Search Results (123)

Background/Objective: The COVID-19 pandemic profoundly transformed social life worldwide, indiscriminately affecting individuals across all age groups. Children have not been exempted from the risk of severe illness and death caused by COVID-19. Objective: This paper sought to describe the clinical findings, laboratory and imaging results, and hospital care provided for severe and critical cases of COVID-19 in unvaccinated children, with or without severe asthma, hospitalized in a public referral service for COVID-19 treatment in the Brazilian state of Pernambuco. Methods: This was a case series study of severe and critical COVID-19 in hospitalized, unvaccinated children, with or without severe asthma, conducted in a public referral hospital between March 2020 and June 2021. Results: The case series included 80 children, aged from 1 month to 11 years, with the highest frequency among those under 2 years old (58.8%) and a predominance of males (65%). Respiratory diseases, including severe asthma, were present in 73.8% of the cases. Pediatric multisystem inflammatory syndrome occurred in 15% of the children, some of whom presented with cardiac involvement. Oxygen therapy was required in 65% of the cases, mechanical ventilation in 15%, and 33.7% of the children required intensive care in a pediatric intensive care unit. Pulmonary infiltrates and ground-glass opacities were common findings on chest X-rays and CT scans; inflammatory markers were elevated, and the most commonly used medications were antibiotics, bronchodilators, and corticosteroids. Conclusions: This case series has identified key characteristics of children with severe and critical COVID-19 during a period when vaccines were not yet available in Brazil for the study age group. However, the persistence of low vaccination coverage, largely due to parental vaccine hesitancy, continues to leave children vulnerable to potentially severe illness from COVID-19. These findings may inform the development of public health emergency contingency plans, as well as clinical protocols and care pathways, which can guide decision-making in pediatric care and ensure appropriate clinical management, ultimately improving the quality of care provided. Full article

Background: Migration of the peritoneal end of the ventriculoperitoneal shunt (VPS) into the scrotum is a rare but recognized complication. Inguinoscrotal migration typically occurs as a result of increased intra-abdominal pressure combined with a patent processus vaginalis. A 14-month-old pediatric patient presented to the emergency department with abdominal pain, vomiting, and swelling of the right scrotum that had persisted for two days. The patient had a history of a head injury that had resulted in a large secondary arachnoid cyst for which a VPS had been placed at eight months of age. Examination of the inguinoscrotal region revealed a swollen and painful right side of the scrotum with a hydrocele and a palpable distal portion of the ventriculoperitoneal catheter in the right groin extending to the scrotum. After a brief preoperative preparation, the patient underwent laparoscopic abdominal emergency exploration, during which shunt repositioning and laparoscopic closure of the patent processus vaginalis were performed. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: A total of 30 case reports and six case series were included, analyzing 52 pediatric patients with scrotal migration of the VPS. The median age at presentation was 24 months (range: 1–169 months). The indication for VPS placement was hydrocephalus. Migration of the VPS catheter occurred on the right side in 34 cases. The median interval from VPS placement to the onset of symptoms was 9.0 months (range: 1 day–72 months). The most frequently reported symptoms were scrotal/inguinoscrotal swelling (n = 50), vomiting (n = 7), and fever (n = 3). Diagnostic methods included abdominal X-ray (n = 43), ultrasound (n = 5), scrotal transillumination test (n = 5), and computed tomography (n = 1). Regarding treatment, surgical repositioning of the VPS catheter into the peritoneal cavity was performed in 47 patients (90.4%), with no intraoperative or postoperative complications reported. Conclusions: Laparoscopic repositioning of the VPS into the peritoneal cavity, combined with closure of the processus vaginalis, appears to be a safe and effective treatment option for scrotal migration of the VPS. However, further well-designed studies are warranted to provide more comprehensive, generalizable, and unbiased evidence regarding this complication in the pediatric population. Full article

Introduction: Pertussis, a vaccine-preventable disease caused by Bordetella pertussis, is resurging globally due to declining immunization rates. This study explores the clinical and epidemiological features of pediatric pertussis cases in a regional Romanian hospital amid growing vaccine hesitancy. Methods: We conducted a retrospective cohort study on 99 children diagnosed with pertussis and admitted to Ploiești Pediatric Hospital between January 2024 and January 2025. Demographic, clinical, laboratory, and radiological data were analyzed using SPSS 25.0. Results: The median age was 11 months (IQR 4–25), with 12.1% under two months, and ineligible for the first DTaP dose. Notably, 72.7% of children were unvaccinated; 59.4% had missed scheduled doses. None of the mothers received the DTaP vaccination during pregnancy. Most cases (55.6%) had bilaterally accentuated interstitial patterns on chest X-ray, significantly associated with vaccination status (p = 0.019). The leukocyte count was higher in children with alveolar infiltrates (p = 0.028), and as the number of vaccine doses increased, the leukocyte count tended to slightly decrease (p = 0.022, R = −0.229). PCR confirmation was obtained after a mean of 2.2 days, with 12.1% of cases confirmed post-discharge. Azithromycin was used in 74.7% of cases, with good tolerability. Conclusions: Low pediatric and maternal vaccine uptake was a major contributor to pertussis resurgence in this cohort. Radiological severity correlated with vaccination status, suggesting that vaccination may confer protection not only against infection but also against severe pulmonary involvement. These findings support urgent public health efforts to restore vaccine confidence and coverage, particularly among vulnerable infant populations and expectant mothers. Full article

Background: Pericoronitis is defined as inflammation of the soft tissues around the crown of an erupting tooth or a tooth with incomplete eruption, most commonly during eruption of the third molars. Pediatric dentists frequently encounter pericoronitis of the first molar, most of which resolve spontaneously. We describe the case of a 7-year-old girl who was referred to our hospital with intractable swelling in the right buccal region. Case Presentation: Intraoral examination showed an erupting right mandibular first molar and facial examination revealed swelling and an accumulation of pus in the cheek region. Radiographic examination revealed no pathological findings; therefore, it was diagnosed as a cheek abscess, and the region was incised that day. However, the symptoms recurred 3 weeks later, and cone-beam computed tomography detected a bone defect in the right mandibular first molar region, confirming a diagnosis of dentoalveolar abscess caused by pericoronitis of the first molar. The swelling resolved after incision of the abscess, and bone recovery was confirmed by X-ray in the follow-up period. Conclusions: Erupting first molars is at risk of pericoronitis, which may sometimes progress to a dentoalveolar abscess. Dental professionals should be alert to this possibility and should advise pediatric patients and their guardians to maintain good oral hygiene around erupting molars. Full article

Objectives: Pediatric obesity represents a significant public health challenge, requiring accurate and accessible tools for assessing body composition in pediatric populations. This systematic review (PROSPERO CRD42024592366) compares the methodological accuracy and clinical utility of bioelectrical impedance analysis (BIA) and dual x-ray absorptiometry (DXA) in evaluating obesity among children and adolescents. Methods: Utilizing a comprehensive search across PubMed, EMBASE, and Web of Science between 1 January 2014 and 31 December 2024, we identified 28 studies meeting our inclusion criteria. The studies included involved participants aged 2–17 years with obesity and compared BIA with DXA as the reference standard. The exclusion criteria were studies focusing on adults, those that assessed BC solely using anthropometry, and those that did not report primary outcomes relevant to the comparison of BIA vs. DXA. Results: The findings reveal that despite recent technological advances improving BIA’s precision, it consistently underestimates body fat percentage and fat mass, particularly in overweight and obese pediatric populations. DXA it is often used as a reference method in the evaluation of whole-body composition due to its higher accuracy and reliability. BIA offers significant practical advantages in accessibility, cost-effectiveness, and portability, but enhancements are needed to improve its accuracy for individual-level assessments. Conclusions: While BIA shows promise as a practical tool for body composition assessment in children, its accuracy varies significantly by device type. Multi-frequency segmental analyzers, such as InBody 720, demonstrate better agreement with DXA, whereas simpler models tend to underestimate fat mass. Therefore, conclusions regarding BIA performance should be device-specific and its clinical utility should be carefully weighed based on the technology used. Full article

Background: Influenza B usually causes mild illness in children. Severe and fatal cases can occur when complicated by secondary Staphylococcus aureus (S. aureus) pneumonia, including community-acquired methicillin-resistant Staphylococcus aureus (MRSA). We present a rare, rapidly progressive fatal case in an adolescent with no known medical history to highlight diagnostic and therapeutic pitfalls. Case Presentation: A 16-year-old boy with no known underlying conditions (unvaccinated for influenza) presented critically ill at “Sf. Ioan” Clinical Emergency Pediatric Hospital in Galați after one week of high fever and cough. He was in respiratory failure with septic shock, requiring immediate intubation and vasopressors. Chest X-ray (CXR) showed diffuse bilateral infiltrates (acute respiratory distress syndrome, ARDS). Initial laboratory tests revealed leukopenia, severe thrombocytopenia, disseminated intravascular coagulation (DIC), rhabdomyolysis, and acute kidney injury (AKI). Reverse transcription polymerase chain reaction (RT-PCR) confirmed influenza B, and blood cultures grew MRSA. Despite maximal intensive care, including mechanical ventilation, antibiotics (escalated for MRSA), antiviral therapy, and cytokine hemoadsorption therapy, the patient developed refractory multi-organ failure and died on hospital day 6. Autopsy revealed bilateral necrotizing pneumonia (NP) without radiographic cavitation, underscoring the diagnostic challenge. Discussion: The initial chest radiography showed diffuse bilateral pulmonary infiltrates, predominantly in the lower zones, with an ill-defined, patchy, and confluent appearance. Such appearance, in our case, was more suggestive of rapid progressive NP caused by MRSA rather than the typical pneumococcal one. This is one of the few reported cases of influenza B–MRSA coinfection with fulminant rhabdomyolysis and autopsy-confirmed necrosis. Our fulminant case illustrates the synergistic virulence of influenza and MRSA. Toxin-producing MRSA strains can cause NP and a “cytokine storm,” causing capillary leak, ARDS, shock, and DIC. Once multi-organ failure ensues, the prognosis is grim despite aggressive care. The absence of early radiographic necrosis and delayed anti-MRSA therapy (initiated after culture results) likely contributed to the poor outcome. Conclusions: Influenza B–MRSA co-infection, though rare, demands urgent empiric anti-MRSA therapy in severe influenza cases with leukopenia or shock, even without radiographic necrosis. This fatal outcome underscores the dual imperative of influenza vaccination and early, aggressive dual-pathogen targeting in high-risk presentations. Full article

Pediatric pneumonia remains a critical global health challenge requiring accurate and interpretable diagnostic solutions. Although deep learning has shown potential for pneumonia recognition on chest X-ray images, gaps persist in understanding model interpretability and feature learning during training. We evaluated four convolutional neural network (CNN) architectures, i.e., InceptionV3, InceptionResNetV2, DenseNet201, and MobileNetV2, using three approaches—standard convolution, multi-scale convolution, and strided convolution—all incorporating the Mish activation function. Among the tested models, InceptionResNetV2, with strided convolutions, demonstrated the best performance, achieving an accuracy of 0.9718. InceptionV3 also performed well using the same approach, with an accuracy of 0.9684. For DenseNet201 and MobileNetV2, the multi-scale convolution approach was more effective, with accuracies of 0.9676 and 0.9437, respectively. Gradient-weighted class activation mapping (Grad-CAM) visualizations provided critical insights, e.g., multi-scale convolutions identified diffuse viral pneumonia patterns across wider lung regions, while strided convolutions precisely highlighted localized bacterial consolidations, aligning with radiologists’ diagnostic priorities. These findings establish the following architectural guidelines: strided convolutions are suited to deep hierarchical CNNs, while multi-scale approaches optimize compact models. This research significantly advances the development of interpretable, high-performance diagnostic systems for pediatric pneumonia using chest X-rays, bridging the gap between computational innovation and clinical application. Full article

Characterizing imaging performance requires a multidisciplinary approach that evaluates various interconnected parameters, including dosage optimization and dynamic accuracy. Radiation dose and dynamic accuracy are challenged by patient motion that results in poor image quality. These challenges are more prevalent in the brain/cardiac pediatric patient imaging, as they relate to excess radiation dose that may be associated with various complications. Scanning vulnerable pediatric patients ought to eliminate anesthesia due to critical risks associated in some cases with intracranial hemorrhages, brain strokes, and congenital heart disease. Some pediatric imaging, however, requires prolonged scanning under anesthesia. It can often be a laborious, suboptimal process, with limited field of view and considerable dose. High dynamic accuracy is also necessary to diagnose tissue’s dynamic behavior beyond its static structural morphology. This study presents several performance characterization experiments from a new robotic multimodal imaging system using specially designed calibration methods at different system configurations. Additional musculoskeletal imaging and imaging from a pediatric brain stroke patient without anesthesia are presented for comparisons. The findings suggest that the system’s large dynamically controlled gantry enables scanning at full patient movement and with important improvements in scan times, accuracy, radiation dose, and the ability to image brain structures without anesthesia. This could position the system as a potential transformative tool in the pediatric interventional imaging landscape. Full article

Pneumonia is one of the leading causes of morbidity and mortality in children, making its early detection critical for effective treatment. The objective of this study is to develop and evaluate a hybrid deep learning framework that combines convolutional neural networks with intuitionistic fuzzy estimators to enhance the accuracy, sensitivity, and robustness of pneumonia detection in pediatric chest X-rays. The main background is the use of intuitionistic fuzzy estimators (IFEs). The hybrid model integrates the powerful feature extraction capabilities of CNNs with the uncertainty handling and decision-making strengths of intuitionistic fuzzy logic. By incorporating an IFE, the model is better equipped to deal with ambiguity and noise in medical imaging data, resulting in more accurate and robust pneumonia detection. Experimental results on pediatric chest X-ray datasets demonstrate the effectiveness of the proposed method, achieving higher sensitivity and specificity compared to traditional CNN approaches. The hybrid system achieved a classification accuracy of 94.93%, confirming its strong diagnostic performance. In conclusion, this hybrid model offers a promising tool to assist healthcare professionals in the early and accurate diagnosis of pneumonia in children. Full article

Wrist fractures, especially those involving the elbow and distal radius, are the most common injuries in children, teenagers, and young adults, with the highest occurrence rates during adolescence. However, the demand for medical imaging and the shortage of radiologists make it challenging to ensure accurate diagnosis and treatment. This study explores how AI-driven approaches are used to enhance fracture detection and improve diagnostic accuracy. In this paper, we propose the latest version of YOLO (i.e., YOLO11) with an attention module, designed to refine detection correctness. We integrated attention mechanisms, such as Global Attention Mechanism (GAM), channel attention, and spatial attention with Residual Network (ResNet), to enhance feature extraction. Moreover, we developed the ResNet_GAM model, which combines ResNet with GAM to improve feature learning and model performance. In this paper, we apply a data augmentation process to the publicly available GRAZPEDWRI-DX dataset, which is widely used for detecting radial bone fractures in X-ray images of children. Experimental findings indicate that integrating Squeeze-and-Excitation (SE_BLOCK) into YOLO11 significantly increases model efficiency. Our experimental results attain state-of-the-art performance, measured by the mean average precision (mAP50). Through extensive experiments, we found that our model achieved the highest mAP50 of 0.651. Meanwhile, YOLO11 with GAM and ResNet_GAM attained a maximum precision of 0.799 and a recall of 0.639 across all classes on the given dataset. The potential of these models to improve pediatric wrist imaging is significant, as they offer better detection accuracy while still being computationally efficient. Additionally, to help surgeons identify and diagnose fractures in patient wrist X-ray images, we provide a Fracture Detection Web-based Interface based on the result of the proposed method. This interface reduces the risk of misinterpretation and provides valuable information to assist in making surgical decisions. Full article

Space maintainers (SMs) are essential for preserving dental arch integrity after premature tooth loss. This study aimed to develop a deep learning model to predict the necessity of SMs and identify specific teeth requiring intervention. A dataset of 400 dental X-rays was preprocessed to standardize image dimensions and convert them into numerical representations for machine learning. The dataset was divided into training (80%) and testing (20%) subsets. A Convolutional Neural Network (CNN) was designed with multiple convolutional and pooling layers, followed by fully connected layers for binary classification. The model was trained using 30 epochs and evaluated with accuracy, precision, recall, F1-score, ROC AUC, and MCC. The CNN achieved 94% accuracy, with a precision of 0.93 for Class 0 (no SM needed) and 0.95 for Class 1 (SM needed). The ROC AUC was 0.94, and the MCC was 0.875, indicating strong reliability. When tested on 86 X-ray images, the model successfully identified specific teeth (showing teeth number) requiring SMs, with minimal errors. These results suggest that the proposed AI model provides high-performance predictions for SM necessity, offering a valuable decision-support tool for pediatric dentistry. Full article

Background: Bone marrow (BM) adipocytes play a critical role in the progression of both solid tumor metastases and expansion of hematological malignancies across a spectrum of ages, from pediatric to aging populations. Single-point biopsies remain the gold standard for monitoring BM diseases, including hematologic malignancies, but these are limited in capturing the full complexity of loco-regional and global BM microenvironments. Non-invasive imaging techniques such as Magnetic Resonance Imaging (MRI), Computed Tomography (CT), and Positron Emission Tomography (PET) could provide valuable alternatives for real-time evaluation in both preclinical translational and clinical studies. Methods: We developed a preclinical proton density fat fraction (PDFF) MRI technique for the quantitative assessment of BM composition, focusing on the fat fraction (FF) within mouse femurs. We validated this method using aging mice and young mice subjected to 10 Gy X-ray irradiation, compared to young control mice. Water–fat phantoms with varying fat percentages (0% to 100%) were used to optimize the imaging sequence, and immunohistochemical (IHC) staining with H&E validated equivalent adipose content in the femur BM region. Results: Significant differences in FF were observed across age groups (p = 0.001 for histology and p < 0.001 for PDFF) and between irradiated and control mice (p = 0.005 for histology and p = 0.002 for PDFF). A strong correlation (R²~0.84) between FF values from PDFF-MRI and histology validated the accuracy of the technique. Conclusions: These findings highlight PDFF-MRI’s potential as a non-invasive, real-time, in vivo biomarker for quantitatively assessing the BM fat fraction in preclinical studies, particularly in studies evaluating the effects of aging, disease progression, and cytotoxic cancer therapies, including chemotherapy and radiation. Full article

Background: Body composition analysis is crucial in clinical practice, yet few methods are suitable for pediatric patients, and data on young children with obesity are limited. Methods: This study measured body fat percentage (BFP), fat mass (FM), and fat-free mass (FFM) in 26 pediatric patients with obesity (BMI: 35.6±6.9 kg/m²), using two bioelectrical impedance analysis (BIA) devices (TANITA and BIACORPUS), and the results were compared to those of the gold-standard dual-energy X-ray absorptiometry (DXA). Additionally, air displacement plethysmography (BODPOD) was compared with DXA, and all methods were evaluated against each other. Results: Significant differences were observed between all methods and parameters (p < 0.05). For example, Bland–Altman analysis for BFP identified differences between BIACORPUS and DXA (mean: −3.5%; 95% limits of agreement: −16.7% to 9.8%) and between TANITA and DXA (mean: −3.1%; 95% limits of agreement: −12.2% to 6.1%). These differences can be regarded as clinically relevant, especially when considering the 95% limits of agreement. Further, moderate differences between BODPOD and DXA were identified, which could be clinically relevant (mean: 2.1%; 95% limits of agreement: −4.2% to 8.5%). Conclusions: TANITA was the most comparable BIA method to the gold standard, DXA. Therefore, TANITA is recommended for assessing body composition in young patients with obesity to monitor therapy progress in clinical settings. When using BODPOD as an alternative to DXA, caution is warranted since we found relevant differences between both methods. Full article

Background: Lamivudine is widely used alone or in combination with other anti-HIV drugs in the infant to adolescent age groups of pediatric populations. Compounding of medications is frequently used for pediatric patients. However, many issues have been reported for the compounded formulation such as assay, stability, safety, and efficacy. Three-dimensional printing can overcome these issues. Objective: The aim of this study was to understand the effect of process and formulation variables on lamivudine printlets for pediatric populations using selective laser sintering. Methods: The Plackett–Burman screening design was used to prepare 12 formulations to study six variables, namely, laser scanning speed (130–150 °C), surface temperature (105–120 °C), chamber temperature (250–350 mm/s), sucrose (0–30%), hydroxypropyl methylcellulose (0–42%), and Kollidon^® CL-M (0–5%). The formulations were tested for dissolution, disintegration, hardness, assay, X-ray diffraction, differential scanning calorimetry, stability, and pharmacokinetics in Sprague Dawley rats. Results: The assay of the printlet formulations varied between 93.1 and 103.5% and the disintegration time was 2.8 ± 1.2 (F1) to 43.7 ± 2.7 (F10) s. Due to high surface temperatures, the unsintered powder in the printing chamber experienced significant changes in crystallinity. No statistical significance was observed between the pharmacokinetic parameters of the printlets and commercial tablets (p > 0.05). The maximum plasma concentration (C_max), time to reach maximum plasma concentration (T_max), and area under the curve (AUC) of the printlets and commercial tablets were 295.5 ± 33.0 and 305.0 ± 70.1 ng/mL, 0.5 ± 0.0 and 1.0 ± 0.8 h, and 1414.1 ± 174.0 and 1987.2 ± 700.5 ng.h/mL, respectively. Conclusions: In summary, fast-disintegrating and dissolving 3D printed lamivudine was found to be bioequivalent to commercial formulation of lamivudine. Thus, it is a viable method for dispensing personalized lamivudine printlets for pediatric populations. Full article

Background/Objectives: The diagnostic guidelines for pediatric patellofemoral instability (PFI) remain incomplete. PFI remains a challenging issue as it affects the biomechanics of the knee joint, triggers anterior knee pain, and is linked to the development of early-onset osteoarthritis. The diagnostic process is complicated by numerous anatomical factors that must be considered. This review aims to consolidate current knowledge presented in the literature on radiological diagnostics for PFI in pediatric populations, with the application of all imaging techniques—including ultrasonography (US), magnetic resonance imaging (MRI), computed tomography (CT), and radiography (RTG)—which enable the evaluation of anatomical risk factors critical for the diagnosis, prevention, and treatment of PFI. Methods: A search of the PubMed/MEDLINE database was conducted to identify relevant studies from 1975 to 2024. The search terms were as follows: (patellar or patella) and (instability or displacement or dislocation) and (diagnostic or diagnosis or imaging or radiographic). A total of 2743 articles were retrieved, which were screened to yield 29 studies for further review. These studies were then divided into seven categories regarding the diagnostic methods: risk factors, tibial tubercle trochlear groove (TT-TG)/tibial tubercle posterior cruciate ligament (TT-PCL), MPFL injury and cartilage damage, patella and trochlear dysplasia, torsional abnormalities, coronal plane alignment, and genetics. Results: The methods presented statistically significant differences, with those most commonly used for the diagnosis of patella dislocation being TT-TG index, MPFL rapture, and trochlear dysplasia. Conclusions: In summary, multiple diagnostic tools, including MRI, CT, X-ray, and physical examination, are available for the assessment of PFI, each contributing to treatment decisions. Although MRI remains the primary diagnostic tool, further research is needed to establish more precise diagnostic criteria. Full article