Background
A parent survey was conducted to assess the sleep habits of children residing in various countries before and during the SARS‐CoV‐2 pandemic. It was hypothesized that lockdown would be ...associated with increased sleep duration.
Methods
Outcomes were changes in bedtime, wake time, and sleep duration in the pandemic compared to before. Logistic regression was applied to evaluate the effects of age and covariates on outcomes.
Results
A total of 845 questionnaires completed from May 1 to June 10, 2020 were analyzed (45.8% female; age 3–17 years). During the pandemic, 23.1% of preschoolers, 46.2% of school‐age children, and 89.8% of adolescents were going to bed after 10 p.m. on weekdays compared to 7.1%, 9.4%, and 57.1% respectively before the pandemic, with these proportions being higher on weekends. Likewise, 42.5% of preschoolers, 61.3% of school‐age children, and 81.2% of adolescents were waking after 8 a.m. on weekdays (11.6%, 4.9%, and 10.3%, before) with these proportions being greater on weekends. Sleep duration did not change in 43% of participants on weekdays and in 46.2% on weekends. The 14–17 years group had fourfold increased odds for longer sleep duration on weekdays (p < .01), and children aged 6–13 years had twofold increased odds for longer sleep duration on weekends relative to the 3–5 years age group (p = .01).
Conclusions
Although lockdown was associated with later bedtime and wake time, this shift did not alter sleep duration in more than 40% of children. Yet, compared to preschoolers, high school‐aged children were more likely to sleep more on weekdays and primary school children on weekends.
Venipuncture is a frequent source of painful procedures for infants. It has been well documented that infants react to pain with a combination of physiologic and behavioral responses. Infants are ...unable to describe pain and at particularly high risk for inadequate pain management. The Vibration Anesthesia Device is a specifically designed device for management of pain from minor procedures. It has been shown to reduce venipuncture pain in older children but has not been studied in infants. The mechanism of its effects has been described by a gate control theory, which states that vibration stimulates the dorsal horn neurons where the pain signal is being modulated. The objective of this study was to investigate the efficacy of this device on pain during and after venipuncture procedures in infants.
Study participants were 60 healthy infants undergoing venipuncture procedure for routine laboratory tests. Infants were divided into 2 groups as follows: group 1 (n = 30) was placed vibration anesthesia device 5 to 10 cm proximally through the site of venipuncture, and group 2 (n = 30) underwent venipuncture only. A single observer rated pain responses using the Face, Legs, Activity, Cry, and Consolability scale before, during, and after the procedure. The χ distribution and Student t test were used for statistical analysis.
Groups did not differ by sex. Mean age of group 2 is less than group 1 and is statistically significant (P = 0.026). There were no differences between pain scores of groups assessed by Face, Legs, Activity, Cry, and Consolability scale before, during, and after venipuncture procedure (P = 0.359, P = 0.907, and P = 0.400 respectively).
We assessed the efficacy of a vibration anesthesia device, and our results suggested that this device did not reduce pain scores in infants during and after venipuncture procedure.
Abstract
Introduction
Obstructive sleep apnea (OSA) is characterized by recurrent episodes of obstruction of the upper airway that cause decreased or absent breathing during sleep. An OSA diagnosis ...is made when the patient experiences recurrent episodes of partial or complete collapse of the upper airway during sleep, which results in apneas or hypopneas, respectively. Polysomnography (PSG) is the gold standard test for diagnosis. HSATs (Home Sleep Apnea Tests) are types of sleep tests that can be conducted in a patient's home to detect obstructive sleep apnea. These tests are becoming increasingly common due to their affordability and convenience. Currently, an in-lab PSG is recommended if the initial HSAT is negative and there is a high clinical suspicion of OSA. Aim of this study is to identify a predictive component of negative HSAT which in turn shows positive PSG.
Methods
We reviewed 50 electronic medical records of patients who underwent an HSAT followed by an in-lab PSG at our Sleep Disorders Center. Patient demographics, comorbidities, HSAT data and PSG data were analyzed. Chi-square test and independent sample t-test were used to compare groups. Predictors of the negative PGA was assessed with Logistic regression. Statistical analysis was performed using Statistical Package of Social Science (SPSS) for Windows, version 15.0 (SPSS Inc, Chicago, IL). A p value <0.05 was considered as statistically significant.
Results
There was no correlation between age, gender, body mass index, comorbidities, and lowest oxygen level in HSAT to predict the result of following PSG.
Conclusion
The results of this study showed no statistically significant predictor in patients who underwent an HSAT followed by an in-lab PSG, although there seems to be a weak correlation between the lowest oxygen levels in HSAT and positive PSG. The gold standard for diagnosing OSA remains in-laboratory PSG; HSAT is an alternative in a select group of patients. For most patients with suspected mild OSA, in-laboratory PSG is preferred since HSAT may under-detect sleep-related events.
Support (If Any)
The aim of this study was to evaluate the predictive value of resistin and visfatin in neonatal sepsis, and to compare these adipocytokines with C-reactive protein (CRP), procalcitonin and ...interleukin 6 (IL-6).
A total of 62 term or near term infants with sepsis proven by positivity of blood culture, and 43 healthy infants were included in this study.
There were no statistically significant differences between the two groups as regards birthweight and gestational age. White blood cell count (p= 0.039), CRP levels (p=0.01), procalcitonin levels (p=0.01), IL-6 levels (p= 0.01), visfatin levels (p=0.01) and resistin levels (p=0.01) were significantly higher in septic infants. There was a positive correlation between visfatin, resistin and other markers (WBC, CRP, procalcitonin and IL-6). A cut-off value of 10 ng/mL for visfatin, showed 92% sensitivity and 94% specificity, and a cut-off value of 8 ng/mL for resistin showed 93% sensitivity and 95% specificity for neonatal sepsis.
In the light of these results, visfatin and resistin can be used as a diagnostic marker similar to CRP, procalcitonin and IL-6 in neonatal sepsis. Further studies are needed to better understand the role and predictive value of these molecules in neonatal sepsis.
The quadriceps femoris muscle ruptures usually occur in the middle-aged population. We present a 4-year-old patient with partial rupture of the quadriceps femoris muscle. To our knowledge, this is ...the youngest patient reported with a quadriceps femoris muscle rupture.
A 4-year-old girl admitted to our clinic with left knee pain and limitation in knee movements. Her father reported that she felt pain while jumping on sofa. There was no direct trauma to thigh or knee. We located a palpable soft tissue swelling at distal anterolateral side of thigh. The history revealed that 10 days ago the patient was treated for upper tract respiratory infection with intramuscular Clindamycin for 7 days. When we consulted the patient with her previous doctor and nurse, we learnt that multiple daily injections might be injected to same side of left thigh. MRI showed a partial tear of vastus lateralis muscle matching with the injection sites. The patient treated with long leg half-casting for three weeks. Clinical examination and knee flexion had good results with conservative treatment.
Multiple intramuscular injections may contribute to damage muscles and make prone to tears with muscle contractions. Doctors and nurses must be cautious to inject from different parts of both thighs.
Objective: Jaundice is a problem in newborns. There are many maternal and infant-related factors affecting neonatal jaundice. The maternal pre-pregnancy weight, maternal body mass index (BMI) and ...gestational weight gain may have an effect on the newborn bilirubin levels. We research the effect of the maternal pre-pregnancy weight and gestational weight gain on the bilirubin levels of the newborn infants in the first 2 weeks prospectively.
Methods: Term and healthy infants who were born between 38 and 42 weeks in our clinic were included in the study. Maternal pre-pregnancy BMIs were calculated. Babies were divided into three groups according to their mothers' advised amount of gestational weight gain. Total serum bilirubin (TSB) values of the newborns were measured in the 2nd, 5th and 15th postnatal days.
Results: In our study, the 5th and 15th day capillary bilirubin level of the babies with mothers who gained more weight than the advised amount during pregnancy were found statistically significant higher compared to the other two groups (p < 0.05). Similarly, the hematocrit level of the babies with mothers who gained more weight than the advised amount were found statistically significant higher compared to the other two groups (p < 0.05).
Conclusions: We conclude that the babies with mothers who gained more weight than the advised amount were under risk for newborn jaundice. Therefore, these babies should be monitored more closely for neonatal jaundice and prolonged jaundice.
In response to systemic infection, mice usually present specific behaviors such as reduced activity and feeding, ruffled fur, hunched position, ataxia and tremor. We aimed to compare tissue ...bioluminescence, tissue cultures and clinical scores of BALB/c mice as potentially complementary outcome measures of Salmonella disease progression In Balb/c mice. The clinical status of the mice was assessed by visual examination for motility, ruffled fur, hunched position, feeding, ataxia and tremor. Patterns of bioluminescent light emission indicated the progression of infection from the abdominal region (initial site) to secondary tissue sites, which was indicative of systemic infection. As the severity and progression of infection increased, the bioluminescence signal became both more prominent and more anatomically disseminated. Bioluminescent Imaging (BLI) of Salmonella that have been genetically engineered to be bioluminescent is a new method that gives the opportunity to track Salmonella dissemination in mice. BLI is a helpful method to estimate tissue Salmonella concentration and may reduce the number of mice used in experiments, providing the opportunity to obtain serial assessments of disease progression in a single mouse subject. Clinical scores helped us to assess the clinical status of BALB/c mice in systemic Salmonella infections.
Complications after adenotonsillectomy (AT) in children have been extensively studied, but differences between children with and without obstructive sleep apnea (OSA) have not been systematically ...reported. Our objective was to identify the most frequent complications after AT, and evaluate if differences between children with and without OSA exist.
Several electronic databases were searched. A partial gray literature search was undertaken by using Google Scholar. Experts were consulted to identify any missing publications. Studies assessing complications after AT in otherwise healthy children were included. One author collected the required information from the selected articles. A second author crosschecked the collected information and confirmed its accuracy. Most of the selected studies collected information from medical charts.
A total of 1254 studies were initially identified. Only 23 articles remained after a 2-step selection process. The most frequent complication was respiratory compromise (9.4%), followed by secondary hemorrhage (2.6%). Four studies compared postoperative complications in children with and without OSA, and revealed that children with OSA have nearly 5 times more respiratory complications after AT than children without OSA (odds ratio = 4.90; 95% confidence interval: 2.38-10.10). In contrast, children with OSA are less likely to have postoperative bleeding when compared with children without OSA (odds ratio = 0.41; 95% confidence interval: 0.23-0.74).
The most frequent early complications after AT are respiratory compromise and secondary hemorrhage. Based on the current limited evidence, children with OSA appear to have more respiratory complications. Conversely, hemorrhage appears to be more frequent in children without OSA.
Cisplatin, an effective antineoplastic agent, frequently induces acute renal failure in animals and humans. Hyperbaric oxygen (HBO) has been shown to prevent cisplatin-induced nephrotoxicity in rats. ...This study investigated the effect of two different HBO regimes on renal functions, oxidative stress, and histopathological changes in rat kidneys after cisplatin treatment. Wistar rats were divided into five groups: control, HBO, cisplatin, cisplatin plus once daily HBO, and cisplatin plus twice daily HBO. Cisplatin was given as a single intraperitoneal dose of 6 mg kg, and HBO was applied for 60 min at 2.5 atm for six days. HBO alone did not alter any biochemical parameters or histopathological findings compared with the control group. Cisplatin increased serum urea and creatinine levels and caused severe histopathological injury. In addition, cisplatin increased lipid peroxidation and impaired superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities in kidney tissue. Once daily HBO after cisplatin treatment slightly reduced serum urea and creatinine levels and attenuated histopathological injury. HBO also reduced lipid peroxidation and increased SOD and GSH-Px activities significantly. Although twice daily HBO was determined to be more effective than once daily HBO on oxidative stress parameters, it increased serum creatinine levels and histopathological injury compared with the cisplatin group. It was concluded that HBO alone does not induce nephrotoxicity and oxidative stress in rat kidneys; once daily HBO may prevent cisplatin-induced nephrotoxicity, an effect that is partially mediated by the modification of oxidant antioxidant systems in the kidneys; and twice daily HBO potentiates cisplatin nephrotoxicity by a ROS-independent mechanism.
Summary The overall validity of biomarkers in the diagnosis of obstructive sleep apnea (OSA) remains unclear. We conducted a scoping review to provide assessments of biomarkers characteristics in the ...context of obstructive sleep apnea (OSA) and to identify gaps in the literature. A scoping review of studies in humans without age restriction that evaluated the potential diagnostic value of biological markers (blood, exhaled breath condensate, salivary, and urinary) in the OSA diagnosis was undertaken. Retained articles were those focused on the identification of biomarkers in subjects with OSA, the latter being confirmed with a full overnight or home-based polysomnography (PSG). Search strategies for six different databases were developed. The methodology of selected studies was classified using an adaptation of the evidence quality criteria from the American Academy of Pediatrics. Additionally the biomarkers were classified according to their potential clinical application. We identified 572 relevant studies, of which 117 met the inclusion criteria. Eighty-two studies were conducted in adults, 34 studies involved children, and one study had a sample composed of both adults and children. Most of the studies evaluated blood biomarkers. Potential diagnostic biomarkers were found in nine pediatric studies and in 58 adults studies. Only nine studies reported sensitivity and specificity, which varied substantially from 43% to 100%, and from 45% to 100%, respectively. Studies in adults have focused on the investigation of IL-6, TNF-α and hsCRP. There was no specific biomarker that was tested by a majority of authors in pediatric studies, and combinatorial urine biomarker approaches have shown preliminary promising results. In adults IL-6 and IL-10 seem to have a favorable potential to become a good biomarker to identify OSA.
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