bluuebunny/crossref_metadata_2025_split huggingface dataset:
#6: High Diagnostic Accuracy of Automated Rapid Strep A Test Reduces Antibiotic Prescriptions for Children in the United Arab Emirates.
Authors: Hendi Salama Bin , Malik Zainab A , Khamis Amar Hassan , Al-Najjar Fadil Y A 
Published: June 2021

Abstract

Background
Diagnosis of Group A Streptococcus (GAS) pharyngitis in children is hindered by variable sensitivity of clinical criteria and rapid Strep A tests (SAT), resulting in reliance on throat cultures as the gold standard for diagnosis. Delays while awaiting culture reports result in unnecessary antibiotic prescriptions among children, contributing to the spread of antimicrobial resistance (AMR).

Methods
Diagnostic accuracy study of an automated SAT (A-SAT) in children up to 16 years of age presenting to an emergency room with signs and symptoms of pharyngitis between March and June 2019. Paired throat swabs for A-SAT and culture were collected. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for A-SAT were calculated.

Results
Two hundred and ninety-one children were included in this study. 168 (57.7%) were boys and the mean age was 4.2 years. A-SAT was positive in 94 (32.3%) and throat culture was positive in 90 (30.9%) children. A-SAT and throat culture results showed a high level of consistency in our cohort. Only 6 (2%) children had inconsistent results, demonstrating that the A-SAT has a high sensitivity (98.9%), specificity (97.5%), PPV (94.7%) and NPV (99.5%) for the diagnosis of GAS pharyngitis in children. Only 92 (32%) children were prescribed antibiotics while the vast majority (68%) were not.

Conclusions
A-SAT is a quick and reliable test with diagnostic accuracy comparable to throat culture. Its widespread clinical use can help limit antibiotic prescriptions to children presenting with pharyngitis, thus limiting the spread of AMR.
#11: Post-malarial Hemolysis is Rare in Malawian Children with Cerebral Malaria
Authors: Guenther Geoffrey , Izem Rima , Saidi Alexuse , Seydel Karl , Postels Douglas 
Published: June 2021

Abstract

Background
In severe malaria, artesunate decreases mortality compared to quinine. Artesunate’s introduction into clinical use in malaria-endemic areas revealed a unique adverse effect: severe hemolysis appearing several weeks after treatment completion. Though initial reports of post-artesunate hemolysis (PAH) were gathered from adult returning travelers, studies of African children revealed that PAH was less common in this semi-immune population. There are no published studies establishing the incidence and severity of PAH in several severe malarial syndromes in African children, including cerebral malaria (CM). We determined the incidence and severity of post-treatment hemolysis in Malawian children surviving CM by analyzing hospital and follow-up data from a long-standing study of CM pathogenesis.

Methods
Children aged 6 months to 14 years admitted to Queen Elizabeth Central Hospital (Blantyre, Malawi) with a clinical diagnosis of CM were enrolled in a retrospective cohort study. Children admitted before 2014 and treated with quinine (n=258) were compared to those admitted in 2014 and after and treated with artesunate (n=235). Hematocrit and parasite density were obtained at admission and every 6 hours until parasite clearance. The last hematocrit obtained during hospitalization was compared with the one-month post-hospitalization hematocrit value.

Results
The overall rate of a post-hospitalization decrease in hematocrit in children surviving CM was 5.3% (4.7% for quinine, 5.8% for artesunate, p value for difference= 0.582); no patients with a hematocrit decrease were symptomatic; none required transfusion. Of the 26 children with a decrease in hematocrit at one month after hospitalization, 23.1% had evidence of a new malaria infection. When children treated with quinine and artesunate were combined, a higher hematocrit on admission, lower quantitative histidine rich protein 2 level, and splenomegaly were independently associated with a post-treatment decrease in hematocrit.

Conclusions
In African survivors of CM, post-treatment hemolysis is rare, mild, and unassociated with the antimalarial treatment received.
#24: Neutropenic Enterocolitis in the Pediatric Patient with Hematological Cancer at Centro Medico Nacional 20 de Noviembre, from June 2019 to May 2020
Authors: Martínez María E , Galán Elizabeth 
Published: June 2021

Abstract

Background
Neutropenic Enterocolitis is a life-threatening condition which occurs in patients presenting neutropenia (absolute neutrophil count &lt;500 / mm3), where secondary to the use of chemotherapy there is an aggressive destruction of tumor cells, which alters the rapid replication phase, in which different types of epithelia are also involved, this is why they decrease their turnover rate, evolving into injury in the intestinal mucosa, especially at the level of the terminal ileus and cecum, although it can affect any part of the intestine. Clinically manifested by fever, pain, and abdominal distension; it is more frequently associated with hematological cancer, although it can occur in other types of cancer. CT is the Gold Standard for diagnosis. Ultrasonography may also be useful, however, this diagnostic tool is operator dependent so its sensitivity and specificity decrease. Medical treatment is usually sufficient, but surgical intervention may be necessary in patients with perforation or deterioration.

Methods
The incidence of Neutropenic Enterocolitis cases in the pediatric population was identified by means of a descriptive, cross-sectional and retrospective study. We used clinical records of patients admitted with a diagnosis of leukemia. Data analysis was carried out by means of a non-probability sampling for convenience, creating the database in electronic system followed by the data analysis obtained by the JASP software version 0.13.1.0.

Results
we took into account a total of 1019 patients with leukemia, from which 95.58 % (n=974) were ALL (Acute Lymphoblastic Leukemia) and 4.41 % (n=45) AML (Acute Myeloblastic Leukemia); the Neutropenic Enterocolitis diagnostic, gave us 49 files, from which we eliminated 12 with a different diagnosis, obtaining a total sample of 37 clinical records. The most affected population was the group of between 10–17 years with an incidence of 51.35 %, the most common type of hematologic cancer was ALL representing 86.4 % of the cases, from which 40.54 % were in the induction phase of treatment when they started with the clinical symptoms of neutropenic enterocolitis, being fever, abdominal pain and diarrhea the most common symptoms. The diagnosis was made based on clinical presentation, and radiology tests being abdominal ultrasound the most common diagnostic tool. The most efficacious treatment because there were no complications and there was no need for escalation, was Piperacillin/Tazobactam, followed by Meropenem.

Conclusions
Neutropenic Enterocolitis was more frequently diagnosed in patients with ALL and in those who were receiving the induction phase of treatment; a total of 28 % presented with sepsis or septic shock. The antibiotic scheme Piperacillin/Tazobactam suffered less modifications unlike Cefepime/Metronidazole which had to be scaled to carbapenem and just 10.81 % of the patients had the Gold Standard diagnostic tool (Abdominal Computed Tomography).
#60: Attention Deficit Hyperactive Disorder and Oppositional Defiant Disorder in Adolescents Living with HIV/AIDS - A Cross Sectional Study
Authors: Bhat Kamalakshi G , Nalwalla Zahabiya , Joseph Nitin 
Published: June 2021

Abstract

Introduction
Perinatally HIV infected neonates are surviving into adulthood with an impact on mental and emotional health. Attention deficit hyperactive disorder (ADHD) and Oppositional Defiant disorder (ODD) are few of the common behavioral disorders, which have been found to have a higher prevalence amongst HIV infected children.

Objectives
The objectives were to assess the proportion of ADHD and ODD in adolescents living with HIV/AIDS and to find its association with various factors.

Materials and Methods
88 adolescents aged 10–19 years living with HIV/AIDS were included in the study. The Swanson, Nolan Pelham (SNAP-IV) scale was administered to the caretakers and children were assessed for the proportion of ADHD/ODD. Association between those who scored positive with duration of treatment, CD4 counts, stage of disease and socio-demographic variables were done using statistical tests.

Results
Our study included 88 participants, of whom 9 scored positive in the inattention subset resulting in a proportion of 10.2%. 5 participants had symptoms of hyperactivity/impulsivity resulting in a proportion of 5.6% and 1 had combined symptoms with a proportion of 1.1%. 13 scored positive in the opposition/defiant subset resulting in a proportion of 14.7%. No statistical significance was found between duration of treatment, CD4 count, stage of disease, socio-demographic variables and ADHD/ODD.

Conclusion
The proportion of ADHD and ODD in this study was found to be comparable to the general population. A holistic approach to improve the long-term health of these youth is needed to ensure that our success in achieving survival of HIV-infected children from infancy is maintained into adulthood.
Molecular Epidemiology of Clostridioides difficile Infections in Children
Authors: Perumalsamy Sicilia , Riley Thomas V 
Published: June 2021

Abstract
Clostridioides difficile is a prominent cause of health care-related gastrointestinal illness in adults. C. difficile infection (CDI) has been researched for over 40 years; however, research on pediatric CDI specifically has lagged behind for various reasons. Over the past decade, C. difficile has been increasingly reported as a cause of a broad spectrum of gastrointestinal diseases in children, ranging from mild self-limiting diarrhea to severe conditions such as pseudomembranous colitis and toxic megacolon. Recent publications have shown a rise in CDI incidence in children in different parts of the world, especially in patients with particular comorbidities such as hematological malignancies and inflammatory bowel disease. In addition, rising CDI rates have been reported in children in the community without traditional risk factors for CDI. Due to the extensive use of sensitive molecular detection methods to diagnose CDI in many countries, differentiating children who require treatment from those colonized with toxigenic strains remains a problem. Consequently, the molecular epidemiology of pediatric CDI is poorly understood. Even though well-known C. difficile strains causing CDI in children have been described (including hypervirulent strains such as ribotypes 027 and 078), there is a paucity of information about specific C. difficile strains. This mini-review summarizes the information that is currently available on the molecular epidemiology of CDI in children.
A novel fixation method for unstable ankle fractures in the elderly using dual percutaneous tibiotalar cannulated screws
Authors: Hancock Daniel W , Hainsworth Louis , Pentlow Alanna K 
Published: June 2021

Abstract
Ankle fractures in the elderly are often complicated by osteoporosis and poor skin quality, resulting in poorer outcomes. This retrospective case-series describes a novel minimally invasive fixation method for managing unstable ankle fractures in the high-risk elderly patient. Six elderly patients who underwent dual tibiotalar cannulated screw fixation for unstable ankle fractures between January 2019 and 2020 were identified. Data on post-operative pain scores, mobility and complications were collected. Pre- and post-operative radiographs were analysed for fracture type and complications. Functional outcomes were excellent with 83.3% of patients pain free, and 100% ambulatory with walking-aids at 10.25 months follow-up. Four of the six patients (66.7%) had satisfactory post-operative radiographs, and there were no soft tissue injury or infections due to the surgery. Dual percutaneous tibiotalar cannulated screws can be used to manage unstable ankle fractures in the low demand elderly patient, resulting in excellent functional outcomes.
Young boy with social impairment and repetitive behaviors
Authors: Ozdemir Sirin , Donnelly Craig L. 
Published: June 2021

Abstract
Autism spectrum disorder (ASD) is a lifelong, highly heterogeneous neurodevelopmental disorder characterized by deficits in social communication and interaction as well as restricted, repetitive patterns of behavior, interests, or activities. The symptoms begin early in development but may not become apparent until social demands exceed abilities. The diagnostic assessment should include a medical assessment; evaluation by a clinician familiar with the signs/symptoms of ASD such as a developmental pediatrician, child psychiatrist, or child neurologist; neuropsychological testing to assess for comorbid intellectual disability; a speech and language evaluation; and an occupational therapy evaluation. There is no cure for ASD, but early diagnosis and intervention are associated with better functional outcomes. The treatment approach should be multidisciplinary and may include behavioral therapy, speech therapy, occupational therapy, and educational interventions. Pharmacologic treatment may be used to manage psychiatric comorbidities and maladaptive behaviors.
Below-average intellectual and adaptive functioning
Authors: Ross Cordelia Y. 
Published: June 2021

Abstract
Intellectual disability (ID) is a neurodevelopmental disorder characterized by deficits in intellectual and adaptive functioning that begins during the developmental period. The case describes a child with Fragile X syndrome, the most common inherited cause of ID. Adaptive functioning deficits include difficulty acquiring age-appropriate conceptual, social, and practical skills. There are many causes of ID including genetic, environmental, and idiopathic etiologies. The assessment of ID includes evaluating for underlying and/or associated medical conditions and neuropsychological testing to evaluate the child’s cognitive and functional abilities. The severity of ID is determined by the child’s functional abilities. Components of treatment may include speech and language therapy, occupational therapy, physical therapy, family counseling and respite care, behavioral interventions, and educational interventions. Families should also be educated on transition-to-adulthood topics including guardianship. Pharmacologic treatments can be used to treat behavioral symptoms, sleep difficulty, or comorbid psychiatric disorders.
Trouble being away from mother
Authors: Sharma Sumita 
Published: June 2021

Abstract
Separation anxiety disorder is characterized by developmentally inappropriate and excessive fear or anxiety that occurs when the child is separated from major attachment figures. The disorder may manifest with challenging behaviors such as school refusal, temper tantrums, or somatic complaints. Worries typically center around fear of untoward events that may occur when separated from loved ones, such as accidents, kidnapping, or death. Cognitive behavioral therapy (CBT) is the initial treatment of choice for separation anxiety disorder. Pharmacotherapy including selective serotonin reuptake inhibitors (SSRIs) may be used as an adjunct to behavioral or psychotherapeutic interventions.
Excessive, uncontrollable worries
Authors: Pereira Joseph A. 
Published: June 2021

Abstract
Generalized anxiety disorder (GAD) is characterized by excessive anxiety and worry that is difficult to control. The worry is accompanied by at least one of restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or sleep disturbance. Anxiety may present with crying episodes, temper tantrums, and irritability in children. Compared to adults, youth are also more likely to report somatic complaints associated with anxiety such as gastrointestinal upset, headaches, and sweating. Psychotherapies for GAD include cognitive behavioral therapy (CBT) and parent guidance to decrease accommodating behaviors. Pharmacotherapy options include selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs).
A boy who could not be comforted
Authors: Epstein Katherine A. 
Published: June 2021

Abstract
Reactive attachment disorder (RAD) is a rare disorder occurring in young children who have experienced extremely insufficient care and have been deprived of the opportunity to form a secure attachment with a reliable caregiver. Children with RAD exhibit inhibited, emotionally withdrawn behavior toward caregivers, rarely seeking and responding to comfort when distressed. They may also have minimal social and emotional responsiveness to others, limited positive affect, and episodes of unexplained irritability, sadness, or fearfulness. Symptoms must begin prior to the age of five years. There are no medication treatments for RAD; however, psychiatric comorbidities may benefit from psychopharmacology. The single effective treatment for RAD is placing the child in an environment where they have the opportunity to form a selective attachment to a caregiver. Symptoms of RAD may completely resolve if this occurs.
Sad mood and changes in behavior after exposure to a traumatic reminder
Authors: Smith Joshua R. 
Published: June 2021

Abstract
Posttraumatic stress disorder (PTSD) is a trauma- and stressor-related disorder that may affect individuals who have experienced a traumatic event. Symptoms of PTSD include intrusion symptoms, avoidance of stimuli associated with the traumatic event, negative alterations in cognition and mood, and alterations in arousal and reactivity. Intrusion symptoms in children may manifest as repetitive play in which themes from the trauma are expressed. Children are often unaware of the connection between their repetitive play and the trauma. Additionally, children may experience frightening dreams without recognizable content. Compared to adults, youth may be less able to describe traumatic events and complex emotional states. It is not uncommon to be unable to recall specific events about the trauma. The evidence supporting the use of selective serotonin reuptake inhibitors (SSRIs) in youth with PTSD is mixed. Trauma-focused cognitive behavioral therapy (TF-CBT) has the greatest empirical support for pediatric PTSD.
A teenage girl with low body mass index due to restricting food intake
Authors: Czepiel Kathryn S. 
Published: June 2021

Abstract
Anorexia nervosa (AN) is an eating disorder that is characterized by restriction of energy intake leading to significantly low body weight, an intense fear of gaining weight or persistent behavior that interferes with weight gain, and disturbance in the way one’s body weight or shape is experienced. Because many patients with AN attempt to conceal their efforts to lose weight and minimize their symptoms, obtaining information from a caregiver is an important part of the assessment. A medical history and physical examination must be completed to assess medical stability, including review of vital signs, electrocardiogram, and laboratory studies. Medically unstable patients require a medical admission for refeeding and stabilization, including monitoring for refeeding syndrome. Pharmacotherapy should not be used as the primary treatment for patients with AN. The most evidence-based psychotherapy approach for children and adolescents is family-based treatment (Maudsley family therapy).
Families and pain
Authors: Higgins Kristen S. , Chambers Christine T. , Birnie Kathryn A. , Boerner Katelynn E. 
Published: June 2021

Abstract
The family has long been acknowledged as an important social context where children learn and receive support for experienced pain. When a child is in pain, the family is responsible for identifying pain and seeking appropriate evaluation and care. Families’ responses may inadvertently encourage or discourage the expression of pain and play a critical role in influencing children’s ability to cope with pain, both positively and negatively. Having a child in pain can pose significant personal, familial, and economic strains to parents, and parents’ health can impact pain and psychological symptoms in their offspring. Therefore, consideration of the family is critical in understanding children’s pain. This chapter describes relevant theoretical models and summarizes current major research themes regarding the role of the family in both acute and chronic pediatric pain. Two illustrative case examples and a parent perspective are provided and key areas for future research are identified.
Chronic pain syndromes in childhood
Authors: Schechter Neil L. 
Published: June 2021

Abstract
Though this volume is replete with detailed discussions about specific pain problems, the focus of this chapter is on a discussion of the commonalities in etiology, associated symptoms, and treatment of many of the frequent chronic pain problems, primarily those categorized as Chronic Primary Pains in the International Classification of Diseases, 11th Revision, and traditionally known as “functional.” We will explore, in brief, the data that demonstrate the co-occurrence of many of the common chronic pain problems in children and the epidemiological similarities that exist between affected individuals. Then, we will review the concept of central sensitization and the physiological evidence that supports its presence in many of the functional pain problems. We will briefly review some of the symptoms associated with these entities (orthostatic intolerance, sleep disturbance, depression, anxiety, hypermobility, and family distress). Finally, we will discuss briefly a general approach to these problems, emphasizing the collection of specific information in the history and physical examination, the critically important presentation of the formulation to the family, and the treatment modalities that appear to be effective for many of these conditions. In-depth discussion of each of these pain problems is available in chapters specifically designated to review them in detail.
Noninflammatory musculoskeletal pain
Authors: Clinch Jacqui 
Published: June 2021

Abstract
Noninflammatory musculoskeletal pain is common in children and adolescents, and when persistent or widespread, can have a negative impact on physical and psychological well-being. Diagnostic labels and criteria are not uniform in the current literature, but musculoskeletal pain may present as widespread pain or juvenile fibromyalgia, complex regional pain syndrome, or in association with joint hypermobility. Chronic musculoskeletal pain, irrespective of its trigger, can bring persistent and recurrent distress, disability, and widespread family disruption. Once serious medical causes have been excluded by history, examination, and relevant investigations, the focus should be on rehabilitation. Multidisciplinary team management to facilitate cohesive working and the introduction of psychological and physical therapies can improve outcome. Further research is required to define the role of pharmacological interventions.
Chronic pelvic pain in children and adolescents
Authors: Sager Susan L. , Laufer Marc R. 
Published: June 2021

Abstract
Pelvic pain is a broad term encompassing pain from viscera within the pelvic cavity, and from the bony and myofascial structures of the pelvis. In children and adolescents, pain due to pelvic pathology may be described as abdominal pain, and is frequently overlooked owing to co-occurrence with gastrointestinal symptoms. Dysmenorrhea is highly prevalent among adolescents and associated with central sensitization of pain pathways and other chronic pain syndromes. Dysmenorrhea is also a risk factor for pelvic pathology; two-thirds of adolescents with dysmenorrhea or chronic pelvic pain who undergo laparoscopy are diagnosed with endometriosis. Other overlooked causes of chronic pelvic pain include pelvic myofascial pain, pelvic floor dysfunction, neuralgias, and nerve entrapment. The importance of obtaining a menstrual history, indications for referral to an adolescent gynecologist, and a multidisciplinary approach to pain management are discussed.