School-aged Patients Research Articles

Development Factors in Dentoalveolar Anomalies Influencing Patients in The Zone of Environmental Woes

The article contains the findings of the analytical research on the dentition anomalies in the patients of preschool and school age in Kizlyar, the revealing of the main factor affecting the development of abnormalities in a dentition.

Mucus and mucus flake composition and abundance reflect inflammatory and infection status in cystic fibrosis

BackgroundMucus hyperconcentration in cystic fibrosis (CF) lung disease is marked by increases in both mucin and DNA concentration. Additionally, it has been shown that half of the mucins present in bronchial alveolar lavage fluid (BALF) from preschool-aged CF patients are present in as non-swellable mucus flakes. This motivates us to examine the utility of mucus flakes, as well as mucin and DNA concentrations in BALF as markers of infection and inflammation in CF airway disease. MethodsIn this study, we examined the mucin and DNA concentration, as well as mucus flake abundance, composition, and biophysical properties in BALF from three groups; healthy adult controls, and two CF cohorts, one preschool aged and the other school aged. BALFs were characterized via refractometry, PicoGreen, immunofluorescence microscopy, particle tracking microrheology, and fluorescence image tiling. ResultsMucin and DNA BALF concentrations increased progressively from healthy young adult controls to preschool-aged people and school-aged people with CF. Notably, mucin concentrations were increased in bronchoalveolar lavage fluid (BALF) from preschool-aged patients with CF prior to decreased pulmonary function. Infrequent small mucus flakes were identified in normal subjects. A progressive increase in the abundance of mucus flakes in preschool and school-aged CF patients was observed. Compositionally, MUC5B dominated flakes from normal subjects, whereas an increase in MUC5AC was observed in people with CF, reflected in a reduced flaked MUC5B/MUC5AC mucin ratio. ConclusionThese findings suggest mucus composition and flake properties are useful markers of inflammatory and infection-based changes in CF airways.

Developing clinical algorithm for identifying acute lumbar spondylolysis in elementary school children – Classification and regression tree analysis

ABSTRACT Objectives To develop a clinical algorithm for classifying acute lumbar spondylolysis from nonspecific low back pain in elementary school-aged patients using the classification and regression tree analysis. Methods Medical records of 73 school-aged patients diagnosed with acute lumbar spondylolysis or nonspecific low back pain were retrospectively reviewed. Fifty-eight patients were examined for establishing an algorithm and 15 were employed for testing its performance. The following data were retrieved: age, gender, school grades, days after symptom onset, history of low back pain, days of past low back pain, height, weight, body mass index, passive straight leg raise test results, hours per week spent on sports activities, existence of spina bifida, lumbar lordosis angle, and lumbosacral joint angle. Classification and regression tree analyses were performed 150 times using the bootstrap and aggregating method. Then, the results were integrated by majority vote, establishing an algorithm. Results Lumbar lordosis angle, days after symptom onset, body mass index, and lumbosacral joint angle were the predictors for classifying those injuries. Conclusion The algorithm can be used to identify elementary school-aged children with low back pain requiring advanced imaging investigation, although a future study with a larger sample population is necessary for validating the algorithm.

Survey of school aged patients and their parents with regards to comprehension of laparoscopic appendectomy procedure

Survey of school aged patients and their parents with regards to comprehension of laparoscopic appendectomy procedure

Radiological methods of research in the diagnosis of asthenic syndrome against the background of pathology of the cervical spine

The results of a comprehensive examination of school-aged patients with asthenic syndrome are presented, which included ultrasound duplex scanning of the arteries of the neck and head, Х-Ray examination of the cervical spine with functional tests. Research results demonstrate the presence of degenerative and/or functional changes in the spine in the vast majority of subjects, which trigger a cascade of pathophysiological reactions that cause blood flow disturbances in the vessels of the vertebro-basilar basin. Irritation of the cervical autonomic ganglia leads to dysfunction of the autonomic supply of cerebral vessels and brain structures, in particular the reticular formation.

SOCIAL STRESS IN CHILDREN AND ITS INFLUENCE ON THE DEVELOPMENT OF BAD HABITS

Learning for children is a necessary stage in the development of personality, which helps the child to more easily acquire the necessary knowledge to further establish the individual. Оn the other hand it is a difficult stage in life of young people who lose the ability to communicate offline, especially during distance learning. It is difficult for children to adapt to the constant stay at home, to communicate with classmates and friends online, to adapt to the new rhythm of life and the dynamics of learning. Staying more than half of the time at the computer with a layer of psychological difficulties in the conditions of distance learning leads to constant stress and chronic stress. The modern educational system has changed so much in the last two years that the student must constantly adapt to new learning platforms and innovations. And the inability to clearly see and do laboratory classes in many subjects, self-study, even physical education classes leads to chronic stress.
 Stress is becoming an increasingly global problem, especially among children, because it negatively affects their lives and health, the progression of bad habits, and in turn, disorders of the dental system. Therefore, it is important to study the problem of social emotional chronic stress in the educational activities of students in terms of distance learning and its impact on the formation of disorders of the dental system.
 To reduce the impact of stressors, children use bad habits: sucking fingers, biting nails, pencils or pens, sitting in front of a monitor with his mouth open, despite a positive breath test (presence of nasal breathing), in the same position resting his head on his hands, causing chronic injury in this area. According to many studies, this may be the result of a person's adaptation to existing chronic stress.
 Our study was based on a quantitative study conducted among school-age patients who have bad habits (sucking a finger or other objects, breathing through their mouths, resting their heads on their hands while listening to an online lesson) through a secret questionnaire that collected information on the most stressful areas of life and distance learning under quarantine.
 The article presents the results of an anonymous survey of 60 patients, which includes periods of onset and progression of a chronic habit, the presence of various stressors, the reasons for poor performance. Our results of a secret survey indicate the state of chronic stress of students, their being in a state of social stress due to new living conditions, frequent changes between periods of live communication and distance learning, psychological problems in the family, emotional relief during the habit. Due to the fact that children live in conditions of chronic stress, they lose motivation to learn. They do not get pleasure from it, but in turn seek help in habits that, according to our patients, help reduce the impact of stress on quality of life and their own emotional state. The results of the study explain the formation of adaptive responses of the body to the stress factor (E. Gelgorn, W. Canon) and confirm the relationship between chronic bad habits in children under social stress.

Sleep quality and emergence delirium in children undergoing strabismus surgery: a comparison between preschool- and school-age patients

BackgroundEmergence delirium (ED) is common in pediatric patients undergoing general anesthesia with sevoflurane. Preoperative sleep quality is associated with the risk factors for ED. However, research on the relationship between sleep quality and ED is limited. We aimed to investigate the relationship between ED and preoperative sleep quality in pediatric patients undergoing strabismus surgery.MethodsThis clinical trial included pediatric patients aged 4–12 years who underwent elective strabismus surgery. The patients and their parents were questioned about the patients’ preoperative sleep quality using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. For anesthesia induction, thiopental (5 mg/kg) and rocuronium (0.6 mg/kg) were used, and anesthesia was maintained with sevoflurane (minimum alveolar concentration, 1–1.5). After administration of a reversal drug, extubation was performed, and the patients were transferred to a post-anesthesia recovery unit. At 10 min after extubation, the degree of ED was measured using the pediatric anesthesia emergence delirium (PAED) and Watcha scale scores.ResultsOf the 62 enrolled patients, three pediatric patients were excluded. The overall incidence of ED was 22%. A total of 59 patients were divided into the two groups. The ED group and the non-ED group comprised 13 and 46 patients. Age, height and weight were significantly lower in the ED group than in the non-ED group. Preoperative PSQI and Watcha scale score were significantly higher in the ED group than in the non-ED group. Multivariate analysis showed that age (adjusted OR [95% CI]: 0.490 [0.290–0.828], p = 0.008) and preoperative PSQI score (adjusted OR [95% CI]: 2.149[1.224–3.771], p = 0.008) was associated with ED. In sub-group analysis, PAED scale and Watcha scale scores showed a moderate correlation with preoperative sleep quality in preschool-age patients.ConclusionIn conclusion, the incidence of ED tended to be higher in younger age and poorer preoperative sleep quality in pediatric patients. In particular, the poorer sleep quality score was associated with higher incidence of ED in the preschool-age. Large-scale clinical studies and long-term follow-up studies on ED and sleep quality are required.Trial registrationThis study was registered with Clinicaltrials.gov (NCT03332407) at November 5th 2017.

An Open-Label Study of the Pharmacokinetics and Tolerability of Once-a-Day Fentanyl Citrate Patch in Japanese Pediatric and Adolescent Patients with Cancer Pain

Transdermal fentanyl is not yet approved for pediatric and adolescent use in Japan. Serum fentanyl concentration and the safety and efficacy of once-a-day fentanyl citrate patch were investigated in pediatric and adolescent patients with cancer pain. In this open-label, uncontrolled study, cancer patients aged 2-19 years being treated with strong opioid analgesics were switched to fentanyl citrate patch for 2 weeks. Serum fentanyl concentration was measured at steady state, and severity of pain was evaluated. Eleven patients (four patients aged 2-5 years and seven patients aged 6-19 years) were enrolled. No patient received a dose exceeding 2 mg. Mean serum fentanyl concentrations after administration of 0.5 mg, 1 mg, and 2 mg were 144 pg/mL (n=4), 277pg/mL (n=3), and 2070pg/mL (n=4), respectively. All patients were included in the efficacy and safety analysis, but one patient was excluded from the pharmacokinetic analysis because blood was sampled on the day after blood transfusion. A subgroup analysis showed that the mean serum fentanyl concentration tended to be higher in pre-school patients (aged 2-5years) than in school-aged and adolescent patients (aged 6-19years) and than in reports of adult patients (aged 20years and above) who received the same dose. No respiratory adverse events were observed, and pain was well controlled. Fentanyl citrate patch tended to result in a higher serum fentanyl concentration in pre-school patients than in school-aged, adolescent, and adult patients who received the same dose. The patch provided adequate pain control, was well tolerated, and did not cause respiratory adverse events. JPRN-JapicCTI-183909.

Intellectual development of patients with biliary atresia who underwent living donor liver transplantation in infancy.

The impact of pediatric liver transplantation on intellectual development has yet to be determined. We investigated the intellectual outcomes of school-aged patients after living donor liver transplantation for biliary atresia in infancy. The Wechsler Intelligence Scale for Children-fourth edition test was administered to 20 patients who survived [Formula: see text] 5years after living donor liver transplantation. Borderline full scale intelligence quotient was defined as ≤ 85. Pre-, peri-, and postoperative data were compared between patients with > 85 and ≤ 85 to identify predictive factors of borderline performance. The one-sample t test demonstrated that the mean full scale intelligence quotient of patients after transplantation for biliary atresia was significantly lower than that of the general population (91.8 vs. 100.0, p = 0.026) and 7 (35%) were classified as intellectual borderline functioning. Multivariable logistic regression models were unable to identify any factors predictive of full scale intelligence quotients of ≤ 85. This is the first study to indicate that the mean full scale intelligence quotient among school-aged patients who underwent living donor liver transplantation for biliary atresia in infancy is significantly lower than that of the general population.

Hyponatremia During Induction Therapy in Distinct Pediatric Oncological Cohorts: A Retrospective Study.

BackgroundHyponatremia is a well-known adverse event of repeated therapy with vincristine in oncological patients. However, to date, data in pediatric patients with malignant diseases other than acute lymphoblastic leukemia (ALL) are sparse or lacking.Materials and MethodsA retrospective study of 98 pediatric patients was conducted to analyze the incidence of hyponatremia in a Caucasian cohort of newly diagnosed ALL. For comparison, we further examined five other pediatric oncological cohorts (Hodgkin’s disease, Ewing sarcoma, Wilms tumor, benign glioma of the CNS, Langerhans cell histiocytosis) that receive alkaloids in their induction regimes.ResultsWe found a high incidence of hyponatremia (14.7%) in our ALL cohort with a trend toward male patients of elementary school age. None of the affected patients showed neurological symptoms. By comparison, patients from other malignancy groups did not show significant hyponatremia, regardless of their comparable therapy with alkaloids. We here show a noticeable coincidence of hyponatremia and hypertriglyceridemia in ALL patients, indicating a possible role of L-asparaginase-related hypertriglyceridemia in the development of severe hyponatremia in such patients.ConclusionWe report a higher incidence of hyponatremia following vincristine therapy in Caucasian children with ALL than published before. This hyponatremia could not be demonstrated in other oncologic cohorts treated with alkaloids. L-Asparaginase-induced hypertriglyceridemia may play a role in the certainly multifactorial development of hyponatremia in childhood leukemia.

Brain MRI Radiomics Analysis of School-Aged Children with Tetralogy of Fallot.

Introduction Radiomics could be potential imaging biomarkers by capturing and analyzing the features. Children and adolescents with CHD have worse neurodevelopmental and functional outcomes compared with their peers. Early diagnosis and intervention are the necessity to improve neurological outcomes in CHD patients. Methods School-aged TOF patients and their healthy peers were recruited for MRI and neurodevelopmental assessment. LASSO regression was used for dimension reduction. ROC curve graph showed the performance of the model. Results Six related features were finally selected for modeling. The final model AUC was 0.750. The radiomics features can be potential significant predictors for neurodevelopmental diagnoses. Conclusion The radiomics on the conventional MRI can help predict the neurodevelopment of school-aged children and provide parents with rehabilitation advice as early as possible.

Ritalinic acid in urine: Impact of age and dose

ObjectivesThe objective of this work was to study the results of urine drug testing for ritalinic acid (RA), the major urinary metabolite of methylphenidate (MP) (e.g., Ritalin®). The impact of age from 4 to 65 years old and older on median levels of RA was investigated as well as potential variations in pH, specific gravity and creatinine content of the patient urine samples. Design and MethodsSamples from patients who were 1) prescribed MP and found to be positive for RA, 2) prescribed MP but found to be negative for RA and 3) not prescribed MP but tested positive for RA were examined by liquid chromatography – mass spectrometry/mass spectrometry (LC-MS/MS) for RA concentration. The levels of RA were examined for median and average levels and further normalized and transformed to reveal a near gaussian distribution. ResultsOver 20,000 samples from patients who were prescribed MP were examined for this work. Analysis of these data for a subset of patients prescribed MP and testing positive for RA revealed statistically different median values of RA for school age patients of 6 years old through 17 years old from adult patients 18 through 64 years old. Another 6751 samples were positive for RA without a prescription but were not included in the overall assessment of these data. ConclusionsWhile not clear as to the reason, these data indicate that school age children under the age of 18 have much higher levels of RA than adult patients. These results can be used to estimate “normal” levels of RA in these chronically dosed populations.

Questionnaire survey on the impact of coronavirus disease 2019 on patients with muscular dystrophy

The coronavirus disease 2019 (COVID-19) pandemic has severe implications for individuals’ health, daily activities, and economy worldwide. We launched a web-based questionnaire survey on May 11, 2020, to clarify the impact of COVID-19 on patients with muscular dystrophy We inquired about impacts on medical care, home/facility services, daily life, support, health conditions, and infection with severe acute respiratory syndrome coronavirus 2. By the end of February 2021, 663 participants completed the survey. Approximately 28% of patients postponed regular consultations, and 23% of patients who underwent consultations more than once a month used telephone consultations. Two of 97 patients with Duchenne muscular dystrophy taking steroids had reduced their doses. A shortage of ventilator accessories and infection protection equipment occurred following the onset of COVID-19, and this shortage had a significant impact on medical care and infection prevention measures. The lives of most school-aged patients were affected because of school closures and remote learning. More than 20% of patients reported physical or mental complaints. Some patients with mild disease complained of deteriorating motor performance due to decreased rehabilitation and the avoidance of going out. Some patients with advanced-stage disease complained of an increased care burden due to reduced service use and mental stress due to information flooding and restrictions in visiting family or friends. Two patients contracted and recovered from COVID-19. COVID-19 has significantly affected the activities and quality of life of patients with muscular dystrophy. We will continue this survey and analyze the longitudinal changes.

Особливості перебігу коронавірусної інфекції COVID-19 у дітей України

Актуальність. Пандемія коронавірусної хвороби COVID-19, спричинена новим коронавірусом SARS-CoV-2, на сьогодні є глобальною проблемою, однак досить обмеженими є дані щодо особливостей перебігу інфекції COVID-19 у дітей. Мета: провести узагальнюючий аналіз демографічних, епідеміологічних і клінічних особливостей перебігу COVID-19 у дітей різного віку з різних регіонів України. Матеріали та методи. З дотриманням принципів біоетики проведено багатоцентрове ретроспективне відкрите когортне дослідження 669 випадків інфекції у дітей, спричиненої коронавірусом SARS-CoV-2, у відділеннях госпітальних баз міст Києва, Вінниці, Чернівців та Одеси. У госпіталізованих дітей визначали комплекс клінічних, лабораторних та інструментальних маркерів перебігу інфекції, спричиненої коронавірусом COVID-19. Результати. До першої (І) групи ввійшли 67 дітей віком до 2 місяців, до другої (ІІ) групи — 320 хворих дітей у віковому проміжку від 60 днів до 6-річного віку, субгрупа зі 127 дітей молодшого та середнього шкільного віку сформувала третю (ІІІ) групу, а до складу четвертої (IV) вікової групи ввійшли 155 підлітків віком від 12 років. Ураження вірусом SARS-CoV-2 систем внутрішніх органів характеризувалося мультисистемним характером і проявлялося змінами з боку верхніх дихальних шляхів у 70,1 % випадків, ураженням нижніх дихальних шляхів — у 54,7 % спостережень, інфекційно-запальними змінами — у 57,2 % випадків, гастроінтестинальними симптомами — у 9,2 %, а також неврологічною симптоматикою — у 17,8 %. Загалом серед клінічних симптомів у загальній когорті пацієнтів найчастіше зустрічались лихоманка (51,1 %), загальна слабкість (51,6 %), біль у горлі (70,1 %), кашель (54,7 %) та зниження апетиту (52,8 %). Ураження паренхіми легень із відповідною клініко-рентгенологічною картиною як прояв коронавірусної хвороби COVID-19 визначалося із частотою від 23,9 до 25,9 % обстежених дітей у різних регіонах України з вірогідним зростанням шансів розвитку пневмонії у підлітковому віці. Найчастішими змінами у додаткових методах обстеження були лейкоцитоз (18,8 % випадків), тромбоцитоз (14,5 % хворих), лейкопенія (11,1 % пацієнтів), збільшення С-реактивного білка у 43,7 % дітей. Підвищений уміст тромбоцитів спостерігався переважно у дітей перших двох місяців життя (у 38,3 % випадків) і вірогідно зростав упродовж періоду стаціонарного лікування, що співпадало з тенденціями до зростання частоти підвищеного вмісту С-реактивного білка у цій віковій когорті. Висновки. Аналіз епідеміологічних, клінічних і лабораторних особливостей перебігу коронавірусної хвороби, викликаної SARS-CoV-2, у дітей різних вікових груп із різних регіональних госпітальних баз України узгоджувався із перебігом у дорослих пацієнтів із COVID-19, але більш високі шанси на легші форми захворювання серед дітей молодшого віку та ураження нижніх дихальних шляхів і вищі шанси тяжкого перебігу серед старших дітей.

Evaluating Psychosocial Problems in School-Age Children with Cleft Lip and Palate in Bandung, Indonesia Using CBCL/6-18.

Cleft lip with or without palate (CL ± P) may impact children's eating, drinking, speaking, breathing, and hearing. We aim to evaluate psychosocial problems in Indonesian cleft center school-age patients identified after one or more surgical interventions. This is a cross-sectional study of parent report of patients with unilateral CL ± P who had cleft surgery from 2011 to 2016 in the Bandung Cleft Center using the Bahasa Indonesia version of CBCL/6-18 questionnaire. Descriptive statistics were completed based on measure norms and score ranges. There were 104 participants (56.7% male) with a median age of 8 years old and 73.0% had unilateral cleft of lip, gum, and palate. We found that speech and appearance problems were not perceived by parents for 34.6% of participants after undergoing surgery. The majority of parents reported normal range scores for the Social scale (93.3%) and the School scale (92.3%). In contrast, largely due to the restrictions in the covid-19 pandemic, 78.8% of the patients had below normal range scores for the Activities scale. Borderline or Clinical range scores were reported for 6.7% of children on the Problem Items section and 15.4% of parents endorsed one or more Critical Items about their children, which indicate significant behavioral concerns. In this study, we found 6.7% of the school-age children population with CL/P had psychosocial problems. The result of this study hopefully can shed some light in the long-term psychosocial conditions of the CL/P children post-operatively.

Anxiety and depression in school-age patients with spinal muscular atrophy: a cross-sectional study

BackgroundSpinal muscular atrophy (SMA) is a rare neurogenetic disease which involves multisystem dysfunctions such as respiratory, digestive, and motor disorders. Anxiety, depression and other psychological disorders often accompany severe chronic physical diseases. The aim of this study was to investigate the prevalence of anxiety and depression along with their influencing factors among school-age patients with SMA.MethodsWe conducted a cross-sectional study on school-age SMA patients in China. Patients aged 8–18 years with a genetic diagnosis of 5qSMA were invited to answer a questionnaire composed of sociodemographic and clinical questions, then to complete the Screen for Child Anxiety-Related Emotional Disorders and Depression Self-Rating Scale for depression and anxiety level evaluation. At the end of the questionnaire, further questions assessed the subjective anxiety and subjective depression of patients’ caregivers and their expectations for their child’s future.ResultsComplete data were available for 155 patients. The sample included 45.8% boys and 54.2% girls; 65.2% were type II, 27.1% were type III, and the remainder were type I SMA. Rates of anxiety and depression in these school-age SMA patients were 40.0% and 25.2%, respectively. Gender, age, and disease type were not associated with anxiety or depression, but respiratory system dysfunction, digestive system dysfunction, skeletal deformity, rehabilitation exercise, academic delay, specialized support from school, household income level, caregivers’ subjective anxiety, and caregivers’ expectations were significantly related to both anxiety and depression.ConclusionsThere was a high prevalence of anxiety and depression in school-age SMA patients in China. Professional psychological care maybe included in the standard of care. These results also call for possible targets for intervention such as reducing complications, improving drug accessibility, retaining normal schooling, strengthening school support, and enhancing the ability of the caregivers of SMA patients to assist in the diagnosis and treatment of the disease, so improving the mental health of SMA patients.

Conservative treatment for lumbar spondylolysis in children of elementary school age

PurposeLumbar spondylolysis in children of elementary school age has different characteristics from those of junior or senior high school patients. The purpose of the present study was to investigate the outcomes of conservative treatment for lumbar spondylolysis in patients of elementary school age. MethodsWe included 46 lesions in 32 consecutive patients of elementary school age with fresh cases of lumbar spondylolysis (5 girls and 27 boys; mean age, 11.3 years). We examined the relationship between bone union after conservative treatment and factors such as the CT axial staging, whether the lesion was unilateral or bilateral, whether the contralateral lesion was terminal stage, and the presence of spina bifida occulta. ResultsBone union was achieved in 33 lesions (72%) in 23 patients, whereas 13 lesions (28%) in 9 patients could not obtain bone union. The proportion of unilateral lesions with bone union was 13 of 13 (100%), significantly higher than that for bilateral lesions (20/33 lesions, 61%, p = 0.009). Of the 33 bilateral lesions, bone union was attained in 20 of 28 (71%) lesions without contralateral terminal stage, whereas bone union was not attained in any of 5 (0%) lesions with contralateral terminal stage, showing a significant difference between those with or without contralateral terminal stage (p = 0.005). ConclusionBilateral lesions and contralateral terminal stage are possible unfavorable factors to bone union in conservative treatment for patients of elementary school age with lumbar spondylolysis. Early diagnosis and treatment before the lesions become bilateral or progressive stage are important.

Neurocognitive correlates of persisting concussion symptoms in youth

Many patients that experience a concussion have impairing symptoms that persist beyond typical recovery timeframes. Concussion symptoms often remit within a month, but persisting impairments are difficult to characterize and attribute to concussion given the poorly defined diagnostic criteria of post-concussion syndrome and inadequate understanding of the cognitive symptoms associated with this condition. The current study aims to clarify the cognitive profiles of school-aged concussion patients (n = 21; N = 36; 64% male) that have persisting symptoms to improve the clinical identification methods for this condition. Logistic regression was used to explore the importance of cognitive processing speed and working memory for identifying patients with persisting concussion symptoms (PCS). Additional exploratory analyses were conducted to clarify cognitive domains that may be impacted by having PCS. Findings indicate processing speed and working memory abilities alone are not adequate to identify patients with PCS. Further, measures of processing speed, fluid reasoning, working memory, and long-term retrieval together were found to be necessary to identify those who had a prior concussion with PCS. These findings indicate clinical neuropsychological batteries must include measures of these four cognitive domains when assessing school-aged patients with chronic symptoms that extend beyond three months following injury.

Revisiting Konzo Risk Factors in Three Areas Differently Affected by Spastic Paraparesis in Eastern Democratic Republic of the Congo Discloses a Prominent Role of the Nutritional Status-A Comparative Cross-Sectional Study.

This comparative cross-sectional study aimed to better understand the respective contributions of protein malnutrition and cassava-derived cyanide poisoning in the development of konzo. We compared data on nutritional status and cyanide exposure of school-age adolescent konzo-diseased patients to those of non-konzo subjects of similar age from three areas in the Eastern Democratic Republic of the Congo. Our results show that konzo patients had a high prevalence of both wasting (54.5%) and stunting (72.7%), as well as of cyanide poisoning (81.8%). Controls from Burhinyi and those from Idjwi showed a similar profile with a low prevalence of wasting (3.3% and 6.5%, respectively) and intermediate prevalence of stunting (26.7% and 23.9%, respectively). They both had a high prevalence of cyanide poisoning (50.0% and 63.0%, respectively), similar to konzo-patients. On the other hand, controls from Bukavu showed the lowest prevalence of both risk factors, namely chronic malnutrition (12.1%) and cyanide poisoning (27.6%). In conclusion, cassava-derived cyanide poisoning does not necessarily coexist with konzo outbreaks. The only factor differentiating konzo patients from healthy individuals exposed to cyanide poisoning appeared to be their worse nutritional status. This further suggests that, besides the known role of cyanide poisoning in the pathogenesis of konzo, malnutrition may be a key factor for the disease occurrence.

Association between Migraine and Asthma in School Age Children

Background: Asthma and migraine are the most common chronic conditions. Few studies have concurrently evaluated the bidirectional association between asthma and migraine in pedaitric patients. Objective: We aimed to identify the relationship between these conditions. Methods: This retrospective study was carried out in a tertiary center. School-age patients diagnosed with migraine were included in the study by evaluating electronic patient files who complain with headache. These patients were diagnosed with asthma by a pediatric allergist. Results: Of 5242 patients whose medical records were accessed. The number of patients with asthma who were referred to the pediatric neurology department for headache during the study period was 1427 (913 girls/514 boys). Two hundred and thirty-six (15.5%) patients were diagnosed with migraine. At the same period, 3815 (2193 girls/1622 boys) patients without asthma presented to the pediatric neurology department for the evaluation of headache. Of those, 207 (5.4%) patients were diagnosed with migraine. The frequency of migraine was significantly higher in patients with asthma than those without asthma (OR = 1.84 (95% CI 1.62-2.05), P <0.001). Conclusion: The risk of migraine is significantly increased in school age children with asthma. This study is very important in that it is one of the largest pediatric studies performed so far in our country.