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Brogan P, Naden R, Ardoin SP, Cooper JC, De Benedetti F, Dicaire JF, Eleftheriou D, Feldman B, Goldin J, Karol SE, Price-Kuehne F, Skuse D, Stratakis CA, Webb N, Stone JH. The pediatric glucocorticoid toxicity index. Semin Arthritis Rheum 2022; 56:152068. [PMID: 35917759 DOI: 10.1016/j.semarthrit.2022.152068] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/21/2022] [Accepted: 07/08/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To develop a Pediatric glucocorticoid toxicity index (pGTI), a standardized, weighted clinical outcome assessment that measures change in glucocorticoid (GC) toxicity over time. METHODS Fourteen physician experts from 7 subspecialties participated. The physician experts represented multiple subspecialties in which GCs play a major role in the treatment of inflammatory disease: nephrology, rheumatology, oncology, endocrinology, genetics, psychiatry, and maternal-fetal medicine. Nine investigators were from Canada, Europe, or New Zealand, and 5 were from the United States. Group consensus methods and multi-criteria decision analysis were used. The pGTI is an aggregate assessment of GC toxicities that are common, important, and dynamic. These toxicities are organized into health domains graded as minor, moderate, or major and are weighted according to severity. The relative weights were derived by group consensus and multi-criteria decision analysis using the 1000MindsTM software platform. Two quantitative scores comprise the overall toxicity profile derived from pGTI data: (1) the Cumulative Worsening Score; and (2) the Aggregate Improvement Score. The pGTI also includes a qualitative, unweighted record of GC side-effects known as the Damage Checklist, which documents less common toxicities that, although potentially severe, are unlikely to change with varying GC dosing. RESULTS One hundred and seven (107) toxicity items were included in the pGTI and thirty-two (32) in the Damage Checklist. To assess the degree to which the pGTI corresponds to expert clinical judgement, the investigators ranked 15 cases by clinical judgement from highest to lowest GC toxicity. Expert rankings were then compared to case ranking by the pGTI, yielding excellent agreement (weighted kappa 0.86). The pGTI was migrated to a digital environment following its development and initial validation. The digital platform is designed to ensure ease-of-use in the clinic, rigor in application, and accuracy of scoring. Clinic staff enter vital signs, laboratory results, and medication changes relevant to pGTI scoring. Clinicians record findings for GC myopathy, skin toxicity, mood dysfunction, and infection. The pGTI algorithms then apply the weights to these raw data and calculate scores. Embedded logic accounts for the impact of age- and sex-related reference ranges on several health domains: blood pressure, lipid metabolism, and bone mineral density. Other algorithms account for anticipated changes in the height Z-scores used in the growth domain, thereby addressing a concern unique to GC toxicity in children. The Damage Checklist ensures comprehensive measurement of GC toxicity but does not contribute to pGTI scoring, because the scored domains emphasize manifestations of GC toxicity that are likely to change over the course of a trial. CONCLUSIONS We describe the development and initial evaluation of a weighted, composite toxicity index for the assessment of morbidity related to GC use in children and adolescents. Developing the pGTI digital platform was essential for performing the nuanced calculations necessary to ensure rigor, accuracy, and ease-of-use in both clinic and research settings.
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Affiliation(s)
- Paul Brogan
- Great Ormond Street Hospital NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London UK
| | - Ray Naden
- McMasterUniversity, Hamilton, Ontario, Canada
| | | | - Jennifer C Cooper
- University of Colorado Anschutz Medical Alifornia, San Francisco, CA, USA
| | | | | | - Despina Eleftheriou
- Great Ormond Street Hospital NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London UK
| | - Brian Feldman
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jon Goldin
- Great Ormond Street Hospital NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London UK
| | - Seth E Karol
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - David Skuse
- Great Ormond Street Hospital NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London UK
| | - Constantine A Stratakis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Nicholas Webb
- Royal Manchester Children's Hospital, Manchester, UK; Rheumatology Clinic, Bulfinch 165, Massachusetts General Hospital, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - John H Stone
- Great Ormond Street Hospital NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London UK.
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Gitomer SA, Giannoni CM, Cañadas KT. Pediatric lymphedema caused by diffuse cervical lymphadenopathy: A case report and review of the literature. Int J Pediatr Otorhinolaryngol 2016; 87:67-70. [PMID: 27368445 DOI: 10.1016/j.ijporl.2016.05.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 03/09/2016] [Revised: 05/12/2016] [Accepted: 05/15/2016] [Indexed: 10/21/2022]
Abstract
Pediatric head and neck lymphedema is rare and there have not been any reported cases in children. Here we discuss severe, diffuse head and neck lymphedema in a child caused by compression of the internal jugular veins by lymphadenopathy from Kawasaki's disease. With steroid and intravenous immunoglobulin treatment, the lymphadenopathy improved and facial edema slowly resolved. In review of the literature, complications of head and neck lymphedema including airway obstruction and blindness are discussed. This case highlights the importance of the pediatric otolaryngologist considering lymphedema as a cause for facial swelling and monitoring for complications of lymphedema.
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Affiliation(s)
- Sarah A Gitomer
- Baylor College of Medicine, Bobby R. Alford Department of Otolaryngology, Houston, TX, USA
| | - Carla M Giannoni
- Baylor College of Medicine, Bobby R. Alford Department of Otolaryngology, Houston, TX, USA; Texas Children's Hospital, Division of Pediatric Otolaryngology, Houston, TX, USA
| | - Karina T Cañadas
- Baylor College of Medicine, Bobby R. Alford Department of Otolaryngology, Houston, TX, USA; Texas Children's Hospital, Division of Pediatric Otolaryngology, Houston, TX, USA.
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Deaño RC, Shah AM, Khan ZS, Bergman G, Roman MJ, Swaminathan RV, Kim LK, Feldman DN, Minutello RM, Wong SC, Narula N, Salemi A, Singh HS. Giant coronary aneurysm diagnosed as incidental mediastinal mass. JACC Cardiovasc Interv 2015; 8:114-5. [PMID: 25616825 DOI: 10.1016/j.jcin.2014.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/14/2014] [Accepted: 07/22/2014] [Indexed: 12/17/2022]
Affiliation(s)
- Roderick C Deaño
- Division of Cardiovascular Disease, Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Ashish M Shah
- Division of Cardiovascular Disease, Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Zarrish S Khan
- Department of Cardiothoracic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Geoffrey Bergman
- Division of Cardiovascular Disease, Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Mary J Roman
- Division of Cardiovascular Disease, Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Rajesh V Swaminathan
- Division of Cardiovascular Disease, Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Luke K Kim
- Division of Cardiovascular Disease, Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Dmitriy N Feldman
- Division of Cardiovascular Disease, Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Robert M Minutello
- Division of Cardiovascular Disease, Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - S Chiu Wong
- Division of Cardiovascular Disease, Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Navneet Narula
- Department of Clinical Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Arash Salemi
- Department of Cardiothoracic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Harsimran S Singh
- Division of Cardiovascular Disease, Department of Medicine, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York; Division of Pediatric Cardiology, Department of Pediatrics, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, New York.
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Abstract
Atypical presentations of Kawasaki's disease have been described in the form of intestinal pseudo-obstruction, tonsillitis, hemorrhagic serous effusions, thrombocytopenia, and non-fulfillment of all criteria for diagnosis of Kawasaki's disease. However, presentation of Kawasaki's disease with shock and need for ionotropic support have been rarely described. We present a 4-year-old girl with Kawasaki's disease who presented with anasarca, oliguria, shock, and presence of dilated coronary arteries within 5 days of fever and responded to intravenous immunoglobulin (IVIG) and inotropic support.
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Affiliation(s)
- I Shah
- Department of Pediatrics, B. J. Wadia Hospital for Children, Parel, Mumbai, India
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Abstract
Although coronary artery aneurysms occur in Kawasaki disease, giant aneurysms are rare. We report a very large coronary artery aneurysm, measuring 25 mm and involving left anterior descending artery, in a 2-year-old child with Kawasaki disease. The challenges in management of such a patient have been highlighted.
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Affiliation(s)
- Sushant Patil
- Department of Cardiology, Dr. Balabhai Nanavati Hospital, Mumbai, India
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Abstract
Vitiligo is a common skin disease, but its pathogenesis has not been fully determined, though an autoimmune etiology is considered likely. Kawasaki disease (KD) is an acute multisystem vasculitis of childhood associated with coronary arteriopathy, and is diagnosed based on clinical criteria. Furthermore, vitiligo has been associated with several other diseases, but no report has been issued about the relationship between vitiligo and Kawasaki's disease. The author's report the case of an 8-year-old male child that presented with depigmented lesions, which developed from the desquamative skin lesions of Kawasaki's disease.
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Affiliation(s)
- Han Kyoung Cho
- Department of Dermatology, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
| | - Lucy Youngmin Eun
- Department of Pediatric Cardiology, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
| | - Ji-Sun Song
- Department of Pathology, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
| | - Won Hyoung Kang
- Department of Dermatology, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
| | - Byung In Ro
- Department of Dermatology, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
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