Saleh A. Alqahtani

Background: Pediatric polypharmacy is increasingly recognized among children with chronic medical conditions; however, data from outpatient settings, particularly in the Middle East, remain limited. This study aimed to determine the prevalence, patterns, and factors associated with pediatric polypharmacy among outpatients at a tertiary care hospital. Methods: We conducted a retrospective cross-sectional study of pediatric outpatients (p < 0.001) and outpatient visit frequency (OR 1.350, 95% CI 1.288–1.417; p < 0.001) as factors independently associated with polypharmacy, whereas sex, inpatient visits, and emergency visits were not independently associated. Epilepsy was the most common diagnosis, followed by bronchial asthma and chronic kidney disease. Pantoprazole was the most frequently prescribed medication, while endocrinology and rheumatology were the most frequently attended specialties. Conclusions: Using a definition requiring sustained concurrent medication use, pediatric polypharmacy was uncommon in this outpatient population but was independently associated with older age and greater outpatient healthcare utilization. These findings support targeted medication review and optimization strategies for children with chronic diseases requiring frequent outpatient follow-up and provide baseline data for pediatric medication safety initiatives.

Background: Frailty is a phenotype of cumulative decline leading to decreased physiologic reserve and vulnerability to stressors. Frailty is associated with adverse outcomes after liver transplantation (LT) in adults, but similar data are not available in children. A prospective multicenter study previously determined that frailty is present in 46% of children with end‐stage liver disease (ESLD). We utilized this cohort to evaluate the impact of pre‐transplant frailty on post‐LT outcomes.Methods: The study included pediatric participants from the original frailty study across 10 North American transplant centers who had subsequently undergone LT. Clinical outcomes were collected up to 1 year post LT. Participants were stratified by their pre‐transplant frailty score (defined by a pre‐LT frailty score of ≥ 6.0) and long‐term outcomes were compared between groups.Results: 28 (60.7% female, 46.4% biliary atresia) pediatric LT recipients were included, and 54% of children met criteria for frailty (n = 15). Baseline characteristics were comparable between groups; however, those with frailty were significantly more likely to have pre‐transplant failure to thrive (33.3% vs. 0%, p = 0.044). Thirty‐four hospital readmissions (22 in frail and 12 in non‐frail children) occurred in 20 patients. Higher pre‐transplant frailty scores were also significantly associated with an increased number of readmissions after transplantation (p = 0.034).Conclusions: Pediatric frailty may be associated with the adverse outcome of increased frequency of hospitalization in the first year after pediatric liver transplantation. These data support the concept that frail children should be identified and targeted for prehabilitation prior to LT.

Developmental coordination disorder (DCD) is a lifelong neurological disorder impairing the coordination and planning of motor and sensory tasks. Its functional manifestation includes difficulties in various aspects of daily living, making early diagnosis and management essential. This cross-sectional, questionnaire-based study targeted healthcare providers in Saudi Arabia’s Eastern Province who work with children under the age of 18. The questionnaire was completed through field visit interviews and electronically via social platforms from October 2023 to March 2024, collecting data on demographics, professional experience, familiarity with related disorders, and awareness of dyspraxia symptoms. Of the participants, 21.2% had previously diagnosed at least one child with dyspraxia, with family physicians comprising 30% of those diagnoses. The overall mean knowledge score was 17%, ranging from 8.3% to 23.1%. The most recognized symptom was motor learning difficulties (22.7%), followed by gross and fine motor skill delays (22.3%). Notably, 65.15% of respondents were unsure about the gender distribution of dyspraxia. The findings align with international studies, showing significant knowledge gaps among healthcare providers in the Eastern Province. These findings also emphasize the need for targeted health promotion programs, promotional activities, and media involvement for enhancing public health outcomes, early identification, and better management of DCD.

Background and Aims: Wilson disease (WD) has diverse presentations that frequently mimic other liver diseases. Distinguishing WD from non‐alcoholic fatty liver disease (NAFLD) and autoimmune hepatitis (AIH), can be difficult and has critical implications for medical management. This study aimed to examine the utility of histological features of WD in children compared to those with NAFLD and AIH.Methods: A review of liver biopsy slides was performed in children with a clinical and/or genetic diagnosis of WD, seen at the Hospital for Sick Children between 1981 and 2019 and compared to controls with NAFLD and AIH. 37 children with WD and 37 disease controls (20 NAFLD; 17 AIH) were included. Three pathologists, blind to clinical details and diagnosis, reviewed all liver biopsies to reach consensus. Clinical and histopathologic features were compared between groups.Results: Most WD cases displayed steatosis or steatohepatitis on histology (34/37), active AIH‐pattern in 1 and inactive cirrhosis in 2 cases. Electron microscopy (EM) findings of mitochondrial abnormalities including dilated tips of cristae, pleomorphism, membrane duplication and dense matrix were more frequent in the WD group as compared to disease controls (p < 0.0001). In WD, dilated tips of mitochondrial cristae had a sensitivity of 91% and specificity of 86%, best among EM features.Conclusions: Light microscopic findings display considerable overlap among children with WD, NAFLD and AIH. Ultrastructural findings of mitochondrial abnormalities are important to distinguish WD from NAFLD and AIH. EM examination should be considered essential in the diagnostic work‐up of paediatric liver biopsies.