Journal of Pediatrics Review
Volume:9 Issue: 3, Jul 2021

 The prevalence of childhood obesity and its complications has increased in the world. Obesity, along with a lack of antioxidants, as a result of an unhealthy diet, might modify the balance in favor of oxidative stress.

 The current study aims to assess current literature on the relationship between obesity and antioxidant status through systematic review and meta-analysis.
Data Sources: This systematic review and meta-analysis study was performed on English language full-text articles published until September 2020 without any time limit. Electronic search was conducted in international databases of Google Scholar, Pub Med, Web of Science, Scopus, Medline, and Cochrane.

Study Selection:

First1255 papers were found in the primary search, after removing duplicates and quality assessment 46 of them were used in the systemic review and 19 articles were entered into the meta-analysis.

Data Extraction:

Two independent researchers searched the following keywords: Vitamin C, Vitamin E, Vitamin A, Carotenoids, Antioxidants, Selenium, Magnesium, Copper, Zinc, Ascorbic acid, Tocopherol, Obesity, Overweight, Childhood, Pediatric, and Adolescence. Articles that examined the association between obesity and antioxidant status were included in the study. Articles research on animal, interventional studies, case studies, case reports, irrelevant studies were excluded. The research team determined the quality of studies using the checklist on strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Heterogeneity of studies was evaluated using index (I2) and probability of diffusion bias by funnel plot and Begg’s and Egger’s tests.

 Beta-carotene levels children was significantly lower in obese children than non-obese (Mean difference: 0.13, 95% CI: 0.09-0.16, P-value<0.001), with significant heterogeneity (P-value< 0.001, I2 = 85%). There was a significant difference between obese and non-obese children in both alpha-tocopherol (pooled mean difference respectively: 0.36, 95% CI: 0.04-0.96, P-value<0.001) with non-significant heterogeneity (P-value>0.05, I2 = 0.0%) and alpha-tocopherol per lipoid (pooled mean difference: 0.42, 95% CI: 0.28-0.55, P-value<0.001), with significant heterogeneity (P-value=0.048, I2=58.8% ). There was no significant association between vitamin E level and obesity (Pooled mean difference: 0.40, 95% CI: -0.05-0.85, P-value>0.05), with significant heterogeneity (P-value< 0.001, I2 = 84.5%). There was significant association between Zinc, Magnesium, Copper, and selenium level and obesity (P-value>0.05), with significant heterogeneity (P-value< 0.001).

 This review revealed significant inverse relationship between childhood obesity and serum antioxidant levels. More studies are necessary to find the underlying mechanisms and clinical impacts of this finding.

Context:

Congenital hypothyroidism is the most common congenital disorder of the endocrine system, which can lead to preventable mental retardation.

We aimed to evaluate the current status of congenital hypothyroidism information registry systems.

Data Sources:

In this systematic review, the databases Scopus, science direct ProQuest, PubMed, as well as the search engine Google scholar (no restriction on date of publication) up to 2020, were searched. Inclusion criteria were the Articles with the English language that examining information registry systems on congenital hypothyroidism. Articles whose full texts were not accessible, case reports, and letters to the editor had to be excluded. In order to selection of relevant studies, the retrieved articles were accordingly screened based on the inclusion and exclusion criteria.

Study Selection:

in this systematic review 290 papers identified. A total of 254 articles were screened, of which 17 qualified articles were selected.

Data Extraction:

Two authors used the data extraction form to independently extract relevant data from included studies. Disagreements between authors were reconciled through discussion and consensus.

The results of this study showed that the main goal of nearly half (50%) of the information registry systems for congenital hypothyroidism is to evaluate the efficiency and effectiveness of the screening program. Other information registry systems for congenital hypothyroidism work with the aim of examining the epidemiology of disease in 4 studies (23.6%), monitoring iodine deficiency 3 studies (18%), surveillance disease 1 study (6%) and describing the clinical and familial features of the patient 1 study (6%).

Few studies have been done on the development of an information registry systems, and most studies have focused on the use of information systems in this field. Further Comprehensive reviews are recommended to investigate the infrastructure to commission national registry and world network to record information units on congenital hypothyroidism.

Context:

Street children may expose to high-risk behaviors such as unwanted pregnancy, abortion, and sexually transmitted diseases (STDs).

This study aimed to systematically review and present preventive strategies for promoting the sexual and reproductive health (SRH) in domains such as unsafe abortion, STDs, and unwanted pregnancy in the street children.  

Data Source and Selection:

In this systematic review databases such as ScienceDirect, Web of Science [ISI], PubMed, Scopus, Scientific Information Database [SID] and Google Scholar were searched. Published articles between 1990 and 2020 were retrieved. Finally, 41 articles were used to compile the results of this study.

Data Extraction:

Data were extracted from the articles according to the selection criteria by two independent reviewers.

A total of 1522 potentially relevant articles were identified, 275 articles were removed due to the duplication and in abstract screening, 766 articles did not meet inclusion criteria or did no focus on research question. 481 remained articles were screened for full-text and studies which were published each language expect English and Persian, studies presented in conferences and also studies which have no information regarding the SRH among street children were removed. Finally, 41 studies were included in this systematic review. Results of this study were categorized into 2 main tables. In table 1, the SWOT of SRH in street children was shown and in table 2, preventive strategies regarding unwanted pregnancy, unsafe abortion, and STDs in the street child were systematically presented in four categories such as expansion program and promotion of educational services, 2- expansion program and promotion of educational services, 3- Creating secure umbrella and social welfare and 4- expansion program and promotion of social protection. 

In conclusion, due to the lack of information on street children regarding SRH, the government should consider adequate sexual education programs such as protected sexual intercourse and counseling on the prevention of STDs and also unsafe abortion. Considering the affordable, accessible healthcare centers and facilities with providing services with no judgment for these children is an important action.

Context: 

One of the human desires is to treat childrenchr('39')s sensorineural hearing loss with stem cell transplantation. Preclinical studies have been performed in this field and the stem cell types have been tested and achieved relative improvement.

Evidence Acquisition:

This narrative review has been prepared about hearing regeneration with stem cell transplantation. The articles with Full-text and English Language have been searched in PubMed, Scopus, and google scholar from 2000 through 2020 using keywords of sensory neural hearing loss and stem cell.

In 2018, the first human study was performed with stem cells from the human umbilical cord, which has promising results in terms of the safety of the method and the positive effect on hearing.

 Autologous stem cell transplantation had induced noticeably relative improvement without serious adverse events in children with acquired sensorineural hearing loss. to obtain more evidence, requires further studies with larger sample sizes and population groups.

 Drug allergy is a subtype of Adverse Drug Reactions (ADR) mediated by the immunologic system. Extreme drug allergy is poorly known in children that contribute to the hospitalization in our region.

 This research aimed to study major drug hypersensitivity reactions in the north of Iran among hospitalized children.

 This corss-sectional study conducted at the Bou Ali Sina hospital, north of Iran, analyzing the medical history of 140 children with drug allergies from 2014 to 2018. Inclusion criteria were based on the DRESS scoring system, and those who scored more than four were enrolled. Patients with incomplete medical charts were excluded. The sampling methodology was based on the consecutive census.

 In the current study, 62 patients were females (44.29%), and 78 were males (55.71%). Ninety-six cases (68.57%) were children under five, and 44 cases (31.43%) were over five years old. Most ADRs were seen in patients from urban areas (58.57%)  than in rural areas (41.43%). In 82.6% (116 children) of these patients, maculopapular rashes were seen. Phenobarbital and cefalexin had the highest levels of drug reactions, including 55.19% of patients (85 persons) and 11.69% of patients (18 persons), respectively. Pruritus, fever, and scaling were the most common symptoms observed in patients. The most commonly used treatment was antihistamines.

 The most causative medication inducing ADR was phenobarbital. The maculopapular rash was the most common skin manifestation, and there were no relationship between sex, age, medication type, and type of hypersensitivity reactions.

Digital clubbing as the initial presentation of lymphoma is rarely reported, particularly in children. In this study, we report an intrathoracic Hodgkin lymphoma patient with digital clubbing as the first presentation and we will review the current literature regarding the same condition.

A 10-years-old boy presented with a 2-month history of cough, mild dyspnea and night sweats, with obvious digital clubbing. A chest X-ray and a computed tomography (CT) scan of the chest showed multiple mediastinal mass. Lymph node biopsy was done. Pathology determined a diagnosis of nodular sclerosis Hodgkin lymphoma.

In patients with digital clubbing, intrathoracic malignancies should be considered as a differential diagnosis and must be ruled out by precise examination and paraclinical help.

The major concern about familial pulmonary arterial hypertension (FPAH) is the development of the right heart failure which ultimately leads to a sudden death. Despite recent advances in pharmacological therapy, the mortality rate in children is still high, emphasizing the importance of novel treatments. Moreover, there is yet no definitive treatment for children with severe pulmonary hypertension. The consequences of right heart failure led to the proposal of a surgical approach, the Potts shunt, to decompress the right ventricle, providing shunting of deoxygenated blood to lower extremities and improving overall cardiac output. This surgical technique creates an anastomosis between the left pulmonary artery and the descending aorta, providing a palliative treatment to off-load the right ventricle.

We report the case of an 11-year-old girl with familial pulmonary arterial hypertension and right ventricular failure who benefited of Potts shunt with good mid-term results. The patient was diagnosed at the age of 5 when she had history of fainting and persistent syncope. The patient was under medical treatment therapy with bosentan, sildenafil, acetylsalicylic acid (ASA), warfarin for six years. The results of molecular genetic testing which was confirmed with direct sequencing of bone morphogenetic protein receptor type 2 (BMPR2) gene revealed a heterozygous pathogenic mutation. Since she was diagnosed with PAH, she lost her grandmother, an aunt, and her father to pulmonary arterial hypertension (PAH). Her 14-year-old sister also had mutated BMPR2 gene without developing FPAH.

The Potts shunt provides an interventional step for palliation of patients with familial pulmonary hypertension and severe right heart failure refractory to medical treatment which opened the door to the possibility of lung transplantation in the future. We didn’t see any complications within 6 years after placing Potts shunt.

Vein of Galen aneurysmal malformations (VGAMs) is a severe and rare congenital brain vasculature anomaly which causes high mortality and morbidity in fetuses, neonates and infants. It can be identified in pregnancy period with fetal echocardiography. We report here a case of VGAMs with severe cardiac manifestations in the fetus of a pregnant woman at 28th weeks of gestational age.

Acute generalized exanthematous pustulosis (AGEP) is a cutaneous reaction that can be appeared after the use of certain medications, such as cephalexin, with non-follicular sterile pustules, erythematous, urticaria, fever over 38  and leukocytosis. Cephalexin belongs to the family of beta-lactam antibiotics, which are widely used around the world to treat infections. However, cephalexin skin sensitivities have been reported worldwide once in a while. Herein, in this case, we aimed to report a patient presented with AGEP due to cephalexin usage.

Case Report:

A 12-year-old boy presented with warmth, skin lesions that gradually appeared on the other limbs, trunk, face, and neck after taking cephalexin powder arbitrarily on his left leg.  Due to his symptoms, acetaminophen, fexofenadine hydrochloride, loxoprofen sodium and ointment including difluprednate and hydrocortisone were prescribed. Over time, the patientchr('39')s fever subsided, and 8 days later, the symptoms of AGEP, including urticaria, erythematous, and pustules in the neck and trunk disappeared.

Cephalexin is one of the antibiotics that is considered by doctors and patients when there is a possibility of infection. AGEP is a rare but severe reaction that can develop into skin rashes of any age and sex following the use of cephalexin, paying attention to this issue forces the patient to be careful when using this antibiotic.

The unicameral bone cyst (UBC) is a benign osteolytic lesion mostly found in the metaphyseal part of long bones in children. It is important as it can cause growth plate involvement, pathological fractures, and deformities of the affected limb. Our goal to report this case was to emphasize that hip area pathologies can be represented with knee pain and discomfort.

The patient was a nine-year-old girl with a bone cyst in the right proximal femur, with functional knee pain and limping. The diagnosis was made after two years of pain in the knee area. As the cyst was symptomatic and the signs of impending pathological fracture were seen, the lesion was managed by a surgical method of curettage and fibular strut allograft and proximal humerus locking plate.

The patient has been examined for knee joint problems for a long time, and her femur bone cyst was diagnosed after two years of pain; while it could become a pathologic fracture or involve the growth plate and cause growth arrest of the limb, which could affect patientchr('39')s quality of life for a lifetime. Therefore, in children with chronic knee pain, careful assessment of the hip area is recommended.