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Paediatric Population (paediatric + population)
Selected AbstractsElevated C-reactive protein in Native Canadian children: an ominous early complication of childhood obesityDIABETES OBESITY & METABOLISM, Issue 5 2006R. Retnakaran Aim:, Subclinical inflammation has been proposed as a pathophysiologic mechanism linking obesity with vascular and metabolic disease. Native North American populations are experiencing high prevalence rates of both (i) childhood obesity and (ii) adult cardiovascular disease (CVD) and type 2 diabetes. Thus, we sought to determine whether subclinical inflammation is an early complication of obesity in Native children. Methods:, Serum concentrations of the inflammatory biomarker C-reactive protein (CRP) were assessed in a population-based, cross-sectional study of the Sandy Lake Oji-Cree community of Northern Ontario, Canada, involving 228 children aged 10,19 years (mean age 14.8). Results:, Median CRP in this population was 0.5 mg/l (interquartile range 0.18,1.79 mg/l). CRP levels were higher than age-matched reference data from the Third National Health and Nutrition Examination Survey (NHANES III). Importantly, fully 15.8% of the children of this community had CRP concentrations between 3 and 10 mg/l, a range that identifies adults at high risk of CVD. Moreover, increasing CRP concentration in this paediatric population was associated with an enhanced CV risk profile, consisting of increased adiposity, higher insulin resistance, worsening lipid profile (higher total cholesterol, triglycerides, low-density lipoprotein cholesterol, apolipoprotein B and total cholesterol : high-density-lipoprotein cholesterol ratio), increased leptin and decreased adiponectin. On multivariate analysis, waist circumference and interleukin-6 (IL-6) emerged as independent determinants of CRP concentration. Conclusion:, Subclinical inflammation is an early complication of childhood obesity in Native children and may foreshadow an increased burden of CVD and type 2 diabetes in the future. [source] Paracetamol versus ibuprofen: A randomized controlled trial of outpatient analgesia efficacy for paediatric acute limb fracturesEMERGENCY MEDICINE AUSTRALASIA, Issue 6 2009Michael Shepherd Abstract Paediatric limb fracture is a common injury that presents frequently to the ED. The primary objective of the present study was to determine whether ibuprofen provides better analgesia than paracetamol for paediatric patients discharged with acute limb fractures. A prospective, randomized controlled study was conducted in a children's ED. Children aged 5,14 years with an acute limb fracture were randomized to be prescribed paracetamol 15 mg/kg/dose every 4 h or ibuprofen 10 mg/kg/dose every 8 h. Objective (child-reported) pain scores using the ,Faces' pain scale were measured over a 48 h period. Child-reported pain did not differ significantly between the paracetamol and ibuprofen groups (mean pain score paracetamol 2.8 [95% CI 2.4,3.4]vs 2.7 [95% CI 2.1,3.3], P= 0.73). Parent-reported sleep quality did not differ between the two groups (P= 0.78). Child-reported pain score decreased over the 48 h of measurement (P < 0.0001). There were no significant differences in side-effects detected between the two groups. The present study shows that in the outpatient paediatric population, ibuprofen does not provide better analgesia than paracetamol. Pain from an acute fracture can be managed by regular simple oral analgesia and immobilization. [source] Paediatric lap-belt injury: A 7 year experienceEMERGENCY MEDICINE AUSTRALASIA, Issue 1 2006Michael Shepherd Abstract Objective:, To highlight the injuries that result from lap-belt use and make recommendations for prevention, the recent experience of a regional paediatric trauma centre was reviewed. Methods:, Retrospective review of admissions to Starship Children's Hospital from 1996 to 2003, with significant injury following involvement in a motor vehicle crash, while wearing a lap-belt. Patients were identified from two prospectively collected databases and discharge coding data. Results:, In total, 19 patients were identified over the 7 year period. The morbidity sustained includes 15 patients with hollow viscus injury, 13 laparotomies, 7 spinal fractures, 2 paraplegia and 1 fatality. A total of 11 patients required laparotomy with a median delay of 24 h. Of patients in the present series, 58% were aged less than 8 years and thus were inappropriately restrained. Conclusions:, Lap-belt use can result in a range of life-threatening injuries or permanent disability in the paediatric population. The incidence of serious lap-belt injury does not appear to be decreasing. Morbidity and mortality could be reduced by the use of three-point restraints, age appropriate restraints and booster seats. [source] A systematic review on the diagnosis and treatment of primary (idiopathic) dystonia and dystonia plus syndromes: report of an EFNS/MDS-ES Task ForceEUROPEAN JOURNAL OF NEUROLOGY, Issue 5 2006A. Albanese chairman To review the literature on primary dystonia and dystonia plus and to provide evidence-based recommendations. Primary dystonia and dystonia plus are chronic and often disabling conditions with a widespread spectrum mainly in young people. Computerized MEDLINE and EMBASE literature reviews (1966,1967 February 2005) were conducted. The Cochrane Library was searched for relevant citations. Diagnosis and classification of dystonia are highly relevant for providing appropriate management and prognostic information, and genetic counselling. Expert observation is suggested. DYT-1 gene testing in conjunction with genetic counselling is recommended for patients with primary dystonia with onset before age 30 years and in those with an affected relative with early onset. Positive genetic testing for dystonia (e.g. DYT-1) is not sufficient to make diagnosis of dystonia. Individuals with myoclonus should be tested for the epsilon-sarcoglycan gene (DYT-11). A levodopa trial is warranted in every patient with early onset dystonia without an alternative diagnosis. Brain imaging is not routinely required when there is a confident diagnosis of primary dystonia in adult patients, whereas it is necessary in the paediatric population. Botulinum toxin (BoNT) type A (or type B if there is resistance to type A) can be regarded as first line treatment for primary cranial (excluding oromandibular) or cervical dystonia and can be effective in writing dystonia. Actual evidence is lacking on direct comparison of the clinical efficacy and safety of BoNT-A vs. BoNT-B. Pallidal deep brain stimulation (DBS) is considered a good option, particularly for generalized or cervical dystonia, after medication or BoNT have failed to provide adequate improvement. Selective peripheral denervation is a safe procedure that is indicated exclusively in cervical dystonia. Intrathecal baclofen can be indicated in patients where secondary dystonia is combined with spasticity. The absolute and comparative efficacy and tolerability of drugs in dystonia, including anticholinergic and antidopaminergic drugs, is poorly documented and no evidence-based recommendations can be made to guide prescribing. [source] Histological assessment of non-alcoholic fatty liver diseaseHISTOPATHOLOGY, Issue 5 2006S G Hübscher Non-alcoholic fatty liver disease (NAFLD) is an important complication of the metabolic syndrome, which is becoming an increasingly common cause of chronic liver disease. Histological changes typically mainly affect perivenular regions of the liver parenchyma and include an overlapping spectrum of steatosis, steatohepatitis and persinusoidal or pericellular fibrosis, in some cases leading to cirrhosis. Once cirrhosis has developed, typical hepatocellular changes are often no longer conspicuous, leading to such cases being mistakenly diagnosed as ,cryptogenic'. Portal inflammation, ductular reaction and periportal fibrosis can also be seen as part of the morphological spectrum of NAFLD, particularly in the paediatric population. Hepatocellular carcinoma has also been described as a complication of NAFLD-associated cirrhosis. NAFLD is also an important cofactor in other chronic liver diseases, especially hepatitis C. Histological assessments have an important role to play in the diagnosis and management of NAFLD. These include making the potentially important distinction between simple steatosis and steatohepatitis and providing pointers to the aetiology, including cases where a dual pathology exists. A number of systems have been devised for grading and staging the severity of fatty liver disease. These require further evaluation, but have a potentially important role to play in determining prognosis and monitoring therapeutic responses. [source] Prophylactic steroids for paediatric open-heart surgery: a systematic reviewINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2008Suzi Robertson-Malt BHSc PhD Background, The immune response to cardiopulmonary bypass in infants and children can lead to a series of post-operative morbidities and mortality, that is, hemodynamic instability, increased infection and tachyarrhythmias. Administration of prophylactic doses of corticosteroids is sometimes used to try and ameliorate this pro-inflammatory response. However, the clinical benefits and harms of this type of intervention in the paediatric patient remain unclear. Objectives, To systematically review the beneficial and harmful effects of the prophylactic administration of corticosteroids, compared with placebo, in paediatric open-heart surgery. Search strategy, The trials registry of the Cochrane Heart Group, the Cochrane Central Register of Controlled Trials in The Cochrane Library (Issue 4, 2006), MEDLINE (1966 to January 2007), EMBASE (1980 to January 2007) were searched. An additional hand-search of the EMRO database for Arabic literature was performed. Grey literature was searched, and experts in the field were contacted for any unpublished material. No language restrictions were applied. Selection criteria, All randomised and quasi-randomised controlled trials of open-heart surgery in the paediatric population that received corticosteroids pre-, peri- or post-operatively, with reported clinical outcomes in terms of morbidity and mortality. Data collection and analysis, Eligible studies were abstracted and evaluated by two independent reviewers. All meta-analyses were completed using RevMan4.2.8. Weighted mean difference (WMD) was the primary summary statistic with data pooled using a random-effects model. Main results, All cause mortality could not be assessed as the data reports were incomplete. There was weak evidence in favour of prophylactic corticosteroid administration for reducing intensive care unit stay, peak core temperature and duration of ventilation (WMD (95% confidence intervals) ,0.50 h (,1.41 to 0.41); ,0.20°C (,1.16 to 0.77) and ,0.63 h (,4.02 to 2.75) respectively). [source] Utility of the PFA-100® analyser in the evaluation of primary haemostasis in a paediatric populationINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 6 2007J.M. Perel [source] A retrospective study of paediatric oral lesions from ThailandINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 4 2007KITTIPONG DHANUTHAI Aim., To survey the paediatric oral lesions in Thailand. Design., Biopsy records over a 15-year period (1990,2004) were retrieved from the files of the Department of Oral Pathology, Faculty of Dentistry, Chulalongkorn University. Paediatric cases with an age of 16 years or younger were selected. The age of the patients was divided into three groups according to the dentition period. The lesions were classified into three categories: inflammatory/reactive lesions, cystic lesions, and tumour/tumour-like lesions. Results., From a total of 8314 oral biopsies, 1251 cases (15.05%) were in the paediatric population. The greatest number of lesions fell into the cystic category, followed closely by the inflammatory/reactive category and tumour/tumour-like category, respectively. The top ten most frequently encountered lesions in the present study were dentigerous cyst, mucocele, pyogenic granuloma, ameloblastoma, radicular cyst, odontoma, odontogenic keratocyst, irritation fibroma (focal fibrous hyperplasia), fibrous dysplasia, and osteomyelitis. The majority of lesions were found in the mixed dentition period (49.24%). There was no statistical difference in the occurrence between genders in this study. Conclusions., The present study shows an almost similar trend to previous studies except in the ranking among and within categories. These differences may be attributable to the nature of the population studied and because Chulalongkorn University is a major referral centre. [source] Mechanisms and management of gingival overgrowth in paediatric transplant recipients: a reviewINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 4 2003D. Chabria Summary. Increasing numbers of children are receiving solid organ transplants namely kidney, liver, heart and lung. Patient survival rates following such transplants are essentially good with much of the success attributable to the development of Cyclosporine A (CyA), an immunosuppressive drug, that minimizes organ rejection. However the gingival overgrowth (GO) associated with the use of CyA is not only disfiguring but in paediatric recipients, may interfere with normal oral development and function. Objective. The aim of this review is to summarize current knowledge concerning the aetiology, pathogenesis and management of gingival overgrowth. Methods. Literature pertaining to gingival overgrowth is reviewed with particular reference to the paediatric population. Emphasis is placed on summarizing the evidence pertaining to the effectiveness of intervention. Conclusion. CyA undoubtedly causes gingival overgrowth, the effects and levels of which appears to be more severe in younger patients. There is conflicting evidence as to the effectiveness of oral hygiene regimes, antibiotics and surgery in reducing overgrowth. The introduction of an alternative immunosuppressive agent (Tacrolimus) offers potential as it does not appear to cause overgrowth, although research to date is limited by the small sample size of many of the studies. This is an area in which multicentre studies would be of great value. [source] Extemporaneous product use in paediatric patients: a systematic reviewINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 1 2008Ms Jennifer A Giam pharmacist, postgraduate student Objective To identify the relative extent of extemporaneous product use reported in the paediatric population and the implications for pharmacy practice. Method A systematic literature review was undertaken to identify the prevalence of extemporaneous product use in paediatric patients including those studies examining both ,off-label' and unlicensed medicine use from which extemporaneous products were separately identified and compared to licensed drug use. Key findings Twenty studies were identified and evaluated in which extemporaneous products prepared by a pharmacy or licensed manufacturer could be identified. Although prescribing of unlicensed drugs and licensed drugs used ,off-label' occurs more frequently in younger children and for more serious conditions, the use of extemporaneous products is consistent across all age groups and therapeutic areas. Studies using pharmacy dispensing records identified details of extemporaneous products more accurately than studies using prescribing records. Despite efforts to improve the availability of suitable licensed medicine products for children, extemporaneously prepared products are still needed to ensure that optimal drug therapy is available to children in accurate and effective doses and dosage forms. Conclusions Paediatric patients have a continuing need for extemporaneously prepared medicines when suitable dose forms are unavailable from manufacturers. Pharmacists require access to stability, compatibility and formulation information, as well as appropriate training to ensure patients are supplied with high-quality, safe and effective preparations. [source] V.A.C.® Therapy in the management of paediatric wounds: clinical review and experienceINTERNATIONAL WOUND JOURNAL, Issue 2009Mona Baharestani ABSTRACT Usage of negative pressure wound therapy (NPWT) in the management of acute and chronic wounds has grown exponentially in the past decade. Hundreds of studies have been published regarding outcomes and methods of therapy used for adult wounds. This treatment is increasingly being used to manage difficult-to-treat paediatric wounds arising from congenital defects, trauma, infection, tumour, burns, pressure ulceration and postsurgical complications in children, although relatively few studies have been aimed at this population. Given the anatomical and physiological differences between adults and children, a multidisciplinary expert advisory panel was convened to determine appropriate use of NPWT with reticulated open cell foam (NPWT/ROCF) as delivered by Vacuum Assisted Closure® (V.A.C.® Therapy, KCI Licensing, Inc., San Antonio, TX) for the treatment of paediatric wounds. The primary objectives of the expert advisory panel were to exchange state-of-practice information on paediatric wound care, review the published data regarding the use of NPWT/ROCF in paediatric wounds, evaluate the strength of the existing data and establish guidelines on best practices with NPWT/ROCF for the paediatric population. The proposed paediatrics-specific clinical practice guidelines are meant to provide practitioners an evidence base from which decisions could be made regarding the safe and efficacious selection of pressure settings, foam type, dressing change frequency and use of interposing contact layer selections. The guidelines reflect the state of knowledge on effective and appropriate wound care at the time of publication. They are the result of consensus reached by expert advisory panel members based on their individual clinical and published experiences related to the use of NPWT/ROCF in treating paediatric wounds. Best practices are described herein for novice and advanced users of NPWT/ROCF. Recommendations by the expert panel may not be appropriate for use in all circumstances. Decisions to adopt any particular recommendation must be made by the collaborating medical team, including the surgeon and wound care specialist based on available resources, individual patient circumstances and experience with the V.A.C.® Therapy System. [source] Is brimonidine ophthalmic a safe therapy for infants?JOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 3 2006G. P. Daubert MD Summary Brimonidine is a topical alpha-2 agonist commonly used in the treatment of glaucoma. Brimonidine toxicity resembles that of clonidine overdose and is probably due to both imidazoline and alpha-2 adrenergic receptor effects. We report a case of a 6-week-old infant with congenital glaucoma who developed bradycardia and hypotension following the administration of brimonidine 0·15% ophthalmic solution. There are occasional reports of brimonidine toxicity in the paediatric population but its overall safety profile in children <2 years of age remains uncertain. Brimonidine is not dosed by weight and therefore paediatric patients may be at increased risk for systemic toxicity. It is recommended that the use of this medication be carefully considered in children <2 years of age. Physicians should be aware of its side effect profile because of its general use in the paediatric population. [source] Acute treatment of paediatric migraine: A meta-analysis of efficacyJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2008Shawna Silver Aim: To undertake a meta-analysis of all randomised controlled trials (RCTs) on the acute pharmacologic treatment of children and adolescents with migraine headache. Methods: In total, 139 abstracts of clinical trials specific to the acute treatment of paediatric migraine were appraised. Inclusion criteria required clinical trials to be randomised, blinded, placebo-controlled studies with comparable endpoints. Non- English language publications were excluded. 11 clinical trials qualified for inclusion in the final meta-analysis. Two endpoints were analysed: the proportion of patients with (1) headache relief, and (2) complete pain relief, 2 h post-treatment. Results: The following medications were included in the analysis: acetaminophen (n = 1), ibuprofen (n = 2), sumatriptan (n = 5), zolmitriptan (n = 1), rizatriptan (n = 2) and dihydroergotamine (n = 1). Results are expressed as a relative benefit (RB) conferred over placebo and the number needed to treat (NNT). Only ibuprofen and sumatriptan provided a statistically significant relative efficacy in comparison with placebo. Two hours post-treatment, ibuprofen was associated with an RB 1.50 (95% CI 1.15,1.95) in the generation of headache relief (NNT 2.4) and RB 1.92 (95% CI 1.28,2.86) in the production of complete pain relief (NNT 4.9). Sumatriptan rendered an RB 1.26 (95% CI 1.13,1.41) in headache relief (NNT 7.4) and an RB 1.56 (95% CI 1.26,1.93) in the production of complete pain relief (NNT 6.9). Conclusion: Despite the pharmacological options for the management of acute migraine, few RCTs in the paediatric population exist. Composite data demonstrate that only ibuprofen and sumatriptan are significantly more effective than placebo in the generation of headache relief in children and adolescents. [source] Transitional cell carcinoma in the paediatric population: Be aware of unusual aetiologiesJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 11 2007Caroline R Dowling Abstract: This is a case report of a 12 year old girl who presented with a rare condition in paediatrics, transitional cell carcinoma of the bladder. It is important because it is readily treated by endoscopic means if diagnosed early. Potential aetiologies for this unusual condition are explored. [source] Paediatric bronchiectasis in the twenty-first century: Experience of a tertiary children's hospital in New ZealandJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 2 2003EA Edwards Objective: Despite its decline in developed countries, bronchiectasis appeared to be a common diagnosis in Auckland, New Zealand children. The aims of this study were: to document the number of children in Auckland with bronchiectasis, their severity, clinical characteristics and possible aetiologies; to assess whether there was a relationship between ethnicity and poverty; and to estimate a crude bronchiectasis prevalence rate for New Zealand. Methods: A retrospective review of the case histories of all children attending a tertiary children's hospital in Auckland with bronchiectasis diagnosed by high-resolution chest computed tomography (CT) scan, during the period 1998,2000 was undertaken. Data collected included patient demographics, number of hospitalizations pre- and post-diagnosis, lung function tests, radiology and investigations. The New Zealand deprivation 1996 index was applied to the data to obtain a measure of socio-economic status. Results: Bronchiectasis was found to be common, with an estimated prevalence of approximately one in 6000 in the Auckland paediatric population. It was disproportionately more common in the Pacific Island and Maori children. In Pacific Island children, bronchiectasis not caused by cystic fibrosis was nearly twice as common in the general population than cystic fibrosis. Socio-economic deprivation and low immunization rates may be significant contributing factors. The bronchiectasis seen was extensive. Ninety-three percent had bilateral disease and 64% had involvement of four or more lobes on chest CT scan. A wide range of comorbidities and underlying aetiologies were evident. Conclusions: Paediatric bronchiectasis in Auckland, New Zealand, is common but underresourced. Only the most severe cases are being recognized, providing a significant challenge for paediatric health professionals. [source] Outcome following surgical closure of secundum atrial septal defectJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2001DA Jones Objective: To assess the current outcome of surgical closure of secundum atrial septal defects (ASD) in an Australian paediatric population. Methodology: A retrospective chart review of 87 children, aged 2 months to 15 years, was performed for surgery between August 1995 and March 1999. Results: There were no deaths in the patients studied. Approximately one in four patients (24.1%) experienced complications requiring further management. Complication rates were similar to those published previously. However, one in nine patients (11.5%) required surgical drainage of a pericardial effusion. A total of five of 87 (5.7%) patients developed post-pericardiotomy syndrome (PPS), of whom four required pericardiocentesis. The risk for developing a pericardial effusion requiring drainage or PPS was more than twice in children older than 5 years of age at the time of surgery compared to those aged under 5 years, although there was an insufficient number of subjects in the study to prove this statistically (Odds ratio 2.31). Conclusions: Most patients have an uncomplicated postoperative course following surgical closure of secundum ASD. However, a significant minority (24.1%) do develop complications requiring further management and have a correspondingly longer period of hospitalization. Patients older than 5 years of age were identified as being potentially at greater risk for the development of PPS or a pericardial effusion requiring drainage. Further research needs to be performed to clarify this. [source] Immediate and 5-year cumulative outcome after paediatric intensive care in SwedenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2008N. GULLBERG Background: Little has been reported about intensive care of children in Sweden. The aims of this study are to (I) assess the number of admissions, types of diagnoses and length-of-stay (LOS) for all Swedish children admitted to intensive care during the years 1998,2001, and compare paediatric intensive care units (PICUs) with other intensive care units (adult ICUs) (II) assess immediate (ICU) and cumulative 5-year mortality and (III) determine the actual consumption of paediatric intensive care for the defined age group in Sweden. Methods: Children between 6 months and 16 years of age admitted to intensive care in Sweden were included in a national multicentre, ambidirectional cohort study. In PICUs, data were also collected for infants aged 1,6 months. Survival data were retrieved from the National Files of Registration, 5 years after admission. Results: Eight-thousand sixty-three admissions for a total of 6661 patients were identified, corresponding to an admission rate of 1.59/1000 children per year. Median LOS was 1 day. ICU mortality was 2.1% and cumulative 5-year mortality rate was 5.6%. Forty-four per cent of all admissions were to a PICU. Conclusions: This study has shown that Sweden has a low immediate ICU mortality, similar in adult ICU and PICU. Patients discharged alive from an ICU had a 20-fold increased mortality risk, compared with a control cohort for the 5-year period. Less than half of the paediatric patients admitted for intensive care in Sweden were cared for in a PICU. Studies are needed to evaluate whether a centralization of paediatric intensive care in Sweden would be beneficial to the paediatric population. [source] Systematic review: steroid withdrawal in anti-TNF-treated patients with inflammatory bowel diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2010E. Bultman Aliment Pharmacol Ther 2010; 32: 313,323 Summary Background, The increasing awareness of increased risk for opportunistic infections when combining several immunosuppressant drugs led to new treatment goals for inflammatory bowel disease including limited use of steroids. Aim, To conduct a systematic review to establish figures for steroid withdrawal in anti-TNF treated inflammatory bowel disease-patients. Methods, Medline was searched using the search-terms Ulcerative Colitis (UC) [Mesh], Crohn Disease (CD) [Mesh], IBD [Mesh], crohn, colitis, IBD and steroid sparing, all combined with infliximab and adalimumab. We selected English-language publications that addressed the effect of anti-TNF on steroid withdrawal. Studies had to assess patients with luminal CD or UC. Numbers of patients who were able to withdraw steroids were calculated. Results, Six studies could be included; five reporting on infliximab and one on adalimumab. Studies were heterogeneously designed. Overall, in the adult population, up to 38% of the patients were able to withdraw corticosteroids during infliximab therapy. In the paediatric population, up to 75% of the patients were able to withdraw corticosteroids during infliximab therapy. Conclusions, Although a consensus on the definition of steroid-sparing is lacking, approximately two-thirds of the inflammatory bowel disease-patients are unable to withdraw corticosteroid treatment during anti-TNF therapy. [source] Statistical issues in the assessment of health outcomes in children: a methodological reviewJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 4 2009Gillian A. Lancaster Summary., The lack of outcome measures that are validated for use on children limits the effectiveness and generalizability of paediatric health care interventions. Statistical epidemiology is a broad concept encompassing a wide range of useful techniques for use in child health outcome assessment and development. However, the range of techniques that are available is often confusing and prohibits their adoption. In the paper an overview of methodology is provided within the paediatric context. It is demonstrated that in many cases assessment can be performed relatively straightforwardly by using standard statistical techniques, although sometimes more sophisticated techniques are required. Examples of both physiological and questionnaire-based outcomes are given. The usefulness of these techniques is highlighted for achieving specific objectives and ultimately for achieving methodological rigour in clinical outcome studies that are performed in the paediatric population. [source] Autoimmune liver diseases in a paediatric population with coeliac disease , a 10-year single-centre experienceALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2010A. R. DI BIASE Summary Backgroud, Coeliac disease (CD) can be associated with liver disease. Gluten-free diet (GFD) normalizes cryptogenic forms, but most likely not autoimmune hepatitis (AIH). For this condition, immunosuppressants represent the treatment. However, when these are stopped, AIH generally relapses. Aim, To determine in CD children liver test abnormality frequency, the effect of GFD alone, or plus prolonged immunosuppressants on AIH course. Methods, Coeliac disease patients with abnormal transaminases were selected; if transaminases <5 × UNL (upper normal limits), GFD alone was administered; if >5 × UNL, liver examinations and biopsy were performed. In AIH, immunosuppressants were administered (5 years). Treatment was stopped only if patients remained in remission during the entire maintenance period and normalized liver histology. Results, A total of 140 out of 350 CD children had hypertransaminaemia: 133 cryptogenic disease, 7 AIH. GFD normalized only cryptogenic hepatitis. During treatment, all AIH persistently normalized clinical and biochemical parameters; after withdrawal, six patients maintained a sustained remission (follow-up range: 12,63 months), while one relapsed. Conclusions, In CD children with AIH, only GFD plus immunosuppressants determines a high remission rate. When clinical remission is reached, a prolonged immunosuppressive regimen induces a high sustained remission rate after treatment withdrawal, indicating that this regimen may prevent early relapse. Aliment Pharmacol Ther,31, 253,260 [source] Prevalence and clinicopathologic findings of antiphospholipid syndrome nephropathy in Thai systemic lupus erythematosus patients who underwent renal biopsiesNEPHROLOGY, Issue 5 2007BOONYARIT CHEUNSUCHON SUMMARY: Aim: To determine the prevalence of antiphospholipid syndrome nephropathy (APSN) in Thai systemic lupus erythematosus (SLE) patients who underwent renal biopsy and to compare the relationship of renal histopathology and other significant clinical parameters between SLE patients with and without APSN. Methods: A retrospective analysis was undertaken in systemic lupus erythematosus patients (n = 150, 44 <15 years old, 106 0e;15 years old) who underwent renal biopsy. The specimens were evaluated for histological features of APSN and other significant clinical parameters. The result of antiphospholipid antibodies, clinical course, and renal function from chart review were analysed. Results: The prevalence of APSN in systemic lupus erythematosus patients who underwent renal biopsies was 34% (16% in <15-year-old group, 41.5% in 0e;15-year-old group). APSN was associated with more severe hypertension (P = 0.002 for systolic and P = 0.004 for diastolic blood pressure), acute renal failure (P = 0.003), persistent heavy proteinuria (P < 0.001 for 4+ proteinuria), severe lupus nephritis (class III and IV, P = 0.014, high activity and chronicity indices, P < 0.001) and a tendency to progress to end-stage renal disease. Conclusion: Systemic lupus erythematosus patients who underwent renal biopsies in our institute showed a prevalence of APSN comparable to those in western countries. The presence of APSN was significantly higher in the adult than in the paediatric population. Its association with poor prognostic indicators suggests poor renal outcome. Clinicians should be aware of this condition in order to give proper care to systemic lupus erythematosus patients. [source] Common variable immunodeficiency: 20-yr experience at a single centrePEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 2 2009Ma Pilar Llobet Common variable immunodeficiency (CVID) is the most common symptomatic primary immunodeficiency. It can present at any age in patients with a history of recurrent bacterial infections, with or without a family history of other primary immunodeficiencies (PID), and shows a wide range of clinical manifestations and immunological data. Diagnosis is based on low IgG, IgM and/or IgA levels. Delayed diagnosis and therapy can lead to bronchiectasis and malabsorption. The aim of this study was to describe a paediatric population diagnosed of CVID and its evolution in the population. Memory B-cell (MB) classification carried out in these patients was correlated with clinical manifestations and outcome. Clinical and immunological data of 22 CVID children under 18 yr treated at our centre between 1985 and 2005 are presented. Immunological studies included those for diagnosis and MB quantification. Differences in form of presentation, familial incidence and MB classification were reviewed. A statistical descriptive analysis was made. Infections were the commonest manifestation, affecting mainly respiratory (19/22) and gastrointestinal (10/22) tracts. Bronchiectasis was present in seven cases, and detected prior to CVID diagnosis in five. Replacement therapy led to a significant reduction in the number of infections. Severe complications appeared mostly in patients without MB. Patients of the same family share the same MB group. Family members had also been diagnosed of CVID in seven cases. Early diagnosis and therapy are essential to improve outcome in these patients. MB studies are useful in children to orient prognosis and further genetic studies. [source] Mycobacterial infection and atopy in childhood: A systematic reviewPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 7 2007Charles C. Obihara The epidemiological relation between mycobacterial infection and the prevalence of atopic disease in humans is still unclear. This is in contrast to studies in murine models in which a clear suppression of atopic symptoms was observed after exposure to mycobacteria or mycobacterial products. We therefore wanted to provide a systematic overview of the published literature on the relationship between mycobacterial infection and atopic disease and to evaluate the causal relationship in a meta-analysis. The EMBASE and MEDLINE databases were searched systematically for papers published in the English literature (1966,2005) on the relation between mycobacterial infection and atopic disease. Original observational or interventional studies involving the paediatric population were included. Two authors independently reviewed articles for data on mycobacterial exposure and atopic disease outcome. Any differences were resolved by discussion. Of a total of 1201 hits, 23 studies (19 cross-sectionals, three case,controls and one prospective cohort) met the inclusion criteria. Only a minority of studies (40%) observed an association between mycobacterial infection and the prevalence of atopic disease outcome. In the meta-analysis, only studies containing data on mycobacterial exposure and atopic disease outcome variables were included. Only cross-sectional studies, in which the relation between a positive tuberculin skin test and allergic symptoms was studied, observed statistically significant negative correlation (odds ratio 0.63; 95% confidence interval: 0.51,0.79). The results of this review show that the evidence of the relationship of mycobacterial infection and atopic disease is based on observations of cross-sectional studies. In a meta-analysis, calculations showed a high level of heterogeneity (I2) within studies with similar design making it difficult to pool effects. This may partly be explained by differences in the type and definition of mycobacterial infection and lack of uniformity in the definition of atopy. The results show that only a minority of studies in the literature shows any evidence of inverse relationship between mycobacterial exposure and atopic disease outcome. The fact that the present epidemiological evidence on the relationship between mycobacterial infection and the development of atopic disease is based mainly on cross-sectional observational studies indicates the need for population-based prospective studies to address this issue. This issue needs to be addressed in view of recent suggestions to developing mycobacterial-based vaccines against atopic disease in the future. [source] Safety of specific sublingual immunotherapy with SQ standardized grass allergen tablets in childrenPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 6 2007Maria Dolores Ibañez The aim of the study was to confirm the safety of an orodispersible grass allergen tablet 75,000 SQ-T (Grazax®, ALK-Abelló A/S, Hørsholm, Denmark) in children aged 5,12 yr. The study was randomized, double-blinded and placebo-controlled. Sixty children aged 5,12 yr suffering from grass pollen-induced rhinoconjunctivitis (with or without asthma) from five centres in two countries (three in Germany and two in Spain) participated in the study. They were randomized at the ratio of 3:1 as receiving either Grazax or placebo tablet given sublingually once daily for 28 days outside the grass pollen season. A total of 810 treatment-related adverse events were reported in the Grazax group. The majority of these were local reactions in the mouth or throat and were mostly mild (71%) to moderate (27%) in severity and resolved within days. Thirty-five (78%) subjects treated with Grazax and five (33%) treated with placebo reported at least one treatment-related adverse event. Oral pruritus, throat irritation, mouth oedema and ear pruritus appeared as the most frequently reported treatment-related adverse events. 62% (28 of 45) of the actively treated subjects reported oral pruritus, 36% (16 of 45) throat irritation, 31% (14 of 45) mouth oedema and 22% (10 of 45) ear pruritus. Two actively treated subjects withdrew from the study: one subject due to four adverse events (moderate eye pruritus, moderate pharyngolaryngeal pain, moderate non-cardiac chest pain and moderate dysphagia) and one subject due to a serious adverse event (asthmatic attack). The subjects recovered completely from the events. In conclusion, in the present study, Grazax was in general tolerated in a paediatric population and considered suitable for further clinical investigations in children. [source] The braun thermoscan thermometer: validation of normal ranges in a paediatric practicePEDIATRIC ANESTHESIA, Issue 9 2002C.A. Streets Introduction Pyrexia is a common cause of operative cancellation in paediatric practice, and so the accurate determination of temperature is of paramount importance. Recently the Braun ThermoScan infrared aural thermometer has been introduced to Derriford Hospital as a safe and non-invasive technique for measuring temperature. Initially the published upper limits of normal for this technique appeared to be higher than expected. Initial experiences with the thermometer in Derriford Hospital produced high temperature readings in children who were otherwise clinically well. The aim of this study was to compare the manufacturer's published normal ranges with those obtained from a general paediatric population. Methods Ethics Committee approval was obtained. The study was conducted between July and November 2001. Patients less than 16 years of age, and admitted to either the Day Surgical Unit or the general paediatric wards for elective surgery were included. Each child had its temperature measured on admission using the Braun ThermoScan aural thermometer. The ages and temperatures were recorded, and the values compared with the manufacturer's normal ranges using standard error of the means. Results Preliminary data are reported from 248 children: 1,2 years (n = 30), 3,10 years (n = 159), and 11,15 years (n = 59). The table demonstrates that there is no significant statistical difference between the manufacturer's ranges and those of the Derriford Hospital paediatric elective surgical population. Discussion The Braun ThermoScan infrared aural thermometer is considered to be a safe, hygienic, and convenient technique for measuring temperature. Despite initial misgivings that a temperature approaching 38°C could not be considered normal, this study has confirmed that the manufacturer's published normal ranges are indeed compatible with those obtained from a district general hospital paediatric population. Conclusion This study validates the manufacturer's published normal range for the Braun ThermoScan thermometer. This therefore leaves a clinical dilemma , does a child with a temperature of 37.9°C have a pyrexia or not? [source] Analgesia for circumcision in a paediatric population: comparison of caudal bupivacaine alone with bupivacaine plus two doses of clonidinePEDIATRIC ANESTHESIA, Issue 6 2001P. Sharpe FRCA Background:,Clonidine is often used to improve the duration and quality of analgesia produced by caudal epidural blockade, although the optimum dose of clonidine with bupivacaine remains uncertain. Methods:,We compared the effect of clonidine, 1 and 2 ,g·kg,1, added to bupivacaine (1.25 mg·kg,1) with that of bupivacaine alone in 75 male children undergoing elective circumcision. Results:,There was a trend towards increasing duration of analgesia with increasing dose of clonidine [group B (bupivacaine) 280.7 (171.6) min, C1 (bupivacaine + clonidine 1 ,g·kg,1) 327.8 (188.3) min and C2 (bupivacaine + clonidine 2 ,g·kg,1) 382.0 (200.6) min], although this difference was not statistically significant. Mean time to arousal from anaesthesia was significantly prolonged with clonidine 2 ,g kg,1 (group C2 21.3 (13,36) min, group C1 14.0 (6,25) min and group B 14.4 (2,32) min. Supplementary analgesic requirements and incidence of adverse effects were low, with no differences between the groups. Conclusions:,For paediatric circumcision, under general anaesthesia, the addition of clonidine 2 ,g·kg,1 to low volume (0.5 ml·kg,1) caudal anaesthetics has a limited clinical benefit for children undergoing circumcision. [source] Homocysteine metabolism in families from southern Italy with neural tube defects: role of genetic and nutritional determinantsPRENATAL DIAGNOSIS, Issue 1 2006Elvira Grandone Abstract Objective To evaluate the role of different polymorphic gene variants involved in homocysteine metabolism and plasma levels of homocysteine, folate and vitamin B12 in families from southern Italy with neural tube defects (NTDs). Methods Eighteen fathers, 15 NTD children and 60 women who had conceived NTD foetuses were investigated. A group of 100 adults and 43 apparently healthy children was used as control. At the time of blood draw, none were taking vitamin pills or nutritional supplements. Results Among controls, 79 (55.2%) were heterozygous for C677T MTHFR variant and 26 (18.2%) were TT homozygous. Among the cases, 35 (61.4%) out of 57 mothers and 7 (38.9%) out of 18 fathers carried the T allele; 12 (21.1%) mothers and 2 (11.1%) fathers had the TT genotype. Four (26.7%) out of 15 probands were TT homozygous and 11 (73.3%) were heterozygous (Fisher exact test p = 0.025). No significant difference between groups was observed for the 1298C MTHFR variant and CBS haplotypes. Median homocysteine in NTD children was significantly higher (10.0 µmol/L) than that of controls (median 4.5 µmol/L, Mann,Whitney p < 0.05). Folate and B12 were not different among groups. Conclusions The T677 MTHFR allele is significantly associated with the occurrence of NTDs; no significant association has been observed with other genetic determinants analysed. Homocysteine levels in children with NTDs are significantly higher than those of the paediatric population from the same geographical area. Copyright © 2006 John Wiley & Sons, Ltd. [source] Noninfectious dermatological diseases associated with chronic exposure to mine tailings in a Peruvian districtBRITISH JOURNAL OF DERMATOLOGY, Issue 1 2008W. Ramos Summary Background, Mine tailings are metallic wastes which are deposited in the environment due to mining activity. Long-term exposure to these metals is harmful to human health. Objective, To determine if chronic exposure to mine tailings constitutes a risk factor for the development of dermatological diseases in the district of San Mateo de Huanchor (Lima, Peru). Methods, An observational case,control study was carried out in the communities of Mayoc, Daza and Tamboraque (exposed to mine tailings, case group) located in the district of San Mateo de Huanchor, and also in the communities of Choccna and Caruya (not exposed to mine tailings, control group) located in the same district. Out of 230 adults, 121 were exposed and 109 were not exposed to mine tailings and out of 135 children, 71 were exposed and 64 were not exposed to mine tailings. Results, In the adult group, 71% of the exposed cases had some noninfectious dermatological disease while in the nonexposed group the frequency was 34% [P < 0·001; odds ratio (OR) 5·40; 95% confidence interval (CI) 3·02,9·68]. A statistically significant difference between groups was found for arsenical dermatitis, nonpruritic papulovesicular eruption, atopic dermatitis, contact dermatitis, seborrhoeic dermatitis and xerosis. In the paediatric population, 71 exposed and 64 nonexposed children were evaluated. Sixty-nine per cent of the exposed group had some noninfectious dermatological disease vs. 30% in the nonexposed group (P < 0·001; OR 6·00; 95% CI 2·71,13·31). A statistically significant difference between groups was found for xerosis and atopic dermatitis. Conclusion, Chronic exposure to mine tailings represents a risk factor for development of noninfectious dermatological diseases in both adults and children. [source] Case series of 406 vernal keratoconjunctivitis patients: a demographic and epidemiological studyACTA OPHTHALMOLOGICA, Issue 3 2006Andrea Leonardi Abstract. Purpose:,To evaluate the specific allergic sensitization and epidemiological characteristics of vernal keratoconjunctivitis (VKC). Methods:,This retrospective non-comparative case series included 406 VKC patients. Data included patient and family histories, and results of allergic tests. Annual incidence and prevalence rates were calculated for a cohort of 128 VKC patients from the greater Padua area. Results:,The great majority of VKC patients were male (76%), with a male : female ratio of 3.3 : 1. A skin prick test, specific serum IgE or conjunctival challenge was positive in 43%, 56% and 58% of patients, respectively. In the cohort of patients from the Padua area, the prevalence of the disease was 7.8/100 000, with a higher rate in young males (57/100 000) compared with young females (22/100 000), and lower rates in people over 16 years of age (3.8/100 000 in males, 1/100 000 in females). The incidence of VKC was 1/100 000, with a higher rate in males under 16 years of age (10/100 000) compared with females (4.2/100 000). In people over 16 years of age, the incidence of the disease was 0.06/100 000, with no difference between males and females. Conclusion:,An IgE-mediated sensitization was found in only half of the VKC patients. Vernal keratoconjunctivitis is not a rare event in the paediatric population but is an extremely rare new disease in adults. [source] Recognition and treatment of genitourinary complications in paediatric Crohn's disease using InfliximabACTA PAEDIATRICA, Issue 7 2010NA Afzal Abstract Although genitourinary complications of Crohn's are well recognized, available information regarding their clinical course and management is sparse especially in the paediatric population. We report a myriad of urological complications in five paediatric cases, our experience from a tertiary paediatric urological and gastroenterological centre. All children with urological complications had severe Crohn's disease which necessitated the use of immuno-suppressants including Infliximab. Three of four children healed and closed their fistulas after treatment, although failed to avoid future surgery, albeit for other reasons. Conclusion:, We suggest Infliximab should be considered as a treatment option but in the absence of a common consensus, treatment be tailored to individual cases. [source] | |||||||||||||||||||||||||||||||