scholarly journals Possible Noninvasive Biomarker of Eosinophilic Esophagitis: Clinical and Experimental Evidence

2016 ◽  
Vol 10 (3) ◽  
pp. 685-692 ◽  
Author(s):  
Sathisha Upparahalli Venkateshaiah ◽  
Murli Manohar ◽  
Alok K. Verma ◽  
Uwe Blecker ◽  
Anil Mishra
Keyword(s):  
Eosinophilic Esophagitis ◽  
Blood Test ◽  
Pediatric Population ◽  
Response To Therapy ◽  
Highly Sensitive ◽  
Before And After ◽  
Noninvasive Biomarker ◽  
Noninvasive Biomarkers ◽  
Blood Eosinophils

Eosinophilic esophagitis (EoE) diagnosis and follow-up response to therapy is based on repeated endoscopies and histological examination for eosinophils/HPF. The procedure is invasive and risky in particular for the pediatric population. Presently, there is no highly sensitive and specific noninvasive blood test available to monitor the disease pathogenesis. Reports indicate the expression of PDL1 (CD274) on the eosinophils in allergic patients. Herein, we report that CD274-expressing and -nonexpressing eosinophils were detected in both examined pediatric and adult EoE patients. We show that CD274 expression on blood eosinophils and blood mRNA expression levels increase in the blood of EoE patients and decrease following treatment. These observations are consistent with the esophageal eosinophilia of before and after treatment in both examined patients. These two clinical and experimental analysis reports provide the possibility that the CD274 mRNA and CD274-expressing esinophil levels may be novel possible noninvasive biomarkers for EoE.

scholarly journals Results of surgical treatment of children with PFAPA syndrome

2019 ◽  
pp. 244-251
Author(s):  
A. S. Yunusov ◽  
T. I. Garashchenko ◽  
P. I. Belavina ◽  
A. G. Ryazanskaya ◽  
E. V. Molodtsova ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Multidisciplinary Approach ◽  
Pediatric Population ◽  
Quality Of Life Indicators ◽  
Before And After ◽  
Pfapa Syndrome ◽  
Primary School Age

Rationale. Currently, the literature describes about 374 cases of Marshall syndrome. According to some authors, the prevalence of Marshall syndrome is 2.3 per 10,000 children, in general, the epidemiology of PFAPA syndrome in the pediatric population is unknown.Purpose. The aim of our study is to justify surgical treatment in children with Marshall syndrome. Objectives. The objectives of this study are to give a comparative assessment of the effectiveness of tonsillectomy and adenotonzyllectomy for this syndrome and to evaluate the quality of life indicators before and after surgical treatment.Materials and methods. The study included 26 patients with Marshall syndrome, of which 18 patients underwent adenotonzyllectomy and 8 patients underwent bilateral tonsillectomy. A clinical case of a typical manifestation of Marshall syndrome is also described, and follow-up results of the effectiveness of surgical treatment for Marshall syndrome are presented. In the course of the work, an adapted questionnaire was developed to assess the quality of life of parents of children with Marshall syndrome.Results. The result of our work is the fact that in relation to the relief of PFAPA-syndrome, children of preschool and primary school age have more effective adenotonsillectomy (88.2%), while tonsillectomy was effective only in 55.6% of patients.Conclusion. A multidisciplinary approach is required to address the diagnosis and treatment of Marshall syndrome.

scholarly journals MiR-4668 as a Novel Potential Biomarker for Eosinophilic Esophagitis

2020 ◽  
Vol 11 ◽  
pp. 215265672095337
Author(s):  
Neeti Bhardwaj ◽  
Maria Sena ◽  
Gisoo Ghaffari ◽  
Faoud Ishmael
Keyword(s):  
Eosinophilic Esophagitis ◽  
Mirna Expression ◽  
Saliva Sample ◽  
Allergic Diseases ◽  
Response To Therapy ◽  
Response To Treatment ◽  
Potential Biomarker ◽  
Before And After ◽  
Interesting Candidate

Introduction Eosinophilic esophagitis (EoE) is a clinico-pathological diagnosis characterized by esophageal dysfunction and eosinophilic infiltration of the esophagus. Demonstration of esophageal eosinophilia (more than 15 eosinophils/hpf) in biopsy specimen obtained by esophagogastroduodenoscopy (EGD) continues to be the gold standard for diagnosis and monitoring of response to therapy. There is a growing necessity for non-invasive biomarkers that can accurately diagnose this condition and assess response to therapy. While microRNAs (miRNA) are being investigated in allergic diseases, including EoE, not many studies have explored the role of salivary miRNAs in EoE. MiR-4668-5p is a particularly interesting candidate, as it is predicted to regulate TGF-beta signaling and has not previously been identified as a target in any allergy disease. We sought to further investigate the role of miR-4668 as a biomarker to characterize and monitor response to treatment with swallowed topical glucocorticoids. Methods After IRB approval, twenty-two adult patients with EoE were randomly enrolled to provide a saliva sample before and after 2 months of swallowed fluticasone therapy. Differences of miRNA expression before and after treatment were analyzed by paired T-test. A significance cutoff of <0.05 was used for all analyses. Results Expression of miR-4668 was higher in EoE vs. non-EoE subjects. The level of miR-4668 decreased in all subjects except one, with a mean fold change 0.49 ± 0.25. There was an association between miRNA expression and number of positive aeroallergens. The miR-4668 high group had a higher number of positive aeroallergen tests, while the miR-4668 low group had a greater number of subjects with drug allergies. Conclusions In this study, we identified that salivary miRNAs may serve as biomarkers to characterize EoE and response to topical corticosteroids. We specifically identified miR-4668 as a novel potential biomarker, which was not previously discovered as a target in EoE or any other allergic disease.

scholarly journals Platelet association with leukocytes in active eosinophilic esophagitis

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250521
Author(s):  
Kelly A. Bartig ◽  
Kristine E. Lee ◽  
Deane F. Mosher ◽  
Sameer K. Mathur ◽  
Mats W. Johansson
Keyword(s):  
Disease Activity ◽  
Eosinophilic Esophagitis ◽  
Area Under The Curve ◽  
Principal Component ◽  
Standard Of Care ◽  
Cell Types ◽  
High Power Field ◽  
Blood Leukocytes ◽  
Before And After ◽  
Blood Eosinophils

We previously demonstrated that the percentage of blood eosinophils that are associated with platelets and thus positive for CD41 (integrin αIIb-subunit) correlates with and predicts peak eosinophil count (PEC) in biopsies of eosinophilic esophagitis (EoE) patients after treatment. Thus, flow cytometric determination of CD41+ eosinophils is a potential measure of EoE disease activity. Determinants of association of platelets with eosinophils and other leukocytes in EoE are largely unknown. The objectives of this study were to test the hypotheses that platelets associate with blood leukocytes other than eosinophils in EoE and that such associations also predict EoE activity. Whole blood flow cytometry was performed on samples from 25 subjects before and after two months of standard of care EoE treatment. CD41 positivity of cells within gates for eosinophils, neutrophils, monocytes, lymphocytes, and natural killer cells was compared. We found that percent CD41+ neutrophils, monocytes, and eosinophils correlated with one another such that principal component analysis of the five cell types identified “myeloid” and “lymphoid” factors. Percent CD41+ neutrophils or monocytes, or the myeloid factor, like CD41+ eosinophils, correlated with PEC after treatment, and CD41+ neutrophils or the myeloid factor predicted PEC < 6/high power field after treatment, albeit with lower area under the curve than for CD41+ eosinophils. We conclude that the processes driving platelets to associate with eosinophils in EoE also drive association of platelets with neutrophils and monocytes and that association of platelets with all three cell types is related to disease activity. Clinicaltrials.gov identifier: NCT02775045.

scholarly journals Predictive Role of MRI and 18F FDG PET Response to Concurrent Chemoradiation in T2b Cervical Cancer on Clinical Outcome: A Retrospective Single Center Study

Cancers ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 659 ◽  
Author(s):  
Anna Myriam Perrone ◽  
Giulia Dondi ◽  
Manuela Coe ◽  
Martina Ferioli ◽  
Silvi Telo ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Tumor Response ◽  
Locally Advanced ◽  
False Negative ◽  
Response To Therapy ◽  
Imaging Tool ◽  
Pet Ct ◽  
Before And After ◽  
Radiological Response

Tumor response in locally advanced cervical cancer (LACC) is generally evaluated with MRI and PET, but this strategy is not supported by the literature. Therefore, we compared the diagnostic performance of these two techniques in the response evaluation to concurrent chemoradiotherapy (CCRT) in LACC. Patients with cervical cancer (CC) stage T2b treated with CCRT and submitted to MRI and PET/CT before and after treatment were enrolled in the study. All clinical, pathological, therapeutic, radiologic and follow-up data were collected and examined. The radiological response was analyzed and compared to the follow-up data. Data of 40 patients with LACC were analyzed. Agreement between MRI and PET/CT in the evaluation response to therapy was observed in 31/40 (77.5%) of cases. The agreement between MRI, PET/CT and follow-up data showed a Cohen kappa coefficient of 0.59 (95% CI = 0.267–0.913) and of 0.84 (95% CI = 0.636–1.00), respectively. Considering the evaluation of primary tumor response, PET/CT was correct in 97.5% of cases, and MRI in 92.5% of cases; no false negative cases were observed. These results suggest the use of PET/CT as a unique diagnostic imaging tool after CCRT, to correctly assess residual and progression disease.

scholarly journals Assessing the Risk Factors for Refractory Eosinophilic Esophagitis in Children and Adults

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Erminia Ridolo ◽  
Irene Martignago ◽  
Irene Pellicelli ◽  
Cristoforo Incorvaia
Keyword(s):  
Risk Factors ◽  
Food Allergy ◽  
Eosinophilic Esophagitis ◽  
Pediatric Population ◽  
Statistical Significance ◽  
Diagnostic Delay ◽  
First Line ◽  
Female Sex ◽  
First Line Therapy

Background. Up to one-third of the patients suffering from eosinophilic esophagitis (EoE) present a refractory form, as defined by nonresponsiveness in clinical, endoscopic, or histological assessment after first-line therapy. Several studies recently investigated which factors can influence the development of this disease, but very few analyzed the factors underlying refractory EoE. Methods. Medical charts of patients affected by EoE were retrospectively evaluated. Phenotyping of patients was conducted according to demographic, clinical, histological, and treatment variables. Then, patients were divided into responder and nonresponder to therapy and distinguished among children and adults. Results. Forty-five children and 35 adult EoE patients were included. In the pediatric population, female sex (p<0.05) and a higher score of visual analogue scale (VAS) at the follow-up visit (p=0.02) were significantly associated to the risk of refractory EoE. Among adults, statistical significance was reached for years of follow-up (p=0.001), diagnostic delay (p=0.03), use of antibiotics during infancy (p=0.01), and food allergy (p=0.04). Conclusions. Our study highlighted female sex and a higher VAS score at the time of follow-up visits as risk factors for refractory EoE in children, while the risk factors in adults were identified as fewer years of follow-up, greater diagnostic delay, use of antibiotics during infancy, and food allergy.

Osteoid osteomas: intraoperative bone scan–assisted resection

2009 ◽  
Vol 4 (3) ◽  
pp. 237-244 ◽  
Author(s):  
Donald J. Blaskiewicz ◽  
Durga R. Sure ◽  
Daniel J. Hedequist ◽  
John B. Emans ◽  
Frederick Grant ◽  
...  
Keyword(s):  
Average Length ◽  
Pediatric Population ◽  
Complete Resection ◽  
Benign Lesions ◽  
Highly Sensitive ◽  
Bone Scans ◽  
Surgical Adjunct ◽  
Initial Resection ◽  
Lesion Localization

Object Osteoid osteomas (OOs) are benign lesions of the spine, but can cause significant pain and spinal deformity in the pediatric population. They are often surgically elusive, and may require multiple surgical procedures to ensure complete resection. Nuclear medicine intraoperative bone scans (IOBSs) are highly sensitive for lesion localization and verification of complete surgical extirpation. Methods A retrospective review of 20 consecutive patients who had undergone resection of a spinal OO at the authors' institution was undertaken. In all cases, IOBSs were used for lesion localization and verification of resection. Postoperative imaging and clinical follow-up were obtained. Results The average length of follow-up was 56 months, with a range of 8–156 months. Five patients had undergone a total of 12 unsuccessful prior procedures for resection at other institutions where IOBSs were not used. In these patients, complete resection was accomplished with the use of IOBSs at the authors' institution. Of the 15 patients who presented to this institution with a newly diagnosed OO and who underwent IOBS-assisted resection, 14 had complete resection without recurrence. One patient, however, was found to have a discrete recurrence adjacent to the initial resection bed at the time of follow-up. Conclusions Osteoid osteomas are benign lesions of the spine, and complete resection is curative. If resection is incomplete, then recurrence is likely. The IOBS modality is highly sensitive for detecting OO and for guiding complete resection. The IOBS modality should be considered as a first-line surgical adjunct in cases of suspected OO.

scholarly journals West syndrome: long-term outcomes depending on etiology and treatment (literature review)

2019 ◽  
Vol 13 (4) ◽  
pp. 53-63
Author(s):  
T. M. Prygunova
Keyword(s):  
Epileptic Seizures ◽  
Severe Form ◽  
West Syndrome ◽  
Response To Therapy ◽  
Psychomotor Development ◽  
Disease Etiology ◽  
Before And After ◽  
Outpatient Settings

West syndrome is a severe form of childhood epilepsy associated with drug-resistant seizures and intellectual disability. The disease  is characterized by specific seizures called infantile spasms, hypsarrhythmia on the electroencephalogram, and delayed psychomotor development. The identification of the disease etiology may affect the prognosis and the choice of therapy. The following prognostic factors have been described so far: etiology, abnormal neurological signs, presence of other epileptic seizures before and after epileptic spasms, response to therapy regardless of the drug type. Difficulties associated with the diagnosis of West syndrome and long-term examination in outpatient settings lead to persistence of hypsarrhythmia and worsen the prognosis. Lack of universal standards for IS therapy results in significant diffe rences in treatment outcomes observed in different regions. Despite significant efforts made towards studying West syndrome, many aspects are still poorly understood. Further studies are needed to help physicians in choosing an optimal treatment strategy and appropriate duration  of follow-up as well as to improve the disease prognosis.

The Use of Antidepressants in School-Age Children

2005 ◽  
Vol 21 (6) ◽  
pp. 318-322 ◽  
Author(s):  
Kelly Brock ◽  
Bich Nguyen ◽  
Nianci Liu ◽  
Melissa Watkins ◽  
Thomas Reutzel
Keyword(s):  
Side Effects ◽  
Pediatric Population ◽  
School Setting ◽  
Response To Therapy ◽  
School Age Children ◽  
School Age ◽  
Or Education ◽  
Treatment Of Depression ◽  
The U.S

Approximately 5% of the pediatric population suffers from depression. Children suffering from depression should be treated first with some type of psychotherapy, cognitive therapy, and/or education. Pharmacotherapy (medications) should be used only as a last resort for those children suffering from severe, chronic, or recurring depression. The only antidepressant approved by the U.S. Food and Drug Administration for the treatment of depression in children is fluoxetine (Prozac), a selective serotonin reuptake inhibitor. In the school setting, children should be monitored closely upon the initiation of antidepressant therapy and changes in dosing or medication. They also should be monitored for side effects of the medication, response to therapy, and new signs of depression or worsening symptoms. After starting an antidepressant, children must be monitored closely for any changes in behavior, especially increased preoccupation with suicide. Any changes should be reported to the physician immediately for follow-up.

scholarly journals Hemodynamic and clinical effects of selexipag in children with pulmonary hypertension

2020 ◽  
Vol 10 (1) ◽  
pp. 204589401987654 ◽  
Author(s):  
Abraham Rothman ◽  
Gabriel Cruz ◽  
William N. Evans ◽  
Humberto Restrepo
Keyword(s):  
Pulmonary Hypertension ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Clinical Deterioration ◽  
Clinical Effects ◽  
Drug Dosing ◽  
Number Of Patients ◽  
Before And After ◽  
6 Minute Walk Test

Selexipag is an oral prostacyclin receptor agonist; it was recently approved for use in adults with pulmonary arterial hypertension. The safety and efficacy of selexipag has not yet been determined in the pediatric population. We describe short-term hemodynamic and clinical data with selexipag therapy in four pediatric patients with pulmonary hypertension. We reviewed clinical, echocardiographic, and hemodynamic data. One patient was transitioned from subcutaneous treprostinil to selexipag, and in three patients, selexipag was added as a third agent. Drug dosing was attained empirically based on patient body size. A follow-up catheterization was performed 12–18 months after initiation of selexipag therapy. All four patients tolerated selexipag well, without significant side effects. One patient transitioned successfully from subcutaneous treprostinil to selexipag. None of the four patients had clinical deterioration. In three patients who were able to perform a 6-minute walk test, pre and post selexipag distances were 350 and 400, 409 and 390, and 300 and 360 m, respectively. Echocardiograms showed no significant changes. Catheterization showed a variable change in pulmonary vascular resistance (small decrease in three patients and increase in one patient). Brain natriuretic peptide levels before and after selexipag in the four patients were 38 and 49, 33 and 54, 29 and 25, and 12 and 14 pg/mL, respectively. Selexipag use for 16–28 months was safe in four pediatric patients; none of them had clinical deterioration. Larger number of patients and longer follow-up intervals are necessary before further recommendations can be made.

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