The Association Between C-Reactive Protein Levels and Pediatric Appendicitis Score and the Severity of Appendicitis in Children.

BACKGROUND: Acute appendicitis is a common cause of abdominal pain leading to emergent abdominal surgery in children. C-reactive protein (CRP), an inflammatory marker typically elevated in acute appendicitis, and Pediatric Appendicitis Score (PAS), a clinical scoring system used for the diagnosis of appendicitis, have the potential to predict the severity of inflammation of the appendix. This may be useful in helping the physician make a treatment plan prior to surgery. OBJECTIVE: The purpose of this study was to assess whether CRP value and PAS differ with the extent of inflammation of the appendix seen on histologic examination. METHODS: This was a prospective observational study of patients diagnosed with acute appendicitis via computed tomography or ultrasound. Enrolled patients had CRP levels drawn, PAS calculated, and appendix pathology reviewed. Appendix pathology was categorized by the pathologist on the basis of the level of inflammation: simple, suppurative, gangrenous, and perforated. RESULTS: One hundred sixty-three patients were enrolled. CRP levels and PAS were statistically different (p < 0.002) among the four pathology classifications. Patients with simple appendicitis (n = 3) had a mean CRP of 2.95 mg/L and PAS of 3.9, patients with suppurative appendicitis (n = 99) had a mean CRP of 26.89 mg/L and PAS of 6.5, patients with gangrenous appendicitis (n = 56) had a mean CRP of 91.11 mg/L and PAS of 7.5, and patients with perforated appendicitis (n = 6) had a mean CRP of 154.17 mg/L and PAS of 7. The results remained statistically significant (p < 0.002) after adjusting for age, race, and sex. When combined-PAS ≥ 8 and CRP level > 40 mg/L-the specificity of complicated appendicitis was 91.2% and positive predictive value was 72.7%. CONCLUSIONS: Higher CRP levels and PAS were associated with increased histologic inflammation of the appendix. This study provides preliminary evidence that CRP and PAS could potentially assist in treatment decisions for appendicitis.

Ondansetron Safety Regarding Prolong QTc for Children with Head Trauma.

BACKGROUND: There have been recent reports of increased QT interval after head trauma in concussed athletes and adult patients. Ondansetron, which is widely used in treatment of nausea and vomiting symptoms in head injuries, was issued a safety warning from the U.S. Food and Drug Administration regarding QT prolongation and risk of fatal dysrhythmias. OBJECTIVE: The purpose of this study was to evaluate the safety of ondansetron regarding QT prolongation for patients experiencing nausea or vomiting after head trauma. METHODS: Patients aged 1-20 years presenting to a pediatric emergency department with head trauma and who required a dose of ondansetron for nausea or vomiting were enrolled in the study. Patients received a baseline 12-lead electrocardiogram (ECG) prior to administration of either oral or IV ondansetron. A second post-ondansetron 12-lead ECG was performed after administration of ondansetron. All ECGs were reviewed and the QTc calculated manually by a board-certified pediatric cardiologist. RESULTS: Forty-two patients met enrollment criteria. Five patients received IV ondansetron and 37 received oral ondansetron. Mean QTc pre ondansetron was 387.5 ms and mean QTc post ondansetron was 400.9 ms (p = 0.120). We found no statistically significant difference in other ECG parameters pre and post ondansetron. CONCLUSIONS: Ondansetron is safe in regard to QTc prolongation in patients with head trauma. Based on this research, ondansetron should continue to be used for the treatment of nausea and vomiting in emergency department patients who present with head injury.

Trichomonas Infection Rates in Males Presenting to the Emergency Department for Sexually Transmitted Infections.

BACKGROUND: Trichomonas vaginalis (TV) is one of the most common sexually transmitted infections (STIs). Overall prevalence is reported to be 3.1%, with rates approaching 12.9-14.4% in high-risk female populations. Although there is a plethora of data on TV in the female population, the corresponding data for the male population are limited. OBJECTIVE: Our aim was to determine the infection rate of TV in male patients seeking care for STIs in the emergency department (ED) and determine the symptoms associated with TV infection in male patients. METHODS: We conducted a retrospective study of male patients aged 13 years or older who presented to the ED for STI evaluation. Male patients included had nucleic acid amplification test (NAAT) TV testing as part of standard STI evaluation. RESULTS: Of the 2137 male patients included, 95 (4.4%) were positive for TV. Male patients who tested positive were significantly older (mean age 38.9 years vs. 30.7 years for male patients who tested negative; p < 0.05). Black male patients were more likely than White male patients to be positive for TV (6.3% prevalence vs. 1.8%; p < 0.05). TV-positive male patients were more likely to have discharge, specifically clear penile discharge, on examination (p < 0.05), and were less likely to have testicular pain or testicular tenderness (p < 0.05). Higher rates of TV were seen in an urban (4.9%) compared with suburban ED (1.6%; p < 0.05). CONCLUSIONS: Rates of TV in male patients who receive STI testing in the ED are similar to rates published previously for female patients. We found higher rates among older and African-American male patients. TV among male patients is prevalent and testing should continue when evaluating for STIs.

Single-Dose Dexamethasone Is Not Inferior to 2 Doses in Mild to Moderate Pediatric Asthma Exacerbations in the Emergency Department.

OBJECTIVE: The purpose of this study was to compare the efficacy of a single dose of dexamethasone to 2 doses of dexamethasone in treating mild to moderate asthma exacerbations in pediatric patients. We anticipated that there would not be a difference in the rate of return visits to the emergency department (ED), urgent care, or primary care physician for continued asthma symptoms. METHODS: This was a prospective, randomized, single-center, unblinded, parallel-group randomized clinical trial of patients 2 to 20 years old presenting to a pediatric ED with mild to moderate asthma exacerbations. The patients were randomized to receive 1 or 2 doses of dexamethasone (0.6 mg/kg per dose, maximum of 16 mg). Telephone follow-up interviews were performed on the sixth day after ED visit. The primary outcome measures were return visits to either primary care physician or ED for continued asthma symptoms. Secondary outcomes were days of symptoms, missed school days, and adverse effects. RESULTS: Of the 318 children initially enrolled, 308 patients met the enrollment criteria. These patients were randomized into 2 groups. There were 116 patients in group 1 and 116 patients in group 2. There was no significant difference between groups regarding return visits (group 1, 12.1%; group 2, 10.3%; odds ratio [OR], 0.892 [95% confidence interval {CI}, 0.377-2.110]), days to symptom resolution (group 1, 2.4; group 2, 2.5; OR, 0.974 [95% 95% CI, 0.838-1.132]), missed school days (group 1, 47%; group 2, 51%; OR, 1.114 [95% CI, 0.613-2.023]), or vomiting (group 1, 8.6%; group 2, 3.4%; OR, 2.424 [95% CI, 0.637-9.228]). CONCLUSIONS: In this single-center, unblinded randomized trial of children and adolescents with mild to moderate acute exacerbations of asthma, there was no difference in the rate of return visits for continued or worsened symptoms between patients randomized to 1 or 2 doses of dexamethasone.

Using Low-Cost Models for Training First-Year Pediatric Residents on 4 Accreditation Council for Graduate Medical Education-Required Procedures: A Pilot Study.

OBJECTIVES: The aims of the study were to assess the feasibility of using low-cost models to train first-year pediatric residents and to examine whether residents who receive such training will be as competent as their experienced colleagues in performing 4 American College of Graduate Education-required procedures, including suturing, splinting, lumbar puncture, and venipuncture. METHODS: We performed a pilot study with postgraduate year (PGY) 1 to 3 residents. Postgraduate year 1 residents completed a self-assessment questionnaire before the onset of training. A lecture was given to all PGY levels residents about procedural techniques. The PGY-1 residents practiced these techniques on low-fidelity models immediately after the lecture. One and 9 months after the initial lecture, all residents were assessed on these models using a 10-point checklist for each skill. RESULTS: Thirteen PGY-1 residents, 10 PGY-2 residents, and 10 PGY-3 residents completed the study. There was no statistically significant difference in performance of PGY-1 residents when compared with PGY-2 and PGY-3 residents in performing lumbar puncture, venipuncture, and suturing on models in the initial assessment that was performed 1 month after the lecture. Postgraduate year 1 residents performed equally well to PGY-3 residents and significantly (P < 0.05) better than PGY-2 residents, in splinting.There was no statistically significant difference between groups at final follow-up, supporting that training on models could help enhance proficiency among residents. CONCLUSIONS: This pilot study supports the feasibility of using low-cost models to train residents on invasive and painful procedures. Furthermore, residents trained on models showed maintenance of skills for a 9-month period.

Association of dairy intake with weight change in adolescents undergoing obesity treatment.

BACKGROUND: The role of dairy products in obesity treatment for adolescents is unclear. The study purpose was to assess the association between dairy intake and changes in BMI z-score (zBMI) during adolescent obesity treatment. METHODS: Observational study nested within a randomized control trial. Linear mixed-effects regression models were adjusted for important non-lifestyle factors then further adjusted for dietary and physical activity variables. In total, 91 adolescents were studied. RESULTS: Each serving of total dairy (ß = -0.0054, P < 0.01), unflavored milk (ß = -0.012, P < 0.01), reduced fat (ß = -0.0078, P < 0.05), and low fat/fat-free products (ß = -0.0149, P < 0.01) was associated with a decrease in zBMI over 12 months. These associations were no longer significant after adjustment for other dietary and physical activity factors. Sugar-sweetened beverage intake was inversely associated with intake of total dairy (ß = -0.186, P = 0.001), unflavored milk (ß = -0.115, P = 0.003) and low fat/fat-free dairy (ß = -0.125, P = 0.001). CONCLUSIONS: Intakes of total dairy, unflavored milk, reduced fat dairy and low fat/fat-free dairy products are associated with improved obesity treatment outcomes among adolescents. This could be due to co-occurring healthy lifestyle behaviors or to replacement of other food and beverages associated with obesity, such as sugar-sweetened beverages, by dairy products.

Occult Head Injury in Children Less Than 2 Years With Suspected Child Abuse in the Emergency Department.

OBJECTIVE: This study aims to determine the frequency of clinically significant findings requiring emergent neurosurgical intervention on computed tomography (CT) in neurologically intact children admitted to the hospital with suspected abuse. METHODS: This was a retrospective review of neurologically stable children (0-24 months) in whom both skeletal survey and CT head were performed for child abuse evaluation from 2000 to 2011. RESULTS: A total of 132 patients met inclusion criteria (mean age, 7.6 mo; 55% male, 52% Caucasian, and 34% African-American). Computed tomography scans demonstrated occult head injury in 5%; none required neurosurgical intervention or had any neurological deterioration. Average length of stay was 4 days, with average time to CT scan being 12.8 hours from triage, and average time to magnetic resonance imaging (MRI) scan of 70.5 hours. Five MRIs were performed, and 4 had identical results on CT scan. CONCLUSIONS: No clinically significant brain injury (requiring intervention) was seen in this cohort. These findings support delaying imaging in neurologically intact children to obtain MRI after hospital admission, thus, limiting radiation exposure.

Development, content validity and test-retest reliability of the Lifelong Physical Activity Skills Battery in adolescents.

Numerous skill batteries assess fundamental motor skill (e.g., kick, hop) competence. Few skill batteries examine lifelong physical activity skill competence (e.g., resistance training). This study aimed to develop and assess the content validity, test-retest and inter-rater reliability of the "Lifelong Physical Activity Skills Battery". Development of the skill battery occurred in three stages: i) systematic reviews of lifelong physical activity participation rates and existing motor skill assessment tools, ii) practitioner consultation and iii) research expert consultation. The final battery included eight skills: grapevine, golf swing, jog, push-up, squat, tennis forehand, upward dog and warrior I. Adolescents (28 boys, 29 girls; M = 15.8 years, SD = 0.4 years) completed the Lifelong Physical Activity Skills Battery on two occasions two weeks apart. The skill battery was highly reliable (ICC = 0.84, 95% CI = 0.72-0.90) with individual skill reliability scores ranging from moderate (warrior I; ICC = 0.56) to high (tennis forehand; ICC = 0.82). Typical error (4.0; 95% CI 3.4-5.0) and proportional bias (r = -0.21, p = .323) were low. This study has provided preliminary evidence for the content validity and reliability of the Lifelong Physical Activity Skills Battery in an adolescent population.

Desaturation in procedural sedation for children with long bone fractures: Does weight status matter?

INTRODUCTION: Childhood obesity remains a serious problem in the United States. Significant associated adverse incidents have been reported with sedation of children with obesity, namely hypoxemia. The objective of our study was to determine if overweight and obesity were associated with increased desaturations during procedural sedation compared with patients of healthy weight. METHODS: This was a single-center retrospective chart review of data from a three-year period of patient's age 2-17years. Of the 1700 charts reviewed 823 of these patients received procedural sedation and met the study inclusion criteria. Weight status was classified based on age and gender specific body mass index (BMI) percentiles: underweight, healthy weight, overweight, obese. RESULTS: Among all weight categories there was no statistical significance, however children with obesity had greater desaturation rates (9.9%) compared with children of underweight, healthy weight, or overweight combined (5.4%), χ2=4.46, p=0.035. DISCUSSION: The results indicate that children with obesity are almost twice as likely to have a desaturation related to procedural sedation compared with children of other weight status. Providers should be aware that children with obesity may be more likely to desaturate than other children, and therefore be skilled at recognizing this.

The Current State of the Diagnosis and Management of Acute Kidney Injury by Pediatric Critical Care Physicians.

OBJECTIVES: Increasingly prevalent in pediatric intensive care, acute kidney injury imparts significant short- and long-term consequences. Despite advances in acute kidney injury research, clinical outcomes are worsening. We surveyed pediatric critical care physicians to describe the current state of acute kidney injury diagnosis and management in critically ill children. DESIGN: Anonymous electronic questionnaire. PARTICIPANTS: Pediatric critical care physicians from academic centers, the Pediatric Acute Lung Injury and Sepsis Investigators network, and/or the pediatric branch of Society of Critical Care Medicine. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 201 surveys initiated, 170 surveys were more than 50% completed and included in our results. The majority of physicians (74%) diagnosed acute kidney injury using serum creatinine and urine output. Acute kidney injury guidelines or criteria were used routinely by 54% of physicians; Risk, Injury, Failure, Loss, and End stage criteria were the most commonly used. Awareness of any acute kidney injury guideline or definition was associated with five-fold higher odds of using any guideline (odds ratio, 5.22; 95% CI, 1.84-14.83) and four-fold higher odds of being dissatisfied with available acute kidney injury biomarkers (odds ratio, 4.88; 95% CI, 1.58-15.05). Less than half of respondents recognized the limitations of serum creatinine. Physicians unaware of the limitations of serum creatinine had two-fold higher odds of being unaware of newer biomarker availability (odds ratio, 2.34; 95% CI, 1.14-4.79). Novel biomarkers were available to 37.6% of physicians for routine use. Physicians with access to novel biomarkers more often practiced in larger (odds ratio, 3.09; 95% CI, 1.18-8.12) and Midwestern (odds ratio, 3.38; 95% CI, 1.47-7.78) institutions. More physicians with access to a novel biomarker reported satisfaction with current acute kidney injury diagnostics (66%) than physicians without access (48%); this finding approached significance (p = 0.07). CONCLUSIONS: Half of PICU attending physicians surveyed are not using recent acute kidney injury guidelines or diagnostic criteria in their practice. There is a positive association between awareness and clinical use of acute kidney injury guidelines. Serum creatinine and urine output are still the primary diagnostics; novel biomarkers are frequently unavailable.

Factors associated With the development of motor proficiency in school children of Kolkata: A cross-sectional study to assess the role of chronic nutritional and socio-economic status.

BACKGROUND: Development of coordinated movements is determined among others by individual growth and environmental factors, but the dynamic relationship between motor proficiency and potential contributing factors such as chronic nutritional status and socio-economic status (SES) is not known in school children of Kolkata. AIM: To characterize the motor proficiency in school children of Kolkata and to investigate association of chronic nutritional and SES on motor proficiency. METHODS: Motor proficiency in 843 school children of Kolkata aged 5-12 years was assessed by the Bruininks-Oseretsky Test of Motor-Proficiency-Second Edition-Short Form (BOT-2 SF). Chronic nutritional status was determined from height-for-age Z-scores (HAZ) using WHO reference and SES was measured using the updated Kuppuswamy's scale. RESULTS: Children's motor proficiency was poor compared with the reference values. Children classified as severely undernourished and children of lower SES were found to be "below average" and "well-below average" in motor proficiency categories compared with normal nourished groups and children of upper SES. Children's BOT-2 SF standardized scores decreased incrementally with the severity of chronic undernutrition and lower grades of SES. CONCLUSION: Chronic undernutrition and lower SES are associated with poorer motor proficiency in children. Understanding the complex interrelationships that shape childen's motor skills can help inform the development of health promotion programs and tailored interventions to help children reach their full potential. © 2016 Wiley Periodicals, Inc. Dev Psychobiol 58:734-744, 2016.

Clinical signs and symptoms associated with intussusception in young children undergoing ultrasound in the emergency room.

OBJECTIVE: The purpose of this study was to evaluate all patients suspected of having intussusception and identify which signs and symptoms were associated with the disease. METHODS: We performed a retrospective review of 553 charts from 2006 to 2010 of patients' age 2 months to 5 years who had an abdominal ultrasound obtained to evaluate for intussusception. Charts were reviewed for signs and symptoms previously shown to be associated with intussusception. RESULTS: There were 452 patients (mean age, 21.5 months, 43% female) evaluated and 101 (22.3%) were found to have intussusception. Of the 18 signs and symptoms, crying (adjusted odds ratio [OR], 3.3; 95% confidence interval [95% CI], 1.3-8.1), abdominal mass (adjusted OR, 15.7; 95% CI, 4.4-55.3), pallor (adjusted OR, 6.5; 95% CI, 1.8-23.5), and vomiting (adjusted OR, 3.1; 95% CI, 1.4-6.5) were associated with disease confirmation in logistic regression analysis. The presence of all 4 clinical signs/symptoms together resulted in a 95% probability of intussusception. Intussusception was unlikely if all 4 clinical indicators were absent (probability = 1.6%). CONCLUSIONS: The presence of crying, abdominal mass, pallor, and vomiting were clinical indicators of intussusception. Individually, none of these variables were helpful in confirming the diagnosis but in the presence of all 4, there is a 95% probability of having the disease. The absence of all 4 of these made the likelihood of having the disease very low.

Validation of the Survey of Sleep Quality in the Pediatric Intensive Care Unit (SSqPICU).

STUDY OBJECTIVES: Observational data suggest pediatric intensive care unit-related sleep and circadian disruption (PICU-SCD) affects many critically ill children. Multicenter trials exploring PICU-SCD have been impractical because measuring sleep in this setting is challenging. This study validates a questionnaire for caregivers to describe children's sleep in the PICU. METHODS: This prospective, multicenter, case-control study enrolled caregivers of children in 4 PICUs or in a hospital-based sleep laboratory (controls). Survey items were compiled from validated adult ICU and pediatric in- and outpatient sleep questionnaires. Control responses were compared to polysomnography to determine accuracy. A score was calculated by summing the level of disruption of sleep timing, duration, efficiency, quality, and daytime sleepiness and irritability. RESULTS: In responses from 152 PICU and 61 sleep laboratory caregivers, sleep survey items had acceptable internal reliability (α = 0.75) and reproducibility on retest surveys (interclass correlation coefficient > 0.600). Caregivers could not assess sleep of sedated children. Factor analysis identified 3 subscales of PICU-SCD. Control parents had good agreement with polysomnography sleep onset time (κ = 0.823) and sleep onset latency (κ = 0.707). There was a strong correlation between sleep scores derived by parental reporting to those by polysomnography (r = .844, P < .001). Scores had a linear association with caregiver-reported child sleep quality. There were no site-specific differences in sleep quality. Nearly all respondents found the survey easy to understand and of appropriate length. CONCLUSIONS: The Survey of Sleep Quality in the Pediatric Intensive Care Unit provides a reliable, accurate description of inpatient sleep disruption in nonsedated children, generalizable across PICUs. It offers practical means to quantify PICU-SCD daily in future investigations. CITATION: Hassinger AB, Mody K, Gomez R, et al. Validation of the Survey of Sleep Quality in the Pediatric Intensive Care Unit (SSqPICU). J Clin Sleep Med. 2024;20(8):1251-1258.

Diagnosis dialog for pediatric physical therapists: hypotonia, developmental coordination disorder, and pediatric obesity as examples.

PURPOSE: To clarify what diagnosis means for pediatric physical therapists, to provide several examples of human movement dysfunction syndromes, and to offer guidance for how pediatric physical therapists may continue this work in any clinical setting. KEY POINTS: The importance of diagnosis in pediatric physical therapy is presented along with examples of 3 different processes used to develop diagnostic labels. These processes included surveys to identify consensus opinion of clinicians, a literature review, and a combination of these 2. Hypotonia, developmental coordination disorder, and pediatric obesity are presented as examples. SUMMARY: The 3 diagnoses serve as a basis for ongoing dialogue, discussion, and development of diagnostic labels for human movement syndromes identified by pediatric physical therapists.

Role of Dual-Contingency Management in Family-Based Obesity Therapy and the Effects of Weight Loss on Liver Transient Elastography Parameters in Youth: A Pilot Study.

The pilot study evaluated contingency management (CM) for family-based obesity therapy (FBT). The secondary outcome assessed the association of the hepatic transient electrography (TE) parameters, including the controlled attenuation parameter (CAP) and liver stiffness (LSM), and changes in liver function blood tests and BMI changes in youth involved in intensive FBT. It included youth-parent dyads from an urban pediatric center randomized to weekly behavioral therapy (BT, n= 4) who received fixed financial compensation for attendance, or BT+CM (n= 5) who received an escalating monetary reward for weight loss. At week 30, all youth and parents had weight-loss trends without significant differences between groups. While the TE measures and blood tests were normal in the youth at baseline and week 30, the CAP changes correlated with BMI changes (R2= 0.86, P< 0.001) and LSM changes with alanine aminotransferase changes (R2= 0.79, P=0.005). In conclusion, BT+CM did not significantly add to the BMI improvement seen with BT alone in youth and their parents. However, in youth with obesity and normal liver blood tests, TE may be useful for monitoring changes in fatty liver disease.

Adolescent obesity prevention in Botswana: beliefs and recommendations of school personnel.

The study's objectives were to gain school personnel's (1) perceptions on diet, physical activity, body size, and obesity, (2) description of school food and physical activity practices, and (3) recommendations for programs to prevent adolescent obesity. The study took place in six junior secondary schools of varying socioeconomic status in Gaborone, Botswana. Using a qualitative descriptive design, semistructured interviews were conducted with key school personnel. Directed content analysis was used to summarize the findings. School personnel believed that obesity was an important problem. They felt that school food was unhealthy and that physical activity was provided insufficiently. Participants shared enthusiasm for a school-based health-promoting intervention that must be fun and include active engagement and education on healthy lifestyles for all students. Participants supported on-site food shop inventory changes and physical activity programs. Potential barriers listed were schools' financial resources, interest of students, and time limitations of all involved.

The Importance of Differentiating Oligoarticular Juvenile Idiopathic Arthritis From Lyme Arthritis in Pediatric Patients.

Objective This study aims to compare clinical and laboratory features between Lyme arthritis (LA) and oligoarticular juvenile idiopathic arthritis (oligoarticular JIA) by examining several potential predictors in pediatric patients. This study also aims to improve and increase awareness of ways to detect LA and oligoarticular JIA in pediatric patients who present with clinical features of joint pain. Methods A medical chart review was conducted among pediatric patients diagnosed with LA or oligoarticular JIA at John R. Oishei Children's Hospital of Buffalo between January 2014 and September 2018. Patients' diagnoses were identified using the International Classification of Disease 10th Revision code for LA (ICD 10 code A69.23) and oligoarticular JIA (ICD 10 code M08.40). Patients with LA were only included in this study if they (1) exhibited arthritis, (2) tested positive for Lyme antibodies, (3) indicated a positive western blot (WB) of five or more out of 10 Borrelia burgdorferi proteins by IgG antibodies or at least two of three B. burgdorferi proteins by IgM antibodies, and (4) at the age of 16 or below at the time of diagnosis. Patients with oligoarticular JIA were included in this study if they (1) exhibited arthritis affecting one to four joints for at least six weeks in the first six months of diagnosis and (2) are at the age of 16 or below at the time of diagnosis after ruling out LA and reactive arthritis. In this study, clinical presentations, physical exam findings during initial healthcare visits, and demographics including age, sex, and race of patients were obtained. In addition, laboratory results including white blood cells (WBCs), hemoglobin (Hgb), platelet count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, Lyme antibodies through enzyme-linked immunosorbent assay (ELISA) and WB, synovial fluid analysis for red blood cells (RBCs), nucleated cells, and polymerase chain reaction (PCR) for B. burgdorferi DNA were also collected and analyzed. Results In our data, ESR and CRP were significantly higher in LA compared to oligoarticular JIA (P=0.0053 and 0.0005, respectively). The mean WBC in the synovial joint fluid was significantly higher in LA compared to oligoarticular JIA (P=0.002). Conclusion LA shares features with oligoarticular JIA. This overlap prevents the creation of a clinically useful predictive model for LA. Therefore, Lyme testing should be performed on all patients presenting with monoarticular and oligoarticular arthritis. In addition, ESR, CRP, and WBC in the synovial joint fluid were significantly higher in LA compared to oligoarticular JIA in our findings. While this difference is not definitive by any means, it may help distinguish between the two in cases where the diagnosis is not clear-cut, and the values of ESR, CRP, and WBC in the joint aspirate may help guide clinical judgment in cases that lack a definitive diagnosis.

Antibody dependent cell cytotoxicity is maintained by the unmutated common ancestor of 6F5, a Gp41 conformational epitope targeting antibody that utilizes heavy chain VH1-2.

In studies on monoclonal IgG antibodies (mAbs) from long-term non-progressors (LTNPs), our laboratory has previously described highly mutated Abs against a complex conformational epitope with contributions from both gp41 the N terminal and C terminal heptad repeat helices. Despite using the VH1-2 gene segment, known to contribute to some of the broadest neutralizing Abs against HIV, members of these Abs, termed group 76C Abs, did not exhibit broad neutralization. Because of the high number of mutations and use of VH1-2, our goal was to characterize the non-neutralizing functions of Abs of group 76C, to assess if targeting of the epitope correlates with LTNP, and to assess the maturation of these Abs by comparison to their predicted common ancestor. Serum competition assays showed group 76C Abs were enriched in LTNPs, in comparison to VRC-01. Specific group 76C clones 6F5 and 6F11, expressed as recombinant Abs, both have robust ADCC activity, despite their sequence disparity. Sequence analysis predicted the common ancestor of this clonal group would utilize the germline non-mutated variable gene. We produced a recombinant ancestor Ab (76Canc) with a heavy chain utilizing the germline variable gene sequence paired to the 6F5 light chain. Competition with group 76C recombinant Ab 6F5 confirms 76Canc binds HIV envelope constructs near the original group C epitope. 76Canc demonstrates comparable ADCC to 6F5 and 6F11 when using gp41 constructs of both clade B and clade C. The functional capability of Abs utilizing germline VH1-2 has implications for disease control and vaccine development.

Response to treatment with intra-articular triamcinolone hexacetonide and triamcinolone acetonide in oligo articular juvenile idiopathic arthritis.

BACKGROUND: Oligo-articular juvenile idiopathic arthritis (Oligo JIA) is the most common subtype of juvenile idiopathic arthritis. Intra-articular corticosteroid (IAC) injection is a mainstay treatment of oligo JIA providing pain relief, improving mobility and preventing further joint destruction in the majority of patients. In 2015, production of triamcinolone hexacetonide (TH) an intra-articular corticosteroid was discontinued in the United States leading to use of triamcinolone acetonide (TA) as an alternative. In this study, we compared response to treatment in children with oligo JIA who underwent therapy with intra-articular TA and TH injection. METHODS: Our study is a retrospective chart review of children with oligo JIA who were treated with IAC injections with TH between January 2012 and June 2015 and TA between J uly 2015 and December 2018. The two groups were followed at John R. Oishei Children's Hospital of Buffalo and were evaluated for response to treatment, side effects and predictors of response including duration of disease before treatment, erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP). Response to treatment was defined as at least 6 months follow up without evidence of active arthritis in injected joints. Patients were considered to be non-responders if they continued to show active arthritis during their first follow up after joint injection. The primary objective was to evaluate whether there was a significant difference in rate of response between TH and TA. RESULTS: Forty-nine patients, 38 female and 11 male with oligo JIA were included in the study. The average age was 6.7 years. A total of 111 joints were injected includin g 78 knees, 13 ankles, 9 wrists, 4 hips, 4 elbows, 2 TMJ and one subtalar joint. In the TA group, 49% (29/59) did not show response to injection compared to 27% (14/52) in the TH group. After 6 months, response rates were better for individuals injected with TH compared to TA (73% vs. 51%). In general, response to intra-articular TH was superior to TA with P = .016 using chi-square test of independence. This difference in outcome was not influenced by other variables such as duration of illness before treatment (P value 0.784) or elevated ESR and CRP. No difference in side effects between the two groups were noted. CONCLUSION: Our results in conjunction with prior published data suggests that TH intra-articular joint injection in oligo JIA is superior to TA, although future controlled trials are necessary for confirmation. An effective, long lasting treatment can have a great impact on the outcome of these children.

The relationship between birth weight and feeding maturation in preterm infants.

AIM: To report changes in ingestive behaviour from 35 to 40 weeks post-conceptual age and examine the association between birth weight and feeding maturation in preterm infants. METHODS: One hundred and four preterm infants born 24 to 34 weeks gestational age were studied. Feeding maturation was assessed as the change from 35 to 40 weeks post-conceptual age in the number of sucks over 5 min, sucking bursts, sucks per burst, time between bursts and maximum pressure during a suck (Pmax). The association between birth weight and each sucking behaviour was examined after adjusting for potential confounders. RESULTS: Significant changes in feeding maturation occurred between 35 and 40 weeks. Birth weight was positively associated with change in Pmax and change in number of sucks per burst for extremely premature infants born 24 to <29 weeks gestational age but not for very premature infants born >/=29 to 34 weeks. The association between birth weight and change in Pmax for extremely premature infants remained significant after adjustment (adjusted beta = 0.128 mmHg increase in change in maximum sucking pressure per every 1 g of birth weight, 95% CI = 0.017, 0.239, p = 0.03). CONCLUSION: Birth weight is positively associated with maturation in maximum sucking pressure among infants born extremely premature.