Predictors And Potential Mechanisms Of Improvement In Asthma Control In Children Following Adenotonsillectomy

Recent small observational studies suggest that asthmatic children receive clinical benefit in asthma control following adenotonsillectomy (TA), but little is known about which clinical and biological characteristics impact improvement. We enrolled 213 children undergoing TA, including 136 children with asthma and 78 controls, in a longitudinal observational cohort study (YCAAD). An asthma questionnaire, Asthma Control Test (ACT) scores, and serum asthma biomarkers levels were obtained at baseline and at six-months. Interim analysis compared patient characteristics to a historical cohort (CT-Kids) of 49 children with asthma who underwent TA. Urgent care visits (P \u3c 0.001), oral steroid courses (P \u3c 0.001), and ACT scores (P \u3c 0.001) all improved in children with asthma following TA. Serum Th2 inflammatory markers, including IL-4 (P = 0.022) and IL-5 (P = 0.002), decreased following TA. Decreased IL-5 levels following surgery correlated with improvement in urgent care visits (P = 0.021), decreases in oral steroids (P = 0.02), and overall improvement in asthma control (P = 0.008). Children who were low or healthy weight, younger, female, had a history of sinusitis, and/or had a history of persistent asthma were more likely have improvement in their asthma following surgery. Elevations of serum IL-2, IL-4, IL-5, IL-13, IFN-γ, TNF-α, and GM-CSF levels were found in children whose asthma improved after TA. These clinical characteristics and biomarkers may help predict which children will receive maximum benefit in asthma control following TA

Prophylaxis in children with haemophilia in an evolving treatment landscape

Introduction For children with haemophilia, early initiation of prophylaxis is crucial to prevent life-threatening bleeds and maintain joint health throughout life. Options for prophylaxis have recently increased from replacement therapy with standard or extended half-life coagulation factor products to include other haemostasis products, such as the non-replacement therapy emicizumab. Aim To review key factors that determine the choice of prophylaxis in young children. Methods Key clinical questions on the implementation of prophylaxis for haemophilia in children were identified and PubMed was searched for evidence supporting guidance on the implementation of prophylaxis. Results The results of the literature search and the practical experience of the authors were used to build consensus on when to start prophylaxis, the pros and cons of the products available to guide the choice of product, and practical aspects of starting prophylaxis to guide the choice of regimen. Conclusions In this era of increasing therapeutic choices, available information about the range of treatment options must be considered when initiating prophylaxis in young children. Parents or care givers must be sufficiently informed to allow informed shared decision making. Although plentiful data and clinical experience have been gathered on prophylaxis with clotting factor replacement therapy, its use in young children brings practical challenges, such as the need for intravenous administration. In contrast, our relatively brief experience and limited data with subcutaneously administered non-replacement therapy (i.e., emicizumab) in this patient group imply that starting emicizumab prophylaxis in young children requires careful consideration, despite the more convenient route of administration.TakedaThis article was written on behalf the European Collaborative Haemophilia Network (ECHN). ECHN is supported by an Independent Educational Grant from Takeda. Medical writing assistance was provided by Janet R. Davies, PhD, ELS, and Kim Grootscholten, MSc, of COR2ED, Basel, Switzerland

Low SARS-CoV-2 seroprevalence but high perception of risk among healthcare workers at children’s hospital before second pandemic wave in Germany

Background!#!Healthcare workers are considered a particularly high-risk group during the coronavirus disease 2019 (COVID-19) pandemic. Healthcare workers in paediatrics are a unique subgroup: they come into frequent contact with children, who often experience few or no symptoms when infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and, therefore, may transmit the disease to unprotected staff. In Germany, no studies exist evaluating the risk of COVID-19 to healthcare workers in paediatric institutions.!##!Methods!#!We tested the staff at a large children's hospital in Germany for immunoglobulin (Ig) G antibodies against the nucleocapsid protein of SARS-CoV-2 in a period between the first and second epidemic wave in Germany. We used a questionnaire to assess each individual's exposure risk and his/her own perception of having already been infected with SARS-CoV-2.!##!Results!#!We recruited 619 participants from all sectors, clinical and non-clinical, constituting 70% of the entire staff. The seroprevalence of SARS-CoV-2 antibodies was 0.325% (95% confidence interval 0.039-1.168). Self-perceived risk of a previous SARS-CoV-2 infection decreased with age (odds ratio, 0.81; 95% confidence interval, 0.70-0.93). Having experienced symptoms more than doubled the odds of a high self-perceived risk (odds ratio, 2.18; 95% confidence interval, 1.59-3.00). There was no significant difference in self-perceived risk between men and women.!##!Conclusions!#!Seroprevalence was low among healthcare workers at a large children's hospital in Germany before the second epidemic wave, and it was far from a level that confers herd immunity. Self-perceived risk of infection is often overestimated

Barriers to Pediatric Osseointegrated Bone-Conduction Hearing Devices

OBJECTIVE: To identify social, demographic, and clinical barriers for implantation with Osseointegrated Bone Conduction Devices (OBCD) in pediatric candidates. STUDY DESIGN: Retrospective cohort study of 94 children who met standard OBCD implantation criteria. SETTING: Tertiary stand-alone children\u27s hospital. MATERIALS AND METHODS: Retrospective chart review comparing demographic (age, race, state of residence, and insurance) and clinical (severity and etiology of hearing loss, medical comorbidities, and early intervention) factors impacting implantation. Members of the existing cohort were then contacted to obtain a better understanding of qualitative factors impacting surgical decision. RESULTS: Of the identified 94 surgical candidates, 47 (50%) underwent OBCD implantation. State of residence significantly impacted implantation rates, with children from the District of Columbia and Virginia being less likely to receive an implant than those from Maryland. Private insurance, race, and ethnicity did not impact rate of implantation (OR 2.8 [95% CI 0.78-10]; 1.34 [95% CI 0.44-3.68]; and 1.0 [95% CI 0.42-2.43], respectively). Children with anotia or microtia and children younger than 10 years old were less likely to have an implant (OR 10.6 (95% CI 1.74-65). Thirty-nine children participated in the qualitative portion. Themes that emerged as reasons to forgo implantation included a child\u27s young age, planned reconstruction for microtia or atresia, and overall device functionality and usage. Thirty-seven children (39%) of the cohort declined surgery and currently wear a nonsurgical bone conduction aid regularly. CONCLUSION: Despite known benefits of implantation, only one-half of children who were candidates underwent OBCD. Unlike cochlear implantation, where insurance status is a major risk factor for implantation delay and underperformance, for OBCD, implantation barriers appear to be more multifactorial and include medical, demographic, and social factors

Interference of a commercial catalase preparation in laccase and peroxidase activities

The influence of commercial catalase preparations (fungal and bovine origin) on laccase and peroxidase activity assays was evaluated using enzymatic extracts obtained from several basidiomycetes grown under different culture conditions. No hydrogen peroxide was detected in the extracts. Inhibition of laccase activity by 40 to 80% was related to the catalase source. In addition, oxidation of the substrate (ABTS) by fungal catalase in the absence of the enzymatic extract from basidiomycetes was observed. The results demonstrated the need for the evaluation of interference of the commercial catalase preparation when its use was required in the reaction mixture.<br>A influência da preparação comercial de catalase (origem fúngica e bovina) nos ensaios de atividade absence and presence of a fungal or bovine de lacase e de peroxidases foi avaliada empregando-se extratos enzimáticos obtidos do crescimento de diversos basidiomicetos em diferentes condições de cultivo. Não foi detectado H2O2 nos extratos. Inibição de 40 a 80% da atividade de lacase foi relacionada à fonte de catalase. Além disso, foi observada oxidação do substrato (ABTS) pela catalase fúngica, na ausência de extrato enzimático do basidiomiceto. Os resultados evidenciaram a necessidade de se proceder a uma avaliação da interferência da preparação comercial de catalase, quando o seu uso se fizer necessário na mistura reacional

Long-term trends in mortality and AIDS-defining events after combination ART initiation among children and adolescents with perinatal HIV infection in 17 middle- and high-income countries in Europe and Thailand: A cohort study

Background Published estimates of mortality and progression to AIDS as children with HIV approach adulthood are limited. We describe rates and risk factors for death and AIDS-defining events in children and adolescents after initiation of combination antiretroviral therapy (cART) in 17 middle-and high-income countries, including some in Western and Central Europe (W&amp;CE), Eastern Europe (Russia and Ukraine), and Thailand. Methods and findings Children with perinatal HIV aged &lt; 18 years initiating cART were followed until their 21st birthday, transfer to adult care, death, loss to follow-up, or last visit up until 31 December 2013. Rates of death and first AIDS-defining events were calculated. Baseline and time-updated risk factors for early/late (&lt;=/&gt; 6 months of cART) death and progression to AIDS were assessed. Of 3,526 children included, 32% were from the United Kingdom or Ireland, 30% from elsewhere in W&amp;CE, 18% from Russia or Ukraine, and 20% from Thailand. At cART initiation, median age was 5.2 (IQR 1.4-9.3) years; 35% of children aged &lt; 5 years had a CD4 lymphocyte percentage &lt; 15% in 1997-2003, which fell to 15% of children in 2011 onwards (p &lt; 0.001). Similarly, 53% and 18% of children &gt;= 5 years had a CD4 count &lt; 200 cells/mm(3) in 1997-2003 and in 2011 onwards, respectively (p &lt; 0.001). Median follow-up was 5.6 (2.9-8.7) years. Of 94 deaths and 237 first AIDS-defining events, 43 (46%) and 100 (42%) were within 6 months of initiating cART, respectively. Multivariable predictors of early death were: being in the first year of life; residence in Russia, Ukraine, or Thailand; AIDS at cART start; initiating cART on a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen; severe immune suppression; and low BMI-for-age z-score. Current severe immune suppression, low current BMI-for-age z-score, and current viral load &gt; 400 c/mL predicted late death. Predictors of early and late progression to AIDS were similar. Study limitations include incomplete recording of US Centers for Disease Control (CDC) disease stage B events and serious adverse events in some countries; events that were distributed over a long time period, and that we lacked power to analyse trends in patterns and causes of death over time. Conclusions In our study, 3,526 children and adolescents with perinatal HIV infection initiated antiretroviral therapy (ART) in countries in Europe and Thailand. We observed that over 40% of deaths occurred &lt;= 6 months after cART initiation. Greater early mortality risk in infants, as compared to older children, and in Russia, Ukraine, or Thailand as compared to W&amp;CE, raises concern. Current severe immune suppression, being underweight, and unsuppressed viral load were associated with a higher risk of death at &gt; 6 months after initiation of cART