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pediatric pharmacology

Jay Adam Lieberman, Jie Zhang, John Whitworth, Cary Cavender
BACKGROUND: There is a need for effective, non-steroid pharmacologic therapies for eosinophilic esophagitis (EoE). Cromolyn sodium offers an option as mast cells have been implicated in the symptomatology of EoE and cromolyn has also been shown to have some anti-eosinophilic properties. OBJECTIVE: To evaluate the efficacy of cromolyn in reducing esophageal eosinophilia in patients with eosinophilic esophagitis. Secondary outcomes included symptom improvement and adverse effects...
March 12, 2018: Annals of Allergy, Asthma & Immunology
Edmund Burke, Sanjeev A Datar
PURPOSE OF REVIEW: The essential role of the lymphatic system in fluid homeostasis, nutrient transport, and immune trafficking is well recognized; however, there is limited understanding of the mechanisms that regulate lymphatic function, particularly in the setting of critical illness. The lymphatics likely affect disease severity and progression in every condition, from severe systemic inflammatory states to respiratory failure. Here, we review structural and functional disorders of the lymphatic system, both congenital and acquired, as they relate to care of the pediatric patient in the intensive care setting, including novel areas of research into medical and procedural therapeutic interventions...
March 13, 2018: Current Opinion in Pediatrics
Natalie Colaneri, Mark Sheldon, Andrew Adesman
PURPOSE OF REVIEW: Given the pervasiveness of psychotropic medication in the youth population and an increasingly competitive culture regarding educational performance, children, teenagers, and/or their parents may increasingly seek psychotropic substances in an effort to enhance a student's cognitive abilities and/or academic performance. Physicians must become aware of this very important and clinically relevant issue and work to ensure that medications remain in the hands of patients seeking wellness and not enhancement...
March 13, 2018: Current Opinion in Pediatrics
Carlyn Patterson-Gentile, Christina L Szperka
Importance: Migraine is a disabling and prevalent condition that affects the pediatric and adolescent population. This review describes current acute and preventive migraine pharmacologic therapies for the pediatric and adolescent population. Observations: Multiple pharmacotherapies that have been used in the treatment of acute headache and prevention in pediatric migraine are reviewed. There have been recent advances in the management of migraines among pediatric and adolescent patients, including US Food and Drug Administration approval of triptans for acute management in children as young as 6 years, and the first prospective, randomized, double-blind, placebo-controlled comparative study of preventive pharmacotherapy in pediatric migraine...
March 12, 2018: JAMA Neurology
Virginia Neyro, Evelyne Jacqz-Aigrain, Tiphaine Adam de Beaumais
Identification of markers involved in drug disposition is crucial for drugs with a narrow therapeutic index. Individual genomic differences can affect the pharmacology of some drugs and participate to inter-individual variability in drug response. Pharmacogenetics is a useful tool in clinical practice for dosage adjustment and to limit drug toxicities. In pediatrics, physiological changes can also influence the disposition of drugs in infants, children and adolescents. The importance of ontogeny translates into different responses to the same drug in children and adults...
February 16, 2018: Thérapie
J J Garcia-Penas
INTRODUCTION: Most individuals with epilepsy will respond to pharmacologic treatment; however, approximately 20-30% will develop medically refractory epilepsy. Cognitive side effects of antiepileptic drugs are common and can negatively affect tolerability, compliance, and long-term retention of the treatment. Ketogenic diet is an effective and well-tolerated treatment for these children with refractory epilepsy without any negative effect on cognition or behavior. AIM: To review the current state of experimental and clinical data concerning the neuroprotective and cognitive effects of the ketogenic diet in both humans and animals...
March 1, 2018: Revista de Neurologia
Andrea Brusaferro, Edoardo Farinelli, Letizia Zenzeri, Rita Cozzali, Susanna Esposito
Recurrent abdominal pain (RAP) is one of the most common health complaints in both children and adults. Although RAP is considered a functional disorder rather than an organic disease, affected children and their families can still experience anxiety and concerns that can interfere with school, sports, and regular daily activities and lead to frequent attendances at pediatric emergency departments or pediatric gastroenterology clinics. Our review shows experts do not agree on a universally proven management that will work on every child presenting with functional abdominal pain (FAP)...
March 2, 2018: Paediatric Drugs
Christelle Khadra, Ariane Ballard, Johanne Déry, David Paquin, Jean-Simon Fortin, Isabelle Perreault, David R Labbe, Hunter G Hoffman, Stéphane Bouchard, Sylvie LeMay
Background: Virtual reality (VR) is a non-pharmacological method to distract from pain during painful procedures. However, it was never tested in young children with burn injuries undergoing wound care. Aim: We aimed to assess the feasibility and acceptability of the study process and the use of VR for procedural pain management. Methods: From June 2016 to January 2017, we recruited children from 2 months to 10 years of age with burn injuries requiring a hydrotherapy session in a pediatric university teaching hospital in Montreal...
2018: Journal of Pain Research
Ryan J McDonough, Patria Alba, Kavitha Dileepan, Joseph T Cernich
BACKGROUND: The High Dose Adrenocorticotropic Hormone (ACTH) Stimulation Test is the gold standard to diagnose adrenal insufficiency. Normal adrenal function is defined as a peak cortisol response to pharmacologic stimulation with cosyntropin of ≥18 μg/dL. Our practice was to obtain cortisol levels at 0, 30 and 60 min after cosyntropin administration. Once a value of ≥18 μg/dL has been obtained, adrenal insufficiency is ruled out and there is little diagnostic utility in subsequent stimulated levels...
February 24, 2018: Journal of Pediatric Endocrinology & Metabolism: JPEM
Ali Anwar, Michael D Yingling, Alicia Zhang, Ujjwal Ramtekkar, Ginger E Nicol
As part of a university-based quality improvement project, we aimed to evaluate child psychiatrists' knowledge, skills, attitudes, and practices regarding assessment and treatment of pediatric sleep problems. We developed a nine-question survey of knowledge, skills, attitudes, and practices regarding assessing for and treating sleep complaints in pediatric patients, and administered this survey to child psychiatrists in training and in practice in the state of Missouri. Respondents reported sleep hygiene as the first-line treatment strategy, followed by the use of supplements or over-the-counter remedies...
February 23, 2018: Medical Sciences: Open Access Journal
Brian R Branchford, Marisol Betensky, Neil A Goldenberg
Multiple observational studies have identified risk factors for venous thromboembolism (VTE) in hospitalized children, but very few interventional studies have assessed the safety and efficacy of thromboprophylaxis in this population. In recent years, however, evidence in pediatric VTE risk stratification has grown considerably. This has led to the conception of a pediatric subpopulation-specific risk-based paradigm for mechanical and pharmacological thromboprophylaxis in hospitalized children. More research is required to validate and further refine pediatric subpopulation-specific risk models and to subsequently investigate risk-stratified thromboprophylaxis strategies for hospitalized children...
February 17, 2018: Thrombosis Research
Manish Aggarwal, R Mark Grady
Pulmonary hypertension (PH) is an increasingly recognized problem in children, particularly within tertiary pediatric hospitals. This increase is, in large part, due to ever improving survival among previously fatal conditions, such as extreme prematurity and complicated congenital heart disease. This increased recognition has paralleled burgeoning pharmacologic and interventional PH-specific treatment options. Unfortunately, most PH-specific therapies have not been tested in children with rigorous, randomized, controlled trials...
February 20, 2018: Current Treatment Options in Cardiovascular Medicine
Nagma Dalvi, Lalitha Sivaswamy
Life-threatening headaches in children can present in an apoplectic manner that garners immediate medical attention, or in an insidious, more dangerous form that may go unnoticed for a relatively long period of time. The recognition of certain clinical characteristics that accompany the headache should prompt recognition and referral to an institution equipped with neuroimaging facilities, pediatric neurosurgeons, and neurologists. Thunderclap headaches, which reach a peak within a very short period of time, may be the presenting feature of conditions such as arterial dissection, venous sinus thrombosis, and reversible cerebral vasoconstriction syndrome, which can be addressed by specific pharmacological options instituted in an intensive care setting...
February 1, 2018: Pediatric Annals
Gabriela Maciel Vieira, Gabriela Molinari Roberto, Régia Caroline Lira, Edgard Eduard Engel, Luiz Gonzaga Tone, María Sol Brassesco
Ewing's sarcoma (EWS) is a highly aggressive bone cancer that affects children and adolescents. Despite advances in multimodal management, 5-year event-free survival rates for patients presenting with metastases at diagnosis remain at 25%. As key regulators of actin organization, the Rho-associated coiled-coil containing protein kinases, ROCK1 and ROCK2, have been associated with cancer dissemination and poorer prognosis. Recently, in vitro data indicating ROCK2 as a molecular target for the treatment of EWS has been presented...
February 2018: Oncology Letters
Marco Antônio Arruda, Camila Flaksberg Chevis, Marcelo Eduardo Bigal
Migraine is a chronic-recurrent disorder that progresses in some adults and also in many children. Chronic migraine (CM) is the clinical result of this process. Since migraine does not progress in most children, identifying the risk factors for progression is an important public health priority that should be matched by evidence-based treatment. Areas covered: Herein we conduct a systematic review on the comorbidities and treatment of CM in children and adolescents in the last ten years, summarizing evidence-based recommendations for disease management...
March 2018: Expert Review of Neurotherapeutics
Ariana M Chao, Thomas A Wadden, Robert I Berkowitz
Pediatric obesity is a serious public health concern. Five medications have been approved by the Food and Drug Administration (FDA) for chronic weight management in adults with obesity, when used as an adjunct to lifestyle modification. Orlistat is the only FDA-approved medication for pediatric patients aged 12 years and above. Areas covered: This paper summarizes safety and efficacy data from clinical trials of weight loss medications conducted among pediatric samples. Relevant studies were identified through searches in PubMed...
February 7, 2018: Expert Opinion on Drug Safety
Roberta Bortolozzi, Elena Mattiuzzo, Luca Trentin, Benedetta Accordi, Giuseppe Basso, Giampietro Viola
Dysregulation of the cyclin D1-CDK4/CDK6 complex is frequently observed in almost all human cancer and contributes to aberrant cell proliferation and consequent tumorigenesis. Although many reports described the importance of CDK4/CDK6 in different set of human tumors, only few studies have been performed on leukemia. By gene expression analysis performed in a cohort of childhood patients affected by B-acute lymphoblastic leukemia (B-ALL) we found that both CDK4 and CDK6 are highly expressed. Moreover, Reverse Phase Protein Array (RPPA) analysis showed that cyclin D1 levels are higher in patients undergoing relapse...
February 3, 2018: Biochemical Pharmacology
Shaman Rajindrajith, Judith Zeevenhooven, Niranga Manjuri Devanarayana, Bonaventure Jayasiri Crispus Perera, Marc A Benninga
Chronic abdominal pain is a common problem in pediatric practice. The majority of cases fulfill the Rome IV criteria for functional abdominal pain disorders (FAPDs). At times, these disorders may lead to rather serious repercussions. Area covered: We have attempted to cover current knowledge on epidemiology, pathophysiology, risk factors related to pathophysiology, clinical evaluation and management of children with FAPDs. Expert commentary: FAPDs are a worldwide problem with a pooled prevalence of 13.5%. There are a number of predisposing factors and pathophysiological mechanisms including stressful events, child maltreatment, visceral hypersensitivity, altered gastrointestinal motility and change in intestinal microbiota...
February 16, 2018: Expert Review of Gastroenterology & Hepatology
Bernadette Nedelec, Leo LaSalle
The problem of postburn itch has been underevaluated and undertreated in the past. However, recently published data have expanded the evidence base, which provides clinicians and their patients with new evaluation and treatment options that can help reduce and potentially eliminate the prolonged distress experienced by burn survivors faced with postburn itch. Although a gold standard evaluation method has not yet been agreed upon, there are a number of tools that have been published that clinicians can use for assessment...
January 2018: Wounds: a Compendium of Clinical Research and Practice
Tatsuhiko Urakami
The principal treatment for children and adolescents with type 2 diabetes is dietary and exercise management. However, the blood glucose levels of some patients receiving this treatment fail to improve; thus, pharmacological treatment is eventually required. The pathophysiology of type 2 diabetes in pediatric patients appears to be similar to that in adults; thus, the range of antidiabetic drugs used in adults is likely to be effective in pediatric patients as well. However, in the majority of countries, including Japan, only metformin, glimepiride, and insulin have been approved for use in pediatric patients...
2018: Clinical Pediatric Endocrinology: Case Reports and Clinical Investigations: Official Journal of the Japanese Society for Pediatric Endocrinology
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