EoE, eosinophilic esophagitis. 1. Hirano I, Furuta GT. Gastroenterology. 2020;158(4):840-851. 2. Muir AB, et al. Clin Exp Gastroenterol. 2019;12:391-399. 3. Lucendo AJ, et al. United European Gastroenterol J.2017;5(3):335-358.​​​​​​​ 4. Chang JW, et al. Dis Esophagus. 2022;35(6):doab073.​​​​​​​ 5. Schoepfer AM, et al. Gastroenterology. 2014;147(6):1255-66.e21.​​​​​​​ 6. Kennedy KV, et al. Am J Gastroenterol. Published online January 18, 2024.​​​​​​​ 7. Alexander R, et al. Clin Gastroenterol Hepatol. 2019;17(11):2371-2373.​​​​​​​ 8. COREOS Collaborators; Ma C, et al. J Allergy Clin Immunol.&nbsp; 
 2022;149(2):659-670.​​​​​​​ 9. von Arnim U, et al. Clin Gastroenterol Hepatol. 2023;21(10):2526-2533. 10. Dellon ES, et al. Gastroenterology. 2022;163(1):59-76.

EOSINOPHILIC-ESOPHAGITIS-EOE

GASTROENTEROLOGY

Adaptive Eating Behaviors in EoE

<h1>Pediatric EoE: Indicators for Early Diagnosis and Intervention</h1>

Not an actual EoE patient. *Data from a retrospective, single-center study with 379 patients.3 † Symptoms reported by patients or parent/proxy.17 
 EoE, eosinophilic esophagitis; hpf, high-power field; QoL, quality of life. 1. Chehade M, et al. J Allergy Clin Immunol Pract. 2018;6(5):1534-1544.e5. 2. Oliva S, et al. J Pediatr Gastroenterol Nutr. 2022;75(3):325-333. 3. Dellon ES, et al. Gastrointest Endosc. 2014;79(4):577-585.e4. 4. Visaggi P, et al. Therap Adv Gastroenterol. 2021;14:1756284820980860. 5. Hannan N, et al. J Pediatr Psychol. 2021;46(1):100-111. 6. Lucendo AJ, et al. United European Gastroenterol J. 2017;5(3):335-358. 7. Amil-Dias J, et al. J Pediatr Gastroenterol Nutr. 2024;79(2):394-437. 8. Chehade M. Rev Paul Pediatr. 2016;34(4):395-396. 9. Barni S, et al. Ital J Pediatr. 2021;47(1):230. 10. Votto M, et al. Front Pediatr. 2022;920192. 11. Klinnert MD. Immunol Allergy Clin North Am. 2009;29(1):99-107. 12. Pokrzywinski RB, et al. Adv Ther. 2020;37(10):4458-4478. 13. Mukkada V, et al. Clin Gastroenterol Hepatol. 2018;16(4):495-503.e8 14. Jensen ET, et al. J Pediatr Gastroenterol Nutr. 2020;71(4):524-529. 15. Dellon ES, Gupta SK. Clin Gastroenterol Hepatol. 2019;17(11):2149-2160. 16. Aceves SS, et al. Gastrointest Endosc. 2022;96(4):576-592.e1. 17. COREOS Collaborators: Ma C, et al. J Allergy Clin Immunol. 2022;149(2):659-670

Pediatric EoE: Indicators for Early Diagnosis and Intervention

POMPE

RARE-DISEASE

Long-term Safety and Efficacy of Avalglucosidase Alfa IN Patients with Late-Onset Pompe Disease (NEO-EXT)

Safety and efficacy of Avalglucosidase Alfa versus Alglucosidase Alfa in patints with Late-Onset Pompe Disease (COMET): a phase 3, randomized, multicentral study results

This educational animation illustrates the OX40-Ligand pathway and its role in AD pathophysiology.
<ul>
 <li>OX40-Ligand is an upstream co-stimulatory signalling molecule that promotes persistent T-cell-driven inflammation and drives the chronicity of AD.</li>
 <li>OX40-Ligand pathway promotes T-cell proliferation and survival and cytokine release in AD (Type 2 and non-Type 2).</li>
</ul>
Learn how this pathway plays a role in amplifying and sustaining T-cell-mediated inflammation in atopic dermatitis.

OTHER-TOPICS

DERMATOLOGY

Decoding OX40L: A Key Player in Atopic Dermatitis Pathways

<h3>Clinical and epidemiological characteristics of respiratory syncytial virus, SARS-CoV-2 and influenza paediatric viral respiratory infections in southwest Saudi Arabia</h3>

Study Design &amp; Setting:&nbsp;
<ul>
 <li>Retrospective hospital-based study.</li>
 <li>Conducted at Abha Maternity and Children Hospital, Southern (Aseer) region Saudi Arabia, covering January 2021 – December 2022</li>
 <li>423 children admitted with acute respiratory infections (ARI).</li>
</ul>

Study Objectives:&nbsp;
<ul>
 <li>Primary Aim: Compare clinical and epidemiological characteristics of infections caused by RSV, influenza (A&amp;B), and SARS CoV-2 in hospitalized children.</li>
 <li>Additional Goal: Identify predictors of pediatric intensive care unit (PICU) admission among these patients.</li>
</ul>

Study Population:&nbsp;
<ul>
 <li>Population: Children admitted to Abha Maternity and Children Hospital in 2022 with acute respiratory infections.</li>
 <li>Case inclusion: Only those confirmed positive for RSV, influenza A/B or SARS-CoV-2.</li>
</ul>

Figure 1. Age distribution of RSV, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza (A and B) infections among the enrolled children according to the age groups &lt;6 months, 6–12 months and &gt;12 months.
<h3>Epidemic curves of RSV, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza (A and B) infections among hospitalized children from 1 January 2022 to 31 December 2022.</h3>

<h3>Gestational Age Distribution – RSV Cases Only</h3>

<h3>Distribution of Viral Infections in Hospitalized Children</h3>

<h3>Clinical Outcomes of RSV</h3>

Oxygen therapy:&nbsp; 61.6% of RSV-positive children&nbsp;
Ventilator support:&nbsp; 4.3% of cases

ICU admission rate:&nbsp; 13.3% → higher than influenza &amp; SARS-CoV-2&nbsp;
Average hospital stay:&nbsp; 6.1 days (longer than other viral infections)

Seasonality:&nbsp; 
 RSV peaked&nbsp; November–February

Mortality:&nbsp; 
 all deaths in infants&nbsp; &lt;1 year with&nbsp; comorbidities

References

RESPIRATORY-SYNCYTIAL-VIRUS

VACCINES

Epidemiological Characteristics of RSV

<h2>Disease Overview</h2>
Atopic dermatitis (AD), is a common chronic inflammatory skin condition characterized by dry, itchy, and inflamed skin that can flare periodically throughout life. It most often begins in childhood but can affect individuals of any age.1-3
Diagnostic Criteria for Atopic Dermatitis (AD)
Atopic dermatitis is diagnosed clinically, based on a combination of essential, important, and supportive features, as well as by excluding
other similar skin conditions. There is no single definitive laboratory test for AD4-6.

Essential Features (Must Be Present)
Pruritus (itching): Persistent itching is the hallmark of 4,5
Eczema: This includes acute, subacute, or chronic skin changes such as erythema and scaling, with a typical age-specific distribution (e.g., cheeks and extensor surfaces in infants; flexural areas in older children and adults) 4,5
Chronic or Relapsing Course: Symptoms must have a history of chronicity or recurring flares4,5

Important Features (Support Diagnosis)
<ul>
 <li>Personal or Family History of Atopy: Includes atopic diseases such as asthma, allergic rhinitis, or food allergies4,5,7</li>
 <li>Early Age at Onset: Most cases begin in childhood, often before age five4,5</li>
 <li>Immunoglobulin E (IgE) Reactivity: Elevated IgE levels are common but not required4</li>
 <li>Xerosis: Dry skin is frequently observed4,5</li>
</ul>

Associated Features (Suggestive but Nonspecific)
<ul>
 <li>Atypical Vascular Responses: Such as facial pallor or white dermographism.5</li>
 <li>Skin Findings: Keratosis pilaris, pityriasis alba, hyperlinear palms, ichthyosis, lichenification, prurigo lesions.5</li>
 <li>Ocular or Periorbital Changes: Such as Dennie-Morgan folds.5</li>
</ul>

Exclusionary Conditions
<ul>
 <li>Diagnosis also requires exclusion of other conditions that can mimic AD, including:</li>
 <li>Seborrheic dermatitis</li>
 <li>Psoriasis</li>
 <li>Contact dermatitis</li>
 <li>Scabies</li>
 <li>Tinea (fungal) infections</li>
 <li>Immunodeficiency syndromes</li>
 <li>Cutaneous T-cell lymphoma</li>
</ul>

<h2>Clinical Features of Patients With AD</h2>
<ul>
 <li>Clinical diagnosis can be difficult in infants, toddlers and in elderly people8</li>
 <li>Skin biopsies in adults help exclude malignant diseases (e.g. cutaneous T cell lymphoma)8</li>
 <li>AD lesions typically show an age-related distrubution8,9</li>
</ul>

References

AD Disease Overview

<h2>Understanding the Burden of Atopic Dermatitis on Patients</h2>
Atopic dermatitis (AD) places a significant burden on patients’ lives, impacting much more than just the skin. For millions worldwide, AD causes
ongoing discomfort, affects mental and social well-being, and leads to both direct and indirect economic challenges.1-3
<h2>Chronic Symptoms of Atopic Dermatitis</h2>
Chronic atopic dermatitis is marked by a persistent and evolving set of symptoms that can severely impact patients’ daily lives. These symptoms often
last for months or years and are characterized by both their physical appearance and their impact on comfort and function.3

<h2>Key Chronic Symptoms</h2>

Lichenification

Persistent Itching (Pruritus)

Dry, Scaly Skin (Xerosis)

Skin Thickening and Hyperpigmentation

Eczematous Lesions

Cracked or Fissured Skin

Secondary Infections

Other Chronic Features

Chronic atopic dermatitis symptoms not only cause physical discomfort but are also associated with substantial psychosocial and quality-of-life
burdens, highlighting the need for comprehensive, ongoing management.5,7,8
&nbsp;
<h2>Impact of Atopic Dermatitis on Quality of Life</h2>
Atopic dermatitis (AD) goes far beyond the skin, reducing quality of life (QoL) in profound and lasting ways for both patients and their families.10,11

Physical and Emotional Burden
<ul>
 <li>
 Persistent itch and discomfort are the most distressing symptoms, reported as severe by most patients, leading to constant scratching,
 pain, and skin damage.10,11,15</li>
 <li>
 Sleep disturbances are common, with poor sleep quality affecting up to 92% of patients, resulting in daytime fatigue, impaired
 concentration, and decreased school or work performance.10,11</li>
 <li>
 Emotional consequences such as depression, anxiety, embarrassment, and low self-esteem are frequently reported, especially in those
 with severe or visible disease.10,15,16</li>
 <li>Over half of adult AD patients report a moderate to extremely large impact on their overall quality of life.12,13,16</li>
 <li>In children and adolescents, AD can lead to social isolation, bullying, and fewer friendships, especially for those with severe disease.11</li>
</ul>

Social and Daily Functioning
<ul>
 <li>Social withdrawal and limitations: The visibility of lesions and constant need for treatment cause many patients and families to avoid social activities or alter their routines.10,11</li>
 <li>Academic and work impact: Nearly one-third of adults with AD have experienced challenges at school or work, and 14% believe their academic or career advancement has been hindered by their disease.11</li>
 <li>Family burden: Caregivers—especially parents of children with AD—report significant stress, time commitment for treatments, and emotional distress related to their child’s condition.11,13,15</li>
</ul>

Severity Matters
The impact of AD on all quality of life measures increases sharply with disease severity. In studies using quality of life indexes, children
and adults with moderate-to-severe AD report a “very large” or “extremely large” effect on daily life more than twice as often as those
with mild disease.12-14,16
Long-term and Lifelong Impact
<ul>
 <li>Severe, uncontrolled AD from childhood into adulthood leads to enduring difficulties in school, work, and forming social relationships, sometimes even influencing career paths.10</li>
 <li>The burden can accumulate over a lifetime, contributing to poorer long-term health and social outcomes.10,11</li>
</ul>

<h2>Comorbidities17-22:</h2>

<h2>Economic Burden of Atopic Dermatitis on Patients</h2>
Atopic dermatitis (AD) imposes a substantial financial and productivity burden on patients, families, and society. The costs are both direct—arising
from medical care—and indirect, resulting from reduced productivity and impaired daily functioning.
Direct Costs
The impact of AD on all quality of life measures increases sharply with disease severity. In studies using quality of life indexes, children
and adults with moderate-to-severe AD report a “very large” or “extremely large” effect on daily life more than twice as often as those
with mild disease.12-14,16
<ul>
 <li>Medical Expenses: Patients with AD face significantly higher health care expenditures than those without AD. In adults, annual direct health care costs can be nearly $5,000 higher per patient, encompassing physician visits, hospitalization, prescription medications (including costly newer therapies), and outpatient services.23</li>
 <li>Treatment-Related Costs: Frequent clinic appointments, management of complications, and long-term use of topical or systemic therapies further increase financial strain.24</li>
 <li>Out-of-Pocket Expenses: Patients and families often pay for moisturizers, special skin care products, specific clothing or bedding, and transportation to healthcare providers.23,24</li>
</ul>
Indirect Costs
Lost Productivity: AD leads to increased absenteeism and loss of workdays. Adults with AD report more missed work or school days and higher utilization of short-term disability benefits compared to the general population.23
Reduced Work Capacity: The physical discomfort and sleep disturbances from AD negatively impact concentration, work efficiency,
and even career choices or advancement.23
Family Burden: Beyond the patient, family members may incur additional costs for caregiving and experience productivity loss due to
time devoted to ongoing care needs.25
Healthcare utilization: Patients with AD have increased physician office visits and outpatient pharmacy use.26
Severity dependence: Economic burden intensifies with increasing severity of AD, leading to more interventions, treatment changes,
and lost workdays.26

AD Burden on Patients

<h2>Atopic Dermatitis Prevalence</h2>

Atopic dermatitis (AD) is a common chronic inflammatory skin disease affecting approximately 20% to 25% of children and about 10% of adults
worldwide1. The onset of AD typically occurs in infancy or early childhood, with around 60% of cases starting within the first year of life and up to
85% before the age of five2. However, adult-onset AD accounts for 20-25% of adult cases, highlighting that the disease can also develop later in
life3. Prevalence varies regionally, with higher rates reported in industrialized countries and urban areas, likely due to environmental and lifestyle
factors4. The Global Burden of Disease Study 2021 estimated that over 129 million people worldwide are affected by AD, with pediatric cases
reaching approximately 72 million, predominantly in children aged 5 to 9 years5.
&nbsp;
Atopic dermatitis prevalence in the GCC region is considerably higher than the global average, especially among children and adolescents, with rates
ranging roughly from 12% to 30% depending on the country and age group. This elevated prevalence highlights the necessity to increase awareness, diagnosis, and management efforts tailored to the regional population.

<ul>
 <li>The United Arab Emirates (UAE) shows notably high AD prevalence rates compared to global averages. For the general population, UAE has an estimated prevalence of about 12.0%, with children showing even higher rates around 19.7%6.</li>
 <li>Saudi Arabia shows an adult AD prevalence of about 30%, indicating a significant disease burden in the adult population7.</li>
</ul>

Epidemiology

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The ADCT gives a measure of how controlled the eczema is. Answer these 6 simple questions with your patient to find the ADCT score. It will indicate proper course of action.

Atopic dermatitis, a type of eczema, may be affecting your Patient's life in more ways than you know.

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