Vitamin D status in diabetic Egyptian children and adolescents: a case–control study

Background

Recently, studies suggesting that vitamin D deficiency correlates with the severity and frequency of Type 1 (insulin-dependent) diabetes mellitus (T1DM) and that vitamin D supplementation reduces the risk of developing T1DM have been reported.

Objective

In this study, we aimed to assess vitamin D status in Egyptian children and adolescents with T1DM.

Methods

This was a case–control study including 80 T1DM diagnosed cases aged 6 to 16 years and 40 healthy children with comparable age and gender as the control group. For all subjects, serum 25 (OH) D levels were measured by ELISA, Serum parathyroid hormone (PTH) and serum insulin were measured by an electrochemiluminesce immunoassay. Serum glucose, Glycosylated hemoglobin (HbA1c) levels and homeostasis model assessment of insulin resistance (HOMA-IR) were also assessed.

Results

Compared to the control group, serum vitamin D levels were not significantly lower in diabetic subjects (24.7?±?5.6 vs 26.5?±?4.8 ng/ml; P?>?0.05). Among diabetic cases 44(55%) were vitamin D deficient; meanwhile 36(45%) cases had normal vitamin D level (P?<?0.01). In addition, 26(32.5%) diabetic cases had 2ry hyperparathyroidism and 54(67.5%) cases had normal parathyroid hormone level; meanwhile, none of the control group had 2ry hyperparathyroidism (P?<?0.01). Furthermore, we found a significant difference between vitamin D deficient diabetic cases and those with normal vitamin D level as regards HOMA-IR and diabetes duration (P?<?0.01).

Conclusion

Public health message on the importance of vitamin D status; especially in diabetic children and adolescents, should be disseminated to the public.

     

Is contralateral inguinal exploration necessary in preterm girls undergoing inguinal hernia repair during the first months of life?

Background

To assess the need for contralateral surgical exploration in preterm girls with symptomatic unilateral inguinal hernia.

Methods

The medical data of girls operated for inguinal hernia between 2004 and 2016 in a single pediatric surgery center were retrospectively collected. Preterm girls operated for unilateral hernia before 6 months of life were selected (55/517 cases) to assess the incidence and risk factors for contralateral metachronous inguinal hernia (CMIH).

Results

CMIH was observed in 7% of cases (4 girls with a right inguinal hernia in 3 cases) at a mean age of 4.2 years. Only one case occurred early (3 months). Birth weight and term were comparable (1674?±?620 g and 32?±?5 WA without CMIH vs. 1694?±?582 g and 33?±?3 WA with CMIH).

Conclusion

Contralateral inguinal hernia is very rare and generally occurs several years after inguinal repair surgery in preterm girls, which should encourage practitioners to follow these children throughout childhood for the subsequent development of inguinal hernia. This study did not find any arguments in favor of systematic contralateral exploration in preterm girls.

     

Assessment of Fruit and Vegetable Intake Behavior Among Adolescents in Hangzhou,China

Objective

To evaluate the fruit and vegetable (FV) intake of adolescents, assess factors influencing intake and discuss health education strategies related to this behavior.

Methods

In Hangzhou, China, 861 students aged 13.68?±?1.03 years were randomly recruited to carry out a cross-sectional, school-based survey. The design of the survey questionnaire was based on the Transtheoretical Model (TTM) of Behavior Change. Results of the survey rated FV consumption and children’s readiness to assume healthier dietary choices. The study design incorporated the four core constructs of TTM: stages of change, processes of change, decisional balance and self-efficacy. Results were assessed by chi-square tests, analysis of variance, Tukey’s post-hoc tests and logistic regression analysis.

Results

Majority of the participants were in the TTM contemplation stage of change. The average number of FV servings among participants was 3.12?±?1.41 per day. The specific process of change, number of decisional balance pros (as opposed to cons), and self-efficacy ratings were positively correlated with stage of change transition (Spearman r?>?0, P?>?0, P?<?0.05).

Conclusions

The use of TTM may be a powerful personalized means of decreasing poor dietary behaviors and promoting healthy behaviors, compared to traditional methods of behavioral change.

     

Non-fluoroscopic percutaneous transcatheter closure of atrial septal defects in children under transesophageal echocardiographic guidance

Background

This study sought to investigate the feasibility, safety and effectiveness of transcatheter closure of atrial septal defects (ASDs) under the guidance of transesophageal echocardiography (TEE) in children.

Methods

We reviewed the medical records of patients who underwent percutaneous ASD closure at our center from August 2016 to December 2017. For a total of 88 patients who were identified as having a single-hole defect and were undergoing percutaneous transcatheter ASD closure, a procedure completely guided by TEE was performed. There were 31 male patients and 57 female patients. The patients’ mean age was 60.09?±?36.42 months (13–182 months), and their mean body weight was 20.16?±?10.04 kg (9–77 kg). Patients were followed up by performing transthoracic echocardiography and obtaining chest X-rays and electrocardiograms.

Results

The transcatheter closure of ASDs was successful in all patients. The mean ASD size was 11.58?±?5.31 mm (3–28 mm), and the mean size of the occlusion device was 16.07?±?5.29 mm (6–36 mm). The mean procedural times were 13.33?±?2.82 minutes (6–16 minutes). The mean hospitalization costs were 27,259.66?±?2507.04 RMB (25,200.00–33,911.45 RMB). The mean postoperative hospital stay was 3.22?±?0.53 days (3–5 days). Residual shunt, occlusion device shedding or displacement, and pericardial effusion were not observed during or after the operation.

Conclusion

Percutaneous transcatheter ASD closure completely guided by TEE is a feasible, safe, non-invasive and easy procedure.

     

Phlegmonous appendicitis in children is characterized by eosinophilia in white blood cell counts

Background

Phlegmonous and complicated appendicitis represent independent entities depending on hereditary immunological mechanisms. However, clinically there are no means to distinguish uncomplicated phlegmonous from complicated appendicitis. The ability to distinguish these two forms of appendicitis is relevant as current attempts are to treat both forms of the disease differently. The aim of the present study was to investigate differences in white blood cell counts (WBCs) in these conditions to identify areas of interest for future molecular studies.

Methods

White blood cell counts of patients aged between 7 and 14 years who underwent appendectomy from January 2008 to June 2016 were investigated with special reference to particular cellular subpopulations.

Results

A total of 647 children were included in the study. Within distinct inflammatory patterns, significant eosinophilia and basophilia were found in phlegmonous inflammation compared with complicated inflammation (0.11?±?0.19?×?10⁹/L vs. 0.046?±?0.104?×?10⁹/L, P?<?0.0001, and 0.033?±?0.031?×?10⁹/L vs. 0.028?±?0.024?×?10⁹/L, P?<?0.001).

Conclusions

Compared with complicated disease, phlegmonous appendicitis seems to depend primarily on eosinophil inflammation. This observation is stable over time and indicates a direction for investigation of underlying genetic prerequisites.

     

Implications of non-accidental trauma on resource utilization and outcomes

Purpose

The purpose was to compare the resource utilization and outcomes between patients with suspected (SUSP) and confirmed (CONF) non-accidental trauma (NAT).

Methods

The institutional trauma registry was reviewed for patients aged 0–18 years presenting from 2007 to 2012 with a diagnosis of suspicion for NAT. Patients with suspected and confirmed NAT were compared.

Results

There were 281 patients included. CONF presented with a higher heart rate (142?±?27 vs 128?±?23 bpm, p?<?0.01), lower systolic blood pressure (100?±?18 vs 105?±?16 mm Hg, p?=?0.03), and higher Injury Severity Score (15?±?11 vs 9?±?5, p?<?0.01). SUSP received fewer consultations (1.6?±?0.7 vs 2.4?±?1.1, 95% CI ? 0.58 to ? 0.09, p?<?0.01) and had a shorter length of stay (1.6?±?1.3 vs 7.8?±?9.8 days, 95% CI ? 4.58 to ? 0.72, p?<?0.01). SUSP were more often discharged home (OR 94.22, 95% CI: 21.26–417.476, p?<?0.01). CONF had a higher mortality rate (8.2 vs 0%, p?<?0.01).

Conclusions

Patients with confirmed NAT present with more severe injuries and require more hospital resources compared to patients in whom NAT is suspected and ruled out.

     

Self-management needs of Irish adolescents with Juvenile Idiopathic Arthritis (JIA): how can a Canadian web-based programme meet these needs?

Background

Juvenile Idiopathic Arthritis (JIA) affects over 1000 children and adolescents in Ireland, potentially impacting health-related quality-of-life. Accessible self-management strategies, including Internet-based interventions, can support adolescents in Ireland where specialist rheumatology care is geographically-centralised within the capital city. This study interviewed adolescents with JIA, their parents, and healthcare professionals to (i) explore the self-management needs of Irish adolescents; and (ii) evaluate the acceptability of an adapted version of a Canadian JIA self-management programme (Teens Taking Charge: Managing Arthritis Online, or TTC) for Irish users.

Methods

Focus groups and interviews were conducted with Irish adolescents with JIA (N?=?16), their parents (N?=?13), and Irish paediatric healthcare professionals (HCPs; N?=?22). Adolescents were aged 12–18 (M_age?=?14.19 years), and predominantly female (62.5%). Participants identified the needs of adolescents with JIA and evaluated the usefulness of the TTC programme. Data were analysed using a thematic analysis approach.

Results

Five themes emerged: independent self-management; acquiring skills and knowledge to manage JIA; unique challenges of JIA in Ireland; views on web-based interventions; and understanding through social support. Adolescents acknowledged the need for independent self-management and gradually took additional responsibilities to achieve this goal. However, they felt they lacked information to manage their condition independently. Parents and adolescents emphasised the need for social support and felt a peer-support scheme could provide additional benefit to adolescents if integrated within the TTC programme. All participants endorsed the TTC programme to gain knowledge about JIA and offered suggestions to make the programme relevant to Irish users.

Conclusions

There is scope for providing easily-accessible, accurate information to Irish families with JIA. The acceptability of adapting an existing JIA self-management intervention for Irish users was confirmed.

     

Evaluation of serum 25-Hydroxy vitamin D levels in children with autism Spectrum disorder

Background

Vitamin D plays an important role in etiology of Autism Spectrum Disorders (ASDs). We aimed to evaluate the serum 25 - hydroxyl vitamin D level among children with ASDs in Ahvaz city, Iran.

Methods

It was a cross-sectional study which had conducted on 62 subjects in two groups: a case group (n?=?31) consisted of ASD children who study in especial schools; and a control group (n?=?31) of healthy children who were selected by simple random sampling from regular schools in Ahvaz city, Iran during 2016. Maching between two groups has done regarding Socioeconomic status, type and amount of food intake, place of living and age. The levels of serum 25 - hydroxyl vitamin D were assessed in early morning means fasted state and also measured using ELISA method. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20. The significant level was considered < 0.05.

Results

In ASD children, the average serum 25-hydroxyvitamine D level was 9.03?±?4.14?ng/mg. In ASD group, 96.8% (30 subjects) had vitamin D deficiency. In healthy children group, average serum 25-hydroxyvitamine D level was 15.25?±?7.89?ng/mg. Average serum 25-hydroxyvitamine D level in intervention group was significantly lower than the control group (P?>?0.001). Although the parents of patients in control group reported longer exposure to sun (27.42?m per day against 33.06?m per day), no significant difference was observed between these groups in terms of exposure to sun (P?< 0.05).

Conclusions

A significant difference was observed between serum 25-hydroxyvitamine D levels between the healthy and ASD children. It is recommended to use vitamin D supplement in children with ASDs under medical care.

     

Application of a score system to evaluate the risk of malnutrition in a multiple hospital setting

Background

An increased but unpredictable risk of malnutrition is associated with hospitalization, especially in children with chronic diseases. We investigated the applicability of Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids), an instrument proposed to estimate the risk of malnutrition in hospitalized children. We also evaluated the role of age and co-morbidities as risk for malnutrition.

Methods

The STRONGkids consists of 4 items providing a score that classifies a patient in low, moderate, high risk for malnutrition. A prospective observational multi-centre study was performed in 12 Italian hospitals. Children 1–18 years consecutively admitted and otherwise unselected were enrolled. Their STRONGkids score was obtained and compared with the actual nutritional status expressed as BMI and Height for Age SD-score.

Results

Of 144 children (75 males, mean age 6.5?±?4.5 years), 52 (36%) had an underlying chronic disease. According to STRONGkids, 46 (32%) children were at low risk, 76 (53%) at moderate risk and 22 (15%) at high risk for malnutrition. The latter had significantly lower Height for Age values (mean SD value -1.07?±?2.08; p?=?0.008) and BMI values (mean SD-values -0.79?±?2.09; p?=?0.0021) in comparison to other groups. However, only 29 children were actually malnourished.

Conclusions

The STRONGkids is easy to administer. It is highly sensitive but not specific. It may be used as a very preliminary screening tool to be integrated with other clinical data in order to reliably predict the risk of malnutrition.

     

Anterior Fontanelle Size in Healthy Indian Late Preterm and Full Term Newborns

Objective

To measure the size of the anterior fontanelle (AF) in healthy late-preterm and term newborns and correlate it with birth weight, gestational age, gender, occipito-frontal circumference, small for gestational age status and birth weight z-score.

Methods

This was an observational study carried out from October 2013 through April 2015 at a tertiary care hospital. Newborns?≥?34 wk gestation were enrolled. Fontanelle edge was palpated with index finger and size calculated by adding anterior-posterior and transverse diameters and dividing by two.

Results

A total of 1010 neonates were enrolled. The mean AF size was 2.23?±?0.52 cm (mean?±?SD). There was a significant decrease in the size of the AF with advancing gestational maturity on one-way ANOVA (F?=?31.30) (P?<?0.001) and also by increasing birth weight (F?=?20.34) (P?<?0.001). There was no significant difference in the mean AF size between males; 2.21?±?0.54 cm and females; 2.25?±?0.55 cm (mean?±?SD) (P?=?0.575). There was a strong correlation between AF size with increasing birth weight; correlation (r)?=?0.985. In small for gestational age neonates the AF was larger, 2.27?±?0.55 (mean?±?SD) and a strong correlation between birth weight z-score and AF size was noted (r?=?1.012).

Conclusions

The mean AF size in late-preterm and term Indian newborns in a mixed community hospital was 2.23?±?0.52. A strong correlation was found between AF size with increasing birth weight and with birth weight z-score in small for gestational age babies.

     

Iron Pots for the Prevention and Treatment of Anemia in Preschoolers

Objective

To assess the effect of food cooked in iron pots for the prevention and treatment of iron deficiency anemia.

Methods

In this cluster randomized clinical trial, authors evaluated preschoolers aged 4–5 y for 16 wk. Children were cluster randomized to either eating from iron pots (Group A) or aluminum pots (Group B). Primary outcome variables were change in hemoglobin concentration and anemia prevalence. Two biochemical evaluations were performed, to determine Hb concentrations, before and after intervention. This study was conducted in two public preschools, located in the municipality of Mucambo, Ceará, in the northeast of Brazil.

Results

At baseline, for group A, mean hemoglobin concentration was 12.26?±?1.02 g/dL and 12.29?±?0.95 g/dL after intervention, p?=?0.78. In group B, mean baseline hemoglobin was 12.34?±?1.04 g/dL, and 12.13?±?0.86 g/dL after intervention, p?=?0.07. All ten participants, who were anemic at baseline, were no longer anemic after intervention.

Conclusions

Using iron cooking pots in developing countries could provide an innovative strategy to prevent and treat iron deficiency anemia.

     

Juvenile idiopathic arthritis: magnetic resonance imaging of the clinically unaffected knee

Background

Synovial thickening detected on magnetic resonance imaging (MRI) is present in a significant number of children with clinically inactive juvenile idiopathic arthritis (JIA).

Objective

To evaluate patient characteristics and disease activity parameters in a cohort of children with clinically inactive JIA, both with and without synovial thickening, in order to clarify the observed discrepancy between clinical and MRI assessments.

Materials and methods

We prospectively enrolled 52 clinically inactive JIA patients (median age 13.3 years, 63.5% girls) who underwent MRI of the knee as major target joint in JIA. Children were divided into two groups based on MRI outcome: group 1, with synovial thickening on MRI; and group 2, with no synovial thickening on MRI. We used the Juvenile Arthritis MRI Scoring system to evaluate synovial thickness. We compared patient characteristics and disease activity parameters between the groups.

Results

Synovial thickening on MRI was present in 18 clinically inactive patients (group 1, 34.6%). The age was significantly lower for the patients in group 1 (median 10.7 versus 14.4, P=0.008). No significant differences were observed in any of the other patient characteristics nor the disease activity parameters tested.

Conclusion

Synovial thickening on MRI was present in nearly 35% of the children with clinically inactive JIA. Children with synovial thickening on MRI were significantly younger than those without. This might indicate that younger patients are at risk of subclinical disease activity and under-treatment, although the exact clinical relevance of synovial thickening on MRI has not been determined.

     

Wachstum bei Störungen der Schilddrüsenfunktion im Kindes- und Jugendalter

Background

Disorders of the thyroid function of mother and child can not only irreversibly inhibit maturation of the central nervous system, but may also affect growth and puberty.

Objectives

Review of the consequences of thyroid function disorders on the growth of children and adolescents and the relevance of adequate treatment.

Materials and Methods

This article summarises the current literature concerning the effect of thyroid hormone disorders of mother and child and their therapy on growth.

Results

Every untreated manifestation of congenital or acquired hypothyroidism is associated with a delay of growth and skeletal maturation. In children presenting with acquired hyperthyroidism, height is shifted towards higher values and skeletal maturation is accelerated. Approximately 20?% of children and adolescents with Down syndrome develop primary hypothyroidism, frequently manifesting within the first months of life (approximately 5.5?%). Adequate treatment of the thyroid disorder can normalise growth disorders. About 6?% of children with growth hormone deficiency develop abnormally low free thyroxin (fT4) levels in serum during growth hormone treatment due to increased conversion of T4 to T3. There is no indication for treatment after excluding secondary hypothyroidism.

Conclusions

Early diagnosis and timely, adequate treatment of thyroid function disorders of mother and child are essential to achieving growth that is as age-appropriate as possible in affected children and adolescents

     

Erosive Potential of Sugar Free and Sugar Containing Pediatric Medicines Given Regularly and Long Term to Children

Objective

To assess the erosive potential of 94 pediatric medicines of various therapeutic groups in vitro.

Methods

In vitro measurement of endogenous pH and titratable acidity (mmol) of 94 formulations was done. Endogenous pH was measured using a pH meter, followed by titration with 0.1-M NaOH using phenolphthalein as indicator.

Results

Overall, 55 (59%) formulations had an endogenous pH of <5.5. The mean (±SD) endogenous pH and titratable acidity for 45 SC formulations were 5.52?±?1.18 and 0.165?±?0.131 mmol, respectively; for 49 sugars-free (SF) formulations, these figures were 5.81?±?1.43 and 0.393?±?1.225 mmol (P?>?0.05).Compared with their SC bioequivalents, eight SF medicines showed no significant differences for pH or titratable acidity, while 10 higher-strength medicines showed lower pH (P 0.035) and greater titratable acidity (P 0.026) than their lower-strength equivalents. Chewable and dispersible tablets, gastrointestinal medicines and antibiotics were significant predictors of higher pH. In contrast, effervescent tablets, and nutrition and blood preparations were significant predictors of higher titratable acidity.

Conclusions

Pediatric SF medicines were not more erosive than SC medicines in vitro; a more significant predictor of their erosive potential was dose form. Higher the dose form more was the erosive potential of the medicine.

     

Testicular atrophy following inguinal hernia repair in children

Purpose

We sought to determine the incidence and timing of testicular atrophy following inguinal hernia repair in children.

Methods

We used the TRICARE database, which tracks care delivered to active and retired members of the US Armed Forces and their dependents, including?>?3 million children. We abstracted data on male children?<?12 years who underwent inguinal hernia repair (2005–2014). We excluded patients with history of testicular atrophy, malignancy or prior related operation. Our primary outcome was the incidence of the diagnosis of testicular atrophy. Among children with atrophy, we calculated median time to diagnosis, stratified by age/undescended testis.

Results

8897 children met inclusion criteria. Median age at hernia repair was 2 years (IQR 1–5). Median follow-up was 3.57 years (IQR 1.69–6.19). Overall incidence of testicular atrophy was 5.1/10,000 person-years, with the highest incidence in those with an undescended testis (13.9/10,000 person-years). All cases occurred in children \(\le\)?5 years, with 72% in children <?2 years. Median time to atrophy was 2.4 years (IQR 0.64–3), with 30% occurring within 1 year and 75% within 3 years.

Conclusion

Testicular atrophy is a rare complication following inguinal hernia repair, with children?<?2 years and those with an undescended testis at highest risk. While 30% of cases were diagnosed within a year after repair, atrophy may be diagnosed substantially later.

Level of evidence

Prognosis Study, Level II.

     

Age-related apparent diffusion coefficients of lumbar vertebrae in healthy children at 1.5 T

Background

Diffusion-weighted magnetic resonance imaging with apparent diffusion coefficient (ADC) calculation is important for detecting bone marrow pathologies.

Objective

To investigate age-related differences of lumbar vertebral body ADC to establish normal values for healthy children.

Materials and methods

Forty-nine healthy children without any history of oncological or hematological diseases (10.2±4.7 years, range: 0–20 years) were included in this retrospective study. All magnetic resonance imaging (MRI) examinations were performed at 1.5 T and with similar scan parameters. The diffusion-weighted sequences were performed with b values of 50, 400 and 800 s/mm². ADC values were measured by placing regions of interest at three different levels within each lumbar vertebral body (L1 to L5). ADC values were analyzed for different age groups (0–2 years, 3–6 years, 7–11 years, 12–14 years, 15–20 years), for each vertebral and intravertebral level.

Results

The mean ADC of the whole study group was 0.60±0.09?×?10^?3 mm²/s. Children between the ages of 12 and 14 years had significantly higher ADC compared to the other age groups (P≤0.0003). ADC values were significantly higher in the 1st lumbar vertebral body compared to the other levels of the lumbar spine (P<0.005) with the exception of L5, and in the upper third of the vertebral bodies compared to the middle or lower thirds (P≤0.003).

Conclusion

The age-, vertebral- and intravertebral level-dependent differences in ADC suggest a varying composition and cellularity in different age groups and in different locations.

     

Myocardial stress perfusion magnetic resonance: initial experience in a pediatric and young adult population using regadenoson

Background

Dipyridamole and adenosine are traditional pharmacological stressors for myocardial perfusion. Regadenoson, a selective adenosine A2A agonist, has a lower side effect profile with lower incidence of bronchospasm and bradycardia. There is a growing need for myocardial perfusion assessment within pediatrics. There is no report on the utility of regadenoson as a stress agent in children.

Objective

To observe the safety and feasibility of regadenoson as a pharmacologic stressor for perfusion cardiac MR in a pilot cohort of pediatric patients weighing more than 40 kg who have congenital heart disease and pediatric acquired heart disease.

Materials and methods

We reviewed our initial experience with regadenoson stress cardiac MR in 31 pediatric patients 15.8?±?1.7 years (range 12–22 years) with congenital heart disease and acquired heart disease. Mean patient weight was 60?±?15 kg (range of 40–93 kg). All patients underwent cardiac MR because of concern for ischemia. The cohort included a heterogeneous group of patients at a pediatric institution with potential risk for ischemia. Subjects’ heart rate and blood pressure were monitored and pharmacologic stress was induced by injection of 400 mcg of regadenoson. We evaluated their hemodynamic response and adverse effects using changes in vital signs and onset of symptoms. A pediatric cardiologist and radiologist qualitatively assessed myocardial perfusion and viability images.

Results

One child was unable to complete the stress perfusion portion of the examination, but did complete the remaining portion of the CMR. Resting heart rate was 72?±?14 beats per minute (bpm) and rose to peak of 124?±?17 bpm (95?±?50% increase, P?<?0.005) with regadenoson. Image quality was considered good or diagnostic in all cases. Three patients had irreversible perfusion defects. Four patients had reversible perfusion defects. Nine of the patients underwent cardiac catheterization with angiography and the findings showed excellent agreement.

Conclusion

Regadenoson might be a safe and feasible pharmacologic stress agent for use in cardiac MR in older pediatric patients with congenital heart disease and acquired heart disease. The ease of use as a bolus and the advantage of a prolonged hyperemia make its use appealing in pediatrics. In a limited number of cases, regadenoson stress perfusion showed excellent agreement with cardiac catheterization. Regadenoson might be a viable pharmacologic stress agent in this population.

     

The effect of the broad-spectrum antibiotics for prevention of postoperative intra-abdominal abscess in pediatric acute appendicitis

Background

We investigated the efficacy of broad-spectrum antibiotics for prevention of postoperative intra-abdominal abscess in pediatric acute appendicitis with our 3 risk factors:—WBC?>?16.5 (×?10³/µl), CRP?>?3.1 (mg/dl) and appendix maximum short diameter on diagnostic imaging?>?11.4 mm.

Methods

Four hundred twenty-two patients were reviewed. Patients with 0–1 risk factors were assessed as low-risk and those with 2–3 were high-risk. In the low-risk group, Group A (n?=?66) patients received broad-spectrum antibiotics and Group B patients (n?=?265) received narrow-spectrum monotherapy. In the high-risk group, Group C patients (n?=?63) received broad-spectrum antibiotics and Group D patients (n?=?28), narrow-spectrum antibiotics. The outcomes were the incidence of postoperative abscess and the total duration of intravenous (IV) antibiotics.

Results

The incidence of intra-abdominal abscess was 6.06% in Group A versus 1.89% in Group B (p?=?0.08), and 19.05% in Group C versus 3.57% in Group D (p?=?0.06). Total IV antibiotic duration (days) were 6.12?±?2.87 in Group A versus 3.83?±?0.69 in Group B (p?<?0.01), and 7.84?±?4.57 in Group C versus 4.00?±?0.82 in Group D (p?<?0.01).

Conclusion

Broad-spectrum antibiotics did not prevent postoperative intra-abdominal abscess in either low or high-risk groups.

     

Prevalence of Depression among Caregivers of Indian Children with Cystic Fibrosis

Objective

To study the prevalence of depression among caregivers of children with cystic fibrosis and its impact on the health and well being of these children.

Methods

This cross-sectional study was conducted in a tertiary care hospital from September 2015 through August 2016. Forty one parents of children receiving treatment at the Cystic fibrosis (CF) clinic were approached to be part of the study. Six families declined the request resulting in 85% recruitment rate. The Centre for Epidemiological Studies Depression Scale (CES-D) was used to assess depression score among caregivers. The CES-D provides clinical cut-off scores of ≥16 that help in identifying persons at risk for depression. CES-D was completed by the parent closely associated with care of the affected child. Main outcome measure was to find the number of caregivers of patients who has score of ≥16 on CES-D scale, and its effect on growth and respiratory exacerbations of the affected child.

Results

A total of 23 fathers and 12 mothers participated in the study. The mean age of male and female caregivers was 30.9?±?5.4 and 27.8?±?4.7 y respectively. Eighteen (51.4%) caregivers scored above the clinical cut-off on the CES-D in the index study with mean score of 22.0?±?4.0. The mean CES-D score among non-depressive caregivers was 7.76?±?4.2. Significant negative association was found between parental depression and child’s health. Children with high parental CES-D score suffered significantly more respiratory exacerbations (3.83?±?1.2 episodes) in last six months than parents with low CES-D score (2.18?±?1.28 episodes) (p value?=?0.00). Similarly, stunting was more commonly seen in patients with high caregiver CES-D score (15 vs. 7; P value?=?0.01).

Conclusions

A very high prevalence of caregiver depression was found in cystic fibrosis, which negatively impacted care and well being of the affected patients. Depression was more common in families with poor economic and education level.