Physical Inactivity in Youth During COVID-19: A Narrative Review

The prevalence of physical inactivity in youth during COVID-19 has varied across countries and depending on the age of the youth and whether the data were collected during lockdown versus non-lockdown. In studies that compared activity pre-and during COVID, activity decreased in 40-59% of youth. Several negative effects have been noted, including excessive screen time, sleep problems, over-eating, and affective disturbances. Physical inactivity was a significant correlate of all of these problems. Relatively little intervention research has been conducted, and underlying mechanisms have not been explored. As in most of the COVID-19 literature, this research has the limitations of being typically cross-sectional and self-reported.

Prognostic value of electroencephalography in hypoxic-ischemic encephalopathy

Background: Hypoxic-ischemic encephalopathy (HIE) is one of the main causes of neurodevelopmental disorders. We developed a model that has diagnostic and prognostic value in predicting the neurodevelopmental outcomes in newborns with HIE. HIE staging allows us to start therapeutic interventions early in newborns with suspected encephalopathy. Methods: This was a retrospective study in a cohort of 58 full-term neonates with clinical suspicion of HIE. We assessed electroclinical variables at birth [etiology of hypoxia, neonatal seizures, HIE stages based on Sarnat criteria, use of therapeutic hypothermia, neuroimaging tests and electroencephalography (EEG) findings] and two years of follow up (EEG findings, development of epilepsy, the presence of cognitive deficits, behavioral issues, language problems, visual or hearing disturbances, and cerebral palsy). Results: There was a high electro-clinical correlation to severe HIE (88.8%) and moderate HIE (50%). There was a considerable proportion of patients affected by mild HIE, based on clinical examination, who presented with an abnormal EEG (32.3%). There is a relationship between the onset of neonatal seizures, epilepsy, and severe HIE diagnosed with EEG (88.9%). A higher percentage of patients with moderate and severe HIE, based on EEG findings, present abnormal results in cranial ultrasound and cerebral magnetic resonance imaging (62.5%). At two years of age, functional neurodevelopment disturbances were observed most frequently in patients affected with severe and moderate HIE based on EEG. Conclusions: This study shows a model with diagnostic and prognostic value in predicting newborns' neurodevelopmental outcomes with suspected HIE. This knowledge allows us to assess the role of performing serial EEG in patients with suspected HIE and the relevance of EEG findings in the prognosis of neurodevelopmental disorders.

A 6-Day-Old Newborn with Vomiting and Jaundice

Sixty percent of term neonates and 80% of preterms have jaundice within the first week of life. Jaundice can be pathologic or physiologic, indirect, or direct. Indirect jaundice can be neurotoxic at high levels. In its most severe form, this presents as acute bilirubin encephalopathy or kernicterus. Screening for jaundice using a transcutaneous bilirubin check or serum bilirubin has contributed tremendously to the reduction of kernicterus, which ranges from 0.5-1.3/100,000 births. Often, the etiology is easy to decipher. Otherwise, it may be complicated when there are several factors contributing. We present a case of a 6-day-old with jaundice and vomiting who was suffering from intestinal malrotation and a urinary tract infection.

A case of McCune Albright syndrome in the context of an ovarian mass and late development of café-au-lait macules

McCune-Albright syndrome (MAS) is a genetic disorder characterized by polyostotic fibrous dysplasia, precocious puberty, and café-au-lait spots. In this case, a patient presented with precocious puberty in the setting of an ovarian mass and late development of café-au-lait macules, confounding the final diagnosis of MAS. A 3-year-old girl presented with vaginal bleeding. She had a previous episode of vaginal bleeding, breast budding, and a right ovarian cyst at 5 months of age. Work-up at that time showed no abnormal findings, though past medical history was notable for two fractures. Physical exam was significant for increased height (89th percentile), increased weight (99th percentile), bilaterally elevated breast mounds with palpable breast tissue and darkened areolae (Tanner stage 3), and residual blood in the vaginal introitus. Notable labs included low FSH and high ultrasensitive estradiol. Pelvic MRI showed a right ovarian cyst, which, in the context of precocious puberty, raised the suspicion for a juvenile granulosa cell tumor. Follow-up pelvic MRI demonstrated features that instead suggested an ovarian response to hormonal stimulation. On a subsequent visit several months later, the patient had small café-au-lait macules on the chest and right buttock, which were not present on the initial evaluation. Further workup revealed advanced bone age on an x-ray at 6 years 10 months, and multifocal polyostotic fibrous dysplasia involving bilateral femurs and right tibia. Failure to include MAS in the differential had led to unnecessary oophorectomy. It is crucial to identify MAS as a cause of peripheral precocious puberty to guide proper management.

Term Neonate with Respiratory Distress Syndrome Secondary to Congenital Hypothyroidism

Congenital hypothyroidism presents with characteristic symptoms within the first few months of life: constipation, jaundice, poor feeding, hoarse cry, macroglossia, and hypotonia. However, these symptoms are rare immediately upon delivery, as most neonates are asymptomatic at birth. Therefore, the newborn screens are essential in detecting congenital hypothyroidism, but there are rare cases in which congenital hypothyroidism can be missed or present before the first newborn screen. This paper presents a case of respiratory distress syndrome in a term neonate as the presenting symptom of congenital hypothyroidism. Overall, clinicians should be aware that neonatal respiratory distress can indeed be caused by congenital hypothyroidism, though more common etiologies should be ruled out following stabilization of the patient. Congenital hypothyroidism is an endocrinopathy that may present prior to the onset of symptoms at 3 months or may even present as respiratory distress syndrome prior to the results of the newborn screens. A discussion of this rare case may help physicians in the recognition and treatment of respiratory distress syndrome due to hypothyroidism.

Letter from the Editors

Since it was established in 2014, the International Journal of Integrative Pediatrics and Environmental Medicine (IJIPEM) has strongly adhered to publishing ethics, followed a double-blind review process, and published high-quality papers. Our outstanding linguistic service has assisted many grateful authors for whom English is a second language. Last year was a hard year for everyone, but particularly for the first-line medical care providers. We have given priority to SARS-CoV-2-related manuscripts and published them for free, thereby contributing to our universal knowledge of this new disease. One of the most interesting papers was "Pregnancy and COVID-19, a brief review", one of the first articles published on the topic. Another paper, "The new face of Medicine – care flow strategies developed during COVID" by Dr. Sharon Jacob, addressed how to adjust clinic schedules during this unexpected Global disaster. We also published rare and interesting cases related to the journal's scope, which is focused on the interactions between children and their physical and psychological environment. We want to remind you that the journal topics center on modifiable factors, such as environmental pollution, child-parent relationships, social circumstances, quality of life of the sick child, ill-child school performance, mental health, and sensitivity to environmental factors. Topics concerning integrating conventional pediatrics with complementary and alternative medicine for children and research about environmental impacts on cellular and molecular mechanisms of development are of great interest. We will continue giving priority to manuscripts related to the impact of SARS-CoV-2. We are hopeful that the new year will be very fruitful for our goal of increased scientific knowledge and distribution of these discoveries. We are looking forward to reading, reviewing, and publishing your work. We will also see that it is preserved and recorded with DOI links and advertised widely. Manuscripts funded by NIH or their partners will be indexed as PubMed selected citations. We hope you will enjoy working with our editorial team. If you are reading this letter, you may well already be familiar with IIPEM. If you are interested in working with us, please, register as an author on the web at https://ijipem.com/index.php/ijipem/login. We will put our talents to work to make your paper readable and visible.

THE CONTENTS OF NITRATES AND NITRITES IN FOOD AND THEIR IMPACT ON THE HEALTH OF THE POPULATION OF MELITOPOL

One of the main criteria of the characteristic of the quality and the safety of the food of the plant and the animal origin is the pollution of the most common contaminants such as the nitrates and the nitrites. The observation of their contents has been and remains actual. In 2017-2019, the plant and the animal foods of the contents of the nitrates and the nitrites have been investigated by us in Melitopol. The subjects of the research are potatoes, onions, carrots, tomatoes, cucumbers, apples, strawberries which have been purchased in the supermarkets and in the market in the farmers and in the owners of the farmland. For this purpose, twice a year (6 spring (May) and 6 autumn samples (September)) have been taken samples of each products for the nitrate contents. The meat of pigs and chickens, beef, boiled and smoked sausage (3 samples for each product) have been investigated in the animal products. The research has been carried out in the laboratory of the university with the express-method using a digital nitrate tester SOEKS and the potentiometric method with the ionomer I-160MI with the ion-selective electrode ELIS-121NO3 K80.7. In general, 378 samples of the plant food and 21 samples of the animal food have been analyzed. The presence of the nitrate and the nitrite of the nutritional additives (E 250-253) in the cheese and the meat products (34 types) has been determined according to the corresponding labels on the package. It has been installed that in the food of the plant origin from the Melitopol trade network the nitrates in the different concentrations have been presented in all researched food. The largest amount of the nitrates has contained all spring vegetables and the strawberries from the farms, which is obviously due to the agro-technological conditions of their growing. The minimum contents of the nitrates have been found in the vegetables and the fruit which are grown on the farmland. Safe for the people of Melitopol for the nitrate contents of the product of the animal origin has been detected in the fresh meat, and the sausage products are the most dangerous, which in all samples contain nitrates with a significant exceeding of the concentration. The nitrate and the nitrite pollution of the food affect the health status of the population of Melitopol, which is most often manifested in the increase of the indicator of the morbidity of cardiovascular system, oncopathology, digestive system and food poisoning.

The New Face of Medicine –care flow strategies developed during COVID

The COVID-19 pandemic has redefined the practice of medicine. Adaptive care models to sustain access through integration of virtual and in person essential services have been implemented. Utilization of novel scheduling protocols can create a safe and efficient clinic experience for children and staff in this pandemic time.

Pediatric Bartonella Infection (Cat Scratch Disease) Presenting as Inguinal Lymphadenopathy

Cat scratch disease is an infectious disease resulting from inoculation of Bartonella species through a cat scratch or bite, often presenting as an erythematous papule at the site of inoculation with nearby painful lymphadenopathy. The diagnosis of this disease is complicated by a wide variety of clinical presentations, as the primary lesion may not be initially noticed. Furthermore, cervical and axillary lymph nodes are the most commonly involved regions of tender lymphadenopathy, but there have been reported cases that do not fit the typical clinical picture – such the case discussed in this report of a pediatric Bartonella henselae infection that initially presented as left inguinal lymphadenopathy with underlying necrosis and abscess formation. In this case, a 9-year-old boy presented to the ED with a 4-day history of increasing mass in the left groin, as well as a subjective fever for the previous 2 days. An ultrasound revealed a necrotic abscess in the left inguinal lymph node which necessitated empiric antibiotic therapy and surgical excision; titers revealed a recent infection with Bartonella henselae. Atypical presentations of cat scratch disease, such as inguinal lymphadenopathy, have historically confounded the diagnosis. However, positive serology studies ultimately yielded the correct diagnoses in these children. Given that cat scratch disease can present in an atypical fashion in approximately 5 - 25% of cases, physicians should keep the disease on the differential even when presented with rare presentations such as inguinal lymphadenopathy; serological testing for B. henselae can be utilized once more likely etiologies have been ruled out.

Trisomy 9 Mosaicism Syndrome in a Female Child

Trisomy 9 Mosaic syndrome is one of many rare syndromes. Less than 100 cases is known to date. Our case is the only one we’re aware of in the Panhandle region. We present this case to bring awareness of this rare syndrome to providers in how to facilitate management.