Resumo em Inglês:

Abstract Objective Human Papillomavirus (HPV) is a virus that targets epithelial tissues. Virtually all cases of cervical cancer are related to HPV, emphasizing the importance of vaccines in prevention. Although >200 million doses have been administered worldwide, concerns persist about adverse reactions. This study evaluated the safety of the HPV vaccine and the main adverse effects. Data sources The study was registered in the PROSPERO database (CRD42023365692). The systematic searches were conducted in the PubMed, Scopus, Embase, Cochrane, Science Direct, and Web of Science databases using the search strategy "HPV" AND "vaccine" AND "safety" NOT "COVID" from 01/01/2007 to 31/12/2022. Inclusion criteria were based on the PICOT strategy, focusing on studies with humans, vaccinated populations comprising children, adolescents, and adults, and Phase II/III randomized clinical trials. The PEDro scale was used to assess the quality of the studies. Summary of findings Eleven articles were qualified for qualitative synthesis and meta-analysis. The results indicated that HPV vaccination was associated with increased local reactions, fatigue, and myalgia compared to the placebo. However, there were no significant differences in serious adverse events, gastrointestinal reactions, cutaneous effects, headache, or fever between the vaccine and placebo groups. Conclusion Local reactions, fatigue, and myalgia were more prevalent in the HPV vaccine group; the overall safety profile of the vaccine was favorable. The HPV vaccine was deemed safe, mirroring the profile of adverse reactions seen with other vaccines. With its potential to prevent cancer, the benefits of HPV vaccination far outweigh the minimal risks.

Resumo em Inglês:

Abstract Objective This review explores preventive strategies for pediatric rhinosinusitis and examines their potential impact on children's mental well-being, advocating for a comprehensive holistic approach that includes medical disciplines and government policies to support EU and global prevention strategies. Sources A comprehensive search encompassed Medline, Embase, PubMed, and the Cochrane Library for English-language articles from January 2010 to December 2023. Inclusion criteria involved papers on pediatric rhinosinusitis prevention in the pediatric population, published in peer-reviewed journals. Following the removal of duplicates and exclusion of irrelevant studies, 20 unique titles were included in the review. Summary of the findings The review underscores the challenges posed by the similarity of symptoms between pediatric rhinosinusitis and other common childhood illnesses. It emphasizes the interconnected nature of upper and lower airways, illustrating the potential impact on both physical and mental well-being in children. The findings highlight the necessity for a multifaceted prevention approach, supported by individualized prevention plans, medical professional involvement, and government policies. Conclusions The holistic research and clinical approach proposed in this review contribute valuable insights into the global efforts aimed at reducing the incidence of pediatric rhinosinusitis while promoting the mental well-being of children. The article serves as an informative resource for readers seeking a deeper understanding of pediatric rhinosinusitis prevention strategies. The review emphasizes the necessity of a multidisciplinary approach, involving pediatricians, otolaryngologists, pneumologists, and allergologists, in PRS prevention. Government prioritization of preventive measures is essential. Precision medicine and integrative approaches are recommended for tailored treatment plans.

Resumo em Inglês:

Abstract Objective To analyze palivizumab prophylaxis adherence among newborns and infants, as well as identify its challenges and facilitators. Methods This retrospective study reviewed medical records of individuals who received palivizumab between 2008 and 2019 at a referral center in a metropolitan city in Brazil. Three adherence criteria were evaluated: an adequate number of doses received, interval between doses ≤ 35 days, and complete adherence (meeting both prior criteria). Associations between these criteria and sociodemographic/clinical variables, as well as post-prophylaxis bronchiolitis-related hospitalizations, were examined. Results A total of 908 participants (mean age 6.7 months,50.8 % male,57.8 % residing in the city) were analyzed. During the three-season study period, a total of 1,158 doses were prescribed, and complete adherence was observed in 44.5 % of cases. Based on both the adequate number of doses and complete adherence criteria, lower adherence was noted among those living outside the city (52.8 % vs.60.9 %, p = 0.01; and 41.5 %vs.48.5 %, p = 0.03, respectively) and infants born to mothers younger than 20 years (39.7 % vs.60.3 %,p < 0.01; and 31.5 %vs.68.5 %, p = 0.02, respectively). Infants with gestational age < 28 weeks (65.8 % vs.34.2 %, p = 0.03) and birth weight < 1000 g (67.8 % vs.32.2 %, p = 0.03) had higher adherence under the adequate number of doses criterion. No association emerged between adherence and bronchiolitis-related hospitalizations, which were predominantly linked to maternal smoking during pregnancy and chronic lung disease. Conclusion Adherence to palivizumab prophylaxis was low, highlighting the need to address geographic barriers and maternal age factors. Extreme prematurity and very low birth weight facilitated adherence, indicating that more targeted strategies or decentralized administration may improve outcomes in high-risk populations.

Resumo em Inglês:

Abstract Objective Fulminant myocarditis (FM) is a distinct and rare form of myocarditis. This study probed hsa-miR-21 expression in FM pediatric patients and its clinical value. Methods This study enrolled 88 FM pediatric patients and 90 healthy children (normal controls), with serum sample hsa-miR-21 levels measured by RT-qPCR. FM children were categorized into the good and poor prognosis groups. Correlations of hsa-miR-21 expression with myocardial injury markers [cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB)], and independent risk factors and predictive value of hsa-miR-21 expression for FM patients’ poor prognoses were analyzed by Pearson’s, logistic regression, and receiver operating characteristic (ROC) curve analyses. Results Serum hsa-miR-21 levels were elevated in FM children relative to the healthy controls and linked with poor prognoses. hsa-miR-21 levels positively correlated with myoglobin (MYO), B-type natriuretic peptide (BNP), cTnI, and CK-MB levels. Elevated hsa-miR-21, CK-MB, left ventricular ejection fraction, C-reactive protein, lactate dehydrogenase, and lactate were independent risk factors for FM children’s poor prognoses. Serum hsa-miR-21 levels yielded an area under the ROC curve of 0.790 in predicting FM pediatric patients’ poor prognoses (58.1 % sensitivity, 87.7 % specificity), with positive and negative predictive values of 74.07 % and 81.97 %, respectively, demonstrating that hsa-miR-21 aided in predicting FM pediatric patients’ poor prognoses to some extent. Conclusion Serum hsa-miR-21 was up-regulated in FM pediatric patients, and positively correlated with MYO, BNP, cTnI, and CK-MB. hsa-miR-21 expression was an independent risk factor for FM pediatric patients' poor prognosis, and predicted prognoses to some extent; however, the diagnostic accuracy was limited.

Resumo em Inglês:

Abstract Objective Studies have shown the benefit of ratios between cell types in full blood count for the diagnosis and prognosis of various pathologies, but its use in the investigation of lymphadenopathy is still controversial. The aim of this study is to assess whether there is a difference between the full blood count ratios of children and adolescents with lymphadenopathy who had benign or malignant causes identified in excisional biopsies during the investigation of lymphadenopathy. Method This is a cross-sectional observational study. A total of 72 participants between 0 and 17 years old who underwent an excisional lymph node biopsy and had their full blood count collected up to 15 days before the procedure were included. The participants were divided into two groups, malignant and benign, according to the biopsy result. Neutrophils/lymphocytes (N/L), monocytes/lymphocytes (M/L), and platelets/lymphocytes (P/L) ratios were then calculated and compared between the groups. Results The mean full blood count ratios for the benign and malignant groups, respectively, were: N/L 2.36 × 3.28 (p = 0.09), M/L 0.30 × 0.32 (p = 0.722), P/L 180.53 × 191.30 (p = 0.249). Conclusion The use of full blood count ratios as predictors of malignant or benign results has no proven statistical significance. Higher ratio values tend towards malignant results but should be interpreted with caution, as this is only one of the factors to be considered during the investigation.

Resumo em Inglês:

Abstract Objectives To compare the incidence of AM hospitalizations and complications across three periods: pre-pandemic, pandemic, and post-pandemic. Additionally, the study aims to evaluate associations with patient age, need for surgical intervention, antibiotic therapy, and isolated etiological agents. Methods This retrospective cohort study reviewed pediatric charts from three 22-month periods: pre-pandemic (P1), pandemic (P2), and post-pandemic (P3). These periods were compared in terms of case numbers, presence and severity of AM complications, patient demographics (age and sex), and treatment approaches. Results A total of 9 AM cases were recorded in (P1), 5 in the (P2), and 25 in (P3). This represents a 25.5 % reduction in AM incidence during the pandemic compared to the pre-pandemic period, though this was not statistically significant (p = 0.8027). However, a significant 103.3 % increase in AM incidence was noted between the pre- and post-pandemic periods (p = 0.0322). No significant differences were found among periods regarding age, sex, complications, case severity, surgical intervention, antibiotic duration, or length of hospitalization. Conclusion Although AM incidence slightly declined during the pandemic, the post-pandemic period showed a significant rise in the incidence of cases compared to pre-pandemic values.

Resumo em Inglês:

Abstract Objective Circumcision is a common surgical procedure worldwide, with indications ranging from medical to cultural-religious contexts. Effective pain control is crucial to reduce analgesic use and improve patient safety. Recent advances include the use of the Plastibell® device and ultrasound-guided dorsal penile nerve block, aimed at minimizing surgical time and complications. This study compares postoperative pain in patients undergoing circumcision with either the landmark dorsal penile nerve block (blind block) or ultrasound-guided block. Methods In this prospective, randomized study, patients aged 3-14 years undergoing elective circumcision were assigned to receive either anesthetic technique. Pain was assessed using physiological parameters (heart rate variation, movement during surgery) and subjective measures (Wong-Baker scale) at multiple time points, along with analgesic consumption. The sample was subdivided into patients aged ≤5 years and >5 years. Results Pain scores before hospital discharge were higher in patients under 5 years. The blind block was faster to perform but had a higher incidence of hematomas and a trend toward greater block failure, indicated by increased heart rate, patient movement, and opioid use, although differences were not statistically significant. Ultrasound-guided blocks showed fewer complications and a tendency for better pain control. Conclusion Both anesthetic techniques provide comparable pain control in circumcision; however, ultrasound guidance may reduce complications and improve block success, supporting its use as a safe and effective alternative to the conventional method.

Resumo em Inglês:

Abstract Objective Early diagnosis of autism spectrum disorder (ASD) is advisable to promote better prognosis. The Mini-TEA scale was conceived as a sensitive screening for ASD among children. The authors aimed to confirm the diagnostic accuracy of the scale in a wider population. Method 279 children from 2.5 to 12 yo were recruited, most of them under evaluation for possible ASD in the APAE of Passo Fundo/RS, as well as children with other diagnoses and normal children. Their parents/relatives answered the 48 binary questions (yes/no) of the Mini-TEA scale, divided into 15 items, which resulted in a score from 0 to 15. After that, the children were evaluated regarding the diagnostic criteria of ASD by experienced raters (gold standard) who had previously submitted to a concordance test and remained unaware of the children’s scores. Sensitivity and specificity Figs. were obtained. Factor analysis and Item Response Theory approaches were used for validity evidence. Results 115 children were diagnosed with ASD. Scores ≥9 had 98.3 % of sensitivity and 62.2 % of specificity for the diagnosis. Two cases with the typical presentation of Asperger’s syndrome scored lower than 9. The mean time for screening was about 8.5 min. The validation model presented excellent coefficients of factorability. The analysis showed that the total variance of the scores of the scale through the 15 items was explained only by the set of ASD symptoms (unidimensionality). Conclusion The Mini-TEA scale is a very sensitive tool to screen for ASD and has high internal consistency for assessing typical autistic symptoms.

Resumo em Inglês:

Abstract Objective Cystic fibrosis (CF) treatment has evolved significantly with the development of CFTR modulators, particularly elexacaftor/tezacaftor/ivacaftor (ETI). This study aimed to evaluate in a real-life context, the efficacy, safety and tolerability of ETI in children and adolescents with CF at a national reference center in Brazil. Methods A cohort of 39 patients (mean age: 11.7 years) who had been using ETI for at least three months were evaluated. Anthropometric data, pulmonary function, sweat chloride concentration, pulmonary exacerbations, antibiotic use, and liver function were assessed over a follow-up period of up to 17 months. Results Significant improvements were observed in weight Z-score at three months (p = 0.046) and six months (p = 0.018), as well as absolute weight gain (p < 0.001). Height showed absolute growth, but no significant changes in Z-scores. Sweat chloride concentration decreased by 52.8 mmol/L (p < 0.001). Pulmonary exacerbations and antibiotic use significantly declined (p < 0.001 for both). Despite limitations in spirometry data collection, FEV1 values showed a median increase of 6 percentage points. Oropharyngeal swab cultures for Pseudomonas aeruginosa positivity dropped from 43.6 % to 5.1 %. Safety assessments showed a transient rise in alkaline phosphatase (p = 0.011), but no significant hepatotoxicity. The most common adverse events were increased respiratory secretions (25.6 %) and abdominal pain (15.4 %). One temporary treatment suspension and one dose reduction occurred, but no patient required permanent discontinuation. Conclusions ETI demonstrated effectiveness in improving weight gain, reducing pulmonary exacerbations, and significantly lowering sweat chloride concentration. The treatment was well-tolerated, with a favorable safety profile. These findings align with existing literature, supporting ETI's role as a transformative therapy in pediatric CF management.

Resumo em Inglês:

Abstract Objective To verify parents’/caregivers’ perceptions of changes in their children’s development during the COVID-19 pandemic and factors associated with such perceptions. Methods Cross-sectional study using an online survey made available to parents/caregivers of children between 0-7 years old, from September 2021 to March 2023 in two Brazilian states. Respondents answered questions about their perceptions regarding their children's neurodevelopment, and worsening of neurodevelopment during the COVID-19 pandemic. Validated questionnaires such as M-CHAT, “Swanson, Nolan and Pellham,” and “Strengths and Difficulties “were applied according to age. Comparisons were made using the chi-square test or Fisher's exact test, and Poisson regression was used in the univariate analysis and in the multivariate analysis. Results Data from 589 children were obtained, 49.7% aged 0-3 years and 50.3% 4-7 years. Of the 0-3 age group, 50 (17.1%) were perceived as having abnormal neurodevelopment, and 79 (27.0%) as having worsened neurodevelopment during the pandemic. Of the 4-7 year group, 76 (25.7%) were perceived as having abnormal neurodevelopment, and 104 (35.1%) as having worsened their neurodevelopment. Significant risk factors associated with the perception of abnormal neurodevelopment were maternal schooling, the child's sex and age; for the perception of worsening neurodevelopment were the child's sex and age, low socioeconomic status, degree of social isolation, and death in the family due to COVID-19. Conclusion Data from the present study showed that parents/ caregivers' perception of normal neurodevelopment was significantly higher than their recognition of abnormalities. In addition, a significant percentage perceived a worsening during the COVID-19 pandemic.

Resumo em Inglês:

Abstract Objective To investigate the effectiveness and safety of remimazolam in preventing the emergence of delirium in children undergoing pediatric laparoscopic inguinal hernia surgery under combined intravenous and inhalation anesthesia. Methods A total of 184 pediatric patients aged 3-14 years who were undergoing laparoscopic inguinal hernia surgery were included. Patients were randomly assigned to receive either 0.1 mg/kg remimazolam (experimental group, n = 92) or 0.9 % normal saline (control group, n = 92) after the procedure. The primary outcome was the incidence of emergence delirium, which would manifest as a difference in the pediatric anesthesia emergence delirium (PAED) score between the two groups. The secondary outcomes included postoperative pain severity, duration of postanesthesia care unit (PACU) stay, sufentanil usage, parental satisfaction, mean arterial pressure (MAP), blood oxygen saturation (SpO₂), and heart rate (HR). Results The experimental group showed significantly lower overall PAED scores (mean difference = −2.28, 95 % CI:2.73 to −1.82; Cohen's d = 1.12, p < 0.001) and emergence delirium incidence (7.61 % vs 41.30 %; risk difference = 33.69 %, 95 % CI 21.60 % to 45.10 %; relative risk = 0.18, 95 % CI 0.09-0.37; p < 0.001). They also showed better hemodynamic stability (lower MAP/HR, higher SpO₂), reduced pain, shorter PACU stay, less sufentanil use, and higher parental satisfaction (all p < 0.05). Conclusion Administration of 0.1 mg/kg remimazolam after pediatric laparoscopic inguinal hernia surgery could contribute to preventing the development of emergence delirium by smoothing hemodynamic changes and alleviating postoperative pain.

Resumo em Inglês:

Abstract Objective This study aimed to investigate the predictive value of clinical indicators in community-acquired pneumonia (CAP) complicated with Kawasaki disease (KD). Methods A retrospective analysis was conducted on the clinical data of inpatients with KD (39 cases), CAP (40 cases), and CAP complicated with KD (CAPKD, 32 cases) at the Children's Hospital of Chongqing Medical University from February 2021 to October 2022. The clinical indicators examined included serum cytokines (IL-2, IL-4, IL-6, IL-10, IL-17A, TNF-α, IFN-γ), White Blood Cell (WBC), Neutrophilic granulocyte percentage(NEU%), blood platelet(PLT), Red Blood Cell (RBC), Hemoglobin(Hb), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), procalcitonin(PCT), alanine aminotransferase(ALT), alkaline phosphatase(ALP), Gamma-glutamyl transferase (γ-GT), Aspartate aminotransferase (AST), albumin(Alb), Lactate dehydrogenase (LDH), globulin(Glb), and Total Protein(TP) in patients with KD, CAP, and CAPKD were compared. Results The present findings showed that IL-6 > 55.4pg/mL, IL-10 > 9.15pg/mL, PCT > 0.19ng/mL, and ALT > 22.5 U/L were important predictors of CAPKD. Additionally, Hb > 103.5 g /L, and TP > 63.85 g/L have predictive values for CAP without KD. The authors also observed a positive correlation between PCT and IL-6, IL-10. However, Hb and TP were negatively correlated with IL-6 and IL-10. Conclusion From the perspective of cytokine levels, IL-6 > 55.4 pg/mL and IL-10 > 9.15 pg/mL have important predictive values for CAPKD.

Resumo em Inglês:

Abstract Objective To investigate whether the use of a biparametric score, based on lung ultrasound (LUS) and oxygen saturation/fraction of inspired oxygen ratio (SF ratio), in preterm infants with respiratory distress syndrome (RDS) allows earlier surfactant therapy (first 3 hours of life) compared to classic FiO2 criteria. Material and methods Before-after design study, performed in a tertiary neonatal intensive care unit. Inclusion criteria were newborns with gestational age < 34 weeks with clinical RDS and respiratory support with noninvasive ventilation. The patients were divided into two groups, the control group, with surfactant indication according to classic criteria, collected retrospectively, and the new protocol group, with surfactant criteria according to biparametric score. Results 61 patients were included. The new protocol group received surfactant earlier (all patients in the first 3 hours, p 0.013). Likewise, after surfactant treatment, newborns in this group required lower FiO2 (p 0.001) and a better pulmonary ultrasound evolution according to LUS (p 0.008). Conclusions Biparametric scoring allowed earlier surfactant therapy and reduced post-treatment oxygen requirement. This protocol offers a more personalized approach tailored to the patient's needs, which helps us in decision-making.

Resumo em Inglês:

Abstract Objectives The research aimed to analyze the clinical, epidemiological, laboratory, imaging, and pathological characteristics of pediatric patients who underwent surgery for thyroid nodules, distinguishing and comparing malignant and benign conditions. Methodology A retrospective and descriptive analysis was conducted on patients aged 0-18 years who underwent thyroidectomy. The following variables were evaluated: gender, previous and current pathological history, laboratory thyroid hormone levels, ultrasonography, cytology, and histopathological findings. Results A total of 91 children underwent thyroidectomy from January 2013 to May 2023. The average age was 13 years, and 68 patients were female. Ultrasonography evaluation revealed that 62 children had unimodular disease. Histopathology reports showed benign tumors in 54 patients and malignant tumors in 37. The factors associated with a higher incidence of cancer in univariate analysis were age < 10 years (p = 0.025), the presence of nodules on ultrasound with microcalcification (p < 0.001), and hypoechogenic nodules (p = 0.007). On multivariate analysis, only age under 10 years (OR = 5.69; p = 0.028) and the presence of microcalcifications (OR = 28.44 and p = 0.002) were significantly associated with malignancy. Conclusion The medical community is becoming increasingly aware of the differences in the clinical, epidemiological, pathological, and molecular presentations of benign and malignant thyroid diseases, highlighting the need for further training in this area.

Resumo em Inglês:

Abstract Objectives Necrotizing enterocolitis is a significant cause of morbidity and mortality in premature infants. Various fecal, urinary, and serum biomarkers have all been investigated for their potential in the prediction and early detection of necrotizing enterocolitis. This pilot study aimed to explore the feasibility and clinical utility of measuring serum and fecal calprotectin levels in preterm infants with necrotizing enterocolitis. Methods This prospective pilot study included preterm infants born at < 32 weeks’ gestation with a birth weight of ≤ 1500 g, consisting of patients diagnosed with necrotizing enterocolitis stage II or III and a randomly selected control group without necrotizing enterocolitis. The relationship between serum and fecal calprotectin concentrations and necrotizing enterocolitis severity, need for surgical intervention, and mortality was systematically analyzed. Results A total of 39 necrotizing enterocolitis patients (25 with stage II, 14 with stage III) and 20 randomly selected preterm infants were included as the control group. Serum and fecal calprotectin levels were significantly higher in necrotizing enterocolitis stage III and in infants who required surgery or died (p < 0.05), indicating their potential to predict disease severity and poor outcomes. Conclusions This pilot study suggests that dual assessment of serum and fecal calprotectin may provide insight into necrotizing enterocolitis severity and outcomes. Larger studies are needed to validate these findings and determine clinical applicability. Trial Registration This study was registered with the ClinicalTrials.gov database under the registration number NCT06693154 on November 15, 2024.

Resumo em Inglês:

Abstract Objective In this study, we aimed to evaluate the diagnostic accuracy of X-ray and CT by using the F1 score with its non-inferiority margin in patients who underwent bronchoscopy with suspected diagnoses of foreign body aspiration (FBA). Methods All children aged under 18 who underwent bronchoscopy with suspected diagnoses of FBA between June 2020 and December 2023 were included. The patient’s medical records were examined retrospectively. Results A total of 310 patients were included. Foreign bodies were most frequently located in the right main bronchus (47.52 %). The bronchoscopy (-) rate was 18 % in patients who had X-ray (+), 24 % in those who had CT (+), and 15 % in those who had X-ray (+) and CT (+). Chest x-rays were found to exhibit 42 % sensitivity, 74 % specificity, a positive predictive value (PPV) of 61 %, a negative predictive value (NPV) of 51 %, accuracy of 66 %, precision: 0.63, recall: 0.82, and F1 score: 0.71. Analysis showed that CT exhibited 82 % sensitivity, 37 % specificity, a PPV of 75 %, NPV of 47 %, an accuracy rate of 69 %, precision: 0.83, recall: 0.76, and F1 score: 0.79. In the present study, the diagnostic F1 score was calculated as 0.79 for CT and 0.71 for X-ray. Conclusion Despite a negative bronchoscopy rate of 34.83 % in this study, since the authors observed no severe complications or mortality, the authors recommend that it be performed on all patients with suspected foreign body aspiration. When a 10 % non-inferiority margin was applied, X-ray was found to be not inferior to CT in terms of F1 score.

Resumo em Inglês:

Abstract Objective To investigate the expression of ferroptosis-related proteins GPX4 and PTGS2 in pediatric Crohn’s disease (CD). Methods Pediatric CD colonic tissues by colonoscopy biopsy were selected as the subjects. The Pediatric Crohn’s Disease Activity Index (PCDAI) was used to assess the disease activity of CD. Immunohistochemistry was used to detect the expression of GPX4 and PTGS2. Results 30 CD cases were collected, with an average age of 12.36±2.65 years, including 9 in the mild activity phase, 8 in the moderate activity phase, and 13 in the severe activity phase. The positive expression rate of GPX4 in CD colonic tissues was lower than that in normal colonic tissues (p = 0.02); PTGS2 in CD colonic tissues was higher than that in normal colonic tissues (p = 0.004). Based on the average optical density (AOD) values of the positive reactants, the relative expression levels of GPX4 in CD colonic tissues were lower than those in normal colonic tissues (p = 0.02); PTGS2 in CD colonic tissues were higher than those in normal colonic tissues (p = 0.000). The staining scores of GPX4 decreased with increasing CD disease activity (p < 0.001); PTGS2 increased with increasing CD disease activity (p < 0.001). GPX4 was negatively correlated with CD disease activity (r = −0.326); PTGS2 was positively correlated with CD disease activity (r = 0.299). Conclusion GPX4 and PTGS2 may be involved in the process of ferroptosis in CD intestinal epithelial cells and are correlated with the severity of pediatric CD.

Resumo em Inglês:

Abstract Objectives To evaluate the prevalence of high risk for obstructive sleep apnea syndrome (HR-OSAS) in Brazilian children with cerebral palsy (CP) using the Pediatric Obstructive Sleep Apnea Screening Tool (PosaST) and to analyze its association with demographic, clinical and functional (Gross Motor Function Classification System [GMFCS]) variables. Methods Multicenter, cross-sectional, exploratory study. Results There were 312 children (median age 6.0 years, IQR 5.0-8.0) included. The prevalence of HR-OSAS in GMFCS I-V was 9.0 %. The prevalence of HR-OSAS in GMFCS V (14.7 %) was significantly higher compared to GMFCS I-IV (6.4 %) and to the frequency of OSAS in typically developing (TD) children assessed by polysomnography (5.8 %) according to literature data. Significantly higher frequencies of palatine tonsil hypertrophy, hospitalizations and outpatient antibiotic use for respiratory causes (last 12 months), gastroesophageal reflux disease, drooling and epilepsy were found in GMFCS V. Palatine tonsil hypertrophy was significantly associated with HR-OSAS. GMFCS V was significantly correlated with HR-OSAS at the expense of its significantly higher prevalence of palatine tonsil hypertrophy. Conclusions The prevalence of HR-OSAS in Brazilian children with CP (GMFCS V) was higher than the frequency of OSAS in TD children assessed by polysomnography. HR-OSAS was significantly more prevalent in GMFCS V compared with GMFCS I-IV. Palatine tonsil hypertrophy was significantly associated with HR-OSAS. GMFCS V was significantly correlated with HR-OSAS due to its significantly higher prevalence of palatine tonsil hypertrophy. PosaST may be a reliable questionnaire for Brazilian children with CP, but studies are needed to define the HR-OSAS cutoff score in this population.

Resumo em Inglês:

Abstract Objective To evaluate the Prognostic Nutritional Index as a biomarker for identifying coronary artery lesions in Kawasaki disease. Methods The clinicopathological and laboratory characteristics of 241 patients with Kawasaki disease were collected from patients who were hospitalized in Fuyang People's Hospital from January 2018 to December 2024. Logistic regression analysis was conducted to evaluate the relationship between Prognostic Nutritional Index and coronary artery lesions. The critical levels of hematological parameters were determined by receiver operating characteristic analysis. Results The incidence of coronary artery lesions was 10.3 %. The optimal cut-off point for the Prognostic Nutritional Index was defined as 46.575. Prognostic Nutritional Index was negatively correlated with coronary artery diameter (r = −0.260, p < 0.001). Patients with low Prognostic Nutritional Index levels (Prognostic Nutritional Index < 46.575) were 4.25 times more likely to have coronary artery lesions compared to those with high Prognostic Nutritional Index levels (Prognostic Nutritional Index ≥ 46.575) (OR = 4.25, 95 % CI: 1.688 - 10.697, p < 0.001). The area under the receiver operating characteristic curve for Prognostic Nutritional Index in predicting coronary artery lesions was 0.702 (95 % CI: 0.584 - 0.821, p = 0.001), indicating moderate diagnostic efficacy. Conclusion Prognostic Nutritional Index may be a biomarker for children with Kawasaki disease complicated with coronary artery lesions, and it may help identify high-risk patients of coronary artery lesions among children with Kawasaki disease.