Search Results (5,298)

Background/Objectives: Pediatric Takayasu arteritis (PTA) is a rare large-vessel vasculitis with limited data regarding neurological involvement. This study aimed to evaluate neurological manifestations and associated neuroimaging findings in a cohort of children with PTA. Methods: In this retrospective observational study, 22 patients diagnosed with PTA and followed at a tertiary center between January 2000 and April 2025 were included. Neurological symptoms, examination findings, and neuroimaging data were reviewed. Angiographic involvement was classified according to the Numano classification. Results: Neurological involvement was identified in 5 patients (22.7%), including ischemic stroke (n = 3) and hypertensive encephalopathy (n = 2). Neurological symptoms were present in 15 patients (68.2%), with headache being the most common manifestation (54%). Other symptoms included dizziness, paresthesia, visual disturbances, syncope, and seizures. Neuroimaging revealed ischemic lesions in a subset of patients, as well as nonspecific white matter changes. Angiographic evaluation showed a predominance of extensive disease patterns, particularly Type V and Type IV involvement. Conclusions: Neurological manifestations in pediatric Takayasu arteritis are common but often nonspecific. However, severe complications such as stroke and hypertensive encephalopathy may occur and can be the initial presentation. Careful neurological evaluation and the use of neuroimaging are essential for early detection and appropriate management. Full article

Background: Pancreatoblastoma (PB) is an exceptionally rare malignant epithelial neoplasm of the pancreas that recapitulates the developing pancreatic anlage. It is defined histologically by acinar-predominant differentiation with characteristic squamoid nests, and it may also show ductal and endocrine differentiation within the same tumor, features that distinguish it from acinar cell carcinoma and solid pseudopapillary neoplasm but that are readily overlooked. It occurs predominantly in young children, although adult-onset disease is well documented. We provide a population-based characterization of PB across the full age spectrum and benchmark it against pancreatic ductal adenocarcinoma (PDAC). Methods: Cases diagnosed between 2000 and 2021 were identified in the Surveillance, Epidemiology, and End Results (SEER) 17-registry database using site and histology codes. Cancer-specific survival (CSS) was estimated and compared, and Cox proportional hazards regression was used to explore associations with cancer-specific mortality. Results: Thirty-nine cases of PB were identified, compared with 155,924 cases of PDAC. The median age at diagnosis was 17 years (range, under 1 to 78 years); 12.8% (n = 5) were younger than 1 year. Males accounted for 69.2% (n = 27) of cases. The cohort was divided at the conventional pediatric-to-adult threshold of 18 years into a pediatric subgroup (age < 18 years; n = 20) and an adult subgroup (age ≥ 18 years; n = 19). CSS at 1 and 5 years was 95.0% and 83.5% in the pediatric subgroup, versus 67.7% and 24.6% in the adult subgroup (log-rank p < 0.001). Five-year CSS was 44.8% in males and 75.0% in females. In an exploratory multivariable model, older age was associated with higher cancer-specific mortality both as a dichotomous variable (adjusted hazard ratio [HR] for age ≥ 18 years 10.7, 95% confidence interval [CI] 2.4–48.2; p = 0.002) and, in a parallel model, as a continuous variable (adjusted HR 1.4 per 10-year increment, 95% CI 1.1–1.8; p = 0.002), indicating an age–mortality gradient. Male sex showed an association in the same direction that did not reach statistical significance (adjusted HR 3.3, 95% CI 0.96–11.6; p = 0.06). Relative to PDAC, PB was more frequently diagnosed in males and was associated with markedly superior survival (1- and 5-year CSS 81.8% and 54.9%, versus 28.8% and 4.0%). Conclusions: Pancreatoblastoma is predominantly a malignancy of young males and carries a substantially more favorable prognosis than PDAC, but outcomes differ markedly across the age spectrum, with adult-onset disease showing considerably poorer survival. Translationally, these population-level estimates support age-stratified prognostic counseling, argue for the referral of adults to centers experienced in rare pancreatic tumors, and provide a rationale for prospective molecular profiling to determine whether adult and pediatric PBs are biologically distinct and whether Wnt/beta-catenin pathway activation is therapeutically actionable. Full article

Background: Patients with inflammatory bowel disease (IBD) often follow restrictive diets. Data on dietary habits and beliefs in pediatric IBD are scarce. Our aim was to assess dietary habits, beliefs, and knowledge regarding nutrition and IBD among children with IBD. Method: In this single-center, cross-sectional study, pediatric patients aged 12–18 years with IBD completed a non-scoring, 25-item questionnaire assessing general dietary habits, beliefs about diet’s role in IBD pathogenesis and treatment, food avoidance, and food-related experiences since diagnosis. Results: We included 72 IBD patients (mean age [SD]: 15.2 [2.3] years; 41 (57%) were male, 32 (45%) had Crohn’s disease (CD)). Almost half of the participants did not believe that eating habits contributed to the pathogenesis of IBD. One-third of patients considered diet to be more important than medication. Approximately two-thirds changed their eating habits after diagnosis, regardless of disease type (χ²: 0.70, p = 0.40), or induction therapy (nutritional vs. non-nutritional, χ²: 0.02, p = 0.88). At least one food was avoided by 65% of the participants. Conclusions: Most children have changed their dietary habits and avoided one or more food groups. The type of induction therapy did not relate to the knowledge and dietary beliefs after induction. Our findings suggest that repeated education and dietary counseling should be an integral part of the management of pediatric IBD. Full article

Background/Objectives: Pediatric acute pancreatitis (AP) is increasingly recognized as a clinically significant disease, yet Central and Eastern European cohort data remain limited. Acute recurrent pancreatitis (ARP) affects a substantial proportion of these children and may reflect distinct underlying etiologies. This study aimed to characterize the etiological spectrum, disease severity, and hospitalization outcomes of AP and ARP in a pediatric tertiary referral population, and to identify early clinical predictors of severity. Methods: We retrospectively analyzed 63 children hospitalized between 2018 and 2025 with 77 documented episodes of AP. Diagnosis followed INSPPIRE criteria, and severity was graded using the 2017 NASPGHAN classification. Etiologies, clinical presentation, laboratory parameters, imaging findings, and hospitalization length were compared between AP and ARP groups, across severity and etiological complexity categories using appropriate non-parametric and permutation-based methods. Results: Genetic etiologies predominated in ARP (37.0%), whereas idiopathic and infectious causes were more common in first-episode AP (24.0% and 14.0%, respectively; overall p < 0.001). Severity distribution did not differ between AP and ARP, with mild disease accounting for the majority of episodes in both groups. Serum albumin was significantly lower in moderate/severe episodes (p = 0.030). Within the single-episode subgroup, etiological complexity emerged as a significant predictor of prolonged hospitalization, with complex multifactorial or systemic etiologies associated with markedly longer stays than idiopathic or single-factor disease (Welch ANOVA p = 0.007). Conclusions: In this Romanian pediatric cohort, genetic causes dominate ARP, while idiopathic and infectious etiologies characterize first-episode AP, supporting a stepwise approach in which comprehensive etiological work-up, including genetic testing, is prioritized after recurrence. The predominance of genetic causes in ARP should be interpreted with caution, as genetic testing was applied selectively, predominantly after recurrence. Recurrence status alone does not predict severity, whereas etiological complexity at first presentation and hypoalbuminemia represent practical, accessible early markers for clinically assessing more severe disease. Full article

Background: Accurate identification of pediatric B-cell acute lymphoblastic leukemia (B-ALL) patients at increased risk of relapse remains a major clinical challenge, as relapse occurs in 10–20% of cases, including patients initially classified as low- or intermediate-risk. This study aimed to identify clinical, genomic, and measurable residual disease (MRD) related predictors of relapse in pediatric B-ALL. Methods: 51 pediatric patients with B-ALL were included and followed for a median of 30.5 months (IQR, 16–45.5). Patients were stratified according to relapse status. At diagnosis, all cases underwent comprehensive genomic characterization based on the 2022 WHO and ICC classifications, including SNP-array analysis to identify copy number alterations (CNA) involving recurrent B-ALL genes (IKZF1, CDKN2A/B, PAX5, ETV6, BTG1, EBF1, ERG, RB1, and PAR1) and to determine IKZF1^plus status. Clinical variables, including white blood cell count, cytogenetic risk, and MRD assessed by flow cytometry at day 15, day 33, and at the end of induction, were analyzed. Kaplan–Meier and Firth-penalized Cox regression analyses were performed to identify independent predictors of relapse. Results: 86.3% of patients were classified according to the 2022 WHO/ICC classifications, with high hyperdiploidy being the most frequent subtype. During follow-up, 11 patients relapsed. Relapse was significantly associated with high cytogenetic risk (p = 0.007) and showed a trend toward association with an adverse CNA profile (p = 0.075). Patients with >25% bone marrow blasts at day 15 (p < 0.001) and those with positive MRD at the end of induction (p = 0.017) had a significantly higher risk of relapse. In multivariable analysis, high genetic risk and positive end-of-induction MRD remained independent predictors of relapse, with hazard ratios (HRs) of 9.31 (95% CI, 1.55–56.1), p = 0.010, and 10.9 (95% CI, 2.39–49.9), p = 0.002, respectively. Conclusions: An integrated diagnostic strategy including SNP-array provides a high diagnostic yield. High-risk cytogenetic abnormalities and positive end-of-induction MRD are independent predictors of relapse in pediatric B-ALL. Their combined assessment at diagnosis and early treatment may improve risk stratification and may support personalized therapeutic approaches. Full article

Background/Objective: Vaccination is one of the most effective and cost-effective preventive health measures for preventing infectious diseases. The literature reports that children with chronic illnesses have lower vaccination rates than healthy children and are at higher risk for preventable diseases. This study aimed to determine the immunization status of children with chronic illnesses, assess vaccination rates, and help raise awareness on this issue. Material/Method: Children aged 1 month to 18 years who presented to or were admitted to the Pediatric Clinic of Mersin City Education and Research Hospital between 1 March and 30 June 2024, and who were followed up for their chronic illness, and whose parents gave their consent, were included in the study. Sociodemographic data and information about routine and vaccines outside the national immunization schedule (Rotavirus, meningococcal, HPV, Influenza) were obtained from the parents. The status of vaccination of disease-specific recommended vaccines was also recorded. Results: A total of 256 children were included in the study (mean age 8.7 ± 4.69 years; 42.2% girls). A high rate of complete vaccination according to the routine vaccination schedule was observed. However, non-routine vaccinations were administered at low rates: rotavirus 9%, meningococcal 4.7%, and influenza 12.2%. The HPV vaccine was administered to only one patient in the study group. Recommended vaccines for the disease were administered to only 16.4% of eligible children. Conclusions: Children with chronic illnesses are at high risk for infection and complications. Increasing vaccine awareness among both healthcare professionals and parents will contribute to higher immunization rates. Comprehensive studies are needed to identify factors influencing vaccination in this population. Full article

Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated diarrhoea and a marker of antimicrobial exposure and healthcare quality, yet Central Asia is almost absent from the indexed literature. We reviewed available evidence on CDI epidemiology, antimicrobial use and molecular typing across Kazakhstan, Uzbekistan, Kyrgyzstan, Tajikistan and Turkmenistan, searching PubMed/MEDLINE, Google Scholar and accessible regional sources, and identified priorities for surveillance development. The retrievable evidence is sparse and fragmented. The strongest direct data came from Uzbekistan, where paediatric cohorts documented toxigenic C. difficile in up to 47% of the aetiological structure of antibiotic-associated diarrhoea in early-aged children. Nationwide surveys in Kazakhstan showed substantial antimicrobial use (38.2–40.2% of inpatients) and measurable healthcare-associated infection burdens (2.4–3.8%), indicating environments in which CDI may go unrecognised. No national CDI surveillance, ribotyping or resistance-gene data were identified for any of the five countries, whereas evidence from China, Thailand and other Asian settings indicates that ribotype 017 (sequence type 37) predominates in those countries. This absence appears more consistent with underdiagnosis, fragmented reporting and limited laboratory capacity than with true absence of disease. Sentinel surveillance, standardised diagnostic algorithms, integration with antimicrobial stewardship and infection prevention programmes, and regional typing collaborations are the practical priorities. Full article

Background/Objectives: The oral microbiome plays a central role in maintaining oral health from early life, with childhood representing a critical period for its establishment and long-term stability. While many environmental factors influence this dynamic microbial ecosystem, diet is distinct in being both universal and highly modifiable. This systematic review aims to evaluate and synthesize current evidence regarding the impact and mechanisms of distinct dietary habits, food matrices, and nutritional components on the composition, diversity, and ecological resilience of the pediatric oral microbiome. Methods: A literature review aligned with PRISMA guidelines was conducted via digital searches on PubMed, ScienceDirect, and Cochrane databases (January 2015–December 2025). Search strategies combined MeSH terms and keywords targeting “Microbiota”, “Mouth”, “Child”, “Diet”, and “Oral health”. Results: From 1068 records identified, 16 relevant articles met the inclusion criteria. Dietary habits may influence taxonomic and functional profiles. Frequent consumption of sugar-sweetened beverages, sucrose-rich sodas, and sweet treats induces notable dysbiosis and enriches acidogenic/aciduric taxa. Conversely, protective food matrices, including probiotic-fortified dairy products, polyol-based sugar-free chewing gums (xylitol and maltitol), bovine milk, and bioactive-rich agents like green tea, actively suppress cariogenic pathways (specifically Streptococcus mutans) and support commensal, health-associated genera without disrupting overall microbial structures. Conclusions: Diet represents an important modifiable factor shaping the pediatric oral microbiome, capable of either driving dysbiosis or reinforcing symbiosis. Cultivating a microbiome-informed dietary approach early in childhood supports a resilient microbial architecture, offering a non-invasive, public health framework for long-term oral and systemic disease prevention. Full article

Purpose: Extubation timing after paediatric cardiac catheterisation under general anaesthesia remains a challenging clinical decision, particularly in children with cyanotic or haemodynamically significant congenital heart disease. This study aimed to evaluate factors associated with non-on-table extubation and to assess early postoperative respiratory outcomes in this high-risk population. Design: This was a single-centre retrospective cohort study conducted in a paediatric cardiac catheterisation laboratory. Methods: Paediatric patients with cyanotic or haemodynamically significant/complex congenital heart disease who underwent cardiac catheterisation under general anaesthesia with endotracheal intubation were included. Patients were grouped according to whether they were extubated on-table in the catheterisation laboratory or transferred to the intensive care unit with ongoing invasive mechanical ventilation. The primary outcome was non-on-table extubation. Secondary outcomes included extubation timing, reintubation within 48 h, major respiratory complications within 48 h, intensive care unit length of stay, hospital length of stay, and 7-day and 30-day mortality. Logistic regression analysis was used to identify factors associated with non-on-table extubation. Findings: Seventy-two patients were included. On-table extubation was performed in 52 patients (72.2%), whereas 20 patients (27.8%) were not extubated on-table. Patients not extubated on-table were younger, had lower body weight, higher American Society of Anesthesiologists physical status IV (ASA IV) frequency, higher Catheterization Risk Score for Pediatrics (CRISP) scores, lower baseline SpO₂, and were more frequently undergoing emergency procedures. Reintubation within 48 h occurred only in the non-on-table extubation group (15.0% vs. 0.0%; p = 0.019). Major respiratory complications within 48 h were more frequent in patients not extubated on-table (20.0% vs. 3.8%; p = 0.047). Intensive care unit and hospital length of stay were also longer in this group. In multivariable analysis, higher CRISP score (adjusted odds ratio 1.22; 95% confidence interval 1.009–1.476; p = 0.040) and emergency procedure (adjusted odds ratio 8.74; 95% confidence interval 1.365–55.927; p = 0.022) were independently associated with non-on-table extubation. No 7-day mortality occurred in either group. Conclusions: On-table extubation after paediatric cardiac catheterisation under general anaesthesia was feasible in most selected patients with cyanotic or haemodynamically significant/complex congenital heart disease. Higher CRISP score and emergency procedures were independently associated with non-on-table extubation. These findings suggest that catheterisation-specific risk assessment may help anticipate postoperative ventilatory requirements in high-risk paediatric cardiac catheterisation patients. Full article

Nanotechnology is rapidly transforming the perspective on pediatric neurology, enabling diagnostic, therapeutic, and monitoring strategies tailored to the unique features of neurological illnesses in children. This review acknowledges the problems caused by delays in diagnosis, the limitations of conventional procedures, and the need for new, focused approaches, highlighting recent advances in nanoscale materials and smart nanocarriers. Specifically, this paper summarizes advances in nanomaterials that can overcome physiological barriers, such as the developing blood–brain barrier (BBB) and age-dependent pharmacokinetics. We discuss innovations in stimuli-responsive delivery systems, theranostic platforms, and multimodal nanohybrids designed for precise targeting and real-time treatment monitoring. Special emphasis is placed on pediatric-specific considerations, including developmental differences in immune and metabolic responses, the necessity for age-adjusted dosing, and the potential long-term safety implications of nanoparticle exposure. Transformative applications are explored in various pediatric neurological conditions, including brain tumors, epilepsy, neurodevelopmental disorders, and rare degenerative diseases, emphasizing both achievements and challenges in translation. This paper evaluates various regulatory, ethical, and societal factors, alongside the integration of converging technologies such as AI-driven nanoparticle optimization, brain organoids, and digital twins to accelerate personalized therapy development. Conclusively, this paper emphasizes the importance of interdisciplinary collaboration, pediatric-focused clinical trial designs, and sustained investment to fully realize the potential of nanotechnology in improving neurological outcomes for children. Full article

Pediatric obesity is a complex, multifactorial pandemic with serious early-onset comorbidities, including prediabetes, type 2 diabetes, metabolic dysfunction-associated steatotic liver disease (MASLD), and cardiovascular disorders. While lifestyle modifications and the Mediterranean diet remain primary interventions, artificial intelligence (AI) is emerging as a critical tool for early diagnosis and personalized management. This review evaluates the current role of AI in predicting and treating childhood obesity and its complications. A literature search was conducted on PubMed and Google Scholar for English-language articles published from 2015 onward. Search terms included combinations of keywords related to “obesity”, “pediatric”, “comorbidities” (e.g., MASLD, diabetes), and “artificial intelligence” (e.g., machine learning, deep learning, multi-omics). Eligible study types ranged from original articles to systematic reviews and clinical guidelines. By integrating multi-omic data (genome, epigenome, transcriptome, metabolome, microbiota) with socio-psychological metrics, AI can predict obesity risk and early complications. Machine learning (ML) and deep learning have successfully identified specific metabolites, gut flora alterations, neurological pathways, and metabolic SNPs linked to obesity susceptibility. Furthermore, ML-driven prognostic models enable risk assessment for MASLD or diabetes progression, while specialized software supports remote lifestyle monitoring and tailored dietary interventions. AI has the potential to revolutionize pediatric obesity management through precision medicine. However, challenges regarding data privacy, digital literacy, and equitable access persist. Because current evidence relies heavily on limited and heterogeneous pediatric datasets, large-scale, well-characterized, and externally validated cohorts are essential to establish the clinical applicability of AI models before routine implementation. Full article

Vernal keratoconjunctivitis (VKC) is a chronic pediatric ocular allergy that can progress from seasonal to persistent inflammation with vision-threatening complications. Although Th2-associated mechanisms have been implicated, the immune correlates of disease severity are not well defined. Tear samples from VKC patients (moderate intermittent and moderate persistent) and healthy controls were collected using Schirmer’s strips. Cytokine profiling was performed using the OLINK^® Target 48 Cytokine Panel. Differential expression, correlation with clinical features, and pathway enrichment analyses were performed. Compared to control, IL-15, CXCL11, CXCL9, MMP12, and CCL13 were significantly elevated in VKC, with higher levels in the persistent phenotype. These cytokines correlated with symptom duration, limbal involvement, and papillary hypertrophy. Pathway analysis revealed enrichment of IL-17, JAK–STAT, and chemokine signaling pathways. VKC severity is associated with distinct tear cytokine signatures, with the persistent phenotype showing enhanced chronic inflammatory signaling. These findings identify candidate tear-based markers of disease severity that require validation in larger, independent, and longitudinal cohorts. Full article

Background and Clinical Significance: Intranasal foreign bodies are common pediatric otolaryngologic emergencies and are usually diagnosed and removed without difficulty. However, delayed or occult retention may mimic chronic unilateral sinonasal disease and occasionally result in severe inflammatory or infectious complications. This study presents three illustrative pediatric cases of delayed intranasal foreign bodies supported by a seven-year institutional experience. Case Presentation: A retrospective review was conducted of all pediatric patients (≤16 years) presenting with intranasal foreign bodies at a secondary referral hospital between January 2019 and May 2026. Demographic characteristics, clinical presentation, management, and outcomes were reviewed to provide institutional context. Among 82 identified patients, three children with delayed diagnosis and severe complications were selected for detailed presentation because they represented distinct clinical manifestations of prolonged foreign body retention. These included chronic unilateral rhinosinusitis caused by a retained peanut fragment, a medial orbital subperiosteal abscess secondary to a retained plastic nasal piercing component, and a foreign-body granuloma associated with retained nasal packing material. The remaining patients underwent uncomplicated removal, predominantly in the emergency department. Conclusions: The presented cases illustrate the diverse spectrum of complications that may occur following delayed intranasal foreign body retention in children. Persistent unilateral foul-smelling rhinorrhea, nasal obstruction, recurrent unilateral epistaxis, or refractory unilateral sinonasal symptoms should prompt careful evaluation for a retained foreign body. By combining detailed case descriptions with institutional experience, this report highlights the importance of maintaining a high index of suspicion and timely endoscopic management in children with persistent unilateral sinonasal symptoms. Full article

Coffee is one of the most widely consumed beverages worldwide. Coffee and its bioactive compounds, including caffeine, chlorogenic acid, and caffeic acid, have attracted increasing attention because of their potential health benefits. Evidence from pediatric and adult populations supports a positive association between fructose intake from sugar-sweetened beverages and the increasing prevalence of obesity and other non-communicable diseases. In this context, coffee consumption may represent a potential protective dietary factor against high fructose intake-induced metabolic alterations, including obesity, type 2 diabetes, liver disease, cardiovascular disease, and alterations in gut microbiota composition. Therefore, this review summarizes current evidence on the potential role of coffee consumption and coffee-derived bioactive compounds in modulating fructose-induced metabolic alterations and discusses the mechanisms involved. However, current evidence from human studies remains limited, and the clinical relevance of the beneficial effects observed in experimental models requires confirmation through well-designed clinical trials. Full article

Background: Midazolam is widely used as a pediatric premedication, but evidence from direct comparisons of oral and sublingual administration in children with congenital heart disease remains limited, particularly that from pharmacokinetic and physiologic data analyzed together. Methods: We conducted a single-center prospective randomized study comparing oral midazolam 0.5 mg/kg with sublingual midazolam 0.3 mg/kg in children undergoing cardiac surgery or catheterization procedures under general anesthesia. Plasma midazolam and 1-hydroxymidazolam concentrations were measured approximately 30 min after administration. Log-transformed concentrations were compared using regression/ANCOVA models adjusted for dose and age. Changes in mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SpO₂) were analyzed from baseline to 15 and 30 min. Behavioral outcomes included the sedation score, separation from parents, and mask acceptance. Results: Sixty-eight children were randomized; 65 had evaluable pharmacokinetic samples and formed the complete-case pharmacokinetic cohort. Adjusted plasma midazolam concentrations did not differ significantly between the groups, with an adjusted geometric mean ratio for sublingual versus oral administration of 0.98 (95% CI 0.53–1.79; unadjusted p = 0.940; Holm-adjusted p = 1.000). The corresponding ratio for 1-hydroxymidazolam was 1.37 (95% CI 0.55–3.41; unadjusted p = 0.494; Holm-adjusted p = 1.000). HR and SpO₂ changes were non-significant between the groups. At 30 min, sublingual administration was associated with a lower adjusted change in MAP compared with oral administration (adjusted difference −12.08 mmHg, 95% CI −19.74 to −4.42; unadjusted p = 0.002, Holm-adjusted p = 0.012). Behavioral outcomes did not differ significantly between the groups. Conclusions: In this prospective randomized pediatric cardiac cohort, oral midazolam 0.5 mg/kg and sublingual midazolam 0.3 mg/kg produced comparable plasma concentrations and similar behavioral outcomes. Sublingual administration was not associated with worse HR or SpO₂ responses, although an isolated lower MAP change at 30 min warrants confirmation in larger studies. Sublingual midazolam may represent a feasible lower-dose alternative for premedication in this population. Full article