Journal of Comprehensive Pediatrics
Volume:15 Issue: 3, Aug 2024

Previous evidence suggests that exposure to organochlorine pesticides (OCPs) may contribute to the development of type 2 diabetes.

The relationship between OCPs and type 1 diabetes (T1D) in children and adolescents is not well understood. We aimed to explore the association between organochlorine pesticide levels and T1D in this population.

In this case-control study, we included 147 newly diagnosed T1D cases and 147 healthy controls. Spot urine samples were collected from children under 15 years old in both groups to measure organochlorine pesticide levels. We analyzed six OCPs: β-HCH, heptachlor, aldrin, heptachloro epoxy, α-endosulfan, and p,p'-DDD, categorizing them into tertiles. We examined the relationship between urinary OCP levels and T1D, adjusting for age, sex, duration of breastfeeding, Body mass index (BMI), family history of diabetes, and five dietary patterns.

The average urinary concentration of p,p'-DDD was significantly higher in cases than in controls (0.15 (0.07 - 0.3) vs. 0.09 (0.04 - 0.2) μg/g creatinine, P < 0.001). After adjustments for age, sex, breastfeeding duration, BMI, family history of diabetes, and dietary patterns, a significantly positive association was observed between the highest levels of p,p'-DDD, and T1D (odds ratio (OR) = 4.9; 95% confidence interval (CI): 2 - 12.3). Additionally, participants in the middle tertile of urinary β-BHC had a higher OR for diabetes compared to those in the lowest tertile (OR = 2.9; 95% CI: 1.2 - 6.8). No association was found between other OCPs and T1D.

These findings highlight a potential role for p,p'-DDD, and β-BHC in the development of T1D, urging further investigation into the mechanisms of this association and potential preventive strategies in this area.

Congenital heart defects (CHDs) are among the most common birth disorders worldwide. Human research has produced mixed results regarding the impact of zinc on this population. Children with CHD often exhibit hyperparathyroidism and vitamin D deficiency.

This study aims to assess the levels of serum vitamin D and zinc in children with CHD and compare them to those of a control group.

In this case-control study, we included children with CHD (N = 53) who were admitted to Bandar Abbas Children's Hospital from June 22 to December 21, 2018. The study's inclusion criteria were an age range from one month to 14 years and a CHD confirmation via echocardiography. A control group of children without CHD (n = 53) was also evaluated. We collected demographic information from participants and took 4cc blood samples from the children to measure their serum levels of vitamin D and zinc.

The study found no significant difference in serum vitamin D levels between the two groups (P = 0.242). However, the mean serum zinc level was significantly lower in CHD patients compared to the controls, indicating a moderate effect size (SMD = -0.67, 95% confidence interval [CI] -1.06 to -0.28). The frequency of deficiency and insufficiency in serum vitamin D levels was similar between both groups (P = 1.000 and P = 0.767, respectively). Nevertheless, CHD children were 4.31 times more likely to suffer from zinc deficiency than the control group (OR = 4.31, 95% CI 1.52 to 13.31). Moreover, a simultaneous insufficiency of zinc and vitamin D levels was observed exclusively in CHD children (P = 0.006).

The study observed a zinc deficiency in children with CHD, while no significant differences were found in the deficiency and insufficiency of serum vitamin D levels between children with CHD and the control group. Future longitudinal studies are necessary to verify these findings.

Since the start of the Coronavirus disease (COVID-19) pandemic, people have had to cope with significant mental pressure regarding this mysterious infection. The rapid spread of syndrome coronavirus 2 (SARS-CoV-2) worldwide has led to immense anxiety and depression among people, especially in the immunocompromised population and their close relatives. This study aims to evaluate the mental health of patients with primary immune deficiency (PID) and their mothers during the first year of the COVID-19 outbreak. A cross-sectional study was conducted from September 2020 to March 2021 among pediatric patients with PID and their family members. Thirty PID patients and their mothers were investigated using the Zung Self-Rating Anxiety Scale and Beck Anxiety Inventory (BAI), respectively. The results showed that mothers of younger PID patients experienced higher levels of anxiety (P-value = 0.019). Additionally, PID patients who did not comply with quarantine measures had significantly higher anxiety levels (P-value = 0.02). The results indicate mild to moderate anxiety in PID patients aged 12.1 ± 1.46 years during the first year of the COVID-19 outbreak. Furthermore, there was mild anxiety observed in mothers of PID patients. Non-compliance with quarantine measures significantly contributed to higher anxiety scores in both groups, emphasizing the importance of staying home and adhering to restricted social interactions to improve mental health.

 Functional constipation (FC) is a common issue in pediatric healthcare, causing significant physical and emotional distress for patients and their families.

 This study aimed to investigate the prevalence of behavioral issues in children diagnosed with functional constipation, exploring their characteristics and relationship with various factors.

 We conducted a case-control study involving 107 children and adolescents (aged 2 to 18 years) with chronic functional constipation as the case group and 107 children without this condition as the control group. The Strengths and Difficulties Questionnaire (SDQ) was employed to evaluate different aspects of behavioral patterns.

 The comparison of various behavioral components assessed by the SDQ between the case and control groups revealed significantly higher average scores for emotional symptoms (0.85 ± 0.81 vs. 0.55 ± 1.03, P = 0.019), peer relationship problems (1.76 ± 2.23 vs. 0.76 ± 1.18, P = 0.001), and prosocial behavior (8.12 ± 1.87 vs. 7.42 ± 1.64, P = 0.002) in children with chronic functional constipation. Within the chronic constipation group, peer relationship issues were more common in boys, whereas girls exhibited more problems with prosocial behavior. Moreover, issues related to hyperactivity/inattention and prosocial behavior were more frequent in older children with chronic constipation.

 Chronic functional constipation in children is strongly associated with behavioral changes and problems, which are influenced by the demographic and anthropometric features of the patients.

 Hypercalcemia, although less prevalent, is a critical diagnosis in pediatric patients, consisting of numerous etiologies that differ significantly from those in adults. In children, congenital causes are more prevalent. The differential diagnosis of hypercalcemia encompasses a broad spectrum of etiologies; however, up to 90% of all cases are diagnosed with either primary hyperparathyroidism or malignancy. Primary hyperparathyroidism predominates in ambulatory patients, while malignancy is more common among critically ill hospitalized patients.

 This review addresses several important issues related to calcium metabolism and hypercalcemia:a) Overview of Calcium Metabolism
b) Factors affecting serum total and ionized calcium concentration
c) Clinical manifestations and importance of Hypercalcemia in pediatric patients
d) Overview of the causes of Hypercalcemia in pediatric patients
e) Overview of Hypercalcemia management

 A literature search was conducted for articles published from 2000 to 2024 using PubMed, Scopus, Web of Science, Cochrane, and Embase databases. The keywords used were: CALCIUM, Calcium metabolism disorders, hypercalcemia, Parathyroid hormone, Vitamin D, and acid-base imbalance.

 This study provides a review of calcium metabolism and factors affecting total and ionized calcium concentrations, along with a definition of hypercalcemia, classification of its severity, its clinical manifestations, and a comprehensive overview of hypercalcemia etiologies categorized into parathyroid hormone (PTH)-related and unrelated causes. An overview of its management is also included.

 Hypercalcemia is an important disorder in both pediatric and adult patients. Before initiating a workup for hypercalcemia, it is crucial to understand the physiology of calcium and the factors affecting its serum concentrations. The etiologies of hypercalcemia in pediatric patients have a wide spectrum of differential diagnoses; primary hyperparathyroidism and malignancies account for 80-90% of all hypercalcemia cases found in clinical practice. Genetic and syndromic causes are usually more prevalent in pediatrics due to the nature of these conditions. Managing hypercalcemia requires two simultaneous approaches: first, measures aimed at lowering serum calcium concentrations and second, a workup for the underlying cause.

 The Lung Clearance Index (LCI) serves as a non-uniform ventilation index utilized for monitoring pulmonary function in patients with cystic fibrosis (CF). Lung Clearance Index exhibits higher sensitivity compared to forced expiratory volume in 1 second (FEV1) for early detection of lung disease and does not necessitate active patient cooperation, as required for FEV1 measured through spirometry. Presently, FEV1 is the standard parameter employed for monitoring lung function in CF patients.

 The objective of this study was to assess the correlation between LCI and FEV1 in patients with cystic fibrosis.

 This cross-sectional study enrolled children aged 6 to 18 years with confirmed CF diagnosis, who were referred to the CF clinic at Children's Medical Center Hospital (Tehran, Iran). Participants completed consent forms and subsequently underwent pulmonary function tests. Lung Clearance Index was calculated using the exhaling-D device via the Multiple Breath Washout (MBW) method, followed by FEV1 assessment through spirometry.

 The study included 52 patients with an average age of 12 years, among whom 52% were males. The mean ± standard deviation of FEV1 and LCI were 80.2% ± 25.3 and 8.9 ± 2.8, respectively. A significant inverse relationship was observed between these two parameters in the study (r = -0.49, P = 0.001).

 These findings further underscore the potential utility of LCI, which offers ease of administration and demonstrates high reliability and accuracy compared to FEV1 for monitoring pulmonary function in CF patients.

 The 2019 global coronavirus pandemic is triggered by severe acute respiratory syndrome due to corona virus 2 (SARS-CoV-2). This infection can cause myocardial damage, arrhythmias, acute coronary syndrome, and venous thromboembolism.

 The objective of this study is to provide a comprehensive description of the cardiac manifestations observed in children who have been admitted to the pediatric intensive care unit as a result of SARS-CoV-2 infection.

 The current prospective cross-sectional study included patients from Minia University Hospital's pediatric intensive care unit (PICU) isolation unit from April 2022 to April 2023. The study comprised 80 patients divided into two groups: Group I included 46 Corona Virus Induced Disease (COVID-19)-positive patients with cardiac complications. Group II consisted of 34 patients with COVID-19 infection but without cardiac complications.

 The frequency of cardiac complications was 41.3% (33 children) with arrhythmias and 9% (3 children) with SVT by electrocardiography (ECG), whereas 31.3% of children had myocardial dysfunction (EF < 50%, FS < 25%) on echocardiography (ECHO). In comparison, 7.5% had bundle branch block (BBB). Conversely, 1.3% had pancarditis, and 3.8% had first-degree A-V block.

 More data is needed on COVID-19's cardiovascular effects on children. We found that acute COVID-19 hospitalized children should have cardiac exams and cardiovascular monitoring. COVID-19 infection in children often impairs systolic function, and arrhythmia may arise in COVID-19 individuals.

 Kawasaki disease is an idiopathic febrile systemic vasculitis, recognized as the leading cause of acquired heart disease in pediatric patients. Gastrointestinal manifestations can lead to delayed treatment, underscoring the importance of identifying and predicting factors associated with these manifestations to enable timely intervention.

 The primary objective of this study was to identify the aforementioned factors.

 This retrospective study collected demographic information, medical history, physical examination findings, and laboratory results of 359 children suspected of having Kawasaki disease and referred to Mofid Children’s Hospital between 2013 and 2022. The study assessed the frequency of gastrointestinal manifestations and their association with physical examination findings and laboratory data.

 A total of 359 patients were included in the study, comprising 153 males and 206 females. The mean age of participants was 2.8 ± 2.6 years. Abdominal pain was the most common clinical manifestation, reported in 39% of patients. Elevated levels of aspartate aminotransferase (AST) were observed in 38.1% of patients, while 30.2% showed elevated alanine aminotransferase (ALT) levels, and 10.5% exhibited direct hyperbilirubinemia. Patients with elevated ALT and AST levels had a higher incidence of abdominal pain, nausea/vomiting, and anorexia. Moreover, patients with positive findings of red blood cell (RBC) and white blood cell (WBC) in their stool examination had a higher incidence of fever and abdominal pain.

 Based on our statistical analysis, elevated AST and ALT levels, hyperbilirubinemia, and positive stool findings of RBC and WBC appear to be predictive factors for gastrointestinal manifestations in Kawasaki disease.