Objective:To find reference values for the Timed Up and Go (TUG) test on typically developed Saudi preschool children aged from 3 to 5 years, and to determine whether differences in test scores are based on age or gender. Material and Methods: This pilot exploratory study involved determining TUG values of Saudi preschool-aged children with typical development. Differences in the mean and standard deviation of TUG values for each age group, gender, height, and Body Mass Index (BMI) were tested. Results: During the study period, 61 typically developed Saudi preschool children aged 4.37 ± 1.10 were tested, with 55.7% of the sample being male. TUG values ranged from 4.74 to 5.20 seconds across all age groups, with time taken tending to decrease for older children in the study group. No significant differences between males and females in TUG timing (P=0.81) were observed. Conclusion: This study provides reference data for the TUG test in typically developed Saudi preschoolers, which may benefit clinicians in assessing children with developmental delays and comparing them to age-matched norms.

Patients with Glucose-6-Phosphatase Dehydrogenase (G6PD) enzyme deficiency may develop hemolysis after administering different food, drugs, and herbs. Renal damage could be mild, resolving after administration of high-volume hydration and alkylating agents, or be severe and life-threatening due to acute renal failure. Materials and Methods: All children older than 28 days of age who were experiencing the first episode of the hemolytic crisis were enrolled in this prospective cohort study. In a period between February to May 2017. An acute hemolytic crisis is defined as the acute presence of pallor or jaundice, tea-color urine, normochromic normocytic anemia, reticulocytosis, indirect hyperbilirubinemia, and normal liver function test. Demographic information and laboratory investigation were taken to assess renal damage. Results: Totally, fifty children were included in the study, there was a significant decrease in GFR during the hemolytic crisis (mean=56.1 ml/min/1.73 m2), but the value increased to reach near normal (but still less than normal) during the next three weeks (mean=82.9 ml/min/1.73 m2). Surprisingly, the serum creatinine and BUN during the crisis and three weeks later were in the normal range. Discussion: In the recent survey, we found that the mean of GFR increased but did not reach the normal range three weeks after the hemolysis, although sCr levels were in the normal range. Therefore, we thought that G6PD deficiency per se might have an adverse outcome on the kidney functions. This finding was consistent with the study conducted by Hakeem et al., showing that the damage to the kidneys persisted even after the cessation of hemolysis, while the level of cystatin C was significantly higher compared to the control group fourteen days after hemolysis.

Sialorrhea is defined as the involuntary excess of saliva in the mouth that exceeds the lip margin. This is not due to excessive saliva production but also to an alteration in the process of oral secretions that occurs mostly in people with neurological damage. Among the pathologies that can be treated with sialorrhea are Parkinson's disease, cerebral palsy, stroke, amyotrophic lateral sclerosis or facial paralysis, among others. It is a disabling symptom which, although sometimes is unnoticed and not always recorded, can lead to significant medical problems. Complications include the appearance of cavities, persistent cough, difficulty in eating, dermatitis, skin infections due to Candida Albicans or Staphylococcus Aureus cause d by persistent humidity, and even recurrent pneumonia and aspiration. Furthermore, it has been proved that it harms the patient social life, causing alterations in speech and diminishing their quality of life, sometimes even leading to social isolation. For the therapeutic management of sialorrhoea, there are currently different treatment alternatives. Oral motor training is postulated as a type of conservative therapy that, although it does not completely stop sialorrhoea, can reduce its clinical severity. Functional management is considered to be beneficial especially when is performed concomitantly with other types of treatment. However, these techniques has limited evidence and requires a capacity for understanding and patient participation that is not possible in all cases Pharmacological treatments, such as anticholinergics (glycopyrrolate or atropine), are the most widely used drugs, due to their mechanism of action: they block the parasympathetic innervation of the salivary glands. However, the reduction of side effects such as tachycardia, confusion, or urinary retention after taking this medication is not negligible. Other invasive techniques include radiotherapy of the salivary glands or surgery to remove the glands, ligation of the duct, or neurotomy of the tympanic nerve. This type of treatment, as it obtains irreversible results, is usually carried out when all other therapies fail. Currently, botulinum toxin is one of the most commonly used therapeutic procedures for the treatment of sialorrhea. Although its aesthetic use has historically been the best known, in recent years its therapeutic use has been consolidated by being introduced in numerous pathologies such as focal spasticity, dystonia or facial paralysis. It is a powerful neurotoxin, produced by the bacterium Clostridium, Botulinum, which reduces sialorrhoea by inhibiting the release of acetylcholine in the cholinergic neurosecretory junction of the salivary glands. The main objective of our study was to evaluate the efficacy of the treatment with botulinum toxin type A infiltrations under ultrasound control in children with sialorrhea treated at our Rehabilitation Unit between 2009 and 2019 and to analyse the factors associated with better results of the technique.

Pulmonary arterial hypertension is a common complication of uncorrected left-to-right shunt congenital heart disease. Beraprost have been used widely to treat pulmonary arterial hypertension in adult. However, the efficacy of the drug in Indonesian children has not been investigated. This study aim is to evaluate the efficacy of Beraprost in treating pulmonary arterial hypertension related to left-to-right shunt congenital heart disease. A randomized control trial was used in this study between April to September 2017 in Cardiology outpatient clinic of Dr. Soetomo General Hospital. Subjects aged 2-12 years with pulmonary arterial hypertension randomly received Beraprost 0.35 mcg/kg eight hourly for 12 weeks. Efficacy was evaluated by echocardiography and adverse effect was monitored. Data were analysed by statistical software using t-test and Mann Whitney test with significance level set to 0.05. All procedures were approved by hospital ethics committee and registered at the ClinicalTrials.gov. Twenty two children were recruited into the study. Resolution of Beraprost in decreasing pulmonary arterial pressure was -21.32 ± 11.06 mmHg (p=0.034). Adverse effects reported were headache. As conclusion, Beraprost is effective and safe as initial pharmacologic treatment in treating pulmonary arterial hypertension related to left to right shunt congenital heart disease.

The cause of death for Covid-19 patients is still controversial, some say that the age of children under five and the elderly has a high risk of death, some report a high risk of co-morbid mortality, such as hypertension, diabetes mellitus, asthma, pneumonia Until now, there is no definite cure for the corona virus disease 19, while transmission from person to person through droplets makes it very easily transmitted The morbidity rate is high, and also the mortality rate is around 7% The aim of the study was to prove the etiology of the death of Covid-19 patients at Jakarta Hospital Research Method: Applied research method with case control design Samples of 41 patients died and control of 41 live Covid-19 patients Sampling for patients who died from March to June 2020 a total of 41 people and 41 living Covid-19 patients were taken by random sampling, data collection was using the Eijkman Institute standard questionnaire Frequency distribution analysis, chi square and multiple logistic regression Result: The descriptive results of male gender are 56 1%, minimum age 0 5 years, maximum 92 years, and average 54 years Young people 0 5-59 years, 63 4%, and 60-92 years 36 6% Religion of Islam 68 3%, Non-Muslim 31 7% Clinical symptoms of fever 22%, no fever 78%;shortness of breath 64 6%, pain 8 5%, cough 43 9%, lethargy 20 7%, headache 13 4%, diarrhea 12 2%, nausea 24 4%, pneumonia 74 4%, sore throat 2 4%, cold 1 2%, large stomach 1 2%, swollen legs 1 2%, oxygen saturation was up normal 38 46% Co morbidity: Hypertension 35 4%, Diabetes Mellitus 23 2%, HD/CKD 12 2% X-ray almost of them pneumonia (98 8%) PCR laboratory positive 34 1%, Rapid Anti Body reactive test 25 6 Whole blood test: Hb 4 9% up normal, up normal erythrocytes 42 7% , Hematocrit up normal 42 7%, up normal thrombocytes 28%, up normal leukocytes 54 9%, up normal lymphocytes 74 4%, up normal CRP 35 4%, GDS up normal 7 3%, up normal SGOT 45 1%, up normal SGPT 45 1% Urea up normal 43 9%, creatinine up normal 56 5%, sodium up normal 59 8%, potassium up normal 58 5%, calcium up normal 63 4%, chloride up normal 53 7% Medical Care: ICU 18 2%;ventilator 23 2%, IVFD 52 4%, Oxygen 32 9%, Diet 4 9% TB drugs 6 1%, Azithromycin 3 7% Asering 2 4%, OMZ 11%, Menden 11%, Cefrocidine 41 5%, Lasix 11%, Aspilet 3 7%, Milos 46 3%, Coagulant 3 7%, Dopamine 3 7%, Alloclamide 1 2%, Hazania 1 2%, Tamiflu 1 2%, Lefloxine 2 4%, Oseltamivir 26 8% Hedonic 4 9%, Paracetamol 2 4%, Kalmix 18 3% Amlodipine 14 6% Carnefit 8 5% Renovit 2 4%, Vit C 25 6% Vit E 18 3%, Vit D 1 2%, Vit A 1 2%, Vit B Complex 1 2%, Zinc 7 3%, Vit K 7 3%, Curcuma 8 5% Significant factors associated with death: pneumonia, cough, hypertension, O2 saturation Hb, erythrocyte, Vit A, milos and IVFD The end of the multiple logistic regression model only pneumonia and IVFD were significant Detail final research for pneumonia p value 0 001, Odd Ratio 33 904, 95% CI 3,965-299,906;IVFD p value 0 001 with OR 6 654, 95% CI 2 151-20 580 were contributed 50 5% (R2) while the remaining factors are not examined Conclusion pneumonia was influenced cause of death Covid-19 © 2021, Scientific Publishers of India All rights reserved

Background: Linear growth is the best indicator of children’s well-being and provides an accurate marker of inequalities in human development. Aim: Study and compare the effect of micronutrients supplementation (Iron and zinc) on linear growth of infants and children less than 5 years of age suffering from stunted growth. Patients and Methods: A randomized study included 60 children less than 5 years of age came to the department of clinical nutrition in a university hospital for nutritional assessment. Cases randomly divided equally into two groups. Group A received iron supplementation only and group B received supplementation with iron and zinc. Follow up of length/height was done after 6 months of supplementation. Outcome Measures: Length/height for age and sex (birth to 5 years Z-scores, WHO, 2003). Results: On comparing the length/ height of the two groups before (p=0.472) and after supplementation (p=0.923) respectively, no statistically significant differences were found between supplementation with iron only and with iron plus zinc. Yet, upon calculation the rate of change in linear growth after 6 months, a significant difference (p=0.002) was evident on comparing group B who received zinc plus iron (mean=13.6 cm increase in height) vs. Group A who only received iron (mean=10.8 cm increase in height). Conclusion: Zinc supplementation in addition to iron led to significant acceleration of linear growth of stunted children compared to supplementation with iron alone.

The 20th century witnessed tremendous breakthroughs in medical research by virtue of a plethora of discoveries and advances in fundamental biology and disease management. The 21st century is taking medicine to unprecedented heights. Clinical research sponsored by a flourishing industry shaped our understanding of modern medicine. However, industry funded clinical research cannot answer all medical questions. In this review, we look at the growing impetus on investigator initiated studies, their impact on deeper understanding of real world needs, involvement of pharmaceutical, devices and imaging industry in supporting investigator or institution initiated research and instances of such successful endeavours that has changed the way medicine is practised. We also delve into the changing landscape of clinical research ecosystem in the light of recent advances in technologies like genomics, biologics, companion diagnostics and precision medicine system and the urgent need of creating and supporting a culture of research among individual clinicians, institutions, public and Government bodies in alleviating global disease burden. We recommend structural and functional models of association between the industry and investigator initiated research in order to overcome the traditional challenges of such research and pave the way for a fruitful and collaborative approach towards inclusive and comprehensive patient centric disease management.

Background: The most important autoimmune disease which affects children is Type 1 Diabetes Mellitus (T1DM). The main risk factor for this chronic condition is genetic that contributed to loci within the HLA complex. Even, the environmental issues triggering the disease are still unclear so this study aimed to identify the most important risk factors related to type 1 diabetes mellitus among children and adolescents. Methods: This is a descriptive cross-sectional study conducted among 50 confirmed diabetic children and adolescents visiting AL-Hussainy hospital in Karbala. Time of data collection continuous for two month i.e. July and August 2019. After consenting for voluntary participation in the study, parents were answering a special questionnaire containing demographic and risk factors data. Results: The age range of participate diabetic children was (18 months-17 years), around 70% of patients have never had a family history of diabetes and only 32% mentioned having thyroid diseases among their relatives. Analysis of the related maternal risk factors was showing the majority (84%) was drinking tea during pregnancy; no one had a smoking history. Only 6% diagnosed with gestational diabetes and 3% were treated with insulin. Regarding factors associated with the neonatal period, all children were delivered in the hospitals and 68% of these deliveries were normal and more than half 54% had no disease during their neonatal life. Most of the participant children (80%) continued their breastfeeding for more than 6 months. Conclusion: there are a lot of environmental risk factors related to pregnancy, neonatal period, and early childhood widely distributed among patients with type 1 DM and may have their role in causing diabetes among those patients.

In recent years the understanding about the mechanism of development of wheezing in children has improved and various management strategies were tried by different researchers. A search was made in PubMed by putting search term ‘Recurrent Wheezing in Children Diagnosis and Management’ and ‘Recurrent Wheezing in Children’. The respiratory syncytial virus induced bronchiolitis and rhinovirus infection in preschool children may lead to recurrent wheezing in preschool children. In infant immune system is immature and depends mainly on TLR ligation and maternal derived antibodies. Anti-inflammatory cytokines such as IL-10 and TGF beta are more common. RSV NS1 and NS2 proteins target RLR and TLR 3 dependent signaling and suppress the cellular response to RSV replication .This can lead to Th2 like response leading to asthma and allergy. CDHR3 acts as receptor in rhinovirus C infection. RV infection causes increase in IL 25 and IL 33 both induce Th2 type of immunity by increasing IL5 and IL 13 Daily Inhaled Corticosteroids (ICS) have been found useful in preventing exacerbations. Evidence is inconclusive about intermittent inhaled corticosteroids, intermittent montelukast and daily montelukast in recurrent wheezing. Azithromycin started early may decrease duration of wheezing episode. About intravenous magnesium sulfate and hypertonic saline evidence is inconclusive. Vitamin D supplementation in preterm babies for 6 months and avoidance of cow’s milk for first three days of life may be useful in prevention of recurrent wheezing in preschool children.

Background: The Cytokine Receptor-Like Factor 2 (CRLF2) genes play an important role in early Bcell development. Aberrations in CRLF2 activate the JAK-STAT signaling pathway that contributes to B-cell Acute Lymphoblastic Leukemia (B-ALL). The prognostic significance of CRLF2 overexpression in various B-ALL risk subgroups has not been well established. Methods: Thirty patients with newly diagnosed childhood B-ALL were enrolled from the Egyptian population. All the patients in this study were assessed by detailed history taking, a complete clinical examination required radiological and routine laboratory investigations, and flow cytometry to detect the subtype of ALL. Peripheral Blood and bone marrow samples were taken from patients, and the CRLF2 expression was measured using RT-PCR. Results: The prevalence of CRLF2 overexpression status was analyzed, and the prognostic impact of CRLF2 overexpression on B-ALL was evaluated by assessing their influence on overall survival and event-free survival. CRLF2 overexpression was found in 56% of the whole cohort. The results showed that CRLF2 overexpression was associated with a poor outcome in unselected B-ALL. Conclusion: From the present study's findings, we can conclude that CRLF2 gene expression at diagnosis has a significant prognostic impact on the clinical outcome in childhood ALL.