Background: Headache and Attention Deficit Hyperactivity Disorder (ADHD) are two relatively common, neuropsychiatric conditions seen in children. Recent studies have shown an association between these two disorders, which are otherwise distinct conditions. This study aims to assess the association between migraine and ADHD, as well as the association between screen-time and these two conditions, among children attending a Sri Lankan tertiary care facility. Possible associations will have important implications in the clinical management of these conditions. Methods: This was a comparative cross-sectional study of 226 children aged 5-14 years, attending clinics at a tertiary care hospital in Galle, Sri Lanka. Of them, 141 had a diagnosis of migraine and 85 did not have migraine. The presence or absence of ADHD and the use of screen-time among the two groups was analysed. Chi-square test and Mann-Whitney U test was used to assess the associations between these variables. Results: Approximately 5% of the children with migraine had clinically diagnosed ADHD, compared to 3.5% of those without migraine (p = 0.862). The median SNAP-IV scores (inter-quartile range) of the children with migraine and without migraine were 0.60 (0.27-1.00) and 0.44 (0.16-0.80) respectively (p = 0.014). There was no significant difference in screen-time hours per day between children with and without clinically diagnosed ADHD. However, a significant difference in median screen-time (hours per day) was observed between children with and without migraine (2.0 h and 1.0 h respectively; p = 0.012). Conclusions: Our findings suggest that children with migraine are more likely to show features of hyperactivity/ impulsivity and inattentiveness than those without migraine. While no association was found between clinically diagnosed ADHD and screen-time, migraine was associated with longer daily screen use. Screening for ADHD in children diagnosed with migraine may be of benefit. Further studies are required to understand the possible benefits of reducing screen-time in children with migraine.

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Objectives The objective of this study is to analyse retrospective, observational, longitudinal growth (weight, height and BMI) data in ambulatory boys aged 5–12 years with Duchenne muscular dystrophy (DMD). Background We considered glucocorticoids (GC) use, dystrophin isoforms and amenability to exon 8, 44, 45, 51 and 53 skipping drug subgroups, and the impact of growth on loss of ambulation. We analysed 598 boys, with 2604 observations. This analysis considered patients from the UK NorthStar database (2003–2020) on one of five regimes: “GC naïve”, “deflazacort daily” (DD), “deflazacort intermittent” (DI), “prednisolone daily” (PD) and “prednisolone intermittent” (PI). A random slope model was used to model the weight, height and BMI SD scores (using the UK90). Results The daily regime subgroups had significant yearly height stunting compared to the GC naïve subgroup. Notably, the average height change for the DD subgroup was 0.25 SD (95% CI − 0.30, − 0.21) less than reference values. Those with affected expression of Dp427, Dp140 and Dp71 isoforms were 0.77 (95% CI 0.3, 1.24) and 0.82 (95% CI 1.28, 0.36) SD shorter than those with Dp427 and/or Dp140 expression affected respectively. Increased weight was not associated with earlier loss of ambulation, but taller boys still ambulant between the age of 10 and 11 years were more at risk of losing ambulation. Conclusion These findings may provide further guidance to clinicians when counselling and discussing GCs commencement with patients and their carers and may represent a benchmark set of data to evaluate the effects of new generations of GC.

AimTo correlate the North Star Ambulatory Assessment (NSAA) and timed rise from floor (TRF) recorded at age of expected peak with age at loss of ambulation (LOA) in Duchenne muscular dystrophy (DMD).MethodMale children with DMD enrolled in the UK North Start Network database were included according to the following criteria: follow‐up longer than 3 years, one NSAA record between 6 years and 7 years 6 months (baseline), at least one visit when older than 8 years. Data about corticosteroid treatment, LOA, genotype, NSAA, and TRF were analysed. Age at LOA among the different groups based on NSAA and TRF was determined by log‐rank tests. Cox proportional hazard models were used for multivariable analysis.ResultsA total of 293 patients from 13 different centres were included. Mean (SD) age at first and last visit was 5 years 6 months (1 year 2 months) and 12 years 8 months (2 years 11 months) (median follow‐up 7 years 4 months). Higher NSAA and lower TRF at baseline were associated with older age at LOA (p<0.001). Patients scoring NSAA 32 to 34 had a probability of 0.61 of being ambulant when older than 13 years compared with 0.34 for those scoring 26 to 31. In multivariable analysis, NSAA, TRF, and corticosteroid daily regimen (vs intermittent) were all independently associated with outcome (p=0.01).InterpretationHigher functional abilities at peak are associated with older age at LOA in DMD. This information is important for counselling families. These baseline measures should also be considered when designing clinical trials.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening adverse drug reaction if it is not timely diagnosed and treated. This happens probably following a cascade of immune reactions after the administration of the drug ultimately leading to multiorgan failure and death. Several groups of drugs have been identified as potential aetiologies but the commonest one identified is antiepileptic drugs. The clinical features of DRESS syndrome usually appear several weeks after commencing the offending drug. Initially, fever lymphadenopathy and rash appear followed by hepatitis. Rash is the most prominent feature, and it is a generalized erythematous nonblanching maculopapular rash without the involvement of the mucus membranes or eyes. The rash desquamated over the following days and changed it’s context to an exfoliative dermatitis. We report a case of a 10-year-old boy who is one of the twins born to nonconsanguineous parents at 34 weeks of gestation.