Mass Shootings, Lymphatic Disorders, ADHD, COVID-19, Concussion, MIS-C

shafere1 [at] email.chop.edu (By Emily Shafer)

In this week’s roundup, learn how many mass shootings occur near places children gather. Find out how racial genetic differences relate to attention-deficit hyperactivity disorder. Read about techniques to diagnose lymphatic disorders in infants, and how a handheld device could facilitate concussion diagnosis. Round out the news with the latest PolicyLab projections for COVID-19.

Handheld Device Facilitates Concussion Diagnosis in Teen Athletes

Quantitative pupillary light reflex (PLR) metrics, which are obtained using a handheld dynamic infrared pupillometer (DIP), can be used to differentiate concussed adolescent athletes from healthy adolescents, researchers from CHOP found. The findings appear in JAMA Ophthalmology.

“We know the visual system is affected after a sports-related concussion, and this is something that patients can’t intentionally control or hide,” said Christina L. Master, MD, co-leader of the Minds Matter Concussion Research Program, and a pediatric primary care sports medicine specialist at CHOP. “We thought if PLR could distinguish between concussed and non-concussed athletes, we may have an opportunity for objective assessment where data is easily obtained via a handheld device in clinical and sports settings.”

Previous studies have identified PLR as a potential physiological biomarker for concussion and mild traumatic brain injury in adults. This is the first study to examine PLR metrics in adolescents. In this study, researchers evaluated adolescents between 12 and 18 years old, including 134 healthy athletes and 98 athletes with a sport-related concussion. They found significant differences for almost all PLR metrics. Athletes with concussion had larger maximum and minimum pupil diameter, greater percentage constriction, and greater peak and average constriction and dilation velocity compared with the healthy athletes.

Learn more about the study in the CHOP press release.

Most Mass Shootings Occur Within a Mile of Places Children Gather

One in five mass shootings occurs within a block of a school, and more than 90% occur within a mile of a school or place where children gather, according to a research letter published by CHOP researchers in JAMA Pediatrics.

“Firearms are the second leading cause of trauma-related death in children in our trauma centers,” said Michael Nance, MD, FACS, FAAP, director of the Pediatric Trauma Program and an investigator with the Center for Injury Prevention at CHOP. “Our findings highlight the sheer extent of the problem and show how closely mass shootings are tied to our communities, and especially to the places where children learn and play.”

The researchers used data from the 2019 Gun Violence Archive and defined mass shootings as events involving four or more people injured or killed by a firearm in a single setting. In 2019, 418 mass shootings occurred in 40 states, and children were involved in 121 of the events. Approximately one in 10 of the events took place in a school or where children gather.

“As we struggle to identify solutions to this epidemic, we must also consider the collateral damage mass shootings contribute to children’s overall well-being as most practice lock-down drills in school in preparation for an incident and others witness these events in their communities,” Dr. Nance added. “This can all lead to long-term post-traumatic stress for children.”

Read more about the study in this CHOP press release.

Modern Techniques Assist in Diagnosing Lymphatic Disorders in Infants

Modern, minimally invasive lymphatic imaging techniques can help diagnose the exact nature of lymphatic disorders in infants, researchers at CHOP reported. This helps direct treatment strategies and also provides prognostic information. The findings appeared in the Journal of Perinatology.

“These modes of imaging and treatment represent a paradigm shift in our understanding of these disorders and have led to better outcomes,” said Dalal Taha, DO, an attending neonatologist in the Division of Neonatology at CHOP. “Early recognition of neonatal lymphatic flow disorders and diagnosis with lymphatic imaging may improve morbidity and mortality for this vulnerable population.”

Two lymphatic disorders, neonatal chylothorax (NCTx) and central lymphatic flow disorder (CFLD), are associated with high morbidity and mortality, and have been challenging to diagnose and treatment. In this retrospective study, the researchers found that minimally invasive dynamic contrast MR lymphangiography was effective at diagnosing lymphatic disorders, and also at determining the extent of the problem, developing a treatment strategy, and providing information on potential outcomes.

Other findings from the study include a 100% success rate of intranodal injection of ethiodized oil as treatment for patients with NCTx. For more information on the study, read the CHOP press release.

Key Genetic Differences Observed in ADHD Between African American, European Ancestries

Key genetic differences in the causes of attention-deficit hyperactivity disorder (ADHD) between African Americans and people of European Ancestry may play an important role in response to treatment, according to findings that appear in Scientific Reports.

Hakon Hakonarson, MD, PhD, director of the Center for Applied Genomics at CHOP, and his team generated whole genome sequence data on 875 participants, including 205 patients (116 African American) with ADHD and 670 controls (408 African Americans). While they confirmed several structural variants and target genes associated with ADHD identified in prior studies, they also identified 40 novel structural variants in patients with ADHD. There was little overlap (about 6%) in the genes impacted by these variants between African American and European ancestry.

“We felt as though prior studies of ADHD from a genomic level were not telling the entire story because of whom they were leaving out and what they were studying,” Dr. Hakonarson said. “Given the large number of African American individuals recruited into our studies, whose genomes are fundamentally more complex than those of European ancestry, we wanted to see if comparing the coding and non-coding regions of the genome in those of African American and European ancestry could help us pinpoint areas of focus for future research efforts.”

Find out more about the study in the CHOP press release.

COVID-19 Incidence May Resurge With Cooler Weather

Cooler weather may accelerate the spread of COVID-19 cases, as new projections released by PolicyLab indicate increasing resurgence risk across the Upper Midwest and into the Mountain States over the next four weeks. Projections for Southern states have improved, according to the model.

In the Upper Midwest, the projections are especially concerning across Minnesota and Northern and Western Wisconsin, as well as in the Chicago metropolitan area and into Michigan. The data also show widespread transmission risk in the Mountain States, from Arizona, northward to Utah, Denver, Colorado, and Montana.

“The rapid resurgence risk we’re already seeing in the Upper Midwest and Mountain States, where temperatures have quickly dropped, should serve as a warning – for the Northeast and Mid-Atlantic, in particular – of what we could experience later this fall if we’re not diligent now in our COVID-19 mitigation practices of masking and distancing,” said David Rubin, MD, MSCE, director of PolicyLab and professor of Pediatrics at the University of Pennsylvania Perelman School of Medicine.

Dr. Rubin and the PolicyLab’s COVID-19 projection model have been featured in several media outlets over the past few weeks, most recently in the Washington Post, Scientific American, and Newsweek.

Lab Features May Distinguish MIS-C From Kawasaki Disease, Mild Inflammation

Multisystem inflammatory syndrome in children (MIS-C) presents with certain features that may help distinguish these children from those with Kawasaki disease (KD) or other inflammatory illnesses, CHOP researchers reported in Pediatric Emergency Care.

MIS-C is a severe illness believed to develop in children after an infection with SARS-CoV-2, the virus that causes COVID-19, with some overlap in its presenting features to KD. Daniel Corwin, MD, MSCE, attending physician and associate director of research in the Division of Emergency Medicine at CHOP, and colleagues sought to identify features that would help differentiate patients with MIS-C from those with KD and other inflammatory illnesses.

“We're looking to try to identify an evidence-based way to screen children for MIS-C vs. potentially less-severe illnesses,” Dr. Corwin said. “The symptoms of MIS-C — diarrhea, rash, headache, fever — are common, making this even trickier to diagnose. These findings may help us find that ‘needle in the haystack.’”

Dr. Corwin and colleagues studied 33 patients younger than 21 years of age who met criteria for MIS-C. The patients were classified into three subgroups by clinical outcomes: five with critical illness requiring intensive care, eight with KD, and 20 with mild illness not meeting either criteria. Patients in the critical group had lower median absolute lymphocyte count, platelets and sodium, and they had higher creatinine compared to the other groups, a combination of findings that may help distinguish these entities.

ICYMI

Catch up on our headlines from our Sept. 11 In the News:

• Research Underscores the Need to Drive the Safest Car You Can Afford
• Extending a Warm CHOP Welcome to Dr. Theodore Laetsch
• Research Explores Value of Preventative Care as Voiced by Black Adolescent Males and Parents
• New Computational Methods Provide Longitudinal Footprint of Genetic Epilepsies
• Observed Neurologic Improvement in Patients with Rare, Aggressive Genetic Disorder

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