Fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática / Intervening factors in the management of nursing care for children hospitalized with rheumatic heart disease / Factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática

Objetivo: analisar os fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática. Método: estudo descritivo-exploratório com abordagem qualitativa, que utilizou a Teoria Fundamentada em Dados e o Interacionismo Simbólico, respectivamente, como referencial metodológico e teórico. A coleta de dados foi realizada em uma instituição especializada em atendimento cardiológico, no munícipio do Rio de Janeiro. Foram entrevistados 19 profissionais de enfermagem através de um roteiro semiestruturado. Resultado: emergiram os seguintes fatores intervenientes na prática da gerência do cuidado: condição socioeconômica da família, comportamento da criança, condições de trabalho, comunicação ineficaz, educação permanente, trabalho em equipe e experiência profissional. Conclusão: os resultados apontam para a necessidade de proposição de estratégias de ação e interação que facilitem a prática gerencial de cuidado à criança com cardiopatia reumática e sua família face aos fatores intervenientes identificados.

Objective: to analyze the factors involved in the management of nursing care for children hospitalized with rheumatic heart disease. Method: this is a descriptive-exploratory study with a qualitative approach, which used Data-Based Theory and Symbolic Interactionism, respectively, as methodological, and theoretical references. Data was collected in an institution specializing in cardiac care in the city of Rio de Janeiro. Nineteen nursing professionals were interviewed using a semi-structured script. Result: the following intervening factors in the practice of care management emerged: the family's socioeconomic status, the child's behavior, working conditions, ineffective communication, continuing education, teamwork, and professional experience. Conclusion: the results point to the need to propose strategies for action and interaction that facilitate management practice in caring for children with rheumatic heart disease and their families, given the intervening factors identified.

Objetivo: analizar los factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática. Método: estudio descriptivo-exploratorio con enfoque cualitativo, cuyos marcos metodológico y teórico fueron la Teoría Fundamentada y el Interaccionismo Simbólico, respectivamente. La recolección de datos se realizó en una institución especializada en atención cardiológica, en la ciudad de Río de Janeiro. Fueron entrevistados 19 profesionales de enfermería mediante un cuestionario semiestructurado. Resultado: surgieron los siguientes factores intervinientes en la práctica de la gestión del cuidado: condición socioeconómica de la familia, comportamiento del niño, condiciones de trabajo, comunicación ineficaz, educación continua, trabajo en equipo y experiencia profesional. Conclusión: los resultados indican que es necesario proponer estrategias de acción e interacción que faciliten la práctica de la gestión del cuidado al niño con cardiopatía reumática y a sus familiares, con respecto a los factores intervinientes identificados.

Perspectivas dos pais acerca da interação socialde crianças com cicatrizes de queimaduras / Parents' perspectives on the social interactionof children with burn scars

As queimaduras provocam efeitos físicos e psicológicos devastadores nos indivíduos, sobretudo em crianças e adolescentes, e podem modificar a qualidade de vida da pessoa. O objetivo foi analisar o impacto das cicatrizes por queimaduras em crianças menores de oito anos na interação com amigos, família e escola, na perspectiva dos pais. Estudo quantitativo de corte transversal realizado com os pais de crianças <8 anos de idade, vítimas de queimaduras e internadas em um Centro de Tratamento de Queimados no norte do Paraná e acompanhadas ambulatorialmente, de 2017 a 2020. A coleta de dados ocorreu por meio de dois instrumentos: caracterização sociodemográfica e clínica; e Brisbane Burn Scar Impact Profile. Realizou-se análise descritiva e teste Qui-quadrado utilizando-se o SPSS®. Participaram 34 pais cujas crianças sofreram queimaduras, sendo 52,9% de 1 a 3 anos de idade, 58,8% sexo masculino, 82,2% por agente etiológico térmico e a internação foi de 73,5% devido à Superfície Corpórea Queimada ≤20%. Após a alta os pais identificaram que as cicatrizes de queimaduras tinham "um pouco" e "pouco" impacto nas cicatrizes nas relações de amizade e na interação social. Para os pais, prevaleceu a resposta "nada" de impacto, seguido por "um pouco" e "muito" na escola, nas brincadeiras, nos jogos e nas atividades diárias. Quanto às reações emocionais e ao humor, a maior parte dos pais considerou "nada". Nesse sentido, os pais responderam às questões quanto à própria percepção sobre as atividades diárias do seu filho e, em geral, a cicatriz de queimadura não impactou na qualidade de vida da criança.

Burns cause devastating physical and psychological effects on individuals, especially children and adolescents, and can change a person's quality of life. The objective was to analyze the impact of burn scars in children under eight years of age in the interaction with friends, family and school, from the parents' perspective. Quantitative cross-sectional study carried out with the parents of children <8 years old who were victims of burns and admitted to a Burn Treatment Center in northern Paraná and monitored on an outpatient basis, from 2017 to 2020. Data collection occurred using two instruments: sociodemographic and clinical characterization; Brisbane Burn Scar Impact Profile. Descriptive analysis and Chi-square test were performed using SPSS®. 34 parents participated whose children suffered burns, 52.9% aged 1 to 3 years old, 58.8% male, 82.2% due to thermal etiological agent and 73.5% hospitalization was due to Burned Body Surface ≤ 20%. After discharge, the parents identified that the burn scars had "a little" and "little" impact on the scars in friendship relationships and social interaction. For parents, the answer "nothing" of impact prevailed, followed by "a little" and "a lot" in school, play, games and daily activities. As for emotional reactions and mood, most parents considered "nothing" that impacted the child with burn scars. In this sense, parents answered questions regarding their own perception of their child's daily activities and, in general, the burn scar did not impact the child's quality of life.

The Child Opportunity Index and Outcomes After Pediatric Anterior Cruciate Ligament Reconstruction.

Background: Research at the intersection between social determinants of health (SDOH) and orthopaedics remains an area of active exploration, with recent literature demonstrating significant disparities in a wide array of orthopaedic outcomes in patients with different SDOH. Purpose/Hypothesis: The purpose of this study was to use a validated composite measure of SDOH mapped to census tracts (Child Opportunity Index [COI]) to explore disparities in functional outcomes after anterior cruciate ligament (ACL) reconstruction. It was hypothesized that patients with a lower COI score would have delayed surgical care and worse functional outcomes after ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Demographic, surgical, and functional outcomes data were extracted for all patients aged ≤18 years who underwent primary ACL reconstruction at our institution between 2009 and 2019. Strength deficits were calculated, and COI quintile scores were obtained. One-way analysis of variance, the chi-square test, and the Fisher exact test were used to compare variables of interest between the lower 2 quintiles (low group) and the upper 2 quintiles (high group). Results: Of the 1027 patients, 226 (22.0%) were in the low group, while 801 (78.0%) were in the high group. There was a significantly greater time from injury to surgery in the low group than in the high group (98.15 ± 102.65 vs 71.79 ± 101.88 days, respectively; P < .001). The low group had a significantly lower extension-flexion range of motion at 1- and 3-month follow-up (P = .03 and P = .02, respectively) but no difference at 6-month follow-up (P = .27). The low group attended fewer physical therapy visits than the high group (24.82 ± 10.55 vs 37.81 ± 18.07, respectively; P < .001). The low group had significant deficits in quadriceps strength at 3, 6, and 9 months at 180 deg/s (P = .03, P < .001, and P = .01, respectively) and at 6 months at 300 deg/s (P = .002). Conclusion: In this study, we found that the COI was associated with disparities in key clinical outcomes including time to surgery, postoperative range of motion, and postoperative strength.

Aflatoxin M1 in Milk and Dairy Products: The State of the Evidence for Child Growth Impairment.

Aflatoxin M1 (AFM1) is a metabolite of the more toxic aflatoxin B1 (AFB1) a mycotoxin produced by the fungi Aspergillus flavus and A. parasiticus; which contaminates maize, peanuts, tree nuts, and oilseeds, among other crops in warm regions of the world. When mammals consume AFB1 in these foods, they secrete AFM1 in milk. A recent analysis indicated negligible cancer risk associated with AFM1 exposure, but whether AFM1 impairs children's growth is important to understand because children consume relatively more milk than adults worldwide. Our paper reviews the evidence on the link between AFM1 exposure and child growth impairment. We find that the existing studies are contradictory and necessitates further studies on this question; in particular, those that control for potentially confounding factors such as household socioeconomic status, children's overall diets, hygienic factors, and agroecological zone. Though many nations have policies for maximum AFM1 limits in dairy foods, they are not based on an explicit health risk analysis of AFM1 but on conversion rates of AFB1 levels to AFM1 in dairy products. Future studies on AFM1's potential harmful effects on child growth will help to better inform policies on maximum allowable AFM1 in milk and other dairy products.

Modifiable risk factors for developing otitis media with effusion in children under 12 years in high-income countries: a systematic review.

OBJECTIVE: To systematically assess the modifiable risk factors for developing otitis media with effusion (OME) in children under 12 years. METHODS: We searched Embase, MEDLINE, INAHTA database, CENTRAL, CDSR and Epistemonikos for cohort studies with ≥40 children per arm/prognostic factor, published in English from 2000 to November 2022. We assessed risk of bias using the Quality in Prognosis Studies checklist, and overall evidence quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Outcomes were analysed as risk ratio (RR), OR or Peto OR. RESULTS: Seven studies totalling 2 760 292 children were included. The evidence was very low quality. Fluid or pus discharge from ears (OR 2.1, 95% CI 1.01 to 4.35) and exposure to other children (RR 2.79, 95% CI 1.98 to 3.93) (OR 5.21, 95% CI 2.9 to 9.36) were strongly associated with development of OME. Coughs/colds ≥5 times (OR 1.91, 95% CI 1.22 to 2.99), breathing problems ≥5 times (RR 1.78, 95% CI 1.26 to 2.53) and ear infections (RR 1.95, 95% CI 1.39 to 2.72) in past year were associated with development of OME. Adenoid hypertrophy was strongly associated with development of fluctuating OME (recurrent OME) (OR 9.96, 95% CI 5.17 to 19.19). There was scare evidence for some potential modifiable risk factors, including breast feeding, household smoking, gastro-oesophageal reflux, dummy use and swimming. CONCLUSIONS: Upper respiratory tract infection, ear infection, adenoid hypertrophy and exposure to other children could be the predictors for development of OME. Further observational studies are needed to investigate other potential modifiable risk factors.

Childhood Maltreatment and Physical Health in College Students: Physical Activity and Binge Eating as Moderators.

Child maltreatment leads to pervasive physical health problems. For individuals with a child maltreatment history, physiological risk factors for future disease are apparent by young adulthood. The current study explored the role that physical activity and binge eating may have in the trajectory from child maltreatment to poor adult health. We administered the following measures to 100 female and male college students: resting heart rate assessment, symptoms of illness, and the Childhood Trauma Questionnaire (CTQ-SF) to assess maltreatment history. After this session, participants wore a Fitbit that provided physical activity data (low, moderate, and vigorous activity, and total steps) in a free-living environment for a period of 10 days. Physical activity moderated the pathway between maltreatment history and both resting heart rate and symptoms of illness. In individuals with higher CTQ scores, more low-intensity physical activity and total steps were related to fewer symptoms of illness and lower resting heart rate, respectively. Binge-eating behavior moderated the pathway between maltreatment and symptoms of illness, such that greater binge-eating behavior was associated with more self-reported illness symptoms in participants with higher CTQ scores. These findings suggest that on-campus interventions targeting physical activity and healthy eating behaviors will improve the long-term health of young adults with maltreatment history.

The effects of the SARS-CoV-2 pandemic on the delivery of maternal and child health services in South Africa.

OBJECTIVE: The COVID-19 pandemic severely interrupted the functioning of healthcare systems, negatively affecting the global provision of maternal and child health (MCH) services. This study aims to specify the effects of COVID-19 on these services in the Gauteng province (South Africa) and to put forward context-specific recommendations aimed at augmenting them and ensuring ongoing uninterrupted coverage, even and especially during pandemics. METHODS: In this quantitative study, a retrospective review of District Health Information System data routinely collected between February 2019 and March 2021 was conducted, comparing performance of the relevant indicators across the two-year span. The data were analyzed using Stata 16 statistical software (StataCorp). The two sample t-test with equal variance and the Mann-Whitney test were applied to evaluate the equality of the indicators. RESULTS: Routine MCH services were negatively impacted, with marked declines in all relevant indicators from the onset of the pandemic. There was a statistically significant decline in cervical cancer coverage and maternal postnatal visits within six days of delivery. While declines in the other critical indicators were likewise observed, they were not statistically significant. CONCLUSION: The South African response to the pandemic had negative repercussions on all MCH services in the Gauteng province. The lessons to be drawn from the pandemic experience should help to strengthen health system capacities, boost service provision, and mitigate future damage to the healthcare system.

Is Liver Transplantation Alone an Effective Treatment for Homozygotic Familial Hypercholesterolemia in Children?

AIM: To examine the long-term results and treatment effectiveness of liver transplantation (LT) in the treatment of homozygous familial hypercholesterolemia (HoFH) in children and adolescents. METHOD: Patients who underwent LT due to HoFH between 2007 and 2023 were included in the study. The patients' demographic data, clinical findings, preoperative and postoperative laboratory examinations, transplantation complications, and postoperative disease courses were evaluated. RESULTS: There were five boys with an average age of 6.2 (median: 6, range 4-10) years in the study. The average total cholesterol level of the patients before transplantation was 923 (median: 950, range: 780-1002) mg/dL and the average LDL-cholesterol level was 864 (median: 852, range: 770-957) mg/dL. No patients died of transplant-related complications. After an average follow-up of 9.2 (median: 9, range: 1.5-16) years, the average total cholesterol level of the patients was 197 (median: 164, range: 137-359) mg/dL, and the average LDL-cholesterol level was 138 (median: 92, range: 85-313) mg/dL. Four (80%) patients developed atherosclerotic cardiovascular disease during follow-up, and two (40%) died of this cause. CONCLUSION: LT in the treatment of HoFH did not help our patients reach the target LDL-cholesterol level after transplantation and did not prevent the development of cardiovascular disease. Therefore, LT alone is not curative in the treatment of HoFH.

Examining the Acceptability of Helminth Education Packages "Magic Glasses Lower Mekong" and "Magic Glasses Opisthorchiasis" and Their Impact on Knowledge, Attitudes, and Practices Among Schoolchildren in the Lower Mekong Basin: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: Helminths are a major global health issue, impacting health, educational, and socioeconomic outcomes. Infections, often starting in childhood, are linked to anemia, malnutrition, cognitive deficit, and in chronic cases of Opisthorchis viverrini (OV), cholangiocarcinoma. The main control strategy for helminth infection is mass drug administration; however, this does not prevent reinfection. As such, prevention strategies are needed. The "Magic Glasses" is a school-based cartoon health education package that has demonstrated success in improving knowledge, attitudes, and practices (KAP) surrounding soil-transmitted helminths (STH) in China and the Philippines. This study is designed to assess the acceptability and impact of the 2 new versions of the Magic Glasses targeting STH and OV designed for the Lower Mekong audience in Cambodia, Lao People's Democratic Republic (PDR), and Thailand. OBJECTIVE: The objective of this study is to evaluate the acceptability of the "Magic Glasses Lower Mekong" and "Magic Glasses Opisthorchiasis" education packages among schoolchildren in the Lower Mekong Basin, and the impact of these education packages on students' KAP surrounding STH and OV, respectively. METHODS: Schoolchildren will be recruited into a cluster randomized controlled trial with intervention and control arms in rural schools in Cambodia, Lao PDR, and Thailand. Schoolchildren's initial acceptability of the intervention will be evaluated using an adapted questionnaire. Sustained acceptability will be assessed at 9-month follow-up through focus group discussions with students and interviews with teachers. Impact will be evaluated by KAP questionnaires on STH and OV. KAP questionnaires will be administered to children at baseline and at follow-up. Indirect impact on parents' KAP of OV and STH will be assessed through focus group discussions at follow-up. RESULTS: The trial is in progress in Lao PDR and Thailand and is expected to commence in Cambodia in January 2024. The results of the study are expected to be available 18 months from the start of recruitment. We hypothesize that participants enrolled in the intervention arm of the study will have higher KAP scores for STH and OV, compared with the participants in the control arm at follow-up. We expect that students will have initial and sustained acceptability of these intervention packages. CONCLUSIONS: This trial will examine the acceptability of the "Magic Glasses Opisthorchiasis" and "Magic Glasses Lower Mekong" interventions and provide evidence on the effectiveness of the "Magic Glasses" on KAP related to OV and STH among schoolchildren in the Lower Mekong Basin. Study results will provide insight on acceptability and impact indicators and inform a scaling up protocol for the "Magic Glasses" education packages in Cambodia, Lao PDR, and Thailand. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12623000271606; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385315&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55290.

Posttraumatic stress symptoms in parents of children with newly diagnosed cancer: 1-year trajectories and relationship variables as predictors.

OBJECTIVE: The way in which parental posttraumatic stress symptoms (PTSS) unfold in the first year after a cancer diagnosis in their child is poorly understood. The aims of this study were to identify parental PTSS trajectories and to examine couple-related predictors (dyadic coping and we-disease appraisals), sociodemographic predictors (education and sex), and medical predictors (child's physical impairment) of trajectory membership. METHOD: A 1-year prospective study was conducted, and 157 parents of children newly diagnosed with cancer were assessed. PTSS was measured with the Posttraumatic Diagnostic Scale for DSM-5 (PDS-5) at 3-6 weeks (T1), 6 months (T2), and 12 months (T3) after the diagnosis. The trajectories were identified with Latent Class Growth Analysis, the predictors were explored with binomial logistic regression. RESULTS: Two distinct trajectories were found. The majority of parents (86.0%) followed a low PTSS trajectory, characterized by initially low scores that slightly decreased over 12 months. In contrast, 14.0% of parents displayed a stable, high PTSS trajectory. A high trajectory of child's physical impairment and low scores in parental dyadic coping were significantly associated with the likelihood of a high parental PTSS trajectory. CONCLUSIONS: The findings provide new insights into the critical period of the first year after a child's cancer diagnosis. While most parents display a resilient, low PTSS trajectory, a minority consistently experience high PTSS levels. Child's physical impairment and dyadic coping should be considered as predictors for early identification of vulnerable parents. Incorporating dyadic coping in parental support following a childhood cancer diagnosis could be beneficial for parental mental health.

Histopathology underlying environmental enteric dysfunction in a cohort study of undernourished children in Bangladesh, Pakistan, and Zambia compared with United States children.

BACKGROUND: Environmental enteric dysfunction (EED) is an asymptomatic intestinal disorder associated with growth impairment, delayed neurocognitive development, and impaired oral vaccine responses. OBJECTIVES: We set out to develop and validate a histopathologic scoring system on duodenal biopsies from a cohort study of children with growth failure in Bangladesh, Pakistan, and Zambia ("EED") with reference to biopsies from United States children with no clinically reported histologic pathology (referred to hereafter as "normal") or celiac disease. METHODS: Five gastrointestinal pathologists evaluated 745 hematoxylin and eosin slide images from 291 children with EED (mean age: 1.6 y) and 66 United States children (mean age: 6.8 y). Histomorphologic features (i.e., villus/crypt architecture, goblet cells, epithelial and lamina propria acute/chronic inflammation, Brunner's glands, Paneth cells, epithelial detachment, enterocyte injury, and foveolar metaplasia) were used to score each histopathologic slide. Generalized estimating equations were used to determine differences between EED, normal, and celiac disease, and receiver operating characteristic curves were used to assess predictive value. RESULTS: Biopsies from the duodenal bulb showed higher intramucosal Brunner's gland scores and lower intraepithelial lymphocyte scores than from the second or third parts of the duodenum (D2/3), so only D2/3 were included in the final analysis. Although 7 parameters differed significantly between EED and normal biopsies in regression models, only 5 (blunted villus architecture, increased intraepithelial lymphocytosis, goblet cell depletion, Paneth cell depletion, and reduced intramucosal Brunner's glands) were required to create a total score percentage (TSP-5) that correctly identified EED against normal biopsies (AUC: 0.992; 95% CI: 0.983, 0.998). Geographic comparisons showed more severe goblet cell depletion in Bangladesh and more marked intraepithelial lymphocytosis in Pakistan. CONCLUSIONS: This scoring system involving 5 histologic parameters demonstrates very high discrimination between EED and normal biopsies, indicating that this scoring system can be applied with confidence to studies of intestinal biopsies in EED.

The need for stronger international support to integrate health and well-being and transform education: a perspective on developing countries.

The reciprocal relationship between education and health is well-established, emphasizing the need for integrating health, nutrition, and well-being components into educational sector planning. Despite widespread acknowledgment of this need, countries lack concrete measures to achieve this integration. We examine challenges that countries have faced and the progress they have made in integrating these components into education sector plans and review the extent to which existing educational planning guidelines and tools address health and well-being. The review reveals a significant underrepresentation of health, well-being, and related themes in existing educational planning frameworks. Recent tools and frameworks developed to support a more holistic approach to education have not yet been widely adopted in standard education sector planning processes. The implementation of such approaches remains inconsistent, with significant barriers including limited cross-sectoral collaboration, lack of capacity, and insufficient funding, among others. Addressing these gaps requires improved guidance, technical support, and a multisectoral approach to education planning that includes health, nutrition, and well-being as fundamental components of foundational learning, supported by political commitment, capacity, and adequate financing.

Role of Iodine Status and Lifestyle Behaviors on Goiter among Children and Adolescents: A Cross-Sectional Study in Zhejiang Province, China.

BACKGROUND: Iodine deficiency is a well-established cause of goiter, while the impact of lifestyle factors on goiter development remains underexplored. The study aims to explore the associations between iodine status, lifestyle factors, and the prevalence of goiter among children and adolescents in Zhejiang Province, China. METHODS: A cross-sectional survey was conducted in 2022 using a stratified multistage sampling, involving 2261 children aged 6-17. Among these 1562 participants underwent both urinalysis and thyroid ultrasound. Lifestyle factors were assessed through self-reported questionnaires. RESULTS: The prevalence of goiter in the study population was 10.8%. A high urinary iodine concentration (UIC) (>300 µg/L) was significantly associated with a decreased risk of goiter (OR = 0.49, 95%CI: 0.27-0.88). Excessive recreational screen time and a high frequency of dining out were associated with an increased Tvol, while adequate physical activity and sleep were inversely associated with goiter risk, while the combined effect of high UIC and healthy lifestyle showed a protective effect against goiter. CONCLUSION: Ensuring adequate iodine status and promoting healthy lifestyles are crucial for preventing goiter and enhancing thyroid health in children and adolescents, suggesting that public health strategies should integrate nutritional and lifestyle interventions.

[Impact of short-peptide exclusive enteral nutrition therapy on physical growth and nutritional status in children with Crohn's disease]. / çŸ­è‚½åž‹å ¨è‚ å† è¥å »ç–—æ³•å¯¹å ‹ç½—æ©ç— æ‚£å„¿ä½“æ ¼ç”Ÿé•¿åŠè¥å »çŠ¶æ€çš„å½±å“.

OBJECTIVES: To evaluate the clinical efficacy of short-peptide exclusive enteral nutrition (EEN) therapy in inducing remission during active Crohn's disease (CD) in children, as well as changes in physical growth and nutritional indicators before and after treatment. METHODS: A prospective study included 43 children with active CD who were admitted to the Department of Gastroenterology, Children's Hospital of Nanjing Medical University from January 2017 to January 2024. The participants were randomly divided into a medication treatment group (13 children) and a short-peptide + medication treatment group (30 children). The changes in the Pediatric Crohn's Disease Activity Index (PCDAI) scores, physical growth, and nutritional indicators before and after treatment were analyzed in both groups. RESULTS: The PCDAI scores in the short-peptide + medication treatment group were lower than those in the medication treatment group after treatment (P<0.05). The Z-scores for weight-for-age, body mass index, and albumin levels were higher in the short-peptide + medication treatment group compared to the medication treatment group (P<0.05). In the patients with moderate to severe CD, total protein levels in the short-peptide + medication treatment group were significantly higher than those in the medication treatment group (P<0.05). CONCLUSIONS: Short-peptide EEN therapy can induce clinical remission in children with active CD and promote their physical growth while improving their nutritional status.

[Leigh syndrome caused by the mitochondrial m.8993T>G mutation with hypocitrullinemia: a report of four cases and literature review]. / m.8993T>Gç›¸å ³Leighç»¼åˆå¾åˆå¹¶ä½Žç“œæ°¨é ¸è¡€ç—‡æ‚£å„¿4ä¾‹å¹¶æ–‡çŒ®å¤ä¹ .

OBJECTIVES: To explore early diagnostic biological markers for Leigh syndrome caused by the m.8993T>G mutation. METHODS: A retrospective analysis was performed on the clinical data of four children diagnosed with m.8993T>G mutation-related mitochondrial disease at the Children's Hospital of Chongqing Medical University from January 2014 to January 2024. Additionally, a literature review was conducted. RESULTS: All four children had plasma amino acid and acylcarnitine analyses that revealed decreased citrulline levels, and one child was initially identified through neonatal genetic metabolic disease screening. According to the literature review, there were 26 children with mitochondrial disease and hypocitrullinemia caused by the m.8993T>G mutation (including the four children in this study). Among these, 12 children exhibited clinical phenotypes of Leigh syndrome or Leigh-like syndrome, while 18 children were identified with hypocitrullinemia and/or elevated levels of 3-hydroxyisovalerylcarnitine (C5-OH) during neonatal genetic metabolic disease screening. CONCLUSIONS: Hypocitrullinemia may serve as a potential biomarker for the early diagnosis of m.8993T>G mutation-associated Leigh syndrome, detectable as early as during neonatal genetic metabolic disease screening.

[Autosomal recessive polycystic kidney disease in a girl]. / å¸¸æŸ“è‰²ä½“éšæ€§é—ä¼ æ€§å¤šå›Šè‚¾1例.

A 5-year-old girl was admitted due to one episode of melena and one episode of hematemesis. Upon admission, gastroscopy revealed esophageal and gastric varices. Abdominal CT scan, MRI, and color Doppler ultrasound suggested cirrhosis, intrahepatic bile duct dilation, and bilateral kidney enlargement. Genetic testing identified compound heterozygous mutations in the PKHD1 gene: c.2264C>T (p.Pro755Leu) and c.1886T>C (p.Val629Ala). The c.2264C>T (p.Pro755Leu) mutation is a known pathogenic variant with previous reports, while c.1886T>C (p.Val629Ala) is a novel mutation predicted to have pathogenic potential according to Mutation Taster and PolyPhen2. The child was diagnosed with autosomal recessive polycystic kidney disease. In children presenting with gastrointestinal bleeding without obvious causes, particularly those with liver or kidney disease, consideration should be given to the possibility of autosomal recessive polycystic kidney disease, and genetic testing should be conducted for definitive diagnosis when necessary.

[A case report of Crohn's disease in a child with trisomy 8]. / ä¼´8å·æŸ“è‰²ä½“ä¸‰ä½“çš„å„¿ç«¥å ‹ç½—æ©ç— 1例报告.

The patient is a 12-year-old male who has experienced recurrent perianal abscesses for over 10 years, along with recurrent oral ulcers and deformities in the joints of hands and feet. Gastrointestinal endoscopy and capsule endoscopy revealed multiple ulcers in the digestive tract. Combined with his histopathological examinations, the patient was diagnosed with Crohn's disease. Whole exome sequencing and peripheral blood karyotype analysis indicated a karyotype of 47,XY,+8. The patient was treated with a "step-up" strategy. His clinical symptoms were under control, with significant improvement observed during endoscopic examination. This case suggests that early-onset inflammatory bowel disease may have genetic susceptibility, and when accompanied by other multi-system involvement, the possibility of chromosomal abnormalities, such as trisomy 8, should be considered and given due attention.

[Early identification of acute kidney injury in children with primary nephrotic syndrome]. / å„¿ç«¥åŽŸå‘æ€§è‚¾ç— ç»¼åˆå¾å¹¶å‘æ€¥æ€§è‚¾æŸä¼¤çš„æ—©æœŸè¯†åˆ«.

OBJECTIVES: To investigate the incidence and risk factors for acute kidney injury (AKI) in children with primary nephrotic syndrome (PNS), as well as the role of neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) in the early identification of AKI in these children. METHODS: A prospective collection of clinical data from children hospitalized with PNS at the Children's Hospital of the Capital Institute of Pediatrics from January 2021 to October 2022 was conducted. The children were divided into two groups based on the presence of AKI: the AKI group (47 cases) and the non-AKI group (169 cases). The risk factors for AKI in children with PNS were identified by multivariate logistic regression analysis. Urinary KIM-1 and NGAL levels were compared between the AKI and non-AKI groups, as well as among the different stages of AKI. RESULTS: The incidence of AKI in children with PNS was 21.8%. Multivariate logistic regression analysis revealed that steroid-resistant nephrotic syndrome, gastrointestinal infections, and heavy proteinuria were independent risk factors for AKI in these children with PNS (P<0.05). Urinary KIM-1 and NGAL levels were higher in the AKI group compared to the non-AKI group (P<0.05), and the urinary NGAL and KIM-1 levels in the AKI stage 2 and stage 3 subgroups were higher than those in the AKI stage 1 subgroup (P<0.017). CONCLUSIONS: KIM-1 and NGAL can serve as biomarkers for the early diagnosis of AKI in children with PNS. Identifying high-risk populations for AKI in children with PNS and strengthening the monitoring of related risk factors is of significant importance.

[Current clinical application of glomerular filtration rate assessment methods in pediatric populations]. / 肾小球滤过率评估方法在儿童人群中的应用现状.

Glomerular filtration rate (GFR) is a critical indicator of renal function assessment, which exhibits age-dependency in children and may differ from adults under various disease conditions. In recent years, there has been a growing focus on GFR among scholars, with an increasing number of clinical studies dedicated to refining and optimizing GFR estimation to span all pediatric age groups. However, the methods and assessment equations for estimating GFR may vary under different disease conditions, affecting the accuracy and applicability of assessments. This article reviews the peculiarities of renal function in children, explores GFR measurement methods, and evaluates the application of various GFR assessment equations in pediatric clinical practice, providing a reference for clinical assessment of renal function in children.

Association of nighttime sleep duration at 1.5 years with height at 3 years: The Japan Environment and Children's Study.

CONTEXT: Adequate nighttime sleep duration has been considered beneficial for linear growth in children; however, there is limited and conflicting evidence regarding the association between sleep duration and subsequent linear growth. OBJECTIVE: To investigate the association between sleep duration at 1.5 years and height at 3 years of age. METHODS: The Japan Environment and Children's Study is a nationwide prospective birth cohort study. Data from 52,140 term singleton births born at an appropriate-for-gestational age without background disorders that could potentially affect linear growth in the analyses were included. Nighttime and total sleep durations were calculated based on a self-administered questionnaire completed by caregivers. Tall stature was defined as height at or above the 75th percentile among participants. RESULTS: After adjustment for height at 1.5 years, sex, monthly age, mother's height, presence of siblings at 1.5 years, environmental tobacco smoke at 1.5 years, daily TV/DVD screen time at 2 years, attendance at nursery at 2 years, household annual income at birth, and parents' educational status, multivariate odds ratio (95% confidence interval) for tall stature at 3 years were 1.09 (1.01-1.17), 1.09 (1.01-1.17), and 1.25 (1.14-1.37) for 9.5 or 10, 10.5 or 11, and ≥ 11.5 h of nighttime sleep duration at 1.5 years, respectively, compared with those with ≤ 9 h sleep (p for trend <0.0001). Total sleep duration was not associated with tall stature. CONCLUSION: This study underscores the importance of nighttime sleep duration, not total sleep duration, in the linear growth of very young children.