Influence of Hemoglobin S Haplotypes on the Responses to Hydroxyurea Treatment in Children with Sickle Cell Disease in Abidjan, Côte d’Ivoire

Background: In Côte d’Ivoire so far, the circulating haplotypes have been inferred on the phenotypic profiling of SCD patients. The impact of the circulating haplotypes on the use of Hydroxyurea has not been assessed yet. Therefore the objective of this study is to identify in Abidjan the HbS haplotypes that modulate HU treatment responses. Methods: In a cross-sectional descriptive and analytical study, children aged 5 to 15 years with SCD, and carrying the hemoglobin phenotypes SSFA2 and SFA2, were recruited into a HU treatment cohort. Various parameters on the haplotypes and the outcomes of the treatment were analyzed. Results: Thirty nine children with SCD were included. The phenotypic profile of the cohort was 86.6% of SSFA2 and 15.4% of SFA2. Three haplotypes were found, the Benin haplotype, the Senegal haplotype, and an atypical one. The participants belonged to three genotypes, Benin/atypical (64.1%), Benin/Senegal (33.3%) and Senegal/Senegal (2.6%). Overall, HU treatment was successful in all haplotypes with 12 out of 39 patients failing treatment after 12 months in the Benin haplotype group. The association between HU treatment success and the Benin haplotype was found in terms of the decrease in the number of white blood cells and the students missing class. Conclusion: The study revealed that inferring haplotype based on the phenotypic profile could be inaccurate. The proportion of atypical haplotype that were not previously described in Côte d’Ivoire was high. All the haplotypes seemed to be associated with HU treatment success but some patients with Benin haplotype did not respond well.

Cat scratch disease in children with nocturnal fever:A case report

BACKGROUND Cat scratch disease(CSD)is the most common human infection caused by Barto-nella henselae(B.henselae).The main manifestation is self-limited lymphaden-opathy that primarily affects adolescents,and typically resolves without treat-ment within 2-4 months.However,individuals with compromised immune systems or immunodeficiency require specific antibacterial therapy following diagnosis.Due to its low incidence,nonspecific clinical manifestations,and diagnostic limitations,this condition often poses challenges for clinicians in terms of missed diagnoses and misdiagnoses.CASE SUMMARY The child was ultimately diagnosed with CSD.The primary manifestations included nocturnal fever,enlargement of lymph nodes in the neck,axilla and groin,and suspected brucellosis;however,both brucellosis tests conducted during the course of the illness yielded negative results.Bone marrow cytology indicated stimulated proliferation.Lymph node biopsy indicated hyperplasia of lymphoid tissue in the cervical lymph nodes(right),with combined immunohisto-chemical findings indicating reactive hyperplasia.Immunohistochemical analysis revealed CD20 B(+),CD3 T(+),BCL-6(+),and BCL-2(-).CD21 FDC networks were present and Ki67 expression in the germinal center was~80%.Blood next-generation sequencing indicated B.henselae sequence number was 3.Serological test results demonstrated positive antibody response to B.henselae IgG(+),B.henselae IgM(+),Bartonella quintana(B.quintana)IgG(-)and B.quintana IgM(-),and the final diagnosis was CSD.CONCLUSION In patients presenting with fever at night and swollen lymph nodes of unknown origin,CSD should be considered.

Children with Sickle Cell Disease in Northern Benin: Follow up of a Cohort at the Borgou/Alibori Branch of Integrated Medical Healthcare Center for Infants and Pregnant Women with Sickle Cell Disease from 2017 to 2022

Introduction: Sickle cell disease is a public health problem in sub-Saharan Africa. A national referral center for the management of infants and pregnant women with sickle cell disease (CPMI-NFED) was created three decades ago in Cotonou, in the south of Benin with two regional branches including that of Parakou in the North for better access of patients to specialized care. This work is a review of five years of activities in order to describe the epidemiological, clinical, hematological and evolutionary profiles of the children followed up in the said branch. Method: This was a descriptive and retrospective cross-sectional study on the medical records of children with sickle cell disease, followed up at the regional branch of CPMI-NFED in Borgou/Alibori from June 1, 2017 to May 31, 2022. The variables studied were epidemiological, clinical, biological and evolutionary. Results: A total of 101 children with sickle cell disease were included in the study, including 78 homozygous SS (77.2%) and 23 heterozygous SC (22.8%). Their mean age at inclusion was 51.2 ± 37.6 months [6 - 204]. The sex ratio was 1.4. Vaso-occlusive crises were the main diagnostic circumstances in 42.3% of homozygotes. More than half of the children (51.5%) had a regular follow-up. The average baseline level of hemoglobin (Hb) in homozygous children was 8.8 ± 1.4 g/dl [5.8 - 11.5];and the rate of Hb S varied between 61.9 and 94.7%. In heterozygous SC children, the mean baseline level of Hb was 10.7 ± 0.6 g/dl [9.7 - 11.5]. Acute complications observed during follow-up were dominated by pneumonia and vaso-occlusive crises in both phenotypes. The overall mortality was 3% and only affected homozygous patients. Conclusion: On average, three out of four children were homozygous in our cohort. The main acute complications were infectious and vaso-occlusive. The mortality only affected homozygous carriers. Specialized follow-up has contributed to improving the quality of life of children with sickle cell disease. This could be implemented on a large scale for better survival of children with sickle cell disease.

Appendicitis combined with Meckel’s diverticulum obstruction, perforation, and inflammation in children: Three case reports

BACKGROUND Meckel’s diverticulum is a common congenital malformation of the small intestine,with the three most common complications being obstruction,per-foration,and inflammation.To date,only a few cases have been reported world-wide.In children,the clinical symptoms are similar to appendicitis.As most of the imaging features are nonspecific,the preoperative diagnosis is not precise.In addition,the clinical characteristics are highly similar to pediatric acute appendicitis,thus special attention is necessary to distinguish Meckel’s diver-ticulum from pediatric appendicitis.Patients with poor disease control should undergo laparoscopic exploration to avoid serious complications,including intestinal necrosis,intestinal perforation and gastrointestinal bleeding.CASE SUMMARY This report presents three cases of appendicitis in children combined with intestinal obstruction,which was caused by fibrous bands(ligaments)arising from the top part of Meckel's diverticulum,diverticular perforation,and diver-ticular inflammation.All three patients,aged 11-12 years,had acute appendicitis as their initial clinical presentation.All were treated by laparoscopic surgery with a favorable outcome.A complete dataset including clinical presentation,dia-gnostic imaging,surgical information,and histopathologic findings was also provided.CONCLUSION Preoperative diagnosis of Meckel’s diverticulum and its complications is challenging because its clinical signs and complications are similar to those of appendicitis in children.Laparoscopy combined with laparotomy is useful for diagnosis and treatment.

Clinical Analysis of 128 Children and Adolescents with Echinococcosis

Objective:To comprehend the clinical characteristics and treatment approaches for children and adolescents in Qinghai Province with two types of echinococcosis,cystic echinococcosis(CE)and alveolar echinococcosis(AE).Methods:A total of 128 pediatric inpatients with echinococcosis at the People’s Hospital of Qinghai Province and the Clinical Research Institute of Echinococcosis of Qinghai Province between January 2016 and December 2021 were chosen as subjects.Demographic and clinical data were collected,and double data entry was executed using EpiData 3.02.Factors influencing the cure of echinococcosis were analyzed with echinococcosis cure as the dependent variable,employing statistical analysis via SPSS 19.0.Results:Of the cases,35.9%had CE,and 64.1%had AE.Both types were observed in patients of all ages,with the majority aged 13-18.The number of cysts and their sizes varied between CE and AE.Complications were prevalent,including liver,gallbladder,lung,and nutritional complications.Univariate analyses revealed significant differences in outcomes based on factors such as cyst size(for CE),liver function grade(for AE),hydatid hypersensitivity test,operation,and length of hospital stay(P<0.05).Conclusion:This comprehensive analysis of hospitalized cases sheds light on the clinical data of echinococcosis in children and adolescents in Qinghai Province.The findings contribute to a scientific foundation for formulating effective prevention and control measures tailored to this demographic,facilitating an improved understanding of echinococcosis in Qinghai province.

Intestinal Microecology in Children with Pneumonia: The Relationship Between Digestive Health and Disease Recovery

This paper explores the association between intestinal microecology and digestive health and disease recovery in children with pneumonia.Intestinal microecological imbalance is common in children with pneumonia,which is closely associated with digestive health and disease recovery.Intestinal microecological imbalance may affect digestive enzyme activity,intestinal mucosal barrier function,and nutrient absorption,which in turn affects digestive health.In addition,intestinal microecological imbalances may be associated with immune regulation,inflammatory responses,and pathogen suppression,affecting disease recovery.Strategies to regulate intestinal microecology include probiotic supplementation,dietary modification,and pharmacological treatment.Currently,the study of intestinal microecology in children with pneumonia faces challenges,and there is a need for improved research methods,individualized treatment strategies,and the development of novel probiotics.In conclusion,the intestinal microecology of children with pneumonia is closely related to digestive health and disease recovery,and the regulation of intestinal microecology is of great significance to the treatment of children with pneumonia.Furthermore,future research should further explore the application of the microecology of the intestinal microecology in the treatment of children with pneumonia.

Glomerular Filtration Rate of Children with Sickle Cell Disease Compared to Non-Sickle Cell Patients in Donka Pediatric Emergencies and SOS Drepano-Guinea Center

Introduction: Our study focused on the evaluation of renal function in children with sickle cell disease compared to children without sickle cell disease at the pediatric emergency unit of the Donka National Hospital and SOS Drepano-Guinea center. Patients and Methods: This was a cross-sectional descriptive and analytical study lasting 3 months (October 1 to December 31, 2020). Were included, all sickle cell and non-sickle cell children aged 0 to 15 received on an outpatient basis and had undergone an exploration of renal function (serum creatinine and urine dipstick). Results: We performed the urine dipstick and serum creatinine in 75 children, 45 of whom were sickle cell and 30 were not sickle cell. 27 of our patients or 36% had a reduction in GFR, among them 9 or 20% were sickle cell and 18 or 60% were not sickle cell. The most affected age group was 5 to 9 years in sickle cell (66.7%) and non-sickle cell (38.9%). In sickle cell patients, 9 cases (100%) had mild renal failure (IRL). Non-sickle cell patients, had 14 cases or 77.8% of IRL and 4 cases (22.2%) of moderate IR. Sickle cell disease and antibiotics which had the respective p-value (0.01);(0.02), were statistically significant with the onset of renal failure. Conclusion: Several factors including sickle cell anemia and antibiotics are believed to be involved in lowering GFR. It would be essential to detect early the children received in consultation.

The Correlation of Urine Retinol Binding Protein-4 and Serum HbA1c with Glomerular Filtration Rate in Type 1 (Insulin-Dependent) Diabetic Children: A Perspective on the Duration of Diabetes

Objective: To analyze the correlation between urine retinol binding protein-4 (RBP-4) and serum HbA1c?with glomerular filtration rate (GFR) in type 1 diabetic children. Methods:?This?was a crosssectional observational analytic?study. The subjects?were?type 1 diabetic children aged 2 - 14 years. Sample collection was conducted from October to November 2014. Exclusion criteria were patients with obesity, renal insufficiency?that?was not caused by diabetes, history of hepatic diseases, and history of blood cell disorders. We?performed anamnesis, physical examination, and blood sampling for serum HbA1c?and serum cystatin-C, and urine sampling for RBP-4?on all subjects. Glomerular filtration rate was calculated from the concentration level of cystatin-C using Filler formula. Data analysis was performed?by?Spearman test to determine the correlation between urine RBP-4 and serum HbA1c?with GFR. The Fisher’s exact test was used to determine the correlation between duration of diabetes and RBP-4, HbA1c, and also GFR. Results:?Twelve females (60%) and 8 males (40%) participated in the study. The mean age of the subjects with 95% CI?was: 10.5 (2 - 14) years while the mean age of duration diabetes with 95% CI: 3.8 (0.5 - 10) years. Twelve (60%) subjects had?<5 years duration of diabetes, while eight (40%) subjects had?≥5 years duration of diabetes. Twelve (60%) subjects had normal RBP-4 level, while eight (40%) subjects had?elevated RBP-4 level. The mean level of HbA1c?with 95% CI: 8.9 (5.1 - 15.2)%. Thirteen (65%) subjects had poor metabolic. The mean GFR of the subjects with 95% CI: 99.3 (35.2 - 147.4) mL/1.73/m2. Nineteen (95%) subjects had normal GFR, while 1 (5%) had renal insufficiency. The results of data analysis using Spearman test on the correlation between urine RBP-4 and serum HbA1cwith GFR were not significant. The result of correlation between duration of diabetes and urine RBP-4 was significant?using?Fischer’s test. Conclusion:?The results?showed?no correlation between urine RBP-4 and serum HbA1c?with GFR. Urine RBP-4 could?be considered to assess renal function in type 1 diabetic patients with a duration of diabetes of more than 5 years.

Novel Association of Killer Cell Immunoglobulin-like Receptor Genes with EBV-infectious Diseases in Children

Killer cell immunoglobulin-like receptors （KIRs） which are mainly expressed on natural killer （NK） cells are implicated in many virus infections. However, it is unclear whether or not KIRs are associated with susceptibility to Epstein-Barr virus （EBV） infection related diseases. Therefore, the purpose of our study was to investigate possible correlation between polymorphisms of KIR genes and infectious mononucleosis （IM）/EBV-associated hemophagocytic Iymphohistiocytosis （EBV-HLH）. The polymorphisms of KIR genes were detected by polymerase chain reaction with sequence-specific primers （PCR-SSP）. The results would contribute to clarify the association of KIRs with EBV induced diseases, and provide new insights into the role of NK cells and innate immune response against viral infections and/or subsequent progression.

Liver tumors in children with chronic liver diseases

Liver tumors are rare in children,but the incidence may increase in some circumstances and particularly in chronic liver diseases.Most liver tumors consequent to chronic liver diseases are malignant hepatocellular carcinoma.Other liver tumors include hepatoblastoma,focal nodular hyperplasia,adenoma,pseudotumor,and nodular regenerative hyperplasia.Screening of suspected cases is beneficial.Imaging and surrogate markers of alpha-fetoprotein are used initially as noninvasive tools for surveillance.However,liver biopsy for histopathology evaluation might be necessary for patients with inconclusive findings.Once the malignant liver tumor is detected in children with cirrhosis,liver transplantation is currently considered the preferred option and achieves favorable outcomes.Based on the current evidence,this review focuses on liver tumors with underlying chronic liver disease,their epidemiology,pathogenesis,early recognition,and effective management.

Relationship between Vesicoureteral Reflux and Glomerular Filtration Rate in Children

Vesicoureteral reflux(VUR)is one of the most common urinary tract anomalies in children and causes renal damage and studies focusing on the effect of VUR on renal function are rare.We recruited 35 primary VUR patients with recurrent urinary tract infection(UTI)and 10 non-VUR patients with recurrent UTI.Contrast-enhanced voiding urosonography(ceVUS)was performed for VUR grading,and renal dynamic imaging was used for evaluating glomerular filtration rate(GFR,mL/min).Standardized GFR(sGFR),namely GFR/BSA(mL·min-1·m-2),was calculated based on the body surface area(BSA).Total sGFR(tsGFR,mL·min-1·m-2)was obtained from the sum of sGFR on the left and right sides of all the children.The risk of renal regurgitation was equal in the unilateral reflux group.The sGFR of children with grade Ⅳ(45.74±18.05mL·min-1·m-2)and grade V(49.67±23.63mL·min-1·m-2)reflux was significantly lower than that in children with grade Ⅱ(77.69±22.21 mL·min-1·m-2).The renal function compensation of contralateral non-reflux kidney increased in unilateral reflux group,which was higher than that in the control group and level Ⅱ,Ⅳ and Ⅴ of reflux group respectively.In VUR group of the same grade,sGFR decreased with the age at diagnosis.In unilateral grade V refux group,the tsGFR was lower than that in the unilateral grade I reflux group(133.51±48.21 vs.186.87+53.49mL·min-1·m-2).The patients with VUR of unilateral grade Ⅱ were significantly older than those with VUR of unilateral grades Ⅱ and Ⅳ.This study indicates that severe VUR is significantly associated with decreased renal function.Therefore,VUR should be diagnosed early and managed individually.

Epidemiology of Cardiovascular Diseases in Children at the Teaching Hospital of Brazzaville, Congo

Context: Several studies were conducted throughout the world on heart diseases in children;no data is available in Congolese child. Objective: To evaluate epidemiological profile of Congolese children and teenager carrying cardiovascular diseases. Methods: A descriptive and prospective study was carried out during 4 years in the pediatric department of teaching hospital of Brazzaville, near the children received in consultation of pediatric cardiology. Results: On 41,472 patients admitted in pediatric service, 526 patients were received in consultation for suspicion of heart diseases. Among them, 444 had cardiopathy (incidence of 10.7‰). It was about a congenital heart disease to 316 (60%) incidence of 7.6‰;Acquired heart disease to 128 (24.4%) incidence of 3.1‰. Among congenital heart defects observed frequency of patients with ASD was 20.3%, isolated in 10.1% of cases, and associated with ECD (11.8%). The VSD was observed in 30.1% of cases, and the Tetralogy of Fallot in 10.1% of cases. Among the acquired heart diseases, severe hypo kinetic dilated cardiomyopathy (DCM) was noted in 24.4% of cases. The rheumatic heart diseases accounted for 41.4% of cases. It was mitral regurgitation (33.6%), a mitral stenosis (1.6%). Pericarditis was objectified at 10.1% of the patients. The evolution was favorable for 43.3% of patients. An aggravation of symptoms was observed to 2.7% of patients. Mortality was 11.9% and 71.9% of deaths were observed to not operate carriers of congenital heart disease. 69.9% of dead patients were carrying a cyanogen heart disease. Left to right shunt represented 21.7% of the deaths. Conclusion: Heart diseases are real problem of public health for Congolese children.

Changing trends in nervous system diseases among hospitalized children in the Chongqing region

OBJECTIVE： To investigate the changing trends of nervous system diseases among hospitalized children and the risk factors of death. METHOD： The disease was statistically classified according to the International Statistical Classification of Disease and Health Problem （ICD10）. The retrospective investigation includes demographic characteristics, as well as categories and fatality rates for nervous system diseases. All data was statistically analyzed. RESULTS： The percentage of nervous system diseases among inpatients in all wards was 2.4% （2 537/ 107 250） between January 1993 and December 1999, and 3.6% （6 082/170 619） between January 2000 and December 2006. The first ten patterns of various etiologic forms of nervous system diseases were identical-epilepsies and seizures, infections of the central nervous system, autoimmune and demyelination disorders, cerebral palsy, motor unit disorders, hypoxic-ischemic encephalopathy, hydrocephalus, extra-pyramidal disorders, congenital abnormalities of nervous system, and headache. Epilepsies and seizures took first place in both year groups, with 29.4% and 35%, respectively. Bacterial infections were responsible for the majority of cranial infections in both year groups, with 78.9% and 63.6% respectively. The death rate in the year group January 2000 to December 2006 was significantly less than in the year group January 1993 to December 1999 （ Х^2 = 27.832, P 〈 0.01 ）. CONCLUSION： Among all nervous system diseases, epilepsies and seizures were among the most common with the lowest fatality rate.

The effect of zinc supplementation on diarrheal diseases in children in the Niger Delta Sub-Region of Nigeria

This study evaluated the trend of diarrheal diseases managed with zinc supplementation by comparing it with diarrheal diseases managed without zinc supplementation at the University of Port Harcourt Teaching hospital (UPTH), Nigeria. The study was a descriptive retrospective study done at the Diarrhea Training Unit (DTU) of UPTH to determine the effect of zinc supplementation in the management of diarrhea in children under 5 years. Out of the 134 case records studied, of children aged 0 to 59 months who presented with diarrhea at the DTU, 57 children did not receive zinc supplementation between October and December, 2007 and 77 children received zinc supplementation between October and December 2009. The results showed that (74) 96.1% of patients who received zinc supplementation, and (48) 84.2% of those who did not, had no repeat diarrheal episodes when seen at the follow up clinic. On the other hand, 1.3% of those who received zinc supplementation and 1.8% of those who did not, had increased episodes of diarrhea when seen at the follow up clinic. Of those who received, and those who did not receive zinc supplementation, 2.6% and 14% respectively, had reduced episodes of diarrhea. These findings clearly demonstrate the effectiveness of zinc supplementation in halting the course of diarrheal diseases in children aged 0 to 59 months. We therefore advocate for the use of zinc supplementation in the management of diarrhea in

Prevalence of Contagious Diseases of School Going Children in Bangladesh

Children are becoming increasingly vulnerable to contagious disease around the world. It also leads to chronic health problems. This cross-sectional study aimed to determine the prevalence of contagious diseases in children of 5 - 12 years from five government primary schools (class II to V) in Tangail City, Bangladesh using multistage sampling method. Data were collected using a carry home questionnaire and diseases screening examination was done in the school. Prevalence of common contagious diseases was calculated. A total of 84 students were screened to have contagious diseases by clinical examination, giving a prevalence rate of 8.76% from 958 participated school children. The prevalence of contagious disease among the affected children in the study was found 30.95% for scabies, while 20.24% for influenza and 7.14%, 9.52%, 15.48%, 5.95%, & 10.71% for typhoid, chicken pox, measles, pneumonia, and whooping cough, respectively. Anthropometric measurements were recorded which indicated that 48.8% of children were well-nourished and 21.4%, 17.9%, & 11.9% of children were underweight, stunted, and wasted, respectively. However, these data are extremely important to define the problem and to design proper intervention strategies.

Current Status and Predictors of Diarrhoeal Diseases among Under-Five Children in a Rapidly Growing Urban Setting: The Case of City Administration of Bahir Dar, Northwest Ethiopia

Background: Diarrhoeal disease in under-five children is a serious public health challenge especially in low income countries including Ethiopia. In Ethiopia, several interventions are going on to reduce morbidity, and mortality of children. The objective of the study was to assess the prevalence and associated factors of diarrhoeal diseases among under-five children in the City Administration of Bahir Dar. Methods: A community based cross-sectional study was conducted on a sample size of 667 mothers/caregivers having under-five children. Participants were selected through multistage sampling technique. Structured questionnaire and observation checklist were used to collect data. It was analyzed using SPSS version 16 for windows. Logistic regression was applied to measure possible associations. Strength of association, and statistical significance was measured using odds ratio and confidence interval at 95% confidence level. Results: A total of 667 mothers/ caregivers with under-five children were included in the study. Two-week prevalence of diarrhoea was 21.6%. Households in rural part of the city (OR: 2.82, 95%CI: 1.66 - 4.81), monthly income ≤ birr 500 (OR: 2.27, 95%CI: 1.44 - 3.57, failure to use separate container for storing drinking water (OR: 1.78, 95%CI: 1.17 - 2.70), presence of human excreta in the compound (OR: 1.88, 95% (1.15 - 3.06) were found to be predictors of childhood diarrhoea. Conclusion: Diarrhoeal diseases remain serious public health challenge in rural as well as urban set ups in Ethiopia with particular reference to Bahir Dar City, despite several interventions over decades. Therefore, interventions, and strategies applied so far to eliminate diseases of poverty including diarrhoeal diseases should be re-visited.

Screening of SARS-CoV-2 in 299 Hospitalized Children with Hematooncological Diseases:A Multicenter Survey in Hubei,China

Summary:The SARS-CoV-2 infection status of hospitalized children was surveyed in the department of pediatric hematology and oncology in three different hospitals of epidemic areas in Hubei,China.A cross-sectional study was performed to investigate the clinical characteristics,lung CT scan,SARS CoV-2 nucleic acid test and serum antibodics of hospitalized children with hemato-oncological diseases from January 23 to April 24,2020.299 children were enrolled in this study,including 176 males(58.9%)and 123 females(41.1%),aged from 2 months to 16 years.255 cases(85.3%)received chemotherapy or other immunosuppressive therapies,and there were 44 cases(14.7%)of other benign diseases.Nucleic acid test was performed on 258 children(86.3%)and one case was positive.163 cases(54.5%)were tested for serum antibodies,and all of them were negative.Lung CT scan was performed on 247 children(82.6%),and 107 of them showed infectious changes.Only one case(0.33%)of COVID-19 was diagnosed in the group.The prevalence rate of COVID-19 in enrolled children with hemato-oncological diseases in Hubei was 0.33%.Immunosuppressed patients are not prone to produce related antibodies.Comprehensive protective measures and ward management can reduce the risk of SARS-CoV-2 infection in the group patients.

Gastroesophageal reflux disease in children: What’s new right now?

Gastroesophageal reflux(GER)in children is very common and refers to the involuntary passage of gastric contents into the esophagus.This is often physiological and managed conservatively.In contrast,GER disease(GERD)is a less common pathologic process causing troublesome symptoms,which may need medical management.Apart from abnormal transient relaxations of the lower esophageal sphincter,other factors that play a role in the pathogenesis of GERD include defects in esophageal mucosal defense,impaired esophageal and gastric motility and clearance,as well as anatomical defects of the lower esophageal reflux barrier such as hiatal hernia.The clinical manifestations of GERD in young children are varied and nonspecific prompting the necessity for careful diagnostic evaluation.Management should be targeted to the underlying aetiopathogenesis and to limit complications of GERD.The following review focuses on up-to-date information regarding of the pathogenesis,diagnostic evaluation and management of GERD in children.

Gut microbiota predicts the diagnosis of celiac disease in Saudi children

BACKGROUND Celiac disease(CeD)is a multisystem immune-mediated multifactorial condition strongly associated with the intestinal microbiota.AIM To evaluate the predictive power of the gut microbiota in the diagnosis of CeD and to search for important taxa that may help to distinguish CeD patients from controls.METHODS Microbial DNA from bacteria,viruses,and fungi,was isolated from mucosal and fecal samples of 40 children with CeD and 39 controls.All samples were sequenced using the HiSeq platform,the data were analyzed,and abundance and diversities were assessed.For this analysis,the predictive power of the microbiota was evaluated by calculating the area under the curve(AUC)using data for the entire microbiome.The Kruskal-Wallis test was used to evaluate the significance of the difference between AUCs.The Boruta logarithm,a wrapper built around the random forest classification algorithm,was used to identify important bacterial biomarkers for CeD.RESULTS In fecal samples,AUCs for bacterial,viral,and fungal microbiota were 52%,58%,and 67.7%respectively,suggesting weak performance in predicting CeD.However,the combination of fecal bacteria and viruses showed a higher AUC of 81.8%,indicating stronger predictive power in the diagnosis of CeD.In mucosal samples,AUCs for bacterial,viral,and fungal microbiota were 81.2%,58.6%,and 35%,respectively,indicating that mucosal bacteria alone had the highest predictive power.Two bacteria,Bacteroides intestinalis and Burkholderiales bacterium 1-1-47,in fecal samples and one virus,Human_endogenous_retrovirus_K,in mucosal samples are predicted to be“important”biomarkers,differentiating celiac from nonceliac disease groups.Bacteroides intestinalis is known to degrade complex arabinoxylans and xylan which have a protective role in the intestinal mucosa.Similarly,several Burkholderiales species have been reported to produce peptidases that hydrolyze gluten peptides,with the potential to reduce the gluten content of food.Finally,a role for Human_endogenous_retrovirus_K in immune-mediated disease such as CeD has been reported.CONCLUSION The excellent predictive power of the combination of the fecal bacterial and viral microbiota with mucosal bacteria alone indicates a potential role in the diagnosis of difficult cases of CeD.Bacteroides intestinalis and Burkholderiales bacterium 1-1-47,which were found to be deficient in CeD,have a potential protective role in the development of prophylactic modalities.Further studies on the role of the microbiota in general and Human_endogenous_retrovirus_K in particular are needed.

Ocular manifestations of children with atopic dermatitis in Saudi Arabia

AIM:To examine the incidence of ocular abnormalities in children with atopic dermatitis(AD)in Saudi Arabia and its association with the severity of AD.METHODS:This is a cross-sectional study on 50 children with AD who were between 5 and 16 years of age.The severity of AD was evaluated using the SCORing Atopic Dermatitis(SCORAD)index.All the children underwent slit lamp exams,visual acuity assessment,intraocular pressure measurement,and corneal topography.The children were considered to have an ophthalmic abnormality if one or more of the following signs were present:glaucoma,keratoconus suspicion,in addition to lid,conjunctival,corneal,lenticular,or retinal abnormalities.RESULTS:Based on the SCORAD severity index,14%of children had mild AD(7/50),38%had moderate AD(19/50),and nearly half had severe AD.More than half the children exhibited facial involvement,and half had peri-orbital signs.The mean SCORAD index was 35.75.The mean age was 10.48±3.6y,and the cohort showed a slight male predominance(54%males).Both eyes of the 50 children in the cohort were studied.Based on the ocular examinations,92%of the patients showed ocular abnormalities:lid abnormalities(27/50)followed by keratitis(22/50).Four patients had moderate risk for keratoconus in one eye and eight patients were suspected to have keratoconus.However,SCORAD severity index was not associated with age,sex,or the number or presence of ophthalmic abnormalities.CONCLUSION:This is the first study in Saudi Arabia to evaluate the prevalence of ocular manifestations in children with AD.The results indicate that the majority of children with AD have ocular abnormalities that mainly include lid abnormalities.Based on these findings,larger scale studies are needed to affirm whether regular screening for ophthalmic abnormalities would be beneficial for children with AD in terms of early intervention and prevention of sight-threatening complications.