A-35 Utility of the Child SCAT-5 for Identifying Concussion In Children Aged 5–9 Years

Purpose: The Sport Concussion Assessment Tool-5 Child (Child SCAT-5) is designed to assess concussion in children aged 5 to 12 years and includes child- and parent-reported symptoms, as well as brief cognitive and balance screening. However, researchers have yet to examine the utility of the Child SCAT-5 for identifying concussion in young (5–9 years) children. Methods: 139 total participants aged 5–9 years (M = 7.31 ± 1.15, 43.9% female) consisted of 96 participants presenting within 30 days of concussion (M = 8.90 ± 5.78 days; 38.5% sport-related) and 43 healthy age- and gender-matched controls. Participants and parents completed a clinical interview and Child SCAT-5 at their first visit. Receiver operating characteristic (ROC) curves were estimated on the Child SCAT-5 balance and cognitive screening components, parent and child total and symptom severity reports, as well as each individual parent- and child-rated symptom’s severity. Results: Area under the curve (AUC) values fell between 0.32 and 0.64 for cognitive, balance, and symptom rating components. Variables with highest AUC values included parent-rated symptoms worsening after physical activity (0.73) and cognitive activity (0.72). Individual symptom severity items with highest AUC values included headaches (parent = 0.89; child = 0.81), tired a lot (parent = 0.75), and tired easily (parent = 0.72; child = 0.72). Conclusions: Results suggest the Child SCAT-5’s individual symptoms were useful in identifying concussion, but cognitive/balance domains were not. Parent-rated symptom worsening after cognitive/physical activity fell in the acceptable range. Results support use of the Child SCAT-5 symptom components as part of a multifaceted concussion evaluation.

Correlation between metabolic syndrome and relative telomere length shortening in HIV/AIDS patients on combined antiretroviral therapy

BACKGROUND

Components of the metabolic syndrome (MetS) play an important role in the accelerated aging process. Relative telomere length (RTL) is a marker of biological aging. The aim of our study was to determine RTL and its possible association with MetS and the components of MetS in HIV-infected patients treated with cART.

METHODS

We included 24 HIV-infected men, all Caucasians, with successful cART (<50 HIV-RNA copies/mL) and on stable cART for at least 24 months. The presence of MetS and its components was determined by the criteria prescribed by the International Diabetes Federation. RTL was determined by Real-Time PCR and ΔΔCt method. We performed a multiple linear regression modeling on log-transformed RTL (dependant variable) to evaluate which components of the metabolic syndrome as well as cART duration and cART type, had an impact on RTL.

RESULTS

Eleven (45.8%) patients had and 13 (54.2%) had not MetS. All patients, had an undetectable viral RNA and a relatively good immune status. The mean RTL was 0.62 ± 0.15 and 0.95 ± 0.36 in patients with and without MetS, respectively (p = 0.01). Multiple linear regression model showed no significant association between duration of cART, cART type and RTL (p = 0.2165, p = 0.8628, respectively). The same analysis showed that an increase in number of MetS components was associated with shorter telomere length (β = -0.4982, p = 0.042).

CONCLUSIONS

We showed for the first time association between RTL shortening in HIV-infected men with metabolic syndrome. Furthermore, our study also indicated that an increment of metabolic syndrome components is strongly associated with shorter telomere length.

A-18 Utility of the Child SCAT-5: Performance Differences Across Assessments in Pediatric Concussion

Objective

In 2017, the Sport Concussion Assessment Tool-5 Child (Child SCAT-5) was introduced as a tool for clinicians to assess cognitive function and symptoms in children following a concussion (Davis, 2017; Echmendia, 2017); however, there are limited data supporting its use. The purpose of this study was to assess performance on the Child SCAT-5 among concussed pediatric patients (i.e., 5–9 years) across two clinic visits.

Method

Participants included 95 children (42.15% female) aged 5–9 years (7.42 +/− 1.12) who were diagnosed with a concussion within 30 days of injury (8.75 +/− 5.65 days). Patients underwent clinical interview and Child SCAT-5. Paired t-tests were used to compare measures on symptomatology, neurocognitive function, and balance performance between their first two clinical encounters (18.07 +/− 16.05 days).

Results

Analyses revealed significant improvements for immediate memory (p &lt; 0.001) and delayed recall (p = 0.035), as well as improvements in symptom count (p &lt; 0.001), symptom severity (p &lt; 0.001), and back-to-normal rating (p = 0.004). Headaches (85.6%), feeling tired a lot (65.9%), getting tired easily (59.3%), difficulty concentrating (57.1%), and being distracted (54.9%) were the most commonly reported symptoms at patients’ initial clinic visit.

Conclusions

The findings from this study indicate that the Child SCAT-5 is useful for identifying common symptoms in pediatric patients tracking symptom improvement across clinic visits. The measure was also useful in identifying improvements in neurocognitive functioning in this population, particularly memory performance. Further research should focus on how the Child SCAT-5 and other pediatric-specific measures can assess and track improvement in clinical outcomes for this at-risk population.

A-19 Utility OF ImPACT Pediatric In Patients Aged 5–9 Following Concussion

Objective

Computerized neurocognitive testing has demonstrated sensitivity to the effects of concussion (Kontos et al., 2014). While there have been attempts to develop post-injury assessments for youth concussion, most lack compelling empirical support regarding psychometric properties. The purpose of this study was to expand upon preliminary support for the ImPACT Pediatric neurocognitive test battery (Newman et al., 2013) by examining the clinical utility of this measure in the evaluation of concussion in a pediatric population.

Method

Children, aged 5–9 years, presented to an outpatient clinic within 30 days of concussion. Participants completed ImPACT Pediatric at all clinic visits. ImPACT Pediatric is a computerized neurocognitive test battery that assesses various aspects of memory and visual processing speed. Paired t-tests were used to compare ImPACT Pediatric subtest scores at initial visit and clinical clearance.

Results

Participants (n = 63) were predominantly male (57.8%), aged 7.5 ± 1.0 years who presented to the clinic in 8.5 ± 5.9 days from injury and recovered in 34.1 ± 23.5 days. Design Rotation average time (−11.3%; p &lt; 0.001), Stop and Go average correct time (−4.3%; p = 0.030), and Picture Touch immediate memory average time (−11.3%; p &lt; 0.001) significantly improved from initial visit to clearance. Memory subtest scores did not significantly improve from initial visit to clearance.

Conclusions

Average time was significantly improved at the time of clinical clearance on the Design Rotation, Stop and Go, and Picture Match subtests. The findings indicate that ImPACT Pediatric timed subtests can detect changes between initial and clearance visits. Pediatric ImPACT can be a useful component of the comprehensive evaluation of concussion in younger children.

A-17 Psychological Resilience and Concussion Recovery in Athletes

Objective

Psychological resilience has been positively associated with sport achievement and psychological well-being, while being negatively associated with psychological distress. Lower psychological resilience may also increase the risk of protracted recovery from concussion. The purpose of this study is to examine the relationship between psychological resilience and clinical outcomes among adolescent and young adult athletes.

Method

Fifty-seven patients (11–22 years; m = 15.2, SD = 2.76) were diagnosed with a sport-related concussion (SRC) within two weeks of injury. Patients completed the Conner-Davidson Resilience Scale (CD-RISC-10) and the Depression Anxiety and Stress Scales (DASS-21) at first visit in addition to neurocognitive screening (ImPACT) and vestibular/oculomotor screening (VOMS). Participants were divided into “Low”, “Moderate” and “High” resilience using CD-RISC-10 tertiles. A series of one-way ANOVAS with pairwise comparisons (Tukey post-hoc test) were used to compare groups across outcomes measures.

Results

Significant differences were present between the High Resilience (m = 15.22 days; SD = 8.87) and Low Resilience (m = 30.95 days; SD = 23.76) groups in Days to Clearance (p = .032), DASS-21 Total score (p = 0.01), DASS-21 Depression subscale (p = 0.022), DASS-21 Anxiety subscale (p = 0.01), and DASS-21 Stress subscale (p = 0.002). No significant relationships were observed between resilience and ImPACT, VOMS, or PCSS score for any group.

Conclusions

Athletes with low psychological resilience immediately following concussion had a recovery time twice that of athletes with high resilience. All groups in the study exhibited recovery times within a normal time frame (i.e., ≤ 30 days), but high psychological resiliency may serve as a protective factor for recovery outcomes among athletes experiencing concussion.

Evidence for host genetic regulation of altered lipid metabolism in experimental toxoplasmosis supported with gene data mining results

Toxoplasma gondii is one of the most successful parasites on Earth, infecting a wide array of mammals including one third of the global human population. The obligate intracellular protozoon is not capable of synthesizing cholesterol (Chl), and thus depends on uptake of host Chl for its own development. To explore the genetic regulation of previously observed lipid metabolism alterations during acute murine T. gondii infection, we here assessed total Chl and its fractions in serum and selected tissues at the pathophysiological and molecular level, and integrated the observed gene expression of selected molecules relevant for Chl metabolism, including its biosynthetic and export KEGG pathways, with the results of published transcriptomes obtained in similar murine models of T. gondii infection. The serum lipid status as well as the transcript levels of relevant genes in the brain and the liver were assessed in experimental models of acute and chronic toxoplasmosis in wild-type mice. The results showed that acute infection was associated with a decrease in Chl content in both the liver and periphery (brain, peripheral lymphocytes), and a decrease in Chl reverse transport. In contrast, in chronic infection, a return to normal levels of Chl metabolism has been noted. These changes corresponded to the brain and liver gene expression results as well as to data obtained via mining. We propose that the observed changes in Chl metabolism are part of the host defense response. Further insight into the lipid metabolism in T. gondii infection may provide novel targets for therapeutic agents.

Serum beta2-microglobulin as a marker of congenital toxoplasmosis and cytomegalovirus infection in preterm neonates

BACKGROUND

Fetal serum beta(2)-microglobulin (beta(2)M) has been reported as a reliable indicator of fetal infectious diseases.

OBJECTIVES

To evaluate serum beta(2)M as a marker of congenital toxoplasmosis or cytomegalovirus (CMV) infection in neonates.

METHODS

beta(2)M was retrospectively measured in 72 neonatal serum samples from preterm neonates. Of these, 32 originated from neonates with serological evidence of congenital toxoplasmosis (n = 12) and CMV infection (n = 20), while 40 samples from neonates in which both infections were serologically excluded served as controls. beta(2)M levels were compared between the infection and control groups.

RESULTS

Mean (+/-SEM) beta(2)M levels were significantly higher in the groups of neonates infected with Toxoplasma (5.64 +/- 0.61 mg/l) (p = 0.014) and CMV (6.06 +/- 0.66 mg/l) (p < 0.0001) than in the control group (3.80 +/- 0.2). Against the cut-off level of 5 mg/l, beta(2)M was normal in 36 of the 40 uninfected neonates examined, indicating a specificity of 90%. In contrast, it was elevated in 66.7% (8/12) and 65% (13/20) of the Toxoplasma and CMV-infected neonates, respectively, indicating an overall sensitivity of 66%.

CONCLUSIONS

In the absence of urogenital disorders, an increase in beta(2)M in neonates is likely to be infection-induced. We showed that serum beta(2)M is increased in congenital toxoplasmosis and CMV infection in the first weeks of life.