scholarly journals CRYPTOSPORIDIOSIS IN PEDIATRIC PATIENTS

1998 â—½  
Vol 40 (3) â—½  
pp. 197-200 â—½  
Author(s):  
Nélida SAREDI â—½  
Javier BAVA
Keyword(s):  
Abdominal Pain â—½  
Celiac Disease â—½  
Pediatric Patients â—½  
Buenos Aires â—½  
Running Water â—½  
Concentration Technique â—½  
Bowel Movements â—½  
Stool Samples â—½  
The Mean â—½  
Sanitary Conditions

Cryptosporidium was detected in 21 (3.8%) individual stool samples collected from 553 pediatric patients hospitalized in our center employing a Telemann concentration technique (formalinethercentrifugation) and stained with the modified Kinyoun method. The mean age of populations with Cryptosporidiosis (16 boys and 5 girls) was 11 months; 15 months for girls and 6.5 for boys. Ages of 81% of them were less than 19 months. Seventysix per cent of patients lived on the outskirts of Buenos Aires and 71% lacked pretreated running water at home. In 62% of the cases parasitological diagnoses coincided with warm seasons. At diagnosis mucous (63%) or watery (36%) diarrhea was presented in 90% of the patients with a median of 5 (38) bowel movements per day. Fever was presented in 66% of patients while abdominal pain and vomits in 60% and 52%, respectively. The median time from hospitalization up to parasitologic diagnosis was 20 days. Concomitant diseases observed were malnutrition, acute leukemia, bronchiolitis, HIV infection, anemia, celiac disease, myelofibrosis, vitelline sac tumor, neutropenia, osteosarcoma and dehydration. Cryptosporidiosis in our environment seems to occur more frequently in children younger than 18 months of age; who present diarrhea; are immunodeficient; come from a low socioeconomical background; and who live in poor sanitary conditions with no potable running water.

scholarly journals Eosinophilic Esophagitis in Brazilian Pediatric Patients

2013 â—½  
Vol 7 â—½  
pp. CMPed.S12733 â—½  
Author(s):  
Mayra Isabel Correia Pinheiro â—½  
Luciano Pamplona De Góes Cavalcanti â—½  
Rodrigo Schuler Honório â—½  
Luïs Hélder De Alencar Moreno â—½  
Mayara Carvalho Fortes â—½  
...  
Keyword(s):  
Abdominal Pain â—½  
Topical Corticosteroid â—½  
Eosinophilic Esophagitis â—½  
Pediatric Patients â—½  
Erosive Esophagitis â—½  
Normal Mucosa â—½  
Patient Treatment â—½  
Therapeutic Approaches â—½  
Endoscopic Findings â—½  
The Mean

We examined 11 pediatric patients with eosinophilic esophagitis with a tardy diagnosis. The symptoms were initially thought to be related to other diseases, leading to the use of inadequate therapeutic approaches. The patients were between 3 and 17 years old (mean 7.8 ± 3.8 years), and 8 of the patients were male. Common symptoms included abdominal pain, regurgitation, difficulty in gaining weight, vomiting, dysphagia, and coughing. The mean age for the onset of symptoms was 4.3 ± 2.9 years. Endoscopic findings included normal mucosa in five (45%) patients, thickening of the mucosa with longitudinal grooves in three (27%), erosive esophagitis in two (18%), and a whitish stippling in one (9%) patient. Treatment included the use of a topical corticosteroid for 10 patients. In eight (73%) cases, the treatment made the symptoms disappear. Ten patients underwent histopathological management after treatment, with a decrease in the number of eosinophils.

scholarly journals Patient and Parent Satisfaction with a Dietitian-and Nurse-Led Celiac Disease Clinic for Children at the Stollery Children’S Hospital, Edmonton, Alberta

10.1155/2013/537160 â—½  
2013 â—½  
Vol 27 (8) â—½  
pp. 463-466 â—½  
Author(s):  
Seema Rajani â—½  
Jessica Sawyer-Bennett â—½  
Leanne Shirton â—½  
Gail DeHaan â—½  
Cheryl Kluthe â—½  
...  
Keyword(s):  
Celiac Disease â—½  
Online Survey â—½  
Pediatric Patients â—½  
Parent Satisfaction â—½  
Clinic Attendance â—½  
Present Survey â—½  
Disease Clinic â—½  
The Mean â—½  
Regular Contact

OBJECTIVE: To assess patient and parent satisfaction with a primarily nurse- and dietitian-led celiac disease clinic in a tertiary pediatric centre.METHODS: An online survey was sent to families and patients attending the Stollery Children’s Hospital’s Multidisciplinary Pediatric Celiac Clinic (Edmonton, Alberta) since 2007. The survey focused on clinic attendance, satisfaction with clinic structure, processes, and education and preference for alternatives to the current process. Respondents were asked to rank satisfaction or preference on a five-point Likert scale, with 1 being lowest and 5 being highest.RESULTS: Most satisfaction related to follow-up with serology (4.6) and with a dietitian (4.3). The most preferred changes included either meeting the entire multidisciplinary team after the biopsy (4.7), or meeting with only the dietitian and nurse after the biopsy (4.4). The preferred education resources were the Internet (4.3) and the dietitian (4.2). The mean overall satisfaction score of the Multidisciplinary Pediatric Celiac Clinic was 4.0.CONCLUSIONS: Results of the present survey suggested that patients and families value a multidisciplinary follow-up clinic for children with celiac disease. In particular, feedback based on repeat blood work and regular contact with a dietitian were highly valued. The present survey, outlining the most valued aspects of the clinic, may be useful for service delivery in other regions. In addition, it provides information on how to better support pediatric patients with celiac disease.

scholarly journals The concordance of endoscopic and histologic findings of 530 pediatric patients suspicious for celiac disease in a referral center, Isfahan, Iran

2020 â—½  
Vol 5 (2) â—½  
pp. e27-e27
Author(s):  
Azar Naimi â—½  
Azar Baradaran â—½  
Elahe Pirpiran â—½  
Peiman Nasri â—½  
Masoud Akhlaghi
Keyword(s):  
Celiac Disease â—½  
Sampling Method â—½  
Pediatric Patients â—½  
Data Gathering â—½  
Age And Gender â—½  
Agreement Coefficient â—½  
The Mean â—½  
Spss Software â—½  
And Gender â—½  
Kappa Agreement

Introduction: The purpose of this study is evaluation of concordance of histologic and endoscopic findings in pediatrics referred to Imam Hossein children’s hospital, in Isfahan for evaluation of celiac disease. An accurate prediction of the likelihood of a histologic finding in the setting of a visually normal endoscopy can help prepare families for unanticipated results. Patients and Methods: This is a retrospective study conducted from 2015-2017. The sampling method is census and all eligible patients are included in the study. At the beginning of the work, obtaining consent for entering the project has been done through interviews. After that, patients information such as file number, age and gender according to the file were entered into the data gathering sheet. Data were analyzed using SPSS software version 22. Pvalue< 0.05 was considered significant. Results: Around 530 patients suspected of having celiac disease participated in the present study. The mean age of the subjects was 6.88 ± 4.31 years. Among them, 57.6% (305 patients) were girls and 42.4% (225 patients) were boys. According to the results, the kappa agreement coefficient is equal to 0.42. There was moderate agreement between endoscopy and pathology findings (kappa = 0.42). Conclusion: The results of the study and the kappa Cohen coefficient indicate the appropriateness of using endoscopy in patients with suspected celiac disease.

scholarly journals Multicentre, non-interventional study of the efficacy and tolerability of linaclotide in the treatment of irritable bowel syndrome with constipation in primary, secondary and tertiary centres: the Alpine study

BMJ Open â—½  
2019 â—½  
Vol 9 (12) â—½  
pp. e025627 â—½  
Author(s):  
Daniel Pohl â—½  
Michael Fried â—½  
Dominic Lawrance â—½  
Elmar Beck â—½  
Heinz F. Hammer
Keyword(s):  
Irritable Bowel Syndrome â—½  
Abdominal Pain â—½  
Clinical Practice â—½  
Routine Clinical Practice â—½  
Secondary Outcome â—½  
Interventional Study â—½  
Intensity Score â—½  
Bowel Movements â—½  
The Mean â—½  
Irritable Bowel

ObjectivesWe evaluated the effectiveness and tolerability of linaclotide, a minimally absorbed guanylate cyclase-C agonist, in patients with irritable bowel syndrome with constipation (IBS-C) in routine clinical practice.SettingA multicentre, non-interventional study conducted between December 2013 and November 2015 across 31 primary, secondary and tertiary centres in Austria and Switzerland.ParticipantsThe study enrolled 138 patients aged ≥18 years with moderate-to-severe IBS-C. Treatment decision was at the physician’s discretion. Patients with known hypersensitivity to the study drug or suspected mechanical obstruction were excluded. The mean age of participants was 50 years, and >75% of the patients were women. 128 patients completed the study.Primary and secondary outcome measuresData were collected at weeks 0 and 4 in Austria and weeks 0, 4 and 16 in Switzerland. The primary effectiveness endpoints included severity of abdominal pain and bloating (11-point numerical rating scale [0=no pain/bloating to 10=worst possible pain/bloating]), frequency of bowel movements and physicians’ global effectiveness of linaclotide. Treatment-related adverse events (AEs) were recorded.ResultsFollowing a 4-week treatment period, the mean intensity score of abdominal pain was reduced from 5.8 at baseline to 2.7, while the bloating intensity score was reduced from 5.8 at baseline to 3.1e (both indices p<0.001). The frequency of mean weekly bowel movements increased from 2.1 at baseline to 4.5 at week 4 (p<0.001). Global effectiveness and tolerability of linaclotide were assessed by the treating physicians as ‘good’ or ‘excellent’ in >70% of patients. In total, 31 AEs were reported in 22 patients, the most common being diarrhoea, reported by 6 (7%) and 8 (15.4%) patients in Austria and Switzerland, respectively.ConclusionsPatients with IBS-C receiving linaclotide experienced effective treatment of moderate-to-severe symptoms in routine clinical practice. Linaclotide was safe and well tolerated and no new safety concerns were raised, supporting results from previous clinical trials.

scholarly journals Cyclospora cayetanensis in sputum and stool samples

2000 â—½  
Vol 42 (2) â—½  
pp. 115-117 â—½  
Author(s):  
Angela Beatriz DI GLIULLO â—½  
Marta S. CRIBARI â—½  
Amadeo Javier BAVA â—½  
Jorge S. CICCONETTI â—½  
Roberto COLLAZOS
Keyword(s):  
Potable Water â—½  
Buenos Aires â—½  
Sputum Sample â—½  
Hymenolepis Nana â—½  
Cyclospora Cayetanensis â—½  
Loss Of Weight â—½  
Stool Samples â—½  
Sanitary Conditions â—½  
First Time â—½  
Hiv Negative

We report the observation of acid-fast Cyclospora cayetanensis oocysts in a sputum sample. The patient, a 60 year-old, HIV negative man, was successfully treated for pulmonary tuberculosis during 1997. On February 1998, he was admitted to our center due to loss of weight, cough with purulent expectoration, dysphonia and a radiological picture of pulmonary fibrosis. Bacilloscopic study of sputum (negative for acid-fast bacilli) stained with Ziehl-Neelsen technique showed large (8-10 µm) spherical, acid-fast Cyclospora cayetanensis oocysts. No other pathogens were isolated on cultures from this sample or from laryngeal biopsy. Serial parasitologic studies showed C. cayetanensis and also eggs of Trichuris trichiura, Ascaris lumbricoides and Hymenolepis nana and of Entamoeba coli cysts. The patient lives in the outskirts of Buenos Aires in a brick-made house with potable water and works as builder of sewers. He travelled in several occasions to the rural area of province of Tucumán which has poor sanitary conditions. C. cayetanensis is an emergent agent of diarrhea and as far as we know this is the first time the parasite is observed in respiratory samples.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 â—½  
Vol 24 (5) â—½  
pp. 549-557
Author(s):  
Malia McAvoy â—½  
Heather J. McCrea â—½  
Vamsidhar Chavakula â—½  
Hoon Choi â—½  
Wenya Linda Bi â—½  
...  
Keyword(s):  
Conservative Management â—½  
Functional Outcomes â—½  
Pediatric Patients â—½  
Clinical Presentation â—½  
Case Series â—½  
Csf Leak â—½  
Single Institution â—½  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

Hydrocephalus-related quality of life as assessed by children and their caregivers

2020 â—½  
Vol 26 (4) â—½  
pp. 353-363 â—½  
Author(s):  
Kathrin Zimmerman â—½  
Bobby May â—½  
Katherine Barnes â—½  
Anastasia Arynchyna â—½  
Elizabeth N. Alford â—½  
...  
Keyword(s):  
Posttraumatic Stress â—½  
Traumatic Stress â—½  
Pediatric Patients â—½  
Emotional Health â—½  
Social Emotional â—½  
Proxy Report â—½  
Cognitive Health â—½  
The Mean â—½  
Anxiety Depression

OBJECTIVEHydrocephalus is a chronic medical condition that has a significant impact on children and their caregivers. The objective of this study was to measure the quality of life (QOL) of children with hydrocephalus, as assessed by both caregivers and patients.METHODSPediatric patients with hydrocephalus and their caregivers were enrolled during routine neurosurgery clinic visits. The Hydrocephalus Outcomes Questionnaire (HOQ), a report of hydrocephalus-related QOL, was administered to both children with hydrocephalus (self-report) and their caregivers (proxy report about the child). Patients with hydrocephalus also completed measures of anxiety, depression, fatigue, traumatic stress, and headache. Caregivers completed a proxy report of child traumatic stress and a measure of caregiver burden. Demographic information was collected from administration of the Psychosocial Assessment Tool (version 2.0) and from the medical record. Child and caregiver HOQ scores were analyzed and correlated with clinical, demographic, and psychological variables.RESULTSThe mean overall HOQ score (parent assessment of child QOL) was 0.68. HOQ Physical Health, Social-Emotional Health, and Cognitive Health subscore averages were 0.69, 0.73, and 0.54, respectively. The mean overall child self-assessment (cHOQ) score was 0.77, with cHOQ Physical Health, Social-Emotional Health, and Cognitive Health subscore means of 0.84, 0.79, and 0.66, respectively. Thirty-nine dyads were analyzed, in which both a child with hydrocephalus and his or her caregiver completed the cHOQ and HOQ. There was a positive correlation between parent and child scores (p < 0.004 for all subscores). Child scores were consistently higher than parent scores. Variables that showed association with caregiver-assessed QOL in at least one domain included child age, etiology of hydrocephalus, and history of endoscopic third ventriculostomy. There was a significant negative relationship (rho −0.48 to −0.60) between child-reported cHOQ score and child-reported measures of posttraumatic stress, anxiety, depression, and fatigue. There was a similar significant relationship between caregiver report of child’s QOL (HOQ) and caregiver assessment of the child’s posttraumatic stress symptoms as well as their assessment of burden of care (rho = −0.59 and rho = −0.51, respectively). No relationship between parent-reported HOQ and child-reported psychosocial factors was significant. No clinical or demographic variables were associated with child self-assessed cHOQ.CONCLUSIONSPediatric patients with hydrocephalus consistently rate their own QOL higher than their caregivers do. Psychological factors such as anxiety and posttraumatic stress may be associated with lower QOL. These findings warrant further exploration.

Celiac Disease in Kosovar Albanian Children: Evaluation of Clinical Features and Diagnosis

2020 â—½  
Vol 16 (3) â—½  
pp. 241-247
Author(s):  
Atifete Ramosaj-Morina â—½  
Alije Keka-Sylaj â—½  
Arbana Baloku Zejnullahu â—½  
Lidvana Spahiu â—½  
Virgjina Hasbahta â—½  
...  
Keyword(s):  
Celiac Disease â—½  
Disease Onset â—½  
Clinical Manifestations â—½  
Gastrointestinal Symptoms â—½  
Dominant Mode â—½  
Primary School Children â—½  
Cross Sectional â—½  
Classical Form â—½  
Wide Range â—½  
The Mean

Background: Celiac disease is an immune-mediated disorder characterized by variable clinical manifestations, specific antibodies, HLA-DQ2/DQ8 haplotypes, and enteropathy. Objectives: The aim of this study was to present the clinical spectrum and patterns of celiac disease in Kosovar Albanian children. Methods: A cross-sectional retrospective study was performed with Albanian children aged 0-18 years, treated for celiac disease in the Pediatric Clinic, University Clinical Center of Kosovo from 2005 to 2016. Results: During the study period, 63 children were treated for celiac disease. The mean age at diagnosis was 5.5 years (SD ± 3.31). The mean age at celiac disease onset was 3.3 years (SD ± 2.02), while the mean delay from the first symptoms indicative of celiac disease to diagnosis was 2.2 years (SD ± 2.09). More than 70% of the patients were diagnosed in the first 7 years of life, mainly presented with gastrointestinal symptoms, while primary school children and adolescents mostly showed atypical symptoms (p<0.001). The classical form of celiac disease occurred in 78% of the cases. Sixty (95%) patients carried HLA-DQ2.5, DQ2.2 and/or HLA-DQ8 heterodimers, and only three of them tested negative. Conclusions: Kosovo, as the majority of developing countries, is still facing the classical form of celiac disease as the dominant mode of presentation; as a result, most children with other forms of the celiac disease remain undiagnosed. : Physicians should be aware of the wide range of clinical presentations and utilize low testing thresholds in order to prevent potential long-term problems associated with untreated celiac disease.

scholarly journals Non-Celiac Gluten Sensitivity: A Challenging Diagnosis in Children with Abdominal Pain

10.1159/000493929 â—½  
2018 â—½  
Vol 73 (Suppl. 4) â—½  
pp. 39-46 â—½  
Author(s):  
Frank M. Ruemmele
Keyword(s):  
Abdominal Pain â—½  
Celiac Disease â—½  
Clinical Symptoms â—½  
Gluten Sensitivity â—½  
Gluten Free â—½  
Clear Cut â—½  
Clinical Presentations â—½  
New Findings â—½  
Three Phase â—½  
Gi Symptoms

Several disorders related to the ingestion of gluten are well recognized despite overlapping clinical presentations: celiac disease, an autoimmune enteropathy triggered by gluten ingestions in susceptible individuals, allergy to wheat, and more recently non-celiac gluten sensitivity (NCGS). While celiac disease and wheat allergy are well-known disorders with a clear-cut diagnosis based on clinical tests and biological parameters, NCGS is a more difficult diagnosis, especially in children with functional gastrointestinal (GI) complaints. NCGS is considered a syndrome of intestinal but also extraintestinal symptoms occurring within hours, but sometimes even after several days of gluten ingestion. In children, the leading symptoms of NCGS are abdominal pain and diarrhea, while extraintestinal symptoms are rare, in contrast to adult patients. No precise diagnostic test nor specific biomarkers exist, except a rather cumbersome three-phase gluten-exposure, gluten-free diet, followed by a blinded placebo-controlled gluten challenge with crossover to provoke symptoms elicited by gluten in a reproducible manner that disappear on gluten-free alimentation. Recent data indicate that the peptide part of wheat proteins is not necessarily the sole trigger of clinical symptoms. Mono- or oligosaccharides, such as fructan and other constituents of wheat, were able to provoke GI symptoms in clinical trials. These new findings indicate that the term gluten sensitivity is probably too restrictive. The incidence of NCGS was reported in the range of 1–10% in the general population and to increase steadily; however, most data are based on patients’ self-reported gluten intolerance or avoidance without a medically confirmed diagnosis. Treatment consists of gluten avoidance for at least several weeks or months. Patients with NCGS require regular reassessment for gluten tolerance allowing with time the reintroduction of increasing amounts of gluten.

scholarly journals Parasitic infections in Swiss children: Are we overtesting?

2021 â—½  
Vol 21 (1) â—½  
Author(s):  
Corinne Légeret â—½  
Céline Rüttimann â—½  
Hans Fankhauser â—½  
Henrik Köhler
Keyword(s):  
Retrospective Study â—½  
Positive Result â—½  
Pediatric Patients â—½  
Intestinal Parasites â—½  
Gastrointestinal Symptoms â—½  
International Travel â—½  
Parasitic Infections â—½  
Stool Samples â—½  
Stool Specimens

Abstract Background A wide variation of causes can lead to gastrointestinal symptoms in children- an infection with parasites is one of them. The expansion of international travel might lead to an increase in testing children for a correspondent infection. Currently there are no guidelines available, which patients should be tested for a possible parasitical infection. The aim of the study was to characterize Swiss children suffering from intestinal parasites, in order to provide more knowledge for the clinician who should be tested. Methods This is a retrospective study of Swiss pediatric patients, whose stools have been tested for parasites and helminths. Results A total of 1855 stool samples, belonging to 572 different children with an average age of 7.9 years, were tested within a 10-year period. The prevalence of a positive result was 4.2%, of which all were positive for Blastocystis, and 12.5% had a co-infection with Endolimax nana. Conclusion Immigrants, immune compromised children with diarrhea and pediatric patients with bloody or protracted diarrhea should have 2 different stool specimens examined for a possible parasitical infection.

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