Context: Mourning following the death of a loved one is a natural and necessary process, but some people lack the skills and abilities to deal with the grief process, which can lead to many psychological problems. Bereaved children are a vulnerable population at risk of social and psychological harm. Objectives: The present study aimed to investigate the effects of grief on children and effective interventions to increase adaptation to it. Evidence Acquisition: The present study was a review-type design based on the review of the literature on loss and bereavement in children, reactions, and effective interventions. The literature search was conducted in PubMed, Scopus, and Web of Science databases, as well as in the Google Scholar search engine up to December 2024. Relevant keywords and their combinations used for the literature search were as follows: Loss, bereavement, children. Results: Supportive interventions in children's traumatic bereavement include cognitive behavioral therapy, developing coping skills, relaxing activities (yoga), and creative counseling techniques (expressing feelings or experiences through poems, drawings, singing, dancing, writing and drawing trauma narratives, epitaphs which are short texts performed in honor of a deceased person, holding a memorial service, holding a holiday program that focuses on helping the child cope with the grief during important family holidays). Conclusions: Childhood grief reactions are distinct from those in adults and are affected by developmental and contextual factors such as the age of the child and changes in caregiving environments. Empirically supported interventions can help young people to navigate the many grief-related challenges.
Background: Nucleated red blood cells (nRBCs) are infrequently observed in the peripheral blood of healthy infants, adults, and elderly individuals. Studies have indicated that the presence of these cells in the peripheral blood of premature infants suggests intrauterine hypoxia. Objectives: This study aims to determine the association between nRBCs in the peripheral blood of premature infants and outcomes, specifically mortality, using accelerated failure time (AFT) models. Methods: This registry-based, single-center cohort study was conducted on premature infants between March 5,2019, and September 10,2020, at a university hospital in Ilam, southwest Iran. A total of 450 premature infants were included in the study. Accelerated failure time models were applied to the dataset, and their performance was evaluated using visual Cox-Snell residuals and Akaike’s information criterion (AIC). Results: In the adjusted model, the Weibull model results indicated that the presence of nRBCs [adjusted time ratio (TR) 1.05, 95% CI: 1.01 - 1.08, P = 0.04] was a significant factor accelerating progression to death in premature infants. Conclusions: The presence of nRBCs is a risk factor for mortality in premature infants. Counting nRBCs on the first day of birth in premature infants could serve as a simple, accessible, cost-effective, and prognostic factor for mortality and morbidity related to retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH).
Background: Due to the impact of coronavirus disease 2019 (COVID-19), all schools in Japan were closed in March 2020, including those providing compulsory education. They remained closed for up to 3 months. Objectives: Researchers investigated the difference in children’s physical fitness results before and after the spring of 2020, during which time Japanese schools were closed and fitness opportunities were limited. Methods: Researchers compared the athletic performances of Japanese elementary school children before and after the COVID-19 pandemic (2014 and 2022 - 2023, respectively). This was a retrospective epidemiological study of 438 students between the ages of 8 and 10 years old at Elementary School A in Osaka Prefecture. Researchers used an unpaired t-test to investigate whether significant differences occurred according to grade, sex, and activity. Results: Results showed that in physical fitness exams for third- and fourth-grade children, the athletic performances of children in 2022 and 2023 significantly declined in all examined activities other than the trunk forward flexion and the 50-m run, compared with children in the same grade in 2014. In the 20-m shuttle run, there was a significant difference at the P < 0.01 level for fourth-grade boys and girls and a significant difference at the P < 0.05 level for those in third grade. In 2023, improvements were seen in explosive exercises. Following the self-restraint period during the COVID-19 pandemic, the 2022 and 2023 physical fitness exam results were substantially inferior in several aspects, compared with the results from similar exams conducted in 2014. Notably, muscle endurance and general endurance had significantly decreased. Conclusions: Because the muscle endurance and general endurance of elementary school students were heavily impacted, sufficient caution is required when resuming physical education activities in the future. It is therefore necessary to teach students how to exercise safely using a detailed exercise program.
Background: Neonatal cardiac surgery is crucial for addressing congenital heart anomalies yet poses a risk of notable perioperative electrolyte disturbances. Imbalances resulting from blood loss, fluid shifts, and surgical effects can negatively impact patients, leading to issues such as acute kidney injury (AKI), arrhythmias, and elevated mortality rates. Objectives: The objective of this research is to assess the prevalence and outcomes of electrolyte imbalances during the perioperative, intraoperative, and postoperative phases on morbidity and mortality in neonates undergoing cardiac surgery. Methods: This study, conducted as a retrospective, single-center analysis, encompassed 355 neonatal patients who underwent cardiac surgery at a tertiary city hospital from January 2021 to January 2024. The study involved neonates under one month old diagnosed with congenital heart disease who underwent cardiac surgery within this timeframe. Electrolyte levels (sodium, potassium, calcium, chloride) were documented preoperatively, intraoperatively, and postoperatively, along with clinical outcomes such as AKI, arrhythmias, seizures, intensive care unit (ICU) length of stay, and mortality. Statistical analyses, both descriptive and inferential, were conducted to examine the connections between electrolyte imbalances and clinical outcomes, using logistic regression. Results: Notable correlations were identified between preoperative hyponatremia, hypocalcemia, hypochloremia, and the onset of AKI. The presence of arrhythmias was connected to preoperative hypocalcemia and postoperative hypernatremia and hyperchloremia. No significant relationship was found between any electrolyte imbalance and seizures. Mortality showed a significant association with preoperative hyponatremia, hypocalcemia, and hypochloremia, as well as postoperative hypernatremia and hyperchloremia. Conclusions: Perioperative electrolyte imbalances are commonly observed in neonates undergoing cardiac surgery and have a strong association with negative outcomes. Managing these imbalances proactively may result in a decrease in complications, notably AKI and arrhythmias, and an enhancement in survival rates.
Background: Adolescents experience rapid height growth during puberty, which eventually slows down and ceases due to epiphyseal senescence. Menarche marks the final stage of puberty and often raises concerns about the cessation of height growth. Objectives: This study aims to examine post-menarche height growth and identify the factors associated with it. Methods: This retrospective cross-sectional study included adolescent females who visited pediatric endocrinology clinics in Hamadan between 2001 and 2018 and had a minimum follow-up period of three years. Data extracted from patients' medical records included demographic details, birth weight, birth order, height, weight, Body Mass Index (BMI), and stages of thelarche and pubarche. Data analysis was conducted using SPSS version 26. Results: The medical records of 91 girls were evaluated. The mean age of menarche was 11.93 +/- 1.27 years. On average, the participants grew 7.98 +/- 3.47 cm in height within three years after menarche. The study revealed a significant inverse correlation between post-menarche height growth and both the age at menarche and height at the onset of menarche. No correlation between height growth and other variables was observed. Conclusions: Post-menarche height growth was negatively correlated with height and age at menarche. However, there is limited research on post-menarche height growth in Iranian girls, highlighting the need for further studies.
Background: One of the most common movement disorders in children with cerebral palsy (CP) is upper limb function impairment. This limitation can lead to increased dependency in daily life activities and self-care. Recently, a new treatment method called transcranial direct current stimulation (tDCS) has been developed to improve hand function in neurological disorders involving upper limb impairments. Objectives: This study aimed to investigate the effectiveness of the tDCS technique, combined with occupational therapy exercises, on upper limb function in children with CP. Methods: In this randomized clinical trial, 50 children aged 5 - 10 years with hemiplegic CP were randomly divided into two groups: An experimental group and a control group, with 25 children in each. The experimental group received 45 minutes of occupational therapy exercises along with 20 minutes of electrical stimulation via tDCS, while the control group received therapy exercises with the tDCS in off mode. The intervention lasted four weeks, with five sessions per week. Upper extremity motor function was assessed using the Fugl-Meyer test, and gross manual dexterity was evaluated with the Box and Block test. The Bruininks-Oseretsky test was employed to assess fine and gross motor skills across four motor areas: Fine manual control, manual coordination, body coordination, and strength and agility. Outcomes were measured in both groups before and after the 4-week interventions. An independent t-test or Mann-Whitney test was used for between-group comparisons. Results: The study results showed that all outcomes related to upper limb function improved in both groups after the 4-week intervention. However, the group that received tDCS alongside routine occupational therapy demonstrated significantly greater improvement compared to the group that received only routine occupational therapy (P < 0.001). Moreover, no significant side effects were observed during or after the use of tDCS. Conclusions: The results suggest that although both therapy exercises and tDCS interventions individually enhance upper limb function in children with unilateral CP, the combined use of these two interventions led to significantly better outcomes compared to routine occupational therapy alone. This finding underscores the clinical applicability of incorporating both modalities into rehabilitation programs for children with CP. Therefore, combining occupational therapy exercises with tDCS is recommended for improved results in enhancing upper limb function in CP.
Introduction: Vici syndrome is a congenital multisystem disorder characterized primarily by callosal agenesis, cataracts, cardiomyopathy, combined immunodeficiency, and oculocutaneous hypopigmentation, along with additional newly recognized findings. Autosomal recessive variants in the EPG5 gene, which encodes ectopic P-granules autophagy protein 5 (EPG5), a key regulator of autophagy, are known genetic causes of this syndrome. The aim of this case report is to present a novel disease-causing variant identified through EPG5 gene sequence analysis. Case Presentation: We report on a 2-month-old Turkish girl who presented with developmental delay, bilateral congenital cataracts, microcephaly, hypotonia, hypertrophic cardiomyopathy, hypopigmented skin lesions, and agenesis of the corpus callosum. Genetic analysis revealed a homozygous c.7504delC (p.G1n2502Argfs*4) frameshift variant in the EPG5 gene, which has not been previously documented. Conclusions: Adding a new variant to the literature is crucial, as it highlights the feasibility of reaching an accurate diagnosis through well-conducted physical examination findings in patients with early developmental delay. This case also raises awareness about such rare diseases. Moreover, recognizing new mutations is critical for understanding atypical findings, prognosis, treatment responses, and the genetic risks for other family members.
Background: Community-acquired pneumonia (CAP) in childhood is an acute lung infection in a child caused by a pathogen originating outside the hospital, i.e., in the community. This disease is a significant cause of illness in developed countries and a major cause of death in developing countries. Objectives: This study aims to assess the factors predicting the incidence of pulmonary complications in children with community-acquired pneumonia. Methods: This study involved all children hospitalized in Zahra Mardani Azari Children's Hospital in Tabriz due to CAP between October 2022 and October 2023. Patients were compared in terms of demographic information, prescription records, medicines prescribed during hospitalization, clinical signs and symptoms, laboratory findings at admission and during hospital treatment; imaging results, and the clinical course of the disease. The study data was analyzed using SPSS version 23 software; and we used logistic regression analysis for identifying the related risk factors. Results: We included 361 patients, of which 104 (28.8%) were in the case group, and 257 (71.2%) were in the control group. The frequent complication was parapneumonic effusion (81.7%) following necrotizing pneumonia (27.9%), empyema (20.2%), and lung abscess (6.7%). Risk factors for pulmonary complications in children with CAP were weight (OR = 1.129), height (OR = 1.112), Body Mass Index (BMI) (OR = 1.112), administration of oral and intravenous acetaminophen during hospitalization (OR = 1.112, 1.209), Tachypnea (OR = 5.178), duration of Fever (OR = 1.290), ESR (OR = 1.312) and HRAD (OR = 3.473). Conclusions: We found that high weight and BMI, receiving acetaminophen during hospitalization, Tachypnea, and Fever duration until hospitalization, as well as high WBC and ESR, were predictive factors of pulmonary complications in children with CAP.
Background: Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disorder commonly found in populations from the Mediterranean region,including Turks, Armenians, Arabs, and Jews. It is characterized by recurrent episodes of fever and inflammation, primarily affecting the peritoneum, pleura,and joints. Familial Mediterranean fever is caused by mutations in the MEFV gene, which encodes pyrin, a protein that regulates the inflammatory response. Themost common mutations associated with FMF are M694V, M680I, and V726A. These mutations lead to the overproduction of interleukin-1 beta (IL-1 beta), triggering theinflammatory episodes that are the hallmark of the disease.Objectives: This study aims to explore the clinical implications of MEFV gene mutations in a cohort of patients diagnosed with FMF and treated withcolchicine. The primary objective is to determine the frequency of various MEFV mutations in the patient cohort and examine their association with clinicalpresentations, such as symptom severity and response to treatment.Methods: A retrospective cohort of 302 patients diagnosed with FMF and undergoing colchicine treatment was examined. Demographic data, clinicalsymptoms, and genetic mutations were systematically collected and analyzed. Mutation analysis focused on identifying the most common MEFV variants andtheir potential influence on clinical outcomes. Consanguinity and family history were also considered for their role in FMF genetic predisposition.Results: The study included 157 females and 145 males, with a mean age of 142.60 +/- 48.04 months at the time of analysis. The average age of diagnosis was 94 +/- 42 months, with no significant differences between genders. Abdominal pain was the most common symptom (90.3%), followed by fever (69.0%) and arthralgia(42.3%). Consanguinity was reported in 35.1% of cases, mainly between first-degree cousins, and 24.5% had a family history of FMF. Genetic analysis revealed thatthe M694V mutation was the most common homozygous mutation (71.4%), followed by the E148Q mutation as the most frequent heterozygous mutation (37.5%).The compound heterozygous mutation M694V/E148Q was found in 20% of cases. A statistically significant association was found between arthritis andhomozygous mutations (P = 0.001) as well as with the M694V mutation (P = 0.004). Homozygous M694V mutations were detected in 16.9% of patients. Thefindings underscore a strong correlation between the M694V mutation and the development of FMF. Despite the efficacy of colchicine in managing symptomsand preventing complications such as amyloidosis, some patients exhibited treatment resistance, particularly those with arthritis.Conclusions: This study highlights the significant role of MEFV gene mutations, particularly M694V, in the pathogenesis of FMF. It underscores theimportance of early diagnosis and the potential for personalized treatment based on genetic findings. While the retrospective design of the study presentslimitations, such as selection and information bias, the results provide valuable insights into the clinical and genetic dimensions of FMF. Future studies shouldbuild on these findings by using prospective designs and investigating the interaction between genetic and environmental factors in FMF. Expanding the scopeof genetic analysis could also lead to the discovery of new mutations, enhancing our understanding of this complex disorder.
Background: Evaluating pain after surgery is particularly important in children due to their limited ability to communicate effectively. The intensity, duration, and threshold of pain make it challenging to assess in this age group. Objectives: The aim of this study was to compare the effects of ultrasound-guided caudal block at different timings on children's pain and drug consumption during unilateral knee osteotomy surgery. Methods: In a randomized clinical trial, fifty patients were randomly included in the study. The patients were children aged 2 - 6 years, candidates for unilateral osteotomy surgery under general anesthesia with total IV anesthesia (TIVA). The patients were divided into two groups based on the timing of the caudal block: The first group received the block after induction, and the second group received it after surgery and before extubation. Results: There was no statistically significant difference between the two groups in terms of the average amount of Propofol and narcotic consumption during recovery at different time points (P > 0.05). However, significant differences in pain levels were observed during the operation at 60 minutes (P-value < 0.001) and 120 minutes (P-value = 0.006) between the two groups. Pain scores at the start of recovery and at 2, 4, 6, 12, and 24 hours postoperatively were significantly lower in the second group than in the first group. Additionally, the mean difference in Bispectral Index (BIS) at 60 minutes between the two groups was significant (P-value = 0.003), but there was no significant difference at 120 minutes (P-value = 0.896). The second group consistently had significantly lower pain levels than the first group at all times. Conclusions: Based on the results of this study, patients who received a caudal block had lower pain scores, and performing the block before extubation had more beneficial effects on postoperative pain management in children undergoing osteotomy surgery than performing it after induction.
Background: Children with tic disorder (TD) have been reported to exhibit abnormal levels of certain peripheral proteins, but none of these abnormalities have been established as biomarkers for diagnosis. Objectives: The purpose of this study is to evaluate serum histidine decarboxylase (HDC) and tumor necrosis factor-alpha(TNF-alpha) levels in children with TD, assess their relationship with TD development, and provide reliable biomarkers for prediction and risk management in clinical settings. Methods: In the present study, serum HDC and TNF-alpha levels from 118 no-comorbid and medication-naive TD patients and 111age-matched healthy controls were measured using enzyme-linked immunosorbent assay (ELISA) kits. Tic severity was assessed using the Yale Global Tic Severity Scale (YGTSS). Binary logistic regression analysis was used to evaluate the relationship between serum HDC and TNF-alpha levels and TD development. Results: An increase in serum HDC and TNF-alpha levels was observed in TD patients compared with controls. Further analysis revealed a significant association between elevated HDC and TNF-alpha levels and TD development, with a significant ROC curve for HDC and TNF-alpha as potential risk factors. Conclusions: This study identified a high prevalence of elevated serum HDC and TNF-alpha levels in children with TDs and provides evidence that elevated blood HDC and TNF-alpha may be potential risk factors for TD development.
Background: The current newborn screening for Classic Galactosemia (CG) presents significant challenges, including a low positive rate and a high false-positive rate. Objectives: In this study, we aimed to establish new cut-off values (COVs) for CG screening and introduce a novel approach. Methods: Total galactose (TGAL: The sum of galactose (Gal) and galactose-1-phosphate (G-1-P)) levels of all newborns born in Fars, Iran, from August 2006 to December 2020, were reviewed to establish cut-off ranges. A receiver operating characteristic (ROC) curve analysis was performed to define an optimal COV. Results: Out of 1,187,436 newborns, 4,893 (0.41%) were recalled for further evaluation due to an initial TGAL >= 4 mg/dI. from a positive screening test, with 160 (3.26%) confirmed to have CG. In the initial negative screening results, nine infants were missed as false negatives. An area under the curve of 0.868 suggested that TGAL is a reliable indicator for distinguishing galactosemia from normal subjects. Receiver operating characteristic curve analysis indicated that a cut-off value (COV) of 5.2 mg/dI. provided a sensitivity and specificity of 80.0% and 81.3%, respectively, making it an optimal conservative value for deciding on further recall in the Iranian setting. Additionally, a COV of 735 mg/dI. demonstrated a sensitivity of 71.3% and specificity of 95.7%, making it a suitable cut-off for immediate referral. Conclusions: We proposed a novel protocol for newborn screening in Iran, establishing a TGAL level of 5.2 mg/dL as a conservative cut-off for CG screening, showing excellent sensitivity while ensuring specificity for recalling suspicious cases. Furthermore, a cut-off of 735 mg/dL was identified for prompt consideration of urgent treatment.
Objectives: The purpose of the present study was to investigate the relationships between the Zn level in the umbilical cord blood and the birth weight, height, and head circumference of term newborns. Methods: A cross-sectional study was conducted on full-term newborns in Tehran, Iran, in 2021. Neonates' Zn levels in umbilical cord blood were evaluated. Data related to perinatal and neonatal variables such as the number of pregnancies (gravida), birth height, weight, and head circumference were recorded, and their relationships with umbilical cord Zn levels were assessed. P-values < 0.05 were considered statistically significant. Results: One hundred mothers with a mean age of 30.792 +/- 5.908 years and a parity of 2.693 +/- 1.181 were included. Of all the newborns, 68% were boys, and 2% had low birth weight. The mean level of cord blood Zn was 107.703 +/- 27.843 pg/dL. Evaluating the correlations between cord blood Zn levels and maternal and neonatal qualitative variables, data analysis showed no relationships between Zn levels and neonatal sex (P = 0.70), low birth weight (P = 0.87), and maternal underlying disease (P = 0.49). Data analysis regarding correlations between quantitative variables also showed no significant correlations between cord blood Zn levels and birth weight (P = 0.466), height (P = 0.466), and head circumference (P = 0.925). Conclusions: Although adequate Zn levels were observed in all neonates, these levels did not significantly influence neonatal anthropometric measures or immediate health indicators. Further studies with larger sample sizes are recommended to provide more comparative data, particularly in relation to long-term growth outcomes.
Context: Spinal muscular atrophy (SMA) is a rare genetic disorder that significantly impacts the quality of life. This paper aims to gather current understanding of the safety, efficacy, and economic aspects of common SMA treatments to assist Iranian policymakers in adopting these novel treatments for this vulnerable population. Methods: This rapid health technology assessment (HTA) research was conducted in four steps: Database review, screening, data extraction, and thematic analysis. Inclusion criteria consisted of studies focused on assessing the safety, efficacy, and economic aspects of medical interventions in SMA patients compared to those who did not receive such interventions. Results: Based on current data, nusinersen was found to be the most effective treatment (increasing mobility achievements in SMA types 1 and 2) with the least side effects for SMA types 1 and 2. In terms of economic evaluations, none of the treatments were found to be cost-effective. Conclusions: The decision regarding reimbursement for such medical drugs should not focus solely on their cost-effectiveness but rather on creating access to essential care, meeting patient needs, and considering national budget limitations. Managed entry agreements (MEAs) are flexible tools that service providers or payers can use to negotiate and reduce the financial burden for both patients and payers.
Background: Brachial plexus neuropathy is a common and frequently occurring disease that may present with upper limbnumbness and dysfunction, leading to a high disability rate.Objectives: To analyze the magnetic resonance imaging (MRI) features of brachial plexus neuropathy in children.Methods: This study included 60 children who underwent MRI of the brachial plexus at our hospital from July 2019 to May2024. The MRI scans included axial T1WI and T2WI sequences, axial and coronal T2-STIR sequences, and coronal 3D-FIESTAsequences. The imaging results were analyzed to identify features of brachial plexus neuropathy.Results: In this study, all 60 children underwent MRI of the brachial plexus. It was found that 34 (56.67%) cases were diagnosedas brachial plexus nerve injury via imaging, including 12 (20.00%) cases on the left side, 18 (30.00%) cases on the right side, and 4(6.67%) cases on both sides. The imaging diagnoses were consistent with the clinical diagnoses in 32 cases and inconsistent in 2cases. Meanwhile, 4 (6.67%) cases were diagnosed as other types of brachial plexus neuropathy, including 1 (1.67%) case ofneurofibroma, 2 (3.33%) cases of neurosheathoma on the left side, and 1 (1.67%) case of right radicular sleeve cyst. The results wereconsistent with the clinical diagnoses in 3 cases and inconsistent in 1 case. Additionally, 7 (11.67%) cases were diagnosed as non-brachial plexus neuropathy, while 15 (25.00%) cases showed no obvious abnormality of the brachial plexus nerve. The sensitivity,specificity, and positive/negative predictive values were 100.00% (14/14), 78.95% (15/19), 91.11% (41/45), and 100.00% (15/15),respectively. The imaging features of brachial plexus nerve injury included thickening and thinning of nerve roots, high signalson T2 fat-suppression sequences, small cystic low signals at the level of the intervertebral foramen, cystic dilatation of nerveroots, formation of spinal cysts, and irregularly shaped long T1 and T2 signals at the C6 intervertebral foramen. The imagingfeatures of neurofibroma included spike-shaped isometric T1 and T2 signals in the cervical soft tissues and high signals on T2 fat-suppression sequences, with relatively homogeneous signals, a clear boundary, and an irregular morphology of the lesionwrapping around the brachial plexus nerve. Additionally, the imaging features of neurosheathoma included space-occupyinglesions, predominantly oval-shaped isometric T1 and slightly longer T2 signals, located at the lateral upper edge of the thorax,the lower part of the posterior clavicle, and the left side of the brachial plexus.Conclusions: The MRI can effectively show the location, range, and type of lesions, providing a valuable imaging reference forthe early diagnosis and treatment of brachial plexus neuropathy in children
Background: Chronic kidney disease (CKD) is a rare condition that causes significant health problems in children. Objectives: To evaluate changes in serum and urinary levels of soluble Fas (sFas), soluble Fas Ligand (sFasL), and soluble E-selectin (sE-selectin) over time in children with CKD and determine their potential as biomarkers for CKD progression. Methods: This longitudinal study was conducted as part of the PROGRESS study. A total of 117 patients with CKD and 56 healthy children were included. The CKD cohort underwent a 24-month prospective follow-up. Soluble Fas, sFasL, and sE-selectin levels were measured using the Luminex method at baseline, the 12th month, and the 24th month of the study. Results: At baseline, patients with CKD had significantly higher serum median levels of sFas, sFasL, and sE-selectin compared to the control group (8337 pg/mL vs. 3951 pg/mL, 68 pg/mL vs. 33 pg/mL, and 26460 pg/mL vs. 19801 pg/mL, respectively; P < 0.0001 for all). Additionally, the CKD group showed significantly higher urinary ratios of sFas/Cr, sFasL/Cr, and sE-selectin/Cr compared to the control group (P < 0.0001 for all). In the CKD group, median serum sFasL levels (68 pg/mL vs. 51 pg/mL) and urinary sFasL/Cr ratios (19 pg/mg vs. 14 pg/mg) significantly decreased at the 24th month compared to baseline (P < 0.0001 for both). Similarly, serum sE-selectin median levels and urinary sE-selectin/Cr ratios showed significant decreases over time (P = 0.003 and P < 0.0001, respectively). Baseline urinary sFas/Cr, sFasL/Cr, and sE-selectin/Cr ratios were highest in CKD stages 4 - 5 compared to stages 2, 3a, and 3b (P < 0.0001, P < 0.0001, and P = 0.007, respectively), while no significant differences were observed in baseline serum levels of sFas, sFasL, and sE-selectin across CKD stages (P > 0.05). Baseline serum sFasL median levels were lower (P = 0.038), while baseline serum sFas median levels were higher (P = 0.045) in patients with rapid CKD progression compared to those without rapid progression. Urinary sFas/Cr, sFasL/Cr, and sE-selectin/Cr ratios positively correlated with all urinary HSP/Cr ratios (P < 0.0001 for all). Conclusions: Our study highlights that CKD progression is a complex process involving sFas, sFasL, and sE-selectin; however, these biomarkers do not serve as predictors of CKD progression.
Background: With the increase in pediatric obesity, the prevalence of metabolic syndrome (MetS) is rising worldwide. Early identification of children with obesity who are prone to developing MetS is important. Objectives: This study aimed to evaluate the value of the Systemic Immune-Inflammation Index (SII) and the Systemic Inflammatory Response Index (SIRI) in predicting MetS in obese children and adolescents. Methods: This prospective single-center cross-sectional study involved 99 children and adolescents with obesity. The patients were assigned to two groups, MetS+ (n = 42) and MetS- (n = 57), based on the presence of MetS. Complete blood count results from the first visit were evaluated. Results: The white blood cell (WBC), platelet, and neutrophil counts were higher in the MetS+ group (P = 0.003, P = 0.022, and P < 0.001, respectively), while no significant difference was observed in lymphocyte (P = 0.865) and monocyte counts (P = 0.488) between the two groups. When inflammatory parameters were compared, SII (P < 0.001), platelet-to-lymphocyte ratio (PLR) (P = 0.024), neutrophil-to-lymphocyte ratio (NLR) (P = 0.002), and SIRI (P = 0.012) were significantly elevated in the MetS+ group compared to the MetS- group. Binary logistic regression analysis revealed that SII and homeostasis model assessment of insulin resistance (HOMA-IR) were statistically significant risk factors for the presence of MetS (P = 0.003, P = 0.012, respectively). Additionally, a significant positive correlation was found between SII and diastolic blood pressure (DBP) (P = 0.024), high-density lipoprotein cholesterol (HDL-C) (P = 0.019), and fasting plasma glucose (FPG) (P = 0.048), as well as between SIRI and HDL-C (P = 0.044) and FPG (P < 0.001). Receiver operating characteristic analysis of the SII and SIRI ability to predict MetS in adolescents and children with obesity showed that the SII was more discriminative than the SIRI, with a specificity of 0.82, sensitivity of 0.57, and an area under the curve of 0.708. Conclusions: The SII and SIRI can be used for the early diagnosis of MetS in pediatric obesity patients.
Background: HALP and modified-HALP (m-HALP) scores are novel indices combining albumin, hemoglobin, platelets, and lymphocytes, reflecting systemic inflammation and the physiological well-being of an individual. These scores provide information about a patient's prognosis. Objectives: In this study, we examined the prognostic effectiveness of HALP and m-HALP scores in patients with acute bronchiolitis for the first time. Method: This retrospective cross-sectional study, which was conducted at the Department of Pediatrics, Balikesir Ataturk City Hospital, Turkey, between January 2021 and January 2023, focused on children over 2 years of age diagnosed with acute bronchiolitis. Children who did not provide all necessary laboratory tests, were transferred to another center, or had comorbidities were excluded. HALP and m-HALP scores were calculated based on data obtained from patients' blood samples, including albumin, hemoglobin, platelet, and lymphocyte counts. The primary outcome was defined by the necessity for admission to the intensive care unit (ICU). Secondary outcome measures included the need for intubation and the patients' clinical course. Results: A total of 344 pediatric patients were included in the study. The mean age of the patients was 13.17 +/- 9.28 months (range: 1- 24 months). Of the participants, 40.9% were male, and 43.31% required hospitalization in the ICU. Statistically significant differences were observed in albumin, lymphocyte count, NLR, PLR, HALP, and m-HALP values when comparing patients based on service and ICU hospitalization. HALP and m-HALP scores were effective parameters for differentiating the need for ICU admission, the need for intubation, and the severity of bronchiolitis in pediatric patients. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performance of HALP and m-HALP in predicting the need for ICU hospitalization. The optimal cut-off values were 50.54 and 7645023, respectively, and the area under the curve (AUC) values were 0.605 (95% CI: 0.544- 0.667) and 0.631 (95% CI: 0.571- 0.690), respectively. The sensitivity and specificity of the HALP score were 0.54 and 0.67, respectively, while the sensitivity and specificity of the m-HALP score were 0.57 and 0.69, respectively. Conclusions: HALP and m-HALP scores are effective parameters for predicting poor prognosis in patients with bronchiolitis and may be useful for clinicians in patient follow-up and prognosis prediction.
Background: Caffeine citrate is a commonly prescribed drug in preterm neonates. The direct effect of caffeine citrate on the activation of diaphragmatic motion has not been extensively researched. Objectives: This observational study aimed to assess the changes in electrical activity of the diaphragm in response to caffeine citrate administration and discontinuation in preterm neonates. Methods: Preterm infants [<34 weeks' gestational age (GA)] admitted to a level-IV neonatal intensive care unit in South Korea supported by invasive or non-invasive neurally adjusted ventilatory assist with caffeine citrate administration were prospectively enrolled in this observational study. The electrical activities of the diaphragm (Edi), Edipeak and Edimin values, before and after administering the loading and initial maintenance doses of caffeine citrate, and before and up to 48 hours after discontinuation, were analyzed. Results: Thirteen infants with a GA and birthweight of 28.8 +/- 2.1 weeks and 1231 +/- 441 g, respectively, were included. Edipeak and Edimin tended to increase when the neural respiration rate was >= 30 breaths/min. Edipeak and Edimin showed a higher trend after caffeine citrate loading and maintenance dose administration, particularly in infants born at < 28 weeks of GA or with a birthweight of < 1250 g, compared with those born at >= 28 weeks of GA or with a birthweight >= 1250 g. Caffeine citrate discontinuation resulted in an increased number of episodes of apnea and de saturation. Conclusions: Changes in Edipeak and Edimin showed different trends depending on perinatal factors. On caffeine citrate cessation, monitoring changes in clinical symptoms in near-term post-menstrual age may be prudent.
Background: Neonatal respiratory distress syndrome (RDS), also known as hyaline membrane disease (HMD), occurs due to a deficiency of pulmonary surfactant (PS), leading to rapid onset, fast progression, and poor prognosis of the disease. Objectives: To analyze the perinatal high-risk factors for RDS in late preterm infants. Methods: This was a case-control study. One hundred and thirty-eight late preterm infants admitted to our hospital from January 2022 to December 2023 were selected and divided into the observation group (n = 36) and the control group (n = 102) based on the occurrence of RDS. The general conditions and risk factors of the two groups were analyzed using univariate analysis and multivariate logistic regression analysis. Results: Univariate analysis of perinatal high-risk factors in late preterm infants indicated significant differences in male sex, elective cesarean section, amniotic fluid aspiration, premature rupture of membranes (PROM), intrauterine hypoxia, pregnancy complications, and other factors between the two groups (P < 0.05). Meanwhile, a multivariate logistic regression analysis was performed for the factors with statistically significant differences. This analysis found that all univariate factors with statistically significant differences, except for intrauterine hypoxia, were high-risk factors for RDS in late preterm infants (P < 0.05). Conclusions: The indications for cesarean section should be strictly controlled, health education during pregnancy should be strengthened, maternal newborns with pregnancy complications should be monitored as early as possible, and effective intervention measures should be taken to reduce the risk of RDS.
