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Minimal Changes In Pediatric

R K Pilania, A K Jindal, G Sandesh, P Vignesh, D Suri, R Nada, S Singh
Systemic lupus erythematosus (SLE) is an autoimmune disorder that can affect virtually any organ. Chylous ascites as a presenting manifestation of SLE has been described in a handful of cases in adults. However, to the best of our knowledge this presentation has never been reported in the pediatric age group. Podocytopathy in SLE was initially considered to be a chance association. However, more recently it has been suggested that minimal change disease is not only a chance association; it is part of the lupus nephritis spectrum...
December 8, 2018: Lupus
Graham David Ogle, Julia Elisabeth von Oettingen, Angie Middlehurst, Ragnar Hanas, Trevor Orchard
Optimal care for children and adolescents with type 1 diabetes is well-described in guidelines such as those of the International Society for Pediatric and Adolescent Diabetes. High-income countries can usually provide this, but the cost of this care is generally prohibitive for lower-income countries. Indeed, in most of these countries, very little care is provided by government health systems, resulting in high mortality, and high complications rates in those who do survive. As lower-income countries work towards establishing guidelines-based care, it is helpful to describe the levels of care that are potentially affordable, cost-effective, and result in substantially improved clinical outcomes...
November 23, 2018: Pediatric Diabetes
L Cavazzana, M Fornili, G Filocamo, C Agostoni, F Auxilia, S Castaldi
BACKGROUND: Juvenile idiopathic arthritis (JIA) is the most common pediatric chronic rheumatic disease, which requires constant follow-up over the years, due to relapses during its progression. To maintain a good quality of life, it is important to limit admissions as far as possible. With the development of a Diagnostic Therapeutic Assistance Pathway (DTAP), we aim to select patients with suitable clinical conditions to be moved from routine hospital management to day care or outpatient treatment, evaluating the number of patients to whom this would apply...
November 20, 2018: Italian Journal of Pediatrics
David T Selewski, Josephine M Ambruzs, Gerald B Appel, Andrew S Bomback, Raed Bou Matar, Yi Cai, Daniel C Cattran, Aftab S Chishti, Vivette D D'Agati, Cynthia J D'Alessandri-Silva, Rasheed A Gbadegesin, Jonathan J Hogan, Sandra Iragorri, J Charles Jennette, Bruce A Julian, Myda Khalid, Richard A Lafayette, Helen Liapis, Francesca Lugani, Sarah A Mansfield, Sherene Mason, Patrick H Nachman, Cynthia C Nast, Carla M Nester, Damien G Noone, Jan Novak, Michelle M O'Shaughnessy, Heather N Reich, Michelle N Rheault, Dana V Rizk, Manish K Saha, Neil S Sanghani, C John Sperati, Rajasree Sreedharan, Tarak Srivastava, Agnieszka Swiatecka-Urban, Katherine Twombley, Tetyana L Vasylyeva, Donald J Weaver, Hong Yin, Jarcy Zee, Ronald J Falk, Ali G Gharavi, Brenda W Gillespie, Debbie S Gipson, Larry A Greenbaum, Lawrence B Holzman, Matthias Kretzler, Bruce M Robinson, William E Smoyer, Michael Flessner, Lisa M Guay-Woodford, Krzysztof Kiryluk
Introduction: The Cure Glomerulonephropathy Network (CureGN) is a 66-center longitudinal observational study of patients with biopsy-confirmed minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy (IgAN), including IgA vasculitis (IgAV). This study describes the clinical characteristics and treatment patterns in the IgA cohort, including comparisons between IgAN versus IgAV and adult versus pediatric patients. Methods: Patients with a diagnostic kidney biopsy within 5 years of screening were eligible to join CureGN...
November 2018: KI Reports
Jennifer A Rama, Carla Falco, Dorene F Balmer
Background : Graduate medical education programs are expected to conduct an annual program evaluation. While general guidelines exist, innovative and feasible approaches to program evaluations may help efforts at program improvement. Appreciative Inquiry is an approach that focuses on successful moments, effective processes, and programs' strengths. Objective : We implemented a novel application of Appreciative Inquiry and its 4 phases (Inquire, Imagine, Innovate, and Implement) and demonstrate how it led to meaningful improvements in a pediatric pulmonology fellowship program...
October 2018: Journal of Graduate Medical Education
Philippe Rémy, Vincent Audard, Pierre André Natella, Gaëlle Pelle, Bertrand Dussol, Helene Leray-Moragues, Cecile Vigneau, Khedidja Bouachi, Jacques Dantal, Laurence Vrigneaud, Alexandre Karras, Frank Pourcine, Philippe Gatault, Philippe Grimbert, Nawelle Ait Sahlia, Anissa Moktefi, Eric Daugas, Claire Rigothier, Sylvie Bastuji-Garin, Dil Sahali
First-line therapy of minimal change nephrotic syndrome (MCNS) in adults is extrapolated largely from pediatric studies and consists of high-dose oral corticosteroids. We assessed whether a low corticosteroid dose combined with mycophenolate sodium was superior to a standard oral corticosteroid regimen. We enrolled 116 adults with MCNS in an open-label randomized controlled trial involving 32 French centers. Participants randomly assigned to the test group (n=58) received low-dose prednisone (0.5 mg/kg/day, maximum 40 mg/day) plus enteric-coated mycophenolate sodium 720 mg twice daily for 24 weeks; those who did not achieve complete remission after week 8 were eligible for a second-line regimen (increase in the prednisone dose to 1 mg/kg/day with or without Cyclosporine)...
October 20, 2018: Kidney International
Omer Faruk Calim, Hasan N H Hassouna, Yavuz Selim Yildirim, Remzi Dogan, Orhan Ozturan
OBJECTIVES: The aim of this study was to assess the effectiveness of bilateral submandibular duct relocation and bilateral sublingual gland excision in combination with botulinum toxin A injection into the parotid glands in children with sialorrhea. Previously in the literature, either surgery or botulinum toxin injection but not their combination has been reported. METHODS: Preoperative and at least 6-month postoperative assessments using the Drooling Severity Scale and Drooling Frequency Scale (Thomas-Stonell and Greenberg classification) and the Teacher Drooling Scale and by interviewing parents and caregivers face to face or via telephone were performed...
October 29, 2018: Annals of Otology, Rhinology, and Laryngology
F Li, Y F Chi, Q Hu, K N Yin, W Liu, Q Chen, Q X Zhang, X Chen, F C Cao, Z L Liang, Y J Sun
Objective: To observe the effects of minimally invasive tangential excision in treating deep partial-thickness burn wounds on trunk and limbs in pediatric patients in the early stage post burn. Methods: Clinical data of 40 children with deep partial-thickness burn wounds on trunk and limbs, admitted to our burn ward from January 2016 to June 2017, conforming to the study criteria, were retrospectively analyzed. They were divided into conventional treatment group (CT, n =19) and minimally invasive tangential excision group (MITE, n =21) according to the different treatments...
October 20, 2018: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
Wenyan Xu, Yue Huang, Jie Bai, Anna M Varughese
BACKGROUND: Quality improvement methods can identify solutions and make dramatic improvements in patient safety during daily clinical care. The science of quality improvement in health care is still a very new concept in developing countries like China. AIM: We initiated a quality improvement project to minimize adverse respiratory events in our post-anesthesia care unit with the guidance of an experienced quality improvement expert from Cincinnati Children's Hospital Medical Center...
October 26, 2018: Paediatric Anaesthesia
Mark Sueyoshi, Arthur J Olch, Kevin X Liu, Alisha Chlebik, Desirae Clark, Kenneth K Wong
PURPOSE: The Radiation Oncology Incident Learning System demonstrated that incorrect or omitted patient shifts during treatment are common near-misses or incidents. This single pediatric hospital quality improvement experience evaluated a markless isocenter localization workflow to improve safety and streamline treatment, obviating the need for daily shifts. METHODS AND MATERIALS: Patients undergoing radiation therapy were simulated and treated with indexed immobilization devices...
October 19, 2018: Practical Radiation Oncology
Sophie Adler, Mallory Blackwood, Gemma B Northam, Roxana Gunny, Seok-Jun Hong, Boris C Bernhardt, Andrea Bernasconi, Neda Bernasconi, Thomas Jacques, Martin Tisdall, David W Carmichael, J Helen Cross, Torsten Baldeweg
Objective: In contrast to adult cohorts, neocortical changes in epileptic children with hippocampal damage are not well characterized. Here, we mapped multimodal neocortical markers of epilepsy-related structural compromise in a pediatric cohort of temporal lobe epilepsy and explored how they relate to clinical factors. Methods: We measured cortical thickness, gray-white matter intensity contrast and intracortical FLAIR intensity in 22 patients with hippocampal sclerosis (HS) and 30 controls...
October 2018: Annals of Clinical and Translational Neurology
Hisham S Alhajala, Ha S Nguyen, Saman Shabani, Benjamin Best, Mayank Kaushal, Mona M Al-Gizawiy, Eun-Young Erin Ahn, Jeffery A Knipstein, Shama Mirza, Kathleen M Schmainda, Christopher R Chitambar, Ninh B Doan
Pediatric glioblastoma (GBM) is a relatively rare brain tumor in children that has a dismal prognosis. Surgery followed by radiotherapy is the main treatment protocol used for older patients. The benefit of adjuvant chemotherapy is still limited due to a poor understanding of the underlying molecular and genetic changes that occur with irradiation of the tumor. In this study, we performed total RNA sequencing on an established stable radioresistant pediatric GBM cell line to identify mRNA expression changes following radiation...
September 25, 2018: Oncotarget
J W Varni, A M Delamater, K K Hood, J K Raymond, N T Chang, K A Driscoll, J C Wong, J P Yi-Frazier, E K Grishman, M A Faith, S D Corathers, J C Kichler, J L Miller, E M Doskey, V P Aguirre, R W Heffer, D P Wilson
AIM: To test the measurement properties of the revised and updated Pediatric Quality of Life Inventory (PedsQL) 3.2 Diabetes Module originally developed in Type 1 diabetes in youth with Type 2 diabetes. METHODS: The PedsQL 3.2 Diabetes Module and PedsQL Generic Core Scales were administered in a field test study to 100 young people aged 9-25 years with Type 2 diabetes. Factor analysis was conducted to determine the factor structure of the items. RESULTS: The 15-item Diabetes Symptoms Summary Score and 12-item Type 2-specific Diabetes Management Summary Score were empirically derived through factor analysis...
October 21, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
Marie R Waterhouse, Phung K Pham, Todd P Chang
OBJECTIVES: Adolescent female patients who are not sexually active and who present to a pediatric emergency department with abdominal pain require a full bladder prior to transabdominal ultrasound. Procedures to fill the bladder are largely institution or provider dependent. We examined adolescent females' attitudes and opinions toward 2 common methods of bladder filling, intravenous fluid administration and transurethral Foley catheter placement, by means of a Q-sort study. METHODS: Two convenience samples of adolescent female patients in the pediatric emergency department at an academic children's hospital participated in the study...
October 17, 2018: Pediatric Emergency Care
Lindsey Hathaway, Jeremy Michael Sen, Michael Keng
Relapsed/refractory (R/R) acute lymphoblastic leukemia (ALL) is associated with a poor prognosis in both children and adults. Traditionally, there were limited options for salvage therapy, which consisted mostly of conventional chemotherapy. However, in the past 5 years, novel agents have changed our treatment strategies in this population. Blinatumomab, a bispecific CD19 directed CD3 T-cell engager, has shown to be effective in both minimal residual disease and R/R B-cell ALL. In R/R B-cell ALL, blinatumomab was associated with an improved median overall survival of 7...
2018: Patient related Outcome Measures
Chang-Hoon Koo, Sun Young Lee, Seung Hyun Chung, Jung-Hee Ryu
The purpose of this study was to compare the incidence of airway complications between extubation under deep anesthesia (deep extubation) and extubation when fully awake (awake extubation) in pediatric patients after general anesthesia. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement standards. The review protocol was registered with the International Prospective Register of Systematic Reviews (registration number: CRD 42018090172)...
October 14, 2018: Journal of Clinical Medicine
Kunj R Sheth, Jason P Van Batavia, Diana K Bowen, Chester J Koh, Arun K Srinivasan
As the frontiers of minimally invasive surgery (MIS) continue to expand, the availability and implementation of new technology in pediatric urology are increasing. MIS is already an integral part of pediatric urology, but there is still much more potential change to come as both recent and upcoming advances in laparoscopic and robotic surgery are surveyed.
November 2018: Urologic Clinics of North America
Joseph A Sujka, Justin Sobrino, Leo A Benedict, Hanna Alemayehu, Shawn St Peter, Richard Hendrickson
INTRODUCTION: Enteric duplication is a congenital anomaly with varied clinical presentation that requires surgical resection for definitive treatment. This had been approached with laparotomy for resection, but has changed with minimally invasive technique. The purpose of our study was to determine the demographics, natural history, operative interventions, and outcomes of pediatric enteric duplication cysts in a contemporary cohort. METHODS: With IRB approval, we performed a retrospective chart review of all patients less than 18 years old treated for enteric duplication between January 2006 and August 2016...
December 2018: Pediatric Surgery International
Ting-Chi Yeh, Der-Cherng Liang, Jen-Yin Hou, Tang-Her Jaing, Dong-Tsamn Lin, Chao-Ping Yang, Ching-Tien Peng, Iou-Jih Hung, Kai-Hsin Lin, Chih-Cheng Hsiao, Shiann-Tarng Jou, Shyh-Shin Chiou, Jiann-Shiuh Chen, Shih-Chung Wang, Te-Kau Chang, Kang-Hsi Wu, Jiunn-Ming Sheen, Hsiu-Ju Yen, Shih-Hsiang Chen, Meng-Yao Lu, Meng-Ju Li, Tai-Tsung Chang, Ting-Huan Huang, Yu-Hsiang Chang, Shu-Huey Chen, Yung-Li Yang, Hsiu-Hao Chang, Bow-Wen Chen, Pei-Chin Lin, Chao-Neng Cheng, Yu-Hua Chao, Shang-Hsien Yang, Yu-Mei Y Chao, Hsi-Che Liu
BACKGROUND: To eliminate cranial irradiation (CrRT)-related sequelae and to minimize the adverse impact of traumatic lumbar puncture (TLP) with blasts, the Taiwan Pediatric Oncology Group (TPOG) introduced a modified central nervous system (CNS)-directed regimen characterized by delayed triple intrathecal therapy (TIT) and the omission of CrRT for all children with newly diagnosed acute lymphoblastic leukemia (ALL). METHODS: This study compared the treatment outcomes of patients overall and patients with a non-CNS-1 status (CNS-2, CNS-3, or TLP with blasts) in 2 treatment eras, one before and another after the revision of the TPOG-ALL-2002 protocol by the introduction of the modification (era 1 [2002-2008] with CrRT and era 2 [2009-2012] with delayed first TIT and no CrRT)...
October 10, 2018: Cancer
Rohit S Loomba, Seth B Gray, Saul Flores
INTRODUCTION: Ketamine is a drug often used for procedural sedation or as adjunct agent for general sedation in children with congenital heart disease. In the clinical realm, there is often confusion regarding the effects of ketamine on hemodynamics, particularly pulmonary vascular resistance and systemic vascular resistance. We performed a meta-analysis of studies investigating the effects of ketamine on hemodynamics. METHODS: A systematic review was conducted to identify studies characterizing the hemodynamic effects of ketamine in children with congenital heart disease...
September 27, 2018: Congenital Heart Disease
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