Clinical Symptoms In Children Research Articles

Effect and safety of Burosumab in the treatment of 4 children with X-linked hypophosphatemia

Objective: To evaluate the effectiveness and safety of treatment with Burosumab in pediatric X-linked hypophosphatemia (XLH) patients. Methods: In this retrospective case study, 4 children with pediatric XLH, who were treated with Burosumab in Beijing Children's Hospital, Capital Medical University and Shandong Provincial Hospital affiliated to Shandong First Medical University from July 2022 to December 2023, were selected as the study objects. We collected and analyzed their clinical characteristics, biochemical indicators, imaging results, and treatment. The children were followed up every 3 months until December 2023, and the clinical outcomes and adverse drug reactions after treatment were evaluated. Results: Of the 4 patients, 3 were males and 1 was female; they were aged 6.7, 2.9, 2.1, and 2.3 years, respectively. Three patients had previously received treatment with phosphate supplements and active vitamins, but their wadding gait and lower limb deformities did not improve significantly, neither did their imaging changes of active richets. The initial dose of Burosumab in the 4 patients was 0.8 mg/kg, administered subcutaneously every 2 weeks, with a treatment course of 0.8-1.3 years. The fasting serum phosphorus and tubular maximum reabsorption of phosphate/glomerular filtration rate (TmP/GFR) of the 4 patients before treatment were 0.72, 0.95, 0.81, 0.66 mmol/L and 0.67, 0.85, 0.87, 0.61 mmol/L, respectively. At the last follow-up, the fasting serum phosphorus and TmP/GFR levels were significantly increased (0.96, 1.09, 1.09, 0.90 mmol/L, and 0.85, 0.79, 1.03, 0.98 mmol/L, respectively). Among them, only the TmP/GFR level (1.17 mmol/L) in case 2 achieved normal values at 3 months post-therapy, while the rest did not reach the normal range for children of the same age. After treatment, the alkaline phosphatase levels of all patients gradually decreased (the values were 461, 240, 423, and 237 U/L, respectively), and the ALP levels in cases 2 and 4 returned to normal at the last visit. Case 4 showed a slight increase in parathyroid hormone (PTH) levels after 9 months of treatment, while the PTH levels in the rest 3 cases remained normal. Case 1 underwent a 6-minute walking test, and the walking distance increased from 245 m to 570 m. Abnormal gait, lower limb deformity, and the severity of rickets in the 4 patients had all improved. No adverse drug reactions such as nephrocalcinosis, local skin injection reaction, hyperphosphatemia, or vitamin D deficiency were observed. Conclusion: Burosumab can improve clinical symptoms in children with XLH with a good safety profile.

Clinical characteristics, diagnosis and treatment of nasal cartilage mesenchymal hamartoma in infants

Objective: To explore the clinical characteristics, pathological features, and diagnosis and treatment strategies of nasal chondromesenchymal hamartoma (NCMH) in infants and young children. Methods: A retrospective analysis was conducted on seven cases of NCMH infants and young children admitted to Beijing Children's Hospital, Capital Medical University from April 2015 to January 2022. The cohort included 5 males and 2 females, aged from 6 days to 2 years and 3 months. General information, clinical symptoms, imaging findings, treatment plans, postoperative complications, recurrence and follow-up time were collected, summarized and analyzed. Additionally, immunohistochemical characteristics of the lesion were examined. Results: The clinical symptoms of 7 children included nasal congestion, runny nose, open mouth breathing, snoring during sleep, difficulty feeding, and strabismus. All patients underwent electronic nasopharyngoscopy examination, with 5 cases of tumors located in the right nasal cavity and 2 cases in the left nasal cavity. No case of bilateral nasal cavity disease was found. All 7 patients underwent complete imaging examinations, with 5 patients underwent MRI and CT examinations, 1 patient underwent CT examination only, and 1 patient underwent MRI examination only. The CT results showed that all tumors were broad-based, with uneven density, multiple calcifications and bone remodeling, and some exhibited multiple cystic components. The MRI results showed that the tumor showed low signal on T1 weighted imaging and high or slightly high signal on T2 weighted imaging. All patients were diagnosed through histopathological examination and immunohistochemistry, including 7 cases of Ki-67 and SMA (+), 5 cases of S-100 and Vimentin (+), and all EMA and GFAP were negative. All patients underwent endoscopic resection surgery through the nasal approach, with 3 cases using navigation technology. Five cases of tumors were completely removed, and two cases of tumors were mostly removed. No nasal packing was performed after surgery, and no postoperative nasal, ocular, or intracranial complication occurred in all patients. Follow up assessments conducted 6 to 84 months post-surgery revealed no instances of tumor recurrence in any of the patients. Conclusions: The clinical symptoms of children with NCHM mainly depend on the size and location of the tumor. Nasal endoscopic surgery is the main treatment method. In cases where critical structures like the skull base or orbit are implicated, staged surgical interventions may be warranted. Long-term follow-up is strongly advised to monitor for any potential recurrence or complications.

Meta-analysis of the adoption of omalizumab in the treatment of pediatric allergic diseases

IntroductionAllergic diseases are common chronic conditions in children, omalizumab has a wide range of adoptions in various diseases. A meta-analysis was implemented to demonstrate the efficacy of omalizumab in the therapy of pediatric allergic diseases. Materials and methodsEnglish databases were searched. The search terms included “Omalizumab”, “Children”, “Allergic asthma”, and “Atopic dermatitis”. The literature was screened regarding inclusion and exclusion criteria, and data were extracted and analyzed using RevMan5.3. Resultsa total of six suitable studies, comprising 2761 patients, were selected for inclusion. The meta-analysis results implied that at 24 weeks, OR for worsening of symptoms in children was 0.10 (95 % confidence interval [CI] 0.03–0.41), Z = 3.24, P = 0.001 (P < 0.05); at 52 weeks, OR was 0.27 (95 % CI 0.09–0.83), Z = 2.28, P = 0.02 (P < 0.05); and during treatment, OR for adverse events in children was 0.87 (95 % CI 0.60–1.29), Z = 0.68, P = 0.49 (P > 0.05). Conclusionthe study comprised six investigations that examined the effectiveness of omalizumab in treating pediatric allergic diseases. The findings demonstrated that, in comparison to standard treatment, omalizumab can greatly alleviate allergy-related clinical symptoms in children, slow down disease progression, and has a higher safety profile with fewer adverse reactions. These results have practical implications and highlight the potential value of omalizumab in pediatric allergy treatment.

An Open-Label Pilot Trial of a Brief, Parent-Based Sleep Intervention in Children With ADHD.

To assess the effects of a brief parent-based behavioral sleep intervention in children with ADHD. Families with a child with ADHD and parent-reported sleep problems received a brief parent-based sleep intervention, which involved two one-to-one consultation sessions and one telephone follow-up with the parent/caregiver. Child's sleep and clinical symptoms, and parental sleep and daytime functioning were assessed at baseline, 2-week post-intervention, and 3-month follow-up. Sixty eligible families (mean age of the child: 9.4 ± 1.5 years; boys: 75%) were recruited, and 43 (72%) completed the whole intervention. The intervention resulted in significant improvements in the child's sleep, clinical symptoms, and parental sleep and parenting stress, and these improvements were generally maintained at 3-month follow-up. The findings supported the promising effects of a brief parent-based sleep intervention on improving sleep and clinical symptoms in children with ADHD and parental sleep and parenting stress. Further randomized clinical trials with long-term follow-up are needed to test the robustness of the effectiveness of the intervention.

Investigation of Laboratory Indicators, Clinical Symptoms, and COVID-19 Vaccination History in Children Referred to Imam Khomeini Hospital in Jiroft City, South Iran

Background: The commencement of COVID-19 vaccination has had an impact on hospitalizations and deaths of patients. This study aims to investigate the effect of COVID-19 vaccination on children›s hospitalizations and deaths. Methods: This cross-sectional study examined 893 children infected with COVID-19 referred to Imam Khomeini hospital in Jiroft City in the south of Iran in 2022. Data collected and analyzed included demographic variables including age, sex, place of residence, underlying disease, vaccination status, injection dose of vaccine, history of contact with a patient with COVID-19, and clinical and laboratory characteristics such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell (WBC), creatinine (CR) and days of hospitalization. The data were analyzed using SPSS-v20 software. Results: The average age±SD of the patients is 4.6±3.9 years. There were 302 (33.81%) children in the age group of 9 to 12 years and 133 (14.89%) of children were in the age group under one year. The most common clinical symptoms in children with COVID-19 were fever (67.41%), diarrhea (38.63%), and cough (30.57%). ESR and CRP were 27.72±20.8, and 25.51±32.8 respectively amongst the participants. Out of 893 children, 480 (53.75%) were vaccinated and 413 (46.24%) had not received the vaccine. Out of 480 vaccinated children, 460 (95.83%) were outpatient, and only 20 (4.16%) were hospitalized, and out of 413 non-vaccinated children, 241 (58.35%) were outpatient, and 172 (41.64%) were hospitalized. Conclusion: The results showed that vaccination led to a 95.83% reduction in hospitalization and a 100% reduction in long-term hospitalization. The COVID-19 vaccination is very effective in preventing the harmful effects of COVID-19 in future trends and pandemics.

Cool and hot executive function problems in young children: linking self-regulation processes to emerging clinical symptoms.

Self-regulation (SR) difficulties are implicated in a wide range of disorders which develop in childhood, including attention deficit hyperactivity disorder (ADHD), oppositional defiance disorder (ODD), anxiety and depression. However, the integration of the existing research evidence is challenging because of varying terminology and the wide range of tasks used, as well as the heterogeneity and comorbidity within and across diagnostic categories. The current study used the Research Domain Criteria (RDoC) framework to guide the examination of different SR processes in young children showing a wide range of symptomatology. Children (aged 4-8) referred by teachers for moderate-to-high conduct, hyperactivity and/or emotional problems at school (assessed using the Strengths and Difficulties Questionnaire (SDQ) subscales; n=212), and children in SDQ typical ranges (n=30) completed computerised cognitive control and decision-making tasks. Parents completed questionnaires to assess ADHD, ODD, anxiety and depression symptoms (n=191). Compared to children with no teacher-reported difficulties, those with moderate-to-high problems showed poorer visuomotor control and decision-making. A factor analysis revealed that task variables adhered to RDoC dimensions and predicted variance in specific disorders: difficulties in cognitive control predicted ADHD symptoms, low reward-seeking was associated with depression and high reward-seeking was associated with ODD. This study highlights how the assessment of cognitive processes positioned within the RDoC framework can inform our understanding of disorder-specific and transdiagnostic difficulties in SR which are associated with diverse clinical symptoms in children.

Association between vaccination and the risk of immunoglobulin A vasculitis in children

To study the effect of vaccination on the short-term risk of immunoglobulin A vasculitis (IgAV) in children. A retrospective analysis was conducted on the general data and the vaccination history within one year prior to onset in children with IgAV hospitalized in the Children's Hospital Affiliated to Zhengzhou University from November 2021 to January 2023. Vaccine exposure rates in the risk period (3 months prior to IgAV onset) and the control period were compared by autocontrol-case crossover analysis, and the odds ratio and 95% confidence interval (95%CI) were calculated. A sensitivity analysis for the one-month and two-month risk periods was conducted. A total of 193 children with IgAV were included, with a median age of 7.0 years. Among the 193 children, 36 (18.7%) received at least one dose of the vaccine within 1 year prior to IgAV onset, and 14 (7.3%) received at least one dose of the vaccine during the 3-month risk period. Compared to the unvaccinated IgAV group, the vaccinated IgAV group had a significantly younger age of onset (P<0.05). There were no significant differences in the proportions of children with gastrointestinal involvement, renal involvement, and joint involvement between the two groups (P>0.05). The odds ratio for developing IgAV after receiving any type of vaccine within 3 months prior to IgAV onset was 2.08 (95%CI: 0.82-5.27, P>0.05). Further sensitivity analysis for the 1-month and 2-month risk periods demonstrated that the odds ratios for developing IgAV after receiving any type of vaccine were 2.74 (95%CI: 0.72-10.48, P>0.05) and 2.72 (95%CI: 0.95-7.77, P>0.05), respectively. Vaccination dose not increase the risk of IgAV, nor does it exacerbate clinical symptoms in children with IgAV.

Clinical manifestations and risk factors of coronary artery lesions in children with Kawasaki disease.

To analyze the clinical manifestations of children with Kawasaki disease (KD), and risk factors of coronary artery lesion (CAL). A total of 223 patients admitted to Anhui Children Hospital from January 2017 to December 2019 were enrolled. According to the clinical data, the children with KD were divided into complete Kawasaki disease (CKD) and incomplete Kawasaki disease (IKD) groups. According to the results of the cardiac color ultrasound, the children were divided into the CAL and nCAL groups. The clinical symptoms of children with KD were compared between the CKD and IKD groups. The risk factors of CAL were analyzed by univariate and binary logistic regression analyses. The incidence constituent ratio of KD increased annually from 2017 to 2019 (P < .05). The proportion of fever duration no longer than 10 days, chapped lips, fingertip decrustation, perianal desquamation, and fever combined with rash in the CKD group was significantly higher compared to the IKD group (P < .05), while intravenous immunoglobulin non-response and CAL were significantly lower than those in the IKD group (P < .05). The proportion of males, age <1 year, fever duration longer than 10 days, and IKD in the CAL group were significantly higher compared to the nCAL group, while hemoglobin levels were significantly lower than that in the nCAL group (P < .05). Sex, age, fever duration, atypical KD, and hemoglobin levels were risk factors for CAL in children with KD. Persistent fever, conjunctival hyperemia, chapped lips, and rash were common clinical symptoms in children with KD. The risk of CAL was relatively higher in children with low hemoglobin levels and IKD, whose ages were <1 year old and whose fever time was more than 10 days, which requires high clinical vigilance.

Clinical analysis of sixty-nine children with anomalous aortic origin of the coronary artery

We aimed to analyse the clinical characteristics of children with different types of anomalous aortic origin of the coronary artery (AAOCA) at different ages, and to discuss the factors related to myocardial ischaemia. In this retrospective study, we included 69 children diagnosed with AAOCA using CT coronary angiography; we classified the participants based on the type of AAOCA, age, and high-risk anatomy. The clinical characteristics of the different AAOCA types and age groups were compared, and the correlation between manifestations and high-risk anatomy was analysed. Anomalous origin of the left coronary artery from the right coronary artery sinus, anomalous origin of the right coronary artery from the left coronary artery sinus, and a coronary artery origin without coronary sinuses was found in 10 (14.5%), 57 (82.6%), 2 (2.9%) patients, respectively. There were no significant differences in sex, clinical manifestations, percentage of positive myocardial injury markers, electrocardiogram, transthoracic echocardiography, or proportion of high-risk anatomy among the groups with different AAOCA types. According to age group, the proportion of asymptomatic infants and pre-schoolers was the highest (p < 0.001). Forty-three patients (62.3%) had high-risk anatomy and were more likely to present with severe symptoms and cardiac syncope (p < 0.05). Conclusion: There were no significant differences in the proportions of high-risk anatomy and clinical characteristics among children with different AAOCA types. We found a relation between the severity of AAOCA clinical symptoms and anatomical risk.What is Known:• Clinical symptoms in children with AAOCA are varied and the results of routine cardiological examinations lack specificity.• High-risk anatomical features, exercise, cardiac symptoms, and ALCA are risk factors for the occurrence of SCD in patients with AAOCA.What is New:• Compared the clinical characteristics of different types of AAOCA and ages.• Analysed the correlation between symptoms and high-risk anatomical features.

Venous 3D Phase Contrast Magnetic Resonance Angiography Increases Diagnostic Certainty in Children with Ventriculoperitoneal Shunt and Suspected Shunt Failure

BackgroundClinical symptoms in children with suspected malfunction of ventriculoperitoneal shunt may not be specific and difficult to interpret. The presence or absence of ventricular enlargement on magnetic resonance imaging (MRI) does not reliably predict raised intracranial pressure (ICP) in these patients. Therefore, the aim was to investigate the diagnostic utility of 3D venous phase-contrast MR angiography (vPCA) in these patients.MaterialsThe MR studies of two groups of patients at two different examination dates were retrospectively analyzed; one group without clinical symptoms on both examinations and one with symptoms of shunt dysfunction on one examination receiving surgery. Both MRI examinations had to have been performed including axial T2 weighted (T2-w) images and 3D vPCA. Two (neuro)radiologists evaluated T2-w images alone and in combination with 3D vPCA in terms of suspected elevated ICP. Interrater reliability, sensitivity and specificity were assessed.ResultsCompression of venous sinuses was seen significantly more often in patients with shunt failure (p = 0.00003). Consequently, evaluation of 3D vPCA and T2-w images increases sensitivity to 0.92/1.0 compared to T2-w images alone with 0.69/0.77, the interrater agreement for the diagnosis of shunt failure rises from κ = 0.71 to κ = 0.837. Concerning imaging markers, three groups could be identified in children with shunt failure.ConclusionIn accordance with the literature, the results show that ventricular morphology alone is an unreliable marker for elevated ICP in children with shunt malfunction. The findings confirmed 3D vPCA as a valuable supplemental diagnostic tool improving diagnostic certainty for children with unchanged ventricular size in cases of shunt failure.

Effects of Li-Dan-He-Ji on regulating oxidative stress and antagonising infantile cholestatic hepatic fibrosis

To explore the clinical effect of Li-Dan-He-Ji in the treatment of infantile cholestatic hepatic fibrosis. Patients who met the diagnostic criteria of infantile cholestatic hepatic fibrosis in the department of integrated traditional Chinese and Western medicine and the department of gastroenterology of Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January to December 2021 were included in the study by prospective randomized controlled trial. They were divided into the conventional treatment group and Li-Dan-He-Ji group according to the random number table. The patients in the conventional treatment group were given conventional treatment according to the guidelines. In the Li-Dan-He-Ji group, the self-made Chinese medicinal compound Li-Dan-He-Ji (prescription: Herba Artemisiae Scopariae, Fructus Forsythiae, Radix et Rhizoma Rhei preparata, Radix Polygoni Multiflori Preparata, Radix Paeoniae Rubra, Ramulus Cinnamomi, Fructus Aurantii, Rhizoma Atractylodis Macrocephalae, Fructus Schisandrae Chinensis, Carapax Trionycis, and Radix Glycyrrhizae) was given on the basis of the routine treatment, by oral, enema or nasal feeding, 60 mL each day, divided into 2 or 3 times, for 28 days. Outpatient follow-up was maintained for 4 weeks. Before and after treatment, serum liver fibrosis 4 items [type IV collagen (IV-C), hyaluronidase (HA), type III procollagen (PC III), laminin (LN)], liver function and cholestasis-related markers [total bilirubin (TBil), direct bilirubin (DBil), total bile acid (TBA), alkaline phosphatase (ALP), γ-glutamyl transpeptidase (γ-GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST)], oxidative stress markers [superoxide dismutase (SOD), malondialdehyde (MDA), and glutathione (GSH)], liver stiffness measurement (LSM) detected by transient elastography (TE), aspartate aminotransferase-to-platelet ratio index (APRI), and liver and spleen retraction time were recorded in the two groups. During the observation period, a total of 40 cases of cholestatic hepatic fibrosis were treated, including 21 cases in the conventional treatment group and 19 cases in the Li-Dan-He-Ji group. Before treatment, the differences in serum liver fibrosis 4 items, serum liver function and cholestasis-related markers, oxidative stress indexes, LSM and APRI of the two groups were not statistically significant. After treatment, the liver fibrosis 4 items, liver function and cholestasis-related markers, LSM, and APRI were all significantly decreased in both groups, and the indexes in the Li-Dan-He-Ji group were significantly lower than those in the conventional treatment group [HA (ng/L): 165.81±21.57 vs. 203.87±25.88, PC III (μg/L): 69.86±9.32 vs. 81.82±7.39, IV-C (μg/L): 204.14±38.97 vs. 239.08±24.93, LN (μg/L): 162.40±17.39 vs. 190.86±15.97, TBil (μmol/L): 37.58±27.63 vs. 53.06±45.09, DBil (μmol/L): 20.55±19.34 vs. 30.08±27.39, ALP (U/L): 436.50±217.58 vs. 469.60±291.69, γ-GGT (U/L): 66.78±35.84 vs. 87.00±32.82, ALT (U/L): 64.75±50.53 vs. 75.20±50.19, AST (U/L): 77.25±54.23 vs. 96.80±59.77, TBA (μmol/L): 74.35±44.44 vs. 85.45±39.50, LSM (kPa): 5.24±0.39 vs. 7.53±3.16, APRI: 0.52±0.39 vs. 0.98±0.29, all P < 0.05]. After treatment, MDA in the two groups were significantly lower than those before treatment, and SOD and GSH were significantly higher than those before treatment. The level of SOD in the Li-Dan-He-Ji group was significantly higher than that in the conventional treatment group (kU/L: 64.56±6.69 vs. 51.58±5.98, P < 0.05). In addition, the liver retraction time (day: 20.13±10.97 vs. 24.33±13.46) and spleen retraction time (day: 25.93±13.01 vs. 29.14±14.52) in the Li-Dan-He-Ji group were significantly shorter than those in the conventional treatment group (both P < 0.05). The use of Li-Dan-He-Ji in the treatment of cholestatic hepatic fibrosis can effectively improve the indicators of cholestasis, hepatic fibrosis, oxidative stress and clinical symptoms in children.

Auditory processing disorders in children – diagnosisand management

Introduction: Auditory Processing Disorders (APD) is a syndrome characterized by impairment of the perception of soundsverbal and non-verbal ones, and weakening cognitive abilities such as auditory attention and auditory memory. This symptoms occur despite correct functioning of the peripheral part of the organ of hearing. Aim: A review of the current literature on diagnostic criteria of APD and its subtypes, clinical symptoms in children, diagnostic procedures and methods and therapeutic interventions. Methods: The study was based on the guidelines of the British Audiological Society (BSA), the guidelines of the American Speech, Language and Hearing Society (ASHA) as well as a literature review in the PubMed database. Results: APD is divided into developmental (without an established cause), acquired (with an established cause) and secondary (a consequence of long-term peripheral hearing loss). Symptoms that indicate the likelihood of APD in schoolaged children include: poor school performance, problems with learning to read and write and understanding speech, difficulties in repeating and remembering information given by hearing and maintaining attention on the spoken word. APD diagnosis should be made by a specialist in audiology and phoniatrics based on a full battery of tests and consultations with a speech therapist, psychologist and pedagogue. The set of behavioral diagnostic tests should include both verbal and non-verbal tests, from at least three groups of tests: dichotic (e.g. dichotic digit test; DDT), evaluating temporal aspects of hearing (e.g. Frequency Pattern Test; FPT and Duration Pattern Test; DPT ) and low redundancy speech tests. The diagnosis can be made when the child is at least 7 years old, the result is below the norm in at least two tests evaluating different auditory processes and the child has previous been excluded from intellectual disability and autism spectrum disorders. The therapeutic procedure is based on active auditory training, specific for the deficit shown in the tests. It is important to improve the acoustic environment at school (FM systems) and to treat comorbidities. Conclusions: Diagnostics and therapy of APD requires a highly qualified team of specialists and should be carried out in centers specially prepared for this purpose.

Effectiveness of Anodal Transcranial Direct Current Stimulation of Left Dorsolateral Prefrontal Cortex in Facial Emotion Recognition and Clinical Symptoms of Boys with Autism Spectrum Disorder

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a deficit in communication and social skills, stereotypical and repetitive patterns of behaviors, interests, and activities. The gold standard treatment, behavioral therapy, imposes a great cost on families, and its efficacy depends on the life stage at which the therapy is started. As an alternative treatment, the efficacy and safety of transcranial direct current stimulation (tDCS) have been investigated in different patient groups; however, its efficacy on facial emotion recognition (FER) has not been investigated in children with ASD. Objectives: We investigated the effectiveness of anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) in FER and clinical symptoms of children with ASD. Methods: Twenty-four boys with ASD were selected from a school in Tehran, Iran. The eligible participants were randomized to receive the intervention (15 minutes of electrical stimulation) or not (20 seconds with device-off; control group). The emotion recognition task and autism treatments evaluation checklist (ATEC) were evaluated before and after the intervention and compared using the mixed ANOVA test. Results: Eleven boys in each group completed the study. The groups were similar regarding mean age, ASD severity, and intelligence quotient. The interactive effect of group and time was significant on both scales (emotion recognition task and ATEC). Conclusions: Anodal tDCS of DLPFC is an effective therapeutic method for specific behaviors, including FER, in school-aged boys with ASD. Further studies are required to suggest this treatment as a safe and effective strategy in children with ASD.

Investigation of Clinical Manifestations and Laboratory Findings of COVID-19 During National Peaks of Alpha, Beta, Delta, and Omicron in the Pediatric Emergency Department of Mofid Children's Hospital, Tehran, Iran

Background: The global spread of the coronavirus since 2019 has caused significant concern. Objectives: In this study, we aimed to investigate the clinical manifestations and laboratory findings of children infected with the alpha, beta, delta, and omicron strains. Methods: We included all patients who were referred to Mofid Children's Hospital during the peak of the alpha strain in November 2020, the beta strain in April 2021, the delta strain in August 2021, and the omicron strain in February 2022, corresponding to the national peaks of four SARS-CoV-2 variants of concern (VOC). All patients had a positive nasopharyngeal PCR test and were admitted to the emergency ward. We analyzed the collected data using SPSS software. Results: A total of 649 patients were included in this survey, of whom 58.1% were male. The most and least frequent clinical manifestations were fever and skin presentation, respectively. The mean white blood cell count (WBC) was 8423.9 ± 5427.3. The mean values for C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were 30.14 ± 20.07 and 38 ± 22.6, respectively. There was no significant association between coronavirus type, age, and gender. Gastroenteritis, urinary tract infection, and croup showed a statistically significant positive correlation with delta, beta, and omicron (P-values of &lt; 0.003, 0.000, and 0.000, respectively). Cough was more frequent in patients infected with alpha and beta subtypes, while lymphocyte counts were elevated in patients suffering from delta, omicron, and alpha. C-reactive protein and ESR levels were significantly increased in patients with delta infection, and in patients with omicron infection, CRP levels were significantly elevated. Conclusions: Our study revealed that the different strains of COVID-19, corresponding to the World Health Organization (WHO) peak of VOCs, can cause variable clinical symptoms in children. These findings could be helpful in the diagnosis of COVID-19.

The association of vitamin A, zinc and copper levels with clinical symptoms in children with autism spectrum disorders in Jilin Province, China

BackgroundThis study evaluated vitamin A (VA), copper (Cu), and zinc (Zn) levels in the population with autism spectrum disorder (ASD) in Jilin Province, China. Furthermore, we examined their links to core symptoms and neurodevelopment, as well as gastrointestinal (GI) comorbidities and sleep disorders.MethodsThis study included 181 children with autism and 205 typically developing (TD) children. The participants had not taken vitamin/mineral supplements in the prior three months. High-performance liquid chromatography was used to measure serum VA levels. By using inductively coupled plasma–mass spectrometry, Zn and Cu concentrations in plasma were determined. Importantly, the Childhood Autism Rating Scale, the Social Responsiveness Scale, and the Autism Behavior Checklist were used to measure core ASD symptoms. However, the Griffith Mental Development Scales-Chinese were used to measure neurodevelopment. GI comorbidities and sleep abnormalities were assessed with the 6 Item-Gastrointestinal Severity Index and Children’s Sleep Habits Questionnaire, respectively. Children with ASD with GI issues were grouped according to severity (low GI severity and high GI severity groups).Results(i) The difference in VA, Zn, Cu levels and the Zn/Cu ratio between ASD and TD children is small. But children with ASD had lower VA levels and Zn/Cu ratio, higher Cu levels than TD children. Cu levels in children with ASD were associated with the severity of core symptoms. (ii) Children with ASD were much more likely than their TD counterparts to suffer from GI comorbidities or sleep problems. Furthermore, it was observed that high GI severity was associated with lower levels of VA, whereas low GI severity was associated with higher levels of VA. (iii) The children with ASD who had both lower VA and lower Zn/Cu ratio had more severe scores on the Autism Behavior Checklist, but not on other measures.ConclusionChildren with ASD had lower VA and Zn/Cu ratio, and higher Cu levels. Cu levels in children with ASD were weakly correlated with one subscale on social or self-help. ASD children with lower VA levels may face more serious GI comorbidities. Children with ASD combined VA-Zn/Cu lower had more severe core symptoms.Trial registrationRegistration number: ChiCTR-OPC-17013502. Date of registration: 2017-11-23.

Unspecified Meningoencephalitis with Empiric Antimicrobial Therapy: A Case Report

Meningoencephalitis is inflammation of the central nervous system (CNS) including the brain parenchyma, lining of the brain and brainstem.Inflammation in meningoencephalitis can be caused by infectious or non-infectious processes (autoimmune diseases, neoplastic processes, drug reactions).In cases of suspected encephalitis in children, empirical therapy that can be given within the first 6 hours after admission to the hospital without a diagnosis of a cause other than a virus is acyclovir at a dose of 500 mg/m2 or 10 mg/kg every 8 hours at the age of 3 months to 18 years to 14 days. Acyclovir is given because the most common cause is HSV. Steroids may be given if the cause is suspected or streptococcus pneumonia or Haemophilus influenzae. In this case a 6 year old boy came to the emergency room unconscious, the patient was diagnosed with meningoencephalitis. The patient was given antimicrobial drugs in the form of ceftriaxone due to the limitations of antiviral drugs at the hospital. It turned out that there was an improvement in clinical symptoms in children on the 3rd day of treatment which was marked by an improvement in general conditions and a decrease in temperature.

The effects of glucocorticoid plus intravenous immunoglobulin (IVIG) vs IVIG alone on platelet activation in children with Kawasaki disease.

Even though intravenous immunoglobulin (IVIG) is a current treatment for Kawasaki disease (KD), 10-20% of patients require additional therapy. This study seeks to investigate the therapeutic effects of glucocorticoids plus IVIG on KD and to ascertain the subsequent effect on platelet activation during the acute phase. A total of 32 children with KD were randomly classified into two groups: the experimental group (16 cases) and the control group (16 cases). The control group was exposed to IVIG (2 g/kg), whereas children in the experimental group were treated with IVIG (2 g/kg) + glucocorticoid. Peripheral venous blood samples were obtained from all participants before treatment as well as three days post-treatment to test platelet activation levels with procaspase activating compound-1 (PAC-1) antibody, Toll-like receptor 4 (TLR4), interleukin-6 (IL- 6), tumor necrosis factor-α (TNF-α), procalcitonin (PCT), and C-reactive protein (CRP). Fever duration posttreatment was documented for both groups. Additionally, the coronary arteries in both groups were evaluated during three months of treatment. After treatment, the experimental group had remarkably lower levels of TNF-α, CRP, PCT, IL-6, PAC- 1, and TLR4 relative to the control group. The fever persistence rate was considerably elevated in the control group compared to the experimental group (log-rank, P=0.024). In addition, the z-score of coronary artery size dropped after IVIG + glucocorticoids treatment compared to the control group, although this difference was not significant. The IVIG + glucocorticoids can quickly mitigate the inflammatory response and platelet activation. Moreover, it can also improve clinical symptoms in children with KD.

The Effect of Family-Centered Smoking Cessation Counseling on the Respiratory Function of Asthmatic Children With a Smoker in the Family Referred to Besat Hospital Children’s Clinic, Sanandaj in 2019

Background: Asthma is the most prevalent allergic respiratory condition and may be triggered by tobacco smoke. The aim of the present study was to investigate the effect of family-centered counseling on the respiratory function of children with asthma referred to the pediatric clinic of Besat hospital, Sanandaj in 2019. Materials and Methods: The present randomized quasi-experimental study was performed on 60 children with asthma from a smoking family who were referred to the pediatric clinic of Besat hospital in Sanandaj. The participants were placed into comparison and intervention groups (30 per group). No intervention was performed in the comparison group, and they only received general education by a specialist doctor. The intervention group received family-centered smoking cessation counseling. The child’s forced expiratory volume in the first second (FEV1) level was measured before and three months after the intervention, and clinical symptoms, including daily cough, night cough, sputum production, wheezing, and dyspnea, were determined before, one, and three months after the intervention in both groups. Finally, the results were compared between the two groups. Results: The results showed that clinical symptoms (daily cough, wheezing, and dyspnea) decreased, while FEV1 increased in the intervention group compared to the comparison group, and the difference was significant (P&lt;0.05). The amount of sputum production and night cough decreased in both groups, and the decrease was higher in the intervention group, but it was not statistically significant. Conclusion: According to the results, it is recommended that intervention strategies such as family-centered counseling be adopted to stop smoking and improve clinical symptoms in children with asthma.

Dupilumab improves clinical symptoms in children with Netherton syndrome by suppressing Th2-mediated inflammation.

Netherton syndrome is a rare, life-threatening autosomal recessive genetic disorder with no effective treatment yet. Skin barrier dysfunction caused by SPINK5 gene mutations is a hallmark of the disease. Antigen penetration through the defective skin and nonspecific inflammation provide a pro-T helper 2 (Th2) immune microenvironment in the disease. Therefore, Th2 cytokines are considered to be candidate therapeutic targets. To evaluate the clinical responses of patients with Netherton syndrome to dupilumab, an IL-4Rα antagonist, and identify changes in the Th1/2/17 pathway activity, skin barrier defect protein LEKTI expression after treatment. Four children with severe Netherton syndrome (aged 2 y to 4 y and 6m) who were treated with dupilumab from January to June 2022 were evaluated at baseline, and at 4, 8, 12, 16, and 20 weeks after the start of dupilumab administration. Treatment response was assessed using the Eczema Area and Severity Index (EASI), the Numerical Rating Scale (NRS), the Dermatology Life Quality Index (CDLQI), and the Dermatitis Family Impact-questionnaire (DFI). Blood eosinophil counts, serum IgE levels and inflammatory cytokines were measured. The immunotyping of Th1/2/17 cells was performed by flow cytometry and cytokine expressions in T cell subsets were analyzed by single-cell RNA sequencing. In addition, expression of the LEKTI in skin lesions was evaluated by immunohistochemical analysis. All four patients experienced clinical improvement, with significantly reduced EASI scores (by 75.0-83.9%) and NRS (by 87.5-90.0%) from baseline to 20 weeks of treatment. Improved quality of life scores were also seen for all patients, as measured by CDLQI and DFI. Serum IgE levels also fell by 75.6-86.9%. The serum Th2 cytokines IL-4, IL-5 and IL-13 were found at low level, with no significant changes during the treatment. However, Th2 cytokines expressed by T cells, especially IL-4, decreased at single-cell level after treatment (P = 0.029). The baseline percentage of Th2 cells (among total CD3+CD4+ T cells) was significantly higher in patients than that in healthy controls (HC) (P < 0.0001); this percentage fell from 8.25% ± 0.75% to 4.02% ± 0.62% after 20 weeks dupilumab treatment. There was no noticeable change in LEKTI protein expression in skin lesions pre- and post-treatment. Two patients reported mild ocular adverse effects, but there were no severe adverse events. Dupilumab may be an effective and safe treatment option in a subset of pediatric patients with Netherton syndrome, especially in improving itch and the quality of life. These effects were achieved in part by suppression of the Th2-mediated inflammation.

Duration of clinical symptoms in children with acute respiratory infection.

To investigate duration of clinical symptoms associated with various respiratory viruses and with the co-detection of respiratory viral and bacterial pathogens. This prospective cohort study included 737 acutely ill children treated in a paediatric emergency department prior to the COVID-19 pandemic. Nasal swab samples were analysed with multiplex PCR panels for 16 viral and 7 bacterial respiratory pathogens. Parents filled in a questionnaire about the symptoms at the time of the visit and 14 days afterwards. Persistent symptoms 2 weeks after the onset of acute illness were common: 32% of the patients with a coronavirus 229 E, NL63 or OC43 finding, 31% of those with human metapneumovirus and 25% of those with rhinovirus reported ongoing symptoms. At least one symptom lasting more than 4 weeks was observed in 3-4% of the children. Children with viral and bacterial co-detection had a longer duration of fever than those with only viral detection (3.3 days [SD 2.8] vs. 1.6 days [SD 2.4], p < 0.001). Symptoms lasting for more than 2 to 4 weeks appear to be relatively frequent in all respiratory viral infections in children. Viral and bacterial co-detection may increase the duration of illness.