LONG-COURSE ORAL CORTICOSTEROID TOXICITY IN CHILDREN

2016 ◽  
Vol 101 (9) ◽  
pp. e2.53-e2 ◽  
Author(s):  
Fahad Aljebab ◽  
Imti Choonara ◽  
Sharon Conroy
Keyword(s):  
Weight Gain ◽  
Growth Retardation ◽  
Oral Prednisolone ◽  
Incidence Rates ◽  
Cochrane Library ◽  
Varicella Zoster ◽  
Susceptibility To Infection ◽  
Oral Corticosteroids ◽  
Long Course ◽  
Increased Susceptibility

BackgroundLong courses of oral corticosteroids are commonly used in children in the management of conditions such as nephrotic syndrome, leukaemia, asthma and others. Various adverse drug reactions (ADRs) are known to occur with their use. This systematic review aimed to identify the most common and serious ADRs and to determine their relative risk levels.MethodsA literature search of several databases; Embase, Medline, International Pharmaceutical Abstracts, CINAHL, the Cochrane Library and PubMed was performed to identify all studies where corticosteroids had been administered to paediatric patients ranging from 28 days to 18 years of age for at least 15 days of treatment. Each database was searched from their earliest dates to March 2014. All types of studies that provided clear information on ADRs were included.Results91 relevant studies were found from 27 countries. These studies represented a total of 6653 children and contained reports of 4124 ADRs, the majority in patients with leukaemia, haemangioma and asthma. Oral prednisolone was the most commonly prescribed corticosteroid (74% of patients). The three most frequent ADRs were weight gain, Cushingoid features and growth retardation. The incidence rates of patients with these three ADRs were 22.4%, 20.6% and 18.9%, respectively. Increased susceptibility to infection was the most serious ADR. 24 children died from infections, ten from varicella zoster and the others from different microorganisms.ConclusionsWeight gain, Cushingoid features and growth retardation were the most frequent ADRs seen when long-course oral corticosteroids were given to children. In addition, increased susceptibility to infection was the most common cause of mortality.

scholarly journals Systematic review of the toxicity of short-course oral corticosteroids in children

2016 ◽  
Vol 101 (4) ◽  
pp. 365-370 ◽  
Author(s):  
Fahad Aljebab ◽  
Imti Choonara ◽  
Sharon Conroy
Keyword(s):  
Sleep Disturbance ◽  
Incidence Rates ◽  
Cochrane Library ◽  
Varicella Zoster ◽  
Risk Levels ◽  
Behavioural Changes ◽  
Susceptibility To Infection ◽  
Short Course ◽  
Oral Corticosteroids ◽  
Randomised Controlled

BackgroundShort-course oral corticosteroids are commonly used in children but are known to be associated with adverse drug reactions (ADRs). This review aimed to identify the most common and serious ADRs and to determine their relative risk levels.MethodsA literature search of EMBASE, MEDLINE, International Pharmaceutical Abstracts, CINAHL, Cochrane Library and PubMed was performed with no language restrictions to identify studies in which oral corticosteroids were administered to patients aged 28 days to 18 years of age for up to and including 14 days of treatment. Each database was searched from their earliest dates to December 2013. All studies providing clear information on ADRs were included.ResultsThirty-eight studies including 22 randomised controlled trials (RCTs) met the inclusion criteria. The studies involved a total of 3200 children in whom 850 ADRs were reported. The three most frequent ADRs were vomiting, behavioural changes and sleep disturbance, with respective incidence rates of 5.4%, 4.7% and 4.3% of patients assessed for these ADRs. Infection was one of the most serious ADRs; one child died after contracting varicella zoster. When measured, 144 of 369 patients showed increased blood pressure; 21 of 75 patients showed weight gain; and biochemical hypothalamic–pituitary–adrenal axis suppression was detected in 43 of 53 patients.ConclusionsVomiting, behavioural changes and sleep disturbance were the most frequent ADRs seen when short-course oral corticosteroids were given to children. Increased susceptibility to infection was the most serious ADR.Trial registration numberCRD42014008774. By PROSPERO International prospective register of systematic reviews.

SHORT-COURSE ORAL CORTICOSTEROID TOXICITY IN CHILDREN

2015 ◽  
Vol 101 (1) ◽  
pp. e1.30-e1
Author(s):  
Fahad Ajebab ◽  
Imti Choonara ◽  
Sharon Conroy
Keyword(s):  
Blood Pressure ◽  
Relative Risk ◽  
Adverse Events ◽  
Hpa Axis ◽  
Oral Prednisolone ◽  
Incidence Rates ◽  
Cochrane Library ◽  
Behavioural Changes ◽  
Short Course ◽  
Oral Corticosteroids

BackgroundMultiple studies have evaluated and reported adverse drug reactions (ADRs) of corticosteroids. Short course oral corticosteroids are commonly used in children in the management of conditions such as asthma exacerbations. This systematic review aimed to identify the most common and serious ADRs associated with short courses of oral corticosteroids and to determine their relative risk levels in children.MethodsA literature search of the databases: Embase, Medline, International Pharmaceutical Abstracts, CINAHL, the Cochrane Library and PubMed was performed to identify all studies where corticosteroids had been administered to paediatric patients ranging from 28 days to 18 years of age for up to and including 14 days of treatment. Each database was searched from their earliest dates to December 2013. All types of studies that provided clear information on adverse events were included with no language restrictions. Quality assessments were performed on all studies by two independent reviewers.ResultsThirty eight studies met the inclusion criteria. These studies represented 3202 children and contained reports of 847 adverse events. The three most frequent ADRs were vomiting, increased blood pressure and behavioural changes. The incidence rates of these three ADRs were 6.3%, 8.5% and 4.8% of patients respectively. The risk of vomiting was greater with oral prednisolone than oral dexamethasone with a relative risk of 3.62 (95% CI 1.89, 6.95; P=0.0001). Prednisolone sodium phosphate was reported to cause vomiting less frequently than other prednisolone dosage forms (P=0.047). HPA axis suppression was detected in 43 of 53 patients who were tested. The relative risk of oral prednisolone to cause HPA axis suppression compared with inhaled steroids was 9.95 (95% CI 1.73, 53.03; P=0.010). Infection was one of the most serious ADRs, one child died after contracting a varicella zoster infection.ConclusionsVomiting, increased blood pressure and behavioural changes were the most frequent ADRs seen when short-course oral corticosteroids were given to children. In addition, infection was the most serious ADR. The majority of children who receive short course oral corticosteroids will experience HPA axis suppression.

Nonenzymic glycation of human immunoglobulins does not impair their immunoreactivity.

1989 ◽  
Vol 35 (6) ◽  
pp. 1039-1042 ◽  
Author(s):  
L G Morin ◽  
G E Austin ◽  
G E Rodey ◽  
J E Johnson
Keyword(s):  
Complement Fixation ◽  
Diabetic Patients ◽  
Cell Agglutination ◽  
Varicella Zoster ◽  
Susceptibility To Infection ◽  
Human Immunoglobulins ◽  
Functionally Impaired ◽  
Antigen Antibody ◽  
Binding Cell ◽  
Increased Susceptibility

Abstract Diabetic patients have an increased proportion of their immunoglobulins nonenzymically glycated. To investigate the possibility that this may contribute to increased susceptibility to infection, we compared the immunoreactivity of glycated and nonglycated human immunoglobulins against rubella and hepatitis; streptococcal exoenzyme and infectious mononucleosis; human lymphocytotoxic antigens (HLA); and Varicella zoster in terms of antigen-antibody binding, cell agglutination, cytotoxicity, and complement-fixation properties, respectively. We found no evidence to support the supposition that glycated immunoglobulins are functionally impaired.

Cognitive function and risk for depression in old age: a meta-analysis of published literature

2010 ◽  
Vol 23 (4) ◽  
pp. 516-525 ◽  
Author(s):  
Chang-Quan Huang ◽  
Zheng-Rong Wang ◽  
Yong-Hong Li ◽  
Yi-Zhou Xie ◽  
Qing-Xiu Liu
Keyword(s):  
Cognitive Impairment ◽  
Relative Risk ◽  
Cognitive Function ◽  
Longitudinal Studies ◽  
Old Age ◽  
Meta Analysis ◽  
Incidence Rates ◽  
Cochrane Library ◽  
Cross Sectional ◽  
Risk For Depression

ABSTRACTBackground: We assessed the relationship between cognitive impairment (including mild cognitive impairment with no signs of dementia, and dementia) and risk for depression in old age (60 years and older).Methods: MEDLINE, EMBASE and the Cochrane Library database were used to identify potential studies. All of the clinical studies that produced data on the association between cognitive function and risk of depression among individuals aged 55 years or older were identified and included in this review. The studies were classified into cross-sectional and longitudinal subsets. The quantitative meta-analysis of cross-sectional and longitudinal studies were performed. For prevalence and incidence rates of depression, odds risk (OR) and relative risk (RR) were calculated, respectively.Results: Since all but two studies found in the search were for individuals aged 60 years or over, we assessed and reported on results for this larger group only. In this review we included 13 cross-sectional and four prospective longitudinal studies. The quantitative meta-analysis showed that, in old age, individuals with non-dementia cognitive impairment had neither significant higher prevalence nor incidence rates of depression than those without (odds risk (OR): 1.48, 95% confidence intervals (95% CI): 0.87–2.52; relative risk (RR): 1.12, 95% CI: 0.62–2.01). In old age, individuals with dementia had both significant higher prevalence and incidence rates of depression than those without (OR: 1.82, 95% CI: 1.15–2.89; RR: 3.92, 95% CI: 1.93–7.99).Conclusions: Despite the methodological limitations of this meta-analysis, we found that in old age, there was no association between depression and cognitive impairment with no dementia; however, there was a definite association between depression and dementia and thus dementia might be a risk for depression.

Hypothyroidism and Precocious Sexual Development: Another Case

PEDIATRICS ◽  
1973 ◽  
Vol 52 (1) ◽  
pp. 149-150
Author(s):  
Adolfo Perez Comas
Keyword(s):  
Weight Gain ◽  
Short Stature ◽  
Growth Retardation ◽  
Sexual Development ◽  
Similar Case ◽  
Pubic Hair ◽  
Breast Development ◽  
Attention Span ◽  
Admission Data ◽  
Irregular Menses

Recently, an article in Pediatrics by Costin et al.1 described two new cases of hypothyroidism and precocious sexual development. I would like to report another similar case with our available data. M.L.M., a 13-year-old girl was first seen by us at age 12-4/12 for short stature. Her history included growth retardation, diminution of attention span, somnolence, anorexia with weight gain, and constipation beginning between ages 4 to 6. At 9½ years of age irregular menses began, breast development was first noticed at 10 years, and pubic hair at 11½ years. Her initial admission data are in Table I.

Effect of Oral Motor Intervention on Oral Feeding in Preterm Infants: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-11
Author(s):  
Danna Chen ◽  
Zhen Yang ◽  
Chujie Chen ◽  
Pu Wang
Keyword(s):  
Weight Gain ◽  
Hospital Stay ◽  
Preterm Infants ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Oral Feeding ◽  
Transition Time ◽  
Cochrane Library ◽  
Oral Motor ◽  
Feeding Efficiency

Objective This review article aimed to explore the effect of oral motor intervention on oral feeding in preterm infants through a meta-analysis. Method Eligible studies were retrieved from four databases (PubMed, Embase, Cochrane Library, and Web of Science) up to July 2020 and screened based on established selection criteria. Thereafter, relevant data were extracted and heterogeneity tests were conducted to select appropriate effect models according to the chi-square test and I 2 statistics. Assessment of risk of bias was performed among the included studies. Finally, a meta-analysis was carried out to evaluate the effect of oral motor intervention in preterm infants according to four clinical indicators: transition time for oral feeding, length of hospital stay, feeding efficiency, and weight gain. Results Eighteen randomized controlled trials with 848 participants were selected to evaluate the effect of oral motor intervention on preterm infants. The meta-analysis results revealed that oral motor intervention could effectively reduce the transition time to full oral feeds and the length of hospital stay as well as increase feeding efficiency and weight gain. Conclusions Oral motor intervention was an effective way to improve oral feeding in preterm infants. It is worthy to be used widely in hospitals to improve the clinical outcomes of preterm infants and reduce the economic burdens of families and society. Future studies should seek to identify detailed intervention processes and intervention durations for clinical application.

Defect in neutrophil killing and increased susceptibility to infection with nonpathogenic gram-positive bacteria in peptidoglycan recognition protein-S (PGRP-S)–deficient mice

Blood ◽  
2003 ◽  
Vol 102 (2) ◽  
pp. 689-697 ◽  
Author(s):  
Roman Dziarski ◽  
Kenneth A. Platt ◽  
Eva Gelius ◽  
Håkan Steiner ◽  
Dipika Gupta
Keyword(s):  
Inflammatory Responses ◽  
Protein S ◽  
Intracellular Killing ◽  
Gram Positive ◽  
Peptidoglycan Recognition Protein ◽  
Susceptibility To Infection ◽  
Gram Positive Bacteria ◽  
Recognition Protein ◽  
Factor Α ◽  
Increased Susceptibility

AbstractInsect peptidoglycan recognition protein-S (PGRP-S), a member of a family of innate immunity pattern recognition molecules conserved from insects to mammals, recognizes bacterial cell wall peptidoglycan and activates 2 antimicrobial defense systems, prophenoloxidase cascade and antimicrobial peptides through Toll receptor. We show that mouse PGRP-S is present in neutrophil tertiary granules and that PGRP-S–deficient (PGRP-S-/-) mice have increased susceptibility to intraperitoneal infection with gram-positive bacteria of low pathogenicity but not with more pathogenic gram-positive or gram-negative bacteria. PGRP-S-/- mice have normal inflammatory responses and production of tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6). Neutrophils from PGRP-S-/- mice have normal phagocytic uptake of bacteria but are defective in intracellular killing and digestion of relatively nonpathogenic gram-positive bacteria. Therefore, mammalian PGRP-S functions in intracellular killing of bacteria. Thus, only bacterial recognition by PGRP-S, but not its effector function, is conserved from insects to mammals.

scholarly journals Nutrition and Covid-19 epidemic

2021 ◽  
Vol 117 (2) ◽  
pp. 1
Author(s):  
Tanja PAJK ŽONTAR ◽  
Rajko VIDRIH
Keyword(s):  
Physical Activity ◽  
Immune System ◽  
Immune Function ◽  
Omega 3 ◽  
Healthy Foods ◽  
Susceptibility To Infection ◽  
Iron And Zinc ◽  
Dietary Nutrient ◽  
Current Context ◽  
Increased Susceptibility

Proper nutrition is an essential part of an individual’s defence against numerous diseases including coronavirus disease SARS-CoV-2 (Covid-19). Nutritional status of individual is affected by several factors such as age, sex, health status, physical activity, life style and medications. Optimal nutrition and dietary nutrient intake impact the immune system, therefore the sustainable way to survive in current context is to strengthen the immune system. Inadequate intake of energy, protein, and specific micronutrients are associated with depressed immune function and increased susceptibility to infection. Predominantly vital for the encouraging of immune function are elements selenium, iron and zinc and vitamins A, D, C, E, B6, B9 (folate) and B12 as well as omega-3 polyunsaturated fatty acids. Thus, during this time it is important to take care of nutritional habits, following a healthy and balanced nutritional pattern containing a high amount of elements, antioxidants and vitamins. It is also recommended, that individuals should be mindful of physical activity, known to be associated with all-cause mortality. Regular physical activity also improves mental health and overall feelings of wellbeing. Thus, now in the time of epidemic, more than ever, wider access to healthy foods should be a top priority for governments around the world

scholarly journals Chediak-Higashi syndrome: reversal of increased susceptibility to infection by bone marrow transplantation

Blood ◽  
1976 ◽  
Vol 47 (4) ◽  
pp. 555-559
Author(s):  
JA Kazmierowski ◽  
RJ Elin ◽  
HY Reynolds ◽  
WA Durbin ◽  
SM Wolff
Keyword(s):  
Bone Marrow ◽  
Candida Albicans ◽  
Bone Marrow Transplantation ◽  
Human Disease ◽  
Marrow Transplantation ◽  
Normal Bone Marrow ◽  
Susceptibility To Infection ◽  
Normal Bone ◽  
Chediak Higashi Syndrome ◽  
Increased Susceptibility

Transplantation of normal bone marrow to mice with the Chediak-Higashi syndrome (CHS) resulted in normal granulopoiesis and a reversal of their increased susceptibility to challenge with intravenous Candida albicans. These findings suggest that (1) the leukocyte defect in CHS can be reversed by marrow transplantation and (2) the mechanism for increased susceptibility to infection in these animals is due to a bone- marrow-derived cellular defect. Because of similarities between murine and human CHS, bone marrow transplantation might be considered as a mode of therapy in selected cases of the human disease.

scholarly journals Effects of Different Integrase Inhibitors on Body Weight in Patients with HIV/AIDS: A Network Meta-Analysis

2020 ◽  
Author(s):  
Ruojing Bai ◽  
Shiyun Lv ◽  
Hao Wu ◽  
Lili Dai
Keyword(s):  
Body Weight ◽  
Weight Gain ◽  
Meta Analysis ◽  
Biomedical Literature ◽  
Cochrane Library ◽  
Weight Changes ◽  
Aids Patients ◽  
First Choice ◽  
Significant Difference ◽  
Hiv Aids

Abstract Background: Global antiretroviral therapy has entered the era of integrase strand transfer inhibitor (INSTI). Because INSTIs have the advantages of high antiviral efficacy, rapid virus inhibition, and good tolerance, they have become the first choice in international acquired immunodeficiency syndrome (AIDS) treatment guidelines. However, they may also increase the risk of obesity. There are differences in the effects of different INSTIs on weight gain in Human immunodeficiency virus (HIV) infection / AIDS patients, but there is no evidence-based medical evidence. This study aimed to assess the effect of different INSTIs on body weight in HIV/AIDS patients.Methods: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database, and Wanfang databases were searched by computer to screen the relevant literature on INSTI treatment of HIV/AIDS patients, extract the data on weight changes in the literature, and perform network meta-analysis using Stata16.0 software.Results: Eight articles reported weight changes in HIV/AIDS patients, and weight gain was higher after treatment with dolutegravir (DTG) than with elvitegravir (EVG) in HIV/AIDS patients, and the difference was statistically significant [MD = 1.13, (0.18, 2.07)]. The network meta-analysis's consistency test results showed no overall and local inconsistency, and there was no significant difference in the results of the direct and indirect comparison (P > 0.05). The rank order of probability was DTG (79.2%) > Bictegravir (BIC) (77.9%) > Raltegravir (RAL) (33.2%) > EVG (9.7%), suggesting that DTG may be the INSTI drug that causes the most significant weight gain in HIV/AIDS patients.Conclusion: According to the literature data analysis, among the existing INSTIs, DTG may be the drug that causes the highest weight gain in HIV/AIDS patients, followed by BIC.

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