Noor Alzraikat

Background: Secretory phospholipase A ₂ (sPLA ₂ ) is an inflammatory mediator linked to acute chest syndrome (ACS) in sickle cell disease (SCD), a serious complication that can develop during an acute vaso‐occlusive pain episode (VOE). Plasma sPLA ₂ levels have been proposed as a potential biomarker for predicting ACS onset. Objective: To assess serial plasma sPLA ₂ levels in 105 pediatric patients hospitalized for SCD‐VOE and determine the effects of arginine therapy compared to placebo. Procedures: This is a pharmacokinetics/pharmacodynamics and randomized controlled trial of intravenous arginine therapy. Statistical methods included t ‐tests, chi‐square, and correlation analyses. Results: Mean age was 12.7 ± 3.7 years, 48% were male, 67% had Hb‐SS, and 70% were prescribed hydroxyurea. Using a previously established SCD‐specific cutoff of 48 ng/mL, presenting sPLA ₂ levels were elevated in 33% of patients (mean sPLA ₂ level 85.7 ± 32.9 ng/mL). SPLA ₂ elevation in the emergency department was more common in patients with ACS compared to those without ACS (64% vs. 30%; p = 0.02; negative predictive value of 94%). Peak sPLA ₂ levels were significantly higher in febrile ( n = 34) versus afebrile patients ( n = 71;101.0 ± 45.3 vs. 48.7 ± 35.4 ng/mL; p < 0.0001). Among subjects with elevated baseline sPLA ₂ , arginine therapy resulted in a significant reduction in sPLA ₂ levels by discharge compared to placebo (−27.8 ± 38.1 ng/mL; p = 0.002; n = 23 vs. −15.0 ± 41.2 ng/mL; p = 0.23; n = 12). Conclusions: SPLA ₂ is an underutilized biomarker of ACS given accumulating evidence of its role. In particular, low levels may identify patients at low risk for ACS. Arginine therapy may modulate inflammation in patients with SCD during VOE and/or ACS. Trial Registration: ClinicalTrials.gov identifiers: NCT02447874; NCT02536170

Analysis of the placebo cohort in the STArT trial shows that patient characteristics and hospital site strongly influence time-to-crisis-resolution and total opioid use in children and young adults with sickle cell disease, highlighting the need to account for these factors in the design of future clinical trials.

Magnesium Sulfate (MgSO4) is a widely used adjuvant in anesthesia. Often administered with local anesthetics, it is known to reduce analgesic and opioid consumption while extending the duration of analgesia. MgSO4 applications extend to orthopedic surgeries, cardiovascular and urogenital procedures, offering extended postoperative pain relief. While commonly administered through various routes, there is a research gap concerning the comparative efficacy of intrathecal (IT) and intravenous (IV) MgSO4 administration. This narrative review aims to provide a comparison between IT and IV administration of MgSO4 particularly following orthopedic procedures, where pain management is paramount. A comprehensive literature search was conducted across several electronic databases, trial registries, and gray literature from inception to 2023. Inclusion criteria encompassed studies investigating the effects of perioperative IT administration of magnesium compared to perioperative IV administration of MgSO4 in patients undergoing surgery, with no language restrictions. Our search identified 4326 articles, of which 9 randomized controlled trials met our inclusion criteria. We summarized these selected articles. Four studies discussed IT magnesium sulfate (MgSO4) administration, 2 focused on IT administration in orthopedic surgeries, and 3 explored both IV and IT administration of MgSO4 in orthopedic surgery. IT MgSO4 shows promise in postoperative pain management, delaying block onset and extending duration. Personalized administration choice, considering patient factors and surgery type, is crucial. Further research is needed to refine strategies for better patient outcomes, particularly following orthopedic surgeries.

This review aims to highlight the diverse skin manifestations in children and adolescents with COVID induced multisystem inflammatory syndrome in children (MIS‐C). The symptoms of COVID‐19 can vary greatly in severity between different age groups. Although most children infected with SARS‐CoV‐2 experience either no symptoms or only mild symptoms, some reported cases of severely affected children with a clinical presentation similar to incomplete Kawasaki disease have led to the definition of a new condition called MIS‐C. MIS‐C can involve multiple organs, including the skin, and may pose a life‐threatening risk to affected children. Such cases highlight the need for continuous research into the possible skin manifestations associated with COVID‐19 in pediatric populations to aid in early diagnosis and prompt treatment. We conducted a search of PubMed, Scopus, and ScienceDirect databases for studies published up until October 1, 2022. Three reviewers independently examined each study, and a fourth reviewer resolved any disagreements. A narrative review of all relevant papers was conducted. We present an overview of the clinical presentation, pathophysiology, diagnosis, and treatment of the various skin manifestations in children and adolescents with COVID‐19 or MIS‐C. The skin manifestations of COVID‐19 and MIS‐C can be diverse and are frequently overlooked. It is important to conduct further research to better understand the impact of this disease on children to provide appropriate care for these at‐risk populations.