In the field of pediatric nursing, in the perinatal period, numerous ethical issues arise alongside the advancement of medical technology. However, sufficient education on bioethics is not provided in the pediatric nu...In the field of pediatric nursing, in the perinatal period, numerous ethical issues arise alongside the advancement of medical technology. However, sufficient education on bioethics is not provided in the pediatric nursing domain of basic nursing education. The purpose of this research is to examine the current status of bioethics education in the pediatric nursing domain of basic nursing education and explore the challenges perceived by the pediatric nursing faculty regarding bioethics education. The research method was a questionnaire survey on 100 randomly selected pediatric nursing faculty members from nursing universities across Japan. The results revealed that although bioethics issues were considered important, the emphasis remained primarily on addressing bioethics as part of nursing that respects children’s rights. Furthermore, respondents expressed difficulties regarding teaching methods and content related to bioethics.展开更多
There are few pharmacologic options for the treatment of cognitive deficits associated with traumatic brain injury in pediatric patients.Acetylcholinesterase inhibitors such as donepezil have been evaluated in adult p...There are few pharmacologic options for the treatment of cognitive deficits associated with traumatic brain injury in pediatric patients.Acetylcholinesterase inhibitors such as donepezil have been evaluated in adult patients after traumatic brain injury,but relatively less is known about the effect in pediatric populations.The goal of this review is to identify knowledge gaps in the efficacy and safety of acetylcholinesterase inhibito rs as a potential a djuvant treatment fo r neurocognitive decline in pediatric patients with traumatic brain injury.Investigators queried PubMed to identify literature published from database inception thro ugh June 2023 desc ribing the use of donepezil in young adult traumatic brain injury and pediatric patients with predefined conditions.Based on preselected search criteria,340 unique papers we re selected for title and abstra ct screening.Thirty-two reco rds were reviewed in full after eliminating preclinical studies and pape rs outside the scope of the project.In adult traumatic brain injury,we review results from 14 papers detailing 227 subjects where evidence suggests donepezil is well tole rated and shows both objective and patient-reported efficacy for reducing cognitive impairment.In children,3 pape rs report on 5 children recovering from traumatic brain injury,showing limited efficacy.An additional 15 pediatric studies conducted in populations at risk for cognitive dysfunction provide a broader look at safety and efficacy in 210 patients in the pediatric age group.Given its promise for efficacy in adults with traumatic brain injury and tole rability in pediatric patients,we believe further study of donepezil for children and adolescents with traumatic brain injury is warranted.展开更多
Rationale:Rabies is a zoonotic disease with a high mortality,primarily transmitted through the bite of infected mammals,particularly dogs and cats.Despite being a well-known disease since ancient times,it continues to...Rationale:Rabies is a zoonotic disease with a high mortality,primarily transmitted through the bite of infected mammals,particularly dogs and cats.Despite being a well-known disease since ancient times,it continues to cause a significant number of human deaths worldwide,with approximately 65000 fatalities reported annually.Patient concerns:We present two fatal cases of rabies in a 12-year-old immigrant boy and a 7-year-old boy.The first case was subject to a 24-hour delay in receiving appropriate medical attention and rabies preventive measures due to the lack of awareness among emergency hospital staff,leading to the administration of wound dressing only.The second case received timely rabies immunoglobulin administration;however,there was a 4-day delay in administering the fourth dose of the rabies vaccine,despite presenting evident symptoms of rabies.Diagnosis:Postmortem examination of brain samples from both patients confirmed the presence of rabies virus.Interventions:Post-exposure prophylaxis for rabies.Outcomes:Both patients were admitted to the hospital after the manifestation of rabies-related symptoms,with the 12-year-old child seeking medical care 47 days after the animal bite and the 7-year-old child seeking medical care 58 days after the exposure.Finally,the first patient died after 27 days and the second patient died after 40 days of hospitalization.Lessons:There is an urgent need for heightened awareness and education among both healthcare professionals and the public regarding the urgency of seeking immediate medical attention after potential rabies exposure.Timely recognition and initiation of post-exposure prophylaxis are pivotal in preventing the progression of the disease.Strengthening surveillance and reporting systems,coupled with continuous training for healthcare professionals,can contribute to early detection and management of rabies cases.展开更多
Crohn’s disease(CD)is a chronic inflammatory disease of the digestive tract.The incidence of pediatric CD is increasing and is currently 2.5-11.4 per 100000 world-wide.Notably,approximately 25%of children with CD dev...Crohn’s disease(CD)is a chronic inflammatory disease of the digestive tract.The incidence of pediatric CD is increasing and is currently 2.5-11.4 per 100000 world-wide.Notably,approximately 25%of children with CD develop stricturing CD(SCD)that requires intervention.Symptomatic stricturing diseases refractory to pharmacological management frequently require non-pharmacological interventions.Non-pharmacological therapeutic strategies include endoscopic balloon dilatation,stricturoplasty,and surgical resection of the strictured seg-ment.However,strictures tend to recur postoperatively regardless of treatment modality.The lifetime risk of surgery in patients with childhood SCD remains at 50%-90%.Thus,new and emerging strategies,advanced diagnostic tools,and minimally invasive approaches are under investigation to improve the outcomes and overall quality of life of pediatric patients with SCD.展开更多
With the implementation of China’s innovation-driven development strategy,the competition among sci-tech talents has become increasingly fierce.Stimulating the innovative vigor of sci-tech talents has become a hot to...With the implementation of China’s innovation-driven development strategy,the competition among sci-tech talents has become increasingly fierce.Stimulating the innovative vigor of sci-tech talents has become a hot topic in theoretical research and policy practice.Based on the data from 246 questionnaires collected from sci-tech talents in Hebei province,this study explored the influence mechanism of an inclusive organizational climate on innovation input from technological talents and verified the mediating effects of innovation self-efficacy and intrinsic motivation.The results indicate that an inclusive organizational climate has a significant positive impact on innovation input,innovation self-efficacy,and intrinsic motivation of sci-tech talents.Both innovation self-efficacy and intrinsic motivation play a partial mediating role between an inclusive climate and innovation input.This study verified the important role of an inclusive climate in an organization’s human resource management practices and encouraged managers to emphasize enhancing the innovation self-efficacy and intrinsic motivation of sci-tech talents,thereby continuously improving the level of innovation.展开更多
Introduction: Cystic lymphangiomas are rare benign malformative tumors of the lymphatic system of obscure etiopathogenesis. The cervico-facial location remains the most common (75%). Although benign, these tumors rema...Introduction: Cystic lymphangiomas are rare benign malformative tumors of the lymphatic system of obscure etiopathogenesis. The cervico-facial location remains the most common (75%). Although benign, these tumors remain potentially fatal, due to possible compression of the upper aero-digestive tract. The aim of this work is to study the epidemiological, diagnostic and therapeutic characteristics of cervico-mandibular congenital cystic lymphangiomas in the pediatric surgery department of the Donka National Hospital (HND) Conakry. Patients and methods: This is a retrospective and descriptive study of 13 files lasting 7 years from January 2015 to December 31, 2021. The files of children whose age is less than or equal to 15 years operated on cervical tumor with histological evidence of cystic lymphangioma were retained. The data were analyzed using SPSS statistical software 21 and anonymously. Results: The incidence of this study was 1.86 cases per year and a sex ratio of 0.62 in favor of girls. The average age was 8 months 19 days. In the antecedents, we only find poorly monitored pregnancies. The average size of the tumors was 11.85 cm. Cervical ultrasound and standard x-ray of the cervical mass were the only examinations performed. Total surgical excision of the cervical tumor was performed in all patients. The mass was polycystic on exploration. The histological examination of the surgical specimens was in favor of a cystic lymphangioma. The surgical consequences were simple in 11 patients (84.62%) and complicated by parietal suppuration in 2 cases (15.38%). There were no cases of recurrence after one year of follow-up. Conclusion: Cervico-mandibular cystic lymphangiomas are the most frequent locations of congenital lymphangiomas in children. Their severity is linked to the risk of compression of the aero-digestive tracts. Their diagnosis must be confirmed by the histology of the surgical specimen. Despite the therapeutic arsenal, excision of the cystic mass remains the only effective alternative in our socio-economic conditions to avoid recurrences and loss of follow-up of patients.展开更多
BACKGROUND Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types:Supracondylar(SC),lateral condyle(LC),and medial epicondyle(ME)fractu...BACKGROUND Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types:Supracondylar(SC),lateral condyle(LC),and medial epicondyle(ME)fractures.AIM To evaluate the epidemiology of pediatric distal humerus fractures(SC,LC,and ME)from an American insurance claims database.METHODS A retrospective review was performed on patients 17 years and younger with the ICD 9 and 10 codes for SC,LC and ME fractures based on the IBM Truven MarketScan®Commercial and IBM Truven MarketScan Medicare Supplemental databases.Patients from 2015 to 2020 were queried for treatments,patient age,sex,length of hospitalization,and comorbidities.RESULTS A total of 1133 SC,154 LC,and 124 ME fractures were identified.SC fractures had the highest percentage of operation at 83%,followed by LC(78%)and ME fractures(41%).Male patients were,on average,older than female patients for both SC and ME fractures.CONCLUSION In the insurance claims databases used,SC fractures were the most reported,followed by LC fractures,and finally ME fractures.Age was identified to be a factor for how a pediatric distal humerus fractures,with patients with SC and LC fractures being younger than those with ME fractures.The peak age per injury per sex was similar to reported historic central tendencies,despite reported trends for younger physiologic development.展开更多
Pediatric inflammatory bowel disease(IBD)is a chronic inflammatory disorder,with increasing incidence and prevalence worldwide.There have been recent advances in imaging and endoscopic technology for disease diagnosis...Pediatric inflammatory bowel disease(IBD)is a chronic inflammatory disorder,with increasing incidence and prevalence worldwide.There have been recent advances in imaging and endoscopic technology for disease diagnosis,treatment,and monitoring.Intestinal ultrasound,including transabdominal,transperineal,and endoscopic,has been emerging for the assessment of transmural bowel inflammation and disease complications(e.g.,fistula,abscess).Aside from surgery,IBD-related intestinal strictures now have endoscopic treatment options including through-the-scope balloon dilatation,injection,and needle knife stricturotomy and new evaluation tools such as endoscopic functional lumen imaging probe.Unsedated transnasal endoscopy may have a role in patients with upper gastrointestinal Crohn’s disease or those with IBD with new upper gastrointestinal symptoms.Improvements to dysplasia screening in pediatric patients with longstanding colonic disease or primary sclerosing cholangitis hold promise with the addition of virtual chromoendoscopy and ongoing research in the field of artificial intelligence-assisted endoscopic detection.Artificial intelligence and machine learning is a rapidly evolving field,with goals of further personalizing IBD diagnosis and treatment selection as well as prognostication.This review summarized these advancements,focusing on pediatric patients with IBD.展开更多
BACKGROUND Screening for iron deficiency anemia(IDA)is important in managing pediatric patients with inflammatory bowel disease(IBD).Concerns related to adverse reactions may contribute to a reluctance to prescribe in...BACKGROUND Screening for iron deficiency anemia(IDA)is important in managing pediatric patients with inflammatory bowel disease(IBD).Concerns related to adverse reactions may contribute to a reluctance to prescribe intravenous(IV)iron to treat IDA in this population.AIM To track the efficacy and safety of IV iron therapy in treating IDA in pediatric IBD patients admitted to our center.METHODS A longitudinal observational cohort study was performed on 236 consecutive pediatric patients admitted to our tertiary IBD care center between September 2017 and December 2019.92 patients met study criteria for IDA,of which 57 received IV iron,17 received oral iron,and 18 were discharged prior to receiving iron therapy.RESULTS Patients treated with IV iron during their hospitalization experienced a significant increase of 1.9(±0.2)g/dL in mean(±SE)hemoglobin(Hb)concentration by the first ambulatory follow-up,compared to patients who received oral iron 0.8(±0.3)g/dL or no iron 0.8(±0.3)g/dL(P=0.03).One out of 57(1.8%)patients that received IV iron therapy experienced an adverse reaction.CONCLUSION Our findings demonstrate that treatment with IV iron therapy is safe and efficacious in improving Hb and iron levels in pediatric patients with IDA and active IBD.展开更多
Pneumonia ranks as a leading cause of mortality, particularly in children aged five and under. Detecting this disease typically requires radiologists to examine chest X-rays and report their findings to physicians, a ...Pneumonia ranks as a leading cause of mortality, particularly in children aged five and under. Detecting this disease typically requires radiologists to examine chest X-rays and report their findings to physicians, a task susceptible to human error. The application of Deep Transfer Learning (DTL) for the identification of pneumonia through chest X-rays is hindered by a shortage of available images, which has led to less than optimal DTL performance and issues with overfitting. Overfitting is characterized by a model’s learning that is too closely fitted to the training data, reducing its effectiveness on unseen data. The problem of overfitting is especially prevalent in medical image processing due to the high costs and extensive time required for image annotation, as well as the challenge of collecting substantial datasets that also respect patient privacy concerning infectious diseases such as pneumonia. To mitigate these challenges, this paper introduces the use of conditional generative adversarial networks (CGAN) to enrich the pneumonia dataset with 2690 synthesized X-ray images of the minority class, aiming to even out the dataset distribution for improved diagnostic performance. Subsequently, we applied four modified lightweight deep transfer learning models such as Xception, MobileNetV2, MobileNet, and EfficientNetB0. These models have been fine-tuned and evaluated, demonstrating remarkable detection accuracies of 99.26%, 98.23%, 97.06%, and 94.55%, respectively, across fifty epochs. The experimental results validate that the models we have proposed achieve high detection accuracy rates, with the best model reaching up to 99.26% effectiveness, outperforming other models in the diagnosis of pneumonia from X-ray images.展开更多
Objective:To observe and explore the value of the combined application of red blood cell distribution width(RDW),platelet distribution width(PDW),and immunoglobulin E(IgE)in the process of clinical diagnosis of childr...Objective:To observe and explore the value of the combined application of red blood cell distribution width(RDW),platelet distribution width(PDW),and immunoglobulin E(IgE)in the process of clinical diagnosis of children with asthma.Methods:Fifty-five children with suspected asthma were admitted to the hospital from July 2021 to July 2023.They underwent a bronchodilator test upon admission and their RDW,PDW,and IgE were detected.The efficacy of diagnosis with a single indicator(RDW/PDW/IgE)and combined parameters(PDW+PDW+IgE)were compared with the results of the bronchodilator test.Results:49 cases of pediatric asthma were diagnosed by the bronchodilator test.RDW and PDW of asthmatic children were lower than those of non-asthmatic children,while the IgE of asthmatic children was higher than that of non-asthmatic children,and there was a significant difference in the RDW,PDW,and IgE among children with different degrees of asthma severity(P<0.05).The positive rate of the three combined diagnostic tests of RDW,PDW,and IgE was significantly higher than the positive rate of a single-parameter diagnosis(P<0.05).Conclusion:The combination of RDW,PDW,and IgE plays a crucial role in the clinical diagnosis of asthmatic children.These tests further improve the efficiency of clinical diagnosis and help identify the severity of the disease.展开更多
Objective:To analyze the effectiveness of modified non-traumatic filling technology in the treatment of pediatric dental caries.Methods:Ninety-seven children with dental caries who were treated in our hospital(Panyu M...Objective:To analyze the effectiveness of modified non-traumatic filling technology in the treatment of pediatric dental caries.Methods:Ninety-seven children with dental caries who were treated in our hospital(Panyu Maternal and Child Care Service Center of Guangzhou)from January 2022 to December 2023 were selected and randomly divided into two groups,with 48 cases in the experimental group and 49 in the control group.The experimental group was treated with modified non-traumatic filling techniques,while the control group was treated with conventional filling techniques.Observation indicators such as the total effectiveness of the treatment,incidence of adverse events,treatment compliance,and pain scores were analyzed after the intervention.Result:After intervention,the total effectiveness of the treatment in the experimental group was higher than that in the control group(P<0.05).The incidence of adverse events in the experimental group was lower than that of the control group(P<0.05).The treatment compliance of patients in the experimental group was higher than that in the control group(P<0.05).The pain score of the experimental group was lower than that of the control group(P<0.05).Conclusion:The application of modified non-traumatic filling technology in the treatment of pediatric dental caries showed good therapeutic outcomes.After the intervention,the child’s symptoms were significantly alleviated,the incidence of adverse events such as filling material falling off was reduced,their compliance was improved,and the pain was relieved.This procedure is worth to be promoted for clinical application.展开更多
BACKGROUND: Despite the rapid development of pediatric intensive care medicine, there are still limited data in the literature regarding the follow-up of pediatric trauma patients in pediatric intensive care units(PIC...BACKGROUND: Despite the rapid development of pediatric intensive care medicine, there are still limited data in the literature regarding the follow-up of pediatric trauma patients in pediatric intensive care units(PICUs). In this study, we aim to evaluate our experience with children admitted and followed up with the diagnosis of trauma at our PICU.METHODS: We evaluated the retrospective data of 77 pediatric trauma patients who were admitted to the PICU at Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital from August 2020 to December 2022. The demographic data, clinical parameters and laboratory results were recorded. The primary outcome was the mortality in PICU. The performances of markers in predicting mortality were evaluated with receiver operating characteristic(ROC) curves.RESULTS: The median age of the patients was 70(33–157) months, and the median duration of hospitalization in the PICU was 6(2–11) d. Of the 77 patients, 9 died due to trauma(11,1%). Among the clinical parameters, Pediatric Risk of Mortality III(PRISM III) Score, inotrope requirement, extracorporeal treatment requirement, and mechanical ventilator requirement were significantly higher in non-survivors than in survivors. Among the laboratory parameters, procalcitonin(PCT), lactate/albumin ratio(LAR), neutrophil/lymphocyte ratio(NLR), and transfusion requirement were significantly higher in non-survivors than in survivors.CONCLUSION: In pediatric trauma patients, baseline PCT, LAR, and NLR values can be used to identify patients at risk for mortality.展开更多
BACKGROUND:To promote the shared decision-making(SDM)between patients and doctors in pediatric outpatient departments,this study was designed to validate artificial intelligence(AI)-initiated medical tests for childre...BACKGROUND:To promote the shared decision-making(SDM)between patients and doctors in pediatric outpatient departments,this study was designed to validate artificial intelligence(AI)-initiated medical tests for children with fever.METHODS:We designed an AI model,named Xiaoyi,to suggest necessary tests for a febrile child before visiting a pediatric outpatient clinic.We calculated the sensitivity,specificity,and F1 score to evaluate the efficacy of Xiaoyi’s recommendations.The patients were divided into the rejection and acceptance groups.Then we analyzed the rejected examination items in order to obtain the corresponding reasons.RESULTS:We recruited a total of 11,867 children with fever who had used Xiaoyi in outpatient clinics.The recommended examinations given by Xiaoyi for 10,636(89.6%)patients were qualified.The average F1 score reached 0.94.A total of 58.4%of the patients accepted Xiaoyi’s suggestions(acceptance group),and 41.6%refused(rejection group).Imaging examinations were rejected by most patients(46.7%).The tests being time-consuming were rejected by 2,133 patients(43.2%),including rejecting pathogen studies in 1,347 patients(68.5%)and image studies in 732 patients(31.8%).The difficulty of sampling was the main reason for rejecting routine tests(41.9%).CONCLUSION:Our model has high accuracy and acceptability in recommending medical tests to febrile pediatric patients,and is worth promoting in facilitating SDM.展开更多
BACKGROUND Children with acute liver failure(ALF)who meet the criteria are eligible for super-urgent transplantation,whereas children with end-stage chronic liver disease(ESCLD)are usually transplanted electively.Pedi...BACKGROUND Children with acute liver failure(ALF)who meet the criteria are eligible for super-urgent transplantation,whereas children with end-stage chronic liver disease(ESCLD)are usually transplanted electively.Pediatric liver transplantation(PLT)in ALF and ESCLD settings has been well described in the literature,but there are no studies comparing the outcomes in these two groups.AIM To determine if there is a difference in post-operative complications and survival outcomes between ALF and ESCLD in PLT.METHODS This was a retrospective observational study of all primary PLTs performed at a single center between 2000 and 2019.ALF and ESCLD groups were compared for pretransplant recipient,donor and operative parameters,and post-operative outcomes including graft and patient survival.RESULTS Over a 20-year study period,232 primary PLTs were performed at our center;195 were transplanted for ESCLD and 37 were transplanted for ALF.The ALF recipients were significantly older(median 8 years vs 5.4 years;P=0.031)and heavier(31 kg vs 21 kg;P=0.011).Living donor grafts were used more in the ESCLD group(34 vs 0;P=0.006).There was no difference between the two groups concerning vascular complications and rejection,but there were more bile leaks in the ESCLD group.Post-transplant patient survival was significantly higher in the ESCLD group:1-,5-,and 10-year survival rates were 97.9%,93.9%,and 89.4%,respectively,compared to 78.3%,78.3%,and 78.3%in the ALF group(P=0.007).However,there was no difference in 1-,5-,and 10-year graft survival between the ESCLD and ALF groups(90.7%,82.9%,77.3%vs 75.6%,72.4%,and 66.9%;P=0.119).CONCLUSION Patient survival is inferior in ALF compared to ESCLD recipients;the main reason is death in the 1st year post-PLT in ALF group.Once the ALF children overcome the 1st year after transplant,their survival stabilizes,and they have good long-term outcomes.展开更多
To the Editor:Pediatric liver transplantation is the only treatment option for end-stage liver disease in children,and the 5-year and 20-year survival rates after living donor liver transplantation(LDLT)can reach 91.5...To the Editor:Pediatric liver transplantation is the only treatment option for end-stage liver disease in children,and the 5-year and 20-year survival rates after living donor liver transplantation(LDLT)can reach 91.5% and 84.2%[1].Many Asian countries,including China,have begun to develop LDLT and achieved good progress.However,the shortage of donor livers in children remains a serious problem.展开更多
Objective: To study the epidemiological, clinical and therapeutic aspects of sickle cell disease in children admitted to the pediatric emergency department of the Gabriel Toure University Hospital. Materials and metho...Objective: To study the epidemiological, clinical and therapeutic aspects of sickle cell disease in children admitted to the pediatric emergency department of the Gabriel Toure University Hospital. Materials and methods: This was a prospective study over 12 months in sickle cell children aged 6 months to 15 years. Results: The frequency of sickle cell disease was 4.67% with 71.1% of SS form. The age range of 60 - 120 months predominated with 43.4% and the sex ratio 1.4. Vaso-occlusive crises (VOC) were the most frequent reason for consultation (50.6%) and osteoarticular pain was the main symptom followed by fever and pallor with respectively 67.5%, 60.2%, 39.8%. The pain subsided in less than 72 hours in 39.8% and hyper hydration was performed in 85.1% of patients. Analgesic treatment was given in 90.4%, antibiotic therapy in 51.8% and phenotyped red blood cells transfusion was performed in 36.1%. The average duration of treatment was 10 days. Conclusion: Vaso-occlusive crisis remains the main reason for consultation in sickle cell disease children at Gabriel Toure University Hospital. The management consisted, in addition to the correction of the triggering factors, of hyper hydration and the administration of analgesics and blood products.展开更多
Dear Editor,We reported the results of endoscopic transnasal optic canal decompression(ETOCD)procedure in 3 pediatric cases(9 to 12y,mean age 10.3y)of traumatic optic neuropathy(TON)with no light perception suffering ...Dear Editor,We reported the results of endoscopic transnasal optic canal decompression(ETOCD)procedure in 3 pediatric cases(9 to 12y,mean age 10.3y)of traumatic optic neuropathy(TON)with no light perception suffering from road traffic accident.TON is a rare but serious complication secondary to ocular or head trauma,resulting in partial or complete visual loss.In China,the incidence of road traffic accident induced TON is on the rise.The rate of incidence has been reported about 0.5% to 5% in closed head trauma cases[1].展开更多
The clinical scenario of pediatric liver disease is becoming more intricate due to changes in the disease spectrum,in which an increasing number of inherited/metabolic liver diseases are reported,while infectious dise...The clinical scenario of pediatric liver disease is becoming more intricate due to changes in the disease spectrum,in which an increasing number of inherited/metabolic liver diseases are reported,while infectious diseases show a decreasing trend.The similar clinical manifestations caused by inherited/metabolic diseases might be under-recognized or misdiagnosed due to nonspecific characteristics.A delayed visit to a doctor due to a lack of symptoms or mild symptoms at an early stage will result in late diagnosis and treatment.Moreover,limited diagnostic approaches,especially liver biopsy,are not easily accepted by pediatric patients,leading to challenges in etiological diagnosis.Liver dysfunction due to inherited/metabolic diseases is often caused by a variety of metabolites,so precision treatment is difficult;symptomatic treatment is a compelling option for inherited disorders.展开更多
Scientific research has brought about enormous national advancements in cancer management. Currently, Morocco provides several therapeutic tools for cancer, among them chemotherapy, surgery and radiotherapy. In Morocc...Scientific research has brought about enormous national advancements in cancer management. Currently, Morocco provides several therapeutic tools for cancer, among them chemotherapy, surgery and radiotherapy. In Morocco, there is not enough published data on the use of alternative medicine in pediatric oncology. Owing to the increased interest and lack of data on this practice, we conducted this study. It aims to evaluate the uptake, the types of therapies used, the factors influencing, the reasons for this choice and the cost of AM used by patients. An investigation through a questionnaire was carried out on thirty-four children following for cancer within the pediatric hematology and oncology department (PHO) of Marrakech. The survey was conducted over a period of one month and a half between July 25 and September 5, 2022. Data were collected through a questionnaire. From the medical files, we collected data regarding type of cancer, date of admission to PHO department and the treatment received. We asked about the type of AM used: herbs, honey, spiritual AM, zamzam water (water from a “sacred” source in Mecca). Using alternative therapies is a common practice in pediatric oncology with various reasons, among them, the declining socioeconomic level, the diversity, the cultural background, the psychological and the functional status of patients and sometimes the dissatisfaction with conventional medicine.展开更多
文摘In the field of pediatric nursing, in the perinatal period, numerous ethical issues arise alongside the advancement of medical technology. However, sufficient education on bioethics is not provided in the pediatric nursing domain of basic nursing education. The purpose of this research is to examine the current status of bioethics education in the pediatric nursing domain of basic nursing education and explore the challenges perceived by the pediatric nursing faculty regarding bioethics education. The research method was a questionnaire survey on 100 randomly selected pediatric nursing faculty members from nursing universities across Japan. The results revealed that although bioethics issues were considered important, the emphasis remained primarily on addressing bioethics as part of nursing that respects children’s rights. Furthermore, respondents expressed difficulties regarding teaching methods and content related to bioethics.
基金Division of Neurology,Cincinnati Children’s Hospital Medical Center(as a Medical Student Scholars Program award to ALM)。
文摘There are few pharmacologic options for the treatment of cognitive deficits associated with traumatic brain injury in pediatric patients.Acetylcholinesterase inhibitors such as donepezil have been evaluated in adult patients after traumatic brain injury,but relatively less is known about the effect in pediatric populations.The goal of this review is to identify knowledge gaps in the efficacy and safety of acetylcholinesterase inhibito rs as a potential a djuvant treatment fo r neurocognitive decline in pediatric patients with traumatic brain injury.Investigators queried PubMed to identify literature published from database inception thro ugh June 2023 desc ribing the use of donepezil in young adult traumatic brain injury and pediatric patients with predefined conditions.Based on preselected search criteria,340 unique papers we re selected for title and abstra ct screening.Thirty-two reco rds were reviewed in full after eliminating preclinical studies and pape rs outside the scope of the project.In adult traumatic brain injury,we review results from 14 papers detailing 227 subjects where evidence suggests donepezil is well tole rated and shows both objective and patient-reported efficacy for reducing cognitive impairment.In children,3 pape rs report on 5 children recovering from traumatic brain injury,showing limited efficacy.An additional 15 pediatric studies conducted in populations at risk for cognitive dysfunction provide a broader look at safety and efficacy in 210 patients in the pediatric age group.Given its promise for efficacy in adults with traumatic brain injury and tole rability in pediatric patients,we believe further study of donepezil for children and adolescents with traumatic brain injury is warranted.
文摘Rationale:Rabies is a zoonotic disease with a high mortality,primarily transmitted through the bite of infected mammals,particularly dogs and cats.Despite being a well-known disease since ancient times,it continues to cause a significant number of human deaths worldwide,with approximately 65000 fatalities reported annually.Patient concerns:We present two fatal cases of rabies in a 12-year-old immigrant boy and a 7-year-old boy.The first case was subject to a 24-hour delay in receiving appropriate medical attention and rabies preventive measures due to the lack of awareness among emergency hospital staff,leading to the administration of wound dressing only.The second case received timely rabies immunoglobulin administration;however,there was a 4-day delay in administering the fourth dose of the rabies vaccine,despite presenting evident symptoms of rabies.Diagnosis:Postmortem examination of brain samples from both patients confirmed the presence of rabies virus.Interventions:Post-exposure prophylaxis for rabies.Outcomes:Both patients were admitted to the hospital after the manifestation of rabies-related symptoms,with the 12-year-old child seeking medical care 47 days after the animal bite and the 7-year-old child seeking medical care 58 days after the exposure.Finally,the first patient died after 27 days and the second patient died after 40 days of hospitalization.Lessons:There is an urgent need for heightened awareness and education among both healthcare professionals and the public regarding the urgency of seeking immediate medical attention after potential rabies exposure.Timely recognition and initiation of post-exposure prophylaxis are pivotal in preventing the progression of the disease.Strengthening surveillance and reporting systems,coupled with continuous training for healthcare professionals,can contribute to early detection and management of rabies cases.
文摘Crohn’s disease(CD)is a chronic inflammatory disease of the digestive tract.The incidence of pediatric CD is increasing and is currently 2.5-11.4 per 100000 world-wide.Notably,approximately 25%of children with CD develop stricturing CD(SCD)that requires intervention.Symptomatic stricturing diseases refractory to pharmacological management frequently require non-pharmacological interventions.Non-pharmacological therapeutic strategies include endoscopic balloon dilatation,stricturoplasty,and surgical resection of the strictured seg-ment.However,strictures tend to recur postoperatively regardless of treatment modality.The lifetime risk of surgery in patients with childhood SCD remains at 50%-90%.Thus,new and emerging strategies,advanced diagnostic tools,and minimally invasive approaches are under investigation to improve the outcomes and overall quality of life of pediatric patients with SCD.
基金This paper is funded by Humanities and Social Sciences Research Project of the Ministry of Education:The Research on the Influence Mechanism of Chinese Enterprise Employees’Participation on Adaptive Performance—An Explanation Based on the JDR Theory and Self-Consistency Theory(19YJC630226)Soft Science Project of Hebei Provincial Department of Science and Technology:The Research on the Incentive Mechanism for Innovation of Sci-Tech Talents in Hebei Province from the Perspective of AMO Theory(225576109D)Humanities and Social Sciences Foundation of Hebei Normal University:The Research on the Influence Mechanism of Enterprise Employees’Participation on Growth Performance in the Context of Technological Change(S20GD009).
文摘With the implementation of China’s innovation-driven development strategy,the competition among sci-tech talents has become increasingly fierce.Stimulating the innovative vigor of sci-tech talents has become a hot topic in theoretical research and policy practice.Based on the data from 246 questionnaires collected from sci-tech talents in Hebei province,this study explored the influence mechanism of an inclusive organizational climate on innovation input from technological talents and verified the mediating effects of innovation self-efficacy and intrinsic motivation.The results indicate that an inclusive organizational climate has a significant positive impact on innovation input,innovation self-efficacy,and intrinsic motivation of sci-tech talents.Both innovation self-efficacy and intrinsic motivation play a partial mediating role between an inclusive climate and innovation input.This study verified the important role of an inclusive climate in an organization’s human resource management practices and encouraged managers to emphasize enhancing the innovation self-efficacy and intrinsic motivation of sci-tech talents,thereby continuously improving the level of innovation.
文摘Introduction: Cystic lymphangiomas are rare benign malformative tumors of the lymphatic system of obscure etiopathogenesis. The cervico-facial location remains the most common (75%). Although benign, these tumors remain potentially fatal, due to possible compression of the upper aero-digestive tract. The aim of this work is to study the epidemiological, diagnostic and therapeutic characteristics of cervico-mandibular congenital cystic lymphangiomas in the pediatric surgery department of the Donka National Hospital (HND) Conakry. Patients and methods: This is a retrospective and descriptive study of 13 files lasting 7 years from January 2015 to December 31, 2021. The files of children whose age is less than or equal to 15 years operated on cervical tumor with histological evidence of cystic lymphangioma were retained. The data were analyzed using SPSS statistical software 21 and anonymously. Results: The incidence of this study was 1.86 cases per year and a sex ratio of 0.62 in favor of girls. The average age was 8 months 19 days. In the antecedents, we only find poorly monitored pregnancies. The average size of the tumors was 11.85 cm. Cervical ultrasound and standard x-ray of the cervical mass were the only examinations performed. Total surgical excision of the cervical tumor was performed in all patients. The mass was polycystic on exploration. The histological examination of the surgical specimens was in favor of a cystic lymphangioma. The surgical consequences were simple in 11 patients (84.62%) and complicated by parietal suppuration in 2 cases (15.38%). There were no cases of recurrence after one year of follow-up. Conclusion: Cervico-mandibular cystic lymphangiomas are the most frequent locations of congenital lymphangiomas in children. Their severity is linked to the risk of compression of the aero-digestive tracts. Their diagnosis must be confirmed by the histology of the surgical specimen. Despite the therapeutic arsenal, excision of the cystic mass remains the only effective alternative in our socio-economic conditions to avoid recurrences and loss of follow-up of patients.
文摘BACKGROUND Distal humerus elbow fractures are one of the most common traumatic fractures seen in pediatric patients and present as three main types:Supracondylar(SC),lateral condyle(LC),and medial epicondyle(ME)fractures.AIM To evaluate the epidemiology of pediatric distal humerus fractures(SC,LC,and ME)from an American insurance claims database.METHODS A retrospective review was performed on patients 17 years and younger with the ICD 9 and 10 codes for SC,LC and ME fractures based on the IBM Truven MarketScan®Commercial and IBM Truven MarketScan Medicare Supplemental databases.Patients from 2015 to 2020 were queried for treatments,patient age,sex,length of hospitalization,and comorbidities.RESULTS A total of 1133 SC,154 LC,and 124 ME fractures were identified.SC fractures had the highest percentage of operation at 83%,followed by LC(78%)and ME fractures(41%).Male patients were,on average,older than female patients for both SC and ME fractures.CONCLUSION In the insurance claims databases used,SC fractures were the most reported,followed by LC fractures,and finally ME fractures.Age was identified to be a factor for how a pediatric distal humerus fractures,with patients with SC and LC fractures being younger than those with ME fractures.The peak age per injury per sex was similar to reported historic central tendencies,despite reported trends for younger physiologic development.
文摘Pediatric inflammatory bowel disease(IBD)is a chronic inflammatory disorder,with increasing incidence and prevalence worldwide.There have been recent advances in imaging and endoscopic technology for disease diagnosis,treatment,and monitoring.Intestinal ultrasound,including transabdominal,transperineal,and endoscopic,has been emerging for the assessment of transmural bowel inflammation and disease complications(e.g.,fistula,abscess).Aside from surgery,IBD-related intestinal strictures now have endoscopic treatment options including through-the-scope balloon dilatation,injection,and needle knife stricturotomy and new evaluation tools such as endoscopic functional lumen imaging probe.Unsedated transnasal endoscopy may have a role in patients with upper gastrointestinal Crohn’s disease or those with IBD with new upper gastrointestinal symptoms.Improvements to dysplasia screening in pediatric patients with longstanding colonic disease or primary sclerosing cholangitis hold promise with the addition of virtual chromoendoscopy and ongoing research in the field of artificial intelligence-assisted endoscopic detection.Artificial intelligence and machine learning is a rapidly evolving field,with goals of further personalizing IBD diagnosis and treatment selection as well as prognostication.This review summarized these advancements,focusing on pediatric patients with IBD.
文摘BACKGROUND Screening for iron deficiency anemia(IDA)is important in managing pediatric patients with inflammatory bowel disease(IBD).Concerns related to adverse reactions may contribute to a reluctance to prescribe intravenous(IV)iron to treat IDA in this population.AIM To track the efficacy and safety of IV iron therapy in treating IDA in pediatric IBD patients admitted to our center.METHODS A longitudinal observational cohort study was performed on 236 consecutive pediatric patients admitted to our tertiary IBD care center between September 2017 and December 2019.92 patients met study criteria for IDA,of which 57 received IV iron,17 received oral iron,and 18 were discharged prior to receiving iron therapy.RESULTS Patients treated with IV iron during their hospitalization experienced a significant increase of 1.9(±0.2)g/dL in mean(±SE)hemoglobin(Hb)concentration by the first ambulatory follow-up,compared to patients who received oral iron 0.8(±0.3)g/dL or no iron 0.8(±0.3)g/dL(P=0.03).One out of 57(1.8%)patients that received IV iron therapy experienced an adverse reaction.CONCLUSION Our findings demonstrate that treatment with IV iron therapy is safe and efficacious in improving Hb and iron levels in pediatric patients with IDA and active IBD.
文摘Pneumonia ranks as a leading cause of mortality, particularly in children aged five and under. Detecting this disease typically requires radiologists to examine chest X-rays and report their findings to physicians, a task susceptible to human error. The application of Deep Transfer Learning (DTL) for the identification of pneumonia through chest X-rays is hindered by a shortage of available images, which has led to less than optimal DTL performance and issues with overfitting. Overfitting is characterized by a model’s learning that is too closely fitted to the training data, reducing its effectiveness on unseen data. The problem of overfitting is especially prevalent in medical image processing due to the high costs and extensive time required for image annotation, as well as the challenge of collecting substantial datasets that also respect patient privacy concerning infectious diseases such as pneumonia. To mitigate these challenges, this paper introduces the use of conditional generative adversarial networks (CGAN) to enrich the pneumonia dataset with 2690 synthesized X-ray images of the minority class, aiming to even out the dataset distribution for improved diagnostic performance. Subsequently, we applied four modified lightweight deep transfer learning models such as Xception, MobileNetV2, MobileNet, and EfficientNetB0. These models have been fine-tuned and evaluated, demonstrating remarkable detection accuracies of 99.26%, 98.23%, 97.06%, and 94.55%, respectively, across fifty epochs. The experimental results validate that the models we have proposed achieve high detection accuracy rates, with the best model reaching up to 99.26% effectiveness, outperforming other models in the diagnosis of pneumonia from X-ray images.
文摘Objective:To observe and explore the value of the combined application of red blood cell distribution width(RDW),platelet distribution width(PDW),and immunoglobulin E(IgE)in the process of clinical diagnosis of children with asthma.Methods:Fifty-five children with suspected asthma were admitted to the hospital from July 2021 to July 2023.They underwent a bronchodilator test upon admission and their RDW,PDW,and IgE were detected.The efficacy of diagnosis with a single indicator(RDW/PDW/IgE)and combined parameters(PDW+PDW+IgE)were compared with the results of the bronchodilator test.Results:49 cases of pediatric asthma were diagnosed by the bronchodilator test.RDW and PDW of asthmatic children were lower than those of non-asthmatic children,while the IgE of asthmatic children was higher than that of non-asthmatic children,and there was a significant difference in the RDW,PDW,and IgE among children with different degrees of asthma severity(P<0.05).The positive rate of the three combined diagnostic tests of RDW,PDW,and IgE was significantly higher than the positive rate of a single-parameter diagnosis(P<0.05).Conclusion:The combination of RDW,PDW,and IgE plays a crucial role in the clinical diagnosis of asthmatic children.These tests further improve the efficiency of clinical diagnosis and help identify the severity of the disease.
文摘Objective:To analyze the effectiveness of modified non-traumatic filling technology in the treatment of pediatric dental caries.Methods:Ninety-seven children with dental caries who were treated in our hospital(Panyu Maternal and Child Care Service Center of Guangzhou)from January 2022 to December 2023 were selected and randomly divided into two groups,with 48 cases in the experimental group and 49 in the control group.The experimental group was treated with modified non-traumatic filling techniques,while the control group was treated with conventional filling techniques.Observation indicators such as the total effectiveness of the treatment,incidence of adverse events,treatment compliance,and pain scores were analyzed after the intervention.Result:After intervention,the total effectiveness of the treatment in the experimental group was higher than that in the control group(P<0.05).The incidence of adverse events in the experimental group was lower than that of the control group(P<0.05).The treatment compliance of patients in the experimental group was higher than that in the control group(P<0.05).The pain score of the experimental group was lower than that of the control group(P<0.05).Conclusion:The application of modified non-traumatic filling technology in the treatment of pediatric dental caries showed good therapeutic outcomes.After the intervention,the child’s symptoms were significantly alleviated,the incidence of adverse events such as filling material falling off was reduced,their compliance was improved,and the pain was relieved.This procedure is worth to be promoted for clinical application.
文摘BACKGROUND: Despite the rapid development of pediatric intensive care medicine, there are still limited data in the literature regarding the follow-up of pediatric trauma patients in pediatric intensive care units(PICUs). In this study, we aim to evaluate our experience with children admitted and followed up with the diagnosis of trauma at our PICU.METHODS: We evaluated the retrospective data of 77 pediatric trauma patients who were admitted to the PICU at Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital from August 2020 to December 2022. The demographic data, clinical parameters and laboratory results were recorded. The primary outcome was the mortality in PICU. The performances of markers in predicting mortality were evaluated with receiver operating characteristic(ROC) curves.RESULTS: The median age of the patients was 70(33–157) months, and the median duration of hospitalization in the PICU was 6(2–11) d. Of the 77 patients, 9 died due to trauma(11,1%). Among the clinical parameters, Pediatric Risk of Mortality III(PRISM III) Score, inotrope requirement, extracorporeal treatment requirement, and mechanical ventilator requirement were significantly higher in non-survivors than in survivors. Among the laboratory parameters, procalcitonin(PCT), lactate/albumin ratio(LAR), neutrophil/lymphocyte ratio(NLR), and transfusion requirement were significantly higher in non-survivors than in survivors.CONCLUSION: In pediatric trauma patients, baseline PCT, LAR, and NLR values can be used to identify patients at risk for mortality.
基金This study was supported by the Science and Technology Innovation-Biomedical Supporting Program of Shanghai Science and Technology Committee(19441904400)Program for artificial intelligence innovation and development of Shanghai Municipal Commission of Economy and Informatization(2020-RGZN-02048).
文摘BACKGROUND:To promote the shared decision-making(SDM)between patients and doctors in pediatric outpatient departments,this study was designed to validate artificial intelligence(AI)-initiated medical tests for children with fever.METHODS:We designed an AI model,named Xiaoyi,to suggest necessary tests for a febrile child before visiting a pediatric outpatient clinic.We calculated the sensitivity,specificity,and F1 score to evaluate the efficacy of Xiaoyi’s recommendations.The patients were divided into the rejection and acceptance groups.Then we analyzed the rejected examination items in order to obtain the corresponding reasons.RESULTS:We recruited a total of 11,867 children with fever who had used Xiaoyi in outpatient clinics.The recommended examinations given by Xiaoyi for 10,636(89.6%)patients were qualified.The average F1 score reached 0.94.A total of 58.4%of the patients accepted Xiaoyi’s suggestions(acceptance group),and 41.6%refused(rejection group).Imaging examinations were rejected by most patients(46.7%).The tests being time-consuming were rejected by 2,133 patients(43.2%),including rejecting pathogen studies in 1,347 patients(68.5%)and image studies in 732 patients(31.8%).The difficulty of sampling was the main reason for rejecting routine tests(41.9%).CONCLUSION:Our model has high accuracy and acceptability in recommending medical tests to febrile pediatric patients,and is worth promoting in facilitating SDM.
文摘BACKGROUND Children with acute liver failure(ALF)who meet the criteria are eligible for super-urgent transplantation,whereas children with end-stage chronic liver disease(ESCLD)are usually transplanted electively.Pediatric liver transplantation(PLT)in ALF and ESCLD settings has been well described in the literature,but there are no studies comparing the outcomes in these two groups.AIM To determine if there is a difference in post-operative complications and survival outcomes between ALF and ESCLD in PLT.METHODS This was a retrospective observational study of all primary PLTs performed at a single center between 2000 and 2019.ALF and ESCLD groups were compared for pretransplant recipient,donor and operative parameters,and post-operative outcomes including graft and patient survival.RESULTS Over a 20-year study period,232 primary PLTs were performed at our center;195 were transplanted for ESCLD and 37 were transplanted for ALF.The ALF recipients were significantly older(median 8 years vs 5.4 years;P=0.031)and heavier(31 kg vs 21 kg;P=0.011).Living donor grafts were used more in the ESCLD group(34 vs 0;P=0.006).There was no difference between the two groups concerning vascular complications and rejection,but there were more bile leaks in the ESCLD group.Post-transplant patient survival was significantly higher in the ESCLD group:1-,5-,and 10-year survival rates were 97.9%,93.9%,and 89.4%,respectively,compared to 78.3%,78.3%,and 78.3%in the ALF group(P=0.007).However,there was no difference in 1-,5-,and 10-year graft survival between the ESCLD and ALF groups(90.7%,82.9%,77.3%vs 75.6%,72.4%,and 66.9%;P=0.119).CONCLUSION Patient survival is inferior in ALF compared to ESCLD recipients;the main reason is death in the 1st year post-PLT in ALF group.Once the ALF children overcome the 1st year after transplant,their survival stabilizes,and they have good long-term outcomes.
基金supported by grants from the National Natural Science Foundation of China(82071797 and 81873874)Clinical Research Plan of SHDC(SHDC2020CR2021B and SHDC2020CR5012)。
文摘To the Editor:Pediatric liver transplantation is the only treatment option for end-stage liver disease in children,and the 5-year and 20-year survival rates after living donor liver transplantation(LDLT)can reach 91.5% and 84.2%[1].Many Asian countries,including China,have begun to develop LDLT and achieved good progress.However,the shortage of donor livers in children remains a serious problem.
文摘Objective: To study the epidemiological, clinical and therapeutic aspects of sickle cell disease in children admitted to the pediatric emergency department of the Gabriel Toure University Hospital. Materials and methods: This was a prospective study over 12 months in sickle cell children aged 6 months to 15 years. Results: The frequency of sickle cell disease was 4.67% with 71.1% of SS form. The age range of 60 - 120 months predominated with 43.4% and the sex ratio 1.4. Vaso-occlusive crises (VOC) were the most frequent reason for consultation (50.6%) and osteoarticular pain was the main symptom followed by fever and pallor with respectively 67.5%, 60.2%, 39.8%. The pain subsided in less than 72 hours in 39.8% and hyper hydration was performed in 85.1% of patients. Analgesic treatment was given in 90.4%, antibiotic therapy in 51.8% and phenotyped red blood cells transfusion was performed in 36.1%. The average duration of treatment was 10 days. Conclusion: Vaso-occlusive crisis remains the main reason for consultation in sickle cell disease children at Gabriel Toure University Hospital. The management consisted, in addition to the correction of the triggering factors, of hyper hydration and the administration of analgesics and blood products.
文摘Dear Editor,We reported the results of endoscopic transnasal optic canal decompression(ETOCD)procedure in 3 pediatric cases(9 to 12y,mean age 10.3y)of traumatic optic neuropathy(TON)with no light perception suffering from road traffic accident.TON is a rare but serious complication secondary to ocular or head trauma,resulting in partial or complete visual loss.In China,the incidence of road traffic accident induced TON is on the rise.The rate of incidence has been reported about 0.5% to 5% in closed head trauma cases[1].
基金Supported by the Shenzhen Science and Technology Innovation Program,No.JCYJ20220818102801004(to Dai DL).
文摘The clinical scenario of pediatric liver disease is becoming more intricate due to changes in the disease spectrum,in which an increasing number of inherited/metabolic liver diseases are reported,while infectious diseases show a decreasing trend.The similar clinical manifestations caused by inherited/metabolic diseases might be under-recognized or misdiagnosed due to nonspecific characteristics.A delayed visit to a doctor due to a lack of symptoms or mild symptoms at an early stage will result in late diagnosis and treatment.Moreover,limited diagnostic approaches,especially liver biopsy,are not easily accepted by pediatric patients,leading to challenges in etiological diagnosis.Liver dysfunction due to inherited/metabolic diseases is often caused by a variety of metabolites,so precision treatment is difficult;symptomatic treatment is a compelling option for inherited disorders.
文摘Scientific research has brought about enormous national advancements in cancer management. Currently, Morocco provides several therapeutic tools for cancer, among them chemotherapy, surgery and radiotherapy. In Morocco, there is not enough published data on the use of alternative medicine in pediatric oncology. Owing to the increased interest and lack of data on this practice, we conducted this study. It aims to evaluate the uptake, the types of therapies used, the factors influencing, the reasons for this choice and the cost of AM used by patients. An investigation through a questionnaire was carried out on thirty-four children following for cancer within the pediatric hematology and oncology department (PHO) of Marrakech. The survey was conducted over a period of one month and a half between July 25 and September 5, 2022. Data were collected through a questionnaire. From the medical files, we collected data regarding type of cancer, date of admission to PHO department and the treatment received. We asked about the type of AM used: herbs, honey, spiritual AM, zamzam water (water from a “sacred” source in Mecca). Using alternative therapies is a common practice in pediatric oncology with various reasons, among them, the declining socioeconomic level, the diversity, the cultural background, the psychological and the functional status of patients and sometimes the dissatisfaction with conventional medicine.
