Current Issue : October - December Volume : 2013 Issue Number : 4 Articles : 6 Articles
Background: Hypoxia associated with bronchiolitis is not always easy to assess on clinical grounds alone. The aim\r\nof this study was to determine the value of food intake during the previous 24 hours (bottle and spoon feeding), as\r\na percentage of usual intake (24h FI), as a marker of hypoxia, and to compare its diagnostic value with that of usual\r\nclinical signs.\r\nMethods: In this observational, prospective, multicenter study, 18 community pediatricians, enrolled 171 infants,\r\naged from 0 to 6 months, with bronchiolitis (rhinorrhea + dyspnea + cough + expiratory sounds). Infants with risk\r\nfactors (history of prematurity, chronic heart or lung disorders), breast-fed infants, and infants having previously\r\nbeen treated for bronchial disorders were excluded.\r\nThe 24h FI, subcostal, intercostal, supracostal retractions, nasal flaring, respiratory rate, pauses, cyanosis, rectal\r\ntemperature and respiratory syncytial virus test results were noted. The highest stable value of transcutaneous\r\noxygen saturation (SpO2) was recorded. Hypoxia was noted if SpO2 was below 95% and verified.\r\nResults: 24h FI = 50% was associated with a 96% likelihood of SpO2 = 95% [95% CI, 91ââ?¬â??99]. In univariate analysis,\r\n24h FI < 50% had the highest odds ratio (13.8) for SpO2 < 95%, compared to other 24h FI values and other clinical\r\nsigns, as well as providing one of the best compromises between specificity (90%) and sensitivity (60%) for\r\nidentifying infants with hypoxia. In multivariate analysis with adjustment for age, SpO2 < 95% was related to the\r\npresence of intercostal retractions (OR = 9.1 [95% CI, 2.4-33.8%]) and 24h FI < 50% (OR = 10.9 [95% CI, 3.0-39.1%]).\r\nHospitalization (17 infants) was strongly related to younger age, 24h FI and intercostal retractions.\r\nConclusion: In practice, the measure of 24 h FI may be useful in identifying hypoxia and deserves further study....
Background: Juvenile idiopathic arthritis (JIA) is the most common arthropathy of childhood. Different diseases\r\naffect school attendance to varying degrees. The aim of this study was to assess the impact of juvenile idiopathic\r\narthritis (JIA) on Moroccan children�s schooling.\r\nMethods: Thirty-three children with JIA were included in this study, having been previously diagnosed according\r\nto the classification criteria of the International League of Associations for Rheumatology (ILAR). Seventy-four\r\nhealthy children were recruited to serve as controls. Data was obtained for all children on their school level,\r\neducational performance, and attendance. The rate of absenteeism due to health complications was noted.\r\nResults: All healthy children were able to attend school (p<0.0001), while 33% of children with JIA were unable to\r\nattend school due to their condition. The students with JIA who were able to attend school were absent much\r\nmore often than controls (63% compared to 20%), with a highly significant p value (p<0.0001). Slightly less than\r\nhalf of the JIA patients (48.5%) failed in their schooling. In univariate analysis, there was an association between\r\nabsenteeism and tender joints (p=0.02), disease activity score (DAS28) (p=0.007), Childhood Health Assessment\r\nQuestionnaire (CHAQ) (p=0.01), and erythrocyte sedimentation rate (ESR) (p=0.03). In multivariate analysis, the only\r\nassociation persisted between DAS28 and absenteeism.\r\nConclusions: Our study suggested that the schooling of children with JIA was negatively impacted due to the\r\ndisorder. More studies, with a larger sample of children, are needed to confirm our findings....
Background: Obesity is the most common chronic pediatric disease in westernized, especially low socioeconomic\r\nsocieties. We previously demonstrated the beneficial effects of a randomized prospective school-based health\r\neducation program for low socioeconomic status Arab-Israeli kindergarten children.\r\nMethods: To examine whether the effects of our program on nutrition and physical activity knowledge and\r\npreferences, anthropometric measures, and fitness persisted one year after the end of intervention.\r\nWe were able to perform the one year follow-up in 203 kindergarten children (59% of our 342 original cohort;\r\n85 control, 118 intervention).\r\nResults: At one year following the intervention BMI and BMI percentiles approached baseline level in both the\r\nintervention (16.4�±0.2 kg/m2 and 61.5�±2.4%, respectively) and control group participants (16.5�±0.2 kg/m2 and\r\n58.5�±3.3%, respectively). Yet, a year after the end of the intervention, the decrease in BMI%ile from baseline was\r\nsignificantly greater in the intervention group (-7.8�±1.5 vs. -1.9�±1.9, p<0.012). Nutritional and physical activity\r\nknowledge and preferences, and physical fitness remained significantly elevated in the intervention compared to\r\nthe control group participants.\r\nConclusions: The beneficial effects of a kindergarten dietary-physical activity intervention applied by the\r\nkindergarten teachers, on nutrition and physical activity knowledge and preferences, fitness, and BMI percentile\r\nwere evident one year after the end of intervention. This promising program may play a role in health\r\npromotion, prevention and treatment of childhood obesity....
Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in children. NAFLD has emerged to\r\nbe extremely prevalent, and predicted by obesity and male gender. It is defined by hepatic fat infiltration >5%\r\nhepatocytes, in the absence of other causes of liver pathology. It includes a spectrum of disease ranging from\r\nintrahepatic fat accumulation (steatosis) to various degrees of necrotic inflammation and fibrosis\r\n(non-alcoholic steatohepatatis [NASH]). NAFLD is associated, in children as in adults, with severe metabolic\r\nimpairments, determining an increased risk of developing the metabolic syndrome. It can evolve to cirrhosis and\r\nhepatocellular carcinoma, with the consequent need for liver transplantation. Both genetic and environmental factors\r\nseem to be involved in the development and progression of the disease, but its physiopathology is not yet entirely\r\nclear. In view of this mounting epidemic phenomenon involving the youth, the study of NAFLD should be a priority for\r\nall health care systems. This review provides an overview of current and new clinical-histological concepts of pediatric\r\nNAFLD, going through possible implications into patho-physiolocical and therapeutic perspectives....
Background: Non-Hodgkinââ?¬â?¢s Lymphomas (NHL) are common in African children, with endemic Burkittââ?¬â?¢s lymphoma\r\n(BL) being the most common subtype. While the role of Epstein-Barr Virus (EBV) in endemic BL is known, no data\r\nare available about clinical presentations of NHL subtypes and their relationship to Human Immunodeficiency Virus\r\n(HIV) infection and Epstein Barr Virus (EBV) load in peripheral blood of children in north-western, Tanzania.\r\nMethods: A matched case control study of NHL subtypes was performed in children under 15 years of age and\r\ntheir respective controls admitted to Bugando Medical Centre, Sengerema and Shirati district designated hospitals\r\nin north-western, Tanzania, between September 2010 and April 2011. Peripheral blood samples were collected on\r\nWhatman 903 filter papers and EBV DNA levels were estimated by multiplex real-time PCR. Clinical and laboratory\r\ndata were collected using a structured data collection tool and analysed using chi-square, Fisher and Wilcoxon rank\r\nsum tests where appropriate. The association between NHL and detection of EBV in peripheral blood was assessed\r\nusing conditional logistic regression model and presented as odds ratios (OR) and 95% confidence intervals (CI).\r\nResults: A total of 35 NHL cases and 70 controls matched for age and sex were enrolled. Of NHLs, 32 had BL with\r\nequal distribution between jaw and abdominal tumour, 2 had large B cell lymphoma (DLBCL) and 1 had NHL-not\r\notherwise specified (NHL-NOS). Central nervous system (CNS) presentation occurred only in 1 BL patient; 19 NHLs\r\nhad stage I and II of disease. Only 1 NHL was found to be HIV-seropositive. Twenty-one of 35 (60%) NHL and 21 of\r\n70 (30%) controls had detectable EBV in peripheral blood (OR = 4.77, 95% CI 1.71 ââ?¬â?? 13.33, p = 0.003). In addition,\r\nlevels of EBV in blood were significantly higher in NHL cases than in controls (p = 0.024).\r\nConclusions: BL is the most common childhood NHL subtype in north-western Tanzania. NHLs are not associated\r\nwith HIV infection, but are strongly associated with EBV load in peripheral blood. The findings suggest that high\r\nlevels of EBV in blood might have diagnostic and prognostic relevance in African children....
Background: Treatment and prophylaxis of sepsis in very low birth weight neonates is a matter of concern and\r\nresearch is being undertaken with the aim to give rise to shared approaches based on solid evidence. As part of a\r\nEuropean initiative, a survey was set up to describe the use of two drugs in this area. The Italian national practices\r\nconcerning neonatal sepsis, as well as calls for related guidance, are described.\r\nMethods: A standardized and previously tested questionnaire was submitted online to all Italian level III NICUs.\r\nA 5-point Likert scale was used to analyze attitudinal replies. Categorical variables were compared by ?2 analysis\r\nand 2-tailed P-values are reported.\r\nResults: Data was provided by 38 Italian NICUs (36% of the countryââ?¬â?¢s level III centers), 53% of which have 1ââ?¬â??10\r\ncases of bacterial sepsis monthly and 90% a prevalence of <1% fungal infections. Ciprofloxacin and fluconazole\r\ntreatment for neonatal sepsis are scantly used in Italian NICUs (13% and 45%, respectively). Major concerns are\r\nrelated to the safety of ciprofloxacin and the efficacy of fluconazole. On the contrary, prophylaxis of fungal\r\ninfections is a routine approach in many Italian NICUs. The use of both ciprofloxacin and fluconazole is\r\ncharacterized by a large inter-NICU variability in dose and scheme of use. The lack of adequate, shared evidence is\r\na common consideration made by the survey participants.\r\nConclusions: Common approaches are needed to standardize and update a national drug strategy for the\r\nprevention and treatment of sepsis in very low birth weight newborns. This can be achieved through collaborative\r\ninitiatives aimed at setting up guidelines, based on available data, and multicenter trials to produce new evidence\r\nthat will address the knowledge gaps....
Loading....