Background:Mycoplasma pneumoniae (MP) is a common cause of pediatric community-acquired pneumonia, accounting for 10-40% of cases, with co-infection and severe Mycoplasma pneumoniae pneumonia (SMPP) associated with worse outcomes. Lung ultrasound (LUS) offers a radiation free, reproducible alternative for pneumonia diagnosis, with high sensitivity and specificity; however, its diagnostic utility in Mycoplasma pneumoniae pneumonia (MPP) remains underexplored. This study therefore aimed to evaluate the diagnostic value of LUS in hospitalized children with MPP. Methods:A retrospective study included 392 hospitalized children (≤14 years) with MPP (April 2023 to January 2024). Patients were grouped into single-infection (n=263) vs. mixed-infection (n=129) cohorts; the single-infection group was further stratified into mild (n=156) and severe (n=107) subgroups. LUS parameters (consolidation number/location/diameter, B-lines, LUS score) were compared across groups. Results:Multivariate logistic regression showed each additional pulmonary consolidation reduced mixed infection risk by 22.6% (P<0.05). The severe subgroup had significantly larger consolidation diameters, more consolidations, and higher rates of multiple confluent B-lines (all P<0.05). A consolidation diameter >2.25 cm predicted severe Mycoplasma pneumoniae pneumonia (SMPP) with an area under the curve (AUC) of 0.693 (sensitivity =53.3%, specificity =77.6%). Conclusions:LUS-detected parameters, including the number and diameter of pulmonary consolidations, may serve as valuable indicators for differentiating mixed infections and assessing disease severity in pediatric MPP.

PURPOSE:Respiratory allergies impair children's health-related quality of life (HRQoL) and increase caregiver burden. While allergen-specific subcutaneous immunotherapy (SCIT) is known to improve clinical outcomes, its short-term impact on HRQoL in children and their parental caregivers remains underexplored. We aimed to evaluate the 12-month impact of SCIT on HRQoL, identify the determinants of HRQoL, and assess the correlation between symptom improvements and HRQoL gains. METHODS:This prospective study enrolled children with allergic rhinitis and/or asthma receiving either SCIT or standard pharmacotherapy, alongside their parental caregivers. Validated generic and disease-specific HRQoL instruments were administered at baseline and the 12-month follow-up. HRQoL changes were analyzed using paired t-tests and Cohen's d effect sizes (ESs). Factors influencing HRQoL were identified using multivariable regression, and correlations between symptom changes and HRQoL gains were examined. RESULTS:After 12 months, children in the SCIT group (n = 132) showed significantly greater improvements in HRQoL than those receiving standard pharmacotherapy (n = 120) (ESs: 0.52-1.34 vs. 0.21-1.05), particularly in the domains of "usual activities" and "pain/discomfort." Caregivers in the SCIT group also experienced greater improvements in HRQoL (ESs: 0.54-0.60 vs. 0.23-0.26), particularly in the domains of "exhaustion," "anxiety," and "day-to-day activities." Multivariable regression analysis identified significant factors influencing HRQoL for both children and caregivers, including coexisting allergic conditions, disease control status, SCIT, and caregiver burdens. Symptom improvements with SCIT showed moderate-to-strong correlations with HRQoL gains. CONCLUSIONS:Over a 12-month period, SCIT was associated with significantly greater improvements in HRQoL for children with respiratory allergies and their parental caregivers compared with standard pharmacotherapy. Generic HRQoL instruments demonstrated good sensitivity to short-term treatment-related changes, supporting their utility as complementary outcome measures in SCIT evaluation. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT06535087.

Mitochondrial dysfunction is implicated in asthma pathogenesis, but causal roles of mitochondrial-related genes in paediatric asthma remain unclear. We performed a multi-omics Mendelian randomization study integrating GWAS data from paediatric asthma cohorts with blood-based methylation quantitative trait loci (mQTLs), expression QTLs (eQTLs) and protein QTLs (pQTLs) datasets. Causal inference was assessed using Summary-data-based Mendelian Randomization (SMR) and HEIDI testing, complemented by colocalization analysis. Findings were validated in independent cohorts and evaluated for tissue specificity using GTEx. Functional enrichment and protein-protein interaction (PPI) network analyses were conducted. SMR analysis identified 80 methylation sites spanning 54 genes, 26 gene expressions, and three proteins significantly associated with paediatric asthma. Colocalization analysis confirmed strong evidence for 10 methylation sites (7 genes), the STX17 eQTL (PP.H4 = 0.98) and the UNG pQTL (PP.H4 = 0.84). Tissue-specific eQTL validation replicated the STX17 association. Multi-omics integration associated ALAS1 (cg13241645, cg15698299) and TXNRD1 (cg09884423) with asthma at both methylation and expression levels, with colocalization supporting both ALAS1 associations. Furthermore, integrated mQTL-eQTL analysis suggests that DNA methylation potentially regulates ALAS1 and TXNRD1 expression. Functional enrichment and network analyses revealed that these candidate genes converge on mitochondrial metabolic pathways and identified seven hub genes with potential regulatory significance (SDHB, MFN2, GLDC, PHB2, TXNRD1, ATP5MC1 and PHB). This study provides multi-omics evidence supporting a causal role for mitochondrial-related genes, particularly ALAS1 and TXNRD1, in paediatric asthma, offering new insights into pathogenesis and potential therapeutic targets.

OBJECTIVE:The three-level and five-level child-friendly versions (EQ-5D-Y) are widely employed for assessing health-related quality of life (HRQoL) in children. However, their effectiveness in asthma remains understudied. We aimed to assess their psychometric properties in asthmatic children. METHODS:Seventy-six dyads of patients and their parents completed EQ-5D-Y-5L and EQ-5D-Y-3L, respectively, at two visits. Test-retest reliability and patient-caregiver agreement were assessed using intraclass correlation coefficient (ICC). Known-groups validity was assessed by comparing scores across varying asthma control levels. Responsiveness was assessed in children showing improved overall health and asthma control. RESULTS:ICCs for test-retest reliability of EQ-5D-Y-3L and EQ-5D-Y-5L summary scores ranged from 0.744 to 0.898 (self-report) and 0.525 to 0.767 (proxy-report), indicating satisfactory reliability. As expected, EQ-5D-Y summary scores for both versions were better in well- or partially-controlled patients, with fewer problems reported for each dimension as well. Effect sizes ranged from 0.19 to 1.00 for the self-completed version, from 0.39 to 0.83 for the proxy version, and from 0.26 to 1.40 for EQ VAS in patients showing improvement. Patient-caregiver agreement ranged from moderate to good. CONCLUSION:The results support the use of the self-complete and proxy versions of both EQ-5D-Y-3L and EQ-5D-Y-5L to assess health outcomes in children with asthma. The self-complete EQ-5D-Y-3L is preferred where possible, but parental carer reports can be used as a reasonable proxy when necessary. The EQ VAS offers a valuable complementary perspective on overall health. Further investigation of the EQ-5D-Y-5L is recommended once a value set becomes available.

Immunoglobulin A vasculitis (IgAV) is the most common cause of systemic vasculitis in childhood. Due to the continued use of the disease name “anaphylactoid purpura” in China, several misunderstandings have arisen in clinical practice and treatment regimens differ widely. In addition, new research and evidence-based data have grown. The Subspecialty Group of Immunology, Society of Pediatrics, Chinese Medical Association and the Chinese Alliance of Pediatric Rheumatic and Immunologic Diseases initiated an update of guidelines for the diagnosis and management of childhood IgAV. The aim therefore was to provide agreed consensus recommendations for diagnosis and treatment for children with IgAV. This study utilized the Delphi technique to develop an evidence-based expert consensus for childhood IgAV. We conducted a systematic literature review to retrieve evidence, which was graded using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria. Two rounds of Delphi voting and a consensus meeting involving 23 experts were conducted. Recommendations were accepted when ≥ 75

OBJECTIVE:To evaluate the effects of treatment with nebulized budesonide inhalation suspension (BIS) at dosages of 500 µg/day and 250 µg/day on mild to moderate asthma in young children. METHODS:This was a randomized, parallel group, open-label study at 19 Chinese clinical sites. A total of 340 patients (4-7 years) with mild to moderate persistent pediatric asthma were randomly and evenly divided into the 500-µg group (BIS 500 µg/day) and the 250-µg group (BIS 250 µg/day); 323 patients completed the study. The Children-Asthma Control Test (C-ACT), asthma control, Pediatric Asthma Quality of Life Questionnaire (PAQLQ), pulmonary function tests (PFT), additional asthma-related therapy, and adverse effects (AEs) were compared after 1, 3, and 6 months of treatment between groups. RESULTS:There were no statistically significant differences in C-ACT scores, level of asthma control, PAQLQ scores, PFT parameters, additional medications and AE occurrences from baseline to 6 months post-treatment between the two groups (all p > 0.05). Compared with baseline values, both groups showed improvements in C-ACT and PAQLQ scores, the rate of well-controlled asthma, and PFT parameters (all p < 0.05). The cumulative number of unplanned outpatient visits (50 vs. 49) and hospitalizations (3 vs. 0) in the 250-µg group was higher than that in the 500-µg group (p < 0.05). CONCLUSIONS:The lower dosage of 250 µg/day BIS was found to be as effective as 500 µg/day BIS. For young children with mild to moderate persistent asthma who have well-controlled, a lower dose of BIS treatment can be chosen.

Objective:To evaluate real-world efficacy and safety of dupilumab in children and adults with moderate to severe atopic dermatitis (AD) combined with Type-II inflammatory diseases. Methodology:A retrospective analysis was conducted on pediatric and adult AD patients treated with dupilumab at Renji Hospital (July 2021 to November 2023). Changes in medication scores, symptom severity and quality of life (QoL) assessments at three and six months were compared to baseline. Adverse events were monitored. Results:All 33 patients demonstrated significant improvements in AD medication scores, symptoms and Qol at three/six months vs baseline. Efficacy at three months correlated with six months outcomes. The dupilumab regimen was associated with significantly improved symptoms of Type-II inflammatory comorbidities. Treatment was associated with symptoms that completely disappeared in 18.18% of AR patients and improved in 68.18% of AR cases. Of 11 FA patients, 90.90% reported symptom improvement. The dupilumab regimen led to a 100% and 20% prevalence of symptom improvement in chronic urticaria (CU) and AS patients, respectively, while 80% of AS patients reported complete disappearance of clinical symptoms. Among 15 AC patients, four (26.67%) had symptoms disappeared, seven (46.67%) improved. The dupilumab regimen led to symptom disappearance in one case of a patient with RS. Adverse effects of the treatment were mild. Conclusion:Dupilumab is an effective and safe treatment for moderate-to-severe AD with Type-II inflammatory comorbidities, significantly improving clinical symptoms, reducing concomitant medication needs and enhancing QoL in real-world settings.

‘Caregiver health spillovers’ refer to the broader impacts of an individual’s illness and interventions on informal caregivers’ health and well-being. This study focuses on the spillover effects experienced by parental carers of children with coronavirus disease 2019 (COVID-19), aiming to compare the psychometric properties of the EQ-5D-5L and the experimental EQ Health and Wellbeing Short version (EQ-HWB-S) in capturing these effects. A longitudinal study was conducted with 861 parental carers of children aged 0–18 years with COVID-19 and 231 parents of healthy children as the control group. The EQ-5D-5L and EQ-HWB-S were used to assess parental health and well-being. Analyses included known-groups validity (multivariable regression), test–retest reliability (Gwet’s AC1, intraclass correlation coefficient) and responsiveness to health improvement (Glass’ Δ effect size). Parents of infected children reported more problems than those of healthy controls. The EQ-HWB-S better discriminated between sub-groups defined by the child’s COVID-19 presence, caring time and work impact. Test–retest reliability was fair to good for EQ-HWB-S dimensions (Gwet’s AC1: 0.33–0.79), moderate to good for EQ-5D-5L (Gwet’s AC1: 0.40–0.76), and good for index scores and EQ VAS (intraclass correlation coefficient: 0.70–0.77). Parental health and well-being improved as children recovered, with the EQ-5D-5L showing slightly higher responsiveness (effect size: 0.77–0.87) than EQ-HWB-S (effect size: 0.62–0.74). Both EQ-HWB-S and EQ-5D-5L are valid, reliable and responsive for measuring parental spillover effects related to a child’s COVID-19 infection. EQ-HWB-S outperformed in distinguishing social and emotional impacts of caregiving, while EQ-5D-5L better captured physical health improvements. The choice between tools may depend on study objectives.

Respiratory infectious diseases like COVID-19 profoundly impacts the health of children and adolescents, but validated instruments to measure their impacts on health-related quality of life (HRQoL) are lacking. The EQ-5D-Y-3L, widely used for youth HRQoL, now features a Chinese value set. The experimental EQ-TIPS addresses HRQoL assessment for toddlers and infants. This study tested the psychometric properties of both instruments in paediatric COVID-19 patients, and compared the performance of self-complete and proxy EQ-5D-Y-3L. This longitudinal study recruited 861 COVID-19 patients aged 0–18 years and their parental caregivers, with 311 dyads completing the follow-up. Digital administration included the EQ-TIPS, the EQ-5D-Y-3L, and Overall Health Assessment (OHA). Controls comprised 231 healthy children. Analysis encompassed known-group validity, child-parent agreement, and responsiveness to change in disease severity and OHA. COVID-19 children exhibited lower HRQoL than non-infected peers. The EQ-TIPS and the EQ-5D-Y-3L distinguished groups by disease presence, severity and symptoms, showing moderate to good known-group validity (ESs: 0.45–1.39 for EQ-TIPS, 0.44–1.91 for self-complete EQ-5D-Y-3L, and 0.32–1.67 for proxy EQ-5D-Y-3L). Child-parent agreement was moderate to good for EQ-5D-Y-3L (ICC: 0.653–0.823; Gwet’s AC1: 0.470–0.738), and responsiveness was good for both EQ-TIPS Level Sum Score (LSS) (ESs: 1.21–1.39) and EQ-5D-Y-3L index scores (ESs: 1.00–1.16). This study demonstrates the reliability, validity, and responsiveness of the experimental EQ-TIPS and the EQ-5D-Y-3L in paediatric COVID-19 patients. It is the first evidence of the EQ-TIPS’ responsiveness, supporting its use in assessing the impact of COVID-19 on paediatric HRQoL. The study validates the experimental version of EQ-TIPS, offering the first evidence of EQ-TIPS’ responsiveness. It addresses the scarcity of validated instruments for infants and toddlers, contributing to improved paediatric HRQoL assessment. The research pioneers the application of the Chinese value set for EQ-5D-Y-3L in paediatric COVID-19 patients. The study enhances the existing knowledge base by providing psychometric evidence for this instrument in a clinical context, supporting its utility in diverse healthcare settings. Both instruments can be used in COVID-related clinical and resource allocation decision-making and in monitoring the well-being of infants, children and adolescents affected by COVID-19 and respiratory infections.

Abstract Background This study examined the knowledge, attitude, and practice (KAP) toward allergic rhinitis (AR) among parents. Methods This cross-sectional study enrolled parents of children with AR at Ningbo Hangzhou Bay Hospital between December 2022 and March 2023. A self-administered questionnaire was developed to collect the demographic characteristics, knowledge, attitudes, and practices toward AR. Results This study included 480 questionnaires, and 78.33% were mothers. The mean knowledge, attitude, and practice scores were 13.49 ± 6.62 (possible range: 0–24), 33.99 ± 3.40 (possible range: 8–40), and 21.52 ± 3.36 (possible range: 5–26), indicating poor knowledge, positive attitudes, and proactive practice. Multivariable logistic regression analysis showed living in urban areas in Ningbo outside Hangzhou Bay New Zone (OR = 4.33, 95%CI: 1.52–12.34, P = 0.006), living in rural areas in Ningbo (OR = 2.15, 95%CI: 1.00-4.59, P = 0.049), being self-employed (OR = 1.99, 95%CI: 1.00-3.95, P = 0.049), monthly income per capita ≥ 20,000 CNY (OR = 1.89, 95%CI: 1.02–3.47, P = 0.042), child with one biological sibling (OR = 0.48, 95%CI: 0.30–0.78, P = 0.003), and ≥ 6 times hospital visits for AR (OR = 2.32, 95%CI: 1.40–3.86, P = 0.001) were independently associated with adequate knowledge. The knowledge (OR = 1.09, 95%CI: 1.05–1.13, P < 0.001) and ≥ 6 times hospital visits for AR (OR = 1.84, 95%CI: 1.06–3.22, P = 0.032) were independently associated with a positive attitude. The knowledge (OR = 1.08, 95%CI: 1.04–1.13, P = 0.001), attitude (OR = 1.41, 95%CI: 1.28–1.55, P < 0.001), monthly income per capita ≥ 20,000 CNY (OR = 3.59, 95%CI: 1.49–8.65, P = 0.004), no previous hospital visit for AR (OR = 0.35, 95%CI: 0.16–0.78, P = 0.003), and ≥ 6 times hospital visits for AR (OR = 0.40, 95%CI: 0.20–0.81, P = 0.011) were independently associated with the practice scores. Conclusions The parents of children with AR had poor knowledge but positive attitudes and proactive practice toward AR. This study has identified a need for specific and reliable information initiatives to be introduced as a means of reducing parental concern and ensuring evidence-based strategies for managing children with AR.

Objective: To explore factors influencing the acceptance of allergen immunotherapy (AIT) for the treatment of allergic respiratory diseases by pediatric patients and their families. Methods: A total of 406 children (210 males and 196 females) attending the pediatric outpatient clinics and wards of the Renji Hospital, Shanghai Jiao Tong University School of Medicine from June 2020 to April 2022. Those who met the criteria for the AIT treatment, were included in the survey. An online 20-item questionnaire was developed. Data on patient’s general characteristics, allergic disease status, family history of allergies, general family information, parental knowledge of allergic diseases, and whether the AIT treatment was recommended by a physician, were collected. The patients were divided into two groups according to their willingness to receive AIT: a reluctant or neutral group (n = 182), and a willing group (n = 224). A univariate analysis of the willingness to undergo AIT was done to detect parameters that significantly differed between the groups, and the identified factors were used as independent variables in the multifactorial logistic regression analysis. Results: The severity of allergic disease, presence of drug allergy, occurrence of severe allergic reactions, mother’s education, distance from home to the hospital, parental knowledge of allergic diseases, and whether the doctor recommended AIT were all statistically different between the groups (p < 0.05). Multifactorial logistic regression analysis showed that the degree of allergic rhinitis (AR), or asthma (AS), parental knowledge of allergic diseases, and doctor’s recommendation of AIT were the factors that influenced the willingness of pediatric patients to receive AIT. Conclusions: The severity of AR and AS, parental knowledge of allergic diseases, and doctor’s recommendation influenced the willingness of pediatric patients to receive AIT. doi: https://doi.org/10.12669/pjms.40.5.8581 How to cite this: Ding B, Zhong J, Jiang C, Ma T, Shen Q, Lu Y. Measurement of Service Quality Gaps in Dental Services using SERVQUAL in Public Hospitals of Rawalpindi. Pak J Med Sci. 2024;40(5):820-828. doi: https://doi.org/10.12669/pjms.40.5.8581 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Limited evidence was available on ambient air pollution and pediatric atopic dermatitis (AD). The study aimed to evaluate the associations between short-term exposure to air pollutants and outpatient visits for pediatric AD. From 2016-2018, we collected data on six criteria air pollutants (PM2.5, PM10, NO2, SO2, CO and O3) and daily outpatient visits for pediatric AD in 66 hospitals, covering all districts in Shanghai, China. The over-dispersed Poisson generalized additive model (GAM) was applied to fit the associations of criteria air pollutants with hospital visits. Two-pollutant models were fitted and stratified analyses by sex, age and season were conducted. We identified 477,833 outpatient visits for pediatric AD. Each interquartile range (IQR) increase in PM2.5 (IQR: 30.9 μg/m3), PM10 (8.9 μg/m3), NO2 (25.5 μg/m3), SO2 (5.8 μg/m3) and CO (0.283 mg/m3) on the concurrent day was significantly associated with increments of 2.08 % (95 % CI: 0.53 %, 3.65 %), 2.53 % (95 % CI: 0.87 %, 4.22 %), 8.14 % (95 % CI: 6.24 %, 10.08 %), 5.67 % (95 % CI: 3.58 %, 7.80 %), and 2.27 % (95 % CI: 0.70 %, 3.87 %) in pediatric AD outpatient visits, respectively. The effects of NO2 remained robust after adjustment for other air pollutants. The exposure-response curves for PM2.5 and PM10 were steeper for moderate-lower concentrations, with a flatten curves at high concentration; nearly linear relationships were found for NO2. Higher associations of NO2 exposure on AD were detected in children under 6 years old (p=0.01); and we observed larger effect of air pollutants in cool seasons (p<0.001 for PM2.5, PM10, NO2 and CO; p=0.043 for SO2). This study indicated that short-term exposure to air pollution could increase risk of outpatient visits for pediatric AD.

We describe the case of a 10-year-old boy with asthma (AS), accompanied by allergic rhinitis (AR), food allergy (FA), and combined attention-deficit/hyperactivity disorder (ADHD), who was treated at Shanghai Renji Hospital on 11 July 2020. The efficiency of the previous treatment with salmeterol/ticlosone was poor. Treatment with montelukast sodium resulted in development of neurological symptoms. Treatment with omalizumab in combination with subcutaneous immunotherapy (SCIT) was then initiated in our department based on anti-asthmatic therapy. Symptoms of asthma were completely controlled, and FA and AR symptoms improved. The treatment regimen led to a significant improvement in ADHD symptoms and the overall quality of life of the patient. The literature search was done in the PubMed database using “attention deficit/hyperactivity disorder/ADHD” and “asthma” as keywords, and we identified 47 relevant articles. In conclusion, our results show that treating asthma with omalizumab in combination with salmeterol/ticlosone and SCIT is efficient in controlling symptoms of multiple allergies and may lead to the improvement in ADHD symptoms and the overall quality of life of pediatric patients with ADHD. While current studies suggest that allergic diseases are closely related to ADHD, there is still a lack of studies or case reports of complete treatment protocols to provide clinical clues for management of the disease.

Objective:To investigate the clinical characteristics of children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variants, and the impact factors of duration of cycle threshold (Ct) values turning to ≥35 detected by nucleotide test.Methods:Children aged 0 to 14 years with clinical symptoms of Omicron variants infection who admitted to designated hospital in Shanghai City (Renji Hospital, South Branch, Shanghai Jiao Tong University School of Medicine) from April 7 to June 2, 2022 were enrolled. The daily nasopharyngeal swab specimens were used for SARS-CoV-2 nucleic acid detecting by polymerase chain reaction and the results were expressed as Ct values. The T Ct≥ x was defined as from the symptom onset or first positive nucleic acid test results (the earlier data) to Ct≥ x of the open reading frame 1ab ( ORF1 ab) gene, which was the time duration from the initial to a specific Ct value.Clinical data were collected, including age, sex, vaccination and comorbidities.Cox model was performed to analyzed the impact factors of T Ct≥35. Results:A total of 871 pediatric cases with a median age of two years (ranging from one month to 14 years old) were included. Among them, 474 cases (54.4%) were male, and 89 cases (10.2%) had underlying diseases including congenital heart disease, solid tumors and epilepsy. There were 572(65.7%) mild cases, 298(34.2%) common cases, one (0.1%) severe case and no critical cases or deaths. The T Ct≥35 was 12(10, 14) days. Cox model indicated that compared to children aged one to 12 months, children aged 37 to 84 months and 85 to 168 months had shorter T Ct≥35 (hazard ratio ( HR)=1.55 and 1.84, respectively, both P<0.001). After adjusted with age, comparing to unvaccinated patients, patients with one or two shots vaccine had shorter T Ct≥35 (adjected hazard ratio (a HR)=1.49, P=0.011), and common patients had longer T Ct≥35 than mild patients (a HR=0.78, P=0.002), and patients with comorbidities had longer T Ct≥35than patients without comorbidities (a HR=0.38, P<0.001).The duration of T Ct≥28, T Ct≥30, T Ct≥33 and T Ct≥35 in children without underlying diseases were 7(6, 9) d, 9(7, 10) d, 10(8, 11) d and 12(10, 14) d, respectively. Conclusions:Age, vaccination, disease severity and underlying diseases could affect the duration of SARS-CoV-2 nucleotide turning to negative (Ct value≥35) in children infected with Omicron variants.

Background The child-friendly EQ-5D (EQ-5D-Y) has been available in both a 3-level (Y-3L) and a 5-level (Y-5L) version. The study aimed to assess the measurement properties of both versions in paediatric patients with asthma and their caregivers. Methods Patients and their caregivers completed the self-complete and proxy Y-5L and Y-3L questionanires, respectively, twice in two consecutive visits. Test-retest reliability and patient-caregiver agreement of Y-3L index, Y-5L level sum score (LSS) and EQ Visual Analogue Scale (VAS) were assessed using intraclass correlation coefficient (ICC). Known-groups validity compared scores of patients with different asthma control statuses. Responsiveness to improved overall health and asthma control was assessed uisng standardized effect size (SES). Results Seventy-six patients (age range: 8-16.7 years) and their caregivers participanted. The ICC for test-retest reliability of the Y-3L, Y-5L and EQ VAS scores ranged from 0.744 to 0.898 for the slef-complete version and 0.525 to 0.767 for the proxy version. As hypothesized, Y-3L, Y-5L and EQ VAS scores derived from both EQ-5D-Y versions indicated that well or partially controlled patients had better health than uncontrolled patients. SES values ranged from 0.20 to 1.40 for self-complete version and 0.39 to 1.26 for proxy version. ICC for parient-caregiver agreement ranged from 0.556 for Y-5L LSS to 0.833 for Y-3L index. Conclusion The results support the relaibility, validity, and responsiveness of both the self-complete and proxy versions of the two EQ-5D-Y questionnaires for assessing health outcomes of asthmatic children. Moreover, the self-complete and proxy-reported versions appears to have good agreement.

Background:The management of LT patients during COVID-19 pandemic is important. Immunosuppressants (IS) are key therapy agents after liver transplant. Different ISs have different side effects. Calcineurin inhibitor (CNI) may lead to metabolic acidosis while mycophenolate mofetil (MMF) showed rare nephrotoxicity. We report a post-liver transplant girl who was infected with SARS-CoV-2, developing a severe mixed acidosis 3 months after the transplantation. Her acidosis was improved after withdrawing of MMF, leading the suspicion that acidosis maybe a rare side effect of MMF.Case presentation:A girl was admitted to our hospital due to SARS-CoV-2 infection, 3 months before admission the patient received LT due to Niemann-Pick disease (NPD). During hospitalization, blood gas analysis showed severe mixed acidosis. To relieve mixed acidosis, the patient was given oral rehydration salt and liquid replacement therapy. Considering that immunosuppressants may cause metabolic acidosis, dose of CsA was decreased and MMF was discontinued.Results:However, liquid replacement therapy and decreased CsA dose cannot improve the condition. As an attempt, MMF was discontinued, and 3 days later, the girl's acidosis was relieved, the latest blood gas analysis was normal with the original dose of CsA and no use of MMF or other IS. In addition, we used Naranjo Scale to see if adverse drug reactions (ADRs) existed. The final score was 6 which means MMF contributes to acidosis probably.Conclusion:The girl's mixed acidosis cannot be explained by Niemann-Pick disease and SARS-CoV-2 infection. CNIs could cause metabolic acidosis but declining the dose of CsA didn't improve her acidosis while withdrawing MMF showed a good effect. Together with the Naranjo Scale result, we suspect that acidosis maybe a rare side effect of MMF.

BACKGROUND:Gut microbiota alterations have been implicated in the pathogenesis of coronavirus disease 2019 (COVID-19). This study aimed to explore gut microbiota changes in a prospective cohort of COVID-19 children and their asymptomatic caregivers infected with the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) Omicron variant.METHODS:A total of 186 participants, including 59 COVID-19 children, 50 asymptomatic adult caregivers, 52 healthy children (HC), and 25 healthy adults (HA), were recruited between 15 April and 31 May 2022. The gut microbiota composition was determined by 16S rRNA gene sequencing in fecal samples collected from the participants. Gut microbiota functional profiling was performed by using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) software.RESULTS:The gut microbiota analysis of beta diversity revealed that the fecal microbial community of COVID-19 children remained far distantly related to HC. The relative abundances of the phyla Actinobacteria and Firmicutes were decreased, whereas Bacteroidetes, Proteobacteria, and Verrucomicrobiota were increased in COVID-19 children. Feces from COVID-19 children exhibited notably lower abundances of the genera Blautia, Bifidobacterium, Fusicatenibacter, Streptococcus, and Romboutsia and higher abundances of the genera Prevotella, Lachnoclostridium, Escherichia-Shigella, and Bacteroides than those from HC. The enterotype distributions of COVID-19 children were characterized by a high prevalence of enterotype Bacteroides. Similar changes in gut microbiota compositions were observed in asymptomatic caregivers. Furthermore, the microbial metabolic activities of KEGG (Kyoto Encyclopedia of Genes and Genomes) and COG (cluster of orthologous groups of proteins) pathways were perturbed in feces from subjects infected with the SARS-CoV-2 Omicron variant.CONCLUSION:Our data reveal altered gut microbiota compositions in both COVID-19 children and their asymptomatic caregivers infected with the SARS-CoV-2 Omicron variant, which further implicates the critical role of gut microbiota in COVID-19 pathogenesis.

[Background] EQ-5D instruments (HRQOL), incuding the three-level (Y-3L) and five-level (Y-5L) child-friendly versions (EQ-5D-Y) are widely employed for assessing health-related quality of life. However, their effectiveness in children with asthma remains understudied. This study aimed to assess their performance in pediatric asthma patients and their caregivers. [Methods] Dyads of asthmatic patients (n=76, aged 8-16.7) and caregivers completed Y-5L and Y-3L, respectively, at two visits. Test-retest reliability and patient-caregiver agreement were assessed via intraclass correlation coefficient (ICC). Known-groups validity was assessed by comparing scores across varying asthma control levels. Responsiveness was assessed in children showing improved overall health and asthma control. [Results] ICCs for test-retest reliability ranged from 0.744 to 0.898 (self-complete) and 0.525 to 0.767 (proxy), indicating satisfactory reliability. As expected, overall scores for both EQ-5D-Y versions were higher (better HRQOL) in well-/partially-controlled asthma patients. Standardized effect sizes ranged from 0.19 to 1.00 (self-complete), 0.39 to 0.83 (proxy), and 0.26 to 1.40 (EQ VAS) in improved patients. Patient-caregiver agreement ranged from moderate to good. [Conclusion] Both self-complete and proxy EQ-5D-Y versions appeared to be suitable for assessing HRQOL in pediatric asthma patients, with the self-complete version being more preferable. Further investigation on the responsiveness of EQ-5D-Y is warranted.

With the development of economy and medicine, chronic diseases have become a more and more prominent problem affecting children′s physical and mental development.Juvenile idiopathic arthritis(JIA)is a common rheumatic disease in children.As an important medium of immune response, cytokines play a role in systemic juvenile idiopathic arthritis(SJIA)and its complication such as macrophage activation syndrome(MAS), which has attracted more and more attention.Many studies have found that a variety of cytokines play an inflammatory or anti-inflammatory role in the occurrence and development of SJIA and MAS.Therefore, this paper summarizes the specific mechanism of action and clinical significance of related cytokines in SJIA and MAS, and reviews the progress of related drug therapy targeting cytokines.By exploring the pathogenesis of SJIA, we hope to provide theoretical basis for identifying new therapeutic targets.