Bioactive aerogels based on native and phosphorylated potato (Solanum tuberosum L.) starches incorporated with star fruit extract (Averrhoa carambola L.).

The aim of this study was to develop a star fruit extract (SFE) and incorporate it into aerogels based on native and phosphorylated potato starches. The phosphorylation of starch enhances its properties by incorporating phosphate groups that increase the spaces between starch molecules, resulting in a more resilient, intact aerogel with enhanced water absorption. The bioactive aerogels based on potato starch and 10, 15, and 20 % (w/w) of SFE were characterized by their morphological and thermogravimetric properties, infrared spectra, water absorption capacity, loading capacity, and antioxidant activity. Epicatechin was the major compound present in SFE. The thermal stability of SFE increased when incorporated into phosphorylated starch aerogels at a concentration of 20 %. The water absorption capacity was higher in phosphorylated starch aerogels (reaching 1577 %) than in their native counterparts (reaching 1100 %). Native starch aerogels with 15 and 20 % SFE exhibited higher antioxidant activity against hydroxyl free radicals compared to phosphorylated starch aerogels, achieving 79.9 % and 86.4 % inhibition for the hydroxyl and nitric oxide radicals, respectively. The ideal choice of freeze-dried aerogel depends on the desired effect, either to act as an antioxidant agent by releasing bioactive compounds from SFE or as a water-absorbent agent in food products.

Hard drugs use and tooth wear: a scoping review.

OBJECTIVES: This study aims to map evidence on the relationship between hard drug use and dental wear. The scoping review is guided by the question: What is the relationship between hard drug consumption and dental wear? MATERIALS AND METHODS: Adhering to PRISMA-ScR guidelines, searches were conducted across PubMed, Embase, and four databases in March 2024. Inclusion criteria included studies investigating the association between hard drug use and dental wear, regardless of publication date or language. Data were presented through narrative exposition, tables, and a conceptual framework. RESULTS: Twenty-eight studies (four case-control, three cross-sectional, five case reports, and sixteen literature reviews) were included. Among case-control studies, 75% observed an association between drug use and dental erosion; however, no cross-sectional studies demonstrated this association. Despite questionable quality, reviews established connections between drug use and dental erosion. Studies aimed to elucidate potential causes for dental erosion. CONCLUSIONS: Analysis suggests a potential link between hard drug use and dental wear, though indirect. Factors like bruxism and reduced salivary pH may contribute to dental wear among drug users. Further investigation through primary studies exploring this relationship is necessary. CLINICAL RELEVANCE: Dentists should focus not only on clinical characteristics of dental wear but also on mediating factors such as bruxism and decreased salivary pH associated with drug use. This holistic approach allows for a deeper understanding of dental wear mechanisms, enabling targeted preventive and therapeutic interventions.

Sociodemographic profile and clinical presentation of young children unintentionally exposed to marijuana: A single site retrospective cohort.

BACKGROUND AND OBJECTIVES: Legalization of medical marijuana has increased unintentional exposure to marijuana in young children. We aim to explore the sociodemographic disadvantage profile, prevalence, and clinical presentation of children diagnosed with unintentional exposure to marijuana. METHODS: We conducted a retrospective chart abstraction of 121 children (aged 0-6) seen at the Emergency Department (ED) at a single tertiary hospital center in Dayton, Ohio between January 01, 2010 and January 09, 2022. RESULTS: Majority were female (62.8%), white (50.4%), and with Medicaid as their primary insurance (84.3%). The median age at exposure was 1.8 years. There was a 14-fold increase in unintentional marijuana cases pre-2017 (7 cases) versus post-2017 (114 cases), the year of legalization of medical marijuana in the state of Ohio. Majority of the patients were using public assistance (66.4%). 26.7% of the cases had a prior social work consultation and 38.1% had a prior children services consultation. 51.3% of the children had a social disadvantage index score of 3 or greater (range 0-5) with higher scores indicating greater disadvantage. DISCUSSION AND CONCLUSIONS: The number of patients presenting to the ED at the hospital has increased 14-fold since the legalization of medical marijuana in Ohio. Half of the children displayed a higher sociodemographic disadvantage index score. SCIENTIFIC SIGNIFICANCE: Our study is the first study investigating the sociodemographic profile of children exposed to marijuana. The findings of this study may be utilized to inform policy for safely dispensing recreational and medicinal marijuana products and focus the efforts on families with sociodemographic disadvantage.

Reducing Discharge Medication Reconciliation Errors at a Pediatric Neurology Inpatient Unit.

Background and Objectives: Medication reconciliation errors are a common problem in health care, particularly during transitions of care. Discharge medication reconciliation (DMR) errors in a pediatric setting can range from 26% to 42.2%. We conducted a quality improvement project to decrease DMR error rate at Dayton Children's Hospital in Dayton, Ohio. Methods: We conducted 2 interventions, each with 3 Plan-Do-Study-Act cycles from September 2021 through February 2023. The first intervention focused on using current specialty neurology nurses as scribes and creating a template note to include the plan of care and review of DMR before discharge. Our second intervention consisted of standardizing the seizure rescue medication order by creating an order panel within our electronic medical record system for all the rescue medications presently available. Medication errors were documented by the specialty neurology nurse during a phone conversation on the next business day post discharge. DMR error rates were calculated for each week using a control chart. Medication errors and patient harm were classified according to the National Coordinating Council for Medication Error Reporting and Prevention Index. Results: One hundred six errors were noted. Of these, 98 (92%) occurred in patients with seizure and 64 (60%) were related to prescription of seizure rescue medication specifically. The baseline error rate was calculated at 15.7% or 7 errors per month (January 2021 through June 2021). The average error rate dropped from 15.7% to 5.3% (2 errors per month) after initiation of our first intervention (September 2021). Twelve weeks after initiation of the second intervention, a 2.9% (1 error per month) was noted. Afterward, there was a ten-week period of 0% errors. Discussion: Sustainable reduction of DMR errors in pediatric patients with epilepsy was achieved by using specialty neurology nurses to scribe the care plan and creating order panels to facilitate accuracy of discharge medication orders without additional cost to the hospital.

Cassava starch esterification with formic acid for fabrication of electrospun fibers.

Formic acid is utilized to induce esterification and chemical gelatinization in starch, particularly in the fabrication of electrospun fibers for nanomaterial production. This study investigated the impact of different concentrations (15, 20, 25, and 30 %) of cassava starch and formic acid as a solvent on the characteristics of the resultant polymeric solutions and electrospun fibers. Morphology, size distribution, thermogravimetric properties, diffraction patterns, and relative crystallinity were evaluated for the electrospun fibers. The amylose content of starch varied from 16.5 to 23.7 %, decreasing with esterification, achieving a degree of substitution of approximately 0.93. The solution-rheology exhibited elastic behavior, with viscosity increasing as starch concentration increased, hindering the fabrication of fibers at 25 and 30 % starch. Successful electrospun fibers were formed using 15 % and 20 % starch, displaying homogeneous morphologies with mean diameters of 165 nm and 301 nm, respectively. Esterification influenced thermogravimetric properties, leading to fibers with reduced degradation temperatures and mass loss compared to native starches. The electrospun fibers presented an amorphous structure, indicating a drastic reduction in relative crystallinity from 35.2 % in native starch to 8.5 % for esterified starches. This study highlights the intricate relationship between starch concentration, esterification, and solution viscosity, affecting the electrospinnability and properties of starch-polymeric solutions.

Antimicrobial activity of geranium (Pelargonium graveolens) essential oil and its encapsulation in carioca bean starch ultrafine fibers by electrospinning.

Geranium (Pelargonium graveolens) is known for being an aromatic plant rich in bioactive compounds with antibacterial properties. In this study, geranium essential oil (GEO) was extracted and encapsulated in ultrafine bean starch fibers produced by electrospinning as an antibacterial agent. GEO revealed a composition rich in volatile compounds, including citronellol, cis-geraniol, ß-linalool, citronellyl formate, and linalool formate. In its free form, GEO exhibited high antibacterial activity against pathogenic bacteria strains (L. monocytogenes, S. aureus, and E. coli). The bean starch fibers, produced with and without the addition of GEO, were uniform and continuous, with an average diameter ranging from 249 to 373 nm. Confocal analysis indicated a uniform distribution of GEO in the fibers, with a loading capacity of 54.0 %, 42.9 %, and 36.5 % for 20 %, 30 %, and 40 % GEO concentrations, respectively. Remarkably, fibers containing 40 % GEO showed a significant reduction in tested bacteria (L. monocytogenes, S. aureus, and E. coli), suggesting promising applications in preventing losses and extending the shelf life of food through active packaging.

Electrospun nanofibers based on zein and red onion bulb extract (Allium cepa, L.): Volatile compounds, hydrophilicity, and antioxidant activity.

Onion is rich in bioactive and volatile compounds with antioxidant activity. However, the pungent odor of volatile compounds (VOCs) released restricts its use. The encapsulation of red onion extract by electrospinning is an alternative to mask this odor and protect its bioactive compounds. The main objective of this study was to encapsulate red onion bulb extract (ROE) in different concentrations into zein nanofibers by electrospinning and evaluate their thermal, antioxidant, and hydrophilicity properties. The major VOC in ROE was 3(2H)-furanone, 2-hexyl-5-methyl. Incorporating ROE into the polymeric solutions increased electrical conductivity and decreased apparent viscosity, rendering nanofibers with a lower average diameter. The loading capacity of ROE on fibers was high, reaching 91.5% (10% ROE). The morphology of the nanofibers was random and continuous; however, it showed beads at the highest ROE concentration (40%). The addition of ROE to the nanofibers increased their hydrophilicity. The nanofibers' antioxidant activity against 2,2-diphenyl-1-picrylhydrazyl, nitric oxide, and hydroxyl radicals ranged from 32.5% to 57.3%. The electrospun nanofibers have the potential to protect and mask VOCs. In addition, they offer a sustainable alternative to the synthetic antioxidants commonly employed in the food and packaging industry due to their antioxidant activities.

Intracranial Arachnoid Cyst in Children: Clinical Presentation and Risk Factors for Surgical Intervention.

INTRODUCTION: Intracranial arachnoid cysts (IAC) in children are a common incidental finding on imaging. Most IACs are asymptomatic and can be monitored; however, a small percentage may enlarge and require surgical intervention. This study aimed to identify clinical risk factors in patients with IAC who underwent surgery versus those who did not. METHODS: We conducted a retrospective chart review from 2009 to 2021 at a free-standing children's hospital. A total of 230 patients diagnosed with an IAC aged 0-21 years of age were included in the study. Data on demographics, imaging, and neurological follow-up were analyzed. RESULTS: Out of 230 patients, 45 (19.6%) underwent surgery. At time of IAC diagnosis, the surgical patients were younger (median age 1.1 years), and their median cyst volume was larger (41.7 cm3), compared to nonsurgical patients (median age 5.9 years, volume 11.8 cm3, respectively). Headache was the most common reason for initial imaging in nonsurgical patients (54/185, 29.2%) while prenatal ultrasound (11/45, 24.4%) and macrocephaly (11/45, 24.4%) were the most common reasons for surgical patients. The majority of both surgical and nonsurgical patients had the IAC incidentally found (41/45, 91.1% and 181/185, 97.8%, respectively). Surgery relieved symptoms in 38/45 (84.4%) patients. Cyst volume and age were predictors of increased odds of having surgery. DISCUSSION/CONCLUSION: Patients who underwent surgery were younger and had larger cyst volumes at time of diagnosis. The majority of the IAC were found incidentally and remained stable over prolonged follow-up. The majority of the patients experienced relief of symptoms postsurgical intervention. There is a greater odds of having surgical treatment with decreased age and greater cyst volume at diagnosis, and therefore these patients should be monitored closely for development of symptoms indicating need for surgical intervention.

Starch extraction from avocado by-product and its use for encapsulation of ginger essential oil by electrospinning.

Starches from alternative sources, such as avocado seed, have potential for application in the encapsulation of essential oils. This study aimed to extract starch from avocado seeds and its use as wall material to encapsulate ginger essential oil (GEO), at different concentrations. The fibers were produced by electrospinning and evaluated by morphology, size, infrared spectra, thermogravimetric properties, contact angle, loading capacity, and antibacterial activity. The major compounds in GEO were α-zingiberene, ß-sesquiphellandrene, α-farnesene, and α-curcumene. The starch-GEO fibers presented a higher diameter (∼553 nm) than those without GEO (345 nm). Encapsulation of GEO in starch fibers increased their thermal degradation temperatures from 165.8 °C (free GEO) to 257.6 °C (40 % GEO fibers). The starch-GEO fibers presented characteristic bands of their constituents by infrared spectra. Loading capacity ranged from 44 to 54 %. The fibers showed hydrophilic character, with a contact angle of <90°. Free GEO and the fibers with 50 % of GEO displayed antibacterial activity against Escherichia coli, proving the bioactivity of the starch-GEO fibers and its possible applicability for food packaging. Avocado seed starch showed to be a great wall material for GEO encapsulation.

Applications of propolis encapsulation in food products.

Propolis has beneficial health properties attributed to of phenolic compounds. However, its application is limited. Thus, encapsulation protects the bioactive compounds of propolis from degradation, allowing their release under controlled and specific conditions and increasing their solubility. In addition to protecting flavonoids, encapsulation also minimises the undesirable characteristics of propolis, such as strong odour. We brought attention to the high antioxidant and antimicrobial activities of encapsulated propolis, and its maintained biological activity enables more uses in different areas. Encapsulated propolis can be applied in food products as an ingredient. This review describes recent advances in improving the bioactivity of propolis extracts by using encapsulation techniques, and biopolymer research strategies, focusing on applications in food products. Encapsulated propolis has a promising market perspective due to the industrial and scientific-technological advancement, the increase in the amount of research, the improvement of propolis extraction techniques, and the need of consumers for innovative products.

Oleogels based on germinated and non-germinated wheat starches and orange essential oil: Application as a hydrogenated vegetable fat replacement in bread.

This study aimed to produce oleogels based on non-germinated and germinated wheat starches with orange essential oil, apply them to replace hydrogenated vegetable fat in bread, and assess the antifungal action. The oleogels were prepared using sunflower oil, wheat starches, beeswax, water, and orange essential oil (OEO). They were evaluated to determine the volatile compounds, oil binding capacity, texture profile, storage stability for 20 days, thermogravimetric analysis, and functional groups. The breads were evaluated by their moisture content, specific volume, texture profile, volatile compounds, and microbiological contamination during 15 days of storage. The oleogels showed high storage stability, were fully intact after 20 days of storage, and had a high oil binding capacity (∼100 %). The oleogels with OEO presented increased adhesiveness and reduced hardness compared to the ones without essential oil. The oleogels with OEO based on germinated wheat starch released a high amount of volatile compounds. Substituting saturated vegetable fat with oleogels in bread formulation resulted in decreased hardness and maintained specific volume. Furthermore, incorporating OEO oleogels in the bread led to reduced growth of total mesophiles and fungi.

Absorbent bioactive aerogels based on germinated wheat starch and grape skin extract.

This study aimed to produce water-absorbent bioactive aerogels using biodegradable raw materials, wheat starch and poly ethylene oxide (PEO), and derived from agro-industrial residues (grape skin) obtained in the wine industry. The aerogels were produced using germinated wheat starch (GWS), with and without PEO, and incorporating grape skin extract (GSE) at concentrations of 5 and 10 % (w/w). The GSE was evaluated for total and individual phenolic compounds, anthocyanins, and antioxidant activity. The starch aerogels were characterized for morphology, density, porosity, functional groups by FT-IR, relative crystallinity and diffraction pattern, water absorption capacity, antioxidant activity, and in vitro release profile of phenolic compounds in food simulant medium. The total phenolic compounds in GSE was 226.25 ± 0.01 mg equivalent of gallic acid/g GSE. The aerogels showed low density and high porosity. All aerogels demonstrated high water absorption capacity (581.4 to 997.5 %). The antioxidant activity of the aerogels increased with increasing GSE concentration and the addition of PEO. The aerogels could release GSE gradually for up to 120 days in the hydrophilic simulant medium and 240 h for the hydrophobic medium. Starch-based aerogels with GSE showed potential to be applied as exudate absorbers with antioxidant activity to develop active food packaging.

Demographic and geographic variations in the access time of pediatric patients presenting with staring spells.

OBJECTIVE: To assess the demographic and geographic variations in access time - defined as years between the date of symptom onset and initial date of neurological care - in pediatric patients presenting with staring spells. MATERIALS AND METHODS: We conducted a secondary analysis of a retrospective chart review study from 2011 to 2021. A total of 1,353 staring spell patients, aged 0 to 17.9 years, were analyzed for age, sex, race/ethnicity, insurance, county, average county annual per capita personal income, and access time. RESULTS: Patients aged 0-2.9 years had the shortest median access time of 0.3 years, compared to 1.2 years in patients aged 3-12.9 years and 1.0 year in patients aged 13-17.9 years. Statistically significant differences were seen based on race/ethnicity and insurance with White patients having shorter access time of 0.5 years compared to Black patients with 1.0 year and self-pay patients having the shortest access time of 0.4 years compared to patients with private insurance (0.7 years). Warren County had the largest annual per capita personal income of $65,855 and access time of 0.5 years compared to Preble county with the least annual per capita personal income of $45,016 and access time of 1.1 years. CONCLUSION: Demographic parameters of age, race/ethnicity, insurance, and annual county per capita personal income appeared to be associated with access time to initial neurological care in patients with staring spells. These associations need to be investigated further to ensure timely access to neurological care and to ensure equity in health care.

Intercellular contacts affect secretion and biosynthesis of pancreatic islet cells.

Cell protein biosynthesis is regulated by different factors, but implication of intercellular contacts on alpha and beta cell protein biosyntheses activity has not been yet investigated. Islet cell biosynthetic activity is essential in regulating not only the hormonal reserve within cells but also in renewing all the proteins involved in the control of secretion. Here we aimed to assess whether intercellular interactions affected similarly secretion and protein biosynthesis of rat alpha and beta cells. Insulin and glucagon secretion were analyzed by ELISA or reverse hemolytic plaque assay, and protein biosynthesis evaluated at single cell level using bioorthogonal noncanonical amino acid tagging. Regarding beta cells, we showed a positive correlation between insulin secretion and protein biosynthesis. We also observed that homologous contacts increased both activities at low or moderate glucose concentrations. By contrast, at high glucose concentration, homologous contacts increased insulin secretion and not protein biosynthesis. In addition, heterogeneous contacts between beta and alpha cells had no impact on insulin secretion and protein biosynthesis. Regarding alpha cells, we showed that when they were in contact with beta cells, they increased their glucagon secretion in response to a drop of glucose concentration, but, on the other hand, they decreased their protein biosynthesis under any glucose concentrations. Altogether, these results emphasize the role of intercellular contacts on the function of islet cells, showing that intercellular contacts increased protein biosynthesis in beta cells, except at high glucose, and decreased protein biosynthesis in alpha cells even when glucagon secretion is stimulated.

Identification of newly synthetized proteins by mass spectrometry to understand palmitate-induced early cellular changes in pancreatic islets.

Obesity and lipid metabolism dysregulation are often associated with insulin resistance, and can lead to type 2 diabetes. However, mechanisms linking insulin resistance, high levels of plasma free fatty acids (FFA), and ß cell failure remain unclear. The aim of this work was to search for proteins whose synthesis was modified by a short exposure to FFA. This could help in the future to identify molecular mechanisms underlying islet dysfunction in the presence of FFA. Therefore, we assessed by mass spectrometry de novo protein synthesis of freshly isolated rat islets after palmitate short exposure. Quantitative proteome and secretome analyses were performed by combining metabolic incorporation of azidohomoalanine (AHA) and pulse labeling with stable isotope labeling by amino acids in cell culture (SILAC). We showed that pancreatic islets, in response to 4-h exposure to palmitate, increased the synthesis of ribosomal proteins and proteins of the cytoskeleton, and increased their secretion of proteins involved in insulin synthesis and insulin secretion, as well as insulin itself. First, these results show that de novo protein quantification analysis by LC-MS/MS is a useful method to investigate cellular modifications induced by FFA on pancreatic islets. Also, these results show that short exposure to palmitate increases the expression of ribosomal proteins and proteins involved in insulin secretion, and it remains to be determined if these effects are responsible or linked to the harmful effect of palmitate on ß cells.NEW & NOTEWORTHY These results show that pancreatic rat islets cultured with palmitate mainly increase synthesis of ribosomal proteins and some proteins of the cytoskeleton. They also show a significant increase of secreted proteins involved in insulin synthesis and insulin secretion, as well as insulin itself. These data provide information to understand the mechanisms of ß cell failure induced by lipotoxicity via the identification of all newly synthesized proteins in islets in response to short-term exposure to palmitate.

Staring Spells: An Age-based Approach Toward Differential Diagnosis.

Evaluations to rule out epileptic vs nonepileptic staring spells may entail unnecessary evaluations that can be costly and time consuming. Our study aims to identify common etiologies for staring spells across 3 different pediatric age groups and to propose an age-based clinical guidance to help determine which patients warrant further workup. Methods: This was a single-center retrospective chart analysis of 1496 patients aged 0.0-17.9 years presenting with confirmed staring spell diagnosis from January 2011 to January 2021. The patients were divided into 3 groups based on their age: 0.0-2.9, 3.0-12.9, and 13.0-17.9 years. Patient information collected included demographics, clinical presentation, comorbidities, and final diagnosis. Multilevel likelihood ratios and a receiver operating characteristic curve were determined using 8 of the 11 clinical variables. A total of 1142 patients who met the inclusion criteria were included for the final analysis. The most common final diagnosis was attention-deficit hyperactivity disorder (ADHD) (35%), followed by normal behavior (33%). Generalized and focal epilepsy were diagnosed in 8% and 4% of the patients, respectively. In the 0.0-2.9-year age group, normal behavior was the final diagnosis in 72% patients. In the 3.0-12.9-year and 13.0-17.9-year age groups, ADHD was the most frequent final diagnosis in 46% and 60%, respectively. Overall, ADHD and normal behaviors remain the most common final diagnoses. Multilevel likelihood ratios can be used to develop an age-based guidance to differentiate between epileptic and nonepileptic staring spell diagnoses.

Red onion skin extract rich in flavonoids encapsulated in ultrafine fibers of sweet potato starch by electrospinning.

Electrospinning encapsulation is a highly viable method to protect bioactive compounds and prevent their degradation. Hence, this study produced ultrafine fibers based on yellow and white sweet potato starches and a red onion skin extract (ROSE; 0, 3, 6, and 9 %, w/w) using electrospinning. The fibers were evaluated for morphology, thermogravimetric properties, antioxidant, in vitro release simulation, thermal resistance (100 and 180 °C), and wettability. The fibers with ROSE presented 251-611 nm diameters, 67-78 % loading capacity, and 51.6-95.4 and 13.4-99.4 % thermal resistance (100 and 180 °C, respectively); apigenin presented the highest thermal protection. The phenolic compounds showed low release using 10 % ethanol and greater release with 50 % ethanol. The fibers with 9 % ROSE showed 2,2'-azino-bis(3-ethylbenzothiazoline) 6-sulfonic acid radical inhibition above 92 %. The ultrafine fibers and the unencapsulated ROSE showed inhibitory action against Escherichia coli and Staphylococcus aureus; only unencapsulated ROSE showed bactericidal activity.

Generation of Insulin-Producing Multicellular Organoids.

Clinical islet transplantation (CIT) is an established noninvasive treatment for type I diabetes (T1D) and has demonstrated improved glycemic control, preventing the occurrence of severe hypoglycemia. However, CIT has several limitations, such as the need for multiple donors, lifelong immunosuppression, and suboptimal long-term graft function. Most of the transplanted islets are lost due to inflammation, ischemic damage, and delayed revascularization.Generation of organoids have gained increasing interest in regenerative medicine in recent years. In the context of beta-cell replacement, it offers a possibility to address limitations of CIT by allowing to produce uniform organoids from single or multiple cell types facilitating revascularization and anti-inflammatory and/or immunomodulatory protection. We have previously generated multicellular insulin-secreting organoids composed of islet cells and the human amniotic epithelial cells (hAECs). These 3D insulin-secreting structures demonstrated improved viability and function both in vitro and in vivo. Here we detail a stepwise methodology to generate insulin-secreting organoids using two different methods. In addition, quality assessment in vitro tests are also described.

Rate and Predictors of Intractable Status Migrainosus among Patients Aged 13-18 Years.

Purpose: To assess associations for intractable status migrainosus in the pediatric inpatient setting. Methods: A retrospective cohort study of 1,805 patients presenting to the pediatric hospital in Dayton, Ohio with status migrainosus from 2017 to 2022, was performed. Among 1,805 patients, 159 received 3 lines of sequentially more aggressive abortive migraine treatment and were included in this analysis. Responders and non-responders were categorized based on a visual analogue scale (VAS) of pain scores from time of admission to discharge with responders having a reduction of 50% or greater in VAS. Patient demographic information, migraine history, headache type, medication history, self-reported pain, anxiety level and co-morbidities were assessed. Results: Out of 159 patients, 125 (78.6%) achieved the target pain control with decrease in VAS pain score by ≥ 50% from the baseline. The remaining 34/159 (21.4%) patients remained refractory to treatment. Non-responder patients had a longer hospital stay (6.1 days) and greater readmission rate within 7 days (17.6%) compared to responders (4.7 days and .8% respectively). Among the non-responder patients, 14/34 (41.2%) had attention-deficit/hyperactivity disorder (ADHD) compared to the responder group in which 17/125 (13.6%) had ADHD. Among patients who had comorbidity of anxiety, non-responders had greater severe generalized anxiety disorder (GAD-7 ≥15) (6/14, 42.9%) than responders (2/39, 5.1%). Conclusion: ADHD and severe GAD are associated with poorer response to treatment in pediatric patients with refractory migraine admitted for inpatient therapy. This study highlights the prolonged hospital stay and modest clinical outcomes seen with intractable migraine in 13-18-year-old pediatric patients.