International Journal of Pediatrics and Adolescent Medicine最新文献

Background

The aim of this study was to use Body Surface Area (BSA) data calculated with the Mosteller equation to test potential new equations that estimate BSA using Body Weight (BW) alone in children aged 0–18 years.

Mosteller’s equation, the golden standard at our hospital, was used to calculate the BSA in infants and children aged 0–18 years using BW and height data from 27,440 hospital visits by 20,635 patients over one year.

Methods

The best fit of three nonlinear regression equations (third-order polynomial, Meeh-type, and modified Boyd self-adjusting-type) to a plot of the calculated Mosteller BSA values versus BW was then investigated. The correlation between the BSA values estimated by these equations and the Mosteller BSA values was established by the Spearman rank correlation test. Bias and precision were evaluated as outlined by Sheiner and Beal. Measured and estimated BSA values were compared using the Eksborg plot.

Results

The estimated BSA values from all three equations and the BSA values from the Mosteller equation were closely correlated (P < .0001). The third-order polynomial and Meeh-type equations overestimated BSA by 0.13% and 0.40%, respectively, while the Boyd self-adjusted-type equation underestimated BSA by 0.060%. For the entire pediatric population, the best fit was obtained with the Meeh-type equation: 99.2% of the Meeh/Mosteller BSA ratios were within the range of 0.9–1.1 when compared with 98.3% and 97.2% for the polynomial and Boyd-type equations, respectively.

Conclusion

A single Meeh-type equation can be used to predict the results of Mosteller equation when H is not available with high precision and accuracy in children aged 0–18 years, including term neonates. We now plan to include the results of this study in CPOE systems in Sweden to improve drug dosage in all children.

Introduction

Basidiobolomycosis is a rare fungal disease, lately appearing in the gastrointestinal system of pediatric patients. Their clinical presentation resembles that of lymphoma or granulomatous inflammations. This non-specific presentation makes Gastrointestinal Basidiobolomycosis (GIB) a diagnostic challenge.

Methods

We are reporting the largest series of pediatric GIB, from Saudi Arabia. 12 patients were diagnosed between January 2012 and December 2019, between the ages of 16 months and 8 years.

Results

The most common symptoms were fever and abdominal pain. Further examination revealed an abdominal mass. Biopsy of the mass was the mainstay of diagnosis, with histological findings of typical filamentous fungal hyphae and zygospores, surrounded by eosinophils.

Conclusion

Role of surgery was limited to establishing the diagnosis and dealing with complications. Antifungal medication was the cornerstone of treatment in all our patients. Three of our patients were exceptional with complications such as entero-cutaneal fistula, entero-enteric fistula and short bowel syndrome. These complications have not been previously reported. We have discussed the challenges related to their management.

The diagnosis of GIB in pediatric patients with abdominal mass, needs a high index of suspicion. We believe outcome depends on the severity of disease, involvement of surrounding tissues and presence of complications at the time of diagnosis.

Background and Objective

Peritoneal dialysis (PD) associated peritonitis is the most common cause of morbidity, mortality, and treatment failure in patients undergoing PD. We aimed to identify the incidence, pathogens, antibiotic susceptibility, and the outcome of peritoneal dialysis (PD)-associated peritonitis in children.

Methods

Data from medical records of children who underwent PD between 2007 and 2018 in King Fahad Medical City were retrospectively collected. All children aged <14 years undergoing chronic PD were included. The demographic characteristics of patients, peritonitis rates, and clinical outcomes‏ were collected.

Results

In total, 131 children [boys, 68 (51.9%)] underwent automated PD for 305 years. The most common age group was 6–12 years (61 patients, 46.6%). A total of 74.0% of patients were new to dialysis; 25.2% were transferred from hemodialysis. Peritonitis incidence was 0.6 episodes/patient-year. Gram-positive and -negative organisms were identified in 50.1% and 22% episodes, respectively, whereas cultures remained negative in 20.5% episodes. Coagulase-negative Staphylococcus was the most common isolated organism (22.1%), followed by methicillin-sensitive S. aureus (11.1%). Peritonitis was resolved in 153 (73.6%) episodes, whereas 52 (25.0%) episodes required removal through the catheter. The multivariate logistic regression analysis found the exit site infection to be a risk factor for catheter removal. Three (1.4%) episodes caused death due to peritonitis complicated by septic shock‏.

Conclusions

Our data showed that the most common organisms causing peritonitis were similar to those reported in the previous international registry. The rate of peritonitis was high, but markedly improved in the past two years.

ALCAPA syndrome is a rare congenital heart disease and a cause of myocardial ischemia in pediatric population. The authors present the case of a 10-year-old girl admitted to the emergency room after experiencing cardiac arrest at school. In the echocardiogram, the inability to identify the origin of the left coronary artery raised the hypothesis of abnormal origin of the left coronary artery from the pulmonary artery (ALCAPA). A CT-scan and a cardiac catheterization were performed confirming the diagnosis. Infants with the syndrome may have myocardial infarction and congestive heart failure^. She successfully underwent cardiac surgery. Most undiagnosed patients die within the first year of life, and it is necessary to develop an extensive network of collaterals to ensure survival. ALCAPA syndrome rarely manifests in late childhood, teenagers, and adults and may be an important cause of sudden cardiac arrest.

Introduction

Sickle cell disease (SCD) is an autosomal recessive disorder. The incidence of bacterial infection in children with SCD globally is 16% compared 3–14% in general children. Bacterial infection in children is a severe problem and is considered to be a life-threatening condition. To reduce antibiotic overuse, the following factors might be associated with bacterial infection could help: age, C-reactive protein (CRP), white blood cells (WBCs) count, absolute neutrophil count (ANC), and genotype. Therefore, this study is designed to evaluate the CRP, ANC, WBCs, and platelet count levels as predictors for bacterial infection in febrile children with sickle cell anemia over a six-year period in a tertiary center in Jeddah, Saudi Arabia.

Methods

This study was a retrospective record review that included all SCD patients below the age of 18 years who presented with a febrile episode at any hospital’s department from 2017 to 2019. Data were extracted from patient files that included culture result and the causative organism, CRP level, WBCs, ANC, and platelet count.

Results

The study included 62 children diagnosed with SCD who presented with 89 febrile episodes. There was no statistically significant difference in the median of CRP and ANC between the bacterial and nonbacterial febrile episodes (P = .314, .735, respectively). However, the level of WBC> 20 K/μL was statistically significant at P = .025.

Conclusion

WBCs significantly associated with a bacterial infection in SCD febrile children along with clinical assessments. This parameter can guide the physicians to determine the children at high risk of bacterial infection.

Background

Primary ciliary dyskinesia (PCD) is a ciliopathy with diverse clinical and genetic findings caused by abnormal motile cilia structure and function. In this study, we describe the clinical characteristics of confirmed PCD cases in our population and report the radiological, genetic, and laboratory findings.

Methods

This was a retrospective, observational, single-centre study. We enrolled 18 patients who were diagnosed with confirmed PCD between 2015 and 2019. We then analyzed their data, including clinical findings and workup.

Results

In our cohort, 56% of patients had molecularly confirmed PCD, and RSPH9 was the most common gene identified. Transmission electron microscopy (TEM) showed an ultrastructural defect in 64% of samples, all of which matched the genetic background of the patient. Situs inversus (SI) was observed in 50% of patients, and congenital heart disease was observed in 33%. The median body mass index (BMI) was 15.87 kg/m², with a median z score of -1.48. The median FEV1 value was 67.6% (z score - 2.43). Radiologically, bronchiectasis was noted in 81% of patients at a variable degree of severity. Lung bases were involved in 91% of patients. We were unable to correlate the genotype-phenotype findings.

Conclusion

We describe the clinical and molecular characteristics of patients with confirmed PCD in a tertiary centre in Saudi Arabia and report 9 new pathogenic or likely pathogenic variants in one of the PCD-associated genes.

Background and objectives

Physical education (PE) classes are among the main intervention strategies for increasing levels of physical activity (PA) to adolescent's health improvements. However, low levels of psychological satisfaction in physical education classes (PE satisfaction) and multiple associations with some factors as sex, age, sedentarism, sports practice, sleep, quality of life can act as moderators of levels of physical activity. Considering these aspects, this study aims to propose a theoretical model of multivariate relationships to verify the association between PE satisfaction with PA levels, considering the contribution of sports practice, health indicators, age, and sex on these relations.

Methods

A cross-sectional study with 470 adolescents (230 boys) aged 11–17 years from the south of Brazil. Several questionnaires were applied to measure the study variables. The theoretical/statistical support of the structural equation model was evaluated according to fit parameters and strength of relations.

Results

Sports practice, health indicators, age, and sex were mediators of the relationship between PE satisfaction and PA levels.

Conclusion

There is a positive, however indirect, relationship between PE satisfaction with the levels of physical activity in adolescents, with greater strength of association in boys and at younger ages. It was identified that the practice of sport contributes to the main mediator factor for all relationships beneficial to the health of adolescents in the multivariate model. This means that adolescents who practiced sports showed greater PE satisfaction, more appropriate health indicators, associated with higher levels of physical activity as compared to nonpractitioners of sport.

Background

Current guidelines recommend the introduction of allergenic foods as early as 4–6 months of age to decrease the risk of food allergy. However, caregivers’ knowledge about such practices and adherence to them is ambiguous.

Objectives

The purpose of this study was to evaluate the timing of introduction of potentially allergenic foods into children’s diet and the level of maternal awareness about and degree of compliance with current recommendations.

Materials and methods

We conducted a cross-sectional study from May 2019 to January 2020 at Imam Mohammad Ibn Saud Islamic University Medical Center, Riyadh, Saudi Arabia. Data were collected through questionnaire-based surveys, and a total of 405 mothers were enrolled in the study. The eligibility criteria included mothers of children between the ages of 12 and 36 months.

Results

Most mothers in this study had initiated allergenic foods, and the average time of introduction was 9.84 ± 3.16 months for eggs, 14.6 ± 5.78 months for peanuts, and 13.6 ± 5.37 months for fish. Around one-quarter (n = 102, 25.2%) of the children were identified as being in the high-risk group. Most mothers did not know or disagreed that the timing of introducing allergenic foods might help in preventing food allergy, but there was no difference between the risk groups (33.8% and 26.2%, respectively). Moreover, only 18.6% and 13.2% of the high- and low-risk groups, respectively, received correct information from their health care providers (P = .004). Mothers with only one child were less likely to start eggs at an early age (odds ratio [OR] = 0.5 and P = .005). Furthermore, children at a high risk of food allergy were two times more likely to start eggs at an earlier age (OR = 2.12 and P = .003).

Conclusion

In this study, the allergenic food feeding practices being followed for infants and young children were found to be suboptimal. Parental education level and the number of siblings were identified as potential barriers to the implementation of and adherence to recent guidelines. There is a need for corrective measures to ensure safe and appropriate feeding practices in the Saudi community.

Background

During their residency program, pediatric residents frequently face ethical challenges. The aim of the study is to evaluate the pediatric residents’ knowledge and confidence to handle common ethical dilemmas during their training.

Methods

This is a survey-based cross-sectional study on all pediatric residents in the largest pediatric training center in Saudi Arabia. The survey had six sections: a) Demographics and self-assessment of religiosity, b) Sources of ethics education, c) Degree of confidence in dealing with ethical challenges in clinical practice, d) Rating of the quality of ethics education during residency, e) Agreement or disagreement regarding ten ethical scenarios, and f) Confidence level in handling 21 different ethical situations.

The response to the survey questions was based on a Likert scale; the survey was electronically distributed to all pediatrics residents. Mean knowledge scores and 95% confidence intervals (CI) were calculated for each independent variable to test for associations. Comparisons were made using an independent t-test or an ANOVA test when there were more than two groups.

Result

Eighty residents responded to the study (85.1% response rate). Over 60% reported that the best source of ethical education for them was through discussions with a senior physician and it was through formal lecturers in 13.8%. One-fifth felt confident in dealing with ethical challenges. Only 2.5% rated the ethics education as “very good/excellent” and 12.5% rated the “support from residency program for ethics education” as being “very good/excellent.” Agreement of more than 80% was only noted for 4 of 10 of the ethical scenarios. Overall, only 16.4% felt “confident/extremely confident” in handling different ethical situations while 38.5% felt “not confident/a little confident” with more confidence among male residents (35.3% versus 18.7% p = 0.01). Marital status, year of residency, religiosity, and source of ethics knowledge had no impact on the level of confidence.

Conclusion

Overall, the ethics education was considered inadequate. Only one fifth had the confidence in dealing with ethical situations. Gender but not marital status, year of residency, religiosity, or source of ethics knowledge had an impact on the level of confidence in handling ethical situations.

Background

The Gulf Cooperation Council (GCC), with a predominant ‘youth bulge’ among its 54 million people, has witnessed an exponential increase in research pertinent to child and adolescent mental health (CAMH). Aside from a few narrative reviews, to date, no critical appraisal examining the magnitude of CAMH has emerged from this region.

Aims

This study aimed to report the prevalence rates of CAMH disorders in the GCC through a systematic review of the existing literature followed by a meta-analysis.

Methods

A systematic review of the literature from the six GCC countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) was conducted. The databases used included Scopus, ProQuest, Pubmed, and a final check was performed on Google Scholar to account for any remaining studies that may have still been under review. Meta analytic techniques were then used to estimate prevalence rates of each specific mental disorder, i.e. ADHD, depression, anxiety, stress, eating disorders, and tobacco use disorder.

Results

A total of 33 studies from the six countries were included. The pooled prevalence of ADHD as per the Vanderbilt ADHD Diagnostic Rating Scale (VADHDDRS), clinical judgments, Attention Deficit Disorders Evaluation Scale (ADDES), and the Strengths and Difficulties Questionnaire (SDQ) was found to be 13.125%, 13.38%, 26.135%, and 12.83%, respectively. The pooled prevalence of depressive symptoms solicited by the Patient Health Questionnaire (PHQ-9), Depression, Anxiety, and Stress Scale (DASS), and Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) was 44.684%, 45.09%, and 26.12%, respectively. The pooled prevalence of anxiety according to the DASS and the MINI Kid was 57.04% and 17.27%, respectively, while the pooled prevalence of stress as per the DASS was found to be 43.15%. The pooled prevalence of disordered eating solicited by the Eating Attitudes Test (EAT-26) was 31.55%. Lastly, the pooled prevalence of tobacco use disorder per the Global Youth Tobacco Survey was 19.39%.

Discussion

To date, this is the first systematic review and meta-analysis of its kind from the GCC. The prevalence rate of CAMH disorders appears to be in the upper range of international trends. The higher rates could be attributed to the existing studies using suboptimal methodological approaches and instruments to solicit the presence of CAMH.