Genitourinary Tract Tumors in Children: An Update

Background: Genitourinary tract tumors in children are less common than in adults. Most of these tumors have different genetic backgrounds, clinical presentation, and oncologic behavior than their adult counterpart. As a result of low prevalence in children, some of the treatment approaches and recommendations are based on treatment experience in adult patients. However, thanks to scientific and technological development, survival rates have risen considerably. Objective: This paper presents a review of the principal features of the tumors involving the genitourinary tract in children and an update in genetic background, diagnosis, and treatment. Methods: A narrative review was performed on published literature about genitourinary tract tumors in pediatric patients. Papers presented in English and Spanish literature were reviewed. PubMed, Science Direct, and SciELO databases were used to collect information and present this article. Results: Kidney tumors are the most common type of genitourinary tumors in children. Among those, Wilms tumor represents the majority of cases and shows the successful work of clinical trial groups studying this tumor type. Other tumors involving the genitourinary tract in children include Rhabdomyosarcoma, Transitional cell carcinoma, Testicular, and Adrenal tumors. Conclusion: Genitourinary tract tumors in children represent significant morbidity and economic burden, so awareness in early diagnosis represents improvement in treatment, clinical and oncological outcomes.

Clinical and Laboratory Findings of Viral Influenza among Children Hospitalized in Qazvin Pediatric Hospital in Iran, 2015-2020

Background: Children are one of the most important groups at risk of catching the influenza infection. The consequences of influenza in some children, especially children with chronic and underlying diseases, can be very severe and lead to hospitalization. Objective: Purpose of this research was to determine children with influenza and their clinical and laboratory findings in Qazvin children hospital between 2015 to 2020 years. Methods: In this descriptive cross-sectional study, epidemiological and clinical finding of children hospitalized due to confirmed influenza were considered. A total of 1468 children with a suspected diagnosis to influenza were included in this study. Then, based on the Real-time Polymerase Chain Reaction (PCR) a total of 229 were confirmed positive to influenza. Statistical analysis was done using software SPSS 23.0, Analysis Of Variance (ANOVA) and t-test (p≤0.05). Results: Most of patients (53.7%) were infected with influenza H1N1 type. Most comorbidity was observed with Central Nervous System (CNS) disease and febrile seizure (each one 3.10%). Highest clinical feature was fever (83.4%). Significant relationship was observed between the season (p=0.001), sore in throat (p=0.001), febrile seizure (p=0.051), muscle and joint pain (p=0.059), rhinorrhea (p=0.006) and shiver (p=0.051) and occurrence of influenza. Also 4 children had died from influenza during hospitalization. Conclusion: Children with influenza disease were found in this study. Influenza has some side effects on children health. Due to the irreversible and dangerous effects of the influenza, early diagnosis and appropriate treatment in children is important.

COVID-19 vaccination in children: an open question

Background: A safe and effective vaccine represents the best way to control the COVID-19 pandemic, which caused, to date, more than 4 millions deaths. Several vaccines are now approved worldwide, according to the country. Being administered to healthy people, anti-SARS-CoV-2 vaccines must meet high safety standards, and this is even more important among the pediatric population in which the risk of developing a severe disease is significantly lower than adults. However, vaccination of pediatric population could help in reducing viral spread in the whole population. Objective: Our narrative review analyzes and discusses the currently available literature on the advantages and disadvantages of COVID-19 vaccination in the pediatric population. Methods : Our bibliographic research was conducted through Pubmed, Read and Scopus using COVID-19, SARS-CoV-2, immunization, antibody, COVID-19 vaccine efficacy, COVID-19 vaccine safety, children, adolescents, MIS-C, adverse effects as keywords. Results: Although children are less susceptible to COVID-19 infection, they can develop serious consequences, including multi-inflammatory Syndrome. However, before administering children vaccination with complete safety, any vaccine-related side effects should be evaluated. To date, adverse effects are reported in adolescents and young adults following vaccination; but these are mostly isolated reports. Conclusions : Further investigation is needed to establish whether there is indeed a cause-and-effect relationship in the development of vaccine-related adverse effects. However, to date, COVID-19 vaccination is recommended for children and adolescents older than 12 years of age. However, this question is still under debate and involves ethical, political, and social issues.

Assessment of iodofolic supplementation on thyroid function in pregnant women with iodine sufficient status and their infants in Birjand

Background: Maintaining iodine at sufficient levels is necessary throughout the pregnancy to prevent adverse outcomes in infants. This study aimed to assess iodofolic supplementation's impact on thyroid function in women at the end of the third trimesters of gestation. Methods: This case-control study was conducted on 130 pregnant women in the Birjand, east of Iran, during the period from August 2017 to February 2019. We assessed iodofolic supplementation effect in the women at the first trimesters of gestation and followed them at the end of the third trimesters and also their infants on days 3-5. Serum samples were obtained from women and infants for measuring levels of thyroid-stimulating hormone (TSH). Urinary iodine concentration (UIC) was also determined at the end of the third trimester. Results: The median serum TSH concentration in the folic acid consumed group (3.26 ± 1.91) did not significantly differ from another group (2.98 ± 1.41), (p = 0.68). There is also no considerable difference in the mean serum TSH concentration between infants born from mothers who consumed folic acid in the first trimester of pregnancy and another group (p = 0.50). The TSH concentration in all infants was below 5 µM/L. The significant difference in the mean of UIC was also not observed between pregnant women in the folic acid consumed group (188.02 ± 105.38) and iodofolic consumed group (225.77 ± 130.26), (p = 0.13). Conclusion: Iodine intake in our study was sufficient according to the WHO recommendation and idofolic supplementation was not emphasized.

Vaginal Delivery Could Affect on Lactose Content of Human Milk

Objective: The macronutrients of human milk are considered as essential nutritional sources in the first few months of a newborn’s life. The present study aimed to investigate the effect of delivery mode on the macronutrients of human milk. Methods: This retrospective cohort study was conducted on 102 women who gave birth by cesarean section or vaginal delivery between September 2019 and November 2019. The participants were requested to provide their milk samples on day 15±1 after childbirth. Results: There were no significant differences between the two groups (cesarean and vaginal delivery) regarding the sociodemographic characteristics and intake of fat, carbohydrate, protein, and energy. The lactose level was significantly higher in women who gave birth by vaginal delivery [adjusted mean difference, 1.2 (95% CI 0.02- 1.82)]. For other macronutrients, there were no statistically significant differences between the two groups. Conclusion: The vaginal delivery might influence the mature milk lactose level.

Recent insights into COVID-19 in children and clinical recommendations

: Pediatric coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C) have been recognized in multiple countries globally. In this review, we provide recent insights into SARS-CoV-2 infection in children from epidemiological, clinical, and laboratory perspectives, including reports on the disease course and therapy. We highlight key features of SARS-CoV-2 infection in children, the relationship between MIS-C and Kawasaki disease, and summarize treatment guidelines for COVID-19 in children from institutional protocols from Colombia, case reports, recommendations based on expert consensus, and official statements from organizations such as the World Health Organization (WHO), United States Center for Disease Control (CDC), Colombian Association of Infectious Diseases, and the Colombian Society of Pediatrics. Finally, we discuss gaps in research with suggestions for future research on the pathogenesis underlying pediatric COVID-19.

Prevalence of white spot caries lesions in primary teeth in preschool children: systematic review and meta-analysis

Background: The first clinically detectable stage of caries lesion is a non-cavitated white spot lesion (WSL). The detection of early stages of caries lesions allows non-invasive management by fluoride usage, oral hygiene and diet control. There is a lack of information in the literature regarding the prevalence of these caries lesions in preschool children, which is important especially for public health strategies. Objective: The aim of this study was to conduct a systematic review with meta-analysis to verify the WSLs prevalence in primary teeth of preschool children. Methods: A literature search with MEDLINE/PubMed, Scopus, Web of Science, and Open Gray databases was conducted. Included studies fulfilled the eligibility criteria. Meta-analyses were performed using random effects model, for prevalence of pooled WSLs and subgroups analyses. Results: The search strategy identified 4922 potentially relevant articles, with final inclusion of 16 studies. The pooled prevalence of WSLs in primary teeth was 14.0% (95% CI: 8.0-24.0), without publication bias (p=0.2668). For subgroup analyses, an increase in WSLs prevalence for children of low-income economy (24.0%; 95% CI: 20.0-28.0), for age >31 months (22.0%; 95% CI: 12.0-37.0), for validated visual criteria assessment (20.0%; 95% CI: 11.0-33.0), and for tactile assessment with ball-ended probe (26.0%; 95% CI: 11-50.0) were detected. Conclusion: It is suggested that the prevalence of WSLs in primary teeth of preschool children increases in countries with low income economy, with age greater than 31 months as the texture was assessed with visual validated criteria or ball-end probe.

The Effects of Clinical Factors and Neonatal Morbidities on Hearing Screening Among Neonatal Admissions

Background: Hearing loss is an important disorder affecting newborns admitted to NICU. A national hearing screening program using otoacoustic emission testing is an essential tool to identify hearing loss early in neonates enabling early intervention to avoid further challenges of pediatric deafness. On the other hand, a delay of the auditory pathway maturation in preterm babies compared to term newborns has already been suggested in the literature. Taking this information into account, in this paper, we aim to identify the best time to perform NICU infant hearing screening tests. Objectives: We aim to study the clinical factors and neonatal morbidities that may affect neonatal hearing screening results using otoacoustic emission test, in order to decrease the false positive test results that increase parental anxiety and increase the need for subsequent investigations. Methods: This is a prospective cross-sectional study that included 204 infants who were admitted to a tertiary referral hospital NICU unit between September 2017 and May 2018. Both transient evoked otoacoustic emissions (TEOAE) and distortion product otoacoustic emission (DPOAE) screening tests were performed in order to screen hearing loss. Results: Our study included 204 infants, 52.9% of which were males and 47.1% females. There were correlations between both hyperbilirubinemia and ventilation ≥5 days and the failure rate of the first OAE test results among NICU infants where the P-values were (p=0.0133) and (p=0.0456) respectively. Moreover, 165 babies (80.9%) passed the first OAE with a mean birth weight of 2759 gram and mean maternal age of 30.6 years, while 39 babies (19.1%) failed the test with a mean birth weight of 2436 gram and mean maternal age of 32 years. There was no statistically significant relation between both maternal age and birth weight with failure of the first screening test. Conclusion: Our study suggests a higher failure rate of the first OAE in NICU infants who had hyperbilirubinemia or ventilation ≥5 days. Therefore, our recommendation is to postpone the first phase of hearing screening for those infants until the first scheduled vaccine appointment to achieve high compliance to attendance and decrease distress to the family that can be associated with false-negative results of the test.