Fulminant varicella infection complicated by disseminated intravascular coagulation following influenza-A case report

Objectives: Varicella is common infectious disease mainly in childhood, usually is a mild, self-limited illness and complications are usually rare. The incubation period for this disease is generally 14- 16 days but may vary from 7 to 21 days. Varicella in the adults with comorbidities or immunosuppressed children may be severe and prolonged with complications. Method(s): A case report of a 6-year-old girl hospitalized for new-onset manifestations of disseminated vesicular exanthema, the manifestations of which occurred mainly on the chest, back, capillitium, oral cavity, and genital area. The child was suffering from abdominal, knee and lumbosacral pain at that time. The patient's history revealed that 10 days prior to the cutaneous manifestations, she had influenza with bronchopneumonia requiring oxygen therapy, steroids and antibiotics. Result(s): The condition progressed within 48 h, complicated by the development of multi-organ failure, coagulopathy with the development of disseminated intravascular coagulopathy over the course of antiviral, antibiotic and antifungal therapy. Laboratory parameters included high elevation of C-reactive protein, il-6, leukocytosis, neutrophilia and highly elevated liver enzymes. Varicella infection was confirmed by detection of herpes zoster virus - polymerase chain reaction (PCR) from vesicles. The patient received intravenous immunoglobulin therapy at a dose of 2 g/L and fresh frozen plasma, thrombocyte concentrate. The girl was intubated with analogization. Laboratory parameters subsequently revealed high anti CoV-2 positivity, high CoV-2 IgG positivity and negative CoV-2 IgM. The patient's condition did not preclude the course of multisystem inflammatory syndrome in children (MIS-C) corticosteroids were added to the treatment at a dose of 1 mg/kg weight. Patient's condition stabilized after 1 month. Discussion(s): Our case report presents an example of fulminant complicated life-threatening course of varicella. Even in common respiratory infections, we must think about the risk and consequences of coinfections and post-infectious complications such as in our case especially influenza and COVID-19.

SARS-COV-2 Infection in Children and Young People in Bulgaria - A Prospective, Single-Center, Cohort Study

Compared to other respiratory viruses, the proportion of hospitalizations due to SARS-CoV-2 among children is relatively low. While severe illness is not common among children and young individuals, a particular type of severe condition called multisystem inflammatory syndrome in children (MIS-C) has been reported. The aim of this prospective cohort study, which followed a group of individuals under the age of 19, was to examine the characteristics of patients who had contracted SARS-CoV-2, including their coexisting medical conditions, clinical symptoms, laboratory findings, and outcomes. The study also aimed to investigate the features of children who met the WHO case definition of MIS-C, as well as those who required intensive care. A total of 270 patients were included between March 2020 and December 2021. The eligible criteria were individuals between 0-18 with a confirmed SARS-CoV-2 infection at the Infectious Disease Hospital "Prof. Ivan Kirov"in Sofia, Bulgaria. Nearly 76% of the patients were <= 12 years old. In our study, at least one comorbidity was reported in 28.1% of the cases, with obesity being the most common one (8.9%). Less than 5% of children were transferred to an intensive care unit. We observed a statistically significant difference in the age groups, with children between 5 and 12 years old having a higher likelihood of requiring intensive care compared to other age groups. The median values of PaO2 and SatO2 were higher among patients admitted to the standard ward, while the values of granulocytes and C-reactive protein were higher among those transferred to the intensive care unit. Additionally, we identified 26 children who met the WHO case definition for MIS-C. Our study data supports the evidence of milder COVID-19 in children and young individuals as compared to adults. Older age groups were associated with higher incidence of both MIS-C and ICU admissions.Copyright © 2023 P. Velikov et al., published by Sciendo.

Preoperative COVID-19 RT-PCR Testing of Asymptomatic Patients for Ophthalmic Surgery: Experience from Two Tertiary Referral Centers

Purpose: The aim of this study was to evaluate how prevalent asymptomatic SARS-CoV-2 virus infection (COVID-19) is among patients undergoing ophthalmic surgery at two tertiary referral hospitals. Material(s) and Method(s): This retrospective study included patients without COVID-19 symptoms who underwent preoperative screening using reverse transcription-polymerase chain reaction (RT-PCR) before ophthalmic surgery at the Kocaeli University and Gaziantep University departments of ophthalmology [between September 1, 2020, and December 15, 2020 (group 1);between March 1, 2021, and May 30, 2021 (group 2)]. Patients scheduled for surgery and followed up in the retina, glaucoma, pediatric ophthalmology and strabismus, cataract and refractive surgery, and cornea departments were examined. Result(s): RT-PCR was positive for SARS-CoV-2 in 12 (1.4%) of 840 patients in group 1 and 7 (1.1%) out of 600 patients in group 2. None of the patients were symptomatic of COVID-19. The majority of the patients were scheduled for retina or cataract and refractive surgery in both groups (group 1;retina: 29.2%, cataract and refractive: 57.0%, group-2;retina: 31.3%, cataract and refractive: 54.5%). SARS-CoV-2 RT-PCR testing was positive for seven patients in group 1 (7/245, 2.9%) and five patients in group 2 (5/188, 2.6%) who were scheduled for retinal surgery. Conclusion(s): The necessity, availability, and practicality of COVID-19 RT-PCR testing prior to ophthalmic surgeries varies depending on the protocols of each institution. COVID-19 RT-PCR testing is suggested especially before vitreoretinal surgeries and general anesthesia procedures, because of the difficulty in managing postoperative complications.Copyright © 2023 Gazi Eye Foundation. All rights reserved.

Sleep across childhood during the COVID-19 pandemic: A narrative review of the literature and clinical case examples

Without the structure and schedule of traditional activities such as in-person school and socialization, evidence is emerging of pediatric sleep changes during the COVID-19 pandemic. A narrative review was conducted of the sleep literature during the pandemic for preschoolers, school-aged children, and adolescents. Changes in sleep and risk and protective factors for sleep heath during the COVID-19 pandemic are reviewed along with real-life clinical case examples for each developmental period. Given the high rates of pediatric sleep disturbance, clinicians, researchers, and policymakers should refine screening strategies and facilitate referrals for behavioral interventions to support sleep health during pandemics and other natural disasters. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Distance Learning in an Inclusive Preschool Focused on Autism During the COVID-19 Pandemic: A Mixed-Methods Multiple Case Study of Four Children

Despite the widespread use of distance learning during the coronavirus disease-2019 (COVID-19) pandemic, little is known about the developmental appropriateness of this instructional format for preschoolers, particularly when implemented in inclusive settings. The current research was implemented in a university-affiliated, state-funded inclusive preschool classroom focused on autism spectrum disorder (ASD) where parents were given the option to enroll in a full distance program (FDP) during the first 9 weeks of the 2020/21 school year. Parents of four children, including two children with ASD, selected the FDP option. Synchronous whole group, small group, and individual online sessions were recorded using screen capture and coded for children's maintained attention and directed communication. Further, parents and teachers completed exit interviews or a focus group, which were transcribed and analyzed using qualitative research methods. This is the first study to use observational methods to measure child engagement during preschool FDP sessions. Results from this mixed-method multiple case study paint a rich picture of both opportunities and limitations inherent in distance learning when implemented in inclusive preschool settings. General conclusions, future directions, and study limitations are discussed.

Predictors of early literacy skills in kindergarteners with dyslexia familial risk

This dissertation research study aimed to determine the predictors of early literacy skills in kindergarteners with dyslexia familial risk. The home literacy environment, preschool attendance, and parental self-efficacy are known predictors of early literacy skills, specifically letter naming knowledge, in typically developing children. Letter naming knowledge is an early literacy skill that is important to future reading achievement and outcomes. Letter naming knowledge is also a powerful pre-literacy predictor of dyslexia. Dyslexia commonly manifest as difficulties in acquiring basic reading skills and is highly heritable. The population for this study was primary caregivers of kindergarteners with a first degree relative with a diagnosis of dyslexia. Participants completed the Home Literacy Checklist, Tool to Measure Parenting Self-Efficacy via an online survey with questions regarding preschool attendance, letter naming knowledge skills, and the presence of a diagnosis of dyslexia among first degree relatives. SPSS Statistics (Version 28) was used to run descriptive statistics. The sample was comprised of 12 primary caregivers. This sample size was not appropriate for the chosen analysis of multiple regression. Using exploratory data analysis, the data was organized and summarized. Due to an inadequate sample size caused by a low response rate, no conclusions could be drawn from this data. The research questions were not answered and there were no findings. COVID-19 restrictions impacted research sites and the level of participation, with participants being less available, school closures, and mandatory quarantines, creating a difficult atmosphere for completion of this research study. As a result, the lack of data during the COVID-19 pandemic and subsequent lockdowns led to several revisions of the research plan. The revisions involved eliminating the need for standardized test scores, using primary caregiver report to determine the level of difficulty of letter naming knowledge of the kindergarten student, and using social media to recruit participants. Recommendations for further research were comprised of ways to increase the pool of participants by expanding inclusion criteria, eliminating the use of standardized test scores, considering the length of the survey, and the use of social media along with an incentive. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Bilateral Spontaneous Pneumothorax in a Child with Multisystem Inflammatory Syndrome Associated with COVID-19

Introduction: Spontaneous pneumothorax is a rare complication of coronavirus disease 2019 (COVID-19), primarily reported in adults. Pediatric cases with bilateral pneumothorax are much less reported. Case Presentation: We presented the case of a five-year-old previously healthy boy who developed persistent fever, abdominal pain, generalized maculopapular rash, and dyspnea before admission. His chest computed tomography (CT) showed a viral involvement pattern of pneumonia suggestive of COVID-19. Subsequently, he was confirmed with multisystem inflammatory syndrome in children (MIS-C). While he responded well to the therapies, on the fifth day of admission, he developed respiratory distress again. A chest roentgenogram showed bilateral spontaneous pneumothorax. Bilateral chest tubes were inserted, and his condition improved sig-nificantly after five days of admission to the intensive care unit. Two weeks later, he was discharged in good condition. Conclusion(s): Children with MIS-C associated with COVID-19 may develop primary spontaneous pneumothorax. Owing to the clinical picture overlapping with MIS-C associated with COVID-19, the timely diagnosis of pneumothorax may be challenging in such patients.Copyright © 2022, Author(s).

Anti-SARS-CoV-2 antibodies important in diagnostics of acute hepatitis in children

The most common causes of acute hepatitis in children are hepatitis A and autoimmune hepatitis. Hepatitis in the course of Wilson's disease is sporadically registered in adolescents. An increase of activity of aminotransferases both in the course of multisystem inflammatory syndrome in children (MIS-C) and in the course of COVID-19 has been observed. Hepatitis is common in children with MIS-C and is associated with a more severe presentation and persistent elevation of liver function tests. To date, no cases of acute hepatitis in children due to COVID-19 have been reported. We present 2 cases of acute hepatitis in children where the only cause seems to be a previous asymptomatic SARS-CoV-2 infection.Copyright © 2023 Termedia Publishing House Ltd.. All rights reserved.

PPP1R13L-Related Cardiomyopathy Stability Following IL1 Inhibition

Introduction: Variants in PPP1R13L are associated with severe childhood-onset cardiomyopathy resulting in rapid progression to death or cardiac transplantation. PPP1R13L is proposed to encode a protein that limits the transcriptional activity of the NFkappaB pathway leading to elevated IL-1, IL-6, and TNF-alpha production in murine models. Optimal medical management for PPP1R13L-related cardiomyopathy is unknown. Here we report usage of a targeted anti-IL-1 immuno-modulatory therapy resulting in cardiac stabilization in a pediatric patient with congenital cardiomyopathy secondary to PPP1R13L variants. Case Report: A 4-year-old boy presented acutely with fever in the setting of persistent abdominal pain, vomiting, fatigue, and decreased appetite for two months following a mild COVID-19 related illness. Echocardiogram revealed severely depressed biventricular systolic function with an ejection fraction of 30%. Due to acute decompensated heart failure symptoms with hemodynamic instability, he was intubated and placed on continuous inotropic infusions with aggressive diuresis. Cardiac MRI demonstrated extensive subepicardial to near transmural fibrosis by late gadolinium enhancement in right and left ventricles. An implantable cardioverter-defibrillator (ICD) was placed due to frequent runs of polymorphic non-sustained ventricular tachycardia. Testing for viral pathogens was positive for rhino/enterovirus. Initial genetic testing was non-diagnostic (82-gene cardiomyopathy panel) but given the patient's significant presentation whole genome sequencing was pursued that showed two separate PPP1R13L variants in trans (c.2167A>C,p.T723P and c.2179_2183del,p. G727Hfs*25, NM_006663.4). Patient serum cytokine testing revealed elevations in IL-10 (4.7 pg/mL) and IL-1beta (20.9 pg/mL). Given the patient's tenuous circumstances and concern for continued progression of his cardiac disease, a trial of IL-1 inhibition via anakinra dosed at 3 mg/kg or 45 mg daily was initiated following hospital discharge. With approximately 6 months of therapy, the patient's cardiac function is stable with normalization of IL-10 and IL-1beta serum levels. Notably, the ventricular arrhythmia decreased after initiation of anakinra with no ICD shocks given. Therapy overall has been well tolerated without infectious concerns. Conclusion(s): In patients with PPP1R13L-related cardiomyopathy, immuno-modulatory therapies should be considered in an attempt to slow cardiac disease progression.Copyright © 2023 Elsevier Inc.

Experiences of delivering virtual therapy groups for children with osteogenesis imperfecta during the Covid-19 pandemic

OBJECTIVE: To explore the experiences of a virtual group therapy programme for children with Osteogenesis Imperfecta (OI) who were unable to access face to face therapy due to a global pandemic. In a regional OI service up to 3 face to face 6-week therapy groups are offered for children during summer school holidays. Throughout the Covid-19 pandemic, OI children were at risk of deconditioning due to government restrictions in school attendance, exercise and socialisation. An alternative means of delivering therapy was required. METHOD(S): 30 families with school age children were invited to attend a virtual therapy group. Following initial interest from 21 children, 14 (age range 4-14 years) participated in a 5 week therapy group. Children were split into 3 age groups (4-7/8-12/13-14). Weekly 75 minute sessions comprised functional gross and fine motor activities. Educational elements with opportunities to explore thoughts and feelings were included. Each group were set a challenge to compete a virtual race from Bristol to Lands' End, recording their distance (walking, wheeling, cycling) throughout the week. Feedback was collected from participants and parents. RESULT(S): Feedback was received from 12/14 of attendees and parents and 4/7 who did not attend. Reasons for non-attendance included anxiety around video calls, other commitments and injuries. Of those that attended 100% (n=12) enjoyed the group and reported increased activity levels. Scavenger Hunt was cited as the favourite activity. 16.6% (n=2) children reported discussion on personal feelings uncomfortable. 16.6% (n=2) reported exercises were hard. 100% (n=9) of parents reported no significant difficulties with IT. Parent reported benefits included positive social interaction with other children with OI (66%, n=6), improving routine in preparation for school return (55%, n=5). Challenges for therapy team included identifying appropriate IT platform, choosing activities appropriate for various abilities and virtual instruction. Successes included time efficiency, full inclusion regardless of geographic location, increased activity levels of children with OI in preparation for school return. CONCLUSION(S): A safe, socially distanced method of delivering group therapy during a pandemic was achieved. Virtual therapy can be a useful adjunct, however this should not replace face to face therapy where possible.

Halo Traction Followed by Halo Vest Immobilization for the Treatment of Chronic Atlantoaxial Rotatory Fixation: A Case Report and Tips for Avoiding Complications in Pediatric Patients

CASE: A 4-year-old girl sustained a traumatic atlantoaxial rotatory subluxation. She presented at the treating facility 8 months after injury with cervical deformity, neck pain, gait instability, and decreased cervical motion. Her delay in presentation was partially because of international Corona Virus of 2019 (COVID-19) travel restrictions. The case was successfully treated with halo traction, followed by halo vest immobilization. CONCLUSION: Chronic atlantoaxial rotatory fixation can be treated nonsurgically with closed reduction and halo traction, but is associated with operative risks. Optimal pin placement is challenging in the pediatric skull and may be improved with a preoperative or intraoperative computed tomography (CT) scan. Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.

Primary immunodeficiency associated with a SAMD9L mutation

Background: SAMD9L is a tumor suppressor involved in regulating the proliferation and maturation of cells, particularly those derived from the bone marrow, and appears to play an important role in cerebellar function. It can be activated in hematopoietic stem cells by type I and type II interferons. It has been hypothesized to act as a critical antiviral gatekeeper regulating interferon dependent demand driven hematopoiesis. Gain of function mutations can present with an immunodeficiency due to transient severe cytopenias during viral infection. Case presentation: We report a 3-year-old boy born full term with a history of severe thrombocytopenia requiring transfusions, developmental delay, ataxia, seizure disorder, and recurrent severe respiratory viral infections. His infectious history was significant for respiratory syncytial virus with shock requiring extracorporeal membrane oxygenation complicated by cerebral infarction and a group A streptococcus empyema, osteomyelitis requiring a left below the knee amputation, and infections with rhinovirus, COVID-19, and parainfluenza requiring hospitalizations for respiratory support. Initial immunologic evaluation was done during his hospitalization for parainfluenza. His full T cell subsets was significant for lymphopenia across all cell lines with CD3 934/microL, CD4 653/microL, CD8 227/microL, CD19 76/microL, and CD1656 61/microL. His mitogen stimulation assay to phytohemagglutinin and pokeweed was normal. Immunoglobulin panel showed a mildly decreased IgM of 25 mg/dL, but normal IgA and IgG. Vaccine titers demonstrated protective titers to 12/22 pneumococcus serotypes, varicella, diphtheria, mumps, rubella, and rubeola. Repeat full T cell subsets 6 weeks later revealed marked improvement in lymphocyte counts with CD3 3083/microL, CD4 2101/microL, CD8 839/microL, CD19 225/microL, and CD1656/microL. A primary immunodeficiency genetic panel was ordered and positive for a heterozygous SAMD9L c.1549T>C (p.Trp517Arg) mutation classified as a variant of unknown significance. Discussion(s): This patient's history of severe viral infections, ataxia, thrombocytopenia, and severe transient lymphopenia during infection is suggestive of a SAM9DL gain of function mutation. Protein modeling done by the laboratory suggests this missense mutation would affect protein structure. The mutation found has been observed in individuals with thrombocytopenia. This case highlights the importance of immunophenotyping both during acute illness and once recovered.Copyright © 2023 Elsevier Inc.

Unexpected Severe Bocavirus Infections among Hospitalized Children during the COVID-19 Pandemic

Objective: Acute respiratory tract infections are one of the leading causes of morbidity and mortality in children. Although human bocavirus (HBoV) infections are not as common as other seasonal respiratory viruses, children who are infected with HBoV are more likely to suffer from a variety of respiratory conditions, including the common cold, acute otitis media, asthma exacerbations, bronchiolitis pneumonia, some of the affected children require pediatric intensive care unit stay. Here, we aimed to evaluate pediatric bocavirus (HBoV) cases presenting with severe respiratory tract symptoms during the coronavirus disease 2019 (COVID-19) pandemic. Method(s): This retrospective study evaluated the medical records of children diagnosed with respiratory infections, followed up at the Faculty of Medicine, Eskisehir Osmangazi University between September 2021 and March 2022. In this study, patients with HBoV identified using nasopharyngeal polymerase chain reaction (PCR) were considered positive. Cases were analyzed retrospectively for their clinical characteristics. Result(s): This study included 54 children (29 girls and 25 boys) with HBoV in nasopharyngeal PCR samples. The cases ranged in age from 1 month to 72 months (median 25 months). At the time of presentation, cough, fever, and respiratory distress were the most prevalent symptoms. Hyperinflation (48%), pneumonic consolidation (42%), and pneumothorax-pneumomediastinum (7%) were observed on the chest X-ray;54% of the children required intensive care unit stay. The median length of hospitalization was 6 days. Bacterial coinfection was detected in 7 (17%) children, while HBoV and other viruses were present in 20 (37%) children;57% of children received supplemental oxygen by mask, 24% high-flow nasal oxygen, 7% continuous positive airway pressure, and 9% invasive mechanical ventilation support. Antibiotics were given to 34 (63%) cases, and systemic steroid treatment was given to 41 (76%) cases. Chest tubes were inserted in three out of the four cases with pneumothorax-pneumomediastinum. All patients were recovered and were discharged from the hospital. Conclusion(s): The COVID-19 pandemic changed the epidemiology of seasonal respiratory viruses and the clinical course of the diseases. Although it usually causes mild symptoms, severe respiratory symptoms can lead to life-threatening illnesses requiring intensive care admission.Copyright © 2023. The Author(s).

Socioemotional functioning as a moderator of the predictive ability of the DIAL-4 on academic achievement

Student performance on kindergarten screening measures and level of kindergarten-entry skills have been shown to be predictive of subsequent academic achievement, thus making kindergarten screening measures a useful tool that guides the monitoring of student progress over time. Though a commonly used tool to assist in kindergarten placement considerations by educators nationwide, the literature is lacking in studies that demonstrate the predictive ability of the Developmental Indicators for the Assessment of Learning - Fourth Edition (DIAL-4) on later academic achievement. Related, behavioral and emotional functioning has been demonstrated to significantly impact student achievement. While the literature supports the predictive ability of kindergarten screening measures on academic performance, research is limited on how behavioral functioning moderates this predictive relationship. The present study aimed to examine the predictive ability of the DIAL-4 on later academic achievement and identify whether behavioral and emotional functioning impacts upon, and to what degree, the relationship between academic achievement and the DIAL-4. Additionally, this study examined the impact of the pause of in-person learning, as caused by the COVID-19 pandemic on student achievement and behavioral and emotional functioning through within-samples comparisons of student functioning in 2019 and 2021 to identify change amongst individual students. The results support the predictive ability of the DIAL-4 on subsequent academic achievement with significant correlations between DIAL-4 scores obtained before kindergarten with subsequent measures of academic achievement. The was no evidence found for a moderation effect of behavioral and emotional functioning on the prediction of academic achievement. Lastly, when controlling for scores on the DIAL-4, the data suggest a decrease in rate of student academic achievement and an increase in emotional and behavioral dysregulation following the onset of the COVID-19 pandemic demonstrated by statistically significant differences in BERI scores as well as significant decreases in rates of growth in reading ability within some cohorts. These findings provide educators with empirical evidence for the utility of the DIAL-4 in predicting academic achievement as well as insight into how the COVID-19 pandemic impacted students' functioning. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Managing severe warm autoimmune haemolytic anaemia after the SARS-Cov- 2 vaccine with emergency splenectomy and eculizumab

Autoimmune haemolytic anaemia (AIHA) is rare but described after the SARS-CoV- 2 Pfizer-BioNTech vaccine. We present a case of severe refractory warm AIHA after this vaccine, managed with emergency splenectomy and complement inhibition with eculizumab. A male in his teens with a history of liver transplant for biliary atresia (aged 2 years) and AIHA (aged 6 years) presented to his district general hospital with jaundice, dark urine, fatigue and chest discomfort 48 h after the first dose of SARS-CoV- 2 Pfizer-BioNTech vaccine (BNT162b2 mRNA). Investigations revealed haemoglobin (Hb) of 70 g/L and bilirubin of 98 mumol/L, which was treated as AIHA. The patient initially responded to prednisolone (1 mg/kg, 60 mg) but subsequently deteriorated and failed to respond to second-line rituximab (375 mg/m2) and two units of packed red blood cells (PRBC). By day 29 the patient had developed life-threatening anaemia culminating in a Hb of 35 g/L (after transfusion), lactate dehydrogenase (LD) of 1293 units/L and bilirubin of 228 mumol/L. This necessitated an immediate transfer to our tertiary centre for specialist support. Further investigations revealed a haptoglobin <0.1 g/L and direct antiglobulin test (DAT) strongly positive for IgG (4+) and negative for C3d. The peripheral blood film showed severe anaemia, nucleated red cells, anisocytosis and spherocytes with no autoagglutination, schistocytes or platelet clumps. Thrombocytopaenia (platelets 49 +/- 109/L) was present. Differentials were ruled out, such as paroxysmal nocturnal haemoglobinuria and heparin-induced thrombocytopaenia. HIV and hepatitis serology were negative, as were adenovirus, cytomegalovirus and Epstein-Barr virus PCR assays. A CT showed splenomegaly of 15.5 cm. Urinalysis found urobilinogen and bilirubin at high concentrations and negative urinary haemosiderin. Together, the investigations were consistent with warm AIHA. On day 29, four units of PRBC were transfused alongside 100 mg methylprednisolone and 1 g/kg IVIG. On day 30 the patient deteriorated despite the escalated treatment: Hb had only increased to 54 g/L, bilirubin was 200 mumol/L and LD was rising. Considering this life-threatening fulminant haemolysis, an emergency splenectomy was performed. This slowed haemolysis but did not completely ameliorate it: by day 33 the patient had received 15 units of PRBC. Thus, eculizumab, a terminal complement pathway inhibitor, was trialled to arrest intravascular haemolysis, alongside rituximab, repeat IVIG 1 g/kg, prednisolone 40 mg and tacrolimus 2 mg. This showed a favourable response, requiring less frequent transfusions and settling haemolysis. This case highlights the rare complication of warm AIHA with the SARS-CoV- 2 Pfizer-BioNTech vaccine, the use of emergency splenectomy for disease control, and the potential of eculizumab for refractory cases.

Report on the Condition of Education 2023. NCES 2023-144

The "Report on the Condition of Education" is a congressionally mandated annual report from the National Center for Education Statistics (NCES). Using the most recent data available (at the time this report was written) from NCES and other sources, the report contains key indicators on the condition of education in the United States at all levels, from prekindergarten through postsecondary, as well as labor force outcomes and international comparisons. There are core indicators that are updated every year and spotlight indicators that provide in-depth analyses on topics of interest to education agencies, policymakers, researchers, and the public. At the broadest level, the Condition of Education Indicator System is organized into five sections: family characteristics;preprimary, elementary, and secondary education;postsecondary education;population characteristics and economic outcomes;and international comparisons. The Report on the "Condition of Education 2023" encompasses key findings from the Condition of Education Indicator System. The full contents of the Indicator System can be accessed online through the website or by downloading PDFs for the individual indicators. [For "The Condition of Education 2023": At a Glance, see ED628291. For the "Report on the Condition of Education 2022. NCES 2022-144," see ED619870.]

LANGERHANS CELL HISTIOCYTOSIS IN A CHILD WITH MULTISYSTEMIC LESIONS ASSOCIATED WITH INFECTED POLIOMYELITIS AND SARS-COV-2, FEATURES OF DIAGNOSTICS. CLINICAL CASE.

Langerhans cell histiocytosis (LCH) is an abnormal clonal proliferation of Langerhans cells. The prognosis varies depending on the form of the disease and organ damage. Any organs and systems can be involved in the pathological process in various combinations. A poor response to standard therapy and an unfavorable prognosis are characteristic of patients with a multisystem form of LCH and involvement of organs at risk. Skin lesions are a classic sign of LCH. Purpose - to describe the complexity and duration of diagnosis of LCH with multisystem damage in a boy aged 2 years and 2 months, infected with poliomyelitis and coronavirus. Clinical case. The first clinical manifestations of LCH in the child debuted with an eczematous-seborrheic rash on the scalp with spread to the limbs and trunk. The child was treated for toxicoderma, hemorrhagic vasculitis at the place of residence for 6 months. The boy lost 1.5 kg of body weight in 1 month. At the time of hospitalization, seborrheic-eczematous rashes on the skin with a hemorrhagic component, trophic-inflammatory changes in the nails of the hands, signs of protein-energy deficiency, stomatitis, gingivitis, hepatosplenomegaly, polyserositis, diabetes insipidus, osteolytic foci of the frontal bones were found. Results of the tests: anemia, thrombocytopenia, hypoproteinemia and hypoalbuminemia, coagulation disorders. The patient had the onset of lower flaccid paraparesis, muscle hypotonia. The boy was diagnosed with a number of infectious complications, including poliomyelitis (a derivative of vaccine poliovirus type 2), COVID-19. The child received LCH-III cytostatic therapy with a positive effect. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.Copyright © 2023 Institute of Physics of the Russian Academy of Sciences. All rights reserved.

Preschool teacher practices and beliefs about digital technology use in classrooms

The focus of this dissertation centers around the beliefs that early education teachers hold regarding the role digital technology plays in the learning and development of young children and how those beliefs are implemented in the classroom. Although there is some previous research on this topic not enough is known about digital technology beliefs and practices at the preschool level. Thus, the focus of this dissertation centers around including the "voices of preschool teachers."Using a mixed methods approach via survey and selected follow-up interviews;100 preschool teachers expressed their beliefs and practices about digital technology use. Three groupings emerged;one group that favored using technology with young children, one group that favored technology use but with limitations, and a final group that did not see any benefit in using technology with young children. Preschool teachers also related the role technology may play in the learning and development of young children and levels of technology access. Almost all teachers reported that they had access to at least one electronic device;children's access, however, was much more limited.Lived experiences as teachers worked through the COVID-19 pandemic were also reported. Many teachers found that they were able to form better connections with parents and families via an electronic format, often at times that were more convenient for parents to talk. Teachers also reported learning how to use various types of digital technology during the COVID-19 pandemic and they reported continuing to implement what they had learned. Teachers' beliefs about technology use in classrooms by teacher demographics were tested to detect whether there were differences between the three belief groupings. The results indicated that when teachers received technology support they were more likely to have favorable beliefs about technology use. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Lymphoproliferation- a clue towards an underlying monogenic disorder of immune dysregulation- a retrospective analysis from a single center in India

Background: Lymphoproliferation is the persistent proliferation of lymphoid cells and it's incidence in inborn errors of immunity varies from 0.7 to 18%. Material(s) and Method(s): This is a retrospective analysis of patients referred to the department of Immunology, B. J. Wadia Hospital for Children, Mumbai between March 2017 to December 2022. Inclusion criteria consisted of 3 months duration of significant lymphadenopathy and/or splenomegaly or history of lymphoma. The clinical characteristics, laboratory and molecular findings of the included patients were analyzed. Result(s): A total of 66 patients were included. There was a male preponderance with male:female ratio of 25:8. Median age of onset of lymphoproliferation was 4.75 years(Range 1 year to 60 years). Splenomegaly was seen in 75%. Infections included recurrent pneumonia (14/66), recurrent ear infections(5/66), COVID(4/66), one episode of pneumonia(6/66), herpes zoster(3/66), recurrent subcutaneous abscess (3/66), abdominal koch(3/66), chronic sinusitis(2/66), dermatophytosis(2/66), esophageal candidiasis(2/66), recurrent malaria(1/66), recurrent varicella(1/66), cryptococcal meningitis(1/66), gram negative sepsis(1/66), BCG adenitis(1/66), pseudomonas osteomyelitis(1/66), impetigo (1/66), pseudomonas urinary tract infection (1/66), chicken pox(1/66), herpes keratitis(1/66), dengue(1/66), Other manifestations included Evans plus phenotype(10/66), Evans phenotype(8/66), Autoimmune hemolytic anemia(5/66), bronchiectasis(5/66), Type 1 diabetes(3/66), hyper reactive airway disease(2/66), inflammatory bowel disease(4/66), autoimmune thrombocytopenia(2/66), stroke(3/66), hemophagocytic lymphohistiocytosis(2/66), hypertriglyceridemia(2/66), hypothyroidism(2/66), celiac disease(1/66), Type 2 diabetes(1/66), autoimmune encephalitis(1/66), autoimmune hepatitis(2/66), anti-parietal cell antibody(1/66), arthritis(1/66), autoimmune enteropathy(1/66), systemic lupus erythromatosus(1/66), primary biliary cirrhosis requiring liver transplant(1/66), nephrotic syndrome(1/66), lymphoedema(1/66), hypersplenism(1/66), recurrent oral ulcers(1/66), gout(1/66), dermatitis(1/66), ovarian teratoma(1/66), alopecia areata(1/66). Hodgkin's lymphoma(HL) was the most common malignancy(9/66), followed by non Hodgkin lymphoma(NHL)(6/66), transformation from NHL to HL(1/66), Burkitt to T-cell lymphoma(1/66), HL to DLBCL(1/66), HL to anaplastic T-cell lymphoma(1/66). EBV driven lymphoproliferation was seen in biopsy of21/66. Genetic testing showed mutations in LRBA(11/66), PIK3CD(5/66), CTLA4(3/66), TET2(2/66), IL2RA (1/66), IL12RB1(1/66), BACH2(1/66), PRKCD(1/66), TNFSFR13B(1/66), TNFAIP3(1/66), FAS(2/66), FASL(1/66), Caspase8(1/66), CARD11(1/66), RTEL1(1/66), AICD(1/66), PIK3R1(1/66), IKBKB(1/66). Treatment included IVIG, chemotherapy, rituximab, sirolimus, abatacept, HSCT. Conclusion(s): All children with persistent lymphoproliferation, with or without autoimmunity and/or infections should be worked up for an underlying monogenic disorder of immune dysregulation. Lymphomas presenting at abnormal site and/or age, relapse and EBV driven lymphomas require further evaluation. Presence of monogenic cause helps in providing targeted therapy.Copyright © 2023 Elsevier Inc.

Cohort study on the change trend of astigmatism among preschool children in Baiyun district, Guangzhou from 2018 to 2021.

AIM: To explore the characteristics of astigmatism in preschool children before, during and after the COVID-19 epidemic, so as to provide a reference for further prevention and control of children's vision. *METHODS: In the consecutive four years from January 2018 to December 2021, a retrospective analysis of vision data was conducted on 2 273 preschool children (4546 eyes) younger than 4 years old who participated in children' s vision screening test in Baiyun district, Guangzhou. They were divided into 1 - year old group (ages<1-year old, 420 cases), 2-year old group (1-year <= ages < 2- year, 543 cases), 3- year old group (2- year <=ages <3-year, 614 cases), and 4 - year old group (3 - year <= ages< 4- year, 696 cases) according to ages. The analysis included astigmatic degrees of children's eyes as well as their conditions of astigmatism. *RESULTS: In 2018, the astigmatic degrees of the both eyes of 1-year-old group were higher than those of other groups (P<0.05). The binocular astigmatic degrees of the preschool children in four groups were obviously higher in 2020 than 2019 (P < 0. 05), while they were significantly decreased in 2021 when compared with 2020 (P < 0. 05). From 2019 to 2020, the increase of astigmatic degrees of the right eye is more considerable than the left eye of preschool children in those four groups (P < 0. 001). Furthermore, the morbidity of astigmatism basically echoes with the changing tendency of astigmatic degrees from 2018 to 2021. *CONCLUSIONS: Preschool children in Baiyun district, Guangzhou, have the highest degree of astigmatism and the fastest progression rate within 1 year old. Before COVID - 19 epidemic, the changes in astigmatism and prevalence were relatively stable;during COVID - 19 epidemic, the astigmatism and prevalence increased significantly and the astigmatic degrees of right eye increased more than that of the left eye;after the normalization of epidemic prevention and control, the astigmatism and prevalence decreased significantly.Copyright © 2023 International Journal of Ophthalmology (c/o Editorial Office). All rights reserved.