Journal of Comprehensive Pediatrics
Volume:14 Issue: 2, May 2023

Context:

 Infectious diseases are still one of the main causes of morbidity and mortality in children, especially in developing countries. In various studies, the weight of children has been found to be influential in the risk of occurrence of these diseases or their severity, and sufficient information on this matter can be important in improving the management and prognosis of patients. This study aimed to determine the impact of being underweight or obese on the risk of infection in children

Evidence Acquisition: 

The ISIWeb of Sciences, Scopus, PubMed, and Google Scholar databases were reviewed for relevant articles published from 2010 to 2022. The keywords used included: Infections, body mass index, obesity, thinness, underweight, and child.

Studies show that underweight children are associated with an increased risk of various parasitic, viral, and bacterial infections or their severity. Being overweight and obese have received less attention, but they have been shown to be effective in some respiratory and urinary infections in children.

According to obtained results, being underweight or obese has been linked to an increased risk of various parasitic, viral, and bacterial infections or their severity in children. Therefore, determining the weight of children, even in emergency cases, and considering it, along with other initial evaluations of children with infection, can be effective in improving the management and prognosis of these children.

The coronavirus disease-19 (COVID-19) pandemic has significantly affected healthcare systems. Down syndrome (DS) is a chronic disease caused by trisomy of chromosome21 which is associated with a variety of medical problems such asautoimmune thyroid disease (AITD) that necessitate comprehensive routine treatment. During the COVID-19 pandemic, there was an increasing an unavailability, which became an impediment to chronic disease patients’ drug consumption.

The purpose of this study was to examine the barriers to medication adherence faced by DS patients during the COVID-19 pandemic.

An observational analytic study was conducted from January to July 2021 among parents of DS patients who registered in the pediatric endocrinology outpatient clinic of Dr. Soetomo General Hospital. Inclusion criteria include: The parents of DS with AITD patients aged 1 - 18 yearswhocameto the pediatric endocrinology polyclinic, routinely took oral medication beforeMarch2020, can fill out questionnaire forms independently, and signed the informed consent. Exclusion criteria were parents of DS patients who did not take regular medication, or started treatment after March 2020. Data were collected and analyzed using the Wilcoxon comparison test

There are 31 DS patients responded and completed the questionnaires. Adherence to hospital visits in DS with AITD patients before and during the COVID-19 pandemic showed significant differences (P = 0.001). The main barriers to follow-up visits during the pandemic were lockdown protocol which made travel difficult (28%). The compliance for taking medication was still high although 13 (41.9%) obtained the medicine without a prescription.

Changes in terms of medication adherence during the pandemic have highlighted the importance of improving DS patient’s access to healthcare. Shifting medication counseling to the nearest primary health care provider with supervision from a tertiary referral specialist appears to be a reasonable and potentially cost-effective strategy in improving treatment adherence especially in a pandemic setting.

Periodic fever syndrome (PFS) is a rare monogenic autoinflammatory disease group. The innate immune system abnormalities have a characteristic onset and spontaneous inflammation without any infectious or autoimmune trigger. It differs from autoimmune disorders (e.g., systemic lupus erythematosus (SLE)) occurring due to a defect in the adaptive immune system with auto-antibodies.

The clinical features of three patients presented with a periodic pattern of fever and a different constellation of symptoms were investigated. The final diagnosis of Periodic fever syndrome was reached based on standard diagnostic criteria and genetic testing. All three cases were observed to present with recurrent fever episodes at an interval of 6 - 12 weeks, 3 - 4 weeks, and one month, respectively. The first patient, presenting with a diffuse erythematous plaque-like lesion along the calf with severe calf pain and tenderness with signs of meningeal irritation, was diagnosed with a tumor necrosis factor receptor-associated periodic fever syndrome (TRAPS) like phenotype. The genetic panel was negative in this case. The second patient presenting with recurrent pharyngitis, cervical adenitis, and tonsillitis unresponsive to antibiotics was diagnosed with periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome. The last patient presenting with recurrent monoarthritis, hepatosplenomegaly, and a positive Mediterranean fever (MEFV) gene mutation was diagnosed with familial Mediterranean fever (FMF). All three patients had normal growth and development.

Although periodic fever syndrome was an uncommon entity, it was recommended that this syndrome should be considered when a patient presented with recurring fever episodes with a characteristic constellation of symptoms.

Nausea and vomiting are among the most common side effects of chemotherapy, and despite using pharmaceutical treatments, no desired outcome has yet been achieved in this regard. Therefore, using non-pharmacological techniques has been recommended.

The present study examined the effect of overshadowing on chemotherapy-induced nausea and vomiting in children with leukemia.

In this clinical trial study, participants were 70 children aged 3 - 18 years admitted to the Oncology Department of Mofid hospital in Tehran, Iran, and were randomly assigned to 2 intervention and control groups. A flavored candy was given to each child in the intervention group 10 minutes before the start of chemotherapy. This process was repeated during 3 rounds of chemotherapy. The severity of nausea was measured with the Baxter Animated Retching Faces Scale. The frequency of vomiting was measured using a checklist in both groups 10 minutes before and immediately after chemotherapy. The data were analyzed with SPSS software (version 25).

The data revealed no statistically significant difference in the severity of nausea in the first and second chemotherapy rounds between the intervention and control groups (P > 0.05). However, there was a significant difference in the third chemotherapy round between the 2 groups (P < 0.05). The severity of nausea and frequency of vomiting in 3 chemotherapy rounds was not significant (P > 0.05).

The results indicated that overshadowing was not effective in reducing the severity of nausea and frequency of vomiting. Further studies are needed to determine the potential effects of this technique on gastrointestinal symptoms, including nausea and vomiting.

Functional constipation (FC) is a common problem in childhood worldwide. This disorder can lead to various physical and behavioral problems and ultimately reduce the quality of life. Sleep disorders are also among the complaints of patients with FC.

In this study, we aimed to investigate the prevalence of sleep disorders in children with chronic FC.

This cross-sectional study was conductedon140 children aged 5 to 12 with chronic FC referred to the specialized pediatrics clinic of Amirkabir Hospital of Arak, Iran. The functional constipation was diagnosed based on Rome IV criteria. Children and their parents were requested to complete the Children’s Sleep Habits Questionnaire (CSHQ). Data analysis was performed in SPSS version 22 using the chi-square and Mann-Whitney tests to find significant associations at the significance level of 5%.

The mean (SD) age of the participants was 7.36 ± 1.6, and most participants were boys (65.7%). The prevalence of sleep disorders in children with chronic FC was 62.9% (95% CI: 54.5 - 70.2). Sleep resistance and sleep apnea were themost common minor sleep disorders. The prevalence of sleep disorders was significantly higher in girls (81.3%) than in boys (53.3%) with chronic FC (P = 0.001). There was no significant difference in the prevalence of sleep disorders in children with chronic FC aged 5 to 8 and 9 to 12.

In the present study, the results showed that the prevalence of sleep disorders in children with chronic FC was significant, and it was higher compared to other studies conducted on healthy children, and also it was found that girls had a significantly higher rate of sleep disorders than boys.

Portal hypertension (PH) refers to a clinical syndrome characterized by an elevation in the pressure gradient between the portal and hepatic veins. It is necessary to identify the underlying causes to manage this disorder effectively.

This study aimed to investigate the etiology, clinical manifestations, and endoscopic findings in children with PH.

This analytic cross - sectional study was performed on patients (< 18 years) with PH who were referred to the Pediatric Gastroenterology Clinic of Mofid Children’s Hospital in Tehran, Iran, within 2014 - 2020. The demographic details of the patients were collected from their medical records. Clinical manifestations, age at diagnosis, family history, and endoscopic findings were also recorded.

A total of 102 patients participated in this study. The subjects’ mean age was 6.81 ± 4.46 years. The results revealed that 50 (49.0%) and 46 (45%) cases had PHdue to extrahepatic and intrahepatic diseases, respectively. Autoimmune hepatitis and portal vein thrombosis were the most common etiology of intrahepatic and extrahepatic PH, respectively. Based on the endoscopic analysis, esophageal varices were the most common findings (95.8%) observed in patients with PH.

Extrahepatic diseases were the most prevalent PH etiology in children referred to the Pediatric Gastroenterology Clinic of Mofid Children’s Hospital.

Vitamin D levels lower than 20 ng/mL are defined as vitamin D deficiency and levels between 20 and 30 ng/mL are defined as insufficient vitaminD.Dueto the high prevalence of vitaminDdeficiency in premature infants and the need for obtaining optimal treatment methods, we compared the serum levels of vitamin D before and fifteen days after administration of the drug orally and by injection.

In this randomized clinical trial, 90 premature infants with gestational age < 37 weeks were admitted to NICU of Shahid Akbarabadi Hospital, with concomitant vitamin D deficiency and insufficiency entered the study and randomly received oral (with oral drops of 1,000 units daily for 15 days) or injectable (a single dose of 15,000 units intramuscularly) vitamin D supplement and followed on the 16th day after drug administration by measuring 25 (OH) D, calcium, phosphorus, and serum alkaline phosphatase (ALP).

In this study, the gestational age of the patients was 29.39 ± 2.42 weeks, and their average birth weight was 1,208.45 ± 238.98 grams. There was no significant difference between the two groups that received the drug, and they were similar. The level of vitamin D in premature infants suffering from vitamin D deficiency was equal to 13.20 ± 6.37 ng/dL. There was no significant difference between the serum levels of ALP, phosphorus, and calcium in the patients of the injection and oral groups before and after the intervention (P-value > 0.05). Although there was no significant difference between the serum vitamin D levels in the two groups before the intervention, its level in the oral group was significantly higher than in the injection group after the intervention (P-value = 0.006). However, none of the treatment methods independently changed the effectiveness of the treatment (P-value = 0.073).

The results of our study showed that, in premature infants with vitamin D deficiency or insufficiency, administration of vitamin D orally or by injection significantly increases the serum concentration of 25 (OH) D3 to sufficient levels safely, and both treatment routes can be used in practice.

Nephrotic syndrome (NS) is characterized by swelling, proteinuria, hypoalbuminemia, or hyperlipidemia. The incidence of NS depends on the country and ethnicity and is highest in Asia than in Europe. Nephrotic syndrome can cause complications such as arterial thromboembolism (ATE) due to a hypercoagulable state.

We encountered a 9-year-old boy with NS and infarct stroke, which was treated with corticosteroid and low molecular weight of heparin with clinical improvement.

We recommend that all NS children with high platelet levels perform thromboelastography (TEG) examination and use prophylactic anticoagulation with monitoring of bleeding risk during therapy.

Immune dysregulation happens after exposure to corona virus disease-2019 (COVID-19) and affects many organs. It is confirmed with a positive COVID-19 test history, fever, and the involvement of 2 or more organs, but it is hard to diagnose in neonates.

There were 2 Persian neonates admitted to the Neonatal Intensive Care Unit or neonatal ward of the Children’s Medical Center, Tehran, Iran, with sepsis in this case presentation. The trunk and extremities were affected by macular rashes in both cases. COVID-19 tests in both cases were negative, but both of their mothers were affected by COVID-19 before delivery. In both cases, systemic and macular rashes responded to corticosteroids.

Macular rash can present multisystem inflammatory disease in neonates. Neonates with a positive history of COVID- 19 in parents or relatives should be considered for this syndrome.