Journal of Pediatrics Review
Year:2018 | Volume:6 | Issue:2|Papers Count:8

Context: Given the high prevalence of metabolic syndrome (MetS) among children and adolescents, the role of dietary habits on MetS development, and formation of food preferences from childhood, it is highly important to determine the association of dietary habits with pediatric MetS.Objective: This study aimed at systematically reviewing the association of different dietary patterns with MetS in a pediatric age group.Data Sources and Study Selection: An electronic search was conducted in international electronic databases including PubMed, Cochrane, Scopus, Google Scholar, and domestic data sources. The following keywords were used; ((“Child”(Mesh) OR “Adolescent”(Mesh) AND (“Metabolic Syndrome”(Mesh) AND “Diet”(Mesh) OR “Dietary Pattern” (Mesh)). We included all published data on the association of MetS (presence of a cluster of 3 or more metabolic abnormalities) with dietary pattern in the pediatric age group aged 3 to 18 years.Data Extraction: At first, 4194 articles were identified (PubMed: 566; Scopus: 60; Google scholar: 3550; domestic data source: 18). Results: After quality assessment, 17 studies were selected for text appraisal, of which 15 qualified articles were evaluated at the final step. The number of total population and points of data were 19 298. From reported studies, 10 had a cross- sectional design, 3 were interventional studies, 1 was cohort study, and 1 was a systematic review on Korean adolescents.Conclusion: Our results indicated that the Mediterranean diet or diets with a higher score of healthy eating index, i.e., with higher content of grains, vegetables, fruits, milk, and meat/meat alternatives, have inverse associations with the prevalence of MetS, whereas Western type diets are associated with higher frequency of MetS in children and adolescents.

Context: Neural tube defects (NTDs) are one of the most common birth defects with a high rate of mortality. Several studies have shown the reduction of the rate of NTD due to preconceptional usage and flour fortification with folic acid.Objectives: The aim of this systematic literature review was to assess the appropriate information about the prevalence of Neural Tube Defects among the Iranian population, geographic areas of Iran.Data Sources: We searched PubMed, Embase, Scopus, and data banks in Iran, such as the scientific information database (SID), Magiran, and Barekat knowledge network system from January 1969 to February 2017. The following keywords were used to search all fields in the above databases (“Neural Tube Defects” OR “NTD” AND “Iran”).Study Selection: NTDs were classified as given by Moore to include anencephaly, spina bifida, encephalocele, iniencephaly, and craniorachischisis. Primary outcomes of interest for estimating the prevalences were the total number of births (including live and stillbirths if available separately) and the total number of NTD affected births (including live and stillbirths if available separately). Data Extraction: Data extracted from selected studies, included: first author, study design, city, sample size, duration of studies, and the prevalence of NTDs and subtypes of neural tube defects.Results: A total of 429 studies were initially identified in the databases. After excluding duplicate studies, 244 articles were retrieved and reviewed based on their titles and abstracts; 221 articles were excluded. Twenty-three articles were selected for a more detailed review. There were some publications of the same study, data were extracted from the most complete and up-to-date publication. Four articles were added by reference searching and one forthcoming article was added. Finally, 21 articles have been included in the study.Conclusions: The surveillance of NTD in Iran is currently limited due to the fact that provinces have established systems to report national and local NTD prevalence. However, when data are available, reported NTD prevalence, which varies by geographic region from 1.01 to 8.29 per 1000 live births, is in some areas of Iran.

Context: Nonalcoholic fatty liver disease (NAFLD) is a chronic liver illness that results from exceeding fat cumulating in the liver. NAFLD can result in progressive fibrosis, which leads to end-stage liver disease. It has rapidly evolved into the most common liver disease seen in the pediatric and adolescent population, being an increasingly common indication for liver transplant even in youths. Best practices in the management of pediatric NAFLD have not been clearly defined. Objectives: Due to increasing prevalence and the nature of the disease as well as importance of treatment plans and efficacy of each mode of treatment, all studies for pediatric fatty liver disease have been investigated for introducing definite or potential therapies. Data Sources: This systematic review aimed to include and analyze all studies descry the effectiveness of lifestyle modification, pharmacological, non-pharmacological, and dietary supplement treatments in children suffered from fatty liver, NAFLD, or NASH. The PUBMED/MEDLINE for Controlled Trials, Scopus, and OVID databases were searched for articles published up to and including December 2016. Study Selection, Data Extraction: All study in the pediatric group with diagnosis of fatty liver spectrum were included in this review. Adult studies were excluded. The results extracted and expanded.Results: A total of 27 randomized controlled trials were identified after the complete search, deletion of duplicates, removal of irrelevant studies, and final assessment of studies. Treatment plans of interest in these pediatrics articles included: lifestyle modifications, fish oil, and omega-3 fatty acids, including docosahexaenoic acid (DHA), probiotics, vitamin E, metformin, ursodeoxycholic acid, vitamin D, and bariatric surgery.Conclusions: Lifestyle modification is the only approved treatment modality for which evidence-based studies have documented benefits. Omega-3 fatty acids, particularly DHA, are probably effective. Probiotics likely have therapeutic effects in cases of fatty liver; however, further research is needed. Vitamin E and metformin have equivocal results. Ursodeoxycholic acid is recommended as an adjuvant; however, the data are insufficient for vitamin D. Bariatric surgery is not an acceptable plan in pediatric patients. Research of fatty liver diseases in children in all aspects of treatments is urgently needed.

Context: Thalassemia is a genetic disorder of hemoglobin production. Patients with thalassemia major (TM) require regular blood transfusions to keep a compatible hemoglobin level for oxygenating organs. These patients suffer from different complications such as infections, autoimmunity and alloimmunization due to transfusion. Such complications link the immune system to TM pathogenesis. In the present study, we have reviewed the latest data available on interactions of TM pathophysiologic determinants and immune system components.Evidence Acquisition: A comprehensive search was performed on PubMed, Scopous, and Web of Knowledge databases using keywords thalassemia, immune system, autoimmune, alloimmune, adaptive immunity, innate immunity, complications, and immunesenescnce. Results: It seems that persistent antigenic stimulation and oxidative stress from excessive iron are the two main pathophysiologic factors of TM impacting the immune system. Regarding innate immunity, functional activity of neutrophils, and natural killer cells (NKCs) is decreased in TM. On the other hand, higher levels of TNF-a and IL-1b, IL-6, IL-8, and C-reactive protein proinflammatory cytokines have been observed in the serum of patients. TM patients have demonstrated higher ratios of regulatory B lymphocytes (CD19+, CD38+, CD24+), helper T cells, suppressor T cells, and T regulatory (CD4+/CD25+/Foxp3+) lymphocytes. TM patients have shown significant higher levels of IgA immunoglobin respective to normal counterparts that may predispose them to diabetes and coeliac disease. Immune cells, however, rendered lower than optimal activity in TM patients, which may be due to nutritional insufficiencies. Potential relationships have been suggested between immune system and various thalassemia compilations including heart infraction, hypertension, atherosclerosis, diabetes, thyroid dysfunction, and osteoporosis.Conclusions: Immune genetic determinants may be involved in modulating the clinical picture of TM. TM patients generally represents with higher immune cell counts, likely as a result of persistent antigenic challenge from blood transfusions. However, these patients face compromised immune cell functions. The role of immunologic interactions in pathogenesis of TM needs to be further divulged in future studies.

Context: Scheuermann’s disease (kyphosis) is an essential kyphosis of the thoracic spinal column, and it is the most public source of kyphosis in adolescents. It has been shown that the imaging characteristics of the disease are sequential 3 vertebrae by minimum 5 degrees of wedging of anterior part of vertebral body. Frequently, the disease is presented at 8 to 12 years of age. Kyphosis is regularly managed with conservative methods. The purpose of this review was to discuss challenging issues in evaluation and treatment of this disease in the mentioned age group.Evidence Acquisition: Medline, Google scholar, PubMedand Ovid were searched and a total of 44 articles were found to be involved in the pediatric evaluation of this disease.Results: The precise basis of Scheuermann’s kyphosis remnants is unidentified. Diagnosis is made by careful clinical examination and radiologic evaluations. In neurologic defects, MRI must be taken. Conservative managing plans for SK involve observation, physical therapy, and bracing. Some writers recommended evading the operation till skeletal maturity is completed. Surgery is commonly suggested for patients with deformity progress, permanent pain, neurological discrepancy, pulmonary insufficiency, or cosmetic complain. Thoracic kyphosis with curving of smaller than 75 degrees seldom requires surgery. Posterior only or combined with anterior methods are the surgery options based on severity of disease. Conclusions: Today, new and more modern braces have been designed to increase global advantages of bracing in Scheuermann’s disease. Patients with more than 75 degrees of curving, kyphotic progress, intolerable cosmetic features, or neurological discrepancy might be supposed for operation. New surgical procedures permit improved correction of the deformity via posterior surgery with lesser complication rates. Concurrent shortening of the posterior spinalcolumncrossways the apical levels, combined bymonitoring of spinal cord, decreases the danger of neurological deficits. Though patients state great satisfaction rates through surgery, both proximal and distal junctional complications can remain. New systems with dynamic instrumentation and improving surgical methods with biologic handling are almost convinced to become typical treatment possibilities.

Context: Dandy-Walker syndrome (DWS) or malformation (DWM) characterizes a hereditary abnormality categorized via agenesis or hypoplasia of the cerebellar vermis, cystic dilation of the fourth ventricle, and expansion of the posterior fossa with or without hydrocephalus. This review aimed at describing the basic clinic pathologic features of DWS, its diagnosis by other central nervous system (CNS), systemic genetic relatives, and new treatment modalities.Evidence Acquisition: Training and publishing in this field is very limited. Among54 articles in this era, a total of in 31 articles were included in the current evaluation.Results: The etiology of DWSis uncertain, however, is supposed to be a consequence of the mixture of ecological and genetic causes. The most common postnatal appearance is macro crania. Additional signs and symptoms could include huge posterior fossa, sunset sign, seizures, spasticity, apnea, respiratory failure, delayed milestones, hydrocephalus, and increased intracranial pressure. Currently, DWS is diagnosed completely with anatomic definitions that can be recognized on ultrasound or Magnetic resonance imaging (MRI) and computed tomography (CT) intrauterine or postnatal.Conclusions: Dandy walker syndrome occurs as a comparatively rare origin of hydrocephalus and might go along with numerous inherited CNS and systemic anomalies. Even though it is usually treated for related hydrocephalus, the abnormality causes no detectable clinical syndrome. It is identified with antenatal or postnatal imaging via ultrasound, CT, or MRI. Hydrocephalus and the cyst in posterior fossa can be treated with surgery, via shunting processes, endoscopy, or both. Prognosis has enhanced meaningfully from the time of its original report; yet, it is typically dependent on the accompanying abnormalities.

Background: Pediatric stroke is defined as rapid developing clinical signs of focal (or global) disturbance of cerebral function without any apparent cause other than of vascular origin lasting for 24 hours or longer in the ages of 1 month to 18 years. It is relatively rare in children, however, it can lead to significant mortality and morbidity.Objectives: The present study aimed to identify clinical presentations, etiologies, and outcomes of pediatric stroke in southern Iran.Methods: This case-series study included all patients that were diagnosed with a pediatric stroke and admitted to the Pediatric Neurology ward at Namazi hospital in Shiraz, Iran, from May 2009 through March 2012.Results: During the study period, 40 newly diagnosed patients (27 males and 13 females) between the ages of 10 months and 18 years old were identified. The most prevalent referring symptoms were hemiparesis and hemiplagia (65%), seizures (45%), speech difficulties (42.5%), and altered mental status (35%). A known single etiology was identified in 82.5% of patients. The most common single risk factor was cardiac abnormalities with 30% frequency, followed by idiopathic and vascular with 17.5%. The outcome of pediatric patients revealed incomplete recovery with moderate neurological deficits (45%) including residual epilepsy (15%), speech difficulties (15%), and behavioral dysfunction (7%), which indicate their need for help in some of their daily activities. Conclusions: Stroke in southern Iranian pediatric patients demonstrated different patterns of causes and risk factors with similar clinical presentations and outcomes.

Background: Worldwide, 20% of children and adolescents experience a disabling mental illness, almost half of which begin by the age of 14. Puberty, also marks a transition in risks for depression and other mental disorders, psychosomatic syndromes, and antisocial behavior. The increase in stress during adolescence due to nutritional and pubertal transitionmayimpact physical health and behavior.Objectives: The current study aimed at determining the association between psychological morbidity and nutritional status, as well as the association of psychological morbidity and physical activity, sleep duration, and dietary behavior.Methods: This study was based on a world health organization (WHO) Global School Health Survey (GSHS) conducted on 13- to 15- year-old age group. The study was held at 3 different schools of Aligarh. Strength and difficulties questionnaire (SDQ) was used to measure psychological morbidity and its association with obesity, physical activity, sleep duration, and dietary behavior. Results: A total of 1456 students were included in the study and the prevalence of psychological morbidity was 9.75%. Those with psychological morbidity had higher odds for being obese (35.36), physically inactive (1.78), having sleep duration inadequacy (5.42), and poor dietary behavior (7.46) on multivariate analysis.Conclusions: Psychological problems were present in seemingly normal adolescent student population in India. Most of these students and their parents/teachers were either unaware of this problem or thought that these problems were not worthy of attention. The association of these problems with lifestyle, dietary behavior, and physical activity warrants special attention.