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1.
Background
Hypertension is a prevalent cardiovascular disease risk factor among blacks and adolescent hypertension can progress into adulthood.Objective
To determine the prevalence of hypertension and prehypertension among secondary school adolescents in Enugu South East Nigeria.Methodology
A study of 2694 adolescents aged 10-18 years in Enugu metropolis was carried out. Socio-demographic profile anthropometric and blood pressure readings were obtained. Derived measurements such as Prehypertension, hypertension and BMI were obtained.Results
The results showed that the mean systolic blood pressure and diastolic blood pressure for males were 106.66+ 11.80 mmHg and 70.25 + 7.34 mmHg respectively. The mean SBP and DBP for females were 109.83+ 11.66 mmHg and 72.23 + 8.26 mmHg respectively (p < 0.01). Blood pressure was found to increase with age. Prevalence of hypertension and prehypertension was 5.4% and 17.3% respectively with a higher rate in females (6.9%) than males (3.8%). Prevalence of prehypertension among males and females were 14.3% and 20.1% respectively. The prevalence of obesity was 1.9%.Conclusion
Modifiable risk factors exist among adolescents. Early lifestyle modification and a strengthened school health are recommended.2.
Valentina Rossi Cinzia Mazzola Lorenzo Leonelli Paolo Gandullia Serena Arrigo Marina Pedemonte Maria Cristina Schiaffino Margherita Mancardi Oliviero Sacco Nicola Massimo Disma Clelia Zanaboni Giovanni Montobbio Arrigo Barabino Girolamo Mattioli 《Pediatric surgery international》2016,32(3):277-283
Background
Fundoplication is considered a mainstay in the treatment of gastro-esophageal reflux. However, the literature reports significant recurrences and limited data on long-term outcome.Aims
To evaluate our long-term outcomes of antireflux surgery in children and to assess the results of redo surgery.Methods
We retrospectively analyzed all patients who underwent Nissen fundoplication in 8 consecutive years. Reiterative surgery was indicated only in case of symptoms and anatomical alterations. A follow-up study was carried out to analyzed outcome and patients’ Visick score assessed parents’ perspective.Results
Overall 162 children were included for 179 procedures in total. Median age at first intervention was 43 months. Comorbidities were 119 (73 %), particularly neurological impairments (73 %). Redo surgery is equal to 14 % (25/179). Comorbidities were risk factors to Nissen failure (p = 0.04), especially children suffering neurological impairment with seizures (p = 0.034). Follow-up datasets were obtained for 111/162 = 69 % (median time: 51 months). Parents’ perspectives were excellent or good in 85 %.Conclusions
A significant positive impact of redo Nissen intervention on the patient’s outcome was highlighted; antireflux surgery is useful and advantageous in children and their caregivers. Children with neurological impairment affected by seizures represent significant risk factors.3.
Objective
To quantitatively summarize the evidence from observational studies on the relation between pediatric asthma and food allergy.Methods
A literature search was conducted in Medline and EMBASE (August 2016). Two independent reviewers appraised the studies and extracted the estimates of interest. Methodological quality of the included studies was assessed using National Heart Lung and Blood Institute (NHLBI) Quality Assessment Tools. Data were pooled using random-effects meta-analysis.Results
A total of 32 relevant studies were identified but only 8 studies met the inclusion criteria. Using random-effect model, food allergy showed strong association with asthma in children (OR = 2.87 [95% CI: 2.05–4.00]; P < 0.0001).Conclusions
This study suggested that food allergy is associated with an increased risk of asthma in children.4.
Purpose
The aim of this study was to determine the current UK practice regarding timing of surgical repair of hydroceles in young boys.Methods
Through a validated, online survey, participants were asked their preferred management option in five different clinical scenarios across five age ranges.Results
71 responses were included in the analysis. The most common age to offer surgical intervention for a congenital hydrocele that is stable or increasing in size, or a hydrocele of the cord is 24–36 months. For a stable hydrocele presenting after 12 months of age, the most common age to offer repair is between 36 and 48 months. Approximately ¼ of respondents defer surgery until 4 years of age for any stable hydrocele. For a congenital hydrocele that is decreasing in size, the majority of respondents (57%) do not offer surgical intervention even over 4 years of age. The majority of respondents (61%) do not differentiate between communicating and non-communicating hydroceles when considering age for repair.Conclusion
These results suggest that there is uncertainty regarding the optimum age for PPV ligation and adequate underlying variability in practice to support a prospective study of the optimum age for hydrocele repair and the natural history of PPV closure.5.
Yan-Ni Chen Hui-Ying Du Zhuo-Yue Shi Li He Yu-Ying He Duan Wang 《World journal of pediatrics : WJP》2018,14(3):233-237
Background
The pathogenesis of autism spectrum disorders remains elusive and currently there are no diagnostic or predictive biomarkers in autism available. Proteomic profiling has been used in a wide range of neurodevelopmental disorder studies, which could produce deeper perceptions of the molecular bases behind certain disease and potentially becomes useful in discovering biomarkers in autism spectrum disorders.Methods
Serum samples were collected from autistic children about 3 years old in age (n = 32) and healthy controls (n = 20) in similar age and gender. The samples were identified specific proteins that are differentially expressed by magnetic bead-based pre-fractionation and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-ToF-MS).Results
Eight protein peaks were significantly different in autistic children from the healthy controls (P < 0.0001). The two peaks with the most significant differences were 6428 and 7758 Da in size.Conclusion
According to differences in serum protein profiles between the autistic children and healthy controls, this study identified a set of differentially expressed proteins those are significant for further evaluation and might function as biomarkers in autism.6.
Quentin ballouhey Pauline clermidi Alexia roux Claire bahans Roxane compagnon Jérôme cros Bernard longis Laurent fourcade 《Pediatric surgery international》2016,32(11):1047-1052
Purpose
To compare the learning curves for mastering OP and LP surgical techniques, in terms of effects on completion times and postoperative outcomes/complications.Methods
A retrospective analysis was performed for 198 patients with hypertrophic pyloric stenosis. The learning curves were in regard to two groups of surgeons: three of whom performed 106 OPs while three others performed 92 LPs. Treatment-related complications were divided into two categories: specific complications relating to the pyloromyotomy and non-specific complications. A logistic regression model with repeated data was used to explore the occurrence of complications.Results
The overall postoperative complication rates were not significantly different between the OP (15.1 %) and the LP (11.8 %) groups. Specific complications were more frequent in the LP group (6.4 versus 2.8 %), while non-specific complications were more frequent in the OP group (12.1 versus 5.3 %). The occurrence of complications exhibited a statistically decreasing risk with each supplementary procedure that was performed (p = 0.0067) in the LP group, but not in the OP group (p = 0.9665).Conclusion
From a learning process perspective, laparoscopy is mainly associated with a significantly higher risk of specific complications. This risk decreases in line with the surgeon’s level of experience, whereas non-specific complications remain stable in open procedures.7.
Purpose
Tracheal cartilage reconstruction is an essential approach for the treatment of tracheal congenital abnormalities or injury. Here, we evaluated the use of allogeneic decellularized tracheas as novel support scaffolds.Methods
Six weaned pigs (4-week-old domestic males) were transplanted with allogeneic tracheal graft patches (three decellularized and three fresh tracheal scaffolds) onto artificial defects (approximately 15 × 15 mm). After 11 weeks, the tracheas were evaluated by bronchoscopy and histological studies.Results
No pigs displayed airway symptoms during the observation period. Tracheal lumen restored by fresh graft patches showed more advanced narrowing than that treated with decellularized grafts by bronchoscopy. Histologically, fresh grafts induced typical cellular rejection; this was decreased with decellularized grafts. In addition, immunohistochemistry demonstrated regenerating foci of recipient cartilage along the adjacent surface of decellularized tracheal grafts.Conclusion
Decellularized allogeneic tracheal scaffolds could be effective materials for restoring impaired trachea.8.
Background
The effects and potential hazards of brain magnetic resonance imaging (MRI) at 3 T in newborns are debated.Objective
Assess the impact of 3-T MRI in newborns on body temperature and physiological parameters.Material and methods
Forty-nine newborns, born preterm and at term, underwent 3-T brain MRI at term-corrected age. Rectal and skin temperature, oxygen saturation and heart rate were recorded before, during and after the scan.Results
A statistically significant increase in skin temperature of 0.6 °C was observed at the end of the MRI scan (P<0.01). There was no significant changes in rectal temperature, heart rate or oxygen saturation.Conclusion
Core temperature, heart rate and oxygen saturation in newborns were not affected by 3-T brain MR scanning.9.
Xing-Wang Li Xin Ni Su-Yun Qian Quan Wang Rong-Meng Jiang Wen-Bo Xu Yu-Cai Zhang Guang-Jun Yu Qiang Chen Yun-Xiao Shang Cheng-Song Zhao Hui Yu Ting Zhang Gang Liu Hui-Ling Deng Jie Gao Xian-Gui Ran Qiao-Zhi Yang Bian-Li Xu Xue-Yong Huang Xing-Dong Wu Yi-Xiao Bao Yi-Ping Chen Zhi-Hai Chen Qing-Quan Liu Guo-Ping Lu Chun-Feng Liu Rong-Bing Wang Guo-Liang Zhang Fang Gu Hong-Mei Xu Ying Li Tao Yang 《World journal of pediatrics : WJP》2018,14(5):437-447
Background
Hand, foot, and mouth disease (HFMD) is a common infectious disease in childhood caused by an enterovirus (EV), and which is principally seen in children under 5 years of age. To promote diagnostic awareness and effective treatments, to further standardize and strengthen the clinical management and to reduce the mortality of HFMD, the guidelines for diagnosis and treatment have been developed.Methods
National Health Commission of China assembled an expert committee for a revision of the guidelines. The committee included 33 members who are specialized in diagnosis and treatment of HFMD.Results
Early recognition of severe cases is utmost important in diagnosis and treatment of patients with HFMD. The key to diagnosis and treatment of severe cases lies in the timely and accurate recognition of stages 2 and 3 of HFMD, in order to stop progression to stage 4. Clinicians should particularly pay attention to those EV-A71 cases in children aged less than 3 years, and those with disease duration less than 3 days. The following indicators should alert the clinician of possible deterioration and impending critical disease: (1) persistent hyperthermia; (2) involvement of nervous system; (3) worsening respiratory rate and rhythm; (4) circulatory dysfunction; (5) elevated peripheral WBC count; (6) elevated blood glucose and (7) elevated blood lactic acid. For treatment, most mild cases can be treated as outpatients. Patients should be isolated to avoid cross-infection. Intense treatment modalities should be given for those severe cases.Conclusion
The guidelines can provide systematic guidance on the diagnosis and management of HFMD.10.
Purpose
To correlate expression of Glypican-3 in Wilms tumor with histopathology, stage, and outcome.Methods
Glypican-3 mRNA expression by real-time PCR on tumor and normal germline samples from 75 fresh nephrectomies for Wilms tumor with fold change after normalization against GAPDH was compared. Survival analysis for event-free and overall survival (EFS, OS) with 2-year follow-up for Glypican-3 overexpression (>1.5 times) and clinicopathological parameters was performed.Results
Glypican-3 was overexpressed in 37/75 (49.3%). It was overexpressed in 77% (10/13) cases with blastema predominance or anaplastic histology, as compared to 44% of other histologies (27/62) (p = 0.03). OS was 73 and 93%, respectively (p = 0.016), for those with and without GPC-3 overexpression. EFS was not significantly different with Glypican-3 overexpression (p = 0.11). All 5 deaths among blastema predominant tumors and 4/5 deaths among triphasic tumors had overexpressed Glypican-3. Most deaths in Stage IV, Stage III, and Stage I + II (5/7, 3/3, 1/1) had GPC-3 overexpression. On multivariate analysis, only histology and stage were found to have independent prognostic value.Conclusion
Glypican-3 overexpression in Wilms tumor correlates with poor OS on univariate analysis. However, only histology and stage have independent prognostic value. Glypican-3 levels may help to stratify intermediate outcome histology (triphasic) and Stage III Wilms tumors.11.
Background
Acute hemorrhages in neonates and young children can be compensated for a long period of time until a decrease in blood pressure and manifest shock occur.Objective
To determine the characteristics of the pathophysiology of the circulation in children and to recognize critical signs and symptoms of hemorrhage.Material and methods
Pathophysiology and discussion of the literatureResults
Shock in neonates and children can be present long before a decrease in blood pressure occurs. It is characterized by tachycardia, tachy(dys)pnea, prolonged capillary refilling time, disorders of consciousness (apathy), disturbance of temperature regulation and reduced urine output. Laboratory markers are metabolic acidosis and elevated lactate and a normocytic anemia earlier than in adults.Conclusion
In contrast to adults a decrease in blood pressure in neonates and young children is a late sign of shock, whereas normocytic anemia occurs earlier than in adults.12.
Objective
To summarize the experience of the diagnosis and treatment of 31 H-type tracheoesophageal fistula (TEF) at the Children’s Hospital of Chongqing Medical University, Chongqing, China.Methods
A total of 31 patients with H-type TEF were enrolled in this retrospective study from January 2000 to July 2017, and the diagnosis and treatment of the disease were analyzed and summarized.Results
Iodine oil examination of the esophagus, fiberoptic bronchoscopy combined with esophagoscopy and three-dimensional computed tomography (3-D CT) reconstruction of the trachea and esophagus was used separately in 31 patients. 1 patient who had his TEF ligatured directly experienced recurrence 1 month after surgery, but recovered after TEF suturing. Subsequently, the remaining 30 patients were treated by suturing after TEF excision. All patients were followed up for 3 months–2 years and did not suffer from anastomosis orifice stenosis, gastroesophageal reflux, and a recurrent respiratory tract infection. Three patients exhibited vocal cord paralysis and improved spontaneously after a follow-up of 3–6 months.Conclusion
H-type TEF is diagnosed by iodine oil examination of the esophagus, fiberoptic bronchoscopy combined with esophagoscopy, and 3-D CT reconstruction of the trachea and esophagus. Excision and suturing of the TEF separately are an effective treatment for the disease and are an excellent outcome.13.
Newton Banupriya Ballambattu Vishnu Bhat Bosco Dhas Benet Christina Catherine Magadi Gopalakrishna Sridhar Subhash Chandra Parija 《Indian journal of pediatrics》2018,85(1):5-9
Objective
To evaluate the efficacy of short term zinc supplementation on the mortality rate and neurodevelopment outcome in neonates with sepsis at 12 mo corrected age.Methods
The clinical trial was undertaken in the neonatal intensive care unit of JIPMER during the time period from September 2013 through December 2016. Neonates with clinical manifestations of sepsis who exhibited two positive screening tests (microESR, C- reactive protein, band cell count) were included and randomized into no zinc and zinc group. The intervention was zinc sulfate monohydrate given at a dose of 3 mg/kg twice a day orally for 10 d along with standard antibiotics. The no zinc group was on antibiotic treatment. Blood samples from both groups were collected at baseline and after day 10. Babies were carefully discharged from the hospital. The babies were followed up till 12 mo corrected age using DASII (Development Assessment Scale for Indian Infants).Results
At the time of enrolment, patient characteristics were similar in both the groups. The mortality rate was significantly higher in no zinc compared to zinc group (5 vs. 13; P = 0.04). Although motor development quotient was similar, mental development quotient was significantly better among babies who received zinc supplementation.Conclusions
Short term zinc supplementation of newborns with sepsis reduces mortality and improves mental development quotient at 12 mo of age.14.
Objective
To determine peak flow rate nomogram in children between 5 to 12 y of age in suburban population.Methods
This was a cross-sectional study randomly done on 5000 healthy school children. Mini-Wright flow meter was used for measurement of peak expiratory flow rate (PEFR). The range of age, weight and height were defined and linear and multiple regression analysis were performed.Results
Correlation between PEFR and height was more significant and between PEFR and weight was lower. On the basis of height, the regression equation for both sexes were drawn; Boys: PEFR = 3.29 (Height in cm) - 218.38; Girls: PEFR = 3.25 (Height in cm) - 216.49.Conclusions
Thus, region specific nomograms for PEFR for assessing the severity and monitoring of airway obstruction in relation to age, sex, weight and height of children can be determined.15.
Luis De La Torre Kimberly Cogley Juan Calisto Gary Nace Catalina Correa 《Pediatric surgery international》2016,32(8):767-772
Purpose
To present our experience in patients with chronic idiopathic constipation complicated by megarectosigmoid and fecal incontinence who underwent a primary sigmoidectomy and appendicostomy.Methods
We reviewed eight patients referred to the Colorectal Center from 2014 to 2016 with chronic idiopathic constipation and undergoing a sigmoidectomy and appendicostomy. We analyzed the previous medical treatment, indications for the surgical procedure, and outcomes.Results
Age at operation was 5–19 years. Time with constipation was 4–15 years. All patients received multiple laxatives, mainly polyethylene glycol, and all had severe social problems. Four patients have autism. The indication for surgery was an unsuccessful laxative trial, refusal to continue with rectal enemas or both, and social fear of continued fecal incontinence. Post-operatively, all patients were having daily bowel movements without fecal accidents.Conclusion
Selected patients with chronic idiopathic constipation complicated by megarectosigmoid and fecal incontinence can obtain great benefit from primary sigmoidectomy and appendicostomy.16.
Background
During surgery for spinal deformities, accurate placement of pedicle screws may be guided by intraoperative cone-beam flat-detector CT.Objective
The purpose of this study was to identify appropriate paediatric imaging protocols aiming to reduce the radiation dose in line with the ALARA principle.Materials and methods
Using O-arm® (Medtronic, Inc.), three paediatric phantoms were employed to measure CTDIw doses with default and lowered exposure settings. Images from 126 scans were evaluated by two spinal surgeons and scores were compared (Kappa statistics). Effective doses were calculated. The recommended new low-dose 3-D spine protocols were then used in 15 children.Results
The lowest acceptable exposure as judged by image quality for intraoperative use was 70 kVp/40 mAs, 70 kVp/80 mAs and 80 kVp/40 mAs for the 1-, 5- and 12-year-old-equivalent phantoms respectively (kappa = 0,70). Optimised dose settings reduced CTDIw doses 89–93%. The effective dose was 0.5 mSv (91–94,5% reduction). The optimised protocols were used clinically without problems.Conclusions
Radiation doses for intraoperative 3-D CT using a cone-beam flat-detector scanner could be reduced at least 89% compared to manufacturer settings and still be used to safely navigate pedicle screws.17.
Background
Psychosocial health is of major importance for kindergartener’s development.Objective
The aim of the study was to examine correlations between developmental and health problems and behavioral problems. Additionally, we examined inter-rater reliability between parent’s and kindergarten teacher’s ratings on developmental and health problems. The total sample consisted of 1036 kindergarteners aged 3 to 6 years.Materials and methods
A questionnaire was assessed by both parents and kindergarten teachers. The developmental and the health status, as well as the child’s behavior over the past four weeks, were addressed.Results
Statistically significant correlations were found between developmental and health problems and behavioral problems. Inter-rater reliability varies by questionnaire scales.Conclusions
Results stress the need for integration of various judgments of different information sources and plead for a multiperspective elicitation of psychosocial health in kindergarteners.18.
Background
The pelvis is composed of three paired primary ossification centers: the pubis, the ischium and the ilium. During maturation, multiple secondary ossification centers can be seen in the synchondroses between these bones and in the pelvic apophyses. The fragmented appearance of these centers can be confused with pathology.Objective
To examine development of pelvic ossification centers by CT and determine normal appearance throughout childhood.Materials and methods
Three pediatric radiologists reviewed 325 pelvic CT scans in children and young adults 5–18 years old and graded 6 pelvic ossification centers to evaluate maturational changes in critical structures.Results
Rate and progression of ossification and age at complete fusion vary with gender at the different ossification centers in the growing pelvis.Conclusion
Knowledge of the normal CT appearance of ossification centers throughout childhood is important to differentiate the normal appearance from pathology.19.
Achal Gulati Alexander Hochdorn Haralappa Paramesh Elizabeth Cherian Paramesh Daniele Chiffi Malathi Kumar Dario Gregori Ileana Baldi 《Indian journal of pediatrics》2014,81(1):47-54
Objective
To assess the prevalence of physical activity and its relation with socio-demographic variables and eating habits among school-aged children in India.Methods
The study incorporated secondary analysis of anthropometric measurements and questionnaires on lifestyle and dietary habits of 1,680 school children aged between 3 and 11 y, obtained while carrying out the OBEY-AD project. The inventory contained questions about several variables concerning to physical activity, educational background, lifestyles and eating habits for both children and parents. Questions were organized along specific contents, which could be informative topics, picture choices and multiple answers choices.Results
Prevalence of inactivity was 21 % and exhibited significant variations between cities. Physical activity was significantly associated to socio-economic status and consumption of fruits and vegetables. No association could be revealed with children’s BMI.Conclusions
Health-promotion interventions aimed at improving healthy lifestyles in Indian children should focus on population strata with low socio-economic status.20.
Ceren Cıralı Emel Ulusoy Tuncay Kume Nur Arslan 《World journal of pediatrics : WJP》2018,14(5):448-453