scholarly journals A risk-stratified approach toward safely resuming OnabotulinumtoxinA injections based on dosing and ambulatory status in pediatric patients with cerebral palsy during the Coronavirus pandemic of 2019 (COVID-19)

2020 ◽  
Vol 13 (3) ◽  
pp. 273-279
Author(s):  
Matthew J. McLaughlin ◽  
Mark T. Fisher ◽  
Sathya Vadivelu ◽  
Justin Ramsey ◽  
Denesh Ratnasingam ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Pediatric Patients ◽  
Botulinum Toxin Type A ◽  
Retrospective Chart Review ◽  
Botulinum Toxin Type ◽  
Control Group ◽  
Classification Score ◽  
Increased Risk ◽  
Significant Difference ◽  
Inpatient Hospitalizations

PURPOSE: After the onset of the Coronavirus pandemic of 2019–2020 (COVID-19), physicians who inject OnabotulinumtoxinA (BoNT-A) were left with determining risks and benefits in pediatric patients with cerebral palsy. Many of these patients have pre-existing conditions that make them more prone to COVID-19 symptoms, and this susceptibility potentially increases after BoNT-A injections. METHODS: A retrospective chart review of 500 patients identified 256 pediatric patients with cerebral palsy who received an intramuscular BoNT-A injection to determine relative doses used for each Gross Motor Functional Classification Score (GMFCS). Data regarding age, weight, GMFCS, BoNT-A total body dosage, and inpatient hospitalizations for 6 months post-injection were collected. Differences between GMFCS levels were analyzed using one-way analysis of variance testing. Inpatient hospitalizations were recorded and assessed using relative risk to determine the population risk of hospitalization in the setting of initiating injections during the COVID-19 pandemic. RESULTS: Based on GMFCS level, patients who were GMFCS I or II received fewer units of BoNT-A medication per kilogram of body weight compared to GMFCS III–V (p< 0.0005, F= 25.38). There was no statistically significant difference in frequency or time to hospitalization when comparing patients receiving BoNT-A compared to a control group. CONCLUSIONS: Resumption of BoNT-A injections during the time of COVID-19 requires a systematic approach based on risks and potential benefits. Data from this analysis does not show increased risk for patients who received injections historically; however, recommendations for resumption of injections has not previously been proposed in the setting of a pandemic. In this manuscript, a tiered approach to considerations for injections was proposed. Botulinum toxin type A injections have a history of improving spasticity in the pediatric patient with cerebral palsy. Ensuring appropriate selection of patients for injection with BoNT-A during this pandemic is increasingly important.

610 Small Pediatric Burns Can Be Safely Managed on an Outpatient Basis

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S148-S149
Author(s):  
Andrea C Grote ◽  
Alexandra M Lacey ◽  
Warren L Garner ◽  
Justin Gillenwater ◽  
Ellen Maniago ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Outpatient Setting ◽  
Outpatient Basis ◽  
Close Monitoring ◽  
Burn Center ◽  
Increased Risk ◽  
Significant Difference ◽  
Pediatric Burns ◽  
Inpatient Management

Abstract Introduction American Burn Association guidelines recommend that all pediatric burns be transferred to a burn center if their presenting hospital lacks the necessary personnel or equipment for their care. Our institution often treats small (&lt; 10% TBSA) burns in pediatric patients as outpatients with a non-daily dressing. The aim of this study was to determine if small pediatric burns could be managed in an outpatient manner and risk factors for failure. Methods A retrospective chart review was conducted from July 2016 to July 2019 at a single ABA-verified burn center. All patients under the age of 18 who presented for evaluation were included. Post burn day, age, sex, TBSA, burn etiology, body area burned, burn dressing type, outpatient versus inpatient management, reason(s) for admission, and any operative intervention were collected. Results In total, 742 patients were included in our cohort (Table 1). The most common burn etiologies were scald (68%), contact (20%), and flame (5%). From initial presentation, 101 patients (14%), mean TBSA 9%, were admitted to the burn unit and 641 patients (86%), mean TBSA 3%, were treated outpatient. Of those, 613 (96%) were treated entirely outpatient and 28 (4%) were admitted at a later date. There were no significant differences in age (p=0.6) nor gender distribution between those who were successfully treated outpatient and those who failed. There was a significant difference (p &lt; 0.001) in TBSA between the patients who were treated successfully as outpatients (3±2%) versus those who failed outpatient care (4±3%). The primary reason for admission of these patients was nutrition optimization (61%). Conclusions The vast majority of small pediatric burns can be treated as an outpatient with a non-daily dressing with good results. Over 80% of pediatric patients seen in our clinic were successfully managed in this manner. As suspected, when the burns are larger in size (&gt;4% TBSA) there is a potential increased risk for admission especially with regards to poor PO intake, so this requires close monitoring and family education. Applicability of Research to Practice Pediatric patients with small burns can be safely managed in an outpatient setting with a non-daily dressing. Those who fail will most likely fail from poor PO intake at home.

scholarly journals 222 Simulation Training in Aesthetic Medicine; A Safe, Effective and Ethically Sound Modality to Teach Basic and Advanced Aesthetic Interventions

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
X Chalhoub ◽  
A Ghanem
Keyword(s):  
Test Scores ◽  
Botulinum Toxin Type A ◽  
Simulation Models ◽  
Confidence Score ◽  
Botulinum Toxin Type ◽  
Control Group ◽  
High Fidelity ◽  
Aesthetic Medicine ◽  
Significant Difference ◽  
Post Test

Abstract Introduction The role of high-fidelity prosthetic simulation models for Botulinum Toxin Type A (BoNT-A) and cross-linked Hyaluronic Acid dermal fillers (HA) was evaluated and its efficacy and safety discussed in addition to its ethical and cost-effective advantages. Method The experiment group (N = 26) included a high-fidelity simulation silicone head to inject as part of dexterity training prior to injecting live adult voluntary models. The control group (N = 8) had only live adult voluntary models for the practical session. Pre-test and post-test of self- assessment of procedure competence and confidence to perform the procedure unaided was evaluated using a modified reflective CEX. Results The average competency and confidence pre-test for score for students was (mean±SD) 7.2±4.6 and 2.9±2.9 respectively. The post-test scores rose to 15.8± 2.5 and 7.8±1.5. The improved competency and confidence score were statistically significant (p &lt; 0.05). There was no statistically significant difference of pre-test or post-test scores between the experimental and control group. Conclusions High fidelity synthetic simulation models allow novice practitioners to improve pre-procedure counselling, technical skills, management plan and follow up as well as confidence to perform the procedure effectively. We therefore recommend this method as a first-line training model in aesthetic medicine.

Efficacy of Outpatient Infusion Therapy in Pediatric Patients With Post-Concussive Headaches

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S14.3-S15
Author(s):  
James Pate ◽  
James Mooney ◽  
Erin Katz ◽  
Marshall Chandler McLeod ◽  
Sara Gould
Keyword(s):  
Oral Therapy ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Symptom Relief ◽  
Retrospective Chart Review ◽  
Return To Play ◽  
Infusion Therapy ◽  
Control Group ◽  
Treatment Protocols ◽  
Significant Difference

ObjectiveThe objective of this study is to determine the relative efficacy of an intravenous therapy for post-concussive headaches in a pediatric population, as compared to oral therapy.BackgroundPost traumatic headache is extremely common in the acute and chronic phases after concussion. To date, there is still not significant evidence-based treatment protocols defined for treatment.Design/MethodsPediatric patients who were treated for post-concussive headaches at an outpatient infusion clinic from 2016 to 2018 were selected for inclusion in the study. Clinic visits before and after infusions were reviewed to determine changes in headache score (HA), symptom severity score (SSS), and self-reported symptom relief. The control group received only oral therapy for their headaches. The infusion consisted of parenteral ketorolac, compazine, diphenhydramine, and a normal saline bolus (20 mg/kg). Of the 95 patients who were treated in clinic, 53 patients were selected for a retrospective chart review.ResultsFollowing infusion therapy, overall mean HA and SSS scores were both reduced (1.6346, SD 1.8997, p < 0.0001 and 23.0385, SD 29.4971, p < 0.0001 respectively). Oral therapy demonstrated a similar mean overall reduction in HA and SS scores (1.4151, SD 1.4992, p < 0.0001 and 25.4906, SD 30.2042, p < 0.0001). While both groups achieved a reduction in HA and SS scores, there was not a statistically significant difference in reduction of symptoms scores between the oral and infusion groups.ConclusionsInfusion therapy is as effective at reducing HA and SSS as established oral therapies. It is hypothesized that infusion therapy may have a shorter time to headache abortion than oral therapy based on pharmacokinetics. Further, some physicians are unwilling to allow an athlete to return to play while taking suppressive medication. Future studies may show that an infusion could allow a more rapid return to play and resolution of symptoms.

scholarly journals Investigation of TAGAP gene polymorphism (rs1738074) in Turkish pediatric celiac patients

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Melek Pehlivan ◽  
Tülay K. Ayna ◽  
Maşallah Baran ◽  
Mustafa Soyöz ◽  
Aslı Ö. Koçyiğit ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Disease Risk ◽  
Polymerase Chain Reaction Method ◽  
Control Group ◽  
Healthy Children ◽  
Single Nucleotide ◽  
Significant Difference ◽  
Allele Specific ◽  
And Control

Abstract Objectives There are several hypotheses on the effects of the rs1738074 T/C single nucleotide polymorphism in the TAGAP gene; however, there has been no study on Turkish pediatric patients. We aimed to investigate the association of celiac disease (CD) and type 1 diabetes mellitus (T1DM) comorbidity with the polymorphism in the TAGAP gene of Turkish pediatric patients. Methods Totally, 127 pediatric CD patients and 100 healthy children were included. We determined the polymorphism by the allele-specific polymerase chain reaction method. We used IBM SPSS Statistics version 25.0 and Arlequin 3.5.2 for the statistical analyses. The authors have no conflict of interest. Results It was determined that 72% (n=154) of only CD patients had C allele, whereas 28% (n=60) had T allele. Of the patients with celiac and T1DM, 42.5% (n=17) and 57.5% (n=23) had T and C alleles, respectively. Of the individuals in control group, 67% (n=134) had C allele, whereas 33% (n=66) had T allele. Conclusions There was no significant difference in the genotype and allele frequencies between the patient and control groups (p>0.05). There was no significant association between the disease risk and the polymorphism in our study group.

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.

A Systematic Review of Assessments and Interventions for Chronic Pain in Young Children With or at High Risk for Cerebral Palsy

2021 ◽  
pp. 088307382199691
Author(s):  
Lisa Letzkus ◽  
Darcy Fehlings ◽  
Lauren Ayala ◽  
Rachel Byrne ◽  
Alison Gehred ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Cerebral Palsy ◽  
High Risk ◽  
Online Survey ◽  
Botulinum Toxin Type A ◽  
Botulinum Toxin Type ◽  
Parent Report ◽  
Medical Cannabis ◽  
Nonpharmacologic Intervention

Background: Pain is common in children with cerebral palsy. The purpose of this systematic review was to evaluate the evidence regarding assessments and interventions for chronic pain in children aged ≤2 years with or at high risk for cerebral palsy. Methods: A comprehensive literature search was performed. Included articles were screened using PRISMA guidelines and quality of evidence was reviewed using best-evidence tools by independent reviewers. Using social media channels, an online survey was conducted to elicit parent preferences. Results: Six articles met criteria. Parent perception was an assessment option. Three pharmacologic interventions (gabapentin, medical cannabis, botulinum toxin type A) and 1 nonpharmacologic intervention were identified. Parent survey report parent-comfort and other nonpharmacologic interventions ranked as most preferable. Conclusion: A conditional GRADE recommendation was in favor of parent report for pain assessment. Clinical trials are sorely needed because of the lack of evidence for safety and efficacy of pharmacologic interventions.

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