Research in Pediatrics & Neonatology

Journal Information
EISSN : 2576-9200
Current Publisher: Crimson Publishers (10.31031)
Total articles ≅ 92

Latest articles in this journal

Research in Pediatrics & Neonatology; doi:10.31031/rpn

Klepikov I
Research in Pediatrics & Neonatology, Volume 4, pp 1-3; doi:10.31031/rpn.2020.04.000599

Klepikov I* Pediatric Surgeon, USA *Corresponding author: Klepikov I, Pediatric Surgeon, USA Submission: August 24, 2020; Published: September 08, 2020 DOI: 10.31031/RPN.2020.04.000599 ISSN: 2577-9200 Volume4 Issue5 Modern ideas about the nature of acute inflammatory processes in the lungs are focused on the leading significance of the etiology of the disease. The predominance of this concept defines etiotropic therapy as the basis for providing medical care to this category of patients. In fact, the causative agent of acute pneumonia in most patients remains unknown or the accuracy of its diagnosis is questionable. At the same time, the targeted use of etiotropic drugs is always delayed due to the delay in the results of microbiological diagnostics. Recently, these difficulties of etiotropic therapy have been compounded by an increase in the number of patients with viral lung inflammation and the lack of effective antiviral drugs. The paradoxical and illogical nature of the situation is supplemented by a discrepancy between the intended and actual goals of diagnosis and treatment. Declaring the leading role of pathogens in the development and severity of AP, the assessment of the condition of patients and their further observation within the existing concept of views are based on signs and tests that are due to the pathogenesis of the disease and do not depend directly on its etiology. For example, a cardinal diagnostic test such as an x-ray reflects inflammatory changes in the lung tissue and their dynamics, without having absolute etiological signs. Changes in the parameters of respiration, gas exchange and hemodynamics are the result of impaired lung function as a result of inflammation, regardless of its pathogen. In other words, the AP pathogen plays the role of a burning match that ignites the hearth, and then the fire continues to spread. But the most important mistake arising from the existing system of views on the nature of the disease is that by focusing on the fight against infection, we lose sight of the unique features of the lesion of the lung tissue in contrast to all other localities of inflammation. The concentration of efforts on the infectious origin does not exclude the use of General Therapeutic measures instead of strictly specific ones. It is well known that the lungs provide not only respiration and gas exchange, but also perform a number of non-respiratory functions, among which one of the most important is participation in blood circulation and its regulation. Having an indissoluble anatomical connection with the system of the great circle of blood circulation, the vessels of the lungs are functionally their complete opposite. Maintaining equal volumes of blood entering each circulatory circle, and simultaneously maintaining the inverse proportions of their blood pressure are the basis of compensatory and adaptive mechanisms in the case of pathological abnormalities. Taking into account these features of pulmonary circulation in the dynamics of AP development is extremely important, especially since it is a scientifically proven and indisputable fact. Acute inflammation of the lung tissue primarily affects the blood flow in the vessels of this organ. However, in practice, correction of circulatory disorders in the body of patients with AP is carried out on the basis of evaluating the parameters of systemic circulation. In other words, therapeutic efforts are directed not at the cause of pathological deviations, but at their consequence, which has other, directly opposite norms, is a secondary link in the mechanism of the disease and reflects an extreme compensatory reaction. The desire to normalize the indicators of peripheral blood flow without eliminating the root cause (for example, by intravenous infusions, vasopressors, hormones) contradicts the pathogenesis of AP and is not just a paradox, but one of the serious misconceptions in the interpretation of the mechanisms of disease development. At a time when bacterial forms of inflammation prevailed, the attention and main efforts of doctors were focused on etiotropic therapy of AP for a long period. Treatment of this group of patients was considered impossible without the widespread use of antibiotics. The decrease in the effectiveness of antibacterial therapy and the increase in the number of resistant strains during this time had a gradual development without sharp jumps and changes, which did not require accelerated solutions. This dynamic is largely stimulated the development of new antimicrobial drugs than the study of pathogenetic methods of treatment. The sudden increase in the number of severe patients with viral forms of pneumonia and the drop from the General medical list of ways to suppress the pathogen destroyed the usual stereotypes and clearly showed the weaknesses of providing assistance for AP. It is necessary to pay attention to one undoubted, but very important fact of the current pandemic, which is noted in the modern literature. For example, in the conditions of large groups isolated from the outside world, it was found that not all were subjected to viral aggression, and among the infected, the disease in most cases had an asymptomatic course [1,2]. The authors of these publications are quite rightly concerned about the large number of carriers of the virus with an asymptomatic course and, consequently, the risk of spreading infection. There is no doubt that this data is a serious problem for epidemiologists, but the statistics presented here allow us to draw another important conclusion. In bacterial forms of lung inflammation, the variety of possible pathogens and the difficulty of determining them allowed us to use these reasons to explain failures in the etiotropic treatment of AP. At the same time, the microbial factor did not pose such a threat to the spread of the disease as is observed in coronavirus. Yes, the current pandemic creates conditions for strict compliance with...
Fedir Yurochko, Dzvenyslava Kopanska, Wojciech Domka
Research in Pediatrics & Neonatology, Volume 4, pp 1-2; doi:10.31031/rpn.2020.04.000598

Fedir Yurochko1*, Wojciech Domka2,3 and Dzvenyslava Kopanska1 1Department of Pediatric Otorhinolaryngology, Lviv Regional Pediatric Clinical Hospital OHMATDYT, Ukraine 2University of Rzeszow, Faculty of Medicine, Poland 3Clinical Department of Otorhinolarygology, Frederic Chopin Clinical Voivodeship Hospital, Poland *Corresponding author: Fedir Yurochko, Department of Pediatric Otorhinolaryngology, Lviv Regional Pediatric Clinical Hospital OHMATDYT, Lviv, Ukraine Submission: August 01, 2020; Published: August 13, 2020 DOI: 10.31031/RPN.2020.04.000598 ISSN: 2577-9200 Volume4 Issue5 Acute otitis media-infection or inflammation? The answer to this philosophical question has real practical consequences. Initially, otitis can be an infection followed by an organism’s reaction in the form of inflammation. Or it is primarily inflammation, which is associated with a bacterial pathogen or proceed without the addition of a pathogen. In the case of “otitis-infection”, further therapeutic tactic is clearan antibiotic is needed. In the case of “otitis-inflammation” there are three possible scenarios of the subsequent development of process-self-healing, attachment of bacterial infection or gradual transition to otitis media with effusion. In clinical practice, it is important to distinguish between these scenarios in order to choose the right treatment strategy. Keywords: Otitis media; Inflammation; Infection; Middle ear What came first-chicken or egg? In other words, what comes first in case of otitis-infection or inflammation? This article will explore the difference between infection and inflammation as a cause of development of “infectious otitis” or “inflammatory otitis”. Both cases of otitis will be examined and explained whether a pathogen (virus or bacterium) first gets into the body and causes inflammation or it is the inflammation that develops first with or without infection following. How to distinguish between inflammation and infection? Infection is the penetration and reproduction of microorganisms in body tissues. Body responses to penetration of microorganisms by developing antibodies and inflammation [1]. As a rule, there is always inflammation when there is infection, however the latter is not always present in case of inflammation [2,3]. Inflammation is a protective response of the body aimed at elimination of traumatizing factors and initiation of recovery/healing processes. Pathogens, damaged cells or irritants might belong to traumatizing factors [4]. Inflammation is a fundamental pathological process that includes a dynamic complex of cytological changes, cellular infiltration and release of mediators [5]. Its course includes destruction or removal of pathogenic factor, with its response leading to tissue restoration [5]. Inflammation is not synonymous to infection even if it is usually caused by it. Since infection is caused by a microorganism, inflammation is one of the host responses to this pathogen. Inflammation is a stereotype response, and as such is considered the mechanism of innate immunity [6]. On the other hand, ear inflammation may occur without any infection as well. Otitis as infection. It is also called “infectious otitis”. Bacterial infection from nasopharynx getting into the middle ear via the auditory tube is the natural cause of inflammatory response of the middle ear tissues and development of classical bacterial otitis media. In this case otitis is an infection, with microorganism being the dominating factor which has to be properly impacted during treatment. Infection may be viral or bacterial. Otitis as inflammation. It is also called “inflammatory otitis”. If inflammation plays the primary role in otitis, what causes this response in the case where infection is not present? “Otitis is a phenomenon of pressures” says John Pauers, assistant professor at George Washington University [7]. What does this mean? Impaired auditory tube function results in the change of pressure in the middle ear. Auditory tube blockage leads to impaired middle ear ventilation and drainage, changes in gas composition of cavities, mucosal edema, tissue damage (due to hypoxia, edema, microcirculation disorders). Thus, inflammation is the reaction of the middle ear mucous membrane to this tissue damage. Therefore, in otitis with the inflammatory onset the host response to tissue damage and changes in pressure in the middle ear prevails. What happens next in “inflammatory otitis”? There are three possible scenarios of the subsequent development of inflammation in the ear. A. Scenario 1: Inflammation can be self-limiting-the body will “take care” of the blockage and damaged tissues (inflammation will eliminate damaged tissues and facilitate their recovery, auditory tube will unblock and restore its normal function). B. Scenario 2: A bacterial infection develops and grows. Clinical situation gets worse. Sometimes complications might develop. C. Scenario 3: Aseptic inflammation results in mucus formation in the middle ear. Mucus thickens, gets stuck in the midear and inflammatory activity decreases. Secretory otitis media starts developing. How to distinguish “infectious otitis” from “inflammatory otitis”? How can one clinically “identify” the “infectious otitis” scenario? Bacteria’s entering the middle ear and actively multiplying there leads to the fulminant onset of otitis with its typical manifestations and deterioration of the patient’s general condition. In this case otitis is an infection where microorganism plays the leading role. Thus, treatment should be antibacterial. What is the evidence of “otitis inflammation”? There is a large proportion of otitis that tend to be self-limiting or subside during antibiotics free anti-inflammatory treatment. Nonsteroidal anti-inflammatory drugs...
Jayanthi P
Research in Pediatrics & Neonatology, Volume 4; doi:10.31031/rpn.2020.04.000597

De La Peña Fr, Serment M, Rodriguez-Delgado A
Research in Pediatrics & Neonatology, Volume 4, pp 1-7; doi:10.31031/rpn.2020.04.000595

Serment M1, de la Peña FR2* and Rodriguez-Delgado A3 1Adolescent Clinic, Directorate of Clinical Services, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico 2Research Promotion Unit, Directorate of Clinical Services, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico 3Clinic of Borderline Personality Disorder, Directorate of Clinical Services, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico *Corresponding author: de la Peña FR, Research Promotion Unit, Directorate of Clinical Services, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico Submission: May 23, 2020; Published: July 31, 2020 DOI: 10.31031/RPN.2020.04.000595 ISSN: 2577-9200 Volume4 Issue4 The present study aims to determine the correlation between Limited Prosocial Emotions (LPE) specifier for disruptive behavior disorders and the cognitive and affective subtypes of Empathy in a clinical population of adolescents in Mexico City. Sample was integrated with 49 participants between 13 and 18 years old from the Clínica de Adolescentes, an outpatient service of the Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz. All adolescents included, received LPE specifier diagnosed by certified psychiatrist using a categorical and dimensional instrument. The Global Empathy Scale parent/tutor and self-report versions were used to evaluate cognitive and affective empathy subtypes. The results showed an inversely correlation (r=-0.54, p
Samiul Hasan, Ayub Ali, Umama Huq
Research in Pediatrics & Neonatology, Volume 4, pp 1-4; doi:10.31031/rpn.2020.04.000596

Samiul Hasan1*, Ayub Ali2 and Umama Huq3 1Assistant Professor, Division of Pediatric Surgery, Dhaka Shishu (Children) Hospital, Bangladesh 2Assistant Professor & Resident surgeon, Division of Pediatric Surgery, Dhaka Shishu (Children) Hospital, Bangladesh 3Resident, Division of Pediatric Surgery, Dhaka Shishu (Children) Hospital, Bangladesh *Corresponding author: Samiul Hasan, Assistant Professor, Division of Pediatric Surgery, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh Submission: July 20, 2020; Published: July 31, 2020 DOI: 10.31031/RPN.2020.04.000596 ISSN: 2577-9200 Volume4 Issue5 Background: COVID-19 is currently a public health emergency around the world. Increasingly more people are being identified with this deadly viral disease. Though children experience a milder disease course, severe and life threatening disease has also been reported. An atypical presentation may delay the diagnosis, isolation, and treatment. The aim of this study was to share our experience of atypical presentation of COVID-19 cases as acute abdomen in children. Method: We retrospectively reviewed data of all children diagnosed to have COVID 19 in our department between April to June 2020. Epidemiological & clinical data of children presented with acute abdomen were retrieved and placed in Microsoft Excel 2016. The data were then analyzed and literature reviewed. Result: Total 32 children were diagnosed to have COVID 19 during this period. Six children among them presented with features of acute abdomen, without any respiratory symptom. The diagnostic workout for acute abdomen did not match clinical diagnosis rather RT PCR of nasopharyngeal swab was positive for SARS CoV 2. Four of them were female and 2 were male. Age range was 3 years 10 months to 14 years. Only one patient had radiological evidence of lung injury. All of them improved clinically within 4 days and were discharged from the hospital with advice for home isolation. Conclusion: The clinical course of COVID 19 is yet to understand completely. A high index of suspicion is required for early diagnosis of children with atypical presentation to reduce further transmission of the disease and to avoid serious complications. Keywords: COVID-19; Acute abdomen; COVID-19 in Children; Atypical presentation of COVID-19; Diagnosis of COVID-19 More than 10 million people around the world have been infected with SARS CoV 2 [1]. Bangladesh detected its first case of COVID-19 on 8th March, 2020. Following this, 141,801 confirmed cases were recorded till 29th June with a case fatality rate of 1.26% [2]. Fortunately, the infection rate in much less in children compared to adults. Data from China and the US showed that around 2% of confirmed cases are below 20 years of age [3,4]. In Bangladesh it is around 8% [2]. Therefore, clear information about clinical features and course of the disease in children is scarce till now. Children infected with SARS CoV 2 are mostly asymptomatic or show mild symptoms but critical illness and even death has been reported in children especially those with pre-existing medical conditions. The presenting symptoms are also variable in children. The typical respiratory problems and fever are infrequent in children [4-10]. Severe gastrointestinal symptoms have also been reported as the presenting features of COVID-19 in children [11]. These can lead to confusion about the diagnosis and may cause delays in isolation and treatment and these patients can transmit the disease further while not being identified early. Delayed diagnosis may also lead to serious complications. The aim of this study was to share our experience of atypical presentation of COVID-19 cases as acute abdomen in children. This is a retrospective study. We collected data of all children diagnosed to have COVID 19 in our department between April to June 2020 from our hospital record. Diagnosis of COVID 19 was confirmed in all patients using RT PCR test of nasopharyngeal swab for SARS CoV 2. Epidemiological & clinical data of children presented with acute abdomen were retrieved and placed in Microsoft Excel 2016. The data were then analyzed and literature reviewed. Ethical permission has been taken from hospital ethical review board. Total 32 children were diagnosed to have COVID 19 during this study period. Among them 6 patients presented with features of acute abdomen such as sudden, severe abdominal pain and several episodes of non-bilious vomiting. Detailed epidemiological and clinical data are shown in Table 1. Age of the patients ranges from 3 years 10 months to 14 years. Four patients were female, and two were male. There was no respiratory symptom in any of the patients. After the initial evaluation, the provisional diagnosis was acute appendicitis in four patients and acute pancreatitis in two patients, but laboratory and imaging findings did not match the provisional diagnoses. Initially, we treated the patients with analgesic and empirical antibiotics. Real-time polymerase chain reaction (RT PCR) of the nasopharyngeal swab was found positive for novel coronavirus in all six patients and only one patient had left lower zone opacity in chest x-ray (Figure 1). All of them improved clinically within 4 days without any respiratory support and were discharged from the hospital with advice for home isolation. Figure 1: X ray showing opacity in left lower lung zone. Table 1: Demographic & clinical data of all six patients. Our hospital is the largest dedicated pediatric hospital in the country, but it was not assigned for COVID-19 treatment till June 2020. From the middle of March, we cancelled all elective admission to limit the spread of COVID-19 and admitted only emergency patients without COVID-19 symptoms. A nasopharyngeal swab is taken from all patients for RT PCR to exclude asymptomatic COVID-19 cases. A chest X-ray is used for the immediate isolation of suspected cases. None of the six patients had any respiratory symptoms. Reports from China and...
Bittmann S, Alieva Em, Villalon G, Luchter E
Research in Pediatrics & Neonatology, Volume 4, pp 1-3; doi:10.31031/rpn.2020.04.000594

Bittmann S*, Alieva EM, Villalon G and Luchter E Department of Pediatrics, Ped Mind Institute, Medical and Finance Center Epe, Germany *Corresponding author: Bittmann S, Department of Pediatrics, Ped Mind Institute (PMI), Germany Submission: June 11, 2020; Published: July 31, 2020 DOI: 10.31031/RPN.2020.04.000594 ISSN: 2577-9200 Volume4 Issue4 Alice in Wonderland; Seizure; Physical abuse; Child Alice in Wonderland Syndrome (AIWS) was named after Lewis Carroll’s description in his novel. It was in 1955 that John Todd, a psychiatrist, first described this entity. Todd described it as “Alice’s Adventures in Wonderland” by Lewis Carroll. The author Carroll suffered from severe migraine attacks. Alice in Wonderland Syndrome is a confusing state of seizures that affect visual perception. AIWS is a neurological form of seizures that affect the brain, causing impaired perception. The patients describe visual, auditory and tactile hallucinations and perceptual disorders. The causes of AIWS are not yet known exactly. Cases of migraines, brain tumors, depression episodes, epilepsy, delirium, psychotropic drugs, ischemic stroke, EBV, mycoplasma and malaria infections correlate like seizures with AIWS. Neuroimaging studies show disorders of brain regions including the temporoparietal junction, the temporal lobe and the occipital lobe as a typical localization of the visual pathway. The individual chronological report was described by a 67 years-old men, who contacted me in early June 2020 from California, USA. An email interview was analyzed and retrospective described as following: Fever before age 9 People talking to me sounded like they were speaking really fast. I had the feeling of being upside down. I was at my grandmother’s house and was on her red sofa. I found out later that I was not there but, in my own home. Age 9 Evening watching T.V. while lying down. Visual perception was like looking through wrong end of binoculars. Everything was push far away only lasted a short time. Age 15 While driving at night. Same visual perception as in age 9. Had to pull over because of the distortion. Lasted a few minutes. Age 21 During Meditation during the day outside. As I relaxed more the visual perception as in Age 9 happened spontaneously. Even though my eyes were closed I knew IF I opened my eyes I would be seeing through the wrong end of binoculars. Then the body sensations started happening. I was sitting cross legged outside but couldn’t feel my body. It was as if I had no body and even though I was outside with the sun shining I was in total darkness. I didn’t know where or how my body was positioned. Like I was in space and I was a pin point of energy. I felt quiet and at peace. There was a feeling that I could go deeper into the silence but I was hesitant. I became a little frightened because I felt I could stay there forever and not be able to come back out of it. (Now, when you actually look through the wrong end of binoculars it’s only a visual thing, you don’t feel anything. But in the AIWS I felt a sensation in my eyes. I could feel like a pulling at my temples.) When I became hesitant, I decided I should come out of my meditation. I opened my eyes but the visual perception continued. Everything was still pushed far away. I shook my head and in a few seconds I was back to normal. Age in early 30’s Having meditated off and on for years I couldn’t go into deep meditation like the yogi’s talked about. It was always what I call, surface meditating. I wanted to get that feeling of going into deep meditation and I thought if I can get that visual perception thing going, so I focused on my Pineal gland and my eyes to see if I could bring on the visual perception intentionally and I did, within a few minutes. What I found out was I could only go so deep into the meditation as I did at 21 because the old fear would come back. Getting stuck there. Throughout the following years I tried to break through that fear barrier but, I couldn’t. What did happen was that it was harder to get back to normal. The wrong end of binocular vision perception took longer to get back to normal. I don’t see them as seizures. But nothing unusual happen before the early episodes. Nothing unusual before the ones I initiated. Parents Father was verbally a physically abusive. He would beat us for insignificant things. Eg. Like not mopping the floor. Mother was passive. Not stopping the abuse. Physical. Whipping with various forms of articles. Belts, a pliable hard rubber belt he crafted, tree branches. (The switch). This is mainly why I kept leaving home. Well, the abuse Started when we were very young I was 5 Years old I think. It could have been earlier but I can’t remember. And stopped for me when I left at home at 17. So there could be a correlation. I have one brother and 3 sisters and none have had my experience. Didn’t know the reason till last week. Possible reason. I found out from my Aunt, my mother’s sister that my mother didn’t like doing any chores around the house. She always had an excuse. Had rheumatic fever and a heart murmur when she was young. Everyone took care of her. The poor baby. After she got better, it was like expected for people to take care of her. Anyway, my Father came from a clean home. At that time it was expected that the wife clean and have food ready when my father got home. It never was. She always had an excuse. Taking care of the babies. So I think my Father resented that and took it out on me and the others. They have other issues. All the basic text book type issues. I ran away from home at 15-16. At 17 I saved money and left home for over a year. Then suddenly in my late 30’s, early 40’s I couldn’t get back into that space intentionally through meditation. I was kind of relieved but also disappointed. I still meditate and can get very relaxed but, I...
Roig Jc, Major E, Leibovici A, Taylor K, Roig Sm
Research in Pediatrics & Neonatology, Volume 4, pp 1-4; doi:10.31031/rpn.2020.04.000593

Roig JC1*, Leibovici A2, Taylor K3, Major E1 and Roig SM3 1Department of Pediatrics, Division of Neonatology, University of Florida College of Medicine, Florida, USA 2Advent Health Orlando, Florida, USA 3East Carolina University, Greenville, North Carolina, USA *Corresponding author: Department of Pediatrics, Division of Neonatology, University of Florida College of Medicine, Florida, USA Submission: June 04, 2020; Published: June 25, 2020 DOI: 10.31031/RPN.2020.04.000593 ISSN: 2577-9200 Volume4 Issue4 The majority of supernumerary or accessory tragus in humans are noted soon after birth, and are generally benign isolated lesions not associated with other genetic abnormalities. When present, these lesions are typically managed by the primary care provider, but occasionally the caretakers opt to refer the patient to a surgeon to have the lesion resected surgically as an outpatient. This practice may place an unnecessary financial burden on the patient’s family, and may pose added difficulty due to the availability of the subspecialist. The current literature lacks other practical and effective methods for dealing with these lesions despite the incidence of up to 1.5% of the population [1]. Traditionally, however, these lesions are managed by pediatricians or the PCP by placing a suture ligature at its base so that the distal portion of the tragus will fall off after the ischemic necrosis has occurred [2]. This approach is the current standard of care, and is the method being taught at most pediatric training programs. When successful, this process can take days if not weeks to run its course. Another approach may be to refer these patients to a Plastic Surgeon or a Pediatric Surgeon for care which may be to have the lesions managed by means of application of surgical clips [3] at their base thus achieving a similar effect as a ligature. Alternatively, the lesions can be permanently surgically excised later when the patient is older. At the University of Florida we have been successfully excising these lesions when devoid of cartilage prior to the patient’s discharge using the Digiclamp® device. We report 7 lesions which were permanently removed using this method; the clamp was placed at their base flush with the skin, and the accessory tragus was excised. This novel minimally invasive procedure does not require suturing, and has proven to be safe and poses minimal risk to the patient when performed correctly. All of these excisions took place prior to the patient’s discharge and uniformly required only minimal care thereafter. Among the advantages of utilizing this procedure are: the time needed to perform the procedure is brief, on average requires only 10 minutes or less to perform; the procedure has consistently been well tolerated by all of the patients; and although all of the excisions took place in the patient’s center of birth prior to their discharge, it can easily be performed in the outpatient setting since it requires minimal time, equipment, and is relatively simple to perform. Keywords: Accessory Tragus; Supernumerary Tragus; Accessory Auricle; Ear Tag; Removal Procedure; Digiclamp® The supernumerary or accessory tragus, first reported by Burkett in 1858 [4], is a benign congenital abnormality that typically is unilaterally present at birth (Figure 1). The embryological derivation of the tragus is the first branchial arch which also gives rise to the mandible in humans [5]. When present, the most typical appearance for these lesions is that of a nodular skin colored protrusion located in the pre-auricular region on either side of the head. Less commonly, these nodules can also be located along the line from the tragus to the angle of the mouth; along the anterior aspect of sternocleidomastoid muscle; in the cheeks; the upper sternum or on the glabella [6-10]. Additionally, other clinical conditions may resemble the accessory tragus, such as acrochordons or “skin tags”, auricular fistulas, fibromas, polyps, epidermoid cysts, and wattles [7,11,12]. These lesions are more frequently present unilaterally, but may also be present bilaterally, and may be pedunculated or sessile [4]. These lesions may or may not contain cartilage, the presence of which is accurately confirmed with a careful physical exam. Generally these lesions are 10 mm or less in size at their base and are typically removed for cosmetic reasons only [13]. In cases where the lesions contain a central core of elastic cartilage, surgical excision is generally recommended. Figure 1: Example of a left sided pedunculated supernumerary tragus. Figure 2: Disposable Digiclamp® device. Figure 3: Site of local block for the Digiclamp® application and excision. A careful manual examination of each of the accessory or supernumerary tragi is initially performed to confirm that no cartilage is contained within the lesion. Those patients with cartilage were excluded from the Digiclamp® excision procedure (Figure 2) and referred for surgical resections. All of our patient’s families had previously been offered and declined options the suture ligature application and outpatient surgical referral prior to giving us their consent. After consent was obtained and “timeout” was observed, the site of the lesion was prepped in sterile fashion using either povidone iodine and 70% Isopropyl alcohol or Hibistat. The patients were then offered oral Sucrose solution for analgesia after which, the pre-auricular area was infiltrated subcutaneously just below and anterior to the pinna using a 27 French needle and injected with approximately 0.25mL of 1% lidocaine solution without Epinephrine (Figure 3). After allowing several minutes for the anesthetic to take effect, the Digiclamp® was placed at the base of the accessory tragus applying gentle upward traction to the distal part of the lesion prior to closing the device (Figure 4). Figure 4: Digiclamp application...
Farrag S, Afolabi Mo, Rehab Abd El-Aziz El Sayed
Research in Pediatrics & Neonatology, Volume 4, pp 1-11; doi:10.31031/rpn.2020.04.000592

Farrag S1,2*, Afolabi MO3 and Rehab Abd El-Aziz El Sayed4 1Faculty of Nursing, Umm Al-Qura University, Saudi Arabia 2Faculty of Nursing, Mansoura University, Egypt 3Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, UK 4Faculty of Nursing, Mansoura University, Egypt *Corresponding author: Farrag S, Faculty of Nursing, Umm Al-Qura University, Saudi Arabia Submission: May 13, 2020; Published: June 19, 2020 DOI: 10.31031/RPN.2020.04.000592 ISSN: 2577-9200 Volume4 Issue4 Background: Speech language delay is a common developmental problem among Egyptian children. There is paucity of reliable data on parent involvement interventions in speech language problems and of communication disorders in Egypt. Objective: We evaluated the effect of parent involvement in language development intervention programmes on a population of late talking toddlers recruited from local kindergarten schools in Alexandria, Egypt, using interaction-promoting strategies which encourage children to take turns in a conversation, ask questions and wait for a response. Methods: Seventy-nine mother-child pairs were randomly assigned into an experimental group where a validated Language Development Survey (LDS) was administered while study mothers assigned to control arm had routine care according to kindergartens policy in Egypt. Pre-and post-intervention assessments were conducted on all domains of the tool. Results: Approximately one third (30.9%) of the study children in the experimental group had severe language delay pre-intervention and this decreased to 16.2% of children post-intervention. On the other hand, less than one quarter (18.2%) of the study children in the control group had severe language delay pre-intervention, this increased to about half (54.5%) of children post-intervention (p=
Kumba C, Bittmann S, Weissenstein A, Villalon G, Moschüring-Alieva E, Luchter E
Research in Pediatrics & Neonatology, Volume 4, pp 1-4; doi:10.31031/rpn.2020.04.000591

Kumba C* Department of Pediatric Anesthesia and Critical Care, Necker Enfants Malades University Hospital, Assistance Publique Hôpitaux de Paris, APHP, University of Paris, Paris, France Ecole Doctorale 563 Médicament-Toxicologie-Chimie-Imageries (MTCI), Université de Paris, Paris, France *Corresponding author: Kumba C, Department of Pediatric Anesthesia and Critical Care, Necker Enfants Malades University Hospital, Assistance Publique Hôpitaux de Paris, APHP, University of Paris, Paris, France Ecole Doctorale 563 Médicament- Toxicologie-Chimie-Imageries (MTCI), Université de Paris, Paris, France Submission: May 15, 2020; Published: June 04, 2020 DOI: 10.31031/RPN.2020.04.000591 ISSN: 2577-9200 Volume4 Issue4 Background: Goal directed therapies (GDT) include goal directed fluid and hemodynamic therapy (GDFHT), transfusion goal directed protocols (TGDP) and enhanced recovery after surgery (ERAS). These GDT share common aims which are to optimize tissular oxygen delivery (DO2), oxygen consumption (VO2) and extraction ratio (O2ER). Objectives: This editorial on the Thesis Project entitled ´Do goal directed therapies improve postoperative outcome in children’ highlights the physiology and rationale of GDT. Methods: Editorial on the rationale of the Thesis Project in GDT in children. Result: GDFHT, TGDP and ERAS have the same aim which is the optimization of tissular DO2, VO2 and O2ER to avoid and prevent organ dysfunction. Conclusion: Understanding the physiology of GDT is important for optimal patients management. Keywords: Goal directed fluid and hemodynamic therapy; Transfusion goal directed protocols; Enhanced recovery after surgery; Postoperative outcomes, Children; Oxygen delivery; Oxygen consumption; Oxygen extraction ratio; Tissular perfusion pressure A Thesis Project has been undertaken which has the objectives to determine the impact of Goal directed therapies on postoperative outcome in children [1]. The background of this Thesis Project were the results of five retrospective observational studies realized in the pediatric surgical settings [2-6]. These studies had the objectives of determining predictors of adverse postoperative outcomes in the surgical pediatric population. The aim of this Thesis Project is to bring improvement measures in domains where predictors of postoperative adverse outcomes were identified. In order to implement these measures prospective and randomized controlled trials need to be developed. The hypothesis of the Thesis is by implementing goal directed therapies in fields were predictors of pejorative postoperative outcome have been identified, outcome in terms of postoperative morbidity and length of hospital stay will be improved. Goal directed therapies (GDT) include goal directed fluid and hemodynamic therapy (GDFHT), transfusion goal directed protocols (TGDP) and enhanced recovery after surgery (ERAS) [7-33]. GDFHT, TGDP and ERAS share common goals. These aims are to optimize oxygen delivery (DO2), oxygen consumption (VO2) and oxygen extraction in different tissues of the organism. Considering the following equations, one will understand the physiology and the basis of GDT [14,22,23,34,36]. DO2= COxCaO2= COx(Hbx1.31xSaO2+0.0031xPaO2) VO2= CO(CaO2-CvO2) CaO2=Hbx1.31xSaO2+0.0031xPaO2 CvO2= Hbx1.31xSvO2+0.0031xPvO2 O2ER= CaO2-CvO2/CaO2=SaO2-SvO2/SaO2=VO2/DO2 CO= SV x HR= VTIxD²x Π /4xHR SV= Aortic Velocity Time Integral x area of the aortic valve=VTIxD²x Π /4 PP= SVR x CO Where CO= Cardiac output, SV= Stroke volume, HR= Heart rate, PP= Tissular perfusion pressure, SVR= Systemic vascular resistance, VTI= Aortic velocity time integral, D= Diameter of the aortic valve, CaO2= Arterial oxygen content, CvO2= Venous oxygen content, Hb= Hemoglobin levels, PaO2= Arterial oxygen partial pressure, PvO2= Venous oxygen partial pressure, SaO2= Arterial oxygen saturation, SvO2= Venous oxy-gen saturation, O2ER= Oxygen extraction ratio. The determinants of DO2 are CO, Hb, SaO2, PaO2. The determinants of VO2 are CO, Hb, SaO2, PaO2, SvO2, PvO2. The determinants of CO are SV and heart rate. The determinants of SV are afterload [ventricular relaxation and compliance (diastolic function); systemic arterial blood pressure, systemic vascular resistance; pulmonary arterial pressure, pulmonary vascular resistance], preload (volemia) and heart contractility (systolic function). The determinants of tissular perfusion pressure are SVR and CO. Optimizing DO2, VO2 and O2ER means that the demand (VO2) has to be fulfilled by the offer (DO2) [23]. If VO2 exceeds DO2, the tissues have to increase oxygen extraction in order to fulfill the demand [23]. If VO2 exceeds DO2 and oxygen extraction does not increase, a deficit in oxygen will occur which will lead to anaerobic metabolism which will increase lactate production and decrease tissular perfusion which will lead to organ dysfunction [22,23,34-36]. In normal states, VO2 is independent of DO2. If DO2 decreases to a critical state, VO2 becomes dependent on oxygen delivery. In this situation O2ER increases to fulfill VO2. However O2ER cannot increase continuously when DO2 decreases under the critical point. In this state of DO2 dependency, hypoxia occurs and leads to organ dysfunction and lactate levels increase due to anaerobic metabolism [22,23,34-36]. Considering the goal directed fluid and hemodynamic therapy (GDFHT) point of view [9-20]. The objectives of the GDFHT are to optimize DO2 to the tissues and tissular VO2. DO2 can be optimized in GDFHT by increasing CO. CO can be increased by optimizing SV. SV can be assessed echocardiograph-ically with aortic peak velocity variation (ΔVpeak), aortic velocity time integral (VTI) and distance minute (DM) at the aortic valve [9-20]. Assessing aortic velocity time integral (VTI) and aortic peak velocity variation (ΔVpeak) will determine fluid responsiveness if fluid therapy with crystalloids and or colloids...
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