Chronic hepatitis B in children with or without malignancies:A 13-year follow-up

AIM:To evaluate the outcome of chronic hepatitis B(CHB)in children with or without malignancies.METHODS:Twenty four children(15 boys and 9 girls)with malignancies,followed up by the pediatric gastroenterology outpatient clinic for CHB between January 2000 and December 2013,were enrolled in the study(Group 1).Group 2 was formed with twenty five children(11 girls and14 boys)diagnosed with CHB without malignancies.The data from the patients’records were compared between the two groups.RESULTS:Hepatitis B e antigen(HBe Ag)/anti HBe seroconversion was observed in 3 patients(12.5%)in group 1 and 15 patients(60%)in group 2,with annual seroconversion rates of 1.61%and 16.6%,respectively,and the difference was significant(P0.01).One patient(6.6%)in Group 1 and 9 patients(53%)in Group 2 showed HBe Ag/anti HBe seroconversion after treatment and the difference between the two groups was significant(P0.06)Loss of hepatitis B surface antigen was observed in one patient in each of group1 and 2.No clinical,laboratory and imaging findings of liver disease were observed in any of the patients at the end of the study.CONCLUSION:HBe Ag/anti HBe seroconversion rate was lower in patients who had recovered from cancer.     

Risk of child poverty and social exclusion in two Spanish regions: social and family determinants

ObjectiveDescribe the risk of poverty and social exclusion in children aged 8-11 years from Gipuzkoa and Valencia (Spain), through AROPE (At Risk Of Poverty or Social Exclusion) indicators, and evaluate their associated factors in the INMA Project (Childhood and Environment).MethodFamilies in Gipuzkoa and Valencia (394 and 382, respectively) completed a questionnaire in 2015-2016. Low work intensity (LWI), at risk of poverty (RP) and material deprivation (MD) were estimated. AROPE consisted in meeting any of the previous sub-indicators. Socio-demographic, family and parental characteristics were considered. Frequencies, Venn's diagrams, and chi-square and Fisher tests were used in bivariate analysis and logistic regression in multivariate analysis.ResultsFor LWI, RP, MD and AROPE, prevalence of 2.5%, 5.6%, 2.3% and 7.2% were obtained in Gipuzkoa, and 8.1%, 31.5%, 7.8% and 34.7% in Valencia, respectively. In the multivariate analysis, the AROPE was associated in both areas with maternal social class and non-nuclear families. In Gipuzkoa, it was also related to maternal education. In Valencia, other factors were the mother's foreign origin, and paternal education and smoking.ConclusionThere is higher AROPE prevalence in Valencia. Social class and family type were shared factors, but a differential pattern is observed in other social determinants. It is essential to implement social policies to reduce this axis of inequalities in health, especially in childhood.     

Screen exposure exacerbates ADHD symptoms indirectly through increased sleep disturbance

ObjectivesThe aim of this study was twofold. First, to confirm the deleterious aspect of evening screen exposure in school-aged children, in particular the effect of screens in the bedroom. Second, to explore the three-way association between degree of screen exposure, sleep disturbance, and ADHD symptoms. Solid evidence exists on the link between sleep disturbance and ADHD symptoms, and screen exposure and sleep disturbance. However, no studies have formally assessed the impact of screen exposure on ADHD symptoms in children, as a function of sleep disturbance.MethodsParents of 374 French children (201 girls, 173 boys, mean age of 10.8 ± 2.8 years old) completed the Sleep Disturbance Scale for Children (SDSC), the Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale, and a questionnaire about their children's screen habits (total hours in the morning, afternoon, and evening per day). Correlational analyses between evening screen exposure, sleep quality and behavioral problems were conducted. Then, formal mediation analyses were run in order to quantify the relationship between variables.ResultsSchool-aged children with screens in their bedrooms demonstrated more sleep and behavioral problems. Evening TV exposure was associated with higher SDSC and ADHD scores. Furthermore, the Structural Equation Modelling approach confirmed that evening screen exposure is directly associated with more disrupted sleep, which in turn is directly associated with behavioral problems.ConclusionsThese findings encourage families to avoid putting screens in their children's bedrooms, and limit evening screen exposure. They furthermore demonstrate the importance of taking into account screen exposure time (morning, afternoon, evening) and location (bedroom or elsewhere) in future studies.     

The interplay between airway epithelium and the immune system – A primer for the respiratory clinician

The respiratory epithelium is one of the primary interfaces between the body’s immune system and the external environment. This review discusses the innate and adaptive immunomodulatory effects of the respiratory epithelium, highlighting the physiologic immune responses associated with health and the disease-causing sequelae when these physiologic responses go awry. Airway macrophages, dendritic cells, and innate lymphoid cells are discussed as orchestrators of physiological and pathological innate immune responses and T cells, B cells, mast cells, and granulocytes (eosinophils and neutrophils) as orchestrators of physiologic and pathologic adaptive immune responses. The interplay between the airway epithelium and the varied immune cells as well as the interplay between these immune cells is discussed, highlighting the importance of the dose of noxious stimuli and pathogens in immune programming and the timing of their interaction with the immune cells that determine the pattern of immune responses. Although each cell type has been researched individually, this review highlights the need for simultaneous temporal investigation of immune responses from these varied cells to noxious stimuli and pathogens.     

First growth reference curves for Tunisian children and adolescents

A growth chart is a powerful graphical tool displaying children's growth patterns. The aim of this study was to develop growth reference curves appropriate for Tunisian children. The collection of data from this cross-sectional study was conducted on 4358 healthy subjects (2182 girls and 2176 boys) in three pediatric centers and 15 schools. Smoothed growth curves were estimated using the LMS method. The smoothed percentile curves for height, weight, sitting height (SH), and leg length (LL) increase rapidly during the 1st years of life and then progress slowly until 18 years. However, the sitting height-to-height ratio (SHTHR) curves decrease sharply before the age of 4 and then stabilize in both sexes. In addition, the comparison between boys and girls indicated that the values are very similar at most ages. Except during puberty, the values in boys increase (P < 0.0001) for the weight, height, SH, and LL parameters and decline (P < 0.0001) in the SHTHR compared to the values in girls. The growth rate curves presented two remarkable velocity peaks: the first appears during the 1st years of life and the second at puberty. Height gains at the last stage of growth (puberty) are around 15.45% of final height for boys and 15.52% for girls. This study showed a number of discrepancies for certain age groups when comparing the median weight and height values with those of the World Health Organization, the National Center for Health Statistics, and Algerian references in both sexes. Conclusion: The smoothed percentile curves for weight and height will be useful to access the general growth of Tunisian children. Furthermore, the SH, LL, and SHTHR curves can be used to monitor body proportions during childhood.     

The role of cardiopulmonary exercise testing in evaluating children with exercise induced dyspnoea

Exercise induced dyspnoea (EID) is a common manifestation in children and adolescents. Although EID is commonly attributed to exercise induced bronchoconstriction, several conditions other than asthma can cause EID in otherwise healthy children and adolescents. Cardiopulmonary exercise testing (CPET) offers a non-invasive comprehensive assessment of the cardiovascular, ventilatory and metabolic responses to exercise and is a powerful diagnostic and prognostic tool. CPET is a reproducible, non-invasive form of testing that allows for comparison against age- and gender-specific norms. CPET can assess the child’s exercise capacity, determine the limiting factors associated with this, and be used to prescribe individualised interventions. EID can occur due to asthma, exercise induced laryngeal obstruction, breathing pattern disorders, chest wall restriction and cardiovascular pathology among other causes. Differentiating between these varied causes is important if effective therapy is to be initiated and quality of life improved in subjects with EID.     

Instrumented gait analysis for management of gait disorders in children with cerebral palsy: A scoping review

BackgroundThe use of Instrumented Gait Analysis (IGA) for the clinical management of individuals with cerebral palsy (CP) has increased in recent years. Previous systematic reviews have been completed to evaluate and summarize the evidence related to the efficacy of IGA in general. However, a focused summary of research studies on IGA for children with CP related gait disorders is needed.Research QuestionThe purpose of the current work was to perform a scoping review to describe and categorize the range of existing literature about IGA as applied to the clinical management of children with CP related gait disorders.MethodA health sciences librarian developed a search strategy to include four key inclusion criteria of original research study, population included children with CP, study employed IGA, available in English. The available literature was organized into six study categories: reliability and validity, documentation of subgroups or model development, IGA for clinical decision making, effectiveness of treatments that depend on IGA, cost effectiveness, IGA used to evaluate the outcome of surgical, medical or rehabilitation treatment.Results909 studies met the inclusion criteria and were placed into the six study categories. 14 % of studies were in reliability and validity, 33 % in subgroups or modeling, 2% in IGA for clinical decision making, 2% in treatments that depend on IGA, 1% in cost effectiveness, and 49 % of studies had IGA used as an outcome measure for treatment.SignificanceThis scoping review has documented the wide range, diversity and extent of original research studies investigating the use of IGA for the clinical management of children with CP related gait disorders. The large volume of studies provides a basis for future work to develop a CPG about the use of IGA for the clinical management of children with CP related gait disorders.