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Improving Equitable Transition to Adult Care for Transgender and Gender Expansive Adolescents and Young Adults
Baer Karrington,
Marshall Hamilton,
David J Inwards-Breland
Issue:
Volume 8, Issue 1, March 2022
Pages:
1-5
Received:
8 November 2021
Accepted:
27 December 2021
Published:
8 January 2022
Abstract: Transgender and gender expansive (TGE) adolescents and young adults are a marginalized group who have many health disparities in relation to their cisgender peers secondary to transphobia and cis-normativity, with TGE people of racially minoritized identities also having to navigate the intersection of racism. One area of TGE care with little to no research, yet that has the potential to help improve overall wellbeing of TGE individuals, is transitioning care from pediatric to adult care. In other medical specialties, such as diabetes management and mental health, transition of care (ToC) interventions have been correlated with positive health outcomes. In this paper, we explore how ToC may be tailored for TGE adolescents and young adults through an anti-racist and health equity lens using a current review of ToC interventions in other realms of care. Four domains of ToC were identified in the review: planning for transition, transfer assistance, integration into adult care, and care coordination. We explore TGE specific intervention recommendations for each domain, with additional recommendations for how to approach research in this area. ToC from pediatrics to adult care is a vital time for all patients, and improved ToC has been correlated with better health outcomes. Tailoring ToC interventions to TGE adolescents and young adults may help to address health disparities in this group.
Abstract: Transgender and gender expansive (TGE) adolescents and young adults are a marginalized group who have many health disparities in relation to their cisgender peers secondary to transphobia and cis-normativity, with TGE people of racially minoritized identities also having to navigate the intersection of racism. One area of TGE care with little to no...
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The Difference of Anti-HBs Levels in Babies Vaccinated with Hepatitis B Vaccine Between at 2, 4, 6 Months with 2, 3, 4 Months Schedule in Denpasar
Vania Catleya Estina,
I Gusti Ngurah Sanjaya Putra,
Dyah Kanya Wati,
Hendra Santoso,
I Gusti Agung Ngurah Sugitha Adnyana,
Komang Ayu Witarini
Issue:
Volume 8, Issue 1, March 2022
Pages:
6-9
Received:
8 December 2021
Accepted:
6 January 2022
Published:
12 January 2022
Abstract: Background: Hepatitis B virus is one of the causes of the major health problem throughout the world. Hepatitis B vaccine is one way to control HBV infections effectively. The prevalence of HB infection shows a decreased effectivity of Hepatitis B vaccination. Objective: To discover the differences in anti-HBs levels between two schedules of vaccination recommended by the Indonesian Pediatric Society (at 2, 4, 6 months vs 2, 3, 4 months of age). Methods: This was an observational study on healthy babies comparing the effect of two treatment groups, each consisting of 30 subjects. Subjects were chosen by stratified random sampling. Blood samples were withdrawn three months after the subjects received their last dose of Hepatitis B vaccination, either in 2, 4, 6 months schedule (Group 1) or in 2, 3, 4 months schedule (Group 2). We used the independent t-test to assess the mean differences between the anti-HBs levels of the two groups. A p-value of<0.05 was considered statistically significant. Results: We found a significant difference in anti-HBs levels between Group 1 and Group 2 (820.06 mIU/ml vs 540.54 mIU/ml, respectively, p=0.002). Conclusion: Both vaccination schedules produced protective anti-HBs levels three months after the completed schedule. The anti-HBs level in group 1 produced higher anti-HBs level compared to Group 2.
Abstract: Background: Hepatitis B virus is one of the causes of the major health problem throughout the world. Hepatitis B vaccine is one way to control HBV infections effectively. The prevalence of HB infection shows a decreased effectivity of Hepatitis B vaccination. Objective: To discover the differences in anti-HBs levels between two schedules of vaccina...
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Routine Placental Histopathological Examination: Provides Answers in Neonatal Management
Roy Bithi,
Gonzalez Jeannette,
Kwok Adrian,
Walker Karen,
Morgan Catherine,
Webb Annabel,
Badawi Nadia,
Novak Iona
Issue:
Volume 8, Issue 1, March 2022
Pages:
10-13
Received:
19 November 2021
Accepted:
14 December 2021
Published:
17 January 2022
Abstract: Placental abnormality may affect the fetus adversely. The purpose of this study was to identify the prevalence of placental histopathological examination in a private hospital setting and analyse the placental histopathology findings for high-risk pregnancies. A retrospective cross-sectional study was conducted at the Mater Hospital in Sydney from January 2018 to June 2020. The placental histopathology was classified as per the 2014 Amsterdam Placental Workshop Group criteria, enabling uniformity for analysis. There were 5594 live births during the study period. Of these, 5% (256/5594) were low birth weight (LBW). Placental histopathology was conducted for 8% (443/5594) of the live births and 59% (152/256) of LBW births. The LBW group was subclassified into small for gestation (SGA) (n=66) and non-SGA (n=86) to analyse differences in placental abnormalities between the two groups. Of SGA, 82% (54/66) had placental abnormality compared to 76% (65/86) for non-SGA. Intervillous fibrin deposits (p=0.013) and smaller placental weight (p=0.008) were more common in the SGA; whereas the placental inflammatory-immune process was more common in the non-SGA. Original placental histopathology reports did not employ the objective Amsterdam classification system, thereby risking subjective or variable interpretation by clinicians. In conclusion, placental histopathology plays an important role in neonatal management. A quality improvement project may improve the prevalence of placental histopathological examination.
Abstract: Placental abnormality may affect the fetus adversely. The purpose of this study was to identify the prevalence of placental histopathological examination in a private hospital setting and analyse the placental histopathology findings for high-risk pregnancies. A retrospective cross-sectional study was conducted at the Mater Hospital in Sydney from ...
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Intra Ventricular Colistin in Neonatal Brain Abscess Management: A Case of Multiple Brain Abscesses
Farhad Abolhasan Choobdar,
Zahra Soltani,
Alireza Nateghian,
Vahid Heidari
Issue:
Volume 8, Issue 1, March 2022
Pages:
14-16
Received:
24 December 2021
Accepted:
11 January 2022
Published:
17 January 2022
Abstract: Neonatal Brain abscess is a rare sever neonatal infection requiring careful medical and neurosurgical intervention strategies to reduce morbidity and mortality rates. Gram-negative bacterial agents are the most common pathogens involved in brain abscesses of neonates. The use of wide spectrum antibiotics in combination with neurosurgical drainage of abscesses larger than 2.5 cm is the mainstay of treatment. Colistin is a polymyxin antibiotic used to treat bacterial infections caused by susceptible gram-negative bacteria but with a limited penetration in blood brain barrier. However, there is limited data on using intraventricular Colistin in neonatal intracranial infections. A 12-day-old male neonate with multiple brain abscesses in frontal and parietal lobes is presented. The abscesses were successfully managed with a combination of intravenous antimicrobial agents, intraventricular Colistin and concurrent administration of Interferon-ɣ. Subsequently, he developed ventriculomegaly which was successfully managed by endoscopic third ventriculostomy. He had an acceptable neurologic outcome. Due to reduced penetration of colistin in blood brain barrier, use of intraventricular Colistin in combination with its intravenous form can be beneficial in management of neonatal brain abscesses. Concurrent administration of Interferon-ɣ may improve the treatment process and outcome given that reduced secretion of this agent by neonatal T lymphocytes may contribute to a partial immunodeficiency state at this period of life.
Abstract: Neonatal Brain abscess is a rare sever neonatal infection requiring careful medical and neurosurgical intervention strategies to reduce morbidity and mortality rates. Gram-negative bacterial agents are the most common pathogens involved in brain abscesses of neonates. The use of wide spectrum antibiotics in combination with neurosurgical drainage o...
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Hypoglycaemia in the Early Neonatal Period in Newborns
Tatyana E. Taranushenko,
Ekaterina V. Antsiferova,
Natalia G. Kiseleva
Issue:
Volume 8, Issue 1, March 2022
Pages:
17-22
Received:
23 January 2021
Accepted:
22 April 2021
Published:
28 January 2022
Abstract: Neonatal hypoglycaemia is a topical problem in neonatology and paediatric endocrinology. In recent years, problems of glycaemia monitoring during first days of life have been discussed as well as the strategy for management of newborns with the syndrome of hypoglycemia and evaluation of metabolism in brain neurons has been a matter of scientific research. Scientific publications regarding the detection rate and duration of low glucose values in the early neonatal period as well as means of their correction and conducted therapy results are very scarce and ambiguous, which determines the necessity of new modern data regarding the problem considered. Purpose of the study: to study the detection rate and dynamics of clinical and laboratory manifestations of hypoglycaemia in children in the early neonatal period in order to optimise observation of newborns at the risk of developing this condition. Materials and methods: an open, retrospective, continuous, single-centre study was conducted to obtain preliminary data important for development of monitoring strategies for newborns at the risk of hypoglycaemia (neonates with high birth weight, children born to mothers with diabetes, newborns with intrauterine growth restriction). The target studied group was constituted by 522 newborns of both genders in the early neonatal period (aged 0 to 7 days). Results: the paper presents data on hypoglycaemia detection rate in newborns with risk factors for hypoglycaemia development, clinical and laboratory features of this condition, dynamics of glycaemia during the early neonatal period as well as the timing of blood glucose stabilisation (the age of normoglycaemia achievement).
Abstract: Neonatal hypoglycaemia is a topical problem in neonatology and paediatric endocrinology. In recent years, problems of glycaemia monitoring during first days of life have been discussed as well as the strategy for management of newborns with the syndrome of hypoglycemia and evaluation of metabolism in brain neurons has been a matter of scientific re...
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Anti-Rituximab Antibodies in Idiopathic Nephrotic Children Treated with Rituximab: A Prospective Single Centre Study
Snehamayee Nayak,
Rina Tripathy,
Subal Kumar Pradhan
Issue:
Volume 8, Issue 1, March 2022
Pages:
23-29
Received:
6 December 2021
Accepted:
21 December 2021
Published:
28 January 2022
Abstract: Corticosteroids have been the main treatment of nephrotic syndrome (NS) for decades however many patients fail to respond. In such children, alternative immunosuppressive medications such as rituximab is used to maintain remission of NS. However, antibodies to rituximab develops during treatment reduces its efficacy. Therefore, this study aimed to measure anti-rituximab antibody (ARA) levels and efficacy of rituximab in children treated for NS. This prospective observational study was conducted among children with difficult to treat nephrotic syndrome. After baseline assessment, patients received single dose of intravenous infusion of 375 mg/m2 rituximab. ARA levels were determined at base line, 3-month, 6-month, and 12-month interval. Thirty-four patients with a mean age of 7 years were evaluated in this study. During follow up visits five patients developed ARA; two patients detected ARA of 23.7 IU/ µL at 3-month, one patient had ARA level of 53.2 IU/µL at 6-month and during last follow up visit (at 12 month) two patients had mean ARA level of 24.1 IU/µL. The number of relapses per person year before rituximab was 1.5 (Incidence density) which changed to 0.14 per person year after the rituximab administration in the study subjects. Twenty-Nine patients became relapse-free during rituximab treatment. Out of five patients with ARA, one had relapse during follow up. There was no major adverse effect observed during and post-rituximab therapy. In conclusion, the study demonstrated ARA levels in few patients who were treated with rituximab having sustained clinical outcomes without any major adverse events.
Abstract: Corticosteroids have been the main treatment of nephrotic syndrome (NS) for decades however many patients fail to respond. In such children, alternative immunosuppressive medications such as rituximab is used to maintain remission of NS. However, antibodies to rituximab develops during treatment reduces its efficacy. Therefore, this study aimed to ...
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Evolutionary Trajectories in Children with Autism Spectrum Disorder
Magda Di Renzo,
Federico Bianchi Di Castelbianco,
Elena Vanadia,
Massimiliano Petrillo,
Monica Rea
Issue:
Volume 8, Issue 1, March 2022
Pages:
30-35
Received:
18 January 2022
Accepted:
11 February 2022
Published:
15 March 2022
Abstract: Autism spectrum disorders are generally regarded as lifelong conditions, affecting communication, relationships, and adaptive skills. Studies on the developmental trajectories of people out of autism have found adequate adaptive social-communication skills, effective experiences of inclusion in regular education classrooms, normal intellective functioning, and an absence of typical autism symptomatology. It therefore seems plausible to start reading the ‘after autism’ psychopathological conditions in a continuum that features several possible clinical and non-clinical phenotypes. The present retrospective research aimed to examine the different developmental trajectories of 17 children with an original diagnosis of autism, evaluated in a follow-up approximately 5 years after the end of the therapy. The stability of the optimal outcomes is evidenced by the absence of clinical diagnostic criteria for autism spectrum disorder. However, some difficulties persisted in adaptive functioning, especially in the social domain, consistent with the dysfunctional core that characterized the clinical features of autism in childhood. Furthermore, many of the participants showed residual relational atypia, such as alterations in pragmatic communication, or a psycho-affective disorder, or specific developmental disorders. The presence of some residual atypia provides important food for thought, not only in orienting any therapy with which continue to support older children, but also for a greater understanding of the pathological core towards which has evolved the original diagnosis of autism.
Abstract: Autism spectrum disorders are generally regarded as lifelong conditions, affecting communication, relationships, and adaptive skills. Studies on the developmental trajectories of people out of autism have found adequate adaptive social-communication skills, effective experiences of inclusion in regular education classrooms, normal intellective func...
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Giant Orbital Rhabdomyosarcoma in a Newborn: Case Report
Ghizlane Amri,
Yasmine Bennani,
Mohammed Belmekki
Issue:
Volume 8, Issue 1, March 2022
Pages:
36-38
Received:
21 February 2022
Accepted:
15 March 2022
Published:
23 March 2022
Abstract: Rhabdomyosarcoma is the single most common type of soft tissue sarcoma in childhood and teenage, it has been reported from birth to the seventh decade, with the majority of cases presenting in early childhood but it is very rare in neonates. The orbit including the eyelids is the usual primary site in the head and neck, and it is a highly malignant tumor. There have been only a few cases of congenital orbital rhabdomyosarcoma previously reported in the literature. We report a case of a newborn girl that was admitted in our structure 2 days after her birth with giant right orbital mass inducing proptosis that was discovered at birth. MRI showed a poorly defined mass but biopsy of the tumor confirmed the diagnosis of Rhabdomyosarcoma. Chemotherapy was started accordingly with VAC regimen with a good evolution under treatment infortunatly the patient died at four month old from an infectious disease because she doen’t receive any vaccination. Congenital RMS has a poor prognosis and must benefit from a multidisciplinary approach. Children with cancer need to be immunized against the common vaccine-preventable diseases sometimes during ongoing chemotherapy to increase their chance of survival. Prenatal diagnosis may also improve the prognosis of these patients.
Abstract: Rhabdomyosarcoma is the single most common type of soft tissue sarcoma in childhood and teenage, it has been reported from birth to the seventh decade, with the majority of cases presenting in early childhood but it is very rare in neonates. The orbit including the eyelids is the usual primary site in the head and neck, and it is a highly malignant...
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Association of Functional Ability with Nutritional Status Among Children with Cerebral Palsy
Razia Sultana,
Ariful Islam,
Naila Zaman Khan,
Samsun Nahar Sumi,
Narayan Chandra Saha,
Mohammad Mohsin
Issue:
Volume 8, Issue 1, March 2022
Pages:
39-50
Received:
20 February 2022
Accepted:
25 March 2022
Published:
31 March 2022
Abstract: Cerebral palsy (CP) is the most common physical disability in childhood. Children with CP are particularly vulnerable to malnutrition. There is a paucity of studies among these individuals to find the association between functional ability with nutritional status. In this study our objective was to find out the association between functional ability (functional level measured by four functional classification systems) and nutritional status in children with cerebral palsy (CP) attending in a tertiary care hospital in Bangladesh. We performed a cross-sectional study on 127 children (aged 18 months to 12 years) with a diagnosis of CP who were attending outpatient and inpatient department of National Institute of Neurosciences & Hospital, Dhaka, Bangladesh (January 2020–December 2020). Functional ability was assessed by standard CP classification systems (GMFCS, MACS, CFCS, EDACS, Level I through level V). Nutritional status was evaluated and classified according to the WHO growth charts. To find out the association, Spearmann-rho correlation analysis were applied. Sixty five patients (51%) were found underweight, 86 (67.7%) were stunted and 40 (31.5%) were wasted. Among them, severe underweight, severe stunting and severe wasting were found in 21.3%, 41.7% and 11.8% cases respectively. Severe thinness measured by BMI was found in 81.1% cases. Forty one percent (41.1%), 40.2%, 11%, 7.9% patients were functionally leveled as severe in GMFCS, MACS, CFCS and EDACS, although CFCS and EDACS were not applicable for all ages (36.2%, 37.8%). A significant negative association was found between weight for height, weight for age, BMI and functional level measured by GMFCS, MACS, CFCS and EDACS (P value <0.05 to<0.001) but no significant negative association was found between height for age and functional level measured by GMFCS, MACS. Stunting and wasting are more common among pediatric patients with CP. In our study stunting was more prevalent. We found significant negative association between functional level and nutritional status as measured by scales applied in this study.
Abstract: Cerebral palsy (CP) is the most common physical disability in childhood. Children with CP are particularly vulnerable to malnutrition. There is a paucity of studies among these individuals to find the association between functional ability with nutritional status. In this study our objective was to find out the association between functional abilit...
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