A Review of Febrile Seizures: Recent Advances in Understanding of Febrile Seizure Pathophysiology and Commonly Implicated Viral Triggers

Febrile seizures are one of the commonest presentations in young children, with a 2–5% incidence in Western countries. Though they are generally benign, with rare long-term sequelae, there is much to be learned about their pathophysiology and risk factors. Febrile seizures are propagated by a variety of genetic and environmental factors, including viruses and vaccines. These factors must be taken into consideration by a clinician aiming to assess, diagnose and treat a child presenting with fevers and seizures, as well as to explain the sequelae of the febrile seizures to the concerned parents of the child. Our article provides an overview of this common childhood condition, outlining both the underlying mechanisms and the appropriate clinical approach to a child presenting with febrile seizures.

Maximum intensity projection aids in diagnosing acute appendicitis and mobile caecum: A case report and literature review

Appendicitis is a common childhood condition requiring surgical intervention and delayed diagnosis can have serious consequences. This report describes the case of a child who presented with an acute abdomen and intestinal obstruction. Multidetector (MD) CT demonstrated a left-sided caecum and an inflamed appendix with a faecolith. Maximum intensity projection (MIP) post-processing was key in identifying the appendicular artery and determine the diagnosis. At surgery, however, a mobile caecum and the appendix were positioned on the right side.

Case Report: Children with Severe Nutritional Rickets in the Naga Region in Northwest Myanmar, on the border with India

Rickets is an often-neglected, painful, and disabling childhood condition of impaired bone mineralization. In this case series we describe a cluster of 29 children with severe, painful bone deformities who live in the very remote region of Nagaland in northwest Myanmar. Children were found to have low 25-hydroxyvitamin D, elevated parathyroid hormone, and elevated alkaline phosphatase levels, consistent with nutritional rickets secondary to vitamin D deficiency, calcium deficiency, or a combination of the two. After treatment with vitamin D3 and calcium carbonate, significant improvement was seen in symptoms, biochemistry, and radiography. This is the first report of nutritional rickets in Myanmar in more than 120 years. Vitamin D and calcium supplementation, and food fortification for pregnant women and young children may be required to prevent this potentially devastating disease.

Advancing clinical genetics diagnostic skills: Cherubism

Background: Cherubism is a very rare, mostly a childhood condition that can be horribly disfiguring. We have previously reported our extensive experiences with the diagnosis of rare genetic disorders in a plethora of publications. We have previously reported a large number of rare conditions in Iraq, and we have also helped physicians in the diagnosis and publication of rare syndromes observed in other countries. The aim of this papers is to help physicians in advancing the diagnostic skills in the field of clinical genetics by reviewing briefly a rare syndrome that have not been reported in Iraq, but it is associated with certain clinical characteristics that allow an early diagnosis when seen for the first time. Patients and methods: During the last week of January, 2021, several TV channels presented and discussed the problem of two brothers from Egypt who were considered to have a very rare poorly defined condition that has been associated with progressive disfigurement which resulted in embarrassing social encounters. The cases of the two brothers are presented. Results: The older brother aged 15 and the younger brother aged 14 years. Both had abnormal bilateral and symmetric growth of the jaw resulting in a wide jaw appearance and a round and swollen appearance of cheeks. They also had no teeth on the lower jaw and loose or misplaced teeth on the upper jaw. The parents and a third brother were unaffected. Both children didn’t have mental retardation. The older brother had more severe disfigurement, and many people were asking him to remove the mask he is wearing. He also had very poor vision of left eye resulting from the pressure effect and upward displacement of the eye. The younger brother had a surgical operation to remove a benign tumor from the lower jaw which reduced his disfigurement. Conclusion: Awareness of doctors with this condition “Cherubism” is helpful, and denosumab can be tried in severe cases based on the evidence provided by Bar Droma et al (2020).

Advancing Clinical Genetics Diagnostic Skills: Cherubism.

1. Abstract 1.1. Background: Cherubism is a very rare, mostly a childhood condition that can be horribly disfiguring. We have previously reported our extensive experiences with the diagnosis of rare genetic disorders in a plethora of publications. We have previously reported a large number of rare conditions in Iraq and we have also helped physicians in the diagnosis and publication of rare syndromes observed in other countries. The aim of this papers is to help physicians in advancing the diagnostic skills in the field of clinical genetics by reviewing briefly a rare syndrome that have not been reported in Iraq, but it is associated with certain clinical characteristics that allow an early diagnosis when seen for the first time. 1.2. Patients and methods: During the last week of January, 2021, several TV channels presented and discussed the problem of two brothers from Egypt who were considered to have a very rare poorly defined condition that has been associated with progressive disfigurement which resulted in embarrassing social encounters. The cases of the two brothers are presented. 1.3. Results: The older brother aged 15 and the younger brother aged 14 years. Both had abnormal bilateral and symmetric growth of the jaw resulting in a wide jaw appearance and a round and swollen appearance of cheeks. They also had no teeth on the lower jaw and loose or misplaced teeth on the upper jaw. The parents and a third brother were unaffected. Both children didn’t have mental retardation. The older brother had more severe disfigurement and many people were asking him to remove the mask he is wearing. He also had very poor vision of left eye resulting from the pressure effect and upward displacement of the eye. The younger brother had a surgical operation to remove a benign tumor from the lower jaw which reduced his disfigurement. Conclusion: Awareness of doctors with this condition “Cherubism” is helpful and denosumab can be tried in severe cases based on the evidence provided by Bar Droma, et al (2020).

Ileoileal intussusception as initial manifestation of Crohn’s disease

Intussusception is usually considered a childhood condition, but it may also be present in adults, where it is more often associated with an underlying pathology. There is no agreement upon the correct treatment of adult intussusception, although surgical intervention is considered necessary. Resection without prior reduction has been the traditional treatment of choice due to the significant risk for malignancy found in most series. We describe an unusual case of intestinal necrosis secondary to ileoileal intussusception caused by Crohn's disease. A long intestinal resection was necessary and the patient was discharged without major complications. Based on the details of this case, the authors emphasize the potential importance of considering individualized treatment of adult intussusception. The practical benefit for reduction of viable bowel in Crohn ́s patients is the preservation of bowel length.

Effectiveness of adenotonsillectomy in improving of nocturnal enuresis in children with adenotonsillar hypertrophy

Nocturnal enuresis (NE) is an old & common childhood condition. It has been found that,there is a relationship between adenotonsillar hypertrophy in children & nocturnal enuresis. This study was conducted to see the effects of adenotonsillectomy on nocturnal enuresis in children with adenotonsillar hypertrophy.This study was conducted in Diwaniyah teaching hospital,Diwaniyah city,Iraq from May 2012 to August 2014. The total number of children admitted for adenotonsillectomy or tonsillectomy alone were 287. 76 children out of the total number were included in the study. The children were followed by the same questionnaire for four months postoperatively,including,age,the number of night bed wettings,type of enuresis and the results of urine examinationof total 287 children who were submitted for surgery,76 children were eligible for the study,48 (63.16%) of the total number included in the study were males and 28 (36.84%) were females. The mean age was 7.2 years. Adenotonsillectomy was performed in 64 children,and tonsillectomy in12 children. A complete improvement of nocturnal enuresis (NE) & daytime incontinence was achieved in 32 (42.11%) children. A mild to moderateimprovement was observed in 38 (50%),while no improvement seen in the remaining 6 (7.89%) children postoperatively.Nocturnal enuresis (NE) is an old & common childhood condition & there is a relation between nocturnal enuresis in children & adenotonsillar hypertrophy. Children with nocturnal enuresis should be evaluated by ENT surgeon to rule out any adenotonsillar hypertrophy for possible adenotonsillectomy effect. However,a wide base studies are needed to clarify these results.

Does a poor childhood associate with higher and steeper inflammation trajectories in the English Longitudinal Study of Ageing?

ABSTRACTInflammation has been implicated in many diseases in later life of older Britons. Moreover, health outcomes in later life have also been markedly affected by childhood poverty. But no study has established whether childhood poverty has the effect of upregulating inflammation throughout later life. Using the English Longitudinal Study of Ageing (2004 – 2013) life history information and longitudinal observations of C-reactive protein and fibrinogen as inflammatory biomarkers, we studied the association between childhood condition and trajectories of inflammation for people aged 50 to 97 years. Retrospective childhood poverty some four to eight decades in the past was treated as a latent construct; attrition in longitudinal observations is addressed using inverse proportional to attrition weighting. The analytis revealed significantly higher levels of both biomarkers throughout later life among those with a poor childhood, though there is no evidence of a steeper inflammation trajectory among them. We discussed possible epigenetic changes underlying this strong and long arm of childhood condition. The results suggest that eliminating child poverty can prove to be a wise investment with the prospect of a lifelong reward.

The strong grip of childhood conditions in older Europeans

Among older Europeans grip strength has been found to be marked by a disadvantaged adulthood. Across the Channel, among older Britons gait speed as another measure of physical function has been found to be marked by disadvantaged childhood. Using the Survey of Health, Ageing, and Retirement in Europe (2004-2013), we studied whether childhood poverty led to Europeans aged 50 to 104 years having a weaker grip. We then drew their trajectories of repeatedly measured grip strength to discern a steeper decline among the childhood poor. Retrospective childhood poverty some four to nine decades in the past was treated as a latent construct following the above literature; attrition during repeated measurements is handled using inverse proportional to attrition weighting. The data showed the childhood poor to have a weaker grip for half a century in later life. However, they do not show a steeper decline. Most important, by contributing to levels of grip strength in later life, adult condition holds the potential to shape the strong and long arm of childhood condition. The results are another impetus to eliminate childhood poverty to ensure healthy ageing Europeans.