Relationship between nutritional factors and clinical outcome in children with tuberculous meningitis / 中华儿科杂志

Objective: To investigate the relationship between nutritional risk status and clinical outcome in children with tuberculous meningitis (TBM). Methods: The clinical data (basic information, clinical symptoms and laboratory test results) of 112 patients with TBM, who were admitted to Department of Pediatric Infectious Diseases of West China Second Hospital of Sichuan University,from January 2013 to December 2020 were retrospectively analyzed. The patients were divided into the nutritional risk group and the non-nutritional risk group according to the assessment of the nutritional risk by the STRONGkids Scale. The variables of basic information, clinical symptoms and laboratory test measurements etc. were compared between the two groups by using Student t test, Rank sum test or Chi-square test. Multivariate Logistic regression analysis were used to analyze nutritional risk factors. Results: Among 112 patient with TBM, 55 were males and 57 females. There were 62 cases in the nutritional risk group and 50 cases in the non-nutritional risk group. The proportion of cases with nutritional risk was 55.4% (62/112). Patients in the nutritional risk who lived in rural areas, had symptoms of brain nerve damage, convulsions, emaciation and anorexia, with a diagnosis time of ≥21 days, and the level of cerebrospinal fluid (CSF) protein were all higher than those in the non-nutritional risk group ((50 cases (80.6%) vs. 32 cases (64.0%), 20 cases (32.3%) vs.8 cases (16.0%), 33 cases (53.2%) vs. 15 cases (30.0%), 30 cases (48.4%) vs. 2 cases (4.0%), 59 cases (95.2%) vs. 1 case (2.0%),41 cases (66.1%) vs.18 cases (36.0%), 1 406 (1 079, 2 068) vs. 929 (683, 1 208) mg/L, χ2=3.91, 3.90, 6.10, 26.72, 98.58, 10.08, Z=4.35, all P<0.05). The levels of serum albumin,hemoglobin,lymphocyte count, white blood cell count, and CSF glucose were significantly lower in patients with nutritional risk ((36±5) vs. (41±4) g/L, (110±17) vs. (122±14) g/L, 1.4 (1.0, 2.0)vs. 2.3 (1.6, 3.8)×109/L, 7.8 (6.3, 10.0)×109 vs. 10.0 (8.3, 12.8)×109/L, 1.0 (0.8, 1.6) vs. 2.1 (1.3, 2.5) mmol/L, t=-6.15, -4.22, Z=-4.86, -3.92, -4.16, all P<0.05).Increased levels of serum albumin (OR=0.812, 95%CI:0.705-0.935, P=0.004) and lymphocyte count (OR=0.609, 95%CI:0.383-0.970, P=0.037) may reduce the nutritional risk of children with TBM; while convulsions (OR=3.853, 95%CI:1.116-13.308, P=0.033) and increased level of CSF protein (OR=1.001,95%CI:1.000-1.002, P=0.015) may increase the nutritional risk of children with TBM. Similarly, the rate of complications and drug-induced liver injury was higher in the nutritional risk group (47 cases (75.8%) vs. 15 cases(30.0%), 31 cases (50.0%) vs.8 cases (16.0%), χ2=23.50, 14.10, all P<0.05). Moreover, the length of hospital stay was also longer in the nutritional risk group ((27±13) vs. (18±7) d, t=4.38, P<0.05). Conclusions: Children with TBM have a high incidence of nutritional risk. Convulsive, the level of serum albumin, the level of lymphocyte count and CSF protein may affect the nutritional risk of children with TBM. The nutritional risk group has a high incidence of complications and heavy economic burden.It is necessary to carry out nutritional screening and nutritional support for children with TBM as early as possible.

Research advances in nutritional assessment methods in children with chronic liver diseases / 中国当代儿科杂志

Malnutrition is commonly seen in children with chronic liver diseases, and there are interactions between them. Chronic liver diseases can cause malnutrition and this can affect the prognosis of children with chronic liver diseases. Due to the complexity of nutritional assessment in children with chronic liver diseases, there are still no unified standards for the diagnosis of malnutrition. Early identification of malnutrition and related intervention helps to improve the prognosis of children with chronic liver diseases. This article reviews the features of nutrition in children with chronic liver diseases and related nutritional assessment methods.

Current status of research on infantile cholestatic liver disease in China: a visualization analysis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the current status of research on infantile cholestatic liver disease in China and future research trends.</p><p><b>METHODS</b>A co-word analysis was performed in October 2016. Document retrieval and screening were performed in the Chinese databases CNKI and Wanfang Data using "cholestasis" and "infant" as key words. Excel 2010 was used to establish a co-occurrence matrix of high-frequency key words, and Ucinet 6.0 and Netdraw were used to develop a visualized network of these high-frequency key words.</p><p><b>RESULTS</b>A total of 383 articles were included. The co-occurrence analysis showed that "infant" and "cholestasis" were the core of research in this field, and "infantile hepatitis syndrome", "neonate", "intrahepatic", "biliary atresia", "heredity and metabolism", "hepatitis", "cytomegalovirus", "jaundice", and "conjugated bilirubin" were main research topics. Most of the other articles focused on "parenteral nutrition", "hepatobiliary imaging", "gene mutation", and "liver biopsy". There were relatively few articles on surgical diagnostic techniques and treatment for this disease.</p><p><b>CONCLUSIONS</b>The research on infantile cholestatic liver disease in China focuses on etiology and differential diagnosis, and genetic diagnosis has become a hot topic in recent years. The research on treatment should be enhanced, and new diagnostic techniques are the research interest in future.</p>

Research advances in association between childhood obesity and gut microbiota / 中国当代儿科杂志

In recent years, more and more studies have noted the close association between gut microbiota and the development and progression of obesity. Gut microbiota may act on obesity by increasing energy intake, affecting the secretion of intestinal hormones, inducing chronic systemic inflammation, and producing insulin resistance. This article reviews the association between childhood obesity and gut microbiota, as well as possible mechanisms, in an attempt to provide a reference for the etiology, prevention and treatment of childhood obesity.

A clinical study of invasive fungal disease in children without underlying diseases / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical features of invasive fungal disease (IFD) in children without underlying diseases.</p><p><b>METHODS</b>The clinical data of 49 children without underlying diseases who were diagnosed with IFD were retrospectively studied.</p><p><b>RESULTS</b>Fungal pathogens were detected in 37 (76%) out of 49 patients, including Cryptococcus neoformans (17 children, 46%), Candida albicans (10 children, 27%), Aspergillus (3 children, 8%), and Candida parapsilosis (3 children, 8%). Fungal pneumonia (17 children, 46%) was the most commonly seen disease, with Candida albicans as the major pathogen (9 children, 53%). The 49 children had at least one high-risk factor for infection, including the use of antibiotics, a long length of hospital stay, and invasive procedures. Of all the children, 82% did not respond well to antibiotic treatment or experienced recurrent pyrexia. Among the 24 children who underwent G tests, 17 (71%) showed positive results. All the children were given antifungal therapy, and among these children, 37 (75%)were cured, 3 (6%) were still in the treatment, 5 (10%) died, and 4 (8%) were lost to follow-up.</p><p><b>CONCLUSIONS</b>In IFD children without underlying diseases, Cryptococcus neoformans and Candida are the main pathogens, and lung infection is the most common disease. Long-term use of high-dose antibiotics may be an important risk factor for fungal infection. The IFD children without underlying diseases are sensitive to antifungal drugs and have a satisfactory prognosis.</p>

A visualization study of research papers on childhood tuberculous meningitis in China and abroad over the past decade / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To introduce co-word analysis into the analysis of the current research status of childhood tuberculous meningitis, to compare the similarities and differences in research topics of the field in China and abroad over the past decade, and to discover the advantages and weak links in the study field in China.</p><p><b>METHODS</b>PubMed, CNKI, VIP, and Wanfang Data were searched for the articles which met the inclusion criteria. Ucinet 6.0 and Netdraw were used for co-occurrence analysis, and the co-article relationship between high-frequency key words was visualized.</p><p><b>RESULTS</b>A total of 226 articles abroad and 186 Chinese articles on childhood tuberculous meningitis were obtained. The figures for co-occurrence analysis of high-frequency key words in research articles on childhood tuberculous meningitis in China and abroad were successfully plotted. Compared with the studies in China, the studies abroad were more sophisticated and well-developed, with more studies on drug-resistant tuberculosis, the relationship between tuberculosis and AIDS, and the epidemiology of tuberculosis. The key words listed in the studies abroad were more standard. The studies in China on childhood tuberculous meningitis concentrated on vaccination and nursing.</p><p><b>CONCLUSIONS</b>In general, the studies on childhood tuberculous meningitis in China and abroad have the same directions. The studies abroad have a complicated network and use more standard key words. The studies on childhood tuberculous meningitis are well conducted in China. However, more studies are needed for drug-resistant tuberculosis, the relationship between tuberculosis and AIDS, and the epidemiology of tuberculosis in future.</p>

A young boy with elevated aminotransferases in physical examination--Two novel missense mutations associated with Wilson's disease were found / 中国当代儿科杂志

A 3-year-old boy had abnormal liver function, which was found in physical examination, for 5 months before admission. He had no symptoms such as anorexia, poor appetite, and jaundice, had normal growth and development, and showed no hepatosplenomegaly. Laboratory examination revealed significantly reduced ceruloplasmin (35 mg/L), as well as negative hepatotropic virus, cytomegalovirus, and Epstein-Barr virus. There were normal muscle enzymes, blood glucose, and blood ammonia and negative liver-specific autoantibodies. The boy had negative K-F ring and normal 24-hour urine copper (0.56 μmol/L). The ATP7B gene testing for the boy, his sister, and their parents detected two novel missense mutations in the boy and his sister, i.e., compound heterozygous mutations in exon 7 (c.2075T>C, p.L692P) and exon 13 (c.3044T>C, p.L1015P), which were inherited from their father and mother, respectively. Wilson's disease was confirmed by genetic diagnosis in the boy and his sister. The boy and his sister were given a low-copper diet. The boy was administered with penicillamine for decoppering and zinc supplement against copper uptake. His sister received zinc supplement alone because no clinical symptoms were observed. The boy showed normal liver function in the reexamination after 3 months of treatment.

Epidemiological study on nasal carriage in hospitalized children infected with Staphylococcus aureus / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the relationship between nasal carriage and Staphylococcus aureus (S. aureus) infection in hospitalized children.</p><p><b>METHODS</b>Fifty-six hospitalized children infected with S. aureus were recruited in this study. Nasal swabs were collected and cultured, and the nasal carriage rate of S. aureus was examined. PVL virulence gene and mecA resistance gene were both detected in clinical strains and nasal carriage strains by PCR.</p><p><b>RESULTS</b>Twenty-two (39%) of the 56 children had nasal carriage of S. aureus, and most of them (18 cases) were younger than one year. Among these 22 children, 11 (50%) had previous hospitalization over the past year. In the infected strains, the rate of methicillin-resistant S. aureus (MRSA) was 29% (16/56), while it was 32% (7/22) in carriage strains. The mecA positive results in clinical strains were consistent with the results in nasal carriage strains. Among 5 PVL-positive nasal carriage strains, 4 (90%) could be matched with their clinical strains, all of which were MRSA.</p><p><b>CONCLUSIONS</b>Nasal carriage is a potential risk factor for S. aureus infection. Nosocomial transmission may lead to nasal carriage, which can cause S. aureus infection. The isolation rate of MRSA is high in hospitalized children infected with S. aureus, which implies that more attention is needed for this situation. The isolates from noses may be clonally identical to the isolates from clinical secretions, and the homology between them needs to be confirmed by multi-locus sequence typing.</p>

Factors influencing short-term prognosis of tuberculous meningitis in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the factors influencing short-term prognosis of tuberculous meningitis (TBM) in children.</p><p><b>METHODS</b>The clinical data of 137 hospitalized children with TBM between January 2007 and February 2011 were retrospectively reviewed. A total of 30 potential factors influencing short-term prognosis of TBM were evaluated by univariate analysis and multivariate logistic regression analysis.</p><p><b>RESULTS</b>Clinical staging showed that of the 137 children 21 cases (15.3%) were in the early stage, 67 cases (48.9%) in the medium stage and 49 cases (35.8%) in the late stage of TBM. The univariate analysis revealed 8 factors associated with a poor short-term prognosis: clinical stage of TBM (late), coma, positive Babinski signs, cranial nerve involvements, paralysis, seizures, obvious abnormalities in brain computed tomography (CT) or magnetic resonance imaging (MRI) and elevated protein concentrations in cerebrospinal fluid (CSF). Factors associated with a favourable short-term prognosis for TBM included glucocorticoid steroids therapy, positive reaction of PPD skin test and an increased length of stay in hospital. Multivariate logistic analysis revealed two independent risk factors for a poor short-term prognosis: clinical stage of TBM (late) (OR: 11.168, 95%CI: 3.521-35.426) and positive signs of meningeal irritation (OR: 4.275, 95%CI: 1.043-17.521). An increased length of stay in hospital was shown as a favorable factor (OR: 0.893, 95%CI: 0.825-0.968).</p><p><b>CONCLUSIONS</b>Late-stage TBM and positive signs of meningeal irritation suggest a poor prognosis, while an appropriately longer length of stay in hospital may contribute to a favorable short-term prognosis for children with TBM.</p>

Clinical features of drug-induced liver injury in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the clinical features of drug-induced liver injury in children.</p><p><b>METHODS</b>The clinical data of the hospitalized children with drug-induced liver injury over 5 years were retrospectively reviewed.</p><p><b>RESULTS</b>Of 641 cases of hospitalized children with liver injury, there were 64 cases (10%) of drug induced liver injury. Hepatocellular injury was the most common type of drug-induced liver injury (81%). The major drugs causing drug-induced liver injury included chemotherapy drugs, antibiotics and anti-tuberculosis drugs. Rash (16%), gastrointestinal reaction (15%), fever (14%) and liver intumescence (12%) were common clinical symptoms. A part of patients with drug-induced liver injury (11%) had no symptoms and signs.</p><p><b>CONCLUSIONS</b>Drug-induced liver injury is one of the common causes of liver damage in hospitalized children. Some children with drug-induced liver injury have no symptoms and signs. Hepatocellular injury is a major type of drug-induced liver injury in children, resulting less severe liver damage.</p>

Nasal carriage of community-acquired methicillin-resistant Staphylococcus aureus in healthy children from Chengdu / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To evaluate the prevalence of nasal carriage of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in healthy children from Chengdu.</p><p><b>METHODS</b>Strains of Staphylococcus aureus were isolated from nasal swabs of healthy children from five kindergartens in Chengdu from September, 2005 to December, 2005 and questionnaires were obtained. Antibiotic susceptibility test was performed with agar disk diffusion and Bauer-Kirby on Mueller-Hinton medium method to determine CA-MRSA. mecA and PVL genes were detected with PCR in all of the CA-MRSA isolates.</p><p><b>RESULTS</b>A total of 801 children were enrolled. Overall 147 children (18.4%) were carried with Staphylococcus aureus and 9 (1.1%) were carried with CA-MRSA. All CA-MRSA isolates were positive for mecA gene, and 5 CA-MRSA isolates were positive for PVL gene. Of the 9 CA-MRSA isolates, 6 were multiresistant.</p><p><b>CONCLUSIONS</b>CA-MRSA nasal colonization is present among Chengdu healthy children. The CA-MRSA isolates are multiresistant and parts of CA-MRSA isolates carry PVL gene. The nasal carriage of CA-MRSA in healthy children should be a concerned issue.</p>