Attacks In Children Research Articles

Syncopal attacks in children: Is it cardiac or epilepsy related?

Transient loss of consciousness (TLOC) may be mistaken for other disorders like epilepsy. Our objectives were to identify symptoms that could help differentiate epilepsy from syncope among children with TLOC and to validate previously suggested criteria. We retrospectively reviewed the charts of patients aged 18years or younger who presented with TLOC attacks from January 2008 to December 2018 at King Saud University Medical City, Riyadh, Saudi Arabia. Symptoms from which epilepsy and syncope could be predicted with high accuracy were included in the previously suggested criteria. The discriminative abilities of current and previous criteria were examined in receiver-operating characteristic analyses. Data from 46 patients, 32 with confirmed epilepsy and 14 with syncope, were included in this analysis. The mean age was 12.1years (S.D., 4.3years), and 60.9% of the patients were girls. According to our proposed criteria, the sensitivity, specificity, and accuracy of symptoms in predicting epilepsy were 68.8%, 85.7%, and 73.9%, respectively, and the area under the curve was 0.814 (confidence interval 0.686 to 0.941, P=0.001). According to previously suggested criteria, the sensitivity, specificity, and accuracy of symptoms in predicting epilepsy were 63.2%, 62.5%, and 63.0%, respectively, and the area under the curve was 0.730 (confidence interval 0.541 to 0.92, P=0.063). A number of self-reported/observed symptoms can be used to distinguish epilepsy from syncope with high discriminative ability. The current findings still need to be validated in larger, preferably multiple populations before they can be safely relied upon.

Fungal sensitization and positive fungal culture from sputum in children with asthma are associated with reduced lung function and acute asthma attacks respectively.

Sensitization to thermotolerant fungi, including filamentous fungi and Candida albicans, is associated with poor lung function in adults with severe asthma. Data in children are lacking. Environmental exposure to fungi is linked with acute severe asthma attacks, but there are few studies reporting the presence of fungi in the airways during asthma attacks. We investigated the association between fungal sensitization and/or positive fungal sputum culture and markers of asthma severity in children with chronic and acute asthma. Sensitization was determined using serum-specific IgE and skin prick testing against a panel of five fungi. Fungal culture was focused towards detection of filamentous fungi from sputum samples. We obtained sensitization data and/or sputum from 175 children: 99 with chronic asthma, 39 with acute asthma and 37 controls. 34.1% of children with chronic asthma were sensitized to thermotolerant fungi compared with no children without asthma (p=<0.001). These children had worse pre-bronchodilator lung function compared with asthmatics without sensitization including a lower FEV1 /FVC ratio (p<.05). The isolation rate of filamentous fungi from sputum was higher in children with acute compared with chronic asthma. Fungal sensitization is a feature of children with chronic asthma. Children sensitized to thermotolerant fungi have worse lung function, require more courses of systemic corticosteroids and have greater limitation of activities due to asthma. Asthma attacks in children were associated with the presence of filamentous fungi positive sputum culture. Mechanistic studies are required to establish whether fungi contribute directly to the development of acute asthma.

Plasma Exchange for Treatment of Refractory Demyelination.

Researchers from the National Pediatric Hospital in Buenos Aires, Argentina, describe their experience with therapeutic plasma exchange (TPE) for refractory inflammatory central nervous system (CNS) attacks in children over the course of the last 15 years.

Hereditary angioedema: Special considerations in children.

Patients with hereditary angioedema (HAE) can experience attacks at any age; however, the onset of swelling is typically in childhood. Unlike adults, this population is uniquely vulnerable; attacks in young children may be subtle, resemble other diseases, and often lead to a delay in diagnosis. Misdiagnosis contributes to significant delays in treatment, painful attacks, increased emotional stress, unnecessary procedures, and a potential risk of death. Older children may hide their symptoms due to anxiety or fear of social isolation. Attacks typically become more severe and more frequent during and after puberty. The impact of HAE attacks on school attendance and school performance may prevent future career or education opportunities. Living with HAE poses significant psychosocial stress on children and their families. In the United States, medical treatments for acute attacks in children approved for self-administration are limited to intravenous therapies, which complicates early treatment. To provide optimal care, we suggest that physicians screen all children with a family history of HAE, appreciate the dynamic nature of the disease during adolescence, proactively assess the psychosocial impact of disease, and continually reassess the treatment plan.

Levels and factors of knowledge about the related health risks of exposure to secondhand smoke among medical students: A cross-sectional study in Jeddah, Saudi Arabia.

INTRODUCTIONSecondhand smoke (SHS) appears to be an insidious public health issue in Saudi Arabia, with a high percentage of people being reportedly exposed. In an attempt to raise awareness about this issue, we explored medical students’ level of knowledge about SHS risks, as well as their levels of exposure to SHS and the correlation between knowledge and exposure.METHODSA cross-sectional study was conducted in February 2020 at the Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. An online, modified version of a validated questionnaire was distributed among 2nd to 6th year medical students. The questionnaire mainly explored the following items: 1) exposure level to SHS; 2) impact of SHS exposure; and 3) knowledge about SHS related health risks, with calculation of a knowledge score (range: 0–8). Adequate knowledge was defined as a score ≥5 (median = 5), and associations with sociodemographic and lifestyle factors and exposure to SHS were analyzed using chi-squared and independent t-test, as appropriate.RESULTSOf a total 416 participants, 65.0% declared having one or more smoking persons among acquaintances, 26.4% being exposed to SHS at home, and 40.1% exposed to parental smoking during childhood. Further, 79.8% reported being regularly exposed to SHS in public places. Majority of participants reported significant discomfort (53.2%) and physical symptoms (98.3%) subsequent to SHS exposure. Among the list of 8 health risks, ear infection in children (28.1%), heart attack in children (37.5%), and cognitive deficit (47.8%) were the least frequently identified. Adequate knowledge was found among 57.5% of the participants, and was higher among females and lower among participants living with their friends, compared to their counterparts (p<0.05). No association of knowledge level was observed with the parameters of exposure to SHS and poor discomfort feeling.CONCLUSIONSThe level of knowledge of medical students about health risks related to passive smoking is inadequate, while their exposure to SHS in public places is still substantial. This urges for the reinforcement of tobacco control strategies and highlights the great interest for medical colleges to implement effective educational interventions by improving their curricula regarding the risks of SHS and the benefits of smoking cessation.

Anxiety, Depression, and Body Weight in Children and Adolescents With Migraine.

Background: There is a lack of studies that explore the possible association between body weight, psychological symptoms, and migraine severity in pediatric populations. The purpose of the study was to explore: (1) the association between body weight and the frequency of migraine attacks, (2) the possible differences in anxiety and depression symptoms according to the frequency of attacks and body weight, and (3) the possible mediating role of anxiety and/or depression in the association between body weight and frequency of migraine attacks in children.Methods: One hundred and eleven children/adolescents with migraine were included (47 boys and 64 girls; mean age 11.7; ±2.4 years). The patients were classified as: (1) high frequency patients, reporting from weekly to daily episodes and (2) low frequency patients, with ≤3 episodes per month. According to their body mass index percentiles, the patients were divided in “Normal weight” (from ≥5 to <85 percentile), “Overweight” (from ≥85 to <95 percentile), and “Obese” (≥95 percentile). Given the low number of obese patients, the overweight and obese groups were considered together in the “Overweight” group. Anxiety and depression symptoms were assessed by the Self-Administered Psychiatric Scales for Children and Adolescents (SAFA).Results: Fifty-four patients were normal in weight (49.6%), while 56 patients (50.4%) were overweight. The overweight patients showed a higher frequency of migraine attacks (64.7%; p < 0.05). Patients with a high frequency of attacks reported higher scores in all SAFA-Anxiety subscales (SAFA-A Tot: F = 15.107; p = 0.000). Overweight patients showed a significantly higher score in the “Separation anxiety” subscale (F = 7.855; p = 0.006). We found a mediating role between the overweight and high frequency for total anxiety (z = 2.11 ± 0.03; p < 0.05) and social anxiety (z = 2.04 ± 0.03; p < 0.05).Conclusions: Our results suggest that, among the children suffering from migraine, the overweight status is associated with a higher frequency of attacks and separation anxiety symptoms. In particular, our study provides the first evidence of the role of anxiety in linking overweight and the frequency of migraine attacks in children and adolescents.

Physiotherapy Complex for the Treatment of Children with Somatoform Dysfunction, Often Suffering from Recurrent Infection

The aim. to optimize the treatment of children with ADHD who often suffer from recurrent infections by justifying the effectiveness of a therapeutic and physiotherapy complex that includes a BOS-bioacoustic effect on the head area and NILI on the projection of the cubital area and thymus. Method of research. In children (140 people) with a verified diagnosis of ADHD, often suffering from recurrent infection, humoral-cellular immunity indicators (immunoglobulins: IgA; IgG; IgM); T-and B-lymphocytes; cytokines) were studied in the dynamics of the use of therapeutic measures. Depending on the applied physiotherapy method of treatment, the children were divided into 3 groups: the 1st group-received NILI on the projection of the cubital area and thymus, the 2nd – received BOS-bioacoustic effect on the head area, the 3rd – developed physiotherapy complex, including BOS-bioacoustic effect on the head area and NILI on the projection of the cubital area and thymus. Conclusion. the developed physiotherapy complex, including BOS-bioacoustic effect on the head area and NILI on the projection of the cubital area and thymus, can be considered as a therapeutic and preventive model of respiratory viral attacks in children with SSDVNS, since it reduces the number of recurrent viral attacks by 3.7 times, correcting the activity of circulating cytokines, T-lymphocytes (CD3+), T-helpers (CD4+) and T-suppressors (CD8+) in the population white blood cells.

Proposal for a new therapeutic high dosage of Pidotimod in children with periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome: a randomized controlled study

BackgroundDespite to PFAPA syndrome is considered a benign and self-limited condition in childhood its impact on patients and families can be remarkable in many cases. Currently, the therapeutic options for managing are non-specific and no consensus exists about the best treatment to use. Pidotimod has been suggested as a new potential treatment in PFAPA syndrome for its immunodulatory effects. We conducted a preliminary, prospective, controlled, open, cross-over trial to assess the efficacy and the safety of Pidotimod in the treatment of children with PFAPA syndrome.Methods22 children with PFAPA syndrome were randomly allocated to treatment with pidotimod (with 2 vials of 400 mg daily) in combination with betamethasone 0.5–1 mg on need, based on parents/caregivers’ decision (group A) or betamethasone 0.5-1 mg on need, based on parents/caregivers’ decision (group B). Each treatment period was for 3 months (Phase 1), after that patients were switched to the other arm for other 3 months (Phase 2). Efficacy was expressed in terms of number of episodes of fever, pharyngitis, or aphthous stomatitis, as well as the additional use of betamethasone on need. Safety and tolerability of the Pidotimod were evaluated on the basis of the number and type of adverse events (AEs) recorded during the treatment.ResultsPatients receiving Pidotimod and use betametasone showed a significant decrease in frequency of fevers (p = 0.002); number of episodes of pharyngitis (p = 0.049); aphthous stomatitis (p = 0.036) as well as the betamethasone use on need (p = 0.007). Overall, 19/22 (86.4%) showed benefits from Pidotimod administration. The safety profile of Pidotimod was excellent as no serious adverse events have been reported in the treated groups.ConclusionsWe firstly showed that high dosage of Pidotimod could be an effective and safe to reduce the PFAPA attacks in children.

Predicting the risk of asthma attacks in children, adolescents and adults: protocol for a machine learning algorithm derived from a primary care-based retrospective cohort

IntroductionMost asthma attacks and subsequent deaths are potentially preventable. We aim to develop a prognostic tool for identifying patients at high risk of asthma attacks in primary care by leveraging...

Paracetamol versus Ibuprofen for the Acute Treatment of Migraine Headache in Children: A Blinded Randomized Controlled Trial.

To compare the efficacy of oral paracetamol and oral ibuprofen for the management of acute headache in children with migraine without aura. This randomized-controlled trial was done at the Pediatric department of a public hospital in India between 20 May, 2017 and 22 March, 2018, and enrolled children (aged 6-12 y) with Migraine without aura as per International Classification for Headache Disorders, 3rd edition (ICHD-3) criteria. The 50 patients (21 females, mean age 9.9 y) consecutively enrolled were randomized by block randomization to two study groups, with one group (n =25) receiving oral paracetamol (15mg/kg/dose) and the other group (n = 25) oral ibuprofen (10mg/kg/dose), at home, during a single episode of acute migraine headache. The study drugs were dispensed in a blinded fashion. Pain-freedom (score of zero in a 0-10 Visual analogue pain scale) and Pain-relief (≥2-point reduction from the baseline) two-hours after the study drug intake were the primary outcomes. Side-effects to the study drugs were actively solicited. Non-parametric tests for paired data were used. The two groups were similar at baseline. Forty-three children (22 paracetamol group and 21 ibuprofen group) completed the study. Both pain-freedom (32% vs. 28%, P = 0.77) and pain-relief (80% vs. 80%, P = 0.86) were not significantly different between the Paracetamol and Ibuprofen groups, respectively. Ten (23.2%) children had a side-effect due to the study drug, with no significant difference between the groups (13.6% vs. 33.3%; P = 0.11). Both paracetamol and ibuprofen are effective and safe for the treatment of acute migraine attacks in children.

Retrospective analysis of epidemic thunderstorm asthma in children in Yulin, northwest China.

An epidemic of thunderstorm asthma in pediatric patients occurred in Yulin, a northwest city of China, on 11 September 2018. We described the epidemic and retrospectively analyzed the demographic and clinical aspects of the involved children. The caseload data of patients were collected from the hospital information system in Yulin Pediatric Hospital. The detailed document of hospitalized children with thunderstorm asthma was sourced from the medical records. The mean number of daily visits to emergency/outpatient department and the daily admission to hospital were 2.7 and 16 times, respectively, than on the other days of September. A gender prominence of males was observed in both emergency/outpatient and inpatient department. Among the 51 hospitalized children with detailed medical records, 56% of them had never experienced or were diagnosed with asthma and 25% had confirmed diagnosis of asthma. Sixty-seven percent had a history of allergic rhinitis during August and September. Seventy-six percent of the hospitalized children presented as moderate asthma. Ninety-four percent of the pediatric patients had positive IgE against mugwort pollen and 78% were monosensitized to pollen. Thunderstorm asthma can affect children, especially who has allergic rhinitis or asthma without preventive management. Mugwort is also an aeroallergen in thunderstorm asthma attacks. Thunderstorm can induce asthma attacks in children with allergic rhinitis owing to mugwort and aggravate symptoms in children with confirmed diagnosis of asthma. Children with mugwort allergy are susceptible to thunderstorm asthma and a preponderance of boys was observed. Better identification of allergic children to mugwort, giving suitable protective measures during thunderstorm and standard therapy to existing allergic situation could be a benefit for children at risk of thunderstorm asthma.

Effectiveness of Structured Teaching Program on Knowledge Regarding the Use on Spacer Among Parents of Bronchial Asthmatic Children Admitted in the Pediatric Wards in Different Hospitals

Use of spacer among bronchial asthmatic children presents a different set of challenges for their parents. Use of spacer in asthmatic children consider being successful, it requires an accurate understanding by the parents of asthmatic children admitted in the pediatric ward to have adequate skills regarding the use of a spacer. The present study “A study to assess the effectiveness of structured teaching program on knowledge regarding the use of spacer among parents of Bronchial Asthmatic children admitted in the pediatric wards in Different Hospitals, Uttarakhand”. The Objective evaluate the effectiveness of structured teaching program on the use of a spacer among parents of bronchial asthmatic children by comparing pre and post-test knowledge The nature of the study was pre-experimental. The study was conducted in Different Hospitals, Uttarakhand. The research design used for the study was one group pre-test and one group post-test design. Data collected using non-probability convenient sampling. The pilot study was conducted with a constructed tool with which it as found reliable respectively. The data were collected to evaluate the effectiveness of structured teaching program on knowledge regarding the use of spacer among 30 parents of bronchial asthmatic children. The data collected were analysed and interpreted by using descriptive and inferential statistics. Major findings of the study are the highest percentage (53.3%) and the lowest percentage (10%) of the child had suffered from asthma. There is the highest percentage of children 53.3% in the age group of more than 14 years. The education of parents reveals that the highest percentage of 33.3% of mothers and 40% of fathers had secondary education. Pre-test analysis revealed that 90% of parents are having inadequate knowledge and 10% of the parents are having moderate knowledge regarding the use of spacer and that can cause the problems of an asthma attack in children. It can be concluded that pre-test knowledge score was less among parents on asthmatic children. After implementing a structured teaching program the knowledge score was increased. So it was effective in increasing knowledge.&#x0D; Keywords: knowledge; use of spacer; parents; bronchial asthmatic; children

New therapeutic perspectives for IgA nephropathy in children.

Childhood IgA nephropathy (cIgAN) differs from the adult by having an abrupt clinical onset, often presenting as an acute attack that can progress to a chronic phase. No treatment guidelines have been established for the treatment of cIgAN. Given the severity of acute attack in children, and the number of life-years at stake, pediatricians prescribe immunosuppression in addition to renin-angiotensin system blockade. Non-specific immunosuppressors, such as corticosteroids, have systemic toxic effects, and given recent therapeutic advances in adult glomerulonephritis, new tailored strategies should be expected for children. The mucosal immune system has been highlighted as a key player in IgAN pathogenesis, and several biomarkers have been identified with a direct role in pathogenesis. In this review, we discuss current studies of conventional and novel therapeutic approaches for cIgAN.

Acupoint herbal patching during Sanfu Days on reducing frequency of acute asthma attack in children: A systematic review and meta-analysis.

Acupoint herbal patching (AHP) is an external therapy of Traditional Chinese Medicine. This systematic review and meta-analysis sought to evaluate whether AHP during Sanfu Days has additional benefits in children with asthma. A comprehensively electronic literature search was performed in the Cochrane Library, PubMed, Embase, CNKI, VIP, and WanFang databases from their inception to March 2019. Randomized controlled trials that evaluated the AHP during Sanfu Days treatment for pediatric asthma were included. The main outcome measures were frequency of acute asthma attack, relapse of asthma, and pulmonary function. Eleven trials involving 882 children with asthma were identified. White mustard seed, rhizoma corydalis, and radix kansui were the most frequently used herbs. Adjunctive treatment with AHP significantly reduced the frequency of acute asthma attack (mean difference [MD] -1.62 times/year; 95% confidence intervals [CI] -2.13 to -1.11). Moreover, AHP improved the peak expiratory flow (standardized mean differences [SMD] 0.61; 95% CI 0.39-0.82) and forced expiratory volume in 1 s (SMD 0.48; 95% CI 0.31-0.66). Application of AHP during Sanfu Days has additional benefits in reducing the frequency of acute attack and improving pulmonary function in children with asthma. However, the current findings should be interpreted with caution owing to the methodological flaws of the analyzed trials.

Advance in research on sleep disorder in children with bronchial asthma

Bronchial asthma in children attacks or exacerbates at night and/or in the early morning.Sleep disorders are common concomitant symptoms of nocturnal asthma, including prolonged sleep onset latency, frequent wake-ups at night, daytime sleepiness, and sleep-disordered breathing, especially in children with poor asthma control.Asthma and sleep apnea share similar risk factors, and the interaction of potential causes promotes the disease progression.When it comes to treating children with asthma, it is necessary to clear whether sleep apnea exists or not.Sleep hygiene management and the treatment of obstructive sleep apnea play an important role in the standardized treatment of childhood asthma, which could improve asthma control and the sleep quality, thereby enhancing the quality of life in children with asthma. Key words: Bronchial asthma; Sleep disorder; Obstructive sleep apnea syndrome

Reducing Asthma Attacks in Children using Exhaled Nitric Oxide as a biomarker to inform treatment strategy: a randomised trial (RAACENO)

BackgroundChildhood asthma is a common condition. Currently there is no validated objective test which can be used to guide asthma treatment in children. This study tests the hypothesis that the addition of fractional exhaled nitric oxide (FENO) monitoring in addition to standard care reduces the number of exacerbations (or attacks) in children with asthma.MethodsThis is a multi-centre, randomised controlled study. Children will be included of age 6–16 years who have a diagnosis of asthma, currently use inhaled corticosteroids (ICSs) and have had an exacerbation in the previous 12 months. Exclusion criteria include being unable to provide FENO measurement at baseline assessment, having another chronic respiratory condition and being currently treated with maintenance oral steroids. Participants will be recruited in both primary and secondary care settings and will be randomised to either receive asthma treatment guided by FENO plus symptoms (FENO group) or asthma treatment guided by symptoms only (standard care group). Within the FENO group, different treatment decisions will be made dependent on changes in FENO. Participants will attend assessments 3, 6, 9 and 12 months post randomisation. The primary outcome is asthma exacerbation requiring prescription and/or use of an oral corticosteroid over 12 months as recorded by the participant/parent or in general practitioner records. Secondary outcomes include time to first attack, number of attacks, asthma control score and quality of life. Adherence to ICS treatment is objectively measured by an electronic logging device. Participants are invited to participate in a “phenotyping” assessment where skin prick reactivity and bronchodilator response are determined and a saliva sample is collected for DNA extraction. Qualitative interviews will be held with participants and research nurses. A health economic evaluation will take place.DiscussionThis study will evaluate whether FENO can provide an objective index to guide and stratify asthma treatment in children.Trial registrationISRCTN, ISRCTN67875351. Registered on 12 April 2017. Prospectively registered.

The relation between serum vitamin D levels, viral infections and severity of attacks in children with recurrent wheezing

Introduction and ObjectivesVitamin D deficiency is associated with increased susceptibility to infections and wheezing. We aimed to evaluate the relation between vitamin D levels, viral infections and severity of attacks in children with recurrent wheezing. Materials and methodsA total of 52 patients who applied with wheezing, at the ages of 12–60 months with a history of three or more wheezing attacks in the last year and 54 healthy children were included. Sociodemographic data, risk factors for recurrent wheezing, and the severity of the wheezing attacks were recorded. 25(OH)D3, calcium, phosphor, alkaline phosphatase and parathormone levels of all children were measured. Nasopharyngeal samples of the patients for viruses were studied by multiplex polymerase chain reaction. ResultsFor the patient group, being breastfed for six months or less, history of cesarean section, cigarette exposure, humid home environment, and family history of allergic disease were significantly higher compared with the control group. Serum vitamin D levels in the patient group were significantly lower compared to the control group. There was no significant relationship between vitamin D levels and hospitalization, oxygen or steroid therapy. Virus was detected in 38 patients (73%). Rhinovirus (63.2%) was the most frequently detected virus. Coinfection was found in 14 (36.8%) patients. There was no statistically significant difference between detection of virus and vitamin D levels. ConclusionsCigarette exposure, being breastfed six months or less, humid home environment, history of cesarean section, family history of allergic disease and vitamin D deficiency might be risk factors for recurrent wheezing.

Feasibility and efficacy of an educational programme to increase awareness of stroke and heart attack in children

Objective:The objective of this study was to evaluate the feasibility and effectiveness of an innovative school stroke and heart attack educational programme for children.Design:Non-randomised controlled trial with intervention and control group conducted in set time periods. Results were compared among time periods in both groups and also between both groups.Setting:The study included children from 47 schools in Czech Republic. Children from 37 schools in one county ( N = 2,436) participated as the target population. The control group involved 900 pupils from 10 schools in another county.Methods:The 45-minute multimedia Web-based video programme was designed to teach the appropriate response to stroke and heart attack symptoms. The target population received education and testing. The control population received only testing and no education.Results:Baseline knowledge assessment was identical across the target and the control populations. After education, knowledge in the target population had improved significantly. After 3 months, knowledge assessment scored 65% in the target population and 66% in the control population (intergroup difference p = .75).Conclusion:The educational programme increased response to stroke and heart attack symptoms compared to the control group, although in the target group comprehension improved only in short term when compared to the baseline. Knowledge for heart attack was better than for stroke.

Preliminary Evidence that Melatonin Is not a Biomarker in Children and Adolescents With Episodic Migraine.

To date, there have not been reliable biomarkers to identify impending migraine episodes. A prior study in adults with migraine demonstrated a reduction in the urinary metabolic substrate of melatonin (urinary 6-sulfatoxymelatonin; aMT6s) during a migraine. The aim of this study was to examine whether evening urinary melatonin metabolite levels could predict migraine the next day in children and adolescents with migraine. Twenty-one children and adolescents with migraine (aged 5-17years) were recruited to this observational study conducted at UC San Francisco to provide urine samples for 10days and maintain a prospective headache diary during the same period. Nightly melatonin metabolite 6-sulfatoxymelatonin in urine was assayed and results from nights preceding migraine were compared to nights preceding a non-headache day. Mean (±SD) aMT6s levels the night prior to a migraine attack were 56.2±39.0 vs 55.4±46.6ng/mL (P=.915), and mean melatonin metabolite levels the night following migraine were 55.5±46.9 vs 57.0±37.7ng/mL (P=.841). However, in post hoc exploratory analyses, aMT6s levels were lower the night before a migraine in those who experienced aura or premonitory symptoms. While urinary melatonin metabolites do not predict migraine attacks in children and adolescents overall, they may be predictive in those who experience premonitory phase symptoms as part of their migraine attacks.

PHirst Aid - Management of Chemical Attacks in Children

pHirst Aid - Management of Chemical Attacks in Children