Pediatric sepsis is a leading cause of global morbidity and mortality, yet high-resolution, granular subnational assessments remain scarce. Chile and Mexico are the only countries in Latin America that possess robust vital registration systems and open access databases with marginal levels of missing cases. This offers a unique opportunity to quantify the subnational burden of pediatric sepsis, identify healthcare system constrictions, and guide targeted public health interventions. This retrospective longitudinal study analyzed official hospital discharge and non-fetal death records of pediatrics (< 10 years old) from Chile and Mexico between 2014 and 2024. Age-standardized incidence (ASIR) and mortality (ASMR) rates, standardized ratios, and the mortality-to-incidence ratio (MIR), were calculated to assess mortality relative to subnational hospital output. A novel dynamic risk stratification matrix was developed to classify ICD-10 sepsis-related causes into four risk/severity quadrants based on year-specific ASIR and MIR indicators. A total of 656,234 discharges and 2,035 deaths in Chile, and 964,452 discharges and 77,252 deaths in Mexico were analyzed. Subnational trends were highly heterogeneous. Chile exhibited a predominantly low pediatric MIR (median < 1%) with isolated hotspots with significant structural deviations to the North. High-severity sepsis causes in Chile were relatively rare. Conversely, Mexico displayed an alarmingly high MIR (median 7.2%), with systemic persistency in States such as Chiapas and Nuevo León. Strikingly, high-severity causes in Mexico (e.g., unspecified septicaemia, bacterial meningitis) were highly frequent, accounting for 88-97% of pediatric sepsis deaths. Furthermore, systemic instances of code-specific MIR > 1.0 in Mexico suggest significant health system fragmentation and decoupling of hospital discharge from vital statistic registries. Pediatric sepsis in Latin America encompasses distinct realities, ranging from localized critical care gaps to high-lethality persistency. One-size-fits-all national policies may be inadequate. These findings advocate for precision public health, urging the deployment of decentralized, data-driven interventions and specialized resource allocation based on high-risk subnational hotspot identification.
Interleukin-33 (IL-33) is an epithelial alarmin positioned upstream of type 2 (T2) inflammation, yet its clinical correlates and systemic molecular context in paediatric asthma remain incompletely defined. We investigated whether circulating IL-33 is associated with objective disease-burden measures and whether IL-33 elevation co-occurs with exploratory plasma lipid differences. In a paediatric case-control cohort (August 2023-June 2025; asthma n = 60, controls n = 60), plasma IL-33 was quantified by ELISA and related to spirometry (FEV1, FEV1/FVC, PEF) and T2 markers (blood eosinophils, total IgE, FeNO). Associations were assessed using correlation analyses and multivariable linear regression treating IL-33 as a continuous exposure (mean-centred ln[IL-33]) with adjustment for age, sex, BMI, and group, plus an Age × IL-33 interaction. ROC analyses were used to describe case-control discrimination within the cohort. Untargeted plasma lipidomics was performed in an exploratory discovery subset (asthma n = 8, controls n = 8) to define differential lipids, IL-33-anchored lipid patterns, and an exploratory six-lipid IL-33-linked score; score-trait associations were evaluated as exploratory analyses with group residualization. Compared with controls, children with asthma showed worse lung function and higher T2 burden (all P < 0.001), alongside higher IL-33 (107.1 ± 38.5 vs. 52.4 ± 21.6 pg/mL; P < 0.001). Across the cohort, IL-33 correlated inversely with lung function (FEV1 r = - 0.652; FEV1/FVC r = - 0.585; PEF r = - 0.683; all P < 0.001) and positively with T2 markers (eosinophils r = 0.534; IgE r = 0.583; FeNO r = 0.622; all P < 0.001). In multivariable models, ln(IL-33) remained significantly associated with each outcome after adjustment for age, sex, BMI, and group status, whereas the Age × IL-33 interaction was not significant (all P > 0.05). IL-33 showed case-control discrimination within the cohort (AUC 0.92; cut-off 75.4 pg/mL). In the exploratory lipidomics subset, PCA suggested group separation, although this should be interpreted cautiously given the small sample size. Differential lipids were dominated by glycerophospholipids (66.67%), followed by sphingolipids (18.1%). Exploratory IL-33-anchored analyses identified provisional glycerophospholipid/cardiolipin-positive and sphingomyelin-negative lipid patterns. The exploratory IL-33-linked lipid score showed high apparent discrimination within the discovery subset (AUC 0.96; LOOCV AUC 0.97) and, after group residualization, remained directionally associated with lung function and T2 markers. In this paediatric case-control cohort, circulating IL-33 was elevated in children with asthma and was significantly associated with objective airflow limitation and systemic type 2 inflammatory burden. Higher IL-33 levels also co-occurred with exploratory plasma lipid differences. These findings should be interpreted as adjusted associations observed within a cross-sectional case-control design and require longitudinal and external validation before any broader biomarker or clinical application can be considered.
Systemic urokinase infusion via the dorsal foot vein is commonly used for acute lower-extremity deep-vein thrombosis (DVT) complicated by pulmonary embolism (PE), but drug dilution within the superficial venous system may reduce local efficacy. We evaluated whether localized circumferential elastic compression applied at the thigh level was associated with improved short-term recanalization without compromising safety during urokinase thrombolysis. In this retrospective cross-sectional study, 207 consecutive patients with acute proximal DVT and concomitant PE received urokinase via the dorsal foot vein and were stratified by use of localized circumferential elastic compression. The primary outcome was ≥ 50% venous recanalization on duplex ultrasound at 4 weeks. Compression was applied in 93 patients (44.9%). Recanalization was higher with compression than without (62.4% vs. 47.4%; adjusted OR 3.60, 95% CI 1.73-7.47; P = 0.001), without an increase in bleeding or limb complications (5.4% vs. 11.4%; P = 0.126). Benefits were consistent across key subgroups. These findings suggest an association between localized compression and improved short-term recanalization.
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To identify factors influencing the spontaneous resolution of pediatric primary hydrocele (PPH) and construct a predictive nomogram. A retrospective analysis was performed on 16 clinical indicators from 449 PPH patients, who were categorized by outcome into the resolution hydroceles (RH) group (n = 215) and the persistent hydroceles (PH) group (n = 234). Indicators showing significant differences in univariate analysis were incorporated into a multivariate binary logistic regression to identify independent risk factors. A nomogram prediction model was subsequently constructed and internally validated. Eight independent factors for resolution were identified (all p < 0.05): bilateral hydrocele (OR = 1.916, 95% CI: 1.155-3.180), older age at diagnosis (OR = 0.989, 95% CI: 0.981-0.998), variable-sized hydrocele (OR = 0.375, 95% CI: 0.241-0.583), positive relevant family history (OR = 0.186, 95% CI: 0.105-0.328), excessive crying during infancy (OR = 0.156, 95% CI: 0.041-0.567), history of functional/organic constipation (OR = 0.169, 95% CI: 0.066-0.434), chronic cough/asthma (OR = 0.361, 95% CI: 0.164-0.791), and abnormal growth status (OR = 0.331, 95% CI: 0.113-0.969). The nomogram showed acceptable discriminatory ability (AUC = 0.798, P < 0.001). The identified factors were independently associated with spontaneous resolution of pediatric primary hydrocele. The constructed nomogram demonstrated favorable predictive performance in the study population, although its clinical applicability warrants further validation in external cohorts.
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Medicinal fungi supplements have gained widespread recognition, increasing off-label use in pediatric populations. However, their safety profile remains inadequately characterized, and the potential for toxic effects, including neurotoxicity, is underrecognized in clinical practice. Here we report a pediatric case of suspected multi-component medicinal fungi supplement-related neurotoxicity, in which the parents were aware that the ingredient was a mushroom for their son's alternative treatment. We report acute neurotoxicity in a 9-year-old boy with prematurity, cerebral palsy, and well-controlled epilepsy presenting with generalized myoclonic seizures, hallucinations, and altered mental status following ingestion of multiple medicinal fungi supplements, including Ganoderma lucidum and Cordyceps sinensis. Comprehensive investigations, including laboratory studies and neuroimaging, excluded infectious, structural, and metabolic etiologies. The temporal relationship between dose escalation of the supplement and symptom onset, combined with resolution upon discontinuation, suggested a supplement-related mechanism. This case highlights the potential neurotoxic effects of mushroom supplements containing both Ganoderma lucidum (reishi mushroom) and Cordyceps sinensis in children with underlying neurological disorders. The temporal association between dose escalation and symptom onset, with complete symptom resolution upon discontinuation, suggests a supplement-related mechanism. Given the increasing use of medicinal fungi in complementary medicine, greater clinical vigilance and public awareness of their potential risks are essential.
Patients with spastic cerebral palsy (CP) are at a high risk of neurogenic hip dysplasia/subluxation depending on the severity of the neuromuscular disorder. Untreated, approximately one third of all patients develop hip dislocation. Reconstruction with femoral varus derotational osteotomy (VDRO) combined with Dega acetabuloplasty (PO) represents the gold standard. The goal of this study was the radiographic assessment after reconstructive treatment of spastic hip dysplasia/(sub)luxation and to derive specific thresholds and target values of neck shaft angle NSA) and femoro-epiphyseal acetabular roof (FEAR)-index that could be beneficial in predicting long-term outcome. In this retrospective evaluation, 121 patients (224 hips) with CP who underwent VDRO/acetabuloplasty were grouped according to their age at surgery and postoperative radiographic parameters (NSA and FEAR-index) and compared with each other over time (5-year follow-up). The preoperative, postoperative and follow-up X-rays were analyzed. For this purpose, the FEAR, lateral center-edge angle (LCE) and migration percentage (MP) were analyzed as outcome measures at hip-level using linear mixed models (LMM). Patients older than 8 years and with a postoperative FEAR > -20° or a postoperative NSA > 130° showed a significantly worse postoperative result (FEAR, LCE and MP). A deterioration of the outcome parameters was found in all subgroups to approximately the same extent up to 2 years postoperatively. After 5 years, the findings remained stable. Failure rates and relative risks of inferior subgroups (FEAR-index ≥-20°, NSA ≥ 130°, age ≥ 8 years) were approximately twice as high (nAGE 18/114 vs. 34/110; nFEAR 20/150 vs. 25/74; nNSA 22/132 vs. 27/92). A sufficient postoperative head coverage/reduction of MP and thus joint stability is crucial for long-term outcomes after VDRO and PO. Particularly the FEAR-index seems to be a useful parameters for the surgeon for preoperative planning and postoperative aftercare. If postoperative risk factors are present, an individualized aftercare program and hip monitoring plan that establishes more frequent postoperative assessment and possible prolonged abduction therapy should be considered.
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Neonatal mortality remains a critical public health challenge in Sub-Saharan Africa, with The Gambia reporting one of the highest rates in the region. Despite global progress, the neonatal mortality rate has shown limited decline, and context-specific data on delivery setting-related risk factors remain needed to inform health system strengthening in The Gambia. We aimed to identify risk factors for neonatal mortality at Kanifing General Hospital (KGH), and examine the association between place of delivery and survival outcomes. We conducted a retrospective cohort study of 1,354 neonates admitted to KGH between January 2022 and December 2024. The primary outcome was neonatal death during admission. Kaplan-Meier survival analysis and Cox proportional hazards regression with robust standard errors clustered by facility were used to identify risk factors. During the study period, 137 deaths occurred (10.1% mortality; 95% CI: 8.6-11.9). Median follow-up was 96 h. Overall, survival at 7 days was 87.8%, but differed substantially between neonates delivered at KGH Labour Ward (91.3%) versus peripheral facilities (78.9%; log-rank p < 0.001). In multivariable analysis, delivery at KGH Labour Ward was strongly protective (adjusted hazard ratio [aHR] 0.41; 95% CI: 0.28-0.58; p < 0.001), representing a 59% reduction in mortality risk. Higher birth weight was protective (aHR 0.58 per kg; 95% CI: 0.37-0.90; p = 0.016), while birth asphyxia increased mortality risk (aHR 1.30; 95% CI: 1.11-1.53; p = 0.001). The model demonstrated acceptable discrimination (C-statistic = 0.713). E-value sensitivity analysis indicated robustness to unmeasured confounding (E-value = 4.36 for facility effect). Study limitations include the retrospective design and single-center setting. Neonates referred from peripheral facilities experienced substantially higher mortality compared to those delivered at the referral hospital. Birth weight and birth asphyxia were independently associated with survival. These findings highlight the critical importance of strengthening referral hospital capacity and improving quality of care at peripheral facilities to reduce neonatal mortality in The Gambia.
University students are at a key life stage in their lives for the development of health-related behaviors, yet few studies have explored their overall lifestyle using multidimensional tools. The present exploratory study aimed to assess lifestyle through the Short Multidimensional Inventory Lifestyle Evaluation for University Students (U-SMILE) and to determine its sociodemographic and health correlates in a sample of Spanish university students. This cross-sectional analysis was based on baseline data collected at Universidad Loyola Andalucía (Spain) as part of the UNIversity students' LIFEstyle behaviors and Mental health (UNILIFE-M) multicenter project during the 2024 academic year. A total of 671 first-year students (median age = 18 years, 50.1% female) completed validated self-report questionnaires assessing lifestyle behaviors, sociodemographic variables, body mass index (BMI), and diagnosed health conditions. Lifestyle was evaluated using the U-SMILE. Descriptive statistics and robust linear models were applied to identify associated factors. The median overall U-SMILE score was 69.0 points (interquartile range [IQR] = 64-73). Older students (> 18 years old) presented lower scores (unstandardized beta coefficient [B] = -1.59; p = 0.006), as did those enrolled in non-health science degrees (B = -1.47; p = 0.005), single students (B =-1.40; p = 0.013), and those with a mental disorder (B = -2.79; p = 0.001). Heterosexual students scored higher than non-heterosexual peers (B = 2.49; p = 0.007), and students with normal weight showed better results than underweight participants (B = 2.08; p = 0.020). Domain-specific analyses revealed that males scored higher in physical activity, sleep, and social support, whereas females performed better in stress management. Students residing outside university accommodation generally achieved higher domain scores. These exploratory findings suggest that lifestyle, as measured by the U-SMILE, is associated with several sociodemographic and health-related characteristics in Spanish university students. Lower scores were associated with older age, enrolment in non-health science degrees, underweight status, non-heterosexual orientation, single marital status, and the presence of a diagnosed mental disorder. Sex, BMI status, accommodation, and employment status were associated with specific lifestyle domains.
This study evaluated the effects of surgical timing, microscope-assisted operation, and partial helix crus cartilage resection on operation duration, postoperative incision healing, recurrence rate, and scar formation in children with infected classic preauricular fistula, analyzed the clinical value of different surgical strategies for its standardized treatment, and ensured result reliability via rigorous control of selection and temporal confounding. A retrospective analysis was performed on 74 children who underwent surgery for infected classic preauricular fistula, grouped by intraoperative infection status (early erythema-swelling, prolonged erythema-swelling, localized abscess), microscope application, and cartilage resection. Selection bias was controlled by baseline comparison; confounders (age, sex, infection severity) were adjusted via 1:1 propensity score matching (PSM) and multivariable regression. Group differences in key efficacy indicators were compared, with nonparametric tests for non-normally distributed data (median [IQR]). Post-hoc power analysis and learning curve analysis (study period: 2021-2023 [early], 2024-2025 [late]) were also conducted. Baseline characteristics were comparable across all groups (P > 0.05). For surgical timing subgroups, recurrence rate and incision healing showed no intergroup differences (P > 0.05), but the localized abscess group had significantly longer operation duration (61.8 ± 8.8 min, median 62.0 [56.0-68.0] min) and lower scar scores (2.5 ± 0.6 points, median 2.0 [2.0-3.0] points) than the early (37.7 ± 4.9 min, median 38.0 [35.0-41.0] min) and prolonged erythema-swelling groups (42.7 ± 7.4 min, median 43.0 [38.0-47.0] min) (P < 0.05), with no significant difference in median [IQR] follow-up time (P > 0.05). Microscope application had no significant effects on all efficacy indicators (P > 0.05), with consistent results after PSM; follow-up time and recurrence rate also showed no intergroup differences (P > 0.05). The cartilage resection group had a significantly lower postoperative recurrence rate (1.75%, 1/57) than the non-resection group (17.65%, 3/17), with this difference remaining significant after multivariable regression (P < 0.05). Learning curve analysis revealed significantly shorter operation duration in the late study stage (59.2 ± 10.8 min) than the early stage (68.5 ± 12.3 min, P < 0.001), with no difference in recurrence rate (4.8% vs. 1.7%, P = 0.321). Post-hoc power analysis showed 72% power for detecting recurrence rate differences and 89% for operation duration differences. Subgroup analyses found no significant recurrence rate differences between non-abscess and abscess groups (2.0% vs. 4.5%, P = 0.432) or between different preoperative management groups (2.6% vs. 4.5%, P = 0.587). For children with infected classic preauricular fistula, early infection stage before localized abscess formation is the recommended surgical timing, which shortens operation duration and improves scar satisfaction. Intraoperative partial helix crus cartilage resection effectively reduces postoperative recurrence risk, with strict control of resection range to preserve auricle morphology. Microscope-assisted operation has no obvious advantages in reducing recurrence or improving incision healing, and its clinical application can be individualized. This study is limited by small sample size, only 4 recurrence events in 74 patients leading to underpowered detection for the primary outcome (recurrence rate), and premature 3-month scar assessment prior to full scar maturation (6-12 months). The conclusions require verification via large-sample multicenter randomized controlled trials.
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The COVID-19 pandemic has led to significant restrictions in access to oral health services and may have affected the need for dental treatment in pediatric patients. This study aimed to retrospectively evaluate the effect of the COVID-19 pandemic on the extraction rates of permanent first molar teeth in pediatric patients aged 9-14 years. In this retrospective archival study, the records of patients aged 9-14 years who visited our clinic between January 1, 2017, and December 31, 2025, were reviewed. The study period was divided into three periods: pre-pandemic (January 1, 2017-March 9, 2020), pandemic (March 11, 2020-May 5, 2023), and post-pandemic (May 6, 2023-December 31, 2025). The number of permanent first molar extractions and their proportion of total extractions were compared across ages and periods. Pearson's chi-square test was used to analyse the data, and a significance level of p < 0.05 was accepted. Extraction rates were positively associated with increasing age across all study periods (p < 0.001). It was determined that the rate of permanent first molar extractions increased significantly in the post-pandemic period compared to the pre-pandemic period (RR = 1.82; 95% CI: 1.69-1.95; p < 0.001). Although there was a decrease in the total number of extractions during the pandemic period, the rate of permanent first molar extractions among total extractions were found to be significantly higher than before the pandemic (RR = 1.4; 95% CI: 1.28-1.53; p < 0.001). The COVID-19 pandemic was found to have a significant effect on permanent first molar extraction rates in pediatric patients. Restrictions in access to oral health services and delayed visits during the pandemic may be associated with increased extraction rates in the post-pandemic period. These findings emphasize the importance of continuity of preventive oral health services during extraordinary circumstances.
Since 1990, the survival rate of very preterm (VP) infants (born < 32 weeks of gestation) has significantly improved due to advancements in neonatal care practices. This study aimed to investigate whether these medical advances have translated into better growth and neurodevelopmental outcomes during the early life of VP children. A comparative analysis was performed using data from two community-based studies: POPS (1983) and LOLLIPOP (2002/2003). A total of 1,294 very preterm (VP) infants provided data on height, weight, and head circumference during the first two years of life, as well as fine motor skills, gross motor skills, and communication milestones at 24 months of age. Rigorous harmonization procedures were applied to ensure comparability, including the standardization of growth metrics and consistent definitions for neurodevelopmental milestones across cohorts. Analyses were adjusted for higher parental education, severe intraventricular haemorrhage (IVH) and extended neonatal hospital stay to uncover if improvements reduce the differences in growth and neurodevelopment. The LOLLIPOP cohort showed better height and weight growth trajectories within the first 24 months of life, even after controlling for sociodemographic and neonatal factors. Differences in head circumference trajectories were significant in unadjusted analyses but lost significance when adjusted for higher parental education, severe IVH, and extended hospital stays. Neurodevelopmental milestones, particularly gross and fine motor skills (e.g., "imitates others" and "squats or bends to pick things up"), improved in the LOLLIPOP cohort but were attenuated after adjustment. Substantial delays in communication (e.g., "says sentences of two words") and gross motor milestones (e.g., "walks well alone") were observed across both cohorts compared to the norms derived from full-term children. VP infants born in the 2000s exhibited modest improvements in growth outcomes compared to those born in the 1980s. Reductions in neurodevelopmental impairments for the VP infants born in the 2000s are associated with higher parental education levels and reduced neonatal complications. Despite these advancements, persistent delays in cognitive and motor development underscore the necessity for early and targeted interventions to support VP children effectively.
To evaluate the effect of maternal COVID-19 infection on oxidative stress indicators in the umbilical cord. This was a prospective study. The umbilical cord oxidative stress biomarkers, which include malondialdehyde (MDA), total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI), were compared between COVID-19 positive (study group) and COVID-19 negative mothers (control group). There were 25 mothers in each group.Malondialdehyde, TOS, TAS, and OSI values were not associated with maternal age, delivery mode, gestational age, gender, anthropometric measurements, or APGAR scores.Malondialdehyde (26.97 nmol/L [11.14-46.88] vs. 9.93 nmol/L [7.33-13.40], p = 0.001) and TAS (2.13 ± 0.30 mmol/L vs. 1.93 ± 0.19 mmol/L, p = 0.005) values in the study group were significantly higher compared to the control group.The TOS and OSI were similar between the groups. Malondialdehyde and TAS were higher in the umbilical cord blood of COVID-19 positive mothers than in healthy controls during the third trimester. Third trimester maternal COVID-19 infection may be associated with increased oxidative stress, accompanied by a compensatory antioxidant response.
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The study aimed to investigate the prevalence of osteoporosis in children and adolescents with transfusion-dependent thalassemia (TDT) and evaluate the diagnostic value of different osteoporosis indicators. Clinical data were collected from children and adolescents with TDT treated with blood transfusion between March 2022 and January 2024 at Huizhou Central People's Hospital and Huizhou First Hospital. The patients were grouped according to the presence of osteoporosis (International Society for Clinical Densitometry [ISCD] criteria). Of 138 patients included in the study, 48 (34.8%) had osteoporosis. The patients with osteoporosis mainly had asymptomatic grade I fractures of the spine. Using the dual-X-ray absorptiometry (DXA) standards from the World Health Organization, height-corrected TBLH Z-score ≤-2 was associated with osteoporosis (30.4% vs. 14.9%, P = 0.035), displaying 30.4% sensitivity and 85.1% specificity. According to the Chinese DXA standards, height-corrected and age-specific Z-scores ≤-2 were not associated with osteoporosis. The prevalence of osteoporosis among children and adolescents with TDT was 34.8%, indicating the need for screening for osteoporosis in that population. In TDT, the diagnosis of osteoporosis requires early detection of spinal fractures because bone density assessed by DXA is of limited value.