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Acute promyelocytic leukemia (APL) accounts for up to 10% of all childhood acute myeloid leukemia cases with a median age at presentation of 9–12 years and a higher incidence in Italy, China, and L...

Background. The purpose was to optimize the diagnosis and treatment in the affected children with complicated transcondylar and supracondylar fractures of the humerus with the help of the developed protocol scheme of providing medical assistance to the patients with transcondylar and supracondylar fractures of the humerus. Materials and methods. The retrospective analysis of the treatment of 255 patients at the Lviv City Children’s Hospital for the period of 2013–2017 is the basis of our work. Results. The analysis of treatment results indicated that in the first group complications were noted in 21.0 % of cases, and in the second group — only in 9.1 %. Among the patients of the first group, anatomical complications were detected in 38.4 % of children, and in the second group they were not present at all. Functional complications also prevailed in the first group, they were found twice as often than in the second group. The period of inpatient treatment in the first group was 9.2 ± 0.5 days, while in the second group it was 6.5 ± 0.4 days. Conclusions. The introduction of a unified protocol for the treatment of transcondylar and supracondylar fractures of the humerus in pediatric patients has significantly improved both the anatomical and functional results of the treatment., Цель — оптимизация диагностики и тактики лечения у пострадавших детского возраста с осложненными чрезмыщелковыми и надмыщелковыми переломами плечевой кости с помощью разработанной протокольной схемы оказания медицинской помощи пострадавшим с чрезмыщелковыми и надмыщелковыми переломами плечевой кости. Материалы и методы. В основу нашей работы положен ретроспективный анализ лечения 255 пациентов, лечившихся в Львовской городской детской больнице за период 2013–2017 годы. Результаты. Анализ результатов лечения показал, что в первой группе осложнения отмечались в 21,0 % случаев, а во второй группе — только в 9,1 %. Среди пострадавших первой группы анатомические осложнения отмечались в 38,4 % случаев, а во второй группе их не было вообще. Функциональные осложнения также превалировали в первой группе, они обнаруживались в два раза чаще, чем во второй группе. Период стационарного лечения в первой группе составил 9,2 ± 0,5 суток, во второй — 6,5 ± 0,4 суток. Выводы. Внедрение унифицированной протокольной схемы лечения чрезмыщелковых и надмыщелковых переломов плечевой кости у пациентов детского возраста позволило значительно улучшить как анатомические, так и функциональные результаты лечения пациентов этой категории., Мета — оптимізація діагностики і тактики лікування в постраждалих дитячого віку з ускладненими черезвиростковими та надвиростковими переломами плечової кістки за допомогою розробленої протокольної схеми надання медичної допомоги постраждалим із черезвиростковими та надвиростковими переломами плечової кістки. Матеріали та методи. В основу нашої роботи покладений ретроспективний аналіз лікування 255 пацієнтів, які лікувались у Львівській міській дитячій лікарні за період 2013–2017 роки. Результати. Аналіз результатів лікування показав, що в першій групі ускладнення відмічались у 21,0 % випадків, а в другій групі — лише в 9,1 %. Серед постраждалих першої групи анатомічні ускладнення відмічались у 38,4 % випадків, а у другій групі їх не було взагалі. Функціональні ускладнення також превалювали в першій групі, що виявлялися майже удвічі частіше, ніж у другій групі. Період стаціонарного лікування в першій групі становив 9,2 ± 0,5 доби, у другій — 6,5 ± 0,4 доби. Висновки. Впровадження уніфікованої протокольної схеми лікування черезвиросткових та надвиросткових переломів плечової кістки в пацієнтів дитячого віку дозволило значно покращити як анатомічні, так і функціональні результати лікування пацієнтів цієї категорії.

Background COVID-19, the novel coronavirus, has caused a global pandemic affecting millions of people around the world. Risk factors for critical disease in adults are advanced age and underlying medical comorbidities, including cancer. Data are sparse on the effect of COVID-19 infection on pediatric patients with cancer during their active antineoplastic therapy. The optimal management of antineoplastic treatment during COVID-19 infection in this unique population is controversial. Aim To describe the severity and clinical course of COVID-19 infection in pediatric patients with cancer during active antineoplastic treatment and to study their course of treatment. Methods Clinical and laboratory data were collected from medical files of patients diagnosed with COVID-19, confirmed by polymerase chain reaction (PCR), who received active antineoplastic treatment between March 2020 and May 2021 in a large tertiary pediatric medical center. Results Eighteen patients with diverse pediatric cancers are described. They were infected with COVID-19 at different stages of their antineoplastic treatment regimen. Eight had an asymptomatic COVID-19 infection, nine had mild symptoms, and one had severe disease. All of them recovered from COVID-19 infection. Two patients experienced delays in their antineoplastic treatment; none of the other patients had delays or interruptions, including patients who were symptomatic for COVID-19. Conclusion In pediatric patients with cancer who test positive for COVID-19, yet are asymptomatic or have mild symptoms, the continuance of antineoplastic therapy may be considered.

Supplemental Digital Content is available in the text., Background: Ceftobiprole, the active moiety of the prodrug ceftobiprole medocaril, is an advanced-generation, broad-spectrum, intravenous cephalosporin, which is currently approved for the treatment of adults with hospital-acquired or community-acquired pneumonia. Methods: Noncompartmental pharmacokinetics and safety were analyzed from 2 recently completed pediatric studies, a single-dose, phase 1 study in neonates and infants up to 3 months of age (7.5 mg/kg) and a phase 3 study in patients 3 months to 17 years of age with pneumonia (10–20 mg/kg with a maximum of 500 mg per dose every 8 hours for up to 14 days). Results: Total ceftobiprole plasma concentrations peaked at the end of infusion. Half life (median ranging from 1.9 to 2.9 hours) and overall exposure (median AUC ranging from 66.6 to 173 μg•h/mL) were similar to those in adults (mean ± SD, 3.3 ± 0.3 hours and 102 ± 11.9 μg•h/mL, respectively). Calculated free-ceftobiprole concentrations in the single-dose study remained above a minimum inhibitory concentration (MIC) of 4 mg/L (fT > MIC of 4 mg/L) for a mean of 5.29 hours after dosing. In the pneumonia study, mean fT > MIC of 4 mg/L was ≥5.28 hours in all dose groups. Ceftobiprole was well tolerated in both studies. Conclusions: Pharmacokinetic parameters of ceftobiprole characterized in the pediatric population were within the range of those observed in adults. In the pneumonia study, the lowest percentage of the dosing interval with fT > MIC of 4 mg/L was 50.8%, which suggests that pharmacokinetic-pharmacodynamic target attainment can be sufficient in pediatric patients. Ceftobiprole was well tolerated.

Summary Aim The aim of this study was to evaluate the nutritional status, the nutritional effect on the risk of infection and the severity of the disease, and the contribution of nutrition to the course of the infection in pediatric patients diagnosed with coronavirus disease who required additional nutritional support after hospitalization. Methods The body weight, height, body mass index, upper arm circumference, and triceps skinfold thickness of 49 patients aged 1 month to 18 years and diagnosed with Covid-19 and then hospitalized at the Ankara City Hospital, Pediatric Health and Diseases Hospital, Pediatric Infection ward between 15 May and 15 June 2020 were measured. Total protein, albumin, prealbumin, selenium, zinc, ferritin, folate, and selenium, C, D, E, and B12 levels were studied from blood drawn simultaneously from the patients. Results A total of 49 patients aged 8–18 years were evaluated. The median age was 13 years (age range 8–18). The females made up 53% and the males 47% of the group. No patient needed intensive care admission. Only 3 patients received antibiotic treatment and the others were followed up without treatment. The weight was normal in 75% and the height was normal in 90%. Mid-arm circumference and triceps thickness were normal in 72% of the patients. Vitamin D deficiency was present in 82%, vitamin B12 deficiency in 18%, vitamin C deficiency in 17%, ferritin deficiency in 16%, folate deficiency in 15%, vitamin A deficiency in 13%, and vitamin E deficiency in 7%. Conclusion No patient required intensive care admission. Only 3 patients received antibiotic treatment and the others were followed up without treatment. Malnourishment was present in 3% of the patients while 9% were obese. Vitamin D deficiency was the most common vitamin deficiency while vitamin B12, vitamin C, Ferritin, vitamin A, vitamin E, and Folate deficiency were less common. Selenium and zinc levels were normal in all patients. There was no correlation between anthropometric values and susceptibility to childhood COVID-19 infection or the clinical course. It is possible that vitamin D deficiency increases susceptibility to the infection.

Background Lesser tuberosity fractures are relatively rare, with an incidence of 0.46 per 100,000 persons per year. This systematic review was performed to address patient-reported outcomes (PROMs), shoulder function, and complications after lesser tuberosity fractures in pediatric and adult patients, as well as patients with an associated posterior shoulder dislocation. Within these groups, identical outcomes were evaluated for nonoperative, surgical, acute and delayed treatment. Method A comprehensive search was carried out in multiple databases. Articles were included if patients sustained a lesser tuberosity fracture without a concomitant proximal humerus fracture. There were no restrictions on age, type of treatment, fragment displacement, time to presentation, or associated injuries. Results One thousand six hundred forty-four records were screened for eligibility of which 71 studies were included (n = 172). Surgical treatment was provided to 50 of 62 (81%) pediatric patients, 49 of 66 (74%) adults, and 34 of 44 (77%) patients with an associated posterior shoulder dislocation. In the pediatric group, the mean of PROMs was 94 (range 70-100) and among adults 89 (range 85-100). In the posterior shoulder dislocation group, 89% did not regain full range of motion and the complication rate was 17%. In pediatric patients, surgery was associated with fewer complications (P = .021) compared to nonoperative treatment. Conclusion Pediatric patients have excellent outcomes after lesser tuberosity fractures and respond well to surgical treatment. Adults have acceptable outcomes but patients with an associated posterior shoulder dislocation have impaired range of shoulder movement and are more likely to develop complications.

Objective: To evaluate the levels of N-terminal pro-B-type Natriuretic Peptide in infants and children with non-cardiac diseases especially respiratory diseases. Study Design: Cross-sectional study. Place and Duration of Study: Department of Chemical Pathology/Biochemistry Laboratory Services of Liaquat National Hospital Karachi Pakistan, from Dec 2018 to Nov 2019. Methodology: Infants and children admitted to the Pediatric department with non-cardiac diseases were included in the study. Non-probability consecutive sampling was done. Blood was taken and analyzed for N- terminal pro-B-type Natriuretic Peptide, Troponin I, urea, creatinine, Lactate dehydrogenase, Creatinine Kinase, lactate and sodium analysis. Results: Out of the 93 patients, 74 (80%) were diagnosed with respiratory disorders, with bronchopneumonia making up 54 (59%) Bronchiolitis 15 (17%) and 4% had miscellaneous respiratory diseases. Out of the remaining 20%, 8 (9%) patients were diagnosed with sepsis, and the remaining 11% were diagnosed with miscellaneous diseases. There was a positive correlation of N- terminal pro-B-type Natriuretic Peptide with Troponin I, urea, creatinine, Creatinine Kinase and Lactate dehydrogenase levels (p

This is the first published case report of a child with acute lymphatic leukemia developing a fatal mucormycosis during blinatumomab treatment. The patient showed multiple, systemic thromboembolic lesions with ischemia, bleeding and infarction in almost all organs. The child succumbed to increased brain pressure resulting in cerebral herniation. This case particularly illustrates the fulminant progression and huge challenges of diagnosing and treating mucormycosis in children with hemato-oncological diseases during treatment with targeted therapeutic antibodies (blinatumomab).

Background: Inferior vena cava (IVC) ultrasound measurement is a reliable indicator used in the assessment of intravascular volume status. The aim of this study was to evaluate intravascular volume changes in pediatric patients by measuring the IVC diameter and collapsibility index (CI) in children whose oral feeding was restricted preoperatively. Material and Methods: From May 2018 to October 2018, a total of 55 pediatric patients who were scheduled for surgery were included in this prospective, observational, cohort study. Fasting and satiety IVC diameters and CIs of patients were determined by ultrasonographic evaluation twice: in the preoperative preliminary evaluation, when the patients were satiated, and before surgery, during a fasting period of 6–8 hours. Ultra-sonographic data were recorded and compared between fasting and satiety periods. Results: In the grey scale (B-mode), mean IVC diameter was significantly higher when the patients were satiated, compared to the measurements made just before surgery during the fasting period. In the M-mode, the mean IVC diameter was significantly higher only during the inspiratory phase when the patients were satiated, while during the expiratory phase it was detected to be statistically similar. Mean CI was significantly higher in the immediate preoperative period, compared to the assessment made when satiated. Conclusion: Preoperative ultrasound IVC diameter and CI measurement can be a practical and useful method for evaluating preoperative intravascular volume in children.

The diagnosis of vascular tumors and malformations is usually achieved with clinical history and physical examination. The imaging of these patients has been sufficiently refined to answer pertinent questions when trying to make an accurate differential diagnosis in order to establish an informed treatment plan. The imaging modalities at hand include ultrasound, doppler sonography, magnetic resonance imaging and contrast material enhanced magnetic resonance angiography. We present two cases of different vascular anomalies that were managed according to the clinical aspect, natural history and imaging performed. Moreover, with better understanding of the imaging features, the radiologist has become a key player in the diagnosis and management plan of the vascular anomalies. This is crucial in avoiding misdiagnosis and improper treatment.

Purpose COVID-19 pandemic has adversely affected the medical services offered for non-COVID related pathologies all over the world. This led to most of the elective services being postponed. In this study, we investigated the impact of the initial wave of COVID-19 pandemic on patients with esophageal strictures that were listed on the endoscopic dilatation program. Methods Medical records were reviewed from March–September 2020 (study group). The study period was divided into three intervals guided by the number of confirmed cases with COVID-19 and the measures taken during the lockdowns in the corresponding periods. Case burden, dilatation sessions, dysphagia score, and further interventions were reviewed. Case burden and dilatation sessions were compared to equivalent periods in 2019 (control group). Results The study group included 13 patients that had 19 dilatation sessions in contrast to 29 patients that had 98 sessions in the comparative group. In the study group, eight cases experienced deterioration in their dysphagia score, while further interventions were performed on four of them. Conclusion To avoid morbidities during the pandemic, high-risk patients should be precisely identified and actively followed. Parents and caregivers should be reassured and encouraged to seek medical advice as quickly as possible whenever the need arises.

Objective This report summarizes the clinical features and 1‐month follow‐up observations for pediatric patients who were hospitalized with coronavirus disease 2019 (COVID‐19) in Wuhan Women and Children's Hospital. Methods The 1‐month follow‐up data included clinical manifestations and results from serum severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) IgG and IgM tests, reverse‐transcription polymerase chain reaction (RT‐PCR) for SARS‐CoV‐2, lung computed tomography (CT) scans, and laboratory tests. Results Between January 20 and March 15, 2020, 127 patients aged 0–15 years were hospitalized for COVID‐19 treatment, including 3 severe cases and 124 mild or moderate cases. The main therapies included inhalation of aerosolized interferon‐α (122/127) and additional antiviral drugs (28/127). Among the 81 patients who had pneumonia at admission, 35 with right lobe pneumonia had the longest hospital stay (mean 14.5 ± 7 days); 17 with left lobe pneumonia had the highest creatine kinase (154 ± 106 U/L) and creatine kinase myocardial band (CK‐MB, 43 ± 48 U/L) levels; and 29 with bilateral pneumonia had the highest white blood cell counts (8.3 ± 4 × 109/L). Among the 46 patients who were successfully followed up 1 month after discharge, two notable findings were right lobe pneumonia in 22% (95% confidence interval [CI]: 11%–37%) of patients and persistently elevated serum creatine kinase and CK‐MB levels. The median duration of elevated CK‐MB was 45 days. The mean concentrations of serum SARS‐CoV‐2 IgG and IgM in 41 patients were 8.0 ± 7.5 and 98 ± 40 ng/ml, respectively. At follow‐up, four patients retested positive for SARS‐CoV‐2. Conclusions The involvement of different lung lobes in patients with COVID‐19 was associated with variations in the persistence of pneumonia and elevation of CK‐MB levels and body temperature.

Supplemental Digital Content is available in the text., OBJECTIVES: To demonstrate the efficacy, safety, and pharmacokinetics of dexmedetomidine as a potential sedative for pediatric surgery patients in the ICU. DESIGN: Phase 3, multicenter, open-label study. SETTING: This study included 61 patients at 13 tertiary hospitals in Japan. PATIENTS: Pediatric patients (≥ 45 wk corrected gestational age to < 17 yr) undergoing intensive care treatment with mechanical ventilation requiring greater than 6 hours estimated duration of sedation following elective cardiac surgery. INTERVENTIONS: Dexmedetomidine was IV administered without a loading dose at age-specific dose regimens 0.2–1.4 (< 6 yr) and 0.2–1.0 µg/kg/hr (≥ 6 yr). The primary endpoint was the percentage of patients who did not require a rescue sedative (midazolam) infusion during mechanical ventilation or for the first 24 hours of a greater than 24 hours ventilation following the commencement of dexmedetomidine administration. MEASUREMENTS AND MAIN RESULTS: Overall, 47 of the 61 patients (77.0%) did not require rescue midazolam. Adverse events were reported in 53 patients (86.9%). Frequently observed adverse events were hypotension (47.5%), bradycardia (31.1%), and respiratory depression (26.2%). Most of these adverse events were mild, a few moderate, and none severe. Although serious adverse events occurred in four patients, including one cardiac tamponade resulting in the withdrawal of dexmedetomidine, none of the adverse events resulted in mortality or were directly related to dexmedetomidine. The plasma dexmedetomidine concentration generally reached the target concentration of 0.3–1.25 ng/mL at 1–2 hours prior to completion of administration or immediately prior to the commencement of tapering. CONCLUSIONS: The age-specific dose regimens of dexmedetomidine without an initial loading dose achieved an adequate sedation level during mechanical ventilation and caused no clinically significant adverse events in the intensive care pediatric patients. These effects were achieved within the therapeutic range of dexmedetomidine plasma concentration and were accompanied by minimal effects on hemodynamics and respiration.

Background. The purpose of this study is to evaluate functional and radiological outcomes of subtalar arthroereisis in the treatment of symptomatic pediatric flexible flatfeet. Methods. A total of 16 patients (26 feet) were treated with a Kalix II as subtalar motion blocker between 2009 and 2014. Calcaneal pitch (CP) and Meary’s angle (MA) were measured on radiographs preoperatively, directly postoperatively, and at follow-up 47 ± 17 (range 19-79) months. Patient satisfaction surveys were used to assess functional outcome and patient satisfaction. Results. Surgery was performed mostly for pain, walking problems, or a combination of both at a mean age of 12.5 ± 1.5 (range 10-15) years. Symptoms were relieved in 62.5% of patients in the postoperative phase and increased to 68.75% at follow-up. A statistically significant increase in CP of 2.8° and decrease in MA of 14.0° was observed directly postoperatively, which persisted during the follow-up period irrespective of Kalix removal. Revision surgery was necessary in 6 cases (23%) because of arthroereisis migration. Conclusion. Subtalar Kalix II arthroereisis significantly reduced clinical symptoms and improved the CP and MA directly postoperatively, which persisted during follow-up, irrespective of Kalix removal. Therefore, subtalar arthroereisis is a considerable intervention to reduce symptoms in children with symptomatic flexible flatfeet. Levels of Evidence: Level IV: Case series

Treatment for pediatric-onset multiple sclerosis (POMS) currently reflects treatment for adult-onset MS, despite some differences in its clinical course. First-choice treatment of POMS generally consists of interferon β-1a or glatiramer acetate, with therapies such as natalizumab or fingolimod reserved for second-choice treatment. In cases of severe disease, both fingolimod and natalizumab can be considered first-choice therapy. This paper presents three case histories of patients with POMS and highlights the different uses of fingolimod within the POMS treatment algorithm. The first and third cases are examples of escalation therapy, both in females aged 16 to 17 years, with fingolimod administering as second choice following disease progression. The second case is an example of using fingolimod as first-choice therapy, given to a 12-year-old male with severe disease. In all three cases, over a period of approximately 1 year after the initiation of fingolimod treatment, there was no further disease progression and no adverse events were recorded.

Supplemental Digital Content is available in the text., Background: The advanced-generation, broad-spectrum, intravenous (IV) cephalosporin, ceftobiprole, is an effective and well-tolerated treatment for adults with hospital-acquired pneumonia (HAP) or community-acquired pneumonia (CAP), but its effects in pediatric patients have not been established. Methods: In this multicenter, investigator-blinded, active-controlled, phase 3 study, patients 3 months to

IntroductionVarious neurological complications may occur as a consequence of arterial ischemic stroke (AIS) and have an impact on daily activity of the patients, costs of their medical care and rehabilitation. The aim of this study was to analyze risk factors, stroke symptoms and post-stroke consequences in Polish pediatric patients depending on stroke subtype.Material and methodsWe retrospectively reviewed 77 children under the age of 18 years following their first AIS. Patients were white, Polish Caucasians, recruited in the Department of Pediatric Neurology at the Medical University of Silesia in Katowice (Poland). Statistical analysis was performed using Statistica 12.0.ResultsGender differed significantly between stroke subgroups (p = 0.030). The presence of focal cerebral arteriopathy (FCA) and chronic diseases was associated with type of AIS (p = 0.003 and p = 0.050, respectively). An outcome without neurological deterioration (normal outcome) was observed in 43% of children with lacunar anterior circulation infarct (LACI). Hemiparesis was present in almost all children with total anterior circulation infarct (TACI), in two thirds of children with partial anterior circulation infarct (PACI) and in almost 50% of children with LACI or posterior circulation infarct (POCI). In every child with hemiplegia the stroke symptom evolved into hemiparesis at follow-up. Additionally, patients with a normal outcome were older at the time of AIS than those with at least one neurological consequence (OR = 0.894, p = 0.034).ConclusionsThe presence and number of neurological outcomes depend on stroke subtypes. A relation between the presence of post-stroke deficits and age at onset was observed. The odds of deficit after ischemic stroke decreases by an average of 10.6% if the child is 1 year older at the time of AIS.

Background: The dental quality alliance of the American Dental Association developed quality and performance measure concepts (QMCs) for pediatric dentistry to identify variations in care and to improve quality of care. Objectives: This study evaluated the relationship between the proposed QMCs and oral health, measured as caries status. Methodology: Parents/guardians of new patients presenting to the Nationwide Children's Hospital Dental Clinic for a nonurgent hygiene appointment were asked to complete a 10-question survey that reflected the QMCs. An oral examination was completed on each patient to determine his/her caries status. Results: For the majority of the QMCs evaluated in the study, there was no statistically significant difference in caries status between patients who had attended care according to the QMCs and those who had not. Conclusions: From the findings, attending care as outlined by the QMCs may be no better than counting procedures as a measure of quality oral health-care outcomes.

Accessing the veins for blood delivery, sampling or nutrition is a critical factor in the process of care and management of pediatric patients. In this regard, the peripherally inserted central catheter (PICC) is one of the main alternatives which could be applied effectively as traditional central venous devices in neonates and adults. Due to their essential role in providing safe central venous entry, PICCs could be applied extensively in patients who are critically ill. The main aims of the present study are to review approximately all relevant publications concerning PICC procedures, any possible complications, and the most appropriate decision for preventing these complications due to their high mortality rate. We carried out a comprehensive search on PubMed, HubMed, EMBASE, MEDLINE, Science Direct, Scopus, MEDLINE, and EMBASE databases for identifying the most relevant publications related to potential complications following the application and insertion of PICCs in hospitalized children and infants. Through appropriate care of catheters, the rate of possible infectious, mechanical and thrombotic complications would decrease considerably compared to those patients who received traditional central venous catheters. However, the process of vascular access in neonatal and children is very challenging. Any delay or denying treatment due to the lack of vascular access is intolerable. In this regard, anesthesiologists must achieve extra knowledge of various vascular devices.

The appropriate treatment of pediatric mandibular condyle fractures is subject to much debate and concern among surgeons, with improper treatment potentially resulting in a number of adverse outcomes. Such outcomes include the disruption of mandible growth, decreased posterior facial height, facial asymmetry, and temporomandibular joint ankylosis. Several surgical and nonsurgical approaches to these fractures have been described in the literature; however, each one carries its own risk of various complications. In this study, the authors illustrate a new atraumatic approach for mild to moderately displaced subcondylar fractures, with least possible complications and unexpected outcomes. In this study, 6 patients (2 female and 4 male) with unilateral medially displaced condylar base and neck fractures, angulated between 30 and 45 degrees, were treated using a novel intraoral approach. The follow-up period varied from 12 to 18 months. All patients achieved normal occlusion and had painless functioning of the temporomandibular joint with proper mouth opening (>35 mm) without any recurrence at long term follow up. This minimally invasive approach could eliminate the possibility of major complications and be considered a safe and feasible surgical technique for certain cases of pediatric mandibular condyle fracture.

Background Leukemia can create a significant economic burden on the patients and their families. The objective of this study is to assess the medical expenditure and compensation of pediatric leukemia, and to explore the incidence and determinants of catastrophic health expenditure (CHE) among households with pediatric leukemia patients in China. Methods A cross‐sectional interview was conducted among households living with pediatric leukemia using a questionnaire in two tertiary hospitals. CHE was defined as out‐of‐pocket (OOP) payments that were greater than or equal to 40% of a household's capacity to pay (CTP). Chi‐square tests and logistic regression analysis were performed to identify the determinants of CHE. Results Among 242 households living with pediatric leukemia, the mean OOP payment for pediatric leukemia healthcare was $9860, which accounted for approximately 35.7% of the mean household's CTP. The overall incidence of CHE was 43.4% and showed a downward trend with the lowest income group at 69.0% to the highest income group at 16.1%. The logistic regression model found that medical insurance, frequency of hospital admissions, charity assistance, and income level were significant predictors of CHE. Conclusion The results revealed that pediatric leukemia had a significant catastrophic effect on families, especially those with lower economic status. The occurrence of CHE in households living with pediatric leukemia could be reduced by addressing income disparity. In addition, extending coverage and improving compensation from medical insurance could also alleviate CHE. Some other measures that can be implemented are to address the barriers of charity assistance for vulnerable groups., Leukemia had a significant catastrophic effect on families, especially those with lower economic status. The occurrence of catastrophic health expenditure (CHE) in households living with pediatric leukemia could be reduced by addressing income disparity. In addition, extending coverage and improving reimbursement from medical insurance could also alleviate CHE. Some other measures that can be implemented are to address the barriers of charity assistance for vulnerable groups.

No abstract available

Supplemental Digital Content is available in the text., Background: Given the lack of specific antiviral drugs and effective vaccine for dengue infection, factors such as host nutritional status that may alter disease progression require investigation. This study examined the relationship between baseline nutritional status and severity of dengue infection in pediatric patients. Methods: Data from dengue patients 1–14 years of age treated at four hospitals in southern Thailand (2017–2018) were reviewed. Dengue infection was classified as dengue fever, dengue hemorrhagic fever and dengue shock syndrome. Children’s nutritional status was assessed based on international and national growth charts. Binary logistic regression was used to identify factors associated with dengue severity and malnutrition. Results: Overall, 248, 281 and 43 patients had dengue fever, dengue hemorrhagic fever and dengue shock syndrome, respectively. Overweight was associated with increased risk of dengue severity [odds ratio (OR) = 1.76, 95% confidence interval (CI): 1.13–2.75, P = 0.012; OR = 1.84, 95% CI: 1.09–3.09, P = 0.022, per international and national growth criteria, respectively). Stunting was associated with decreased risk of dengue severity (OR = 0.54, 95% CI: 0.33–0.88, P = 0.013; OR = 0.61, 95% CI: 0.39–0.95, P = 0.030, per international and national growth criteria, respectively). Being overweight was significantly and positively associated with levels of hemoglobin >14 g/dL, hematocrit >42%, hemoconcentration ≥20% and platelet count ≤50,000/mm3, whereas being stunted was significantly and negatively associated with levels of hemoglobin >14 g/dL and hematocrit >42%. Conclusions: These findings support a hypothesis that malnutrition might influence the severity of dengue infection through host immune response. Overweight children with dengue infections should be closely observed for early signs of severe dengue infection.

There is a current outbreak of coronavirus disease 2019 (COVID‐19), with a global spread. With the rapid increase in the number of infections, an increase is observed in the number of children with COVID‐19. Most research findings are regarding adult cases, which are not always transferrable to children. Evidence‐based studies are still expected to formulate clinical decisions for pediatric patients. In this review, we included 2597 pediatric patients that reported recently and evaluated the demographic, clinical, laboratory, and imaging features of children with COVID‐19. We found that even lymphopenia was the most common lab finding in adults; it infrequently occurred in children (9.8%). Moreover, elevated creatine kinase MB isoenzyme was much more commonly observed in children (27.0%) than that in adults, suggesting that heart injury would be more likely to occur in pediatric patients. Our analysis may contribute to determine the spectrum of disease in children and to develop strategies to control the disease transmission., Highlights There is a current outbreak of coronavirus disease 2019 (COVID‐19), with a global spread. Most research findings are regarding adult cases, which are not always transferrable to children. Here, we include 2597 pediatric patients and summarize the demographic, clinical, laboratory, and imaging characteristics of children with COVID‐19.

Purpose Evaluate the type and severity of potential drug-drug interactions and identify risk factors involved, in pediatric patients admitted in a hospital setting. Methods Transversal retrospective analytical study was carried out with hospitalized pediatric patients from a Hospital in the West of Mexico, second and third level. The patients included were ≤18 years old hospitalized in the children wards; those admitted at the emergency room, neonatal intermediate and intensive therapy units were not included. Medical prescriptions were reviewed taking into consideration anthropometric characteristics, diagnosis and number of drugs prescribed to identify potential drug–drug interactions using Micromedex 2.0 database. Results 88 patients were included, an average of 4.6 ± 2.8 of drugs were prescribed per patient. 37 subjects (42%) presented some degree of potential drug-drug interactions of which 25.5% were major and 27.7% moderate according to the software. Identified risk factors were: age ≥ 4 years (OR 1.917; 95% CI 1.081-3.399), BSA ≥ 0.8m2(OR 1.825; 95% CI 1.021–3.263), height ≥ 1 m (OR 2.556;95% CI 1.322 - 4.941), and number of prescribed medications ≥ 4 (OR 2.106;95% CI 1.248 - 3.556). Conclusion Some of the interactions found were for the benefit of the patient, but others were considered undesirable because they altered the pharmacokinetics of some of the medications administered. Detecting in time the harmful interactions for a patient may favor the patient's safety.

Introduction and objectives: Cases of viral hepatitis reported in Mexico are typically identified as hepatitis A, B and C. However, unspecified cases are reported annually. Hepatitis E virus (HEV) is an emergent agent that causes a self-limiting infection that can evolve to chronic in immunosuppressed individuals. In Mexico, HEV genotype 2 is considered endemic, though it's the prevalence is not well known. Therefore, the present study was designed to determine the prevalence of HEV among patients at the “Hospital Infantil de Mexico Federico Gomez”. Materials and methods: The study included 99 patients, anti-HEV antibody (IgG and IgM) were detected by indirect ELISA and viral genome was identified using RT-PCR technique. Two PCR products of positive cases were sequenced. Results: ELISA results were positive in 3% and 6%, for IgG and IgM respectively, 54.5% prevalence was found by PCR. Low lymphocyte count (p

Background:Personal protective equipment (PPE) is worn by prehospital providers (PHPs) for protection from hazardous exposures. Evidence regarding the ability of PHPs to perform resuscitation procedures has been described in adult but not pediatric models. This study examined the effects of PPE on the ability of PHPs to perform resuscitation procedures on pediatric patients.Methods:This prospective study was conducted at a US simulation center. Paramedics wore normal attire at the baseline session and donned full Level B PPE for the second session. During each session, they performed timed sets of psychomotor tasks simulating clinical care of a critically ill pediatric patient. The difference in time to completion between baseline and PPE sessions per task was examined using Wilcoxon signed-rank tests.Results:A total of 50 paramedics completed both sessions. Median times for task completion at the PPE sessions increased significantly from baseline for several procedures: tracheal intubation (+4.5 s; P = 0.01), automated external defibrillator (AED) placement (+9.5 s; P = 0.01), intraosseous line insertion (+7 s; P < 0.0001), tourniquet (+8.5 s; P < 0.0001), intramuscular injection (+21-23 s, P < 0.0001), and pulse oximetry (+4 s; P < 0.0001). There was no significant increase in completion time for bag-mask ventilation or autoinjector use.Conclusions:PPE did not have a significant impact on PHPs performing critical tasks while caring for a pediatric patient with a highly infectious or chemical exposure. This information may guide PHPs faced with the situation of resuscitating children while wearing Level B PPE.

Circulating miRNAs (c-miRNAs) are promising biomarkers for HF diagnosis and prognosis. There are no studies on HF pediatric patients undergoing VAD-implantation. Aims of this study were: to examine the c-miRNAs profile in HF children; to evaluate the effects of VAD on c-miRNAs levels; to in vitro validate putative c-miRNA targets. c-miRNA profile was determined in serum of HF children by NGS before and one month after VAD-implant. The c-miRNA differentially expressed were analyzed by real time-PCR, before and at 4 hrs,1,3,7,14,30 days after VAD-implant. A miRNA mimic transfection study in HepG2 cells was performed to validate putative miRNA targets selected through miRWalk database. Thirteen c-miRNAs were modified at 30 days after VAD-implant compared to pre-VAD at NSG, and, among them, six c-miRNAs were confirmed by Real-TimePCR. Putative targets of the validated c-miRNAs are involved in the hemostatic process. The in vitro study confirmed a down-regulatory effect of hsa-miR-409-3p towards coagulation factor 7 (F7) and F2. Of note, all patients had thrombotic events requiring pump change. In conclusion, in HF children, the level of six c-miRNAs involved in the regulation of hemostatic events changed after 30 days of VAD-treatment. In particular, the lowering of c-miR-409-3p regulating both F7 and F2 could reflect a pro-thrombotic state after VAD-implant.

Background: Vitamin D is involved in human immune system homeostasis and thought to be beneficial for COVID-19 patients, including pediatric population. However, there is still a paucity of information on association of serum vitamin D levels and COVID-19 clinical manifestation in pediatric patients. This study evaluated the association between serum vitamin D levels and clinical manifestations of COVID-19 in pediatric patients. Methods:We searched PubMed and Google Scholar for articles reporting association between vitamin D and COVID-19 clinical manifestations in pediatric patients. We searched for English-written articles only. PRISMA-MOOSE guideline and quality checklist was complied and statistical analysis was performed using RevMan 5.4. Results:Ten studies with total of 1,225 patients reported were reviewed. Low vitamin D levels was significantly associated with higher incidence of severe COVID-19 with pooled OR was 5.57 (1.59-19.55; p=0.007). Clinical symptoms were compared between low and normal vitamin D levels. Incidence of fever, cough, ageusia, anosmia, headache, and fatigue were not significantly different between group, with pooled RR was 2.13 (0.13-33.73; p=0.59), 1.25 (0.25-6.22; p=0.78), 0.47 (0.05-4.76; p=0.52), 1.25 (0.21-7.41; p=0.81), 0.91 (0.33-2.55; p=0.86), and 1.02 (0.47-2.22; p=0.96), respectively. The mean count of leukocytes and lymphocytes in the two groups were also not significantly different with pooled RR was -0.49 (-1.39-0.41; p=0.28), and -0.73 (-1.65-0.20; p=0.12), respectively. Conclusion:Low serum vitamin D level (

Hyperglycemic hyperosmolar syndrome (HHS) is a rare complication of diabetes mellitus among pediatric patients. Since its treatment differs from diabetic ketoacidosis (DKA), hence, pediatricians should be aware of its diagnosis and management.

Studies suggest that breastfeeding can help resolve skeletal and dental malocclusions. But there is no clear evidence that breastfeeding duration affects skeletal or dental malocclusions in pediatric patients. Therefore, the objective of this narrative review was to review all the available updated articles on the impact of breastfeeding and non-nutritive sucking behaviors in deciduous and mixed teeth on different forms of malocclusions. The following electronic databases were used PubMed, Scopus, Web of Science, and Google Scholar to obtain relevant data that met the eligibility criteria. The studies in this narrative review were covered the last 10 years. Primary research identified 368 papers. In addition, three articles were selected from the gray literature for consideration. On the basis of duplication, title, abstract, methodology and/or irrelevant information, 177 articles were removed. This narrative review was focused on seventeen articles that met the eligibility criteria. When it comes to deciduous and mixed teeth, breastfeeding appears to decrease the occurrence of skeletal class II, posterior crossbite, and malocclusion. There appears to be a favorable correlation between prolong duration of breastfeeding and risk reduction. To avoid bias in the results, more longitudinal study is warranted, with data collected prospectively on the duration of exclusive breastfeeding and non-nutritive sucking behaviors, using specific survey questions, and subsequent clinical investigation of the occlusal status at the deciduous, mixed, and permanent teeth stages.

Ceftobiprole is an advanced-generation cephalosporin for intravenous administration with activity against Gram-positive and Gram-negative organisms. A population pharmacokinetic (PK) model characterizing the disposition of ceftobiprole in plasma using data from patients in three pediatric studies was developed. Model-based simulations were subsequently performed to assist in dose optimization for the treatment of pediatric patients with hospital-acquired or community-acquired pneumonia. The population PK data set comprised 518 ceftobiprole plasma concentrations from 107 patients from 0 (birth) to 17 years of age. Ceftobiprole PK was well described by a three-compartment model with linear elimination. Ceftobiprole clearance was modeled as a function of glomerular filtration rate; other PK parameters were scaled to body weight. The final population PK model provided a robust and reliable description of the PK of ceftobiprole in the pediatric study population. Model-based simulations using the final model suggested that a ceftobiprole dose of 15 mg/kg of body weight infused over 2 h and administered every 12 h in neonates and infants

Ventricular Assist Device (VAD) therapy is considered as a part of standard care for end-stage Heart Failure (HF) children unresponsive to medical management, but the potential role of miRNAs in response to VAD therapy on molecular pathways underlying LV remodeling and cardiac function in HF is unknown. The aims of this study were to evaluate the effects of VAD on miRNA expression profile in cardiac tissue obtained from HF children, to determine the putative miRNA targets by an in-silico analysis as well as to verify the changes of predicated miRNA target in the same cardiac samples. The regulatory role of selected miRNAs on predicted targets was evaluated by a dedicated in vitro study. miRNA profile was determined in cardiac samples obtained from 13 HF children [median: 29 months, 19 LVEF%, 9 Kg] by NGS before VAD implant (pre-VAD) and at the moment of heart transplant (Post-VAD). Only hsa-miR-199b-5p, hsa-miR-19a-3p, hsa-miR-1246 were differentially expressed at post-VAD when compared to pre-VAD, and validated by real-time PCR. Putative targets of the selected miRNAs were involved in regulation of sarcomere genes, such as cardiac troponin (cTns) complex. The expression levels of fetal ad adult isoforms of cTns resulted significantly higher after VAD in cardiac tissue of HF pediatric patients when compared with HF adults. An in vitro study confirmed a down-regulatory effect of hsa-miR-19a-3p on cTnC expression. The effect of VAD on sarcomere organization through cTn isoform expression may be epigenetically regulated, suggesting for miRNAs a potential role as therapeutic targets to improve heart function in HF pediatric patients.

Background: Lactulose can be used to manage chronic constipation and children who are withholding their bowel movements, but no studies are available regarding lactulose to treat pediatric extraordinary daytime urinary frequency (PEDUF). To explore the benefits of different therapeutic regimens (non-drug treatment vs. oral lactulose) in patients with PEDUF.Methods: This prospective study included PEDUF patients admitted to the Pediatric Center of Qilu Hospital of Shandong University (Qingdao) from January 2015 to December 2019. The patients randomized received non-drug treatment (counseling), drug treatment (lactulose), or combination therapy. A therapeutic effect was defined by a decrease of>10% of the urination frequency.Results: A total of 210 patients were included. They were 5.9 ± 0.4 years. There were 98 boys and 112 girls. Among the 210 patients, 82.4% (173/210) of their family members reported symptoms of constipation. Among the three groups, the response rate was 61.4% (43/70) in the non-drug treatment group, 90.0% (63/70) in the drug treatment group, and 91.4% (64/70) in the combination therapy group (P < 0.0001).Conclusion: The frequency of constipation in children with PEDUF is high. The use of a laxative, like lactulose, might achieve a high therapeutic response rate in children with PEDUF, higher than counseling alone. That might represent a valuable therapeutic strategy for PEDUF.

To assess the pharmacokinetic parameters of vancomycin in Chinese critically ill pediatric patients, children treated with vancomycin, hospitalized in the intensive care unit were included. Samples to determine peak and trough serum concentrations were obtained on the third day of treatment. Half‐life was significantly longer in neonates and showed a decreasing trend in infants and children. In patients aged ≥1 month, AUC24/MIC ≥400 was achieved in 31.8% at the dose of 40 mg/kg/d, and in 48.7% at the dose of 60 mg/kg/d with an assumed MIC of 1 mg/L. Augmented renal clearance (ARC) was present in 27.3% of children, which was associated with higher vancomycin clearance and lower AUC values. A good correlation was observed between trough concentration and AUC24, and the trough concentration that correlated with AUC24 of 400 were varied according to the dosage regimens, 8.42 mg/L for 6‐hintervals, and 6.63 mg/L for 8‐h intervals. To conclude, vancomycin trough concentration that related to the AUC24 of 400 was much lower in critically ill children than that in adults. The dosage of 60 mg/kg/day did not enough for producing AUC24 in the range of 400–600 mg h/L in critically ill children, especially in those with ARC., A good correlation was observed between trough concentration and AUC24. The trough concentration that correlated with AUC24 of 400 were varied according to the dosage regimens, 8.42 mg/L for 6‐h intervals, and 6.63 mg/L for 8‐h intervals.

Background Healthcare management faces complex challenges in allocating hospital resources, and predicting patients’ length-of-stay (LOS) is critical in effectively managing those resources. This work aims to map approaches used to forecast the LOS of Pediatric Patients in Hospitals (LOS–P) and patients’ populations and environments used to develop the models. Methods Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) methodology, we performed a scoping review that identified 28 studies and analyzed them. The search was conducted on four databases (Science Direct, Scopus, Web of Science, and Medline). The identification of relevant studies was structured around three axes related to the research questions: (i) forecast models, (ii) hospital length-of-stay, and (iii) pediatric patients. Two authors carried out all stages to ensure the reliability of the review process. Articles that passed the initial screening had their data charted on a spreadsheet. Methods reported in the literature were classified according to the stage in which they are used in the modeling process: (i) pre-processing of data, (ii) variable selection, and (iii) cross-validation. Results Forecasting models are most often applied to newborn patients and, consequently, in neonatal intensive care units. Regression analysis is the most widely used modeling approach; techniques associated with Machine Learning are still incipient and primarily used in emergency departments to model patients in specific situations. Conclusions The studies’ main benefits include informing family members about the patient’s expected discharge date and enabling hospital resources’ allocation and planning. Main research gaps are associated with the lack of generalization of forecasting models and limited reported applicability in hospital management. This study also provides a practical guide to LOS–P forecasting methods and a future research agenda.

Introduction/Aim: Children and adolescents with a chronic somatic disease have a higher risk of developing psychological disorders than healthy peers. Therefore, we aim to investigate internalizing and behavioral problems in pediatric patients with esophageal atresia (EA) and compare this sample with German reference values using both childrens' self-reports and parents' proxy reports.Methods: The present cross-sectional study is part of the German-Swedish EA-QOL study developing a condition-specific instrument to assess Health-related Quality of Life in children and adolescents born with EA from both self and proxy perspectives. The current analyses use data from the German sample collected within the field test phase. Participants were enrolled from the Medical School Hannover and “Auf der Bult” Children's Hospital, Hannover. The cooperating clinicians provided the medical records while socio-demographic information was collected through the parent-report within the questionnaires. We used the Strengths and Difficulties Questionnaire (SDQ) to measure internalizing and behavioral problems of children and adolescents born with EA ranging from 2 to 18 years.Results: A total of 51 families participated in the field test phase. Eighty-eight parent reports and 22 child reports were included in the analyses. While the parents' perspective from the SDQ leads to a higher percentage of abnormal or borderline behavior, there is no difference to the reference group from the children's perspective.Conclusion: Incorporating routine psychological assessment into pediatric health care can help improve understanding of the burden of illness, examine treatment outcomes, assess the quality of care, and tailor interventions to meet patient and parent needs. Involving the whole family can help develop appropriate and functional coping strategies. From our point of view, it is necessary to address parental needs and concerns as well in order to provide the best possible holistic development in the family system. The family is the basis for the children's successful development, especially for children with special health care needs.

Genetic disorders are a frequent cause of hospitalization, morbidity and mortality in pediatric patients, especially in the neonatal or pediatric intensive care unit (NICU/PICU). In recent years, rapid genome-wide sequencing (exome or whole genome sequencing) has been applied in the NICU/PICU. However, mtDNA sequencing is not routinely available in rapid genetic diagnosis programs, which may fail to diagnose mtDNA mutation-associated diseases. Herein, we explored the clinical utility of rapid exome sequencing combined with mtDNA sequencing in critically ill pediatric patients with suspected genetic disorders. Rapid clinical exome sequencing (CES) was performed as a first-tier test in 40 critically ill pediatric patients (aged from 6 days to 15 years) with suspected genetic conditions. Blood samples were also collected from the parents for trio analysis. Twenty-six patients presented with neuromuscular abnormalities or other systemic abnormalities, suggestive of suspected mitochondrial diseases or the necessity for a differential diagnosis of other diseases, underwent rapid mtDNA sequencing concurrently. A diagnosis was made in 18 patients (45.0%, 18/40); three cases with de novo autosomal dominant variants, ten cases with homozygous or compound heterozygous variants, three cases with hemizygous variants inherited from mother, three cases with heterozygous variants inherited from either parent, and one case with a mtDNA mutation. The 18 patients were diagnosed with metabolic (n = 7), immunodeficiency (n = 4), cardiovascular (n = 2), neuromuscular (n = 2) disorders, and others. Genetic testing reports were generated with a median time of 5 days (range, 3–9 days). Thirteen patients that were diagnosed had an available medical treatment and resulted in a positive outcome. We propose that rapid exome sequencing combined with mitochondrial DNA sequencing should be available to patients with suspected mitochondrial diseases or undefined clinical features necessary for making a differential diagnosis of other diseases.

Background Solid-organ transplantation is the treatment of choice for children with end-stage organ failure. Ongoing recovery and medical management at home after transplant are important for recovery and transition to daily life. Smartphones are widely used and hold the potential for aiding in the establishment of mobile health (mHealth) protocols. Health care providers, nurses, and computer scientists collaboratively designed and developed mHealth family self-management intervention (myFAMI), a smartphone-based intervention app to promote a family self-management intervention for pediatric transplant patients’ families. Objective This paper presents outcomes of the design stages and development actions of the myFAMI app framework, along with key challenges, limitations, and strengths. Methods The myFAMI app framework is built upon a theory-based intervention for pediatric transplant patients, with aid from the action research (AR) methodology. Based on initially defined design motivation, the team of researchers collaboratively explored 4 research stages (research discussions, feedback and motivations, alpha testing, and deployment and release improvements) and developed features required for successful inauguration of the app in the real-world setting. Results Deriving from app users and their functionalities, the myFAMI app framework is built with 2 primary components: the web app (for nurses’ and superadmin usage) and the smartphone app (for participant/family member usage). The web app stores survey responses and triggers alerts to nurses, when required, based on the family members’ response. The smartphone app presents the notifications sent from the server to the participants and captures survey responses. Both the web app and the smartphone app were built upon industry-standard software development frameworks and demonstrate great performance when deployed and used by study participants. Conclusions The paper summarizes a successful and efficient mHealth app-building process using a theory-based intervention in nursing and the AR methodology in computer science. Focusing on factors to improve efficiency enabled easy navigation of the app and collection of data. This work lays the foundation for researchers to carefully integrate necessary information (from the literature or experienced clinicians) to provide a robust and efficient solution and evaluate the acceptability, utility, and usability for similar studies in the future. International Registered Report Identifier (IRRID) RR2-10.1002/nur.22010

Background: In April 2015, ivabradine was approved by the Food and Drug Administration for the treatment of patients with coronary artery disease and heart failure (HF). The use of this medication has been linked with improved clinical outcomes and reduced rates of hospitalization in patients with symptomatic HF and a baseline heart rate of 70 bpm and above. Nonetheless, little is known about the use of ivabradine in pediatric patients with supraventricular tachycardia (SVT). This use is not well-studied and is only endorsed by a few case reports and case series.Aim: This study discusses the off-label utilization of ivabradine in pediatric patients with SVT, and highlights its efficacy in treating treatment-resistant (refractory) SVT.Methods: We conducted a retrospective single-center observational study involving pediatric patients with SVT treated at our center between January 2016 and October 2020. We identified the total number of patients with SVT, and the number of patients with refractory SVT treated with Ivabradine. Similarly, we performed a thorough review of the databases of PubMed, Medline and Google Scholar to compare the clinical course of our patients to those described in the literature.Results: Between January 2016 and October 2020, 79 pediatric patients with SVT were seen and treated at our center. A treatment-resistant SVT was noted only in three patients (4%). Ivabradine was used in these patients as a single or combined therapy. The rest (96%) were successfully treated with conventional anti-arrhythmics such as β-blockers, flecainide, and other approved medications. In the ivabradine group, successful reversal to sinus rhythm was achieved in two of the three patients (66%), one patient was treated with a combination therapy of amiodarone and ivabradine, and the other patient was treated only with ivabradine.Conclusion: Overall, promissory results are associated with the use of ivabradine in pediatric patients with refractory SVT. Ivabradine appears to be a safe and well-tolerated medication that can induce adequate suppression of SVT, complete reversal to sinus rhythm, and effective enhancement of left ventricular function.

Purpose: To evaluate extravascular findings on thoracic MDCT angiography in secondary pulmonary vein stenosis (PVS) due to total anomalous pulmonary venous connection (TAPVC) repair in children. Materials and Methods: All patients aged ≤18 years with a known diagnosis of secondary PVS after TAPVC repair, confirmed by echocardiography, conventional angiography, and/or surgery, who underwent thoracic MDCT angiography studies between July 2008 and April 2021 were included. Two pediatric radiologists independently examined MDCT angiography studies for the presence of extravascular thoracic abnormalities in the lung, pleura, and mediastinum. The location and distribution of each abnormality (in relation to the location of PVS) were also evaluated. Interobserver agreement between the two independent pediatric radiology reviewers was studied using kappa statistics. Results: The study group consisted of 20 consecutive pediatric patients (17 males, 3 females) with secondary PVS due to TAPVC repair. Age ranged from 2 months to 8 years (mean, 16.1 months). In children with secondary PVS due to TAPVC repair, the characteristic extravascular thoracic MDCT angiography findings were ground-glass opacity (19/20, 95%), septal thickening (7/20, 35%), pleural thickening (17/20, 85%), and a poorly defined, mildly heterogeneously enhancing, non-calcified soft tissue mass (17/20, 85%) which followed the contours of affected pulmonary veins outside the lung. There was excellent interobserver kappa agreement between two independent reviewers for detecting extravascular abnormalities on thoracic MDCT angiography studies (k = 0.99). Conclusion: Our study characterizes the extravascular thoracic MDCT angiography findings in secondary pediatric PVS due to TAPVC repair. In the lungs and pleura, ground-glass opacity, interlobular septal thickening, and pleural thickening are common findings. Importantly, the presence of a mildly heterogeneously enhancing, non-calcified mediastinal soft tissue mass in the distribution of the PVS is a novel characteristic thoracic MDCT angiography finding seen in pediatric secondary PVS due to TAPVC repair.

Intraoperative trans-esophageal echocardiography (TEE) is an important monitoring and diagnostic tool used during surgery for the repair of congenital heart lesions. Its ability to be used intraoperatively before and after cardiac repair makes it a unique tool. Although it is generally a safe procedure, due to the relatively large size and rigid nature of TEE probes airway complications, inadvertent extubation and insertion failures have been reported to occur predominantly in smaller patients (mean weight

Due to the increasing incidence of terminal illnesses in children, there is great urgency within pediatric medicine to give these patients the best palliative care possible. The main focus of palliative care is to alleviate suffering resulting from the psychophysical condition of the child, which is mostly due to physical pain. The first phase of managing pain in palliative care is quantifying and qualifying pain levels, although this is sometimes difficult to do with pediatric patients. In addition to implementing strategies that alleviate or remove pain for patients, it is also crucial to give patients and their families a feeling of full control over pain. In practice, non-pharmacological and pharmacological methods of analgesia are present. Pharmacological methods include non-opioid and opioid analgesics, followed by co-analgesics as well as methods of regional anesthesia. In order to give these patients the best care possible, it is necessary that the approach be individual, multimodal, multidisciplinary, and considerate of every detail.

Introduction/Objective. The aim of this study was to report visual, refractive, and tomographic outcomes of corneal collagen cross-linking (CXL) in pediatric keratoconus. Methods. This retrospective study included 17 eyes of 12 patients with progressive keratoconus who underwent epithelium-off CXL at the age ? 18 years. Following data were analyzed at baseline and postoperatively at one, three, six, nine, 12 months for all the patients, and annually where available: uncorrected distant visual acuity (UDVA) and best spectacle-corrected distant visual acuity (CDVA), refraction and corneal tomography. Results. Mean UDVA improved significantly from 0.52 ? 0.38 at baseline to 0.24 ? 0.29 logarithm of minimum angle resolution (log MAR) at one year (p = 0.011) and remained stable at two-year follow-up (0.21 ? 0.34 log MAR). Mean CDVA was 0.15 ? 0.21 at baseline and 0.06 ? 0.13 log MAR at one year (p = 0.248). Maximum keratometry showed a significant flattening of 1.30 ? 1.99 D (p = 0.011) after a year and remained stable two years after CXL. Minimum keratometry significantly decreased with a mean change of 1.34 ? 1.37 (p = 0.001). Mean reduction of corneal thickness after CXL was 55.35 ? 64.42 ?m (P=0.003). After a year, seven (42%) eyes showed Kmax regression, nine (53%) stabilization, and one (5%) progression. Conclusion. In our study CXL effectively prevented progression of keratoconus in 95% of pediatric patients after a year, while improving UDVA and keratometry values. One patient with eye rubbing behavior showed signs of keratoconus progression after CXL treatment.

Introduction: Herpes zoster oticus (HZO) occurs due to the reactivation of the varicella zoster virus (VZV) in the geniculate ganglion of the facial nerve. It is characterized by erythematous vesicular eruptions on the pinna and external auditory canal with severe otalgia. When it is associated with ipsilateral facial nerve paralysis, a diagnosis of Ramsay Hunt syndrome (RHS) can be made. It is rare in the pediatric age group but with low immunity, so prone for increased risk of disseminated infections, neurological complications, and recurrence of infections. Objective: The aim of this study was to evaluate the clinical profile and management of the HZO among pediatric patients at a tertiary care teaching hospital. Materials and Methods: In this prospective study, 24 pediatric patients of HZO were reviewed those presented during the period of December 2015–January 2020. All pediatric patients underwent thorough clinical examinations before getting the diagnosis. All the participants also underwent thorough neuro-otological and otolaryngological examinations. Results: Out of 24 pediatric patients, 15 were boys and 9 were girls. All were in the pediatric age group with age ranging from 5 years to 16 years. After the diagnosis of HZO/RHS, all were treated with acyclovir for 10 days along with tapering dose of deflazacort, labyrinthine sedatives, and eye care in case of facial palsy. All the pediatric patients were recovered by our treatment protocol except 3 cases those are still in follow-up with facial weakness. Conclusions: Adequate awareness for the HZO in pediatric patients is required, and the management of RHS patients is paramount among pediatrician or pediatric otorhinolaryngologists.

The aim of the study was to validate the impact of the single-nucleotide polymorphism rs2413739 (T > C) in the PACSIN2 gene on thiopurines pharmacological parameters and clinical response in an Italian cohort of pediatric patients with acute lymphoblastic leukemia (ALL) and inflammatory bowel disease (IBD). In ALL, PACSIN2 rs2413739 T allele was associated with a significant reduction of TPMT activity in erythrocytes (p = 0.0094, linear mixed-effect model, multivariate analysis considering TPMT genotype) and increased severe gastrointestinal toxicity during consolidation therapy (p = 0.049). A similar trend was present also for severe hematological toxicity during maintenance. In IBD, no significant effect of rs2413739 could be found on TPMT activity, howeverazathioprine effectiveness was reduced in patients carrying the T allele (linear mixed effect, p = 0.0058). In PBMC from healthy donors, a positive correlation between PACSIN2 and TPMT protein concentration could be detected (linear mixed effect, p = 0.045). These results support the role of PACSIN2 polymorphism on TPMT activity and mercaptopurine adverse effects in patients with ALL. Further evidence on PBMC and pediatric patients with IBD supports an association between PACSIN2 variants, TPMT activity, and thiopurines effects, even if more studies are needed since some of these effects may be tissue specific.

Introduction. Haemophilus influenzae and Haemophilus parainfluenzae are known as human-restricted respiratory microbiota representatives. The aim of the present paper was to assay haemophili prevalence in middle ear effusion specimens in pediatric patients with otitis media with effusion (OME). Methods. A total of 86 ear effusion specimens (from the left and right ear independently) were collected from 43 pediatric patients with OME. For comparison, 58 nasopharyngeal specimens were taken from 58 pediatric patients prone to recurrent respiratory tract infections (RRTI). Isolation and identification of haemophili biotypes and antimicrobial susceptibility was accomplished by standard microbiological methods. The cell surface hydrophobicity (CSH) of isolates was assayed by the method of aggregation in ammonium sulfate (SAT). Results. Haemophili were isolated in 25.6% (11/43) of all OME patients: in 5/43 (11.6%)– H. influenzae (biotypes II, III), in 5/43 (11.6%) – H. parainfluenzae, in 1/43 (2.3%) – both species were found. Haemophili-positive nasopharyngeal specimen was found in 27/58 (46.6%) RRTI patients: in 19/58 (32.8%) – H. influenzae, in 8/58 (13.8%) – H. parainfluenzae. About 90% of all haemophili isolates were characterised by extreme to strong CSH. Antimicrobial resistance occurred mainly among H. parainfluenzae (80%) and to a much lower percentage among H. influenzae (33.3%) isolates. The obtained data suggest that both H. influenzae and H. parainfluenzae can be involved in pathology of OME in pediatric patients. The high cell surface hydrophobicity can affect on the haemophili prevalence and ear colonization, and induces predisposition to the presence of these bacteria as a biofilm that serves as a virulence factor with great importance for the survival of these opportunistic bacteria and their persistence in the ear environment.

Purpose The aim of our study was to evaluate the efficacy and safety of epi-off conventional and accelerated corneal collagen cross-linking in the treatment of progressive keratoconus in pediatric patients up to 4 years after treatment. Patients and methods Conventional (standard) CXL epi-off technique was performed in 37 eyes (S-CXL group) and accelerated CXL in 27 eyes (A-CXL group). Refraction, keratometry, cylindrical equivalent, spherical equivalent, slit lamp examination, pachymetry, corneal tomography, anterior segment ocular coherence tomography and visual acuity were performed up to 4 years. Results In the S-CXL group: the flat K values decreased from 47.41±3.39 D to 45.36±3.62 D at 4 years (p=0.004); steep K decreased from 51.98±4.11 to 50.21±4.81 D at 4 years (p=0.0078); mean K decreased with 1.99 D at 4 years (p=0.009). In the A-CXL group: the flat K values decreased from 46.97±4.17 D to 44.97±4.24 D at 4 years (p=0.048); steep K decreased from 50.55±4.10 D to 48.75±4.17 D at 4 years (p=0.0287); mean K decreased from 48.79±3.86 D to 46.86±4.11 D at 4 years (p=0.0356). The preoperative mean UCVA in the S-CXL group was 0.8 ±0.23 logMar and improved during the follow-up reaching 0.65 ±0.24 logMar at 4 years (p=0.072). The baseline mean UCVA in A-CXL group was 0.77±0.25 logMar and increased during the follow-up to 0.63 ±0.25 logMar at 4 years (p=0.0039). A similar improvement of BCVA was observed during the follow-up. Conclusion Epi-off conventional and accelerated CXL are efficient procedures for progressive keratoconus in pediatric patients. Accelerated and conventional CXL were comparable at all time points and both represent viable options for the therapy of KC in these patients.

The safety and efficacy of OPA‐15406 (international non‐proprietary name, difamilast; also referred to as MM36), a new topical, selective phosphodiesterase type‐4 inhibitor, in Japanese pediatric patients with atopic dermatitis aged 2–14 years were evaluated in a phase 2, randomized, double‐blind, vehicle‐controlled, 4‐week study. Seventy‐three patients were randomized 1:1:1 to receive OPA‐15406 0.3%, OPA‐15406 1% or vehicle ointment twice daily for 4 weeks. The mean age of patients was similar across treatment groups. No deaths or serious treatment‐emergent adverse events were reported; all treatment‐emergent adverse events were mild or moderate in severity. The incidence of treatment‐emergent adverse events leading to treatment discontinuation was 4.2% (1/24) in the OPA‐15406 0.3% group, 4.0% (1/25) in the OPA‐15406 1% group and 16.7% (4/24) in the vehicle group, all of which were worsening of atopic dermatitis. Both OPA‐15406 groups demonstrated a higher incidence of success in the Investigator Global Assessment score compared with the vehicle group over the 4‐week study. The OPA‐15406 groups also showed greater improvements from baseline compared with the vehicle group in the Investigator Global Assessment score, Eczema Area and Severity Index overall score and subscale (erythema, induration/papulation, excoriation and lichenification) scores, Visual Analog Scale pruritus score, Patient‐Oriented Eczema Measure score, and percentage of affected body surface area over the 4‐week study. Topical OPA‐15406 twice daily for 4 weeks was considered a safe and effective treatment option in this phase 2 study in pediatric patients with atopic dermatitis, and phase 3 development is currently ongoing.

PubMedID: 30638664 Purpose: To the best of our knowledge, in the literature, there is no data regarding clinical utility of the abdominal perfusion pressure (APP) in critically ill children. Thus, in the present study, we aimed to investigate the clinical utility of APP in predicting of survival in critically ill children with IAH. Design: A prospective cohort study of patients between 1 month to 18 years who had risk for intra-abdominal hypertension from June 2013 to January 2014. Setting: Pediatric intensive care unit (PICU) at a tertiary university hospital. Patients: Thirty-five (16 female) PICU patients who had risk for the development of IAH were included. Serial intraabdominal pressure (IAP) and mean arterial pressure (MAP) measurements were performed. Abdominal perfusion pressure was calculated using the formula (MAP-IAP). Measurements and Main Results: Overall mortality rate was 49% (n = 17). The mortality rate in patients with IAP mean ? 10 mmHg (n = 27, 77%) was 55% (n = 15), while 53% (n = 16) in patients with IAP max ? 10 mmHg (n = 30, 86%) and 47% (n = 7) in patients with IAP min ? 10 mmHg (n = 15, 43%). Overall mean APP was 58 ± 20 mmHg. Logistic regression analysis revealed that decrease in minAPP was associated with increased risk for mortality (Odds ratio for each 1 mmHg decrease in APP was 1.052 [CI 95%, 1.006–1.100], p < 0.05). ROC curve analysis revealed that, in predicting mortality, area under curve for minAPP was 0.765. The optimal cut-off point for APP was obtained as 53 mmHg with the 77.8% sensitivity and 70.6% specificity using the IU method. Conclusions: Our findings showed that APP seems to be a useful tool in predicting mortality. Interventions to improve APP may be associated with better outcomes in critically ill PICU patients. Level of evidence: Level II. Type of study: Diagnostic. © 2018 Elsevier Inc.