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Micangeli G, Menghi M, Profeta G, Paparella R, Tarani F, Petrella C, Barbato C, Minni A, Greco A, Ferraguti G, Tarani L, Fiore M. Malignant and Benign Head and Neck Tumors of the Pediatric Age: A Narrative Review. Curr Pediatr Rev 2024; 20:CPR-EPUB-137392. [PMID: 38310547 DOI: 10.2174/0115733963258575231123043807] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/22/2023] [Accepted: 11/02/2023] [Indexed: 02/06/2024]
Abstract
Malignant tumors of the head and neck are rare in children, but it is important to know these lesions and identify them early in order to have a good outcome for these patients. Benign lesions of the head and neck are much more frequent and have an excellent prognosis. For this reason, it is necessary to recognize the warning signs and symptoms and understand when to refer the patient to a reference center for the treatment of these pathologies. The clinical presentation of both benign and malignant lesions in children may be similar as usually, both categories have compressive effects. This confirms the fact that the clinical diagnosis is not sufficient and always requires instrumental investigations and biopsies. In this narrative review, we analyzed both malignant lesions such as lymphoma, rhabdomyosarcoma, thyroid tumors, salivary gland tumors, neuroblastoma, and nasopharyngeal carcinoma, and benign ones such as cystic dermoid teratoma, hemangioma, juvenile angiofibroma and fibrosis dysplasia. Indeed, we set out to discuss the most common lesions of this site by evaluating their characteristics to highlight the differentiation of malignant tumors from benign lesions and their correct clinical-therapeutic management. A literature search was carried out in the PubMed and Google Scholar databases to identify all narrative reviews addressing malignant and benign head and neck tumors of the pediatric age. In conclusion, the care of children affected by head and neck benign lesions and malignancy must be combined and multidisciplinary. It is essential to recognize the diseases early in order to differentiate and intervene as soon as possible for the correct clinical-therapeutic management.
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Affiliation(s)
- Ginevra Micangeli
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Italy
| | - Michela Menghi
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Italy
| | - Giovanni Profeta
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Italy
| | - Roberto Paparella
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Italy
| | - Francesca Tarani
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Italy
| | - Carla Petrella
- Institute of Biochemistry and Cell Biology (IBBC-CNR), Department of Sensory Organs, Sapienza University of Rome, 00185, Roma, Italy
| | - Christian Barbato
- Institute of Biochemistry and Cell Biology (IBBC-CNR), Department of Sensory Organs, Sapienza University of Rome, 00185, Roma, Italy
| | - Antonio Minni
- Department of Sensory Organs, Sapienza University of Rome, 00185Roma, Italy
- ASL Rieti-Sapienza University, Division of Otolaryngology-Head and Neck Surgery, Ospedale San Camillo de Lellis, Viale Kennedy, 02100 Rieti, Italy
| | - Antonio Greco
- Department of Sensory Organs, Sapienza University of Rome, 00185Roma, Italy
| | - Giampiero Ferraguti
- Department of Experimental Medicine, Sapienza University of Rome, 00185Roma, Italy
| | - Luigi Tarani
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Italy
| | - Marco Fiore
- Institute of Biochemistry and Cell Biology (IBBC-CNR), Department of Sensory Organs, Sapienza University of Rome, 00185, Roma, Italy
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Ehrsam JP, Meier Adamenko O, Pannu M, Markus Schöb O, Inci I. Lung transplantation in children. Turk Gogus Kalp Damar Cerrahisi Derg 2024; 32:S119-S133. [PMID: 38584780 PMCID: PMC10995684 DOI: 10.5606/tgkdc.dergisi.2024.25806] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/05/2023] [Indexed: 04/09/2024]
Abstract
Lung transplantation is a well-established treatment for children facing advanced lung disease and pulmonary vascular disorders. However, organ shortage remains highest in children. For fitting the small chest of children, transplantation of downsized adult lungs, lobes, or even segments were successfully established. The worldwide median survival after pediatric lung transplantation is currently 5.7 years, while under consideration of age, underlying disease, and peri- and posttransplant center experience, median survival of more than 10 years is reported. Timing of referral for transplantation, ischemia-reperfusion injury, primary graft dysfunction, and acute and chronic rejection after transplantation remain the main challenges.
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Affiliation(s)
- Jonas Peter Ehrsam
- School of Medicine, University of Zurich, Zurich, Switzerland
- Department of Thoracic Surgery, Klinik Hirslanden Zurich, Zurich, Switzerland
- Klinik Hirslanden Zurich, Centre for Surgery, Zurich, Switzerland
| | | | | | - Othmar Markus Schöb
- School of Medicine, University of Zurich, Zurich, Switzerland
- Department of Thoracic Surgery, Klinik Hirslanden Zurich, Zurich, Switzerland
- Klinik Hirslanden Zurich, Centre for Surgery, Zurich, Switzerland
| | - Ilhan Inci
- School of Medicine, University of Zurich, Zurich, Switzerland
- Department of Thoracic Surgery, Klinik Hirslanden Zurich, Zurich, Switzerland
- Klinik Hirslanden Zurich, Centre for Surgery, Zurich, Switzerland
- University of Nicosia Medical School, Nicosia, Cyprus
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Castro S, Velasco Suárez C, Vieites A, Bergadá I, Cassinelli H. [Rickets associated to the use of elemental formula: A case report]. ARCH ARGENT PEDIATR 2021; 119:e49-e53. [PMID: 33458991 DOI: 10.5546/aap.2021.e49] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/27/2020] [Indexed: 11/12/2022]
Abstract
The rickets is a disease that affects the differentiation and mineralization of the growth cartilage, as an ultimate consequence of a balance loss in calcium and phosphate levels. Vitamin D deficiency is the most common cause of the rickets (nutritional rickets). Its clinical manifestation during the first years of life involves long bones epiphysis in a more severe way. We report an 8-month-old infant who was diagnosed with cow´s milk protein allergy and suffered from multiple fractures while receiving elemental formula as part of his treatment. The final etiology was hypophosphatemic rickets secondary to phosphate deficiency, and after 3 months of phosphate, calcium and calcitriol supplementation, in addition to the gradually reduction of the proportion of elemental formula intake and the decline of the antacid doses, clinical and radiological heal was achieved.
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Affiliation(s)
- Sebastián Castro
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Fundación de Endocrinología Infantil (FEI), División de Endocrinología, Hospital de Niños "Ricardo Gutiérrez", Ciudad Autónoma de Buenos Aires.
| | - Carlos Velasco Suárez
- Hospital Alemán, Consultorios Pediátricos, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ana Vieites
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Fundación de Endocrinología Infantil (FEI), División de Endocrinología, Hospital de Niños "Ricardo Gutiérrez", Ciudad Autónoma de Buenos Aires
| | - Ignacio Bergadá
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Fundación de Endocrinología Infantil (FEI), División de Endocrinología, Hospital de Niños "Ricardo Gutiérrez", Ciudad Autónoma de Buenos Aires
| | - Hamilton Cassinelli
- Centro de Investigaciones Endocrinológicas "Dr. César Bergadá" (CEDIE), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Fundación de Endocrinología Infantil (FEI), División de Endocrinología, Hospital de Niños "Ricardo Gutiérrez", Ciudad Autónoma de Buenos Aires
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Anglemyer A, Sturt A, Maldonado Y. The Effect of Combination Antiretroviral Therapy Use Among HIV Positive Children on the Hazard of AIDS Using Calendar Year as an Instrumental Variable. Curr HIV Res 2019; 16:151-157. [PMID: 29629663 DOI: 10.2174/1570162x16666180409150826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/10/2017] [Revised: 03/25/2018] [Accepted: 04/03/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Instrumental variable (IV) analyses are a common causal inference technique used in the absence of randomized data. Combination Antiretroviral Therapy (cART) was first introduced in 1996 and calendar periods have been used as a proxy for cART use. However, cART use misclassification can bias IV analyses. OBJECTIVE We aim to highlight the differences in the effects of antiretroviral therapy on clinical outcomes between the applications of traditional and adapted IV analysis techniques. METHODS This study includes children with perinatal human immunodeficiency virus (HIV-1) infection followed from 1988 to 2009. We describe an application of traditional and adapted IV analysis techniques. Noncompliance adjustments were applied to correct the misclassification of cART-use. Weighting the inverse probability of calendar era, the selected covariates were performed to control for variables that may be related to both the IV and outcome. RESULTS During 48,380 person-days, 78 HIV-positive children progressed to an initial stage-3- defining diagnosis or death. The Intention to Treat (ITT) rate ratio (RR) of stage-3-defining diagnosis or death comparing the pre-cART and cART eras was estimated at 2·67 (95% confidence interval (CI): 1·.47, 4·84). The IV estimator was used to adjust for cART use misclassification, yielding an IV RR of 5·42 (95% CI: 2·99, 9·83). Weighting analyses did not markedly alter the results. CONCLUSION cART use decreased progression to stage-3-defining diagnosis or death. The use of noncompliance adjustments for cART misclassification in IV analyses may provide more robust evidence of cART's effectiveness than traditional ITT analysis.
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Affiliation(s)
- Andrew Anglemyer
- Operations Research Department, Naval Postgraduate School, Monterey, CA, United States
| | - Amy Sturt
- Pediatrics-Infectious Diseases, Stanford University, Stanford, CA, United States
| | - Yvonne Maldonado
- Pediatrics-Infectious Diseases, Stanford University, Stanford, CA, United States
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Leung AKC, Leung AAM, Wong AHC, Hon KL. Breath-Holding Spells in Pediatrics: A Narrative Review of the Current Evidence. Curr Pediatr Rev 2019; 15:22-29. [PMID: 30421679 PMCID: PMC6696822 DOI: 10.2174/1573396314666181113094047] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/02/2018] [Accepted: 11/08/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breath-holding spells are common, frightening, but fortunately benign events. Familiarity with this condition is important so that an accurate diagnosis can be made. OBJECTIVE To familiarize physicians with the clinical manifestations, diagnosis, evaluation, and management of children with breath-holding spells. METHODS A PubMed search was completed in Clinical Queries using the key term "breath-holding spells". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS Breath-holding spells affect 0.1 to 4.6% of otherwise healthy young children. The onset is usually between 6 and 18 months of age. The etiopathogenesis is likely multifactorial and includes autonomic nervous system dysregulation, vagally-mediated cardiac inhibition, delayed myelination of the brain stem, and iron deficiency anemia. Breath-holding spells may be cyanotic or pallid. The former are usually precipitated by anger or frustration while the latter are more often precipitated by pain or fear. In the cyanotic type, the child usually emits a short, loud cry, which leads to a sudden involuntary holding of the breath in forced expiration. The child becomes cyanosed, rigid or limp, followed by a transient loss of consciousness, and a long-awaited inspiration and resolution of the spell. In the pallid type, crying may be minimal or "silent". The apneic period in the pallid type is briefer than that in the cyanotic type prior to the loss of consciousness and posture. The episode in the pallid type then proceeds in the same manner as a cyanotic spell except that the child in the pallid type develops pallor rather than cyanosis. In both types, the entire episode lasts approximately 10 to 60 seconds. The spells usually disappear spontaneously by 5 years of age. CONCLUSION Although breath-holding spells are benign, they can be quite distressing to the parents. Confident reassurance and frank explanation are the cornerstones of treatment. Underlying cause, if present, should be treated. Interventions beyond iron supplementation may be considered for children with severe and frequent breath-holding spells which have a strong impact on the lifestyle of both the child and family.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Amy A M Leung
- Department of Family Medicine, The University of Alberta, Edmonton, Alberta, Canada
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
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Goycochea-Valdivia WA, Baquero-Artigao F, Del Rosal T, Frick MA, Rojo P, Echeverría MJ, Noguera-Julian A, Bringué X, Saavedra-Lozano J, Vives-Oñós I, Moliner E, Cilleruelo MJ, Cuadrado I, Colino E, Castells L, Tagarro A, Vilas J, Soler-Palacin P, Blázquez-Gamero D. Cytomegalovirus DNA Detection by Polymerase Chain Reaction in Cerebrospinal Fluid of Infants With Congenital Infection: Associations With Clinical Evaluation at Birth and Implications for Follow-up. Clin Infect Dis 2018; 64:1335-1342. [PMID: 28158709 DOI: 10.1093/cid/cix105] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 10/16/2016] [Accepted: 01/31/2017] [Indexed: 12/20/2022] Open
Abstract
Background DNA detection of human cytomegalovirus (hCMV) in cerebrospinal fluid (CSF) by polymerase chain reaction (PCR) is a marker of central nervous system (CNS) involvement in congenital hCMV infection (cCMV), but its prognostic value is unknown. Methods A multicenter, retrospective study was performed using the Spanish Congenital Cytomegalovirus Infection Database (REDICCMV; http://www.cmvcongenito.es). Newborns with cCMV and a lumbar puncture performed were included and classified according to their hCMV-PCR in CSF result (positive/negative). Clinical characteristics, neuroimaging abnormalities, plasma viral load, and audiological and neurological outcomes of both groups were compared. Results A total of 136 neonates were included in the study: 21 (15.4%) with positive CSF hCMV-PCR and 115 (84.6%) with negative results. Seventeen patients (81%) in the positive group were symptomatic at birth compared with 52.2% of infants in the negative group (odds ratio [OR], 3.86; 95% confidence interval [CI], 1.28-14.1; P = .01). Only 4 asymptomatic newborns (6.8%) had a positive CSF hCMV-PCR. There were no differences between groups regarding the rate of microcephaly, neuroimaging abnormalities, neurological sequelae at 6 months of age, or plasma viral load. Sensorineural hearing loss (SNHL) at birth was associated with a positive CSF hCMV-PCR result (OR, 3.49; 95% CI, 1.08-11.27; P = .04), although no association was found at 6 months of age. Conclusions A positive hCMV-PCR result in CSF is associated with symptomatic cCMV and SNHL at birth. However, no differences in neuroimaging studies, plasma viral load, or outcomes at 6 months were found. These results suggest that hCMV-PCR in CSF may not be a useful prognostic marker in cCMV.
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Affiliation(s)
| | | | - Teresa Del Rosal
- Pediatric Infectious Diseases Unit, Hospital Universitario La Paz, Madrid
| | - Marie-Antoinette Frick
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d Hebrón, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona
| | - Pablo Rojo
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid
| | | | - Antoni Noguera-Julian
- Malalties infeccioses i resposta inflamatòria sistèmica en pediatria. Unitat d'Infeccions, Servei de Pediatria. Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona.,Departament de Pediatria, Universitat de Barcelona.,CIBER de Epidemiología y Salud Pública (Ciberesp, Spain) Barcelona
| | - Xavier Bringué
- Department of Pediatrics and Neonatal Unit, Hospital Universitario Arnau de Vilanova, Lleida
| | | | - Isabel Vives-Oñós
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d Hebrón, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona.,Department of Pediatrics, Hospital Quirónsalud Barcelona
| | - Elisenda Moliner
- Pediatric Infectious Diseases Unit, Hospital de la Santa Creu y Sant Pau, Barcelona
| | | | | | - Elena Colino
- Pediatric Infectious Diseases Unit, Hospital Las Palmas de Gran Canaria
| | - Laura Castells
- Department of Pediatrics and Neonatology Unit, Hospital Universitario General de Cataluña, Barcelona
| | - Alfredo Tagarro
- Department of Pediatrics, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid; and
| | - Javier Vilas
- Department of Pediatric Infectious Diseases, Complejo Hospitalario de Pontevedra, Spain
| | - Pere Soler-Palacin
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d Hebrón, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona
| | - Daniel Blázquez-Gamero
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid
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Abstract
BACKGROUND It is well known that there is a common interplay between atopic conditions and that having one atopic condition can predispose to the development of others. The link between asthma and food allergy has been well researched over the years; although the exact interplay between the two atopic conditions is yet to be fully described. Research suggests that children who have both asthma and food allergy are at greater risk of more severe asthmatic episodes. CONCLUSION They are also at risk of food allergen triggered asthmatic episodes as well as foodallergen induced anaphylaxis. Therefore, it is important for clinicians to understand and recognise the association between these two atopic conditions to provide children and their families with the correct treatment and management to avoid potentially life-threatening events related to their disease.
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Affiliation(s)
- Ru-Xin Foong
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London and Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, United Kingdom.,Institute of Child Health, University College of London, London, United Kingdom
| | - George du Toit
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London and Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
| | - Adam T Fox
- Division of Asthma, Allergy and Lung Biology, Department of Paediatric Allergy, King's College London and Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
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Downes KJ, Weiss SL, Gerber JS, Klieger SB, Fitzgerald JC, Balamuth F, Kubis SE, Tolomeo P, Bilker WB, Han X, Nachamkin I, Garrigan C, Han JH, Lautenbach E, Coffin SE. A Pragmatic Biomarker-Driven Algorithm to Guide Antibiotic Use in the Pediatric Intensive Care Unit: The Optimizing Antibiotic Strategies in Sepsis (OASIS) Study. J Pediatric Infect Dis Soc 2017; 6:134-141. [PMID: 27147715 PMCID: PMC5907860 DOI: 10.1093/jpids/piw023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 10/07/2016] [Accepted: 03/27/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND. Biomarkers that identify critically ill children with systemic inflammatory response syndrome (SIRS) at low risk for bacterial infection may help clinicians reduce unnecessary antibiotic use. METHODS. We conducted a prospective cohort study of children with SIRS and suspected infection admitted to a pediatric intensive care unit from January 5, 2012 to March 7, 2014. We enrolled patients upon initiation of new antibiotics (Time 0) and measured a panel of 8 serum biomarkers daily over 72 hours. Microbiology, imaging, and clinical data were reviewed to classify bacterial infections using Centers for Disease Control and Prevention definitions. We identified cut points of biomarker combinations to maximize the negative predictive value (NPV) and specificity for bacterial infection. Excess antibiotics were calculated as days of therapy beyond day 2 after SIRS onset in patients without bacterial infection. RESULTS. Infections were identified in 46 of 85 patients: bacterial (n = 22) and viral (24), whereas 39 patients had no infection identified. At Time 0, C-reactive protein (CRP) <5 mg/dL plus serum amyloid A <15.0 µg/mL had an NPV of 0.92 (95% confidence interval [CI], 0.79-1.0) and specificity of 0.54 (95% CI, 0.42-0.66) to identify patients without bacterial infection, whereas CRP <4 mg/dL plus procalcitonin <1.75 ng/mL had an NPV of 0.90 (95% CI, 0.79-1.0) and specificity of 0.43 (95% CI, 0.30-0.55). Patients without bacterial infection received a mean of 3.8 excess days of therapy. CONCLUSIONS. Early measurement of select biomarkers can identify children with SIRS in whom antibiotics might be safely discontinued when there is no other objective evidence of infection at 48 hours.
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Affiliation(s)
- Kevin J Downes
- Division of Infectious Diseases
- Center for Pediatric Clinical Effectiveness
| | | | - Jeffrey S Gerber
- Division of Infectious Diseases
- Center for Pediatric Clinical Effectiveness
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology
| | | | | | - Fran Balamuth
- Division of Emergency Medicine, The Children's Hospital of Philadelphia
| | | | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology
| | - Warren B Bilker
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology
| | - Xiaoyan Han
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology
| | - Irving Nachamkin
- Department of Pathology and Laboratory Medicine, Department of Medicine, and
| | - Charles Garrigan
- Department of Pathology and Laboratory Medicine, Department of Medicine, and
| | - Jennifer H Han
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ebbing Lautenbach
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Susan E Coffin
- Division of Infectious Diseases
- Center for Pediatric Clinical Effectiveness
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9
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Macumber IR, Weiss NS, Halbach SM, Hanevold CD, Flynn JT. The Association of Pediatric Obesity With Nocturnal Non-Dipping on 24-Hour Ambulatory Blood Pressure Monitoring. Am J Hypertens 2016; 29:647-52. [PMID: 26310663 DOI: 10.1093/ajh/hpv147] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [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: 06/05/2015] [Accepted: 08/01/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Obesity has been linked with abnormal nocturnal dipping of blood pressure (BP) in adults, which in turn is associated with poor cardiovascular outcomes. There are few data regarding abnormal dipping status in the obese pediatric population. The goal of this study was to further describe the relationship between obesity and non-dipping status on ambulatory blood pressure monitor (ABPM) in children. METHODS We conducted a cross-sectional study using a database of patients aged 5-21 years who had undergone 24-hour ABPM at Seattle Children's Hospital from January 2008 through May 2014. Subjects were grouped by body mass index (BMI) into lean (BMI 15th-85th percentile) and obese (BMI >95th percentile) groups. RESULTS Compared to lean subjects (n = 161), obese subjects (n = 247) had a prevalence ratio (PR) for non-dipping of 2.15, adjusted for race (95% confidence interval (CI) = 1.25-3.42). Increasing severity of obesity was not further associated with nocturnal non-dipping. Nocturnal non-dipping was not associated with left ventricular hypertrophy (PR = 1.01, 95% CI = 0.71-1.44). CONCLUSIONS These results suggest that in children, just as in adults, obesity is related to a relatively decreased dipping in nocturnal BP.
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Affiliation(s)
- Ian R Macumber
- Division of Nephrology, Seattle Children's Hospital, Seattle, Washington, USA;
| | - Noel S Weiss
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Susan M Halbach
- Division of Nephrology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Coral D Hanevold
- Division of Nephrology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Joseph T Flynn
- Division of Nephrology, Seattle Children's Hospital, Seattle, Washington, USA
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Mourato FA, Nadruz W, Moser LRDN, de Lima Filho JL, Mattos SS. A modified blood pressure to height ratio improves accuracy for hypertension in childhood. Am J Hypertens 2015; 28:409-13. [PMID: 25194155 DOI: 10.1093/ajh/hpu159] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The blood pressure to height ratio (BP:HT) has been proposed as a simple method for identifying children with elevated BP. This procedure shows good accuracy for the screening of hypertension in adolescents but less so in younger children. Our aim in this study was to modify the BP:HT ratio and determine if this change would increase accuracy when measuring hypertension during childhood. METHODS BP levels of 4,327 children (aged 5-12 years) were retrospectively obtained from medical charts. The modified ratio (BT:eHT13) was calculated as: BP/(HT + 7 × (13 - age in years)). Receiver operating characteristic curves were used to estimate cutoff points and the accuracy of the conventional and modified ratio to detect prehypertension and hypertension. RESULTS The prevalences of prehypertension and hypertension were 3.91% and 5.44%, respectively. In general, BP:eHT13 showed higher sensitivity (ranging from 0.95 to 1.00) and specificity (ranging from 0.80 to 0.98) in detecting prehypertension, level I hypertension, and level II hypertension than BP:HT (sensitivity ranging from 0.91 to 1.00; specificity ranging from 0.59 to 0.89). CONCLUSIONS The modified BP:eHT13 ratio showed better sensitivity and specificity for the screening of BP abnormalities in children aged 5-12 years.
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Affiliation(s)
- Felipe A Mourato
- Círculo do Coração de Pernambuco, Pernambuco, Brazil; Laboratório de Imunopatologia Keizo Asami, Pernambuco, Brazil; and
| | - Wilson Nadruz
- Laboratório de Imunopatologia Keizo Asami, Pernambuco, Brazil; and Universidade Estadual de Campinas, São Paulo, Brazil
| | | | | | - Sandra S Mattos
- Círculo do Coração de Pernambuco, Pernambuco, Brazil; Laboratório de Imunopatologia Keizo Asami, Pernambuco, Brazil; and
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11
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Affiliation(s)
- Felipe A Mourato
- Círculo do Coração de Pernambuco, Pernambuco, Brazil; Laboratório de Imunopatologia Keizo Asami, Pernambuco, Brazil;
| | - Wilson Nadruz
- Laboratório de Imunopatologia Keizo Asami, Pernambuco, Brazil; Universidade Estadual de Campinas, São Paulo, Brazil
| | - Sandra S Mattos
- Círculo do Coração de Pernambuco, Pernambuco, Brazil; Laboratório de Imunopatologia Keizo Asami, Pernambuco, Brazil
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12
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Fisher BT, Sammons JS, Li Y, de Blank P, Seif AE, Huang YS, Kavcic M, Klieger S, Harris T, Torp K, Rheam D, Shah A, Aplenc R. Variation in Risk of Hospital-Onset Clostridium difficile Infection Across β-Lactam Antibiotics in Children With New-Onset Acute Lymphoblastic Leukemia. J Pediatric Infect Dis Soc 2014; 3:329-35. [PMID: 26625453 PMCID: PMC4854370 DOI: 10.1093/jpids/piu008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 08/09/2013] [Accepted: 12/17/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Antibiotic exposure is common among children with leukemia. However, limited data exist regarding the risk of Clostridium difficile infection (CDI) across anti-pseudomonal β-lactam antibiotics commonly used for fever and neutropenia. METHODS A multicenter cohort of children with newly diagnosed acute lymphoblastic leukemia (ALL) was established from 43 freestanding children's hospitals from 1999 to 2009. Patients were followed until their index CDI event, defined by the CDI ICD-9 code plus a C difficile test charge, or until 180 days from ALL diagnosis. Cox proportional hazards models were performed to identify the hazards of CDI after exposure to anti-pseudomonal β-lactams, adjusting for demographics, other antibiotic exposures, severity of illness, antacids, gastrointestinal manipulation, and confounding by hospital. RESULTS A cohort of 8268 ALL patients was assembled; median age was 5.5 years (interquartile range, 3.26-10.58). Two-hundred sixty-eight (3.2%) patients developed CDI within 180 days of ALL diagnosis. Each 1-day increase in exposure to an anti-pseudomonal β-lactam within the prior 30 days was associated with a significantly increased risk for CDI (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01, 1.09). Ceftazidime (HR, 1.05; 95% CI, 1.02, 1.08) and cefepime (HR, 1.07; 95% CI, 1.02, 1.12) were each independently associated with CDI. CONCLUSIONS Efforts to reduce total exposure to anti-pseudomonal β-lactam agents may help to reduce the risk of CDI in children with newly diagnosed ALL. Cefepime and ceftazidime were independently associated with CDI, whereas anti-pseudomonal penicillins and carbapenems were not. These findings, if confirmed, have potential implications for antibiotic choice during periods of fever and neutropenia.
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Affiliation(s)
- Brian T. Fisher
- Division of Infectious Diseases,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania,Department of Pediatrics, and,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Julia Shaklee Sammons
- Division of Infectious Diseases,Department of Infection Prevention and Control,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania,Department of Pediatrics, and
| | - Yimei Li
- Division of Oncology, and,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Peter de Blank
- Division of Pediatric Hematology and Oncology, Rainbow Babies & Children's Hospital,Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Alix E. Seif
- Division of Oncology, and,Department of Pediatrics, and
| | | | | | | | | | | | | | | | - Richard Aplenc
- Division of Oncology, and,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Pennsylvania,Department of Pediatrics, and,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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13
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Alvarez-Uria G, Midde M, Pakam R, Naik PK. Gender differences, routes of transmission, socio-demographic characteristics and prevalence of HIV related infections of adults and children in an HIV cohort from a rural district of India. Infect Dis Rep 2012; 4:e19. [PMID: 24470926 PMCID: PMC3892649 DOI: 10.4081/idr.2012.e19] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 10/31/2011] [Accepted: 12/29/2011] [Indexed: 11/23/2022] Open
Abstract
Despite 67% of HIV infected people in India are rural residents, the epidemiology of HIV in rural areas is not well known. This is an observational cohort study of 11,040 HIV infected people living in a rural district of India. The prevalence of hepatitis B, hepatitis C and syphilis of HIV infected patients were compared to the seroprevalence in 16,641 blood donors from the same area. The age of diagnosis in adults was below 35 years in 70% of cases and 56% were illiterate. One third of women were widows and only 3.6% of adults had a permanent job. Women were diagnosed at earlier age, had lower level of education, had poorer employment conditions and depended more on their relatives than men. In a survey performed to a subgroup of patients, 81% of women referred to have acquired HIV from their spouse, whereas 51% of men acquired HIV from commercial sex. Patients with HIV had significantly higher prevalence of hepatitis B, hepatitis C and syphilis than blood donors. Seroprevalence of HIV-2, hepatitis C and toxoplasmosis were low compared to other sites. Six percent were children (<15 years) and almost half of them had lost one or both of their parents. The study shows the poor socio-economical situation and the high level of illiteracy of people living with HIV in rural India, especially women. Future health programmes of HIV in India should take into account the particularities of the HIV epidemic in rural areas.
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Affiliation(s)
- Gerardo Alvarez-Uria
- Department of Infectious Diseases. Rural Development Trust Hospital, Bathalapalli, Anantapur district, AP, India
| | - Manoranjan Midde
- Department of Infectious Diseases. Rural Development Trust Hospital, Bathalapalli, Anantapur district, AP, India
| | - Raghavakalyam Pakam
- Department of Infectious Diseases. Rural Development Trust Hospital, Bathalapalli, Anantapur district, AP, India
| | - Praveen Kumar Naik
- Department of Infectious Diseases. Rural Development Trust Hospital, Bathalapalli, Anantapur district, AP, India
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Joffe AR, Schulz C, Rosychuk RJ, Dyck J, Rebeyka IM, Ross DB, Schulz R, Cheung PY. Plasma matrix metalloproteinases in neonates having surgery for congenital heart disease. Heart Int 2011; 4:e4. [PMID: 21977281 PMCID: PMC3184692 DOI: 10.4081/hi.2009.e4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/24/2009] [Revised: 05/11/2009] [Accepted: 05/15/2009] [Indexed: 11/23/2022] Open
Abstract
During cardiopulmonary-bypass matrix-metalloproteinases released may contribute to ventricular dysfunction. This study was to determine plasma matrix-metalloproteinases in neonates after cardiopulmonary-bypass and their relation to post-operative course. A prospective observational study included 18 neonates having cardiac surgery. Plasma matrix-metalloproteinases-2 and 9 activities were measured by gelatin-zymography pre-operatively, on starting cardiopulmonarybypass, 7–8 min after aortic cross-clamp release, and 1h, 4h, 24h, and 3d after cardiopulmonary-bypass. Plasma concentrations of their tissue inhibitors 1 and 2 were determined by enzyme-linked immunosorbent assay. Cardiac function was assessed by serial echocardiography. Paired t-tests and Wilcoxon tests were used to assess temporal changes, and linear correlation with simultaneous clinical and cardiac function parameters were assessed using Pearson's product-moment correlation coefficient. Plasma matrix-metalloproteinases activities and their tissue inhibitor concentrations decreased during cardiopulmonary-bypass. Matrix-metalloproteinase-2 plasma activity increased progressively starting 1h after cardiopulmonarybypass and returned to pre-operative levels at 24h. Matrix-metalloproteinase-9 plasma activity increased significantly after release of aortic cross-clamp, peaked 7–8min later, and returned to baseline at 24h. Plasma tissueinhibitor 1 and 2 concentrations increased 1h after cardiopulmonary-bypass. Cardiac function improved from 4h to 3d after surgery (p<0.05). There was no evidence of significant correlations between matrix-metalloproteinases or their inhibitors and cardiac function, inotrope scores, organ dysfunction scores, ventilation days, or hospital days. The temporal profile of plasma matrix-metalloproteinases and their inhibitors after cardiopulmonary-bypass in neonates are similar to adults. In neonates, further study should determine whether circulating matrix-metalloproteinases are useful biomarkers of disease activity locally within the myocardium, and hence of clinical outcomes.
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Caselli D, Cesaro S, Livadiotti S, Ziino O, Paolicchi O, Zanazzo G, Milano GM, Licciardello M, Barone A, Cellini M, Raffaella DS, Giacchino M, Rossi MR, Aricò M, Castagnola E. Preventing transmission of infectious agents in the pediatric in-patients hematology-oncology setting: what is the role for non-pharmacological prophylaxis? Pediatr Rep 2011; 3:e9. [PMID: 21647282 PMCID: PMC3103128 DOI: 10.4081/pr.2011.e9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 03/16/2011] [Indexed: 11/23/2022] Open
Abstract
The most intensive chemotherapy regimens were used in the past for leukemia patients who were the main focus of trials on infections; today there are increasing numbers of children with solid cancer and considerable risk of infection who do receive intensive standard-dose chemotherapy. Despite a continuous will to protect the immune-compromised child from infections, evidence-based indications for intervention by non-pharmacological tools is still lacking in the pediatric hematology-oncology literature. Guidelines on standard precautions as well as precautions to avoid transmission of specific infectious agents are available. As a result of a consensus discussion, the Italian Association for Pediatric Hematology-Oncology (AIEOP) Cooperative Group centers agree that for children treated with chemotherapy both of these approaches should be implemented and vigorously enforced, while additional policies, including strict environmental isolation, should be restricted to patients with selected clinical conditions or complications. We present here a study by the working group on infectious diseases of AIEOP.
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Affiliation(s)
- Désirée Caselli
- Dipartimento Oncoematologia Pediatrica, Azienda Ospedaliero-Universitaria Meyer, Firenze
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Schreuder L, Peters G, Nijhuis-van der Sanden R, Morava E. Aerobic exercise in children with oxidative phosphorylation defects. Neurol Int 2010; 2:e4. [PMID: 21577340 PMCID: PMC3093217 DOI: 10.4081/ni.2010.e4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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: 06/29/2009] [Revised: 01/25/2010] [Accepted: 01/29/2010] [Indexed: 12/02/2022] Open
Abstract
Fatigue and exercise intolerance are symptoms in children with metabolic myopathy. Frequently this is combined with muscle pain in children with mitochondrial myopathy. Offering therapeutic advice remains challenging in this patient group. Here we describe five children above the age of four years, with normal intelligence, myopathy, exercise intolerance, motor developmental delay, and fatigue, who were diagnosed with a mitochondrial dysfunction. Based on the positive experience of condition training in adults with mitochondrial disease and inactivity, aerobic exercise training was advised for all the children. Because of the lack of clear protocols for individualized mitochondrial myopathies, regular training was initiated. The Movement Assessment Battery of Children, the Jamar dynamometer for grip force, and the Bruce protocol treadmill test were applied for evaluation. No patient showed significant disease progression on a weekly scheme of strength training or on aerobic training during periods varying between 6 and 18 months. Only one out of the five patients has shown an improvement after a period of structured, aerobic training, demonstrating good compliance and motivation over the course of 18 months. Some patients developed severe muscle pain after explosive exercise. Even in a relatively homogenous, intelligent group of patients and motivated parents, we could not reach full compliance. With our case studies, we would like to draw attention to the importance and pitfalls of movement therapy in children with mitochondrial disease.
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Affiliation(s)
- Luuk Schreuder
- Radboud University Nijmegen Medical Centre, Nijmegen Centre for Mitochondrial Disorders, Departments of Pediatrics and Neurology
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