scholarly journals Treatment of Dyslipidaemia in Children

Biomedicines ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1078
Author(s):  
Riccardo Fiorentino ◽  
Francesco Chiarelli
Keyword(s):  
Children And Adolescents ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Pharmacological Therapy ◽  
Lifestyle Changes ◽  
Lipid Lowering ◽  
First Line ◽  
Bile Acid Sequestrants ◽  
Therapeutic Lifestyle Changes ◽  
Lipid Abnormalities

Childhood dyslipidaemia is one of the main traditional cardiovascular risk factors that initiate and exacerbate the atherosclerotic process. Healthcare providers may play a key role in the management of children with lipid abnormalities; however, they have to properly evaluate the normal lipid values and know the available treatment options in children and adolescents. Current guidelines recommend healthy behaviours as the first-line treatment for childhood dyslipidaemia. The therapeutic lifestyle changes should focus on dietary modifications, daily physical activity, reduction in body weight and tobacco smoking cessation. Parents play a key role in promoting their children’s healthy habits. In children with more severe forms of lipid abnormalities and in those who do not benefit from healthy behaviours, pharmacological therapy should be considered. Safe and effective medications are already available for children and adolescents. Statins represent the first-line pharmacological option, while ezetimibe and bile acid sequestrants are usually used as second-line drugs. Despite their limited use in children, other lipid-lowering agents (already approved for adults) are currently available or under study for certain categories of paediatric patients (e.g., familial hypercholesterolemia). Further studies are needed to evaluate the long-term efficacy, safety and tolerability of novel lipid-lowering drugs, especially in children.

scholarly journals Immunotherapy in hepatocellular carcinoma: evaluation and management of adverse events associated with atezolizumab plus bevacizumab

2021 ◽  
Vol 13 ◽  
pp. 175883592110311
Author(s):  
Chiun Hsu ◽  
Lorenza Rimassa ◽  
Hui-Chuan Sun ◽  
Arndt Vogel ◽  
Ahmed O. Kaseb
Keyword(s):  
Hepatocellular Carcinoma ◽  
Adverse Events ◽  
Kinase Inhibitor ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Safety Data ◽  
Standard Of Care ◽  
Antiangiogenic Agents ◽  
Efficacy And Safety ◽  
First Line

In light of positive efficacy and safety findings from the IMbrave150 trial of atezolizumab plus bevacizumab, this novel combination has become the preferred first-line standard of care for patients with unresectable hepatocellular carcinoma (HCC). Several additional trials are ongoing that combine an immune checkpoint inhibitor with another agent such as a multiple kinase inhibitor or antiangiogenic agent. Therefore, the range of first-line treatment options for unresectable HCC is likely to increase, and healthcare providers need succinct information about the use of such combinations, including their efficacy and key aspects of their safety profiles. Here, we review efficacy and safety data on combination immunotherapies and offer guidance on monitoring and managing adverse events, especially those associated with atezolizumab plus bevacizumab. Because of their underlying liver disease and high likelihood of portal hypertension, patients with unresectable HCC are at particular risk of gastrointestinal bleeding, and this risk may be exacerbated by treatments that include antiangiogenic agents. Healthcare providers also need to be alert to the risks of proteinuria and hypertension, colitis, hepatitis, and reactivation of hepatitis B or C virus infection. They should also be aware of the possibility of rarer but potentially life-threatening adverse events such as pneumonitis and cardiovascular events. Awareness of the risks associated with these therapies and knowledge of adverse event monitoring and management will become increasingly important as the therapeutic range broadens in unresectable HCC.

Two dilemmas for medical ethics in the treatment of gender dysphoria in youth

2021 ◽  
pp. medethics-2021-107260
Author(s):  
Teresa Baron ◽  
Geoffrey Dierckxsens
Keyword(s):  
Decision Making ◽  
Medical Ethics ◽  
Medical Treatment ◽  
Children And Adolescents ◽  
Gender Dysphoria ◽  
Ethical Dilemmas ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Bioethical Issues ◽  
The Subject

Both the diagnosis and medical treatment of gender dysphoria (GD)—particularly in children and adolescents—have been the subject of significant controversy in recent years. In this paper, we outline the means by which GD is diagnosed in children and adolescents, the currently available treatment options, and the bioethical issues these currently raise. In particular, we argue that the families and healthcare providers of children presenting with GD currently face two main ethical dilemmas in decision making regarding treatment: the pathway dilemma and the consent dilemma.

scholarly journals Therapeutic Options for the Treatment of Hypertension in Children and Adolescents

2012 ◽  
Vol 6 ◽  
pp. CCRPM.S7602 ◽  
Author(s):  
Mary M. Stephens ◽  
Beth A. Fox ◽  
Lisa Maxwell
Keyword(s):  
Children And Adolescents ◽  
The United States ◽  
Secondary Hypertension ◽  
Lifestyle Changes ◽  
Primary Hypertension ◽  
Treatment Of Hypertension ◽  
Diagnosis And Classification ◽  
Therapeutic Lifestyle Changes ◽  
Hypertension In Children

Primary hypertension in children is increasing in prevalence with many cases likely going undiagnosed. The prevalence is currently estimated at between 3%-5% in the United States and may be higher in certain ethnic groups. Primary hypertension, once felt to be rare in children, is now considered to be about five times more common than secondary hypertension. This review provides information to guide physicians through an organized approach to: 1) screening children and adolescents for hypertension during routine visits; 2) using normative percentile data for diagnosis and classification; 3) performing a clinical evaluation to identify the presence of co-morbidities; 4) initiating a plan of care including subsequent follow-up blood pressure measurements, therapeutic lifestyle changes and pharmacologic therapies.

scholarly journals Pushing the Limits of Medical Management in HCM: A Review of Current Pharmacological Therapy Options

2021 ◽  
Vol 22 (13) ◽  
pp. 7218
Author(s):  
Cristian Stătescu ◽  
Ștefana Enachi ◽  
Carina Ureche ◽  
Laura Țăpoi ◽  
Larisa Anghel ◽  
...  
Keyword(s):  
Drug Class ◽  
Treatment Options ◽  
Phenotypic Expression ◽  
Data Gathering ◽  
Invasive Procedure ◽  
Pharmacological Therapy ◽  
First Line ◽  
Future Directions ◽  
Refractory Heart Failure ◽  
Calcium Channel Inhibitors

Hypertrophic cardiomyopathy (HCM) is the most common monogenic cardiac disease with a highly variable phenotypic expression, ranging from asymptomatic to drug refractory heart failure (HF) presentation. Pharmacological therapy is the first line of treatment, but options are currently limited to nonspecific medication like betablockers or calcium channel inhibitors, with frequent suboptimal results. While being the gold standard practice for the management of drug refractory HCM patients, septal reduction therapy (SRT) remains an invasive procedure with associated surgical risks and it requires the expertise of the operating centre, thus limiting its accessibility. It is therefore with high interest that researchers look for pharmacological alternatives that could provide higher rates of success. With new data gathering these past years as well as the development of a new drug class showing promising results, this review provides an up-to-date focused synthesis of existing medical treatment options and future directions for HCM pharmacological treatment.

scholarly journals Peculiarities of topical therapy in pediatric psoriasis

2021 ◽  
Vol 16 (S4) ◽  
pp. 54-57
Author(s):  
Ana Maria Alexandra STĂNESCU ◽  
◽  
Vlad DIMA ◽  
Ioana Veronica GRĂJDEANU ◽  
Mira FLOREA ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Topical Therapy ◽  
Treatment Options ◽  
Efficacy And Safety ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Atypical Manifestations ◽  
Chromosomal Loci ◽  
Therapy Treatment

In children and adolescents, psoriasis affects between 0.5% and 1.2% of the population. Currently, at least 80 chromosomal loci have been discovered that are significantly linked to psoriasis, and some of these loci are mainly linked to the onset of psoriasis in childhood. Pediatric psoriasis can be more difficult to diagnose due to an easier course of the disease, with smaller and thinner plaques, which are less scalable and with atypical manifestations. First-line therapy in psoriasis in both children and adults is represented by topical therapy. Treatment options for psoriasis in children and adolescents are largely off-label, with little data available on efficacy and safety.

scholarly journals Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents

Circulation ◽  
2007 ◽  
Vol 115 (14) ◽  
pp. 1948-1967 ◽  
Author(s):  
Brian W. McCrindle ◽  
Elaine M. Urbina ◽  
Barbara A. Dennison ◽  
Marc S. Jacobson ◽  
Julia Steinberger ◽  
...  
Keyword(s):  
Drug Therapy ◽  
High Risk ◽  
Children And Adolescents ◽  
Familial Hypercholesterolemia ◽  
Lipid Lowering ◽  
Lifestyle Recommendations ◽  
Lowering Drug ◽  
Lipid Abnormalities ◽  
New Evidence ◽  
Early Atherosclerosis

Despite compliance with lifestyle recommendations, some children and adolescents with high-risk hyperlipidemia will require lipid-lowering drug therapy, particularly those with familial hypercholesterolemia. The purpose of this statement is to examine new evidence on the association of lipid abnormalities with early atherosclerosis, discuss challenges with previous guidelines, and highlight results of clinical trials with statin therapy in children and adolescents with familial hypercholesterolemia or severe hypercholesterolemia. Recommendations are provided to guide decision-making with regard to patient selection, initiation, monitoring, and maintenance of drug therapy.

scholarly journals An Update on Pharmacotherapy of Dyslipidemia for Adults

2020 ◽  
pp. 86-109
Author(s):  
Sheikh Salahuddin Ahmed
Keyword(s):  
Microvascular Complications ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Pharmacological Therapy ◽  
Atherosclerotic Cardiovascular Disease ◽  
First Line ◽  
Pcsk9 Inhibitors ◽  
Bile Acid Sequestrants ◽  
Increased Risk ◽  
Very High

Dyslipidemia is an important cause of atherosclerotic cardiovascular disease (ASCVD) worldwide that leads to increased risk of morbidity and mortality; treating dyslipidemia to goal reduces the risks. This article reviews the pharmacological therapy of dyslipidemia which is often required in addition to life style intervention to achieve target lipid levels. Currently, there are seven types of approved lipid modifying drugs which are effective in treating dyslipidemia when used singly or in combination. Statins are considered as first line drug and have been used extensively in the primary and secondary prevention of ASCVD. Ezetimibe is used as a first line add-on drug for patients already on a statin who have not reached their low density lipoprotein (LDL-C) goals; however, ezetimibe can be used as initial drug in statin intolerant patients. Bile acid sequestrants are a useful alternative to statins or ezetimibe in pregnant women or patients with liver disease. They also lower blood glucose and are useful in diabetes mellitus (DM). The PCSK9 inhibitors are powerful lipid modifying drugs, are expensive, need injection for delivery, and are used when statin in maximum doses with other drugs cannot lower the LDL-C level to targets in patients with very high CV risk. Fibrates have recently shown to slow the progression of microvascular diseases and are found beneficial for DM with hypertriglyceridemia and microvascular complications. Currently, niacin use is markedly decreased due to development of more effective alternative drugs for managing dyslipidemia and because of the adverse effects related to niacin use. Recent trials reveal that, ω-3 fatty acids, when added in pharmacological doses to statin therapy (after controlling LDL-C), are effective in reducing CV events in patients having moderate hypertriglyceridemia with high or very high CV risks.

Lipids

2015 ◽  
Author(s):  
Željko Reiner ◽  
Olov Wiklund ◽  
John Betteridge
Keyword(s):  
Familial Hypercholesterolaemia ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Lifestyle Changes ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
First Line ◽  
Cvd Risk ◽  
Low Concentrations

Dyslipidaemia, particularly elevated low-density lipoprotein (LDL) cholesterol, is one of the most important risk factors for cardiovascular disease (CVD). Low concentrations of high-density lipoprotein (HDL) cholesterol are independently associated with high CVD risk, while moderately elevated triglycerides are considered to be a marker of increased CVD risk. The presence of dyslipidaemias secondary to other conditions must be excluded before beginning treatment. All patients with familial hypercholesterolaemia are at high risk and should be treated by lipid-lowering therapy. Lifestyle changes are the backbone of treatment for dyslipidaemia. Statins are recommended as the first-line drugs for hypercholesterolaemia while fibrates are used primarily to decrease elevated triglycerides. If the treatment targets cannot be reached by monotherapy with lipid-lowering drugs, combination treatment may be needed.

scholarly journals Identifying key elements for paediatric advance care planning with parents, healthcare providers and stakeholders: A qualitative study

2020 ◽  
Vol 34 (3) ◽  
pp. 300-308 ◽  
Author(s):  
Kerstin Hein ◽  
Kathrin Knochel ◽  
Vedrana Zaimovic ◽  
Daniel Reimann ◽  
Anna Monz ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Advance Directives ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Emergency Services ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Care Planning ◽  
Care Providers ◽  
Advance Care

Background: Although international guidelines recommend discussions about goals of care and treatment options for children with severe and life-limiting conditions, there are still few structured models of paediatric advance care planning. Aim: The study aimed at identifying key components of paediatric advance care planning through direct discussions with all involved parties. Design: The study had a qualitative design with a participatory approach. Participants constituted an advisory board and took part in two transdisciplinary workshops. Data were collected in discussion and dialogue groups and analysed using content analysis. Setting/participants: We included bereaved parents, health care providers and stakeholders of care networks. Results: Key elements were discussions, documentation, implementation, timing and participation of children and adolescents. Parents engage in discussions with facilitators and persons of trust to reach a decision. Documentation constitutes the focus of professionals, who endorse brief recommendations for procedures in case of emergencies, supplemented by larger advance directives. Implementation hindrances include emotional barriers of stakeholders, disagreements between parents and professionals and difficulties with emergency services. Discussion timing should take into account parental readiness. The intervention should be repeated at regular intervals, considering emerging needs and increasing awareness of families over time. Involving children and adolescents in advance care planning remains a challenge. Conclusion: A paediatric advance care planning intervention should take into account potential pitfalls and barriers including issues related to timing, potential conflicts between parents and professionals, ambiguity towards written advance directives, the role of non-medical carers for paediatric advance care planning implementation, the need to involve the child and the necessity of an iterative process.

scholarly journals Total angiographic regression of coronary atherosclerosis with optimal medical therapy

2019 ◽  
Vol 12 (11) ◽  
pp. e230456
Author(s):  
Kudel Kunhali ◽  
Robin George Manappallil
Keyword(s):  
Medical Therapy ◽  
Stable Angina ◽  
Coronary Intervention ◽  
Lifestyle Changes ◽  
Optimal Medical Therapy ◽  
First Line ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Therapeutic Lifestyle Changes ◽  
Current Guidelines

Coronary artery disease has shown a dramatic increase worldwide. According to the current guidelines, optimal medical therapy (OMT) is recommended as the first-line treatment for stable angina; with revascularisation being reserved for those with persistent or progressive symptoms despite intensive medical therapy. We report the case of a young man with stable angina, who was advised percutaneous coronary intervention for stenosis of left anterior descending artery. As he was not willing for the same, he was treated with OMT (according to the then relevant Adult Treatment Panel (ATP) III guidelines) and therapeutic lifestyle changes, following which he became asymptomatic along with total regression of the atherosclerotic plaque on coronary angiogram. This case highlights that OMT can be an effective line of management in patients with stable angina; and interventions like angioplasty, stents and surgery may be reserved for those who do not respond adequately.

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