scholarly journals An audit assessing the monitoring of SSRIS after initiation in children and adolescents

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S41-S41
Author(s):  
Ella McGowan
Keyword(s):  
Adverse Effect ◽  
Side Effects ◽  
Adverse Effects ◽  
Children And Adolescents ◽  
Alternative Plan ◽  
Medication Dose ◽  
The Common ◽  
The One ◽  
Accurate Record

AimsTo identify children and adolescents started on SSRIs to see if they are being followed up in accordance to NICE and Maudsley guidelinesObjectivesHas the patient been followed up after a week to check for adverse effects or improvement in their mental state?Has the patient been re-evaluated every 4-6 weeks, if not is there an alternative plan?If there is no improvement has the dose been increased?If there is an adverse effect has the dose been lowered or the medication stopped?MethodPaper case notes including clinic letters and handwritten notes were reviewed on the 19/10/2020. The following data were collected anonymously.AgeGenderDate seen / Date medication startedName of medicationDate medication startedDate of Follow-upMonitoring of improvementMonitoring of adverse effectsOutcome of monitoringResultA total of 18 sets of cases were identified.Follow-up occurred in 17 of the 18 cases.The one case that had not been followed up had started the medication 8 weeks before the audit. The median follow-up time was 42 days (6 weeks). No cases were followed up within a week.Monitoring of improvement was recorded in 88% of case notes reviewed.Monitoring for adverse effects occurred in 36% of case notes and none of these patients had reported any side effects. 53% of cases did not have monitoring of adverse effects documented. There were two patients (11%) who did not take the medication as prescribed. One out of choice and one their parent had not collected it.The medication dose was increased in 22% of patients without clear documentation of monitoring for adverse effects.ConclusionAfter discussion with the clinical lead it was decided it is impractical to follow up patients a week after starting medication. However, patients and their carers should be informed of the side effects and advised to contact CAMHS if adverse effects occur.The area of practice that can be improved is the documentation of adverse effects at follow-up.Recommendations:All patients to be informed of the common side effects of the medication before it is initiated and advised to contact the CAMHS team if they have concernsAll CAMHS patients started on SSRIs should be followed up within 4-6 weeksAt follow-up any adverse events and clinical response should be discussedAn accurate record of the exchanges of the above information should be documented in the notesRe-audit

Does Lead at Low Dose Affect Intelligence in Children?

PEDIATRICS ◽  
1981 ◽  
Vol 68 (6) ◽  
pp. 894-896
Author(s):  
Herbert L. Needleman ◽  
David Bellinger ◽  
Alan Leviton
Keyword(s):  
Adverse Effects ◽  
Low Dose ◽  
Intelligence Test ◽  
Pediatric Clinic ◽  
Study Find ◽  
Group Data ◽  
Low Levels ◽  
The One ◽  
The Individual

Ernhart et al, on the basis of their own follow-up data and an incorrect critique of a single study, find reason to question the entire literature documenting the adverse effects of low levels of lead. They assert that, if effects exist, they are minimal. To reach this sweeping conclusion, they contradict or ignore the findings of the earlier study by Perino and Ernhart, misread a table from the one study they single out for criticism, and draw debatable conclusions from their own data. We conclude by calling the readers' attention to this sentence: "While the effects of subclinical lead intoxication may not be noted in the individual cases seen in a pediatric clinic, analysis of group data indicate quite clearly (emphasis added) that performance on an intelligence test is impaired."

Recommendations for Monitoring Lithium Therapy

1983 ◽  
Vol 17 (5) ◽  
pp. 346-350 ◽  
Author(s):  
Ronald B. Salem
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Serum Levels ◽  
Normal Serum ◽  
Lithium Therapy ◽  
Organ Systems

The literature concerning side effects of normal serum levels of lithium on various organ systems is reviewed. Suggestions for monitoring and managing these adverse effects are discussed. A table is presented that provides recommendations for evaluation prior to initiation and during follow-up of therapy.

Outcome of Patients Age 60 and Over with Acute Lymphoblastic Leukemia (ALL) Treated with a Modified Pediatric Protocol

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3962-3962 ◽  
Author(s):  
Susan Kao ◽  
Wei Xu ◽  
Vikas Gupta ◽  
Mark Minden ◽  
Andre Schuh ◽  
...  
Keyword(s):  
Overall Survival ◽  
Side Effects ◽  
Lymphoblastic Leukemia ◽  
Maintenance Phase ◽  
Induction Phase ◽  
Cns Prophylaxis ◽  
Grade 3 ◽  
One Year ◽  
The One

Abstract Acute lymphoblastic leukemia (ALL) in patients over age 60 years is a poor prognosis disease with complete remission rate of 50–60% and median overall survival of less than a year. Between July 2004 and June 2007, we treated 17 elderly patients with newly diagnosed ALL with a modified pediatric protocol that included a remission induction phase, a CNS prophylaxis phase with intrathecal chemotherapy × 4, a 21-week intensification phase (7 cycles × 3 weeks each), and a 72-week maintenance phase. Induction chemotherapy consisted of vincristine 2 mg weekly × 3, doxorubicin 30mg/m2 × 2 doses, methotrexate 40mg/m2 × 1, asparaginase 12,000/m2 U × 1, and dexamethasone 40mg/day × 8 doses; BCR-ABL+ patients received imatinib mesylate 400 mg daily × 16 days instead of asparaginase. The intensification phase consisted of vincristine 2 mg × 7 doses, doxorubicin 30mg/m2 × 7 doses, asparaginase 6000 U/m2 weekly × 21 doses, 6-mercaptopurine 14/21 days, and dexamethasone 6 mg BID × 5/21 days. BCR-ABL+ patients received imatinib 400 mg daily × 14/21 days instead of asparaginase. Maintenance was the same as intensification except that no asparaginase was given. The median age was 66 years (range 60–78 years). Seven patients (41%) were BCR-ABL+ and four (24%) were pre-B with WBC > 30. Major side effects during the induction phase included infection (71%), hyperglycemia requiring insulin (24%), and cardiac toxicity (18%). The complete remission (CR) rate was 71% with an induction mortality of 29%. Of the five induction deaths, four were due to bacterial sepsis or pneumonia, and one was due to tumor lysis syndrome. CNS prophylaxis was well-tolerated except in one patient who required IV hydration for nausea/vomiting. Eleven patients proceeded to intensification. Major side effects during the intensification phase included infections (64%), peripheral neuropathy (64%), thrombosis (27%), and grade 3 nausea/vomiting (27%). Two patients required hospitalization during the intensification phase; there was one myocardial infarction and one acute pancreatitis. Eleven patients proceeded to the maintenance phase; major side effects during maintenance included infections (36%) and grade 3 peripheral neuropathy (18%). Two patients (17%) have relapsed, both during early maintenance phase; both had had a number of dose modifications and delays during intensification. The one year overall survival (OS) was 71% and the median OS has not been reached. After a median follow-up duration of 17 months (range 9–40 months), the median relapse-free survival (RFS) of the CR patients has not been reached; the one year RFS was 82%. These results show that administering a modified pediatric protocol to patients over age 60 years with ALL is feasible with an improved CR rate than generally reported. The OS and RFS also compare favorably to previously reported results, although further follow-up is required. However, induction mortality was high, and infectious complications persisted throughout the entire course of induction and intensification, though much diminished during the maintenance phase. Accrual to the protocol is continuing.

scholarly journals Ocular Adverse Effects of Antidepressants – Need for an Ophthalmic Screening and Follow up Protocol

2019 ◽  
pp. 1-6
Author(s):  
Varsha Narayanan
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Selective Serotonin Reuptake Inhibitors ◽  
The Elderly ◽  
Visual Disturbance ◽  
Significant Rise ◽  
Angle Closure ◽  
Ocular Side ◽  
Screening Protocol

Depression is emerging to be one of the commonest mental health disorders worldwide affecting a wide age group. The prescription of antidepressants has risen considerably in last decade with a preference for using newer antidepressants like Selective Serotonin Reuptake Inhibitors (SSRIs). There have been many published reports of Ocular side effects with Antidepressants related to Dry eye, Visual disturbance, Angle closure glaucoma and Retinal effects. There has also been a significant rise in antidepressant usage by the elderly, which is a population at risk for ocular adverse effects. Therefore, it is pertinent to understand the antidepressants from the perspective of their mechanisms of action and all possible Ocular adverse effects, and develop an Ophthalmic screening protocol and follow up for patients being put on Antidepressants. Patients should also be counselled for reporting alert signs of ocular side effects immediately. These steps may help to avert and decrease visual complications with Antidepressants.

Delayed Onset Adverse Effects Associated with Rituximab Treatment in Patients with Non-Hodgkin's Lymphoma – A Single Center Experience

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4888-4888
Author(s):  
Evelyne Shabad ◽  
Eitan Mangoubi ◽  
Olga Valkovsky ◽  
Salim Habib Alla ◽  
Miriam Quitt
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
B Cell ◽  
Medical Center ◽  
Infectious Complications ◽  
Risk Of Infection ◽  
Late Side Effects ◽  
Late Side ◽  
Lymphoma Type

Abstract Abstract 4888 Introduction. Rituximab (RTX), a chimeric anti-CD20 monoclonal antibody, has now become a cornerstone in the treatment of many CD20 positive B cell lymphomas. RTX induces a rapid depletion of normal CD20 expressing B-cells in the peripheral blood, and their level remains low for 2–6 months before returning to pretreatment levels, generally within 12 months. Some patients develop late side effects such as neutropenia and hypogammaglobulinemia regardless of the level of B cells; these patients are more vulnerable to life-threatening infections. In addition, treatment with RTX is a risk factor for HBV and HCV reactivation in occult and chronic carriers. Aims. The goal of the study was to identify the clinical and laboratory indices that serve as predictors of risk for developing late side effects in patients with non- Hodgkin's lymphoma (NHL) treated with RTX in a single medical center. Statistical correlation between these variables and occurrence of infectious complications secondary to late hematologic adverse effects such as neutropenia and hypogammaglobulinemia was performed. Clinical outcome of patients with infectious complications was evaluated. Methods. We conducted a retrospective study of 120 patients who were diagnosed with B cell NHL and were followed in the Institute of Hematology of Carmel Medical Center in Haifa between 2000–2008. Each patient received RTX as a monotherapy or in combination with chemotherapy. All the patients in the study were RTX naive. The study was approved by the local Helsinki committee. For the purpose of the study, the follow-up period was defined from the time of termination until a period of 24 months from the last therapeutic dose of RTX. Late side effects were defined as side effects that appeared 6 months after the last therapeutic dose of RTX or continued beyond the 6 month period. For each variable we evaluated retrospectively the proportion of patients who developed late side effects. In an attempt to characterize the risk factors such as age, sex, status of lymphoma, type of chemotherapy, number of treatments and the interval between the treatments, comparison was made between the patients who developed side effects and those who did not. Results. Twenty two of the 120 surveyed patients (18.3%) developed infections. Hematologic side effects observed were anemia (28.3%), thrombocytopenia (7.5%) and neutropenia (3.28%). We found that age ≥70 years and recurrence of the disease were significant risk factors for developing side effects. Laboratory indexes that were found to be significant predicting factors for the risk of infection were: PMN<2.0×109/mm3, LDH≥480u/l, SGOT≥44u/l. An active disease and grade 3–4 neutropenia were both variables that contributed to the risk of infection. There was no correlation between gender of patients, the histological type and stage of lymphoma, type of chemotherapy, or number of therapeutic courses with RTX and increased risk of infection. We did not find any association between hypogammaglobulinemia and the risk of infection. Regarding viral infections, only 2 HCV carriers were detected in the study; none of them had reactivation during the follow up. Reactivation of HBV occurred in 1 of the 6 occult carriers (16.7%). Conclusions. In recent years RTX has become an essential component in the therapy of B cell NHL. Late side effects of this drug are now beginning to emerge and require new risk assessment for safety. Twenty two patients (18.33%) in our study developed infectious complications. This rate is lower than the one reported in the literature (30%). In contrast, mortality following infection was 7% as compared to 2% reported in the literature. These data can be explained by the fact that our study examined hospitalized patients who had more severe infections. Our study supports the previous observation that hypogammaglobulinemia does not present a risk factor for infection. In contrary to the reports in literature, we found no correlation between the number of therapeutic courses with RTX and the risk of infection. In conclusion, we suggest that RTX should be used with caution in patients over age 70 and in patients with recurrent disease. In order to confirm our findings, further assessment of late adverse effects on the larger population of patients treated with rituximab is warranted. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Optimizing asteroid orbit computation forGaiawith normal points

2018 ◽  
Vol 620 ◽  
pp. A101
Author(s):  
Grigori Fedorets ◽  
Karri Muinonen ◽  
Thierry Pauwels ◽  
Mikael Granvik ◽  
Paolo Tanga ◽  
...  
Keyword(s):  
Independent Observation ◽  
Short Term ◽  
New Approach ◽  
Low Weight ◽  
Main Effect ◽  
The Common ◽  
Characteristic Features ◽  
The One ◽  
Orbit Computation

Context.In addition to the systematic observations of known solar-system objects (SSOs), a continuous processing of new discoveries requiring fast responses is implemented as the short-term processing ofGaiaSSO observations, providing alerts for ground-based follow-up observers. The common independent observation approach for the purposes of orbit computation has led to unrealistically large ephemeris prediction uncertainties when processing realGaiadata.Aims.We aim to provide ground-based observers with a cloud of sky positions that is shrunk to a fraction of the previously expected search area by making use of the characteristic features ofGaiaastrometry. This enhances the efficiency ofGaiaSSO follow-up network and leads to an increased rate of asteroid discoveries with reasonably constrained orbits with the help of ground-based follow-up observations ofGaiaasteroids.Methods.We took advantage of the separation of positional errors ofGaiaSSO observations into a random and systematic component. We treated theGaiaobservations in an alternative way by collapsing up to ten observations that correspond to a single transit into a single so-called normal point. We implemented this input procedure in theGaiaSSO short-term processing pipeline and the OpenOrb software.Results.We validate our approach by performing extensive comparisons between the independent observation and normal point input methods and compare them to the observed positions of previously known asteroids. The new approach reduces the ephemeris uncertainty by a factor of between three and ten compared to the situation where each point is treated as a separate observation.Conclusions.Our new data treatment improves the sky prediction for theGaiaSSO observations by removing low-weight orbital solutions. These solutions originate from excessive curvature of observations, introduced by short-term variations ofGaiaattitude on the one hand, and, as a main effect, shrinking of systematic error bars in the independent observation case on the other hand. We anticipate that a similar approach may also be utilized in a situation where observations from a single observatory dominate.

scholarly journals Adverse effects associated to the application of ultrasound-guided percutaneous needle electrolysis

2019 ◽  
Vol 02 (02) ◽  
pp. 115-116
Author(s):  
Valera Garrido F. ◽  
Minaya Muñoz F. ◽  
Ramírez Martínez P. ◽  
Medina i Mirapeix F.
Keyword(s):  
Adverse Effect ◽  
Physical Therapy ◽  
Adverse Effects ◽  
Case Series ◽  
Lower Limbs ◽  
Ultrasound Guided ◽  
Post Intervention ◽  
Case Series Study ◽  
Degenerative Processes

Abstract Background Percutaneous needle electrolysis is a technique of invasive physical therapy which is increasingly used by physical therapists in their clinical practice. However, to date, no studies have analyzed the presence of adverse effects.The aim of the present study was to evaluate the incidence of adverse effects and the associated impact of the application of ultrasound-guided percutaneous needle electrolysis in disorders of the neuro-musculoskeletal system. Material and Method A prospective case series study was performed over a period of six months at the Sannus Clinic center (Madrid). A sample of patients was identified and recruited, and follow-up was performed up to six months after discharge. Initial information was collected regarding demographic data (age and sex) and clinical data (affected structure, area, type of pain and process associated to the pathology). During each of the sessions performed, percutaneous needle electrolysis was applied in an isolated manner and data were gathered on the treatment received, as well as the presence of any adverse effects. An adverse effect was considered as being any incident related with the application of percutaneous needle electrolysis which caused any damage, as perceived by both the patient and the physical therapist who applied the treatment. The type of adverse effect was recorded (pain, bleeding, hematoma, post-intervention vegetative reactions [sweating, pallor, abdominal discomfort], syncope, skin lesions, damage to organs, nerve lesions, pneumothorax, metal allergy), the moment these appeared (during application, after application, days after the application), its severity (transitory (<48h), reversible (resolved at discharge), irreversible), its impact (did not require any specific intervention, required an additional specific physical therapy intervention, required intervention from medical staff (without hospitalization), and cause (insufficient skill with the technique, malpractice, inappropriate protocol). The adverse effects were classified as mild or severe depending on whether or not an intervention was required. Results 214 patients (60.7% men; 39.3% women) received a total of 772 sessions, the mean number (and standard deviation) of sessions was 3.6 (1.1). The totality of patients treated with ultrasound-guided percutaneous electrolysis received more than one session, according to the methodology described by Valera & Minaya. The main reasons for consultation were tendinous pathologies (70.5%), muscle pathologies (11.7%), ligaments (6.5%), joint capsule-synovia (5.6%), nerve entrapments (4.2%) and others (1.4%). Degenerative processes were more common than acute inflammatory processes. The greatest incidence was in the lower limbs. Degenerative processes were significantly more frequent than tendinous problems. During the 772 sessions of ultrasound-guided percutaneous needle electrolysis, the most common adverse effects were pain during the intervention (96.1%) and in the days following treatment (71.1%), as well as mild vasovagal responses post-intervention (80.1%). One syncope was recorded (0.13%). All the effects were transitory and without impact. No hematomas were detected in the days after a mild bleeding, when this occurred (9.3%). Interventions were performed on the thorax in 1.5% of the procedures, close to organs (0.5%) or close to peripheral nerves (4.2%) without any adverse effect. In the 6-week follow-up after discharge no adverse effects were detected. Conclusions Percutaneous needle electrolysis is a safe technique. The adverse effects provoked by the application of percutaneous needle electrolysis are mild, transitory, without impact on the person's health and following a homogenous pattern. The pain and the mild vasovagal response associated with the intervention are frequent and inherent to the stimulus generated by the needling and the electric current employed.

Fifteen-minute consultation: A clinical approach to the management of the child with hypertonia

2020 ◽  
Vol 105 (5) ◽  
pp. 276-281
Author(s):  
Daniel E Lumsden ◽  
Jill Cadwgan
Keyword(s):  
Side Effects ◽  
Young People ◽  
Adverse Effects ◽  
Clinical Approach ◽  
High Tone ◽  
Children And Young People ◽  
Functional Problems

Elevated tone (hypertonia) is a common problem seen in the paediatric clinic. For most children and young people, hypertonia is just one aspect of a broader disorder of movement and posture. This paper describes a clinical approach to the management of hypertonia in children, considering the contribution of high tone to the functional problems experienced by the child, the potential adverse effects of reducing tone, side effects of the intervention and the importance of setting objectives/goals for intervention which can be measured at follow-up. We describe this as the ‘MOTOR’ approach and provide some examples of how it can be used in practice.

scholarly journals Weight Gain and Hair Loss during Anti-TNF Therapy

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Abdo Lutf ◽  
Mohammed Hammoudeh
Keyword(s):  
Adverse Effect ◽  
Weight Gain ◽  
Psoriatic Arthritis ◽  
Ankylosing Spondylitis ◽  
Side Effects ◽  
Adverse Effects ◽  
Hair Loss ◽  
Rheumatology Clinic ◽  
Relationship Of ◽  
The Relationship

Objectives. To investigate the incidence of weight gain and hair loss as adverse effects of anti-TNF therapy in rheumatic diseases.Methods. Patients using anti-TNF therapy, who are followed in rheumatology clinic, were interviewed using a questionnaire to investigate the side effects of anti-TNF therapy. Patients who complained of hair loss and weight gain were asked additional questions concerning the relationship of these adverse effects to anti-TNF use, whether therapy was stopped because of these adverse effects and if the adverse effects reversed after stopping therapy. The files were reviewed to follow the weight change before, during, and after discontinuation of anti-TNF.Results. One hundred fifty consecutive patients (82 RA, 34 ankylosing spondylitis, 32 psoriatic arthritis, and 4 for other indications) were interviewed .Weight gain was observed in 20 patients (13.3%) with average gain of 5.5 Kg. Anti-TNF was stopped in five patients because of this adverse effect. Hair loss during anti-TNf therapy was reported in five females (3.3%) and anti-TNF therapy was stopped in all of them.Conclusion. Weight gain and hair loss appear to be associated with anti-TNF therapy and may be one reason for discontinuing the therapy.

scholarly journals Response to Front-Line Imatinib Treatment in Children and Adolescents with CML - Data from a Large Pediatric Cohort

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. 898-898
Author(s):  
Meinolf Suttorp ◽  
Philipp Schulze ◽  
Ingmar Glauche ◽  
Gudrun Göhring ◽  
Nils Von Neuhoff ◽  
...  
Keyword(s):  
Stem Cell ◽  
Side Effects ◽  
Stem Cell Transplantation ◽  
Children And Adolescents ◽  
Research Funding ◽  
Newly Diagnosed ◽  
First Line ◽  
Free Survival ◽  
Grade 3

Abstract Purpose Results of the prospective trial "CML-PAED-II" assessing treatment efficacy and side effects in children and adolescents with newly diagnosed chronic myeloid leukemia (CML) are reported. Patients and Methods 156 patients (age range 1.3-18.0 years, 91 male) with newly diagnosed CML (N= 146 chronic phase (CML-CP), N= 3 accelerated phase (CML-AP), N= 7 blastic phase (CML-BP)) received imatinib upfront (300 mg/m², 400 mg/m², 500 mg/m², respectively). Therapy response, progression-free survival, causes of treatment failure and proportion of patients undergoing stem cell transplantation were analyzed in 148 patients with complete data. Results Event-free survival rate at 18 months for pediatric patients diagnosed in CML-CP (median follow-up time 25 months, range: 0.1-120) was 97% (95% CI, 94.2%-99.9%). According to the 2006 ELN-criteria complete hematologic response at month 3, complete cytogenetic response (CCyR) at month 12, and molecular response (MR3.0) at month 18 were achieved in 98%, in 63%, and 59% of the patients, respectively. At month 36 on continuous first line imatinib or 2nd generation tyrosine kinase inhibitor treatment, 86% of the patients achieved CCyR and 74% achieved MR3.0. 66% of the patients experienced at least one side effect. Imatinib-related anemia was the most frequent toxicity observed if all grades were considered (N=98; 66%) while neutropenia was the most frequently reported grade 3/4 hematologic adverse effect (N=22; 15%). Among non-hematologic toxicities, all grades of gastrointestinal toxicity were observed most frequently (N=57, 38%), however, it occurred at lower grades 1/2 in all but one patient. Higher grade 3/4 musculoskeletal pain was also frequent (N=53, 36%). Twenty-seven patients (18%) had to discontinue treatment temporarily while nine patients permanently terminated imatinib due to non-tolerable side effects (neutropenia N= 4, muscle cramps N= 3, skin N= 1, liver N= 1). Thirty-eight patients (27%) experienced imatinib failure because of unsatisfactory response (N= 27) or intolerance (N= 9). 28/148 patients (19%) underwent stem cell transplantation (SCT). In the SCT sub-cohort 2/23 patients diagnosed in CML-CP, 0/1 in CML-AP, and 2/4 in CML-BP, respectively, died of relapse (N=3) or SCT-related complications (N=2). Conclusion This large pediatric trial provides evidence confirming that first line imatinib in children is highly effective. Observed adverse effects are acceptable and mainly comprise hematological side effects. Long term outcome and effects of a potentially life-long TKI treatment have to be registered in cooperation with adult hematologists in extended surveillance follow-up studies. Disclosures Suttorp: Novartis: Research Funding. Schrappe: JAZZ Pharma: Consultancy, Research Funding; Baxalta: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; SigmaTau: Consultancy, Research Funding; Medac: Consultancy, Research Funding. Thiede: Novartis: Consultancy, Speakers Bureau; Bayer: Consultancy, Speakers Bureau; Roche: Consultancy; Agendix: Employment.

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