranging from growth hormone deficiency, anomalies of puberty, diabetes insipidus to panhypopituitarism. Immediately at diagnosis, all patients with brain tumors require a complete assessment of the hypothalamic–pituitary function in order to address eventual endocrine disorders. Moreover, children and adolescents undergoing brain surgery must receive peri- and postoperative hydrocortisone stress therapy. Post-operative disorders of water homeostasis are frequent, ranging from transient diabetes insipidus, as well as syndrome of inappropriate antidiuretic hormone secretion to persistent diabetes insipidus. Late endocrine disorders may result from surgery near or within the hypothalamic–pituitary region. Pituitary deficits are frequent after radiotherapy, especially growth hormone deficiency. Thyroid nodules or secondary thyroid cancers may arise years after radiotherapy. Gonadal dysfunction is frequent after chemotherapy especially with alkylating agents. Conclusion: Early detection and treatment of specific endocrine disorders at diagnosis, perioperatively, and during long-term follow-up result in improved general and metabolic health and quality of life. Full article

Background: Handgrip strength (HGS) is a predictor of health in both children and adults. Evidence suggests that without a possible strategy, children with low HGS may become adults with low HGS. However, little is known about what strategies are effective for children with low HGS to achieve a higher baseline level in adulthood. This narrative review aimed to investigate whether physical exercise interventions could improve HGS in children. Methods: The relevant databases/search engine was searched using keywords related to the main topics discussed throughout this review. Results: Our findings suggest that it may not be possible to improve HGS over that observed from normal development with physical education or traditional resistance-training programs. However, if the training program includes exercises that directly stimulate the forearm/hand muscle groups to grip, it may be possible to obtain changes in HGS that exceed the changes due to normal developmental growth. Conclusion: Although there are associations between HGS and markers of health, no research could be identified that examined whether increasing HGS would lead to an improvement in health. If an increase in HGS really does represent an improvement in long-term health, then gripping exercise may need to be included into physical activity programs during the growth/development phase. Full article

Knowledge of the sequencing of the 16S rRNA gene constitutes a true revolution in understanding the composition of the intestinal microbiota and its implication in health states. This study details microbial composition through next-generation sequencing (NGS) technology in children with anemia. Anemia is the most frequent hematological disorder that affects human beings. In Peru, it is one of the conditions that presents the most significant concern due to the adverse effects that cause it, such as delayed growth and psychomotor development, in addition to a deficiency in cognitive development. Full article

This study aims to determine the impact of the disease on the perceived stress levels of caregivers of adolescents with asthma. A total of 140 primary caregivers, whose mean age was 45.43 years (SD = 5.03), of whom 85% were mothers, were assessed using the perceived stress questionnaire (PIP), and medical indicators related to asthma were recorded. Mean comparisons, correlations, and qualitative comparative analysis (QCA) models were used. The results indicated moderate levels of perceived stress in caregivers, no kinship differences were found, and age was negatively associated with perceived stress. QCA models suggested that perceived stress could be explained by a higher frequency of visits, poorer adherence, more frequent daily medication doses, and higher severity of asthma. In conclusion, the development of psychological interventions addressing the subjective overload of the family caregiver may benefit them, increasing their well-being, and in turn help to manage the emotional difficulties of adolescents. Full article

The current study explored the potential influence of infant sleep, measured by parental report and actigraphy, and family functioning on attention development using eye tracking. The use of actigraphy in parallel with parental report, has the advantage of measuring participant’s sleep throughout the night without parental observation and the ability to objectively assess sleep quality. An eye-tracking version of the Gap-Overlap task was used to measure visual attention. Questionnaires and behavioural assessment were used to assess family function, and general cognitive development. Fifty infants (Mean age = 13.44 months, SD = 3.10) participated in the study, 23 of which had full final datasets. Results show that daytime sleep duration, as measured by parental report, and proportion of light sleep at night, as measured by actigraphy, are linked to visual attention. A higher proportion of light sleep, a marker of poorer sleep quality, and less daytime sleep were negatively linked with facilitation and disengagement on the Gap-Overlap task. Family functioning was not associated with attention. The results provide initial evidence that in addition to the amount of daytime sleep; quality of night-time sleep as measured by proportion of light sleep, is a potentially useful sleep variable which requires further focus in the study of attention development. Full article

(1) Background: Isotretinoin (ISO) is a systemic retinoid known for its teratogenic effects on embryos and fetuses. The aim of this study was to compare the pregnancy outcomes of women who were exposed to isotretinoin with those of women without such exposure from a teratogenic point of view. (2) Methods: A total of 1459 female patients from three clinical hospitals in Poland and Romania, segregated into two groups depending on their ISO exposure, were evaluated between January and December 2019. Medical records were screened to identify the pregnancy outcomes and congenital malformation rates. (3) Results: The congenital malformation rate for the exposed group was 1.2% (four cases), and no specific signs of Accutane embryopathy were identified. Women from the unexposed group were more likely to deliver preterm and through cesarean deliveries and had a higher rate of newborn congenital malformations as compared to women from the exposed group. (4) Conclusions: Even though we could not find a significant association between ISO exposure and teratogenic effects in newborns, effective contraceptive measures are key to preventing unfavorable pregnancy outcomes. Full article

Currently, ultrasound-guided central venous catheter (CVC) insertion is recommended in pediatric patients. However, the clinical practice may vary. The primary aim of this study was the overall success rate and the first attempt success rate in ultrasound-guided CVC insertion versus anatomic-based CVC insertion in pediatric patients. The secondary aim was the incidence of associated complications and the procedural time. The physician could freely choose the cannulation method and venous approach. Data were collected for 10 months. Overall, 179 patients were assessed for eligibility and 107 patients were included. In almost half of the patients (48.6%), the percutaneous puncture was performed by real-time ultrasound navigation. In 51.4% of the patients, the puncture was performed by the landmark method. The overall success rate was 100% (n = 52) in the real-time ultrasound navigation group, 96.4% (n = 53) in the landmark insertion group, (p = 0.496). The first percutaneous puncture success rate was 57.7% (n = 30) in the real-time ultrasound navigation group and 45.5% (n = 25) in the landmark insertion group, (p = 0.460). The data show a higher overall success rate and the first success rate in the US-guided CVC insertion group, but the difference was not statistically significant. Full article

Childhood and adolescent obesity has become an important public health issue, as it leads to higher risk of cardio–metabolic, orthopedic, and psychological comorbidities. The aim of this study was to evaluate the changes in nutritional state and cardiovascular system parameters in obese children. Sixty respondents aged 9–17 years with alimentary obesity participated in this research. Anthropometric parameters (body weight (BWT), body mass index (BMI), percentage of body fat (%), waist and hip circumference (WC and HC), waist–hip ratio (WHR)) and cardiovascular parameters (systolic and diastolic blood pressure (SP and DP), cardio-ankle vascular index (CAVI), ankle-brachial index (ABI), pulse wave velocity and its variability (PWV and PWV_V), and parameters of pulse wave analysis) were measured. Every respondent went through two sets of measurements, the first (I.) after their admission to the children’s hospital and the second (II.) at the end of their one-month-long therapeutic stay. Statistically significant differences between measurements I. and II. were observed in the following parameters: BWT (p < 0.01), BMI (p < 0.01), WC (p < 0.01), HC (p < 0.01), DP (p < 0.01), PWV (p < 0.05), and ABI (p < 0.01). The results of this study show that obesity has a mostly negative impact on the cardiovascular health of affected children, with likely negative results in their adulthood. Full article

Bilingual bimodalism is a great benefit to deaf children at home and in schooling. Deaf signing children perform better overall than non-signing deaf children, regardless of whether they use a cochlear implant. Raising a deaf child in a speech-only environment can carry cognitive and psycho-social risks that may have lifelong adverse effects. For children born deaf, or who become deaf in early childhood, we recommend comprehensible multimodal language exposure and engagement in joint activity with parents and friends to assure age-appropriate first-language acquisition. Accessible visual language input should begin as close to birth as possible. Hearing parents will need timely and extensive support; thus, we propose that, upon the birth of a deaf child and through the preschool years, among other things, the family needs an adult deaf presence in the home for several hours every day to be a linguistic model, to guide the family in taking sign language lessons, to show the family how to make spoken language accessible to their deaf child, and to be an encouraging liaison to deaf communities. While such a support program will be complicated and challenging to implement, it is far less costly than the harm of linguistic deprivation. Full article

Postural balance is an important but not well-studied concept in the treatment of adolescent scoliosis. The aim of this study was to assess whether conservative treatment with Sforzesco bracing induced negative perturbations on postural stability, as related to static, postural, and dynamic baropodometric indicators. Twelve subjects (12 females, aged 11–16) with moderate AIS, were selected among a group of 97 patients. Inclusion criteria were: (1) confirmed diagnosis of moderate AIS (Cobb angle of 21° to 35° for the primary curve); (2) thoracic or thoracolumbar primary curve; (3) skeletal immaturity with growth cartilage visible on pretreatment radiographs (Risser < 5); (4) chronological age between 11 and 16 years; and (5) Sforzesco bracing treatment. All patients underwent a physical examination and radiological measurements with anteroposterior and lateral scans. Static, postural, and dynamic assessments were performed twice by barefoot patients, with and without Sforzesco bracing. Comparison between demographic, anthropometric, and clinical data highlighted a homogeneity of the sample. We evaluated the point of maximum pressure with and without bracing and found no statistically significant differences (p value = 0.22). In postural measurements, the laterolateral oscillations, anteroposterior oscillations, and average speed of oscillations were evaluated, comparing measurements with and without bracing. There were no statistically significant differences, except for the mean rate of oscillation, which was slightly increased in the recordings with a brace compared to those without a brace, p value = 0.045. Our findings show no statistically significant differences (p > 0.05) in static, postural, and dynamic baropodometric indicators. Full article