Spectrum Of Children Research Articles

Children with bicytopenia and pancytopenia – clinical picture, etiological spectrum, and outcome

Background: Children who develop cytopenias present with several etiological causes, posing diagnosis, and management difficulties for both physicians and pathologists. With these in mind, we assessed the clinical profile and etiology of children who attended a healthcare facility in South India with bicytopenia or pancytopenia. Aims and Objectives: (1) The primary objective of this study was to find out the clinical and etiological spectrum in children with bicytopenia and pancytopenia who were admitted to the Institute of Child Health and Research Center, Government Rajaji Hospital, Madurai. (2) The secondary objective of this study is to follow-up children with bicytopenia and pancytopenia to find out the outcome and prognosis. Materials and Methods: This study was in the Department of Pediatrics at the Government Rajaji Hospital in Madurai, Madurai Medical College’s Institute of Child Health and Research Center, which is where we carried out the study. Two hundred and sixty-four patients with bicytopenia and 36 patients with pancytopenia were included in this study. Once in 2 weeks, all children with bicytopenia and pancytopenia were assessed in our Saturday hematology outpatient clinics. Results: Fever was the most prevalent sign of both pancytopenia and bicytopenia in this investigation. Etiological variables among cases of pancytopenia, cancer, infections, non-infections, and idiopathic causes were recorded in 11%, 58%, 17%, and 14% of cases, respectively. Similarly, bicytopenia, malignancy, infections, non-infections, and idiopathic causes were found in 23%, 70%, 4%, and 3% of cases, respectively. According to the prognosis, 28%, 33%, 6%, and 33% of cases with pancytopenia recovered, passed away, were lost to follow-up, or were undergoing treatment, respectively. Similar to those individuals, 67%, 11%, 4%, and 18% of bicytopenia cases were treated, recovered, or lost to follow-up, respectively. Conclusion: In children, there is a wide etiological range of cytopenias. Infections and dangerous diseases like acute leukemia are among the reasons. The geographical location of the hospital, the frequency of malnutrition, and the regional presence of certain diseases such as malaria and enteric fever determine the causes reported in a hospital environment.

Specific Phobia, Fear, and the Autism Spectrum in Children and Adolescents: Adapting OST for ASD.

Fears and phobias are a common mental health concern for youth, and particularly for autistic youth. The following review briefly summarizes the extant literature on specific phobias and specific phobias in autistic youth. The evidence base is briefly highlighted pointing to the strong base behind behavioral and cognitive-behavioral treatments and techniques. A broad discussion of key evidence-based treatment findings is presented, leading up to the impactful work of Thomas H. Ollendick in researching Öst's One-Session Treatment (OST) with children and adolescents. OST for child specific phobias is discussed, and particular emphasis is given to this treatment's ongoing adaptation for use with youth on the autism spectrum.

The role of infectious agents and the gut microbiome in the development of the autistic spectrum in children

The article presents the results of studies of microbiome features in patients with autism spectrum disorders. The role of the microbiota as a part of the enteral nervous system influencing the dynamics of autism symptoms is considered. The links between eating behavior and the severity of autistic disorders, increased permeability of the gastrointestinal mucosa and hypoxia of brain cells, the nature of intestinal dysbiotic disorders, the severity and clinical manifestations of autism are shown. Taking into account the presented data, optimal approaches to the diagnosis and therapy of autism spectrum disorders are shown, which can significantly improve the quality of life of patients.

Molecular analysis of cancer genomes in children with Lynch syndrome: Exploring causal associations.

Lynch syndrome (LS) predisposes to cancer in adulthood and is caused by heterozygous germline variants in a mismatch repair (MMR) gene. Recent studies show an increased prevalence of LS among children with cancer, suggesting a causal relationship. For LS-spectrum (LSS) cancers, including high-grade gliomas and colorectal cancer, causality has been supported by typical MMR-related tumor characteristics, but for non-LSS cancers, causality is unclear. We characterized 20 malignant tumors of 18 children with LS, including 16 non-LSS tumors. We investigated second hits, tumor mutational load, mutational signatures and MMR protein expression. In all LSS tumors and three non-LSS tumors, we detected MMR deficiency caused by second hit somatic alterations. Furthermore, these MMR-deficient tumors carried driver variants that likely originated as a consequence of MMR deficiency. However, in 13 non-LSS tumors (81%), a second hit and MMR deficiency were absent, thus a causal link between LS and cancer development in these children is lacking. These findings demonstrate that causality of LS in children with cancer, which can be determined by molecular tumor characterization, seems to be restricted to specific tumor types. Large molecular and epidemiological studies are needed to further refine the tumor spectrum in children with LS.

Rate of Positive Culture Isolates and Pathogen Spectrum in Children with Suspected Meningitis: Findings from a Tertiary Facility in South-Eastern Nigeria

Rate of Positive Culture Isolates and Pathogen Spectrum in Children with Suspected Meningitis: Findings from a Tertiary Facility in South-Eastern Nigeria

Effect of Sensory Integration-based Training on the Sensory Profile of Male Children with High-Performance Autism

Background and Aims Psychological disorders such as autism spectrum in children can cause decreased awareness and performance in different areas. The present study aims to investigate the effect of sensory integration-based training on the sensory profile of male children with high-functioning autism. Methods This is a quasi-experimental study with a pretest/posttest design. The study population consists of all male children with high-functioning autism referred to Kahrizak Rehabilitation Center in Mohammad Shahr, Karaj, Iran, in 2019-2020, from whom 30 were selected using a purposive sampling method and equally divided into training and control groups. The training group received twelve 90-minute sessions of sensory integration-based training, while the control group did not receive any training. the Gilliam autism rating scale and short-form sensory profile (Dunn, 1999) were used to collect data. The data were analyzed using ANCOVA in SPSS software, version 23. Results The sensory integration-based training had a significant effect on the improvement of the sensory profile of children with high-spectrum autism spectrum. Conclusion Sensory integration-based training is effective in improving the sensory profile of male children with high-performance autism and can be used for this purpose.

Influence of COVID-19 pandemic on the virus spectrum in children with respiratory infection in Xuzhou, China: a long-term active surveillance study from 2015 to 2021

BackgroundTo investigate the impact of the coronavirus disease 2019 (COVID-19) outbreak on the prevalence of respiratory viruses among pediatric patients with acute respiratory infections in Xuzhou from 2015–2021.MethodsSevere acute respiratory infection (SARI) cases in hospitalized children were collected from 2015–2021 in Xuzhou, China. Influenza virus(IFV), respiratory syncytial virus (RSV), human parainfluenza virus type 3(hPIV-3), human rhinovirus (hRV), human adenovirus(hAdV), human coronavirus(hCoV) were detected by real-time fluorescence polymerase chain reaction(RT-qPCR), and the results were statistically analyzed by SPSS 23.0 software.ResultsA total of 1663 samples with SARI were collected from 2015–2021, with a male-to-female ratio of 1.67:1 and a total virus detection rate of 38.5% (641/1663). The total detection rate of respiratory viruses decreased from 46.2% (2015–2019) to 36% (2020–2021) under the control measures for COVID-19 (P < 0.01). The three viruses with the highest detection rates changed from hRV, RSV, and hPIV-3 to hRV, RSV, and hCoV. The epidemic trend of hPIV-3 and hAdV was upside down before and after control measures(P < 0.01); however, the epidemic trend of RV and RSV had not changed from 2015 to 2021(P > 0.05). After the control measures, the detection rate of hPIV-3 decreased in all age groups, and the detection rate of hCoV increased in all except the 1 ~ 3 years old group.ConclusionsImplementing control measures for COVID-19 outbreak curbed the spread of respiratory viruses among children as a whole. However, the epidemic of RV and RSV was not affected by the COVID-19 control policy.

Effect of scalp acupuncture combined with low frequency repetitive transcranial magnetic stimulation on brain function of pediatric patients with spastic cerebral palsy

ObjectiveTo observe the changes of Electroencephalogram (EEG) spectrum in children with spastic cerebral palsy before and after treatment, and to analyze the effects of scalp acupuncture combined with low-frequency repetitive transcranial magnetic stimulation (rTMS) therapy on brain function. MethodsFrom January 2021 to December 2022, 90 children aged 2–6 with spastic cerebral palsy were treated at our hospital. The patients were divided into treatment and control groups. The treatment group (combined group, n = 30) received scalp acupuncture combined with low-frequency rTMS treatment. The control group received only scalp acupuncture treatment (n = 30) or rTMS treatment (n = 30). The Gross Motor Function Measure (GMFM), the modified Ashworth spasticity scale, and the Gesell scale were used to assess the motor and developmental functions of pediatric patients with spastic cerebral palsy in each group. ResultsThe patients in the three groups showed different degrees of improvement in EEG after treatment, mainly in wave amplitude reduction, background rhythm slowdown, background rhythm asymmetry improvement and spike and multi-spike/slow wave distribution reduction. The improvement in the scalp-acupuncture combined with low-frequency rTMS group was more significant than that in the other two groups. The GMFCS classification, modified Ashworth score, D and E areas of GMFM, and adaptability, gross motor, and language in Gesell Developmental Diagnostic Scale (GDDS) improved in all three groups after treatment (P < 0.05). In the combined group, the improvement in the modified Ashworth score, the E area of GMFM, and the adaptation, gross motor, and language in the GDDS was more significant than that in the other two groups (P < 0.05). ConclusionBy combining scalp acupuncture with low-frequency rTMS to treat children with spastic cerebral palsy, the brain function is improved by bringing the EEG spectrum towards the normal range, thus improving the mental and developmental functions of the child.

Quantitative assessment of cognitive profile and brain asymmetry in the characterization of autism spectrum in children: A task-based EEG study.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by learning, attention, social, communication, and behavioral impairments. Each person with Autism has a different severity and level of brain functioning, ranging from high functioning (HF) to low functioning (LF), depending on their intellectual/developmental abilities. Identifying the level of functionality remains crucial in understanding the cognitive abilities of Autistic children. Assessment of EEG signals acquired during specific cognitive tasks is more appropriate in identifying brain functional and cognitive load variations. The spectral power of EEG sub-band frequency and parameters related to brain asymmetry has the potential to be employed as indices to characterize brain functioning. Thus, the objective of this work is to analyze the cognitive task-based electrophysiological variations in autistic and control groups, using EEG acquired during two well-defined protocols. Theta to Alpha ratio (TAR) and Theta to Beta ratio (TBR) of absolute powers of the respective sub-band frequencies have been estimated to quantify the cognitive load. The variations in interhemispheric cortical power measured by EEG were studied using the brain asymmetry index. For the arithmetic task, the TBR of the LF group was found to be considerably higher than the HF group. The findings reveal that the spectral powers of EEG sub-bands can be a key indicator in the assessment of high and low-functioning ASD to facilitate appropriate training strategies. Instead of depending solely on behavioral tests to diagnose autism, it could be a beneficial approach to use task-based EEG characteristics to differentiate between the LF and HF groups.

Commercially available CD4 + and CD8 + IFN-γ release assays combined with an HBHA-induced IGRA improve the characterization of the tuberculosis spectrum and monitoring of treatment in children

Commercially available Interferon-γ release assays (IGRAs), including the last-generation QuantiFERON TB-Plus (QFT-Plus), are effective in aiding the diagnosis of tuberculosis (TB) infection but cannot distinguish latent TB subjects from active TB patients. The aim of this study was to prospectively evaluate the performance of an HBHA-based IGRA, combined with commercially available IGRAs, to assess their usefulness as a prognostic biomarkers and aid in the monitoring of TB treatment in children. Following clinical, microbiological, and radiological assessment, children younger than 18 years of age classified as either LTBI or active TB were tested at baseline and during treatment by the QuantiFERON TB-Plus (QFT) assay and an aliquot of whole-blood was stimulated with HBHA. Among the 655 children evaluated, 559 (85.3%) were classified as “Non TB”, 44 patients (6.7%) with active TB, and 52 (7.9%) with LTBI. The median HBHA-IGRA IFN-gamma responses were able to discriminate active TB from LTBI (0.13 IU/ml vs 1.995, (p < 0,0001), those with asymptomatic TB from those with symptomatic TB (1.01 IU/ml vs 0.115 IU/ml, p 0.017), or more severe TB (p 0.022), and significantly raised during successful TB treatment (p < 0.0001). Conversely, CD4 + and CD8 + responses were similar in all groups of patients, although active TB patients had higher CD4 + responses and LTBI higher CD8 + responses. Conclusion: HBHA-based IGRA, combined with CD4 + and CD8 + responses assessed by commercially available IGRAs, is a useful support in the characterization of the TB spectrum in children and monitoring of TB-therapy.What is Known:• Current immune diagnostics are not able to discriminate active and latent Ttuberculosis, including the recently approved QFT-PLUS..• New immunological assays with prognostic value are highly needed.What is New:• HBHA-based IGRA, combined with CD4+ and CD8+ responses assessed by commercially available IGRAs, is a useful support for the differentiation of active and latent TB in children..• HBHA-based IGRA, combined with CD4+ and CD8+ responses assessed by commercially available IGRAs, is a useful support in the monitoring of TBtherapy in children..

Clinicoetiological profile of children with bicytopenia and pancytopenia

BackgroundBicytopenia, and pancytopenia have a wide etiological spectrum in children, ranging from viral infections to malignancies. There is limited data describing the clinicoetiological profile of bicytopenia and pancytopenia in children in recent times. MethodologyFifty children, aged 1 month to 12 years admitted with bicytopenia and pancytopenia were enrolled and evaluated. Basic patient information and clinical findings along with relevant investigations were obtained on a predesigned proforma and analyzed statistically. ResultsAmong the 50 cases studied, 46 had non-malignant causes, 24 (92.3%) cases had bicytopenia and 22 (91.66%) had pancytopenia. Among the 46 cases, 20 were infectious in origin. Sepsis was the commonest cause comprising 7 out of 20 cases (35%). Other causes included dengue fever, enteric fever, and malaria. The commonest cause of bicytopenia was nutritional anemia, observed in 8 out of 15 (53%) cases. The common causes of pancytopenia were megaloblastic anemia and aplastic anemia. Hematological parameters were significantly different among the bicytopenic and pancytopenic groups. MCH and MCHC were not significantly different between the groups. Hemoglobin and low white cell count were observed in aplastic anemia while thrombocytopenia was more marked in patients with megaloblastic anemia. A diagnosis of leukemia was made in 4 out of 50 cases, of which 2 each had pancytopenia and bicytopenia at presentation. ConclusionThe common causes of bicytopenia and pancytopenia were infections and nutritional deficiency. A history, examination and basic diagnostic tests were rewarding for the diagnosis in the majority.

Причинно-значимые аллергены и спектр сенсибилизации детей, перенесших пищевую анафилаксию

Aim: to assess the spectrum of sensitization and reveal causative allergens in Ekaterinburg children with the clinical history of food-induced anaphylaxis (FIA) for reducing the number of life-threatening food allergy (FA) episodes in these children. Patients and Methods: the study included 60 children — 36 (60.0%) boys and 24 (40.0%) girls aged from 4 months to 16 years who lived in Yekaterinburg. All children had (FIA) episodes in their clinical histories. The children underwent physical examination, and their allergy- focused clinical history was taken. Also, the ISAC-112 ImmunoCAP assay, a multiplex test with allergen components, was used. Results: the sensitization was assessed, and the causative allergens were identified in 100% of cases. In 31 children (51.67%) FIA was initiated by milk proteins (Bos d4, Bos d5, Bos d8); in 10 (16.67%) – chicken egg (Gal d2, Gal d1); in 10 (16.67%) – walnut (Jug r1, Jug r2, Jug r3); in 9 (15.00%) – fish (Gad c1); in 7 (11.67%) – kiwi (Act d1); in 7 (11.67%) – peanut (Ara h1, Ara h2, Ara h3, Ara h6); and in 20 (33%) – by different nuts (Ber e1, Ana o2, Cora 9, Cora 8). Elevated specific immunoglobulin E (sIgE) levels for birch tree allergens (Bet v1) were found in 39 (65.00%) patients, cat allergens (Fel d1, Fel d2, Fel d4) – in 41 (68.33%), dog allergens (Can f1, Can f2, Can f3, Can f5) – in 24 (40.0%), timothy allergens (Phl p1, Phl p4, Phl p5) – in 10 (16.6%), artemisia allergens (Art v1) – in 8 (13.3%), and house dust mites in 2 (3.33%). Respiratory symptoms in sensitized children with FIA developed in 4 of 5 cases. Conclusion: to reduce the number of life-threatening FA episodes in children with FIA it is necessary to reveal and assess the entire spectrum of sensitization, identify the causative allergens and triggers of potential anaphylactic reaction for the further development of an elimination diet and individualized patient management plan. KEYWORDS: food allergy, food-induced anaphylaxis, children, allergens, sensitization. FOR CITATION: Lepeshkova T.S. Causative allergens and sensitization spectrum in children with the history of food-induced anaphylaxis. Russian Medical Inquiry. 2023;7(2):75–80 (in Russ.). DOI: 10.32364/2587-6821-2023-7-2-75-80.

Association of e-Cigarette Exposure with Pediatric Otitis Media Recurrence.

Otitis media (OM) is a common inflammatory disease spectrum in children and a leading cause of pediatric physician visits, antibiotic prescriptions and surgery. Tobacco exposure is associated with increased risk of OM recurrence, chronicity and surgeries. Tobacco products have changed dramatically in recent years with the advent of electronic cigarettes (e-cigarettes). While users frequently perceive vape as less harmful than traditional cigarettes, burgeoning evidence supports its contribution to respiratory pathologies. The consequences of secondhand exposure, particularly among children, are understudied. The aim of this study was to examine the association of e-cigarette emissions (EE) with OM recurrence and surgeries in the US. Questionnaire data regarding ear infections and tobacco exposure was gathered for all pediatric respondents of the National Health and Nutrition Examination Survey (NHANES) 2017 to 2018. Weighted analyzes and logistic regression models were used to assess associations. Data was available for 2022 participants (aged 6-17); all were included for analyzes. Tobacco exposure was observed in 42%; 9% were exposed to EE. EE contributed to risk of ≥3 ear infections (OR = 1.61, 95% CI 1.01-2.58, P = .047). After adjustment for significant covariates (race and asthma), the association fell below significance (P = .081). No other significant associations were observed between ear infections, or tympanostomy tube insertion and exposure variables (EE, gestational or other household exposure). Exposure to EE may confer greater risk of pediatric OM than previously identified factors such as household smoke, or gestational exposure. Further investigation of EE and its health implications in children is warranted. IV.

Neurovirological Aspects of Congenital Cytomegalovirus and Its Connection to Autistic Spectrum Disorder

Autism Spectrum Disorder (ASD) is a neurodevelopmental disease that includes a wide range of functional impairments, such as social and communication deficiencies, as well as limited and selective interest and behavioral patterns that are repetitive. Children with ASD often show developmental delay, which is noticeable at an early age, and show a wide range of symptoms that interfere with daily functioning, so early diagnosis includes early interventions. A complex set of genetic and environmental factors is associated with the development of ASD, which makes ASD a complex disorder, so there is a clear distinction between neurodivergent and neurotypical individuals. Since ASD is caused by a combination of certain genetic mutations and the prenatal/postnatal environment, we focused on the etiology of ASD in viral infections, i.e., Cytomegalovirus (CMV) as a possible cause of ASD. CMV is a neurotropic herpesvirus, which can be transmitted from mother to child during pregnancy. Cytomegalovirus (CMV) infection, which is often asymptomatic and can remain latent throughout life, can pose a danger to immune insufficiency individuals during pregnancy. CMV is the most common pathogen that causes intrauterine infections, is the most common cause of nongenetic sensorineural hearing loss in children, and the main cause of neurodevelopmental delay, so research suggests an association between congenital CMV infection with ASD and maternal seropositivity for CMV in pregnancy. spectrum in children. In the research, we used various online databases as sources for our study. The result of our research and processing of the given information indicates that maternal CMV infection in pregnancy is related to the development of autism spectrum disorders in children.

Disease system spectrum of blood transfusion in Chinese children.

Disease system spectrum of blood transfusion in Chinese children.

Non-Hodgkin Lymphoma Imaging Spectrum in Children, Adolescents, and Young Adults.

In children, adolescents, and young adults (CAYA), non-Hodgkin lymphoma (NHL) is characterized by various age-related dissimilarities in tumor aggressiveness, prevailing pathologic subtypes, and imaging features, as well as potentially different treatment outcomes. Understanding the imaging spectrum of NHL in CAYA with particular attention to children and adolescents is critical for radiologists to support the clinical decision making by the treating physicians and other health care practitioners. The authors discuss the currently performed imaging modalities including radiography, US, CT, MRI, and PET in the diagnosis, staging, and assessment of the treatment response. Familiarity with diagnostic imaging challenges during image acquisition, processing, and interpretation is required when managing patients with NHL. The authors describe potentially problematic and life-threatening scenarios that require prompt management. Moreover, the authors address the unprecedented urge to understand the imaging patterns of possible treatment-related complications of the therapeutic agents used in NHL clinical trials and in practice. Online supplemental material is available for this article. ©RSNA, 2022.

0523 Prevalence And Severity Of Sleep Disordered Breathing In Asthmatic Children

Abstract Introduction Children with severe and poorly controlled asthma have a higher predisposition for sleep disordered breathing (SDB). It can lead to cardiovascular, neurocognitive, and behavioral problems. Variable data exists currently whether demographic factors like age, sex, obesity, adeno-tonsillar hypertrophy tend to increase the risk of SDB in asthmatics. Our objective was to evaluate the risk factors and prevalence of SDB in asthmatics as compared to non - asthmatics and describe the polysomnographic parameters in asthmatics with SDB. Methods Asthmatic and non - asthmatic children aged 5 – 15 years, were recruited in this case – control study. Parameters like age, gender, body mass index, adeno-tonsillar hypertrophy, and the history of snoring were compared. All participants completed the Sleep-Related Breathing Disorder scale, extracted from the Pediatric Sleep Questionnaire (SDBS-PSQ) and prevalence of risk of SDB (defined as SDBS - PSQ ≥ 0.33) was calculated. A subset of asthmatics with risk of SDB underwent polysomnography, and subjects were classified into no, mild, moderate, and severe SDB [based on apnea-hypopnea index (AHI) ≤1, 1-5, 5-10, and ≥10, respectively]. Results 120 children, with 60 asthmatics were included. Amongst asthmatic group, 61.7% were male and mean age was 9.51 ± 2.50 years. Risk of SDB was significantly higher in asthmatics compared to non - asthmatics (18.33% vs 1.67%, p = 0.001; with mean SDBS-PSQ score 0.14 ± 0.17 vs 0.05 ± 0.08, p = 0.001). History of snoring was reported in 25% of asthmatic children versus 11.7% in non – asthmatics (p&amp;gt; 0.05). Other parameters were similar in both the groups (p&amp;gt; 0.05). Of the 11 asthmatics with risk of SDB, 10 underwent polysomnography. 9 patients (15% of asthmatics) were diagnosed with SDB, with a mean AHI of 4.21 ± 3.28, mean total sleep time of 279.23 ± 57.69 minutes and mean arousal index of 10.23 ± 8.67. In this subset, 60% had mild SDB. Conclusion Prevalence of SDB is higher in asthmatics, compared to general population. SDBS-PSQ is a useful screening tool for diagnosing SDB and should be incorporated in the daily practice, the gold standard being polysomnography. Further studies would help in a better understanding of SDB spectrum in children. Support (If Any) Nil

Young Carer Perception of Control: Results of a Phenomenology with a Mixed Sample of Young Carers Accessing Support and Unknown to Services.

Identification challenges have resulted in young carers research largely being conducted with those who access support. Positive and negative impacts have been evidenced but there remains little consideration of the wider population. This phenomenology defines young carers as a spectrum of children with different experiences and aims to study the larger group. Participants were recruited from schools and projects, resulting in a mixed sample of young carers who were accessing support but also those who were unknown to services. Participants attended three interviews that initially gathered data on their caring role and family circumstances, before focusing on their health and well-being in the context of change. All interviews were transcribed and analysed at a whole-text and in-depth level to identify shared understanding. A study of the wider spectrum enabled the emergence of perception of control over their caring responsibilities as key to routine development. Although high levels of control helped some participants manage their roles, threats to control were identified, including instability in the care receiver’s condition, excessive caring and medical tasks. The original findings demonstrate how researching the wider spectrum can aid understanding of problematic care, and highlights the importance of recruiting young carers as a hard-to-reach group.

Drug concentration at the site of disease in children with pulmonary tuberculosis.

BackgroundCurrent TB treatment for children is not optimized to provide adequate drug levels in TB lesions. Dose optimization of first-line antituberculosis drugs to increase exposure at the site of disease could facilitate more optimal treatment and future treatment-shortening strategies across the disease spectrum in children with pulmonary TB.ObjectivesTo determine the concentrations of first-line antituberculosis drugs at the site of disease in children with intrathoracic TB.MethodsWe quantified drug concentrations in tissue samples from 13 children, median age 8.6 months, with complicated forms of pulmonary TB requiring bronchoscopy or transthoracic surgical lymph node decompression in a tertiary hospital in Cape Town, South Africa. Pharmacokinetic models were used to describe drug penetration characteristics and to simulate concentration profiles for bronchoalveolar lavage, homogenized lymph nodes, and cellular and necrotic lymph node lesions.ResultsIsoniazid, rifampicin and pyrazinamide showed lower penetration in most lymph node areas compared with plasma, while ethambutol accumulated in tissue. None of the drugs studied was able to reach target concentration in necrotic lesions.ConclusionsDespite similar penetration characteristics compared with adults, low plasma exposures in children led to low site of disease exposures for all drugs except for isoniazid.

Stress during transition from home to public childcare

Four saliva probes were collected per day from 104 children (10 to 35 months old) transitioning from home (T0) to childcare across a four-month period (until T3), resulting in over one thousand cortisol values. Latent Profile Analysis classified three profiles within a regular spectrum of children’s cortisol rhythms and described a fourth hypocortisol stress profile. Further Latent Transition Analysis revealed that profiles frequently changed across the transition but stabilized at T3. Most importantly, regular profiles across transition most likely occurred with high AQS scores of mother-child and care provider–child attachment. A machine learning procedure (XGBoost) featured predictors for stress profiles at T3 (when the child ought to be adjusted and stress profiles should be rare) referring to characteristics of the children (e.g., gender, number of siblings, peer contact before entry), the mothers (their worries), the care providers (their work experience, engagement, attachment) and the groups in the childcare centers (e.g., size, age differences, illness frequency). As a result, experience with siblings and peers before entry facilitated the transition. However, most conditions not linearly affecting children’s cortisol revealed even opposite effects when analyzed at different times. For example, smaller group size and large age-differences at T1 helped the child to stabilize a Regular profile, perhaps due to better control over the situation and greater support from the older children in the group. At T3, however, Regular profiles were associated with larger group size and smaller age-differences which might be helpful for establishing close peer relationships to buffer stress.