Relationship between Clinical and Biologic Variables and Chloramphenicol Pharmacokinetic Parameters in Pediatric Patients with Sepsis

2000 ◽  
Vol 34 (3) ◽  
pp. 393-397 ◽  
Author(s):  
Gustavo Lugo Goytia ◽  
Ismael Lares-Asseff ◽  
María Gabriela Pérez Guillé ◽  
Adrián Guillé Pérez ◽  
Cynthia Larios Mejía
Keyword(s):  
Population Model ◽  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Pharmacokinetic Parameters ◽  
Pharmacokinetic Data ◽  
Study Group ◽  
Validation Group ◽  
Wbc Count ◽  
Biologic Factors

OBJECTIVE: To evaluate the influence of several clinical and biologic factors on the disposition kinetics of oral chloramphenicol in pediatric patients and to determine the usefulness of this information to predict chloramphenicol serum concentrations. STUDY DESIGN: The clinical, biologic, and pharmacokinetic data of 30 consecutive pediatric patients diagnosed with sepsis and admitted to a tertiary care center were analyzed retrospectively. The patients were randomly assigned to a study group and a validation group. The model was developed by a three-step approach involving Bayesian estimation of pharmacokinetic parameters, selection of covariates by principal component analysis, and final selection by stepwise multiple linear regression. The model was tested in the study group and compared with a general population model using a prediction error analysis. RESULTS: Regression analysis revealed that weight, albumin, and white blood cell (WBC) count were the most important determinants for chloramphenicol distribution volume, whereas age, WBC count, and serum creatinine were the most important determinants for chloramphenicol clearance. The performance of the constructed population model improved significantly in terms of both bias and precision compared with the general model when tested in the validation group. CONCLUSIONS: Clinical and biologic factors may significantly influence chloramphenicol's disposition in pediatric patients with sepsis and therefore should be considered in programming dosage regimens.

scholarly journals CHARACTERISTICS AND LONGER-TERM OUTCOMES OF PEDIATRIC PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY: A TERTIARY CARE CENTER EXPERIENCE

2019 ◽  
Vol 73 (9) ◽  
pp. 878
Author(s):  
Alaa Alashi ◽  
Laurence Svensson ◽  
Jared Klein ◽  
Kenneth Zahka ◽  
Nicholas Smedira ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center

Abstract W MP70: Characteristics of Patients With Microemboli Detected With Transcranial Doppler Monitoring

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Lauren Koffman ◽  
Zubair Ahmed ◽  
Rebecca Michael ◽  
Leasa Baus ◽  
Larry Raber ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Care Center ◽  
Cerebral Arteries ◽  
Tertiary Care ◽  
Cryptogenic Stroke ◽  
Final Analysis ◽  
Stroke Patients ◽  
Artery Disease ◽  
Wbc Count

Introduction: TCD emboli monitoring (TCDe) is a non-invasive tool used to detect the presence of ongoing microembolic signals (MES) in the intracranial arterial vessels. The clinical utility of this test in the evaluation of acute stroke patients has been debated. Our goal was to evaluate clinical factors associated with MES in ischemic stroke patients who underwent TCDe to determine which patient population may benefit from TCDe. Methods: Retrospective cohort study of adult patients admitted to our tertiary care center for TIA or ischemic stroke from 2011 to 2012 who underwent TCDe. Monitoring was performed for 20 minutes using a standardized protocol. Inclusion criteria included insonatation of both middle cerebral arteries and completion of TCD bubble study (TCB). Repeat TCDe performed on the same patient were excluded from the analysis. Demographic, clinical and objective data were collected using our EMR system. Results: Of the 113 patients included in the final analysis, mean age was 57.9 years and 46.9% were female. MES occurred in 33.6% patients. Mean # of MES was 9.3 (SD 60.6). Patients with MES were significantly younger (51.8 years vs 61.0, p.006) and had fewer vascular risk factors: diabetes (10.5% vs 33.3%, p 0.006), hyperlipidemia (23.7% vs 49.3%, p 0.007), hypertension (47.4% vs 17.33%, p 0.067), atrial fibrillation (7.9% vs 17.33 %, p 0.16), congestive heart failure (5.3% vs 10.7%, p 0.32) and coronary artery disease (18.4 % vs 29.3%, p 0.2). Cryptogenic stroke and the presence of right to left shunt (RLS) was more frequent in patients with MES than those without. Mean WBC count and usCRP were both nonsignificantly higher in patients with MES. Conclusions: Clinical characteristics of patients with MES on TCDe differed from those without MES, which may have diagnostic and clinical implications. Patients with MES were younger and had fewer stroke risk factors. MES were seen more often in patients with RLS and in those with cryptogenic stroke, which raises the possibility of an association between these two factors. Interestingly, patients with MES also had higher usCRP and WBC values, suggesting a possible inflammatory component to the occurrence of MES. More research is needed with a larger sample size to better define the significance of the above findings.

scholarly journals Clinical Spectrum of COVID-19 in a Pediatric Mexican Population

2020 ◽  
Author(s):  
Edgar Bustos-Cordova ◽  
Daniela Castillo-García ◽  
Magdalena Cerón-Rodriguez ◽  
Nadia Soler-Quiñones
Keyword(s):  
Emergency Department ◽  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Clinical Spectrum ◽  
Tertiary Care Center ◽  
Rt Pcr ◽  
Excessive Crying ◽  
Pcr Test

Abstract ObjectiveFrom the beginning of the COVID-19 pandemic, it has become evident that the spectrum of manifestations in children is different from those seen in adults. In this study, we aimed to describe a broader clinical spectrum of COVID-19 in children.MethodsIn this descriptive, prospective study, we included confirmed pediatric patients with COVID-19 who presented to the emergency department of a pediatric tertiary care center from April to July 2020. All patients were confirmed by the SARS-CoV-2 RT-PCR test, and we analyzed 24 symptoms and 25 signs.ResultsWe analyzed 50 patients with COVID-19. From the evaluated signs and symptoms, the most common symptoms were fever, excessive crying and dry cough, digestive symptoms were frequently found (24%), and the most common signs were pharyngeal erythema and irritability.ConclusionClinicians should recognize that the clinical spectrum of COVID-19 in children is wider than previously described, often with nonspecific signs and symptoms, and digestive symptoms should raise suspicion.

scholarly journals Perioperative hypothermia in pediatric patients operated in a tertiary care center: Incidence and correlates

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Osman ESEN ◽  
Gülseren YILMAZ ◽  
Nevin AYDIN
Keyword(s):  
Body Temperature ◽  
Surgical Procedures ◽  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Fluid Replacement ◽  
Prospective Clinical Study ◽  
Tertiary Care Center ◽  
Body Temperatures ◽  
Perioperative Hypothermia

Background & Objectives: Hypothermia, described as temperature < 35°C, is a frequent condition encountered in patients operated under general anesthesia. It is associated with significant morbidity and mortality. We aimed to estimate its incidence and to investigate the conditions associated with hypothermia in pediatric patients. Methods: This prospective clinical study was carried out in the operating theatre of a tertiary care center between August 2015 and September 2015. A total of 108 pediatric patients who underwent various surgical procedures that lasted for more than 30 minutes were enrolled. Baseline demographic data, types of surgical procedures, duration of operations, preoperative and perioperative body temperatures were recorded. The incidence of hypothermia and its possible correlates were sought. Results: Our series consisted of 108 children (77 males, 71.3%; 31 females, 28.7%) with an average age of 6.08±5.09 years were included in the study. There was no case diagnosed with hypothermia in the preoperative, perioperative and postoperative periods. Patients in American Society of Anesthesiologists classification (ASA) three group had significantly higher preoperative body temperatures compared to those in ASA-1 and ASA-2 groups (p = 0.027). The postoperative body temperature in patients receiving intravenous fluid replacement was significantly lower (p=0.017). Conclusion: For pediatric patients scheduled for surgical interventions, we recommend close monitorization and follow-up of body temperature, implementation of preventive measures to avoid hypothermia and routine perioperative heating. Avoidance of hypothermia may prevent hazardous consequences of postoperative hypothermia. doi: https://doi.org/10.12669/pjms.36.4.456 How to cite this:Esen O, Yilmaz G, Aydin N. Perioperative hypothermia in pediatric patients operated in a tertiary care center: Incidence and correlates. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.456 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Foreign body ingestion and associated factors in pediatric patients at a tertiary care center

2021 ◽  
Author(s):  
L.A. Navia-López ◽  
J.F. Cadena-León ◽  
K.R. Ignorosa-Arellano ◽  
E.M. Toro-Monjaraz ◽  
F. Zárate-Mondragón ◽  
...  
Keyword(s):  
Foreign Body ◽  
Associated Factors ◽  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Foreign Body Ingestion ◽  
Tertiary Care Center

scholarly journals Pediatric Dental Emergency Pattern and Dental Care Provided during COVID-19 Pandemic Lockdown at a Tertiary Care Center in Kathmandu, Nepal

2021 ◽  
Vol 2 (1) ◽  
pp. 3-11
Author(s):  
Senchhema Limbu ◽  
Parajeeta Dikshit ◽  
Manisha Malla ◽  
Lokesh Verma ◽  
Anju Khapung
Keyword(s):  
Dental Care ◽  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Definitive Treatment ◽  
Age Group ◽  
Cross Sectional ◽  
Common Diagnosis ◽  
Dental Hospital ◽  
Dental Emergency

 Introduction: Pediatric dental management is difficult in its own way which was even more challenging during COVID-19 outbreak and lockdown period. Constrained dental providing clinics and hospitals severely compromised the pediatric dental needs and services. Objective: The aim of this study was to describe pattern of dental emergencies encountered and services provided to the pediatric patients visiting a dental hospital during the first lockdown period in Kathmandu, Nepal. Methods: A cross sectional study was done from 24 March 2020 to 21 July 2020 among the pediatric patients who visited dental hospital during lockdown. Data was collected from questionnaire and dental case history sheet, and statistically analyzed in Statistical Package of Social Sciences (SPSS) version 20. Results: Of the total 172 pediatric patients of mean age 8.3± 2.60 years, majority were males (59.3%) and of 6-12 age group (76.2%). Major complain was mobile/retained teeth (38.4%) and most common diagnosis was exfoliating mobility (23.3%). According to American Dental Association (ADA, 2020) guidelines, urgent dental care (46.5%) followed by non-emergency dental care (43.6%) were mostly found. The predominant procedures were emergency (68.6%) and least was elective (9.3%) and treatment given to majority was extraction (51.8%).There was a statistically significant association between age group and pediatric dental care (ADA). Conclusions: The findings of this study regarding dental emergency encountered and definitive treatment received even during pandemic lockdown can be helpful in finding out how dental care was provided and can be applicable in similar future pandemics.

scholarly journals Evaluating the Clinical Outcomes of Parotid Hemangiomas in the Pediatric Patient Population

2019 ◽  
pp. 014556131987776
Author(s):  
Jacqueline Harris ◽  
James D. Phillips
Keyword(s):  
Pediatric Patients ◽  
Care Center ◽  
Tertiary Care ◽  
Interferon Α ◽  
Duration Of Treatment ◽  
Blocker Therapy ◽  
First Line Therapy ◽  
Age Of Diagnosis ◽  
Β Blocker ◽  
Accepted Practice

Introduction: Infantile hemangiomas (IHs) are the most common tumor of the parotid gland in children; however, there is no standard protocol for the treatment of IH. The generally accepted practice is to begin the patient on β-blocker therapy if there are no contraindications. Objective: The purpose of this study is to better understand the challenges and successes of management of pediatric patients with parotid IH. Methods: This retrospective study analyzed 15 patients diagnosed with parotid IH from 2009 to 2016 who were cared for at a tertiary care center. Demographic information, lesion characteristics, and treatment course were obtained through patient chart review. Results: Fifteen pediatric patients with parotid IH were evaluated. The female:male ratio was 4:1; the average age of diagnosis was 8.75 months. Most lesions were greater than 3 cm in their widest dimension (73.3%), and 13 patients underwent imaging to further clarify the parotid mass in their clinical workup. Fourteen patients began treatment with propranolol; 10 patients saw complete resolution of their IH (66.7%) and 3 had a partial response to β-blocker therapy (20%). After discontinuation of propranolol, 2 patients had regrowth 2 to 3 months later after regression and were restarted on therapy. The average duration of treatment was 9.9 ± 8.45 months. The known adverse effects of propranolol—hypoglycemia, hypotension, bradycardia, and bronchospasm—were not observed in any patient. Conclusion: In the treatment of parotid IH, propranolol is the generally accepted first-line therapy, as compared to corticosteroid or interferon α injections of years past. Parotid hemangiomas, however, have a lower response rate to propranolol and a similar recurrence rate compared to IH at other sites. The treatment duration necessary tends to be longer. Future studies will aim at identifying and evaluating potential predictors of outcomes to help inform the management of parotid hemangiomas.

scholarly journals Risk Assessment and Outcome of Venous Thromboembolism in Pediatric Population in an Academic Care Center of a Low-Middle Income Country

2021 ◽  
Vol 27 ◽  
pp. 107602962199589
Author(s):  
Muhammed Wahhaab Sadiq ◽  
Ronika Devi Ukrani ◽  
Aiman Arif ◽  
Inaara Akbar ◽  
Sadaf Altaf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Middle Income Country ◽  
Income Country ◽  
Tertiary Care Center ◽  
Middle Income

Venous thromboembolism (VTE) is a recognized complication of hospital stay in young patients in many developed countries, but such an information is largely unavailable from a low middle-income country (LMIC). This study aimed at identifying the frequency, risk factors, treatment options and outcome of deep venous thrombosis/pulmonary embolism (DVT/PE) in pediatric population in a tertiary care center from a LMIC. International classification of disease, ninth revision (ICD-9) was used to identify VTE in patients aged 0-18 years during January 2011 to September 2019. In-house computerized system was used to collect data for demographics, clinical and laboratory details. SPSS version 19 was used to analyzed data. The study was approved by Institutional ethical review committee (3872-Pat-ERC-15). During the study period, 134617 pediatric patients were hospitalized, DVT/PE was observed in 77 unique patients (47 males and 30 females) with a median (IQR) age of 14 (5-16) years equivalent to 5.9 VTE events /10,000 hospital admissions. Malignancy, community acquired infections and autoimmune diseases were the predominant risk factors (75%) in adolescent age-group while surgery for congenital heart anomalies was the primary reason (71%) in infants. Overall, lower extremity thrombosis was the most frequent (51%) followed by pulmonary embolism (25%). and upper extremity thrombosis (24%). Enoxaparin and unfractionated heparin were mainly used to treat VTE and all-cause mortality was 13% in the cohort studied. We observed substantial VTE events in pediatric patients during their hospital stay in a tertiary care center of a low-middle income country.

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