scholarly journals Cardiomyopathy Associated with Anti-SARS-CoV-2 Vaccination: What Do We Know?

Viruses ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2493
Author(s):  
Alfredo Parra-Lucares ◽  
Luis Toro ◽  
Sebastián Weitz-Muñoz ◽  
Cristóbal Ramos
Keyword(s):  
Messenger Rna ◽  
Pediatric Patients ◽  
Low Frequency ◽  
The Elderly ◽  
Autoimmune Response ◽  
Age Group ◽  
Medium Term ◽  
Moderate Severity ◽  
Term Evolution

The SARS-CoV-2 pandemic has mobilized many efforts worldwide to curb its impact on morbidity and mortality. Vaccination of the general population has resulted in the administration of more than 6,700,000,000 doses by the end of October 2021, which is the most effective method to prevent hospitalization and death. Among the adverse effects described, myocarditis and pericarditis are low-frequency events (less than 10 per 100,000 people), mainly observed with messenger RNA vaccines. The mechanisms responsible for these effects have not been specified, considering an exacerbated and uncontrolled immune response and an autoimmune response against specific cardiomyocyte proteins. This greater immunogenicity and reactogenicity is clinically manifested in a differential manner in pediatric patients, adults, and the elderly, determining specific characteristics of its presentation for each age group. It generally develops as a condition of mild to moderate severity, whose symptoms and imaging findings are self-limited, resolving favorably in days to weeks and, exceptionally, reporting deaths associated with this complication. The short- and medium-term prognosis is favorable, highlighting the lack of data on long-term evolution, which should be determined in longer follow-ups.

scholarly journals Comparative efficacy of IV phenytoin, IV valproate and IV levetiracetam in childhood seizures

2019 ◽  
Vol 6 (4) ◽  
pp. 1592
Author(s):  
Sheeraz A. Dar ◽  
Wasim A. Wani ◽  
Mudasir Nazir ◽  
Zul Eidain Hussan
Keyword(s):  
Pediatric Patients ◽  
Seizure Control ◽  
Randomized Study ◽  
P Value ◽  
Age Group ◽  
Seizure Recurrence ◽  
Comparative Efficacy ◽  
Acute Setting ◽  
Neurologic Disorder

Background: Seizures are the most common pediatric neurologic disorder, with 4% to 10% of children suffering at least one seizure in the first 16 years of life objectives to compare efficacy of IV phenytoin, IV valproate, and IV levetiracetam in childhood seizures between 2months to 16 years of age.Methods: This prospective, randomized, study was done on pediatric patients in the age group of 2 months to 16 years who present actively convulsing to the emergency department of pediatrics.Results: At 24 hours seizures were controlled in 44 (88%) patients out of 50 patients in phenytoin group, 39 (78%) out of 50 patients in levetiracetam group and 46 (92%) out of 50 patients in valproate group (p-value 0.115). The relative risk of seizure recurrence for levetiracetam and phenytoin groups when compared to valproate was 2.75 and 1.5, respectively.Conclusions: Present study demonstrates that IV levetiracetam and IV valproate were comparable to IV phenytoin in terms of seizure control in acute setting. All the three are safe and efficacious. Time to regain consciousness was less in valproate group and long-term seizure control too was also better.

Cochlear implantation in the elderly: outcomes, long-term evolution, and predictive factors

2018 ◽  
Vol 275 (4) ◽  
pp. 913-922 ◽  
Author(s):  
Leire Garcia-Iza ◽  
Zuriñe Martinez ◽  
Ane Ugarte ◽  
Mercedes Fernandez ◽  
Xabier Altuna
Keyword(s):  
Predictive Factors ◽  
Cochlear Implantation ◽  
The Elderly ◽  
Long Term Evolution ◽  
Term Evolution

Cumulative Efficacy and Safety of 5-Year Deferasirox (Exjade®) Treatment in Pediatric Patients with Thalassemia Major: A Phase II Multicenter Prospective Trial

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 5413-5413 ◽  
Author(s):  
Antonio Piga ◽  
Kamila Kebaili ◽  
Renzo Galanello ◽  
Valentine Jehl ◽  
Corinne Rebischung ◽  
...  
Keyword(s):  
Iron Overload ◽  
Children And Adolescents ◽  
Sexual Development ◽  
Pediatric Patients ◽  
Prospective Trial ◽  
Thalassemia Major ◽  
Age Group ◽  
Iron Intake ◽  
Relative Change

Abstract Background: Pediatric thalassemia major (TM) patients may begin lifelong iron chelation therapy (ICT) as early as 2 years to avoid potential complications of iron overload, such as impaired growth and the later development of cardiac dysfunction. Deferasirox (Exjade®), administered orally once daily, was developed to improve compliance to long-term ICT in patients with transfusion-dependent anemias. We report cumulative efficacy, safety and development data in pediatric patients with transfusion-dependent TM treated with deferasirox for 5 years (study 106). Methods: Pediatric TM patients stratified into two age groups (children 2-≤12 years; adolescents 12–17 years) were enrolled in study 106 and received deferasirox 10 mg/kg/day for 1 year. Patients completing the 1 year study were able to continue deferasirox treatment for an additional 4 years at adjusted doses, to evaluate long term safety and effect on liver iron concentration (LIC). Safety was assessed by the incidence and type of adverse events (AEs), laboratory parameters and growth/sexual development. Efficacy was evaluated by changes in LIC by SQUID. Results: 20 children (mean age 6.7±2.8 years) and 20 adolescents (mean age 14.1±1.6 years) were enrolled. Children had a greater mean iron intake (0.46–0.49 mg/kg/day) than adolescents (0.39–0.41 mg/kg/day). Median exposure to deferasirox was 5.0 years for children, 5.5 years for adolescents; mean dose in children and adolescents was 18.9±5.7 and 20.9±4.5 mg/kg/day, respectively. On average, 30% of children and 10% of adolescents received <15 mg/kg/day. Mean final dose was 26.3 mg/kg/day for children and 27.8 mg/kg/day for adolescents. Relative change in LIC over the treatment period is shown in Figure 1. Figure 1. Boxplot of relative change in LIC during deferasirox treatment, by age group Figure 1. Boxplot of relative change in LIC during deferasirox treatment, by age group Overall, 24 patients (60.0%; 11 children and 13 adolescents) completed the 5-year study. Reasons for discontinuation were AEs (n=8), consent withdrawal (n=7), unsatisfactory therapeutic effect (n=1). Most common AEs were cough, pyrexia (n=34, 85%) and rhinitis (n=30, 75%); the annual frequency of reported AEs did not increase from year to year and generally occurred in similar proportions for children and adolescents. One child had a serious AE (increased transaminases) assessed as drug-related. Two other patients had an ALT increase >10 × ULN on at least one visit; baseline levels were >8 × ULN in one patient, and normal in the other. Both patients were restarted on deferasirox after 2 week interruptions without further incident. No patient had an increase in serum creatinine >33% above baseline and ULN at two consecutive visits. Neutropenia (neutrophil count <1.5×109/L at two consecutive visits), assessed unrelated to treatment, occurred in one child and two adolescents. There were no clinically significant visual defects and one child had a drug-related audiometric abnormality (hypoacusis). Physical development was normal in both groups; growth velocity was higher in children. Sexual development progressed normally in adolescents. Conclusions: Deferasirox dose-dependently reduced iron overload over 5 years of treatment in these heavily transfused pediatric patients with TM. Dose increases over time, with a stable iron intake, were associated with a decrease in LIC for both groups, but the reduction in LIC was greater in adolescents. Despite having a higher transfusional iron intake, more children than adolescents were on a dose <15 mg/kg/day, highlighting that transfusional iron intake should be considered when selecting deferasirox dose. Deferasirox was generally well tolerated. There was no evidence of progressive renal, hepatic or bone marrow dysfunction. Deferasirox treatment had no negative impact on growth and sexual development.

Management Outcomes for Ruptured and Unruptured Aneurysms in the Elderly

Neurosurgery ◽  
2000 ◽  
Vol 47 (4) ◽  
pp. 827-833 ◽  
Author(s):  
Richard Y. Chung ◽  
Bob S. Carter ◽  
Alex Norbash ◽  
Ronald Budzik ◽  
Christopher Putnam ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Barthel Index ◽  
Functional Disability ◽  
The Elderly ◽  
Individual Treatment ◽  
Age Group ◽  
Difficult Patient ◽  
Unruptured Aneurysms ◽  
Long Term Follow Up

AbstractOBJECTIVEIn a patient older than 70 years, the decision to treat an intracranial aneurysm remains difficult whether it is ruptured or unruptured. We sought to review our institutional risks of treatment of such lesions in the context of the risks of rupture and its associated morbidity and mortality in this age group.METHODSOne hundred twenty-nine consecutive patients aged 70 years or older, who were treated at a single institution for an intracranial aneurysm, were retrospectively reviewed. Forty patients were treated for unruptured aneurysms, and 89 patients presented after subarachnoid hemorrhage. Seven additional patients in this age group who had solely intracavernous lesions, as well as one patient with a dolichoectatic fusiform basilar lesion, were excluded. Management outcomes were assessed using a modification of the Glasgow Outcome Scale, and additional physical and functional disability was assessed using the Barthel index and the Reintegration to Normal Living index.RESULTSSix-month outcomes for the unruptured group were: excellent, 70%; good, 15%; fair, 5%; poor, 7.5%; and death (2.5%). Outcomes for all patients with ruptured lesions (including those not offered aggressive therapy) were: excellent, 34%; good, 9%; fair, 5.6%; poor, 3.4%; and death, 45%. Long-term follow-up was performed by questionnaire to assess physical and functional disability. Although physical disability (Barthel index) was similar among survivors, the Reintegration to Normal Living index, a global assessment of function, was significantly higher in patients with unruptured aneurysms (84.8 versus 70.1;P = 0.05), which highlights the disabling effects of hemorrhage.CONCLUSIONOn the basis of an individual treatment center's management risks, annual aneurysmal rupture rates can be estimated that justify treatment in this difficult patient population. Despite recent controversy regarding aneurysmal hemorrhage rates, we think that symptomatic unruptured aneurysms should be treated and good results can be achieved, even in older patients.

scholarly journals Long-Term Antithyroid Treatment in Pediatric and Juvenile Graves’ Disease

2020 ◽  
Vol 18 (Suppl) ◽  
Author(s):  
Hossein Delshad ◽  
Miralireza Takyar
Keyword(s):  
Pediatric Patients ◽  
Radioactive Iodine ◽  
Remission Rate ◽  
Current Evidence ◽  
Graves Disease ◽  
Age Group ◽  
Pediatric Age ◽  
Pediatric Age Group ◽  
Review Articles

Context: Thyroid hormones can affect the development and function of the central nervous system and various other organs. As such, the pathologic excess of these hormones, known as thyrotoxicosis, can be the source of significant damage during childhood and adolescence. The objective of this study was to review the management of Graves’ disease (GD) in the pediatric age group, especially concerning long-term antithyroid drug (ATD) treatment. Evidence Acquisition: A thorough search of literature published from 1980 to 2019 was performed in PubMed only for English language literature. The following key terms were used: “Graves’ disease, hyperthyroidism, thyrotoxicosis in children, thyrotoxicosis remission, thyrotoxicosis relapse, definite therapy, radioactive iodine, thyroidectomy, anti-thyroid drugs, propylthiouracil, methimazole, and carbimazole”. We also did a thorough search in review articles, observational studies, open-label/controlled randomized/non-randomized trials, and meta-analyses, as well as the articles cited by textbooks, chapters, and review articles, which led us to locate older sources of information on the topic. Results: More than 90% of thyrotoxicosis in the pediatric age group is attributable to GD. A host of strategies, including ATDs, radioiodine therapy, and surgery, are employed to treat this entity. However, there is still significant controversy regarding the most optimal strategy. Current evidence suggests that ATDs are the best initial treatment in pediatric patients with GD. Although ATDs are widely used, the duration of their administration is controversial and varies significantly between protocols. A major problem is the high relapse rate (up to 70%), but extending the duration of such treatment could potentially bring the remission rate up to 88%. Indications for using radioactive iodine treatment include the lack of remission following years of receiving ATDs, poor compliance, and the emergence of a major side effect. In pediatric patients aged five-years-old or younger who suffer from very large goiter, severe ophthalmopathy, and persistent hyperthyroidism, as well as those with the lack of response to or showing adverse effects of ATDs, it is advisable to consider total or near-total thyroidectomy. Conclusions: Antithyroid drugs are the mainstay of treatment of juvenile GD, and long-term methimazole therapy increases the remission rate in pediatric GD.

scholarly journals Understanding site choice and competition through the adaptive dynamics of microbial settling strategy in a chemostat

2020 ◽  
Author(s):  
Yuhua Cai ◽  
Stefan A. H. Geritz
Keyword(s):  
Evolutionary Dynamics ◽  
Adaptive Dynamics ◽  
Low Frequency ◽  
Long Term Evolution ◽  
Operating Conditions ◽  
Settling Rate ◽  
Nutrient Input ◽  
Occupied Site ◽  
Term Evolution

AbstractTo understand the choice and competition of sites in nature, we consider an ecological environment in a chemostat consisting of a polymorphic microbial population that can float in the fluid or settle down on the wall of the chemostat. For the transition of a microbe from its floating state to its settled state at a particular settling rate involving the choice and competition of sites on the wall, we consider three different mechanisms: (i) unimolecular-Bourgeois settling, i.e., floaters land freely on the wall, but in an occupied site, the owner keeps the site (Bourgeois behaviour); (ii) unimolecular-anti-Bourgeois settling, i.e., floaters land freely on the wall, but in an occupied site, the intruder gets the site (anti-Bourgeois behaviour); (iii) bimolecular settling, i.e., floaters land only on the vacant sites of the wall. Employing the framework of adaptive dynamics, we study the evolution of the settling rate with different settling mechanisms and investigate how physical operating conditions affect the evolutionary dynamics. Our results indicate that settling mechanisms and physical operating conditions have significant influences on the direction of evolution and the diversity of phenotypes. (1) For constant nutrient input, theoretical analysis shows that the population is always monomorphic during the long-term evolution. Notably, the direction of evolution depends on the settling mechanisms and physical operating conditions, which further determines the composition of the population. Moreover, we find two exciting transformations of types of Pairwise Invasibility Plots, which are the gradual transformation and the bang-bang transformation. (2) For periodic nutrient input, numerical analysis reveals that evolutionary coexistence is possible, and the population eventually maintains dimorphism. Remarkably, for all three settling mechanisms, the long-term evolution leads to one of the two coexisting species settle down totally on the wall if the input is low-frequency but float entirely in the fluid if the input becomes high-frequency.

scholarly journals Low-Frequency Repetitive Transcranial Magnetic Stimulation for the Treatment of Chronic Tinnitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Changhong Dong ◽  
Cheng Chen ◽  
Teng Wang ◽  
Chunjiu Gao ◽  
Yidan Wang ◽  
...  
Keyword(s):  
Repetitive Transcranial Magnetic Stimulation ◽  
Low Frequency ◽  
Chronic Tinnitus ◽  
Medium Term ◽  
Short Term ◽  
Tinnitus Severity ◽  
Randomized Controlled ◽  
Low Frequency Rtms

Background. Chronic tinnitus affects approximately 10-15% of the population. Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been considered as a promising and well-tolerated therapeutic strategy for chronic tinnitus. However, a recent large-scale multicenter clinical trial showed a negative result. Objective. This systematic review is aimed at assessing the efficacy and safety of low-frequency rTMS in chronic tinnitus. Methods. We searched PubMed, Embase, and Cochrane Library for randomized controlled studies of rTMS treatment of chronic tinnitus. A pooled analysis of standardized mean difference (SMD) was performed with 95% confidence intervals (CI). Results. Ten RCTs involving 567 participants were included in this review. Compared with sham stimulation, rTMS showed no significant efficacy in tinnitus severity and disability measured by Tinnitus Handicap Inventory (THI) in short-term (SMD=−0.04, 95% CI -0.23 to 0.16, P=0.72), medium-term (SMD=−0.13, 95% CI -0.43 to 0.17, P=0.41), and long-term (SMD=−0.16, 95% CI -0.38 to 0.05, P=0.14) follow-up. Tinnitus severity and disability measured by Tinnitus Questionnaire (TQ) also showed no significant improvement in short-term (SMD=−0.11, 95% CI -0.31 to 0.10, P=0.30), medium-term (SMD=−0.10, 95% CI -0.37 to 0.16, P=0.44), and long-term (SMD=−0.20, 95% CI -0.40 to 0.01, P=0.06) follow-up. Additionally, no statistically significant difference was shown in the changes of tinnitus loudness assessed by a visual analogue scale (VAS) between rTMS and sham groups in the short-term (SMD=−0.28, 95% CI -0.59 to 0.02, P=0.07), medium-term (SMD=−0.26, 95% CI -0.59 to 0.07, P=0.13), and long-term (SMD=−0.20, 95% CI -0.53 to 0.13, P=0.24) follow-up. Few mild or moderate adverse events were observed in both the rTMS and sham groups. Conclusion. Low-frequency rTMS is well tolerated but not effective in treating chronic tinnitus based on the current analysis of pooled data. Further studies with modified and uniform protocols are required to investigate the potential benefit of rTMS in chronic tinnitus.

scholarly journals The importance of adherence and persistence in the elderly atrial fibrillation patient

2020 ◽  
Vol 22 (Supplement_I) ◽  
pp. I38-I42
Author(s):  
Elaine M Hylek
Keyword(s):  
Atrial Fibrillation ◽  
Older Adults ◽  
Medication Adherence ◽  
Natural History ◽  
Atrial Fibrillation Patient ◽  
The Elderly ◽  
Medical System ◽  
Age Group ◽  
History Of

Abstract Older adults with atrial fibrillation are at the highest risk of ischaemic stroke yet are the least likely to be prescribed anticoagulant therapy, adhere to this therapy, and maintain long-term persistence with this therapy. The reasons for this under treatment are multifactorial and include patient-driven factors, physician-driven factors, medical system complexities, and current unknowns regarding the biology and natural history of AF. Understanding these challenges to stroke prevention and addressing identified barriers to medication adherence and persistence in this vulnerable age group will improve outcomes related to AF.

Standard-Phase-height measurements over Europe during 60 years of measurements – Long-term variability and trends of the mesosphere

2020 ◽  
Author(s):  
Dieter H.W. Peters ◽  
Günter Entzian
Keyword(s):  
Global Warming ◽  
Solar Cycle ◽  
Decadal Variability ◽  
Low Frequency ◽  
Radio Waves ◽  
Northern Germany ◽  
Term Evolution ◽  
Low Costs ◽  
Photo Ionization

<p>Beginning with 1959 that means over more than 60 years, field strength measurements of the broadcasting station, Allouis (Central France), have been carried out at Kühlungsborn (54° N, 12° E, Mecklenburg, Northern Germany. These so-called indirect phase-height measurements of low frequency radio waves (here with a frequency of 162 kHz) are used to examine the long-term evolution and trends of the mesosphere over Europe. The advantages of the method are the low costs and the simplicity of operation. The extended reanalyzed fifth release of standard-phase height (SPH) are presented.</p><p>The SPH-series are anti-correlated to the solar cycle as known because stronger photo-ionization is linked with higher number of electrons, which reduces the SPH. The anti-correlation between SPH and proxies of solar cycle are well established. Furthermore the statistical analysis of the SPH-series shows a significant overall trend in the order of hundred meters per decade induced by a shrinking stratosphere due to global warming. Strong intra-decadal variability is related to QBO like and ENSO like variability. The derived thickness temperature of the mesosphere decreased statistically significant over the period 1959-2019 after pre-whitening with summer means of solar sun spot numbers. The trend value is in the order of about -1 K/ decade if the stratopause trend is excluded. The amount of linear regression is weaker, -0.8 K/ decade for the period of 1963-1985 (2 SCs), but stronger, about -1.6 K/ decade during 1995-2016 (last 2 SCs).</p>

The Use of Furosemide in the Treatment of Edema in infants and Children

PEDIATRICS ◽  
1978 ◽  
Vol 62 (5) ◽  
pp. 811-818 ◽  
Author(s):  
Mary Allen Engle ◽  
John E. Lewy ◽  
Peter R. Lewy ◽  
Jack Metcoff
Keyword(s):  
Renal Disease ◽  
Water Retention ◽  
Pediatric Patients ◽  
Oral Route ◽  
Age Group ◽  
Time Intervals ◽  
Pediatric Age Group ◽  
In Infants And Children ◽  
Parenteral Medication

One hundred thirty-seven courses of furosemide therapy were given to 106 hospitalized pediatric patients with salt and water retention associated with cardiac or renal disease. The diuretic was effective and safe in the pediatric age group when administered acutely as a parenteral medication and over a long-term course by the oral route in the doses and at the time intervals used in this study. On the basis of each kilogram of body weight, the infants with edema as a result of cardiac failure and the children with edema secondary to renal disease responded equally well to furosemide therapy.

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