Setting off a global pandemic, coronavirus disease 2019 (COVID-19) has been marked by a heterogeneous clinical presentation that runs the gamut from asymptomatic to severe and fatal. Although less lethal in children than adults, COVID-19 has nonetheless afflicted the pediatric population. This systematic review used clinical information from published literature to assess the spectrum of COVID-19 presentation in children, with special emphasis on characteristics associated with multisystem inflammatory syndrome (MIS-C). An electronic literature search for English and Chinese language articles in COVIDSeer, MEDLINE, and PubMed from 1 January 2020 through 1 March 2021 returned 579 records, of which 54 were included for full evaluation. Out of the total 4811 patients, 543 (11.29%) exhibited MIS-C. The most common symptoms across all children were fever and sore throat. Children presenting with MIS-C were less likely to exhibit sore throat and respiratory symptoms (i.e., cough, shortness of breath) compared to children without MIS-C. Inflammatory (e.g., rash, fever, and weakness) and gastrointestinal (e.g., nausea/vomiting and diarrhea) symptoms were present to a greater extent in children with both COVID-19 and MIS-C, suggesting that children testing positive for COVID-19 and exhibiting such symptoms should be evaluated for MIS-C.

Attention-deficit/hyperactivity disorder (ADHD) is a neurologic disorder characterized by hyperactivity/impulsivity and/or inattentiveness, with genetic and environmental factors contributing to the disorder. With the growing recognition of the microbiome’s role in many neurological disorders, the authors propose that it may also be implicated in ADHD. Here, we describe several evolving areas of research to support this hypothesis. First, a unique composition of gut bacteria has been identified and linked to behaviors in ADHD. Second, our research found an increased incidence of 2 gastrointestinal symptoms (constipation and flatulence) in children with ADHD, as compared to controls. Finally, emerging data may be interpreted to suggest that immune dysregulation in ADHD be associated with an altered microbiome, low-grade inflammation, and gastrointestinal dysfunction. Although more studies are needed to elucidate exact mechanisms and causality, we propose that an altered microbiome, gastrointestinal symptoms, and immune dysregulation may be associated with the ADHD phenotypes.

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Objective The aim of the study was to investigate differences between flail limb syndrome and amyotrophic lateral sclerosis. Design A retrospective chart review identified 16 cases of amyotrophic lateral sclerosis and 16 of flail limb syndrome. Revised Amyotrophic Lateral Sclerosis Functional Rating Scale, compound muscle action potential amsplitudes, and rate of loss of vital capacity were compared. Results Comparing amyotrophic lateral sclerosis and flail limb syndrome patients, rate of loss of vital capacity was 5.26% ± 0.33% versus 0.54% ± 0.06%, respectively (P < 0.05). No patient in the flail limb syndrome group had a rate of loss of vital capacity more than 0.65% per month. No patient in the amyotrophic lateral sclerosis group had a rate of loss of vital capacity less than 4.6% per month. The average ulnar nerve compound muscle action potential amplitudes were significantly lower in flail limb syndrome (P < 0.05). No significant difference was observed in the rate of Revised Amyotrophic Lateral Sclerosis Functional Rating Scale decline or average peroneal, tibial, and median nerve compound muscle action potential amplitudes. Conclusions In flail limb syndrome, an average monthly decrease in vital capacity exceeding 0.65% may suggest a spread of motor neuron loss to higher cervical anterior horn areas and raise the possibility of progression to amyotrophic lateral sclerosis. Larger prospective studies are needed to investigate the rate of VC decline in flail limb syndrome and limb-onset amyotrophic lateral sclerosis and to establish whether a cutoff score combining rate of loss of vital capacity and compound muscle action potential amplitude mainly of the ulnar nerve might predict progression of flail limb syndrome to amyotrophic lateral sclerosis, the knowledge of which can facilitate appropriate patient counseling.