International Journal of Pediatrics
Volume:11 Issue: 111, Mar 2023

The present study was performed to investigate the level of knowledge, attitude, and performance of healthcare personnel working in COVID-19 hospitals in Mashhad regarding the use of respiratory protection equipment.

This cross-sectional study was conducted on 536 personnel working in hospitals admitting COVID-19 patients in Mashhad, Iran. The participants completed a questionnaire containing data related to the knowledge, attitude, and performance of healthcare workers regarding the use of respiratory protection equipment.

According to the results, the evaluated knowledge levels were weak (1.1%), moderate (32.7%), and good (66.2%). Moreover, the levels of attitude were moderate (7.9%) and good (92.1%). In addition, the performance showed moderate (3.6%) and good (96.4%) levels. The mean score of knowledge was significantly higher among employees over 35 years of age (P<0.001), employees with 10 years or more work experience (P<0.001), and among males, compared to females (P<0.001). The mean score of performance was also significantly higher in males than in female employees (P<0.001), in married, compared to single employees (P<0.001), and among individuals who had close contact with a COVID-19 patient (P<0.001).

According to the results of the study, there was an acceptable level of knowledge, attitude, and performance among healthcare personnel working in the COVID-19 hospitals of Mashhad regarding the use of respiratory protection equipment. However, more training in this field seems useful, especially for people with less experience and age.

In the process of intubation, inappropriate placement of the endotracheal tube can lead to hypoxemia, aspiration, insufficient ventilation, atelectasis, barotrauma and pneumothorax. The above complications may be difficult for a patient with severe disease to tolerate; especially when inappropriate placement is not detected by the specialist in the initial evaluation and the diagnosis lasts until the confirmatory chest x-ray is performed. This study evaluated the validity of three formulas in measuring the depth of endotracheal intubation in children under mechanical ventilation. 60 intubated children aged 2 months to 12 years were included in this study. The patients were randomly divided into three study groups. Endotracheal tube length for each patient was calculated on the basis of the endotracheal tube length formulas (12 + age (years) / 2; endotracheal tube diameter * 3; and 5 + height (cm) / 10). The ideal depth of the endotracheal tube based on chest x-ray was measured as the median distance between the first thoracic vertebra (T1) and the carina in cm. The distance between the ideal depth of the endotracheal tube and the end location of the endotracheal tube was also measured and recorded. The mean age of the patients was 42.90 months and 58.3% of them were boys. The most common indication for intubation was pneumonia, along with respiratory distress (33.3%). Considering the difference in endotracheal tube depth between the two values calculated using the formula and chest X-ray equal to± 0.5 cm, formula 12 + (2 / age) in 55% of patients, formula 3 * endotracheal tube length in 70% patients and formula 5 + (10 / height) in 85% of patients, were correctly estimated endotracheal tube length. On the other hand, it was observed that in 15%, 45% and 40% of the patients, the formula predicted the correct length of the endotracheal tube for correct intubation without any difference while compared to the chest X-ray. In evaluating the results obtained from the formula and length of the endotracheal tube measured by chest X-ray, it was also observed that the formulas 12 + (2 / age), 3 * length of the endotracheal tube and 5 + (10 / height) were significantly correlated with CXR. According to the obtained results, it can be concluded that the formulas used to estimate the depth of endotracheal tube placement in children have low accuracies compared to the gold standard of measurement (chest X-ray). Of course, in comparison to the three formulas (height, weight and diameter of the ETT), the height formula was more accurate than others.

Methylmalonic acidemia is a rare autosomal recessive disease in which there is a deficiency of intracellular cobalamin. This study aimed to assess the effectiveness of parenteral hydroxylcobalamin in the treatment of children with methylmalonic acidemia.

This is a quasi-experimental study without a control group. The participants included under-18-year-old children with confirmed methylmalonic acidemia. There were only 17 patients with the inclusion criteria, all of whom were included in the study. They received 1mg hydroxylcobalamin injection for 3 or 7 days based on their clinical status. Data was gathered by a demographic questionnaire, along with laboratory tests of urine-MMA, and plasma homocysteine, measured before and after the intervention. Data analyses were performed using SPSS v. 26.

The samples included 17 patients, most of whom were males (52.9%). They had various clinical manifestations consisting of hypotonia, seizure, verbal disorders, movement disorders, organomegaly, hematologic disorders, and ophthalmic disorders. The parenteral hydroxylcobalamin had a borderline significant effect on urine-MMA (p=0.05); this seems to be due to the sample shortage and can become strongly significant with sample increase.

The results revealed the effectiveness of parenteral hydroxylcobalamin in MMA patients. However, there is no standard guideline to suggest the perfect dose of it to acquire the optimum result; so it is suggested to conduct more clinical trials or cohort studies to be done.

Childhood weight status is one of the important predictors of health status later in life. Some previous studies have postulated a relationship between the pattern of breakfast intake and weight status, but this relationship has not yet been clearly confirmed. This study aimed to assess the status of regularity in intake of breakfast and snacks and its relationship with weight status in elementary school students.

This study was done with a descriptive-analytic design. 362 362 children (Males: 192, Females: 170 child) were selected from elementary schools of Urmia by the use of stratified cluster sampling. A dietary 24-hour recall form was used for the assessment of intakes. Data about breakfast, snacks, height, weight, and waist circumferences were collected. Children's Physical Activity Questionnaire (PAQ-C) was used to assess the participants’ physical activity level. Data were analyzed using the descriptive and inferential statistics in SPSS software.

Mean student age, weight and BMI were 10.57±1.17 years, 37.44±11.30 kg and 18.4±3.39, respectively. 53.2% of girls had a regular breakfast and 55% regular snack intake. Among the boys, 46.8% had regular breakfast and 45% regular snack intake. Results showed a significant relationship between BMI and snacks consumption (p = 0.02). There was a significant relationship between the frequency of irregular breakfast intake and weight (P=0.01), but the relationship was not significant for the body mass index (P = 0.11). 58.1% of the students in the irregular breakfast group and 64.4% of those in the irregular snacks group were lean.

Regular intake of snacks was correlated with higher weight status and maintaining desirable BMI. Irregular breakfast intake was related to lower weight. Most students with irregular breakfast and snack intake were underweight and thin.

Respiratory diseases are the most common cause of death in the pediatric population and acute or progressive respiratory failure, which requires mechanical ventilation, is the most common cause of children’s hospitalization in the intensive care unit. Despite advances in recent decades regarding the treatment of acute respiratory diseases in children and innovative settings in mechanical ventilation, there are no clear and comprehensive guidelines for the use of mechanical ventilation in children. This research aimed to evaluate the correlation between oxygenation and ventilation indices in predicting the duration of mechanical ventilation in children aged two months to 14 years old admitted to PICU. In this cross-sectional study, 56 patients were included. The required information was extracted from the patients' clinical records and entered into the prepared questionnaires. They included age, sex, and diagnosis, duration of intubation, extubation time, mechanical ventilation parameters, and blood gas parameters. Patients' blood and ventilation data were collected and calculated from the first day of mechanical ventilation until 7 days later to calculate Oxygenation (OI) and Ventilation (VI) indices. Pneumonia, the most common cause of hospitalization in the intensive care unit and the need for intubation, was present in our population (82%) due to aspiration and Covid-19 disease. There was a significant relationship between higher levels of FiO2 and longer duration of patients' intubation (P <0.001). The amount of PIP in each of the first days of intubation was significantly correlated with the duration of the study. A significant direct relationship was found between the ventilation index and oxygenation index. (P <0.05) Except for the sixth day, oxygenation index and duration of intubation were significantly correlated. (P <0.05) This means that along with the increase in oxygenation index, the duration of intubation was also increased. Ventilation index and duration of intubation were also significantly correlated, except on the fourth and fifth days (P <0.05). None of the extubated patients required re-intubation. Eventually, a very weak statistical correlation was found between the intubation period and the final result in the form of discharge and recovery of the patient or his death. Using variables such as gender, PIP and oxygenation, and ventilation indices, in the early days of mechanical ventilation, the prognosis of these patients and better management of their treatment can be judged. It is, finally, emphasized that further studies on larger populations, with more variables and long-term follow-ups are required.

Diagnosis and management of precocious puberty are challenging. The two main classes of precocious puberty are Central Precocious Puberty (CPP) and Peripheral Precocious Puberty (PPP), which should be differentiated from normal pubertal variants. Radiology plays an essential role in the diagnosis and management of precocious puberty. We reviewed available studies in the case of different radiology modalities to find the role of these methods in precocious puberty assessment. We found that bone age assessment can be the initial step in the diagnosis of precocious puberty; however, a normal bone age cannot rule out precocious puberty in a deterministic manner. The use of pelvic ultrasound can further help the approach to precocious puberty. Moreover, suspected female and male cases of congenital adrenal hyperplasia should be evaluated with adrenal sonography. Testis and mammary ultrasound assessments are usually conducted in asymmetrical changes. Still, breast ultrasound staging may be helpful in even the diagnosis of precocious puberty. Brain magnetic resonance imaging is another modality used in CPP cases. The role of artificial intelligence is a neglected part, which is partly covered by BoneXpert software. Future studies should focus on scoring methods based on bone age as well as breast and pelvic (ovary and uterus) ultrasound assessments in diagnosing female precocious puberty cases and distinguishing the patients from normal pubertal variants.

Diagnosis of the cystic lesion of the neck in pediatric cases is challenging for radiologists. There are different cystic lesions in the neck region that can present themselves in various parts of this area. Some lesions may lie in the middle parts and some in the lateral areas; however, some cystic defects can be present in every part of the neck. Sonography is the first modality for the assessment of the cases, along with history and physical examination. Sonography is nearly accessible and is not expensive; however, it depends on the expertise of the sonographer. We reviewed sonography findings of various cystic lesions in the neck region and reported the findings with this regard.

Pancreatoblastoma (PB) is an exceedingly uncommon pancreatic tumor arising from pancreatic exocrine cells. It is the most common malignant pancreatic tumor in childhood.

We report a case of PB in a 5-year-old girl who presented to our institution with severe abdominal pain, anorexia, vomiting, and jaundice. Laboratory tests were compatible with cholestasis. Ultrasound imaging showed mild intra- and extrahepatic bile duct dilation as well as a pancreatic mass. A Computed Tomography (CT) scan confirmed a large mass in the head of the pancreas, which was associated with periportal lymphadenopathy as well as anterior and inward displacement of superior mesenteric vessels. Although the mass was unresectable at the time of admission to our center, an open biopsy of the tumor was performed, which revealed a diagnosis of PB. Following six months of neoadjuvant chemotherapy, the size of the tumor was dramatically decreased, allowing the complete resection of it.

When a child presents with a massive solid cystic tumor in the pancreas, the possibility of pancreatoblastoma must be considered. Surgery is utilized to completely remove the tumor, while pathology and immunohistochemistry are used to confirm the diagnosis. Patients with huge tumors or extensive lymphadenopathy typically need neoadjuvant chemotherapy before surgery to downstage their disease.

This study aimed to report on the case of a child with the manifestation of orbital cellulitis which was finally diagnosed as an orbital hydatid cyst.

Case report:

 The case is a 5-year-old girl with an isolated orbital hydatid cyst presented with slowly progressive proptosis, deterioration of vision, chemosis, periorbital swelling, and palpebral edema. Evaluations for other organ involvements including liver and lung were negative. A cystic orbital mass lesion with enhancing walls was found in orbital Computed Tomography (CT) scanning. The cyst was removed completely through the upper lid crease incision and treatment continued with systemic albendazole. The patient was followed for three months with a favorable outcome.

We should consider the diagnosis of a hydatid cyst in a child with the signs and symptoms of orbital cellulitis, specifically in endemic areas.