Bowel Preparation for Pediatric Colonoscopy

Frontiers in Pediatrics ◽

10.3389/fped.2021.705624 ◽

2021 ◽

Vol 9 ◽

Author(s):

Petar Mamula ◽

Noor Nema

Keyword(s):

Bowel Preparation ◽

Pediatric Patients ◽

Intestinal Lumen ◽

Therapeutic Tool ◽

Number Of Factors ◽

Wide Variability ◽

Bowel Preparations ◽

Universal Protocol ◽

Pediatric Colonoscopy

Colonoscopy is an important diagnostic and therapeutic tool in evaluating and treating gastrointestinal tract pathologies. Adequate visualization of the intestinal lumen is necessary for detection of lesions, and thus bowel preparation is a key component of the process. It is estimated that over 25% percent of pediatric patients have sub-optimal bowel preparations, which can lead to longer procedure times, missed pathology, unsuccessful ileal intubation, and possibly repeat procedure/anesthesia. There is no universal protocol for bowel preparation in pediatrics and there is a wide variability of practices around the world. The purpose of this paper is to review the recent published literature regarding bowel preparations for pediatric colonoscopy with focus on published work in the last decade exploring a number of factors involved in bowel preparation including the role of patient education, types of bowel preparation, and their efficacy and safety.

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Child life specialists as facilitators of child participation : a thematic literature review

10.32920/ryerson.14655303 ◽

2021 ◽

Author(s):

Caron Mills

Keyword(s):

Health Care ◽

Personal Experience ◽

Pediatric Patients ◽

Health Care Team ◽

Child Life ◽

Child Life Specialists ◽

Child Participation ◽

Rights Of The Child ◽

Number Of Factors

The child's right to participate is a fundamental right outlined in the UN convention on the rights of the child. Canada signed and ratified this convention in 1991. Through secondary literature and the author's personal experience this paper explores the child's right to participate in the context of canadian pediatric medicine. In particular, this paper examines if and how a child is encouraged to participate in their health care, and which members of the health care team facilitate this participation. The paper also outlines a number of factors that limit or enhance child participation. Recommendations and next steps are included in the paper with the purpose of enhancing the quality and amount of participation that is offered to pediatric patients within hospital settings. One recommendation that is developed and discussed is the increased role of the child life profession as a tool for enabling child participation.

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Child life specialists as facilitators of child participation : a thematic literature review

10.32920/ryerson.14655303.v1 ◽

2021 ◽

Author(s):

Caron Mills

Keyword(s):

Health Care ◽

Personal Experience ◽

Pediatric Patients ◽

Health Care Team ◽

Child Life ◽

Child Life Specialists ◽

Child Participation ◽

Rights Of The Child ◽

Number Of Factors

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ACE2/Angiotensin-(1-7)/Mas Receptor Axis in Human Cancer: Potential Role for Pediatric Tumors

Current Drug Targets ◽

10.2174/1389450121666200210124217 ◽

2020 ◽

Vol 21 (9) ◽

pp. 892-901 ◽

Cited By ~ 4

Author(s):

Ana Luiza Ataide Carneiro de Paula Gonzaga ◽

Vitória Andrade Palmeira ◽

Thomas Felipe Silva Ribeiro ◽

Larissa Braga Costa ◽

Karla Emília de Sá Rodrigues ◽

...

Keyword(s):

Clinical Trials ◽

Angiotensin Ii ◽

Pediatric Cancer ◽

Pediatric Patients ◽

Human Cancer ◽

Experimental Studies ◽

At1 Receptor ◽

Pediatric Tumors ◽

Mas Receptor

Background: Pediatric tumors remain the highest cause of death in developed countries. Research on novel therapeutic strategies with lesser side effects is of utmost importance. In this scenario, the role of Renin-Angiotensin System (RAS) axes, the classical one formed by angiotensinconverting enzyme (ACE), Angiotensin II and AT1 receptor and the alternative axis composed by ACE2, Angiotensin-(1-7) and Mas receptor, have been investigated in cancer. Objective: This review aimed to summarize the pathophysiological role of RAS in cancer, evidence for anti-tumor effects of ACE2/Angiotensin-(1-7)/Mas receptor axis and future therapeutic perspectives for pediatric cancer. Methods: Pubmed, Scopus and Scielo were searched in regard to RAS molecules in human cancer and pediatric patients. The search terms were “RAS”, “ACE”, “Angiotensin-(1-7)”, “ACE2”, “Angiotensin II”, “AT1 receptor”, “Mas receptor”, “Pediatric”, “Cancer”. Results: Experimental studies have shown that Angiotensin-(1-7) inhibits the growth of tumor cells and reduces local inflammation and angiogenesis in several types of cancer. Clinical trials with Angiotensin-( 1-7) or TXA127, a pharmaceutical grade formulation of the naturally occurring peptide, have reported promising findings, but not enough to recommend medical use in human cancer. In regard to pediatric cancer, only three articles that marginally investigated RAS components were found and none of them evaluated molecules of the alternative RAS axis. Conclusion: Despite the potential applicability of Angiotensin-(1-7) in pediatric tumors, the role of this molecule was never tested. Further clinical trials are necessary, also including pediatric patients, to confirm safety and efficiency and to define therapeutic targets.

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ROLE OF PHYSICAL THERAPY IN THE TREATMENT OF POSTERIOR ANKLE IMPINGEMENT IN PEDIATRIC ATHLETES - A PROSPECTIVE STUDY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00082 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0008

Author(s):

Adam Saloom ◽

Nick Purcell ◽

Matthew Ruhe ◽

Jorge Gomez ◽

Jonathan Santana ◽

...

Keyword(s):

Physical Therapy ◽

Prospective Study ◽

Conservative Management ◽

Pediatric Patients ◽

Weight Bearing ◽

Return To Sport ◽

Time To Surgery ◽

Ankle Impingement ◽

Posterior Ankle Impingement

Background: Posterior ankle impingement (PAI) is a known cause of posterior ankle pain in athletes performing repetitive plantarflexion motion. Even though empirically recommended in adult PAI, there is minimal literature related to the role of conservative physical therapy (PT) in pediatric patients. Purpose: To identify patient characteristics and determine if there is a difference in pediatric patients with PAI who were successful with conservative PT and those who were unsuccessful, requiring surgical intervention. Methods: Prospective study at a tertiary children’s hospital included patients <18 years diagnosed with PAI and underwent PT. Patients who received PT at an external facility were excluded. Collected data included demographics, initial presentation at PT evaluation, treatment throughout PT, patient presentation at PT discharge, time to return to sport (RTS) from initial PT evaluation (if successful), time to surgery from initial PT evaluation (if unsuccessful). Visual Analogue Scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were collected. Group comparisons were conducted using independent t-tests or chi-square analyses (alpha level set at .05). Results: 31 (12 males, 19 females) patients diagnosed with PAI were enrolled with a mean age 12.61 years (range: 8-17). Gymnastics, football, and basketball were the most commonly implicated sports (42% patients). All patients underwent initial conservative PT for an average of 16.24 weeks (9.23 visits ±7.73). 20/31(64.5%) patients failed conservative management and underwent arthroscopic debridement. PAI pathology was predominantly bony in 61.3% and soft tissue 38.7%. Between the successful PT group and unsuccessful PT group, there was no difference in the proportion of athletes/non-athletes (p=.643). Average RTS time for successful group was 11.47 weeks and average time to surgery for unsuccessful group was 17.82 weeks. There were no significant differences in sex (p=.332), age (p=.674), number of PT visits (p=.945), initial weight-bearing status (p=.367), use of manual therapy (p=.074) including manipulation (p=.172) and mobilization (p=.507), sport (p=.272), initial evaluation ankle ROM (p>.05). Initial AOFAS scores for pain, function, alignment, or total were not significantly different (p=.551, .998, .555, .964 respectively). Conclusion: The first prospective study in pediatric patients with PAI demonstrates that even though success of PT is not dependent on age, sex, sport or PAI pathology, a notable proportion of patients who undergo PT do not need surgery. Conservative management including PT should be the initial line of management for PAI. PT treatment and surgery (if unsuccessful with PT) allowed patients to return to prior level of activity/sports. Tables/Figures: [Table: see text]

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SAT0636-HPR PATIENT EXPERIENCE WITH THE PRESCRIPTION, INFORMATION AND USE OF METHOTREXATE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4059 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1277.3-1278

Author(s):

T. Oton ◽

L. Carmona ◽

J. L. Andréu Sánchez

Keyword(s):

Side Effects ◽

Focus Groups ◽

Rheumatic Diseases ◽

Lupus Erythematosus ◽

Physical Symptoms ◽

Number Of Factors ◽

Graphic Information ◽

Main Barrier ◽

And Training

Background:Methotrexate (MTX) is currently a mainstream drug in the treatment of rheumatic diseases. However, the response to MTX is not universal and may be conditioned by a number of factors, among which adherence could be crucial.Objectives:The aim of this study is to explore adherence to MTX in patients with rheumatic diseases, facilitators and perceived when taking and maintaining the prescription.Methods:A qualitative study of content analysis was performed. Focus groups with patients taking either oral or subcutaneous MTX (being the main or coadjuvant treatment) for any rheumatic disease was performed. The groups were moderated by a rheumatologist that was unknown for the patients. The speech was recorded and transcribed. Subsequently, an inductive coding was performed with the help of Atlas.ti and main themes and sub-themes were extracted, with examples of verbatim anonymized speech.Results:Three focus groups were conducted, with a total of 12 participants, of whom eight were women, seven had rheumatoid arthritis, three had psoriatic arthritis, one had spondyloarthritis, and one had systemic lupus erythematosus. All patients reported an adequate adherence to treatment. The barriers identified were: information in the leaflet, technical language in the consults, difficult access to doctor´s appointment, social environment, side effects and the subcutaneous device. As facilitators, the following aspects were discussed: good predisposition of the physician, reliable graphic information, role of associations and partners support.The unmet needs detected were: problems with travelling, protocols for eventualities, absence of a plan of care, neglection of “non-physical” symptoms, disinformation on side effects and training in complementary aspects.Conclusion:Getting reliable information was the main barrier identified. The environment and side effects may also negatively impact on adherence. Shared decision making is a goal to be achieved in the future in these patients.Disclosure of Interests:Teresa Oton Consultant of: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), José Luis Andréu Sánchez: None declared

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Current Evidence on the Role of the Gut Microbiome in ADHD Pathophysiology and Therapeutic Implications

Nutrients ◽

10.3390/nu13010249 ◽

2021 ◽

Vol 13 (1) ◽

pp. 249

Author(s):

Ana Checa-Ros ◽

Antonio Jeréz-Calero ◽

Antonio Molina-Carballo ◽

Cristina Campoy ◽

Antonio Muñoz-Hoyos

Keyword(s):

Gut Microbiome ◽

Pediatric Patients ◽

Neurodevelopmental Disorder ◽

Current Evidence ◽

Omega 3 ◽

Therapeutic Implications ◽

Neuropsychiatric Diseases ◽

Bidirectional Relationship ◽

The Central Nervous System

Studies suggest that the bidirectional relationship existent between the gut microbiome (GM) and the central nervous system (CNS), or so-called the microbiome–gut–brain axis (MGBA), is involved in diverse neuropsychiatric diseases in children and adults. In pediatric age, most studies have focused on patients with autism. However, evidence of the role played by the MGBA in attention deficit/hyperactivity disorder (ADHD), the most common neurodevelopmental disorder in childhood, is still scanty and heterogeneous. This review aims to provide the current evidence on the functioning of the MGBA in pediatric patients with ADHD and the specific role of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) in this interaction, as well as the potential of the GM as a therapeutic target for ADHD. We will explore: (1) the diverse communication pathways between the GM and the CNS; (2) changes in the GM composition in children and adolescents with ADHD and association with ADHD pathophysiology; (3) influence of the GM on the ω-3 PUFA imbalance characteristically found in ADHD; (4) interaction between the GM and circadian rhythm regulation, as sleep disorders are frequently comorbid with ADHD; (5) finally, we will evaluate the most recent studies on the use of probiotics in pediatric patients with ADHD.

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Nasal Dermoids in Children: Factors Influencing the Distant Result

Indian Journal of Otolaryngology and Head & Neck Surgery ◽

10.1007/s12070-021-02568-y ◽

2021 ◽

Author(s):

Michal Kotowski ◽

Paulina Adamczyk ◽

Jaroslaw Szydlowski

Keyword(s):

Pediatric Patients ◽

Surgical Techniques ◽

Intracranial Extension ◽

Recurrence Rates ◽

Local Conditions ◽

Aesthetic Result ◽

Factors Influencing ◽

Vertical Incision ◽

External Rhinoplasty

AbstractThe aim of the study was to present a single institution’s treatment strategy for nasal dermoids and to identify factors influencing distant results. The study covered 24 surgically treated pediatric patients with nasal dermoids (NDs). The medical data concerning demographics, preoperative local inflammations and surgical procedures, form of the abnormality, imaging, surgical techniques, and a role of osteotomies and reconstructions were analyzed. The recurrence rates and distant aesthetic outcomes were assessed. The surgical approach included vertical incision in 21 patients, the external rhinoplasty approach in 2 cases, and bicoronal incision in 1 child. The intracranial extension was confirmed in 6 patients. Seven out of 8 cases with preoperative local inflammations and 3 out of 4 with secondary fistulization were < 4 years old. Nine patients required osteotomies. Three children required reconstruction of the nasal skeleton. None of the distant cosmetic results was described as hideous or unsatisfactory. The incidence of local inflammatory complications is unrelated to the age of the patients. The distant aesthetic result depends on both the initial extent of the disease and preoperative local conditions or interventions. Prompt surgical intervention is highly recommended.

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