Welcome to the 9th EAPS Congress Programme Scheduling

Background and Aims

Background: ADHD is one of the commonest psychiatric and phoniatric disorders, presenting in 5.9%– 7.1% of childhood worldwide. The blood neutrophil/lymphocyte ratio (NLR), platelet/ lymphocyte ratio (PLR), and monocyte/ lymphocyte ratio (MLR), have recently been used as indicators of a systemic inflammatory response. Some studies have reported high inflammatory markers in ADHD.

Aim: To assess the relationship between inflammatory blood ratios and severity of ADHD symptoms

Methods

This case-control study enrolled 113 ADHD medication-free cases diagnosed by DSM- 5 with an age range of 6-12.4 yrs; attending outpatient clinics of the Center of Special Needs, Faculty of Postgraduate Childhood Studies, Ain Shams University, Cairo, Egypt. They were matched with 93 healthy control children that were both physically and mentally free of the same socio-demographic characteristics of the case group. Conners’ parents´ Rating Scale (CPRS) was applied to all of them to assess the severity of the symptoms. Inflammatory blood ratios were done for all the studied groups including the following ratios: Platelets/ lymphocytes, Monocytes/ lymphocytes,

Neutrophil/ lymphocytes

Results

The inflammatory blood ratios were statistically significantly higher in cases than in control. There was a positive correlation between CPRS scores and the inflammatory blood ratios among the ADHD group.

Conclusions

The severity of ADHD symptoms was associated with higher levels of inflammatory ratios which could provide insights that will guide future ADHD treatment.

Background and Aims

Multisystemic inflammatory syndrome in children ( MIS-C) is a novel condition temporally associated with SARS-CoV2 infection. Cardiovascular involvement is prominently marked by acute myocardial injury/myocarditis and the development of coronary artery aneurysms.

Methods

We bring in front of you three cases of multisystemic inflammatory syndrome, associated with SARS-CoV-2 infection, which presented with such severe cardiac symptoms that needed intensive care treatment.

Results

Two of the patients presented with acute coronary syndrome (intense chest pain, shortness of breath, ST-segment elevation) and the third one’s symptoms resembled a toxic shock starting with digestive signs and hemodynamic instability. The cardiac ultrasound revealed local kinetic disorders, hypokinesia and major decrease of left ventricle function (LVEF=30%). Cardiac enzymes were extremely elevated: troponins over 3000ng/ml and NTproBNP up to 28.000pg/ml, also increased levels of acute phase-reactants and fibrin degradation products. The mainstays of treatment were inotropic support with noradrenaline and dobutamine, immunoglobulins, steroids, anticoagulants, anti aggregation drugs and antibiotic therapy. All three cases made a spectacular recovery with a swift remission of the inflammatory syndrome and normalisation of the cardiac enzymes and function.

Conclusions

Acute myocarditis with intense systemic inflammation and atypical Kawasaki disease is an emerging severe pediatric condition following SARS-CoV2 infection. Early recognition of this disease is needed and referral to an expert centre is recommended.

Background and Aims

Caregiver education regarding adrenaline auto-injector (AAI) administration and anaphylaxis management is an important method of improving anaphylaxis outcomes¹. During Covid-19, face-to-face caregiver education opportunities were drastically reduced following implementation of virtual clinics. We wish to assess whether virtual education sessions can improve caregiver knowledge and AAI administration

Methods

TEAAM is a prospective, interventional study. Potential participants were identified from outpatient clinic lists and were invited to complete a pre-intervention questionnaire. Those eligible were then enrolled in an online education session involving AAI administration assessment, videos displaying correct AAI administration and anaphylaxis management information, followed by re-assessment of caregiver AAI technique. Caregivers then completed a post-intervention questionnaire which assessed satisfaction and improvement of knowledge

Results

151 participants have been enrolled to date and 37(24.5%) have completed the education session and post-intervention questionnaire. There was a statistically significant increase in anaphylaxis management knowledge following educational intervention (average score 82% vs 90%, p>0.05). AAI administration technique was marked based on observation of key steps. Average score increased from 69.95% to 95% following instruction. There was no statistically significant difference in score improvement between brands of AAI used, time since last training or number of times AAI had been administered. 97.3% found the session useful. Only 1 participant believed face-to-face interaction would be superior. Perceived benefits are displayed in figure 1.

Conclusions

Caregiver performances pre-intervention were above average, and improvements were comparable with face-to-face education². Satisfaction levels were high. Virtual instruction regarding anaphylaxis management and AAI administration appears to be a safe, effective tool for caregiver education

Background and Aims

Infection related morbidity and mortality is higher in children with neurodevelopmental disorders. We aimed to evaluate the effects of lipopolysaccharide (LPS) on lymphocytes, neutrophils, monocytes, and cytokines in children with Severe Neurological Impairment (SNI) compared to age and sex-matched controls.

Methods

Whole blood samples were incubated in the presence or absence of lipopolysaccharide (10ng/ml). Cytokines were analysed by ELISA from isolated serum. Neutrophils (CD66b+), monocyte subsets (based on degree of CD14 and CD16 positivity), B cells (CD3-/CD19+), NK cells (CD3-/CD56+), and T cells (CD3+) were analysed by flow cytometry. TLR-4, CD66b and CD11b are proteins involved in immune cell activation, migration, and adhesion, and were used as markers of activation.

Results

Children with SNI and age-matched controls (n=14 each) participated. Total and CD8+ T-cells, and monocytes were lower at baseline in children with SNI (p=0.02, p=0.0031 & p=0.0002 respectively). CD66b hyporesponsiveness to LPS was seen in the SNI cohort (p=0.0017). TLR-4 expression in total and classical monocytes was hyper-responsive to LPS in children with SNI (p=0.04 & p=0.03 respectively). GM-CSF increased in the control group (p=0.04) but not in the group of children with SNI (p=0.07). Interleukin-6 in the SNI cohort was hyporesponsive to LPS (p=0.012). The SNI cohort had a larger increase in erythropoietin in response to LPS than the comparison group (p=0.0068).

Conclusions

We have demonstrated significant differences in immune regulation in children with SNI. These findings may partially explain increased infection-related morbidity and mortality, and tertiary neurological injury in this population, providing a potential therapeutic target.

Background and Aims

Infectious disease control can be achieved if the vaccine coverage (VC) exceeds 95%. The last decades showed a declining trend in the VC which could lead to severe outbreaks of infectious diseases.

The study analyses the determinants of VC in children aged 0-1 year, monitored high-risk epidemiological periods

Methods

A retrospective observational cohort study were developed in primary care offices (the main Romanian vaccinators) which the data regarding vaccination of children under 1 year of age in the period 2019.01-2019.06 (Measles epidemics) and 2020.01-2020.06 (COVID-19 pandemic) were followed. 2.850 children from 2019 and 2.823 children from 2020, were selected, the data on immunization results and the determinants of parents' decisions regarding vaccination were evaluated.

Results

During 2019- 2020, VC has followed a declining trend. For each type of vaccine included in the National Immunisation Program, the most affected age groups were infants from 9-12 months in both years (p<0.05) with a significant reduction of VC in 2020 vs 2019. Our data show hesitant parents- 2019- 25%, 2020- 35%, denial of vaccination-7%- 2019, 10%- 2020, fear regarding side effects of vaccines, infodemic, anti-vaxxers' online campaigns, negative Media stories regarding potential side-effects of vaccination, are at the forefront of determinants parents' decisions regarding vaccination of their infants.

Conclusions

The low VC produced in the years of epidemic and pandemic can induce the recurrence of severe infectious diseases. Permanent awareness educational campaigns regarding infectious disease risk are needed, empowerement of the primary care physicians preventive activity, immunization management based on national regulatory legislation assumed by political decidents.