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Children, Volume 9, Issue 8 (August 2022) – 168 articles

Cover Story (view full-size image): Three-dimensional (3D) designing and manufacturing technology is a direct derivative of digital technology. Three-dimensional volume and surface acquisition, CAD software, and 3D manufacturing are major changes included in daily practice in many orthodontic and pedodontic offices. The search strategy of this critical review included keywords in combination with MeSH terms in Medline, Scopus, and Cochrane Library up to June 2022 in the English language. Twelve articles selected for our study were in vitro prospective studies. The results suggested that almost all the known appliances can be designed and printed in a tailor-made fashion in contrast to the traditional one-size-fits-all approach. Customized appliances should be manufactured according to the patient’s needs, and this is justified by the certainty that this approach will be beneficial for the patient’s treatment. View this paper
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Systematic Review
Pseudorandom Noise Forced Oscillation Technique to Assess Lung Function in Prematurely Born Children
Children 2022, 9(8), 1267; https://doi.org/10.3390/children9081267 - 22 Aug 2022
Viewed by 360
Abstract
The forced oscillation technique (FOT) is a non-volitional assessment that is used during tidal breathing. A variant of FOT uses a pseudorandom noise (PRN) signal which we postulated might have utility in assessing lung function in prematurely born children. We, therefore, undertook a [...] Read more.
The forced oscillation technique (FOT) is a non-volitional assessment that is used during tidal breathing. A variant of FOT uses a pseudorandom noise (PRN) signal which we postulated might have utility in assessing lung function in prematurely born children. We, therefore, undertook a systematic review to evaluate the evidence regarding PRN FOT. A comprehensive search of the literature was conducted by using the following databases: Medline, Embase, Web of Science and CINAHL. Observational studies, case series/reports and randomized-controlled trials were eligible for inclusion. Article abstracts and full texts were screened independently by two reviewers, with disagreements resolved by discussion or a third reviewer if necessary. Five studies were included (n = 587 preterm children). Three compared PRN FOT with spirometry, and two compare it to the interrupter technique. Most studies failed to report comprehensive methodology of the frequency spectra used to generate the PRN signal. There was evidence that poorer lung function, as assessed by PRN FOT, was associated with a greater burden of respiratory symptoms, but there was insufficient evidence to determine whether PRN FOT performed better than other lung-function tests. Detailed methodological documentation, in accordance with ERS guidance, is needed to assess the benefits of PRN FOT prior to routine clinical incorporation to assess prematurely born children. Full article
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Review
Herbal Approaches to Pediatric Functional Abdominal Pain
Children 2022, 9(8), 1266; https://doi.org/10.3390/children9081266 - 22 Aug 2022
Viewed by 462
Abstract
Chronic abdominal pain is one of the most common problems seen by both pediatricians and pediatric gastroenterologists. Abdominal-pain-related functional gastrointestinal disorders (AP-FGIDs) are diagnosed in children with chronic and recurrent abdominal pain meeting clinical criteria set forth in the Rome IV criteria. AP-FGIDs [...] Read more.
Chronic abdominal pain is one of the most common problems seen by both pediatricians and pediatric gastroenterologists. Abdominal-pain-related functional gastrointestinal disorders (AP-FGIDs) are diagnosed in children with chronic and recurrent abdominal pain meeting clinical criteria set forth in the Rome IV criteria. AP-FGIDs affect approximately 20% of children worldwide and include functional dyspepsia (FD), irritable bowel syndrome (IBS), functional abdominal pain (FAP), and abdominal migraine. IBS accounts for 45% of pediatric AP-FGIDs. The pathophysiology of functional abdominal pain involves an interplay of factors including early life events, genetics, psychosocial influences, and physiologic factors of visceral sensitivity, motility disturbance, altered mucosal immune function, and altered central nervous system processing. Treatment approaches are varied and can include dietary, pharmacologic, and complementary medicine interventions, as well as psychosocial support, depending on the many aspects of the disorder and the needs of the individual patient. There is a strong interest in complementary and integrative medicine approaches to pediatric pain from both patients, providers, and families. In this article, we discuss popular herbal treatments typically used in the field of complementary medicine to treat pediatric AP-FGIDs: peppermint oil, Iberogast®, cannabis, fennel, and licorice. While high-quality data are rather limited, studies generally show that these remedies are at least as effective as placebo, and are well tolerated with minimal side effects. We will need more placebo-controlled, double-blind, and unbiased prospective studies to document and quantify efficacy. Full article
Article
The Effect of Parental Beliefs on Post-Traumatic Symptoms of the Parent and Child after the Child’s Surgery
Children 2022, 9(8), 1265; https://doi.org/10.3390/children9081265 - 22 Aug 2022
Viewed by 382
Abstract
In recent years, many studies have attempted to find the main predictors of the development of post-traumatic symptoms in children following medical procedures. Recent studies found a link between parental beliefs and children’s post-traumatic symptoms in various medical contexts such as life-threatening illness, [...] Read more.
In recent years, many studies have attempted to find the main predictors of the development of post-traumatic symptoms in children following medical procedures. Recent studies found a link between parental beliefs and children’s post-traumatic symptoms in various medical contexts such as life-threatening illness, pain, and hospitalization. This study aims to examine the relationship between parental beleifs and post-traumatic symptoms in children and parents after surgical interventions of the children. The study was conducted among 149 children who underwent surgery and their parents. The children and parents were examined at 2 time points- during hospitalization, and 4 months after the hospitalization. Questionnaires were administered measuring parental beleifs pertaining to parental distress, and post-traumatic symptoms among children. results show a correlation between the factors. In addition, it was found that the parents’ distress is a mediating relationship between the parents’ perceptions and the child’s level of distress. It has been found that there is a link between some of the parental beleifs and parental stress symptoms and post-traumatic symptoms in the children. Parental beliefs that were found to influence these variables were related to parental beliefs regarding children’s suffering and pain during surgery. In addition, children of parents with higher levels of religious and spiritual beliefs were found to have fewer post-traumatic symptoms. This study sheds light on parental beliefs that may have the power to influence parental stress levels and children’s post-traumatic symptoms after surgery. Full article
(This article belongs to the Special Issue Advance in Pediatric Surgery)
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Article
Pediatric Minimally Invasive Surgery—A Bibliometric Study on 30 Years of Research Activity
Children 2022, 9(8), 1264; https://doi.org/10.3390/children9081264 - 21 Aug 2022
Viewed by 501
Abstract
Background: Pediatric minimally invasive surgery (MIS) is a standard technique worldwide. We aimed to analyze the research activity in this field. Methods: Articles on pediatric MIS (1991–2020) were analyzed from the Web of Science™ for the total number of publications, citations, journals, and [...] Read more.
Background: Pediatric minimally invasive surgery (MIS) is a standard technique worldwide. We aimed to analyze the research activity in this field. Methods: Articles on pediatric MIS (1991–2020) were analyzed from the Web of Science™ for the total number of publications, citations, journals, and impact factors (IF). Of these, the 50 most cited publications were evaluated in detail and classified according to the level of evidence (i.e., study design) and topic (i.e., surgical procedure). Results: In total, 4464 publications and 53,111 citations from 684 journals on pediatric MIS were identified. The 50 most cited papers were published from 32 institutions in the USA/Canada (n = 28), Europe (n = 19), and Asia (n = 3) in 12 journals. Four authors (USA/Europe) contributed to 26% of the 50 most cited papers as first/senior author. Hot topics were laparoscopic pyeloplasty (n = 9), inguinal hernia repair (n = 7), appendectomy, and pyloromyotomy (n = 4 each). The majority of publications were retrospective studies (n = 33) and case reports (n = 6) (IF 5.2 ± 3.2; impact index 16.5 ± 6.4; citations 125 ± 39.4). They were cited as often as articles with high evidence levels (meta-analyses, n = 2; randomized controlled trials, n = 7; prospective studies, n = 2) (IF 12.9 ± 22.5; impact index 14.0 ± 6.5; citations 125 ± 34.7; p > 0.05). Conclusions: Publications on laparoscopic pyeloplasty, inguinal hernia repair, appendectomy, and pyloromyotomy are cited most often in pediatric MIS. However, the relevant number of studies with strong evidence for the advantages of MIS in pediatric surgery is missing. Full article
(This article belongs to the Special Issue Progress in Neonatal Surgical Diseases and Minimal Invasive Treatment)
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Article
Usefulness of Procalcitonin in the Diagnosis of Bacterial Infection in Immunocompetent Children
Children 2022, 9(8), 1263; https://doi.org/10.3390/children9081263 - 21 Aug 2022
Viewed by 354
Abstract
Bacterial infections (BIs) need to be differentiated from non-BIs (NBIs) to enable prompt administration of antibiotics. Therefore, inflammatory biomarkers are needed as they can accurately identify BIs. This study evaluated the usefulness of procalcitonin (PCT) in the diagnosis of BI in immunocompetent children. [...] Read more.
Bacterial infections (BIs) need to be differentiated from non-BIs (NBIs) to enable prompt administration of antibiotics. Therefore, inflammatory biomarkers are needed as they can accurately identify BIs. This study evaluated the usefulness of procalcitonin (PCT) in the diagnosis of BI in immunocompetent children. We retrospectively reviewed the medical records of patients <18 years who underwent PCT measurements between July 2012 and June 2019. In total, 474 patients were enrolled and divided into the BI (n = 205) and NBI groups (n = 269). The BI group was subcategorized into the invasive BI (IBI; n = 94), mucosal BI (MBI; n = 31), toxigenic BI (TBI; n = 23), and localized BI (LBI; n = 57) subgroups. The NBI group was further subcategorized into the viral infection (VI; n = 118) and inflammatory disease groups (ID; n = 151). PCT was compared with the levels of C-reactive protein (CRP), white blood cell (WBC), and erythrocyte sedimentation rate (ESR). Between the BI and NBI groups, PCT (4.2 ± 16.9 vs. 1.1 ± 2.5 ng/mL; p = 0.008) and ESR (39.1 ± 32.4 vs. 54.8 ± 28.2 mm/h; p < 0.001) were significantly different. Between the IBI and other groups, WBC (14,797 ± 7148 vs. 12,622 ± 5770 × 106/L; p = 0.007), ESR (35.3 ± 30.3 vs. 51.5 ± 30.3 mm/h; p < 0.001), and PCT (8.1 ± 23.8 vs. 1.0 ± 3.4 ng/mL; p = 0.005) were significantly different. However, none of the biomarkers were useful in differentiating BI from NBI. While WBC (area under curve (AUC) = 0.615, p = 0.003) and PCT (AUC = 0.640, p < 0.001) were useful, they fared poorly in differentiating IBI from other groups. Thus, additional studies are needed to identify more accurate biomarkers capable of differentiating BIs, especially IBIs. Full article
(This article belongs to the Section Pediatric Infectious Diseases)
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Article
Assessing 48 SNPs in Hypertensive Paediatric Patients and Young Adults with Review of Genetic Background of Essential Hypertension
Children 2022, 9(8), 1262; https://doi.org/10.3390/children9081262 - 21 Aug 2022
Viewed by 372
Abstract
Essential hypertension in paediatric patients and young adults is rising, mostly on account of obesity-related hypertension. Clinically, the difference between obese hypertensive and non-obese hypertensive individuals is evident; yet, the pathophysiology of essential and obesity-related hypertension is multifactorial, complex and not fully understood. [...] Read more.
Essential hypertension in paediatric patients and young adults is rising, mostly on account of obesity-related hypertension. Clinically, the difference between obese hypertensive and non-obese hypertensive individuals is evident; yet, the pathophysiology of essential and obesity-related hypertension is multifactorial, complex and not fully understood. The aim of our study was to obtain a comprehensive view of the clinical differences between obesity-related hypertension and hypertension in non-obese paediatric patients and young adults and to do genetic tests to possibly highlight some of the pathophysiological differences with a review of their genetic backgrounds. Four hundred and thirty-six hypertensive paediatric patients and young adults were included in the study, and a study of 48 single-nucleotide polymorphisms, using Kompetitive allele specific PCR, was conducted. The subjects were divided into 243 non-obese participants with hypertension and 193 obese participants with hypertension. The data for the clinical comparison of both groups were collected as well. The differences in some clinical and biochemical parameters were confirmed. Genetic tests showed a significant difference in one allele frequency between both groups in five SNPs: rs6232, rs6235, rs12145833, rs59744560 and rs9568856. In rs6235 and rs59744560, a direct effect of different allele states could be implied. Obesity-related hypertension at a young age differs from essential hypertension in those non-obese. The reported genetic differences could be important in understanding the complex pathophysiology of early-onset obesity-related hypertension and should be further evaluated. Full article
(This article belongs to the Special Issue Recent Advances in Childhood Hypertension)
Article
A Point-of-Care Digital Workflow for 3D Printed Passive Presurgical Orthopedic Plates in Cleft Care
Children 2022, 9(8), 1261; https://doi.org/10.3390/children9081261 - 20 Aug 2022
Cited by 2 | Viewed by 795
Abstract
Cleft lip and palate are one of the most common congenital craniofacial malformations. As an initial treatment, presurgical orthopedics is considered standard treatment at many cleft centers. Digital impressions are becoming feasible in cleft care. Computer-aided design (CAD) and three-dimensional (3D) printing are [...] Read more.
Cleft lip and palate are one of the most common congenital craniofacial malformations. As an initial treatment, presurgical orthopedics is considered standard treatment at many cleft centers. Digital impressions are becoming feasible in cleft care. Computer-aided design (CAD) and three-dimensional (3D) printing are manufacturing standards in dentistry. The assimilation of these technologies has the potential to alter the traditional workflow for the fabrication of customized presurgical orthopedic plates. We present a digital workflow comprising three steps: 3D digital image acquisition with an intraoral scanner, open-source CAD modeling, and point-of-care 3D printing for the fabrication of personalized passive presurgical plates for newborns with cleft lip and palate. The digital workflow resulted in patient-related benefits, such as no risk of airway obstruction with quicker data acquisition (range 1–2.5 min). Throughput time was higher in the digital workflow 260–350 min compared to 135 min in the conventional workflow. The manual and personal intervention time was reduced from 135 min to 60 min. We show a clinically useful digital workflow for presurgical plates in cleft treatment. Once care providers overcome procurement costs, digital impressions, and point-of-care 3D printing will simplify these workflows and have the potential to become standard for cleft care. Full article
(This article belongs to the Special Issue Current Research on Cleft Lip in Children)
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Article
Neonatal Mortality and Education Related Inequality in Cesarean Births in Sub-Saharan Africa: Multi-Country Propensity Score Matching and Meta-Analysis
Children 2022, 9(8), 1260; https://doi.org/10.3390/children9081260 - 20 Aug 2022
Viewed by 322
Abstract
Background: Sub-Saharan African (SSA) newborns are ten times more likely to die in the first month than a neonate born in a high-income country. The objective of this study was to examine the relationship between educational attainment and neonatal mortality (NM) among women [...] Read more.
Background: Sub-Saharan African (SSA) newborns are ten times more likely to die in the first month than a neonate born in a high-income country. The objective of this study was to examine the relationship between educational attainment and neonatal mortality (NM) among women with cesarean section (CS) deliveries in SSA countries. Methods: Using data from recent demographic and health surveys from 33 countries in SSA, we applied propensity score matching to estimate the effect of education attainment on post-CS neonatal mortality using a propensity-matched cohort where being educated was defined as completing at least primary school education Results: The number of reported CS births ranged from 186 in Niger to 1695 in Kenya. The odds of neonatal mortality between uneducated and educated women ranged from as low as 2.31 in Senegal to 35.5 in Zimbabwe, with a pooled overall risk for NM from all of the countries of OR 2.54 (95% CI: 1.72–3.74) and aOR 1.7 (95% CI: 1.12–2.57). From the 17,220 respondents, we successfully matched 11,162 educated respondents with 2146 uneducated respondents. Uneducated women had a 6% risk compared to a 2.9% risk among educated women for neonatal mortality, with an overall risk of 3.4%; babies from uneducated women were twice as likely to die compared to babies from educated women, RR 2.1 (95% CI, 1.69–2.52). Conclusion: Neonates from uneducated women were twice as likely to die following CS delivery than neonates from educated women. This evidence suggests that a means of achieving Sustainable Development Goal target 3.2 to lower newborn and child mortality is ensuring that everyone has access to high-quality care with efforts made at ensuring education for all and improving socio-economic conditions. Full article
(This article belongs to the Section Pediatric Neonatology)
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Article
Outcomes of Femoral Arterial Catheterisation in Neonates: A Retrospective Cohort Study
Children 2022, 9(8), 1259; https://doi.org/10.3390/children9081259 - 20 Aug 2022
Viewed by 292
Abstract
Background: To review the outcome of all femoral arterial catheter (FAC) insertions in a single, large neonatal unit over a 12 year period, we will describe the incidence of harms arising from FAC insertion and to identify risk factors associated with ischaemic injury. [...] Read more.
Background: To review the outcome of all femoral arterial catheter (FAC) insertions in a single, large neonatal unit over a 12 year period, we will describe the incidence of harms arising from FAC insertion and to identify risk factors associated with ischaemic injury. Methods: Retrospective survey of data relating to all episodes of FAC insertion in a single neonatal intensive care unit over a 12 year period up to 2020. Results: 146 FACs were inserted into 139 babies with a median (interquartile range) gestation and birth weight of 27 (24 to 37) weeks and 1092 (682 to 2870) g. Impaired limb perfusion occurred in 32 (22%). This was transient and recovered with no injury in 26 of the 32. There was an increased risk of impaired limb perfusion in babies with lower weight at the time of insertion; from 5.7% in babies over 3000 g to 34.7% in babies under 1000 g (relative risk 6.1 (1.5 to 24.6)). Six babies (4%) had ischaemic injury. Risk factors for ischaemic injury included weight below 1000 g (four cases), pre-existing partial arterial obstruction (two cases), concerns about limb perfusion prior to FAC insertion (two cases) and a delay in removing the FAC after recognition of the poor perfusion (five cases). Two clinicians inserted 71 (50%) FACs and had no associated injuries. Conclusions: FAC can be used in neonates, although there is a risk of ischaemic injury, particularly in very small babies. Our data can be used to inform decisions about patient selection for this procedure. Full article
(This article belongs to the Section Pediatric Neonatology)
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Systematic Review
Antibiotherapy in Children with Cystic Fibrosis—An Extensive Review
Children 2022, 9(8), 1258; https://doi.org/10.3390/children9081258 - 20 Aug 2022
Viewed by 572
Abstract
In cystic fibrosis (CF), the respiratory disease is the main factor that influences the outcome and the prognosis of patients, bacterial infections being responsible for severe exacerbations. The etiology is often multi-microbial and with resistant strains. The aim of this paper is to [...] Read more.
In cystic fibrosis (CF), the respiratory disease is the main factor that influences the outcome and the prognosis of patients, bacterial infections being responsible for severe exacerbations. The etiology is often multi-microbial and with resistant strains. The aim of this paper is to present current existing antibiotherapy solutions for CF-associated infections in order to offer a reliable support for individual, targeted, and specific treatment. The inclusion criteria were studies about antibiotherapy in CF pediatric patients. Studies involving adult patients or those with only in vitro results were excluded. The information sources were all articles published until December 2021, in PubMed and ScienceDirect. A total of 74 studies were included, with a total number of 26,979 patients aged between 0–18 years. We approached each pathogen individual, with their specific treatment, comparing treatment solutions proposed by different studies. Preservation of lung function is the main goal of therapy in CF, because once parenchyma is lost, it cannot be recovered. Early personalized intervention and prevention of infection with reputable germs is of paramount importance, even if is an asymmetrical challenge. This research received no external funding. Full article
(This article belongs to the Special Issue Lung Diseases in Children: From Rarer to Commonest)
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Review
Diagnostic Tools in the Detection of Physical Child Abuse: A Systematic Review
Children 2022, 9(8), 1257; https://doi.org/10.3390/children9081257 - 20 Aug 2022
Viewed by 380
Abstract
Child abuse is a critical social issue. The orthopedic surgeon’s role is essential in noticing signs and symptoms of physical abuse. For this reason, several authors have proposed scoring systems to identify abuse early on and reduce undiagnosed cases. The aim of this [...] Read more.
Child abuse is a critical social issue. The orthopedic surgeon’s role is essential in noticing signs and symptoms of physical abuse. For this reason, several authors have proposed scoring systems to identify abuse early on and reduce undiagnosed cases. The aim of this systematic review is to overview the screening tools in the literature. In 2021, three independent authors performed a systematic review of two electronic medical databases using the following inclusion criteria: physical child abuse, questionnaire, survey, score, screening tool and predictive tool. Patients who had experienced sexual abuse or emotional abuse were excluded. The risk of bias evaluation of the articles was performed according to the Newcastle–Ottawa Quality Assessment Scale Cohort Studies. Any evidence-level study reporting clinical data and dealing with a physical child abuse diagnosis tool was considered. A total of 217 articles were found. After reading the full texts and checking the reference lists, n = 12 (71,035 patients) articles were selected. A total of seven screening tools were found. However, only some of the seven diagnostic tools included demonstrated a high rate of sensitivity and specificity. The main limits of the studies were the lack of heterogeneity of evidence and samples and the lack of common assessing tools. Despite the multiplicity of questionnaires aimed at detecting validated child abuse, there was not a single worldwide questionnaire for early diagnosis. A combination of more than one test might increase the validity of the investigation. Full article
(This article belongs to the Special Issue Bone Development and Disease in Infants (Volume II))
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Review
Ovarian Tissue Cryopreservation in Children and Adolescents
Children 2022, 9(8), 1256; https://doi.org/10.3390/children9081256 - 19 Aug 2022
Viewed by 470
Abstract
Cancer during childhood and adolescence remains a major public health issue, affecting a significant portion of this age group. Although newer anti-cancer treatments have improved survival rates, this comes at a cost in terms of gonadotoxic effects. As a result, the preservation of [...] Read more.
Cancer during childhood and adolescence remains a major public health issue, affecting a significant portion of this age group. Although newer anti-cancer treatments have improved survival rates, this comes at a cost in terms of gonadotoxic effects. As a result, the preservation of fertility is important. Ovarian tissue cryopreservation, one of the newest methods, has some advantages, especially for prepubertal patients: no need for ovarian stimulation, thus, no further risk for estrogen-sensitive cancer types, and preservation of more and better-quality primordial follicles of the ovarian cortex. The most frequent indications include treatment with alkylating agents, ovarian-focused radiotherapy, leukemias, lymphomas, brain and neurological tumors, as well as Turner syndrome and benign hemoglobinopathies. An expected survival exceeding 5 years, the absence of systematic disease and an overall risk of premature ovarian insufficiency over 50% are among the criteria that need to be fulfilled in order for a patient to undertake this method. Orthotopic transplantation is more frequently used, since it can allow both live birth and the recovery of endocrine function. Reimplantation of malignant cells is always a major risk and should always be taken into consideration. Histological analysis, as well as immunohistochemical and molecular methods, are needed in order to improve the search for malignant cells before transplantation. Ovarian tissue cryopreservation appears to be a method with specific benefits, indications and risks which can be an important tool in terms of preserving fertility in younger women. Full article
Article
Quality of Life in Children and Adolescents with Stickler Syndrome in Spain
Children 2022, 9(8), 1255; https://doi.org/10.3390/children9081255 - 19 Aug 2022
Viewed by 500
Abstract
Objective: To describe the quality of life and daily functioning of Spanish children and adolescents living with Stickler syndrome (SS) and to estimate the prevalence of associated disease features in a representative sample. Methods: A cross-sectional study of children and adolescents with SS [...] Read more.
Objective: To describe the quality of life and daily functioning of Spanish children and adolescents living with Stickler syndrome (SS) and to estimate the prevalence of associated disease features in a representative sample. Methods: A cross-sectional study of children and adolescents with SS were recruited via telephone calls through the Spanish SS Association. All participants underwent a structured clinical interview and filled in questionnaires reporting their quality of life (EuroQol-5D, TSK-11, CHAQ and PedsQoL). The prevalence of the main features associated with the syndrome and the mean scores of the questionnaires were estimated with 95% confidence intervals (95% CI). Results: The recruited sample included 26 persons who were mainly children (mean age 10.4 ± 4.5 (SD) range: 5–14) and male (65.4%). The prevalence estimates of SS features were as follows: the presence of moderate pain (52%), hearing loss 67% (95% CI: 54.8 to 91.3) and myopia 96% (95% CI: 87.2 to 104.4). The mean scores of the QoL indices were as follows: 22.4 (95% CI: 19.2 to 25.5) (±7.5) for TSK-11; 76.2 (95% CI: 68.8 to 83.6) (±17.1) for PedsQoL, 0.8 (95% CI: 0.7 to 0.9) (±0.3) for EQ-5D and 0.61 (95% CI: 0.24 to 1.0) (±0.9) for the cHAQ functional index. Conclusions: Our results confirmed a high variability in syndrome-related manifestations, with a large prevalence of visual and hearing deficits, pain and maxillofacial alterations. These findings may facilitate the detection of the most prevalent problems in this population, which could be a target to be addressed during the treatment of children and adolescents with SS. Full article
(This article belongs to the Section Integrative Pediatrics)
Review
Role of Ultrasound Evaluation of Temporomandibular Joint in Juvenile Idiopathic Arthritis: A Systematic Review
Children 2022, 9(8), 1254; https://doi.org/10.3390/children9081254 - 19 Aug 2022
Viewed by 380
Abstract
Background: Juvenile idiopathic arthritis (JIA) is childhood’s most frequent chronic rheumatic disease. JIA is a broad term that includes all arthritides starting before 16 years, lasting at least six weeks, and of unknown cause. The temporomandibular joint (TMJ) could be involved in JIA [...] Read more.
Background: Juvenile idiopathic arthritis (JIA) is childhood’s most frequent chronic rheumatic disease. JIA is a broad term that includes all arthritides starting before 16 years, lasting at least six weeks, and of unknown cause. The temporomandibular joint (TMJ) could be involved in JIA both at onset and during the disease course. The presence of TMJ synovitis might severely impair dentofacial maturation in pediatric patients. The ultrasound (US) application to detect early signs of TMJ synovitis in children with JIA has provided contradictory results. We sought to assess the current role of TMJ US in JIA through a systematic literature review. Methods: The systematic review was conducted according to the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Results: The literature search found 345 records. After duplicates removal, 253 records were screened, 20 full-text articles were reviewed to assess their eligibility, and 7 of them were included in the qualitative analysis. Joint effusion was the most recorded parameter, followed by bony condylar abnormalities. Compared to contrast enhancement MRI, the capability to detect signs of active synovitis of TMJ by US is low, especially at the early stages. Conclusion: Understanding how US may help diagnose and manage children with JIA is advisable for several reasons. MRI cannot be frequently repeated, may need sedation, and is expensive. The constant technical improvement of US will undoubtedly allow for better evaluation of what, in the past, was not clear or not even captured by sonography. So far, the role of US in the assessment of TMJ involvement in JIA is indubitably secondary to the MRI. Even so, we think that a baseline MRI of TMJ and the repetition of the sonography over time might both help the interpretation of US images and intercept significative changes. Full article
(This article belongs to the Special Issue Advances in Juvenile Idiopathic Arthritis)
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Review
Novel Lung Growth Strategy with Biological Therapy Targeting Airway Remodeling in Childhood Bronchial Asthma
Children 2022, 9(8), 1253; https://doi.org/10.3390/children9081253 - 19 Aug 2022
Viewed by 524
Abstract
Anti-inflammatory therapy, centered on inhaled steroids, suppresses airway inflammation in asthma, reduces asthma mortality and hospitalization rates, and achieves clinical remission in many pediatric patients. However, the spontaneous remission rate of childhood asthma in adulthood is not high, and airway inflammation and airway [...] Read more.
Anti-inflammatory therapy, centered on inhaled steroids, suppresses airway inflammation in asthma, reduces asthma mortality and hospitalization rates, and achieves clinical remission in many pediatric patients. However, the spontaneous remission rate of childhood asthma in adulthood is not high, and airway inflammation and airway remodeling persist after remission of asthma symptoms. Childhood asthma impairs normal lung maturation, interferes with peak lung function in adolescence, reduces lung function in adulthood, and increases the risk of developing chronic obstructive pulmonary disease (COPD). Early suppression of airway inflammation in childhood and prevention of asthma exacerbations may improve lung maturation, leading to good lung function and prevention of adult COPD. Biological drugs that target T-helper 2 (Th2) cytokines are used in patients with severe pediatric asthma to reduce exacerbations and airway inflammation and improve respiratory function. They may also suppress airway remodeling in childhood and prevent respiratory deterioration in adulthood, reducing the risk of COPD and improving long-term prognosis. No studies have demonstrated a suppressive effect on airway remodeling in childhood severe asthma, and further clinical trials using airway imaging analysis are needed to ascertain the inhibitory effect of biological drugs on airway remodeling in severe childhood asthma. In this review, we describe the natural prognosis of lung function in childhood asthma and the risk of developing adult COPD, the pathophysiology of allergic airway inflammation and airway remodeling via Th2 cytokines, and the inhibitory effect of biological drugs on airway remodeling in childhood asthma. Full article
(This article belongs to the Special Issue Asthma and Its Impact in Adolescents)
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Article
Role of Ultrasonography in the Diagnosis of Wilms’ Tumour
Children 2022, 9(8), 1252; https://doi.org/10.3390/children9081252 - 19 Aug 2022
Viewed by 257
Abstract
Background. Wilms’ tumour or nephroblastoma is the most common renal malignancy encountered in the paediatric population. Imaging findings are of great importance to the surgeon, the oncologist and the radiologist in the diagnosis and the staging and surveillance of this tumour. Material and [...] Read more.
Background. Wilms’ tumour or nephroblastoma is the most common renal malignancy encountered in the paediatric population. Imaging findings are of great importance to the surgeon, the oncologist and the radiologist in the diagnosis and the staging and surveillance of this tumour. Material and Methods. This study was carried out as a 10-year retrospective study of patients who were diagnosed with Wilms’ tumour. Results. The study included 12 boys and 11 girls. Ultrasound and computed tomography were performed in all cases. Ultrasonography was found to be superior to the CT examination when approximating the antero-posterior and transverse diameters; the computer-tomographic examination is cited as superior for estimating the invasion of nephroblastomas. Conclusions: Ultrasound has been shown to be effective in detecting the rupture of the renal capsule, tumour calcifications and invasion of the renal vein, pelvis and ureter. However, ultrasound cannot replace CT in the detection of lymphadenopathy and the invasion of adjacent organs. Full article
(This article belongs to the Section Pediatric Surgery)
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Article
Chronic Olfactory Dysfunction in Children with Long COVID: A Retrospective Study
Children 2022, 9(8), 1251; https://doi.org/10.3390/children9081251 - 19 Aug 2022
Cited by 1 | Viewed by 405
Abstract
Olfactory dysfunction is one of the long-term consequences of acute SARS-CoV-2 infection in adults. This study aims to analyze the prevalence of chronic anosmia among COVID-19 children and to bring to light its impact on their families’ quality of life and wellbeing. Children [...] Read more.
Olfactory dysfunction is one of the long-term consequences of acute SARS-CoV-2 infection in adults. This study aims to analyze the prevalence of chronic anosmia among COVID-19 children and to bring to light its impact on their families’ quality of life and wellbeing. Children younger than 18 years old, who were detected as being COVID-19-positive by RT-PCR and were assessed in a pediatric post-COVID outpatient clinic at least 28 days after the onset of the acute infection, were included in the study. The patients suffering from persisting smell disorders were asked to answer a questionnaire about their symptoms and how they influence their daily life. Out of the 784 children evaluated, 13 (1.7%) presented olfactory impairment at a mean follow-up since the acute infection of more than three months. Parents’ answers showed that they were worried about their children’s health, in particular they wanted to know if and when they would recover and if these disorders would have long-term consequences. They also wanted to share their experiences, in order to help other people who are experiencing the same disorders in everyday life. Our study highlights that smell disorders can significantly upset children’s eating habits and everyday activities. Furthermore, these findings suggest that future research should try to better understand the mechanisms causing loss of smell in COVID-19 patients and find the most appropriate treatment. Full article
(This article belongs to the Special Issue SARS-CoV-2 Infections in Children: Current Updates and Challenges)
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Article
Food Insecurity among Low-Income Households with Children Participating in a School-Based Fruit and Vegetable Co-Op
Children 2022, 9(8), 1250; https://doi.org/10.3390/children9081250 - 19 Aug 2022
Viewed by 428
Abstract
The purpose of this study was to evaluate the impact of a nutrition intervention on food insecurity among low-income households with children. Data were collected from 371 parent–child dyads in a quasi-experimental evaluation study of a 1-year intervention (n = 6 intervention [...] Read more.
The purpose of this study was to evaluate the impact of a nutrition intervention on food insecurity among low-income households with children. Data were collected from 371 parent–child dyads in a quasi-experimental evaluation study of a 1-year intervention (n = 6 intervention schools receiving Brighter Bites, n = 6 wait-list control schools), and longitudinal follow-up of the intervention group 2 years post-intervention in Houston, Texas. Data were collected at three timepoints: at baseline and 1 year for all participants, and at 2 year follow-up for the intervention group (the wait-list control group received the intervention during that time). At baseline, most parents reported food insecurity (60.6%; 70% intervention group, 53.6% control). Food insecurity decreased significantly from 81.3% to 61.7% [(−0.32, −0.07) p = 0.002] among intervention participants immediately post-intervention. After adjusting for ethnicity, 2 years post-intervention the predicted percentage of participants reporting food insecurity decreased significantly by roughly 35.4% from 76.4% at baseline to 41.0% [(−0.49, −0.22), p < 0.001]. Between-group changes were not significant. The re-sults of this study demonstrated a significant positive impact of Brighter Bites on food security in the short and long-term among low-income households with children, albeit results should be in-terpreted with caution. Full article
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Article
Factors Affecting High-Risk for Diabetes among Korean Adolescents: An Analysis Using the Eighth Korea National Health and Nutrition Examination Survey (2020)
Children 2022, 9(8), 1249; https://doi.org/10.3390/children9081249 - 19 Aug 2022
Viewed by 344
Abstract
The purpose of this study was to identify significant factors affecting diabetes and pre-diabetes in South Korean adolescents, including adolescents’ and parental factors. We used data on 416 Korean adolescents aged 12–18 years and their parents (302 fathers and 375 mothers) from the [...] Read more.
The purpose of this study was to identify significant factors affecting diabetes and pre-diabetes in South Korean adolescents, including adolescents’ and parental factors. We used data on 416 Korean adolescents aged 12–18 years and their parents (302 fathers and 375 mothers) from the eighth National Health and Nutrition Examination Survey gained in 2020. The data were analyzed by descriptive statistics, t-test, Rao–Scott χ2 test, and univariate logistic regression using complex sample analysis. Among the participants, 101 adolescents (22.7%) were classified as the high-risk group for diabetes. Significant factors affecting the risk for adolescent diabetes in both sexes were higher BMI, fasting plasma glucose, hemoglobin A1c, and insulin. The father’s high degree of stress perception was only related to male adolescents, and the father’s poor subjective health status was related to females at risk for diabetes. In mothers, physician-diagnosed diabetes, fasting plasma glucose, and hemoglobin A1c were factors affecting both sexes. Results from this study can be used as preliminary data for the early detection of high-risk groups for diabetes in adolescents, and for the development of systematic health care guidelines to prevent diabetes in adolescents. Full article
Article
The Study of Nutrient Intake and Adolescent Girls’ Quality of Life in a Rural Area of Indonesia
Children 2022, 9(8), 1248; https://doi.org/10.3390/children9081248 - 19 Aug 2022
Cited by 1 | Viewed by 345
Abstract
An inadequate nutrient intake correlates with malnutrition, a problem affecting many adolescents worldwide. Nutrient intake is associated with quality of life (QoL). Our study analyzed the relationship between nutrient intake and adolescents’ QoL. We conducted a cross-sectional study. Through simple random sampling, 157 [...] Read more.
An inadequate nutrient intake correlates with malnutrition, a problem affecting many adolescents worldwide. Nutrient intake is associated with quality of life (QoL). Our study analyzed the relationship between nutrient intake and adolescents’ QoL. We conducted a cross-sectional study. Through simple random sampling, 157 adolescent girls were selected. Nutrition status was assessed using anthropometric measurements. Nutrient intake was collected using the food frequency questionnaire (FFQ). WHOQOL BREF was used to explore adolescent girls’ quality of life. The median of nutrient intake: energy (908.25 kcal); protein (24.16 g); carbohydrate (128.89 g); fat (21.89 g); vitamin A (77.10 mg); vitamin E (1.40 mg); vitamin B1 (0.19 mg); vitamin B2 (0.29 mg); vitamin B6 (0.45 mg); folic acid (35.13 mg); vitamin C (12.60 mg); calcium (197.46 mg); magnesium (93.72 mg); iron (2.64 mg); and zinc (2.09 mg). The adolescents’ QoL scores were physical health 44 (25–81), psychological domain 56 (19–94), social relationships 56 (19–94), and environmental domain 56 (31–100). The strongest correlations were between (1) physical health with carbohydrates, vitamin C, and fat; (2) psychological domain with calcium; (3) social relationships with carbohydrates and vitamin C; and (4) environmental domain with BMI and zinc. There was a significant positive correlation between the intake of some nutrients and adolescents’ QoL, despite the observation of some significant negative correlations. The findings of this study indicate that more attention should be focused on adolescents’ nutrient intake in order to improve their QoL. Full article
(This article belongs to the Special Issue Advances in Research on Nutrition and Childhood Obesity)
Article
Does a Gluten-Free Diet Affect BMI and Glycosylated Hemoglobin in Children and Adolescents with Type 1 Diabetes and Asymptomatic Celiac Disease? A Meta-Analysis and Systematic Review
Children 2022, 9(8), 1247; https://doi.org/10.3390/children9081247 - 18 Aug 2022
Viewed by 422
Abstract
Background: Children diagnosed with type 1 diabetes mellitus (T1DM) are more prone to having celiac disease (CD) than the normal population. Moreover, patients with this dual diagnosis who are also on a diabetic and gluten-free diet (GFD) risk faltering growth and uncontrolled blood [...] Read more.
Background: Children diagnosed with type 1 diabetes mellitus (T1DM) are more prone to having celiac disease (CD) than the normal population. Moreover, patients with this dual diagnosis who are also on a diabetic and gluten-free diet (GFD) risk faltering growth and uncontrolled blood glucose levels. This review aims to assess the efficacy and effectiveness of managing patients with T1DM screened for CD with GFD to prevent complications associated with these chronic pathologies in childhood and adulthood. Materials and Methods: We abided by the PRISMA guidelines in this meta-analysis and used multiple databases and search engines. We included case–control studies. The primary outcomes were changes in the standard deviation score, body mass index (SDS BMI), and glycosylated hemoglobin (HA1C) after being on a GFD for at least twelve months. Results: The pooled data from the six studies included showed that there was neither a statistically significant difference in the mean SDS BMI (−0.28 (95% CI −0.75, 0.42)) (p = 0.24) nor in the mean of HA1C (mean −0.07 (95% CI −0.44, 0.30)) (p = 0.36) for the same group. HDL cholesterol improved significantly in patients on a strict GFD (p < 0.01). Conclusions: In children with T1DM and asymptomatic CD, being on a GFD had no significant effect on BMI or HA1C. However, it can have a protective effect on the other complications found in both chronic pathologies. Full article
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Article
Positive Parenting Behaviors and Child Development in Ceará, Brazil: A Population-Based Study
Children 2022, 9(8), 1246; https://doi.org/10.3390/children9081246 - 18 Aug 2022
Viewed by 372
Abstract
Parenting practices have been identified as a key determinant of children’s developmental outcomes. The aim of this study was to evaluate the association of parenting practices with child development in a cross-sectional population-based study in a low-income state in northeastern Brazil. The study [...] Read more.
Parenting practices have been identified as a key determinant of children’s developmental outcomes. The aim of this study was to evaluate the association of parenting practices with child development in a cross-sectional population-based study in a low-income state in northeastern Brazil. The study included data on 3566 caregiver–child pairs, and the children were aged 0–66 months. Positive parenting behaviors (PPBs) were conceptualized in areas of interactive play, social development, and speech and language interactions. Child development was evaluated using the Brazilian Ages and Stages Questionnaire. Linear regression analysis was used to assess the relationships. We found that a greater number of PPBs was associated with better child development domain scores. Among infants < 1 year, each additional PPB was associated with a 0.32 standardized mean difference (SMD) greater communication (95% CI: 0.24–0.41) and 0.38 SMD greater problem-solving scores (95% CI: 0.24–0.52). Among children aged 4–6 years old, each additional PPB was associated with improved communication (SMD: 0.22; 95% CI: 0.13–0.32), problem solving (SMD: 0.21; 95% CI: 0.10–0.32) and personal–social domain scores (SMD: 0.26; 95% CI: 0.17–0.36). Our findings indicate that PPB were robustly associated with better outcomes across developmental domains among Brazilian children. Programs and interventions that support PPB can contribute to improvements in development outcomes. Full article
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Article
Administration of 3% Sodium Chloride and Local Infusion Reactions
Children 2022, 9(8), 1245; https://doi.org/10.3390/children9081245 - 18 Aug 2022
Viewed by 368
Abstract
Three-percent sodium chloride (3% NaCl) is a hyperosmolar agent used to treat hyponatremic encephalopathy or other cases of increased intracranial pressure. A barrier to the use of 3% NaCl is the perceived risk of local infusion reactions when administered through a peripheral vein. [...] Read more.
Three-percent sodium chloride (3% NaCl) is a hyperosmolar agent used to treat hyponatremic encephalopathy or other cases of increased intracranial pressure. A barrier to the use of 3% NaCl is the perceived risk of local infusion reactions when administered through a peripheral vein. We sought to evaluate reports of local infusion reactions associated with 3% NaCl over a 10-year period throughout a large healthcare system. A query was conducted through the Risk Master database to determine if there were any local infusion reactions associated with peripheral 3% NaCl administration throughout the entire UPMC health system, which consists of 40 hospitals with 8400 licensed beds, over a 10-year time period from 14 May 2010 to 14 May 2020. Search terms included infiltrations, extravasations, phlebitis, IV site issues, and IV solutions. There were 23,714 non-chemotherapeutic and non-contrast-associated intravenous events, of which 4678 (19.7%) were at UPMC Children’s Hospital. A total of 2306 patients received 3% NaCl, of whom 836 (35.8%) were at UPMC Children’s Hospital. There were no reported local infusion reactions with 3% NaCl. There were no reported local infusion reaction events associated with 3% NaCl in a large healthcare system over a 10-year period. This suggests that 3% NaCl can be safely administered through a peripheral IV or central venous catheter. Full article
(This article belongs to the Special Issue Fluid and Electrolyte Therapy in Children)
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Review
The Association between Obesity and Depression among Children and the Role of Family: A Systematic Review
Children 2022, 9(8), 1244; https://doi.org/10.3390/children9081244 - 18 Aug 2022
Viewed by 396
Abstract
One of the most critical factors that affects or leads to obesity is depression. However, another point of view is that obesity leads to depression. This systematic review estimates evidence arising from observational and systematic studies concerning the association between obesity and depression [...] Read more.
One of the most critical factors that affects or leads to obesity is depression. However, another point of view is that obesity leads to depression. This systematic review estimates evidence arising from observational and systematic studies concerning the association between obesity and depression in children and adolescents. Moreover, the role of the family environment is investigated in this review. A systematic literature search was performed for research conducted between 2014 and 2021 on PubMed. The basic inclusion criteria were the language, study issue and type, and age of the participants. Studies that examined non-healthy populations, or were not related, or with no access were excluded. Titles and abstracts were screened independently, and full-text manuscripts meeting inclusion criteria were extracted. Finally, twenty-seven studies were retained. Most of them highlighted a positive association between obesity and depression. However, it is not clear whether obesity leads to depression or vice versa. Our review also revealed that the role of the family in this association has not been well studied and understood, since only one study addressed the issue. The evidence from our review emphasizes major public health issues; therefore, appropriate health policies should be developed. Moreover, additional research is required to fully understand the role of the family environment in the association between depression and obesity in childhood. Full article
(This article belongs to the Special Issue Advances in Research on Nutrition and Childhood Obesity)
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Article
Pediatric Open Long-Bone Fracture and Subsequent Deep Infection Risk: The Importance of Early Hospital Care
Children 2022, 9(8), 1243; https://doi.org/10.3390/children9081243 - 17 Aug 2022
Viewed by 424
Abstract
The purpose of the current study was to identify risk factors for deep infection after an open long-bone fracture in pediatric patients. Systematic billing queries were utilized to identify pediatric patients who presented to a level I trauma center from 1998 to 2019 [...] Read more.
The purpose of the current study was to identify risk factors for deep infection after an open long-bone fracture in pediatric patients. Systematic billing queries were utilized to identify pediatric patients who presented to a level I trauma center from 1998 to 2019 with open long-bone fractures. There were 303 open long-bone fractures, and 24 (7.9%) of these became infected. Fractures of the tibia/fibula (p = 0.022), higher revised Gustilo-Anderson type (p = 0.017), and a longer duration of time between the injury and hospital presentation (p = 0.008) were all associated with the presence of deep infection. Those who went on to have a deep infection also required more operative debridements (p = 0.022) and a total number of operative procedures (p = 0.026). The only factor that remained significant in multivariable regression was the duration between the injury and hospital presentation (OR 1.01 [95%CI 1.003–1.017]; p = 0.009), where the odds of deep infection increased by 1% for every minute of delayed presentation. Full article
(This article belongs to the Special Issue Orthopedics and Trauma in Children)
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Communication
Changing Epidemiology of Acute Viral Respiratory Infections in Hospitalized Children: The Post-Lockdown Effect
Children 2022, 9(8), 1242; https://doi.org/10.3390/children9081242 - 17 Aug 2022
Viewed by 421
Abstract
Several reports highlighted how public health measures aimed at limiting severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) circulation have likely contributed to reducing the circulation of other respiratory viruses, particularly during the first year of the COVID-19 pandemic. We evaluated the epidemiology of acute [...] Read more.
Several reports highlighted how public health measures aimed at limiting severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) circulation have likely contributed to reducing the circulation of other respiratory viruses, particularly during the first year of the COVID-19 pandemic. We evaluated the epidemiology of acute respiratory infections in a large cohort of hospitalized children during the third year of the pandemic (2021–2022). We retrospectively analyzed data from the health records of children (<14 years) hospitalized for acute respiratory infections between 1 July 2021 and 31 March 2022. A total of 1763 respiratory panels were collected. Overall, 1269 (72%) panels hadpositive results for at least one pathogen. Most positive panels (53.8%) belonged to patients aged 1–12 months. The most detected pathogen was respiratory syncytial virus (RSV) (57.8% of positive panels). The RSV peak occurred in November 2021. Nine hundred and forty-five (74.5%) panels were positive for one pathogen while three hundred and twenty-four (25.5%) showed multiple infections. Patients with multiple infections were significantly older than those with a single infection. The 2021–2022 peak of RSV infection in Italy occurred earlier than in the previous pre-pandemic seasons. A high number of children have been hospitalized because of acute viral infections also due to less aggressive viruses. Full article
(This article belongs to the Section Pediatric Infectious Diseases)
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Article
A Comparison of Clinical Features of Youth with and without Rhinitis Signs and Symptoms Who Are Hospitalized for Headache
Children 2022, 9(8), 1241; https://doi.org/10.3390/children9081241 - 17 Aug 2022
Viewed by 297
Abstract
Headache and allergic rhinitis (AR) are common in children and often co-occur. We investigated the clinical characteristics of pediatric headaches and the association of AR and chronic headaches. We retrospectively reviewed the medical records of patients admitted to our pediatric inpatient and outpatient [...] Read more.
Headache and allergic rhinitis (AR) are common in children and often co-occur. We investigated the clinical characteristics of pediatric headaches and the association of AR and chronic headaches. We retrospectively reviewed the medical records of patients admitted to our pediatric inpatient and outpatient clinics with complaints of headache between January 2017 and June 2020 for headache-specific history, AR signs and symptoms, allergy skin prick test, inhalant multiple allergen simultaneous test results, laboratory and imaging findings, and medication history. The patients were divided into three subgroups: AR, non-AR, and headache groups, reporting 45.7% patients with headache alone, 13.7% with additional AR, and 31.6% with abnormal imaging findings, suggesting that headache was combined with sinusitis (24.3%) or mastoiditis (7.3%). Furthermore, 6% of the patients had both AR and sinusitis. Body mass index (BMI) differed significantly between the AR and the non-AR and headache groups (p = 0.03). The BMI differed significantly according to headache severity (p ˂ 0.001). The most common allergen was “dust or mites” (41.1%). Acetaminophen (35.9%) was the most commonly used painkiller. The coexistence of AR and headache may indicate that these conditions share a similar pathophysiology. Better management of allergies may facilitate diagnosis, treatment, and prophylaxis of headaches. Full article
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Article
Aspects Regarding the Innovative Conceptual Design for Children’s Recreational Areas
Children 2022, 9(8), 1240; https://doi.org/10.3390/children9081240 - 17 Aug 2022
Viewed by 285
Abstract
Conceptual design approaches the definition of an innovative concept design applied to a product intended for children’-=s recreational area, corresponding to a personal profile located around the age of childhood, namely aged 2 to 5. The case study presented highlights the development of [...] Read more.
Conceptual design approaches the definition of an innovative concept design applied to a product intended for children’-=s recreational area, corresponding to a personal profile located around the age of childhood, namely aged 2 to 5. The case study presented highlights the development of an innovative concept for children’s recreational areas, to be precise the design, and the conceptual design applied to a roto-pendular carousel for children’s recreational areas. The working method aims at identifying the chronological stages of development and the conceptual design, starting from the idea, prospectographic research, analysis of constructive solutions, and finally the materialization of the assisted design in detail, applied to the new concept. Based on the prospectographic study, several constructive variants are highlighted, at the draft level, and after the analysis, the optimized variant of the carousel concept is established that should match the functions and characteristics pursued and imposed on the new concept. Following the justification of the choice of the optimal variant of the concept, the model is designed in an assisted environment in order to follow aspects related to technology associated with each component of the whole assembly, as well as aspects related to ergonomics, safety in exploration and proportion associated to the typology and to the age criteria of children. Full article
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Article
“The Peer Educator Is the Game-Changer of My Life”: Perceptions of Adolescents Living with HIV in DR Congo on Involving Peer Educators in the Process of HIV Disclosure
Children 2022, 9(8), 1239; https://doi.org/10.3390/children9081239 - 17 Aug 2022
Viewed by 310
Abstract
Several approaches to the disclosure of HIV status to children and adolescents have been described. Each of these places particular emphasis on the role of parents and health care workers (HCWs) to mitigate the impact of disclosure on the adolescent without exploring the [...] Read more.
Several approaches to the disclosure of HIV status to children and adolescents have been described. Each of these places particular emphasis on the role of parents and health care workers (HCWs) to mitigate the impact of disclosure on the adolescent without exploring the possible roles that other individuals might play in the process of disclosure. This article assesses the perceptions of adolescents living with HIV (ALHIV) about disclosure done by parents, guardians, HCWs, peer educators in the role of peer supporters, accidentally or by self-discovery, and the subsequent effects of disclosure method on their mental health. We used a qualitative study to conduct semi-structured interviews with 73 ALHIV at the Kalembelembe Paediatric Hospital, in DR Congo disclosed to by parents, guardians, HCWs, and/or peer educators, respectively, or disclosed to accidentally or by self-discovery. Microsoft Excel analysis matrix was used to organize the qualitative data. The majority of ALHIV whose disclosure involved a peer educator unanimously acknowledged the important role of the peer in accepting their HIV status, in their ART adherence, and their development of self-esteem. However, most ALHIV disclosed without involving peers declared that they had accepted their situation after a relatively long period followed by contact with the peer and integration in the self-support group. We found that the peer approach is the game-changer of the HIV status disclosure process that would allow ALHIV to accept their HIV status with minimum distress, it builds resilience, and allows them to adhere to treatment. Full article
(This article belongs to the Section Global and Public Health)
Case Report
Adrenal Crisis Mimicking COVID-19 Encephalopathy in a Teenager with Craniopharyngioma
Children 2022, 9(8), 1238; https://doi.org/10.3390/children9081238 - 17 Aug 2022
Viewed by 445
Abstract
There is an increasing number of reported cases with neurological manifestations of COVID-19 in children. Symptoms include headache, general malaise, ageusia, seizure and alterations in consciousness. The differential diagnosis includes several potentially lethal conditions including encephalopathy, encephalitis, intracranial hemorrhage, thrombosis and adrenal crisis. [...] Read more.
There is an increasing number of reported cases with neurological manifestations of COVID-19 in children. Symptoms include headache, general malaise, ageusia, seizure and alterations in consciousness. The differential diagnosis includes several potentially lethal conditions including encephalopathy, encephalitis, intracranial hemorrhage, thrombosis and adrenal crisis. We report the case of a 17-year-old boy with a positive antigen test of COVID-19 who presented with fever for one day, altered mental status and seizure, subsequently diagnosed with adrenal insufficiency. He had a history of panhypopituitarism secondary to a suprasellar craniopharyngioma treated with surgical resection; he was treated with regular hormone replacement therapy. After prompt administration of intravenous hydrocortisone, his mental status returned to normal within four hours. He recovered without neurologic complications. Adrenal insufficiency can present with neurological manifestations mimicking COVID-19 encephalopathy. Prompt recognition and treatment of adrenal insufficiency, especially in patients with brain tumors, Addison’s disease or those recently treated with corticosteroids, can rapidly improve the clinical condition and prevent long-term consequences. Full article
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