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Esmatullah Esmat,1 Ramin Saadaat,1 Noor Hassan Saedi,1 Ahmadullah Hakimi,1 Abdul Tawab Baryali,2 Abdul Jamil Rasooli,3 Sahar Noor,3 Maryam Ahmad,1 Ahmed Maseh Haidary1 1Department of Pathology and Clinical Laboratory, French Medical Institute for Mother and Children (FMIC), Kabul, Afghanistan; 2Department of Quality and Patient Safety, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan; 3Department of Paediatric Medicine, French Medical Institute for Mother and Children (FMIC), Kabul, AfghanistanCorrespondence: Ahmed Maseh Haidary, Department of Pathology and Clinical Laboratory, French Medical Institute for Mother and Children (FMIC), Behind Kabul Medical University, Kabul, PO, BOX:472, Afghanistan, Email ahmed.maseh9t9@gmail.comIntroduction: The widespread use of antibiotics is a serious and alarming situation in terms of the development of antimicrobial resistance. The current study was conducted to demonstrate the types of organism isolated from the urine of patients presenting with UTI symptoms as well as their antimicrobial sensitivity spectrum.Methodology: A descriptive cross-sectional study was conducted, and 272 positive urine cultures from children under 5 years of age with signs and symptoms of a UTI were included in the study. The types of organisms isolated from the urine cultures and their susceptibility to antibiotics were identified. The data collection form was designed as an Excel spreadsheet that included both dependent and independent variables, such as patient age, gender, WBC, red blood cell (RBC) count, nitrite, organism isolated, and antiprogram results.Results: Of the patients included, 64% were female. The majority were under one year of age, followed by children aged one to three. Among these children, 63% had pyuria and hematuria, and 64% had nitrite-positive urine samples. The most commonly isolated organisms included Escherichia coli, Klebsiella species, Candida species, Candida albicans, and Enterococcus species. In this study, 62% of gram-negative organisms were ESBL positive, among which the Proteus species demonstrated the highest ESBL positivity, followed by the Klebsiella species and E. coli. The majority of Enterobacteriaceae isolates in this study showed resistance to Augmentin and Ampicillin. Similarly, E. coli was highly resistant to third-generation cephalosporins, ceftazidime, and ceftriaxone.Conclusion: Due to the high prevalence of UTIs in pediatric patients and their nonspecific signs and symptoms, particularly in infants or young children, diagnosing and treating them, whilst difficult, is crucial. Urine samples should be analyzed for all pediatric patients with fever and, if pyuria is present, a urine culture is necessary.Keywords: bacterial isolates, antimicrobial susceptibility, pediatric patients, UTI

Abstract Background Guillain-Barré syndrome (GBS) is an autoimmune disease that affects the peripheral nervous system leading to motor, sensory, and sometimes autonomic manifestations. Therapeutic plasma exchange (TPE), which involves the selective removal of pathological molecules, such as auto-antibodies, from plasma, has proven to be safe and effective in adults with GBS. However, its application in pediatric patients lacks sufficient evidence. This study aims to evaluate the efficacy and safety of TPE in pediatric patients with severe GBS, in a low-resource setting. Methods This is a single-center retrospective study of 36 GBS patients aged between 2 and 13 years. A total of 122 TPE sessions were administered, with a median of four sessions per patient. A human albumin solution was the exchange fluid in all the sessions. Clinical improvement was evaluated through general examination and muscle power assessment using the Medical Research Council (MRC) scale. Results All patients showed clinical improvement upon treatment with TPE. The grade of power in the upper extremities increased from a mean of 1.7 ± 1.1 at the peak of illness to 3.7 ± 0.9 at discharge, indicating an increase of 2.0 ± 1.1 (95% CI, 1.6 to 2.4, p< 0.001). Alternatively, in the lower extremities, it increased from 1.2 ± 1.1 to 2.5 ± 0.8, indicating a significant rise of 1.4 ± 0.8 (95% CI, 1.1 to 1.6, p< 0.001). There was a significant improvement in the cranial, autonomic, and respiratory functions among all patients. Half of the patients were available for follow-up and showed full recovery, with six of them still exhibiting minimal residual deficits. TPE-related complications were mostly mild or moderate, with tachycardia, hypotension, and mild anemia being the most common. However, serious complications occurred in three of the patients, necessitating the discontinuation of the treatment in two of them. There was no mortality related to TPE in this study. Conclusions TPE shows promise in treating pediatric GBS. In this study, TPE was associated with the recovery of neurological functions, yielding positive outcomes with only minimal residual deficits. However, balancing its benefits with potential risks requires careful clinical judgment and rigorous monitoring to ensure patient safety and optimize outcomes. TPE was a more cost-effective and accessible option than IVIG in this financially restricted, low-income setting.

Abstract Context Since the outbreak of COVID-19 in late 2019, the transmission dynamics and clinical presentation patterns of influenza A (Flu A) virus have undergone changes. Objectives This article conducted a comparative analysis in clinical characteristics and laboratory results of pediatric patients with Flu A before, during, and after the COVID-19 pandemic. Methods The medical records of 885 children hospitalized with Flu A virus infection at a tertiary hospital in Guangdong Province, China, were retrospectively analyzed. Flu A was confirmed in these cases using a direct immunofluorescence antigen assay. The clinical data for this study span from January 1, 2018, to May 31, 2023. Results In our study, we observed a total of 340 cases before the COVID-19 pandemic, 196 cases during the pandemic, and 349 cases after the pandemic. Patients after the pandemic had a higher median age on admission (5.66 years, range 3.41–7.70) and exhibited more respiratory symptoms such as cough, sore throat, and nasal stuffiness. The length of hospital stay was longer, and there was a higher percentage of patients with fever duration ≥ 5 days among Flu A patients during the pandemic. Compared to before and during the COVID-19 pandemic, Flu A patients after the pandemic showed significantly reduced white blood cell (WBC) and platelet (PLT) counts (P

Abstract This study aimed to investigate the safety and effect of omitting chest tubes after thoracoscopic lobectomy in children with congenital lung malformation. A multicenter retrospective study was performed with 632 thoracoscopic lobectomy CLM patients in four hospitals between 2014.1 and 2023.1, which were divided into non-chest tube (NCT)group and chest tube (CT)group. Baseline data, operation and follow-up outcomes were compared. In total, 312 patients were included in the NCT group, and 320 in the CT group. There were no statistically significant differences in baseline data between the two groups. The FLACC scale score in the NCT group was less than the CT group (2.7 ± 0.43 vs. 5.8 ± 0.26 p = 0.027). The median length of postoperative hospital stay in the CT group was significantly longer than the NCT group (5 d vs.3 d, p = 0.045). Eight (2.5%) patients developed chest tube related infections in the CT group(p = 0.004). Six patients developed atelectasis in the NCT group, which was significantly less than the 18 patients in the CT group(p = 0.014). No chest tube placement in selected CLM pediatric patients may be safe and avoid chest tube-related complications, which may also contribute to a rapid recovery.

Qian Wang,1,2,&ast; Guimin Huang,3,&ast; Ruikun Wang,4 Zhilong Cao,5 Jieqiong Liang,1 Mengyao Li,1 Qinglong Gu1,2 1Department of Otolaryngology-Head and Neck Surgery, Capital Institute of Pediatrics, Beijing, People’s Republic of China; 2Graduate School of Peking Union Medical College, Beijing, People’s Republic of China; 3Child Health Big Data Research Center, Capital Institute of Pediatrics, Beijing, People’s Republic of China; 4Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, People’s Republic of China; 5School of Software, Beihang University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qinglong Gu, Department of Otolaryngology-Head and Neck Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel +86-13146836613, Email gql71@163.comPurpose: This study investigates the prevalence, risk factors, and clinical characteristics of positional obstructive sleep apnea (POSA) among pediatric patients diagnosed with obstructive sleep apnea (OSA).Patients and Methods: A total of 1,236 children aged 0 to 17 years who underwent nocturnal polysomnography (PSG) and completed the Sleep Questionnaire were included. After excluding those with an AHI < 1, neurological or muscular disorders, or insufficient sleep time in specific positions, 908 patients remained: 158 with POSA and 750 with non-positional OSA (NPOSA). Propensity score matching (PSM) was applied at a 1:2 ratio, resulting in a final sample of 153 POSA and 306 NPOSA patients. Data analyses were performed using R software (version 4.2.3).Results: The prevalence of POSA was 12.8%. After PSM, patients with POSA had a lower overall AHI (8.66 vs 10.30), REM-AHI (14.30 vs 17.40), and NREM-AHI (7.43 vs 8.77) compared to those with NPOSA. POSA patients also had a shorter total sleep time (411 vs 427 minutes), spent less time in the supine position (168 vs 225 minutes), and more time in non-supine positions (241 vs 202 minutes) than NPOSA patients. Additionally, while the supine AHI was higher in POSA patients (15.60 vs 10.30), the non-supine AHI was lower (5.00 vs 11.00) compared to NPOSA patients. The minimum oxygen saturation was slightly higher in POSA patients (0.88 vs 0.87). All differences were statistically significant (P < 0.05). Risk factors for POSA included mild OSA, allergic rhinitis, non-allergic rhinitis, and obesity.Conclusion: The prevalence of POSA in children is lower than in adults, and its severity is less than that of NPOSA. Compared to NPOSA patients, POSA patients had significantly higher AHI during supine sleep and lower AHI during non-supine sleep. POSA patients also spent more time in non-supine positions, suggesting that avoiding supine sleep may help reduce apnea events. These findings highlight the importance of monitoring and managing sleep posture in POSA patients.Keywords: obstructive sleep apnea, pediatric patients, risk factors, polysomnography, sleep position, sleep-disordered breathing

Abstract Background Altitude influences bicarbonate levels, it is a variable that is hardly considered in diagnosing Renal Tubular Acidosis (RTA), so it should be a factor to consider when diagnosing this pathology, especially at 2250 mts over the sea level as it is the case of Mexico City. RTA is most often misdiagnosed. Regarding of this, the present study established reference limits for bicarbonate levels in healthy children without pathologies associated with alterations in the acid-base balance in Mexico City and it´s metropolitan area. Methods A total of 267 healthy pediatric patients were included, within normal estimated glomerular filtration rate (eGFR), and without any associated pathology of any alteration in the acid-base balance. Results Compared to older children, children younger than two years of age showed statistically higher levels of calcemia and cystatin C. On the other hand, this same group showed lower values of creatininemia, pCO2, and HCO3 -. Percentile 50 of bicarbonate in children under two years of age were 19.9 mEq/L and 21.9 mEq/L in those over that age. A correlation was identified between HCO3 - levels and pCO2 (r = 0.68; p

Galectin-3 (Gal-3) has been demonstrated to play a pivotal role in the pathogenesis of several fibrotic disorders. A number of studies have examined the relationship between galectin-3 levels and cardiac fibrosis in heart failure. Nevertheless, the role of galectin-3 in the etiology of supraventricular (SVa) and ventricular (Va) arrhythmias remains largely unexamined. The objective of this prospective study was to investigate the potential correlation between galectin concentration and the occurrence of idiopathic cardiac arrhythmias in pediatric patients. Biochemistry analysis was performed on 30 children (11–18 years; 14 boys and 16 girls). The control group consisted of 20 children. Cardiac arrhythmia was confirmed by a 24 h Holter ECG recording. Serum galectin-3 levels were measured via enzyme-linked immunosorbent assay (ELISA). Statistical analysis of the data showed significant associations between creatinine kinase (CK) and Gal-3 in patients with SVa (SVT—supraventricular tachycardia) arrhythmias, suggesting a potential effect of CK on Gal-3 levels. However, no correlation was identified between Gal-3 concentration and the occurrence of cardiac arrhythmias under investigation. We concluded that galectin-3 does not have the potential to be a biomarker in the diagnosis of idiopathic arrhythmias in pediatric patients.

Radicular cysts are the most often documented inflammatory cysts in the adult population, although their incidence in children is regarded as unusual. This study presents a 12-year-old female patient, who had an asymptomatic radicular cyst along with a retained and decayed deciduous tooth in the left posterior mandibular area, the cyst. The patient underwent cystic enucleation after a clinical and radiographic evaluation which led to a provisional diagnosis that was corroborated by the histological findings. In this article, the differential diagnosis and treatment of a radicular cyst in a pediatric patient is discussed.

Background: This study aimed to identify the epidemiological, clinical, and laboratory features and treatment options of children with COVID-19 in Kosovo. Methods and Results: This retrospective study analyzed the hospitalization records of all children at the Department of Pediatrics of the University Clinical Center of Kosovo diagnosed with COVID-19 between March 16 and December 31, 2022. The diagnosis of SARS-CoV-2 infection was confirmed by PCR performed on nasopharyngeal or oropharyngeal swabs. The recorded case characteristics included age, sex, disease onset and diagnosis dates, and family and contact information. The collected clinical data comprised the duration and severity of symptoms and treatment. Laboratory parameters such as complete blood count, biochemical tests, chest X-ray, and chest computed tomography (CT) were also documented. One hundred and seventy-six pediatric COVID-19 cases were confirmed, with boys accounting for 59.65% (n = 105) and girls for 40.35% (n = 71). The median age was 62 months (1–210) for girls and 44.6 months (1-204) for boys. The most common symptoms were fever, cough, vomiting, diarrhea, and dyspnea. Twenty-six patients (14.77%) had underlying diseases among the total cases. Laboratory findings included elevated ESR in 39.77% of cases, high CRP level (38.63%), high WBC count (46.02%), and high AST level (56.25%). Chest X-rays were normal in the majority of patients. Pathological CT scans were found in 77.78% of cases. Antibiotics and rehydration were commonly used for treatment. Conclusion: This is one of the largest pediatric data sets about confirmed COVID-19 cases in Kosovo. Children of all ages appear to be susceptible to COVID-19. Based on available data, children have lower rates of hospitalization compared to adults with COVID-19, indicating that children may experience less severe illness than adults. However, research indicates that the incidence and frequency of cases have been progressively rising.

Qingbao Guo,1,2,&ast; Manli Xie,3,&ast; Qian-Nan Wang,4,&ast; Jingjie Li,1,2 Simeng Liu,1,2 Xiaopeng Wang,1,2 Dan Yu,5 Zhengxing Zou,5 Gan Gao,1,2 Qian Zhang,5 Fangbin Hao,1,2 Jie Feng,5 Rimiao Yang,5 Minjie Wang,1,2 Heguan Fu,5 Xiangyang Bao,5 Lian Duan2 1Medical School of Chinese PLA, Beijing, People’s Republic of China; 2Department of Neurosurgery, First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China; 3Department of Occupational Diseases, Xi’an Central Hospital, Xi’an, Shanxi, People’s Republic of China; 4Department of Neurosurgery, Eighth Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China; 5Department of Neurosurgery, Fifth Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xiangyang Bao; Lian Duan, Email bzy123@163.com; duanlian307@sina.comBackground: Moyamoya disease (MMD) signifies a cerebrovascular disorder with obscure origin and a more rapid and severe progression in children than adults. This investigation aims to uncover age-associated distinctions through proteomic and metabolomic profiling to gain insights into the underlying mechanisms of MMD.Methods: Twelve MMD patients—six children and six adults—along with six healthy controls (HC), participated, each providing a 10 mL blood sample. Serum proteomic and metabolomic analyses were conducted using ultra-performance liquid chromatography and high-resolution mass spectrometry, complemented by bioinformatics to identify differential biomolecules and their interactions. Pathway implications were ascertained using GO and KEGG enrichment analysis.Results: Notable proteomic and metabolomic discrepancies were observed between pediatric and adult MMD subjects. A total of 235 and 216 proteins varied in adult and pediatric cases compared to HCs, with 73 proteins shared. In addition, 129 and 74 anionic, plus 96 and 104 cationic metabolites, were differentially expressed in the pediatric and adult groups, respectively, with 34 anionic and 28 cationic metabolites in common. Age-specific biomolecules further characterized these distinctions. Enrichment analysis pinpointed immunity and inflammation pathways, with vitamin digestion and absorption highlighted as pivotal in pediatric MMD.Conclusion: This study unveils distinct metabolic and proteomic patterns within pediatric and adult MMD patients. The critical role of the vitamin digestion and absorption pathway in the pathogenesis of pediatric MMD offers novel insight into disease mechanisms. Keywords: proteomics, metabolomics, pediatric patients, moyamoya disease, integration analysis

Despite trials and programs for the prevention of childhood mortality due to pneumonia, Ethiopia is among the top five countries with the highest number of deaths due to pneumonia. Although the prevalence of pneumonia has increased in the above-mentioned trials, little is known about the recovery time from severe pneumonia and its predictors in the study area. Therefore, this study aimed to assess the time to recovery from severe pneumonia and its predictors among pediatric patients admitted to Mizan-Tepi University Teaching Hospital, Ethiopia, in 2022.

Abstract Background Children and adolescents with Pompe disease (PD) face chronic and progressive myopathy requiring time-intensive enzyme replacement therapy (ERT). Little is known about their perspectives on the disease and its treatment. This study explored their perceptions of disease symptoms and functioning status, and more subjective feelings about the impacts on their lives as part of developing a disease-specific questionnaire. Methods Eleven pediatric patients aged 8–18 years and 26 caregivers from six children’s hospitals in Germany, Austria, and Switzerland underwent semi-structured interviews. Data were recorded, transcribed using MAXQDA software, and analyzed using qualitative content analysis. A system of meaningful categories was developed. Results Sixteen main categories were derived across four major thematic areas: perceptions of symptoms and limitations, experiences to do with the biopsychosocial impact of PD, treatment experiences, and general emotional well-being/burden. Participants demonstrated broad heterogeneity in symptom perceptions such as muscle weakness, breathing difficulties, pain, and fatigue. Emotional appraisals of limitations were not directly proportional to their severity, and even comparatively minor impairments were often experienced as highly frustrating, particularly for social reasons. The main psychosocial topics were social exclusion vs. inclusion and experiences to do with having a disease. The main finding regarding treatment was that switching ERT from hospital to home was widely viewed as a huge relief, reducing the impact on daily life and the burden of infusions. Emotional well-being ranged from not burdened to very happy in most children and adolescents, including the most severely affected. Conclusion This study provided qualitative insights into the perceptions and experiences of pediatric PD patients. Interestingly, biopsychosocial burden was not directly related to disease severity, and tailored psychosocial support could improve health-related quality of life. The present findings ensure the content validity of a novel questionnaire to be tested as a screening tool to identify patients in need of such support.

Abstract Background Medical fear is a common psychological reaction in hospitalized children, especially during radiotherapy for central nervous system (CNS) cancers. This fear not only causes negative emotions such as anxiety and depression but also affects children’s quality of life and treatment outcomes. It is exacerbated by factors such as unfamiliar environments during radiation therapy and separation from parents. Child Life, as a professional service, offers physical and mental support to children through medical understanding and psychological preparation, addressing their social and psychological needs, among other things. This study aims to construct a comprehensive Child Life intervention program (CCLIP), consisting of four key components: psychological adjustment and preparation, therapeutic play, pain management and coping strategies, and family support. The integration of effective intervention methods aims to reduce medical fear in children undergoing radiotherapy, promote psychological well-being, improve treatment compliance, and enhance quality of life. Methods This study is a protocol for a randomized controlled trial. Using a random number table method, we plan to recruit 38 eligible children who meet the inclusion criteria and then randomize them into two distinct groups: the intervention group and the control group. The intervention group will receive the CCLIP, and the control group will receive standardized care. Data will be collected through questionnaires and on-site assessments during the one-month intervention period at four distinct time points: the day of admission (T0), the first radiotherapy positioning (T1), mid-radiotherapy (T2), and postradiotherapy (T3). The primary outcome measure is the effectiveness of the CCLIP in reducing medical fear among children receiving radiation treatment for CNS cancers. Secondary outcomes include anxiety, depression, radiation adherence, quality of life among children, and parental satisfaction. Discussion This study aims to alleviate medical fear among children with CNS tumors undergoing radiotherapy through the implementation of the CCLIP while enhancing their mental health and quality of life. The expected outcomes of this research include providing effective intervention strategies for clinical practice, improving the treatment experience and long-term prognosis of children, and having positive impacts on children and their families. Trial registration This study is registered at the Chinese Clinical Trial Registry, ChiCTR2400082622. Registered 2 April, 2024.

Abstract Antibiotics are often prescribed inappropriately, either when they are not needed or with an unnecessarily broad spectrum of activity. This is a serious problem that can lead to the development of antimicrobial resistance (AMR). This study was conducted to assess the antibiotic prescribing pattern in pediatric patients hospitalized at a quaternary hospital in Nampula, Mozambique, using the WHO indicators and Framework as a reference. A retrospective study was conducted using secondary data obtained from medical records. The study population consisted of children aged 0–10 years who were hospitalized in a quaternary-level hospital ward in Nampula, Mozambique. The pattern of antibiotic prescriptions was assessed using indicators and the WHO classification of antibiotics into AWaRe categories. Descriptive statistics were applied. A total of 464 antibiotics were prescribed during the study. The age groups of 1–3 years and 28 days-12 months were prescribed more antibiotics. The most common antibiotics were ceftriaxone and crystallized penicillin, which were frequently prescribed for patients suffering from bronchopneumonia, gastroenteritis, and malaria. 74.8% of the antibiotics prescribed belonged to the Access group, while 23.7% belonged to the Watch group. There were no prescriptions of antibiotics from the Reserve group. The average number of antibiotics per prescription was 1.51 (SD ± 0.725). The percentage of antibiotic prescribing was 97.5%, with 96.20% by injection. All antibiotics prescribed were on the essential medicines list and prescribed by generic name. These results are concerning and highlight the urgency of strengthening antimicrobial optimization measures, as well as implementing the AWaRe framework in antibiotic prescribing as an essential strategy to combat AMR.

Human Pegivirus-1, typically regarded as a commensal virus, exhibits high prevalence in humans. Its frequency and impact on oncologic pediatric patients with febrile neutropenia (FN), a frequent chemotherapy complication, remains unexplored. In this study, we assessed HPgV-1 RNA prevalence in pediatric patients experiencing FN. Blood samples were collected from 30 children, 15 presenting FN and 15 comprising a control group of either undergoing treatment or in remission. Overall, HPgV-1 RNA was detected in 23.3 % of samples (26.7 % among FN patients and 20.0 % among those under treatment or in remission). Phylogenetic analysis unveiled HPgV-1 genotype 2 predominance among these samples, the most prevalent strain circulating in Brazil. Our findings prompt crucial inquiries into the role of HPgV-1 RNA in FN: is it an incidental finding and if it can influences this clinical entity? Further investigation is imperative to elucidate HPgV-1 implications in vulnerable patients cohorts, potentially informing new approaches and understanding viral dynamics in immunocompromised populations.

The diagnosis of acute lymphoblastic leukemia (ALL), which is the most common type of cancer in children, has become more accurate with the use of flow cytometry. Here, this technology was used to immunophenotype leukemic cells in peripheral blood samples from Libyan pediatric ALL patients. We recruited 152 newly diagnosed patients at Tripoli Medical Center (Tripoli, Libya) by morphological examination of blood and bone marrow. Twenty-three surface and cytoplasmic antigen markers were used to characterize B and T cells in circulating blood cells by four-color flow cytometry. Six children (3.9%) turned out to have biphenotypic acute leukemia, 88 (57.9%) had B ALL, and 58 (38.1%) had T ALL. There were 68 cases of pro-B ALL CD10-positive (44.7%), 8 cases of pro-B ALL CD10-negative (5.2%), 6 cases of pre-B ALL (3.9%), and 6 of mature-B ALL (3.9%). CD13 was the most commonly expressed myeloid antigen in ALL. We present immunophenotypic data for the first time describing ALL cases in Libya. The reported results indicate that the most common subtype was pro-B ALL, and the frequency of T-ALL subtype was higher compared to previous studies. Six cases were positive for both myeloid and B lymphoid markers. Our findings may provide the basis for future studies to correlate immunophenotypic profile and genetic characteristics with treatment response among ALL patients.

Abstract Background Pulmonary aspergillosis is a prevalent opportunistic fungal infection that can lead to mortality in pediatric patients with underlying immunosuppression. Appropriate and timely treatment of pulmonary aspergillosis can play a crucial role in reducing mortality among children admitted with suspected infections. Case presentation The present study reports three cases of inappropriate treatment of pulmonary aspergillosis caused by Aspergillus flavus in two Iranian pediatric patients under investigation and one Afghan patient. Unfortunately, two of them died. The cases involved patients aged 9, 1.5, and 3 years. They had been diagnosed with pulmonary disorders, presenting nonspecific clinical signs and radiographic images suggestive of pneumonia. The identification of A. flavus was confirmed through DNA sequencing of the calmodulin (CaM) region. Conclusion A. flavus was the most prevalent cause of pulmonary aspergillosis in pediatric patients. Early diagnosis and accurate antifungal treatment of pulmonary aspergillosis could be crucial in reducing the mortality rate and also have significant potential for preventing other complications among children. Moreover, antifungal prophylaxis seems to be essential for enhancing survival in these patients.

Abstract The association between oral dysbiosis and celiac disease (CD) remains poorly understood, as does the impact of CD-associated dysbiosis on disease development or exacerbation. This study aims to investigate alterations in salivary microbial composition among children with CD. In this cross-sectional study, saliva samples from 12 children with active CD (A-CD group), 14 children with CD on a gluten-free diet (GFD), and 10 healthy control (HC) children were analyzed using DNA sequencing targeting the 16S ribosomal RNA. Both patients in A-CD and GFD groups showed a significant increase (p = 0.0001) in the Bacteroidetes phylum, while the Actinobacteria phylum showed a significant decrease (p = 0.0001). Notably, the Rothia genus and R.aeria also demonstrated a significant decrease (p = 0.0001) within the both CD groups as compare to HC. Additionally, the control group displayed a significant increase (p = 0.006) in R.mucilaginosa species compared to both CD patient groups. Distinct bacterial strains were abundant in the saliva of patients with active CD, indicating a unique composition of the salivary microbiome in individuals with CD. These findings suggest that our approach to assessing salivary microbiota changes may contribute to developing noninvasive methods for diagnosing and treating CD.

Abstract Background Postoperative respiratory adverse events are the most common perioperative complications in pediatric anesthesia, particularly prevalent in children undergoing tonsillectomy and adenoidectomy, with an incidence rate as high as 50%. The choice of anesthetic induction regimen directly influences the incidence of respiratory adverse events during the induction period. However, this effect seems to have minimal impact on postoperative outcomes. The occurrence rate of postoperative respiratory adverse events is likely more closely associated with the anesthetic maintenance phase, yet this relationship remains uncertain at present. Methods The objective of this study was to assess the impact of different anesthetic maintenance regimens on postoperative respiratory adverse events in pediatric patients undergoing tonsillectomy and adenoidectomy. The AmPRAEC study is a multicenter, randomized, double-blind controlled trial. A total of 717 pediatric patients were recruited from 12 medical centers and randomly assigned to three groups: group A (intravenous maintenance group, receiving propofol infusion); group B (intravenous-inhalational combination group, maintained with 1% sevoflurane combined with propofol); and group C (inhalational maintenance group, maintained with 2–3% sevoflurane inhalation). The primary outcome measure was the incidence rate of postoperative respiratory adverse events. Discussion This clinical trial aims to elucidate the impact of various anesthetic maintenance regimens on postoperative respiratory adverse events in pediatric patients. The outcomes of this study are anticipated to facilitate anesthesiologists in devising more comprehensive perioperative management strategies, enhancing comfort, and improving the clinical outcomes for this patient population. Trial registration Chinese Clinical Trial Registry ( http://www.chictr.org.cn ) ChiCTR2300074803. Registered on August 16, 2023.

To investigate the impact of the recently released pediatric reference voxel phantoms (0-, 1-, 5-, 10-, 15-year-old males and females) of the International Commission on Radiological Protection (ICRP) on organ dose estimates for radioactive iodine (RAI) treatment in pediatric patients, we calculated and analyzed pediatric-specific iodine-131 S values (rT ← thyroid) for the 30 radiosensitive organs by conducting Monte Carlo simulations using the Geant4. The gender dependency in the S values was frequently seen for the 15-year-old phantoms with higher S values of female than male. In addition, the age dependency in the S values was observed for most target organs; that is, the S values tend to decrease for older ages (e.g., ∼120 times for the gonads between the adult and newborn) due mainly to the inter-organ distances generally longer for older ages. Moreover, we observed that the iodine-131 S values tend to be significantly greater by up to ∼145.5 times than those of the stylized phantoms that have been widely used for organ dose estimates of pediatric RAI patients. We believe that the pediatric-specific iodine-131 S values (rT ← thyroid) of the ICRP pediatric reference voxel phantoms should be beneficial to improve the dosimetry of pediatric RAI patients.

Nan Dang,1 Yunqing Ren2 1Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 2Children’s Hospital of Zhejiang University School of Medicine, Hangzhou, People’s Republic of ChinaCorrespondence: Yunqing Ren, Children’s Hospital of Zhejiang University School of Medicine, 3333 Binsheng Road, Hangzhou, Zhejiang, 310052, People’s Republic of China, Email yqren@zju.edu.cnAbstract: Kaposiform hemangioendothelioma(KHE) without Kasabach-Merritt phenomenon is a rare tumor primarily observed in pediatric patients; however, its documentation in the literature remains limited. We reported about a 1-year-old boy diagnosed with superficial KHE who received oral propranolol in combination with topical sirolimus and reviewed relevant reports and treatment of superficial KHE.Keywords: superficial kaposiform hemangioendothelioma, pediatric patients, rare tumor, case treatment

Abstract Background Infection with the Epstein-Barr virus (EBV) elicits a complex T-cell response against a broad range of viral proteins. Hence, identifying potential differences in the cellular immune response of patients with different EBV-associated diseases or different courses of the same disorder requires interrogation of a maximum number of EBV antigens. Here, we tested three novel EBV-derived antigen formulations for their ability to reactivate virus-specific T cells ex vivo in patients with EBV-associated infectious mononucleosis (IM). Methods We comparatively analyzed EBV-specific CD4+ and CD8+ T-cell responses to three EBV-derived antigen formulations in 20 pediatric patients during the early phase of IM: T-activated EBV proteins (BZLF1, EBNA3A) and EBV-like particles (EB-VLP), both able to induce CD4+ and CD8+ T-cell responses ex vivo, as well as an EBV-derived peptide pool (PP) covering 94 well-characterized CD8+ T-cell epitopes. We assessed the specificity, magnitude, kinetics, and functional characteristics of EBV-specific immune responses at two sequential time points (v1 and v2) within the first six weeks after IM symptom onset (Tonset). Results All three tested EBV-derived antigen formulations enabled the detection of EBV-reactive T cells during the early phase of IM without prior T-cell expansion in vitro. EBV-reactive CD4+ and CD8+ T cells were mainly mono-functional (CD4+: mean 64.92%, range 56.15-71.71%; CD8+: mean 58.55%, range 11.79-85.22%) within the first two weeks after symptom onset (v1) with IFN-γ and TNF-secreting cells representing the majority of mono-functional EBV-reactive T cells. By contrast, PP-reactive CD8+ T cells were primarily bi-functional (>60% at v1 and v2), produced IFN-γ and TNF and had more tri-functional than mono-functional components. We observed a moderate correlation between viral load and EBNA3A, EB-VLP, and PP-reactive CD8+ T cells (r s = 0.345, 0.418, and 0.356, respectively) within the first two weeks after Tonset, but no correlation with the number of detectable EBV-reactive CD4+ T cells. Conclusions All three EBV-derived antigen formulations represent innovative and generic recall antigens suitable for monitoring EBV-specific T-cell responses ex vivo. Their combined use facilitates a thorough analysis of EBV-specific T-cell immunity and allows the identification of functional T-cell signatures linked to disease development and severity.

Abstract The purpose of this study was to review the literature on the clinical use of voriconazole (VRC) in pediatric patients. MEDLINE, Embase, PubMed, Web of Science, and Cochrane Library were searched from January 1, 2000, to August 15, 2023 for relevant clinical studies on VRC use in pediatric patients. Data were collected based on inclusion and exclusion criteria, and a systematic review was performed on recent research related to the use of VRC in pediatric patients. This systematic review included a total of 35 observational studies among which there were 16 studies investigating factors influencing VRC plasma trough concentrations (Ctrough) in pediatric patients, 14 studies exploring VRC maintenance doses required to achieve target range of Ctrough, and 11 studies focusing on population pharmacokinetic (PPK) research of VRC in pediatric patients. Our study found that the Ctrough of VRC were influenced by both genetic and non-genetic factors. The optimal dosing of VRC was correlated with age in pediatric patients, and younger children usually required higher VRC doses to achieve target Ctrough compared to older children. Establishing a PPK model for VRC can assist in achieving more precise individualized dosing in children.

Background: HIV infection is a serious lifelong health risk, leading to increased illness and death. In children, adhering to antiretroviral therapy (ART) is crucial to reduce these harmful effects. Yet, due to the challenges of pediatric patients and the social issues related to HIV, sticking to ART can be difficult in this group. Aims and Objectives: The study was conducted to evaluate the adherence of pediatric patients to their daily ART dosages. We also tried to understand the causes that led to the failure to follow the scheduled dosages and evaluate how these factors affected our study population. Materials and Methods: We examined the adherence to ART in 49 patients, aged 2–15, who had been on ART for at least 12 months. They visited the ART center at Medical College and Hospital, Kolkata, between August 01 and September 30, 2022. Ethical clearance was granted by the Institution’s Ethics Committee. The participants were chosen through systematic random sampling. We collected data through interviews and chart reviews and analyzed it using SPSS version 19. Results: Out of the 49 participants, 34 (69.38%) adhered to ART in the preceding month. For the non-adherent patients (n=15), the main reasons included conflicting ART dosage timing with school hours and children falling asleep at dosing time. Most (53.1%) were in the 5–10 age groups, with 93.88% in WHO Stage 1 of the disease and 6.12% in Stage II. In 77.6% of cases, mothers were the primary caregivers, and 79.6% of caregivers were HIV positive. Many children (71.43%) were unaware of their disease. Out of the 31 children whose disease status was known to others, grandparents of 23 and siblings of 12 were aware. Six of these children faced stigma from relatives and neighbors. ART adherence was significantly associated (P

Background: Lactobacilli are common microorganisms in the human body. Some species were used as probiotics supplement for many purposes such as preventing necrotizing enterocolitis, or improving allergic diseases or diarrhea. Previously, Lactobacillus infection was thought of as contamination due to its low pathogenicity. However, there have been reports of invasive Lactobacillus infection in immunocompromised patients or patients with comorbidities. The purpose of this study was to analyze the clinical characteristics, antibiotic treatment and outcomes of pediatric patients with invasive Lactobacillus infection. Methods: We retrospectively reviewed pediatric patients diagnosed with invasive Lactobacillus infection between 2004 and 2020. Invasive Lactobacillus infection was diagnosed if sterile sites yielded Lactobacillus spp. Clinical manifestations, chronic diseases, potential predisposing factors, medical treatments, antimicrobial susceptibility tests and outcomes were recorded. Results: Fifteen pediatric patients were diagnosed with invasive Lactobacillus infection, accounting for 2.4% of total invasive Lactobacillus infections during the 16-year period. Eleven infections were bacteremia, two were intra-abdominal infections, and two were biliary tract infections. Fever was the most common symptom. Potential predisposing factors were immunocompromised status, central venous device, prolonged antibiotics use and receiving supplemented probiotics for at least one week. All patients survived with favorable outcomes. Most pathogens were identified as Lactobacillus spp, and two were Lactobacillus rhamnosus, which were related to supplemented probiotics. The antimicrobial susceptibility tests showed that Lactobacilli were all sensitive to ampicillin but resistant to glycopeptides. Conclusion: Invasive Lactobacillus infections in pediatric patients were rare. Despite its low pathogenicity, Lactobacillus could cause invasive infection in those immunocompromised patients.

Background and Objectives: This study employed platelets cross-matched by the solid-phase red cell adherence (SPRCA) method and oc-related it with posttransfusion platelet count increment in terms of corrected count increment (CCI) and percent platelet recovery (PPR) among pediatric hemato-oncology patients. It did not study subgroups of patients nor did it have a control group. This was an observational study. The objective of the study was to assess platelet crossmatch results by the SPRCA method and find its correlation with posttransfusion platelet count increment among pediatric hemato-oncology patients in a tertiary care oncology center. Methods: This was a prospective observational study performed on pediatric patients with hematological malignancies requiring platelet transfusions during August 2019–January 2020. An assessment of the response to platelet transfusion on the participants was analyzed against the crossmatch results using SPRCA to measure the response in terms of CCI and PPR. Results: A total of 80 pediatric multiply transfused patients of hematological malignancies were transfused with ABO-identical single donor platelet unit which was subsequently tested for compatibility SPRCA assay. Among a total of 80 platelet crossmatches, 86% (69/80) were found to be compatible. Among 69 patients with compatible platelet crossmatches, 91% (63/69) had adequate CCI (>7500). Among 11 patients with incompatible crossmatches, 73% (8/11) had adequate CCI, and 27% (3/11) had inadequate CCI. Statistically significant association was found between crossmatch compatibility and PPR. Conclusions: Transfusion of crossmatched platelets from the available inventory to multiply transfused patients of hematological malignancies can be an option. It is very important to assess the posttransfusion platelet responses in such patients in terms of CCI as well as PPR. The SPRCA assay is a rapid and effective method to select the compatible unit from the inventory and is feasible to implement in an oncology setup to cater the requirement of multiple platelet transfusions to patients with hematological malignancies.

Background: The investigation into risk factors, molecular epidemiology, and resistance mechanisms of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in pediatric populations in China is currently inadequate. Methods: To assess epidemiology, molecular characteristics, and resistance mechanisms, virulence-associated genes were analyzed, alongside multi locus sequence typing (MLST), PCR, and qRT-PCR. Finding: Multivariate analysis identified prolonged hospitalization (OR: 1.026; 95 % CI: 1.004–1.049; P = 0.023) and increased exposure to enzyme inhibitor complex preparations (OR: 3.165; 95 % confidence interval [CI]: 1.113–8.999; P = 0.031) as independent risk factors for CRPA healthcare-associated infections (HAIs). Mortality rates were significantly higher in the HAI group compared to the non-HAI group (19.1 % vs. 6.0 %, P = 0.021). Analysis of virulence-associated gene combinations revealed 10 and 15 distinct profiles among HAI and non-HAI isolates, respectively, characterized by exoS−/exoU+ or exoS+ /exoU− genotypes, with no isolates exhibiting both exoS+ and exoU+ genotypes concurrently.Infections predominantly correlated with CC244, with a significantly greater occurrence in the HAI group (72.1 % vs. 46.3 %, P = 0.002). Antimicrobial susceptibility testing identified that both CC244 + and HAI isolates demonstrated elevated resistance across all tested antibiotics. Furthermore, low oprD expression was observed in 77.9 % of HAI isolates and 67.2 % of non-HAI isolates, while increased ampC production and mexB gene overexpression were infrequently detected (all P > 0.05). Conclusions: Prolonged hospital stays and an increased exposure to enzyme–inhibitor complex therapies were identified as independent risk factors for CRPA HAIs. CRPA demonstrated considerable genetic diversity, with STs predominantly represented by CC244, and virulence-associated genes have spread. The primary mechanism driving carbapenem resistance involved the downregulation of outer membrane porin protein oprD, accompanied by oprD mutation inactivation.

BackgroundSedation-related adverse events not only referred to a cause for morbidity and mortality but also included events that could disrupt routine procedures and thus lead to reduced procedural efficiency or quality. To date, no literature is available to predict the risk factors associated with prolonged recovery in pediatric patients during procedural sedation. Thus, we retrospectively analyzed the two-year sedation data to explore the above questions.MethodsPediatric patients who underwent procedural sedation between January 2022 and January 2024 were retrospectively analyzed. The patients were divided into two groups according to sedation duration

BackgroundTacrolimus is widely used to treat pediatric nephrotic range proteinuria (NRP). Diltiazem, a CYP3A4/5 inhibitor, is often administered with tacrolimus, affecting its pharmacokinetic profile. The impact of this combination on tacrolimus exposure, particularly in CYP3A5*3 genetic polymorphism, remains unclear in pediatric NRP patients. This study aimed to evaluate the effects of diltiazem on tacrolimus pharmacokinetics, focusing on the CYP3A5*3 polymorphism.MethodsWe conducted a retrospective clinical study involving pediatric NRP patients, divided into two groups: those receiving tacrolimus with diltiazem and those receiving tacrolimus alone. Propensity score matching (PSM) was used to balance the baseline characteristics between the groups. We compared daily dose-adjusted trough concentrations (C0/D) of tacrolimus in both the original and PSM cohorts. The influence of diltiazem on tacrolimus C0/D, stratified by CYP3A5*3 genetic polymorphism, was assessed in a self-controlled case series study.ResultsBefore PSM, the tacrolimus C0/D in patients taking diltiazem was significantly higher compared to those with tacrolimus alone (75.84 vs. 56.86 ng/mL per mg/kg, P = 0.034). This finding persisted after PSM (75.84 vs. 46.93 ng/mL per mg/kg, P= 0.028). In the self-controlled case study, tacrolimus C0/D elevated about twofold (75.84 vs. 34.76 ng/mL per mg/kg, P < 0.001) after diltiazem administration. CYP3A5 expressers (CYP3A5*1/*1 and *1/*3) and CYP3A5 non-expressers (CYP3A5*3/*3) experienced a 1.8-fold and 1.3-fold increase in tacrolimus C0/D when combined with diltiazem, respectively.ConclusionDiltiazem significantly increased tacrolimus C0/D, with CYP3A5*3 expressers showing higher elevations than non-expressers among pediatric NRP patients. These findings highlight the importance of personalized tacrolimus therapy based on CYP3A5*3 genotypes in pediatric patients taking diltiazem.

Background: The Ethiopian Federal Ministry of Health has been working by introducing vaccines, and integrating the management of newborn and child illnesses to prevent pneumonia, pneumonia-related hospitalization, and mortality. Despite these attempts, the prevalence of pneumonia and the proportion of hospitalizations have increased. Little is known about recovery time from severe pneumonia and its predictors in pediatric patients in the study area. Therefore, this study aimed to determine the time to recovery from severe pneumonia and its predictors in pediatric patients admitted to government hospitals in the southwest Region. Methods and Materials: A hospital-based prospective follow-up study was conducted among 791 pediatric patients admitted with severe pneumonia at a governmental hospital in the South West Region, of Ethiopia. A systematic sampling technique was used to recruit participants. Data were entered into Epi-data 4.4.2.1 and exported to STATA 14 for analysis. The assumptions of Cox proportional hazard models and goodness of fit were assessed using the Shoenfield residual and Cox-Snell, respectively. Bivariate and multivariable Cox regression models were used to identify the predictors of time to recovery. Variables with a p-value of

BackgroundThe emergence of ESBLs producing cephalosporin-resistant Escherichia coli isolates poses a threat to public health. This study aims to decipher the genetic landscape and gain insights into ESBL-producing E. coli strains belonging to the high-risk clone ST410 from pediatric patients.Methods29 E. coli ST410 isolates were collected from young children and subjected to antimicrobial susceptibility testing, Whole-genome sequencing (WGS), serotype analysis, MLST, ESBL genes, virulence genes, and plasmid profiling.ResultsAntimicrobial susceptibility testing demonstrated a high level of resistance to cephalosporins followed by aminoglycoside, sulfonamide, carbapenem and penicillin group of antibiotics. However, n=20/29 shows MDR phenotype. Phylogenetic group B2 (n=15) dominated, followed by group D (n=7), group A (n=4), and group B1 (n=3). Serotyping analysis identified O1:H7 (n=8), O2:H1 (n=6), O8:H4 (n=5), O16:H5 (n=4), and O25:H4 (n=3). Other serotypes identified included O6:H1, O15:H5, and O18:H7 (n=1 each). The most commonly detected ESBL genes were blaCTX-M, (n=26), followed by blaTEM (n=23), and blaSHV (n=18). Additionally, blaOXA-1 (n=10), blaOXA-48 (n=5), blaKPC-2 (n=3), blaKPC-3 (n=2), blaNDM-1 (n=4), blaNDM-5 (n=1), blaGES-1 (n=2), blaGES-5 (n=1), and blaCYM-1 (n=3). Notable virulence genes identified within the ST410 isolates included fimH (n=29), papC (n=24), hlyA (n=22), and cnf1 (n=18), among others. Diverse plasmids were observed including IncFIS, IncX4, IncFIA, IncCol, IncI2 and IncFIC with transmission frequency ranges from 1.3X10-2 to 2.7X10-3.ConclusionThe ST410 clone exhibited a complex resistance profile, diverse serotypes, the presence of specific resistance genes (ESBL genes), virulence gene repertoire, and diverse plasmids. The blaCTX-M was the most prevalent ESBL gene detected.

Background: Tuberculosis (TB) is a global public health challenge, contributing significantly to morbidity and mortality worldwide. This research aims to investigate the epidemiology, clinical characteristics, diagnostic methods, and early mortality rate among pediatric patients with pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) who were admitted to a hospital in Syria. Methods: This retrospective cohort study was conducted at the University Children's Hospital in Syria, involving pediatric patients diagnosed with TB between January 2013 and January 2023. Data were collected from medical records and encompassed socio-demographic characteristics, diagnostic methods, clinical presentation, chest radiography findings, and patient outcomes. Statistical analysis was performed using SPSS version 25. Results: A total of 129 patients were included in the study, with 26.4 % diagnosed with PTB and 73.6 % with EPTB. The most common types of EPTB were lymphatic (25.6 %) and gastrointestinal (17.1 %). Patients with PTB and EPTB did not differ significantly in terms of age, weight, or gender. Significant cough was more common in PTB cases (67.6 %), while lymphadenopathy was more prevalent in EPTB cases (48.4 %). Chest X-ray abnormalities were found in 58.1 % of patients, with PTB patients more likely to have abnormal findings (97.1 %). Microbiological confirmation was higher in PTB cases (76.5 %) compared to EPTB cases (25.3 %). The overall mortality rate was 14 %, with higher mortality observed in patients with EPTB (16.8 %), particularly in cases of TB meningitis. Conclusion: Our study highlights the epidemiological challenges of TB among hospitalized children, with a focus on the complexities of diagnosing and managing EPTB. We emphasize the urgent need for enhanced diagnostic and management strategies, particularly in conflict zones like Syria, where TB control efforts face significant obstacles. Prompt solutions are imperative to improve outcomes, given the high occurrence of EPTB and its associated mortality rates. Clinical recommendations stress the need for comprehensive contact histories and awareness of varied clinical presentations in pediatric TB diagnosis.

ObjectiveTo analyze the clinical characteristics, treatment, and prognosis of children infected with SARS-CoV-2 following the adjustment of COVID-19 prevention and control policies in China in December 2022.MethodsA retrospective study was conducted on 9 cases of severe neurological dysfunction caused by SARS-CoV-2 infection in children admitted to Foshan First People's Hospital from December 17 to 31, 2022.ResultsAmong the 9 cases, 7 (71.43%) were under 3 years old, and 2 (22.2%) were over 3 years old with underlying diseases. All patients presented with fever and neurological symptoms such as consciousness disturbance and/or convulsions, and their conditions deteriorated rapidly within 24 h after the onset of fever, without respiratory symptoms. Levels of IL-6, LDH, and d-dimer were significantly elevated. Five cases died within 48 h of admission, one case died after 7 days of treatment due to secondary bacterial infection, and three cases survived for more than 48 h after the initial rescue. All patients developed rapid shock, and five cases experienced multi-organ failure within a short period. In terms of treatment, glucocorticoids were used in 5 cases, intravenous immunoglobulin (IVIG) in 3 cases, and blood purification and tocilizumab in 2 cases.ConclusionSARS-CoV-2 infection in children can lead to severe neurological damage. High fever, convulsions, and inflammatory factors serve as early warning indicators. Glucocorticoids, immunoglobulins, blood purification, and tocilizumab may have some therapeutic effects, but further research is needed to confirm the efficacy.

Abstract Introduction - Les dérivations internes par implantation de shunts ont été pourde nombreuses années le traitement quasiment unique de l’hydrocéphalie maisaussi l’objet de nombreuses complications ce qui a poussé le neurochirurgien àdévelopper la chirurgie endoscopique notamment la ventriculocisternostomie et lacoagulation des plexus choroïdes.Matériel et méthode - L’objectif de notre travail est de rapporter l’expérience duservice de neurochirurgie du CHU d’Oran dans le traitement de l’hydrocéphalie pédiatriquepar chirurgie endoscopique, à travers une étude rétrospective, s’étalantdu 1er octobre 2015 au 30 septembre 2016.Resultats - Nous avons réalisé 67 procédures endoscopiques chez 63 patients âgésde moins de 15 ans dont quatre ont été opérés à deux reprises. L’âge moyen denos patients était de 20,38 +/- 3,6 mois avec une légère prédominance féminine (3filles pour 2 garçons) et 75% de malformations. Nous avons recensé 17 complicationsdans le post opératoire immédiat, représentées par les crises convulsives (15%),les collections sous durales (6%), les fistules du liquide céphalorachidien à traversla cicatrice du cuir chevelu (3%) et les complications infectieuses (1%). Le taux desuccès du traitement endoscopique de l’hydrocéphalie dans notre série était de74,62 %. Nous avons déploré deux décès (3%).Conclusion - La chirurgie endoscopique présente peu de complications. Elle représenteune alternative efficace pour le traitement de l’hydrocéphalie pédiatrique. AbstractIntroduction - For many years, internal derivations by implantation of shunts have been the only treatment for hydrocephalus but also the subject of many compli-cations, which has led the neurosurgeon to develop endoscopic surgery, especially endoscopic third ventriculostomie and choroid plexus coagulation. Materials and methods - The objective of our work is to report the experience of the Neurosurgery Department of Oran university hospital in the treatment of pediatric hydrocephalus by endoscopic surgery, through a retrospective study, conducted from October 1st, 2015 to September 30th, 2016. Results - We performed 67 endoscopic procedures in 63 patients under the age of 15 years, four of whom were operated on twice. The average age of our patients was 20.38 +/- 3.6 months with a slight female predominance (3 girls for 2 boys) and 75% malformations. We identified 17 complications in the immediate postoperative, represented by seizures (15%), subdural collections (6%), cerebrospinal fluid fistulas through the scalp scar (3%) and infectious complications (1%). The success rate of endoscopic treatment of hydrocephalus in our series was 74.62%. We lamented two deaths (3%).Conclusion - Endoscopic surgery presents few complications. It represents an effec-tive alternative for the treatment of pediatric hydrocephalus.IntroductionL’hydrocéphalie (HDC) est une dilatation active des ventri-cules cérébraux liée à un trouble de la circulation et/ ou de la résorption du liquide céphalo-rachidien (LCR). C’est l’une des pathologies neurologiques les plus fréquentes en neurochirurgie pédiatrique [1]. Son incidence est variable en fonction du niveau socioéconomique du pays considéré [2]. Les dérivations ventriculo-péritonéales (DVP) ont été pour de nombreuses années, le seul traitement de l’hydrocépha-lie mais aussi l’objet de complications infectieuses dans 0,5% à 10% des cas [3] et mécaniques dans 50% à 100% des cas [4, 5, 6,7]. Ces complications ont incité les neurochirurgiens à déve-lopper la chirurgie endoscopique notamment la ventriculo-cisternostomie (VCS) et la coagulation des plexus choroïdes (CPC). Bien qu’elle soit connue depuis le début du 20ème siècle, cette technique n’a prouvé son efficacité qu’au cours de ces dernières années, grâce aux progrès considé-rables dans l’amélioration de la résolution du matériel en-doscopique [8]. La VCS a pour but, de créer une voie de contournement de l’obstacle. Elle consiste à mettre en com-munication le troisième ventricule et les espaces sous-arach-noïdiens au niveau de la citerne inter pédonculaire par per-foration du plancher ventriculaire sous endoscope. Il s’agit d’un traitement qui rétablit une circulation du LCR proche de la normale et évite ainsi les complications mécaniques et infectieuses de la mise en place de corps étranger (shunt).L’objectif de ce travail est de rapporter l’expérience du ser-vice de Neurochirurgie du CHU d’Oran dans le traitement de l’hydrocéphalie pédiatrique par chirurgie endoscopique.Matériels et méthodes Il s’agit d’une d’étude descriptive, rétrospective, mono centrique, menée au service de neurochirurgie du CHU d’Oran entre octobre 2015 et septembre 2016. Notre étude a porté sur des cas pédiatriques d’hydrocépha-lie traités par chirurgie endoscopique. Nous n’avons pas inclus les patients présentant une dilatation ventriculaire passive ou secondaire à une atrophie cérébrale. Nous avons étudié les paramètres suivants : l’âge, le sexe, les signes cliniques, les étiologies, les données neuroradiologiques, les complications postopératoires, et le taux de dysfonctionne-ment de la VCS. Les causes de l’hydrocéphalie ont été clas-sifiées comme suit : - Congénitales en rapport avec différentes malformations de l’enfant et en particulier (la sténose de l’aqueduc de Sylvius, des dysraphismes, la malformation de DANDY WALKER) ;

Objective: This retrospective review aimed to analyze the outcomes of tonsillectomy and adenoidectomy (T and A) procedures in pediatric patients, focusing on complications and recurrence rates. Methods: Medical records of pediatric patients who underwent T and A were retrospectively reviewed. Data on patient demographics, preoperative indications, surgical techniques, intraoperative findings, postoperative complications, and recurrence rates were collected and analyzed. Results: A total of 240 pediatric patients were included in the study. Postoperative complications occurred with postoperative bleeding being the most common (5.2%). Other complications included infection (3.1%), respiratory compromise (1.7%), and velopharyngeal insufficiency (0.6%). Recurrence of tonsillitis and adenoiditis was observed in 6.7% of cases, respectively. Conclusion: This retrospective review provides valuable insights into the outcomes of T and A procedures in pediatric patients. Postoperative complications, including bleeding and infection, underscore the importance of meticulous surgical technique and postoperative care. Recurrence rates of tonsillitis and adenoiditis highlight the need for long-term follow-up and surveillance in pediatric patients undergoing T and A.

Background: Effective management of child behavior during dental procedures is crucial for successful treatment outcomes and promoting oral health. Parental involvement has been recognized as a key factor influencing child compliance in various healthcare settings, but its specific impact on child compliance during dental appointments remains understudied. Methods: A cross-sectional clinical research involving 100 children scheduled for routine dental treatments. Parental involvement was categorized as high, moderate, or low based on the level of parental presence and interaction during the dental appointment. Child compliance was assessed using a validated behavior rating scale, evaluating factors such as cooperation, anxiety, and disruptive behavior during the dental procedure. Statistical analysis, including correlation analysis and ANOVA, was performed to determine the association between parental involvement and child compliance. Results: The results revealed a significant correlation between parental involvement and child compliance (P < 0.05). Children with high levels of parental involvement demonstrated greater compliance during dental procedures compared to those with moderate or low levels of parental involvement. Specifically, children with high parental involvement exhibited lower levels of anxiety, reduced disruptive behavior, and greater cooperation with the dental team. Conclusion: This research provides evidence of the positive impact of parental involvement on child compliance during dental procedures in pediatric patients. Higher levels of parental presence and interaction were associated with improved child behavior and cooperation, highlighting the importance of parental involvement in promoting positive oral health behaviors and facilitating successful dental treatments. These findings underscore the need for tailored interventions targeted at enhancing parental involvement and optimizing child compliance in the dental setting.

Abstract Background Dravet Syndrome (DS) is a rare and severe form of childhood epilepsy that is often refractory to conventional antiepileptic drugs. Emerging evidence suggests that Cannabidiol (CBD) offer therapeutic benefits for DS. This review aims to evaluate the efficacy and safety of CBD in pediatric patients with DS based on data from ten clinical trials. Methods A review was conducted to identify clinical trials assessing the efficacy and safety of CBD in pediatric patients diagnosed with DS. PubMed, MEDLINE, Scopus, Web of Science, and relevant grey literature were systematically searched for relevant articles up to October 2023, and clinical trials within the last 10 years were included. The search strategy incorporated controlled vocabulary terms and keywords related to "Cannabidiol," "Dravet Syndrome," and "pediatric patients." Results The analysis revealed promising efficacy outcomes. Notably, CBD demonstrated substantial reductions in seizure frequency, with some patients achieving seizure freedom. The findings emphasised the consistency of CBD's efficacy across different patient subgroups. The safety profile of CBD was generally acceptable, with adverse events often being manageable. Conclusion This review consolidates evidence from multiple clinical trials, affirming the potential of CBD as a promising treatment option for pediatric patients with DS. While further research is needed to address existing knowledge gaps, CBD's efficacy and acceptable safety profile make it a valuable addition to the therapeutic tools for DS.

Introduction. Pediatric airway management poses unique challenges due to anatomical differences from adults, rendering children more susceptible to airway complications. Historically, uncuffed endotracheal tubes (ETTs) were preferred in pediatric intubation to minimize risks, but microcuffed (low volume, low pressure) ETTs offer advantages including improved seal and better ventilation efficiency. This study aims to compare the ease of intubation and post-operative airway complications between microcuffed and uncuffed ETTs. Aim. To assess the ease of intubation and post-extubation complications of the airway due to the use of microcuffed endotracheal tubes and uncuffed endotracheal tubes. Methodology. An observational study was conducted on pediatric patients aged 0-10 years undergoing elective surgeries under general anesthesia. Convenience sampling was used to select 54 participants. Patients were divided into two groups: uncuffed endotracheal tube (UG) and cuffed endotracheal tube (CG). Data on intubation attempts and post-operative complications were collected. Results. Baseline characteristics including age, gender, weight, and ASA grade were comparable between groups. Single-attempt intubation success was higher in the uncuffed group (55.6%) compared to the cuffed group (40.7%). Post-operative complications such as respiratory distress, stridor, hypoxemia, and restlessness were more prevalent in the uncuffed group but not statistically significant. Conclusion. This observational study suggests fewer postoperative complications with cuffed endotracheal tube insertion in pediatric patients. However, more research is needed to confirm these findings and explore the efficacy of microcuffed tubes in pediatric anesthesia.

Background Diabetic ketoacidosis (DKA) is a severe, acute compli- cation of diabetes characterized by hyperglycemia, ketoacidosis, and ke- tonuria, posing a potentially fatal risk, especially in individuals with type 1 diabetes. Objective of the study The study aims to evaluate the knowledge of healthcare providers regarding pediatric DKA at Babylon Hospital for Maternal and Child. Methods A cross-sectional descriptive study design was employed from August 1, 2023, to March 1, 2024, involving the assessment of healthcare providers’ knowledge about DKA using a two-section questionnaire. Sec- tion one gathered sociodemographic data, while section two assessed knowl- edge about pediatric DKA. Convenience sampling included 100 healthcare providers. Both inferential and descriptive statistical analyses were applied to the data. Results The study revealed a significant relationship between health- care providers’ knowledge of DKA and their sociodemographic character- istics, including age, residency, marital status, educational level, work site, years of experience, and years of experience in the unit. Conclusion The findings suggest that the majority of healthcare providers exhibited moderate to poor levels of knowledge regarding the management of pediatric DKA. Recommendations It is imperative to implement targeted educa- tional programs and training sessions to enhance healthcare providers’ un- derstanding and management skills related to pediatric DKA. Additionally, continuous monitoring and evaluation of healthcare providers’ knowledge levels are essential to ensure optimal patient care outcomes.

The risk factors of severe infections in children during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in Beijing remain elusive. SARS-CoV-2-positive children admitted to the intensive care unit (ICU) with collected plasma specimens were enrolled and screened for common pathogens using capillary electrophoresis-based multiplex PCR from December 12, 2022, to January 24, 2023. The SARS-CoV-2 sub-variants were identified using next-generation sequencing. Plasma was positive for two (positive; P), one (suspicious; S), or no (negative; N) SARS-CoV-2 genes were classified as plasmatic RNA-positive (RNAemia; P + S) or without RNAemia (N). Clinical and laboratory data of the enrolled cases were then collected and analyzed. The 34 enrolled children included 26 males and 24 younger than three years. All were negative for other respiratory pathogens. BF.7.14 (18/29) was the predominant subvariant. Viral loads in respiratory specimens, hours from symptom onset to the first respiratory specimen collection (time-variable), with comorbidities and BF.7.14 and BA.5.2 distributions were significantly different in P vs. N and RNAemia vs. without RNAemia group. Among most cases, the T lymphocyte ratios decreased, while the cytokine level and the B lymphocyte ratio increased. The time variables were 2.22 ± 2.05 and 4.00 ± 2.49 days in BF.7.14 and BA.5.2 infections, respectively. In conclusion, SARS-CoV-2 was more likely to cause severe infections among males aged ≤ 3 years old with comorbidities during the SARS-CoV-2 outbreak in Beijing, while RNAemia is more common in children at the early stage of severe BF.7.14 infections, and most had high cytokine levels and B-cell activation.

Abstract Objective To evaluate the efficacy of high-flow nasal cannula oxygenation (HFNC) versus non-invasive ventilation (NIV) in pediatric patients post-congenital heart surgery (CHS) through a meta-analysis. Methods A comprehensive literature search was conducted across the Chinese biomedical literature database, Vip database, CNKI, Wanfang, PubMed, Embase, Cochrane Library, and Web of Science until December 20, 2022. We selected RCTs or cohort studies that met inclusion criteria for a meta-analysis using RevMan 5.4 software. Results Our search yielded five publications, comprised of one randomized controlled trial and four cohort studies. Meta-analysis revealed a significant reduction in reintubation rates in children post-CHS treated with HFNC as compared to NIV [RR = 0.36, 95%CI(0.25 ~ 0.53), P 0.05). Furthermore, both groups showed no significant difference in the duration of extracorporeal circulation [MD = -8.27, 95%CI(-17.16 ~ 0.62), P = 0.07]. Conclusions For pediatric patients post-CHS, HFNC appears to be more effective than NIV in reducing reintubation rates and shortening the CICU stay.

Abstract Background Macrophages play an important role in the pathogenesis of lupus nephritis (LN), but less is known about macrophage subtypes in pediatric LN. Here we compared renal inflammation in LN with other inflammatory pediatric kidney diseases and assessed whether inflammation correlates with clinical parameters. Methods Using immunofluorescence microscopy, we analyzed renal biopsies from 20 pediatric patients with lupus nephritis (ISN/RPS classes II–V) and pediatric controls with other inflammatory kidney diseases for infiltration with M1-like (CD68 + /CD206 − , CD68 + /CD163 −), M2a-like (CD206 + /CD68 +), and M2c-like macrophages (CD163 + /CD68 +) as well as CD3 + T-cells, CD20 + B-cells, and MPO + neutrophilic granulocytes. In addition, the correlation of macrophage infiltration with clinical parameters at the time of renal biopsy, e.g., eGFR and serum urea, was investigated. Macrophage subpopulations were compared with data from a former study of adult LN patients. Results The frequency of different macrophage subtypes in biopsies of pediatric LN was dependent on ISN/RPS class and showed the most pronounced M1-like macrophage infiltration in patients with LN class IV, whereas M2c-like macrophages were most abundant in class III and IV. Interestingly, on average, only half as many macrophages were found in renal biopsies of pediatric LN compared to adult patients with LN. The distribution of frequencies of macrophage subpopulations, however, was different for CD68 + CD206 + (M2a-like) but comparable for CD68 + CD163 − (M1-like) CD68 + CD163 + (M2c-like) cells in pediatric and adult patients. Compared to other inflammatory kidney diseases in children, fewer macrophages and other inflammatory cells were found in kidney biopsies of LN. Depending on the disease, the frequency of individual immune cell types varied, but we were unable to confirm disease-specific inflammatory signatures in our study due to the small number of pediatric cases. Worsened renal function, measured as elevated serum urea and decreased eGFR, correlated particularly strongly with the number of CD68 + /CD163 − M1-like macrophages and CD20 + B cells in pediatric inflammatory kidney disease. Conclusion Although M1-like macrophages play a greater role in pediatric LN patients than in adult LN patients, M2-like macrophages appear to be key players and are more abundant in other pediatric inflammatory kidney diseases compared to LN.

Bakground/Aims: This single-center, cross-sectional study aimed to investigate the prevalence and patterns of cardiovascular symptoms and findings among pediatric patients aged 1-18 years, focusing on age and gender as potential influencing factors. Methods: Pediatric patients aged 1-18 with cardiovascular symptoms were studied, categorized by age (1-6, 7-12, 13-18) and gender (male and female) using electronic medical records, undergoing comprehensive clinical assessments including examinations, ECGs, and echocardiograms. Statistical analyses unveiled prevalence trends. Results: 720 patients were included the study and 53.9% of them were female. The prevalence of symptoms and diseases varied by age. Chest pain was common in 13-18 group; murmurs linked to congenital defects in 1-6 group. Valve and pericardial/myocardial diseases in 7-12 group, tied to rheumatic risks. Gender had minimal impact on patterns. Conclusion: The study underscores tailored management, age-specific considerations, and gender's minor role in pediatric cardiovascular symptoms and diseases.

Background: Food allergy (FA)-related bullying is a significant public health concern affecting pediatric patients. This systematic review investigates the prevalence, characteristics, and psychosocial impact of FA-related bullying, as well as current intervention strategies within educational and healthcare settings. Methods: A systematic literature search was conducted across the PubMed, Web of Science, and CINAHL databases, covering publications up to February 2024. The review followed PRISMA guidelines and included studies on children and adolescents (0–18 years) diagnosed with FAs. Studies were selected based on eligibility criteria and assessed for quality using the Newcastle–Ottawa Scale. Results: The initial search identified a total of 260 records (6 from scientific databases and 254 from registries). Twenty-six studies met the inclusion criteria. The findings of these studies reveal that FA-related bullying is prevalent, with rates varying between 17% and 60%, depending on the study population and methods. Bullying often involves verbal teasing, social exclusion, and physical threats using allergens, presenting both psychological and physical risks. Psychological consequences include increased anxiety, depression, and social withdrawal, which persist over time, significantly impacting quality of life for both children and their families. Notably, bullying often occurs in school settings, emphasizing the need for targeted interventions. Conclusion: FA-related bullying profoundly affects mental health and quality of life for affected children and their families. Interventions, such as school-based allergy education programs and policies promoting inclusivity and safety, have shown promise in reducing bullying incidents. A collaborative approach involving healthcare providers, educators, and policymakers is essential to mitigate the impact of FA-related bullying and improve outcomes for affected children.

In the context of the near-global eradication of wild poliovirus, the significance of non-polio enteroviruses (NPEVs) in causing acute flaccid paralysis (AFP) and their impact on public health has gained increased attention. This research, conducted from 2001 to 2021, examined stool samples from 1597 children under 15 years in São Paulo, Brazil, through the AFP/Poliomyelitis Surveillance Program, detecting NPEVs in 6.9% of cases. Among the 100 NPEV-positive strains analyzed, 90 were genotyped through genomic sequencing of the partial VP1 region, revealing a predominance of EV-B species (58.9%), followed by EV-A (27.8%) and EV-C (13.3%). This study identified 31 unique NPEV types, including EV-A71, CVB2, and E11, as the most prevalent, along with the first documented occurrence of CVA19 in Brazil. These findings emphasize the importance of NPEV genotyping in distinguishing AFP from poliomyelitis, enhancing understanding of these viruses’ epidemiology. Moreover, it ensures that AFP cases are correctly classified, contributing to the effective surveillance and eradication efforts for poliomyelitis.

OBJECTIVE: This retrospective study aimed to investigate the association between orthodontic treatment and development of temporomandibular disorders (TMDs) in pediatric patients. METHODS: This study analyzed 122 pediatric patients (age 10–18 years) who underwent orthodontic treatment. The inclusion criteria included comprehensive orthodontic records and substantial clinical documentation, while the exclusion criteria targeted preexisting TMDs or syndromes affecting the temporomandibular joint. Demographic details, treatment characteristics, and radiographic analyses, including standardized cephalometric measurements, were recorded. Clinical records were systematically reviewed for signs and symptoms of TMD, with categorization based on TMD severity using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). RESULTS: Demographic characteristics revealed a mean age of 14.2 years, with a sex distribution of 36.9% males and 63.1% females. Pain, clicking/popping sounds, and limited jaw movement were reported by 23.0%, 16.4%, and 12.3% of the patients, respectively. TMD severity classification showed that 73.8% had no symptoms, 20.5% had mild symptoms, 4.1% had moderate symptoms, and 1.6% had severe symptoms. Statistical analyses revealed a significant association between TMD symptoms and sex (P = 0.023). Correlations among TMD severity, treatment duration (P = 0.036), and cephalometric changes were observed. Radiographic findings showed a moderate correlation with the gonial angle (r = 0.42) and a strong correlation with the condylar position (r = 0.58). CONCLUSION: This study provides insights into the complex relationship between orthodontic treatment and TMD development in pediatric patients. These findings suggest potential associations between treatment characteristics, cephalometric changes, and TMD symptoms.

Shigella species significantly impact global health due to their role in diarrheal diseases. A 2019–2022 cross-sectional study on 432 stool samples from pediatric patients in Mashhad, Iran, identified Shigella spp. and tested their susceptibility to 12 antimicrobials by the disk diffusion method. The presence of virulence factors, namely ipaH, virA, stx1, and stx2, as well as plasmid-mediated quinolone resistance (PMQR) genes, including qnrA, qnrB, qnrC, qnrD, and qnrS, were ascertained through the utilization of polymerase chain reaction techniques. Sequencing of 15 isolates detected mutations within quinolone resistance-determining regions (QRDRs) at the gyrA and parC genes, indicating fluoroquinolone (FQ) resistance. 19.2 % (83/432) of stool samples contained Shigella, primarily S. sonnei (77.1 %), followed by S. flexneri (21.6 %) and S. boydii (1.2 %). Most isolates were from children under five (55.4 %). All strains had the ipaH gene, lacked stx1 and stx2, and 86.7 % had virA. High resistance was noted for ampicillin and tetracycline (84.3 % each), trimethoprim-sulfamethoxazole (81.9 %), and azithromycin (60.2 %). 87.1 % of isolates were multidrug-resistant (MDR). The most common PMQR genes were qnrA and qnrS (41 % each). The qnrD gene, prevalent in 36.1 % of cases, is reported in Iran for the first time. The most common PMQR profile was qnrADS (15.7 %). Resistance to nalidixic acid and ciprofloxacin was 45.8 % and 12 %, respectively. The Shigella isolates exhibited mutations in the gyrA (at codons 83, 87, and 211) and parC (at codons 80, 84, 93, 126, 128, 129, and 132) genes. The D87Y mutation in the gyrA gene was the most common in Shigella isolates, occurring in 73 % of cases. The F93S and L132T mutations in the parC gene were unique to this study. Empirical FQ therapy in patients infected with MDR Shigella, possessing PMQR determinants and/or mutations in the QRDRs of gyrA and parC, may escalate the risks of secondary diseases, extended treatment duration, therapeutic failure, and resistance spread. Consequently, the necessity for continuous surveillance and genetic testing to detect FQ-resistant Shigella strains is of paramount importance.

Objectives: Fungal bloodstream infection (fBSI) following pediatric liver transplantation presents a significant challenge; however, there remains a paucity of guidance regarding antifungal prophylaxis in this population. This study aimed to evaluate the effectiveness of universal antifungal prophylaxis and propose a desirable strategy. Methods: We enrolled 604 pediatric patients who underwent liver transplantation between 2020 and 2023, including 242 patients with empirical prophylaxis and 362 patients with universal prophylaxis. Univariate and multivariate logistic regression analyses were performed to identify independent factors for fBSI. Results: Eight (2.2%) pediatric recipients in the universal prophylaxis group and 13 (5.4%) in the empirical group developed fBSI (P = 0.038). Universal prophylaxis was a protective factor (P = 0.044), while high-volume intraoperative plasma transfusion and deceased donor liver transplantation were independent risk factors for fBSI (P = 0.035 and 0.008, respectively). Universal antifungal strategy showed an increased overall survival trend after liver transplantation although without significant statistical difference (P = 0.217). Patients with fBSI had poorer survival than those without fBSI (P

IntroductionEnteroviruses (EVs) are recognized as potential causative agents of acute gastroenteritis (AGE) in children worldwide. This study aimed to investigate the epidemiology and molecular characteristics of EV infection in children admitted to hospitals with AGE in Chiang Mai, Thailand from 2019 to 2022.MethodsA total of 1,148 fecal samples collected from patients with AGE were screened for the presence of EV using RT-PCR. The prevalence, co-infection with common diarrheal viruses, and seasonal pattern of EV were examined. The genotypes of EV were identified based on the VP1 sequence and phylogenetic analysis.ResultsThe overall prevalence of EV in AGE patients was 8.8% (101/1,148). After the COVID-19 outbreak in 2019, a significant decrease in the EV infection rate and genotype diversity was observed (p

Key Clinical Message Transverse colonic volvulus (TCV) is a serious condition with a mortality rate of up to 33%. It is very rare, especially in children. Despite its rarity, surgeons should have a high index of suspicion and include it in the list of differential diagnoses, especially in patients with developmental delays and associated uncommon syndromes. Resection and anastomosis, whether as a one‐stage or two‐stage procedure, proved to be the best treatment options for children. Since prompt identification and management are vital, this paper presents useful information on the presentation, treatment, and outcome of this case report.