P151 Validation of the MaRIA Score in pediatric patients

Abstract Background To validate the Magnetic Resonance Index of Activity (MaRIA Score) in the pediatric population and determine if it would be possible to monitor inflammatory bowel disease (IBD) without invasive tests in some cases. Methods A cross-sectional and descriptive study of paediatric patients with previously diagnosed or suspected IBD who underwent upper endoscopy (EGD) and colonoscopy, blood tests, stool analysis and MR Enterography (MRE) in a 15 days range, from October 2018 to February 2020. The clinical and endoscopic situation were assessed with the activity indices PUCAI/PCDAI/shPCDAI and the activity scores UCEIS/Mayo/SES-CD respectively, according to the underlying pathologies. We considered analytical remission as FC< 250 mcg/g, ERS< 20 mm and CRP< 1 mg/dl. The MRE results were assessed with the MaRIA Score, that is validated for adults. Results Amongst 21 patients, 12 (57%) were males. 12 patients had Crohn ́s disease (CD) (57%), 3 had ulcerative colitis (UC) (14%), 6 had IBD unclassified (IBDu) (28%). The mean age at diagnosis was 14.2 ± 0.7 and the progression time of the disease was 3.9 ± 0.6 years. A total of 16 patients showed clinical remission (76%), 6 of them (28%) also had endoscopic and histological remission. Eight patients were receiving biological treatment (38%). The measured acute phase reactants (APR) were: CRP 0.9 ± 0.5 mg/dl, ESR 13.7 ± 2.6 mm, α1 acid glycoprotein 95.5 ± 1.1 mg/dl and fecal calprotectin (FC) of 1154.3 ± 254.8 mcg/g. Rotavirus, adenovirus, Clostridium difficile toxin analysis and stool culture were performed in 14 patients, all of them negative. The MaRIA Score values were 54.3 ± 53.3, being 0 in 11 cases. We found no differences between the MaRIA Score and the analytical remission. We found a significant correlation between the MaRIA Score and the PUCAI value (p < 0.05), but not with other clinical scores. Patients in clinical remission showed a tendency to have a lower MaRIA Scores, but these differences were not statistically significant (p = 0.09). The MaRIA Score showed lower values for those with endoscopic and histological remission (p < 0.05), All the patients with MaRIA Score> 0 were CD except one, diagnosed with UC. Out of the 15 patients with endoscopic/histological involvement, 10 presented a MaRIA Score> 0. Five of the 11 patients (45%) in whom the MaRIA Score was 0 did not have endoscopic and histological remission, only one of them had a diagnosis of CD. Conclusion The MaRIA Score was significantly correlated with endoscopic scores in pediatric IBD patients, especially in CD. However, based on the results of this study, the MRE should not replace the EGD and colonoscopy in order to thoroughly evaluate the disease activity.

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Fecal Calprotectin Thresholds to Predict Endoscopic Remission Using Advanced Optical Enhancement Techniques and Histological Remission in IBD Patients

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa163 ◽

2020 ◽

Author(s):

Rosanna Cannatelli ◽

Alina Bazarova ◽

Davide Zardo ◽

Olga Maria Nardone ◽

Uday Shivaji ◽

...

Keyword(s):

Ulcerative Colitis ◽

Surrogate Marker ◽

Fecal Calprotectin ◽

Cross Sectional Study ◽

Mucosal Healing ◽

Cross Sectional ◽

Endoscopic Techniques ◽

Endoscopic Remission ◽

Endoscopic Score ◽

Histological Remission

Abstract Background Fecal calprotectin (FC) is a common surrogate marker of mucosal healing (MH) in patients with ulcerative colitis (UC) and Crohn’s disease (CD). We investigated the optimum FC thresholds for defining endoscopic remission (ER) and histological remission (HR) using advanced endoscopic techniques. Patients and Methods In this cross-sectional study, we collected clinical, endoscopic, histological data, and FC from 76 UC and 41 CD patients. Receiver operating characteristic curves were created to evaluate the optimum cut-off of FC to predict ER evaluated by Mayo Endoscopic Score (MES), Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and modified PICaSSO (Paddington International Virtual Chromoendoscopy Score) for UC patients and Simple Endoscopic Score (SES-CD) in CD patients; and HR was scored by the Robarts Histology Index (RHI) and Nancy Index for UC and modified Riley for CD. Results In UC patients, the best thresholds of FC to identify ER calculated with MES, UCEIS, and modified PICaSSO were 112, 148, and 161 mcg/g with accuracy of 86.9% 86.8%, and 81.6%, respectively. The best value of FC to predict HR was 112 mcg/g and 172 mcg/g with accuracy of 84.2% and 81.6% for RHI and Nancy Index, respectively. In CD patients, the best cut-off of FC to predict ER was 96 mcg/g with accuracy of 82.9%. The HR was best predicted by an FC value of 225 mcg/g with accuracy of 75.6%. Conclusions The FC value threshold between 112 and 172 mcg/g could identify ER and HR in UC patients, whereas a value under 225 mcg/g should be considered for CD patients.

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Case Report: Primary Peritonitis as the Onset of Pediatric Ménétrier's Disease

Frontiers in Pediatrics ◽

10.3389/fped.2020.589853 ◽

2021 ◽

Vol 8 ◽

Author(s):

Ana Barrés-Fernández ◽

Andrés Piolatti-Luna ◽

José Rafael Bretón-Martínez ◽

Elena Crehuá-Gaudiza ◽

Carmen Quiñones-Torrelo ◽

...

Keyword(s):

Pediatric Population ◽

Acute Phase Reactants ◽

Protein Losing Enteropathy ◽

Menetrier’S Disease ◽

Primary Peritonitis ◽

Benign Nature ◽

Alpha 1 Antitrypsin ◽

Ménétrier's Disease ◽

Stool Analysis ◽

Menetrier's Disease

Introduction: Primary peritonitis (PP) and Ménétrier's Disease (MD) are both rare conditions among pediatric population. Although about 150 MD cases have been described in the scientific literature to date, its onset with a PP is an unusual condition.Case Presentation: We present a case of an 11-year-old boy who was admitted to our unit because of abdominal pain and distension. Complementary tests showed ascites, bilateral pleural effusion, leukocytosis, increased acute phase reactants and hypoproteinemia with hypoalbuminemia. Laparoscopy ruled out appendicitis or visceral perforations and exposed purulent peritoneal fluid, compatible with PP. Biochemical stool analysis showed increased clearance of alpha-1-antitrypsin, which was consistent with a protein-losing enteropathy. Gastroscopy findings were compatible with MD. The clinical course was favorable and he had no recurrence after 12 months of follow-up.Conclusion: PP can be the first clinical manifestation of pediatric MD. Knowledge of MD and its generally benign nature in children is important in order to avoid excessive testing and unnecessary treatment.

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A ten-year report of microbial keratitis in pediatric population under five years in a tertiary eye center

Journal of Ophthalmic Inflammation and Infection ◽

10.1186/s12348-020-00227-x ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Mohammad Soleimani ◽

Seyed Ali Tabatabaei ◽

S. Saeed Mohammadi ◽

Niloufar Valipour ◽

Arash Mirzaei

Keyword(s):

Pediatric Population ◽

Cross Sectional Study ◽

Eye Drops ◽

Microbial Keratitis ◽

Cyanoacrylate Glue ◽

Cross Sectional ◽

Under Five ◽

Fluoroquinolone Antibiotics ◽

Empiric Antibiotic ◽

Corneal Scraping

Abstract Purpose To report characteristics of microbial keratitis in pediatric patients under five years. Methods Patients with infectious keratitis under the age of 5 years were included in this retrospective cross-sectional study for ten years. All patients were admitted and corneal scraping was performed in 81 children. Fortified empiric antibiotic eye drops including cefazolin (50 mg/cc) and amikacin (20 mg/cc) were started and the antibiotic regimen was continued or changed according to culture results. In the case of fungal keratitis, topical voriconazole (10 mg/cc) or natamycin (50 mg/cc) and topical chloramphenicol (5 mg/cc) were started. A tectonic procedure was done when corneal thinning or perforation was present. Results Ninety-Three Patients between 1 to 60 months with a mean age of 33 ± 18 months old with corneal ulcer were included in the study. The most common risk factor was trauma (40.9%) followed by contact lens use (8.6%). Cultures were negative for microbial growth in 28 (30.1%) patients. The most common pathogens were S. epidermidis (10.8%) and P. aeruginosa (10.8%). Fluoroquinolone antibiotics (ciprofloxacin; 93.8% sensitivity) were the most potent antibiotic against bacterial pathogens. Forty-one patients underwent tectonic procedures, which the most common ones were cyanoacrylate glue 18.3% followed by keratoplasty 16.1%. Conclusion This study emphasizes the role of trauma as the primary cause and S. epidermidis as the most frequent microorganism in pediatric keratitis; according to antibiogram results and poor cooperation of patients under five years, monotherapy with fluoroquinolones could be a good regimen in small non-central lesions without thinning.

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Effect of disease duration on the association between serum albumin and mucosal healing in patients with ulcerative colitis

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2021-000662 ◽

2021 ◽

Vol 8 (1) ◽

pp. e000662

Author(s):

Sen Yagi ◽

Shinya Furukawa ◽

Kana Shiraishi ◽

Yu Hashimoto ◽

Kazuhiro Tange ◽

...

Keyword(s):

Ulcerative Colitis ◽

Serum Albumin ◽

Clinical Outcomes ◽

Clinical Remission ◽

Acute Inflammation ◽

Japanese Patients ◽

Cross Sectional Study ◽

Mucosal Healing ◽

High Serum ◽

Cross Sectional

ObjectiveSerum albumin is used as a marker of acute inflammation. Several studies have addressed the association between serum albumin and clinical outcome in patients with ulcerative colitis (UC). While mucosal healing (MH) has been indicated as the therapeutic goal for UC, the association between serum albumin and MH remains unclear. We evaluated this issue in patients with UC overall and explored whether duration of UC affected this association.DesignThis cross-sectional study recruited consecutive patients with UC. Study subjects consisted of 273 Japanese patients with UC. Serum albumin was divided into tertiles based on its distribution in all study subjects. One endoscopy specialist was responsible for measuring partial MH and MH, which were defined as a Mayo endoscopic subscore of 0–1 and 0, respectively. The association between serum albumin and clinical outcomes was assessed by multivariate logistic regression.ResultsRates of clinical remission, partial MH and MH were 57.9%, 63% and 26%, respectively. Only high serum albumin (>4.4 mg/dL) was significantly positively associated with MH (OR 2.29 (95% CI: 1.03 to 5.29), p for trend=0.043). In patients with short UC duration (<7 years) only, high serum albumin was significantly positively associated with MH and clinical remission. In patients with long UC duration (≥7 years), in contrast, no association between serum albumin and clinical outcomes was found.ConclusionIn Japanese patients with UC, serum albumin was significantly positively associated with MH. In patients with short UC duration, serum albumin might be a useful complementary marker for MH.

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Prevalence of SARS-CoV-2 infection in Italian pediatric population: a regional seroepidemiological study

Italian Journal of Pediatrics ◽

10.1186/s13052-021-01074-9 ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Manola Comar ◽

Simone Benvenuto ◽

Marzia Lazzerini ◽

Giorgio Fedele ◽

Egidio Barbi ◽

...

Keyword(s):

Pediatric Population ◽

Cross Sectional Study ◽

Nasopharyngeal Swab ◽

Strongly Correlated ◽

Igg Antibodies ◽

Cross Sectional ◽

Equal Distribution ◽

Chemiluminescent Immunoassay ◽

Italian National Institute ◽

Friuli Venezia Giulia

Abstract Background Data on the effective burden of the SARS-CoV-2 pandemic in pediatric population are very limited, mostly because of the higher rate of asymptomatic or paucisymptomatic cases among children. Updated data on COVID-19 prevalence are needed for their relevance in public health and for infection control policies. In this single-centre cross-sectional study we aimed to assess prevalence of SARS-CoV-2 infection through IgG antibodies detection in an Italian pediatric cohort. Methods The study was conducted in January 2021 among both inpatients and outpatients referring to Research Institute for Maternal and Child Health “Burlo Garofolo” in Trieste, Friuli Venezia-Giulia, Italy, who needed for blood test for any reason. Collected samples were sent to Italian National Institute of Health for analysis through chemiluminescent immunoassay (CLIA). Results One hundred sixty-nine patients were included in the study, with a median age of 10.5 ± 4.1 years, an equal distribution for sex (49.7% female patients), and a 55.6% prevalence of comorbidities. Prevalence of anti-SARS-CoV-2 trimeric Spike protein IgG antibodies was 9.5% (n = 16), with a medium titre of 482.3 ± 387.1 BAU/mL. Having an infected cohabitant strongly correlated with IgG positivity (OR 23.83, 95% CI 7.19–78.98, p < 0.0001), while a cohabitant healthcare worker wasn’t associated with a higher risk (OR 1.53, 95% CI 0.4–5.86, p 0.46). All of the 5 patients who had previously tested positive to a nasopharyngeal swab belonged to the IgG positive group, with a 3-month interval from the infection at most. Conclusion We assessed a 9.5% SARS-CoV-2 seroprevalence in a pediatric cohort from Friuli Venezia-Giulia region in January 2021, showing a substantial increase after the second peak of the pandemic occurred starting from October 2020, compared to 1% prevalence observed by National Institute of Statistics (ISTAT) in July 2020.

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Prevalence of gout and asymptomatic hyperuricemia in the pediatric population: a cross-sectional study of a Japanese health insurance database

BMC Pediatrics ◽

10.1186/s12887-020-02379-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Shuichi Ito ◽

Tomoko Torii ◽

Akihiro Nakajima ◽

Takeshi Iijima ◽

Hiroshi Murano ◽

...

Keyword(s):

Uric Acid ◽

Health Insurance ◽

Pediatric Population ◽

Gouty Arthritis ◽

Cross Sectional Study ◽

Sectional Study ◽

Insurance Claims ◽

Cross Sectional ◽

Total Prevalence ◽

Health Insurance Claims

Abstract Background Although gout is rare in children, chronic sustained hyperuricemia can lead to monosodium urate deposits progressing to gout, just as in adults. This study assessed prevalence and characteristics of gout and asymptomatic hyperuricemia, and incidence of gouty arthritis in the pediatric population, using data from Japanese health insurance claims. The diagnosis and treatment of pediatric gout and hyperuricemia were analyzed, and specific characteristics of those patients were assessed. Since Japanese guidelines recommend treatment with uric acid lowering drugs for asymptomatic hyperuricemia as well as for gout, these data were also used to investigate the real-world use of uric acid lowering drugs in a pediatric population. Methods This cross-sectional study was based on a 2016–2017 Japanese health insurance claims database, one of the largest epidemiology claims databases available in Japan, which included 356,790 males and 339,487 females 0–18 years of age. Outcomes were measured for prevalence, patient characteristics, treatment with uric acid lowering drugs for gout and asymptomatic hyperuricemia, and prevalence and incidence of gouty arthritis. Because uric acid can be elevated by some forms of chemotherapy, data from patients under treatment for malignancies were excluded from consideration. Results Total prevalence of gout and asymptomatic hyperuricemia in 0–18 year-olds was 0.040% (276/696,277 patients), with gout prevalence at 0.007% (48/696,277) and asymptomatic hyperuricemia at 0.033% (228/696,277). Prevalence of gout and asymptomatic hyperuricemia was highest in adolescent males, at 0.135% (176/130,823). The most common comorbidities for gout and asymptomatic hyperuricemia were metabolic syndrome at 42.8% (118/276) and kidney disease at 34.8% (96/276). Of the patients diagnosed with gout or asymptomatic hyperuricemia, 35.1% (97/276) were treated with uric acid lowering drugs. Gouty arthritis developed in 43.8% (21/48) of gout patients during the study, at an incidence of 0.65 flares/person-year. Conclusions Even the pediatric population could be affected by asymptomatic hyperuricemia, gout, and gouty arthritis, and uric acid lowering drugs are being used in this population even though those drugs have not been approved for pediatric indications. Such off-label use may indicate a potential need for therapeutic agents in this population. Trial registration UMIN000036029.

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The Accuracy of Broselow Tape Weight Estimate among Pediatric Population

BioMed Research International ◽

10.1155/2016/7042947 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 8

Author(s):

Turki M. AlHarbi ◽

Abdullaziz AlGarni ◽

Fasial AlGamdi ◽

Mona Jawish ◽

Tariq Ahmad Wani ◽

...

Keyword(s):

Body Weight ◽

Pediatric Population ◽

Body Height ◽

Age Groups ◽

Cross Sectional Study ◽

The Body ◽

Accurate Estimation ◽

Cross Sectional ◽

Actual Weight ◽

Medical City

Objective.To determine the accuracy of the Broselow Tape (BT) versions 2007 and 2011 in estimating weight among pediatric population.Methods.A cross-sectional study was conducted at King Fahad Medical City and six schools across Riyadh province on 1–143-month-old children. BT 2007 and 2011 estimated weights were recorded. Both tapes via the child’s height produce an estimated weight, which was compared with the actual weight.Results.A total of 3537 children were recruited. The height (cm) of the subjects was97.7±24.1and the actual weight (kg) was16.07±8.9, whereas the estimated weight determined by BT 2007 was15.87±7.56and by BT 2011 was16.38±7.95. Across all the five age groups, correlation between actual weight and BT 2007 ranged between 0.702 and 0.788, while correlation between actual weight and BT 2011 ranged between 0.698 and 0.788. Correlation between BT 2007 and BT 2011 across all the five age groups ranged from 0.979 to 0.989. Accuracy of both the tape versions was adversely affected when age was >95 months and body weight was >26 kilograms.Conclusions.Our study showed that BT 2007 and 2011 provided accurate estimation of the body weight based on measured body height. However, 2011 version provided more precise estimate for weight.

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Can fecal calprotectin accurately identify histological activity of ulcerative colitis? A meta-analysis

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284821994741 ◽

2021 ◽

Vol 14 ◽

pp. 175628482199474

Author(s):

Xiaoqi Ye ◽

Ying Wang ◽

Harry H. X. Wang ◽

Rui Feng ◽

Ziyin Ye ◽

...

Keyword(s):

Ulcerative Colitis ◽

Meta Analysis ◽

Area Under The Curve ◽

Fecal Calprotectin ◽

Secondary Outcome ◽

Histological Response ◽

Summary Receiver Operating Characteristic ◽

Histological Activity ◽

Histological Remission ◽

Sensitivity Specificity

Background and Aims: Elevated fecal calprotectin (FC) levels have been reported to correlate with histological activity in patients with ulcerative colitis (UC). However, the accuracy of FC for evaluating histological activity of UC remains to be determined. The aim of this study was to determine the accuracy of FC for evaluating histological activity of UC, based on updated definitions. Methods: Related studies were retrieved from the PubMed, Web of Science, Embase, and Cochrane databases. Adult participants diagnosed with UC were included when sufficient data could be extracted to calculate the accuracy of FC for evaluating histological activity. The primary outcome was histological response, and the secondary outcome was histological remission, defined according to a recently updated position paper of European Crohn’s and Colitis Organization. Statistics were pooled using bivariate mixed-effects models. The area under the curve was estimated by summary receiver-operating characteristic curves. Results: Nine studies were included, from which 1039 patients were included for the analysis of histological response and 591 patients for histological remission. For the evaluation of histological response, the pooled sensitivity, specificity, and the area under the curve were 0.69 [95% confidence interval (CI): 0.52–0.82], 0.77 (95% CI: 0.63–0.87), and 0.80 (95% CI: 0.76–0.83), respectively. For the evaluation of histological remission, the corresponding estimates were 0.76 (95% CI: 0.71–0.81), 0.71 (95% CI: 0.62–0.78), and 0.79 (95% CI: 0.75–0.82), respectively. FC had a higher accuracy in studies using Nancy Index. For histological response, the cut-off values of FC ranged from 50 to 172 µg/g, and the sensitivity was higher in studies with FC cut-off values >100 µg/g (0.77 versus 0.65). Conclusion: FC is a valuable biomarker for assessing histological activity in patients with UC. A cut-off value of 100–200 µg/g is more appropriate to spare patients from an unnecessary endoscopy and biopsy.

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A Pattern-based Imaging Approach to Pediatric Jaw Lesions

Indian Journal of Radiology and Imaging ◽

10.1055/s-0041-1729767 ◽

2021 ◽

Author(s):

Biswanath Sahu ◽

Rama Anand ◽

Sandeep Kumar ◽

Ravi Shankar Solanki ◽

Pravesh Mehra ◽

...

Keyword(s):

Systematic Approach ◽

Developmental Process ◽

Pediatric Population ◽

Careful Attention ◽

Cross Sectional ◽

Complex Anatomy ◽

Infancy And Childhood ◽

Imaging Approach ◽

Cross Sectional Imaging ◽

Sectional Imaging

AbstractJaw lesions in the pediatric population, although infrequently encountered in clinical practice, can cause functional impairment and cosmetic disfiguring. It is further complicated by the difficulty in diagnosis due to complex anatomy and facial developmental process during infancy and childhood. Intraosseous pediatric jaw lesions may vary from odontogenic to nonodontogenic types with nonspecific clinical features in most cases. They deserve careful attention by a systematic approach to provide a relevant diagnosis or differential diagnosis for timely management. Imaging plays a major role in diagnosis with orthopantomograph being the foremost investigation, followed by cross-sectional imaging, essentially computed tomography as a problem-solving tool. This article highlights the imaging spectrum of various jaw lesions in the pediatric population with a pattern-based approach for radiological diagnosis.

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