Pediatric Subjects Research Articles

A Single-Period, Single-Dose Study of the Pharmacokinetics of Epinephrine After Administration of Intranasal ARS-1 to Pediatric Subjects with a History of Systemic Allergic Reaction

An epinephrine nasal spray (ARS-1) is being developed as a needle-free alternative to autoinjectors for the emergency treatment of systemic allergic reactions including anaphylaxis in children and adults. This study aims to assess the pharmacokinetics of epinephrine after intranasal (IN) administration of ARS-1 in pediatric atopic allergy subjects.

Reference data for left ventricular filling and atrial function in children using cardiovascular magnetic resonance

BackgroundDiastolic dysfunction is associated with morbidity and mortality in multiple pediatric disease processes. Cardiovascular magnetic resonance (CMR) provides a non-invasive method of studying left ventricular (LV) diastolic dysfunction through the assessment of LV filling curves and left atrial (LA) volume and function. However, there are no normative data for LV filling curves and the standard method is time-intensive. This study aims to compare an alternate, more rapid method of obtaining LV filling curves to standard methodology and report normative CMR diastolic function data for LV filling curves and LA volumes and function. MethodsNinety-six healthy pediatric subjects (14.3 ± 3.4 years) with normal CMR defined by normal biventricular size and systolic function without late gadolinium enhancement were included. LV filling curves were generated by removing basal slices without myocardium present throughout the cardiac cycle and apical slices with poor endocardial delineation (compressed method), then re-generated including every phase of myocardium from apex to base (standard method). Indices of diastolic function included peak filling rate and time to peak filling. Systolic metrics included peak ejection rate and time to peak ejection. Both peak ejection and peak filling rates were indexed to end-diastolic volume. LA maximum, minimum and pre-contraction volumes were calculated using a biplane method. Inter-and intra-observer variability were assessed with intraclass correlation coefficient. Multivariable linear regression was used to assess the effects of body surface area (BSA), gender and age on metrics of diastolic function. ResultsBSA had the largest effect on LV filling curves. Normal LV filling data are reported for both compressed and standard methods. The time to perform the compressed method was significantly shorter than the standard method (median 6.1 min vs. 12.5 min, p < 0.001). Both methods had strong to moderate correlation for all metrics. Intra-observer reproducibility was moderate to high for all LV filling and LA metrics except for time to peak ejection and peak filling. ConclusionsWe report reference values for LV filling metrics and LA volumes. The compressed method is more rapid and produces similar results to standard methodology, which may facilitate the use of LV filling in clinical CMR reporting.

285 Performance metrics of a soft wearable acousto-mechanic sensor for measuring itch in children and adults with atopic dermatitis

Abstract Pruritus is a prominent symptom in many systemic (e.g. renal failure, cholestasis) and dermatologic (e.g. urticaria, xerosis) conditions. Atopic dermatitis (AD) is characterized by the itch-scratch cycle, whereby the reflexive scratching leads to greater skin inflammation and worsens pruritus. Itch in AD has also been associated with certain stages of the circadian rhythm. Therefore, an objective method of measuring nocturnal scratching behaviour as a proxy for itch symptom severity would prove useful and insightful in the management of a patient’s AD. The purpose of this study is to validate the performance of a novel wearable sensor, the advanced acousto-mechanic (ADAM) device, in regard to the detection of nocturnal scratching behaviour in paediatric and adult populations with AD. The sensor is able to detect both the accelerometer data (movement in space) and acoustic data generated by finger and wrist movements in scratching. Performance metrics used to evaluate the sensor include sensitivity, specificity, positive predictive value (PPV) and F1 score (combination of precision and recall). The sensor’s performance was compared to video recordings, the gold standard for objectively measuring scratch. A total of 60 healthy adult subjects (22 males and 38 females) were recruited and asked to perform a series of scratching behaviours and non-scratching behaviours while wearing the ADAM sensor on their dorsal hand using a one-use adhesive in a controlled environment. The data were used to create a machine-learning algorithm for scratch detection and validation in both a paediatric and adult AD cohort. Individuals with mild-to-severe AD were recruited to monitor their nocturnal scratching behaviour in the home environment. An infrared camera was provided for each subject to record the patient’s scratching and compared it to data collected by the ADAM sensor worn on the subject’s dominant dorsal hand. Video recordings were graded for scratching activity by at least two graders; scratch was defined as lasting at least 4.5 s. The scratch algorithm’s classification of scratch and non-scratch was then compared to the gold standard video recording and generated performance metrics. The initial scratch algorithm yielded sensitivity of 88%, specificity of 88% and F1 score of 90% when cross-validated with data from 10 healthy adult subjects. When cross-validated with data from all 60 healthy adult subjects, the algorithm yielded a sensitivity of 92%, specificity of 98% and F1 score of 95%. A total of 11 paediatric AD subjects (1 : 3 male-to-female ratio, ages 10.5 ± 9.1) and 46 nights of data were collected in the home setting, yielding a total of 378.4 h of video. The scratch algorithm was able to detect scratching behaviour with sensitivity of 84%, specificity of 99% and F1 score of 83% in the paediatric cohort. In the adult cohort, a total of 11 adults with atopic dermatitis (two males and nine females, ages 29 ± 13) and 73 nights of data were collected, resulting in a total of 457.7 h of video. When the data was applied to the scratch algorithm, the algorithm yielded a sensitivity of 93%, specificity of 100% and F1 score of 91%. The use of a flexible wearable sensor on the dorsal hand for detection of nocturnal scratching behaviour in both paediatric and adult subjects with atopic dermatitis can provide valuable information regarding the degree of scratching and severity of pruritus the wearer is experiencing when compared to video recording. Its ability to serve as an accurate objective measure of itch may be helpful in drug development and can help serve as a tool to guide the clinical management of symptoms.

Effectiveness and Safety of Albuterol Solutions With and Without Benzalkonium Chloride.

Continuous aerosolized β2 agonist, namely albuterol, is the most commonly used therapy for critical asthma. Benzalkonium chloride is a preservative present in some formulations of aerosolized albuterol solutions that can induce bronchospasm. Recent studies have shown that inhalation of albuterol containing benzalkonium chloride might induce unintended bronchoconstriction and poor outcomes. This study aimed to investigate whether using albuterol solutions containing benzalkonium chloride results in prolonged hospital length of stay (LOS). This was a retrospective cohort study of pediatric subjects admitted to the pediatric ICU (PICU) and treated with continuous albuterol. Data were collected and compared before and after a change to benzalkonium chloride-containing solutions. Subjects who were treated with preservative-free solutions were used as control. The primary outcome was PICU and hospital LOS; secondary outcomes included the duration of continuous albuterol and use of adjunctive therapies. A total of 266 admissions were included in the study. One hundred forty subjects (52.6%) were exposed to benzalkonium chloride. Median age and severity of illness scoring were similar between groups. The initial dose of continuous albuterol was significantly higher in the benzalkonium chloride group (median 15 interquartile range [IQR] 10-20 mg/h) compared to the preservative-free group (median 10 IQR 10-20 mg/h) (P < .001). PICU LOS was longer for the preservative-free group, 2.5 (IQR 1.4-4.6) d vs 1.8 (IQR 1.1-2.9) d for benzalkonium chloride group (P = .002). There was no significant difference in duration of continuous albuterol therapy (P = .16) or need for adjunctive respiratory support (heliox [P = .32], noninvasive ventilation [P = .81], and invasive mechanical ventilation [P = .57]). In contrast to published literature showing that benzalkonium chloride may be associated with a longer duration of continuous albuterol nebulization and hospital LOS, our study demonstrated that benzalkonium chloride-containing albuterol is safe for continuous nebulization in critically ill children and not associated with worse outcomes.

Osteocalcin serum concentrations and markers of energetic metabolism in pediatric patients. Systematic review and metanalysis.

Osteocalcin plays a role in glucose metabolism in mice, but its relevance in human energetic metabolism is controversial. Its relationship with markers of energetic metabolism in the pediatric population has not been systematically addressed in infants and adolescents. This study aims to assess the mean differences between tOC, ucOC, and cOC among healthy children and children with type 1 or type 2 diabetes (T1D or T2D) and the correlation of these bone molecules with metabolic markers. A systematic review and metanalysis were performed following PRISMA criteria to identify relevant observational studies published in English and Spanish using PubMed, Scopus, EBSCO, and Web of Science databases. The risk of bias was assessed using New Castle-Ottawa scale. Effect size measures comprised standardized mean difference (SMD) and Pearson correlations. Heterogeneity and meta-regressions were performed. The 20 studies included were of high quality and comprised 3,000 pediatric patients who underwent tOC, cOC, or ucOC measurements. Among healthy subjects, there was a positive correlation of ucOC with WC and weight, a positive correlation of tOC with FPG, HDL-c, WC, height, and weight, and a negative correlation between tOC and HbA1c. Among diabetic subjects, a negative correlation of ucOC with HbA1c and glycemia in both T1D and T2D was found and a negative correlation between tOC and HbA1c in T1D but not in T2D. The ucOC concentrations were lower in T2D, T1D, and patients with abnormal glucose status than among controls. The serum concentrations of tOC concentrations were lower among T1D than in controls. The patient's age, altitude, and HbA1c influenced the levels of serum tOC. Osteocalcin is involved in energy metabolism in pediatric subjects because it is consistently related to metabolic and anthropometric parameters. https://www.crd.york.ac.uk/prospero/, identifier: CRD42019138283.

Evaluation of subclinical changes in recently diagnosed pediatric hypertension patients without hypertensive retinopathy: an OCT study.

To investigate subclinical choroidal and retinal changes in recently diagnosed pediatric hypertension (HT) patients. This prospective case-control study consisted of 62 treatment naive HT patients (34 essential HT and 28 renal-induced HT) and 62 control subjects aged 10-16years. All demographic data and ocular parameters were noted. Macula and choroid measurements were acquired by spectral domain optical coherence tomography (SD-OCT). Choroidal measurements were obtained by taking the mean of the measurements taken from 3 nasal and 3 temporal locations at 500µ intervals (mean nasal, mean temporal) in addition to the subfoveal area. All choroidal thickness (ChT) values in HT subjects were significantly lower than in the healthy group (p < 0.001 for all). Also, there was no statistically significant difference between central macular thickness (CMT) and mean macular thickness (MMT) between the two groups. Subfoveal ChT, mean ChT, and CMT values were statistically lower in patients with renal-induced HT compared to essential HT subjects (p < 0.001, p = 0.04, p = 0.014, respectively). No significant correlation was observed between choroidal thicknesses and blood pressure values in essential and renal HT groups except weak correlation between mean temporal ChT and systolic blood pressure (SBP) in renal HT group (r = - 0.464, p = 0.013). This study demonstrated that choroidal thickness decreased even during the subclinical period in treatment naive pediatric HT subjects. In addition, it has been shown that the choroid is more affected in renal-induced HT compared to essential HT group.

Utility of propensity score-based Bayesian borrowing of external adult data in pediatric trials: A pragmatic evaluation through a case study in acute lymphoblastic leukemia (ALL)

ABSTRACT A fully powered randomized controlled cancer trial can be challenging to conduct in children because of difficulties in enrollment of pediatric patients due to low disease incidence. One way to improve the feasibility of trials in pediatric patients, when clinically appropriate, is through borrowing information from comparable external adult trials in the same disease. Bayesian analysis of a pediatric trial provides a way of seamlessly augmenting pediatric trial efficacy data with data from external adult trials. However, not all external adult trial subjects may be equally clinically relevant with respect to the baseline disease severity, prognostic factors, co-morbidities, and prior therapy observed in the pediatric trial of interest. The propensity score matching method provides a way of matching the external adult subjects to the pediatric trial subjects on a set of clinically determined baseline covariates, such as baseline disease severity, prognostic factors and prior therapy. The matching then allows Bayesian information borrowing from only the most clinically relevant external adult subjects. Through a case study in pediatric acute lymphoblastic leukemia (ALL), we examine the utility of propensity score matched mixture and power priors in bringing appropriate external adult efficacy information into pediatric trial efficacy assessment, and present considerations for scaling fixed borrowing from external adult data.

A Meta-Analysis of the Effectiveness of Vitamin C in the Prevention and Treatment of Childhood Upper Respiratory Tract Infections

Background: The effectiveness of vitamin C in the prevention and treatment of pediatric upper respiratory tract infections was evaluated in a meta-analysis. Methods: A total 2,573 children with upper respiratory tract infections were included in the meta-analysis, 1,280 of whom received vitamin C and 1,293 who received control medication. The analysis of findings related to the studies included was done through random or fixed effects model to determine whether vitamin C supplementation could stop and control upper respiratory tract infections in children using mean difference (MD) with 95% confidence intervals (CIs). Results: On average, vitamin C-treated children had fewer upper respiratory tract infection bouts, their illness lasted shorter (MD -0.84; 95% CI -1.47 to -0.20, P = 0.009), and they were less contagious than the control. Conclusions: The number of episodes and illness duration of upper respiratory tract-infected pediatric subjects were considerably reduced in the intervention group (vitamin C) compared to the control. Due to the small sample size in four of 11 studies and the limited number of studies included for comparison, the outcomes should be carefully examined.

Filaggrin Gene Mutation in Pediatric Patients with Atopic Dermatitis: A Look into Indian Gene Pool, a Pilot Study.

Mutations in the filaggrin (FLG) gene has been reported to be an indicator of poor prognosis of atopic dermatitis (AD). It has been reported that there is a considerable variation in the mutations detected in the FLG gene in different ethnicities. To detect the presence of mutations in the FLG gene in pediatric subjects with atopic dermatitis (AD) and to compare the detected mutations with those already reported from different ethnicities. Genomic DNA extracted using standard procedure from peripheral venous blood of 30 patient and 15 control samples. Sequence analysis of the FLG gene carried out and detected changes was then cross referenced with those mutations already reported to check for novelty of detected changes. Amino acid changes were detected in 28 of the patient samples and in none of the control samples indicating that changes in the FLG gene were more common in the patient group than the control group (Fishers exact test, P < 0.0001). The most commonly reported mutations R501X and 2282del4 were not detected. Only 5 of the detected 22 amino acid changes H2507Q, L2481S, K2444E, E2398Q, and S2366T have been previously reported and are not clinically significant; however, in one patient a stop codon was detected (S2366STOP). P2238N, R2239W, and V2243L detected in 70% of the samples and S2231E detected in 67% of the patient samples have not been reported so far and their clinical significance is yet to be analyzed. Analyses of mutations already reported showed that the changes detected from this study are novel to Indian traits. While this adds on to the minimal data available from the Indian subcontinent further analyses has to be carried out to analyze the pathogenicity of these detected changes on larger samples sizes. To detect the presence of mutations in the FLG gene in pediatric subjects with atopic dermatitis (AD) and to compare the detected mutations with those already reported from different ethnicities.

Implementation of Competency Based Medical Education Curriculum in Paediatrics for Phase 2 MBBS UndergraduatesA Descriptive Study

Introduction: Adoption of Competency Based Medical Education-Undergraduate (CBME-UG) curriculum is made mandatory in medical colleges by National Medical Commission (NMC). CBME-UG curriculum enumerates the expected knowledge and skills in detail and it focuses more on observable outcomes that are important in day-to day medical practice. This curriculum holds the teacher as well as learner equally responsible in running the educational programme. Aim: To put forth the approach adopted in implementation of CBME-UG curriculum for phase 2 MBBS students in paediatric subject. Materials and Methods: This article describes the steps applied in transforming the traditional structured teaching method to the CBME method for undergraduate phase 2 MBBS students in the Department of Paediatrics at Dr. B R Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India, during January 2021 to December 2021. The duration of one year was divided into preimplementation phase (three months) and implementation phase (nine months). The faculty of the department, a coordinator to overview the programmeme, the postgraduate residents, and the students of phase 2 MBBS were the stakeholders identified in order to run the CBME-UG educational programmeme. Results: Preimplementation phase consisted of designing the department module and sensitisation of involved stakeholders. The contents of the module were curriculum planner for three years, time-table plan for phase II MBBS students, structuring of teaching sessions, designing the assessment method, and designing the feedback method. Implementation phase during clinical postings for the phase II MBBS students incorporated the strategies designed in preimplementation phase. The teaching sessions, assessment, the feedback sessions, and student-doctor programmeme were implemented with realistic and feasible planning. Conclusion: The CBME curriculum was successfully implemented among undergraduate second year medical students in term of student feedback and performance. It was noted that appropriate planning and sensitisation of students as well as the teachers, helped in running the programme smoothly.

The Role of Ferritin Serum Level as Predictor Sepsis Mortality on Children in Dr. Moewardi Hospital of Surakarta

Background: Sepsis cause death in the worldwide pediatric population. Eestablishing the diagnosis of sepsis in children is challenging because the symptoms are varied and not specific. Serum ferritin is an acute phase protein which can be elevated in sepsis. This study aimed to determine the role of ferritin level as a predictor for sepsis mortality in pediatric patient Subject and Methods: A cross sectional study was conducted in children aged between 1 months and 18 years old diagnosed with sepsis who were treated at Dr. Moewardi General Hospital, Surakarta from November 2021 to April 2022. The statistical analysis used SPSS 25 with p&lt;0.05 was considered significant. The cut off point of serum ferritin level was determined with ROC curve. Results: Twenty septic children were included in study, of whom 8 children died and 12 children survived. The mean serum ferritin levels of the subjects who survived and died were 925 ng/ml and 1257 ng/ml, respectively. The serum ferritin level wiht the cut off point of 975 ng/ml had sensitivity and specificity of 87.5% and 75% respectively (p=0.006). Conclusion: Serum ferritin level can be predictor of mortality in children with sepsis. Keywords: ferritin, mortality in sepsis, children Correspondence: Agus Sucianto. Department of Pediatrics, Sebelas Maret University/ Dr. Moewardi General Hospital, Surakarta, Central Java, Indonesia. Kolonel Sutarto Street No. 132, Surakarta, Indonesia. Email: sucianto22@gmail.com. Mobile: 081227595134. Journal of Maternal and Child Health (2023), 08(02): 210-216 https://doi.org/10.26911/thejmch.2023.08.02.08

Fall-related injuries at home: Descriptive analysis from a Middle Eastern level 1 trauma center.

Injuries caused by falls from heights (FFH) and fall of heavy objects (FHO) in residential settings are underestimat-ed in the Middle East. We aimed to describe the fall-related injuries at home requiring admission at a level 1 trauma center. We conducted a retrospective analysis of patients who were admitted following fall-related injuries at home between 2010 and 2018. Comparative analyses were performed based on age groups (<18, 19-54, 55-64, and ≥65 years), gender, severity of injuries, and height of fall. Time series analysis of fall-related injuries was performed. A total of 1402 patients were hospitalized due to fall-related injuries occurred at home (11% of total trauma admissions). Three quarters of victims were male. The most injured subjects were young and middle-aged (41.6%), followed by pediatric (37.2%) and elderly subjects (13.6%). FFH was the most frequent mechanism of injury (94%) followed by FHO (6%). Head injury was most common (42%) followed by lower extremity injury (19%). Older adults (≥65 years) had more complications, longer hospital stay, and higher in-hospital mortality. Patients who fell from greater heights had more chest and spinal injuries with greater severity and longer stay in the hospital. Time-series analysis did not show a seasonal variation of fall-related hospitalization. This study showed that 11% of trauma hospitalizations were related to fall at home. FFH was common in all age groups; however, FHO was more evident in the pediatric group. Preventive efforts should address the circumstances of trauma in the residential settings to better inform evidence-based prevention strategies.

Association of micro RNA expressions with pediatric celiac clinical findings

There is a need to determine the relationship between the function of the immune system and miRNA expression in pediatric celiac disease (pCD). We aimed to describe the expression profiles of miRNAs in Turkish pCD patients based on the clinical and pathological findings. This study was conducted on 33 pCD patients and 33 pediatric control subjects with normal biopsy results. Four most common mutations (DQA1*05, DQB1*02, DQA1*03, DQB1*03:0.2) on HLA gene in pCD were screened. Paraffin-embedded biopsy tissue samples were used in miRNA isolations followed by cDNA synthesis. Expression of miRNAs were evaluated in the groups with qRT-PCR array-method. Significant underexpression of hsa-miR-194-5p gene was detected in pCD patients compared to the control group. The hsa-miR-194-5p gene was significantly underexpressed in anemic or short stature pCD patients compared to the control. The genes of hsa-miR-29b-3p, hsa-miR-30e-5p, and hsa-miR-146a-5p were significantly overexpressed in the patients with constipated celiac patients. Significant overexpression of hsa-miR146a-5p gene was detected in the Marsh2 and Marsh3a groups. The hsa-miR-29b-3p, hsa-miR-30e-5p, hsa-let-7a-5p, hsa-miR-27a-3p, hsa-miR141-3p, hsa-miR143-3p, and hsa-miR-146a-5p miRNA genes were significantly overexpressed in the Marsh3b group. Also, the hsa-miR-194-5p and hsa-miR-26a-5p genes were significantly underexpressed in the comparison of Marsh3c group to the control. These results suggest that miRNA expressions are likely to play a role in the pathogenesis of pCD. It is believed that the current results present valuable inferences that may help understand the genetic boundaries on pCD, which might be further supported by follow up studies on other miRNAs.

Natural regulatory T cells increase significantly in pediatric patients with parasitic infections: Flow cytometry study.

The most accepted definition of regulatory T cells (Tregs) relies on the expression of several biomarkers, including CD4, CD25, and transcription factor, Foxp3. The Tregs maintain tolerance to self-antigens and prevent autoimmune diseases. The purpose of this study was to determine the difference in natural Treg levels in Entamoeba histolytica, Schistosoma mansoni, Giardia lamblia, Enterobius vermicularis, and Hymenolepis nana infected patients. Fifty-one pediatric subjects (29 males and 22 females) were recruited from a tertiary care hospital, and were divided into infected and non-infected (control) groups. The mean age of the subjects was 8.7 years. Blood samples were collected from infected and non-infected groups, and change in the level of Tregs in these subjects was investigated by flow cytometry. The statistical analysis of data was performed by SPSS software. Quantitative data used in this study included mean and standard deviation. Data from the two groups were compared by the Student's t-test. The age of the patient and infection status were used for multivariate logistic regression analysis. Odds ratios (ORs) were estimated within a 95% confidence interval, and a P value of <0.05 was considered significant. The levels of natural regulatory T cells, indicated by the biomarkers, CD4+, CD25+, and Foxp3+, increase significantly in patients infected by Entamoeba histolytica, Schistosoma mansoni, Giardia lamblia, Enterobius vermicularis, and Hymenolepis nana as compared to controls. They also increase in cases of mixed infection as compared to infection by a single parasite.

The impact of life of a child with cerebral palsy on the quality of life of mothers: Tuzla Canton/Bosnia and Herzegovina.

The aim of the study was to examine the impact of the quality of life of children with cerebral palsy (CP) on the quality of life of mothers. A total of 122 subjects participated in the study. The general quality of life assessment of paediatric subjects PedsQLTM 4.0 Generic Scale and the specific PedsQLTM 3.0 Module Cerebral Palsy Version 3.0 were used to assess the quality of life of children with CP, and the quality of life of mothers was assessed with the PedsQLTM 2.0 Family Impact Mode Questionnaire. In the present study, the quality of life of mothers is influenced by the physical and social functioning of the child, while the impact of emotional functioning has not been proven. The specific difficulties faced by children with CP, which have a statistically significant effect on the overall quality of life of the mother, are present in the domains: daily activities, mobility and balance and nutrition. The assessment of the quality of life of mothers and children with CP should be an integral part of the clinical assessment, as this will enable professionals to participate more successfully in providing professional assistance in the form of services, therapeutic approaches and prevention programs.

“50 shades of groin pain” in an unusual case of osteomyelitis pubis following surgery

Osteomyelitis pubis (OP) is a rare type of infection involving the pubic bones that often poses diagnostic and consecutive therapeutic problems. The infection can be mono or polymicrobial, bacterial, mycotic or bacillary with Staphylococcus aureus being the most common infectious agent involved. OP is generally seen in immune-suppressed patients of oncologic and diabetic population or in pediatric and geriatric subjects. The main symptom is represented by local pain with radiation to thighs which in later stages is accompanied by general non-specific symptoms such as malaise, fever and loss of appetite. The specificity-lacking initial presentation often leads to diagnostic delays which furthermore decrease the effectiveness of drug therapy, leading to higher chances of bone and joint destruction. Initial therapy consists of empirical antibiotherapy that should cover Staph. aureus; depending on culture results, the scheme should be changed accordingly. Moreover, symptomatic treatment of pain and inflammation consisting of NSAIDs, small dose glucocorticoids and minor opioids should be considered. Selected cases may benefit from surgical intervention when improvement or remission is considered improbable under drug therapy or when severe bony destructions are present.

COMPARATIVE STUDY OF POLYTRAUMA WITHIN A GROUP OF 2004 PATIENTS (PEDIATRICS AND YOUNG ADULTS)

Globally, there are many efforts to reduce the incidence of road accidents. However, the number of patients hospitalized with polytrauma is still high, with approximately 5.8 million deaths associated with traumatic injuries annually. Among the young, active age population, trauma is the current domain and timing a major cause of severe illness.Therefore we aimed by this study to evaluate comparatively the incidence of polytraumas among young adult patients presented in the Emergency - department (information obtained from the archive of the Emergency Clinical Hospital Sfântul Apostol Andrei Galați – 129 young patients) and pediatric subjects from a group of 710 children.The data obtained following the anamnesis, the clinical and paraclinical examination of the patients, were entered into the IBM SPSS Statistics 24 and Excel 2019, then sorted and filtered according to different criteria. In both groups, the incidence of male patients is statistically noticeable and also aspects regarding high frequency according to definite spring seasonality, and paraclinical, clinical, and sociodemographic elements.

Effect of Hearing Device Use on Speech-in-Noise Performance in Children with Severe-to-Profound Unilateral Hearing Loss.

Limited evidence exists for the use of rerouting devices in children with severe-to-profound unilateral sensorineural hearing loss. Many laboratory studies to date have evaluated hearing-in-noise performance in specific target-masker spatial configurations within a small group of participants and with only a subset of available hearing devices. In the present study, the efficacy of all major types of nonsurgical devices was evaluated within a larger group of pediatric subjects on a challenging speech-in-noise recognition task. Children (7-18 years) with unaided severe-to-profound unilateral hearing loss (UHL' n = 36) or bilateral normal hearing (NH, n = 36) participated in the present study. The signal-to-noise ratio (SNR) required for 50% speech understanding (SNR-50) was measured using BKB sentences in the presence of proprietary restaurant noise (R-SPACE BSIN-R) in the R-SPACE Sound System. Subjects listened under 2 target/masker spatial configurations. The target signal was directed toward subjects' NH or hearing-impaired ear (45º azimuth), while the interfering restaurant noise masker was presented from the remaining 7 loudspeakers encircling the subject, spaced every 45º. Head position was fixed during testing. The presentation level of target sentences and masking noise varied over time to estimate the SNR-50 (dB). The following devices were tested in all participants with severe-to-profound UHL: air conduction (AC) contralateral routing of signal (CROS), bone conduction (BC) CROS fitted on a headband with and without the use of remote microphone (RM), and an ear-level RM hearing assistance technology (HAT) system. As a group, participants with severe-to-profound UHL performed best when the target signal was directed toward their NH ear. Across listening conditions, there was an average 8.5 dB improvement in SNR-50 by simply orienting the NH ear toward the target signal. When unaided, participants with severe-to-profound UHL performed as well as participants with NH when the target signal was directed toward the NH ear. Performance was negatively affected by AC CROS when the target signal was directed toward the NH ear, whereas no statistically significant change in performance was observed when using BC CROS. When the target signal was directed toward participants' hearing-impaired ear, all tested devices improved SNR-50 compared with the unaided condition, with small improvements (1-2 dB) observed with CROS devices and the largest improvement (9 dB) gained with the personal ear-level RM HAT system. No added benefit nor decrement was observed when RM was added to BC CROS using a 50/50 mixing ratio when the target was directed toward the impaired ear. In a challenging listening environment with diffuse restaurant noise, SNR-50 was most improved in the study sample when using a personal ear-level RM HAT system. Although tested rerouting devices offered measurable improvement in performance (1-2 dB in SNR-50) when the target was directed to the impaired ear, benefit may be offset by a detriment in performance in the opposing condition. Findings continue to support use of RM HAT for children with severe-to-profound UHL in adverse listening environments, when there is one primary talker of interest, to ensure advantageous SNRs.

Evidence of Chronic Complement Activation in Asymptomatic Pediatric Brain Injury Patients: A Pilot Study.

Physical insult from a mild Traumatic Brain Injury (mTBI) leads to changes in blood flow in the brain and measurable changes in white matter, suggesting a physiological basis for chronic symptom presentation. Post-traumatic headache (PTH) is frequently reported by persons after an mTBI that may persist beyond the acute period (&gt;3 months). It remains unclear whether ongoing inflammation may contribute to the clinical trajectory of PTH. We recruited a cohort of pediatric subjects with PTH who had an acute or a persistent clinical trajectory, each around the 3-month post-injury time point, as well as a group of age and sex-matched healthy controls. We collected salivary markers of mRNA expression as well as brain imaging and psychological testing. The persistent PTH group showed the highest levels of psychological burden and pain symptom reporting. Our data suggest that the acute and persistent PTH cohort had elevated levels of complement factors relative to healthy controls. The greatest change in mRNA expression was found in the acute-PTH cohort wherein the complement cascade and markers of vascular health showed a prominent role for C1Q in PTH pathophysiology. These findings (1) underscore a prolonged engagement of what is normally a healthy response and (2) show that a persistent PTH symptom trajectory may parallel a poorly regulated inflammatory response.

880. Molecular Subtyping and Macrolide-Resistance Determination of Mycoplasma pneumoniae from Children Enrolled in New Vaccine Surveillance Network in the United States during 2015 to 2020

Abstract Background Mycoplasma pneumoniae (MP), a common pediatric pneumonia pathogen, has 2 subtypes based on P1 adhesin gene variation. Macrolide-resistant MP (MRMP), seen since 2000 in many countries, has been subtype associated. Limited U.S. pediatric data exist on MP subtype or MRMP frequency and their clinical importance. Methods During 2015–2020, mid-turbinate nasal swab (MTNS) specimens and/or throat swabs were collected from children with acute respiratory illness (ARI) enrolled in emergency department (ED) or outpatient and inpatient settings at 4 CDC-funded New Vaccine Surveillance Network sites (Cincinnati, Seattle, Houston, and Kansas City). Specimens were tested for MP and common respiratory viruses by singleplex or multiplex polymerase chain reaction assay (PCR). P1-subtyping for MP positive specimens used multiplex TaqMan real-time PCR while MR was assessed by real time PCR with melt curve analysis (Lightmix®, TIBMolbiol). Select demographic/clinical data were analyzed by P1 subtype (P1–1 vs. P1–2). Results Of 208 MTNS specimens from 208 children (median age 5.5 years), 110 (53%) were P1–1, 89 (43%) P1–2, and 9 (4%) untypeable. Of 199 typeable specimens, 111 (56%) came from inpatients while 88 (44%) came from ED/outpatients.Overall MRMP prevalence during 2015–2020 was low (3/208,1.4%); all MRMP (Houston: 1 each in 2016–2017 and 2019–2020, Seattle: 1 in 2018–2019) were P1–1. Differences in P1–2 vs. P1–1 proportions were significant in 2 years: P1–2 dominated in 2015–2016; P1-1 in 2019–2020 (Figure 1). Common clinical symptoms for 199 MP-positive patients were fever (84%, mean 102.5±1.5oF), shortness of breath (82%), wheezing (67%), and cough (60%). Clinical manifestations, hospitalization, and antibiotic use did not differ in P1-1 vs. P1-2 patients. Antibiotics were used in 59/199 (30%) patients overall; amoxicillin was most frequent (48/199, 24%), followed by cefdinir (9/199, 5%) and azithromycin (5/199, 3%). Conclusion MP subtypes co-circulated during 2015–2020; P1-2 dominated in 2015–2016, P1-1 in 2018–2019. Signs/symptoms were similar for P1-1 and P1-2. MRMP detection was uncommon among our pediatric subjects. Ongoing surveillance is important to assess potential changes in MR prevalence and temporal subtype variation. Disclosures Christopher J Harrison, MD, Astellas: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|Pediatric news: Honoraria|Pfizer: Grant/Research Support Brian R. Lee, PhD, MPH, CDC: Grant/Research Support|Merck: Grant/Research Support Mary E. Moffatt, M.D., Becton and Dickinson and Company: Stocks/Bonds|Biogen: Stocks/Bonds|Coloplast B: Stocks/Bonds|Express Scripts: Stocks/Bonds|Novo Nordisk A/S Spons ADR: Stocks/Bonds|Novo Nordisk A/S-B: Stocks/Bonds|Steris PLC: Stocks/Bonds|Stryker Corp: Stocks/Bonds|Thermo Fisher Scientific: Stocks/Bonds Janet A. Englund, MD, Astra Zeneca: Advisor/Consultant|Astra Zeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccine: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Grant/Research Support|SanofiPasteur: Advisor/Consultant.