History Of Asthma Research Articles

Patient Safety: Acknowledging Acute Angioedema Following Cosmetic Injections

To report a case of acute angioedema following hyaluronic acid filler and onabotulinumtoxinA injection in an individual with allergies, recent viral vaccination, and polymyalgia rheumatica. This is a retrospective case report. A 63-year-old female with a history of allergies, asthma, and polymyalgia rheumatica on lisinopril presented with angioedema 4 hours following facial filler injection and botulinum toxin injection. The patient was successfully treated with epinephrine, diphenhydramine, and methylprednisolone. Although cosmetic injections are commonly performed, clinicians must be vigilant about rare, yet serious side-effects such as angioedema. This case underscores the importance of thoroughly evaluating medical histories before cosmetic injections and addressing patient concerns after the procedure.

BN SO55 - Rare case of Ectopic pancreatitis in stomach and its Surgical Management

Abstract Background This presentation covers the case of Mr. D, a 38-year-old male who presented with upper abdominal pain and vomiting, initially treated as gastritis but later developing more complex symptoms. This case highlights the diagnostic challenges and management of ectopic pancreatitis, a rare condition characterized by pancreatic tissue located outside its usual anatomical position.Mr. D, a personal trainer with a history of asthma and Meckel's diverticulum excision, experienced recurring epigastric pain, bloating, and early satiety. His pain was particularly related to eating, fasting and often disrupted his sleep. Despite treatment with proton pump inhibitors (PPIs), his symptoms persisted, prompting further investigation Method Initial investigations including ultrasound, chest X-ray, and ECG showed no significant abnormalities. However, subsequent gastroscopy and CT scans suggested a gastrointestinal stromal tumor (GIST), leading to referral for endoscopic ultrasound (EUS) and biopsy. The findings indicated a highly vascular, mixed echogenic lesion in the submucosa, likely a GIST, but initial biopsies were inconclusive Results Following conservative treatment, Mr. D's inflammation significantly reduced, though he experienced recurrent pain necessitating surgical intervention. Diagnostic laparoscopy and gastroscopy revealed extensive adhesions and an inflammatory mass. The patient underwent a pyloric-preserving sleeve gastrectomy, with histology confirming pancreatic heterotopia with inflammation and cystic degeneration. Post-operatively, Mr. D initially struggled with dietary intake but improved over time, tolerating a solid diet by the last follow-up. Conclusion This case underscores the complexity of diagnosing and managing rare conditions like ectopic pancreatitis. It highlights the importance of a multidisciplinary approach and the potential need for surgical intervention when conservative management fails. The presentation aims to provide valuable insights into the diagnostic process, the role of MDT discussions, and the therapeutic challenges associated with ectopic pancreatitis.

Abstract 4124120: Rare but Deadly - Eosinophilic Myocarditis in a Patient with Eosinophilic Granulomatosis Polyangiitis

Eosinophilic myocarditis (EM) is a rare inflammatory myocarditis characterized by eosinophilic infiltration of myocardial tissue. Despite the high mortality rate, EM is frequently underdiagnosed and is often first identified in postmortem studies. We share a case of EM as an early manifestation of newly diagnosed eosinophilic granulomatosis polyangiitis (EGPA). The patient is a 46-year-old female with a past medical history of ulcerative colitis and adult-onset asthma who presented to the emergency department with a 2–3-week history of worsening positional chest pain radiating to the left upper extremity. Associated symptoms include 3 months of fatigue, headaches, right foot neuropathy, urticaria, and B-symptoms. Prior to admission, the patient was started on empiric prednisone for presumed EGPA. Initial lab work on admission was notable for elevated troponin (602 ng/L), hyper-eosinophilia (19.5%), thrombocytosis (680K/uL), and elevated ESR (42 mm/h) that have improved since initiation of prednisone. Transthoracic echocardiogram revealed a newly reduced LVEF of 40% with basal and mid-septal wall motion abnormalities. Cardiac catheterization showed normal coronaries confirming the diagnosis of non-ischemic cardiomyopathy. Late gadolinium enhancement in cardiac MRI was seen in basal to mid segments with patchy pericardial enhancement, meeting the Lake Louise criteria for myocarditis. An endomyocardial biopsy showed substantial myocardial infiltration with lymphocytes, histiocytes and eosinophils, confirming the diagnosis of EM. After multidisciplinary team discussion with cardiology and rheumatology, the patient was started on guideline-directed medical therapy for her HFrEF and pulse dose steroids with a prolonged taper and cyclophosphamide. She is tolerating her treatment well. This case highlights the importance of early recognition, comprehensive assessment and targeted treatment for EM depending on its underlying etiology. In the case of autoimmune dysfunction, it involves a combination of immunosuppressive and symptomatic therapy. Ongoing research is crucial to enhance our understanding and improve clinical outcomes, like arrhythmias and cardiogenic shock, for this complex condition.

Abstract 4134712: Pheochromocytoma-Induced Cardiomyopathy Requiring Mechanical Support with Ejection Fracture Recovery Following Surgical Resection

Introduction: Pheochromocytomas are catecholamine-secreting tumors that arise from chromaffin cells of the adrenal medulla. The annual incidence is approximately 0.8 per 100,000 persons, though this is an underestimate given a high percentage diagnosed at autopsy. Classically, patients present with episodic headache, sweating, and tachycardia, however, pheochromocytomas can be associated with cardiomyopathy secondary to the catecholamine excess. We present an unusual case of pheochromocytoma-induced cardiogenic shock highlighting an excellent use of mechanical circulatory support with Impella and Extracorporeal Membrane Oxygenation (ECMO) bridging to surgical intervention resulting in left ventricular ejection fraction (LVEF) recovery. Case Description: A 49-year-old female with past medical history of asthma initially presented to an outside hospital for palpitations, chest pain, and hypertension. Transthoracic echo (TTE) showed preserved left ventricle ejection fraction (LVEF) while cardiac MRI showed a LVEF of 43% with dilated left ventricle and diffuse global hypokinesis consistent with a dilated cardiomyopathy. She underwent a coronary angiogram demonstrating nonobstructive CAD. She was then discharged with readmission a month later at our hospital for chest tightness, palpitations, vomiting, weakness, and dizziness. Repeat TTE showed a drop in LVEF to 10-15%. She progressed to cardiogenic shock requiring BiPAP and inotrope initiation, with progressive shock and hypotension ultimately requiring Impella 5.5 and venoartrial ECMO. Abdominal imaging was notable for 4.7 x 4.2 cm right adrenal nodule and further workup with serum and urine metanephrines confirmed pheochromocytoma. While supported, the patient underwent right adrenalectomy with subsequent wean of mechanical circulatory support and biventricular recovery on TTE. Discussion: Pheochromocytoma-induced heart failure is a rare but potentially life-threatening complication from excess catecholamine effects on the myocardium. Pheochromocytomas should be considered in the evaluation of idiopathic heart failure even in the absence of symptoms related to catecholamine excess. Early detection, pharmacological management, and surgical resection may prevent progression of myocardial remodeling. Mechanical circulatory support can be a valuable adjunct in managing refractory heart failure in these patients by providing temporary hemodynamic stabilization while awaiting definitive tumor resection.

Abstract 4135893: The Importance of Genetic Testing in Diagnosis and Management of Peripartum Cardiomyopathy: A Case Study

Introduction: At least 15% of women diagnosed with peripartum cardiomyopathy (PPCM) are found to have a pathogenic genetic variant associated with dilated cardiomyopathy. We present a patient with PPCM who required orthotopic heart transplantation (OHT) for cardiogenic shock. Her explant pathology and genetic testing played a critical role in identifying the etiology of her cardiomyopathy. Case Description: A 22-year-old primigravid woman with a history of asthma presented in labor and underwent a Cesarean delivery for non-reassuring fetal heart tones. She had noted exertional dyspnea, a dry cough, and orthopnea in her final weeks of pregnancy but had an otherwise uncomplicated pregnancy. Immediately following delivery, she suffered a cardiac arrest with pulseless electrical activity and developed cardiogenic shock. She was found to have severe biventricular systolic dysfunction with a left ventricular (LV) ejection fraction of 10%. She was cannulated on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and transferred to our center. She was transitioned from VA-ECMO to an axillary Impella 5.5 device but continued to require inotropic support without evidence of LV recovery. Therefore, she was listed for and successfully underwent OHT. Explant pathology (Figure 1) revealed arrhythmogenic cardiomyopathy (ACM). Her family history was significant for a maternal grandfather who died of an unspecified arrhythmia at age 57. Genetic testing via a commercial arrhythmia and cardiomyopathy panel revealed a pathogenic desmoplakin ( DSP) truncating variant ( DSP tv) p.Ser1894Leufs*34 in the N-terminal constitutive NMD-competent region, confirming the diagnosis of ACM. The patient had minor cutaneous findings, including curly hair, consistent with the clinical presentation of DSP -mediated ACM. Discussion: This case highlights the importance of genetic testing in all patients with PPCM, as well as attention to the explant pathology in those who undergo OHT. These practices can elucidate the mechanism of cardiomyopathy, inform the risks of disease progression and of relapse with subsequent pregnancy, and allow for cascade testing of family members.

Asthma and Memory Function in Children.

Asthma is a chronic respiratory disease affecting approximately 5 million children in the US. Rodent models of asthma indicate memory deficits, but little is known about whether asthma alters children's memory development. To assess whether childhood asthma is associated with lower memory abilities in children. This cohort study used observational data from the Adolescent Brain Cognitive Development (ABCD) Study, a multisite longitudinal investigation that began enrollment in 2015. Approximately 11 800 children aged 9 to 10 years were enrolled at baseline with follow-up at 1 and 2 years. Participants were selected based on exposures described subsequently to determine longitudinal and cross-sectional associations between asthma and memory. Data were analyzed from Month year to Month year. Asthma was determined from parent reports. For the longitudinal analysis, children were selected if they had asthma at baseline and at the 2-year follow-up (earlier childhood onset), at the 2-year follow-up only (later childhood onset), or no history of asthma. For the cross-sectional analysis, children were selected if they had asthma at any time point, or no history of asthma. The comparison group of children with asthma history was matched on demographic and health covariates for each analysis. The primary outcome was episodic memory. Secondary outcomes included processing speed, inhibition and attention. Four hundred seventy-four children were included in the longitudinal analysis (earlier childhood onset: 135 children; mean [SD] age, 9.90 [0.63] years; 76 [56%] male; 53 [28%] Black, 29 [21%] Hispanic or Latino, and 91 [48%] White; later childhood onset: 102 children; mean [SD] age 9.88 [0.59] years; 54 [53%] female; 22 [17%] Black, 19 [19%] Hispanic or Latino, and 83 [63%] White; comparison: 237 children; mean [SD] age, 9.89 [0.59] years; 121 [51%] male; 47 [15%] Black, 48 [20%] Hispanic or Latino, and 194 [62%] White). Children with earlier onset of asthma exhibited lower rates of longitudinal memory improvements relative to the comparison group (β = -0.17; 95% CI, -0.28 to -0.05; P = .01). Two thousand sixty-two children were selected for the cross-sectional analysis (with asthma: 1031 children; mean [SD] age, 11.99 [0.66] years; 588 [57%] male; 360 [27%] Black, 186 [18%] Hispanic or Latino, and 719 [54%] White; without asthma: 1031 children; mean [SD] age 12.00 [0.66] years; 477 [54%] female; 273 [21%] Black, 242 [23%] Hispanic or Latino, and 782 [59%] White). Children with asthma (1031 children) showed lower scores on episodic memory (β = -0.09; 95% CI, -0.18 to -0.01; P = .04), processing speed (β = -0.13; 95% CI, -0.22 to -0.03; P = .01), and inhibition and attention (β = -0.11; 95% CI, -0.21 to -0.02; P = .02). In this cohort study, asthma was associated with memory difficulties in children, which may be more severe if asthma onset is earlier in childhood and may extend to executive function abilities.

Successful Management of High-Risk Pregnancy with TORCH Infection History and Chronic Hypertension

A 41-year-old pregnant woman of Javanese ethnicity attended the outpatient clinic of a private hospital, presented with fifth pregnancy and no living children due to a history of ectopic pregnancy, two times IUFD, and one time neonatal death. The patient also had a history of chronic hypertension and asthma. The examination showed positive IgG Toxoplasma and CMV antibody levels. The patient's blood pressure also never touched the normal limit since the beginning of pregnancy. At the end of pregnancy, she had very high blood pressure and proteinuria. According to WHO Maternal Mortality Rate (MMR) is still very high, where two of the five highest causes are infection and hypertension in pregnancy. High risk pregnancies require special attention in monitoring during pregnancy and management. In a history of bad obstetrical history it is necessary to screen for infection which can be done by antibody serology testing. A positive IgG indicates immunity to the virus, if possible it is necessary to check IgG Avidity to determine whether therapy is still needed or can rely on the immune system that has been formed. Chronic hypertension (Systolic Blood Pressure (SBP) > 140 mmHg and / or Diastolic Blood Pressure (DBP) > 90 mmHg since < 20 Weeks Gestational Age (WGA) until 42 days after delivery). First-line Labetalol and Nifedipine or second-line Methyldopa and Hydrochlorothiazide should be considered depending on the condition and gestational age. If there are signs of preeclampsia, termination should be done if possible, along with antihypertensives and anticonvulsants such as MgSO4.

Machine Learning-Based Risk Prediction of Asthma

This paper will attempt to detect asthma early based on machine learning. This work utilizes a dataset consisting of 21 features such as family history of asthma, intake of drugs, smoking status, and quality of air and much more. The work tries to develop models with maximum precision, recall, and accuracy in asthma classification. These include several machine learning algorithms evaluated: SVM, Decision Trees, and Random Forest. This study focuses on both medical and environmental data when used in combination. The results here show that the Random Forest model performed well in achieving an overall high performance, with an accuracy of 0.926829. This has dire implications for evaluation and early diagnosis of Asthma. Key Words: Asthma detection, Machine learning, Patient history, Environmental factors, Support Vector Machines (SVM), Decision Trees, Random Forests, Predictive models, Air quality, Smoking habits, Medication usage, Family asthma history, Ac- curacy, Precision, Recall, Early diagnosis, Healthcare, Medical data, Environmental data, Predictive power

A Retrospective Study Evaluating Asthma Control in Patients on Fluticasone Propionate/Salmeterol Proactive Regular Dosing with a History of Uncontrolled Asthma.

The MERIT study in Malaysia is a real-world retrospective, observational, multicenter study that evaluated asthma control in patients with uncontrolled asthma who were switched from as-needed (pro re nata [PRN]) budesonide/formoterol or inhaled corticosteroid (ICS) whenever a short-acting beta-agonist (SABA) was taken, to proactive regular dosing of fluticasone propionate/salmeterol (FP/SAL PRD). Data from the medical records of patients who were stepped up to FP/SAL PRD were extracted retrospectively at baseline and follow-up (between 3 and 6months after stepping up to FP/SAL PRD). The primary endpoint was the percentage of patients with improvement in asthma control assessed via the Asthma Control Test (ACT). Secondary endpoints included safety and the percentage of patients with moderate and severe exacerbations. Additionally, patient-reported use of reliever medication, systemic corticosteroids, emergency department visits, or hospitalization was also analyzed. One hundred twenty patients with uncontrolled asthma who were stepped up to FP/SAL PRD were enrolled in the study. Of these, 76 (63.3%) patients were on prior budesonide/formoterol PRN, and 44 (36.7%) were on prior ICS with SABA PRN treatment. After stepping up to FP/SAL PRD with a mean follow-up of 5.8months, 110 (91.7%) patients achieved asthma control at the follow-up visit (p < 0.001). Similar improvements were observed regardless of prior PRN regimen. A statistically significant improvement was observed in the mean ACT score at the follow-up visit (p < 0.0001). The proportion of patients with moderate and severe exacerbations was also reduced after stepping up to FP/SAL PRD, with no adverse events reported. Over 80% of patients reported a decrease in the use of systemic corticosteroids, visits to the emergency department, or hospitalization. This study highlights the effectiveness of the FP/SAL PRD treatment approach in patients with uncontrolled asthma on a PRN treatment regimen.

Predicting post-COVID-19 condition in children and young people up to 24 months after a positive SARS-CoV-2 PCR-test: the CLoCk study

BackgroundPredicting which children and young people (CYP) are at the highest risk of developing post-COVID-19 condition (PCC) could improve care pathways. We aim to develop and validate prediction models for persistent PCC up to 24 months post-infection in CYP.MethodsCYP who were PCR-positive between September 2020 and March 2021, with follow-up data up to 24-months post-infection, were analysed. Persistent PCC was defined in two ways, as PCC at (a) 3, 6, 12 and 24 months post-infection (N = 943) or (b) 6, 12 and 24 months post-infection (N = 2373). Prediction models were developed using logistic regression; performance was assessed using calibration and discrimination measures; internal validation was performed via bootstrapping; the final model was adjusted for overfitting.ResultsWhile 24.7% (233/943) of CYP met the PCC definition 3 months post-infection, only 7.2% (68/943) continued to meet the PCC definition at all three subsequent timepoints, i.e. at 6, 12 and 24 months. The final models predicting risk of persistent PCC (at 3, 6, 12 and 24 months and at 6, 12 and 24 months) contained sex (female), history of asthma, allergy problems, learning difficulties at school and family history of ongoing COVID-19 problems, with additional variables (e.g. older age at infection and region of residence) in the model predicting PCC at 6, 12 and 24 months. Internal validation showed minimal overfitting of models with good calibration and discrimination measures (optimism-adjusted calibration slope: 1.064–1.142; C-statistic: 0.724–0.755).ConclusionsTo our knowledge, these are the only prediction models estimating the risk of CYP persistently meeting the PCC definition up to 24 months post-infection. The models could be used to triage CYP after infection. CYP with factors predicting longer-term symptomology, may benefit from earlier support.

Knowledge, attitude, and practice of asthma among the adults in Shendi locality, Sudan: A cross-sectional study.

Asthma is a chronic inflammatory condition leading to intermittent airway narrowing and obstruction. Although millions suffer from asthma globally, there is limited data from African countries, particularly Sudan. This study addresses the gap in research on asthma knowledge, attitudes, and practices among the adults in Shendi locality, Northern Sudan. This cross-sectional, community-based study was conducted in Kabushiya village, Shendi, Sudan, involving 148 participants selected through multistage random sampling. Data were collected via face-to-face interviews using a validated, structured questionnaire. Statistical analyses included Mann-Whitney, Kruskal-Wallis, Chi-square, Fisher exact tests, and multiple linear regression. Participants demonstrated high levels of knowledge, positive attitudes, and good practices regarding asthma. Knowledge scores were significantly associated with marital status, education, occupation, and income (P values: .040, .003, .000, and .006, respectively), with the highest medians among divorced individuals, those with higher education, professional workers, and people earning <50,000 SDGs (medians: 17, 16, 17, and 16, respectively). Attitude scores varied significantly by marital status, education, occupation, and family asthma history (P values: .001, .000, .003, and .016, respectively), with highest scores among divorced individuals, those with high school or higher education, professionals, and those with a first-degree relative with asthma (medians: 6, 5, 5, and 5, respectively). Patient practice scores differed by marital status and income (P values: .026 and .006, respectively), with higher scores among singles and those earning <50,000 SDGs. Co-patient practice scores were significantly influenced by occupation, personal or familial asthma experience, and family asthma status (P values: .026, .003, and .000, respectively). No significant differences were observed in co-patient practice scores between groups. The study highlights a generally good level of asthma knowledge and positive attitudes among participants, with some variability in practices based on socio-demographic factors. These findings emphasize the need for targeted education and intervention programs to improve asthma management in rural Sudan.

Vitamin D Deficiency and Pediatric Obstructive Sleep Apnea Severity

Prior research has demonstrated an association between vitamin D deficiency and obstructive sleep apnea (OSA) in adults; however, its association with pediatric OSA is emerging. To evaluate the association of vitamin D levels with obstructive Apnea-Hypopnea Index (AHI) in children with OSA. This was a cross-sectional study of children aged 2 to 16 years with severe obstructive OSA (AHI ≥20 on polysomnogram) who were undergoing adenotonsillectomy at a tertiary care pediatric otolaryngology clinic from 2017 to 2022. Age, sex, race, body mass index, history of asthma, and season were considered in the analyses. Data were analyzed from September 3, 2021, to October 8, 2021. Serum 25-hydroxyvitamin D (25[OH]D) levels were measured and assessed for correlation with polysomnography metrics. Fasting blood samples were collected and vitamin D deficiency was defined as 25(OH)D level less than 20 ng/mL. The consecutive sample included 72 patients (mean [SD] age, 6.7 [3.9] years; 34 [47.2%] females and 38 [52.8%] males). The mean (SD) AHI was 42.8 (25.5), and 35 participants (49.0%) had obesity. Vitamin D deficiency was present in 27 participants (37.5%). In univariate analysis, vitamin D deficiency was associated with younger age (difference, -5.0; 95% CI, -7.2 to -2.8), Black race (odds ratio [OR], 4.3; 95% CI, 1.4 to 14.3), female sex (OR, 4.8; 95% CI, 1.7 to 12.5), and higher obstructive AHI (difference, 13.8; 95% CI, 1.2 to 26.4). In multivariable analysis, vitamin D deficiency remained significantly associated with AHI. A 1.0-unit decrease in serum 25(OH)D levels was associated with an AHI increase of 0.7 (95% CI, 0.04 to 1.40). The findings of this cross-sectional study indicate that vitamin D deficiency was common in children undergoing adenotonsillectomy for severe OSA and is significantly associated with increased OSA severity. Future research is needed on vitamin D supplementation and its association with any improvements in pediatric OSA treatment outcomes.

Epilepsy in Loeys-Dietz Syndrome: The Rare Concurrence of a Connective Tissue and Neuronal Migration Disorder

We present a 7-year-old girl who presented to our emergency department in active status epilepticus. Seizures responded to standard antiepileptic medications; however, baseline work-up for seizure etiology remained unremarkable. Her new-onset seizures were further investigated via EEG and MRI brain, which revealed focal epileptiform discharges and periventricular nodular heterotopia, respectively. Concurrently, the clinical evaluation revealed extensive marfanoid features, and a personal history of eczema and asthma. Her family history was pertinent for aortic valve disease, asthma, and tall stature. Given the peculiar skeletal features, allergic propensities and coexistent weighty family history, a molecular genetic panel analysis for Marfan Syndrome and Loeys-Dietz Syndrome (LDS) were sought. Genetic testing revealed an underlying heterozygous variant in the TGFBR-1 gene; thereby confirming the presence of LDS. The child had responded well to single antiepileptic agent therapy and was discharged in good condition with regular outpatient cardiac and neurology follow-up. This is a unique case reported of a child with genetically diagnosed LDS concurring with an underlying neuronal migration disorder, manifesting in an acute, severe, and lifethreatening fashion.

Effect of use of cuffed endotracheal tubes on the occurrence of postoperative extubation-related respiratory adverse events in pediatric patients with airway hypersensitivity: a retrospective cohort study.

Whether endotracheal tube (ETT) configuration (cuffed or uncuffed) influences the occurrence of respiratory adverse events (RAEs) in patients at risk remains largely unknown. We investigated the effects of cuffed ETTs on RAE occurrence after extubation in pediatric patients with airway hypersensitivity. Children aged < 8years with increased airway hypersensitivity (defined as upper airway symptoms, recent upper respiratory infection within 2weeks, or a history of asthma) who underwent general endotracheal anesthesia with inhaled agents between January 2021 and December 2022 were included. We retrospectively examined the patients' background and intraoperative anesthesia conditions by comparing the cuffed and uncuffed ETT groups. Multiple logistic regression analysis was performed to estimate the association between ETT configuration (cuffed vs. uncuffed) and the occurrence of RAEs or respiratory interventions (laryngospasm, peripheral capillary oxygen saturation < 92%, oxygen supplementation, epinephrine inhalation, or reintubation) after extubation. Cuffed ETTs were used in 163 patients and uncuffed ETTs in 143 patients. Apart from the frequency of upper airway surgery and intraoperative fluid balance, no significant differences in background characteristics were observed between the groups. RAEs after extubation were observed in 36 (22.1%) and 28 (19.6%) patients in each cuffed and uncuffed ETT groups. After adjusting for known RAE risk factors, no difference was observed in RAEs or respiratory interventions after extubation between both groups (odds ratio, 1.14; 95% confidence interval: 0.64, 2.06). In pediatric patients with airway hypersensitivity, the use of cuffed ETTs did not increase the occurrence of RAEs or respiratory interventions after extubation.

55 Post-pandemic paediatric asthma admissions: Clinical characteristics and outcomes of children hospitalized with asthma in 2022: The READAPT-Kids study cohort

Abstract Background Asthma exacerbations triggered by acute respiratory infections (ARIs) are a major cause of hospitalizations in children. There were large reductions in asthma admission during the SARS-CoV2 pandemic. Following the relaxation of public health interventions, there was a resurgence in admissions for ARIs. The effect of this rebound in ARIs on asthma management practices and outcomes is not well understood. Objectives To describe sociodemographic characteristics, etiology, management, and clinical outcomes of children and youth under the age of 18 years admitted to a tertiary care paediatric hospital with an acute asthma exacerbation from July 1, 2022 to Dec 31, 2022. Design/Methods An observational cohort study of children and youth less than 18 years, hospitalized with an acute asthma exacerbation from July 1, 2022 to Dec 31, 2022 at a single large Canadian children’s hospital. This was a subgroup analysis of the READAPT-Kids study cohort (Clinical chaRacteristics and outcomEs of hospitAlized children with Acute resPiratory infecTions.) Cases were identified using ICD-10-CA codes, then manually screened for inclusion. Detailed clinical and demographic information was extracted. Results Among 551 patients hospitalized with an ARI, 29.2% (n=161) were diagnosed with an asthma exacerbation. 99 were male (61.5%) with a median age of 3.8 years (IQR 2.2-6.3). 41.3% (n=64) had a previously documented asthma history, and of those, only 16.9% were taking any form of asthma therapy at admission. In hospital, 91.4% were given systemic corticosteroids, 86.5% had at least 1 viral pathogen identified, 72.2% had a chest x ray, 42.1% received antibiotics, and 23.7% had high flow nasal cannula oxygen outside of the paediatric intensive care (PICU). 22.4% (n=36), were admitted to the PICU, and 3.7% required invasive mechanical ventilation, there were no patient deaths. Median length of stay was 2.6 days (IQR 1.7–4.6 days). At discharge, 79.5% were prescribed regular inhaled corticosteroid therapy. Conclusion Asthma admissions accounted for a significant proportion of children hospitalized with ARIs in the post-pandemic era, with one fifth requiring transfer to PICU. CXR and antibiotic usage were high. Over 80% of those with a previous diagnosis of asthma were not taking inhaled corticosteroids at the time of admission.

Childhood Air Pollution Exposure Associated with Self-reported Bronchitic Symptoms in Adulthood.

Rationale: Few studies have examined the effects of long-term childhood air pollution exposure on adult respiratory health, including whether childhood respiratory effects underlie this relation. Objectives: To evaluate associations between childhood air pollution exposure and self-reported adult bronchitic symptoms while considering child respiratory health in the Southern California Children's Health Study. Methods: Exposures to nitrogen dioxide (NO2), ozone, and particulate matter <2.5 μm and <10 μm in diameter (PM10) assessed using inverse-distance-squared spatial interpolation based on childhood (birth to age 17 yr) residential histories. Bronchitic symptoms (bronchitis, cough, or phlegm in the past 12 mo) were ascertained via a questionnaire in adulthood. Associations between mean air pollution exposure across childhood and self-reported adult bronchitic symptoms were estimated using logistic regression. We further adjusted for childhood bronchitic symptoms and asthma to understand whether associations operated beyond childhood respiratory health impacts. Effect modification was assessed for family history of asthma, childhood asthma, and adult allergies. Measurements and Main Results: A total of 1,308 participants were included (mostly non-Hispanic White [56%] or Hispanic [32%]). At adult assessment (mean age, 32.0 yr; standard deviation [SD], 4.7), 25% reported bronchitic symptoms. Adult bronchitic symptoms were associated with NO2 and PM10 childhood exposures. Odds ratios per 1-SD increase were 1.69 (95% confidence interval, 1.14-2.49) for NO2 (SD, 11.1 ppb) and 1.51 (95% confidence interval, 1.00-2.27) for PM10 (SD, 14.2 μg/m3). Adjusting for childhood bronchitic symptoms or asthma produced similar results. NO2 and PM10 associations were modified by childhood asthma, with greater associations among asthmatic individuals. Conclusions: Childhood NO2 and PM10 exposures were associated with adult bronchitic symptoms. Associations were not explained by childhood respiratory health impacts; however, participants with childhood asthma had stronger associations.

Circulatory collapse requiring mechanical circulatory support in a child with autoimmune adrenal insufficiency: a case report

BackgroundWe report a rare case of new onset autoimmune adrenal insufficiency in childhood, presenting with severe shock requiring mechanical circulatory support. In the current era of readily available imaging, laboratory and other diagnostic investigations, medical history and careful physical exam can often provide valuable diagnostic information for timely therapy.Case presentationA 7-year-old boy with a history of mild intermittent asthma, presented with severe cardiogenic shock requiring extracorporeal membrane oxygenation (ECMO). Bronzing of his entire body was noted on physical exam. Stress dose hydrocortisone was given for suspected adrenal insufficiency. After weaning from ECMO and extensive rehabilitation, the patient recovered and was discharged home.ConclusionPrimary adrenal insufficiency (PAI) should be considered in the context of physical exam and laboratory findings, even in the presence of circulatory shock.

Pediatric Clinical Influenza Disease by Type and Subtype 2015-2020: A Multicenter, Prospective Study.

Previous investigations into clinical signs and symptoms associated with influenza types and subtypes have not definitively established differences in the clinical presentation or severity of influenza disease. The study population included children 0 through 17 years old enrolled at 8 New Vaccine Surveillance Network sites between 2015 and 2020 who tested positive for influenza virus by molecular testing. Demographic and clinical data were collected for study participants via parent/guardian interview and medical chart review. Descriptive statistics were used to summarize demographic and clinical characteristics by influenza subtype. Multivariable logistic regression and Cox proportional hazard models were used to assess effects of age, sex, influenza subtype, and history of asthma on severity, including hospital admission, need for supplemental oxygen, and length of stay. Retractions, cyanosis, and need for supplemental oxygen were more frequently observed among patients with influenza A(H1N1)pdm09. Headaches and sore throat were more commonly reported among patients with influenza B. Children with influenza A(H1N1)pdm09 and children with asthma had significantly increased odds of hospital admission (adjusted odds ratio (AOR): 1.39, 95% CI: 1.14-1.69 and AOR: 2.14, 95% CI: 1.72-2.67, respectively). During admission, children with influenza A(H1N1)pdm09 had significantly increased use of supplemental oxygen compared to children with A(H3N2) (AOR: 0.60, 95% CI: 0.44-0.82) or B (AOR: 0.56, 95% CI: 0.41-0.76). Among children presenting to the emergency department and admitted to the hospital, influenza A(H1N1)pdm09 caused more severe disease compared to influenza A(H3N2) and influenza B. Asthma also contributed to severe influenza disease regardless of subtype.

Cluster Analysis Identifies Patients With Severe Eosinophilic Asthma Who Achieve Super-Response and Remission With Mepolizumab.

This study identifies two distinct subgroups of patients with severe eosinophilic asthma who respond differently to mepolizumab. Cluster analysis reveals that patients with a family history of asthma, positive skin prick tests and higher baseline lung function have better treatment outcomes, highlighting the value of personalised treatment strategies.

Associations Between Non-communicable Diseases and Obstetric Complications: A Retrospective Records Review at a Tertiary Referral Hospital in Uganda.

Non-communicable diseases (NCDs) increasingly contribute to maternal morbidity and mortality. We determined the association between NCDs and obstetric complications at Mbarara Regional Referral Hospital(MRRH) in southwestern Uganda. In this retrospectiverecords review, we randomly selected records of women admitted for delivery at MRRH each month from January to December 2022,and extracted their socio-demographicand clinical histories. We defined a history of NCDs aschronic hypertension, pre-gestational diabetes, cardiac disease, anemia, or asthma. We performeda multivariaterobust Poisson regression analysis to assess the association between NCDs and obstetric complications, including preeclampsia, gestational diabetes, venous thromboembolic disease, obstetric hemorrhage, and preterm labor. Models were adjusted for maternal age, gravidity, referral status, employment status, andhumanimmunodeficiencyvirus (HIV) serostatus. Weextracteddata for 2,336 women with a mean age of 26±5.9 years. At least one NCD was present in 6.4% (n=149) of the patients,includinganemia (n=77, 3.3%), chronic hypertension (n=35, 1.5%), pre-gestational diabetes (n=16, 0.7%), asthma (n=9, 0.4%), and cardiac disease (n=6, 0.3%). Overall, 542 (23.2%) women had obstetric complications, including preeclampsia (n=265, 11.3%), preterm labor (n=67, 2.9%), placental abruption (n=29, 1.2%), postpartum hemorrhage (PPH) (n=54, 2.3%), and gestational diabetes (n=5, 0.2%). Women with NCDs had an increased likelihood of having an obstetric complication compared to women without (overall proportion 33.6% vs 22.5% respectively); adjusted prevalence ratio (aPR) was 1.8 (95% CI: 1.4-2.3) overall, 1.8 (95%CI: 1.2-2.8) for preeclampsia, 12.0 (95%CI: 2.0-72.7) for gestational diabetes, 6.0 (95%CI: 1.3-27.1) for deep venous thrombosis, 4.4 (95%CI: 1.5-12.6) for placenta abruption, and 4.3 (95%CI: 2.2-8.3) for PPH. We found that NCDs were associated with a nearly two-fold increase in the risk of obstetric complications. Our findings highlight the need for further research to understand the impact of this risk, particularly on maternal and fetal outcomes. Additionally, these findings suggest strengthened NCD surveillance, as a means of increasing preparedness, and management of potential obstetric complications among pregnant women in Uganda.