Clinical Medicine Insights-Pediatrics最新文献

Background: Previous studies conducted in Ethiopia revealed anemia as a severe public health problem among under-5 children but failed to associate with parasite infection. This study was aimed at assessing the prevalence of intestinal parasite infection (IP) and its association with anemia among children aged 6 to 59 months in Yirgalem General Hospital, Southern Ethiopia.

Method: Institution based cross-sectional study was conducted in 2020 on 367 children aged 6 to 59 months. Trained data collectors administered the questionnaire. Blood was collected and analyzed for hemoglobin using the HemoCue 301. The stool samples were collected and analyzed. Association between IP and anemia was measured using multivariable analysis. The outputs are presented using an adjusted odds ratio (AOR) with 95% confidence intervals.

Results: The prevalence of anemia was 48.8% (95% CI: 43.7, 53.9). Anemia was of mild, moderate, and severe type in 24.5%, 21.5%, and 2.8% of the children respectively. The prevalence of IP was 43.3% (95% CI: 38.2, 48.3). The odds of anemia were higher among children infected with IP (AOR = 3.19, 95% CI: 1.97, 5.17), large family size (AOR = 2.13, 95% CI: 1.26, 3.59), low-income level (AOR = 2.05, 95% CI: 1.25, 3.35), and MUAC < 11 cm (AOR = 3.27, 95% CI: 1.85, 5.81).

Conclusions: The prevalence of IP was high. Anemia has severe public health significance. IP infection, income level, family size, and MUAC level were associated with anemia in children. Strengthening existing programs to prevent childhood anemia, and IP recommended.

Objective: Masses of the sternoclavicular area are rare, and are not well described in the literature. We aim to present a series of patients with masses in this location and to review all reported English language cases of sternoclavicular masses in pediatric patients.

Methods: This is a case series of pediatric patients with masses of the sternoclavicular area presenting to a tertiary care pediatric hospital from 2010 through 2017. Data was collected by using ICD-9 and ICD-10 codes to query the electronic medical record. Chart review included age at presentation, mass characteristics, medical and surgical interventions, and pathology results. A review of the literature was then performed.

Results: Ten patients with masses overlying the sternoclavicular area were identified. Four patients presented with abscess and were treated with incision and drainage. Three of these patients were then treated with staged excision once infection cleared. Two additional patients were treated with primary excision. Four patients were treated with observation. The most common histopathologic finding was epidermoid. One patient was found to have a dermoid cyst, and 1 had a congenital cartilaginous rest.

Conclusion: Epidermoids and dermoids are the most common masses overlying the sternoclavicular area. Controversy remains regarding the embryologic origin of sternoclavicular masses. The differential for masses in this area also includes branchial remnants, bronchogenic cysts, ganglion cysts, or septic arthritis.

Background: Splenic cysts are one of the relatively rare conditions in pediatric surgery practice. Primary non-parasitic splenic cysts are even more scarce.

Case presentation: A 13-years-old female patient presented with chronic left hypochondrial pain of 2 months duration. Abdominal ultrasonography and computed tomography revealed huge 18 cm × 14 cm × 10 cm splenic cyst. Deroofing of the cyst was done which was complicated by secondary infection. Subsequently, the patient was re-operated on and partial splenectomy done with good outcome at 6 months follow up.

Conclusion: Partial splenectomy is the best management strategy for huge non-parasitic splenic cysts in children. There is also less recurrence rate of splenic cysts with preservation of splenic functions.

Background: Breastfeeding education is critical in improving healthcare professionals' competencies in providing breastfeeding care to mothers. We evaluated breastfeeding competencies, training, barriers and satisfaction of breastfeeding educational experiences among nurses and midwives in the Sagnarigu Municipality, Ghana.

Methods: This cross-sectional study included nurses and midwives providing maternal and child health services at various primary healthcare facilities in Sagnarigu Municipality.

Results: Nurses and midwives had higher pre-service breastfeeding training than in-service training with a mean training score of 10.0 and 5.2, respectively. Nurses and midwives who had both pre-service and in-service training had better satisfaction score (P = .003), positive attitudes (P = .016) and higher confidence level about breastfeeding (P = .007). Approximately, 80% of the nurses and midwives reported that they need further training/updating on breastfeeding while 40% reported clinical/professional practice as the significant contributor to their breastfeeding counselling competencies. Mean satisfaction score correlated positively with confidence levels about breastfeeding counselling (r = .224, P = .022) and pre-service training (r = .342, P < .001); confidence levels about breastfeeding counselling also correlated positively with attitudes towards breastfeeding counselling (r = .348, P < .001). Commonly reported barriers to breastfeeding counselling were mother's poor compliance with breastfeeding recommendations, too much workload, inadequate time and materials for breastfeeding counselling.

Conclusion: Nurses and midwives in this study felt confident about breastfeeding counselling, had positive attitudes towards breastfeeding counselling and generally, satisfied with their breastfeeding educational experiences. Despite nurses and midwives agreeing that breastfeeding counselling is integral in their professional practice, their role in providing breastfeeding counselling is hindered by individual and health systems barriers.

Background: There is paucity of data on objectively measured lung function abnormalities in Nigerian children using diagnostic testing methods such as spirometry. Such assessments could prompt early diagnosis and therapeutic interventions.

Methods: This was a cross sectional study among children aged 6 to 12 years in South-Eastern Nigeria. We selected participants from one school using a multistage stratified random sampling technique. A structured respiratory questionnaire was administered to obtain necessary data. The lung functions of the children were measured by spirometry. We used Lower Limits of Normal (LLN) based on GLI reference equations for African-American and mixed ethnicities to define abnormal spirometry. We studied the association between the exposures and lung function using logistic regression/chi-squared tests.

Results: A total of 145 children performed acceptable and repeatable tests. There were 73 males (50.3%), mean age of 9.13 years (+1.5) and age range 6 to 12 years. Frequency of respiratory symptoms was cough- 64 (44.1%) and wheeze in 19 (13.1%). Using GLI for African-Americans, fifty-five (37.9%) children had abnormal spirometryobstructive pattern in 40 (27.6%) and restrictive pattern in 15 (10.3%). The two references showed significant differences in interpretation of abnormality (χ² = 72.86; P < .001). Respiratory symptom-wheeze was an independent determinant of abnormal lung function in this population.(OR = 0.31; 95%CI: 0.10-0.94; P = .04).

Conclusion: There is a high burden of respiratory symptoms and abnormal spirometry among these children. The need for objective evaluation of lung function especially for children with respiratory symptoms is evident.

Background: Congenital anomalies of the kidney and urinary tract (CAKUT) are the leading cause of end stage renal disease in children. Diagnosis by genetic testing has proven challenging due to its genetic and phenotypic heterogeneity, as well as incomplete penetrance. We report a case on a 16-months old female with a history of renal cysts and a PAX2 mutation.

Case presentation: The patient presented with a prenatal diagnosis of Potter sequence and a postnatal diagnosis of renal cysts. An ultrasound at 20 weeks gestation revealed right renal agenesis and possible left renal dysplasia. Post natal genetic analyses identified a novel mutation in PAX2.

Conclusion: Cystic kidney disease is often underdiagnosed due to its variable expressivity and wide range of clinical manifestations; PAX2 genetic screening should be considered for all patients with CAKUT.

Background: Adverse drug events (ADEs) are a burden to the healthcare system. Preventable ADEs, which was ADEs due to medication errors, could be reduced if medication errors can be prevent or ameliorate.

Objective: We investigated the burden of preventable ADEs on the length of hospital stay (LOS) and costs, and estimated the national burden of preventable ADEs in pediatric inpatients in Japan.

Methods: We analyzed data from the Japan Adverse Drug Events (JADE) study on pediatric patients and estimated the incidence of preventable ADEs and associated extended LOS. Costs attributable to extended LOS by preventable ADEs were calculated using a national statistics database and we calculated the effect of preventable ADEs on national cost excess.

Results: We included 907 patients with 7377 patient-days. Among them, 31 patients (3.4%) experienced preventable ADEs during hospitalization. Preventable ADEs significantly increased the LOS by 14.1 days, adjusting for gender, age, ward, resident physician, surgery during hospitalization, cancer, and severe malformation at birth. The individual cost due to the extended LOS of 14.1 days was estimated as USD 8258. We calculated the annual extra expense for preventable ADEs in Japan as USD 329 676 760. Sensitivity analyses, considering the incidence of preventable ADEs and the length of hospital stay, showed that the expected range of annual extra expense for preventable ADEs in Japan is between USD 141 468 968 and 588 450 708.

Conclusion: Preventable ADEs caused longer hospitalization and considerable extra healthcare costs in pediatric inpatients. Our results would encourage further efforts to prevent and ameliorate preventable ADEs.

Moraxella lacunata, a low-virulence Gram-negative coccobacillus, is classically associated with conjunctivitis and upper respiratory tract infections; systemic infections such as sepsis have rarely been reported, especially in children. We describe a 28-month-old girl with atypical hemolytic uremic syndrome and stage II chronic kidney disease on long-term eculizumab therapy who presented with systemic inflammatory response syndrome and was found to have Moraxella lacunata bloodstream infection. Eculizumab, a humanized monoclonal anti-C5 antibody, has been associated with susceptibility to infections with encapsulated bacteria, especially Neisseria meningitidis. This is the first report of an invasive bacterial infection with Moraxella lacunata in a pediatric eculizumab recipient.

Voiding disorders result usually from functional disturbance. However, relevant organic diseases must be excluded prior to diagnosis of functional disorders. Additional tests, such as urinalysis or abdominal ultrasound are required. Further diagnostics is necessary in the presence of alarm symptoms, such as secondary nocturnal enuresis, weak or intermittent urine flow, systemic symptoms, glucosuria, proteinuria, leukocyturia, erythrocyturia, skin lesions in the lumbar region, altered sensations in the perineum. Functional micturition disorders were thoroughly described in 2006, and revised in 2015 by ICCS (International Children's Continence Society) and are divided into storage symptoms (increased and decreased voiding frequency, incontinence, urgency, nocturia), voiding symptoms hesitancy, straining, weak stream, intermittency, dysuria), and symptoms that cannot be assigned to any of the above groups (voiding postponement, holding maneuvers, feeling of incomplete emptying, urinary retention, post micturition dribble, spraying of the urinary stream). Functional voiding disorders are frequently associated with constipation. Bladder and bowel dysfunction (BBD) is diagnosed when lower urinary tract symptoms are accompanied by problems with defecation. Monosymptomatic enuresis is the most common voiding disorder encountered by pediatricians. It is diagnosed in children older than 5 years without any other lower urinary tract symptoms. Other types of voiding disorders such as: non-monosymptomatic enuresis, overactive and underactive bladder, voiding postponement, bladder outlet obstruction, stress or giggle incontinence, urethrovaginal reflux usually require specialized diagnostics and therapy. Treatment of all types of functional voiding disorders is based on non-pharmacological recommendations (urotherapy), and such education should be implemented by primary care pediatricians.

The novel Coronavirus disease 2019 continues to be a worldwide pandemic. Yet, little is still known about the biological features of this emergent infection in children. In this prospective study, we collected 68 children infected with SARS-COV-2 from March 2020 to May 2020, in Marrakesh, Morocco. No severe cases were observed in this cohort, and 66% of the patients were asymptomatic. The main laboratory abnormalities were hematological, as we found Leucopoenia in 4.4% of the cases, hyperleukocytosis in 1.6%. Neutropenia was found in 5 patients (7%) and only 2 cases (3%) had Lymphopenia. The inflammation and coagulation biomarkers were normal in the majority of the cases, as for liver and kidney function. Lactate dehydrogenase (LDH) serum levels were elevated in 8 cases (11.67%). The COVID-19 in children seems to have mild course and better outcome than in adults, which impacts the laboratory findings in this category. More studies must be conducted to learn more about the laboratory abnormalities in pediatric COVID-19.