Chronic Disease Of Childhood Research Articles

Effectiveness of single dose oral dexamethasone versus multidose prednisolone for treatment of acute exacerbations of asthma among children.

Asthma is one of the most common chronic diseases in children and worldwide its prevalence has increased dramatically in the last three decades. We aimed to compare single dose oral dexamethasone versus multiple doses of oral prednisolone in children with acute exacerbation of asthma in terms of post treatment requirement of systemic steroids. This Randomized control trial has been conducted in the Department of paediatrics, KRL Hospital, Islamabad from Dec 2018 to June 2019.312 patients between the age of 2-12 years patients were randomized into Group A receiving a STAT single dose of oral dexamethasone 0.3mg/kg and Group B receiving prednisolone 1mg/kg/day followed by two doses on Day 2 and 3. further dose of systemic steroids were ascertained through PRAM score. In this study mean age in Group A was 8 years with SD±5.68 while mean age in Group B was 7 years with SD±6.12. In Group A 58% patients were male and 42% patients were female. Whereas in Group B 59% patients were male and 41% patients were female. In Group A 12% patients had further requirement of systemic steroids while in Group B 18% patients had further requirement of systemic steroids while 82% patients didn't had further requirement of systemic steroids. Our study concludes that post treatment requirement of systemic steroids is less in single dose oral dexamethasone as compare to multiple doses of oral prednisolone in children with acute exacerbation of asthma.

Preventive Oral Health in Pediatric Primary Care

Oral health is an integral part of every child's overall wellness and affects their development, family, and social life, as well as school performance; it should be addressed at every well-child visit. Tooth decay continues to be the most prevalent yet preventable chronic disease of childhood; it leads to unnecessary pain, infections, poor academic performance, and frequent school absences and adds an unnecessary financial burden to the health care system. Despite improvements in oral health, disparities continue to exist for children from minority backgrounds and lower socioeconomic status. As primary care providers for children, it is important to understand factors that lead to oral disease and be able to anticipate, treat, and, most important, prevent oral disease in children early in their development. [Pediatr Ann. 2022;51(12):e474-e479.].

Exploring Mothers' Perspectives About Why Grandparents in Appalachia Give Their Grandchildren Cariogenic Foods and Beverages: A Qualitative Study.

Dental caries is the most common chronic childhood disease. Past studies revealed that grandparents provide their grandchildren with cariogenic foods and beverages (eg, those with free sugars and/or modified starches). Qualitative research can help identify what drives this phenomenon. Our aim was to examine mothers' explanations for why grandparents in north central and central Appalachia give their grandchildren cariogenic foods and beverages. A qualitative study on children's oral health in Pennsylvania and West Virginia from 2018 through 2020 was performed. In-person, semi-structured interviews were conducted. Qualitative data from interviews were recorded, transcribed, and then coded using NVivo. Data analysis for this study was performed using thematic analysis with iterative theme development. The participants were 126 mothers of children aged 3-5 years from West Virginia (n= 66) and Pittsburgh, PA (n= 60). Mothers' perspectives about why grandparents give their grandchildren cariogenic foods and beverages were analyzed. In the study sample, 85% of mothers (n= 107/126) named at least 1 of their children's grandparents as a member of their social network responsible for their children's oral health. From these interviews, 85% of mothers (n= 91/107) discussed that grandparents gave their grandchildren cariogenic foods and beverages. The mothers described the following 4 themes to explain why grandparents gave their grandchildren cariogenic foods and beverages: privilege of the grandparent role; responsibilities of the grandparent role; symbol of care and affection; and limited consideration or understanding of the detrimental impact. Grandparents play a role in giving their grandchildren cariogenic foods and beverages, which could potentially contribute to childhood caries. Research is needed to develop effective social interventions to help some grandparents understand the implications of a cariogenic diet on their grandchildren's oral health and/or decrease their provision of cariogenic foods and beverages.

Developmental origins of disease highlight the immediate need for expanded access to comprehensive prenatal care.

The prenatal environment plays a critical role in shaping fetal development and ultimately the long-term health of the child. Here, we present data linking prenatal health, via maternal nutrition, comorbidities in pregnancy (e.g., diabetes, hypertension), and infectious and inflammatory exposures, to lifelong health through the developmental origins of disease framework. It is well-established that poor maternal health puts a child at risk for adverse outcomes in the first 1,000 days of life, yet the full health impact of the in utero environment is not confined to this narrow window. The developmental origins of disease framework identifies cognitive, neuropsychiatric, metabolic and cardiovascular disorders, and chronic diseases in childhood and adulthood that have their genesis in prenatal life. This perspective highlights the enormous public health implications for millions of pregnancies where maternal care, and therefore maternal health and fetal health, is lacking. Despite near universal agreement that access to antenatal care is a priority to protect the health of women and children in the first 1,000 days of life, insufficient progress has been achieved. Instead, in some regions there has been a political shift toward deprioritizing maternal health, which will further negatively impact the health and safety of pregnant people and their children across the lifespan. In this article we argue that the lifelong health impact attributed to the perinatal environment justifies policies aimed at improving access to comprehensive antenatal care globally.

Depression in Childhood Asthma vs. Adult-Onset Asthma: A Cross-Sectional Study from the National Health and Nutrition Examination Survey (NHANES).

asthma, a chronic respiratory disease caused by inflammation and narrowing of the small airways in the lungs, is the most common chronic childhood disease. Prevalence of childhood asthma in the United States is 5.8%. In boys, prevalence is 5.7% and it is 6% in girls. Asthma is associated with other comorbidities such as major depressive disorder and anxiety disorder. This study explores the association between asthma and depression. we conducted a retrospective cross-sectional study using NHANES data from 2013 to 2018. Asthma and childhood onset asthma were assessed using questionnaires MCQ010 and MCQ025, respectively. Sociodemographic variables were summarized, and univariate analysis was performed to determine the association between asthma and major depressive disorder and its individual symptoms. there were 402,167 participants from 2013-2018 in our study: no asthma in 84.70%; asthma in 15.30%. Childhood onset asthma (COA) included 10.51% and adult-onset asthma (AOA) included 4.79%. Median age of COA is 5 years and AOA is 41 years. Among the asthma groups, most AOA were females (67.77%, p < 0.0001), most COA were males (52.16%, p < 0.0001), and ethnicity was predominantly White in AOA (42.39%, p < 0001) and in COA (35.24%, p < 0.0001). AOA mostly had annual household income from $0-24,999 (35.91%, p < 0.0001), while COA mostly had annual household income from $25,000-64,999 (36.66%, p < 0.0001). There was a significantly higher prevalence of MDD in COA (38.90%) and AOA (47.30%) compared to NOA (31.91%). Frequency of symptoms related to MDD were found to have a significantly higher prevalence and severity in the asthma groups compared to no asthma, and slightly greater and more severe in AOA than in COA. Symptoms include having little interest in doing things (COA 18.38% vs. AOA 22.50% vs. NOA 15.44%), feeling down, depressed, or hopeless (COA 20.05% vs. AOA 22.77% vs. NOA 15.85%), having trouble sleeping or sleeping too much (COA 27.38% vs. AOA 23.15% vs. NOA 22.24%), feeling tired or having little energy (COA 39.17% vs. AOA 34.24% vs. NOA 33.97%), having poor appetite or overeating (COA 19.88% vs. AOA 20.02% vs. NOA 15.11%), feeling bad about yourself (COA 13.90% vs. AOA 13.79% vs. NOA 10.78%), having trouble concentrating on things (COA 12.34% vs. AOA 14.41% vs. NOA 10.06%), moving or speaking slowly or too fast (COA 8.59% vs. AOA 9.72% vs. NOA 6.09%), thinking you would be better off dead (COA 3.12% vs. AOA 4.38% vs. NOA 1.95%) and having the difficulties these problems have caused (COA 21.66% vs. AOA 26.73% vs. NOA 19.34%, p < 0.0001). MDD and related symptoms were significantly higher and more severe in participants with asthma compared to no asthma. Between adult-onset asthma compared to childhood onset asthma, adult-onset asthma had slightly greater and more severe MDD and related symptoms compared to childhood onset asthma.

Pediatric cardiopulmonary resuscitation in infant and children with chronic diseases: A simple approach?

Infants and children with complex chronic diseases have lifelong, life-threatening conditions and for many, early death is an unavoidable outcome of their disease process. But not all chronic diseases in children are fatal when treated well. Cardiopulmonary resuscitation is more common in children with chronic diseases than in healthy children. Resuscitation of infants and children presents significant challenges to physicians and healthcare providers. Primarily, these situations occur only rarely and are therefore not only medically demanding but also associated with emotional stress. In case of resuscitation in infants and children with chronic diseases these challenges become much more complex. The worldwide valid Pediatric Advanced Life Support Guidelines do not give clear recommendations how to deal with periarrest situations in chronically ill infants and children. For relevant life-limiting illnesses, a "do not resuscitate" order should be discussed early, taking into account medical, ethical, and emotional considerations. The decision to terminate resuscitative efforts in cardiopulmonary arrest in infants and children with chronic illnesses such as severe lung disease, heart disease, or even incurable cancer is complex and controversial among physicians and parents. Judging the "outcome" of resuscitation as a "good" outcome becomes complex because for some, life extension itself and for others, quality of life is a goal. Physicians often decide that a healthy child is more likely to have a reversible condition and thereby have a better outcome than a child with multiple comorbidities and chronic health care needs. Major challenges in resuscitation infants and children are that clinicians need to individualize resuscitation strategies in light of each chronic disease, anatomy and physiology. This review aims to highlight terms of resuscitation infants and children with complex chronic diseases, considering resuscitation-related factors, parent-related factors, patient-related factors, and physician-related factors.

Influence of the personalities and adherence to therapy on the metabolic control type 1 diabetes in adolescents

Introduction. Diabetes mellitus type 1 (T1DM) in children and adolescents occupies a leading place in the structure of chronic diseases of childhood. Despite modern advances in the treatment and control of CT 1, adolescents have problems with glycemic control in comparison with other age groups.Aim. Is to estimate the correlation between the degree of compensation for diabetes in adolescents and the features of the personality profile, emotional and behavioural characteristics and environmental factors.Materials and methods. The study included 101 children aged 11 to 17 years, treated to pump insulin therapy or multiple injections of insulin. Adherence and compliance to therapy was assessed using the Medication Adherence Questionnaire (MAQ) and the Self Care Inventory-Revised Version (SCI-R). Emotional and behavioral problems were evaluated using the Youth self-report for ages 11-18. Characterization of personality profile was assessed using the The Sixteen Personality Factor Questionnaire». Results. Diabetes was compensated in 25% of children (HbA1c < 7,0%). A statistically significant relationship was established between the degree of patient compliance and the level of HbA1c. The predictive role of individual psychological characteristics on compliance has been determined. Factors such as realism and acceptance of moral norms have a positive impact on compliance.Conclusions. The therapy compliance indicator is the most significant indicator of better compensation for type 1 diabetes in adolescents. The personality traits of adolescents, such as acceptance of moral norms and realism — sensitivity have a predictive effect on the therapy compliance.

Physical Activity Frequency and Health-Related Quality of Life in Spanish Children and Adolescents with Asthma: A Cross-Sectional Study.

Asthma is considered the most prevalent chronic childhood disease worldwide. Physical activity (PA) represents a tool to improve patients with respiratory diseases' health-related quality of life (HRQoL). A cross-sectional study examining data from the Spanish National Health Survey (ENSE 2017) was carried out to investigate the associations between the PAF (physical activity frequency) and health-related quality of life (HRQoL) in asthmatic children and adolescents from 8 to 14 years old (total 11.29 years ± 1.91, boys 11.28 ± 1.90 and 11.29 ± 1.95 girls). Data were obtained from the Children Questionnaire, which was completed by their families or legal guardians, achieving a final sample composed of 240 participants with asthma. Data were taken from Survey 2017 (ENSE 2017), the last one before the COVID-19 pandemic. The results revealed significant associations between the PAF and the HRQoL, finding no significant differences between genders.

Annular bullous lesions in a child from Uganda: chronic bullous disease of childhood.

Annular bullous lesions in a child from Uganda: chronic bullous disease of childhood.

THE IMPACT OF COVID-19 PANDEMIC ISOLATION MEASURES ON PEDIATRIC ASTHMA ADMISSIONS

<h3>Introduction</h3> Asthma is the most common chronic disease in children, with about 1 in 20 asthmatic children annually hospitalized for an exacerbation. Since respiratory viruses are common exacerbation triggers, there were concerns that SARS-CoV2 would lead to increased asthma admissions. We hypothesized that the CDC-implemented pandemic isolation measures would instead lead to a decrease in asthma admissions by limiting the spread of other respiratory viruses. <h3>Methods</h3> A retrospective chart review at a pediatric tertiary care center was conducted. Monthly asthma-related hospitalizations of patients 2-18 years of age were counted. Patients with tracheostomy or ventilator dependence were excluded. Admissions from the start of the pandemic in March 2020 until present were compared to baseline data from the 2 years preceding the pandemic. A Chi-square test was used to compare the uniformity of annual admissions and month-by-month admissions over 5 years. <h3>Results</h3> There were 4703 asthma admissions over the 5-year period. There was a statistically significant (p<0.001) decrease in the number of monthly asthma admissions during March 2020-June 2020, when the strictest isolation measures were in place. This decrease, compared to baseline data, persisted for approximately 12 months until again returning to baseline data in Spring 2021, as isolation measures eased. A lower magnitude and shorter duration decrease from baseline admissions was also seen during the Omicron spike. <h3>Conclusion</h3> Asthma admissions sharply declined during the strictest isolation measures and then returned to baseline levels as the measures eased. This data suggests that isolation measures may reduce respiratory virus transmission and contribute toward reduced pediatric asthma admissions.

The burden of asthma among children and adolescents in Saudi Arabia: Anational cross-sectional survey.

Asthma disease is one of the most common chronic diseases of childhood. Studies assessing asthma prevalence in Saudi Arabia have been variable and not recently updated. We sought to assess asthma prevalence, severity, and related risk factors among children and adolescents in Saudi Arabia. A national, cross-sectional design was used following the Global Asthma Network phase I design. Atotal of 3817 children aged 6 to 7 years and 4138 adolescents aged 13 to 14 years were recruited from 137 primary and 140 intermediate schools across 20 regions by using a multistage stratified cluster sampling technique. Standardized written questionnaires were answered by the adolescents and by the parents or guardians of the children. The adolescents also answered a video-based questionnaire. Overall, the prevalences of current wheeze were 10.4% and 13.3% and the prevalences of asthma ever were 13.8% and 15.7%, % in children and adolescents, respectively. Of all the children and adolescents, 5.2% and 5.6% had symptoms of severe asthma, respectively. Among those who reported asthma, 86.0% of the children and 74.8% of the adolescents had their asthma confirmed by a doctor, and 53.0% and 32.4%, respectively, were provided with a written plan to control their asthma. The main risk factors associated with current wheeze included antibiotic use in the first year of life, a history of being diagnosed with pneumonia in children, paracetamol use, and having a cat at home during the past 12 months in adolescents. The prevalence of asthma in children and adolescents in Saudi Arabia is within the average international range and is at a plateau phase.

An Assessment of Pediatric Primary Care Providers’ and Parents’ Dental Health Knowledge and Practices

One in five children aged < 5 years has experienced caries, making it the most prevalent chronic disease in childhood. The failure to address a child's dental health can lead to short-term and long-term complications and problems with permanent dentition. Primary care pediatric providers are in the position to participate in the prevention of caries because of the frequency they see young children before establishing a dental home. A retrospective chart review and two surveys were developed to collect data from health care providers and parents of children aged < 6 years about their dental health knowledge and practices. While providers report being comfortable discussing dental health with patients, review of medical records shows inconsistent discussion and documentation of dental health. There appears to be a lack of education regarding dental health among parents and health care providers. Primary care providers are not effectively communicating the importance of childhood dental health and are not routinely documenting dental health information.

Sensitivity of FEV1 and Clinical Parameters in Children With a Suspected Asthma Diagnosis

Asthma is the most common chronic disease in children and a robust diagnosis is crucial to optimize patient care and reduce its burden. To diagnose asthma in children, the Global Initiative for Asthma (GINA) recommendations propose a 12% improvement in forced expiratory volume in 1 second (FEV1) after a bronchodilation test. Nevertheless, such a criterion is rarely confirmed in these patients in clinical practice. The objective of this study was to evaluate the sensitivity of spirometric and clinical parameters in identifying children with possible asthma. The VERI-VEMS Study is a multicenter international retrospective cohort study. Data were collected, from January 2008 until January 2019, for all consecutive children (aged 5-18 years), with a diagnosis of asthma, who performed a spirometry at the time of the diagnosis. We compared the sensitivity of the reversibility criterion proposed by GINA guidelines, with other spirometric and clinical variables, using physician-diagnosed asthma and response to treatment as the standard. The study included 871 children. The reversibility criterion of 12% of FEV1 showed a sensitivity of 30.4%. The 3 best spirometric or clinical criteria were the presence of dry cough, or wheezing or atopy and dry cough, or wheezing or exercise-induced dyspnea, with a sensitivity reaching 99.5%, with no added value of the spirometric parameters in the calculation of the cumulated sensitivity for the diagnosis of pediatric asthma. Postbronchodilator reversibility of 12%, although essential for patients' follow-up, has an insufficient low sensitivity in reaching a diagnosis of asthma in pediatric patients, compared with a combination of clinical symptoms, that show a better sensitivity. Further studies on specificity will help clarify the role of this change in the diagnostic paradigm in formally diagnosing children with asthma.

Influenza vaccination coverage among an urban pediatric asthma population: Implications for population health.

IntroductionAsthma is the most common chronic disease in children. Children with asthma are at high risk for complications from influenza; however annual influenza vaccination rates for this population are suboptimal. The overall aim of this study was to describe the characteristics of a high-risk population of children with asthma presenting to an urban pediatric emergency department according to influenza vaccination status.MethodsThe study was a retrospective chart review of 4355 patients aged 2 to 18 years evaluated in a Michigan pediatric emergency department (PED) between November 1, 2017 and April 30, 2018 with an ICD-10-CM code for asthma (J45.x). Eligible patient PED records were matched with influenza vaccination records for the 2017–2018 influenza season from the Michigan Care Improvement Registry. Geospatial analysis was employed to examine the distribution of influenza vaccination status.Results1049 patients (30.9%) with asthma seen in the PED had received an influenza vaccine. Influenza vaccination coverage varied by Census Tract, ranging from 10% to >99%. Most vaccines were administered in a primary care setting (84.3%) and were covered by public insurance (76.8%). The influenza vaccination rate was lowest for children aged 5–11 years (30.0%) and vaccination status was associated with race (p<0.001) and insurance type (p<0.001).ConclusionsIdentification of neighborhood Census Tract and demographic groups with suboptimal influenza vaccination could guide development of targeted public health interventions to improve vaccination rates in high-risk patients. Given the morbidity and mortality associated with pediatric asthma, a data-driven approach may improve outcomes and reduce healthcare-associated costs for this pediatric population.

Innovative Easy Google Form for Pediatric Seizure (EGFS) to Improve Knowledges of Pediatric Seizure Among General Practitioners and Medical Students at Maharat Nakhon Ratchasima Hospital

Background: Seizure and epilepsy are common chronic diseases in children that lead to high morbidity and affect the quality of life. However, there is more than 50% treatment gap in epilepsy patients especially in limited-resource or poor income countries. One of the factors causing the treatment gaps is the lack of specialist. Previous studies created tools such as mobile applications to help healthcare worker and non-specialist to diagnose epilepsy to fill these gaps. Objective: To create a tool using Google Form to improve the knowledges of intern and medical students and evaluate the benefit of this tool. Materials and Methods: The authors created the Google Form named Easy Google Form for Pediatric Seizure (EGFS). It contains an easy diagram and framework of knowledge regarding diagnosis, investigation, and treatment of pediatric seizure and epilepsy validated by a pediatric neurologist. The authors recruited fifth- and sixth-year medical students, and interns rotating in the Pediatric ward at Maharat Nakhon Ratchasima Hospital between May 1, 2019 and May 30, 2020. The interns participated in the 30 items Multiple-Choice Questions (MCQ) and Key Feature Examination (KF examination). Each intern was assessed for 60 minutes, the first 30 minutes would be assessed without using EGFS (pretest), and then assessed for 30 minutes using EGFS (posttest). The comparison of the mean score between pretest and posttest was determined to identify the benefit of this EGFS. The feedback in-depth interview was recorded. Results: One hundred twenty-three participants were recruited, 62 (50.41%) were intern with a mean age of 24.07±0.95 years and 51.22% were female. In the intern group, the mean score of every part as the diagnosis, investigation, and treatment were significant different between pretest and posttest. In medical students, the fifth-year medical students showed significant differences in the investigation part, and the sixthyear medical students showed significant differences in the investigation and treatment part. Ninety-two percent of the participants had positive feedback toward the benefit of this EGFS. Conclusion: The EGFS can improve the knowledges of general practitioners and medical students toward pediatric seizure and epilepsy. Keywords: Epilepsy; Seizure; Tool; Diagnosis; Investigation; Treatment

Compared with dietary behavior and physical activity risk, sedentary behavior risk is an important factor in overweight and obesity: evidence from a study of children and adolescents aged 13–18 years in Xinjiang, China

BackgroundMalnutrition or insufficient physical activity (PA) is a risk factor for obesity and chronic disease in children and adolescents. Affected by different economic circumstance, ethnic, dietary behavior, physical activity and other factors, children and adolescents in Xinjiang, China are facing a severe situation of overweight and obesity prevention and control. It is necessary to analyze the dietary behavior and physical activity of children and adolescents with different nutritional status and the relationship between them.MethodsUsing a stratified cluster sampling method in Xinjiang, China, 4833 middle school students aged 13–18 were selected., and tests for height and weight were conducted. Self-assessment questionnaires were completed for Dietary Behaviors, Physical Activity, and Sedentary Behaviors as well. Chi-square test, Logistic regression analysis and other methods were used to analyze the relationship between Dietary Behaviors, Physical Activity, Sedentary Behaviors and other health behavior risk factors and Weight and BMI.ResultsChildren and adolescents aged 13–18 in Xinjiang, China, girls had a lower BMI compared with boys(19.49 VS. 20.41). The proportions of Underweight, Overweight and Obese among girls were lower (Underweight: 11.8 VS. 14.5; Overweight: 7.6 VS. 12.7; Obese 2.3 VS. 7.0).Boys with higher risk of sedentary had a 1.46-fold higher risk of developing Overweight/Obese than those with lower risk of sedentary (95%CI: 1.07–2.01).Girls with higher risky diet had a 1.56-fold higher risk of developing Underweight than those with lower risky diet (95%CI: 1.11–2.19). For all participants, the risk of Overweight/Obese in children and adolescents with higher risk of sedentary was 1.45 times more than that of children and adolescents with lower Risk sedentary (95%CI: 1.12 ~ 1.88). Overall, Weight had a significant correlation with PA risk (r = 0.076, P < 0.01) and sedentary behavior risk (r = 0.035, P < 0.05). BMI had a key correlation with PA risk (r = 0.064, P < 0.01) and sedentary behavior risk (r = 0.037, P < 0.05).ConclusionsThe detection rate of Underweight among children and adolescents aged 13–18 in Xinjiang, China is higher, while the detection rate of Overweight and Obese is lower than that of the whole country. Static behavior was an important factor affecting the occurrence of Overweight and Obese in children and adolescents, and the performance of boys was more obvious than that of girls.The results further improve the data on the weight status of Chinese children and adolescents and their influencing factors, and call on Chinese society and schools to continue their efforts to prevent and reduce malnutrition and obesity among children and adolescents in Xinjiang.

35 Pharmacologic management of children with juvenile idiopathic arthritis in Batna, Algeria

BackgroundJuvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood and is usually treated with non-steroidal anti-inflammatory drugs or disease-modifying anti-rheumatic drugs. The outcome in patients with JIA has markedly improved with the advent of biologic drugs.ObjectivesThe aim of this study was to describe treatments prescribed for children with JIA in Batna, Algeria.MethodsA multicentre retrospective and descriptive study was conducted in Batna health centers (public and private sectors), over a seven-year period from January 2013 to December 2019, based on (JIA patient’s data collection). As public sector source, we referred to the department of pediatrics of the university hospital center (CHU Benflis Touhami Batna), and as private sector source, we referred to private adult rheumatologists based in Batna.ResultsThe study included a total of 69 cases of JIA that were being followed in Batna health centers over the study period. Treatment modalities used for these patients included non-steroidal anti-inflammatory drugs (NSAIDs) in 54 patients (79.4%), steroids (prednisolone) in 37 patients (54.4%), conventional disease-modifying anti-rheumatic drug (c-DMARDs) in 51 patients (72.5%), biologic agents in 11 (15.9%) and intra articular injections in 17 patients (24.6%). The most frequently used c-DMARDs was methotrexate 42 (63.7%). The mean maximal dose reached was 7.5 mg (range 2.5–15). It was associated to other c-DMARDs in 2 cases. Sulfasalazine was used in 8 cases, Leflunomide in 1 case, and Hydroxychloroquine in 1 case. Biologics were used in 11 cases (15.9%).RF-positive polyarthritis 4(50%), RF-negative polyarthritis 3 (33.3), systemic arthritis 2 (33.3) were the groups that most commonly needed a biological therapy. Biologics included Rituximab (n = 2), Tocilizumab (n = 1), Anakinra (n = 1), Etanercept (n = 1) and Infliximab (n = 1). The (mean duration of the disease evolution at the initiation of the biological agent) was 4.8 ± 5.4 years (range 0.5–8 years). At the time of enrolment, 31 patients (44.9%) were in remission: 20 patients (29%) were under treatment and 11 patients (15.9%) were not, while 12 patients (17.4%) had active disease.ConclusionA high proportion of children presenting with JIA received cDMARDs. Biologics were needed in a few cases.Disclosure of InterestNone declared

37 Subtype frequencies and demographic characteristics of juvenile idiopathic arthritis in Batna, Algeria

BackgroundJuvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. There is a disparity in the prevalence of Juvenile idiopathic arthritis (JIA) subsets between different geographical areas or ethnic groups. In Arabic and African populations, data describing JIA are scarce. However, the epidemiological studies remain the best tool to understand the disease and to improve its management.ObjectivesTo determine subtype, frequency, demographic and clinical features of JIA in Batna -Algeria- and to compare the findings with other JIA populations worldwide.MethodsA multicentre retrospective descriptive study was conducted in Batna health centers (public and private sectors), over a seven-year period from January 2013 to December 2019, based on data collected on JIA patients. As public sector source, we referred to the department of pediatrics of the university hospital center (CHU Benflis Touhami Batna), and as private sector source, we referred to private adult rheumatologists based in Batna. The studied variables were: gender, age at the initial symptoms, age at diagnosis, JIA subtype based on International League of Associations for Rheumatology (ILAR) criteria, symptoms at onset, disease duration at the latest follow up, presence of uveitis, auto antibodies (antinuclear antibodies, Rheumatoid Factor and anti-CCP) pattern, joint imaging results, JIA status at the time of enrolment and the latest follow-up.ResultsThe study included a total of 69 cases of JIA that were being followed in Batna health centers over the study period. The female to male ratio was 1.83. The median age at diagnosis was 9 years (range 1–16). Forty-six patients (72%) were diagnosed within the first year after disease onset. At the latest follow-up, the median disease duration onset was 1 year (range 1–8 years). There were 34 oligoarthritis (49.3%), 9(13%) rheumatoid factor (RF) negative polyarticular JIA, 8(11.6%) RF positive polyarticular JIA, 6(8.7%), systemic arthritis, 6(8.7%) enthesitis-related arthritis, 3(4.3%) psoriatic arthritis and 3(4.3%) undifferentiated arthritis. Nine patients (18.7%) were anti-nuclear antibody (ANA) positive, and 21 patients (30.4%) had indeterminate ANA status.ConclusionOligoarthritis was the most common JIA subtype in our study. The RF positive polyarthritis frequency was higher than in literature. Prospective multicentre studies are necessary to better identify the JIA peculiarities in our country.Disclosure of InterestNone declared

34 Subtype frequencies and demographic characteristics of juvenile idiopathic arthritis in Batna, Algeria

BackgroundJuvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. There is a disparity in the prevalence of Juvenile idiopathic arthritis (JIA) subsets between different geographical areas or ethnic groups. In Arabic and African populations, data describing JIA are scarce. However, the epidemiological studies remain the best tool to understand the disease and to improve its management.ObjectivesTo determine subtype, frequency, demographic and clinical features of JIA in Batna -Algeria- and to compare the findings with other JIA populations worldwide.MethodsA multicentre retrospective descriptive study was conducted in Batna health centers (public and private sectors), over a seven-year period from January 2013 to December 2019, based on data collected on JIA patients. As public sector source, we referred to the department of pediatrics of the university hospital center (CHU Benflis Touhami Batna), and as private sector source, we referred to private adult rheumatologists based in Batna. The studied variables were: gender, age at the initial symptoms, age at diagnosis, JIA subtype based on International League of Associations for Rheumatology (ILAR) criteria, symptoms at onset, disease duration at the latest follow up, presence of uveitis, auto antibodies (antinuclear antibodies, Rheumatoid Factor and anti-CCP) pattern, joint imaging results, JIA status at the time of enrolment and the latest follow-up.ResultsThe study included a total of 69 cases of JIA that were being followed in Batna health centers over the study period. The female to male ratio was 1.83. The median age at diagnosis was 9 years (range 1–16). Forty-six patients (72%) were diagnosed within the first year after disease onset. At the latest follow-up, the median disease duration onset was 1 year (range 1–8 years). There were 34 oligoarthritis (49.3%), 9(13%) rheumatoid factor (RF) negative polyarticular JIA, 8(11.6%) RF positive polyarticular JIA, 6(8.7%), systemic arthritis, 6(8.7%) enthesitis-related arthritis, 3(4.3%) psoriatic arthritis and 3(4.3%) undifferentiated arthritis. Nine patients (18.7%) were anti-nuclear antibody (ANA) positive, and 21 patients (30.4%) had indeterminate ANA status.ConclusionOligoarthritis was the most common JIA subtype in our study. The RF positive polyarthritis frequency was higher than in literature. Prospective multicentre studies are necessary to better identify the JIA peculiarities in our country.Disclosure of InterestNone declared

SIGNIFICANCE OF TOLL-LIKE RECEPTOR-2 POLYMORPHISM rs4696480 FOR THE DEVELOPMENT OF FOOD ALLERGY IN CHILDREN WITH ATOPIC DERMATITIS

Relevance. Food allergy is one of the most common chronic diseases in children. Toll-like receptors may be unique in the development of food allergies due to their expression by intestinal epithelial and dendritic cells.&#x0D; Objective. The aim of this study was to investigate the relationship between the rs4696480 polymorphism in TLR2 and the presence of food allergy in children with atopic dermatitis.&#x0D; Material and methods. The study included 103 patients with atopic dermatitis and 84 healthy children. Polymorphism genotyping was performed in the group of patients and the control group using real-time PCR. Food sensitization was determined by presence sIgE to food allergens by the immunochemiluminescent method using an ImmunoCAP 100 (Thermo Fisher Scientific Inc., Phadia, Sweden). The presence of food allergy was determined by a detailed clinical history and review of clinical records.&#x0D; Results. In the subgroup of children with food allergies, 9 children had the AA genotype, 7 patients had the heterozygous variant, and 3 children had the TT genotype. Among patients without food allergy, 20 patients had the AA genotype, 39 were heterozygotes, and 25 had the TT genotype. The OR assessment demonstrated that the AA genotype of the rs4696480 polymorphism is reliably associated with the development of food allergy in children with atopic dermatitis, OR=2,880 (1,0271-8,0757).&#x0D; Conclusion. The rs4696480 polymorphism in TLR2 gene is associated with the development of food allergy in Ukrainian children with atopic dermatitis.