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Objective To summarize and analyze the features of liver function in pediatric patients infected with Delta variant versus Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS - CoV - 2). Methods In this study,an analysis was performed for the liver function test results of the locally transmitted or imported pediatric patients with SARS - CoV - 2 infection during isolation who were admitted to Guangzhou Eighth People's Hospital,Guangzhou Medical University,since May 21,2021,and the clinical data and the constituent ratio of liver injury were compared between the pediatric patients infected with Delta variant and those infected with Omicron variant. The independent samples t - test or the Mann - Whitney U test was used for comparison of continuous data between two groups,and the chi - square test or the Fisher's exact test was used for comparison of categorical data between two groups. Results A total of 85 pediatric patients infected with SARS - CoV - 2 were enrolled,among whom there were 32 (37. 6%)pediatric patients infected with Delta variant and 53 (62. 4%)pediatric patients infected with Omicron variant,and there were no significant differences between the two groups in age,sex, body height,body weight,and comorbidities (all P > 0. 05). There were no significant differences between the two groups in alanine aminotransferase (ALT),aspartate aminotransferase (AST),alkaline phosphatase (ALP),gamma - glutamyl transpeptidase,total bilirubin,albumin,and cholinesterase (all P > 0. 05),and the pediatric patients infected with Omicron variant had a significantly higher level of total bile acid (TBA)than those infected with Delta variant (Z = - 2. 336,P = 0. 020). However,the median values of TBA were within the normal range and the ratios of abnormal TBA were no significant difference between the two groups (P > 0. 05). Among the 85 pediatric patients,10 (11. 8%)had a mild increase in liver function parameters,among whom 7 had an increase in TBA,1 had an increase in ALT, 1 had increases in ALT and AST,and 1 had an increase in ALP. The analysis of liver injury in the pediatric patients infected with Delta variant or Omicron variant showed that there was no significant difference in the constituent ratio of liver injury caused by the two variants (6. 3% vs 15. 1%,chi2 = 0. 691,P = 0. 406). Conclusion Mild liver injury is observed in pediatric patients infected with Delta and Omicron variants of SARS - CoV - 2,but further studies are needed to evaluate the long - term influence of such infection on liver function.Copyright © 2022 Editorial Board of Jilin University
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Objective To analyze the changes of disease spectrum in pediatric inpatients before and after the outbreak of coronavirus disease 2019 (COVID-19). Methods The data of gender, age, habitual residence, diagnosis and other relevant information of 1 931 hospitalized children in Department of Pediatrics, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Feb. 2019 to Jan. 2020 (1 year before the COVID-19 epidemic) and 618 hospitalized children from Feb. 2020 to Jan. 2021 (1 year after the COVID-19 epidemic) were collected. The total number, habitual residence, gender and disease spectrum of hospitalized children 1 year before and 1 year after the COVID-19 epidemic were statistically analyzed. Results The number of hospitalized children decreased by 68.00% (1 313/1 931) 1 year after the COVID-19 epidemic. The number of hospitalized children from other provinces and cities was decreased (17.80%[110/618]vs 29.00%[560/1 931]) and there was significantly difference in the distribution of habitual residence of hospitalized children between 1 year before and 1 year after the COVID-19 epidemic (P<0.01). One year after the COVID-19 epidemic, the number of children with respiratory diseases decreased by 92.04% (971/1 055), and the proportion was also decreased (13.59%[84/618]vs 54.63%[1 055/1 931]);the number of children with endocrine system diseases increased by 20.71% (29/140), and the proportion was increased (27.35%[169/618]vs 7.25%[140/1 931]);the number of children with neonatal diseases decreased by 43.01% (166/386), but the proportion was increased (35.60%[220/618] vs 19.99%[386/1 931]). Compared with 1 year before the COVID-19 epidemic, there were significant differences in the proportions of respiratory diseases, endocrine system diseases and neonatal diseases in hospitalized children 1 year after the COVID-19 epidemic (all P<0.01). The age distribution of hospitalized children 1 year before and 1 year after the epidemic of COVID-19 was different (P<0.01), and the number of hospitalized children was also different in different seasons (P<0.05). One year after the epidemic of COVID-19, the number of hospitalized children with respiratory diseases was decreased most significantly, and the number of children with pneumonia decreased by 93.71% (655/699), with a significant difference found in the proportions of pneumonia between 1 year before and 1 year after the COVID-19 epidemic (52.38%[44/84]vs 66.26% [699/1 055], P<0.05). Compared with 1 year before the COVID-19 epidemic, the proportion of endocrine system diseases such as short stature/growth retardation was decreased and the proportion of precocious puberty/early puberty development was increased 1 year after the COVID-19 epidemic (P<0.05). Conclusion The COVID-19 epidemic has led to a significant decrease in hospitalized children in department of pediatric, especially in the proportion of respiratory diseases, but it has led to an increase in hospitalized children with endocrine system diseases, suggesting that epidemic prevention and control measures can effectively reduce respiratory diseases requiring hospitalization, but may increase precocious puberty and early puberty development. These changes should be considered by department of pediatrics in general hospitals.Copyright © 2022, Second Military Medical University Press. All rights reserved.
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Introduction: The main prevention of cardiovascular disease (CVD) and healthcare cost reduction depend on the early identification and treatment of cardiovascular disease (CVD) risk factors through screening. Hypertension, obesity, a large waist circumference, smoking, poor diets, physical inactivity, and excessive alcohol consumption are well-known and potentially treatable risk factors for cardiovascular disease. This allows for early detection of instances, informs the start of CVD prevention medication, and is also very cost-effective. Method(s): At rural India, between March and August 2021, a cross-sectional survey was conducted in community pharmacies. One thousand two hundred healthy individuals were screened for signs of obesity, high blood pressure, waist circumference, and history of smoking and alcohol intake. A structured questionnaire was used to get participants' physical activity and diet. Result(s): The gender split of the 1200 participants who were screened was 67.8% male and 32.3% female. Participants' ages ranged from 18 to 60 years old in 43.3% of cases, 41 to 60 years old in 26.3%, and over 60 in 30.4% of cases. There were 43.7% of drinkers and 47.3% of smokers, respectively. A BMI of 25 kg/m2 or more indicates being overweight, whereas a BMI of 30 kg/m2 indicates being obese. Using a diagnostic cutoff of >140/90mmHg prevalence of hypertension was 44.3%, and 14.9% out of these were previously hypertensive. 31.5% had high waist circumference, 13.9% had insufficient physical activity, and 34.9% had insufficient intake of fruits and vegetables. Conclusion(s): The majority felt that screening for CVD risk factors was helpful, and more than one-fourth of the study participants had two or more CVD risk factors combined. A cost-effective strategy for the primary prevention of CVD that can have a positive influence on the healthcare delivery system is the capacity to further discover previously undetected risk factors.Copyright © 2023, Global Research Online. All rights reserved.
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BACKGROUND: In Indonesia, the stunting prevalence has reached 24.4% in 2021. AIM: The study aims to examine the determinants of stunting among children under five of age during the COVID-19 pandemic in the working area of the Liwuto-Primary Public Health Center, Baubau city. METHOD(S): A community-based unmatched case-control study was conducted from January 10, to March 10, 2022, on a sample of 94, cases (n = 21), and controls (n = 73) of children aged 0-59 months with their respective mothers. Data were collected using a face-to-face interviewer-administered questionnaire and physical measurements standard. The data were analyzed using SPSS version 17. The variables were entered into the multivariable model using the backward stepwise regression approach. Multivariable logistic regression analysis was used to identify factors associated with stunting. Adjusted odds ratio (AOR) with a 95% confidence interval (95% CI) and p < 0.05 was used to declare the significance. RESULT(S): There are 22% of the stunting become in children under 5 years. Stunting children under 5 years was associated with maternal age (AOR = 5.71, 95%, CI: 1.91-17.03). While family income (AOR = 1.78, 95%, CI: 0.17-18.86), exclusive breastfeeding (AOR = 3.95, 95%, CI: 0.14-112.72), complementary feeding (AOR = 1.24, 95%, CI: 0.18-8.55), formal education (AOR = 0.74, 95%, CI: 0.36-1.53), and occupation (AOR = 2.98, 95%, CI: 0.24-36.55) were not associated with the stunting. CONCLUSION(S): Young mother under 30 years old was an important risk factor on the incidence of stunting in children under 5 years during the COVID-19 pandemic.Copyright © 2023 Jumadi Muhammadong, Ridwan Malimpo, Dahmar Karim, Yusman Muriman, Andi Tenri Mahmud.
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Introduction: Protein energy wasting (PEW) is an established entity in adults with CKD but is not well studied in children. The burden of PEW has been observed to be higher in Indian children with CKD compared to the chronic kidney disease in children (CKiD) cohort. The impact of PEW on outcomes needs to be addressed in these children with CKD. This prospective longitudinal study was undertaken in children with CKD 2-5D to assess the association of PEW with clinical outcomes of infection related hospital admissions (IRHA). Method(s): Children (age 2-18 years) with CKD 2-5D, from a tertiary care center were recruited for PEW assessment from January 2017 following ethical committee approval and informed consent. Children with evidence of infection in the last month and those on dialysis for less than a month were excluded. Demographic characteristics and clinical outcomes of hospital admissions were recorded till June 2022. Based on the CKiD study, PEW was diagnosed and categorized using 5 criteria: 1. Muscle mass (Mid arm muscle circumference);2. Body mass (body mass index);3. Biochemical parameters (serum cholesterol, serum albumin, serum transferrin, and C-reactive protein);4: Appetite and 5. Short stature. PEW was further categorized as mild (> 2 criteria), standard (> 3 criteria), and modified (> 3 criteria with short stature). Infections that needed hospitalization included viral hemorrhagic fever, COVID-19 infection, sepsis, urinary tract infection, lower respiratory tract infection, peritonitis, and catheter-related blood stream infection. Result(s): Among 136 children (45 on dialysis, mean age 122 + 46 months, 70% males) 72 (53%) had PEW. The proportions of those with mild, standard, and modified PEW were 8%, 13%, and 32% respectively. Over a mean follow-up of 38 + 21 months, 104 (76%) children required hospital admissions of which 69% were due to infections. Death was noted in 2%, and 12% got transplanted. The proportion of children needing hospital admissions was significantly higher in those with PEW compared to those without PEW (85% vs 66% respectively, p=0.011). IRHA was observed in 68% of children with PEW compared to 36% without PEW (p<0.001). The proportion of IRHA in those with dialysis with or without PEW ((87% vs 50%, p=0.001) was significantly higher compared to those with CKD 2-5 (54% vs 32%, p= 0.03). In the overall cohort, the proportion of IRHA was significantly higher with modified PEW compared to other PEW categories (p<0.001), [modified: 74.4%, standard: 58.0%, mild: 59%, no PEW: 36%]. On multivariable analysis, by adjusting for age, gender, etiology of CKD, and dialysis, the presence of PEW and dialysis status were independent factors associated with IRHA [Adjusted OR 3.58 (1.62,7.89), p=0.002] and [OR 3.29 (1.4,7.75), p=0.006, respectively]. Similarly, the presence of inflammation was independently associated with IRHA [OR 3.93 (1.49, 10.3), p=0.002]. Figure 1 shows the risk factors associated with IRHA based on PEW categories and inflammation status. [Formula presented] Conclusion(s): In children with CKD 2-5D, the presence of PEW and inflammation were significantly associated with IRHA. Children with modified PEW had nearly 5 times more risk of developing IRHA, reinforcing the importance of growth as a unique parameter of PEW in these children. No conflict of interestCopyright © 2023
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This study aims to investigate the correlation between psychological distress and weight change in Malaysian young adults after the pandemic-led lockdowns. Socio-demographics, body height, body weight during the Movement Control Order 3.0 (MCO 3.0), and post-lockdown body weight (as of January 2022) were self-reported by the young adults. Psychological distress was assessed using a validated 21-item Depression, Anxiety, and Stress Scale (DASS-21). Of the 536 young adults, 54.1% experienced mild to extremely severe anxiety, 47.0% suffered mild to extremely severe depression, and 30.0% experienced mild to extremely severe stress in the post-lockdown pandemic phase. In reference to absolute weight change, 50.6% of the young adults gained weight due to confinement, with an average weight gain of 3.41 ± 2.49 kg. Conversely, 32.0% of the young adults had a lighter weight during the MCO 3.0 than before, with an average weight loss of 3.96 ± 2.76 kg. Additionally, the trajectory in body weight was also expressed in relative weight change. Findings revealed that 23.1% of the young adults gained weight in the post-lockdown pandemic phase, with an average relative weight gain of 9.04 ± 3.90%. On the contrary, approximately one-fifth (17.4%) of the young adults lost weight, with an average relative weight loss of −8.57 ± 2.79%. There were no significant correlations (p> 0.05) between depression, anxiety, and stress with absolute or relative weight change, even after controlling for the socio-demographic variation among young adults. The federal government of Malaysia should take necessary actions to alleviate the psychological impact of the COVID-19 pandemic and reiterate the importance of sustaining a healthy body weight in young adults.
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Children and adolescents with disabilities benefit from physical activity. However, this population has lower fitness levels and higher rates of obesity than their peers, suggesting that they are not meeting physical activity guidelines and are experiencing barriers to participation. The purpose of this study was to quantify physical activity participation and barriers experienced by children and adolescents with disabilities in our area. Forty-five parents or caregivers of children aged 2-18 with physical and/or intellectual disabilities completed a questionnaire regarding physical activity participation in an average week and barriers to participation, prior to the SARS-CoV-2 pandemic. Data were analysed using quantitative and qualitative methodologies. Ninety-one percent (41/45) of the children and adolescents with disabilities did not participate in sufficient physical activity to meet physical activity guidelines irrespective of type and severity of the disability (p > 0.05). Physical activity participation decreased with increasing age (r = -0.478, p = 0.001). The most commonly identified barrier was 'environments and programmes not able to handle nature of disability.' In our sample, the majority of children and adolescents with disabilities did not meet physical activity guidelines, with access reported as a primary barrier. This may have negative consequences on the physical and mental health of children and adolescents with disabilities. The SARS-CoV-2 pandemic may have worsened the rates of physical activity participation noted in our study.
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P1 was referred with short stature aged 2.4 yrs (HtSDS -2.1). Mother's height 165cm (+0.5 SD), father's 185cm (+1.55 SD). Growth hormone (GH) deficiency was diagnosed following two GH stimulation tests (peak GH 6.8 ng/ml at 3.2 yrs, 5.17 ng/ml at 3.7 yrs) IGF1 4.6 nmol/L (1.7-27.6) at 2.5 yrs. Pituitary MRI was normal. GH treatment was started at 5 years at HtSD -2.2. Once P1 demonstrated catchup growth (up one centile in 7 months), P1's older sister P2 was referred for investigation of short stature (HtSDS -1.5). She was not dysmorphic but her mother noted antenatal scans had short foetal femur lengths on the 5th centile. Birth weight was on the 10th centile at 2.65kg at 38 weeks gestation. Short stature was present from age 3 with height tracking along the 2nd centile. Her GH was 7.17 ng/ml at time 0 on a growth hormone stimulation test, IGF1 25.9 nmol/L (3.1 - 51.9). This was performed during the COVID pandemic and could not be repeated. It was felt that GH deficiency was unlikely so a skeletal survey was requested. This showed mild Madelung deformity and short 4th/5th metacarpals. Subsequent SHOX analysis revealed that she was heterozygous for 2 SHOX dosage abnormalities in cis. The first was a deletion located between 133 kb and 163 kb downstream of the SHOX gene. The second was a duplication that included the final exons of the SHOX gene (exons4-6a). Family testing revealed the same SHOX variants in P1's father, who was the smallest in class in early childhood and had grown late into adulthood, reaching a tall final height at aged 21. Mother and P1 did not have these SHOX variants. P1 has demonstrated excellent catch-up growth on GH treatment, HtSDS +0.4. IGF1 36.5 nmol/L (2.7-45.5) at 7.3 years. P2 has been on GH treatment for over a year, latest HtSDS - 1. Conclusion(s): Both siblings were short for the family target. Following a diagnosis of GH deficiency in one sibling, the investigative pathway for the other was assumed. Routine karyotype was performed after GH stimulation test with SHOX analysis requested after the skeletal survey report. The siblings' father has the same SHOX variants as P2 and is tall. Biological effects of SHOX deletion appears to be variable in this family and is present in P2 radiologically. The duplication is of uncertain significance.
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Purpose/Objectives: Understand the rates of pediatric obesity in the Inland Empire of Southern California, in the context of COVID quarantine, to improve counseling and treatment of these patients. Design/Methods: A retrospective chart review was performed on all patients seen at a FQHC in Southern California. Patients between 5 and 18, who had a clinic visit between 6/1/2020 to 7/31/2020 for a well-child visit, with at least one other well-child visit in calendar year 2019 and 2018 were included. Patients with congenital heart disease, short gut syndrome, ADHD on stimulant medications, G tube dependence, diseases affecting growth or stature, complex syndromes (CHARGE, VACTERL, DiGeorge), syndromes affected growth, oncologic conditions, intellectual disability, transplant recipients, incomplete BMI data or malnutrition (BMI Z score <= -1) were excluded. BMI values, Z-scores, and percentiles, as well as relative changes from 2018 to 2019, and 2019 to 2020 were analyzed using one-way ANOVA and Tukey post hoc test. Results: There was a statistical difference in BMI between years as determined by a one-way ANOVA (F(2,509) = 2.811, P = 0.05). A Tukey post hoc test revealed that the BMI of students in 2020 was statistically higher (19.87.65, p = 0.05) compared to the BMI in 2018 (18.25.71). There was no statistical difference in BMI between 2020 and 2019, and 2019 and 2018 (Figure 1). When groups were stratified into morbidly obese (BMI >= 99%), obese (BMI >=95% & <99%), overweight (BMI >=85% & <95%), and healthy weight (BMI >=5% & < 85%), patients who were not at a healthy weight increased from 36.8% in 2018 to 40.4% in 2019, to 44.7% in 2020 (Figure 2). As shown in the SANKEY diagram (Figure 3), while there was an initial decline in morbidly obese patients in 2018 to 2019 (-8.3%), there was a relatively large increase from 2019 to 2020 (+45.5%). From 2018 to 2019, 75 out of 141 patients (53.2%) had a decrease in BMI, while in 2019 to 2020 there were 56 out of 141 patients (39.7%) who had a decrease in BMI. Out of the 75 patients who had a decrease in BMI from 2018 to 2019, 49 (65.3%) had a rebound increase in BMI from 2019 to 2020. Conclusion/Discussion: There was a significant increase in overall BMI from 2018 to 2020 with an overall increase in patients who fall into the obese and overweight categories in 2020. 65.3% of patients who had a decreasing BMI from 2018 to 2019 have a rebound increase in BMI in 2020. This can likely be contributed to the COVID-19 pandemic and stay-at-home orders leading to a more sedentary lifestyle. More research should be performed to elicit multifactorial (physical activity, diet, and psychosocial factors) etiology of the worsening obesity epidemic during the COVID-19 pandemic.
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Introduction: Pulmonary Function Tests (PFTs), especially spirometry is an established mode of assessing chronic lung diseases especially Asthma. Spirometric reference values are essential in assessing pulmonary function. Normative values of these tests differ from population to population and with difference in methods and apparatus used. The normal standards for pulmonary function measurements among the hilly areas of Himachal Pradesh is not reported yet. Aim: To measure the normative values of spirometry (FEV1, FVC, FEV1/FVC, PEFR) in children of 5- 18 years age range living in and around Solan district of Himachal Pradesh, India. Material and Methods: This cross-sectional study was carried out at M.M Medical College and Hospital, Kumarhatti, Solan, HP, India and comprised school-going children and nearby community aged 5-18 years. After noting their gender, age, height and weight, the pulmonary function test measures, Forced vital capacity (FVC), Forced expiratory volume in 1 second (FEV1), FEV1/FVC%, FEF 25-75% and peak expiratory flow rate were taken. Simple and multiple regression models were used for the prediction of pulmonary function test values. SPSS 20 was used for statistical analysis Results: Of the 200 participants, 110(55%) were boys and 90 (45%) were girls. The mean age was 12.47±3.27 years. The means height, weight, forced expiratory volume in 1 second, force vital capacity, peak expiratory flow rate FEV1/FVC% and FEF 25-75% were 147.39±16.07cm, 41.30±12.38kg, 2.54±0.70, 2.90±0.8, 5.42±1.30, 87.41±3.85% and 2.90±0.84 respectively. All the three variables - Age, Height and Weight-had significant linear relationship and positive correlation with the pulmonary function test values (p0.7). Among these three variables maximum correlation was found with height (r=>0.8). Conclusion: Age, height and weight had statistically significant and positive correlation with the PFT values, both for boys and girls. Height was found to be most strongly and positively correlated with the PFT values. Overall significant difference was seen in FEV1/FVC and FEF 25-75 among boys and girls except FEV1, FVC and PEFR of the same age group. The fitted regression equations would help to predict the PFT values for the Indian children living in hilly areas at given age, height and weight. This study should be seen as a pilot study and will require data from a large population to establish normal values for our population.
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Physical inactivity and poor dietary pattern are considered as health related challenges in ASD (ASD) which seems to be affected by Covid-19 pandemic. The purpose of this clinical trial was to investigate the effect of functional training along with online nutritional education on metabolic related biomarkers in children with ASD. 80 verified children with ASD (age=9.73 ± 1.29, weight=49.94 ± 2.08 kg, stature=146.08 ± 40 cm, BMI percentile= 64.88 ± 2.89, FM percentage+24.71 ± 1.48) were randomly divided into four groups including: (1) functional training, (2) online nutritional education, 3) training+ education and 4) control group. Pre-test was taken for metabolic related biomarkers and each experimental group received their interventions for 8 weeks. Post-test was taken at the end of 8 weeks. The results from this study, did not show significant changes for WHR (sig=0.06). Significant changes was indicated for FM (sig<0.001), TC(sig<0.001), TG (sig=0.006), HDL (sig<0.001), LDL (sig=0.001), HOMA (sig=0.04). In conclusion, functional training and online nutritional education can be considered as beneficial interventions for metabolic related biomarkers improvement in children with ASD during Covid-19 pandemic.
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BACKGROUND: One indicator of the health of infants and toddlers is an increase in body weight and length/height following age. This fact has attracted the attention of many parties trying to find solutions and innovations, including re-examining the local wisdom of Indonesian culture, which is believed to have been passed down from generation to generation to help increase the baby’s weight and length. AIM: This study aims to determine the effectiveness of baby massage on increasing a baby’s weight and length in the work area of the Nosarara Community Health Center, Palu City. METHODS: This type of research was a quasi-experimental research design with pre-and post-test control group design. The population in this study were all infants aged 0−11 months in the Nosarara Health Center’s working area, involving 60 infants;30 were the intervention group for a month of massage and 30 were the control group. The sampling technique in this study used the purposive sampling method based on certain considerations. The statistical test used was parametric and the paired t-test. RESULTS: The age of the mother in this study is mostly 28−30 years old, namely, 23.3% with an education level of Senior High School at 63.3% and the mother’s work is Mother’s work, which is 95%. Then, the age of most children aged 4−7 months, namely, 38.3%. There is a difference in children’s weight before and after the intervention where the initial weight is 5.8 kg–6.43 kg after 1 month of intervention. There are differences in the child’s body length before and after the intervention where the initial body length was 56.97 cm–60.03 cm after 1 month of intervention. CONCLUSION: This study showed no significant difference in the increase in body weight and length of infants between the intervention and the control groups. The average increase of massaged infants was 600 g in weight and 3.01 cm in length. Those who were not massaged were 400 g in weight and 1.26 cm in length.
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Introduction: Schaaf-Yang-Syndrome (SYS, OMIM # 615547) is caused by truncating variants of the paternal allele of the maternally imprinted, paternally expressed gene MAGEL2 in the Prader-Willi critical region 15q11–15q13. Prader-Willi syndrome (PWS) and SYS share several phenotypic features, including muscular hypotonia, developmental delay/intellectual disability, and short stature. Evidence exists that similar to PWS, Growth Hormone (GH) deficiency is also a feature of SYS. Since 2000, GH therapy has been approved by the Federal Drug Agency (FDA) for PWS, which poses the question if GH therapy is a suitable treatment for children with SYS. Objective: To assess the prevalence of GH therapy in SYS children, its effect on the clinical endpoints height and body mass index (BMI), possible side effects and parents’ perception of changes during the therapy. Methods: Twenty-eight individuals diagnosed with SYS were recruited through CP Schaaf and the closed Facebook group for SYS. Patients were sent a consent form, a clinical questionnaire, and asked for growth charts of the affected children. Feedback on muscle strength, endurance and satisfaction was measured on a 5-level Likert scale. Height and BMI Z Scores (defined as the standard deviation of average height or BMI compared to children of the same sex and age) were calculated using WHO/CDC data and the PedZ calculator. The effect size of GH therapy was assessed by calculating the change in Height and BMI Z Scoreover the first 6 months of treatment. Data was(figure presented)(figure presented)linearly interpolated if no measurement on exactly 90 and 180 days after treatment start was taken. Results: Of the 28 individuals enrolled, 14 were on GH therapy. Thirteen of the 14 patient families provided feedback for the changes during therapy. Detailed growth charts were available for 8 patients with GH therapy, as well as for 5 patients without GH therapy. GH treatment was initiated at an average age of 2.6 years (range: 5 months up to 8 years). No patient has had to discontinue or interrupt GH therapy. Parental perception of changes after the onset of treatment was unanimously positive: All families noted either an increase (7 patients) or strong increase (6 patients) in muscle strength. For endurance, feedback was exactly the same. Overall, general satisfaction with the treatment was high, with 8 families stating they were very satisfied, 3 families stating they were satisfied and 2 families being neutral. Additional reported benefits were improved cognitive and social skills (6 patients) and improved motor development (5 patients). Negative side effects included worsening of sleep apnea in one individual which did not require further treatment or intervention, and worsening of scoliosis/kyphosis in further two individuals. In both cases of scoliosis, treatment start coincided with local Covid19 restrictions, and physical therapy and new back braces were no longer accessible for both patients.After three months of GH treatment, Height Z Score of the treated group increased on average by +0.70. After six months of treatment, the average increase in Height Z Score was +0.99 (Fig. 1A and 1B). The BMI Z Score of the treated group decreased by −0.48 after three months and by −0.71 after six months of treatment, on average (Fig. 2A and 2B). We calculated Height Z Scores and BMI Z Scores of the treated and nontreated groups, which revealed average Height Z Scores of −1.1 in the treated group, and −3.5 in the non-treated group (Fig. 1C). The average BMI Z Score in the treated group was +0.47, while the average BMI Z Score in the untreated group was +0.93 (Fig. 2C). Conclusion: We present a retrospective, questionnaire-based assessment of GH treatment in individuals with SYS. Our findings suggest that GH therapy should be considered as treatment for SYS. In this cohort, it led to an increase of body height and parental reports suggested an improvement of endurance and muscle strength. Furthermore, several families also noted additional beneficial sideeffects like im roved cognition and motor development. These data pave the way for a prospective clinical trial of GH therapy for individuals with SYS.
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Objective: The present study is based on a novel approach of validated breath-holding technique and efficiency of SpO2 in the adverse COVID-19 outcomes and comparison with normal subjects. Methods: It is a prospective observational study conducted in residential/private nursing colleges, St. Luke’s School and College of Nursing and Smt. Vijaya Luke’s College of Nursing, Visakhapatnam during the period July 2021. Fifty-three student nurses affected with mild COVID-19, 35 student nurses affected with moderate COVID-19, aged 18–23 years were enrolled after taking thorough history about COVID-19 that is after 2 months of complete recovery. They were classified based on the symptom history in which the subjects without symptoms or mild symptoms were taken as mildly affected, whereas subjects with severe symptoms with mild fluctuations in SpO2 who didn’t require hospitalization were classified as moderately affected. The study included 109 normal control cases who are never affected with COVID-19 viral infection. In all the subjects, the oxygen saturation was measured using pulse oxymeter and their Breath holding times were also measured using standard protocols. Results: The mean value of BHT was significantly reduced from normal 16.7339±3.4 to 12.8571±5.1 (p<0.05) in moderate cases. When oxygen saturation levels were compared before and after the breath holding in normal, mild and moderate cases the results were significant. However, when the oxygen saturation levels were compared between normal and mild COVID-19 cases the values were insignificant (p=0.4) and at the same time when the oxygen saturation levels were compared between normal and moderate COVID-19 cases the values were significant (p=0.0001). Conclusion: According to the findings, breath-holding does not need greater energy expenditure or cardiac output, and it eliminates walking and the related contamination of bystanders as occurring with pulse oximeter. Breath holding time is a determinant of respiratory capacity, when used as parameter helps in assessing the progression of lung injury, it gives an idea about respiratory fitness especially in this COVID era. Breath holding time and fluctuations in SpO2 when used conjointly we can assess degree of lung damage so that further treatment such as the continuity of medication, practicing of breathing exercises with or without medical treatment can be planned. This simple non-invasive tool can be used for the self-assessment of improvement in post-Covid patients. Future validation studies validate this hypothesis, measurement of these basic, innovative surrogates requires minimum inventory (i.e., a means to record oximetry and a timing device) and could feasibly provide a useful way to evaluate risks of future deterioration under under-resourced conditions.