Epidemiology, causes, and morbidities of stroke in the young.

PURPOSE OF REVIEW: The purpose is to describe the latest research on epidemiology, causes, and morbidities of stroke in neonates and children. RECENT FINDINGS: The global incidence of childhood stroke is approximately 2 per 100 000 person-years, which is significantly lower compared to neonates (20-40 per 100 000 live births) and adults (80-90 per 100 000 person-years). Placental abnormalities are a risk factor for perinatal stroke, although cause is usually multifactorial. In children, nonatherosclerotic arteriopathies and arteriovenous malformations are major causes of ischemic and hemorrhagic strokes, respectively. The perinatal period confers a high risk of stroke and can lead to long-term disability, including motor delay, cognitive or speech impairment, and epilepsy. Recent studies suggest that at least 50% of survivors of perinatal stroke have abnormal neurodevelopmental scores in long-term follow up. Childhood stroke is associated with significant morbidity, including epilepsy, motor impairments, and behavioral disability. Recent studies have also identified an association between pediatric stroke and behavioral disorders, such as attention deficit hyperactivity disorder and autism. SUMMARY: Perinatal and childhood strokes are important causes of neurological morbidity. Given the low incidence of childhood stroke, prospective research studies on epidemiology, causes, and outcomes remain limited, highlighting the need for continued multisite collaborations.

Utility of Early Magnetic Resonance Imaging to Enhance Outcome Prediction in Critically Ill Children with Severe Traumatic Brain Injury.

BACKGROUND: Many children with severe traumatic brain injury (TBI) receive magnetic resonance imaging (MRI) during hospitalization. There are insufficient data on how different patterns of injury on early MRI inform outcomes. METHODS: Children (3-17 years) admitted in 2010-2021 for severe TBI (Glasgow Coma Scale [GCS] score < 9) were identified using our site's trauma registry. We used multivariable modeling to determine whether the hemorrhagic diffuse axonal injury (DAI) grade and the number of regions with restricted diffusion (subcortical white matter, corpus callosum, deep gray matter, and brainstem) on MRI obtained within 7 days of injury were independently associated with time to follow commands and with Functional Independence Measure for Children (WeeFIM) scores at the time of discharge from inpatient rehabilitation. We controlled for the clinical variables age, preadmission cardiopulmonary resuscitation, pupil reactivity, motor GCS score, and fever (> 38 °C) in the first 12 h. RESULTS: Of 260 patients, 136 (52%) underwent MRI within 7 days of injury at a median of 3 days (interquartile range [IQR] 2-4). Patients with early MRI were a median age of 11 years (IQR 7-14), 8 (6%) patients received cardiopulmonary resuscitation, 19 (14%) patients had bilateral unreactive pupils, the median motor GCS score was 1 (IQR 1-4), and 82 (60%) patients had fever. Grade 3 DAI was present in 46 (34%) patients, and restricted diffusion was noted in the corpus callosum in 75 (55%) patients, deep gray matter in 29 (21%) patients, subcortical white matter in 23 (17%) patients, and the brainstem in 20 (15%) patients. After controlling for clinical variables, an increased number of regions with restricted diffusion, but not hemorrhagic DAI grade, was independently associated with longer time to follow commands (hazard ratio 0.68, 95% confidence interval 0.53-0.89) and worse WeeFIM scores (estimate ß - 4.67, 95% confidence interval - 8.33 to - 1.01). CONCLUSIONS: Regional restricted diffusion on early MRI is independently associated with short-term outcomes in children with severe TBI. Multicenter cohort studies are needed to validate these findings and elucidate the association of early MRI features with long-term outcomes in children with severe TBI.

An Approach to Modify 14-Membered Lactone Macrolide Antibiotic Scaffolds.

A ketolide derivative with (12R)-configuration was obtained via a novel ketene acetal in acidic conditions. The structure of this atypical ß-keto ketene acetal intermediate within the macrocyclic system has been determined by NMR and X-ray methods. The use of basic conditions at an elevated temperature yielded new, doubly α,ß-unsaturated ketone macrolide derivatives with (4E)-configuration as two conformational isomers of folded-in or folded-out conformations.

Diffuse Axonal Injury Grade on Early MRI is Associated with Worse Outcome in Children with Moderate-Severe Traumatic Brain Injury.

BACKGROUND: Traumatic brain injury (TBI) is the leading cause of death and disability in children, but effective tools for predicting outcome remain elusive. Although many pediatric patients receive early magnetic resonance imaging (MRI), data on its utility in prognostication are lacking. Diffuse axonal injury (DAI) is a hallmark of TBI detected on early MRI and was shown previously to improve prognostication in adult patients with TBI. In this exploratory study, we investigated whether DAI grade correlates with functional outcome and improves prognostic accuracy when combined with core clinical variables and computed tomography (CT) biomarkers in pediatric patients with moderate-severe TBI (msTBI). METHODS: Pediatric patients (≤ 19 years) who were admitted to two regional level one trauma centers with a diagnosis of msTBI (Glasgow Coma Scale [GCS] score < 13) between 2011 and 2019 were identified through retrospective chart review. Patients who underwent brain MRI within 30 days of injury and had documented clinical follow-up after discharge were included. Age, pupil reactivity, and initial motor GCS score were collected as part of the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) model. Imaging was reviewed to calculate the Rotterdam score (CT) and DAI grade (MRI) and to evaluate for presence of hypoxic-ischemic injury (MRI). The primary outcome measure was the Pediatric Cerebral Performance Category Scale (PCPCS) score at 6 months after TBI, with favorable outcome defined as PCPCS scores 1-3 and unfavorable outcome defined as PCPCS scores 4-6. The secondary outcome measure was discharge disposition to home versus to an inpatient rehabilitation facility. RESULT: Of 55 patients included in the study, 45 (82%) had severe TBI. The most common mechanism of injury was motor vehicle collision (71%). Initial head CT scans showed acute hemorrhage in 84% of patients. MRI was acquired a median of 5 days after injury, and hemorrhagic DAI lesions were detected in 87% of patients. Each 1-point increase in DAI grade increased the odds of unfavorable functional outcome by 2.4-fold. When controlling for core IMPACT clinical variables, neither the DAI grade nor the Rotterdam score was independently correlated with outcome and neither significantly improved outcome prediction over the IMPACT model alone. CONCLUSIONS: A higher DAI grade on early MRI is associated with worse 6-month functional outcome and with discharge to inpatient rehabilitation in children with acute msTBI in a univariate analysis but does not independently correlate with outcome when controlling for the GCS score. Addition of the DAI grade to the core IMPACT model does not significantly improve prediction of poor neurological outcome. Further study is needed to elucidate the utility of early MRI in children with msTBI.

Comparison of the effect of 5-grass pollen sublingual immunotherapy tablets and drops in children with rhinoconjunctivitis.

BACKGROUND: One of the most important aspects of sublingual immunotherapy (SLIT) is the regimen of administration. AIM: To find any differences in symptom-medication scores between the two groups of SLIT tablets and drops, given pre-coseasonally (starting 8 weeks before the pollen season) in children with rhinoconjunctivitis allergy to grass pollen. The secondary outcome were the differences in lung function and induction of T-regulatory forkhead box P3 (FOXP3) positive cells. METHODS: This was a retrospective, secondary analysis of pooled data obtained from our two prospective randomized placebo controlled trials that involved children who underwent SLIT. Forty-one children, ages 6-18 years, with allergic rhinitis (AR), sensitive to grass pollen, participated in the study. RESULTS: Treatment with both tablets and drops significantly reduced all symptoms (nasal, asthma, and ocular) within the groups; there was no significant difference between both groups. When compared with the tablet therapy, there was a trend for drops therapy to be more effective in the reduction of combined symptom-medication score, but the difference was not statistically significant (p = 0.1036); there was no significant difference in asthma and nasal scores. We showed a significant decrease in the fractional exhaled nitric oxide level comparable in both immunotherapy groups. There were no differences between the groups in the induction of CD4+ CD25+ FOXP3+-positive cells in peripheral blood. CONCLUSIONS: Both protocols showed similar decreases in symptom-medication scores; however, when compared with tablet therapy, there was a trend for drops therapy to be more effective in the reduction of combined symptom-medication score.

Exosomes and other extracellular vesicles in neural cells and neurodegenerative diseases.

The function of human nervous system is critically dependent on proper interneuronal communication. Exosomes and other extracellular vesicles are emerging as a novel form of information exchange within the nervous system. Intraluminal vesicles within multivesicular bodies (MVBs) can be transported in neural cells anterogradely or retrogradely in order to be released into the extracellular space as exosomes. RNA loading into exosomes can be either via an interaction between RNA and the raft-like region of the MVB limiting membrane, or via an interaction between an RNA-binding protein-RNA complex with this raft-like region. Outflow of exosomes from neural cells and inflow of exosomes into neural cells presumably take place on a continuous basis. Exosomes can play both neuro-protective and neuro-toxic roles. In this review, we characterize the role of exosomes and microvesicles in normal nervous system function, and summarize evidence for defective signaling of these vesicles in disease pathogenesis of some neurodegenerative diseases.

Synthesis, structure and antimicrobial evaluation of a new gossypol triazole conjugates functionalized with aliphatic chains and benzyloxy groups.

Synthetic limitations in the copper-catalyzed azide alkyne cycloaddition (CuAAC) on gossypol's skeleton functionalized with alkyne (2) or azide (3) groups have been indicated. Modified approach to the synthesis of new gossypol-triazole conjugates yielded new compounds (24-31) being potential fungicides. Spectroscopic studies of triazole conjugates 24-31 have revealed their structures in solution, i.e., the presence of enamine-enamine tautomeric forms and π-π stacking intramolecular interactions between triazole arms. Biological evaluation of the new gossypol-triazole conjugates revealed the potency of 30 and 31 derivatives, having triazole-benzyloxy moieties, comparable with that of miconazole against Fusarium oxysporum. The results of HPLC evaluation of ergosterol content in different fungi strains upon treatment of gossypol and its derivatives enabled to propose a mechanism of antifungal activity of these compounds.

Total specific airway resistance vs spirometry in asthma evaluation in children in a large real-life population.

BACKGROUND: Total specific airway resistance (sRtot) has been introduced as an alternative technique to assess lung function with a particular application to younger children with asthma. OBJECTIVE: To establish a diagnostic value of the body plethysmographic parameter (sRtot) in asthma diagnosis in young children. METHODS: This was a prospective, noninterventional study. Children 4 to 18 year old with symptoms suggestive of asthma were included (n = 885). Subjects underwent body plethysmography and spirometry (when capable) with reversibility tests. Of 788 subjects who could perform spirometry in addition to body plethysmography, 578 were diagnosed with asthma. Subjects with asthma were treated for minimum of 6 months and then their asthma was confirmed or refuted. RESULTS: In 471 patients, asthma diagnosis was confirmed after 6 months of antiasthmatic treatment; 142 patients were 4 to 6 years old and 329 were 7 to 18 years old. Change in response to bronchodilator in children with asthma was significant for sRtot (P = .02) but not for forced expiration volume in 1 second (P = .21); sRtot was more sensitive and specific in identifying children with reversible obstruction than spirometry. There was a significant association between sRtot and asthma diagnosis in patients 4 to 6 years old (odds ratio 1.02, 95% confidence interval 1.01-1.03, P = .001); to differentiate subjects with asthma from those without asthma, the optimal cutoff point for sRtot was 174.5%. A sRtot value higher than 174.5% was associated with a positive prediction of an asthma diagnosis in patients 4 to 6 years old. A ratio of forced expiration volume in 1 second to forced vital capacity below 80% was not significantly associated with asthma. CONCLUSION: These data support the recommendation of performing sRtot rather than spirometry in young children as a fairly sensitive marker of asthma. TRIAL REGISTRATION: www.ClinicalTrials.gov (NCT01805635).

Dental issues in Rett syndrome.

The advancements in science and technology allowed saving the lives of children, who had no chance of survival before. Hence the problem of so called rare diseases, usually genetically determined. It is a new challenge for both the physicians and the health services. These children require a coordinated multi specialist oriented health care, which includes also dentists. This situation is reflected by the case of an 18 years old girl with Rett Syndrome, described by us. In this patient despite numerous visits to various dental practices, no decision of a radical surgical extraction of the tooth has been conducted. In our Department the extraction of teeth 22, 16 and 14 has been performed, as a part of 1 day surgery procedures, thus eliminating the dental infections and pain. Conclusion: Elaboration and introduction into praxis principles of dental care in children and young adults with rare diseases are needed.

Dental problems in a patient with the classic type of Ehlers-Danlos syndrome--a case report.

The huge progress in diagnostic and therapeutic procedures in developmental medicine allowed not only to save lives of many children and adolescents, but also enforced the necessity of close cooperation between many specialists. Unfortunately dental treatment is still not an integral part of taking care of disabled children and youth with chronic diseases. The situation worsens, when we come across the so-called rare diseases. Lack of access to dental services, when it comes to disabled patients, results from financial situation, healthcare system, as well as parents' ignorance of necessity of more frequent prophylactic and treatment visits. Whereas the reluctance of dentists towards the care of disabled patients is caused by difficulties with enforcing the recommendations and lack of procedures for taking care of patients with rare diseases, which was repeatedly signalled by us. Such situation is ideally pictured by yet another described case of the 17 year old patient with Ehlers-Danlos syndrome. Despite many dental visits, no vital treatment decisions have been made. In our Department, in the procedures of 1-day surgery, tooth 48, being the cause of pain, has been extracted. Basing on all of the above, it can be deduced that preserving the continuation and consequence in spreading the knowledge of rare diseases among patients, as well as physicians and dentists, is a responsibility of everyone who even once came across this problem.

Central giant cell granuloma located in the maxilla in a 8-year old boy.

UNLABELLED: Central giant cell granuloma is a rare occurring tumor-like lesion of the facial part of the skull, located more often in mandible (from 2:1 to 3:1), than in the maxilla. It accounts for 7% of all benign tumors of the jaws, whereas the brown tumor is a complication of a primary hyperparathyroidism and occurs in approximately 4.5%, or in 1.5%, when the tumor is a complication of secondary hyperparathyroidism. However, the brown tumor is significantly less often observed than the presented lesion. The authors describe a case of central giant cell granuloma of the maxilla, located in the area of premolar teeth. Pantomograhic x ray showed unilocular osteolytic bone loss of the maxilla with ectopic teeth. As a part of the One Day surgery procedures, the tumor has been removed with the margin and embedded teeth, and oroantral communication closure performed. In follow-up examination after 10 months and 2 years from the surgery, no recurrence of the tumor has been observed. CONCLUSION: In diferential diagnosis of tumors of face and skull, it is needed to consider the giant cell granuloma and also the brown bone tumor.

ATYPICAL DISLOCATION OF IMPACTED PERMANENT TEETH IN CHILDREN. OWN EXPERIENCE.

INTRODUCTION: Disturbances in forming of the hard tissue of teeth and bones can be a cause of their malformation and translocation. The impact of permanent teeth is one of them. It can occur with translocation of the tooth germ. The aim of the study was to present an atypical translocation of impacted permanent teeth in children. MATERIAL AND METHODS: 3.5 year clinical observation was carried out in 14 children (5 girls and 9 boys), aged between 9 and 12 years old. Patients were referred to our Department by orthodontists, paedodontists and General Dental Practitioners, due to impacted permanent teeth. According to the interview, in 8 cases children suffered from a trauma of a facial part of the skull, caused by a fall. On admitance patients were generally healthy. Basing on the clinical and radiological examination, translocation of the impacted permanent teeth has been diagnosed. In 9 cases it concerned medial maxillary incisors, whereas in remaining children--maxillary premolars. The extraction of such teeth has been performed as a part of the one day surgery procedures. CONCLUSION: In the cases where basing on the radiogram, the position of the tooth allows to predict the latter translocation, the germ has to be extracted.

Predictive value of fractional nitric oxide in asthma diagnosis-subgroup analyses.

BACKGROUND: There are no studies investigating the benefit of using FeNO measurements in correlation with sensitization to perennial and seasonal allergens in children with asthma. OBJECTIVE: To define the group of children with respiratory symptoms in whose FeNO measurement has predictive value for asthma. We assessed the effect of age, allergy profile, atopy, lung function and the presence of allergic rhinitis on interpretation of FeNO levels for clinical applications. METHODS: It was a retrospective, cross-sectional study. We evaluated data from medical documentation of 1767 children with symptoms of allergic diseases such as asthma and/or allergic rhinitis. We included in the analyses subjects who had the following tests done during diagnostic procedures (single measurement): FeNO, spirometry, specific IgE results. All subjects had undergone a minimum 3-years prospective clinical observation after the first FeNO measurement until the later assignment (or not) of an asthma/allergic rhinitis diagnosis. RESULTS: We included 1767 children into the analysis; asthma diagnosis was confirm in 1054 (59.6%) children. We showed that only atopy (OR: 1.9; 95%CI: 1.5-2.4) and presence of allergic rhinitis (OR: 1.6; 95%CI: 1.4-1.9) were independently associated with increased FeNO level. Only among patients with atopy and allergic rhinitis FeNO level (above 23 ppb) was associated with asthma diagnosis. Sensitivity, specificity, positive predictive value and negative predictive value of FeNO >23 ppb for asthma diagnosis were as follows: 0.9(95%CI: 0.68-0.98), 0.52(95%CI: 0.42-0.61), 0.25(95%CI: 0.16-0.37), 0.97(95%CI: 0.88-0.99). CONCLUSION: We showed that in children with atopy and with allergic rhinitis a negative predictive value for asthma diagnosis was very high with the optimal cut-off point of FeNO 23 ppb. Therefore we showed the utility of FeNO measurements to exclude asthma in the subgroup of patients with atopy and allergic rhinitis.

[Large dentigerous cyst caused by retained tooth 25]. / Duza torbiel zawiazkowa spowodowana zatrzymanym zebem 25.

Follicular cysts are benign, non-inflammatory odontogenic cysts, usually painless and discovered during routine radiographic examination. The article describes a case of a large follicular cyst with retained tooth 25. Pantomographic x ray showed the presence of a large follicular cyst located on the side of the impacted 25 tooth. The cyst has been enucleated and the tooth extracted surgically with subsequent closure of oro-antral communication. After 3 months orthodontic treatment was initiated.

[Malignant hyperthermia - problem in dental surgery. An introductory report]. / Hipertermia zlosliwa - problem w chirurgii stomatologicznej. Doniesienie wstepne.

Malignant hyperthermia is a genetic defect of uncontrolled hypermetabolic skeletal muscle response to anesthetic triggering drugs. Some congenital myopathies are regarded as risk increasing factors. The use of volatile anaesthetics or suxamethonium (succinylcholine) in patients who are predisposed to malignant hyperthermia leads to an increase in Ca2+ release from sarcoplasmic reticulum, which in turn causes a set of biochemical and clinical symptoms, which can be a cause of death, if dantrolene is not administered adequately. The aim of the study was to draw attention to the problem of malignant hyperthermia, which is hardly ever described in Polish literature, and requires the necessity of intensifying the cooperation between the dentist and specialists from other medical fields. The origin of the article was a case of congenital myopathy with recognized malignant hyperthermia in an 18-year-old patient, in whom surgical extraction of teeth was indicated. The course of diagnostics and treatment showed once more that contemporary medicine is in need of holistic approach, and in consequence, promising and effective cooperation of many specialists.

Severe Pediatric Neurological Manifestations With SARS-CoV-2 or MIS-C Hospitalization and New Morbidity.

Importance: Neurological manifestations during acute SARS-CoV-2-related multisystem inflammatory syndrome in children (MIS-C) are common in hospitalized patients younger than 18 years and may increase risk of new neurocognitive or functional morbidity. Objective: To assess the association of severe neurological manifestations during a SARS-CoV-2-related hospital admission with new neurocognitive or functional morbidities at discharge. Design, Setting, and Participants: This prospective cohort study from 46 centers in 10 countries included patients younger than 18 years who were hospitalized for acute SARS-CoV-2 or MIS-C between January 2, 2020, and July 31, 2021. Exposure: Severe neurological manifestations, which included acute encephalopathy, seizures or status epilepticus, meningitis or encephalitis, sympathetic storming or dysautonomia, cardiac arrest, coma, delirium, and stroke. Main Outcomes and Measures: The primary outcome was new neurocognitive (based on the Pediatric Cerebral Performance Category scale) and/or functional (based on the Functional Status Scale) morbidity at hospital discharge. Multivariable logistic regression analyses were performed to examine the association of severe neurological manifestations with new morbidity in each SARS-CoV-2-related condition. Results: Overall, 3568 patients younger than 18 years (median age, 8 years [IQR, 1-14 years]; 54.3% male) were included in this study. Most (2980 [83.5%]) had acute SARS-CoV-2; the remainder (588 [16.5%]) had MIS-C. Among the patients with acute SARS-CoV-2, 536 (18.0%) had a severe neurological manifestation during hospitalization, as did 146 patients with MIS-C (24.8%). Among survivors with acute SARS-CoV-2, those with severe neurological manifestations were more likely to have new neurocognitive or functional morbidity at hospital discharge compared with those without severe neurological manifestations (27.7% [n = 142] vs 14.6% [n = 356]; P < .001). For survivors with MIS-C, 28.0% (n = 39) with severe neurological manifestations had new neurocognitive and/or functional morbidity at hospital discharge compared with 15.5% (n = 68) of those without severe neurological manifestations (P = .002). When adjusting for risk factors in those with severe neurological manifestations, both patients with acute SARS-CoV-2 (odds ratio, 1.85 [95% CI, 1.27-2.70]; P = .001) and those with MIS-C (odds ratio, 2.18 [95% CI, 1.22-3.89]; P = .009) had higher odds of having new neurocognitive and/or functional morbidity at hospital discharge. Conclusions and Relevance: The results of this study suggest that children and adolescents with acute SARS-CoV-2 or MIS-C and severe neurological manifestations may be at high risk for long-term impairment and may benefit from screening and early intervention to assist recovery.

Fractional exhaled nitric oxide (FeNO) may predict exercise-induced bronchoconstriction (EIB) in schoolchildren with atopic asthma.

BACKGROUND: There is a need for the performance of exercise-induced bronchoconstriction (EIB) tests in the monitoring of childhood asthma control. We aimed to evaluate whether in children with atopic asthma, EIB can be predicted by one or more of the following parameters or by their combination: fractional exhaled nitric-oxide (FeNO), allergy profile, asthma treatment, total IgE serum concentration and eosinophil blood count (EBC). METHODS: It was a retrospective, cross-sectional study. We evaluated data from medical documentation of children with atopic asthma who had performed standardized spirometric exercise challenge test. RESULTS: One hundred and twenty six patients with atopic asthma, aged 5-18, were included in the analysis. There were two groups of patients: the EIB group (n=54) and the no-EIB group (n=72). The median FeNO level prior to exercise in the EIB group was 27.6 vs. 16.3 ppb in the no-EIB group (p=0.002). FeNO level higher than 16 ppb had the highest diagnostic value to confirm EIB. When using the FeNO level of >16 ppb, the sensitivity, specificity, negative predictive and positive predictive values for EIB were 83%, 46.9%, 74.2%, and 60%, respectively. In the EIB group, the degree of FeNO elevation did correlate positively with the absolute fall in FEV(1) (p=0.002; r=0.45). The FeNO value of >16 ppb, EBC value of >350 cell/mm(3) and allergy to house dust mites presented the highest odds ratios of EIB. However, the FeNO value of >16 ppb was the only independent odds ratio of EIB. CONCLUSIONS: Elevated FeNO level increased the odds of EIB in asthmatic schoolchildren, independently of other asthma severity markers and the intensity of anti-asthma therapy. It seems likely that FeNO measurement may act as a screening tool and help to prevent under-diagnosis and under-treatment of exercise-induced bronchoconstriction in schoolchildren with atopic asthma.

Pediatric asthma caregiver's quality of life questionnaire is a useful tool for monitoring asthma in children.

PURPOSE: There is little agreement among researchers whether a caregiver's QOL can be used to detect changes in asthma severity in children. We assessed correlation between QOL in parents and QOL in children with asthma as well as clinical parameters of asthma. We determined whether changes in caregiver's QOL scores reflect changes in child's QOL and their asthma control. METHODS: This was a 9-week period cohort study. One hundred and ten primary caregivers with 110 children were seen in the clinic at enrollment, at week #1, #5 and #9. At each visit, the parents completed the pediatric asthma caregiver's quality of life questionnaire (PACQLQ). RESULTS: One hundred and one children and 101 caregivers completed the study. We found a significant correlation between asthma diary score in children and QOL in parents (from r = -0.46 to r = -0.53). We also found significant positive correlation between PAQLQ and PACQLQ and significant association between changes in asthma control and PACQLQ score for both domains. We observed significant change in PACQLQ of caregivers whose children obtained asthma control. CONCLUSIONS: PACQLQ is a useful tool for monitoring asthma in children. The implementation of the PACQLQ would be helpful in involving parents in therapy of their children with asthma.

Prevalence and Risk Factors of Neurologic Manifestations in Hospitalized Children Diagnosed with Acute SARS-CoV-2 or MIS-C.

BACKGROUND: Our objective was to characterize the frequency, early impact, and risk factors for neurological manifestations in hospitalized children with acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or multisystem inflammatory syndrome in children (MIS-C). METHODS: Multicenter, cross-sectional study of neurological manifestations in children aged <18 years hospitalized with positive SARS-CoV-2 test or clinical diagnosis of a SARS-CoV-2-related condition between January 2020 and April 2021. Multivariable logistic regression to identify risk factors for neurological manifestations was performed. RESULTS: Of 1493 children, 1278 (86%) were diagnosed with acute SARS-CoV-2 and 215 (14%) with MIS-C. Overall, 44% of the cohort (40% acute SARS-CoV-2 and 66% MIS-C) had at least one neurological manifestation. The most common neurological findings in children with acute SARS-CoV-2 and MIS-C diagnosis were headache (16% and 47%) and acute encephalopathy (15% and 22%), both P < 0.05. Children with neurological manifestations were more likely to require intensive care unit (ICU) care (51% vs 22%), P < 0.001. In multivariable logistic regression, children with neurological manifestations were older (odds ratio [OR] 1.1 and 95% confidence interval [CI] 1.07 to 1.13) and more likely to have MIS-C versus acute SARS-CoV-2 (OR 2.16, 95% CI 1.45 to 3.24), pre-existing neurological and metabolic conditions (OR 3.48, 95% CI 2.37 to 5.15; and OR 1.65, 95% CI 1.04 to 2.66, respectively), and pharyngeal (OR 1.74, 95% CI 1.16 to 2.64) or abdominal pain (OR 1.43, 95% CI 1.03 to 2.00); all P < 0.05. CONCLUSIONS: In this multicenter study, 44% of children hospitalized with SARS-CoV-2-related conditions experienced neurological manifestations, which were associated with ICU admission and pre-existing neurological condition. Posthospital assessment for, and support of, functional impairment and neuroprotective strategies are vitally needed.

The association between fractional exhaled nitric oxide (FeNO) and cat dander in asthmatic children.

BACKGROUND: The aim of our study was to assess risk factors of increased FeNO in asthmatic children with no cat at home. METHODS: It was a retrospective, cross-sectional study. We evaluated data from medical documentation of children with asthma: FeNO results, allergen sensitization, seasonal allergen exposure, FEV(1), allergic rhinitis (AR) diagnosis and cat presence at home. We assessed asthma severity using mean doses of inhaled glucocorticosteroids and a management approach based on control according to the newest guidelines of Global Initiative for Asthma (GINA) throughout the last three months before the measurement of FeNO and spirometry. RESULTS: 316 patients (age 6-18) completed the study. Sensitization to cat dander was associated with the highest median value of FeNO concentration compared to other allergens in our patients (28,4ppb) and co-existing sensitization did not affect FeNO level. Median levels of FeNO increased linearly with patient's age. In asthmatics with AR, the levels of FeNO were increased significantly compared to asthmatics without AR (20.8 vs. 16.3, respectively). We showed that in patients without AR, sensitization to cat allergen was associated with more severe asthma in comparison to other perennial allergy (step 4 vs. other steps according to GINA treatment steps). The above relation was not observed in patients with AR. We did not observe correlation between allergy profile and FEV(1) among patients in neither subgroup nor in general population. CONCLUSIONS: We revealed that sensitization to cat dander was associated with the highest increase of FeNO concentration compared to other allergens in patients not having any cat at home ever. We also observed that in patients without allergic rhinitis, sensitization to cat allergen, compared to other perennial allergy, was associated with more severe asthma.