Journal of Pediatrics Review
Volume:10 Issue: 4, Oct 2022

Chronic Urticaria (CU) is a skin disorder characterized by wheal and flare with a duration of more than 6 weeks affecting 1%-2% of the population (more common in women). Thirty to 35% of cases of CU have angioedema [1]. The etiology of chronic spontaneous urticarial is not usually clear, 40%-50% are idiopathic and 30%-40% are autoimmune [2, 3]. Quality of life in CU is usually disturbed which has a direct relation with severity [4].

Considering the chronic immunosuppression in Inflammatory Bowel Disease (IBD) patients, it is necessary to evaluate the course of COVID-19 in these patients. Studies have shown various results in adult IBD patients. This study aimed to find out the course of this infection in pediatric IBD patients. 

This was a systematic review study according to the PRISMA 2020 guideline. International databases including Scopus, PubMed, and the Web of Science were searched with a combination of “COVID-19” AND “IBD” or synonyms until October 16, 2021. Studies that have reported the outcomes of COVID-19 infection in patients less than 19 years of age were selected. Name of author, country, study duration and type, IBD type and drugs, and COVID-19 outcomes were extracted.

From the initially retrieved 2215 articles, finally 16 articles were eligible. Data from 1040 pediatric IBD patients were reported. Twenty-four patients were hospitalized, 5 developed patients multisystem inflammatory syndrome in children, and others had a mild disease course and were outpatient. Steroid use, severe IBD activity, and comorbidities were shown to increase risk of hospitalization and disease severity.

COVID-19 is a benign and self-limited disease in pediatric IBD patients. Comorbidities, steroid use, and severe IBD activity affect the outcomes.

Over the past three decades, the prevalence of overweight and obesity in children and adolescents has increased up to 3 times. Obesity is a multi-systemic medical problem affecting all socioeconomic statuses and increases the risk of other severe comorbidities even in childhood. In 50% of cases, there is a persistence of obesity from childhood into adulthood. This narrative review aimed to define the etiology, risk factors, prevention, and management of obesity in children. 

This narrative review was conducted through a literature search on articles in English with the keywords of pediatric obesity, child, overweight, and bariatric surgery in PubMed, Scopus, ISI Web of Sciences, Cochrane, and EMBASE databases from 2001 to 2021 for 4 categories of etiology, risk factors, prevention, and management of obesity in children. Scientific articles, systematic reviews, meta-analyses, consensus, recommendations, and international and national guidelines published on pediatric obesity were considered.

In this narrative review, we first assessed relevant articles to define childhood obesity and mention its etiologies. We then discussed the probability of persistent obesity from childhood into adulthood and intergenerational and perinatal transmission risks. We also noticed syndromic obesity, evaluation of childhood obesity, and its complications along with medical/surgical interventions.

Metabolic programming in particular periods of life, such as before and during pregnancy, infancy, and at the age of rebound adiposity (5.5 years old), is necessary to prevent childhood obesity. Lifestyle changes, diet modifications, promoting exclusive breastfeeding, and increased activity are the main principles of preventing and managing obesity. It is prudent to rule out syndromic and endocrinologic causes of obesity in suspicious patients along with their management.

Neonatal polycythemia is a condition that is incidentally encountered in clinical practice. It is characterized by elevated hemoglobin levels (above 22 g/dL) and hematocrit ratios above 65%. It is important to understand both the prevalence as well as the related risk factors of this condition as untreated preventable risk factors can result in the development of hyperviscosity syndromes leading to potential multiple organ failure. 

Prevalence and Risk Factors: 

Risk factors include the presence of twin-to-twin transfusion, pre-eclampsia, maternal hypertension, operator-dependent cord clamping, and the presence of co-morbid conditions in neonates. The prevalence of neonatal polycythemia varies among regions and factors that may affect this variation include elevation above sea level of the patient and the mother, management of perinatal conditions such as gestational diabetes mellitus, and the method of delivery.

From this study, it is evident that not only do existing neonatal and maternal risk factors such as twin-to-twin transfusion syndrome and post-term deliveries, respectively, increase the risk of neonatal polycythemia but also the geographical and socioeconomic status are major factors. It is therefore imperative to conduct more thorough large-scale cohort studies to further understand the reasons for this.

Early Childhood Caries (ECC) has many etiologies such as families’ socioeconomic status, parents’ education and awareness, prolonged and improper bottle or breastfeeding, consuming sweet foods and high-sugar diets, brushing techniques, immaturity of children’s immune system, family size, and Streptococcus mutans. 

Evidence Acquisition:

 The data used in our review were searched from articles published between 1950 to 2021 and using ECC, children, saliva, salivary biomarkers, salivary enzymes, salivary peptides, salivary proteins, and immunity as keywords, collected from official web pages (Scopus, PubMed, Embase, and Google scholar) and documents published from different international institutions. The search was limited to articles published in the English language. After screening the abstract, the full text of 194 related studies was reviewed. Finally, 78 most related studies were selected.

ECC-related salivary proteins and peptides are Proline-rich proteins, salivary mucins, Lactoferrin, immunoglobulins, Toll-like receptors, Lysozyme, Histatins, Statherin, Defensins, Calprotectin, and Cytokines. ECC-related enzymes are Amylase, Lysozyme, Lactoperoxidase, Alkaline phosphatase, Carbonic anhydrase VI, Lactate dehydrogenase, and Glucosyltransferase B. Immunity factors affecting ECC include IgA (sIgA), IgG, IgM, salivary mucins, Lactoferrin, TLRs, Histatins, Statins, Defensins, Calprotectin, Lysozyme, Lactoperoxidase, Cytokines and interleukins, Cathelicidin (LL-37), Agglutinin, Cysteine, and Neutrophils.

Rabies is a fatal and often neglected disease leading to encephalomyelitis following a bite by an infected mammal. According to the necessity of rabies disease in Iran, we present four cases of rabies virus infection. 

We presented 4 cases of rabies virus infection hospitalized in different hospitals in Iran in 2021-2022. Three patients were male. The youngest patient was 6 years old and the oldest was 81 years old. In all 4 cases, RT-PCR detected the positive virus infection. Three cases received rabies immunoglobulin. All of them received at least one dose of rabies vaccination; but, unfortunately, all patients died.

The present case series showed the necessity of early rabies vaccination and also the early organization of stray dogs in the community. Unfortunately, two cases were lost to follow-up. So, the population education and follow-up of suspected rabies patients must be taken seriously by healthcare facilities.

Microcephalic Osteodysplastic Primordial Dwarfism type 2 (MOPD II) is a rare untreatable genetic disorder characterized by severe prenatal and postnatal growth retardation, microcephaly, bird-headed face (receding forehead and chin, a beaklike nose, and prominent eyes), skeletal abnormalities, abnormal dentition, abnormal hair and skin changes, high-pitched nasal voice, and an increased risk for insulin resistance and cerebrovascular disease. MOPDII is caused by mutations in the pericentrin gene and is inherited in an autosomal recessive manner. This study aims to report a MOPD II child patient. 

A seven-year-old girl genetically diagnosed with MOPD II has been presented in this case report. Clinical, radiological, and laboratory findings with emphasis on oral features have been reported, and her dental problems management has also been described.

MOPD II patients have a shorter life expectancy. The main health complications which need regular care include vascular changes of the central nervous system, diabetes mellitus, renal problems, blood pressure, cardiac pathologies, and hematologic profile. MOPD II patients have a high risk of caries because they consume soft and cariogenic foods due to microdontia, oligodontia, and an incompetent masticatory system. On the other hand, dental treatment for such patients can be very challenging. MOPD II cases and their families should be aware of the importance of oral hygiene and routine dental follow-ups.

Germ cell tumors (GCTs) are a heterogeneous group of neoplasms that arise from the primordial germ cells of the human embryo, which are normally destined to produce reproductive cells sperm, or ova. GCTs can be present in both gonadal GCTs and extragonadal GCT sites. Pediatric GCTs are relatively rare tumors with an incidence of 2%-3%. Primary mediastinal germ cell tumors GCTs are very rare extragonadal GCTs that arise in the anterior mediastinum. In this report, we present the case of a 16-year-old boy with primary seminoma arising in the anterior mediastinum. The patient presented with the symptoms of cough, fever, and chest tightness. CT finding was in favor of a large expansive process measuring 12.4x6.7x14.2 cm in the anterior mediastinum, accompanied by a conglomeration of hilar lymph nodes in the level of brachiocephalic veins juncture. Fine needle biopsy and core biopsy were performed transthoracically, under the control of MSCT. Based on histology and immunohistochemistry, the diagnosis of mediastinal germ cell tumor with immunophenotype of seminoma was made. The patient was treated with 4 cycles of chemotherapy by BEP protocol without significant side effects and toxicities. The patient remained disease-free for 16 months. The purpose of reporting this case is to confirm that chemotherapy with cisplatin-based regimens has markedly improved the outcome of adults and children with GCTs as well.

Lipodystrophy is the most common complication of insulin injection that has not been studied yet in children with Type 1 Diabetes Mellitus (T1DM) in Isfahan. 

This study aimed to evaluate the prevalence of insulin injection-induced lipodystrophy based on related risk factors in children and adolescents with T1DM.

In this cross-sectional study, children and adolescents aged less than 18 years with T1DM who referred to the endocrinology clinic of Imam Hossein Hospital in Isfahan, Iran, in 2019 were enrolled. The baseline, anthropometric, and T1DM-related characteristics of the patients were recorded. Lipodystrophy was diagnosed by clinical examination. The characteristics of patients with and without lipodystrophy were compared. The association between lipodystrophy and disease-related factors was investigated.

In this study, 194 patients with T1DM (88 boys and 106 girls) aged 3 to 18 years were evaluated. Lipodystrophy was diagnosed in 91 patients (46.9%), of which 64 patients (33%) had grade 1, 24 patients (12.4%) had grade 2, and 3 patients (1.5%) had grade 3 lipodystrophy. There was a significant difference in the frequency of lipodystrophy based on age, BMI, patient education, parent education, insulin injection site, duration of diabetes, injection site change, needle change, insulin dose, HbA1c, and hypoglycemia (P<0.05). Regression analysis indicated that there is a significant association between the presence of lipodystrophy and HbA1c (P<0.001, t=7.20), insulin dose (P<0.001, t=4.47), BMI (P<0.001, t= -3.78) and duration of T1DM (P=0.002, t=3.15).

In this study, we reported a high prevalence of lipodystrophy among T1DM patients in Isfahan. From the studied risk factors, duration of diabetes, lower BMI, using a high dose of insulin, and uncontrolled diabetes (HbA1c>7) were the most important risk factors for lipodystrophy.

Phenylketonuria is a metabolic disorder resulting from a defect in phenylalanine metabolism with a global prevalence of 1 in 10000. Delayed initiation of dietary modification leads to brain injury and cognitive and behavioral problems. The main objective of this study was to assess the demographic and social factors affecting the metabolic control of patients having phenylketonuria in Southern Khorasan Province, Iran. 

In this cross-sectional descriptive-analytic study which was performed during the summer of 2019, a total of 32 out of 37 known children and adolescents having phenylketonuria in Southern Khorasan Province were assessed. The age and gender of patients, parents’ marital status, parents’ occupational status, parents’ educational level, the distance between home and phenylketonuria clinic, and the number of affected siblings having phenylketonuria were documented. We were not able to contact five patients having phenylketonuria in Southern Khorasan Province. Data were analyzed by SPSS 16 software using the Mann-Whitney U test and the Kruskal-Wallis test. The significance level was considered P<0.05.

Totally, 32 patients with a Mean±SD age of 6.6±4.7 years enrolled in this study among whom 23 were male (71.9%) and 9 patients were female (28.1%). The Mean±SD phenylalanine level in this study group was 8.1±5.2 mg/dL. The disease was optimally controlled in 14 patients (43.3%) and poorly controlled in 18 patients (56.3%). There was not any statistically significant relation between the metabolic control of the disease and any of the assessed social and demographic factors.

The disease was properly controlled in 43.3% of the assessed population, and 56.3% had poor metabolic control. There was not any statistically significant relation between the metabolic control of patients having phenylketonuria in Southern Khorasan Province and the assessed demographic and social variables. As the number of known cases in South Khorasan province is limited, the small sample size could be one of the main limitations of our study.