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Objective: To find the frequency of esotropia, its sub types and subsequent management carried out in pediatric age group presenting to a tertiary care hospital in Quetta.Study Design: Cross-sectional study.Place and Duration of Study: Ophthalmology Department, Tertiary Care Hospital, Quetta Pakistan, from Jul to Dec 2020.Methodology: Two hundred and forty patients were enrolled in the study with age 6 months to 13 years presenting with manifest or latent squint. Data was collected through consecutive sampling technique. A designed form for refraction and orthoptic assessment was used with complete ophthalmological examination on each visit. Diagnosis was made based on international definitions of strabismus and treatment was planned accordingly. Follow up was carried out to observe and analyze the effects of treatment in strabismus.Results: Among 240 patients with strabismus, 152 patients had esotropia. More common in males (n=88) and most common refractive error was hypermetropia (n=94). Out of these 32 had anisometropia and 47 had amblyopia. According toclassification of esotropia, 34.2% of patients had fully accommodative esotropia and 13.2% patients had essential infantile esotropia. Combination of treatment modalities was used. 21 patients were prescribed executive bifocals. Patching for 2 hours daily during activity under observation was advised to patients with amblyopia. 36 patients had surgery and 14 patients were kept under observation.Conclusion: Our study concluded that esotropia was the most prevalent type of strabismus in pediatric age group at tertiary care hospital in Quetta with accommodative type being the most common which can successfully be...

Purpose: Cirrus optical coherence tomography (OCT) provides high resolution cross-sectional images of the retina, vitreous humor, and optic nerve head with an axial resolution of 5 μm and a reproducibility of 1.6 μm. An integrated normative database is available only for adult subjects ≥18 years of age; the normal reference ranges of the macular thicknesses of pediatric subjects are not available. The purpose of this study was to determine the normal reference range of macular thickness of pediatric. Methods: A total of 340 eyes of 170 children 5-17 years of age were recruited for this study. Participants received a full ophthalmic examination including a vision assessment, cycloplegic refraction, fundus examination, intraocular pressure measurement, assessment of ocular motility, and alignment. Macular thickness measurements were obtained through dilated pupils using Cirrus HD-OCT. Results: The mean macular thickness was 114.88 ± 14.74 in the right eye and 113.99 ± 15.62 in the left eye (P = 0.589). On further evaluation, macular thickness was highest in the inner macula, followed by the outer macula and central fovea (P < 0.001). Conclusion: The normative data of macular thickness in pediatric subjects 5-17 years of age will help diagnose macular disorders.

In recent years, a more stable AVP surrogate, called copeptin, has been used as an adjuvant diagnostic tool for dysnatremia in adults and appears to be promising even in the pediatric age. The aim of this study is to present the distribution of plasma copeptin in a large pediatric cohort and to observe the influence of fluid consumption and obesity on its values. A cohort of 128 children and adolescents was divided into two groups on the basis of nocturnal deprivation (group A) or free access to oral fluids in the 6–8 h before blood collection (group B). At all distribution percentiles, copeptin levels were higher (p < 0.0001) in group A, as were plasma sodium levels and osmolality (p = 0.02 and p = 0.008, respectively). The influence of BMI on copeptin levels was investigated by dividing the cohort into nonobese (group C) and obese children and adolescents (group D). Copeptin levels were higher in group D (p = 0.04).Conclusion: The measurement of copeptin could represent a useful tool for the diagnostic pathway of dysnatremic conditions, but its interpretation should take into consideration the state of hydration. Furthermore, it could also be a promising marker for obesity and metabolic syndrome, although this hypothesis needs further studies to be confirmed.What is Known:• Copeptin use as a diagnostic tool in AVP-related disorders, such as diabetes insipidus or syndrome of inappropriate secretion of antidiuretic hormone, is well established in adults• In pediatric age, few studies are available, but the preliminary data, including our previous study, seems to be promising.What is New:• In this study, we represent the distribution of copeptin levels in a pediatric cohort and show the significant influence of fluid ingestion on its plasma levels.• Also BMI seems to be a significant variable on copeptin levels and may be used as an obesity marker in pediatric age

Pediatric cataract is a leading cause of childhood blindness. Untreated cataracts in children lead to tremendous social, economical, and emotional burden to the child, family, and society. Blindness related to pediatric cataract can be treated with early identification and appropriate management. Most cases are diagnosed on routine screening whereas some may be diagnosed after the parents have noticed leukocoria or strabismus. Etiology of pediatric cataract is varied and diagnosis of specific etiology aids in prognostication and effective management. Pediatric cataract surgery has evolved over years, and with improving knowledge of myopic shift and axial length growth, outcomes of these patients have become more predictable. Favorable outcomes depend not only on effective surgery, but also on meticulous postoperative care and visual rehabilitation. Hence, it is the combined effort of parents, surgeons, anesthesiologists, pediatricians, and optometrists that can make all the difference.

Background Long COVID-19 syndrome is a complex of symptoms that occurs after the acute SARS-CoV-2 infection, in the absence of other possible diagnoses. Studies on Long COVID-19 in pediatric population are scanty and heterogeneous in design, inclusion criteria, outcomes, and follow-up time. The objective of the present study is to assess the prevalence of Long COVID-19 syndrome in a cohort of Italian pediatric primary care patients, observed for a period of time of 8 to 36 weeks from healing. Prevalence was also assessed in a cohort of pediatric patients hospitalized during acute infection. Methods Data concerning 629 primary care patients with previous acute SARS-CoV-2 infection were collected by a questionnaire filled in by Primary Care Pediatrician (PCP). The questionnaire was administrated to patients by 18 PCPs based in 8 different Italian regions from June to August 2021. Data concerning 60 hospitalized patients were also collected by consultation of clinical documents. Results Cumulative incidence of Long COVID-19 resulted to be 24.3% in primary care patients and 58% in hospitalized patients. The most frequently reported symptoms were abnormal fatigue (7%), neurological (6.8%), and respiratory disorders (6%) for the primary care cohort. Hospitalized patients displayed more frequently psychological symptoms (36.7%), cardiac involvement (23.3%), and respiratory disorders (18.3%). No difference was observed in cumulative incidence in males and females in both cohorts. Previous diseases did not influence the probability to develop Long COVID-19. The prevalence of Long COVID-19 was 46.5% in children who were symptomatic during acute infection and 11.5% in asymptomatic ones. Children aged 0 to 5 years had a greater risk to develop respiratory symptoms, while adolescents (aged 11–16 years) had a greater risk to develop neurological and psychological Long COVID-19 symptoms. Conclusions Our study demonstrates that Long COVID-19 is a reality in pediatric age and could involve even patients with mild or no acute symptoms. The results stress the importance of monitoring primary care pediatric patients after acute COVID-19 infection and the relevance of vaccination programs in pediatric population, also in order to avoid the consequences of Long COVID-19 syndrome.

Background: The adverse health effects of abdominal obesity are well documented in adults, but such association remains to be determined in the pediatric age group. This study aims to perform a systematic review on the association between abdominal obesity and cardio-metabolic factors such as dyslipidemia, hypertension, and hyperglycemia among children and adolescents. Materials and Methods: A systematic literature search was conducted using PubMed, Scopus and Google Scholar databases to May 2014. Two independent reviewers identified relevant papers in several steps. After studying the titles and texts of documents, repeated and irrelevant ones were excluded. The search was refined to the English language. We did not consider any time limitation. Studies with different measuring methods of abdominal obesity were included. Studies with abdominal obese patients secondary to other disease were excluded from the study. In final, the data of association of cardio-metabolic risk factors and abdominal obesity extracted from studies. Results: Overall, 3966 articles were reviewed, and 61 of them were studied according to the inclusion and exclusion criteria. Waist circumference (WC), waist-to-height ratio, and waist-to-hip ratio were the most common indexes used for defining abdominal obesity. The association of high blood pressure with increasing WC was seen in several studies. The association of other cardio-metabolic risk factors was seen in some studies. Conclusion: Whatever the definition used for abdominal obesity and whatever the methods used for anthropometric measurements, central body fat deposition in children and adolescents increases the risk of cardio-metabolic risk factors. Therefore, more attention should be paid to abdominal obesity of children and adolescents both in clinical practice and in epidemiological studies.

Il dolore toracico in età pediatrica è un motivo frequente di visita ambulatoriale pediatrica o di accesso ai dipartimenti di emergenza ospedalieri. Nella maggioranza dei casi, si tratta di un dolore idiopatico o di origine muscolo-scheletrica mentre un’eziologia cardiaca è riscontrata solo nello 0.5-1% dei casi. L’incidenza ha un picco fra 10 e 14 anni ed è lievemente superiore nei maschi. L’identificazione dei (rari) casi sospetti per un’origine cardiovascolare consente di evitare esami inappropriati e tempi eccessivi di permanenza in ambiente ospedaliero per la maggioranza dei bambini/adolescenti ma anche di avviare rapidamente gli accertamenti nei soggetti con sospetta cardiopatia per i quali è importante una diagnosi precoce.

Purpose In recent years, copeptin stimulation through arginine administration has been evaluated as a new potential tool in the differential diagnosis of polyuria-polydipsia syndrome (PPS) in adults; to date very few data, all retrospective, exist in pediatric age. The aim of this prospective study is to evaluate the diagnostic performance of the arginine-stimulation test for copeptin in a cohort of pediatric patients affected by PPS. Methods All children (<18 years) referred to the Department of Pediatric Endocrinology of the Regina Margherita Children Hospital for polyuria-polydipsia in the period January 2021–June 2023 were enrolled. The Arginine-stimulation test for copeptin was performed in all patients presenting PPS after water deprivation test (WDT). Patients with polyuria-polydipsia were then classified as having primary polyuria (PP), complete and partial central diabetes insipidus (CDI), according to the standardized interpretation. Arginine-stimulation test for copeptin was also performed in a control cohort. Results A significant difference in arginine-stimulated copeptin values was observed at baseline ( p  = 0.005), at 60 min ( p  = 0.01), and at 90 min ( p  = 0.005) in 7 subjects presenting PP, 6 patients affected by CDI and 50 subjects of the control cohort. Plasma osmolality values remained stable at all measurements. The arginine-stimulated copeptin test demonstrated sensitivity and specificity of 100%, whereas the sensitivity of the WDT test was 83.3% and the specificity was 85.7%. Conclusion Given the reliability and the minor adverse effects and costs, the copeptin level after arginine administration could replace the WDT in the diagnostic workup of these in pediatric age.

AimDermoid tumors are uncommon intracranial tumors that grow slowly and typically manifest in individuals aged between their third and fifth decade. Dermoid cyst is an uncommon ectoderm originated benign cyst. Giant dermoid cysts are more rare, especially in the posterior fossa. Although intracranial dermoid cyst may commonly occur in the cerebellopontine angle and chiasma opticum, it can bedetected in cerebral hemispheres as well as intraventricular area. Here, we present a case involving a fourteen years old congenitaly deaf and mute patient with edited operation video.Material and MethodThe patient was fourteen years old and was deaf and mute from birth. There were complaints of headache, vomiting, and imbalance that gradually increased in recent months. In the MR imaging examination;A calcified, cystic mass measuring 5.2 x 4.8 x 3.8 cm, compressing the brainstem and the 4th ventricle, was revealed in the posterior fossa (figure 1A–M).Abstract OP-055 Figure 1Preoperative, intraoperative and postoperative images (figure 1). A- Preop Axial MRI B, C- Preop Coronal MRI D-Preop Sagittal MRI E- Preoperative Diffusion MRI F- Intraop Figure G-Intraop Figure (strand of hair) H- Intraop Figure (Tumor Mass) I- Intraop Figure (Total excision of the mass) H- Postop CT K- Postop Sagittal MRI L- Postop Axial MRI M- Postop Coronal MRI.ResultsWhen the patient‘s MRI examinations are examined;The temporal horn of the ventricle became prominent and hydrocephalus began. The patient underwent surgery in the prone position and total mass resection surgery was performed with posterior fossa craniotomy. There were also strands of hair in the mass. In many surgeries, mass excision surgery is performed after ventriculo-peritoneal shunt or external ventricular drainage. In our case, emergency mass removal surgery was successfully performed without the need for these different surgeries, and it was observed that the hydrocephalus disappeared in the postoperative period. The histopathological diagnosis of the patient was defined as dermoid cyst.ConclusionsPosterior fossa tumors are generally primary in the pediatric age group, unlike adults, and metastasis is not observed. In adults, posterior fossa tumors are considered metastases until proven otherwise. Dermoid tumors are very rare. The mass pressing on vital organs(Pons, mesencephalon) and causing hydrocephalus by obstructing the 4th ventricle requires urgent removal of the mass. In our case, although there was the beginning of hydrocephalus, the mass was completely removed and hydrocephalus was prevented without the need for ventriculoperitoneal shunt placement.

Background In Saudi Arabia, general pediatrics serves children until they are 14 years old. It has contributed to improving the health of Saudi children. Method This study adopted a qualitative method and recruited pediatric physicians to investigate status, successes, challenges, and opportunities. Later, data were analyzed using thematic analysis and hermeneutic phenomenology. Results This study attracted 13 pediatric physicians for interviews. All participants appreciated the role of general pediatricians, but the trainees had a negative attitude regarding the general pediatrics specialty. They all agreed on providing primary care for all children and recommended that their first visit should occur earlier. Shortage of pediatricians, lack of community pediatricians, busy clinics, limited Arabic resources, and poor communication skills are significant barriers to children receiving adequate care. The majority of pediatricians favor extending the pediatric age to 18 years old. One pediatrician stated, “Youths between ages 14–18 years are lost, adults and we refuse to care for them…” Additionally, pediatricians have concerns about managing developmental delays and behavioral issues. They believe the current pediatric residency provides many opportunities for a brighter future. Conclusion General pediatrics is well established in Saudi Arabia. To continue thriving, we need to address some challenges that pediatricians face and attract more residency graduates. The current pediatric residency programs can provide opportunities to address deficit areas.