From Adversity to Agency: Storytelling as a Tool for Building Children’s Resilience
Published on: 11th November, 2024
Children who experience Adverse Childhood Experiences (ACEs)—including trauma, family instability, or significant loss—are at increased risk for enduring mental, emotional, and physical challenges, including conditions such as depression, anxiety, and chronic health issues. Without effective support, these adverse experiences can have lasting effects on a child’s well-being, often persisting into adulthood and impacting mental, emotional, and physical health outcomes over the long term. Storytelling is a powerful method to support resilience in these children by enabling them to process emotions, make sense of complex experiences, and view themselves as active agents in their lives. By framing their experiences within personal narratives, children can create coherent stories that aid emotional regulation and support mental well-being. Through storytelling, children can frame their struggles as part of a larger, purposeful journey, fostering a sense of agency and self-worth. Techniques such as narrative therapy, story circles, and resilience-themed books-exemplified by The Adventures of Gabriel—help children explore their experiences, visualise positive outcomes, and strengthen social bonds. Moreover, storytelling is an accessible tool that aids in perspective—taking, allowing children to relate their challenges to those of characters, which reinforces their ability to overcome adversity and navigate life’s complexities with strength and optimism.
Impact of Intravenous Busulfan Pharmacokinetics on Safety in Pediatric Patients who have undergone Hematopoietic Stem Cell Transplant
Published on: 3rd December, 2024
Introduction: Busulfan (Bu)-based regimens are crucial for myeloablative conditioning in pediatric allogeneic stem cell transplantation. Despite its efficacy, Intravenous Bu has a narrow therapeutic index and variable pharmacodynamics especially in children, heightening the risk of adverse events. This study explores Bu dosing and related organ toxicities in pediatric patients at a tertiary center in Saudi Arabia.Methodology: This retrospective study at King Fahad Specialist Hospital in Dammam (KFSH-D), Saudi Arabia, included pediatric patients (≤16 years) treated with intravenous Bu before bone marrow transplantation from 2010 to 2022. Pharmacokinetic dose adjustments were based on AUC targets of 900-1350 µMol-min. Descriptive measures included mean, Standard Deviation (SD), median, minimum-maximum values, counts, and percentages. Statistical analyses used Kruskal-Wallis, Chi-square, and Fisher’s exact tests. Ethical approval was obtained from KFSH-D.Results: We identified 44 pediatric patients who underwent Bu prior to HSCT. Mean age was 4.95 ± 2.49 years, with a female majority (56.8%). Primary diseases included Beta Thalassemia (34.09%), Neuroblastoma (29.55%) among others. There was no significant difference in the cohort’s demographic and clinical features of the cohort. Nonetheless, higher infections were found in the Low-AUC group (66.7%) compared to the Target-AUC (40.0%) and Higher-AUC groups (0.0%) (p = 0.015).Conclusion: This study emphasizes the need for therapeutic drug monitoring and individualized Bu dosing in pediatric HSCT to minimize toxicity and improve outcomes. Larger multicenter studies are recommended to refine dosing strategies and enhance the safety and efficacy of Bu-based regimens.
Newly Modified Posterior Axilla Maneuver: Tilt and Kristeller Procedure
Published on: 19th December, 2024
Shoulder dystocia is a rare but severe complication of vaginal delivery with possibly serious consequences. Certain risk factors are associated with shoulder dystocia, but a general forecasting model is lacking. We present a Case report using a newly modified Posterior Axilla Maneuver technique that saved a 5.140 g (11 lbs. 5 oz.) newborn from shoulder dystocia. The child was born with Apgar 7/9, pH 7.17. Currently, there are no signs of any long-term sequelae.Our procedure comprised the following steps: 1. First, we pulled the posterior shoulder downwards - in the direction and to the outer surface of the perineum. 2. Then we pulled the posterior shoulder backward - toward the maternal spine - when it was already outside the perineum and finished extracting the posterior shoulder. 3. By completing the first two steps, a Tilt of the shoulder girdle was reached in the midsagittal plane, resulting in a backward slope for the shoulder girdle so that the anterior shoulder touched the symphysis slightly from the back in a skewed manner, freeing it from the initial impacted position. 4. We applied the Kristeller procedure only after dislodging the anterior shoulder from its initial impacted position. 5. We also applied the McRoberts Maneuver at the end of the process to increase the diameter of the birth canal.
Two Endocrine Disorders, One Postpartum Period: “The Coexistence of Thyroiditis and Hypophysitis,” A Case Report
Published on: 24th December, 2024
The postpartum period is a phase during which various endocrine disorders may arise due to changes in the immune system. Postpartum thyroiditis and postpartum hypophysitis (lymphocytic hypophysitis) are two autoimmune diseases that typically occur independently but are rarely found together in the same patient.Postpartum thyroiditis usually starts with thyrotoxicosis and progresses to hypothyroidism, while postpartum hypophysitis can lead to adrenal insufficiency and dysfunction of other pituitary hormones.This case report discusses a female patient who presented with severe headaches, fatigue, and hypotension five months after childbirth. The patient was diagnosed with both postpartum thyroiditis and postpartum hypophysitis simultaneously, and dysfunction of both the thyroid and pituitary was detected. Hormone replacement therapies were administered, and the patient’s symptoms were brought under control.This case emphasizes the importance of carefully evaluating both thyroid and pituitary function during the postpartum period. Early diagnosis and appropriate treatment are crucial for preventing potential complications and improving long-term health outcomes.
Relationship between Vitamin D Deficiency and Lipopolysaccharides Porphyromonas gingivalis Bacteria in Stunting Children
Published on: 24th December, 2024
Background: Stunting is a condition of growth and development disorders in children under 5 years of age who appear shorter than their age caused by nutritional deficiencies. The stunted growth and development of children can be influenced by deficiencies in the intake of macronutrients such as protein and micronutrients such as calcium, phosphorus, zinc, and vitamin D. One nutrient that is relevant to current dental health research is vitamin D. Objective: This review article will further analyze the relationship between vitamin D deficiency and Porphyromonas gingivalis bacterial lipopolysaccharide in stunting children. Literature review: Vitamin D deficiency can cause various problems related to the oral cavity such as a decrease in salivary flow rate, buffer capacity, and salivary content such as protein. A decrease in salivary flow rate causes secretory Immunoglobulin A (IgA) to decrease, thus disrupting the colonization of normal microflora in the oral cavity. Reduced vitamin D levels can potentially increase the number of Porpyhromonas gingivalis bacteria and also lipopolysaccharides (LPS), thus inhibiting the proliferation and differentiation of alveolar bone cells. Conclusion: Therefore, lack of micronutrient intake such as vitamin D deficiency can trigger the growth of Porphyromonas gingivalis bacteria and an increase in bacterial products such as lipopolysaccharides, especially in stunted children.
Case Report: Intussusception in an Infant with Respiratory Syncytial Virus (RSV) Infection and Post-Operative Wound Dehiscence
Published on: 7th January, 2025
Intussusception is a leading cause of intestinal obstruction in young children, typically presenting with colicky abdominal pain and altered stool characteristics, before progressing to abdominal distension and bilious vomiting. This case report describes an 8-month-old male who presented with gastrointestinal symptoms, respiratory distress, and signs of intestinal obstruction. The patient was diagnosed with intussusception and found to be positive for Respiratory Syncytial Virus (RSV). After an attempted ultrasound-guided hydrostatic fluid enema, he underwent laparotomy to resolve the intussusception but developed post-operative complications, including delayed wound healing and wound dehiscence. The interplay of viral infections like RSV, and treatments such as steroids in pediatric surgical cases warrants further attention, especially concerning postoperative outcomes.
Clinical Severity of Sickle Cell Anaemia in Children in the Gambia: A Cross-Sectional Study
Published on: 8th January, 2025
Background: Sickle cell anaemia (SCA) in children demonstrates a broad range of clinical manifestations and serious complications. Assessment of disease severity in specific populations is necessary to plan services and optimise care. Aim: To describe the clinical severity of SCA and associated sociodemographic and clinical factors in children in Gambia.Methods: The presence of lifetime complications was confirmed by history and review of medical charts. We determined clinical severity using a validated scoring system and related the severity to sociodemographic and clinical factors.Results: In 130 study participants, ages ranged from 5 to 15 years with a mean (SD) age of 9.74 (2.81) years. Eleven (8.5%) children had had acute chest syndrome, 7 (5.4%) avascular necrosis of the femoral head, 6 (4.6%) gallstones, 5 (3.8%) stroke and 1 (0.8%) priapism over their lifetime. Disease severity was classified as mild in 108 (83.1%) children, moderate in 17 (13.1%) and severe in 5 (3.8%). Age, age at diagnosis, sex, ethnicity, social class, and treatment with hydroxyurea was not significantly correlated with SCA clinical severity (P values 0.10-0.84).Conclusion: The high proportion of children with mild disease may be due to the high prevalence of Senegalese β-haemoglobin haplotype in the Senegambia subregion. However, the presence of moderate or severe disease in almost 1 in 5 children calls for concerted efforts in SCD care in this region.
Idiopathic Immune Complex-Mediated Membranoproliferative Glomerulonephritis: A Significant Cause of End-Stage Kidney Disease in Children
Published on: 29th January, 2025
Introduction: Membranoproliferative glomerulonephritis (MPGN) is a significant cause of glomerulopathy and chronic kidney disease (CKD) or end-stage renal disease (ESRD) in children. The deposition of circulating immune complexes in the glomerulus and abnormal activation of the alternative complement pathway is believed to trigger the disease. However, there is limited knowledge regarding the optimal treatment and prognosis for children with immune complex-associated MPGN (IC-MPGN) and C3 glomerulopathy (C3G).Case report: We report the case of a 14-year-old child admitted for rapidly progressive glomerulonephritis with anuria managed on haemodialysis. The kidney biopsy showed an appearance compatible with MPGN on light microscopy, with immunoglobulin and complement C3 deposits on direct immunofluorescence. The prognosis was poor, with rapid progression to ESRD despite treatment combining corticosteroid therapy and immunosuppressants.Discussion and conclusion: Evaluating the effectiveness of different therapeutic approaches for MPGN in children is challenging due to the small sample sizes and the short duration of the published controlled studies. As a result, it is crucial to conduct more comprehensive trials that focus on both prognosis and treatment options.
Analysis of Acoustic Parameters of Voice Jitter and Shimmer in Children with Dysphonia after Laryngeal Surgery
Published on: 4th February, 2025
The article conducted a study of computer acoustic analysis of Jitter and Shimmer voice parameters in children with dysphonia after laryngeal surgery. The study found that children with dysphonia had significantly lower preoperative Jitter and Shimmer scores (574359, 587, and 2.3) compared to healthy children (1316743.376 and 4.84). At 1 month after surgery, affected children showed a decrease in Jitter and Shimmer indices compared with these acoustic indices before surgery. However, at 2 months, there was a significant increase in Jitter and Shimmer scores, and at 3 months, Jitter and Shimmer scores were comparable to Jitter and Shimmer scores in healthy children without dysphonia. The results of the study show that the method of analyzing the acoustic parameters of the voice Jitter and Shimmer allows a phoniatrist to objectively assess the occurrence of a voice disease in patients with dysphonia, and this method is the most accurate criterion for determining the pathologies of dysphonia and determining the treatment program for the disease.
Caregivers’ Nutritional Awareness and its Impact on Pediatric Health Outcomes: A Study at Wad-Albasheir Health Center, Sudan
Published on: 3rd April, 2025
Background: Nutritional awareness among caregivers plays a crucial role in ensuring optimal pediatric health and development. This study assesses the level of nutritional awareness among caregivers and examines its association with demographic factors.Objectives: This study aimed to assess the knowledge and awareness of caregivers regarding dietary advice and complementary feeding for children under five years at Wad-Albasheir Family Health Center, Um-Bada locality.Methods: A cross-sectional study was conducted among caregivers in selected healthcare facilities. Data were collected using a structured questionnaire and analyzed using SPSS version 23. Descriptive statistics and chi-square tests were used to evaluate associations between variables.Results: The majority of caregivers demonstrated moderate awareness (60%), while 22.5% had low awareness and 17.5% had high awareness. A significant association was observed between education level and awareness (p < 0.05). Employment status also influenced awareness levels, with employed caregivers showing higher knowledge scores.Conclusion: Nutritional awareness is a key determinant of pediatric health. Strengthening educational programs targeting caregivers can improve child nutrition outcomes.
Unusual Complications of a Dental Prosthesis Esophageal Foreign Body: About a Case
Published on: 16th April, 2025
Foreign bodies of the esophagus are part of the traumatic emergencies in ENT. They are most often encountered in children, whereas in adults they occur in a particular context and are rarely overlooked.This was a 48-year-old patient from a neighboring country referred by a colleague for a history of neglected laryngeal contusion with infectious cervical fistula evolving for 2 years. Further questioning revealed a notion of accidental ingestion of dentures. The first endoscopy was of capital interest in especially in the diagnosis and management of this long-retained foreign body. The extraction under general anesthesia was done by a combined endoscopic and external approach. The postoperative course was marked by superinfection and swallowing disorders.Cervical suppurations secondary to esophageal foreign bodies are rare, especially in adults. Clinicians should consider this possibility in the face of any chronic cervical suppuration that resists treatment.
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