Evaluation of Dietary Diversity, Nutrient Adequacy and Nutritional Status of Pre-school Children in Three Local Government Areas of Ibadan, Nigeria

Malnutrition remains a public health challenge in Nigeria, partly due to poor diversity of diets. Pre-school children are among the vulnerable groups who are mostly affected in communities, as their nutritional status is largely influenced by the quality of diets they consume. Most studies aimed at malnutrition among under-five children have been focused on meeting protein-energy needs without much consideration for micronutrients needs. Dietary diversity has been advocated as a means of meeting nutritional requirements of children. This study was designed to assess the dietary diversity in relation to nutrient adequacy and nutritional status of pre-school children in Ibadan. The descriptive cross-sectional study was carried out among 552 pre-schoolers aged 3-5 years in Egbeda, Ona-Ara and Ido Three Local Government Areas (LGAs) of Ibadan metropolis. A structured questionnaire was used to obtain information on socio-demographic characteristics of mother and child. Nutritional status was determined using anthropometric indices. Food frequency questionnaire of 9 food groups was used to obtain dietary diversity scores (DDS) classified as low (< 4 food groups), average (4 to 6 food groups), and high (≥ 7 food groups);and 24-hour dietary recall was used to obtain nutrient adequacy of diet. Data were analysed using descriptive statistics, Pearson’s correlation coefficient, and level of significance set at p < 0.05. Malnutrition among pre-schoolers was more prevalent among males (22.0%) than females (18.4%). Stunting was the most prevalent form of malnutrition (26.8%). The DDS of pre-schoolers was low (3.2 ± 1.9). The most consumed food group was cereals, roots and tubers (83.9%) while fruit was least consumed (6.5%). Nutrient adequacy ratio for carbohydrate was highest (1.2 ± 0.2) and least in fibre (0.2 ± 0.2), while mean adequacy ratio for food consumed was (0.72 ± 0.13). There was weak relationship between DDS and nutritional status—wasting (r =-0.067), stunting (r =-0.002) and underweight (r =-0.056). Low dietary diversity and malnutrition existed among pre-school children in the three LGAs. Nutrition education and enlightenment programmes are required by the parents/guardians of pre-school children on importance of dietary diversity in these areas.

Comparison Study of Art Therapy and Play Therapy in Reducing Anxiety on Pre-School Children Who Experience Hospitalization

Pain and hospitalization caused a crisis in the child’s life. At the pre-school children, the stress of the disease makes children become less able to cope with separation. As a result, many children show anxious behavior though more vague than toddler age children. Various ways have been conducted by nurses to treat anxiety in children, but the most effective types of the intervention have not be found. Types of intervention that can be done are art therapy and play therapy. This study aims to compare the effects of art therapy and play therapy in reducing anxiety on children who experience hospitalization. A quasi-experimental research design with pre-post test two group design is used. The sample was 23 children pre-school age for art therapy group and 25 children for play therapy with sampling techniques performed purposive sampling. Intervention of art therapy and play therapy each performed for 3 days with duration about 30 minutes. Anxiety levels before and after the intervention were measured by using the facial affective scale. The results show that there is a difference in anxiety between before and after the action in the art therapy group (p = 0.00) and that there are differences in anxiety before and after the action in the play therapy group (0.00). But statistical tests using Man Whitney U indicate that there is no difference in anxiety levels in pre-school children who do art therapy and play therapy (p = 0.26). So, it is concluded that the art therapy and the play therapy can reduce the level of anxiety on pre-school school children that experience hospitalization. Based on these conclusions, it is recommended that the art therapy and the play therapy can be used by nurses and the choice of the intervention should be submitted to the child.

Food Consumption Patterns among Pre-School Children 3 - 5 Years Old in Mateka, Western Kenya

Hunger and malnutrition are burdens that are pronounced in developing countries where they manifest themselves in the forms of protein energy malnutrition. Malnutrition compromises the child’s immune system leading to direct mortality and increased vulnerability to infectious diseases stunting and poor brain development. This study sought to analyze the food consumption patterns of children 3 - 5 years old attending Mateka Primary school, Bungoma County. This study adopted a cross sectional survey. One hundred and twenty five (125) children selected from three ECD classes in the school formed the sample size. Purposive and simple random sampling techniques were used to select the study area and the children respectively. Structured questionnaires were administered to the caregivers of the children. Information on demographics, socio-economic status, and food consumption patterns were gathered. Food consumption patterns were assessed using a HDDS and a quantitative food frequency questionnaire. Socio-demographic data was analyzed using (SPSS) Version 21 (2007) and dietary data was analyzed using Nutri-Survey for Windows (2007). Results revealed that most of the households were of low socio-economic characteristics. The most consumed foods were cereals, roots and tubers. Majority (55.2%) of the children had low dietary diversity, 29.1% had medium dietary diversity and 15.7% had greater dietary diversity. The children were deficient in energy, protein, Vitamin A, Iron and Zinc. It can be concluded that the diets fed to the children are inadequate to meet their nutrient intakes for physiological development and growth. Further research should be done to document the prevalence of micronutrient malnutrition among the children.

Prevalence of Intestinal Parasitic Infection among Pre-School and School-Aged Children Attending to Fann University Hospital, Dakar: Results from Retrospective Analysis

Background: Intestinal parasitic infections represent a major public health problem worldwide. Pre-school and school children have a high risk of infection. The study aimed to determine the epidemiological aspects of intestinal parasitic infections in preschool and school-aged children in Dakar, Senegal. Methods: A retrospective analysis of laboratory records from preschool and school-aged children referred to the Laboratory of Parasitology at the Fann University Hospital in Dakar, Senegal, was carried out. The analysis of the period from 2016 to 2020. Stool samples were examined for the presence of parasites using direct, formal-ether concentration method and the Modified Ziehl Neelsen staining technique. Descriptive and analytic analysis was performed with Stata MP 16.1 software. Results: The overall prevalence of intestinal parasitic infection was 26.8% (429/1603). Blastocystis sp. (34%), Entamaeba coli (28%), Giardia intestinalis (9.6%), Endolimax nana (4.9%) and Ascaris lumbricoides (3.5%) were the common parasites found. Out of the 429 children positive for intestinal parasites, protozoa parasites represent 93.9%. Single infection and mixed infection represent 83.7% and 16.3%. The most prevalent associations were E. coli + Blastocystis sp. (6.3%), E. coli + E. nana (3.3%), and G. intestinalis + Blastocystis sp. (1.9%). Children between the ages of 5 - 10 years and those over 10 years had the most parasitic infections with 28.1% [aOR = 1.91;95% CI (1.25 - 2.89)] and 27.4% [aOR = 11.92 (1.07 - 3.07)]. According to the year of sample collection, the prevalence was higher in 2017, 32.6% [aOR = 1.49 (1.11 - 2.01]. The prevalence of intestinal parasitic infection was not significantly related to gender (p = 0.87), season (p = 0.85) and symptomatology (p = 0.19). The main clinical symptoms were dysenteric syndrome, dyspeptic disorders, constipation and abdominal pain. Intestinal parasite carriage in patients with acute diarrhea was 20.4%. In HIV positive with chronic diarrhea, the prevalence was 28.6%. Conclusion: The results showed the frequency of intestinal parasites in preschool and school-aged children with a high proportion of protozoa parasites. Children aged over 5 years were more affected. Preventive measures such as health education, improved socio-economic conditions and environmental sanitation are required for reducing their frequency.

Diphtheria and Tetanus Antibody Persistence in Indian Pre-school Children and Response to a Booster Dose of DT Vaccine.

Despite effective vaccines, diphtheria (D) resurged recently in the former socialistic block, and tetanus (T) still occurs in less privileged countries. We studied the antibody persistence for D and T in Indian pre-school children who had received four doses of DTP vaccine and subsequently, the response to a booster dose. Anti-D and anti-T IgG antibodies prior to and one month after a DT vaccine were measured by ELISA in 223 healthy children of 4-6 years who had previously received four doses of the triple vaccine. Adverse reactions were monitored for one month. While 30% and 14% of subjects were susceptible to D and T, respectively, 98% and 100% of them attained seroprotection post-vaccination. Both responses were significant. Local, but not systemic reactions except fever were rather common. A high proportion of the Indian pre-school population is susceptible to D and T, despite of receiving four doses. The current policy of giving the fifth dose at this age is appropriate.

Physical Activity in Pre-school Children:Role of the Teacher during Free Play

It has become evident over the past decade that the lack of PA(physical activity)is a major concern for the population at large CDC(Center for Disease Control).This lack is a major reason for the increase in overweight and obese children(USDHHS,2014).The CDC and the American Heart Association recommend children need at least 60 minutes of play time that is not scheduled PA.The purpose of this research was to examine whether children’s PA will increase if teacher activity increases during unstructured free play time.Students’PA was determined by using the SOPLAY(system for observing play and leisure activity in youth-children).SOPLAY is a validated tool for directly observing PA and associated environmental characteristics in free play settings(e.g.,recess and lunch at school).SOPLAY provides objective data on the number of participants and their PA levels during play and leisure opportunities in targeted areas.Children and teachers in a West Texas Lab School(mean age=4.3 years)on a university campus were studied.Control group data(males=13,female=15)were analyzed and MVPA(moderate to vigorous physical activity)was calculated.Data showed that children spent only 30%of their free-time in the recommended intensity levels.Teachers’(n=5)overall metabolic equivalents(METs)were recorded at 1.13.The experimental group(males=11,female=13)recorded teachers’(n=6)METs at 2.47 and children MVPA at 44%.Both the MVPA and METs were significantly different(p<0.001).The value and importance of unstructured play time are important for children as well as the teachers.Children need time to be creative and explore during play and teachers use this free time for various activities including cognitive breaks or administrative work.A stronger push to get teachers moving should be made as this slight increase in METs produces a significant increase in children’s PA.

Relationship between parenting stress and behavioral and emotional problems in preschool children: A mediation effect analysis

BACKGROUND Emotional reactions,such as anxiety,irritability,and aggressive behavior,have attracted clinical attention as behavioral and emotional problems in preschool-age children.AIM To investigate the current status of family rearing,parental stress,and behavioral and emotional problems of preschool children and to analyze the mediating effect of the current status of family rearing on parental stress and behavioral/emo-tional problems.METHODS We use convenience sampling to select 258 preschool children in the physical examination center of our hospital from October 2021 to September 2023.The children and their parents were evaluated using a questionnaire survey.Pearson's correlation was used to analyze the correlation between child behavioral and emotional problems and parental stress and family rearing,and the structural equation model was constructed to test the mediating effect.RESULTS The score for behavioral/emotional problems of 258 preschool children was(27.54±3.63),the score for parental stress was(87.64±11.34),and the score for parental family rearing was(31.54±5.24).There was a positive correlation between the behavioral and emotional problems of the children and the“hostile/mandatory”parenting style;meanwhile,showed a negative correlation with the“support/participation”parenting style(all P<0.05).The intermediary effect value between the family upbringing of parents in parental stress and children's behavior problems was 29.89%.CONCLUSION Parental family upbringing has a mediating effect between parental stress and behavioral and emotional problems of children.Despite paying attention to the behavioral and emotional problems of preschool-age children,clinical medical staff should provide correct and reasonable parenting advice to their parents to promote the mental health of preschool-age children.

Risk factors for congenital nasolacrimal duct obstruction in children under two years of age

·AIM:To identify various risk factors that may play a significant role in the development of congenital nasolacrimal duct obstruction(CNLDO).·METHODS:This observational case-control study included a case group of 122 children less than two years of age with CNLDO who underwent probing and irrigation treatment at the ophthalmology department of Imam Khomeini Hospital in Ahvaz,Iran,from June 2022 to June2024.A control group of 122 age-matched children without CNLDO was also included for comparison.Data was collected from the children's medical records.·RESULTS:The study found a significant correlation between the occurrence of CNLDO and several maternal factors,such as preeclampsia,the use of levothyroxine,hypothyroidism,having more than three pregnancies(gravidity>3),natural pregnancy,and gestational diabetes mellitus.Additionally,in children,factors,such as oxygen therapy,anemia,reflux,jaundice,and a family history of CNLDO in first-degree relatives were associated with CNLDO,and maternal preeclampsia and hypothyroidism were found to significantly increase the risk of developing CNLDO in children.·CONCLUSION:Given that CNLDO affects both premature and full-term children,the present findings may potentially facilitate the early identification of children and infants at risk of nasolacrimal duct obstruction,thereby preventing the onset of chronic dacryocystitis.

The effects of exercise interventions on brain-derived neurotrophic factor levels in children and adolescents:a meta-analysis

Brain-derived neurotrophic factor is a crucial neurotrophic factor that plays a significant role in brain health. Although the vast majority of meta-analyses have confirmed that exercise interventions can increase brain-derived neurotrophic factor levels in children and adolescents, the effects of specific types of exercise on brain-derived neurotrophic factor levels are still controversial. To address this issue, we used meta-analytic methods to quantitatively evaluate, analyze, and integrate relevant studies. Our goals were to formulate general conclusions regarding the use of exercise interventions, explore the physiological mechanisms by which exercise improves brain health and cognitive ability in children and adolescents, and provide a reliable foundation for follow-up research. We used the Pub Med, Web of Science, Science Direct, Springer, Wiley Online Library, Weipu, Wanfang, and China National Knowledge Infrastructure databases to search for randomized controlled trials examining the influences of exercise interventions on brain-derived neurotrophic factor levels in children and adolescents. The extracted data were analyzed using Review Manager 5.3. According to the inclusion criteria, we assessed randomized controlled trials in which the samples were mainly children and adolescents, and the outcome indicators were measured before and after the intervention. We excluded animal experiments, studies that lacked a control group, and those that did not report quantitative results. The mean difference(MD;before versus after intervention) was used to evaluate the effect of exercise on brain-derived neurotrophic factor levels in children and adolescents. Overall, 531 participants(60 children and 471 adolescents, 10.9–16.1 years) were included from 13 randomized controlled trials. Heterogeneity was evaluated using the Q statistic and I^(2) test provided by Review Manager software. The meta-analysis showed that there was no heterogeneity among the studies(P = 0.67, I^(2) = 0.00%). The combined effect of the interventions was significant(MD = 2.88, 95% CI: 1.53–4.22, P < 0.0001), indicating that the brain-derived neurotrophic factor levels of the children and adolescents in the exercise group were significantly higher than those in the control group. In conclusion, different types of exercise interventions significantly increased brain-derived neurotrophic factor levels in children and adolescents. However, because of the small sample size of this meta-analysis, more high-quality research is needed to verify our conclusions. This metaanalysis was registered at PROSPERO(registration ID: CRD42023439408).

Mycoplasma pneumoniae pneumonia in children

Mycoplasma pneumoniae(M.pneumoniae)is a common pathogen that causes community-acquired pneumonia in children.The clinical presentation of this pathogen can range from mild self-limiting illness to severe and refractory cases.Complications may occur,such as necrotizing pneumonia and respiratory failure.Extrapulmonary complications,including encephalitis,myocarditis,nephritis,hepatitis,or even multiple organ failure,can also arise.In this editorial,we dis-cuss the clinical implications of the significant findings from the article"Serum inflammatory markers in children with M.pneumoniae pneumonia and their predictive value for mycoplasma severity"published by Wang et al.They reported that measuring lactic dehydrogenase,interleukin-6 levels,and D-dimer effectively predicts refractory M.pneumoniae pneumonia cases.

Clinical,laboratory,and therapeutic differences between immunoglobulin E-mediated and non-immunoglobulin E-mediated cow’s milk protein allergy in children

BACKGROUND Although breast milk is ideal for newborns,in some cases,it is replaced with cow’s milk,which contains proteins that increase the risk of cow’s milk protein allergy(CMPA).AIM To evaluate CMPA prevalence in Bahrain and compare clinical characteristics of children with immunoglobulin E(IgE)-and non-IgE-mediated CMPA.METHODS This retrospective cohort study examined children with CMPA diagnosed at the pediatric gastroenterology outpatient clinic of the Salmaniya Medical Complex,Bahrain,between 2014 and 2022,and assessed CMPA prevalence.Clinical presentations,laboratory findings,dietary modifications,and outcomes were compared between children with IgE-mediated and non-IgE-mediated CMPA.Categorical variables were compared using Fisher’s exact test or Pearson’sχ2 test,whereas continuous variables were compared using Student’s t-test or the Mann-Whitney U test.RESULTS Of 8332 patients,6022(72.3%)adhered to their appointment.Of them,618(10.3%)were suggested of having CMPA and 595(96.3%)were included;CMPA prevalence was 2%.Most patients were Bahraini(93.8%)and males(55.3%).Non-IgE-mediated type accounted for 77.3%cases and IgE-mediated type,22.7%.IgE-mediated CMPA presented more in boys(P=0.030),and later in life(5.1 months±4.5 months vs 4.2 months±4.2 months,P=0.016,95%CI:0.08-1.73),had more associated diseases(P<0.001);and presented with more cutaneous(P=0.024)and respiratory(P=0.003)manifestations,severe symptoms[rash/dry skin(P=0.031),facial swelling/angioedema(P=0.003),failure to thrive(P=0.013),apparent life-threatening event(P<0.001)],and positive physical findings(P=0.002)than non-IgE-mediated CMPA.Most patients were exclusively fed cow milk formula(50.3%).The amino acid-based formula(AAF)was most prescribed(60.5%)with no difference between the two types(P=0.173).Although breastfeeding was recommended to 49.6%,only 8.2%were exclusively breastfed.IgE-mediated CMPA was associated with a longer follow-up duration than non-IgE-mediated CMPA(17.3 months±14.0 months vs 13.5 months±13.4 months,P=0.005,95%CI:1.1-6.3).CONCLUSION This study revealed a high CMPA prevalence with clinical differences between both types that can influence treatment.AAF was most prescribed,while breastfeeding with dietary modification is rarely applied.

Diet fortification for mild and moderate picky eating in typically developed children:Opinion review of Middle East consensus

BACKGROUND Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental growth.Although common characteristics distinguish peaky eaters,including food selectivity,food neophobia,and food avoidance,there is no clear definition to assess this behavior.Due to the unavailability of data regarding picky eating,it wasn’t easy to estimate its prevalence.AIM To develop a regional protocol to help healthcare professionals identify and manage mild and moderate picky eating cases.METHODS A virtual roundtable discussion was held in April 2021 to gather the opinions of seven pediatricians and two pediatric dietitians from eight Middle Eastern countries who had great experience in the management of picky eating.The discussion covered different topics,including clearly defining mild and moderate picky eating,identifying the role of diet fortification in these cases,and the possibility of developing a systematic approach to diet fortification.RESULTS The panel identified picky eating as consuming an inadequate amount and variety of foods by rejecting familiar and unfamiliar food.Most of the time,moderate picky eating cases had micronutrient deficiencies with over-or undernutrition;the mild cases only showed inadequate food consumption and/or poor diet quality.Paying attention to the organic red flags like growth faltering and development delay and behavioral red flags,including food fixation and anticipatory gagging,will help healthcare professionals evaluate the picky eaters and the caregivers to care for their children.Although dietary supplementation and commercial food fortification play an important role in picky eating,they were no benefit in the Middle East.CONCLUSION The panel agreed that food fortification through a food-first approach and oral nutritional supplements would be the best for Middle Eastern children.These recommendations would facilitate identifying and managing picky-eating children in the Middle East.

Cardiovascular involvement in multisystem inflammatory syndrome in children and midterm follow-up from a pediatric tertiary center in India

BACKGROUND In multisystem inflammatory syndrome in children(MIS-C)with coronavirus disease 2019,there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal outcomes.We planned to estimate the pattern of cardiovascular involvement among children with MIS-C and its mid-term outcomes.AIM To determine association between cardiovascular abnormalities and clinical and laboratory parameters.To study the time-line for resolution of various abnormalities.METHODS In this prospective study done in a tertiary care hospital,270 were recruited from June 2020 to January 2022.Baseline demographic data and clinical presentation were recorded.Laboratory parameters and echocardiography were done at admission.Follow-up was done at 2 weeks,3 months,6 months and 1 year after diagnosis.Descriptive statistics were used for parametric and non-parametric data.Risk factors were identified by multivariate regression analysis.RESULTS The 211(78.2%)had cardiac involvement and 102 needed intensive care unit(ICU)admission.Cardiovascular abnormalities observed were shock 123(45.6%),coronary dilatation 28(10.4%),coronary aneurysm 77(28.5%),left ventricular(LV)dysfunction 78(29.3%),mitral regurgitation(MR)77(28.5%)and pericardial effusion 98(36.3%).Coronary artery aneurysm/dilatation during follow-up at 2 weeks and 1 year were 25.7%and 0.9%respectively.Multivariate regression analysis revealed breathlessness[odds ratio(OR)=3.91,95%CI:1.25-12.21,P=0.019]and hi-flow nasal cannula(HFNC)support(OR=8.5,95%CI:1.06-68.38,P=0.044)as predictors of cardiovascular involvement.Higher mean age(OR=1.16,95%CI:1.02-1.32,P=0.026),breathlessness(OR=4.99,95%CI:2.05-12.20,P<0.001),gallop(OR=4.45,95%CI:0.41-2.52,P=0.016),MR(OR=3.61,95%CI:1.53-8.53,P=0.004)and invasive ventilation(OR=4.01,95%CI:1.28-12.58,P=0.017)were predictive of LV dysfunction.Altered sensorium(OR=4.96,95%CI:2.23-11.02,P<0.001),headache(OR=6.61,95%CI:1.46-29.92,P=0.014),HFNC(OR=7.03,95%CI:2.04-24.29,P=0.002),non-rebreathing mask usage(OR=21.13,95%CI:9.00-49.61,P<0.001)and invasive ventilation(OR=5.64,95%CI:1.42-22.45,P=0.014)were risk factors for shock.Anemia was a risk factor for coronary involvement(OR=3.09,95%CI:1.79-5.34,P<0.001).CONCLUSION Significant number of children with MIS-C had cardiovascular involvement contributing to higher ICU management.Although shock resolved quickly,resolution of ventricular function and coronary abnormalities were slower,and hence warrants a structured long-term follow-up protocol.

Addressing functional constipation in children:A call for comprehensive and collaborative management

Functional constipation(FC)is the most common gastrointestinal disorder in children,with a global prevalence of 14.4%based on Rome IV criteria.This editorial explores the multifactorial pathogenesis and diagnostic complexity of FC,emphasizing the importance of early and accurate diagnosis.Effective management of FC hinges on child-oriented toilet training and the use of osmotic laxatives,particularly polyethylene glycol.Emerging therapies,including probiotics,serotonin 5-HT4 receptor agonists,chloride channel activators,and herbal remedies,offer promising options but require further research.Lifestyle modifications,such as adequate fiber and fluid intake and physiotherapy,are crucial in supporting pharmacological treatments.For intractable cases,a multidisciplinary approach involving pediatric specialists,nutritionists,physiotherapists,and psychologists is essential.This comprehensive strategy aims to improve the quality of life for children with FC and their families through continuous research,education,and collaborative care.

Non-suicidal self-injury risk among left-behind children and adolescents in China:A systematic review and meta-analysis

BACKGROUND Increasing evidence has shown an increased risk of non-suicidal self-injury(NSSI)in left-behind children and adolescents(LBCAs).However,a systematic summary of studies comparing the risk of NSSI between LBCAs and non-LBCAs in China is lacking.AIM To investigate the risk of NSSI among LBCAs in China.METHODS We performed a systematic search of Embase,PubMed,and Web of Science from initiation to October 25,2024,for all relevant studies of NSSI and LBCAs.The effect sizes were reported as odds ratios(ORs)with 95%confidence intervals(CI).Sensitivity analyses were conducted to further confirm the stability of the findings.RESULTS A total of 10 studies with 165276 children and adolescents were included in this study.LBCAs had significantly higher rates of NSSI compared with non-LBCAs(OR=1.33,95%CI:1.19-1.49),with high heterogeneity observed(I^(2)=77%,P<0.001).Further sensitivity analyses were consistent with the primary analysis(OR=1.29,95%CI:1.21-1.39,I^(2)=0%).CONCLUSION LBCAs are found to be at an increased risk of NSSI compared with children and adolescents of non-migrants.More attention and intervention are urgently needed for LBCAs,especially those living in developing countries.

Diffuse panbronchiolitis in children misdiagnosed as asthma: A case report

BACKGROUND Diffuse panbronchiolitis(DPB)is a rare,chronic inflammatory lung disease mar-ked by chronic cough,breathlessness,and preceding sinusitis.Symptoms often persist for years and can be misdiagnosed as asthma,particularly in children.This report describes a DPB case resolved with long-term azithromycin therapy,em-phasizing the need for a timely and accurate diagnosis.CASE SUMMARY A 12-year-old girl,diagnosed with asthma at age five and managed with inhaled corticosteroids and long-acting beta-2 agonists,developed a history of chronic productive cough and chronic sinusitis for a year.On examination,she exhibited wheezing and coarse crackles.Despite receiving treatment for an asthma exacer-bation,her symptoms did not improve.A chest X-ray revealed reticulonodular infiltration in both lower lungs,prompting further evaluation with high-resolu-tion computed tomography(HRCT).The HRCT confirmed centrilobular nodule opacities,a'tree-in-bud'pattern,and non-tapering bronchi,suggesting DPB.Elevated cold hemagglutinin titers at 128 further supported the diagnosis.Her cough and sinusitis resolved within a month after starting azithromycin therapy,chosen for its anti-inflammatory and immunomodulatory effects.Follow-up HRCT scans after 1 year of continuous treatment showed complete normalization.CONCLUSION This case highlights the importance of early diagnosis and prompt treatment in achieving favorable outcomes for DPB.

Comparison of biomechanical indices measured by ocular response analyzer between children and elderly:a systematic review

Biomechanical study of the visual system by ocular response analyzer investigates the inter-structural biological relationships,mechanics,and function of the visual system.This review aimed to investigate the changes in corneal biomechanical parameters with age and sex.The articles published in PubMed between 2000 and 2021 were investigated and critiqued,and valid scientific evidence was collected,reviewed and concluded according to the inclusion and exclusion criteria.Most studies showed that corneal biomechanical changes occur infrequently in children up to the age of 20y,and with increasing age and wider age range,there was a significant decrease in corneal biomechanical indices,especially corneal hysteresis.In children and adults,most studies have shown that these biomechanical indicators,especially corneal resistance factor,were higher in females.Although hormonal changes may contribute to this finding,the role of axial length and other biometric indicators should not be ignored.The axial length,the intraocular pressure,and the corneal thickness are other factors associated with biomechanical parameters that should be taken into account in clinical diagnosis and management especially for patients undergoing refractive surgery as well as keratoconus patients.

Low-concentration atropine(0.01%)on quantitative contrast sensitivity function in Chinese children with myopia

AIM:To investigate the effect of 0.01%low-concentration atropine(LA)on quantitative contrast sensitivity function(qCSF)in children with myopia.METHODS:This paired case-control study included 90 eyes of 58 children who were sex-,age-,and refractionmatched and equally divided into two groups:the 0.01%LA group had undergone 6mo use of daily 0.01%atropine and control group was naïve to LA.Routine ophthalmic examinations and qCSF test without refractive correction were performed.Two groups were compared in monocular and binocular qCSF parameters,including the area under logCSF,CSF acuity,and contrast sensitivity(CS)at 1.0-18.0 cycle per degree(cpd).RESULTS:In the monocular comparison,the CSF acuity of the LA group was significantly higher than that of the control group(7.58±5.51 vs 6.37±4.22 cpd,P<0.05).The subgroup analysis showed that in the 6-9y group,CSF acuity was significantly higher in the LA group than the control group(8.76±6.19 vs 6.54±4.25 cpd,P<0.05),and in the Female group,low refraction sphere group,and high refraction cylinder group,the CS at high spatial frequencies(12.0 and 18.0 cpd)were significantly higher in the LA group than in the control group(all P<0.05).In the binocular test,CSF acuity and CS at 12.0 cpd were significantly higher in the LA group than in the control group(10.95±7.00 vs 8.65±5.12 cpd;0.17±0.33 vs 0.06±0.16,respectively;both P<0.05).CONCLUSION:Use of LA may result in improved CS in children with early onset myopia.

Association of preschool children behavior and emotional problems with the parenting behavior of both parents

BACKGROUND Parental behaviors are key in shaping children’s psychological and behavioral development,crucial for early identification and prevention of mental health issues,reducing psychological trauma in childhood.AIM To investigate the relationship between parenting behaviors and behavioral and emotional issues in preschool children.METHODS From October 2017 to May 2018,7 kindergartens in Ma’anshan City were selected to conduct a parent self-filled questionnaire-Health Development Survey of Preschool Children.Children’s Strength and Difficulties Questionnaire(Parent Version)was applied to measures the children’s behavioral and emotional performance.Parenting behavior was evaluated using the Parental Behavior Inventory.Binomial logistic regression model was used to analyze the association between the detection rate of preschool children’s behavior and emotional problems and their parenting behaviors.RESULTS High level of parental support/participation was negatively correlated with conduct problems,abnormal hyperactivity,abnormal total difficulty scores and abnormal prosocial behavior problems.High level of maternal support/participation was negatively correlated with abnormal emotional symptoms and abnormal peer interaction in children.High level of parental hostility/coercion was positively correlated with abnormal emotional symptoms,abnormal conduct problems,abnormal hyperactivity,abnormal peer interaction,and abnormal total difficulty scores in children(all P<0.05).Moreover,paternal parenting behaviors had similarly effects on behavior and emotional problems of preschool children compared with maternal parenting behaviors(all P>0.05),after calculating ratio of odds ratio values.CONCLUSION Our study found that parenting behaviors are associated with behavioral and emotional issues in preschool children.Overall,the more supportive or involved the parents are,the fewer behavioral and emotional problems the children experience;conversely,the more hostile or controlling the parents are,the more behavioral and emotional problems the children face.Moreover,the impact of fathers’parenting behaviors on preschool children’s behavior and emotions is no less significant than that of mothers’parenting behaviors.

Expert consensus on pediatric orthodontic therapies of malocclusions in children

Malocclusion,identified by the World Health Organization(WHO)as one of three major oral diseases,profoundly impacts the dental-maxillofacial functions,facial esthetics,and long-term development of~260 million children in China.Beyond its physical manifestations,malocclusion also significantly influences the psycho-social well-being of these children.Timely intervention in malocclusion can foster an environment conducive to dental-maxillofacial development and substantially decrease the incidence of malocclusion or reduce the severity and complexity of malocclusion in the permanent dentition,by mitigating the negative impact of abnormal environmental influences on the growth.Early orthodontic treatment encompasses accurate identification and treatment of dental and maxillofacial morphological and functional abnormalities during various stages of dental-maxillofacial development,ranging from fetal stages to the early permanent dentition phase.From an economic and societal standpoint,the urgency for effective early orthodontic treatments for malocclusions in childhood cannot be overstated,underlining its profound practical and social importance.This consensus paper discusses the characteristics and the detrimental effects of malocclusion in children,emphasizing critical need for early treatment.It elaborates on corresponding core principles and fundamental approaches in early orthodontics,proposing comprehensive guidance for preventive and interceptive orthodontic treatment,serving as a reference for clinicians engaged in early orthodontic treatment.