Pulse oximetry in pediatric care:Balancing advantages and limitations

BACKGROUND Pulse oximetry has become a cornerstone technology in healthcare,providing non-invasive monitoring of oxygen saturation levels and pulse rate.Despite its widespread use,the technology has inherent limitations and challenges that must be addressed to ensure accurate and reliable patient care.AIM To comprehensively evaluate the advantages,limitations,and challenges of pulse oximetry in clinical practice,as well as to propose recommendations for optimizing its use.METHODS A systematic literature review was conducted to identify studies related to pulse oximetry and its applications in various clinical settings.Relevant articles were selected based on predefined inclusion and exclusion criteria,and data were synthesized to provide a comprehensive overview of the topic.RESULTS Pulse oximetry offers numerous advantages,including non-invasiveness,real-time feedback,portability,and costeffectiveness.However,several limitations and challenges were identified,including motion artifacts,poor peripheral perfusion,ambient light interference,and patient-specific factors such as skin pigmentation and hemoglobin variants.Recommendations for optimizing pulse oximetry use include technological advancements,education and training initiatives,quality assurance protocols,and interdisciplinary collaboration.CONCLUSION Pulse oximetry is crucial in modern healthcare,offering invaluable insights into patients’oxygenation status.Despite its limitations,pulse oximetry remains an indispensable tool for monitoring patients in diverse clinical settings.By implementing the recommendations outlined in this review,healthcare providers can enhance the effectiveness,accessibility,and safety of pulse oximetry monitoring,ultimately improving patient outcomes and quality of care.

Fecal calprotectin in pediatric gastrointestinal diseases:Pros and cons

BACKGROUND Fecal calprotectin is a valuable biomarker for assessing intestinal inflammation in pediatric gastrointestinal diseases.However,its role,pros,and cons in various conditions must be comprehensively elucidated.AIM To explore the role of fecal calprotectin in pediatric gastrointestinal diseases,including its advantages and limitations.METHODS A comprehensive search was conducted on PubMed,PubMed Central,Google Scholar,and other scientific research engines until February 24,2024.The review included 88 research articles,56 review articles,six metaanalyses,two systematic reviews,two consensus papers,and two letters to the editors.RESULTS Fecal calprotectin is a non-invasive marker for detecting intestinal inflammation and monitoring disease activity in pediatric conditions such as functional gastrointestinal disorders,inflammatory bowel disease,coeliac disease,coronavirus disease 2019-induced gastrointestinal disorders,gastroenteritis,and cystic fibrosis-associated intestinal pathology.However,its lack of specificity and susceptibility to various confounding factors pose challenges in interpretation.Despite these limitations,fecal calprotectin offers significant advantages in diagnosing,monitoring,and managing pediatric gastrointestinal diseases.CONCLUSION Fecal calprotectin holds promise as a valuable tool in pediatric gastroenterology,offering insights into disease activity,treatment response,and prognosis.Standardized protocols and guidelines are needed to optimize its clinical utility and mitigate interpretation challenges.Further research is warranted to address the identified limitations and enhance our understanding of fecal calprotectin in pediatric gastrointestinal diseases.

Metabolomic changes in children with autism

BACKGROUND Autism spectrum disorder(ASD)is a neurodevelopmental condition characterized by deficits in social communication and repetitive behaviors.Metabolomic profiling has emerged as a valuable tool for understanding the underlying metabolic dysregulations associated with ASD.AIM To comprehensively explore metabolomic changes in children with ASD,integrating findings from various research articles,reviews,systematic reviews,meta-analyses,case reports,editorials,and a book chapter.METHODS A systematic search was conducted in electronic databases,including PubMed,PubMed Central,Cochrane Library,Embase,Web of Science,CINAHL,Scopus,LISA,and NLM catalog up until January 2024.Inclusion criteria encompassed research articles(83),review articles(145),meta-analyses(6),systematic reviews(6),case reports(2),editorials(2),and a book chapter(1)related to metabolomic changes in children with ASD.Exclusion criteria were applied to ensure the relevance and quality of included studies.RESULTS The systematic review identified specific metabolites and metabolic pathways showing consistent differences in children with ASD compared to typically developing individuals.These metabolic biomarkers may serve as objective measures to support clinical assessments,improve diagnostic accuracy,and inform personalized treatment approaches.Metabolomic profiling also offers insights into the metabolic alterations associated with comorbid conditions commonly observed in individuals with ASD.CONCLUSION Integration of metabolomic changes in children with ASD holds promise for enhancing diagnostic accuracy,guiding personalized treatment approaches,monitoring treatment response,and improving outcomes.Further research is needed to validate findings,establish standardized protocols,and overcome technical challenges in metabolomic analysis.By advancing our understanding of metabolic dysregulations in ASD,clinicians can improve the lives of affected individuals and their families.

Microphallus early management in infancy saves adulthood sensual life:A comprehensive review

Microphallus/Micropenis is a rare condition with significant physical and psychological implications for affected individuals.This article comprehensively reviews micropenis,its etiology,epidemiology,and various treatment options.We conducted a thorough literature review to collect relevant information on micropenis and microphallus,as well as related disorders.Our primary databases were PubMed,Medline,and Google Scholar.We searched for articles published in English between 2000 and 2023.Our analysis included 67 review articles,56 research studies,11 case reports,one guideline,and one editorial.Our search terms included"microphallus","micropenis","congenital hypogonadotropic hypogonadism","androgen insensitivity syndrome","pediatric management of micropenis","testosterone therapy",and"psychosocial implications of micropenis".We focused on diagnosing micropenis and related conditions,including hormonal assessments,medical and surgical treatment options,psychosocial and psychological well-being,sexual development of adolescents,and sociocultural influences on men's perceptions of penile size.Additionally,we explored parenting and family dynamics in cases of micropenis and disorders of sex development,implications of hormonal treatment in neonates,and studies related to penile augmentation procedures and their effectiveness.The article highlights the importance of early diagnosis and intervention in addressing the physical and psychological well-being of individuals with micropenis.Surgical procedures,such as penile lengthening and girth enhancement,and non-surgical approaches like hormonal therapy are explored.The significance of psychological support,education,and lifestyle modifications is emphasized.Early management and comprehensive care are crucial for individuals with micropenis,from infancy to adolescence and beyond.A multidisciplinary approach involving urologists,endocrinologists,and mental health professionals is recommended.Regular assessment of treatment effectiveness and the need for updated guidelines are essential to provide the best possible care.Healthcare professionals should prioritize early diagnosis,and neonatologists should measure stretched penile length in neonates.A collaborative effort is needed among professionals,parents,and affected individuals to create a supportive environment that recognizes worth beyond physical differences.Continuous research and evidencebased updates are crucial for improving care standards.

Candidemia chronicles:Retrospective analysis of candidemia epidemiology,species distribution,and antifungal susceptibility patterns in Bahrain

BACKGROUND Invasive fungal infections,particularly candidemia,pose significant clinical challenges globally.Understanding local epidemiology,species distribution,and antifungal susceptibility patterns is crucial for effective management despite regional variations.AIM To investigate the epidemiology,species distribution,antifungal susceptibility patterns,and associated risk factors of candidemia among patients in Bahrain from 2021 to 2023.METHODS This retrospective study analyzed demographic data,Candida species distribution,antifungal susceptibility profiles,and risk factors among candidemia patients treated at a tertiary care hospital in Bahrain over three years.Data was collected from medical records and analyzed using descriptive statistics.RESULTS A total of 430 candidemia cases were identified.The mean age of patients was 65.7 years,with a mortality rate of 85.5%.Candida albicans(C.albicans)was the most common species,followed by Candida parapsilosis,Candida tropicalis(C.tropicalis),and emerging multidrug-resistant Candida auris(C.auris).Antifungal susceptibility varied across species,with declining susceptibility to azoles observed,particularly among C.albicans and C.tropicalis.Major risk factors included central venous catheters,broad-spectrum antibiotics,and surgical procedures.CONCLUSION This study highlights the substantial burden of candidemia among older adults in Bahrain,characterized by diverse Candida species.It also concerns levels of antifungal resistance,notably in C.auris.The findings underscore the importance of local epidemiological surveillance and tailored treatment strategies to improve outcomes and mitigate the spread of multidrug-resistant Candida species.Future research should focus on molecular resistance mechanisms and optimizing therapeutic approaches to address this growing public health concern.

Gastrointestinal tolerability of organic infant formula compared to traditional infant formula: A systematic review

BACKGROUND Infants'nutrition significantly influences their growth,development,and overall well-being.With the increasing demand for organic infant formula driven by the perception of health benefits and growing awareness of natural feeding options,it is crucial to conduct a comparative analysis of the gastrointestinal tolerability between organic and traditional infant formulas.AIM To provide a concise and precise analysis of the gastrointestinal tolerability of organic infant formula compared to traditional infant formula.Due to limited direct comparisons,the review synthesizes available literature on each formula type,presenting insights into their potential effects on infants'digestive health.METHODS An extensive literature search was conducted,compiling studies on organic and traditional infant formulas,their compositions,and reported effects on gastrointestinal tolerability.We searched academic databases such as PubMed and Google Scholar and specialized nutrition,paediatrics,and infant health journals using relevant keywords till October 1,2023.RESULTS Although specific comparative studies are scarce and formula heterogeneity is a significant limitation,this systematic review provides an in-depth understanding of organic infant formulas'composition and potential benefits.While scientific evidence directly comparing gastrointestinal tolerability is limited,organic formulas strive to use carefully selected organic ingredients to imitate breast milk composition.Potential benefits include improved lipid profiles,higher methionine content,and decreased antibiotic-resistant bacteria levels.Understanding the gastrointestinal tolerability of organic and traditional infant formulas is crucial for parents and healthcare providers to make informed decisions.CONCLUSION Despite limitations in direct comparisons,this systematic review provides insights into the composition and potential benefits of organic infant formulas.It emphasizes the need for further research to elucidate their gastrointestinal effects comprehensively.

Decoding the genetic landscape of autism:A comprehensive review

BACKGROUND Autism spectrum disorder(ASD)is a complex neurodevelopmental condition characterized by heterogeneous symptoms and genetic underpinnings.Recent advancements in genetic and epigenetic research have provided insights into the intricate mechanisms contributing to ASD,influencing both diagnosis and therapeutic strategies.AIM To explore the genetic architecture of ASD,elucidate mechanistic insights into genetic mutations,and examine gene-environment interactions.METHODS A comprehensive systematic review was conducted,integrating findings from studies on genetic variations,epigenetic mechanisms(such as DNA methylation and histone modifications),and emerging technologies[including Clustered Regularly Interspaced Short Palindromic Repeats(CRISPR)-Cas9 and single-cell RNA sequencing].Relevant articles were identified through systematic searches of databases such as PubMed and Google Scholar.RESULTS Genetic studies have identified numerous risk genes and mutations associated with ASD,yet many cases remain unexplained by known factors,suggesting undiscovered genetic components.Mechanistic insights into how these genetic mutations impact neural development and brain connectivity are still evolving.Epigenetic modifications,particularly DNA methylation and non-coding RNAs,also play significant roles in ASD pathogenesis.Emerging technologies like CRISPR-Cas9 and advanced bioinformatics are advancing our understanding by enabling precise genetic editing and analysis of complex genomic data.CONCLUSION Continued research into the genetic and epigenetic underpinnings of ASD is crucial for developing personalized and effective treatments.Collaborative efforts integrating multidisciplinary expertise and international collaborations are essential to address the complexity of ASD and translate genetic discoveries into clinical practice.Addressing unresolved questions and ethical considerations surrounding genetic research will pave the way for improved diagnostic tools and targeted therapies,ultimately enhancing outcomes for individuals affected by ASD.

Play therapy in children with autism:Its role,implications,and limitations

Play is a pleasurable physical or mental activity that enhances the child’s skills involving negotiation abilities,problem-solving,manual dexterity,sharing,decision-making,and working in a group.Play affects all the brain's areas,structures,and functions.Children with autism have adaptive behavior,adaptive response,and social interaction limitations.This review explores the different applications of play therapy in helping children with autism disorder.Play is usually significantly impaired in children with autism.Play therapy is mainly intended to help children to honor their unique mental abilities and developmental levels.The main aim of play therapy is to prevent or solve psychosocial difficulties and achieve optimal child-healthy growth and development.Play therapy helps children with autism to engage in play activities of their interest and choice to express themselves in the most comfortable ways.It changes their way of self-expression from unwanted behaviors to more non-injurious expressive behavior using toys or activities of their choice as their words.Play therapy also helps those children to experience feeling out various interaction styles.Every child with autism is unique and responds differently.Therefore,different types of intervention,like play therapy,could fit the differences in children with autism.Proper evaluation of the child is mandatory to evaluate which type fits the child more than the others.This narrative review revised the different types of play therapy that could fit children with autism in an evidence-based way.Despite weak evidence,play therapy still has potential benefits for patients and their families.

Pleural effusion in critically ill patients and intensive care setting

Pleural effusion usually causes a diagnostic dilemma with a long list of differential diagnoses.Many studies found a high prevalence of pleural effusions in critically ill and mechanically ventilated patients,with a wide range of variable prevalence rates of up to 50%-60%in some studies.This review emphasizes the importance of pleural effusion diagnosis and management in patients admitted to the intensive care unit(ICU).The original disease that caused pleural effusion can be the exact cause of ICU admission.There is an impairment in the pleural fluid turnover and cycling in critically ill and mechanically ventilated patients.There are also many difficulties in diagnosing pleural effusion in the ICU,including clinical,radiological,and even laboratory difficulties.These difficulties are due to unusual presentation,inability to undergo some diagnostic procedures,and heterogenous results of some of the performed tests.Pleural effusion can affect the patient’s outcome and prognosis due to the hemodynamics and lung mechanics changes in these patients,who usually have frequent comorbidities.Similarly,pleural effusion drainage can modify the ICUadmitted patient’s outcome.Finally,pleural effusion analysis can change the original diagnosis in some cases and redirect the management toward a different way.

Cardiometabolic effects of breastfeeding on infants of diabetic mothers

BACKGROUND Breast milk is the best and principal nutritional source for neonates and infants.It may protect infants against many metabolic diseases,predominantly obesity and type 2 diabetes.Diabetes mellitus(DM)is a chronic metabolic and microvascular disease that affects all the body systems and all ages from intrauterine life to late adulthood.Breastfeeding protects against infant mortality and diseases,such as necrotizing enterocolitis,diarrhoea,respiratory infections,viral and bacterial infection,eczema,allergic rhinitis,asthma,food allergies,malocclusion,dental caries,Crohn's disease,and ulcerative colitis.It also protects against obesity and insulin resistance and increases intelligence and mental development.Gestational diabetes has short and long-term impacts on infants of diabetic mothers(IDM).Breast milk composition changes in mothers with gestational diabetes.AIM To investigate the beneficial or detrimental effects of breastfeeding on the cardiometabolic health of IDM and their mothers.METHODS We performed a database search on different engines and a thorough literature review and included 121 research published in English between January 2000 and December 15,2022,in this review.RESULTS Most of the literature agreed on the beneficial effects of breast milk for both the mother and the infant in the short and long terms.Breastfeeding protects mothers with gestational diabetes against obesity and type 2 DM.Despite some evidence of the protective effects of breastfeeding on IDM in the short and long term,the evidence is not strong enough due to the presence of many confounding factors and a lack of sufficient studies.CONCLUSION We need more comprehensive research to prove these effects.Despite many obstacles that may enface mothers with gestational diabetes to start and maintain breastfeeding,every effort should be made to encourage them to breastfeed.

COVID-19-induced gastrointestinal autonomic dysfunction:A systematic review

BACKGROUND It is common for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection to occur in the gastrointestinal tract,which can present itself as an initial symptom.The severity of coronavirus disease 2019(COVID-19)is often reflected in the prevalence of gastrointestinal symptoms.COVID-19 can damage the nerve supply to the digestive system,leading to gastrointestinal autonomic dysfunction.There is still much to learn about how COVID-19 affects the autonomic nervous system and the gastrointestinal tract.AIM To thoroughly explore the epidemiology and clinical aspects of COVID-19-induced gastrointestinal autonomic dysfunction,including its manifestations,potential mechanisms,diagnosis,differential diagnosis,impact on quality of life,prognosis,and management and prevention strategies.METHODS We conducted a thorough systematic search across various databases and performed an extensive literature review.Our review encompassed 113 studies published in English from January 2000 to April 18,2023.RESULTS According to most of the literature,gastrointestinal autonomic dysfunction can seriously affect a patient's quality of life and ultimate prognosis.Numerous factors can influence gastrointestinal autonomic nervous functions.Studies have shown that SARS-CoV-2 has a well-documented affinity for both neural and gastrointestinal tissues,and the virus can produce various gastrointestinal symptoms by reaching neural tissues through different pathways.These symptoms include anorexia,dysgeusia,heartburn,belching,chest pain,regurgitation,vomiting,epigastric burn,diarrhea,abdominal pain,bloating,irregular bowel movements,and constipation.Diarrhea is the most prevalent symptom,followed by anorexia,nausea,vomiting,and abdominal pain.Although COVID-19 vaccination may rarely induce autonomic dysfunction and gastrointestinal symptoms,COVID-19-induced autonomic effects significantly impact the patient's condition,general health,prognosis,and quality of life.Early diagnosis and proper recognition are crucial for improving outcomes.It is important to consider the differential diagnosis,as these symptoms may be induced by diseases other than COVID-19-induced autonomic dysfunction.Treating this dysfunction can be a challenging task.CONCLUSION To ensure the best possible outcomes for COVID-19 patients,it is essential to take a multidisciplinary approach involving providing supportive care,treating the underlying infection,managing dysfunction,monitoring for complications,and offering nutritional support.Close monitoring of the patient's condition is crucial,and prompt intervention should be taken if necessary.Furthermore,conducting thorough research on the gastrointestinal autonomic dysfunction caused by COVID-19 is vital to manage it effectively.

Role of gastrointestinal health in managing children with autism spectrum disorder

Children with autism spectrum disorders(ASD)or autism are more prone to gastrointestinal(GI)disorders than the general population.These disorders can significantly affect their health,learning,and development due to various factors such as genetics,environment,and behavior.The causes of GI disorders in children with ASD can include gut dysbiosis,immune dysfunction,food sensitivities,digestive enzyme deficiencies,and sensory processing differences.Many studies suggest that numerous children with ASD experience GI problems,and effective management is crucial.Diagnosing autism is typically done through genetic,neurological,functional,and behavioral assessments and observations,while GI tests are not consistently reliable.Some GI tests may increase the risk of developing ASD or exacerbating symptoms.Addressing GI issues in individuals with ASD can improve their overall well-being,leading to better behavior,cognitive function,and educational abilities.Proper management can improve digestion,nutrient absorption,and appetite by relieving physical discomfort and pain.Alleviating GI symptoms can improve sleep patterns,increase energy levels,and contribute to a general sense of well-being,ultimately leading to a better quality of life for the individual and improved family dynamics.The primary goal of GI interventions is to improve nutritional status,reduce symptom severity,promote a balanced mood,and increase patient independence.

May 2022 acute hepatitis outbreak,is there a role for COVID-19 and other viruses?

There has been an increasing number of reported cases of acute hepatitis of unknown origin in previously healthy children since first reported on March 31,2022.This clinical syndrome is identified by jaundice and markedly elevated liver enzymes with increased aspartate transaminase and/or alanine aminotransa-minase(greater than 500 IU/L).We conducted an inclusive literature review with respect to acute hepatitis outbreaks in children using the search terms acute hepatitis,outbreak,children,severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),coronavirus disease 2019(COVID-19),and adenovirus.According to the cumulative data presented in four main studies,the median age is 4 years,with a male predominance(1.3:1).Jaundice was the most common clinical manifestation(69%),followed by vomiting(63%),anorexia(52.9%),diarrhea(47.2%),abdominal pain(39%),pyrexia(33.3%),pale stool(30%),and dark urine(30%).Coryza and lethargy were reported in 16.6%,while pruritus was reported in 2%of cases.Acute liver failure was observed in 25%of cases.The exact mechanism of this acute hepatitis outbreak is still not entirely clear.Adenoviruses and SARS-CoV-2 were detected in a significant number of patients.Coinfection with adenovirus and SARS-CoV-2 could be a possible underlying mechanism.However,other possible infections and mechanisms must be considered in the pathogenesis of this condition.Acute hepatitis of unknown origin in children has been a serious problem since the start of the COVID-19 pandemic but has not yet been sufficiently addressed.Many questions remain regarding the underlying mechanisms leading to acute liver failure in children,and it is likely that extensive future research is needed.

Renal calcification in children with renal tubular acidosis:What a paediatrician should know

Renal tubular acidosis(RTA)can lead to renal calcification in children,which can cause various complications and impair renal function.This review provides pediatricians with a comprehensive understanding of the relationship between RTA and renal calcification,highlighting essential aspects for clinical manage-ment.The article analyzed relevant studies to explore the prevalence,risk factors,underlying mechanisms,and clinical implications of renal calcification in children with RTA.Results show that distal RTA(type 1)is particularly associated with nephrocalcinosis,which presents a higher risk of renal calcification.However,there are limitations to the existing literature,including a small number of studies,heterogeneity in methodologies,and potential publication bias.Longitudinal data and control groups are also lacking,which limits our understanding of longterm outcomes and optimal management strategies for children with RTA and renal calcification.Pediatricians play a crucial role in the early diagnosis and management of RTA to mitigate the risk of renal calcification and associated complications.In addition,alkaline therapy remains a cornerstone in the treatment of RTA,aimed at correcting the acid-base imbalance and reducing the formation of kidney stones.Therefore,early diagnosis and appropriate therapeutic interventions are paramount in preventing and managing renal calcification to preserve renal function and improve long-term outcomes for affected children.Further research with larger sample sizes and rigorous methodologies is needed to optimize the clinical approach to renal calcification in the context of RTA in the pediatric population.

Viruses and autism: A Bi-mutual cause and effect

Autism spectrum disorder(ASD)is a group of heterogeneous,multi-factorial,neurodevelopmental disorders resulting from genetic and environmental factors interplay.Infection is a significant trigger of autism,especially during the critical developmental period.There is a strong interplay between the viral infection as a trigger and a result of ASD.We aim to highlight the mutual relationship between autism and viruses.We performed a thorough literature review and included 158 research in this review.Most of the literature agreed on the possible effects of the viral infection during the critical period of development on the risk of developing autism,especially for specific viral infections such as Rubella,Cytomegalovirus,Herpes Simplex virus,Varicella Zoster Virus,Influenza virus,Zika virus,and severe acute respiratory syndrome coronavirus 2.Viral infection directly infects the brain,triggers immune activation,induces epigenetic changes,and raises the risks of having a child with autism.At the same time,there is some evidence of increased risk of infection,including viral infections in children with autism,due to lots of factors.There is an increased risk of developing autism with a specific viral infection during the early developmental period and an increased risk of viral infections in children with autism.In addition,children with autism are at increased risk of infection,including viruses.Every effort should be made to prevent maternal and early-life infections and reduce the risk of autism.Immune modulation of children with autism should be considered to reduce the risk of infection.

Causative bacteria of ventilator-associated pneumonia in intensive care unit in Bahrain:Prevalence and antibiotics susceptibility pattern

BACKGROUND Ventilator-associated pneumonia(VAP)is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that.It is the most common infection encountered among intubated patients.VAP incidence showed wide variability between countries.AIM To define the VAP incidence in the intensive care unit(ICU)in the central gove-rnment hospital in Bahrain and review the risk factors and the predominant bacterial pathogens with their antimicrobial susceptibility pattern.METHODS The research was a prospective cross-sectional observational study over six months from November 2019 to June 2020.It included adult and adolescent patients(>14 years old)admitted to the ICU and required intubation and mechanical ventilation.VAP was diagnosed when it occurred after 48 h after endotracheal intubation using the clinical pulmonary infection score,which considers the clinical,laboratory,microbiological,and radiographic evidence.RESULTS The total number of adult patients admitted to the ICU who required intubation and mechanical ventilation during the study period was 155.Forty-six patients developed VAP during their ICU stay(29.7%).The calculated VAP rate was 22.14 events per 1000 ventilator days during the study period,with a mean age of 52 years±20.Most VAP cases had late-onset VAP with a mean number of ICU days before the development of VAP of 9.96±6.55.Gram-negative contributed to most VAP cases in our unit,with multidrug-resistant Acinetobacter being the most identified pathogen.CONCLUSION The reported VAP rate in our ICU was relatively high compared to the international benchmark,which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle.

Gut microbiota in various childhood disorders:Implication and indications

Gut microbiota has a significant role in gut development,maturation,and immune system differentiation.It exerts considerable effects on the child's physical and mental development.The gut microbiota composition and structure depend on many host and microbial factors.The host factors include age,genetic pool,general health,dietary factors,medication use,the intestine's pH,peristalsis,and transit time,mucus secretions,mucous immunoglobulin,and tissue oxidation-reduction potentials.The microbial factors include nutrient availability,bacterial cooperation or antagonism,and bacterial adhesion.Each part of the gut has its microbiota due to its specific characteristics.The gut microbiota interacts with different body parts,affecting the pathogenesis of many local and systemic diseases.Dysbiosis is a common finding in many childhood disorders such as autism,failure to thrive,nutritional disorders,coeliac disease,Necrotizing Enterocolitis,helicobacter pylori infection,functional gastrointestinal disorders of childhood,inflammatory bowel diseases,and many other gastrointestinal disorders.Dysbiosis is also observed in allergic conditions like atopic dermatitis,allergic rhinitis,and asthma.Dysbiosis can also impact the development and the progression of immune disorders and cardiac disorders,including heart failure.Probiotic supplements could provide some help in managing these disorders.However,we are still in need of more studies.In this narrative review,we will shed some light on the role of microbiota in the development and management of common childhood disorders.

Paediatric gastrointestinal disorders in SARS-CoV-2 infection:Epidemiological and clinical implications

The coronavirus disease 2019(COVID-19)pandemic is a threat worldwide for individuals of all ages,including children.Gastrointestinal manifestations could be the initial presenting manifestation in many patients,especially in children.These symptoms are more common in patients with severe disease than in patients with non-severe disease.Approximately 48.1%of patients had a stool sample that was positive for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)viral RNA.Children typically form 1%-8%of all laboratoryconfirmed cases of SARS-CoV-2.Gastrointestinal manifestations of COVID-19 in children are not rare,with a prevalence between 0 and 88%,and a wide variety of presentations,including diarrhoea,vomiting,and abdominal pain,can develop before,with or after the development of respiratory symptoms.Atypical manifestations such as appendicitis or liver injury could also appear,especially in the presence of multisystem inflammatory disease.In this review,we discussed the epidemiology of COVID-19 gastrointestinal diseases in children as well as their implications on the diagnosis,misdiagnosis,prognosis,and faecal-oral transmission route of COVID-19 and the impact of gastrointestinal diseases on the gut microbiome,child nutrition,and disease management.

Insulin-resistance in paediatric age:Its magnitude and implications

Insulin resistance(IR)is insulin failure in normal plasma levels to adequately stimulate glucose uptake by the peripheral tissues.IR is becoming more common in children and adolescents than before.There is a strong association between obesity in children and adolescents,IR,and the metabolic syndrome components.IR shows marked variation among different races,crucial to understanding the possible cardiovascular risk,specifically in high-risk races or ethnic groups.Genetic causes of IR include insulin receptor mutations,mutations that stimulate autoantibody production against insulin receptors,or mutations that induce the formation of abnormal glucose transporter 4 molecules or plasma cell membrane glycoprotein-1 molecules;all induce abnormal energy pathways and end with the development of IR.The parallel increase of IR syndrome with the dramatic increase in the rate of obesity among children in the last few decades indicates the importance of environmental factors in increasing the rate of IR.Most patients with IR do not develop diabetes mellitus(DM)type-II.However,IR is a crucial risk factor to develop DM type-II in children.Diagnostic standards for IR in children are not yet established due to various causes.Direct measures of insulin sensitivity include the hyperinsulinemia euglycemic glucose clamp and the insulin-suppression test.Minimal model analysis of frequently sampled intravenous glucose tolerance test and oral glucose tolerance test provide an indirect estimate of metabolic insulin sensitivity/resistance.The main aim of the treatment of IR in children is to prevent the progression of compensated IR to decompensated IR,enhance insulin sensitivity,and treat possible complications.There are three main lines for treatment:Lifestyle and behavior modification,pharmacotherapy,and surgery.This review will discuss the magnitude,implications,diagnosis,and treatment of IR in children。

Cough as a neurological sign:What a clinician should know

Cough is a common respiratory complaint driving patients to seek medical advice.Besides being a fundamental respiratory sign,it is also a crucial neurological sign.There are three main types of coughs:Reflex cough(typeⅠ),voluntary cough(typeⅡ),and evoked cough(typeⅢ).Cough is a reflex predominantly mediated by control centers in the respiratory areas of the brainstem,modulated by the cerebral cortex.Cough reflex sensitivity could be increased in many neurological disorders such as brainstem space-occupying lesions,medullary lesions secondary to Chiari typeⅠmalformations,tics disorders such as Tourette's syndrome,somatic cough,cerebellar neurodegenerative diseases,and chronic vagal neuropathy due to allergic and non-allergic conditions.Meanwhile,cough sensitivity decreases in multiple sclerosis,brain hypoxia,cerebral hemispheric stroke with a brainstem shock,Parkinson's disease,dementia due to Lewy body disease,amyotrophic lateral sclerosis,and peripheral neuropathy as diabetic neuropathy,hereditary sensory and autonomic neuropathy typeⅣ,vitamin B12,and folate deficiency.Arnold's nerve ear-cough reflex,syncopal cough,cough headache,opioids-associated cough,and cough-anal reflex are signs that could help diagnose underlying neurological conditions.Cough reflex testing is a quick,easy,and cheap test performed during the cranial nerve examination.In this article,we reviewed the role of cough in various neurological disorders that increase or decrease cough sensitivity.