Aged 6-12years Research Articles

Does cognitive inhibition contribute to working memory and reasoning during childhood?

Theoretical frameworks suggest that cognitive inhibition suppresses irrelevant information in working memory, preventing overload and promoting the processing of task-relevant information. Consequently, it may also contribute to more complex skills, such as abstract reasoning, by facilitating the retention and processing of patterns and relationships. However, empirical evidence does not consistently show these relationships in early elementary school years. This study aims to examine the validity of the following theoretical proposition: cognitive inhibition is a fundamental process that influences working memory, and both contribute to abstract reasoning in children aged 6-8years. The final sample included 293 schoolchildren from 1st, 2nd, and 3rd grades, who completed tasks measuring cognitive inhibition, working memory, and reasoning. Age was also considered in the analyses. The main results indicate that age is associated with improvements in working memory and reasoning (explaining 19% of the variance), but not with cognitive inhibition performance. Additionally, cognitive inhibition directly contributes to working memory (explaining 19% of the variance), and working memory, but not cognitive inhibition, contributes to abstract reasoning (the model explains 23% of the variance). No indirect effects were found. We discuss the importance of incorporating specific relationships between cognitive skills at different developmental stages into theoretical and practical proposals.

Динамика развития мотивационно-потребностной сферы во второй фазе младшего школьного возраста

<p>The article presents the results of a study based on the principle of a longitudinal study, which reveals the dynamics of the development of educational motivation and broad social motivation in children. The study involved 44 children aged 9-10years (27 boys and 17 girls) who studied in the 3<sup>rd</sup> grade in the 2022-2023 academic year and in the 4<sup>th</sup> grade in the 2023-2024 academic year. In the study of motivation, the methods "The level of motivation of teaching" and "Subjective position", the method of motivational preferences "Goldfish" and the method "Golden Age" were used. It is shown that children at the end of primary school age are characterized by a combination of object and subject positions in relation to education; the changes occurring at this time in educational motivation are traced– a decrease in its level from 3<sup>rd</sup> to 4<sup>th</sup> grade. The relative stability of motivation with a broader social context has been established. There are only two trends – a weakening of "children's" desires (possession of things, toys, etc.) and an increased focus on achieving emotional and material well-being. The correlations between the indicators of educational and broad social motivation are revealed. In particular, a perspective and optimal subjective position in relation to education correlates with a focus on the future, the realization of one's goals, friendship with peers and concern for the well-being of the teacher.</p>

Population Pharmacokinetic Modeling to Support Trofinetide Dosing for the Treatment of Rett Syndrome.

Oral trofinetide administered using a body weight-banded dosing regimen was approved in the US for the treatment of Rett syndrome (RTT) in patients aged≥2years. This approval was principally based on efficacy and safety findings of the phase 3 LAVENDER study in girls and women aged 5-20years with RTT and extended to younger children aged 2-4years with supporting data from the DAFFODIL study. Weight-banded dosing regimens were selected based on early clinical population pharmacokinetic (popPK) modeling and different scenario simulations. We report the development and application of an updated popPK model to confirm that steady-state trofinetide exposures achieved in individual patients in the LAVENDER study were within target exposure range. A previously developed popPK model using data from nine clinical studies was updated based on 13 clinical studies of trofinetide in healthy volunteers and pediatric and adult patients, including the LAVENDER study. PopPK model and empiric individual Bayesian pharmacokinetic parameter estimates were used to generate trofinetide exposures. Covariate data from the pharmacokinetic dataset from LAVENDER study subjects (n=92) were used to estimate individual steady-state trofinetide exposure (area under concentration-time curve over 0-12 h [AUC0-12]). Steady-state exposures in individual patients in the LAVENDER study were used to confirm that the dosing regimens resulted in exposures within the target range. Among 5- to 20-year-olds receiving the LAVENDER BID dosing regimen [trofinetide 6g(12‒20kg), 8g(>20‒35kg), 10g(>35‒50kg), and 12g(>50kg)], simulated AUC0-12 values overlapped with the target exposure range; median AUC0-12 values were within target exposure range for all weight bands. PopPK model-based simulations confirm that weight-banded trofinetide dosing used in LAVENDER in girls and women aged 5-20years with RTT achieved target exposure. Graphical abstract available for this article.

Assessment of sleep bruxism and its association with sleep quality, stress levels, and dental health in pediatric population: a multifactorial analysis.

Bruxism is defined as the recurring muscular activity of the jaw, which is distinguished by the unconscious grinding or clenching of teeth or pushing and forcing of the lower jaw. The present study was conducted to assess sleep bruxism and its association with sleep quality, stress levels, and dental health in the paediatric population. 384 children aged 6-12years were recruited for the study. Ethical approval from the institutional ethical committee and informed consent from parents and guardians were obtained. Children with systemic diseases, mental or developmental disorders, CNS-affecting medications, or those whose parents did not provide consent were not included. Bruxism was identified using the American Academy of Sleep Medicine (AASM) criteria through parental reports. Sleep quality and stress levels were assessed using AASM guidelines and the Perceived Stress Scale for Children (PSS-C). A chi-square test was applied to assess association, with a p value < 0.05 considered to be significant. The number of siblings and the mother's education level were also significantly associated. It was found that sleep bruxism is significantly associated with all parameters of sleep quality except the usage of pillows. When stress levels among children were assessed, it was found that 60 (15.6%) children had very low stress, 131 (34.1%) children had low stress, 95 (24.7%) children had average stress, 92 (24%) children had high stress, and 6 (1.6%) children had a very high level of stress. A statistically highly significant (p = 0.001) association was found between bruxism and stress levels among children. The results of the present study concluded that sleep bruxism was significantly linked with sleep quality and stress levels among children, which ultimately affect dental health.

Longitudinal changes in choroidal structures among children with low to moderate myopia under orthokeratology treatment.

To explore the longitudinal changes in choroidal features in myopic children with low to moderate myopia under orthokeratology (ortho-k) treatment. Children (n=80) aged 8-12years with spherical equivalent refraction of -1.00 to -6.00D were randomly assigned to the control (single vision spectacles) (n=40) and ortho-k (n=40) groups. OCT images were collected at the baseline, 1-, 6-, 12-, 18-, and 24-month visits. Choroidal structure parameters, including choroidal total area (TA), luminal area (LA), stromal area (SA), and choroidal vascularity index (CVI) were calculated. Axial length (AL) was measured as the primary indicator for myopic progression. The analysis followed the intention-to-treat criteria. Compared to the control, ortho-k significantly improved the choroidal structures in choroidal TA and LA at all follow-up points (all P<0.05). Choroidal LA was the primary contributor to TA changes (85.8%[control], 91.4%[ortho-k]), with the most significant improvement within the first 6months. While, the changes in SA and CVI over time were not significantly different between the two groups (all P>0.05). Correlation matrices identified several noteworthy correlations between AL change and choroidal structure features. Further analysis showed a significant interaction effect between baseline choroidal LA and intervention type on subsequent AL change (P for interaction=0.005), suggesting that ortho-k might be more effective in children with larger baseline choroidal LA. This 2-year prospective study demonstrated that ortho-k can improve the choroidal structures, primarily manifested in choroidal LA, although this positive effect diminishes over time. Myopic children with larger baseline choroidal LA might benefit more from ortho-k.

The Effects of Hearing One's Own Name on Subsequent Attention to Visual Stimuli in Autistic and Neurotypical Children: An ERP Study.

Hearing one's own name produces unique patterns of brain activation which triggers attention and orienting responses to the caller. Children with autism spectrum disorder (ASD) rarely orientate towards people calling their own name, but the extent to which it may facilitate processing of the following external stimuli are not yet clear. The current study consisted of both auditory and visual stimuli. Electroencephalogram (EEG) was measured in 28 autistic and neurotypical children (aged 3-7years) to investigate auditory event-related brain potentials (ERPs) while hearing either their own or an unfamiliar name, and subsequent visual ERPs when viewing objects after hearing them. The results demonstrated that, unlike neurotypical children, autistic children did not show enhanced P300 responses upon hearing their own name, but exhibited more negative N1 response in the left frontal region to hearing their own name than an unfamiliar name. However, both autistic and neurotypical children showed equivalent changes in N2, P3 and Late positive potential (LPP) visual ERPs when viewing objects after hearing their own name relative to an unfamiliar name. These findings suggest that autistic children who do not overtly respond to their own name (characterized by a head-turn), nevertheless exhibit increased attention to visual objects in their environment after hearing it. This implies that autistic children do recognize the sound of their name as important but may not understand the social meaning of it.

A Fundamental Movement Skill Test for Preschool Children With and Without Overweight: The SALTO Test Battery.

This study aimed to evaluate a 3-factor model of fundamental movement skills in preschool children, incorporating both process- and product-oriented assessment methods, and to test the model's invariance across subgroups of age, body weight and sex. The SALTO test battery was administered to 736 preschool children aged 3-6years. A single-indicator multitrait-multimethod model was specified with Locomotion, Object Manipulation, and Balance as latent factors and a latent method factor to address the multimethod design. Measurement invariance was tested across subgroups using multigroup confirmatory factor analysis. The 3-factor model yielded good fit indices, confirming the construct validity of the SALzburg Together against Obesity test battery. Strong measurement invariance was found across body mass index groups, whereas partial invariance was observed across age and sex groups. Older children outperformed younger ones in all skill domains, children with overweight had lower skills in Balance and Locomotion, and sex differences were found in Object Manipulation and Balance. The SALTO test battery is a structurally valid tool for evaluating and comparing fundamental movement skills in preschool children across age, weight status, and sex. The findings underscore the importance of considering these factors when designing interventions to enhance fundamental movement skills in early childhood.

Health-related quality of life and its association with socioeconomic status and mental health in 5- to 7-year-old children: a cross-sectional study.

Assessing socioeconomic status (SES), mental health, and health-related quality of life (HRQoL) in young children is crucial for making informed health care decisions and identifying areas of intervention. The present study aimed to investigate potential associations between SES, mental health, and HRQoL in 5-7-year-old children. The present study included mother-reported health assessments for 621 children aged 5-7years in Grade 1 collected between 2019 and 2023 as part of the Starting Right™ project. Online questionnaires were used to support public health nurses in assessing children's health status. HRQoL (KIDSCREEN-27, 5 subscales) and mental health [Strength and Difficulties Questionnaire (SDQ), 4 subscales] were assessed. Sociodemographic characteristics, sex, maternal education, and income were obtained from Statistics Norway. The data were analyzed using multiple robust regression. Mother-reported mean scores for the KIDSCREEN-27 were within the normal range compared with European norms (8-11years). However, for each KIDSCREEN-27 dimension, there were individuals whose mothers reported scores that were substantially lower than average. Having mental health problems, defined as being in the 80th and 90th percentiles of the SDQ Total problem score, was associated with 2.1-10.7-point lower KIDSCREEN-27 scores (p < 0.001-0.021), which was most noticeable in the KIDSCREEN-27 school environment subscale. Weak but significant positive associations were found between SES and HRQoL. Our results provide important insights into the associations between SES, mental health, and HRQoL in young children. Given the strong association between mental health problems and HRQoL in Grade 1 children, the assessment of both is essential, so that early interventions, an improved caring environment, and nurturing support can be initiated.

Multi-Informant Universal Mental Health Screening for Preschool-Aged Children by Parents and Educators: A PRISMA Systematic Review.

Children develop rapidly in the preschool period, making accurate appraisals of mental health (MH) difficult. The preschool years are a key period for early identification of MH concerns and could benefit from multi-informant, universal MH screening (UMHS). This systematic review aimed to identify multi-informant UMHS measures for preschool-aged children, and to examine their clinical utility, effectiveness, and acceptability. Studies reporting the predictive and incremental validity, effectiveness or acceptability of parent and educator-report UMHS measures for children aged 3-5years were identified through CINAHL, Embase, ERIC, Medline, PsycINFO, Scopus and Web of Science. Studies were excluded if screening was not the primary focus, not universal, single informant, or primarily focussed on Autism Spectrum Disorder. A total of 11 studies using 10 measures was identified. Ten studies screened for broad MH difficulties. Three educator-report and one parent- and educator-report measures had acceptable predictive validity. One study reporting incremental validity found that adding educator-report to parent ratings significantly improved the identification of MH concerns. No studies reported on effectiveness. Three studies that explored acceptability reported strong support for either UMHS in general or specific measures. There are promising results that UMHS can accurately identify child MH concerns in the preschool period using parent and educator reports. However, with few of the examined measures reaching the benchmark standards for predictive validity and only one study examining incremental validity, further research is needed to establish clinical utility. UMHS with preschool populations appears to be acceptable; future studies should further examine multi-informant screening in preschool populations. This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; https://www.crd.york.ac.uk/prospero ; registration number: CRD 42022383426).

Comparative evaluation of two audio sensory methods on oral hygiene maintenance in visually impaired children.

To evaluate and compare the efficacy of manual toothbrush, audio-tactile performance (ATP) method, and musical toothbrush on plaque control and oral hygiene maintenance in visually impaired children. The current observational study included 60 visually impaired children aged 9-16years who were randomly divided into 3 groups, each with 20 children receiving oral hygiene instructions in different modes: Group 1 (Control) manual toothbrush, Group 2 (ATP) audio-tactile performance method with a manual toothbrush, and Group 3 musical toothbrush. Both manual (groups 1 and 2) and musical toothbrushes (Group 3) were changed after 3months for better efficiency. Oral hygiene index simplified (OHI-S) and Rustogi Modified Navy Plaque Index (RMNPI) plaque scores were recorded at baseline, at the end of 1, 3, and 6months. The collected data were statistically analysed using SPSS version 21. The intra- and inter-group comparisons were analysed using one-way ANOVA, and the multiple group comparisons were analysed using the Tukey HSD test. In intragroup comparisons from baseline to 6months, both OHI-S and RMNPI plaque scores were reduced for group 3, only OHI-S plaque scores were reduced for group 2. Intergroup comparisons revealed a statistically high significant difference in OHI-S plaque scores from baseline to 6months and RMNPI plaque scores from 1 to 6months. The motivation and education with musical toothbrushes and audio-tactile performance (ATP) method could aid in the improvement of oral hygiene maintenance of visually impaired children.

The impact of early childhood education and care-based interventions on child physical activity, anthropometrics, fundamental movement skills, cognitive functioning, and social-emotional wellbeing: A systematic review and meta-analysis.

This review assessed the effectiveness of ECEC-based interventions to improve child physical activity, and intervention impact on child weight-based anthropometrics, fundamental movement skills (FMS), cognitive functioning, and social-emotional wellbeing. Adverse effects and costs were assessed. Finch et al's 2014 systematic review was updated. Electronic databases were searched 10 September 2014 to 27 October 2022. Included studies were randomized controlled trials of ECEC interventions targeting physical activity among children aged 0-6years. The methodological quality of studies was assessed using Cochrane's Risk of Bias tool v2. Standardized mean differences (SMD) were calculated for each outcome with meta-analysis undertaken; otherwise, findings were described narratively. Fifty-three studies were included. ECEC-based interventions were found to significantly improve child physical activity (SMD 0.193, 95% confidence interval [CI] 0.09 to 0.3; p < 0.001) and FMS (SMD 0.544, 95% CI 0.1 to 0.98; p = 0.015), compared to control. Small positive, but non-significant, effects were found for weight-based anthropometrics, cognitive functioning, and social-emotional wellbeing. Few studies reported adverse effects (n = 10), and no studies reported formal economic analyses. While ECEC-based interventions can significantly improve child physical activity and FMS, further evidence of their impact on cognitive functioning, social-emotional wellbeing, and the cost-effectiveness of such interventions is required to inform policy and practice.

Efficacy of whole body vibration on fascicle length and joint angle in children with hemiplegic cerebral palsy.

Enhancing joint range of motion is regarded as one of the most long-term goals in the management of cerebral palsy (CP). With CP, there are well-documented changes in the neurological drive to skeletal muscle, which leads to modifications in the architecture of the muscles. Whole-body vibration (WBV) is one intervention to modify muscle and joint. However, its efficacy needs to be accurately studied. This study investigates the effects of WBV on fascicle length, knee joint angle and function in children with spastic hemiplegic CP. Eighty children with hemiplegic CP aged 4-6years were enrolled. Participants were randomly divided into experimental and control groups. The control group received a designated physical therapy program and the experimental group received a designated physical therapy program in addition to WBV. Program was performed 3 times a week for 12weeks. Goniometry, ultrasonography and gross motor function measurements were used to measure knee extension joint angle, fascicle length of hamstrings and function, respectively. The results of this study indicated that, designed physical therapy program with WBV could increase the active range of motion in knee extension (p=0.001) and fascicle length of hamstring (p=0.001) muscles as well as improve function in children with hemiplegic CP (p=0.001). According to the findings, the use of WBV can be considered as an effective treatment in increasing the range of motion of knee extension and fascicle length and finally improving function in children with CP.

Toowoomba Healthy Towns: A Citizen Science Initiative on Active Transport in Regional South East Queensland, Australia.

Engaging in active transport will enable individuals across the life course to increase their habitual levels of physical activity. The aim of this study was to engage citizen scientists (CS) to identify factors that influence active transport in their community. The Our Voice citizen science methodology developed at Stanford University was employed. CS completed a "discovery walk," taking photos of things that help or hinder active transport. Three groups were recruited: children aged 10-12years (n = 11), adults (n = 12), and older adults >65years (n = 10). CS rated each photo and provided a narrative explaining their reason for taking the photo. Once all CS in a specific age group had completed the walk, they met for a group discussion. The CS worked together to analyze the data, arranging them into themes and identifying priority actions. Two CS representatives from each age group presented their findings to the local council decision makers. Children highlighted the need for safer crossings, especially from their school to the local park, and suggested zebra crossings as a solution. The adults highlighted that road signs prioritized vehicles, not pedestrians, and requested that this be reversed. Older adults noted that the poor condition of the pavements made it harder for people in wheelchairs to navigate. The CS recommendations have informed the council's walking and cycling network program. Engaging with citizen science provided the community with an opportunity to advocate for meaningful yet realistic improvements in the built environment that could promote neighborhood active transport and physical activity across the lifespan.

The British Preschool Children's Play Survey: When, Where, and How Adventurously Do British Preschool-Aged Children Play?

Outdoor, adventurous play supports physical activity and might help to prevent mental health problems, yet data on preschool-aged children's outdoor play are scarce. Data were collected from a nationally representative sample of 1166 parents/caregivers of children aged 2-4years (52% male; 88% white) living in Britain. Caregivers reported time children spent playing in 7 locations and corresponding adventure level. Responses were used to derive: total play time, outdoor play time, and adventurous play time (in hours per year). Associations between sociodemographic characteristics and play outcomes were examined, controlling for relevant confounding variables. Outside of childcare, preschool-aged children spent approximately 4hours per day playing, with 1hour 45minutes spent playing outdoors. Most outdoor play happened in gardens at home. Away from home, children most often played in playgrounds and green spaces. Levels of adventurous play were reported to be highest at indoor play centers, followed by playgrounds and green spaces. Total play differed significantly by location, with children in rural areas spending more time playing (vs urban areas). Child ethnicity was associated with play and outdoor play, with children belonging to minority ethnic groups (vs white) playing less. Child sex was also a significant predictor of outdoor play time: boys (vs girls) spent more time playing outdoors, driven primarily by time spent in green spaces. No associations were found for adventurous play. These results highlight how inequalities in access to outdoor space at home and good quality local play spaces may impact young children's play opportunities and, in turn, exacerbate health inequalities.

N-acetyl-β-D-glucosaminidase inclinically healthy German Shepherd dogs and dogs with early stages ofchronic kidney disease.

Urinary N-acetyl-β-D-glucosaminidase (NAG) activity isassociated with kidney disease. Inour study, wefocused onevaluating the ratio ofNAG tothe urinary creatinine concentration (NAG/Cr) inthe German Shepherd breed. Sixty-two healthy dogs and thirteen dogs with chronic kidney disease (CKD) were examined. The healthy dogs were divided into groups based ontheir sex and age (puppies and adolescent dogs under 2years, adult dogs from 2to 6years and seniors over 6years), while the dogs with CKD were divided based onthe disease stage (CKD stage1 and2). Nosignificant difference was detected between the males and females. Regarding theage dependence, significantly higher values were found indogs older than 6years (P=0.0203) compared todogs aged 2-6years. When comparing the healthy dogs tothe dogs with CKD, the lowest NAG/Cr ratio was observed inthe dogs with CKD stage2. The reference interval for NAG/Cr inthe German Shepherd was established intherange of0.78-7.86U/gCr. Weobserved nocorrelations with the commonly used markers ofkidney disease such ascreatinine, urea, orsymmetrical dimethylarginine. Nevertheless, weencourage the further investigation ofNAG inrelation toCKD, taking the breed, sex and age ofthe patients into account.

Adolescents and parents' knowledge of chronic kidney disease: the potential of school-based education.

Preventing the progression of chronic kidney disease (CKD), reducing the incidence of new dialysis patients, and increasing public awareness about CKD are pivotal in mitigating renal impairment. This study aimed to assess the relevance of kidney disease and CKD knowledge among junior high school students and their parents. A questionnaire survey on kidney function and CKD was conducted among students aged 14-15years and their parents (851 pairs). Parents were also asked about their age, sex, and participation in health checkups. The study achieved a collection rate of 49.1%, with a valid response rate of 79.7%. Both junior high school students and their parents exhibited limited knowledge about kidney functions, primarily understanding these functions only in terms of waste product excretion and lacking awareness of other functions. A significant positive correlation was observed in awareness of kidney functions between students and their parents. Regarding CKD awareness, only 2.4% of students and 16.5% of parents were knowledgeable about CKD itself, while 18.9% of students and 45.3% of parents were aware of its name only. Importantly, CKD knowledge among both students and parents was associated, with those aware of CKD also demonstrating better understanding of kidney functions. This study highlights inadequate knowledge among junior high school students and their parents regarding renal function and CKD. A significant correlation was observed in CKD awareness between students and their parents. These findings underscore the need for targeted strategies to enhance public education and awareness about kidney health.

Peer-Mediated Social Skills Interventions in Primary School Settings for Autistic Children in the Light of the ICF Bio-psycho-social Model. A Systematic Review.

This systematic review expands the current knowledge about Peer-Mediated Interventions (PMIs) for children with Autism Spectrum Disorder, focusing exclusively on primary school age (6-12years). The study has three aims: (1) describing the main features of the PMI programs; (2) discussing the PMIs efficacy on autistic children's social skills; (3) analyzing whether the PMIs were coherent with the bio-psycho-social model promoted by the International Classification of Functioning, Disability and Health (ICF) classification system, by referring to the person-environment interaction and to the concepts of body functions and structures, environmental factors, and activity and participation. The systematic review followed the PRISMA-P method. The literature search was conducted in August 2024 through PsycInfo, PsycArticles, Education Source, and PubMed databases. A total of 558 articles were generated; 1 study was later added. Twenty-four articles were finally included. Most of the studies used a multiple baseline design across subjects and proved to be effective. Yet, only 5 studies included a follow-up assessment, which showed contrasting results. PMIs partly fit the ICF bio-psycho-social vision, even if they were not designed for this purpose. Our analysis arises from the belief that systematically including the perspective of individual-environment interaction could better guarantee the intervention efficacy.

Unveiling patterns in pediatric appendectomy: A comparative study on healthcare resource capacity and surgical decisions in Brazil.

Appendicitis is the most prevalent surgical emergency in children. This study examined hospital infrastructure, surgical techniques, patient demographics, and hospitalization parameters to assess the provision of safe and adequate care within the Brazilian public healthcare system. Pediatric hospitalizations for acute appendicitis in 2022 were extracted from the Brazilian national database. We included all hospitalizations for patients aged 0-16years with a primary ICD-10 diagnosis of acute appendicitis who underwent an operation. Parameters of interest were the type of surgical approach, mortality, and total cost of hospitalization. Facilities were defined as basic-facility, full-facility, and pediatric according to the level of pediatric resources available. In 2022, there were 29,983 pediatric appendectomies due to acute appendicitis. Of these, 90.2% were open appendectomies. Most occurred in basic-facility general hospitals (53.0%), followed by full-facility (35.2%) and pediatric hospitals (11.8%). Full-facility hospitals had a higher median cost (USD126.3, IQR 99.5-154.4) compared to basic (USD96.8, IQR 87.6-130.1) and pediatric hospitals (USD103.0, IQR 91.9-117.5), though the cost difference between basic and pediatric was not significant (p=0.367). Death was a rare event across all levels of hospital infrastructure and for all types of procedures performed. The majority of hospitalizations for acute appendicitis occurred in hospitals with minimal pediatric infrastructure. Open appendectomies remain the most predominant procedure across all hospital types.

Eculizumab as first-line treatment for patients with severe presentation of complement factor H antibody-mediated hemolytic uremic syndrome.

Complement factor H (FH) antibody-mediated hemolytic uremic syndrome (HUS) has varying prevalence globally. Plasmapheresis and immunosuppressive drugs are the standard treatment. Recently, eculizumab has been reported as an effective alternative. This study aims to report four children with FH antibody-mediated HUS managed with eculizumab plus immunosuppression as first-line therapy. A retrospective chart review was conducted for children aged ≤ 18years old with complement-mediated HUS in two referral centers. Patients with FH antibody-mediated HUS treated with eculizumab as first-line therapy were included. Four children (aged 6-11years old) were included. Dialysis was necessary in three patients. Eculizumab was administered 5-23days after onset. None of them received plasmapheresis. Prednisone and mycophenolate mofetil were added after receiving positive FH antibody results. Hematological signs and kidney function improved after the second eculizumab dose. Eculizumab was discontinued in three patients after 6months. One patient required rituximab due to persistent high FH antibody titers; discontinuation of eculizumab occurred after 15months without recurrence. No treatment-related complications were observed. During a mean 12-month follow-up (range 6-24months), no relapses were recorded and all patients ended with normal GFR. Our data suggest that a short course of 6months of C5 inhibitor might be sufficient to reverse thrombotic microangiopathy symptoms and improve kidney function in patients with severe FH antibody-mediated HUS. Simultaneously, adding immunosuppressive agents might reduce the risk of relapse and allow cessation of C5 inhibition in a shorter period of time.

Potential associations between Schistosoma mansoni infection and physico-chemical characteristics and water-related human activities in Côte d'Ivoire: a cross-sectional study.

Schistosomiasis remains a public health problem, particularly in sub-Saharan Africa. The disease is intimately connected to poverty and environmental factors. Our research was readily embedded into a multi-country schistosomiasis oversampling study. The aim of the study presented here was to determine the prevalence of Schistosoma mansoni and to investigate the role of water body characteristics and water-related human activities in disease transmission. In August and September 2022, a cross-sectional study was conducted in the western part of Côte d'Ivoire. Stool and urine samples were collected from 1602 and 1729 children aged 5-14years, respectively, in 65 villages in the health districts of Biankouma, Ouaninou and Touba. Additionally, data were collected from direct observation of water-related activities at water bodies and interviews conducted with community leaders and health workers. The prevalence and risk factors for Schistosoma infection were assessed using generalised estimating equation models. The prevalence ofS.mansoni and S.haematobium were 27.4% (95% confidence interval [CI] 21.5-34.3%) and 0.1% (95% CI 0.03-0.5%), respectively. Low prevalence of soil-transmitted helminths was observed with 2.4%, 0.4% and 0.2% for hookworm, Trichuris trichiura and Ascaris lumbricoides, respectively. At the health district level, we found S.mansoni prevalence of 34.4% (95% CI 25.0-45.3%), 34.3% (95% CI 24.0-46.2%) and 16.3% (95% CI 9.5-26.6%) for Biankouma, Ouaninou and Touba, respectively. Female and male participants were at a similar risk of infection (29.0% vs. 26.0%, odds ratio [OR]: 1.18, 95% CI 0.92-1.50). Children aged 9-14years showed a higher prevalence than their younger counterparts aged 5-8years (34.5% vs. 22.7%, OR: 1.80, 95% CI 1.42-2.27). High infection prevalence was observed in villages where children were washing clothes and dishes at open surface water sites and pursued recreational activities (e.g. swimming and playing in the water). The temperature, total dissolved solids and pH of water samples showed no significant association with S.mansoni infection at the village unit. Human water-related activities such as washing clothes and playing in the water are risk factors for S.mansoni transmission. Hence, preventive chemotherapy should be combined with information, education and communication to avoid or reduce the frequency of water exposure in children as part of a comprehensive package of interventions towards elimination of schistosomiasis as a public health problem.