Clinical Presentation Of Children Research Articles

Clinical, Sociobiological, and Cognitive Predictors of ADHD Persistence in Children Followed Prospectively Over Time.

With increasing awareness that ADHD is chronically disabling, a burgeoning literature has examined childhood clinical indicators of ADHD persistence. This study investigates whether childhood factors reflecting biological risk and cognitive reserve have additive predictive value for the persistence of ADHD that is unique beyond childhood indicators of disorder severity. One-hundred thirty children with ADHD (mean age=8.9years, 75% male) were followed into adolescence (mean age=14.0years). Childhood ADHD and co-morbidities were assessed via interviews with parents and teachers; parental psychopathology was assessed via parent interview; exposure to neurobiological and psychosocial adversity were indexed by parent questionnaire; and cognitive reserve was evaluated through children's performance on measures of IQ and executive functioning. Univariate analyses identified childhood inattention and hyperactivity-impulsivity, co-morbid oppositional defiant disorder, overall impairment, and paternal anxiety and depression as more prevalent amongst adolescents with persistent compared with remitted ADHD. Only child-level predictors remained significant in a final multivariate model. These results suggest that children who are most likely to experience persistent ADHD have a more severe clinical presentation in childhood, reflected by increased levels of inattention, oppositional behavior, and impairment. They also are more likely to have fathers with internalizing concerns, but these concerns do not uniquely predict ADHD persistence beyond child-level factors. Contrary to expectations, childhood adversity and cognitive functioning did not predict the course of ADHD.

Ebola virus disease in children: towards a better clinical picture and improved management.

Ebola virus disease in children: towards a better clinical picture and improved management.

Imaging of Abusive Head Trauma: A Review and Update

Abusive head trauma is the leading cause of severe traumatic brain injury in children <2 years of age. Because the clinical presentation of children with abusive head trauma can be nonspecific, CT and MR imaging play an important role in distinguishing these cases from episodes of accidental head trauma. In this article, we review the pathophysiology, imaging appearance, and specificity of patterns of traumatic brain injury associated with abusive head trauma, and highlight recent updates in the understanding of these injuries.

Gender dysphoria in childhood

Gender dysphoria (GD) in childhood is a complex phenomenon characterized by clinically significant distress due to the incongruence between assigned gender at birth and experienced gender. The clinical presentation of children who present with gender identity issues can be highly variable; the psychosexual development and future psychosexual outcome can be unclear, and consensus about the best clinical practice is currently under debate.In this paper a clinical picture is provided of children who are referred to gender identity clinics. The clinical criteria are described including what is known about the prevalence of childhood GD. In addition, an overview is presented of the literature on the psychological functioning of children with GD, the current knowledge on the psychosexual development and factors associated with the persistence of GD, and explanatory models for psychopathology in children with GD together with other co-existing problems that are characteristic for children referred for their gender. In light of this, currently used treatment and counselling approaches are summarized and discussed, including the integration of the literature detailed above.

B-66Gender Differences in Clinical Presentation in Children Referred for Autism Spectrum Disorder Evaluation

B-66Gender Differences in Clinical Presentation in Children Referred for Autism Spectrum Disorder Evaluation

Intussusception in Children: A Short-Term Analysis in a Tertiary Care Hospital

In children especially in infancy and early childhood intussusception is a common cause of bowel obstruction. The pattern of clinical presentations in children and outcomes of intussusception management in low resource setup and to tackle the challenging problems in the management of problem were analyzed. From January 2012 to December 2014 the records of all children below 15 years of age who experienced intussusception were reviewed. All these children were managed and treated at Manipal Teaching Hospital, Pokhara in the Western Region of Nepal. Clinical outcomes were correlated with age, sex, clinical symptoms, diagnostics and treatment protocol and length of hospital stay. Total 26 children of intussusception were managed during the three years period (2011-2014) with male to female ratio of 1.6:1. The common symptoms were abdominal pain (62%) and bleeding per rectum (31%) and irritability (25%). Ileocolic intussusceptions (76%) was the commonest type of intussusception in this study and mesenteric lymph nodes (46%) and appendix (23%) were the common lead points. The patients who had undergone operative reduction stayed in the hospital longer than those who had not undergone operative procedure. Surgical site infection (23%), postoperative ileus (15%), pneumonia (11%) were the commonest complications. Lack of specialized facilities and trained personnel were main reason for nonsurgical reduction. Intussusception cases usually reported late, therefore, operative procedure was the main treatment modality in the present hospital setup.

Long-term outcome of children with pediatric-onset cutaneous and visceral polyarteritis nodosa

ObjectiveTo assess the prognostic impact of clinical presentation in children with polyarteritis nodosa (PAN). MethodsChildren diagnosed between 1986 and 2006 in a tertiary care pediatric rheumatology center were classified as “cutaneous PAN” (group 1), “cutaneous PAN with significant extra-cutaneous features” (group 2) or “visceral childhood PAN” (group 3). Outcome measures: (1) clinical remission off-therapy at last follow-up, (2) requirement and length of glucocorticoid therapy, (3) presence of disease-related sequelae. ResultsTwenty-nine children were included. Sixteen met the Ankara criteria for PAN. Nine patients were qualified as group 1, 11 as group 2, and 9 as group 3. At last follow-up, 15 children were in clinical remission off-therapy: 4 from group 1 (44%), 4 from group 2 (36%) and 7 from group 3 (78%). Glucocorticoid therapy was required for 8 (89%), 7 (64%) and 7 (78%) patients from groups 1, 2 and 3, respectively. Seven children did not require any glucocorticoid therapy. Time-dependent probability of achieving glucocorticoid-free clinical remission was similar between the three groups. Three patients (one from each group) had digital ischemia leading to amputation. There were no significant between-group differences in outcome based on the three outcome measures addressed. ConclusionOutcome was not strikingly predictable from initial presentation in children with PAN. The organ distribution-based distinction between cutaneous and visceral PAN had little prognostic power in this series.

Phenotypic Variability in Childhood of Skeletal Muscle Sodium Channelopathies

BackgroundMutations of the SCN4A gene cause several skeletal muscle channelopathies and overlapping forms of these disorders. However, the variability of the clinical presentation in childhood is confusing and not fully understood among pediatric neurologists. PatientsWe found three different mutations (p.V445M, p.I693L, and a novel mutation, p.V1149L) in SCN4A but not in the CLCN1 gene. The patient with p.V445M showed the clinical phenotype of sodium channel myotonia, but her clear symptoms did not appear until 11 years of age. Her younger sister and mother, who have the same mutation, displayed marked intrafamilial phenotypic heterogeneity from mild to severe painful myotonia with persistent weakness. The patient with p.I693L exhibited various symptoms that evolved with age, including apneic episodes, tonic muscular contractions during sleep, fluctuating severe episodic myotonia, and finally episodic paralyses. The patient with the novel p.V1149L mutation exhibited episodic paralyses starting at 3 years of age, and myotonic discharges were detected at 11 years of age for the first time. ConclusionThe present cohort reveals the complexity, variability, and overlapping nature of the clinical features of skeletal muscle sodium channelopathies. These are basically treatable disorders, so it is essential to consider genetic testing before the full development of a patient's condition.

The Importance of Eculizumab in Patients with Atypical Hemolytic Uremic Syndrome: Single Center Experience

INTRODUCTION:The atypical hemolytic uremic syndrom (aHUS) is a rare disease especially seen in childhood. It can be differentiated from HUS with the absence of diarrhea history in the prodromal phase. Although the disease is rarely seen in children, it is even rarer in adults and is usually misdiagnosed as TTP (thrombotic thrombocytic purpura). The most prominent differential findings of the disease compared to TTP, are the development of chronic renal failure requiring hemodialysis and persistant hypertension attacks. Plasmapheresis and hemodialysis has been the choice of therapy for a long time until Eculizumab. In this abstract we will report 20 cases of aHUS that are treated with Eculizumab in our clinic.MATERIALS AND METHOD:Plasma samples of the patients were analysed for the ADAMTS13 activity and inhibitor levels before plasmapheresis. One patient out of 20 responded to plasmapheresis treatment in one week and started to be followed on out – patient clinic without any further medication, of the remaining 19 were planned to be given Eculizumab therapy. All of of the patients were vaccinated for Neisseria meningitides, Pneumococcus and Hemophilus influenza type B prior to 2 weeks of initiation of Eculizumab. We used antibacterial prophylaxis with amoxicillin – clavulanic acid in patients requiring urgent Eculizumab. Eculizumab was administered 900mg/day for 4 weeks and dosage was elevated to 1.200 mg/day in week 5, then 1.200 mg/day every other week as maintenance therapy. The response to therapy was evaluated by the fragmentation level in the peripheral blood samples, blood cell counts, serum LDH, reticulocytes ratio, creatinine levels and proteinuria.FINDINGS AND RESULTS:We enrolled 20 subjects to our study who were diagnosed as aHUS and followed in our clinic since 2012. Seventeen of the 20 patients were female and the median age was 37,5 years (ranging from 23 – 80). One of the patients responded to plasmapheresis treatment and no further medication was needed. Of the remaining 19 patients eculizumab treatment was planned. However two of them died due to acute respiratory distress prior to therapy in intensive care unit. Three of the 17 patients were diagnosed with aHUS recently (in one month) and they are currently on the induction phase of eculizumab.Fourteen of our patients are using Eculizumab for 2 to 26 months (median 8 months). One of them has been diagnosed during pregnancy and eculizumab treatment was started immediately. She had a successful delivery with preserved renal functions. Four patients did not require hemodialysis at the time of diagnosis. While four of the patients who were on dialysis, dialysis requirements were gradually decreased and was stopped in median 10 months (in 4 to 13 months). The remaining eight patients who were on eculizumab in median 2.5 months still require dialysis. 8 patient who had been on eculizumab therapy in median 2,5 months (in 1 to 7 months) still on dialysis. We terminated eculizumab therapy in patient after 13 months due to full clinical and laboratory improvement. We lost one of our patient due to severe respiratory failure in her third month of therapy.DISCUSSION AND CONCLUSION:Although aHUS is quite a well – established clinical presentation in childhood it is extremely rare in adults without settled diagnostic criteria and serologic features. The clinical outcome is unfavorable in this group with death rates as high as 25% during the acute phase and up to 50% of cases progressing to end-stage renal failure. It is confirmed that progress in intensive care and dialysis opportunity has contributed to the decrease of mortality. Death rate was 15% in our cohort but it would be higher without awareness of the syndrome. Even in induction period of the therapy, both clinical and laboratory findings were improved significantly with eculizumab. Renal functions were restored in nine of the 17 patients. Eculizumab has changed the future perspectives of patients with aHUS and both FDA and the EMA have approved it as life-long treatment. But, there are still some unresolved issues about the follow-up such as the optimal duration of eculizumab treatment and whether it can be stopped or how to stop the therapy. All these questions can be resolved with the data from large international prospective cohort studies. DisclosuresNo relevant conflicts of interest to declare.

Sepsis-like disease in infants due to human parechovirus type 3 during an outbreak in Australia.

Infections with human parechoviruses (HPeVs) are associated with a wide range of clinical presentations in children, ranging from mild or asymptomatic infections to severe sepsis-like presentations or meningoencephalitis. We reviewed medical records of infants admitted to 5 hospitals in New South Wales, Australia, during an outbreak of HPeV-3 infection. Data were collected on clinical presentation, laboratory markers, and outcome of infants with HPeV infection confirmed by reverse transcription polymerase chain reaction. We identified 118 infected infants. Most presented with an acute sepsis-like syndrome with high fever, tachycardia, poor perfusion, and severe irritability. Other common features were erythrodermic rash, abdominal distension, edema, and hepatitis. The age range of infants was 4 days to 9.5 months; 75% were <2 months old, including all but 1 of the 30 infants (25%) admitted to intensive care units (ICUs), who as a group, were significantly younger than infants not admitted to ICUs. Only 4% of evaluable cerebrospinal fluid samples had pleocytosis, but HPeV was detected in 95%. Brain magnetic resonance imaging on a small number of children demonstrated white matter changes and diffusion restriction. Sequencing of the VP1 gene confirmed HPeV-3 in all samples tested. All children recovered without ongoing complications at last follow-up. We report the largest series of HPeV-3 infection in infants, and the first outbreak in Australia. Infants presented with a severe sepsis-like syndrome with a high rate of ICU admissions, but all recovered from the acute infection without complications. Long-term sequelae are unknown.

Clinical presentation of children with pulmonary tuberculosis: 25 years of experience in Lima, Peru.

To describe clinical presentation across age groups in 2855 children with pulmonary tuberculosis (TB) attending the Children's Hospital, Lima, Peru, to improve the diagnosis, treatment and care of childhood TB. Children aged 0-14 years admitted between 1 January 1973 and 31 December 1997 with active pulmonary TB were enrolled. Demographic information, history, physical examination data, laboratory and microbiological results, chest radiograph data, disease classification, treatment and adverse effect data, and outcome at the time of discharge were recorded by pulmonologists using detailed chart abstractions. Of the 2855 enrollees, 47% were malnourished and 56% had a household contact. Older children presented with classic TB symptoms, while weight loss and anorexia were rare in children aged <5 years. Microbiological or pathologic confirmation was obtained in 71% of children aged 10-14 years compared with 34% of children aged <2 years; however, severe extra-pulmonary TB was most common among children aged <2 years (41%). Classic TB symptoms should be considered when making a diagnosis; however, systematic symptoms among young children are also important. In high-burden settings, clinicians should have a low threshold to diagnose and treat children for TB across all ages, even in the context of a negative tuberculin skin test result and lack of micro-pathological confirmation.

Fifteen-minute consultation: a structured approach to the diagnosis of idiopathic orbital inflammation

48 BSPAR157 FIFTEEN-MINUTE CONSULTATION: A STRUCTURED APPROACH TO THE DIAGNOSIS OF IDIOPATHIC ORBITAL INFLAMMATION E. Oliver, E. Mosley and S. Rangaraj Nottingham Children’s Hospital, University Hospitals Nottingham, UK Correspondence to: E. Oliver. E-mail: emma_oliver05@hotmail.com Introduction: Idiopathic orbital inflammation (IOI) also known as orbital pseudotumour was first noted in 1905 by Birch Hirchfield. IOI is the third most common condition to affect the orbit. Aims: Sclerosing IOI is a rare subdivision of IOI, causing 5% of all orbital inflammation. Oral corticosteroids, immunosuppression, radiotherapy and surgery have been successful in a number of cases; however, there remains to be a consensus on treatment. Results: We present two cases which failed to respond to oral corticosteroids and were subsequently successfully treated with i.v. pulsed methylprednisolone. Case 1, a 13-year old boy presented with a painless diplopia, ptosis, proptosis and right eyelid swelling. Initial treatment with i.v. antibiotics failed. Investigations for autoimmune and infective causes were negative. Imaging revealed a 3 x 1 cm extraocular mass overlying the right globe. Biopsy was consistent with an inflammatory lesion. Oral corticosteroid failed to improve the clinical picture. Pulsed i.v. methylprednisolone weaned over a 9 month period resulted in resolution of the lesion. Case 2, a 10-year-old girl presented with peri-orbital oedema, ptosis, proptosis and diplopia of the left eye. Treatment for orbital cellulitis resulted in resolution of erythema only. Imaging revealed a left ocular mass in the left lacrimal gland. Histopathology was consistent with sclerosing idiopathic orbital inflammation. Oral steroids resulted in limited improvement. Subsequent pulsed i.v. methylprednisolone for 5 months resulted in resolution of the lesion. Conclusion: We report two cases successfully treated with pulsed methylprednisolone. We propose pulsed methylprednisolone as first line treatment for IOI. Disclosure statement: The authors have declared no conflicts of interest. ABSTRACT 49 BSPAR158 PHYSICAL ACTIVITY, SELF-EFFICACY AND PERCEPTIONS OF ILLNESS IN ADOLESCENTS WITH CHRONIC MUSCULOSKELETAL DISEASE W. Williamson, A. Doherty, C. Foster, E. Kendall, E. Parsons, J. Sheehan, J. Dwyer and N. Wilkinson BHF Health Promotion Research Group, University of Oxford, OxPARC Oxford University Hospitals Trusts, Oxford, UK and University of Guelph, Canada Correspondence to: W. Williamson. E-mail: wilby.williamson@dph.ox.ac.uk Introduction: Moderate-to-vigorous physical activity (MVPA) is essential for growth, well-being and reducing cardio-metabolic risk. Promoting activity in adolescent disease groups requires understanding of baseline behaviour. Aims: Survey MVPA of adolescents attending a regional rheumatology clinic and identify associations been health beliefs and self-efficacy measures that may explain MVPA behaviour. Method: Three validated questionnaires covering physical activity, sedentary behaviour, self-efficacy to overcome barriers to activity and illness perceptions, were distributed over six consecutive clinics. Results: Questionnaires were completed by 42 patients [mean age 15 (range 11–21) years; 25 with JIA and 26 females]. Activity profiles: 17% inactive (zero days 60 min MVPA), 36% low-active (1–2 days 60 min MVPA), 33% moderately active (3–4 days 60 min MVPA) 14% active (>5 days 60 min MVPA). Sedentary profile: 55% report 4 or more h daily TV viewing and digital recreation. Illness-perception responses: 1 in 3 report severe symptoms, restricted lives and limited activity, 1 in 2 report negative emotional well-being. Positive illness perceptions for illness duration, concern, understanding and emotional response tended towards significant for being active (P1⁄4 0.054–0.073). MVPA self-efficacy responses did not correlate significantly with activity. The majority were confident overcoming harassment and physical environment barriers and somewhat confident overcoming internal, social and symptom barriers. TV viewing (OR 0.18 P1⁄4 0.05) and being on a sports teams (OR 9.7 P1⁄40.01) are strong correlates of inactivity/ activity. Reporting lots of opportunity for activity positively correlated with MVPA (r1⁄4 0.5, P1⁄40.03). Conclusion: Adolescents with musculoskeletal disease are less active than the general population. Reducing screen-time and promoting social sports are potential targets for MVPA promotion. A larger sample with repeated measures is required to explore correlation of self-efficacy and illness-perceptions with MVPA. Disclosure statement: The authors have declared no conflicts of interest. ABSTRACT 50 BSPAR15950 BSPAR159 PAEDIATRIC SARCOIDOSIS: A SINGLE CENTRE PAEDIATRIC RHEUMATOLOGY EXPERIENCE E. Mosley, M. Yiallorides and S. Rangaraj Nottingham Children’s Hospital, University Hospitals Nottingham, UK Correspondence to: E. Mosley. E-mail: EllenMosley@doctors.org.uk Introduction: Sarcoidosis is a rare chronic multisystem granulomatous disease. We present two cases highlighting the varied clinical presentation in children. Aims: Case 1, a 6-year-old girl, with a 4-month history of parotid swelling, unresponsive to antibiotic treatment. Paediatric referral and subsequent multisystem investigations revealed raised ACE level, elevated calcium, Schirmer’s test showed 2 mm of wetting after 5 min, punctate epithelial erosions on the cornea, pan uveitis. Renal investigations revealed hypertension, raised calcium, renal impairment POSTER PRESENTATIONS iii17

Prevalence and Correlates of Psychopathology in Children and Adolescents Evaluated with the Strengths and Difficulties Questionnaire Dysregulation Profile in a Clinical Setting

Background: The clinical presentation of children and adolescents referred to mental health services is frequently complicated by comorbid and severe affective and behavioral dysregulation. This dysregulation phenotype seems to be an indicator of overall psychopathology, symptom severity and functional impairment. Currently, this phenotype is assessed by the Child Behavior Checklist. However, the widely used Strengths and Difficulties Questionnaire (SDQ) has been recently validated to screen the Dysregulation Profile (SDQ-DP) in clinical settings. The objective of this study was to determine the prevalence and demographic, psychosocial and clinical correlates of the SDQ-DP phenotype in a Spanish clinical sample. Sampling and Methods: In a clinical sample of 623 consecutively referred children and adolescents (4-17 years old), we compared clinical and sociodemographic correlates between subjects who met the SDQ-DP criteria (DP) and those who did not (NO_DP). Sociodemographic data, parent-rated SDQ, Children's Global Assessment Scale, Clinical Global Impression, family Apgar scale and clinical diagnoses were collected by experienced child and adolescent psychiatrists. Results: Overall in our sample, 175 subjects (28.1%) met the SDQ-DP criteria (DP group). Compared with the NO_DP group, the DP subjects had significantly higher scores on internalizing and externalizing psychopathology, problems with peers and overall problems as well as significantly lower scores on prosocial behavior. Clinical diagnoses assigned revealed that DP subjects showed significantly greater psychiatric comorbidity. DP subjects also showed significantly worse family functioning and increased symptom severity and significantly lower scores on psychosocial functioning. Conclusions: A high prevalence of children and adolescents with the dysregulated profile, assessed by the SDQ-DP, was found in our clinical setting. The SDQ-DP may serve as an index of overall psychological severity and functional impairment. In addition, it may indicate family dysfunction. Further research is needed to validate the clinical value of SDQ-DP by examining longitudinal stability, heritability, adult outcome, risk factors and diagnostic correlates.

Human Parechovirus Central Nervous System Infections in Southern California Children

Human parechoviruses (hPeV) are increasingly recognized as significant etiological agents for meningoencephalitis especially in young children, but testing of cerebrospinal fluid (CSF) for hPeV by PCR is not routinely performed. We used real-time reverse transcriptase PCR for detection of serotypes 1-6 in CSF samples of 440 children who underwent a lumbar puncture to exclude an infectious etiology of their clinical presentation. We then compared the prevalence and clinical presentation of children with hPeV-positive CSF with that of children with enterovirus (EV)-positive CSF. HPeV was detected in 2.7% and EV in 10.7% of CSF samples. Many hPeV-positive patients were <3 months of age and usually had CSF parameters within the age-adjusted normal range. However, children with hPeV-positive CSF presented with neurologic symptoms more frequently than those with EV-positive CSF. HPeV infections of the central nervous system occurred mainly in young infants and were more commonly associated with neurologic symptoms at presentation, despite the fact that CSF findings were within the normal range in the vast majority of these cases. HPeV should be included in the differential diagnosis of young children with central nervous system symptoms and sepsis-like illness, even in the presence of normal CSF parameters.

G32(P) Benign Acute Childhood Myositis: Clinical Presentation in an Emergency Department

<h3>Aims</h3> To describe the demographics and clinical presentation of children who attended the emergency department of Temple Street hospital with acute onset difficulty in walking or refusal to walk and who were subsequently diagnosed with benign acute myositis. <h3>Methods</h3> We collected a list of all the ED patients who had a raised Creatinine kinase result from the pathology laboratory. We used the Emergency Department Clinical Information System, Symphony to review the medical records of these children and collect the data we needed. <h3>Results</h3> Fifty one (51) children, (40 males and 11 females) were seen with clinical myositis and raised Creatinine kinase levels between November and February of 2012–2013. Mean age was 5.9 years. Twenty eight (54.9%) presented with leg pain, sixteen (29.4%) non-weight bearing and seven (5.9%) with difficulty walking. 64.7% of these patients had calf tenderness, 5.9% had thigh tenderness and in 29.4% muscle tenderness was not clearly documented in the clinical notes. There was evidence of concurrent viral disease in thirty one (61%) of these patients with nineteen (37.2%) having had a viral illness in the preceding week. Creatinine Kinase levels were elevated in all patients with levels ranging from 183 – 7584. <h3>Conclusion</h3> Benign acute childhood myositis (BACM) is a syndrome more commonly seen in childhood typically affecting males. Symptoms include calf pain and refusal or difficulty to walk, often after a viral illness. It has been epidemiologically linked to Influenza virus. Previous studies have described much fewer cases. The Temple street University Hospital emergency department (ED) is one of the busiest in Western Europe and in the 2012/2013 winter months we did experience a surge of children with this history. BACM can be differentiated from other more serious causes of difficulty walking in children by the presence of calf tenderness in the presence of otherwise normal lower limb exam on a background of concurrent or preceding viral illness as shown in this study. These children may not necessarily need extensive investigation or routine follow up but can be discharged with appropriate advice to parents to seek review if symptoms continue.

Clinico-Mycological Evaluation of Dermatophytes and Other Fungal Agents Isolated from Various Clinical Samples

Background : Human pathogenic dermatophytes are keratinophilic molds that infect human skin, nails and hairs. Three genera (Trichophyton, Micosporum and Epidermophyton) of these organisms exist: however, their preferred sites for infections vary. Current management often consists of the topical and systemic administration of antifungal agents or a combination of both. However, these approaches may not be successful in every case due to such factors as difficulty with long term application of topical medications. Despite the successful use of systemic medications side effects and drug resistance remains a major obstacle. The treatment of dermatophyte infections represents a significant cost burden. Aims and Objectives : To study the epidemiology, clinical types and mycological features of dermatophytes from various clinical samples from dermatology department, Santosh Hospital. Material and Method : A total of 100 samples were collected including infected skin, hair and nail samples for a period of six months. Before collecting the samples, 70% alcohol was applied to the infected area and ensured that it was totally dried. Skin samples were collected by scraping, nail sample by clipping and hair samples collected by using sterile forcep or scalpel. Identification was done by KOH mount, culture on SDA, pigment production, lactophenol cotton blue staining and biochemical tests and slide culture techniques. Results : Dermatophytosis was manifested clinically more in the age group 21 - 30 years age. Tinea corporis was the predominant clinical presentation followed by Tinea cruris. Tinea capitis was the predominant clinical presentation in children and Tinea manuum was the commonest clinical type found in female patients. In the present study the male to female ratio was found 1.5 : 1. Majority of patients were belonged to the low socio-economic status. Trichophyton rubrum was the predominant pathogen followed by the Trichophyton mentagrophytes. Conclusion : Tinea corporis was found the most common clinical type of dermatophytosis and Trichophyton rubrum was found the most common fungal isolate in this part of Uttar Pradesh.

Idiopathic eosinophilic pneumonia in children: the French experience

BackgroundIdiopathic eosinophilic pneumonia is extremely rare in children and adults. We present herein the first series describing the specificities of idiopathic chronic (ICEP) and acute (IAEP) eosinophilic pneumonia in children.MethodsWe retrospectively analyzed all cases of ICEP and IAEP in children that were retrieved from French Reference Centers for rare pediatric lung diseases.ResultsFive cases of pediatric ICEP were identified. Corticosteroid or immunosuppressive therapy dramatically improved the outcome in three cases. The remaining two cases had a persistent interstitial pattern with progressive development of cystic airspace lesions. Three cases of IAEP in adolescents were reported, with one requiring four days of extracorporeal membrane oxygenation.ConclusionICEP is a rare disease with a polymorphic clinical presentation in children. We identified patients with persistent interstitial patterns progressing to cystic airspace regions, for which the boundaries with idiopathic interstitial pneumonias are difficult to establish. We therefore propose a specific pediatric definition and classification algorithm. IAEP in children remains an inflammatory reaction of the lung to an acute toxic exposure, mainly tobacco, as in adults. International studies are required to comprehensively assess the various clinical forms of the disease as well as the appropriate therapeutic regimens.

PReS-FINAL-2268: Sarcoidosis in children seen at the pediatric rheumatology clinics of two referral hospitals in Cape Town, South Africa

Sarcoidosis is a relatively uncommon condition in children. Reports from multiracial societies such as the USA indicate that sarcoidosis is more common in Africans than other racial groups. However, few reports of cases of childhood Sarcoidosis have been published from sub-Saharan Africa to shed light on the burden of sarcoidosis and the demographics and clinical presentation of children diagnosed with sarcoidosis.

Changes in clinical presentation of children with autistic disorder, at an autism clinic in Taiwan from 1987 to 1995

Autistic disorder was originally viewed as a distinct, rare, and severe childhood mental disorder that caused life-long disability. However, since the late 1990s autistic disorder was found to have a high prevalence rate and to affect children on a spectrum from mild to severe dysfunction. The purpose of this retrospective, descriptive study was to examine changes in the characteristics of patients with autistic disorder in Taiwan from 1987 to 1995. To that end, we examined the characteristics, age at diagnosis, symptoms, and developmental condition of affected children and the educational background of their parents who visited an autism clinic at the children's mental health center of a medical center in Taipei. This clinic was the first, largest, and for many years the only autistic disorder clinic in Taiwan. Across the 9-year study period, we observed trends in decreasing age at first visit, increasing age at assessment, rising maternal educational level, lessening autistic disorder symptomatology, and increasing developmental quotients. These changes may have been due to improved diagnostic criteria, government policy, and healthcare professionals’ and parents’ increased awareness of autistic disorder. Clinical implications and related policy making toward these changes are proposed.

Eosinophilic Esophagitis Associated with Celiac Disease in Children

Purpose: Celiac disease (CD) and eosinophilic esophagitis (EoE) are distinct diseases of the gastrointestinal tract with specific clinico-pathological characteristics. Recent studies have found higher rates of EoE in patients with CD than in the general population. However, these studies were retrospective reviews and of predominantly adult populations. Our aim was to estimate the incidence of EoE among children diagnosed with CD at our center over a 36-month period. Methods: Patients diagnosed with CD based on endoscopy and histopathological findings from January 2010-December 2012 were included. Histopathology reports of esophageal biopsies were reviewed to identify all cases of EoE, defined as more than 15 eosinophils per high power field. The presenting symptoms, laboratory evaluations, histopathological findings, treatment, and follow-up of these patients were analyzed. Results: 56 patients with CD were identified, of whom six (10.7%) were diagnosed with both CD and EoE. Most of these patients (4/6) presented with abdominal pain and diarrhea, and two with failure to thrive. Food allergies were seen in three patients. An abnormal celiac screening test (positive for anti-tissue transglutaminase antibody IgA) was seen in all 6. Endoscopic changes typical of EoE were observed in five patients, while histopathological changes were evident in all six. Topical corticosteroid therapy plus a gluten-free diet was required in two patients, who showed clinical amelioration of symptoms with significant improvement in endoscopic and histopathological EoE findings after six months.Table: Table. The characteristics and clinical presentation of children with CD and EoETable: Table. Endoscopic, histopathological findings and treatment of children with CD and EoEConclusion: The incidence of EoE in our cohort of children with CD was 10.7%, which is higher than the reported for the general population. In all children undergoing upper gastrointestinal endoscopy for suspected CD, coexistent EoE should be considered. Esophageal biopsies should be obtained, irrespective of whether esophageal mucosa appears normal or abnormal at endoscopy.