scholarly journals Severe Lactic Acidosis in a Critically Ill Child: Think About Thiamine! A Case Report

2020 ◽  
Author(s):  
Clémence Didisheim ◽  
Diana Ballhausen ◽  
Marie-Louise Choucair ◽  
David Longchamp ◽  
Julia Natterer ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Aerobic Glycolysis ◽  
Pediatric Population ◽  
Parasitic Infection ◽  
Unknown Origin ◽  
Nutritional Deficiencies ◽  
Maintenance Chemotherapy ◽  
Refractory Shock ◽  
Patients At Risk ◽  
Critically Ill Child

AbstractWe present a teenager, in maintenance chemotherapy for leukemia, who was admitted for digestive symptoms related to a parasitic infection and required nutritional support with parenteral nutrition. After 6 weeks, his condition worsened with refractory shock of presumed septic origin, necessitating extracorporeal membrane oxygenation. Despite hemodynamic stabilization, his lactic acidosis worsened until thiamine supplementation was started. Lactate normalized within 12 hours. Thiamine is an essential coenzyme in aerobic glycolysis, and deficiency leads to lactate accumulation through anaerobic glycolysis. Thiamine deficiency is uncommon in the pediatric population. However, it should be considered in patients at risk of nutritional deficiencies with lactic acidosis of unknown origin.

scholarly journals 1707. Clinical Profile of Human T-Lymphotropic Virus Type I Infection in Pediatric Population in a Referral Hospital in Colombia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S836-S837
Author(s):  
Juliana Mejia- Mertel ◽  
Juan P Rojas -Hernandez
Keyword(s):  
Virus Type ◽  
Low Income ◽  
Pacific Coast ◽  
Vision Loss ◽  
Pediatric Population ◽  
Clinical Manifestations ◽  
Low Income Countries ◽  
Nutritional Deficiencies ◽  
Type I ◽  
T Lymphotropic Virus

Abstract Background The Human T-lymphotropic virus type 1 (HTLV-1), affects around ten to twenty million people worldwide, predominantly in intertropical regions (Africa, Japan, Melanesia, Australia, and South America Pacific Coast). The most common disorders associated are T-cell leukemia/lymphoma (ALT) and HTLV-1-associated myelopathy (HAM). Studies have reported other clinical manifestations in HTLV-1, still studies are needed in pediatric population to improve diagnosis and treatment of infected patients. Methods Descriptive, retrospective cohort study, conducted in our referral pediatric hospital in Cali, Colombia. Included pediatric patients (1 to 18 years of age) diagnosed with HTLV-1 infection, between January 2017 to March 2020. Results Twelve patients were included, seven males and five females. Eleven patients were from and resided in the Colombian Pacific coast. Ten patients showed nutritional deficiencies. None showed clinical or laboratory signs of ALT, neither neurological symptoms or physical exam suggesting HAM. In terms of associated diseases and opportunistic infections, none had a positive HIV ELISA test, and stool tests were all negative for Strongiloydes. Four presented infective dermatitis, and two showed lesions suggesting scabies. Eight patients presented respiratory symptoms with chest CT scans showing signs of chronic inflammation, bronchiectasis, and subpleural bullae as the major findings. Additional tests were carried out in bronchoalveolar fluid, four had positive galactomannan test,suggesting pulmonary aspergillosis, two exhibited positive gene PCR testing for Mycobacterium tuberculosis. Regarding inflammatory diseases, one patient presented with symptoms of Inflammatory Bowl Disease, with biopsy confirming Crohn’s disease. Another patient presente abrupt vision loss, diagnosed with Vogt Koyanagi Hadara Syndrome after ophthalmological evaluation. Summary features HTLV-1 patients Ground-glass opacity diffusely distributed in both lungs with multiple bronchiectasis involving predominantly lung bases. Cystic images diffusely distributed in both lungs, some subpleural and other centrilobular. Conclusion It is important to consider alternative manifestations of HTLV-1 infection in the pediatric population, including pulmonary disease, opportunistic co-infections, and inflammatory disorders. It is crucial to diagnose this disease in childhood to reach a better control of this neglected infection that affects predominantly vulnerable population in low-income countries. Disclosures All Authors: No reported disclosures

scholarly journals NURS-10. IMPROVEMENTS IN A BEHAVIORAL TRAINING AND PHARMACOLOGICAL ANXIOLYSIS ALGORITHM FOR INCREASED COMPLIANCE IN PEDIATRIC PATIENTS IN PREPARATION FOR RADIATION THERAPY: A RETROSPECTIVE ANALYSIS

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii422-iii423
Author(s):  
Judy Tran ◽  
Jennifer Holt ◽  
Danielle Crump ◽  
Anita Shea ◽  
Lin Whetzel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Statistical Significance ◽  
Radiation Risk ◽  
Proton Radiation ◽  
Behavioral Training ◽  
Duration Of Treatment ◽  
Behavioral Compliance ◽  
Patients At Risk

Abstract BACKGROUND In the pediatric population, the probability of compliance with radiation involves multifactorial elements. Younger pediatric patients often require anesthesia to ensure accurate delivery of radiotherapy. The purpose of this analysis was to refine our algorithm in pediatric patients to better identify children who would benefit from behavioral training and/or anxiolyxis intervention with the goal of minimizing anesthesia use. METHOD Retrospective data was collected from electronic medical records from 150 pediatric oncology patients <18 years old, treated with photon and proton radiation at our center from August 2016 to December 2019. We identified potential socio-developmental treatment factors thought to impact behavioral compliance and categorized risk factors based on an algorithm to determine risk for noncompliance with radiotherapy. RESULTS Six categories demonstrated statistical significance (p<0.05) in their influence on behavioral compliance during radiotherapy: age category (specifically age <7: Odds ratio [OR] 3.0, 95% Confidence Interval [CI] 1.0, 9.1), need for sedation with prior imaging studies (p<0.001), parental premonition of requiring anesthesia for successful treatment (p<0.001), duration of treatment, primary language (p<0.001), and use of total body irradiation (OR 3.1, 95% CI 1.1, 9.3). CONCLUSION Identification of pre-radiation risk factors allowed for better recognition of patients at risk for treatment non-compliance and for requiring daily sedation. Future studies should focus on implementing the algorithm prospectively in an effort to identify and direct early intervention with behavioral training and/or anxiolytics to minimize the need for sedation.

Artificial Intelligence in Predicting Cardiac Arrest: A Scoping Review (Preprint)

2021 ◽  
Author(s):  
Asma Alamgir ◽  
Osama Mousa 2nd ◽  
Zubair Shah 3rd
Keyword(s):  
Artificial Intelligence ◽  
At Risk ◽  
Cardiac Arrest ◽  
Scoping Review ◽  
Pediatric Population ◽  
Data Extraction ◽  
Warning System ◽  
Reference List ◽  
Evaluation Tool ◽  
Patients At Risk

BACKGROUND Cardiac arrest is a life-threatening cessation of heart activity. Early prediction of cardiac arrest is important as it provides an opportunity to take the necessary measures to prevent or intervene during the onset. Artificial intelligence technologies and big data have been increasingly used to enhance the ability to predict and prepare for the patients at risk. OBJECTIVE This study aims to explore the use of AI technology in predicting cardiac arrest as reported in the literature. METHODS Scoping review was conducted in line with guidelines of PRISMA Extension for Scoping Review (PRISMA-ScR). Scopus, Science Direct, Embase, IEEE, and Google Scholar were searched to identify relevant studies. Backward reference list checking of included studies was also conducted. The study selection and data extraction were conducted independently by two reviewers. Data extracted from the included studies were synthesized narratively. RESULTS Out of 697 citations retrieved, 41 studies were included in the review, and 6 were added after backward citation checking. The included studies reported the use of AI in the prediction of cardiac arrest. We were able to classify the approach taken by the studies in three different categories - 26 studies predicted cardiac arrest by analyzing specific parameters or variables of the patients while 16 studies developed an AI-based warning system. The rest of the 5 studies focused on distinguishing high-risk cardiac arrest patients from patients, not at risk. 2 studies focused on the pediatric population, and the rest focused on adults (n=45). The majority of the studies used datasets with a size of less than 10,000 (n=32). Machine learning models were the most prominent branch of AI used in the prediction of cardiac arrest in the studies (n=38) and the most used algorithm belonged to the neural network (n=23). K-Fold cross-validation was the most used algorithm evaluation tool reported in the studies (n=24). CONCLUSIONS : AI is extensively being used to predict cardiac arrest in different patient settings. Technology is expected to play an integral role in changing cardiac medicine for the better. There is a need for more reviews to learn the obstacles of implementing AI technologies in the clinical setting. Moreover, research focusing on how to best provide clinicians support to understand, adapt and implement the technology in their practice is also required.

The Certainty of a Post-Bone Marrow Diagnosis: A Study of the Yield of Bone Marrow Biopsies in a Community Hospital Setting

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 34-35
Author(s):  
Manasi M. Godbole ◽  
Peter A. Kouides
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Fever Of Unknown Origin ◽  
Conflicts Of Interest ◽  
Diagnostic Yield ◽  
Hospital Setting ◽  
Unknown Origin ◽  
Nutritional Deficiencies ◽  
Bone Marrow Biopsies

Introduction: Most studies on the diagnostic yield of bone marrow biopsy including the one by Hot et al. have focused on the yield of bone marrow biopsies in diagnosing the source of fever of unknown origin. However, there have not been any studies performed to our knowledge looking at overall practice patterns and yield of bone marrow biopsies for diagnoses other than fever of unknown origin. We aim to determine the most common indications for performing bone marrow biopsies in a community-based teaching hospital as well as the yield of the biopsies in patients with specified and unspecified pre-test indications to estimate the rate of uncertain post-test diagnoses. Methods: We performed a retrospective data collection study at Rochester General Hospital, NY. A comprehensive search was conducted in our electronic medical data to identify all patients who underwent bone marrow biopsies over a 5 year period from January 2011 - December 2016 for indications other than fever of unknown origin. Patient data including demographics, pre-bone marrow biopsy diagnosis and post-bone marrow diagnosis was obtained. All patients above the age of 18 who underwent bone marrow biopsy for indications other than fever of unknown origin or follow up treatment of a hematological malignancy were included. Results: A total of 223 biopsies were performed. The median age was 59 years (age range- 23-95). One hundred and sixteen patients were male and 107 were female. The most common indications for performing bone marrow biopsy were evaluation of the following possible conditions: multiple myeloma (n=54), myelodysplastic syndrome [MDS] (n=47), lymphoma (n=28) and leukemia (n=18) as well as non-specific indications such as pancytopenia (n=40), anemia (n=22) and thrombocytopenia (n=11). The proportion of cases confirmed by bone marrow biopsy was 45/54 (83%) with the pre-marrow diagnosis of multiple myeloma, 34/47 cases (72%) with the pre-marrow diagnosis of MDS, 15/18 (83%) with the pre-marrow diagnosis of leukemia and 13/28 (46%) in those with the pre-marrow diagnosis of rule out lymphoma. Thirteen cases (18%) with possible MDS had post-bone marrow diagnoses of leukemia, anemia of chronic disease, myelofibrosis or medication-related changes. Five out of twenty two cases (23%) for anemia and 3/11 cases (27%) for thrombocytopenia without otherwise specified pre-bone marrow etiology had uncertain diagnosis after bone marrow biopsy. Conclusion: In about a fifth of patients necessitating a bone marrow, the diagnosis is discordant and can be surprising. It is also worth reporting that in these discordant results, non-hematological causes such as medications, anemia due to chronic diseases or conditions such as cirrhosis or splenomegaly from other etiologies were among the final diagnoses. Interestingly, 20% of the patients with unspecified pre-bone marrow diagnoses such as anemia or thrombocytopenia in our study had an unclear post-bone marrow diagnosis despite undergoing bone marrow biopsy. Our findings are a reminder that the bone marrow exam does not always lead to a definitive diagnosis and the need by exclusion to include in the differential non-hematological etiologies such as nutritional deficiencies, chronic kidney disease or autoimmune disorders. Disclosures No relevant conflicts of interest to declare.

Type B lactic acidosis due to Warburg effect in a child presenting with T cell acute lymphoblastic leukaemia: a milder phenotype

2020 ◽  
Vol 13 (3) ◽  
pp. e233941
Author(s):  
Sanjeev Khera ◽  
Suman Kumar Pramanik ◽  
Suprita Kalra ◽  
Aradhana Dwivedi
Keyword(s):  
T Cell ◽  
Lactic Acidosis ◽  
Acute Lymphoblastic Leukaemia ◽  
Lymphoblastic Leukaemia ◽  
Warburg Effect ◽  
Aerobic Glycolysis ◽  
Cellular Level ◽  
Haematological Malignancies ◽  
Type B ◽  
Mild Phenotype

Lactic acidosis (LA) is characterised by persistently increased blood lactate >5 mmol/L. Type A LA due to anaerobic glycolysis is frequently seen during management of haematological malignancies. A rare form of LA known as type B LA, which occurs as a result of metabolic dysregulation at cellular level has been described recently. This has been reported to be because of Warburg effect (WE) or aerobic glycolysis, which is seen in cancerous cells as they rely on aerobic glycolysis rather than oxidative phosphorylation for energy generation. Presence of type B LA at initial presentation of haematological malignancies is a poor prognosticating factor and has rarely been reported in children. We present a child with T cell acute lymphoblastic leukaemia with mild phenotype of type B LA due to WE. She responded dramatically to definitive chemotherapy and tolerated intensive phase of chemotherapy without any significant morbidity.

scholarly journals Peritonitis Of Unknown Origin In a Patient With Refractory Shock

2018 ◽  
Vol 5 (1) ◽  
pp. 1-2
Author(s):  
E. Guerra Hernández ◽  
Z. Hussein Dib González ◽  
R. Fariña Castro
Keyword(s):  
Unknown Origin ◽  
Refractory Shock

scholarly journals Rapid Growth of Hydatid Cyst: A Pediatric Case Report

2021 ◽  
Author(s):  
Mehdi FOROUGHI ◽  
Ali BAHADOR ◽  
Zahra BEIZAVI
Keyword(s):  
Case Report ◽  
Hydatid Cyst ◽  
Echinococcus Granulosus ◽  
Hydatid Disease ◽  
Rapid Growth ◽  
Pediatric Population ◽  
Parasitic Infection ◽  
Abdominal Discomfort ◽  
Pediatric Case ◽  
Worldwide Distribution

Hydatid disease is a parasitic infection caused by Echinococcus granulosus with worldwide distribution. The most affected organs are liver and lungs, but it can be detected in any other organs as well. We reported a 5-yr-old boy from Shiraz, southern Iran in 2017 who presented with abdominal discomfort. Imaging revealed multiple liver hydatid cyst and a huge kidney hydatid cyst. This case showed the possible implication of rapid growth of multiple hydatid cyst as well as unusual organ presentation in the pediatric population.

scholarly journals A Review on Vitamin D Deficiency Treatment in Pediatric Patients

2013 ◽  
Vol 18 (4) ◽  
pp. 277-291 ◽  
Author(s):  
Ji Yeon Lee ◽  
Tsz-Yin So ◽  
Jennifer Thackray
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Pediatric Patients ◽  
Calcium Absorption ◽  
Pediatric Population ◽  
Vitamin D Supplementation ◽  
The Body ◽  
Nutritional Deficiencies ◽  
Bone Demineralization ◽  
Symptomatic Hypocalcemia

Vitamin D is essential for calcium absorption and for maintaining bone health in the pediatric population. Vitamin D deficiency may develop from nutritional deficiencies, malabsorption, enzyme-inducing medications, and many other etiologies. It may present as hypocalcemia before bone demineralization at periods of increased growth velocity (infancy and adolescence) because the increased calcium demand of the body cannot be met. In children, inadequate concentrations of vitamin D may cause rickets and/or symptomatic hypocalcemia, such as seizures or tetany. In this review, we will discuss the pharmacology behind vitamin D supplementation, laboratory assessments of vitamin D status, current literature concerning vitamin D supplementation, and various supplementation options for the treatment of vitamin D deficiency in the pediatric population.

MR Imaging of Rheumatic Diseases Affecting the Pediatric Population

2021 ◽  
Vol 25 (01) ◽  
pp. 082-093
Author(s):  
Eva Schiettecatte ◽  
Lennart Jans ◽  
Jacob Lester Jaremko ◽  
Min Chen ◽  
Caroline Vande Walle ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Pediatric Population ◽  
Vascular Diseases ◽  
Unknown Origin ◽  
Chronic Recurrent Multifocal Osteomyelitis ◽  
Joint Inflammation ◽  
Response To Treatment ◽  
Collagen Vascular Diseases ◽  
Juvenile Spondyloarthritis

AbstractThis article reviews the application of magnetic resonance imaging (MRI) to pediatric rheumatic diseases. MRI can detect early manifestations of arthritis, evaluate the extent of disease, and monitor disease activity and response to treatment.Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disorder, representing a diverse group of related diseases that share a definition of joint inflammation of unknown origin with onset before 16 years of age and lasting > 6 weeks. JIA may lead to significant functional impairment and is increasingly imaged with MRI to assess for active inflammation as a target for therapy. This is particularly true for juvenile spondyloarthritis that includes multiple subgroups of JIA and primarily involves the spine and sacroiliac joints.Other less common pediatric rheumatic diseases considered here are chronic recurrent multifocal osteomyelitis and collagen vascular diseases including polymyositis, dermatomyositis, scleroderma, and juvenile systemic lupus erythematosus.

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