Clinical Characteristics Of Children Research Articles

Clinical aspects of HLA-B27 positive enthesitis-related arthritis in childhood

Introduction: Enthesitis-related arthritis (ERA) is a form of juvenile idiopathic arthritis (JIA) according to the International League Against Rheumatism (ILAR) classification. Enthesitis-related arthritis accounts for 8.6 to 18.9% of all children with JIA. The first clinical sign of ERA is usually asymmetrical arthritis of large joints, especially of the lower extremities. Axial involvement is typically presented by unilateral or bilateral sacroiliitis. Enthesopathy is a unique feature of ERA. Aim: The aim of this study is to determine the most common clinical characteristics in children with HLA-B27 positive ERA. Materials and Methods: We performed a retrospective analysis of 55 patients up to 16 years of age, diagnosed with HLA-B27 positive ERA. We used physical and laboratory tests as well as imaging techniques to assess various clinical aspects of ERA in every patient. Results: Demographic characteristics showed prevalence of male gender—44 boys vs. 11 girls (4:1 ratio). The mean age of onset was 13.3 years for boys and 9.9 years for girls. The most commonly affected joints were as follows: knees in 49% of the cases, ankles—in 43.6%, hip joints—in 36.3%, intertarsal/metatarsophalangeal joints—in 20%. Physical examination found enthesitis in 24 of the patients (43.6%). The most commonly affected entheses were: the site of attachment of the Achilles tendon in 66.6% of the cases, the site of attachment of the plantar fascia in 45.8%, the site of attachment of the patellar tendon in 12.5%. Plain X-ray of the sacroiliac joints detected sacroiliitis in 34 of the patients (61.8%). In over 90% of the cases, the sacroiliitis was bilateral. Conclusion: HLA-B27 positive ERA is a rare pathology in childhood. This study confirms typical epidemiological and clinical characteristics of the disease among Bulgarian children.

Clinical Characteristics of Children With Anti-N-Methyl-d-Aspartate Receptor Encephalitis After Japanese Encephalitis

BackgroundViral encephalitis is an important trigger for anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis. We analyzed the clinical characteristics of anti-NMDAR encephalitis after Japanese encephalitis (JE) in children. MethodsClinical data of 185 children with anti-NMDAR encephalitis were retrospectively reviewed. Patients with a history of viral encephalitis other than JE or who were identified with other autoantibodies were excluded. ResultsTwenty children with anti-NMDAR encephalitis after JE were enrolled with a median age of 6 years and 10 months (interquartile range [IQR]: 3 years to 11 years and 5 months). The median time from JE to anti-NMDAR encephalitis was 29 (IQR: 25 to 32) days. At 12 months, most patients (17 of 18) recovered to at least their baseline modified Rankin scale (mRS) scores caused by JE. One hundred forty two children with classical anti-NMDAR encephalitis were enrolled. Compared with classical anti-NMDAR encephalitis, patients after JE had significantly more decreased level of consciousness (50% vs 18.3%, P = 0.003), more autonomic dysfunction (30.0% vs 9.9%, P = 0.021), fewer psychiatric or behavioral symptoms (70.0% vs 90.8%, P = 0.016), fewer seizures (25.0% vs 68.3%, P < 0.001), lesser improvement 4 weeks after immunotherapy (35.0% vs 73.2%, P = 0.001), and worse outcomes at 12 months (median mRS: 1 vs 0, P < 0.001). ConclusionsAnti-NMDAR encephalitis after JE in children mainly occurred within two months. Their clinical manifestation may differ from classical anti-NMDAR encephalitis. The prognosis of children with anti-NMDAR encephalitis after JE probably depends on the neurological sequelae after JE.

Mycoplasma Pneumoniae Infection and Persistent Wheezing in Young Children: A Retrospective Case-Control Study.

BackgroundTo investigate the clinical characteristics of children with persistent wheezing (PW) with Mycoplasma pneumoniae (MP) DNA in bronchoalveolar lavage fluid (BALF).MethodsThis retrospective case-control study included consecutive admitted children under 3 years of age who were diagnosed with PW and had MP DNA detected in BALF. Patients with mycoplasma pneumoniae pneumonia (MPP) and foreign-body aspiration (FBA) were enrolled as controls. The clinical characteristics of the groups were compared.ResultsDuring the study period, there were 89 patients diagnosed with PW without structural anomalies of the conductive airways, and 30 of these patients (33.7%, 30/89) with MP DNA detected in the BALF were selected as the study group. We included 44 patients with MPP and 44 patients with FBA as controls. Patients with MPP were older and had a higher occurrence of fever and C-reactive protein (CRP) than patients with PW (all P < 0.001). The median MP DNA copy number in patients with MPP was higher than that of patients with PW (P = 0.004). The median level of MP IgG in patients with PW was lower than that of patients with MPP and higher than that of patients with FBA (all P < 0.001). MP DNA copy number positively correlated with age (r = 0.392, P = 0.001) and CRP (r = 0.235, P = 0.048).ConclusionsOur study reveals that MP was highly detected in the BALF of PW patients. In addition, young patients with a low load of MP infection showed lower amounts of antibody, and a weak inflammatory response might be associated with PW.

Rapid onset functional tic-like behaviours in children and adolescents during COVID-19: Clinical features, assessment and biopsychosocial treatment approach.

AimTo report the prevalence and clinical characteristics of children with rapid onset functional tic‐like behaviours during the COVID‐19 pandemic.MethodsSingle centre, retrospective cohort study of children (<18 years) referred to the tic clinic from January 2018 to July 2021. We calculate the prevalence of newly diagnosed functional tics, and compare the clinical features to chronic tic disorder/Tourette syndrome (CTD/TS).ResultsA total of 185 new patients were referred to the tic clinic between 2018 and 2021. There was a significant increase in the percentage of functional tics in 2020 and 2021 (2% in 2018, 5.6% in 2019, 10.6% in 2020 and 36% in 2021). Differences between functional tics (n = 22) and CTD/TS (n = 163) include female predominance (100 vs. 28%, P < 0.0001), later age of onset (mean age 13.8 vs. 6.8 years, P < 0.0001) and higher rates of anxiety/depression (95 vs. 41%, P < 0.0001). The functional tic group were more likely to present with coprolalia‐like behaviours (77 vs. 10%, P < 0.0001), complex phrases (45 vs. 0.6%, P < 0.0001), copropraxia (45 vs. 2%, P < 0.0001), self‐injury (50 vs. 4%, P < 0.0001), hospitalisation/emergency visits (36 vs. 2%, P < 0.0001) and school absenteeism (56 vs. 7%, P < 0.0001). A total of 18.2% of patients with functional tics reported preceding exposure to social media content involving tics.ConclusionsThere is an increase in adolescent females presenting with rapid onset functional tic‐like behaviours during the COVID‐19 pandemic. We highlight differences in clinical features between the functional tic group and CTD/TS to aid diagnosis and management in the community. Based on our findings, we propose a mixed model of neuropsychiatric vulnerability and social media contagion in this group of adolescents with functional tics.

Comparison between Rural and Urban Appalachian Children in Hospice Care.

The goal of this study was to compare rural and urban pediatric hospice patients in Appalachia. Using a retrospective, nonexperimental design, we sought to compare characteristics of Appalachian rural and urban children younger than 21 years enrolled in the Medicaid hospice benefit. Descriptive statistics were calculated on the demographic, hospice, and clinical characteristics of children from Appalachia. Comparisons were calculated using Pearson χ2 for proportions and the Student t test for means. Less than half of the 1788 Appalachian children admitted to hospice care resided in rural areas (40%). Compared with children in urban areas of Appalachia, rural children were significantly younger (8 years vs 9.5 years) and more often had a complex chronic condition (56.0% vs 35.1%) and comorbidities (38.5% vs 17.0%) with technology dependence (32.6% vs 17.0%). Children in rural Appalachian were commonly from communities in the southern region of Appalachia (27.9% vs <10.0%), with median household incomes <$50,000/year (96.7% vs 22.4%). Significant differences were present in clinical care between rural and urban Appalachian children. Rural children had longer lengths of stay in hospice care (38 days vs 11 days) and were less likely to use the emergency department during hospice admission (19.0% vs 43.0%). These children more often visited their primary care provider (49.9% vs 31.3%) and sought care for symptoms from nonhospice providers (18.1% vs 10.0%) while admitted to hospice. Our results suggest that children admitted to hospice care in rural versus urban Appalachia have distinct characteristics. Rural children are admitted to hospice care with significant medical complexities and reside in areas of poverty. Hospice care for rural children suggests a continuity of care with longer hospice stays and fewer transitions to the emergency department; however, the potential for care fragmentation is present, with frequent visits to primary care and nonhospice providers for symptom management. Understanding the unique characteristics of children in Appalachia may be essential for advancing knowledge and care for these children at the end of life. Future research examining geographic variation in hospice care in Appalachia is warranted.

Clinical characteristics of children and adolescents with ADHD with or without methylphenidate prescription at their first diagnostic assessment.

Attention Deficit/Hyperactivity Disorder (ADHD) is the most prevalent neurodevelopmental disorder diagnosed in the scholar age. It is associated with significant impairment in global functioning, and in moderate/severe presentations the outcome is critically dependent on pharmacological optimization of the multi-modal treatment. Methylphenidate (MPH) is the first-choice pharmacological treatment in children and adolescents with ADHD, with substantial evidence of significant efficacy and effectiveness on global functioning and symptoms' severity. There is some evidence supporting a few clinical and socio-demographic variables as predictors of pharmacological treatment prescription in children with ADHD independently of ADHD symptoms severity. However, it is warranted to investigate clinical and general psychopathological characteristics potentially associated with negative outcomes and the need for pharmacological treatment to inform appropriate prescription strategies. In this context, we compared 268 children and adolescents who were prescribed MPH (ADHD/MPH) for the first time after their first diagnostic assessment at our center, and 444 children and adolescents with ADHD (ADHD/noMPH) who were recommended non-pharmacological evidence-based interventions alone. ADHD/MPH group had higher severity of non-ADHD psychopathological symptoms compared to the ADHD/noMPH group, as documented by higher scores on the Child Behavior Checklist (CBCL) subscales, higher severity of ADHD symptoms, lower average IQ and lower adaptive levels independently of IQ. More specifically, beside externalizing symptoms, also internalizing symptoms were significantly higher in the ADHD/MPH group. The presence of significant non-ADHD psychopathology should be considered as a clinical factor associated with the need for MPH prescription in children and adolescents with ADHD.

Low Bronchoalveolar Lavage Absolute Granulocytes Differentiate A Novel Phenotype of Children with Severe Asthma: Decreased Allergen Sensitization and Normal Lung Function

Lung granulocyte patterns are useful to select therapies for patients with treatment-refractory asthma. Although common, little is known about the clinical features of patients with a pauci-granulocytic phenotype. The purpose of this analysis was to define differentiating clinical features in children with pauci-granulocytic asthma.

High occurrence of perinatal risk factors and more severe impairments in children with postneonatal cerebral palsy in Norway.

To describe causal events, perinatal risk factors and clinical characteristics in children with postneonatal cerebral palsy (PNCP). Population-based registry study of Norwegian children born 1999-2013. Prevalence, causal events and clinical characteristics of PNCP were described. The occurrence of perinatal risk factors for CP was compared with the general population. Among 1710 children with CP, 67 had PNCP (3.9%; 0.75 per 10,000 livebirths [95%CI: 0.59-0.96]). The prevalence of PNCP decreased during the study period. Leading causal events were cerebrovascular events (32.8%), head injuries/other accidents (22.4%), infections (19.4%) and hypoxic events (14.9%). Spastic hemiplegic (53.7%) or spastic quadriplegic/dyskinetic CP (31.3%) was more common in children with PNCP than non-PNCP (42.3% and 20.1%, respectively; p<0.001). Children with PNCP had more severe motor and associated impairments. Perinatal risk factors for CP were more common in children with PNCP than in the general population. The prevalence of PNCP among Norwegian children was low and decreasing. The main causes were cerebrovascular events and head injuries/other accidents. Although spastic hemiplegic CP was the dominating subtype, children with PNCP had more severe motor and associated impairments than children with non-PNCP, as well as a higher occurrence of perinatal risk factors than in the general population.

The Clinical Characteristics in Children with Sinonasal Inverted Papilloma: A Case Report and Review of the Literature.

Sinonasal inverted papilloma (SNIP) is one of the most common benign epithelial tumors but rarely occurs in children. The case of a 9-year-old Chinese boy, who presented with a left maxillofacial hump, nasal obstruction, and left nasal cavity and maxillary sinus masses under nasal endoscopy, is reported. The lesion was first diagnosed as a sinonasal tumor. However, to our surprise, the mass was determined to be an inverted papilloma after a detailed histological examination. We retrospectively reported the clinical data of this case and reviewed the relevant literatures on SNIP. This report aims to provide new insights into the clinical characteristics in children with SNIP and improve the understanding of this disease.

Heterogeneity of DKA Incidence and Age-Specific Clinical Characteristics in Children Diagnosed With Type 1 Diabetes in the TEDDY Study.

The Environmental Determinants of Diabetes in the Young (TEDDY) study is uniquely capable of investigating age-specific differences associated with type 1 diabetes. Because age is a primary driver of heterogeneity in type 1 diabetes, we sought to characterize by age metabolic derangements prior to diagnosis and clinical features associated with diabetic ketoacidosis (DKA). The 379 TEDDY children who developed type 1 diabetes were grouped by age at onset (0-4, 5-9, and 10-14 years; n = 142, 151, and 86, respectively) with comparisons of autoantibody profiles, HLAs, family history of diabetes, presence of DKA, symptomatology at onset, and adherence to TEDDY protocol. Time-varying analysis compared those with oral glucose tolerance test data with TEDDY children who did not progress to diabetes. Increasing fasting glucose (hazard ratio [HR] 1.09 [95% CI 1.04-1.14]; P = 0.0003), stimulated glucose (HR 1.50 [1.42-1.59]; P < 0.0001), fasting insulin (HR 0.89 [0.83-0.95]; P = 0.0009), and glucose-to-insulin ratio (HR 1.29 [1.16-1.43]; P < 0.0001) were associated with risk of progression to type 1 diabetes. Younger children had fewer autoantibodies with more symptoms at diagnosis. Twenty-three children (6.1%) had DKA at onset, only 1 (0.97%) of 103 with and 22 (8.0%) of 276 children without a first-degree relative (FDR) with type 1 diabetes (P = 0.008). Children with DKA were more likely to be nonadherent to study protocol (P = 0.047), with longer duration between their last TEDDY evaluation and diagnosis (median 10.2 vs. 2.0 months without DKA; P < 0.001). DKA at onset in TEDDY is uncommon, especially for FDRs. For those without familial risk, metabolic monitoring continues to provide a primary benefit of reduced DKA but requires regular follow-up. Clinical and laboratory features vary by age at onset, adding to the heterogeneity of type 1 diabetes.

Gender-Related Clinical Characteristics in Children and Adolescents with ADHD.

Attention Deficit/Hyperactivity Disorder (ADHD) is the most frequently diagnosed neurodevelopmental disorder in school-age children, and it is usually associated with a significant impairment in global functioning. Traditionally, boys with ADHD are more likely to be referred for clinical assessments due to a higher prevalence of externalizing symptoms. However, as regards gender-related differential clinical characteristics between boys and girls with ADHD, further investigation is warranted in light of conflicting results found in currently available literature. In fact, a more precise clinical characterization could help increase appropriate diagnoses and treatment planning. In this context, we carried out a retrospective observational study on 715 children and adolescents diagnosed with ADHD from 2018 to 2020 at our center, in order to describe their gender-related clinical characteristics. Boys displayed higher average IQs, but they were comparable to girls in functional impairments and adaptive skills. Girls displayed higher scores on the Attention Problems subscale of the CBCL 6–18 and on several CPRS-R:L subscales, suggesting higher general ADHD symptom severity. Boys showed higher scores on CBCL 6–18 subscales, such as withdrawn/depressed, internalizing, and obsessive-compulsive problems. In conclusion, girls showed more severe ADHD features and lower IQ in clinically referred settings, while boys showed more internalizing problems and obsessive-compulsive symptoms.

A prospective study of etiology and clinical characteristics of children with short stature and response to treatment

OBJECTIVE: To study the etiological and clinical profile of children presenting with short stature and to assess growth velocity in children after 6 months of treatment.METHODS: This prospective observational study was conducted between January 2017 to May 2018. One hundred consecutive children attending the outpatient department for short stature were thoroughly evaluated clinically and investigations were done as deemed necessary. The cases were followed up for 6 months to assess the growth velocity.RESULTS: Female to male ratio was 1.56. Nutritional short stature (NSS) and normal variant short stature were the most prevalent, with the equal frequency of 19% each, followed by endocrine and other causes. The significant number of children had Vitamin D deficiency/insufficiency (92%). mid-parental height (MPH) was below-1 standard deviation score (SDS) from the national standard in all the children studied.CONCLUSION: In the present study, normal variants of short stature and NSS were the most common causes of short stature, followed by endocrine disorders. Vitamin D status was low in the majority of the children (92%), with possible contribution to short stature in all groups irrespective of primary diagnosis and needs further exploration. Growth hormone (GH) therapy in select non GH deficiency short stature can be promising. We also noted that maternal, paternal heights, and consequently, MPH was below the national standard in 100% of children. This may implicate ethnic variations and maybe a call for local growth charts. It needs further studies to look for factors responsible for lower MPH in our cohort.

Congenital malformations of the urinary tract: progression to chronic renal disease.

Congenital nephrourological abnormalities (CAKUT) are a particularly relevant group of diseases due to their high prevalence and the fact they are the main cause of chronic renal disease (CRD) in the pediatric population. Our objective was to determine the characteristics and prevalence of CAKUT in our setting, while identifying the factors associated with the occurrence of renal damage. A retrospective, descriptive, analytical, cross-sectional study of patients seen in the Pediatric Nephrology Department of a third-level hospital from January 1 to December 31, 2018 was carried out. Epidemiological, clinical, and analytical variables were assessed, and potential risk factors associated with CRD were searched for. The study involved 685 patients with 827 kidney units affected by CAKUT with a mean age of 9.98 ± 5.12 years. 62.2% were male, and the mean follow-up period after diagnosis was 9.95 ± 5.09 years. 58.8% were non-obstructive dilations, followed by renal dysplasia, obstructive dilations, and number and position abnormalities. The most frequent malformation was vesicoureteral reflux (VUR). The most commonly affected side was the left (47.5%). 55% of the diagnoses were prenatal. 172 patients underwent surgery. The initially chosen treatment for VUR was endourological. Overall re-intervention rate was 20%. Of the total number of patients, glomerular filtration rate was analyzed in 383, 95 (24.8%) of whom had CRD (86% in stage 2). Male sex, bilaterality, and proteinuria were risk factors associated with CRD. Knowledge of the epidemiological and clinical characteristics of children with CAKUT and the factors associated with CRD helps to individualize the clinical follow-up of these patients, thus customizing diagnostic tests and healthcare resources.

Demographics and Clinical Features of Children with Functional Neurological Symptom Disorder/Conversion Disorder: A retrospective cross-sectional study

Amaç: Konversiyon bozukluğu, psikolojik stresin fiziksel yollarla kendini ortaya koymasıdır. Bu çalışmanın amacı, konversiyon bozukluğu tanılı hastaların kayıtlarının incelenmesiyle elde edilen demografik ve klinik veriler aracılığıyla çocuklarda konversiyon bozukluğunun özelliklerini araştırmaktır.&#x0D; &#x0D; Gereç ve Yöntemler: Yaşları 4-17 arasında değişen, Atatürk Üniversitesi Tıp Fakültesi Hastanesi Çocuk Nöroloji ve Çocuk Psikiyatri polikliniğinden konversiyon bozukluğu tanısı ile takipli olan 44 olgu çalışmaya alınmıştır. Olguların çocuk nöroloji ve çocuk psikiyatri kliniklerindeki dosya kayıtları geriye dönük incelenerek elde edilen sosyodemografik özellikleri, klinik durumları ve tedavi yanıtları gibi klinik veriler irdelenmiştir. &#x0D; &#x0D; Bulgular: Olguların %65,9’u (n=29) kız olmakla birlikte %61,8’i (n=21) kırsal alanda yaşamaktadır. %41,2’sinin konversiyonu tetikleyen faktörleri okul/öğrenme stresörleri iken, %23,5’inin ise kayıp/boşanma/ölümdür. İlk atakta doktora başvuru oranı %88,4’tür. Doktora başvuran olguların %61,4’ü (n=27) ilk atağında acile başvururken, olguların aynı oranda da pediyatri kliniğine yatışları yapılmıştır. Konversiyon alt tipleri açısından olguların %40,9’u ataklarla veya katılmalarla giden tiptir. Olguların %50’sinde komorbid psikiyatrik rahatsızlık saptanmıştır. Tanı alana kadar geçen süre ilk atakta doktora götürülen olgularda, doktora götürülmeyen olgulara kıyasla anlamlı olarak daha kısadır. 6 aydan uzun süren konversiyon vakalarının %85,7’si sebat ediyorken, 6 aydan kısa süren konversiyonların %90’ı düzelmiştir.&#x0D; &#x0D; Sonuç: Konversiyon bozukluğu daha çok nörolojik semptom ve bulgularla kendini göstermektedir. Bu hastaların erken tanı ve tedavisi ile kronikleşmenin önüne geçilebilir.

Clinical features of children with horseshoe kidney in Japan

Clinical features of children with horseshoe kidney in Japan

Clinical characteristics of children with multisystemic inflammatory syndrome associated with COVID-19

Clinical characteristics of children with multisystemic inflammatory syndrome associated with COVID-19

Clinical characteristics of attention-deficit/hyperactivity disorder in children and adolescents: association with quality of life and behavioral aspects.

Objective:To identify associations between clinical characteristics of children with attention-deficit/hyperactivity disorder (ADHD) and their sociodemographic aspects, quality of life, and results from the strengths and difficulties questionnaire.Methods:This is an observational analytical cross-sectional study with a non-probabilistic sample consisting of 72 children diagnosed with ADHD, aged 6 to 13 years, treated at 2 neuropediatric outpatient clinics. The instruments used were the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder – Swanson, Nolan, and Pelham, version IV (MTA-SNAP-IV), the Strengths and Difficulties Questionnaire (SDQ), the Brazilian Economic Classification Criteria (CCEB), and the Quality of Life Assessment Scale for Children and Adolescents (AUQEI). We performed descriptive, bivariate, and multivariate analyses, considering a 5% significance level.Results:SDQ results were associated with abnormal MTA-SNAP-IV results (inattentive/hyperactive/combined). A 1-point increment in the SDQ score increased by 36.5% the likelihood of the child having an abnormal MTA-SNAP-IV classification. Regarding AUQEI, 30.6% of participants perceived their quality of life as poor and 69.4% as good.Conclusions:A higher SDQ score increased the child's chance of having an abnormal MTA-SNAP-IV result.

Clinical Features of Children with COVID-19 in Initial Time of Pandemic.

COVID-19 (Coronavirus Disease 2019) is now a global pandemic. Although children are said to have mild symptom, their clinical features are not known well. We conducted a retrospective study during initial term of pandemic to understand the difference of clinical features including clinical symptoms and patients' characteristics of COVID-19 children and those without COVID-19. To compare clinical features between children with and without COVID-19, we collected data on children who received a COVID-19 test between March 25th and October 31st, 2020. All data were collected from medical records. There were three groups of patients in the study sample; patients with COVID-19, patients with close COVID-19 contact and performed COVID-19 tests, and patients suspected COVID-19 but tested negative. We analyzed the clinical features of the groups. A total of 108 patients were included in this study, of whom 30 were patients with COVID-19, 25 were patients with close COVID-19 contact, 51 were suspected COVID-19 but tested negative, and two were excluded because they were infants born from COVID-19 mothers. The statistical analysis showed that children with COVID-19 had contact with COVID-19 patients had fewer clinical symptoms including cough and fever compared to children with a negative test of COVID-19. Sensitivity analysis showed that fever, cough, fever and/or cough could not distinguish children with COVID-19 from those without COVID-19. As conclusion, children with COVID-19 have less symptoms as fever or cough and the clinical symptoms cannot distinguish them from children with other diseases.

Clinical features of children with coronavirus disease2019 (COVID-19) at a single isolation centre in Ghana

Background: Children with coronavirus disease 2019 (COVID-19) who do not require hospitalisation must isolate to prevent the virus’s spread. Objective: This study describes the prevalence, characteristics, source of infection, and treatment outcome among children with asymptomatic or mild COVID-19 admitted to Ghana’s largest isolation centre. Methods: We conducted a retrospective descriptive study among children 0-18 years admitted to Pentecost Convention Isolation Centre in Ghana between April 24 and August 31, 2020. We extracted their clinical details and patient outcome information from their medical records. Results: The number of children enrolled was 57, with a median age of 16 years (interquartilerange:12–17years). The most common symptom was a headache. Most of the participants admitted from school attributed their source of infection to a school colleague. One patient required transfer to a hospital while the rest were discharged home after de-isolation. Conclusion: Children with asymptomatic and mild COVID-19 were managed successfully in a facility repurposed as an isolation centre. The use of repurposed isolation centres can reduce hospital care load during this pandemic. As schools re-open fully, school authorities must collaborate closely with public health institutions for rapid testing of all persons suspected to have COVID-19, to initiate early contact tracing and isolate those who are positive.

Pediatric severe factor XI deficiency: A multicenter study.

Factor XI (FXI) deficiency is a rare autosomal recessive bleeding disorder. Only scarce publications address its clinical features in children. The increased prevalence of FXI deficiency in Israel enabled data collection for this large multicenter cohort study. Some hemostatic challenges may be unique or more common in children, such as bleeding in the neonatal period or trauma-related injury. The current study was designed to explore the potential impact of these differences in children with severe FXI deficiency. Medical files of all children with FXI level under 15% followed at five tertiary centers were evaluated. The retrieved data comprised demographic and clinical characteristics, including bleeding episodes, surgical interventions, treatment strategies, as well as laboratory features. Sixty children, whose median age at diagnosis was 4.2years and their median FXI level was 4%, were included. Three children experienced triggered intracranial hemorrhage (ICH) and two children had major bleeds. No bleeding complications occurred in surgeries in which hemostatic treatment consisting mostly of tranexamic acid or fresh frozen plasma was applied (n=45). In contrast, excessive bleeding was noted in 25% of surgical procedures performed without hemostatic preparation (p=.002). This study's findings confirm the generally favorable outcome of this rare bleeding disorder, with no spontaneous bleeds or cases of perinatal ICH. Nonetheless, proper diagnosis and adequate hemostasis in the surgical setting are imperative. Unlike previous studies in adults, our pediatric study suggests an association between the severity of FXI deficiency and bleeding tendency.