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Robinson K, Menon S, Rungvivatjarus T. Symptomatic Pericardial Effusion Associated With Graves' Disease in a Pediatric Patient. Pediatrics 2024; 153:e2023064782. [PMID: 38699804 DOI: 10.1542/peds.2023-064782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 05/05/2024] Open
Abstract
Pericarditis is a well-known complication of hypothyroidism. Although pericarditis and pericardial effusions have been reported as rare complications of hyperthyroidism in adults, they are rarely reported in the pediatric population. In this case report, we describe a 12-year-old, previously healthy girl with nighttime chest pain, dyspnea, tachycardia, and abnormal thyroid function studies consistent with hyperthyroidism who was found to have pericarditis and pericardial effusion requiring pericardiocentesis.
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Affiliation(s)
- Kelly Robinson
- Rady Children's Hospital, San Diego, California; and University of California San Diego, San Diego, California
| | - Sahit Menon
- Rady Children's Hospital, San Diego, California; and University of California San Diego, San Diego, California
| | - Tiranun Rungvivatjarus
- Rady Children's Hospital, San Diego, California; and University of California San Diego, San Diego, California
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2
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Ribeiro ER, Hurtado CG, Knapp T, Maul TM, Nelson JS. Idiopathic Pericardial Effusions in Children: Workup and Final Diagnoses. Pediatr Cardiol 2024; 45:926-933. [PMID: 36576526 DOI: 10.1007/s00246-022-03083-9] [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: 09/10/2022] [Accepted: 12/18/2022] [Indexed: 12/29/2022]
Abstract
Pediatric idiopathic pericardial effusions are common and often have a prolonged clinical course. We hypothesized that these effusions have no standardized diagnostic workup, and ultimately have a final etiology not initially appreciated. To test these hypotheses, a hospital system-wide retrospective (1/1/1990-10/1/2019) cohort study of pericardial effusions in children (< 18 years) was conducted. Effusions were grouped by etiology and patients receiving an initial idiopathic diagnosis were further analyzed. Effusion size, diagnostic workup, final diagnosis, and time to resolution were abstracted. In total, 42/366 effusions were initially diagnosed as idiopathic. Workup was not standardized and included up to six laboratory tests including pericardial fluid analysis and infectious, metabolic, rheumatologic and thyroid workups. Treatment course involved 1 readmission in 24%, and > 1 readmission in 12%. Resolution of effusion occurred in 83% of patients within a median of 1 admission (range 1-4). Of those effusions initially deemed idiopathic, 12/42 (29%) were later found to have an underlying etiologic diagnosis including: autoimmune (7, 58%), neoplastic (2, 16%), infectious (2, 16%), and renal (1, 8%). Children initially diagnosed with idiopathic pericardial effusions have an underlying etiologic diagnosis 29% of the time, and a standardized workup may prevent delays in definitive diagnosis and treatment.
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Affiliation(s)
- Emily R Ribeiro
- Department of Pediatrics, Nemours Children's Hospital, 6535 Nemours Parkway, Orlando, FL, 32827, USA.
| | | | - Thomas Knapp
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Timothy M Maul
- Department of Cardiovascular Services, Nemours Children's Hospital, Orlando, FL, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer S Nelson
- University of Central Florida College of Medicine, Orlando, FL, USA
- Department of Cardiovascular Services, Nemours Children's Hospital, Orlando, FL, USA
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3
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Amare S, Tadele H. Pericardial effusion in children at tertiary national referral hospital, Addis Ababa, Ethiopia: a 7-year institution based review. BMC Emerg Med 2024; 24:6. [PMID: 38185639 PMCID: PMC10773101 DOI: 10.1186/s12873-023-00922-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/19/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Pericardial effusion (PE) is a rare yet an important cause of child mortality due to collection of excess fluid in pericardial space. The study aimed to describe the PE profile in the national cardiac referral hospital, Addis Ababa, Ethiopia. METHODS The study employed cross-sectional study design for a 7-year review of childhood PE in Tikur Anbessa Specialized Hospital. Descriptive and analytic statistics were applied. RESULTS There were 17,386 pediatric emergency/ER admissions during the study period, and PE contributed to 0.47% of ER admissions. From 71 included subjects, 59% (42) were males with mean age of 7.8 ± 3.3 years. Cough or shortness of breath,73.2% (52) and fever or fast breathing, 26.7% (19), were the common presenting symptoms. The median duration of an illness before presentation was 14days (IQR: 8-20). The etiologies for pericardial effusion were infective (culture positive-23.9%, culture negative-43.6%, tuberculous-4.2%), hypothyroidism (4.2%), inflammatory (12.7%), malignancy (7%) or secondary to chronic kidney disease (1. 4%). Staphylococcus aureus was the most common isolated bacteria on blood culture, 12.7% (9) while the rest were pseudomonas, 7% (5) and klebsiella, 4.2% (3). Mild, moderate and severe pericardial effusion was documented in 22.5% (16), 46.5% (33), and 31% (22) of study subjects, respectively. Pericardial tamponade was reported in 50.7% (36) of subjects. Pericardial drainage procedure (pericardiocentesis, window or pericardiotomy) was performed for 52.1% (37) PE cases. The case fatality of PE was 12.7% (9). Pericardial drainage procedure was inversely related to mortality, adjusted odds ratio 0.11(0.01-0.99), p 0.049). CONCLUSION PE contributed to 0.47% of ER admissions. The commonest PE presentation was respiratory symptoms of around two weeks duration. Purulent pericarditis of staphylococcal etiology was the commonest cause of PE and the case fatality rate was 12.7%. Pericardial drainage procedures contributed to reduction in mortality. All PE cases should be assessed for pericardial drainage procedure to avoid mortality.
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Affiliation(s)
- Selamawit Amare
- Department of Pediatrics and Child Health, Yekatit 12 Medical College, Addis Ababa, Ethiopia
| | - Henok Tadele
- Department of Pediatrics and Child Health, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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Avula S, Madsen N. Management of acute pericarditis. Curr Opin Cardiol 2023; 38:364-368. [PMID: 37115909 DOI: 10.1097/hco.0000000000001056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
PURPOSE OF REVIEW Provide an update on current management and most recent evidence in the treatment of pediatric pericarditis. RECENT FINDINGS While treatment of acute pericarditis has not significantly changed over the last decade, management of recurrent acute pericarditis, with increased attention to autoinflammation as a causal mechanism, has evolved substantially. This includes clinical trial evidence that newer medications targeting interleukin-1 receptors are effective in recurrent forms of pericarditis. In addition, advanced imaging utilizing cardiac magnetic resonance has emerged as a particularly effective way to detect ongoing pericardial inflammation in support of more difficult-to-treat patients. SUMMARY Recent advances in acute and recurrent pericarditis management have allowed for a more tailored approach to the individual patient. Yet, unresolved questions require further research.
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Affiliation(s)
- Sravani Avula
- Division of Pediatric Cardiology, UT Southwestern, Children's Medical Center, Dallas, Texas, USA
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Shahid R, Jin J, Hope K, Tunuguntla H, Amdani S. Pediatric Pericarditis: Update. Curr Cardiol Rep 2023; 25:157-170. [PMID: 36749541 PMCID: PMC9903287 DOI: 10.1007/s11886-023-01839-0] [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] [Accepted: 12/23/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW While there have now been a variety of large reviews on adult pericarditis, this detailed review specifically focuses on the epidemiology, clinical presentation, diagnosis, and management of pediatric pericarditis. We have tried to highlight most pediatric studies conducted on this topic, with special inclusion of important adult studies that have shaped our understanding of and management for acute and recurrent pericarditis. RECENT FINDINGS We find that the etiology of pediatric pericarditis differs from adult patients with pericarditis and has evolved over the years. Also, with the current COVID-19 pandemic, it is important for pediatric clinicians to be aware of pericardial involvement both due to the infection and from vaccination. Oftentimes, pericarditis maybe the only cardiac involvement in children with COVID-19, and so caregivers should maintain a high index of suspicion when they encounter children with pericarditis. Large-scale contemporary epidemiological data regarding incidence and prevalence of both acute and recurrent pericarditis is lacking in pediatrics, and future studies should focus on highlighting this important research gap. Most of the current management strategies for pediatric pericarditis are from experiences gathered from adult data. Pediatric multicenter trials are warranted to understand the best management strategy for those with acute and recurrent pericarditis. CASE VIGNETTE A 6-year-old child with a past history of pericarditis almost 2 months ago comes in with a 2-day history of chest pain and fever. Per mother, he stopped his steroids about 2 weeks ago, and for the last 2 days has had a temperature of 102F and has been complaining of sharp mid-sternal chest pain that gets worse when he lies down and is relieved when he sits up and leans forward. On examination, he is tachycardic (heart rate 160 bpm), with normal blood pressure for age. He appears to be in pain (5/10), and on auscultation has a pericardial friction rub. His lab studies are notable for elevated white blood cell count and inflammatory markers (CRP and ESR). His electrocardiogram reveals sinus tachycardia and diffuse ST-elevation in all precordial leads. His echocardiogram demonstrates normal biventricular function and a trace pericardial effusion. His cardiac MRI confirms recurrent pericarditis. He is started on indomethacin and colchicine. He has complete resolution of his symptoms by day 3 of admission and is discharged with close follow-up.
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Affiliation(s)
- Rida Shahid
- grid.239578.20000 0001 0675 4725Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, OH USA
| | - Justin Jin
- grid.413808.60000 0004 0388 2248Division of Pediatric Cardiology, Northwestern Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Kyle Hope
- grid.39382.330000 0001 2160 926XLillie Frank Abercrombie Division of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Hari Tunuguntla
- grid.39382.330000 0001 2160 926XLillie Frank Abercrombie Division of Pediatric Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX USA
| | - Shahnawaz Amdani
- grid.239578.20000 0001 0675 4725Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, OH USA
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Sasaki J, Sendi P, Hey MT, Evans CJ, Sasaki N, Totapally BR. The Epidemiology and Outcome of Pericardial Effusion in Hospitalized Children: A National Database Analysis. J Pediatr 2022; 249:29-34. [PMID: 35835227 DOI: 10.1016/j.jpeds.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the epidemiology of pericardial effusion in hospitalized children and evaluate risk factors associated with the drainage of pericardial effusion and hospital mortality. STUDY DESIGN A retrospective study of a national pediatric discharge database. RESULTS We analyzed hospitalized pediatric patients from the neonatal age through 20 years in the Kids' Inpatient Database 2016, extracting the cases of pericardial effusion. Of the 6 266 285 discharged patients recorded, 6417 (0.1%) were diagnosed with pericardial effusion, with the highest prevalence of 2153 patients in teens (13-20 years of age). Pericardial effusion was drained in 792 (12.3%), and the adjusted risk of pericardial drainage was statistically low with rheumatologic diagnosis (OR, 0.485; 95% CI, 0.358-0.657, P < .001). The overall mortality in children with pericardial effusion was 6.8% and 10.9% of those who required pericardial effusion drainage (P < .001). The adjusted risk of mortality was statistically high with solid organ tumor (OR, 1.538; 95% CI, 1.056-2.239, P = .025) and pericardial drainage (OR, 1.430; 95% CI, 1.067-1.915, P = .017) and low in all other age groups compared with neonates, those with cardiac structural diagnosis (OR, 0.322; 95% CI, 0.212-0.489, P < .001), and those with rheumatologic diagnosis (OR, 0.531; 95% CI, 0.334-0.846, P = .008). CONCLUSION The risk of mortality in hospitalized children with pericardial effusion was higher in younger children with solid organ tumors and those who required pericardial effusion drainage. In contrast, it was lower in older children with cardiac or rheumatologic diagnoses.
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Affiliation(s)
- Jun Sasaki
- Division of Pediatric Critical Care Medicine and Pediatric Cardiology, Weill Cornell Medicine/NewYork-Presbyterian Komansky Children's Hospital, New York, NY
| | - Prithvi Sendi
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL; Division of Critical Care Medicine, Nicklaus Children's Hospital, Miami, FL
| | - Matthew T Hey
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Cole J Evans
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Nao Sasaki
- Division of Pediatric Critical Care Medicine and Pediatric Cardiology, Weill Cornell Medicine/NewYork-Presbyterian Komansky Children's Hospital, New York, NY
| | - Balagangadhar R Totapally
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL; Division of Critical Care Medicine, Nicklaus Children's Hospital, Miami, FL
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Schwier NC, Stephens K, Johnson PN. Management of Idiopathic Viral Pericarditis in the Pediatric Population. J Pediatr Pharmacol Ther 2022; 27:595-608. [DOI: 10.5863/1551-6776-27.7.595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/06/2022] [Indexed: 11/11/2022]
Abstract
Idiopathic (viral) pericarditis (IP) is one of the most common etiologies of acute and recurrent pericarditis in children. IP is associated with significant morbidity, and recurrence rates of IP are high and require treatment to decrease risk of recurrence and pericarditis-related chest pain. Despite significant morbidity, sparse guidance exists to comprehensively address management of IP in children. The purpose of this review is to provide an overview of the pharmacotherapy of IP in children, including clinical pearls for managing pediatric patients. Clinicians should consider using the combination of colchicine and nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line therapy, in order to reduce the risk of recurrence and foster symptom improvement in IP. Colchicine dosing may vary depending on patient age, weight, concomitant pharmacotherapies, and disease states. Choice of NSAID should be based on cost, tolerability, and adverse drug events (ADEs). Children should receive higher NSAID attack dosing for >1 week to ensure a reduction in high sensitivity C-reactive protein concentrations and symptom relief. Corticosteroids should be considered last-line for treatment of IP in children, because they increase the risk of recurrence. Immunotherapies may be considered for children with multiple recurrences related to IP despite the use of NSAIDs, colchicine, and/or corticosteroids. Similar to adults, diligent monitoring should be implemented, to prevent drug-drug interactions, drug-disease interactions, and/or ADEs in children.
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Affiliation(s)
- Nicholas C. Schwier
- Department of Pharmacy Practice and the Office of Experiential Education (NCS), School of Pharmacy and Pharmaceutical Sciences, SUNY Binghamton, Johnson City, NY
| | - Katy Stephens
- Department of Pharmacy (KS), Oklahoma Children's Hospital at OU Health, Oklahoma City, OK
| | - Peter N. Johnson
- Department of Pharmacy: Clinical and Administrative Sciences (PNJ), College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Cesa K, Cunningham C, Harris T, Sunseri W. A Review of Extraintestinal Manifestations & Medication-Induced Myocarditis and Pericarditis in Pediatric Inflammatory Bowel Disease. Cureus 2022; 14:e26366. [PMID: 35911289 PMCID: PMC9334219 DOI: 10.7759/cureus.26366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/26/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a systemic disorder where extraintestinal symptoms may involve virtually any organ system. Of these extraintestinal symptoms, those involving the heart are relatively rare but associated with significant morbidity. We reviewed the existing literature on noninfectious myocarditis and pericarditis in the pediatric IBD population, including extraintestinal manifestations (EIMs) of IBD and extraintestinal complications (EICs) from medication. We focused on the incidence, presentation, diagnosis, treatment, and outcomes for timely diagnosis and management of these potentially deadly diseases. In addition, we aim to identify and highlight the gaps in current knowledge for future studies and investigations.
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Mehdizadegan N, Mohammadi H, Amoozgar H, Pournajaf S, Edraki MR, Naghshzan A, Yazdani MN. Pericardial effusion among children: Retrospective analysis of the etiology and short-term outcome in a referral center in the south of Iran. Health Sci Rep 2022; 5:e652. [PMID: 35620532 PMCID: PMC9125871 DOI: 10.1002/hsr2.652] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/09/2022] [Accepted: 04/21/2022] [Indexed: 12/14/2022] Open
Abstract
Background and Aims We reinvestigated the causes, symptoms, and management of childhood pericardial effusion (PE) and its gradual changes during recent years in a referral pediatric cardiology center in the south of Iran. Methods We retrospectively analyzed the profile of PE patients who were under 18 years old from 2015 to 2020. The patient's demographic, clinical, and paraclinical information was extracted and analyzed using SPSS software. Result In general, 150 out of 63,736 admitted patients (0.23% of the total pediatric admissions) were diagnosed with PE (male/female 1:1.17). The median age was 3.25 years (range:\ 2 days to 18 years; interquartile range: 9.5), and 50% of them were under 3 years of age. 32.6% had moderate to severe PE. Most patients presented with acute symptoms (68%) and respiratory problems, as the most common symptoms (30.6%). Tamponade signs were presented in 2% (n = 3) of the patients, and 80.7% (n = 121) were in a stable hemodynamic condition. In total, renal failure (22%) and parapneumonic effusion were the leading etiologies. Viral (7%) and bacterial (5%) pericarditis were the seventh and eighth causes; however, in severe cases, renal failure (22%) and bacterial pericarditis (14%) were dominant. In total, 14.1% (n = 21) of the patients needed pericardiocentesis that increased to 78.3% (n = 18) in severe cases. Only 6% had persistent PE for more than 3 months. Conclusion Childhood PE is mostly a result of renal failure and noninfectious causes. True pericarditis cases are not common, except in severe cases. It is more common in less than 3-year-old patients, and chronicity is rare. Severe cases had a high chance of pericardiocentesis, but other cases were mainly managed by treatment of the underlying causes.
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Affiliation(s)
- Nima Mehdizadegan
- Department of Pediatrics, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Hamid Mohammadi
- Department of Pediatrics, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Hamid Amoozgar
- Neonatology Research CenterShiraz University of Medical SciencesShirazIran
| | - Samira Pournajaf
- Department of Pediatrics, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Mohammad Reza Edraki
- Department of Pediatrics, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Amir Naghshzan
- Department of Pediatrics, School of MedicineShiraz University of Medical SciencesShirazIran
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Klein A, Cremer P, Kontzias A, Furqan M, Forsythe A, Crotty C, Lim-Watson M, Magestro M. Clinical Burden and Unmet Need in Recurrent Pericarditis: A Systematic Literature Review. Cardiol Rev 2022; 30:59-69. [PMID: 32956167 PMCID: PMC8812421 DOI: 10.1097/crd.0000000000000356] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Inflammation of the pericardium (pericarditis) is characterized by excruciating chest pain. This systematic literature review summarizes clinical, humanistic, and economic burdens in acute, especially recurrent, pericarditis, with a secondary aim of understanding United States treatment patterns and outcomes. Short-term clinical burden is well characterized, but long-term data are limited. Some studies report healthcare resource utilization and economic impact; none measure health-related quality-of-life. Pericarditis is associated with infrequent but potentially life-threatening complications, including cardiac tamponade (weighted average: 12.7% across 10 studies), constrictive pericarditis (1.84%; 9 studies), and pericardial effusion (54.7%; 16 studies). There are no approved pericarditis treatments; treatment guidelines, when available, are inconsistent on treatment course or duration. Most recommend first-line use of conventional treatments, for example, nonsteroidal antiinflammatory drugs with or without colchicine; however, 15-30% of patients experience recurrence. Second-line therapy may involve conventional therapies plus long-term utilization of corticosteroids, despite safety issues and the difficulty of tapering or discontinuation. Other exploratory therapies (eg, azathioprine, immunoglobulin, methotrexate, anakinra) present steroid-sparing options, but none are supported by robust clinical evidence, and some present tolerability challenges that may impact adherence. Pericardiectomy is occasionally pursued in treatment-refractory patients, although data are limited. This lack of an evidence-based treatment pathway for patients with recurrent disease is reflected in readmission rates, for example, 12.2% at 30 days in 1 US study. Patients with continued recurrence and inadequate treatment response need approved, safe, accessible treatments to resolve pericarditis symptoms and reduce recurrence risk without excessive treatment burden.
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Affiliation(s)
- Allan Klein
- From the Department of Cardiovascular Medicine, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Paul Cremer
- From the Department of Cardiovascular Medicine, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Apostolos Kontzias
- Department of Medicine, Division of Rheumatology, Allergy and Immunology, Center of Autoinflammatory Diseases, State University of New York Stonybrook, New York, NY
| | - Muhammad Furqan
- From the Department of Cardiovascular Medicine, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
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Ziesenitz VC, Welzel T, van Dyk M, Saur P, Gorenflo M, van den Anker JN. Efficacy and Safety of NSAIDs in Infants: A Comprehensive Review of the Literature of the Past 20 Years. Paediatr Drugs 2022; 24:603-655. [PMID: 36053397 PMCID: PMC9592650 DOI: 10.1007/s40272-022-00514-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in infants, children, and adolescents worldwide; however, despite sufficient evidence of the beneficial effects of NSAIDs in children and adolescents, there is a lack of comprehensive data in infants. The present review summarizes the current knowledge on the safety and efficacy of various NSAIDs used in infants for which data are available, and includes ibuprofen, dexibuprofen, ketoprofen, flurbiprofen, naproxen, diclofenac, ketorolac, indomethacin, niflumic acid, meloxicam, celecoxib, parecoxib, rofecoxib, acetylsalicylic acid, and nimesulide. The efficacy of NSAIDs has been documented for a variety of conditions, such as fever and pain. NSAIDs are also the main pillars of anti-inflammatory treatment, such as in pediatric inflammatory rheumatic diseases. Limited data are available on the safety of most NSAIDs in infants. Adverse drug reactions may be renal, gastrointestinal, hematological, or immunologic. Since NSAIDs are among the most frequently used drugs in the pediatric population, safety and efficacy studies can be performed as part of normal clinical routine, even in young infants. Available data sources, such as (electronic) medical records, should be used for safety and efficacy analyses. On a larger scale, existing data sources, e.g. adverse drug reaction programs/networks, spontaneous national reporting systems, and electronic medical records should be assessed with child-specific methods in order to detect safety signals pertinent to certain pediatric age groups or disease entities. To improve the safety of NSAIDs in infants, treatment needs to be initiated with the lowest age-appropriate or weight-based dose. Duration of treatment and amount of drug used should be regularly evaluated and maximum dose limits and other recommendations by the manufacturer or expert committees should be followed. Treatment for non-chronic conditions such as fever and acute (postoperative) pain should be kept as short as possible. Patients with chronic conditions should be regularly monitored for possible adverse effects of NSAIDs.
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Affiliation(s)
- Victoria C. Ziesenitz
- grid.5253.10000 0001 0328 4908Pediatric Cardiology and Congenital Heart Diseases, Centre for Child and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany ,grid.6612.30000 0004 1937 0642Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, University of Basel, Basel, Switzerland
| | - Tatjana Welzel
- grid.6612.30000 0004 1937 0642Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, University of Basel, Basel, Switzerland ,grid.411544.10000 0001 0196 8249Pediatric Rheumatology and Autoinflammatory Reference Center, University Hospital Tuebingen, Tuebingen, Germany
| | - Madelé van Dyk
- grid.1014.40000 0004 0367 2697Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Adelaide, SA Australia
| | - Patrick Saur
- grid.5253.10000 0001 0328 4908Pediatric Cardiology and Congenital Heart Diseases, Centre for Child and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Matthias Gorenflo
- grid.5253.10000 0001 0328 4908Pediatric Cardiology and Congenital Heart Diseases, Centre for Child and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Johannes N. van den Anker
- grid.6612.30000 0004 1937 0642Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel, University of Basel, Basel, Switzerland ,grid.239560.b0000 0004 0482 1586Division of Clinical Pharmacology, Children’s National Hospital, Washington DC, USA ,grid.416135.40000 0004 0649 0805Intensive Care and Department of Pediatric Surgery, Sophia Children’s Hospital, Rotterdam, The Netherlands
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Begic E, Iglica A, Gojak R, Baljic R, Begic Z, Durak-Nalbantić A, Halilcevic M, D�ubur A, Begic A, Lepara O, Begic N, Šljivo A, Naser N, Stanetic B. Pericardial effusion in postcoronavirus disease patients with preserved ejection fraction of the left ventricle and normal values of N-Terminal-Pro B-Type natriuretic peptide-link with C-Reactive protein and D-Dimer. Int J Appl Basic Med Res 2022; 12:157-160. [PMID: 36131860 PMCID: PMC9484506 DOI: 10.4103/ijabmr.ijabmr_802_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/27/2022] [Accepted: 04/29/2022] [Indexed: 11/04/2022] Open
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Schwier NC, Tsui J, Perrine JA, Guidry CM, Mathew J. Current pharmacotherapy management of children and adults with pericarditis: Prospectus for improved outcomes. Pharmacotherapy 2021; 41:1041-1055. [PMID: 34669979 DOI: 10.1002/phar.2640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/21/2021] [Accepted: 10/16/2021] [Indexed: 12/16/2022]
Abstract
Pericarditis is the most common inflammatory pericardial disease in both children and adults. Since the 2015 European Society of Cardiology Guidelines for the diagnosis and management of pericardial disease were published, there have been significant updates to management. Pharmacotherapy has been historically reserved for idiopathic pericarditis (IP). However, there has been increasing use of pharmacotherapies, such as anti-inflammatory therapies, colchicine, and immunotherapies for other causes of pericarditis, such as post-cardiac injury syndromes (PCIS). Nevertheless, the quality of data varies depending on PCIS or idiopathic etiologies, as well as the adult and pediatric population. High-dose anti-inflammatory therapies should be used to manage symptoms associated with either etiology of pericarditis in both adults and children, but do not ameliorate the inflammatory disease process. Choice of anti-inflammatory should be guided by drug-drug/disease interactions, cost, tolerability, patient age, and should be tapered accordingly over several weeks to months. Colchicine should be added as adjuvant therapy to anti-inflammatory therapies in adults and children with IP, as it has been shown to lower the risk of recurrence, reduce pericarditis symptoms, and improve morbidity. Colchicine is also reasonable to add to adults and children with pericarditis secondary to PCIS. Systemic glucocorticoids increase risk of recurrence in adults and children with IP and are reserved for second-line treatment in acute and recurrent IP; they are generally avoided in PCIS. Immunotherapies are regarded as third-line for recurrent IP in adults and children. Limited evidence exists to support their use in patients with pericarditis from PCIS. Pharmacovigilance strategies, such as C-reactive protein and adverse drug event monitoring, are also important toward balancing efficacy and safety of the various strategies used to manage pericarditis in adults and children.
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Affiliation(s)
- Nicholas C Schwier
- University of Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City, Oklahoma, USA
| | | | - Jordan A Perrine
- University of Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City, Oklahoma, USA
| | - Corey M Guidry
- University of Oklahoma Health Sciences Center College of Pharmacy, Oklahoma City, Oklahoma, USA
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14
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Soma G, Simmons MA, Canarie MF, Karnik R, Steele J, Tiyyagura G, Asnes J. A 13-Year-Old With Fever and Chest Pain. Pediatrics 2021; 148:peds.2021-050960. [PMID: 34344802 DOI: 10.1542/peds.2021-050960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | - Michael F Canarie
- Critical Care, Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut
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15
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Krasic S, Prijic S, Ninic S, Borovic R, Petrovic G, Stajevic M, Nesic D, Dizdarevic I, Djordjevic N, Vukomanovic V. Predictive factors of recurrence after pediatric acute pericarditis. J Pediatr (Rio J) 2021; 97:335-341. [PMID: 32738200 PMCID: PMC9432167 DOI: 10.1016/j.jped.2020.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The predisposing factors for pericarditis recurrence in the pediatric population have not yet been established. This study aimed to define the risk factors for the unfavorable prognosis of pediatric acute pericarditis. METHODS This was a retrospective study that included all patients with acute pericarditis treated from 2011 to 2019 at a tertiary referent pediatric center. RESULTS The study included 72 children. Recurrence was observed in 22.2% patients. Independent risk factors for recurrence were: erythrocyte sedimentation rate≥50mm/h (p=0.003, OR 186.3), absence of myocarditis (p=0.05, OR 15.2), C-reactive protein≥125mg/L (p=0.04, OR 1.5), and non-idiopathic etiology pericarditis (p=0.003, OR 1.3). Corticosteroid treatment in acute pericarditis was associated with a higher recurrence rate than treatment with non-steroid anti-inflammatory therapy (p=0.04). Furthermore, patients treated with colchicine in the primary recurrence had lower recurrence rate and median number of repeated infections than those treated without colchicine (p=0.04; p=0.007, respectively). CONCLUSION Independent risk factors for recurrence are absence of myocarditis, non-idiopathic etiology pericarditis, C-reactive protein≥125mg/L, and erythrocyte sedimentation rate≥50mm/h. Acute pericarditis should be treated with non-steroid anti-inflammatory therapy. A combination of colchicine and non-steroid anti-inflammatory drugs could be recommended as the treatment of choice in recurrent pericarditis.
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Affiliation(s)
- Stasa Krasic
- Mother and Child Health Institute of Serbia, Cardiology Department, Belgrade, Serbia
| | - Sergej Prijic
- Mother and Child Health Institute of Serbia, Cardiology Department, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Sanja Ninic
- Mother and Child Health Institute of Serbia, Cardiology Department, Belgrade, Serbia
| | - Ruzica Borovic
- Hospital "Sveti Vracevi", Pediatrics Department, Bijeljina, Bosnia and Herzegovina
| | - Gordana Petrovic
- Mother and Child Health Institute of Serbia, Immunology Department, Belgrade, Serbia
| | - Mila Stajevic
- University of Belgrade, School of Medicine, Belgrade, Serbia; Mother and Child Health Institute of Serbia, Cardiac Surgery Department, Belgrade, Serbia
| | - Dejan Nesic
- University of Belgrade, School of Medicine, Belgrade, Serbia; Institute of Medical Physiology "Rihard Burian", Belgrade, Serbia
| | - Ivan Dizdarevic
- Mother and Child Health Institute of Serbia, Cardiac Surgery Department, Belgrade, Serbia
| | - Nemanja Djordjevic
- Mother and Child Health Institute of Serbia, Cardiac Surgery Department, Belgrade, Serbia
| | - Vladislav Vukomanovic
- Mother and Child Health Institute of Serbia, Cardiology Department, Belgrade, Serbia; University of Belgrade, School of Medicine, Belgrade, Serbia.
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16
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Myers F, Aggarwal V, Bass JL, Berry JM, Knutson S, Narasimhan S, Steinberger J, Ambrose M, Shah KM, Hiremath G. Anatomic Approach and Outcomes in Children Undergoing Percutaneous Pericardiocentesis. Pediatr Cardiol 2021; 42:918-925. [PMID: 33590324 DOI: 10.1007/s00246-021-02563-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
Pericardiocentesis is traditionally performed using a subxiphoid approach. Hepatomegaly or loculated and noncircumferential effusions warrant nonstandard approaches to drain effusions; echocardiographic guidance has made these less traditional, non-subxiphoid approaches feasible. The study is aimed at comparing clinical outcomes of the subxiphoid and non-subxiphoid approaches to percutaneous pericardiocentesis in a pediatric population. This is a retrospective chart review of all children undergoing percutaneous pericardiocentesis from August 2008 to December 2019 at a single-center. A total of 104 patients underwent echocardiography-guided pericardiocentesis during the timeframe. Additionally, fluoroscopy was also used in 80 patients. Hematopoietic stem cell transplantation was the most common underlying diagnosis (n = 53, 50.9%). A non-subxiphoid approach was used in 58.6% (n = 61) of patients. The fifth and sixth intercostal spaces were the most commonly used (n = 17 each). The non-subxiphoid group tended to be older (95.9 vs. 21.7 months, p = 0.006) and weighed more (23.6 vs. 11.2 kgs, p = 0.013) as compared to the subxiphoid group. Non-subxiphoid approach was associated with shorter procedure times (21 vs. 37 min, p = 0.005). No major complications were seen. Five minor complications occurred and were equally distributed in the two groups. Complications were more likely in younger patients (p = 0.047). The technique and anatomic approach to pericardiocentesis, and the location or size of effusion did not influence the risk of complications. Echocardiography-guided percutaneous pericardiocentesis in children was associated with low complication rates in this single-center pediatric experience. The use of a non-traditional, non-subxiphoid approach was associated with shorter procedure times and did not significantly affect complication rates.
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Affiliation(s)
- Faith Myers
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA
| | - John L Bass
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA
| | - James M Berry
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA
| | - Stacie Knutson
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA
| | - Shanti Narasimhan
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA
| | - Julia Steinberger
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA
| | - Matthew Ambrose
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA
| | - Kavisha M Shah
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA
| | - Gurumurthy Hiremath
- Division of Pediatric Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, East Building Room MB547, Minneapolis, MN, 55454, USA.
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Lubocka P, Sabiniewicz R. Case Report: Unexplained Fever and Chest Pain in a 5-Year-Old. Front Pediatr 2021; 9:694678. [PMID: 34239851 PMCID: PMC8259459 DOI: 10.3389/fped.2021.694678] [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: 04/13/2021] [Accepted: 05/19/2021] [Indexed: 11/23/2022] Open
Abstract
Pericarditis is a rare, but severe cause of chest pain in children that can easily be overlooked during routine diagnostics. Fibrinous pericarditis was recognized in a 5-year old patient who presented with fever and chest pain. Despite thorough diagnostics, no evident etiological factor was found. Furthermore, the disease was unresponsive to broad-spectrum antibiotics and NSAIDs, however oral prednisone was found to cause rapid improvement in the patients' condition. It was presumed that the patient's condition was caused by a blunt trauma to the chest experienced 3 days prior to the onset of symptoms. In an 8-month follow-up the patient remains in good overall condition and no recurrences were observed.
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Affiliation(s)
- Paulina Lubocka
- Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdańsk, Gdańsk, Poland
| | - Robert Sabiniewicz
- Department of Pediatric Cardiology and Congenital Heart Disease, Medical University of Gdańsk, Gdańsk, Poland
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18
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Motonaga T, Furuta T, Okada S, Ohnishi Y, Suzuki Y, Yasudo H, Hasegawa S. Responses to Treatment According to the Cytokine Profiles of Pericardial Effusion in Two Children with Idiopathic Pericarditis. Int Heart J 2020; 61:1307-1310. [PMID: 33191347 DOI: 10.1536/ihj.20-282] [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] [Indexed: 11/18/2022]
Abstract
Acute pericarditis is inflammation of the pericardium with or without pericardial effusion. In the pediatric population, most patients with acute pericarditis are diagnosed with idiopathic pericarditis. Herein, we present two children with idiopathic pericarditis who underwent immunological assessment of pericardial effusion for the first time. Both patients showed equally high levels of interleukin-6 in the pericardial effusion. However, they had different treatment responses, in accordance with the pericardial effusion and serum interleukin-10 concentrations. Our present cases suggest that interleukin-10 may be associated with the response to anti-inflammatory therapy in idiopathic acute pericarditis.
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Affiliation(s)
- Takahiro Motonaga
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Takashi Furuta
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Seigo Okada
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Yuji Ohnishi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Yasuo Suzuki
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Hiroki Yasudo
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Shunji Hasegawa
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
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19
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Affiliation(s)
- Gal Barbut
- Maimonides Children's Hospital, Brooklyn, NY
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20
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Das BB, Dodson M, Guzman A. Recurrent pericarditis in an adolescent with Crohn's colitis. Ann Pediatr Cardiol 2020; 13:256-259. [PMID: 32863666 PMCID: PMC7437634 DOI: 10.4103/apc.apc_16_20] [Citation(s) in RCA: 2] [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: 01/31/2020] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 12/16/2022] Open
Abstract
Extraintestinal manifestations are common complications of inflammatory bowel disease (IBD), whereas the recurrent pericarditis during remission of Crohn's disease is rarely reported. Chest pain developed in a 13-year-old adolescent male who had a history of Crohn's colitis since 9 years of age and was in remission for 4 years after treatment with infliximab, adalimumab, and vedolizumab. Physicians should be aware of the pericardial involvement in patients with a history of IBD. The literature on pericardial involvement in Crohn's disease is reviewed with emphasis on the management of recurrent pericardial effusion in the pediatric age group.
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Affiliation(s)
- Bibhuti B Das
- Division of Pediatric Cardiology, Texas Children's Hospital, Austin Specialty Care, Austin, Texas, USA
| | - Morgan Dodson
- Division of Pediatric Cardiology, Texas Children's Hospital, Austin Specialty Care, Austin, Texas, USA
| | - Angel Guzman
- Division of Pediatric Cardiology, Texas Children's Hospital, Austin Specialty Care, Austin, Texas, USA
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21
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Tombetti E, Mulè A, Tamanini S, Matteucci L, Negro E, Brucato A, Carnovale C. Novel Pharmacotherapies for Recurrent Pericarditis: Current Options in 2020. Curr Cardiol Rep 2020; 22:59. [PMID: 32562029 PMCID: PMC7303578 DOI: 10.1007/s11886-020-01308-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recent advances have shown impressive results by anti-interleukin 1 (IL-1) agents in refractory idiopathic recurrent pericarditis. PURPOSE OF REVIEW: We critically discuss the current state of the art of therapy of relapsing pericarditis, with a focus on new pharmacological approaches and on specific clinical settings such as pregnancy, pediatric patients, and secondary forms of relapsing pericarditis. RECENT FINDINGS: Antagonism of the IL-1 is highly effective in idiopathic recurrent pericarditis with autoinflammatory features. Currently, available anti-IL-1 agents are anakinra and canakinumab. Rilonacept is another IL-1 antagonist, currently studied in the phase-3 clinical trial RHAPSODY. Available data suggest similar efficacy and safety profiles of these three agents, although only anakinra has been tested in randomized clinical trials. These agents have slightly different pharmacological properties, being canakinumab a specific IL-1ß antagonist while anakinra and rilonacept are unselective IL-1α and IL-1ß blockers. To date, there is no evidence that specificity against IL-1ß affects safety and efficacy in patients with relapsing pericarditis, although it has been proposed that unspecific blockage might be useful in severe disease. Anakinra is the first anti-IL-1 agent with well-documented efficacy and safety in adult and pediatric patients with idiopathic relapsing pericarditis. Other anti-IL-1 agents are currently under study. Future research should clarify the optimal duration of therapy and tapering schedule of treatment with these agents. Moreover, biomarkers would be required to understand which patients will benefit from early administration of IL-1 blockers due to refractoriness to conventional therapy and which others will suffer from recurrences during the tapering of these agents. Lastly, future studies should focus on the subjects with the autoimmune or the pauci-inflammatory phenotype of idiopathic refractory pericarditis.
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Affiliation(s)
- Enrico Tombetti
- Department of Biomedical and Clinical Sciences, Università di Milano, Fatebenefratelli Hospital, Milan, Italy
| | - Alice Mulè
- Internal Medicine, Fatebefratelli Hospital, Milan, Italy
| | | | - Luca Matteucci
- Internal Medicine, Fatebefratelli Hospital, Milan, Italy
| | - Enrica Negro
- Internal Medicine, Fatebefratelli Hospital, Milan, Italy
| | - Antonio Brucato
- Department of Biomedical and Clinical Sciences, Università di Milano, Fatebenefratelli Hospital, Milan, Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università di Milano, Via GB Grassi 74, 20157 Milan, Italy
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22
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Gura GF. Pediatric Pericarditis Case Report. J Pediatr Health Care 2020; 34:67-70. [PMID: 31831113 DOI: 10.1016/j.pedhc.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/04/2019] [Accepted: 09/15/2019] [Indexed: 11/15/2022]
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23
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Vukomanovic V, Prijic S, Krasic S, Borovic R, Ninic S, Nesic D, Bjelakovic B, Popovic S, Stajević M, Petrović G. Does Colchicine Substitute Corticosteroids in Treatment of Idiopathic and Viral Pediatric Pericarditis? MEDICINA-LITHUANIA 2019; 55:medicina55100609. [PMID: 31547038 PMCID: PMC6843123 DOI: 10.3390/medicina55100609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/07/2019] [Accepted: 09/16/2019] [Indexed: 12/12/2022]
Abstract
Background and Objectives: Recurrence of pericarditis (ROP) is an important complication of the acute pericarditis. The aim of this study was to analyse the influence of aetiology, clinical findings and treatment on the outcome of acute pericarditis. Methods: Data were retrospectively collected from medical records of patients treated from 2011 to 2019 at a tertiary referent heart paediatric center. Results: Our investigation included 56 children with idiopathic and viral pericarditis. Relapse was registered in 8/56 patients, 2/29 (7.41%) treated with nonsteroidal anti-inflammatory drugs (NSAID) and 6/27 (28.57%) treated with corticosteroids (CS) and NSAID. Independent risk factors for ROP were viral pericarditis (p = 0.01, OR 31.46), lack of myocardial affection (p = 0.03, OR 29.15), CS use (p = 0.02, OR 29.02) and ESR ≥ 50 mm/h (p = 0.03, OR 25.23). In 4/8 patients the first recurrence was treated with NSAID and colchicine, while treatment of 4/8 patients included CS. Children with ROP treated with CS had higher median number of recurrence (5, IQR: 2–15) than those treated with colchicine (0, IQR: 0–0.75). Conclusions: Independent risk factors for recurrence are CS treatment, viral aetiology, pericarditis only and ESR ≥ 50 mm/h. Acute pericarditis should be treated with NSAID. Colchicine and NSAID might be recommended in children with the first ROP.
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Affiliation(s)
- Vladislav Vukomanovic
- Cardiology Department, Mother and Child Health Care Institute of Serbia "Dr.Vukan Cupic", 11070 Belgrade, Serbia.
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
| | - Sergej Prijic
- Cardiology Department, Mother and Child Health Care Institute of Serbia "Dr.Vukan Cupic", 11070 Belgrade, Serbia.
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
| | - Stasa Krasic
- Cardiology Department, Mother and Child Health Care Institute of Serbia "Dr.Vukan Cupic", 11070 Belgrade, Serbia.
| | - Ruzica Borovic
- Pediatrics Department, Hospital "Sveti Vracevi", 76300 Bijeljina, Bosnia and Herzegovina.
| | - Sanja Ninic
- Cardiology Department, Mother and Child Health Care Institute of Serbia "Dr.Vukan Cupic", 11070 Belgrade, Serbia.
| | - Dejan Nesic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
- Institute of Medical Physiology "Rihard Burian", 11000 Belgrade, Serbia.
| | - Bojko Bjelakovic
- Clinic of Pediatrics, Clinical Center Nis, School of Medicine, University of Nis, 18000 Nis, Serbia.
| | - Sasa Popovic
- Cardiology Department, Mother and Child Health Care Institute of Serbia "Dr.Vukan Cupic", 11070 Belgrade, Serbia.
| | - Mila Stajević
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
- Cardiac Surgery Department, Mother and Child Health Care Institute of Serbia "Dr.Vukan Cupic", 11070 Belgrade, Serbia.
| | - Gordana Petrović
- Immunology Department, Mother and Child Health Care Institute of Serbia "Dr.Vukan Cupic", 11070 Belgrade, Serbia.
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24
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Perez-Brandão C, Trigo C, F Pinto F. Pericarditis - Clinical presentation and characteristics of a pediatric population. Rev Port Cardiol 2019; 38:97-101. [PMID: 30876791 DOI: 10.1016/j.repc.2018.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 05/01/2018] [Accepted: 05/13/2018] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Pericarditis is an inflammation of the pericardium. It may be infectious or secondary to a systemic disease. The aim of this study was to analyze the clinical findings, course, treatment and follow-up of children diagnosed with pericarditis at our center. METHODS We performed a retrospective analysis of all children admitted to our pediatric cardiology unit with pericarditis between 2003 and 2015. Patient characteristics were summarized using frequencies and percentages for categorical variables and medians with percentiles for continuous variables. RESULTS Fifty patients were analyzed (40 male, 10 female) with a median age of 14 years. The most common diagnosis was acute pericarditis (80%). Thirty-five patients (70%) presented with chest pain and 26% reported fever. Cardiomegaly was identified on chest X-ray in 11 patients (22%), 30 patients (60%) had an abnormal ECG and 44 patients (80%) had alterations on the transthoracic echocardiogram. In 17 cases (34%) there was myocardial involvement. Forty-eight percent of patients presented with infectious pericarditis and the pathologic agent was identified in half of them. Postpericardiotomy syndrome was diagnosed in five cases. The first-line therapy was aspirin in 50% of cases. Pericardiocentesis was performed in 12 patients. The median length of stay was nine days. There was symptom recurrence in seven children. CONCLUSIONS In this study, acute infectious pericarditis was the most common presentation and about one third of patients also had myocarditis. The symptom recurrence rate was not negligible and is probably related to the type of therapy employed.
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Affiliation(s)
- Catarina Perez-Brandão
- Serviço de Cardiologia Pediátrica, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal.
| | - Conceição Trigo
- Serviço de Cardiologia Pediátrica, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
| | - Fátima F Pinto
- Serviço de Cardiologia Pediátrica, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal
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25
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Perez-Brandão C, Trigo C, Pinto FF. Pericarditis – clinical presentation and characteristics of a pediatric population. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2018.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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26
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Affiliation(s)
- Hari Tunuguntla
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Aamir Jeewa
- Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susan W Denfield
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
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27
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Tombetti E, Giani T, Brucato A, Cimaz R. Recurrent Pericarditis in Children and Adolescents. Front Pediatr 2019; 7:419. [PMID: 31681717 PMCID: PMC6813188 DOI: 10.3389/fped.2019.00419] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/02/2019] [Indexed: 12/13/2022] Open
Abstract
Recurrent pericarditis (RP) is a clinical syndrome characterized by recurrent attacks of acute pericardial inflammation. Prognosis quoad vitam is good, although morbidity might be significant, especially in children and adolescents. Multiple potential etiologies result in RP, in the vast majority of cases through autoimmune or autoinflammatory mechanisms. Idiopathic RP is one of the most frequent diagnoses, that requires the exclusion of all known etiologies. Therapeutic advances in the last decade have been significant with the recognition of the effectiveness of anti IL1 therapy, but a correct diagnostic and therapeutic algorithm is of key importance. Unfortunately, most of evidence comes from studies in adult patients. Here we review the etiopathogenesis, diagnosis and management of RP in pediatric patients.
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Affiliation(s)
- Enrico Tombetti
- Department of Medicine, Azienda Socio Sanitaria Territoriale (ASST) Fetebenefratelli-Sacco and Department of "Biomedical and Clinical Sciences Luigi Sacco", Milan University, Milan, Italy
| | - Teresa Giani
- Rheumatology Unit, Department of Pediatrics, Anna Meyer Children's Hospital, University of Florence, Florence, Italy.,Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Antonio Brucato
- Department of Medicine, Azienda Socio Sanitaria Territoriale (ASST) Fetebenefratelli-Sacco and Department of "Biomedical and Clinical Sciences Luigi Sacco", Milan University, Milan, Italy
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Azienda Socio Sanitaria Territoriale (ASST) G.Pini, Milan, Italy
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Shin JH, Lee DH, Choi HJ. Colchicine for steroid-resistant recurrent pericarditis in a child. Yeungnam Univ J Med 2018; 35:222-226. [PMID: 31620598 PMCID: PMC6784700 DOI: 10.12701/yujm.2018.35.2.222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/04/2018] [Accepted: 01/17/2018] [Indexed: 12/25/2022] Open
Abstract
Recurrent pericarditis is rare in children and is considered idiopathic in most cases. Its course is chronic, and preventing recurrences is important for the patient's quality of life. Although a treatment strategy in pediatric recurrent pericarditis has not yet been established, non-steroidal anti-inflammatory drugs (NSAIDs) are the most common treatment for management of this condition, followed by corticosteroids, colchicine, immunosuppressive agents, immunoglobulins, and interleukin-1β receptor antagonists (e.g. anakinra). Herein, we report a case of recurrent pericarditis with pericardial effusion in a 5-year-old child who presented with fever and epigastric pain. He responded poorly to NSAIDs and corticosteroid therapy, but was successfully treated with colchicine.
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Affiliation(s)
- Ju Hee Shin
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
| | - Dong Hyun Lee
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
| | - Hee Joung Choi
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
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Baskar S, Betancor J, Patel K, El Yaman M, Cremer PC, Zeft AS, Klein AL. Cardiac MRI in evaluation and management of pediatric pericarditis. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.05.003] [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: 10/28/2022]
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Brucato A, Emmi G, Cantarini L, Di Lenarda A, Gattorno M, Lopalco G, Marcolongo R, Imazio M, Martini A, Prisco D. Management of idiopathic recurrent pericarditis in adults and in children: a role for IL-1 receptor antagonism. Intern Emerg Med 2018; 13:475-489. [PMID: 29633070 DOI: 10.1007/s11739-018-1842-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/21/2018] [Indexed: 01/01/2023]
Abstract
Recurrent pericarditis is one of the most frequent pericardial diseases, affecting up to 30% of the patients who have experienced acute pericarditis. While the diagnosis of acute pericarditis is sometime straight forward, its etiology and therapeutic management are still a challenge for physicians. In developed countries, the idiopathic form is the most frequent, and the search for an infectious etiology is almost invariably negative. Nevertheless, since standard treatment with nonsteroidal anti-inflammatory drugs and colchicine is not always able to neutralize pericardial inflammation in recurrent pericarditis, anakinra, an IL-1 receptor antagonist, has been proposed as a possible therapeutic alternative for refractory forms. IL-1 is a cytokine that exerts a pivotal role in innate immunity and in the pathogenesis of some autoimmune diseases, such as rheumatoid arthritis, and in autoinflammatory disorders, as familial Mediterranean fever and cryopyrin-associated periodic syndromes. The successful management of patients with acute idiopathic recurrent pericarditis (IRP) needs a teamwork approach, where cardiologists, rheumatologists, clinical immunologists and internists are involved. In this review, we will discuss the clinical and therapeutical challenges of IRP both in adults and children from a clinical practice standpoint. We will also briefly illustrate the main pathogenic mechanisms of IRP to provide internists and cardiologists with the rationale for approaching the use of anakinra in selected clinical cases.
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Affiliation(s)
- Antonio Brucato
- Internal Medicine Division, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Largo Brambilla 3, 50134, Firenze, Italy.
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease Clinic and Rheumatology-Ophthalmology Collaborative Uveitis Center, University of Siena, Siena, Italy
| | | | - Marco Gattorno
- Unit of Autoinflammatory Diseases and Immunodeficiencies, Clinic of Pediatrics and Rheumatology, "G. Gaslini" Institute, Genoa, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Renzo Marcolongo
- Clinical Immunology, Department of Medicine, Azienda Ospedaliera-Università, Padua, Italy
| | - Massimo Imazio
- AOU Città della Salute e della Scienza di Torino, University Cardiology, Torino, Italy
| | - Alberto Martini
- Unit of Autoinflammatory Diseases and Immunodeficiencies, Clinic of Pediatrics and Rheumatology, "G. Gaslini" Institute, Genoa, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, Largo Brambilla 3, 50134, Firenze, Italy
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Kang YL, Cui Y, Wu Y, Hao S, Kuang XY, Zhang YC, Huang WY, Zhu GH. Chylopericardium in a child with IgA nephropathy: a case report. BMC Pediatr 2018; 18:127. [PMID: 29618325 PMCID: PMC5885464 DOI: 10.1186/s12887-018-1101-3] [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: 04/20/2016] [Accepted: 03/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chylopericardium effusion is characterized by the accumulation of milky effusion in the pericardium. It is often idiopathic but it can be secondary to trauma, chest radiation, tuberculosis and malignancy. If cardiac tamponade ensues, it becomes life-threatening. Herein we describe chylopericardium tamponade in a child with IgA nephropathy. To the best of our knowledge, this is the first reported case of chylopericardium tamponade in IgA nephropathy. CASE PRESENTATION A 6 years old boy with IgA nephropathy presented with dyspnea, orthopnea, pretibial pitting edema, ascites and fever. Muffled heart sounds and hepatomegaly were also noted. Echocardiography and thoracic CT revealed that there was a large volume of hydropericardium. Moreover, the pericardial milky fluid by pericardiocentesis was analyzed and chylopericardium effusion was eventually confirmed. Pericardial drainage was continued and his diet was modified to low fat, rich MCT and high protein. Complete remission was achieved after 3 weeks of this combined treatment. CONCLUSION Chylopericardial tamponade could be a rare and life-threatening complication of IgA nephropathy. Etiological analysis is critical for determining the therapeutic approach in patients with pericardial effusion.
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Affiliation(s)
- Yu-Lin Kang
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yun Cui
- Pediatric Intensive Care Unit, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Wu
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shen Hao
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xin-Yu Kuang
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Cai Zhang
- Pediatric Intensive Care Unit, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wen-Yan Huang
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Guang-Hua Zhu
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
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Characteristics of Non-postoperative Pediatric Pericardial Effusion: A Multicenter Retrospective Cohort Study from the Pediatric Health Information System (PHIS). Pediatr Cardiol 2018; 39:347-353. [PMID: 29086807 DOI: 10.1007/s00246-017-1762-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022]
Abstract
Little is known about the causes and risks of non-postoperative pericardial effusion (PCE) in pediatric patients. We sought to assess the diagnoses most frequently associated with admissions for PCE, and to determine if certain conditions were associated with higher in-hospital mortality and rates of readmission. Nationally distributed data from 44 pediatric hospitals in the 2004-2015 Pediatric Health Information System database were used to identify patients with hospital admissions for International Classification of Disease, Ninth Revision (ICD-9) codes for PCE and/or cardiac tamponade. Children with congenital heart disease were excluded. ICD-9 codes for conditions associated with PCE were grouped into eight categories: neoplastic, renal, autoimmune/inflammatory, pneumonia, viral, bacterial, hypothyroidism, and idiopathic. Multivariable models were used to evaluate odds of in-hospital mortality and readmission within 30 and 90 days. There were 9902 patients who met inclusion criteria. Total in-hospital mortality was 8.2% (n = 813); of those without a neoplastic diagnosis, mortality was 6.5% (n = 493/7543). Idiopathic PCE accounted for the most admissions (36%), followed by neoplasms (24%), pneumonia (20%), and autoimmune/inflammatory disease (19%). In multivariable models, odds of death were highest for neoplasms (adjusted odds ratio 3.83, p < 0.001) and renal disease (adjusted odds ratio 2.86, p < 0.001). Children with a neoplasm, renal disease, and those undergoing pericardiocentesis had the highest rates of readmission at 30 and 90 days. Children admitted with non-postoperative PCE have multiple associated conditions. Neoplasm and renal disease in the setting of PCE are associated with the highest odds of in-hospital mortality among concomitant conditions; children with a neoplasm, renal disease, and those undergoing pericardiocentesis have the highest odds of readmission.
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Abstract
Pericardial diseases are not uncommon in daily clinical practice. The spectrum of these syndromes includes acute and chronic pericarditis, pericardial effusion, constrictive pericarditis, congenital defects, and neoplasms. The extent of the high-quality evidence on pericardial diseases has expanded significantly since the first international guidelines on pericardial disease management were published by the European Society of Cardiology in 2004. The clinical practice guidelines provide a useful reference for physicians in selecting the best management strategy for an individual patient by summarizing the current state of knowledge in a particular field. The new clinical guidelines on the diagnosis and management of pericardial diseases that have been published by the European Society of Cardiology in 2015 represent such a tool and focus on assisting the physicians in their daily clinical practice. The aim of this review is to outline and emphasize the most clinically relevant new aspects of the current guidelines as compared with its previous version published in 2004.
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Alabed S, Pérez-Gaxiola G, Burls A. Colchicine for children with pericarditis: systematic review of clinical studies. Arch Dis Child 2016; 101:953-6. [PMID: 27083755 DOI: 10.1136/archdischild-2015-310287] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/24/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To review the evidence for the efficacy and safety of colchicine in children with pericarditis. DESIGN Systematic review. SEARCH STRATEGY The following databases were searched for studies about colchicine in children with pericarditis (June 2015): Cochrane Central, Medline, EMBASE and LILACS. ELIGIBILITY CRITERIA All observational and experimental studies on humans with any length of follow-up and no limitations on language or publication status were included. The outcomes studied were recurrences of pericarditis and adverse events. DATA EXTRACTION Two authors extracted data and assessed quality of included studies using the Cochrane risk of bias tool for non-randomised trials. RESULTS Two case series and nine case reports reported the use of colchicine in a total of 86 children with pericarditis. Five articles including 74 paediatric patients were in favour of colchicine in preventing further pericarditis recurrences. Six studies including 12 patients showed that colchicine did not prevent recurrences of pericarditis. LIMITATIONS No randomised controlled trials (RCTs) were found. CONCLUSIONS Although colchicine is an established treatment for pericarditis in adults, it is not routinely used in children. There is not enough evidence to support or discourage the use of colchicine in children with pericarditis. Further research in the form of large double-blind RCTs is needed to establish the efficacy of colchicine in children with pericarditis.
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Affiliation(s)
- Samer Alabed
- Academic Radiology Registrar at Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Amanda Burls
- Professor of Public Health, City University London, London, UK
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Imazio M, Brucato A, Badano L, Charron P, Adler Y. Whatʼs new in 2015 ESC guidelines on pericardial diseases? J Cardiovasc Med (Hagerstown) 2016; 17:315-22. [DOI: 10.2459/jcm.0000000000000358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, Brucato A, Gueret P, Klingel K, Lionis C, Maisch B, Mayosi B, Pavie A, Ristić AD, Sabaté Tenas M, Seferovic P, Swedberg K, Tomkowski W. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2015; 36:2921-2964. [PMID: 26320112 PMCID: PMC7539677 DOI: 10.1093/eurheartj/ehv318] [Citation(s) in RCA: 1383] [Impact Index Per Article: 153.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Yehuda Adler
- Corresponding authors: Yehuda Adler, Management, Sheba Medical Center, Tel Hashomer Hospital, City of Ramat-Gan, 5265601, Israel. Affiliated with Sackler Medical School, Tel Aviv University, Tel Aviv, Israel, Tel: +972 03 530 44 67, Fax: +972 03 530 5118,
| | - Philippe Charron
- Corresponding authors: Yehuda Adler, Management, Sheba Medical Center, Tel Hashomer Hospital, City of Ramat-Gan, 5265601, Israel. Affiliated with Sackler Medical School, Tel Aviv University, Tel Aviv, Israel, Tel: +972 03 530 44 67, Fax: +972 03 530 5118,
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