Journal of Pediatrics Review
Volume:9 Issue: 4, Oct 2021

The specialists should identify the features of Wilson disease and autoimmune hepatitis when both affect a patient to adopt appropriate treatment. 

This study was conducted to determine features of the patient, disease, diagnostic studies, and therapeutic measures in cases of simultaneity of Wilson disease and autoimmune hepatitis.

To find evidence related to the study objectives, we searched databases such as Barakat knowledge network system, SID, Magiran, Google Scholar, Web of Science, ProQuest, Springer, ScienceDirect, Medline via PubMed, and Scopus with specified Persian and English keywords, including “Wilson’s Disease”, “Autoimmune”, and “Hepatitis”. The inclusion criteria for the studies were 1) the study was observational and 2) the study was published in Persian or English. The exclusion criteria included low-quality studies based on the score obtained from the checklist. The obtained studies were screened in terms of titles, abstracts, and full text, and finally, the qualified studies entered the review process. The relevant data were extracted according to a designed checklist.

Finally, 10 studies were included in the review process. Information about 14 patients was reported. The Mean±SD age of the participants in the studies was 19±11 years. The direction of diagnosis was from autoimmune hepatitis to Wilson disease in 8 cases and from Wilson disease to autoimmune hepatitis in 3 cases. The simultaneity of autoimmune hepatitis and Wilson disease was considered in 3 patients with no primary and secondary diagnosis.

The comorbidity of Wilson disease and autoimmune hepatitis is uncommon but is important. In the presence of relevant symptoms in these patients, the comorbidity of these two diseases should be considered. Accordingly, additional assessments such as serum ceruloplasmin, urinary 24-h copper, molecular genetic testing, MRI, serological tests, anti-nuclear antibody, anti-mitochondrial antibody, anti-smooth muscle antibody, complement level, gamma globulin, IgG, albumin, Kayser-Fleischer ring eye examination, and liver biopsy should be considered for correct diagnosis. If appropriate treatment was started for the disease with a diagnosis of Wilson disease or autoimmune hepatitis, but the response to treatment was insufficient, it is better to consider the simultaneous occurrence of two diseases or the initial misdiagnosis.

Adolescents need services that improve their physiological, cognitive, emotional, and social alteration into adulthood. Since the adolescent health needs have been identified, the focus of service delivery has mainly been on access to sexual health care assistance, including HIV issues. 

This systematic review aims to assess the perceived barriers and facilitators of adolescent friendly health services in the world because teens are a positive and energetic force for the present and future of a community.

All qualitative studies from 2000 to 2019 have been considered in this review. The searched databases include Cochrane Central Register, MEDLINE, Google Scholar, Embase, ProQuest, Scopus, Web of Science, CINAHL, and the Ovid platform. The studies included those conducted on all gender and ethnic groups adolescents between 10 to19 years that received health services, as well as their families and health care providers. Selected studies will be critically appraised by two independent reviewers using the Joanna Briggs Institute (JBI) critical appraisal checklist for qualitative research. Qualitative data will be extracted from papers using the standardized data extraction tool from JBI SUMARI (System for the Unified Management, Assessment, and Review of Information) by two independent reviewers. Qualitative research findings will, where possible, be integrated using JBI SUMARI and the meta-aggregation approach, and the final synthesized findings will be graded according to the ConQual approach for establishing confidence in the output of qualitative research synthesis and illustrated in the summary of results.

This systematic review addresses perceived barriers and facilitators of adolescent friendly health services in the world. Developing and extending young people’s demands is a concern for all societies. So the results of this study can help us to discover barriers and providers of adolescent friendly health services, and by removing barriers and strengthening facilitators, we will promote the possibility of adolescents accessing adolescent friendly health services.

Legg-Calvé-Perthes Disease (LCPD), a juvenile hip disorder, is caused by impaired blood flow to the femoral head. In severe LCPD cases, the femoral head may develop a flattening deformity. Furthermore, if LCPD is diagnosed at the later stages, it causes early osteoarthritis of the hip. The etiology of LCPD is complex and embraces both genetic and epigenetic factors. 

This review attempts to summarize the current knowledge on the role of these genetic variants in the incidence of LCPD.

We searched for articles published in English using the special related search terms.

The genetic causes of this disease include mutations in the genes of thrombophilia factors, such as FV Leiden and anticardiolipin antibodies. The mutations of COL2A1, TRPS1, eNOS genes are the other causes. Moreover, the clinical symptoms of avascular necrosis may be indiscernible in patients with Gaucher’s disease or LCPD, and the differential diagnosis is a challenge.

The results indicated that genetic testing may be useful in diagnosing and managing patients with juvenile hip disorders.

Acne vulgaris is a skin condition in children and has various presentations and differential diagnoses. 

The purpose of this review was to evaluate the therapeutic approaches of infantile acne.

In this narrative review, we searched articles published in English on infantile acne in Google Scholar, PubMed, and Scopus from 1981 to 2019. 

A total of 35 articles were selected for review. The treatment of acne often involves various medications that acne lesions. Different factors contribute to the pathogenesis of acne and its severity. The same principle and treatment strategy applies to all age groups diagnosed with acne.

The treatment strategy for infantile acne is similar to acne treatment at any age. Treatment is based on the severity of the acne and the risk of a future scar.

Inadvertent and erroneous prescription of vitamin D beyond the recommended dosage and route of administration can cause vitamin D intoxication in children. Infants are particularly vulnerable to such toxicity. Clinical features are due to hypercalcemia, ranging from mild to life-threatening symptoms. We report two infants and one child who had varied manifestations due to hypercalcemia resulting from empirical treatment with high doses of vitamin D. We discuss the management strategies in these cases along with a brief review of the literature. 

Our first case was a 10-month-old infant who presented with fever, vomiting, and failure to thrive. Our detailed clinical examination and investigation revealed hypertension and bilateral nephrocalcinosis along with urinary tract infection. The second child was a 2-year-old girl with severe hypercalcemia with clinical features mimicking acute bacterial meningitis. The third infant had mild symptoms like constipation and irritability, and investigations showed moderate hypercalcemia. All had a history of inappropriate vitamin D administration, either in oral or parenteral form, and they were all successfully treated.

These case series highlight the importance of proper dosage, avoidance of parenteral route, along with appropriate clinical and biochemical monitoring during the course, whenever a dose of vitamin D is advised.

Generally presents in childhood, orbital lymphangioma is an uncommon unencapsulated vascular malformation of the lymphatic system. These benign cystic lesions represent 1%-4% of all orbital masses and may appear after an upper respiratory infection or minor trauma. Because of its nature, the management can be challenging and depends on the clinical presentation. We report an 8-year-old boy with orbital lymphangioma presented with acute proptosis. Then, we discuss different features of this disorder plus its management 

An 8-year-old boy was presented with sudden left eye proptosis. He had normal visual acuity and color vision without ocular pain or diplopia. An infiltrative and diffused intraconal plus extraconal mass was detected in orbital computed tomography. Contrast-enhanced MRI revealed a multilobulated infiltrative heterogeneous lesion with fluid-fluid levels. The diagnosis was made on imaging, and he went under treatment with an oral corticosteroid. The symptoms were entirely resolved, and no recurrence occurred during the follow-up. There are several surgical and nonsurgical therapies for orbital lymphangioma. Still, the priority is conservative management, such as sclerotherapy (including OK-432, doxycycline, sodium tetradecyl sulfate, etc.), bleomycin, carbon dioxide laser, systemic corticosteroids, and so on.

In most cases, the current imaging methods make a noninvasive diagnosis of orbital lymphangioma possible. Conservative management should be considered the first treatment.

Supracondylar fractures of the humerus are common elbow fractures in children. Supracondylar fractures have two subtypes: flexion, which makes up less than 2% of all such fractures, and extension, which makes up more than 98% of supracondylar fracture of the humerus. Supracondylar fractures of the humerus can develop vascular and neurological complications, either following the fracture itself due to the detached pieces of bone or after reduction or K-wire fixation therapy. The most common complication is damage to the brachial artery. 

Our patient is a healthy 7-year-old right dominant boy who sustained a Gartland type III fracture following a fall and was admitted to the Emergency Ward. At first, a weak pulse was detected in the distal part of the right upper extremity. After the reduction using 2 K-wires, the distal pulse of the limb became undetectable. Vascular examination revealed that the adventitia of the brachial artery was trapped between the condyle parts. The artery was then released, and the distal pulse returned.

This case shows that although entrapment and pulling of the adventitia of the brachial artery between the condyles of the humerus following a supracondylar fracture is a rare occurrence, it can happen in this type of fracture. After reduction using K-wires percutaneously, a neurovascular examination in all cases of supracondylar fractures is necessary. In supracondylar fractures with pink pulseless limbs, immediate arterial exploration can achieve a markedly better outcome than simply monitoring.

Puberty is an essential milestone in a person’s life. Studies show that precocious puberty is more common in girls than in boys. 

The aim of this study was to survey the causes of precocious puberty in children referred to the endocrine clinic in Qazvin city, Iran, from 2006 to 2018. 

This case-series study was performed from March 2006 to June 2018 on patients referred to the endocrine clinic of Qazvin University of Medical Sciences, Qazvin City, Iran, for precocious puberty. To diagnose premature puberty and find its causes, we surveyed sex steroids levels, thyroid function, and, if necessary, performed GnRH test. The patients’ height and weight were measured, and their BMIs (Body Mass Index) were calculated. Uterine ultrasound was performed for all girls. Additionally, brain MRI was performed for all boys and girls under age 6 with precocious puberty. X-ray of the left hand was performed to assess skeletal growth acceleration.Based on the type of puberty, the patients were divided into three groups: Central Precocious Puberty (CPP), Peripheral Precocious Puberty (PPP), and normal variant of puberty. The study data were collected from patients› electronic files and analyzed using SPSS 23.

Out of 724 cases, 642 (88.70%) were girls. The mean age of all children was 7.07 (95%CI: 6.99-7.15) years. About 70.5% of cases had CPP, 5% PPP, and 24.5% normal variant of puberty. Cases of Idiopathic Precocious Puberty (IPP), PPP, Neurogenic Central Precocious Puberty (NCPP), and premature pubarche were significantly higher in girls than boys (P<0.001). None of the boys had NCPP. Most girls had normal BMI, but boys were more obese. Mean bone age and bone age/age ratio were higher in girls with NCPP (P<0.001). 

In our study, most girls and boys had idiopathic precocious puberty, and none of the boys had brain lesions. About half of the cases were overweight or obese, indicating the role of obesity in increasing bone age and the onset of puberty.

The traditional large group didactic lectures have many shortcomings, so small group discussions have been proposed to overcome some of these shortcomings. However, a typical Small Group Discussion (SGD) remains a mini-interactive lecture in most cases. To improve students’ participation and their better understanding, many newer teaching-learning methods have been tried. Jigsaw teaching method, a type of cooperative learning, is one of these new methods. Obviously, the usefulness of jigsaw teaching must be compared with other small group teaching methods. 

The aim of this study was to compare the effectiveness of the Jigsaw teaching technique with the small group teaching method.

A quasi-experimental study was conducted over one month in the Paediatrics Department of DM WIMS medical college. After obtaining written informed consent, 30 students were randomly selected and allocated to the SGD and jigsaw groups (15 students in each group). Four topics were taken to both the groups who were crossed over after one session (a total of eight exposures). Their post-intervention mean scores were tabulated and analyzed. The Likert scale was used to assess the students’ evaluations of the jigsaw method.

The results showed that the jigsaw method had better students’ performance, which was statistically significant with a P<0.05. Also, the students’ evaluation showed that they appreciated the jigsaw teaching method, but time constraints were noted as a drawback. 

Jigsaw teaching is an excellent small group teaching method to ensure better students’ participation and understanding and can add to our repertoire of teaching-learning methods, which Competency-Based Medical Education (CBME) warrants.

Severe pneumonia in children has a grave prognosis. Clinical presentations and hypoxemia have shown a significant association with mortality. 

We aimed to determine the risk association between pulse oximetry and clinical parameters.

This observational cross-sectional study was conducted from March 2018 to December 2019. The children (aged 2 months to 5 years) diagnosed with severe pneumonia or very severe disease based on IMNCI (Integrated Management of Neonatal and Childhood Illness) guidelines were consecutively selected. Hypoxemia was defined as oxygen saturation less than 90%. We used univariate and multivariate logistic regression to determine the odds ratio of variables to predict hypoxemia. Accordingly, sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of signs and symptoms were calculated to predict hypoxemia.

Of 400 children enrolled in the study, 159 children (39.75%) were hypoxemic. Cough, cyanosis, intercostal retractions, nasal flaring, grunting, and lethargy were independent risk factors of hypoxemia with an adjusted odds ratio of 3.13, 213.562, 29.178, 57.762, 179.648, and 19.417, respectively. Predictors with a high sensitivity for hypoxemia were breathing difficulty (99.37%), intercostal retractions (98.64%), subcostal retractions (98.76%), nasal flaring (99.37%), lethargy (96.86%), and crepitations (99.87%). Predictors with high specificity were convulsion (98.53%), cyanosis (97.99%), suprasternal retractions (99.59%), grunting (97.78%), and head nodding (99.17%).

The study provides conclusive results of the risk association of clinical features in predicting hypoxemia in children with severe pneumonia. The easy use of pulse oximeter and significant association of clinical features with hypoxemia may be helpful in better categorization, diagnosis, and management of children with severe pneumonia.