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Talathi S, Wilkinson L, Meloni K, Shroyer M, Zhang L, Ding Z, Eipers P, Van Der Pol W, Martin C, Dimmitt R, Yi N, Morrow C, Galloway D. Factors Affecting the Gut Microbiome in Pediatric Intestinal Failure. J Pediatr Gastroenterol Nutr 2023; 77:426-432. [PMID: 37184493 DOI: 10.1097/mpg.0000000000003828] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND There is little data on gut microbiome and various factors that lead to dysbiosis in pediatric intestinal failure (PIF). This study aimed to characterize gut microbiome in PIF and determine factors that may affect microbial composition in these patients. METHODS This is a single-center, prospective cohort study of children with PIF followed at our intestinal rehabilitation program. Stool samples were collected longitudinally at regular intervals over a 1-year period. Medical records were reviewed, and demographic and clinical data were collected. Medication history including the use of acid blockers, scheduled prophylactic antibiotics, and bile acid sequestrants was obtained. Gut microbial diversity among patients was assessed and compared according to various host characteristics of interest. RESULTS The final analysis included 74 specimens from 12 subjects. Scheduled prophylactic antibiotics, presence of central line associated bloodstream infection (CLABSI) at the time of specimen collection, use of acid blockers, and ≥50% calories delivered via parenteral nutrition (PN) was associated with reduced alpha diversity, whereas increasing age was associated with improved alpha diversity at various microbial levels ( P value <0.05). Beta diversity differed with age, presence of CLABSI, use of scheduled antibiotics, acid blockers, percent calories via PN, and presence of oral feeds at various microbial levels ( P value <0.05). Single taxon analysis identified several taxa at several microbial levels, which were significantly associated with various host characteristics. CONCLUSION Gut microbial diversity in PIF subjects is influenced by various factors involved in the rehabilitation process including medications, percent calories received parenterally, CLABSI events, the degree of oral feeding, and age. Additional investigation performed across multiple centers is needed to further understand the impact of these findings on important clinical outcomes in PIF.
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Affiliation(s)
- Saurabh Talathi
- From the Department of Pediatrics, Division of Pediatric Gastroenterology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
- the Department of Pediatrics, Division of Pediatric Gastroenterology, The University of Alabama at Birmingham, Birmingham, AL
| | - Linda Wilkinson
- the Department of Surgery, Division of Pediatric Surgery, The University of Alabama at Birmingham, Birmingham, AL
| | - Katie Meloni
- the Department of Clinical Nutrition, Children's of Alabama, Birmingham, AL
| | - Michelle Shroyer
- the Department of Surgery, Division of Pediatric Surgery, The University of Alabama at Birmingham, Birmingham, AL
| | - Li Zhang
- the Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Zhenying Ding
- the Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Peter Eipers
- the Department of Cell, Developmental, & Integrative Biology, The University of Alabama at Birmingham, Birmingham, AL
| | - William Van Der Pol
- the Biomedical Informatics Center for Clinical and Translational Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Colin Martin
- the Department of Surgery, Division of Pediatric Surgery, The University of Alabama at Birmingham, Birmingham, AL
| | - Reed Dimmitt
- the Department of Pediatrics, Division of Pediatric Gastroenterology, The University of Alabama at Birmingham, Birmingham, AL
| | - Nengjun Yi
- the Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Casey Morrow
- the Department of Cell, Developmental, & Integrative Biology, The University of Alabama at Birmingham, Birmingham, AL
| | - David Galloway
- the Department of Pediatrics, Division of Pediatric Gastroenterology, The University of Alabama at Birmingham, Birmingham, AL
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Gupta N, Ali C, Talathi S. SO,MCT,OO,FO-ILE Is Associated With Better Side Effect Profile Than SO-ILE in Critically Ill Children Receiving Parenteral Nutrition. J Pediatr Pharmacol Ther 2023; 28:329-334. [PMID: 37795287 PMCID: PMC10547041 DOI: 10.5863/1551-6776-28.4.329] [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: 01/07/2022] [Accepted: 09/12/2022] [Indexed: 10/06/2023]
Abstract
OBJECTIVES This study aimed to evaluate the side effect profile of soybean oil lipid injectable emulsion -(SO-ILE) and soybean oil, medium-chain triglyceride, olive oil, fish oil lipid injectable emulsion (SO,MCT,OO,FO-ILE) in critically ill children requiring parenteral nutrition (PN). METHODS This is an observational study of children admitted to our pediatric intensive care unit requiring PN for ≥7 days. Patients were divided into 2 cohorts: SO,MCT,OO,FO-ILE (n = 34) and SO-ILE (n = 111). Outcomes included development of hypertriglyceridemia (HTG), intestinal failure-associated liver disease (IFALD), length of stay, and mortality. Logistic regression was performed after controlling for duration and maximum dose of lipids. RESULTS The median maximum lipid dose was significantly higher in the SO,MCT,OO,FO-ILE cohort (2.7 vs 3 g/kg; p = 0.01). Prevalence of baseline HTG was similar in both cohorts. After excluding patients with baseline HTG, incidence of HTG upon PN introduction was higher in the SO-ILE cohort (51.2% vs 26.7%; p = 0.02). The SO-ILE cohort also had significantly higher triglyceride concentrations at peak and upon discontinuation of PN (p < 0.05). Direct bilirubin and C-reactive protein were significantly higher in the SO-ILE cohort after stopping PN. Five patients (3.4%) developed IFALD, 4 of whom were in the SO-ILE cohort (p = 0.85). Upon logistic regression, mortality rate and incidence of HTG remained significantly higher in the SO-ILE cohort (adjusted odds ratio, 2.3 [95% CI, 1.1-5.3]; p = 0.04; and adjusted odds ratio, 2.0 [95% CI, 1.3-5.1]; p = 0.03, respectively). CONCLUSIONS In critically ill children requiring PN, SO-ILE was associated with a higher risk of HTG, -elevated direct bilirubin, inflammatory markers and mortality compared with SO,MCT,OO,FO-ILE.
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Affiliation(s)
- Neha Gupta
- Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
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Middelberg LK, Leonard JC, Shi J, Aranda A, Brown JC, Cochran CL, Eastep K, Haasz M, Hoffmann JA, Koral A, Lamoshi A, Levitte S, Lo YHJ, Montminy T, Myer S, Novotny NM, Parrado RH, Ruan W, Stewart AM, Talathi S, Tavarez MM, Townsend P, Zaytsev J, Rudolph B. Warning Labels and High-Powered Magnet Exposures. Pediatrics 2022; 150:189659. [PMID: 36189482 DOI: 10.1542/peds.2022-056325] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND AND OBJECTIVES High-powered magnets are among the most dangerous childhood foreign bodies. Consumer advocates and physicians have called for these products to be effectively banned, but manufacturers assert warning labels would sufficiently mitigate risk. METHODS Subjects from Injuries, Morbidity, and Parental Attitudes Concerning Tiny High-powered Magnets (IMPACT of Magnets), a retrospective, multicenter study of children with high-powered magnet exposures (ie, ingestion or bodily insertion), were contacted. Consenting participants responded to a standardized questionnaire regarding the presence and utility of warning labels, magnet product manufacturer, and attitudes around risk. RESULTS Of 596 patients in the IMPACT study, 173 parents and 1 adult patient were reached and consented to participate. The median age was 7.5 years. Subjects reported not knowing if a warning label was present in 60 (53.6%) cases, whereas 25 (22.3%) stated warnings were absent. Warnings were present in 28 (24.1%) cases but only 13 (46.4%) reported reading them. A manufacturer was identified by families in 28 (16.1%) exposures; 25 of these were domestic and 27 had warnings. Subjects reported knowing magnets were dangerous in 58% of the cases, although 44.3% believed they were children's toys and only 6.9% knew high-powered magnets were previously removed from the United States market. CONCLUSIONS Over 90% of subjects from the IMPACT study didn't know if warning labels were present or failed to read them if they were, whereas almost half believed high-powered magnets were children's toys. Warning labels on high-powered magnet products are, therefore, unlikely to prevent injuries in children.
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Affiliation(s)
- Leah K Middelberg
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio
| | - Julie C Leonard
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio
| | - Junxin Shi
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio
| | - Arturo Aranda
- Division of Pediatric Surgery, Wright State University, Dayton Children's Hospital, Dayton, Ohio
| | - Julie C Brown
- Department of Pediatrics, Division of Emergency Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Christina L Cochran
- Department of Pediatrics, Division of Emergency Medicine, Children's of Alabama, University of Alabama at Birmingham College of Medicine, Birmingham, Alabama
| | - Kasi Eastep
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Norton Children's Hospital affiliated with University of Louisville School of Medicine, Louisville, Kentucky
| | - Maya Haasz
- Department of Pediatrics, Section of Pediatric Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer A Hoffmann
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alexander Koral
- Department of Pediatrics, Section of Pediatric Gastroenterology and Hepatology, Yale New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Abdulraouf Lamoshi
- Division of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, Queens, New York
| | - Steven Levitte
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - Yu Hsiang J Lo
- Department of Emergency Medicine, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Taylor Montminy
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Sara Myer
- Albert Einstein College of Medicine, Bronx, New York
| | - Nathan M Novotny
- Beaumont Children's, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Raphael H Parrado
- Department of Surgery, Division of Pediatric Surgery Medical University of South Carolina Shawn Jenkins Children's Hospital, Charleston, South Carolina
| | - Wenly Ruan
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Amanda M Stewart
- Department of Pediatrics, Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Saurabh Talathi
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Oklahoma Children's Hospital, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Melissa M Tavarez
- Department of Pediatrics, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Peter Townsend
- Department of Pediatrics, Division of Gastroenterology, Connecticut Children's Hospital, University of Connecticut School of Medicine, Hartford, Cennecticut
| | - Julia Zaytsev
- University of Texas Southwestern Medical School, Dallas, Texas
| | - Bryan Rudolph
- Division of Pediatric Gastroenterology, Children's Hospital at Montefiore, Hepatology, and Nutrition, Albert Einstein College of Medicine, Bronx, New York
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Namjoshi SS, Galloway D, Herdes RE, Talathi S, Ding VY, Mezoff EA. Bacterial overgrowth assessment and treatment among pediatric intestinal rehabilitation & nutrition support providers: an international survey of clinical practice patterns. JPEN J Parenter Enteral Nutr 2022; 46:1914-1922. [PMID: 35274342 DOI: 10.1002/jpen.2369] [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: 10/28/2021] [Revised: 02/15/2022] [Accepted: 03/06/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Small bowel bacterial overgrowth (SBBO) is a common, but difficult to diagnose and treat problem in pediatric short bowel syndrome (SBS). Lack of clinical consensus criteria and unknown sensitivity and specificity of bedside diagnosis makes research on this potential SBS disease modifier challenging. The objective of this research was to describe clinical care of SBBO among international intestinal rehabilitation and nutrition support (IR&NS) providers treating patients with SBS. METHODS & MATERIALS A secure, confidential, international, electronic survey of IR&NS practitioners was conducted between March 2021 and May 2021. All analyses were conducted in the R statistical computing framework ™, version 4.0 RESULTS: 60% of respondents agreed and 0% strongly disagreed that abdominal pain, distension, emesis, diarrhea, and malodorous stool, were attributable to SBBO. No more than 20% of respondents strongly agreed and no more than 40% agreed that any sign or symptom was specific for SBBO. For a first-time diagnosis, 31 practitioners agreed with use of a 7-day course of a single antibiotic, with a majority citing Grade 5 evidence to inform their decisions (case series, uncontrolled studies, or expert opinion). The most common first antibiotic used to treat a new onset SBBO was metronidazole, and rifaximin was the 2nd most commonly used. 100% of respondents reported they would consider a consensus algorithm for SBBO, even if the algorithm may be divergent from their current practice. CONCLUSION SBBO practice varies widely among experienced IR&NS providers. Development of a clinical consensus algorithm may help standardize care to improve research and care of this complex problem and to identify risks and benefits of chronic antibiotic use in SBS. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shweta S Namjoshi
- Stanford University School of Medicine & the Lucile Packard Children's Hospital, Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition
| | - David Galloway
- University of Alabama at Birmingham, Center for Advanced Intestinal Rehabilitation, Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition
| | - Rachel E Herdes
- Stanford University School of Medicine & the Lucile Packard Children's Hospital, Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition
| | - Saurabh Talathi
- University of Oklahoma College of Medicine, Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition
| | - Victoria Y Ding
- Stanford University School of Medicine, Department of Medicine, Department of Biomedical Informatics Research
| | - Ethan A Mezoff
- The Ohio State University College of Medicine, Center for Intestinal Rehabilitation and Nutrition Support, Division of Gastroenterology, Hepatology & Nutrition at Nationwide Children's Hospital
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Middelberg LK, Leonard JC, Shi J, Aranda A, Brown JC, Cochran CL, Eastep K, Gonzalez R, Haasz M, Herskovitz S, Hoffmann JA, Koral A, Lamoshi A, Levitte S, Lo YHJ, Montminy T, Novak I, Ng K, Novotny NM, Parrado RH, Ruan W, Shapiro J, Sinclair EM, Stewart AM, Talathi S, Tavarez MM, Townsend P, Zaytsev J, Rudolph B. High-Powered Magnet Exposures in Children: A Multi-Center Cohort Study. Pediatrics 2022; 149:184737. [PMID: 35112127 DOI: 10.1542/peds.2021-054543] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Accepted: 11/23/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES High-powered magnets were effectively removed from the US market by the Consumer Product Safety Commission (CPSC) in 2012 but returned in 2016 after federal court decisions. The United States Court of Appeals for the 10th Circuit cited imprecise data among other reasons as justification for overturning CPSC protections. Since then, incidence of high-powered magnet exposure has increased markedly, but outcome data are limited. In this study, we aim to describe the epidemiology and outcomes in children seeking medical care for high-powered magnets after reintroduction to market. METHODS This is a multicenter, retrospective cohort study of patients aged 0 to 21 years with a confirmed high-powered magnet exposure (ie, ingestion or insertion) at 25 children's hospitals in the United States between 2017 and 2019. RESULTS Of 596 patients with high-powered magnet exposures identified, 362 (60.7%) were male and 566 (95%) were <14 years of age. Nearly all sought care for magnet ingestion (n = 574, 96.3%), whereas 17 patients (2.9%) presented for management of nasal or aural magnet foreign bodies, 4 (0.7%) for magnets in their genitourinary tract, and 1 patient (0.2%) had magnets in their respiratory tract. A total of 57 children (9.6%) had a life-threatening morbidity; 276 (46.3%) required an endoscopy, surgery, or both; and 332 (55.7%) required hospitalization. There was no reported mortality. CONCLUSIONS Despite being intended for use by those >14 years of age, high-powered magnets frequently cause morbidity and lead to high need for invasive intervention and hospitalization in children of all ages.
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Affiliation(s)
- Leah K Middelberg
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Julie C Leonard
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Junxin Shi
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Arturo Aranda
- Division of Pediatric Surgery, Dayton Children's Hospital, Dayton, Ohio
| | - Julie C Brown
- Seattle Children's Hospital, Department of Pediatrics, Division of Emergency Medicine, Seattle, Washington
| | - Christina L Cochran
- Department of Pediatrics, Division of Emergency Medicine, Children's of Alabama, University of Alabama at Birmingham College of Medicine, Birmingham, Alabama
| | - Kasi Eastep
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Norton Children's Hospital affiliated with University of Louisville School of Medicine, Louisville, Kentucky
| | - Raquel Gonzalez
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida
| | - Maya Haasz
- Department of APediatrics, Section of Pediatric Emergency Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Scott Herskovitz
- Department of Pediatrics, Division of Emergency Medicine, Rady Children's Hospital, San Diego, California
| | - Jennifer A Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alexander Koral
- Department of Pediatrics, Section of Pediatric Gastroenterology and Hepatology, Yale New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Abdulraouf Lamoshi
- Division of Pediatric Surgery, Cohen Children's Medical Center; Northwell Health, Queens, New York
| | - Steven Levitte
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - Yu Hsiang J Lo
- Department of Emergency Medicine, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Taylor Montminy
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Inna Novak
- Children's Hospital at Montefiore, Albert Einstein College of Medicine; Bronx, New York
| | - Kenneth Ng
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nathan M Novotny
- Beaumont Children's, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Raphael H Parrado
- Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina Shawn Jenkins Children's Hospital, Charleston, South Carolina
| | - Wenly Ruan
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Joseph Shapiro
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
| | - Elizabeth M Sinclair
- Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Healthcare of Atlanta, Emory University School of Medicine, Department of Pediatrics, Atlanta, Georgia
| | - Amanda M Stewart
- Department of Pediatrics, Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Saurabh Talathi
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Oklahoma Children's Hospital, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Melissa M Tavarez
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Peter Townsend
- Department of Pediatrics, Division of Gastroenterology, Connecticut Children's Hospital, University of Connecticut School of Medicine, Hartford, Connecticut
| | - Julia Zaytsev
- University of Texas Southwestern Medical School, Dallas, Texas
| | - Bryan Rudolph
- Children's Hospital at Montefiore, Albert Einstein College of Medicine; Bronx, New York
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Saeed W, Talathi S, Suneja U, Gupta N, Mandadi AR, Xu H, Leber M, Waseem M. Utility of Body Habitus Parameters to Determine and Improve the Accuracy of the Broselow Tape. Pediatr Emerg Care 2022; 38:e111-e116. [PMID: 32740637 DOI: 10.1097/pec.0000000000002170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/27/2022]
Abstract
OBJECTIVES The aims of this study were to determine and improve accuracy of the Broselow Tape (BT) in estimating children's weight by adding body habitus parameters. METHODS This cross-sectional study was conducted in an urban hospital pediatric clinic. Children up to 8 years old coming in for well-child visit were included. Children with acute illness or presence of any chronic condition potentially resulting in growth disturbance and out of BT height range were excluded. The following body habitus parameters were measured using the Centers for Disease Control and Prevention guidelines: actual weight, predicted weight using BT (BTW), mid-thigh circumference (MTC), body mass index, mid-arm circumference, and waist-to-hip ratio. RESULTS A total of 301 children were enrolled. Of these, 151 were male (50%). Hispanics constituted 160 (53.2%). There was a positive linear association between BTW and actual weight in the overall cohort (adjusted R2 = 0.9164, P < 0.001). However, there was a difference in this association among children younger than 2 years and children older than 2 years (adjusted R2 = 0.89 vs 0.4841). Incorporating MTC and/or waist circumference along with BTW in the model increased the accuracy, providing a better estimate of actual weight (adjusted R2 = 0.94, P < 0.001). CONCLUSIONS We conclude that there might be inaccuracies in the weight predicted by BT in our patient population, especially those weighing more than 15 kg and older than 2 years. Our study also demonstrates that MTC correlates closely with the actual weight and could be used in addition to BT for more accurate weight estimation.
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Affiliation(s)
- Wajeeha Saeed
- From the Department of Pediatric Emergency Medicine, Medical College of Georgia/Augusta University, Augusta, GA
| | - Saurabh Talathi
- Departments of Pediatric Gastroenterology, Hepatology, and Nutrition
| | - Upma Suneja
- Departments of Pediatric Gastroenterology, Hepatology, and Nutrition
| | - Neha Gupta
- Pediatric Critical Care Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Akhila Reddy Mandadi
- Department of Pediatric Emergency Medicine, The University of Florida College of Medicine, Jacksonville, FL
| | - Hongyan Xu
- Department of Population Health Science: Biostats & Data Science, Medical College of Georgia/Augusta University, Augusta, GA
| | - Mark Leber
- Department of Emergency Medicine, Brooklyn Hospital Center, Brooklyn
| | - Muhammad Waseem
- Department of Pediatric Emergency Medicine, Lincoln Medical Center, NY
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Gupta N, Talathi S. Factors Differentiating Multisystem Inflammatory Syndrome in Children (MIS-C) From Severe/Critical COVID-19 Infection in Children. Indian Pediatr 2021. [PMID: 34553691 PMCID: PMC8913231 DOI: 10.1007/s13312-022-2442-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective Methods Results Conclusion Electronic Supplementary Material
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Gupta N, Talathi S, Woolley A, Wilson S, Franklin M, Robbins J, Colston C, Hayes L. Performance of Cornell Assessment of Pediatric Delirium Scale in Mechanically Ventilated Children. J Pediatr Intensive Care 2021; 12:24-30. [PMID: 36742252 PMCID: PMC9894695 DOI: 10.1055/s-0041-1728784] [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: 03/01/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023] Open
Abstract
Accuracy of delirium diagnosis in mechanically ventilated children is often limited by their varying developmental abilities. The purpose of this study was to examine the performance of the Cornell Assessment of Pediatric Delirium (CAPD) scale in these patients. This is a single-center, prospective, observational study of patients requiring sedation and mechanical ventilation for 2 days or more. CAPD scale was implemented in our unit for delirium screening. Each CAPD assessment was accompanied by a physician assessment using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Sensitivity analysis was performed to determine the best cut-off score in our target population. We also evaluated ways to improve the accuracy of this scale in patients with and without developmental delay. A total of 837 paired assessments were performed. Prevalence of delirium was 19%. Overall, CAPD score ≥ 9 had sensitivity of 81.8% and specificity of 44.8%. Among typically developed patients, the sensitivity and specificity were 76.7 and 65.4%, respectively, whereas specificity was only 16.5% for developmentally delayed patients. The best cut-off value for CAPD was 9 for typically developed children and 17 for those with developmental delay (sensitivity 74.4%, specificity 63.2%). Some CAPD questions do not apply to patients with sensory and neurocognitive deficits; upon excluding those questions, the best cut-off values were 5 for typically developed and 6 for developmentally delayed children. In mechanically ventilated patients with developmental delay, CAPD ≥ 9 led to a high false-positive rate. This emphasizes the need for either a different cut-off score or development of a delirium scale specific to this patient population.
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Affiliation(s)
- Neha Gupta
- Division of Pediatric Critical Care, Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States,Address for correspondence Neha Gupta, MD 1200 Everette Drive, Suite 8305, Oklahoma City, OK 73104United States
| | - Saurabh Talathi
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, United States
| | - Allison Woolley
- Department of Family Services, Children's of Alabama, Birmingham, Alabama, United States
| | - Stephanie Wilson
- Department of Physical and Occupational Therapy, Children's of Alabama, Birmingham, Alabama, United States
| | - Mildred Franklin
- Department of Nursing, Children's of Alabama, Birmingham, Alabama, United States
| | - Johanna Robbins
- Department of Physical and Occupational Therapy, Children's of Alabama, Birmingham, Alabama, United States
| | - Candice Colston
- Division of Pediatric Critical Care, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Leslie Hayes
- Division of Pediatric Critical Care, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Talathi S, Mezoff E, Galloway D, Rahhal R. Anticipated impact of recent ethanol lock shortage and price increase on practice among pediatric intestinal rehabilitation programs across the United States. JPEN J Parenter Enteral Nutr 2021; 46:319-323. [PMID: 33914379 DOI: 10.1002/jpen.2128] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Ethanol lock use has been associated with significantly lower rates of central line-associated bloodstream infection (CLABSI) in children with intestinal failure. Concerns have been raised among intestinal rehabilitation program providers regarding the impact of recent changes in cost and availability of ethanol locks in the US. METHODS We conducted a survey among the members of the North American Society For Pediatric Gastroenterology, Hepatology & Nutrition Intestinal Rehabilitation Special Interest Group (NASPGHAN IR-SIG) regarding practice changes among providers to tackle this issue and the anticipated effect on CLABSI rates. RESULTS The results show that the vast majority of US participants use ethanol locks in their population with intestinal failure, with most anticipating or already experiencing reduction in access to ethanol locks. Most worrisome is that more than half of participating programs expect an increase in CLABSI rates in this vulnerable patient population as a consequence of limited access to ethanol locks. CONCLUSION Further multicenter prospective studies to assess the efficacy of alternative locking agents, besides ethanol, are needed in order to have readily available and affordable options for CLABSI prevention in the future.
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Affiliation(s)
- Saurabh Talathi
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, OU Center for Pediatric Intestinal Rehabilitation, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ethan Mezoff
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Center for Intestinal Rehabilitation and Nutrition Support, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - David Galloway
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Riad Rahhal
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Iowa, Iowa City, Iowa, USA
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Abstract
The advent of biologics has changed outcomes in many chronic conditions, including inflammatory bowel disease (IBD). Biologics have been used for the induction and remission of ulcerative colitis and Crohn's disease for almost two decades and are effective in patients who used to fail conventional treatment with steroids, immunomodulators. The use of biologics in the treatment of IBD has increased over the last few years, partly due to the rise in its incidence and the use of biologics as a first-line treatment in severe disease as well as in complicated diseases like penetrating/fistulating Crohn's disease. However, their use is associated with a significant burden to the society with respect to healthcare costs, resulting in the premature discontinuation of therapy in some patients, leading to exacerbations and complications. The introduction of biosimilars a decade ago seems to be a promising approach to reducing the costs related to therapy. Since their introduction, numerous studies conducted in adults and some in children show the efficacy of biosimilars with a similar side-effect profile to biologics. This review discusses the history of biosimilars in the treatment of IBD, enumerates several such studies and discusses the possibility of using biosimilars in the future.
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Affiliation(s)
- Saurabh Talathi
- Department of Pediatrics, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
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Talathi S, Wilkinson L, Meloni K, Shroyer M, Eipers P, Van Der Pol WJ, Martin C, Dimmitt R, Yi N, Morrow C, Galloway D. Scheduled Empiric Antibiotics May Alter the Gut Microbiome and Nutrition Outcomes in Pediatric Intestinal Failure. Nutr Clin Pract 2020; 36:1230-1239. [PMID: 33078427 DOI: 10.1002/ncp.10594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/17/2020] [Accepted: 09/21/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In this study, we aim to determine the effect of scheduled antibiotics on gut microbiome in pediatric intestinal failure (IF) and to evaluate the effect of the gut microbiome on nutrition outcomes in IF. METHODS Fecal samples were collected at regular intervals from pediatric patients with IF for gut microbiome comparison between 2 cohorts: (group 1) those on scheduled prophylactic antibiotics and (group 2) those who were not on scheduled antibiotics. Gut microbiome composition and diversity were compared among the 2 cohorts. The association among gut microbiome composition, diversity, and nutrition outcomes (mainly ability to decrease parenteral nutrition [PN] energy requirement and ability to attain positive growth) was also determined. RESULTS The microbiome of patients with IF on scheduled antibiotics differed significantly from those not on scheduled antibiotics. Abundance of certain Gram-negative and pathogenic bacteria (Pseudomonas, Prevotella, and Sutterella) was higher in the scheduled cohort. Patients with decreased Enterobacteriaceae demonstrated a greater ability to demonstrate a reduction in PN requirement, as well as attain positive growth. CONCLUSION Scheduled antibiotics may alter the gut microbiome in children IF, which in turn may have an influence on important nutrition outcomes in pediatric IF. Further larger, multicenter studies are needed to determine the effect of scheduled antibiotics on the gut microbiome in this patient population and their overall effect on nutrition outcomes.
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Affiliation(s)
- Saurabh Talathi
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Linda Wilkinson
- Department of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Katie Meloni
- Department of Clinical Nutrition, Children's of Alabama, Birmingham, Alabama, USA
| | - Michelle Shroyer
- Department of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter Eipers
- Department of Cell, Developmental, & Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William J Van Der Pol
- Biomedical Informatics Center for Clinical and Translational Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Colin Martin
- Department of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Reed Dimmitt
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nengjun Yi
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Casey Morrow
- Department of Cell, Developmental, & Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David Galloway
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Talathi S, Nagaraj P, Jester T, Maclin J, Knight T, Barnes MJ. Relations between disease status and body composition in pediatric inflammatory bowel disease. Eur J Pediatr 2020; 179:1499-1505. [PMID: 32206894 DOI: 10.1007/s00431-020-03629-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 12/18/2022]
Abstract
To evaluate the effect of remission status on physical activity and body composition in pediatric patients with inflammatory bowel disease (PIBD) and healthy peers. Single-center cohort study, including 54 PIBD patients and 33 healthy peers. During the initial study visit, a brief demographic questionnaire, physical activity questionnaire completed by participants, and instructions on recording dietary intake were given. Physicians completed the Physician Global Assessment (PGA) for disease severity. Medical chart abstraction was done to obtain disease variables of interest. DEXA scan completed 1 week later to obtain information on body composition. Variables of interest were compared between the three groups (IBD-Remission, IBD-Active, and healthy controls) using an ANOVA or Chi-square test as appropriate. IBD patients were older than controls, reported lower quality of life (73.9 vs. 80.9), and engaged in less MVPA (195.4 versus 361.1). The IBD-Active group had a significantly lower lean body mass, bone mineral density, and time spent in MVPA compared to the IBD-Remission group and healthy controls. IBD-Remission group had a significantly lower percentage of biologic use (55% vs. 87%) and comorbidities (26% vs. 44%) compared to IBD-active group. IBD-remission group also had a lower fat mass percentage. In this study, we report significantly favorable LBM, BMD, and time spent in MVPA in patients with IBD in remission compared to those not in remission with the former demonstrating a body composition resembling that of healthy peers.Conclusion: While an improvement in BMD was observed with remission, the scores were still lower than controls. What is Known: • Body composition deficits in pediatric inflammatory bowel disease are common and some persist despite achievement of remission leading to long term outcomes including osteopenia and osteoporosis. • Weight restoration in patients with pediatric IBD is primarily explained by gains in fat mass without similar gains in lean mass. What is New: • While an improvement in bone mineral density was observed, the achievement of remission significantly improves affects physical activity and body composition in pediatric inflammatory bowel disease. • However, some parameters of body composition do not reach levels comparable to healthy peers.
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Affiliation(s)
- Saurabh Talathi
- Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue South, McWane Suite 5604, Birmingham, AL, 35294, USA
| | - Pooja Nagaraj
- Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue South, McWane Suite 5604, Birmingham, AL, 35294, USA
| | - Traci Jester
- Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue South, McWane Suite 5604, Birmingham, AL, 35294, USA
| | - Jeanine Maclin
- Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue South, McWane Suite 5604, Birmingham, AL, 35294, USA
| | - Taylor Knight
- Children's of Alabama, 1600 7th Avenue South, McWane Suite 5604, Birmingham, AL, 35294, USA
| | - Margaux J Barnes
- Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue South, McWane Suite 5604, Birmingham, AL, 35294, USA.
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Talathi S, Barnes M, Aban I, Dimmitt R, Askenazi DJ. Serum Transaminases at Presentation and Association with Acute Dialysis in Children with Hemolytic Uremic Syndrome. Kidney360 2020; 1:337-342. [PMID: 35369368 PMCID: PMC8809299 DOI: 10.34067/kid.0000222020] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/10/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND To determine whether serum transaminases at presentation predict the need for dialysis in children with hemolytic uremic syndrome (HUS). METHODS Single-center, retrospective chart review of pediatric patients with HUS. Data collected included demographics, clinical and laboratory parameters, and need for dialysis. These factors were compared between two groups: "dialysis" versus "no dialysis." Continuous data were compared using a t test whereas categoric data were compared by the chi-squared test. Multivariate logistic regression was performed on a prior set of variables to determine if serum transaminases independently predict the need for dialysis. RESULTS A total of 70 children were included in the study, of which, 39 (27%) received dialysis. The no-dialysis group had a higher proportion of white patients compared with the dialysis group (74% dialysis versus 94% no dialysis). The only clinical sign at admission associated with dialysis was reduced urine output (56% versus 16%, P<0.001). Univariate logistic regression identified admission serum creatinine, aspartate transaminase (AST), and alanine transaminase (ALT) to be associated with the need for dialysis. Multivariate logistic regression showed serum AST and ALT to be independent predictors of the need for dialysis, with both improving the performance of the regression model. Sensitivity analysis showed a cutoff of 129 U/L for AST and 83 U/L for ALT with high specificity. CONCLUSIONS Serum transaminases at presentation are independently associated with the subsequent need for dialysis in patients with HUS. Our study suggests that when both serum ALT and AST are normal, the likelihood to need dialysis is very low; alternatively, when both serum ALT and AST are more than two times the upper level of normal, the need for dialysis is very high.
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Affiliation(s)
- Saurabh Talathi
- Division of Pediatric Gastroenterology, Department of Pediatrics, Hepatology and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Margaux Barnes
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Inmaculada Aban
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Reed Dimmitt
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - David J. Askenazi
- Division of Pediatric Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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Gupta N, Talathi S, Kalantre S. Syncope in a 3-year-old male: A case report. World J Emerg Med 2020; 11:188-190. [PMID: 32351654 DOI: 10.5847/wjem.j.1920-8642.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Neha Gupta
- Department of Pediatrics, Lincoln Medical Center, Bronx, New York, USA
| | - Saurabh Talathi
- Department of Pediatrics, Lincoln Medical Center, Bronx, New York, USA
| | - Sarika Kalantre
- Department of Pediatrics, Lincoln Medical Center, Bronx, New York, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York, USA
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Talathi S, Knight T, Dimmitt R, Mestre J, Jester T. Concurrent eosinophilic esophagitis in pediatric patients with inflammatory bowel disease: A case series. Ann Allergy Asthma Immunol 2019; 123:313-316. [PMID: 31238100 DOI: 10.1016/j.anai.2019.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Saurabh Talathi
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
| | | | - Reed Dimmitt
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jose Mestre
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Traci Jester
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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Janson CM, Bhupathiraju V, Talathi S, Glotzbach K. Multiple Accessory Pathways in an Infant With Cardiac Rhabdomyomas and Tuberous Sclerosis. JACC Clin Electrophysiol 2018; 4:553-554. [DOI: 10.1016/j.jacep.2017.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/04/2017] [Accepted: 12/07/2017] [Indexed: 11/29/2022]
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Talathi S, Gupta N, Sethuram S, Khanna S, Sitnitskaya Y. Otitis Media in Fully Vaccinated Preschool Children in the Pneumococcal Conjugate Vaccine Era. Glob Pediatr Health 2018; 4:2333794X17749668. [PMID: 29308427 PMCID: PMC5751904 DOI: 10.1177/2333794x17749668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/08/2017] [Indexed: 11/17/2022] Open
Abstract
Objectives. To evaluate the effect of pneumococcal conjugate vaccine (PCV13) on the burden of acute otitis media (AOM) and to evaluate the characteristics of AOM versus otitis media with effusion (OME) in the 2 PCV periods. Methods. A cohort of fully vaccinated children aged 18 to 60 months diagnosed with AOM from 2006 to 2015 was identified. Patients with otorrhea/bulging tympanic membrane were considered as true AOM, while those without bulging/otorrhea were considered to have OME. Burden of true AOM in the PCV7 and PCV13 periods and clinical features of true AOM versus OME were compared. Results. Of 393 episodes in our cohort, 50.8% occurred in PCV7 period. Burden of true AOM in the 2 PCV groups was similar: 26% in PCV7 versus 26.4% in PCV13 (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 0.65-1.60). Factors significantly associated with OME were cold season (OR = 1.54, 95% CI = 1.04-2.4), fever (OR = 2.05, 95% CI = 1.29-3.3), and recurrence (OR = 2.24, 95% CI = 1.22-4.09). No complications of AOM were identified. Majority episodes were treated with antibiotics. Conclusion. Unlike the role of PCV13 in reducing invasive pneumococcal disease, its effect on reducing the burden of AOM is minimal as compared with PCV7. With regard to characteristics of AOM versus OME, findings of tympanic membrane should be used to suggest a diagnosis of AOM, instead of occurrence of fever or recurrence of AOM episodes. Using this approach would help in guiding the use of antibiotics appropriately.
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Abdel-Wahab N, Talathi S, Lopez-Olivo MA, Suarez-Almazor ME. Risk of developing antiphospholipid antibodies following viral infection: a systematic review and meta-analysis. Lupus 2017; 27:572-583. [PMID: 28945149 DOI: 10.1177/0961203317731532] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective The objective of this paper is to conduct a systematic review and meta-analysis on the risk of developing elevated antiphospholipid (aPL) antibodies and related thromboembolic and/or pregnancy events following a viral infection. Method We searched Medline, EMBASE, Web of Science, PubMed ePubs, and Cochrane Central Register of Controlled Trials through June 2016. Independent observational studies of elevated aPL antibodies in patients with a viral infection compared with controls or patients with lupus were included. Results We analyzed 73 publications for 60 studies. Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) were most commonly reported. Compared with healthy controls, patients with HIV were more likely to develop elevated anticardiolipin (aCL) antibodies (risk ratio (RR) 10.5, 95% confidence interval (CI) 5.6-19.4), as were those with HCV (RR 6.3, 95% CI 3.9-10.1), hepatitis B virus (HBV) (RR 4.2, 95% CI 1.8-9.5), and Epstein-Barr virus (EBV) (RR 10.9 95% CI 5.4-22.2). The only statistically significant increased risk for anti-β2-glycoprotein I (anti-β2-GPI) antibodies was observed in patients with HCV (RR 4.8 95% CI 1.0-22.3). Compared with patients with lupus, patients with HIV were more likely to develop elevated aCL antibodies (RR 1.8, 95% CI 1.3-2.6), and those with EBV, elevated anti-β2-GPI antibodies (RR 2.2, 95% CI 1.3-3.9). Thromboembolic events were most prevalent in patients with elevated aPL antibodies who had HCV (9.1%, 95% CI 3.0-18.1), and HBV (5.9%, 95% CI 2.0-11.9) infections, and pregnancy events were most prevalent in those with parvovirus B19 (16.3%, 95% CI 0.78-45.7). However, compared to virus-infected patients with negative aPL antibodies, the only statistically significant increased risk was observed in those with HCV and positive aPL. Conclusions Viral infection can increase the risk of developing elevated aPL antibodies and associated thromboembolic events. Results are contingent on the reported information.
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Affiliation(s)
- N Abdel-Wahab
- 1 Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The 4002 University of Texas MD Anderson Cancer Center , Houston, TX, USA.,2 Rheumatology and Rehabilitation Department, Assiut University Hospitals, Faculty of Medicine, Assiut, Egypt
| | - S Talathi
- 3 2011 Lincoln Medical Center , Weill Cornell Medical College, Bronx, NY, USA
| | - M A Lopez-Olivo
- 1 Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The 4002 University of Texas MD Anderson Cancer Center , Houston, TX, USA
| | - M E Suarez-Almazor
- 1 Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The 4002 University of Texas MD Anderson Cancer Center , Houston, TX, USA
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Talathi S, Gupta N, Reddivalla N, Prokhorov S, Gold M. Anaplastic astrocytoma mimicking herpes simplex encephalitis in 13-year old girl. Eur J Paediatr Neurol 2015; 19:722-5. [PMID: 26272584 DOI: 10.1016/j.ejpn.2015.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 07/13/2015] [Indexed: 01/06/2023]
Abstract
Astrocytoma is the most common childhood brain tumor. Anaplastic astrocytoma (AA) are high grade gliomas (HGG), found very rarely in pediatric patients. AA mainly results from a dedifferentiation of a low grade astrocytoma. Clinical features of supra-tentorial tumors vary according to their anatomic location, biologic aggressiveness and age of the patient. They can be either completely asymptomatic or present with signs of raised intracranial pressure, seizures (about 40% of cases), behavior changes, speech disorders, declining school performance, or hemiparesis. There have been published adult cases of brain tumor misdiagnosed as viral encephalitis. Due to variety of clinical presentations, diagnosis of AA can be challenging. Here we report a case of a 13 year old girl who presented with clinical features suggestive of viral encephalitis, such as fever, headache, dizziness, and first seizure with postictal sleep and prolonged drowsiness. However, her brain MRI findings were consistent with long standing mass effect from the underlying intracranial contents and that coupled with her history of unusual taste led to further investigations and the diagnosis of the AA. In retrospect, this presentation could have been a temporal epileptic aura. High grade astrocytomas are particularly difficult to treat with a two-year survival rates range from 10% to 30%. The treatment is multimodal with gross total surgical resection of the tumor, followed by radiotherapy with or without nitrosourea-containing chemotherapy regimen. Recent promising results seen with the use of temozolamide in adults has not been yet demonstrated in the pediatric patients. The extent of tumor resection remains the most significant indicator of survival and early recognition of this tumor is essential. This case report emphasizes the fact that mass lesions in the temporal lobe, including high-grade astrocytoma, should be considered in the differential diagnosis of suspected herpes simplex encephalitis, especially those not responding to therapy. Remodeling of the calvarium adjacent to an intracranial lesion suggests a long standing process.
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Affiliation(s)
- Saurabh Talathi
- Department of Pediatrics, Lincoln Medical Center, Bronx, United States; University of Texas, School of Public Health, Houston, TX, United States
| | - Neha Gupta
- Department of Pediatrics, Lincoln Medical Center, Bronx, United States
| | - Naresh Reddivalla
- Department of Pediatrics, Lincoln Medical Center, Bronx, United States; Children's Mercy Hospital, Kansas City, United States
| | - Sergey Prokhorov
- Department of Pediatrics, Lincoln Medical Center, Bronx, United States.
| | - Menachem Gold
- Weill Cornell Medical Center, NY, United States; Department of Radiology, Lincoln Medical Center, Bronx, United States
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