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The aim of this study is to identify the prevalence of stunted growth in Syrian refugee children with chronic burn injuries and to compare it to other children (±burn) of similar socioeconomic status. This is a retrospective medical chart review conducted on 142 Syrian refugee children (≤18 years of age) who have sustained war-related and nonwar-related chronic burn injuries between 2014 and 2020. Stunted growth was measured using the height-for-age zscore. The majority of burn injuries were among children below 5 years of age. The prevalence of stunting was 9.2% in our sample, with an overall mean z-score of –0.491 (SD = 1.1). There was no statistically significant difference in z-scores between males and females. The majority of stunted patients are those who sustain their burn injuries at an early age. Early management of burn injuries is key in preventing adverse outcomes associated with stunting. Further research, planning, funding, and targeted interventions are required by stakeholders to alleviate the burden of stunting in the pediatric refugee population, along with the health and economic consequences that it entails.

Introduction:Global arginine bioavailability ratio (GABR) (Arginine/[Citrulline+Ornithine]) is associated with clinical outcomes including pain, pulmonary hypertension, and mortality in patients with sickle cell disease (SCD). Arginine replacement therapy has demonstrated opioid-sparing effects, improved blood pressure and cardiovascular function, and shorten length of hospital stay. Arginine is a conditionally essential amino acid synthesized from citrulline in the kidneys. During a vaso-occlusive pain episode (VOE), hemolysis leads to the release of erythrocyte-arginase (arginine-metabolizing enzyme) that metabolizes arginine into ornithine. Arginine-to-ornithine ratio (arg/orn) is a biomarker of arginase activity and GABR incorporates the impact of kidney function on global arginine bioavailability. The association between arginine bioavailability and clinical outcomes has not been sufficiently explored in children with SCD-VOE.

Introduction: Low L-Arginine (Arg) bioavailability is associated with sickle cell disease (SCD) mortality and morbidity, including acute pain severity. Multiple phase 2 trials support the safety and efficacy of Arg therapy in children with SCD experiencing vaso-occlusive pain. Nitric oxide (NO) is a potent vasodilator depleted in SCD due to hemolysis. As the obligate substrate for NO production, Arg's mechanism-of-action is unknown but thought to be related in part to NO production. Kyotorphin (KTP) is an endogenous opioid analgesic composed of the amino acids tyrosine and Arg. Its nociceptive effects are through induction of Met-enkephalins release in the brain. Oral administration of Arg in wild-type mice increases the levels of KTP centrally. We have previously shown that Arg supplementation increases NO metabolites (NOx), improves mitochondrial function, decreases oxidative stress, and has opioid sparing effects in children with SCD. The association between IV Arg supplementation as a precursor to KTP in SCD is unknown and may represent a novel mechanism by which Arg decreases pain in patients with SCD.