OBJECTIVE: Endoscopic dacryocystorhinostomy (EDCR) entails creating an opening from the lacrimal sac directly into the nasal cavity to counteract nasolacrimal duct obstruction. We reviewed the literature to determine the effectiveness and the safety of primary EDCR to treat pediatric nasolacrimal duct obstruction.
METHOD: A literature search was conducted by using a number of medical literature data bases for the period from 1995 to 2016. The following search words were used either individually or in combination: epiphora, nasolacrimal duct obstruction, endoscopic dacryocystorhinostomy, powered endoscopic dacryocystorhinostomy, laser-assisted endoscopic dacryocystorhinostomy, children, congenital, acquired, presaccal obstruction, and postsaccal obstruction. In addition, a few articles were identified based on the experience and information provided by the senior authors (B.A., S.H., D.Y.W.). The search was conducted over a 1-month period (January 2017). Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook for Systematic Reviews of Interventions were followed when possible.
RESULTS: Only 10 original clinical research articles were selected based on our objectives and selection criteria. All the studies were at level of evidence III: nonrandomized and noncomparative prospective or retrospective case series. Altogether, 313 patients with ages that ranged from 4 months to 18 years were enrolled. A total of 352 EDCRs were performed that were either single sided (n = 313) or bilateral (n = 39). The most common causes of the obstruction were classified as congenital, followed by idiopathic, and then acquired. A meta-analysis was not performed because of the heterogeneity of the patient groups and variability of the methods used to measure outcomes.
CONCLUSION: Analysis of the results indicated that EDCR was an effective, safe therapeutic approach to treating nasolacrimal duct obstruction in pediatric patients. It should be considered as an alternative procedure to external dacryocystorhinostomy after a failed conservative treatment.
MATERIALS AND METHODS: A total of 119 healthy infants and children fulfilling our inclusion and exclusion criteria were recruited. They were divided into three groups according to age - 0-2 years old in group 1; 2-6 years old in group 2; 6- 12 years old in group 3. Sonography B-mode was used to assess bilateral diaphragmatic thickness and M-mode to assess diaphragmatic excursion during quiet spontaneous respiration.
RESULTS: In our paediatric population, the normal right and left diaphragmatic thickness were 2.0 mm ± 0.5 and 2.0 mm ± 0.5 for group 1; 2.5 mm ± 0.8 and 2.4 mm ± 0.6 for group 2; 2.7 mm ± 0.7 and 2.5 mm ± 0.5 for group 3, respectively. The normal right and left diaphragmatic excursion were 7.7 mm ± 2.5 and 7.3 mm ± 2.6 for group 1; 11.5 mm ± 3.8 and 10.6 mm ± 3.8 for group 2; 13.8 mm ± 3.9 and 12.9 mm ± 3.3 for group 3, respectively (data presented in mean ± standard deviation). There were no significant differences between two genders for each group. Significant positive correlation between age, weight, height, and body surface area with bilateral diaphragmatic thickness and excursion were detected in all studied population. The percentage difference between excursions of both hemidiaphragm was below 40%.
CONCLUSIONS: M-mode sonography is the modality of choice for diaphragmatic kinetics especially in paediatric population. This study provides normal sonographic reference value of diaphragmatic excursion and thickness in the Malaysian paediatric population as well as percentile curves for right diaphragmatic excursion plotted against body weight. The availability of this data will aid in the diagnosis of diaphragmatic dysfunction and hence immediate intervention for better recovery.
OBJECTIVES AND DESIGN: Following the popular analysis strategy used in the Global Burden of Disease Study, the age-, sex-, country-specific prevalence, and disability-adjusted life years (DALYs) of asthma in China were analyzed. Meanwhile, the comparison in trends between China and other countries in the G20 was also evaluated.
RESULTS: In 2019, asthma was the 8th leading cause of the DALYs' burden of 369 diseases in China. From 1990 to 2019, the age-standardized prevalence and DALY rates of asthma in China decreased by 14% and 51%, respectively; further, the decline rate of DALYs was much higher than the global average (-51%: -43%). It is worth noting that the overall population age-standardized DALYs rate of asthma in China was the lowest in the G20 during 2019 (102.81, 95% UI: (72.30,147.42)/100,000). Moreover, the age-standardized asthma prevalence rate peaks in both childhood (178.14, 95% UI: (90.50, 329.01)/100,000) and the elderly (541.80, 95% UI: (397.79, 679.92)/100,000). Moreover, throughout the study, subjects in the 5 to 9 years old interval were a constant focus of our attention.
CONCLUSIONS: The disease burden of asthma has varied greatly by gender and age over the past 30 years. In contrast to the increasing burden in most other G20 countries, the age-standardized prevalence rate of asthma shows a significant decreasing trend in China, however, the age-standardized DALYs rate shows a fluctuating change, and has even shown a rebound trend in recent years.
METHODS: A total of 9,737 pediatric patients aged <18 years with unintentional injuries cared for at participating centers of the Pan-Asian Trauma Outcome Study (PATOS) from October 2015 to December 2020 were reviewed retrospectively. Patients were divided into two groups: those <8 and those ≥8 years of age. Variables such as patient demographics, injury epidemiology, Injury Severity Score (ISS), and prehospital care were collected. Injury severity and administered prehospital care stratified by gross national income were also analyzed.
RESULTS: Pediatric unintentional injuries accounted for 9.4% of EMS-transported trauma cases in the participating Asian centers, and the mortality rate was 0.88%. The leading cause of injury was traffic injuries in older children aged ≥8 years (56.5%), while falls at home were common among young children aged <8 years (43.9%). Compared with younger children, older children with similar ISS tended to receive more prehospital interventions. Uneven disease severity was found in that older children in lower-middle and upper-middle-income countries had higher ISS compared with those in high-income countries. The performance of prehospital interventions also differed among countries with different gross national incomes. Immobilizations were the most performed prehospital intervention followed by oxygen administration, airway management, and pain control; only one patient received prehospital thoracentesis. Procedures were performed more frequently in high-income countries than in upper-middle-income and lower-middle-income countries.
CONCLUSIONS: The major cause of injury was road traffic injuries in older children, while falls at home were common among young children. Prehospital care in pediatric unintentional injuries in Asian countries was not standardized and might be insufficient, and the economic status of countries may affect the implementation of prehospital care.
METHODS: We conducted a two-stage time-stratified case-crossover study to examine the association between temperature and under-five mortality, spanning the period from 2014 to 2018 across all six regions in Malaysia. In the first stage, we estimated region-specific temperature-mortality associations using a conditional Poisson regression and distributed lag nonlinear models. We used a multivariate meta-regression model to pool the region-specific estimates and examine the potential role of local characteristics in the association, which includes geographical information, demographics, socioeconomic status, long-term temperature metrics, and healthcare access by region.
RESULTS: Temperature in Malaysia ranged from 22 °C to 31 °C, with a mean of 27.6 °C. No clear seasonality was observed in under-five mortality. We found no strong evidence of the association between temperature and under-five mortality, with an "M-" shaped exposure-response curve. The minimum mortality temperature (MMT) was identified at 27.1 °C. Among several local characteristics, only education level and hospital bed rates reduced the residual heterogeneity in the association. However, effect modification by these variables were not significant.
CONCLUSION: This study suggests a null association between temperature and under-five mortality in Malaysia, which has a tropical climate. The "M-" shaped pattern suggests that under-fives may be vulnerable to temperature changes, even with a small temperature change in reference to the MMT. However, the weak risks with a large uncertainty at extreme temperatures remained inconclusive. Potential roles of education level and hospital bed rate were statistically inconclusive.
METHODOLOGY: A cross-sectional two-phase study was carried out to develop the scale. In phase 1, a preliminary parent-report measure questionnaire was developed in Bahasa Malaysia. Later, it was sent to four experts for content validity followed by face validity. In Phase 2, a total of 386 parents of pre-school children aged 4 to 6 years old, split into two samples, were involved in the field study for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).
RESULT: Sample 1 was used to perform EFA to determine the factorial structure of the SDS. All items with a factor loading of >0.4 were included. Sample 2 was used to perform the CFA. RMSEA and CFI analysis showed that the SDS has a good fit and confirms the dimensional structure found via EFA. The final questionnaire consists of 15 items with a 4 factors' structure and has excellent internal consistency reliability.
CONCLUSIONS: The Screen Dependency Scale (SDS) is a reliable and valid questionnaire to detect screen dependency among pre-school children aged 4 to 6 years old in Malaysia.
MATERIAL AND METHODS: A cross-sectional study was done among 300, 3-6 year old school children of Udupi district. A total of 40 children who were caries free, with no past systemic illness or craniofacial anomalies and 40 children with dental caries with no history of dental treatment for caries, with no past systemic illness or craniofacial anomalies were included in control and test groups respectively. Salivary CD14 was evaluated using ELISA test.
RESULTS: The mean salivary soluble CD14 concentration was significantly higher in caries free (1.34±0.35 µg/ml) children than caries experienced (0.54±0.36 µg/ml) (p<0.001). There was significant strong negative correlation between number of decayed teeth and soluble salivary CD14 (r = -0.868, P< 0.001) among all the children. Similarly, sub-group analysis of caries experienced children also showed significant strong negative correlation between number of decayed teeth and soluble salivary CD14 (r = -0.774, P<0.001).
CONCLUSIONS: Results obtained in our study suggested that salivary CD14 can be a indicator of dental caries in young children. Key words:Caries, CD14, Children, Saliva.
METHODS: Children aged 5 months to 5 years who were admitted and referred for CPT from January to April 2017 were randomised to either manual CPT or mechanical CPT with LEGA-Kid®. Outcomes measured at pre-intervention and 2 hours post-intervention were respiratory rate (RR), oxygen saturation and modified Respiratory Distress Assessment Instrument (mRDAI) score.
RESULTS: All 30 enrolled patients had significant reduction in post-intervention RR and mRDAI scores. There was an 8% reduction in RR for the manual CPT group (p = 0.002) and a 16.5% reduction in the mechanical CPT group (p = 0.0001), with a significantly greater reduction in the latter (p = 0.024). mRDAI scores decreased by 2.96 in the manual group (p = 0.0001) and 3.62 in the mechanical group (p = 0.002), with no significant difference between the groups. There was no significant improvement in oxygen saturation, and no adverse events were observed after CPT.
CONCLUSION: Children receiving either manual or mechanical CPT showed improvements in respiratory distress symptoms with no adverse effects. A combined strategy of nebulised hypertonic saline followed by CPT for LRTI removes airway secretions and results in improvements of moderately severe respiratory distress. The LEGA-Kid mechanical CPT method was superior in reducing RR.