Folic Acid Supplementation Inhibits Proliferative Retinopathy of Prematurity

BACKGROUND

Retinopathy of prematurity (ROP) is the major cause of blindness in children. It is a biphasic disease with retinal vessel growth cessation and loss (Phase I) followed by uncontrolled retinal vessel growth (Phase II). Folate is an essential nutrient for fetal development and growth. Premature infants have a high risk for folate deficiency. However, the contribution of folate to ROP risk remains unknown.

METHODS

In mouse oxygen-induced retinopathy (OIR), the nursing dams were fed with a folic acid-deficient or control diet after delivery until the end of hyperoxia. Alternatively, pups received direct injection of either folic acid or vehicle during Phase I hyperoxia. Genes involved in the folate cycle and angiogenic responses were examined using real-time PCR. Total retinal folate levels were measured with the Lactobacillus casei assay.

RESULTS

Maternal folic acid deficiency in early life exacerbated pathological retinal vessel growth, while supplementation with folic acid suppressed it. Genes involved in the folate cycle were downregulated in Phase I OIR retinas and were highly expressed in Müller glia. Folic acid reduced pro-angiogenic signaling in cultured rat retinal Müller glia in vitro.

CONCLUSIONS

Appropriate supplementation of folic acid might be a new and safe treatment for ROP at an early stage.

Understanding the adult and adolescent patient experience with cyclic vomiting syndrome: a concept elicitation study

BACKGROUND

Cyclic vomiting syndrome (CVS) is a phasic disorder of gut-brain interaction characterized by episodes of severe nausea and vomiting. In-depth qualitative research on phase-specific CVS symptoms and impacts is lacking. The study objectives were to explore the experience of patients with CVS in the United States and to identify CVS symptoms and impacts on adults, adolescents, and caregivers.

METHODS

Qualitative, cross-sectional, semi-structured concept elicitation interviews were conducted with adults and adolescents with CVS and with adolescents' caregivers. Adolescents either participated alone or in a dyad format with their caregiver. Interview data were analyzed using an open coding approach.

RESULTS

Concept elicitation interviews were conducted with 13 adults (mean age 45.3 years [standard deviation (SD) 13.1]) and 15 adolescents (mean age 14.6 years [SD 1.8]). The most frequently reported prodrome phase symptoms were nausea (n = 12, 92.3%), anxiety (n = 10, 76.9%), and abdominal pain (n = 9, 69.2%) in adults, and nausea (n = 15, 100%), abdominal pain (n = 11, 73.3%), and headache (n = 11, 73.3%) in adolescents. All adults reported nausea, tiredness, and dry heaves in the emetic phase, and 12 (92.3%) reported vomiting and retching. The remaining patient said they no longer vomited due to abortive medications. All adolescents reported nausea and vomiting in the emetic phase; other common emetic phase symptoms were abdominal pain (n = 14, 93.3%), dehydration (n = 13, 86.7%), and tiredness (n = 13, 86.7%). The leading most bothersome impact reported by adults was anxiety associated with impending vomiting (n = 5, 38.5%). Among adolescents, the leading most bothersome impact was on school (n = 7/13 asked, 53.8%), and among their caregivers, it was seeing their child suffer (n = 6/11 asked, 54.5%).

CONCLUSIONS

Patients with CVS experience considerable gastrointestinal and extra-intestinal symptoms. CVS impacts the activities of daily life of patients and their caregivers, with patients reporting negative effects of CVS on their emotional status and their ability to maintain a normal school or work routine.

Association between constipation and insufficient dietary intake to achieve satiety in preschool age

Background: Few studies have explored the relationship between constipation and not eating enough to feel satiety. Aim: The study aims to examine the association between constipation and not eating enough to feel satiety. Methods: This cross-sectional study included 189 children 3 to 6 years of age. Constipation was defined as two or fewer defecations per week. To assess the satiety of children, mothers were asked, "Does your child eat until he/she is full every day?" The response options were as follows: "eats every day," "eats occasionally," "neither eats every day nor eats occasionally," "does not eat much," or "does not eat at all." "Eats every day" was defined as eating enough to feel satiety. The other four responses were defined as not eating enough to feel satiety. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a logistic regression analysis. Results: Thirty-nine (20.6%) children had constipation and 112 (59.3%) children did not eat enough to feel satiety. The association between constipation and not eating enough to feel satiety was significant. The crude OR of constipation for children who did not eat enough to feel satiety was 2.25 (95% CI 1.02-4.96). After adjusting for sex and age, the OR was 2.15 (95% CI 1.01-4.98). After further adjustment for underweight and overweight, the OR was 2.11 (95% CI 0.94-4.76). Conclusion: Not eating enough to feel satiety was associated with constipation independent of sex and age.

Early Life Determinants of Overweight and Obesity in a Sample of Mexico City Preschoolers

INTRODUCTION

Childhood obesity is a growing public health problem with long-term consequences. Understanding the early contributing factors is crucial for prevention and early intervention. This study explored the influence of breastfeeding, birth weight, gestational age, parental education, and sex on body mass index (BMI) during infancy.

METHODS

Standardized weight and height measurements of children followed a common World Health Organization protocol. Information on sex, gestational age, birth weight, breastfeeding practices and duration, family income, and mother's educational level, as well as other sociodemographic factors, was collected from clinical records. Linear regression models were calculated.

RESULTS

This study analyzed factors associated with overweight and obesity in 286 children under 5 years of age, using data from daycare records. Several significant associations were found. Regarding breastfeeding, while 85% of children received breast milk, only 23% did so exclusively for at least six months. Although no significant difference was observed in BMI change between exclusive and partial breastfeeding groups between birth and 5 years of age, the duration of exclusive breastfeeding, the birth BMI, and the educational level predicted 54% of the variability in BMI percentile change from birth to two years (p = 0.001). In addition, girls showed significantly longer exclusive breastfeeding. Regarding gestational age, preterm infants showed a significantly greater increase in BMI percentile compared to term infants. Gestational age also proved to be a significant factor in explaining BMI variability up to 5 years of age. Regarding sex, at age 5, boys showed a significantly higher prevalence of overweight and obesity than girls. With respect to family income, no statistically significant difference was found in BMI change between birth and 2 years of age; however, this variable warrants further investigation in future studies with greater statistical power. Finally, birth BMI was a significant predictor of BMI variability at 5 years of age.

CONCLUSIONS

In this study, gestational age, sex, birth BMI, and the duration of exclusive breastfeeding were the most important determinants of BMI and the prevalence of overweight and obesity in children up to 5 years of age. Further studies are needed to thoroughly explore the role of family income and other factors.

Toward Understanding and Halting Legacies of Trauma

Echoes of natural and anthropogenic stressors not only reverberate within the physiology, biology, and neurobiology of the generation directly exposed to them but also within the biology of future generations. With the intent of understanding this phenomenon, significant efforts have been made to establish how exposure to psychosocial stress, chemicals, over- and undernutrition, and chemosensory experiences exert multigenerational influences. From these studies, we are gaining new appreciation for how negative environmental events experienced by one generation impact future generations. In this review, we first outline the need to operationally define dimensions of negative environmental events in the laboratory and the routes by which the impact of such events are felt through generations. Next, we discuss molecular processes that cause the effects of negative environmental events to be initiated in the exposed generation and then perpetuated across generations. Finally, we discuss how legacies of flourishing can be engineered to halt or reverse multigenerational influences of negative environmental events. In summary, this review synthesizes our current understanding of the concept, causes, and consequences of multigenerational echoes of stress and looks for opportunities to halt them.

Future anxiety and the motives for postponing parenthood: generational time perspective and life satisfaction as mediators

Introduction

Research to date has focused largely on the consequences of delayed parenting. However, little is known about the reasons and relevant mechanisms that are involved in people's decisions to delay parenthood. The aim of our study was to verify how anxiety about the future relates to the motives for deferred parenthood and how this relationship is mediated by generational time perspective and life satisfaction.

Methods

A total of 203 Polish adults between 18 and 40 years of age participated in the study. All of them were of reproductive age but did not yet have children. Respondents completed the following questionnaires: The Dark Future Scale, The Multidimensional Scale of Motives for Postponing Parenthood, The Generational Time Perspective Questionnaire, and The Riverside Life Satisfaction Scale.

Results

The results obtained in the study show that future anxiety correlates significantly and positively with all six motives for postponing parenthood, postponed parenthood overall, and generational affectivity. It is also associated with the generational cognitive perspective at the level of tendency, and negatively with life satisfaction. According to our findings, in all seven models, at least one of the factors mediated the relationship between future anxiety and motives for postponing parenthood/its total score.

Conclusion

The current study advances the understanding of how the subjective future time perspective is related to delayed parenthood through generational concern and reduced life satisfaction. Our findings may indicate that despite the importance of sociodemographic variables in postponing parenthood (e.g., lack of housing, financial instability, acquiring knowledge, education, etc.), variables related to personality and time perspective play a very important role in postponing the decision to have a child.

The Efficacy and Safety of Simultaneous Vaccination with Polysaccharide Conjugate Vaccines Against Pneumococcal (13-Valent Vaccine) and Haemophilus influenzae Type b Infections in Children with Juvenile Idiopathic Arthritis Without Systemic Manifestations: A Prospective Cohort Study

Background: Immunosuppressive therapy (methotrexate and biological agents) for juvenile idiopathic arthritis (JIA) is associated with an increased risk of severe infections, higher infection rates, treatment interruptions, failure to achieve disease remission, and recurrent disease flares. Our study aimed to evaluate the safety and efficacy of simultaneous immunization with 13-valent polysaccharide conjugate vaccines (PCV13) against S. pneumoniae (SP) and Hemophilus influanzae type b infections (HibV) in children with JIA without systemic manifestations. Methods: A total of 371 non-systemic JIA patients who received 13PCV and HibV were included in this prospective cohort study. In every patient, we evaluated clinical, laboratory, anti-SP, and anti-Hib IgG antibodies before vaccination, three weeks after, and six months after, and all adverse events (AEs) were collected during the study. The number and duration of acute respiratory infection (ARI) episodes and requirements for antibacterial treatment and AE six months before and after the baseline were collected. Results: The levels of the Ig G anti-SP and anti-Hib antibodies increased in the 3 weeks after vaccination; then, anti-SP antibodies slightly decreased and anti-Hib antibodies remained increased during the whole study, as well as in a part of the patients with a protective titer. During the study, there were no patients with significant flares, and the main JIA outcomes gradually decreased during the trial. The number of patients with uveitis remained equal, as well as the part of the patients with active, low-active, and inactive uveitis. There was no significant rise in the hs-CRP or S100 protein after the vaccination. Previous or ongoing treatment with non-biological (p = 0.072) and biological (p = 0.019) disease-modified anti-rheumatic drugs affected the Hib and did not affect the anti-SP protective titer at the end of the study. Within 6 months following vaccination, the number of ARI episodes (p < 0.001) and the number of courses of antibacterial treatment (p < 0.0001) decreased twice. The median duration of ARI episodes decreased four times (p < 0.0001). Mild AEs (injection site reactions and short-term fever episodes) were found in 58 (15.6%) patients with JIA, and 1 patient (0.2%) developed an SAE. Conclusions: Simultaneous vaccination against pneumococcal and Hib infections reduces the frequency and duration of episodes of ARI, as well as the number of courses of antibacterial drugs, and does not lead to significant JIA flares. The number of reported AEs is consistent with what was expected.

Phytoconstituents of Hericium erinaceus Exert Benefits for ADHD Conditions by Targeting SLC6A4: Extraction, Spectroscopic Characterization, Phytochemical Screening, In Vitro, and Computational Perspectives

Attention-deficit/hyperactivity disorder (ADHD) is a persistent neurodevelopmental disorder. Despite pharmacological interventions, there is a need for effective lead molecules and therapeutic targets. Recently, Hericium erinaceus (HE) has been traditionally reported to treat various diseases. Herein, we aimed to explore the noncytotoxic properties, phytochemical composition, and spectroscopic characterization of HE aqueous extract. Additionally, we used computational workflows to identify key therapeutic targets for ADHD and assess HE extract phytoconstituents for potential targeting. Initially, the HE aqueous extract was obtained using Soxhlet extraction, and its cytotoxicity was assessed on SH-SY5Y cells using MTT assays. FTIR spectroscopy characterized the extract's functional groups, while biochemical methods and GC-MS identified its phytochemical constituents. A protein-protein interaction network identified ADHD targets, and molecular docking, dynamics, and QM/MM calculations were used to find potential drug candidates from the HE extract. As a result, the HE extract exhibited no cytotoxicity in SH-SY5Y cells across concentrations (0.625 to 10 μg/mL) after 24 h. FTIR spectroscopic analysis detected 13 different functional groups that hold diverse biological importance. Qualitative phytochemical screening revealed the presence of carbohydrates, flavonoids, anthocyanins, tannins, alkaloids, saponins, steroids, and phenolic compounds. GC-MS profiling identified 17 diverse metabolites. Simultaneously, ADHD-related genes and known therapeutic protein targets were integrated into a network, identifying SLC6A4 as a hub target. Molecular docking of HE extract compounds showed myo-inositol's high binding efficiency (-6.53 kcal/mol). Dynamic simulations demonstrated stable interactions, and QM/MM analysis confirmed myo-inositol's ability to transfer electrons, reinforcing its interaction potential. Overall, the HE aqueous extract shows a potent nontoxic profile and contains phytoconstituents like myo-inositol, offering promising therapeutic potential by targeting SLC6A4 for ADHD.

Family correlates of behavioral problems among adolescents in Rwanda

BACKGROUND

Globally, 20% of adolescents exhibit behavioral problems. Behavioral problems are associated with individual and environmental factors. However, little is known about the contribution of the nuclear family to the development of behavioral problems in adolescents from sub-Saharan Africa. This study aimed to explore family-based correlates influencing behavioral problems among adolescents in Rwanda.

METHODS

With an institutional-based cross-sectional study design, a convenience sample of 158 participants {107 males and 51 females; Mean age (M) = 16.96, Standard Deviation (SD) = 1.86; age ranging from 13 to 23 years} was selected in secondary schools in the Nyarugenge district. Participants filled out Behavioral Problems Scale (BPS), Child and Adolescent Trauma Screen (CATS), University of California, Los Angeles Loneliness Scale (UCLA Loneliness Scale), Multidimensionality of Perceived Social Support Scale (MSPSS), Multidimensional Neglectful Behavior Scale (MNBS), and Paediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q) to record pertinent scores. Socio-demographic information was also collected. SPSS version 24 was used for statistical analysis.

RESULTS

Females exhibited more behavioral problems than males. Child and adolescent trauma (β = 0.705, t = 8.21, p < .001) and neglect (β = 0.147 t = 2.15, p < .05) were two significant family correlates in our sample. Poor quality of life enjoyment and satisfaction, loneliness, and poor parental perceived social support were not identified as family-based factors that influence behavioral problems in our sample.

CONCLUSIONS

Results highlighted the importance of implementing family and community-based interventions to sustain family well-being, change parenting behaviors, and help children and adolescents adopt positive behaviors.

Community Caregivers' Perspectives on Health IT Use for Children With Medical Complexity: Qualitative Interview Study

BACKGROUND

Children with medical complexity represent a unique pediatric population requiring extensive health care needs and care coordination. Children with medical complexities have multiple significant chronic health problems that affect multiple organ systems and result in functional limitations and high health care needs or use. Often, there is a need for medical technology and total care for activities of daily living, much of which is provided at home by family and caregivers. Health IT (HIT) is a broad term that includes various technologies, such as patient portals, telemedicine, and mobile health apps. These tools can improve the care of children with medical complexity by enhancing communication, information exchange, medical safety, care coordination, and shared decision-making. In this study, we identified children with medical complexity as children aged <21 years who have >3 chronic health conditions. Community caregivers contribute to the care management of children with medical complexity, serving as advocates and coordinators, primary sources of information about children's needs, and facilitators of access to care. They are often the first point of contact for the families of children with medical complexity, particularly in vulnerable communities, including families in rural areas, low-income households, and non-English-speaking immigrant populations.

OBJECTIVE

This study aims to introduce the HIT needs and preferences for children with medical complexity from the perspective of community caregivers. By including their perspective on HIT development, we can better appreciate the challenges they face, the insights they offer, and the ways in which they bridge gaps in care, support, and resources.

METHODS

We conducted semistructured interviews (n=12) with formal community caregivers of children with medical complexity populations from a parent advocacy network on the US East Coast. Interviews were audio recorded via Zoom and then transcribed. An inductive thematic analysis was conducted to reveal HIT challenges and preferences for improving the care of children with medical complexity.

RESULTS

We categorized the interview results into themes and subthemes. There are four main themes: (1) telehealth transforming care for children with medical complexity during the COVID-19 pandemic, (2) suggested tools and technologies for care for children with medical complexity, (3) HIT feature preferences, and (4) transition to adult care. Each theme had multiple subthemes capturing all details related to design features of needed technologies.

CONCLUSIONS

The study emphasizes the need to develop and enhance HIT for the care of children with medical complexity. The identified themes can serve as design guidelines for designers by establishing a foundation for user-centered HIT tools to effectively support children with medical complexity and their families. Telehealth and mobile health apps could improve care management and quality of life for children with medical complexity.

Dentofacial deformities as independent predictors of sleep disorders: a cross-sectional study of young adults

BACKGROUND

Sleep disorders (SDs), a public health concern, can lead to critical physiological conditions, and are associated with mental and behavior problems such as psychosocial stress, smoking, alcohol consumption, etc. This study aimed to investigate the cross-sectional associations between dentofacial deformities and sleep quality in young adults in China.

METHODS

Data were collected from 2,479 young adults (aged 17-25 years) enrolled at Fudan University across various regions of China. Participants completed a self-reported questionnaire that included general information and the Pittsburgh Sleep Quality Index (PSQI) under standardized guidance. Dentofacial characteristics were examined by experienced orthodontists. Data analysis employed one-way ANOVA, student's t-test, chi-square tests, and multivariable logistic regression models.

RESULTS

The study revealed a median PSQI score of 5.92 ± 1.66, with 16.3% of participants classified as SDs. Higher PSQI scores were reported by females, underweight individuals, and participants from southern regions. Among the subjects, 44.36% exhibited protruding profiles, 6.86% had concave profiles, and various dentofacial abnormalities were prevalent. Logistic regression analysis identified protruding lateral profiles (OR 1.93, 95% CI 1.18-3.16, p = 0.008) and anterior crossbite (OR 1.44, 95% CI 1.01-2.04, p = 0.043) as significant risk factors for SDs. Additionally, reduced anterior overbite was associated with a higher prevalence of SDs, while deep overbite acted as a protective factor. Moderate overbite demonstrated statistical significance (OR 0.51, 95% CI 0.35-0.76, p = 0.001).

CONCLUSION

These findings suggest a significant association between dentofacial characteristics and sleep quality in young adults. Protruding facial profiles and anterior crossbites were identified as independent predictors for SDs. These findings underscore the importance of screening for SDs in individuals with dentofacial deformities and highlight the potential benefits of early correction of such dentofacial abnormalities to reduce the risk of SDs in adulthood.

Clinical and Public Health Challenge of Handling Synthetic Cathinone and Cannabinoid Abuse in Pediatric Care: A Narrative Review

BACKGROUND

Synthetic cathinones and cannabinoids have emerged as significant public health concerns, particularly in pediatric populations. Marketed under deceptive names such as "bath salts" and "K2/Spice", these substances pose unique challenges due to their accessibility, potency, and unpredictable effects. This narrative review synthesizes evidence on the toxicological effects of synthetic cathinones and cannabinoids in pediatric patients, emphasizing clinical presentations, management challenges, and public health implications.

METHODS

A structured narrative review was conducted using PubMed and Scopus databases to identify peer-reviewed studies published between January 2010 and September 2024. The selected articles focus on neuropsychiatric, systemic, and management outcomes associated with these substances in individuals aged 0-18 years.

RESULTS

Five studies demonstrate that synthetic cathinones frequently cause seizures, sympathomimetic toxidrome (tachycardia, hypertension), and neuropsychiatric effects like paranoia and catatonia. Seven studies show synthetic cannabinoids induce psychosis, respiratory depression requiring ventilation in 12% of cases, and cardiovascular complications like myocardial ischemia. One study highlighted severe outcomes in pediatric accidental exposures, emphasizing the unpredictable and life-threatening effects of these substances, often exacerbated by co-ingestion with alcohol or THC.

CONCLUSIONS

Pediatric exposure to synthetic cathinones and cannabinoids results in severe and unpredictable toxicological effects, necessitating tailored clinical management strategies and enhanced diagnostic capabilities. Public health measures, including stringent regulatory controls, targeted education initiatives, and robust surveillance systems, are critical to mitigating these risks. A multidisciplinary approach is essential to safeguard vulnerable pediatric populations from the escalating dangers posed by synthetic drugs, and future research must address the long-term impacts and mechanisms of toxicity.

Ued F, Contini AA, Nogueira-de-Almeida ME, Martinez EZ, Ferraz IS, Del Ciampo LA, Nogueira-de-Almeida CCJ, Fisberg M. Nutritional Factors and Therapeutic Interventions in Autism Spectrum Disorder: A Narrative Review

Objective: To explore recent findings on how nutritional, gastrointestinal, social, and epigenetic factors interact in autism spectrum disorder, highlighting their implications for clinical management and intervention strategies that could improve development and quality of life of affected children. Sources: Studies published from 2000 to 2024 in the PubMed, Web of Science, Scopus, Scielo, Lilacs, and Google Scholar databases were collected. The process for the review adhered to the Search, Appraisal, Synthesis, and Analysis framework. Summary of the findings: Children with autism spectrum disorder have restrictive eating habits and often exhibit food selectivity with either hyper- or hypo-sensory characteristics. This review provides an overview of the literature on diagnosis and intervention strategies for selectivity in autism spectrum disorder, including the involvement of family members in meals, sharing a healthy diet and positive relationship with food, and the importance of exploring visual, olfactory, and tactile experiences of food and introducing new foods through play activities to expand the food repertoire. Modifications in the microbiota and gastrointestinal disorders may also be present in autism spectrum disorder and are presented due to their frequent nutritional repercussions. The medium and long-term implications of food preferences and behavior issues for nutritional status are also discussed, given the tendency for children with autism spectrum disorder to consume low-quality and energy-dense foods, leading to nutritional problems. Conclusions: Children with autism spectrum disorder have feeding difficulties, especially selectivity, gastrointestinal problems, changes in the microbiota and can evolve with micronutrient deficiencies, malnutrition and obesity. This review describes the evidence for possible targets for interventions aiming to improve nutritional health for children with autism spectrum disorder.

Evaluating the reflux suppression properties of Gaviscon Infant powder with different milk formulations using an in vitro model of the infant stomach

Gastroesophageal reflux (GER) is common in babies and infants and is characterized by effortless regurgitation (with or without vomiting), which is a common symptom of other infant conditions, including cow's milk protein allergy (CMPA). Various milk formulations are commercially available to help manage GER and CMPA symptoms (extensively hydrolyzed [eHF], partially hydrolyzed [pHF], and amino-acid formulas [AAF]). We aimed to understand if an alginate product (Gaviscon Infant powder) worked as intended in the presence of different milk formulations. A previously evaluated artificial infant stomach model simulated an internal pressure-inducing reflux event (five reflux events performed at 5 min intervals). Suppression activity of Gaviscon Infant combined with eHF, pHF, and AAF was assessed by measuring the height that the refluxate event traveled up a tube mimicking the infant esophagus, alongside a benchmark unhydrolyzed formulation (uHF) with Gaviscon Infant and a negative control without Gaviscon Infant. Each experiment was repeated six times per formulation in a random order. Gaviscon Infant combined with each milk formulation produced a lower height of refluxate versus the negative control. When formulations combined with Gaviscon Infant were grouped by category (eHF, pHF, AAF), two or more products from each category showed a lower refluxate height than the benchmark (uHF). There was a significant difference in median refluxate height (p = 0.0011 in Wilcoxon rank sum test) when comparing Gaviscon Infant combined with eHF against Gaviscon Infant combined with pHF, AAF, or uHF (benchmark). Refluxate height did not change significantly between events one and five for each milk formulation combined with Gaviscon Infant. In an artificial infant stomach model, Gaviscon Infant combined with different milk formulations (uHF, eHF, pHF, AAF) produced a lower refluxate height compared with a negative control (uHF without Gaviscon Infant), suggesting that Gaviscon Infant suppresses reflux as intended when used with different milk formulations.

Paliperidone-Induced Massive Asymptomatic Creatine Kinase Elevation in Youth: From a Case Report to Literature Review

BACKGROUND/OBJECTIVES

Unlike rhabdomyolysis and neuroleptic malignant syndrome (NMS), massive asymptomatic creatine kinase elevation (MACKE) represents a condition commonly detected during routine screening in patients receiving antipsychotic drugs. In particular, current evidence indicates a greater incidence of this condition in patients without signs of NMS, rhabdomyolysis, or other causes of CK increase during exposure to second-generation antipsychotics (SGAs) than first-generation antipsychotics (FGAs) with a variable onset and duration. Although its pathophysiology is still not fully elucidated, MACKE has usually been recognized as a self-limiting condition, but drug discontinuation might also be required to successfully revert it. Overall, knowledge in this field is mainly extrapolated from adult data, while similar evidence in youths is still limited. As clinicians might often deal with MACKE, its understanding needs to be expanded to avoid misdiagnosis, potentially leading to wasteful healthcare spending and unfavorable patient outcomes.

METHODS

By reporting the first case of MACKE in an adolescent receiving an SGA, namely paliperidone, we also aimed to provide a comprehensive overview of this medical condition.

CONCLUSIONS

Making a MACKE diagnosis is essential since its relevant clinical and economic implications are mainly related to unnecessary closer laboratory monitoring or therapeutic changes (e.g., drug discontinuation or switch to another medication).

An interpretative phenomenological analysis of the experience of a nature-based therapy intervention for children with long-term health conditions and associated psychological difficulties

Children and young people (CYP) with long-term health conditions (LTC) are at higher risk of developing mental health difficulties. Research suggests nature-based therapeutic interventions (NBTIs) may benefit CYP's wellbeing, but less is known about the impact on CYP with LTC. This study's objective was to explore how CYP with LTC and associated psychological difficulties experienced a NBTI and the impact on their wellbeing. Ten participants aged 10-13 attended a NBTI and took part in semi-structured interviews that explored how they made sense of their journey through the intervention, its impact on mental, physical wellbeing and sense of self. An interpretative phenomenological analysis of the interview data yielded four group experiential themes: 'Overcoming Illness-Identity', 'Freedom to Choose', 'Sense of Connection' and 'A Mindful Presence'. Participants reported improved self-esteem, a deepened sense of belonging with peers and nature, and enhanced emotion regulation. Clinical implications and directions for future research are discussed.

The Role of Oxidative Stress in Autism Spectrum Disorder Pathophysiology, Diagnosis and Treatment

Autism spectrum disorder (ASD) is a significant health problem with no known single cause. There is a vast number of evidence to suggest that oxidative stress plays an important role in this disorder. The author of this article reviewed the current literature in order to summarise the knowledge on the subject. In this paper, the role of oxidative stress is investigated in the context of its influence on pathogenesis, the use of oxidative stress biomarkers as diagnostic tools and the use of antioxidants in ASD treatment. Given the heterogeneity of ASD aetiology and inadequate treatment approaches, the search for common metabolic traits is essential to find more efficient diagnostic tools and treatment methods. There are increasing data to suggest that oxidative stress is involved in the pathogenesis of ASD, both directly and through its interplay with inflammation and mitochondrial dysfunction. Oxidative stress biomarkers appear to have good potential to be used as diagnostic tools to aid early diagnosis of ASD. The results are most promising for glutathione and its derivatives and also for isoprostanses. Probably, complex dedicated multi-parametric metabolic panels may be used in the future. Antioxidants show good potential in ASD-supportive treatment. In all described fields, the data support the importance of oxidative stress but also a need for further research, especially in the context of sample size and, preferably, with a multicentre approach.

Imperative for long-term management and surveillance in Kawasaki disease

Kawasaki disease (KD) is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications. Despite the effectiveness of initial treatments, such as intravenous immunoglobulin, KD patients can experience long-term cardiovascular issues, as evidenced by a recent case report of an adult who suffered a ST-segment elevation myocardial infarction due to previous KD in the World Journal of Clinical Cases. This editorial emphasizes the critical need for long-term management and regular surveillance to prevent such complications. By drawing on recent research and case studies, we advocate for a structured approach to follow-up care that includes routine cardiac evaluations and preventive measures.

Length of hospital stay and its factor associated among neonates with perinatal asphyxia in the Northwest Amhara Region, Northwest Ethiopia 2023: a multicentre retrospective cross-sectional study

OBJECTIVE

To determine the length of hospital stay and related factors in newborns with perinatal asphyxia in comprehensive specialised hospitals in Northwest Ethiopia.

DESIGN

A multicentre institutional-based cross-sectional study.

SETTING

Tertiary hospitals in Northwest Amhara Regional State, Northwest Ethiopia, from 1 to 30 December 2023.

PARTICIPANTS

A total of 609 neonates with perinatal asphyxia were admitted to the neonatal intensive care unit of selected public hospitals in Northwest Amhara from September 2018 to October 2023.

OUTCOME MEASURES

Length of hospital stay and associated factors in newborns with perinatal asphyxia were noted.

RESULTS

A total of 609 newborns with perinatal asphyxia were included in this study. The mean hospital stay for the newborns was 13.9 days (coef=13.9, 95% CI 13.43 to 14.38), with minimum and maximum hospital stays of 4-28 days, respectively. Neonatal sepsis, AKI, hypoxic ischaemic encephalopathy, fetal macrosomia and prolonged labour were significantly associated with a longer hospital stay in neonates with perinatal asphyxia.

CONCLUSIONS

The current study indicated that the mean length of hospital stay in newborns with perinatal asphyxia was 13.9 days. Contributing factors to prolonged hospital stays include neonates with neonatal sepsis, prolonged second-stage labour, acute neonatal kidney injury stages 2 and 3 hypoxic ischaemic encephalopathy and fetal macrosomia. The length of hospital stay for neonates with perinatal asphyxia can be reduced by implementing appropriate standards of care.

The prevalence of and the effect of global stressors on eating disorders among medical students

Background

Eating disorders (EDs) are among the most serious forms of psychiatric illness, potentially leading to multi-systemic complications. Owing to their high stress levels, medical students are more likely to experience mental health difficulties that predispose them to developing EDs. Societal stigmatization and misinformation, especially in a middle eastern context, contribute to the underreporting and challenges in seeking the appropriate treatment at an early stage, increasing the risk of complications and mortality. EDs remain an under-studied phenomena in the middle east, limiting understanding and treatment options.

Objective

The objectives of the current study were to assess the prevalence of EDs, potential contributing factors, and the impact of the COVID-19 pandemic as an independent global stressor among medical students at the Arabian Gulf University.

Methods

This cross-sectional study consisted of a three-part self-administered questionnaire comprising of demographic data, the Eating Attitudes-26 (EAT-26) test, and COVID-19 associated stressors. The study was conducted on medical students at the AGU in the preparatory year up to Year 6. Data was collected from September 2022 to February 2023.

Results

Three hundred and ninety-seven students were recruited in the present study. 32.1% of the tested students demonstrated an elevated risk for developing EDs. Living situation, earlier years of study, and mental health status were significantly associated with increased risk. Response to global stressors such as COVID-19 pandemic was significantly correlated to worsening EDs status in high-risk individuals.

Conclusion

Eating disorders have been discovered to be highly prevalent among medical students, which brings to light an undervalued health concern. This warrants both awareness programs on campus, and the development of individual-tailored eating disorder treatment programs to halt progression and increase overall quality of life and education.

Neonatal skin antisepsis with alcohol-based compared to aqueous 2% chlorhexidine, used in moderate preterm infants or extremely preterm infants after the first week of life, is safe and may be associated with a reduced incidence of catheter-related bloodstream infections

BACKGROUND

Skin antisepsis is one of the most important bundle measures to decrease central line-related bloodstream infections (CRBSIs). However, in the neonatal population, the use of alcoholic chlorhexidine is limited by the risk of skin lesions.

OBJECTIVE

We hypothesised that skin antisepsis with alcohol-based 2% chlorhexidine instead of aqueous 2% chlorhexidine could reduce the incidence of CRBSI without increasing skin complications.

DESIGN

We conducted a double cohort study comparing two periods of 3 years, first using aqueous and second using alcohol-based chlorhexidine, leaving a 1-year washout interval between them. In extremely preterm infants, aqueous chlorhexidine was used during the first week of life in both periods.

RESULTS

A total of 1783 patients and 2493 episodes of central line catheter were analysed. There were no statistically significant differences in clinical and demographic data from infants in both periods. There was a significant reduction in the pooled incidence density of CRBSI in the second compared with the first period (4.03 vs 9.05 episodes/1000 central line days, OR 0.45 (95% CI 0.29 to 0.68)). The overall absolute risk reduction was 0.039 (95% CI 0.023 to 0.056) and the number needed to treat was 25. A similar but not significant reduction of the small number of CRBSI was observed in extremely preterm infants within the first week of life OR 0.43 (95% CI 0.134 to 1.379). No statistically significant differences in skin lesions were observed between periods, making erythema the most common injury(5.1% vs 4.2%).

RELEVANCE

Alcohol-based 2% chlorhexidine as a skin antiseptic could reduce the incidence of CRBSI in neonates without producing an increase in skin lesions.

Perinatal hypoxia augments contractile impact of NADPH oxidase-derived ROS in early postnatal rat arteries

BACKGROUND

 Reactive oxygen species (ROS), including those produced by NADPH oxidase (NOX), play an important vasomotor role, especially at early postnatal period. Mechanisms for regulating vascular tone can change significantly due to neonatal asphyxia and accompanying hypoxia. We tested the hypothesis that normobaric hypoxia (8% O2) for 2 h at the second day of life changes the functional contribution of NOX-derived ROS to the regulation of agonist-induced contraction in early postnatal rats.

METHODS

We studied saphenous arteries from 11- to 14-day-old male offspring using isometric myography and Western blotting and assessed the content of biochemical parameters in blood serum.

RESULTS

 The values of main biochemical parameters in blood serum and the protein content of NOXs and superoxide dismutases in arterial tissue did not differ between "Control" and "Hypoxia" pups. The NOX inhibitor VAS2870 equally reduced the contractile responses of arteries to α1-adrenoceptor agonist methoxamine in "Control" and "Hypoxia" pups, but its effect was more pronounced in the arteries from "Hypoxia" pups when vasocontraction was evoked by the agonist of thromboxane A2 receptors U46619.

CONCLUSION

 Perinatal hypoxia at the second day of life increases procontractile influence of NOX-derived ROS to the regulation of U46619-induced vasocontraction in the systemic arteries at early postnatal ontogenesis.

IMPACT

Nothing is known about programming effects of perinatal hypoxia, including birth asphyxia, on the ROS-mediated regulation of contraction in systemic arteries of early postnatal organism. 2-h normobaric hypoxia (8% O2) in rats at the second day of life increases the procontractile contribution of NOX-produced ROS to the regulation of U46619-induced vasocontraction in the systemic arteries at early postnatal ontogenesis. This fact may serve as a risk factor for the development of various disorders at later developmental stages and should be considered regarding the therapy for newborns who have suffered neonatal asphyxia.

EnvironMental Health: A Framework for an Emerging Field at the Intersection of the Environment and Mental Health Crises

Understanding how the environment shapes our mental and cognitive health is imperative to support efforts that promote healthy and sustainable living conditions. The etiology of mental health conditions remains often unclear, and social factors have received more scrutiny than natural or built environments. We present a conceptual framework illustrating the emerging intersection between the environment and neuropsychological health, intended to structure and guide research and funding, as well as public health and environmental initiatives. We conducted a scoping review of reviews of existing evidence on the impacts of the environment on mental and cognitive health. We found that an extensive body of work was focused on chemical hazards and the built environment and their associations with neurological and mental health, including attention-deficit/hyperactivity disorder (ADHD), autism, dementia, and mood. We identified emerging areas of research intersecting environmental factors such as air, water, light, and green space with schizophrenia and behavioral health. Our analysis of the intersections between the environment and mental and cognitive health allows for the identification of knowledge clusters and gaps, contextualizing needs and opportunities for future research and funding strategies. These significant connections showcase the importance of understanding the relationships between the environment and mental and cognitive health. With this work, we assert that the protection of the environment and its integration into healthcare can bring cascading benefits and synergies to mental and cognitive health and well-being and address the social and economic burden of the mental health crises.

Successful Use of Caffeine Citrate for Neonate With Bronchiolitis-Related Apnea: Case Report and Clinical Insights

To date, there is no clear evidence supporting the use of caffeine therapy in bronchiolitis-related apnea in pediatric intensive care units. Generalizing the approach for all bronchiolitis cases could be behind this limitation of the evidence. Here, we report a successful use of caffeine citrate for a neonate with bronchiolitis-related apnea. Understanding the limitations of case reports, we think being a neonate diagnosed with bronchiolitis-related apnea without respiratory distress, on top of a prematurity background, might be the key characteristic for this successful use.

Validation of the Postnatal Growth and Retinopathy of Prematurity (G-ROP) criteria in a Slovenian cohort

PURPOSE

To validate the Postnatal Growth and ROP (G-ROP) study criteria for retinopathy of prematurity (ROP) screening in a Slovenian cohort.

METHODS

We conducted a retrospective cohort study of preterm infants screened in 2021 at the University Medical Centre Ljubljana, Slovenia. The G-ROP criteria were systematically applied. Primary outcomes were sensitivity for ROP requiring treatment, sensitivity for any ROP, and reduction in the number of infants screened.

RESULTS

Of 102 infants screened, 27 (26.4%) developed ROP. Eleven infants (10.7%) had type 1 ROP, of whom 2 (1.9%) had aggressive ROP; 5 infants (4.9%) had type 2 ROP, and 11 (10.7%) had milder ROP. Using the original or simplified G-ROP criteria, all infants who developed type 1 ROP (sensitivity, 100% [95% CI, 74%-100%]), and all infants who developed ROP (sensitivity, 100% [95% CI, 88%-100%]) were correctly identified. Application of the original G-ROP criteria would have reduced the number of infants screened by 29.4% (30 of 102).

CONCLUSIONS

In our cohort, both the original and simplified G-ROP criteria showed 100% sensitivity for predicting ROP type 1 while reducing the number of unnecessary screenings. These results confirm the reliability of the G-ROP criteria in the Slovenian context and suggest that their use improves screening efficiency.

Predictive model of neurodevelopmental outcome in neonatal hypoxic ischemic encephalopathy

OBJECTIVES

To build an early, prognostic model for adverse outcome in infants with hypoxic ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH) based on brain magnetic resonance images (MRI), electrophysiological tests and clinical assessments were performed during the first 5 days of life.

METHODS

Retrospective study of 182 neonates with HIE and managed with TH. The predominant pattern of HIE brain injury on MRI performed following cooling was scored by neuroradiologists. The electroencephalogram (EEG) background and evoked potential (EP) response, were analyzed. Area under the curve (AUC) of these tools for adverse outcome including death and/or moderate disabilities using the Bayley-III at 36 months were calculated. A stepwise model approach was used to reach the final most efficient predictive model.

RESULTS

Of 182 neonates, 99 were male (54.4 %), with median gestational age of 39 weeks (IQR 38-40) and median weight of 3.3 kg (IQR 2.9-3.7). On admission, 47 (26 %), 104 (57 %) and 31(17 %) neonates presented with mild, moderate and severe encephalopathy respectively. In multivariate analysis of 129 infants who received all prognostic modalities, the predictive value of a model of EEG plus MRI, AUC = 84 %) is equivalent to models of EEG plus MRI with added EP and clinical assessment at discharge (AUC = 84 and 85 % respectively).

CONCLUSION

In the era of cooling for neonatal HIE, the combination of EEG background and MRI during the first few days of life, provide an objective and highly reliable model for prediction of death and long-term disabilities.

Simulated haemodynamic parameters and different infusion set-up affect drug delivery during syringe pump change over: A bench-top study in a laboratory setting

BACKGROUND

Infusion therapy is widely used in clinical settings, particularly in intensive care units.

AIM

to explore the influence of simulated cardiac output on "bolus" or "backflow" events that can occur during syringe pump changeover, considering several factors that have been previously outlined in published research. Syringe infusion pumps are commonly used for precise continuous intravenous drug delivery. Syringe pump changeover can be a challenging procedure.

METHODS

Bench-top study in a laboratory setting. An extracorporeal circuit was used to simulate a cardiac output of 5 l/min. The following variables were used: three levels of vertical position of the syringe pump (-50 cm, 0, +50 cm), three levels of Central Venous Pressure (-5, 10, and 15 mmHg), presence/absence of carrier infusion (5 ml/h), and presence/absence of a needle-free connector between the syringe and extension line.

RESULTS

A total of 108 syringe pump changes were performed with different combinations of the investigated variables. The mean time for syringe pump changeover was equal to 9.48 ± 2.45 s and the overall fluid displacement was 8 ± 40 µL (microlitres) (range, -262-156 µL). The CVP level and vertical position of the pump always statistically affected the overall displacement during syringe pump changeover. When a second infusion with an equal velocity rate to that of a syringe pump infusion is present in the same lumen, the presence of a needle-free device reduces the overall volume of displacement.

CONCLUSIONS

Syringe pump changeover can be a critical moment for patients when vasoactive drugs are administered.

IMPLICATIONS FOR CLINICAL PRACTICE

In a simulated environment with a cardiac output of 5 L/min, the CVP level and vertical position of the syringe pump generated bolus or backflow events during the syringe pump changeover. The application of carrier infusion appeared to intensify these phenomena. Employing a neutral, needle-free system can potentially aid in reducing the development of boluses or backflows.

Health-related quality of life association with sociodemographic characteristics among children under-five with Down syndrome in Western Region Secondary Care Hospitals, Saudi Arabia

Background

The Health-Related Quality of Life (HRQoL) of children with Down syndrome (DS) can be significantly affected by various physical, social, and cognitive elements. There is a scarcity of research on the HRQoL of Saudi children and its correlation with sociodemographic factors. Therefore, our objective was to evaluate the HRQoL of children under the age of 5 years with DS in the Western Region of Saudi Arabia.

Methods

The study included children under 5 years with DS who were receiving care at secondary care hospitals in Taif, Mecca, and Jeddah. The children were accompanied by their parents or caregivers, who provided sociodemographic and child-specific data as well as medical information. They completed a validated TNO-AZL Preschool Children Quality of Life (TAPQOL) questionnaire. The association between HRQoL and respondents' characteristics was assessed using independent samples t-test, ANOVA, Mann-Whitney, and Kruskal-Wallis tests. A multivariate linear regression analysis was conducted to examine the association between the TAPQOL scores and sociodemographic characteristics in children under the age of 5 years children with DS.

Results

A total of 460 responded to the questionnaire. The overall HRQoL score was high. The scores for physical functioning were relatively high, particularly for motor functioning (mean = 86.64) and skin health (mean = 85.68). In addition, social functioning exhibited a lower level, with a significant difference (mean = 25.29). The cognitive functioning scores exhibited variability, with communication scoring relatively high (mean = 76.68), while positive mood (mean = 19.51) and liveliness (mean = 21.25) were significantly low. There was a significant correlation between the educational level and occupation of both fathers and mothers and their HRQoL. Specifically, individuals with higher education and stable employment had better HRQoL scores. Parents' health also has an impact on HRQoL, with children of parents without comorbidities scoring higher. Furthermore, there was a significant association between higher sociodemographic levels of parents and improved HRQoL of the patients.

Conclusions

The level of HRQoL among children with DS was high, particularly in the physical and cognitive domains. The sociodemographic factors of parents, specifically the level of education and occupation of fathers, have been identified as essential factors influencing HRQoL. Providing increased economic and educational support for families has a significant positive impact on the quality of life for these children.

Imaging and endovascular management of haemoptysis in congenital heart disease

Haemoptysis, a rare but serious complication that can arise in patients with congenital heart disease, necessitates prompt diagnosis and specialized care. The radiologist plays a critical role in this scenario, including identifying the source of haemoptysis, devising treatment plans, and delivering endovascular interventions. This article highlights the importance of imaging techniques, especially computed tomography, in identifying the cause of haemoptysis and the therapeutic value of endovascular interventions. Furthermore, a suggested algorithmic approach is presented to assist with the diagnostic and management process.

PBMC transcriptome reveals an early metabolic risk profile in young rats with metabolically obese, normal-weight phenotype

Metabolically obese, normal-weight (MONW) phenotype is characterized by visceral adiposity and obesity-related complications despite the absence of excess body weight. Early identification of this phenotype is crucial to establish preventive strategies. We aim to validate the utility of peripheral blood mononuclear cells (PBMC) transcriptome to detect metabolic risk related to the MONW phenotype at early life stages (young adulthood). Male Wistar rats were pair-fed either standard (NW group) or a high-fat diet (MONW group) after weaning, until 3.5 months. Global gene expression was examined by microarray in PBMC, and specific genes of interest by RT-qPCR in PBMC and liver. Results were validated in adult 6-month-old MONW rats. Young MONW animals had similar weight to controls (NW group) but greater adiposity, including liver fat content, and insulin resistance signs. PBMC transcriptome distinguished clearly MONW from NW rats. Neurological pathways were affected in line with impaired cognition in these animals. Most top-regulated genes were related to inflammation, including the top-up and down-regulated genes, Hpgds and Slfn4. Expression of fatty liver-related genes like Mkrn1 and Nampt was also affected in PBMC of the young MONW group mirroring liver alteration. Slfn4 and Mkrn1 appeared as especially relevant biomarkers with altered expression also in PBMC of adult 6-month-old MONW rats. In conclusion, PBMC transcriptomic analysis emerges as a tool for identifying early biomarkers of obesity-related metabolic risk in young and apparently healthy (lean) subjects, pointing towards increased inflammation, liver fat deposition, and cognitive alterations.

Prenatal Methamphetamine Exposure Impairs Helping Behaviour in Male Offspring: The Possible Role of miR-223 and NLRP3 Inflammasomes in the Amygdala

The increasing prevalence of methamphetamine abuse among women, particularly pregnant females, is a global concern. Methamphetamine can readily cross anatomical barriers like the blood-placenta barrier and cause detrimental impacts on the growing fetus. The current research evaluated the effects of prenatal methamphetamine exposure on helping behaviour and neuroinflammatory cascade in the amygdala of male offspring. On the tenth day of pregnancy, female rats received either saline or methamphetamine (5 mg/kg) until delivery. Once the offspring reached 21 days of age, the male ones were sep arated from their mothers and housed with normal male rats. An empathy-like behaviour test, which measured helping behaviour towards the cage mate, was conducted. The expression levels of miR-223-3p, NLRP3, Caspase 1, and gasdermin D (GSDMD) were evaluated in the amygdala of male offspring. Moreover, interleukin-1β (IL-1β) protein level was measured. Findings of this study revealed that male offspring exposed to methamphetamine during pregnancy had impaired helping behaviour. At the molecular level, prenatal methamphetamine exposure decreased miR-223-3p and increased inflammasome signaling by raising the levels of NLRP3, caspase-1, and GSDMD along with IL-1β levels. These findings indicate that prenatal methamphetamine exposure impairs emotional behaviour and activates inflammasome pathway in the amygdala.

Nutrition support in children with medical complexity and chronic critical illness: A narrative review

Children with medical complexity (CMC) and children with chronic critical illness (CCI) represent growing populations with high healthcare use and dependence on specialized care, both in the hospital and community setting. Nutrition assessment and delivery represent critical components of addressing the short-term and long-term health needs for these populations across the care continuum. This article provides a framework and reviews existing literature for the assessment of nutrition status and subsequent delivery of nutrition prescriptions in CMC and children with CCI. The specific aims are to (1) describe the epidemiology of health services experience for CMC and children with CCI, with a focus on their nutrition outcomes; (2) detail how to assess their nutrition status and energy requirements; (3) review methods of delivery of the nutrient prescription; (4) introduce perioperative considerations; (5) highlight examples of special populations of CMC and children with CCI; and (6) propose future research initiatives to improve nutrition and overall outcomes for these populations.

Zinc as a potential prophylactic adjuvant therapy for prolonged hospitalization: A systematic review and meta-analysis of an umbrella of randomized controlled trials

AIMS

The present study evaluated the effect of oral zinc supplementation on shortening hospital length of stay.

METHODS

A systematic review was conducted for randomized control trials in patients who were hospitalized regardless of age and cause of admission. Studies were collected from PubMed, Web of Science, SCOPUS, and the Cochrane Library until July 2023. Results were compared between the zinc group and those who received a placebo and/or the standard therapy.

RESULTS

Eight studies were qualified for our meta-analysis. Of the 1267 patients, 633 and 634 were in the zinc supplementation and control groups, respectively. The meta-analysis found that oral zinc supplementation group experienced a lower length of hospital stay than the control group (mean difference, -0.43 days; 95% confidence interval, -0.65 to -0.22; P < 0.0001; heterogeneity, I2 = 20%).

CONCLUSION

The administration of oral zinc supplements was associated with a slightly reduced duration of hospital stay.

"When I became older, I started having to manage that more myself"-Experiences of adolescents with food allergies: A qualitative study

BACKGROUND

It's often caregivers or healthcare professionals' experiences that are studied in the field of allergy, but the adolescents' perspective is crucial to develop interventions that support them in areas they find most challenging. This study aims to explore adolescents' experience of managing food allergies, particularly how they navigate the transition from parental management to self-management.

METHODS

This is an interpretive descriptive qualitative study. Semi-structured interviews were conducted with ten adolescents with food allergies aged 12-16 years. Reflexive thematic analysis was conducted. The Reflexive Thematic Analysis Reporting Guidelines were used.

RESULTS

Four themes were generated, (1) belonging-seeing me, (2) not knowing (3) taking responsibility-"So I guess when I became older, I started having to manage that more myself" and (4) variation in coping strategies. These describe adolescents need for belonging, that their peers acknowledge their food allergies without making them feel like a burden. Adolescents understanding of essential food allergy information was lacking, with some unaware of this lack of knowledge. Adolescents were conscious of the need to take over responsibility from their parents, although this could be difficult. Finally, how adolescents coped with all these aspects of their food allergy could be seen as avoidant due to high anxiety, minimizing of risk, or adaptive, where adolescents are aware of and mitigate risks appropriately, without avoiding life experiences.

CONCLUSION

Adolescents find the transition of responsibility from their parents difficult. A trusted source of allergy information is required, aimed at adolescents, covering both physical allergy management and psychosocial content.

RETRAGAM: Resistance training based on gamification during physical education. Rationale and study protocol

Children's physical inactivity and increasing sedentary behaviour have become major public health concerns, with a concurrent decline in muscular fitness (MF) contributing to poor physical outcomes during childhood and adolescence, highlighting the importance of developing resistance training (RT) programs. Furthermore, several educational strategies such as gamification seem to increase students' motivation which can produce an increase in performance outcomes. This study describes the rationale and protocol of a school-based randomized controlled trial called "RETRAGAM" (REsistance TRAining based on GAMification). For this investigation, a total of ≃180 children (grades 5 and 6; 10-12 years of age) from 6 randomly selected schools in Valencia (Spain) will be enrolled for 8 weeks in one of the experimental groups: EG (15 min of RT Functional HIIT circuit program), EG + G (the same EG program but with a gamification approach) or CG (Control Group). Outcomes will include physical activity profile, MF, anthropometry and body composition, as well as the enjoyment and motivation during Physical Education (PE). An interactive app for digital devices will be used for gamified storytelling, earning points for personalized children's avatars, and implementing a flipped classroom learning model. We conclude that the RETRAGAM will provide information about the effectiveness and implementation of a school-based RT intervention during PE with and without gamification in students' MF, body composition, motivation and enjoyment.

Behavioral Phenotypes and Comorbidity in 3q29 Deletion Syndrome: Results from the 3q29 Registry

3q29 deletion syndrome (3q29del) is associated with a significantly increased risk for neurodevelopmental and neuropsychiatric disorders. However, the full spectrum of behavioral phenotypes associated with 3q29del is still evolving. Individuals with 3q29del (n = 96, 60.42% male) or their guardian completed the Achenbach Child or Adult Behavior Checklist (CBCL/ABCL) via the online 3q29 registry (3q29deletion.org). Typically developing controls (n = 57, 49.12% male) were ascertained as a comparison group. We analyzed mean performance on the CBCL/ABCL for individuals with 3q29del and controls across composite, DSM-keyed, and developmental scales; and the relationship between CBCL/ABCL performance and clinical and developmental phenotypes for individuals with 3q29del. Individuals with 3q29del showed significantly elevated behavioral and developmental impairment relative to controls across CBCL/ABCL domains. A substantial proportion of study participants with 3q29del scored in the Borderline or Clinical range for composite and DSM-keyed scales, indicating significant behavioral problems that may require clinical evaluation. We found that the preschool CBCL DSM-keyed autism spectrum problems scale is a potential screening tool for autism spectrum disorder (ASD) for individuals with 3q29del; CBCL/ABCL DSM-keyed scales were not accurate screeners for anxiety disorders or attention-deficit/hyperactivity disorder (ADHD) in our study sample. We identified a high degree of psychiatric comorbidity in individuals with 3q29del, with 60.42% (n = 58) of individuals with 3q29del scoring in the Borderline or Clinical range on two or more DSM-keyed CBCL/ABCL scales. Finally, we found that the degree of developmental delay in participants with 3q29del does not explain the increased behavioral problems observed on the CBCL/ABCL. The CBCL/ABCL can be used as screening tools in populations such as 3q29del, even in the presence of substantial psychiatric comorbidity. These results expand our understanding of the phenotypic spectrum of 3q29del and demonstrate an effective method for recruiting and phenotyping a large sample of individuals with a rare genetic disorder.

Administration time of caffeine in preterm infants: systematic review and meta-analysis

To assess the ideal time for caffeine administration in preterms, identifying its effects and safety. Study Design: Meta-analysis conducted including preterms <32 weeks GA or BW < 1500 g, comparing caffeine administration time: <24 x ≥24HOL, <48 x ≥48HOL, <72 x ≥72HOL. 18 studies included 76.998 patients. The median age of starting caffeine was the first 24 HOL. In the overall comparisons, there was reduction in patent ductus arteriosus (OR 0.71 [0.55, 0. 92]; low evidence), retinopathy of prematurity (OR 0.71 [0.54, 0.93]; moderate evidence), severe brain injury (OR 0.79 [0.70, 0.91]; moderate evidence), bronchopulmonary dysplasia (BPD) (OR 0.69 [0.59, 0.81]; moderate evidence), composite outcome of BPD or death (OR 0.76 [0.66, 0.88]; moderate evidence). Mortality increase was found (OR 1.20 [1.12, 1.29], very low evidence).Caffeine in the first 24 HOL has benefits in reducing morbidities associated with prematurity. Mortality finding is potentially due to survival bias.

Evaluation and management of pediatric refractory constipation: Recommendations from the NASPGHAN neurogastroenterology and motility committee

Refractory constipation (RC) in pediatric patients should be recognized as a distinct condition with long-term impacts on patient and family quality of life. RC requires a more targeted diagnostic evaluation and complex management strategy that may involve management by pediatric neurogastroenterology and motility specialists and multidisciplinary teams including surgeons. Currently, there is a lack of a clear definition, evaluation, and management strategies for RC. This is the first North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition position paper to address pediatric RC regarding its definition, evaluation, and management.

Real-time ultrasound to assess the umbilical catheter position in neonates: a randomized, controlled trial

OBJECTIVE

To compare real-time ultrasound (RT-US) use as an adjunct tool to verify umbilical catheter placement versus standard care without ultrasound.

STUDY DESIGN

Neonates requiring umbilical venous catheter (UVC) and umbilical artery catheter (UAC) placement were randomized into the standard formula (No-US) and the RT-US groups. X-rays were used to confirm the catheter position.

RESULT

Fifty and forty-nine neonates were in the RT-US and No-US groups, respectively. RT- US showed a significantly higher rate of initial X-ray-confirmed proper catheter position than No-US (p < 0.001). The rates of proper positions of UVCs and UACs were significantly higher in the RT-US group than in the No-US group (both p < 0.001). Neonates in the RT-US group required fewer catheter adjustments and subsequent X-rays than those in the No-US group.

CONCLUSION

RT-US enhances the accuracy of UVC and UAC placement, reduces catheter adjustments, and the number of X-rays required.

TRIAL REGISTRATION

TCTR20190622001.

HPA axis dysregulation and postpartum depression and anxiety symptoms in breastfeeding vs bottle-feeding parents

OBJECTIVE

Hypothalamic-pituitary-adrenal (HPA) axis dysregulation has been implicated in the pathogenesis of perinatal mood disorders. Further, HPA axis response is known to be blunted during breastfeeding. We hypothesized that 1) postpartum depression/anxiety symptoms would be associated with HPA axis dysregulation, indexed by loss of expected adrenocorticotropic hormone (ACTH)-cortisol coupling, and 2) this association would vary by method of infant feeding.

METHODS

Participants (N=222) intending to breastfeed were recruited in their 3rd trimester of pregnancy. During a lab visit at 2 months postpartum, depression and anxiety symptoms were assessed (Beck Depression Inventory score ≥14 and/or Speilberger State-Trait Anxiety Inventory score ≥40). Participants then breast or bottle-fed their infants as they would at home. After a 10-minute rest, participants completed the Trier Social Stress Test (TSST), a standardized stressor involving speech and math tasks. Blood ACTH and cortisol were measured 10 minutes after feeding, during each task, and at 10, 20, and 30 minutes of recovery. Multilevel models evaluated whether coupling of ACTH at time j with cortisol at time j+1 differed between those with and without depression/anxiety symptoms, and whether differences varied by feeding method.

RESULTS

Of 205 participants who completed the TSST, 44 had depression/anxiety symptoms at 2-months postpartum. Depression/anxiety symptoms were associated with reduced ACTH-cortisol coupling (adjusted beta: -0.03; p-value: 0.03). Among those who breastfed, those with depression/anxiety showed greater blunting of ACTH-cortisol coupling than those without (adjusted beta: -0.04; p-value: 0.02), while those who bottle-fed had similar coupling patterns regardless of depression/anxiety symptoms (adjusted beta: -0.01; p-value: 0.87).

CONCLUSION

HPA axis response was blunted in those with postpartum depression/anxiety symptoms, and blunting varied by method of infant feeding. Findings support HPA axis dysregulation in perinatal mood and anxiety disorders. Future research should explore how method of infant feeding influences the relationship between perinatal mood disorders and HPA axis dysregulation. Elucidating the mechanistic pathways underlying perinatal mood disorders can aid in the development of better diagnostic and treatment strategies.

The complexity of caffeine's effects on regular coffee consumers

Why does coffee wake us up? Is it because it contains caffeine, or because we are used to it waking us up after drinking it? To answer this question, we recruited twenty habitual coffee drinkers who received either caffeinated or decaffeinated coffee (placebo) in a double-blind, randomized fashion. The two substances were identical except for the presence of caffeine. We measured cognitive performance, cardiovascular responses, and whole-head EEG during rest and during an auditory-oddball task. The same measurements were done before and after ingestion. We expected to find significant differences between caffeine and placebo groups across the outcome measures. However, except for the resting-state alpha power, changes due to ingestion in physiological responses and in cognitive functioning were not significantly different between the two groups. Actually, only one of the three cognitive measures was found to be significantly altered by the ingestion. These findings suggest that regular coffee consumers respond to coffee-like beverages independently of the presence of caffeine.

Is maternal diabetes during pregnancy associated with neurodevelopmental, cognitive and behavioural outcomes in children? Insights from individual participant data meta-analysis in ten birth cohorts

BACKGROUND

Growing evidence shows that dysregulated metabolic intrauterine environments can affect offspring's neurodevelopment and behaviour. However, the results of individual cohort studies have been inconsistent. We aimed to investigate the association between maternal diabetes before pregnancy and gestational diabetes mellitus (GDM) with neurodevelopmental, cognitive and behavioural outcomes in children.

METHODS

Harmonised data from > 200 000 mother-child pairs across ten birth cohorts in Europe and Australia were available. Mother-child pairs were included for analysis to determine whether GDM was recorded (yes or no) and whether at least one neurodevelopmental, cognitive and behavioural outcome was available in children aged 3 to 13 years. Confounder-adjusted regression models were used to estimate associations between maternal diabetes and child outcomes using two-stage individual participant data (IPD) meta-analysis. Model 1 included a crude estimate. The full adjustment model (model 2) included adjustment for child sex, maternal age, pre-pregnancy BMI, pregnancy weight gain, maternal smoking during pregnancy, plurality, parity and maternal education.

RESULTS

Children (aged 7-10 years) born to mothers with GDM had higher attention-deficient hyperactive disorder (ADHD) symptoms compared to non-exposed controls (model 2, regression coefficient (β) 3.67 (95% CI 1.13, 6.20), P = 0.001). Moreover, children (aged 4-6 years) born to mothers with GDM exhibited more externalising problems than those born to mothers without GDM (model 2, β 2.77 (95% CI 0.52, 5.02), P = 0.01). A pre-existing maternal history of type 1 and type 2 diabetes mellitus was associated with ADHD symptoms at 4-6 years (model 1, β 8.82 (95% CI 2.21, 15.45, P = 0.009) and β 7.90 (95% CI 0.82, 14.98, P = 0.02), respectively). The association was no longer apparent in further adjustments.

CONCLUSIONS

This study found that children between 4 - 6 and 7-10 years of age born to mothers with GDM have a greater likelihood of developing externalising problems and ADHD symptoms, respectively. Externalising problems often co-exist with ADHD symptoms and precede formal ADHD diagnosis. Overall, this large-scale multi-cohort study suggested that a dysregulated metabolic environment during pregnancy may contribute to ADHD symptoms and externalising problems in young children.

Role of Kctd13 in modulating AR and SOX9 expression in different penile cell populations

OBJECTIVE

Micropenis is a condition with significant physical and psychological implications caused mainly by decreased androgen action in penile development. Kctd13-knockout (Kctd13-KO) mice have micropenis, cryptorchidism, and fertility defects because of reduced levels of androgen receptor (AR) and SOX9. We hypothesized that normalizing the levels of AR and SOX9 in the Kctd13-KO penis could help us to understand the mechanism of action of these signaling pathways on penile development.

METHODS

We generated transgenic mice lacking Kctd13 and conditionally expressing AR in the urethral mesenchyme after Cre activation with Twist2cre (Kctd13-KO; AR-CMV; Twist2cre; herein called AR+), and Sox9 in the urethral epithelium after Cre activation with Shhcre (Kctd13-KO; Sox9-CAG; Shhcre; herein called SOX9+). Mice penile morphology, fertility, and the effect of KCTD13 on AR and SOX9 ubiquitination were evaluated.

RESULTS AND DISCUSSION

Kctd13-KO micropenis phenotype was rescued after increasing levels of penile AR or SOX9 as transgenic AR+ and SOX9+ mice have longer penile lengths than Kctd13-KO mice and are comparable to WT mice. In addition, male-urogenital-mating-protuberance and the baculum were significantly shorter and narrower in Kctd13-KO mice compared with transgenic AR+ and SOX9+ mice. The position of the urethral meatus was similar and orthotopic in location in Kctd13-KO, AR+, SOX9+, and WT penises indicating that none of these mice had hypospadias. The subfertility of AR+ and SOX9+ mice was improved. The ectopic expression of KCTD13 in HEK293 cells strongly reduced AR ubiquitination which is abolished when the proteasome pathway is inhibited and this process is mediated by the ubiquitin ligase, STUB1. The effect of KCTD13 on SOX9 ubiquitination is minimal.

CONCLUSION

KCTD13 regulates AR ubiquitination by modulating STUB1 binding to AR. Penile restoration of AR and SOX9 improved penile development in Kctd13-KO mice allowing us to discern the contribution from individual signaling pathways and cell types in penile development.

Short- and Long-Term Nutritional Status in Children and Adolescents with Celiac Disease Following a Gluten-Free Diet: A Systematic Review

BACKGROUND/OBJECTIVES

Numerous studies have highlighted the nutritional imbalances that are commonly observed in children and adolescents diagnosed with celiac disease (CD) who follow a gluten-free diet (GFD). However, the development and timeline of these nutritional deficiencies remain unclear. The aim of the present study is to investigate the short-term (≥6 months to <12 months) and long-term (≥12 months) association between adherence to a GFD and nutrient intake as well as micronutrient blood status in children and adolescents aged from 0 to 18 years with CD.

METHODS

A systematic review was conducted in PubMed and Scopus for observational studies published up to June 2024.

RESULTS

A total of 15 studies (case-control, cross-sectional, and prospective studies) with 2004 children and adolescents were included. Their quality was assessed using the ROBINS-E tool. Despite the lack of high-quality data and the heterogeneity of the methods used in the included studies, the results of the cross-sectional/case-control studies show that, in the short term, children and adolescents with CD consumed excessive amounts of protein and carbohydrates compared to controls. After long-term adherence to a GFD, significant changes in the diets of children and adolescents with CD persisted. Fat intake was higher, while protein intake remained excessive compared to controls. Based on prospective studies, vitamin C and iodine intake improved both in the short and long term after adherence to a GFD. However, most other nutrients either remain inadequate or continue to decline, indicating that it is difficult to meet nutrient requirements despite dietary adjustments.

CONCLUSIONS

Gaps in adherence to dietary recommendations appear to be widespread in children and adolescents with CD, emphasizing the need for improved diet quality and regular monitoring.

Unraveling the Connections: Eating Issues, Microbiome, and Gastrointestinal Symptoms in Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by challenges in social communication, restricted interests, and repetitive behaviors. It is also associated with a high prevalence of eating disorders, gastrointestinal (GI) symptoms, and alterations in gut microbiota composition. One of the most pressing concerns is food selectivity. Various eating disorders, such as food neophobia, avoidant/restrictive food intake disorder (ARFID), specific dietary patterns, and poor-quality diets, are commonly observed in this population, often leading to nutrient deficiencies. Additionally, gastrointestinal problems in children with ASD are linked to imbalances in gut microbiota and immune system dysregulation. The aim of this narrative review is to identify previous associations between the gut-brain axis and gastrointestinal problems in ASD. We discuss the impact of the "microbiome-gut-brain axis", a bidirectional connection between gut microbiota and brain function, on the development and symptoms of ASD. In gastrointestinal problems associated with ASD, a 'vicious cycle' may play a significant role: ASD symptoms contribute to the prevalence of ARFID, which in turn leads to microbiota degradation, ultimately worsening ASD symptoms. Current data suggest a link between gastrointestinal problems in ASD and the microbiota, but the amount of evidence is limited. Further research is needed, targeting the correlation of a patient's microbiota status, dietary habits, and disease course.

The Impact of Sleep on Sensory Processing in Typically Developing Children: Insights from Cross-Sectional and Longitudinal Data

BACKGROUND/OBJECTIVES

Previous research suggests that sleep quality and duration may significantly impact sensory experiences, yet the specific relationships in healthy early childhood remain unclear. This study explores the relationship between sleep parameters and sensory processing outcomes in typically developing children followed longitudinally from 3 to 12 months to 4 years of age.

METHODS

We assessed sleep problems, sleep duration, sleep onset latency, parasomnias, and sensory processing in a sample of typically developing children (N = 85). Sleep parameters were reported by parents, and sensory processing was evaluated using the Sensory Processing Measure-Parent version (SPM-P). Cross-sectional and longitudinal analyses examined predictors of sensory outcomes based on sleep patterns at 3-12 months, 18 months, 2 years, and 4 years of age.

RESULTS

Our findings indicate that greater sleep problems correlate with heightened sensory sensitivity across modalities, including touch and vision, as well as higher-order cognitive functions such as planning and social interactions. Specifically, sleep problems at 18 months were significant predictors of sensory processing at 4 years, while sleep duration at 2 years predicted planning skills. Additionally, longer sleep duration during infancy (3-12 months) positively influenced social participation at 4 years.

CONCLUSIONS

This study underscores the critical role of sleep in shaping sensory processing outcomes in early childhood. Promoting healthy sleep habits may mitigate sensory processing difficulties, ultimately supporting emotional and social development.

Celiac Disease: Beyond Diet and Food Awareness

Celiac disease is attributable to a combination of genetic predisposition and exposure to dietary gluten, with immune system involvement. The incidence is increasing globally, and the societal economic burden of celiac disease stretches beyond the cost of gluten-free food. This enteropathy that affects the small intestine has been related to different disorders and comorbidities. Thus, the implications of suffering from this disease are multidimensional and need further consideration. Celiac disease is a serious condition that remains under-recognized, resulting in an increased need for programs for better management. This review aims to summarize the current evidence regarding celiac diseases, with special emphasis on clinical implications, diagnosis, dietary management, socioeconomical aspects, and future perspectives.

Up-flow anaerobic sludge blanket bioreactor for the production of carboxylates: effect of inocula on process performance and microbial communities

This research investigated the acidogenic fermentation (AF) of sugar cane molasses in an up-flow anaerobic sludge blanket (UASB) reactor for the production of carboxylates. The first step was to assess the optimum process temperature (25, 35 or 55 ºC) using two different granular inocula, one from a brewery company (BGS) and other from a paper plant company (PGS). These experiments determined that the most suitable temperature for carboxylates production was 25 ºC, obtaining higher bioconversions (27.3 ± 0.3% using PGS and 39.2 ± 0.2% using BGS), despite the low pH value recorded (4.0-4.2). Then, both inocula were tested in UASB reactors. As a consequence of the operational conditions (25 ºC, pH = 5.5-6, organic loading rate (OLR) = 3 gCOD·L-1·d-1 and hydraulic retention time (HRT) = 10 d), the microbial communities changed from those typical for biogas production to those specialised in the production of volatile fatty acids (VFAs). Indeed, the highest bioconversion efficiency (70.1%) was obtained with BGS, where uncultured Eubacteriaceae family microorganisms (56.0%) prevailed, enhancing the production of butyric acid (59.5 ± 2.4%w/w). Consequently, this inoculum was used to further identify the OLR threshold that should not be exceeded to attain optimal carboxylates production. OLR of 6 gCOD·L-1·d-1 resulted in a decrease in bioconversion efficiency (59.5%). The VFAs pool was dominated by butyric acid (63.0 ± 1.4%w/w at an OLR of 4.5 gCOD·L-1·d-1 and 52.8 ± 2.2%w/w at 6 gCOD·L-1·d-1). The microbial community became even more specialised, increasing the presence of Firmicutes and Actinobacteriota phyla, proving that the imposed conditions favoured the production of VFAs when operating semicontinuously fed UASB reactors.

Effects of a Gluten-Free Diet on Brain Bioelectrical Activity and Neurological Symptoms in Children with Celiac Disease: A Study Using EEG Assessment

Celiac disease (CeD), also known as gluten enteropathy, is an immune-mediated inflammatory enteropathy triggered by intolerance to gluten. It presents with a spectrum of symptoms, including both gastrointestinal and extraintestinal manifestations, as well as neurological symptoms. A review of the literature indicates that 10-22% of patients with CeD present with neurological symptoms. The objective of this study is to assess the influence of a gluten-free diet (GFD) on brain bioelectrical activity and neurological symptoms in children with CeD. Methods: The study was conducted using a multidisciplinary approach, encompassing a comprehensive array of clinical data gathered alongside laboratory test results, questionnaires, and electroencephalogram (EEG) assessments. The study population included 85 children: 18 newly diagnosed cases of CeD patients (NDC), subsequently reassessed after 6 months on a GFD as a celiac disease on diet (CDD); 27 CeD patients on a GFD for over 12 months (CDD2); and 40 healthy individuals in the comparison group (CG). Results: It was observed that over half of the NDC group exhibited neurological symptoms, particularly headaches. Following a six-month period on a GFD, there was a notable reduction in symptom severity. In comparison to the CG, the NDC patient group exhibited a higher prevalence of abnormalities in EEG recordings (p = 0.032), including focal sharp waves or slow waves. Conclusions: The results demonstrate that a GFD has a positive impact on the neurological condition of children with CeD. The clinical improvements correspond with EEG normalization, which supports the hypothesis that dietary intervention plays a role in mitigating CeD-associated neurological dysfunction.