scholarly journals Nephrotoxicity with Combination Vancomycin-Aminoglycoside Therapy

2005 ◽  
Vol 10 (3) ◽  
pp. 174-182 ◽  
Author(s):  
Erin M. Timpe
Keyword(s):  
Prospective Studies ◽  
Pediatric Patients ◽  
Medical Literature ◽  
Case Reports ◽  
Pediatric Population ◽  
Vancomycin Therapy ◽  
Drug Induced ◽  
Search Terms ◽  
Aminoglycoside Therapy ◽  
Number Of Patients

OBJECTIVES The purpose of this paper is to review the medical literature regarding vancomycinaminoglycoside induced nephrotoxicity in the pediatric population. METHODS MEDLINE (1966 through June 2005), EMBASE (1980 through 1st quarter 2005), and International Pharmaceutical Abstracts databases were reviewed using appropriate search terms for articles related to nephrotoxicity with vancomycin and aminoglycoside use. Case reports, letters to editors, retrospective and prospective studies evaluating nephrotoxicity with the agents in pediatric patients were compiled and summarized. Studies in animals and adults were also briefly reviewed. RESULTS One case report, two letters to editors, one retrospective study, and two prospective studies evaluated the nephrotoxicity of combination aminoglycoside and vancomycin therapy in pediatric patients. The collective number of patients in the reports was 165. Patients ranged in age from 3 days to 19 years old. Four out of the six reports, including all of the prospective studies, concluded that combination therapy does not potentiate nephrotoxicity. CONCLUSIONS Although vancomycin and the aminoglycosides have been associated with drug induced nephrotoxicity, reports in the literature do not appear to support the idea that the combination of vancomycin and an aminoglycoside is more nephrotoxic than either medication alone.

scholarly journals 385. Kawasaki’s Disease and Sars-Cov-2: an Unexpected Pediatric Global Crisis?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S261-S261
Author(s):  
Lucca G Giarola ◽  
Braulio Roberto Gonçalves Marinho Couto ◽  
Carlos Ernesto Ferreira Starling ◽  
Handerson Dias Duarte de Carvalho
Keyword(s):  
Pediatric Patients ◽  
Case Reports ◽  
Pediatric Population ◽  
Fold Increase ◽  
Quick Recovery ◽  
Coronary Aneurysms ◽  
Number Of Patients ◽  
Pubmed Database ◽  
Kawasaki’S Disease ◽  
Kawasaki's Disease

Abstract Background Infection by SARS-CoV-2 can lead to dyspnea, edema, deposition of intra alveolar fibrin, thrombosis and hemorrhages. During the COVID-19. outbreak, several questions were raised about the risks for the pediatric population. Pediatric patients appeared to be relatively safe, with only minor symptoms and a quick recovery. However, there have been reports of a relationship between COVID 19 and a Kawasaki-like inflammatory disease in this population. Kawasaki’s disease (KD) is a rheumatological vasculitis prevalent in childhood characterized mainly by diffuse inflammation of the arteries associated with skin rash, changes in the mucosa and its main complication is coronary aneurysms. Methods A systematic literature review was performed in the PubMED database using the keywords “Kawasaki disease”, “COVID-19” and “Pediatrics”. The selected filters were “Case reports”, “Multicenter study”, “Clinical Study”, “Observational study”, “Human” and “English”. A total of 18 articles were seleted. Results There seems to be a convergence between the literature published so far, pointing to a greater propensity for pediatric patients infected with Sars-Cov-2 to develop KD. The number of patients with KD symptoms seen at a specific center increased from 2 to 17 in 11 days (MOREIRA, 2020). In a sample space of 21 patients diagnosed with KD, 91% had previous contact with SARS-CoV-2 (TOUBIANA, 2020) whereas other studies point to a 30-fold increase in the prevalence of KD since the beginning of 2020 (VERDONI, 2020). There is already an established relationship between DK and HCoV-NH, describing that 4.5% of patients with this infection develop KD. Therefore, it was suggested that infection with another Coronavirus strain could have a similar relationship. Conclusion Despite the relationship described between pediatric patients infected with COVID-19 being more likely to develop KD, further studies are needed to prove a statistical relationship between both condition. Disclosures All Authors: No reported disclosures

Drug-Induced Yawning—A Review

2011 ◽  
Vol 45 (10) ◽  
pp. 1297-1301 ◽  
Author(s):  
Edna Patatanian ◽  
Nancy Toedter Williams
Keyword(s):  
Case Reports ◽  
Data Extraction ◽  
Background Information ◽  
Drug Induced ◽  
Data Synthesis ◽  
Search Terms ◽  
Dopaminergic Agents ◽  
Study Selection ◽  
Physiologic Function ◽  
Induction Agents

Objective: To review the current literature on drug-induced yawning. Data Sources: Literature was accessed through MEDLINE/PubMed (1996-July 2011), International Pharmaceutical Abstracts (1997-July 2011), and EMBASE, using the search terms yawning, drug-induced yawning, and adverse drug reactions. Study Selection and Data Extraction: Relevant clinical trials and case reports were selected and included to present background information. Bibliographies of all relevant articles were reviewed for additional citations. Data Synthesis: Yawning is a common stereotype behavior with unknown physiologic function that occurs in most vertebrates and humans as early as 15 weeks of intrauterine life. Yawning Is under the control of several neurotransmitters and neuropeptides, Including dopamine, serotonin, oxytocin, and acetylcholine. Among drugs, antidepressants, opioids, dopaminergic agents, benzodiazepines, and induction agents are the main pharmacologic classes associated with yawning. Conclusions: Yawning is rarely a serious adverse reaction and is not frequently listed in the drug summary. Most available data are based on case reports, small studies, and older literature. Clinicians should be aware of the agents commonly triggering this behavior.

scholarly journals Arthroscopic Management of Pigmented Villonodular Synovitis of the Hip in Children and Adolescents

2018 ◽  
Vol 6 (3) ◽  
pp. 232596711876311 ◽  
Author(s):  
S. Clifton Willimon ◽  
Tim Schrader ◽  
Crystal A. Perkins
Keyword(s):  
Pediatric Patients ◽  
Case Reports ◽  
Pediatric Population ◽  
Case Series ◽  
Pigmented Villonodular Synovitis ◽  
Villonodular Synovitis ◽  
Arthroscopic Synovectomy ◽  
Duration Of Symptoms ◽  
Pigmented Villonodular

Background: Pigmented villonodular synovitis (PVNS) is a benign proliferative synovial disorder most commonly described to affect the knee in adults. Literature describing PVNS in the pediatric population is limited to 2 small case series and a handful of single-patient case reports. Within these studies, only 2 patients with PVNS of the hip are described. Purpose: To describe the presentation, management, and outcomes of a single-center series of pediatric patients with PVNS of the hip treated with arthroscopic synovectomy. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of consecutive pediatric patients treated for PVNS at a single institution was performed. Inclusion criteria consisted of patients younger than 19 years with surgically treated PVNS of the hip. Results: Five pediatric patients with a mean age of 11.0 years were treated for PVNS of the hip from 2011 to 2016. The mean duration of symptoms from onset to surgical treatment was 247 days (range, 3-933 days). Upon review of magnetic resonance imaging (MRI) results, radiologists included PVNS in their differential in 3 patients. Seven surgeries were performed in 5 patients. All therapeutic procedures were arthroscopic synovectomies. Nodular PVNS was present in 4 patients, and diffuse disease was present in 1 patient. At a mean 32-month follow-up (range, 12-63 months), all patients were considered to be free of recurrence based on clinical examination and/or follow-up MRI. Four patients were asymptomatic and returned to all of their previous sports activities. Conclusion: Young age at the time of diagnosis is a point to be highlighted in this cohort, and symptoms may be present for many months prior to diagnosis due to the failure to consider PVNS in children. Therefore, for patients with “atypical” presentations or lack of improvement with treatment for rheumatologic, bleeding, or infectious disorders, PVNS should be strongly considered. MRI with gradient echo sequences is the diagnostic imaging study of choice. One patient with diffuse involvement and preoperative degenerative changes showed progressive changes postoperatively. This type of PVNS may have a worse prognosis, but more diffuse cases are needed before the prognosis can be determined. Arthroscopic synovectomy following a timely diagnosis of PVNS produces good outcomes in nodular cases, with no evidence of symptomatic or radiographic disease persistence among these patients.

scholarly journals Primary Meningeal Rhabdomyosarcoma

Sarcoma ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Manisha Palta ◽  
Richard F. Riedel ◽  
James J. Vredenburgh ◽  
Thomas J. Cummings ◽  
Scott Green ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Medical Literature ◽  
Case Reports ◽  
Brain Magnetic Resonance Imaging ◽  
Radiographic Appearance ◽  
Lower Extremity Weakness ◽  
Sagittal Sinus ◽  
Word Finding ◽  
Magnetic Resonance Imaging Mri ◽  
Disseminated Disease

Primary meningeal rhabdomyosarcoma is a rare primary brain malignancy, with scant case reports. While most reports of primary intracranial rhabdomyosarcoma occur in pediatric patients, a handful of cases in adult patients have been reported in the medical literature. We report the case of a 44-year-old male who developed primary meningeal rhabdomyosarcoma. After developing episodes of right lower extremity weakness, word finding difficulty, and headaches, a brain magnetic resonance imaging (MRI) demonstrated a vertex lesion with radiographic appearance of a meningeal-derived tumor. Subtotal surgical resection was performed due to sagittal sinus invasion and initial pathology was interpreted as an anaplastic meningioma. Re-review of pathology demonstrated rhabdomyosarcoma negative for alveolar translocation t(2;13). Staging studies revealed no evidence of disseminated disease. He was treated with stereotactic radiotherapy with concurrent temozolamide to be followed by vincristine, actinomycin-D, and cyclophosphamide (VAC) systemic therapy.

scholarly journals Ivabradine: A Potential Therapeutic for Children With Refractory SVT

2021 ◽  
Vol 8 ◽  
Author(s):  
Nour K. Younis ◽  
Bernard Abi-Saleh ◽  
Farah Al Amin ◽  
Omar El Sedawi ◽  
Christelle Tayeh ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Pediatric Patients ◽  
Case Reports ◽  
Combined Therapy ◽  
Case Series ◽  
Left Ventricular ◽  
Baseline Heart Rate ◽  
Treatment Resistant ◽  
Number Of Patients ◽  
Complete Reversal

Background: In April 2015, ivabradine was approved by the Food and Drug Administration for the treatment of patients with coronary artery disease and heart failure (HF). The use of this medication has been linked with improved clinical outcomes and reduced rates of hospitalization in patients with symptomatic HF and a baseline heart rate of 70 bpm and above. Nonetheless, little is known about the use of ivabradine in pediatric patients with supraventricular tachycardia (SVT). This use is not well-studied and is only endorsed by a few case reports and case series.Aim: This study discusses the off-label utilization of ivabradine in pediatric patients with SVT, and highlights its efficacy in treating treatment-resistant (refractory) SVT.Methods: We conducted a retrospective single-center observational study involving pediatric patients with SVT treated at our center between January 2016 and October 2020. We identified the total number of patients with SVT, and the number of patients with refractory SVT treated with Ivabradine. Similarly, we performed a thorough review of the databases of PubMed, Medline and Google Scholar to compare the clinical course of our patients to those described in the literature.Results: Between January 2016 and October 2020, 79 pediatric patients with SVT were seen and treated at our center. A treatment-resistant SVT was noted only in three patients (4%). Ivabradine was used in these patients as a single or combined therapy. The rest (96%) were successfully treated with conventional anti-arrhythmics such as β-blockers, flecainide, and other approved medications. In the ivabradine group, successful reversal to sinus rhythm was achieved in two of the three patients (66%), one patient was treated with a combination therapy of amiodarone and ivabradine, and the other patient was treated only with ivabradine.Conclusion: Overall, promissory results are associated with the use of ivabradine in pediatric patients with refractory SVT. Ivabradine appears to be a safe and well-tolerated medication that can induce adequate suppression of SVT, complete reversal to sinus rhythm, and effective enhancement of left ventricular function.

scholarly journals Oral Desmopressin Lyophilisate Formulation (MELT): Efficacy and Safety in Children and Adults

2018 ◽  
Vol 11 (1) ◽  
pp. 171-177
Author(s):  
P. Ferrara ◽  
F. Ianniello ◽  
E. Del Vescovo ◽  
G. Sodero ◽  
A. Gatto ◽  
...  
Keyword(s):  
Side Effects ◽  
Nocturnal Enuresis ◽  
Renal Colic ◽  
Pediatric Population ◽  
Adult Population ◽  
Viral Gastroenteritis ◽  
First Line ◽  
Limb Weakness ◽  
Search Terms ◽  
Number Of Patients

Nocturnal enuresis (NE) is a common disorder in childhood and desmopressin is one of the most widely and well-tolerated medications for NE. The recent oral lyophilisate formulation of desmopressin (MELT) is effective in the treatment of NE in children and nocturia in adults. A MEDLINE literature search MEDLINE (2000-July 2017) was performed using the search terms MELT enuresis, MELT desmopressin, sublingual desmopressin, lyophilisate desmopressin. Twenty articles were analyzed with a number of patients of 3448. In 12 articles were reported 1275 pediatric patients (<18 years old), and in 8 articles 2213 adult patients. In pediatric population the indication was enuresis in 1269 patients and central diabetes insipidus in 6 patients. In adult population the indication was nocturia in 1941 patients, renal colic in 259 patients, healthy volunteers 13 patients. In 17 studies desmopressin was administered alone while in 3 studies in association respectively with Tolterodina, Ketorolac and Tamsulosin. In 7 studies were reported side effects in only 81 patients, 60 in pediatric population and 21 in adult population. The reported side effects in pediatric population were nausea, lethargy, lower limb weakness, headache, diarrhea, viral gastroenteritis. The reported side effects in adult population were asymptomatic hyponatriemia, nausea, diarrhea, dizziness, symptomatic hyponatriemia. Our review confirm that the MELT formulation of desmopressin guarantee the same response of other formulations with a lower doses and a lowest number of side effects. We believe according with the literature that this formulation is actually the first line and safety treatment for nocturnal enuresis and nocturia.

Effectiveness of Levetiracetam Monotherapy in Pediatric Patients With Epilepsy

2019 ◽  
Vol 34 (10) ◽  
pp. 593-597 ◽  
Author(s):  
Rafal D. Mazur ◽  
Qianyu Wang, BA ◽  
Kenneth Kato, BS ◽  
Richard Buchsbaum, BS ◽  
Jennifer Bonito, BS ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Adverse Events ◽  
Prospective Studies ◽  
Pediatric Patients ◽  
Retention Rate ◽  
Retention Rates ◽  
Seizure Freedom ◽  
Entire Cohort ◽  
Number Of Patients ◽  
Patients With Epilepsy

The main objective of this study was to assess the efficacy, safety, and retention rates of levetiracetam monotherapy in children with epilepsy. A retrospective review of pediatric patients receiving levetiracetam monotherapy at 2 large tertiary epilepsy centers over an 11-year period was conducted. One hundred two patients using levetiracetam monotherapy with a mean age of 13.1 years were identified. For the entire cohort, a 6-month retention rate was 61.1% and a 12-month retention rate 53.1%. With regard to seizure freedom, 46.8% of those patients that remained on monotherapy for at least 6 months became seizure free. Twelve-month seizure freedom was reached by 41.2%. About one-third (32.4%) of patients reported adverse effects, with irritability, moodiness, and depression being the most common. Despite a number of patients that reported adverse events, levetiracetam monotherapy was found to be potentially effective in this cohort of children with epilepsy and warrants further, prospective studies.

Continuous and Extended Infusions of β-Lactam Antibiotics in the Pediatric Population

2012 ◽  
Vol 46 (11) ◽  
pp. 1537-1546 ◽  
Author(s):  
Mary Covington Walker ◽  
Weng Man Lam ◽  
Kalen B Manasco
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Continuous Infusion ◽  
Pediatric Patients ◽  
Case Reports ◽  
Pediatric Population ◽  
Case Series ◽  
Current Evidence ◽  
Pharmacokinetic Studies ◽  
Randomized Controlled

OBJECTIVE: To conduct a systematic review of available data on the use of extended or continuous infusion of β-lactam and monobactam therapy in the pediatric population (aged 0–18 years). DATA SOURCES: A literature search was performed using PubMed (1975-May 2012), International Pharmaceutical Abstracts (1970-May 2012), and Web of Science (1977-May 2012) to identify studies for inclusion. In addition, reference citations from identified publications were reviewed. The following search terms were used: pediatric, children, neonate, infant, adolescent, β-lactam, cephalosporin, carbapenem, penicillin, monobactam, continuous infusion, extended infusion, and/or prolonged infusion. Individual names of drugs in each class of antibiotics were also included in the search. STUDY SELECTION AND DATA EXTRACTION: Randomized controlled clinical trials, pharmacokinetic/pharmacodynamic studies, observational studies, and case reports involving pediatric patients who received extended or continuous infusion of β-lactam or monobactam antibiotics were reviewed. Only English-language publications were included. DATA SYNTHESIS: One randomized controlled clinical trial, 5 pharmacokinetic studies, 2 pharmacodynamic studies using Monte Carlo simulation, 1 case series, and 7 case reports were included in the analysis. The cephalosporin class has been studied the most and currently represents the only clinical trial using a continuous infusion dosing strategy in pediatric patients. There is limited clinical evidence available to support the use of extended or continuous infusion of β-lactam antibiotics in the pediatric population. Pharmacodynamic studies conducted in this population mirror the current evidence in adults for cefepime and meropenem. The single prospective clinical trial using continuous infusion of ceftazidime failed to demonstrate any clinical benefit over traditional dosing; however, there was equal efficacy. CONCLUSIONS: More well-designed prospective clinical trials are required to determine the role of extended or continuous infusion of β-lactam antibiotics in treatment of pediatric patients.

Morbidity and mortality in a national cohort of pediatric patients with hemophagocytic lymphohistiocytosis.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 10062-10062
Author(s):  
Steven William Allen ◽  
Meghan McCormick ◽  
Ram Kalpatthi ◽  
Louis Rapkin
Keyword(s):  
Health Care ◽  
Median Time ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Morbidity And Mortality ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Number Of Patients ◽  
Initial Hospitalization

10062 Background: Despite significant advances in diagnosing and treating hemophagocytic lymphohistiocytosis (HLH) in the pediatric population, survival remains low and the extent of disease morbidity and health care utilization is poorly characterized. Thus, we sought to investigate morbidity, mortality, and the health care burden of HLH in a pediatric population. Methods: We queried the Pediatric Health Information System (PHIS) for children admitted with HLH and treated with etoposide and dexamethasone between 1/1/2004 – 9/30/2018. Collected data included demographics and clinical variables associated with morbidity and mortality. Results: A total of 493 patients (10.5 per 100,000 patients admitted) met inclusion criteria during the study period. The majority of patients (n = 284, 58%) were less than 5 years of age. A total of 331 patients were readmitted after the initial hospitalization, with 29% of readmissions complicated by infections. Median cost for initial hospitalization was $101,906 (IQR: $47,552 – $271,822). A significant number of patients required ICU care during both the initial admission (60%) and readmission (57%). Hematopoietic stem cell transplant (HSCT) was performed in 136 patients (28%) with a median time to HSCT of 126 days (IQR: 75-193 days). Overall mortality was 32% (n = 158), half occurring during the initial admission. There was a trend towards increased mortality in younger age groups. Median time to death during and after the initial admission was 45 days (IQR: 20-84 days) and 198 days (IQR: 108-368 days), respectively. Post-HSCT mortality rate was 35%. Conclusions: This represents the largest cohort of pediatric patients treated for HLH. Overall and post-HSCT mortality was consistent with prior publications. We observed significant morbidity and increased health care resource utilization in our cohort. These findings emphasize the need for novel therapeutic approaches to improve not only patient survival but also long-term quality of life. Planned future analysis of the PHIS data will be aimed at assessing treatment variability, morbidity and mortality depending on treatment, and risk factors associated with mortality in pediatric patients with HLH.

MINIMAL INVASIVE MANAGEMENT OF PEDIATRIC CROHN’S ANORECTAL STRICTURE, LESS IS MORE

2021 ◽  
Vol 27 (Supplement_1) ◽  
pp. S16-S16
Author(s):  
Dorothy Rocourt ◽  
Travis Hoover
Keyword(s):  
Disease Control ◽  
Crohn Disease ◽  
Pediatric Patients ◽  
Biologic Therapy ◽  
Case Reports ◽  
Pediatric Population ◽  
Treatment Options ◽  
Ileocecal Resection ◽  
Rectal Stricture ◽  
Less Is More

Abstract Background Anorectal stricture (ARS) is an uncommon but potentially disabling manifestation of perianal Crohn disease (CD) in pediatric patients. Various treatment options are available but there is little data regarding their efficacy, particularly in the pediatric population. We present three case reports of patients with symptomatic ARS treated with serial dilation and biologic therapy. Methods An institutional review board-approved retrospective review was performed using electronic health records. Three patients with ileocolonic CD and perianal involvement with symptomatic ARS were identified. All patients were treated with serial rectal dilations under general anesthesia using Hegar dilators. Results All patients are currently asymptomatic at follow-ups ranging from 1 to 3.5 years since the last dilation. Patient demographics and details of ARS management are presented in Table 1. All patients tolerated the procedures well and did not experience complications such as perforation, sepsis, or fecal incontinence. Rectal biopsy in each patient showed active inflammation, suggesting type 1 stricture according to the Hughes-Cardiff Classification (vs. type 2 fibrotic stricture). Patient 1 experienced 6 recurrences, each managed with an average of 2 dilations until disease control was established with ustekinumab (USK) and eventually vedolizumab (VDZ). She underwent ileocecal resection three years after the final dilation. Patient 2 underwent ileocecal resection immediately following the first series of dilations. He later experienced one stricture recurrence at 2 years, which was managed with one dilation and increased USK dosing frequency. Patient 3 received steroid suppositories prior to dilation and has been self-dilating at home. He has had no recurrences requiring operative dilation. Self-dilation was not feasible in patients 1 and 2. Conclusion Inflammatory anorectal stricture associated with perianal Crohn disease in pediatric patients can be managed successfully with dilation until disease control with biologic therapy. Recurrences of stricture can also be managed with dilation and modification of biologic therapy. If tolerated, self-dilation may reduce recurrence. Background Anorectal stricture (ARS) is an uncommon but potentially disabling manifestation of perianal Crohn disease (CD) in pediatric patients. Various treatment options are available but there is little data regarding their efficacy, particularly in the pediatric population. We present three case reports of patients with symptomatic ARS treated with serial dilation and biologic therapy. Crohn’s rectal stricture pre and post dilation

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