Background and objectives. Nephrotic syndrome (NS) is characterized by massive proteinuria, which may lead to urinary loss of vitamin D-binding protein and subsequent vitamin D deficiency. Vitamin D has immunomodulatory effects mediated through vitamin D receptor activation, including modulation of the T helper 17 (Th17) pathway and interleukin-17 (IL-17), a cytokine involved in podocyte injury and inflammation. This study evaluated the effects of two doses of vitamin D₃ supplementation on serum 25-hydroxyvitamin D [25(OH)D] and IL-17 levels in children with NS. Materials and methods. In this randomized, double-blind, controlled trial, children aged 1-18 years with NS were allocated to receive standard therapy plus oral vitamin D₃ at either 400 IU/day (Group I) or 1000 IU/day (Group II) for four weeks. Serum 25(OH)D and IL-17 concentrations were measured at baseline and after the intervention. Within-group and between-group analyses were performed to assess changes in these parameters. Results. After four weeks, serum 25(OH)D levels increased significantly in both groups. The median increase was 4.7 ng/mL in Group I (p = 0.001) and 5.1 ng/mL in Group II (p = 0.018), with no significant difference between groups (p = 0.903). IL-17 levels decreased in both groups; however, these reductions were not statistically significant. The median change was −0.26 pg/mL in Group I (p = 0.057) and −0.18 pg/mL in Group II (p = 0.469), with no significant between-group difference (p = 0.682). Conclusions. Vitamin D₃ supplementation at 400 IU/day and 1000 IU/day modestly increased serum 25(OH)D levels in children with NS but did not significantly reduce IL-17 levels over four weeks. The short intervention duration, relatively low supplementation doses, and persistent proteinuria may have limited the detectable immunomodulatory effects of vitamin D in this population.
Background and objectives. Differentiating simple from complicated pediatric acute appendicitis remains challenging. Interleukin-8 (IL-8) has been proposed as a potential severity biomarker. This study evaluated the association between preoperative serum IL-8 levels and clinical severity in pediatric acute appendicitis. Materials and methods. This cross-sectional study included 34 pediatric patients undergoing appendectomy at a tertiary center. Perforation was defined based on combined intraoperative findings and histopathological grading. Preoperative serum IL-8 levels were measured using ELISA. Due to the non-normal distribution of IL-8 values, data were analyzed using the Mann-Whitney U and Kruskal-Wallis tests, including a sensitivity analysis for imbalanced Pediatric Appendicitis Score (PAS) subgroups (PAS ≤6 vs. PAS ≥7). Results. The cohort had a median age of 11.5 years, and the perforation rate was 61.8%. The overall median IL-8 level was 43.34 pg/mL (IQR: 10.12-1123.88). Although median IL-8 levels were higher in perforated than in non-perforated cases (143.90 vs. 10.87 pg/mL; p = 0.073) and increased across PAS categories (PAS 5-6: 11.54 pg/mL; PAS 9-10: 1994.68 pg/mL; p = 0.360), these trends did not reach statistical significance. Sensitivity analysis comparing PAS ≤6 and PAS ≥7 also yielded non-significant results (p = 0.296). Conclusions. In this exploratory study, serum IL-8 showed an upward trend with increasing clinical severity and perforation status. However, because these associations did not reach statistical significance, the findings should be interpreted strictly as hypothesis-generating. The results suggest that systemic IL-8 may reflect localized inflammatory burden rather than serve as a standalone predictive clinical tool. Adequately powered studies incorporating multivariable modeling are required to evaluate its potential value in combination with clinical and laboratory parameters.
Introduction. Acute pancreatitis due to biliary disease is increasingly recognized in the pediatric population, particularly in older children and adolescents. Early identification of a biliary obstructive mechanism is clinically relevant, as definitive treatment may reduce the risk of recurrence. Case presentation. We report the case of a 13-year-old girl with obesity, hypothyroidism, and previously documented biliary lithiasis, who presented with acute-onset upper abdominal pain, nausea, and vomiting. Laboratory evaluation revealed marked hyperamylasemia associated with elevated cholestatic and liver enzymes. Abdominal ultrasonography demonstrated biliary microlithiasis and common bile duct dilatation, while contrast-enhanced abdominal CT showed a hydropic gallbladder, dilatation of the intrahepatic bile ducts and common bile duct, pancreatic edema, and peripancreatic inflammatory changes. These findings supported the diagnosis of acute biliary pancreatitis due to an obstructive mechanism associated with biliary microlithiasis. Conservative management, including gastrointestinal rest, intravenous fluids, antispasmodic therapy, proton pump inhibitor treatment, and antiemetics, was followed by favorable clinical and biochemical evolution. Given the recurrent biliary symptoms and documented obstructive biliary mechanism, the patient subsequently underwent cholecystectomy, with a favorable postoperative outcome. Conclusions. This case emphasizes biliary microlithiasis as a clinically relevant cause of acute pancreatitis in adolescence, especially in adolescents with obesity, and highlights the importance of early etiological assessment, clinical, laboratory, and imaging correlation, as well as timely definitive biliary management.
Background and objective. There is still controversy regarding whether placement of peripherally inserted central catheters (PICCs) in the upper or lower limb is associated with a lower risk of catheter-related complications. This study was conducted to compare complications associated with upper- and lower-limb PICC placement in infants admitted to the NICU. Methods. Present prospective cohort study included 200 infants (100 with upper-limb PICCs and 100 with lower-limb PICCs) hospitalized in the NICU of Shahid Akbarabadi Hospital in 2022 who received their first PICC during hospitalization. Data on demographic characteristics, insertion site, PICC duration, and complications, including leakage, sepsis, thrombosis, edema, phlebitis, pleural effusion, cardiac complications, and catheter displacement, were recorded. PICC insertion was performed by trained neonatal nurses under supervision, and tip position was confirmed by radiography and echocardiography. All infants were followed until discharge, and complications were analyzed using SPSS version 24 with chi-square tests. Results. Overall, 27.5% of the infants had complications, and no significant difference was observed between the two groups in the total complication rate. Sepsis (positive blood culture or PICC tip culture; upper limb = 10%, lower limb = 0%), edema (upper limb = 8%, lower limb = 0%), and tachycardia (upper limb = 0%, lower limb = 9%) showed significant differences, whereas phlebitis (upper limb = 5%, lower limb = 1%) did not show a statistically significant difference. Conclusion. Although there was no significant difference in the overall incidence of complications between premature infants with upper- and lower-limb PICCs, sepsis and edema were more frequent in the upper-limb group, whereas tachycardia was more frequent in the lower-limb group. Phlebitis was also more common in the upper-limb group, but the difference was not statistically significant.
Background. Sharp foreign body ingestion in children is uncommon but carries significant risk of gastrointestinal bleeding, obstruction, and perforation. Glass fragments, in particular, pose diagnostic and management challenges due to variable radiopacity and unpredictable migration. Case presentation. A three-year-old boy presented after swallowing a glass shard from a broken drinking glass. He remained asymptomatic with unremarkable physical examination and laboratory results. Plain abdominal radiography did not clearly identify the foreign body. CT imaging demonstrated a triangular radiopaque fragment within the gastric antrum. Esophagogastroduodenoscopy revealed esophageal erosion but failed to locate the glass shard. Given the benign clinical status, conservative management was initiated, including high-fiber diet, laxatives, mobilization, and close observation. On day three, the glass shard passed spontaneously in the stool without any complication. Conclusion. This case demonstrates that carefully selected pediatric patients with sharp glass ingestion may be safely managed conservatively under vigilant monitoring and readiness for surgical intervention.
Introduction. Urinary tract infections (UTIs) are among the most common bacterial infections in children and may signal underlying structural or functional abnormalities, particularly in febrile cases. Escherichia coli is the leading pathogen, and prompt diagnosis with appropriate treatment is essential to prevent complications such as renal scarring. Case presentation. We report a 5-month-old baby girl, admitted with high-grade fever, vomiting, irritability, and diarrhea. Laboratory tests revealed leukocytosis, elevated inflammatory markers, significant pyuria, nitrite positivity, and proteinuria. Presepsin level (1903 pg/mL) confirmed systemic bacterial infection. Empirical intravenous cefuroxime was initiated and later escalated to cefotaxime due to clinical deterioration. Supportive measures included intravenous fluids, antipyretics, and probiotics. Abdominal ultrasound showed bilateral renal involvement consistent with acute pyelonephritis, preserved corticomedullary differentiation, and no post-void residual. The patient improved gradually, with normalization of inflammatory markers, and was discharged after 9 days with recommendations for oral antibiotics, dietary adjustments, and pediatric nephrology follow-up. Conclusion. This case highlights the importance of early recognition, biomarker use, and targeted antimicrobial therapy in pediatric UTIs. Addressing comorbidities, such as cow’s milk protein allergy, may reduce recurrence risk. A multidisciplinary approach, combined with careful monitoring and preventive strategies, is essential to optimize outcomes and prevent longterm renal damage.
Background. Yellow phosphorus is a highly toxic rodenticide known to cause fulminant hepatic failure and cardiotoxicity. Adolescent ingestions are often impulsive and associated with emotional distress. Case presentation. We report a 16-year-old girl who ingested approximately 5 g of yellow phosphorus and developed progressive hepatitis, coagulopathy, and severe reversible left ventricular dysfunction. Early administration of N-acetylcysteine and six cycles of plasma exchange led to full hepatic and cardiac recovery. Cardiac dysfunction developed during the acute hepatic failure phase and resolved within 10 days. The patient was followed up for 14 days until discharge. Conclusion. Early aggressive management, including therapeutic plasma exchange, may improve survival in severe yellow phosphorus poisoning. Cardiac dysfunction may be reversible. Psychiatric care is essential in adolescent toxic ingestions.
Background. Sellar and suprasellar tumors can cause visual impairment due to compression of the optic pathways, with bitemporal hemianopia representing a characteristic visual field defect associated with chiasmal involvement. Case report. A 13-year-old boy presented with one month of progressive bilateral blurred vision, more pronounced in the left eye. Best-corrected visual acuity was 20/25 in the right eye and light perception in the left eye. Initial visual field examination demonstrated severe, asymmetric visual field loss. Fundoscopic examination revealed bilateral optic disc atrophy, and optical coherence tomography of the retinal nerve fiber layer showed marked thinning. Magnetic resonance imaging revealed an intrasellar mass with suprasellar extension. The patient underwent transsphenoidal tumor resection followed by hormonal replacement therapy, and histopathological analysis confirmed adamantinomatous craniopharyngioma. At the final follow-up of three months postoperatively, visual acuity improved to 20/20 in the right eye and 20/50 in the left eye. Visual field testing demonstrated residual bitemporal hemianopia. Conclusions. Optic atrophy and bitemporal hemianopia are classic manifestations of suprasellar tumors. Early diagnosis and multidisciplinary management are essential to optimize visual outcomes.
Background. Asthma is a common chronic childhood illness that causes recurrent symptoms and reduced quality of life. In low-resource settings, oral therapies such as montelukast and ketotifen are frequently used. This study compared their effects on asthma severity and pulmonary function in children. Methodology. A randomized, open-label, pragmatic comparative study was conducted at Isra University Hospital, Hyderabad, from March to July 2025. One hundred children aged 5-15 years with clinically stable mild to moderate asthma were enrolled; baseline severity was additionally characterized using PASS, which may reflect current clinical status at presentation. Participants were then randomly assigned to receive montelukast 5 mg nightly (n = 50) or ketotifen 1 mg daily (n = 50) for 3 months. The primary outcome was change in Pediatric Asthma Severity Score (PASS), used pragmatically as a longitudinal measure of symptom burden. Secondary outcomes included FEV₁ and the FEV₁/FVC ratio. Clinically meaningful improvement was evaluated using responder analysis (PASS reduction ≥2 points; FEV₁ improvement ≥10%). Data were analyzed using SPSS version 26. Results. Baseline characteristics were comparable between groups. After 3 months, montelukast showed statistically greater improvement in asthma severity scores than ketotifen (mean PASS reduction 3.16 ± 0.43 vs 2.40 ± 0.53; between-group difference 0.76, 95% CI: 0.57-0.95; p < 0.001). Pulmonary function improved in both groups, with greater gains in the montelukast group for FEV₁ (0.52 ± 0.14 L vs 0.37 ± 0.11 L) and the FEV₁/FVC ratio (0.047 ± 0.014 vs 0.031 ± 0.014; both p < 0.001). Clinically meaningful improvement was more frequent in the montelukast group (PASS ≥2 points: 84.0% vs 62.0%; FEV₁ ≥10%: 76.0% vs 56.0%). Both treatments were well tolerated, with only minor adverse events reported. Conclusion. Montelukast modestly improved asthma severity scores and pulmonary function compared with ketotifen. These findings provide context-specific evidence for low-resource settings but should be interpreted cautiously because of the sample size, short follow-up, open-label design, and pragmatic outcome assessment approach.
Background. Asthma is a common chronic childhood illness that causes recurrent symptoms and reduced quality of life. In low-resource settings, oral therapies such as montelukast and ketotifen are frequently used. This study compared their effects on asthma severity and pulmonary function in children. Methodology. A randomized, open-label, pragmatic comparative study was conducted at Isra University Hospital, Hyderabad, from March to July 2025. One hundred children aged 5-15 years with clinically stable mild to moderate asthma were enrolled; baseline severity was additionally characterized using PASS, which may reflect current clinical status at presentation. Participants were then randomly assigned to receive montelukast 5 mg nightly (n = 50) or ketotifen 1 mg daily (n = 50) for 3 months. The primary outcome was change in Pediatric Asthma Severity Score (PASS), used pragmatically as a longitudinal measure of symptom burden. Secondary outcomes included FEV₁ and the FEV₁/FVC ratio. Clinically meaningful improvement was evaluated using responder analysis (PASS reduction ≥2 points; FEV₁ improvement ≥10%). Data were analyzed using SPSS version 26. Results. Baseline characteristics were comparable between groups. After 3 months, montelukast showed statistically greater improvement in asthma severity scores than ketotifen (mean PASS reduction 3.16 ± 0.43 vs 2.40 ± 0.53; between-group difference 0.76, 95% CI: 0.57-0.95; p < 0.001). Pulmonary function improved in both groups, with greater gains in the montelukast group for FEV₁ (0.52 ± 0.14 L vs 0.37 ± 0.11 L) and the FEV₁/FVC ratio (0.047 ± 0.014 vs 0.031 ± 0.014; both p < 0.001). Clinically meaningful improvement was more frequent in the montelukast group (PASS ≥2 points: 84.0% vs 62.0%; FEV₁ ≥10%: 76.0% vs 56.0%). Both treatments were well tolerated, with only minor adverse events reported. Conclusion. Montelukast modestly improved asthma severity scores and pulmonary function compared with ketotifen. These findings provide context-specific evidence for low-resource settings but should be interpreted cautiously because of the sample size, short follow-up, open-label design, and pragmatic outcome assessment approach.
Background and objective. Malnutrition is associated with deficiencies in macronutrients, micronutrients, and trace elements that are necessary for maintaining proper body homeostasis. Protein-energy malnutrition has been linked to low serum zinc and copper levels. The aim of this study was to determine serum zinc and copper levels in malnourished children and to assess their relationship with selected clinical variables. Methodology. A hospital-based case-control study was conducted over a period of 10 months. Forty malnourished patients admitted to Basrah Teaching Hospital were included. Sixty apparently healthy children, matched for age and sex, were selected as a control group. Serum zinc and copper levels were measured in all participants. Results. Severe underweight, wasting, and stunting were recorded in 87.5%, 84.4%, and 78.1% of patients, respectively. Malnourished children had very low mean serum levels of zinc and copper (zinc: 6.32 ± 2.34 µmol/L; copper: 18.45 ± 5.34 µg/dL; p = 0.001). Binary logistic regression analysis showed that age and paternal occupation were independent risk factors for low serum zinc and copper levels (p < 0.05). Conclusion. Mean serum zinc and copper levels were reduced in malnourished children. Parental unemployment and socioeconomic status may be associated with low levels of these trace elements. Further studies are needed to confirm these findings and explore the underlying mechanisms.
Background. Pediatric myocarditis often presents with nonspecific manifestations, making early recognition in the emergency department (ED) challenging. In Vietnam, data describing the clinical and diagnostic features of pediatric myocarditis at ED presentation remain limited. This study aimed to describe the clinical characteristics, chest X-ray (CXR), and electrocardiographic (ECG) findings of children diagnosed with acute myocarditis at ED admission. Methods. We conducted a retrospective descriptive case series of pediatric patients diagnosed with acute myocarditis and admitted to the Emergency Department of Vietnam National Children’s Hospital between February 2020 and October 2022. Myocarditis was diagnosed according to the 2013 European Society of Cardiology criteria, based on compatible clinical features combined with supportive laboratory, ECG, and imaging findings. Clinical manifestations, CXR, and ECG abnormalities were analyzed across age groups, and initial ED management outcomes were recorded. Results. Forty-eight pediatric patients were included (mean age, 6.2 ± 4.7 years). Tachypnea (79.2%) and tachycardia (75.0%) were the most frequent presenting signs. Respiratory failure occurred in 100% of infants, 75.0% of children aged 1–5 years, and 34.8% of those aged 6–15 years. Heart failure was observed in 85.4% of patients, and shock in 45.8%. Gastrointestinal symptoms, including vomiting (47.9%) and abdominal pain (20.8%), as well as chest pain (20.8%), were more common in older children. Cardiomegaly on CXR was present in 62.5% of cases. ECG abnormalities were identified in 70.8% of patients, most commonly atrioventricular block and premature ventricular contractions (each 18.8%), with ST-segment elevation in 16.7%. Conclusion. Pediatric myocarditis shows age-dependent and largely nonspecific presentations in the ED. Early suspicion and rapid assessment using ECG and chest X-ray are essential to support timely recognition and appropriate escalation of care.
Background. Infective endocarditis is an infection of the heart’s endothelial surfaces. Despite being more prevalent in adults, its incidence is increasing in the pediatric population. Congenital heart disease remains the most important predisposing factor to the infection. In our locality, the characteristics, management, and outcomes of infective endocarditis are not well documented and therefore we aimed to provide a descriptive local overview regarding different aspects of the condition. Methods. A retrospective single-center observational study was conducted using tertiary referral hospital records from January 2022 to December 2024. The data of patients under 18 years diagnosed with infective endocarditis were reviewed. Variables such as demographics, geographic location, clinical presentation, and microbiological data were evaluated. Two separate sets of blood cultures were obtained from each patient. Antimicrobial susceptibility testing was performed using disk diffusion, and results were interpreted according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Treatment plans and outcomes were also described. Results. A total of 15 patients younger than 18 years were diagnosed with infective endocarditis during the study period. Of these, 66.7% were female, and the mean age at diagnosis was 7.6 years. Congenital heart disease was present in 80% of patients, with ventricular septal defect as the most common type (40%). Blood cultures were positive in 10 out of 15 patients (66.7%), while 5 of 15 patients (33.3%) had culture-negative results. The most commonly encountered pathogen was Staphylococcus aureus (33.3%). Echocardiography demonstrated vegetations in 73.3% of patients, most commonly on the ventricular septal defect. Most patients received ceftriaxone plus vancomycin as empiric therapy. The mortality rate was estimated to be around 6.7%. Conclusion. Infective endocarditis is a rare condition that predominantly affects children with congenital heart disease. Despite the study’s limitations, our findings are broadly consistent with published reports. Our findings revealed that two-thirds of patients had positive culture, and Staphylococcus aureus was the most frequently isolated organism. At our center, careful antibiotic use is recommended to limit the emergence of resistant strains, and highlight the needs of larger population studies.
Background and objectives. Atypical hemolytic uremic syndrome (aHUS) is a rare, life-threatening complement-mediated disorder classically defined by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. We report a pediatric case highlighting recurrent disease, initial misdiagnosis, and therapeutic challenges in a resource-limited setting. Case presentation. An 18-month-old boy presented with recurrent episodes of hemolytic uremic syndrome. During his first hospitalization, the condition was misdiagnosed as nephrotic syndrome due to atypical and incomplete clinical features. At the second admission, the patient developed the full HUS triad without evidence of infectious triggers and showed persistently low complement C3 levels, raising strong suspicion of aHUS. Genetic testing was performed after clinical stabilization. Results. Molecular analysis of the complement factor H (CFH) gene identified one likely pathogenic variant and a second variant of uncertain significance, supporting a genetic susceptibility consistent with CFH-associated atypical hemolytic uremic syndrome. Because eculizumab was not available in Vietnam, the patient was managed with repeated fresh frozen plasma transfusions, resulting in marked improvement in hematologic parameters and renal function. The patient was discharged in stable clinical condition with normalization of platelet counts and improvement of hemolytic markers and renal function. Conclusions. This case underscores the importance of considering aHUS in children with recurrent thrombotic microangiopathy, even when the initial presentation is atypical and misleading. It also highlights the diagnostic value of complement studies and genetic testing, as well as the feasibility of plasma-based therapy when targeted complement inhibitors are inaccessible. Early recognition, timely genetic evaluation, and context-appropriate management are critical to improving outcomes in pediatric aHUS, particularly in resource-limited settings.
Background. Mycoplasma pneumonia (MP) infection is a leading cause of respiratory infection as well as community-acquired pneumonia in school-aged children. Case report. A 4-year-old female child presented with fever, cough, dyspnea, tachypnea and hypoxemia. She was clinically diagnosed with severe community-acquired pneumonia with a right-sided pleural effusion, necessitating PICU admission. Initial management included supplemental oxygen and broad-spectrum antibiotics (ceftriaxone and vancomycin), along with oseltamivir and azithromycin. Nasopharyngeal polymerase chain reaction (PCR) identified Mycoplasma pneumoniae, and thoracentesis yielded serosanguineous fluid with elevated adenosine deaminase (ADA). The patient’s worsening clinical status despite initial antibacterial therapy prompted consideration of resistant M. pneumoniae, necessitating the initiation of doxycycline. The patient’s clinical condition improved rapidly, and she was discharged after 7 days with oral doxycycline to complete a 10-day course. She remained asymptomatic during subsequent follow-up. Conclusions. Non-tuberculous infections such as Mycoplasma pneumoniae can cause significant ADA elevation in pleural fluid. Although macrolide antibiotics remain the cornerstone of MP treatment, patients not responding within 72 hours to azithromycin should be evaluated for resistant M. pneumoniae and considered for second-line therapy.
Introduction. Children with congenital heart disease (CHD) are at increased risk for neurodevelopmental impairments, but the magnitude and nature of this association remain unclear. Objective. The present study aimed to evaluate the prevalence and types of neurological abnormalities in infants with CHD. Methods. A systematic search was conducted in international databases such as Web of Science, Psyc INFO, PubMed, Scopus, and Google Scholar for articles published up to September 2024. The review followed the PRISMA 2020 guidelines. Out of 48 initially identified articles, 5 met the inclusion criteria and were included in the final analysis. Studies were assessed using the Newcastle-Ottawa Scale. Results. A total of 570 infants who underwent neurological examination between 5 and 12 months of age were included across the five studies analyzed in this review. Overall, an estimated 72% of infants presented abnormalities in at least one neurological domain. The pooled effect size was 72%, with a 95% confidence interval (CI) ranging from 57% to 88%, indicating that the true prevalence of neurological abnormalities in this population is highly likely to fall within this range. The heterogeneity among studies was low (I² = 10.26%), suggesting consistency across the included data sources. Conclusion. Neurological abnormalities are common in infants with CHD, highlighting the importance of routine neurodevelopmental screening in this high-risk population. Early identification and intervention may help reduce long-term morbidity and improve developmental outcomes. This information may be important for clinical management, parental counseling, and the decision-making process regarding follow-up and therapy.
Background. A common glomerular disease in children, childhood nephrotic syndrome (NS) causes proteinuria, hypoalbuminemia, hyperlipidaemia, and oedema; peak incidence falls between ages 2 and 6. The age at onset greatly affects illness presentation, treatment response, and long-term prognosis; thus, age-specific methods for diagnosis and therapy are rather important. The study matches ages of SSNS children with sociodemographic, clinical, and laboratory characteristics. Method. From January to November 2022, 60 children with steroid-sensitive nephrotic syndrome (SSNS) were studied in Al-Immamain Al-Kadhmain Medical City, Baghdad, Iraq. Interviews, medical records, and physical exams gathered data on demographics, illness features, and clinical parameters; extra blood and urine tests were conducted during relapses. Applying standardised definitions for NS, SSNS, relapse, and other criteria, ethical clearance was obtained before enrolment. Results. While older children (>5 years) had greater blood creatinine and cholesterol levels, suggesting possible variations in disease severity, younger children (<5 years) with nephrotic syndrome (NS) had an earlier illness onset and were more likely to live in urban settings. The absence of any appreciable age-related variations in steroid response, infections, or IgE levels emphasises the necessity of more study to investigate age-specific illness processes. Conclusion. The study revealed variations depending on age between children with nephrotic syndrome (NS). For instance, older children (≥5 years) had greater rates of asthma, elevated blood creatinine and cholesterol levels; younger children (≤5 years) started the disease sooner and resided in cities more commonly. These results highlight the need for age-specific therapy approaches to solve different clinical and metabolic profiles even in cases with similar steroid responses.
Introduction. Anemia remains a significant global health challenge, particularly among children in resource-limited settings, with substantial impacts on morbidity, mortality, and socioeconomic development. Point-of-care testing (POCT) devices for hemoglobin (Hb) measurement offer a promising alternative to automated hematology analyzers in resource-limited settings, but their diagnostic accuracy and implementation challenges require systematic evaluation. Material and method. This systematic review adhered to PRISMA 2020 guidelines, analyzing studies published between 2020-2025 that evaluated POCT devices for Hb measurement in children (0-18 years) in resource-limited settings. Five studies met inclusion criteria, assessing four POCT devices (HemoCue Hb301, Aptus, Sahli’s hemoglobinometer, and Masimo Rad-67). Data on sensitivity, specificity, measurement differences (bias), and the range of variation in those differences (Limits of Agreement, LOA) were extracted, and quality assessment was performed using Joanna Briggs Institute (JBI) tools. Results. Of 483 records screened, only five studies met inclusion criteria, encompassing four POCT devices. Due to substantial heterogeneity in design and outcome reporting, a meta-analysis could not be performed. POCT devices demonstrated variable diagnostic accuracy: sensitivity ranged from 24.4% to 100%, and specificity from 70% to 100%. The HemoCue Hb301 was the most widely used device (80% of studies) but showed inconsistent performance, with mean bias ranging from −0.27 to 2.5 g/dL and wide LOA (−3.68 to 5.2 g/dL). Non-invasive devices like the Masimo Rad-67 had lower sensitivity (24.4–95.5%) and high specificity (89.1–96.7%). Key challenges included over/underestimation of Hb levels, environmental sensitivity (temperature, altitude), high costs, and the need for trained personnel. Conclusion. While POCT devices provide rapid, portable solutions for anemia screening in resource-limited settings, their accuracy varies significantly, potentially leading to misclassification. Standardized protocols, improved device robustness, and cost-effective innovations are urgently needed to enhance reliability. Future research should prioritize validation studies and meta-analyses to guide optimal POCT implementation in pediatric populations.
Background and objectives. Preterm birth and neonatal hospitalization in a Neonatal Intensive Care Unit (NICU) represent major stressors for parents, often associated with elevated levels of anxiety, depression, and psychological distress. This pilot study aimed to (1) conduct a preliminary cultural validation of the Romanian version of the PSS:NICU scale and (2) evaluate maternal stress, anxiety, and depressive symptoms in mothers of preterm and term newborns hospitalized in NICU. Materials and methods. A cross-sectional pilot study was conducted between April and August 2025 at the NICU of Mureș County Emergency Clinical Hospital. A total of 22 postpartum mothers (15 with preterm births and 7 with term births) were included. Instruments used: PSS:NICU (Romanian version), Beck Depression Inventory-II (BDI-II), and State-Trait Anxiety Inventory (STAI-Y1 and Y2). Descriptive and inferential statistics were applied. Internal consistency was assessed using Cronbach’s Alpha. Results. Mothers of preterm infants showed higher mean scores for anxiety and depression compared to mothers of term infants, though differences were not statistically significant. PSS:NICU responses from six mothers of preterm infants indicated elevated stress levels, particularly in the Parental Role and Relationship and Infant Appearance and Behavior domains. The Romanian version of PSS:NICU demonstrated excellent internal consistency for most domains, with slightly lower reliability in the Visual and Auditive domain. Conclusions. The Romanian version of the PSS:NICU scale shows promising psychometric properties and can be used in future research. The results highlight increased psychological vulnerability in mothers of preterm infants and underscore the need for systematic psychological screening and culturally adapted perinatal support protocols in Romanian NICUs.
Background. Shingles in infants is a rare condition caused by intrauterine exposure to the varicella-zoster virus (VZV). Nutritional rickets due to vitamin D deficiency is associated with impaired immune function, potentially predisposing to viral reactivation and severe complications. Case report. We describe an 11.5-month-old infant who developed facial herpes zoster one month after contact with an older sibling with varicella. The disease began with fever, localized vesicular rash on the left cheek, vesicles with crusts and painful cervical lymphadenitis, later progressed to gingivostomatitis and bacterial pneumonia on a background of vitamin D avitaminosis and deficiency/nutritional rickets. Laboratory investigations revealed marked vitamin D deficiency (25(OH)D = 5.3 ng/mL), hypocalcemia, and elevated alkaline phosphatase, consistent with nutritional rickets. Chest radiography confirmed bilateral pneumonia with signs of rickets. Treatment included intravenous amoxicillin-clavulanate for 5 days, oral acyclovir (20 mg/kg/day for 5 days), vitamin D3 supplementation (4000 IU/day), oral calcium, oxygen therapy, and symptomatic care. The patient improved rapidly and was discharged after 7 days. At 13 months follow-up, the child remained symptom-free. Conclusions. This case highlights the potential for severe complications of herpes zoster in infants with profound vitamin D deficiency and rickets, emphasizing the importance of early recognition and intervention. The severe vitamin D deficiency clinically expressed by rickets, in a child with HZ in the first year of life can lead to quite severe complications such as bacterial pneumonia and aphthous gingivostomatitis.
