High rate of clinically unrecognized SARS-CoV-2 infections in pediatric palliative care patients

AbstractLittle is known about the frequency and clinical course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in pediatric patients with severe comorbidities. In this prospective cross-sectional trial, the seroprevalence of SARS-CoV-2-IgG in patients with life-limiting conditions being treated by a large specialized pediatric palliative home-care team was determined. In order to gain insight into the infection chain, close contacts of seropositive patients were also included in the study. We analyzed the sera of 39 patients and found a 25.6% seroprevalence for SARS-CoV-2. No SARS-CoV-2 infections were known prior to the study. No significant difference was found in the symptom load between seropositive and seronegative patients during the risk period for SARS-CoV-2 infections. Of the 20 close contacts tested, only one was seropositive for SARS-CoV-2.Conclusions: Our results indicate a substantially high prevalence of silent SARS-CoV-2 infections in pediatric palliative care patients. Surprisingly, no severe outcomes were seen in this fragile patient collective with severe comorbidities. The chain of infection and thus the reason for the high frequency of SARS-CoV-2 infections in pediatric palliative care patients remain unclear. What is Known:•Even though severe disease courses of COVID-19 have been reported in children, there are yet no established risk factors for SARS-CoV-2 in pediatric patients. What is New:•In this cross-sectional seroprevalence study of palliative pediatric patients with severe life-limiting conditions, a high rate of seropositive patients (25.6%) was found.•Surprisingly, all seropositive patients were previously unrecognized, despite the severe comorbidities of our collective.

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Pediatrics Palliative Care and Ethical Consideration From Nursing and PharmD Perspectives: A Study in Jordan

10.21203/rs.3.rs-45495/v1 ◽

2020 ◽

Author(s):

Sawsan Abuhammad ◽

Suhiab Mufleh ◽

Karem H Alzoubi ◽

Roaa Almasri ◽

Omar Khraisat

Keyword(s):

Palliative Care ◽

Nursing Students ◽

Science And Technology ◽

Terminally Ill ◽

Pediatric Palliative Care ◽

Cross Sectional ◽

Convenience Sample ◽

Correlational Design ◽

Significant Difference ◽

The Subject

Abstract Aim: This research aimed to survey a sample of nursing students and PharmD students in Jordan about their knowledge of pediatric palliative care (PPC) in the context of treating terminally ill children.Method: A descriptive, cross-sectional, correlational design was used to fulfill the goal of this research. A convenience sample of nursing and PharmD students currently studying in Jordan University of Science and Technology in Jordan was recruited to complete a survey that contained 20 statements about issues on and around the subject of PPC Results: The results showed that there a significant difference in PPC between nurses and PharmD students. Mother’s education (t= 2.158, p= .032) and being a nursing or PharmD student ( t=1.969, p=.050) were associated with knowledge toward PPC. Other listed factors such as gender, working ward, and age were not associated with knowledge toward PPC.Conclusion: this was the first study in Jordan to survey a sample of nursing students and PharmD students in Jordan about their knowledge of PPC. The current study found that knowledge of nursing and PharmD students regarding PPC was satisfactory according to the scale used.

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Opioid-Induced Respiratory Depression in Pediatric Palliative Care Patients with Severe Neurological Impairment—A Scoping Literature Review and Case Reports

Children ◽

10.3390/children7120312 ◽

2020 ◽

Vol 7 (12) ◽

pp. 312

Author(s):

Maximilian David Mauritz ◽

Carola Hasan ◽

Larissa Alice Dreier ◽

Pia Schmidt ◽

Boris Zernikow

Keyword(s):

Risk Factors ◽

Palliative Care ◽

Young Adults ◽

Scoping Review ◽

Pediatric Patients ◽

Case Reports ◽

Neurological Impairment ◽

Opioid Therapy ◽

Pediatric Palliative Care ◽

Severe Neurological Impairment

Pediatric Palliative Care (PPC) addresses children, adolescents, and young adults with a broad spectrum of underlying diseases. A substantial proportion of these patients have irreversible conditions accompanied by Severe Neurological Impairment (SNI). For the treatment of pain and dyspnea, strong opioids are widely used in PPC. Nonetheless, there is considerable uncertainty regarding the opioid-related side effects in pediatric patients with SNI, particularly concerning Opioid-Induced Respiratory Depression (OIRD). Research on pain and OIRD in pediatric patients with SNI is limited. Using scoping review methodology, we performed a systematic literature search for OIRD in pediatric patients with SNI. Out of n = 521 identified articles, n = 6 studies were included in the review. Most studies examined the effects of short-term intravenous opioid therapy. The incidence of OIRD varied between 0.13% and 4.6%; besides SNI, comorbidities, and polypharmacy were the most relevant risk factors. Additionally, three clinical cases of OIRD in PPC patients receiving oral or transdermal opioids are presented and discussed. The case reports indicate that the risk factors identified in the scoping review also apply to adolescents and young adults with SNI receiving low-dose oral or transdermal opioid therapy. However, the risk of OIRD should never be a barrier to adequate symptom relief. We recommend careful consideration and systematic observation of opioid therapy in this population of patients.

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Paediatric palliative screening scale as a useful tool for clinicians’ assessment of palliative care needs of pediatric patients: a retrospective cohort study

BMC Palliative Care ◽

10.1186/s12904-021-00765-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

In Gyu Song ◽

Seung Yeon Kwon ◽

Yoon Jung Chang ◽

Min Sun Kim ◽

Sung Hoon Jeong ◽

...

Keyword(s):

Palliative Care ◽

Retrospective Cohort ◽

Pediatric Patients ◽

Palliative Care Team ◽

Pediatric Palliative Care ◽

Care Needs ◽

Palliative Care Teams ◽

Primary Care Clinicians ◽

Palliative Care Needs ◽

Screening Scale

Abstract Background Although the importance of palliative care in pediatric patients has been emphasized, many health care providers have difficulty determining when patients should be referred to the palliative care team. The Paediatric Palliative Screening Scale (PaPaS) was developed as a tool for screening pediatric patients for palliative care needs. The study aimed to evaluate the PaPaS as a reliable tool for primary care clinicians unfamiliar with palliative care. Methods This was a retrospective cohort study of patients referred to the pediatric palliative care teams in two tertiary hospitals in the Republic of Korea between July 2018 and October 2019. Results The primary clinical and pediatric palliative care teams assessed the PaPaS scores of 109 patients, and both teams reported a good agreement for the sum of the PaPaS score. Furthermore, the PaPaS scores correlated with those obtained using the Lansky performance scale. Although the mean PaPaS score was higher in the pediatric palliative care team, the scores were higher than the cut-off score for referral in both groups. Conclusion The PaPaS can be a useful tool for primary care clinicians to assess the palliative care needs of patients and their families.

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Factors associated with relapse of schizophrenia

Bangladesh Journal of Psychiatry ◽

10.3329/bjpsy.v29i2.37851 ◽

2018 ◽

Vol 29 (2) ◽

pp. 59-63

Author(s):

AKM Akramul Haque ◽

AHM Kazi Mostofa Kamal ◽

Zinat De Laila ◽

Luna Laila ◽

Helal Uddin Ahmed ◽

...

Keyword(s):

Life Events ◽

Expressed Emotion ◽

Stressful Life Events ◽

Economic Status ◽

Cross Sectional Study ◽

High Rate ◽

Stressful Life ◽

Cross Sectional ◽

Significant Difference ◽

Schizophrenic Patients

Schizophrenia is a chronic psychiatric illness with high rate of relapse which is commonly associated with noncompliance of medicine, as well as stress and high expressed emotions. The objective of the study was to determine the factors of relapse among the schizophrenic patients attending in outpatient departments of three tertiary level psychiatric facilities in Bangladesh. This was a cross sectional study conducted from July, 2001 to June, 2002. Two hundred patients including both relapse and nonrelapse cases of schizophrenia and their key relatives were included by purposive sampling. The results showed no statistically significant difference in terms of relapse with age, sex, religion, residence, occupation and level of education (p>0.05), but statistically significant difference was found with marital status and economic status (p<0.01). The proportion of non-compliance was found to be 80% and 14%, of high expressed emotion was 17% and 2% and of the occurrence of stressful life events was 10% and 1% in relapse and non-relapse cases respectively which were statistically significant (p<0.001). The study indicated that stressful life events, high expressed emotion, and noncompliance with medication had a role in schizophrenic patients for its relapse.Bang J Psychiatry December 2015; 29(2): 59-63

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Hypertension and Micro-Vascular Complications Among Type 2 Dm Adult Patients in Mukalla, Yemen

Journal of Clinical Research and Reports ◽

10.31579/2690-1919/056 ◽

2020 ◽

Vol 3 (5) ◽

pp. 01-04

Author(s):

Abdullah Ghouth

Keyword(s):

Care Center ◽

Vascular Complications ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Cross Sectional ◽

Health Care Center ◽

Age Related ◽

Significant Difference ◽

High Prevalence

The Background and Purpose: to assess the prevalence of hypertension and micro-vascular complications among type 2 diabetic patients registered in primary health care center in Mukalla city at eastern Yemen. Methods: A Cross-sectional study was conducted in a randomly selected eligible patients from the diabetic registry of the AL Noor Charity Center (ACC), Mukalla city in Yemen. Results: Prevalence of hypertension in the T2DM patients were 46.7% (56/120). Retinopathy is the most micro-vascular complications among the adults having T2DM (73/120, 60.8%) while nephropathy is the least prevalence (13/120, 10.8%), prevalence of neuropathy was 49.2% (59/120). a high prevalence of retinopathy in males (66%) than females (55.7%) and a high prevalence of neuropathy in male adults (52.2%) than females (46%).No statistical significant difference were exit related to gender for any studied complications. Similar findings were observed regarding age related variations. Conclusion: A high prevalence of hypertension, retinopathy and neuropathy were reported among T2DM patients in Mukalla. Adopting effective and safe treatment strategies are highly recommended to prevent premature death and complications due to DM.

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Nutritional and micronutrient status of adolescent schoolgirls in eastern Sudan: A cross-sectional study

F1000Research ◽

10.12688/f1000research.12721.1 ◽

2017 ◽

Vol 6 ◽

pp. 1831

Author(s):

Hyder M. Mahgoub ◽

Omar E. Fadlelseed ◽

Ammar H. Khamis ◽

Jalal A. Bilal ◽

Ishag Adam

Keyword(s):

Cross Sectional Study ◽

High Rate ◽

Nutrition Status ◽

Published Data ◽

Sectional Study ◽

Cross Sectional ◽

Micronutrient Status ◽

Significant Difference ◽

More Care ◽

Eastern Sudan

Background: Adolescents, especially girls, are susceptible to malnutrition and their diet must be adequate to support their very rapid growth and development. Currently, there is little published data on the nutritional state amongst adolescent girls in Sudan. Methods: A cross sectional study was conducted to assess the nutritional and micronutrient status of adolescent schoolgirls in eastern Sudan during the period of January-February 2015. Weight and height were measured using standard methods. Haemoglobin and ferritin levels were measured using blood samples, and blood films for malaria and stool samples for Schistosoma mansoni were investigated. Nutritional status was assessed according to the WHO 2006 reference values. Copper and zinc concentrations were measured by atomic absorption. Results: Twenty-five (13.7%) out of 183 girls were stunted. Seventy (38.3%) were thin; 17.5, 9.3 and 11.5% had mild, moderate and severe thinness, respectively. Only 10 (5.5%) and six (3.3%) girls were overweight and obese, respectively. The prevalence of anaemia was 77.0%. While there was no significant difference in the haemoglobin, ferritin, copper levels and thinness; thin children had significantly lower zinc (P=0.007). Conclusions: There is a high rate of stunting, thinness and anaemia among adolescent schoolgirls in eastern Sudan. More care has to be taken in order to provide a better nutrition status in the area.

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Effect of dengue hemorrhagic fever on thrombomodulin level

Paediatrica Indonesiana ◽

10.14238/pi49.5.2009.259-63 ◽

2009 ◽

Vol 49 (5) ◽

pp. 259

Author(s):

Hendra Widjaja ◽

Max F. J. Mantik

Keyword(s):

Endothelial Cells ◽

Dengue Hemorrhagic Fever ◽

Pediatric Patients ◽

Hemorrhagic Fever ◽

Cross Sectional Study ◽

Blood Analysis ◽

Cross Sectional ◽

Significant Difference ◽

The Difference ◽

Difference Test

Background Thrombocyte and endothelial cells play animportant role in dengue hemorrhagic fever pathogenesis.Thrombomodulin is a part of glycoprotein membrane inendothelial cells. Therefore, thrombomodulin level willincrease if endothelial cells disruption occurs.Objective To acknowledge the correlation between thedegree of dengue hemorrhagic fever and thrombomodulinlevel.Methods This was a cross-sectional study. Subjects werehospitalized pediatric patients with age ranging from oneto 13 year old in pediatric ward at Pro£ Dr. R.D. KandouHospital, Manado, who had fever. Three milliliters of bloodwere taken from vein, and were divided for two tests whichwere routine blood analysis and thrombomodulin analysis.Different data resulted from the dengue hemorrhagic fevergroup were processed, and analyzed statistically using F Testand LSD (least significant difference) test. The relationbetween dengue hemorrhagic fever and thrombomodulinwas analyzed with Spearman correlation coefficient.Results There was a significant result in the difference ofthrombomodulin level on four dengue hemorrhagic fevergroups which were classified according to the severity ofdengue hemorrhagic fever. There was a very significantpositive correlation between the severity of denguehemorrhagic fever and thrombomodulin level in detectingendothelial cells impairment.Conclusion Thrombomodulin level can be used as amarker to detect endothelial cells impairment in denguehemorrhagic fever. Higher grade of dengue hemorrhagicfever will have higher thrombomodulin level.

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Revisiting comorbidities in gout: a cluster analysis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2013-203779 ◽

2013 ◽

Vol 74 (1) ◽

pp. 142-147 ◽

Cited By ~ 76

Author(s):

Pascal Richette ◽

Pierre Clerson ◽

Laure Périssin ◽

René-Marc Flipo ◽

Thomas Bardin

Keyword(s):

Cluster Analysis ◽

Renal Failure ◽

Large Cohort ◽

High Rate ◽

Cross Sectional ◽

High Prevalence ◽

History Of ◽

Obesity Hypertension ◽

Almost All

ObjectivesThe reciprocal links between comorbidities and gout are complex. We used cluster analysis to attempt to identify different phenotypes on the basis of comorbidities in a large cohort of patients with gout.MethodsThis was a cross-sectional multicentre study of 2763 gout patients conducted from November 2010 to May 2011. Cluster analysis was conducted separately for variables and for observations in patients, measuring proximity between variables and identifying homogeneous subgroups of patients. Variables used in both analyses were hypertension, obesity, diabetes, dyslipidaemia, heart failure, coronary heart disease, renal failure, liver disorders and cancer.ResultsComorbidities were common in this large cohort of patients with gout. Abdominal obesity, hypertension, metabolic syndrome and dyslipidaemia increased with gout duration, even after adjustment for age and sex. Five clusters (C1–C5) were found. Cluster C1 (n=332, 12%) consisted of patients with isolated gout and few comorbidities. In C2 (n=483, 17%), all patients were obese, with a high prevalence of hypertension. C3 (n=664, 24%) had the greatest proportion of patients with type 2 diabetes (75%). In C4 (n=782, 28%), almost all patients presented with dyslipidaemia (98%). Finally, C5 (n=502, 18%) consisted of almost all patients with a history of cardiovascular disease and renal failure, with a high rate of patients receiving diuretics.ConclusionsCluster analysis of comorbidities in gout allowed us to identify five different clinical phenotypes, which may reflect different pathophysiological processes in gout.

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Knowledge and Attitude Toward Geriatric Palliative Care among Health Professionals in Vietnam

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16152656 ◽

2019 ◽

Vol 16 (15) ◽

pp. 2656 ◽

Cited By ~ 1

Author(s):

Huyen Thi Thanh Vu ◽

Long Hoang Nguyen ◽

Thanh Xuan Nguyen ◽

Thu Nguyen ◽

Tam Ngoc Nguyen ◽

...

Keyword(s):

Palliative Care ◽

Health Professionals ◽

The Elderly ◽

Attitude Score ◽

Cross Sectional ◽

Intensive Training ◽

Care For The Elderly ◽

Significant Difference ◽

Geriatric Hospital ◽

Knowledge And Attitude

This study assessed the knowledge and attitude toward palliative care for the elderly among health professionals in a tertiary geriatric hospital in Vietnam and explored their determinants. Cross-sectional data were obtained on 161 geriatric health professionals at the National Geriatric Hospital. Modified-Palliative Care Knowledge Test and Frommelt Attitudes Toward Care of the Dying instruments were used to measure knowledge and attitude toward geriatric palliative care. As a result, 40.5% physicians and 74.2% nurses showed insufficient knowledge about geriatric palliative care (p < 0.05). The lowest score was for dyspnea, following by gastrointestinal and pain problems. No significant difference was found regarding the attitude between physicians and nurses (p > 0.05). Health professional category, age, and years of experience were found to be associated with knowledge about palliative care. Meanwhile, only knowledge score had correlations with total attitude score (Coef. = 0.2; 95%CI = 0.1–0.3), attitude toward patients (Coef. = 0.1; 95%CI = 0.0–0.1) and toward patients’ family (Coef. = 0.1; 95%CI = 0.0–0.1). This study highlights a significant knowledge gap and preferable attitude toward palliative care for the elderly among physicians and nurses in the geriatric hospital. Intensive training about geriatric palliative care, focusing on pain, dyspnea and gastrointestinal issue management, should be performed to ensure the quality of palliative care services, especially in nurses.

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Effects of nomophobia on anxiety, stress and depression among Saudi medical students in Jeddah, Saudi Arabia

Journal of the Pakistan Medical Association ◽

10.47391/jpma.983 ◽

2020 ◽

pp. 1-11

Author(s):

Nusrat Bano ◽

Muhammad Anwar Khan ◽

Uzma Asif ◽

Jennifer de Beer ◽

Hawazen Rawass ◽

...

Keyword(s):

Saudi Arabia ◽

Medical Students ◽

Cross Sectional Study ◽

Cross Sectional ◽

Significant Difference ◽

High Prevalence ◽

Prevalence Of Depression ◽

Anxiety Depression ◽

Severe Anxiety ◽

Different Levels

Abstract Objective: To assess the prevalence of depression, anxiety and stress in medical students, and to analyse effects of demographics and nomophobia on depression, anxiety and stress. Method: The descriptive cross-sectional study was conducted at the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia, from April 1 to May 23, 2019, and comprised male and female medical students aged 19-25 years. Data was collected using a demographic information form, the 21-item depression, anxiety and stress scale and the 20-item nomophobia questionnaire. Data was analysed using SPSS 20. Results: Of the 230 students, 108(47%) were boys and 122 (53%) were girls. The overall mean age was 21.93+1.80 years. Anxiety, depression and stress was reported in 168 (74.6%), 158 (70.2%) and 127 (55.9%) of the students. Extremely severe anxiety, depression and stress were self-reported by 92 (40.9%), 38 (16.8%) and 16 (7.04%) students. There was a significant difference in the distribution of subjects within different levels of anxiety across gender (p<0.05). Higher anxiety and stress scores were observed in 78 (33.9%) students with severe nomophobia. Differences in the levels of anxiety and stress with regards to type of residence and nomophobia levels were significant (p<0.05). Conclusion: There was high prevalence of depression, anxiety and stress associated with gender, nomophobia levels and residence type. Key Words: Depression, Anxiety, Stress, Medical, Nomophobia.

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