Pediatric CIDP: Diagnosis and Management. A Single-Center Experience.

Background: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare acquired polyneuropathy that especially among youngest children should be differentiated with hereditary neuropathies. Even though upon diagnosis treatment options are similar in children and adults, diagnostic challenges are faced in the pediatric population. Methods: We conducted a retrospective analysis of clinical symptoms, nerve conduction study results, modes of treatment, and final outcome in 37 children aged 3.5-17 years with a final diagnosis of CIDP (18 girls, 19 boys). We established three groups of patients based on age at onset of CIDP: 0-4, 4-13, and 13-18 years. Follow-up ranged from 10 to 222 months. Results: In our analysis, 19/37 patients (51.4%) had an atypical presentation: distal variant of CIDP in 12/37 patients (32.4%) and pure motor variant of CIDP in 5/37 patients (13.5%), and one patient had a pure sensory variant (1/37, 2.7%). Furthermore, 3/37 patients (8.1%) had additional concurring symptoms, including involuntary movements of face muscles (1/37, 2.7%) or hand tremor (2/37, 5.4%). During the follow-up, 23/37 patients (62.2%) received intravenous immunoglobulin (IVIg); 22/37 patients (59.5%) received steroids, 6/37 patients (16.2%) received IVIg and steroids, and 12/37 patients (32.4%) received immunosuppressive drugs, mostly azathioprine, but also methotrexate and rituximab. One patient was treated with plasmapheresis. Complete remission was achieved in 19/37 patients (51.4%) with CIDP in its typical form. Remission with residual symptoms or minimal deficit was observed in 4/37 patients (10.8%), whereas 14/37 patients (37.8%) remain on treatment with gradual improvement. Conclusion: Childhood CIDP may occur in its typical form, but even ~50% of children can present as an atypical variant including distal, pure motor, or pure sensory. Most children have a good prognosis; however, many of them may require long-term treatment. This highlights the importance of an early diagnosis and treatment for childhood CIDP.

Corrigendum: Pediatric CIDP: Diagnosis and Management. A Single-Center Experience.

[This corrects the article DOI: 10.3389/fneur.2021.667378.].

Decrease of interleukin (IL)17A gene expression in leucocytes and in the amount of IL-17A protein in CD4+ T cells in children with Down Syndrome.

BACKGROUND: Down Syndrome is by far the most common and best known chromosomal disorder in humans. It expresses multiple systemic complications with both structural and functional defects as part of the clinical manifestation. The mechanisms of immune changes occurring in Down Syndrome are complex and include an extra gene copy of chromosome 21 and secondary dysregulation of numerous intercellular interactions. Recent studies suggest a role of interleukin 17A (IL-17A), a pro-inflammatory cytokine located on 6p12 chromosome, in the pathogenesis of inflammatory and autoimmune diseases. We aimed to analyze IL17A gene expression in peripheral white cells and IL-17A intracellular expression on CD4+ T-cells. METHODS: The research was carried out on a group of 58 children aged 6-12 years including a group of 30 children with Down Syndrome (simple trisomy of chromosome 21 only) and a reference group of 28 healthy children. We evaluated gene IL17A expression using real-time PCR and intracellular IL-17A analyzed by flow cytometry. RESULTS: We found significantly decreased gene expression in white cells and significantly decreased expression of IL-17A levels on CD4+ T-cells in Down Syndrome. CONCLUSIONS: Our data indicate that decreased IL-17A expression may play a significant role in the etiology of infections in Down Syndrome. Moreover, we demonstrated that in Down Syndrome the other gene located outside the extra chromosome 21 is also affected.

A volumetric magnetic resonance imaging study of brain structures in children with Down syndrome.

BACKGROUND AND PURPOSE: Down syndrome (DS) is the most common genetic cause of mental retardation with deficits in language and memory. Mental retardation of varying degrees is the most consistent feature of DS. The objective of this study was to use high-resolution magnetic resonance imaging (MRI) techniques to investigate the volumes of the hippocampus, amygdala, and temporal and frontal lobes in children with DS compared with healthy children. MATERIAL AND METHODS: MRI of 49 patients was reviewed prospectively. The study included 23 children with DS (9 girls and 14 boys, mean age 6.7 ± 3.7 years) and 26 healthy children (11 girls and 15 boys, mean age 8.3 ± 2.4 years). Volumes of the right and left hippocampus, the right and left amygdala, temporal and frontal lobes and the total brain volume were measured by a radiologist who was unaware of the diagnosis. RESULTS: Total brain volume in children with DS was significantly lower compared with controls. It was associated with significantly lower volume of the frontal and temporal lobes. Children with DS had a significantly smaller right and left hippocampus volume and a significantly smaller right and left amygdala volume than did the control group. We also found a negative correlation between mental retardation and volume of the right hippocampus. CONCLUSIONS: The presence of these abnormalities from an early age contributes to the specific cognitive and developmental deficits seen in children with DS.

[To know more about the Prader-Willi syndrome. Diagnosis]. / Wiedziec wiecej o zespole Pradera-Williego. Diagnostyka.

Prader-Willi syndrome, induced by a function changes of paternal genes in the subcentrometric region of the chromosome 15 (q11.2q13), is the most common genetic cause of obesity resulting from hyperphagia. Behavioural disturbancies with compulsions in which psychiatric interventions are necessary, are relatively frequently seen. In this paper we reviewed the recent data of the clinical diagnosis verified by molecular studies.

[To know more about the Prader-Willi syndrome. Multidisciplinary support]. / Wiedziec wiecej o zespole Pradera-Williego. Opieka wielospecjalistyczna.

Prader-Willi syndrome, induced by a loss of function of paternal genes in the subcentrometric region of the chromosome 15 (q11.2q13), is a complex neurodevelopmental disorder with characteristic obesity resulting from hyperphagia. In addition behavioural disturbancies with obsessive-compulsive features, aggression, temper tantrums included, are relatively frequently seen and they often require psychiatric intervention. In this part of the paper we reviewed the recent data of behavioural phenotype the correlations of phenotype-genotype and possibilities of the multidisciplinary support for the affected persons and theirs families.

[Quality of life and therapy in the elderly patients on chronic peritoneal dialysis]. / Jakosc terapii i jakosc zycia u chorych w podeszlym wieku leczonych dializa otrzewnowa.

UNLABELLED: In this study quality of life adequacy of treatment was assessed in 32 PD patients over 65 years of age and compared with younger patients on PD (age 40 on average). Quality of life was examined with help of QLQ-C30 questionnaire, negative emotions with use of HADS and own Aggression Scale, life satisfaction on the Cantril's Ladder. Total weekly clearances were used for adequacy assessment as well as nutrition parameters and rate of anaemia and EPO use. Frequency of complications was also compared. Elderly patients were starting dialysis with lower GFR, but in the course of observation neither total clearances nor nutrition parameters and degree of anaemia did not differ between the groups. Elderly used EPO significantly less frequently in comparison to the younger patients. Peritonitis rate was similar and exit site infections were less frequent in elderly population. There was no difference between quality of life and level of negative emotions between the groups. IN CONCLUSION: PD appears to be effective and acceptable method of dialysis for the elderly.