Background: The effectiveness of montelukast for wheezing in young children is not clear. We aimed to evaluate whether the use of montelukast in the treatment of wheezing affects the number of attacks in children aged 1 to 6 years. Methods: This is a single center study. It was conducted between August 2019 – 2020. Children with aged 0-6 years old with a wheezing complaint who applied to the pediatric allergy and immunology outpatient clinic were included in the study. Modified asthma predictive index of the patients were evaluated. It was classified as episodic viral wheezing (EVW) or multiple trigger wheezing (MTW) based on the type of wheezing. Montelukast treatment was started and the number of attacks was checked. Results: The total of 141 children who applied with wheezing complaints were included in the study. The majority of the patients were boys (n=99). The mean age of the children was 4.2 ± 1.5 years. The median number of attacks before treatment was 2 (2-3). In 2.8% of the patients, eczema, in 12.8% of them, rhinitis and in 26.7% of them, elevated eosinophils were detected. IgE levels were 148.25 ± 279.20 IU/mL. According to the number of attacks before treatment, there was a significant decrease in the number of attacks in the control (p <0.001). Conclusion: In this study, montelukast has been shown to reduce the number of EVW attacks and we believe montelukast may be a potential treatment option for EVW in preschool children.

Evaluation of Ventilator-Associated Tracheitis in Children with Pre-Existing Tracheostomies: Organisms and Empiric Coverage Objectives: This study aims to describe the outcomes, microbiome, and empiric antimicrobial coverage of ventilator associated tracheitis (VAT) in pediatric patients with pre-existing tracheostomies. Patients and Methods: This is a retrospective chart review of pediatric patients with pre-existing tracheostomies admitted to the Children’s Hospital of Georgia for initial inpatient treatment for VAT between January 1, 2007 and February 21, 2021. Patients were evaluated for incidence of ventilator associated pneumonia (VAP), tracheostomy culture results, and antibiotic choice. Results: Thirty-nine patients were included. Across all patients evaluated with pre-existing tracheostomies, 60% developed VAT. There was no difference in the development in VAP between shorter and longer treatment durations (0 vs 1, p = 1). Patients who developed Pseudomonas aeruginosa VAT were likely to have a previous culture of P. aeruginosa (p = 0.003), have a tracheostomy for longer (p = 0.011), and be older than 1 year of age (p = 0.0002). MRSA VAT was associated with a previous culture growing MRSA (p= 0.0042). Conclusions: VAT incidence was higher than what was shown in pediatric patients without pre-existing tracheostomies but VAP incidence was lower and there was no difference between treatment groups. VAT should be treated based on previous cultures and Pseudomonas aeruginosa should be considered as a causative organism.

Reports of early and catastrophic acute structural valve deterioration (SVD) in Trifecta valves (Abbott, St Paul, MN, USA) with multiple leaflet detachment are rare. We encountered two cases of early SVD in Trifecta valves with tears on two leaflets. Both cases presented with acute heart failure because of aortic insufficiency and underwent redo aortic valve replacement; one patient died due to multiple organ failure caused by cardiogenic shock. Durability issues with valves necessitate long-term vigilance in aortic valve replacement patients.

Background: Over the past few years, the benefits of co-administration of omega-3 and antioxidants have been reported in the management of non-alcoholic fatty liver disease (NAFLD) complications.This study evaluated the effects of Camelina sativa oil (CSO) supplementation as one of the richest dietary sources of omega-3 fatty acids on glucose homeostasis,inflammation, metabolic endotoxemia, and oxidative stress in NAFLD patients. Methods: In all, 43 subjects with NAFLD were allocated to either an intervention (20g/d CSO) or placebo (20g/d sunflower oil) group receiving a calorie-restricted diet for 12 weeks. Fasting serum levels of glycemic indices, hs-CRP, endotoxin, antioxidant enzymes activity, total antioxidant capacity (TAC), malondialdehyde (MDA), 8-iso-prostaglandin F2α (8-iso-PGF2α), and uric acid were measured at baseline and post-intervention. Results: CSO intake led to a significant decrease in insulin concentration (-17.49%), homeostasis model assessment of insulin resistance (HOMA-IR) (-20%), high-sensitive C-reactive protein (hs-CRP), (-12.94%), lipopolysaccharide endotoxin (-32.55%), malondialdehyde (MDA) (-18.75%), 8-iso-prostaglandin F2α (8-iso-PGF2α) (-19.55%) and a significant increase in the levels of total antioxidant capacity (TAC) (31.82%) and superoxide dismutase activity (10.22%) in the CSO group compared with the placebo group. Also, there was no significant difference between the two groups in fasting plasma glucose, quantitative insulin sensitivity check index (QUICKI), catalase, glutathione peroxidase activity, and uric acid level. In addition, within-group analyses showed a significant reduction of insulin, QUICKI, hs-CRP, and endotoxin levels in the intervention group. Conclusion: These findings indicate that CSO may improve glycemic, inflammation, metabolic endotoxima, oxidative stress status, and mental health in patients with NAFLD.

Background: The Covid-19 pandemic currently represents a foremost global contemporary public health challenge, with alarming death rate. Pregnant women by virtue of reduced immunity may be at increased risk of contracting the disease. Objective: To elicit the knowledge of, and behavior, in response to the covid-19 pandemic among pregnant Nigerian Igbo women. Subjects and methods: Cross-sectional questionnaire-based study of 370 pregnant women from health facilities in Anambra state Nigeria, to elicit information on their knowledge of causes, mode of transmission, availability of vaccines, treatment modalities, and behavioural changes consequent on covid-19. Data obtained was analyzed using SPSS IBM windows version 26. Result: The modal age, parity and gestational age of the respondents were 25-29 years (49.2%); Para 1-4(89.5%) and <28 weeks (44.1%) respectively. Majority of the participants had tertiary education (54.1%) and of modal social class 5. All (100%) of the participants knew about covid-19; 91.4% recognized it was of viral aetiology; and 75.1% agreed it is an infectious disease. Indicated modes of transmission include air, droplets, faeces, urine, dust, ingested foods, and drinks. Most of the participants recognized the unavailability of drugs (88.6%) and vaccine (80%) for covid-19 management. Stated treatment modalities include symptomatic therapy; inhalation of steam from hot water, herbs, and roots; consumption of spices; antimalarial, Antibiotics, Multivitamins therapy; physical exercises; rest; and prayer. Majority of the respondents (67%) believed that covid-19 had affected their general behavior and most adhered to covid-19 safety measures - wearing of face mask; hand washing; use of hand-sanitizers and social distancing. The most common source of information to participants on covid-19 was electronic media. Conclusion: The knowledge of covid-19 among the respondents was high and their behavior, satisfactory. There is need to maintain the public enlightenment tempo to sustain the good behavior in response to covid-19 amongst pregnant women.

Creutzfeldt – Jakob disease (CJD) is a rare neurodegenerative disease with complex clinical manifestations. Neuroleptic malignant syndrome (NMS) is a complication of antipsychotic medications which are used to treat neuropsychiatric symptoms of CJD. We present a case of a 51-year-old woman with CJD who developed NMS after being prescribed quetiapine.

Although one of the serious manifestations of advanced malignancies is pericardial involvement, pericardial involvement of lymphoma is extremely rare. We present a case of a 6-year-old girl arriving at the hospital with dyspnea and pleuritic chest pain, which is eventually diagnosed with massive pericardial effusion due to mediastinal non-Hodgkin lymphoma.

Background Mature aggressive B-cell lymphoma are heterogenous malignancies that make up more than half of all diagnosed Non-Hodgkin lymphoma in children and adolescents. The overall survival rate increased over the last decades to 80–90%, due to fine tuning of polychemotherapy. However, new therapeutic implications are needed to further increase the overall survival. Current clinical trials analyze the therapeutic effect of rituximab in pediatric patients, while the mechanism of action in vivo is still not fully understood. Methods Effector molecules important for tumor defense were analyzed before and at day five after rituximab treatment via flow cytometry. Serum rituximab levels were measured with an ELISA. Results We evaluated patient parameters that may affect treatment response in relation to rituximab administration and serum rituximab levels. We indeed found a reduction of FcγRII levels after rituximab treatment in monocyte subtypes, while FcγRI expression was significantly increased, pointing to exhaustion of FcγRII mediated B cell depletion and compensation via FcγRI mediated trogocytosis. Serum levels of proinflammatory marker proteins S100A8/A9 and S100A12 significantly decreased after treatment to normal levels from an overall proinflammatory state before treatment. CD57, perforin and granzyme B expression decreased after treatment, probably due to exhaustion of NK cells. Conclusion The highlighted effects of rituximab treatment on patient’s immune response help understanding the biology behind tumor defense mechanisms and effector function. After subsequent studies, these novel insights might be translated into patient care and could contribute to improve treatment of pediatric patients with mature aggressive B-cell lymphoma.

Background: Vicilin seed storage proteins are translated with N-terminal leader sequences (LSs) that are cleaved to yield the mature protein. These LSs were thought to be unstructured and rapidly degraded. However, Ara h 1 and Jug r 2 LS (A1LS, J2LS) have been identified in seeds, and immunodominant IgE epitopes detected. Here, common sequences containing structured CxxxC-repeat motifs were identified as potential mediators of IgE cross-reactivity despite very low (17%) sequence identity. Method: Linear IgE epitopes were identified by peptide microarrays, in which overlapping 15-mer peptides on glass slides, were incubated with sera from peanut, walnut or dual allergic individuals. Similar epitopes were computationally predicted. Peanut A1LS and walnut J2LS fragments (J2.1, J2.2, J2.3) each with a CxxxC vicilin LS motif were identified, cloned, expressed, purified and their structures solved using solution-NMR to locate and assess epitopes on the structure. Results: A1LS and J2LSs reveal similar helix-turn-helix motifs connected by disulfide bonds between adjacent CxxxC repeats forming α-hairpin structures. Peanut-allergic IgE bound more frequently to the J2LSs, regardless of walnut allergic status or A1LS binding. IgE binding pattern to peptides from both J2LS and A1LS, along with structure and computational predictions, suggest that the structure and conserved amino acid properties of peptides determine cross-reactivity. The properties of LS IgE epitopes were closely related to epitopes in 2S albumins. Conclusion: The shared α-hairpin structure is a stable scaffold that contributes to cross-reactivity despite low sequence identity. Biophysical properties are a better predictor of distant cross-reactivity than traditional measures of evolutionary conservation.

In this paper we consider the global existence, regularizing-decay rate and asymptotic behavior of mild solutions to the Cauchy problem of fractional drift diffusion system with power-law nonlinearity. Using the properties of fractional heat semigroup and the classical estimates of fractional heat kernel, we first prove the global-in-time existence and uniqueness of the mild solutions in the frame of mixed time-space Besov space with multi-linear continuous mappings. Then we show the asymptotic behavior and regularizing-decay rate estimates of the solution to equations with power-law nonlinearity by the method of multi-linear operator and the classical Hardy-Littlewood-Sobolev inequality.

Surgical implantation of a complete or incomplete ring to reduce the valve annulus and improve leaflet coaptation is the mainstay of mitral valve surgery. The Cardioband® system (Edwards Lifesciences, Irvine, CA, USA) was designed to address the pathophysiological mechanism of annular dilatation through a catheter-based approach. We present the histopathological workup of a Cardioband® device, which had been implanted 21 months earlier in a 34-year-old male with ischemic cardiomyopathy. Device examination demonstrate a well-positioned and securely anchored device. The described tissue reactions may have an impact on choice of device and timing in case of re-do surgery.

Abstract Interleukin 6 (IL-6) is a circulating cytokine that is implicated in a range of inflammatory diseases. However, the broad effects of IL-6 receptor (IL-6R) signalling on other circulating cytokines is not known. Using summary-level data from genome-wide association studies, we leveraged genetic variants that proxy IL-6R signalling in two-sample Mendelian randomization analyses to investigate effects on levels of 40 circulating cytokines. Increased genetically proxied IL-6R signalling was associated with reduced levels of 10 circulating interleukins, chemokines, and growth factors. The findings from this study support feedback effects of IL-6R signalling on reducing levels of a range of circulating cytokines and identify compensatory mechanisms that may be modulating its inflammatory effects. These results provide novel insight into the mechanisms by which IL-6R signalling may be contributing to inflammatory and autoimmune diseases.

Vastly understudied, mesophotic coral ecosystems lie below shallow reefs (> 30 m depth) and comprise ecologically distinct communities. Brooding reproductive modes appear to predominate among mesophotic-specialist species and may limit genetic connectivity among populations. Using reduced representation genomic sequencing, we assessed spatial population genetic structure (at 50 m depth) in an ecologically important mesophotic-specialist species, Agaricia grahamae among locations in the Southern Caribbean. We also tested for hybridisation with the closely related (but depth-generalist) species Agaricia lamarcki, within their sympatric depth zone (50 m). In contrast to our predictions, no spatial genetic structure was detected between the reefs of Curaçao and Bonaire (~ 40 km apart) within A. grahamae. However, cryptic taxa were discovered within both nominal species, with those in A. lamarcki (incompletely) partitioned by depth and those in A. grahamae occurring sympatrically (at the same depth). Hybrid analyses and demographic modelling identified contemporary and historical gene flow among cryptic taxa, both within and between A. grahamae and A. lamarcki. These results (1) indicate that spatial genetic connectivity in these ecologically important mesophotic species may be maintained over large geographic distances and (2) highlight that gene flow links taxa within this relativity diverse Caribbean genus.

Introduction: the Pain management in internal medicine ward is a common problem. Studies have shown that the evaluation of pain and its documentation by the medical staff is inaccurate and tends to underestimate the level of pain reported by patients. In addition, Physicians often report lack of knowledge and misconceptions regarding pain management. Objectives: To assess the impact of a structured pain educational program on knowledge, skills and abilities [KSA’s] of internal medicine ward physicians in pain management. Methods: Eleven physicians from Internal medicine ward B at Bnai-Zion Medical Center, a tertiary academic center in Israel, participated in a pain educational program. Questioners regarding pain KSA’s, were completed before and after the educational intervention. Concomitantly, a pain management protocol was implemented in the department. Results: There was a 55.5% (P.value = 0.003) improvement in the overall satisfaction of the physicians regarding pain management in the internal ward on a 1 to 6 Likert scale (1-strongly disagree, 6-strongly agree) .In a modified KnowPain50 [KP50] questionnaire that assesses physicians KSA, the average score for all physicians improved by 15.3% (P.value = 0.012) after the intervention. Conclusion: A targeted educational intervention on pain management can improve physician’s KSA, and this we belive may lead to a better treatment for patients suffering from pain in the hospital scenerio.

Aim: To evaluate the tendency, knowledge, awareness and behavior patterns of urology residents training at different institutions in Turkey about the use of fluoroscopy in operations. Methods: The 13-questioned survey prepared using “Google Forms©” as of 01.03.2021 was shared for four weeks in the “WhatsApp®” application group, which includes 279 urology residents studying with university hospitals and training and research hospitals in Turkey. One hundred and thirteen participants, who completed the questionnaire were included in the study. Results: Of the 113 urology residents included in the study, 56 (49.6%) were studying in university hospitals and 57 (50.4%) were in training and research hospitals. 67.3% of the residents stated that they never hesitated to participate in the operations which fluoroscopy was used. Additionally, the residents stated that, also 43.4% of the auxiliary healthcare staff frequently refrain from being involved in these cases(p <0.001). While 21 (37.5%) of the residents trained in the university hospital reported that they hesitated from these cases, this rate was found that 16 (28.2%) of the residents who were trained in the training and research hospitals and a significant difference was observed between two groups (p <0.016). Among residents, the rate of using radioprotective lead apron was 94.7%, and the rate of thyroid shield use was 98.2%. While the rate of using radiation protective glasses was 1.8%, it was learned that none of the residents used radioprotective gloves. Only 5.3% of the residents stated that they are trained in subjects about the harmful radiation effect. Conclusion: Urology residents in Turkey do not receive sufficient training on the harmful effects of fluoroscopy, which they frequently use in their daily practice. In addition, the residents whom training in university hospitals are more scared of the radiation exposure from fluoroscopy than their colleagues working in training and research hospitals.

Background: Although changes of the main lymphocyte subsets (T cells, T helper, T cytotoxic, B cells, NK cells) and lymhocyte activation status in COVID-19 patients have been reported, the results of the studies differ each other. Therefore, we aimed to determine lymphocyte subgroups and activation status of them with flow cytometry at the time of diagnosis in COVID-19 patients and examine the relation of them with disease stage and length of hospital stay. Methods: Fourty patients included in the study were compared with the age and sex matched 40 healthy controls. COVID-19 patients were divided into 2 groups as mild and severe stage disease. Flow cytometry assay was performed to examine the numbers of lymphocyte subsets and activation status of them. Total lymphocyte count was calculated and CD45, CD3, CD4, CD8, CD19, CD27, CD38, CD56, CD57, IgD were studied on lymphocyte gate. T helper / T cytotoxic rates and length of hospital stay were recorded. Results: The patients’ CD3(+)CD4(+) ( T helper) count and CD27 expression on T cells counts were significantly lower, and CD57 expression on CD3(+)CD8(+) T cytotoxic cells were significantly higher (p<0.05) than control gruop. When the patients were divided into mild and severe stages, it was observed that CD38 expression on T cells were significantly lower in severe stage patients (p< 0.05) Total lymphocyte count and CD3(+) T lymphocyte count were negatively correlated with the lengt of hospital stay as statistically significant (p <0.05). Conclusion: Our data showed that the SARS-CoV-2 primarly effects on T lymphocytes. It was thought that this effect occured by impairment of development and activation of T lymphocytes. There are some discordances among the studies on T lympocytes in the literature. Studies with more patients are needed to make this information more reliable.

Insectivores gain macronutrients and elements from consuming arthropod prey, but must also deal with indigestible components (i.e., exoskeleton) of prey. For example, avian chicks (e.g. northern bobwhites; Colinus virginianus) have limited gut space, and ingesting prey with relatively higher proportions of indigestible components may impact assimilation efficiency, growth, and survival. The ability of insectivores to choose higher quality prey would depend on prey taxa varying consistently in nutritional content. We tested if there were consistent differences among taxonomic orders of arthropod prey in their macronutrient (protein and lipid), elemental (C and N), and exoskeleton content. We used northern bobwhite chicks as our focal insectivore and focused on their potential prey as a case study. We also tested the influence of indigestible exoskeleton on the measurement of macronutrient content and the ability of elemental content to predict macronutrients. We found large and consistent variation in macronutrient and elemental content within and between arthropod orders. Some orders had consistently high protein content and low exoskeleton content (i.e., Araneae) and are likely higher quality prey for insectivores. Abundant orders common in the diets of insectivores, like Hymenoptera and Coleoptera, had high exoskeleton content and low protein content. We also found support for the ability of elements to predict macronutrients, and found that metabolizable (i.e. exoskeleton removed) elemental content better predicted macronutrient content. A better understanding of arthropod nutrient content is critical for elucidating the role of spatial and temporal variation in prey communities in shaping the growth and survival of insectivores.

Eating Behaviour and Alexithymia

The hyporheic exchange below dune-shaped bedforms has a great impact on the stream environment. One of the most important properties of the hyporheic zone is the residence time distribution (RTD) of flow paths in the sediment domain. Here we evaluate the influence of an impervious layer, at a dimensionless sediment depth of \(d_{b}^{*}=\frac{2\pi d_{b}}{\lambda}\) where \(\lambda\) is the dune wavelength, on the form of the hyporheic exchange RTD. Empirical RTDs were generated, over a range of \(d_{b}^{*\ }\ \)values, from numerical particle tracking experiments in which \(10000\) particles sinusoidally distributed over a flatbed domain were released. These empirical RTDs are best represented by the Gamma, Log-Normal and Fréchet distributions over normalized bed depth of \({0\ <=d}_{b}^{*\ }\leq 1.2\),\({1.2<d}_{b}^{*\ }\leq 3.1\), and \(d_{b}^{*\ }>3.1\), respectively. The depth dependence of the analytical distribution parameters is also presented, together with a set of regression formulae to predict these parameters based on \(d_{b}^{*\ }\)with a high degree of accuracy (\(R^{2}>99.8\%\)). These results contribute to our understanding of the physical and mixing processes underpinning hyporheic exchange in streams and allow for a quick evaluation of its likely impact on nutrient and contaminant processing (e.g., based on the magnitude of the Damköhler number).Keywords: Dunes, bedforms, residence times distribution, sediment depth effect, Hyporheic residence times, analytical representation, two parametric distributions, Damköhler Number.

Soil properties have a significant influence on solutes redistribution in the soil vadose zones. The aim of this study was to assess the relevance of soil properties for solute transport characteristics in degraded wetland soils using 72 undisturbed soil columns from two experimental fields located in Robinia pseudoacacia (CH) and Tamarix chinensis (CL) communities. Combining soil column tracer experiments, all experiments were conducted under the same initial and boundary conditions using Brilliant Blue FCF as a conservative tracer. Solute transport characteristics were described by four measures of dye solution steady infiltration rate of effluents, dye solution concentration of effluents, soil column dye staining patterns, and cumulative dye solution leaching. Numerical modeling by the dual-permeability model in HYDRUS-1D was used to simulate the proportion of cumulative dye solution leaching from soil macropore flow. This study showed that basic soil properties exhibited a significant difference at CH site and at CL site. Dye solution steady infiltration rate of effluents at CH site decreased with soil depth, but increased at first and then decreased with soil depth at CL site. Dye solution concentration of effluents both at CH site and at CL site decreased nonlinearly with soil depth. Soil column dye staining patterns were significantly different among different soil locations, indicating the largest dark blue staining domains from soil depth of 0-10 cm at CH site and 20-40 cm at CL site. The proportion of cumulative dye solution leaching from soil macropore flow was from 37.6 to 61.1% at CH site, whereas from 0 to 99.9% at CL site. Basic soil properties played inconsistent roles in solute transport characteristics. The understanding of soil properties and its correlation with solute transport characteristics is the first step for degraded wetland restoration and development. Some alternative solutions of wetland restoration are proposed for managers.

The use of antioxidants in Chinese hamster ovary (CHO) cell cultures to improve monoclonal antibody production has been a topic of great interest. Nevertheless, the mechanisms by which antioxidant pathways are regulated in CHO cells and their effect on metabolism are not fully understood. In this work, we investigated how treatment with the antioxidant rosmarinic acid (RA) improved viable cell density and titer in CHO cell cultures, and attempted to explore the underlying mechanism(s) using transcriptomics and metabolomics. In particular, transcriptomics analysis indicated that RA treatment modified gene expression and strongly affected the MAPK and Akt signaling pathways which regulate cell survival and cell death. Moreover, we observed that these effects did not appear related to an intracellular metabolism change. In summary, this integrated ‘omics analysis has important implications for the role of the antioxidant RA in industrial cell culture processes. The current study also represents an example in the industry of how multi-omics can be applied to gain an in‐depth understanding of CHO cell biology and to identify critical pathways that can contribute to cell culture process improvement and cell line engineering.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease caused by skin barrier defects and a misdirected type 2 immune response against antigens. The skin microbiome in AD is characterised by a reduction in microbial diversity with a dominance of staphylococci, including Staphylococcus epidermidis (S. epidermidis). To assess whether S. epidermidis antigens play a role in AD, we studied the immune response against the extracellular serine protease (Esp). Methods: We analyzed the binding of human IgG4 to S. epidermidis extracellular proteins using immunoblotting and mass spectrometry. We then measured serum antibodies specific for recombinant Esp by ELISA in healthy and AD individuals. We also stimulated T cells from AD patients and control subjects with Esp and measured the secreted cytokines. Finally, we analyzed the proteolytic activity of Esp against IL-33 and determined the cleavage sites by mass spectrometry. Results: We identified Esp as the dominant IgG4-binding antigen of S. epidermidis. Esp-specific IgE was present in human serum; AD patients had higher concentrations than controls. The T cell response to Esp in healthy adults was characterized by IL-17, IL-22, IFN-γ, and IL-10, whereas the AD patients’ T cells lacked IL-17 production and released only low amounts of IL-22, IFN-γ, and IL-10. In contrast, Th2 cytokine release was higher in T cells from AD patients than from healthy controls. Mature Esp cleaved and activated the alarmin IL-33. Conclusions: Esp elicits type 2-biased response in AD patients. This suggests that S. epidermidis can aggravate AD through the allergenic properties of Esp.

We describe an unusual case of a young girl presenting with a large vagal schwannoma necessitating a transcervical-mandibulotomy approach for total tumor resection. The presentation is unique due to the size of the lesion, the patient's age, the operative approach, and molecular pathology.

Introduction: The implementation of interdisciplinary care strategies for the follow-up of patients with asthma has proven to be very effective in improving the long-term evolution of these children. Objectives: Describe the clinical, functional and therapeutic characteristics of patients with a diagnosis of uncontrolled severe asthma (UCSA), identify the differences in the characteristics in the management between patients with difficult-to-treat severe asthma (SDCA) and treatment-resistant severe asthma (STRA Materials: Analytical study of serial cases, patients were evaluated for 6 months, patients with UCSA diagnosis were admitted to the Pneumonology Service of the Pediatric Hospital of Córdoba, with ages between 5 and 15 years old. Results: 23 patients entered the study. 47.82% were defined as SDCA and 52.17% STRA. During the first 6 months of the program; hospitalizations were only 4% (p: 0.001). Besides, the number of visits to the emergency room decreased to 39.13% (p: 0.003). Regarding the Inhalation technique, 73.9% (n: 17) presented improvement (p: 0.0001). Only 13% (n = 3) of the patients continued with ACT <20 (p: 0.0001). We found differences in the use of rescue medication (p: 0.003) and greater attendance at Emergency Rooms (p: 0.005), during the 6-month evaluation process, in favor of the group of treatment-resistant asthmatics Conclusion: Implementing this type of interdisciplinary program allowed a marked improvement in all modifiable variables of asthma in patients with SDCA. All this not only leads to improving the management of patients with UCSA.