The effect of the COVID-19 pandemic on pediatric physiatric health care in Croatia among children with neurological risk: A retrospective study.

BACKGROUND: Since the start of COVID pandemic, the Croatian government issued many recommendations and guidelines, imposed reorganization of health care system, and ordered two lock-downs to mitigate the spread of the disease. All of this may have had an unwanted effect on the standard of health care for non-COVID-19 patients, including children with neurological risk factors. OBJECTIVE: To highlight the possibility that measures taken to mitigate the COVID-19 pandemic may lead to a substantial delay of examination by physical medicine specialists and timely rehabilitation programs for children with neurological risks. DESIGN: A retrospective medical history-based study between 2020 and 2021. SETTING: The study was performed in Department of Physical and Rehabilitation Medicine at the University Hospital Centre of Split, Croatia. PATIENTS: Children with neurological risk examined by pediatric physical rehabilitation specialists in the Department of Physical and Rehabilitation Medicine between January 2017 and December 2021. METHODS: Case records of patients were reviewed, dividing them into groups according to severity of neurological risk and their age at the time of first examination. We also noted in what months of the year those examinations were performed. MAIN OUTCOME MEASUREMENTS: The outcome was change in the number of the first examinations and the age of the patients when the examination was first performed. RESULTS: During the pandemic year 2020, the total number of first examinations was lower by 244 (38%; 95% confidence interval [CI]: 34%-42%), and the number of first examinations of children with neurological risks was lower by 216 (36%; 95% CI: 33%-40%).On the contrary, in 2021, there was an increase in the total number of first examinations by 114 (18%; 95% CI: 15%-21%) and first examinations of children with neurological risks compared to the pre-pandemic years by 97 (16%; 95% CI: 13%-20%). Furthermore, the division of patients according to age at the time of first examination significantly differed in the pre-pandemic and pandemic 2021 periods (λ = 11.8; p = .018). The greatest contributing factor to this difference was the group of patients older than 12 months. CONCLUSIONS: The study suggests that the chaotic initial stages of the COVID-19 pandemic during 2020 caused delay in examinations by physical medicine specialists for children with neurological risks that could potentially affect neurodevelopmental outcomes.

INNOVATIVE THERAPIES REDEFINE TREATMENT GOALS IN MULTIPLE SCLEROSIS.

The treatment of multiple sclerosis (MS) is becoming more complex, especially with the expanding number of available therapies for relapsing forms of MS. Greater understanding of the degenerative aspects of MS pathogenesis is redefining treatment goals and creating new treatment strategies. The existing immunomodulation drugs (disease-modifying therapies, DMTs) used in MS treatment have shown only partial benefits in controlling disease progression, primarily by reducing the inflammation component. However, new therapies for MS have been shown to be effective in delaying disease progression by protecting against brain atrophy, which is considered the most important preindicator of future patient disability. The favorable effect on reducing brain atrophy suggests the potential neuroprotective or even neuroregenerative effects of new treatments, marking progress in the treatment of MS.

Analysis of the C609T polymorphism of NQO1 gene in South Croatian patients with hematological malignancies.

In this study we analyzed the effect of polymorphic variation of NAD(P)H: quinone oxidoreductase1 (NQO1) gene that encode enzyme which detoxifies harmful quinines and protect hematopoietic stem cells against oxidative stress. C609T polymorphism of NQO1 gene leads to loss of enzyme activity, which may be a risk factor in the etiology of specific types of hematopoietic malignancies. We analyzed C609T polymorphism in NQO1 gene in the group of 82 patients (56 adult and 26 children) with different type of hematopoietic malignancies and 99 healthy participants (61 adult and 38 children) using PCR and the RFLP method. We confirmed that the polymorphism C609T in NQO1 gene was more frequent in the adult patients' group with myeloid disorders, (p = 0.0267) compared with adult controls. We could not confirm the association C609T polymorphism with recurrent chromosome translocations (clonal karyotype changes) neither in the adult nor in pediatric group of patients.