Mild To Severe Traumatic Brain Injury In Children: Altered Cytokines Reflect Severity

Background: Paediatric traumatic brain injury (TBI) is recognised to have significant longer–term neurocognitive effects. Childhood is a time of high risk for head injury. Functional recovery is variable with a combination of any or all of physical, cognitive and emotional impairment. Immune activation and alteration in cytokine levels are present following TBI which may differ from adults. Methods: Pro and anti-inflammatory cytokines including Interleukin (IL)-2, IL-4, IL-6, IL-8, IL-10, IL-17A, Tumor Necrosis Factor (TNF)-α and Interferon (IFN)-γ were examined at baseline and following in vitro treatment with endotoxin of whole blood, in the following children: severe TBI (sTBI: initial Glasgow coma scale(GCS) £8), mild TBI (mTBI; GCS 14/15) at 0-4d and at 10-14d post-TBI and compared to healthy age-matched controls Results: The study enrolled 208 children including 110 with TBI cohort (n=104 mild; 6 severe) and controls (n=98). At baseline all children with TBI had increased IL-6. The mTBI group had significantly increased IFN-γ versus controls. In sTBI at baseline, IFN-γ was decreased compared to controls. At baseline IL-8, IL-10, IL-17A, and TNF-α were decreased in mTBI compared to controls. This persisted at two weeks post-mTBI. The AUC for detecting mTBI was 0.801 CI (0.73 – 086) using IL6/IL10 ratio. mTBI showed a greater fold change in IL-8 and TNF-α in response to endotoxin stimulation, a response that persisted at two weeks. Children with sTBI did not have a significant IL-6 response to endotoxin but did show an increase in IL-17A. Conclusion: Children with all TBI including mTBI show altered cytokine profiles and altered endotoxin responses. Although cytokines increased in sTBI especially in response to endotoxin, suppressed responses were found in mTBI coupled with persistent immune dysfunction post injury.

ADHD Symptoms and School Impairment History in Parents of ADHD Children are a Fundamental Diagnostic and Therapeutic Clue.

Background: Attention Deficit and Hyperactivity Disorder (ADHD) is a multi-factorial condition, with inheritance playing a major role. Recognizing parents’ ADHD represents a clue not only for an earlier diagnosis of the disease in their children, but also to optimize psycho-educational therapy outcome, by addressing the impairment of parenting related to untreated ADHD. This study aimed to assess the frequency of features suggestive of ADHD during childhood among parents of affected children, and the presence of school and emotional impairment.Methods: We administered the Wender Utah Rating Scale-25, a self-assessment tool for the retrospective identification of symptoms consistent with ADHD during childhood, to a cohort of 120 parents of 60 children diagnosed with ADHD, and to a consistent number of “controls”.Results: The WURS-25 proved positive in 49.1% of fathers and 30.0% of mothers of ADHD patients, compared to 1.7% of fathers and 1.7% of mothers of non-ADHD patients (p < 0.0001). The questions addressing learning and emotional impairment provided significantly higher scores in parents with an overall positive test compared to those with negative test (p < 0.0001).Conclusions: This study demonstrates a remarkably high rate of symptoms consistent with ADHD during childhood in parents of affected children. Physicians should be aware that this is a relevant anamnestic clue and, given the relevance of parents’ role in the management of children with ADHD, an important issue in order to improve patients’ treatment.

Tunable Q wavelet transform based emotion classification in Parkinson’s disease using Electroencephalography

Parkinson’s disease (PD) is a severe incurable neurological disorder. It is mostly characterized by non-motor symptoms like fatigue, dementia, anxiety, speech and communication problems, depression, and so on. Electroencephalography (EEG) play a key role in the detection of the true emotional state of a person. Various studies have been proposed for the detection of emotional impairment in PD using filtering, Fourier transforms, wavelet transforms, and non-linear methods. However, these methods require a selection of basis and are confined in terms of accuracy. In this paper, tunable Q wavelet transform (TQWT) is proposed for the classification of emotions in PD and normal controls (NC). EEG signals of six emotional states namely happiness, sadness, fear, anger, surprise, and disgust are studied. Power, entropy, and statistical moments based features are elicited from the highpass and lowpass sub-bands of TQWT. Six features selected by statistical analysis are classified with a k-nearest neighbor, probabilistic neural network, random forest, decision tree, and extreme learning machine. Three performance measures are obtained, maximum mean accuracy, sensitivity, and specificity of 96.16%, 97.59%, and 88.51% for NC and 93.88%, 96.33%, and 81.67% for PD are achieved with a probabilistic neural network. The proposed method proved to be very effective such that it classifies emotions in PD and could be used as a potential tool for diagnosing emotional impairment in hospitals.

Hereditary angioedema: Epidemiology and burden of disease

<title/> Hereditary angioedema (HAE) is a rare autosomal dominant genetic disorder characterized by swelling of subcutaneous, mucosal, and submucosal tissue without associated pruritus or wheals caused by a temporary localized increase in vascular permeability. Swelling attacks primarily affect the cutaneous tissue, abdominal viscera, genitals, or airways. <title/> Reports of the prevalence of HAE C1 inhibitor (C1-INH) deficiency varies widely, from 1:50,000 to 1:100,000. The prevalence of HAE normal C1-INH is unknown but is likely much lower than HAE C1-INH. Approximately one-third of patients with recurrent angioedema without wheals have HAE. <title/> The burden of disease for patients with HAE is substantial. Attacks are unpredictable with respect to frequency, severity, and the site that swells. Laryngeal attacks can be fatal if not treated promptly and appropriately. Feelings of stress, anxiety, and depression can trigger attacks, and begin a cycle of attacks that cause anxiety that, in turn, triggers further attacks. Despite full physical recovery between attacks, patients often experience continual emotional impairment and reduced quality of life (QoL). Absenteeism from work and presenteeism at work or educational activities for patients and caregivers increase stress and reduce productivity during and between attacks. Missed opportunities for career development are common. <title/> Significant advances have been made in the past decade to expand both acute and prophylactic treatment options for patients with HAE, lowering both the disease and treatment burden, and improving the QoL of patients with HAE.