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McClain W, Luttrell J, Lambert E. Pediatric Dysphagia. Otolaryngol Clin North Am 2024; 57:531-540. [PMID: 38521722 DOI: 10.1016/j.otc.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
Pediatric dysphagia is a common condition encountered in clinical practice. We review the physiology and development of swallow, presentation, epidemiology, and etiology of dysphagia. Additionally, comorbidities, associated conditions, and medical management of dysphagia are discussed.
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Affiliation(s)
- Wade McClain
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina, 101 Manning Drive Campus, Box #7070, Chapel Hill, NC 27514, USA.
| | - Jordan Luttrell
- Department of Otolaryngology, University of Tennessee Health Science Center, 910 Madison Avenue, Suite 430, Memphis, TN 38163, USA
| | - Elton Lambert
- Department of Otolaryngology, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, MC:CC640, Houston, TX 77030, USA
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Rousseau A, Michiels S, Simon-Tillaux N, Lolivier A, Bonastre J, Planchard D, Barlesi F, Remon J, Lavaud P, Aldea M, Frelaut M, Le Pechoux C, Botticella A, Levy A, Gazzah A, Foulon S, Besse B. Impact of pembrolizumab treatment duration on overall survival and prognostic factors in advanced non-small cell lung cancer: a nationwide retrospective cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 43:100970. [PMID: 39040528 PMCID: PMC11262181 DOI: 10.1016/j.lanepe.2024.100970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/04/2024] [Accepted: 06/04/2024] [Indexed: 07/24/2024]
Abstract
Background The efficacy of front-line pembrolizumab has been established in studies that limit treatment duration to 2 years, but decision to stop pembrolizumab after 2 years is often at physician's discretion. ATHENA is a retrospective cohort study using a comprehensive administrative database aimed firstly at exploring the optimal duration of pembrolizumab and secondly real-life prognosis factors in patients with advanced non-small cell lung cancer (NSCLC). Methods Using the French National Health Insurance database (SNDS), we identified patients with incident lung cancer in France from 2015 to 2022. Treatments and patients' characteristics were extracted or inferred from hospital, outpatient care, pharmacy delivery reports. The duration's hazard ratio (HR) was estimated with Cox model weighted by inverse of propensity score to account for confounding. Prognostics factors in first line population were identified with Cox model selected by a LASSO procedure. Findings 391,106 patients with lung cancer were identified, of whom 43,359 received up-front pembrolizumab for an advanced disease. There were 67% (29,040/43,359) of male and the median age at diagnosis was 65 years old. After a median follow-up time of 25.9 months (min-max, [0-97.6]), the median overall survival (OS) after pembrolizumab initiation in first line was 15.7 [CI 95, 15.3-16.0] months. In multivariable analysis, several covariables were independently associated with worse OS, including male sex with chemo-immunotherapy, age, hospital category, high deprivation index, inpatient hospitalization for first pembrolizumab, and history of diabetes, diuretic, beta blocker, painkiller prescription. At landmark time of 29 months after pembrolizumab initiation, continuation beyond 2 years was not associated with better OS than a fixed 2-year treatment, HR = 0.97 [0.75-1.26] p = 0.95. Interpretation This study supports the notion that stopping pembrolizumab after 2 years could be safe for patients with advanced NSCLC. However, because observational studies are prone to confounding and selection bias, causality cannot be affirmed. Funding This study did not receive any specific grant.
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Affiliation(s)
- Adrien Rousseau
- Department of Cancer Medicine, Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers (CICT), Paris-Saclay University, Villejuif, France
- Oncostat U1018, Inserm, Labeled Ligue Contre le Cancer, Paris-Saclay University, Villejuif, France
- Sorbonne University, Paris, France
| | - Stefan Michiels
- Oncostat U1018, Inserm, Labeled Ligue Contre le Cancer, Paris-Saclay University, Villejuif, France
- Biostatistics and Epidemiology Department, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Noémie Simon-Tillaux
- Oncostat U1018, Inserm, Labeled Ligue Contre le Cancer, Paris-Saclay University, Villejuif, France
- Biostatistics and Epidemiology Department, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Alexandre Lolivier
- Oncostat U1018, Inserm, Labeled Ligue Contre le Cancer, Paris-Saclay University, Villejuif, France
- Biostatistics and Epidemiology Department, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Julia Bonastre
- Oncostat U1018, Inserm, Labeled Ligue Contre le Cancer, Paris-Saclay University, Villejuif, France
- Biostatistics and Epidemiology Department, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - David Planchard
- Department of Cancer Medicine, Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers (CICT), Paris-Saclay University, Villejuif, France
| | - Fabrice Barlesi
- Department of Cancer Medicine, Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers (CICT), Paris-Saclay University, Villejuif, France
| | - Jordi Remon
- Department of Cancer Medicine, Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers (CICT), Paris-Saclay University, Villejuif, France
| | - Pernelle Lavaud
- Department of Cancer Medicine, Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers (CICT), Paris-Saclay University, Villejuif, France
| | - Mihaela Aldea
- Department of Cancer Medicine, Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers (CICT), Paris-Saclay University, Villejuif, France
| | - Maxime Frelaut
- Department of Cancer Medicine, Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers (CICT), Paris-Saclay University, Villejuif, France
| | - Cecile Le Pechoux
- Department of Radiation Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Angela Botticella
- Department of Radiation Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Antonin Levy
- Department of Radiation Oncology, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Anas Gazzah
- Department of Drug Development, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Stephanie Foulon
- Oncostat U1018, Inserm, Labeled Ligue Contre le Cancer, Paris-Saclay University, Villejuif, France
- Biostatistics and Epidemiology Department, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Benjamin Besse
- Department of Cancer Medicine, Gustave Roussy, Thoracic Group and International Center for Thoracic Cancers (CICT), Paris-Saclay University, Villejuif, France
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Blangis F, Drouin J, Launay E, Miranda S, Zureik M, Cohen JF, Weill A, Dray-Spira R, Chalumeau M. Maternal, prenatal and postnatal risk factors for early child physical abuse: a French nationwide cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 42:100921. [PMID: 39070743 PMCID: PMC11281928 DOI: 10.1016/j.lanepe.2024.100921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 07/30/2024]
Abstract
Background Identifying risk factors for early child physical abuse (CPA) is crucial for understanding its mechanisms and defining effective preventive interventions. We aimed to identify maternal, prenatal and postnatal factors associated with early CPA. Methods This cohort study was based on comprehensive data from the Mother-Child EPI-MERES nationwide register and included all infants born alive in France between 2010 and 2019. Factors associated with early CPA (before age 1) were identified with a multilevel Cox regression model with random intercepts at the regional level. Findings Among the 6,897,384 included infants, 2994 (40/100,000) had a diagnosis of early CPA, at a median age of 4 months. Independent factors most strongly associated with early CPA were maternal low financial resources (adjusted hazard ratio [aHR] 1.91; 95% confidence interval [95% CI] 1.67-2.18), maternal age <20 years versus 35-40 years (aHR 7.06; 95% CI 6.00-8.31), maternal alcohol use disorder (aHR 1.85; 95% CI 1.48-2.31), opioid use disorder (aHR 1.90; 95% CI 1.41-2.56), intimate partner violence (aHR 3.33; 95% CI 2.76-4.01), diagnosis of a chronic mental disorder (aHR 1.50; 95% CI 1.14-1.97) or somatic disorder (aHR 1.55; 95% CI 1.32-1.83), hospitalisation for a mental disorder (aHR 1.88; 95% CI 1.49-2.36), very preterm birth (aHR 2.15; 95% CI 1.68-2.75), and diagnosis of a chronic severe neurocognitive disorder in the infant (aHR 14.37; 95% CI 11.85-17.44). Interpretation Independent risk factors of early CPA identified at the national level in France may help in understanding CPA mechanisms and developing effective prevention programs including risk-stratification tools to optimise the allocation of parenting interventions to parents who could most benefit from them. Funding Ile-de-France regional council, L'Oréal-UNESCO For Women In Science France Young Talent Award, French National Observatory for Child Protection [ONPE], French Association of Ambulatory Paediatrics [AFPA], HUGO university hospitals network, Mustela Foundation and Sauver la Vie prizes.
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Affiliation(s)
- Flora Blangis
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), F-93200, Saint-Denis, France
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and StatisticS, Université Paris Cité, INSERM, F-75014, Paris, France
- Inserm CIC 1413, Nantes University Hospital, F-44000, Nantes, France
- Child Protection Unit - Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Necker-Enfants Malades Hospital, Université Paris Cité, F-75015, Paris, France
| | - Jérôme Drouin
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), F-93200, Saint-Denis, France
| | - Elise Launay
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and StatisticS, Université Paris Cité, INSERM, F-75014, Paris, France
- Inserm CIC 1413, Nantes University Hospital, F-44000, Nantes, France
- Department of Pediatric Emergency Care, Nantes University Hospital, F-44000, Nantes, France
| | - Sara Miranda
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), F-93200, Saint-Denis, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), F-93200, Saint-Denis, France
- Université Versailles Saint-Quentin-en-Yvelines, F-78180, Montigny-le-Bretonneux, France
| | - Jérémie F. Cohen
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and StatisticS, Université Paris Cité, INSERM, F-75014, Paris, France
- Child Protection Unit - Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Necker-Enfants Malades Hospital, Université Paris Cité, F-75015, Paris, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), F-93200, Saint-Denis, France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), F-93200, Saint-Denis, France
| | - Martin Chalumeau
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and StatisticS, Université Paris Cité, INSERM, F-75014, Paris, France
- Child Protection Unit - Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Necker-Enfants Malades Hospital, Université Paris Cité, F-75015, Paris, France
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Hirsch S, Liu E, Rosen R. Proton Pump Inhibitors and Risk of COVID-19 Infection in Children. J Pediatr 2024; 274:114179. [PMID: 38944187 DOI: 10.1016/j.jpeds.2024.114179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/22/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE To evaluate the influence of proton pump inhibitor (PPI) use on COVID-19 susceptibility and severity in children. STUDY DESIGN This retrospective, case-control study included all children ≤21 years undergoing COVID-19 polymerase chain reaction testing at a tertiary children's hospital between March 2020 and January 2023. The main exposure was PPI usage. The primary outcome was COVID-19 infection. The secondary outcome was COVID-19 hospitalization. Log-binomial regressions were used to examine associations between PPI use and these outcomes. RESULTS 116 209 patients age 8.5 ± 6.2 years underwent 234 867 COVID-19 tests. Current PPI use was associated with a decreased risk of COVID-19 test positivity compared with PPI nonuse [RR 0.85 (95% CI 0.76, 0.94), P = .002]; however, there was a significant interaction with time of testing, and an effect of PPIs was no longer seen in the final months of the study following lessening of COVID-19 precautions [RR 1.04 (95% CI 0.0.80, 1.36), P = .77]. PPI use was not associated with risk of hospitalization in patients positive for COVID-19 after adjusting for other hospitalization risk factors [RR 0.85 (95% CI 0.64, 1.13), P = .26]. CONCLUSIONS We did not find an association between PPI use and increased COVID-19 susceptibility or severity in this pediatric sample. These results provide reassuring evidence that PPIs may not worsen COVID-19 outcomes in children.
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Affiliation(s)
- Suzanna Hirsch
- Division of Gastroenterology, Hepatology & Nutrition, Aerodigestive Center, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA.
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA
| | - Rachel Rosen
- Division of Gastroenterology, Hepatology & Nutrition, Aerodigestive Center, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA
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Thompson EJ, Jeong A, Helfer VE, Shakhnovich V, Edginton A, Balevic SJ, James LP, Collier DN, Anand R, Gonzalez D. Physiologically-based pharmacokinetic modeling of pantoprazole to evaluate the role of CYP2C19 genetic variation and obesity in the pediatric population. CPT Pharmacometrics Syst Pharmacol 2024. [PMID: 38837864 DOI: 10.1002/psp4.13167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/11/2024] [Accepted: 04/30/2024] [Indexed: 06/07/2024] Open
Abstract
Pantoprazole is a proton pump inhibitor indicated for the treatment of gastroesophageal reflux disease, a condition that disproportionately affects children with obesity. Appropriately dosing pantoprazole in children with obesity requires understanding the body size metric that best guides dosing, but pharmacokinetic (PK) trials using traditional techniques are limited by the need for larger sample sizes and frequent blood sampling. Physiologically-based PK (PBPK) models are an attractive alternative that can account for physiologic-, genetic-, and drug-specific changes without the need for extensive clinical trial data. In this study, we explored the effect of obesity on pantoprazole PK and evaluated label-suggested dosing in this population. An adult PBPK model for pantoprazole was developed using data from the literature and accounting for genetic variation in CYP2C19. The adult PBPK model was scaled to children without obesity using age-associated changes in anatomical and physiological parameters. Lastly, the pediatric PBPK model was expanded to children with obesity. Three pantoprazole dosing strategies were evaluated: 1 mg/kg total body weight, 1.2 mg/kg lean body weight, and US Food and Drug Administration-recommended weight-tiered dosing. Simulated concentration-time profiles from our model were compared with data from a prospective cohort study (PAN01; NCT02186652). Weight-tiered dosing resulted in the most (>90%) children with pantoprazole exposures in the reference range, regardless of obesity status or CYP2C19 phenotype, confirming results from previously published population PK models. PBPK models may allow for the efficient study of physiologic and developmental effects of obesity on PK in special populations where clinical trial data may be limited.
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Affiliation(s)
- Elizabeth J Thompson
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Angela Jeong
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Victória E Helfer
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Valentina Shakhnovich
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Divisions of Gastroenterology, Hepatology and Nutrition & Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Kansas City, Kansas City, Missouri, USA
- Ironwood Pharmaceuticals, Boston, Massachusetts, USA
| | - Andrea Edginton
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Stephen J Balevic
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Laura P James
- Department of Pediatrics, University of Arkansas for Medical Sciences, Section of Clinical Pharmacology and Toxicology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - David N Collier
- Department of Pediatrics and Center for Health Disparities, Division of General Pediatrics, East Carolina University, Greenville, North Carolina, USA
| | | | - Daniel Gonzalez
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Division of Clinical Pharmacology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Størdal K, Ma A, Beck CE. Reducing the use of proton pump inhibitors in infants with reflux symptoms. BMJ 2024; 385:e074588. [PMID: 38816024 DOI: 10.1136/bmj-2022-074588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Affiliation(s)
- Ketil Størdal
- Department of Paediatric Research, Faculty of Medicine, University of Oslo, Pb 4956 Nydalen, NO-0424 Oslo, Norway
- Department of Paediatrics, Oslo University Hospital, Oslo
| | | | - Carolyn E Beck
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
- University of Toronto, Toronto
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Duncan DR, Golden C, Growdon AS, Larson K, Rosen RL. Brief Resolved Unexplained Events Symptoms Frequently Result in Inappropriate Gastrointestinal Diagnoses and Treatment. J Pediatr 2024; 272:114128. [PMID: 38815745 DOI: 10.1016/j.jpeds.2024.114128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/19/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE To determine associations between presenting symptoms and oropharyngeal dysphagia diagnoses, gastroesophageal reflux disease (GERD) diagnoses, and treatment with acid suppression medication in infants with brief resolved unexplained event (BRUE). STUDY DESIGN We performed a prospective cohort study of infants with BRUE to review presenting symptoms and their potential impact on testing and treatment. Videofluoroscopic swallow study (VFSS) results and explanatory diagnoses were obtained from medical record review; acid suppression use was determined by parental survey. Binary and multivariable logistic regression models were used to evaluate associations between presenting symptoms and obtaining VFSS, VFSS results, GERD diagnoses, and acid suppression medication. RESULTS Presenting symptoms were varied in 157 subjects enrolled at 51.0 ± 5.3 days of age, with many symptoms that may be related to GERD or dysphagia. Of these, 28% underwent VFSS with 71% abnormal. Overall, 42% had their BRUE attributed to GERD, and 33% were treated with acid suppression during follow-up. Presenting symptoms were significantly associated with the decision to obtain VFSS but not with abnormal VFSS results. Presenting symptoms were also associated with provision of GERD explanatory diagnoses. Both presenting symptoms and GERD explanatory diagnoses were associated with acid suppression use (aOR 2.3, 95% CI 1.03-5.3, P = .04). CONCLUSIONS Presenting symptoms may play a role in clinicians' decisions on which BRUE patients undergo VFSS but are unreliable to make a diagnosis of oropharyngeal dysphagia. Presenting symptoms may also influence assignment of GERD explanatory diagnoses that is associated with increased acid suppression medication use.
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Affiliation(s)
- Daniel R Duncan
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA.
| | - Clare Golden
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA
| | - Amanda S Growdon
- Division of General Pediatrics, Hospital Medicine Program, Boston Children's Hospital, Boston, MA
| | - Kara Larson
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA
| | - Rachel L Rosen
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA
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Alla D, Shah DJ, Seepana M, Salian RB, Alla SSM, Krishna Mohanan M, Sabıroğlu M, Vegesna MSS, Singh A, Gupta S, Shivalingappa Rekha S. Safety of Proton Pump Inhibitors in Pediatric Population: A Systematic Review. Glob Pediatr Health 2024; 11:2333794X241248967. [PMID: 38685999 PMCID: PMC11057350 DOI: 10.1177/2333794x241248967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/27/2024] [Accepted: 04/05/2024] [Indexed: 05/02/2024] Open
Abstract
Objective. Commonly recommended drugs for adults and children include proton pump inhibitors (PPIs), proven effective for treating peptic diseases like stomach ulcers, GERD, and Helicobacter pylori infections in children over 1-year-old. Yet, prolonged PPI use carries higher risks of adverse reactions, prompting this study's analysis. Methods. We have performed a systematic review of 30 articles, which include a total of 762 505 pediatric patients. Results. Adverse effects were encountered in 6.98% of the population. The 5 most common adverse effects were respiratory tract complications, gastrointestinal complications, urinary tract infections, asthma, and ENT infections. Conclusion. Hence, PPIs should be prescribed only when necessary, and physicians should prioritize patient education when considering their use.
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Affiliation(s)
- Deekshitha Alla
- Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
| | | | | | | | | | - Midhun Krishna Mohanan
- Sree Uthradom Thirunal (SUT) Academy of Medical Sciences, Thiruvananthapuram, Kerala, India
| | | | | | - Aradhya Singh
- Spartan Health Sciences University, Vieux Fort, Saint Lucia
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Roland N, Neumann A, Hoisnard L, Duranteau L, Froelich S, Zureik M, Weill A. Use of progestogens and the risk of intracranial meningioma: national case-control study. BMJ 2024; 384:e078078. [PMID: 38537944 PMCID: PMC10966896 DOI: 10.1136/bmj-2023-078078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To assess the risk of intracranial meningioma associated with the use of selected progestogens. DESIGN National case-control study. SETTING French National Health Data System (ie, Système National des Données de Santé). PARTICIPANTS Of 108 366 women overall, 18 061 women living in France who had intracranial surgery for meningioma between 1 January 2009 and 31 December 2018 (restricted inclusion periods for intrauterine systems) were deemed to be in the case group. Each case was matched to five controls for year of birth and area of residence (90 305 controls). MAIN OUTCOME MEASURES Selected progestogens were used: progesterone, hydroxyprogesterone, dydrogesterone, medrogestone, medroxyprogesterone acetate, promegestone, dienogest, and intrauterine levonorgestrel. For each progestogen, use was defined by at least one dispensation within the year before the index date (within three years for 13.5 mg levonorgestrel intrauterine systems and five years for 52 mg). Conditional logistic regression was used to calculate odds ratio for each progestogen meningioma association. RESULTS Mean age was 57.6 years (standard deviation 12.8). Analyses showed excess risk of meningioma with use of medrogestone (42 exposed cases/18 061 cases (0.2%) v 79 exposed controls/90 305 controls (0.1%), odds ratio 3.49 (95% confidence interval 2.38 to 5.10)), medroxyprogesterone acetate (injectable, 9/18 061 (0.05%) v 11/90 305 (0.01%), 5.55 (2.27 to 13.56)), and promegestone (83/18 061 (0.5%) v 225/90 305 (0.2 %), 2.39 (1.85 to 3.09)). This excess risk was driven by prolonged use (≥one year). Results showed no excess risk of intracranial meningioma for progesterone, dydrogesterone, or levonorgestrel intrauterine systems. No conclusions could be drawn concerning dienogest or hydroxyprogesterone because of the small number of individuals who received these drugs. A highly increased risk of meningioma was observed for cyproterone acetate (891/18 061 (4.9%) v 256/90 305 (0.3%), odds ratio 19.21 (95% confidence interval 16.61 to 22.22)), nomegestrol acetate (925/18 061 (5.1%) v 1121/90 305 (1.2%), 4.93 (4.50 to 5.41)), and chlormadinone acetate (628/18 061 (3.5%) v 946/90 305 (1.0%), 3.87 (3.48 to 4.30)), which were used as positive controls for use. CONCLUSIONS Prolonged use of medrogestone, medroxyprogesterone acetate, and promegestone was found to increase the risk of intracranial meningioma. The increased risk associated with the use of injectable medroxyprogesterone acetate, a widely used contraceptive, and the safety of levonorgestrel intrauterine systems are important new findings.
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Affiliation(s)
- Noémie Roland
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Anke Neumann
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
| | - Léa Hoisnard
- EpiDermE Epidemiology in Dermatology and Evaluation of Therapeutics, EA7379, Paris Est Créteil University UPEC, Créteil, France
| | - Lise Duranteau
- Department of Medical Gynaecology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Paris Saclay University, 94270, Le Kremlin-Bicêtre, France
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière University Hospital, Paris-Cité University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mahmoud Zureik
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
- University Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France
| | - Alain Weill
- EPI-PHARE Scientific Interest Group, French National Agency for Medicines and Health Products Safety, French National Health Insurance, Saint-Denis, France
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Mauritz MD, von Both U, Dohna-Schwake C, Gille C, Hasan C, Huebner J, Hufnagel M, Knuf M, Liese JG, Renk H, Rudolph H, Schulze-Sturm U, Simon A, Stehling F, Tenenbaum T, Zernikow B. Clinical recommendations for the inpatient management of lower respiratory tract infections in children and adolescents with severe neurological impairment in Germany. Eur J Pediatr 2024; 183:987-999. [PMID: 38172444 PMCID: PMC10951000 DOI: 10.1007/s00431-023-05401-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
Children and adolescents with severe neurological impairment (SNI) require specialized care due to their complex medical needs. In particular, these patients are often affected by severe and recurrent lower respiratory tract infections (LRTIs). These infections, including viral and bacterial etiology, pose a significant risk to these patients, often resulting in respiratory insufficiency and long-term impairments. Using expert consensus, we developed clinical recommendations on the management of LRTIs in children and adolescents with SNI. These recommendations emphasize comprehensive multidisciplinary care and antibiotic stewardship. Initial treatment should involve symptomatic care, including hydration, antipyretics, oxygen therapy, and respiratory support. In bacterial LRTIs, antibiotic therapy is initiated based on the severity of the infection, with aminopenicillin plus a beta-lactamase inhibitor recommended for community-acquired LRTIs and piperacillin-tazobactam for patients with chronic lung disease or tracheostomy. Ongoing management includes regular evaluations, adjustments to antibiotic therapy based on pathogen identification, and optimization of supportive care. Implementation of these recommendations aims to improve the diagnosis and treatment of LRTIs in children and adolescents with SNI. What is Known: • Children and adolescents with severe neurological impairment are particularly affected by severe and recurrent lower respiratory tract infections (LRTIs). • The indication and choice of antibiotic therapy for bacterial LRTI is often difficult because there are no evidence-based treatment recommendations for this heterogeneous but vulnerable patient population; the frequent overuse of broad-spectrum or reserve antibiotics in this patient population increases selection pressure for multidrug-resistant pathogens. What is New: • The proposed recommendations provide a crucial framework for focused diagnostics and treatment of LRTIs in children and adolescents with severe neurological impairment. • Along with recommendations for comprehensive and multidisciplinary therapy and antibiotic stewardship, ethical and palliative care aspects are taken into account.
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Affiliation(s)
- Maximilian David Mauritz
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, 45711, Datteln, Germany.
- Department of Children's, Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine , Herdecke University, 58448, WittenWitten, Germany.
| | - Ulrich von Both
- Department of Infectious Diseases, Dr von Hauner Children's Hospital, LMU University Hospital, 80337, Munich, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care Medicine, and Pediatric Neurology, University Hospital Essen, 45147, Essen, Germany
| | - Christian Gille
- Department of Neonatology, Heidelberg University Children's Hospital, 69120, Heidelberg, Germany
| | - Carola Hasan
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, 45711, Datteln, Germany
- Department of Children's, Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine , Herdecke University, 58448, WittenWitten, Germany
| | - Johannes Huebner
- Department of Infectious Diseases, Dr von Hauner Children's Hospital, LMU University Hospital, 80337, Munich, Germany
| | - Markus Hufnagel
- Department of Paediatrics and Adolescent Medicine, Medical Faculty, University Medical Centre, University of Freiburg, 79106, Freiburg, Germany
| | - Markus Knuf
- Department for Pediatric and Adolescent Medicine, Worms Clinic, 67550, Worms, Germany
| | - Johannes G Liese
- Department of Paediatrics, Division of Paediatric Infectious Diseases, University Hospital of Wuerzburg, 97080, Würzburg, Germany
| | - Hanna Renk
- University Children's Hospital Tuebingen, 72076, Tuebingen, Germany
| | - Henriette Rudolph
- Department of Pediatrics, Goethe University Frankfurt, 60590, Frankfurt am Main, Germany
| | - Ulf Schulze-Sturm
- University Children's Hospital, University Medical Centre Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Arne Simon
- Pediatric Oncology and Hematology, University Hospital Homburg Saar, 66421, Homburg/Saar, Germany
| | - Florian Stehling
- Department of Pediatric Pulmonology and Sleep Medicine, University Children's Hospital Essen, 45147, Essen, Germany
| | - Tobias Tenenbaum
- Clinic for Child and Adolescent Medicine, Sana Klinikum Lichtenberg, Academic Teaching Hospital, Charité-Universitätsmedizin, 10365, Berlin, Germany
| | - Boris Zernikow
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital, 45711, Datteln, Germany
- Department of Children's, Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine , Herdecke University, 58448, WittenWitten, Germany
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11
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Swital M, Drouin J, Miranda S, Bakchine S, Botton J, Dray-Spira R. Use of multiple sclerosis disease-modifying therapies during pregnancy in France: Nationwide study between 2010 and 2021. Mult Scler 2024; 30:227-237. [PMID: 38281078 PMCID: PMC10851628 DOI: 10.1177/13524585231223395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) frequently affects women of childbearing age and pregnant women. OBJECTIVE To assess the use of MS disease-modifying therapies (DMTs) during pregnancy in France over the last decade, marked by an increasing DMTs availability. METHODS All pregnancies ended from April 2010 to December 2021 in women with MS were identified based on the nationwide Mother-Child Register EPI-MERES, built from the French National Health Data System (Système National des Données de Santé (SNDS)). RESULTS Of a total of 20,567 pregnancies in women with MS, 7587 were exposed to DMT. The number of DMT-exposed pregnancies markedly increased from 1079 in 2010-2012 to 2413 in 2019-2021 (+124%), especially those exposed to glatiramer acetate, natalizumab, dimethyl fumarate, and anti-CD20. Among pregnancies of women on DMT 6 months before pregnancy, 78.0% underwent DMT discontinuation and 7.6% switched DMT, generally before (33.0% and 77.0%, respectively) or during the first trimester of pregnancy (58.3% and 17.8%, respectively). DMT discontinuation decreased from 84.0% in 2010-2012 to 72.4% in 2019-2021 and was less frequent among women aged ⩾35 years and those socioeconomically disadvantaged. CONCLUSION Despite MS therapeutic management adaptations to pregnancy, exposure during pregnancy to treatments whose safety profile has not yet been clearly established has increased sharply over the last decade.
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Affiliation(s)
- Morgane Swital
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products-ANSM, French National Health Insurance-CNAM), Saint-Denis, France
- French National Institute of Health and Medical Research (INSERM), Department of Social Epidemiology (ERES), Pierre Louis Institute for Epidemiology and Public Health (IPLESP), Paris, France
| | - Jérôme Drouin
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products-ANSM, French National Health Insurance-CNAM), Saint-Denis, France
| | - Sara Miranda
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products-ANSM, French National Health Insurance-CNAM), Saint-Denis, France
| | - Serge Bakchine
- University of Reims Champagne Ardennes (URCA), Reims, France
| | - Jérémie Botton
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products-ANSM, French National Health Insurance-CNAM), Saint-Denis, France
- Faculty of Pharmacy, Paris-Saclay University, Orsay, France
| | - Rosemary Dray-Spira
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products-ANSM, French National Health Insurance-CNAM), Saint-Denis, France
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12
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Prabhoo RY, Pai UA, Wadhwa A, Pillai BV, D'souza C, Wadhawan M, Bhatnagar M, Prabhoo MR, Shetty S, Seshadri VP, Bhatnagar S, Manchanda SC, Kher V. Multidisciplinary Consensus for Rationalizing the Use of Acid Suppressants in Children and Adults: CONFOR. Euroasian J Hepatogastroenterol 2024; 14:99-119. [PMID: 39022200 PMCID: PMC11249898 DOI: 10.5005/jp-journals-10018-1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 04/22/2024] [Indexed: 07/20/2024] Open
Abstract
The use of acid suppression therapy (AST) is a common approach for managing a wide spectrum of acid peptic disorders. Histamine type 2-receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) are the most widely prescribed AST in routine clinical practice. However, an exponential surge in the prescriptions of PPIs, such as Omeprazole, Esomeprazole, Pantoprazole, Lansoprazole in recent years and their associated adverse effects have raised concern about their inappropriate and overuse, both in children and adults. To address these issues, a three-step modified Delphi polling process was employed to establish best practice consensus statements for rationalizing the use of acid suppressants. A multidisciplinary expert panel of 13 health professionals across medical specialties, including gastroenterologists, hepatologists, pediatric gastroenterologists, pediatricians, otolaryngologists, cardiologists, nephrologists, gynecologist and orthopedists actively contributed to this collaborative process of consensus development. The expert panel proposed 21 consensus statements providing best practice points on the general use and safety of acid suppressants based on a comprehensive review of scientific literature and clinical expertise. The panel also collaboratively developed a PPI deprescribing algorithm. Altogether, this consensus paper offers evidence-based recommendations and guidance for the rational use of acid suppressants with a blueprint for deprescribing PPIs. This consensus paper contributes to aiding primary care practitioners in improving patient outcomes and minimizing healthcare costs. Additionally, it enhances patient safety and curtail inappropriate usage. How to cite this article Prabhoo RY, Pai UA, Wadhwa A, et al. Multidisciplinary Consensus for Rationalizing the Use of Acid Suppressants in Children and Adults: CONFOR. Euroasian J Hepato-Gastroenterol 2024;14(1):99-119.
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Affiliation(s)
- Ram Y Prabhoo
- Department of Orthopedics, Mukund Hospital, Mumbai, Maharashtra, India
| | - Uday A Pai
- Department of Pediatrics, Sai Kutti Clinic, Mumbai, Maharashtra, India
| | - Arun Wadhwa
- Department of Pediatrics, Arun Wadhwa Clinic, New Delhi, India
| | - Bhanu V Pillai
- Department of Pediatric Gastroenterology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Chris D'souza
- Department of ENT, Holy Family Hospital, Mumbai, Maharashtra, India
| | - Manav Wadhawan
- Department of Hepatology and Liver Transplant, BLK-Max Super Speciality Hospital, Delhi, India
| | - Manish Bhatnagar
- Department of Gastroenterology, Orchid Mediservices, Ahmedabad, Gujarat, India
| | - Meena R Prabhoo
- Department of Gynecology, Mukund Hospital, Mumbai, Maharashtra, India
| | - Sadanand Shetty
- Department of Cardiology, Somaiya Super Specialty Institute, Mumbai, Maharashtra, India
| | | | - Shrish Bhatnagar
- Department of Pediatric Gastroenterology, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | | | - Vijay Kher
- Department of Nephrology and Transplant Medicine, Epitome Kidney and Urology Institute, New Delhi, India
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Cho NA, Strayer K, Dobson B, McDonald B. Pathogenesis and therapeutic opportunities of gut microbiome dysbiosis in critical illness. Gut Microbes 2024; 16:2351478. [PMID: 38780485 PMCID: PMC11123462 DOI: 10.1080/19490976.2024.2351478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
For many years, it has been hypothesized that pathological changes to the gut microbiome in critical illness is a driver of infections, organ dysfunction, and other adverse outcomes in the intensive care unit (ICU). The advent of contemporary microbiome methodologies and multi-omics tools have allowed researchers to test this hypothesis by dissecting host-microbe interactions in the gut to better define its contribution to critical illness pathogenesis. Observational studies of patients in ICUs have revealed that gut microbial communities are profoundly altered in critical illness, characterized by markedly reduced alpha diversity, loss of commensal taxa, and expansion of potential pathogens. These key features of ICU gut dysbiosis have been associated with adverse outcomes including life-threatening hospital-acquired (nosocomial) infections. Current research strives to define cellular and molecular mechanisms connecting gut dysbiosis with infections and other outcomes, and to identify opportunities for therapeutic modulation of host-microbe interactions. This review synthesizes evidence from studies of critically ill patients that have informed our understanding of intestinal dysbiosis in the ICU, mechanisms linking dysbiosis to infections and other adverse outcomes, as well as clinical trials of microbiota-modifying therapies. Additionally, we discuss novel avenues for precision microbial therapeutics to combat nosocomial infections and other life-threatening complications of critical illness.
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Affiliation(s)
- Nicole A Cho
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kathryn Strayer
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Breenna Dobson
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Braedon McDonald
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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