scholarly journals Immunohistochemical Staining for Uroguanylin, a Satiety Hormone, is Decreased in Intestinal Tissue Specimens From Female Adolescents With Obesity

2017 ◽  
Vol 21 (3) ◽  
pp. 285-295 ◽  
Author(s):  
Matthew D Di Guglielmo ◽  
Lacey Perdue ◽  
Adebowale Adeyemi ◽  
Kenneth L van Golen ◽  
Diana U Corao
Keyword(s):  
Chart Review ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Staining Intensity ◽  
Female Adolescents ◽  
Guanylyl Cyclase C ◽  
Age Cohort ◽  
Satiety Hormone ◽  
The Difference ◽  
Tissue Specimens

Gastrointestinal tract–secreted satiety hormones play a significant role in one of the largest health-care challenges for children and adults, obesity. Recent studies in mice identified a novel role for uroguanylin, the endogenous intestinal hormone that binds guanylyl cyclase C (GUCY2C), in regulating satiety via a gut-brain signaling pathway. Mice bred without GUCY2C receptors over-ate and developed obesity. We hypothesized that intestinal uroguanylin expression in pediatric patients with obesity would be lower than patients without obesity, and we attempted to examine the difference with immunohistochemistry. Retrospective chart review of gastrointestinal endoscopic procedures at an academic children’s hospital identified patients with normal pathology findings on biopsy. Children aged 8–17 were included in the review; we analyzed biopsy samples from 20 matched pairs that differed only by body mass index (BMI)-for-age (average: 25%–75% vs. high: >95%). Biopsies of the duodenum, terminal ileum, ascending colon, and descending colon were subjected to immunohistochemistry for GUCY2C, uroguanylin, and the endogenous colonic hormone, guanylin. Intensity staining of all specimens was scored by a blinded pathologist. The overall staining intensity for females with high BMI-for-age was less for uroguanylin and guanylin as compared to average BMI-for-age females while GUCY2C staining was equal. Males did not exhibit different staining intensities for uroguanylin or guanylin. More matched female pairs had greater uroguanylin and guanylin staining in the average BMI-for-age cohort. The intestinal expression of uroguanylin, a key satiety hormone, appears to be diminished in female pediatric patients in the setting of obesity.

An Evaluation of the Effects of Elevated Body Mass Index on Skeletal Age

2021 ◽  
Author(s):  
Michael H. French ◽  
Michael S. Kung ◽  
W. Nathan Holmes ◽  
Hossein Aziz ◽  
Evelyn S. Thomas ◽  
...  
Keyword(s):  
Chart Review ◽  
Pediatric Patients ◽  
Intraclass Correlation ◽  
Retrospective Chart Review ◽  
Skeletal Age ◽  
Chronological Age ◽  
Age Group ◽  
Obese Children ◽  
Significant Difference ◽  
Hand Radiographs

Abstract BackgroundMany treatment decisions in children’s Orthopaedics are based on age. This study determined whether a discrepancy between chronological age (CA) and skeletal age (SA) is dependent on BMI and if overweight or obese children would have an advanced SA.Materials and Methods120 children between ages 8-17 with an adequate hand radiograph and a correlating BMI were enrolled by retrospective chart review. Stratification based on age, sex, ethnicity, and BMI percentile was performed. For each age group, 6 males and 6 females were selected with 50% of each group having an elevated BMI. Two blinded physicians independently evaluated hand radiographs and recorded the SA. Statistical analyses evaluated inter-rater reliability and any discrepancy between groups.ResultsThe final statistical analysis included 96 children. The Intraclass Correlation Coefficient for SA determined by the two reviewers was excellent at 0.95. A difference of 13 months was found between CA and SA in the elevated BMI cohort versus the non-elevated BMI cohort, (p<0.001). No significant difference was seen between CA and SA for the non-elevated cohort (p=0.72), while matching for age and sex. ConclusionChronological age and skeletal age are not always equivalent especially in pediatric patients who are overweight or obese.

65 Complication rate of cuffed versus uncuffed PICC lines placed by interventional radiology in pediatric patients

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e46-e46
Author(s):  
Maria Al Bandari ◽  
John Donnellan ◽  
Filomena Tavares
Keyword(s):  
Chart Review ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Electronic Record ◽  
Subject Area ◽  
Mechanical Failure ◽  
Complication Rates ◽  
Tertiary Referral Centre ◽  
Complications Rate ◽  
Premature Removal

Abstract Primary Subject area Paediatric Radiology Background Peripherally inserted central catheters are commonly used in pediatrics to offer stable access for administering prolonged courses of antibiotics, chemotherapy, parenteral nutrition, or other intravenous fluids. Objectives To assess the complication rates of cuffed versus uncuffed PICCs in a pediatric tertiary referral centre. Design/Methods Research ethics board approval was sought and granted. A dual arm study design was employed with a retrospective chart review of PICCs inserted between June 2017 - June 2018, and a prospective chart review of PICCS inserted between January 2019 - June 2019 at a large tertiary pediatric referral center. Data collected from the electronic record included age, weight, and diagnosis. Line type, size, location, insertion and removal dates, and indications were recorded. Primary outcome was removal of PICC after completion of therapy or premature removal due to the following complications: infection, thrombosis, or mechanical failure (defined as catheter breakage, blockage, or dislodgement). Results The study included 266 patients. Across all patients weighing &lt; 10 kg, 90.5% of those with cuffed PICCs and 65% of those with uncuffed catheters completed therapy. The predominant complication resulting in premature removal was mechanical failure, but this was only observed in patients with uncuffed catheters (25%). Infection was also observed only in uncuffed catheters (10%), and thrombosis (4.8%) was only in the cuffed lines. For patients weighing ≥ 10 kg, 86% of those with cuffed PICCs and 77.2% with uncuffed catheters completed therapy. More complications were observed in uncuffed catheters (infection 7.7%, mechanical failure 6.6%, thrombosis 5%). Infection resulting in premature removal occurred in 7% of cuffed catheters. There was no reported mechanical failure or thrombosis in the cuffed group. The distribution of diagnoses was relatively homogenous between the groups for most diagnoses. However, there was a higher percentage of oncology patients in the uncuffed group (23%) than the cuffed group (7%) due to the need for power-injectable lines, which were not available in a cuffed variant during this study. Conclusion All-cause pediatric PICC-associated complications rate in the neonate group for patients &lt; 10kg in the uncuffed group is 35% and in the cuffed group is 4.8%. Whereas in the pediatric group ≥ 10kg, all-cause pediatric PICC-associated complications rate in the uncuffed group is 19.3% and in the cuffed group is 7%. There were no mechanical complications in the cuffed group and the vast majority of lines made it to completion of therapy. This work supports utilization of cuffed PICC lines in selected pediatric patients.

scholarly journals Is Orally Administered Pentobarbital a Safe and Effective Alternative to Chloral Hydrate for Pediatric Procedural Sedation?

2018 ◽  
Vol 23 (6) ◽  
pp. 460-465
Author(s):  
Jordan Anderson ◽  
Sevilay Dalabih ◽  
Esma Birisi ◽  
Abdallah Dalabih
Keyword(s):  
Chart Review ◽  
Chloral Hydrate ◽  
Pediatric Patients ◽  
Age Groups ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Age Group ◽  
Imaging Studies ◽  
Airway Complications ◽  
Adequate Sedation

OBJECTIVES Chloral hydrate had been extensively used for children undergoing sedation for imaging studies, but after the manufacturer discontinued production, pediatric sedation providers explored alternative sedation medications. Those medications needed to be at least as safe and as effective as chloral hydrate. In this study, we examined if pentobarbital is a suitable replacement for chloral hydrate. METHODS Subjects who received pentobarbital were recruited from a prospectively collected database, whereas we used a retrospective chart review to study subjects who received chloral hydrate. Sedation success was defined as the ability to provide adequate sedation using a single medication. We included electively performed sedations for subjects aged 2 months to 3 years who received either pentobarbital or chloral hydrate orally. We excluded subjects stratified as American Academy of Anesthesiologists category III or higher and those who received sedation for electroencephalogram. The data collected captured subject demographics and complications. RESULTS Five hundred thirty-four subjects were included in the final analysis, 368 in the chloral hydrate group and 166 in the pentobarbital group. Subjects who received pentobarbital had a statistically significant higher success rate [136 (82%) vs 238 (65%), p &lt; 0.001], but longer sleeping time (18.1% vs 0%, p &lt; 0.001) in all age groups. Subjects who received chloral hydrate had a higher risk of airway complications in the &lt;1 year of age group (6.5% vs 1.8%, p = 0.03). CONCLUSIONS For pediatric patients younger than 3 years of age undergoing sedation for imaging studies, oral pentobarbital may be at least as effective and as safe as chloral hydrate, making it an acceptable and practical alternative.

A sixteen‐year single‐center retrospective chart review of Spitz nevi and spitzoid neoplasms in pediatric patients

2020 ◽  
Vol 37 (6) ◽  
pp. 1073-1082
Author(s):  
Olivia M.T. Davies ◽  
Jacquelyn Majerowski ◽  
Annette Segura ◽  
Scott W. Kelley ◽  
Olayemi Sokumbi ◽  
...  
Keyword(s):  
Chart Review ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Single Center ◽  
Spitz Nevi

scholarly journals Perioperative Intravenous Acetaminophen in Pediatric Tonsillectomies

2018 ◽  
Vol 53 (5) ◽  
pp. 316-320 ◽  
Author(s):  
Brandi Bowman ◽  
Leslie Sanchez ◽  
Preeyaporn Sarangarm
Keyword(s):  
Chart Review ◽  
Primary Outcome ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Descriptive Statistics ◽  
Pain Medications ◽  
Frequent Administration ◽  
Intravenous Acetaminophen ◽  
Sparing Effect ◽  
Opiate Administration

Purpose: This study investigated the effect of perioperative intravenous (IV) acetaminophen on opioid requirements in pediatric patients undergoing tonsillectomy at a single center. Methods: This retrospective chart review included patients who were less than 18 years old and underwent an outpatient tonsillectomy procedure. Patients who received non–Food and Drug Administration (FDA)-approved dosing of IV acetaminophen, without documented weights, and on chronic pain medications at the time of the procedure were excluded. The primary outcome was opioid requirements postoperatively prior to discharge measured as morphine equivalents per kilogram. Descriptive statistics were used to compare differences between groups. A multivariate analysis was performed, accounting for differences between groups in baseline and procedural characteristics. Results: In total, 157 patients were included in this study, of whom 55 had received IV acetaminophen and 102 had not. The average IV acetaminophen dose for was 14.5 mg/kg for patients weighing less than 50 kg (n = 22); the remaining patients received the maximum 1 g dose. Patients who received IV acetaminophen were less likely to be administered postoperative opiates as compared with those did not (45.5% vs 63.7%, odds ratio = 0.48, P = .036). There was a trend toward a decrease in total amount of opiates administered with IV acetaminophen (0 vs 0.033 µg/kg, P = .61). After adjusting for age and documented pain assessment, IV acetaminophen administration remained a significant factor for postoperative opiate administration. Conclusions: Perioperative administration of IV acetaminophen was associated with less frequent administration of symptom-directed opiates in pediatric tonsillectomies. This finding indicates that the agent may have an opioid-sparing effect in this patient population.

Clinical features and sex differences in pediatric post-traumatic headache: A retrospective chart review at a Boston area concussion clinic

Cephalalgia ◽  
2019 ◽  
Vol 40 (7) ◽  
pp. 701-711 ◽  
Author(s):  
Haley McEvoy ◽  
David Borsook ◽  
Scott A Holmes
Keyword(s):  
Clinical Features ◽  
Chart Review ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Retrospective Chart Review ◽  
Post Injury ◽  
Equivalent Representation ◽  
Childhood Education ◽  
History Of ◽  
Post Traumatic

Background Often concussion/mTBI triggers a chronic headache syndrome called persistent post-traumatic headache (P-PTH) that can last from months to years post-injury, and produce significant disruption of childhood education, social interaction and development. Although prevalent and highly disabling, P-PTH is underrepresented in headache and pain research and lacks clear definition and pathophysiology. Clinical presentation of P-PTH frequently resembles that of other headache disorders, like migraine, yet the pathophysiological mechanisms are distinct and not fully understood, making the disorder difficult to treat in the clinical setting. Methods In a retrospective analysis of 1506 pediatric patients attending Boston Children’s Hospital clinics, demographic trends, symptom features, and the influence of sex on clinical presentation of PTH are presented. We compare clinical characteristics of P-PTH with a published cohort of migraine patients to evaluate the clinical features that are unique to P-PTH. Results Findings show that despite equivalent representation of sex in the clinic, P-PTH is expressed more in females than males and is weighted towards somatic symptoms. Relative to migraine, PTH is less associated with a family history of headache. Conclusions The ability to identify persons with PTH can help manage risk factors and identify persons likely to develop persistent post-concussion symptoms.

Early Detection of Renal Dysfunction in Pediatric Sickle Cell Patients

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1017-1017
Author(s):  
Marwah W. Farooqui ◽  
Santosh Saraf ◽  
Victor R. Gordeuk ◽  
Kimberly Czech ◽  
Eunice John ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Renal Dysfunction ◽  
Sickle Cell ◽  
Chart Review ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
The Other ◽  
Cell Disease ◽  
Urine Protein ◽  
Sickle Cell Nephropathy

Abstract Abstract 1017 In sickle cell disease, patients are predisposed to renal dysfunction and eventual renal failure as they reach adulthood. Many advances have been made within the field of sickle cell anemia, yet to this day sickle cell nephropathy remains an important cause of mortality in adult patients. Previous studies have determined that proteinuria and hematuria are two useful markers of sickle cell nephropathy. Currently, the best marker for detecting early renal dysfunction is proteinuria on urine dipstick due to its ease of use and efficiency. Our goal in this study is to determine the age at which the first signs of renal dysfunction appear. Pediatric patients with sickle cell disease were selected for a retrospective chart review to determine age of onset for renal abnormalities. The sickle cell pediatric roster was used from the Children's Hospital University of Illinois to study a total of 175 patients within the age range of 0–31 years. Urinalysis was captured at patient's baseline when available and possible risk factors for glomerular dysfunction were studied. Factors such as urine protein and blood on dipstick were recorded and proteinuria was further quantified by using the urine protein to creatinine ratio. Blood on dipstick was further analyzed by red blood cells on microscopic urinalysis. Patients with positive urine for blood on dipstick with <5 RBCs on microscopic UA were marked as patients with hemoglobinuria. Other factors such as sickle cell hemoglobin type, LDH, reticulocyte count, HbF, and hydroxyurea treatment were also recorded to look for correlation with predictors of early renal dysfunction. The Fisher's exact test was used to compute the (two-tailed) probability. Urinalysis results were available for 141 of the 175 pediatric patients from the sickle cell roster. From the 141 patients that were studied 65% of the patients had urinalysis done at baseline, the other 35% had UA when acutely ill. The mean overall age was 9.9 years and a total of 25 of the 141 (17.7%) patients were observed to have proteinuria on dipstick. In the proteinuria group, 64% of the UA were obtained at baseline and the other 36% were during a sick visit. The majority (66%) of these ‘sick’ patients were febrile under the age of 7. Obtaining a UA during an acute illness could skew our results since pediatric patients who are acutely ill may have transient proteinuria but none at baseline. In our pediatric sickle cell population, about 14% had hemoglobinuria. Analysis of only baseline UA showed that no patients under the age of 5 at baseline had proteinuria and there is a strong correlation between age and proteinuria (R2 = 0.81, p<0.02). Similarly there is a correlation between age and hemoglobinuria (R2 = 0.57). Hemoglobinuria is occasionally observed in 11.4% of children <5 years of age, and at 12.9% in the teenage group. A significant increase in incidence of hemoglobinuria is noted in the young adults (40%). Of the 16 patients with hemoglobinuria only 8 had concurrent proteinuria. A larger sample size is needed to determine whether proteinuria and hemoglobinuria are independent versus correlated markers of early renal dysfunction. Preliminary analyses of baseline UA found no correlations between proteinuria and Hb level, LDH, reticulocytes, serum creatinine, or creatinine clearance. From this retrospective chart review in this pediatric sickle cell disease population, it can be deduced that proteinuria becomes a concern in sickle patients in the adolescent years while hemoglobinuria appears in late teen to young adult years. It can be concluded that the first clinical signs of renal dysfunction which lead to nephropathy in sickle patients are more frequently seen in adolescent to late teen years and this is likely the marks the beginning of the deterioration of kidney function. Further studies are needed for multivariate analysis of other markers (GFR, Cr, Cr Clearance) of nephropathy and to improve early detection of renal dysfunction by conducting longitudinal studies. Our goal is to improve our current practice by routine screening in sickle patients to preserve renal function and improve the morbidity and mortality related to sickle cell nephropathy in the aging patient. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Occipital headaches and neuroimaging in children

Neurology ◽  
2017 ◽  
Vol 89 (5) ◽  
pp. 469-474 ◽  
Author(s):  
Joshua J. Bear ◽  
Amy A. Gelfand ◽  
Peter J. Goadsby ◽  
Nancy Bass
Keyword(s):  
Cohort Study ◽  
Chart Review ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Radiographic Evidence ◽  
Head Pain ◽  
Neurology Clinic ◽  
The Common ◽  
Clinically Significant

Objective:To investigate the common thinking, as reinforced by the International Classification of Headache Disorders, 3rd edition (beta), that occipital headaches in children are rare and suggestive of serious intracranial pathology.Methods:We performed a retrospective chart review cohort study of all patients ≤18 years of age referred to a university child neurology clinic for headache in 2009. Patients were stratified by headache location: solely occipital, occipital plus other area(s) of head pain, or no occipital involvement. Children with abnormal neurologic examinations were excluded. We assessed location as a predictor of whether neuroimaging was ordered and whether intracranial pathology was found. Analyses were performed with cohort study tools in Stata/SE 13.0 (StataCorp, College Station, TX).Results:A total of 308 patients were included. Median age was 12 years (32 months–18 years), and 57% were female. Headaches were solely occipital in 7% and occipital-plus in 14%. Patients with occipital head pain were more likely to undergo neuroimaging than those without occipital involvement (solely occipital: 95%, relative risk [RR] 10.5, 95% confidence interval [CI] 1.4–77.3; occipital-plus: 88%, RR 3.7, 95% CI 1.5–9.2; no occipital pain: 63%, referent). Occipital pain alone or with other locations was not significantly associated with radiographic evidence of clinically significant intracranial pathology.Conclusions:Children with occipital headache are more likely to undergo neuroimaging. In the absence of concerning features on the history and in the setting of a normal neurologic examination, neuroimaging can be deferred in most pediatric patients when occipital pain is present.

scholarly journals Augmented ustekinumab dosing is needed to achieve clinical response in patients with anti-TNF refractory pediatric Crohn’s disease: a retrospective chart review

F1000Research ◽  
2021 ◽  
Vol 9 ◽  
pp. 316
Author(s):  
Phinga Do ◽  
John Andersen ◽  
Ashish Patel ◽  
Gaith Semrin ◽  
Luis Sifuentes-Dominguez ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Response ◽  
Chart Review ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Previous Treatment ◽  
Therapeutic Drug ◽  
Duration Of Treatment ◽  
Drug Levels

Background: Ustekinumab is a monoclonal antibody that inhibits interleukins 12 and 23. It is approved for treatment of Crohn’s disease (CD) in adults; however, there is a paucity of data regarding its use in pediatric CD. We describe our experience using ustekinumab in anti-TNF refractory CD pediatric patients. Methods: We performed a retrospective chart review on pediatric patients with CD who were started on ustekinumab from January 2016 to November 2018. We collected patient’s clinical history, previous treatment history, surgeries related to CD, disease severity, as measured by abbrPCDAI, and endoscopic severity as recorded by SES-CD before and after ustekinumab. Results: We identified 10 patients with CD who were started on ustekinumab due to non-response to currently approved agents. Seven patients needed augmented maintenance dosing every 4-6 weeks to achieve clinical response or remission. Six of these seven patients had therapeutic drug monitoring during the course of treatment, with five patients showing subtherapeutic drug levels of <4.5 μg/mL while on standard maintenance dosing every 8 weeks, and four patients showing therapeutic drug levels of >4.5 μg/mL on augmented dosing interval. The remaining three patients were on standard maintenance dosing for the duration of treatment. Conclusion: In this retrospective chart review, 7 out of 10 patients with anti-TNF refractory pediatric-onset CD required augmented maintenance doses of ustekinumab to achieve clinical response or remission. A prospective study is needed to define appropriate ustekinumab dosing and interval in management of pediatric CD.

scholarly journals Similar Long-Term Outcomes in Children Presenting With Abscess vs Phlegmon at Diagnosis of Crohn Disease

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Andrew W Fondell ◽  
Maua H Mosha ◽  
Ross M Maltz ◽  
Brendan M Boyle ◽  
Barbara Joanna Niklinska-Schirtz ◽  
...  
Keyword(s):  
Crohn Disease ◽  
Chart Review ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Limited Data ◽  
Long Term Outcomes ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Disease Present

Abstract Background Limited data are available for long-term outcomes of pediatric patients with abdominal abscess or phlegmon at diagnosis of Crohn disease. Methods We performed a retrospective chart review of such children over a recent 6-year period at 5 pediatric inflammatory bowel diseases. Results Fifty-two patients (mean age 15.9 ± 1.8 years) were reviewed. Thirty-six had an abscess and 27 (75%) required resectional therapy compared to 16 with phlegmon which 10 (63%) requiring surgery. Overall (37/52) 71% had surgery which was performed within 6 months in 32 (86%). Conclusions A similar high surgical rate exists whether pediatric patients with Crohn disease present with abscess or phlegmon.

Sign in / Sign up

Export Citation Format

Share Document