Abstract Objective This study aimed to investigate the prevalence of autism spectrum disorder and its possible correlations with clinical characteristics in patients with infantile epileptic spasms syndrome in a single center in Brazil. Methods This retrospective cross-sectional study examined 53 children with the diagnosis of infantile epileptic spasms syndrome prior to an autism spectrum disorder assessment. Participants were divided into two groups based on the presence or absence of autism spectrum disorder. Available variables (sex, medications, median age at onset of infantile epileptic spasms syndrome, and presence of comorbidities) were compared using Mann-Whitney U or chi-square tests. Results Among the included patients, 12 (23 %) were diagnosed with autism spectrum disorder, corresponding to a relative risk of 0.29 (95 % confidence interval 0.174-0.492). The age at the first seizure ranged from 3 to 15 months, with a mean of 6.65 months. This age significantly differed between participants with autism spectrum disorder (10.58 months) and those without (5.43 months), p<0.001. Conclusion Children with infantile epileptic spasms syndrome have a higher risk of being diagnosed with autism spectrum disorder. Later age of onset and period of spasm occurrence might be predisposing risk factors. Brazil crosssectional cross sectional 5 assessment sex, sex (sex medications comorbidities MannWhitney Mann Whitney chisquare chi square tests 1 23 (2 029 0 29 0.2 95 (9 0.1740.492. 01740492 0.174 0.492 . 174 492 0.174-0.492) months 665 6 65 6.6 10.58 1058 10 58 (10.5 5.43 543 43 (5.4 , p0001 p 001 p<0.001 factors 2 ( 02 0. 9 1740 0.1740.492 0174049 0174 0.17 0492 0.49 17 49 0.174-0.492 66 6. 10.5 105 (10. 5.4 54 4 (5. p000 00 p<0.00 0.1740.49 017404 017 0.1 049 0.4 0.174-0.49 10. (10 5. (5 p00 p<0.0 0.1740.4 01740 01 04 0.174-0.4 (1 p0 p<0. 0.1740. 0.174-0. p<0 0.1740 0.174-0 p< 0.174-

Abstract Objective To determine reference intervals (RI) for fasting blood insulin (FBI) in Brazilian adolescents, 12 to 17 years old, by direct and indirect approaches, and to validate indirectly determined RI. Methods Two databases were used for RI determination. Database 1 (DB1), used to obtain RI through a posteriori direct method, consisted of prospectively selected healthy individuals. Database 2 (DB2) was retrospectively mined from an outpatient laboratory information system (LIS) used for the indirect method (Bhattacharya method). Results From DB1, 29345 individuals were enrolled (57.65 % female) and seven age ranges and sex partitions were statistically determined according to mean FBI values: females: 12 and 13 years-old, 14 years-old, 15 years-old, 16 and 17 years-old; and males: 12, 13 and 14 years-old, 15 years-old, 16 and 17 years-old. From DB2, 5465 adolescents (67.5 % female) were selected and grouped according to DB1 partitions. The mean FBI level was significantly higher in DB2, on all groups. The RI upper limit (URL) determined by Bhattacharya method was slightly lower than the 90 % CI URL directly obtained on DB1, except for group female 12 and 13 years old. High agreement rates for diagnosing elevated FBI in all groups on DB1 validated indirect RI presented. Conclusion The present study demonstrates that Bhattacharya indirect method to determine FBI RI in adolescents can overcome some of the difficulties and challenges of the direct approach. (RI (FBI old approaches determination DB , (DB1) DB2 (DB2 LIS (LIS method. . method) 2934 57.65 5765 57 65 (57.6 values females yearsold, yearsold years-old males yearsold. 546 67.5 675 67 5 (67. (URL 9 presented approach (DB1 (DB 293 57.6 576 6 (57. 54 67. (67 29 57. (57 (6 (5 (

Abstract Objective Platelet to albumin ratio (PAR) and prognostic nutritional index (PNI) are potential indicators for evaluating nutritional and inflammatory status. This study aimed to examine the relationship between PAR and PNI and the acute complicated course of acute hematogenous osteomyelitis (AHO). Methods AHO patients were divided into the simple course group and the acute complicated course group. The patient's gender, age, site of infection, body temperature, laboratory results, and pathogen culture results were collected and compared. Multivariate logistic regression analysis was used to determine the independent risk factors of the acute complicated course group. The receiver operating characteristic curve was applied to determine the optimal cut-off value. Results In total, 101 AHO patients with a median age of 7.58 years were included. There were 63 cases (62.4 %) in the simple course group and 38 cases (37.6 %) in the complicated course group. Binary logistic regression analysis revealed that PAR and PNI were independent risk factors for predicting the acute complicated course of AHO (p = 0.004 and p < 0.001, respectively). Receiver operating characteristic curve analysis demonstrated that the combination of PAR and PNI had an area under the curve of 0.777 (95 % CI: 0.680-0.873, p < 0.001) with a cut-off value of 0.51. Conclusions The incidence of acute complicated courses was significantly higher in patients with high PAR and low PNI. A combined factor greater than 0.51, derived from PAR and PNI measurements within 24 h of admission, may be useful for predicting AHO patients who are likely to develop severe disease. (PAR (PNI status AHO. . (AHO) patient s gender infection temperature compared cutoff cut off total 10 758 7 58 7.5 included 6 62.4 624 62 4 (62. 3 37.6 376 37 (37. 0004 0 004 0.00 0001 001 0.001 respectively. respectively respectively) 0777 777 0.77 95 (9 CI 0.6800.873, 06800873 0.680 0.873, 680 873 0.680-0.873 051 51 0.51 2 admission disease (AHO 1 75 5 7. 62. (62 37. (37 000 00 0.0 077 77 0.7 9 ( 6800 0.6800.873 0680087 0680 0.68 0873 0.873 68 87 0.680-0.87 05 0.5 (6 (3 0. 07 0.6800.87 068008 068 0.6 087 0.87 8 0.680-0.8 0.6800.8 06800 06 08 0.8 0.680-0. 0.6800. 0.680-0 0.6800 0.680-

Abstract Objective To evaluate the growth trajectory of head circumference and neurodevelopment, and to correlate head circumference with cognitive, language, and motor outcomes during the first two years. Method Prospective cohort study in a tertiary hospital including 95 newborns under 32 weeks or 1500 g. Neonates who developed major neonatal morbidities were excluded. The head circumference was measured at birth, at discharge, and at term-equivalent age, 1, 3, 5, 12, 18, and 24 months of corrected age, and the Bayley Scales (Bayley-III) were applied at 12, 18 and 24 months of corrected age to assess cognitive, language and, motor domains. Scores below 85 were classified as mild/moderate deficits and scores below 70 as severe deficits. The association between head circumference Z score and Bayley scores was assessed using Pearson's correlation. The study considered a significance level of 0.05. Results There was a decrease of -0.18 in the head circumference Z score between birth and discharge and the catch-up occurred between discharge and 1 month (an increase of 0.81 in the Z score). There was a positive correlation between head circumference and Bayley scores at 18 months. There was also a positive correlation between head circumference at discharge and at 5 months with the three domains of the Bayley. Conclusion Serial measurements of head circumference provide knowledge of the trajectory of growth, with early catch-up between discharge and 1 month, as well as its association with neurodevelopment. Head circumference is therefore a valuable clinical marker for neurodevelopment, especially in very preterm newborns. neurodevelopment cognitive years 9 3 150 g excluded termequivalent term equivalent 12 2 BayleyIII III (Bayley-III 8 mildmoderate mild moderate 7 Pearsons Pearson s 005 0 05 0.05 0.18 018 -0.1 catchup catch up an 081 81 0.8 score. . score) 15 00 0.0 0.1 01 -0. 08 0. -0 -

Abstract Objective To compare the effectiveness of inhaled Magnesium Sulfate associated with Salbutamol versus Inhaled Salbutamol alone in patients with moderate and severe asthma exacerbations. Method Clinical, prospective and randomized study with patients between 3 and 14 years of age divided into two groups: one to receive inhaled salbutamol associated with magnesium sulfate (GSM), the other to receive inhaled salbutamol alone (GS). The sample consisted of 40 patients, 20 patients in each group. Severity was classified using the modified Wood-Downes score, with values between 4 and 7 classified as moderate and 8 or more classified as severe. Results Post-inhalation scores decreased both in patients who received salbutamol and magnesium and in those who received salbutamol alone, with no statistically significant difference between the groups. Conclusions Despite the benefits when administered intravenously, inhalation of the drug alone or in combination did not reduce the severity of the exacerbation. exacerbations Clinical 1 groups GSM, GSM , (GSM) GS. GS . (GS) 2 group WoodDownes Wood Downes score Postinhalation Post intravenously exacerbation (GSM (GS

Abstract Objective To assess FEES findings in defining oral feeding safety in children with suspected dysphagia, comparing them with clinical feeding evaluation results. Methods This study comprised a case series involving children with suspected dysphagia, referred for evaluation by otolaryngologists and speech-language pathologists (SLPs) at a Brazilian quaternary public university hospital. These children underwent both clinical evaluations and fiberoptic endoscopic evaluation of swallowing (FEES), with a comprehensive collection of demographic and clinical data. Subsequently, the authors performed a comparative analysis of findings from both assessments. Results Most patients successfully completed the FEES procedure (93.7%), resulting in a final number of 60 cases included in the study. The prevalence of dysphagia was confirmed in a significant 88% of these cases. Suspected aspiration on clinical SLP evaluation was present in 34 patients. Of these, FEES confirmed aspiration or penetration in 28 patients. Among the 35 patients with aspiration or penetration on FEES, 7 (20%) had no suspicion on SLP clinical assessment. All seven patients in whom clinical SLP evaluation failed to predict penetration/aspiration had neurological disorders. The median age of the children was 2.8 years, and 49 (81.6%) had neurological disorders, while 35 (58.3%) had chronic pulmonary disease. The most prevalent complaints were choking (41.6%) and sialorrhea (23.3%). Conclusion FEES can diagnose structural anomalies of the upper aerodigestive tract and significantly contribute to the detection of aspiration and penetration in this group of patients with suspected dysphagia, identifying moderate and severe dysphagia even in cases where clinical assessment had no suspicion. results speechlanguage speech language SLPs (SLPs hospital , (FEES) data Subsequently assessments 93.7%, 937 93.7% 93 (93.7%) 6 88 3 2 20% 20 (20% penetrationaspiration disorders 8 2. years 4 81.6% 816 81 (81.6% 58.3% 583 58 (58.3% disease 41.6% 416 41 (41.6% 23.3%. 233 23.3% . 23 (23.3%) (FEES 93.7 9 (93.7% (20 81.6 (81.6 58.3 5 (58.3 41.6 (41.6 23.3 (23.3% 93. (93.7 (2 81. (81. 58. (58. 41. (41. 23. (23.3 (93. ( (81 (58 (41 (23. (93 (8 (5 (4 (23 (9

Abstract Objectives This study aims to evaluate the characteristics and treatment response of patients with pityriasis lichenoides seen in the last 43 years in a pediatric dermatology service. Methods This was a retrospective, analytical, longitudinal study of patients under 15 years of age. The medical records were reviewed and data were presented as frequencies, means and variances. Student's t-test, Mann-Whitney test, Fisher's exact test, Pearson/Yates chi-square test and multivariate logistic regression model were used, with p < 0.05 considered. Results 41 patients were included, 32 (78.0%) with pityriasis lichenoides chronica (PLC), five (12.2%) with pityriasis lichenoides et varioliformis acuta (PLEVA) and four (9.8%) with clinical PLC without biopsy. The age range of school children and adolescents was 19 (46.3%) and 13 (31.7%) respectively and 27 (65.8%) were male. Two peaks of the highest frequency were observed between 2004 and 2006 (10 patients - 24.4%) and another between 2019 and 2021 (6 patients - 14.7%). There was remission in 71.9% (n = 23), with 56.6% (n = 17) of those who used antibiotic therapy and 80% (n = 4) of those who had phototherapy. The chance of remission was 13 times greater in patients with disease onset after 5 years of age. Conclusions The clinical form most commonly found was PLC mainly in school children and adolescents. The frequency peaks coincided with infectious outbreaks. The remission rate was satisfactory with antibiotic therapy, but higher with phototherapy. Remission was greater in patients with disease onset after 5 years of age. 4 service retrospective analytical 1 frequencies variances Students Student s ttest, ttest t t-test MannWhitney Mann Whitney Fishers Fisher PearsonYates Pearson Yates chisquare chi square 005 0 05 0.0 considered included 3 78.0% 780 78 (78.0% PLC, , (PLC) 12.2% 122 12 2 (12.2% PLEVA (PLEVA 9.8% 98 9 8 (9.8% biopsy 46.3% 463 46 (46.3% 31.7% 317 31 7 (31.7% 65.8% 658 65 (65.8% male 200 10 (1 24.4% 244 24 201 202 6 ( 14.7%. 147 14.7% . 14 14.7%) 719 71 71.9 n 23, 23 23) 566 56 56.6 17 80 phototherapy outbreaks 00 0. 78.0 (78.0 (PLC 12.2 (12.2 9.8 (9.8 46.3 (46.3 31.7 (31.7 65.8 (65.8 20 24.4 14.7 71. 56. 78. (78. 12. (12. 9. (9. 46. (46. 31. (31. 65. (65. 24. 14. (78 (12 (9 (46 (31 (65 (7 (4 (3

Abstract Objectives To investigate the associations between caregivers’ burden, family quality of life (QoL), and siblings’ QoL in Brazilian families of children with cerebral palsy, and to analyze siblings’ QoL using as a parameter the QoL of typically developed Brazilian children. Methods It was a cross-sectional study. The 212 families, 212 caregivers and 131 siblings completed the Family Quality of Life Scale, Burden Interview, and KIDSCREEN-27 Child and Adolescent Version and Parents Version questionnaires at a neurorehabilitation center in southeast Brazil. Univariable and multivariable models were used. Results Family QoL significantly worsened as caregivers’ burden increased (95 % CI -0.66 to -0.38). Caregivers’ burden was significantly lower with increasing family QoL scores (95 % CI -0.52 to -0.30). Self-reported siblings’ QoL was significantly worse than that of their typically developed peers (95 % CI -7.6 to -3.6). Self-reported siblings’ QoL was significantly lower as siblings’ age (95 % CI -2.52 to -0.59) and caregivers’ burden (95 % CI -0.35 to -0.05) increased. Parent-reported siblings’ QoL was significantly lower with increasing caregivers’ burden (95 % CI -0.45 to -0.16) and higher as family QoL increased (95 % CI 0.09 to 0.37). Conclusions The cross-sectional nature of these data precludes any statement of causality. Family QoL worsened with higher caregivers’ burden levels. Lower caregivers’ burden scores were associated with a higher family QoL. Siblings’ QoL was impaired as compared to typically developed peers, worse among older siblings, and as caregivers’ burden increased and better with higher family QoL levels. Future multicenter studies may validate the generalizability of the present findings. QoL, , (QoL) palsy crosssectional cross sectional study 21 13 Scale Interview KIDSCREEN27 KIDSCREEN 27 KIDSCREEN-2 Brazil used 95 (9 0.66 066 0 66 -0.6 0.38. 038 0.38 . 38 -0.38) Caregivers 0.52 052 52 -0.5 0.30. 030 0.30 30 -0.30) Selfreported Self reported 7.6 76 7 6 -7. 3.6. 36 3.6 3 -3.6) 2.52 252 2 -2.5 0.59 059 59 -0.59 0.35 035 35 -0.3 0.05 005 05 -0.05 Parentreported Parent 0.45 045 45 -0.4 0.16 016 16 -0.16 009 09 0.0 0.37. 037 0.37 37 0.37) causality levels Siblings findings (QoL 1 KIDSCREEN2 KIDSCREEN- 9 ( 0.6 06 -0. 03 0.3 -0.38 0.5 5 -0.30 7. -7 3. -3.6 2.5 25 -2. 00 -0.0 0.4 04 4 0.1 01 -0.1 0. -0 - -3. 2. -2 -3

Abstract Objective Complications of ascariasis are a significant cause of abdominal pain in pediatric emergencies, especially where it is endemic. A literature review was conducted with the aim of improving diagnostic and therapeutic approaches for these patients. Data sources A PubMed search was conducted using the key terms “ascariasis complications” and “hepatobiliary ascariasis”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, case reports, and reviews published up to December 2023. Summary of findings Obstruction of the small bowel is the most common complication. Others that are, rarer and more difficult to properly identify and treat, such as biliary, hepatic, and pancreatic complications, acute appendicitis, Meckel's diverticulitis, or peritoneal granulomas. Hepatic and pancreatic complications are rarer and more serious in children than in adults. While plain radiography is usually the only option in cases of intestinal obstruction, ultrasonography is the examination of choice in cases of hepatobiliary, pancreatic, and appendicular ascariasis complications in childhood. The treatment is clinical and conservative in most patients. Surgical treatment is indicated if conservative therapy fails, or if there are signs of complications. Laparoscopy has been used as an excellent technical alternative in adults with hepatobiliary complications of ascariasis, but further studies on its use in children are still needed. Conclusion The creation of protocols and greater debate on this subject should be encouraged for a better understanding of the disease and to establish an early diagnosis and adequate treatment for children with complications resulting from massive infestation by Ascaris lumbricoides. emergencies endemic patients ascariasis. . ascariasis” metaanalyses, metaanalyses meta analyses, analyses meta-analyses trials reports 2023 complication treat biliary hepatic appendicitis Meckels Meckel s diverticulitis granulomas obstruction childhood fails needed lumbricoides 202 20 2

Abstract Objective Monitoring the disease status of Epstein-Barr virus (EBV)-related hemophagocytic lymphohistiocytosis (HLH) patients is crucial. This study aimed to investigate the different strategies and outcomes of patients with EBV-HLH and re-elevated EBV-DNA. Method A retrospective analysis was conducted on 20 patients diagnosed with EBV-HLH. Clinical features, laboratory tests, treatments, plasma EBV-DNA levels, and outcomes were assessed. Three cases were highlighted for detailed analysis. Results Nine of the 20 patients had a re-elevation of EBV-DNA during treatment, and 55.5 % (5/9) experienced relapses. Patients with persistently positive plasma EBV-DNA (n = 4) and those with re-elevated EBV-DNA after conversion (n = 9) showed a significantly higher relapse rate compared to those with persistently negative EBV-HLH (n = 7) (p < 0.05). Among the highlighted cases, Case 1 exhibited plasma EBV-DNA re-elevation after four weeks of treatment without relapse, maintaining stability with the original treatment regimen, and eventually, his plasma EBV-DNA turned negative. In Case 2, plasma EBV-DNA was elevated again with a recurrence of HLH after L-DEP. Consequently, she underwent allogeneic hematopoietic stem cell transplantation and eventually achieved complete remission (CR) with negative plasma EBV-DNA. Case 3 experienced plasma EBV-DNA re-elevation after L-DEP but remained in CR, discontinuing chemotherapy without relapse. Conclusion The re-elevation of plasma EBV-DNA during EBV-HLH treatment poses challenges in determining disease status and treatment strategies. Optimal management decisions require a combination of the level of elevated EBV-DNA, the intensity of hyperinflammation, and the patient's immune function. EpsteinBarr Epstein Barr EBVrelated EBV related (HLH crucial EBVHLH reelevated re EBVDNA. EBVDNA DNA. DNA 2 EBVHLH. HLH. features tests treatments levels assessed reelevation elevation 555 55 5 55. 5/9 59 9 (5/9 relapses n 4 7 p 0.05. 005 0.05 . 0 05 0.05) regimen LDEP. LDEP L DEP. DEP Consequently CR (CR EBVDNA, DNA, hyperinflammation patient s function 5/ (5/ 00 0.0 (5 0. (

Abstract Objective To evaluate the association between inflammatory markers and abdominal fat assessed by ultrasound in prepubertal children with and without excess weight. Methods A cross-sectional study involving 241 prepubertal children, 156 with obesity, 37 with overweight, and 48 with normal weight, aged five to ten years, who were followed at a research unit on Childhood Obesity from a teaching hospital belonging to a public health system. The concentration of interleukin-6, tumor necrosis factor-α and C-reactive protein were assessed and regression analyses, considering outcome variables such as abdominal wall and intra-abdominal fat thickness measured by ultrasound, were performed. Results The findings highlighted an association between abdominal fat and inflammatory markers, even in children at this young age group. Subcutaneous fat showed a stronger association with inflammatory biomarkers compared to intra-abdominal fat when performing logistic regression, with a positive association between tumor necrosis factor-α and abdominal wall thickness equal to or greater than the 75th percentile in adjusted logistic regression (OR: 18.12; CI 95 %: 1.57: 209.55). Conclusions Abdominal wall fat, in contrast to what is often observed in adults, appears to have a greater impact on chronic inflammation related to excessive weight in very young children. crosssectional cross sectional 24 15 obesity 3 overweight 4 years system interleukin6, interleukin6 interleukin 6, 6 interleukin-6 factorα factor α Creactive C reactive analyses intraabdominal intra performed group th OR (OR 18.12 1812 18 12 9 % 1.57 157 1 57 209.55. 20955 209.55 . 209 55 209.55) adults 2 interleukin- 18.1 181 1.5 5 2095 209.5 20 18. 1. 209.

Abstract Objective To compare the phase angle (PhA) through bioelectrical impedance (BIA) of children with intestinal failure (IF) using prolonged parenteral nutrition (PN) followed by an Intestinal Rehabilitation Program, with a control group. Methods Children under 10 years of age with IF using prolonged PN for >60 days (study group) were included. The control group consisted of healthy children without chronic pathologies, matched by sex and age. Anthropometric parameters evaluated were: weight, height, weight/age z-score (W/A), height/age z-score (H/A), BMI, BMI/A z-score, arm circumference, triceps skinfold, subscapular skinfold, mid-arm muscle circumference. BIA parameters were resistance (R), reactance (Xc), and phase angle (PhA). Results Twenty-eight children were included in the study group, median (IQR) age was 11 (8-27) months, 53.6 % were male. In the control group, 28 children were included, median (IQR) age was 12.5 (8-24.7) months, 50 % were male. Children from the study group had W/A z-scores and H/A z-scores significantly lower than controls. There was no significant difference between PhA in the study group and controls, [median (IQR) 4.3° (3.8;4.6) vs 4.0° (3.8;5.4) respectively, p = 0.980]. Prematurity was significantly higher in the study group than in the controls, but there was no significant correlation between gestational age at birth and PhA of the children from the study group. Conclusion Children with IF using prolonged PN showed lower W/A and H/A compared to the control group, but without significant difference between the PhA of children with IF compared to controls. (PhA (BIA (IF (PN Program 1 60 >6 pathologies weight height weightage zscore z score W/A, WA , W A (W/A) heightage H/A, HA H (H/A) BMI BMIA zscore, score, circumference skinfold midarm mid R, R (R) Xc, Xc (Xc) PhA. . Twentyeight Twenty eight IQR (IQR 827 8 27 (8-27 months 536 53 6 53. male 2 125 12 5 12. 824.7 8247 24.7 24 7 (8-24.7 zscores scores controls 43 4 3 4.3 3.84.6 3846 3.8 4.6 (3.8;4.6 40 0 4.0 3.85.4 3854 5.4 (3.8;5.4 respectively 0.980. 0980 0.980 980 0.980] > (W/A (H/A (R (Xc 82 (8-2 824 824. 247 24. (8-24. 4. 84 3.84. 384 38 3. 46 (3.8;4. 85 3.85. 385 54 5. (3.8;5. 098 0.98 98 (8- (8-24 3.84 (3.8;4 3.85 (3.8;5 09 0.9 9 (8 (3.8; 0. ( (3.8 (3. (3