Precalcaneal congenital fibrolipomatous hamartomas (PCFH) are rare, benign lesions of infancy that present as painless plantar heel nodules and are often identified incidentally. Misidentification may lead to unnecessary investigation or intervention. We report a case of PCFH in a one-year-old child referred for ultrasound assessment of bilateral heel nodules noticed at birth, which became more visually prominent over time. Clinical examination demonstrated soft, non-tender nodules on the heels with normal overlying skin. USG demonstrated bilateral, avascular, subcutaneous fibrofatty lesions representing focal prominence of the plantar fat pad, with no evidence of a well-defined, encapsulated tumour; no biopsy was performed. Given the typical clinical and sonographic features, a clinical and radiological diagnosis of PCFH was made, and the child was discharged back to the care of the general practitioner. This case highlights that recognising the typical features of bilateral congenital heel nodules can prevent unnecessary invasive investigations in asymptomatic children and reinforces the value of a clinical and radiological approach for clinicians who may encounter such lesions.
Speech-language therapy in Kenya is an emerging profession, yet its workforce practices are not well-understood, and the needs of professionals have yet to be determined. While similar gaps have been reported in sub-Saharan Africa, the Kenyan context remains unknown. To describe current characteristics, practices and needs of speech-language therapists (SLTs) rendering services in Kenya. An electronic survey was completed by 46 SLTs across Kenya. Descriptive and inferential statistics were used, and open-ended questions were analysed qualitatively. Most Kenyan SLTs in this sample (78.4%) were located in the urban counties, multilingual and worked across multiple settings. Participants had varied qualifications and backgrounds. The sample included SLTs with overlapping caseloads of client ages - 67.0% served paediatric clients and 53.0% served adults, with many participants reporting that they worked across both groups. Challenges included limited resources (69.6%), high caseloads (52.0%) and a limited workforce. Participants expressed the need for peer support and improved guidelines for practice. Despite the notable growth of the profession in Kenya, persistent challenges remain within the SLT workforce and structure of service provision. Addressing these requires strengthened collaboration, improved regulation and guidelines and targeted capacity-building to support equitable access to services. This study aimed to outline what the speech-language therapy profession in Kenya looks like, to contribute towards advocating for the profession and planning that can ultimately enhance the impact of SLTs in Kenya.
According to the South African Nursing Council's regulation R 2127, staff and auxiliary nurses must be supervised by professional nurses. This supervision is essential for quality care, leading to fewer patient complaints and higher satisfaction. This study aimed to explore and describe the experiences of staff nurses and auxiliary nurses on the supervision of nursing care by professional nurses in Limpopo province. The study was conducted in three selected regional hospitals located in different districts of Limpopo province: Vhembe, Mopane, and Waterberg. A qualitative approach using exploratory, descriptive, and appreciative inquiry research designs was selected to gain insights into professional nurses' supervision of nursing care. Non-probability purposive sampling was used to choose districts, hospitals, units, and participants. Data were collected through focus group interviews with participants from paediatric, maternity, and casualty units and analysed using Tesch's eight steps of data analysis. Four themes emerged: Staff shortages, educational and training challenges, attributes of a good supervisor, and the roles and responsibilities of supervisors. To improve the quality of patient care outcomes and reduce patient complaints and lawsuits, professional nurses must supervise nursing care. However, the current difficulties jeopardise professional nurses' ability to optimally supervise nursing care. This study contributes to improving the quality of supervision of nursing care, which is aimed at achieving high patient satisfaction, reducing patient complaints and related medico-legal negligence cases. This study also demonstrates how effective supervision by registered professional nurses can enhance the knowledge and skills of both staff nurses and auxiliary nurses.
Long COVID has been an important health concern in children and adolescents, yet factors associated with its development remain incompletely understood. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are widely prescribed for pediatric neuropsychiatric conditions and may influence immune and autonomic pathways involved in postinfectious symptoms. Here we show associations between SSRI/SNRI use and long coronavirus disease (COVID)-related outcomes in a retrospective cohort of 110,955 children and adolescents with pre-existing neuropsychiatric conditions across 37 US health systems participating in the National Institutes of Health Researching COVID to Enhance Recovery consortium. SSRI/SNRI use was not associated with clinician-recorded long COVID diagnosis but showed heterogeneous associations with individual symptoms. Lower risks were observed for some symptoms, including fever, chills and hair loss, whereas higher risks were observed for neurological and systemic outcomes, including postural orthostatic tachycardia syndrome, cognitive dysfunction and fatigue. These findings suggest that antidepressant exposure may be associated with differing post-COVID symptom patterns in youth and warrant further investigation.
Pituitary stalk interruption syndrome is a rare, congenital endocrine disorder of hypopituitarism. It has highly variable clinical presentation depending on the extent and type of hormonal deficiency and age at presentation, with growth hormone deficiency being the most common manifestation. Growth hormone plays an important role in maintaining normal blood glucose levels during stress or fasting, by stimulating hepatic gluconeogenesis and lipolysis. Therefore, hypoglycemia should alert us to a possibility of growth hormone deficiency necessitating imaging and facilitating early diagnosis of pituitary stalk interruption syndrome.
Autism spectrum disorder (ASD) is a neurodevelopmental condition associated with metabolic and environmental factors. We investigated associations between urinary tryptophan-pathway metabolites and essential/toxic trace elements in children with ASD and healthy controls. In a cross-sectional cohort of 216 children (149 ASD, 67 controls), urinary tryptophan metabolites were quantified by LC-MS/MS and normalized to creatinine. Trace elements were assessed by ICP-MS. Matching yielded 1:1 (n = 57/57) and 1:2 (n = 30/60) age- and sex-matched subsets. Correlations (Pearson or Spearman, FDR-adjusted) and group comparisons were performed; autism severity (CARS) was analyzed within ASD. Creatinine-normalized tryptamine, 5-hydroxyindoleacetic acid, and N-acetyltryptophan showed moderate, positive correlations with essential elements (Mg, Zn, Se; r ≈ 0.5-0.7; N-acetyltryptophan and IAA correlated modestly with toxic elements (Tl, Cs; r ≈ 0.3-0.4). Group differences in individual metabolites and elements were modest; however, the composite toxic element index was significantly lower in ASD (P = .002). CARS scores did not show robust, FDR-corrected associations. Essential trace elements are closely linked to tryptophan metabolism, suggesting cofactor-dependent modulation in ASD. N-acetyltryptophan may serve as a sensor for specific toxic elements. Intervention studies are warranted to clarify causality.
Preterm birth is associated with long-term neurodevelopmental challenges, yet evidence on psychosocial outcomes in Chinese preschool children, particularly in less developed regions, remains scarce. A cross-sectional study was conducted in a western Chinese city from February 28 to March 5, 2025. Using stratified cluster sampling, 20,913 parent-child dyads were recruited from 189 kindergartens. Preterm birth (< 37 weeks gestation) was parent-reported. For the assessment of psychosocial functioning, the Chinese adaptation of the Strengths and Difficulties Questionnaire (SDQ) was utilized, with its focus on total difficulties, internalizing problems, externalizing problems and prosocial behavior. Multivariable regression models were used, adjusting for child age and gender, child birth weight, number of children, parental age, parental gender, education level, employment status, marital status, annual family income, smoking status, alcohol intake status, and parental depressive symptoms (CES-D score). Subgroup analyses explored effect modification. Of 20,913 children (mean age 4.82 ± 0.89 years), 860 (4.1%) were preterm. After full adjustment, preterm birth was significantly associated with increased odds of total difficulties (OR = 1.32, p = 0.0015), but not with internalizing problems (OR = 1.07, p = 0.4153), externalizing problems (OR = 1.02, p = 0.8083), or prosocial behavior (OR = 0.89, p = 0.1009). Preterm birth in preschool children from Western China was associated with higher odds of total difficulties, but not with internalizing problems, externalizing problems, or prosocial behavior after full adjustment. Stratified interaction analyses revealed that these associations differed by alcohol intake status (for total difficulties) and parental education level (for prosocial behavior) after FDR correction.
Over the past two decades, the conceptualization of neurodevelopmental disorders (NDDs) has undergone a profound transformation, shifting from a primarily brain-centric framework toward a systems-level perspective that integrates peripheral physiological processes. Among these, the gut microbiota has emerged as a critical determinant of neurodevelopmental trajectories. Through its involvement in immune modulation, metabolic signaling, and neural communication, the microbiota-gut-brain axis (MGBA) exerts a pervasive influence on brain maturation and function. A growing body of evidence indicates that early-life disruptions of microbiota composition-commonly referred to as dysbiosis-are associated with an increased risk of NDDs, including autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and epilepsy. These disruptions are frequently driven by environmental exposures such as antibiotic use, cesarean delivery, dietary patterns, and psychosocial stress. Despite the expanding recognition of these associations, current therapeutic strategies aimed at restoring microbiota balance, including probiotics and fecal microbiota transplantation, have yielded inconsistent and often transient results. In this context, Vagus Nerve Stimulation (VNS), particularly in its non-invasive forms (nVNS), has emerged as a promising approach capable of modulating environmental exposures through the host-centered regulatory mechanisms of the MGBA. By influencing autonomic tone, activating the cholinergic anti-inflammatory pathway, and modulating neurotransmitter systems, nVNS may restore microbiota homeostasis while simultaneously improving neurodevelopmental outcomes. This article provides a comprehensive and integrative review of the mechanistic, preclinical, and clinical evidence supporting the role of nVNS as a microbiota-modulating intervention. We further discuss its potential as a safe, cost-effective and promising therapeutic strategy for neurodevelopmental disorders, with a particular emphasis on pediatric populations.
Parkinson's disease (PD) is a progressive neurodegenerative disorder causing a variety of motor and non-motor symptoms. To date, no disease modifying treatment exists, and diagnosis is based on the manifestation of the clinical motor symptoms, which occurs when the neurodegenerative process is already advanced. Studies designed to find diagnostic/prognostic biomarkers and pathophysiological pathways involved in disease onset/progression are needed. To describe the study protocol of the Vall d'Hebron Initiative for Parkinson (VHIP) Cohort, a prospective and longitudinal observational cohort study aimed at deeply phenotyping de novo PD patients, including carriers of PD-linked mutations. We anticipate this initiative will contribute to identifying biomarkers for PD risk, diagnosis, and prognosis, as well as to stratify disease subtypes and increase our understanding of pathophysiology at early disease stages. Subjects are prospectively recruited by movement disorder specialists at the Vall d'Hebron University Hospital (VHUH). To date, the study cohort includes 174 subjects-consisting of 117 patients with de novo Parkinson's disease, 17 individuals with REM sleep behavior disorder (RBD), and 33 healthy controls-and recruitment is still ongoing. After informed consent, subjects are evaluated in detail to primarily assess objectives within four major domains of PD: motor, cognitive-affective, autonomic function, and vision. This includes first an extensive clinical evaluation (i) recording demographic, personal history, lifestyle, and dietary habits and (ii) performing clinical scales covering motor and non-motor symptoms. Second, data from autonomic function and visual function tests, together with neuroimaging data, are acquired. And finally, a wide range of biospecimens are collected for biochemical and molecular assessments including the genotyping of all participants. Participants receive follow-up assessments at 2.5 and 5-year intervals. VHIP is the first study to establish a Spanish cohort combining clinical, imaging, biochemical and molecular data over time in de novo patients, including PD-linked mutation carriers. VHIP provides a unique opportunity to link pre-diagnosis disturbances to PD development, as well as to identify risk, diagnosis, and prognosis biomarkers. https://vhir.vallhebron.com/es/investigacion/proyecto-vall-dhebron-iniciativa-para-el-parkinson-vhip.
Williams syndrome (WS) is a rare microdeletion disorder affecting chromosome 7q11.23, including the ELN gene, which encodes elastin. Haploinsufficiency of ELN leads to vascular abnormalities, such as supravalvular aortic stenosis (SVAS), pulmonary stenosis, and coronary artery disease. SVAS can also occur in isolation due to heterozygous loss-of-function variants in ELN, independent of the broader WS deletion. We present a case of a term neonate with a Grade 4/6 systolic ejection murmur who underwent echocardiography, revealing severe supravalvular pulmonary stenosis, branch pulmonary artery stenosis, and mild SVAS. Due to these WS-like features, a chromosomal microarray was performed, which ruled out WS. Cardiac catheterization for pulmonary artery balloon angioplasty was complicated by ventricular fibrillation, requiring resuscitation. Angiography identified coronary artery stenosis. Intraoperative cardiac instability raised concerns for an ELN-related vasculopathy. Whole-exome sequencing (WES) revealed an ELN frameshift mutation in exon 6. This case describes a neonate with a WS-like cardiovascular phenotype but no WS-associated deletion, instead harboring a heterozygous pathogenic ELN loss-of-function variant consistent with isolated SVAS, thereby challenging genotype-phenotype correlations.
In Uganda, 1 in 4 girls has been pregnant by 18 years. This was worse during the COVID 19 pandemic. We determined risk factors for pregnancy among rural and urban dwelling adolescents in Uganda. We conducted a mixed-methods study among girls aged 13 to 19 years in a rural and urban district in Uganda. Quantitatively, we used an unmatched case control design involving 200 adolescents with pregnancy experience and 400 controls with no pregnancy experience. Quantitative data was analyzed using STATA version 14. Qualitative methods included 17 focus group discussions, 10 in-depth interviews and 20 key informant interviews with key stakeholders. Transcribed audio recordings were analyzed using a content thematic approach using Nvivo. Of the 600 girls, mean age was 16.9 years (SD 3.84). Independent risk factors for pregnancy were age, out-of-school, a friend with teenage pregnancy, cigarette smoking, working for money and correct contraceptive knowledge. Protective factors included positive personal attitudes, father's education and larger household size. Qualitatively, inadequate information on sexual and reproductive health, early sexual debut, alcohol and drug abuse, absence of parental supervision, negative peer influence and poverty were reported. Overall, individual characteristics, behaviors and inadequate information increased the risk of pregnancy.
Congenital chloride diarrhea (CCD) is a rare genetic disorder characterized by persistent watery diarrhea and electrolyte imbalances. Herein, we report the case of a 6-year-old girl with a significantly delayed diagnosis of CCD, who had been misdiagnosed with Bartter syndrome since infancy due to atypical symptoms. Notably, the patient presented with rare gastrointestinal complications, including colonic ulcerations and an active perianal fistula. While the colonic ulcerations resolved under standard conservative medical treatment, the concurrent perianal fistula completely healed using an innovative, non-surgical approach consisting of local rectal antibiotic application (cefdinir powder) and antiseptic sitz baths. This case demonstrates that CCD can present with unusual structural complications. Crucially, although CCD typically manifests in early infancy, clinicians should consider this genetic metabolic disorder even in older children presenting with chronic diarrhea and recurrent electrolyte disturbances.
Neuroglial heterotopia is a congenital developmental anomaly characterised by mature glial tissue located outside the cranial cavity or spinal canal, without intracranial communication. A 12-month-old girl presented with an enlarging left cervical mass and worsening respiratory symptoms. MRI demonstrated a trans-spatial, multiseptated cystic lesion in the left parotid and submandibular spaces, extending medially into the parapharyngeal space with upper airway compression. No intracranial communication was identified. The postoperative specimen revealed mature glial tissue interspersed within fibroconnective stroma, confirming neuroglial heterotopia. This case highlights the importance of considering neuroglial heterotopia in the differential diagnosis for congenital or progressive cystic neck masses in infants. Although MRI plays a central role in defining the lesion extent, a definitive diagnosis requires histopathological confirmation.
To report an infrequent but potentially devastating complication following strabismus surgery and its approach to management. A 5-year-old girl underwent bilateral medial rectus recessions for esotropia. She quickly developed progressive orbital cellulitis that was confirmed on computed tomography along with non-occlusive thrombosis of the superior ophthalmic vein. She was treated with intravenous antibiotics, additional surgery (which found a dehisced medial rectus muscle), and anticoagulation. Cultures grew Streptococcus pyogenes (Group A). Ultimately the patient made a full recovery. Although orbital cellulitis is a known complication following strabismus surgery, surgeons should be aware of additional secondary complications that can occur and have a low threshold for imaging and repeat surgical intervention.
Weaning from mechanical ventilation remains a major challenge in pediatric critical care. Diaphragm ultrasound has emerged as a promising bedside, radiation-free tool for assessing respiratory muscle function. However, the value of diaphragm thickening fraction (DTF) in neonates and children remains heterogeneous rather than definitive. While several pediatric studies have reported potentially useful DTF thresholds, often around 20%-25%, other cohorts and physiological validation studies have shown weak or inconsistent associations with extubation outcomes or inspiratory effort. These discrepancies likely stem from developmental differences in diaphragm structure and function, high chest wall compliance in children, disease heterogeneity, varying ventilator settings, and technical challenges in obtaining reliable measurements in small patients. Importantly, DTF reflects only one aspect of the respiratory pump and does not evaluate pulmonary factors that increase breathing workload, such as atelectasis, pulmonary edema, consolidation, or poor lung aeration. Lung ultrasound can complement diaphragm assessment by identifying these sources of increased respiratory load during spontaneous breathing trials and after extubation. This mini-review summarizes the current evidence on diaphragm and lung ultrasound for pediatric weaning assessment and proposes an integrated PUMP-LOAD framework: diaphragm ultrasound to evaluate respiratory pump function and lung ultrasound to assess pulmonary load. Although physiologically sound and clinically feasible, this combined approach requires standardized pediatric protocols, age-specific reference values, and prospective multicenter validation before it can reliably guide extubation decisions.
[This corrects the article DOI: 10.3389/fimmu.2026.1796820.].
Pediatric repetitive mild traumatic brain injury (rmTBI) is a major public health concern with links to chronic cognitive dysfunction. Neuroinflammation represents a significant maladaptive outcome after rmTBI. Persistent innate and adaptive immune cell responses can lead to neurodegeneration and deficits in brain development. Therefore, a deeper understanding of the early dynamics of peripheral immune cell infiltration after pediatric rmTBI is critical for the development of effective treatment. We hypothesize that pediatric rmTBI alters neuroinflammation through T cell infiltration. We used wild-type (C57BL/6) and T cell knockout (TCRβ-/- δ-/-) mice to test this hypothesis. We developed a pediatric postnatal day 21 rmTBI model, with three consecutive subconcussive impact acceleration injuries separated in time by 1 week. After inducing rmTBI in juvenile mice, we observed a progressive infiltration of macrophages, CD8+, and CD4+ T cells into the brain parenchyma, which increased with repeated injury. Furthermore, neuroinflammation in the white matter was detected when we analyzed the lateral corpus callosum (CC). Since increased infiltration of CD4+ and CD8+ T cells was detected, we utilized TCRβ-/- δ-/- mice to further explore the role of T cells on neuroinflammation after pediatric rmTBI. We observed a reduction in the infiltration of pro-inflammatory macrophages and decreased neuroinflammation in the lateral CC. Overall, our findings highlight the significant role of T cell infiltration in the modulation of neuroinflammation following rmTBI in the developing brain, suggesting that they may serve as potential therapeutic targets for managing neuroinflammation following pediatric brain injuries.
Postoperative opioid exposure in opioid-naive patients may carry a risk of persistent opioid use. We present the case of a 16-year-old female with no significant family history who was recently diagnosed with neurofibromatosis type 1 and found to have a rapidly enlarging mass in her left upper extremity. She was scheduled for excisional biopsy. To minimize the need for postoperative opioids, analgesia via a continuous peripheral nerve catheter was employed following resection of the malignant peripheral nerve sheath tumor. This case report reviews the clinical applications of multimodal analgesia via a continuous peripheral nerve catheter in pediatric patients, including placement techniques and dosing considerations.
To evaluate the efficacy and postoperative survival following laparoscopic and laparotomy hepatectomy of pediatric liver neoplasm (PLN). A retrospective analysis was conducted on 180 patients who underwent hepatectomy of PLN in our center between January 2014 and May 2025. Demographic information, perioperative clinical data, postoperative liver function recovery, complications, and survival outcomes were collected to evaluate the efficacy, postoperative complications, and survival rates after laparoscopic and laparotomy hepatectomy of PLN. In this study, 89 patients (49.44%) were male and 91 (50.56%) were female. The median age at surgery was 5.7 years. 66 patients (36.67%) were diagnosed with benign liver neoplasms (BLN), and 114 patients (63.33%) with malignant liver neoplasms (MLN). Laparoscopy was performed in 83 patients (46.11%), while laparotomy was performed in 97 patients (53.89%). In the BLN group, there were no significant differences between the laparoscopic and laparotomy groups in terms of postoperative liver function recovery or complication rates. The postoperative survival rate was 100% in both groups. However, the length of hospital stay was significantly shorter in the laparoscopic group (P < 0.001). In the MLN group, there were no significant differences in postoperative liver function recovery or complication rates between the two surgical approaches. However, the laparoscopic group had a significantly longer operative time (P = 0.009), more frequent Pringle maneuver (P < 0.001). The 5-year cumulative survival rate was 78.13% in the laparoscopic group and 81.23% in the laparotomy group, with no significant difference between the two approaches (P = 0.732). Surgical treatment for PLN yields favorable outcomes. Laparoscopy is recommended for BLN or MLN with localized lesions. However, for large MLN that encase vessels or show diffuse infiltration, laparotomy is recommended.
This case series highlights the critical role of radiological imaging in patients presenting with positional vertigo initially suggestive of benign paroxysmal positional vertigo (BPPV) but ultimately attributable to central nervous system pathology. The objective is to raise awareness among clinicians and paramedical professionals regarding the importance of early imaging when atypical clinical features are present. We report 6 cases of central positional vertigo in patients aged 18-85 years (3 men and 3 women) initially referred for physiotherapy with a presumed diagnosis of BPPV. Detailed clinical analysis revealed red flags prompting neurological evaluation and neuroimaging. Magnetic resonance imaging (MRI) played a decisive role in all cases, enabling accurate etiological diagnosis. Imaging protocols included brain MRI with T1- and T2-weighted, FLAIR, diffusion-weighted imaging with apparent diffusion coefficient mapping, susceptibility-weighted imaging when indicated, and postcontrast T1 sequences following gadolinium administration. Additional sequences such as constructive interference in steady state (CISS/FIESTA) were used when neurovascular conflict was suspected. Identified etiologies included cerebellar hemangioblastoma, vestibular migraine with radiologic findings, neurovascular compression syndrome, cerebellar atrophy, cerebellar meningioma, and midbrain ischemic stroke. MRI findings were essential for differentiating central from peripheral causes of positional vertigo and for guiding urgent management, particularly in vascular and tumoral conditions. In all cases, imaging corrected the initial misdiagnosis of peripheral vertigo and prevented inappropriate repositioning maneuvers. This case series underscores the importance of integrating clinical examination with early neuroimaging when positional vertigo presents with central warning signs. Brain MRI remains the gold standard for identifying central causes and improving patient outcomes.