Clinical characteristics of unvaccinated or incompletely vaccinated children with neurological manifestations due to SARS-CoV-2 Omicron infection.

Omicron generally causes milder disease than previous strains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), especially in fully vaccinated individuals. However, incompletely vaccinated children may develop Omicron-related complications such as those affecting the central nervous system. To characterize the spectrum of clinical manifestations of neuro-COVID and to identify potential biomarkers associated with clinical outcomes, we recruited 15 children hospitalized for Omicron-related neurological manifestations in three hospitals in Hong Kong (9 boys and 6 girls aged 1-13 years). All were unvaccinated or incompletely vaccinated. Fourteen (93.3%) were admitted for convulsion, including benign febrile seizure (n = 7), complex febrile seizure (n = 2), seizure with fever (n = 3), and recurrent breakthrough seizure (n = 2), and the remaining nonconvulsive patient developed encephalopathic state with impaired consciousness. None of the seven children with benign febrile seizure and six of eight children with other neurological manifestations had residual deficits at 9-month follow-up. SARS-CoV-2 RNA was undetectable in the cerebrospinal fluid (CSF) specimens of seven patients who underwent lumbar puncture. Spike-and-wave/sharp waves affecting the frontal lobes were detected in four of seven (57.1%) patients who underwent electroencephalogram. Children with Omicron-related neurological manifestations had significantly higher blood levels of IL-6 (p < 0.001) and CHI3L1 (p = 0.022) than healthy controls, and higher CSF levels of IL-6 (p = 0.002) than children with non-COVID-19-related febrile illnesses. Higher CSF-to-blood ratios of IL-8 and CHI3L1 were associated with longer length of stay, whereas higher ratios of IL-6 and IL-8 were associated with higher blood tau level. The role of CSF:blood ratio of IL-6, IL-8, and CHI3L1 as prognostic markers for neuro-COVID should be further evaluated.

Primary varicella zoster infection compared to varicella vaccine reactivation associated meningitis in immunocompetent children.

We diagnosed varicella zoster virus (VZV) meningitis in a healthy adolescent boy who presented without a rash or fever. We aim to compare VZV reactivation meningitis in children after primary VZV infection and VZV vaccination. We reviewed the literature up until June 2020 using Pubmed/MEDLINE and EMBASE databases using 'varicella zoster', 'meningitis' and 'children' as keywords. Only English articles were included. Twenty-five cases were included in this review. Children who had VZV reactivation meningitis after vaccination were younger (7 ± 3.4 years vs. 11.9 ± 3.6 years, P = 0.0038), had a shorter interval between first exposure to reactivation (5.6 ± 2.9 years vs. 8.8 ± 3.2 years, P = 0.018) and more likely to have a rash (100% vs. 55%, P = 0.04). VZV reactivation meningitis occurs after both primary VZV infection and VZV vaccination. The absence of exanthem, fever or meningism does not rule out VZV meningitis.

Isoniazid-induced gynaecomastia: report of a paediatric case and review of literature.

BACKGROUND: Gynaecomastia is a fairly common condition in puberty but is rare in prepubertal boys. While it is necessary to exclude possible endocrinopathay in prepubertal gynaecomastia, medication is an important and potentially reversible cause to consider in new onset gynaecomastia. Isoniazid-induced gynaecomastia has been reported in adult males, but none was reported in the paediatric population and general paediatricians may not be aware of this uncommon side effect. CASE PRESENTATION: We hereby report a 11-year-old prepubertal boy who developed gynaecomastia while taking anti-tuberculosis drugs. Investigations excluded endocrinopathies. Gynaecomastia subsided 8 weeks after stopping isoniazid. CONCLUSION: This case is the first paediatric case report describing the association of gynaecomastia with isoniazid use. It is important for general paediatricians to recognize this entity, as prompt diagnosis and cessation of the offending drug can lead to resolution of the problem.

Linking Healthcare and Social Service Databases to Study the Epidemiology of Child Maltreatment and Associated Health Problems: Hong Kong's Experience.

OBJECTIVE: To examine the incidence and trend of child maltreatment and its associated health problems in Hong Kong by linking healthcare and social service databases. STUDY DESIGN: Data on 4816 children under the age of 18 years registered with the Child Protection Registry and matching health records in public hospitals in Hong Kong from 2003 to 2010 were extracted. Associations were examined between different types of child maltreatment and child's medical diagnosis according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes including suicidal attempt (X60-X84), nonchild maltreatment related injuries (S00-S99; T00-T98, excluding T74 and T76 that are maltreatment related injuries), mental health problems (F00-F99), and congenital malformations/chromosomal abnormalities (Q00-Q99). RESULTS: Significant rising trends were found for child physical abuse, neglect, and sexual abuse during the period from 2003 to 2010. Psychological abuse remained stable. Risk of suicide attempt was higher among children suffering from sexual abuse, psychological abuse, and children experiencing multiple abuses; mental health diagnoses were more common in victims of psychological and multiple abuses. Congenital malformations and chromosomal abnormalities were more commonly found among neglected children. CONCLUSIONS: In contrast to the decreasing trend observed in the West during the study period, there has been an escalating trend in child maltreatment in Hong Kong and child maltreatment is strongly associated with major health problems. This is one of the first studies to demonstrate the power of linking healthcare and social service databases, which allows for both a better understanding of the impact of child maltreatment and as a guide future policy and service planning.

Effectiveness of a culturally attuned Internet-based depression prevention program for Chinese adolescents: A randomized controlled trial.

BACKGROUND: Depression prevention among adolescents is crucial for reducing the global disease burden. Internet-based depression prevention approaches are found to be effective but they were mostly evaluated in a Western context. Grasping the Opportunity is a Chinese Internet intervention, which was translated and modified from CATCH-IT developed in the West. We aimed to evaluate the effectiveness of Grasp the Opportunity in reducing depressive symptoms in Chinese adolescents. METHODS: In this randomized controlled trial, Chinese adolescents aged 13 to 17 years with mild-to-moderate depressive symptoms were recruited from three secondary schools in Hong Kong. The participants (n = 257) were randomly assigned to receive either intervention or attention control. The primary outcome was the improvement in depressive symptoms according to the revised Center for Epidemiologic Studies Depression Scale (CESD-R) at the 12-month follow-up. Analyses were performed using intention to treat (ITT). RESULTS: The participants were randomly assigned to receive the intervention (n = 130) or attention control (n = 127). Follow-up data were obtained from 250 (97%) participants. Only 26 (10%) participants completed the intervention. Compared to the attention control, Grasp the Opportunity led to reductions in depressive symptoms at the 12-month follow-up with a medium effect size using ITT analysis (mean difference 2.6, 95% CI 0.59-5.55, effect size d = 0.36). CONCLUSIONS: Grasp the Opportunity is effective in reducing depressive symptoms in Chinese adolescents over a long follow-up period. Poor completion rate is the major challenge in the study.

Adaptation of an internet-based depression prevention intervention for Chinese adolescents: from "CATCH-IT" to "grasp the opportunity".

BACKGROUND: There is a dearth of information on the compatibility of Western-developed, internet-based interventions that prevent onset and precipitation of depression in global settings. Recently, Project CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral, Humanistic and Interpersonal Training), an information technology-based intervention, was adapted to prevent depression in Hong Kong Chinese adolescents. This paper evaluates qualitative data from consultations to develop a revised intervention of CATCH-IT for Hong Kong youth. METHODS: A theoretical thematic analysis approach was used to analyze data. Materials from three consultation trips which included focus groups (2007), an expert panel (2007), a public health campaign (2009), and a joint primary care physician-social worker review group (2010) were compiled. Authors (KS and AZ) independently reviewed the data and applied the theoretical framework of behavioral vaccines to code the data. These data were subsequently consolidated to provide a coherent narrative analysis. RESULTS: The cognitive behavioral therapy (CBT), behavioral activation (BA), and resiliency modules were maintained, while the interpersonal therapy (IPT) modules of CATCH-IT were excluded in the Hong Kong adaptation. Concurrent self-reports of drinking, smoking, illicit drug use and gambling behavior were added. Rather than primary care consultations, social worker consultations may be the best point of entry for intervention. CONCLUSION: Socio-cultural relevance of psychotherapeutics and delivery context of internet-based interventions will require significant adaptation for the Hong Kong setting. However, because of community engagement throughout the process of adaptation, we believe the CATCH-IT intervention can be adapted for Chinese adolescents in Hong Kong with retained fidelity. The revised intervention is called "Grasp the Opportunity".

Diazoxide-unresponsive Hyperinsulinemic Hypoglycaemia in a Preterm Infant with Heterozygous Insulin Receptor Gene Mutation.

Homozygous or compound heterozygous mutations in insulin receptor gene (INSR) lead to marked insulin resistance and hyperglycaemia in Donohue syndrome and Rabson-Mendenhall syndrome, conditions which are associated with significant morbidity early in life. On the other hand, heterozygous INSR gene mutations result in milder phenotype known as type A insulin resistance syndrome. While presentation in adults with this condition is well reported, phenotypes in infant are less well-characterized. We herein report an infant presenting with hyperinsulinemic hypoglycaemia who did not respond to diazoxide therapy. She was subsequently found to carry heterozygous INSR gene mutation. Our patient was a female infant born at 29 weeks of gestation who developed recurrent hypoglycaemia in early infancy. Workup showed hyperinsulinism and she was started on first-line therapy with diazoxide and high-calorie feeds. However, continuous blood glucose monitoring showed post-prandial hyperglycaemia followed by rapid fall to hypogylcaemia. Whole exome sequencing was performed to investigate for diazoxide-unresponsive hyperinsulinism, which revealed a likely pathogenic mutation in the INSR gene c.1246C>T p. (R416X). This nonsense mutation was inherited from the father. With the molecular diagnosis, diazoxide was stopped and she followed a diet with low glycaemic-index food. Subsequent monitoring showed stable glucose profile. Our case highlights the importance to consider type A insulin resistance syndrome when no mutation could be identified in the ABCC8/KCNJ11 genes in diazoxide-unresponsive hyperinsulinism. With autosomal dominant inheritance, cascade screening should be performed in family members to identify those harbouring the mutation as they are at risk of early onset diabetes.

Air dispersal of respiratory viruses other than severe acute respiratory coronavirus virus 2 (SARS-CoV-2) and the implication on hospital infection control.

BACKGROUND: Air dispersal of respiratory viruses other than SARS-CoV-2 has not been systematically reported. The incidence and factors associated with air dispersal of respiratory viruses are largely unknown. METHODS: We performed air sampling by collecting 72,000 L of air over 6 hours for pediatric and adolescent patients infected with parainfluenza virus 3 (PIF3), respiratory syncytial virus (RSV), rhinovirus, and adenovirus. The patients were singly or 2-patient cohort isolated in airborne infection isolation rooms (AIIRs) from December 3, 2021, to January 26, 2022. The viral load in nasopharyngeal aspirates (NPA) and air samples were measured. Factors associated with air dispersal were investigated and analyzed. RESULTS: Of 20 singly isolated patients with median age of 30 months (range, 3 months-15 years), 7 (35%) had air dispersal of the viruses compatible with their NPA results. These included 4 (40%) of 10 PIF3-infected patients, 2 (66%) of 3 RSV-infected patients, and 1 (50%) of 2 adenovirus-infected patients. The mean viral load in their room air sample was 1.58×103 copies/mL. Compared with 13 patients (65%) without air dispersal, these 7 patients had a significantly higher mean viral load in their NPA specimens (6.15×107 copies/mL vs 1.61×105 copies/mL; P < .001). Another 14 patients were placed in cohorts as 7 pairs infected with the same virus (PIF3, 2 pairs; RSV, 3 pairs; rhinovirus, 1 pair; and adenovirus, 1 pair) in double-bed AIIRs, all of which had air dispersal. The mean room air viral load in 2-patient cohorts was significantly higher than in rooms of singly isolated patients (1.02×104 copies/mL vs 1.58×103 copies/mL; P = .020). CONCLUSION: Air dispersal of common respiratory viruses may have infection prevention and public health implications.

Who should return for an oral glucose tolerance test? A proposed clinical pathway based on retrospective analysis of 332 children.

OBJECTIVES: Fasting plasma glucose or oral glucose tolerance test (OGTT) is the traditional diagnostic tool for type 2 diabetes (T2DM). However, fasting is required and implementation in all overweight/obese subjects is not practical. This study aimed to formulate a clinical pathway to stratify subjects according to their risk of abnormal OGTT. METHODS: This retrospective study included patients with overweight or obesity who had undergone OGTT in a tertiary paediatric unit from 2012 to 2018. The optimal haemoglobin A1c (HbA1c) cutoff that predicts abnormal OGTT was evaluated. Other non-fasting parameters, in combination with this HbA1c cutoff, were also explored as predictors of abnormal OGTT. RESULTS: Three hundred and thirty-two patients (boys: 54.2%, Chinese: 97.3%) were included for analysis, of which, 272 (81.9%) patients had normal OGTT while 60 (18.0%) patients had abnormal OGTT (prediabetes or T2DM). Optimal HbA1c predicting abnormal OGTT was 5.5% (AUC 0.71; sensitivity of 66.7% and specificity of 71%). When HbA1c≥5.5% was combined with positive family history and abnormal alanine transaminase (ALT) level, the positive predictive value for abnormal OGTT was increased from 33.6 to 61.6%. CONCLUSIONS: HbA1c, family history of T2DM and ALT level could be used to derive a clinical pathway to stratify children who have high risk of abnormal OGTT.

Rebounds, regresses, and recovery: A 15-year study of the coral reef community at Pila'a, Kaua'i after decades of natural and anthropogenic stress events.

Pila'a reef on the north shore of Kaua'i, Hawai'i was subjected to a major flood event in 2001 that deposited extensive sediment on the reef flat, resulting in high coral mortality. To document potential recovery, this study replicated benthic and sediment surveys conducted immediately following the event and 15 years later. Coral cores were analyzed to determine coral growth rates and density. Our results suggest that significant reduction in terrigenous sediments has led to partial ecosystem recovery based on coral species and colony increases, more balanced size frequency distributions, improved coral condition, and enhanced coral recruitment despite lack of recovery of large dead coral colonies. However, within this 15-year period, episodic storms and a bleaching event impeded the recovery process, preventing full recovery and continuously threatening the coral reef community. As climate change progresses, the intensity and frequency of these disturbances are predicted to increase.