Symptoms In Early Childhood Research Articles

Breastfeeding and asthma outcomes at the age of 6 years: The Generation R Study.

Breastfeeding is associated with a lower risk of asthma symptoms in early childhood, but its effect at older ages remains unclear. We examined the associations of duration and exclusiveness of breastfeeding with asthma outcomes in children aged 6 years, and whether these associations were explained by atopic or infectious mechanisms. We performed a population-based prospective cohort study among 5675 children. Information about breastfeeding was collected by questionnaires. At age 6 years, we measured interrupter resistance (Rint) and fractional exhaled nitric oxide (FeNO). Information about wheezing patterns (early (≤3 years only), late (>3 years only), persistent (≤3 and >3 years)), and current asthma at 6 years was derived from repeated questionnaires. Compared to children who were ever breastfed, those who were never breastfed had lower FeNO levels (sympercent (95% CI): -16.0 (-24.5, -7.5)) and increased risks of late and persistent wheezing (OR(95% CI): 1.69 (1.06, 2.69) and 1.44 (1.00, 2.07), respectively). Shorter duration of breastfeeding was associated with early wheezing and current asthma (1.40 (1.14, 1.73) and 2.19 (1.29, 3.71), respectively). Less exclusive breastfeeding was associated with early wheezing (1.28 (1.08, 1.53)). Breastfeeding duration and exclusiveness were not associated with FeNO or Rint. The associations were not explained by inhalant allergies, partly by lower respiratory tract infections in early life, and to a lesser extent by lower respiratory tract infections in later life. Breastfeeding patterns may influence wheezing and asthma in childhood, which seems to be partly explained by infectious mechanisms.

Latent class profiles of depressive symptoms from early to middle childhood: predictors, outcomes, and gender effects.

There has been little available data to inform the predictors and outcomes of latent class trajectories of depressive symptoms beginning during preschool and continuing throughout school age. Further, the extant literature in this domain has been limited by the use of parent report checklists of nonspecific 'internalizing' psychopathology rather than diagnostic interviews for depression. To address these gaps in the literature, this study applied growth mixture modeling to depressive symptom severity endorsed by children and/or their caregivers (N=348) during a structured clinical interview in a 10-year longitudinal dataset spanning from preschool into late school age. Three distinct trajectories of depressive symptom severity were found in boys and girls. For boys, but not girls, the high depression severity latent class increased in depressive symptoms from preschool through school age, followed by a decline in depressive symptom severity during later school age. For girls, the high depression severity latent class remained stable across time. Early childhood social adversity, familial history of affective disorder, preschool-onset ODD/CD, and school age functional impairment differentiated high-risk trajectory classes among both boys and girls. Extending the literature on trajectories of depressive symptoms to the preschool period, these findings incorporate structured clinical interviews of depressive symptom severity and indicate gender differences as well as psychosocial predictors and functional outcomes among children in high severity latent classes. The findings from this study suggest that increased attention to screening for depressive symptoms in early childhood is of significant public health importance.

High Tolerability of a Rice and Carob-Based Cereal Demonstrated in Highly Allergic Infants and Children: A Randomized Open-Food Challenge Trial

Background: Food allergy is the most common cause of atopic symptoms in early childhood. Standard care is an exclusion diet to avoid symptoms, but is associated with a risk of nutritional deficiencies. Sinlac® is a rice- and carob-based infant cereal free from major allergens, providing full nutritional support for children suffering from food allergies. Apple polyphenols (AP) have been shown to have favorable anti-allergy properties. Methods: A randomized clinical trial (NCT01029184) based on open-label food challenges was conducted to compare the tolerability of Sinlac® cereals with or without AP, with that of well-known allergenic foods, in subjects with severe food allergy (aged 4-40 months). Study products were Sinlac®, Sinlac®AP (0.3% in matrix), wheat, potato, milk and hen’s egg. The primary endpoint was a positive reaction to open-label food challenges. Results: Of the 51 subjects randomized, 48 completed the study. Both Sinlac® and Sinlac®AP were significantly better tolerated by atopic infants than other allergenic foods: incidence of allergic reactions was 2% with Sinlac® and Sinlac®AP, versus 49% with wheat, potato, milk or hen’s egg. Conclusion: Sinlac® and Sinlac®AP are very well tolerated and offer a nutritionally balanced option for atopic infants and children. Studies are needed to assess the benefit of adding AP to low allergenic products.

Child behavior problems: Mothers’ and fathers’ mental health matters today and tomorrow

Informed by a family systems framework, this study utilizes the actor-partner-interdependence model to examine how parents’ mental health, including depressive symptoms and parenting stress, predict their own (actor effects) and their partners’ (partner effects) reports of their children’s behavior problems among 730 low-income families. Further, we examine whether mothers’ and fathers’ mental health in early childhood predicts children’s teacher-reported social development in fifth grade. Both mothers’ and fathers’ depressive symptoms and parenting stress were associated with their own (actor effects) ratings of child behavior problems when children were 3 years (M=37.16 months, SD=1.53); parenting stress exerted a larger effect than depressive symptoms. Further, ratings of child behavior were predicted by partners’ parenting stress for fathers but not for mothers. Greater parent depression symptoms in early childhood was associated with higher fifth graders’ hyperactivity, and fathers’ greater depressive symptoms was associated with lower fifth graders’ cooperation. Results indicate that the mental health of both parents predicts child social skills and problem behaviors, both in early childhood and later development.

Is there an association between eating behaviour and attention-deficit/hyperactivity disorder symptoms in preschool children?

There is some evidence that aberrant eating behaviours and obesity co-occur with attention-deficit/hyperactivity disorder (ADHD) symptoms. The present study is the first that aims to investigate the association between eating behaviours and ADHD symptoms in early childhood in a population-based cohort. We included 471 preschool children from the Rhea mother-child cohort in Crete, Greece. Parents completed the Children's Eating Behaviour Questionnaire to assess children's eating behaviour and the 36-item ADHD test (ADHDT) to evaluate ADHD symptoms at 4years of age. Multivariable linear regression models were used to examine the association of eating behaviours with ADHD symptoms. Regarding children's food approach eating behaviours, we observed a positive association between food responsiveness and total ADHD index, as well as impulsivity, inattention and hyperactivity subscale, separately. Similarly, there was a significant positive association between emotional overeating and ADHD symptoms. With regard to children's food avoidant behaviours, food fussiness was found to be significantly associated with the impulsivity subscale. A dose-response association between the food approach behaviours and ADHD symptoms was also observed. Children on the medium and highest tertile of the food responsiveness subscale had increased scores on the ADHD total scale, as compared to those on the lowest tertile. As regards emotional overeating, children in the highest tertile of the scale had higher scores on ADHD total and hyperactivity. Our findings provide evidence that food approach eating behaviours such as food responsiveness and emotional overeating are associated with the increased ADHD symptoms in preschool children. Future studies to better understand this overlap will enhance potential interventions.

Low-Level Symptoms of Depression in Mothers of Young Children are Associated with Behavior Problems in Middle Childhood.

Examine the association between mothers' low- and high-level depressive symptoms in early childhood and children's behavior problems in middle childhood. We used data from 1844 families in a multi-site, longitudinal study beginning when children were 14 months and continuing to age 11 years. Children's internalizing and externalizing behavior problems at age 11 were assessed using the child behavior checklist for ages 6-18. Mothers' scores on the Center for Epidemiological Studies-Depression Scale when children were 14 months were used to classify them into three groups: 'no depressive symptoms', 'low-level depressive symptoms (below the clinical cut-off)' and 'clinically significant depressive symptoms (above the clinical cut-off).' Mothers were racially/ethnically diverse, including Caucasian (38.9 %), African-American (34.4 %), Hispanic (21.6 %), or other (5.1 %). More than one-third (39.2 %) were teenaged mothers, and 46.0 % did not complete high school. Of the 1844 families, 1172 had age 11 child outcome data. Logistic regression analyses controlling for family demographics revealed a significant association between early maternal depressive symptoms and later child behavioral outcomes. Both low level and clinically significant symptoms were associated with internalizing and externalizing behavior problems. For example, children whose mothers had low-level depressive symptoms were twice as likely to have clinically elevated internalizing problems compared with children whose mothers never had symptoms of depression. Children whose mothers experience low-level depressive symptoms early in their development have increased risk for later behavioral problems, suggesting a possible need for new screening and intervention strategies for mothers with lower than clinically elevated symptoms.

Additive effects of maternal depressive symptoms during pregnancy and three years after childbirth on offspring psychiatric symptoms in early childhood

Introduction: Themechanisms underlying the effects ofmaternal prenatal stress on foetal development remain elusive. One hypothesis is that maternal stress leads to increased cortisol blood concentrations, which in turn may overstimulate the secretion of placental corticotropin releasing hormone (CRH) into the foetal circulation. However, whether acute stress-induced rises in maternal cortisol affect foeto-placental CRH levels is unknown. We therefore aimed at exploring the association between the acutematernal psychobiological stress response as well as chronic maternal stress perception and foeto-placental CRH levels. Methods: We examined thirty-four healthy pregnant women (37.4±4.0 years) undergoing second-trimester amniocentesis. The amniocentesis served as a naturalistic stress situationduringwhich we repeatedly obtained questionnaires on maternal acute stress perception and saliva samples for cortisol analysis. We furthermore monitored maternal cardiac activity continuously (i.e., heart rate, heart rate variability). Thewomen also responded to the social overload scale of the Trier Inventory of Chronic Stress (Schultz and Schlotz, 1999). CRH levels were analysed from an amniotic fluid aliquot. Results: The amniocentesis induced significant changes in maternal stress perception, salivary cortisol, and cardiac activity. No significant association between the acute psychobiological stress response and amniotic CRH was apparent (all p> .10). However, maternal chronic social overload was positively correlated with CRH levels (Kendall’s tau= .34, p= .02). Conclusions: The current findings provide evidence thatmaternal chronic stress affects placental CRH secretion. However, we cannot exclude that a different or longer timeframe might be required to detect an association between acute maternal stress and foeto-placental CRH. Further studies are called for.

Developmental predictors of inattention-hyperactivity from pregnancy to early childhood.

ObjectiveThe objective of the study was to characterize the developmental sequence of pre- and postnatal risk factors for inattention-hyperactivity symptoms in preschoolers.Materials and MethodsLongitudinal data came from a French population based birth cohort study (EDEN; N = 1311 mother-child pairs followed from the pregnancy onwards). Inattention-hyperactivity symptoms were assessed with the Strengths and Difficulties Questionnaire when participating children were 3 years of age. Potential risk factors were classified in four domains (fetal exposures and child somatic characteristics, child temperament, child neurodevelopmental status, psychosocial environment) and four periods (before pregnancy, prenatal/birth, infancy, toddlerhood). Their role as potential moderator or mediator was tested with path analysis to determine the developmental sequence.ResultsA low family socioeconomic status before pregnancy was the main environmental risk factor for inattention-hyperactivity symptoms at 3 years, and its effect occurred via two pathways. The first was a risk pathway, where lower SES was associated with higher maternal depression and anxiety during pregnancy; then to higher maternal and child distress and dysregulation in infancy; and in turn to higher levels of inattention-hyperactivity at 3 years. The second was a protective pathway, where higher SES was associated with longer duration of breastfeeding during infancy; then to better child neurodevelopmental status in toddlerhood; and in turn to lower levels of inattention-hyperactivity at 3 years.DiscussionThis study identified psychosocial factors at several developmental periods that represent potential targets for preventing the emergence of inattention-hyperactivity symptoms in early childhood.

Early treatment in preschool children: an evidence-based approach.

Wheezing is a common symptom in early childhood but only some of these children will experience continued wheezing symptoms in later childhood making the diagnosis and treatment of these children challenging. This review covers recent findings regarding the epidemiology, diagnosis, evaluation, and treatment of preschool-aged children with asthma. Key characteristics that distinguish the childhood asthma-predictive phenotype include male sex, history of wheezing with lower respiratory tract infections, history of parental asthma, history of atopic dermatitis, eosinophilia, early sensitization to food or aeroallergens, or lower lung function in early life. The preschool-aged asthma population tends to be characterized as exacerbation prone with relatively limited impairment. The diagnosis of asthma in preschool-aged children is often based on symptom patterns, presence of risk factors, and therapeutic responses. Asthma management includes intermittent and daily inhaled corticosteroids, daily leukotriene-receptor antagonists, and, in rare cases, combination therapies. The diagnosis of asthma in preschool-aged children is based on symptom patterns and the presence of risk factors, and the goals of asthma management are achieved through a partnership between the family and the healthcare team using regular assessment of symptom control and response to daily controller therapy.

ケルビズムと診断された両側下顎骨中心性巨細胞病変の1例

Cherubism is a rare inherited disease characterized by a cherubic facial appearance. Generally, symmetric jaw swellings and indolent clinical course are early symptoms in early childhood. A few sporadic cases have been decribed1,2）. We report the case of a central giant cell lesion diagnosed to be cherubism. The patient was 7-year-old girl who consulted our clinic because of bilateral painless swelling of the jaws. Computed tomographic examination showed well-delineated multilocular radiolucent lesions associated with bilateral enlargement of the jaws. Her father had a clinical history of bilateral giant cell reparative granuloma arising in the mandible. Because histopathological examination of a biopsy specimen revealed central giant cell granuloma, enucleation of the lesions was performed with the patient under general anesthesia. Histopathological examination of the enucleated specimen revealed an accumulation of giant cells resembling osteocyte and hemosiderin deposits in granulation tissue with spindle cells. There has been no evidence of recurrence as of 3 years after surgery.

Asthma trajectories in early childhood: identifying modifiable factors.

BackgroundThere are conflicting views as to whether childhood wheezing represents several discreet entities or a single but variable disease. Classification has centered on phenotypes often derived using subjective criteria, small samples, and/or with little data for young children. This is particularly problematic as asthmatic features appear to be entrenched by age 6/7. In this paper we aim to: identify longitudinal trajectories of wheeze and other atopic symptoms in early childhood; characterize the resulting trajectories by the socio-economic background of children; and identify potentially modifiable processes in infancy correlated with these trajectories.Data and MethodsThe Millennium Cohort Study is a large, representative birth cohort of British children born in 2000–2002. Our analytical sample includes 11,632 children with data on key variables (wheeze in the last year; ever hay-fever and/or eczema) reported by the main carers at age 3, 5 and 7 using a validated tool, the International Study of Asthma and Allergies in Childhood module. We employ longitudinal Latent Class Analysis, a clustering methodology which identifies classes underlying the observed population heterogeneity.ResultsOur model distinguished four latent trajectories: a trajectory with both low levels of wheeze and other atopic symptoms (54% of the sample); a trajectory with low levels of wheeze but high prevalence of other atopic symptoms (29%); a trajectory with high prevalence of both wheeze and other atopic symptoms (9%); and a trajectory with high levels of wheeze but low levels of other atopic symptoms (8%). These groups differed in terms of socio-economic markers and potential intervenable factors, including household damp and breastfeeding initiation.ConclusionUsing data-driven techniques, we derived four trajectories of asthmatic symptoms in early childhood in a large, population based sample. These groups differ in terms of their socio-economic profiles. We identified correlated intervenable pathways in infancy, including household damp and breastfeeding initiation.

Childhood Asthma-Predictive Phenotype

Wheezing is a fairly common symptom in early childhood, but only some of these toddlers will experience continued wheezing symptoms in later childhood. The definition of the asthma-predictive phenotype is in children with frequent, recurrent wheezing in early life who have risk factors associated with the continuation of asthma symptoms in later life. Several asthma-predictive phenotypes were developed retrospectively based on large, longitudinal cohort studies; however, it can be difficult to differentiate these phenotypes clinically as the expression of symptoms, and risk factors can change with time. Genetic, environmental, developmental, and host factors and their interactions may contribute to the development, severity, and persistence of the asthma phenotype over time. Key characteristics that distinguish the childhood asthma-predictive phenotype include the following: male sex; a history of wheezing, with lower respiratory tract infections; history of parental asthma; history of atopic dermatitis; eosinophilia; early sensitization to food or aeroallergens; or lower lung function in early life.

Fabry disease in infancy and early childhood: a systematic literature review.

Fabry disease is a pan-ethnic, progressive, X-linked genetic disorder that commonly presents in childhood and is caused by deficient activity of the lysosomal enzyme alpha-galactosidaseA (α-gal A). Symptoms of Fabry disease in the pediatric population are well described for patients over five years of age; however, data are limited for infancy and early childhood. The purpose of this article is to delineate the age of detection for specific Fabry symptoms in early childhood. A systematic retrospective analysis of PubMed indexed, peer-reviewed publications and case reports in the pediatric Fabry population was performed to review symptoms in patients reported before 5 years of age. The most frequently reported symptom in all age groups under 5 years was acroparesthesias/neuropathic pain, reported in 9 children, ranging in age from 2.0-4.0 years. Also notable is the frequency of gastrointestinal issues reported in 6 children aged 1.0-4.1 years of age. This article finds clear evidence that symptoms can occur in early childhood, before age 5 years. Given early presenting symptoms and the ability to monitor these disease hallmarks, a timely referral to a medical geneticist or other specialty clinician experienced in managing children with Fabry disease is strongly indicated.

Secondhand Smoke Exposure, Parental Depressive Symptoms and Preschool Behavioral Outcomes

Little is known about the association of secondhand smoke (SHS) exposure and behavioral conditions among preschoolers. A cross-sectional analysis was used to examine billing and pharmacy claims from November 2004 to June 2012 linked to medical encounter-level data for 2,441 children from four pediatric community health clinics. Exposure to SHS was associated with attention deficit-hyperactivity disorder/ADHD and disruptive behavior disorder/DBD after adjusting for potential confounding factors. Assessment of exposure to SHS and parental depressive symptoms in early childhood may increase providers' ability to identify children at higher risk of behavioral issues and provide intervention at the earliest stages.

G89 Individual Risk Assessment Tool for Asthma Prediction at School Age in a UK Birth Cohort

BackgroundCommonly used Asthma Predictive Index (API; Castro-Rodriguez 2000) has good negative but poor positive predictive value (PPV) which reduces its clinical usefulness. We aimed to develop, within a population-based cohort,...

Catechol‐O‐methyltransferase gene val158met polymorphism and depressive symptoms during early childhood

Catechol-O-Methyltransferase (COMT) is a critical regulator of catecholamine levels in the brain. A functional polymorphism of the COMT gene, val158met, has been linked to internalizing symptoms (i.e., depression and anxiety) in adolescents and adults. We extended this research by investigating whether the val158met polymorphism was associated with childhood symptoms of depression and anxiety in two independent samples of young children (Ns = 476 and 409). In both samples, preschool-aged children were genotyped for the COMT val158met polymorphism. Symptoms of psychopathology were assessed via parent interviews and primary caregiver reports. In both samples, children homozygous for the val allele had higher levels of depressive symptoms compared to children with at least one copy of the met allele. Our findings extend previous research in older participants by showing links between the COMT val158met polymorphism and internalizing symptoms in early childhood.

Autism spectrum disorders

The revision of the diagnostic criteria for ASD has been widely anticipated and is expected to be an important contribution to the refinement of the definition of ASD. In the upcoming DSM-5, several changes have been made compared to the previous diagnostic criteria. They include no emphasis on language delay and age of onset except that ASD is defined as a neurodevelopmental disorder with symptoms in early childhood although the disorder may first be diagnosed later in life. The three areas of impairments in ASD are reduced to two areas, namely a social-communication domain and a behavioral domain including fixated interests and repetitive behaviors. In addition, the clinical presentation of ASD in the individual is described in more detail in terms of clinical specifiers. In addition to reporting these changes in the classification, the major international guidelines are introduced and a brief description of good clinical practice of assessment and the overall principles of intervention is provided.

Parental depressive and anxiety symptoms during pregnancy and attention problems in children: a cross‐cohort consistency study

BackgroundMaternal depression and anxiety during pregnancy have been associated with offspring-attention deficit problems.AimWe explored possible intrauterine effects by comparing maternal and paternal symptoms during pregnancy, by investigating cross-cohort consistency, and by investigating whether parental symptoms in early childhood may explain any observed intrauterine effect.MethodsThis study was conducted in two cohorts (Generation R, n = 2,280 and ALSPAC, n = 3,442). Pregnant women and their partners completed questionnaires to assess symptoms of depression and anxiety. Child attention problems were measured in Generation R at age 3 with the Child Behavior Checklist, and in ALSPAC at age 4 with the Strengths and Difficulties Questionnaire.ResultsIn both cohorts, antenatal maternal symptoms of depression (Generation R: OR 1.23, 95% CI 1.05–1.43; ALSPAC: OR 1.33, 95% CI 1.19–1.48) and anxiety (Generation R: OR 1.24, 95% CI 1.06–1.46; ALSPAC: OR 1.32, 95% CI 1.19–1.47) were associated with a higher risk of child attention problems. In ALSPAC, paternal depression was also associated with a higher risk of child attention problems (OR 1.11, 95% CI 1.00–1.24). After adjusting for maternal symptoms after giving birth, antenatal maternal depression and anxiety were no longer associated with child attention problems in Generation R. Moreover, there was little statistical evidence that antenatal maternal and paternal depression and anxiety had a substantially different effect on attention problems of the child.ConclusionsThe apparent intrauterine effect of maternal depression and anxiety on offspring-behavioural problems may be partly explained by residual confounding. There was little evidence of a difference between the strength of associations of maternal and paternal symptoms during pregnancy with offspring-attention problems. That maternal symptoms after childbirth were also associated with offspring-behavioural problems may indicate a contribution of genetic influences to the association.

Novel mutation in the ATM gene in a Malian family with ataxia telangiectasia

Dear Sirs, Ataxia telangiectasia (A-T) is a rare, autosomal recessive disorder of childhood characterized by progressive cerebellar ataxia, telangiectasia, and immune defects, and is caused by mutations in the ataxia-telangiectasia mutated (ATM) gene [1]. The incidence of the disease is about 1 in 40,000 to 100,000 births [2]. A-T has been reported worldwide [3], but reports of this disease in Africa are rare and generally limited to clinical description. We describe a Malian family with parental consanguinity (Fig. 1a) and three of ten children presenting with cerebellar symptoms in early childhood. Two patients, 14- and 10-year-old boys, had normal births and development until age 2, when they presented with progressive gait difficulty, including difficulty stopping when running and falls. They both later developed slurred speech, weakness, and decreased coordination of the upper extremities. No sensory or bladder difficulty was noted. Family history was remarkable for a grandfather who died at age 75 and had balance problems since he was a teenager. Fig. 1 Pedigree and genetic features of the family. a Pedigree of the family showing consanguinity, and unaffected (white) and affected (black) individuals. b Sequencing shows a homozygous T7985A mutation (asterisk) in ATM. c ATM protein alignment in various ... Neurological examination of both patients showed an ataxic gait, markedly reduced hand coordination, and nystagmus on fixation and lateral gaze. They had slight distal weakness and atrophy in the lower legs. Reflexes were normal to reduced, and the Babinski sign was absent. The older brother had scoliosis. Cardiologic examination and testing were normal. Brain CT scan showed cerebellar atrophy with prominent cisterna magna. Vitamin E and beta and gamma tocopherol serum levels were normal. Genetic testing for Friedreich's ataxia was negative. A follow-up clinical assessment showed oculomotor apraxia, ocular telangiectasia, and square wave jerks. The parents noted that the patients had recurrent diarrhea and upper respiratory infections. These new findings were in favor of ataxia telangiectasia (Table 1). Additional blood testing showed high alphafetoprotein (AFP) levels and low IgA, IgE, and IgG2 levels. Also, aspartate and alanine aminotransferases (AST, ALT), and C-reactive protein (CRP) were elevated in the two patients, suggesting liver dysfunction. Genetic analysis of the ATM gene identified a novel homozygous single-nucleotide substitution at position c.7985T > A (Fig. 1b), predicting the amino acid substitution V2662D. Five available unaffected siblings did not have this sequence variant. The V2662 residue lies in a predicted ATP binding domain [3] and is conserved across a broad range of vertebrate species (Fig. 1c). In addition, this non-conservative amino acid change yields a score of –3 according to the BLOSUM 62 substitution matrix [4], and was not found in 100 ethnically matched controls, suggesting that the mutation found here is likely deleterious. Table 1 Summary of clinical and laboratory findings in patients More recently, the parents noticed that their 2-year-old son also had an ataxic gait. His AFP levels were elevated, but he had no telangiectasias. This highlights the usefulness of AFP testing in the diagnosis of A-T, as previously discussed [5]. Recurrent upper respiratory infections due to immune deficiency [6] occur in ataxia telangiectasia, but the two older patients also presented with frequent diarrhea, which may represent an associated infectious disease specific to the region in Mali where the patients live. Increased cancer susceptibility has been associated with A-T [7], however, hemato-oncological examination showed no signs of malignancy in our patients. In addition, abdominal and inguinal echography showed no tumors. Although cases of A-T have been reported in populations with African ancestry [3, 8] and in North Africa [9–11], reports of this disease in sub-Saharan Africa have been limited to clinical characterization [12, 13]. We report here genetically confirmed A-T with a novel mutation in this region, and add to the global spectrum of this disease. Our study shows that hereditary neurological diseases may not be uncommon in this region of Africa, although limited expertise and lack of diagnostic tools might lead to their underestimation and neglect.

Local and systemic immunological parameters associated with remission of asthma symptoms in children.

The immunological and clinical parameters that are associated with asthma remission are poorly understood. The cytokine and local mediator changes associated with the resolution of asthma symptoms were examined in three groups of subjects 12–18 years of age (n = 15 in each group): (a) continuing asthma group (CA) who had persistent symptoms since early childhood, (b) an age, sex and atopic status-matched group who had persistent symptoms in early childhood but in whom these had resolved (RA), and (c) a non-atopic, non-asthmatic control group. Clinical parameters, sputum cell counts, peripheral blood mononuclear cell (PBMC) cytokine production and activation marker expression were determined. All of the CA had methacholine airway hyperresponsiveness compared with only half of the RA subjects. The CA showed elevated numbers of eosinophils and increased ECP and IL-5 in sputum, which were not observed in the RA. PBMC cytokine studies revealed increased production of the type 1 cytokines IL-12, IFN-γ and TNF-α in the CA group compared with the RA group, under a range of activation conditions, however, the production of IL-4 and IL-5 were unchanged. These findings suggest that decreased type 1 cytokine expression as well as decreased eosinophilic inflammation is associated with the resolution of asthma symptoms.