Abdominal pseudohernia in a child after surgical correction of congenital scoliosis: case report.

Abdominal wall relaxation is a rare complication of various surgical procedures or diseases, when the intercostal or upper lumbar nerves are affected, and the innervation of the muscles of the abdominal wall is damaged. The result is a mass that can visually mimic a ventral hernia. We present a clinical case and the results of a literature review on this topic. Clinical case: The 2 years 5 months patient diagnosed with a congenital deformity of the spine (posterolateral hemivertebra) underwent extraction of the hemivertebra from the retroperitoneal approach. In the postoperative period, a pseudohernial protrusion of the anterior abdominal wall was observed. 4.5 months later the protrusion resolved spontaneously. Discussion: Abdominal wall relaxation is studied worldwide and is presented primarily as clinical case reports, mainly in older patients with neurological diseases. Single cases of this pathology are described among children. The Th10-Th12 roots are most often affected. Possible manifestations include: bloating and abdominal pain, pseudo-obstruction of the small and/or large intestine, and constipation. In the described case, only unilateral bloating at rest was observed, which increased with crying and strain. The natural course and prognosis of this diagnosis are usually favorable-the recovery period, according to the literature, takes an average of 4-5 months, which also coincided with our case. Conclusion: Pseudohernias are a rare complication and may can occur during correction of spinal deformities in children. This condition is a transient disorder of the anterior abdominal wall muscles, the cause of which may be neuropathy caused by infection, metabolic disorders, or mechanical damage. The main principles of treatment of this condition include active observation and symptomatic therapy. The prognosis is usually favorable.

Regional anesthesia for pain control in children with solid tumors-a review of case reports.

Introduction: Around seventy percent of all childhood cancer patients suffer from severe pain. This pain can arise from various sources, including tumors themselves, pain caused by metastasizing tumor cells or as the outcome of therapy meant to deal with tumors. If managed inadequately, such pain can lead to many hazardous sequelae. However, there are extreme cases when pain does not respond to standard treatment. For such cases, regional anesthesia or nerve blocks are utilized as the utmost pain control measure. Blocks are used to treat pain in patients who no longer respond to conventional opioid-based treatment or whose worsened condition makes it impossible to receive any other therapy. The data regarding the use of regional anesthesia for such cases in the children population is limited. Methods: For this review we searched for case reports in Scopus and PubMed from inception to 2023. The descriptive search items included terms related to childhood cancer and the description of each block. The inclusion criteria for review include children (0-18 years old) receiving oncology-related surgical procedures or palliative care. The data collection was limited to solid tumor-related cases only. We analyzed a total of 38 studies that included case reports and one retrospective study. Results and discussion: It was concluded that nerve blocks, although rarely performed, are a safe and efficient way of pain control in children with solid tumors. The major settings for block performance are postoperative pain control and palliative care. We observed that block indication and its outcomes depend on unique health circumstances in which they should be performed. Patients with similar diagnoses had differing outcomes while receiving the same block treatment.

The results of surgical treatment of preschool and primary school age children with congenital deformation of the spine in isolated hemivertebra: Comparative analysis.

Introduction: Despite a detailed study of the natural development of congenital spinal deformity in an isolated hemivertebra and the methods of surgical correction of this pathology, some issues remain unresolved. The age at which the surgical correction of congenital spinal deformity should be performed is a controversial issue among specialists dealing with this problem. The aim of the work was to conduct a comparative analysis of the results of spinal deformity correction in children with congenital kyphoscoliosis with an isolated hemivertebra of preschool and primary school age. Materials and methods: The study involved 26 patients aged from 1 year 9 months to 9 years 6 months (10 girls and 16 boys) with congenital kyphoscoliosis caused by an isolated hemivertebra. The patients underwent surgical interventions of partial or complete resection of the hemivertebra with adjacent intervertebral discs from the dorsal or combined approach, correction, and stabilization of congenital deformity of the spine with a posterior multi-support metal structure. All the patients were divided into two groups by age: the first group-children under 4 years old (14 children), and the second group-children of 6 years and older (12 children). Results: Metal fixation during surgical treatment in children of primary school and preschool ages was carried out in the majority of cases in a polysegmental manner. Regarding the approach for surgical treatment, it can be noted that in the 2nd group of patients, preference was more often given to the dorsal surgical approach. The duration of the surgical intervention and the amount of blood loss between different age groups did not have statistically significant differences. In the group of children of preschool age, in three cases, the destabilization of the metal structure was noted in the early postoperative period when control radiographs were performed after surgical treatment. In the group of older children, after surgical treatment, the spinal dysplastic deformity above or below the zone of metal fixation was detected in three cases. Conclusion: The effectiveness of surgical treatment of congenital deformity was significantly higher in children of the younger age group compared to school-age patients.

Mycoplasma pneumoniae Infections and Primary Immune Deficiencies.

Mycoplasma pneumoniae (M. pneumoniae) is one of the leading causes of community-acquired pneumonia in children and is also implicated in a variety of reactive extrapulmonary diseases. Recurrent and/or severe respiratory infections are one of the most frequent manifestations of several types of primary immunodeficiency. Here, we reviewed the medical literature to assess the potential relevance of M. pneumoniae in the infections observed in children affected with combined, humoral, and innate primary immune deficiencies. M. pneumoniae does not result to be epidemiologically prevalent as a cause of pneumonia in children affected by primary immunodeficiencies, but this infection can have a persistent or severe course in this category of patients. Indeed, the active search of M. pneumoniae could be useful and appropriate especially in children with humoral immune deficiencies. Indeed, most cases of M. pneumoniae infection in primary immunodeficiencies are described in patients affected by a/hypo-gammaglobulinemia.

New Therapeutic Approach to Reduce Methotrexate Toxicity after High-Dose Chemotherapy in a Child with Acute Lymphocytic Leukemia: Efficacy and Safety of Hemoadsorption with HA-230 Adsorber.

BACKGROUND: High-dose methotrexate (HDMTX) is likely to cause a number of side effects and manifest itself as hepatotoxicity, nephrotoxicity, mucositis, and neurotoxicity. A several studies demonstrated the efficacy of extracorporeal detoxification methods such as plasma exchange, hemodialysis (HD), HD filtration, and hemoperfusion for the treatment of MTX delayed clearance. However, none of the existing methods as effective as expected and limited for general implementation due to a procedure-related complication. CASE REPORT: Here, we report a successful implementation of HA-230 hemoadsorption procedure to remove cumulated MTX from the body and reduce its toxicity in a child with ALL after high-dose chemotherapy. RESULTS AND CONCLUSION: Based on our results, single-hemoadsorption procedure with the HA-230 adsorber in case of delayed methotrexate clearance was safe and well-tolerated in a pediatric patient with ALL and would significantly improve the patient's condition. Further studies need to demonstrate its safety and efficacy in a large number of pediatric patients.

Case Series: Efficacy and Safety of Hemoadsorption With HA-330 Adsorber in Septic Pediatric Patients With Cancer.

Background: Sepsis is a frequent cause of death in hospitalized patients and, in detail, in neonatal, pediatric, and adult intensive care units (ICUs). Severe sepsis has a very poor prognosis. Indeed, the mortality rate varies between 30 and 70% during the first 7-14 days. Despite a timely and appropriate therapy, the prognosis of severe sepsis is too often negative. Therefore, new therapeutic resources are under investigation in order to further improve prognosis. Case series: Here, we reported three septic children in whom we used extracorporeal blood purification therapy with hemoadsorption device HA330 (Jafron Biomedical Co., Ltd., China), aiming to scavenge and eliminate bacterial toxins and inflammatory mediators from the blood. Discussion and Conclusion: This small case series first showed that hemoperfusion with HA330 cartridge may be an effective and relatively safe adjunctive treatment to counterbalance the cytokine storm in septic children with hematological disorders. Further studies are needed to confirm and further support its safety and efficacy in a large number of pediatric patients.

Macrophage Activation Syndrome in Pediatric Systemic Lupus Erythematosus: A Systematic Review of the Diagnostic Aspects.

Macrophage Activation Syndrome (MAS) is a very severe complication of different rheumatic diseases, including pediatric Systemic Lupus Erythematosus (pSLE). MAS is not considered as a frequent complication of pSLE; however, its occurrence could be under-estimated and the diagnosis can be challenging. In order to address this issue, we performed a systematic review of the available medical literature, aiming to retrieve all those papers providing diagnostic (clinical/laboratory) data on patients with pSLE-related MAS, in individual or aggregated form. The selected case reports and series provided a pool of 46 patients, accounting for 48 episodes of MAS in total. We re-analyzed these patients in light of the diagnostic criteria for MAS validated in systemic Juvenile Idiopathic Arthritis (sJIA) patients and the preliminary diagnostic criteria for MAS in pSLE, respectively. Five clinical studies were also selected and used to support this analysis. This systematic review confirms that MAS diagnosis in pSLE patients is characterized by several diagnostic challenges, which could lead to delayed diagnosis and/or under-estimation of this complication. Specific criteria should be considered to diagnose MAS in different rheumatic diseases; as regards pSLE, the aforementioned preliminary criteria for MAS in pSLE seem to perform better than the sJIA-related MAS criteria, because of a lower ferritin cut-off.

Vaccine adherence: the rate of hesitancy toward childhood immunization in Kazakhstan.

OBJECTIVES: Vaccines are considered one of the most important inventions of human history that enabled the containment of several infectious diseases. However, there is a global decrease in the rate of vaccination and an increase in outbreaks of vaccine-preventable diseases. The aims of the current study are to determine childhood vaccine hesitancy and its influencing factors in Kazakhstan. METHODS: This cross sectional online-based study was conducted between Sep until Nov of 2019. RESULTS: A total of 387 participants of which 70% were females with the majority under the age of 40 years and having one child or more. More than a third (35%) of the participants identified themselves as vaccine hesitant, 71% believed that vaccines are effective, and 65% believed that vaccines are good. Vaccine source of information appears to be an influential factor as those who receive information from healthcare providers have no concerns about vaccination. CONCLUSION: This is the first study to identify factors associated with vaccine hesitancy in Kazakhstan. There is a high rate of vaccine hesitancy and low rate of vaccine knowledge identified in the participant group. Healthcare providers have a unique position in improving parents' vaccine knowledge and acceptance.

First successful hemoadsorption using CytoSorb® in a septic pediatric patient in Kazakhstan: A case report.

PURPOSE: For the first time in Kazakhstan, we have used a combined extracorporeal support, by including the CytoSorb system in a continuous veno-venous hemofiltration system in an 8-month-old patient with a body weight of 5600 g. RESULTS: The CytoSorb therapy session resulted in a reduction of inflammation markers IL-6, S100, procalcitonin, and C-reactive protein. Simultaneously, the level of transaminases, creatine kinase, and troponin were normalized, by the end of the session patient hemodynamics were stable and there was no need for vasopressors, acid-base balance was maintained, and the patient was weaned from mechanical ventilation to spontaneous breathing. CONCLUSION: Treatment using the CytoSorb device was safe and well-tolerated in a pediatric patient and has proven its practical value as an adjuvant therapy for sepsis in pediatric patient populations.

Acute acalculous cholecystitis in children.

Acute acalculous cholecystitis (AAC) is the inflammatory disease of the gallbladder in the absence of gallstones. AAC is estimated to represent at least 50% to 70% of all cases of acute cholecystitis during childhood. Although this pathology was originally described in critically ill or post-surgical patients, most pediatric cases have been observed during several infectious diseases. In addition to cases caused by bacterial and parasitic infections, most pediatric reports after 2000 described children developing AAC during viral illnesses (such as Epstein-Barr virus and hepatitis A virus infections). Moreover, some pediatric cases have been associated with several underlying chronic diseases and, in particular, with immune-mediated disorders. Here, we review the epidemiological aspects of pediatric AAC, and we discuss etiology, pathophysiology and clinical management, according to the cases reported in the medical literature.