Outcome Of Disease In Children Research Articles

Retrospective Analysis of Clinical Characteristics and Disease Outcomes in Children and Adolescents Hospitalized Due to COVID-19 Infection in Tunisia

Due to low susceptibility of coronavirus disease of 2019 (COVID-19) in children, limited studies are available regarding COVID-19 in the pediatric population in Tunisia. The current study evaluated the incidence, clinical characteristics, and outcomes of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection among children hospitalized at Béchir Hamza Children’s Hospital. A retrospective cohort analysis was conducted using the hospital database between March 2020 and February 2022 with children aged ≤15 years with SARS-CoV-2 infection (confirmed by RT-PCR). A total of 327 COVID-19 hospitalized patients with a mean age of 3.3 years were included; the majority were male. Neurological disease (20%) was the most common comorbidity, while fever (95.3%) followed by cough (43.7%) and dyspnea (39.6%) were the most frequent symptoms reported. Severe disease with oxygen requirement occurred in 30% of the patients; 13% were admitted in the Intensive Care Unit. The overall incidence rate of COVID-19 hospitalization (in Tunis governorates) was 77.02 per 100,000 while the inpatient case fatality rate was 5% in the study population. The most prevalent circulating variant during our study period was Delta (48.8%), followed by Omicron (26%). More than 45% of the study population were <6 months and one-fourth (n = 25, 26.5%) had at least one comorbidity. Thus, the study findings highlight the high disease burden of COVID-19 in infants.

Association of Preterm Birth with Adverse Glomerular Disease Outcomes in Children and Adults.

While some studies of children with nephrotic syndrome have demonstrated worse outcomes in those born preterm compared with term, little data exists on associations of preterm birth with outcomes in adult-onset glomerular disease. Cardiovascular outcomes in those born preterm with glomerular disease are unknown. We performed a cross-sectional and longitudinal analysis of participants in the Cure Glomerulonephropathy (CureGN) cohort. Preterm (<37 weeks' gestation) was compared to term (≥37 weeks' gestation). A survival analysis and adjusted Cox proportional hazards model were used to examine a composite outcome of 40% decline in estimated glomerular filtration rate (eGFR) or progression to kidney failure. An adjusted logistic regression model was used to examine remission of proteinuria. There were 2,205 term and 235 preterm participants. APOL1 risk alleles were more common in those born preterm. More pediatric than adult participants in CureGN were born preterm: 12.8% vs. 7.69% (P<0.001). Adults born preterm as compared to term had a higher prevalence of Focal Segmental Glomerulosclerosis (FSGS) (35% vs. 25%, P=0.01) and APOL1 high-risk genotype (9.4% vs 4.2%, P=0.01). Participants born preterm had a shorter time interval to a 40% eGFR decline/kidney failure after biopsy (P=0.001). In adjusted analysis, preterm participants were 28% more likely to develop 40% eGFR decline/kidney failure (Hazard Ratio: 1.28 [1.07, 1.54], P=0.008) and 38% less likely to attain complete remission of proteinuria (Odds Ratio: 0.62 [0.45, 0.87], P=0.006). There was no significant difference in cardiovascular events. Preterm birth was a risk factor for adverse outcomes in this heterogenous cohort of children and adults with glomerular disease. Adults born preterm were more likely to have an APOL1 high-risk genotype and FSGS. In analyses adjusted for FSGS and APOL1 risk status, there was less remission and faster progression of kidney disease in those born preterm.

Impact of Duodenal Pathology on Oral Drug Bioavailability and Disease Outcomes in Pediatric Crohn’s Disease

Crohn's disease with upper gastrointestinal tract involvement occurs more often in children than adults and has the potential to interfere with oral drug absorption. We aimed to compare disease outcomes in children receiving oral azathioprine for the treatment of Crohn's disease with (DP) and without (NDP) duodenal pathology at diagnosis. Duodenal villous length, body mass index (BMI), and laboratory studies were compared in DP vs. NDP during the first year post-diagnosis, using parametric/nonparametric tests and regression analysis (SAS v9.4); the data are reported as the median (interquartile range) or the mean ± standard deviation. Thiopurine metabolite concentration (pmol/8 × 108 erythrocytes) 230-400 was considered therapeutic for 6-thioguanine nucleotides (6-TGN), and >5700 was considered hepatotoxic for 6-methylmercaptopurine (6-MMPN). Twenty-six of the fifty-eight children enrolled (29 DP, 29 NDP) started azathioprine for standard medical care, including nine DP and ten NDP who had normal thiopurine methyltransferase activity. Duodenal villous length was significantly shorter in DP vs. NDP (342 ± 153 vs. 460 ± 85 μm; p < 0.001) at diagnosis; age, sex, hemoglobin, and BMI were comparable between groups. A trend toward lower 6-TGN was observed in the DP vs. NDP subset receiving azathioprine (164 (117, 271) vs. 272 (187, 331); p = 0.15). Compared to NDP, DP received significantly higher azathioprine doses (2.5 (2.3, 2.6) vs. 2.2 (2.0, 2.2) mg/kg/day; p = 0.01) and had an increased relative risk of sub-therapeutic 6-TGN. At 9 months post-diagnosis, children with DP had significantly lower hemoglobin (12.5 (11.7, 12.6) vs. 13.1 (12.7, 13.3) g/dL; p = 0.01) and BMI z-scores (-0.29 (-0.93, -0.11) vs. 0.88 (0.53, 0.99); p = 0.02) than children with NDP. For children with Crohn's disease, duodenal pathology, marked by villous blunting, increased the risk of sub-therapeutic 6-TGN levels, despite higher azathioprine dosing during the first year post-diagnosis. Lower hemoglobin and BMI z-scores at 9 months post-diagnosis suggest the impaired absorption/bioavailability of nutrients, as well as oral drugs, in children with duodenal disease.

Association between drug trough concentration and disease outcome before infliximab maintenance treatment in children with Crohn's disease

To study the association between infliximab trough level (IFX-TL) prior to maintenance treatment and disease outcome in children with Crohn's disease (CD). A retrospective analysis was performed on 35 children with CD who received induction therapy with infliximab (IFX) and the measurement of IFX-TL before maintenance treatment from August 2018 to November 2021. Clinical data and laboratory markers at baseline and before maintenance treatment were collected, and the association between outcome and IFX-TL was analyzed. The clinical remission group, endoscopic remission group, and combined remission group had a significantly higher IFX-TL level than the corresponding non-remission groups (P<0.05), and there was no significant difference in the IFX-TL level between the biological remission and non-biological remission groups (P>0.05). The receiver operating characteristic (ROC) curve showed that IFX-TL had an area under the ROC curve of 0.959 (95%CI: 0.894-1) in predicting clinical remission, with a sensitivity of 90% and a specificity of 100% at the optimal cutoff value of 2.3 µg/mL (P<0.001). Among children with CD receiving infliximab induction therapy, the children achieving clinical and endoscopic remission before maintenance treatment tend to have a higher level of IFX-TL. IFX-TL has a certain predictive value for clinical remission.

Use of Albumin in the NICU: An Evidence-based Review

Albumin is the most abundant protein in human blood with distinctive functions throughout the human body. Low albumin levels are a predictor of mortality as well as disease outcome in children and adults. However, the clinical significance of hypoalbuminemia and the role of albumin infusions in NICUs remain unclear and controversial.

COVID-19 vaccination for children aged 5–11 years

COVID-19 vaccination for children aged 5–11 years

Associations between comorbidity-related functional limitations and pneumonia outcomes.

Underlying comorbidities are common in children with pneumonia. To determine associations between comorbidity-related functional limitations and risk for severe pneumonia outcomes. We prospectively enrolled children <18 years with and without comorbidities presenting to the emergency department with clinical and radiographic pneumonia at two institutions. Comorbidities included chronic conditions requiring daily medications, frequent healthcare visits, or which limited age-appropriate activities. Among children with comorbidities, functional limitations were defined as none or mild, moderate, and severe. Outcomes included an ordinal severity outcome, categorized as very severe (mechanical ventilation, shock, or death), severe (intensive care without very severe features), moderate (hospitalization without severe features), or mild (discharged home), and length of stay (LOS). Multivariable ordinal logistic regression was used to examine associations between comorbidity-related functional limitations and outcomes, while accounting for relevant covariates. A cohort of 1116 children, including 452 (40.5%) with comorbidities; 200 (44.2%) had none or mild functional limitations, 93 (20.6%) moderate, and 159 (35.2%) had severe limitations. In multivariable analysis, comorbidity-related functional limitations were associated with the ordinal severity outcome and LOS (p < .001 for both). Children with severe functional limitations had tripling of the odds of a more severe ordinal (adjusted odds ratio [aOR]: 3.01, 95% confidence interval[2.05, 4.43]) and quadrupling of the odds for longer LOS (aOR: 4.72[3.33, 6.70]) as compared to children without comorbidities. Comorbidity-related functional limitations are important predictors of disease outcomes in children with pneumonia. Consideration of functional limitations, rather than the presence of comorbidity alone, is critical when assessing risk of severe outcomes.

Interest of Procalcitonin Measurement in Children with Cerebral Malaria in Southern Benin

Introduction: Cerebral malaria is a major complication of the Plasmodium falciparum infection with a high case fatality rate. The objective of this study was to determine the relationship between cerebral malaria and high serum procalcitonin (PCT) level in children. Method: This was a prospective descriptive and analytical cohort study conducted over 12 months, on a series of PCT blood tests in children aged 6 months to 15 years old hospitalized for cerebral malaria in the pediatric wards of four hospitals in southern Benin. The cerebral malaria diagnosis was done based on WHO criteria. Blood samples for PCT measurement were collected on admission, 24 hours and 48 hours after the malaria therapy initiation. Student’s test, Pearson’s chi2 test, Fisher’s test and Kruskal-Wallis test were used where appropriate. For all comparisons the difference was significant when p was less than 5%. Results: Sixty-five children were included in the study with a sex ratio of 1.41. The age group of children under 5 years was the most represented, at 57%. PCT levels were high in 92.3% of children at admission, 90.8% at 24 hours and 84.6% at 48 hours. Forty-nine children had a positive clinical outcome while 16 died (24.6%). PCT levels were generally high over the three days of hospitalization, but higher at admission in case of death (p = 0.000). The association between PCT level and parasitemia at admission was significant (p = 0.04). Conclusion: In the view of the results, blood PCT level measured at admission could be predictive of the disease outcome in children with cerebral malaria.

Сучасне уявлення про роль мутацій протеїнів сурфактанту в формуванні інтерстиціальних захворювань легень у новонароджених і немовлят

У статті наведено сучасне уявлення про компоненти сурфактанту, функції несироваткових протеїнів ­SP-A, SP-B, SP-C і SP-D. Описана історія відкриття спадкових дефіцитів протеїнів SP-B, SP-С та ABCA3. Авторами проаналізовано сучасну епідеміологію, клінічні та гістологічні особливості різних варіантів недостатності білків сурфактанту. Продемонстровано різні варіанти мутацій SFTPС, SFTPВ і ABCA3 та їх вплив на перебіг, клінічні прояви і наслідок інтерстиціального захворювання легень у дітей.

Relation between renal resistive index in children with nephrotic syndrome

Context: Renal resistive index (RRI) is a non-invasive marker of several kidney diseases. It is an indicator of resistance to flow within the kidneys, which is a calculation of relationship between systolic and diastolic renal pressure changes. However, there is a limited knowledge in the use of RRI in the management and prognostication of Nephrotic syndrome. Aims: The aim of this study was to see the relation of RRI with Nephrotic syndrome. Materials and Methods: This hospital-based analytical study was conducted over a period of 1 year (June 2019–May 2020) in a tertiary care teaching institution. All the Nephrotic syndrome cases admitted in the pediatric ward were included in the study after taking consent from the parents/guardians. USG renal Doppler was done and blood and urine investigations were done. The RRI recorded from renal Doppler was compared with different categories of Nephrotic syndrome. Results: A total 63 children admitted with Nephrotic syndrome were included in the study. The mean RRI value was 0.66±0.14, 0.64±0.15 and 0.66±0.12 as well as 0.63±0.12, 0.67±0.16 and 0.71±0.13 on the right and left kidney, respectively, for each upper, middle, and lower pole interlobar renal arteries. Thus, the average RRI value of right kidney was 0.65±0.09 and left kidney was 0.67±0.09. Neither of the kidneys showed significant relationship between RRI of different poles. Conclusion: In our study, we could not find the USG Doppler useful to predict the disease outcome in children with Nephrotic syndrome.

Chronic kidney disease in children in Ukraine

The study aimed to summarize data of Chronic Kidney Disease (CKD) in children and adolescents in Ukraine.&#x0D; Methods. There were performed a qualitative study based on published documents and registers, and a cohort observational study included 3528 depersonalized patients with CKD diagnosed before the age of 18. That was used cross-sectional and longitudinal design for the structure, etiology, and outcomes analysis, period comparison (years 2014 and 2019), quantitative analyzes depending on patients age and nosology, risk measurements and survival function.&#x0D; Results. There was found the tendency to reduce the incidence of the genitourinary system diseases in childhood, and the predominance of these classes of diseases in adolescents. The main causes of CKD were congenital structural or histological abnormalities and glomerulonephritis. Prolonged kidney function preservation at the initial level was confirmed in many patients (CKD1 was maintained in 33.0% and CKD5 - in 56.6% causes after 5 years period) with the partial function improvement in CKD1-3. CKD1-4 probability at the 1st year of observation was 91.7±0.47%, at the 5th year - 84.2±0.82%. The structural CKD5 specialties in patients receiving Kidney Replacement Therapy have been established. There was a significantly higher risk of CKD5 during 5 years period after Acute Kidney Injury (OR 2.81-2.10), and a lower probability of CKD5 in patients with glomerulonephritis (OR 0.66-0.54) compared to other nosology. CKD pathomorphosis was found in the year 2019 compared to the year 2014: the kidney dysplasia as an etiological factor was increased (from 19.3% to 22.0%, р=0.040); the immediate outcome at the 1st year of observation was improved with the lower risk of declaring of Glomerular Filtration Rate (GFR) to CKD5 level (93.6% vs. 90.0%), but the late follow-up prognosis became worse (the cumulative probability of CKD1-4 at the 5th year of observation decreased from 85.5 to 73.9%, p=0.016); the structure of Kidney Replacement Therapy changed with the increasing part of transplanted patients (from 30.5% to 48.9%, p&lt;0.001), especially as a first choice (pre-dialysis); the tendency to decrease the proportion of polycystic kidney disease in CKD and to increase it in CKD5 was revealed with risk raising of GFR loss &lt;15 ml/min in the year 2019 compared to other nosology (OR 1.69, p=0.027).&#x0D; Conclusions. The established epidemiological and clinical realities are important for determining the kidney disease outcome in children and adolescents, assessing the medical management of these patients, sharpening the priorities of pediatric nephrology, and emphasizing the significance of further studies with appropriate regulations.

Relation between hematological derangements and disease outcomes in children with COVID-19 are likely indirect

Relation between hematological derangements and disease outcomes in children with COVID-19 are likely indirect

Risk Factors and Outcome of Respiratory Disease in Children Aged between 2 Months to 5 Years: A Prospective Observational Study

Risk Factors and Outcome of Respiratory Disease in Children Aged between 2 Months to 5 Years: A Prospective Observational Study

Complement C2 polymorphisms in children with Henoch Schönlein purpura

Purpose: The aim of this study was to investigate whether C2 polymorphisms influence the symptoms and disease outcomes in children with Henoch Schönlein purpura (HSP).Materials and Methods: This cross-sectional study included 49 children with HSP, diagnosed and followed for at least 6 months in our department between July 2016 and March 2018. Sanger sequencing was performed for detecting C2 gene polymorphisms. Statistical analysis was performed for comparison of clinical and laboratory parameters between patients according to having C2 polymorphisms.Results: Only 6 patients (12.2%) had following C2 gene polymorphisms: rs9332739 (n=3), rs36221133 (n=2), rs146054348 (n=1). Age at disease onset, gastrointestinal and joint involvement, serum complement levels, renal involvement, requirement of systemic steroids and disease relapse were found similar between the patients with and without C2 gene polymorphism. We found higher serum IgM level and lower leukocyte counts in HSP patients with confirmed C2 polymorphisms than the patients with normal C2 gene.Conclusion: Although C2 gene polymorphisms were not related to clinical manifestations and disease outcome in children with HSP, we speculate that C2 gene polymorphisms may be associated with elevated serum IgM levels in patients with HSP.

Improved transplant survival and long-term disease outcome in children with MHC class II deficiency

AbstractMHC class II deficiency is a rare, but life-threatening, primary combined immunodeficiency. Hematopoietic cell transplantation (HCT) remains the only curative treatment for this condition, but transplant survival in the previously published result was poor. We analyzed the outcome of 25 patients with MHC class II deficiency undergoing first HCT at Great North Children's Hospital between 1995 and 2018. Median age at diagnosis was 6.5 months (birth to 7.5 years). Median age at transplant was 21.4 months (0.1-7.8 years). Donors were matched family donors (MFDs; n = 6), unrelated donors (UDs; n = 12), and haploidentical donors (HIDs; n = 7). Peripheral blood stem cells were the stem cell source in 68% of patients. Conditioning was treosulfanbased in 84% of patients; 84% received alemtuzumab (n = 14) or anti-thymocyte globulin (n = 8) as serotherapy. With a 2.9-year median follow-up, OS improved from 33% (46-68%) for HCT before 2008 (n = 6) to 94% (66-99%) for HCT after 2008 (n = 19; P = .003). For HCT after 2008, OS according to donor was 100% for MFDs and UDs and 85% for HIDs (P = .40). None had grade III-IV acute or chronic graft-versus-host disease. Latest median donor myeloid and lymphocyte chimerism were 100% (range, 0-100) and 100% (range, 64-100), respectively. Latest CD4+ T-lymphocyte number was significantly lower in transplant survivors (n = 14) compared with posttransplant disease controls (P = .01). All survivors were off immunoglobulin replacement and had protective vaccine responses to tetanus and Haemophilus influenzae. None had any significant infection or autoimmunity. Changing transplant strategy in Great North Children's Hospital has significantly improved outcomes for MHC class II deficiency.

Hematopoietic Cell Transplantation for MHC Class II Deficiency.

Major histocompatibility complex (MHC) class II deficiency is a rare and fatal primary combined immunodeficiency. It affects both marrow-derived cells and thymic epithelium, leading to impaired antigen presentation by antigen presenting cells and delayed and incomplete maturation of CD4+ lymphocyte populations. Affected children are susceptible to multiple infections by viruses, Pneumocystis jirovecii, bacteria and fungi. Immunological assessment usually shows severe CD4+ T-lymphocytopenia, hypogammaglobulinemia, and lack of antigen-specific antibody responses. The diagnosis is confirmed by absence of constitutive and inducible expression of MHC class II molecules on affected cell types which is the immunologic hallmark of the disease. Hematopoietic cell transplantation (HCT) is the only established curative therapy for MHC class II deficiency but it is difficult as affected children have significant comorbidities at the time of HCT. Optimization organ function, implementing a reduced toxicity conditioning regimen, improved T-cell depletion techniques using serotherapy and graft manipulation, vigilant infection surveillance, pre-emptive and aggressive therapy for infection and newer treatments for graft-versus-host disease have improved the transplant survival for children with MHC class II deficiency. Despite persistent low CD4+ T-lymphopenia reported in post-HCT patients, transplanted patients show normalization of antigen-specific T-lymphocyte stimulation and antibody production in response to immunization antigens. There is a need for a multi-center collaborative study to look at transplant survival of HCT and long-term disease outcome in children with MHC class II deficiency in the modern era of HCT.

Effects of Second-Hand Smoke on Pancreatitis in Children.

Pediatric pancreatitis incidence is increasing, but little is known about risk factors. Smoking increases the risk for adult pancreatitis and has been shown to affect CFTR function in vitro. Therefore, we evaluated passive smoke exposure effects on disease outcomes in children with various pancreatitis etiologies. We conducted a 5-year retrospective chart review of patients admitted for pancreatitis to Children's Healthcare of Atlanta. Demographic data, etiology of pancreatitis, and number of hospitalizations with length of stay (LOS) were compared with smoking exposure, obtained through telephone query. Of the 134 subjects admitted for pancreatitis, 90 reported no smoke exposure (none), 33 reported outdoor smoke exposure (outside), and 11 reported exposure to indoor smoking (inside). Average hospital admissions (P = 0.038) and LOS (P = 0.004) were significantly higher among subjects with inside smoke exposure compared with those with outdoor or no exposure. Average hospital admissions were significantly higher in subjects with CFTR mutations compared with those with nongenetic or other genetic etiologies (P ≤ 0.001). Second-hand smoke exposure may increase hospital admission rates and LOS for pediatric pancreatitis. Children with an identifiable CFTR mutation may have increased risk for hospital admissions compared with those who do not.

Filarial infection during pregnancy has profound consequences on immune response and disease outcome in children: A birth cohort study.

BackgroundCurrent Global Program to Eliminate Lymphatic Filariasis (GPELF) that prohibits pregnant mothers and children below two years of age from coverage targeted interruption of transmission after 5–6 rounds of annual mass drug administration (MDA). However, after more than 10 rounds of MDA in India the target has not been achieved, which poses challenge to the researchers and policy makers. Several studies have shown that in utero exposure to maternal filarial infections plays certain role in determining the susceptibility and disease outcome in children. But the mechanism of which has not been studied extensively. Therefore the present study was undertaken to understand the mechanism of immune modulation in children born to filarial infected mother in a MDA ongoing area.Methodology and principal findingTo our knowledge this is the first study to conduct both cellular and humoral immunological assays and follow up the children until older age in a W bancrofti endemic area,where the microfilariae (Mf) rate has come down to <1% after 10 rounds of MDA. A total 57 (32: born to infected, 25: born to uninfected mother) children were followed up. The infection status of children was measured by presence of Mf and circulating filarial antigen (CFA) assay. Filaria specific IgG1, IgG2, IgG3 and IgG4 responses were measured by ELISA. Plasma level of IL-10 and IFN-γ were evaluated by using commercially available ELISA kit. The study reveals a high rate of acquisition of filarial infection among the children born to infected mother compared to uninfected mothers. A significantly high level of IgG1 and IgG4 was observed in children born to infected mother, whereas high level of IgG3 was marked in children born to uninfected mother. Significantly high level of IL-10 positively correlated with IgG4 have been observed in infected children born to infected mother, while high level of IFN-γ positively correlated with IgG3 was found in infection free children born to mother free from infection at the time of pregnancy. Moreover a negative correlation between IL-10 and IFN-γ has been observed only among the infected children born to infected mother.Significance conclusionThe study shows a causal association between maternal filarial infection and impaired or altered immune response in children more susceptible to filarial infection during early childhood. As lymphatic damage that commences in childhood during asymptomatic stage has major implications from public health point of view, understanding maternal programming of the newborn immune system could provide a basis for interventions promoting child health by implementing MDA campaigns towards all women of childbearing age and young children in achieving the target of global elimination of LF.

Early Treatment Response Predicts Outcome in Paediatric Ulcerative Colitis: GASTROENTEROLOGY: INFLAMMATORY BOWEL DISEASE.

The disease course of children with ulcerative colitis (UC) varies substantially. Published data on predictors of disease outcomes in children remain scarce. We validate clinical predictors of outcomes in 93 children with UC in a single centre (age range: 2-18 years, minimum follow-up: 18 months). We stratified children into 3 groups according to their disease course, that is, 1 = mild (38/93, 40.9%), 2 = moderate (38/93, 40.9%), 3 = severe (17, 18.2%). Comparison of clinical and biochemical parameters was performed between groups using Chi-square, Mann-Whitney, and log-rank tests. Predictors of a severe disease course included pancolitis (P 0.01), low albumin (P 0.005), low haemoglobin at diagnosis (P 0.04), paediatric ulcerative colitis activity index (PUCAI) at 3 months, and nonresponse to steroids at 3 months (P 0.0001). In our cohort, failure to achieve remission at 3 months implied an 80% likelihood to require biologics or major surgery within 18 months. A specific 3-month review point is recommended to guide future management.

20161631, Phillippi - Race and income affects outcomes in juvenile dermatomyositis

The relationship of race and income, the latter as a surrogate for socioeconomic status, on disease outcomes has been widely researched in many diseases and chronic conditions. For example black (and Hispanic) race is associated with a worse outcome in pediatric systemic lupus erythematosus. In this volume of The Journal, Phillippi et al investigated the relationship of these factors to the functional outcome and development of calcinosis as a measurement of morbidity (and perhaps disease control) in juvenile dermatomyositis, a rare disease with an annual incidence of 1-4 per million children. Calcinosis, if severe, can result in substantial disability. In a cross sectional study based on 438 children reported by North American pediatric rheumatologists to the Childhood Arthritis and Rheumatology Research Alliance Legacy Registry, they found that both black race and low income (defined as <$50 000 per year) independently negatively affected patient function and was positively associated with the development of calcinosis. It is important to state that despite these statistically significant disparities, the functional outcome of the patients, including those from black race and low income, was generally good. The cause of these disparities could not be ascertained from this study and can include genetic/pharmacogenetic and environmental effects, as well as patient-related factors such as adherence, type of insurance, or other unknown factors. Disparities did not appear to be related to access to expert medical care or differences in treatments prescribed. This study also demonstrates the importance of using well designed registries to investigate rare diseases in “real life.” Registries, used for many years, especially in oncology, are now used more frequently in childhood rheumatic diseases. Newly developed registries that include prospectively collected data and biologic specimens will improve the quality of these studies and enable us to answer some of the questions left open in this study. Article page 38 ▶ Race, Income, and Disease Outcomes in Juvenile DermatomyositisThe Journal of PediatricsVol. 184PreviewTo determine the relationships among race, income, and disease outcomes in children with juvenile dermatomyositis (JDM). Full-Text PDF