AbstractPreeclampsia (PE) is a prevalent disease especially in developing countries. PE influences maternal immune cells and cytokines, with prevailing of proinflammatory cytokines and reduction of regulatory cells. It has a short- and long-term impact on newborn mortalities and morbidities. The aim of this study is to provide an overview of previous literature discussing the effect of PE on infant immunity to help design future research. A comprehensive search was done on three databases including PubMed, Medline, and EMBASE with mesh and text terms. We could identify 851 titles published from 2000 to the time of search. Twenty-four studies met the inclusion criteria, and they were included in the quality assessment. Twenty-four studies were identified, covering the impact of PE on various neonatal immune cells and cytokines. PE is associated with a decrease in the number of several immune cells in newborns, particularly neutrophils, with enhancing cytotoxic effect of both neutrophils and natural killer (NK) cells. Treg cells were considerably reduced with increase of cytotoxic T cells CD8+ and memory cells CD45RO+ in both CD4+ and CD8 + . Proinflammatory cytokines like IL6, IL8, and TNF were raised in severe PE. PE is linked to a decrease in regulatory immune cells and an increase in the immune cells' cytotoxic capability, as well as the prevalence of proinflammatory cytokines in newborns. These changes were observed in cord blood and peripheral blood samples; however, future research should investigate the long-term effect of PE on neonatal immunity.

Abstract Objective Prolonged jaundice is defined as a serum bilirubin level of more than 5 mg/dL, which persists at postnatal 14 days in term infants and 21 days following birth in preterm infants. Although the underlying causes cannot be found in the majority of prolonged jaundice cases, this may be the first sign of a serious issue. Therefore, this study aimed to evaluate the association between vitamin B12 deficiency and prolonged jaundice in newborns. Material and Methods This descriptive cross-sectional study was performed in a university hospital between January 1, 2015 and October 1, 2020. All participants consisted of infants who were admitted to the pediatric outpatient clinics. Infants > 35 weeks of gestation and with prolonged jaundice of unknown etiology were included in the study group. The control group consisted of infants > 35 weeks of gestation without prolonged jaundice. Demographic and clinical characteristics and serum vitamin B12 levels were evaluated comparatively. Results A total of 126 infants, 66 of whom had prolonged jaundice, were included. The mean gestational week of the study group was 38.4 ± 1.8, and the control group was 38.6 ± 1.9 weeks. There was no difference between the groups in terms of demographics and laboratory data. The vitamin B12 level of the study group was significantly lower (median = 170 pg/mL) than the control (median = 268 pg/mL). Conclusion Based on the findings of this study, vitamin B12 deficiency was thought to be an important cause of prolonged jaundice, and further studies are needed to explain the role of vitamin B12 deficiency in the etiology of prolonged jaundice.

AbstractDental radiography is an important diagnostic tool for the detection and assessment of the extent of dental caries and accurate treatment planning. There is no safe limit for X-ray exposure. The associated risks of X-ray exposure are higher in children due to a higher rate of cell proliferation in them, compared with adults. This study aimed to assess the genotoxic and cytotoxic effects of dental radiographic modalities on buccal mucosal cells in children. This interventional study evaluated 80 children between 3 and 12 years who required periapical, panoramic, bitewing, or bitewing plus panoramic radiography for treatment planning. Twenty eligible patients were assigned to each of the aforementioned four groups. Buccal mucosal cells were scraped bilaterally by a plastic spatula after complete rinsing of the oral cavity. The collected specimens were directly mounted on microscopic slides and after air-drying, they were fixed with 80% methanol and Giemsa stain. The cells were then inspected under a light microscope at 400x magnification for cytogenetic changes. Data were tabulated and analyzed by SPSS version 20 at a p < 0.001 level of significance. The results showed a significant increase in the frequency of karyolysis, karyorrhexis, and pyknosis in all four groups after dental radiography (p < 0.001). Also, the number of micronuclei significantly increased after panoramic plus bitewing radiography (p < 0.05). X-ray exposure in panoramic, periapical, bitewing, and bitewing plus panoramic radiographies can be cytotoxic, while bitewing plus panoramic radiography can be genotoxic in children as well.

AbstractIn this article, we reviewed ruqyah from past to present and its use among patients with cancer to attract attention to the importance of ruqyah. Ruqyah, one of the mind–body interventions among complementary and alternative medicine therapies, refers to the healing method based on the Quran and hadith through the recitation of the Quran, seeking of refuge, remembrance, and dua (supplication) that is used as a means of treating sickness and other problems, by reading ayats of the Quran, the names and attributes of Allah, or by using the duas in Arabic or in an understandable language. Ruqyah is frequently used in patients with cancer in combination with medical treatment, and many patients benefit from ruqyah practices. It is usually used to improve emotional and physical well-being, relax, cope with the disease, strengthen the immune system, increase vitality, decrease pain and stress, treat disease, accelerate the healing process, increase the duration of life, improve sleep quality, reduce side effects associated with treatment, and to be self-sufficient. Ruqyah is a complementary method for modern cancer treatment. It is not an alternative to chemotherapy and cannot directly replace medical treatment. Patients can perform ruqyah by themselves without applying to Muslim faith healers or spiritual healing centers. It can be by everyone regardless of their religion and belief. Although ruqyah has been successfully used in various social, mental, spiritual, and physical disorders for over 1,440 years, there are limited randomized controlled trials about its use in patients with cancer due to lack of cooperation between health professionals and Muslim faith healers applying ruqyah. Therefore, we suggest that health professionals develop joint projects and studies with Muslim faith healers and Islamic religion professionals on this subject. Finally, we strongly believe that ruqyah must be integrated into mainstream modern medicine as in the “Malaysia model” in both developing and developed countries.

AbstractMyxedema heart disease is an exceptionally rare condition with few reported cases. We present a rare case of a child who presented with severe congestive heart failure secondary to myxedema heart disease complicated by preexisting valvular heart disease. The patient was admitted to the pediatric intensive care unit and medical management. An echocardiogram showed severe biventricular dysfunction and severe valvular disease. She was started on levothyroxine and liothyronine. During the patient's hospitalization, the thyroxine level normalized but the thyroid-stimulating hormone continued to remain elevated. Likewise, her cardiac ventricular function improved, though it did not return to baseline. Our case highlights the importance of maintaining a broad differential diagnosis in a child who presents with congestive heart failure, to include thyroid disease, which necessitates a rare but specific management strategy.

AbstractFamily is crucial for the development and health of children. Parental disharmony and quarrels before or after divorce can negatively affect children's development and health; therefore, we strongly suggest that physicians should question the interparental relationship when evaluating a child. Marriage, which forms the basis of the family, has been accepted as the only legitimate relationship in all Divine religions that allows men and women to create their privacy and share space and contribute to the continuation of the human race. Since ancient times in all cultures and religions worldwide, interparental fidelity has been the most important thing in marriage. Happy family life is perpetuated through confidence between husband and wife and heartfelt respect and love. Immodest dress and free-and-easy behavior destroy confidence and spoil mutual respect and love. Therefore, religion has established the rule of marital fidelity. The definition of adultery in all religions consists of very similar elements. Men and women who commit adultery have been punished in various ways. In this article, we discussed marriage and marital fidelity, which determine the course of the interparental relationship, from a religious perspective to draw attention to the importance of the family institution in child health.

Abstract Background The efforts of clinicians are focused on determining the predictors for electrical status epilepticus in sleep (ESES) manifestation, due to the negative effect of ESES on cognition. Treatment approaches remain a leading problem because of therapeutic resistance. Objective We looked for potential risk factors for ESES manifestation and summarize the clinical course and therapeutic approaches in patients with idiopathic and symptomatic ESES. Patients and Methods We retrospectively reviewed the medical data of 51 children with idiopathic ESES and 20 children with symptomatic ESES. Results We observed an earlier age of seizure onset (p = 0.0002) and a higher percentage of cases with multiple seizures (p < 0.00001) and with postictal paralysis (p < 0.00001) in idiopathic ESES compared with childhood epilepsy with centrotemporal spikes. In the idiopathic ESES, the treatment consisted of corticosteroids in patients with permanent ESES remission and transient remission, levetiracetam (LEV) children with permanent ESES remission and transient, clonazepam (CZP) children with permanent ESES remission and transient, ethosuximide (ESM), and sulthiame. The patients with symptomatic ESES had more unfavorable evolution, as 19 children had persistent or relapsing ESES course. Conclusion We consider the earlier age of seizure onset (below 5 years) and the presence of multiple seizures and postictal paresis as risk factors for ESES manifestation. ESES is characterized by a significant therapeutic resistance, especially in the group of symptomatic cases. Good results are observed with LEV, ESM, CZP, and steroids.

AbstractWe describe the case of a previously healthy toddler with the finding of supraventricular tachycardia after being rescued from a garage fire. The patient's initial presentation was concerning for inhalational injury and a 2% total body surface area burn to the forehead. Additionally, the patient was noted to be extremely agitated in the trauma bay. Given the patient's agitation and the mysterious circumstances surrounding the fire, a urine toxicology was performed shortly after admission and was positive for cocaine. Passive cocaine inhalation, possibly during the fire, is a likely explanation for the child's arrhythmia.

AbstractPreschool children at risk of dyslexia show inadequate progress in their preliteracy skills; they often perform poorly in the domain of phonological awareness, letter knowledge, and rapid automatized naming. As a result, they tend to fall behind academically, specifically in reading, when they enter primary school. Because time is of the essence, early intervention becomes necessary to provide the best possible preliteracy outcome. To date, there has not been a study that investigates the effectiveness of early intervention in Thai, a language that is typologically and orthographically different from those in previous studies. In this preliminary study, training materials, created with phonological awareness and letter knowledge at the core, were presented via interactive Siriraj Pre-Literacy Enhancement software. In total, 73 typically developing preschoolers, aged 60 to 66 months, were enrolled. Preliteracy skills were measured by Rama Pre-Read (RPR). At-risk children received the 11-week computer-based early intervention training. After the intervention was completed, participants' preliteracy skills were evaluated by RPR (posttest). Sixteen children (21.9%) were at risk of dyslexia. Results after training indicated that preschool at-risk children of dyslexia in Thailand show a high magnitude of improvement in preliteracy skills, across all three domains. The computer-based early intervention to promote preliteracy skills is a feasible and effective form of remediation for Thai children at risk of dyslexia.

Abstract Objective We reviewed 50 infant cases with short bowel syndrome (SBS) to examine the treatment outcome of SBS management in a tertiary hospital in Vietnam. Material and Methods A case series was performed at the National Children's Hospital, Hanoi, Vietnam. A total of 50 cases with SBS were reviewed. Clinical and laboratory characteristics before and after treatment were collected. Results The most common cause of SBS was necrotizing enterocolitis. Common clinical symptoms included watery stools, dehydration, and malnutrition. After treatment, the patient's weight, albumin, and prothrombin improved markedly. There are 72% of children with good or fair treatment results. The rate of sepsis was high (18%). There was one case with complications of catheter infection and one case of liver failure. Three children died during treatment, one died from septic shock and multiple organ failure, and two died from respiratory failure. Conclusion This study showed promising treatment outcomes in pediatrics.

AbstractThe hospitalization of newborn infants causes their parents to suffer stress, depression, feelings of powerlessness, emotions of shock, worry, fear, anguish, anxiety, and loneliness interspersed with those of faith, joy, and hope. Religion may provide a framework for understanding emotional and physical suffering and can facilitate perseverance or acceptance in the face of stressors. Religious coping is a religiously framed cognitive, emotional, or behavioral response to stress that encompasses multiple modalities and goals, as well as positive and negative dimensions. Gaining meaning in life can serve many purposes, including closeness to Allah, hope, peace, connection with others, personal growth, and personal restraint. Spirituality emerges as an “intensification of human experience” from any birth, not just out of ordinary situations. The significant differences in some spiritual issues indicate the need to consider the spirituality of both parents. In this article, we reviewed the role of religious coping in the neonatal intensive care units to attract attention to the importance of religious coping for parents whose infants are hospitalized in the neonatal intensive care unit.

Abstract Background The international and Thai asthma guidelines recommend stepping-down controller treatment in patients whose asthma symptoms have been controlled and maintained for 3 months or longer. After stepping-down treatment, some patients experienced exacerbations and required emergency care. There is limited understanding of stepping-down treatment for asthmatic children. The goal of this study was to determine the failure rate and associated factors after stepping-down treatment in pediatric asthma. Methods A retrospective study of electronic medical records of asthmatic patients aged between 3 and 15 years with controlled symptoms and indications for stepping-down treatment was conducted at Maharat Nakhon Ratchasima Hospital, a tertiary care center in Northeast Thailand, between January 2015 and December 2019. Results Of the 110 asthmatic patients with well-controlled asthma who received stepping-down treatment, 90 patients were followed over 12 months. Failure of treatment within 12 months of follow-up was 37.8% (34 of 90). Patients who failed to stepping-down treatment had asthma onset at a younger age (p = 0.026) and less than 9 months duration of asthma stability before stepping-down (p = 0.049). In multivariate analysis, the factor associated with failed stepping-down treatment was the length of asthma stability of fewer than 9 months with an odds ratio of 4.8 (95% confidence interval: 1.02–22.47). Conclusion Stepping-down treatment in well-controlled pediatric asthma resulted in a high failure rate. The author suggests initiating stepping-down treatment in patients whose duration of asthma stability is greater than 9 months may improve the rate of success.

Abstract Background Surgical procedures in children with overweight and obesity have many difficulties due to the high incidence of postoperative complications. This impact on comorbidity has a great interest in various surgical pathologies, such as acute appendicitis, since it is the most frequent surgical emergency in all age and sex groups. However, there are few studies assessing the effect of body mass index (BMI) and other parameters like the Glasgow Prognostic Score (GPS) and C-reactive protein (CRP)/albumin ratio on the course of acute appendicitis in children. Objectives Identify the impact of BMI and other biomarkers like CRP/albumin ratio and GPS on the clinical course of acute appendicitis in children. Patients (Materials) and Methods This is a prospective study conducted on 90 pediatric patients of acute appendicitis (30 high BMI and 60 non-high BMI) admitted at Pediatric Surgery Department, Children Hospital Cairo University (CHCU) during the period from March 2022 to September 2022. All patients had preoperative laboratory tests, intraoperative assessment regarding the type of surgery, duration of surgery, and type of appendicitis, then the postoperative assessment. Results Among the 90 patients, the mean age of participants was 8.74 (2.23) years and there was a male predominance. Frequencies of open surgeries were higher in overweight and obese children (children with high BMI). There was a significant positive correlation between the preoperative CRP/albumin ratio and GPS, and an inverse significant correlation of preoperative albumin with the postoperative hospital length of stay, duration of surgery (operation time), and duration of postoperative fever. Conclusion There is a significant relationship between the preoperative inflammatory and nutritional markers and postoperative hospital length of stay, duration of surgery (operation time), and duration of postoperative fever.

AbstractTobacco, cannabis, and alcohol consumption, found to be most common among college students, is known to cause life-threatening diseases, and is correlated with social, financial and health problems. For the present study, we aimed to assess the sociodemographic factors affecting tobacco, alcohol, and cannabis consumption among university students. A cross-sectional study was conducted from January to March 2020, on a random sample of 507 undergraduates, between the ages of 18 and 24. The research instrument was a self- administered questionnaire with questions on the sociodemographic characteristics, and questions regarding the consumption of tobacco, alcohol, and cannabis.The mean ± standard deviation age of study sample was 21.56 ± 1.81 years, and 56.4% participants were females. The lifetime prevalence of tobacco usage among the study sample was 66.7%, alcohol 54.2%, and the cannabis had a prevalence of 13.8%. About 46.2% (n = 234) were co-users of tobacco smoking and alcohol, and 12.6% (n = 64) were co-user of tobacco smoking, alcohol consumption, and drug use. Analyzed with Pearson's chi-squared test, there was no statistically significant difference between students from private and public institutions on lifetime, in the past 1 year/1 month of tobacco smoking, alcohol consumption, and cannabis use (p > 0.05). The logistic regression model for dependent variable cannabis abuse in the past 1 year is associated with lower odds among female students (odds ratio: 0.337, 95% confidence interval: 0.167–0.682; p = 0.002). Smoking, drinking, and cannabis were found to be highly prevalent among university students. These findings can help program managers and policy makers devise effective and appropriate control programs and policies for substance-using university students.

AbstractThis study aims to describe the relation between media use characteristics and executive dysfunction in Thai preschoolers. Secondary data were retrieved from a cross-sectional study to compare two Thai executive functions (EFs) assessment forms. Questionnaire data from 110 caregivers of preschool children were analyzed. The research materials included a sociodemographic information form, parenting style and dimensions questionnaire, a 1-week screen time diary, and the behavior rating inventory of executive function-preschool version (BRIEF-P). Findings showed a 23.6% prevalence of executive dysfunction among Thai preschool children. Children's media use characteristics associated with global executive dysfunction included less co-viewing time with caregivers. Shorter co-viewing time was linked to a deficiency of inhibition, emotional control, and planning and organization. Meanwhile, extended viewing of low-quality content was associated with impaired working memory. However, total screen time and setting screen time limits were not associated with executive dysfunction. Co-viewing with caregivers and limiting exposure to low-quality content must be promoted to minimize the adverse effects on EF development.

AbstractAcute kidney injury (AKI) is an independent risk factor for neonatal death. Since neonatal early renal injury usually has no specific clinical symptoms, many AKI cases are often missed the best time of early intervention if there is no relevant examination. Perinatal asphyxia (PA) can lead to AKI. The study aimed to assess efficacy of serum cystatin C (CystC) in early prediction of AKI in full-term neonates with PA. The study was conducted at the neonatal intensive care unit, Assiut University Children Hospital from January 2019 to January 2021. Seventy full-term neonates with documented PA were enrolled in the study. Baseline laboratory data and serum CystC levels were assessed. Out of those 70 neonates with PA, 21 (30%) developed AKI, while 49 (70%) neonates did not develop AKI. Majority of non-AKI group had stage-I hypoxic-ischemic encephalopathy (HIE) (61.2%), while majority of AKI had stage-III HIE (61.9%). A significantly higher serum CystC level was found among AKI group than those without AKI (1.50 ± 0.12 vs. 0.90 ± 0.14, p < 0.001). The predictors for AKI among neonates with PA were low birth weight, serum CystC levels, hypotension, and stage-III HIE. Serum CystC has 94.3% overall accuracy for prediction of AKI. In conclusion, AKI in neonates with PA is common. CystC is a promising biomarker in early prediction of AKI in such cases. Future studies are warranted to confirm these findings.

AbstractAnemia and stunted growth are major health problems with adverse consequences for children. This study aimed to determine the prevalence, characteristics, and hematological profile of anemia among stunted children under 2 years old. A nested cross-sectional study from a child cohort was conducted in Bandung Regency, West Java, Indonesia. Two hundred twenty-two children aged 6 to 24 months were randomly selected. These children were reexamined from November 2019 to March 2020 for anthropometric measurements and hematological assessment and interviewed for relevant risk factors of stunted growth and anemia. Ninety-eight stunted children were identified and distributed into stunted and severely stunted groups (47.96 vs. 52.04%). Around 85.4% of the children came from low-income families and 31.7% were severely underweight for age. Surprisingly most of these stunted children had normal birth weight and length and were born at term (68.3, 53.7, and 85.4%). The prevalence rate of anemia among stunted children was 41.8%, they had decreased mean corpuscular volume (56%), decreased mean corpuscular hemoglobin (73%), and normochromic mean corpuscular hemoglobin concentrations (51.2%). Leucocytosis was higher than leucopenia (10 vs. 3.7%) and thrombocytosis (n = 15, 36%) as compared to thrombocytopenia (n = 5, 12%). The prevalence of anemia was high among stunted children. The characteristics of stunted children with and without anemia were similar. The fact that these stunted children had few risk factors for stunting emphasizes the need to focus on improved postnatal care to prevent faltering. Based on the hematology profile, iron deficiency anemia was suspected to be the most etiology in these cases warranting further follow-up and management.

AbstractThe preschool period is marked by the development of several domains such as communication, cognition, social skills, and literacy skills. As language and literacy skills overlap during the preschool period, it is important to understand the dynamics of language and literacy in early school years. Due to language diversity, India does not bear a single-language system, and often the language spoken at home may not be the same at school for curricular instructions. Therefore, the present study focuses on the influence of script in bi- or multilingual scenarios in India. More importantly, the home language may or may not have its specific script; thus, facilitating early literacy skills at home can be questionable. The study followed a cross-sectional study design. One hundred and forty participants were divided into two groups based on their native language (Malayalam and Tulu groups). Each group was further divided based on their age, younger and older groups. An early literacy checklist and a parent perception questionnaire were developed to assess the early literacy skills in second language (L2). The findings revealed a developmental trend in early literacy skills in children with the older group performing better than the younger group. The study results also shed light on this less researched domain of influence of native script on L2 learning in a linguistically diverse country like India. The study's findings emphasize the parental understanding of the importance of home literacy–based activities for children and evaluation of early literacy skills which will help in early identification and treatment.

AbstractPostoperative fibrotic band formation is a common complication that causes bowel obstruction, chronic pain, and especially reoperation problems. We tried to evaluate the ultrasound signs of different adhesions over time in children. This descriptive study was performed in children hospital of Mashhad University of Medical Sciences. Sixty-five children aged 4 months to 15 years (mean age of 7.2 ± 6.5 years) were enrolled in the study. Complete abdominal sonography using 5 to 12 MHz multifrequency probes was performed by a pediatric radiologist. The sonographic findings and data analysis were performed. In first week after surgery, the fibrinous exudates are seen as hypoechoic shadows. It has uneven thickness and usually encases the bowel loops in a circular shape. In second week, they gradually become straighter with uniform thickness. In this period, in 68% of cases, a hyperechoic line is formed in the center of hypoechoic fibrinous exudates, which is usually placed between the bowel loops (interloop fibrosis). The omentum or mesentery entrapment in the fibrinous exudates was occurred in ∼50% and 25% of these cases, respectively. In this state, echogenic omentum or mesentery was seen simultaneously with the hypoechoic fibrinous exudates. After 1 month from surgical procedure, One of the following four sonographic patterns are seen: attachment hyperechoic omentum to retroperitoneum (50%), attachment hyperechoic mesentery to anterior abdominal wall (26%), interloop fibrosis (39%), and severe hypoechoic fibrotic band (30%). Absence of visceral sliding was seen in 65 to 80% of patients. Overall, there are five morphologic patterns of adhesion on ultrasound: fibrinous exudates, interloop fibrosis, fibrotic band, fixed omentum to retroperitoneum, and fixed mesentery to abdominal wall.

Abstract Background Retinopathy of prematurity (ROP) is the most frequent problem which causes blindness in preterm babies. In our study we evaluate the frequency of retinopathy, the risk factors, and their effects on disease development in premature newborns admitted to our neonatal intensive care unit (NICU). Methods A total of 139 premature infants with gestational ages less than 34 weeks followed in our NICU between January 1, 2008 and January 1, 2011. The infants were divided into two groups as group 1 (no ROP/mild ROP) and as group 2 (severe ROP). Results The demographics of 139 patients were as follows: 79 (56.83%) were female and 60 (43.17%) were male. Overall, 104 (74.8%) patients were found to have no or mild ROP and 35 (25.2%) had severe ROP. Among the patients in the severe ROP group, 25 of them had plus disease. With logistic regression analysis, lower gestational age (odds ratio [OR]: 4.1, confidence interval [CI]: 1.9–9.2), the central catheter usage (OR: 13.4, CI: 1.2–146.6), hypotension (OR: 7.5, CI: 1.1–49.6), perinatal asphyxia (OR: 261.3, CI: 8.8–7725.4), apnea (OR: 18.1, CI: 1.6–202.6), and high FiO2 (OR: 1.2 CI: 1.0–1.5) were found to be related to severe ROP. Conclusion Among the preterms with very low body weight included in our study, we found that the frequency of severe ROP requiring treatment was low. The most important factors related to severe ROP were found to be low gestational age and birth weight. Being aware of the risk factors related to severe ROP in addition to screening every preterm infant carrying these risk factors is extremely important for the early diagnosis and treatment to prevent blindness due to severe retinopathy.