Journal of Pediatrics Review
Volume:8 Issue: 2, April 2020

Although biological sex influences Acute Lower Respiratory Tract Infections (ALRIs) morbidity and mortality patterns in children living in sub-Saharan Africa, the exact mechanism about the effect is unknown. 

We assessed the quality and strength of evidence on the association of sex with incidence, etiology, and outcomes of ALRI in African children.

We systematically searched electronic databases for publications from 1971-2016 in PubMed, African Journals Online, and Google scholar for ALRI literature in the African children. We used (pneumonia OR bronchiolitis OR “community-acquired pneumonia” OR CAP OR “hospital-acquired pneumonia” OR “nosocomial pneumonia” OR “ventilator-acquired pneumonia” OR “lung abscess” OR “pleural effusion” OR “empyema thoracis”) AND (sex OR gender) AND (Africa OR Sub-Saharan) as search terms. We included the published peer-reviewed journal articles reporting on incidence, etiology, and case fatality. We summarized the findings using narrative and meta-analysis methods.

We included 14 studies with sex-related data; the median (IQR) number of reported pneumonia cases was 148 (87-770) and 114 (56-599) for male and female patients, respectively. Only two studies reported a sex-specific incidence. The odds of sex were in favor of male sex, and the chances of identification of Respiratory Syncytia Virus (RSV) were significantly lower in males than in females (OR=0.60; 95% CI: 0.42, 0.86). Estimates from 9 studies showed that the death rate for males was significantly higher than for females (OR=1.26; 95% CI=1.20–1.33).

Sex-disaggregated data on incidence, etiology, and case fatality of pneumonia are scarcely reported in studies published in Africa. However, males appear to die more often than females, and females more likely to have RSV infection.

Although biological sex influences Acute Lower Respiratory Tract Infections (ALRIs) morbidity and mortality patterns in children living in sub-Saharan Africa, the exact mechanism about the effect is unknown.

We assessed the quality and strength of evidence on the association of sex with incidence, etiology, and outcomes of ALRI in African children.

We systematically searched electronic databases for publications from 1971-2016 in PubMed, African Journals Online, and Google scholar for ALRI literature in the African children. We used (pneumonia OR bronchiolitis OR “community-acquired pneumonia” OR CAP OR “hospital-acquired pneumonia” OR “nosocomial pneumonia” OR “ventilator-acquired pneumonia” OR “lung abscess” OR “pleural effusion” OR “empyema thoracis”) AND (sex OR gender) AND (Africa OR Sub-Saharan) as search terms. We included the published peer-reviewed journal articles reporting on incidence, etiology, and case fatality. We summarized the findings using narrative and meta-analysis methods.

We included 14 studies with sex-related data; the median (IQR) number of reported pneumonia cases was 148 (87-770) and 114 (56-599) for male and female patients, respectively. Only two studies reported a sex-specific incidence. The odds of sex were in favor of male sex, and the chances of identification of Respiratory Syncytia Virus (RSV) were significantly lower in males than in females (OR=0.60; 95% CI: 0.42, 0.86). Estimates from 9 studies showed that the death rate for males was significantly higher than for females (OR=1.26; 95% CI=1.20–1.33).

Sex-disaggregated data on incidence, etiology, and case fatality of pneumonia are scarcely reported in studies published in Africa. However, males appear to die more often than females, and females more likely to have RSV infection.

Pediatric optic neuritis can occur in isolation or association with neuroinflammatory disorders. We reviewed the abnormal orbital and cranial magnetic resonance imaging in literature diagnosed as pediatric optic neuritis, which was primarily presented with visual problems.

A PubMed literature search was accomplished using the following key terms: “Neuroimaging", “Pediatric", “Optic Neuritis", “Multiple Sclerosis", and “Magnetic Resonance Imaging".

Poorly demarcated changes in white and or gray matter, well-demarcated white matter changes, confluent lesions in white matter, and small nonspecific lesions or nothing in some areas of the brain are the most common patterns of children with optic neuritis. The thin, fat suppression imaging technique can reveal optic nerve lesions. Contrast-enhanced sequences, especially by short tau inversion recovery, allow differentiation of particular high-signal intensity foci in the optic nerve and newly formed active lesions from inactive lesions.

Brain imaging should be performed in all patients, if possible, during the two weeks after the initial diagnosis. The cranial neuroimaging can predict multiple sclerosis development in pediatric patients with demyelinating brain lesion

Low birth weight infants are prone to an altered ocular development in childhood, resulting in refractive errors of the eye. Myopia (short-sightedness) is the most common refractive error of the eye that reduces vision.

A PubMed literature search was conducted using the following search terms: “low birth weight infant", “myopia", “prematurity", and “refractive error".

The underlying cause of myopia is usually excessive growth of the eye, which is under the influence of early-life pressure on human growth. Children with low birth weight have significantly shallower anterior chamber depth and thicker lens. At the ages of 10-12 years, preterm children have an increased likelihood of all types of refractive errors. However, in low birth weight children, a 1 diopter of myopic change occurs over the first decade of life.

The progression of myopia is higher in children with low birth weight, suggesting that prematurity and low birth weight may simultaneously affect the development of optical components, leading to myopia.

Most children do not receive sexual education. This ignorance may adversely affect different dimensions of one’s sexual health. However, talking to children about this issue constantly but briefly can have positive impacts on their relationships and sexual health. This study aimed at reviewing different types of educational interventions related to the sexual health of children under 12 years.

In this narrative review, Google Scholar, PubMed, Scopus, Science Direct, and Web of Science databases were searched using the following keywords: “sex education", “sexual education", “sexual health", “sexual training and children". Two researchers (Zahra Barimani Aboksari and Maedeh Rezaei) searched articles related to children’s sexual health up to December 2018. 

The relevant articles were categorized into 4 groups: 1. children-focused interventions: sexuality education coaching program, child sexual abuse prevention program, body image, and decrease in gender-typed remarks; 2. parent-focused interventions: child sexual abuse prevention education and child sexual training; 3. children- and parent-focused interventions: HIV/AIDS prevention program and saving sex for later; and 4. the impact of culture and religion. 

Sexual health in childhood can guarantee the sexual health of the coming years of life; therefore, it is worthwhile to pay attention to this issue and set plans and policies in familial and social aspects based on the interventions mentioned in this study.

Neuromyelitis Optica Spectrum Disorder (NMOSD) is a rare autoimmune inflammatory and astrocytopathic demyelinating disease of the Central Nervous System (CNS). In most patients, an autoantibody to the water channel protein aquaporin-4 (AQP4) would cause humoral inflammatory demyelination and axonal damage. The disease is characterized by clinical syndromes of the optic nerve, area postrema, spinal cord, diencephalon, or cerebrum; or MRI finding related to these regions. According to recent consensus diagnostic criteria, NMOSD is categorized as NMOSD with AQP4-Ab and NMOSD without AQP4-Ab. Early onset is defined as the disease presentation before 17 years. According to the pediatric NMOSD working group, most clinical, laboratory characteristics, and neuroimaging findings of this disease are the same as adult onset one, and the same criteria could be used for pediatric NMOSD. Differentiation of Neuromyelitis Optica (NMO) from MS and Acute Disseminated Encephalomyelitis (ADEM) is vital in choosing the appropriate therapy. It has also been reported that some MS therapies could aggravate NMO and lead to permanent disability.

Three patients under the age of 17 years presented in the neurology clinic, because of their recurrent optic neuritis and cervical myelopathy. AQP4-Ab was positive in two patients, and the other patient was seronegative for AQP4-Ab. According to the recent international consensus definition, all of the patients went under treatment with corticosteroid pulse therapy in acute relapses. Then two of them received azathioprine as a disease-modifying therapy, and the other patient went under rituximab because of a new relapse in spite of azathioprine therapy. Azathioprine and rituximab were safe, and all patients tolerated them well without any significant side effects.

Pediatric NMOSD is a rare but life-threatening disease, which pediatricians and pediatric neurologists must be aware of its presentations and treatment.

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare cardiovascular disease presented with an incidence of 1 per 300000 live births.

In this article, we present four cases of ALCAPA in infancy. Two infants presented with respiratory distress and two with a heart murmur. Their coronary arteries were derived from their pulmonary arteries. Two of them died, one after surgical procedure and one before surgical intervention. Of remained cases, one of them had a good surgical outcome, and another was missed in the follow-up.
A brief review was done on case reports of ALCAPA in children. Eighteen articles were found, including 201 pediatric cases.

The vast majority of affected children will die within the first year of life if ALCAPA is not diagnosed and treated appropriately.

Immune thrombocytopenia (ITP) is an autoimmune disorder associated with decreased platelet production and accelerated platelet destruction. An impaired immune system may induce by or be associated with ITP. 

This study aimed to evaluate complement and humoral immune systems in ITP. 

We evaluated 30 children (under 19 years old) with acute and chronic ITP referred to a tertiary hospital and compared them with 30 healthy volunteers. We assessed the samples’ CBC with differentiation, serum immunoglobulins (IgG, IgE, IgM, IgA, IgG1, IgG2, IgG3, IgG4) by nephelometry, antistreptolysin O titer by agglutination, CH50, C3, C4 by nephelometry, CD19 by flow cytometry, and anti-tetanus antibody titer by ELISA. Their demographic data were obtained with a questionnaire.

Our findings showed that humoral and complement components were normal in both patients and healthy groups. However, based on independent t test results, the mean serum levels of IgM, IgE, IgG1, C3, and tetanus antibody levels were significantly higher in the patient group.

Humoral and complementary immunodeficiency in these patients is unlikely. However, more studies with larger sample sizes are needed.

COVID‐19 is an acute infectious respiratory disease caused by a novel coronavirus. The World Health Organization (WHO) has declared the infection a global pandemic. The incidence, severity, and prognosis of this disease are likely to be different in children compared with adults. Herein we present 9 pediatric patients with COVID-19 infection in Iran.

We present 9 pediatric cases of COVID-19 admitted to different hospitals in Iran. Six patients were male. The youngest was two years old and the oldest one ten years. All children had at least one infected family member. Fever, chills, myalgia, cough, tachypnea, retraction, and crackle were common in all cases. None of our patients presented with diarrhea, vomiting, or a runny nose. Three cases had leukopenia and lymphopenia. COVID‐19 RNA was identified in three cases. In all cases, elevated C-reactive protein and erythrocyte sedimentation rate were detected. Two cases had a high level of lactate dehydrogenase. All cases received supportive care and antibiotic therapy and were discharged within six days with a good general condition.

COVID-19 pneumonia prognosis is good in children with no underlying diseases. Our patients recovered without the need for LPN/r, ribavirin, or mechanical ventilation.