Months-18 Years Research Articles

Glycopyrronium 320 μg/mL in children and adolescents with severe sialorrhoea and neurodisabilities: An open-label study extension of the SALIVA trial.

To test the long-term efficacy, safety, and impact on quality of life (QoL) of an oral paediatric formulation of 320 μg/mL glycopyrronium in the 36-week SALIVA (Sialanar plus orAl rehabiLitation against placebo plus oral rehabilitation for chIldren and adolescents with seVere sialorrhoeA and neurodisabilities) trial. In the initial 12-week blinded period, 87 children with neurodisabilities and severe sialorrhoea were randomized to 320 μg/mL glycopyrronium versus placebo. In the subsequent 24-week open-label study extension, 74 children received 320 μg/mL glycopyrronium (37 continued glycopyrronium, 37 switched from placebo). The open-label study extension population included 39 males and 35 females. The median age was 10 years 2 months (quartile 1, quartile 3: 7 years 5 months, 14 years 7 months; range: 3 years 5 months-17 years 8 months). Over 36 weeks, continued 320 μg/mL glycopyrronium resulted in a median 39-point reduction in Drooling Impact Scale (DIS) score from baseline (quartile 1, quartile 3: -51, -21; p < 0.001), with an 81.1% response rate (DIS improvement ≥ 13.6 points) and a 70.3% good response rate (≥ 28 points). Improvements in the impact of drooling on QoL seen in the blinded period were sustained with continued glycopyrronium. Treatment-related adverse events occurred most frequently during titration (0-4 weeks: 40.9%; 5-20 weeks: 32.4% in those who switched). Constipation was the most common adverse event. Long-term treatment with 320 μg/mL glycopyrronium resulted in significant sustained improvements in drooling and QoL, with fewer adverse events after initial titration and overall good tolerability.

P-1139. Surveying Antibiotic Treatment for Pediatric Patients with Suspected Urinary Tract Infections at Madigan Army Medical Center

Abstract Background Urinary tract infections (UTIs) are one of the most common bacterial infections in pediatric patients presenting to the Emergency Department (ED). However, the gold standard for diagnosis is a urine culture which takes 24-48 hours to result leading to antibiotics started empirically while results are pending. This study was implemented with the primary aim of evaluating the antibiotic management of pediatric patients who were seen at a single medical center ED with suspected UTI. Methods Using the electronic medical record we identified pediatric cases (ages 2 months-18 years) where UTI was diagnosed in the ED during 2023 using the ICD-10 code. Data collected on each case included demographics, laboratory work-up, prescribed medications, and follow-up. Outcomes were categorized as confirmed, unknown, or negated. A confirmed UTI required an abnormal urinalysis and single species growth exceeding 50,000 cfu/mL; UTI was negated when growth was &amp;lt; 10,000 cfu/mL. Descriptive statistics and comparison tests were used as appropriate. Results There were 80 UTI diagnoses in 70 patients. 18 (22.5%) cases were confirmed and 36 (45%) were negated (Table 1). We analyzed 54 cases with confirmed or negated UTIs: 15 (27.8%) had follow-up with primary care (PCM) within 96 hours of their ED visit. When UTI was negated, 4 cases (11%) had antibiotics discontinued and all had PCM follow-up within 96 hours (p=0.043) (Table 2). Enterococcus-UTI accounted for 75% of cases where empiric treatment was inadequate. Of those without confirmed UTI, 3 returned to the ED with adverse effects from antibiotics and 2 with multiple inconclusive evaluations were referred to urology. The ED providers notified families with positive urine culture results, but no one was notified if the urine culture was negative. Conclusion Many pediatric patients who are treated for UTI in our ED have inconclusive or negative workups resulting in unnecessary antibiotic use, ED visits for antibiotic complications, and subspecialty referrals. Our current system does not support the discontinuation or tailoring of unnecessary or inappropriate antibiotics unless patients have close follow-up. Antibiotic stewardship requires systematic support within the ED to limit unnecessary antibiotics and the inherent complications that follow. Disclosures All Authors: No reported disclosures

P-1138. Quantifying Antibiotic Prescribing in Children with Tracheostomies

Abstract Background Prolonged or unnecessary antibiotic prescribing is associated with adverse outcomes. Children with tracheostomies are at risk for antibiotic overprescribing. We sought to quantify and characterize systemic antibiotic prescribing among children with tracheostomies, and to identify predictors of higher prescribing. Methods This single-center retrospective cohort study included children with tracheostomies 2 months-18 years old cared for between 2010-2018. Detailed demographic, clinical, and antibiotic prescribing data were extracted from the medical record. Patient-level antibiotic prescribing was quantified using antibiotic courses initiated and DOT per child per year of enrollment. Group-level prescribing was summarized using total antibiotic courses and days of therapy (DOT) per 1000 person-days. Antibiotics prescribed for &amp;gt; 1 day were classified by spectrum of activity and stratified by setting and year. Clinical predictors of patient-level prescribing were identified using backward stepwise multivariable analyses within a generalized linear model. Results The 548 children with tracheostomies (47.6% with baseline ventilator use) were prescribed a median 8 antibiotic courses per child per year (IQR: 4-16) for a total median exposure of 49.3 DOT per child per year (IQR: 22.6-123.2) or 183.7 DOTs per 1000 person-days. Most courses (73.9%) were broad-spectrum, with vancomycin, piperacillin-tazobactam, and ampicillin-clavulanate being the top 3 most frequently-prescribed antibiotic courses. Azithromycin and gentamicin represented a high proportion of all DOTs (azithromycin 25.4%, gentamicin 13.0%). Annual antibiotic prescribing decreased 34.5% from 2010-2018. In adjusted analysis to identify predictors, ventilator use at baseline was associated with fewer DOT per child per year, while higher patient complexity and more ICU hospital days were risk factors for higher DOT. Conclusion Children with tracheostomies have high antibiotic use, and are predominantly prescribed broad-spectrum antibiotics. Chronic ventilator use was a protective factor against higher prescribing. This data may inform antimicrobial stewardship work. Disclosures All Authors: No reported disclosures

Vulvar lichen planus a retrospective analysis.

Vulvar lichen planus (VLP) is a rare mucocutaneous disorder with significant impacts on quality of life and a potential risk of malignancy. Comprehensive data on its clinical features and treatment outcomes remain limited. To analyze the demographic and clinical characteristics of patients diagnosed with VLP and to evaluate the efficacy of current therapeutic approaches. A retrospective review was conducted on 70 female patients diagnosed with VLP at a single institution between January 2014 and August 2024. Clinical characteristics, treatment modalities, and outcomes were analyzed. Statistical comparisons were performed using Student's t-test, Mann-Whitney U test, and χ² test as appropriate. The mean age at diagnosis was 59.3 ± 12.4 years, with a median disease duration of 2 years (range: 6 months-10 years). Pruritus (80.0%) and dyspareunia (62.9%) were the most prevalent symptoms. Corticosteroid therapy was the mainstay treatment, administered to 97.1% of patients, with superpotent topical corticosteroids being the most common (47.1%). Remission was achieved in 25.7% of cases, with younger patients exhibiting significantly higher remission rates (p = 0.005). Thyroid disease was the most common comorbid autoimmune condition, present in 32.9% of patients. VLP predominantly affects middle-aged women, with corticosteroids remaining the first-line therapy. Younger age appears to be associated with better treatment outcomes. These findings underscore the importance of early intervention and individualized therapeutic strategies. Further studies are warranted to explore the underlying mechanisms driving age-related differences in disease outcomes.

The Influence of Electroencephalographic Density Spectral Array Guidance of Sevoflurane Administration on Recovery From General Anesthesia in Children. A Randomized Controlled Trial.

In children, monitoring depth of anesthesia is challenging because of the still developing brain. Electroencephalographic density spectral array monitoring provides age- and anesthetic drug-specific electroencephalographic patterns, making it suitable for use in children. Yet, not much is known about the benefits of using density spectral array on post-operative recovery in children. In this randomized controlled trial, the primary aim was to investigate the influence of density spectral array monitoring during general anesthesia on the speed of recovery after surgery. Children aged 6 months-12 years scheduled for elective surgery under general anesthesia supplemented with caudal analgesia had either sevoflurane anesthesia titrated to maintain a characteristic density spectral array pattern or based on a predefined end-tidal sevoflurane concentration of 2.3% (standard care group). The time interval between the discontinuation of sevoflurane and the moment when discharge criteria from the operating room were met (Steward score of 3 or more) was defined as the primary outcome parameter of this trial. Data from 96 children were analyzed. The time until discharge readiness from the operating room was shorter in group density spectral array (6 min. [13[4-16.8]]) than in group standard care (12 min. [18[6-24.3]]), with a difference between medians of 6 min (95% CI -7 to 0), p = 0.041. The mean end-tidal sevoflurane concentration during the surgical procedure was lower in group density spectral array, 1.8% (0.34) versus 2.3% (0.1) in group standard care (95% CI 0.4-0.7), p < 0.001. This randomized controlled trial provides initial evidence of an added value of density spectral array monitoring in terms of the speed of recovery and allows sevoflurane to be dosed 22% lower during maintenance than with a more traditional approach using a minimal alveolar concentration of 0.9. ClinicalTrials.gov identifier: NCT05525104.

First Palmar Intermetacarpal Flap for Congenital First Web Contracture: A Case Series.

Pediatric first web space contractures of the hand can lead to disability in hand function. Several techniques have been proposed for treating this condition. Recently, a new technique involving the first palmar cutaneous flap was described in a cadaveric study. This report aimed to elucidate the clinical outcomes of the first palmar intermetacarpal flap in patients with congenital first web space contractures. Case series of patients with moderate-to-severe first web contracture underwent surgery with the first palmar intermetacarpal flap. The variables included age, sex, diagnosis, preoperative and postoperative first intermetacarpal angle (IMCA), associated surgical procedures, postoperative complications, and follow-up time. Ten patients with a median age of 4 years and 8 months (range: 1 year and 5 months-16 years and 6 months) underwent surgery on a total of 12 hands. The median follow-up was 25 months (range: 12-49 months). IMCA increased in all patients following surgery, from a preoperative median of 20° (range: 0°-20°) to a postoperative median 40° (range: 30°-40°). Associated surgical procedures were performed in eight cases. Five simple complications occurred, including four cases of full-thickness skin graft pigmentation and one case of distal flap tip dehiscence. The first palmar intermetacarpal flap is an effective option in the surgical management of moderate-to-severe first web contractures.

Morbidities and comorbidities associated with optic nerve hypoplasia and septo-optic-pituitary dysplasia.

To quantify optic nerve hypoplasia (ONH) and septo-optic-pituitary dysplasia (SOD) morbidities and comorbidities. A retrospective population-based study with a case-control design was undertaken using administrative health data from Manitoba, Canada. Cases were 124 patients with ONH or SOD (70 males, 54 females; age range 6 months-36 years 8 months [mean 13 years, SD 7 years 2 months]) diagnosed from 1990 to 2019, matched to 620 unrelated population-based controls (350 males, 270 females; age range 0-36 years 8 months [mean 12 years 5 months, SD 7 years 2 months]) on birth year, sex, and area of residence. Additionally, 76 cases with ONH or SOD (46 males, 30 females; age range 2 years 5 months-36 years 8 months [mean 13 years 11 months, SD 7 years 3 months]) were matched one-to-one with sibling controls (40 males, 36 females; age range 7 months-33 years 1 month [mean 11 years 8 months, SD 7 years 3 months]). We used χ2 or Fisher's exact tests to test for differences in prevalence in morbidities and comorbidities between cases and controls; odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. Cox proportional hazards models were used to test for differences in subgroups of cases; hazard ratios and 95% CIs were estimated. Visual impairment and visual impairment with hypopituitarism were core morbidities associated with ONH and SOD cases respectively compared to unrelated controls (OR = 58.6, 95% CI = 22.5-152.5; OR = 243.4, 95% CI = 32.9-1799.0 respectively). Developmental delay or intellectual disability (OR = 6.9, 95% CI = 3.3-14.4), autism spectrum disorder (OR = 4.0, 95% CI = 2.0-8.3), epilepsy (OR = 14.9, 95% CI = 6.1-36.5), cerebral palsy (OR = 40.9, 95% CI = 14.0-119.6), and mood or anxiety disorders (OR = 1.7, 95% CI = 1.0-2.8) were the comorbidities more common among cases with ONH and SOD. Cases matched to siblings showed similar results except for mood and anxiety disorders. Visual impairment and visual impairment with hypopituitarism are the main morbidities in patients with ONH and SOD respectively, while developmental delay or intellectual disability, autism spectrum disorder, epilepsy, cerebral palsy, and mood or anxiety disorders are important comorbidities.

Exploring the use of digital technology for injury prevention and self-management among recreational runners.

Explore digital technology use among recreational runners in Wales and assess attitudes toward a proposed digital intervention for running-related injury (RRI) prevention and self-management. Exploratory survey. Online questionnaire, closed questions distributed to runners over a 7 week period. Recreational runners living in Wales (N=232). Data analysed descriptively. Inferential analysis conducted via IBM SPSS v25. Pearson's Chi square and logistic regression applied to assess effects of age, sex, and weekly mileage on technology use. 97% of participants reported using digital technology to monitor training, primarily through running watches (45.1%) and smartphone apps (37.6%). Pearson's chi square indicated that younger (18-24 years) and less experienced runners (3 months-2 years) were more likely to use multiple apps. Runners felt these technologies did not offer realistic advice for RRI prevention or self-management. Most runners (84.5%) were interested in the proposed intervention. Runners wanted to see injury advice, exercises to improve running and a diagnostic feature within the proposed intervention. Digital technologies are widely used by recreational runners but are not perceived as useful for injury prevention/self-management. There is therefore an opportunity to develop tailored, evidence-based digital interventions for RRI prevention and self-management.

Prevalence and Morphological Identification of Eimeria Species on Bali Cattle in Sumbawa District, West Nusa Tenggara

This study aims to determine the prevalence and morphological identification of Eimeria spp. from Bali cattle feces on traditional farms in Sumbawa District. A total of 300 samples were identified and 238 samples were positive, resulting in a prevalence of Eimeria spp. of 79.33%. Based on age category, the highest prevalence of Eimeria spp. was found in cattle aged 6 months-2 years (88.76%; 79/89), followed by cattle aged &lt;6 months (88%; 88/100) and the lowest prevalence in cattle aged &gt;2 years (63.96%; 71/111). Female Bali cattle had the highest prevalence of Eimeria spp. (80.55%; 145/180) than male Bali cattle (77.50%; 93/120). Based on livestock systems, the highest prevalence of Eimeria spp. was found in semi-intensive (89.15%; 74/83), then extensive (80.76%; 105/130) and the lowest in intensive (67.81%; 59/87). Six different Eimeria species were identified: E. bovis (33.19%), E. auburnensis (21.42%), E. zuernii (15.96%), E. alabamensis (12.18%), E. ellipsoidalis (10.50%), and E. canadensis (6.72%). Preventing and controlling coccidiosis infection in cattle can be done with good hygiene management.

Real-world use of integrated intraoperative OCT in pediatric cataract.

To study the utility of integrated intraoperative OCT (i2OCT) in pediatric patients with cataracts in the real world. It was a retrospective case series. We included patients aged 0-12 years with unilateral or bilateral cataracts who underwent cataract surgery or membranectomy for visual axis opacification between July 2022 and December 2023, where intraoperative OCT was used. We matched the clinical data with i2OCT images and tried to identify any useful information i2OCT provided. Intraoperative notes were reviewed to analyze any changes in the surgical plan or steps after doing i2OCT. The mean age of the children undergoing surgery was 5.9 ± 2.4 years (range: 6 months-9 years). OCT provided valuable insights into the anterior, posterior capsule, and vitreolental surface morphology. The surgical decision was modified in 10 cases after doing the intraoperative OCT (31.3%). The study adds to the database of pediatric patients imaged using i2OCT in the real world. i2OCT complements the preoperative examination and aids intraoperative decision-making in cases of white cataracts with excellent real-time delineation of the vitreolental interface in children.

Endoscopic Screening for Laryngotracheal Complications in Children Following Prolonged Mechanical Ventilation Maintained Through Endotracheal Intubation: A Cross-Sectional Pilot Project

Background: An endoscopic screening program following successful weaning from prolonged mechanical ventilation maintained through endotracheal tube (ET; prolonged intubation) may be justified to assess the upper (laryngotracheal) airway in children who may not always be symptomatic for intubation-related complications. Objectives: To evaluate effects of prolonged intubation in children through endoscopic screening of the laryngotracheal airway. Methods: In this cross-sectional pilot project, children (2 months-12 years) successfully extubated following prolonged intubation were selected, irrespective of having symptoms, for a 1-time flexible nasolaryngoscopy at third to sixth month post-extubation (follow-up window). Laryngotracheal airway changes, if present, were noted. Results: Out of 122 children, 42 developed symptoms of complications. Five of them attended within 3 months post-extubation, the rest were evaluated in the follow-up window. Eighty children aged ≤6 years and 4 children &gt;6 years were intubated with uncuffed ET. Symptoms, when present, included respiratory distress (100%), noisy breathing (~36%), cough (~29%), and dysphagia (~12%). Screening revealed positive findings in 40 out of 42 symptomatic children, and in 8 out of 80 asymptomatic children (χ2 = 80.314; after Yate’s correction; significant at P &lt; .0001). The commonest lesion was subglottic stenosis (~54%) and intubation granuloma (~48%). Relationship between the nature of ET (cuffed/uncuffed) and complications of prolonged intubation was statistically significant (χ246.553; significant at P &lt; .0001). Conclusion: The present study proposes the potential utility of follow-up endoscopic screening of upper (laryngotracheal) airway in children successfully weaned from prolonged intubation. A statistically significant relationship existed between prolonged intubation and upper airway complications that were not always symptomatic.

VGLL-fusions define a new class of intraparenchymal CNS schwannoma.

Intracerebral schwannomas are rare tumors resembling their peripheral nerve sheath counterparts but localized in the CNS. They are not classified as a separate tumor type in the 2021 WHO classification. This study aimed to compile and characterize these rare neoplasms morphologically and molecularly. We analyzed 20 tumor samples by histology, RNA Next-Generation Sequencing, DNA-methylation profiling, copy number analyses, and single nucleus RNA sequencing (snRNA-seq). Clinical data, including age, sex, and disease progression, were collected. MRI series were included when available. All cases with tissue available for histology review (n=13) were morphologically consistent with intracerebral schwannoma, but differed in their extent of GFAP staining. All (n=20) shared DNA-methylation profiles distinct from other CNS tumors, as well as from VGLL-altered peripheral nerve sheath tumors. Most cases (n=14/17) harbored fusions of either VGLL3 or VGLL1 (CHD7::VGLL3 (n=9/17) and EWSR1::VGLL1 (n=5/17)). In two cases the presence of a VGLL3 fusion was also confirmed by CNA analyses (n=2/17). MRI (n=4) showed well-defined, nodular tumors with strong, homogeneous enhancement and no diffusion restriction. Tumors were located throughout the neuroaxis [supratentorial (n=15), infratentorial (n=4), and spinal (n=1)]. snRNA-seq of a VGLL1-fused tumor indicated VGLL1 upregulation in 28.6% of tumor cells (n=1). During median follow-up of 1.8 years (range 3 months-9 years), none of the tumors recurred (n=10). We identify and define a new benign tumor class, designated VGLL-altered intraparenchymal CNS schwannomas. These tumors feature VGLL alterations and a specific DNA-methylation profile, with schwannoma-like histopathology and CNS localization, akin to previously classified intracerebral schwannomas.

Indications and outcomes of pediatric high flow nasal cannula use in the home setting.

To describe the patient characteristics, indications, and clinical outcomes of home high flow nasal cannula (HFNC) among pediatric patients. To evaluate secular trends in home HFNC initiation between 2013 and 2022. A retrospective review of all children on home HFNC between 2013 and 2023 was conducted at a tertiary care pediatric hospital in Ontario, Canada. Descriptive statistics were used to summarize results and identify indications for home HFNC initiation. Mann-Kendall Trend test was used to assess trends in HHF initiation between 2013 and 2022. A total of 35 patients, ages 6 months-14 years old, were started on home HFNC between 2013 and 2023. HFNC initiation increased over time, from 0 patients in 2013-2016 to nine patients per year in 2021 and 2022 (p < .001). Home HFNC was almost exclusively prescribed for children with multisystem conditions, 77% with an underlying genetic disorder, and 77% with prior home feeding tube use. Most children (83%) had multiple indications leading to initiation of home HFNC. The main indications included the following: (i) upper airway obstruction (66%), (ii) clearance of retained CO2 (57%), (iii) increased work of breathing without sleep-disordered breathing (29%), (iv) promotion of secretion clearance/plastic bronchitis (29%), and (v) palliative care (14%). In addition, 37% did not tolerate a previous trial of Continuous/Bi-Level Positive Airway Pressure. Complications were rare, with only two children developing epistaxis requiring an emergency department visit and 4 children requiring escalation in home respiratory support to CPAP or BiPAP. HFNC is increasingly being initiated among children in the home setting for varied indications. Preliminary data suggests few complications and a need for escalation of therapy with home HFNC.

Pediatric Mitochondrial Disease: Experience from A Tertiary Care Hospital in Bangladesh

Background: Mitochondrial diseases are rare group of heterogeneous, genetically determined disorders that affect multiple organs with variable severity due to the dysfunction of mitochondria. They usually present with acute or chronic features with intermittent decompensation. The common features are neuro-regression, hypotonia, failure to thrive, stroke, seizures, myopathy, cardiomyopathy, deafness, blindness, movement disorder, lactic acidosis etc. The aim of this study was to describe the clinical, neuroimaging and genetic analysis of mitochondrial diseases. Methodology: This retrospective study was done among sixteen admitted patients in the Department of Pediatric Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2016 to December 2023. Results: Total sixteen patients were included in the study. The age of the patients ranged from 3 months-8 years; 11 patients were male. Developmental delay and regression, seizure, hypotonia, dystonia, ataxia were the key clinical manifestations. About 12.5% had persistent hypoglycemia. 6.13% presented with periodic paroxysms of dyskinesia and weakness. In MRI of brain, predominant feature was bilateral basal ganglia involvement. Genetic analysis showed variable presentation. Here, 12.5% was diagnosed with Leigh syndrome, 12.5% had primary carnitine deficiency, 12.5% had SURF-1 mutation causing mitochondrial complex IV deficiency, 6.13% had mitochondrial short chain enoyl co-A hydratase deficiency,12.5% had mitochondrial DNA depletion syndrome and 6.13% had progressive external ophthalmoplegia with mitochondrial DNA deletions. Conclusion: Multisystem heterogenous involvement gives a clue to the suspicion of mitochondrial disease in pediatric population. Bangladesh J Child Health 2023; Vol 47 (2) : 65-71

Epistaxis Risk in Patients Treated With Left Atrial Appendage Occlusion Versus Oral Anticoagulation.

Anticoagulants (AC) are associated with epistaxis in atrial fibrillation (AF) patients. Left atrial appendage occlusion (LAAO) is a treatment that allows AF patients to stop AC. The aim of this study is to evaluate the risk of developing epistaxis following LAAO versus direct oral anticoagulants (DOAC) and warfarin. This study uses the TriNetX database as well as institutional records. The TriNetX database was searched for AF patients on a DOAC, warfarin, or treated with LAAO. Epistaxis odds ratios were compared 1 day-6 months and 6 months-3 years following initiation of DOAC, warfarin, or LAAO. Records of LAAO patients at our institution were also reviewed. The TriNetX query returned 1,185,862 patients. On TriNetX, LAAO patients had significantly higher odds of epistaxis likely due to antiplatelet therapy from 1 day-6 months compared to warfarin patients with DOAC patients (p < 0.0001). From 6 months-3 years after treatment initiation, LAAO patients experience reduced odds of epistaxis and epistaxis requiring nasal packing compared to warfarin patients (OR: 0.69 p = 0.0003; OR: 0.58 p = 0.0043). Institutionally, epistaxis resolved in 66% (8/12) LAAO patients with a history of epistaxis with an average follow-up of 1.5 years. LAAO decreased the frequency of epistaxis and epistaxis requiring nasal packing in AF patients on warfarin after 6 months. Our institutional experience demonstrates long-term improvement in epistaxis after LAAO for DOAC and warfarin patients. Additional studies need to be performed to account for dual antiplatelet following LAAO on epistaxis risk. Level 3 Laryngoscope, 2024.

Protection From COVID-19 Vaccination and Prior SARS-CoV-2 Infection Among Children Aged 6 Months-4 Years, United States, September 2022-April 2023.

To understand how coronavirus disease 2019 vaccines impact infection risk in children <5 years, we assessed risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from September 2022 to April 2023 in 3 cohort studies. There was no difference in risk by vaccination status. While vaccines reduce severe disease, they may not reduce SARS-CoV-2 infections in naïveyoung children.

Serum proteome profiling of plateau acclimatization in men using Olink proteomics approach.

Plateau acclimatization involves adaptive changes in the body's neurohumoral regulation and metabolic processes due to hypoxic conditions at high altitudes. This study utilizes Olink targeted proteomics to analyze serum protein expression differences in Han Chinese individuals acclimatized for 6 months-1 year at 4500 and 5300 m altitudes, compared to those residing at sea level. The objective is to elucidate the proteins' roles in tissue and cellular adaptation to hypoxia. We identified 54 metabolism-related differentially expressed proteins (DEPs) in the serum of the high-altitude group versus the sea-level group, comprising 20 significantly upregulated and 34 downregulated proteins. Notably, 2 proteins were upregulated and 11 downregulated at both 4500 and 5300 m altitudes. The top three protein correlations among DEPs included CRKL with CA13, RNASE3 with NADK, and NADK with APEX1, alongside APLP1 with CTSH, CTSH with SOST, and CTSH with NT-proBNP in inverse correlations. KEGG enrichment analysis indicated significant DEP involvement in various metabolic pathways, particularly those associated with hypoxic cellular metabolism like glycolysis/gluconeogenesis and the HIF-1 signaling pathway. Correlation with clinical phenotypes showed positive associations of SOST, RNASE3, CA13, NADK, and CRKL with SaO2 and negative correlations with Hemoglobin and Hematocrit; ALDH1A1 positively correlated with Triglyceride; and SDC4 inversely correlated with Uric acid levels. This study provides insights into specific DEPs linked to metabolic adaptations in high-altitude acclimatized individuals, offering a foundation for understanding acclimatization mechanisms and potential therapeutic targets.

Transfusion-Associated Graft-Versus-Host Disease in Pediatric Patients: Clinical Features and Outcomes.

Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare, usually fatal complication of blood transfusion. To describe the characteristics of TA-GVHD in children. The clinical records of pediatric patients diagnosed with TA-GVHD between January 2007 and December 2021 were reviewed. We analyzed 94 clinical records of pediatric patients (0-18 years) with a diagnosis of GVHD, of whom 6 (6.38%) were associated with TA-GVHD; both genders being equally affected. The median age at diagnosis of the underlying disorder was 9 years, 1 month (range 2 months-15 years, 3 months); the median age at diagnosis of TA-GVHD was 9 years, 5.5 months (range 1 year, 7 months-15 years, 7 months). There were 27 grafts; 8 were irradiated and 12 were filtered. All patients presented with Stage 3 cutaneous TA-GVHD and histopathological Grade 2. All cases corresponded to classic acute TA-GVHD with global clinical Grade I-II. Mortality rate was 67%. The median follow-up of our patients was 2 years and 2 months (range 4 months-3 years, 4 months). TA-GVHD, although less frequently encountered than in previous years, is still a concern. Early suspicion of TA-GVHD is mandatory due to its high mortality rates and rapid progression. Prevention by using irradiated blood products is the sole effective measure against this condition. Failing to identify and preempt TA-GVHD not only jeopardizes patient survival but also underscores the critical importance of vigilant monitoring and proactive intervention in at-risk patients.

Long-Term Outcome of Children With Steroid-Resistant Nephrotic Syndrome: A Single Center Experience From Pakistan

Objective: To determine the long-term outcome of children with steroid-resistant nephrotic syndrome at a single center in Pakistan. Study Design: Retrospective, observational study. Place and Duration of Study: Pediatric Nephrology Department, Sindh Institute of Urology and Transplantation, Karachi, Pakistan from July 2008 to June 2014. Methodology: The study included 153 children aged 4 months-12 years with steroid-resistant nephrotic syndrome. We collected data at the time of diagnosis and the last follow-up. The data was entered and analyzed by SPSS version 20. Results: Among 153 children, 84(55%) were males and 69(45%) females. At the time of diagnosis, 118(77%) were hypertensive and 65 (42.5%) had microscopic hematuria. Histopathological spectrum included focal segmental glomerulosclerosis, 63(41%); minimal change disease, 33(22%); IgM nephropathy, 9 (6%); mesangioproliferative glomerulonephritis, 26(17%), membranous glomerulonephritis, 13(8%) and membranoproliferative glomerulonephritis, 9(6%). Complete remission with cyclosporine was seen in 53(34.6%), partial remission in 36(23.5%), while 53(35%) developed chronic kidney disease, of which 26(78.8%) needed renal replacement therapy. Mortality was 21(13.7 %) and 11(7.2%) were lost to follow-up. Calcineurin inhibitors’ toxicity was seen in 52(34%). One patient received renal transplant but lost the graft 6 years post-transplant due to disease recurrence. Conclusion: Steroid-resistant nephrotic syndrome has significant long-term morbidity and mortality. Recurrence of disease in transplanted kidney is common and can result in graft loss.

Novel Multicomponent Digital Care Assistant and Support Program for People After Stroke or Transient Ischaemic Attack: A Pilot Feasibility Study.

Evidence is increasing for digital health programs targeting the secondary prevention of stroke. We aimed to determine the feasibility of the novel Care Assistant and support Program for people after Stroke (CAPS) or transient ischaemic attack (TIA) by combining person-centred goal setting and risk-factor monitoring through a web-based clinician portal, SMS messages, a mobile application (app), and a wearable device. We conducted a 12-week mixed-methods, open-label feasibility study. Participants (6 months-3 years after stroke or TIA, access to the internet via a smartphone/tablet) were recruited via the Australian Stroke Clinical Registry. Participants set one or two secondary prevention goals with a researcher and provided access and training in technology use. Feasibility outcomes included recruitment, retention, usability, acceptability, and satisfaction. Secondary outcomes included goal attainment, health outcomes, and program costs. Following 600 invitations, 58 responded, 34/36 (94%) eligible participants commenced the program (one withdrawal; 97% retention), and 10 were interviewed. Participants (27% female, 33% TIA) generally rated the usability of the mobile application as 'Good' to 'Excellent' (System Usability Scale). Most (94%) agreed the program helped with engagement in health self-monitoring. Overall, 52 goals were set, predominantly regarding exercise (21/52), which were the most frequently achieved (9/21). At 12 weeks, participants reported significant improvements (p < 0.05) in self-efficacy (Cohen's d = 0.40), cardiovascular health (d = 0.71), and the mental health domain of the PROMIS GH (d = 0.63). CAPS was acceptable, with good retention and engagement of participants. Evaluation of this program in a randomised controlled trial is warranted.