Children's Perceptions of Pictures Intended to Measure Anxiety During Hospitalization

Many children experience anxiety during a hospital stay, which can have an adverse impact on their recovery and response to future hospital care. To facilitate assessment of anxiety in young children and children with communicative disabilities, the short S-STAI (short version of the State scale of the State-Trait Anxiety Inventory), has previously been adapted to a visual format. The aims of the present study were (a) to validate the pictures used to represent emotions and the steps of a quantitative scale ('a lot' - 'some' - 'a little'), including to determine whether any of them should be replaced, and (b) to assess different pictures to be used for a qualitative scale ('good/like' - 'in between/so-so' -'bad/dislike') in the same instrument. A total of 103 children aged 5-8 years were asked to choose verbal labels for pictures of facial expressions intended to represent emotions, match those pictures with the emotional categories used in the short S-STAI (Tense/Nervous, Worried/Afraid, Calm/Relaxed, and Happy/Content) and indicate their preferences for pictures intended to represent the steps of a quantitative scale and a qualitative one. The children understood both scales and the differences between positive and negative emotions in the short S-STAI. The older children (aged 7 and 8) significantly more often chose a picture for each step of the scales that was intended to represent that particular step. The article discusses implications for the choice of pictures representing emotional states in the short S-STAI and presents recommended pictures.

Early Caffeine Administration and Neurodevelopmental Outcomes in Preterm Infants

BACKGROUND

Although caffeine use for apnea of prematurity is well studied, the long-term safety and benefit of routine early caffeine administration has not been explored. Our objective was to determine the association between early (within 2 days of birth) versus late caffeine exposure and neurodevelopmental outcomes in preterm infants.

METHODS

Infants of <29 weeks' gestation born between April 2009 and September 2011 and admitted to Canadian Neonatal Network units and then assessed at Canadian Neonatal Follow-up Network centers were studied. Neonates who received caffeine were divided into early- (received within 2 days of birth) and late-caffeine (received after 2 days of birth) groups. The primary outcome was significant neurodevelopmental impairment, defined as cerebral palsy, or a Bayley Scales of Infant and Toddler Development, Third Edition composite score of <70 on any component, hearing aid or cochlear implant, or bilateral visual impairment at 18 to 24 months' corrected age.

RESULTS

Of 2108 neonates who were eligible, 1545 were in the early-caffeine group and 563 were in the late-caffeine group. Rates of bronchopulmonary dysplasia, patent ductus arteriosus, and severe neurologic injury were lower in the early-caffeine group than in the late-caffeine group. Significant neurodevelopmental impairment (adjusted odds ratio 0.68 [95% confidence interval 0.50-0.94]) and odds of Bayley Scales of Infant and Toddler Development, Third Edition cognitive scores of <85 (adjusted odds ratio 0.67 [95% confidence interval 0.47-0.95]) were lower in the early-caffeine group than in the late-caffeine group. Propensity score-based matched-pair analyses revealed lower odds of cerebral palsy and hearing impairment only.

CONCLUSIONS

Early caffeine therapy is associated with better neurodevelopmental outcomes compared with late caffeine therapy in preterm infants born at <29 weeks' gestation.

Delivery of the UN Convention on the Rights of the Child in an acute paediatric setting: an audit of information available and service gap analysis

BACKGROUND

The United Nations Convention on Children's Rights stresses the importance of providing children with information relating to their health and well-being, yet reports suggest children are offered insufficient support in healthcare environments. We audited the information provided to children and families requiring planned surgical admission in comparison to those admitted acutely to medical paediatrics. Additionally, we identified examples of child-specific information resources in national and international hospitals.

METHODS

Three approaches were taken to gain insight into practice locally, nationally and internationally.(1) Information resources provided to paediatric inpatients admitted to the acute receiving unit were audited in comparison to information given to children with planned admissions via process observations.(2) Qualitative feedback was gained from play specialists (n=2), families (n=30) and children (n=9; aged 3-15 years) via interviews.(3) A review, including UK, Australian and US hospitals, was conducted to assess child-specific information resources (n=36 hospitals) and to systematically compare the information available on websites (n=9 hospitals).

RESULTS

At the study site, no child-specific information resources were available for acute admissions, whereas planned admissions were offered significant information face-to-face with supplemental resources. Child, parent and play specialist interviews highlighted gaps in information provision regarding hospital practicalities and processes. Twelve external child-specific resources were identified, for 4-14 year olds, explaining key care information: medical procedures, equipment and staff. These resources could positively respond to the topics cited as lacking by the interviewed patients and families at the study site. International hospital websites provided considerably more in-depth information compared with UK hospitals.

CONCLUSIONS

The hospital experience of children and families can be improved by ensuring they are provided with adequate information relating to their hospital stay. It is essential that suitable high-quality resources are consistently available and that feedback from children informs the process of resource development.

Intravitreal Ranibizumab Injection for the Treatment of Retinopathy of Prematurity

OBJECTIVES

To evaluate the efficacy of a single injection of 0.3 mg intravitreal ranibizumab for the treatment of retinopathy of prematurity (ROP).

METHODS

We conducted this retrospective case series study at King Abdul Aziz Medical City, Riyadh, Saudi Arabia. Seventy-four eyes of 37 preterm infants with ROP stage III with plus disease in zone I, posterior zone II, and aggressive posterior ROP received a single injection of 0.3 mg intravitreal ranibizumab. The favorable outcome measure was complete regression of the disease with normal vascularization of the retina of those infants.

RESULTS

The gestational age of the 37 included cases was in the range of 23-28 weeks and their body weight at birth was between 510 and 1,235 g except for one case with 2,550 g under oxygen therapy <7days with severe hypoglycemia. All eyes showed a favorable response in terms of regression of plus disease from the first day after treatment, followed by regression of stage III retinopathy. All patients developed complete vascularization over variable periods of time.

CONCLUSION

One injection of 0.3 mg intravitreal ranibizumab is effective in treating ROP stage III mainly in zones I and II.

Interest of URS-L in the Treatment of Ureterolithiasis in Preschool Children

Urolithiasis can affect all children even preschool ones. Diagnostic difficulties in the youngest children are due to the problems in locating pain and determining its character and severity. In keeping with the ALARA (As Low As Reasonably Achievable) protocol, the number of imaging tests possible to perform is very limited. Ultrasound is the first line exam of choice. After diagnosis of the presence of a stone, ESWL (Extracorporeal Shock Wave Lithotrypsy) should always be considered and offered to parents due to its high effectiveness and minimal invasiveness. If ESWL is contraindicated or not well-accepted by parents, authors suggest another minimal invasive approach: URS-L (Uretherorenoscopy-Lithotrypsy). Our study clinically analyzes 87 children, which were treated between 2009 and 2017 using the URS-L procedure. URS-L treatments were performed using Lithoclast until 2009, and after that time, using the holmium laser Ho:YAG. The overall effectiveness of treatments was 93.3%. There was no failure in the access to the stones. A macroscopic hematuria (Clavien-Dindo I grade) was observed through the second post-operative day in 9.2% of treated patients. No urosepsis was observed. Full metabolic evaluation was performed on all patients. Children remained under constant urological and nephrological observation. A recurrence of urolithiasis was observed in 35.6% of the cases. Treating ureteral lithiasis in young infants remains a big challenge. Our series shows that modern minimal invasive techniques used by very experienced pediatric urologists in high volume centers gives excellent results. In most cases, surgery should no longer need to be an option.

Automated Analysis for Retinopathy of Prematurity by Deep Neural Networks

Retinopathy of Prematurity (ROP) is a retinal vasproliferative disorder disease principally observed in infants born prematurely with low birth weight. ROP is an important cause of childhood blindness. Although automatic or semi-automatic diagnosis of ROP has been conducted, most previous studies have focused on "plus" disease, which is indicated by abnormalities of retinal vasculature. Few studies have reported methods for identifying the "stage" of the ROP disease. Deep neural networks have achieved impressive results in many computer vision and medical image analysis problems, raising expectations that it might be a promising tool in the automatic diagnosis of ROP. In this paper, convolutional neural networks with a novel architecture are proposed to recognize the existence and severity of ROP disease per-examination. The severity of ROP is divided into mild and severe cases according to the disease progression. The proposed architecture consists of two sub-networks connected by a feature aggregate operator. The first sub-network is designed to extract high-level features from images of the fundus. These features from different images in an examination are fused by the aggregate operator, then used as the input for the second sub-network to predict its class. A large data set imaged by RetCam 3 is used to train and evaluate the model. The high classification accuracy in the experiment demonstrates the effectiveness of the proposed architecture for recognizing the ROP disease.

Ictal Electroencephalographic Findings in Children with Migraine Headache

OBJECTIVES

In this study, the EEG findings in children with migraine headache were assessed in Bahrami Hospital, Tehran, Iran from 2014 to 2016.

MATERIALS & METHODS

In this observational cross-sectional study, 71 consecutive children with migraine headache were enrolled. The EEG findings were determined and compared with other variables.

RESULTS

There were 25 cases (35.2%) with abnormal EEG and the type of EEG abnormality comprised slow waves and sharp waves in 19(68%) and 8(32%) patients, respectively.

CONCLUSION

Nearly one-third of children with migraine might have abnormal EEG.

The Development of an Interventional Package on "Receptive Vocabulary" For Cochlear Implanted Children

OBJECTIVES

Considering the shortage of language intervention protocols which specifically concentrate on cochlear implanted children and considering the importance of timely language intervention in this group of children, the aim of the present study was to develop an interventional package on "receptive vocabulary" for cochlear implanted children.

MATERIALS & METHODS

By reviewing the literature related to language acquisition theories in normal and language disordered children, as well as literature on production of intervention protocols, especially those for language impaired children, and also considering the normal process of language and speech development in normal children, the first draft of the intervention protocol was prepared. Then, the face and content validity of the intervention protocol was assessed by a Delphi team through three rounds and finally approved.

RESULTS

A language intervention protocol was developed to enhance receptive vocabulary in 12-48 months-old cochlear implanted children, based on cognitive, behavioral and developmental theories. This protocol includes 5 interventional stages: 1-Drilling and Imitation; 2-Modeling; 3-Motor training; 4-Deliberate error correction; 5- Reinstatement and Generalization. Each stage consists of the description of the aims of that stage, a list of techniques, the tools required, the detailed step by step explanation of the intervention, how re-enforcement must take place, and finally the indicators of success which permit to move forward to the next stage.

CONCLUSION

The interventional package produced is believed to facilitate language acquisition in cochlear implanted children, according to expert qualitative assessment and approval. Experimental research is required for verification of this assumption.

Comparative observational study of aminophylline with prophylactic and therapeutic uses for clinical outcomes in preterm infants

Objectives Aminophylline has been used for prevention or treatment of apnea in preterm infants with idiopathic apnea of prematurity. The aim of this study was to assess the clinical usefulness of prophylactic in comparison with therapeutic aminophylline therapy. Methods This retrospective observational study included infants born with a birth weight of &lt; 2,500 g or at &lt; 36 weeks of gestation. Infants born between August 2013 and July 2014 who received aminophylline therapy within 24 hr after birth were assigned to the prophylactic group, while infants born between August 2014 and July 2015 who received aminophylline therapy after obvious apnea were assigned to the therapeutic group. We compared clinical characteristics, including days of ventilator and oxygen therapy and bronchopulmonary dysplasia (BPD) between both groups. Results Sixty—four patients and 25 infants were identified in the prophylactic and therapeutic groups, respectively. The mean gestational age and birth weight were 32.57 ± 1.96 weeks and 1765 ± 205 g, respectively, in the prophylactic group and 32.46 ± 1.82 weeks and 1770 ± 250 g, respectively, in the therapeutic group. No significant differences in clinical characteristics were found between the two groups. Similar clinical outcomes, including days of ventilator and oxygen therapy, intraventricular hemorrhage (IVH), periventricular leukomalacia, and BPD, were observed between the two groups. Conclusions The present study showed that the prophylactic use of aminophylline does not improve the clinical outcomes, including BPD, IVH, and ventilator dependency as compared with therapeutic use. In other words, routine prophylactic use of aminophylline is unnecessary.

Turkish Neonatal Society guideline on the management of respiratory distress syndrome and surfactant treatment

Respiratory distress syndrome is the leading cause of respiratory failure in preterm infants. The incidence and severity of respiratory distress syndrome are inversely related to the gestational age of the newborn. The major underlying pathophysiologic mechanisms are surfactant deficiency and anatomic, structural immaturity of the lung. Recent improvements such as antenatal steroid treatment to enhance pulmonary maturity, appropriate resuscitation facilitated by placental transfusion and immediate use of continuous positive airway pressure for alveolar recruitment, early rescue administration of surfactant, ventilation with gentler modes to minimize damage to the immature lungs, and the other supportive therapies have significantly decreased respiratory distress syndrome-related morbidity and mortality. This guideline was addressed to overview the mentioned improvements in order to standardize respiratory distress syndrome management in neonatal intensive care units in Turkey.

Efficacy and Safety of Different Maintenance Doses of Caffeine Citrate for Treatment of Apnea in Premature Infants: A Systematic Review and Meta-Analysis

BACKGROUND

Caffeine is widely used for the treatment of neonatal apnea, but there is no agreement on the optimum maintenance dose for preterm infants.

OBJECTIVE

The aims of this meta-analysis were to compare the efficacy and safety of high versus low maintenance doses of caffeine citrate for the treatment of apnea in premature infants.

METHODS

Literature searches were conducted using PubMed, Cochrane Library, OVID, Embase, Web of Science, Chinese Biomedical Literature, Weipu Journal, Wanfang, and CNKI databases up to September 2018. Only randomized controlled trials (RCTs) of caffeine citrate for apnea treatment in premature infants were included. Trials were divided into those testing high maintenance doses (10-20 mg/kg daily) and low maintenance doses (5-10 mg/kg daily) for comparison. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards.

RESULTS

Among the 345 studies initially identified, thirteen RCTs involving 1515 patients were included. Compared to the low-dose group, the high-dose group exhibited greater effective treatment rate (RR: 1.37, 95%CI: 1.18 to 1.60, P<0.0001) and success rate for ventilator removal (RR: 1.74, 95%CI: 1.04 to 2.90, P=0.03), but higher incidence of tachycardia (RR: 2.02, 5%CI: 1.30 to 3.12, P=0.002). The high-dose group also demonstrated lower extubation failure rate (RR: 0.5, 95%CI: 0.35 to 0.71, P=0.0001), frequency of apnea (WMD: -1.55, 95%CI: -2.72 to -0.39, P=0.009), apnea duration (WMD: -4.85, 95%CI: -8.29 to -1.40, P=0.006), and incidence of bronchopulmonary dysplasia (RR: 0.79, 95%CI: 0.68 to 0.91, P=0.002). There were no significant group differences in other adverse events including in-hospital death (P>0.05).

CONCLUSIONS

Higher maintenance doses of caffeine citrate appear more effective and safer than low maintenance doses for treatment of premature apnea, despite a higher incidence of tachycardia.

Early features of Kawasaki disease with pyuria in febrile infants younger than 6 months

Background

Children with Kawasaki disease (KD) and pyuria have been misdiagnosed with urinary tract infection (UTI). We compared clinical and laboratory features at admission between two groups of infants under 6 months of age who showed initial pyuria, to identify the initial clues suggestive of KD.

Methods

We retrospectively reviewed the medical records of children with fever who were under 6 months of age with pyuria, over a 10-year period (2007–2017). We included infants with sterile pyuria who were finally diagnosed with KD and those with UTI.

Results

During the period investigated, 12 (9.9%) KD patients with sterile pyuria and 378 infants with UTI were included in this study. Older age (P < 0.01), a longer duration of fever; total and before admission (P < 0.01), more negative nitrite test (P < 0.01), higher platelet count (P = 0.04), increased C-reactive protein (CRP) (P < 0.01) and erythrocyte sedimentation rate (ESR) (P < 0.01), were identified as initial features of infants finally diagnosed with KD. In the receiver operating characteristic analysis, optimal cut-off values of 509 k/μL for platelet count, 60 mg/L for CRP, and 68 mm/H for ESR were selected. Patients with ESR > 68 mm/hr had a ninefold higher odds of KD compared to those with lower ESR levels (odds ratio: 8.963, 95% confidence intervals: 1.936–41.493, P = 0.005), whereas CRP and platelet count could not significantly increase in the odds of KD at a cut-off point.

Conclusion

Persistent fever, elevated ESR, and negative urine nitrite test can serve as early clues to suspect KD in febrile infants with pyuria.

Is human milk feeding protective for Retinopathy of Prematurity?

Objective:

To find the association between breast milk feeding with retinopathy of prematurity (ROP) in preterm infants.

Methods:

This was a cross sectional study to examine the effects of breast milk feeding on ROP. Premature newborns below 34 weeks from neonatal unit retinopathy of prematurity program during the years 2015 to 2017 of The Lahore General Hospital were included. We recorded the gestational age, birth weight, presence of ROP and the type of feeding (breastfeeding vs. formula milk).

Results:

Out of 428 preterm babies 210 (49%) were males. More babies were between 32-34 weeks of gestation 229 (53.5%) as compared to < 32 weeks 199 (46.5%). Among all 428 preterm infants 19(4.4%) developed ROP. Majority 13 (68.4%) who developed ROP were <32 weeks of gestation (p=0.042). The mean birth weight of infants without ROP was 1.51± 0.36 kg (95%CI; 1.47-1.55), while it was 1.36 ± 0.29 kg (95%CI; 1.22-1.50) with ROP and all who developed ROP were < 2kg. The estimated odds ratio of developing ROP for breast fed versus top feeding was (ORs: 0.571, 95% CI; 0.222- 1.489). There was a trend toward lower incidence of ROP in the group of newborns who received breast-feeding (36.8%) as compared to top feeding (63.2%) but almost similar percentage who didn’t develop ROP were breast fed or top fed with statistically insignificant results (p= 0.24).

Conclusions:

Slightly lesser percentage of preterm babies who were breast fed developed retinopathy of prematurity.

Periconceptional folic acid supplementation and sex difference in prevention of neural tube defects and their subtypes in China: results from a large prospective cohort study

BACKGROUND

Folic acid (FA) supplementation is known to prevent neural tube defects (NTDs). We examined whether this preventive effect differs by the sex of the infant.

METHODS

Data were gathered from a large population-based cohort study in China that evaluated the effects of FA supplementation on NTDs. All births at 20 complete gestational weeks, including live births, stillbirths, and pregnancy terminations, and all NTDs, regardless of gestational age, were recorded. In a northern China province, a total of 30,801 singleton live births to women whose use of FA supplements during the first trimester was known at the time were included in the study. The birth prevalence of NTDs was classified by sex, subtype, and maternal FA supplementation. Male to female rate ratios [RR] and their 95% confidence intervals [CI] were calculated.

RESULTS

A total of 106 NTDs cases were recorded. The overall prevalence of NTDs was 2.5‰ among males and 4.4‰ among females; NTDs were less prevalent among males than among females (RR, 0.58; 95% CI, 0.54-0.63). There was a higher prevalence of anencephaly (RR, 0.34; 95% CI, 0.27-0.43) and spina bifida (RR, 0.73; 95% CI, 0.63-0.84) among females. However, FA supplementation led to significantly greater decreases in the rates of anencephaly (4.8‰) and total NTDs (7.6‰) in females than in males (1.6‰ and 2.8‰, respectively).

CONCLUSIONS

FA supplementation successfully reduces the prevalence of NTDs in both male and female infants, although we found a significantly greater decrease in anencephaly and total NTDs in females than in males. How the protective effects of FA supplementation affect the sexes differently needs to be studied further.

Asymptomatic Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: Extent and implications for infection control: A systematic review

Background

The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) emerged in 2012 and attracted an international attention as the virus caused multiple healthcare associated outbreaks. There are reports of the role of asymptomatic individuals in the transmission of MERS-CoV, however, the exact role is not known.

Method

The MEDLINE/PubMed and Scopus databases were searched for relevant papers published till August 2018 describing asymptomatic MERS-CoV infection.

Results

A total of 10 papers were retrieved and included in the final analysis and review. The extent of asymptomatic MERS infection had increased with change in the policy of testing asymptomatic contacts. In early cases in April 2012–October 2013, 12.5% were asymptomatic among 144 PCR laboratory-confirmed MERS-CoV cases while in 2014 the proportion rose to 25.1% among 255 confirmed cases. The proportion of asymptomatic cases reported among pediatric confirmed MERS-CoV cases were higher (41.9%–81.8%). Overall, the detection rate of MERS infection among asymptomatic contacts was 1-3.9% in studies included in this review. Asymptomatic individuals were less likely to have underlying condition compared to fatal cases. Of particular interest is that most of the identified pediatric cases were asymptomatic with no clear explanation.

Conclusions

The proportion of asymptomatic MERS cases were detected with increasing frequency as the disease progressed overtime. Those patients were less likely to have comorbid disease and may contribute to the transmission of the virus.

Pain Management Issues as Part of the Comprehensive Care of Patients with Sickle Cell Disease

BACKGROUND

Vaso-occlusive pain crisis is one of the primary complications of sickle cell disease (SCD) and is responsible for the majority of hospital visits in patients with SCD. Stints of severe pain can last for hours to days and are difficult to treat and manage, often resulting in drastically reduced quality of life.

PURPOSE

Our purpose is to provide an overview of pain management issues in SCD populations.

METHODS

We explored literature using PubMed and Embase for the etiology and management of pain in SCD. Databases were searched employing the following terms: sickle cell, pain pathways, pain perception, pharmacological therapies, psychological therapies, physical therapies and genetics.

RESULTS

Pain in SCD can vary from acute to chronic (persistent) or mixed and understanding of the underlying mechanisms is important for proper pain management. Currently, there are many means of managing pain in children with SCD, which involve pharmacological and non-pharmacological approaches. A combination of psychotherapy and pain medications can be used for treatment of pain and other psychosocial co-morbidities in complex persistent pain.

CONCLUSIONS

Providing more appropriate medication and optimal dosage based on individual's genomic variations is the future of medicine, and this will allow the physicians to hone in on optimal pain management in patients with SCD.

Experiences with the Mass Distribution of LPG Stoves in Rural Communities of Ghana

Household air pollution (HAP) is a leading cause of morbidity and mortality worldwide. To limit HAP exposure and environmental degradation from biomass fuel use, the Government of Ghana promotes liquefied petroleum gas (LPG) use in rural Ghana via the Rural LPG program (RLP). We assessed the experiences of the RLP in 2015, 2 years after its launch. A mixed methods approach was used involving Focus Group Discussions (19) and in-depth interviews (25). In addition, a survey questionnaire was administered to elicit socio-demographic characteristics, household cooking practices and stove use patterns of 200 randomly selected respondents. At about 9 months after LPG acquisition, < 5% of LPG beneficiaries used their stoves. Some of the reasons ascribed to the low usage of the LPG cookstoves were financial constraints, distance to LPG filling point and fear of burns. Community members appreciate the convenience of using LPG. Our results underscore a need for innovative funding mechanisms contextualized within an overall economic empowerment of rural folks to encourage sustained LPG use. It emphasizes the need for innovative accessibility interventions. This could include establishing new LPG filling stations in RLP beneficiary districts to overcome the barriers to sustained LPG use.

Paediatric appendiceal ultrasound: a survey of Australasian sonographers' opinions on examination performance and sonographic criteria

INTRODUCTION

The objectives of this study were to identify knowledge gaps and/or perceived limitations in the performance of paediatric appendiceal ultrasound by Australasian sonographers. We hypothesised that: sonographers' confidence in visualising the appendix in children was poor, particularly outside predominantly paediatric practice; workplace support for prolonging examinations to improve visualisation was limited; and the sonographic criteria applied in diagnosis did not reflect contemporary literature.

METHODS

A cross-sectional survey of Australasian sonographers regarding paediatric appendicitis was conducted using a mixed methods approach (quantitative and qualitative data). Text responses were analysed for key themes, and quantitative data analysed using chi-square, Mann-Whitney U and Wilcoxon signed-rank tests.

RESULTS

Of the 124 respondents, 27 (21.8%) reported a visualisation rate of less than 10%. Workplace support for extending examination time was significantly related to a higher appendix visualisation rate (χ2 (2) = 16.839, P < 0.001). Text responses reported frustration locating the appendix and a desire for more time and practice to improve visualisation. Sonographers suggested a significantly lower maximum diameter cut-off in a 5-year-old compared to a 13-year-old (Z = -6.07, P < 0.001), and considered the presence of inflamed peri-appendiceal mesentery as the most useful sonographic criterion in diagnosing acute appendicitis.

CONCLUSIONS

Respondents had a low opinion of their ability to confidently identify the appendix. Confidence was greater in those centres where extending scanning time was encouraged. Application of echogenic mesentery as the most significant secondary sonographic criterion is supported by recent studies. Opinions of diameter cut-offs varied, indicating potential for improved awareness of recent research.

The umbilical cord, preeclampsia and the VEGF family

Introduction

The VEGF family has been identified as abnormal in preeclampsia (PE). Hypertensive disorders of pregnancy (HDP) are major contributors to maternal and neonatal morbidity and mortality worldwide; likewise, umbilical cord anatomical abnormalities (UCAA) are linked to poor neonatal outcomes. Based on the relationship described between PE and UCAA and the role of the VEGF family in PE, this study explored VEGF expression in placental and UC tissued from patients with PE and with UCAA.

Methods

We performed an observational, analytical study on placentas, comparing protein and mRNA expression in four groups: patients with PE, patients with UC abnormalities, patients with both, and patients with none of them. Using immunohistochemistry, we studied VEGF A, VEGF R1 (FLT1), MMP1, and PLGF. With quantitative reverse transcription polymerase chain reaction we described mRNA expression of PLGF, VEGF and sFLT1, and sFLT1/PLGF ratio.

Results

Forty newborns were included. Sixty-seven percent of mothers and 45% of newborns developed no complications. Immunohistochemistry was performed on UC and placental disc paraffin-embedded tissue; in the latter, the mRNA of the VEGF family was also measured. Statistically significant differences were observed among different expressions in both HDP and UCAA groups. Interestingly, the UCAA group exhibited lower levels of sFLT1 and VEGF-A in comparison with other groups, with significant P-value for sFLT1 (P=0000.1).

Conclusion

The origin of UCAA abnormalities and their relation with HDP are still unknown. VEGF family alterations could be involved in both. This study provides the first approach related to molecules linked to UCAA.

Temporal patterns of circulating cell-free DNA (cfDNA) in a newborn piglet model of perinatal asphyxia

Perinatal asphyxia is a severe medical condition resulting from oxygen deficiency (hypoxia) at the time of birth, causing worldwide approximately 680,000 newborn deaths every year. Better prediction of severity of damages including early biomarkers is highly demanded. Elevated levels of circulating cell-free DNA (cfDNA) in blood have been reported for a range of different diseases and conditions, including cancer and prematurity. The objective of this study was to validate methods for assessing cfDNA in blood and cerebrospinal fluid (CSF) and to explore temporal variations in a piglet model of neonatal hypoxia-reoxygenation. Different cfDNA extraction methods in combination with cfDNA detection systems were tested, including a fluorescent assay using SYBR Gold and a qRT-PCR-based technique. Newborn piglets (n = 55) were exposed to hypoxia-reoxygenation, hypoxia-reoxygenation and hypothermia, or were part of the sham-operated control group. Blood was sampled at baseline and at post-intervention, further at 30, 270, and 570 minutes after the end of hypoxia. Applying the fluorescent method, cfDNA concentration in piglets exposed to hypoxia (n = 32) increased from 36.8±27.6 ng/ml prior to hypoxia to a peak level of 61.5±54.9 ng/ml after the intervention and deceased to 32.3±19.1 ng/ml at 570 minutes of reoxygenation, whereas the group of sham-operated control animals (n = 11) revealed a balanced cfDNA profile. Animals exposed to hypoxia and additionally treated with hypothermia (n = 12) expressed a cfDNA concentration of 54.4±16.9 ng/ml at baseline, 39.2±26.9 ng/ml at the end of hypoxia, and of 41.1±34.2 ng/ml at 570 minutes post-intervention. Concentrations of cfDNA in the CSF of piglets exposed to hypoxia revealed at post-intervention higher levels in comparison to the controls. However, these observations were only tendencies and not significant. In a first methodological proof-of-principle study exploring cfDNA using a piglet model of hypoxia-reoxygenation variations in the temporal patterns suggest that cfDNA might be an early indicator for damages caused by perinatal asphyxia.

Accuracy of real-time delivery room resuscitation documentation

OBJECTIVE

To assess the accuracy of real-time delivery room resuscitation documentation.

DESIGN

Retrospective observational study.

SETTING

Level 3 academic neonatal intensive care unit.

PARTICIPANTS

Fifty infants with video recording of neonatal resuscitation.

MAIN OUTCOME MEASURES

Vital sign assessments and interventions performed during resuscitation. The accuracy of written documentation was compared with video gold standard.

RESULTS

Timing of initial heart rate assessment agreed with video in 44/50 (88%) records; the documented heart rate was correct in 34/44 (77%) of these. Heart rate and oxygen saturation were documented at 5 min of life in 90% of resuscitations. Of these, 100% of heart rate and 93% of oxygen saturation values were correctly recorded. Written records accurately reflected the mode(s) of respiratory support for 89%-100%, procedures for 91%-100% and medications for 100% of events.

CONCLUSION

Real-time documentation correctly reflects interventions performed during delivery room resuscitation but is less accurate for early vital sign assessments.

What role do family composition and functioning play in emotional and behavioural problems among adolescent boys and girls?

OBJECTIVES

The aim was to explore the associations of family composition, family support and communication with emotional and behavioural problems among adolescents as well as a possible moderating effect of gender on these associations.

METHODS

Data from the Health Behaviour in School-aged Children study conducted in 2014 in Slovakia were used. The final sample consisted of 2908 students (mean age 14.36; 49.7% boys). We explored the association using generalized linear models.

RESULTS

We found that non-intact family was significantly associated with a higher score in emotional and behavioural problems. Family support and communication were found to be significantly associated with a lower score in emotional and behavioural problems. Significant interactions of gender and family communication with emotional and behavioural problems were found, showing that family communication decreased emotional and behavioural problems only in girls.

CONCLUSIONS

Family composition, family support and communication play an important role in the occurrence of emotional and behavioural problems in adolescence. Family communication lowers these problems only in girls. Prevention and intervention programmes could be focused on parent-child communication strategies with the importance of differences in the needs of boys and girls.

Behavioural and emotional issues among primary school pupils with congenital colour vision deficiency in the Federal Territory of Kuala Lumpur, Malaysia: A case-control study

Background: Congenital colour vision deficiency (CCVD) is an untreatable disorder which has lifelong consequences. Increasing use of colours in schools has raised concern for pupils with CCVD. This case-control study was conducted to compare behavioural and emotional issues among age, gender and class-matched pupils with CCVD and normal colour vision (NCV). Methods: A total of 1732 pupils from 10 primary schools in the Federal Territory of Kuala Lumpur were screened, of which 46 pupils (45 males and 1 female) had CCVD. Mothers of male pupils with CCVD (n=44) and NCV (n=44) who gave consent were recruited to complete a self-administered parent report form, Child Behaviour Checklist for Ages 4-18 (CBCL/ 4-18) used to access behavioural and emotional problems. The CBCL/ 4-18 has three broad groupings: Internalising, Externalising and Total Behaviour Problems. Internalising Problems combines the Withdrawn, Somatic Complaints and Anxiety/ Depression sub constructs, while Externalising Problems combines the Delinquent and Aggressive Behaviour sub constructs. Results: Results from CBCL/ 4-18 showed that all pupils from both groups had scores within the normal range for all constructs. However, results from the statistical analysis for comparison, Mann-Whitney U test, showed that pupils with CCVD scored significantly higher for Externalising Problems (U=697.50, p=0.02) and Total Behaviour Problems (U=647.00, p= 0.01). Significantly higher scores were observed in Withdrawn (U=714.00, p=0.02), Thought Problems (U=438.50, p<0.001) and Aggressive Behaviour (U=738.00, p=0.04). Odds ratios, 95% CI, showed significant relative risk for high Total Behaviour Problem (OR:2.39 ,CI:1.0-5.7), Externalising Problems (OR:2.32, CI:1.0-5.5), Withdrawn (OR:2.67, CI:1.1-6.5), Thought Problems (OR:9.64, CI:3.6-26.1) and Aggressive Behaviour (OR:10.26, CI:3.4-31.0) scores among pupils with CCVD. Conclusion: Higher scores among CCVD pupils indicates that they present more behavioural and emotional problems compared to NCV pupils. Therefore, school vision screenings in Malaysia should also include colour vision to assist in the early clinical management of CCVD children.

The Relationship between Body Composition and a Gluten Free Diet in Children with Celiac Disease

The primary and proven therapy, in cases of celiac disease (CD), is a rigorous gluten-free diet (GFD). However, there are reports of its negative effects in the form of nutritional deficiencies, obesity, and adverse changes in body composition. The study aimed to assess the impact of a GFD on the body composition of children with CD. In a case-controlled study (n = 41; mean age 10.81 y; SD = 3.96) children with CD, in various stages of treatment, underwent medical assessment. The control group consisted of healthy children and adolescents, strictly matched for gender and age in a 1:1 case-control manner. More than half of the examined children (n = 26) followed a GFD. CD children had significantly higher mean values of the fat free mass (FFM% = 80.68 vs. 76.66, p = 0.015), and total body water (TBW% = 65.22 vs. 60.47, p = 0.012), and lower mean values of the fat mass (FM% = 19.32 vs. 23.34, p = 0.015). Children who were on a GFD presented slightly higher, but not statistically significant, mean values of FM and FFM, than children who did not follow dietary recommendations (FM [kg] = 7.48 vs. 5.24, p = 0.064; FM% = 20.81 vs. 16.73, p = 0.087; FFM [kg] = 28.19 vs. 22.62, p = 0.110). After minimum one year of a GFD, CD children showed significantly higher values of FFM [kg] (p = 0.001), muscle mass (MM) [kg] (p < 0.001), TBW [L] (p < 0.001) and body cell mass (BCM) [kg] (p < 0.001). Furthermore, CD children who were on a GFD presented a significantly higher increase in weight (p = 0.034) and body mass index (BMI) (p = 0.021). The children adhering to a GFD demonstrate a tendency towards higher indices of selected body composition components.

Birthplace is a risk factor for exchange transfusion in outborn infants admitted for jaundice in Myanmar: a case-control study

Aim: To evaluate the role of pathway to admission for jaundice among the risk factors for exchange transfusion in outborn infants in a low resource setting.Methods: This retrospective case-control study (1:1 ratio) was carried out at the Yankin Children's Hospital in Yangon (Myanmar). All cases were neonates admitted for treatment of jaundice between March 2013 and February 2014 and who required an exchange transfusion. Each control was the next noncase neonate admitted for treatment of jaundice and treated with phototherapy. Infant characteristics, pathways of admission and clinically relevant factors for exchange transfusion were collected.Results: One hundred thirty-four cases and 134 controls were included in the study. Among cases, home was the most common place of birth while public hospital was the most frequent source of referral. Among controls, private/public hospitals were the commonest places of birth and referral. At multivariable analysis, homebirth was associated with increased likelihood of receiving exchange transfusion at admission (OR 3.30, 95% C.I. 1.31-8.56).Conclusion: Homebirth was an independent risk factor for exchange transfusion at admission for jaundice in a low-resource setting. Appropriate health education of pregnant women and traditional/home birth attendants may contribute to reduce the need for exchange transfusion in low-resource settings.

Association of Exclusive Breastfeeding with Risk of Obesity in Childhood and Early Adulthood

OBJECTIVE

To explore the effects of exclusive breastfeeding and its duration on the development of childhood and early adulthood obesity.

MATERIALS AND METHODS

A random sample of 5,125 dyad children and their mothers was extracted from a national database. With the use of a standardized questionnaire, telephone interviews were carried out for the collection of maternal lifestyle factors (e.g., breastfeeding). The body mass index was determined based on International Obesity Task Force criteria. Body weight and height of the offspring at the age of 8 was calculated from measurements derived from the national database, while the corresponding body measurements at early adulthood were self-reported.

RESULTS

Mothers who had breastfed or exclusively breastfed ≥6 months were 22.4% and 15.2%, respectively. Exclusive breastfeeding ≥6 months (versus never) was associated with a lower risk of overweight in childhood (8 years old; odds ratio [OR] = 0.89; 95% confidence interval [95% CI], 0.82-0.96) and adolescence/adulthood (15-25 years old; OR = 0.83; 95% CI, 0.68-0.97). Also, exclusive breastfeeding ≥6 months (versus never) was associated with a decreased risk of childhood and adolescence obesity by 30% (95% CI, 0.54-0.91) and 38% (95% CI, 0.40-0.83), respectively.

CONCLUSIONS

Exclusive breastfeeding had a favorable influence on offspring's overweight and obesity not only in childhood but also in adolescence/adulthood.

Comparative study of computed tomography of normal and lymphoid follicular hyperplasia thymus in myasthenia gravis patients

The aim of the present study was to evaluate the thymuses of non-thymomatous myasthenia gravis (MG) patients by computed tomography (CT) for differentiating lymphoid follicular hyperplasia (LFH) thymus from normal/involuted thymus in order to assist surgeons in determining whether a non-thymomatous MG patient requires an operation. In the present retrospective review over 10 years, 80 patients who received CT scan and thymectomy at the Affiliated General Hospital of Tianjin Medial University (Tianjin, China) were included. According to the pathological records, 54 of the cases initially detected on CT were confirmed as LFH thymus. Thymic measurements, including anteroposterior and transverse dimensions, width (the longest axis of the lobe on a transverse scan) and thickness (the largest dimension perpendicular to the long axis of the lobe) and CT attenuation of the thymus region, adipose tissue and chest wall musculature in each CT slice were included to assess differences between the LFH group and the normal/involuted thymus group. Although a negative association between patient age and the CT attenuation of the thymus region was identified (r=-0.779, P<0.05, Pearson's correlation test), the LFH thymus group featured nodular changes on CT, while no such changes were observed in the normal/involuted thymus group. The mean age of disease onset in the LFH thymus group was significantly lower than that in the normal thymus group (40.2±17.3 vs. 59.2±9.3 years). Furthermore, significant differences in CT attenuation were identified between the LFH group and the normal/involuted thymus group [-41.21±54.42 vs. -108.23±8.72 Hounsfield units (HU) on unenhanced CT; -25.57±58.65 vs.-117.40±6.22 HU on contrast-enhanced CT]. In the LFH group, the difference in mean CT attenuation between the thymus region and adipose tissue was significant, while no significant difference was observed in the normal/involuted thymus group. In conclusion, CT may be used to distinguish LFH thymus from normal/involuted thymus in MG patients.

Sex differences in the prevalence of neural tube defects and preventive effects of folic acid (FA) supplementation among five counties in northern China: results from a population-based birth defect surveillance programme

OBJECTIVES

Sex differences in prevalence of neural tube defects (NTDs) have previously been recognised; however, the different susceptibility of men and women have not been examined in relation to the effects of folic acid (FA) supplementation. We hypothesised that FA may have a disproportionate effect that alters the sex-specific prevalence of NTDs.

SETTING

Data from two time points, before (2003-2004) and after (2011-2016) the start of the supplementation programme, were obtained from a population-based birth defect surveillance programme among five counties in northern China. All live births (28 or more complete gestational weeks), all stillbirths of at least 20 weeks' gestational age and pregnancy terminations at any gestational age following the prenatal diagnosis of NTDs were included.

PARTICIPANTS

A total of 25 249 and 83 996 births before and after the programme were included respectively.

PRIMARY AND SECONDARY OUTCOME MEASURES

The prevalence of NTDs by sex and subtype, Male:female rate ratios and their 95% CI were calculated.

RESULTS

Overall, NTDs were less prevalent among men than among women (rate ratio (RR) 0.92; 95% CI 0.90 to 0.94), so was anencephaly (RR 0.77; 95% CI 0.73 to 0.81) and encephalocele (RR 0.75; 95% CI 0.61 to 0.92), while spina bifida showed a male predominance (RR 1.10; 95% CI 1.05 to 1.15). The overall prevalence of NTDs decreased by 78/10 000 in men and 108.7/10 000 in women from 2003 to 2004 to 2011 to 2016. There was a significant sex difference in the magnitude of reduction, being greater in women than men, particularly for anencephaly.

CONCLUSIONS

The prevalence of NTDs decreased in both sexes after the implementation of a massive FA supplementation programme. While female predominance was observed in open NTDs and total NTDs, they also had a greater rate of decrease in NTDs after the supplementation programme.

Late Relapse of Ovarian Germ Cell Tumour

BACKGROUND

Malignant ovarian germ cell tumours typically require multimodal therapy including surgery and systemic platinum-based chemotherapy. Most patients are cured, with survival rates exceeding 95%.

CASE

This report describes an unusual case of ovarian germ cell tumour (GCT) recurring 15 years after surgery and manifesting as metastatic disease to the liver, lung, and retroperitoneal lymph nodes.

CONCLUSION

Thymic hyperplasia was a confounding finding in this case, and it should be considered in the differential diagnosis of a mediastinal mass in heavily treated patients with GCT.

Impact of bariatric surgery on outcomes of patients with celiac disease: a nationwide inpatient sample analysis, 2004-2014

Background

While patients with celiac disease have increasingly developed an atypical pattern of weight gain and obesity, the role of bariatric surgery remains unclear. The primary aim of this study was to evaluate the effect of bariatric surgery on clinical outcomes among hospitalized patients with celiac disease.

Methods

The United States Nationwide Inpatient Sample database was queried for discharges with co-diagnoses of morbid obesity and celiac disease between 2004 and 2014. The primary outcome was in-hospital mortality. Secondary outcomes included renal failure, urinary tract infection, malnutrition, sepsis, pneumonia, respiratory failure, thromboembolic events, strictures, micronutrient deficiency, length of stay, and hospitalization costs. Using Poisson regression, adjusted incidence risk ratios (IRR) were derived for clinical outcomes in patients with prior bariatric surgery compared to those without bariatric surgery.

Results

Among 1499 patients with a discharge diagnosis of celiac disease and morbid obesity, 126 patients (8.4%) underwent bariatric surgery. Despite an increase in morbid obesity over the study period, the proportion of morbidly obese patients with celiac disease who had bariatric surgery declined by 18.5% (P_trend<0.05). On multivariable analysis, bariatric surgery did not influence mortality (P=0.98), but was associated with a lower risk of renal failure, pneumonia, sepsis, urinary tract infection and respiratory failure (all P<0.05). Bariatric surgery increased the risk of vitamin D deficiency (IRR 3.5; 95% confidence interval [CI] 1.6-7.7; P=0.002) and post-operative strictures (IRR 3.3; 95%CI 1.5-7.5; P=0.004).

Conclusion

Despite the underutilization of bariatric surgery in morbidly obese celiac disease patients, the procedure is safe and appears to significantly reduce morbidity.

E-cigarettes-An unintended illicit drug delivery system

Since the introduction of electronic cigarettes (e-cigarettes) in 2003, the technology has advanced allowing for greater user modifications, with users now able to control voltage, battery power, and constituents of the e-cigarette liquid. E-cigarettes have been the subject of a growing body of research with most research justifiably focused on the chemical makeup and risk analysis of chemicals, metals, and particulates found in e-cigarette liquids and vapor. Little research to date has focused on assessing the risks associated with the drug delivery unit itself and its potential for use as an illicit drug delivery system. In light of this, a range of illicit drugs was researched focusing on pharmacodynamics, usual method of administration, the dosage required for toxicity, toxic effects, and evidence of existing use in e-cigarettes in both literature and online illicit drug forums. A systematic literature search found evidence of current use of e-cigarettes to vape almost all illicit drug types analyzed. This presents both a potential population health risk and a management issue for clinicians. It also raises the issue of policing illicit drugs due to potential altered characteristic smells and storage within e-cigarette fluids. E-cigarettes are a viable illicit drug delivery system with evidence both inside and outside of the formal medical literature detailing their potential use for drug delivery of a wide range of illicit and legal drugs.

Community Mental Health Providers' Beliefs About Addressing Weight Loss Among Youth Clients with Serious Emotional Disturbance and Overweight/Obesity: An Elicitation Study

Youth with Serious Emotional Disturbance (SED) have high rates of overweight/obesity. Factors influencing mental health provider intentions to deliver weight-related advice are unclear. This study used qualitative methodology and Theory of Planned Behavior (TPB) constructs to examine these factors. Community mental health providers serving youth with SED were recruited via convenience sampling and an online provider list. Participants completed an open-ended TPB-based questionnaire online. Content analysis identified thematic beliefs. Twenty-one providers completed the questionnaire. Providers identified behavioral beliefs (e.g., client defensiveness), normative beliefs (e.g., medical professionals), and control beliefs (e.g., limited resources) that impact decisions to provide weight-related advice. Knowledge of factors that may influence providers' delivery of weight-related advice may lead to more effective healthy lifestyle programming for youth with SED.

A comparison of levetiracetam and phenobarbital for the treatment of neonatal seizures associated with hypoxic-ischemic encephalopathy

PURPOSE

Seizures are common in term infants with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia. Although phenobarbital (PHB) is generally considered first-line therapy, some centers have embraced third-generation antiepileptic drugs (AEDs) such as levetiracetam (LEV) given the impression of comparable efficacy and superior tolerability. We set out to compare the efficacy of PHB and LEV in a large single-center cohort.

METHODS

We retrospectively identified consecutive newborns with HIE who were monitored with continuous video-electroencephalogram (VEEG) for the duration of therapeutic hypothermia. After identification of seizures, infants were treated with PHB or LEV at the discretion of treating physicians. We assessed time to seizure freedom as a function of AED choice, with adjustment for HIE severity and initial seizure frequency using the Kaplan-Meier procedure and multivariate Cox proportional hazards regression.

RESULTS

We identified 78 infants with HIE. Among 44 (56%) patients who had VEEG-confirmed seizures, 34 became seizure-free during monitoring, and the remaining 10 died. Initial treatment with LEV, in comparison with PHB, predicted a shorter interval to seizure freedom in a univariate analysis (Hazard ratio (HR) = 2.58, P = 0.007), even after adjustment for initial seizure frequency and an unbiased ad hoc measure of HIE severity (adjusted HR = 2.57, P = 0.010). This effect was recapitulated in an analysis in which patients with treatment crossover were excluded. As expected, severity of HIE was an independent predictor of longer duration to seizure freedom (HR = 0.16, P < 0.001) and remained a significant predictor after adjustment for initial seizure burden and treatment agent.

CONCLUSION

Despite a relatively small sample size and retrospective design, this study suggests that LEV is a viable alternative to PHB in the treatment of neonatal seizures associated with HIE. A large-scale randomized controlled trial is needed to confirm these findings.

Pediatric Liver Tumors

Although liver tumors are rare in the pediatric population, they are common in the setting of children with specific risk factors requiring increased awareness and, in some instances, screening. The evaluation of a liver mass in children is largely driven by the age at diagnosis, the presence of any medical comorbidities, and initial testing with alpha fetoprotein and imaging. Specific guidelines for the management of different tumors have been implemented in recent years such that a multidisciplinary approach is ideal and care should be provided by centers with experience in their management.

Evidence of Human Parvovirus B19 Infection in the Post-Mortem Brain Tissue of the Elderly

After primary exposure, the human parvovirus B19 (B19V) genome may remain in the central nervous system (CNS), establishing a lifelong latency. The structural characteristics and functions of the infected cells are essential for the virus to complete its life cycle. Although B19V has been detected in the brain tissue by sequencing PCR products, little is known about its in vivo cell tropism and pathogenic potential in the CNS. To detect B19V and investigate the distribution of its target cells in the CNS, we studied brain autopsies of elderly subjects using molecular virology, and optical and electron microscopy methods. Our study detected B19V in brain tissue samples from both encephalopathy and control groups, suggesting virus persistence within the CNS throughout the host’s lifetime. It appears that within the CNS, the main target of B19V is oligodendrocytes. The greatest number of B19V-positive oligodendrocytes was found in the white matter of the frontal lobe. The number was significantly lower in the gray matter of the frontal lobe (p = 0.008) and the gray and white matter of the temporal lobes (p < 0.0001). The morphological changes observed in the encephalopathy group, propose a possible B19V involvement in the demyelination process.

Activation of the interferon type I response rather than autophagy contributes to myogenesis inhibition in congenital DM1 myoblasts

Congenital myotonic dystrophy type 1 (CDM1) is characterized by severe symptoms that affect patients from birth, with 40% mortality in the neonatal period and impaired skeletal muscle development. In this paper, we examined the relationship between autophagy and abnormal myogenic differentiation of CDM1 myoblasts. We investigated these pathological features at both ultrastructural and molecular levels, utilizing two CDM1 foetal myoblasts, CDM13 and CDM15, with 1800 and 3200 repeats, respectively. The congenital nature of these CDM1 myoblasts was confirmed by the high methylation level at the DMPK locus. Our results indicated that abnormal autophagy was independent of myogenic differentiation, as CDM13 myoblasts differentiated as well as control myoblasts but underwent autophagy like CDM15, displaying impaired differentiation. miRNA expression profiles revealed that CDM15 myoblasts failed to upregulate the complex network of myo-miRNAs under MYOD and MEF2A control, while this network was upregulated in CDM13 myoblasts. Interestingly, the abnormal differentiation of CDM15 myoblasts was associated with cellular stress accompanied by the induction of the interferon type 1 pathway (innate immune response). Indeed, inhibition of the interferon (IFN) type I pathway restores myogenic differentiation of CDM15 myoblasts, suggesting that the inappropriate activation of the innate immune response might contribute to impaired myogenic differentiation and severe muscle symptoms observed in some CDM1 patients. These findings open up the possibility of new therapeutic approaches to treat CDM1.

MERS coronavirus outbreak: Implications for emerging viral infections

In September 2012, a novel coronavirus was isolated from a patient who died in Saudi Arabia after presenting with acute respiratory distress and acute kidney injury. Analysis revealed the disease to be due to a novel virus which was named Middle East Respiratory Coronavirus (MERS-CoV). There have been several MERS-CoV hospital outbreaks in KSA, continuing to the present day, and the disease has a mortality rate in excess of 35%. Since 2012, the World Health Organization has been informed of 2220 laboratory-confirmed cases resulting in at least 790 deaths. Cases have since arisen in 27 countries, including an outbreak in the Republic of Korea in 2015 in which 36 people died, but more than 80% of cases have occurred in Saudi Arabia.. Human-to-human transmission of MERS-CoV, particularly in healthcare settings, initially caused a ‘media panic’, however human-to-human transmission appears to require close contact and thus far the virus has not achieved epidemic potential. Zoonotic transmission is of significant importance and evidence is growing implicating the dromedary camel as the major animal host in spread of disease to humans. MERS-CoV is now included on the WHO list of priority blueprint diseases for which there which is an urgent need for accelerated research and development as they have the potential to cause a public health emergency while there is an absence of efficacious drugs and/or vaccines. In this review we highlight epidemiological, clinical, and infection control aspects of MERS-CoV as informed by the Saudi experience. Attention is given to recommended treatments and progress towards vaccine development.

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2220 laboratory-confirmed cases of MERS-CoV resulting in at least 790 deaths since 2012

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MERS-CoV is on the WHO list of priority blueprint diseases

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Zoonotic and human-to-human transmission modes need further clarification.

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No specific therapy has yet been approved.

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There is a need for well-controlled clinical trials on potential direct therapies.