This study aimed to assess clinical outcomes and associated factors among children with meningitis at Ras Desta Damtew Memorial Hospital. A retrospective cohort study was conducted from April 2022 to May 2024. Multivariable logistic regression analyses were performed after adjusting for potential confounders and P < .05 considered significant. The magnitude of good clinical outcome was 90.9% (95% CI: 87.3, 94.4). Factors significantly associated were: age >2 months (AOR: 12.1; 95% CI: 3.39, 42.89; P < .001), duration of illness <72 hours prior to hospital admission (AOR: 4.75; 95% CI: 1.36, 16.56; P = .014), completed immunization status (AOR: 3.72; 95% CI: 1.19, 11.63; P = .024), and absence of severe acute malnutrition (AOR: 5.18; 95% CI: 1.18, 22.71; P = .029). Public health strategies should prioritize addressing severe acute malnutrition, ensuring complete immunization, and promoting early healthcare-seeking within 72 hours of symptom onset.
Dengue is endemic in India, placing all pregnant women at risk, with the highest likelihood of vertical transmission in the third trimester. Perinatal dengue remains poorly understood, particularly its hepatic manifestations and management in preterm neonates. We report a preterm male neonate (30 + 6 weeks, 1.94 kg) born to a dengue-infected mother, presenting with fever on day 4. Vertically transmitted dengue was confirmed by positive IgM and NS1 antigen. The infant developed severe hepatitis (SGOT 2160 U/l, SGPT 358 U/l), refractory thrombocytopenia (nadir 21 000/cumm) and hyperferritinaemia (>100 000 ng/ml). The baby was successfully managed with intravenous N-acetylcysteine for dengue-associated hepatitis and methylprednisolone for refractory thrombocytopenia, resulting in dramatic clinical improvement. Subsequently, he developed prolonged cholestasis, and by day 36, ultrasound showed hepatic dystrophic calcifications as post-infective sequelae, highlighting the need for vigilance and prolonged follow-up.
Hemolytic uremic syndrome is an acute condition where microvascular thrombi occur in the vasculature of the renal system, resulting in thrombocytopenia, microangiopathic hemolytic anemia, and acute kidney injury. Hemolytic uremic syndrome may originate from either congenital or acquired causes. Hemolytic uremic syndrome is initially treated with supportive care measures; however, if fulminant renal failure ensues, dialysis may be necessary.
To investigate the association of serum 25(OH)D levels with dengue severity in Vietnamese children and the association of common VDR gene polymorphisms with disease outcomes. This cross-sectional study included 178 children with confirmed dengue at a tertiary hospital in 2024. Serum 25(OH)D levels were measured, and 4 VDR polymorphisms (FokI, ApaI, TaqI, BsmI) were genotyped. Associations with WHO-defined severity were assessed using logistic regression. Severe dengue was more common in older children and was characterized by greater plasma leakage and thrombocytopenia (P < .001). Serum 25(OH)D concentrations were independently and inversely associated with dengue severity, with an adjusted odds ratio of 0.89 (95% CI: 0.85-0.93; P < .001). In contrast, allele and genotype distributions of the 4 VDR polymorphisms did not differ significantly across severity groups (P > .05). Our findings suggest vitamin D status may be more relevant to dengue severity than inherited VDR variation.
Primary renal Ewing sarcoma (ES) is an extremely rare and aggressive malignancy, with fewer than 100 cases reported worldwide. Diagnosis is difficult because its clinical and radiologic features mimic more common renal tumors, particularly in children, and the challenge increases in resource-limited settings where molecular testing may not be available. We report a 12-year-old Palestinian boy presenting with flank pain, weight loss, and night sweats. Contrast-enhanced CT revealed a large left renal mass, and radical nephrectomy was performed. Histopathology demonstrated small round blue cells with strong CD99 and NKX2.2 expression and negative WT1 staining, supporting the diagnosis of primary renal Ewing sarcoma. Confirmatory EWSR1 rearrangement testing was unavailable. The patient-initiated adjuvant chemotherapy and showed no radiologic recurrence at 3 months. This case highlights the important diagnostic role of immunohistochemistry when molecular testing is limited.
Access to timely and appropriate care for children with congenital heart disease (CHD) remains highly inequitable in low- and middle-income countries (LMICs). This systematic review synthesizes recent evidence on barriers to healthcare access for pediatric CHD and applies the SHEL human factors framework to analyze system-level determinants. This updated systematic review extends a prior analysis, applying PRISMA guidelines. Search was conducted in PubMed/MEDLINE, Scopus, and Web of Science. Regional trends were mapped via WHO classifications. Most studies reported barriers related to environmental factors, followed by workforce limitations, infrastructure constraints, and policy or organizational deficiencies. Many obstacles originated at the primary care level, contributing to delayed diagnosis and referral. Although all regions exhibited barriers across SHEL domains, their relative distribution varied by region. These findings highlight that improving CHD outcomes in LMICs requires integrated health system strengthening across levels of care.
Effective pulse oximetry monitoring in a newborn unit requires clinician action. However, if thresholds are not adapted to each neonate, frequent alarms cause alarm fatigue, which impacts the quality of patient monitoring, staff workload and clinical workflow. We conducted an observational study from October 2021 to December 2022 in a Kenyan newborn unit which enrolled neonates through convenience sampling. Data were analysed in R using default thresholds of 85% to 96% for SpO2 and 90 to 200 bpm for PR. Among the 49 neonates enrolled, median hourly alarms per patient were 12 visual and 9 audible. Half of SpO2 values were outside the set thresholds. The hourly alarm density per neonate was 4 SpO2 alarms and 1 PR alarm. The selected SpO2 alarm thresholds resulted in a high alarm burden which necessitates neonate-specific thresholds and delays. This improves monitoring specificity and sensitivity, enhancing neonatal care and effectiveness in resource-limited settings.
Pain is a common symptom at cancer diagnosis and often worsens with treatment and disease progression. Comprehensive evidence on its prevalence and severity in Africa remains limited. This systematic review and meta-analysis aimed to estimate the prevalence and severity of cancer-related pain among adult cancer patients in Africa using available evidence. Google Scholar, PubMed, and the Cochrane Library were searched for articles that reported the prevalence of pain in cancer patients in African countries. The methodological quality of included studies was assessed using a quality assessment tool for prevalence studies, and the certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Pooled estimates of the prevalence and severity of cancer-related pain were calculated. Study heterogeneity was assessed using I², while sensitivity analyses were performed to test the robustness of the findings. This meta-analysis included 23 studies conducted in African nations. In all included studies, 5378 patients with cancer at various stages of anticancer treatment were included. The pooled prevalence of pain was 76% (95% CI: 71%-81%, I 2 = 96.09%, p < 0.01), with 69% of individuals experiencing moderate-to-severe pain, all with moderate certainty. Regional estimates showed comparable pain prevalence in East and West Africa (78%, 95% CI: 70%-86%, I² = 96.3%) and 81% (95% CI: 76%-85%, I² = 67.3%), respectively, with lower prevalence in Southern Africa (67%, 95% CI: 55%-80%, I² = 97.5%). However, the heterogeneity was substantial. More than three-quarters of patients suffer from cancer-related pain, with a substantial proportion experiencing moderate-to-severe levels with moderate certainty. Considerable variability exists in pain prevalence and severity across studies and regions of Africa. As a result, findings should be interpreted with caution. Improving access to analgesics may help alleviate pain and enhance quality of life for cancer patients.
Lipoma of the corpus callosum is a rare congenital malformation of the central nervous system and is seldom encountered in clinical practice. These lesions are most often discovered incidentally during neuroimaging performed for unrelated clinical indications. We report the case of a male neonate presenting with transient hypotonia, in whom a congenital lipoma of the corpus callosum was identified on imaging. The diagnosis was established using cranial ultrasonography followed by magnetic resonance imaging. The clinical course was favorable, with spontaneous resolution of hypotonia under conservative management. This case highlights the role of ultrasound and MRI in the diagnosis of congenital intracranial lipomas and the typically benign course of isolated corpus callosum lipomas.
Angiotensin receptor blockers (ARBs) are commonly used to slow the progression of chronic kidney disease (CKD) but may worsen renal function in advanced kidney disease. We describe a 35-year-old man with stage 4 CKD who developed acute kidney injury shortly after starting an ARB, followed by severe abdominal pain and biochemical evidence of pancreatitis. Imaging excluded gallstones and ductal obstruction. Laboratory studies ruled out hypertriglyceridemia and hypercalcemia. He was found to have profound azotemia, consistent with uremia. His abdominal pain and elevated pancreatic enzymes improved rapidly with hemodialysis, supporting a diagnosis of uremic pancreatitis rather than direct losartan toxicity. Uremic pancreatitis is rare and usually described in patients with end-stage renal disease; its occurrence in earlier CKD stages is underrecognized. This case highlights uremia as a rare cause of pancreatitis that should be considered in the setting of worsening azotemia and abdominal pain. Patients should be carefully monitored when initiating ARBs in the setting of advanced CKD.
Early childhood development is shaped by interactions between biological, prenatal, nutritional, and social factors. Evidence regarding their domain-specific associations across ASQ-3 domains remains limited in Eastern Europe. To examine biological, prenatal, nutritional, and social predictors of developmental outcomes measured with the ASQ-3. This cross-sectional study included 167 full-term Bulgarian children aged 14-42 months. Parents completed age-appropriate ASQ-3 questionnaires and a structured survey on prenatal and family characteristics. Raw ASQ-3 scores were converted into age-standardized Z-scores. Stepwise multiple linear regression analyses were conducted for each domain. Longer breastfeeding duration was positively associated with communication, fine motor, and problem-solving outcomes. Prenatal tobacco exposure was associated with lower communication, fine motor, and problem-solving scores. Communication outcomes were additionally associated with residential setting and bilingual home environment. No significant predictors were identified for gross motor development. Early developmental domains demonstrate distinct associations with prenatal, nutritional, and social factors.
Pneumonia is an inflammation of the air sacs in the lungs in response to an injury, such as infection. When the lungs are also involved, it could be referred to as bronchopneumonia. It can be one area of the lung or several areas. According to international data, pneumonia has been the main cause of lower respiratory tract infection (RTI)-related morbidity and mortality. With an anticipated 505,000 deaths worldwide in 2021 (range from 454,000 to 555,000), S. pneumonia was the cause of the greatest percentage of all age-lower RTI-related deaths. To identify risk factors of pneumonia among under-five children who visit under-five OPD in Hadiya Zone public hospitals Central Ethiopia 2024. An institution-based unmatched case-control research design was used in Hadiya zone public hospitals, with 160 cases and 321 controls of children aged 2-59 months included in the sample. The cases were children with pneumonia, while the controls did not have pneumonia. Ethical clearance was obtained. Data was entered using Epi-Data version 4.6 and analyses using SPSS 27 statistical software. Bivariable and multivariable logistic regression analyses were performed to identify determinant factors. Statistical significance was declared at a p-value ≤ 0.05 with adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Place of cooking (AOR: 2.75, 95%CI: 1.66, 4.58), History of Diarrhea in the past 2 weeks (AOR: 6.37, 95%CI: 3.63, 11.2), History of parental asthma in the family (AOR: 4.32, 95%CI: 2.31, 8.05), and a children received PCV vaccine during their infancy period (AOR: 2.09 95%CI: 1.24, 3.51), were found to be risk factors of under-five pneumonia. In this study, the risk of pneumonia among under-five children was significantly associated with several factors, including whether the children came from households where people cooked indoors, whether the children had experienced diarrhea in the past two weeks, whether the children came from families where parents experienced asthma, and whether the children received the PCV vaccine in infancy. These factors are of critical importance in the management of pneumonia among under-five children and therefore warrant interventions aimed at reducing the risk of pneumonia in this group of people.
AI-driven triage presents a transformative opportunity to address persistent challenges in pediatric emergency care, from overcrowding and waiting times to human error and outcome disparities. This narrative review demonstrates that AI systems can achieve high accuracy in predicting critical outcomes, with pooled AUROCs of 0.87 for hospital admission, 0.93 for ICU admission, and 0.93 for mortality, significantly outperforming traditional triage scales, while observational studies report associations with improved efficiency, reduced triage errors, and enhanced resource allocation. However, publication bias favoring positive results affects the available evidence, and studies reporting no benefit or performance degradation exist. The promise of AI is tempered by significant challenges: performance varies across pediatric subgroups, the risks of perpetuating and amplifying bias remain inadequately addressed, and workflow integration and medico-legal liability require careful navigation. AI augments clinical judgment, guided by robust governance frameworks, fairness auditing, and human oversight for more equitable emergency care.
Henoch-Schoenlein purpura (HSP) is an immunoglobulin A mediated vasculitis and mainly affects skin, joints, gastrointestinal tract, and kidneys. Typically, skin lesions present as erythematous maculopapular, petechiae, and purpuric rash and atypically as a bullous lesion. A 6-year-old female presented with bullous lesions over her hands and legs, oligoarthritis, abdominal pain complicated with hypotensive shock. The patient was managed with fluid resuscitation, corticosteroids, and antibiotics which offered significant improvement. Bullous IgA vasculitis complicated by non-hemorrhagic hypovolemic shock is rare and may pose diagnostic challenges. Early recognition and timely management are essential to prevent morbidity.
This study aimed to determine the magnitude of premature mortality from sudden infant death syndrome (SIDS) in Ethiopia. The Global Burden of Disease data used to estimate the Years of life lost (YLLs) attributed to SIDS. The finding indicated 3153 YLLs rate per 100 000 infants (95% UI: 1569, 5206) attributed to SIDS, with 4278 YLLs per 100 000 males (UI: 2005, 7929) and 1972 YLLs per 100 000 females (UI: 774, 4406). The rate was higher in the first 5 months of life [5861 per 100 000 infants (UI: 2922, 9606)]. Lower than the national rate was estimated in Addis Ababa [1299 YLLs per 100 000 neonates (UI: 618, 2260)]. In conclusion higher YLL rate attributed by SIDS was found at the national and sub-national level, with infants in the first 5 months of life were disproportionately affected.
While the World Health Organization recommends exclusive breastfeeding (EBF) for the first 6 months, evidence on EBF practices among HIV-positive mothers in Ethiopia remains limited. This study aimed to assess the prevalence and determinants of EBF among HIV-positive mothers in the Gurage Zone and Yem Special Woreda, Central Ethiopia. A cross-sectional study was conducted from June 1 to 30, 2023, among mothers attending antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT) services. Data were collected using interviewer-administered questionnaires and analyzed with Statistical Package for the Social Sciences version 26. Logistic regression identified determinants of EBF, with significance at P < .05. Of 311 participants, 72.6% practiced EBF. Awareness of complementary feeding time, early breastfeeding initiation, family support, and HIV-status disclosure were determinants of EBF. The overall EBF among HIV-positive mothers was 72.6%. Interventions targeting the identified determinant factors could help improve mothers' adherence to EBF practices.
Infant mortality is a key indicator of population health and health system performance. This national study analyzed infant mortality in Mexico, examining temporal trends, leading causes of death, territorial inequalities, and indicators of surveillance quality. Using official mortality microdata for 224 212 deaths, we assessed patterns by cause of death, sex, health system affiliation, city size, and state of residence. Infant mortality remained largely stable during the study period (10.7 per 1000 live births in 2014 to 10.6 in 2023), despite an increase in reported medical attendance at death to 99.5% in 2023. Neonatal conditions including respiratory disorders, sepsis, prematurity, and congenital heart malformations accounted for most deaths. Territorial gradients were evident: smaller localities had lower probabilities of medical attendance and autopsy performance and higher proportions of deaths recorded as presumed external causes. Nearly 88% of infant deaths occurred among infants without social security affiliation, highlighting persistent inequities.
Markedly elevated IgE in children is an important but nonspecific clue, particularly with early-onset atopic dermatitis, eosinophilia, and infections. We report a boy who developed generalized eczema at approximately 6 months of age and was repeatedly hospitalized during infancy for severe dermatitis, prolonged diarrhea, pneumonia, acute otitis media, and Staphylococcus aureus bacteremia. Early investigations showed eosinophilia, hypoalbuminemia, rapid IgE escalation, and lymphocyte subsets not suggestive of a clear T-, B-, or NK-cell deficiency. After 12 months, no further severe infections requiring hospitalization were documented, whereas chronic severe dermatitis, eosinophilia, markedly elevated IgE, and later asthma became dominant. Whole-exome sequencing identified two FLG variants; among these, Sanger sequencing confirmed a heterozygous FLG NM_002016.2:c.6950_6957del (p.Ser2317Ter) variant. This case highlights overlaps between severe barrier-related atopic dermatitis and hyper-IgE syndrome and emphasizes longitudinal follow-up, immunological evaluation, vaccine history, genetic interpretation, and gene-environment interactions.
Pediatric nursing is rapidly evolving with the integration of innovative technologies aimed at improving healthcare delivery and outcomes for children. To map the extent and characteristics of pediatric nursing literature on (1) virtual reality (VR) for procedural care, (2) telehealth models, (3) artificial intelligence (AI)-supported diagnostics, (4) technology-enabled obesity interventions, and (5) digital mental-health tools; and to identify outcomes studied, populations/settings, study designs, and research gaps. A scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines was conducted. Peer-reviewed articles published from 2010 to 2024 were retrieved from PubMed, CINAHL, Scopus, Cochrane Library, and Google Scholar. Inclusion criteria were studies involving pediatric populations and addressing one of the specified technologies or interventions. Twenty-five studies were included. VR was effective in reducing procedural pain and anxiety. Telehealth improved care access, especially in underserved areas. AI-supported early diagnosis of diseases such as congenital heart defects. Nursing interventions for childhood obesity were most effective when multidisciplinary and personalized. Digital tools helped pediatric patients manage mental health conditions associated with chronic illness. However, gaps exist in long-term effectiveness, scalability, and integration. Emerging technologies in pediatric nursing offer substantial benefits but require further validation and structured implementation. Future research should focus on standardizing protocols, assessing cost-effectiveness, and addressing equity in access.
The topic of acute pain, especially post-operative pain, risks being unfairly relegated to the background. Although significant progress has been made in pediatric anesthesia, with a drastic reduction in perioperative mortality and morbidity, much remains to be done in terms of organization and training. Artificial intelligence can potentially help here. Combining data from large, well-structured datasets can provide predictive models that guide patients at higher risk of developing pain. Having reliable alerts would allow resources to be used not only more effectively, but also more rationally. Furthermore, artificial intelligence could help us diagnose and measure the pain of all those patients with cognitive barriers, exploiting nonverbal communication.