OBJECTIVES:5α-reductase deficiency type 2 (5αRD2) is the second most common cause of 46, XY disorders of sex development. The 5α-reductase type 2 isozyme, which is encoded by the SRD5A2 gene, catalyzes the conversion of testosterone (T) to dihydrotestosterone (DHT). This study aimed to evaluate the clinical, laboratory, and molecular characteristics of patients with 5αRD2. METHODS:We retrospectively analyzed the clinical, laboratory, and genetic features of thirteen patients diagnosed with 5αRD2. Age, gender assignment, presenting features, hormonal profiles, and SRD5A2 variants were evaluated. RESULTS:The median age of the patients at diagnosis was 4.16 years (IQR: 0.63-10.73 years) (range: 1 month - 14.4 years). At presentation, two patients were in mini-puberty, seven were prepubertal, and four were pubertal. All patients were genetically 46,XY; however, their assigned gender at presentation differed. Gender was assigned as male in 77% of cases and as female in 23% of cases. The most common presenting feature was micropenis. The median baseline and stimulated T/DHT ratios were 6.7 (IQR: 5.3-33) and 61.7 (IQR: 32.18-104.73), respectively. Molecular analysis revealed four different variants of the SRD5A2 gene; homozygous deletion of exon 1, c.193G>C (p.Ala65Pro), c.578A>G (p.Asn193Ser) and c.586G>A (p.Gly196Ser). Clinical features and hormonal data were compared between patients with missense variants and those with homozygous deletion of exon 1. The frequencies of hypospadias and cryptorchidism, as well as baseline T/DHT ratios, were similar between the groups. However, stimulated T/DHT ratios were higher in patients with deletion of exon 1. CONCLUSIONS:This study provides valuable insights into the clinical and molecular spectrum of 5αRD2. To the best of our knowledge, this is the first report presenting a large family with a homozygous deletion of exon 1 in the SRD5A2 gene.
OBJECTIVE:Human metapneumovirus (HMPV) is a significant cause of acute respiratory tract infections (ARTIs) in young children. This study aimed to describe the clinical characteristics, co-infection patterns, and seasonal trends of HMPV in children under 5 years of age. METHODS:This retrospective study included pediatric patients under 5 years old admitted to Jordan University Hospital (JUH) between October 2014 and May 2024 with PCR-confirmed HMPV infection. Demographic, clinical, laboratory, and outcome data were extracted from medical records. RESULTS:A total of 109 pediatric patients were diagnosed with HMPV. The most frequent symptoms were fever (75%), difficulty breathing (72%), and feeding difficulties (68%), while common clinical signs included dyspnea (63%), abnormal chest sounds (60%), and retractions (45%). Co-infection was significantly associated with prematurity (p = 0.039). Patients with isolated HMPV infections were more likely to receive nebulized therapy (p = 0.020), whereas those with co-infections more frequently required high-flow nasal cannula support (p = 0.007). Rhinovirus, RSV, and bocavirus were the most commonly detected co-pathogens. Most HMPV cases occurred between January and April. CONCLUSIONS:HMPV represents a significant cause of pediatric respiratory illness. Co-infections were frequent and associated with increased respiratory support requirements. These findings enhance understanding of HMPV's clinical presentation and outcomes.
BACKGROUND:Chronic diseases affect up to 15% of adolescents, and their prevalence continues to rise. As adolescence and chronic diseases interact in complex and evolving ways, ensuring comprehensive care and facilitating a successful transition to adult services are major challenges for pediatric services. It is essential to take psychosocial aspects into account to promote autonomy and continuity of care during this vulnerable period. OBJECTIVES:To assess how psychosocial dimensions are evaluated and documented among adolescents with chronic illnesses in specialized pediatric services, and to explore healthcare professionals' views on barriers to addressing sensitive issues. METHODS AND SETTING:We conducted a retrospective analysis of paper and electronic medical records of adolescents transferred to adult care between December 2015 and February 2021 from two pediatric units (Gastroenterology and Urological & Digestive Surgery). Psychosocial data were extracted using a form. In parallel, 27 healthcare professionals (16 physicians, 11 nurses) completed a self-administered questionnaire about their practices and the perceived obstacles to discussing psychosocial issues. RESULTS:Forty-six patient records were analyzed (35% female). The median follow-up time was 19 years [IQR 10-20] in Surgery and 7 years [IQR 5-12] in Gastroenterology, with a total of 16 diagnoses. Home (96%), education (93%), and activities (87%) were the most frequently recorded domains, while substance use (26%), sexuality (30%), and mental health (32%) were rarely noted. Sexuality was documented significantly more often in girls than boys (75% vs 7%, p < 0.001). Reported barriers included lack of time (62%), privacy concerns (56%), and the assumption that another professional would address the issue (44%). CONCLUSION:Although psychosocial assessment is recognized as essential, it remains irregularly performed and documented. Implementing validated and structured tools could help standardize practice, improve multidisciplinary communication, and ultimately facilitate the transition of adolescent to adult care.
BACKGROUND:In cystic fibrosis (CF), respiratory disease is the main determinant of prognosis. However, the prevalence and determinants of bronchodilator reversibility (BDR) in pediatric patients remain poorly characterized. OBJECTIVE:This study aimed to estimate the prevalence of significant BDR and to identify associated clinical and microbiological factors in children with CF (CwCF). METHODS AND SETTINGS:We conducted a retrospective study including CwCF under 20 years of age followed at Armand Trousseau Hospital between April 2018 and July 2024. A total of 48 CwCF and 164 pulmonary function tests (PFTs) including a bronchodilator assessment were analyzed. BDR was assessed using spirometric indexes and respiratory resistance measured by the interrupter technique (Rint). Univariate and multivariate logistic regression analyses were performed to identify factors associated with BDR. RESULTS:Significant BDR (BDR+) was observed in 16 CwCF (33% [95% CI: 20-48]) at least once during follow-up, mainly detected through a significant decrease in Rint (n = 14, 87.5%), and less frequently through spirometric criteria (increase in forced expiratory volumes, n = 6, 37.5%). In multivariate analysis, BDR+ remained independently associated with the presence of an obstructive ventilatory defect (p = 0.007) and with the total number of PFTs performed (p = 0.035). Chronic colonization with Pseudomonas aeruginosa was associated with BDR+ in univariate analysis (p = 0.006) but not after adjustment (p = 0.30). No significant association was found with sex, clinical asthma, or allergic bronchopulmonary aspergillosis. CONCLUSION:Significant bronchodilator reversibility was present in approximately one-third of CwCF, predominantly detected using respiratory resistance measurements. These findings highlight the importance of comprehensive functional respiratory follow-up in CwCF, including resistance measurements, and support a more individualized and functionally guided use of inhaled therapies.
PURPOSE:This systematic review explores the family experiences of hospital-at-home (HaH) care for children in paediatric palliative care (PPC). While the HaH model is increasingly promoted as a safe and cost-effective alternative to hospital-based care, particularly in paediatrics, little is known about how families and children in PPC actually experience this form of care. METHODS:We conducted a comprehensive search across five databases: PsycArticles, PsycInfo, PubMed, ScienceDirect, and Scopus. The search was limited to articles published between 2010 and 2023, in English or French, involving children in PPC aged 0-18 receiving HaH care. RESULTS:Twenty studies were included. Most of them focus on the parents' perspective, describing both the benefits and the emotional challenges of caring for a dying child at home. At home, children receiving PPC, find comfort in their daily routine, the closeness of their loved ones and reassuring familiar surroundings. Parents experience ambivalence between the relief of being together and the burden of care, fatigue and isolation, with mothers often taking on the bulk of the responsibility. Siblings, who are more present than in hospital, oscillate between participation, withdrawal and anxiety about death. Home hospitalisation strengthens family cohesion while accentuating tensions and emotional strain at home. CONCLUSION:Overall, the review highlights the value of HaH care while underscoring the need for more inclusive, child-centred and family-oriented research.
INTRODUCTION:In France, 4866 cases of tuberculosis were reported in 2023, of which 5.3% involved children. The pediatric population is at higher risk of developing severe forms (miliary or meningeal tuberculosis). The BCG vaccine is effective in protecting young children against these severe forms. It is recommended for a targeted pediatric population, but vaccine coverage remains insufficient. Early prevention through identifying eligible newborns in maternity care could help improve vaccination coverage among high-risk populations. OBJECTIVE:This study assessed caregivers' knowledge of BCG vaccination indications and circuits in two maternity wards in the city of Toulouse (France), using a questionnaire. A second evaluation was conducted after a training session and the distribution of practical tools, to measure their impact on caregivers' knowledge and involvement. RESULTS:Caregivers' knowledge of BCG vaccination indications was insufficient (2.2 ± 0.33 correct indications out of 6). The development and implementation of training and prevention tools for caregivers helped improve their understanding of vaccination indications (2.6 ± 0.14 correct indications), identification (22.6 vs 45%), and prevention (17.7 vs 30%) CONCLUSION: Targeted vaccination requires greater caregiver training efforts than generalized and/or mandatory vaccination to improve implementation. For BCG vaccination, such training should ideally be provided to maternity staff.
INTRODUCTION AND OBSERVATIONS:Hemiconvulsion-hemiplegia-epilepsy (HHE) syndrome is a rare complication of prolonged focal status epilepticus in childhood. The typical course follows a complex febrile convulsion and status epilepticus, typically in a child under 4 years of age, accompanied by cytotoxic edema of one hemisphere, evolving secondarily to atrophy and refractory seizures. We present a case series from Mayotte Island, providing a clinical and radiological chronological picture of this neurological disorder, with Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans taken at different stages of the disease. CONCLUSION:HHE syndrome is a rare clinic-radiological syndrome that complicates prolonged febrile illness. Understanding the spontaneous evolution of this pathology makes it possible to limit explorations and even to project on the long-term prognosis, in the absence of known therapies.
BACKGROUND:The digital world affects people, especially children, who are exposed to it from an early age. This consumption, excessive at times, and its effects on children's development are of growing concern to pediatric authorities and the public sector. However, few studies on digital use among children aged 3 to 11 have been conducted in priority education networks in France. OBJECTIVES:The aim of this study is to investigate screen exposure by elementary school children and its evolution with age in a disadvantaged socioeconomic context. METHODS AND SETTINGS:Data on family structure and socio-professional category were collected from parents on paper. Quantitative data were collected from 366 children (divided into 3 cycles: aged 3-6, 6-9, and 9-12), in a school group located in a priority education network. RESULTS:Among the 366 children interviewed, 85.2 % reported using screens daily, particularly after school in the evening. This proportion was quite stable across school cycles, ranging from 81 % to 88 %. Close to 50 % of children in Cycles 1 and 2 have their own screen, a proportion that rises to 79.1 % in Cycle 3 (p < .0001). Among significant developments across cycles, we observed an increase in smartphone ownership (from 6.6 % to 57.1 %, p < .0001). Watching television during meals was already high in Cycle 1 (77.9 %) and did not significantly change across cycles, but appeared significantly more in single-parent than in two-parent families (p = .006). CONCLUSION:We observed that the new uses in Cycle 2 is linked to children's autonomy, whereas it is linked to the ownership of a digital device in Cycle 3. The type of digital device children own at each cycle reflected both the intrinsically nomadic nature of screens and their fun dimension. Exposure to screens at an early age is steadily increasing, exceeding official recommendations, particularly in priority education networks.
BACKGROUND:Few studies have examined the quality of life (QOL) of children undergoing surgery for non-syndromic craniosynostosis (NSC), with no age-specific assessment in France. OBJECTIVE:The CRANIOQUALITY study aimed to assess QOL across different age groups in children treated for non-syndromic craniosynostosis at Clermont-Ferrand University Hospital, France. PATIENTS AND METHODS:We evaluated QOL in a cohort of children who underwent surgery for NSC between 2012 and 2020, using the PedsQL™ 4.0 and the PedsQL™ Family Impact Module. RESULTS:The study included 37 participants, with 33 PedsQL™ Family Impact Module questionnaires, 32 PedsQL™ 4.0 parent questionnaires, and 20 PedsQL™ 4.0 child questionnaires for analysis. The average family impact score was 90.74%, with mean QOL scores of 87.36% for parents and 87.93% for children. Children reported significantly higher QOL scores than a control group in the physical (p=.0206) and academic (p=.0052) dimensions, while parents noted higher QOL scores in the physical dimension (p=.0340). CONCLUSION:Surgical treatment for NSC in children at Clermont-Ferrand University Hospital did not significantly affect their health-related QOL. QOL indicators can serve as valuable tools for assessing rare disease care quality. Age-specific QOL assessment could provide a more accurate evaluation of surgical treatment's impact on QOL.
BACKGROUND:Traditional medicine plays a central role in Morocco, particularly in rural and disadvantaged communities where access to modern healthcare remains limited. Among traditional healers, those specializing in pediatrics, known as ferraguas, are frequently consulted during infancy and childhood. This study aimed to determine the frequency of recourse to pediatric traditional healers, identify associated determinants, and describe the profiles of families involved. METHODS:We conducted a prospective survey among 500 parents of children presenting to the Pediatric Emergency Department of the Children's Hospital of Rabat between October 1 and November 15, 2023. A standardized questionnaire was used to collect sociodemographic data, reasons for consulting traditional healers, symptoms managed, practices employed, family satisfaction, and awareness of associated risks. Data were analyzed using Jamovi 2.5; chi-square tests were applied to assess associations (p < 0.05). RESULTS:Of the 500 families surveyed, 295 (59 %) reported consulting a pediatric traditional healer. Consultations were primarily initiated by mothers (79.7 %) and grandmothers (14.9 %). Recourse to pediatric traditional healers increased with caregiver age (30 % among those aged 17-25 years, 58 % among those aged 26-45 years, 74 % among those aged 46-55 years, and 69 % among those aged ≥55 years; p < 0.001), rural residence (75.9 % vs. 47 % in urban areas, p < 0.001), and lower educational level (77 % among parents with no schooling vs. 29 % with higher education, p < 0.001). The most common reasons for consultation were lower cost (27 %) and limited access to modern healthcare (21 %). The most frequent conditions managed included respiratory disorders (26 %), fever (20 %), cranial deformities (19 %), and persistent crying (17 %). Unidentified herbal mixtures were administered in 44 % of cases, and although 61 % of parents expressed satisfaction, only 40 % of respondents were aware of potential risks. CONCLUSION:Recourse to traditional pediatric healers remains highly prevalent in Morocco and is strongly associated with rural residence, low educational attainment, and older caregiver age. These findings highlight the need to strengthen caregiver health education, particularly in underserved regions, given the limited awareness of potential risks observed in this study.
BACKGROUND:Adolescent obesity is a chronic condition. The pathophysiology of this complex disease involves genetic mechanisms that influence appetite regulation via the hypothalamus, with environmental factors acting as triggers or aggravating factors. METHODS:Curative treatment relies on a restrictive diet, which is difficult to maintain long term. In this context, pharmacotherapy, particularly GLP-1 analogues, has proven effective in adults and is considered a therapeutic alternative for adolescents. However, their efficacy and tolerance in obese adolescents without diabetes remain poorly studied, particularly in France. RESULTS:This study evaluated the efficacy and tolerance of liraglutide in 20 obese, non-diabetic adolescents in France. Overall efficacy was lower than expected and lower than in previous publications. Eleven patients (55%) lost weight, but only 3 (15%) lost >5%. However, 7 of the 12 patients (58%) whose body composition was measured lost at least 5% of their fat mass. Sixty-five percent of patients experienced gastrointestinal side effects (nausea, vomiting, diarrhea). These side effects led to discontinuation of treatment in 20% of patients. CONCLUSION:Although our study is limited by its small sample size and single-center design, it confirms the poor efficacy of liraglutide in obese adolescents. However, drug treatments remain a promising therapeutic option for adolescent obesity. Future development will likely enable more effective management of obese adolescents.
INTRODUCTION:In recent years, neonatal care has undergone major transformations, moving toward a philosophy of Infant and Family Centered Developmental Care (IFCDC). This shift includes promoting parental involvement and adapting neonatal unit architecture accordingly. In France, the GREEN of the French Neonatal Society has issued recommendations to support this evolution, but little data exist on their implementation. METHODS:A nationwide survey was conducted from February to May 2025 across all 60 level III maternity hospitals in mainland France. A 25-question online form was distributed to neonatal intensive care units (NICUs). The objective was to assess NICU architecture and the implementation of the IFCDC guidelines in France. RESULTS:A total of 35 centers responded (58% response rate), including 80% of university hospitals. On average, individual rooms represented 69% of NICUs, 65% of neonatal intermediate care units, and 71% of standard neonatal care units, while family individual rooms accounted for only 8%, 7%, and 21%, respectively. When available, their mean surface area was 17.4 m² ± 4.80 m². Unrestricted sibling visits were allowed in 71.4% of centers, and unrestricted extended family or friend visits in 51.4%. Family-centered rounds (FCR) were implemented in 34.3% of units. Nearly all centers (97.1%) had windows with blinds or shutters, and 48.6% reported that all rooms had external windows. Ambient light cycling was practiced in 54.3% of units. Most centers provided parental amenities such as communal living spaces, counseling rooms, and lactation rooms with milk storage facilities. CONCLUSION:This study provides a nationwide overview of the architectural design of the NICUs and the implementation of the IFCDC guidelines in France. It highlights thoroughgoing improvements but also underlines existing structural and organizational limitations.
BACKGROUND:Acute gastroenteritis (AGE) is a common childhood infection that causes vomiting and diarrhea due to gastrointestinal inflammation. While clinical scoring systems exist to assess dehydration severity, predicting the most suitable rehydration method remains challenging. Studies have suggested a correlation between blood ketone levels and clinical dehydration in children with AGE. OBJECTIVE:This study aimed to determine a threshold value for capillary blood ketone levels to guide the selection of appropriate rehydration methods in children with mild to moderate AGE. METHODS AND SETTINGS:This observational, retrospective, single-center study analyzed data from 540 children aged 3 months to 10 years presenting with AGE symptoms at a pediatric emergency department between September 2023 and August 2024. Clinical parameters, biological markers, and rehydration methods were collected. Statistical analysis included ROC curves to assess the predictive value of capillary blood ketone levels for intravenous (IV) or nasogastric tube rehydration. RESULTS:The median age was 2 years, and 52% of the children were girls. Of the 405 children with measured blood ketone levels, 186 (35%) required IV or nasogastric tube rehydration. Median capillary blood ketone levels were significantly higher in children requiring IV/nasogastric rehydration (3.45 mmol/L, IQR 3.5) compared to those managed without or with oral rehydration (1.2 mmol/L, IQR 2.1)(p < 0.001). ROC curve AUC was 0.75 (95% CI: 0.70-0.80). A threshold value of 2.5 mmol/L demonstrated 62% sensitivity, 79% specificity, 68% positive predictive value, and 74% negative predictive value. CONCLUSION:The need for IV or nasogastric tube rehydration in children with AGE can be determined with moderate accuracy using capillary blood ketone measurement. A point-of-care blood ketone measurement with a threshold of 2.5 mmol/L could be an additional objective, rapid, and cost-effective tool that helps healthcare providers make treatment decisions and improve patient referrals in both primary and emergency settings.
BACKGROUND:Health-related physical fitness is critical from early childhood, yet it is unclear whether children and adolescents with attention-deficit/hyperactivity disorder (ADHD) differ from their typically developing (TD) peers. OBJECTIVE:To systematically review and meta-analyze differences in health-related physical fitness between children and adolescents with and without ADHD. METHODS:and Setting: Seven electronic databases were searched for studies comparing cardiorespiratory fitness, muscular strength, and flexibility between children and adolescents with ADHD and TD peers. Methodological quality was evaluated using the Mixed Methods Appraisal Tool. RESULTS:Thirteen studies including 1,814 participants (560 with ADHD, 1,254 typically developing [TD]) were reviewed. Eleven studies assessed cardiorespiratory fitness. Pooled data from two VO₂peak studies (28 ADHD, 33 TD) showed no significant group differences (mean difference = -4.28 mL·kg⁻¹·min⁻¹; 95% CI: -10.51 to 1.96; p = 0.18; I² = 59%). Seven studies using field-based tests revealed mixed outcomes. Pooled data from six studies using the 20-meter Shuttle Run or PACER test (149 ADHD, 949 TD) indicated significantly lower performance in the ADHD group (standardized mean difference = -0.46; 95% CI: -0.78 to -0.14; p = 0.004; I² = 47%). Five studies examining heart rate variables reported no significant differences (mean difference = 2.23 bpm; 95% CI: -2.72 to 7.19; p = 0.38; I² = 42%). Muscular strength outcomes (six studies) and flexibility (five studies) showed minimal differences between groups (strength: SMD = -0.07, 95% CI: -0.31 to 0.17; flexibility: SMD = -0.16, 95% CI: -0.65 to 0.33), with low-to-moderate heterogeneity. CONCLUSION:Children and adolescents with ADHD exhibit comparable levels of muscular strength and flexibility to their TD peers. Evidence on cardiorespiratory fitness is mixed and depends on assessment methods: field-based tests indicate lower performance in ADHD, while laboratory peak oxygen uptake (VO₂peak) and resting heart rate measures show no significant differences.
BACKGROUND:Early notification of suspected child abuse (SCA) to the authorities is a public health issue. OBJECTIVE:To assess clinical and imaging findings associated with notification. METHODS AND SETTINGS:Retrospective, single-center cross-sectional study involving children under three years of age with SCA. Clinical and imaging findings were collected. Reports of suspected child abuse were analyzed according to patients' demographic characteristics, clinical features, and imaging findings. RESULTS:We included 126 children suspected of child abuse. Notification was more likely for neurologic ([odds ratio] OR = 5.49, [95% confidence interval] 95% CI [1.29, 23.36], p= 0.021) or orthopedic signs (OR = 6.00, 95% CI [1.02, 35.38], p= 0.048). Positive findings in MRI (OR = 7.35, 95% CI [3.23, 16.70], p < 0.001), skeletal survey (OR = 2.46, 95% CI [0.97, 6.25], p= 0.059), bone scintigraphy (OR = 11.0, 95% CI [1.34, 90.21], p= 0.026) and fundus examination (OR = 9.14, 95% CI [2.51, 33.29], p < 0.001) were also associated with a notification. The absence of a skeletal survey (OR = 0.09, 95% CI [0.02-0.33], p < 0.001), bone scintigraphy (OR = 0.21, 95% CI [0.09-0.49], p < 0.001), or fundus examination (OR = 0.08, 95% CI [0.02-0.29]) was significantly associated with a lower likelihood of suspected child abuse notification. CONCLUSION:Good knowledge of the clinical and imaging signs (including sentinel lesions and standardized additional examinations) that are suggestive of child abuse is essential for child abuse detection and notification to the authorities.
BACKGROUND:Although recommendations for structured transition programs in adolescents with Inflammatory Bowel Diseases (IBD) have been published, few studies have addressed the implementation of transition in real-life settings at a national level. OBJECTIVES:The aim of this study was to report nationwide transition practices in IBD patients. METHODS AND SETTING:Data were collected using two anonymous questionnaires sent to pediatric gastroenterologists (PGs) and adult gastroenterologists (AGs) via the newsletters of French societies and groups specializing in adult and pediatric gastroenterology, between December 2023 and March 2024. RESULTS:A total of 127 questionnaires were analyzed (PGs: n = 83; AGs: n = 44). Transition was structured for 44% of respondents, more frequently among PGs than AGs (51%vs 32%, p = 0.042). Among those, 52% had a designated transition coordinator and 64% provided an educational program. Structured practices and joint consultations were more common in University Hospitals (UHs) than in General Hospitals (GHs) or private practice (PP), for both PGs (p = 0.002 and p = 0.003, respectively) and AGs (p = 0.008 and p < 0.001, respectively). Although the prerequisites expected of patients before transition differed between PGs and AGs, patient adherence was considered essential by 91% of respondents. Among PGs, transfer occurred mainly after the age of 17 years (91%). For AGs, 66% considered 17-18 years as the optimal age for transfer, with no significant difference across practice settings. CONCLUSION:While some structured processes are in place, broader efforts are needed to enhance IBD transition practices nationwide.
BACKGROUND:Oral abnormalities resulting from childhood leukemia treatment may significantly impact long-term health outcomes. OBJECTIVES:This prospective study aims to evaluate oral health, to assess oral health-related quality of life (OHRQoL) among leukemia survivors, its impact on general Health Related Quality of Life (HRQoL) and to identify risk factors for oral health impairments. METHODS:Dental examination was proposed to patients included in the LEA cohort (long-term follow-up of childhood/adolescent leukemia survivors) in two pediatric hematology centers. For cavities, Decayed/Missing/Filled/Teeth (DMFT/dmft) index was determined. Quantitative and qualitative saliva analyses were performed. Orthopantomograms were independently reviewed. OHRQoL was assessed using age-adapted questionnaires. Patient characteristics, treatment history, socio-economic status and HRQoL were extracted from LEA database. Statistical analyses were performed using SPSS software. Pearson's Chi2/Fisher's exact test/Student's t-test/Spearman correlation test/Adjusted multivariate logistic regression model were used when appropriate. RESULTS:Eighty-nine patients were included with a mean follow-up from diagnosis of 12.5 ± 0.8 years. Females represented 48% of the cohort, acute lymphoblastic leukemia 76%. A history of leukemia relapse concerned 27% of patients; 45% of the cohort underwent hematopoietic stem cell transplantation (HSCT). Eighty-five patients had ≥1 oral abnormalities (excluding cavities); 53 required treatment intervention. Mean DMFT/dmft index was 2.3 ± 0.4; lower parents' education level was linked with higher index (p = 0.029). Younger age at diagnosis (<6 years old) was associated with enamel defects (p = 0.001). History of relapse was associated with teeth number, morphology and eruption abnormalities (p < 0.05). HSCT was associated with morphology abnormalities (p < 0.05). Among transplanted patients, no significant impact of total body irradiation on oral abnormalities was found as compared to busulfan-based conditioning regimen. In children, altered OHRQoL tend to have a negative impact on body image and physical well-being. CONCLUSION:The high prevalence of oral abnormalities in pediatric leukemia survivors necessitates proactive dental monitoring and early interdisciplinary collaboration between pediatrician and dentists.
Background Intrafamilial violence against children is a significant public health issue with long-lasting medical, psychological, and legal consequences. Forensic physicians play a critical role in documenting such abuse, yet their contributions are often overlooked. Objective Describe the characteristics of forensic medical evaluations performed on child victims of suspected intrafamilial abuse and assess the scope of the forensic physician’s role. Methods and Settings This retrospective observational study was conducted at the Forensic Medical Unit (UMJ) of La Timone Hospital in Marseille. All medico-legal reports for minors (under 18 years old) who were referred for suspected intrafamilial violence between January 2020 and May 2022 were reviewed. Cases involving accidental or extrafamilial violence were excluded. Results Among the 15,569 individuals examined at the Forensic Unit, 1008 forensic certificates involved minors in cases of intrafamilial abuse: 423 boys and 585 girls aged from 6 days to 17 years. Physical abuse was reported by 78% of children: 61% had at least one injury upon physical examination (mainly bruising), and more than a quarter of these injuries were identified as non-accidental. Psychological abuse was reported by 16% of children and was associated with physical abuse in 94% of cases. Significant psychological distress was observed in 16%, primarily among those over 12 years old. Neglect, mainly physical neglect, was reported in 19% of minors. Conclusion The study underscores the recurrent and complex nature of intrafamilial abuse and highlights the unique yet constrained role of forensic physicians. Enhancing multidisciplinary collaboration, such as through specialized pediatric forensic units (UAPED), is crucial for improving the assessment and documentation of all dimensions of child abuse.
