World journal of clinical pediatrics最新文献

{"title":"Association of <i>Helicobacter pylori</i> infection with insulin resistance, tumor necrosis factor-alpha, and dyslipidemia in obese children with metabolic syndrome.","authors":"Noura M Ibrahim Elbakry, Mohamed S Hemeda, Ayat Mostafa Mohamed Ahmed, Hager Adel Zaky, Aya Nabil Gamil, Abd Elmoaty Arafat Abd Elmoaty, Mahmoud M Khafagi, Ashraf Mohamed Alkabeer, Aldosoky Abd Elaziz Alsaid, Ahmed A Elhagary, Walid Mohammed Aboassy, Ahmed Nabil Gamil Mohammed","doi":"10.5409/wjcp.v15.i3.121926","DOIUrl":"10.5409/wjcp.v15.i3.121926","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Previous studies have suggested a link between &lt;i&gt;Helicobacter pylori&lt;/i&gt; (&lt;i&gt;H. pylori&lt;/i&gt;) and metabolic complications outside the gastrointestinal tract, but the relationship with pediatric obesity remains unclear. We aim to study the correlation between &lt;i&gt;H. pylori&lt;/i&gt; infection and components of insulin resistance (IR), inflammation [tumor necrosis factor-alpha (TNF-α)], and cardiometabolic parameters in obese children/adolescents with a metabolic syndrome (MetS) phenotype.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To elucidate the association between &lt;i&gt;H. pylori&lt;/i&gt; infection and metabolic disturbances in children with obesity and MetS, focusing on homeostasis model assessment of IR (HOMA-IR), inflammatory markers (TNF-α), and the lipid profile.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study recruited 70 obese children/adolescents with MetS phenotype from the pediatric units of Minia University Hospital from September 2023 to October 2024. &lt;i&gt;H. pylori&lt;/i&gt; stool antigen quantitative enzyme-linked immunosorbent assay was used to classify participants into &lt;i&gt;H. pylori&lt;/i&gt;-negative (&lt;i&gt;n&lt;/i&gt; = 35) and &lt;i&gt;H. pylori&lt;/i&gt;-positive (&lt;i&gt;n&lt;/i&gt; = 35). Assessment of fasting glucose, glycated hemoglobin (HbA1c), fasting insulin, lipid profile, liver enzymes, TNF-α, adiponectin, and leptin, as well as other parameters, was done. IR was calculated in detail using the HOMA-IR formula (fasting insulin × fasting glucose/405). Various statistical analyses, including intergroup comparisons, correlation analyses, and receiver operating characteristic curve analyses, were also performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Groups were similar in age, sex, and standardized body mass index (BMI) value. Elevated blood pressure (65.7% &lt;i&gt;vs&lt;/i&gt; 31.4%, &lt;i&gt;P&lt;/i&gt; = 0.004) and hepatomegaly (62.9% &lt;i&gt;vs&lt;/i&gt; 28.6%, &lt;i&gt;P&lt;/i&gt; = 0.004) were more common in &lt;i&gt;H. pylori&lt;/i&gt;-positive participants. The infected group had higher alanine aminotransferase and aspartate aminotransferase (AST) levels (both &lt;i&gt;P&lt;/i&gt; &lt; 0.001). It had higher triglycerides and low-density lipoprotein cholesterol and lower high-density lipoprotein cholesterol (HDL) levels, indicating a more unfavorable lipid profile (all &lt;i&gt;P&lt;/i&gt; &lt; 0.001) and more impaired glycemic/IR indices: Fasting glucose (158.5 ± 40.1 mg/dL &lt;i&gt;vs&lt;/i&gt; 109.5 ± 22.7 mg/dL, &lt;i&gt;P&lt;/i&gt; &lt; 0.001), HbA1c (8.5 ± 2.2 &lt;i&gt;vs&lt;/i&gt; 7.4 ± 1.7, &lt;i&gt;P&lt;/i&gt; = 0.019), fasting insulin (9.4 ± 3.6 μIU/mL &lt;i&gt;vs&lt;/i&gt; 3.9 ± 1.0 μIU/mL, &lt;i&gt;P&lt;/i&gt; &lt; 0.001), and HOMA-IR (3.61 ± 1.45 &lt;i&gt;vs&lt;/i&gt; 1.06 ± 0.36, &lt;i&gt;P&lt;/i&gt; &lt; 0.001). TNF-α was elevated in the infected group (median 7.13 &lt;i&gt;vs&lt;/i&gt; 6.23, &lt;i&gt;P&lt;/i&gt; = 0.011). In &lt;i&gt;H. pylori&lt;/i&gt;-positive participants, HOMA-IR had a strong positive correlation with standardized BMI value (&lt;i&gt;r&lt;/i&gt; = 0.889, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) and TNF-α (&lt;i&gt;r&lt;/i&gt; = 0.896, &lt;i&gt;P&lt;/i&gt; &lt; 0.001). HOMA-IR &gt; 1.67 had excellent sensitivity and specificity for detecting &lt;i&gt;H. pylori&lt;/i&gt; positivity [area under the curve (AUC): 0.954; sensitivity 88.6%,","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"121926"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric occipital lobe epilepsy: A modern review of etiological classification, management, and outcomes.","authors":"Preeti Srivastava, Deb Sanjay Nag, Shikha Swaroop, Sanjay Kumar Tanti, Shikhar Deep Jain, Rishi Anand, Gaurav Patel","doi":"10.5409/wjcp.v15.i3.119877","DOIUrl":"10.5409/wjcp.v15.i3.119877","url":null,"abstract":"<p><p>Pediatric occipital lobe epilepsy (OLE) comprises syndromes with seizures originating from the posterior cerebral cortex. Previously \"benign\", recent International League Against Epilepsy (ILAE) updates reclassified these as self-limited or structural focal epilepsies, reflecting their complex causes and morbidity potential. The 2017 ILAE guidelines shifted from syndromic recognition to an etiology-driven approach. High-resolution magnetic resonance imaging is crucial to differentiate self-limited genetic syndromes from structural OLE (<i>e.g.</i>, focal cortical dysplasia), as the latter often requires surgery. Self-limited epilepsy with autonomic seizures (formerly Panayiotopoulos syndrome) presents with prolonged nocturnal autonomic seizures. Childhood occipital visual epilepsy (previously Gastaut type) manifests as frequent, brief daytime visual hallucinations. Despite high seizure freedom rates with monotherapy, patients face neurocognitive challenges in visuospatial processing and academic performance. For drug-resistant structural cases, surgery offers high seizure freedom rates, though with risk of visual deficits. Accurate differentiation between idiopathic and structural OLE is essential for improving outcomes. The shift from \"benign\" to \"self-limited\" terminology emphasizes the need to monitor cognitive comorbidities and syndrome evolution. Early diagnosis is critical to avoid clinical mimics and enhance neurodevelopmental outcomes. This review examines the evolving landscape of pediatric OLE, highlighting the shift from syndromic to etiological classification and management strategies.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"119877"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a structured protocol for the prevention of acute respiratory tract infections in daycare centers: A quasi-experimental study.","authors":"Klaita Srisingh, Nittaya Sribuarom, Chanikan Suasing, Sagoontee Inkate","doi":"10.5409/wjcp.121288","DOIUrl":"10.5409/wjcp.121288","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory tract infections (ARTIs) are a major cause of pediatric morbidity. Daycare centers (DCCs) are high-risk environments where close interpersonal contact facilitates rapid viral transmission. Effective and practical preventive strategies are therefore essential to reduce infection-related burden in these settings.</p><p><strong>Aim: </strong>To determine the incidence of ARTIs in DCCs following implementation of a structured protocol designed to mitigate respiratory virus transmission.</p><p><strong>Methods: </strong>A cluster study was conducted in which two centers were centers to either intervention or control groups <i>via</i> lottery. Although allocation was randomized, the study was not designed as a randomized controlled trial; therefore, potential bias and confounding were considered. Participants were followed for 25 weeks. The primary outcome was physician-diagnosed ARTIs per 100 child-weeks. Incidence rate ratios (IRRs) with 95%CIs were estimated using Poisson regression with a log link and person-time offset, adjusting for covariates under the intention-to-treat principle. Results cautious interpretation Due to limited clusters, results require cautious interpretation. Statistical significance was defined as <i>P</i> < 0.05.</p><p><strong>Results: </strong>A total of 223 children (149 intervention, 74 control) across 2 clusters were enrolled. By week 25, the cumulative proportion of ARTIs was 18.1% in the intervention group compared with 60.8% in the control group. The incidence rate of ARTIs was lower in the intervention group, with adjusted rates of 1.09 per 100 child-weeks <i>vs</i> 13.00 per 100 child-weeks. The adjusted IRR was 0.14 (95%CI: 0.09-0.22; <i>P</i> < 0.001), suggesting an observed difference in incidence between groups under the study conditions.</p><p><strong>Conclusion: </strong>Protocol implementation was associated with a lower observed incidence of ARTIs under the study conditions. However, interpretation is constrained by the study design, the small number of clusters, and potential sources of bias. Larger, well-designed randomized studies are required to further evaluate this association in daycare settings.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"121288"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent acute liver failure in infancy - a novel <i>SCYL1</i> mutation: A case report.","authors":"Doaa Zourob, Amal Al Teneiji, Mohammad Miqdady, Eman Al Atrash","doi":"10.5409/wjcp.120925","DOIUrl":"10.5409/wjcp.120925","url":null,"abstract":"<p><strong>Background: </strong>Recurrent acute liver failure (ALF) in children is rare and diagnostically challenging. Despite rigorous investigations, a significant proportion of patients remain without a definitive diagnosis. Recently across the literature, biallelic pathogenic variants in the <i>SCYL1</i> gene had been identified to cause a hepatocerebellar syndrome characterized by low gamma-glutamyl transferase (GGT) cholestasis, episodic ALF, and progressive neurodegeneration, collectively termed cholestasis, ALF, and neurodegeneration (CALFAN) syndrome (or spinocerebellar ataxia, autosomal recessive type 21). A high index of suspicion is paramount to recognizing this entity early, given that its presentation overlaps with more prevalent conditions, and delayed diagnosis carries significant morbidity and mortality risk.</p><p><strong>Case summary: </strong>We report a 19-month-old girl of Middle Eastern ethnicity, presenting with recurrent episodes of febrile illness, ALF, and low-GGT cholestasis initially misattributed to viral hepatitis. Clinical evaluation revealed subtle neurological abnormalities, including tremors and fine motor delay. The highlight of her presentation was pancytopenia, which expanded the known phenotypic spectrum. Extensive metabolic, infectious, and autoimmune investigations were inconclusive. Whole exome sequencing identified a homozygous likely pathogenic <i>SCYL1</i> variant (c.1420C>T; p.Arg474*), consistent with CALFAN syndrome/spinocerebellar ataxia, autosomal recessive type 21. Liver biopsy showed degenerative and early fibrotic changes. Liver function partially improved with corticosteroids and supportive care but did not normalize; a third episode of liver failure occurred at 22 months in the setting of a febrile urinary tract infection.</p><p><strong>Conclusion: </strong><i>SCYL1</i>-related disease should be considered in children with unexplained recurrent ALF, particularly when low-GGT cholestasis and neurological features co-exist. Early genetic evaluation using whole exome sequencing is essential for establishing the diagnosis. Steroid therapy was transiently associated with partial biochemical improvement, although its mechanism in a genetic disorder remains uncertain. This case further demonstrates that pancytopenia may be part of the CALFAN phenotypic spectrum.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"120925"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bovine colostrum for prevention of recurrent urinary tract infections in susceptible children: A randomized controlled trial.","authors":"Ragia M Said, Abanoub A Wissa, Sara T Wahib, Noha U Hashem","doi":"10.5409/wjcp.118300","DOIUrl":"10.5409/wjcp.118300","url":null,"abstract":"<p><strong>Background: </strong>Recurrent urinary tract infections (UTIs) in children with congenital anomalies of the kidney and urinary tract (CAKUT) are a major cause of deterioration of kidney functions and possibly, renal scarring. Rising antimicrobial resistance necessitates alternative preventive strategies. Bovine colostrum (BC), a bioactive prebiotic, has emerged as a promising adjuvant therapy in upper respiratory and gastrointestinal (GIT) infections. Given the shared mucosal immune mechanisms, the urinary tract may represent a suitable target for this preventive strategy to reduce UTI recurrence.</p><p><strong>Aim: </strong>To evaluate the potential role of oral BC as an adjuvant therapy for preventing recurrent UTIs in children with CAKUT.</p><p><strong>Methods: </strong>This randomized, double-blinded, placebo-controlled trial enrolled 60 children (< 18 years) with CAKUT and culture-confirmed recurrent UTIs. Children with urinary stones or endo-urinary devices were excluded. Participants were randomized to receive either oral BC sachets (<i>n</i> = 30) or placebo (<i>n</i> = 30) daily for one month. All patients were followed monthly for six months for UTI symptoms, physical examination, urine analysis, urine culture and sensitivity, complete blood count and C-reactive protein when indicated.</p><p><strong>Results: </strong>The two study groups were comparable in age, sex, and chronic kidney disease stage (<i>P</i> > 0.05). Colostrum supplementation showed a nonsignificant reduction in the overall incidence of upper and lower UTIs <i>vs</i> placebo over six months [relative risk (RR) = 0.84, 95%CI: 0.63-1.12; <i>P</i> = 0.22]. However, significant reductions of 73%-75% in UTI incidence were observed during the fourth, fifth, and sixth months of follow up (<i>P</i> < 0.05 for each). When stratified by infection type, cystitis incidence was significantly lower in the colostrum group (43.3% <i>vs</i> 70.0%; RR = 0.62; 95%CI: 0.39-0.99; <i>P</i> = 0.037), while no significant difference was observed in pyelonephritis. GTI and respiratory infections were reduced by 34% (RR = 0.66; 95%CI: 0.50-0.87; <i>P</i> = 0.001). No allergic reactions were reported.</p><p><strong>Conclusion: </strong>BC supplementation may reduce cystitis, as well as respiratory and GIT infections, in children with CAKUT. The observed month-specific reduction in UTIs suggests a possible cumulative benefit with continued supplementation, warranting further research.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"118300"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic predisposition of Asparaginase-induced hypertriglyceridemia in children with acute lymphoblastic leukemia: Two case reports and review of literature.","authors":"Maria Krivosheina, Victoria Bakaleiko, Yulia Toshina, George Baratashvili, Polina Sokolnikova, Olga V Kalinina, Asiiat Alieva, Yulia Dinikina, Anna A Kostareva","doi":"10.5409/wjcp.120927","DOIUrl":"10.5409/wjcp.120927","url":null,"abstract":"<p><strong>Background: </strong>Asparaginase (ASP) is an essential antitumor agent of acute lymphoblastic leukemia (ALL) in children. Hypertriglyceridemia (HTG) represents one of several ASP-associated toxicities, alongside with hypersensitivity reactions, pancreatitis, liver dysfunction, and thrombotic events. HTG may necessitate immediate therapy modification and can lead to life-threatening complications that contraindicate further anticancer treatment. However, the clinical and genetic mechanisms underlying this condition remain poorly understood.</p><p><strong>Case summary: </strong>We report two rare cases of severe HTG in pediatric patients with B-ALL following treatment with pegylated ASP (PEG-ASP). To investigate the genetic basis of this susceptibility, we performed genetic testing using a targeted gene panel for hyperlipidemia and identified several potential disease-related variants associated with inherited dyslipidemia. Although the functional and causal roles of these variants require further validation, we hypothesize that they contributed substantially to the development of HTG in these patients.</p><p><strong>Conclusion: </strong>Genetic factors may predispose to HTG during PEG-ASP therapy; with further evidence, genetic testing might be considered before ASP treatment.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"120927"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nigerian youth FitnessGram edge: A bright signal with important caveats.","authors":"Vijaya Lakshmi Bodiga, Praveen Kumar Vemuri, Sreedhar Bodiga","doi":"10.5409/wjcp.119985","DOIUrl":"10.5409/wjcp.119985","url":null,"abstract":"<p><p>In this editorial we comment on the article by Musa <i>et al</i> published in the recent issue of the <i>World Journal of Clinical Pediatrics</i>. Childhood obesity and low cardiorespiratory fitness are escalating drivers of pediatric cardiometabolic risk worldwide, yet data from low- and middle-income countries remain scarce. A recent FitnessGram-based assessment of 3225 Nigerian youth aged 9-16 years from Benue State revealed that 82.7% of males and 78.7% of females achieved the healthy fitness zone (HFZ) for aerobic capacity (AZ), while 94.5% and 96.9% respectively met HFZ body mass index (BMI) criteria. These rates markedly exceed typical AZ achievement in United States and European cohorts, where HFZ attainment often hovers around 55%-80% and BMI failure can surpass 70%. The Nigerian findings point to protective lifestyle patterns rooted in habitual, unstructured physical activity, yet age- and sex-specific gaps-particularly among older males and adolescent females-signal emerging vulnerabilities. This editorial situates these results within global fitness disparities, questions the universal application of largely United States-derived FitnessGram standards, and underscores the need for ancestry-sensitive benchmarks. It further highlights opportunities for Nigeria to establish national fitness surveillance and school-based interventions that preserve early advantages as urbanization, sedentary behavior, and nutritional transitions intensify.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"119985"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interface between inborn errors of immunity and rheumatological disorders in children: A pediatrician's conundrum.","authors":"Abarna Thangaraj, Ridhima Aggarwal, Soumyadeep Sarkar, Rakesh Kumar Pilania","doi":"10.5409/wjcp.118174","DOIUrl":"10.5409/wjcp.118174","url":null,"abstract":"<p><p>Rheumatological disorders encompass a broad and complex spectrum of conditions, often driven by dysregulated immune responses and autoantibody formation. Increasing evidence highlights the significant overlap between rheumatological diseases and inborn errors of immunity (IEIs). The 2024 update of the International Union of Immunological Societies phenotypic classification describes 559 IEI, including 67 novel monogenic defects and 2 new phenocopies. This review examines the clinical spectrum of rheumatological manifestations associated with IEIs, encompassing arthritis, cytopenias, vasculitis, macrophage activation syndrome, systemic lupus erythematosus, inflammatory bowel disease phenotypes, polyautoimmunity, and autoimmune lung disease. Several soft clinical \"red flags\" can alert physicians to an IEI in a child with rheumatological disease, including very early age of onset, atypical or severe disease course, recurrent or unusual infections, lymphoproliferation, multi-organ autoimmunity, and poor or refractory response to standard therapies. Understanding the mechanisms of immune dysregulation in IEIs provides critical insight into their clinical expression. Defects in central and peripheral tolerance checkpoints, impaired T- and B-cell regulation, abnormal cytokine signaling, and skewed interferon responses contribute to the loss of self-tolerance and autoimmunity. Pediatric rheumatologists and pediatricians should remain highly vigilant for IEI when evaluating children who present with atypical, severe, or treatment-resistant rheumatologic conditions. While these disorders may mimic polygenic autoimmunity, their aggressive nature, multi-system involvement, and association with infections often distinguish them. Early genetic diagnosis not only clarifies prognosis but also enables precision-based therapies, significantly improving outcomes.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"118174"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of preterm admission, morbidity, and mortality in a tribal-district neonatal intensive care unit: A retrospective cohort study.","authors":"Pushparaj Nilkanth Patil, Zubair Khan, Mitalikumari Patel, Darshankumar K Mahyavanshi","doi":"10.5409/wjcp.118603","DOIUrl":"10.5409/wjcp.118603","url":null,"abstract":"<p><strong>Background: </strong>Preterm birth remains the leading cause of neonatal morbidity and mortality worldwide. Data from tribal-district neonatal intensive care units (NICUs) in India are scarce, despite these populations bearing a disproportionate burden of adverse perinatal outcomes.</p><p><strong>Aim: </strong>To evaluate morbidity patterns and identify predictors of mortality among preterm neonates in a tribal-district NICU.</p><p><strong>Methods: </strong>The present retrospective cohort study included total 1438 preterm neonates admitted between January 2022 and December 2024 to the tribal-district NICU. Clinical data were extracted from medical records. Mortality was analyzed by gestational age. Multivariable logistic regression, with multiple imputation for missing data, was used to identify independent predictors of in-hospital mortality.</p><p><strong>Results: </strong>Mortality demonstrated a steep inverse gradient with gestational age, decreasing from 49% among extremely preterm neonates to 4.6% among late preterm infants. The most common morbidities were respiratory distress syndrome (42%-55%) and neonatal sepsis (32%-45%). Early continuous positive airway pressure (CPAP) initiation (< 1 hour) was associated with reduced need for mechanical ventilation (<i>P</i> < 0.001). In multivariable analysis, increasing gestational age [adjusted odd ratios (AOR): 0.82 per week; 95%CI: 0.75-0.89], higher birth weight (AOR: 0.93 per 100 g; 95%CI: 0.89-0.97), culture-positive sepsis (AOR: 3.41; 95%CI: 1.98-5.89), delayed CPAP initiation (AOR: 1.94; 95%CI: 1.15-3.28), and outborn status (AOR: 1.67; 95%CI: 1.01-2.74) were independently associated with mortality. Discharge against medical advice rates remained high (9%-11%).</p><p><strong>Conclusion: </strong>Lower gestational age, lower birth weight, infection, and delayed respiratory stabilization are associated with mortality. Strengthening early neonatal care may improve survival in tribal settings.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"118603"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbial and functional shifts between flare and remission in a single-center cohort of children with inflammatory bowel disease.","authors":"James Guoxian Huang, Carina Jing-Xuan Tay, Marion Margaret Aw, Yung-Seng Lee, Delicia Shu-Qin Ooi","doi":"10.5409/wjcp.120066","DOIUrl":"10.5409/wjcp.120066","url":null,"abstract":"<p><strong>Background: </strong>Gut microbial dysbiosis is central to the pathogenesis of inflammatory bowel disease (IBD). While gut microbiome differences between patients with and without IBD are well established, microbiome changes associated with disease activity and remission remain limited, particularly in paediatric populations.</p><p><strong>Aim: </strong>To examine intra-individual taxonomic and functional gut microbiome changes during transition from active flare to remission under maintenance immunosuppression in a pilot single-center Singapore cohort of children with IBD.</p><p><strong>Methods: </strong>Paired stool samples and clinical data were collected from seven patients with paediatric IBD [5 Crohn's disease (CD), 2 ulcerative colitis; ≤ 18 years] during active disease/flare (visit 1; Pediatric CD Activity Index/Pediatric Ulcerative Colitis Activity Index ≥ 10) and subsequent clinical remission (visit 2; Pediatric CD Activity Index/Pediatric Ulcerative Colitis Activity Index < 10). Samples underwent shotgun metagenomic sequencing for high-resolution taxonomic profiling and functional annotation of Kyoto Encyclopaedia of Genes and Genomes pathways.</p><p><strong>Results: </strong>Gut microbial diversity was reduced during flare compared to remission, with Actinobacteria abundance significantly higher in remission. Two distinct microbial clusters differentiated flare and remission states: The remission cluster was enriched with <i>Bifidobacterium adolescentis</i>, <i>Bifidobacterium dentium</i>, <i>Lactobacillus gasseri</i>, <i>Faecalibacterium prausnitzii</i>, while the flare state showed increased <i>Klebsiella pneumoniae</i>. Remission was further characterized by a downregulation of pathogenic microbes and an upregulation of beneficial microbes including a higher abundance of the butyrate producer <i>Anaerostipes hadrus</i> (<i>P</i> = 0.046). Microbial functional genes enriched in remission were predominantly associated with metabolic pathways including vitamin and cofactor biosynthesis, as well as carbohydrate, amino acid, and lipid metabolism.</p><p><strong>Conclusion: </strong>The transition from flare to remission in Singaporean children with IBD is characterized by functional remodeling of the gut microbiome, which may contribute to recovery processes related to intestinal barrier integrity, cellular maintenance, and tissue repair. Targeted modulation of the gut microbiome may help sustain remission in paediatric IBD.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 3","pages":"120066"},"PeriodicalIF":0.0,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}