Drug-induced sleep endoscopy (DISE) is used for directly visualizing sites of obstruction among patients with obstructive sleep apnea (OSA). Owing to the scarcity of data, there is still no consensus on the anesthetic regimen for conducting pediatric DISE.

This paper presents a 5-year-old patient who underwent DISE using an opioid-sparing regimen with dexmedetomidine and propofol infusion.

Simultaneous dexmedetomidine and propofol infusion is a promising opioid-sparing regimen for pediatric DISE.

BACKGROUND

Bronchial asthma is one of the most common chronic childhood diseases encountered in the primary care setting. Adherence to recommendations from clinical practice guidelines on asthma can be utilized as an indicator of quality of care when evaluating the implementation of the universal health care in the Philippines.

To determine the clinical profile of pediatric patients with bronchial asthma; and to evaluate the prescription patterns for asthma treatment in a primary care setting.

This was a retrospective cohort study that involved review of the electronic medical records in a rural site of the Philippine Primary Care Studies (PPCS). All patients less than 19 years old who were diagnosed with asthma from April 2019 to March 2021 were included. Quality indicators for asthma care were based on adherence to recommendations from the 2019 Global Initiative for Asthma (GINA) Guidelines.

This study included 240 asthmatic children with mean age of 6 years (SD ± 4.9) and a slight male preponderance (55.4%). Majority (138 children or 57.5%) were less than 6 years old. Out of the 240 children, 224 (93.3%) were prescribed inhaled short-acting beta-agonists (SABA) and 66 (27.5%) were prescribed oral SABA. Only 14 children (5.8%) were prescribed inhaled corticosteroids (ICS), with 13 children (5.4%) given ICS with longacting beta-agonists (LABA) preparations, and one child (0.4%) given ICS alone. Quality indicators used in this study revealed underutilization of ICS treatment across all age groups, and an overuse of SABA-only treatment in children 6 years old and above. Moreover, 71.3% of the total patients were prescribed antibiotics despite the current GINA recommendation of prescribing antibiotics only for patients with strong evidence of lung infection, such as fever or radiographic evidence of pneumonia.

There were 240 children diagnosed with asthma over a 2-year period in a rural community, with a mean age of 6 years old and a slight male predominance. This quality-of-care study noted suboptimal adherence of rural health physicians to the treatment recommendations of the GINA guidelines, with overuse of SABA and underuse of ICS for asthma control.

BACKGROUND AND OBJECTIVES

The etiology of pneumonia in the pediatric population varies by age group. Among patients one month to 59 months old, viral pathogens are the most common cause of lower respiratory infections. The study aims to determine the frequency distribution of antibiotic prescription among patients one month to 59 months old and to determine the adherence of primary care facilities to local guidelines with recommended antibiotics.

A descriptive retrospective study using electronic medical records was conducted at two primary care sites. Patients aged 1 month to 59 months old seeking consult via telemedicine or face-to-face diagnosed with community acquired pneumonia from April 2019-March 2020 in the rural facility and May 2019-April 2020 in the remote facility were included in the study. The primary outcome was to determine the patterns of antibiotic use in pneumonia in remote and rural areas and adherence to the recommended antibiotics by the 2016 Philippine Academy of Pediatric Pulmonologists pediatric community-acquired pneumonia clinical practice guidelines (CPG).

There were 30 pediatric patients diagnosed with pneumonia in the rural facility and 213 in the remote facility. Of these patients with pneumonia, 96.7% and 94.8% were prescribed antibiotics in the rural and remote sites, respectively. The most commonly prescribed antibiotic in the rural facility was co-amoxiclav (26.7%), while amoxicillin (51.6%) was the most common in the remote facility. Adherence to the CPG in the rural site was lower at 23.3% (n=8/30) compared to the remote site which was 55.9% (n=119/213).

Primary care physicians prescribed antibiotics in over 90% of the time upon the diagnosis of pneumonia in children aged one month to 59 months old, despite viral pneumonia being the more common in primary care setting. Adherence to recommended antibiotics was higher in the remote setting than in the rural setting. Use of EMR to monitor quality of care can improve patient outcomes and safety, pointing out the importance of improving the quality of documentation in the study sites.

Objective To explore the application value of multi-model adaptive statistical iterative reconstruction-Veo (ASiR-V) in ultra-low dose chest CT examination of children in the plateau area. Methods The children who underwent chest CT examination in Xizang Autonomous Region People's Hospital were enrolled in this study and assigned into two groups according to the scanning conditions.Group A underwent scanning at a tube voltage of 100 kV and ASiR-V 50% reconstruction,and group B underwent scanning at a tube voltage of 80 kV and ASiR-V 0 (Group B1) and ASiR-V 50% (Group B2) reconstruction.The image quality of each group was evaluated objectively and subjectively.The radiation dose and image quality were compared between groups. Results Groups A and B showed the volume CT dose indexes of (2.33±0.62) mGy and (0.86±0.01) mGy and the dose length products of (65.01±25.12) mGy·cm and (23.55±3.38) mGy·cm,respectively,which presented differences between groups (both P<0.001).The image noise in the bilateral upper and middle lung areas in group B2 was lower than that in group B1 but higher than that in group A (all P<0.001).There was no significant difference in image quality score of the lung window among groups (all P>0.05).Groups A,B1,and B2 had no significant differences in ascending aorta (P=0.538) or liver CT value (P=0.175) in the mediastinal window.The signal-to-noise ratios and contrast-to-noise ratios of ascending aorta and liver in group B2 were higher than those in group B1 (all P<0.001) and lower than those in group A (all P<0.05).The image quality score of the mediastinal window followed a descending order of group A>group B2>group B1 (all P<0.001)。Conclusion ASiR-V combined with low tube voltage can effectively reduce the radiation dose and guarantee the image quality of chest CT of children in the plateau area.
Humans ; Radiation Dosage ; Tomography, X-Ray Computed/methods* ; Child ; Male ; Female ; Child, Preschool ; Radiography, Thoracic/methods* ; Infant ; Models, Statistical ; Image Processing, Computer-Assisted/methods*

PURPOSE: Polytrauma is still a challenge for health care organizations. Today, the search for factors to reduce lethality continues. This study aims to describe the causes of death associated with polytrauma in 1 year. METHODS: This retrospective study analyzed autopsy data of trauma deaths in Moscow for the whole of 2017. We identified victims with polytrauma, taking into account the Berlin definition as the main inclusion criteria with penetrating and blunt trauma. Each forensic report had information about the pre-hospital and hospital stages of treatment and autopsy data. The exclusion criteria for this study were: isolated injury, forensic reports not related to the examination of entire corpses, and autopsy studies of children (<18 years old). Statistical analysis was performed according to basic principles, including a comparison of groups using the Chi-squared test with Bonferroni comparison test and Fisher's exact test. The critical level of significance (p value) in testing statistical hypotheses in this study was taken as 0.05. RESULTS: We analyzed 2337 forensic medical examinations of victims who died of trauma in Moscow in 2017, of which 41.5% (n = 969) were polytrauma deaths. Most of the victims (65.4%, n = 634) died on the scene, and only 30.0% were admitted to the hospital. The most frequent cause of death was bleeding (72.0%, n = 698), followed by traumatic brain injury (43.8%, n = 424). They accounted for the first peak (78.4%, p = 0.005) of deaths, occurring in the first hours. Then these causes of death in the first peak go down in a few hours, and the second peak of mortality appears in 3 - 7 days (p = 0.001). CONCLUSIONS This is the largest full-year autopsy study of polytrauma victims. Our data show that the main cause of polytrauma death is massive bleeding, with a lethality peak in the first hours after injury. The time distribution of polytrauma deaths has a bimodal pattern - the second period of polytrauma deaths occurs in 3 - 7 days.
Humans ; Retrospective Studies ; Male ; Female ; Moscow/epidemiology* ; Autopsy ; Multiple Trauma/mortality* ; Adult ; Adolescent ; Middle Aged ; Child ; Child, Preschool ; Cause of Death ; Young Adult ; Infant ; Aged ; Aged, 80 and over

This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias. We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between October 2012 and October 2022. In total, 31 patients underwent the conventional Byars procedure (conventional group), and 45 patients underwent the modified Byars staged procedure (modified group). Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage. Notably, there were no statistically significant differences in the preoperative baseline characteristics, duration of surgery, amount of blood loss, or occurrence of postoperative complications, including urethral fistula, stricture and diverticulum, or penile curvature, between the conventional and modified groups. However, there was a significantly lower incidence of coronal sulcus fistula (0 vs 16.1%, P = 0.02) and glans dehiscence (0 vs 12.9%, P = 0.02) in the surgical group than that in the conventional group. In addition, the modified group exhibited a notably greater rate of normotopic urethral opening (100.0% vs 83.9%, P = 0.01) and a higher mean score on the Hypospadias Objective Penile Evaluation (HOPE; mean ± standard error of mean: 8.6 ± 0.2 vs 7.9 ± 0.3, P = 0.02) than did the conventional group. In conclusion, the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula. Consequently, it offers a promising approach for achieving favorable penile esthetics, thereby providing a reliable therapeutic option for severe hypospadias.
Humans ; Hypospadias/surgery* ; Male ; Retrospective Studies ; Urologic Surgical Procedures, Male/methods* ; Child, Preschool ; Child ; Postoperative Complications/etiology* ; Urethra/surgery* ; Plastic Surgery Procedures/methods* ; Surgical Flaps ; Penis/surgery* ; Treatment Outcome ; Infant

This study was conducted retrospectively on a cohort of 68 patients with steroid 5 α-reductase 2 (SRD5A2) deficiency and 46,XY disorders of sex development (DSD). Whole-exon sequencing revealed 28 variants of SRD5A2 , and further analysis identified seven novel mutants. The preponderance of variants was observed in exon 1 and exon 4, specifically within the nicotinamide adenine dinucleotide phosphate (NADPH)-binding region. Among the entire cohort, 53 patients underwent initial surgery at Sichuan Provincial People's Hospital (Chengdu, China). The external genitalia scores (EGS) of these participants varied from 2.0 to 11.0, with a mean of 6.8 (standard deviation [s.d.]: 2.5). Thirty patients consented to hormone testing. Their average testosterone-to-dihydrotestosterone (T/DHT) ratio was 49.3 (s.d.: 23.4). Genetic testing identified four patients with EGS scores between 6 and 9 as having this syndrome; and their T/DHT ratios were below the diagnostic threshold. Furthermore, assessments conducted using the crystal structure of human SRD5A2 have provided insights into the potential pathogenic mechanisms of these novel variants. These mechanisms include interference with NADPH binding (c.356G>C, c.365A>G, c.492C>G, and c.662T>G) and destabilization of the protein structure (c.727C>T). The c.446-1G>T and c.380delG variants were verified to result in large alterations in the transcripts. Seven novel variations were identified, and the variant database for the SRD5A2 gene was expanded. These findings contribute to the progress of diagnostic and therapeutic approaches for individuals with SRD5A2 deficiency.
Humans ; 3-Oxo-5-alpha-Steroid 4-Dehydrogenase/genetics* ; Disorder of Sex Development, 46,XY/blood* ; Male ; Membrane Proteins/genetics* ; Child, Preschool ; Child ; Retrospective Studies ; Adolescent ; Female ; Mutation ; Testosterone/blood* ; Infant ; Dihydrotestosterone/blood*

Isolated male epispadias typically presents with preputial defects and dorsal urethral dehiscence. A less common subtype, known as concealed epispadias, is distinguished by an intact prepuce. Despite its clinical relevance, there is limited literature on this variant. In this study, we retrospectively analyzed the clinical data of 86 pediatric patients with isolated male epispadias treated in Beijing Children's Hospital (Beijing, China) from May 2004 to July 2023, including 19 cases of concealed epispadias and 67 of nonconcealed epispadias. We compared clinical characteristics, preoperative diagnostics, surgical techniques, postoperative outcomes, and sexual function during follow-up between the concealed and nonconcealed groups. No significant differences were observed between the two groups regarding surgical methods, postoperative complications, or rates of urinary incontinence. However, notable distinctions were found in the age at initial diagnosis, timing of surgery, frequency of incontinence, location of the urethral meatus, and postoperative urinary incontinence scores (all P < 0.05). Given the absence of penopubic epispadias in concealed cases, we categorized glans and penile epispadias within nonconcealed epispadias as distal epispadias ( n = 40) and subsequently compared them with concealed epispadias cases. The postoperative urinary incontinence scores did not differ significantly between the concealed and distal epispadias groups. These findings suggest that concealed epispadias represents a relatively milder form of the condition, characterized by the absence of penopubic involvement, lower rates of urinary incontinence, and favorable surgical outcomes. However, the intact prepuce in concealed cases underscores the need for careful identification and early diagnosis.
Humans ; Male ; Retrospective Studies ; Epispadias/classification* ; China ; Tertiary Care Centers ; Child, Preschool ; Child ; Postoperative Complications/epidemiology* ; Urinary Incontinence/epidemiology* ; Urethra/surgery* ; Infant ; Penis/surgery* ; Adolescent ; Urologic Surgical Procedures, Male/methods* ; East Asian People

The aim of this study was to investigate the trend in testicular volume changes after orchiopexy in children with cryptorchidism. The clinical data of 854 children with cryptorchidism who underwent orchiopexy between January 2013 and December 2016 in Shenzhen Children's Hospital (Shenzhen, China) were retrospectively analyzed. The mean (standard deviation) age of the patients was 2.8 (2.5) years, and the duration of follow-up ranged from 1 year to 5 years. Ultrasonography was conducted preoperatively and postoperatively. The variables analyzed included age at the time of surgery, type of surgical procedure, laterality, preoperative testicular position, preoperative and postoperative testicular volumes, and the testicular volume ratio of them. The average testicular volumes preoperatively and at 1 year, 2 years, 3 years, and 5 years postoperatively were 0.27 ml, 0.38 ml, 0.53 ml, 0.87 ml, and 1.00 ml, respectively ( P < 0.001). The corresponding testicular volume ratios were 0.67, 0.76, 0.80, 0.83, and 0.84 ( P < 0.001). The mean volume of the undescended testes was significantly smaller than the mean normative value ( P < 0.001, lower than the 10 th percentile). The postoperative testicular volumes in children with cryptorchidism were generally lower than those in healthy boys but were still greater than the 10 th percentile and exhibited an increasing trend. The older the child is at the time of surgery, the larger the gap in volume between the affected and normal testes. Although testicular volume tends to gradually increase after orchiopexy for cryptorchidism, it could not normalizes. Earlier surgery results in affected testicular volumes closer to those of healthy boys.
Humans ; Male ; Cryptorchidism/diagnostic imaging* ; Orchiopexy ; Child, Preschool ; Testis/surgery* ; Retrospective Studies ; Organ Size ; Ultrasonography ; Infant ; Child ; Postoperative Period ; Follow-Up Studies

OBJECTIVES: To investigate the epidemiological characteristics and changing trends of communicable diseases among children and adolescents in China from 1990 to 2021. METHODS: Based on the Global Burden of Disease Database, epidemiological indicators for communicable diseases among the population aged under 20 years in China from 1990 to 2021 were selected to analyze the burden of communicable diseases in this population, and a comparative analysis was performed with global data as well as data from Western Europe and North America. RESULTS: In 1990-2021, the overall burden of communicable diseases tended to decrease among children and adolescents in China. In 2021, the prevalence rate of communicable diseases in China was lower than the global prevalence rate and was higher than that in Western Europe and North America. There was a significant reduction in the mortality rate of communicable diseases, and the gap with Western Europe and North America gradually narrowed year by year. The overall incidence rate, mortality rate, and disability-adjusted life year rate of communicable diseases in males were higher than those in females, and respiratory infections and intestinal infections were more common in children aged <5 years, while the incidence rate of sexually transmitted diseases was higher in adolescents. CONCLUSIONS From 1990 to 2021, the disease burden of communicable diseases among the population under 20 years old in China has significantly decreased. However, there is still a certain gap compared to developed regions. Strengthening the prevention and control of diseases such as respiratory infections and acquired immunodeficiency syndrome, as well as enhancing health interventions for children under 5 years old, will help improve the overall health level of children and adolescents in China.
Humans ; Adolescent ; Communicable Diseases/mortality* ; Child ; China/epidemiology* ; Male ; Female ; Child, Preschool ; Infant ; Young Adult ; Cost of Illness ; Infant, Newborn