Incidence and predictors of readmission following tonsillectomy in pediatric population.

BACKGROUND: Tonsillectomy is one of the most common surgical procedures performed in the pediatric population. This study aims to estimate the incidence rate of readmission post tonsillectomy in pediatrics and identify the causes and predictors contributing to the readmission post-surgery. METHODS: A retrospective cohort study included 1280 pediatric patients (18 years or younger) who underwent tonsillectomy at a tertiary hospital in 2019 and 2020. The study sample was divided into two groups based on readmission and were compared using the appropriate statistical tests. Significant variables (p-value≤0.05) were included in the logistic regression model to determine the predictors of readmission following tonsillectomy in these patients. RESULTS: The readmission rate following tonsillectomy was 6.3 % (95 % confidence interval 5.1-7.9). The causes of readmission included poor oral intake followed by bleeding and vomiting, 55.6 %,49.4 %, and 13.6 %, respectively. In the multivariable logistic regression model, the only significant predictor of post-tonsillectomy readmission was the use of a single postoperative analgesia (OR: 57.27, P = 0.000). CONCLUSION: The readmission rate following tonsillectomy in this study was relatively high. The most common causes contributing to readmission post tonsillectomy were poor oral intake and hemorrhage. The study also revealed a significant association between the utilization of single postoperative analgesia and an increased likelihood of readmission.

Computationally Designed AMPs with Antibacterial and Antibiofilm Activity against MDR Acinetobacter baumannii.

The discovery of new antimicrobials is necessary to combat multidrug-resistant (MDR) bacteria, especially those that infect wounds and form prodigious biofilms, such as Acinetobacter baumannii. Antimicrobial peptides (AMPs) are a promising class of new therapeutics against drug-resistant bacteria, including gram-negatives. Here, we utilized a computational AMP design strategy combining database filtering technology plus positional analysis to design a series of novel peptides, named HRZN, designed to be active against A. baumannii. All of the HRZN peptides we synthesized exhibited antimicrobial activity against three MDR A. baumannii strains with HRZN-15 being the most active (MIC 4 µg/mL). This peptide also inhibited and eradicated biofilm of A. baumannii strain AB5075 at 8 and 16 µg/mL, which is highly effective. HRZN-15 permeabilized and depolarized the membrane of AB5075 rapidly, as demonstrated by the killing kinetics. HRZN 13 and 14 peptides had little to no hemolysis activity against human red blood cells, whereas HRZN-15, -16, and -17 peptides demonstrated more significant hemolytic activity. HRZN-15 also demonstrated toxicity to waxworms. Further modification of HRZN-15 could result in a new peptide with an improved toxicity profile. Overall, we successfully designed a set of new AMPs that demonstrated activity against MDR A. baumannii using a computational approach.

Extraskeletal Ewing's sarcoma of the head and neck region in pediatric patients: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Extraskeletal Ewing's sarcoma (EES) is a collection of malignant cells that appear small and round and occur mostly in pediatrics and adolescence. Head and neck EES tumors are considered rare and require multidisciplinary care to achieve ideal results in management. CASE PRESENTATION: A 14-year-old boy who complained of a mass protruding from the back of his neck which gradually increased in size in the last few months prior to the diagnosis. He was referred to a pediatric otolaryngology clinic with a one-year history of chronic painless nape swelling. Ultrasound prior to the referral was done and the findings revealed a well-defined rounded hypoechoic lesion with internal vascularity. MRI was done and the impression was a large subcutaneous, well defined enhancing soft tissue lesion which raised the suspicion of sarcoma. The multidisciplinary team decision was to go for complete resection with a free margin followed by chemoradiation postoperatively. No evidence of recurrence was detected throughout the follow-up. CLINICAL DISCUSSION: The literature review included ages of the pediatric group from 4 months up to 18-year-old. Clinical features are highly dependable on the size and site of the lesion. Complete resection of the tumor plays an important role in the local control and prognosis. CONCLUSION: We present a rare case of extraskeletal Ewing's sarcoma of the nape. Computed tomography and magnetic resonance imaging are frequently used as imaging modalities in evaluating and diagnosing EES. Management commonly includes surgery with adjuvant chemotherapy to decrease recurrence and prolong the survival rate.

Clinical manifestations of COVID-19 versus other upper respiratory tract infections in pediatric patients.

OBJECTIVES: To explore the differences between COVID-19 and upper respiratory tract infections (URTI) in the pediatric population, emphasizing smell and taste disturbances. METHODS: A case-control study included 468 patients, 234 with COVID-19 (cases) and 234 with URTI (controls) at a tertiary hospital, Riyadh, Saudi Arabia, from 2020-2021. Patients with bacterial URTI, lower tract respiratory infections, and speech or developmental delays were excluded. Statistical analysis was carried out using Statistical Analysis System, 9.2 version. A p-value of ≤0.05 was considered significant. RESULTS: The male-to-female ratio was almost equal, with a mean age of 9.90±2.34. Multivariable logistic regression analysis showed that a change in taste significantly increases the probability of COVID-19 by 21.98 times. On the other hand, sore throat (81.5%), dyspnea (63.5%), nasal obstruction (72.7%), and otalgia significantly (74.8%) decrease the likelihood of COVID-19. CONCLUSION: Taste disturbances increase the probability of COVID-19 infections, whereas sore throat, dyspnea, nasal obstruction, and otalgia increase the likelihood of other URTIs. The described differences might aid physicians in their differential diagnosis and treatment during the pandemic.

GATR-3, a Peptide That Eradicates Preformed Biofilms of Multidrug-Resistant Acinetobacter baumannii.

Acinetobacter baumannii is a gram-negative bacterium that causes hospital-acquired and opportunistic infections, resulting in pneumonia, sepsis, and severe wound infections that can be difficult to treat due to antimicrobial resistance and the formation of biofilms. There is an urgent need to develop novel antimicrobials to tackle the rapid increase in antimicrobial resistance, and antimicrobial peptides (AMPs) represent an additional class of potential agents with direct antimicrobial and/or host-defense activating activities. In this study, we present GATR-3, a synthetic, designed AMP that was modified from a cryptic peptide discovered in American alligator, as our lead peptide to target multidrug-resistant (MDR) A. baumannii. Antimicrobial susceptibility testing and antibiofilm assays were performed to assess GATR-3 against a panel of 8 MDR A. baumannii strains, including AB5075 and some clinical strains. The GATR-3 mechanism of action was determined to be via loss of membrane integrity as measured by DiSC3(5) and ethidium bromide assays. GATR-3 exhibited potent antimicrobial activity against all tested multidrug-resistant A. baumannii strains with rapid killing. Biofilms are difficult to treat and eradicate. Excitingly, GATR-3 inhibited biofilm formation and, more importantly, eradicated preformed biofilms of MDR A. baumannii AB5075, as evidenced by MBEC assays and scanning electron micrographs. GATR3 did not induce resistance in MDR A. baumannii, unlike colistin. Additionally, the toxicity of GATR-3 was evaluated using human red blood cells, HepG2 cells, and waxworms using hemolysis and MTT assays. GATR-3 demonstrated little to no cytotoxicity against HepG2 and red blood cells, even at 100 µg/mL. GATR-3 injection showed little toxicity in the waxworm model, resulting in a 90% survival rate. The therapeutic index of GATR-3 was estimated (based on the HC50/MIC against human RBCs) to be 1250. Overall, GATR-3 is a promising candidate to advance to preclinical testing to potentially treat MDR A. baumannii infections.

Predictors of tympanostomy tube extrusion time in otitis media with effusion.

OBJECTIVES: To investigate the impact and predictors of tympanostomy tube (TT) extrusion. METHODS: A retrospective study on 258 ears underwent TT insertion during 2016-2018 at King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia. Patients were followed for 36-48 months postoperatively to detect the recurrence rate. The sample was divided into 2 groups based on extrusion time and were compared to determine the predictors of TT extrusion. RESULTS: Otitis media with effusion (OME) recurrence after TT insertion was detected in 28.7%. A shorter TT extrusion time was associated with a higher recurrence (p=0.002). Small TTs increased the probability of early TT extrusion (odds ratio = 5.144; 95% confidence interval: [1.602-16.519]). CONCLUSION: More than one-fourth of the patients who underwent TT insertion for OME developed recurrence. Tympanostomy tube extrusion earlier than 12 months was associated with a higher recurrence rate. Small TTs increased the probability of early TT extrusion.

Dandy-Walker syndrome with bilateral choanal atresia: A case report.

INTRODUCTION: Dandy-Walker syndrome is a rare congenital brain malformation characterized by cerebellar vermis agenesis or hypoplasia, cystic dilatation of the fourth ventricle and a large posterior fossa causing upward displacement of tentorium and torcula. In this paper, we present a case of bilateral choanal atresia with Dandy-Walker Syndrome in a female newborn. CASE PRESENTATION: We present a case of a female patient who was born at 38th weeks of gestation via emergency cesarean section due to non-reassuring cardiotocography and abnormal antenatal ultrasounds findings. The imaging revealed the presence of Dandy-walker malformation. The patient presented with cyanosis and respiratory distress. Bedside flexible nasoendoscopy revealed bilateral choanal atresia which is confirmed by computed tomography of sinuses. Endoscopic bilateral choanal atresia repair was performed. On postoperative follow up, nasal endoscopy showed bilateral intact flap and patent neochoana. DISCUSSION AND CONCLUSION: Dandy-Walker syndrome is a congenital disorder that can be diagnosed prenatally. The syndrome is associated with multiple anomalies. However, there are few published reports of bilateral choanal atresia in Dandy-Walker Syndrome. Bilateral choanal atresia is considered a life-threatening condition in newborns that requires early surgical intervention.

Predictors of Otitis Media with Effusion Recurrence Following Myringotomy.

Otitis media with effusion (OME) is the most common cause of acquired pediatric hearing loss. The treatment of persistent OME includes myringotomy with or without tube insertion, with a reported recurrence rate of 19.9-40%. This study aims to investigate the recurrence rate of OME and its predictors following myringotomy. A retrospective study that included 345 ears that underwent myringotomy for persistent OME in 179 pediatric patients during 2016-2018. Patients were followed for 36-48 months post myringotomy procedure to detect the recurrence rate. The study sample was divided into two groups based on recurrence status, and the groups were compared using chi-square test and independent T-test. Significant variables (p-value ≤ 0.05) were included in the logistic regression model to determine the predictors of OME recurrence after myringotomy. OME recurrence was detected in 85 ears (24.64%). The OME recurrence rate is higher in patients who underwent myringotomy alone compared to myringotomy with tube insertion (44.1% vs. 22.8%). The insertion of a tympanostomy tube decreases the recurrence rate of OME by 59.9% (OR 0.401; 95% CI 0.162-0.933). The other socio-demographic and clinical characteristics such as age, siblings, daycare attendance, passive smoking, previous acute otitis media, atopy, and adenoidectomy did not significantly influence OME recurrence (p-value > 0.05). The recurrence rate of OME following myringotomy is high. Myringotomy with tube insertion significantly decreases the recurrence rate and the need for further surgeries compared to myringotomy alone. Adenoidectomy and the patient's age have no impact on the recurrence rate of OME.

Ab initio Designed Antimicrobial Peptides Against Gram-Negative Bacteria.

Antimicrobial peptides (AMPs) are ubiquitous amongst living organisms and are part of the innate immune system with the ability to kill pathogens directly or indirectly by modulating the immune system. AMPs have potential as a novel therapeutic against bacteria due to their quick-acting mechanism of action that prevents bacteria from developing resistance. Additionally, there is a dire need for therapeutics with activity specifically against Gram-negative bacterial infections that are intrinsically difficult to treat, with or without acquired drug resistance. Development of new antibiotics has slowed in recent years and novel therapeutics (like AMPs) with a focus against Gram-negative bacteria are needed. We designed eight novel AMPs, termed PHNX peptides, using ab initio computational design (database filtering technology combined with the novel positional analysis on APD3 dataset of AMPs with activity against Gram-negative bacteria) and assessed their theoretical function using published machine learning algorithms, and finally, validated their activity in our laboratory. These AMPs were tested to establish their minimum inhibitory concentration (MIC) and half-maximal effective concentration (EC50) under CLSI methodology against antibiotic resistant and antibiotic susceptible Escherichia coli and Staphylococcus aureus. Laboratory-based experimental results were compared to computationally predicted activities for each of the peptides to ascertain the accuracy of the computational tools used. PHNX-1 demonstrated antibacterial activity (under high and low-salt conditions) against antibiotic resistant and susceptible strains of Gram-positive and Gram-negative bacteria and PHNX-4 to -8 demonstrated low-salt antibacterial activity only. The AMPs were then evaluated for cytotoxicity using hemolysis against human red blood cells and demonstrated some hemolysis which needs to be further evaluated. In this study, we successfully developed a design methodology to create synthetic AMPs with a narrow spectrum of activity where the PHNX AMPs demonstrated higher antibacterial activity against Gram-negative bacteria compared to Gram-positive bacteria. Thus, these peptides present novel synthetic peptides with a potential for therapeutic use. Based on our findings, we propose upfront selection of the peptide dataset for analysis, an additional step of positional analysis to add to the ab initio database filtering technology (DFT) method, and we present laboratory data on the novel, synthetically designed AMPs to validate the results of the computational approach. We aim to conduct future in vivo studies which could establish these AMPs for clinical use.

Hearing impairment in military personnel in Eastern Saudi Arabia.

BACKGROUND: Noise exposure is one of the most common occupational hazards worldwide. Studies have shown that the prevalence of hearing loss and tinnitus is higher in military personnel than in other occupations. This study aimed to estimate the prevalence of hearing impairment in military personnel in Eastern Saudi Arabia. MATERIALS AND METHODS: A cross-sectional study was conducted among 409 military personnel. A self-administered questionnaire collected data on level of awareness, hearing impairment, and protection of hearing. Pure-tone audiometry (PTA) was conducted on 141 participants to determine the prevalence and pattern of hearing impairment. Multivariate analysis was used to determine the predictors of hearing loss in military personnel. RESULTS: More than half of the participants (54.3%) were unaware of the consequences of noise exposure and none used proper hearing protection. A small percentage (5.9%) complied with the annual hearing examination, and only 23% had had a previous hearing evaluation. More than half of the participants (58.4%) had one or more abnormal hearing-related symptoms, with tinnitus as the most common symptom (43.8%). PTA showed hearing impairment in 71.6% of the participants. Multivariate analysis showed older age as only significant factor associated with hearing impairment in military personnel. CONCLUSION: Noise-induced hearing loss and tinnitus are common occupational disabilities in military personnel. Hearing conservation programs have to be initiated to ensure the application of hearing protection measures and control the effects of exposure to noise.

Otolaryngology manifestations of COVID-19 in pediatric patients.

BACKGROUND: The coronavirus disease 2019 pandemic has affected millions of people since its outbreak in December 2019. Limited data exist on otolaryngology manifestations of COVID-19 in pediatrics. This study aims to discuss the clinical features of COVID-19 in pediatrics, with an emphasis on otolaryngology manifestations. METHODS: The study included 660 COVID-19 laboratory-confirmed positive pediatric patients (aged 3-15 years) diagnosed at King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia. Data were retrospectively retrieved from January to July 2020 from electronic medical records and included patients' epidemiological and clinical features. Patients were then followed-up via phone calls to document any symptoms encountered after the first visit. Patients were categorized into three main groups according to age (3-6 years, 7-10 years, 11-15 years). RESULTS: Nearly half of the patients (43.6%) had asymptomatic infections. Fever and cough were the most commonly reported manifestations accounting for 39.2% and 19.8%, respectively. The most frequently reported otolaryngology symptoms were sore throat (17.3%) and rhinorrhea (14.4%). Moreover, 10.4% and 13.1% of children aged 7-15 years old experienced smell and taste disturbances, respectively. Older children (11-15 years) were more likely to report taste disturbances when compared to the younger children (17.2% vs 9.8%, p-value 0.02). Children aged between 3 and 6 years had significantly higher rates of admission (13.7%) and mortality (0.9%) when compared to the older groups (p-value 0.00). CONCLUSION: COVID-19 in pediatrics has a milder disease course and a better prognosis than adults. Multiple otolaryngology symptoms were reported in pediatric patients with COVID-19, which can help identify the suspected cases before the test result.

Lipoarabinomannan antigenic epitope differences in tuberculosis disease subtypes.

An accurate urine test for diverse populations with active tuberculosis could be transformative for preventing TB deaths. Urinary liporabinomannan (LAM) testing has been previously restricted to HIV co-infected TB patients. In this study we evaluate urinary LAM in HIV negative, pediatric and adult, pulmonary and extrapulmonary tuberculosis patients. We measured 430 microbiologically confirmed pretreatment tuberculosis patients and controls from Peru, Guinea Bissau, Venezuela, Uganda and the United States using three monoclonal antibodies, MoAb1, CS35, and A194, which recognize distinct LAM epitopes, a one-sided immunoassay, and blinded cohorts. We evaluated sources of assay variability and comorbidities (HIV and diabetes). All antibodies successfully discriminated TB positive from TB negative patients. ROAUC from the average of three antibodies' responses was 0.90; 95% CI 0.87-0.93, 90% sensitivity, 73.5% specificity (80 pg/mL). MoAb1, recognizing the 5-methylthio-D-xylofuranose(MTX)-mannose(Man) cap epitope, performed the best, was less influenced by glycosuria and identified culture positive pediatric (N = 19) and extrapulmonary (N = 24) patients with high accuracy (ROAUC 0.87, 95% CI 0.77-0.98, 0.90 sensitivity 0.80 specificity at 80 pg/mL; ROAUC = 0.96, 95% CI 0.92-0.99, 96% sensitivity, 80% specificity at 82 pg/mL, respectively). The MoAb1 antibody, recognizing the MTX-Man cap epitope, is a novel analyte for active TB detection in pediatric and extrapulmonary disease.

Oral Hygiene Behavior of School Children in Saudi Arabia: A Descriptive Cross-sectional Survey.

AIM: Oral health is an integral part of general health, and good knowledge and oral hygiene practices are the key to achieving oral health. This study assessed the knowledge, attitude, and oral hygiene practices of school children in Saudi Arabia and the need for dental health education and intervention. MATERIALS AND METHODS: This descriptive cross-sectional study was conducted among male school children (n = 451), aged 6-12 years, in the Al-Zulfi region of Saudi Arabia. Participants were included in this study using one-stage cluster sampling. The subjects completed a questionnaire, and the oral hygiene index-simplified was recorded. The collected data were statistically analyzed using SPSS version 21. RESULTS: Only 41.9% of the children had good oral hygiene. Of the sampled children, 72.7% used a toothbrush and toothpaste, but only 2.2% were aware of dental floss; 62.7% children brushed for 1-2 minutes and had good oral hygiene, but 55.9% of children had no knowledge about periodontal health. Only 30.1% parents observed their children during tooth brushing. CONCLUSION: Use of a toothbrush and toothpaste is the most commonly used and most effective oral hygiene aid. Brushing twice a day for 1-2 minutes seems to be effective. Oral health care education should be included in the school curriculum, and a parental awareness program is needed to emphasize their role in the dental health of their children. HOW TO CITE THIS ARTICLE: Kannan SPK, Alfahaid SF, Alharbi AS, et al. Oral Hygiene Behavior of School Children in Saudi Arabia: A Descriptive Cross-sectional Survey. Int J Clin Pediatr Dent 2020;13(1):66-71.

Impact of pediatric obesity on the prevalence and outcome of otitis media with effusion.

INTRODUCTION: Otitis Media with Effusion (OME) is the most common cause of hearing impairment in the pediatric population. Pediatric obesity is another major health issue with numerous reported health consequences, however, published studies about its role in OME are limited. This study aims to investigate the impact of pediatric obesity on the prevalence and outcome of OME. METHODS: A case-control study on 112 children aged 2-18 years who underwent ventilation tube insertion for the treatment of OME during 2015-2017 (cases) and 130 children with no history of OME matching for age and gender (control group). Each group was divided into four subgroups based on BMI by age and gender. The differences in the BMI between the cases and the control group were explored. The cases were further divided into obese and non-obese subgroups and were compared to determine the impact of obesity on the presentation and outcome of OME. RESULTS: Mean±SD BMI is significantly higher in the cases compared to the control group (19.98±5.20 vs. 17.25±4.21) (P=0.032). Obesity is significantly more prevalent in patients with OME compared to the control group (25.0% vs. 19.2%) (P=0.021). Obese OME patients are more prone to develop recurrence compared to non-obese OME patients (OR 3.51, 95% CI1.12, 11.01). CONCLUSION: Pediatric obesity might be associated with the development of OME. Moreover, obese OME patients are more prone to develop recurrence compared to non-obese patients.

Foreign body aspiration in a rare tracheal anomaly: A case report.

INTRODUCTION: Tracheal bronchus is a rare anomaly in which an accessory bronchial branch originates superior to the tracheal bifurcation. It is usually incidentally found in patients with recurrent chest infection, persistent stridor and less commonly due to foreign body aspiration. PRESENTATION OF CASE: A 6-year-old medically and surgically free boy presented to the Emergency Department with severe shortness of breath. The patient was initially saturating well, but then suddenly worsened and was rushed for intubation. The patient was taken to the operating room for direct laryngobronchoscopy to retrieve the foreign body obstructing the airway. The foreign body was successfully retrieved, and the presence of a tracheal bronchus was confirmed. DISCUSSION: The presence of tracheal bronchus has its implications on airway management. CONCLUSION: Knowledge about tracheal bronchus is of great importance to the otolaryngologist and anesthetist to maintain the airway.