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Question: Is there a difference in immune cells in human breast milk by parity? Finding: There were higher proportions of monocytes and T/B cells in the primiparous and multiparous group, respectively. The expression of genes with a direct role in the infant immune system and immune response-related genes were highest in the primiparous group Meaning: There were parity-dependent differences in the expression of genes between innate and adaptive immune cells. |
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Transabdominal ultrasonography is increasingly used as a novel modality for detecting pediatric functional constipation (FC). This systematic review and metaanalysis aimed to assess the diagnostic parameters of FC including rectal diameter (RD) and anterior rectal wall thickness. A systematic search was conducted of the Ovid MEDLINE, Embase, Scopus, and PubMed databases through September 29, 2023, to identify studies comparing RD... |
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· Anorectal manometry is safe in children. · Defecation Dyssynergia is one of the commonest cause of chronic constipation. · Positive Rectoanal inhibiory reflex rules out Hirschsprung's Disease |
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Question: What are the risk factors for prolonged diarrhea in children under 2 years old? Finding: History of antibiotic use, zinc deficiency, and elevated fecal alpha-1 antitrypsin levels were the main risk factors of prolonged diarrhea in children under 2 years old with acute diarrhea. Meaning: Rational antibiotic usage is necessary as well as thorough testing of serum zinc level and fecal alpha-1 antitrypsin levels. |
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Question: The inferior vena cava to aorta (IVC/Ao) ratio measured via ultrasound has been touted as a promising noninvasive technique to assess clinically significant dehydration in pediatric patients. Finding: Our meta-analysis found that IVC/Ao ratio had a positive likelihood ratio of 3.2 (95% confidence interval [CI], 2.1–5.1) and negative likelihood ratio of 0.18 (95% CI, 0.12–0.28). Meaning: Hence, IVC/Ao ratio is insufficient to exclude or confirm significant dehydration in pediatric patients. |
· Point-of-care ultrasound imaging, including measurement of the inferior vena cava/aorta ratio, is powerful for evaluating the hemodynamic status of pediatric patients. · Owing to the limited feasibility of randomized clinical trials and insufficient data in children, imaging tools require validation. · Objective validity meta-analyses of imaging studies can affect clinical decision-making and serve as a cornerstone for evidence-based practice in pediatrics. |
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Question: Is polycystic ovary syndrome (PCOS) a risk factor for nonalcoholic fatty liver disease (NAFLD) in adolescents? Finding: The frequency of NAFLD did not increase in adolescents with PCOS. However, hyperandrogenemia was a risk factor for NAFLD. Meaning: Adolescents with PCOS and hyperandrogenemia should be closely monitored for hepatic steatosis. |
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· Pediatric small intestinal bacterial overgrowth (SIBO) manifestations range from nonspecific abdominal symptoms to malabsorption or malnutrition. · SIBO is prevalent in children and adolescents with functional abdominal pain disorders. · Predisposing factors include disturbed intestinal motility, altered anatomy, and/or abnormal body defense systems against intestinal bacteria. · Breath tests are safe and noninvasive. · Treatment principles include managing predisposing conditions, nutritional support, symptom control, and antibiotics. |
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Question: What causes childhood constipation, and what can predict organic constipation? Finding: Constipation represents 14.7% of gastroenterology visits. Functional constipation is more common among constipation types, while organic constipation is more common in young children and those with a low body weight, stunted growth, mucus in the stool, and associated diseases. Meaning: Younger children and those with lower growth or mucus in the stool should be assessed for underlying organic causes of constipation. |
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· An imbalance of the gut microbiota with a relative increase in Firmicutes versus Bacteroidetes is associated with the pathogenesis of obesity. · Dysbiosis is associated with microbial genes associated with short-chain fatty acids (SCFA) production and increased colonic SCFA levels. SCFAs have also been shown to regulate appetite and satiety hormones, which can affect food intake and energy balance. · A dietary high-fat intake is reportedly associated with increased plasma lipopolysaccharide. Altered Toll-like receptor-4 signaling leads to propagating the cascade of further inflammation and promoting insulin resistance. |
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· Epigenetic mechanisms are involved in rapidly increasing food allergy. · There is still no definitive way to diagnose food allergy. · Early introduction of peanuts, eggs, and cow’s milk reduces food allergy incidence. · Administration of probiotics such as Lactobacillus rhamnosus GG, Bifidobacterium bifidum can partially reduce the occurrence of allergic symptoms. |
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· Eosinophilic gastrointestinal disease (EGID) is uncommon, with a prevalence of 1–30/100,000 in the general population; however, it is increasing worldwide. · The diagnosis of EGID is based on histopathological findings of endoscopic mucosal biopsy in which tissue eosinophils are counted in each gastrointestinal tract segment of patients with chronic or recurrent gastrointestinal symptoms. · Individualized treatment strategies, including adequate dietary and pharmacological therapy, may help improve outcomes of children with EGID. |
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· Social media use can cause adverse health outcomes, including gastrointestinal disorders, in children and adolescents. · Recent findings have shown a high prevalence of social media use and decreased well-being in patients with functional gastrointestinal disorders. · The biopsychosocial nature of functional gastrointestinal disorders and the clear influence of social media on the psychosocial lives of children suggests the likely involvement of social media in their development. |
Social media use has potential benefits and risks, including links to adverse health problems in children such as functional gastrointestinal disorders (FGIDs). Screen time control, emotional support, and parental guidance can help children navigate social media safely and reduce the risk of developing FGIDs. |
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High-resolution esophageal manometry can be safely performed in children where recurrent vomiting and persistent dysphagia is the working diagnosis after excluding nonluminal and structural obstructive pathologies using pediatric upper gastrointestinal endoscopy. Normal manometry values are available. Clinical picture, biochemical tests, radiological interpretation, and endoscopic findings with manometry completes the analysis of patients with recurrent vomiting and dysphagia. |
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· Chronic liver diseases in children are heterogenous but converge in the common pathway of fibrosis. · Much of the literature on mechanisms of fibrogenesis focus on adults but pediatric physiology has documented differences. · Understanding of these distinctions are necessary to define, treat, and prevent fibrosis. · Current management of liver fibrosis relies heavily on liver biopsy. Multiple tools have shown high diagnostic performance in pediatric and adult populations. Large, multicenter studies are needed for validation. |
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Question: What are the risk factors of newborn birth weight? Does gestational weight gain and prepregnancy body mass index affect childhood weight? Finding: Excess maternal weight gain increases the risk of overweight/obesity, newborn birth weight, and child body mass index at 4–6 years. Meaning: Maternal weight control before and during pregnancy should be well controlled. |
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· Intussusception, the most common cause of small bowel obstruction in young children, has an overall incidence in Korea of 28.3 cases per 100,000 person-years. · Its cause is idiopathic inmost cases, although viral or bacterial gastroenteritis has beenpostulated as a cause. Approximately 4% of children have pathological lead points for intussusception, and Meckel’s diverticulum is the most common cause. · Intussusception in preterm infants is extremely rare. Older children (>5 years of age) are at increased risk of pathological lead points. |
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· This study compared the ability of 2 probiotics to reduce and improve functional abdominal pain (FAP) in children. · In the polymicrobial probiotic (PMP) group, 10.34% of children reported no pain; in the mono-strain probiotic (MSP) group, all patients reported low-degree pain. The mean pain score decreased significantly over time in both groups. · The use of both PMP and MSP is recommended to reduce pain in patients with FAP. |
· The ability of probiotics to relieve pain caused by functional abdominal pain disorders (FAPD) in children is unclear. · Lactobacillus reuteri may effectively reduce pain caused by childhood FAPD. · Since the routine use of probiotics cannot be recommended due to a lack of clinical evidence, research into probiotic mixtures or symbiotics remains necessary. |
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Question: Do probiotics added to maternal nutrition affect infantile colic symptoms and intestinal microbiota? Finding: Infants whose mothers ingested probiotics demonstrated decreased crying frequency and intensity and significantly increased bacterial diversity in the stools. The bacterial variety was substantially affected by the added probiotic product. Meaning: The addition of probiotics to maternal nutrition in early infancy could play an important role in preventing infantile colic. |
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∙ Microbial colonization primarily occurs after birth but there may be some colonization in utero, although this remains highly controversial. ∙ Maternal factors during pregnancy affect the infant microbiota: diet, weight, gestational weight gain, and antibiotic usage. ∙ Microbes are passed from mother-to-infant during and after birth. Delivery mode, breastfeeding, early life antibiotic, and proton pump inhibitor treatment have the largest effects on microbial composition in early life. ∙ The early life gut microbiome plays an important role in the development of the immune system and metabolism. |
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Nutrients are important in the developing immune system. Human milk supplies diverse bioactives to prevent acute infection or chronic inflammation. Immunoglobulins, lactoferrin, and glutamine in human milk decrease gastrointestinal and respiratory infection. Human milk oligosaccharides promote the growth of intestinal microbiota, the gut barrier, and antimicrobial or antiviral activity. Micronutrients act as anti-inflammatory immunonutrients, too. However, the toxicity of some nutrients from an overdose should be considered. |
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· Clinical manifestations of upper gastrointestinal (UGI) tract involvement in Crohn's disease (CD) are common but often clinically underestimated. · Diagnosing CD by confirming inflammation of the UGI tract histologically is challenging because macroscopic and microscopic findings overlap with those of other diseases. · Ongoing efforts are needed to enable a standardized assessment of UGI CD in the future. |
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Question: Are functional gastrointestinal disorders (FGIDs) common in Italy? If so, what are the associated risk factors? Finding: In this cross-sectional study of 1,594 adolescents, the prevalence of FGIDs was 30.9% and was mainly associated with smartphone addiction. Meaning: Smartphone use and dietary habits should be monitored in children with FGIDs. |
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Functional gastrointestinal disorders are common disorders characterized by persistent and recurrent gastrointestinal symptoms. Pathophysiological mechanisms have been suggested, including intestinal microbiota, altered intestinal permeability and motility, dietary effects, sensory abnormalities, and brain-gut dysregulation. Lifestyle factors such as diet, sleep, affect, and physical activity might function as moderators. |
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Question: What are the prevalence and clinical characteristics of celiac disease (CD) in children in Bahrain? Finding: We found a significant increase in CD prevalence over the last decade (P=0.0001). A male predominance was noted. Atypical presentations were common. Most patients had poor adherence to a gluten-free diet. Meaning: CD is an underdiagnosed condition. Atypical symptoms should be considered to prevent missing patients with CD. |
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· Norovirus is the most common virus in Korean children with acute gastroenteritis. · Escherichia coli and Salmonella spp. are the most common cause of bacterial gastroenteritis in Korean children, with a detection rate of 3%–20%. · Uncommon bacterial and parasitic gastroenteritis require attention because of increasing international exchange and overseas travel. |
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Question: What is the value of the diagnostic code in identifying cases of biliary atresia in a large administrative database? Finding: The diagnostic code’s accuracy and sensitivity are acceptable for identifying algorithm-defined cases. A history of pale stool and a presumed diagnosis of biliary atresia prior to referral added value. Meaning: The addition of clinical data to the diagnostic code significantly increased the diagnostic yield. |
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