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Gong Y, Zhou C, Wan Y, Yin H. Association of magnesium deficiency, tobacco smoke exposure and hypertension in children and adolescents: evidence from the NHANES 2007-2018. BMC Pediatr 2024; 24:647. [PMID: 39390435 PMCID: PMC11465525 DOI: 10.1186/s12887-024-05097-z] [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: 05/31/2024] [Accepted: 09/23/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Recent studies suggested that the combination of tobacco smoke exposure (TSE) and dietary nutrients intake may be related to a higher or lower risk of hypertension. However, the relationship between dietary magnesium (Mg) intake, TSE and the odds of hypertension remain unclear. This study aimed to evaluate the association of TSE, dietary Mg intake and the odds of hypertension among children and adolescents. METHOD Data of this study were extracted from the National Health and Nutrition Examination Surveys (NHANES) 2007-2018. Dietary Mg intake was calculated as the average of two days of dietary and supplementations intake. Serum cotinine concertation ≥ 0.05 µg/L or at least one-person smoking in the household was considered as exposing to the tobacco smoke. The weighted univariate and multivariate logistic regression models were utilized to explore the associations of dietary Mg intake, TSE and the odds of hypertension among children and adolescents with the evaluation index of odds ratio (ORs) and 95% confidence intervals (CIs). Subgroup analyses based on different age, gender and overweight were further assessed these associations. RESULTS A total of 7,122 children and adolescents aged 8-17 years old and with the blood pressure measurement were included. Of which, 948 (13.31%) had hypertension. After adjusting all covariates, we observed children and adolescents exposed to tobacco smoke was related to higher odds of hypertension (OR = 1.34, 95%CI: 1.01-1.78); children and adolescents not reached the dietary Mg references intakes was related to higher odds of hypertension (OR = 1.48, (95%CI: 1.11-1.97); compared to children and adolescents non-TSE and reached the DRIs of Mg, those not reached the DRIs of Mg and exposed to tobacco smoke have the highest odds of hypertension (OR = 1.94, 95%CI: 1.30-2.89, P for trend = 0.002). These associations of dietary Mg intake, TSE and hypertension remain robust after the stratified analysis based on age, gender and overweight was conducted. CONCLUSION Our findings suggested there were a robust association between dietary Mg intake, TSE and hypertension in children and adolescents. Those children and adolescents with deficiency dietary Mg intake and exposed to tobacco smoke may have the high odds of hypertension. More restrictions on smoking as well as Mg supplementation in the prevention and treatment of hypertension among children and adolescents might be justified.
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Affiliation(s)
- Yongjian Gong
- Department of Pediatrics, The Second People's Hospital of Changzhou, the Third Affiliated Hospital of Nanjing Medical University, No.68 Gehu Road, Wujin District, Changzhou, Jiangsu Province, 213000, China
| | - Cheng Zhou
- Department of Pediatrics, The Second People's Hospital of Changzhou, the Third Affiliated Hospital of Nanjing Medical University, No.68 Gehu Road, Wujin District, Changzhou, Jiangsu Province, 213000, China
| | - Yu Wan
- Department of Pediatrics, The Second People's Hospital of Changzhou, the Third Affiliated Hospital of Nanjing Medical University, No.68 Gehu Road, Wujin District, Changzhou, Jiangsu Province, 213000, China
| | - Haibin Yin
- Department of Pediatrics, The Second People's Hospital of Changzhou, the Third Affiliated Hospital of Nanjing Medical University, No.68 Gehu Road, Wujin District, Changzhou, Jiangsu Province, 213000, China.
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Bertazza Partigiani N, Vigezzi S, Meneghesso D, Tinnirello M, Brazzale AR, Daverio M, Vidal E. Efficacy and safety of fenoldopam for the treatment of hypertensive crises in children with kidney disease: a retrospective study. Pediatr Nephrol 2024:10.1007/s00467-024-06490-7. [PMID: 39249125 DOI: 10.1007/s00467-024-06490-7] [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: 02/06/2024] [Revised: 07/13/2024] [Accepted: 08/06/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Hypertensive crises in children represent critical medical situations characterized by severe hypertension and potential organ damage. Fenoldopam, a dopaminergic medication, offers a viable therapeutic option for managing such clinical scenarios. We aimed to evaluate efficacy and safety of fenoldopam in the management of hypertensive urgencies and emergencies. METHODS This retrospective analysis focused on pediatric patients affected by acute or chronic kidney disease, aged 1 month-18 years, admitted to the Pediatric Nephrology and the Pediatric Intensive Care Unit at University-Hospital of Padua, Italy, who presented with a hypertensive crisis treated with fenoldopam between March 2010 and December 2022. RESULTS The study included 74 patients with median age 10 years (interquartile range [IQR] 4-15 years) who received 102 fenoldopam infusions. Seventy-two percent were already receiving antihypertensive treatment before admission. In all cases, fenoldopam was associated with a reduction of blood pressure (BP) after 8 h of treatment, but in 87% of patients reduction of the initial mean arterial pressure (MAP) was higher than 25% of calculated drop pressure. MAP normalized in 26% of cases after 24 h and in 35% after 48 h. Occurrence of hypotension was 7%, while hypokalemia was observed in 13% of cases. Patients who presented a MAP reduction not exceeding 25% of calculated drop pressure received a lower median fenoldopam dose (0.2 mcg/kg/min; IQR 0.1-0.2) compared with patients having a MAP reduction > 25% of calculated drop pressure (0.4 mcg/kg/min; IQR 0.2-0.6; p = 0.002). CONCLUSIONS Fenoldopam seems effective and safe for the treatment of hypertensive crises in children with kidney disease, at a starting dose of 0.2 mcg/kg/min. Strict BP monitoring is required to identify possible excessive drop pressure in the first hours of infusion.
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Affiliation(s)
| | - Serena Vigezzi
- Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Davide Meneghesso
- Pediatric Nephrology Unit, Department for Women's and Children's Health, University-Hospital of Padua, Padua, Italy
| | - Matteo Tinnirello
- Department for Women's and Children's Health, University of Padua, Padua, Italy
| | | | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Enrico Vidal
- Pediatric Nephrology Unit, Department for Women's and Children's Health, University-Hospital of Padua, Padua, Italy
- Department of Medicine (DMED), University of Udine, Udine, Italy
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Bima C, Lopez C, Tuli G, Munarin J, Arata S, Procopio M, Bollati M, Maccario M, De Sanctis L, Parasiliti-Caprino M. Prevention and management of hypertensive crises in children with pheochromocytoma and paraganglioma. Front Endocrinol (Lausanne) 2024; 15:1460320. [PMID: 39229379 PMCID: PMC11368778 DOI: 10.3389/fendo.2024.1460320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 08/05/2024] [Indexed: 09/05/2024] Open
Abstract
Hypertensive crises in pediatric patients are rare conditions. However, determining their precise prevalence is more challenging than in adults due to the heterogeneity in the definition itself. These crises frequently occur without a prior diagnosis of hypertension and may indicate an underlying cause of secondary hypertension, including pheochromocytoma/paraganglioma (PPGL). The mechanisms of hypertensive crises in the pediatric population with PPGL are directly related to different types of catecholamine excess. Noradrenergic tumors typically present with sustained hypertension due to their predominant action on α1-adrenoceptors in the vasculature. Conversely, adrenergic tumors, through epinephrine binding to β2-adrenoceptors in addition to stimulation of α1- and α2-adrenoceptors, more frequently cause paroxysmal hypertension. Furthermore, the biochemical phenotype also reflects the tumor localization and the presence of a genetic mutation. Recent evidence suggests that more than 80% of PPGL in pediatric cases have a hereditary background. PPGL susceptibility mutations are categorized into three clusters; mutations in cluster 1 are more frequently associated with a noradrenergic phenotype, whereas those in cluster 2 are associated with an adrenergic phenotype. Consequently, the treatment of hypertensive crises in pediatric patients with PPGL, reflecting the underlying pathophysiology, requires first-line therapy with alpha-blockers, potentially in combination with beta-blockers only in the case of tachyarrhythmia after adequate alpha-blockade. The route of administration for treatment depends on the context, such as intraoperative or pre-surgical settings, and whether it presents as a hypertensive emergency (elevated blood pressure with acute target organ damage), where intravenous administration of antihypertensive drugs is mandatory. Conversely, in cases of hypertensive urgency, if children can tolerate oral therapy, intravenous administration may initially be avoided. However, managing these cases is complex and requires careful consideration of the selection and timing of therapy administration, particularly in pediatric patients. Therefore, facing these conditions in tertiary care centers through interdisciplinary collaboration is advisable to optimize therapeutic outcomes.
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Affiliation(s)
- Chiara Bima
- Endocrinology, Diabetes and Metabolism; Department of Medical Sciences; University of
Turin, Turin, Italy
| | - Chiara Lopez
- Endocrinology, Diabetes and Metabolism; Department of Medical Sciences; University of
Turin, Turin, Italy
| | - Gerdi Tuli
- Department of Sciences of Public Health and Pediatrics, University of
Turin, Turin, Italy
| | - Jessica Munarin
- Department of Sciences of Public Health and Pediatrics, University of
Turin, Turin, Italy
| | - Stefano Arata
- Endocrinology, Diabetes and Metabolism; Department of Medical Sciences; University of
Turin, Turin, Italy
| | - Matteo Procopio
- Endocrinology, Diabetes and Metabolism; Department of Medical Sciences; University of
Turin, Turin, Italy
| | - Martina Bollati
- Endocrinology, Diabetes and Metabolism; Department of Medical Sciences; University of
Turin, Turin, Italy
| | - Mauro Maccario
- Endocrinology, Diabetes and Metabolism; Department of Medical Sciences; University of
Turin, Turin, Italy
| | - Luisa De Sanctis
- Department of Sciences of Public Health and Pediatrics, University of
Turin, Turin, Italy
| | - Mirko Parasiliti-Caprino
- Endocrinology, Diabetes and Metabolism; Department of Medical Sciences; University of
Turin, Turin, Italy
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Nagata JM, Shim JE, Balasubramanian P, Talebloo J, Al-Shoaibi AAA, Shao IY, Ganson KT, Testa A, Dooley EE, Gooding HC, Pettee Gabriel K, Baker FC. Sociodemographic Associations With Blood Pressure in 10-14-Year-Old Adolescents. J Adolesc Health 2024; 74:1125-1130. [PMID: 38323959 PMCID: PMC11102280 DOI: 10.1016/j.jadohealth.2023.12.015] [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: 07/28/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE To determine the association between sociodemographic characteristics and blood pressure among a demographically diverse population-based sample of 10-14-year-old US adolescents. METHODS We conducted cross-sectional analyses of data from the Adolescent Brain Cognitive Development Study (N = 4,466), year two (2018-2020). Logistic and linear regression models were used to determine the association between sociodemographic characteristics (sex, race/ethnicity, sexual orientation, household income, and parental education) with blood pressure among early adolescents. RESULTS The sample was 49.3% female and 46.7% non-White. Overall, 4.1% had blood pressures in the hypertensive range. Male sex was associated with 48% higher odds of hypertensive-range blood pressures than female sex (95% confidence interval [CI], 1.02; 2.14), and Black race was associated with 85% higher odds of hypertensive-range blood pressures compared to White race (95% CI, 1.11; 3.08). Several annual household income categories less than $100,000 were associated with higher odds of hypertensive-range blood pressures compared to an annual household income greater than $200,000. We found effect modification by household income for Black adolescents; Black race (compared to White race) was more strongly associated with higher odds of hypertensive-range blood pressures in households with income greater than $75,000 (odds ratio 3.92; 95% CI, 1.95; 7.88) compared to those with income less than $75,000 (odds ratio 1.53; 95% CI, 0.80; 2.92). DISCUSSION Sociodemographic characteristics are differentially associated with higher blood pressure in early adolescents. Future research could examine potential mediating factors (e.g., physical activity, nutrition, tobacco) linking sociodemographic characteristics and blood pressure to inform targeted interventions.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California.
| | - Joan E Shim
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | | | - Jonanne Talebloo
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Abubakr A A Al-Shoaibi
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Iris Yuefan Shao
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, Texas
| | - Erin E Dooley
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Holly C Gooding
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Emory University School of Medicine, and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kelley Pettee Gabriel
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, California; School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
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Magutah K, Mbuthia GW, Osengo G, Odhiambo D, Meiring R. Prevalence of modifiable risk factors for cardiovascular disease among school-going children and adolescents in Eldoret, Kenya. Pan Afr Med J 2024; 47:100. [PMID: 38799190 PMCID: PMC11126747 DOI: 10.11604/pamj.2024.47.100.42340] [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: 12/05/2023] [Accepted: 12/17/2023] [Indexed: 05/29/2024] Open
Abstract
Introduction Cardiovascular disease (CVD) prevalence in Kenya is rising. Overweight, pre-hypertension and physical inactivity at younger ages is contributory. These risk factors are inadequately documented among Kenyan children and adolescents, hampering CVD prevention. Methods this cross-sectional study randomly sampled 384 participants from Eldoret, Kenya. After ethical considerations, physical activity was assessed. Body mass index (BMI), Waist-Hip-Ratio (WHR) and Waist-Height-Ratio (WHtR) were determined, and blood pressure (BP) was measured. Results participants were 14.6±2.7 years, and 62.6% were female. Eight percent had BMI ≥25.0 kg/m2. Of these, 87% were in secondary schools. Using SBP, 27.9% had CVD risk (42.5% and 20% for males and females ≥13 years and 26.5% and 27% for those <13 years, respectively). For DBP, 12.8% had elevated-to-hypertensive BP (13.2% and 8.3% for males and females ≥13 years and 11.8% and 25.4% for those <13 years, respectively). Combining SBP and DBP, 8.1%, mostly males, had elevated-to-hypertensive BP. Using respective WHR cutoffs of 0.90 and 0.85, 31% (boys) and 15.6% (girls) were at CVD risk. For WHtR, 39.6% of boys were >0.463 cut-off (0.493±0.02) against 32.4% for girls >0.469 cut-off (0.517±0.05). Of these, 52.6% (boys) and 69.7% (girls) were in secondary schools. Overall, 45% of participants were sports-inactive and 77.2% did minimal physical activities. Conclusion among school-going children and adolescents in Eldoret, Kenya, the prevalence of CVD risk factors was high, especially among boys and in high schools. Large proportions had elevated BP, BMI, WHR and WHtR, and, further, were sedentary, posing a high CVD risk. Lifestyle interventions to mitigate this are urgently needed.
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Affiliation(s)
| | | | | | | | - Rebecca Meiring
- Department of Exercise Science, University of Auckland, Auckland, New Zealand
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Hayes J, Mahoney AB, Ayers C, Sarma A, Ess KC, Hunley TE, Smith CM. A rare cause of posterior reversible encephalopathy syndrome: Acute lymphoblastic leukemia. Clin Case Rep 2023; 11:e8238. [PMID: 38028041 PMCID: PMC10659917 DOI: 10.1002/ccr3.8238] [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: 10/21/2022] [Revised: 06/08/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message The presentation of posterior reversible encephalopathy syndrome (PRES) as the initial presenting sign of acute lymphoblastic leukemia is unusual, as PRES is more often a complication of therapy. This case highlights the importance of maintaining a broad differential diagnosis for pediatric hypertension and its complications. Abstract A 6-year-old male presented with a seizure-like episode. Evaluation revealed hypertension and brain imaging showed findings consistent with posterior reversible encephalopathy syndrome. Complete blood count showed lymphoblasts, and the cause of his hypertension was determined to be renal infiltration of leukemia cells due to B-cell acute lymphoblastic leukemia.
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Affiliation(s)
- Jessica Hayes
- Department of Pediatrics, Vanderbilt University Medical CenterMonroe Carell Jr. Children's HospitalNashvilleTennesseeUSA
| | - Anne Byrd Mahoney
- Department of Pediatrics, Vanderbilt University Medical CenterMonroe Carell Jr. Children's HospitalNashvilleTennesseeUSA
- Division of Pediatric Hematology/OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Claci Ayers
- Department of Pediatrics, Vanderbilt University Medical CenterMonroe Carell Jr. Children's HospitalNashvilleTennesseeUSA
- Division of Pediatric Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Asha Sarma
- Department of RadiologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Kevin C. Ess
- Department of Pediatrics, Vanderbilt University Medical CenterMonroe Carell Jr. Children's HospitalNashvilleTennesseeUSA
- Division of Pediatric NeurologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Tracy E. Hunley
- Department of Pediatrics, Vanderbilt University Medical CenterMonroe Carell Jr. Children's HospitalNashvilleTennesseeUSA
- Division of Pediatric NephrologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Christine Moore Smith
- Department of Pediatrics, Vanderbilt University Medical CenterMonroe Carell Jr. Children's HospitalNashvilleTennesseeUSA
- Division of Pediatric Hematology/OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt‐Ingram Cancer CenterVanderbilt University Medical CenterNashvilleTennesseeUSA
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Coulthard MG. Managing severe hypertension in children. Pediatr Nephrol 2023; 38:3229-3239. [PMID: 36862252 PMCID: PMC10465398 DOI: 10.1007/s00467-023-05896-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 03/03/2023]
Abstract
Severe childhood hypertension is uncommon and frequently not recognised and is best defined as a systolic blood pressure (SBP) above the stage 2 threshold of the 95th centile + 12 mmHg. If no signs of end-organ damage are present, this is urgent hypertension which can be managed by the slow introduction of oral or sublingual medication, but if signs are present, the child has emergency hypertension (or hypertensive encephalopathy if they include irritability, visual impairment, fits, coma, or facial palsy), and treatment must be started promptly to prevent progression to permanent neurological damage or death. However, detailed evidence from case series shows that the SBP must be lowered in a controlled manner over about 2 days by infusing short-acting intravenous hypotensive agents, with saline boluses ready in case of overshoot, unless the child had documented normotension within the last day. This is because sustained hypertension may increase pressure thresholds of cerebrovascular autoregulation which take time to reverse. A recent PICU study that suggested otherwise was significantly flawed. The target is to reduce the admission SBP by its excess, to just above the 95th centile, in three equal steps lasting about ≥ 6 h, 12 h, and finally ≥ 24 h, before introducing oral therapy. Few of the current clinical guidelines are comprehensive, and some advise reducing the SBP by a fixed percentage, which may be dangerous and has no evidence base. This review suggests criteria for future guidelines and argues that these should be evaluated by establishing prospective national or international databases.
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Affiliation(s)
- Malcolm G Coulthard
- Great North Children's Hospital, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, UK.
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Eppenberger LS, Schmid MK, Clerici M. Acute Ocular Complications after Recently Diagnosed Goodpasture's Syndrome - An Unusual Case of Hypertensive Retinopathy. Klin Monbl Augenheilkd 2023; 240:505-508. [PMID: 37164428 PMCID: PMC10129409 DOI: 10.1055/a-2034-6314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Leila Sara Eppenberger
- Eye Clinic, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Martin K Schmid
- Eye Clinic, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Giammattei VC, Weaver DJ, South AM. Management of acute severe hypertension in youth: from the philosophical to the practical. Curr Opin Pediatr 2023; 35:251-258. [PMID: 36437756 PMCID: PMC9992153 DOI: 10.1097/mop.0000000000001209] [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] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Acute severe hypertension remains an uncommon but important source of morbidity and mortality in youth. However, there has been very little progress made in our understanding of how to best manage youth with acute severe hypertension to improve patient outcomes. RECENT FINDINGS Our understanding of what is acute severe hypertension is undergoing a philosophical change. Management of patients with acute severe hypertension is evolving towards more of a risk and outcomes-based approach. SUMMARY We should be intentional when we consider whether a patient has acute severe hypertension and if they are truly at an increased risk for life-threatening target organ injury. We should consider their specific risk factors to best interpret the risks and benefits of how best to treat a patient with acute severe hypertension, rather than relying on traditional approaches and conventional wisdom. We should always ask 'why' when we are pursuing a given management course. Future studies should clearly define the research questions they are investigating to best advance the field to ultimately improve patient outcomes.
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Affiliation(s)
| | - Donald J. Weaver
- Division of Nephrology and Hypertension, Department of Pediatrics, Atrium Health Levine Children's, Charlotte, NC, USA
| | - Andrew M. South
- Section of Nephrology, Department of Pediatrics, Brenner Children’s, Wake Forest University School of Medicine, Winston Salem, NC, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston Salem, NC, USA
- Cardiovascular Sciences Center, Wake Forest University School of Medicine, Winston Salem, NC, USA
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10
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Lucas I, Puteikis K, Sinha MD, Litwin M, Merkevicius K, Azukaitis K, Rus R, Pac M, Obrycki L, Bårdsen T, Śladowska-Kozłowska J, Sagsak E, Lurbe E, Jiménez-Murcia S, Jankauskiene A, Fernández-Aranda F. Knowledge gaps and future directions in cognitive functions in children and adolescents with primary arterial hypertension: A systematic review. Front Cardiovasc Med 2022; 9:973793. [PMID: 36337900 PMCID: PMC9631488 DOI: 10.3389/fcvm.2022.973793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/04/2022] [Indexed: 01/04/2024] Open
Abstract
Arterial hypertension (AH) among adults is known to be associated with worse cognitive outcomes. Similarly, children and adolescents with AH could be expected to underperform during neuropsychological evaluations when compared with healthy peers. Our aims were to review the existing literature on cognitive functioning among children and adolescents with primary AH and to identify what additional evidence may be needed to substantiate the impact of hypertension on poor cognitive outcomes in this population. We conducted a systematic review of articles in PubMed and Web of Science published before 17 January 2022, reporting on cognitive testing among children and adolescents with primary AH. From 1,316 records, 13 were included in the review-7 used battery-testing while other employed indirect measures of cognitive functions. Most of the studies reported worse results among individuals with AH. Results of two prospective trials suggested that cognitive functioning may improve after starting antihypertensive treatment. Ambulatory blood pressure monitoring was shown to be more strongly related to cognitive testing results than office measures of blood pressure. Significant confounders, namely obesity and sleep apnea, were identified throughout the studies. Our review indicates that evidence relating AH with poor cognitive functioning among youth is usually based on indirect measures of executive functions (e.g., questionnaires) rather than objective neuropsychological tests. Future prospective trials set to test different cognitive domains in children and adolescents undergoing treatment for AH are endorsed and should consider using standardized neuropsychological batteries as well as adjust the assessing results for obesity and sleep disorders.
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Affiliation(s)
- Ignacio Lucas
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | | | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- British Heart Foundation Centre, King’s College London, London, United Kingdom
| | - Mieczysław Litwin
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children’s Memorial Health Institute, Warsaw, Poland
| | | | - Karolis Azukaitis
- Faculty of Medicine, Clinic of Pediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Rina Rus
- Department of Pediatric Nephrology, Children’s Hospital, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Michał Pac
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Lukasz Obrycki
- Department of Nephrology, Kidney Transplantation and Hypertension, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Tonje Bårdsen
- Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Elif Sagsak
- University of Health Sciences Turkey, Clinic of Pediatric Endocrinology, Gaziosmanpaşa Training and Research Hospital, Istanbul, Turkey
| | - Empar Lurbe
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Department of Pediatric, Consorcio Hospital General, University of Valencia, Valencia, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Augustina Jankauskiene
- Faculty of Medicine, Clinic of Pediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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de Simone G, Mancusi C, Hanssen H, Genovesi S, Lurbe E, Parati G, Sendzikaite S, Valerio G, Di Bonito P, Di Salvo G, Ferrini M, Leeson P, Moons P, Weismann CG, Williams B. Hypertension in children and adolescents. Eur Heart J 2022; 43:3290-3301. [PMID: 35896123 DOI: 10.1093/eurheartj/ehac328] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 05/11/2022] [Accepted: 06/07/2022] [Indexed: 12/12/2022] Open
Abstract
Definition and management of arterial hypertension in children and adolescents are uncertain, due to different positions of current guidelines. The European Society of Cardiology task-force, constituted by Associations and Councils with interest in arterial hypertension, has reviewed current literature and evidence, to produce a Consensus Document focused on aspects of hypertension in the age range of 6-16 years, including definition, methods of measurement of blood pressure, clinical evaluation, assessment of hypertension-mediated target organ damage, evaluation of possible vascular, renal and hormonal causes, assessment and management of concomitant risk factors with specific attention for obesity, and anti-hypertensive strategies, especially focused on life-style modifications. The Consensus Panel also suggests aspects that should be studied with high priority, including generation of multi-ethnic sex, age and height specific European normative tables, implementation of randomized clinical trials on different diagnostic and therapeutic aspects, and long-term cohort studies to link with adult cardiovascular risk. Finally, suggestions for the successful implementation of the contents of the present Consensus document are also given.
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Affiliation(s)
- Giovanni de Simone
- Hypertension Research Center & Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Costantino Mancusi
- Hypertension Research Center & Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Basel, Switzerland
| | - Simonetta Genovesi
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital & School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy
| | - Empar Lurbe
- Paediatric Department, Consorcio Hospital General, University of Valencia; CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Madrid, Spain
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital & School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy
| | - Skaiste Sendzikaite
- Clinic of Paediatrics, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, Naples, Italy
| | - Procolo Di Bonito
- Department of Internal Medicine, 'S.Maria delle Grazie' Hospital, Pozzuoli, Italy
| | - Giovanni Di Salvo
- Paediatric Cardiology Unit, Department of Woman's and Child's Health, University-Hospital of Padova, University of Padua, Padua, Italy
| | - Marc Ferrini
- St Joseph and St Luc Hospital Department of Cardiology and Vascular Pathology, Lyon, France
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, RDM Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Belgium & Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Constance G Weismann
- Paediatric Heart Center, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London, and NIHR University College London Hospitals Biomedical Research Centre, London, UK
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12
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Brant Pinheiro SV, de Freitas VB, de Castro GV, Rufino Madeiro BC, de Araújo SA, Silva Ribeiro TF, Simões E Silva AC. Acute Post-Streptococcal Glomerulonephritis In Children: A Comprehensive Review. Curr Med Chem 2022; 29:5543-5559. [PMID: 35702785 DOI: 10.2174/0929867329666220613103316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/23/2022] [Accepted: 03/17/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acute post-streptococcal glomerulonephritis (APSGN) is an immune-complex (ICs) mediated glomerular disease triggered by group A β-hemolytic streptococcus (GAS) or Streptococcus pyogenes infections. APSGN represents a major cause of acquired kidney injury in children. METHODS This non-systematic review summarizes recent evidence on APSGN. We discuss the epidemiology, pathogenesis, clinical and laboratory findings, histopathology, treatment and prognosis of the disease. RESULTS The median APSGN incidence in children in developing countries is estimated at 24.3/100,000 per year, compared with 6.2/100,000 per year in developed countries. Nephritis-associated plasmin receptor, identified as glyceraldehyde-3-phosphate dehydrogenase, and the cationic cysteine proteinase streptococcal pyrogenic exotoxin B are thought to be two leading streptococcal antigens involved in the pathogenesis of APSGN, which activate the complement system, mainly via the alternative but also the lectin pathway. This process is critical for the generation of inflammation by the ICs deposited in the glomerulus. The classic phenotype is an acute diffuse proliferative glomerulonephritis leading to features of the nephritic syndrome including hematuria, oliguria, hypertension and edema. The histopathology shows that the glomeruli are diffused affected, mostly presenting enlarged glomerular tuffs due to hypercellularity. Proliferative endothelial and mesangial cells and inflammation are also observed. APSGN frequently has spontaneous recovery. There is no specific therapy, but its morbidity and mortality are drastically reduced by the prevention and/or treatment of complications. CONCLUSION Despite recent advances, the pathogenesis of APSGN is not fully understood. There is no specific treatment for APSGN. The prognosis is generally good. However some cases may evolve to chronic kidney disease.
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Affiliation(s)
- Sérgio Veloso Brant Pinheiro
- Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Victor Buchini de Freitas
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazil
| | - Gustavo Valverde de Castro
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazil
| | | | | | - Thomas Felipe Silva Ribeiro
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazil
| | - Ana Cristina Simões E Silva
- Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazil
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13
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Ba H, Peng H, Xu L, Qin Y, Wang H. Clinical Characteristics of Hospitalized Pediatric Patients With Hypertensive Crisis—A Retrospective, Single-Center Study in China. Front Cardiovasc Med 2022; 9:891804. [PMID: 35711370 PMCID: PMC9193964 DOI: 10.3389/fcvm.2022.891804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundA hypertensive crisis is a medical emergency that causes acute damage to multiple organs. However, the etiology, clinical features, and prognosis of hypertensive crisis in Chinese children remain relatively unknown. The purpose of this study was to analyze the clinical characteristics of pediatric hypertensive crisis patients from a single center in China.MethodsWe analyzed data from 70 children with hypertensive crisis between January, 2000, and January, 2022. The patients were divided into two groups: those diagnosed with a hypertensive emergency (n = 46) and those diagnosed with hypertensive urgency (n = 24). Baseline etiologies and risk factors were compared between the two groups. The following data were collected and analyzed: age, sex, weight, height, family history of hypertension, blood pressure, clinical manifestations of hypertensive crisis, underlying causes, biochemical indicators, and antihypertensive drugs.ResultsThe major symptoms of hypertensive crisis were headache (n = 31, 44.29%), followed by visual symptoms (n = 15, 21.43%), and dizziness (n = 13, 18.57%). Further analysis showed that the incidence of convulsions was significantly higher in patients with hypertensive emergency than those with hypertensive urgency (χ2 = 5.38, p = 0.02). The leading underlying causes were renal disease (n = 34, 48.57%), followed by vascular disease (n = 11, 15.71%), essential hypertension (n = 9, 12.86%), oncological disease (n = 9, 12.86%), central nervous system disease (n = 3, 4.29%), endocrine and metabolic diseases (n = 2, 2.86%), and other (one case with lead poisoning, one case with histiocytosis). End-organ damage occurred in 46 patients with hypertensive crisis, including retinal damage (n = 20, 43.48%), brain damage (n = 19, 41.30%), heart damage (n = 15, 32.61%), and renal damage (n = 3, 6.52%). Hypertensive crisis was most common among children aged 7–12 years. Among children aged 13–18 years, hypertensive urgency was more common than hypertensive emergency. The incidence of dyslipidemia, elevated serum creatinine, and elevated uric acid did not differ significantly between the two groups. Most patients with hypertensive crisis need combined antihypertensive therapy (n = 60, 85.71%). There were no cases of mortality.ConclusionsHypertensive crisis is caused by secondary diseases, especially renal disease and vascular disease, in the majority of pediatric patients. Combination therapy with antihypertensive agents and treatment of secondary etiology results in a good prognosis.
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Affiliation(s)
- Hongjun Ba
- Department of Paediatric Cardiology, Heart Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Huimin Peng
- Department of Paediatric Cardiology, Heart Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Lingling Xu
- Department of Pediatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Youzhen Qin
- Department of Paediatric Cardiology, Heart Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Youzhen Qin
| | - Huisheng Wang
- Department of Paediatric Cardiology, Heart Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Huisheng Wang
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14
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Castellano-Martinez A, Roldán-Cano V, Morales-Arandojo P, Rodriguez-González M. Posterior reversible encephalopathy syndrome as a debut of postinfectious glomerulonephritis. An Pediatr (Barc) 2022; 96:452-454. [DOI: 10.1016/j.anpede.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022] Open
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15
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Van Why SK, Pan CG. Primary Causes of Hypertensive Crisis. Crit Care Clin 2022; 38:375-391. [DOI: 10.1016/j.ccc.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Pandey VK, Prabhudesai AA, Gupta S. Acute respiratory distress after liver transplantation in infants-looking beyond infection and hepatopulmonary syndrome: A brief report. Indian J Anaesth 2022; 65:843-844. [PMID: 35001961 PMCID: PMC8680426 DOI: 10.4103/ija.ija_435_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vijay K Pandey
- Anaesthesiology and Critical Care, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Aaditya A Prabhudesai
- Anaesthesiology and Critical Care, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Subhash Gupta
- Liver Transplant Surgery, CLBS, Max Super Speciality Hospital, Saket, New Delhi, India India
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17
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Efficacy and Safety of Intravenous Labetalol in Acute Hypertensive Crisis in Children. Indian J Pediatr 2022; 89:7-12. [PMID: 33893609 DOI: 10.1007/s12098-021-03707-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 02/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the efficacy and safety of intravenous (IV) labetalol in the management of hypertensive crisis in children. METHODS A retrospective chart review of 56 consecutive children (age > 1 mo to ≤ 12 y) with hypertensive crisis admitted to a pediatric intensive care unit (PICU) from July 2009 to 2019. RESULTS The proportion of children attaining the primary endpoint (target 95th percentile in > 12 to ≤ 48 h) was significantly more in the group receiving labetalol as first-line or add-on (n = 23) as compared to those not receiving labetalol (n = 33) (62% vs. 30.3%, p = 0.03). Higher proportion of neurological recovery was seen in the labetalol group (56.2% vs. 18.7%, p = 0.02). The proportion of children with hypotension before 12 h was similar in both treatment groups (13% vs. 15%, p = 0.82). The practice variations between two periods of 5 y each (2009-2013 and 2014-2019) showed significantly more use of labetalol in the latter cohort (53% for 2014-2019 vs. 25% for 2009-2013, p = 0.03). CONCLUSION Labetalol, when used alone or as an add-on drug, was more efficacious than IV nitroprusside/nitroglycerine in attaining the primary endpoint in children up to ≤ 12 y of age with hypertensive crisis. Labetalol was safe and associated with higher neurological recovery.
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18
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Posterior reversible leukoencephalopathy syndrome associated with acute postinfectious glomerulonephritis: systematic review. Pediatr Nephrol 2022; 37:833-841. [PMID: 34546419 PMCID: PMC8960599 DOI: 10.1007/s00467-021-05244-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Kidney diseases are a recognized cause of posterior reversible leukoencephalopathy syndrome, usually abbreviated as PRES. The purpose of this review was to systematically address the association between acute postinfectious glomerulonephritis and PRES. METHODS We performed a systematic review of the literature on acute postinfectious glomerulonephritis associated with PRES. The principles recommended by the Economic and Social Research Council guidance on the conduct of narrative synthesis and on the Preferred Reporting Items for Systematic Reviews and Meta-analyses were used. Databases searched included Excerpta Medica, US National Library of Medicine, and Web of Science. RESULTS For the final analysis, we evaluated 47 reports describing 52 cases (32 males and 20 females). Fifty patients were ≤ 18 years of age. Blood pressure was classified as follows: normal-elevated (n = 3), stage 1 hypertension (n = 3), stage 2 hypertension (n = 5), and severe hypertension (n = 41). Acute kidney injury was classified as stage 1 in 32, stage 2 in 16, and stage 3 in four cases. Neuroimaging studies disclosed a classic posterior PRES pattern in 28 cases, a diffuse PRES pattern in 23 cases, and a brainstem-cerebellum PRES pattern in the remaining case. Antihypertensive drugs were prescribed in all cases and antiepileptic drugs in cases presenting with seizures. A resolution of clinical findings and neuroimaging lesions was documented in all cases with information about follow-up. CONCLUSIONS The main factor associated with PRES in acute postinfectious glomerulonephritis is severe hypertension. Prompt clinical suspicion, rapid evaluation, and management of hypertension are crucial. A higher resolution version of the Graphical abstract is available as Supplementary information.
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19
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Bertazza Partigiani N, Spagnol R, Di Michele L, Santini M, Grotto B, Sartori A, Zamperetti E, Nosadini M, Meneghesso D. Management of Hypertensive Crises in Children: A Review of the Recent Literature. Front Pediatr 2022; 10:880678. [PMID: 35498798 PMCID: PMC9051430 DOI: 10.3389/fped.2022.880678] [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: 02/21/2022] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
Hypertensive emergency is a life-threatening condition associated with severe hypertension and organ damage, such as neurological, renal or cardiac dysfunction. The most recent guidelines on pediatric hypertension, the 2016 European guidelines and the 2017 American guidelines, provide recommendations on the management of hypertensive emergencies, however in pediatric age robust literature is lacking and the available evidence often derives from studies conducted in adults. We reviewed PubMed and Cochrane Library from January 2017 to July 2021, using the following search terms: "hypertension" AND "treatment" AND ("emergency" OR "urgency") to identify the studies. Five studies were analyzed, according to our including criteria. According to the articles reviewed in this work, beta-blockers seem to be safe and effective in hypertensive crises, more than sodium nitroprusside, although limited data are available. Indeed, calcium-channel blockers seem to be effective and safe, in particular the use of clevidipine during the neonatal age, although limited studies are available. However, further studies should be warranted to define a univocal approach to pediatric hypertensive emergencies.
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Affiliation(s)
- Nicola Bertazza Partigiani
- Paediatric Nephrology Unit, Department of Womens's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Rachele Spagnol
- Paediatric Nephrology Unit, Department of Womens's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Laura Di Michele
- Paediatric Nephrology Unit, Department of Womens's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Micaela Santini
- Paediatric Nephrology Unit, Department of Womens's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Benedetta Grotto
- Paediatric Nephrology Unit, Department of Womens's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Alex Sartori
- Paediatric Nephrology Unit, Department of Womens's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Elita Zamperetti
- Paediatric Nephrology Unit, Department of Womens's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Womens's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Davide Meneghesso
- Paediatric Nephrology Unit, Department of Womens's and Children's Health, University Hospital of Padua, Padua, Italy
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20
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Flynn JT. 50 Years Ago in TheJournalofPediatrics: The Search for Safe and Effective Treatment of Acute Severe Hypertension in Childhood. J Pediatr 2021; 238:117. [PMID: 34702492 DOI: 10.1016/j.jpeds.2021.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joseph T Flynn
- Department of Pediatrics, University of Washington School of Medicine, Division of Nephrology, Seattle Children's Hospital, Seattle, Washington
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21
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Albornoz Pardo AE, Keefe D, Neville Levin D, Lorenzo AJ, Munshey F. Anesthetic and surgical considerations for staged bilateral nephrectomies in a pediatric patient: A case report. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.5554/22562087.e1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We present a 9-year-old patient with end-stage renal disease, on peritoneal dialysis, who underwent a staged prone retroperitoneoscopic bilateral nephrectomy. Bilateral nephrectomy was indicated in preparation for renal transplant in the context of genetic predisposition malignancy when immunosuppressed. The two mirror-image surgeries enable the comparison of the anesthetic management and outcomes in a single patient. Features of interest to anesthesiologists include approach to a child with chronic kidney disease, different requirements for intraoperative antihypertensives; pain management strategies, including a comparison of erector spinae plane block with and without adjunct dexmedetomidine; anesthetic management of retroperitoneoscopic pediatric surgery and the first description of using a Foley bag attached to a peritoneal dialysis catheter to aid in diagnosis and repair of posterior peritoneal cavity entry.
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22
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Jan M, Brothers E, Nakagawa TA. Midodrine overdose in children: a case report and review of treatment for hypertensive emergencies. Transl Pediatr 2021; 10:2398-2401. [PMID: 34733680 PMCID: PMC8506054 DOI: 10.21037/tp-21-153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/21/2021] [Indexed: 11/06/2022] Open
Abstract
Midodrine is an antihypotensive agent used primarily in the adult population for orthostatic hypotension and reflex syncope, postural orthostatic tachycardia syndrome (POTS), and hemodialysis-induced hypotension. Limited information about midodrine ingestion and overdose exists in children with only a single case series reported in the literature. Varying presentations of midodrine ingestion in children have not been shown to be acutely life-threatening in doses up to 50 mg. We present a case of a 12-year-old who intentionally ingested 100 mg of midodrine and presented with a hypertensive emergency and seizure activity. This is the largest reported dose ingested in a child. The patient was observed and treated with a nicardipine infusion in the pediatric intensive care unit (PICU). Prompt identification and treatment of symptoms contributed to a favorable outcome with no neurologic deficits and complete recovery from an intentional ingestion of midodrine. Mechanism, duration of action, and management of midodrine ingestion including treatment for a hypertensive emergency in children are discussed. Commonly used pharmacologic agents to treat hypertension are reviewed. This case report of a significant ingestion of midodrine reviews management of hypertensive emergencies and provides information and guidance to healthcare professionals unfamiliar with this medication and its potentially fatal effects.
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Affiliation(s)
- Meryam Jan
- Department of Pediatrics PGY3, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA
| | - Elizabeth Brothers
- Pediatric Critical Care, Wolfson Children's Hospital, Jacksonville, FL, USA
| | - Thomas A Nakagawa
- Department of Pediatrics, Division of Pediatric Critical Care, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA.,Division of Pediatric Critical Care Medicine, Wolfson Children's Hospital, Jacksonville, FL, USA
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23
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Castellano-Martinez A, Roldán-Cano V, Morales-Arandojo P, Rodriguez-González M. [Posterior reversible encephalopathy syndrome as a debut of postinfectious glomerulonephritis]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00225-3. [PMID: 34304985 DOI: 10.1016/j.anpedi.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/24/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
| | - Virginia Roldán-Cano
- Sección de Nefrología Pediátrica, Hospital Universitario Puerta del Mar, Cádiz, España
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24
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Kováčiková Ľ, Chocholová M, Ilčík M, Varényiová Ž, Seeman T, Podracká Ľ. Hypertensive crisis in an 11-year-old girl with kidney and inferior vena cava abnormalities and leg thrombosis: Questions. Pediatr Nephrol 2021; 36:1977-1979. [PMID: 33216220 DOI: 10.1007/s00467-020-04825-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/22/2020] [Accepted: 10/13/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ľubica Kováčiková
- Department of Pediatrics, Medical Faculty, Comenius University and National Institute of Children's Diseases, Limbova 1, 833 40, Bratislava, Slovakia
| | - Mária Chocholová
- Department of Pediatrics, Medical Faculty, Comenius University and National Institute of Children's Diseases, Limbova 1, 833 40, Bratislava, Slovakia
| | - Milan Ilčík
- Department of Pediatric radiology, Medical Faculty, Comenius University and National Institute of Children's Diseases, Bratislava, Slovakia
| | - Žofia Varényiová
- Department of Pediatrics, Medical Faculty, Comenius University and National Institute of Children's Diseases, Limbova 1, 833 40, Bratislava, Slovakia.,Department of Pediatrics, 2nd Faculty of Medicine and Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Tomáš Seeman
- Department of Pediatrics, 2nd Faculty of Medicine and Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Ľudmila Podracká
- Department of Pediatrics, Medical Faculty, Comenius University and National Institute of Children's Diseases, Limbova 1, 833 40, Bratislava, Slovakia.
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25
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Wu JGA, Tong A, Evangelidis N, Manera KE, Hanson CS, Baumgart A, Amir N, Sinha A, Dart A, Eddy AA, Guha C, Gipson DS, Bockenhauer D, Yap HK, Groothoff J, Zappitelli M, Alexander SI, Furth SL, Samuel S, Carter SA, Walker A, Kausman J, Martinez-Martin D, Gutman T, Craig JC. Patient and caregiver perspectives on blood pressure in children with chronic kidney disease. Nephrol Dial Transplant 2021; 37:1330-1339. [PMID: 34086937 DOI: 10.1093/ndt/gfab194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Over 50% of children with chronic kidney disease (CKD) have uncontrolled hypertension, increasing their long-term risk of cardiovascular disease and progression to kidney failure. Children receiving medications or dialysis may also experience acute blood pressure fluctuations accompanied by debilitating symptoms. We aimed to describe the perspectives of children with CKD and their parental caregivers on blood pressure, to inform patient-centered care. METHODS Secondary thematic analysis was conducted on qualitative data from the Standardized Outcomes in Nephrology-Children and Adolescents initiative, encompassing 16 focus groups, an international Delphi survey, and two consensus workshops. We analyzed responses from children with CKD (aged 8-21 years) and caregivers (of children aged 0-21 years) pertaining to blood pressure. RESULTS Overall, 120 patients and 250 caregivers from 22 countries participated. We identified five themes: invisibility and normalization (reassured by apparent normotension, absence of symptoms, expected links with CKD); confused by ambiguity (hypertension indistinguishable from cardiovascular disease, questioning need for prophylactic intervention, frustrated by inconsistent messages, struggling with technical skills in measurement); enabling monitoring and maintaining health (gauging wellbeing, preventing vascular complications); debilitating and constraining daily living (provoking anxiety and agitation, helpless and powerless, limiting life activities); and burden of medications (overwhelmed by quantity of tablets, distress from unexpected side effects). CONCLUSIONS For children with CKD and their caregivers, blood pressure was an important heath indicator, but uncertainty around its implications and treatment hampered management. Providing educational resources to track blood pressure, and minimizing symptoms and treatment burden, may improve outcomes in children with CKD.
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Affiliation(s)
- Justin Guang-Ao Wu
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Nicole Evangelidis
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Karine E Manera
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Amanda Baumgart
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Noa Amir
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Allison Dart
- Department of Pediatrics and Child Health, The Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Allison A Eddy
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Debbie S Gipson
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Detlef Bockenhauer
- UCL Department of Renal Medicine and Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Hui-Kim Yap
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jaap Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital AMC Academic Medical Center, Amsterdam, The Netherlands
| | - Michael Zappitelli
- Department of Pediatrics, Division of Nephrology, Hospital for Sick Children, Toronto, Canada
| | - Stephen I Alexander
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine, at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Susan Samuel
- Section of Pediatric Nephrology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon A Carter
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.,Department of Nephrology, and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Amanda Walker
- Department of Nephrology, and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Joshua Kausman
- Department of Nephrology, and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - David Martinez-Martin
- School of Biomedical Engineering, The University of Sydney, Sydney, Australia.,The University of Sydney Nano Institute (Sydney Nano), The University of Sydney, Sydney, Australia
| | - Talia Gutman
- Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Ni Y, Szpiro A, Loftus C, Tylavsky F, Kratz M, Bush NR, LeWinn KZ, Sathyanarayana S, Enquobahrie DA, Davis R, Fitzpatrick AL, Sonney J, Zhao Q, Karr CJ. Associations Between Maternal Nutrition in Pregnancy and Child Blood Pressure at 4-6 Years: A Prospective Study in a Community-Based Pregnancy Cohort. J Nutr 2021; 151:949-961. [PMID: 33561258 PMCID: PMC8030724 DOI: 10.1093/jn/nxaa395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/30/2020] [Accepted: 11/16/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The intrauterine environment may influence offspring blood pressure, with effects possibly extending into adulthood. The associations between prenatal nutrition and offspring blood pressure, alone or in combination with other sociodemographic or behavioral factors, are unclear. OBJECTIVES To investigate the associations of maternal dietary patterns and plasma folate concentrations with blood pressure in children aged 4-6 years, and assess the potential effect modifications by child sex, maternal race, pre-pregnancy overweight or obesity, maternal smoking, and breastfeeding. METHODS Participants were 846 mother-child dyads from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study. Maternal nutrition was characterized by the Healthy Eating Index 2010 (HEI) scores and plasma folate concentrations in pregnancy. We calculated the systolic blood pressure (SBP) and diastolic blood pressure percentiles, incorporating sex, age, and height, and categorized children as either having high blood pressure (HBP; ≥90th percentile) or normal blood pressure. Linear regressions were performed to quantify the associations between maternal nutrition and continuous blood pressure percentiles, and Poisson regressions were used to estimate the incidence rate ratio (IRR) of binary HBP. We examined the effect modifications using interaction models. RESULTS Mean HEI scores and folate concentrations were 60.0 (SD, 11.3) and 23.1 ng/mL (SD, 11.1), respectively. Based on measurements at 1 visit, 29.6% of the children were defined as having HBP. Maternal HEI scores and plasma folate concentrations were not associated with child blood pressure percentiles or HBP in the full cohort. Among mothers self-identified as white, there was an inverse relationship between maternal HEI score and child SBP percentile (β, -0.40; 95%CI: -0.75 to -0.06). A maternal HEI score above 59 was associated with a reduced risk of HBP in girls (IRR, 0.53; 95% CI: 0.32-0.88). No modified associations by pre-pregnancy overweight or obesity, maternal smoking, or breastfeeding were indicated. CONCLUSIONS We found little evidence for effects of maternal nutrition during pregnancy on childhood blood pressure, but detected sex- and race-specific associations. The study contributes to the evolving scientific inquiry regarding developmental origins of disease.
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Affiliation(s)
- Yu Ni
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Adam Szpiro
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Christine Loftus
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Frances Tylavsky
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mario Kratz
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nicole R Bush
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kaja Z LeWinn
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sheela Sathyanarayana
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Daniel A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Robert Davis
- Center for Biomedical Informatics, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Annette L Fitzpatrick
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, USA
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Jennifer Sonney
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - Qi Zhao
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Catherine J Karr
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
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27
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Eberl S, Ahne G, Toni I, Standing J, Neubert A. Safety of clonidine used for long-term sedation in paediatric intensive care: A systematic review. Br J Clin Pharmacol 2020; 87:785-805. [PMID: 33368604 DOI: 10.1111/bcp.14552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 01/02/2023] Open
Abstract
AIM Although not approved, the α-adrenoceptor agonist clonidine is considered an option for long-term sedation protocols in paediatric intensive care. We reviewed adverse effects of clonidine occurring in this indication. METHODS Relevant literature was systematically identified from PubMed and Embase. We included interventional and observational studies on paediatric patients admitted to intensive care units and systemically long-term sedated with clonidine-containing regimes. In duplicates, we conducted standardised and independent full-text assessment and extraction of safety data. RESULTS Data from 11 studies with 909 patients were analysed. The studies were heterogeneous regarding patient characteristics (age groups, comorbidity, or comedication) and sedation regimes (dosage, route, duration, or concomitant sedatives). Just four randomised controlled trials (RCTs) and one observational study had comparison groups, using placebo or midazolam. For safety outcomes, our validity evaluation showed low risk of bias only in three studies. All studies focused on haemodynamic problems, particularly bradycardia and hypotension. Observed incidences or subsequent interventions never caused concerns. However, only two RCTs allowed meaningful comparisons with control groups. Odds ratios showed no significant difference between the groups, but small sample sizes (50 and 125 patients) must be considered; pooled analyses were not reasonable. CONCLUSION All evaluated studies concluded that the use of clonidine in paediatric intensive care units is safe. However, a valid characterisation of the safety profile remains challenging due to limited, biased and heterogeneous data and missing investigation of long-term effects. This evaluation demonstrates the lack of data, which prevents reliable conclusions on the safety of clonidine for long-term sedation in critically ill children. For an evidence-based use, further studies are needed.
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Affiliation(s)
- Sonja Eberl
- Department of Paediatrics and Adolescents Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Gabriele Ahne
- Department of Paediatrics and Adolescents Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Irmgard Toni
- Department of Paediatrics and Adolescents Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Joseph Standing
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Antje Neubert
- Department of Paediatrics and Adolescents Medicine, University Hospital Erlangen, Erlangen, Germany
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28
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Hussain A, Mahmood F, Arshad MS, Abbas N, Qamar N, Mudassir J, Farhaj S, Nirwan JS, Ghori MU. Personalised 3D Printed Fast-Dissolving Tablets for Managing Hypertensive Crisis: In-Vitro/In-Vivo Studies. Polymers (Basel) 2020; 12:E3057. [PMID: 33419348 PMCID: PMC7765967 DOI: 10.3390/polym12123057] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023] Open
Abstract
Hypertensive crisis (HC) is an emergency health condition which requires an effective management strategy. Over the years, various researchers have developed captopril based fast-dissolving formulations to manage HC; however, primarily, the question of personalisation remains unaddressed. Moreover, commercially these formulations are available as in fixed-dose combinations or strengths, so the titration of dose according to patient's prerequisite is challenging to achieve. The recent emergence of 3D printing technologies has given pharmaceutical scientists a way forward to develop personalised medicines keeping in view patients individual needs. The current project, therefore, is aimed at addressing the limitations as mentioned above by developing fast-dissolving captopril tablets using 3D printing approach. Captopril unloaded (F1) and loaded (F2-F4) filaments were successfully produced with an acceptable drug loading and mechanical properties. Various captopril formulations (F2-F4) were successfully printed using fused deposition modelling technique. The results revealed that the formulations (F2 and F3) containing superdisintegrant had a faster extent of dissolution and in-vivo findings were endorsing these results. The present study has successfully exhibited the utilisation of additive manufacturing approach to mend the gap of personalisation and manufacturing fast-dissolving captopril 3D printed tablets. The procedure adopted in the present study may be used for the development of fused deposition modelling (FDM) based fast-dissolving 3D printed tablets.
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Affiliation(s)
- Amjad Hussain
- University College of Pharmacy, University of the Punjab, Lahore 54000, Pakistan; (F.M.); (N.A.); (N.Q.)
| | - Faisal Mahmood
- University College of Pharmacy, University of the Punjab, Lahore 54000, Pakistan; (F.M.); (N.A.); (N.Q.)
| | - Muhammad Sohail Arshad
- Department of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (M.S.A.); (J.M.)
| | - Nasir Abbas
- University College of Pharmacy, University of the Punjab, Lahore 54000, Pakistan; (F.M.); (N.A.); (N.Q.)
| | - Nadia Qamar
- University College of Pharmacy, University of the Punjab, Lahore 54000, Pakistan; (F.M.); (N.A.); (N.Q.)
| | - Jahanzeb Mudassir
- Department of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan; (M.S.A.); (J.M.)
| | - Samia Farhaj
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK; (S.F.); (J.S.N.)
| | - Jorabar Singh Nirwan
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK; (S.F.); (J.S.N.)
| | - Muhammad Usman Ghori
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK; (S.F.); (J.S.N.)
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Fishbein JE, Sethna CB, Singer P, Castellanos‐Reyes L. Acute severe hypertension associated with acute gastroenteritis in children. J Clin Hypertens (Greenwich) 2020; 22:2141-2145. [PMID: 32931636 PMCID: PMC8029787 DOI: 10.1111/jch.14029] [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: 06/02/2020] [Revised: 07/30/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022]
Abstract
Acute severe hypertension in otherwise healthy children with acute illness requiring hospitalization for BP management is uncommon and warrants immediate evaluation. We describe 10 cases of children presenting with acute gastroenteritis and found to have acute severe hypertension. They required admission to the hospital for antihypertensive treatment, including 2 to the intensive care unit, but all had normalization of BP and were able to stop treatment with resolution of the acute illness. All patients had thorough testing for secondary causes of hypertension and for signs of end-target organ damage, which were unremarkable. To our knowledge, acute severe hypertension in the setting of acute gastroenteritis without underlying kidney pathology and with complete resolution after illness has not been previously described. The mechanism of this association is not clear, although activation of the sympathetic nervous system is suspected. These cases illustrate the importance of thoroughly assessing BP in the acute setting.
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Affiliation(s)
| | - Christine B. Sethna
- Department of PediatricsDivision of NephrologyCohen Children’s Medical CenterNew Hyde ParkNew YorkUSA
| | - Pamela Singer
- Department of PediatricsDivision of NephrologyCohen Children’s Medical CenterNew Hyde ParkNew YorkUSA
| | - Laura Castellanos‐Reyes
- Department of PediatricsDivision of NephrologyCohen Children’s Medical CenterNew Hyde ParkNew YorkUSA
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30
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Peak blood pressure and prediction of posterior reversible encephalopathy syndrome in children. Pediatr Nephrol 2020; 35:1967-1975. [PMID: 32385528 PMCID: PMC8086820 DOI: 10.1007/s00467-020-04577-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hypertension is a risk factor for posterior reversible encephalopathy syndrome (PRES), but the timing and severity of hypertension relative to PRES are unknown. The objective was to identify a clinically meaningful blood pressure (BP) threshold that predicts PRES development in high-risk children. METHODS We recorded peak systolic BP, diastolic BP, BP z-scores, and mean arterial pressure over the 14 days preceding clinical concern for PRES in 35 subjects who developed PRES, compared to 14 controls who had normal brain magnetic resonance imaging and similar underlying disease, renal function, and medications. We used multivariable logistic regression models adjusted for fluid overload and obesity to estimate the association of peak BP with PRES. We used receiver operating characteristic curves to determine which peak BP thresholds best predicted PRES and calculated the corresponding sensitivity, specificity, and positive and negative predictive values. RESULTS Peak systolic BP z-score was most strongly associated with PRES (OR 3.97, 95% CI 1.62-9.74), and peak systolic BP z-score ≥ 3.0 predicted PRES (area under the curve 0.95, 95% CI 0.88-1.0) with 91% sensitivity and 85% specificity, indicating 94% positive predictive value and 79% negative predictive value. CONCLUSIONS We demonstrated that peak systolic BP z-score ≥ 3.0 in the preceding 14 days predicted PRES development in cases compared with controls in children at high risk. Our study suggests that stage 2 hypertension, corresponding to a z-score ≥ 3.0, could help define hypertensive emergency in high-risk children and indicate when more aggressive treatment is warranted to prevent neurologic injury.
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Masoudi-Sobhanzadeh Y, Masoudi-Nejad A. Synthetic repurposing of drugs against hypertension: a datamining method based on association rules and a novel discrete algorithm. BMC Bioinformatics 2020; 21:313. [PMID: 32677879 PMCID: PMC7469914 DOI: 10.1186/s12859-020-03644-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Drug repurposing aims to detect the new therapeutic benefits of the existing drugs and reduce the spent time and cost of the drug development projects. The synthetic repurposing of drugs may prove to be more useful than the single repurposing in terms of reducing toxicity and enhancing efficacy. However, the researchers have not given it serious consideration. To address the issue, a novel datamining method is introduced and applied to repositioning of drugs for hypertension (HT) which is a serious medical condition and needs some improved treatment plans to help treat it. RESULTS A novel two-step data mining method, which is based on the If-Then association rules as well as a novel discrete optimization algorithm, was introduced and applied to the synthetic repurposing of drugs for HT. The required data were also extracted from DrugBank, KEGG, and DrugR+ databases. The findings indicated that based on the different statistical criteria, the proposed method outperformed the other state-of-the-art approaches. In contrast to the previously proposed methods which had failed to discover a list on some datasets, our method could find a combination list for all of them. CONCLUSION Since the proposed synthetic method uses medications in small dosages, it might revive some failed drug development projects and put forward a suitable plan for treating different diseases such as COVID-19 and HT. It is also worth noting that applying efficient computational methods helps to produce better results.
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Affiliation(s)
- Yosef Masoudi-Sobhanzadeh
- Laboratory of Systems Biology and Bioinformatics (LBB), Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| | - Ali Masoudi-Nejad
- Laboratory of Systems Biology and Bioinformatics (LBB), Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
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32
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Arterial Hypertension in Children. Handb Exp Pharmacol 2020. [PMID: 32458136 DOI: 10.1007/164_2020_359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Pharmacological treatment of arterial hypertension in children is mainly based on individual experience, but there is evidence that blocking the angiotensin system reduces systolic and diastolic blood when compared to placebo, and these drugs are safe to use for a short duration, also in children under 6 years of age. Blocking the angiotensin system either by angiotensin-converting enzyme inhibitors or by antagonizing the angiotensin 1 receptor is effective, but did not display a consistent dose-response relationship with escalating doses, but the effective doses are known. Calcium channel antagonists are effective antihypertensives in children, but the evidence is limited. Based on small-sized studies, beta-blockers modestly reduce systolic blood pressure, but have no significant effect on diastolic blood pressure compared to placebo. They act in combination to antagonize reflex tachycardia induced by vasodilators. The most commonly used antihypertensive agents are safe to use in short-term studies.
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Göknar N, Çalışkan S. New guidelines for the diagnosis, evaluation, and treatment of pediatric hypertension. TURK PEDIATRI ARSIVI 2020; 55:11-22. [PMID: 32231445 PMCID: PMC7096568 DOI: 10.14744/turkpediatriars.2020.92679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/02/2019] [Indexed: 12/14/2022]
Abstract
Childhood hypertension has become a significant public health problem due to increased prevalence in recent decades. High blood pressure causes increased mortality and morbidity in childhood, precedes adult hypertension, and causes increased cardiovascular events in adulthood. These concerns have led to an update of guidelines about childhood hypertension by the European Society of Hypertension in 2016 and the American Academy of Hypertension in 2017. This review highlights the important developments in these guidelines and recent literature about childhood hypertension in terms of diagnosis, prevalence, risk factors, diagnostic tools, prevention and management.
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Affiliation(s)
- Nilüfer Göknar
- Division of Pediatric Nephrology, Department of Pediatrics, İstanbul Medeniyet University, Faculty of Medicine, İstanbul, Turkey
| | - Salim Çalışkan
- Division of Pediatric Nephrology, Department of Pediatrics, İstanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, İstanbul, Turkey
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