Current Pediatric Reviews - Volume 20, Issue 2, 2024

Background: Roseola infantum is a common viral disease that occurs during childhood worldwide. Objective: The purpose of this article is to familiarize pediatricians with the clinical manifestations, evaluation, diagnosis, and management of roseola infantum. Methods: A search was conducted in April, 2022, in PubMed Clinical Queries using the key terms "roseola infantum" OR “exanthem subitum” OR “sixth disease”. The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. Results: Roseola infantum is a viral illness characterized by high fever that lasts 3 to 4 days, followed by the sudden appearance of rash at defervescence. The disease occurs most frequently in children between 6 months and 2 years of age. Human herpesvirus-6 (HHV-6) is the major cause of roseola infantum, followed by HHV-7. Transmission of the infection most likely results from the asymptomatic shedding of the virus in the saliva of the caregivers or other close contacts. Characteristically, the rash is discrete, rose-pink in color, circular or elliptical, macular or maculopapular, measuring 2 to 3 mm in diameter. The eruption is first seen on the trunk. It then spreads to the neck and proximal extremities. Typically, the rash blanches on pressure and subsides in 2 to 4 days without sequelae. Most children look well otherwise and appear to be happy, active, alert, and playful. The diagnosis is mainly clinical. Febrile seizures occur in 10 to 15 % of children with roseola infantum during the febrile period. In general, serious complications are rare and occur more often in individuals who are immunocompromised. There is no specific treatment. An antipyretic may be used to reduce fever and discomfort. Conclusion: Roseola infantum is generally a benign and self-limited disease. Failure to recognize this condition may result in undue parental fear, unnecessary investigations, delay in treatment for conditions that mimic roseola infantum and complications from roseola infantum, unnecessary treatment of roseola infantum per se, and misuse of healthcare expenditure.

Disaster poses a huge threat to physical health as much as mental health, and COVID-19 is not any different. Understanding that physical and social factors can all contribute to mental health disruptions explains the rising concern of the global community about the impacts of COVID-19 on mental health, especially among the vulnerable, including children and adolescents. It is imperative to explore the diverse impacts of COVID-19 on the paediatric age group, especially to better address its effect and adequately strategize for its resulting conditions. This narrative review, therefore, explores literature reports on the effect of the pandemic on the mental health of children and adolescents. As observed in the literature, COVID-19 did not only threaten the physical health of children and adolescents but also their mental health, especially in terms of anxiety, depression, sleep alteration, etc. In this paper, we have discussed interventions, such as adequate sleep, healthy lifestyles, and nutritious foods, to improve paediatric mental health even after the pandemic.

In the past decade, there has been a global resurgence of bed bug infestations, especially in developed countries. Proper awareness and identification of bed bug infestations are essential to guide treatment and eradication. The purpose of this article is to familiarize physicians with bed bug bites so that they can effectively diagnose, treat, and address questions about bed bug bites and infestations. Bed bug bites are often painless. Typical reactions include pruritic, erythematous maculopapules occurring in clusters or in a linear or curvilinear distribution in exposed areas of the body. A small red punctum may be visualized at the center of the bite mark. Lesions that appear three in a row and papules on the upper eyelid associated with erythema and edema are highly suggestive of bites from bed bugs. Exaggerated local reactions such as vesicles, urticarial wheals, urticarial perilesional plaques, diffuse urticaria, bullae, and nodules may occur in previously sensitized individuals. Reactions to bed bug bites are self-limited. As such, treatment is mainly symptomatic. Topical pramoxine and oral antihistamines can be used to alleviate pruritus. Topical corticosteroids can be used for significant eruptions to control inflammation and pruritus, and to hasten resolution of the lesions. Integrated pest management, an approach for the eradication of bed bugs, includes monitoring devices (active monitors include the use of heat or carbon dioxide attractants and passive monitors include the use of sticky pads for trapping), and judicious use of nonchemical and chemical treatments known to be effective. Nonchemical interventions include keeping affected areas clean and free of clutter, vacuuming, washing linens with hot water, caulking wall holes and cracks where bugs can hide, proper disposal of highly infested items, and placement of bed bug traps/interceptors at the base of beds and furniture. Chemical interventions involve the use of insecticides such as synthetic pyrethroids, silicates, insect growth disruptors, carbamates, organophosphates, neonicotinoids, diethyl-meta-toluamide, chlorfenapyr, fipronil and plant essential oils. Insecticides should be used with caution to prevent over-exposure and toxicity (in particular, cardiovascular and neurologic toxicity), especially if there are young children around. It is important to note that multiple mechanisms of insecticide resistance exist and as such, chemical treatment should only be undertaken by trained professionals who understand the current literature on resistance. Both nonchemical and chemical technologies should be combined for optimal results. Bed bug infestations may cause diverse dermal reactions, stigmatization, poor self-esteem, emotional stress, anxiety, significant adverse effect on quality of life, and substantial socioeconomic burden to society. As such, their rapid detection and eradication are of paramount importance. Consultation with a professional exterminator is recommended to fully eradicate an infestation.

Background: Congenital anomalies are responsible for approximately 20% of all neonatal deaths worldwide. Improvements in antenatal screening and diagnosis have significantly improved the prenatal detection of birth defects; however, these improvements have not translated into the improved neonatal prognosis of babies born with congenital anomalies. Objectives: An attempt has been made to summarise the prenatal interventions, if available, the optimal route, mode and time of delivery and discuss the minimum delivery room preparations that should be made if expecting to deliver a fetus with a congenital anomaly. Methods: The recent literature related to the perinatal management of the fetus with prenatally detected common congenital anomalies was searched in English peer-reviewed journals from the PubMed database to work out an evidence-based approach for their management. Results: Fetuses with prenatally detected congenital anomalies should be delivered at a tertiary care centre with facilities for neonatal surgery and paediatric intensive care if needed. There is no indication for preterm delivery in the majority of cases. Only a few congenital malformations, like highrisk sacrococcygeal teratoma, congenital lung masses with significant fetal compromise, fetal cerebral lesions or neural tube defects with Head circumference >40 cm or the biparietal diameter is ≥12 cm, gastroschisis with extracorporeal liver, or giant omphaloceles in the fetus warrant caesarean section as the primary mode of delivery. Conclusion: The prognosis of a fetus with congenital anomalies can be significantly improved if planning for delivery, including the place and time of delivery, is done optimally. A multidisciplinary team should be available for the fetus to optimize conditions right from when it is born.

Background: Irritable bowel syndrome (IBS) is a disorder that causes stomach pain in children and adolescents. It may also impact one's quality of life. IBS is linked to gastrointestinal issues such as diarrhoea and constipation. Despite the identification of several potential pathophysiological pathways, the aetiology of IBS remained unknown. Objective: The aim of this paper is to discuss the diagnosis, pathogenesis, case studies and treatment of Irritable bowel syndrome in children and adolescents. Methods: This systematic review covered relevant papers from the previous ten years that were accessible in Science Direct, Elsevier, NCBI, and Web of Science related to the pathophysiology and function of pharmacological drugs such as antidepressants, antispasmodics, prokinetics, and antibiotics in children with irritable bowel syndrome. Results: Only a few prospective therapy techniques have been investigated in children, and even fewer of those have been demonstrated to be effective. This article presents case studies including 50-59 children, which demonstrate a favourable acceptable impact that is more effective than a placebo in terms of reducing symptoms and improving the overall quality of life in children who have irritable bowel syndrome. Furthermore, the majority of the pathophysiological explanations and treatment options discussed are based on adult studies. These major issues arose when treating paediatric IBS, and they must be addressed in order to properly treat children with IBS. Trials that focus on many combinations of pharmacological and non-pharmacological therapies seem to be more helpful. Discussion: In recent years, a number of systematic reviews have been conducted to evaluate the efficacy of medication treatments in children for IBS; however, the dependability of these systematic reviews needs to be further investigated owing to the various experimental designs and levels of evidence used. This article highlights paediatric therapy options, including pharmaceutical medications such as antidepressants, antispasmodics, prokinetics, and antibiotics. The goal is to alleviate IBS symptoms while also enhancing the quality of life for children with this illness.

Introduction: The amount of research exploring the use of virtual reality (VR) and augmented reality (AR) technologies in health care has exploded. This has resulted in a massive body of work, making it difficult to obtain all of the research. The objective of this study was to map out and put together the scientific output of research and global trends in virtual and AR in pediatrics. Methods: Publications were collected from the Web of Science (WoS) database. The R tool was used to categorize and evaluate the research outputs, as well as the most productive and influential countries, journals, institutions, authors, articles, subject areas, and the latest research themes. The most utilized and co-occurring keywords were also examined. Texts, tables, and images were used to assess and describe the retrieval of findings. Results: The research was based on information from 7423 publications. The strongest growth in publications occurred in 2020. The most productive and influential country was the USA. The journal was Pediatrics, the author was G Riva, and the institution was the University of Washington. The most frequently occurring keywords were simulation, rehabilitation, and stroke. The main research themes were therapy, surgical education, and rehabilitation. Pain, stroke, anxiety, depression, fear, dementia, and neurodegenerative illnesses were all common medical issues investigated. Conclusion: VR studies have mainly focused on surgical education or procedures, simulation technologies, and neurological conditions. Neurological conditions are linked to balance, gait, and rehabilitation, reflecting the prevalence of these disease groups. This article provides a thorough overview of VR and AR studies in the healthcare field. This work will allow academics, policymakers, and practitioners to gain a deeper understanding of the evolution of VR and AR studies in the healthcare field and its potential practical implications. Future VR and AR research should focus on bridging the gap between VR and AR healthcare research and clinical applications. Emerging trends in related fields, such as navigation, rehabilitation, stroke, dementia, and VR exposure therapy, should be given special attention.

Background: Many new cases of brucella infections are seen in Turkey every year, especially in March, April, and May, due to the consumption of local unpasteurized cheese. Amino acids profiles have not been studied in brucellosis so far. Aims: The amino acid profiles may be affected by infectious diseases. Our study aims to evaluate the plasma amino acid profile in the progression of acute brucellosis. Methods: Plasma amino acid profile was performed by an 8045 LC-MS / MS device (Shimadzu 8045, Japan) using JASEM amino acid kit. Results: Analysis of 45 amino acid profiles was made and results profiles showed significant differences in concentrations and types of amino acids in brucella patients. We observed a significant difference in terms of alanine, arginine, aspartic acid, glutamine, glutamic acid, glycine, isoleucine, ornithine, phenylalanine, proline, tyrosine, valine, alpha-aminoadipic acid, alpha-amino-pimelic acid, argininosuccinic acid, gamma-aminobutyric acid, thiaproline, 1-methylhistidine, 3-methylhistidine, hydroxylysine, hydroxyproline, cystine, serotonin, ethanolamine, and taurine (p-value < 0.05 for each). No significant differences were determined regarding asparagine, citrulline, histidine, leucine, alloisoleucine, lysine, methionine, serine, threonine, tryptophan, anserine, alpha aminobutyric acid, beta aminoisobutyric acid, beta-alanine, cystathionine, histamine, and 5-oh-trp (p-value > 0.05 for all). Conclusion: Patients with brucellosis have a specific profile of amino acids which may reflect sequelae of pathological and metabolic biochemical changes in the disease process due to the growth of Brucella spp. in the human body leading to an imbalance of amino acid levels.

Palliative care model can be carried out at home, in the community, or in long-term home care. Home visits in palliative care have an important role in providing continuity of care and psychosocial support to both the patient and their parents/caretakers. This study is aimed to determine the impact of home visit program to the frequency of emergency room (ER) admissions in children with cancer. Methods: Randomized controlled trial of 60 pediatric patients with malignancies who were given palliative care (a 3-months home visit) and those who were not was conducted. Patients were children with cancer aged 2-18 years old. Emergency room admissions from the last three months were recorded before patients were enrolled. A two-way communication between a trained health worker and patients with or without their parents were conducted as the intervention. Interventions were given in six sessions (1 session every 2 weeks). During study period, ER admissions were recorded further. Data was analyzed using bivariate analysis, OR calculations were performed. Results: In the intervention group, 11 children (36.7%) had fewer ER admissions, while 4 (13.3%) had more and 15 children (50%) had constant ER admissions, respectively. Meanwhile, only 2 children (7.7%) were found to have fewer ER admissions in the control group. Others in this group have varying results, 11 children (42.3%) were found to have more admissions to the ER and 13 children (50%) had constant ER admissions. In the intervention group, ER admissions were reduced by 10 visits, while in the control group, the admissions were increased by 16 visits (OR 4.77, 95% CI 1.29-17.65; p = 0.018). Conclusion: Palliative home visit provides care matched to patient and family needs, trained parents to be skillful in managing child, and enabling avoidance of unnecessary hospitalizations (4.7 times).