Comparative analysis of chemical contamination of baby foods and primary pediatric morbidity

The safety of baby foods is key to a child’s health, which, in turn, is one of the prioritized national goals. As they grow, children get exposed to numerous negative environmental impacts. Chemical contamination of baby foods can increase pediatric morbidity. The aim of this study was to investigate possible correlations between baby food contamination and primary pediatric morbidity using data on 65 Russian regions collected in 2012–2017 by the Russian Federal Information Public Health Surveillance Foundation. The data were processed in Microsoft Word 2010 and Microsoft Excel 2010. Of 67,940 samples of baby foods analyzed for chemical contamination, priority pollutants (toxic element) were detected in 14.1%. The most contaminated were fruit and vegetable purees (47.1%), followed by milk formulas and cultured dairy products (19.9%). We also analyzed 32,914 indicators of pediatric morbidity. The Pearson correlation analysis detected reliable correlations between baby food contamination and the primary incidence of endocrine disorders in infants, as well as the primary incidence of obesity, diabetes mellitus and cancer in children aged 0 to 14 years.

It’s time to eliminate the mismatch between pediatric training and practice

The quality of pediatric clinical practice is dependent on the training received during residency. It is assumed that the content of the training will adequately prepare pediatricians for the sorts of problems and issues they will be asked to manage in community settings. While over the past several decades there have been major changes in pediatric morbidity, there is evidence that training and service delivery models have not evolved; there is a significant mismatch between training and evidence-based clinical practice. A recent paper published in this journal (1) drew attention to the inadequacy of pediatricians’ training in child development. The reality of major gaps in the content and experiences of pediatric training in Israel are widely held, and there have been repeated calls for an increased focus on community child health and developmental and behavioural pediatrics. While it appears that finally there are some small initial steps to this end, it is strongly recommended that there be a long overdue, radical rethink of pediatric training programs.

The efficacy and safety of the cytomucoprotector gelatin tannate in the treatment of acute gastroenteritis in children

Introduction. Acute gastroenteritis (AGE) is one of the leading causes of pediatric morbidity and mortality. The use of cytomuco-protectors that stabilize the intestinal barrier can increase the effectiveness of treatment.The aim is to determine the gelatin tannate (GT) clinical efficacy, safety and antiviral activity in AGE in children admitted to the hospital.Materials and methods. An open, prospective, randomized study included 52 children <7 years of age with AGE. The intervention group (n = 28) received GT, which was administered orally at 250 mg to children <3 years of age and 500 mg to children £ 3 years of age 4 times a day for 7 days. The severity of AGE (Vizikari scale: 10-14 points and CDC: 1-5 points) in parallel groups was significant. Standard treatment included rehydration and probiotic B. bifidum 1 (15 * 108 CFU / day in three divided doses). Antibiotic therapy (ABT) was received by 50% of children from each group. Fecal samples at screening and on the 7th day of treatment were examined in Real-time PCR with the determination of nucleic acids of rotaviruses A, noro-, adeno-, astro- and enteroviruses. The viral etiology of AGE was confirmed in 53.8%, salmonellosis - in 3.8% and campylobacteriosis - in 1.9% of patients.Results. GT reduced the risk of diarrhea on day 5 by 32% [95% confidence interval 14-50%] OR 0.25 [0.11-0.25] and by 14% [4-24%] by day 7. In the GT group, on day 7 of treatment, all patients had normal stool consistency. GT reduced the time for stool normalization by 1.3 days [0.2-2.3]. A more significant effect was obtained in patients with risk factors for insufficient treatment efficacy and in patients with inflammatory AGE requiring ABT. In those who received GT, a decrease in the concentration of viruses in feces was found, in the control - no statistical differences. The recurrence of AGE symptoms during hospital treatment was recorded with a frequency of 3.6% and 16.7%, respectively (p = 0.111).Conclusions. GT significantly reduced the risks of incomplete therapy effect by day 7 of treatment and the average positiveness of stool normalization. Trends in the antiviral action of GT and its positive effect on the incidence of nosocomial viruses.

Maternal metal concentration during gestation and pediatric morbidity in children: an exploratory analysis

Background The majority of studies linking exposure to metals with certain health outcomes focus on known toxic metals. Alternatively, this study assesses the extent to which exposure to a wider range of metals during gestation is associated with childhood morbidity. Methods We analyzed the concentrations of 25 metals found in urine samples of 111 pregnant women of Arab-Bedouin origin collected prior to birth. In addition, we collected medical records on their offspring for six years following birth, including every interaction with HMOs, local hospitals, and pharmacies. Results The main types of morbidities diagnosed and treated during this period were preterm births, malformations, asthma-like morbidity, cardiovascular and behavioral problems, and obesity. Multivariable analysis showed that offspring born before term were more likely to have been exposed to elevated maternal concentrations of zinc, thallium, aluminum, manganese, and uranium, all with adjusted relative risk above 1.40 for an increase by each quintile. Likewise, children with asthma had been exposed to higher levels of magnesium, strontium, and barium at gestation, while behavioral outcomes were associated with elevated biometals, i.e., sodium, magnesium, calcium, selenium, and zinc, as well as higher levels of lithium, cobalt, nickel, strontium, cadmium, vanadium, arsenic, and molybdenum. A heatmap of adjusted relative risk estimates indicates the considerable implications that exposure to metals may have for preterm birth and developmental outcomes. Conclusions The current study shows that perinatal exposure to metals is adversely associated with pediatric morbidity. Further such analyses on additional samples are warranted.

Cysticercosis in Madagascar

Introduction: Cysticercosis (CC) is the most common parasitic disease of the central nervous system. It is endemic in most developing countries where pigs are raised and consumed. An overview of all available data of this parasite in Madagascar is lacking. Methodology: We conducted a literature review, collecting information on published and available literature about cysticercosis in Madagascar between January 1st, 1990 and June 30th, 2020. Results: Out of 858 publications; 61 were included, issued from peer-review indexed journals, non-indexed journals, books, Ministry reports and press releases. In Madagascar, porcine cysticercosis has been reported since 1901; human cysticercosis is highly prevalent with an overall estimated seroprevalence between 7 and 21%. Serological analysis is based on Enzyme-Linked Immunosorbent Assay (ELISA) and Enzyme-linked immunoelectrotransfer blot techniques (EITB) for confirmative testing. Neurocysticercosis (NCC) is the most common pattern of cysticercosis in Madagascar and it is reponsible for pediatric morbidity causing more than 50% of epilepsy cases. Though CT-Scan is now available and tends to be considered the gold standard for NCC diagnosis, it remains unaffordable for most Malagasy patients and implies the proposal of a diagnostic algorithm for physicians. Conclusions: Our review has revealed that human taeniasis and bovine cysticercosis is a considerable burden in Madagascar. A national control program has been developed aiming to decrease the seroprevalence rate from 16 to 10% in 2015. The aim of the country is now to implement a CC control and elimination program. Meanwhile, some massive cysticercosis screenings have been conducted in the capital Antananarivo to drive people's attention on this widespread infection.

COVID-19 Infection in Children: Estimating Pediatric Morbidity and Mortality

ABSTRACTBACKGROUNDEstimates of pediatric morbidity and mortality from COVID-19 are vital for planning optimal use of human and material resources throughout this pandemic.METHODSGovernment websites from countries with minimum 1000 cases in adults and children on April 13, 2020 were searched to find the number of cases confirmed in children, the age range, and the number leading to hospitalization, intensive care unit (ICU) admission or death. A systematic literature search was performed April 13, 2020 to find additional data from cases series.RESULTSData on pediatric cases were available from government websites for 23 of the 70 countries with minimum 1000 cases by April 13, 2020. Of 424 978 cases in these 23 countries, 8113 (1.9%) occurred in children. Nine publications provided data from 4251 cases in 4 additional countries. Combining data from the websites and the publications, 330 of 2361 cases required admission (14%). The ICU admission rate was 2.2 % of confirmed cases (44 of 2031) and 7.2% of admitted children (23 of 318). Death was reported for 15 cases.CONCLUSIONChildren accounted for 1.9% of confirmed cases. The true incidence of pediatric infection and disease will only be known once testing is expanded to individuals with less severe or no symptoms. Admission rates vary from 0.3 to 10% of confirmed cases (presumably varying with the threshold for testing) with about 7% of admitted children requiring ICU care. Death is rare in middle and high income countries.

Iron Packaging Regulations in the United States and Pediatric Morbidity: A Retrospective Cohort Study

Iron poisoning was a leading cause of pediatric morbidity and mortality. We sought to assess whether the removal of strict iron packaging requirements in 2003 resulted in an increase in iron-related morbidity and mortality in pediatric exposures. We performed a retrospective cohort study utilizing the National Poison Data System from 2000 to 2017. A total of 4110 exposures met inclusion criteria: 847 from before (2000-2003) and 3263 after removal of unit-dose package regulations (2004-2017). The incidence of any marker of severity (7.2% vs 3.8%; odds ratio = 0.51, 95% confidence interval = 0.37-0.69) and frequency of deferoxamine use were both higher in the early time period (2.6% vs 1.0%; odds ratio = 0.38, 95% confidence interval = 0.22-0.66). There was no difference in the frequency of key serious effects (acidosis, elevated transaminases, hypotension). Despite removal of iron packaging regulations in the United States, there continues to be a decrease in the incidence of severe iron exposures in children.