scholarly journals Home Artificial Nutrition in Polish Children: An Analysis of 9-Year National Healthcare Provider Data

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 1007
Author(s):  
Karolina Wyszomirska ◽  
Adam Wyszomirski ◽  
Michał Brzeziński ◽  
Anna Borkowska ◽  
Maciej Zagierski ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Pediatric Patients ◽  
Artificial Nutrition ◽  
Gastrointestinal Disorders ◽  
Principal Diagnosis ◽  
National Healthcare ◽  
Number Of Patients ◽  
Developing Method ◽  
Symptoms And Signs

Background: Home artificial nutrition (HAN) is a developing method of treatment that reduces the need for hospitalizations. The epidemiology of pediatric HAN in Poland has not yet been covered in detail. This study is a longitudinal nationwide analysis of incidence, prevalence, and patients’ profile for HAN in Polish children. Methods: Assessment of National Health Fund (NFZ) data covering all pediatric patients treated with HAN in Poland between 2010 and 2018. Results: HAN was received by 4426 children, 65 patients were on home enteral nutrition (HEN) or home parenteral nutrition (HPN) at different times (HEN n = 3865, HPN n = 626). HAN was most frequently started before the child was 3 years old and long-term HAN programs (5–9 years) were reported. The most common principal diagnosis in HEN was food-related symptoms and signs. In HPN, it was postoperative gastrointestinal disorders. A regionally differentiated prevalence of HAN patients and centers was demonstrated. Mortality among patients was 24.9% for HEN, and 9.6% for HPN, and the main in-hospital cause of death was cardiac arrest. Conclusions: HAN’s use is increasing and evolving in Poland. Uneven distribution of patients and centers results in difficult access to the nutritional procedure which, together with the increasing number of patients, highlights the need for data analysis and development of nutrition centers.

Neurological morbidity in survivors of childhood acute lymphoblastic leukemia (ALL)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9529-9529
Author(s):  
B. Morris ◽  
R. Khan ◽  
D. Ledet ◽  
C. Howell ◽  
C. Pui ◽  
...  
Keyword(s):  
Back Pain ◽  
Lymphoblastic Leukemia ◽  
Sensory Neuropathy ◽  
Neurological Symptoms ◽  
Term Survival ◽  
Childhood All ◽  
Number Of Patients ◽  
Neurological Morbidity ◽  
Symptoms And Signs

9529 Background: The majority of children diagnosed with ALL over the past two decades have achieved long-term survival. This remarkable success is attributed in part to intensive central nervous system (CNS)-directed therapy that effectively prevents CNS relapse. Because treatment-related neurological morbidity is recognized but poorly characterized, the objective of this cross-sectional study was to estimate the prevalence of neurological symptoms and signs in long-term survivors of childhood ALL. Methods: After obtaining IRB approval, all long-term ALL survivors (≥ 5 years since diagnosis) aged 6–28 years who remained active patients at our institution were identified. All participants completed a questionnaire consisting of independent (and when possible validated) instruments designed to identify various neurological symptoms, as well as, a comprehensive and standardized neurologic examination by a board-certified neurologist. Results: Of the 433 potentially eligible subjects, 162 (37.4%) were enrolled. Participant demographic information and previous treatment exposure were similar to those not enrolled in the study. The rates of endorsed neurological symptoms were: neuropathy (40.1%), dizziness (33%), back pain (22.8%), fatigue (19.1%), falls (15.4%), headache (14.8%), seizures (10.5%), urinary incontinence (8.6%), and stroke (1.2%). Neurological examination confirmed an underlying sensory neuropathy in 44 patients (27.3%). Otherwise, signs of chronic cranial nerve dysfunction (1.9%) and motor weakness (5.6%) were rare. Conclusions: Symptoms and signs of a chronic sensory neuropathy, presumably from previous vincristine exposure, were evident in many patients. Complaints of fatigue, dizziness, and chronic back pain were also relatively common. The number of patients who routinely fall is of concern. Whether these falls are associated with symptoms/signs of neuropathy, weakness, and/or dizziness will require further analysis. Although headache was a common complaint, its prevalence may not differ significantly from a normal age-matched population. No significant financial relationships to disclose.

Ionizing Radiation Exposure in Pediatric Patients With Intestinal Failure

2020 ◽  
pp. 000313482095484
Author(s):  
Jessica L. Rauh ◽  
Angie Almond ◽  
Michael Glock ◽  
Evelyn Anthony ◽  
Kristen A. Zeller
Keyword(s):  
Ionizing Radiation ◽  
Pediatric Patients ◽  
Intestinal Failure ◽  
Imaging Studies ◽  
Number Of Patients ◽  
Long Term Follow Up ◽  
Vulnerable Patient ◽  
Ionizing Radiation Exposure ◽  
The Impact

Background Children with intestinal failure (IF) are frequently exposed to imaging studies using ionizing radiation. Due to many advancements in care of pediatric patients with IF, the number of patients living with this condition is growing. This burden of disease as pertains to pediatric IF patients has not been previously described. Methods and Results 10 patients in a multidisciplinary clinic for IF were included in a retrospective review of ionizing imaging studies. Ages ranged from 2-6 years old. The average number of studies performed exposing patients to ionizing radiation was 69.1 (±41.0). A majority of the studies were plain radiographs. Fluoroscopy studies were common. The Computed tomography scans were less common. An average of 31% (±25.7%) of these studies were obtained before the first discharge from the hospital. Conclusions While survival and outcomes of IF patients continue to improve, it is important to consider the impact of radiation-related exposure to which this population is frequently subjected. Long-term follow-up will be necessary to determine whether or not this translates to increased risks or complications in this already vulnerable patient population.

Long-Term Therapy with Deferasirox in Young Pediatric Patients with Transfusional Hemosiderosis Completing up to 5 Years of Treatment in the Observational E.N.T.R.U.S.T. Study

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2470-2470
Author(s):  
Elliott Vichinsky ◽  
Amal El-Beshlawy ◽  
Azzam Alzoebie ◽  
Annie Kamdem ◽  
Suzanne Koussa ◽  
...  
Keyword(s):  
Weight Gain ◽  
Serum Ferritin ◽  
Research Funding ◽  
Pediatric Patients ◽  
Study Drug ◽  
Early Age ◽  
Iron Intake ◽  
Number Of Patients

Abstract Introduction:Regular supportive transfusion therapy from an early age is common practice in young children with β thalassemia major (βTM), sickle-cell disease (SCD) and Diamond-Blackfan anemia (DBA). Patients consequently accumulate iron that can affect organ function and delay growth/development. As such, iron chelation therapy is often necessary from an early age, with lifelong requirements for patients who cannot be cured with hematopoietic stem cell transplantation. Deferasirox, a once-daily oral iron chelator, has demonstrated efficacy and safety in adult and pediatric patients with chronic iron overload. Long-term evaluation of deferasirox in young pediatric patients with transfusional hemosiderosis is valuable, as conducted in the 5-yr multinational, observational ENTRUST study. Here, we report safety and efficacy outcomes in pediatric patients with transfusional hemosiderosis receiving up to 5 yrs of continuous deferasirox treatment in clinical practice. Methods :Patients aged 2-<6 yrs at enrolment were prescribed deferasirox according to local labels, with recommendations to adjust dose based on serum ferritin levels, therapeutic goals, tolerability and weight gain. Patients were followed prospectively for 5 yrs in this observational study. Safety was evaluated by regular monitoring and recording of adverse events (AEs) in all patients who received ≥1 dose of deferasirox and had ≥1 post-baseline safety assessment (safety set). Serum ferritin levels were also analyzed (as a surrogate marker for body iron) in all patients who received ≥1 dose of deferasirox (full analysis set; FAS). Results:267 patients (mean age 3.2 yrs: 61.4% <4 yrs, 38.6% ≥4 yrs) with βTM (n=176, 65.9%), SCD (n=52, 19.5%), DBA (n=12, 4.5%), and other anemias (n=27, 10.1%) were enrolled and received ≥1 deferasirox dose. Overall mean ± SD deferasirox exposure was 44.1 ± 21.2 (range 1.2-65.6) months and mean ± SD dose was 25.8 ± 6.5 mg/kg/day. Dose was generally aligned with weight, though initial doses were suboptimal to manage iron intake and adjustments based on weight gain were delayed. 130 patients (49.8%) received deferasirox for ≥60 months. 122 patients (45.7%) patients discontinued treatment prematurely, most commonly (>5% of patients) because of loss to follow-up (n=19, 7.1%) and AEs (n=18, 6.7%; most commonly increased alanine or aspartate aminotransferase [ALT/AST], n=7 each). The number of patients discontinuing treatment because of AEs declined year on year; n=10 in Yr 1, n=4 in Yr 2, n=2 in Yr 3, and n=1 in Yrs 4 and 5, respectively. From Yr 3 onwards, there were no discontinuations due to an increase in ALT or AST. Change from baseline in serum ferritin by duration of deferasirox exposure (FAS) is summarized (Table). In the 130 patients exposed to deferasirox for 5 yrs, median serum ferritin levels decreased from 1777 (range 509-5804) ng/mL at baseline to 1414 (range 166-7030) ng/mL, a median change from baseline of -425 (range -4131-5576) ng/mL (Table). 145 patients completed 5 yrs of follow-up and had data on AEs collected during this entire period. The most frequently occurring AEs with suspected relationship to study drug (occurring in ≥4 patients) were increased ALT (n=29, 20.0%), increased AST (n=12, 8.3%), vomiting (n=9, 6.2%), rash (n=6, 4.1%) and increased blood creatinine (n=6, 4.1%). Overall, there was a gradual decrease in the number of patients experiencing drug-related AEs in the safety set with each year of deferasirox exposure (Figure). Conclusions:This long-term, observational study of deferasirox in pediatric patients supports previous findings indicating favorable safety and efficacy. Approximately half the patients completed the 5-yr study, with many patients discontinuing for reasons unrelated to study drug, indicating good acceptance of treatment. Patients remaining on deferasirox benefited from sustained improvements in iron load, though this was not immediate, likely because of delayed increases in dose based on weight gain and ongoing iron intake. Among patients who continued on deferasirox tolerance was increasing over time as indicated by yearly decreasing numbers of AEs. In patients followed for up to 5 yrs, AEs were consistent with the known deferasirox safety profile, with no progressive increases in the incidence of renal-related AEs. These data therefore support the long-term use of deferasirox in young iron overloaded patients in everyday clinical practice. Disclosures Vichinsky: Novartis, ApoPharma Inc. and ARUP Laboratories: Research Funding; Novartis: Consultancy. El-Beshlawy:Novartis, ApoPharma Inc: Research Funding. Bruederle:Novartis Pharmaceuticals Corporation: Employment. Han:Novartis: Employment.

Abstract 112: One Year Later: Patient-reported Outcomes Among Survivors of In-hospital Cardiac Arrest in Veterans Administration Hospitals

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Elizabeth M Viglianti ◽  
Kaitlyn Hanisko ◽  
Rachel Bucy ◽  
Lee Ewing ◽  
Bradley Youles ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Patient Reported Outcomes ◽  
Veterans Administration ◽  
Instrumental Activities ◽  
Number Of Patients ◽  
Patient Reported

Background: Short term mortality following in-hospital cardiac arrests (IHCA) is well understood. However, little is known about long term patient-reported outcomes - such as activities of daily living, cognitive function, and depression among survivors of IHCA. Objective: To assess the patient-reported outcomes in IHCA survivors 12-months after cardiac arrest. Methods: Veteran survivors of IHCA (ICD-9-CM codes 99.60, 99.63 or 427.5) who were discharged alive from a U.S. Veterans Administration Medical Center from September 1, 2013 to October 31, 2013 were identified. After confirmation of eligibility by medical record review, they were mailed a research information packet. Those who did not opt-out were contacted by phone two weeks later. Veterans who consented were surveyed by phone or mail. The survey encompassed Katz Activities of Daily Living (ADL), Lawton Instrumental Activities of Daily Living (IADLs), self-reported depressive symptoms (via the PHQ-9) and an assessment of cognition (via the modified Telephone Interview for Cognitive Status (mTICS) as used by the Health and Retirement Study). Results: Among 50 IHCA survivors, 37 (74%) completed surveys; survey operations are detailed in another abstract. Among those 37 who completed the survey, answers to all patient-reported outcomes items were obtained from 29 (78%). Respondents’ median age was 66 years old (range 38 to 87) and 95% were male. The survivors self-reported health assessment of their health was poor, with 8% and 40% describing their health as “poor” or fair” respectively, but only 5% saying “very good” and none reporting “excellent”. Similarly, 27% reported having 4 or more health-related difficulties in their basic and instrumental activities of daily living, 24% reported 1-3, and 46% none. On the PHQ-9, 19% had scores consistent with severe depression. Of those tested for cognitive impairment, 32% were at risk for at least some cognitive impairment. Conclusion: Among survivors of IHCA, we found that few patients at 12-months reported an overall sense of good health, and a significant number of patients had high-levels of disability, cognitive impairment and depression. There is an urgent need to understand the epidemiology and trajectory of this poor health, and develop interventions to improve the long term outcomes of IHCA.

Therapeutic Plasma Exchange Application in Children Requires Individual Decision

2020 ◽  
Author(s):  
Gürkan Atay ◽  
Demet Demirkol
Keyword(s):  
Plasma Exchange ◽  
Vascular Access ◽  
Pediatric Patients ◽  
Demyelinating Disease ◽  
Pediatric Intensive Care ◽  
Therapeutic Plasma Exchange ◽  
Transplantation Rejection ◽  
Access Problems ◽  
Uremic Syndrome

AbstractTherapeutic plasma exchange (TPE) is a treatment administered with the aim of removing a pathogenic material or compound causing morbidity in a variety of neurologic, hematologic, renal, and autoimmune diseases. In this study, we aimed to assess the indications, efficacy, reliability, complications, and treatment response of pediatric patients for TPE. This retrospective study analyzed data from 39 patients aged from 0 to 18 years who underwent a total of 172 TPE sessions from January 2015 to April 2018 in a tertiary pediatric intensive care unit. Indications for TPE were, in order of frequency, macrophage activation syndrome (28.2%, n = 11), renal transplantation rejection (15.4%, n = 6), liver failure (15.4%, n = 6), Guillain–Barre's syndrome (15%, n = 6), hemolytic uremic syndrome (7.7%, n = 3), acute demyelinating disease (7.7%, n = 3), septic shock (5.1%, n = 2), and intoxication (5.1%, n = 2). No patient had any adverse event related to the TPE during the procedure. The TPE session was ended prematurely in one patient due to insufficient vascular access and lack of blood flow (2.6%). In the long term, thrombosis due to the indwelling central catheter occurred (5.1%, n = 2). TPE appears to be an effective first-stage or supplementary treatment in a variety of diseases, may be safely used in pediatric patients, and there are significant findings that its area of use will increase. In experienced hands and when assessed carefully, it appears that the rate of adverse reactions and vascular access problems may be low enough to be negligible.

Ixekizumab in the Management of Non-Selected Out Patients with Moderate to Severe Psoriasis -New Data and Personal Clinical Experience

2018 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Clinical Experience ◽  
Personal Experience ◽  
Therapeutic Response ◽  
Systemic Disease ◽  
Severe Psoriasis ◽  
Adequate Treatment ◽  
Scalp Psoriasis ◽  
Number Of Patients ◽  
Genital Psoriasis

Introduction: Too many patients with moderate to severe psoriasis do not receive adequate treatment. This means a vast undersupply in the treatment of patients with psoriasis. Only biologics fulfill the whole range of the treatment of psoriasis – psoriasis does not affect only skin but the whole organism: It is a systemic disease! Between the biologics are evident differences concerning the effect. Discussion: Based on broad personal experience in the management of patients with moderate to severe psoriasis new data from clinical studies with ixekizumab are examined. This contains new data on long-term-efficacy of ixekizumab, effectiveness in special localizations (scalp psoriasis, nail psoriasis, palmoplantar psoriasis, genital psoriasis) as well as safely data and experience on patients switched to ixekizumab from other biologics. Personal clinical experience is based on >300 non-selected outpatients with moderate to severe psoriasis, >250 patients on biological therapies, > 50 patients with ixekizumab. Conclusions: Focusing on a relevant number of patients switched from secukinumab to ixekizumab due to first or secondary loss of efficacy significant differences between both IL-17A-inhibitors mainly in terms of efficacy and speed of therapeutic response are shown. Finally the correlation between PASI-90-/PASI-100 response and significant changes in DLQI are highlighted.

Inflammatory disease of the womans reproductive system: modern trends in diagnosis and therapy (literature review)

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 35-41
Author(s):  
T Yu Pestrikova ◽  
I V Yurasov ◽  
E A Yurasova
Keyword(s):  
Genital Tract ◽  
Inflammatory Diseases ◽  
Diagnosis And Treatment ◽  
Long Term Results ◽  
Modern Approach ◽  
Pelvic Organs ◽  
Results Of Treatment ◽  
Number Of Patients ◽  
Diagnostic Approaches

Medical, social and economic relevance of inflammatory diseases of the woman's reproductive organs requires a very careful attitude to the diagnosis and treatment of this pathology. The number of patients with genital infections and inflammatory diseases of the pelvic organs can takes the first place in structure of gynecological morbidity, and is 60.4-65.0%, and this fact is not unique to Russia, but all over the world. Incidence rate of inflammatory diseases of the pelvic organs in the first decade of the twenty-first century is increased at 1.4 times in patients who are from 18 to 24 years old and at 1.8 times in patients aged 25-29 years. At the same time, the cost of diagnosis and treatment has increased, reaching 50-60% of the total cost of providing gynecological care for population. The inflammatory diseases of pelvic organs are a collective concept. It includes of various nosological forms. There are numerous contradictions in the views on diagnostic approaches and treatment tactics, the nature of screening and control over the long-term results of treatment, the etiological and pathogenetic significance of various microorganisms found in the genital tract in patients with inflammatory diseases of the pelvic organs. Currently, there are many opinions among specialists about diagnostic approaches and treatment tactics, the type of screening and monitoring the long-term results of treatment, the etiological and pathogenetic role of various microorganisms which can be found in the genital tract in patients with inflammatory diseases. This review presents the results of a modern approach to the diagnosis, management and rehabilitation of patients with inflammatory diseases of the pelvic organs.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

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