B-cell acute lymphoblastic leukemia (B-ALL) is the most common pediatric cancer, comprising almost 25 % of childhood malignancies. Despite advances in chemotherapy, relapse remains a major cause of treatment failure, particularly in high-risk patients. Blinatumomab, a CD19-directed bispecific T-cell engager, approved for relapsed/refractory and measurable residual disease (MRD)-positive B-ALL, but its benefit in pediatric patients at increased risk of relapse remains uncertain. To evaluate whether adding blinatumomab to chemotherapy improves survival and MRD outcomes in pediatric patients with relapsed/refractory or high-risk frontline B-ALL. We searched PubMed, EMBASE, and Cochrane Library through March 2025, following PRISMA 2020 guidelines. Randomized controlled trials (RCTs) evaluating blinatumomab versus chemotherapy in pediatric B-ALL patients at increased risk of relapse. Primary outcomes were disease-free survival (DFS). Overall survival (OS), MRD, and adverse effects were also assessed. Risk ratios (RRs) with 95 % confidence intervals (CIs) were pooled using random-effects models. Four RCTs involving 2,011 patients were included. Blinatumomab significantly improved DFS (RR: 0.63, 95 % CI: 0.47-0.83; P = 0.001) and OS (RR: 0.62, 95 % CI: 0.47-0.84; P = 0.002). No statistically significant improvement was observed in MRD clearance (RR: 1.21, 95 % CI: 0.56-2.62; P = 0.62). Adverse event rates were similar between groups (RR: 1.00, 95 % CI: 0.57-1.75; P = 0.99), although heterogeneity was high. This meta-analysis suggests that adding Blinatumomab to chemotherapy improves survival in pediatric relapsed/refractory B-ALL and selected high risk frontline populations. However, limited frontline evidence and variability in MRD and toxicity reporting warrant further standardized pediatric studies.
Pediatric dog bite injuries are a common cause of emergency department. This study aimed to characterize management, and outcomes of pediatric dog bite injuries at a tertiary care center and identify implications for pediatric emergency practitioners. A retrospective chart review was conducted of patients with dog bite injuries over two-years at a single pediatric tertiary care center. Descriptive statistical analysis was performed on injury characteristics, management, and outcomes. Most injuries occurred in familiar environments. Facial injuries were most common (83%). Nearly all patients (98.9%) required laceration repair mostly in the emergency department. Most patients had antibiotics. Minimal complications were observed and were primarily cosmetic. Pediatric dog bite injuries most frequently involve the face and are typically managed nonoperatively. Multidisciplinary consultation is often required, particularly for complex facial injuries. This supports prompt assessment, appropriate wound management, and targeted antibiotic use in pediatric emergency care.
The annual economic burden of obesity has reached 190 billion dollars in the US and around 62 billion Egyptian pounds in Egypt. It is linked to many harmful diseases, including diabetes mellitus, cardiovascular, liver, reproductive, bone diseases, and many others. Modeling of obesity and obesity-associated comorbidities represents a fruitful area of research. Animal models of obesity have many limitations regarding reliability, translatability, and extrapolation to human obesity. Microfluidic "organ on a chip" has emerged in recent decades as a potent in vitro tool for studying human diseases, offering advantages over traditional in vitro models, thereby facilitating the development of a human on a chip model. This review will briefly discuss obesity-associated metabolic disturbances and the recent publications that tried to use microfluidic devices to answer obesity-related questions. This review covers the role of in vitro modeling using microfluidic devices in obesity research. The different species of invertebrates utilized in obesity research have also been investigated, including nematodes, with a highlight on Caenorhabditis elegans. Research on anti-obesity drugs, which could potentially aid in managing obesity, has been increasing daily. Natural anti-obesity phytoconstituents have shown considerable therapeutic potential in obesity, with many plant extracts and single components with promising effects. In conclusion, integrating microfluidics, invertebrate models, and phytochemical screening is promising for obesity research, yet it requires further standardisation and clinical validation to enable personalised therapies.
Excessive scarring (ES), including keloids and hypertrophic scars, impairs function, appearance, and quality of life in children. Its pediatric comorbidity spectrum is not well defined, limiting anticipatory guidance and multidisciplinary care. This research aims to investigate comorbidities of ES in a diverse pediatric cohort using a phenome-wide association study (PheWAS). This population-based study leveraged longitudinal electronic health record (EHR) data from participants enrolled in the Children's Hospital of Philadelphia (CHOP) from 2006. Diagnosis codes (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] and Tenth Revision [ICD-10-CM]) were mapped to 3109 phenotype codes (PheCodes). PheWAS analyses were conducted using logistic regression, with Bonferroni correction applied to account for multiple testing. Among 86,092 pediatric participants, 662 (0.77%) were identified with ES; the remaining served as controls. Multivariable PheWAS screening identified 154 significant associations across 16 disease categories, of which 105 were not reported previously to our knowledge. Dermatologic phenotypes (n = 28; 18%) were most enriched, including acne and other follicular disorders, eczema, pigmentary changes, papulosquamous and granulomatous disorders, and cutaneous infections. Respiratory phenotypes (n = 21; 14%) included respiratory failure, pneumonia, asthma, allergic rhinitis, pharyngitis, and tonsillar hypertrophy. Sense organ disorders (n = 19; 12%) comprised conjunctivitis, refractive errors, otitis, and hearing impairment. Infection-related phenotypes (n = 14; 9%) highlighted susceptibility to viral (influenza, human papillomavirus [HPV], molluscum contagiosum), fungal (candidiasis, dermatophytosis), and bacterial infections. These findings suggest that ES in children indicates not only localized wound-healing impairment, but also systemic immune, developmental, and proliferative dysregulations, emphasizing the need for genetic and mechanistic studies to clarify causal pathways and multidisciplinary surveillance beyond dermatologic care.
The aim of this study was to develop a conceptual framework for understanding surgeon grief in pediatric neurosurgery, examine its intersection with moral distress and professional burnout, and review evidence for institutional interventions supporting physician well-being after patient death. The author conducted a narrative review of English-language literature on physician grief, moral distress, and burnout in surgical specialties, with attention to pediatric practice. PubMed, PsycINFO, and CINAHL were searched for publications from January 2000 to December 2024. The initial search yielded 847 articles; after screening, 67 met inclusion criteria for narrative synthesis. An illustrative case of a neonate with an unresectable brain tumor contextualizes the framework. Five dimensions of surgeon grief specific to therapeutic futility were identified: grief of unexpressed mastery (inability to deploy technical expertise), grief of identity disruption (challenge to action-oriented surgical identity), grief of anticipatory knowledge (burden of prognostic awareness), grief of perceived failure (internalization of patient death as personal defeat), and disenfranchised grief (grief not socially recognized within surgical culture). These dimensions interact bidirectionally with moral distress to produce cumulative emotional burden contributing to burnout and career attrition. Evidence supports institutional interventions that include structured debriefing, peer support programs, Schwartz Rounds, and early palliative care integration. Surgeon grief represents a significant but understudied occupational hazard in pediatric neurosurgery. The proposed 5-dimension framework provides a conceptual foundation for research, instrument development, and targeted interventions. Recognizing that providing a good death is a form of surgical success and that surgeon grief reflects preserved humanity is essential for workforce sustainability.
Despite high efficacy and favorable safety profile in adults, Onabotulinumtoxin A (ONA) injections have not been Food and Drug Administration approved for pediatric migraine due to a lack of consistent data in children with chronic headaches. We prospectively surveyed 45 patients between 12 and 22 years of age with chronic migraine receiving ONA treatments using the Phase II Research Evaluating Migraine Prophylaxis Therapy protocol in our pediatric headache clinic. Subgroup analysis was performed on patients with daily chronic migraine. Headache frequency, pain scores, and disability were assessed at baseline and 6 weeks after each treatment. Forty-five patients were included for analysis; median age was 17 years, and 36/45 (80%) were female. Twelve out of forty-five (27%) patients had a greater than 50% reduction in headache days after one treatment (P < 0.005). Of the patients with available data following two treatments, 8/24 (33%) patients had a greater than 50% decrease in headache days (P = 0.004). In the subset of patients with daily chronic migraine, 6/27 (22%) patients had a greater than 50% reduction in headache days after the first treatment (P = 0.016). Mean headache disability as measured by the Headache Impact Test decreased after the first four treatments in the entire cohort and after the second and third treatments in the subset of patients with chronic daily migraine. These results suggest that ONA is effective in decreasing headache frequency and disability in pediatric patients with both chronic migraine and daily chronic migraine, which may improve quality of life.
ObjectiveChildren with congenital heart disease are highly vulnerable to drug-related adverse effects due to the use of complex polypharmacy. This study aimed to develop and retrospectively evaluate a hybrid clinical decision support system for predicting drug-related adverse effects in this population.MethodsThis two-phase study combined machine-learning techniques and expert clinical rules. Phase 1 included a retrospective analysis of 4651 pediatric congenital heart disease reports from the Food and Drug Administration Adverse Event Reporting System to train and compare five machine-learning models. The best-performing model, Random Forest, was selected. In Phase 2, a hybrid clinical decision support system integrating the Random Forest model with an expert-validated rule-based engine was developed and retrospectively evaluated using 330 inpatient records of pediatric patients with congenital heart disease.ResultsThe Random Forest model achieved a mean area under the receiver operating characteristic curve of 0.902. During clinical validation, the hybrid clinical decision support system demonstrated a mean accuracy of 0.85 across 11 common drug-adverse effect pairs, outperforming standalone machine-learning- and rule-based approaches. This study demonstrated the feasibility and clinical fidelity of using a hybrid clinical decision support system for predicting drug-related adverse effects in pediatric patients with congenital heart disease, supporting safer and more personalized pharmacotherapy.ConclusionsThis study demonstrated the feasibility and clinical fidelity of using a hybrid clinical decision support system for predicting drug-related adverse effects in pediatric patients with congenital heart disease, supporting safer and more personalized pharmacotherapy.
Pediatric tuberculosis (TB) remains underdiagnosed in high-burden, resource-limited settings. Caregivers' knowledge and perceptions, along with healthcare providers' practices, are crucial for early recognition and timely care-seeking for children with suspected TB. To assess knowledge, perceptions, and care-seeking practices related to pediatric tuberculosis among caregivers and healthcare providers in the Kabondo-Dianda Health Zone, Democratic Republic of the Congo. A descriptive cross-sectional study was conducted in 2024 among 163 caregivers and 27 healthcare providers selected through convenience sampling. Data were collected through face-to-face interviews using a structured questionnaire covering sociodemographic characteristics, knowledge of tuberculosis transmission and prevention, perceptions of tuberculosis transmission, and care-seeking practices. Tuberculosis knowledge was assessed using 11 items related to transmission and prevention, and composite knowledge scores were calculated. Perceptions were assessed through structured items exploring biomedical and non-biomedical beliefs, including perceived transmission through coughing, contact, evil spirits, and domestic animals. Care-seeking practices were assessed by documenting the first point of care, timing of consultation, and reasons for choosing specific care options. Data were analyzed descriptively using frequencies, percentages, mean scores, and group-level comparisons. No inferential statistical tests were performed. Caregivers had a low tuberculosis knowledge score, with a mean of 2.7 ± 1.28 out of 11 and a knowledge index of 24.5/100. Healthcare providers had a higher score, with a mean of 8.3 ± 1.36 and a knowledge index of 75.5/100. Among caregivers, misconceptions were common, including perceived transmission by evil spirits and domestic animals. Only 49.1% of caregivers reported seeking care first at a health facility, while 64.5% reported delayed care-seeking and 50.9% reported informal care-seeking. Among healthcare providers, 70.4% reported health facilities as the first point of care, 48.1% reported delayed consultation, and 29.6% reported informal care-seeking. In descriptive comparisons, healthcare providers showed higher tuberculosis knowledge scores and reported more frequent use of formal health services than caregivers. However, no inferential statistical tests were performed; therefore, these observations should not be interpreted as statistically significant associations. This study identified important gaps in pediatric tuberculosis knowledge, perceptions, and care-seeking practices, particularly among caregivers. The findings suggest the need to strengthen community-based tuberculosis education, culturally appropriate risk communication, and continued capacity-building of frontline healthcare providers, while recognizing the descriptive nature of the study. Given the descriptive design and convenience sampling, the findings should be interpreted cautiously and cannot establish statistical associations or causal relationships.
To compare real-world initial treatment strategies for pediatric head and neck lymphatic malformations using a multidimensional outcome framework that distinguishes complete radiological response, objective lesion response, progression control, and treatment burden, and to examine how lesion complexity influences treatment selection and outcomes. We conducted a retrospective cohort study of pediatric patients with head and neck lymphatic malformations treated at a tertiary referral center between January 2016 and December 2025. Patients were categorized into surgery alone, interventional therapy alone, medical therapy alone, or combined therapy according to the initial treatment strategy. Radiological outcomes were classified as complete response, partial response, stable disease, or progression/recurrence. Primary outcomes included complete response, objective response rate, progression/recurrence, and progression-free survival. Lesion complexity was classified using an exploratory, literature-informed framework based on De Serres stage, cystic subtype, number of involved anatomical regions, and critical structure involvement. Multivariable logistic regression, generalized propensity score-based overlap weighting, propensity score matching, event-density analysis, and follow-up sensitivity analyses were used to address confounding by indication and unequal follow-up. Among 210 patients, 40 received surgery alone, 110 interventional therapy alone, 23 medical therapy alone, and 37 combined therapy. Surgery alone achieved the highest complete response rate (75.0%). Interventional therapy alone showed the highest objective response rate (87.3%), highest disease control rate (95.5%), lowest progression/recurrence rate (4.5%), and lowest additional-treatment rate (4.5%). Medical therapy alone had the highest progression/recurrence rate (39.1%), a pattern that may at least partly reflect the selection of systemic therapy for more complex disease, although a contribution from limited treatment effect in this heterogeneous group cannot be excluded. High-complexity lesions were less likely to achieve complete response and had numerically higher progression/recurrence. The main outcome patterns remained directionally consistent after multivariable adjustment, overlap weighting, propensity score-matched sensitivity analysis, and follow-up sensitivity analyses. Initial treatment strategies for pediatric head and neck lymphatic malformations demonstrated distinct outcome profiles rather than a simple hierarchy of effectiveness. Surgery alone was most strongly associated with complete radiological response, whereas interventional therapy alone showed a favorable objective-response and progression-control profile. A multidimensional framework integrating eradication, objective response, lesion complexity, treatment burden, and progression control may better support individualized treatment selection.
Pediatric idiopathic intracranial hypertension (IIH) and growth plate disorders (GPD) show parallel epidemiological trends and carry possible pathophysiological links, especially regarding obesity and hormonal dysregulation. This study investigated their indirect relationship through structural equation modeling (SEM) to identify age-dependent mechanisms and guide precision treatment strategies. Following PRISMA 2020 guidelines, we searched literature databases from inception to May 15, 2025, identifying studies reporting pediatric IIH and/or GPD parameters. SEM analysis was performed with age-stratified models to evaluate the mediating effects of obesity and hormonal factors between prepubertal (<10-12 years) and postpubertal (>10-12 years) cohorts. We included 22 eligible studies with total of 2293 individuals. SEM revealed peculiar age-dependent mechanisms. In prepubertal children, venous pressure (β = 0.68, P-value<0.001) and vitamin D/hormonal pathways (β = 0.56, P-value<0.001) dominated, with obesity showing minimal effect (β = 0.28, P-value = 0.001). In a controverse manner, in postpubertal patients, the obesity pathway predominated (β = 0.76, P-value<0.001) with reduced venous (β = 0.29, P-value = 0.003) and hormonal (β = 0.16, P-value = 0.038) contributions. Mechanism-specific therapeutic efficacy showed parallel patterns: acetazolamide/surgical interventions were superior for venous-dominant cases (g = 1.86/1.74), while weight management demonstrated greatest efficacy for obesity-dominant phenotypes (g = 1.75). Vitamin D supplementation showed significant benefit only in hormonal-dominant cases (g = 1.64). Pediatric IIH demonstrates fundamental mechanistic heterogeneity across development. A puberty-associated shift from venous/hormonal to obesity-dominant mechanisms explains the changing demographics and provides a framework for precision treatment. Targeted therapeutic approaches based on dominant mechanisms showed 63% improved outcomes compared to standard of care of IIH.
Pyoderma gangrenosum is a rare neutrophilic dermatosis that presents as rapidly progressive ulcerative lesions, often associated with systemic diseases. Pyoderma gangrenosum remains an uncommon and challenging diagnosis particularly in a pediatric population. We report a 3-year-old male with myelodysplastic syndrome who developed a nonhealing ulcer of the right forearm following minor trauma. The lesion was misdiagnosed as an infection, leading to prolonged antibiotic therapy. The patient underwent surgical debridement and closure of the ulcer with bilateral advancement flaps with biopsies taken. However, the wound dehisced and ulcerated. Due to the progressive nature and lack of response to antimicrobials, pyoderma gangrenosum was suspected and later confirmed through clinical and histopathologic findings. The patient demonstrated significant clinical improvement with 2 months of topical and systemic corticosteroid therapy. This case highlights the challenges of diagnosing pyoderma gangrenosum in pediatric populations, and the utility of histology in management, given the low index of suspicion in children.
Drowning is a leading cause of pediatric death in the United States, yet data characterizing these arrests is limited. Our study aimed to describe demographic and emergency medical services (EMS) response characteristics for drowning-related pediatric out-of-hospital cardiac arrests (pOHCAs). Using the 2023 National Emergency Medical Services Information System dataset, we conducted a cross-sectional study of EMS-attended 9-1-1 responses involving children 1 day-17 years old who experienced a drowning-related pOHCA. We used descriptive statistics and multivariable logistic regression (adjusted odds ratio; 95% confidence intervals) to identify factors associated with return of spontaneous circulation (ROSC). Our study included 753 drowning-related pOHCAs. Most arrests were toddlers aged 1-4 years (57.8%), males (64.5%), at private residences (72.5%), and in urban settings (83.7%). EMS clinicians were commonly dispatched during the summer (46.7%) and between 12:00 and 17:59 (47.4%). Arrests were often unwitnessed (73.7%) and received bystander cardiopulmonary resuscitation (CPR) (81.3%). Fifty-four percent of adolescent arrests were unwitnessed compared to 80.5% among toddlers (P < 0.001). Most arrests (81.3%) received bystander CPR. Shockable rhythms were uncommon (4.6%). EMS-witnessed ROSC was obtained in 42.0% of arrests. In multivariable regression, adolescent age (3.25; 1.25-8.79), witnessed arrests (1.59; 1.03-2.45), and bystander CPR (2.83; 1.67-4.96) were associated with higher odds of ROSC. Most drowning-related pOHCAs involved young children, with age-based differences in scene characteristics and pre-EMS arrival factors. Adolescent arrests were more frequently witnessed and more likely to obtain ROSC. Opportunities exist to improve drowning prevention among children and enhance the chain of survival.
Zinc supplementation is recommended in both acute and persistent diarrhea; however, comparative data on longitudinal biochemical response between these conditions are limited. This prospective observational study was conducted at the pediatric department of a tertiary care center in Northern India, which enrolled 72 children: 36 with acute diarrhea (group A) and 36 with persistent diarrhea (group B). All participants received oral zinc sulfate syrup providing 20 mg elemental zinc daily for 14 days. Serum zinc was measured at Day 1, 14, and 28. Longitudinal analysis was performed using a linear mixed-effects model with time and group as fixed effects and subject as a random effect. A gradual increase in serum zinc was observed in both groups. No statistically significant group-time interaction was detected, indicating similar trajectories. Zinc supplementation resulted in a modest but consistent increase in serum zinc levels in both groups. No significant difference was detected between acute and persistent diarrhea. These findings do not suggest a need for higher dosing; however, further adequately powered studies are warranted.
Hyperferritinemia is increasingly recognized as a marker of inflammation and severity in sepsis. This study aimed to ascertain the level of ferritin as a predictor of septic shock (SS) and its association with outcome. A prospective observational study was conducted on 123 children diagnosed with severe sepsis and SS at a tertiary care hospital of North India. Serum ferritin levels were measured, with hyperferritinemia defined as levels >500 ng/ml. Good outcome was defined as discharge or improving clinical status, and bad outcome was defined as death or clinical deterioration. The association of hyperferritinemia with SS and clinical outcomes was analyzed and statistically evaluated. Analysis of the area under the curve (AUC) and the receiver operating characteristic (ROC) curve was constructed to assess the predictive strength of ferritin as a marker of SS. Sensitivity, specificity, and positive and negative likelihood ratios were calculated at different cutoff values of serum ferritin. Hyperferritinemia was found in 66.6% of patients, with significantly higher levels in SS (1,624.67 ± 1,522.02 ng/ml) than sepsis (727.02 ± 1,081.12 ng/ml, p = 0.005). Hyperferritinemia (serum ferritin ≥ 730 ng/ml) was a predictor of SS (AUC = 0.80; 95% CI = 0.72-0.89; p value = 0.02). Mortality was higher in patients with hyperferritinemia (odd ratio = 12.9; 95% CI = 1.67-99.90; p value = 0.001). Serum ferritin at a level of 2,214 ng/ml was found to be predictive of secondary hemophagocytic lymphohistiocytosis (sensitivity of 100% and specificity of 94.8%). Hyperferritinemia is prevalent in pediatric sepsis and SS and is significantly associated with higher mortality. Serum ferritin may serve as a potential prognostic marker for identifying high-risk patients.
Sleep electroencephalography (EEG) patterns exhibit complex variations influenced by multiple factors, including age and sex. While sex effects in sleep neurophysiology are well-described in adults, evidence in pediatric populations is limited, particularly in the context of neurodevelopmental disorders (NDDs). Here, we analyzed a large pediatric clinical dataset to examine sex differences in whole-night sleep EEG among children without NDDs (N = 1523, 2.5-17.5 years) and those with autism spectrum disorder (ASD,N = 196), attention deficit hyperactivity disorder (ADHD,N = 523), and intellectual disabilities (IntDis,N = 167). We investigated sleep macro- and microarchitecture, including spectral power, density and morphology of spindles and slow oscillations, and their temporal coupling. Significant sex differences in the non-NDD sample were observed across features of sleep macroarchitecture, spectral power, sleep spindles, and slow oscillations, with the majority of findings replicated in an independent cohort. More specifically, non-NDD boys exhibited more fragmented sleep compared to girls, but this pattern was not observed among children with NDDs. In contrast, fast spindle density was lower in boys regardless of NDD diagnosis, which may contribute to males' increased susceptibility to developing NDDs. No sex differences were observed in EEG-based brain age predictions. Medical record analysis revealed limited sex differences in the prevalence of sleep disorders. We found strong evidence of altered sleep EEG characteristics in boys and girls with IntDis. Several sleep EEG metrics showed nominal group-by-sex interactions with ASD and ADHD girls displaying more pronounced alterations, pointing to a varying degree of sleep disturbance. Our findings demonstrate that many sleep EEG features exhibit significant sex differences during childhood, but these differences may be distinct in NDD populations. The sex-specific sleep alterations in NDDs highlight the potential importance of considering sex in pediatric sleep research.
Brain abscess is a focal, life-threatening infection of the central nervous system associated with high morbidity and mortality, remaining scarcely studied in low-income settings. This study describes the clinical and epidemiological profile of patients with brain abscess at Hospital Escuela, Honduras (2018-2023), including treatment patterns and in-hospital outcomes. A retrospective descriptive case series was conducted at a tertiary referral hospital. Thirteen medical records were identified through ICD-10 coding (G06.0-G06.2). With diagnoses confirmed by radiological, microbiological, or documented clinical-team criteria. Analyzed variables included demographics, predisposing conditions, neuroanatomical location, number and estimated volume of abscesses, neuroimaging modality, microbiological findings, empirical and pathogen-directed antibiotic regimens, intensive care admission, and modified Rankin Scale at discharge. Descriptive statistics (frequencies and proportions with 95% confidence intervals by the Wilson method) were used. The study followed the STROBE reporting guidelines. Of 13 patients, 61.5% were male, and 53.8% were pediatric (≤15 years; range 8-14 years). All abscesses were supratentorial (100%; 95% CI: 77.0-100.0%), with parietal and occipital lobes each affected in 30.8% of cases. Traumatic brain injury was the most frequent individual predisposing condition (23.1%; all three cases pediatric). Etiologic identification at any level was achieved in 30.8% of cases; direct microbiological confirmation from cerebrospinal fluid was available in one case. Identified organisms included Streptococcus spp. and uncommon opportunistic pathogens (Burkholderia pseudomallei, Cryptococcus neoformans, Staphylococcus spp., and Nocardia spp.). Neurological status at admission was preserved in 84.6% (GCS 13-15). All patients were managed exclusively with intravenous antimicrobial therapy; no patient underwent neurosurgical drainage. In-hospital mortality was 0, and 46.2% of patients were discharged with no significant disability (mRS 0-1), 30.8% with slight disability (mRS 2), and 23.1% with moderate disability (mRS 3). This first institutional clinical-epidemiological characterization of brain abscess in Honduras demonstrates a pediatric-skewed cohort, a low etiologic identification rate, and a management pattern characterized by exclusive medical therapy. Survival was universal, but substantial neurological morbidity persisted at discharge. The findings should be interpreted as descriptive of a single national referral center and provide baseline data for future multicenter research in Central America.
Adults with developmental and epileptic encephalopathies (DEEs) often enter adult neurology care without etiologic clarification because of incomplete transition from pediatric services, outdated investigations, and attenuation of childhood electro-clinical features over time. We aimed to assess the clinical utility and diagnostic yield of a structured, phenotype-guided etiologic workup in adults meeting study criteria for DEE and to explore associations between electro-clinical phenotype and etiologic category. We prospectively enrolled consecutive adults (≥18 years) with drug-resistant epilepsy and neurodevelopmental impairment temporally related to epileptic activity, consistent with the ILAE operational definition of DEE, referred to a tertiary epilepsy center between May 2022 and December 2025. Patients underwent a 4-phase reassessment pathway including critical review of prior documentation, detailed clinical and semiologic phenotyping, prolonged video-EEG monitoring, phenotype-guided genetic testing (targeted resequencing, chromosomal microarray), high-resolution neuroimaging, and multidisciplinary case review to support etiologic clarification and treatment planning. Among 144 patients (mean age 28.4 years; 57.6% male), a confirmed etiology was identified in 91 (63.2%). Genetic causes predominated (65 patients, 45.1%), including monogenic (53, 36.8%) and chromosomal (12, 8.3%) disorders, primarily resolved via targeted resequencing gene panels and via chromosomal microarray analysis respectively, while structural-metabolic etiologies accounted for 26 cases (18.1%). Lennox-Gastaut syndrome was significantly associated with structural-metabolic and chromosomal etiologies (69.2% and 58.3% vs. 9.4% in monogenic; p < 0.0001), whereas, excluding patients with a broader Lennox-Gastaut syndrome phenotype, absence seizures occurred exclusively in monogenic cases (p = 0.024). Etiologic clarification changed clinical management in 27.1% of the cohort, including antiseizure medication optimization/precision therapies (25%) and pre-surgical referral (2.1%). In adults with suspected DEE, the practical value of this approach lies not only in diagnostic yield, but in showing that structured adult reassessment remains clinically worthwhile. Electro-clinical phenotype can help prioritize etiologic testing, and etiologic clarification can support more informed treatment planning and counseling even long after transition from pediatric care. Adults with developmental and epileptic encephalopathy (DEE) often reach adult epilepsy services without a clear diagnosis. In this study, we used a structured approach combining clinical review, video-EEG, MRI, genetic testing, and multidisciplinary discussion in 144 adults with suspected DEE. We identified a confirmed cause in 63.2% of patients. Genetic causes were the most common, but structural and metabolic causes were also important. Some seizure patterns helped guide diagnosis: Lennox-Gastaut syndrome was more common in structural-metabolic and chromosomal cases, while absence seizures occurred only in monogenic cases. Identifying the cause also helped guide treatment decisions, including medication changes, targeted therapies, surgery referral, and genetic counseling. This study shows that adults with suspected DEE can still benefit from careful diagnostic reassessment, even years after childhood.
The aim of this study was to investigate the potential relationship between rod overhang (RO) and quality of life (QoL) scores, as well as implant-related irritation, in patients with adolescent idiopathic scoliosis (AIS) and Scheuermann's kyphosis (SK). Between October 2016 and December 2018, a total of 33 pediatric patients with AIS and SK who underwent posterior instrumentation were retrospectively analyzed. On radiographs, the longest RO at both the superior and inferior ends (right or left) was recorded, and patients were grouped according to whether RO exceeded 1 cm. Quality of life outcomes were assessed using the Scoliosis Research Society-22r (SRS-22r), Oswestry Disability Index (ODI), and Short Form-36 (SF-36) questionnaires, and patients were also asked about implant-end irritation. Of the patients, 10 were male and 23 were female. The mean age at the time of operation was 15.18 ± 1.98 years, while the mean age at the latest follow-up was 23.85 ± 1.86 years. The median follow-up was 104.08 months. The mean maximum RO was 11.3 ± 7.8 mm superiorly and 11.1 ± 6.2 mm inferiorly. Superior RO correlated significantly with SF-36 role-physical (r = -0.36, p = 0.04) and vitality (r = -0.43, p = 0.01) subdomains; no other significant QoL correlations were found. Implant-related irritation was reported in eight (n = 3 superior, n = 5 inferior) patients. There was no significant difference in RO between patients who did and did not report implant-related irritation (superior p = 0.18 vs. inferior p = 0.48). There were no significant differences in QoL scores (for superior, inferior, and either end; p > 0.05) or in the rate of implant-related irritation between patients with RO greater or less than 1 cm (superior p = 0.70; inferior and either end p = 1.00). Our study results suggest that rod overhangs up to 3 cm may not be a clinically relevant determinant of patient-reported outcomes or implant-related irritation in AIS and SK surgery. From a clinical perspective, this may help reduce concern regarding minor distal or proximal overhang during posterior instrumentation, particularly when optimal correction and fixation require slight extension of the construct. The absence of a measurable association with QoL or irritation also supports a more flexible intraoperative decision-making approach, prioritizing deformity correction and implant stability over strict limitation of rod length within this range.
Collaboration between healthcare and education sectors is essential for advancing pediatric research, yet it is often limited by disciplinary silos and the lack of high-quality linked data. Few child health cohorts have been able to link individualized health information with academic achievement. To examine whether early child growth and screen time were associated with academic achievement in elementary school in Ontario, Canada. A prospective cohort study was conducted among children participating in the TARGet Kids! primary care practice-based cohort (www.targetkids.ca) in Ontario, Canada between 2008 and 2023. TARGet Kids! collects repeated measures of child growth (direct anthropometric measurements) and health behaviours (parent-reported screen use) since birth and has access to participants' electronic medical record. Through a data sharing partnership with the provincial testing agency (EQAO), participants have been linked to their Grade 3 and Grade 6 annual standardized assessments in reading, writing, and math since 2012. Proportional odds models were used to examine associations between child growth, daily screen time, and academic achievement, adjusting for covariates. Linked data were available for 3322 Grade 3 and 2084 Grade 6 students. Each additional hour of screen time was associated with 10 % lower odds of achieving a higher academic level in reading and math. Underweight and overweight status were also associated with lower academic achievement. Strengthening collaboration and data linkage between health and education sectors is important. Early interventions that promote healthy behaviours and growth should be developed and tested to support academic success in elementary school.
Congenital heart disease (CHD) is the most common congenital anomaly world-wide, yet data from Rwanda remain limited. Understanding its clinical profile and outcomes is essential for improving pediatric cardiac care. This study aimed to describe the clinical characteristics, diagnostic patterns, management strategies, and outcomes of cCHD among children under 5 years of age at a tertiary hospital in Kigali, Rwanda, and to compare these parameters across different CHD subtypes. A retrospective hospital-based cross-sectional study was conducted at the University Teaching Hospital of Kigali (CHUK), Rwanda, from June 2022 to December 2023. Medical records of children under 5 years with echocardiographically confirmed CHD were reviewed. Demographic, clinical, management, and outcome data were analyzed using descriptive statistics and comparative tests, with statistical significance set at P < .005. Among 361 children with CHD, the mean age was 33.3 ± 20.8 months, and 51.8% were female. Acyanotic CHD predominated (83.7%), with ventricular septal defect (VSD) (35.1%) and patent ductus arteriosus (PDA) (29.8%) most common; Tetralogy of Fallot (TOF) was most frequent among cyanotic lesions (76.3%). The most common clinical features were breathing difficulties (71.5%) and failure to thrive (53.5%). Transthoracic echocardiography was the primary diagnostic tool, preceded by cardiac ultrasound in 66.2%. Medical therapy was the mainstay (furosemide 76.5%), with cardiac interventions performed in 34.6% (most commonly VSD closure and atrial septal defect (ASD) repair). Follow-up was the most frequent outcome (acya-notic 54%, cyanotic 71%), with low mortality (3.0% vs 3.4%). Children with cyanotic CHD wereolder and had higher anthropometric measurements, while stunting was more frequent in acyanotic lesions (96% vs 78%, P < .001). Clinical features were not associated with mortality, and alldeaths occurred in children without comorbidities, suggesting an acute course of deterioration. Acyanotic CHDs were predominant among children under 5 in Rwanda, with late presentation and limited access to definitive interventions. Strengthening early screening, diagnostic capacity, and surgical services is crucial to improving outcomes. Further research on genetic and familial risk factors is warranted.