Clinical Characteristics Of Children Research Articles

Clinical Features in Children With Kawasaki Disease Shock Syndrome: A Systematic Review and Meta-Analysis

Objective: This study aimed to identify the clinical features of Kawasaki disease shock syndrome (KDSS) in children.Methods: The case-control studies of KDSS and KD children up until April 30, 2021 were searched in multiple databases. The qualified research were retrieved by manually reviewing the references. Review Manager 5.3 software was used for statistical analysis.Results: The results showed that there was no significant difference in the incidence of male and female in children with KDSS. Children with KDSS compared with non-shocked KD, there were significant difference in age, duration of fever, white blood cell (WBC) count, percentage of neutrophils (NEUT%), platelet count (PLT), c-reactive protein level (CRP), alanine transaminase concentration (ALT), aspartate transaminase concentration (AST), albumin concentration (ALB), sodium concentration (Na), ejection fraction, and length of hospitalization as well as the incidence of coronary artery dilation, coronary artery aneurysm, left ventricular dysfunction, mitral regurgitation, pericardial effusion, initial diagnosis of KD, intravenous immunoglobulin (IVIG) resistance and receiving second dose of IVIG, vasoactive drugs, hormones, and albumin. In contrast, there was no difference in the hemoglobin concentration, erythrocyte sedimentation rate, and the incidence of conjunctival injection, oropharyngeal change, polymorphous rash, extremity change, and incomplete KD.Conclusion: Current evidence suggested that the children with KDSS had more severe indicators of inflammation and more cardiac abnormalities. These patients were resistant to immunoglobulin treatment and required extra anti-inflammatory treatment.Systematic Review Registration: PROSPERO registration number CRD42021241207.

Особливості клініко-лабораторної діагностики хвороби Помпе у дітей

Мета. Аналіз особливостей клінічної картини хвороби Помпе (ХП) у хворих дитячого віку. Визначення за результатами лабораторних та інструментальних досліджень основних клініко-лабораторних характеристик, що дозволяють виділити таких пацієнтів у групу селективного скринінгу для проведення ферментної діагностики на наявність ХП у сухій краплі крові. Матеріали та методи. В період 2002–2016 рр. у Центрі орфанних захворювань НДСЛ «Охматдит» обстежені 522 дитини з підозрою на ХП. Вік пацієнтів — від 4 місяців до 13 років; хлопчиків було 282, дівчаток — 240. Результати. У 98 (19 %) хворих за даними електронейроміографії і на підставі виявлення мутацій у гені SMN діагностована спінальна м’язова атрофія, у 70 (13 %) — первинна м’язова дистрофія Дюшена. У 71 (13,6 %) пацієнта виявлені різні форми спадкової нейромотосенсорної невропатії. У 38 (7,2 %) пацієнтів відзначали домінантний тип успадкування захворювання, в подальшому лабораторні дослідження з метою підтвердження діагнозу ХП у них не проводили. Отже, у селективну (скринінгову) групу для проведення ферментодіагностики у сухій краплі крові для виявлення ХП включено 245 (47 %) осіб. У цих пацієнтів відзначали гетерогенну клінічну картину захворювання: м’язову слабкість, зумовлену міопатичним синдромом, у поєднанні з кардіоміопатією, затримкою фізичного розвитку, гіперкреатинфосфатемією. У 25 хворих віком 2–8 місяців, крім міопатичного синдрому, спостерігали підвищення рівня аланінамінотрансферази та аспартатамінотрансферази, креатинфосфокінази (понад 220 од/л), лактатдегідрогенази (понад 250 од/л), гіпертрофічну кардіоміопатію лівого шлуночка; у 10 з цих хворих виявлені гепатомегалія та серцево-легенева недостатність. За результатами ферментодіагностики, діагноз ХП (інфантильна форма) встановлений у 5 пацієнтів (у 3 — класична форма, у 2 — атипова, або некласична). Клінічна картина була гетерогенною, проте в усіх спостереженнях відзначали сповільнене збільшення маси тіла, затримку формування статокінетичних навичок. Три пацієнти отримували ферментозамісну терапію, що дало можливість запобігти ранній смерті у цих пацієнтів і в одному випадку практично відновити самостійну ходьбу. Висновки. ХП у дітей характеризується мультисистемним ураженням, різними клінічними формами, за відсутності специфічного лікування призводить до ранньої смерті хворих. Основними ознаками ХП у дітей є гіпертрофічна кардіоміопатія, міопатичний синдром у поєднанні зі специфічним біохімічним фенотипом. Ферментодіагностика у сухій краплі крові в групі селективного скринінгу може підвищити ефективність ранньої діагностики та лікування дітей при ХП.

A Neglected Disease: Scabies a Retrospective Study On Children

Objective: Scabies is one of the diseases that can be minimized with preventive health measures. Accurate diagnosis of scabies is important for both patient and public health. Diagnosis of scabies in children can be challenging, since the clinical features in children may differ from those of adults. The aim of the present study was to investigate the demographic and clinical characteristics of the patients with scabies in childhood. Material and Methods : The patients aged 0-18 years, who were diagnosed with scabies and presented to the dermatology outpatient clinic of our hospital, were included in the study. The demographic characteristics of the patients, time of admission, duration of symptoms, family history, the presence of specific lesions, and any lesions on the scalp, face, palmoplantar region, laboratory findings (if any), previous hospital admissions, treatment, and complications were recorded retrospectively. Results: Fifty six of the 104 patients were male (53.8%) and 48 were female (46.2%). The mean age was 5.82±5.21 years. The mean duration of symptoms was 2.41±2.24 months. Eighty four patients had a family history of scabies (80.7%). Seventy patients (67.3%) had at least one specific lesion of scabies. Atypical sites of involvement were palmoplantar region (33.6%), head (6.7%), and face (2.8%). The most commonly used diagnostic tool was dermatoscopy. Forty-one patients were treated with permethrin 5% lotion (39.4%) and 63 with sulfur ointment (60.5%). Of all admissions to the hospital, admissions were highest in fall (40.4%), followed by winter (30.8%), summer (18.2%), and spring (10.6%). Eight patients developed complications (7.6%), including 5 with impetigo and 3 with paronychia. Conclusion: Scabies is an important health issue that can be treated with an accurate and prompt diagnosis. It was observed that the head, face, palms, and soles often are involved in infants and very young children, unlike adults. Therefore, clinicians should consider the clinical differences between adults and children in the management of scabies in children. Also, dermatoscopy is a practical and effective diagnostic tool especially in infants and young children with scabies.

Pediatric Headaches: One year of Observation from A Tertiary Center

Objective: This study aims to investigate the demographic, clinical features of children and adolescents with headaches which is one of the most common reason for referral to pediatric neurology clinics in addition to elucidating the frequency of primary and secondary headaches as well as their management. Material and Methods: We retrospectively reviewed the medical reports of children and adolescents who were referred to Ankara City Hospital, Department of Pediatric Neurology between December 2019 and December 2020. Results: During the study period, 236 (86.8%) children, and adolescents were diagnosed with primary headaches and 36 (13.2%) were diagnosed with secondary headaches. Tension headaches were the most frequent (71.2%) type of primary headaches while headache or facial pain attributed to disorders of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure were the most frequent (38.8%) type of secondary headaches. All patients with secondary headaches had at least one red flag while 23 (63.8%) patients had 2 or more red flags. Magnetic resonance imaging was diagnostic in 58.3% of the patients while EEG was diagnostic in 6% of the patients. Conclusion: Pediatric patients presenting with headaches should be carefully examined to diagnose and treat the causes of secondary headaches which can be life-threatening and require urgent treatment. On the other hand, accurate diagnosis is very important in primary headaches which constitute more than 80% of all headaches and have detrimental effects on life quality as a result of refraining from daily activities.

Medical Device-related Pressure Injuries Associated With Electroencephalogram Leads in a Tertiary Care Children’s Hospital: A Retrospective Chart Review

Medical device-related pressure injuries (MDRPIs) present a substantial safety risk for children who are hospitalized. This study aimed to describe patient and clinical characteristics of children who develop MDRPIs related to electroencephalogram (EEG) leads, determine risk factors associated with their development, and determine if there are common risk factors that can lead to actionable strategies to reduce MDRPIs related to EEG leads. A retrospective review was completed of the electronic health records of all 3136 children who had EEG lead placements between January 1, 2014, and April 16, 2018, at a large tertiary care children's hospital. Data abstracted included demographic variables, patient and pressure injury characteristics, as well as length of stay. Twenty-four (24) of the 3136 children (0.8%) developed an MDRPI. Most were stage 2 pressure injuries. Patients who developed a pressure injury were significantly younger than patients who did not (median age, 0.9 and 5.2 years, respectively; P = .005). Fifty percent (50%) of all patients who developed pressure injuries were younger than 1 year of age compared with 27% of patients who did not develop pressure injuries. The median length of stay for patients in whom MDRPI developed was 84.5 days (interquartile range, 45-137) versus 3.0 days (interquartile range, 2-8) for those who did not develop an MDRPI (P < .001). The mortality rate during the hospital stay was 21% (n = 5) for those who developed MDPRIs versus 4% (n = 19) for those who did not (P = .002). All patients received standard preventive strategies. The incidence of MDRPIs in this patient population was significantly higher in younger and longer-stay patients, and their mortality rate was significantly higher. This suggests that the patients who developed an MDRPI were more critically ill than those who did not. Vigilant assessment and more research are needed to determine if there are appropriate strategies to reduce MDRPIs related to EEG lead placement.

Evaluation of Children with Attention Deficit Hyperactivity Disorder on the Wechsler Intelligence Scale for Children-IV

Objective: The aim of this study was to evaluate the cognitive performance and clinical characteristics of children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) who had attended a tertiary center. Method: Fifty-six children and adolescents aged 7-16 years with ADHD who had been admitted to the Child and Adolescent Psychiatry clinic between June 2020 and March 2021 were retrospectively included in the study. A semi-structured interview form for the Affective Disorders and Schizophrenia Interview Schedule-Present Version for School-Age Children was used to determine mental disorders. The Clinical Global Impression Scale (CGIS) was completed to assess the severity of ADHD symptoms. The Wechsler Intelligence Scale for Children-IV (WISC-IV) was used in the assessment of cognitive skills. Results: The median age of the participants was 13 and 71.4% of them were male. The Working memory index (s=83.3) and Full-Scale IQ (FSIQ) (s=84) were found to be the lowest scores. According to the comparisons between CGIS, the FSIQ score (χ2 =0.736; p=0.947), verbal comprehension index (χ2 =2.882; p=0.578), perceptual reasoning index (χ2 =1.412; p=0.842), working memory index (χ2 =1.980; p=0.739), processing speed index (χ2 =1.673; p=0.796) were not found to be statistically different between the groups. Conclusion: The WISC-IV scale, which is increasingly preferred in the clinic use, could help to obtain information about cognitive performance in children with ADHD, regardless of the severity of ADHD symptoms.

Clinical profile of reading ability and reading and writing achievement of children with borderline full-scale intellectual quotient: a prospective study

BackgroundPoor reading ability is one of the common causes of low academic performance. In previous studies, children with dyslexia were found to demonstrate poor academic achievement due to poor reading ability. However, the relationship between academic achievement and reading ability in children with a borderline full-scale intellectual quotient (FSIQ) is unknown. This study aimed to clarify the clinical characteristics of children with borderline FSIQ and poor reading ability, and differentiate these characteristics from those of children with higher FSIQ and poor reading ability.MethodsA total of 126 children (aged 6–15 years) identified as having low academic performance were enrolled. The reading ability of children was assessed through their performance on the hiragana (Japanese syllabary) reading task, while their reading and writing achievement was assessed through their reading and writing score on the Kaufman Assessment Battery for Children, Second Edition. Children were categorized into two groups based on their FSIQ score (FSIQ > 85 and 85 ≥ FSIQ ≥ 70). Reading ability in children was evaluated by referring to the linear relationship between FSIQ and the standard deviation value of reading tasks in typically developing children. A one-way analysis of variance (ANOVA) was performed to examine clinical characteristics between higher and lower FSIQ groups. Associations between reading and writing achievement, reading ability, and ages of children were assessed using Pearson’s product-moment correlation coefficients for the higher and lower FSIQ groups.ResultsPoorer reading and writing achievement was associated with poorer reading ability in the higher FSIQ group. Conversely, poorer reading and writing achievement and poor reading ability were associated with older age in the lower FSIQ group.ConclusionsPoor reading and writing achievement were associated with older age, not with poor reading ability in the lower FSIQ group. Children with lower FSIQ need appropriate educational interventions based on independent assessments to further their academic achievement and reading ability. Moreover, they need more frequent evaluations of their academic achievement than do children with higher FSIQ and poor reading ability since they are more likely to be at a lower academic achievement level at an older age.

Clinical features of children with cow's milk sensitization

Objective: To investigate sensitization rate of cow's milk in children, and explore its clinical features. Methods: This study enrolled a total of 818 patients under 18 years old with suspected food allergy who were admitted to the Allergy department in Beijing Shijitan Hospital during June 2018 to November 2020. The ImmunoCAP fluorescent enzyme-linked immunoassay system was used to quantify cow milk-specific immunoglobulin E (sIgE). Mild sensitization to cow's milk was defined as Radio-Allergo-Sorbent-Test (RAST) class 1, moderate sensitization was defined as class 2-3 and severe sensitization was class 4-6. Statistical methods such as χ2 test, independent sample t-test, one-way analysis of variance, and Spearman correlation analysis were used to retrospectively clarify differences of cow's milk sensitization rate between ages of children and elaborate its clinical features. Results: Overall sensitization rate of cow's milk reached 25.7% (210/818). Positive rate of cow milk sensitization (39.2%), cow milk sIgE levels [0.93 (0.52, 2.62)] kU/L, and moderate to severe sensitization rate (23.5%) were highest in infants aged between 0-3 years old. The sensitization rate and severity of sensitization declined with age. Most common clinical manifestation of cow milk sensitization was skin symptoms (50.0%), followed by respiratory symptoms (38.9%) and gastrointestinal symptoms (36.1%). Skin symptoms were the most common manifestation in 0-3 year-old group (47.3%), and respiratory symptoms were more common in 4-6 and 7-18 year-old groups (58.7%, 56.0%). Multiple-sensitization rate of patients with moderate to severe cow milk sensitization was 74.1%, most of which (70.4%) were co-sensitized by other food allergens, and 31.5% were co-sensitized by inhaled allergens. Conclusions: In population with age under 18 years old, infants aged between 0-3 years old suffered highest cow milk sensitization rate and increased sensitization severity. Then the severity decreased with age increasing. Patients with cow milk sensitization manifested skin symptoms most.

Clinical characteristics of children with airway malacia complicated by pneumonia

BackgroundAirway malacia is an important cause of noisy breathing, recurrent wheezing and respiratory infections, chronic coughing, and episodes of respiratory distress in young children. As the clinical manifestations of airway malacia are not common, many clinicians have insufficient understanding of this disease. So the purpose of this study is to summarize the pathogenic bacteria and clinical manifestations of airway softening complicated with pneumonia in children.MethodsChildren hospitalized with airway malacia complicated by pneumonia were eligible for enrollment from January 1, 2013 to December 31, 2019. Medical records of patients were reviewed for etiology, clinical characteristics, and laboratory examination results.ResultsA total of 164 pneumonia patients with airway malacia were admitted. The male-to-female ratio was 3:1. The age of patients ranged from 1 month to 4 years old. The median age was 6 (3–10) months. The most commonly detected pathogen were Mycoplasma pneumoniae (25/164, 15.24%), Streptococcus pneumoniae (18/164, 10.98%), and respiratory syncytial virus (16/164, 9.76%). Common signs among the 164 patients with confirmed airway malacia included cough (98.78%), wheezing (67.07%), fever (35.37%), intercostal retractions (23.17%), dyspnea (10.98%), cyanosis (11.11%), and crackles (50%). Compared with those without airway malacia, the incidence of premature delivery and mechanical ventilation was higher, and the duration of symptoms before admission (median, 13.5 d) and hospital stay (median 10.0 d) were longer. Of the children with pneumonia, 11.59% of those with airway malacia required supplemental oxygen compared with 4.88% of those without airway malacia (p < 0.05).ConclusionThe median age of children with airway malacia was 6 months. The most common pathogen in patients with airway malacia complicated by pneumonia was Mycoplasma pneumoniae. Patients with airway malacia complicated by pneumonia often presented with a longer disease course, more severe symptoms, and had delayed recovery.

Transcriptomic Evaluation of Juvenile Localized Scleroderma Skin With Histologic and Clinical Correlation.

Juvenile localized scleroderma (LS) is an autoimmune disease of the skin whose pathogenesis is not well understood due to the rarity of the disease. This study was undertaken to determine the skin transcriptome in skin biopsy tissue from children with juvenile LS compared to pediatric healthy controls, with identification of significant molecular targets using RNA sequencing (RNA-Seq). In this study, differentially expressed genes (DEGs) were assessed for correlations with histopathologic and clinical features in children with juvenile LS, and were used to group the children into distinct genetic clusters based on immunophenotype. RNA-Seq was performed on sections of paraffin-embedded skin tissue obtained from 28 children with juvenile LS and 10 pediatric healthy controls. RNA-Seq was carried out using an Illumina HTS TruSeq RNA Access library prep kit, with data aligned using STAR and data analysis using a DESeq2 platform. A standardized histologic scoring system was used to score skin sections for the severity of inflammation and levels of collagen deposition. Histologic scoring was completed by 2 pathologists who were blinded with regard to the status of each sample. Spearman's rank correlation coefficients were used to assess significant correlations between DEG expression profiles and skin histologic findings in patients with juvenile LS. We identified 589 significant DEGs in children with juvenile LS as compared to healthy controls. Hierarchical clustering was used to demonstrate 3 distinct juvenile LS immunophenotype clusters. The histologic scores of skin inflammation (based on numbers and categories of inflammatory cell infiltrates) were significantly correlated with the expression levels of HLA-DPB1, HLA-DQA2, HLA-DRA, and STAT1 genes (rs > 0.5, P < 0.01). Collagen thickness correlated with the expression levels of collagen organization genes as well as with genes found to be correlated with the severity of inflammation, including genes for major histocompatibility complex (MHC) class I, MHC class II, and interferon-γ signaling. Among children with juvenile LS, 3 distinct genetic signatures, or clusters, were identified. In one cluster, inflammation-related pathways were up-regulated, corresponding to the histologic skin inflammation score. In the second cluster, fibrosis-related pathways were up-regulated. In the third cluster, gene expression in the skin corresponded to the patterns seen in healthy controls. Up-regulation of HLA class II genes was observed within the first cluster (characterized by predominant inflammation), a feature that has also been observed in the peripheral blood of patients with morphea and in the skin of patients with systemic sclerosis.

The prevalence, immune profile, and clinical characteristics of children with celiac disease and type 1 diabetes mellitus in the state of Qatar

Children with antibody positive type 1 diabetes mellitus (type 1 diabetes) are at an increased risk of developing celiac disease (CD) which suggests a common autoimmune basis with both high-risk human lymphocyte antigen (HLA) and non-HLA factors playing a role in the pathophysiology. We aim to describe the prevalence, immune profile, and clinical characteristics of children with CD who have type 1 diabetes mellitus in Qatar. All children (aged 0-18 years) attending a regional diabetes clinic with antibody positive type 1 diabetes were screened for CD. Measurement of tissue transglutaminase IgA and IgG as well as anti-endomysial antibody, was done, clinical details about the birth history, family history of diabetes and CD, age of onset, and ethnicity were collected. Out of the 1,325 children with antibody positive type 1 diabetes, 54 were identified to have CD on screening and then confirmed on small bowel biopsy. The prevalence of CD in the type 1 diabetes childhood population in Qatar is 4.07%. CD and type 1 diabetes were more prevalent in the Qatari children (n=32) as compared to non-Qatari (n=22) and occurred mostly in the age group 6-10 years. The most common type 1 diabetes antibodies in children with CD were glutamic acid decarboxylase and insulin autoantibody. Twelve subjects were asymptomatic for CD symptoms and picked up only on screening. The prevalence of CD in children with type 1 diabetes in Qatar is comparable to reports from around the world. Many children were asymptomatic and thus routine screening is recommended.

No Correlation between Positive Fructose Hydrogen Breath Test and Clinical Symptoms in Children with Functional Gastrointestinal Disorders: A Retrospective Single-Centre Study.

Fructose malabsorption is regarded as one of the most common types of sugar intolerance. However, the correlation between gastrointestinal symptoms and positive results in fructose hydrogen breath tests (HBTs) remains unclear. The aim of this study was to assess the clinical importance of positive fructose HBT by correlating the HBT results with clinical features in children with various gastrointestinal symptoms. Clinical features and fructose HBT results were obtained from 323 consecutive children (2–18 years old, mean 10.7 ± 4.3 years) that were referred to the Tertiary Paediatric Gastroenterology Centre and diagnosed as having functional gastrointestinal disorders. A total of 114 out of 323 children (35.3%) had positive HBT results, of which 61 patients were females (53.5%) and 53 were males (46.5%). Children with positive HBT were significantly younger than children with negative HBT (9.0 vs. 11.6 years old; p < 0.001). The most frequent symptom among children with fructose malabsorption was recurrent abdominal pain (89.5%). Other important symptoms were diarrhoea, nausea, vomiting, and flatulence. However, no correlation between positive fructose HBT results and any of the reported symptoms or general clinical features was found. In conclusion, positive fructose HBT in children with functional gastrointestinal disorders can be attributed to their younger age but not to some peculiar clinical feature of the disease.

Clinical characteristics of 967 children with pertussis: a single-center analysis over an 8-year period in Beijing, China.

The purpose of this study is to understand children’s clinical characteristics with pertussis and analyze risk factors on critical pertussis patients. Demographic data from patients with pertussis at Children’s Hospital affiliated to the Capital Institute of Pediatrics between March 2011 and December 2018 were collected. We retrospectively gathered more information with the positive exposure, vaccination, antibiotic usage before diagnosis, clinical manifestation, laboratory tests, therapy, and complications for hospitalized children. We divided the patients into severe and non-severe groups, comparing related factors and clinical characteristics among each group. In particular, we summarize the clinical features of the severe patients before aggravation. A total of 967 pertussis cases were diagnosed, of which 227 were hospitalized. The onset age younger than 3 months old accounted for the highest proportion, and 126 patients received hospitalization. For those patients, the incidence of post-tussive vomiting, paroxysmal cyanosis, post-tussive heart rate decrease, hypoxemia, severe pneumonia, and mechanical ventilation was significantly higher than that in the ≥ 3-month-old group (p < 0.05). Among 227 hospitalized patients, 54 suffered from severe pertussis. Risk factors for severe patients included early age of onset, pathogen exposure, and unvaccinated status. Cough paroxysms, post-tussive vomiting, paroxysmal cyanosis, facial flushing/cyanosis/fever during cough, increased WBC, and chest X-ray revealing pneumonia/consolidation/atelectasis were important indications of severe pertussis. Unvaccinated status was an independent risk factor for severe pertussis. The most vulnerable population was infants < 3 months old to pertussis, and may be on the severe end of the disease. Pediatricians must detect and treat severe cases promptly and recommend timely vaccination for all eligible children.

Clinical characteristics of children with Guillain-Barré syndrome and factors associated with disease severity

Guillain-Barré syndrome (GBS) is the leading cause of pediatric acute flaccid paralysis.This study aimed to summarize the clinical features of children with GBS and to explore factors associated with the severity of weakness. One hundred and twenty-two children with GBS (73 males and 49 females) were retrospectively analysed. The median age (IQR) at diagnosis was 4.0 years (2.9–7.2 years), and 26.2% of patients were at the age of 2–3 years. Of the 122 cases, 71 (58.2%) had an antecedent infection, 58 (47.5%) had cranial nerve involvement, 36 (29.1%) had dysautonomia, 77 (63.1%) had sensory symptoms, 28 (23.0%) had difficulty in breathing of which 15 (12.3%) patients required mechanical ventilation, and 8 (6.6%) had normal tendon reflex or hyperreflexia. Cytoalbuminologic dissociation of the cerebrospinal fluid was observed in 97 cases (82.9%). Further, 120 patients underwent nerve conduction studies: 76 (63.3%) exhibited demyelinating features whereas 36 (30.0%) had axonal type of CBS. 70.2% of patients could walk independently at 12 weeks. Fourteen (11.5%) patients were classified into the mild group [GBS disability score (GBS-DS) < 3] and 108 (88.5%) were classified into the severe group (GBS-DS ≥ 3). The incidence of cranial involvement (P = 0.038) and decreased tendon reflexes (P = 0.048) were significantly different between the two groups. These findings suggested that cranial nerve involvement is associated with severe muscle weakness in children with GBS.

Characteristics of children and adolescents with atopic dermatitis who attended therapeutic patient education

Atopic dermatitis (AD) is a chronic, relapsing, inflammatory skin disease. Therapeutic patient education (TPE) has been demonstrated to be effective in AD in reducing disease severity and improving coping and quality of life. To describe the sociodemographic and clinical characteristics of children and adolescents with AD who had attended TPE sessions, as well as the characteristics of their parents, and compare them with those who did not attend TPE. Parents of children with AD aged 6-17years old were recruited from a representative sample of the French population contacted by e-mail. Sociodemographic data and clinical information were collected in patients and parents. Clinical severity was assessed by parents using a proxy version of the Patient-Oriented Eczema Measure (POEM). Attendance to TPE sessions was assessed by the following question 'did your child or one or both parents attended TPE for AD?'. Also, the number of sessions was recorded. Determinants of TPE attendance were evaluated by univariable and multivariable analyses. Data were collected on 1063 parents and children with AD. A total of 131 (12.3%) children and/or parents attended TPE sessions. Most of them attended 2-5 TPE sessions. In that group, there were 85 boys (64.9%), and severity evaluated by POEM was mild in 29.8%, moderate in 52.7% and severe in 17.6% of patients. In the multivariable model, attending TPE sessions was significantly associated with sex of the child (boy vs. girl), consultation with a dermatologist or a paediatrician, high clinical severity and presence of AD in parents. Despite recommendations, the use of TPE in children with AD is still low in France. There is a need for implementing such programmes in the management of the disease, in particular when the disease is severe.

Epidemiology of intussusception among infants in Ethiopia, 2013-2016.

Introductionintussusception is a condition in which one segment of the bowel prolapses into another causing obstruction. Information on the epidemiology of intussusception in sub-Saharan Africa is limited. We describe the sociodemographic and clinical characteristics of children with intussusception in Ethiopia.Methodsactive surveillance for children < 12 months of age with intussusception was conducted at six sentinel hospitals in Ethiopia. Limited socio-economic and clinical data were collected from enrolled children. Characteristics among children who died and children who survived were compared using the Wilcoxon rank sum test for continuous variables and Chi-square tests for categorical variables.Resultstotal of 164 children < 12 months of age with intussusception were enrolled; 62% were male. The median age at symptom onset was 6 months with only 12 (7%) of cases occurring in the first 3 months of life. Intussusception was reduced by surgery in 90% of cases and 10% were reduced by enema; 13% of cases died. Compared to survivors, children who died had a significantly longer time to presentation to the first health care facility and to the treating health care facility (median 3 days versus 2 days, p = 0.02, respectively).Conclusionthe high mortality rate, late presentation of intussusception cases, and lack of modalities for non-surgical management at some facilities highlight the need for better management of intussusception cases in Ethiopia.

Clinical features of children with atopic dermatitis according to filaggrin gene variants

Filament aggregating protein (Filaggrin) is a skeletal cell component that provides a protective function for the epidermis. Mutations of the filaggrin gene (FLG) cause a loss of filaggrin protein. These mutations are seen in 50% of atopic dermatitis (AD). The aim of the study was to investigate the polymorphisms and mutations of the FLG in Iranian children with AD. This project was a case-controlled study with 25 children diagnosed with AD as the case group and 25 healthy children as the control group. Demographic data, clinical manifestations, and filaggrin single nucleotide polymorphisms (SNPs) and mutations were recorded. Blood samples were collected for the immunoglobulin E (IgE) assay and complete blood count tests. We found a significant association between the presence of polymorphism (rs66831674) and patients' age, and polymorphism (rs41267154) and early onset of AD. We found no significant differences between the FLG polymorphisms with respect to the severity of AD, ethnicity, concurrent allergic diseases, eosinophilia, and IgE serum levels. Interestingly, FLG variants (rs66831674 and rs41267154) were associated with age and early onset of AD. However, additional studies are required to confirm these results on a large scale of Iranian population. Moreover, establishing a cohort prospective study is suggested to assess the progression of other atopic disorders based on FLG polymorphisms.

#7: Clinical Characteristics of Children with COVID-19: A Multicenter Study in the United Arab Emirates

BackgroundTo date, coronavirus disease-2019 (COVID-19) has infected over 82 million people globally. The first confirmed case in the United Arab Emirates (UAE)was reported on 29th January 2020. Current data suggests that children with COVID-19 have a mild disease course. There is a lack of extensive published data about COVID-19 infection among children in the Arabian Gulf region.MethodsThis cross-sectional multicenter study included children with confirmed COVID-19 infection admitted between March 1st and June 15th, 2020 to three large hospitals in Dubai, UAE. Serial nasal swabs for COVID-19 polymerase chain reaction (PCR) testing were collected during hospitalization. We investigated patients’ demographics,clinical characteristics, radiological and laboratory investigations during their inpatient hospital course.Results111 children were included in our study and represented 22 nationalities. Fifty-nine (53.2%) were boys. The mean age was 7 years (±5.3), and 15.3% of children were younger than 1 year. Only 4 (3.6%) children had pre-existing asthma, all of whom had an uneventful clinical course. At presentation 43 (38.7%) were asymptomatic, 68 (61.2%) had mild or moderate symptoms and none had severe illness requiring intensive care. Fever (20.7%), cough (19.8%) and rhinorrhea (15.3%) were the most common presenting symptoms, most of which resolved by day 5 of hospitalization. Most of our patients had a normal chest x-ray. The most common laboratory abnormalities on admission included variations in neutrophil count (24.7%), aspartate transaminase (22.5%), alkaline phosphatase (36.7%) and lactate dehydrogenase (42.5%). Children were infrequently prescribed targeted medications, with only 4 (3.6%) receiving antibiotics. None of the 52 patients tested for viral co-infections were positive. COVID-19 PCR turned negative at a median of 10 days [6–14 days] after the first positive test. Overall, there was no significant difference in time to negative PCR between symptomatic and asymptomatic children.ConclusionThis pediatric study of COVID-19 presents a first look into the burden of COVID-19 infection among children in the UAE. Patients had various laboratory abnormalities despite clinical stability. We conclude that a large percentage of children with COVID-19 infection experience no symptoms, and severe disease is uncommon in the UAE. Ongoing surveillance, contact tracing and public health measures will be essential in containing future outbreaks.

International Analysis of Electronic Health Records of Children and Youth Hospitalized With COVID-19 Infection in 6 Countries

Additional sources of pediatric epidemiological and clinical data are needed to efficiently study COVID-19 in children and youth and inform infection prevention and clinical treatment of pediatric patients. To describe international hospitalization trends and key epidemiological and clinical features of children and youth with COVID-19. This retrospective cohort study included pediatric patients hospitalized between February 2 and October 10, 2020. Patient-level electronic health record (EHR) data were collected across 27 hospitals in France, Germany, Spain, Singapore, the UK, and the US. Patients younger than 21 years who tested positive for COVID-19 and were hospitalized at an institution participating in the Consortium for Clinical Characterization of COVID-19 by EHR were included in the study. Patient characteristics, clinical features, and medication use. There were 347 males (52%; 95% CI, 48.5-55.3) and 324 females (48%; 95% CI, 44.4-51.3) in this study's cohort. There was a bimodal age distribution, with the greatest proportion of patients in the 0- to 2-year (199 patients [30%]) and 12- to 17-year (170 patients [25%]) age range. Trends in hospitalizations for 671 children and youth found discrete surges with variable timing across 6 countries. Data from this cohort mirrored national-level pediatric hospitalization trends for most countries with available data, with peaks in hospitalizations during the initial spring surge occurring within 23 days in the national-level and 4CE data. A total of 27 364 laboratory values for 16 laboratory tests were analyzed, with mean values indicating elevations in markers of inflammation (C-reactive protein, 83 mg/L; 95% CI, 53-112 mg/L; ferritin, 417 ng/mL; 95% CI, 228-607 ng/mL; and procalcitonin, 1.45 ng/mL; 95% CI, 0.13-2.77 ng/mL). Abnormalities in coagulation were also evident (D-dimer, 0.78 ug/mL; 95% CI, 0.35-1.21 ug/mL; and fibrinogen, 477 mg/dL; 95% CI, 385-569 mg/dL). Cardiac troponin, when checked (n = 59), was elevated (0.032 ng/mL; 95% CI, 0.000-0.080 ng/mL). Common complications included cardiac arrhythmias (15.0%; 95% CI, 8.1%-21.7%), viral pneumonia (13.3%; 95% CI, 6.5%-20.1%), and respiratory failure (10.5%; 95% CI, 5.8%-15.3%). Few children were treated with COVID-19-directed medications. This study of EHRs of children and youth hospitalized for COVID-19 in 6 countries demonstrated variability in hospitalization trends across countries and identified common complications and laboratory abnormalities in children and youth with COVID-19 infection. Large-scale informatics-based approaches to integrate and analyze data across health care systems complement methods of disease surveillance and advance understanding of epidemiological and clinical features associated with COVID-19 in children and youth.

Chromosome 10 abnormality predicts prognosis of neuroblastoma patients with bone marrow metastasis

BackgroundNeuroblastoma (NB) is the most common extracranial solid tumor in children. It is known for high heterogeneity and concealed onset. In recent years, the mechanism of its occurrence and development has been gradually revealed. The purpose of this study is to summarize the clinical characteristics of children with NB and abnormal chromosome 10, and to investigate the relationship between the number and structure of chromosome 10 abnormalities and NB prognosis.MethodsChromosome G-banding was used at the time of diagnosis to evaluate the genetics of chromosomes in patients with NB and track their clinical characteristics and prognosis. All participants were diagnosed with NB in the Medical Oncology Department of the Beijing Children’s Hospital from May 2015 to December 2018 and were followed up with for at least 1 year.ResultsOf all 150 patients with bone marrow metastases, 42 were clearly diagnosed with chromosomal abnormalities. Thirteen patients showed abnormalities in chromosome 10, and chromosome 10 was the most commonly missing chromosome. These 13 patients had higher LDH and lower OS and EFS than children with chromosomal abnormalities who did not have an abnormality in chromosome 10. Eight patients had both MYCN amplification and 1p36 deletion. Two patients had optic nerve damage and no vision, and one patient had left supraorbital metastases 5 months after treatment.ConclusionsThe results indicated that chromosome 10 might be a new prognostic marker for NB. MYCN amplification and 1p36 deletion may be related to chromosome 10 abnormalities in NB. Additionally, NB patients with abnormal chromosome 10 were prone to orbital metastases.