Effect of vitamin D3 supplement in glycemic control of pediatrics with type 1 diabetes mellitus and vitamin D deficiency

Background: Glycemic control prevents microvascular complications in patients with type I diabetes mellitus such as retinopathy, nephropathy and neuropathy that influences quality of life. Some studies show the immunomodulatory effect of vitamin D in synthesis and secretion of insulin. Aims: In this study we evaluate glycemic changes after vitamin D3 supplement in children with type I diabetes mellitus and vitamin D deficiency. Materials and Methods: In children with type I diabetes mellitus, level of vitamin D and HbA1C was measured. Patients with type I diabetes mellitus who had vitamin D deficiency (25OHD 9.9. This supplement transfer patients toward better glycemic control for the entire group (p-value < 0.0001). Conclusion: Vitamin D3 supplement improves HbA1C in pediatrics with type I diabetes mellitus and vitamin D deficiency. © 2015, Journal of Clinical and Diagnostic Research. All Rights Reserved

Third-degree heart block in thalassemia major: A case report

Background: First and second-degree heart blocks are partly common rhythm disorders in thalassemic patients but complete heart block is a very rare complication of iron overload cardiomyopathy. Case Presentation: This 15-year-old boy, a known case of major β-thalassemia was admitted to our emergency unit with dyspnea and cough because of decompensated heart failure. The electrocardiogram showed complete heart block with junctional escape rhythm. Interestingly, his previous electrocardiogram taken 2 months earlier, had some PVC and second degree, Mobitz type 1 (Wenckebach) heart block. After improvement of dyspnea and control of blood pressure in normal range, the patient was referred to ER. A dual-chamber permanent pacemaker was implanted and his symptoms improved, but he died 24 days after discharge from hospital. Conclusion: We present a rare case of complete heart block after a second-degree (Mobitz 1) heart block that was due to severe iron overload cardiomyopathy. © 2012 by Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences

Child Health Providers\u27 Precautionary Discussion of Emotions During Communication about Results of Newborn Genetic Screening

Objective To demonstrate a quantitative abstraction method for Communication Quality Assurance projects to assess physicians\u27 communication about hidden emotions after newborn genetic screening. Design Communication quality indicator analysis. Setting Standardized parent encounters performed in practicing physicians\u27 clinics or during educational workshops for residents. Participants Fifty-nine pediatrics residents, 53 pediatricians, and 31 family physicians. Intervention Participants were asked to counsel standardized parents about a screening result; counseling was recorded, transcribed, and parsed into statements (each with 1 subject and 1 predicate). Pairs of abstractors independently compared statements with a data dictionary containing explicit-criteria definitions. Outcome Measures Four groups of precautionary empathy behaviors (assessment of emotion, anticipation/validation of emotion, instruction about emotion, and caution about future emotion), with definitions developed for both definite and partial instances. Results Only 38 of 143 transcripts (26.6%) met definite criteria for at least 1 of the precautionary empathy behaviors. When partial criteria were counted, this number increased to 80 of 143 transcripts (55.9%). The most common type of precautionary empathy was the instruction about emotion behavior (eg, don\u27t be worried ), which may sometimes be leading or premature. Conclusions Precautionary empathy behaviors were rare in this analysis. Further study is needed, but this study should raise concerns about the quality of communication services after newborn screening

The Efficacy of GLP-1 Agonists in Pediatrics with Type 2 Diabetes and Obesity

GLP-1 therapies show promise in managing type 2 diabetes and obesity in adolescents. This review explores the efficacy, safety, and variations in treatment outcomes. GLP-1 therapies (liraglutide, dulaglutide, exenatide) effectively reduce HbA1c levels. Weight reduction is a positive outcome crucial for type 2 diabetes and obesity management. Safety concerns and gastrointestinal effects emphasize the need for monitoring during GLP-1 therapy. Insights from studies on Lixisenatide offer valuable information for healthcare providers. There is consensus on general effectiveness, but debates on specific outcomes and long-term effects persist. Case-based investigations suggest potential variations in treatment responses, requiring further exploration. Bridging the gap between research and application. Empowering clinicians to make informed decisions, considering individual patient needs for enhanced quality of care.https://commons.und.edu/pas-grad-posters/1309/thumbnail.jp

Prevalence of Urinary Tract Infection in Children from One to Fifteen Years Old in Basra City in 2014

A descriptive cross-sectional study carried out  in Basra  city to assess the prevalence of urinary tract infection depending on the result of urine culture in the central five hospitals(Al Basra Maternity and Pediatrics Hospital,Al Basra General Hospital ,Al Mawaniaa Hospital ,AlFaihaa Hospital and Al Shifaa Hospital) that was done to the attendance of pediatrics outpatient clinic  and their age range  from one year to fifteen years .From total 38841 patient recorded as an attendance to the pediatrics outpatient clinic in the year  2014 ,urine culture was done for 824 patient  of them and it was positive in 321 (39%) and negative in 503 (61%). From the 321 patients with positive urinary culture 142 patients (44.33%) were male and 179 patient (55.67%) were female with significant association between the result of urinary culture and sex (p=0.042).Patients with positive urine culture were divided into three age group and the result was that 84 patients (26.16%)  were in the first age group (1-5years),151 patients (47%) in the second age group (6-10years) and 86patients(26.8%) in the third age group(11-15years) .Five type of bacteria were found in the result of patients with positive urine culture , the most common type of bacteria was(Escherichia Coli ) (73.83 %),followed by Staphylococcus aureus (17.13%), Klebsiella pneumonia (4.36%), and  Pseudomonas aeruginosa (0.64%)The prevalence of urinary tract infections in Basra city at years 2014 was  (8.26/1000children attending outpatient clinics in Basra city hospitals ).The  Prevalence of urinary tract infection in the five major hospitals in Basra in  2014 was calculated  and the  result  was  that the prevalence of urinary tract infection   was highest  in Al Basra Maternity&amp;  Pediatrics  Hospital  (13.96) followed  by Al Mawanaa Hospital   ( 9.86 ) , Al Faihaa Hospital  ( 8.34 ) AL Basra General Hospital (7.44) and AlShifaa Hospital(3.18).Then the Prevalence of urinary tract infection in Basra city  for every month in2014 was calculated to compare the prevalence for each month and the result was that there was high prevalence in March (10.17), April(13.72), July (11.58)August (10.11) comparing with the other months.This study conclude that in Basra city the urinary tract infection is more common in female than in male and mostly in age group from (6-10) years ,and that (  Escherichia Coli ) is the most common  type of the  causative microorganisms, high prevalence of urinary tract infection was found in Al Basra Maternity and Pediatrics Hospital, the prevalence increase mainly in March ,April,  July, August

Transition from pediatric to adult care in emerging adults with type 1 diabetes: a blueprint for effective receivership

Abstract For adolescents and emerging adults, the transition from pediatrics to adult care is fraught with challenges both inside and outside the clinical arena, including assuming independent care for diabetes, working with new adult providers, and overcoming concomitant psychosocial issues, while maintaining work/school-life balance. Not surprisingly, glycemic control in emerging adults with type 1 diabetes is amongst the worst in all age groups. Thus, new and comprehensive strategies are needed by both pediatric and adult diabetes care teams to support young adults during the transition to adult care. In this review, we focus on challenges during the transition period and provide evidence-based recommendations for a receivership model to assist adult diabetes care teams in addressing these concerns. By coordinating efforts with pediatrics providers, identifying strengths and deficiencies in self-care, establishing rapport with young adult patients, directly addressing prevalent psychosocial concerns, and developing a team-based approach to keep patients engaged, adult care teams can prioritize support for the most vulnerable transition patients. Improved strategies to propel emerging adult patients through the transition period towards habits leading to optimal glycemic control could have a major long-term impact on preventing diabetes-related complications.https://deepblue.lib.umich.edu/bitstream/2027.42/148213/1/40842_2019_Article_78.pd

Biased Language in Simulated Handoffs and Clinician Recall and Attitudes

Importance: Poor-quality handoffs can lead to medical errors when transitioning patient care. Biased language within handoffs may contribute to errors and lead to disparities in health care delivery. Objective: To compare clinical information recall accuracy and attitudes toward patients among trainees in paired cases of biased vs neutral language in simulated handoffs. Design, Setting, and Participants: Surveys administered from April 29 to June 15 and from July 20 to October 10, 2023, included 3 simulated verbal handoffs, randomized between biased and neutral, and measured clinical information recall, attitudes toward patients, and key takeaways after each handoff. Participants included residents in internal medicine, pediatrics, and internal medicine–pediatrics and senior medical students at 2 academic medical centers in different geographic regions of the US. Data were analyzed from November 2023 to June 2024. Exposures: Each participant received 3 handoffs that were based on real handoffs about Black patients at 1 academic center. These handoffs were each randomized to either a biased or neutral version. Biased handoffs had 1 of 3 types of bias: stereotype, blame, or doubt. The order of handoff presentation was also randomized. Internal medicine and pediatrics residents received slightly different surveys, tailored for their specialty. Internal medicine–pediatrics residents received the pediatric survey. Medical students were randomly assigned the survey type. Main Outcomes and Measures: Each handoff was followed by a clinical information recall question, an adapted version of the Provider Attitudes Toward Sickle Cell Patients Scale (PASS), and 3 free-response takeaways. Results: Of 748 trainees contacted, 169 participants (142 residents and 27 medical students) completed the survey (23% overall response rate), distributed across institutions, residency programs, and years of training (95 female [56%]; mean [SD] age, 28.6 [2.3] years). Participants who received handoffs with blame-based bias had less accurate information recall than those who received neutral handoffs (77% vs 93%; P = .005). Those who reported bias as a key takeaway of the handoff had lower clinical information recall accuracy than those who did not (85% vs 93%; P = .01). Participants had less positive attitudes toward patients per PASS scores after receiving biased compared with neutral handoffs (mean scores, 22.9 [3.3] vs 25.2 [2.7]; P  Conclusions and Relevance: In this survey study of residents and medical students, biased handoffs impeded accurate transfer of key clinical information and decreased empathy, potentially endangering patients and worsening health disparities. Handoff standardization is critical to addressing racial bias and improving patient safety.</p

Towards Early Risk Stratification in Children and Adolescents with Type 1 Diabetes

The general objective of this thesis is to improve this risk stratification in children and adolescents with type 1 diabetes, aiming to fill a scientific gap by studying some underexposed complication fields in pediatrics

Study of occurrence of childhood hypertension in school going children attending pediatrics OPD in Moradabad city

Background: In developed countries, childhood hypertension is a proven indicator of adult hypertension and organ damage and is estimated to be great concern. This study was conducted to assess the occurrence of childhood hypertension in school going children attending pediatrics OPD.Methods: An observational study was performed at TMMC and RC among 500 school going children attending pediatrics OPD in TMMC and RC over a period of 1 year. Socio-demographic variables including age, gender, family history of hypertension, parental smoking habits were recorded in a proforma. Dietary habits including consumption of junk food, fruits and daily calorie intake was evaluated utilizing number of times diet intake questionnaire and 24 hour recall method. Height was measured by stadiometer with candidate posing in bare feet. Weight assessment was done with bare footed and candidate clad in light clothing with weighing instrument of electronic type rounded to nearest unit.Results: Elevated blood pressure and hypertension was reported among 9.4% and 6.8% of the subjects respectively. High blood pressure was significantly associated with presence of family history, stress and lack daily physical activity. Chances of elevated blood pressure and hypertension increase along with the increase in subject height, weight and BMI.Conclusions: Performing the BP measurements in routine consultations becomes essential for diagnosis and early intervention

Narrative Review of the Role of Technology in Pediatric Diabetes: From Testing Blood Glucose to Subcutaneous Automated Therapy and Hope for Cure

BACKGROUND AND OBJECTIVE: Type 1 diabetes, the most common cause of diabetes in pediatrics, is defined by the hyperglycemia that results from the permanent autoimmune damage to the pancreas. The Diabetes Control and Complications Trial (DCCT) demonstrated that strict glycemic control targeting lower HbA1c goals can both delay the onset and progression of its complications that include diabetic neuropathy, nephropathy, retinopathy, and increased cardiovascular events. Our primary objective is to review the literature available regarding the technology applied for the treatment of diabetes, not only aiding patients\u27 quality of life but addressing its effects on hypoglycemia and reduced risk of the long-term complications. It will synthesize the evolution of glucose monitoring devices; the development of insulin: from animal to recombinant engineering, smart insulin in the future; the development of algorithm-driven insulin delivery devices, the closed loop system/artificial pancreas; and the future utilization of technology to support islet cell transplant with the goal of a long-term cure. Emphasis will be made on what is known about the impact on its outcomes in children and adolescents. METHODS: A literature search was conducted using PubMed for publications from 1985 to present. Keywords used: type 1 diabetes, children, adolescents, pediatrics, continuous glucose monitoring (CGM), insulin pumps. Referenced articles include other reviews, current care guidelines as supported by cross sectional studies, cohort studies and randomized clinical trials. KEY CONTENT AND FINDINGS: Understanding the pathophysiology of type 1 diabetes has led to the design of technology that facilitates glucose monitoring and insulin administration in a personalized manner. The current technology has improved outcomes and quality of life by decreasing hypoglycemic events and decreasing risk of long-term metabolic complications. Barriers remain, for children and adults, often driven by patient\u27s preference as well as their understanding of the limitations of what they are wearing. CONCLUSIONS: With the progressive evolution of this technology, it is now realistic to lower the burden of diabetes self-management while reducing hypoglycemia and risk of complications that otherwise impact daily life from academics, physical activity, career choices and even life expectancy