Search Results (1,426)

Spigelian hernia (SH) is an infrequent aponeurotic defect in Spiegel’s semilunar line. The literature on pediatric SH is scarce. A comprehensive review of the previous literature was conducted. Eligible studies were identified by searching primary medical bibliography databases, and a pooled analysis of published case-level data was performed. Medians and interquartile ranges were used to describe the quantitative variables and proportions for categorical variables. The Kruskal–Wallis, Mann–Whitney U, and Fisher’s exact tests were used to compare group variables. Spearman’s and Pearson’s correlation analyses were used to assess the degree of correlation between variables, while Cramér’s V was applied to evaluate the degree of association among the variables. A p-value < 0.05 (two-tailed) was considered statistically significant. Our search identified 82 publications reporting on 123 patients (106 male, 86.2%), with an age range of 0–21 years. Forty-seven patients (38.2%) had a left-sided SH, fifty-six (45.5%) had a right-sided SH, and thirteen (10.6%) had a bilateral SH. Traumatic SH, mostly from bicycle injuries, accounted for 45 cases (36.6%), while 41 (33.3%) were associated with undescended testis (UDT). In this series of published cases, hernia incarceration/strangulation (I/S) was reported in 15 patients (12.2%), who were significantly younger (p = 0.02). Surgical correction was performed in 95 cases (77.2%), 14 of them laparoscopically, with a 35.7% conversion rate. Eight cases (6.5%) were managed conservatively. Overall, outcomes were favorable. SH is an infrequent pediatric condition that, based on the synthesized literature, predominantly affects males. The published cases suggest two main clinical phenotypes: a congenital form, often linked to ipsilateral UDT, and an acquired form, typically resulting from trauma. Analysis of the reported data indicates a higher risk of incarceration in early childhood. Surgical treatment is the most frequently reported approach with generally favorable outcomes, whereas the evidence for conservative management remains limited. This comprehensive review highlights the dual nature of pediatric SH and underscores the need for a high index of suspicion in relevant clinical scenarios. Full article

Mucormycosis is a rare invasive fungal disease in pediatric patients with hematological malignancies and is associated with poor outcomes. We present a fulminant and ultimately fatal case of rhino-orbito-cerebral mucormycosis, addressing important issues including clinical signs and symptoms, diagnostic approaches and the challenges of timely diagnosis. The patient was an 11-year old girl undergoing re-induction chemotherapy for Central Nervous System relapse of B-cell precursor acute lymphoblastic leukemia. She presented six days into the second course of chemotherapy in profound neutropenia with aggravating headaches, painful abducens nerve palsy and anisocoria. At first (day −3), no significant radiological or ophthalmological correlations were found, and methyl–prednisolone was started due to suspected vasculitis following ICU admission. After further clinical deterioration, a second MRI scan (day 0) revealed a prolonged occlusion of the left carotid artery, which was successfully stented in a neuroradiological intervention (day +1). However, during the next day the child developed clinical signs indicating severe cerebral dysfunction. An emergency CT scan showed complete infarction of the left hemisphere including a progredient perfusion deficit and beginning brain edema. Based on the unfavorable prognosis, best supportive care was initiated, and the patient deceased on day +2. Pathological and microbiological workup identified thrombotic infarction in all major cerebral arteries. While microscopy was suspicious for mucormycosis, nested PCR from retained blood specimens confirmed the genus Lichtheimia. Final NGS on brain tissue led to the identification of Lichtheimia ramosa. This case illustrates the rapidity and severity of Mucorales infection. It shows the importance of early clinical suspicion and the need for an aggressive laboratory testing algorithms. The stratification of risk factors and definition of red flags may be a future task fighting these infections. Full article

Objectives: Acute drug poisoning represents a significant public health issue among the pediatric population. The aim of this study was to evaluate the characteristics of drug poisoning in children and adolescents in the Vojvodina region from 2018 to 2023. Methods: In a retrospective observational study, 82 patients with confirmed drug poisoning were included, and data was collected regarding demographic characteristics, clinical manifestations, types of drugs involved, and the therapeutic interventions administered. The severity of poisonings was evaluated using the Poisoning Severity Score, and toxicological analysis was performed using gas chromatography–mass spectrometry. Results: The results indicated that poisonings were most prevalent in adolescent girls (72%), with 78% of cases resulting from intentional poisoning, while unintentional poisoning was more common in children. Benzodiazepines, antipsychotics, and analgesics were the primary drugs causing these poisoning incidents. The majority of patients (78%) experienced mild clinical symptoms, whereas 9% of pediatric patients suffered from severe poisoning, related to complications such as aspiration pneumonia and acute renal failure. Addressing pediatric drug poisoning in Vojvodina requires an increased focus on preventive strategies, including parental education and appropriate psychosocial support for the youth. Conclusions: Through collaborative efforts among healthcare providers, educators, and policymakers, prevention, treatment, and support mechanisms can be enhanced to combat this pressing public health challenge. Full article

Background: The emergence and spread of the tigecycline resistance gene tet(A)-v1 in carbapenem-resistant Klebsiella pneumoniae (CRKP) poses significant public health challenges. However, the prevalence of tet(A)-v1-positive CRKP, especially in pediatric patients, remains poorly understood. This study aims to address the gap by performing an in-depth analysis of isolates collected from a children’s hospital in China. Methods: A 4-year retrospective study was conducted in the children’s hospital in Suzhou, China. Non-duplicated specimens were obtained from pediatric patients, and antimicrobial susceptibility profiles were assessed. Whole-genome sequencing and bioinformatics analyses were conducted to characterize the genetic background, antimicrobial resistance determinants, hypervirulence-associated genes, diversity of tet(A)-v1-carrying plasmids, the genetic environment of tet(A)-v1, and the potential for clonal transmission. Conjugative transferability of tet(A)-v1-carrying plasmids was also evaluated via conjugation assays. Results: Of the 73 tet(A)-v1-positive CRKP isolates from pediatric patients, 10.96% were non-susceptible to tigecycline. These isolates exhibited high genetic diversity, spanning across 13 STs (sequence types), with ST17 being predominant. Three carbapenemases were identified, with IMP being the most common. Isolates from diverse backgrounds, such as ST17, ST20, ST323, ST792, and ST3157, demonstrated evidence of clonal transmission. The tet(A)-v1 gene was located on 14 distinct plasmids across seven replicon types, with IncFIA/IncHI1 and IncFII being most commonly detected. All tet(A)-v1-carrying plasmids were multidrug-resistant, and 68.49% were conjugatively transferable, indicating a high potential for horizontal transfer. Four genetic contexts bordering tet(A)-v1 were identified, which points to active clonal dissemination. Conclusions: Although limited to a single hospital, this study represents one of the first in-depth investigations of tet(A)-v1-positive CRKP in pediatric patients, providing valuable insights into the prevalence and spread of tet(A)-v1 in this vulnerable group. These findings emphasize the urgent need for enhanced surveillance and infection control measures to curb the spread of tet(A)-v1-positive CRKP in pediatric healthcare environments, offering critical insights to mitigate its public health impact. Full article

Background: Examining medico-legal cases within hospitals aids in identifying care-related problems, facilitating necessary corrections and emphasizing successful preventive measures. The case of Meyer Children’s Hospital is particularly noteworthy as it offers insights into the evolution of litigation in regard to a tertiary pediatric hospital. Methods: The study sample comprised 158 malpractice claims received by Meyer Children’s Hospital from 1 January 2010 to 31 December 2023, which were managed by the Claims Management Committee (CMC) responsible for civil liability within the hospital. In this observational retrospective study, the following variables were analyzed: (1) The characteristics of the patients (age–sex) and the manner in which they interacted with the hospital, ultimately resulting in the compensation claim (method of access, area of specialty, outcomes based on the International Classification of Patient Safety (ICPS)). (2) Medico-legal factors: the details of the compensation claim, the significant issues noted in various cases, and the findings of the medico-legal inquiry conducted by the CMC. In cases of ADR (Alternative Dispute Resolution), we evaluated the nature of the procedure, the results, and the amount of compensation awarded. Results: We conducted a descriptive statistical analysis to delineate the trend of claims and identify specific deficiencies within structures or departments over time. Invasive procedures and surgical operations were identified as the leading causes of accidents, resulting in heightened mortality rates and serious injuries. The most common errors observed were diagnostic and therapeutic. Conclusions: The data that emerged highlighted a low rate of claims (11.28/year) and a low claim/service ratio (0.0002%), suggesting a high level of safety of patient care at the hospital. The acceptance rate (32%), the percentage of rejected cases (48/158~30% of total, or 48/99~49% of resolved claims), the average compensation (EUR 68,312), and the percentage of cases (92%) with judicial opinions consistent with those of the CMC indicate a tendency to pursue exploratory compensation requests and the effectiveness of CMC’s activity. Meanwhile, the predominant error types (surgical and diagnostic) are in accordance with national and international data. Finally, the scarcity of disputes concerning informed consent reflects the impressive effectiveness of the communication strategies utilized by the pediatricians at this center. Full article

Objectives: Type1 diabetes (T1D) is one of the most common chronic diseases in pediatric age. Continuous glucose monitoring (CGM) has been shown to improve glycaemic control in adults compared to self-monitoring of blood glucose (SMBG); however, evidence about its use in the pediatric field is limited and fragmented and needs to be improved. This paper aims to address all the critical aspects linked to the use of CGM in a pediatric population while also describing a methodology for conducting health technology assessment (HTA) to support the decision-making process. Methods: The use of CGM and SMBG in a pediatric population was compared by using a decision-making support tool (DoHTA method). Twenty-seven Key Performance Indicators (KPIs) were identified, defining safety, clinical effectiveness, organizational, patient perspective, and economic aspects. Performance scores for both monitoring systems were assessed based on these KPIs, leading to a final comparative ranking. Results: CGM demonstrated a 29.3% performance advantage over SMBG, highlighting its benefits in terms of clinical effectiveness, patient perspectives, safety, and economic evaluation. No substantial differences were identified in terms of organizational aspects. Conclusions: This study critically evaluates the benefits and drawbacks of the use of CGM in a pediatric population. It integrates the assessment of the clinical effectiveness with the organizational aspects, the cost, the patient perspective, and the safety, providing a valuable proof of evidence as well as a reliable and transferable method for conducting decision-making processes in a hospital setting. Full article

The rising prevalence of pediatric food allergies represents a growing public health concern, with hospitalizations for food-induced anaphylaxis on the rise. Early cutaneous manifestations, particularly in the setting of atopic dermatitis (AD), may indicate sensitization via the skin—a critical route for allergen exposure in early life. Pediatric food allergies can be IgE-mediated, non-IgE-mediated, or mixed, with each type presenting distinct pathophysiological and clinical features. IgE-mediated reactions often involve acute urticaria and angioedema, while non-IgE forms, such as food protein-induced enterocolitis syndrome (FPIES), manifest with delayed gastrointestinal symptoms and limited skin involvement. AD is closely linked with food allergies, both in pathogenesis and symptom exacerbation, with a high prevalence of co-occurrence. Diagnosis primarily relies on clinical evaluation, supported by testing such as skin prick testing, serum IgE, and oral food challenges, though limitations exist in sensitivity and specificity. Management emphasizes allergen avoidance, symptom control, and multidisciplinary care. While many pediatric food allergies resolve with age, others persist or present chronically, necessitating long-term strategies. Coordinated management between allergy and dermatology is key to minimizing complications and supporting better long-term outcomes for affected children. Full article

Background: The integration of global longitudinal strain (GLS) with stress echocardiography (SE) represents a significant advancement in non-invasive cardiac diagnostics, particularly in the evaluation of coronary artery disease (CAD). GLS, derived from speckle-tracking echocardiography, quantifies myocardial deformation and offers superior sensitivity for detecting subclinical myocardial dysfunction compared to conventional metrics like wall motion and ejection fraction. Recent studies have validated the prognostic and diagnostic efficacy of GLS both at rest and during stress, notably enhancing the detection of obstructive and non-obstructive CAD, microvascular dysfunction, and other cardiac pathologies. Methods: This manuscript synthesizes extensive clinical data demonstrating the added value of GLS during stress echocardiography across diverse cardiac conditions—including valvular heart disease, heart failure, cardio-oncology, and pediatric cardiology. Novel metrics like longitudinal strain reserve (LSR), myocardial work indices, and post-systolic strain have further enriched risk stratification strategies. Results: The combination of GLS with SE has been shown to approximate the accuracy of invasive coronary angiography in intermediate-risk patients and in cases with equivocal traditional SE findings. Despite its clinical promise, the utility of GLS is challenged by technical limitations, including image quality dependency, inter-vendor variability, and limited applicability during high heart rate states. Conclusions: As technological refinement and standardization progress, GLS integrated with SE is poised to become a mainstay in precision cardiology, improving diagnostic yield, guiding therapeutic decisions, and enhancing patient outcomes. Full article

Background: As global populations age, the demand for effective and compassionate geriatric care has intensified. Humanized nursing emphasizes empathy and person-centered care, while community-based nursing builds on local resources and networks to support health and well-being. Together, these approaches offer promising strategies for improving care for older adults. This integrative review explores the evolution, clinical contributions, and implementation barriers of these models. Methods: A comprehensive literature search was performed using PubMed, CINAHL, Scopus, and Web of Science, targeting peer-reviewed studies, including qualitative and quantitative studies published between 2010 and 2025, that involved adults aged 60 years and older. Inclusion criteria emphasized humanized and community-based nursing interventions while excluding non-nursing and pediatric-focused studies. Quality appraisal was performed using CASP and JBI checklists, and data were thematically synthesized. Results: Evidence indicates that these care models significantly improve functional independence and psychosocial well-being and reduce hospital readmissions. For instance, community-based care in Taiwan improved activities of daily living in dementia patients by 15%, while U.S.-based programs reduced depressive symptoms by 30% among Latino older adults. Interdisciplinary, nurse-led interventions in South Korea and Puerto Rico showed a 22% reduction in readmissions and an 85% increase in care access. Despite these benefits, numerous barriers hinder widespread implementation, including workforce shortages, inadequate funding, fragmented healthcare systems, cultural resistance, digital literacy challenges, and policy constraints, particularly in low-resource settings such as the Philippines and Nepal. Conclusions: These findings underscore the transformative potential of humanized and community-based nursing while highlighting the need for targeted strategies such as task-shifting, inclusive technologies, and policy reform to advance equitable, sustainable geriatric care globally. Full article

Background: This study aimed to evaluate the cytotoxicity of bulk-fill composite materials compared to conventional compomers on stem cells from human exfoliated deciduous teeth. Methods: 90 standardized resin composite discs (4 mm thick, 4 mm diameter) were fabricated using a 3D-printed plate, comprising four bulk-fill composites (SDR, Tetric EvoCeram Bulk-Fill, VisCalor Bulk, Cention-N) and one compomer (Dyract XP). Samples were polymerized per the manufacturer’s instructions and sterilized. Stem cells were isolated from the pulp of exfoliated primary teeth. Cells were cultured and exposed to extracts of the composite materials soaked in culture medium for 24 h. Cytotoxicity was assessed using the MTT colorimetric assay, measuring cell viability via mitochondrial activity, and the Annexin V assay, quantifying apoptosis and necrosis via flow cytometry. Statistical analysis was performed using ANOVA and Tukey post hoc tests. Results: All materials significantly reduced cell viability compared to the control (p < 0.05), with optical density values indicating high cytotoxicity. Tetric EvoCeram exhibited the lowest necrosis and apoptosis levels, while Dyract XP showed the highest necrosis. Statistical analysis revealed no significant cytotoxicity differences among most bulk-fill composites (p < 0.05). Conclusion: Bulk-fill composites and conventional compomer tested exhibit comparable and significant cytotoxic effects on stem cells from human exfoliated primary teeth pulp. While these materials offer clinical advantages in pediatric dentistry due to ease and speed of application, their use underscores the dilemma of balancing operative efficiency with biological safety, and their cytotoxic profiles should be taken into consideration prior to application. Full article

Pediatric asthma and allergic rhinitis are prevalent chronic inflammatory diseases ruled by complex interactions among genetic, environmental, and nutritional factors. Zinc, an essential trace element, plays a crucial role in immune modulation, oxidative stress regulation, and epithelial barrier maintenance, all of which are significant in the context of allergic airway diseases. This review aimed to explore and synthesize current evidence on the biological mechanisms and clinical implications of zinc in pediatric asthma and allergic rhinitis. A comprehensive literature search was conducted through PubMed and the Cochrane Library for studies published between 2015 and 2025. Eligible studies included observational and interventional research focused on zinc status or supplementation in children with asthma or allergic rhinitis. Numerous observational studies and meta-analyses indicated reduced circulating zinc levels in children with asthma, often correlating with poor symptom control, increased oxidative stress, and lower pulmonary function. In allergic rhinitis, zinc depletion in nasal mucosa was associated with elevated local inflammation, although paradoxical increases in zinc concentrations have been observed in nasal secretions during active disease. Interventional trials in pediatric asthma populations showed that zinc supplementation may improve clinical symptoms, reduce inflammation, and enhance lung function, although the results were inconsistent and limited by methodological variability. In conclusion, zinc plays a multifactorial role in modulating immune responses and maintaining mucosal health in pediatric allergic airway diseases. While zinc supplementation holds promise as a safe and accessible adjunctive therapy, further high-quality randomized controlled trials are needed to define its clinical utility and establish evidence-based guidelines. Full article

Background/Objective: Pediatric obesity negatively impacts metabolic and musculoskeletal health, particularly muscle quality and function. Ultrasound-derived measures like muscle thickness and echo intensity, combined with body composition data, provide a more comprehensive assessment of muscle status in this population. The purpose of our study was to examine the relationship between anthropometric measurements, muscle strength, and bioelectrical impedance estimations with ultrasound-derived indicators such as subcutaneous fat and quadriceps femoris thickness, as well as muscle quality, through EI. Methods: This cross-sectional study included Hispanic children aged 6 to under 18 years with overweight or obesity (BMI ≥ 85th percentile per CDC standards). Participants were recruited consecutively from outpatient visits. All eligible children were invited for a standardized nutritional assessment, and those who consented were included. Results: The study included 294 children and adolescents (153 boys, 141 girls) with overweight or obesity, showing significant sex differences in anthropometric and body composition variables. Girls had higher intramuscular adipose tissue (IMAT) (p < 0.001), while boys had more lean and musculoskeletal mass. Body fat percentage was significantly correlated with muscle echo intensity (EI corrected: R² = 0.264, p < 0.001; EI uncorrected: R² = 0.242, p < 0.001) and with IMAT (R² = 0.268, p < 0.001). These associations were stronger in girls. Linear models identified body fat and BMI percentile as key predictors of muscle quality indicators (p < 0.001). Conclusions: This study found that higher body fat in children and adolescents with overweight or obesity is linked to poorer muscle quality, and especially increased echo intensity and intramuscular fat. Ultrasound proves useful for early, non-invasive detection of musculoskeletal changes, emphasizing the need to assess both muscle size and quality. Full article

Full-thickness skin grafts are a cornerstone in reconstructive surgery for extensive skin defects, particularly in pediatric patients, where rapid vascularization is essential for successful engraftment. Traditional defatting methods using scalpels and scissors are labor-intensive and increase the risk of graft or operator injury. To improve efficiency and safety, a mechanical defatting device called LOMA (named after the inventors Loff and Maja) was developed at Klinikum Stuttgart. This study evaluates the first 28 transplants performed with it, assessing graft outcomes using the POSAS and comparing physical properties of the grafts with those of healthy contralateral skin, ankle skin, and palmar skin using DermaLab Combo’s ultrasound and elasticity probes. Results showed that grafts prepared with LOMA exhibited similar physical characteristics to contralateral healthy skin. Differences in elasticity were observed when compared to ankle skin, and significant disparities were found when compared to palmar skin. POSAS scores averaged 3.3 from patients and 2.2 from physicians, indicating satisfaction with functional and aesthetic outcomes. The findings support the effectiveness of full-thickness skin grafts, particularly when prepared using the LOMA system. Further multicenter studies are recommended to compare LOMA-prepared grafts with those using conventional techniques to quantify the added value of this mechanical defatting approach. Full article

Background: The Mediterranean diet is widely recognised for its health benefits and remains a key reference point in shaping dietary guidelines across populations. Despite its growing international relevance, there is a lack of validated tools assessing Mediterranean diet adherence among children and adolescents in Central and Eastern Europe. Methods: The present study aimed to adapt and validate the KIDMED 2.0 questionnaire for use in Polish children and adolescents aged 10 to 18 years (KIDMED 2.0 PL). The adaptation process involved forward–backward translation, expert consultations, and pilot testing to ensure linguistic and cultural relevance. A total of 102 participants completed the questionnaire twice over a two-week interval, and anthropometric data were collected. Results: The KIDMED 2.0 PL demonstrated high test–retest reliability (Spearman’s ρ = 0.876; p < 0.001) and strong criterion validity, with a significant negative correlation between KIDMED scores and BMI centile (ρ = −0.854; p < 0.001). Children with normal weight showed the highest adherence to the Mediterranean diet, while scores were significantly lower in overweight and obese participants. Item-level analysis indicated that fruit and vegetable consumption was relatively frequent, whereas intake of legumes, whole grains, and extra virgin olive oil remained low. Conclusions: The KIDMED 2.0 PL is a valid and reliable tool for evaluating diet quality and Mediterranean dietary adherence in the Polish pediatric population. Full article

Background/Objectives: Increased blood pressure variability (BPV) was found in adults with primary (essential) hypertension (PH) and is associated with increased cardiovascular risk. Our study aimed to analyze the relation between BPV and low-grade inflammation in children with primary hypertension. Methods: In 56 treatment-naive pediatric patients with PH (15.1 ± 2.1 years) and 30 healthy children (14.9 ± 1.4 years), we evaluated BPV: BP dipping, standard deviation (SD) of ambulatory blood pressure measurements (ABPMs), pulse pressure (PP)/systolic blood pressure ratio (24 h PP/SBP), rate–pressure index (24 h RPI), 24-h weighted BPV (24 h WSBPV, 24 h WDBV, 24 h WMAPV), coefficient of variation (24 h CoVSBP, 24 h CoVDBP, 24 h CoVMAP), ambulatory arterial stiffness index (AASI), and morning BP surge. We also analyzed indices of subclinical inflammation (markers derived from complete blood count, high-sensitivity C-reactive protein (CRP), interleukin 18), and office and ambulatory BP. Results: Patients with PH had significantly higher hsCRP, neutrophils, monocytes, and platelets, neutrophil-to-lymphocyte (NLR), platelet-to-mean platelet volume (PMPVR), and lower monocyte-to-neutrophil (MNR) ratios, and higher BPV: 24 h ABPM SBP SD, 24 h ABPM MAP SD, 24 h RPI, 24 h WSBPV, 24 h WDBV, 24 h WMAPV, and 24 h CoVSBP. Low-grade inflammation markers correlated with BPV indices in both groups. In multivariate analysis, MNR predicted 24 h ABPM MAP SD (beta = 0.290, 95CI: 0.029–0.551), 24 h RPI (beta = −0.348, 95CI: −0.587–−0.108), and 24 h WDBPV (beta = 0.286, 95CI: 0.032–0.540); monocyte count—24 h RPI (beta = 0.281, 95CI: 0.041–0.521), and hsCRP—24 h WDBV (beta = 0.310, 95CI: 0.055–0.564). ROC analysis revealed a good diagnostic profile for lymphocyte count as a positive determinant of non-dipping status in PH children (cut-off point 2.59 [×10³/µL]). Conclusions: BPV is higher in children with PH compared to healthy peers and is associated with low-grade inflammation. MNR may be the most helpful indicator of BPV, whereas high lymphocyte count predicts the best non-dipping status in these patients. Full article