scholarly journals Options for Treating Resistant Shigella Species Infections in Children

2008 ◽  
Vol 13 (1) ◽  
pp. 29-43
Author(s):  
Sharon M. Erdman ◽  
Elizabeth E. Buckner ◽  
Janet F. Hindler
Keyword(s):  
Pediatric Population ◽  
Safety Data ◽  
Public Health Problem ◽  
The United States ◽  
Efficacy And Safety ◽  
First Line ◽  
Important Public Health Problem ◽  
American Academy Of Pediatrics ◽  
Shigella Species

Infection due to Shigella species remains an important public health problem, especially in developing countries where it remains the most common cause of bloody diarrhea. In the United States (US), 10,000 to 15,000 cases of shigellosis are reported each year in both children and adults. US surveillance data from 2004 has demonstrated increased resistance in Shigella species to first-line antibiotics such as ampicillin and trimethoprim-sulfamethoxazole, with approximately 37% of isolates demonstrating resistance to both ampicillin and trimethoprim-sulfamethoxazole. Since approximately 69% of Shigella infections occur in children younger than 5 years of age, it is important that alternative antibiotics other than typical first-line agents such as ampicillin and trimethoprim-sulfamethoxazole be available to treat Shigella infections in this population. The American Academy of Pediatrics (AAP) recommends cefixime, ceftriaxone, azithromycin, and fluoroquinolones as alternative antibiotics for the treatment of Shigella species infections in children. This paper will review the microbiology, susceptibility, efficacy and safety data of these alternative antibiotics with regard to the treatment of Shigella species infections in children, and will attempt to define the role of each of these agents in the pediatric population.

Japanese cohort study of first-line chemotherapy (CT) for metastatic colorectal cancer (mCRC) containing fluorouracil, oxaliplatin, and bevacizumab: EMERaLD study, first report.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 586-586
Author(s):  
Keisei Taku ◽  
Kou Ohata ◽  
Toraji Amano ◽  
Yasuo Ohashi ◽  
Kentaro Yamazaki ◽  
...  
Keyword(s):  
Cohort Study ◽  
Interim Analysis ◽  
Safety Data ◽  
Progression Free Survival ◽  
The United States ◽  
Public Health Research ◽  
Current Status ◽  
Efficacy And Safety ◽  
First Line ◽  
Japanese Cohort

586 Background: An observational cohort study plays a crucial role to understand the current status of clinical practice and can be utilized as database for multi-purpose outcome research. Such database is available in Europe and the United States based on several cohort studies especially in mCRC, while there is no database available including treatments for mCRC patients in Japan. Methods: We planned and conducted a large cohort study to establish database available including treatments for mCRC patients. Major enrollment criteria included documented mCRC and first line CT containing fluorouracil, oxaliplatin and bevacizumab, started treatment in or after January 2010. The primary objectives are to evaluate overall survival(OS), liver metastasectomy rate (LMR), R0 liver resection rate (R0). The secondary objectives are progression-free survival, response rate (RR), and safety. We performed a preplanned interim analysis of 6-month efficacy and safety data after the 500th patient registration. Results: From October 2010 to September 2011, data from 1,353 patients were recruited from 132 centers in Japan, and we analyzed data on 538 patients of them. The background of 538 patients were as the following; male/female, 335/203; median age of 65 (range, 27-85); ECOG PS 0/1/2/3, 453/77/6/2; site of primary tumor colon/rectum/colorectal, 299/238/1; and site of metastatic disease liver/lung/others, 352/162/226; FOLFOX/ CapeOx/ others with bevacizumab, 234/290/14, KRAS-status wild/mutant/unknown, 131/88/319. 6-month efficacy and safety data were OS 97.5%, LMR 15.1%, R0 12.5%, RR 48.3%, G3/4(CTC-AEv4.0) related to bevacizumab; hypertension 1.5%, proteinuria 0.2%, thromboembolism 0.6%, bleeding 1.0%, and gastrointestinal perforation 1.3%. Conclusions: We have started the large Japanese cohort study which investigates first line CT for mCRC. We performed a preplanned interim analysis on 538 patients and there was no difference from past reports. We will further investigate and analyze 2-year efficacy and safety data on all 1,353 patients. This study is sponsored by the Public Health Research Center Foundation CSPOR in Japan. Clinical trial information: UMIN000006392.

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.

Update From the Advisory Committee on Immunization Practices

2019 ◽  
Vol 8 (6) ◽  
pp. 495-500
Author(s):  
Sean T O’leary ◽  
Yvonne A Maldonado ◽  
David W Kimberlin
Keyword(s):  
Advisory Committee ◽  
Hepatitis A Virus ◽  
Safety Data ◽  
The United States ◽  
Vaccine Research ◽  
Vaccine Preventable Diseases ◽  
American Academy Of Pediatrics ◽  
Control And Prevention ◽  
Clinical Trial Results ◽  
Health Experts

Abstract The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts, meets 3 times per year to develop recommendations for vaccine use in the United States. There usually are 15 voting members, but at the June 2019 meeting, only 14 were present; each member’s term is 4 years. ACIP members and Centers for Disease Control and Prevention (CDC) staff discuss the epidemiology of vaccine-preventable diseases and vaccine research, effectiveness, safety data, and clinical trial results. Representatives from the American Academy of Pediatrics (AAP) (Y. A. M. and D. W. K.) and the Pediatric Infectious Diseases Society (S. T. O.) are present as liaisons to the ACIP. The ACIP met on June 26 to 27, 2019, to discuss the use of human papillomavirus (HPV) vaccine in adults, pneumococcal vaccines in adults, measles updates, zoster vaccine, influenza vaccines, hepatitis A virus (HAV) vaccines, meningococcal vaccines, and dengue vaccine.

The Role of Preoperative Duplex Ultrasound Vessel Mapping in Determining Primary Failure of Pediatric Hemodialysis Arteriovenous Fistula

2019 ◽  
Vol 43 (2) ◽  
pp. 63-68
Author(s):  
Tam T. T. Huynh ◽  
B. N. Garza ◽  
J. Geer ◽  
K. C. Broadbent ◽  
W. A. Martinek ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Arteriovenous Fistula ◽  
Pediatric Population ◽  
Duplex Ultrasound ◽  
The United States ◽  
Chronic Hemodialysis ◽  
Maturation Time ◽  
Pediatric Hemodialysis ◽  
Potential Risk Factors

The autogenous arteriovenous fistula (AVF) is the preferred vascular access for pediatric and adult patients on chronic hemodialysis (HD). However, the prevalent rate of AVF use in children remains low in the United States. Duplex ultrasonography (DUS) of arm vessels is an essential step in the planning of AVF creation in adults, but its use in children is not described in much detail. In this retrospective study, we examined the role of preoperative DUS in children and adolescents who underwent AVF creation at a single large pediatric hospital, from 2008 to 2017. In addition, we sought to determine the potential risk factors for primary failure (PF), which was defined as the inability to use the AVF for at least a sustained 6-week period either due to thrombosis or any other reasons. We created 67 AVFs in 57 patients (34 male; 60%). The overall PF was 16% (11/67), and higher in cephalic AVF (10/40, 25%) compared to basilic (1/27, 3.7%), P = .04. The median maturation time was longer for basilic compared to cephalic AVF (105±47 vs. 88±38 days, respectively, P = .006). The size of the juxta-anastomotic vein and artery on preoperative DUS was not significantly different in cephalic versus basilic AVFs. However, the median diameter of the outflow vein was significantly smaller in the cephalic compared to basilic AVF (3.4 mm vs. 4.2 mm, P = .042). In addition, the outflow vein size was the only preoperative factor found to be significant as possible predictor for PF on univariable analysis. The results of this study show that the PF rate and maturation time for AVFs created in children and adolescents are comparable to adults, with the routine use of preoperative DUS. We postulate that vessel selection for AVF in the pediatric population should take into consideration the size of the vein at the outflow (and not just at the anastomosis).

scholarly journals Update from the Advisory Committee on Immunization Practices

2020 ◽  
Vol 9 (1) ◽  
pp. 3-5
Author(s):  
Sean T O’Leary ◽  
Yvonne A Maldonado ◽  
David W Kimberlin
Keyword(s):  
Advisory Committee ◽  
Safety Data ◽  
Vaccine Safety ◽  
The United States ◽  
Vaccine Research ◽  
Vaccine Preventable Diseases ◽  
American Academy Of Pediatrics ◽  
Control And Prevention ◽  
Adult Immunization ◽  
Health Experts

Abstract The Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts, meets 3 times per year to develop recommendations for vaccine use in the United States. There are usually 15 voting members; members’ terms are for 4 years. ACIP members and Centers for Disease Control and Prevention staff discuss the epidemiology of vaccine-preventable diseases and vaccine research, effectiveness, safety data, and results from clinical trials. Representatives from the American Academy of Pediatrics (Y. A. M., D. W. K.) and the Pediatric Infectious Diseases Society (S. T. O.) are present as liaisons to the ACIP. The ACIP met on 23–24 October 2019 to discuss pertussis vaccines, the child/adolescent and adult immunization schedule, influenza vaccine effectiveness and safety, Ebola vaccine, orthopoxvirus vaccines, Dengue vaccine, rabies vaccine, measles, and vaccine safety update.

scholarly journals Role of Carbamazepine in the Symptomatic Treatment of Subacute Sclerosing Panencephalitis: A Case Report and Review of the Literature

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Sandhya Ravikumar ◽  
John Ross Crawford
Keyword(s):  
Clinical Presentation ◽  
Vegetative State ◽  
Subacute Sclerosing Panencephalitis ◽  
Symptomatic Treatment ◽  
The United States ◽  
Review Of The Literature ◽  
First Line ◽  
Epileptiform Discharges ◽  
The Subject

We describe the clinical presentation and clinical course of subacute sclerosing panencephalitis in a 13-year-old previously healthy boy who recently immigrated to the United States from Iraq. He presented with macular retinopathy, followed by progressive myoclonus and encephalopathy. After extensive workup, a diagnosis of subacute sclerosing panencephalitis was suspected by the presence of period epileptiform discharges on electroencephalogram and confirmed by elevated measles titers in the cerebrospinal fluid. Combination immunomodulatory therapy with isoprinosine, ribavirin, and intra-Ommaya interferon alpha did not result in clinical improvement. Within days following the administration of carbamazepine, there was remarkable improvement in the myoclonus and he was able to ambulate independently for a period of 4 months at which time he unfortunately progressed to a vegetative state. This case highlights the importance of carbamazepine as a potential first line symptomatic treatment of subacute sclerosing panencephalitis and provides a review of the literature on the subject.

scholarly journals Asthma Linked with Rhinosinusitis: An Extensive Review

2014 ◽  
Vol 5 (1) ◽  
pp. ar.2014.5.0083 ◽  
Author(s):  
Marianne Frieri
Keyword(s):  
Early Recognition ◽  
Pediatric Population ◽  
Treatment Options ◽  
The Elderly ◽  
The United States ◽  
Arachidonic Acid Metabolism ◽  
Airway Smooth Muscle Cells ◽  
Extensive Review ◽  
Immune Genes

Current literature related to asthma diagnosis, epidemiology, pathogenesis, and treatment linked with rhinosinusitis is important. Asthma is very heterogeneous; new theories and treatments are emerging. It is a growing epidemic among children and adults in the United States and the severity of asthma is caused by many factors such as lack of education, poor early recognition, decreased symptom awareness, improper medications, and phenotypic changes. Genetic variation, innate immune genes, those involved in tissue remodeling and arachidonic acid metabolism, and inflammatory mediators might contribute to the pathogenesis of chronic rhinosinusitis (CRS) linked with asthma. This extensive review addresses concepts of the burden of asthma and sinusitis, altered innate immunity, adaptive immunity, asthma remodeling, the airway epithelium, the role of airway smooth muscle cells, united allergic airway, genetics, an integral part in asthma, and CRS. In addition, the role of vitamin D in both asthma and CRS in the elderly and pediatric population, various treatment options, and exhaled nitric oxide are briefly addressed.

Efficacy and safety results from AvaALL: An open-label, randomized phase III trial of standard of care (SOC) with or without continuous bevacizumab (Bev) treatment beyond progression (PD) in patients (pts) with advanced non-small cell lung cancer (NSCLC) progressing after first-line Bev and chemotherapy (chemo).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 9004-9004 ◽  
Author(s):  
Jaafar Bennouna ◽  
Javier De Castro ◽  
Anne-Marie C. Dingemans ◽  
Frank Griesinger ◽  
Francesco Grossi ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Safety Data ◽  
Phase Iii ◽  
Positive Trend ◽  
Efficacy And Safety ◽  
First Line ◽  
Open Label ◽  
Phase Iii Trial ◽  
Significance Level ◽  
Safety Signals

9004 Background: The role of treatment with Bev beyond PD is unclear in the multiline treatment strategy of advanced NSCLC.AvaALL(NCT01351415), a multinational, open-label, randomized phase III trial, assessed continuous Bev and SOC beyond first PD (PD1) in pts with NSCLC following first-line treatment with platinum-based chemo plus Bev. Here we present efficacy and safety data from AvaALL. Methods: Pts with NSCLC who received 4–6 cycles of chemo + Bev and ≥2 cycles of maintenance Bev were randomized after PD1 to second-line SOC therapy (docetaxel, pemetrexed or erlotinib) ± Bev. After second PD (PD2) and third PD (PD3), pts received third-line or fourth-line SOC ± Bev treatment, respectively. Primary endpoint was overall survival (OS). Secondary endpoints were OS rates (6, 12, and 18-months [mos]), progression-free survival (PFS) from PD1 to PD2/from PD2 to PD3, overall response rate (ORR), disease control rate (DCR), and safety. Data cut-off: 24 Jun 2016. Results: Overall, 485 pts were randomized (n = 475 treated). Pt characteristics were well balanced between the two arms. Bev plus chemo resulted in a median OS of 11.9 mos versus 10.2 mos for SOC alone (HR 0.84, 90% CI 0.71–1.00; p = 0.1016; 387 OS events). The primary endpoint was not met (416 OS events were required, at 10% two-sided significance level). OS rates were 10% higher in the Bev arm vs SOC alone at 6-, 12- and 18-mos. Median PFS2 was 4.9 mos with Bev vs 3.8 mos with SOC (HR 0.85, 90% CI 0.72–1.00; p = 0.0907). PFS3 was significantly improved (3.5 mos for Bev, 2.4 mos for SOC; HR 0.65, 90% CI 0.51–0.84; p = 0.0047). ORR and DCR were slightly higher in the Bev arm versus the SOC arm (ORR 9.7% vs 6.7%; DCR 86.2% vs 79.3%, respectively). No new safety signals were identified. Grade ≥3 adverse events were reported in 78.2% of Bev pts and 61.6% of SOC pts. Conclusions: Although the primary endpoint was not met, efficacy data suggest a positive trend for continued Bev plus SOC after PD1 compared with SOC alone. No cumulative safety signals were identified. Clinical trial information: NCT01351415.

scholarly journals Identification of Enterohemorrhagic Escherichia coli O26:H− Genes Required for Intestinal Colonization in Calves

2005 ◽  
Vol 73 (3) ◽  
pp. 1735-1743 ◽  
Author(s):  
Pauline M. van Diemen ◽  
Francis Dziva ◽  
Mark P. Stevens ◽  
Timothy S. Wallis
Keyword(s):  
Escherichia Coli ◽  
Public Health Problem ◽  
The United States ◽  
Human Infection ◽  
Enterohemorrhagic Escherichia Coli ◽  
Secreted Proteins ◽  
Type I ◽  
Intestinal Colonization ◽  
Important Public Health Problem ◽  
Type Iii

ABSTRACT Enterohemorrhagic Escherichia coli (EHEC) infections in humans are an important public health problem and are commonly acquired via contact with ruminant feces. The serogroups that are predominantly associated with human infection in the United States and Europe are O157 and O26. Serotypes O157:H7 and O26:H− differ in their virulence and tissue tropism in calves and therefore may colonize calves by distinct mechanisms. The mechanisms underlying EHEC intestinal colonization and pathogenesis are poorly understood. Signature-tagged mutagenesis was used to identify 59 genes of EHEC O26:H− that are required for the intestinal colonization of calves. Our results indicate important roles for locus of enterocyte effacement (LEE)-encoded type III secreted proteins in intestinal colonization. In addition, colonization is facilitated by cytotoxins, putative type III secreted proteins unlinked to the LEE, a putative fimbrial operon, and numerous genes involved in central metabolism and transport and genes of unknown function. Our data also imply that the elaboration of type I fimbriae by EHEC O26:H− is disadvantageous for persistence within the bovine intestines. These observations have important implications for the design of vaccines to control these important zoonotic pathogens.

scholarly journals The first isolation of Panton-Valentine leukocidin (PVL) positive community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in Russia

2007 ◽  
Vol 12 (11) ◽  
Author(s):  
T Baranovich ◽  
V Potapov ◽  
T Yamamoto
Keyword(s):  
Public Health ◽  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Public Health Problem ◽  
The United States ◽  
Important Public Health Problem ◽  
Methicillin Resistant ◽  
Important Public Health ◽  
Panton Valentine Leukocidin ◽  
Valentine Leukocidin

Since the first report of pediatric deaths in 1997-1999 in the United States, community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has become an increasingly important public health problem worldwide.

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