1
|
Kamin-Friedman S, Davidovitch N, Yang YT. Israel's repeal of a sweet beverages tax harms public health. Front Public Health 2023; 11:1231709. [PMID: 38162613 PMCID: PMC10755473 DOI: 10.3389/fpubh.2023.1231709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Shelly Kamin-Friedman
- Department of Health Policy and Management, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Nadav Davidovitch
- Department of Health Policy and Management, Faculty of Health Sciences, School of Public Health, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Y. Tony Yang
- Center for Health Policy and Media Engagement, George Washington University, Washington, DC, United States
| |
Collapse
|
2
|
Zhang A, Vazquez S, Das A, Spirollari E, Dominguez JF, Finnan K, Turkowski J, Salik I. High area deprivation index is associated with increased injury severity in pediatric burn patients. Burns 2023; 49:1670-1675. [PMID: 37344308 DOI: 10.1016/j.burns.2023.05.018] [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: 02/28/2023] [Revised: 04/27/2023] [Accepted: 05/12/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Burn injuries play a significant role in pediatric injury-related mortality and morbidity. In this study, we aim to explore the relationship between patient demographics, socioeconomic factos and burn severity in pediatric patients. METHODS Patients under age 14 hospitalized at Westchester Medical Center for burn injury between 2015 and 2021 were reviewed. Demographic variables including mechanism of burn, total body surface area (TBSA) involvement, surgical intervention, hospital length of stay (LOS), and LOS per TBSA burn were extracted. The Area Deprivation Index (ADI) was calculated to further assess socioeconomic factors. RESULTS We included 399 patients under the age of 14 hospitalized for burn injuries at our institution between 2015 and 2021. The median age was 2 (IQR 1-6) years old, and 42.6% were female. High ADI (p = 0.018), Caucasian race (p = 0.001), and flame mechanism (p < 0.001) were independently associated with burn TBSA> 5%. LOS per TBSA was shorter in the Caucasian population (p = 0.022). CONCLUSION In burn injury patients, further research is necessary to investigate modifiable risk factors in individuals of Caucasian race or lower socioeconomic status to target effective prevention campaigns.
Collapse
Affiliation(s)
- Alice Zhang
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Sima Vazquez
- School of Medicine, New York Medical College, Valhalla, NY, USA.
| | - Ankita Das
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Eris Spirollari
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center, New York Medical College School of Medicine, Valhalla, NY, USA
| | - Kerri Finnan
- Department of Burn Care, Westchester Medical Center, Valhalla, NY, USA
| | - Joseph Turkowski
- Department of Burn Care, Westchester Medical Center, Valhalla, NY, USA; Department of General Surgery, Westchester Medical Center, New York Medical College School of Medicine, Valhalla, NY, USA
| | - Irim Salik
- Department of Pediatric Anesthesiology, Westchester Medical Center, New York Medical College School of Medicine, Valhalla, NY, USA
| |
Collapse
|
3
|
Lazar I, Wizeman-Orlov D, Hazan G, Orbach A, Haim A, Cavari Y, Feinstein Y, Neeman E, Hershkovitz E, Faingelernt Y. The role of anion gap normalization time in the management of pediatric diabetic ketoacidosis. Front Pediatr 2023; 11:1198581. [PMID: 37334219 PMCID: PMC10275565 DOI: 10.3389/fped.2023.1198581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/02/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Our aims were to determine whether anion gap normalization time (AGNT) correlates with risk factors related to the severity of diabetic ketoacidosis (DKA) in children, and to characterize AGNT as a criterion for DKA resolution in children admitted with moderate or severe disease. Methods A ten-year retrospective cohort study of children admitted to the intensive care unit with DKA. We used a survival analysis approach to determine changes in serum glucose, bicarbonate, pH, and anion gap following admission. Using multivariate analysis, we examined associations between patients' demographic and laboratory characteristics with delayed normalization of the anion gap. Results A total of 95 patients were analyzed. The median AGNT was 8 h. Delayed AGNT (>8 h) correlated with pH < 7.1 and serum glucose >500 mg/dL. In multivariate analysis, glucose >500 mg/dL was associated with an increased risk for delayed AGNT, by 3.41 fold. Each 25 mg/dL elevation in glucose was associated with a 10% increment in risk for delayed AGNT. Median AGNT preceded median PICU discharge by 15 h (8 vs. 23 h). Discussion AGNT represents a return to normal glucose-based physiology and an improvement in dehydration. The correlation observed between delayed AGNT and markers of DKA severity supports the usefulness of AGNT for assessing DKA recovery.
Collapse
Affiliation(s)
- Isaac Lazar
- Pediatric Intensive Care Unit, Saban Center of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Dorit Wizeman-Orlov
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Guy Hazan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Department of Pediatrics D, Saban Center of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel
| | - Asaf Orbach
- Pediatric Intensive Care Unit, Saban Center of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel
| | - Alon Haim
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Department of Pediatrics D, Saban Center of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel
- Pediatric Endocrinology Unit, Saban Center of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel
| | - Yuval Cavari
- Pediatric Intensive Care Unit, Saban Center of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yael Feinstein
- Pediatric Intensive Care Unit, Saban Center of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Eitan Neeman
- Pediatric Intensive Care Unit, Saban Center of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Eli Hershkovitz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Department of Pediatrics D, Saban Center of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel
- Pediatric Endocrinology Unit, Saban Center of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel
| | - Yaniv Faingelernt
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Department of Pediatrics D, Saban Center of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel
| |
Collapse
|
4
|
Rugg-Gunn CEM, Dixon E, Jorgensen AL, Usher-Smith JA, Marcovecchio ML, Deakin M, Hawcutt DB. Factors Associated With Diabetic Ketoacidosis at Onset of Type 1 Diabetes Among Pediatric Patients: A Systematic Review. JAMA Pediatr 2022; 176:1248-1259. [PMID: 36215053 DOI: 10.1001/jamapediatrics.2022.3586] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Presenting with diabetic ketoacidosis (DKA) at onset of type 1 diabetes (T1D) remains a risk. Following a 2011 systematic review, considerable additional articles have been published, and the review required updating. OBJECTIVE To evaluate factors associated with DKA at the onset of T1D among pediatric patients. EVIDENCE REVIEW In this systematic review, PubMed, Embase, Scopus, CINAHL, Web of Science, and article reference lists were searched using the population, intervention, comparison, outcome search strategy for primary research studies on DKA and T1D onset among individuals younger than 18 years that were published from January 2011 to November 2021. These studies were combined with a 2011 systematic review on the same topic. Data were pooled using a random-effects model. FINDINGS A total of 2565 articles were identified; 149 were included, along with 46 from the previous review (total 195 articles). Thirty-eight factors were identified and examined for their association with DKA at T1D onset. Factors associated with increased risk of DKA were younger age at T1D onset (<2 years vs ≥2 years; odds ratio [OR], 3.51; 95% CI, 2.85-4.32; P < .001), belonging to an ethnic minority population (OR, 0.40; 95% CI, 0.21-0.74; P = .004), and family history of T1D (OR, 0.46; 95% CI, 0.37-0.57; P < .001), consistent with the 2011 systematic review. Some factors that were not associated with DKA in the 2011 systematic review were associated with DKA in the present review (eg, delayed diagnosis: OR, 2.27; 95% CI, 1.72-3.01; P < .001). Additional factors associated with risk of DKA among patients with new-onset T1D included participation in screening programs (OR, 0.35; 95% CI, 0.21-0.59; P < .001) and presentation during the COVID-19 pandemic (OR, 2.32; 95% CI, 1.76-3.06; P < .001). CONCLUSIONS AND RELEVANCE In this study, age younger than 2 years at T1D onset, belonging to an ethnic minority population, delayed diagnosis or misdiagnosis, and presenting during the COVID-19 pandemic were associated with increased risk of DKA. Factors associated with decreased risk of DKA included greater knowledge of key signs or symptoms of DKA, such as a family history of T1D or participation in screening programs. Future work should focus on identifying and implementing strategies related to these factors to reduce risk of DKA among new patients with T1D.
Collapse
Affiliation(s)
| | - Eleanor Dixon
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Andrea L Jorgensen
- Department of Biostatistics, University of Liverpool, Liverpool, England
| | - Juliet A Usher-Smith
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, England
| | | | - Mark Deakin
- Alder Hey Children's Hospital, Liverpool, England
| | - Daniel B Hawcutt
- NIHR Alder Hey Clinical Research Facility, Liverpool, England.,Department of Women's and Children's Health, University of Liverpool, Liverpool, England
| |
Collapse
|
5
|
Smuel-Zilberberg K, Shalitin S, Yackobovitch-Gavan M, Phillip M, Nimri R. Diabetes ketoacidosis recovery in youth with newly diagnosed and established type 1 diabetes. Pediatr Res 2022; 91:1272-1277. [PMID: 34148066 DOI: 10.1038/s41390-021-01618-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/06/2021] [Accepted: 05/21/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The objective of this study was to describe the differences in metabolic parameters and in time to recovery from diabetes ketoacidosis (DKA), between children and adolescents with newly diagnosed diabetes compared with established type 1 diabetes (T1DM). METHODS This was a single-center, retrospective study. The cohort consists of 356 children and adolescents with T1DM who had DKA during 2008-2018. Data were obtained from the patients' medical files. Recovery of DKA was defined as the resolution of acidosis (pH >7.3 and bicarbonate >15 meq/L). RESULTS The mean time to recovery from DKA was significantly longer in patients with newly diagnosed diabetes than in those with established diabetes (13± versus 8.5± h) (p < 0.001). This difference was maintained in an analysis according to DKA severity: mild, moderate, and severe. pH at presentation did not differ between the groups, but bicarbonate at presentation was significantly lower in patients with newly diagnosed diabetes than in those with established diabetes, 9.9± versus 12± mmol/L (p < 0.001). Potassium and phosphorus levels were lower, and sodium and chloride levels were higher in patients with newly diagnosed diabetes than in those with established diabetes (p < 0.001). CONCLUSIONS DKA is associated with a shorter recovery time in patients with established diabetes compared to newly diagnosed diabetes. This may have implications on the treatment of people with established diabetes. IMPACT DKA is associated with a shorter recovery time in patients with established diabetes compared with newly diagnosed diabetes. Shorter recovery time in a patient with established diabetes compared with newly diagnosed diabetes was observed in any DKA severity. The time to recovery from DKA did not differ significantly between patients treated with an insulin pump and those treated with multiple daily injections. Triggers for DKA among patients with established diabetes were poor compliance with treatment, infection, pump dysfunction, and dehydration.
Collapse
Affiliation(s)
- Keren Smuel-Zilberberg
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Shlomit Shalitin
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Yackobovitch-Gavan
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Revital Nimri
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
| |
Collapse
|
6
|
Gruber N, Rathaus M, Ron I, Livne R, Sheinvald S, Barhod E, Hemi R, Tirosh A, Pinhas-Hamiel O, Tirosh A. Fatty acid-binding protein 4: a key regulator of ketoacidosis in new-onset type 1 diabetes. Diabetologia 2022; 65:366-374. [PMID: 34806114 DOI: 10.1007/s00125-021-05606-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/06/2021] [Indexed: 02/05/2023]
Abstract
AIMS/HYPOTHESIS Fatty acid-binding protein 4 (FABP4) is an adipokine with a key regulatory role in glucose and lipid metabolism. We prospectively evaluated the role of FABP4 in the pathophysiology of diabetic ketoacidosis (DKA) in new-onset type 1 diabetes. METHODS Clinical and laboratory data were prospectively collected from consecutive children presenting with new-onset type 1 diabetes. In addition to blood chemistry and gases, insulin, C-peptide, serum FABP4 and NEFA were collected upon presentation and 48 h after initiation of insulin treatment. In a mouse model of type 1 diabetes, glucose, insulin, β-hydroxybutyrate and weight were compared between FABP4 knockout (Fabp4-/-) and wild-type (WT) mice. RESULTS Included were 33 children (mean age 9.3 ± 3.5 years, 52% male), of whom 14 (42%) presented with DKA. FABP4 levels were higher in the DKA group compared with the non-DKA group (median [IQR] 10.1 [7.9-14.2] ng/ml vs 6.3 [3.9-7] ng/ml, respectively; p = 0.005). The FABP4 level was positively correlated with HbA1c at presentation and inversely correlated with venous blood pH and bicarbonate levels (p < 0.05 for all). Following initiation of insulin therapy, a marked reduction in FABP4 was observed in all children. An FABP4 level of 7.22 ng/ml had a sensitivity of 86% and a specificity of 78% for the diagnosis of DKA, with an area under the receiver operating characteristic curve of 0.78 (95% CI 0.6, 0.95; p = 0.008). In a streptozotocin-induced diabetes mouse model, Fabp4-/- mice exhibited marked hypoinsulinaemia and hyperglycaemia similar to WT mice but displayed no significant increase in β-hydroxybutyrate and were protected from ketoacidosis. CONCLUSIONS/INTERPRETATION FABP4 is suggested to be a necessary regulator of ketogenesis in insulin-deficient states.
Collapse
Affiliation(s)
- Noah Gruber
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Moran Rathaus
- The Dalia and David Arabov Diabetes Research Center, Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Idit Ron
- The Dalia and David Arabov Diabetes Research Center, Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Rinat Livne
- The Dalia and David Arabov Diabetes Research Center, Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Sharon Sheinvald
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Ehud Barhod
- The Dalia and David Arabov Diabetes Research Center, Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Rina Hemi
- The Dalia and David Arabov Diabetes Research Center, Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Amit Tirosh
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Dalia and David Arabov Diabetes Research Center, Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Orit Pinhas-Hamiel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Tirosh
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- The Dalia and David Arabov Diabetes Research Center, Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel.
| |
Collapse
|
7
|
Yahal O, Eshel R, Manor U, Lennon JM, Stern M, Geller D, Pessach IM. Pediatric burns unique characteristics among Ultra-Orthodox Jewish minority - retrospective study. J Burn Care Res 2021; 43:596-601. [PMID: 34651639 DOI: 10.1093/jbcr/irab188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Burn injuries are a significant cause of morbidity among children. Ultra-Orthodox Jewish children are at higher risk for burn injuries. The goal of this study was to examine the clinical characteristics of moderate to severe burns in this population in comparison to the general population in Israel. METHODS This retrospective cohort study included all pediatric patients 0-18 years of age admitted with burn injuries from January 1, 2015 through December 31, 2018. Data was collected regarding demography, etiology and clinical characteristics. RESULTS Of 778 burns injuries presented to our tertiary center, 385 (49.5%) were hospitalized. Of those 212 (55%) were non-Ultra-Orthodox Jews, 135 (35%) were Ultra-Orthodox Jews, and 38 (10%) were non-Jewish patients. The Total Body Surface Area percentage (TBSA%) of scald-type burns was larger in Ultra-Orthodox compared to non-Ultra-Orthodox children (median TBSA% of 7% Vs 5% respectively(p<0.05)). Among the Ultra-Orthodox group, the median TBSA percentage during weekdays was 6%, and for weekends the TBSA% was 7.5% (p<0.05). Females demonstrated the greatest diversity between subgroups. On weekends, Ultra-Orthodox female's median TBSA% was 10%, and non-Ultra-Orthodox female's TBSA% was 4.5% (p<0.05). CONCLUSIONS Ultra-Orthodox children and especially girls had a significantly higher median TBSA% than non-Ultra-Orthodox children for burns occurring during weekends. This may be the result of the unique cultural norms of the Ultra-Orthodox Jewish community, in particular, their lifestyle and observation of the Sabbath. These findings provide focus for better intervention and prevention of pediatric burns among this unique population.
Collapse
Affiliation(s)
- Orr Yahal
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Eshel
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Manor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Internal Medicine C, Sheba Medical Center, Tel Hashomer, Israel
| | - Joshua M Lennon
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Internal Medicine C, Sheba Medical Center, Tel Hashomer, Israel.,Northwestern Memorial Hospital Department of Internal Medicine, Division of Hospital Medicine.,The Feinberg School of Medicine at Northwestern University, Chicago, IL
| | - Michal Stern
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Geller
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itai M Pessach
- The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
8
|
Yardeni M, Abebe Campino G, Hasson‐Ohayon I, Basel D, Hertz‐Palmor N, Bursztyn S, Weisman H, Pessach IM, Toren A, Gothelf D. Trajectories and risk factors for anxiety and depression in children and adolescents with cancer: A 1-year follow-up. Cancer Med 2021; 10:5653-5660. [PMID: 34309238 PMCID: PMC8366094 DOI: 10.1002/cam4.4100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/04/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There is limited data on the longitudinal trajectories of psychiatric disorders in children with cancer and risk factors for their persistence. The current study aimed to longitudinally assess the trajectories and risk factors for anxiety and depressive symptoms and disorders in children and adolescents with cancer. METHODS Children and adolescents with cancer and their parents completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety Module and were interviewed by the semi-structured Affective and Anxiety Modules of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), at 4 time points, 1, 4, 7, and 12 months following the diagnosis of cancer. RESULTS Of the 99 patients enrolled, 48% met criteria for anxiety and/or depressive disorders at least once during the follow-up period. There was a significant decrease in PROMIS pediatric and parent anxiety and depression scores (all p's < 0.01) and in the rate of depressive disorders over time (p = 0.02), while rates of anxiety disorders remained stable. Anxiety PROMIS pediatric and parent scores at baseline, having brain tumors and being in the acute treatment phase significantly predicted the presences of anxiety disorders at endpoint. CONCLUSIONS Our results highlight the importance of screening for anxiety and disorders in children with cancer, especially among those with brain tumors and at the acute phase of treatment.
Collapse
Affiliation(s)
| | - Gadi Abebe Campino
- The Chaim Sheba Medical CenterRamat GanIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | | | - Dana Basel
- The Chaim Sheba Medical CenterRamat GanIsrael
| | | | | | | | - Itai M. Pessach
- The Chaim Sheba Medical CenterRamat GanIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Amos Toren
- The Chaim Sheba Medical CenterRamat GanIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Doron Gothelf
- The Chaim Sheba Medical CenterRamat GanIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Sagol School of NeuroscienceTel Aviv UniversityTel AvivIsrael
| |
Collapse
|
9
|
Schwartz-Lifshitz M, Basel D, Lang C, Hertz-Palmor N, Dekel I, Zohar J, Gothelf D. Obsessive compulsive symptoms severity among children and adolescents during COVID-19 first wave in Israel. J Obsessive Compuls Relat Disord 2021; 28:100610. [PMID: 33288995 PMCID: PMC7709811 DOI: 10.1016/j.jocrd.2020.100610] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/20/2020] [Accepted: 11/28/2020] [Indexed: 12/14/2022]
Abstract
Several current publications have considered persons with obsessive compulsive disorder (OCD) as particularly vulnerable during the COVID-19 period, and to require more frequent symptom monitoring. The purpose of this study was to evaluate whether OCD exacerbated during the first wave of COVID-19 in children and adolescents. Twenty-nine children and adolescents with OCD were evaluated in the midst of the first outbreak of the COVID-19 pandemic in Israel (April-May 2020). Obsessive-compulsive symptoms (OCS) were assessed using the Clinical Global Impression Scale (CGI), by means of a functional questionnaire and by the Obsessive-Compulsive Inventory-child version (OCI-CV) questionnaires. Obsessive-compulsive symptoms were not found to have exacerbated during the period investigated, as evident by a lack of change in CGI severity scores and by improvement rather than deterioration among more participants, based on the CGI improvement scores. Additionally, the children and adolescents reported better general functioning during the COVID-19 period and had relatively low scores on the OCI-CV scale. Our findings indicate that Israeli children and adolescents with OCD coped well with COVID-19 during the first two months of the pandemic and mostly did not experience exacerbation of OCS. However, due to the short duration of exposure to the pandemic at the time of the study, social isolation and lockdown might have masked OCS; thus, further longitudinal studies are needed.
Collapse
Affiliation(s)
- Maya Schwartz-Lifshitz
- Child and Adolescent Psychiatry Division, Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Dana Basel
- Child and Adolescent Psychiatry Division, Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Claudia Lang
- Child and Adolescent Psychiatry Division, Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Nimrod Hertz-Palmor
- Child and Adolescent Psychiatry Division, Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Idit Dekel
- Child and Adolescent Psychiatry Division, Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Joseph Zohar
- Psychiatry Division, Chaim Sheba Sheba Medical Center, Israel
- The Israeli Center for OCD, Modiin, Israel
| | - Doron Gothelf
- Child and Adolescent Psychiatry Division, Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
10
|
Kangin M, Talay MN, Tanriverdi Yilmaz S, Unal E, Demiral M, Asena M, Ozbek MN. A Retrospective Analysis of Children and Adolescents With Diabetic Ketoacidosis in the Intensive Care Unıt: Is It Significant that the Blood Ketone Level Becomes Negative in Diabetic Ketoacidosis? Cureus 2020; 12:e10844. [PMID: 33178500 PMCID: PMC7651777 DOI: 10.7759/cureus.10844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction: Diabetic ketoacidosis (DKA) is the most common cause of acute morbidity and mortality in children and adolescents with type 1 diabetes mellitus (T1DM). Because DKA management is associated with complications, endocrine communities have published guidelines and attempted to set standards for DKA diagnosis and management worldwide. In this study, for the patients followed up in the intensive care unit who have been treated according to DKA protocols, clinical and laboratory characteristics, differences between new and old diagnosed patients, and results of treatment were evaluated. Methods: The records of 67 patients hospitalized in the pediatric intensive care unit for the past two years were reviewed retrospectively. Patients were grouped as newly diagnosed and old diagnosed diabetics. Results: The mean age of the patients was 8.66 ± 5.0 years (3 months to 17.9 years) and 39 (58.2%) were male. Forty-five patients (67.1%) presented with mild DKA and 22 (33.9%) with severe DKA. Fourteen (63.6%) of the severe DKA cases were newly diagnosed with T1DM. Six patients had hyponatremia (corrected serum Na level <135 mmol/L) and five had hypernatremia (serum Na level >145 mmol/L). Only one of the hyponatremic patients had severe acidosis, while four of the hypernatremic patients had severe acidosis. At the 14th hour, blood glucose levels were below 200 mg/dl, blood ketones became negative in 5.8 hours, and at 9.1 hours, blood pH and/or HCO3 levels were normalized, recovery criteria were completed, and subcutaneous (SC) insulin injection was started. Of the patients, 38 (56.7) were newly diagnosed with T1DM. The mean age of newly diagnosed T1DM patients was smaller (7.40 ± 4.96) than those with old diagnosis, respiratory rates (RRs) were higher and pCO2 levels were lower on admission. Blood glucose, blood ketone negativity, acidosis, and Glasgow coma score (GCS) scores of the newly diagnosed T1DM patients improved later than the previous diagnoses. Only one patient under two years of age with a pH of 6.89 was given HCO3. None of the patients had symptomatic brain edema and death. Conclusions: As a result, DKA is an acute and serious complication of diabetes, whose results are promising when managed only with minimal individual changes according to guidelines. Bicarbonate administration is not needed except in patients with very severe acidosis. Bedside blood ketone monitoring seems to be important because it allows for early enteral feeding.
Collapse
Affiliation(s)
- Murat Kangin
- Pediatric Intensive Care, Saglik Bilimleri University, Gazi Yasargil Training and Research Hospital, Diyarbakir, TUR
| | - Mehmet Nur Talay
- Pediatric Intensive Care, Saglik Bilimleri University, Gazi Yasargil Training and Research Hospital, Diyarbakir, TUR
| | - Sibel Tanriverdi Yilmaz
- Pediatric Intensive Care, Saglik Bilimleri University, Gazi Yasargil Training and Research Hospital, Diyarbakir, TUR
| | - Edip Unal
- Pediatric Endocrinology, Saglik Bilimleri University, Gazi Yasargil Training and Research Hospital, Diyarbakir, TUR
| | - Meliha Demiral
- Pediatric Endocrinology, Saglik Bilimleri University, Gazi Yasargil Training and Research Hospital, Diyarbakir, TUR
| | - Muhammed Asena
- Pediatrics, Saglik Bilimleri University, Gazi Yasargil Training and Research Hospital, Diyarbakir, TUR
| | - Mehmet Nuri Ozbek
- Pediatric Endocrinology, Saglik Bilimleri University, Gazi Yasargil Training and Research Hospital, Diyarbakir, TUR
| |
Collapse
|
11
|
Yardeni M, Abebe Campino G, Bursztyn S, Shamir A, Mekori-Domachevsky E, Toren A, Gothelf D. A three-tier process for screening depression and anxiety among children and adolescents with cancer. Psychooncology 2020; 29:2019-2027. [PMID: 32691478 DOI: 10.1002/pon.5494] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/03/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To establish and to evaluate the effectiveness of a three-tier screening process of depressive and anxiety disorders among children and adolescents with cancer based on questionnaires (first tier), semistructured psychiatric interviews (second tier), and referral for psychiatric assessment and recommendations for treatment (third tier). We also aimed to determine the rates of depressive and anxiety disorders among participants. METHODS Participants and their parents completed the Patient Reported Outcomes Measurement Information System (PROMIS) Depression and Anxiety modules. Then, they were interviewed separately using the semistructured Affective and Anxiety Modules of the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). PROMIS cutoff values for diagnosing depressive and anxiety disorders, based on the K-SADS, were calculated by receiver-operating characteristics (ROCs). RESULTS Of 91 participants 34 (37.4%) aged 7 to 21 years with cancer met the K-SADS criteria for depressive and/or anxiety disorders. The results of the ROC analyses were stronger for depressive disorders than for anxiety disorders and for more severe cases. The cutoff of 13 on the child-reported PROMIS for a major depressive episode had a sensitivity of 0.80 and a specificity of 0.82, and a cutoff of 14 on the parent-reported PROMIS for generalized anxiety disorder had a sensitivity of 0.78 and a specificity of 0.79. CONCLUSIONS Using the K-SADS, we found that anxiety and depressive disorders are very common in youngsters with cancer. The three-tier screening process we developed for depression and anxiety in this population provides practical cutoff values for identifying depressive and anxiety disorders in children with cancer.
Collapse
Affiliation(s)
- Maya Yardeni
- Pediatric Hemato-Oncology Division, Sheba Medical Center Tel Hashomer, Tel Hashomer, Israel
| | - Gadi Abebe Campino
- Pediatric Hemato-Oncology Division, Sheba Medical Center Tel Hashomer, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Bursztyn
- Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Anat Shamir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Mekori-Domachevsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Amos Toren
- Pediatric Hemato-Oncology Division, Sheba Medical Center Tel Hashomer, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Gothelf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Child Psychiatry Division, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
12
|
Almansour HA, Chaar B, Saini B. Perspectives and experiences of patients with type 2 diabetes observing the Ramadan fast. ETHNICITY & HEALTH 2018; 23:380-396. [PMID: 27998181 DOI: 10.1080/13557858.2016.1269156] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Diabetes is a common chronic disease among Australians. Culturally and linguistically diverse groups are observed to have higher prevalence rates of diabetes. Continuing management needs adherence to medication and diet regimens. Religious practices such as fasting can affect diabetes management and medication use. Pharmacists as medication specialists have a significant role in helping people observing religious practices such as the Ramadan fast, which involves month-long absolute abstinence from food during daylight hours, to maintain good control over their condition. OBJECTIVE This study investigated the perspective of patients with type 2 diabetes (T2D) who undertake the fast of Ramadan, to understand their experiences, health-related needs and service preferences regarding diabetes management. METHODS A qualitative, exploratory design was used in this study. Data collection comprised the conduct of semi-structured interviews with a purposive convenient sample of patients in areas of ethnic diversity in Sydney, using a standardised interview guide. Interview data were transcribed verbatim and thematically analysed. RESULTS Twenty-five semi-structured interviews (68% males) among a heterogeneous sample of fasting T2D patients were conducted. Themes emerging from analysis of transcripts included issues relating to sociocultural pressure for T2D patients to fast; lack of awareness about the role of pharmacists and, most importantly, the need to train pharmacists in cultural sensitivity and clinical implications thereof. CONCLUSIONS Community awareness about the role of the pharmacists in assisting medication use and adjustment during fasting periods should be enhanced. Furthermore, community pharmacists need to be trained about the unique religious and sociocultural issues of patients with diabetes opting to observe spiritual rituals such as the Ramadan fast. Clinical education in this area should up-skill pharmacists to inculcate self-management behaviours in fasting T2D patients.
Collapse
Affiliation(s)
- Hadi A Almansour
- a Faculty of Pharmacy , University of Sydney , Sydney , NSW , Australia
| | - Betty Chaar
- a Faculty of Pharmacy , University of Sydney , Sydney , NSW , Australia
| | - Bandana Saini
- a Faculty of Pharmacy , University of Sydney , Sydney , NSW , Australia
| |
Collapse
|
13
|
Szypowska A, Dżygało K, Wysocka-Mincewicz M, Mazur A, Lisowicz L, Ben-Skowronek I, Sieniawska J, Klonowska B, Charemska D, Nawrotek J, Jałowiec I, Bossowski A, Jamiołkowska M, Pyrżak B, Rogozińska I, Szalecki M. High incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes among Polish children aged 10-12 and under 5 years of age: A multicenter study. Pediatr Diabetes 2017; 18:722-728. [PMID: 27726262 DOI: 10.1111/pedi.12446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/06/2016] [Accepted: 08/11/2016] [Indexed: 11/28/2022] Open
Abstract
AIM Despite its characteristic symptoms, type 1 diabetes (T1D) is still diagnosed late causing the development of diabetic ketoacidosis (DKA). The aim of this study was to estimate the incidence of DKA and factors associated with the development of acidosis at T1D recognition in Polish children aged 0-17. METHODS The study population consisted of 2100 children with newly diagnosed T1D in the years 2010-2014 in 7 hospitals in eastern and central Poland. The population living in these areas accounts for 35% of the Polish population. DKA was defined as a capillary pH < 7.3, blood glucose > 11 mmol/L. The analyzed data included age, sex, diabetes recognition, pH, glycated hemoglobin (HbA1c), fasting C-peptide, and body mass index standard deviation score (BMI-SDS). RESULTS We observed DKA in 28.6% of children. There were 2 peaks in DKA occurrence: in children <5 years of age (33.9%) and aged 10-12 (34%). The highest incidence of DKA was noted in children aged 0-2 (48.4%). In the group with DKA, moderate and severe DKA occurred in 46.7% of children. Girls and children <2 years of age were more prone to severe DKA. The multiple logistic regression analysis showed the following factors associated with DKA: age (P = .002), fasting C-peptide (P = .0001), HbA1c (P = .0001), no family history of T1D (P = .0001), and BMI-SDS (P = .0001). CONCLUSIONS The incidence of DKA is high and remained unchanged over the last 5 years. Increasing the awareness of symptoms of DKA is recommended among children <5 years of age (especially <2 years of age) and aged 10-12. Children <2 years of age and girls were at the highest risk of severe DKA.
Collapse
Affiliation(s)
| | - Katarzyna Dżygało
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Marta Wysocka-Mincewicz
- Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland
| | - Artur Mazur
- II Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical Faculty University of Rzeszow, Rzeszow, Poland
| | - Lucyna Lisowicz
- II Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical Faculty University of Rzeszow, Rzeszow, Poland
| | - Iwona Ben-Skowronek
- Department of Pediatric Endocrinology and Diabetology, Medical University of Lublin, Lublin, Poland
| | - Joanna Sieniawska
- Department of Pediatric Endocrinology and Diabetology, Medical University of Lublin, Lublin, Poland
| | - Bożenna Klonowska
- Department of Clinical Pediatrics, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Provincial Specialist Children's Hospital, Olsztyn, Poland
| | - Dorota Charemska
- Department of Clinical Pediatrics, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Provincial Specialist Children's Hospital, Olsztyn, Poland
| | - Jolanta Nawrotek
- Endocrinology and Diabetology Ward, General District Hospital, Kielce, Poland
| | - Irena Jałowiec
- Endocrinology and Diabetology Ward, General District Hospital, Kielce, Poland
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Białystok, Białystok, Poland
| | - Milena Jamiołkowska
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Białystok, Białystok, Poland
| | - Beata Pyrżak
- Department of Pediatric and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Izabela Rogozińska
- Department of Pediatric and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Mieczysław Szalecki
- Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland.,Faculty of Medicine and Health Sciences, UJK, Kielce, Poland
| |
Collapse
|
14
|
Ketoacidosis at first presentation of type 1 diabetes mellitus among children: a study from Kuwait. Sci Rep 2016; 6:27519. [PMID: 27328757 PMCID: PMC4916451 DOI: 10.1038/srep27519] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/29/2016] [Indexed: 12/13/2022] Open
Abstract
We examined the frequency and severity of diabetic ketoacidosis (DKA) in 679 children and adolescents (0-14 years) at diagnosis of Type 1 Diabetes Mellitus (T1DM) in Kuwait. Between 1(st) January 2011 and 31(st) December 2013, all newly diagnosed children with diabetes were registered prospectively in a population-based electronic register. DKA was diagnosed using standard criteria based on the levels of venous pH and serum bicarbonate. At the time of diagnosis, mild/moderate DKA was present in 24.8% of the children, while severe DKA was present in 8.8%. Incidence of ketoacidosis was significantly higher in young children less than 2 (60.7% vs 32.4% p = <0.005) compared to children 2-14 years old, and a higher proportion presented with severe DKA (21.4% vs 8.3% p = <0.05). No association was seen with gender. Significant differences were found in the incidence of DKA between Kuwaiti and non-Kuwaiti children (31.1% vs 39.8%; p < 0.05). Family history of diabetes had a protective effect on the occurrence of DKA (OR = 0.44; 95% CI = 0.27-0.71). Incidence of DKA in children at presentation of T1DM remains high at 33.6%. Prevention campaigns are needed to increase public awareness among health care providers, parents and school teachers in Kuwait.
Collapse
|
15
|
Deeb A, Yousef H, Abdelrahman L, Tomy M, Suliman S, Attia S, Al Suwaidi H. Implementation of a Diabetes Educator Care Model to Reduce Paediatric Admission for Diabetic Ketoacidosis. J Diabetes Res 2016; 2016:3917806. [PMID: 27294150 PMCID: PMC4886092 DOI: 10.1155/2016/3917806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/23/2016] [Accepted: 04/24/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction. Diabetic Ketoacidosis (DKA) is a serious complication that can be life-threatening. Management of DKA needs admission in a specialized center and imposes major constraints on hospital resources. Aim. We plan to study the impact of adapting a diabetes-educator care model on reducing the frequency of hospital admission of children and adolescents presenting with DKA. Method. We have proposed a model of care led by diabetes educators for children and adolescents with diabetes. The team consisted of highly trained nurses. The model effectiveness is measured by comparing the rate of hospital admission for DKA over 4-year period to the baseline year prior to implementing the model. Results. There were 158 admissions for DKA over a 5-year period. Number of patients followed up in the outpatient diabetes clinics increased from 37 to 331 patients at the start and the end of the study years. Admission rate showed a downward trend over the five-year period. Percentage of admission for DKA is reduced from 210% to 1.8% (P 0.001). Conclusion. Diabetes educator care model is an effective and a sustainable measure to reduce hospital admission for DKA in children and adolescents.
Collapse
Affiliation(s)
- Asma Deeb
- Paediatric Endocrinology Department, Mafraq Hospital, P.O. Box 2951, Abu Dhabi, UAE
- *Asma Deeb:
| | - Hana Yousef
- Paediatric Endocrinology Department, Mafraq Hospital, P.O. Box 2951, Abu Dhabi, UAE
| | - Layla Abdelrahman
- Paediatric Endocrinology Department, Mafraq Hospital, P.O. Box 2951, Abu Dhabi, UAE
| | - Mary Tomy
- Paediatric Endocrinology Department, Mafraq Hospital, P.O. Box 2951, Abu Dhabi, UAE
| | - Shaker Suliman
- Paediatric Endocrinology Department, Mafraq Hospital, P.O. Box 2951, Abu Dhabi, UAE
| | - Salima Attia
- Paediatric Endocrinology Department, Mafraq Hospital, P.O. Box 2951, Abu Dhabi, UAE
| | - Hana Al Suwaidi
- Paediatric Endocrinology Department, Mafraq Hospital, P.O. Box 2951, Abu Dhabi, UAE
| |
Collapse
|