Pediatrics
Early Outcomes of Hirschsprung's Disease after Definitive Surgery: A Ten-year Experience
This study aimed to examine the characteristics of Hirschsprung’s Disease (HD) in patients aged<18 who underwent surgical procedure at Dr. Zainoel Abidin (RSUDZA) General Hospital Banda Aceh Indonesia between January 2010 and December 2020.
This retrospective study collected and analyzed data from medical records of 18-year-old or younger children (n = 180) diagnosed with HD at RSUDZA. The surgical procedures included the Duhamel procedure Soave procedure the Soave Transanal Endorectal Pull-through (TEPT) procedure and the Swenson TEPT procedure. Early outcomes of the surgery were then compared between males and females. The comparrative analysis was determined based on Chi-square analysis where p<0.05 was considered significant.
There were 111 (61.7%) male patients and 69 (38.3%) female patients with a mean age of 15.2 months. The Soave TEPT is the most frequently performed procedure (91.7%). Emerging clinical manifestations include constipation (176; 97.8%) and soiling (171; 95%). Preoperative barium enema and postoperative pathological examination confirmed that almost all patients (99.4%) had an aganglionic segment confined to the rectosigmoid area. The average length of operation was 69.7 ± 65 minutes and average bleeding time was 5.4 ± 34 mL. The average discharge time was 3.3 ± 73.3 days. No significant difference was found in post-surgery complications between males and females (p>0.5). The immediate complications were not associated with surgical methods (p = 0.83).
Our descriptive study has suggested the Soave TEPT technique as appropriate to manage HD.
Awareness, Practice and Views of Pediatricians, General Physicians, and Pharmacists about Prescribing Off-label Medication in Pediatric Patients in Eastern Province, Saudi Arabia
An off-label medication involves the use of an approved drug for an unapproved indication population route of administration or dosage.The physiological state of children differs from that of adults making the adult formulation potentially dangerous to children. Off-label prescribing is quite common in children due to challenges in the development of pediatric formulations. The current study was conducted to determine the awareness practice and views of pediatricians general physicians and pharmacists about prescribing Off-label medication to pediatric patients in Eastern Province Saudi Arabia.
A cross-sectional study based on a questionnaire was conducted among pediatricians general physicians and pharmacists (clinical and community) in Eastern Province Saudi Arabia. Statistical analysis was conducted using the data exported from Google Forms (Mountain View California USA) and Microsoft Excel (Version 2016) and then exported into Statistical Package for Social Sciences (SPSS) version 26.0 (IBM Inc. Armonk NY USA). Chi-square was deemed suitable. The level of significance was set at 0.05.
Among the study participants 53(35.09%) were pharmacists followed by 24(15.89%) others 22(14.565) pediatricians 19(12.58%) other specialists 17(11.25%) general physicians and 16(10.59%) were clinical pharmacist. About 73(48.34%) described the definition of off-label correctly. About 114(75.49%) believed that parents and guardians must be informed about off-label medicine prescribed to their children. About 52(34.43%) had concerns about the safety of the medication and 98(64.90%) believed they should be tested in pediatrics during clinical trials. Further 97(64.23%) considered themselves not enough knowledgeable about off-label medications. The barriers reported by the participants were as follows: 89(58.945%) said lack of information resources 71(47.01%) said lack of training 56(37.08%) said lack of information on the safety of excipients used in pediatrics 47(31.12%) said lack of formulary 44(29.13%) said lack of guidelines and 58(5.29%) said lack of information related to the safety of excipient concentration in pediatrics. The proportion of healthcare professionals who agreed that excipients in adult medication may be harmful to pediatrics was 103(68.21%). The drugs most often prescribed as off-label were paracetamol 54(21.68%) followed by Phenobarbital 35(14%) and Amoxicillin 33(13.25%).
There are a considerable number of healthcare professionals unaware of the description of off-label medication. The majority have concerns over the safety and efficacy of the off-label drugs and believe that most frequently used off-label drugs in pediatrics must be tested in pediatrics during clinical trials. In addition excipient safety data are of considerable importance to ensure off-label drug safety in pediatrics who believe their knowledge is inadequate and need proper guidelines and training on this issue.
A Survey on Diagnosis and Prognosis of Prenatal Asphyxia based on Oxidant Antioxidant Balance: Evidence from a Systematic Review and Meta-analysis
The mechanism of occurrence and complications of asphyxia change in the treatment process and the future prognosis of newborns. One of the discussed mechanisms is the disruption of oxidant anti-oxidant balance. Therefore the current study was conducted aiming to systematically review and meta-analysis in the diagnosis and prognosis of prenatal asphyxia based on oxidant-antioxidant balance.
A comprehensive electronic search was conducted with PubMed Cochrane Library Scopus and Web of Science databases up to February 2023 to identify relevant studies examining the association between Prooxidant anti-oxidant balance (PAB) and Malondialdehyde 1 levels with the risk of prenatal asphyxia. Only English studies were incorporated. The search terms used included Asphyxia Diagnosis Prognosis Newborns Prenatal Oxidant antioxidant balance and oxidative stress. A total of 13 studies were retrieved. Data regarding the standard mean difference (SMD) were collected and a pooled SMD with 95%CI was calculated using a random-effect model to determine the strength of the relationship. Furthermore the risk of publication bias was assessed through funnel plot and Egger’s linear regression tests. Inclusion criteria was 1) The studies conducted on neonates diagnosis and outcomes of prenatal asphyxia oxidants and antioxidants were included. Research conducted on adults or on animals or review articles and articles which only their abstracts were available were excluded. The quality of the reported studies was also assessed.
Out of 980 searched articles 13 articles (10 prospective articles and 3 cross-sectional articles) were studied. An increase in antioxidant enzymes (Glutathione peroxidase (GSH-Px) catalase (CAT) and Plasma superoxide dismutase (SOD)) cannot be dealt with excessive oxidants produced in the body (Plasma and cerebrospinal fluid levels of Malondialdehyde (MDA) free radical products (F8-isoprostane and MDA) saturated fatty acids and % CoQ-10). Prooxidant anti-oxidant balance (PAB) levels among neonates who had asphyxia were announced to be two times higher than normal newborns. PAB values in neonates with asphyxia who had adverse prognosis were about three times higher than those with favorable prognosis. The sensitivity of PAB in predicting the prognosis of neonates with asphyxia was reported 83- 89% and its specificity was 71- 92%. The pooled SMD analysis revealed a significant association between PAB and MDA levels with the risk of prenatal asphyxia both overall (SMD = 1.447 95%CI: 0.961-1.934 P < 0.001) as well as separately in subgroups of PAB (SMD = 1.134 95%CI: 0.623-1.644 P < 0.001) and MDA (SMD = 1.910 95%CI: 0.916-2.903 P < 0.001).
Our meta-analysis findings revealed the potential of evaluating antioxidant enzymes and oxidant agents as well as assessing the balance between them (PAB) in diagnosing and predicting the prognosis of neonatal asphyxia. The limitations of the present study included not having access to all related complete articles lack of quality and usability in reports of some articles and the different diagnostic methods of prenatal asphyxia in different studies.
Novel Compound Heterozygous Mutations of LIG4 Gene in an Indian LIG4 Syndrome Patient with Severe Microcephaly: Case Report, In-silico Analysis and Systematic Review
LIG4 syndrome characterized by immunodeficiency sensitivity to ionizing radiations intrauterine growth retardation postnatal growth retardation and microcephaly is a rare genetic disorder caused by pathogenic variants of the LIG4 gene. Few patients are presented with no immune dysregulation as well.
We present here a male child of 2 years and 4 months of age with severe microcephaly and short stature. His birth weight was 1.9 Kg and his current height weight and head circumference are 83.2 cm (z score = -2.37) 9.5 Kg (z score = -2.76) and 36 cm (z score = -9.24) respectively. Possible causative pathogenic compound heterozygous variants of the LIG4 gene which were inherited from the parents were identified by whole exome sequencing of the DNA of the patient and his parents. A systematic review of the literature is also performed to summarize the patients of LIG4 syndrome reported worldwide and summarize the associated genetic mutations of the LIG4 gene. Compound heterozygous variants (c.597_600delTCAG/ c.342del) of LIG4 gene were identified. The parents were found to be heterozygous carriers of one variant each.
The in-silico analysis of identified variants explains their effect on the structure and function of the LIG4 protein hence explaining the genotype-phenotype correlation.
Effects of Vitamin D and E Supplementation on Prevention of Bronchopulmonary Dysplasia (BPD) in Premature Neonates: A Systematic Review and Meta-analysis
Bronchopulmonary Dysplasia (BPD) has a multifactorial etiology. Vitamin E and vitamin D play an important role in lung development and can potentially be beneficial in the prevention of BPD.
The study aimed to compare the risk of BPD occurrence in preterm neonates supplemented with vitamin D or E versus those who did not get supplementation.
The literature search was conducted for this systematic review by searching the PubMed Scopus and Web of Science databases up to December 2022. Randomized controlled trials involved administering vitamin D or E to preterm neonates and examining the occurrence of BPD. We excluded non-English articles and articles with non-relevant and insufficient data. We used the Critical Appraisal Skills Programme (CASP) checklist to assess the quality of the included studies. We used Egger’s test to evaluate the risk of bias among the included studies. Heterogeneity was also assessed through Q-test and I2. We applied the random effect model for analysis. A P-value less than 0.05 was considered as significant. All the statistical analysis in the current study was performed using STATA 14. The Relative Risk (RR) was calculated as the effect size with 95% Confidence Interval (CI).
Three eligible studies seeking the role of vitamin D in the prevention of BPD were analysed. Meta-analysis revealed that receiving vitamin D supplementation can significantly reduce the risk of BPD in preterm infants (RR = 0.357 95% CI: 0.189-0.675 I2 = 0.0%; p = 0.002). Similarly for assessing the role of Vitamin E in the prevention of BPD three eligible studies were analysed. Vitamin E supplementation was not found to play a significant role in the reduction of BPD (RR = 0.659 95%CI = 0.243-1.786 I2 = 38.7%; p = 0.412).
Vitamin D supplementation could be beneficial in preventing BPD in preterm infants. However evidence is not enough regarding vitamin E's role in reducing the incidence of BPD in preterm infants.
Pinworm (Enterobius Vermicularis) Infestation: An Updated Review
Pinworm infestation is an important public health problem worldwide especially among children 5 to 10 years of age in developing countries with temperate climates. The problem is often overlooked because of its mild or asymptomatic clinical manifestations.
The purpose of this article was to familiarize pediatricians with the diagnosis and management of pinworm infestation.
A search was conducted in August 2023 in PubMed Clinical Queries using the key terms “Enterobius vermicularis” OR “enterobiasis” OR “pinworm.” The search strategy included all clinical trials observational studies and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.
Enterobiasis is a cosmopolitan parasitosis caused by Enterobius vermicularis. It affects approximately 30% of children worldwide and up to 60% of children in some developing countries. Predisposing factors include poor socioeconomic conditions inadequate sanitation poor personal hygiene and overcrowding. Children aged 5 to 14 years have shown the highest prevalence of enterobiasis.. Egg transmission is mainly by the fecal-oral route. Approximately 30 to 40% of infested patients do not show any clinical symptoms of the disease. For symptomatic patients the most common presenting symptom is nocturnal pruritus ani. The diagnosis of E. vermicularis infection is best established by the cellophane tape test. The sensitivity of one single test is around 50%; however the sensitivity increases to approximately 90% with tests performed on three different mornings. If a worm is visualized in the perianal area or the stool a pathological examination of the worm will yield a definitive diagnosis. As pinworms and eggs are not usually passed in the stool examination of the stool is not recommended. The drugs of choice for the treatment of pinworm infestation are mebendazole (100 mg) pyrantel pamoate (11 mg/kg maximum 1 g) and albendazole (400 mg) all of the above-mentioned drugs are given in a single dose and repeated in two weeks. Mebendazole and albendazole are both adulticidal and ovicidal whereas pyrantel pamoate is only adulticidal. Given their safety and effectiveness mebendazole and albendazole are currently the best available drugs for the treatment of pinworm infestation. For pregnant women pyrantel is preferred to mebendazole and albendazole. Treatment of all household members should be considered especially if there are multiple or repeated symptomatic infections because reinfection is common even when effective medication is given.
In spite of effective treatment of pinworm infestation recurrences are common. Recurrences are likely due to repeated cycles of reinfection (particularly autoinfection) because of the short life span of adult pinworms. Good personal hygiene such as frequent handwashing especially after bowel movements and before meals clipping of fingernails avoidance of finger-sucking nail-biting and scratching in the anogenital area are important preventive measures. Treatment of all household members should be considered especially if there are multiple or repeated symptomatic infections.
Insights from Overviewing Selective International Guidelines for Pediatric Asthma
Asthma is a chronic atopic and inflammatory bronchial disease characterized by recurring symptoms episodic reversible bronchial obstruction and easily triggered bronchospasms. Asthma often begins in childhood. International guidelines are widely accepted and implemented; however there are similarities and differences in the management approaches. There is no national guideline in many cities in Asia. This review aims to provide a practical perspective on current recommendations in the management of childhood asthma specifically in the following aspects: diagnosis classification of severity treatment options and asthma control and to provide physicians with up-to-date information for the management of asthma.
We used the PubMed function of Clinical Queries and searched keywords of “Asthma” “Pediatric” AND “Guidelines” as the search engine. “Clinical Prediction Guides” “Etiology” “Diagnosis” “Therapy” “Prognosis” and “Narrow” scope were used as filters. The search was conducted in November 2022. The information retrieved from this search was used in compiling the present article.
Diagnosis is clinically based on symptom pattern response to therapy with bronchodilators and inhaled corticosteroids and spirometric pulmonary function testing (PFT). Asthma is classified in accordance with symptom frequency peak expiratory flow rate (PEFR) forced expiratory volume in one second (FEV1) and atopic versus nonatopic etiology where atopy means a predisposition toward a type 1 hypersensitivity reaction. Asthma is also classified as intermittent or persistent (mild to severe). Unfortunately there is no disease cure for asthma. However symptoms can be prevented by trigger avoidance and suppressed with inhaled corticosteroids. Antileukotriene agents or long-acting beta-agonists (LABA) may be used together with inhaled corticosteroids if symptoms of asthma are not controlled. Rapidly worsening symptoms are usually treated with an inhaled short-acting beta-2 agonist (SABA e.g. salbutamol) and oral corticosteroids. Intravenous corticosteroids and hospitalization are required in severe cases of asthma attacks. Some guidelines also provide recommendations on the use of biologics and immunotherapy.
Asthma is diagnosed clinically with supporting laboratory testing. Treatment is based on severity classification from intermittent to persistent. Inhaled bronchodilator and anti-inflammatory corticosteroid form the main stay of management.
Prune-belly Syndrome: An Update
The Prune-Belly (Eagle-Barrett) syndrome (PBS) is a congenital and genetically heterogeneous disease more prevalent in males defined by the clinical triad (1) deficiency of abdominal muscles (2) bilateral cryptorchidism and (3) urinary tract abnormalities. The abdomen of an infant with PBS has a typical appearance similar to the aspect of a prune which gives it its name. Although the etiology of this disorder is still unknown numerous theories mutations and genetic disturbances have been proposed to explain the origin of PBS. Prognosis can differ a lot from one patient to another since this condition has a wide spectrum of clinical presentation. Despite being a rare condition the importance of PBS should not be underestimated in the light of the potential of the disorder to lead to chronic kidney disease and other severe complications. In that regard this review gathers the most up-to-date knowledge about the etiopathogenesis clinical features diagnosis management and prognosis of PBS.
Persistent Inflammation, Immunosuppression and Catabolism Syndrome in Pediatric Populations: A Brief Perspective
Surviving near-lethal insults such as sepsis trauma and major surgery is more common due to advances in medical care. The decline in mortality has unmasked a population of chronic critically ill patients many with the pathological immunophenotype known as Persistent inflammation Immunosuppression and Catabolism Syndrome (PICS). Though initially described in adults many critically ill children exhibit the hallmarks of PICS including lymphopenia hyperinflammation and evidence of ongoing somatic protein catabolism. These patients are plagued with recurrent infections and suffer worse outcomes. There remains a need to understand the pathophysiology underlying this condition to elucidate potential therapies and develop interventions. This perspective provides the most current update of PICS within the pediatric population.
Is Necrotizing Enterocolitis and Spontaneous Intestinal Perforation Part of Same Disease Spectrum - New Insights?
The diagnosis of NEC is based on the presence of pneumatosis dilated bowel loops portal venous gas or pneumoperitoneum on the abdominal x-ray. Published studies suggest that the appearance of pneumatosis most likely depends on the gestational age with a shift occurring between 27-28 weeks. For infants of gestational age under 27 weeks pneumoperitoneum is the most likely presentation of bowel injury due to the thin bowel wall and the colonization of the gut with the non-gas-producing bacteria. Assessment of postoperative morbidity and white matter injury on the brain MRI at term equivalent age in a cohort of preterm infants failed to identify differences between SIP and NEC groups when confirmed by histology. These findings illustrate the difficulty in conclusively identifying cases as SIP or NEC particularly when gestational age is considered and raise speculation that both conditions lie on the same spectrum of intestinal injury.
Strategies for Pain Management after Extraction of Primary Teeth: A Systematic Review of Randomized Clinical Trials
In dental extractions particularly when local anesthesia is used it usually offers analgesic relief for a few hours. However pain can become a notable concern in the immediate postoperative period due to the trauma experienced by both soft and hard oral tissues.
This systematic review aimed to evaluate the most effective strategies for managing postoperative pain in primary tooth extractions.
Two examiners conducted a search across electronic databases: MEDLINE (via PubMed) Embase Scopus Web of Science CENTRAL and OpenGray. Studies were included if they met the following criteria after reviewing their titles and abstracts: they involved children and evaluated pain management following primary tooth extraction. Subsequently articles that described extractions performed under any form of sedation were not conducted under local anesthesia in an outpatient setting and in children aged 0 to 12 years or were not randomized controlled trials were excluded.
The search yielded 374 relevant articles of which 9 were included. Among these 5 utilized preoperative medications as a pain management strategy one evaluated low-level laser therapy (LLLT) postoperatively one assessed calendula drops postoperatively and another explored virtual reality during the procedure and arnica in solution both pre and postoperatively.
Among all the strategies evaluated the strategy involving analgesics administered 30 minutes before tooth extractions was supported by better-designed studies. However there is a high risk of bias.
“Non-COVID-19” Coronavirus Diseases Not to be Misdiagnosed as COVID-19
The COVID-19 global pandemic was caused by a novel coronavirus (SARS-CoV-2) which then became an endemic infection. COVID refers to the World Health Organization’s coined acronym for coronavirus disease.
We have herein reported three cases of COVIDs that could have been misdiagnosed as COVID-19. All of these families reported previous COVID-19 infection based on self- administered Rapid Antigen Testing (RAT) and completed a period of home isolation. In these 3 cases one child had an RSV-associated asthma attack one had norovirus gastritis and another had an infection with Campylobacter and E. coli. NL63 OC43 and 229E respectively were found by PCR in these patients.
Seven human coronaviruses cause human infectious diseases. Confusion and issues associated with coronavirus disease diagnosis by Polymerase Chain Reaction (PCR) testing and Rapid Antigen Test (RAT) may arise. Some RATs are Antigen Fluorescent Immunoassays (FIA) that target monoclonal antibodies for the detection of viral nucleocapsid protein. Others target the non-nucleocapsid proteins. False positivity is possible. False negativity is also possible if the specimen’s antigen level is below the test's detection limit. RAT results usually remain positive for 6 to 7 days but they may stay positive as long as 2 weeks. Stigmatization with the COVID-19 diagnosis may occur. The PCR test is a highly sensitive ‘gold standard’ for the detection of COVID-19 but it can also detect non-infectious individuals’ fragmented non-infectious viral nucleic acids and could be positive for a long period. An individual may be tested positive for a few weeks to months after the individual becomes non-infectious.
The cases presented here had COVID other than COVID-19 caused by coronavirus variants other than SARS-CoV-2. Co-infections with other pathogens are present in these "Non- COVID-19" COVIDs. PCR testing of non-COVID-19 COVIDs may help in the accurate diagnosis of these ailments and respiratory co-infections.
Acute Respiratory Tract Infections in Pediatric Populations of Slum Areas: Navigating Challenges and Dynamics of Immune Responses
The study presents a thorough examination of immune responses in pediatric populations within slum areas specifically addressing respiratory infections. It explores the impact of slum conditions on respiratory health detailing the epidemiology of infections including common pathogens and environmental factors. The review delves into the etiology clinical manifestations and challenges associated with viral respiratory infections co-infections and complications in slum environments. The discussion extends to immune responses in pediatric respiratory infections emphasizing unique challenges in diagnosis and treatment within slum areas. Prevention and intervention strategies are highlighted encompassing vaccination programs health education and improving living conditions. It underscores the importance of targeted interventions accounting for socio-economic factors community-based strategies and culturally sensitive approaches. It proposes the exploration of novel approaches and the development of vaccines tailored to prevalent respiratory pathogens in slum settings. Furthermore the feasibility and impact of routine immunization programs emphasizing accessibility acceptance and long-term sustainability are explored. It advocates strengthening primary healthcare systems investing in healthcare workforce training and improving diagnostic facilities. The potential of digital health technologies in enhancing surveillance early detection and the development of mobile applications or telemedicine platforms is discussed. In conclusion the study emphasizes the multifaceted challenges faced by children in slum areas regarding respiratory infections necessitating informed interdisciplinary interventions. Addressing healthcare disparities improving living conditions and enhancing vaccination coverage are deemed crucial for mitigating the burden of respiratory infections. This review calls for collaborative efforts among researchers healthcare professionals policymakers and community stakeholders to develop sustainable solutions for enhanced respiratory health in slum-dwelling pediatric populations.
Lichen Striatus: An Updated Review
Lichen striatus is a benign dermatosis that affects mainly children. This condition mimics many other dermatoses.
The purpose of this article is to familiarize pediatricians with the clinical manifestations of lichen striatus to avoid misdiagnosis unnecessary investigations unnecessary referrals and mismanagement of lichen striatus.
A search was conducted in June 2023 in PubMed Clinical Queries using the key term “Lichen striatus”. The search strategy included all observational studies clinical trials and reviews published within the past ten years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of this article.
Lichen striatus is a benign self-limited T-cell mediated dermatosis characterized by a linear inflammatory papular eruption seen primarily in children. The onset is usually sudden with minimal or absent symptomatology. The eruption in typical lichen striatus consists of discrete skin-colored pink erythematous or violaceous flat-topped slightly elevated smooth or scaly papules that coalesce to form a dull red potentially scaly interrupted or continuous band over days to weeks. Although any part of the body may be involved the extremities are the sites of predilection. Typically the rash is solitary unilateral and follows Blaschko lines. In dark-skinned individuals the skin lesions may be hypopigmented at onset. Nails may be affected alone or more commonly along with the skin lesions of lichen striatus. The differential diagnoses of lichen striatus are many and the salient features of other conditions are highlighted in the text.
Lichen striatus is a self-limited condition that often resolves within one year without residual scarring but may have transient post-inflammatory hypopigmentation or hyperpigmentation. As such treatment may not be necessary. For patients who desire treatment for cosmesis or for the symptomatic treatment of pruritus a low- to mid-potency topical corticosteroid or a topical immunomodulator can be used. A fading cream can be used for post-inflammatory hyperpigmentation.
Child Maltreatment and Psychopathology: A Brief Review on the Potential Role of the Hypothalamic-pituitary-adrenal Axis
Child maltreatment is a widespread global issue involving any form of harm or neglect by a parent or caregiver leading to various forms of physical or emotional damage with approximately 150 million affected children globally.
This study discusses the potential mechanism of the hypothalamic-pituitary-adrenal axis dysfunction and cortisol hormone changes in linking child maltreatment to mental health disorders. It also discusses supportive strategies to prevent mental diseases and counteract the biological embedding of these conditions emphasizing the need for comprehensive interventions to address the long-term impact of child maltreatment on mental health.
Articles were selected using established methods previously described. Key information was obtained from scientific articles published during the past 20 years including original studies systematic reviews and meta-analyses. Articles search was performed using top academic search engines.
While research on hypothalamic-pituitary-adrenal axis response to stress in maltreated children is ongoing and far from conclusive its impact and implications for physiological functioning and the predisposition to psychopathology are significant. Childhood maltreatment increases the risk of psychiatric illnesses severity of diseases and poor treatment responses.
Childhood maltreatment manifests as disruptions to hypothalamic-pituitary-adrenal axis functioning with the extent varying based on factors such as the age of onset parental responsiveness and the type and characteristics of maltreatment. The complex interplay of these factors contributes to the diversity of hypothalamic-pituitary-adrenal axis responses to stress in maltreated children creating a spectrum of physiological functioning and vulnerability to psychopathology.
A Survey of the Course: ‘How to Successfully Write a Scientific Article in Pediatric Settings’
The aim of the present survey was to analyze the knowledge and skills in medical paper writing of physicians who attended the course “how to write successfully a scientific paper.”
A blind survey was used to analyze participants' knowledge on the topic of the course “how to write successfully a scientific paper.” Before starting the workshop participants anonymously filled out the input questionnaire containing 12 preliminary data questions. The three-hour course included a lecture on the steps of creating and writing a scientific article with examples. At the end all participants anonymously completed the exit questionnaire consisting of 18 questions. Differences and associations between the collected data were analyzed using appropriate statistical tests.
The survey included 22 participants most of whom were women (16 72.7%). The participants' educational level was proportional to their age. 12 of the participants had an intermediate level while the others reported higher English proficiency. Half of the participants had never published an article. A significant difference was observed between English level and being the first author of an article published in a scientific journal (p = 0.044). Before class only 13.6% of participants knew that guidelines are mandatory for making clinical decisions according to evidence-based medicine. There was a significant positive correlation between sex and current affiliation (p = 0.038). A negative correlation was observed between sex and article publication (p = 0.037). A positive correlation was observed between English level and current affiliation (p = 0.020). There was a negative correlation observed between previous sources of learning scientific article writing and having already published an article (p = 0.025). A positive correlation was found between reading an article and publishing it (p = 0.046). Statistical analysis showed a significant difference between reading frequency number of published articles being the first author and knowing the title of a scientific article (p = 0.036 p = 0.027 and p = 0.030 respectively).
The results of the questionnaires revealed discrepancies in prior research engagement and understanding of scientific concepts and rules. This survey highlights the importance of the course “how to successfully write a scientific article” in improving participants' knowledge of scientific work and the process of creating an article for submission to medical journals.
Cord Blood Cortisol Level - A Possible Predictor for Respiratory Distress Syndrome in Preterm Neonates
Respiratory Distress Syndrome (RDS) is a leading cause of death in premature infants. There are different clinical/ biochemical markers associated with the RDS. One of the potential biochemical markers is cortisol in cord blood.
This study aims to correlate cortisol levels in preterm neonates with RDS and to establish whether cord blood cortisol is a reliable predictor for RDS.
This prospective analytical study was conducted in a tertiary care hospital over nine months among fifty preterm neonates. Data was collected using proforma and cord blood was collected at the time of delivery. Cortisol levels were compared and correlated to the development of RDS.
The mean ± SD cord blood cortisol level among preterm neonates was 5.97 ± 2.74 (SD) µg/dl. The levels were higher in neonates whose mothers received antenatal steroids and were significantly lower (2.86 ± 1.66 µg/dl) in those who developed RDS. Association between cord blood cortisol level and RDS was found with an odds ratio of 57.4 which was statistically significant.
The percentage of babies developing RDS in mothers not covered with antenatal steroids was significantly higher than those covered (p-value is 0.000).
The mean cord blood cortisol levels were exceptionally low (1.89 µg/dl) in neonates who expired compared to those who survived (7.02 µg/dl).
There is an association between cord blood cortisol levels and RDS. Hence Cord blood cortisol levels may be used to predict RDS and help initiate early treatment thus preventing mortality and morbidity.
The Role of Newborn Pulse Oximetry Screening for Detecting Critical Congenital Heart Defects: A Narrative Review
Critical congenital heart diseases are life-threatening with a high morbidity rate and mortality among newborns; in fact a newborn discharged from the hospital with undiagnosed heart disease may experience severe complications during the initial days or weeks of their life necessitating emergency care and even death. Among all kinds of critical congenital heart disease coarctation of the aorta is one of the most difficult to diagnose because it only becomes noticeable a few days after birth when patients have already been discharged from the hospital. This underlines the importance of having a reliable diagnostic tool to discover these diseases. The identification of some of these patients can be achieved through newborn screening with pulse oximetry but only a small number are diagnosed.
Hence the objective of this review was to determine the value of pulse oximetry screening for the early detection of congenital heart defects in newborns with a focus on coarctation of the aorta. A literature search was conducted between December 2023 and February 2024 using four electronic databases: Pubmed Google Scholar Embase and Scopus to identify studies that evaluated the efficacy of pre- and post-discharge neonatal ductal saturation monitoring for the diagnosis of critical congenital heart defects before discharge.
Twenty research studies with a large number of patients demonstrating moderate sensitivity and high specificity of pulse oximetry test in detecting critical heart defects especially coarctation of the aorta were selected and analyzed.
Many confirmations have been found of how good the specificity of screening is reaching an average value of 99.9% in each study analyzed. The problem still lies in the sensitivity of the screening which is not as good as the specificity never reaching 90% in any of the studies analysed. So it is crucial to keep up with efforts to improve the efficacy of the pulse oximetry screening method.
Necrotizing Enterocolitis: A Current Understanding and Challenges for the Future
This perspective reviews the definition and current understanding of necrotizing enterocolitis and evaluates a future prevention approach to this multifactorial disease. An overview of the prevention approach in general is presented where key aspects and emerging criticisms are identified. In addition key elements of early diagnosis and treatment are presented together with some of their challenges and ambiguities. Moreover it concludes with emerging questions from the global community to reach a consensus on the definition diagnosis and management of necrotizing enterocolitis disease.