scholarly journals Pediatric Anticholinergic Toxidrome and Treatment with Physostigmine

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Sarah Huber ◽  
Bob Avera, MD ◽  
Adam Overberg PharmD, BCPS, CSPI ◽  
Shannon Morton, MPH ◽  
Kristine Nanagas MD
Keyword(s):  
Safety Profile ◽  
Pediatric Patients ◽  
Poison Center ◽  
Anticholinergic Agents ◽  
Poison Centers ◽  
Treatment Plans ◽  
Potential Impact ◽  
The Difference ◽  
National Poison Data System ◽  
Favorable Safety

Background and Hypothesis: Physostigmine is the antidote to anticholinergic poisoning. Widely used in the 1970s, 2 cases published in 1980 associated use of physostigmine with significant adverse cardiotoxic events. This caused widespread opposition to the use of physostigmine. More recently, the safety profile has been re-examined, and it has been shown to have a more favorable safety profile than was previously believed. Current literature focuses on adult populations, and the available pediatric data does not comprehensively evaluate treatment plans for anticholinergic toxicity in pediatrics. We sought to establish the prevalence of pediatric anticholinergic toxicity as well as determine the prevalence of exposure types associated with physostigmine administration. We then looked at the difference in outcomes, including mortality, for those treated with physostigmine versus those treated with benzodiazepines. Project Methods: We retrospectively analyzed data from the National Poison Data System (NPDS), a database collected from poison centers nationwide. We queried for all poison center exposure cases for ages 2-18 to selected anticholinergic agents or any cases that received physostigmine from January 1, 2013 – December 31, 2017. Results: The NPDS had a total of 109,833 patients exposed to one of the selected anticholinergic agents or plants. Only 0.27% of cases were treated with physostigmine (n=298), versus 3.3% that were treated with benzodiazepines (n=3626). The most prevalent exposure was diphenhydramine. The most likely pediatric patients to be treated with physostigmine are those that are adolescents, exposed to diphenhydramine, or ingested the substance intentionally with suspected suicidal intent. Conclusion and Potential Impact: Despite a good safety profile and superior efficacy to benzodiazepines, physostigmine is still under-utilized by physicians to treat patients with an anticholinergic toxidrome. Further study can also be carried out on the potential of physostigmine to reduce resource utilization in treating the anticholinergic toxidrome.

Effectiveness of a Regional Poison Center in Reducing Excess Emergency Room Visits for Children's Poisonings

PEDIATRICS ◽  
1983 ◽  
Vol 72 (2) ◽  
pp. 164-169 ◽  
Author(s):  
Claire Chafee-Bahamon ◽  
Frederick H. Lovejoy
Keyword(s):  
Emergency Room ◽  
Hospital Care ◽  
Pediatric Patients ◽  
Effective Means ◽  
Poison Center ◽  
Emergency Room Visits ◽  
Emergency Rooms ◽  
Poison Centers ◽  
Hospital Visits ◽  
The Impact

A study was done to assess the necessity of hospital care for poisoning episodes in children less than 5 years old and to evaluate the impact of a regional poison center on the use of emergency rooms for pediatric poisonings. Of the pediatric patients seen in emergency rooms for acute poisonings, 63% did not require the services of a hospital; 95% did not contact the regional poison center before going to the hospital. When all poisoning episodes were considered, the regional poison center was found to reduce significantly pediatric visits to emergency rooms. Of parents who did not call the poison center, 44% went to an emergency room whereas less than 1% of parents who called the poison center went to a hospital (P < .001). Moreover, 28% of those who did not call made unnecessary visits to the hospital compared with only 0.5% of parents who called the poison center (P < .001). A regional poison center was found to be an effective means of decreasing unnecessary hospital visits for pediatric poisonings. Regional poison centers, however, need to further their impact by addressing outreach efforts to parents who do not call poison centers, emergency rooms, and pediatricians.

scholarly journals Identifying Incidents of Public Health Significance Using the National Poison Data System, 2013–2018

2020 ◽  
Vol 110 (10) ◽  
pp. 1528-1531
Author(s):  
Joseph E. Carpenter ◽  
Arthur S. Chang ◽  
Alvin C. Bronstein ◽  
Richard G. Thomas ◽  
Royal K. Law
Keyword(s):  
Public Health ◽  
Data System ◽  
Poison Control ◽  
Poison Center ◽  
Public Health Department ◽  
National Poison ◽  
Public Health Significance ◽  
Poison Centers ◽  
Health Significance ◽  
National Poison Data System

Data System. The American Association of Poison Control Centers (AAPCC) and the Centers for Disease Control and Prevention (CDC) jointly monitor the National Poison Data System (NPDS) for incidents of public health significance (IPHSs). Data Collection/Processing. NPDS is the data repository for US poison centers, which together cover all 50 states, the District of Columbia, and multiple territories. Information from calls to poison centers is uploaded to NPDS in near real time and continuously monitored for specific exposures and anomalies relative to historic data. Data Analysis/Dissemination. AAPCC and CDC toxicologists analyze NPDS-generated anomalies for evidence of public health significance. Presumptive results are confirmed with the receiving poison center to correctly identify IPHSs. Once verified, CDC notifies the state public health department. Implications. During 2013 to 2018, 3.7% of all NPDS-generated anomalies represented IPHSs. NPDS surveillance findings may be the first alert to state epidemiologists of IPHSs. Data are used locally and nationally to enhance situational awareness during a suspected or known public health threat. NPDS improves CDC’s national surveillance capacity by identifying early markers of IPHSs.

scholarly journals Namodenoson in Advanced Hepatocellular Carcinoma and Child–Pugh B Cirrhosis: Randomized Placebo-Controlled Clinical Trial

Cancers ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 187
Author(s):  
Salomon M. Stemmer ◽  
Nebojsa S. Manojlovic ◽  
Mihai Vasile Marinca ◽  
Petar Petrov ◽  
Nelly Cherciu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Safety Profile ◽  
Progression Free Survival ◽  
Rank Test ◽  
Controlled Clinical Trial ◽  
Advanced Hepatocellular Carcinoma ◽  
Adenosine Receptor Agonist ◽  
A3 Adenosine Receptor ◽  
The Difference ◽  
Favorable Safety

Namodenoson, an A3 adenosine-receptor agonist, showed promising results in advanced hepatocellular carcinoma (HCC) and moderate hepatic dysfunction (Child–Pugh B; CPB) in a phase I/II clinical study. This phase II study investigated namodenoson as second-line therapy in such patients. Patients were randomized 2:1 to twice a day (BID) namodenoson (25 mg; n = 50) or placebo (n = 28). The primary endpoint (overall survival [OS]) was not met. Median OS was 4.1/4.3 months for namodenoson/placebo (hazard ratio [HR], 0.82; 95% confidence interval [CI] 0.49–1.38; p = 0.46). Pre-planned subgroup analysis of CPB7 patients (34 namodenoson-treated, 22 placebo-treated) showed a nonsignificant improvement in OS/progression-free survival (PFS). OS: 6.9 versus 4.3 months; HR, 0.81; 95% CI: 0.45–1.43, p = 0.46. PFS: 3.5 versus 1.9 months; HR, 0.89; 95% CI: 0.51–1.55, p = 0.67 (log-rank test). The difference in 12-month OS was significant (44% versus 18%, p = 0.028). Response rates were determined in patients for whom ≥ 1 assessment post-baseline was available (34 namodenoson-treated, 21 placebo-treated). Partial response was achieved by 3/34 (8.8%) and 0/21 (0%) patients, respectively. Namodenoson was well-tolerated, with a safety profile comparable to that of the placebo group. No treatment-related deaths were reported; no patients withdrew due to toxicity. In conclusion, namodenoson demonstrated a favorable safety profile and a preliminary efficacy signal in HCC CPB.

scholarly journals QOLP-17. GROUP MEDICAL PLAY EFFECTIVELY IMPROVES HOSPITALIZATIONADAPTABILITY OF PEDIATRIC PATIENTS WITH NEUROTUMOR

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii178-ii178
Author(s):  
Xing Zhang ◽  
Fuqiang Zhang ◽  
Mingyao Lai ◽  
Juan Li ◽  
Yangqiong Zhang ◽  
...  
Keyword(s):  
Social Status ◽  
Pediatric Patients ◽  
Picture Book ◽  
Family Satisfaction ◽  
Control Group ◽  
Play Intervention ◽  
Significant Difference ◽  
The Difference ◽  
Therapeutic Play ◽  
Experimental Group

Abstract OBJECTIVE To explore the effect of group medical games on the hospitalization adaptability of pediatric patients with neuro tumor. METHODS pediatric patients with neuro tumor (age:6 to 13 years) who were treated in hospital from June to December 2019 and were hospitalized for 1 month to 2 months. 29 pediatric patients(mean age:9y) were selected as the control group and treated as usual; 26 pediatric patients(meanage:8y) were selected as the experimental group for group therapeutic play intervention. Interventions last Monday, Wednesday and Friday of each week, with an average duration of one hour. Group medical play include: medical picture book education, medical preview game, emotional games, social table games. Two groups completed self-made questionnaires at the time of admission and two weeks after admission, including: diet, sleep, compliance, and social status, hospital adaptation and other related issues, two groups completed a satisfaction questionnaire after two weeks of admission, recorded analysis and compared the difference of questionnaire data and satisfaction of the two groups of pediatric patients. RESULTS There was no statistical difference in age and sex between the two groups, and there was no significant difference in baseline RESULTS: The re-test results showed that the experimental group was significantly better than the control group in terms of social status, hospital adaptation, compliance and family satisfaction(p＜0.05). CONCLUSION Group medical games can effectively improve the adaptability, compliance and family satisfaction of pediatric with neuro tumor.

scholarly journals Premedication Does Not Influence the Incidence of Infliximab Infusion Reactions in Pediatric Patients with Inflammatory Bowel Disease—A Single Center Case–Control Study

2021 ◽  
Vol 10 (14) ◽  
pp. 3177
Author(s):  
Edyta Szymanska ◽  
Maciej Dadalski ◽  
Joanna Sieczkowska-Golub ◽  
Dorota Jarzebicka ◽  
Monika Meglicka ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Pediatric Patients ◽  
Case Control Study ◽  
Case Control ◽  
Chi Square ◽  
Infusion Reactions ◽  
Inflammatory Bowel ◽  
The Difference ◽  
Control Study

Background: Infusion reactions (IRs) are the most common adverse events (AEs) of infliximab (IFX) treatment in patients with inflammatory bowel disease (IBD). Prophylactic premedication (PM) with corticosteroids or antihistamines prior to IFX infusions has been used in clinical practice, but its efficacy is not known. The aim of this study was to assess the influence of steroid PM on IR incidence in pediatric patients with IBD receiving IFX. Methods: We performed a case–control study that included pediatric patients with IBD receiving IFX. Patients were divided into four subgroups according to the agent and PM they received: Remicade (original drug) + PM, and two biosimilars—Reshma +/− PM, and Flixabi—PM. At our site, until 2018, PM with steroids was used as a part of standard IFX infusion (PM+); however, since then, this method has no longer been administered (PM−). IRs were divided into mild/severe reactions. Differences between subgroups were assessed with the appropriate chi-square test. Multivariate logistic regression was used to assess associations between PM and IR incidence, correcting for co-medication usage. Results: There were 105 children (55 PM+, 44 male, mean age 15 years) included in the study who received 1276 infusions. There was no difference between the PM+ and PM− subgroups, either in incidence of IR (18.2% vs. 16.0% of patients, p > 0.05) or in percentage of infusions followed by IR (2.02% vs. 1.02% of infusions, p > 0.5). The OR of developing IR when using PM was 0.34, and the difference in IRs ratio in PM+ and PM− patients was not statistically significant (95% CI, 0.034–1.9). There were 11/18 (61.1%) severe IRs (anaphylactic shock) reported in all patients (both PM+ and PM−). Conclusion: At our site, the incidence of IR was low, and PM did not decrease the incidence of IR in pediatric patients with IBD receiving IFX. These results indicate that PM with steroids should not be a standard part of IFX infusion to prevent IR.

Early safety and efficacy from a phase I open-label clinical trial of CD137(4-1BB) agonistic antibody LVGN6051 as monotherapy and in combination with pembrolizumab.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 2521-2521
Author(s):  
Siqing Fu ◽  
Wael A. Harb ◽  
Sapna Pradyuman Patel ◽  
Charles Lu ◽  
Daniel M. Halperin ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Antitumor Activity ◽  
Safety Profile ◽  
Single Agent ◽  
Human Study ◽  
Hepatic Metastases ◽  
Preliminary Evidence ◽  
Open Label ◽  
Grade 3 ◽  
Favorable Safety

2521 Background: LVGN6051, a monoclonal antibody against CD137 (also known as 4-1BB or TNFRSF9) with an engineered Fc capable of selectively binding to the Fcγ receptor IIB, acts as a conditional CD137 agonist, resulting in immune activation optimally in tumor microenvironment ( Qi, Nat. Commun. 2019 ). In preclinical models, LVGN6051 demonstrated robust anti-tumor efficacy and safety as a single agent and in combination with anti-PD-1 antibodies. Therefore, we have initiated this first-in-human study of LVGN6051 alone or in combination with pembrolizumab for the treatment of advanced or metastatic malignancy. Methods: This study includes accelerated dose escalation monotherapy up to 2 mg/kg of LVGN6051, and traditional 3 + 3 design for higher doses of LVGN6051 alone or in combination with pembrolizumab. Then, this study will enroll patients with specific types of malignancies following Simon’s two-stage design. Both agents are administered once every 3 weeks. Primary objectives of this study were to define the safety profile and to establish the recommended phase 2 dose (RP2D) of LVGN6051 alone or in combination with pembrolizumab. Pharmacokinetics, immunogenicity, pharmacodynamics and clinical efficacy will be also evaluated. Results: At the cut-off date on January 18, 2021, 16 subjects have been enrolled into the monotherapy cohorts (n=12, no DLT observed up to 7 mg/kg), and the combination cohort (n=4, ongoing at LVGN6051 2 mg/kg and pembrolizumab 200 mg, one DLT observed). No treatment-related adverse event (TRAE) was observed in monotherapy. Treatment-emergent adverse events (TEAE) in combination included increased ALT/AST, thrombocytopenia, and fatigue. In the combination cohort, one patient with predominant hepatic metastases and history of intermittent grade 2 hepatic impairment experienced grade 3 increased ALT/AST (DLT) on cycle 1 day 15 that were resolved to her baseline without corticosteroids on cycle 1 day 18. TRAE included increased ALT/AST, thrombocytopenia, neutropenia, nausea and fatigue. Seven of 10 evaluable patients in the monotherapy cohorts demonstrated stable disease with the longest treatment being 8+ months. Tumor reductions by >10% were observed in melanoma and neuroendocrine tumor on monotherapy. One patient with metastatic head and neck squamous cell carcinoma who had progressed on an anti-PD-L1 based therapy showed an immune partial response (iPR) for 6+ months to the combination therapy. Conclusions: Preliminary evidence showed that LVGN6051 was well tolerated and tumor shrinkages were observed. While we continue assessing its safety profile, antitumor activity was observed in the LVGN6051 and pembrolizumab cohort. The favorable safety profile and preliminary antitumor activity warrant further evaluation in patients with advanced malignancies. Clinical trial information: NCT04130542.

Poison Centers, Poison Prevention, and the Pediatrician

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 220-224 ◽  
Author(s):  
Frederick H. Lovejoy ◽  
William O. Robertson ◽  
Alan D. Woolf
Keyword(s):  
The United States ◽  
Poison Control ◽  
Poison Center ◽  
Department Of Health ◽  
Household Products ◽  
Prevention Model ◽  
Poison Centers ◽  
History Of ◽  
Poison Prevention ◽  
Remarkable Progress

The first poison centers were established in the United States in the early 1950s, stimulated by an American Academy of Pediatrics' survey of office-based pediatric practices which ascertained that its members had no place to turn for ingredient information on medications and household products.1 With the help of the Academy, pediatrician Dr. Edward Press, the Illinois Department of Health, and several community hospitals, the first poison center emerged. Over the subsequent 40 years, remarkable progress has occurred in the fields of clinical toxicology, poison control, and poison prevention. Yet despite these accomplishments, challenging clouds are appearing on the horizon which threaten these gains. This commentary, by the authors who have viewed and participated in a large part of the history of this progress, will focus on these major accomplishments with an emphasis on (a) poison prevention utilizing the pre-event (primary prevention), (b) the event (secondary prevention), and (c) the postevent (tertiary prevention) model.2

scholarly journals Correlation between Innercanthal Distance and Mesiodistal Width of Maxillary Anterior Teeth in a Thrissur, Kerala, India, Population

2016 ◽  
Vol 17 (5) ◽  
pp. 382-387 ◽  
Author(s):  
Kamalakanth Shenoy ◽  
George Attokaran
Keyword(s):  
Statistical Significance ◽  
Age Group ◽  
Dynamic Changes ◽  
Anterior Teeth ◽  
High Statistical Significance ◽  
Treatment Plans ◽  
Facial Proportions ◽  
Males And Females ◽  
The Difference ◽  
Changes Over Time

ABSTRACT Background Selecting and replacing missing teeth to natural proportions and esthetic preference of a patient in the absence of pre-extraction records is a very challenging task. Although facial analysis and proportions are well discussed in many populations, none exists for the Thrissur, Kerala, population. A prosthodontic rehabilitation for Kerala patients relying on other racial norms may result in dissonant facial proportions. Therefore, the purpose of this study was (1) to evaluate the validity of innercanthal distance as a guide in determining the mesiodistal dimension of six maxillary anterior teeth in a selected Malayalee population in the Thrissur Municipal Corporation area; (2) to check whether innercanthal distance undergoes dynamic changes over time as a result of aging; and (3) to evaluate whether there is a gender difference in the analyzed mean facial and dental proportions in this population. Materials and methods The study was conducted on 1,200 subjects in the Thrissur Municipal Corporation area. From five wards, 240 subjects were selected, out of which 120 were from the 18 to 25 years age group and 120 from the 40 to 50 years age group. Sixty males and females were selected from each group. The innercanthal distance was measured using a Digital Vernier Caliper, and alginate impressions were made to evaluate the size of maxillary anteriors. The data was analyzed statistically. Results The study showed that there is a high statistical significance between the innercanthal distance and the mesiodistal width of six maxillary anterior teeth in females (p < 0.01) and no significance in males. There was also dynamic changes in the innercanthal dimension and the mesiodistal width of maxillary anteriors with increase in age (p < 0.001). The difference in the mean of innercanthal distance between the genders was highly statistically significant, but no significance was found between the genders in the mesiodistal width of maxillary anteriors. Conclusion Within the population evaluated, there was a high statistical significance in females between the innercanthal distance and the mesiodistal width of six maxillary anterior teeth, but not for males. Innercanthal dimension was found to undergo dynamic changes as age increases in both males and females, and it was much higher in males than in females. There was no statistical significance in the comparative evaluation of mesiodistal width of maxillary anteriors of males and females in the study. Clinical significance Teeth selection is a critical step in determining the outcome of successful prosthodontic treatment. No definite guidelines for the selection of maxillary anterior teeth pertaining to the Thrissur, Kerala, population exist. A prosthodontic rehabilitation of Thrissur, Kerala, patients relying on other racial norms will result in dissonant facial proportions. In selecting maxillary anterior teeth, the knowledge of racial norms will help specify certain esthetic and functional modifications in treatment plans, which might be specific to each group. Therefore, there remains an unquestionable need for a scientific and reliable method for maxillary anterior teeth selection, which can be applied on this group of Indian population. How to cite this article Attokaran G, Shenoy K. Correlation between Innercanthal Distance and Mesiodistal Width of Maxillary Anterior Teeth in a Thrissur, Kerala, India, Population. J Contemp Dent Pract 2016;17(5):382-387.

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