Change in Pediatric Health Care Spending and Drug Utilization during the COVID-19 Pandemic

Objective: To evaluate how the restrictive measures implemented during the SARS-CoV-2 pandemic have influenced the incidence of the most common children’s diseases and the consumption of medications in 2020 compared to 2019. Methods: We involved all family pediatricians of the local health authority of Latina, from which we requested data of monthly visits in 2019 and 2020 for six common diseases disseminated through droplets and contact, and the territorial and integrative pharmaceutical unit of the area, from which we requested data of the net expenditure regarding the most commonly used drugs at pediatric age. Results: There was significant reduction in the incidence of the evaluated diseases and in the consumption of investigated drugs between 2019 and 2020 in the months when the restrictive measures were in place, with an attenuation of this effect during the months of the gradual loosening of those measures. Conclusion: Nonpharmaceutical intervention measures have caused changes in the diffusion of common pediatric diseases. We believe that the implementation of a reasonable containment strategy, even outside of the pandemic, could positively influence the epidemiology of infectious and allergic diseases in children, and healthcare system spending.

Thyroid surgery in children: our experience

Introduction: Thyroid surgery in children is a rare operation. The aim of our paper is to point out the specifics of thyroid surgery in children. Methods: Retrospective analysis of patients hospitalized at the Department of Paediatric Surgery, Faculty of Medicine, Comenius University and National Institute of Children’s Diseases in Bratislava during a 10-year period (2007−2016) who underwent thyroid surgeries. Results: The retrospective analysis included 81 patients: 66 (81%) girls and 15 (19%) boys. The mean age of the patients was 14 years ±8 months (range 4−18 years). The most common indications for thyroid surgery were: a nodule in 36 (44.4%) patients, Graves Basedow thyrotoxicosis in 19 (23.5%) patients, and suspected thyroid carcinoma in 11 (13.6%) patients. Cervical lymph node metastases (mts) were diagnosed in 9 (11.1%) patients, and distant pulmonary metastases in 5 (6.17%) patients. Total thyroidectomy (TTE) was performed in 43 (53%) patients, total lobectomy (TL) in 20 (24.7%) patients. Extended surgery on regional lymph nodes was performed in 9 (11.1%) patients. Eight (9.9%) patients underwent reoperation. A total of 12 (14.8%) patients experienced postoperative complications. Unilateral transient recurrent laryngeal nerve (RLN) paralysis occurred in 2 patients, and permanent in one patient. Transient postoperative hypoparathyroidism with hypocalcaemia was reported in 8 (9.9%) patients; no permanent condition of this type was observed. Conclusion: Multidisciplinary collaboration ensures that optimal surgical results are achieved in the patients. Experience of the surgeon performing thyroid surgery in children remains crucial.

Risk of Leukemia and Brain Tumors in Children Exposed to Pesticide Residual in Households and Approaches to Reduce its Side Effect

Context: Using various pesticides to control pests and vectors of diseases has a long history in households worldwide. However, most pesticides are considered toxic to and harmful to the environment. Evidence Acquisition: Electronic databases such as Google Scholar, PubMed, and Scopus were searched using the following search terms: “children”, “pesticide residues”, “risks”, “leukemia”, and “brain neoplasms”. This review was designed to identify the relevant electronic studies published from January 2000 to February 2020. Results: Children are more susceptible to pesticides because of their underdeveloped metabolic processes and disability to detoxify chemicals. Over 30% of the children’s diseases are due to environmental factors, including pesticides. The possibility of children’s pesticide exposure inside of urban houses is more than outside. In general, children can be exposed to pesticides in two ways: Direct and indirect contact. Direct contact refers to hand-to-mouth behavior in daily plays that absorbs household pesticides. Indirect contact refers to exposure via their parents’ work in hazardous environments and during pregnancy. There is a significant association between pesticide exposure via households and some cancers in children, such as leukemia and brain tumors. Conclusions: Due to the positive association between pesticide residues in households and the risk of cancers in children, public health policies must be adopted to minimize children’s exposure to pesticides in the urban household.

Use of off-label medicines in pediatric population

Modern use of drugs in the treatment of diseases of children and newborns is increasingly based on off-label use of drugs. The lack of adequate formulations for the pediatric population, the lack of appropriate therapeutic parallels for the treatment of children's diseases and the small number of clinical trials involving the pediatric population have contributed to the mass use of these drugs. The use of these drugs implies extrapolation of doses and indications registered for adults to children, although it is known that the pharmacodynamics and pharmacokinetics of children and adults differ significantly. In the past two decades, many legislative and regulatory initiatives have been taken around the world to improve the use of drugs in children. However, children are still prescribed off-label and unlicensed drugs. The aim of this study was to present a review of the literature in which off-label and unlicensed use in the pediatric population was investigated. Literature was searched through the Google Scholar and Pub Med search engines and using the keywords off label drug, pediatric medicine, use in pediatrics, in the period from May to August 2019. Selected and presented in this article are studies published in the period from 1996 to 2015, which as a subject of research had the use of off-label and unlicensed drugs in the pediatric population. Medicines prescribed for children should be registered for use in the pediatric population and used in accordance with approved indications for children, whenever possible. It is necessary to take measures for more rational use of medicines in pediatrics, which include the collaboration of health workers in order to provide medicines for children that are proven to be effective, high quality and safe to use.

Sistem Pakar Deteksi Penyakit pada Anak Menggunakan Metode Forward Chaining

Health is the most valuable thing for humans, because anyone is vulnerable to health problems. Especially in children, children are very susceptible to germs and sensitivity to symptoms of a disease is a fear for parents themselves. However, with the convenience of having an expert doctor, sometimes there are also weaknesses such as limited working hours or doctor's practice hours and the number of patients who have to wait for queues and also the many parents who do not know about the symptoms and types of children's diseases, a system is built to facilitate the medical team and system users. The purpose of this study was to detect children's diseases using the Forward Chaining method precisely and accurately. The data that were processed were 25 symptoms and 5 types of childhood diseases which were sourced from patient medical records and interviews with experts at the Ibnu Sina Simpang Empat Islamic Hospital. The symptoms and types of disease are entered into the Expert System using the rules of rules and the Forward Chaining method. To diagnose a child's disease, a Forward Chaining method is needed with the following stages: Preparing input data, determining decision tables, determining rules, tracking processes, making decision trees. The results of the study with 25 symptom data obtained as many as 5 decision rules, namely which type of childhood disease the patient has and the initial treatment that must be done. Based on the analysis carried out, it can be seen the types of diseases suffered by children so that it can be used as a reference for making decisions to diagnose diseases in children. This expert system calculation shows the percentage of success from the expert.

PROTOCOL No. V. Administrative appointment on May 4, 1895. (§ 34).

25 members attended.1) Chitan and approved protocol No. IV.2) The Chairman reported to the Society that the congress of doctors on obstetrics, women's and children's diseases in Bordeaux would not take place on 12, as previously announced, but on August 8 this 1895.

Therapeutic physical culture for children's diseases

The textbook presents the content of the main sections of the discipline, as well as includes teaching materials for independent work of students. It is intended for students studying in the areas of training "Physical culture" and "Physical culture for people with disabilities in health (adaptive physical culture)".

Sistem Pakar Deteksi Penyakit pada Anak Menggunakan Metode Forward Chaining

Health is the most valuable thing for humans, because anyone is vulnerable to health problems. Especially in children, children are very susceptible to germs and sensitivity to symptoms of a disease is a fear for parents themselves. However, with the convenience of having an expert doctor, sometimes there are also weaknesses such as limited working hours or doctor's practice hours and the number of patients who have to wait for queues and also the many parents who do not know about the symptoms and types of children's diseases, a system is built to facilitate the medical team and system users. The purpose of this study was to detect children's diseases using the Forward Chaining method precisely and accurately. The data that were processed were 25 symptoms and 5 types of childhood diseases which were sourced from patient medical records and interviews with experts at the Ibnu Sina Simpang Empat Islamic Hospital. The symptoms and types of disease are entered into the Expert System using the rules of rules and the Forward Chaining method. To diagnose a child's disease, a Forward Chaining method is needed with the following stages: Preparing input data, determining decision tables, determining rules, tracking processes, making decision trees. The results of the study with 25 symptom data obtained as many as 5 decision rules, namely which type of childhood disease the patient has and the initial treatment that must be done. Based on the analysis carried out, it can be seen the types of diseases suffered by children so that it can be used as a reference for making decisions to diagnose diseases in children. This expert system calculation shows the percentage of success from the expert.