Journal of Pediatrics Review
Volume:9 Issue: 1, Jan 2021

Context: 

Asthma is a chronic inflammatory respiratory disorder, and nutritional conditions affect allergic diseases such as asthma. This study aims to find the relationship between maternal gestational vitamin D levels and asthma progression and wheezing in children later in life. 

Allergic disorders are common everywhere in the world. Asthma is the most chronic inflammatory respiratory disorder among children. It causes significant morbidity and mortality in children as well as adults. Vitamin D deficiency or insufficiency, is a global problem. Vitamin D has immunological effects, and it may prevent autoimmune diseases. Maternal plasma vitamin D during pregnancy has a different impact on children’s allergic disorders.

Evidence Acquisition:

 This is a review article. We searched databases, including Google Scholar, PubMed, SID, IranDoc, Scopus, until now. The keywords for the search included maternal vitamin D, asthma, wheezing, children, and pediatric. We searched in the mentioned databases until March 2020. Full-text articles in the English language were included in this study.

A few articles were found in our search. All of them were cohort studies. They evaluated maternal vitamin D and its outcomes in their children’s asthma and wheezing using questionnaire data and serum samples. After assessing the articles (more than 100), 15 papers were included in our review. Six and four articles showed that higher maternal vitamin D levels reduce children’s asthma and or wheezing, respectively. In contrast, 7 articles showed no association between maternal vitamin D and children’s asthma or wheezing. Vitamin D does not have any serious side effects. Because the articles were heterogenic, a meta-analysis could not be done.

Administering vitamin D supplements or food enriched vitamin D during pregnancy has different effects on the prevalence of wheezing and or asthma in children.

Context: 

Using various pesticides to control pests and vectors of diseases has a long history in households worldwide. However, most pesticides are considered toxic to and harmful to the environment. 

Evidence Acquisition:

 Electronic databases such as Google Scholar, PubMed, and Scopus were searched using the following search terms: “children”, “pesticide residues”, “risks”, “leukemia”, and “brain neoplasms”. This review was designed to identify the relevant electronic studies published from January 2000 to February 2020.

Children are more susceptible to pesticides because of their underdeveloped metabolic processes and disability to detoxify chemicals. Over 30% of the children’s diseases are due to environmental factors, including pesticides. The possibility of children’s pesticide exposure inside of urban houses is more than outside. In general, children can be exposed to pesticides in two ways: Direct and indirect contact. Direct contact refers to hand-to-mouth behavior in daily plays that absorbs household pesticides. Indirect contact refers to exposure via their parents’ work in hazardous environments and during pregnancy. There is a significant association between pesticide exposure via households and some cancers in children, such as leukemia and brain tumors.

Due to the positive association between pesticide residues in households and the risk of cancers in children, public health policies must be adopted to minimize children’s exposure to pesticides in the urban household.

Context:

 Chronic airway inflammation in asthma is affected by a complex network of interacting cytokines. The exact role of each cytokine in childhood asthma development has remained poorly understood. In this study, we aimed to review articles investigating cytokine levels and polymorphisms in childhood asthma among the Iranian population to assess susceptible cytokines related to childhood asthma.

Evidence Acquisition: 

We performed a literature search in PubMed, Scopus, Science direct, and Embase databases to find articles that have evaluated the cytokine levels and gene polymorphisms in childhood asthma among the Iranian population until March 2, 2020. The terms used to search included “cytokine”, “interleukin”, “polymorphism”, “Asthma”, and “Iran” in the international databases. Only case-control studies with a healthy control group that investigated cytokine levels and polymorphism in childhood asthma among the Iranian population have been included.

Considering these criteria, we extracted 7 articles from international databases and included them in the current review. We investigated 4 cytokine levels and 4 cytokine polymorphism patterns in asthmatic and non-asthmatic subjects in Iran. Interleukin (IL)-23, IL-17, and IL-33 levels were statistically higher in asthmatic children, and also IL-33, IL-17 levels were associated with asthma severity. There were no significant differences between healthy and asthmatic subjects regarding IL-35 levels. Polymorphisms in cytokine IL-4, IL-10, tumor necrosis factor (TNF)-α, and IL-2 were susceptible to childhood asthma in the Iranian population. 

Increased IL-33 and IL-17 levels were related to disease severity in childhood asthma. Four cytokine polymorphisms (IL-4, IL-10, IL-2, and TNF-α) were associated with the risk of pediatric asthma in the Iranian population.

Context: 

Early marriage is relatively common in the world and has become a public concern. One of the problems seen in early marriage is the high prevalence of partner violence against women, which, along with other harmful effects of early marriage, can hurt a woman’s mental and physical health. This research is the first narrative review investigating the most prevalent type of intimate partner violence and the risk factors for violence against women who marry as a child. 

Evidence Acquisition: 

A skim and scan review related to the correlation between child marriage and any type of intimate partner violence was done. Also a comprehensive search of the Web of Science, PsycINFO, PubMed (MEDLINE), Scopus, and Google Scholar was carried out from 2000 to 2019. A comprehensive search of the Web of Science, PsycINFO, PubMed (MEDLINE), Scopus, and Google Scholar was carried out from 2000 to 2019. The second stage of the search was conducted in grey literature. To facilitate a systematic approach, we adopted the PECO framework.

The database search yielded 756 articles relevant to child marriage and different types of intimate partner violence, with other articles added in a manual review of reference lists. In the final review, a total of 12 articles were included as they contained the eligibility criteria. The result of this narrative review study showed the relationship between child marriage and intimate partner violence. 

ince the present study considers physical and sexual violence the most common type of violence against women and other studies have explicitly pointed to the adverse consequences of such violence, it seems necessary to make efforts to reduce early marriage by providing economic opportunities and promoting education and as a result to avoid adverse effects, including partner violence.

Context:

 Fluoride is a necessary element for bone growth and the prevention of dental caries. Diet and dentifrices are the most significant sources of fluoride exposure in children. The concentration of fluoride differs in various types of foods. Although at optimal levels, fluoride has beneficial effects on dental health, in high concentrations, it has some adverse effects, such as structural and functional defects in organs like the kidney and interference with thyroid function. High doses of fluoride can lead to fluoride toxicity, affecting different parts of the body like teeth. Our study aimed to review the previous studies on fluoride toxicity and provide relevant information to dentists and specialists about fluoride safety in children. 

Evidence Acquisition: 

The data we used in our review were found from articles published until 2019 and collected from official web pages and documents published from different international institutions. Topics discussed in this review were dietary intake of fluoride, fluoride metabolism, history of fluoride use, mechanism of fluoride action, overuse, and toxicity of fluoride. After the abstract screening, we reviewed relevant studies for full-text review.

Fluoride is generally found in the human daily diet. There are different sources of fluoride, such as fluoride supplements or fluoride dentifrices. Fluoride also has a topical protective effect against teeth decay. Ingestion of high doses of fluoride in a short time can lead to fluoride poisoning. Emergency treatment is needed when the toxic dose of 15 mg/kg has been exceeded. This problem usually happens in children while using products such as fluoridated toothpaste for oral hygiene; this illness can threaten their overall health.

Fluoride can damage organs such as the liver and kidney as the principal organs susceptible to toxicity induced by fluoride. Although the intake of high doses of fluoride has some adverse health effects, its topical use is considered safe. Fluoride can improve children’s dental health in different ways and prevent caries.

Context: 

Based on current literature, there is no consensus regarding the proper emergency management of Pediatric Acute Ischemic Stroke (P-AIS). In other words, there are lots of considerable controversies in this regard. Therefore, the current review was conducted to provide a more comprehensive discussion on this topic. 

Evidence Acquisition: 

The search was conducted using the terms “pediatrics”, “stroke”, and “recombinant tissue plasminogen activator” in the PubMed database. English papers on the management of P-AIS published after 2000 were selected. An expert panel performed a critical appraisal to summarize the findings and make them applicable. Finally, the extracted data were categorized under proper subheadings, and the manuscript was prepared.

The related papers provided limited evidence on this topic. All extracted findings were categorized as follows: etiology and the underlying diseases, clinical presentations, diagnosis, management (thrombolytic therapy and thrombectomy), and outcome.

Although thrombolytic therapy is recommended in P-AIS, most cases are diagnosed outside the therapeutic window, so P-AIS is practically impossible, and they are candidates for mechanical interventions. On the other hand, the proper device may not be available to fit the size of the younger children’s vasculature.

Context: 

Henoch-Schonlein purpura (HSP) is a significant cause of chronic renal disease in children. This review determines some risk factors associated with renal involvement in childhood HSP. 

Evidence Acquisition:

 Electronic databases, including Google Scholar, PubMed, and Scopus were searched using the following keywords: “children”, “Henoch-Schonlein”, “risk factor”, “renal involvement”, and “IgA vasculitis”. This review was designed to identify the relevant electronic studies published in the English language from December 1998 to August 2018.

This review revealed that clinically older age at presentation, persistent rash, atypical rash, rash on unusual location, and gastrointestinal bleeding were significant risk factors for renal involvement. In contrast, joint involvement was not associated with renal involvement. Among biochemical markers, high red blood cell distribution width is a risk marker of renal involvement in HSP. In contrast, peripheral blood immunoglobulin A, antinuclear antibody, anti-streptolysin O titer, erythrocyte sedimentation rate, and C-reactive protein were not associated with renal involvement. In several studies, leukocytosis, thrombocytosis, or thrombocytopenia have been mentioned as predictors for renal involvement. Still, other studies showed the white blood cell count or platelet count are not risk factors. The effect of corticosteroids as a predictive factor of renal involvement in HSP is challenging and controversial. Furthermore, their impact was dose-dependent.

Demographic factors, clinical features, and some abnormal laboratory findings are significant predictive factors for renal involvement in HSP.

Melanocytoma is a rare benign stationary tumor that usually appears as a pigmented lesion on the optic disk. Optic Disc Melanocytoma (ODM) can compress the optic nerve or undergo necrosis, leading to ischemic axonal loss and visual field defect, similar to those caused by glaucoma. Also, ODM often displays a clinical diagnostic dilemma due to its similarities with melanoma. Some patients have undergone enucleation because of uncertainty between both pathologies. Progressive growth and malignant transformation can be documented by close monitoring of the patient’s eyes. Fundus examination and ancillary imaging procedures such as fundus photo, autofluorescence, B-scan ultrasonography, fluorescein angiography, and spectral-domain optic coherence tomography are powerful tools for ODM diagnosis and management. 

A 19-year-old female presented with a decrease in vision in the left eye for about 3 months. Her visual acuity was 20/20 and 20/80 in her right and left eyes, respectively. Funduscopic examination of the left eye showed a well-defined deeply pigmented brownish-black, dome-shaped nodular mass covered the entire optic disc with the normal-appearing overlying vitreous, macula, and surrounding retina. Short-wave autofluorescence revealed hypo-autofluorescence on the pigmented mass lesion. The patient’s condition did not change significantly over 2 years of follow-up. The diagnosis was made as ODM.

Melanocytomas grow very slowly over several years or remains stable, in contrast to malignant melanoma. Although ODM tends to have benign behavior, it may adversely affect visual function. Yearly fundus examination is necessary for monitoring growth and detecting malignant transformation. Visual loss can result from optic neuropathy or retinal vascular obstruction. In suspicious cases, close follow-up with serial fundus photographs is essential, even though the malignant transformation is exceptional.

Cyclic Vomiting Syndrome (CVS) is an idiopathic disorder, identified by recurrent stereotypic episodes of severe nausea and vomiting and intervals of normal health between episodes. There is no specific diagnostic test for CVS, and clinical features are relied on for diagnosis. Many medications have been used to treat CVS, such as antiemetic, anti-migraine, and sedative medications. Nevertheless, treatment is difficult in some resistant cases.

We report a child with frequent and intensive vomiting episodes after an asymptomatic 2-year period. The patient was unresponsive to many medications but was successfully treated with chlorpromazine and then controlled using olanzapine, followed by aripiprazole. We also performed a brief literature review related to this case report in international databases.

Since CVS management has remained challenging to the clinician in the severe and resistant patients, the empiric treatment of CVS is recommended.

Childhood diarrheal diseases are common with mild-to-severe mortality rate worldwide. Lower-middle-income countries (LMICs), including Bangladesh in South Asia, are still unable to save their under-5 lives due to diarrheal conditions.

The main aim of this study was to evaluate the duration of hospital stay and use of antibiotics in under-2 children with moderate diarrhea in Bangladesh. 

This study was done on hospitalized 6 months to 2 years old pediatric patients (n=212) with an uncontrolled moderate type of diarrhea in 3 districts of Bangladesh. Based on the history of diarrhea onset, 133 and 79 patients were allocated in the early hospitalization (EH) and delayed hospitalization (DH) groups, respectively.

To treat uncontrolled diarrhea at home, antibiotic therapy was initiated in 36.7% of patients in the DH group without any valid prescription, whereas only 7.5% of patients in the EH group received antibiotics (P<0.05). In the DH group, 67.1% of children received different antibiotic therapies for treating their diarrhea with or without other hospital-acquired infections during their extended hospital-stay period, resulting in antibiotic-associated adverse events (AAAEs) in 17.7% of the patients. At the same time, 21.1% of the patients in the EH group received antibiotics that caused AAAEs in 2.2% of them (P=0.001). The EH group, who received doctors’ consultations and hospitalized within 2 days of the onset of diarrhea, stayed in the hospital for a maximum of 4 days. It was less than half a time that of the children in the DH group (P<0.05) (stayed for a maximum of 10 days), who visited doctors and admitted to hospitals at a later stage of diarrheal-onset.

Early doctor visits and hospitalization of under-2 children with uncontrolled moderate diarrhea may reduce the severity of the disease and risk of severe acute malnutrition, minimize the use of antibiotics with minimum chance of occurrence of adverse drug events, and cause early discharge from hospital.