Evaluation of Gastroesophageal Reflux and Gastroesophageal Reflux Disease with Esophageal Endoscopy and Histology in Children

Objectives:The roles of esophageal endoscopy and mucosal biopsy in making diagnoses of gastroesophageal reflux( GER) and gastroesophageal reflux disease( GERD) were retrospectively examined in children.Methods:Thirty-four patients, whose ages ranged from 1 month to 18 years (median, 4 years), underwent diagnostic evaluation of GER/GERD. Group I patients( n=5) had symptoms suggesting GER, but had no underlying abnormalities. Group II patients( n=23) had chronic symptoms suggesting GERD and underlying abnormalities, neurologic impairment( n=22) and post-repair of esophageal atresia( n=1). Group III patients( n=6) were neurologically impaired but had no symptoms and underwent evaluation as a preoperative examination of gastrostomy placement. Reflux esophagitis was endoscopically graded according to the modified Los Angeles classification and grouped into grades?M, A, and?B. The results of GER studies and the histologic findings of reflux esophagitis were compared between these groups.Results:The parameters of 24-h pH monitoring were significantly higher in patients with grade?B than grade?M, and endoscopic grades improved after antireflux surgery along with the improvements in reflux index. There were no significant correlations between the endoscopic grade and the percentages of patients in whom histologic findings of reflux esophagitis were present.Conclusion:Esophageal endoscopy is useful for examining the severity of reflux esophagitis and monitoring the effect of treatment in children with GER/GERD. The modified Los Angeles classification can also be used for that purpose. Although treatment is seldom influenced by the results, histologic evaluation of the esophageal mucosa should be performed to exclude other disorders

The Prevalence of Renal Scar in Urinary Tract Infection Using Dimercaptosuccinic Acid (DMSA) Scan, and Related Factors in Children under 16 Years Old during the Years 2012-2016 in Sari City, Iran

Background: Urinary tract infection is one of the main causes of renal scar that can lead to serious complications such as hypertension or chronic renal failure. Therefore, accurate and timely diagnosis of urinary tract infection and other risk factors related to scar is very important. This study aimed to determine the prevalence of renal scar using dimercaptosuccinic acid (DMSA) scan after urinary tract infection in children under 16 years old in Bu Ali Sina hospital located in Sari City, Iran, during the years 2012 to 2016. Methods: In this cross-sectional study, the data were extracted from files related to those patients suffering UTI referred to Bu Ali Sina hospital, for whom DMSA scan was performed. Results: Of 208 enrolled children, 83.2% were girls and 16.8% were boy with mean age of 32.80 ± 32.57 months. Based on the first DMSA scan, the prevalence of scars was about 40%; and based on second DMSA scan (delayed), the prevalence was about 34%. In people who had scar, the frequency of UTI was more. In these patients, the most common organisms were Escherichia coli (71.4%), Proteus (14.3%), and Klebsiella (10.7%). Proteus significantly led to scar formation more than the others. Vesicoureteral reflux (VUR) with prevalence of 67.9% was the most common observed disease; and all patients with severe scars suffered from VUR. Scar in DSMA scan had no significant relationship with age and gender. Conclusion: Scar is a relatively common complication of UTI in children and VUR is an important risk factor for permanent damage. It is mandatory to think to this critical complications in children with UTI. Keywords Urinary tract infection; Scar; DMS

Acute Necrotizing Encephalopathy of Childhood due to Influenza Type A Virus

A 1 year and 11 month-old boy developed convulsions and disturbance of consciousness after an antipyretic was administered. Influenza type A virus reaction was positive on rapid antigen test of nasal discharge. Although no significant abnormality was found by brain CT on admission, abnormal densities were observed in the bilateral thalami, brain stem and tegmentum on brain CT performed 12 hours later, so the patient was diagnosed with acute necrotizing encephalopathy (ANE) of childhood due to influenza type A virus. In spite of we diagnosed and performed methylprednisolone pulse and antithrombin III therapy in the early stage of this encephalopathy, which resulted in serious neurologic sequelae remaining. The clinical course of our case suggests that the early diagnosis and these treatments for ANE may not be effective. At present, we have no established therapy for this encephalopathy, so the vaccination is only a method for prevention of ANE due to influenza type A virus

キョウクウ センパ ニヨル ノウキョウ ガッペイ オ ミトメタ セイジュクガタ ジュウカク キケイシュ ノ 1レイ

症例は16 歳女性,咳嗽,発熱,左前胸部痛を主訴に来院.胸部CT にて内部不均一な径7 cm の前縦隔腫瘍及び左舌区・下葉の完全無気肺を確認,また,MRI にて前縦隔腫瘍内に脂肪組織と同一の吸収域を認め,成熟型奇形腫穿破による膿胸と診断.膿胸に対し胸腔内繊維素溶解療法,ドレナージ及び抗生剤にて加療,膿胸改善を確認した上で,前縦隔腫瘍摘出術施行,病理にて嚢胞性成熟型奇形腫と診断した.病理組織にて膵類似の腺組織を確認,穿破の原因として,腫瘍内膵酵素の存在が考えられた.成熟型縦隔奇形腫は穿破により重篤な合併症発生の危険性があり,また経過中悪性転化する可能性もあることから,早期の外科治療が重要と考えられた.A 16-year-old female visited our hospital, complaining ofcough, fever, and left precordial pain. Chest computed tomographyshowed a heterogeneous anterior mediastinal tumormeasuring 7 cm in diameter and complete atelectasis inthe lingula and lower lobe of the left lung. Magnetic resonanceimaging also showed an area of intensity identical tothat of adipose tissue in the anterior mediastinal tumor.Thus, empyema due to rupture of a mature teratoma wasdiagnosed. The empyema was treated with intra-pleural fibrinolytictherapy, drainage, and antibiotics. After confirmingresolution of the empyema, we resected the anteriormediastinal tumor and pathologically diagnosed it as cysticmature teratoma. Histopathological examination showedglandular tissue resembling the pancreas, suggesting thatthe rupture had been caused by pancreatic enzymes in thetumor. Mediastinal mature teratoma carries a risk of seriouscomplications developing due to rupture and the possibilityof malignant transformation during the diseasecourse. Thus, early surgical treatment is important

Adherence to antiretroviral therapy in young children in Cape Town, South Africa, measured by medication return and caregiver self-report: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>Antiretroviral therapy (ART) dramatically improves outcomes for children in Africa; however excellent adherence is required for treatment success. This study describes the utility of different measures of adherence in detecting lapses in infants and young children in Cape Town, South Africa.</p> <p>Methods</p> <p>In a prospective cohort of 122 HIV-infected children commenced on ART, adherence was measured monthly during the first year of treatment by medication return (MR) for both syrups and tablets/capsules. A questionnaire was administered to caregivers after 3 months of treatment to assess experience with giving medication and self-reported adherence. Viral and immune response to treatment were assessed at the end of one year and associations with measured adherence determined.</p> <p>Results</p> <p>Medication was returned for 115/122 (94%) children with median age (IQR) of 37 (16 – 61) months. Ninety-one (79%) children achieved annual average MR adherence ≥ 90%. This was an important covariate associated with viral suppression after adjustment for disease severity (OR = 5.5 [95%CI: 0.8–35.6], p = 0.075), however was not associated with immunological response to ART. By 3 months on ART, 13 (10%) children had deceased and 11 (10%) were lost to follow-up. Questionnaires were completed by 87/98 (90%) of caregivers of those who remained in care. Sensitivity of poor reported adherence (missing ≥ 1 dose in the previous 3 days) for MR adherence <90% was only 31.8% (95% CI: 10.7% – 53.0%). Caregivers of 33/87 (38.4%) children reported difficulties with giving medication, most commonly poor palatability (21.8%). Independent socio-demographic predictors of MR adherence ≥ 90% were secondary education of caregivers (OR = 4.49; 95%CI: 1.10 – 18.24) and access to water and electricity (OR = 2.65; 95%CI: 0.93 – 7.55). Taking ritonavir was negatively associated with MR adherence ≥ 90% (OR = 0.37; 95%CI: 0.13 – 1.02).</p> <p>Conclusion</p> <p>Excellent adherence to ART is possible in African infants and young children and the relatively simple low technology measure of adherence by MR strongly predicts viral response. Better socio-economic status and more palatable regimens are associated with better adherence.</p

Psychosocial factors and early childhood caries among low-income African–American children in Detroit

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75540/1/j.1600-0528.2006.00352.x.pd

Defining Kawasaki disease and pediatric inflammatory multisystem syndrome-temporally associated to SARS-CoV-2 infection during SARS-CoV-2 epidemic in Italy: results from a national, multicenter survey

Background: There is mounting evidence on the existence of a Pediatric Inflammatory Multisystem Syndrome-temporally associated to SARS-CoV-2 infection (PIMS-TS), sharing similarities with Kawasaki Disease (KD). The main outcome of the study were to better characterize the clinical features and the treatment response of PIMS-TS and to explore its relationship with KD determining whether KD and PIMS are two distinct entities. Methods: The Rheumatology Study Group of the Italian Pediatric Society launched a survey to enroll patients diagnosed with KD (Kawasaki Disease Group - KDG) or KD-like (Kawacovid Group - KCG) disease between February 1st 2020, and May 31st 2020. Demographic, clinical, laboratory data, treatment information, and patients' outcome were collected in an online anonymized database (RedCAP®). Relationship between clinical presentation and SARS-CoV-2 infection was also taken into account. Moreover, clinical characteristics of KDG during SARS-CoV-2 epidemic (KDG-CoV2) were compared to Kawasaki Disease patients (KDG-Historical) seen in three different Italian tertiary pediatric hospitals (Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste; AOU Meyer, Florence; IRCCS Istituto Giannina Gaslini, Genoa) from January 1st 2000 to December 31st 2019. Chi square test or exact Fisher test and non-parametric Wilcoxon Mann-Whitney test were used to study differences between two groups. Results: One-hundred-forty-nine cases were enrolled, (96 KDG and 53 KCG). KCG children were significantly older and presented more frequently from gastrointestinal and respiratory involvement. Cardiac involvement was more common in KCG, with 60,4% of patients with myocarditis. 37,8% of patients among KCG presented hypotension/non-cardiogenic shock. Coronary artery abnormalities (CAA) were more common in the KDG. The risk of ICU admission were higher in KCG. Lymphopenia, higher CRP levels, elevated ferritin and troponin-T characterized KCG. KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p = 0.04 and 71,9% vs 43,4%; p = 0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p &lt; 0.0001). SARS-CoV-2 assay more often resulted positive in KCG than in KDG (75,5% vs 20%; p &lt; 0.0001). Short-term follow data showed minor complications. Comparing KDG with a KD-Historical Italian cohort (598 patients), no statistical difference was found in terms of clinical manifestations and laboratory data. Conclusion: Our study suggests that SARS-CoV-2 infection might determine two distinct inflammatory diseases in children: KD and PIMS-TS. Older age at onset and clinical peculiarities like the occurrence of myocarditis characterize this multi-inflammatory syndrome. Our patients had an optimal response to treatments and a good outcome, with few complications and no deaths

A Review of the Global Literature on Dental Therapists

OBJECTIVE: Access to adequate oral health care is deficient in many parts of the world. Many countries are now using dental therapists to increase access, particularly for children. To inform the discussion on dental therapists in the workforce, particularly in the United States, the W.K. Kellogg Foundation funded a review of the global literature to identify as many documents as possible related to the practice of dental therapists since the establishment of the School Dental Service in New Zealand in 1921. METHODS: Consultants in each of the countries considered to have a substantive literature on dental therapists were asked to participate in the research; seventeen in total. In addition to identifying and reviewing published articles, a focus of the research was on identifying \u27gray\u27 documents. Standard databases were searched for key words associated with dental therapists. In addition, searches were conducted of the governmental and dental association websites of all countries known to have dental therapists in their oral health workforce. RESULTS: Fifty-four countries, both developing and developed, were identified where dental therapists are members of the workforce. Eleven hundred documents were identified from 26 of these countries, with over 2/3 of them cited in the published monograph. Reliable evidence from the related literature and verbal communication confirmed the utilization of dental therapists in an additional 28 countries. Thirty-three of the countries were members of the Commonwealth of Nations, suggesting a mechanism of spread from New Zealand. Variable lengths of training/education existed for dental therapists with the tradition being 2 years postsecondary. In a few countries, the training of therapists and hygienists is now being combined in a three academic year program. Historically, dental therapists have been employed by government agencies caring for children, typically in school-based programs. Initiatives in some countries allow limited care for adults by dental therapists with additional training. CONCLUSIONS: The evidence indicates that dental therapists provide effective, quality, and safe care for children in an economical manner and are generally accepted both by the public and where their use is established, by the dental profession

ANALYSIS OF CHEMICAL COMPOSI TION OF THE MOST EFFICIENT ESSENTIAL OILS TOWARDS ENTEROCOCCUS FAECALIS REFERENT STRAIN ATCC 29212 AND CLINICAL ISOLATES

Twenty one essential oils (EOs) documented their significant antimicrobial effect with regard to our pre–set criterion of the Minimal Inhibitory Concentration (MIC ≤ 200 μL / mL) of EOs towards Enterococcus faecalis (ATCC 29212 and or clinical isolates); the best effect MIC 0.4 μL / mL (approx. 0.26 μg / mL) achieved Satureja horvatii L. EO, while the EOs with the lowest antimicrobial efficacy were Rosmarinus officinalis L. and Achilea milefolium L., both with MIC s160.0 μg / mL. Analysis of the MIC values within the groups revealed that ATCC strain of E. faecalis is generally lower, ranging from 0.26 to 156 μg / mL, in comparison to those for clinical isolateswhich ranged from 10 to 160 μg / mL. Twelve 12 components that are common in EOs whith MIC s ≤ 200 μg / mL in testings towards both, the clinical  and  referent  strains  are  given  in  descending  order  according  to number of oils they are present in: trans–β–caryophyllene  (13) > myrcene (8)> α–pinene (8) > linalool (7) > p–cymene (7) > borneol (7) > geraniol (6) > camphene  (6) > limonene  (5) > 1,8– cineol  (5) > γ –terpinene  (5) > α–terpinene (4). Comparison of EO constituents reviled that only, geraniol and 1,8–cineol, contributed with ≥ 10 % to more than one EO (MIC 0.3–200 μg / mL) efficient against both E. faecalis strains. Thirteen components in 11 EOs with MIC ≤ 200 µg / mL towards ATCC 29212 were representative based on their contents in EOs: eugenol 82.9 % > thymol 63.7 % > hexadecanoic acid 47.8 % > menthol 46.6 % > cis–b–ocimene 44.2 % > geranial 42.1 % > trans–β–caryophyllene  40.8 % > citronellal  36.7 % > α–pinene  31.2 % > neral 30.5 % > α–eudesmol 22.4 % > citronellol 13.1 % > menthone 11.3 %. Following seven components, representative in 10 EOs with MIC ≤ 200 µg / mL towards clinical isolates, are presented in order of their contribution to EOs: phenylethyl alcohol 57.7 % > geranial 32.9 % > neral 22.2 % > p– cymene 20 % > carvacrol 14 % > α–pinene 11.5 % > linalool 11.4 %. Out of 21 highly efficient EOs selected in this study, six EOs proved to be the most efficient (MIC ≤ 30 μg / mL ); three oils in control of E.faecalis ATCC strain (Satureja horvatii, Mentha pulegium and Rosmarinus  officinalis) and other three  in control of E. faecalis clinical isolates (Leptospermum petersonii, Thymus algeriensis,  Thymus serpyllum).  Thymol is a major component  in three out of the six aforementioned most efficient EOs. The aim of our study was to investigate differences in efficacy of selected EOs that proved to possess great antimicrobial activity, towards the referent strain ATCC 29212 and clinical isolates of E. faecalis on, and to estimate which of their constituents might contribute to desired activity, as “markers compunds”