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Volume 64(5); May 2021
Review Articles
Critical Care Medicine
The use of extracorporeal membrane oxygenation in children with acute fulminant myocarditis
Silver Heinsar, Sainath Raman, Jacky Y. Suen, Hwa Jin Cho, John F. Fraser
Clin Exp Pediatr. 2021;64(5):188-195.   Published online August 10, 2020
Acute fulminant myocarditis (AFM) occurs as an inflammatory response to an initial myocardial insult. Its rapid and deadly progression calls for prompt diagnosis with aggressive treatment measures. The demonstration of its excellent recovery potential has led to increasing use of mechanical circulatory support, especially extracorporeal membrane oxygenation (ECMO). Arrhythmias, organ failure, elevated cardiac biomarkers, and decreased ventricular function at presentation...
Adolescence Medicine
The impacts of exercise on pediatric obesity
Ronald J. Headid III, Song-Young Park
Clin Exp Pediatr. 2021;64(5):196-207.   Published online August 4, 2020
Pediatric obesity contributes to the development of vascular dysfunction and metabolic and cardiovascular diseases which have all been shown to track into adulthood, increasing the risk of early mortality. Early exercise intervention is critical for combating obesity-related comorbidities and the optimal exercise prescription has yet to be well documented. Exercise prescriptions to combat pediatric obesity should incorporate both aerobic and muscle-strengthening exercises with an emphasis on long-term adherence.
Genetics and Metabolism
Understanding the genetics of systemic lupus erythematosus using Bayesian statistics and gene network analysis
Seoung Wan Nam, Kwang Seob Lee, Jae Won Yang, Younhee Ko, Michael Eisenhut, Keum Hwa Lee, Jae Il Shin, Andreas Kronbichler
Clin Exp Pediatr. 2021;64(5):208-222.   Published online July 15, 2020
Bayesian false-discovery probability and false-positive report probability are the 2 major Bayesian methods used to evaluate noteworthiness of a genetic variant.
Application of stricter P value is needed to confirm statistical significance in meta-analyses.
Gene network analysis of noteworthy genetic variants shows a blueprint of the genetic background in complex diseases.
Editorials
Allergy
Targeting eosinophils: another strategy for asthma treatment
Hye Mi Jee
Clin Exp Pediatr. 2021;64(5):223-224.   Published online March 5, 2021
Identifying phenotypes and endotypes of asthma patients is challenging, and eosinophilic phenotypes are generally characterized by severe or refractory asthma.
Biologicals targeting eosinophils are promising for the control of severe or refractory asthma symptoms.
To ensure proper treatment, increased understanding of the diverse phenotypes of high Th2 inflammation in pediatric asthma is needed.
Other
Is multisystem inflammatory syndrome related with coronavirus disease 2019, Kawasaki disease, and angiotensin-converting enzyme 2 in children?
Lucy Youngmin Eun
Clin Exp Pediatr. 2021;64(5):225-226.   Published online March 5, 2021
With the coronavirus disease (COVID-19) pandemic, it is important to consider why Kawasaki disease (KD) is prevalent in young children and its symptoms are similar to multisystem inflammatory syndrome in older children. We hypothesized that angiotensin-converting enzyme 2 (ACE2) expression may be related. In fact, this may be an answer why COVID-19 occurs less frequently in children with lower ACE2 expression.
Cardiology
When should mechanical circulatory support be considered in pediatric patients with acute fulminant myocarditis?
Hye Won Kwon
Clin Exp Pediatr. 2021;64(5):227-228.   Published online September 22, 2020
Acute fulminant myocarditis is an uncommon syndrome characterized by sudden and severe cardiac inflammation, which leads to cardiogenic shock, ventricular arrhythmia, heart blocks, or multiorgan failure. Despite aggressive clinical course, patients with acute fulminant myocarditis have better outcomes than those with the nonfulminant type when appropriately supported during the acute phase of the disease. Therefore, early recognition of deteriorating myocarditis and timely mechanical circulatory support are crucial to improve outcomes.
Original Articles
Allergy
Sex-based differences in factors associated with bronchial hyperresponsiveness in adolescents with childhood asthma
Young Hwan Kim, Yoon Young Jang, Jieun Jeong, Hai Lee Chung
Clin Exp Pediatr. 2021;64(5):229-238.   Published online January 14, 2021
Question: What factors are associated with bronchial hyperresponsiveness (BHR) in adolescents with childhood asthma?
Finding: Age, mold sensitization, and increased eosinophil count were associated with BHR in boys versus a reduced forced expiratory volume in 1 second/forced vital capacity ratio in girls. Early mold sensitization was a risk factor for persistent BHR in boys only.
Meaning: Sex-specific differences were observed in the factors associated with BHR in adolescents.
Neonatology (Perinatology)
Perinatal outcome and possible vertical transmission of coronavirus disease 2019: experience from North India
Ritu Sharma, Shikha Seth, Rakhee Sharma, Sanju Yadav, Pinky Mishra, Sujaya Mukhopadhyay
Clin Exp Pediatr. 2021;64(5):239-246.   Published online February 16, 2021
Question: Is there any risk of vertical transmission of coronavirus disease 2019 (COVID-19), and what is its neonatal profile?
Finding: Biological samples for vertical transmission were negative in all deliveries; however, 2 neonates tested positive for nasopharyngeal COVID-19 reverse transcription-polymerase chain reaction. No significant neonatal morbidity was observed.
Meaning: COVID-19 does not increase adverse neonatal outcomes and shows a negligible risk of vertical transmission; however, horizontal transmission cannot be underestimated.
Clinical note
Infection
Coronavirus disease 2019 in a 13-year-old patient with acute lymphoblastic leukemia
Seyed Kamal Eshagh Hossaini, Zahra Movahedi, Ahmad Hormati, Hosein Heydari, Seyed Jalal Eshagh Hosseini, Fatemeh Khodadust, Mahboubeh Afifian, Sajjad Ahmadpour
Clin Exp Pediatr. 2021;64(5):247-250.   Published online March 8, 2021
Question: What should be considered in an immunocompromised child with coronavirus disease 2019 (COVID-19)?
Finding: Due to the importance of appropriately managing COVID-19 in children with cancer, the possibility of a fatal outcome should be considered in immunocompromised patients who receive chemotherapy agents.
Meaning: In all kinds of infections including COVID-19, disuse management and the development of international guidelines for children with cancer is challenging but important.