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Bass R, Mascarenhas M, Kelly A, Mousa H. Gastroesophageal reflux burden in youth with CF treated with elexacaftor-tezacaftor-ivacaftor. Pediatr Pulmonol 2023; 58:3637-3640. [PMID: 37737463 DOI: 10.1002/ppul.26694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/21/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Rosara Bass
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria Mascarenhas
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrea Kelly
- Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Endocrinology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hayat Mousa
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Tindall A, Mascarenhas M, Maqbool A, Stallings VA. Corrigendum to 'Lysophosphatidylcholine-Rich Nutrition Therapy Increased Gut Absorption of Coingested Dietary Fat: a Randomized Controlled Trial' [Curr Dev Nutr. 2023 Sep; 7(9): 101985]. Curr Dev Nutr 2023; 7:102030. [PMID: 38116520 PMCID: PMC10730306 DOI: 10.1016/j.cdnut.2023.102030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
[This corrects the article DOI: 10.1016/j.cdnut.2023.101985.].
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Affiliation(s)
- Alyssa Tindall
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, PA, United States
| | - Maria Mascarenhas
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, PA, United States
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, PA, United States
| | - Asim Maqbool
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, PA, United States
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, PA, United States
| | - Virginia A. Stallings
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, PA, United States
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, PA, United States
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Abu-El-Haija M, Hornung L, Ellery K, Fishman DS, Gonska TY, Gariepy C, Lowe M, Larson Ode K, Maqbool A, Mascarenhas M, Morinville VD, Ooi CY, Perito ER, Schwarzenberg SJ, Sellers ZM, Zemel BS, Yuan Y, Wang F, Uc A, Kalkwarf HJ. Bone health in children with recurrent and chronic pancreatitis: A multi-center cross sectional analysis. Pancreatology 2023; 23:755-760. [PMID: 37723006 PMCID: PMC10843133 DOI: 10.1016/j.pan.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/02/2023] [Accepted: 08/25/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND/OBJECTIVES Bone health of children with acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) is not well studied. METHODS This retrospective study was performed at three sites and included data from INSPPIRE-2. RESULTS Of the 87 children in the study: 46 had ARP (53%), 41 had CP (47%). Mean age was 13.6 ± 3.9 years at last DXA scan. The prevalence of low height-for-age (Z-score < -2) (13%, 10/78) and low bone mineral density (BMD) adjusted for height (Z-score < -2) (6.4%, 5/78) were higher than a healthy reference sample (2.5%, p < 0.0001 and p = 0.03, respectively). CONCLUSION Children with ARP or CP have lower height and BMD than healthy peers. Attention to deficits in growth and bone mineral accrual in children with pancreatic disease is warranted.
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Affiliation(s)
- Maisam Abu-El-Haija
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Lindsey Hornung
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kate Ellery
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Douglas S Fishman
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | | | | | - Mark Lowe
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, MO, USA
| | - Katie Larson Ode
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA; Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA, USA
| | - Asim Maqbool
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maria Mascarenhas
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Chee Y Ooi
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Medicine and Health, University of New South Wales and Department of Gastroenterology, Sydney Children's Hospital Randwick, Sydney, Australia
| | - Emily R Perito
- University of California San Francisco, San Francisco, CA, USA
| | | | - Zachary M Sellers
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Stanford University, Palo Alto, CA, USA
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ying Yuan
- Department of Biostatistics, University of Texas MD, Anderson Cancer Center, Huston, TX, USA
| | - Fuchenchu Wang
- Department of Biostatistics, University of Texas MD, Anderson Cancer Center, Huston, TX, USA
| | - Aliye Uc
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA; Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA, USA; Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Heidi J Kalkwarf
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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4
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Irving SY, Berry KG, Morgan S, Seiple SM, Nagle ML, Stetzer M, Tabatabaei N, Murphy S, Srinivasan V, Mascarenhas M. Nutrition association with skin integrity and pressure injury in critically ill pediatric patients. Nutr Clin Pract 2023; 38 Suppl 2:S125-S138. [PMID: 37721464 DOI: 10.1002/ncp.11063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Current research highlights the positive impact of nutrition therapy, particularly enteral nutrition, in critical illness. However, little attention is given to the impact of nutrition on skin integrity during critical illness. Skin integrity is at risk in critically ill children owing to necessary clinical therapies and challenges of providing nutrition therapy. METHODS We conducted a narrative literature review with three main thematic concepts to drive our literature search: the association of nutrition therapy with (1) skin integrity; (2) injury, wounds, and wound healing; and (3) differences of skin color. Using pertinent search and subject terms, PubMed, CINAHL, EMBASE, and SCOPUS databases were searched, yielding 316 articles. After removal of duplicates, articles were reviewed based on inclusion and exclusion criteria defined by the authors; only eight articles met the defined criteria to inform this review. RESULTS Large and important gaps exist in the current literature regarding an association between nutrition therapy, skin injury, and wound healing. Little to no attention was found for associations with skin color. The resulting narrative review addresses these topics and subtopics with additional references included that are independent of the original search strategy. CONCLUSIONS A dearth of evidence exists describing associations between nutrition and disruption of skin integrity in pediatric critical illness. Children with dark skin are at increased risk, as manifestation and identification of disruption to skin integrity may not be recognized. Research is needed to describe these associations and the impact of nutrition on skin integrity, including differences of skin color.
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Affiliation(s)
- Sharon Y Irving
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Department of Nursing and Clinical Care Services, Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Katarina G Berry
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sherry Morgan
- Holman Biotech Commons, Robert Wood Johnson Pavilion, Philadelphia, Pennsylvania, USA
| | - Stephanie M Seiple
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Monica L Nagle
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Molly Stetzer
- Wound Ostomy and Vascular Access Services, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Neeka Tabatabaei
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sara Murphy
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Vijay Srinivasan
- Division of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Maria Mascarenhas
- Department of Clinical Nutrition, Division of Gastroenterology and Nutrition, Philadelphia, Pennsylvania, USA
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5
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Tindall A, Mascarenhas M, Maqbool A, Stallings VA. Lysophosphatidylcholine-Rich Nutrition Therapy Increased Gut Absorption of Coingested Dietary Fat: a Randomized Controlled Trial. Curr Dev Nutr 2023; 7:101985. [PMID: 37671264 PMCID: PMC10475471 DOI: 10.1016/j.cdnut.2023.101985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 09/07/2023] Open
Abstract
Unintentional weight loss is common in persons with chronic and acute disease and is often caused by insufficient intake or malabsorption. A new lysophosphatidylcholine (LPC)-rich structured lipid powder has micelle-like activity that facilitates digestion and absorption, independent of lipase and bile acids. The aim of this secondary analysis was to determine if recycled LPC increased fat absorption of coingested food. Fasting plasma fatty acid (FA) concentrations were measured at baseline and 3 mo in children (n = 84) with cystic fibrosis and pancreatic insufficiency. Plasma palmitic acid was selected because of its dietary prevalence and was a minor component of the LPC product. Palmitic acid increased 15% in the LPC product-treated total subjects (P = 0.01) and 23% in the subgroup with more severe malabsorption (P = 0.007), with no change in either group on placebo. Total FAs increased 11% (P = 0.009) and 20% (P = 0.005), respectively. Increased palmitic acid and total FA suggest that LPC provided by the product created an intraluminal environment that increased coingested dietary fat absorption and provided more calories. This trial was registered at clinicaltrials.gov as NCT00406536.
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Affiliation(s)
- Alyssa Tindall
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, PA, United States
| | - Maria Mascarenhas
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, PA, United States
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, PA, United States
| | - Asim Maqbool
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, PA, United States
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, PA, United States
| | - Virginia A. Stallings
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, PA, United States
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, PA, United States
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6
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Benitez AJ, McGar A, Kohser K, Gibbons T, Muir A, Mascarenhas M, Rossi C, Dogias F, Golden A, Kassam-Adams N, Marsac ML. The Cellie Coping Kit for children with Eosinophilic Esophagitis: Feasibility, acceptability, and preliminary outcomes. J Child Health Care 2023; 27:374-385. [PMID: 34978212 PMCID: PMC11007661 DOI: 10.1177/13674935211064126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Children with eosinophilic esophagitis (EoE) are faced with ongoing treatments that can impact their wellbeing. There are no evidence-based resources that families can implement independently to cope with EoE-related stressors. This study aimed to examine acceptability, feasibility, and preliminary outcomes of the newly developed Cellie Coping Kit for Children with EoE intervention. Forty child-caregiver dyads completed a baseline assessment (T1) and initiated the intervention; 30 (75%) child participants and 33 (82.5%) caregivers were retained to follow-up (T2). Of those who completed the T2 assessment, most reported that the intervention was easy to use (>90%) and would recommend the intervention to others (>90%). The intervention was feasible: >70% used the kit, and most indicated they would use it again (>75%). More than half of families reported learning new information and/or coping strategies. No statistically significant changes were identified in comparing T1 and T2 coping and health-related quality of life. These findings suggest that the Cellie Coping Kit for Children with EoE is a promising intervention in that it was well accepted, feasible, and helped many families learn novel strategies on how to manage EoE challenges. Future research should examine how to strengthen the intervention to achieve longer-term targeted outcomes.
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Affiliation(s)
- Alain J Benitez
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ashley McGar
- University of Kentucky School of Medicine and Kentucky Children’s Hospital, Lexington, KY, USA
| | - Kristen Kohser
- Center for Pediatric Traumatic Stress, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Troy Gibbons
- University of Kentucky School of Medicine and Kentucky Children’s Hospital, Lexington, KY, USA
| | - Amanda Muir
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Maria Mascarenhas
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Carmen Rossi
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Francesca Dogias
- Center for Pediatric Traumatic Stress, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anneliese Golden
- Center for Pediatric Traumatic Stress, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nancy Kassam-Adams
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Pediatric Traumatic Stress, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Meghan L Marsac
- University of Kentucky School of Medicine and Kentucky Children’s Hospital, Lexington, KY, USA
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7
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Mascarenhas M, Nobrega N, Fleming R, Gaudoin M. O-293 The GnRH-agonist trigger alone can be used for egg maturation in altruistic egg donors using long-acting reversible contraceptives without compromising the outcome. Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Does use of long-acting reversible contraceptives (LARC) compromise the efficacy of a GnRH agonist trigger in egg donors?
Summary answer
Using a GnRH-agonist trigger in altruistic egg donors using LARCs does not appear to compromise oocyte yield or maturity.
What is known already
GnRH-agonist triggers are recommended for altruistic egg donors to reduce the risk of ovarian hyperstimulation syndrome (OHSS) as any impact on the luteal phase would be clinically irrelevant. There is increasing usage of LARCs by young women due to their convenience and side-effect profile. A recent British Fertility Society survey (Mascarenhas et. al., 2021) indicated that many clinicians recommend removal before starting ovarian stimulation which incurs inconvenience to the donors and also risks unintended pregnancy. We had previously confirmed that women with LARC would respond to a GnRH-agonist trigger with an LH release deemed sufficient to induce oocyte maturation.
Study design, size, duration
Electronic records of 56 altruistic egg donation cycles with a GnRH-agonist trigger between January 2017 and December 2021 were retrospectively analysed. Of these, 38 were not on contraception or using non-hormonal contraceptive methods (Nil group), five were using oral contraception (Pill group), nine had a copper or levonorgesterol intrauterine device in situ (IUCD group) and four had a LARC in situ (LARC group).
Participants/materials, setting, methods
All stimulation involved GnRH-antagonist control. Donors with IUCDs or LARCs in situ were advised they could continue on their choice of contraception throughout the egg donation process. Oocyte retrieval was performed 36-37 hours post-GnRH-agonist trigger. The number of oocytes retrieved and the number of mature oocytes were recorded. As the numbers were small, the data is presented as median and interquartile range (IQR) and, given the small numbers, statistical analyses were expectedly, not significantly different.
Main results and the role of chance
The median age and AMH of the Nil group was 27.2 (IQR 25.4-29.3) years and 41.0 (IQR 33.0-65.3) pmol/L, for the IUCD group was 28.8 (IQR 24.8-29.3) years and 45.0 (IQR 38.0-54.0) pmol/L, and for the Pill group was 26.0 (IQR 24.0-27.2) years and 36.0 (31.0-40.0) pmol/L. Women in the LARC group were younger than in the nil group with a median age of 23.3 (IQR 22.6-23.6) (p = 0.016), but with no significant difference in the AMH levels 32.6 (IQR 22.8-40.5) pmol/L.
There was no difference apparent in the number of oocytes retrieved between the groups: Nil group = 18.5 (IQR 12-24); Pill group = 21 (IQR 21-23); IUCD group = 19 (IQR 18-20); LARC group = 23 (IQR 11-33).
The number of mature oocytes also appeared similar: Nil group = 14 (IQR 9-22); Pill group = 19 (IQR 17-20); IUCD group = 17 (IQR 15-18); LARC group = 19 (IQR 11-26).
The oocyte maturity rates were also similar: Nil group = 86%; Pill group = 83%; IUCD group = 89%; LARC group = 78%.
Limitations, reasons for caution
A retrospective cohort study carries inherent disadvantages of confounding variables or variation in baseline characteristics as compared with a randomised controlled trial. The low sample size would have meant that results of any statistical analysis runs the risk of being insignificant or spurious which we have therefore deliberately refrained from.
Wider implications of the findings
Although derived from a small sample size, the finding that the GnRH-trigger alone can be deployed in women using LARCs without compromising egg numbers or maturity can give clinicians confidence to perform GnRH-agonist triggering for altruistic egg donors or others wishing to store eggs or embryos, thus maximising patient safety.
Trial registration number
Not applicable
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Affiliation(s)
- M Mascarenhas
- TFP-GCRM Fertility, The Fertility Partnership , Glasgow, United Kingdom
| | - N Nobrega
- TFP-GCRM Fertility, The Fertility Partnership , Glasgow, United Kingdom
| | - R Fleming
- TFP-GCRM Fertility, The Fertility Partnership , Glasgow, United Kingdom
| | - M Gaudoin
- TFP-GCRM Fertility, The Fertility Partnership , Glasgow, United Kingdom
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8
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Stallings V, Tindall A, Mascarenhas M, Maqbool A. WS15.04 Unanticipated increase in commonly consumed dietary fat when consumed with a new lysophosphatidylcholine-rich nutritional therapy. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00240-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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9
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Diamond T, DiVito D, Savoca M, Mascarenhas M, Goldstein A. Nutrition rehabilitation-related complications in primary mitochondrial disorders. Nutr Clin Pract 2022; 37:377-382. [PMID: 34270139 DOI: 10.1002/ncp.10739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Primary mitochondrial disorders (PMDs) comprise a group of hundreds of individual genetic diseases affecting mitochondrial function, including oxidative phosphorylation and energy production. The estimated prevalence of these disorders ranges from 2.9 to 20 cases per 100,000. PMDs are commonly associated with malnutrition and growth failure. There is a paucity of literature regarding nutrition assessment and long-term data in the PMD population. We present three patients with various PMDs who presented complications related to malnutrition: (1) a 16-year-old male with Kearns-Sayre syndrome developed type 2 insulin-requiring diabetes mellitus after the initiation of high-calorie nutrition rehabilitation via gastrostomy tube (G-tube); (2) an 11-year-old female with myoclonic epilepsy associated with ragged red fibers developed diarrhea with metabolic decompensation and profound neurological and respiratory deterioration during nutrition rehabilitation after surgical G-tube placement; and (3) a 19-year-old male with a WARS2-associated PMD manifesting with developmental delay and severe parkinsonism presented complications related to poor wound healing after gastrojejunostomy tube placement. The last patient required prolonged hospitalization in the intensive care unit. Clinicians should be vigilant in monitoring these possible complications, as no standards of care exist for the initiation of enteral nutrition for this unique population.
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Affiliation(s)
- Tamir Diamond
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Donna DiVito
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Melanie Savoca
- Department of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Maria Mascarenhas
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amy Goldstein
- Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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10
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Perito ER, Pohl JF, Bakker C, Armfield MA, Barth B, Cuneo A, Mascarenhas M, Mehta M, Schwarzenberg SJ. Outpatient Pain Management in Children With Chronic Pancreatitis: A Scoping Systematic Review. Pancreas 2022; 51:135-147. [PMID: 35404888 PMCID: PMC9009154 DOI: 10.1097/mpa.0000000000001973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Although pain management is central to pediatric chronic pancreatitis (CP) care, no evidence-based guidelines exist. In this scoping systematic review, we sought promising strategies for CP pain treatment in children. METHODS We systematically reviewed literature on pain management in children and adults with CP, and 2 conditions with similar pain courses: juvenile idiopathic arthritis and sickle cell disease. RESULTS Of 8997 studies identified, 287 met inclusion criteria. There are no published studies of analgesic medications, antioxidants, dietary modification, integrative medicine, or regional nerve blocks in children with CP. In adults with CP, studies of nonopioid analgesics, pancreatic enzymes, and dietary interventions have mixed results. Retrospective studies suggest that endoscopic retrograde cholangiopancreatography and surgical procedures, most durably total pancreatectomy with islet autotransplant, improve pain for children with CP. Follow-up was short relative to a child's life. Large studies in adults also suggest benefit from endoscopic therapy and surgery, but lack conclusive evidence about optimal procedure or timing. Studies on other painful pediatric chronic illnesses revealed little generalizable to children with CP. CONCLUSIONS No therapy had sufficient high-quality studies to warrant untempered, evidence-based support for use in children with CP. Multicenter studies are needed to identify pain management "best practices."
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Affiliation(s)
- Emily R Perito
- From the Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - John F Pohl
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | | | - Matthew A Armfield
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Bradley Barth
- Department of Pediatrics, University of Texas Southwestern and Children's Medical Center Dallas, Dallas, TX
| | - Addison Cuneo
- From the Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Maria Mascarenhas
- Department of Pediatrics, Children's Hospital of Philadelphia/University of Pennsylvania, Philadelphia, PA
| | - Megha Mehta
- Department of Pediatrics, University of Texas Southwestern and Children's Medical Center Dallas, Dallas, TX
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11
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Mascarenhas M, Mehlawat P, Choudhary M. P–770 Two in One - Monozygotic splitting and associated perinatal outcomes after oocyte freezing; an exploratory analysis of the UK national database from 1990 to 2016. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Is oocyte freezing a risk factor for monozygotic splitting?
Summary answer
There is a trend towards a higher monozygotic splitting incidence among frozen oocytes, but this did not reach statistical significance.
What is known already
Laboratory techniques which involve embryo manipulation such as ICSI, assisted hatching, embryo biopsy for pre-implantation genetic testing and extended culture to the blastocyst stage appear to increase the risk of monozygotic splitting. Whilst there is some data that embryo freezing does not appear to increase the risk of monozygotic splitting, there is no comparable analysis on whether oocyte freezing increases the risk of monozygotic splitting.
Study design, size, duration
This was a retrospective cohort study analysing 988 015 ART (assisted reproductive technique) cycles from the HFEA anonymised database from 1990 to 2016. As frozen oocytes require ICSI, only fresh oocytes with ICSI were taken for comparison and frozen embryo transfers were excluded. Only single embryo transfers were included.[CM1] [MM2] We also noted ages of the female partner at the time of treatment, stage of embryo transfer, and whether pre-implantation genetic testing had been performed.
Participants/materials, setting, methods
There were 84 085 ICSI cycles with single embryo transfers using fresh oocytes and 596 using frozen oocytes. Monozygotic splitting was defined as the presence of two foetal hearts [CM1] [MM2] on ultrasound. Live birth (LB)was defined as either a singleton or a twin LB resulting from a monozygotically split embryo. Preterm birth (PTB) was defined as birth prior to 37 weeks gestation and early PTB as birth prior to 32 weeks gestation.
Main results and the role of chance
The frozen oocyte group had fewer women in the under–35 age group (frozen oocytes 16.6% vs fresh oocytes 53.6%, p < 0.0001) and a higher proportion of blastocyst transfers ( frozen oocytes 55.1% vs fresh oocytes 48.8%, p = 0.002) There were only 10 PGT cycles amongst monozygotically split embryos from fresh oocytes in our analysis, and none in the frozen oocyte group. Hence, this was not included as a confounder. There was a non-significant trend toward a higher incidence of monozygotic splitting amongst frozen oocytes (4/596, 2.3%, all monozygotic twins) than amongst fresh oocytes (378/27 019, 1.4%, 372 monozygotic twins and 6 monozygotic triplets); OR 1.688, 95% CI 0.623 to 4.574 and aOR 1.506, 95% CI 0.531 to 4.274 (maternal age and stage of embryo transfer adjusted as confounders). Of the 378 monozygotically split embryos from fresh oocytes, 308 (81.5%) had a LB: of which 47 (15.3%) were singletons and the rest were twins; 241 (78.2%) were PTB and 56 (18.2%) were early PTB. Of the four monozygotic twins from frozen oocytes, all reached a LB; one was a singleton term LB (Birthweight 3–3.5kg) whilst three were twin preterm LBs at 35–36 weeks, with no early PTBs and twin median birthweight 2–2.5 kg.
Limitations, reasons for caution
Albeit a large national database, this cohort study was restricted due to absence of data on potential confounders such as age at oocyte freezing, method of cryopreservation and length of storage.[CM1] Data was also lacking on amnionicity, obstetric risks including pre-eclampsia, twin-to-twin-transfusion syndrome, intrapartum and late effects.
Wider implications of the findings: With rapid rise in egg freezing, our findings would help reassure women that eggs on ice does not predispose to significant risk of two-in-one monozygotic splitting. However, the marginal trend (from 1.4% in fresh to 2.3% in frozen oocytes), does indicate that this subject merits further research.
Trial registration number
Not applicable. A database based retrospective study
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Affiliation(s)
- M Mascarenhas
- Glasgow Centre for Reproductive Medicine, GCRM- Glasgow, Glasgow, United Kingdom
| | - P Mehlawat
- Royal Grammar School, Royal Grammar School, Newcastle upon Tyne, United Kingdom
| | - M Choudhary
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Department of Reproductive Medicine, Newcastle upon Tyne, United Kingdom
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Mascarenhas M, Mehlawat H, Kirubakaran R, Bhandari H, Choudhary M. Live birth and perinatal outcomes using cryopreserved oocytes: an analysis of the Human Fertilisation and Embryology Authority database from 2000 to 2016 using three clinical models. Hum Reprod 2021; 36:1416-1426. [PMID: 33313698 DOI: 10.1093/humrep/deaa343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/11/2020] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION Are live birth (LB) and perinatal outcomes affected by the use of frozen own versus frozen donor oocytes? SUMMARY ANSWER Treatment cycles using frozen own oocytes have a lower LB rate but a lower risk of low birth weight (LBW) as compared with frozen donor oocytes. WHAT IS KNOWN ALREADY A rising trend of oocyte cryopreservation has been noted internationally in the creation of donor oocyte banks and in freezing own oocytes for later use in settings of fertility preservation and social egg freezing. Published literature on birth outcomes with frozen oocytes has primarily utilised data from donor oocyte banks due to the relative paucity of outcome data from cycles using frozen own oocytes. STUDY DESIGN, SIZE, DURATION This was a retrospective cohort study utilising the anonymised database of the Human Fertilisation and Embryology Authority, which is the statutory regulator of fertility treatment in the UK. We analysed 988 015 IVF cycles from the Human Fertilisation and Embryology Authority (HFEA) register from 2000 to 2016. Perinatal outcomes were assessed from singleton births only. PARTICIPANTS/MATERIALS, SETTING, METHODS Three clinical models were used to assess LB and perinatal outcomes: Model 1 compared frozen own oocytes (n = 632) with frozen donor oocytes (n = 922); Model 2 compared frozen donor oocytes (n = 922) with fresh donor oocytes (n = 24 706); Model 3 compared first cycle of fresh embryo transfer from frozen donor oocytes (n = 917) with first cycle of frozen embryo transfer created with own oocytes and no prior fresh transfer (n = 326). Preterm birth (PTB) was defined as LB before 37 weeks and LBW as birth weight <2500 g. Adjustment was performed for confounding variables such as maternal age, number of embryos transferred and decade of treatment. MAIN RESULTS AND THE ROLE OF CHANCE The LB rate (18.0% versus 30.7%; adjusted odds ratio (aOR) 0.61, 95% CI 0.43-0.85) and the incidence of LBW (5.3% versus 14.0%; aOR 0.29, 95% CI 0.13-0.90) was significantly lower with frozen own oocytes as compared with frozen donor oocytes with no significant difference in PTB (9.5% versus 15.7%; aOR 0.56, 95% CI 0.26-1.21). A lower LB rate was noted in frozen donor oocyte cycles (30.7% versus 34.7%; aOR 0.69, 95% CI 0.59-0.80) when compared with fresh donor oocyte cycles. First cycle frozen donor oocytes did not show any significant difference in LB rate (30.1% versus 19.3%; aOR 1.26, 95% CI 0.86-1.83) or PTB, but a higher incidence of LBW (17.7% versus 5.4%; aOR 3.77, 95% CI 1.51-9.43) as compared with first cycle frozen embryos using own oocytes. LIMITATIONS, REASONS FOR CAUTION The indication for oocyte freezing, method of freezing used (whether slow-freezing or vitrification) and age at which eggs where frozen were unavailable. We report a subgroup analysis of women using their own frozen oocytes prior to 37 years. Cumulative LB rate could not be assessed due to the anonymous nature of the dataset. WIDER IMPLICATIONS OF THE FINDINGS Women planning to freeze their own eggs for fertility preservation or social egg freezing need to be counselled that the results from frozen donor egg banks may not completely apply to them. However, they can be reassured that oocyte cryopreservation does not appear to have a deleterious effect on perinatal outcomes. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was sought for the study. The authors have no relevant conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M Mascarenhas
- Glasgow Centre for Reproductive Medicine, Glasgow G51 4FD, UK
| | - H Mehlawat
- Department of Population Health Sciences, University College London, London WC1E 6BT, UK
| | - R Kirubakaran
- Department of Biostatistics, Christian Medical College, Vellore 632004, India
| | - H Bhandari
- Department of Reproductive Medicine, Leeds Fertility, Leeds Teaching Hospitals NHS Trust, Leeds LS14 6UH, UK
| | - M Choudhary
- Department of Reproductive Medicine, Newcastle Fertility Centre at Life, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4EP, UK
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Santucci NR, Chogle A, Leiby A, Mascarenhas M, Borlack RE, Lee A, Perez M, Russell A, Yeh AM. Non-pharmacologic approach to pediatric constipation. Complement Ther Med 2021; 59:102711. [PMID: 33737146 DOI: 10.1016/j.ctim.2021.102711] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/12/2021] [Indexed: 01/24/2023] Open
Abstract
Functional constipation (FC) is a pervasive problem in pediatrics. Although pharmaceuticals are commonly used for FC, parents and patients show reluctance or find dissatisfaction with available medications at times. Further, patients often have interest in utilizing nutraceutical supplements and botanicals that are available over the counter. This literature review aims to summarize research studies performed on non-pharmacologic approaches to constipation and to evaluate the safety and efficacy of these modalities. Overall data on non-pharmacologic treatments for childhood constipation were sparse, and though some studies were available for adult populations, pediatrics studies were generally limited, lacking or flawed. Certain supplements, such as prebiotics, probiotics and fiber, are safe and are without significant side effects. Though fiber supplements such as glucomannan, green banana mass, cocao husk and various fiber blends have emerging evidence in children, evidence for psyllium, cellulose and flaxseed only have supportive studies in adults. Other than senna, studies of botanicals indicate significant safety concerns (in particular with Aloe vera with aloin and Cascara sagrada) and insufficient evidence. For patients with a significant behavioral or anxiety component to their FC and exhibit dyssynergia, mind-body interventions (e.g. diaphragmatic breathing, biofeedback, cognitive behavioral therapy, and behavioral modifications) are certainly safe and effective. Finally, movement and manipulative interventions such as abdominal massage, reflexology, acupuncture and transcutaneous nerve stimulation show promise in the field of pediatric constipation, and data is accumulating for efficacy. These modalities require further study to determine mechanisms of action and which populations may benefit the most from these therapies.
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Affiliation(s)
- Neha R Santucci
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, OH, USA
| | - Ashish Chogle
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Orange County, Orange, CA, USA
| | - Alycia Leiby
- Division of Gastroenterology, Hepatology and Nutrition, Goryeb Children's Hospital/ Atlantic Health System, Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, NJ, USA
| | - Maria Mascarenhas
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rachel E Borlack
- Division of Gastroenterology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY, USA
| | - Amanda Lee
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Oregon Health and Science University, OR, USA
| | - Maria Perez
- Division of Gastroenterology, Hepatology and Nutrition, Goryeb Children's Hospital/ Atlantic Health System, Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, NJ, USA
| | - Alexandra Russell
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Ann Ming Yeh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, CA, USA.
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Rothman JM, Bilici N, Mergler B, Schumacher R, Mataraza-Desmond T, Booth M, Olshan M, Bailey M, Mascarenhas M, Duffy W, Virudachalam S, DeLisser HM. A Culinary Medicine Elective for Clinically Experienced Medical Students: A Pilot Study. J Altern Complement Med 2020; 26:636-644. [DOI: 10.1089/acm.2020.0063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joshua M. Rothman
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Pediatric Residency Training Program, Division of Gastroenterology, Hepatology and Nutrition, and Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nadir Bilici
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Blake Mergler
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan Schumacher
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Maddy Booth
- Vetri Community Partnership, Philadelphia, PA, USA
| | | | - Melissa Bailey
- Pediatric Residency Training Program, Division of Gastroenterology, Hepatology and Nutrition, and Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maria Mascarenhas
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Pediatric Residency Training Program, Division of Gastroenterology, Hepatology and Nutrition, and Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - William Duffy
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Senbagam Virudachalam
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Pediatric Residency Training Program, Division of Gastroenterology, Hepatology and Nutrition, and Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Horace M. DeLisser
- Academic Programs Office, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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15
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Perito ER, Palermo TM, Pohl JF, Mascarenhas M, Abu-El-Haija M, Barth B, Bellin MD, Fishman DS, Freedman S, Gariepy C, Giefer M, Gonska T, Heyman MB, Himes RW, Husain SZ, Lin T, Liu Q, Maqbool A, McFerron B, Morinville VD, Nathan JD, Ooi CY, Rhee S, Schwarzenberg SJ, Shah U, Troendle DM, Werlin S, Wilschanski M, Zheng Y, Zimmerman MB, Lowe M, Uc A. Factors Associated With Frequent Opioid Use in Children With Acute Recurrent and Chronic Pancreatitis. J Pediatr Gastroenterol Nutr 2020; 70:106-114. [PMID: 31567889 PMCID: PMC6934913 DOI: 10.1097/mpg.0000000000002502] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The aim of the study was to understand the association of frequent opioid use with disease phenotype and pain pattern and burden in children and adolescents with acute recurrent (ARP) or chronic pancreatitis (CP). METHODS Cross-sectional study of children <19 years with ARP or CP, at enrollment into the INSPPIRE cohort. We categorized patients as opioid "frequent use" (daily/weekly) or "nonfrequent use" (monthly or less, or no opioids), based on patient and parent self-report. RESULTS Of 427 children with ARP or CP, 17% reported frequent opioid use. More children with CP (65%) reported frequent opioid use than with ARP (41%, P = 0.0002). In multivariate analysis, frequent opioid use was associated with older age at diagnosis (odds ratio [OR] 1.67 per 5 years, 95% confidence interval [CI] 1.13-2.47, P = 0.01), exocrine insufficiency (OR 2.44, 95% CI 1.13-5.24, P = 0.02), constant/severe pain (OR 4.14, 95% CI 2.06-8.34, P < 0.0001), and higher average pain impact score across all 6 functional domains (OR 1.62 per 1-point increase, 95% CI 1.28-2.06, P < 0.0001). Children with frequent opioid use also reported more missed school days, hospitalizations, and emergency room visits in the past year than children with no frequent use (P < 0.0002 for each). Participants in the US West and Midwest accounted for 83% of frequent opioid users but only 56% of the total cohort. CONCLUSIONS In children with CP or ARP, frequent opioid use is associated with constant pain, more healthcare use, and higher levels of pain interference with functioning. Longitudinal and prospective research is needed to identify risk factors for frequent opioid use and to evaluate nonopioid interventions for reducing pain and disability in these children.
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Affiliation(s)
- Emily R. Perito
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Tonya M. Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - John F. Pohl
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Maria Mascarenhas
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Maisam Abu-El-Haija
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Bradley Barth
- Department of Pediatrics, University of Texas Southwestern, Dallas, TX
| | - Melena D. Bellin
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | | | | | - Cheryl Gariepy
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Matthew Giefer
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - Tanja Gonska
- Department of Pediatrics, Sick Kids Hospital, University of Toronto, Toronto, ON, Canada
| | - Melvin B. Heyman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Ryan W. Himes
- Department of Pediatrics, Texas Children’s Hospital, Houston, TX
| | - Sohail Z. Husain
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
| | - Tom Lin
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Quin Liu
- Department of Pediatrics, Cedars-Sinai, Los Angeles, CA
| | - Asim Maqbool
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Brian McFerron
- Department of Pediatrics, Indiana University, Indianapolis, IN
| | - Veronique D. Morinville
- Department of Pediatrics, Montreal Children’s Hospital, McGill University, Montreal, QC, Canada
| | - Jaime D. Nathan
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Chee Y. Ooi
- School of Women’s and Children’s Health, Medicine, University of New South Wales, New South Wales, Sydney, Australia
| | - Sue Rhee
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | | | - Uzma Shah
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - David M. Troendle
- Department of Pediatrics, University of Texas Southwestern, Dallas, TX
| | - Steven Werlin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | | | - Yuhua Zheng
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA
| | | | - Mark Lowe
- Department of Pediatrics, Washington University, St. Louis, MO
| | - Aliye Uc
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
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Mascarenhas M, Balen AH. Could ethnicity have a different effect on fresh and frozen embryo transfer outcomes: a retrospective study. Reprod Biomed Online 2019; 39:764-769. [PMID: 31615725 DOI: 10.1016/j.rbmo.2019.07.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 12/31/2022]
Abstract
RESEARCH QUESTION Does a woman's ethnicity affect her fresh and frozen embryo transfer outcomes differently? DESIGN A retrospective cohort study of the first fresh and first frozen embryo transfer per woman carried out at a single tertiary level fertility unit between 2010 and 2016 using data retrieved from an electronic database. Biochemical pregnancy, biochemical pregnancy loss, clinical pregnancy, miscarriage and live birth rates per embryo transfer were compared between 5876 white Caucasian, 1071 South Asian and 114 Black Afro-Caribbean women undergoing their first fresh embryo transfer and for 1418 Caucasian, 273 South Asian and 31 Afro-Caribbean women undergoing their first frozen embryo transfer. Logistic regression was used to adjust for age, number of oocytes retrieved, and number and stage of embryos transferred. RESULTS South Asian (26% versus 32%, adjusted OR 0.622, 95% CI 0.533 to 0.725) and Black Afro-Caribbean women (21% versus 32%, adjusted OR 0.528, 95% CI 0.332 to 0.839) had a lower live birth rate per fresh embryo transfer compared with white Caucasian women. In contrast, the live birth rates per frozen embryo transfer were not significantly different between South Asian and Caucasian women (26% versus 28%, adjusted OR 0.890, 95% CI 0.661 to 1.200) and between Afro-Caribbean and Caucasian women (29% versus 28%, adjusted OR 0.983, 95% CI 0.447 to 2.162). CONCLUSION South Asian and Black Afro-Caribbean women have a significantly lower live birth rate than white Caucasian women after fresh embryo transfer, but their frozen embryo transfer live birth rates are not significantly different.
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Affiliation(s)
- M Mascarenhas
- Leeds Fertility, Leeds Teaching Hospitals NHS Trust, Leeds LS14 6UH, UK.
| | - A H Balen
- Leeds Fertility, Leeds Teaching Hospitals NHS Trust, Leeds LS14 6UH, UK
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17
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Stallings V, Maqbool A, Mascarenhas M, Schall J. Benefits of LYM-X-SORB, a Highly Absorbed Structured Lipid Compound, in Children with Cystic Fibrosis and Pancreatic Insufficiency with Varying Degrees of Malabsorption (P08-125-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz044.p08-125-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
The treatment of fat malabsorption and optimizing growth and nutritional status in patients with cystic fibrosis (CF) and pancreatic insufficiency (PI) is a challenge. A readily absorbable structured lipid (LYM-X-SORB™ [LXS]) improved fat absorption, growth, choline and essential fatty acid (EFA) status in children with CF and PI. Our objective in this secondary analysis is to determine if subjects with varying degrees of fat malabsorption show greater improvements with 3-month LXS treatment.
Methods
Subjects with CF and PI (5–17yrs) participated in a 12-month double-blind randomized placebo-controlled LXS trial with a 3-month interim visit. LXS and placebo had similar calorie (303 or 456 kcal/d) and fat content (11 or 18 g/d), and LXS had 7-fold greater choline; dose depended on age. CFA was assessed with 72-hour stool and 3-day weighed food records. Height, weight and BMI Z-scores were calculated. Plasma linoleic and α-linolenic acid were assessed. Secondary analyses were restricted to children with baseline CFA who completed 3-month treatment (n = 66, 10.5 ± 3.0 yrs, 40% female). Subjects were divided into two groups at baseline: those with lower CFA (≤87.8%, median) and higher CFA (above median).
Results
In those with lower baseline CFA, 3-month LXS treatment improved CFA significantly (8.7%, from 77.4 to 86.0%, P < 0.01), with a significant drop in stool fat loss (−6.6 g/24 hours) and no change in dietary fat intake. This was accompanied by significantly increased (P < 0.01) linoleic acid (434 nmol/L, 19% increase) and α-linolenic acid (25 nmol/L, 53% increase). Both weight and BMI Z scores increased ≥0.16 (P < 0.01). With placebo treatment, CFA did not change (72.5 to 71.1%), nor did EFA status, and growth status improved less (≤0.14, P < 0.05). For subjects with higher CFA at baseline, CFA did not change (92.1 to 90.1%) with either treatment, although EFA and growth status improved somewhat, with greater improvement evident in the LXS group.
Conclusions
Subjects with CF and PI at higher risk for fat malabsorption had a dramatic improvement in CFA with LXS treatment, accompanied by improved EFA and growth status. This suggests that LXS may help those with CF and other pancreatic diagnoses in need of optimizing nutritional status and avoiding unintentional weight loss.
Funding Sources
Supported by NIH.
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18
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Hill DL, Carroll KW, Snyder KJG, Mascarenhas M, Erlichman J, Patterson CA, Barakat LP, Feudtner C. Development and Pilot Testing of a Coping Kit for Parents of Hospitalized Children. Acad Pediatr 2019; 19:454-463. [PMID: 30415078 DOI: 10.1016/j.acap.2018.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/20/2018] [Accepted: 11/02/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Serious pediatric illness places great stress on families. Parents who learn coping skills may better manage these stressors. This study sought to develop and refine a stress coping intervention for parents of hospitalized children, assess the intervention acceptability among these parents, and gather preliminary data on stress, negative and positive affect, anxiety, depression, and self-efficacy. METHODS We conducted an observational study in 2 phases, enrolling parents of children who were inpatients with serious illness, 10 in Phase 1 and 40 in Phase 2. All parents completed at baseline measures of stress and psychological well-being and were introduced to the Coping Kit for Parents. Follow-up interviews were conducted at 1 week (all parents) and 1 month (Phase 2 parents only) regarding the acceptability of the intervention. RESULTS At baseline, parents reported that stressful situations were frequent (mean = 30.6, standard deviation [SD] = 6.8) and difficult (mean = 26.2, SD = 7.1) and revealed elevated levels of negative affect (mean = 27.3, SD = 7.7), depression (mean = 8.5, SD = 3.7), and anxiety (mean = 11.3, SD = 3.1) and moderate levels of self-efficacy related to their child's illness (mean = 3.3, SD = 0.5). The majority of parents used the kit regularly and on a scale of 1 to 7 agreed that the kit was helpful (mean = 6.0, SD = 0.9), interesting (mean = 5.7, SD = 1.3), practical (mean = 5.7, SD = 1.4), enjoyable (mean = 6.0, SD = 1.3), and they would recommend it to other parents (mean = 6.4, SD = 0.9). CONCLUSIONS The Coping Kit for Parents is an acceptable stress management intervention that could be made available to parents of children with serious illness at pediatric hospitals with minimal staff training or time commitment.
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Affiliation(s)
- Douglas L Hill
- Pediatric Advanced Care Team (DL Hill, KW Carroll, KJG Snyder, C Feudtner), Division of Gastroenterology (M Mascarenhas, J Erlichman), Division of Neonatology (CA Patterson), and Division of Oncology (LP Barakat), The Children's Hospital of Philadelphia, Philadelphia, Pa.
| | - Karen W Carroll
- Pediatric Advanced Care Team (DL Hill, KW Carroll, KJG Snyder, C Feudtner), Division of Gastroenterology (M Mascarenhas, J Erlichman), Division of Neonatology (CA Patterson), and Division of Oncology (LP Barakat), The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - K J G Snyder
- Pediatric Advanced Care Team (DL Hill, KW Carroll, KJG Snyder, C Feudtner), Division of Gastroenterology (M Mascarenhas, J Erlichman), Division of Neonatology (CA Patterson), and Division of Oncology (LP Barakat), The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Maria Mascarenhas
- Pediatric Advanced Care Team (DL Hill, KW Carroll, KJG Snyder, C Feudtner), Division of Gastroenterology (M Mascarenhas, J Erlichman), Division of Neonatology (CA Patterson), and Division of Oncology (LP Barakat), The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Jessi Erlichman
- Pediatric Advanced Care Team (DL Hill, KW Carroll, KJG Snyder, C Feudtner), Division of Gastroenterology (M Mascarenhas, J Erlichman), Division of Neonatology (CA Patterson), and Division of Oncology (LP Barakat), The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Chavis A Patterson
- Pediatric Advanced Care Team (DL Hill, KW Carroll, KJG Snyder, C Feudtner), Division of Gastroenterology (M Mascarenhas, J Erlichman), Division of Neonatology (CA Patterson), and Division of Oncology (LP Barakat), The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Lamia P Barakat
- Pediatric Advanced Care Team (DL Hill, KW Carroll, KJG Snyder, C Feudtner), Division of Gastroenterology (M Mascarenhas, J Erlichman), Division of Neonatology (CA Patterson), and Division of Oncology (LP Barakat), The Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Chris Feudtner
- Pediatric Advanced Care Team (DL Hill, KW Carroll, KJG Snyder, C Feudtner), Division of Gastroenterology (M Mascarenhas, J Erlichman), Division of Neonatology (CA Patterson), and Division of Oncology (LP Barakat), The Children's Hospital of Philadelphia, Philadelphia, Pa
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Greig JD, Young I, Harding S, Mascarenhas M, Waddell LA. A scoping review of Lyme disease research relevant to public health. Can Commun Dis Rep 2018; 44:243-256. [PMID: 31524886 PMCID: PMC6707479 DOI: 10.14745/ccdr.v44i10a03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Lyme disease (LD) is an emerging infectious disease in Canada associated with expansion of the geographic range of the tick vector Ixodes scapularis in eastern and central Canada. A scoping review of published research was prioritized to identify and characterize the scientific evidence concerning key aspects of LD to support public health efforts. Prior to initiation of this review, an expert advisory group was surveyed to solicit insight on priority topics and scope. A pre-tested search strategy implemented in eight databases (updated September 2016) captured relevant research. Pre-tested screening and data characterization forms were completed by two independent reviewers and descriptive analysis was conducted to identify topic areas with solid evidence and knowledge gaps. Of 19,353 records screened, 2,258 relevant articles were included in the review under the following six public health focus areas: a) surveillance/monitoring in North America (n=809); b) evaluation of diagnostic tests (n=736); c) risk factors (n=545); d) public health interventions (n=205); e) public knowledge, attitudes and/or perceptions in North America (n=202); and f) the economic burden of LD or cost-benefit of interventions (n=32). The majority of research investigated Borrelia burgdorferi (n=1,664), humans (n=1,154) and Ixodes scapularis (n=459). Sufficient research was identified for potential systematic reviews in four topic areas: a) accuracy of diagnostic tests; b) risk factors for human illness; c) efficacy of LD intervention strategies; and d) prevalence and/or incidence of LD in humans or B. burgdorferi sensu stricto in vertebrate reservoirs or ticks in North America. Future primary research could focus on closing knowledge gaps, such as the role of less studied vertebrate reservoirs in the transmission cycle. Results of this scoping review can be used to quickly identify and summarize relevant research pertaining to specific questions about LD or B. burgdorferi sensu lato in humans, vertebrate hosts or vectors, providing evidence-informed information within timelines that are conducive for public health decision-making.
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Affiliation(s)
- JD Greig
- National Microbiology Laboratory at Guelph, Public Health Agency of Canada, Guelph, ON
| | - I Young
- School of Occupational and Public Health, Ryerson University, Toronto, ON
| | - S Harding
- National Microbiology Laboratory at Guelph, Public Health Agency of Canada, Guelph, ON
| | - M Mascarenhas
- National Microbiology Laboratory at Guelph, Public Health Agency of Canada, Guelph, ON
| | - LA Waddell
- National Microbiology Laboratory at Guelph, Public Health Agency of Canada, Guelph, ON
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Mascarenhas M, Fox SJ, Thompson K, Balen AH. Cumulative live birth rates and perinatal outcomes with the use of time-lapse imaging incubators for embryo culture: a retrospective cohort study of 1882 ART cycles. BJOG 2018; 126:280-286. [PMID: 29443441 DOI: 10.1111/1471-0528.15161] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Comparison of live birth rates and the perinatal outcomes after fresh and frozen embryo transfer between time-lapse imaging (TLI) and standard culture (SC) incubators. DESIGN Retrospective cohort study. SETTING A single tertiary level IVF unit. POPULATION Women undergoing IVF between January 2014 and October 2015. METHODS Comparison was done between 1064 IVF cycles using TLI (TLI cycles) and 818 IVF cycles using SC (SC cycles). MAIN OUTCOME MEASURES Cumulative live birth rate per oocyte retrieval and perinatal outcomes including birthweight, gestational age, preterm birth (PTB) (<37 weeks), early preterm birth (PTB; <32 weeks), low birthweight (LBW; <2500 g), very LBW (<1500 g) and macrosomia (>4500 g). RESULTS The fresh embryo transfer live birth rate was noted to be higher for TLI cycles [TLI 36.8 versus SC 33.9%, adjusted odds ratio (aOR) 1.28, 95% CI 1.05-1.57], but the frozen embryo transfer live birth rates were not significantly different. The mean birthweight was higher in the TLI group after both fresh [adjusted mean difference (aMD) 174.78 g, 95% CI 64.80-284.77] and frozen embryo transfers (aMD 175.91 g, 95% CI 16.98-334.84). After a fresh embryo transfer, there was a lower risk of early PTB and very LBW in the TLI group. Among frozen embryo transfers, there was a lower risk of early PTB and LBW in the TLI group. CONCLUSIONS TLI incubators are associated with improved perinatal outcomes and higher mean birthweight after fresh and frozen embryo transfer. TWEETABLE ABSTRACT Time-lapse imaging incubators in IVF improve perinatal outcomes after both fresh and frozen embryo transfers.
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Affiliation(s)
- M Mascarenhas
- Leeds Fertility, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - S J Fox
- Leeds Fertility, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - K Thompson
- Leeds Fertility, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - A H Balen
- Leeds Fertility, Leeds Teaching Hospital NHS Trust, Leeds, UK
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Scheers I, Palermo JJ, Freedman S, Wilschanski M, Shah U, Abu-El-Haija M, Barth B, Fishman DS, Gariepy C, Giefer MJ, Heyman MB, Himes RW, Husain SZ, Lin TK, Liu Q, Lowe M, Mascarenhas M, Morinville V, Ooi CY, Perito ER, Piccoli DA, Pohl JF, Schwarzenberg SJ, Troendle D, Werlin S, Zimmerman B, Uc A, Gonska T. Autoimmune Pancreatitis in Children: Characteristic Features, Diagnosis, and Management. Am J Gastroenterol 2017; 112:1604-1611. [PMID: 28374818 PMCID: PMC5908471 DOI: 10.1038/ajg.2017.85] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/01/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Autoimmune pancreatitis (AIP) is an increasingly recognized disease entity, but data in children are limited. AIP presentation and outcome in children might differ from the adult experience. We aim to determine the characteristic features of AIP in children. METHODS Data about clinical symptoms, imaging, histology, and treatment were collected using two sources: (i) a systematic literature search and (ii) the INSPPIRE database, the largest international multicenter study of pancreatitis in children and the Cliniques Universitaires St-Luc (CUSL) registry. RESULTS We identified 48 AIP cases: 30 from literature review, 14 from INSPPIRE, and 4 from CUSL. The median age at diagnosis was 13 years (range 2-17 years). Abdominal pain (43/47, 91%) and/or obstructive jaundice (20/47, 42%) were the most common symptoms at diagnosis. Elevated serum IgG4 levels were only observed in 9/40 (22%) children. Cross-sectional imaging studies were abnormal in all children including hypointense global or focal gland enlargement (39/47, 83%), main pancreatic duct irregularity (30/47, 64%), and common bile duct stricture (26/47, 55%). A combination of lymphoplasmacytic inflammation, pancreatic fibrosis, and ductal granulocyte infiltration were the main histological findings (18/25, 72%). Children with AIP had a prompt clinical response to steroids. Complications of AIP included failure of exocrine (4/25, 16%) and endocrine (3/27, 11%) pancreas function. CONCLUSIONS Pediatric AIP has a distinct presentation with features similar to type 2 AIP in adults. This comprehensive report on the largest group of children with AIP to date is expected to help with the diagnosis and management of this disease and pave the way for future research studies.
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Affiliation(s)
- Isabelle Scheers
- Hospital for Sick Children, Toronto, Ontario, Canada,Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Joseph J. Palermo
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Steven Freedman
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Uzma Shah
- Harvard Medical School, Massachusetts General Hospital for Children, Boston, Massachusetts, USA
| | | | - Bradley Barth
- University of Texas Southwestern Medical School, Dallas, Texas, USA
| | | | | | | | - Melvin B. Heyman
- University of California at San Francisco, San Francisco, California, USA
| | | | - Sohail Z. Husain
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Tom K. Lin
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Quin Liu
- Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Mark Lowe
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Maria Mascarenhas
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Chee Y. Ooi
- Discipline of Paediatrics, School of Women’s and Children’s Health, Medicine, University of New South Wales and Sydney Children’s Hospital Randwick, Sydney, New South Wales, Australia
| | - Emily R. Perito
- University of California at San Francisco, San Francisco, California, USA
| | - David A. Piccoli
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | - David Troendle
- University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Steven Werlin
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Aliye Uc
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Tanja Gonska
- Hospital for Sick Children, Toronto, Ontario, Canada
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22
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Lee D, Barsky D, Hughes R, Driggers J, Poupard N, Mascarenhas M. Evaluation of the safety of iron dextran with parenteral nutrition in the paediatric inpatient setting. Nutr Diet 2017; 74:471-475. [PMID: 28758365 DOI: 10.1111/1747-0080.12355] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/04/2017] [Accepted: 03/12/2017] [Indexed: 11/30/2022]
Abstract
AIM Practitioners often avoid administering iron dextran in parenteral nutrition (PN) for hospitalised children because of the concern for anaphylaxis. The primary aim of the present study was to determine the risk of anaphylaxis associated with exposure to PN containing iron dextran in the inpatient setting. METHODS Charts were reviewed for all children admitted to The Children's Hospital of Philadelphia from January 1, 2011 to December 30, 2013 who received PN containing low molecular weight (LMW) iron dextran. Subject characteristics, primary diagnoses and PN orders were evaluated. The pharmacy adverse events database was queried for adverse drug reactions. RESULTS Over three years, 89 subjects received PN containing a maintenance dose of LMW iron dextran with a total of 2774 days of exposure. Subjects ranged from two months to 21 years of age and received between 1 and 196 days of PN containing iron dextran. The mean dose of iron dextran in children decreased as the weight category increased from <5 kg (0.21 ± 0.05 mg/kg/day) to ≥40 kg (1.9 ± 0.5 mg/day; P-value for trend <0.005). No anaphylactic reactions occurred in any subjects. CONCLUSIONS PN containing a maintenance dose of LMW iron dextran can be safely administered to hospitalised children, and further studies are need to evaluate the potential to prevent iron deficiency anaemia and the need for additional IV iron infusions.
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Affiliation(s)
- Dale Lee
- Division of Gastroenterology and Hepatology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Diane Barsky
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rachel Hughes
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Julia Driggers
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nicole Poupard
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Maria Mascarenhas
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Worthington P, Balint J, Bechtold M, Bingham A, Chan LN, Durfee S, Jevenn AK, Malone A, Mascarenhas M, Robinson DT, Holcombe B. When Is Parenteral Nutrition Appropriate? JPEN J Parenter Enteral Nutr 2017; 41:324-377. [PMID: 28333597 DOI: 10.1177/0148607117695251] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Parenteral nutrition (PN) represents one of the most notable achievements of modern medicine, serving as a therapeutic modality for all age groups across the healthcare continuum. PN offers a life-sustaining option when intestinal failure prevents adequate oral or enteral nutrition. However, providing nutrients by vein is an expensive form of nutrition support, and serious adverse events can occur. In an effort to provide clinical guidance regarding PN therapy, the Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) convened a task force to develop consensus recommendations regarding appropriate PN use. The recommendations contained in this document aim to delineate appropriate PN use and promote clinical benefits while minimizing the risks associated with the therapy. These consensus recommendations build on previous ASPEN clinical guidelines and consensus recommendations for PN safety. They are intended to guide evidence-based decisions regarding appropriate PN use for organizations and individual professionals, including physicians, nurses, dietitians, pharmacists, and other clinicians involved in providing PN. They not only support decisions related to initiating and managing PN but also serve as a guide for developing quality monitoring tools for PN and for identifying areas for further research. Finally, the recommendations contained within the document are also designed to inform decisions made by additional stakeholders, such as policy makers and third-party payers, by providing current perspectives regarding the use of PN in a variety of healthcare settings.
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Affiliation(s)
| | - Jane Balint
- 2 Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | | | - Angela Bingham
- 4 University of the Sciences, Philadelphia, Pennsylvania, USA
| | | | - Sharon Durfee
- 6 Central Admixture Pharmacy Services, Inc, Denver, Colorado, USA
| | | | | | - Maria Mascarenhas
- 9 The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel T Robinson
- 10 Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Beverly Holcombe
- 11 American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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24
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Waddell L, Greig J, Mascarenhas M, Otten A, Corrin T, Hierlihy K. Current evidence on the transmissibility of chronic wasting disease prions to humans-A systematic review. Transbound Emerg Dis 2017; 65:37-49. [PMID: 28139079 DOI: 10.1111/tbed.12612] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Indexed: 12/19/2022]
Abstract
A number of prion diseases affect humans, including Creutzfeldt-Jakob disease; most of these are due to genetic mutations in the affected individual and occur sporadically, but some result from transmission of prion proteins from external sources. Of the known animal prion diseases, only bovine spongiform encephalopathy prions have been shown to be transmissible from animals to humans under non-experimental conditions. Chronic wasting disease (CWD) is a prion disease that affects cervids (e.g., deer and elk) in North America and isolated populations in Korea and Europe. Systematic review methodology was used to identify, select, critically appraise and analyse data from relevant research. Studies were evaluated for adherence to good conduct based on their study design following the Cochrane collaboration's approach to grading the quality of evidence and the strength of recommendations (GRADE). Twenty-three studies were included after screening 800 citations from the literature search and evaluating 78 full papers. Studies examined the transmissibility of CWD prions to humans using epidemiological study design, in vitro and in vivo experiments. Five epidemiological studies, two studies on macaques and seven studies on humanized transgenic mice provided no evidence to support the possibility of transmission of CWD prions to humans. Ongoing surveillance in the United States and Canada has not documented CWD transmission to humans. However, two studies on squirrel monkeys provided evidence that transmission of CWD prions resulting in prion disease is possible in these monkeys under experimental conditions and seven in vitro experiments provided evidence that CWD prions can convert human prion protein to a misfolded state. Therefore, future discovery of CWD transmission to humans cannot be entirely ruled out on the basis of current studies, particularly in the light of possible decades-long incubation periods for CWD prions in humans. It would be prudent to continue CWD research and epidemiologic surveillance, exercise caution when handling potentially contaminated material and explore CWD management opportunities.
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Affiliation(s)
- L Waddell
- Public Health Risk Sciences Division of the National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, Canada
| | - J Greig
- Public Health Risk Sciences Division of the National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, Canada
| | - M Mascarenhas
- Public Health Risk Sciences Division of the National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, Canada
| | - A Otten
- Public Health Risk Sciences Division of the National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, Canada
| | - T Corrin
- Public Health Risk Sciences Division of the National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, Canada
| | - K Hierlihy
- Public Health Risk Sciences Division of the National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, Canada
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Abstract
Food is essential for life. Yet, poor food choices may cause poor health. Dietary manipulation is frequently integrated into the management of common chronic pediatric conditions. Parents seek dietary information to have more control over child's condition and to avoid side effects of medicine. This article reviews selected diets for a few common pediatric disorders including eczema, attention deficit hyperactivity disorder, headache and migraine, non-celiac gluten sensitivity, and irritable bowel syndrome.
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Affiliation(s)
| | - Amanda Hall
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Amy Dean
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Bridget Godwin
- The Children's Hospital of Philadelphia, Philadelphia, PA
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26
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Alshaikh B, Schall JI, Maqbool A, Mascarenhas M, Bennett MJ, Stallings VA. Choline supplementation alters some amino acid concentrations with no change in homocysteine in children with cystic fibrosis and pancreatic insufficiency. Nutr Res 2015; 36:418-29. [PMID: 27101760 DOI: 10.1016/j.nutres.2015.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/23/2015] [Accepted: 12/24/2015] [Indexed: 01/17/2023]
Abstract
The present study determined the plasma amino acid status in children with cystic fibrosis (CF) and pancreatic insufficiency (PI) in the modern medical and nutritional care setting and investigated the effect of choline supplementation on amino acid status. A total of 110 children aged 5 to 18 years with CF and PI were randomized to receive choline-enriched structured lipid (LYM-X-SORB) or placebo with similar energy and fat content. Plasma amino acids were measured at baseline and 3 and 12 months. We hypothesized that choline supplementation would result in lower plasma homocysteine concentrations in children with CF. At baseline, dietary protein intake was high and the amino acid profile was within laboratory reference ranges in most participants. Alanine and cysteine were elevated in 24% and 36% of participants, respectively. Children with baseline alanine above reference range had improved weight, body mass index, and fat-free mass. Low homocysteine was found in 62% of children 11 years and older. After 3 and 12 months, there was no effect of choline supplementation on methionine or homocysteine status. Compared with placebo, choline supplementation resulted in increased glycine and decreased threonine, histidine, valine, and total branch chained amino acids at 12 months. In conclusion, daily choline supplementation with LYM-X-SORB did not alter methionine-homocysteine metabolism but did result in alterations in other amino acids in children with CF and PI.
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Affiliation(s)
- Belal Alshaikh
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Joan I Schall
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Asim Maqbool
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Maria Mascarenhas
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Michael J Bennett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Philadelphia, PA, USA.
| | - Virginia A Stallings
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Irving SY, Seiple S, Nagle M, Falk S, Mascarenhas M, Srinivasan V. Perceived barriers to anthropometric measurements in critically ill children. Am J Crit Care 2015; 24:e99-e107. [PMID: 26523018 DOI: 10.4037/ajcc2015807] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Anthropometric measurements are vital for safe care in pediatric intensive care units. OBJECTIVE To identify barriers to anthropometric measurements and determine if perceptions of barriers differ between ordering providers and nurses. METHODS A 21-item survey to elicit perceptions of barriers to obtaining anthropometric measurements was distributed via e-mail to societies with members who provide care in pediatric intensive care units. RESULTS Most of the 258 eligible respondents (46% ordering providers) were from North America (90%). Although 84% agreed that anthropometric measurements are important, only 3% knew if these measurements were obtained upon admission to their unit. Estimates of patients' measurements by parents or caregivers were commonly used (72%) when actual measurements were not obtained. Leading barriers were presence of medical devices (57%), use of extracorporeal life support (54%), and unstable hemodynamic status (52%). More ordering providers than nurses considered osteopenia/fragile bones as a barrier to weight measurement (46% vs 29%; P = .007) and traumatic brain injury a barrier to measurement of head circumference (42% vs 24%; P = .002). More nurses than ordering providers perceived dialysis (21% vs 9%; P = .01) and obesity (26% vs 15%; P = .04) as barriers to measurement of stature. Ordering providers more than nurses perceived nurses' workload (51% vs 33%; P < .001) and lack of importance (43% vs 20%; P < .001) as barriers. CONCLUSIONS Barriers to obtaining anthropometric measurements exist in pediatric intensive care units; ordering providers and nurses have different perceptions of what constitutes a barrier.
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Affiliation(s)
- Sharon Y Irving
- Sharon Y. Irving is an assistant professor, Department of Family and Community Health, University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania; Pediatric nurse practitioner, Department of Nursing, Respiratory Care, and Neurodiagnostic Services and Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Stephanie Seiple, Monica Nagle, and Shiela Falk are clinical dietitians, in the Pediatric Intensive Care Unit at the Children's Hospital of Philadelphia. Maria Mascarenhas is medical director, Department of Clinical Nutrition, Children's Hospital of Philadelphia, and associate professor, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Vijay Srinivasan is an attending physician, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, and assistant professor, Perelman School of Medicine, University of Pennsylvania.
| | - Stephanie Seiple
- Sharon Y. Irving is an assistant professor, Department of Family and Community Health, University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania; Pediatric nurse practitioner, Department of Nursing, Respiratory Care, and Neurodiagnostic Services and Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Stephanie Seiple, Monica Nagle, and Shiela Falk are clinical dietitians, in the Pediatric Intensive Care Unit at the Children's Hospital of Philadelphia. Maria Mascarenhas is medical director, Department of Clinical Nutrition, Children's Hospital of Philadelphia, and associate professor, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Vijay Srinivasan is an attending physician, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, and assistant professor, Perelman School of Medicine, University of Pennsylvania
| | - Monica Nagle
- Sharon Y. Irving is an assistant professor, Department of Family and Community Health, University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania; Pediatric nurse practitioner, Department of Nursing, Respiratory Care, and Neurodiagnostic Services and Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Stephanie Seiple, Monica Nagle, and Shiela Falk are clinical dietitians, in the Pediatric Intensive Care Unit at the Children's Hospital of Philadelphia. Maria Mascarenhas is medical director, Department of Clinical Nutrition, Children's Hospital of Philadelphia, and associate professor, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Vijay Srinivasan is an attending physician, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, and assistant professor, Perelman School of Medicine, University of Pennsylvania
| | - Shiela Falk
- Sharon Y. Irving is an assistant professor, Department of Family and Community Health, University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania; Pediatric nurse practitioner, Department of Nursing, Respiratory Care, and Neurodiagnostic Services and Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Stephanie Seiple, Monica Nagle, and Shiela Falk are clinical dietitians, in the Pediatric Intensive Care Unit at the Children's Hospital of Philadelphia. Maria Mascarenhas is medical director, Department of Clinical Nutrition, Children's Hospital of Philadelphia, and associate professor, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Vijay Srinivasan is an attending physician, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, and assistant professor, Perelman School of Medicine, University of Pennsylvania
| | - Maria Mascarenhas
- Sharon Y. Irving is an assistant professor, Department of Family and Community Health, University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania; Pediatric nurse practitioner, Department of Nursing, Respiratory Care, and Neurodiagnostic Services and Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Stephanie Seiple, Monica Nagle, and Shiela Falk are clinical dietitians, in the Pediatric Intensive Care Unit at the Children's Hospital of Philadelphia. Maria Mascarenhas is medical director, Department of Clinical Nutrition, Children's Hospital of Philadelphia, and associate professor, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Vijay Srinivasan is an attending physician, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, and assistant professor, Perelman School of Medicine, University of Pennsylvania
| | - Vijay Srinivasan
- Sharon Y. Irving is an assistant professor, Department of Family and Community Health, University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania; Pediatric nurse practitioner, Department of Nursing, Respiratory Care, and Neurodiagnostic Services and Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Stephanie Seiple, Monica Nagle, and Shiela Falk are clinical dietitians, in the Pediatric Intensive Care Unit at the Children's Hospital of Philadelphia. Maria Mascarenhas is medical director, Department of Clinical Nutrition, Children's Hospital of Philadelphia, and associate professor, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Vijay Srinivasan is an attending physician, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, and assistant professor, Perelman School of Medicine, University of Pennsylvania
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28
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Lakdawalla DN, Mascarenhas M, Jena AB, Vanderpuye-Orgle J, LaVallee C, Linthicum MT, Snider JT. Impact of Oral Nutrition Supplements on Hospital Outcomes in Pediatric Patients. JPEN J Parenter Enteral Nutr 2014; 38:42S-9S. [DOI: 10.1177/0148607114549769] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Darius N. Lakdawalla
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California
| | | | - Anupam B. Jena
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
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Greig J, Rajić A, Young I, Mascarenhas M, Waddell L, LeJeune J. A scoping review of the role of wildlife in the transmission of bacterial pathogens and antimicrobial resistance to the food Chain. Zoonoses Public Health 2014; 62:269-84. [PMID: 25175882 DOI: 10.1111/zph.12147] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Indexed: 11/28/2022]
Abstract
Wildlife can contribute to environmental contamination with bacterial pathogens and their transfer to the human food chain. Global usage and frequent misuse of antimicrobials contribute to emergence of new antimicrobial resistant (AMR) strains of foodborne pathogens. We conducted a scoping review of published research to identify and characterize the evidence on wildlife's role in transmission of AMR and/or bacterial pathogens to the food chain. An advisory group (AG) of 13 North American experts from diverse disciplines was surveyed to solicit insight in the review scope, priority topics and research characteristics. A pre-tested search strategy was implemented in seven bibliographic databases (1990 to January 2013). Citations were relevance screened, and key characteristics on priority topics extracted independently by two reviewers. Analysis identified topic areas with solid evidence and main knowledge gaps. North America reported 30% of 866 relevant articles. The prevalence of five targeted bacterial pathogens and/or AMR in any pathogen in wildlife was reported in 582 articles. Transmission risk factors for selected bacteria or AMR in any bacteria were reported in 300. Interventions to control transmission were discussed in 124 articles and formally evaluated in 50. The majority of primary research investigated birds, cervids, rodents, feral pigs, opossums, E. coli (n = 329), Salmonella (n = 293) and Campylobacter (n = 124). An association between wildlife and transmission of bacterial pathogens and/or AMR to the food chain was supported in 122 studies. The scoping review identified a significant body of research on the role of wild birds in the prevalence and transmission of E. coli, Salmonella and Campylobacter. There was little research employing molecular methods contributing to the evidence concerning the importance and direction of transmission of wildlife/pathogen combinations. Given the advancements of these methods, future research should focus in this area to help prioritize future intervention studies and risk mitigation strategies.
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Affiliation(s)
- J Greig
- Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, Guelph, Ontario, Canada
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Bernardino J, Bispo R, Costa H, Mascarenhas M. Estimating bird and bat fatality at wind farms: a practical overview of estimators, their assumptions and limitations. New Zealand Journal of Zoology 2013. [DOI: 10.1080/03014223.2012.758155] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ott J, Ullrich A, Mascarenhas M, Stevens G. Global cancer incidence and mortality caused by behavior and infection. J Public Health (Oxf) 2010; 33:223-33. [DOI: 10.1093/pubmed/fdq076] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Since the identification of cystic fibrosis (CF) in the 1940s, nutrition care of patients who have CF has been a challenge. Through optimal caloric intake and careful management of malabsorption, patients are expected to meet genetic potential for growth. Yet factors beyond malabsorption, including nutrient activity at the cellular level, may influence growth and health. This article reviews nutrition topics frequently discussed in relationship to CF and presents intriguing new information describing nutrients currently being studied for their impact on overall health of patients who have CF.
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Affiliation(s)
- Suzanne H Michel
- Department of Clinical Nutrition, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Boulevard, 9NW, Room 82, Philadelphia, PA 19104-4399, USA.
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Chaston T, Chung B, Mascarenhas M, Marks J, Patel B, Srai SK, Sharp P. Evidence for differential effects of hepcidin in macrophages and intestinal epithelial cells. Gut 2008; 57:374-82. [PMID: 17965061 DOI: 10.1136/gut.2007.131722] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Reticulo-endothelial macrophages together with duodenal enterocytes coordinate body iron homeostasis. The aim of this study was to investigate the regulatory actions of the hormone hepcidin on ferroportin expression in these two cell types. METHODS We investigated the in vitro effects of hepcidin in well-characterised human cell culture models of macrophages (differentiated THP-1 cells) and intestinal epithelial cells (Caco-2 cells). The in vivo effects of hepcidin were also investigated in mice injected with a synthetic hepcidin peptide. RESULTS Exposure to hepcidin (presented either as conditioned medium from interleukin-6-stimulated HuH7 cells or as a synthetic peptide) resulted in a rapid (within 4 h) decrease in ferroportin expression in THP-1 macrophages but had no effect on ferroportin levels in Caco-2 cells. To determine whether these rapid effects of hepcidin were also evident in vivo we injected mice with a synthetic hepcidin peptide. Four hours post-injection, ferroportin levels in the macrophage-rich red pulp of the spleen were decreased significantly and the hepcidin-treated mice developed hypoferraemia. Interestingly, in the same mice there was no effect of hepcidin on duodenal ferroportin protein expression or duodenal iron transport. CONCLUSIONS These data suggests that the rapid response to hepcidin is cell type and tissue specific. Upon its release, hepcidin initially targets macrophage iron recycling. The duodenum appears to be less sensitive to this initial rise in hepcidin levels. We believe the fact that macrophages respond more acutely to a hepcidin challenge is fully consistent with their central role in maintaining body iron homeostasis.
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Affiliation(s)
- T Chaston
- Nutritional Sciences Division, King's College London, London, SE1 9NH, UK
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Liacouras CA, Spergel JM, Ruchelli E, Verma R, Mascarenhas M, Semeao E, Flick J, Kelly J, Brown-Whitehorn T, Mamula P, Markowitz JE. Eosinophilic esophagitis: a 10-year experience in 381 children. Clin Gastroenterol Hepatol 2005; 3:1198-206. [PMID: 16361045 DOI: 10.1016/s1542-3565(05)00885-2] [Citation(s) in RCA: 570] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Eosinophilic esophagitis (EoE) is a disorder characterized by a severe, isolated eosinophilic infiltration of the esophagus unresponsive to aggressive acid blockade but responsive to the removal of dietary antigens. We present information relating to our 10-year experience in children diagnosed with EoE. METHODS We conducted a retrospective study between January 1, 1994, and January 1, 2004, to evaluate all patients diagnosed with EoE. Clinical symptoms, demographic data, endoscopic findings, and the results of various treatment regimens were collected and evaluated. RESULTS A total of 381 patients (66% male, age 9.1 +/- 3.1 years) were diagnosed with EoE: 312 presented with symptoms of gastroesophageal reflux; 69 presented with dysphagia. Endoscopically, 68% of patients had a visually abnormal esophagus; 32% had a normal-appearing esophagus despite a severe histologic esophageal eosinophilia. The average number of esophageal eosinophils (per 400 x high power field) proximally and distally were 23.3 +/- 10.5 and 38.7 +/- 13.3, respectively. Corticosteroids significantly improved clinical symptoms and esophageal histology; however, upon their withdrawal, the symptoms and esophageal eosinophilia recurred. Dietary restriction or complete dietary elimination using an amino acid-based formula significantly improved both the clinical symptoms and esophageal histology in 75 and 172 patients, respectively. CONCLUSIONS Medications such as corticosteroids are effective; however, upon withdrawal, EoE recurs. The removal of dietary antigens significantly improved clinical symptoms and esophageal histology in 98% of patients.
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Affiliation(s)
- Chris A Liacouras
- Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
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Leung PS, Srai SK, Mascarenhas M, Churchill LJ, Debnam ES. Increased duodenal iron uptake and transfer in a rat model of chronic hypoxia is accompanied by reduced hepcidin expression. Gut 2005; 54:1391-5. [PMID: 15914574 PMCID: PMC1774692 DOI: 10.1136/gut.2004.062083] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Despite the requirement for increased iron delivery for erythropoiesis during hypoxia, there is very little information on how duodenal iron uptake and its transfer to the blood adapts to this condition. AIMS To assess the effects of 30 days of chronic hypoxia in rats on luminal iron uptake and transfer of the metal to blood, together with gene expression of hepcidin, a proposed negative regulator of iron transport. METHODS 59-Fe uptake by isolated duodenum and its transfer to blood by in vivo duodenal segments was measured after exposure of rats to room air or 10% oxygen for four weeks. Liver hepcidin expression was measured by real time reverse transcription-polymerase chain reaction. The effects of hypoxia on hepcidin gene expression by HepG2 cells was also determined. RESULTS Hypoxia did not affect villus length but enhanced (+192.6%) luminal iron uptake by increasing the rate of uptake by all enterocytes, particularly those on the upper villus. Hypoxia promoted iron transfer to the blood but reduced mucosal iron accumulation in vivo by 66.7%. Hypoxia reduced expression of hepcidin mRNA in both rat liver and HepG2 cells. CONCLUSIONS Prolonged hypoxia enhances iron transport from duodenal lumen to blood but the process is unable to fully meet the iron requirement for increased erythropoiesis. Reduced secretion of hepcidin may be pivotal to the changes in iron absorption. The processes responsible for suppression of hepcidin expression are unknown but are likely to involve a direct effect of hypoxia on hepatocytes.
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Affiliation(s)
- P S Leung
- Department of Physiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, P R China
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Affiliation(s)
- Binita M Kamath
- Department of Pediatrics, Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104-4399, USA
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Brown KA, Back SJ, Ruchelli ED, Markowitz J, Mascarenhas M, Verma R, Piccoli DA, Baldassano RN. Lamina propria and circulating interleukin-6 in newly diagnosed pediatric inflammatory bowel disease patients. Am J Gastroenterol 2002; 97:2603-8. [PMID: 12385446 DOI: 10.1111/j.1572-0241.2002.06030.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Understanding cytokine production patterns in early mucosal lesions of pediatric patients newly diagnosed with inflammatory bowel disease (IBD) may be critical to understanding IBD pathogenesis. Interleukin-6 (IL-6) has a central role in a multitude of immune system reactions; however, inconsistent lamina propria and serum IL-6 has been reported in IBD patients. Newly diagnosed pediatric IBD patients have not previously been evaluated for lamina propria or serum IL-6. METHODS Serum and intestinal lamina propria biopsy whole organ culture supernatants were evaluated by ELISA for IL-6 obtained from newly diagnosed IBD patients, before initiation of immunomodulatory therapies. RESULTS Levels of lamina propria IL-6 demonstrated significant correlation with graded severity of histological inflammation (p < 0.001). Log-transformed serum and organ culture IL-6 levels demonstrated significant correlation (p < 0.0001, R2 = 0.6226). Assigning a demarcation level of >400 pg/ml, serum IL-6 concentrations were a superior marker for the presence of microscopic intestinal inflammation than erythrocyte sedimentation rate (ESR), with a sensitivity of 82%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 82%. When evaluating subtypes of IBD, serum IL-6 levels were correlated more significantly with active disease in ulcerative colitis patients (p = 0.01, R2 = 0.74) than in Crohn's disease patients (p = 0.21, R2 = 0.33). CONCLUSIONS This study outlines graded production of IL-6 in intestinal lamina propria and serum of newly diagnosed pediatric IBD patients, confirming the presence of IL-6 in early IBD patients. In addition, serum IL-6 may be a good predictor of IBD in pediatric patients with suspected or newly diagnosed IBD.
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Affiliation(s)
- Kurt A Brown
- Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Pennsylvania 19104, USA
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Spergel JM, Beausoleil JL, Mascarenhas M, Liacouras CA. The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis. J Allergy Clin Immunol 2002; 109:363-8. [PMID: 11842310 DOI: 10.1067/mai.2002.121458] [Citation(s) in RCA: 387] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Eosinophilic esophagitis is a disease entity in which patients have (1) elevated eosinophils on esophageal biopsy and (2) symptoms of gastroesophageal reflux. The symptoms do not improve on aggressive acid blockade but do improve on elimination diet or corticosteroid treatment, which tentatively links food allergies to this disorder. OBJECTIVE The purpose of this study was to identify potential food antigens in eosinophilic esophagitis. METHODS Patients with eosinophilic esophagitis were identified by biopsy. Potential food antigens were identified prospectively by skin prick testing and patch testing, which were performed through use of standard methods. Atopic tendencies, demographics, and potential food allergies were identified. Repeat esophageal biopsies were reviewed when possible. RESULTS A total of 26 patients (22 male, 4 female) with a biopsied-confirmed diagnosis of eosinophilic esophagitis underwent both skin prick testing and patch testing to identify potential causative foods. Milk and egg were the most common positive foods with skin prick testing. Wheat was the most common positive food with patch testing. The patients were advised to avoid positive foods as identified by skin prick testing and patch testing. In all, 18 patients had resolution of their symptoms, 6 patients had partial improvement, and 2 were lost to follow-up. Overall, after intervention, esophageal eosinophil counts improved from 55.8 to 8.4 eosinophils per high-power field. The foods most commonly identified by patients as causing symptoms were milk and egg. CONCLUSION The combination of skin prick testing and patch testing can identify potential causative foods that might contribute to the pathogenesis of eosinophilic esophagitis.
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Affiliation(s)
- Jonathan M Spergel
- Allergy Section, Division of Immunologic and Infectious Disease, The Children's Hospital of Philadelphia, PA 19104, USA
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Michael Spergel J, Beausoleil JL, Mascarenhas M, Liacouras C. The use of prick skin tests and patch tests to identify causative foods in eosinophilic esophagitis. J Allergy Clin Immunol 2002. [DOI: 10.1016/s0091-6749(02)81797-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cardoso CS, Oliveira P, Porto G, Oberkanins C, Mascarenhas M, Rodrigues P, Kury F, de Sousa M. Comparative study of the two more frequent HFE mutations (C282Y and H63D): significant different allelic frequencies between the North and South of Portugal. Eur J Hum Genet 2001; 9:843-8. [PMID: 11781701 DOI: 10.1038/sj.ejhg.5200723] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2001] [Revised: 07/12/2001] [Accepted: 08/19/2001] [Indexed: 02/03/2023] Open
Abstract
An earlier study of reference values of iron parameters in Portugal showed significant differences between populations from northern and southern villages. This study addresses the question of the geographical distribution in Portugal of the two main mutations (C282Y and H63D) of the hereditary hemochromatosis gene, HFE. For that purpose, a stratified sample of 640 anonymous dried blood spot samples was randomly selected from the major regions of Portugal: North, Center, Lisbon and the Tagus Valley, Alentejo and Algarve. Differences in the geographical distribution of these two mutations were observed thus confirming the presumed differences between the age of the two mutations which is compatible with the postulated Celtic/Nordic origin of the C282Y mutation. The finding of a significantly higher allelic frequency of the C282Y mutation in the North (0.058) than in the South (0.009) could also point to an effect of differential selective forces acting in the different geographical areas of the country. Data on archaeological, ethnographic and linguistic records and on the North/South distribution of Portuguese cattle breeds of European or African origin have also been reported. In addition to their interest for population genetics, the results represent a reminder of the need to take into account regional differences in the design of strategies for population screening of hereditary hemochromatosis.
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Affiliation(s)
- C S Cardoso
- Molecular Immunology and Pathology, ICBAS, Porto, Portugal, and Molecular Immunology, IBMC, Porto, Portugal
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41
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Jones NL, Islur A, Haq R, Mascarenhas M, Karmali MA, Perdue MH, Zanke BW, Sherman PM. Escherichia coli Shiga toxins induce apoptosis in epithelial cells that is regulated by the Bcl-2 family. Am J Physiol Gastrointest Liver Physiol 2000; 278:G811-9. [PMID: 10801274 DOI: 10.1152/ajpgi.2000.278.5.g811] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Human intestinal cells lack globotriaosylceramide (Gb(3)), the receptor for Shiga toxin-1 (Stx1) and Shiga toxin-2 (Stx2). Therefore, the role of these toxins in mediating intestinal disease during infection with Shiga toxin-producing Escherichia coli is unclear. The aims of this study were to determine whether Stx1 and Stx2 induce apoptosis in epithelial cells expressing (HEp-2, Caco-2) or lacking (T84) Gb(3) and to characterize the role of the Bcl-2 family. Stx1 (12.5 ng/ml) induced apoptosis in both HEp-2 (21.9 +/- 7.9% vs. 0.8 +/- 0.3%, P = 0.01) and Caco-2 (10.1 +/- 1.2% vs. 3.1 +/- 0.4%, P = 0.006) cells but not in Gb(3)-deficient T84 cells. Toxin-mediated apoptosis of HEp-2 cells was associated with enhanced expression of the proapoptotic protein Bax. Inhibition of caspase activation prevented toxin-stimulated apoptosis. In addition, overexpression of Bcl-2 by transient transfection blocked Stx1-stimulated cell death. These findings indicate that Shiga toxins produced by E. coli signal Gb(3)-expressing epithelial cells to undergo apoptosis in association with enhanced Bax expression, thereby resulting in activation of the caspase cascade.
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Affiliation(s)
- N L Jones
- Research Institute, Hospital for Sick Children, University of Toronto, Toronto M5G 1X8, Canada L8N 3Z5
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Correia MJ, Mascarenhas M, Madureira R, Neves LS, Ferreira JA, Gonçalves MD. Extra-adrenal pheochromocytoma (paraganglioma). Rev Port Cardiol 2000; 19:117-9. [PMID: 10731797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
The authors describe the case of a 19-year-old female patient with an abdominal paraaortic extra-adrenal pheochromocytoma (paraganglioma), presenting arterial hypertension. The predominant catecholamine produced by the tumor was norepinephrine (4110 pg/ml; normal < 450 pg/ml). 131I metaiodobenzylguanidine (131I-MIBG), computed tomography and magnetic resonance imaging allowed location and characterization of the tumor. Histologically the tumor (weight = 34.2 g; 5.8 x 4 x 3 cm) was a typical pheochromocytoma.
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Affiliation(s)
- M J Correia
- UTIC-Arsénio Cordeiro, Hospital de Santa Maria, Lisboa
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Rapado A, Hawkins F, Sobrinho L, Díaz-Curiel M, Galvao-Telles A, Arver S, Melo Gomes J, Mazer N, Garcia e Costa J, Horcajada C, López-Gavilanes E, Mascarenhas M, Papapietro K, López Alvarez MB, Pereira MC, Martinez G, Valverde I, García JJ, Carballal JJ, García I. Bone mineral density and androgen levels in elderly males. Calcif Tissue Int 1999; 65:417-21. [PMID: 10594158 DOI: 10.1007/s002239900726] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To clarify the relationship of sex male hormones and bone in men, we studied in 140 healthy elderly men (aged 55-90 years) the relation between serum levels of androgens and related sex hormones, bone mineral density (BMD) at different sites, and other parameters related to bone metabolism. Our results show a slight decrease of serum-free testosterone with age, with an increase of follicle stimulating hormone (FSH) and luteinizing hormone (LH) in a third of the elderly subjects studied. BMD decreased significantly with age in all regions studied, except in the lumbar spine. We found a positive correlation between body mass index (BMI) and BMD at the lumbar spine and femoral neck (P < 0.001). No relationship was found (uni- and multivariate regression analysis) between serum androgens or sex hormone-binding globulin (SHBG) and BMD. We found a positive correlation of vitamin D binding protein (DBP) and osteocalcin with lumbar spine BMD and with BMI, DBP, IGF-1, and PTH with femoral neck BMD. In conclusion, there is a slight decline in free testosterone and BMD in the healthy elderly males. However, sex male hormones are not correlated to the decrease in hip BMD. Other age-related factors must be associated with bone loss in elderly males.
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Affiliation(s)
- A Rapado
- Clínica de Na Sra de la Concepción, Fundación Jiménez Díaz, Madrid, Spain
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Liacouras CA, Mascarenhas M, Poon C, Wenner WJ. Placebo-controlled trial assessing the use of oral midazolam as a premedication to conscious sedation for pediatric endoscopy. Gastrointest Endosc 1998; 47:455-60. [PMID: 9647368 DOI: 10.1016/s0016-5107(98)70244-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study was performed to evaluate the effect of midazolam, as premedication before intravenous conscious sedation, on preprocedural, procedural, and post-procedural patient comfort and anxiety in children undergoing endoscopy. METHODS A placebo-controlled, double-blind, randomized study was conducted in 123 children (age 7.75 +/- 4.46 years, 56% male) using oral midazolam (0.5 mg/kg, maximum 20 mg) as a premedication before insertion of an intravenous access device (i.v.) and upper endoscopy. Patients were evaluated with regard to changes in vital signs, level of sedation during i.v. placement, level of pre- and post-procedure conscious sedation, ease of separation from parents, ease and duration of procedure, recovery time, and amnesia to objects shown before i.v. placement and immediately before the start of the procedure. RESULTS A significant difference was noted in the study group for the following parameters: level of sedation for i.v. placement (p < 0.0001), pre-procedural sedation (p < 0.001), ease of i.v. insertion (p < 0.003), ease of separation from parents (p = 0.022), and ease of the nursing personnel's ability to monitor the patient during the procedure (p = 0.0012). The patient's amnesia to an object shown immediately before beginning the endoscopy was increased (p < 0.001). Patients and parents were also more satisfied with the procedure process (p < 0.05). No significant difference was noted with regard to the length or performance of the procedure or recovery time or in the dose of i.v. medication required for successful completion of the endoscopy. CONCLUSION Oral midazolam is an effective and safe premedication for children undergoing upper endoscopy and should be used in all anxious children and in patients previously judged to be difficult to sedate.
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Affiliation(s)
- C A Liacouras
- Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Pennsylvania 19104, USA
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45
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Lye SJ, Nicholson BJ, Mascarenhas M, MacKenzie L, Petrocelli T. Increased expression of connexin-43 in the rat myometrium during labor is associated with an increase in the plasma estrogen:progesterone ratio. Endocrinology 1993; 132:2380-6. [PMID: 8389279 DOI: 10.1210/endo.132.6.8389279] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The molecular mechanisms that regulate the synthesis of the myometrial gap junction protein, connexin-43 (Cx-43), are controversial. We measured myometrial Cx-43 messenger RNA, protein and gap junction frequency, and area in myometrial samples collected from nonpregnant rats and pregnant rats at days 5, 10, 15, 17, 18, 19, 20, 21, 22, 23 (during delivery), and 1 day postpartum and correlated these data with plasma concentrations of estradiol 17 beta and progesterone. Cx-43 transcripts were low or undetectable (connexin-43:glyceraldehyde phosphate dehydrogenase ratio < 0.2) in nonpregnant rats or in rats before day 10 of pregnancy. Transcripts rose to 0.52 +/- 0.11 on day 10, increased (2.9-fold) to 1.51 +/- 0.48 on day 22, and increased a further 2.9-fold to maximal levels of 4.42 +/- 0.67 during labor. Cx-43 protein was barely detectable on day 21 [0.12 +/- 0.04 relative optical density (ROD) units], increased 2.5-fold on day 22 (0.30 +/- 0.04 ROD units), and a further 3.7-fold during delivery (1.10 +/- 0.15 ROD units), at a time when gap junctions were present in large numbers in the cell membrane. Between day 21 and delivery the increase in Cx-43 transcripts (8.2-fold) and protein (9.2-fold) were of a similar magnitude. There was a significant positive correlation between the increases in Cx-43 transcripts and the increase in the ratio of plasma estradiol to progesterone. Levels of Cx-43 transcripts, protein, and gap junctions fell rapidly postpartum. Our data demonstrate: 1) that transcripts encoding the gap junction protein, Cx-43, are at maximal levels during delivery and that this increase is temporally associated with increases in Cx-43 protein and the appearance of gap junctions; and 2) that these data, in association with changes in plasma steroid concentrations, are consistent with myometrial Cx-43 transcript levels being regulated positively by estrogen and negatively by progesterone during pregnancy.
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Affiliation(s)
- S J Lye
- Division of Perinatology, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
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Cappell MS, Hassan T, Rosenthal S, Mascarenhas M. Gastrointestinal obstruction due to Mycobacterium avium intracellulare associated with the acquired immunodeficiency syndrome. Am J Gastroenterol 1992; 87:1823-1827. [PMID: 1449151 DOI: 10.1111/j.1572-0241.1992.tb07317.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Three patients with the acquired immunodeficiency syndrome (AIDS) had complete or incomplete gastrointestinal obstruction resulting from infection with Mycobacterium avium intracellulare. The pathophysiologic mechanisms of the obstruction in the three cases were ileal volvulus due to adhesions from matted infected mesenteric lymph nodes, ileal intussusception due to engorged infected ileal mucosa, and small bowel displacement and compression by massively enlarged infected intraabdominal lymph nodes. These reports extend the clinical manifestations of Mycobacterium avium intracellulare infection in patients with AIDS to include partial and complete gastrointestinal obstruction.
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Affiliation(s)
- M S Cappell
- Department of Medicine, University of Medicine of New Jersey-Robert Wood Johnson, New Brunswick
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Sores FN, Forjaz NJ, Mascarenhas M. [Use of injectable medazepam (preliminar report)]. Rev Bras Med 1970; 27:19-61. [PMID: 5504868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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