Journal of Pediatrics Review
Volume:11 Issue: 3, Jul 2023

The exact prevalence of cardiac anomalies in diagnosed cases of echogenic foci is still unknown, as various studies have been carried out across multiple populations with different methodologies. 

The primary objective of this study was to determine the precise prevalence of cardiac anomalies found in cases with intracardiac echogenic foci. 

The authors manually searched the electronic databases (Cochrane Library, PubMed, EMBASE, Scopus, Web of Science). Two reviewers independently did data extraction and quality control; a third reviewer resolved any raised conflicts. The data were analyzed by comprehensive meta-analysis software version 2. Risk of bias assessment and strobe checklist were used for quality assessment. 

Out of 531 articles identified, 32 studies met the inclusion criteria and were included in the meta-analysis with a total sample size of 7568. The pooled prevalence of cardiac anomalies in the fetuses with intracardiac echogenic foci was 4.8% (95% CI, 3.6%-6.4%). Subgroup analysis was done according to the geographical distribution of cases, maternal age, gestational age, year of publication, risk of bias, and ultrasonography operator. 

The current study represents the first and only meta-analysis concerning the prevalence of cardiac anomaly in fetuses diagnosed with intracardiac echogenic focus (ICEF). This study supports a definitive relationship between ICEF and underlying congenital heart disease. We recommend increased training of individuals performing this ultrasonography to improve early detection, ultimately enhancing the care given to infants immediately post-birth.

This study aims to assess the zinc deficiency prevalence in Iran during the past two decades and compare it with other countries.

We searched PubMed, Google Scholar, Web of Sciences, Scientific Information Database (SID), and Magiran for English and Persian reports on zinc deficiency prevalence in Iran. The search terms were “zinc”, zinc deficiency”, “low zinc level”, “low zinc concentration”, “prevalence”, “epidemiology”, “status”, “Iran”, “Iranian”, and “Persian”, using Boolean operators ‘AND’ or ‘OR.’ The preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist were applied during the review. Two authors reviewed the articles independently. We included all articles published from 2001 to 2021 that reported zinc deficiency prevalence based on serum zinc levels (μg/dL) in the Iranian population. We excluded clinical intervention studies and studies on pregnant women, children with stunting or malnutrition, and patients with a particular disease. The effect sizes of prevalence rates were extracted from original studies. Meta-analysis with the random-effects model was used to estimate the pooled prevalence of zinc deficiency. Publication bias was evaluated by Egger’s test and the Funnel plot.

This systematic review and meta-analysis included 20 studies (12 for males, 13 for females, and 18 for both that involved 16138 participants; 8424 males and 9053 females). Using the random effect model, the overall prevalence of zinc deficiency in the general population was 16% (95% CI, 11%-20%), and in males and females, 18.4% (95% CI, 0.12%-0.24%) and 15% (95% CI, 10%-20%), respectively. In subgroup analysis, the prevalence rates of zinc deficiency for 6 years old children and adolescents were 29% and 12%, respectively. 

The overall prevalence of zinc deficiency in the Iranian population was 16%, lower than the 20% set by IZiNCG (the International Zinc Nutrition Consultative Group) to indicate the need for national intervention programs. However, the COVID-19 pandemic and climate changes threaten this fragile margin. Dietary diversification/modifications, supplementation programs, fortification, and bio-fortification can be used to minimize the problem in high-risk populations. Since this study evaluates the adult healthy population of Iran, we should be cautious about generalizing its results on other population groups like children.

Jaundice is the most prevalent reason for infants’ hospitalization during their first month of birth, and herbal medicine has long been used alongside phototherapy to treat this problem. 

The present systematic review investigates chicory’s influence on bilirubin levels in infants with jaundice. 

In this systematic review study, Iranian databases, including Barekat Gostar, Scientific Information Database (SID), Irandoc, and Magiran, along with international databases, including Cochrane Library, Web of Science, Scopus, PubMed, and Google Scholar search engines were explored with relevant keywords to retrieve pertinent studies. 

Among the 7 selected articles with a sample size of 408 (204 people in the intervention group and 204 in the control group) from 2006 to 2020, 4 studies were in vitro and 3 were randomized clinical trials. Among these studies, mothers’ pregnancy duration ranged between 30.9 and 38.8 weeks, infants’ age ranged between 3 and 7 days, and their weight ranged between 1544 and 3316 g. Although chicory administration varied across the studies, 4 studies reported its effectiveness in reducing infants’ bilirubin, whereas the other 3 articles reported no effect of chicory on bilirubin levels in infants. 

Iran was the only country that evaluated the effect of chicory on neonatal jaundice in the form of several research studies. However, due to the limited number of studies and the different dosages of chicory, the way of consuming chicory, the type of studies, and the age and weight of babies, we could not reach a general conclusion on the efficacy of chicory.

Children generally are less contaminated by COVID-19 than other age groups, but multisystem inflammatory syndrome-children (MIS-C) can cause severe outcomes in some children. The information about MIS-C patient mortality is limited, and the cause of mortality may vary by geographical region. Therefore, we performed this case series study to report the clinical features and treatment of MIS-C patients associated with COVID-19 who died in selected referral hospitals in Iran.

We presented 9 cases of deceased MIS-C patients hospitalized from March 2020 to September 2021. The median age of deceased patients was 89 months (interquartile range: 8-162 mo). Five patients (55%) were male. The COVID-19 reverse transcription polymerase chain reaction (PCR) or serology test was positive in 7 children (77%). About 80% of the patients had comorbidities, most commonly obesity. All the patients were febrile at admission, and 77.78% had a fever for over 5 days. Respiratory, cardiac, and gastrointestinal signs were the most common. On admission, 6 patients were transferred to the pediatric intensive care unit. All patients received intravenous immunoglobulin and steroids. 

The most common organ failure was lung, heart, liver, and kidney, but the main cause of death was cardiopulmonary failure. Early diagnosis and management of MIS-C are necessary to prevent severe complications and death.

The incidence of pancreatic neoplasms in infants and children is 1.8 cases per 1000000. Three of children’s most common primary pancreatic neoplasms are pancreatoblastoma, solid pseudopapillary neoplasm of the pancreas, and pancreatic endocrine neoplasms. Solid pseudopapillary neoplasm of the pancreas is a low-grade malignant tumor. Solid pseudopapillary neoplasm in children is presented with a palpable mass (60%), followed by abdominal pain (33.3%). Although duodenal invasion frequently occurs in patients with pancreatic cancer, massive gastrointestinal bleeding is seldom encountered. The most helpful imaging technique is the CT scan. Surgical resection is the treatment of choice for solid pseudopapillary neoplasms.

A 14 years old male adolescent was presented to our pediatric emergency department with fatigue, dizziness, fever, vomiting, and tachycardia. He had melena 5 days before admission. Crystalloids, pantoprazole, and packed red blood cells were administered to stabilize the patient. As the initial resuscitation measures stabilized the patient, endoscopic gastroduodenoscopy was performed, and a vascular lesion measuring 60×70 mm was noted in the second part of the duodenum. CT scan of the abdomen with intravenous and oral contrast showed a mass with solid and cystic components measuring 75×52 mm between the head of the pancreas and gallbladder origination from the head of the pancreas. The patient underwent Whipple surgery. The diagnosis of the pathologic evaluation was a solid pseudopapillary tumor of the pancreas.

Most pediatric pseudopapillary tumors of the pancreas present with a palpable mass and abdominal pain, and gastrointestinal bleeding is a rare presentation not mentioned in previous case reports.

Fever is defined as a rectal temperature of 100.4oF or more. It is a physiologic response characterized by an elevation of body temperature above normal variation. Fever is one of the common causes of medical consultation in children, responsible for 15%–25% of consultations in Pediatrics practice. Children with prolonged fever worry their parents and are a diagnostic challenge to pediatricians. Persistence of fever raises clinical queries towards diagnosis, especially in patients without identifiable focus. Children with a temperature of more than 38°C (100.4°F) recorded by a healthcare professional without any determined reason after at least 8 days of evaluation should be classified as having a “fever of unknown origin”. Most fevers with unknown causes usually have atypical presentations of common illnesses. 

We reviewed the case records of 9 children admitted to our pediatric ward with prolonged fever episodes from December 2021 to October 2022. They were diagnostic challenges for clinicians. In our cases, 2 children had scrub typhus, 1 was diagnosed with acute lymphoblastic leukemia, and 1 had multidrug-resistant typhoid fever. However, 2 patients remained with a fever of unknown origin. Three children were found to have coinfections and diagnosed with enteric fever with other coinfections like dengue, leptospirosis, and urinary tract infection. Cases 1, 2, and 9 had persistent fever despite appropriate antibiotics therapy based on sensitivity patterns, hence a significant diagnosis challenge. Cases 3 and 6 had initial diagnostic deviations due to their atypical presentations, and both cases were diagnosed as scrub typhus. After extensive evaluation, case 4 was diagnosed as malignancy (acute lymphoblastic leukemia). Cases 5 and 7 posed a diagnostic challenge: The causes were not found after extensive evaluation, and there was persistent fever after 10 days of admission. Hence, they were diagnosed as “fever of unknown origin”.

A complete history and detailed examination are essential in evaluating pediatric illnesses. We have found that there might be deviators during disease evolution. We should not settle with a single diagnosis until a good clinical response is achieved and also consider alternative diagnoses or coinfections. Common causes of prolonged fever should be ruled out first. Coinfections should also be considered if there is no clinical response to treatment in a patient. A practical, systematic, and stepwise approach can be helpful with the assessment and management of prolonged fever in the pediatric age group.

Aplasia cutis congenita (ACC) is a rare condition regarded as a congenital absence of the epidermis, dermis, and in some cases, subcutaneous tissues in the newborn. The pathogenic mechanism is unclear, although the condition has been described as a result of the disrupted development or degeneration of skin in utero. ACC may be observed with fetus papyraceous (FP).

We report a case of an 8-hour-old newborn female with bilateral symmetrically distributed, stellate type of truncal ACC at birth. She was the survivor twin as the other fetus died at 13wk+3d gestation. This condition describes ACC with FP. Physical examination showed otherwise normal and managed with no other congenital abnormalities. The newborn was treated with antibacterial ointment and antibiotics, and lesions resolved spontaneously within 5 days, leaving scars.

This report explained a newborn with type V cutis aplasia congentia in whom the detection was approved based on the revision of antenatal history and clinical features. The protocol outcome revealed that the topical and systemic antibiotic and washing with normal saline could be an effective treatment for the healing of ACC lesions. Follow-up after 3 months indicated that the skin lesion completely healed, leaving a very small atrophic scar, and no further lesion management was required.

Ataxia-telangiectasia is a multi-organ disease. It is due to a mutation of the Exon No. 5 ataxia telangiectasia mutated gene (c.381delA: p.v128fls). Complications including recurrent infections, progressive cerebellar ataxia, and varying degrees of humoral and cellular immunodeficiency arise. 

We report a 7-year-old girl patient with A-T who developed acute rheumatic fever. 

Rheumatoid disorders and or infectious diseases such as acute rheumatic fever could be observed in A-T patient.

Diabetes mellitus (DM) is a common metabolic disorder. The hemoglobin A1c (HbA1c) test is a simple laboratory test that shows the average amount of blood sugar in the last 3 months. Studies have shown that sleep is important in controlling blood sugar levels, so that sleep deprivation can reduce glucose tolerance. Lack of sleep and sleep disorders are also predictors of DM.

Given the contradictory information about the effect of sleep on blood sugar, the impact of various factors in the process of DM, including the lifestyle of patients, and the limited number of studies in this field in Iran, we decided to investigate the effect of sleep disorders on blood sugar control in people with type 1 DM.

This cross-sectional descriptive-analytical study was performed on children with type 1 DM referred to the diabetes clinic. Their HbA1c levels were recorded in a checklist from the patient’s last test recorded in their files, and the standard Pittsburg sleep quality index (PSQI) was completed to assess their sleep disorders with the help of the child’s parents. Achieving a score higher than 5 in the whole questionnaire means poor sleep quality. After collecting data, they were analyzed in SPSS software, version 21.

A total of 200 children with type 1 DM were studied, of whom 119(59.5%) were boys, 81(40.5%) were girls. Also, 79 children (39.5%) were less than 1 year old, 67(33.5%) were 1 to 2 years old and 54 were more than 3 years old. Also, 104 children (52.6%) had no sleep disorders, while 69(32.1%) had moderate, 20(11.6%) had severe, and 7(3.7%) had very severe sleep disorders. Their Mean±SD age was 10.86±4.68 years, and HbA1c level was 9.64±3.35 mmol/mol.

This study showed that the prevalence of sleep disorders based on the PSQI was approximately 50%. There was a significant relationship between elevated HbA1c and the prevalence of sleep disorders.

The immense assorted variety of data accessible through the Internet, containing unconfirmed pernicious data, can spread rapidly and misguide nursing and allied health staff (NAHS). False impressions among NAHS postpone controlling endeavors to deliver important treatment, lead to the quick spread of contamination in clinical settings, and put patients’ lives in danger. This research aimed to assess the impact of NAHS digital health literacy and other determinants on their behaviors during the COVID-19 pandemic. 

This study was conducted on allied health and nursing staff in healthcare organizations affiliated with Semnan University of Medical Sciences in Iran. Two valid questionnaires were used: Digital health literacy and preventive behaviors. Multiple logistic models were used to explain the relationship between one dependent binary variable and other variables. 

There were significant direct and positive relationships between digital health literacy (β=0.60; 95% CI, 1.35%-2.45%; P<0.001) and English language skills (β=2.29; 95% CI, 1.79%-54.03%; P=0.009) with preventive behaviors.

Strengthening the digital health literacy of medical staff can help reduce the spread of COVID-19 infections in healthcare settings. It is proposed that policymakers and nursing informatics educators adjust e-health policies to advance digital health literacy in healthcare settings.