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.

Etiology and classification of acute pancreatitis in children admitted to ICU using the Pediatric Sequential Organ Failure Assessment (pSOFA) score

Background:Pediatric acute pancreatitis(AP)is rare but increasing.Severe AP is associated with higher morbidity and mortality.However,there are no universally accepted prognostic criteria for AP.Methods:This retrospective study included children with AP admitted to an intensive care unit(ICU)of our tertiary pediatric center between January 2009 and December 2018.The severity of organ dysfunction in AP was assessed according to the modified Atlanta criteria using the Pediatric Sequential Organ Failure Assessment(p SOFA)and Computed Tomography Severity Index(CTSI).Results:Seventy acute episodes of AP were evaluated in 55 children with primary pancreatitis.In addition,secondary AP was diagnosed in 15 patients originally admitted to ICU for different indications.Mild AP[no organ dysfunction,normal computed tomography(CT)finding]was the most prevalent(64/85 episodes in 49 children),followed by moderate AP(15 children;p SOFA 2-9 points,CTSI 3-4 points on admission).Severe AP(p SOFA 4-17 points,CTSI 6-10 points)was diagnosed in 6 children with traumatic or secondary AP.The most frequent etiologies of primary AP episodes were idiopathic(39%)and biliary(31%).Children with idiopathic AP had frequent relapses and comorbidities.Hereditary AP was typically mild,but presented with high pancreatic enzyme levels and recurrence rates.Admission at ICU and an interval without enteral nutrition(EN)were relatively short in drug-induced AP and relatively long in secondary and traumatic AP.Endoscopic retrograde cholangiopancreatography(ERCP)was performed in 13 patients with biliary AP and in 4 patients with traumatic AP.No AP-related death was observed.Conclusion:p SOFA score accurately reflects the severity and prognosis of AP in children.

Respiratory Distress in Neonates at the Teaching Hospitals of Lomé, Togo

Introduction: Respiratory distress in neonates is a neonatal emergency that can lead to serious complications if not treated appropriately. The aim of this study was to describe the epidemiology, the diagnostic, and the outcomes of neonatal respiratory distress. Methods: This was a cross-sectional study carried out in the pediatric wards of Lomé Teaching Hospitals (CHU Sylvanus Olympio and CHU Campus), including neonates treated for respiratory distress (dyspnea associated with the use of accessory muscles of respiration, noisy breathing and with or without cyanosis) from January 1, 2021 to December 31, 2021. Data were entered using Epi Data 3.1 and SPSS software version 12.0. Results: The total number of neonates hospitalized for respiratory distress was 353, with a frequency of 12.5% and a sex ratio of 1.5. The mean age was 0.82 ± 3.20 days;the 0 - 6-day age group accounted for 92.4% of cases. Neonates had been resuscitated at birth in 46.7% of cases. Dyspnea was tachypnea in 94% of cases and bradypnea in 6%. Dyspnea was associated with cyanosis in 21.5% of cases. The severity of the respiratory distress was moderate in 64.9% of cases. Perinatal asphyxia (49.1%), inhalation pneumonitis (17.1%) and neonatal bacterial infection (14.1%) were the main etiologies. The mortality rate was 20.4%. Age greater than or equal to seven days, no neonatal resuscitation were protective factors against death. Prematurity, no antenatal consultations follow up, neonatal resuscitation, severe respiratory distress were risk factors of death. Conclusion: Neonatal respiratory distress was common in the early neonatal period and its mortality was high.

Diseases of bile duct in children

Several diseases originate from bile duct pathology.Despite studies on these diseases,certain etiologies of some of them still cannot be concluded.The most common disease of the bile duct in newborns is biliary atresia,whose prognosis varies according to the age of surgical correction.Other diseases such as Alagille syndrome,inspissated bile duct syndrome,and choledochal cysts are also time-sensitive because they can cause severe liver damage due to obstruction.The majority of these diseases present with cholestatic jaundice in the newborn or infant period,which is quite difficult to differentiate regarding clinical acumen and initial investigations.Intraoperative cholangiography is potentially necessary to make an accurate diagnosis,and further treatment will be performed synchronously or planned as findings suggest.This article provides a concise review of bile duct diseases,with interesting cases.

Actors of Psychoactive Drug Initiation among Adolescents in Yaoundé-Cameroon

Introduction: Actors of psychoactive drug initiation refer to those who introduce others to psychoactive drug use (initiators) and those who are introduced to psychoactive drugs (users). By identifying their features, better prevention and intervention programs can be developed to reduce psychoactive drug use among adolescents. This article describes the role of actors of psychoactive drug initiation among teenagers in secondary schools in Yaoundé (Cameroon). Methodology: A cross sectional study was carried out in twelve secondary schools in Yaoundé from October 2022 to May 2023. Adolescents from Form four to upper sixth, who assented to participate in the study and received parental consent were included. Data were collected in a structured self-reported questionnaire and analyzed using SPSS 23. Quantitative variables were expressed using means, standard deviations, median and interquartile ranges depending on the distribution of data. Qualitative variables were expressed in the form of frequency and percentages. Results: Drug use was more prevalent among male adolescents (55.3%) from nuclear families (91.4%) who received relatively high pocket money. The main sources of drug exposure were non-family members (49.7%), especially friends outside school. The most frequent place of initiation was snack bars (33.1%). Conclusion: The study revealed the importance of the family, friends and leisure places in the initiation process of drug use in teenagers. Based on these results, parents and school authorities should work together to create a safe and supportive environment that fosters communication, education to prevent drug abuse among adolescents in Yaoundé.

Correlation between DKK-1 Level and Bone Density Status in Children on Maintenance Haemodialysis

Background: Renal osteodystrophy (ROD) is a bone disorder resulting from chronic kidney disease (CKD) and related metabolic diseases. Dickkopf-related protein-1 (DKK-1) is critical in regulating bone biology. This study aimed to evaluate the serum DKK-1 level as a bone marker in children with CKD who undergo regular hemodialysis (HD). Subjects and Methods: This case-control study involved 40 children with CKD on HD and 40 healthy children as controls. The study measured serum DKK-1 levels and performed a dual-energy X-ray absorptiometry scan (DEXA) in line with routine laboratory investigations. Results: There was a significant increase in the serum level of DKK-1 in the patient group compared to the control group. The DKK-1 levels were 2540.65 (2215.4 - 2909.2) pg/ml and 1110.45 (885.45 - 1527.65) pg/ml, respectively, with a p-value of less than 0.001. In the hemodialysis group, 25 patients (62.5%) had low bone mineral density (BMD) with a Z-score of under -2.0. Eighteen of these patients had low BMD in both the neck of the femur and lumbar spines. Additionally, there was a significant increase in serum DKK-1 level in patients with low BMD (2567.35 (2303.8 - 3108.1) pg/ml) compared to patients with normal BMD (2454 (1859 - 2820) pg/ml) (p = 0.041). There was also a significant positive correlation between DKK1 level and phosphorus, alkaline phosphatase, and Parathormone serum levels. In conclusion, the study indicates a clear correlation between DKK-1 and BMD in children undergoing maintenance hemodialysis. DKK1 is a promising biomarker for CKD-MBD.

Childhood asthma biomarkers including zinc: An exploratory crosssectional study

BACKGROUND Childhood bronchial asthma(BA)is a chronic inflammatory respiratory disease.Nutritional conditions,including zinc deficiency,can affect such allergic disorders.AIM To outline the difference in serum zinc levels between asthmatic children and healthy controls.METHODS A cross-sectional study was carried out at Children’s Hospital,Cairo University,investigating serum zinc levels in children with BA(n=40)and healthy children(n=21).Other markers included serum ferritin,iron,hemoglobin(Hb),and immunoglobulin E(IgE)levels.Independent t-tests and Mann-Whinny tests were used for comparisons.The Kruskal-Wallis test was applied to compare serum ferritin and IgE levels with regard to asthma severity.Spearman's rank correlation was performed to explore the relationship between serum ferritin levels and both iron and Hb levels in asthmatic children.RESULTS Children with BA had higher levels of zinc,yet the difference was not significant(P=0.115).Serum ferritin and IgE levels were significantly higher in asthmatic children(P=0.006 and 0.001,respectively),yet their levels did not differ significantly by severity(P=0.623 and 0.126,respectively).There was a nonsignificant weak correlation between serum ferritin levels and both serum iron and Hb levels.CONCLUSION Serum zinc levels do not seem to differ between asthmatic children and healthy children.Serum ferritin levels may be a marker of asthma control.Serum IgE levels are not markers of asthma severity.

Acceptance and Experience of HIV-Infected Adolescents in Two Hospitals in Yaoundé

Introduction: Access to antiretroviral drugs has improved the survival of children infected with the Human Immunodeficiency Virus (HIV). As they reach adolescence, they are confronted with various constraints related to the infection and its treatment, in addition to those of the growth period they are going through. The main aim of the study was to assess the acceptance and describe the experience of HIV infection by infected adolescents but also to investigate the factors associated with good acceptance and a positive experience. Methodology: The cross-sectional analytic study concerned HIV-infected adolescents aged 15 to 19 followed up at the Chantal Biya Foundation-Mother and Child Centre (CME-FCB) and the Yaoundé University Hospital Centre (CHUY) between February 2020 and June 2020. The study saw participants complete a questionnaire containing socio-demographic data and assessing acceptance and experience with the infection. Data analysis was accomplished using Epi info software version 7.2.2.6. Results: One hundred and thirteen HIV-infected adolescents were included in the study. The sex ratio was 0.68 and the mean age was 17 years. More than half of the adolescents had a good acceptance and positive experience with the infection. Related factors were the adolescent’s perception of good health and participation in an association with other infected adolescents. Conclusion: Emphasizing the psychological and educational follow-up of infected adolescents and encouraging their participation in associations for adolescents living with HIV could reduce the consequences of poor acceptance and ensure a better transition to adulthood. .

Salivary C-reactive protein and mean platelet volume as possible diagnostic markers for late-onset neonatal pneumonia

BACKGROUND Neonatal sepsis,a formidable threat to newborns,is a leading cause of neonatal mortality,with late-onset sepsis manifesting after 72 hours post-birth being particularly concerning.Pneumonia,a prevalent sepsis presentation,poses a significant risk,especially during the neonatal phase when lung defenses are compromised.Accurate diagnosis of pneumonia is imperative for timely and effective interventions.Saliva,a minimally invasive diagnostic medium,holds great promise for evaluating infections,especially in infants.AIM To investigate the potential of serum C-reactive protein(CRP),salivary CRP(sCRP),and mean platelet volume(MPV)as diagnostic markers for late-onset neonatal pneumonia(LONP).METHODS Eighty full-term neonates were systematically examined,considering anthropometric measurements,clinical manifestations,radiology findings,and essential biomarkers,including serum CRP,sCRP,and MPV.RESULTS The study reveals noteworthy distinctions in serum CRP levels,MPV,and the serum CRP/MPV ratio between neonates with LONP and healthy controls.MPV exhibited a robust discriminatory ability[area under the curve(AUC)=0.87]with high sensitivity and specificity at a cutoff value of>8.8.Correlations between serum CRP,sCRP,and MPV were also identified.Notably,sCRP demonstrated excellent predictive value for serum CRP levels(AUC=0.89),underscoring its potential as a diagnostic tool.CONCLUSION This study underscores the diagnostic promise of salivary and serum biomarkers,specifically MPV and CRP,in identifying and predicting LONP among neonates.These findings advocate for further research to validate their clinical utility in larger neonatal cohorts.

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.

The interplay mechanism between IDH mutation, MGMT-promoter methylation, and PRMT5 activity in the progression of grade 4 astrocytoma: unraveling the complex triad theory

Background:The dysregulation of Isocitrate dehydrogenase(IDH)and the subsequent production of 2-Hydroxyglutrate(2HG)may alter the expression of epigenetic proteins in Grade 4 astrocytoma.The interplay mechanism between IDH,O-6-methylguanine-DNA methyltransferase(MGMT)-promoter methylation,and protein methyltransferase proteins-5(PRMT5)activity,with tumor progression has never been described.Methods:A retrospective cohort of 34 patients with G4 astrocytoma is classified into IDH-mutant and IDH-wildtype tumors.Both groups were tested for MGMT-promoter methylation and PRMT5 through methylation-specific and gene expression PCR analysis.Inter-cohort statistical significance was evaluated.Results:Both IDH-mutant WHO grade 4 astrocytomas(n=22,64.7%)and IDH-wildtype glioblastomas(n=12,35.3%)had upregulated PRMT5 gene expression except in one case.Out of the 22 IDH-mutant tumors,10(45.5%)tumors showed MGMT-promoter methylation and 12(54.5%)tumors had unmethylated MGMT.All IDH-wildtype tumors had unmethylated MGMT.There was a statistically significant relationship between MGMT-promoter methylation and IDH in G4 astrocytoma(p-value=0.006).Statistically significant differences in progression-free survival(PFS)were also observed among all G4 astrocytomas that expressed PRMT5 and received either temozolomide(TMZ)or TMZ plus other chemotherapies,regardless of their IDH or MGMT-methylation status(p-value=0.0014).Specifically,IDH-mutant tumors that had upregulated PRMT5 activity and MGMT-promoter methylation,who received only TMZ,have exhibited longer PFS.Conclusions:The relationship between PRMT5,MGMT-promoter,and IDH is not tridirectional.However,accumulation of D2-hydroxyglutarate(2-HG),which partially activates 2-OG-dependent deoxygenase,may not affect their activities.In IDH-wildtype glioblastomas,the 2HG-2OG pathway is typically inactive,leading to PRMT5 upregulation.TMZ alone,compared to TMZ-plus,can increase PFS in upregulated PRMT5 tumors.Thus,using a PRMT5 inhibitor in G4 astrocytomas may help in tumor regression.

Low Birth Weight and Intermittent Preventive Treatment of Malaria in Pregnant Women in Lomé (Togo) in 2021: A Cross-Sectional Study

Background: Since 2012, the World Health Organization has recommended intermittent preventive treatment with sulfadoxine-pyrimethamine (IPT-SP) to prevent malaria-related complications in pregnant women. Ten years following these recommendations, we conducted this study to estimate the coverage for three doses of IPT-SP (IPT3) as well as the prevalence of low birth weight (LBW), and its associated factors in Lomé (Togo) in 2021. Methods: A cross-sectional study was conducted between January and March 2021. An exhaustive recruitment of women and their newborns was carried out in the maternity wards of the Sylvanus Olympio University Hospital Center. Data from antenatal consultations and clinical data of the newborns were collected. Multivariate logistic regression was carried out to determine factors associated with LBW. Results: A total of 252 mother-child pairs were included in this study. Median age of the mothers was 27 years, IQR [24-31]. More than a third (35.3%) of the mothers were primigravida. IPT3 coverage was 66.7% and 14.7% of newborns had a LBW. The prevalence of LBW was 33.3% [23.3-43.4] in women who had received fewer than 3 doses of IPT-SP and 5.4% [2.0-8.8] in those who had received at least 3 doses of IPT-SP (p Conclusion: Ten years following recommendations of the WHO on IPT-SP, malaria prevention based on IPT-SP is not optimal among pregnant women in Lomé, and the proportion of LBW children remains high. Actions to strengthen the three-dose IPT-SP policy are needed to prevent malaria and its consequences among newborns in Togo.

Practical guide:Glucagon-like peptide-1 and dual glucosedependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonists in diabetes mellitus

Practical guide:Glucagon-like peptide-1 and dual glucosedependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonists in diabetes mellitus common second-line choice after metformin for treating T2DM.Various considerations can make selecting and switching between different GLP-1 RAs challenging.Our study aims to provide a comprehensive guide for the usage of GLP-1 RAs and dual GIP and GLP-1 RAs for the management of T2DM.

Risk Factors for Geo-Helminthiasis in Children Aged 6 - 36 Months in a Rural Health District in Cameroon

Introduction and Objectives: Soil-Transmitted-Helminthiasis (STH) is a public health problem in Cameroon. The control strategies currently in place, particularly chemoprevention, has shortcomings linked to the target population, which are school-age children. The objective was to determine the prevalence and the risk factors associated with geo-helminthiasis in children aged 0 to 3 years in a rural health district. Method: From December 2020 to May 2021, a descriptive and analytical cross-sectional study of 376 children between 6 and 36 months was carried out in the Akonolinga health district. This was a cluster sampling in 4 health areas. Stool samples were collected and analysed using the mini-FLOTAC method. The results expressed as the number of eggs per gram of stool. A questionnaire on socio-demographic and lifestyle data was administered to the parents. The Chi-squared test was used to measure the association between geo-helminth infection and the data collected. A multivariate analysis using logistic regression was performed (p 0.05). Results: The prevalence of STH was 19.4% (Ascaris lumbricoides: 16% and Trichuris trichiura: 8%). Risk factors were: consumption of contaminated water (AOR = 1.93 [1.03 - 3.6];p = 0.040), early contact of the child with the ground (before age of 4 months) (AOR = 4.9 [2.1 - 11.37];p .001), habit of walking barefoot (AOR = 2.91 [1.1 - 7.97];p = 0.038), and living in a habitat with unpaved ground (AOR = 7.4 [1.55 - 35.7];p = 0.012). Conclusion: The prevalence of STHs in infants was high. Preventive chemotherapy should be extended to this age-group, and other measures intensified.

Outcomes of long-acting injectable antipsychotics use in pregnancy:A literature review

BACKGROUND Women with a history of serious psychotic disorders are at increased risk of disease relapse during pregnancy.Long-acting injectable(LAI)antipsychotics have been widely used to improve adherence and prevent relapse in patients with various severe psychotic disorders,but there is a lack of high-quality data from previous research on the safety of LAI antipsychotics during pregnancy.AIM To summarize relevant data on maternal,pregnancy,neonatal,and developmental outcomes from published cases of LAI antipsychotic use in pregnancy.METHODS A literature search was performed through November 11,2023,using three online databases:PubMed/MEDLINE,Scopus,and Web of Science.Case reports or case series that reported information about the outcomes of pregnancy in women who used LAI antipsychotics at any point in pregnancy,with available full texts,were included.Descriptive statistics,narrative summation,and tabulation of the extracted data were performed.RESULTS A total of 19 publications satisfied the inclusion criteria:3 case series,15 case reports,and 1 conference abstract.They reported the outcomes of LAI antipsychotic use in 74 women and 77 pregnancies.The use of secondgeneration LAI antipsychotics was reported in the majority(n=47;61.0%)of pregnancies.First-generation LAI antipsychotics were administered during 30 pregnancies(39.0%).Most of the women(approximately 64%)had either satisfactory control of symptoms or no information about relapse,while approximately 12%of them had developed gestational diabetes mellitus.A minority of cases reported adverse outcomes such as stillbirth,spontaneous abortion,preterm birth,low birth weight,congenital anomalies,and neurological manifestations in newborns.However,there were no reports of negative long-term developmental outcomes.CONCLUSION Currently available data seem reassuring,but further well-designed studies are required to properly evaluate the risks and benefits of LAI antipsychotic use during pregnancy.

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.

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.

Case of pediatric traditional serrated adenoma resected via endoscopic submucosal dissection

Traditional serrated adenoma(TSA)is a type of serrated polyp of the colorectum and is thought to be a precancerous lesion.There are three types of serrated polyps,namely,hyperplastic polyps,sessile serrated adenomas/polyps,and TSAs.TSA is the least common of the three types and accounts for about 5% of serrated polyps.Here we report a pediatric case of TSA that was successfully resected by endoscopic submucosal dissection(ESD).This rare case report describes a pediatric patient with no family history of colonic polyp who was admitted to our hospital with hematochezia.On colonoscopy,we found a polypoid lesion measuring 10 mm in diameter in the lower rectum.We selected ESD as a surgical option for en bloc resection,and histopathological examination revealed TSA.The findings in this case suggest that TSA with precancerous potential can occur in children,and that ESD is useful for treating this lesion.

Validation of different pediatric triage systems in the emergency department

BACKGROUND: Triage system in children seems to be more challenging compared to adults because of their different response to physiological and psychosocial stressors. This study aimed to determine the best triage system in the pediatric emergency department.METHODS: This was a prospective observational study. This study was divided into two phases. The fi rst phase determined the inter-rater reliability of fi ve triage systems: Manchester Triage System(MTS), Emergency Severity Index(ESI) version 4, Pediatric Canadian Triage and Acuity Scale(CTAS), Australasian Triage Scale(ATS), and Ramathibodi Triage System(RTS) by triage nurses and pediatric residents. In the second phase, to analyze the validity of each triage system, patients were categorized as two groups, i.e., high acuity patients(triage level 1, 2) and low acuity patients(triage level 3, 4, and 5). Then we compared the triage acuity with actual admission.RESULTS: In phase I, RTS illustrated almost perfect inter-rater reliability with kappa of 1.0(P<0.01). ESI and CTAS illustrated good inter-rater reliability with kappa of 0.8–0.9(P<0.01). Meanwhile, ATS and MTS illustrated moderate to good inter-rater reliability with kappa of 0.5–0.7(P<0.01). In phase II, we included 1 041 participants with average age of 4.7±4.2 years, of which 55% were male and 45% were female. In addition 32% of the participants had underlying diseases, and 123(11.8%) patients were admitted. We found that ESI illustrated the most appropriate predicting ability for admission with sensitivity of 52%, specifi city of 81%, and AUC 0.78(95%CI 0.74–0.81).CONCLUSION: RTS illustrated almost perfect inter-rater reliability. Meanwhile, ESI and CTAS illustrated good inter-rater reliability. Finally, ESI illustrated the appropriate validity for triage system.

Modification of Serum Galectin-3 and Reversal of Cardiac Remodeling Following Pediatric Transcatheter Atrial Septal Defect Closure

Objectives:We aimed to evaluate the effect of percutaneous atrial septal defect(ASD)closure in children using right heart indices and serum galectin-3(Gal-3),as potential biomarkers of right heart remodeling.Methods:This case–control prospective study included 40 children with ASD and 25 control subjects.An echocardiographic evaluation was performed before the procedure,as well as 24 h,1 month,and 6 months after intervention.Serum Gal-3 was measured before,and 1 month after the procedure.Results:Serum Gal-3 concentration,right atrial(RA)dimensions,right ventricular(RV)dimensions,indexed RA area,and right index of myocardial performance(RIMP)were significantly increased in children with ASD compared with control subjects while tricuspid annular plane systolic excursion(TAPSE)was significantly decreased.Six months after closure,RA,and RV dimensions significantly decreased and RVfunction improved(RIMP decreased and TAPSE increased).Gal-3 oncentration significantly decreased 1 month after ASD closure,but it did not reach normal range compared with control subjects.A positive correlation between Gal-3 and age at closure,RA area,RV dimensions,and RIMP was observed.A positive correlation was observed between the decrease in Gal-3 concentration and the decrease in RA area and RV dimensions 1 month after ASD closure.A significant negative correlation was observed between TAPSE and Gal-3 concentration before and after intervention.Conclusions:Percutaneous ASD closure can improve right-sided indices and decrease serum Gal-3 concentration.Gal-3 can be used as a sensitive biomarker of right heart remodeling,with a decrease in Gal-3 concentration suggesting reversal of maladaptive remodeling.