Journal of Pediatrics Research Reviews & Reports
Journal of Pediatrics Research Reviews & Reports is an open access peer-reviewed journal from the publishers of Scientific Research and Community (SRC) which publishes articles in the form of written, video and power-point presentations from the arena of Pediatrics Research Reviews. The journal focuses to build up accessing the complete content of articles freely from online for reader’s perusal. Article acceptance will be in the form of research, review, case reports, analysis, magazines, editorials, opinion, communications, mini-review, short communications, picturized, book review, video type and power point presentations (PPTS). Articles can be submitted through online from https://srcpublishers.com/pediatrics-research-reviews/user/register or can send through an e-mail with attachment for pediatricsresearch@onlinescientificresearch.info or editor.jprrr@onlinescientificresearch.net 1.5 Impact Factor 84.5% Citations 90% Acceptance
Metabolic Differences in Monozygotic Twins: Evidence of Epigenetic Modulation in Lipid, Inflammatory and Hormonal Markers
Monozygotic twins share identical genomes but frequently present relevant phenotypic differences throughout development. Such differences have been attributed to epigenetic mechanisms that modulate gene expression in response to environmental exposures. In this study, we analyzed 21 pairs (42 individuals) of monozygotic twins, evaluating intra-pair discrepancies in anthropometric, metabolic, hormonal, and lipid variables. After standardization, the largest differences were found in metabolic and lipid markers. The results strengthen the role of epigenetics in shaping phenotypic difference between genetically identical individuals.
Twins, Homozygotic, Epigenetics, Environment, Genes
Copyright (c) 2026 Journal of Pediatrics Research Reviews & Reports
Wheezing in Preschool Children Following Viral RSV or Rhinovirus Infections: Results of a 4-Year Retrospective Experience at the Largest Pediatric Hospital in Greece and Comparative Literature Review
Introduction: Recurrent wheezing following viral lower respiratory tract infections is common in early childhood and may predispose children to the development of asthma later in life. Data from the Greek pediatric population remain limited. Objective: To describe the clinical course of post-viral wheezing in preschool children followed at the Pediatric Pulmonology Department of our hospital and to compare our findings with those reported in the international literature. Methods: A retrospective analysis was conducted on 110 children (aged 6 months–5 years; mean age 2.1 ± 1.2 years) who experienced ≥2 wheezing episodes within 12 months following confirmed Respiratory Syncytial Virus infection (RSV, n=62) or rhinovirus infection (Rhino, n=48). Data collected included the number of exacerbations, hospitalizations, FEV1 values (for children aged ≥3 years), response to bronchodilator therapy, and the requirement for inhaled corticosteroids (ICS). The literature review assessed prevalence, risk factors, and progression rates to asthma in cohort studies. Results: The mean number of wheezing episodes per child was 3.1 ± 1.2 in the RSV group and 4.3 ± 1.5 in the Rhinovirus group (p=0.01). Hospitalization rates were 18% for RSV versus 25% for Rhinovirus infections (p=0.25). Predicted FEV1 <85% was observed in 21% of children aged ≥3 years. ICS therapy was required in 42% of the total cohort. Overall, a favorable clinical response was observed in 78% of patients. The literature review reported progression to recurrent wheezing or asthma in 25–40% of cases, with rhinovirus infection associated with a higher risk, consistent with our findings. Male sex, history of atopy, and younger age at first infection were identified as additional risk factors. Conclusions: Post-infectious (viral-associated) wheezing episodes following RSV or Rhinovirus infection are common and clinically significant. Our single-center experience confirms international findings identifying Rhinovirus infection as the strongest predictive factor for recurrent wheezing episodes and possible asthma development. Early identification of high-risk children may enable targeted and timely interventions.
Digital- and AI-Driven Transformation of Child Health Education: An Exploration
Background and Aims: Parents are the primary decisionmakers for their children’s health but often face challenges in accessing timely and accurate information on infectious disease prevention. This study aims to evaluate the effectiveness and dissemination potential of an AI-powered Q&A assistant “Tian Tian” for health education on child infectious diseases. Research Question: Compared to conventional health education, can the AI assistant more effectively enhance parental knowledge, improve preventive practices, and serve as a tool for dissemination within community networks Methods: This study will conduct a two-arm randomized controlled trial. Participants: 100 parents of children aged 0–6 years will be recruited from pediatric departments of hospitals in Zhejiang Province and randomly assigned to either an intervention group using the AI assistant or a control group receiving conventional health education. Outcome Measures: The primary outcomes include changes in knowledge scores assessed using a validated questionnaire and observed preventive behaviors e.g., handwashing, vaccination adherence evaluated at baseline, immediately post-intervention short-term, and at a 3-month follow-up long-term. Key secondary outcomes are the tool sharing rate and download growth rate, measured via self-report and referral link tracking. Anticipated Results: The authors hypothesize that the AI assistant group will demonstrate significantly greater improvement in knowledge retention and the adoption of correct preventive behaviors in both the short and long term. It is further anticipated that a higher proportion of parents in the intervention group will actively share the tool with other parents, indicating its perceived value and dissemination potential. The findings will provide a robust optimization model for AI-driven health communication tools targeting child caregivers
Pulmonary Function in School-Aged Preterm Children with a History of Bronchopulmonary Dysplasia (BPD): A Single-Center Greek Cohort Study and Comparative Literature Review
Introduction: Preterm children with bronchopulmonary dysplasia (BPD) frequently demonstrate persistent abnormalities in pulmonary function testing. Long-term follow-up clinical data from Greece remain limited. Objective: To evaluate pulmonary function, exercise capacity, and respiratory quality of life in school-aged children (>6 years) with BPD followed at a major Pediatric Pulmonology Center, and to compare our findings with those reported in the international literature. Methods: Thirty children (aged 6–12 years; mean age 8.6 ± 1.9 years) born at <32 weeks of gestation with a history of BPD were evaluated. Assessments included spirometry (FEV1, FEV1/FVC ratio, bronchodilator responsiveness), the 6-minute walk test (6MWT), respiratory quality-of-life assessment using the PedsQL score, and neonatal risk factors (duration of mechanical ventilation, systemic corticosteroid use, and home oxygen therapy). Multivariable analysis was performed to identify predictive factors associated with impaired pulmonary function. Results: Mean predicted FEV1 was 84 ± 14%. A total of 38% of children had FEV1 <80% predicted, while 29% had FEV1/FVC values below the lower limit of normal (LLN). Bronchodilator responsiveness was observed in 34% of participants. The mean 6MWT distance was 520 ± 65 m, with 34% performing below age-related reference values. Hospitalization during the previous year occurred in 22% of patients, and 46% required inhaled corticosteroid therapy. Independent predictors of reduced FEV1 included severe BPD (β = −0.45, p<0.001), prolonged mechanical ventilation >14 days (β = −0.31, p=0.002), postnatal corticosteroid administration (β = −0.28, p=0.01), and exposure to passive smoking (β = −0.25, p=0.02). Comparative literature demonstrates similar pulmonary function deficits (~10–20% lower predicted FEV1), increased airway obstruction, and comparable exercise limitations, supporting the validity of our findings. Conclusions: A substantial proportion of Greek preterm children with BPD exhibit persistent airway obstruction, exercise limitation, and impaired respiratory quality of life during school age. Early identification of neonatal risk factors may facilitate targeted interventions and close follow-up, highlighting the need for structured long-term care.
Functional Predictors of Academic Performance in Portuguese in Children and Adolescents with Down Syndrome: A Documentary Study
Down syndrome is a genetic condition associated with intellectual disability, characterized by variability in cognitive and adaptive functioning, directly impacting academic development, particularly literacy acquisition. Evidence suggests that adaptive functioning plays a central role in learning outcomes in this population. This study aimed to investigate the relationship between adaptive functioning and academic performance in Portuguese in children and adolescents with Down syndrome. This is a documentary, exploratory study conducted using secondary data from a specialized educational institution (ADID), following ethical criteria applicable to this type of research. The sample consisted of 33 participants aged between 9 and 17 years (M = 14; SD = 2.6). Adaptive functioning was assessed using the International Classification of Functioning, Disability and Health (ICF), and academic performance was measured through Match-to-Sample (MTS) tasks in Portuguese. Spearman correlation analysis revealed a moderate positive association between adaptive functioning and performance in Portuguese (rs = 0.546; p = 0.001), with an effect size of r² = 0.30, indicating that approximately 30% of the variability in performance can be explained by functional abilities. Additionally, odds ratio analysis showed that individuals with higher levels of adaptive functioning had a greater likelihood of adequate performance in Portuguese (OR = 5.42). The findings suggest that adaptive functioning is a relevant predictor of literacy-related skills in individuals with Down syndrome. The results reinforce the importance of parental guidance and behavioral intervention in the development of adaptive skills, contributing to the literacy process. Interventions targeting functional and behavioral domains may support educational planning and lead to improved developmental outcomes in this population.
Procalcitonin Versus Serial Quantitative C-Reactive Protein for Guiding Antibiotic Therapy in Children with Suspected Sepsis in Resource Limited Settings: A Critically Appraised Topic
Background: In children with suspected sepsis, antibiotics are often started early but many do not go on to have proven bacterial infection. In resource limited settings, clinicians therefore need tools that can support safer antibiotic review without relying on expensive or inaccessible tests. Objective: To compare procalcitonin with serial quantitative C-reactive protein (CRP) as biomarkers for guiding antibiotic therapy in children with suspected sepsis, with particular attention to practicality in lower resource settings. Methods: A critically appraised review of contemporary paediatric literature was undertaken using PubMed/MEDLINE, Embase, CINAHL and the Cochrane Library, supported by hand searching of reference lists. Key papers were selected for direct relevance to paediatric antibiotic decision making, serial biomarker use and low resource applicability. Results: The direct paediatric evidence favours procalcitonin. A meta-analysis of paediatric randomised trials found that procalcitonin guided care reduced antibiotic duration, while older comparative studies showed better early discrimination of bacterial sepsis than CRP. However, the BATCH trial found that procalcitonin guided care did not significantly shorten intravenous antibiotic duration in children managed within a strong stewardship system, suggesting that benefit is context dependent. Evidence for serial CRP is less direct but clinically relevant. Serial CRP trajectories have been shown to distinguish faster from poorer responders during therapy, and a recent feasibility study from Zanzibar suggested that serial CRP point of care testing can support antibiotic review in a low resource setting. CRP is less specific and slower to change, whereas procalcitonin may be falsely high in non-bacterial inflammation and falsely low in very early, chronic or focal infection. Conclusions: Procalcitonin has the stronger direct evidence base for antibiotic guidance in children, but serial quantitative CRP remains the more pragmatic option in many resource limited settings because it is cheaper, more available and easier to repeat. Neither biomarker should be used in isolation.
Clinical Examination and Management of Mandibular Fractures: A Focus on Open and Closed Reductions
Mandibular fractures represent one of the most common injuries in maxillofacial trauma due to the anatomical prominence and functional importance of the mandible. Effective management of these fractures requires accurate clinical and radio-graphic evaluation, restoration of occlusion, and selection of an appropriate treatment modality tailored to the individual patient. Special consideration is given to bio-mechanical factors influencing fracture patterns and displacement, as well as age-related differences between pediatric and adult patients. Diagnostic protocols, including clinical assessment and imaging modalities, are discussed in detail to ensure accurate diagnosis and treatment planning. Treatment strategies are evaluated with respect to fracture location, displacement, dentition status, and patient compliance, highlighting the advantages and limitations of closed reduction, open reduction and internal fixation, and combined approaches. The chapter also presents a series of six clinical cases illustrating various fracture types and management strategies across different age groups, demonstrating that successful outcomes depend primarily on accurate restoration of occlusion and stable fixation rather than the exclusive use of a single treatment modality. Comparative discussion with current literature supports an individualized, evidence-based approach to mandibular fracture management. The chapter concludes that meticulous assessment, correct occlusion alignment, and appropriately selected reduction techniques are critical for achieving optimal functional and aesthetic outcomes while minimizing complications
Rhythms of Containment: Suffering Babies and Preventing Obstaclesin Psychic Development
Today I shall speak in identification with a Premature Infant who can only non-verbally tell you what he/she needs. Intermittently, I shall also speak as the Premature Baby’s Advocate trying to support you in taking very seriously the HUGE IMPACT those early days, weeks and months have on the premature infant’s capacity to stay alive. I believe research definitely suggests that the premature infant’s beginning life in NICU Tells the Tale of the Child’s Later Life! Now I begin interlacing the PREMATURE INFANT’S nonverbal communication which I have put into words and my own comments as THE ADVOCATE. The term clinician refers to all members of the NICU Team.
Reconstruction of the Phrenoesophageal Ligament: An Alternative to Avoid Post-Fundoplication Paraesophageal Hernia in Children
Purpose: Migration of Nissen fundoplication to the thorax is a frequent complication of antireflux surgery. Occurring in up to 12% of children. Achieving adequate intra-abdominal esophageal length requires dissection of the phrenoesophageal membrane. The primary objective of this study was to assess the effectiveness of phrenoesophageal membrane reconstruction in preventing thoracic migration of the fundoplication in children undergoing laparoscopic surgery. Methods: Retrospective cohort study of 690 children undergoing laparoscopic fundoplication, Group A without membrane reconstruction, and Group B with membrane reconstruction. The outcome was intrathoracic migration of the postoperative fundoplication. Odds ratio (OR) and 95% confidence intervals (CI) were calculated with p ≤ 0.05. Results: A total of 631 patients met inclusion criteria, 52.1% in Group A and 47.9% in Group B. Intrathoracic migration occurred in 7.0% in Group A and 1.3% in Group B (p < 0.001). Phrenoesophageal reconstruction in Group B resulted in an 82.1% reduction in the likelihood of migration (OR 0.179; 95% CI: 0.06-0.52). Conclusion: This study highlights the need to perform a reconstruction of the phrenoesophageal membrane when performing a fundoplication in children, which significantly reduces the intrathoracic migration of fundoplication.
Nissen Fundoplication, Intrathoracic Migration, Gastroesophageal Reflux, Phrenoesophageal Membrane
From Adverse Childhood Experiences to Digital Trauma-Informed Care: Rethinking Prevention Infrastructure for Pediatric and Population Health
The Adverse Childhood Experiences (ACE) Study established a durable association between early adversity and long-term health risk. What has proven more difficult is translating that insight into consistent prevention practice within pediatric and community systems. While ACE scores quantify exposure, they do not fully capture how long stress responses remain active after adversity occurs. Emerging work in stress physiology suggests that the duration of stress activation may represent a clinically meaningful and potentially modifiable target. This paper revisits ACE science through that lens and examines whether digitally delivered trauma informed supports can serve as scalable components of prevention infrastructure. Drawing from research on stress regulation, Positive Childhood Experiences (PCEs), and Mind–Body interventions, we propose that reducing stress persistence-particularly during childhood-may offer a pragmatic strategy for improving long-term health trajectories while easing system burden.
Clinical and Genetic Characterization of Late-Onset Pompe Disease in an Adolescent Carrying a Rare GAA Coding Mutation
Background: Pompe disease (Glycogen Storage Disease Type II) is a rare autosomal recessive neuromuscular disorder caused by acid α-glucosidase (GAA) deficiency. Late-onset Pompe disease (LOPD) exhibits variable clinical presentations, often delaying diagnosis. Case Report: We describe a 12-year-old male presenting with progressive proximal lower limb weakness, exercise intolerance, and persistent hyperCKemia. Neurological examination revealed macroglossia and mild proximal hypotrophy. EMG showed a myopathic pattern. Biochemical testing revealed markedly alfa, resulting in modest functional improvement. reduced GAA activity, and genetic analysis confirmed compound heterozygosity for c.2480_2426del (rare frameshift) and c.-32-13T>G (common LOPD splicing mutation). Pulmonary assessment indicated diaphragmatic weakness. The patient was initiated on enzyme replacement therapy with avalglucosidase Conclusion: This case highlights the importance of early recognition, enzymatic testing, and genetic confirmation in pediatric LOPD, particularly in patients harboring rare or underreported mutations.
Pompe Disease, Glycogen Storage Disease Type II, Genetic Mutation, Neuromuscular Disorders, Case Report, Enzyme Replacement Therapy
Salvage Re-Irradiation after Complex Treatment in Childhood Leptomeningeal Metastatic Medulloblastoma-Clinical Case withLiterature Review
Leptomeningeal metastases diagnosed in a child with high-risk medulloblastoma immediately after surgery are very rare. The primary treatment is extremely complicated, namely the assessment of the duration of systemic and intraventricular chemo- and immunotherapy, as well as the timing of starting craniospinal radiotherapy. Even more complicated is the question “When in time, in what volume and with what cumulative doses should salvage re-radiotherapy be performed in a child with long-term observed leptomeningeal spread diagnosed immediately after the initial surgery?”. Based on a clinical case of a child with high-risk medulloblastoma and a literature review, we aim to answer the above questions.
Pediatric Psychology: Understanding the Mind of a Growing Child
Pediatric psychology is a specialized branch of psychology that focuses on the emotional, behavioral, and developmental well-being of children from infancy through adolescence. It bridges two worlds-medicine and psychology-to ensure that a child’s mental health is understood within the context of their physical health, family environment, and social experiences.
Long-Term Evaluation of Supracondylar Fractures of the Humerus (SHF) in Elbow Extension in Children at the Pediatric Surgery Department of the Aristide Le Dantec University Hospital Centerin Dakar
Objective: The aim of this study was to evaluate the surgical management of extension supracondylar fractures of the elbow in children at the pediatric surgery department of the Aristide Le Dantec University Hospital. Patients and Methods: This was a retrospective, descriptive, single-center study conducted over a 5-year period from January 1, 2020, to December 31, 2024, at the pediatric surgery department of the Aristide Le Dantec University Hospital in Dakar. The study included all patients under 16 years of age with a recent extension supracondylar fracture of the humerus (occurring within 21 days) requiring surgical intervention, with a 3-year follow-up. Results: A total of 24 patients agreed to participate in our 3-year evaluation study. The mean age was 6.12 ± 3.34 years. The distribution was 17 boys and 7 girls. 71% were classified as type IV, compared to 29% as type III. Open surgery with a posterior approach and internal cross-shaped pinning was performed in 91.6% of cases, compared to 8.4% for percutaneous pinning using the Judet method. The mean length of hospital stay was 10 days. Removal of the osteosynthesis hardware was performed in the majority of cases between 45 and 90 days. Postoperative complications included one case of vascular injury, three cases of surgical site infection, one case of forearm compartment syndrome, and four surgical revisions. With a mean follow-up of 36 months, we observed joint stiffness in 19 cases, including six cases of stiffness greater than 50 degrees, seven cases of stiffness between 20 and 50 degrees, and six cases of stiffness less than 20 degrees. Axial deviation was observed in 11 patients, including six cases of cubitus varus (25%) and five cases of cubitus valgus (20.8%). Nine cases (37.5%) of disfiguring hypertrophic scarring were observed. According to the Marion-Lagrange criteria, the results were satisfactory in 75% of cases. Conclusion: Open surgery for supracondylar fractures of the humerus is the most frequently performed surgical technique in our low-income country setting. It has a high complication rate.
A Horseshoe Appendix Duplex in Pediatrics: Do Not Misdiagnosethis Anatomical Anomaly!
Introduction: Horseshoe appendix duplex is an extremely rare anomaly with 16 cases de-scribed worldwide. The objective of this work is to bring the 17th global case and to do a re-view of the literature. Case Report: A 15-year-old boy, received for acute appendicitis. The abdominal ultrasound revealed acute appendicitis with a small collection around. Surgery was performed and we found a horseshoe appendix in the right iliac fossa with the two bases, each communicating with the cecum. Histological examination confirmed the digestive origin of the duplex appen-dix with the four typical histological layers. Conclusion: The horseshoe shape is the rarest of appendicular duplications. It is most often discovered during appendectomies.
Interleukin-10 Gene Expression Predicts Response to Therapy in Childhood Acute Lymphoblastic Leukemia
Several studies have demonstrated that IL-10 have been associated with therapy outcome in hematological malignancies. IL-10 might therefore also correlate with clinical outcome in childhood acute lymphoblastic leukemia (ALL). In addition to expressing full-length IL-10, a new splicing-derived IL-10 variant (termed IL-10δ3) can be detected in ALL samples. These isoforms generally have different affinities to their receptors, contributing to generating important function in modulating the biologic activity of normal IL-10. Most childhood malignancies lack reliable and specific biochemical tumor markers correlating with disease extent and aggressiveness. That is why several non-specific indirect indicators, including ESR, CRP and LDH, are used in common practice as additional diagnostic and prognostic tools. The study presented here aimed to assess whether the expression of IL-10 and its isoform, IL-10δ3 correlate with other prognostic factors. Mainly, the response to treatment and risk of relapse in 60 children with B-cell precursor (BCP)-ALL, treated at the Pediatric Oncology Department, National Cancer Institute, Cairo University and Damnhour Teaching hospital (DMNI) during the time period from August 2009 to May 2014 according to NCI protocols modified from the St. Jude Total XV protocols. The median age of the patients was 6 years (range, 0.91 years to 24 years) and the male: female ratio was 1.61:1 (37 males and 23 females). Study data showed a possible role of IL-10δ3 particularly decreased incidence of relapse and prolonged event-free survival in first complete remission, whereas no association between response to therapy and IL-10 and IL-10 isoform, IL-10δ3, expression. Moreover, CD34 expression with a good prognosis was higher in patients displaying IL-10δ3 expression compared to patients not expressing the isoform. Results revealed correlation between pro-B stage and IL-10δ3 expression (the 4 patients with pro-B stage expressed IL-10δ3). This relation was not clear since the pro-B immunophenotype is often associated with unfavorable outcome and IL-10δ3 was linked to better clinical outcomes and prolonged event free survival at relapse and first complete remission. May be IL-10δ3 expression reversed bad prognosis. In childhood B-cell precursor (BCP)-ALL, IL-10 isoform, IL-10δ3, expression was associated with a favorable prognosis, better event-free survival and decreased the incidence of relapse in first complete remission.
Screening of Helicobacter Pylori in Symptomatic Libyan Children
Helibacobater (H. pylori) is among the most common bacterial infection in humans The prevalence of H. pylori varies markedly between countries. In Libya we have not a good ideas about the the epidemiology in children. (H. pylori) is usually associated with peptic ulcer disease and gastric carcinoma.Typically, children get infected during the first decade of life, but diseases associated with H. pylori are seen mainly in adults. Since evidence from the literature postulates that H. pylori infection occurs mostly during childhood. Studying the epidemiology of this infection in pediatric patients can enable better understanding of the risk factors and consequences of infection. Multiple diagnostic methods are available for the detection of H. pylori infection.The aim of this study was to use non-invasive method (IgG serology) for diagnosis of H. pylori infection in a prospective observational study conducted among 130 children from May 2022 to May 2025 symptomatic children mainly complaining of recurrent abdominal pain, between two and eighteen years of age. attending outpatient clinic in Gharyan Teaching Hospital. IgG antibodies were measured in these patients’ sera using a commercially available enzyme linked immunosorbent assay (ELISA). H. pylori IgG antibodies were concordant in the general proportion of H. pylori infection for both male and female were 29%, 73% of infected children by H. pylori were males, 80% of H. pylori infected children were > 8 years old.
Fathia Hameda Ben Saleh Fathia Hameda Ben Saleh
Farag Abussalam Ahmed Farag Abussalam Ahmed
Copyright (c) 2025 Journal of Pediatrics Research Reviews & Reports
Six Years Old Boy with Post Covid-19 Isolated Palatal Paralysis, A Rare Clinical Case
Unilateral acquired isolated palatal paralysis is rarely seen in COVID 19 children with unclear pathogenesis. Post-infectious immune-associated cranial mono-neuropathy is a suggestive theory. Cases due to trauma, tumor, and brainstem lesions have been also reported. The presentation is usually nasal regurgitation and uvular deviation. A case report of acquired isolated palatal palsy in a 6 years old boy is presented below with a good response to treatment.
Nashaat Elsayed Farara Nashaat Elsayed Farara
Hatem Ibrahim Elsarnagawe Ibrahim Elsarnagawe
Insight into Down Syndrome and its Rehabilitation
Down syndrome (DS), also known as trisomy 21, is a well-characterized genetic disorder caused by an extra copy of chromosome 21, leading to developmental delays, congenital anomalies, and intellectual disability. Despite significant scientific advances in identifying its chromosomal basis and risk factors, the precise cause of nondisjunction during meiosis remains unknown, limiting our understanding of its true origins. This incomplete understanding also contributes to suboptimal treatment outcomes. However, according to the teachings of Guan Yin Citta Dharma Door (心灵法门), DS is not merely a genetic condition but a karmic manifestation arising from unresolved spiritual debts, ancestral karma, or spiritual possession. This study presents seven responses from Dharma Master Jun Hong Lu to inquirers, which clarify the karmic causes of DS and propose Buddhist-based solutions, such as spirit ascension and karma elimination. Additionally, we highlight four real-world cases where families of children with DS applied these Golden Buddhist Practices, resulting in incredible documented improvements in behavior, cognition, and overall health. These outcomes suggest that DS may be more accurately understood as a karmic condition with limited physical genetic expression. This perspective explains why Dharma-based practices can yield extraordinary therapeutic effects in children with DS.
Covariates of Maternal Health Care Utilization: Evidence from Agricultural Households in Rural Nigeria
Maternal health care utilization remains a persistent public health concern in Nigeria, particularly in rural areas where maternal mortality rates are among the highest globally. This study investigates the socio-economic and demographic covariates influencing maternal health care utilization among agricultural households in rural Nigeria. Using data from the 2018 Nigeria Demographic and Health Survey (NDHS), the analysis focused on 2,751 women in agricultural households, employing a Tobit regression model. The findings reveal that maternal health care utilization is significantly influenced by factors such as mother’s education, age at first birth, employment type,media exposure, household head’s sex, regional location, and birth order. Contrary to prior studies, the study found that formal education, media exposure, and full-time engagement in agriculture were negatively associated with maternal health care utilization, suggesting underlying sociocultural barriers. For instance, religious and patriarchal norms in some northern regions were noted to limit women’s autonomy in health-seeking decisions. The study also affirms regional disparities, with women in the South-East and South-West zones less likely to utilize maternal care compared to those in the North-Central zone.The study concludes that maternal health care utilization in rural agricultural households is shaped by intersecting social, economic, and cultural factors.Addressing these determinants is vital for improving health outcomes and enhancing household productivity in Nigeria’s rural economy. The results underscore the need for multi-sectoral policy approaches that promote female education, delay early marriage, improve healthcare infrastructure in rural areas, and economically empower women. Additionally, targeted media campaigns and male involvement in maternal health decisions are crucial for fostering behavioral change and boosting service uptake. Addressing these barriers is crucial not only for improving maternal health but also for enhancing agricultural productivity and reducing rural poverty in Nigeria
Phenotypic Spectrum and Diagnostic Challenges in Non-21-Alfa-Hydroxylase Deficiency Congenital Adrenal Hyperplasia: A Case Series from a Tertiary care Centre
Purpose: Congenital adrenal hyperplasia (CAH) is an autosomal recessive disorder caused by enzyme deficiencies in adrenal steroidogenesis, with 21-hydroxylase deficiency (21-OHD) being the most common. However, rarer forms such as 11β-hydroxylase (11β-OHD), 3β-hydroxysteroid dehydrogenase type 2 (3β-HSD2), 17α-hydroxylase (17α-OHD), and steroidogenic acute regulatory protein (StAR) deficiency present diagnostic challenges due to variable phenotypes. This study describes the clinical, biochemical, and genetic profiles of non-21OHD CAH cases at a tertiary care centre. Methods: A retrospective review of 87 CAH patients from 2008 to 2022 identified 13 cases of non-21OHD CAH. Clinical, biochemical, imaging and genetic data were analysed. The diagnosis was confirmed by hormonal assays and next-generation sequencing (NGS)-based genetic analysis. Results: Among the 13 cases, six patients had 11β-OHD, primarily presenting with precocious puberty, hypertension, and hyperpigmentation, with elevated ACTH, 17-OHP, and suppressed renin levels. Three patients with 3β-HSD2 deficiency were diagnosed in early infancy following salt-wasting crises. 17α-OHD was diagnosed in three adolescent females presenting with primary amenorrhea, tall stature, hypertension, and elevated gonadotropins.One case of StAR deficiency was diagnosed at 45 days of life, presenting with adrenal crisis and severe adrenal insufficiency. Conclusion: Non-21OHD CAH presents diagnostic challenges due to its varied clinical spectrum. Hypertension and hypokalemia are key differentiators for 11β-OHD and 17α-OHD, while steroid profiling (LC-MS) aids in diagnosing 3β-HSD2 deficiency. However, the most crucial aspect is the early diagnosis, which is a significant factor in preventing complications like hypertensive cardiomyopathy and adrenal crises.
A Parasitic Twin Diagnosed Prenatally As a Sacrococcygeal Teratoma: A Case Report
Parasitic twinning is a rare entity. It is an asymmetric conjoined twinning in which a poorly formed twin, known as the parasite, is attached to a fully developed co-twin, known as the autosite. The parasite depends on the autosite for blood supply. It is diagnosed prenatally with ultrasound, and treatment involves resection of the parasite postnatally. We describe a case that was prenatally diagnosed on 2D ultrasound as a sacrococcygeal teratoma at 25 weeks.No other anomaly was detected. Caesarean delivery was conducted at 34 weeks on account of failure to progress following spontaneous preterm labour.At delivery, we found that the sacrococcygeal mass was a parasitic twin with a poorly formed body, lower limb, and hair. These fetal components were not demonstrated on the prenatal 2D ultrasound. Postnatal assessment revealed no other abnormality. The mass was successfully resected on day 3 of life. The resection was done early on account of ulceration of the mass/ parasite. The histopathological assessment revealed more fetal parts, including brain tissue and lungs. Prenatal diagnosis is essential as it identifies associated anomalies and helps with prognostication and planning of obstetric and surgical management by a multidisciplinary team.
Neurodevelopmental Outcome of High-Risk Neonates At 24 Months of Age, With Respect to General Movements of Prechetl at Term or Within 3 Months of Age
Background: Advances in secondary and tertiary level neonatal care in India and the state of Kerala have resulted in better survival and reduction of mortality of high risk neonates. So it is essential to have follow up of these babies more frequently and start early interventions to prevent or reduce the severity of developmental delay. Various non- invasive, cost effective methods are being tried to detect or predict early the developmental delay, one among these methods is general movements of Prechetl, since only a small percentage of neonates with risk factors are developing significant developmental delay later. Methods: Neonates 25 weeks and above, but less than 42 weeks, admitted with risk factors and discharged, presenting for follow up within 3 months of age were enrolled for the study. Those babies having visible birth defects (VBD), chromasomal or other genetic disorders, and dysmorphic or syndromic features were excluded from the study. Neonates at term or their first visit within 3 months were observed for general movements of Prechetl when the baby is remaining alert without crying and noted as normal or absent/abnormal. These high risk babies (N=375) in this prospective observational analytic study were followed up to their completed or corrected 24 months of age. Neurodevelopmental assessment done in domains- cognitive, communication, motor, and social-emotional at 24 months using Bayley scales of infant and toddler development edition-3 (BSID-III). The study was conducted over a period of 6 years from 2017 in south of middle Kerala, India. Results: Out of total 375 high risk babies, 53 babies were having abnormal/absent general movements pattern of Prechetl and 322 had normal general movements pattern. High risk babies with absent/abnormal general movements cohort babies were having significantly lower total and domain-wise (cognitive, language, motor and social-emotional) developmental scores compared to high risk babies with normal general movements pattern cohort at their corrected/completed 24 months of age, using BSID-III indicating higher chance for babies with absent/abnormal general movements to have moderate to severe developmental delay and cerebral palsy at 24 months of age. Conclusion: Abnormal or absent general movements pattern at term or within 3 months of age of high risk infants are associated with high chance of moderate to severe developmental delay and cerebral palsy at their corrected/completed 24 months of age, compared to high risk infants with normal general movements pattern, at term or within 3 months of age.
Immature Intracranial Teratoma in Childhood - A Rare Clinical Case from Our Practice
Immature teratomas are rare intracranial malignant tumors of childhood, predominantly localized in the pineal or suprasellar brain region. We present a rare clinical case of a 12-year-old boy with an immature intracranial teratoma who underwent apparently total tumor excision followed by local cranial radiotherapy. The presented clinical case focuses on the diagnosis and complex treatment of these rare non-germ cell brain tumors in childhood. A strict pathohistological diagnosis, serum and cerebrospinal fluid tumor marker testing (AFP and HCG), and MRI of the craniospinal axis are required.
Assessing the Effectiveness of HIV Counseling and Testing Programs: A Retrospective Study at an Apex Regional STD Centre in North India
Background: HIV counseling and testing are foundational in the fight against HIV/AIDS, offering opportunities for prevention, early diagnosis, and treatment linkage. This study evaluated the effectiveness of HIV counseling and testing services at an Apex Regional STD Centre in North India. Methods: A retrospective observational study was conducted from January to December 2023. Data were extracted from center registers, including the number of individuals receiving pre-test counseling, undergoing HIV testing, and testing positive. Partner engagement, HIV transmission routes, age and gender distribution, and referral of suspected TB cases were also analyzed. Quality indicators such as counseling completeness, content delivered, and partner notification services were reviewed. Results: A total of 29,017 individuals received pre-test counseling, with 28,609 undergoing HIV testing (98.59% uptake). HIV positivity was highest among individuals aged 35–49 years (2.13%). Heterosexual contact with casual partners in males and regular partners/spouses in females were the most reported transmission routes. Among 389 partners tested, 180 were HIV-positive (46.3%). However, only 230 partners (59.1%) received formal counseling. The TB referral system identified sputum-positive TB in 0.10% of referred clients. Counseling session quality was adequate in 85% of cases based on adherence to national counseling guidelines. Conclusion: HIV counseling and testing services at the center demonstrated high uptake and significant case detection. However, gaps in partner counseling and data tracking limit the full evaluation of program effectiveness. Strengthening partner services, standardizing counseling quality audits, and integrating follow-up mechanisms are critical for enhancing outcomes.
Metabolic Characteristics in Obese Children
Introduction: Metabolic syndrome is one of the complications of obesity with a significant impact on health. This MS is diagnosed according to the International Diabetes Federation 2007 in children aged 10 to 16 years with waist circumference > 90th percentile according to the curves of McCarthy and two of the following metabolic characteristics: HDL C < 40 mg/dL, TG≥150 mg/dL, blood glucose ≥ 100 mg/dL and blood pressure≥130/85mmHg. Goals: We performed a retrospective and prospective study at the pediatric obesity consultation. The main objective is to assess the metabolic syndrome in a population of obese children and adolescents. The secondary objectives are the evaluation of the various criteria of the metabolic syndrome, and the impact of the degree of obesity, the search for comorbidities and their repercussions, and finally the evaluation of the care. Results: The survey involved 74 children and adolescents,from January 2011 to December 2021. The frequency of metabolic syndrome is 35.1%.with an average age around puberty of 12.92 years. There is no significant difference in frequency by sex. This frequency increases with the degree of obesity Insulin resistance remains the first factor responsible for the genesis of MS, Dyslipidemia affects more than a third of these children. Arterial hypertension is noted in 14% of subjects.For glycemic abnormalities, 16.21% of children have fasting hyperglycemia. For complications the non alcoholic fatty liver disease NAFLD affects approximately 33% of these children, the obstructive sleep apnea OSA was only confirmed in 4% of these children.
Standardization of Viral Neutralization Assay Used in To the Determination of Neutralizing Antibodies in the Evaluation Studies of the Cuban Vaccines against COVID-19
The epidemiological situation created by SARS-CoV-2 imposed the challenge of developing vaccines and demonstrating their efficacy through a test capable of detecting functional neutralizing antibodies. It was proposed to standardize of viral neutralization assay used in the determination of neutralizing antibodies in the evaluation studies of the Cuban vaccines against COVID-19. Serial doubling dilutions of the serum samples were used and mixed with equal volumes of strain D614G at different infective doses an concentrations of Vero E6. The neutralization titer was determined by the colorimetric method and the cytopathic effect. 24 hours were defined as virus harvest time, the fourth day as the optimal time for reading the assay, 2x104 cells/well as cell concentration, and 100 TCID50 as optimal infective dose. The analytical specificity was 100%, as well as the specificity and diagnostic sensitivity. There was a high correlation between the micro neutralization assay and the UMELISA anti RBD system and a strong association with the molecular neutralization test. There were no differences between the cytopathic effect readings between the two reading methods. It was shown that it is a sensitive, specific and precise method, which guarantees the feasibility of its use in the evaluation of vaccine candidates against COVID-19.
Yaday Alfonso Mirabal Yaday Alfonso Mirabal
Danay Carrillo Valdes Danay Carrillo Valdes
Yanin Hernández Rodríguez Yanin Hernández Rodríguez
Does Simultaneous Intensity Modulated Radiotherapy with Temozolomide Increase the Radiosensitivity of Childhood Diffuse Intrinsic Pontine Glioma (DIPG)?- a Clinical Case from our Practice
Diffuse intrinsic pontine glioma (DIPG} is a high-grade glioma (HGG) that originates in the pons and is seen almost exclusively in children. The healing results achieved after a self -conducted conventional, hyperfractionated and hypofractionated radiotherapy (RT) up to a total tumor dose of 54 Gy at DIPG are unfavorable. We present our observations in a child with a locally advanced DIPG after a conventional concomitant Temozolomide radiotherapy. In order to increase the survival in this clinical case, we decided to conduct a simultaneous Temozolomide RT with an extended target volume with the inclusion of the ventricles. Two months after the Temozolomide intensity modulated radiotherapy (IMRT), the MRI reports a reduction in the tumor with a pronounced tumor necrosis, which is evidence of the radio -sensitization effect of Temosolomide.
Association between Breast Feeding and Development of Atopy
Background: Childhood atopic diseases are becoming more prevalent over time, making it an issue to investigate. One of the possible associated factors that has been studied is breastfeeding, which remains a controversial subject. A number of studies show a protective role of breastfeeding against atopic diseases such as asthma, allergic rhinitis, atopic dermatitis, food allergy, and others. However, other research could not find a positive relationship between breastfeeding and some types of allergies. Accordingly, we set out to investigate the relationship between breastfeeding and the development of atopy in our study. Methods: A hospital based cross-sectional study. The study was conducted in the Maternity and Children Hospital (MCH) in Hail region, between November 2022 and February 2023, targeting mothers with at least one child over the age of one month in the paediatrics and obstetrics/gynaecological clinics’ waiting areas and admission wards. Results: A sample of 423 children from Hail were studied in our research. Most of them were over twelve months old. Although most of the participants believed that breastfeeding reduces the incidence of atopic skin disease, the most prevalent type of feeding was formula feeding, followed by mixed feeding and exclusive breastfeeding. The study showed no significant effects of breastfeeding type on the development of allergies in children, as well as breastfeeding type and duration. However, there was a significant association between formula feeding and the development of allergic rhinitis, as it increases the incidence. Conclusion: The findings of this study demonstrated that no definitive link could be made between breastfeeding duration and the development of atopy or between breastfeeding type and the occurrence of atopy in children. However, the study shows that formula feeding is a significant risk factor for the development of allergic rhinitis.
Long-Term Drug Treatment of a Giant Liver Hydatid Cyst in a Child
Background: Cystic еchinococcosis is a chronic parasitosis caused by the larvae of the tapeworm Echinococcus granulosus. Humans act as intermediate hosts and the larvae can affect any organ in the form of cysts. They are most often found incidentally by diagnostic imaging, where they have become large in size, with treatment being primarily invasive. Conservative treatment with albendazole is one of the appropriate treatment options, but it features a low success rate in cysts over 5 cm. Case Presentation: We describe a case of an 16-year-old girl with an active 12 cm cyst in the liver. Two consecutive courses with albendazole, with duration 3 months each, were conducted. The cyst reached a safe inactive stage and no relapses have been observed for 1 year since the last administration of the medication. Conclusions: Our experience shows that with large cysts albendazole courses may be extended including in childhood. Ultrasonography has clearly demonstrated its ability to follow-up patient in a cost effective manner and avoiding ionizing radiations.