scholarly journals Time to Antibiotics in Pediatric Patients with Fever in Neutropenia during Chemotherapy for Cancer -- Data from the Prospective Multicenter SPOG 2015 FN Definition Study

2021 ◽  
Author(s):  
Christa Koenig ◽  
Claudia Kuehni ◽  
Nicole Bodmer ◽  
Philipp Agyeman ◽  
Marc Ansari ◽  
...  
Keyword(s):  
Propensity Score ◽  
Pediatric Patients ◽  
Severe Disease ◽  
Standard Of Care ◽  
Cancer Data ◽  
Intravenous Antibiotics ◽  
Time To Antibiotics ◽  
Lag Period ◽  
The Impact ◽  
Timely Administration

Background. Fever in neutropenia (FN) remains an unavoidable, potentially lethal complication of chemotherapy. Timely administration of empirical broad-spectrum intravenous antibiotics has become standard of care. But the impact of time to antibiotics (TTA), the lag period between recognition of fever or arrival at the hospital to start of antibiotics, remains unclear. Here we aimed to analyze the association between TTA and safety relevant events (SRE) in data from a prospective multicenter study. Procedure. We analyzed the association between time from recognition of fever to start of antibiotics (F-TTA) and SRE (death, admission to intensive care unit (ICU), severe sepsis and bacteremia) with three-level mixed logistic regression. We adjusted for possible triage bias using a propensity score and stratified the analysis by severity of disease at presentation. Results. We analyzed 266 FN episodes, including 53 (20%) with SRE, reported in 140 of 269 patients recruited from April 2016 to August 2018. F-TTA (median, 120min; interquartile range, 49 to 180min) was not associated with SRE, with a trend for less SREs in episodes with longer F-TTA. Analyses applying the propensity score suggested a relevant triage bias. Only in patients with severe disease at presentation there was a trend for an association of longer TTA with more SRE. Conclusion. We found little evidence that longer TTA leads to a higher risk of poor clinical outcome in pediatric patients with FN, except for those with severe disease at presentation. We saw strong evidence for triage bias which could only be partially adjusted.

scholarly journals Presentation and outcome of COVID-19 in HIV patients with high viral loads and opportunistic infections: a case series

2020 ◽  
Vol 54 (4s) ◽  
pp. 121-124
Author(s):  
Yasmine O. Hardy ◽  
Divine A. Amenuke ◽  
Kojo A. Hutton-Mensah ◽  
David R. Chadwick ◽  
Rita Larsen-Reindorf
Keyword(s):  
Opportunistic Infections ◽  
Severe Disease ◽  
Case Series ◽  
Standard Of Care ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Viral Loads ◽  
Increased Risk ◽  
Negative Clinical Outcome ◽  
The Impact

Coronavirus disease 2019 (COVID-19) is especially severe in patients with underlying chronic conditions, with increased risk of mortality. There is concern that people living with HIV (PLWH), especially those with severe immunosuppression, and COVID-19 may have severe disease and a negative clinical outcome. Most studies on COVID-19 in PLWH are from Asia, Europe and America where population dynamics, antiretroviral treatment coverage and coexisting opportunistic infections may differ from that in sub-Saharan Africa. We report on the clinical profile and outcome of three cases of PLWH co-infected with SARS-CoV-2. They all presented with fever, cough and breathlessness and also had advanced HIV infection as evidenced by opportunistic infections, high HIV viral loads and low CD4 counts. The patients responded favourably to the standard of care and were discharged home. Our findings suggest that PLWH with advanced immunosuppression may not necessarily have an unfavourable disease course and outcome. However, case-controlled studies with a larger population size are needed to better understand the impact of COVID-19 in this patient population.

scholarly journals 280. Burden of Hyperglycemia in Patients Receiving Dexamethasone for Severe COVID-19

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S245-S246
Author(s):  
Kirk B Fetters ◽  
Stephen Judge ◽  
Timothy Hatlen ◽  
Eric Daar
Keyword(s):  
Blood Glucose ◽  
Medical Center ◽  
Severe Disease ◽  
Standard Of Care ◽  
Diabetic Patients ◽  
Before And After ◽  
Dexamethasone Therapy ◽  
Hospital Resources ◽  
The Impact ◽  
Research Grant

Abstract Background Previous studies demonstrated the adverse impact corticosteroids can have on blood glucose homeostasis in both diabetics and non-diabetics. This raises concern for corticosteroid use in severe COVID-19 where the population is enriched for those at highest risk of severe disease, such as diabetics and patients with obesity. Previous studies of dexamethasone in COVID-19 were limited by the inability to assess steroid-induced hyperglycemia or the impact of hyperglycemia on hospital resources. Objective The study aimed to describe the clinical characteristics, management, and outcomes related to hyperglycemia, before and after dexamethasone therapy was used as the standard of care in patients with severe COVID-19. Methods We performed a pre/post retrospective study of patients with severe COVID-19 pneumonia admitted from May to July 2020 to Harbor-UCLA Medical Center. 126 patients were evaluated. 64 received dexamethasone and 62 did not. To quantify the effect of dexamethasone on diabetic vs. non-diabetic patients, we documented the average blood glucoses and frequency of correctional insulin doses required by each patient group (diabetic with and without dexamethasone, non-diabetic with and without dexamethasone). Results While dexamethasone was associated with higher median blood glucose and more frequent correctional insulin dosing in diabetic patients, there was minimal effect of dexamethasone on hyperglycemia in non-diabetic patients. Furthermore, while non-diabetic patients receiving dexamethasone required more doses of correctional insulin per day vs non-diabetic patients not receiving dexamethasone (0.3 doses per day vs 0.1 doses per day), the frequency of correctional insulin doses required by non-diabetics on dexamethasone remained low at 0.3 doses per day. Conclusion NIH COVID-19 guidelines recommend administering dexamethasone only if the patient is in a monitored setting. Our data support the NIH concerns that outpatients with diabetes receiving steroids are at risk for hyperglycemic complications. However, contrary to the NIH guidelines, our data suggest that patients without diabetes receiving steroids are at low risk for complications due to hyperglycemia and a majority do not require monitoring. Disclosures Eric Daar, MD, Gilead (Consultant)Gilead (Research Grant or Support)Merck (Research Grant or Support)Merck (Consultant)ViiV (Research Grant or Support)

scholarly journals Time to Stable Dose of Psychostimulants in Pediatric Patients With ADHD

2020 ◽  
Vol 25 (3) ◽  
pp. 228-234
Author(s):  
Selena R. Pasadyn ◽  
Kimberly Giuliano ◽  
Deanna LaBianca ◽  
Michael Manos
Keyword(s):  
Chart Review ◽  
Extended Release ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Stable Dose ◽  
Stimulant Use ◽  
Hyperactivity Disorder ◽  
The Impact ◽  
Medication Switching

OBJECTIVES The prevalence of attention-deficit/hyperactivity disorder (ADHD) is increasing and psychostimulants are the pharmacological standard of care. Patients benefit most when there is efficient titration to a stable dose of medication as defined by maintaining that same dose for 6 months. The aims of this study were to describe time to stable dose in a cohort of children with ADHD and examine the impact of demographic factors. METHODS A list of pediatric patients with a diagnosis of ADHD in the electronic health record was generated, and a retrospective chart review of stimulant use was conducted on 500 patients randomly selected from 2010 to 2015 who met inclusion criteria. Time to stable dosing and its association with demographic characteristics were assessed. RESULTS Patients were predominantly male (72%), white (81%), and privately insured (67%). Fifty-five percent of patients achieved a stable dose of medication on first attempt; therefore, the median time to stable dosing for the cohort was 0 days with the interquartile range being 0 to 133.8 days. There was significant increase in time to stable dose for patients younger than 10 years compared with those ≥10 years of age (p = 0.01). Time to stable dose was not significantly associated with race (p = 0.13), sex (p = 0.72), type of insurance (p = 0.56), or formulation being immediate or extended release (p = 0.56). CONCLUSIONS Many patients had long titration periods when trying to reach a stable dose. Given that medication switching can be challenging for patients and families, more frequent contact with providers during titration may be necessary.

CIScoSI Study [Children Immunization Status and cases of Systemic Illness]

2018 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Infectious Diseases ◽  
East Asia ◽  
Pediatric Patients ◽  
Severe Disease ◽  
Tertiary Care ◽  
Immunization Coverage ◽  
South East Asia ◽  
Immunization Status ◽  
Tertiary Care Hospitals ◽  
Total Coverage

To determine the immunization status of pediatric patients under age of 5 years visiting pediatric department of tertiary care hospitals in South East Asia. The aim of this study was to appreciate the awareness and implementation of vaccination in pediatric patients who came into pediatric outpatient Department with presenting complain other than routine vaccination. we can also know the count of patients who do not complete their vaccination after birth. we can differentiate between vaccinated and unvaccinated patients and incidence of severe disease in both groups. Immunization is a protective process which makes a person resistant to the harmful diseases prevailing in the community, typically by vaccine administration either orally or intravenously. It is proven for controlling and eliminating many threatening diseases from the community. WHO report that licensed vaccines are available for the prevention of many infectious diseases. After the implementation of effective immunization the rate of many infectious diseases have declined in many countries of the world. South-East Asia is far behind in the immunization coverage. An estimated total coverage is 56%-88% for a fully immunized child, which is variable between countries. Also the coverage is highest for BCG and lowest for Polio.

Using an App to monitor postoperative pain at home in pediatric patients

2021 ◽  
pp. 136749352091931
Author(s):  
Emanuela Tiozzo ◽  
Valentina Biagioli ◽  
Matilde Brancaccio ◽  
Riccardo Ricci ◽  
Anna Marchetti ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Intensity ◽  
Health Professionals ◽  
Pediatric Patients ◽  
Pain Scale ◽  
Factors Associated ◽  
Prospective Comparative Study ◽  
Paper And Pencil ◽  
The Impact ◽  
At Home

A prospective comparative study was conducted in 487 pediatric patients (69% male, mean age = 6.4 ± 4.0) to evaluate (a) the incidence, intensity, and characteristics of pain in pediatric patients at home during the first 24 hours and 5 days after surgery and (b) the factors associated with higher pain intensity, including the impact of an application (App) compared to the paper-and-pencil approach. Postoperative pain was assessed by patients or their parents at home using the ‘Bambino Gesù’ Children’s Hospital (Ospedale Pediatrico Bambino Gesù, OPBG) tool for participants aged 4–17 years or the Faces, Legs, Arms, Cry, and Consolability scale for participants less than four years old. Participants were assigned to two groups: those who used the paper-and-pencil version of the pain scale and those who used the App. Overall, 209 of the 472 (44%) participants reported pain during the first 24 hours, and 92 of the 420 (22%) reported pain between one and five days after surgery. Higher pain intensity scores were associated with being in the App group, directly assessing own pain, and using the OPBG tool. The App was effective in facilitating pain assessment. Health professionals could empower pediatric patients and their parents in assessing pain at home through a dedicated App.

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