Prevalence of SARS-CoV-2 positivity in infants with bronchiolitis: a multicentre international study.

BACKGROUND: Bronchiolitis is the leading acute respiratory tract infection in infants during the winter season. Since the beginning of the SARS-CoV-2 pandemic, a reduction in the number of bronchiolitis diagnoses has been registered. OBJECTIVE: The present study aimed to describe the incidence and clinical features of bronchiolitis during the 2020-2021 winter season in a large cohort of children in Europe and Israel, and to clarify the role of SARS-CoV-2. SETTING, PATIENTS, INTERVENTIONS: We conducted a multicentre observational cross-sectional study in 23 paediatric emergency departments in Europe and Israel. Clinical and demographic data about all the cases of infants diagnosed with bronchiolitis from 1 October 2020 to 30 April 2021 were collected. For each enrolled patient, diagnostic tests, treatments and outcomes were reported. MAIN OUTCOME MEASURES: The main outcome was the prevalence of SARS-CoV-2-positive bronchiolitis. RESULTS: Three hundred and fourteen infants received a diagnosis of bronchiolitis during the study period. Among 535 infants who tested positive for SARS-CoV-2, 16 (3%) had bronchiolitis. Median age, male sex predominance, weight, history of prematurity and presence of comorbidities did not differ between the SARS-CoV-2-positive and SARS-CoV-2-negative groups. Rhinovirus was the most common involved pathogen, while respiratory syncytial virus (RSV) was detected in one case. SARS-CoV-2 bronchiolitis had a mild clinical course, with one patient receiving oxygen supplementation and none requiring paediatric or neonatal intensive care unit admission. CONCLUSIONS: During the SARS-CoV-2 pandemic, a marked decrease in the number of bronchiolitis diagnoses and the disappearance of the RSV winter epidemic were observed. SARS-CoV-2-related bronchiolitis was rare and mostly displayed a mild clinical course.

Unusual presentation of a five-month-old boy with NaPi2a homozygous mutation without hyperphosphaturia: Case report and review of the literature.

Deletions of the NaPi2a gene and mutations in the SLC34A gene should be considered in patients with atypical presentation, without phosphaturia, with mild hypo to normal phosphatemia, and nephrocalcinosis.

Low-Intensity Laser Light Projection for Improved Reading Abilities in Low-Vision Patients.

PURPOSE: To evaluate the efficacy of a new laser imaging device that projects images onto functioning macular areas, to improve visual acuity (VA) in low-vision patients with macular diseases. METHODS: An interventional case series of consecutive patients with low vision in their right eyes (RE). RE VA was measured by showing the patients digits of various standard sizes and measuring their best-corrected VA (BCVA). Then, using the I.C.INSIDE device to project the same standard digits onto functioning macular areas. Patient's ability to recognize the digits with the I.C.INSIDE device was correlated with patient's performance using telescopic low-vision aids. The main outcome measure was change in VA with the different visual aids. RESULTS: Eleven patients (6 males and 5 females) with an average age of 75 ± 6.7 years and low vision in their RE due to macular diseases were included in the study. Baseline BCVA was 1.554 ± 0.50 logMAR. Low-vision aids improved mean VA in 10 patients to 0.64 ± 0.40 logMAR (p < .0001), further improvement was noticed in 8 patients to 0.35 ± 0.16 logMAR (p < .0001) using the laser device, but, three patients did not recognize any digit using the laser device. CONCLUSIONS: The I.C.INSIDE device significantly improved baseline VA in low-vision patients with macular diseases, using extra-foveal fixation.

One-month-old girl presenting with pseudohypoaldosteronism leading to the diagnosis of CDK13-related disorder: a case report and review of the literature.

BACKGROUND: It is not uncommon that an infant with a disease of unknown etiology is presented to a physician. Facial dysmorphic features lead to a different diagnosis. It is a challenge to link the presentation to the newfound diagnosis. CASE PRESENTATION: A 37-day-old Yemenite Jewish girl was presented to our institution with a clinical picture of pseudohypoaldosteronism due to abnormal facial features and a psychomotor developmental delay. Further investigation led to the diagnosis of CDK13-related disorder. According to the literature, CDK13 has a key role in the cell cycle, but no interference with the aldosterone signaling pathway or electrolyte balance was described. No mutations in the previously described gene NR3C2 (cytogenetic location 4q31.23), encoding the mineralocorticoid receptor, were found. Although the clinical presentation corresponded to pseudohypoaldosteronism type 1, we could not genetically confirm this. CONCLUSIONS: Probably pseudohypoaldosteronism was a coincidental finding in this girl with a CDK13 mutation, but because only limited information is known about CDK13-related disorders, further investigation could be more informative to clarify this presentation.

The Duration of Breastfeeding and Its Association with Metabolic Syndrome among Obese Children.

OBJECTIVE: The objective of this study was to evaluate whether duration of breastfeeding is associated with a lower prevalence of metabolic syndrome in obese children. METHODS: A retrospective analysis of obese children aged 3 to 18 years followed at a pediatric outpatient clinic at a single center between the years 2008 and 2012. The children were divided according to their breastfeeding duration: no breastfeeding, a short period of breastfeeding, and a long term breastfeeding. Also, they were divided into metabolic and nonmetabolic syndrome groups, based on physical examination and laboratory tests. RESULTS: Out of 4642 children who visited the clinic, 123 were obese and were included in the study. About half of them matched the metabolic syndrome criteria. There was no correlation between the prevalence of metabolic syndrome and the duration of breastfeeding. Hypertension, abnormal low levels of HDL, high levels of HbA1c, and high fasting triglyceride levels were very common in our study population, yet no statistical significance was noted among the different breastfeeding groups. CONCLUSION: In this study, breastfeeding was not associated with a reduced risk for metabolic syndrome, compared with formula feeding, in children who are obese.

A significant and consistent reduction in rotavirus gastroenteritis hospitalization of children under 5 years of age, following the introduction of universal rotavirus immunization in Israel.

Universal rotavirus vaccination with RotaTeq was introduced in Israel in December 2010. We examined hospitalization rates of children under 5 years of age due to all-cause and rotavirus gastroenteritis, both before and 3 years after universal introduction of the vaccination. An ongoing hospital-based surveillance network that was established in November 2007, accessed information regarding hospitalization of children due to gastroenteritis (n = 6205) in 3 hospitals in northern Israel, with an annual average of about 60,000 children under 5 years of age living in the catchment area of these hospitals. Stool samples were tested for rotavirus by immunochromatography. Compared to the period preceding implementation of the universal rotavirus vaccination (2008-2010), hospitalizations due to rotavirus gastroenteritis in children <5 years of age decreased significantly, by 55% (95% CI 43%-67%) during the period of universal vaccination (2011-2013), a decrease that was sustained throughout the 3 year period. This reduction was greater in children aged 0-23 months (60-61%) than in toddlers aged 24-59 months (36%). A 32% (95% CI 21%-45%) decrease in the incidence of all-cause gastroenteritis was also observed. During the period preceding universal vaccination, rotavirus diarrhea showed typical winter seasonality, with highest incidence in December. However, the winter peak was substantially blunted during the period of universal immunization. Surveillance of rotavirus gastroenteritis should continue to assess the long-term impact of such a program. Our findings are of relevance to high and middle-income countries considering the introduction of a universal rotavirus immunization program.

Cancer incidence among physicians in Israel.

BACKGROUND: Physicians' occupational environment includes exposures to potential carcinogenic factors on a regular basis. The prevalence of specific tumor types and subsequent mortality are reported to be elevated in physicians. OBJECTIVES: To assess the incidence of various cancer types among Israeli physicians of various specialties, as compared with the general population, and to determine the role, if any, of gender and ethnicity. METHODS: This historical retrospective cohort analysis incorporated data on Israeli officially licensed physicians and information retrieved from the Israel National Cancer Registry database (INCR). Physicians were divided into five groups: non-specialists, internists, pediatricians, surgeons, and potentially at-risk specialties. Data were collected retrospectively for the years 1980-2007. RESULTS: The study cohort comprised 37,789 physicians, of whom 33,393 (88.37%) were Jews and 4396 (11.63%) were Arabs. Comparing Jewish physicians to the general population revealed higher rates of: a) breast cancer among female specialized physicians, and b) melanoma among specialized male and female physicians. All cancer types were more prevalent in the Arab physicians than in the general Arab population. CONCLUSIONS: This study revealed incidences of specific cancer types among different medical specialties as compared to the general population. Hopefully, these findings will prompt changes in the occupational environment of physicians of particular specialties in order to reduce their high risk for cancer occurrence.

Salivary and serum analysis in children diagnosed with pneumonia.

The aim of the current study was to evaluate specific markers for pneumonia by using a non-invasive assessment of inflammatory/oxidative biomarkers in saliva accompanying a routine serum analysis. No study evaluating saliva of children with pneumonia has been published previously. Salivary analysis was performed in 15 children diagnosed with lobar pneumonia and in a parallel group of 16 children matching in age and gender in whom there was no respiratory illness, and compared to the serum analysis obtained routinely in both groups of children. Salivary flow rate was lower in the patients' group as was uric acid concentration (by 60%). Increase in salivary concentrations of almost all parameters analyzed was found: Ca, P, and Mg concentrations were higher in the patients' group by 23%, 55%, and 33%, respectively, while LDH, total protein amylase and albumin concentrations were higher by 275%, 79%, and 42%, respectively. In the serum, white cell counts and neutrophils were significantly higher, and sodium level significantly lower in the patients' group. Compositional changes were in the range of 3-80% while the saliva alterations were more profound, in the range of 42-275%. The results demonstrated in the current study indicate salivary analysis as a potentially novel tool for children with pneumonia. Human salivary collection and analysis is a non-invasive tool that could provide additional information for diagnosis and follow-up of pneumonia, especially in children. This is especially beneficial for pediatric patients, as salivary collection is simple, non-invasive, and patient-friendly.

Risk factors for child abuse: quantitative correlational design.

The aim of this research study is to identify risk factors typical of different types of suspected child abuse reported at a hospital. The study was based on 114 cases of children for whom some type of abuse was reported. Physical abuse was the most frequently reported of all types of suspected child abuse. Most victims of sexual abuse were female and at least half the cases of neglect and physical abuse were attributed to parents. Most cases were identified in the emergency room by nurses. Children older than 10 were more susceptible to physical abuse and neglect.

Parents' attitudes toward oral rehydration therapy in children with mild-to-moderate dehydration.

OBJECTIVE: According to current guidelines, the first line of treatment for mild-to-moderate dehydration is oral rehydration; the second line is rehydration through a nasogastric tube. Both methods are widely underused. This study was conducted to evaluate parents' attitudes towards rehydration methods used in pediatric emergency departments. DESIGN: 100 questionnaires were distributed to parents of children who visited emergency room due to gastroenteritis and suspected dehydration. RESULTS: 75 of the parents expected their child to get IV fluids. 49 of them would refuse to consider oral rehydration. 75 of the parents would refuse to consider insertion of nasogastric tube. Parents whose children were previously treated intravenously tended to be less likely to agree to oral treatment. Parents were more prone to decline oral rehydration if the main measurement of dehydration was the child's clinical appearance, clinical appearance with vomiting, or child's refusal to drink and were more likely to agree if the main measurement was diarrhea, diarrhea with clinical appearance, or clinical personnel opinion. CONCLUSIONS: This is the first study to examine parents' expectations. We found that in the majority of cases, parents' expectations contradict current guidelines. Efforts should be taken to educate parents in order to allow full implementation of the guidelines.

Chronic valproic acid intoxication.

Valproic acid intoxication may be associated with cerebral, cardiovascular, respiratory, gastrointestinal, and hematologic complications. We report a case of a 7-year-old girl, epilepsy-treated chronically with valproic acid, sulthiame, and clonazepam, who presented to the emergency room because of a global deterioration during the preceding 2 months, including poorer feeding and worsened general responsiveness. The girl was later diagnosed to have chronic valproic acid intoxication.

Urinary concentration of cytokines in children with acute pyelonephritis.

Urinary tract infection (UTI) is a common bacterial infection among infants and children. Predicting which children with upper UTI will develop long-term sequelae remains difficult. We aimed at evaluating the predictive value of urine concentrations of interleukin-6 (UIL-6) and interleukin-8 (UIL-8) in subsequent renal scarring. In the current observational prospective study, urine samples for UIL-6 and UIL-8 were obtained from two groups: 31 children with first episode of febrile UTI and 22 febrile children of other origin. UIL-6 and UIL-8 were increased in children with febrile UTI, compared to children with fever of other origin [median and range (picograms per milliliter): (1) UIL-6, 74.46 (0-168) vs. 10.51 (0-47.50), respectively, p = 0.0001; (2) UIL-8, 2,660.38 (0-13,801) vs. 0, respectively, p = 0.0001]. Renal scarring was found in 5/31 (16 %) children with acute pyelonephritis. Initial median UIL-8 values were significantly higher in children with later renal scarring than in those without renal scarring [median and range (picograms per milliliter): 6,163 (2,021-13,801) vs. 1,490.5 (0-5,737), respectively, p = 0.018]. In conclusion, UIL-8 might serve as a predictive biomarker for renal scarring after an acute episode of pyelonephritis. Since UIL-8 emerges as a renal-specific diagnostic and prognostic marker, it may be suitable as a selective screening tool for children with febrile UTI.

Incidence and characteristics of sporadic norovirus gastroenteritis associated with hospitalization of children less than 5 years of age in Israel.

The incidence of sporadic GII norovirus gastroenteritis associated with hospitalization was examined among 515 children aged <5 years in a prospective study in Israel. Using real-time polymerase chain reaction, norovirus was detected in stools of 89 (17.3%) children, yielding an estimated incidence of 3.3 per 1000 children. Genotypes GII.3 (40.4%) and GII.4a (21.3%) predominated, though year-to-year variation was observed.

[Asymptomatic classical hereditary xanthinuria type 1].

We report on a girl who was diagnosed with classical hereditary xanthinuria due to an incidental finding of extremely low Levels of uric acid in the blood. The girl is compLetely asymptomatic. Hereditary xanthinuria is a rare autosomal recessive disease that usually causes early urolithiasis but may cause rheumatoid arthritis-like disease and even be associated with defects in the formation of bone, hair and teeth. In Israel it has mostly been described in patients of Bedouin origin. Throughout the world, only about 150 cases have been described; about two thirds of these patients were asymptomatic. Since the clinical presentation and age of symptom appearance are diverse, the case raises questions as to the required follow-up of these patients and as to whether a low oxalate diet should be initiated.

Return visits to the emergency department among febrile children 3 to 36 months of age.

OBJECTIVES AND METHODS: The aim of the present retrospective, cross-sectional, descriptive study was to determine the characteristics of febrile 3- to 36-month-old children who were admitted to the emergency department (ED) with the chief complaint of fever and returned with the same complaint within 72 hours (returning group), compared with age-matched children who did not return to the ED (nonreturning group). Demographics and predischarge evaluation extent were focused on. RESULTS: Compared with the nonreturning group (n = 305), the returning group (n = 92) demonstrated higher mean temperature at home (P = 0.008), longer fever duration (P < 0.0001), and greater pain frequency (P = 0.03). Demographics and predischarge evaluation extent were similar in both groups. Within the returning group, fever duration was longer at the time of the second visit (P = 0.004). CONCLUSIONS: Higher fever causes higher rate of return visits. Among the investigated groups, pain was the sole differentiating symptom. Further studies should identify patterns that diminish children's ED readmission.

Effectiveness of rotavirus vaccines for prevention of rotavirus gastroenteritis-associated hospitalizations in Israel: a case-control study.

The association between rotavirus gastroenteritis (RVGE)-associated hospitalization and rotavirus vaccine receipt was examined, and vaccine effectiveness was estimated in a case-control study conducted between 11/2007 and 12/2009 among Israeli children age eligible for rotavirus vaccination. Cases (n=111) were hospitalized children with diarrhea testing positive for rotavirus by immunochromatography. Controls (n=216) were hospitalized children with diarrhea testing negative for rotavirus. Among controls 36 (16.7%) children were vaccinated against rotavirus compared with two children (1.8%) among cases (p < 0.001). Rotavirus immunization was associated with lower risk of RVGE-associated hospitalization; adjusted OR 0.106 (95% CI 0.024, 0.481), yielding a vaccine effectiveness of 89.4% (95% CI 51.9%, 97.6%) in preventing hospitalization. These data demonstrate high effectiveness of rotavirus vaccines in a high income country.

Incidence, characteristics, and economic burden of rotavirus gastroenteritis associated with hospitalization of israeli children <5 years of age, 2007-2008.

BACKGROUND: Limited data exist on the epidemiology and burden of rotavirus gastroenteritis in Israel. Objectives. Our objective was to examine the incidence, characteristics, and economic burden of rotavirus gastroenteritis associated with hospitalization of children <5 years of age in Israel. METHODS: A prospective study was initiated in pediatric wards at 3 hospitals in northern Israel. Presence of rotavirus in stool specimens was detected by immunochromatography, and G and P genotypes were determined by reverse-transcriptase polymerase chain reaction. Demographic data, clinical manifestations, and expenditures related to a child's illness were studied using parental interviews. RESULTS: From November 2007 through October 2008, 472 children hospitalized with gastroenteritis were enrolled in the study. Rotavirus gastroenteritis was diagnosed in 39.1% of children, with a peak identification rate during November 2007-January 2008 (62.5%-71.0%). Most cases of rotavirus gastroenteritis (87.2%) occurred in children <2 years of age. In infections with 1 rotavirus genotype, G1P[8] was the most frequently detected (49.1%), followed by G1P[4] (11.1%) and G9P[8] (9.3%). Mixed rotavirus isolates were identified in 28.9% of the children. The estimated incidence of primary hospitalizations for rotavirus gastroenteritis among children aged 0-5 years was 5.7 hospitalizations per 1000 children per year (95% confidence interval, 5.1-6.3 hospitalizations per 1000 children per year), resulting in an estimate of 4099 annual national hospitalizations (95% confidence interval, 3668-4531 hospitalizations per year). This figure represents approximately 6.5% of the total annual hospitalizations among Israeli children <5 years of age. The annual calculated cost of hospitalizations for rotavirus gastroenteritis was US $7,680,444, including US $4,578,489 (59.6%) in direct costs to the health care system and US $3,101,955 in overall household costs. CONCLUSIONS: Our findings are important for decision making regarding implementation and evaluation of a routine immunization program against rotavirus gastroenteritis.